As artificial intelligence (AI) becomes increasingly integrated into healthcare and nursing education, existing competency standards and training systems for clinical nursing educators are no longer sufficient to meet the demands of technology-enabled teaching. This study aimed to explore the lived experiences and perceived competency demands and training needs of clinical nursing educators in the AI era, and to provide empirical evidence to inform competency framework development and training-system optimization. A descriptive phenomenological qualitative study was conducted in four tertiary hospitals in Chengdu, China, between July and September 2025. Fourteen clinical nursing educators were recruited using purposive sampling. Data were collected through semi-structured interviews and analyzed using Colaizzi's seven-step method. Five themes and 17 subthemes were identified. The core competency framework comprised four key domains: professional foundation and specialized technical skills, communication and humanistic care, AI tool application, and research translation. Training-system optimization involved four interrelated areas: systematic training design, incentive and support mechanisms, specialty-based and tiered teaching design, and the educational value and practical challenges of integrating AI into clinical teaching. These findings suggest that clinical nursing educators require both foundational teaching competencies and new AI-related capabilities. Clinical nursing educators in the AI era require a competency-based development pathway that integrates pedagogical, clinical, technological, and research capabilities. Hospitals and nursing education institutions should establish tiered training programs, practice-oriented assessments, and supportive organizational policies to strengthen educator preparedness and facilitate the intelligent transformation of clinical nursing education. This is a qualitative study, not a health care intervention trial, so no trial registration is applicable.
Clinical competence is pivotal for nursing students to succeed in their clinical training and future practice. Traditional education often emphasizes technical skills at the expense of holistic care, humanistic competencies, and core clinical abilities. This study therefore reformed the "Basic Nursing Intensive Training" course by integrating humanistic care with the Mini-Clinical Evaluation Exercise (Mini-CEX). This reform aims to investigate its effectiveness in enhancing the clinical competence of nursing students. This study utilized a quasi-experimental design. From February to June 2025, The study enrolled 193 third-year undergraduate nursing students from a Chinese university. Using a cluster random sampling approach, participants were assigned to either the intervention group (n = 97) or the control group (n = 96). The control group received conventional instruction, while the intervention group received conventional instruction enhanced by a teaching strategy that integrated humanistic care with the Mini-Clinical Evaluation Exercise. Following the instructional period, both groups underwent comprehensive course assessments and evaluations of clinical core competencies. Additionally, Mini-CEX scores, humanistic care competence, and Self-Directed Learning (SDL) ability were measured in both cohorts. Following the instructional intervention, nursing students in the intervention group demonstrated significantly higher scores compared to the control group in core competency (152.44 ± 12.34 vs. 142.56 ± 13.89, t = 5.244, P < 0.001), comprehensive course performance (87.03 ± 3.21 vs. 84.51 ± 4.00, t = 2.977, P = 0.040), humanistic care ability (181.89 ± 16.03 vs. 168.19 ± 13.49, t = 4.356, P = 0.013), SDL ability (87.02 ± 10.27 vs. 78.45 ± 9.99, t = 5.875, P < 0.001), and Mini-CEX score (53.67 ± 5.81 vs. 50.40 ± 5.12, t = 4.140, P < 0.001) (all P < 0.05). No statistically significant differences were found between the two groups in operational skills assessment scores (P = 0.057) or the personal traits dimension (P = 0.055). Although the teaching method integrating humanistic care with Mini-CEX did not yield significant improvements in procedural technical skills (hard skills), it enhanced nursing students' soft skills essential for clinical practice, including clinical competence, humanistic care literacy, and SDL ability. This approach may help prepare students for the humanistic and cognitive demands of clinical nursing work.
