BACKGROUND:During the COVID-19 pandemic, residents of Taiwanese nursing homes, many of whom suffered from chronic illnesses and lived in relatively enclosed environments, were particularly vulnerable to infection. The absence of clear and effective pandemic prevention strategies hindered the development of related risk-reduction policies and planning within these institutions. PURPOSE:The aim of this study was to: (1) explore the challenges and prospects related to COVID-19 pandemic prevention in nursing homes in Taiwan and offer recommendations for the future, (2) evaluate the effectiveness of the prevention strategies implemented across nursing homes of various types and scales, and (3) assess the need for pandemic-related institutional training. METHODS:In this exploratory sequential mixed-methods study, a focus group discussion was first conducted to identify key challenges and recommendations, which were then used to inform the development of a quantitative survey. The survey was administered using stratified random sampling based on institution type and scale. Thematic analysis was used for qualitative data, and descriptive statistics, t-tests, analysis of variance, and multiple linear regression were applied to analyze the quantitative findings. RESULTS:Ten pandemic-prevention leaders participated in the focus group discussion, which revealed the four key themes of "Adapting to evolving and unfamiliar roles," "Being overwhelmed by exhaustion during the sudden pandemic," "Lack of competence in nonroutine care," and "Comprehensive and systematic approach at all levels." The quantitative survey yielded 253 valid responses. The average score for Strategies for Prevention Effectiveness was 28.1 (scale range=9-36), indicating a generally positive self-assessment. However, 6.8% of pandemic prevention supervisors (17 of the 253 participants) had not received COVID-19-related training. The analysis highlighted the importance of incorporating successful prevention experiences from other institutions and providing frontline health care workers with education on pandemic-related regulations. The average score for Educational Training was 16.2 (scale range=5-20), reflecting strong agreement with the listed training items. No significant differences were found in pandemic strategy effectiveness by either institution type (t=1.664, p=.097) or scale (F=0.571, p=.566). CONCLUSIONS/IMPLICATIONS FOR PRACTICE:The results show generally positive self-assessments of prevention strategies but revealed key challenges, including role confusion, frontline exhaustion, and training gaps. Although the World Health Organization has declared COVID-19 to no longer be a public health emergency of international concern, these issues remain critical to institutional preparedness. The findings offer transferable insights that may inform future pandemic response planning in long-term care settings, regardless of the nature of the infectious threat.

Background: Nursing remains one of the most gender-segregated professions worldwide, with men historically underrepresented. Workforce initiatives increasingly aim to diversify the profession by promoting male participation, yet its implications for workforce sustainability, patient outcomes, and sociocultural change remain unclear.Objective: To systematically synthesize evidence on the association between male participation in nursing on 3 types of outcomes: workforce, patient, and sociocultural domains.Methods: Systematic review reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Findings: Fourteen studies from 11 countries were included. Male nurses were more likely to work full-time in inpatient and acute-care settings and were overrepresented in supervisory or higher-paying roles in several contexts. Evidence on retention-relevant indicators, including job satisfaction, wellbeing, social support, and professional development, was mixed. Patient-related studies generally reported positive experiences and high acceptability of care provided by male nurses, although discomfort with intimate care and gendered expectations persisted. Sociocultural findings suggested partial shifts in workplace climate and public perceptions, alongside persistent stereotyping and vertical stratification.Conclusions: Male participation in the clinical nursing workforce is associated with both opportunities and challenges. Professional gains from gender diversification are contingent on organizational structures, workplace interactions, and broader sociocultural norms; demographic change alone is unlikely to yield sustained improvements in retention, equity, or workforce stability.Registration: PROSPERO registration number: CRD420261309048, registered 15/02/2026.

