FANCAS nursing framework for ARDS: A systematic review and synthesis
FANCAS framework for ARDS
DOI:
https://doi.org/10.54205/ccc.v34.281634Keywords:
ARDS, Critical care nursing, FAST-HUG-BID-C, FANCAS, Nursing framework, Systematic reviewAbstract
Background: Acute respiratory distress syndrome (ARDS) carries high mortality ranging from 35% to 46%. Contemporary clinical guidelines predominantly emphasize medical management, leaving nursing care without a comprehensive evidence-based framework.
Method: This study aimed to develop an evidence-based operationalization of the FANCAS nursing framework specifically for ARDS patients through systematic review and narrative synthesis. We conducted a systematic review following PRISMA 2020 guidelines. The detailed search strategy is reported in a companion manuscript. We searched PubMed, Cochrane Library, CINAHL, ThaiJO, and Google Scholar from January 2016 to March 2026. We included studies reporting nursing-sensitive outcomes in ARDS patients. Two reviewers independently coded the data and assessed quality using ROB-2 and ROBINS-I. Inter-rater agreement was substantial for initial coding of nursing interventions into the six FANCAS domains (κ = 0.82).
Result: Our search identified 45 studies that met inclusion criteria: 12 randomized controlled trials, 18 cohort studies, 10 quality improvement projects, and five qualitative studies. The evidence-based FANCAS framework emerged with six domains: Fluid, Aeration, Nutrition, Communication, Activity, and Stimulation. We derived a bedside checklist called FAST-HUG-BID-C, with a rapid version (FAST) for unstable patients. We also identified twelve frugal innovations applicable to resource-limited settings, with nine having feasibility ratings of four or five (ready for immediate implementation).
Conclusion: This study provides the first systematic review-based operationalization of the FANCAS framework for ARDS nursing care. The frugal innovations are ready for implementation in resource-limited settings. The checklist requires prospective validation before widespread clinical implementation.
Registration: This study is part of a project registered with PROSPERO (CRD420261360074) as 'Development of Clinical Nursing Practice Guidelines for Patients with Acute Respiratory Distress Syndrome (ARDS): A Synthesis of Empirical Evidence for Clinical Practice in the Thai Context'.
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