Toward an AI-integrated nursing curriculum: A Kano model analysis of generative AI competency needs.

ObjectiveThis study investigated the perceived clinicians’ roles in penicillin allergy assessment among medical staff in tertiary hospitals in China.DesignThis was a multicentre cross-sectional survey.SettingThe study was conducted at 89 tertiary hospitals in eastern and western China from March to May 2024.ParticipantsA survey was conducted involving 8493 medical staff from tertiary hospitals in eastern and western China using multistage sampling.Outcome measuresA self-designed questionnaire was used to assess evaluation status of penicillin allergy assessment, including allergy history assessment and recording, skin test result evaluation during hospitalisation, allergic reaction recording at discharge and awareness of allergy assessment teams.ResultsAmong 8493 healthcare professionals (doctors 40.0%, nurses 56.3%, pharmacists 3.7%), significant gaps existed in penicillin allergy documentation: while 92.0% acknowledged the need to document specific drug names, only 66.2% practised this (nurses 62.2% vs pharmacists 82.0%, p<0.01). Nurses dominated skin test evaluation (95.3% participation), with 77.5% of all staff endorsing their primary role. For ambiguous test results, 54.6% preferred multi-person consensus (nurses 63.9%, p<0.01). Post-discharge documentation prioritised drug names (94.4%) over clinical indications (70.3%). Pharmacists demonstrated superior documentation awareness (p<0.05). Only 45.5% confirmed having an antimicrobial allergy assessment team, though clinical pharmacists (89.2%) and specialist nurses (88.2%) were deemed essential members.ConclusionsCurrently, the assessment and recording methods for antimicrobial allergies by the medical staff of tertiary hospitals in China are not sufficiently accurate. Nurses play a key role in the assessment of antimicrobial allergies. Thus, medical staff, especially nurses, should receive more vigorous training, and structured assessment tools for antimicrobial allergies based on clinical decision support systems should be devised for them. Our findings also reiterate the need to establish penicillin allergy assessment teams at the hospital level.

The provision of postnatal continuity of care is of significant importance to new mothers. Given the prevalence of "Internet+ Nursing Services", there has been a paucity of research exploring the internet-based home care needs of mothers following their discharge from hospital. This study employs a combination of the SERVQUAL and KANO models to investigate maternal requirements for Internet+ nursing services and to establish a foundation for enhancing the quality of postnatal nursing services. A questionnaire was designed by combining SERVQUAL and KANO models, and a cross-sectional survey was conducted in the obstetrics department of a tertiary hospital in China after expert correspondence. The survey targeted 279 mothers about to be discharged after delivery, aiming to explore their demand for Internet+ nursing services post-discharge. Data were analyzed according to the KANO model. The better values (satisfaction coefficient) of Internet+ nursing services ranged from 42.91% to 78.46%, while the worse values (dissatisfaction coefficient) were 28.91% to 63.20%. The must-be and one-dimensional need attributes of maternity are mainly tangibility, reliability, responsiveness, and assurance dimensions, and empathy and economy are attractive attributes. Two items within the tangibles dimension, namely ease of operation of the platform and nurses' dress code, were deemed to be indifferent attributes. In the quadrant analysis diagram, the attributes of must-be, one-dimensional, attractive, and indifferent were 8(33.3%), 66(25.0%), 8(33.3%), and 2(8.3%), respectively. Attributes of Chinese mothers' needs for Internet+ nursing services after hospital discharge were defined, ranked, and categorized by the KANO model, providing a theoretical basis for the targeted design and improvement of care services. It is suggested that care managers consolidate must-be attributes and one-dimensional attributes, optimize attractive attributes, and transform indifferent attributes to better meet the multifaceted service needs of mothers.