BACKGROUND:Nursing remains one of the most gender-segregated professions worldwide, with men historically underrepresented. Workforce initiatives increasingly aim to diversify the profession by increasing the representation of men in nursing, yet the implications of greater male representation for workforce sustainability, patient outcomes, and sociocultural change remain unclear. PURPOSE:To systematically synthesize quantitative evidence concerning men in nursing across workforce, patient-related, and sociocultural domains. METHODS:A systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DISCUSSION:The findings suggest that greater representation of men in nursing does not necessarily translate into equitable workforce experiences or uniformly improved outcomes. Interpreted through Gendered Organizations Theory, the observed patterns may reflect the influence of organizational structures, workplace interactions, and sociocultural expectations on how men are positioned and supported within nursing. These findings highlight the need to consider representation together with equitable integration, retention, and patient experience. CONCLUSION:Evidence concerning men in nursing revealed varied workforce, patient-related, and sociocultural patterns across contexts. The findings suggest that numerical representation alone may be insufficient to address workforce inequities without attention to organizational structures, workplace interactions, and broader sociocultural norms. REGISTRATION:Retrospectively registered in PROSPERO (CRD420261309048) on 15 February 2026, after the database search was conducted on 30 June 2025.

BACKGROUND:Long-term care institutions are especially vulnerable in pandemics. Despite Taiwan's proximity to COVID-19's epicenter, the country demonstrated effective pandemic management. PURPOSE:This study assessed pandemic prevention competencies of Taiwan's long-term care workers, identifying key influencing factors. METHODS:A cross-sectional survey was conducted, with assessments on competencies via the Emerging Infectious Disease Prevention Competencies Scale. DISCUSSION:A total of 433 valid responses were obtained. Competencies were rated strong (mean 65.2/81), with predictors including sense of purpose, perceived supervisor support, alignment with institutional culture, job satisfaction, and regular pandemic prevention drills. Findings underscore the role of a supportive environment in fostering pandemic competencies and highlight the importance of strengthening problem-solving capacities to enhance preparedness. CONCLUSION:Investing in workforce preparedness, leadership engagement, and institutional culture-building is essential for strengthening long-term care resilience to future pandemics worldwide.

Background Mandatory vaccination policies have sparked global ethical debates, particularly in the context of COVID-19. Among healthcare workers, nurses—the largest segment of the frontline workforce—face distinct tensions between professional responsibilities and personal autonomy. Yet, the ethical challenges these policies pose from nurses' perspectives remain insufficiently examined. Aim This review examines the ethical challenges of mandatory vaccination from nurses' perspectives, informs ethical policymaking, and provides insights to navigate similar future scenarios. Design A mixed-methods systematic review guided by the Joanna Briggs Institute methodology. Data sources Final searches of five databases—Embase, MEDLINE, CINAHL, Web of Science, and Scopus—were conducted in September 2025. Additional records were identified through citation tracking and supplementary searches. Methods Empirical studies published from 2019 onward were screened for relevance and assessed for methodological quality using standardized critical appraisal tools. Studies were included if they examined nurses' experiences, attitudes, or ethical perspectives regarding mandatory vaccination. A narrative synthesis approach was applied to integrate qualitative, quantitative, and mixed-methods findings. Results Twenty-eight studies were included (19 quantitative, 5 qualitative, and 4 mixed methods). Four themes emerged: (1) Walking a Tightrope—Between Vaccine Safety and Effectiveness; (2) Silent Burden—Navigating Stigma in the Shadows; (3) Navigating the Fine Line—Balancing Rights and Public Health in Times of Crisis; and (4) Strengthening Leadership and Communication. Conclusions While mandatory vaccination policies may serve public health goals, they can also generate ethical distress, undermine trust, and increase stigmatization among nurses who remain unvaccinated. Future policies should move beyond enforcement toward fostering ethical alignment through education, open dialog, and respectful engagement. Registration PROSPERO registration number: CRD42024551112, registered 03/06/2024.

