BACKGROUND:Population aging and increasing disease complexity have increased the demand for specialized care provided by clinical nurse specialists (CNSs). However, Taiwan still lacks a comprehensive institutional framework, highlighting an urgent need to establish a structured CNS system to enhance the quality of care. PURPOSE:This study was designed to develop a CNS system to strengthen the nursing profession and improve the overall quality of healthcare delivery. METHODS:A mixed-methods approach combining a literature review, the modified Delphi technique, focus group interviews, and expert consensus forums was used to develop a locally adapted CNS framework for Taiwan. RESULTS:The CNS framework was developed through a rigorous and systematic process. Initially, three rounds of expert focus group discussions were conducted to identify core components and inform the development of a structured questionnaire. Subsequently, 30 expert panelists participated in two rounds of Delphi surveys to evaluate and refine the proposed framework. The finalized framework comprised 19 articles organized into six chapters and demonstrated a high level of consensus, with convergence rates of 94.0%-94.3% for feasibility and 93.6%-95.8% for appropriateness. The resulting CNS system structure consists of: general principles (3 articles), appointment (6 articles), core competencies and responsibilities (4 articles), selection (2 articles), continuing education (2 articles), and performance evaluation (2 articles). CONCLUSIONS / IMPLICATIONS FOR PRACTICE:The CNS system developed in this study contributes substantively to expanding nursing roles and enhancing care quality in Taiwan. Future implementation should focus on strengthening interprofessional support to improve system feasibility in practice. Also, an appropriately funded and supported CNS certification system should be established. Finally, CNS contents must be incorporated into graduate-level nursing education to ensure the quality of CNS practice.
Under the framework of evidence-based practice (EBP), evidence-based knowledge is integrated systematically into clinical care and continuously updated to enhance decision-making, ensure patient safety, and showcase nursing excellence. The rapid evolution and popularization of artificial intelligence (AI) has encouraged its incorporation into EBP, including as a tool for clinical nurses to further increase efficiencies in care provision and decision-making. However, AI integration poses challenges in terms of both care practices and ethics. This article was designed to explore the various applications of AI in EBP, emphasizing sustainability alongside ethical, institutional, and technological issues. While AI can improve care efficiency and quality, it also introduces risks such as data errors, algorithmic bias, privacy concerns, intellectual property issues, access inequities, and ethical accountability concerns. Without transparency and oversight, large language models have the potential to exacerbate health disparities and resource gaps. To achieve the core values of improving care quality and patient safety through technology, integrating AI into EBP requires the building of a robust framework that is clinically practical, regularly updated with new algorithms, and includes monitoring systems and ethical governance. Ultimately, the harmonization of AI capabilities and care principles may be expected to achieve healthcare that is more resilient, value-driven, high-quality, and sustainable.
This article was written to describe the authors' interprofessional collaboration experience with regard to the clinical translation of evidence-based healthcare. Building upon the spirit of evidence-based medicine invoked at the founding of the Cochrane Centre at Oxford University under the United Kingdom's National Health Service in 1992, our institution recognizes nursing as the core driving force supporting the translation of evidence-based healthcare in clinical settings. Using interdisciplinary collaboration mechanisms, systematic education and training, and knowledge translation strategies, the best research evidence is integrated into clinical decision-making and improving care quality, thus deepening the application of evidence-based clinical healthcare. In clinical care, nursing teams have led multiple evidence-based initiatives targeting patient safety and care quality improvement. Issues addressed have included fall prevention, infection control, nasogastric tube dislodgement prevention, hypothermia interventions to improve neurological outcomes in patients with traumatic brain injury, post-operative positioning adjustments, acute-phase COVID-19 pulmonary rehabilitation, and family-centered interventions in intensive care units to reduce the incidence of delirium. These initiatives have been significantly grounded in the findings of systematic literature reviews and outcome evaluations, with results demonstrating a notable reduction in adverse event rates and significant improvements in functional recovery and quality of life in patients. Nursing personnel play an integrative and leading role in assessment-tool development, care process design, outcome monitoring, and the continuous provision of quality feedback, reflecting their professional autonomy in the clinical application of evidence-based practice. In terms of guideline development, the nursing department has taken the lead in constructing guidelines for cancer symptom management and post-curative follow-up care for patients with liver cancer, advocating for an integrated model centered on holistic care, and collaborating with physicians, pharmacists, and dietitians to jointly establish interdisciplinary care standards. Also, the department has actively mentored advanced practice nurses in writing evidence-based clinical care guidelines at an advanced level, strengthening advanced nursing practice competencies and academic output. With regard to shared decision-making and Choosing Wisely initiatives, nursing staff participate in the development of decision support tools and the application of structured communication models to facilitate patient value clarification and engagement in decision-making, while concurrently enhancing healthcare resource-utilization appropriateness and safety. Overall, within the evidence-based clinical system, the nursing profession fulfills multiple functions in the realms of care practice, research participation, education promotion, and knowledge translation, laying a strong foundation for the sustainable development of evidence-based clinical care.
