Journal of Nursing最新文献

The rapid advancement of digital technologies in recent years has profoundly transformed healthcare service models. Among related innovations, virtual care and virtual agents have emerged as integral components of intelligent healthcare systems. Their underlying technologies combine artificial intelligence, natural language processing, affective computing, and multimodal interaction to provide continuous, personalized health education, disease management, postoperative follow-up, and psychological support through text, voice, human-like interfaces and immersive environments. Women's healthcare, characterized by high privacy sensitivity and long-term care needs, has shown growing demand for digital tools that ensure anonymous interaction, empathetic communication, informational accuracy, and cultural sensitivity. In this paper, a synthesis of international and local empirical research and policy frameworks is used to examine virtual agent applications, user experiences and acceptance, and related emerging challenges, ethical considerations, and future directions in the context of women's healthcare. Practical implications and policy recommendations are proposed to inform the integration of virtual agents into clinical practice and health service innovation.

Background & problems: Acute respiratory distress syndrome, associated with mortality rates as high as 30%, consumes substantial healthcare resources. Prone positioning has been proven to effectively improve patient oxygenation and reduce mortality. A recent analysis in our unit found the incidence of adverse events related to prone positioning care had increased by 20.4% over the previous year and that all of these events were associated with care provided by postgraduate-year-two (PGY2) nurses.

Purpose: A program was initiated to enhance knowledge and practical skills related to prone positioning care among PGY2 nurses in our unit with the goal of improving the average accuracy rates of both knowledge and skills to at least 85%.

Resolution: Program components included: prone care education combined with small-group teaching, producing instructional videos on prone positioning care, designing a prone care competency checklist, developing innovative simulation dolls for skill practice, establishing a regular auditing system for prone care, and organizing periodic in-person skill workshops.

Results: After program implementation, the average accuracy of prone care knowledge increased from 44.7% to 93.1% in PGY2 nurses and the average accuracy rate of related practical skills improved from 77.6% to 93.7% in the unit.

Conclusions: Future prone positioning care education and skill assessments should be conducted regularly and incorporated into training programs provided to newly employed nurses. These measures should effectively strengthen the professional competency of intensive care nurses and improve overall patient care quality.

The development of clinical reasoning skills, a key outcome indicator in nursing education, is closely associated with patient safety and quality of care. Simulation-based education is an effective approach to training clinical reasoning. Ongoing advances in technology are accelerating the digital transformation of education, and various forms of digital simulation have emerged to overcome the temporal and spatial limitations of traditional simulation-based learning. In this article, a goal-oriented perspective is adopted to briefly introduce the cultivation of clinical reasoning skills and, within the framework of Kolb's Experiential Learning Theory, illustrate the application and outcomes of digital simulation in nursing education. Finally, future directions and recommendations are proposed, and the feasibility of integrating artificial intelligence into digital simulation is assessed with the aim of supporting educators and students to optimally integrate and use digital technologies and tools in nursing education.

As the world enters the data-driven Fourth Industrial Revolution (Industry 4.0), industries face growing challenges and pressures related to digital technology adoption. Digital twins (DTs) technology, increasingly incorporated into complex, human-centered healthcare systems, has been identified as one of the top technological trends for the coming three years. DTs technology is increasingly viewed as a potential engine of the next healthcare revolution, especially for frontline healthcare workers, for whom DTs may serve as a transformative tool for reshaping how care is defined. Before expanding the application of DTs in health and healthcare, clinicians must first understand the underlying concepts. Only then will they be able to use this technology effectively in addressing clinical problems and improving care quality. In this article, the authors introduce the concept of DTs, outline current applications across different fields, describe potential future developments, and identify the challenges and future directions for DTs technology. Future research should continue to examine issues of accessibility, effectiveness, and data accuracy and work to avoid over-reliance on narrow data sources.

The concept of post-acute care (PAC) has been applied in Taiwan in the field of psychiatry through the "Post-Discharge Follow-Up Visits for High-Risk Patients" system, which is part of the "National Health Insurance Payment Improvement Program for Schizophrenia." Despite the difference in name, the core principles of this system are the same as those of PAC, namely to support patients in functional rehabilitation, reduce the risk of rehospitalization, and delay the need for institutional care. The PAC model has been widely used across various medical specialties and has proven to be substantially beneficial for psychiatric patients. In particular, PAC plays a crucial role in Taiwan's current "multiple treatment" model for forensic psychiatric patients sentenced to custodial protection. Through PAC interventions, patients under forensic disposition can receive continuous psychiatric care and community follow-up services even without hospitalization, thereby enhancing patient stability and social functioning, reducing recidivism and rehospitalization rates, and enabling the executing authorities to meet both legal supervision and psychiatric treatment needs without depriving patients of their freedom. Thus, PAC not only improves treatment outcomes but also allows the multiple treatment model to be effectively implemented at the community level. The practical experiences presented in this article illustrate how PAC is applied in the multiple treatment of forensic psychiatric patients sentenced to custodial protection. These experiences recommend increased implementation of PAC in non-hospital-based treatment models.

