Journal of Nursing最新文献

Under population aging and rising healthcare demand pressures, the nursing workforce has become even more critical to healthcare system stability. However, Taiwan is currently facing a "dual crisis". Nearly 40% of newly licensed nurses do not enter clinical practice, creating a substantial annual workforce gap, while current staff continue to exit the profession at a high rate due to overwork and poor work-life balance. This vicious cycle poses an existential threat to the foundations of healthcare. It is worth noting that this problem is not unique to Taiwan. Similar challenges have been widely observed worldwide in the aftermath of the COVID-19 pandemic, where many nurses left their positions due to burnout (Buchan & Catton, 2023). Fortunately, the government and nursing organizations have been actively advancing targeted reforms. Related initiatives, ranging from legislative advocacy for shift-based nurse-to-patient ratios to the implementation of self-scheduling, target greater nursing workforce flexibility, improved work-life balance, and enhanced retention. Taiwan's experience with such initiatives show the beneficial effects of phased implementation, team communication, and digital tools on efficiency and transparency. However, challenges remain, including traditional workplace culture, fairness concerns, and technological gaps. Although intelligent scheduling shows potential, it will require cultural transformation and managerial support to succeed. On a deeper level, the nursing dilemma is not merely a matter of workforce numbers, but also a structural challenge associated with professional undervaluation. The longstanding undervaluation of nursing labor has eroded professional worth and dignity. This concern resonates with the American Nurses Association's (2024) "Economic Value of Nursing". Enhancing sense of "psychological ownership" in nurses can effectively reduce turnover intention. This includes strengthening self-efficacy, professional identity, and sense of belonging in nurses to assure them that they "have a place" (Chang et al., 2022). While short-term incentives remain necessary, they are insufficient to attract new entrants. Thus, systemic reforms that affirm the value of nursing are essential to ensuring the visible dignity and long-term worth of the profession. We firmly believe the sustainable development of nursing depends not only on government policy and hospital reform but also on renewed societal recognition of the value of nurses and the nursing profession. Only by establishing and maintaining clear career pathways, fair compensation systems, and supportive working environments can new talent be attracted and the current workforce retained. This is both the aspiration of the nursing profession and a vital investment in safeguarding the health and well-being of the people of Taiwan.

Background & problems: Due to immature lung development, premature infants require long-term ventilator support and sputum suction to maintain stable vital signs. However, as the stratum corneum in premature infants has yet to fully develop, using nasal respirators and suction introduces risks including compression and pulling of the nasal prongs of the respirator tube; improper suction frequency, pressure, and depth; and poor suction efficacy Moreover, lack of oxygen and restlessness may result in nasal injury, which was found in 27.9% of premature infants in our hospital.

Purpose: The purpose of this project was to improve the knowledge of nurses regarding nasal injury prevention in premature infants and thus reduce the incidence of these injuries in the neonatal ward.

Resolutions: A guidance manual for premature infant care and a sputum suctioning and sputum suctioning flowchart reminder card were developed and provided to nurses as references during the care process. Also, a ventilator tube fixing support tools were installed to prevent ventilator tubes from slipping and pulling on the nose of premature infants. In addition, educational training on nasal care for premature infants was organized and a specialist assessment mechanism was established to improve nursing staff capabilities and quality of care.

Results: The accuracy rate for knowledge on preventing nasal injury in premature infants among nurses increased to 95.3%, and the incidence of nasal injury in premature infants decreased from 27.9% to 18.5%.

Conclusions: This project was effective in improving clinical operations, completing standard operating procedures, enhancing nursing staff care capabilities, and improving the quality of care provided to premature infants, ensuring premature infants receive more complete and safer care.

Background & problems: Liver transplant recipients require lifelong polypharmacy to maintain graft viability and prevent rejection. However, nurses frequently receive patient complaints regarding the inconvenience of carrying printed educational materials, which are often described as unengaging, text-heavy, and difficult to read due to small font size and unclear images. In addition, patients report difficulties retaining information from verbal counseling sessions, often due to rapid delivery and lack of reinforcement, leading to suboptimal medication literacy. These issues highlight the need for an improved, patient-centered education approach and provided the impetus for this quality improvement project.

Purpose: This project was designed to assess current medication education practices and barriers among post-liver transplant patients and then implement targeted interventions aimed at improving patient medication comprehension and self-management capabilities.

