Journal of Nursing最新文献

Background: Poor oral hygiene among residents of long-term care facilities impacts the health and well-being of these residents and increases care demands and healthcare costs. As nurse aides play a key role in the daily care of these residents, developing an effective oral care education program tailored for nurse aides of diverse backgrounds is essential.

Purpose: This study was developed to examine the effects of an oral care education program based on Social Cognitive Theory in improving the oral-health-related knowledge, skills, and performance of nurse aides working in long-term care facilities.

Methods: A single-group, pre- and post-test, quasi-experimental design was employed. Convenience sampling was used to recruit and enroll 30 nursing aides and 30 residents from four long-term care facilities in Miaoli, Taiwan as participants. The educational intervention, entitled "Maintaining Health, Starting with the Teeth", comprises 570 minutes of instruction. Two and four weeks post-intervention, assessments were conducted on the oral care knowledge and skills of the participants. Data on the oral health of the resident participants were collected at four weeks post-intervention. During the intervention, a supportive oral care environment was established in the long-term care facilities that included oral care tools, educational materials, and standardized operating procedures. The generalized estimating equation method was used to analyze the effect of the intervention on the nursing aide participants' oral care knowledge and skills. The generalized estimation model was used to analyze the effectiveness of the intervention and control staff on oral care cognition and skills.

Results: Thirty nursing aides (M = 36.8, SD = 8.5; 90% foreign) and 30 residents (M = 69.2, SD = 15.2; 56.7% male) were included in the study sample. The results showed the mean scores for oral care knowledge and skills of the nursing aide participants had significantly improved at both the second and fourth post-intervention weeks compared to baseline. For the resident participants, mean scores on the oral health assessment tool and Plaque Index were significantly improved over baseline at the fourth post-intervention week.

Conclusions / implications for practice: Based on the results, the Social Cognitive Theory-based oral care education program has the potential to substantially enhance the oral health knowledge and skills of nursing aides and to consequently improve oral care outcomes for residents in long-term care settings. These findings provide valuable guidance for the design of more-effective oral care education initiatives in long-term care facilities.

Background: Chronic kidney disease (CKD) is a significant health issue in Taiwan, with the number of patients aged 65 and older receiving dialysis increasing annually. Early identification of frailty in older patients with CKD is crucial for delaying the onset of disability.

Purpose: This study was designed to explore the frailty status, physical function performance, and risk factors of older adult outpatients with CKD who have yet to receive dialysis.

Methods: A cross-sectional study was conducted on a total of 191 older adult patients with CKD in an outpatient care setting. The tools used to collect data included a basic patient information datasheet, clinical frailty scale, physical function performance instruments (a MicroFET 2 handheld dynamometer, grip strength dynamometer, and five-time sit-to-stand test), and the timed up and go test.

Results: Over half (57.07%) of the participants were rated as frail, with assignment to the frail group significantly influenced by age (p < .001) and CKD severity (p = .008). The frailty group exhibited significantly poorer upper and lower limb muscle strength and functional strength as well as a higher fall risk than the non-frail group. Age, gender, and physical function (including grip strength, biceps strength, quadriceps strength, five-time sit-to-stand time, and the average of three timed up and go test results) were all found to correlate with frailty severity and were important risk factors, explaining 47.7% of the total variance.

Conclusions: Frailty is a prevalent and critical issue among older adults with CKD. Clinical healthcare professionals should conduct routine frailty screening and physical function performance evaluations in this population. Implementing appropriate self-management strategies and prescribing simple, individualized exercise programs may help maintain health and prevent further functional decline in elderly CKD patients.

Background & problems: Peripheral intravenous cannulation (PIVC) is a common invasive procedure conducted in clinical settings. However, patient-related conditions often increase the difficulty of successful cannulation. Between April and June 2023, 25 PIVC- related complaints were reported in the emergency department of our hospital, with 72% involving multiple failed attempts. An initial analysis revealed a low success rate (53.5%) for difficult PIVC, with primary contributing factors including a lack of standardized protocols, insufficient assistive tools, poor lighting, and limited hands-on experience among novice nurses.

Purpose: This project was planned and implemented to increase the success rate for difficult PIVC by emergency nurses to above 72.5%.

Methods: The improvement strategies included developing a pocket-sized reminder card incorporating the "HANDS" assessment tool, forming a vascular access team, establishing standardized procedures, conducting ultrasound workshops, upgrading lighting, and implementing a training program for new staff.

Results: After implementation, the success rate of difficult PIVC among emergency nurses increased from 53.5% to 75.3%, achieving the project goal.