Soft skills correspond to intrapersonal and interpersonal abilities related to how individuals interact, make decisions, and manage their activities. In the context of undergraduate nursing education, their development is fundamental to the preparation of professionals capable of acting in an ethical, critical, and relational manner, making it relevant to understand how these competencies are incorporated into the teaching and learning process. In this context, the objective of this study is to understand how faculty members in undergraduate nursing programs incorporate soft skills into their pedagogical approaches and practices, identifying the competencies considered essential and the challenges to their implementation. A qualitative study was conducted with 26 nursing faculty members from four federal public universities in southern Brazil. Data were collected between June and September 2025 through semi-structured interviews, following the criteria of the Consolidated Criteria for Reporting Qualitative Research checklist. The interviews were processed using IRaMuTeQ software and analyzed in light of Discursive Textual Analysis. Three analytical categories emerged: faculty understanding of soft skills in nursing education; pedagogical approaches and strategies for the development of these competencies; and perceived difficulties in their promotion within teaching. The faculty members recognize the relevance of soft skills and report the use of active methodologies and reflective strategies for their development. However, most had not received specific training, and the teaching of these competencies occurs predominantly in an implicit manner. The findings demonstrate that, although soft skills are widely valued in nursing education, their promotion still lacks pedagogical systematization and institutional support. Challenges such as the subjectivity of these competencies, the prioritization of technical skills by students, and distractions associated with the use of technologies limit their intentional development. These results contribute to the international literature in nursing education by highlighting the need for structured institutional strategies for faculty development and for the explicit integration of soft skills into nursing curricula.
Preceptorship is a crucial component of nursing education in the final year, as it facilitates the transition to being a registered nurse. Preceptors guide student nurses in the clinical area through supervision and development, typically employing a traditional model with multiple ward-based preceptors who focus on clinical skills. However, the role of the preceptors in shaping nursing students' career adaptability and professional identity has been underemphasized. This study evaluated a strategy of embedding a supplemental role-model mentor that provided continuous, personalized guidance during the final year of clinical placement. This study explored the influence of a newly implemented double preceptorship model on nursing students' career adaptability and professional identity. This study employed a quasi-experimental design. This study was conducted at a top-tier hospital in Guangzhou, China, from July 2023 to May 2024. The research subjects were final-year nursing students undertaking clinical placement in the hospital. The intervention group (n = 39) received additional support from a supplemental role-model mentor for the entire final year, in addition to ward-based clinical preceptors in each ward area. The control group (n = 32) received the traditional preceptorship model. The differences between the two groups were evaluated using the Career Adaptability Scale and the Professional Identity Scale. At baseline, no significant differences were observed between the two groups. Following the intervention, the scores in the intervention group were significantly higher than those in the control group in both career adaptability and professional identity (all p < 0.05). Within-group analyses revealed a significant increase in career adaptability from pre- to post-intervention in the intervention group (p < 0.05), whereas no significant change was observed in the control group. For professional identity, subscale analysis indicated significant improvements across four dimensions (except social modelling) within the intervention group (all p < 0.05). The double preceptorship system, which embeds a supplemental role-model mentor in the final year of clinical placement for nursing students, appears to enhance career adaptability and professional identity, potentially leading to improved retention in the workplace after nursing education.
The complexity and rapidly evolving nature of critical patient care in Intensive Care Units underscore the importance of the accuracy and timeliness of nursing decisions, further highlighting the significance of nursing education. This study aims to examine the accuracy of four generative artificial intelligence tools (ChatGPT 5.0 Plus, ChatGPT 5.0, DeepSeek, and Google Gemini) in answering multiple-choice questions related to the intensive care nursing exam, a fundamental area in nursing education. In the study, the ChatGPT 5.0 Plus, ChatGPT 5.0, DeepSeek, and Google Gemini models were evaluated using a test data set consisting of 55 questions. The questions were classified according to their difficulty levels as easy (n = 16), medium (n = 17), and difficult (n = 22). The models' correct response rates and standard or unique correct/incorrect response distributions were examined. Computer-assisted statistical analysis used the Chi-square, one-way ANOVA, and Post-hoc Tukey tests. The study was reported according to STROBE. According to the study results, the success rates of all models were similar for easy and medium-level questions (70-82%), and the difference between them was not statistically significant (p > 0.05). Under difficult questions, however, the performance of the models diverged significantly, with Google Gemini achieving the highest success rate at 77.27% and DeepSeek showing the lowest performance at 45.45%. The chi-square analysis revealed no statistically significant difference in the correct/incorrect distribution among the models (χ²=3.69; p = 0.296), but at the observational level, Google Gemini had a higher number of unique correct answers (n = 6) compared to the other models. ChatGPT 5.0 was found to have no unique errors. In conclusion, while AI models generally showed similar levels of success in intensive care nursing exam questions, Google Gemini demonstrated superior performance in difficult questions, and DeepSeek showed the lowest level of success among the models. The study provides an essential comparative framework regarding the usability of AI-based learning and assessment tools in nursing education. It offers guidance for the future development of AI-based educational technologies. Not applicable.