"Quiet quitting" has become an important work culture issue since the global outbreak of COVID-19, with the pandemic helping heighten awareness of the importance of physical, psychological, and emotional well-being. A growing number of employees have adopted "quiet quitting" to rebalance work and life priorities, operating as a social strategy reflecting their personal commitment to reducing the centrality of work in their overall life. Currently, a clear definition and systematic conceptual analysis of quiet quitting are not provided in the domestic (Taiwan) literature. Following the steps of Walker and Avant's concept analysis, the concept of quiet quitting is analyzed by verifying dictionary and literature definitions; identifying defining attributes; providing model, borderline, contrary, and related case illustrations; establishing antecedents and consequences; and defining empirical references. Quiet quitting may be seen as a precursor of employee turnover and a predictor of resignation behavior. The objective of this conceptual analysis is to clarify the scholarly understanding of quiet quitting to help guide future nursing practices and related research on the current state of quiet quitting among nursing staff and, ultimately, enable organizations and managers to deploy effective management and improve workplace culture.
This case was a 28-year-old male patient newly diagnosed with metastatic urachal carcinoma who presented with abdominal distension. Metastatic urachal carcinoma is rare and highly aggressive and associated with poor prognosis. The care period was from November 7, 2022 to May 16, 2023. On hospital day four, the patient developed acute respiratory distress, which required endotracheal intubation and transfer to the intensive care unit. The nursing practitioner facilitated cross-coordination between oncology and critical care teams. The "Patient-Centered Care" concept and "Four Quadrants" ethical framework were applied to address dilemmas in medical decision-making. Clinical information was primarily obtained from the patient's mother. This case highlights the challenges involved in respecting patient autonomy regarding chemotherapy, managing severe tumor lysis syndrome with acute kidney injury complications, and dealing with family conflicts regarding medical decision-making in end-of-life care. By coordinating across the healthcare team, we effectively managed a complicated and evolving clinical course. This case report was prepared to share our experience as a reference for clinical nursing practice.
Only when scientific evidence moves beyond research conclusions and is translated into clinical decision-making, organizational systems, and standard patient care can the true value of evidence-based practice be fully realized. Current scholarship suggests that, in addition to high-quality research, leadership capacity, appropriate implementation strategies, and the effective integration and governance of technology-enabled systems within clinical contexts are all critical to ensuring the adoption, practice, and impact of evidence-based healthcare strategies (Fontaine et al., 2024). Reflecting this broader development trajectory, the articles in this issue tackle evidence-based implementation strategies, nursing workforce considerations, systems thinking, and the evolving role of artificial intelligence (AI) in clinical care. At the nursing leadership and organizational governance level, the findings of a recent systematic review indicate nurse leaders with strong evidence-based competencies are well positioned to facilitate changes in clinical practice, strengthen interprofessional collaboration, and enhance both quality of care and organizational performance (V̈lim̈ki et al., 2024). The studies in this review reinforce the view that evidence-based practice, rather than being a responsibility shouldered by frontline nurses alone, must be a shared institutional capacity embedded within leadership and organizational structures. Implementation strategies are central to effectively translating evidence into practice. The findings of a systematic review and meta-analysis by Fontaine et al. (2024) demonstrate multifaceted and integrated approaches such as education and training, clinical reminders, leadership engagement, and structured feedback mechanisms help promote sustained improvements in nursing practice and, in turn, positively influence patient outcomes. As digital health technologies continue to