Journal of Nursing最新文献

{"title":"[Improving the Nasogastric Tube Removal Rate in Stroke Patients Using a Quality Control Circle Method].","authors":"Yi-Hong Li, Chia-Ming Kuo, Yu-Fen Huang, I-Chieh Lo, Chiu-Man Tsai, Tzu-Hui Chiang, Yu-Ju Wu, Tsung-Rung Huang, Li-Chin L Lai, Bo-Lin Ho, Meng-Chuan Huang","doi":"10.6224/JN.26409","DOIUrl":"https://doi.org/10.6224/JN.26409","url":null,"abstract":"<p><strong>Background & problems: </strong>Post-stroke dysphagia, which affects 40% to 70% of stroke survivors, frequently leads to aspiration pneumonia and diminished quality of life. Despite achieving a 98.8% initial swallowing screening rate, the nasogastric tube removal rate in our unit of 52.7% was below the national benchmark of 57.4%. A quality control circle root cause analysis was conducted, with five critical issues identified. These included a lack of routine in-service education, insufficient interdisciplinary collaboration, inconsistent screening tool versions being used, a deficit in integrated educational resources, and ambiguous re-screening protocols during patient transfers that resulted in a low re-screening rate (60.3%).</p><p><strong>Purpose: </strong>This project was implemented to increase the nasogastric tube removal rate in stroke patients from the baseline of 52.7% to a minimum target of 67.8%.</p><p><strong>Resolution: </strong>Four key interventions were implemented using quality control circle methodologies. These included: (1) Organizing interdisciplinary workshops to clarify intervention timing and professional roles across disciplines; (2) Integrating a \"Three-Stage Swallowing Screening Tool\" incorporating pre-procedural oral hygiene protocols and clinical decision-making algorithms; (3) Developing interdisciplinary patient education materials encompassing nursing, traditional Chinese medicine, and speech-language pathology; and (4) Revising standard operating procedures to mandate re-screening during all inter-unit transfers.</p><p><strong>Results: </strong>Post-intervention, the nasogastric tube removal rate increased from 52.7% to 69.9%, which exceeded the targeted goal. Notably, no re-intubations occurred within the six-month post-discharge follow-up period. In addition, the re-screening rate during inter-unit transfers improved markedly from 60.3% to 97.4%. Ancillary benefits included redirecting approximately 15 minutes of tube maintenance time per nurse daily into high-value individualized patient care,and an estimated savings in annual healthcare costs of NT$24,708 per family.</p><p><strong>Conclusions: </strong>The process standardization and enhanced interdisciplinary synergy achieved under this project effectively eliminated gaps in care, resulting in substantially improved patient safety and care quality.</p>","PeriodicalId":35672,"journal":{"name":"Journal of Nursing","volume":"73 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Infection Control Strategies for Cancer Patients Based on Chain of Infection].","authors":"Yaun-Ju Lin, Yeur-Hur Lai","doi":"10.6224/JN.26411","DOIUrl":"https://doi.org/10.6224/JN.26411","url":null,"abstract":"<p><p>Advances in cancer diagnosis and treatment have improved patient survival significantly. However, immunosuppression and the various invasive medical interventions often involved in these treatments increase infection risks. The core concept of \"Chain of Infection\" is used in this article to elaborate systematically on practical infection control strategies for cancer patients in three dimensions: the susceptible host, the infectious agent, and the mode of transmission. Strategies related to the susceptible host focus on enhancing host defense mechanisms and protecting potential portals of entry through the prophylactic use of granulocyte colony-stimulating factor, appropriate vaccinations, mucosal care, and skin integrity maintenance as well as the stringent management of invasive catheters. Strategies related to infectious agent control focus on environmental and dietary source management, including the restriction of live plants, implementation of water management plans, infection-control risk assessment and protection during construction, rigorous environmental cleaning and disinfection, and adherence to food safety protocols. Strategies related to mode of transmission focus on the management of both physical infrastructure and personnel behavior, recommending that protective/isolation rooms and material selection be incorporated into facility planning and that personnel should consistently practice hand hygiene, respiratory hygiene, and cough etiquette; use personal protective equipment properly; and surveil their own health condition. In applying these multi-level and systematic strategies, the incidence of infections may be effectively reduced and treatment safety and quality of care ensured.