Teacher-centered models in fundamental nursing education face issues including high student-instructor ratios and limited personalized feedback, hindering nursing students' clinical competency development. Peer-assisted learning with digital platforms is a promising solution. However, there remains a lack of research exploring the impact of structured digital platforms designed for peer practice in fundamental nursing education. This study aimed to evaluate the effectiveness of a structured digital platform for reciprocal peer practice in fundamental of nursing education. We conducted a quasi-experimental study involving 72 s-year undergraduate nursing students. The intervention group utilized reciprocal peer practice with the WeChat Mini Program, which was based on the BOPPPS teaching model (Bridge-in, Objectives, Pre-assessment, Participatory Learning, Post-assessment, Summary), while the control group participated in traditional group training in 3 weeks. Pre- and post-assessments were conducted using validated instruments. Data analysis was performed using SPSS 23.0, employing independent samples t-test and Mann-Whitney U test to compare the effects between the groups. The intervention group showed statistically significant improvements in the operational skills (Z = -3.566, p < 0.001). Additionally, participants in the intervention group showed improvements in the critical thinking (t = 2.386, p = 0.020). While both groups reported gains in self-efficacy, the intervention group exhibited a more pronounced improvement in self-efficacy (t = 3.152, p = 0.002) with reduced variability. The findings of this study highlight the potential for integrating digital tools for peer-assisted learning in nursing education, particularly within institutions facing faculty shortages or those seeking to modernize their pedagogical approaches.
Health literacy is essential for safe and effective nursing practice, yet traditional teaching methods may not fully address students' needs. This study evaluated a scenario-based interactive e-book integrating multimedia elements (e.g., videos, quizzes, and case-based activities) delivered through a digital learning platform to enhance nursing students' health literacy performance. A quasi-experimental design was conducted with 55 fourth-year nursing students from a Taiwanese university. Students were assigned to an experimental group (n = 28) that received a structured, instructor-guided e-book intervention within a course session or a control group (n = 27) that received traditional teaching. The 26-item Health Literacy Performance Scale, demonstrating strong validity and reliability, was administered three weeks before and immediately after the intervention. For educational parity, the control group accessed the e-book after data collection. Generalized Estimating Equations revealed no significant effects of time or time × group interaction. However, after adjusting for age, the main effect of group was significant (p = .015). Post hoc analysis showed that the experimental group scored higher on the post-test (p = .035), particularly in interpreting health education materials, assessing care needs, and correctly using medication, suggesting improved application of health literacy skills in clinical contexts. Findings indicate that the scenario-based e-book effectively improved nursing students' health literacy performance. This study highlights the value of integrating interactive, scenario-based digital learning tools into nursing education to support the development of practical communication and decision-making competencies.
Strengthening professional identity is crucial to mitigate nursing students' attrition and ensure a sustainable workforce. While the hidden curriculum and learning engagement are believed to influence this identity, their interrelationships remain unclear. This study aims to explore the relationship between hidden curriculum and professional identity and examine whether learning engagement mediates the relationship between hidden curriculum and professional identity. A cross-sectional study was conducted among 623 undergraduate nursing students from two medical colleges in China. The general information questionnaire, Hidden Curriculum Evaluation Scale in Nursing Education, Utrecht Work Engagement Scale-Student, and Professional Identity Scale for Nursing Students were used for data collection, and IBM SPSS 26.0 and PROCESS macro (Model 4) were used for statistical analysis. Hidden curriculum, learning engagement, and professional identity were significantly positively correlated. Learning engagement partially mediated the relationship between hidden curriculum and professional identity, accounting for 44.13% of the total effect. Nursing educators should proactively develop the hidden curriculum and implement strategies to boost learning engagement, thereby fostering students' professional identity and reducing future workforce attrition.
