Journal of Nursing最新文献

Achieving optimal nurse-to-patient ratios, widely recognized as critical to improving care quality, has been a key stated goal of national healthcare policy in Taiwan since 2014. Although the "daily average nurse-to-patient ratio" was codified into law in 2019, this regulation only defined the maximum number of patients per nurse based on an average across all three shifts, hospital-wide, and over a one-month period. This averaging approach dilutes and distorts the actual workload of nurses and fails to adequately protect them from overwork. In response, nursing associations have for years called for the implementation of "three-shift nurse-to-patient ratios" that set specific workload caps for day, evening, and night shifts, respectively. In 2024, following the strain of the COVID-19 pandemic and subsequent wave of post-pandemic nurse resignations, the government announced a new policy addressing three-shift ratios. Nevertheless, the policy maintains the averaging method and, while providing incentives to institutions that achieve targeted levels, does not impose penalties on those that exceed threshold numbers. Thus, this new policy does not resolve the fundamental issues behind the nurse overwork problem in Taiwan. This article was written to delineate the efforts made by labor unions and nursing organizations to enshrine three-shift nurse-to-patient ratios into law. In addition, the use by unions of tools such as surveys, lobbying, and protest actions across the different phases of advocacy to pressure the government, push policy forward, and improve the working conditions for nurses is analyzed.

Background: Cases of chronic disease and disability and the demand for long-term care have risen in step with the steady global increase in aging populations. Foot health is critical to quality of life and mobility in older adults, and proper foot care can reduce the risks of falls and disabilities while preventing foot-issue-related health deterioration. Thus, foot care has become an integral part of long-term care services in Taiwan.

Purpose: The objective of this study was to explore the current status of older-adult foot care in Taiwan and factors influencing the competency of home care nurses in implementing this care.

Methods: This cross-sectional study targeted nurses working at nationally licensed home care institutions. The self-developed structured questionnaire used in this study covered five sections: demographics, foot care knowledge, attitudes, practices, and competencies. After testing for validity and reliability, 250 copies of the questionnaire were distributed, with 183 valid responses collected. Data were analyzed using SPSS 21.0 software.

Results: The average age of participants was 43.1 years. Regarding foot care, 51.4% of the participants had not attended any continuing education on foot care, while those who had reported an average training duration of 4.7 hours. Overall foot care competency scores were highest in the areas of professional ethics, collaboration, and quality management with evidence-based application. Positive correlations were observed between foot care attitudes, practical experience, and training hours. Stepwise regression analysis revealed attitudes, practices, and continuing education as the main predictors of foot care competency, with an explanatory power of 63%.

Conclusions: Attitudes, practical experience, and continuing education are key factors influencing foot care competency in home care nurses. Nursing education curricula should incorporate foot care to systematically enhance student foot health assessment skills, care measures, and professional expertise. Moreover, ongoing in-service education and training should be promoted to strengthen the practical capabilities of home care nurses, addressing the growing demand for long-term care in aging societies.

Background: Physical restraint, commonly used in medical wards to prevent self-extubation and agitation, sometimes fails to achieve one or both of these objectives. Thus, the factors contributing to the occurrence of self-extubation and agitation under restraint require further exploration.

Purpose: This study was developed to identify the predictors of two types of adverse events (unplanned device removal and agitation) among hospitalized patients under physical restraint in medical wards.

Methods: This retrospective study analyzed the medical records of 100 patients aged ≥ 20 years who had been physically restrained in a regional teaching hospital in Taipei between January 2022 and February 2023. Poisson regression was used to examine predictors across the four domains of demographic, emotional, social, and medical factors.

Results: The significant predictors of extubation during physical restraint identified in the analysis included having a foreign caregiver (B = 0.81, p = .01), emotional instability (B = 1.36, p = .02), a history of extubations during restraint (B = 0.61, p = .02), and a history of agitation episodes before restraint (B = 1.13, p = .04). Predictors of agitation during restraint included use of non-steroidal anti-inflammatory drugs (B = 1.27, p < .01), medication use during agitation (B = 0.75, p < .01), restraint for treatment purposes (B = 0.63, p = .04), and a history of extubations (B = 0.55, p = .02) or agitation (B = 1.44, p = .02).

Conclusions: Based on these findings, recommendations for reducing adverse events following physical restraint include prioritizing family caregivers, receiving routine emotional assessments, monitoring medications, and enhancing communication and non-pharmacological strategies prior to restraint.

Background & problems: In patients with end-stage renal disease (ESRD), not establishing arteriovenous access prior to the commencement of dialysis necessitates the use of temporary vascular access, which negatively impacts quality of life and survival. Statistics for the period June 2021 to May 2022 showed the rate of completion of arteriovenous (AV) access in patients with ESRD in our hospital to be only 20.4%. The identified reasons for this low rate were: (1) only 49.3% of patients / family members had correct knowledge regarding the establishment of AV access; (2) relevant education methods varied among case managers; (3) patient decisions were not queried after implementing shared decision-making; (4) no structured communication platform was available to patients after expressing their preferred dialysis modality, leading to inconsistencies in receiving relevant education and establishing AV access.

Purpose: The objective of this project was to raise the pre-dialysis AV access completion rate in patients with ESRD to 40.1%.

Resolution: (1) Add auxiliary educational tools; (2) optimize education materials and processes; and (3) strengthen the shared-decision making tracking mechanism.

Results: The completion rate of pre-dialysis AV access increased from 20.4% to 41.2% in the target patient group.

Conclusions: Conclusion: In addition to meeting the main objective, additional benefits of the project included reduced average hospitalization duration and lower consumption of medical consumables per patient.

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.