Introduction: Dietary adherence remains a critical challenge for individuals with diabetes mellitus (DM), especially within community settings where lifestyle factors strongly influence disease control. Health education plays an crucil role in enhancing self-management behaviors and improving glycemic outcomes. This study aimed to evaluate the effect of structured health education on dietary adherence among people with DM in the community. Methods: A quasi-experimental pre–post design was conducted among 120 participants with type 2 DM in a community health program. Participants received four weekly sessions of health education focusing on nutrition knowledge, meal planning, and behavioral motivation, delivered through interactive workshops and visual aids. Data were collected using the Diabetes Self-Management Questionnaire (DSMQ) and a 24-hour dietary recall, and analyzed using paired t-tests and multiple regression to assess changes in adherence and identify influencing factors. Results: Post-intervention findings showed a significant improvement in dietary adherence scores (p < 0.001) and a mean reduction in fasting blood glucose levels (p < 0.05). Education level, social support, and perceived self-efficacy were strong predictors of adherence improvement (R² = 0.48). Participants reported enhanced understanding of carbohydrate control and portion management. Conclusion: Community-based health education effectively improves dietary adherence and metabolic outcomes in people with DM. Integrating culturally relevant education and continuous community engagement is crucial to sustaining behavioral changes. This approach supports primary prevention efforts and strengthens community health systems in diabetes management

PURPOSE OF STUDY:This study explored the roles, training, and qualifications of case managers in level A of Taiwan's long-term care (LTC) system, established within the Ten-Year LTC Plan 2.0, to identify their challenges and provide recommendations for enhancing their performance. PRIMARY PRACTICE SETTING:This study focuses on community integrated service centers in Taiwan, which serve as key hubs for delivering LTC services to Taiwan's aging population. METHODOLOGY AND SAMPLE:A narrative review approach was implemented, with an extensive analysis of the literature in terms of the functions and training requirements of and the professional challenges faced by case managers in the LTC sector. This review included articles published between 2016 and 2024 in both English and Chinese. RESULTS:Case managers play a key role in linking LTC resources and coordinating care for older clients. However, they often face major challenges, including a high caseload, inadequate training opportunities, and a desire to quit, which adversely affect service quality and outcomes.

In response to the increasing emphasis on reflective practice in nursing education and the emerging potential of generative artificial intelligence (AI), this study investigates the application of ChatGPT as a tool to support reflective learning among nursing students in community health courses. Grounded in Self-Regulation and Goal Attainment Model, a structured AI-assisted reflective activity was designed to guide nursing students through six reflective stages: goal setting, planning, implementation, monitoring, evaluation, and adjustment. A total of 42 nursing students participated in the study and completed a modified version of the Self-Reflection and Insight Scale (SRIS) after the intervention. The questionnaire assessed three key dimensions: Self-Reflection and Learning, Feelings and Attitudes, and Action and Improvement. Results showed consistently high scores in all dimensions, suggesting positive perceptions of AI-assisted reflection, particularly in areas related to reflective thinking and proactive learning attitudes. The findings suggest that AI-supported reflective learning can effectively enhance nursing students’ self-awareness, reflective dispositions, and intention to apply insights into practice. This study offers empirical evidence for integrating large language model technology into reflective education in nursing, with implications for improving educational strategies, clinical decision-making, and the quality of patient care.

Background The global nursing shortage threatens health care systems. While many systematic reviews have examined factors influencing nurse turnover, the results have exhibited inconsistent findings. Purpose This umbrella review holistically synthesizes systematic reviews to identify factors impacting nurse retention and supporting evidence-based practices. Methods This umbrella review was conducted in accordance with Joanna Briggs Institute guidelines. Systematic reviews on factors influencing nurse retention were included, with no restrictions on language or publication year, and were retrieved from six databases up to May 2024. Discussion A total of six systematic reviews with 104 studies were analyzed. The major factors were organizational (58.9%), individual (33%), and cultural (7.8%). The most mentioned themes included personal factors, job characteristics, the significance of work, attitudes toward the organization, leadership, and teamwork. Conclusion The related factors of nurse turnover are complicated, with organizational elements being the primary contributors. Managers can identify these organizational factors while also considering individual-level influences.