The nursing workforce is pivotal to sustaining healthcare systems, yet Southeast Asia faces persistent challenges in recruitment, retention, and competency development. Historical legacies of workforce shortages, migration, and uneven training standards continue to shape the present, as rising demands from demographic transitions, pandemics, and evolving care needs have intensified pressures on the profession. This scoping review aims to synthesize historical and current evidence on nursing workforce issues in Southeast Asia, with a focus on occupational competencies, workforce distribution, and policy responses. Guided by established scoping review frameworks, literature was systematically mapped from regional and international databases, policy documents, and grey sources spanning the colonial era to 2025. Data were charted to capture temporal trends, thematic issues, and multilevel solutions. Workforce issues include long-standing shortages, skill mix imbalances, migration to higher-income regions, limited continuing education, and uneven regulatory capacity. Emerging themes highlight the importance of advanced practice roles, digital health competencies, and resilience-building in crisis contexts. Regional solutions are evident at multiple levels: (i) Macro-level-policy harmonization, regional cooperation through ASEAN frameworks, and investment in nursing education infrastructure; (ii) Meso-level-institutional initiatives to strengthen workplace environments, interprofessional collaboration, and retention strategies; and (iii) Micro-level-competency-based training, mentorship, and leadership development programs tailored to local health system needs. Addressing nursing workforce issues in Southeast Asia requires historically informed, context-sensitive strategies that integrate regional collaboration with practical solutions across policy, institutional, and individual levels. Such approaches are essential for advancing occupational competency, strengthening health systems, and achieving universal health coverage in the region.
Nursing staff working in healthcare are exposed to high job demands, leading to turnover, stress, and decreased motivation. Work-life balance, empowered structures, and thriving have been shown to contribute positively to their psychosocial work environment. This study examined the relationships between job demands, job resources, and the outcomes of thriving, burnout, and work-life conflict among nursing staff. A cross-sectional descriptive correlational design was employed, involving 192 nursing staff within somatic in-patient care. Data were collected using the Copenhagen Psychosocial Questionnaire, the Thriving scale, and the Conditions of Work Effectiveness Questionnaire II. Descriptive statistics, Pearson's correlation coefficients, and multiple regression analyses were conducted to assess the relationships between job demands, job resources, and outcomes. Job resources, quantified as structural empowerment, showed a positive relationship with thriving and negative relationships with both burnout and work-life conflict. Among job demands, quantitative demands, emotional demands, and work pace demonstrated negative relationships with thriving and positive relationships with burnout and work-life conflict. All resources and demands remained statistically significant in multiple regression models except for emotional demands and work pace on thriving. Regarding interaction effects, structural empowerment moderated the relationship between work pace and both thriving and burnout but did not moderate the relationship with work-life conflict. The interaction between structural empowerment and emotional demands was also statistically significantly positively related to thriving. The findings of this study underscore the value of adopting strategies that enhance access to empowering job resources, through both top-down and bottom-up approaches, to improve staff well-being. Recognizing and addressing the complex relationships between job demands, resources, and staff outcomes is important for meeting the diverse needs and staffing challenges in healthcare settings.
Clinical judgment is a core competency across healthcare professions and is commonly conceptualized through Tanner's model, which incorporates four phases of clinical judgment: noticing, interpreting, responding and reflecting. While Tanner's framework has informed assessment and reflection tools, less attention has been paid to how clinical judgment can be facilitated through pedagogical design in digital and blended learning environments. This article presents the new Digital Clinical Judgment Model (DCJM), a pedagogical model developed to support the teaching and learning of clinical judgment in digital nursing education. The DCJM was developed using an iterative conceptual synthesis of Tanner's Clinical Judgment Model, educational theories of sociocultural learning, scaffolding and deep learning, as well as from empirical insights into digital nursing education obtained during the COVID-19 pandemic. The DCJM integrates Tanner's four phases of clinical judgment within three interrelated layers of support: pedagogical structure, social and emotional support and technological support. This approach outlines design conditions that enable meaningful engagement in clinical judgment across digital, blended and practice-based learning contexts. Clinical judgment should be supported through the design of learning environments rather than an outcome to be assessed. This new approach represents a pedagogical rather than an evaluative perspective. As a conceptually grounded pedagogical model, the DCJM offers educators a theoretically informed and practically applicable framework for designing learning environments that support the development of clinical judgment in contemporary nursing education. Further empirical research is needed to determine its usefulness in practice and its impact on student learning and educational design.
