Jia-Ling Tsai

Background: Small Private Online Courses (SPOCs) apply a small-group, blended learning format to facilitate instructor–learner interactions. SPOCs are ideal for time-limited learners in clinical settings. Purpose: This study was designed to evaluate the effectiveness of using an SPOC-based course with a sample of nurses in terms of enhancing their knowledge and reducing their perceived barriers to sexual health communication. Methods: This prospective randomized controlled trial was conducted at a teaching hospital in northern Taiwan. One hundred fifty in-service nurses were recruited and randomly assigned to either the control group ( n = 75), which received the standard in-service nursing education program, or the intervention group ( n = 75), which received the SPOC-based program in sexual health communication in addition to the standard education program. The intervention group completed five 15-minute online courses followed by a 2-hr offline course. Primary outcomes (sexual health care attitudes and perceived barriers to discussing sexuality) and a secondary outcome (frequency of engaging in sexual health communication with patients) were assessed at baseline (pretest, T1) and at 1 and 3 months after module completion (T2 and T3, respectively). Generalized estimating equations were used to analyze between-group differences in pretest–posttest changes. Results: All 150 participants completed the baseline assessment; attrition occurred at the 1- and 3-month follow-ups. No participants were lost at baseline; however, follow-up attrition occurred at T2 and T3. Changes over time from baseline in attitudes toward sexual health communication and perceived barriers to discussing sexual health were significantly greater in the intervention group than in the control group. Importantly, the percentage of intervention group participants engaging in discussions with patients about sexual health increased from baseline to T2 and from T2 to T3, while no similar change over time was observed for the control group. Conclusions: The significant improvements reported for the intervention group demonstrate that cost-effective learning outcomes are achievable in spite of significant time and resource limitations. This was the first time SPOC-based learning has been used in the context of nursing education to improve sexual communication. The findings of this study suggest this format is suitable for a broader range of courses.

Background: Pain and emotional distress are prevalent concerns in pediatric hospital care, underscoring the need for safe and evidence-based nonpharmacological interventions. Socially assistive robots (SARs) are innovative tools that alleviate pain and emotional distress through social interaction. Although previous reviews suggest potential benefits, the evidence remains ambiguous, with insufficient exploration of the contextual factors influencing the effective implementation. Objective: This systematic review with meta-analysis evaluates the effectiveness of SARs in reducing pain and emotional outcomes in pediatric hospital settings and identifies methodological, contextual, and ethical factors informing future implementation. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020, 8 databases (PubMed, MEDLINE, Embase, Cochrane Library, Scopus, IEEE Xplore, Health & Medical Collection, and ProQuest Dissertations & Theses A&I) were searched until October 7, 2025. Eligible studies were randomized controlled trials involving participants aged <19 years in hospital settings. Two reviewers independently screened, extracted data, assessed risk of bias, and evaluated the certainty of evidence. Random-effects meta-analyses were performed using the Hartung-Knapp-Sidik-Jonkman method. Both CIs and prediction intervals (PI) were interpreted. Results: Thirteen randomized controlled trials were included, of which 7 were eligible for meta-analyses. The narrative synthesis, incorporating intervention characteristics and contextual factors, suggested potential psychological benefits. For pain, a pooled analysis of 5 trials showed a significant reduction favoring SARs (difference in means=–0.89, 95% CI –1.32 to –0.47; 95% PI –1.29 to –0.49; I²=11.9%, τ²<0.0001, τ<0.01). For anxiety (3 trials; difference in means=–1.00, 95% CI –2.44 to 0.44; 95% PI –3.45 to 1.45; I²=73.8%, τ²=0.217, τ=0.466), fear (2 trials; difference in means=–0.04, 95% CI –1.72 to 1.64; I²=0%, τ²=0), and distress (2 trials; difference in means=–0.23, 95% CI –6.00 to 5.54; I²=65%, τ²=0.269, τ=0.519), pooled effects were nonsignificant with wide PIs. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) assessment indicated an overall moderate certainty of evidence, limited primarily by the risk of bias, due to the nonblinded nature of the interventions and the small number of studies. Conclusions: SARs may serve as promising nonpharmacological adjuncts for pediatric pain management, demonstrating consistent and reproducible benefits across similar hospital contexts. In contrast, the evidence for emotional outcomes remains ambiguous. The PI indicating that while some children may experience emotional benefits, others may show null or even opposite effects. This variability highlights the real-world implications for the clinical implementation of SARs. Moreover, this study offers an innovative integration of contextual, ethical, and technological perspectives into a comprehensive synthesis, providing a multidimensional understanding of how SARs function within pediatric health care environments. Future research should adopt rigorous designs and incorporate ethical considerations to optimize effects and ensure sustainable implementation of SARs in pediatric health care. Trial Registration: PROSPERO CRD420251026751; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251026751

