Journal of Nursing最新文献

Background & problems: Safe and efficient operational workflows in nursing care can alleviate workloads, enhance quality of care, and improve job satisfaction. A recent survey indicates that the admission process for patients with COVID-19 in nursing care is excessively lengthy due primarily to the waiting time for physicians to enter the ward, external support, and frequent reorganization of medical materials. Inadequate organization measures have resulted in requisite materials not being centralized, leading to increased travel times, interruptions in nursing records maintenance, unprofessional explanations, and time-consuming consent form signing processes.

Purpose: In this project, lean management was implemented to reduce the time spent on the nursing admission process for patients with COVID-19.

Resolutions: The nursing admission process and job responsibilities were revised. Furthermore, new policies were implemented, including introducing remote consent form signing, using intelligent digital health education assistants, revising related inventory processes, and planning admission nursing carts to streamline the admission process.

Results: The average processing time in the isolation room was reduced by 30.5% from 105 minutes to 73 minutes; the average time spent by nurses on the admission process was reduced by 34.1% from 504 minutes to 332 minutes; and nursing satisfaction levels rose from 55.4% to 82.7%.

Conclusions: In this project, lean management was used to investigate the nursing admission process for patients with COVID-19 and a value stream map was compiled to identify low-value activities within the process. Through the implementation and standardization of project measures, processing time was effectively reduced, manual labor was minimized, and job satisfaction improved.

Background: The 2005 revision of the code of ethics for nurses has been in effect in Taiwan for more than 17 years. Although this code has been smoothly implemented during this time, changing social expectations and ethical perspectives, advancements in science and technology, and the evolution of the nurse-patient relationship suggest this code should be once again be updated.

Purpose: This study was conducted to suggest revisions to the Taiwan code of ethics for nurses necessary to meet current needs and address social and medical care environment trends.

Methods: A multivariate research approach was adopted. The classification of the code of ethics for nurses norms in six international nursing organizations and evidence-based ethical and philosophical thinking literature were referenced, with the main notification demands incorporated into the Ministry of Health and Welfare's Nursing Workplace Controversy Reporting Platform. After drafting the aspects and provisions of Taiwan code of ethics for nurses norms, expert review procedures such as focus groups, Delphi expert consensus, and public forums were conducted.

Results: After three expert focus group discussion rounds, a structured questionnaire was completed, and 50 Delphi experts in six fields completed the online questionnaire. After the second consensus round, the importance and clarity of the 47 ethical code provisions in the four aspects were determined with 100% and 99.8% agreement reached, indicating no significant difference in scores between the multidisciplinary expert group and the ethical code. The resulting revision proposed for the Taiwan code of ethics for nurses includes: nursing staff and care recipients (14 provisions), nursing staff and practice (13 provisions), nursing staff and the profession (10 provisions), and nursing staff and society (10 provisions).

Conclusions / implications for practice: In terms of education, the revised Taiwan code of ethics for nurses should be integrated into the nursing education curriculum of nursing colleges and used as teaching material for the continuing education of nurses. In terms of policy, these norms should be included as evaluation benchmarks and inspection items for hospitals. In addition, the attention and support of senior managers in institutions must be secured and a handling protocol for moral dilemma cases and related consultation mechanisms must be established. Nursing supervisors should be guided to develop the ability to address these dilemmas to help foster a positive workplace and a respectful team atmosphere. All professional groups should participate actively in promoting issues related to nursing ethics, organize seminars and continuing education activities, and make the revised Taiwan code of ethics for nurses and learning cases available online for reference by nursing staff nationwide.

Background & problems: Patients with liver transplantation must take lifelong immunosuppressant medication to maintain the function of their hepatic graft. Based on clinical experience, we found that these patients were affected by both insufficient and remaining medication when they returned for outpatient service visits. After investigating the current situation, It was found that post-transplantation perceptions regarding medication were low in this patient group. After analysis, the identified causes of this included: (1) poor learning effect due to the interference from the multiple therapeutic catheter placement postoperatively; (2) delayed timing of assessing the awareness of information or perception of medication and lack of a post-operative follow-up mechanism; and (3) insufficient educational tools and materials for patients.

Purpose: This study was designed to increase medication awareness from the current average of 68.3% to >91% and to increase patient satisfaction with medication guidance from the current 63.0% to >85% in patients who had received liver transplantation.

Resolutions: The improvement strategy included: designing a health education sheet including related medication information and a daily medication record; designing a mnemonic, interactive video, or test to improve medication perception; creating measures associated with a monitor mechanism to assess medication knowledge.