advance, the role of AI in supporting clinical decision-making has become an increasingly prominent focus of evidence-based care discussions. While AI technologies hold considerable promise in supporting nurse clinical decision-making, enhancing efficiency, and reducing workload, their effectiveness in real-world clinical settings remains highly contingent upon user trust, system transparency, and organizational support (Mikkonen et al., 2026; Ouanes & Farhah, 2024). In high-intensity clinical environments, appropriately designed and well-governed AI systems may enable nurses to direct more time and professional judgment toward making complex, person-centered care decisions. Concurrently, emerging evidence cautions that, more than a technical endeavor, the implementation of AI has significant implications in the realms of workflow design, professional autonomy, and ethical responsibility. Almagharbeh (2025) emphasizes that, in the absence of clear role delineation and meaningful clinical engagement, AI-based decision support systems may inadvertently increase workloads and erode trust among healthcare professionals. This perspective aligns closely with the foundational principles of evidence-based care, under which technology is expected to support, not supplant, professional judgment and human-centered practice. In summary, the articles in this issue all support that the future of evidence-based care lies at the intersection of research evidence, organizational design, leadership, and technology governance. Only through the concurrent consideration and integration of high-quality evidence, local clinical contexts, innovative technologies, and ethical accountability can evidence-based care be sustained as a meaningful driver of patient well-being, professional development, and system-level resilience.
BACKGROUND:Given the importance of evidence-based health care (EBHC), some hospitals in Taiwan have incorporated this competency into their clinical ladder systems. However, the details regarding how hospitals implement and integrate EBHC across different ladder levels remain insufficiently understood. Inconsistencies between hospitals may affect clinical practice, staff promotion fairness, and the overall effectiveness of EBHC competency development. PURPOSE:This study was designed to explore the current status of the promotion of EBHC in hospitals, how EBHC is being integrated into nursing clinical ladder systems, and the key facilitators and barriers to implementation. METHODS:A cross-sectional survey was conducted between January and March 2024. Representatives from 240 member hospitals of the Taiwan Nurses Association completed a self-developed questionnaire. Questions on the survey examined how the targeted hospitals promoted EBHC, how EBHC was being incorporated into the clinical ladder system, related implementation methods, required educational hours, and perceived facilitators and barriers. Data were analyzed using descriptive statistics. RESULTS:Of the 215 hospitals that responded (response rate = 89.6%), 66.5% reported having promoted EBHC. Of the 183 hospitals that had implemented a clinical ladder system, 68.9% (n = 126) reported incorporating EBHC competencies by requiring evidence-based reports; however, only 24.6% (n = 31) of these applied this requirement at all ladder levels. In addition, only 53.2% of these 183 hospitals required that nurses complete a specific number of EBHC training hours, with these hours varying substantially across institutions. Moreover, EBHC competency requirements and reporting standards were inconsistent between ladder levels. The key facilitators identified included managerial support for EBHC (73.5%), organizational support (69.2%), and regular training (68.4%). The major barriers identified included limited English proficiency among nurses (70.2%) and a lack of qualified mentors (63.7%). CONCLUSIONS / IMPLICATIONS FOR PRACTICE:To better integrate EBHC into clinical ladder systems, nursing professional associations should convene expert consensus meetings to define EBHC competencies, develop tiered training standards, and set the assessment methods to be used at each ladder level. Nursing schools should incorporate standardized EBHC core curricula into their programs. In addition, collaboration among professional organizations may facilitate the development of systematic, digital continuing education modules to improve accessibility and support the clinical application of EBHC.