BACKGROUND Pain and emotional distress are prevalent concerns in pediatric hospital care, underscoring the need for safe and evidence-based nonpharmacological interventions. Socially assistive robots (SARs) are innovative tools that alleviate pain and emotional distress through social interaction. Although previous reviews suggest potential benefits, the evidence remains ambiguous, with insufficient exploration of the contextual factors influencing the effective implementation. OBJECTIVE This systematic review with meta-analysis evaluates the effectiveness of SARs in reducing pain and emotional outcomes in pediatric hospital settings and identifies methodological, contextual, and ethical factors informing future implementation. METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020, 8 databases (PubMed, MEDLINE, Embase, Cochrane Library, Scopus, IEEE Xplore, Health & Medical Collection, and ProQuest Dissertations & Theses A&I) were searched until October 7, 2025. Eligible studies were randomized controlled trials involving participants aged <19 years in hospital settings. Two reviewers independently screened, extracted data, assessed risk of bias, and evaluated the certainty of evidence. Random-effects meta-analyses were performed using the Hartung-Knapp-Sidik-Jonkman method. Both CIs and prediction intervals (PI) were interpreted. RESULTS Thirteen randomized controlled trials were included, of which 7 were eligible for meta-analyses. The narrative synthesis, incorporating intervention characteristics and contextual factors, suggested potential psychological benefits. For pain, a pooled analysis of 5 trials showed a significant reduction favoring SARs (difference in means=–0.89, 95% CI –1.32 to –0.47; 95% PI –1.29 to –0.49; I²=11.9%, τ²<0.0001, τ<0.01). For anxiety (3 trials; difference in means=–1.00, 95% CI –2.44 to 0.44; 95% PI –3.45 to 1.45; I²=73.8%, τ²=0.217, τ=0.466), fear (2 trials; difference in means=–0.04, 95% CI –1.72 to 1.64; I²=0%, τ²=0), and distress (2 trials; difference in means=–0.23, 95% CI –6.00 to 5.54; I²=65%, τ²=0.269, τ=0.519), pooled effects were nonsignificant with wide PIs. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) assessment indicated an overall moderate certainty of evidence, limited primarily by the risk of bias, due to the nonblinded nature of the interventions and the small number of studies. CONCLUSIONS SARs may serve as promising nonpharmacological adjuncts for pediatric pain management, demonstrating consistent and reproducible benefits across similar hospital contexts. In contrast, the evidence for emotional outcomes remains ambiguous. The PI indicating that while some children may experience emotional benefits, others may show null or even opposite effects. This variability highlights the real-world implications for the clinical implementation of SARs. Moreover, this study offers an innovative integration of contextual, ethical, and technological perspectives into a comprehensive synthesis, providing a multidimensional understanding of how SARs function within pediatric health care environments. Future research should adopt rigorous designs and incorporate ethical considerations to optimize effects and ensure sustainable implementation of SARs in pediatric health care. CLINICALTRIAL PROSPERO CRD420251026751; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251026751

Purpose This study aimed to evaluate the effects of a one-session sexual health education program using a transtheoretical model to enhance sexual self-efficacy in patients with cervical cancer. Methods This study recruited patients with cervical cancer from the gynecological wards of a medical center in northern Taiwan. A total of 63 participants were divided into 2 groups: the control group (n = 30) received traditional sexual health education. The intervention group (n = 33) participated in a transtheoretical model (TTM)‐based sexual health education program. Scores from self-report questionnaires for variables of knowledge, attitudes, and self-efficacy regarding sexual health collected 1 and 6 weeks after the intervention were compared with baseline scores. Results Patients who received transtheoretical model (TTM)-based sexual health education had significantly greater sexual knowledge (β = 3.794, p < 0.01), sexual attitudes (β = 9.226, p < 0.01), and sexual self-efficacy (β = 17.053, p < 0.01) than those who received traditional sexual health education at 1 and 6 weeks. Conclusion Our findings suggest that a one-session sexual health education using a TTM-based model can enhance sexual knowledge, attitudes, and sexual self-efficacy among patients with cervical cancer. This educational program can be translated into routine clinical practice to help patients with cervical cancer enhance their sexual health and improve confidence in their sexual well-being.