Resolutions: The results of the problem analysis confirmed the inadequacy of using current paper-based manuals as educational tools. Therefore, new educational videos on medication were recorded, an "E-learning New Liver Baby Medication Log" was established, a "New Liver Timetable Medication Identification Card Set" and "New Liver Pop Quiz Medication Identification Card Set" were created, a "New Liver Baby Q&A" was added, and a monitoring mechanism was established.

Results: Patient medication knowledge increased from 67.2% pretest to 94.8% posttest and patient satisfaction increased from 79.2% pretest to 98.5% posttest, achieving the project goals.

Conclusions: Using the new educational videos, E-learning medication log, liver timetable and pop quiz medication identification card sets, and liver baby Q&A can improve patient medication knowledge, increase their medication adherence, help maintain transplanted organ functions, and improve quality of life.

The persistent nursing workforce shortage faced in Taiwan negatively impacts healthcare system stability and patient care quality. This article was conducted to analyze national nursing workforce data and trends from 2015 to 2024 in terms of population aging, domestic and international policy shifts, and key clinical practice challenges. Despite a gradual increasing number of practicing nurses, gaps between licensure, willingness to remain, and actual nursing education enrollment numbers highlight the existence of two crises in terms of 1) nurses obtaining licenses but not entering practice and 2) the high rate of attrition among early-career nurses. In this paper, related initiatives implemented by the Executive Yuan and Ministry of Health and Welfare are examined; Taiwan's response is compared to that of other countries; and gaps in nursing role development, compensation structures, and career advancement are identified. The findings call for implementing an integrated, cross-ministerial, and evidence-based nursing policy framework alongside stronger academic-to-clinical transitions and workplace retention strategies. The policy-relevant insights given may be referenced by decision-makers and healthcare administrators aiming to sustain and strengthen Taiwan's nursing foundation.

Background: Perioperative nursing competence encompasses six core areas: foundational knowledge and skills, leadership, proficiency, empathy, professional development, and collaboration. These competences directly affect clinical practice and patient care outcomes.

Purpose: This study was designed to explore the relationship among personality, self-efficacy, and perioperative nursing competence in operating room nurses.

Methods: A cross-sectional correlational design was used and study data were collected from 119 operating room nurses working at a medical center in southern Taiwan. The instruments used included the Work Locus of Control Scale, the General Self-Efficacy Scale, and the Perceived Perioperative Competence Scale-Revised Short Form. The data were analyzed using Pearson's correlation, linear regression, and logistic regression via SPSS version 20.0.

Results: Educational level, professional rank, years of experience, and locus of control personality traits were identified as not significantly related to clinical competence. However, clinical competence was found to correlate positively and significantly with self-efficacy (r = .54, p < .001), explaining 28% of the variance. Moreover, knowledge competence was found to correlate positively and significantly with both educational level (odds ratio, OR = 42.29, p < .001) and years of experience (OR = 1.18, p < .001).

Conclusions / implications for practice: Clinical competence may be improved by enhancing self-efficacy, and knowledge competence is positively associated with higher educational levels and more years of experience. In light of these findings, education and training on perioperative nursing competence should be incorporated into advanced training programs and educational curricula in clinical settings. Further research on the factors related to core competencies in Taiwan and appropriate revisions to relevant scales to meet domestic contexts are also recommended to improve professional and educational quality.

Postpartum hemorrhage, classified as either primary or secondary, is a leading cause of maternal mortality worldwide and a common and potentially life-threatening obstetric complication. Successful management of this condition is largely dependent on early detection and timely, appropriate intervention. In assessing the risk of postpartum hemorrhage, factors such as placental abnormalities and hereditary coagulopathies must be considered. The administration of uterotonic agents may reduce the risk of severe hemorrhage, and surgical facilities should be equipped with hybrid operating rooms with angiographic capabilities. In cases of unexpected emergency postpartum hemorrhage, a multidisciplinary approach is essential, involving obstetricians, anesthesiologists, surgical teams, laboratory hematology staff, and interventional radiologists able to perform procedures such as arterial embolization. Effective communication and coordination within these teams are crucial for optimal patient outcomes. Pre-anesthetic preparation should take into account physiological, psychological, and pathological changes associated with pregnancy. The results of related studies indicate that postpartum hemorrhage within 24 hours is not significantly affected by the use of neuraxial anesthesia during vaginal delivery. However, general anesthesia has been shown to increase the risk of postpartum hemorrhage by 8.15 times compared to when regional anesthesia is used. The close monitoring of blood loss, clinical signs, fluid and blood transfusions, electrolyte balance, and acid-base status is essential to maintaining hemodynamic stability. Endotracheal intubation may be necessary, with postoperative extubation risks carefully assessed. Furthermore, clinicians should monitor for complications such as transfusion-related acute lung injury or circulatory overload. In severe cases, patients should be transferred to the intensive care unit for further management.