This study explored preferences for electronic health (eHealth) information support regarding chemotherapy adverse reactions among young and middle-aged breast cancer patients based on the Kano model. This cross-sectional study recruited eligible breast cancer patients from two tertiary hospitals in China. The participants completed a general information questionnaire, the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events subset, the electronic Health Literacy (eHEALS), and the eHealth information support demand attribute questionnaire based on the Kano model. Data were analyzed using latent profile analysis and binary logistic regression. A total of 388 patients were enrolled. Latent profile analysis classified young and middle-aged breast cancer patients undergoing chemotherapy into two classes: "a low adverse reaction-symptom adaptation group" (C1, 76.3%) and "a high adverse reaction-symptom distress group" (C2, 23.7%). In C1, eHealth demands comprised two one-dimensional attributes, five attractive attributes, and three indifferent attributes. In contrast, all ten identified eHealth demands in C2 were categorized as attractive attributes. Five attractive attributes were common to both groups. Young and middle-aged breast cancer patients exhibited distinct preferences for eHealth information to support concerns regarding chemotherapy adverse reactions. Tailoring eHealth information recommendations to these preference profiles may better address their diverse informational needs, help mitigate adverse reactions, and ultimately improve their quality of life.

In Jiong Tu and colleagues' introduction and discussion about the internet hospitals emerging in China (August, 2015),1Tu J Wang C Wu S The internet hospital: an emerging innovation in China.Lancet Global Health. 2015; 3: e445-e446Summary Full Text Full Text PDF Scopus (54) Google Scholar we are disappointed to see little recognition of, or discussion about, the fact that skilled doctors in top-level (tertiary) hospitals in China are already overworked. These doctors have no additional time or energy to deal with internet diagnoses and prescriptions. In China's health-care system, primary health care is generally weak, with an insufficient number of skilled and experienced health professionals.2Yip W Hsiao W Harnessing the privatisation of China's fragmented health-care delivery.Lancet. 2014; 384: 805-818Summary Full Text Full Text PDF PubMed Scopus (257) Google Scholar Most patients in China prefer to visit tertiary hospitals even for common and minor illnesses since they can freely choose which doctors and medical institutions to visit. According to statistics from the National Health and Family Planning Commission of the People's Republic of China, in January–November, 2014, there were 2·6 billion patient visits to Chinese hospitals, 46% of which were visits to tertiary hospitals.3National Health and Family Planning Commission of the People's Republic of ChinaThe situation of national medical service delivery in China in 2014.http://www.nhfpc.gov.cn/mohwsbwstjxxzx/s7967/201501/0faf05af332b4f9f83bc1244b84f6dfb.shtmlGoogle Scholar Therefore, tertiary hospitals in China are often overcrowded and the doctors in these top-level hospitals are generally overworked and overloaded. A 2014 national survey shows that 92% of doctors in tertiary hospitals need to work overtime, and 72% of doctors who have worked more than 60 h a week on average are in tertiary hospitals in China.4Chinese Medical Doctor AssociationChinese doctors practicing white paper.http://www.cmda.net/xiehuixiangmu/falvshiwubu/tongzhigonggao/2015-05-28/14587.htmlGoogle Scholar In Tu and colleagues' introduction1Tu J Wang C Wu S The internet hospital: an emerging innovation in China.Lancet Global Health. 2015; 3: e445-e446Summary Full Text Full Text PDF Scopus (54) Google Scholar of internet hospitals in China, skilled doctors in top-level hospitals are trained to meet patients and provide diagnoses and prescriptions via the internet. This approach seems to increase the accessibility of patients to high-quality medical services. However, with the consideration of overwork of skilled doctors in tertiary hospitals in China, its effects and sustainability are in doubt. We think that the key solution to the poor access to high-quality medical services in China is to provide enough skilled doctors or general practitioners in primary care institutions. If this situation is not fundamentally improved, the overcrowding and long waiting times experienced by outpatients will soon also become a problem in internet hospitals. To increase the supply of skilled doctors or general practitioners in primary care institutions in China, policies and programmes to encourage these health professionals to work in primary care institutions and reform of the medical education curriculum will be significant. Meanwhile, strengthening of the continuing professional training and development5Liu Q Wang B Kong Y et al.China's primary health-care reform.Lancet. 2011; 377: 2064-2066Summary Full Text Full Text PDF PubMed Scopus (115) Google Scholar for health professionals in primary care institutions and improvements to their working conditions are also important. We declare no competing interests. Skilled doctors in tertiary hospitals are already overworked in China – Authors' replyYinhuan Hu and Zixia Zhang make an important observation that doctors in tertiary hospitals in China are often overworked. The authors believe that the internet hospital will increase the burden on doctors in tertiary hospitals, and therefore that its effects and sustainability are in doubt. To meet patients' demand for high-quality health care, Hu and Zhang propose training and provision of enough skilled doctors in primary health-care institutions. This approach has also been one of the measures promoted by China's health reform. Full-Text PDF Open Access

