Journal of Nursing最新文献

Artificial intelligence (AI) is driving global change, and the implementation of generative AI in higher education is inevitable. AI language models such as the chat generative pre-trained transformer (ChatGPT) hold the potential to revolutionize the delivery of nursing education in the future. Nurse educators play a crucial role in preparing nursing students for a future technology-integrated healthcare system. While the technology has limitations and potential biases, the emergence of ChatGPT presents both opportunities and challenges. It is critical for faculty to be familiar with the capabilities and limitations of this model to foster effective, ethical, and responsible utilization of AI technology while preparing students in advance for the dynamic and rapidly advancing landscape of nursing and healthcare. Therefore, this article was written to present a strengths, weaknesses, opportunities, and threats (SWOT) analysis of integrating ChatGPT into nursing education, providing a guide for implementing ChatGPT in nursing education and offering a well-rounded assessment to help nurse educators make informed decisions.

The current uses, potential risks, and practical recommendations for using chat generative pre-trained transformers (ChatGPT) in systematic reviews (SRs) and meta-analyses (MAs) are reviewed in this article. The findings of prior research suggest that, for tasks such as literature screening and information extraction, ChatGPT can match or exceed the performance of human experts. However, for complex tasks such as risk of bias assessment, its performance remains significantly limited, underscoring the critical role of human expertise. The use of ChatGPT as an adjunct tool in SRs and MAs requires careful planning and the implementation of strict quality control and validation mechanisms to mitigate potential errors such as those arising from artificial intelligence (AI) 'hallucinations'. This paper also provides specific recommendations for optimizing human-AI collaboration in SRs and MAs. Assessing the specific context of each task and implementing the most appropriate strategies are critical when using ChatGPT in support of research goals. Furthermore, transparency regarding the use of ChatGPT in research reports is essential to maintaining research integrity. Close attention to ethical norms, including issues of privacy, bias, and fairness, is also imperative. Finally, from a human-centered perspective, this paper emphasizes the importance of researchers cultivating continuous self-iteration, prompt engineering skills, critical thinking, cross-disciplinary collaboration, and ethical awareness skills with the goals of: continuously optimizing human-AI collaboration models within reasonable and compliant norms, enhancing the complex-task performance of AI tools such as ChatGPT, and, ultimately, achieving greater efficiency through technological innovative while upholding scientific rigor.

This case report addresses the author's experience providing nursing care to a 37-year-old patient diagnosed with multiple myeloma requiring regular renal dialysis due to disease progression who received autologous stem cell transplantation. The patient was diagnosed with cancer in young adulthood and, as a father figure, faced various psychological issues associated with the unexpected challenges encountered during their treatment phase. Psychosocial health, which is closely associated with quality of life in patients with cancer, has gained increasing attention in recent years. The limited research published on the subject of fathers diagnosed with cancer encouraged the author to detail her experience with this case. The care period was from August 5th to August 19th, 2022. During the care period, the Gordons's 11 functional health assessment was applied, with potentially severe infections, coping disorders, anxiety, potential risk of injury existing or potential nutritional deficiencies, oral mucosal changes, and diarrhea identified as the primary health problems of concern. Nursing interventions applied included providing protective isolation measures to prevent post-transplant infection, helping the patient learn effective ways to cope with emotional distress, and providing comprehensive follow-up care information and health education to alleviate the anxiety associated with hospital discharge and life after discharge. The challenges of providing nursing care to adolescent and young adult patients differ significantly from those faced in the care of either elderly or pediatric patients. Furthermore, although extensive research has been conducted on mothers diagnosed with cancer, little research has addressed the impact on the paternal role when fathers are diagnosed with cancer, with limited information available regarding their psychological concerns and issues or the impact on family dynamics. The author hopes this case care experience offers an insightful reference and guide for nursing practice that contributes to a better understanding of the psychological aspects of young adult fathers diagnosed with cancer and facilitates more appropriate care in clinical settings.

Background: After enactment of the Patient Right to Autonomy Act in Taiwan, most of the individuals participating in advance care planning (ACP) and signing advance decisions (AD) have been healthy adults. This demographic is inadequately covered in the literature, in which related studies focus primarily on individuals with major illnesses.

Purpose: This study was implemented to understand the experiences of healthy adults participating in ACP.