Conclusions: Implementing this project effectively improved the success rate for difficult PIVC among emergency nurses, enhanced patient safety and care quality, and strengthened nursing competence.

Nursing education has long relied on either standardized patients or high-fidelity manikins for simulation-based teaching. However, both are constrained by high costs, limited reproducibility of real-world scenarios, and limited opportunities for repeated practice. The utilization of immersive virtual reality pedagogy, AI virtual humans, head-mounted displays, and natural user interfaces offers the potential to create learning environments that are immersive, interactive, and realistic. Related systems support participatory hands-on practice, personalized learning, real-time feedback, and both self-directed and interdisciplinary learning, making it well suited for nursing classrooms and clinical teaching. The process used to develop AI virtual human scenarios using no-code platforms is presented in this article, and the key components and educational outcomes of AI virtual human-based simulation are synthesized. When examined in the context of the four levels of the New World Kirkpatrick Model, existing evidence is concentrated primarily at the "Reaction" and "Learning" levels, with limited assessments of behavior changes or outcomes at the clinical/organizational level conducted. Overall, AI virtual humans may be used to enhance the skills and confidence of nurses in the realms of nurse-patient communication and clinical reasoning/decision-making, and their applications have been gradually expanding to other areas, including suicide prevention and social-emotional learning. In the future, based on appropriate evaluation of platform and equipment costs, more rigorous study designs and multidimensional outcome measures should be incorporated to verify long-term benefits. Also, higher-level clinical implementation effects should be taken into consideration.

Background: Sleep, a fundamental human need and the primary behavioral state of newborns, plays a critical role in brain maturation and development and, in particular, influences the growth of premature infants. However, sleep in premature infants is frequently disturbed and interrupted during their stay in intensive care units, and interventions designed to improve sleep quality during hospitalization have been inadequately investigated.

Purpose: This study was designed to examine the impact of cyclic light exposure on sleep quality in premature infants during hospitalization.

Methods: This randomized controlled trial was conducted using a repeated measures design on a sample of 68 premature infants born between 28 to 36 weeks of gestation. The experimental group was exposed to cyclic lighting starting at 32 weeks of gestation during their NICU stay, while the control group received standard care. The sleep data were collected using actigraphy, with measurements taken at two time points: pre-intervention (pre-test) and immediately prior to discharge (post-test). Data analysis was conducted using generalized estimating equations.

Results: The intervention group reported a significantly greater pre-test / post-test increase in terms of total nighttime sleep duration than the control group (B = 64.52, p = .031). Moreover, the improvement in nighttime sleep efficiency between the two time points in the intervention group (8.92%, p = .032) was significantly greater than in the control group.

Conclusions / implications for practice: The findings suggest cyclic lighting enhances both total nighttime sleep duration and sleep efficiency in premature infants, improving sleep quality during hospitalization. These results informs clinical practice through encouraging healthcare providers to prioritize sleep care for hospitalized premature infants. Implementing cyclic lighting may support the development of more-optimal sleep cycles in premature infants, fostering overall infant development and improving quality of care.

This is a case report on the nursing care of an elderly patient with end-stage renal disease experiencing recurrent intradialytic hypotension resulting in physical discomfort and psychological anxiety during hemodialysis. The period of care spanned from August 1-10, 2024. After conducting a comprehensive assessment based on Gordon's Eleven Functional Health Patterns, three primary health problems were identified: deficient fluid volume, impaired physical mobility, and anxiety. The corresponding interventions employed were 1) implementing low-intensity pedal exercise during dialysis to promote blood circulation and stabilize blood pressure, 2) providing guidance on muscle strengthening exercises and nutritional supplementation to enhance physical function, and 3) offering psychological support and vascular access management education to alleviate anxiety. Through multifaceted and individualized nursing care, the patient demonstrated improved dialysis tolerance, symptom relief, and better psychological adaptation. This report aims to share actual nursing experiences and provide clinical references for dialysis nursing, highlighting the application value of pedal exercise in preventing hypotension and enhancing overall quality of care.

Ubiquitous and enduring, nursing values transcend settings, systems, and time. In this article, the key challenges facing Taiwan's nursing workforce are analyzed through the lenses of workforce data, stakeholder dialogues, and policy. The four major policy directions outlined include: the implementation of a three-shift nurse-patient ratio system, promotion of flexible and autonomous nursing practice, development of nurse-friendly model hospitals, and expansion of advanced nursing roles. The goal of these include: revisiting workforce challenges through evidence, establishing a sustained policy dialogue platform, and achieving more-effective strategic action. With robust and thoughtful policy support, nurses may not only fall in love with their profession and choose to remain but also find fulfillment, as encapsulated in the phrase "Proud to be a Nurse."