Background: Fatigue, one of the most common and burdensome symptoms faced by hemodialysis patients, affects quality of life and increases mortality risk. Although previous studies in Taiwan have explored the factors associated with fatigue and its predictors in dialysis patients, they are limited in terms of number and are largely outdated and do not reflect recent advancements in dialysis care quality. Thus, further investigation is warranted.

Purpose: The aim of this study was to explore fatigue and its related factors in a population of hemodialysis patients.

Methods: A cross-sectional, correlational research design was used and data were collected from medical records and two structured questionnaires, namely the Hemodialysis Patient Fatigue Scale and the Taiwanese Depression Questionnaire. Inferential statistics were performed using independent sample t-tests, one-way ANOVA, Pearson's correlation, and multiple regression analysis.

Results: The participants were primarily females and unemployed. The average age was 63.59 years (SD = 10.29), the mean dialysis duration was 83.70 months (SD = 63.46), and the average fatigue score was 22.74 (SD = 12.34). Significant correlations were found between fatigue level and, respectively, age (r = .185, p = .024) and albumin levels (r = -.245, p = .003). Fatigue levels differed significantly based on number of chronic diseases (F = 7.48, p = .001). Depressive mood and albumin levels were identified as significant predictors, explaining 68.5% of the total variance (F = 157.308, p = .001), with depressive mood being the primary predictor.

Conclusions / implications for practice: The findings of this study provide assessment and care guidelines to clinical healthcare professionals for patients identified to be at high risk of hemodialysis-related fatigue. Through professional education and training, these professionals can gain the skills necessary to offer effective psychological support and clinical resources. In addition, monitoring the nutritional indicators of patients and providing them with individualized nursing guidance are similarly important. The findings of this study can inform clinical education and serve as a reference for future research in the field of patient care.

Entrustable professional activities (EPAs) represent a structured framework for competency-based assessment that operationalizes clinical competencies into observable and measurable clinical activities or tasks. Thus, delineating the activities considered core or critical to practice in a particular profession is critical, with the expectation that trainees will achieve a level of competence sufficient to perform each activity independently and with a high degree of trust. In the context of advanced nursing education, developing EPAs involves identifying the key responsibilities and critical tasks that advanced practice nurses (APNs) must carry out autonomously in specific clinical settings. These tasks are aligned with relevant core competencies to inform the design of educational curricula and assessment standards. EPAs thus provide a practical, competency-oriented approach to evaluating clinical performance in professional training. Integrating EPAs into advanced nursing education not only helps define the roles and scope of APNs but also clarifies the core competencies needed to meet the demands of clinical practice. This alignment helps bridge the gap between education and clinical practice, offering a structured pathway for the professional development of APNs. However, the use of EPAs in nursing education remains in its early stages. In this article, the author reviews key concepts of competency-based education and explores strategies for developing EPAs, with a focus on the anticipated advantages and challenges associated with implementing this framework to advance nursing education.

The evolving global healthcare environment and increasing diversity in patient needs have necessitated a shift in nursing education from a traditional subject-based approach to a competency-based approach. The implications of applying entrustable professional activities (EPAs) in nursing education are explored in this study and practical strategies are proposed for cultivating clinical competencies and designing curriculum assessments. EPAs emphasize task-based learning, integrating knowledge, skills, and attitudes to prepare learners to perform professional roles independently and reliably. In this study, an actual medical-surgical nursing course is used to illustrate how to establish developmental milestones based on student learning stages and how to implement task-oriented learning and assessments using high-fidelity simulation and evaluation tools. Leveraging modular curriculum design and formative feedback mechanisms, EPAs strengthen students' clinical reasoning, communication and collaboration skills, and sense of professional responsibility. However, implementing EPAs in current teaching practice faces challenges, including incomplete curriculum frameworks, lack of consensus among faculty regarding related concepts and methodologies, and limited readiness among students to engage with the integrated and self-directed learning models. EPAs offer a clear structure for teaching and assessment, helping nursing students gradually develop clinical competence and professional identity and ultimately prepare them to become trustworthy nursing professionals.