Methods: A qualitative approach was taken and participants were recruited from ACP outpatient clinics in three hospitals in northern, central, and southern Taiwan. All of the participants were healthy adults who had completed the ACP process, did not have a major illness, had no psychiatric diagnoses, and could express themselves clearly. Data were collected via semi-structured interviews and analyzed using content analysis.

Results: A total of 15 participants were interviewed, generating three major themes: "Establishing the foundations of ACP", "Preserving dignity in end-of-life care", and "Key elements for successful ACP". Their motivation to engage in ACP and sign the AD form was influenced by past experiences and a desire to maintain dignity and physical autonomy through the aging process. Their decision-making processes were influenced by family opinions, sociocultural factors, and systemic dynamics.

Conclusions / implications for practice: During the ACP and AD signing process, the consulting team not only helps healthy adults successfully provide informed consent but also, by fostering a supportive communication environment, ensures medical preferences and expectations are accurately reflected, thus promoting mutual care, support, and understanding among all parties.

Background: Job satisfaction in nurse practitioners is influenced by the level of autonomy and empowerment they perceive within their practice environment. Little in-depth research has been done to explore the relationship among organizational climate, leadership style, and job satisfaction in the context of nurse practitioners.

Purpose: This study was developed to explore the relationship among organizational climate, leadership style, and job satisfaction in nurse practitioners with the goal of enhancing their job satisfaction.

Methods: A cross-sectional correlational approach and snowball sampling method were employed to recruit 400 qualified nurse practitioners to complete an online survey. This survey was a structured questionnaire consisting of the Practice Organizational Climate Scale, Leadership Style Scale, and Job Satisfaction Scale. Statistical analyses used included the independent t test, one-way ANOVA, Pearson's correlation, and multiple linear regression analysis.

Results: Most of the participants were 31 to 50 years old. A significant and positive correlation was identified among overall organizational climate, leadership style, and job satisfaction. In terms of organizational climate components, only professional visibility was not found to significantly correlate with job satisfaction. Transformational leadership, servant leadership, independent work, and relationships with support and management departments collectively explained nearly 72.4% of overall job satisfaction.

Conclusions / implications for practice: The findings demonstrate job satisfaction in nurse practitioners to be significantly influenced by organizational climate and leadership style. Thus, fostering a positive organizational climate and enhancing transformational and servant leadership styles may be expected to improve job satisfaction in this group substantively. Therefore, it is recommended healthcare institutions focus on improving the organizational climate, providing more autonomy and support, and enhancing leadership training for supervisors with the goal of increasing overall job satisfaction and retention rates among nurse practitioners.

Background: End-of-life care in long-term care institutions is increasingly important. Nursing assistants are the primary care workforce, and their end-of-life care capabilities affect the quality of care provided to residents as well as residents' physical and mental health.

Purpose: This study was designed to explore the life attitudes, fear of death status, end-of-life care abilities and experience, and coping styles of nursing assistants in long-term care institutions in the eastern region and the effects of these variables on care.

Methods: A cross-sectional, mixed-methods research design was used. The study included 165 nursing assistants working in long-term care facilities in Taitung and Hualien counties. The study questionnaire included items covering life attitudes, fear of death, and dying care abilities. In addition, in-depth interviews were conducted with 12 of the participants.

Results: Most of the participants held positive attitudes toward life and reported having a low to moderate fear of death. A significant and positive correlation between life attitude and dying care ability was identified (r = .426, p < .001). Although average ability to provide physical care to residents at end of life was found to be relatively good, ability to provide emotional support and allow residents to express their emotions was generally poor. The scales of fear of death, life attitude toward love and care, ideals, and high school education were identified as significant predictors of dying care ability, together explaining 22.8% of the variance. The interview results were summarized into five major themes that also echoed the quantitative results.

Conclusions / implications for practice: Attitudes toward life and fear of death partially were shown to influence the dying care ability of the nursing assistants in this study. Dying care skills should be strengthened in nursing assistants, and they should be encouraged to explore the meanings of life and death through on-the-job education. Also, long-term care institutions should show concern for and support their nursing assistants by sponsoring case discussions, care experience sharing sessions, and support groups.