</p>","PeriodicalId":35672,"journal":{"name":"Journal of Nursing","volume":"73 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Mental Health Recovery in Community Mental Health Nursing: A Practice Reflection].","authors":"Jhe-Jun Wu, Hsin-Pei Feng, Kai-Jo Chiang, Wen-Chii Tzeng","doi":"10.6224/JN.26412","DOIUrl":"https://doi.org/10.6224/JN.26412","url":null,"abstract":"<p><p>Mental health recovery, a core concept in contemporary mental health care, emphasizes that service users can pursue meaningful life goals by rebuilding hope, identity, and purpose even as related symptoms persist. As care has shifted from a biomedical focus on symptom control toward person-centered and community-oriented approaches, the mental health recovery process has presented challenges to traditional nursing roles and practices. Moreover, misperceptions of these approaches as psychiatric rehabilitation or illness management interventions have led to gaps between principles and practice. In this article, the relevant literature is reviewed to describe the meaning of recovery and its influencing factors, and measurement tools widely used to support nurses' understanding of recovery processes are summarized. In addition, the authors integrate their practical experiences in community psychiatric rehabilitation to reflect on challenges related to role positioning, intervention flexibility, and organizational support when implementing recovery-oriented care in practice.</p>","PeriodicalId":35672,"journal":{"name":"Journal of Nursing","volume":"73 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Developing and Validating the Long COVID-19 Symptom Severity Index (LCSSI) for Patients With Chronic Obstructive Pulmonary Disease].","authors":"Ling-Chan Pan, Yu-Hua Lin, Yi-Hui Liu, Chun-Ying Chiang, Jung-Yueh Chen, Ho-Sheng Lee, Yuan-Yuan Fang","doi":"10.6224/JN.26306","DOIUrl":"10.6224/JN.26306","url":null,"abstract":"<p><strong>Background: </strong>Existing tools for assessing Long COVID are primarily designed for the general population. Few instruments adequately capture the needs and vulnerabilities of high-risk groups such as patients with chronic obstructive pulmonary disease (COPD), who have structurally vulnerable lungs.</p><p><strong>Purpose: </strong>This study was designed to develop and validate the Long COVID Symptom Severity Index (LCSSI), a concise and clinically sensitive instrument designed specifically for use on patients with respiratory diseases.</p><p><strong>Methods: </strong>The study was conducted in two phases. In Phase I, item generation was based on a literature review and expert panel discussion involving six pulmonologists. In Phase II, a cross-sectional validation study was conducted in the chest medicine wards and outpatient clinics of a medical center in southern Taiwan. The psychometric properties of the LCSSI were examined.</p><p><strong>Results: </strong>One hundred and twenty-eight patients with COPD (93% male) were enrolled, of whom 63.3% were classified under GOLD (global initiative for chronic obstructive lung disease) Group E. The most prevalent symptoms found were cough/sputum (100%), fatigue/weakness (90.6%), and dyspnea (88.3%). The LCSSI demonstrated excellent internal consistency (Cronbach's α = .88), and correlated positively with the COPD Assessment Test (p < .01) and negatively with the 15D Health-Related Quality of Life scale (p < .01). Mean LCSSI scores differed significantly across GOLD groups, with Group E showing higher mean total and core symptom scores (all p < .01), supporting construct validity.</p><p><strong>Conclusions / implications for practice: </strong>Based on this sample, the results indicate the LCSSI has acceptable internal consistency and validity, supporting its use as a reference tool for symptom assessment in patients with COPD during the late recovery phase for Long COVID.</p>","PeriodicalId":35672,"journal":{"name":"Journal of Nursing","volume":"73 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Enhancing Nursing Competence in Cultural Safety].","authors":"Ying Tsao","doi":"10.6224/JN.26304","DOIUrl":"10.6224/JN.26304","url":null,"abstract":"<p><p>Cultural safety extends beyond physical protection to encompass moral considerations and the relational dimensions of care. The determination of whether healthcare is \"safe\" rests with patients rather than healthcare professionals, and only when patients feel respected, free from denigration, and assured their rights are upheld can care be considered culturally safe. Accordingly, healthcare education must cultivate respect in students for cultural diversity and prepare them to deliver equitable and culturally safe clinical care. In this article, a deconstructive perspective is used to examine the potential of using cultural safety as a framework for addressing health inequities. In practice, cultural safety represents a developmental process progressing from cultural awareness to cultural sensitivity and, ultimately, cultural competence. The cultural teaching capacity of educators may be strengthened through the three interrelated domains of foundational competence, facilitation skills, and curriculum design. Together, these can foster inclusive learning environments and support the development in students of culturally safe nursing practices, which are essential to enhancing quality of care and patient health and well-being.