A survey on antimicrobial stewardship in 116 tertiary hospitals in China

BackgroundInfective endocarditis (IE) is a lethal disease which has been changing significantly over the past decades; however, information about IE in China remains scarce. This study surveyed the changes in clinical characteristics of IE at a tertiary hospital in south China over a period of nearly 18 years.MethodsMedical records with IE patients consecutively hospitalized between June 2001 and June 2018 were selected from the electronic medical records system in Nanfang Hospital of Southern Medical University. Data were divided by admission time into two groups equally: early-period group, June 2001 to December 2009 and later-period group, January 2010 to July 2018.ResultsA Total of 313 IE patients were included in our study. Compared with the early-period group, patients in the later-period group included fewer intravenous drug users (IVDUs), older age at onset, reduced development of pulmonary embolism, less renal dysfunction, decreased proportion of Staphylococcus aureus infection and fewer vegetations observed in the right heart by echocardiography. The later-period group also showed a higher proportion of ischemic strokes and higher proportion of positive microbiological findings compared with the early-period group. The in-hospital mortality remained about the same between the two periods and the multivariate analysis identified intravenous drug addicted, prosthetic valve endocarditis, hemorrhagic stroke, acute congestive heart failure, renal insufficiency, left-sided endocarditis, early surgical as independent predictors of in-hospital mortality.ConclusionsOur study demonstrated a dramatic change in the profile of IE over a period of 18 years at a tertiary hospital in south China and presented several independent predictors of in-hospital mortality. The geographic variations observed in our study will be of important value to profile the clinical feature of China and offer the reference for clinical decisions in our region.

To describe the characteristics of inpatients with diabetes in a tertiary hospital in China using an electronic medical record (EMR)-based database. We identified the medical records of all patients with diabetes from nonpediatric departments of West China Hospital, Sichuan University (from February 2009 to December 2013), and extracted information on demographic, diagnosis, discharge outcome, department of discharge, laboratory test, and prescription from the EMR system. The quality of the database was assessed by analyzing missing data and extreme data and by reviewing the International Classification of Diseases 10th Revision (ICD-10) coding. Among 683,267 discharged patients, 56,784 (8.3%) patients diagnosed with diabetes were identified from all departments. Among the patients with diabetes, the average age was 63.5 ± 13.1 years and the overall death in hospital was 2.2%. Laboratory test results were highly completed in our database with no extreme or discrepant value identified. Anthropometric parameters were of a relatively low quality as 62.2% body-mass index data were missing. HbA1c levels at admission were available for 36.7% patients with diabetes. The ICD-10 coding of the diagnosis of diabetes was accurate in 88.6% records reviewed. Dyslipidemia (76.5%), hypertension (51.3%), chronic kidney disease (22.1%), and hyperuricemia (16.2%) were the most commonly presented comorbidities among inpatients with diabetes. Our study indicated a wide distribution of diabetes throughout the inpatients in a tertiary hospital in southwest China. This EMR-based database of diabetes could be potentially useful in further investigations.