Background & problems: Joint replacement wound stitches are typically not removed until two weeks after the operation. Therefore, patients with joint replacement must be able to execute proper wound care after discharge from the hospital to reduce the risk of wound infection. Prior data from Chang Gung Memorial Hospital's orthopedics ward indicate only 69% of joint-replacement patients are able to perform wound care properly at home. Potential causes for this noted by patients include age-related forgetfulness, being unable to discern redness or swelling in the wound, and language comprehension difficulties (i.e., Taiwanese vs. Mandarin). Poor rates of wound care may also be attributable to incomplete wound care education by nursing staff and wound care education being provided without adequate practice on the day of patient discharge.

Purpose: This project was implemented to improve the accuracy of wound self-care performed by patients after joint replacement surgery and to enhance their related knowledge and wound-care technical correctness.

Resolution: A wound care education checklist, wound care cue cards, wound care video clips, wound condition red flag cue cards, and customized wound care pack were proposed and implemented.

Results: The rate of accuracy of wound self-care performance increased from 69% pretest to 98% posttest, showing the intervention to have effectively improved post-discharge wound care quality.

Conclusions: To effectively improve the post-discharge accuracy of wound self-care in patients with joint replacement, the consistency of post-surgery wound care education given by nursing staff to patients should be improved, patients should be reminded of wound assessment and care steps, and patients should be aware that wound abnormalities require an immediate return to the hospital for follow-up treatment.

Network meta-analysis (NMA), an increasingly appealing method of statistical analysis, is superior to traditional analysis methods in terms of being able to compare multiple medical treatment methods in one analysis run. In recent years, the prevalence of NMA in the medical literature has increased significantly, while advances in NMA-related statistical methods and software tools continue to improve the effectiveness of this approach. Various commercial and free statistical software packages, some of which employ generative artificial intelligence (GAI) to generate code, have been developed for NMA, leading to numerous innovative developments. In this paper, the use of generative AI for writing R programming language scripts and the netmeta package for performing NMA are introduced. Also, the web-based tool ShinyNMA is introduced. ShinyNMA allows users to conduct NMA using an intuitive "clickable" interface accessible via a standard web browser, with visual charts employed to present results. In the first section, we detail the netmeta package documentation and use ChatGPT (chat generative pre-trained transformer) to write the R scripts necessary to perform NMA with the netmeta package. In the second section, a user interface is developed using the Shiny package to create a ShinyNMA tool. This tool provides a no-code option for users unfamiliar with programming to conduct NMA statistical analysis and plotting. With appropriate prompts, ChatGPT can produce R scripts capable of performing NMA. Using this approach, an NMA analysis tool is developed that meets the research objectives, and potential applications are demonstrated using sample data. Using generative AI and existing statistical packages or no-code tools is expected to make conducting NMA analysis significantly easier for researchers. Moreover, greater access to results generated by NMA analyses will enable decision-makers to review analysis results intuitively in real-time, enhancing the importance of statistical analysis in medical decision-making. Furthermore, enabling non-specialists to conduct clinically meaningful systematic reviews may be expected to sustainably improve analytical capabilities and produce higher-quality evidence.

Healthcare systems must embody equity, diversity, and inclusion (EDI) and, in the event of unfairness, appropriate policies / countermeasures should be enacted. The healthcare system response to the COVID-19 pandemic not only highlighted how socioeconomic disparities affect mortality risk but also posed significant challenges to the successful practice of EDI in healthcare. In light of this, this article was written to provide an overview of EDI, analyze the international efforts to promote it, and suggest strategies for promoting EDI in infectious disease healthcare using COVID-19 as an example. In healthcare settings, equity centers on ensuring patients receive fair treatment regardless of race, gender, age, or socioeconomic status; diversity centers on healthcare providers understanding the uniqueness of patients from different cultural backgrounds and the health barriers they face; and inclusion centers on ensuring patients are treated with respect and given the attention they deserve. During pandemics, social determinants of health (SDOH) greatly impact patient health outcomes and hinder the practice of EDI. Reflecting on the impact of COVID-19, healthcare systems can actively apply EDI in clinical practice to provide to all patients equitable access to healthcare opportunities and outcomes. Practical strategies include establishing EDI committees within healthcare systems, monitoring relevant data, conducting staff training, and continuously addressing the SDOH and needs of marginalized groups to achieve EDI in healthcare.