Knee pain poses a substantial concern for older Muslim individuals during religious activities, such as performing salat. When assisting such patients with knee pain management, healthcare professionals may face ethical challenges. This paper explored ethical challenges encountered by older Indonesian Muslims experiencing knee pain, particularly, when considering total knee replacement surgery. The four-box method was used to analyze these challenges, and a "Healthcare providers' Shared Decision-Making Model for Muslim Older Adult Knee Pain Management in Indonesia" framework was established to address these challenges and guide professionals in collaborating with older Muslim adults for knee pain management.

AIM:To develop an instrument for assessing competence in emerging infectious disease prevention among health and care workers in long-term care institutions and evaluate its psychometric properties. DESIGN:A cross-sectional, descriptive design utilising both qualitative and quantitative methods was employed. METHODS:Based on scale development guidelines, the scale was developed in two phases, namely the scale development phase and scale testing phase, with the staff of long-term care institutions as the study population and their workplaces as the sampling unit. RESULTS:The scale comprises 27 items across three dimensions: 14 items pertaining to professional role performance, 7 items addressing workplace resources, and 6 items focusing on soft skills in communication and collaboration. Content analysis was conducted via a focus group discussion; content validity analysis was carried out via expert reviews; item analysis was performed via a pilot study; and construct validity and reliability were ensured via factor analysis and internal consistency testing, respectively. The total variance explained by the three factors of the 27-item scale was 64.8%, demonstrating acceptable validity and reliability with a Cronbach's α value of 0.97. CONCLUSION:This scale demonstrates excellent reliability and validity, making it suitable for clinical practice and research. In practice, this instrument could also assist managers in adjusting policies to adapt to dynamic situations and enhance the quality of care in long-term care institutions. Nonetheless, further research is warranted to refine the scale and enhance its generalisability. IMPACT:The scale is a psychometrically robust tool tailored for the evaluation of competence in emerging infectious disease prevention in long-term care institutions. It assesses the role performance, workplace resources, and soft skills of health and care workers in these institutions, which are crucial for guiding educational interventions and shaping policies to enhance disease prevention, ultimately improving care quality. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

The literature on nursing leadership tends to be mainly based on Western perspectives and models, which could be viewed as an imperialistic and colonialist aspect of nursing knowledge development. Furthermore, leadership competencies and skills could differ across countries due to variations in cultural backgrounds. The purpose of this discussion paper is to identify essential competencies of leaders from Asian nurse leaders’ perspectives and provide suggestions for future nursing leadership. Four themes related to the leadership competencies were identified: “harmony,” “visionary,” “political activism,” and “good character.”

Background:Emerging infectious diseases pose significant risks to vulnerable populations, particularly older adults with underlying health conditions living in long-term care institutions. Yet, while the experiences of healthcare workers in managing these crises are invaluable, there remains limited research on the specific challenges they faced. Aim:To explore the experiences of long-term care workers-including nurses, nursing assistants, and managers-in preventing emerging infectious diseases, the challenges they faced during the pandemic, and how they addressed them. Methods:Twelve participants from long-term care institutions in Taiwan (including assisted living facilities, residential care homes, and nursing homes) were recruited via purposive sampling. All participants worked in the sector during the COVID-19 pandemic, were actively involved in clinical care or institutional management, and were proficient in Mandarin. In-depth interviews were conducted face-to-face between July and August 2024, and data interpretation was guided by thematic analysis. Findings:Four themes emerged. Two themes depicting challenges illustrate challenges arising from inadequate preparation, including technical, cultural, and communication barriers, noncompliance among family members, resource shortages, and the physical and emotional strain endured by frontline workers balancing duty with feelings of guilt and anxiety. Two other themes representing the possibilities for strengthening long-term care highlight the importance of ongoing education, simulation-based training, and fostering participation, as well as the need for adaptive surveillance and tailored crisis response plans. Conclusion:Long-term care workers reported systemic vulnerabilities, including inadequate preparation, communication barriers, and emotional strain. They also emphasized the importance of inclusive training, simulation-based practice, and adaptive response strategies. Implications for Nursing Management:Long-term care institutions should strengthen preparedness by incorporating multilingual, simulation-based infection prevention training, developing family communication strategies that balance clear rationales with dialog, establishing routine surveillance with adaptive response plans, and ensuring psychosocial support for their workforce.

