Journal of Nursing最新文献

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associated with fatigue and its predictors in dialysis patients, they are limited in terms of number and are largely outdated and do not reflect recent advancements in dialysis care quality.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.

Supporting healthy growth in children is a core objective of health care systems. However, numerous factors in modern society can expose children to risks such as precocious puberty, which may further lead to harm to their physical and mental health. In this article, we summarize the state-of-the-art of knowledge on precocious puberty, including its definition, stages, comprehensive influencing factors, natural environmental hormones, and environmental endocrine disruptors (e.g., plasticizers and plastic products). Additionally, we introduce the treatment and strategies for preventing this condition and highlight how nurses can optimize the care of children at risk in precocious puberty. In sum, the knowledge provided here will help nurses be better equipped to disseminate information regarding precocious puberty to children families.

Traditional competency-based education models are no longer adequate to address the practical training needs of nursing education. The concept of entrustable professional activities (EPAs) has been introduced to bridge the gap between theoretical knowledge and clinical practice. EPAs offer a task-based, competency-integrated framework for both instruction and assessment, transforming abstract competencies into observable and assessable clinical tasks. This paper explores the origin and theoretical foundation of EPAs, their structured components, and their practical application in clinical nursing education. Evidence suggests EPAs enhance teaching quality and clinical learning outcomes while fostering professional autonomy and sense of responsibility in learners. It is recommended nursing educators develop training in EPA-based instructional design and that standardized assessment tools and trust-based decision-making mechanisms be developed. These efforts can support professional growth and enhance the alignment between nursing education and clinical practice.

Background: Patients with multiple sclerosis (MS) often experience impaired muscular fitness and fatigue. Exercise is known to help maintain muscle fitness and alleviate fatigue, with resistance training being recommended as a potential intervention. However, due to the variety of resistance exercises used and inconsistencies in the results obtained, an evidence-based systematic review is needed to synthesize the effectiveness of this intervention.

Purpose: This study was designed to synthesize the current research on the effectiveness of resistance training in improving muscle fitness and reducing fatigue in patients with MS.

Methods: A systematic review was conducted in March 2024, with five English and Chinese databases searched using keywords related to MS, resistance training, and fatigue. Only randomized controlled trials (RCTs) were included, and a total of five studies met the inclusion criteria. A quality appraisal of the included studies was performed using the Joanna Briggs Institute's critical appraisal tool for evaluating RCTs.

Results: The five RCTs included in this systematic review examined different resistance training protocols, including high-intensity, fast-velocity concentric, high-intensity eccentric, and respiratory muscle resistance training. Overall, the results indicate resistance training led to better muscular fitness improvements in terms of muscle strength, endurance, maximal inspiratory pressure, maximal expiratory pressure, and fatigue reduction. However, statistical significance was achieved in only some of the studies.

Conclusions / implications for practice: Resistance training appears to be beneficial in improving muscle fitness and reducing fatigue in patients with MS, even though only some of the studies achieved statistical significance. The current evidence is weak due to the limited number of published studies and the small sample sizes and diversity in training protocols used. Further systematic reviews are needed to update findings as more research becomes available. Clinically, resistance training may be considered as part of exercise recommendations for MS patients, and outcomes should be monitored.

The gap between classroom learning and clinical practice has presented a challenge to nursing education for decades, posing significant risks to patient safety and care quality-particularly in light of the chronic global shortage of nursing professionals. Entrustable Professional Activities (EPAs) offer a competency-based approach to bridging this gap by assessing whether learners can independently perform essential clinical tasks in authentic care settings, thereby guiding appropriate levels of supervision and delegation. In Taiwan, EPAs, which have been preliminarily implemented in the context of newly graduated nurse and clinical preceptor training, have demonstrated potential benefits in both competency assessment and nurse retention. Notably, countries such as the Netherlands and Singapore have successfully integrated EPAs into nursing education, highlighting their adaptability in addressing workforce shortages and supporting professional development. The aim of this article is to explore the application of EPAs in nursing education, offering nursing educators new insights on strategies for enhancing curriculum assessment and professional entrustment. By integrating EPAs into nursing education, the goal is to cultivate clinical competencies in nursing professionals more effectively, close the theory-practice gap, and thus better ensure patient safety and the quality of care.

Background: Promoting interprofessional collaboration has become increasingly important in the work of healthcare professionals. However, in Asia, differences in role awareness and professional perceptions remain significant barriers to effective collaboration among these professionals. Interprofessional collaborative practice is recognized as a crucial strategy for achieving patient-centered and high-quality holistic care in Taiwan, with research indicating attitudes toward physician-nurse collaboration significantly shape this relationship and interprofessional collaborative practice, emphasizing the important influence of attitudes toward physician-nurse collaboration on the overall care process.

Purpose: The Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (JSAPNC) was translated into Traditional Chinese and validated in this study. After confirming its reliability and validity, this scale was used to measure and assess the attitudes toward collaboration of medical doctors and nurses.

Methods: The JSAPNC scale was transformed into Chinese using a standardized translation procedure, and the expert content validity of the translated scale was verified. Next, a pre-test questionnaire was distributed to verify its reliability and validity. The participants in this study were all clinical nurses working in a medical center, and 150 valid questionnaires were collected.

Results: The Traditional Chinese version of the JSAPNC was assessed as having good internal consistency (Cronbach's α = .79), with exploratory factor analysis showing good construct validity (factor loading ≥ .05).

Conclusions: In this study, a Traditional Chinese version of the JSAPNC Chinese scale was produced and verified for reliability and validity. This scale may be used by medical institutions to promote cross-field collaboration cultures. It is recommended that, in the future, researchers in the medical field continue to conduct in-depth explorations of the impact of medical and nursing collaboration attitudes in Taiwan and provide guidance for medical decision-making. Developmental trends in promoting collaborative attitudes among physicians and managers with management levels.

Background: Airway-related incidents, common in clinical settings, are characterized by high urgency and complexity. Failure to manage these incidents promptly can pose serious threats to patient safety. However, many of these incidents can be prevented through the effective implementation of airway management education.

Purpose: The objective of this study was to identify the priority educational needs of airway management for nurses to enhance clinical practice and reduce the risk of adverse events.

Methods: A cross-sectional design was employed and 100 nurses from a medical center in northern Taiwan were enrolled as participants. Data were collected via an online questionnaire and analyzed using importance-performance analysis (IPA), Borich's Needs Score, and the Locus for Focus (LF) model, all of which have previously been shown to be effective in identifying educational priorities.

Results: Items identified as top-priority educational needs were respectively located in Quadrant II of the IPA model, ranked among the top-10 in terms of Borich's Needs Score, and situated in Quadrant I of the LF model. The results highlighted "rapid sequence intubation procedures" and "treatment of respiratory failure" as the areas in most need of attention.

Conclusions: The results of this study support that significant gaps exist between the perceived importance and self-assessed performance of nurses with regard to airway management. In this study, these gaps were most significant in the dimensions of rapid sequence intubation procedures and respiratory failure treatment. Targeted, outcome-focused educational programs are recommended to address these gaps to improve patient safety and the quality of clinical nursing care.