This study aimed to explore the relationships between physical disorders (visual impairment, hearing impairment, and chewing impairment) and depression among older adults in nursing homes in one city of China, and to examine the parallel mediating roles of activities of daily living (ADLs) and cognition. The study conducted a cross-sectional study involving 591 older adults from 50 nursing homes in China. Participants provided informations on their vision, hearing, and chewing. Cognition was assessed using tests of memory and thinking skills. ADLs were evaluated through measures of daily task performance, and depression was assessed by epidemiologic studies depression scale. Multiple linear regression analysis and PROCESS macro were used for data analysis. The overall detection rate of depression was 28.43%, and significant correlations were observed among physical disorders, ADLs, cognition, and depression (p < 0.05). Mediation analysis revealed that hearing impairment not only had a direct effect on depression (β = 2.298, p < 0.001) but also significant indirect effects mediated through ADLs (β = 0.630, p < 0.01) and cognition (β = 0.666, p < 0.001). The total indirect effect accounted for 36.06% of the total effect. Similarly, the effects of visual impairment on depression were mediated by ADLs (β = 0.301, p < 0.05) and cognition (β = 0.380, p < 0.01), with the mediation effect accounting for 68.10%. In contrast, chewing impairment showed a direct effect on depression (β = 1.354, p < 0.01), but no significant mediation was found through ADLs and cognition. Our findings indicated that hearing and visual impairments were associated with an increased risk of depression, with these effects operating both indirectly through ADLs and cognition. These findings highlight the necessity of comprehensive geriatric care approaches that integrating sensory rehabilitation with interventions with ADLs and cognitive support.
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In an increasingly technology-driven healthcare environment, digital literacy and clinical decision-making (CDM) are essential competencies for undergraduate nursing students. This study investigates the relationship between digital literacy and clinical decision-making skills among student nurses. A cross-sectional correlational design was employed, involving a convenience sample of 201 undergraduate nursing students at Taif University, Saudi Arabia. Data were collected on campus between August and September 2025 via a secure Google Forms link distributed through official university channels. Analysis included descriptive statistics, independent t-tests to examine sex differences, and Pearson's correlation and linear regression to evaluate the relationship between variables. The nursing students possessed a high level of digital literacy (M = 51.00, SD = 8.44) and a high level of clinical decision-making ability (M = 171.30, SD = 12.60). Female students (M = 51.78) scored significantly higher in digital literacy than male students (M = 44.97), with t(199) = 3.65, p < 0.001. A statistically significant positive correlation was found between the two variables (r = 0.389, p < 0.001), indicating that higher digital competency is associated with stronger clinical decision-making skills. Digital literacy was a significant predictor, accounting for approximately 15.1% (R2 = 0.151) of the variance in CDM scores. Sex differences were highly significant across both domains. Female students reported significantly higher mean digital literacy scores (51.78, SD = 7.73) compared to their male counterparts (44.97, SD = 7.89; t = -3.87, p < 0.001). Furthermore, a significant disparity was observed in clinical decision-making, where female students scored 172.50 (SD = 12.40) compared to 162.03 (SD = 14.15) for males (t = -3.82, p < 0.001). The findings underscore the critical role of digital literacy in clinical performance. The results suggest a need for targeted educational strategies to bridge sex-based competency gaps within nursing education. This ensures all students are prepared for a digitalized healthcare landscape.
Clinical empathy refers to a healthcare professional's ability to understand a patient's experiences and emotions through cognitive and affective perspective taking, and to communicate that understanding through compassionate and appropriate professional behaviors. Aging simulation suits are experiential educational tools designed to replicate the sensory and physical limitations associated with aging. However, evidence regarding their effectiveness in enhancing clinical empathy among active healthcare professionals remains limited. This study aimed to evaluate the effects of an aging simulation suit on clinical empathy among healthcare professionals working in long-term care settings. A randomized controlled trial was conducted with 82 healthcare professionals from four nursing homes in Madrid and Asturias (Spain). Participants were randomly assigned to an experimental group (EG) (n=41) or a control group (CG) (n=41). Both groups received the same structured educational session on empathy and aging. The experimental group additionally participated in an immersive experience using the GERT aging simulation suit, whereas the control group did not receive the simulation component. Self-reported empathy were measured pre- and post-intervention using the Interpersonal Reactivity Index (IRI) and the Jefferson Scale of Empathy-Health Professions version (JSPE-HPS). No significant differences were found between groups in IRI scores. However, the experimental group showed significant improvements in total JSPE-HPS scores and in the subscales Perspective Taking and Compassionate Care (p < 0.05), compared with the control group. These findings suggest that the immersive intervention enhanced both cognitive and affective components of clinical empathy. The use of an aging simulation suit was associated with improvements in specific dimensions of clinical empathy among healthcare professionals working in long-term care. This educational tool offers a valuable experiential approach that enhances understanding and compassion toward older adults. However, these findings are limited to short-term, self-reported measures, and no behavioral or patient outcome data were collected. Further longitudinal studies are needed to determine the long-term sustainability of these effects and their translation into clinical practice. ClinicalTrials.gov, Unique Protocol ID: 2711201916919; ClinicalTrials.gov ID: NCT07280689. Date of registration: 10/10/2025. Retrospectively registered.