BACKGROUND:Cases of chronic disease and disability and the demand for long-term care have risen in step with the steady global increase in aging populations. Foot health is critical to quality of life and mobility in older adults, and proper foot care can reduce the risks of falls and disabilities while preventing foot-issue-related health deterioration. Thus, foot care has become an integral part of long-term care services in Taiwan. PURPOSE:The objective of this study was to explore the current status of older-adult foot care in Taiwan and factors influencing the competency of home care nurses in implementing this care. METHODS:This cross-sectional study targeted nurses working at nationally licensed home care institutions. The self-developed structured questionnaire used in this study covered five sections: demographics, foot care knowledge, attitudes, practices, and competencies. After testing for validity and reliability, 250 copies of the questionnaire were distributed, with 183 valid responses collected. Data were analyzed using SPSS 21.0 software. RESULTS:The average age of participants was 43.1 years. Regarding foot care, 51.4% of the participants had not attended any continuing education on foot care, while those who had reported an average training duration of 4.7 hours. Overall foot care competency scores were highest in the areas of professional ethics, collaboration, and quality management with evidence-based application. Positive correlations were observed between foot care attitudes, practical experience, and training hours. Stepwise regression analysis revealed attitudes, practices, and continuing education as the main predictors of foot care competency, with an explanatory power of 63%. CONCLUSIONS:Attitudes, practical experience, and continuing education are key factors influencing foot care competency in home care nurses. Nursing education curricula should incorporate foot care to systematically enhance student foot health assessment skills, care measures, and professional expertise. Moreover, ongoing in-service education and training should be promoted to strengthen the practical capabilities of home care nurses, addressing the growing demand for long-term care in aging societies.

The raison d’être of nursing is caring for human beings. Mainly due to its close link to the nursing discipline’s raison d’être, “caring,” translational science is recently getting more attention from nursing scientists across the globe. This paper is to discuss the current status of translational science in nursing across four countries (the USA, Taiwan, South Korea, and Japan). The data used in this discussion paper included: (a) written notes on issues related translational research/science in individual countries; (b) written memos on exemplars/cases from their own experiences; and (c) summaries of literature reviews. The data analysis was conducted using a simple content analysis. Four themes reflecting the current status of translational science across the countries were identified: (a) “contextualized in unique culture and history of nursing”; (b) “connecting basic science to clinical practice”; (c) “an extension of evidence-based practice”; and (d) “highly promoted, but still minimal translation of nursing knowledge.”