BackgroundNumerous previous research have established the need for spiritual care among patients with cancer globally. Nevertheless, there was limited research, primarily qualitative, on the spiritual care needs of Chinese inpatients with advanced breast cancer. Furthermore, the need for spiritual care was rarely explored using the Kano model. To better understand the spiritual care needs and attributes characteristics of inpatients with advanced breast cancer, this study examined the Kano model.MethodsA descriptive cross-sectional design study was conducted in the oncology departments of three tertiary grade-A hospitals in China from October 2022 to May 2023. To guarantee high-quality reporting of the study, the Strengthening the Reporting of Observational Studies in Epidemiology Checklist was used. Data on the demographic characteristics questionnaire, the Nurse Spiritual Therapeutics Scale (NSTS), and the Kano model-based Nurse Spiritual Therapeutics Attributes Scale (K-NSTAs) were collected through convenience sampling. The Kano model, descriptive statistics, two independent samples t-tests, and one-way analysis of variance were used to analyze the data.ResultsThe overall score for spiritual care needs was 31.16 ± 7.85. The two dimensions with the highest average scores, “create a good atmosphere” (3.16 ± 0.95), and the lowest average scores, “help religious practice” (1.72 ± 0.73). The 12 items were distributed as follows: three attractive attributes were located in Reserving Area IV; five one-dimensional attributes were distributed as follows: three one-dimensional attributes were located in Predominance Area I, and two were found in Improving Area II; two must-be attributes were located in Improving Area II; and two indifference attributes were located in Secondary Improving Area III.ConclusionThe Chinese inpatients with advanced breast cancer had a middle level of spiritual care needs, which need to be further improved. Spiritual care needs attributes were defined, sorted, categorized, and optimized accurately and perfectly by the Kano model. And “create a good atmosphere” and “share self-perception” were primarily one-dimensional and must-be attributes. In contrast, the items in the dimensions of “share self-perception” and “help thinking” were principally attractive attributes. Nursing administrators are advised to optimize attractive attributes and transform indifference attributes by consolidating must-be and one-dimensional attributes, which will enable them to take targeted spiritual care measures based on each patient’s characteristics and unique personality traits.

This study investigated the relationship between clinical nurses' critical thinking ability and medication safety competence, as well as the factors related to medication safety competence. Nurses can have an active role in promoting medication safety. However, the main factors associating with nurses' competence in medication safety are uncertain. This was a descriptive, multicenter cross-sectional survey study. A total of 1196 nurses from four different tertiary hospital in China were included in this study. A demographic information questionnaire, the Critical Thinking Diagnostic for nurses, and the Medication Safety Competence Scale for nurses were used to survey. Descriptive statistics, comparisons, correlation and regression analysis of the collected data were performed using SPSS 26.00 software. The study was reported using STROBE checklist. Included nurses obtained satisfactory scores on the critical thinking and medication safety scales and subscales. There was a strong statistically significant positive correlation between critical thinking ability and medication safety competence. Multiple linear regression analysis indicated that personal critical thinking scores and working years were positively associated with nurses' medication safety scores, accounting for 62.50% of the variance. Clinical nurses' critical thinking ability is positively associated with medication safety competence. As critical thinking ability positively predicts nurses' medication safety competence, hospitals and nursing administrators should consider continuing nursing education and training to improve critical thinking skills, thereby promoting medication safety competence among clinical nurses.