Borderline personality disorder (BPD) is highly stigmatized. Stigma, including clinicians' resistance, stigmatizing attitudes, and discriminatory beliefs, could be mitigated by a better knowledge of the disorder. This study evaluates the impact of a one-day training session on stigmatization by health personnel (HP). This two-center study prospectively included 172 HP who completed a face-to-face interactive training day embodying dialectical and destigmatizing positions. Elements of psychoeducation, emotional dysregulation model and practical tools were presented. Stigma attitudes and open-mindedness were assessed by the Opening Minds Stigma Scale for Health Care Providers self-questionnaire (OMS-HC); and beliefs (feeling of incompetence, pejorative perception of prognosis, guilt) by a custom Beliefs Questionnaire (BQ). Scores before and immediately after the training were compared using Student's paired t-test. Most HP worked in psychiatry (69%) and had no prior education on BPD (89%). Nurses were most represented (35%), ahead of nursing assistants (22%), psychologists (18%), and psychiatrists (10%). All scores decreased after training (p < 0.001): total OMS-HC (MD ± SD=-4 ± 8), attitude sub-score (2 ± 4), disclosure sub-score (1 ± 4); total BQ (6 ± 9), nurse feeling of incompetence sub-score (4 ± 4) and pejorative perception of prognosis sub-score (-2 ± 3). A one-day training session reduces HPs' stigmatizing attitudes and beliefs and has a positive impact on knowledge and open-mindedness about BPD patients. Training can lean on education about BPD nature, treatment and prognosis, experience-sharing with practical cases, and testimonies. It would enable compassionate and destigmatizing care. Further research is needed about the clinical impact of BPD training and its wider implementation in mental healthcare settings.
Chronic obstructive pulmonary disease (COPD) is a complex, progressive condition associated with substantial physical, psychological, and social burden. Holistic, person-centered care is central to effective COPD management, yet its delivery in outpatient settings remains challenging. Nurses play a pivotal role in providing such care; however, their lived experiences of delivering holistic COPD care within constrained health systems are insufficiently understood. To explore nurses’ experiences of delivering holistic care to patients with COPD in university-affiliated polyclinic settings, and to develop an inductively derived conceptual model of holistic COPD nursing care that may inform future research and practice development. A qualitative study using an interpretive (hermeneutic) phenomenological orientation was employed. In-depth, semi-structured interviews were conducted with 20 nurses working in King Faisal University–affiliated polyclinics in Saudi Arabia. Participants had direct involvement in outpatient COPD care. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis following Braun and Clarke’s six-phase framework. Methodological rigor was ensured through reflexivity, member reflection, and audit trails, in line with SRQR guidelines. Four interrelated themes were identified: (1) Seeing the Whole Person Behind the Breathlessness, reflecting nurses’ efforts to address psychosocial and functional dimensions beyond respiratory symptoms; (2) The Weight of Invisible Care Work, highlighting emotional labour, compassion fatigue, and family mediation; (3) Holistic Care in a Fragmented System, capturing time pressure and system gaps that constrained care delivery; and (4) Striving to Do Right by the Patient, illustrating moral tension alongside professional meaning derived from small relational successes. Holistic COPD care in outpatient settings is a morally driven, relational practice sustained by nurses’ commitment but constrained by fragmented systems and limited time. Structural and educational support is essential to enable sustainable, holistic care and to protect nurses from moral distress and burnout. Not applicable. The online version contains supplementary material available at 10.1186/s12912-026-04673-1.