BACKGROUND:The development of nursing leaders is an important topic in changing healthcare environments. Successful nursing leadership is critical to the reconstruction, implementation, and evaluation of healthcare systems worldwide. However, the characteristics of successful nursing leadership remain unclear, especially in a global context. Furthermore, despite the growing importance of cultural intelligence, cross-cultural concepts of successful nursing leadership have been inadequately addressed in the literature. PURPOSE:This study was designed to identify the characteristics of successful leadership in nursing from the perspective of Asian leaders in four countries (United States, Taiwan, Korea, and Japan) and to make recommendations for successful leadership in nursing in the future. METHODS:A qualitative approach employing five strategies, including in-depth discussions through face-to-face and email discussions, an integrated literature review using multiple databases, responses to 10 topics related to nursing leadership, and written note summaries of the characteristics of successful leadership, was used in this study. A total of 10 nursing leaders from four countries were recruited as participants using snowball sampling. The collected qualitative data were analyzed using line-by-line coding and simple content analysis to extract the characteristics of successful leadership in nursing. RESULTS:The final sample included seven nursing leaders aged between 55 and 70 years. All of the participants were in nursing leadership positions at schools/colleges of nursing or professional organizations for at least two decades and had extensive leadership experience through their schools/colleges, professional organizations, and/or governments. Five key themes related to the characteristics of successful leadership were identified from the participants: (a) culturally and historically prescribed, (b) overcoming gendered experience, (c) equipped with good character, (d) guiding with a vision, and (e) with contextualized leadership. CONCLUSIONS/IMPLICATIONS FOR PRACTICE:Five characteristics of successful leadership were identified from the perspective of Asian nursing leaders. All of the participants recommended that successful nursing leadership be based on contextual leadership and that successful nursing leadership help meet rapidly changing needs, enable mutual trust, and actively commit and complete necessary risks. Moreover, future successful leadership should have a clear vision and strongly guide the implementation of changes as well as be equipped with cultural intelligence. Finally, successful nursing leadership should be based on ethical, trustable, and humane behaviors while promptly and adequately responding to the changing needs of their institutions/organizations. Cross-regional research on successful nursing leadership is essential to enrich the global evidence and knowledge on developing the next generation of nursing leaders.

With the global healthcare landscape evolving, precision medicine has become pivotal, leveraging individual health data to tailor patient care and optimize resource use. However, the scarcity of registered nurses and the resultant increased workload pose challenges, including the risk of incomplete patient care records due to reliance on manual documentation during clinical interviews. To mitigate these issues, this research employs the ChatGPT mobile application to facilitate recording and collecting voice data, utilizing voice-to-text and LLM technologies. By conducting a Unified Theory of Acceptance and Use of Technology questionnaire survey among 25 nurse-interns, the study assesses the acceptance and impact of such technological applications in nursing practices. This study explores the integration of Large Language Models (LLMs) and Artificial Intelligence (AI) in addressing nursing shortages and enhancing precision medicine, aiming to improve the organization of nursing interview data, and provide empirical evidence for the benefits of LLM technology in nursing interviews, thereby offering recommendations for nursing education, enhancing patient care, and supporting the broader adoption of precision medicine strategies.

BackgroundThe aging population in Taiwan has resulted in an increase in the dependent population and the care load on caregivers. Shared care is an interpersonal process in which support is “traded” to “handle” chronic illnesses by home-care patients and family caregivers. The scale of shared care has received little attention in the Taiwanese cultural context. Thus, this study examined the reliability and validity of the Taiwanese versions of Shared Care Instrument-Revised (SCI-R).MethodsThe content validity, construct validity, and discriminant validity were used to test the validity of the translated questionnaires. The Cronbach's α was used to examine reliability. A total of 500 older adults and their caregivers were recruited from three counties in Taiwan.ResultsThe reliability and validity of the Chinese version of the scale were within the acceptable range. The Cronbach's α was between 0.838 and 0.95. However, the scale's reliability was higher than that of the original version. This might be because of the inclusion of participants with less severe diseases than the participants in the original study, high social expectations in the Chinese traditional culture, and a large number of similar items. Future research should simplify the items and consider adopting diverse participant selection criteria.ConclusionsThe results of this study can be used to understand shared care in Taiwan.

In this study, the researchers aimed to understand the life experience of older widowed women living alone. Employing a phenomenological approach, we interviewed 15 older women (age 62 to 95) living alone at homes in two villages in Central Java. Through systematic text condensation procedure, we identified five themes: (1) negative feelings at times, (2) getting used to living alone, (3) needing help to support independent living, (4) coping toward negative feelings, (5) attachment to the original house. We depicted the struggles of older women living alone in their homes. Despite the coping strategies they have developed over time, older women needed help during hard times, especially when getting sick. Families and neighbors were the main resources to maintain their independent living. Improving the home environment to increase suitability for aging residents and providing a support system are the options that best fit the needs and values the older women believed.