Generative artificial intelligence (AI) has the potential to ease the administrative burden placed on nurses and to advance the quality and efficiency of care. Emerging nursing evidence suggests that increasing clinical complexity is associated with missed care, indicating that generative AI may play a role in supporting clinical judgment and streamlining nursing workflows. Despite these possibilities, its use within nursing area remains at an early developmental stage. This study aims to explore current applications of generative AI in clinical nursing, and to identify its advantages and challenges. This integrative review followed the updated methodology of Whittemore and Knafl in 2005. Individual studies in this review were selected based on their relevance to the utilization of generative AI in clinical nursing practice. A literature search was conducted using PubMed, Cochrane, CINAHL, Web of Science, EMBASE, SCOPUS, and Google Scholar, covering the period from January 2000 to September 2025. A quality assessment was performed using a mixed-methods appraisal tool. The 15 included studies, which were published between 2023 and 2025, comprised randomized controlled trials, cross-sectional studies, qualitative studies, and mixed-methods studies. In clinical nursing practice, generative AI is mainly utilized in three areas: clinical decision-making support, patient education and self-management support for chronic diseases, and efficiency of nursing work. The most common purpose of generative AI is to enhance nursing efficiency. ChatGPT is most frequently used in clinical decision-making support and enhancing nursing workflows, while task-oriented chatbots are primarily applied to patient education and self-management. Generative AI requires enhanced accuracy and reliability through continuous learning from new data, empathic conversations, and human interaction. Our findings suggest that the use of generative AI in nursing practice has the potential to support clinical decision-making, educate patients and enable self-management, and improve nursing efficiency. By reducing documentation burdens, optimizing workflows and enabling personalized care, generative AI could enhance nursing practice. However, these findings should be interpreted cautiously given the heterogeneity of study designs and the predominantly exploratory nature of the available evidence. The integration of generative AI into nursing practice requires continued improvements in accuracy, reliability, empathic interaction and meaningful human involvement. These potential benefits can be realized by nurses, with appropriate competencies and a critical understanding of both the advantages and limitations of generative AI being fostered. Not applicable.

Establishing a positive organizational innovation climate can enhance nurses’ innovative performance and work quality. This study aims to explore the cognitive status and influencing factors of the organizational innovation climate among clinical nurses. The findings of this study will provide a scientific basis for developing innovative nursing talent teams and strengthening innovative management. This is a cross-sectional study. From July 2024 to September 2024, we conducted a paper questionnaire survey of 210 clinical nurses in 3 tertiary hospitals in China. Participants self-reported on general demographic questionnaires and organizational innovation climate scales. The collected data were analyzed using various statistical methods, including descriptive analysis, independent sample t-tests, one-way analysis of variance (ANOVA) tests, and multiple linear regression analysis. Multicollinearity was tested using the variance inflation factor and tolerance test. All analyses were performed using the SPSS software (version 26.0). P < .05 indicated that the difference was statistically significant. In this study, the score for organizational innovation climate among 210 clinical nurses was (73.70 ± 9.25). Organizational innovation incentive was the dimension having the highest score. Resource supply was the dimension having the lowest score. Multiple regression analysis showed that gender, highest education level, years of work experience, position, job satisfaction, and academic conference participation experience were the main factors influencing clinical nurses’ cognition of the organizational innovation climate (P < .05). In this study, the cognitive level of nurses’ organizational innovation climate was moderate level. To improve this level, nursing managers should develop targeted intervention measures for various influencing factors. It is recommended that nursing managers strategically integrate scientific research innovation training into their vocational training programs to stimulate nurses’ innovation consciousness and improve the quality of clinical nursing services.

The aim of this study is to investigate the prevalence of emotional eating and the influencing factors among clinical nurses in China. Emotions are closely associated with eating behaviours, and individuals' coping mechanisms for various emotions may manifest in their eating habits. Emotional eating may harm nurses' physical and mental health, ultimately affecting the quality of care. This is a cross-sectional survey study. An online survey was conducted among clinical nurses in a tertiary hospital in China from September to November 2023 using a convenience sampling method. A basic demographic questionnaire, the Chinese version of the Three-Factor Eating Questionnaire, the Pittsburgh Sleep Quality Index and the Depression Anxiety Stress Scale-21 were used. A total of 785 nurses participated and reported an overall emotional eating score of 12.08 (standard deviation = 4.63); 296 (37.7%) were in the high emotional eating group. Female gender, age20-30 years, higher body mass index, work in the intensive care unit, family financial contribution ≤ 10 000 RMB, poor sleep quality and anxiety were risk factors for emotional eating among clinical nurses. The study highlights a prevalent issue of emotional eating among clinical nurses, indicating a pressing need for timely intervention to improve physical and mental health.