BACKGROUND:With the growing emphasis on neonatal developmental care, nurses are being encouraged to provide responsive feeding based on preterm infant behavioral cues. The responsive feeding approach has been shown to reduce stress stimuli, stabilize physiological maturity, and optimize neurodevelopment, making it an important model of care for preterm infants. Consequently, nurses who are proficient in recognizing the behavioral signals of oral feeding readiness in preterm infants are better able to facilitate the safe transition to oral feeding, thereby supporting infant growth and development. PURPOSE:This study was designed to examine the associated factors of nurses in assessment of oral feeding in preterm infants. METHODS:In this cross-sectional correlational study, neonatal nursing staff were recruited using convenience sampling. Data were collected using a demographic questionnaire, the Developmental Care Knowledge and Support Ability Scale, and the Recognition of Preterm Oral Feeding Readiness Scale. Independent t-tests, one-way analysis of variance, and Pearson's product-moment correlation were used in correlation analyses. Stepwise multiple regression was employed for the inferential statistics. RESULTS:Recognition of oral feeding readiness differed significantly by work unit. Specifically, nurses in the sick baby room recognized cues indicating oral feeding readiness more accurately than those in the NICU (t = -3.95, p < .01), while those with prior oral feeding training scored higher than those without (t = 2.03, p < .05). In addition, a positive correlation was found between recognition of oral feeding readiness and developmental care knowledge (r = .28, p < .05). The results of the stepwise regression identified three significant predictors of recognition of oral feeding readiness, which collectively explained 13.8% of the variance. These were: developmental care knowledge (β = 0.28, p < .01), work unit (β = 0.22, p < .001), and oral feeding training (β = 0.17, p < .001). CONCLUSIONS / IMPLICATIONS FOR PRACTICE:In-service education on preterm oral feeding should be incorporated into the training provided to all nurses working with preterm infants to enhance their developmental care knowledge and improve their ability to recognize the signals of oral feeding readiness. Such targeted training may be expected to facilitate the successful implementation of developmental care practices and promote the safe transition to oral feeding in preterm infants.
BACKGROUND:The role of artificial intelligence (AI) in medical care has become increasingly prominent. There is an urgent need to integrate the cross-disciplinary thinking of science, technology, engineering, arts, and mathematics (STEAM) into nursing education to strengthen cross-disciplinary competencies and AI literacy in students. PURPOSE:This study was developed to explore the current status of STEAM literacy, learning interest, and career interest among nursing students. Based on the findings, a targeted, innovative nursing teaching model that integrates AI was developed to improve the cross-disciplinary competencies and workplace competitiveness of these students. METHODS:A self-developed questionnaire on STEAM literacy, learning interest, and career interest was used to collect study data. All 270 first-year nursing students from a junior college in southern Taiwan were invited to participate on a voluntary basis, with 259 valid questionnaires collected. Descriptive statistics, t-tests, correlation analysis, and regression analysis were conducted to examine the predictive power of STEAM literacy and learning interest on career interest. A standardized Z-score matrix was adopted to present the distribution of STEAM learning and career interests visually, establishing an innovative teaching model that helps integrate AI into nursing education. RESULTS:The participants performed well in STEAM literacy, particularly in terms of ethics and social responsibility, collaboration and communication, and problem solving competencies. The survey on STEAM learning interest and STEAM career interest revealed most of the participants exhibited significantly positive affirmation of the science and art fields. STEAM literacy, learning interest, and career interest were found to be significantly positively correlated, with STEAM literacy and STEAM learning interest identified as significant predictors of STEAM career interest. Finally, the results of the Z-score matrix analysis indicate engineering and mathematics fields are associated with the low learning-interest / career-interest quadrant, while the science and technology field is associated with the low learning-interest / high career-interest quadrant. CONCLUSIONS / IMPLICATIONS FOR PRACTICE:The innovative student-centered AI-NURSE (artificial intelligence-navigate, utilize, reflect, solve, execute) teaching model proposed in this study provides specific evaluation criteria as a practical reference for integrating AI into nursing education. The findings may be used to promote the cultivation of nursing professionals, laying the foundation for the future development of smart medical technology.
Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique, has emerged as a promising intervention in post-stroke rehabilitation. With approximately 12 million new stroke cases annually, stroke remains the second leading cause of death and the third leading cause of disability worldwide, with this condition particularly prevalent in individuals over 60 years of age. Strokes are primarily classified as ischemic (85%) or hemorrhagic (10%-15%), with acute-phase treatments involving thrombolytics or surgery, and chronic-phase management integrating rehabilitation and techniques such as rTMS. The current evidence suggests that 85% of patients affected by stroke show functional improvement within 3-6 months of rehabilitation. rTMS modulates cortical excitability and neuroplasticity by inducing electric currents in the magnetic fields across the skull. High-frequency rTMS ( > 1 Hz) enhances excitability in lesioned regions, while low-frequency rTMS ( ≤ 1 Hz) inhibits hyperactivity in non-lesioned areas, thereby rebalancing interhemispheric activity and regulating neurotransmitters such as γ-aminobutyric acid and glutamate. Clinical studies have demonstrated rTMS to significantly enhance the recovery of motor skills, including increased upper limb Fugl-Meyer scores (p = .037) and standardized mean differences in Barthel Index (SMD = 0.580, p < .05), with effects lasting up to one year. In cases with aphasia, 20 sessions of low- or dual-frequency rTMS have been shown to improve fluency and naming ability as well as swallowing function. Cognitively, rTMS has been shown to enhance Montreal Cognitive Assessment scores (p < .001) and reduce task completion time on executive function tests. Psychologically, stimulation of the dorsolateral prefrontal cortex has been shown to reduce Hamilton Depression Rating Scale scores in post-stroke depression patients by 25%-30% (p < .01). Nurses play a pivotal role in rTMS treatments, including pre-treatment screening for contraindications (e.g., pacemakers, metal implants), providing patient education to alleviate anxiety, ensuring an interference-free environment, monitoring vital signs and adverse effects (e.g., headache, seizures), and conducting post-treatment follow-ups. In conclusion, future research should be conducted to explore optimal stimulation parameters and long-term efficacy to further advance clinical applications and enhance quality of care.
"Death literacy" refers to the acquisition, understanding, and application of knowledge related to death and end-of-life care during the final stages of life. Although there is extensive research on health literacy, studies on death literacy remain relatively scarce. In this article, the conceptual analysis approach described by Walker and Avant is applied to define the characteristics of death literacy, which include: (1) the ability to possess and comprehend fundamental knowledge related to death and end-of-life care; (2) communication skills to discuss end-of-life care options with family members and others; (3) the accumulation of wisdom regarding life and death through hands-on experience in end-of-life care and experiential learning in life education; and (4) the dissemination of wisdom on life and death through sharing personal experiences with others. Using typical, borderline, contrary, and related cases, this analysis clarifies the concept, identifies the antecedents and consequences of death literacy, lists current empirical measurement tools, and explores applications in nursing practice, research, and theory. The overall goal of this article is to enhance the understanding of nursing personnel regarding this concept, provide a clinical reference for caregivers, increase public awareness of life and death issues, and, ultimately, ensure and improve the quality of end-of-life care provided to patients.
In recent years, evidence implementation has become an important strategy in improving healthcare quality and patient safety. In this article, the vision, mission, strategies, key priorities, and action plans of the JBI Taiwan Center for Holistic Care and Evidence Implementation are introduced, and the anticipated opportunities and challenges going forward are described. By aligning with global evidence resources in responding to local healthcare needs, the Center promotes cross-national collaboration and knowledge co-creation through Local Solution Rooms, which are responsible to translate global best evidence into practical and locally applicable solutions. Through talent cultivation and knowledge translation, the Center continues to strengthen evidence implementation in aging and community care, solidify Taiwan's position as a knowledge translation hub, deepen institutional collaborations, and expand related international partnerships. The goal of the Center is to advance scalable and sustainable evidence implementation models and, leveraging collective wisdom and cross-sector collaboration, the Center is committed to driving the further development of person-centered, evidence-based healthcare.
BACKGROUND:Stroke is a leading cause of disability and death. Taiwan has implemented a post-acute care (PAC) program for stroke since 2014. However, the impact of this program on primary caregiver burden remains inadequately investigated. PURPOSE:This study was conducted to compare the trajectories of family functioning and caregiver burden over the follow-up period between primary caregivers of patients with acute stroke in PAC and non-PAC groups (as tested using group × time interaction). The caregiver characteristics that may warrant clinical prioritization were also explored as potential hypothesis-generating signals for future research. METHODS:A quasi-experimental design was adopted. One hundred primary caregivers from a medical center in northern Taiwan were enrolled and allocated to either the PAC or non-PAC group (n = 50 each) based on whether the patient had received PAC. Two instruments, including the Family APGAR and Caregiver Burden Inventory, were administered once on hospital days 10-14, and at 1 and 3 months after discharge. Chi-square tests, t tests, and two-way repeated-measures ANOVA were used for analysis. RESULTS:Baseline sociodemographic characteristics did not differ significantly between the PAC and non-PAC groups. Two-way repeated-measures ANOVA showed significant time effects, with caregiver physical, time, and developmental burdens decreasing over time (time main effect, p < .01). The Group × Time interaction was not significant. No significant between-group differences in trajectories were observed under the current design and data conditions. In the exploratory analysis of the overall sample, family function at 3 months post-discharge differed by age and educational level, and female participants reported higher emotional and developmental burden than their male counterparts. Interpretation of the intervention effect should consider the potential for unmeasured confounding variables. CONCLUSIONS:Although caregiver burden declined over time, under the defined study design and data conditions, no significant difference in the trajectories of caregiver burden between the PAC and non-PAC groups was observed. The analytic focus in this study was on between-group differences in longitudinal change (trajectories) rather than cross-sectional differences at each time point. The findings of the exploratory analysis suggest associations between older age, lower educational attainment, and being female with less-favorable profiles on selected measures, warranting clinical prioritization as well as further validation in future studies to inform the development of more effective family-centered PAC support strategies.