Results: After strategy implementation, medication awareness increased from 68.3% to 92.5% and satisfaction with medication guidance increased from 63.0% to 87.2%.

Conclusions: The implementation of several strategies concurrently can enhance medication awareness in patients after liver transplantation and increase patient satisfaction with medication guidance.

Background: Approximately 30% of patients experience postoperative complications after surgery for early-stage lung cancer. However, the relationships among meridian energy during lung cancer surgery, changes in quality of life, and prognosis have not been investigated.

Purpose: This study was designed to explore the associations among meridian energy, changes in quality of life, and prognosis in patients with newly diagnosed lung cancer undergoing surgery.

Methods: A longitudinal, repeated-measures design was used. Basic data forms, meridian energy measurements, and a concise 12-item health status questionnaire were administered to the participants at the time of diagnosis, 2 weeks post-surgery, and 12 weeks post-surgery. During this period, changes were analyzed, and their association with postoperative risks was explored.

Results: Forty-eight cases were investigated. Both meridian energy and quality of life were found to be significantly decreased 2 weeks after surgery. The high/low ratio of meridian energy, the physical component score of the Short Form 12-Item Health Survey Questionnaire, gender, cancer stage, and body mass index were identified as significantly associated with prognosis.

Conclusions / implications for practice: Conclusion/Implications for Practice: The declining trends in meridian energy and quality of life during the 2 weeks after surgery in patients with lung cancer are associated with poor postoperative prognoses. Nurses may use the findings of this study to identify patients at high risk of postoperative complications and develop appropriate strategies to provide comprehensive care.

Background & problems: Readiness process effectiveness significantly impacts the safety of high-risk neonates and requires an immediately responsive and well-trained healthcare team. Analysis of our unit found the high-risk neonatal standby process completion rate among nursing staff to be very low. Reasons for this poor level of performance included absence of standardized procedures for high-risk neonatal standby, lack of an auditing system, inadequate education and training, multiple medical supplies in the standby kits, absence of a checklist for the kits, and failure to regularly inventory the contents of these kits.

Purpose: This study was designed to improve the high-risk neonatal standby process completion rate among nursing staff.

Resolution: We developed standardized procedures and videos for high-risk neonatal standby situations, established an auditing system, conducted regular scenario-based training, organized medical supplies in the standby kits, designed a checklist, and defined procedures for stocking and using the supplies.

Results: The high-risk neonatal care completion rate among nursing staff increased to 100%, and the satisfaction rate with the standby procedure for high-risk neonates rose from 59.5% to 96.5%.

Conclusions: Following proper standardized procedures and conducting education and training can ensure effective and high-quality care in critical healthcare situations.

Background: COVID-19 affected both the physical and mental health of frontline nurses and the stability of the nursing workforce.

Purpose: This study was designed to explore the influence of demographic variables, physical and mental health status, perceived work stress, and job satisfaction on intention to continue working as nurses among nursing staff who had been infected by COVID-19.

Methods: In this cross-sectional study, an internal online survey was used to collect data from 152 nurses at a hospital in southern Taiwan. The questionnaires in the survey included the Chinese Health Survey Scale, Stress Scale on COVID-19 Patient Care, McCloskey/ Mueller Satisfaction Scale, and Employee Retention Scale. Data analysis was conducted using SPSS/Windows 22.0.

Results: The most significant predictors identified included age, seniority, level of education, job satisfaction, physical and mental wellbeing, and work stress. These predictors collectively explained 32% of the total variance in retention willingness (F [18,128] = 4.78, p < .001). Almost half (46.7%; 71/152) of the participants expressed intent to continue working in nursing. Being a senior staff and having a master's degree or higher were positively associated with retention.

Conclusions / implications for practice: The findings may be referenced by healthcare organizations and managers to help healthcare staff gain strength and resilience against future pandemics. Key recommendations include reducing staff work stress, increasing job satisfaction, and facilitating a more equitable life-work balance.

Background: The increasing complexity of the healthcare environment in recent years highlights the importance of cultivating in head nurses the leadership and management competencies necessary to effectively handle complicated administrative tasks and lead nurses in facing various challenges. Identifying the core administrative management competencies required of head nurses and evaluating competency level using behavioral indicators are fundamental to evaluating related training outcomes.

Purpose: This study was designed to identify the core administrative management competencies required of head nurses as well as the associated job responsibilities, tasks, behavioral evaluation indicators, work outputs, and requisite knowledge and skills.