BackgroundEffective hand hygiene is a fundamental aspect of ensuring clinical nursing safety and quality. This study aims to investigate the knowledge, attitudes, and practices (KAP) of hand hygiene among clinical nurses, thereby providing evidence-based recommendations for clinical nursing and hygiene management.MethodsThe study was carried out between September 2024 and January 2025, involving clinical nurses from our hospital. Data were collected using a validated and widely recognized KAP questionnaire. Clinical trial number: not applicable.ResultsA total of 364 clinical nurses participated in the study. The accuracy rate of hand hygiene knowledge was 75.82%. Factors significantly associated with nurses’ hand hygiene knowledge included years of nursing experience, professional title, receipt of hand hygiene training within the past three months, and the total duration of hand hygiene training received over the past three months. Professional title, working department, and receipt of hand hygiene training within the past three months were significant predictors of nurses’ attitudes toward hand hygiene. Working department, receipt of hand hygiene training within the past three months, and the total duration of hand hygiene training received over the past three months were significant factors influencing nurses’ hand hygiene practices.ConclusionsClinical nurses demonstrated moderate levels of hand hygiene knowledge, with notable gaps in identifying specific indications for hand hygiene. These findings underscore the need for targeted training programs, sustained practice reinforcement, and supportive environmental interventions to enhance hand hygiene compliance and reduce the incidence of healthcare-associated infections.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12909-025-08155-x.

The widespread use of antimicrobial agents correlated with the increasing incidence of nosocomial infections and bacterial antibiotic resistance. These have become major challenges in the prevention and control of hospital-acquired infections worldwide. The aims of this study were to analyze the distribution and characteristics of ESKAPE pathogenic bacteria and their antibiotic resistance profile among clinical isolates from a tertiary hospital in China from 2018 to 2023. The results showed that a total of 20,472 non-duplicated pathogenic bacteria were isolated from clinical specimens in this hospital between 2018 and 2023, of which the top five pathogenic bacteria were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Acinetobacter baumannii. In case of E. coli the main detected resistance genes were blaCTX-M, blaTEM and blaOXA. K. pneumoniae mainly carried blaOXA, blaKPC and blaNDM genes. P. aeruginosa was mainly positive for blaOXA, AmpC type beta-lactamases and blaVIM genes. A. baumannii mainly carried ArmA, blaTEM and cas3 genes. S. aureus was mainly positive for mecA, erm(C) and erm(A) genes. In this study, we have found that the antibiotic resistance of common pathogens from clinical isolates in a tertiary hospital in China in the past 6 years is severe, and A. baumannii was particularly a prominent pathogen. There is an urgent need to strengthen the prevention and control of nosocomial infections and antimicrobial drug management in order to curb the spread of multidrug-resistant bacteria.

Falls are among the most frequently reported serious and preventable adverse events in hospitalized adults, often leading to significant injuries, including fractures, subdural hematomas, or even death. This project aimed to promote evidence-based fall prevention practices and reduce fall-related injuries among hospitalized adult patients at a tertiary hospital in China. Guided by the JBI Evidence Implementation Framework, this project was conducted across nine pilot wards at a tertiary hospital in China from July 2024 to April 2025. Eight audit criteria were developed to measure compliance with best practices related to fall risk screening and multifactorial assessment, individualized and patient-centered interventions, staff training, and patient education. Barriers were analyzed and addressed through targeted strategies. A follow-up audit evaluated changes in compliance, as well as improvements in nurses' knowledge, attitudes, and practices. Falls and fall-related rates before and after the intervention were also assessed. Compliance improved across all eight audit criteria. Nurses demonstrated improved knowledge and practice, while patients showed improved knowledge, attitudes, and practices regarding fall prevention. The falls rate declined from 0.48 to 0.25 per 1,000 patient days, while the incidence of fall-related injuries decreased from 35.3% to 0%. This best practice implementation project strengthened multifactorial falls risk assessment and personalized interventions, enhanced nurses' and patients' engagement in falls prevention, and ultimately reduced falls and fall-related injury rates among hospitalized patients. http://links.lww.com/IJEBH/A498.