</p>","PeriodicalId":35672,"journal":{"name":"Journal of Nursing","volume":"73 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Key Factors of Influence on Postpartum Women's Satisfaction With Hospital-Affiliated Postnatal Care Facility Services and Practical Recommendations for Improvement].","authors":"Ming-Ju Yu, Yen-Han Wu, Chin Ping Wang, Hsin-Tzu Li, Chih-Hao Lin","doi":"10.6224/JN.26308","DOIUrl":"10.6224/JN.26308","url":null,"abstract":"<p><strong>Background: </strong>Hospital-affiliated postpartum care centers are preferred by new mothers in Taiwan due to their medical resources and safety. However, overall maternal satisfaction is often influenced by \"non-medical service\"-related factors. These factors have yet to be adequately investigated empirically in the context of these centers.</p><p><strong>Purpose: </strong>This study was designed to explore the relationship between core service dimensions and overall satisfaction at hospital-affiliated postpartum care centers, identify the key determinants of satisfaction, and provide recommendations for improvement.</p><p><strong>Methods: </strong>A cross-sectional design was employed, and a self-developed questionnaire was administered to a convenience sample of 300 postpartum women. The collected data were analyzed using hierarchical multiple regression supplemented by a qualitative content analysis of the open-ended feedback.</p><p><strong>Results: </strong>After controlling for demographic variables, the regression results indicated three dimensions, including \"housing environment\" (β = 0.46), \"care services\" (β = 0.38), and \"postpartum meal provision\" (β = 0.34), collectively explained 98% of the variance in overall satisfaction. The qualitative analysis revealed that, despite high overall satisfaction, potential issues existed regarding facility convenience and provider-patient communication. \"Postpartum meal provision\" was identified as the dimension with the lowest satisfaction and greatest divergence, attributable to insufficient meal diversity and discrepancies in health education content.</p><p><strong>Conclusions / implications for practice: </strong>Service experience is the primary driver of satisfaction in postpartum women staying at postpartum care centers. Based on the findings, institutions should: (1) strengthen inter-departmental integration to minimize service-expectation gaps; (2) optimize the convenience of the housing environment and introduce value-added courses; and (3) leverage the role of nursing staff as bridges between cultural and scientific care. These measures may be expected to enhance client satisfaction and market competitiveness.</p>","PeriodicalId":35672,"journal":{"name":"Journal of Nursing","volume":"73 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A Quality Improvement Project to Enhance Sleep Quality Among Nursing Home Residents].","authors":"Yu-Jyun Gao, Ya-Hui Chou, Yu-Chen Cheng, Mei-Chu Tsai","doi":"10.6224/JN.26310","DOIUrl":"10.6224/JN.26310","url":null,"abstract":"<p><strong>Background & problems: </strong>Poor sleep quality, highly prevalent among nursing home residents, is associated with accelerated functional decline, increased risk of falls, and compromised safety and quality of life. A baseline audit at our facility revealed that 77.5% of the residents experienced sleep disturbances, with a mean overall sleep satisfaction score of 3.8 (out of 5). Factors found to influence sleep disturbance among the residents included the absence of a standardized sleep-assessment protocol, interruptions in nighttime care routines, and environmental conditions such as noise and inappropriate lighting.</p><p><strong>Purpose: </strong>A project was developed and implemented to reduce the prevalence of sleep disturbance among the residents and improve their nighttime sleep satisfaction.</p><p><strong>Resolutions: </strong>A standardized sleep-quality assessment pathway was developed and a multicomponent Good-Sleep Care Bundle was implemented targeting care routines, noise control, and lighting optimization. We concurrently launched a Daylight & Light-Activity program that combined scheduled bright-light therapy with low-intensity daytime activity, lighting fixture repositioning, and the mandating of nighttime illumination thresholds.</p><p><strong>Results: </strong>After implementation, the proportion of residents with poor sleep decreased from 77.5% to 52.5%, and the average nighttime sleep-satisfaction score improved from 3.8 to 4.5, meeting the predefined targets of this project.</p><p><strong>Conclusions: </strong>The developed program, a standardized assessment pathway coupled with a multicomponent, non-pharmacological care bundle, effectively improved sleep quality and nighttime satisfaction in the residents, enhancing their care experience and quality of life. The program is feasible, low risk, and scalable for routine implementation in nursing homes.