Background: A correlation between diabetes and cognitive impairment is supported in the literature. People with both diabetes and cognitive impairment have on average lower medical adherence, self-care abilities, and decision-making capacity than their peers with diabetes only, often leading to poor glycemic control and complications. Enhanced professional support and resource integration are needed to improve care quality and reduce the burden of family caregivers.

Purpose: The goal of this study is to develop an educational guidebook for diabetes educators designed to improve the management of diabetes in patients with cognitive impairment and then establish expert validity and evaluate its clinical applicability.

Methods: The educational guidebook was developed based on a literature review and the findings of prior research. Expert validity was established using a modified Delphi method, and diabetes educators were invited to implement the guidebook in diabetes education to evaluate its applicability.

Results: The educational guidebook developed in this study covers an introduction to diabetes and cognitive impairment, recommendations for diabetes educators, care challenges and recommended strategies, and family support. The expert content validity score was 1.0, and 78.6% of the diabetes educators in the applicability assessment rated the content as important and clear. Furthermore, the qualitative data confirmed the guidebook as a practical and effective tool in diabetes education.

Conclusions: The developed guidebook demonstrated excellent expert validity and clinical applicability, reflecting a high level of endorsement from diabetes educators. It is well suited to addressing the challenges faced in diabetes care by patients with cognitive impairment. The guidebook should be integrated into continuing education for diabetes educators and tailored to meet the specific needs of different institutions.

Background: Young-onset dementia, defined as dementia diagnosed before the age of 65, is characterized by diverse symptoms and a high likelihood of misdiagnosis. Individuals diagnosed with young-onset dementia often face challenges such as early retirement and financial strain, leading to a significant burden for primary caregivers. Although previous studies have documented differences in caregiver burden and family care needs between patients with young-onset and late-onset dementia, few have analyzed both groups concurrently. Similar the state of international research, few studies have examined these aspects concurrently in Taiwan.

Purpose: This study was designed to compare the family care needs and caregiver burdens associated with patients with young-onset and late-onset dementia.

Methods: This cross-sectional study employed convenience sampling. The participants were categorized into young-onset (less than 65 years old) and late-onset (65 years old or older) caregiver groups. Study data were collected using a self-administered questionnaire that included a primary caregiver and patient characteristics datasheet, the Zarit Burden Interview measure, and the Assessment Tool for Family Care Needs of Dementia.

Results: One hundred and five primary caregivers of dementia patients were enrolled as participants. Total care needs, the five care-need subscales (i.e., language and communication, activities of daily living, behavioral and psychological symptoms, care stress, and obtaining resources), and caregiver burden levels were found to be significantly higher in the young-onset group than the late-onset group. Further analysis revealed significantly positive correlations between both behavioral and psychological symptoms and caregiver burden in the young-onset dementia group. Conversely, in the late-onset dementia group, caregiver burden was found to be significantly associated with language, communication, and activities of daily living. Furthermore, age in young-onset dementia patients was found to correlate significantly and negatively with caregiver burden.

Conclusions / implications for practice: Significant differences in family care needs and primary caregiver burden were found between the young-onset and late-onset dementia groups, with the former associated with greater caregiving needs and burdens. Long-term care services should be extended to patients with dementia who do not have an officially recognized disability certificate and below the age of 50. These services should be tailored to meet individual needs, equip caregivers with essential caregiving skills, and provide targeted support.

In this article, the authors explore the benefits of implementing the 'nurse self-scheduling' system, highlighting the positive impact of this system on both nursing staff and healthcare organizations. Under the traditional three-shift system, nurses work long hours and endure physical and mental stressors, contributing to high turnover rates. The inherent flexibility of self-scheduling has been shown to enhance work-life balance, thereby improving job satisfaction and retention rates. However, challenges remain, including ingrained traditional workplace norms, inadequacies in legacy technical systems, and concerns about scheduling fairness. Some hospitals in Taiwan have introduced digital tools such as Google Forms and Teams to enhance scheduling efficiency and transparency. Notably, the phased approach implemented at Changhua Christian Hospital emphasizes team communication and has successfully established new workplace norms supportive of self-scheduling practices. Although technological advancements, especially in the realm of artificial intelligence, offer new potential for intelligent scheduling, sustainable implementation of self-scheduling systems will require organizational cultural shifts and managerial support. In conclusion, nurse self-scheduling represents a key strategy for creating friendly workplaces, enhancing care quality, and achieving a win-win for nurses and organizations.