Methods: This study was conducted in two phases using a qualitative method. The first phase identified the core administrative management competencies and their behavioral definitions. The second phase established competency-related job responsibilities, tasks, behavioral evaluation indicators, work outputs, and requisite knowledge and skills. Each phase consisted of (1) a qualitative interview (first stage) or focus group discussion (second stage) to establish the prototype content; (2) a head nurse workshop to obtain multiple perspectives to modify the prototype content; and (3) a focus group discussion to achieve consensus regarding the content.

Results: Nine core competencies related to head nurse administration were identified, including: strategic planning, care supervision, quality improvement, communication, crisis management, responsible leadership, evidence-based practice, digital technology application, and presentation persuasion. Corresponding to these competencies, four responsibilities and associated work tasks were identified. Finally, the related behavioral evaluation indicators, work outputs, and requisite knowledge and skills were confirmed.

Conclusions / implications for practice: The results of this study may be used as the basis for head nurse administrative management training programs, while the identified behavioral evaluation indicators may be used to evaluate head nurse work performance and training outcomes. We recommend other institutions apply the results of this study and develop their own administrative core competencies and evaluation indicators for head nurses.

Background: The second-generation smoking cessation measures for inpatients in our hospital were provided primarily by physicians. Statistics from January to December 2019 showed a negative trend in the number of inpatient smoking cessation services and health education courses provided.

Purpose: Purpose: In this study, a comprehensive systematic literature review on the application of smoking cessation interventions was conducted with the goal of helping enhance the inpatient quit rate at the author's hospital.

Resolution: The literature on smoking cessation interventions was reviewed, with the findings used to formulate a feasible plan for the implementation of an effective related intervention at our hospital. During the implementation process, the challenges encountered led to the formulation of strategies, including: 'conducting second-generation smoking cessation on-the-job training,' 'revising the referral process for patients taking smoking-cessation medications,' and 'adding patients who do not cease smoking to the referral process.' Data on the number of individuals attempting to quit smoking and the success rate of smoking cessation were collected. The baseline values before project implementation were compared with the values at 12 and 24-months posttest.

Results: The number of individuals receiving smoking cessation services increased from 85 people within 12 months to 105 people, and further increased to 125 people by the 24th month. Comparing the 3-month abstinence rates for 2019 and 2020, an increase from 31.36% before project implementation to 42.67% after implementation was observed, indicating a rise of 11.31%. Also, comparing the 6-month abstinence rates between 2019 and 2020, an increase from 27.16% before project implementation to 42.67% after implementation was observed, indicating a rise of 15.51%. The project outcomes calculated in December 2021 show a three-month abstinence rate of 44.40% and a six-month abstinence rate of 41.82%.

Conclusions: The nursing interventions for smoking cessation in this project increased the abstinence rate among inpatients. Evidence-based practices, including earching for quality research evidence, utilizing the 7A framework to bridge evidence and clinical differences, and promoting the project using a collaborative cross-team approach, were the main factors contributing to the success of the project. The evidence-based application of smoking cessation strategies highlights the significant role played by nurses in enhancing the quality of care. The findings may serve as a reference for the future development of nursing project solutions.

Background: There is growing concern related to the recent rise in consumption of cigarettes, electronic cigarettes, and heated tobacco products. The government should pay more attention to the use of various tobacco products by university students.

Purpose: Problem behavior theory was used in this study to explore the factors influencing the use of various tobacco products by university students in the Greater Taipei area.

Methods: In this cross-sectional study, convenience sampling was used to select eight institutions of higher education in the Greater Taipei area. Eight departments recognized by the Ministry of Education were then listed on a table for use in randomizing the selection of third- and fourth-year undergraduate students. A total of 115 participants filled out the questionnaires included in the self-administered online survey. Data analysis was conducted using logistic regression.

Results: The prevalence of tobacco-product use in the sample was 5.22%. Logistic regression analysis revealed having parents who smoked (adjusted odds ratio, AOR = 2.05), holding a positive attitude toward their parents' smoking (AOR = 4.23), having peers who smoked (AOR = 4.33), engaging in deviant behavior (AOR = 90.44), and having peers involved in deviant behavior (AOR = 103.99) to be associated with a higher likelihood of engaging in tobacco-product use.

Conclusions / implications for practice: Family, peers and delinquency significantly influence the usage behavior of university students with regard to tobacco products. The government should allocate greater resources for tobacco harm prevention education aimed at the parents of university students. In addition, integrating tobacco harm education into campus curricula, utilizing social media for online digital education, and providing students with counseling and support measures are strategies that may help reduce the tobacco-product use among this vulnerable population.