Systemic problems in healthcare exposed during the recent global pandemic include issues involving resource allocation, ethical challenges, and workforce management. During the pandemic, healthcare professionals, and nurses in particular, experienced moral injuries that have significantly impacted their psychological well-being and career development and fueled intent to leave the profession. This threatens the stability of the global nursing workforce. This article was developed to examine how the pandemic intensified the experience of moral injury and the effects of this type of injury at the individual, team, and system levels, and to propose strategies in response. Based on the results, healthcare institutions are encouraged to proactively create safe work environments, foster fair culture, offer psychological support, and provide ethics training. Nurses should be supported in their self-care, encouraged to voice moral concerns, and use anonymous reporting systems to report problems and concerns. Also, experts should establish standardized protocols for the management of moral injury as well as advance related prevention-focused research. Furthermore, to sustain and optimize current healthcare systems, national policies should prioritize the inclusion of nurses' perspectives in related decision-making, address structural inequities, and protect the rights of nurses.

Taiwan is expected to cross the threshold and become a super-aged society in 2025, with over 20% of the population aged 65 and above, leading to a sharp rise in long-term care needs. Due to inadequate family caregiving resources, foreign care workers have become a vital component of Taiwan's long-term care system. Current policies governing the employment of foreign caregivers are based primarily on the Employment Service Act and related regulations. Applicants must present a medical certificate and disability assessment issued by a healthcare institution, and their functional status is evaluated using the Barthel Index to determine eligibility. Since 2023, Taiwan has implemented an assessment exemption policy for certain groups, including individuals who have used long-term care services for more than six months, patients with dementia, and those with moderate to severe physical or mental disabilities, with these groups exempted from the otherwise mandatory Barthel Index assessment when applying for a foreign caregiver. Also, an amendment to Article 46 of the Employment Service Act implemented on August 1, 2025 extends the Barthel Index assessment exemption to foreign caregivers of individuals aged 80 and older and patients aged 70 to 79 with Stage II or above cancer. While this policy simplifies the application process and shortens waiting times, it may also produce unintended consequences. These include exacerbating the imbalance between supply and demand for foreign caregivers, diverting resources from families with severe care needs, accelerating the functional decline of older adults, limiting employment opportunities for local caregivers, and increasing the challenges of managing and supervising caregiver quality. In this paper, these potential impacts are analyzed, with the results pointing to three recommendations. These include: (1) strengthening pre-employment training and language support for foreign caregivers; (2) establishing a quality monitoring and feedback system; and (3) creating a centralized and integrated application platform to enhance efficiency.

Background: Quality of work life (QWL) serves as a basis for human resource management and policy formulation in clinical practice. Personality traits may influence how nurses perceive their work environment which, in turn, may affect their job satisfaction and retention. However, few studies in the literature have explored the relationship between personality traits and QWL.

Purpose: This study was designed to investigate and clarify the relationship between personality traits and QWL in clinical nurses.

Methods: A cross-sectional and correlation design was used, and data from clinical nurses (n = 329) were collected using a web-based survey via snowball sampling between October and November 2023. Nurses working full-time at hospitals in southern Taiwan and who were willing to participate in the study were enrolled as participants. The survey included a demographics datasheet, the Traditional Chinese Version of Big-Five Mini-Markers, and the Taiwanese-Version of the Work-Related Quality of Life Scale.

Results: The mean QWL score was 3.22 (SD = 0.59), with females scoring significantly higher than males (p < .04). The three personality traits of extraversion (β = 0.22, ∆R² = 7.1%), conscientiousness (β = 0.17, ∆R² = 2.7%), and emotional stability (β = 0.15, ∆R² = 1.9%) were identified as significant predictors of QWL, explaining 11.7% of the total variance.

Conclusions / implications for practice: Nursing managers should understand the influence of different personality traits on QWL when designing and implementing strategies to improve QWL in their nursing staff. Also, nursing managers may consider personality traits and QWL when recruiting and training nursing staff. Based on the results of this study, nursing managers should develop strategies to enhance competencies and foster positive attitudes as well as appropriately adjust work roles for nurses who tend to be introverted, less conscientious, or emotionally sensitive to improve their QWL. In addition, nursing managers should integrate personality traits with organizational factors to establish a foundation for human resource management and policy formulation in clinical practice.

Background: Rates of participation in public initiatives to prevent and delay disability differ by gender, with notably lower participation by males. Identifying gender-specific factors is essential for developing effective strategies to boost participation rates.

Purpose: In this study, the attitudes toward the preventability of disability and the core constructs of the Health Belief Model (HBM) were considered in terms of their influence on intention to participate in preventive services among community-dwelling older adults. Gender-based differences in the influence of each factor were examined.

Methods: A cross-sectional design was adopted. A total of 200 community-dwelling older adults aged 65 and above were surveyed using a structured questionnaire. Attitudes toward the preventability of disability, core HBM constructs, and intention to participate in services were measured. Data were analyzed using t-tests, chi-square tests, and regression analyses, and mediation effects were examined using the PROCESS model.

Results: Compared to their male counterparts, the female participants exhibited more positive attitudes toward preventability (t = -2.856, p < .01), perceived benefits (t = -3.069, p < .01), self-efficacy (t = -2.986, p < .01), and intention to participate (t = -3.405, p < .01). The male participants reported higher perceived barriers (t = -2.542, p < .05). Attitudes toward preventability were found to influence intention to participate indirectly in all participants by enhancing perceived benefits and reducing perceived barriers; for males, this also included an increase in self-efficacy. This indirect effect was stronger in the male (β = 0.61) than female (β = 0.23) group.

Conclusions / implications for practice: Intention to participate in disability prevention services differs by gender. In addition to promoting the benefits of participation and reducing barriers, service providers should place greater emphasis on the preventability of disability and focus on enhancing preventive self-efficacy in promotions targeted at male older adults.