Artificial Liver Support System (ALSS) is a core therapeutic modality for liver failure, but hypotension is a common and severe complication during treatment, which may lead to treatment interruption and poor prognosis. This study aims to explore the independent risk factors of hypotension complicating ALSS treatment for liver failure, construct a predictive model, and provide evidence for clinical coping strategies. A retrospective cohort study was conducted. According to the occurrence of hypotension during treatment, they were divided into the hypotension group and the non-hypotension group. Clinical data of the two groups were collected and analyzed. 216 patients with liver failure who received ALSS treatment were included. Multivariate logistic regression analysis confirmed that age ≥ 65 years (OR = 2.379, 95%CI:1.568 ~ 3.605), BMI < 19 kg/m² (OR = 2.782, 95%CI:1.825 ~ 4.226), ALSS treatment duration > 4 h (OR = 2.598, 95%CI:1.689 ~ 3.987), hypokalemia (OR = 2.193, 95%CI:1.452 ~ 3.298) and hypoalbuminemia (OR = 3.099, 95%CI:2.015 ~ 4.756) were independent risk factors for hypotension (all P < 0.001). The constructed scoring predictive model had excellent discriminative efficacy with an AUC of 0.888 (95%CI:0.840 ~ 0.936), and the highest Youden's index (0.642) was obtained when the scoring threshold was 6.5 points. The simplified scoring model exhibits favorable predictive efficacy, enabling early identification and risk stratification of high-risk patients. Implementation of multidimensional prevention strategies-including precision treatment optimization, individualized nursing interventions, and integrated process management-may reduce the incidence of hypotension and improve treatment safety.
This study aimed to explore pediatric nurses' perceptions of using artificial intelligence in the education of children with chronic diseases through metaphor analysis. This study was designed as a qualitative descriptive study using metaphor-based content analysis. Sixty pediatric nurses from a university hospital participated. The data were collected using a semi-structured metaphor form and analyzed using content analysis. The metaphors generated by the participants were organized into thematic categories to identify underlying perceptions and attitudes toward artificial intelligence use in pediatric care. Most participants were female (95%), and only 20% reported prior experience with artificial intelligence. A total of 42 distinct metaphors were identified. These metaphors were grouped into five themes: "providing information and guidance role," "supportive and helpful role," "understanding complexity and multidimensionality," "social-emotional support role," and "technology and mechanical power role." The most frequently used metaphor was "guide," followed by private tutor, machine, smart friend, helping hand, translator, compass, school, information pool, lantern, and light. The findings suggest that pediatric nurses generally have positive perceptions of artificial intelligence, though they may underestimate its ethical and safety challenges due to limited training and experience. It is essential to strengthen nurses' artificial intelligence literacy, ethical awareness and decision-support competencies through education and scenario-based training programs to ensure the safe and effective integration of artificial intelligence technologies into pediatric nursing practice.
Bed-dependent patients are highly vulnerable during emergencies because of restricted mobility, and their rapid evacuation presents a significant challenge for hospitals. This study aimed to identify innovative strategies and the key challenges involved in designing and manufacturing emergency evacuation devices for bed-dependent patients, with a focus on evacuation mattresses and stretchers. This study was conducted on the basis of the five-stage framework proposed by Arksey and O'Malley and in accordance with the Joanna Briggs Institute (JBI) guidelines for scoping reviews. Initially, the research question was clearly defined. A comprehensive literature search was subsequently performed without time restrictions, considering the limited number of product-oriented studies. The search utilized the keywords bed-bound patients, emergency evacuation, hospital, design, manufacture, and evacuation mattress across multiple databases, including Scopus, ProQuest, PubMed, Web of Science, and ScienceDirect, as well as the search engines Google Scholar and Google Patents. National databases such as SID and MagIran were also included. Both English and Persian keywords were finalized. Out of a total of 654 retrieved studies, after removing duplicates and irrelevant records, 28 articles met the inclusion criteria and were analyzed. The findings indicated that design requirements for hospital evacuation equipment can be classified into seven principal categories and 18 subcategories: technical-functional requirements, clinical requirements, environmental requirements, legal and standard requirements, operational barriers, design-related barriers, and technological complexity and innovation. This study demonstrates that designing hospital evacuation equipment, with a focus on mattresses and stretchers, constitutes a multidimensional and complex challenge that necessitates an integrated and innovative approach. Prototypes should be refined through analyzing and adapting, incorporating locally available materials and ergonomic principles. Prioritizing user-centered and context-adaptive innovations enhances health system capacity and ensures safer, more efficient transfer of bed-dependent patients in emergencies. Not applicable.