BACKGROUND & PROBLEMS: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. PURPOSE:A project was developed and implemented to reduce the prevalence of sleep disturbance among the residents and improve their nighttime sleep satisfaction. RESOLUTIONS: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. RESULTS: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. CONCLUSIONS: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.
With the acceleration of both globalization and population mobility, healthcare settings have become increasingly culturally diverse, presenting nurses with more complex cross-cultural challenges. Although cultural sensitivity promotes understanding and respect for cultural differences, its emphasis on knowledge accumulation limits its effectiveness in addressing the power imbalances and structural inequalities embedded in healthcare interactions. In contrast, cultural safety underscores that quality of care should be defined by patients' subjective experiences and highlights the important influence of power relations, critical self-reflection, patient autonomy, and structural contexts on care quality. In this article, the author examines the theoretical transition from cultural sensitivity to cultural safety in the nursing profession and analyzes the implementation of cultural safety in clinical practice, nursing education, and healthcare systems and its related challenges. The results of literature synthesis and analysis show that cultural safety facilitates the reconstruction of nurse-patient relationships, strengthens patient participation and trust, and provides a vital approach to addressing health inequities in multicultural societies. In the Taiwanese context, the health concerns of diverse populations, which include new immigrants, migrant workers, and transgender individuals, underscore the practical and policy implications of cultural safety. Future efforts should continue to integrate cultural safety into nursing education, clinical practice, and institutional design to develop culturally appropriate care models grounded in local contexts to further enhance care quality and promote health equity.
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.
BACKGROUND & PROBLEMS:Surgical safety is a core patient-safety goal. In our hospital, the rate of accuracy among operating room nurses in preparing for fat grafting surgeries was only 55.4%. The main factors found to influence this issue were: reliance on verbal, experience-based teaching; unfamiliarity with processes and complex instruments; lack of operating manuals and checklists; inadequate in-service education; and lack of standardized operating protocols. PURPOSE:This project was developed to establish a systematic education and training program and standardized workflow to improve the accuracy of operating room nurses in preparing for fat grafting surgeries. RESOLUTION:Following the ADDIE (analysis, design, development, implementation, and evaluation) instructional model, the interventions implemented in this project included: compiling a preparation manual and mind map, planning structured in-service education, producing an interactive e-book, and holding simulation workshops. Also, a preparation-accuracy checklist and knowledge test were used to track outcomes in 20 nurses. In addition, the Objective Structured Assessment of Technical Skill instrument was used to provide real-time feedback during the simulation courses, and maintenance follow-up was conducted from April through May 2025. RESULTS:After the intervention, the preparation accuracy rate increased from 55.4% to 96.5% and the knowledge accuracy rate increased from 45.0% to 94.5%. Notably, the preparation accuracy rate was 100% during the maintenance follow-up period. CONCLUSIONS:Conclusions: Combining the ADDIE instructional model with multiple strategies may be an effective strategy for improving preoperative preparation accuracy and professional competence in nurses. Regular interprofessional consensus meetings should be held to allow rolling revisions to be made to the workflow and, accordingly, develop surgical care guidelines as references for clinical practice to further strengthen nursing quality and patient safety.
BACKGROUND: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. PURPOSE: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. METHODS: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. RESULTS: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. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: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.
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.
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.