</p>","PeriodicalId":35672,"journal":{"name":"Journal of Nursing","volume":"73 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Practicing Cultural Safety: Providing Nursing Care to Taiwan's Increasingly Diverse Population].","authors":"Shiu-Yun Fu","doi":"10.6224/JN.26303","DOIUrl":"10.6224/JN.26303","url":null,"abstract":"<p><p>With the increasing pace of globalization and transnational migration, healthcare systems are becoming more culturally diverse. In Taiwan, demographic changes have introduced increasing numbers of patients from diverse cultural backgrounds into clinical care environments, presenting new challenges for nursing practice. Cultural safety has emerged as an important framework for promoting equitable healthcare and improving the quality of patient care. Under this concept, patients' lived experiences and perceptions of care are used as central indicators of healthcare quality, and healthcare professionals are encouraged to reflect critically on the power dynamics and institutional biases within their healthcare interactions. In this article, the practical implications of cultural safety in nursing practice are discussed in the context of four culturally diverse populations in Taiwan: indigenous residents, migrant workers and other expatriates, sexual and gender minorities, and non-Taiwanese spouses and new immigrants. Language barriers, varied levels of health literacy, culturally shaped health beliefs, and limited social support are all factors that may influence patient trust, engagement in care, and adherence to treatment. When healthcare providers lack cultural sensitivity and reflective awareness, communication gaps and subtle forms of exclusion may occur in clinical encounters. Strengthening cross-cultural communication, encouraging patient participation in decision-making, fostering professional self-reflection, and creating institutional environments that support culturally safe practice are essential strategies to improving care. Therefore, cultural safety offers an important framework for developing strategies to enhance patient trust, improve care experiences, and advance health equity in multicultural healthcare settings.</p>","PeriodicalId":35672,"journal":{"name":"Journal of Nursing","volume":"73 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Establishing a Culturally Safe Care Environment: Organizational Culture and Policy Support].","authors":"Yi-Maun Subeq, Hsiao-Ching Huang","doi":"10.6224/JN.26305","DOIUrl":"10.6224/JN.26305","url":null,"abstract":"<p><p>In addition to biomedical factors and individual health behaviors, historical trauma, colonial experiences, and social marginalization are all critical factors that shape profoundly the health inequities experienced by indigenous peoples. Therefore, it is critical that cultural contexts and indigenous perspectives be incorporated into both health policy formulation and healthcare provision processes, with \"cultural safety\" serving as a central guiding principle to ensure healthcare systems earn the trust and serve the needs of indigenous clients. Cultural safety emphasizes cultural awareness, sensitivity, and competence as well as the critical reflection upon and transformation of traditional power relations to promote a truly patient-centered model of care. In this paper, the practical challenges faced by healthcare and long-term care systems, including tensions between standardized procedures and cultural differences, are examined, and institutionalized strategies are proposed to enhance quality of care and reduce structural inequalities. Moreover, the pivotal roles of policy and legislation in advancing cultural safety are highlighted using Taiwan's Indigenous Peoples Health Act as an example. Establishing culturally safe care environments requires a comprehensive effort spanning policy, organizational structures, and education. Leveraging cultural respect and institutional support, this effort holds the potential to facilitate the transformation of healthcare systems and ultimately achieve the goals of diversity, inclusion, and health equity.</p>","PeriodicalId":35672,"journal":{"name":"Journal of Nursing","volume":"73 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Application of Trauma-Informed Care in a Patient With Schizophrenia and Childhood Trauma].","authors":"Yen-Hui Chiang, Yun-Hsuan Lin","doi":"10.6224/JN.26313","DOIUrl":"10.6224/JN.26313","url":null,"abstract":"<p><p>This article presents a case study on the application of trauma-informed care on a male patient with schizophrenia and a history of childhood trauma. The nursing process was designed using the Substance Abuse and Mental Health Services Administration framework. For this case study, the \"4R\" core assumptions were transposed into five actionable principles (safety, trustworthiness, collaboration, empowerment, and choice), which guided all of the provided interventions. From July 14 to August 7, 2025, the nursing care focused on promoting psychological and emotional safety, facilitating the co-regulation of trauma responses, and fostering the development of personalized emotional coping strategies. All of the key outcome measures demonstrated significant improvement, with the patient showing a marked decrease in aggressive behaviors, the development of the ability to identify and articulate trauma triggers, and the ability to successfully use at least three distinct grounding techniques for emotional stabilization. This case confirms that applying trauma-informed care theory in a structured manner can effectively improve patient self-efficacy and strengthen the nurse-patient collaborative relationship. The findings provide a valuable, evidence-informed care model for managing the complexities of co-occurring psychiatric symptoms and trauma.</p>","PeriodicalId":35672,"journal":{"name":"Journal of Nursing","volume":"73 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}