Background. To investigate the effects of robot‐assisted gait training (RAGT) on spasticity and pain in people with spinal cord injury (SCI). Material and methods. Four electronic databases (PubMed, Scopus, Medline, and Cochrane Central Register of Controlled Trials) were searched for studies published up to November 2019. Only human trials and of English language were included. The searched studies were reviewed and extracted independently by two authors. Randomized controlled trials (RCTs) and non‐RCTs were pooled separately for analyses. Primary outcome measures included spasticity assessed by Ashworth scale (AS) or modified Ashworth scale (MAS) and pain assessed by VAS. Secondary outcome measures included lower extremity motor score (LEMS) and walking ability (i.e., 6‐minute walk test, 10‐meter walk test). Results. A total of 225 studies were identified. Eighteen studies (7 RCTs and 11 non‐RCTs) including 301 subjects met inclusion criteria. The outcome measure of spasticity significantly improved in favor of RAGT group in non‐RCTs (AS: 95%CI = −0.202 to ‐0.068, p ≤ 0.001; MAS: 95%CI = −2.886 to ‐1.412, p ≤ 0.001). The results on pain did not show significant change after RAGT in either RCTs or non‐RCTs. LEMS and walking ability significantly increased in favor of RAGT. Conclusions. RAGT can improve spasticity and walking ability in people with SCI. The probable reason for no significant change in pain after RAGT is floor effect. RAGT is beneficial for normalizing muscle tone and for improving lower extremity function in people with SCI without causing extra pain.

Childhood obesity is associated with type 2 diabetes mellitus. We aimed to determine the effects of lifestyle modification programs on fasting plasma glucose (FPG) levels in overweight children. We queried six relevant electronic databases and manually searched for studies published before December 2016. Overweight/obese children who underwent a lifestyle modification for more than 6 months were included. A total of 3923 children from eight randomized controlled trials (RCTs) were included. Compared with the control group, the lifestyle modification group had significantly lower FPG levels by 1.3 mg/dL. The mean differences were significantly decreased for both secondary outcomes; BMI z‐score decreased by 0.16 units and insulin levels decreased by 2.4 mU/L. The metaregression showed that the follow‐up duration was associated with FPG levels and BMI and insulin levels and half year is a suitable follow‐up duration for this population. This study showed that lifestyle modification programs may be effective in reducing the FPG levels of overweight/obese children. Further high‐quality RCTs with longer follow‐up periods are needed to evaluate the long‐term effect of this complementary approach for diabetes mellitus prevention on overweight/obese children.

Understanding the sexual experience of women after gynecological cancer is important for nurses caring for this population. Sexual experience should be studied within women's sociocultural context because it influences the construction of sex. However, the sexual experience of Chinese women after gynecological cancer has not been examined qualitatively. The aim of this study is to explore the sexual experience of Taiwanese women after treatment for gynecological cancer. Data for this phenomenological study were collected during in-depth, semistructured interviews with 11 women purposively recruited from outpatients of the gynecological clinic of a medical center in northern Taiwan. Interview data were analyzed using the Colaizzi method. Data analysis yielded 4 themes: (1) suffering from sexual changes and difficulties, (2) judgments and uncertainty about the appropriateness of sexual behavior, (3) maintenance and transformation of sexual expression, and (4) reinterpretation and reaffirmation of feminine value. This woman-centered view of the sexual experience of Taiwanese gynecological cancer survivors can help healthcare professionals understand and educate Chinese and Asian clients about women's sexual expression during and after cancer treatment. This woman-centered view of the sexual experience of Taiwanese gynecological cancer survivors can help healthcare professionals understand and educate women about possible alternative ways of sexual expression during and after cancer treatment.

Introduction: Postpartum sexual health education was once routinely administered to postpartum women, but few interventions were specifically described or clearly based on theory, and few sexual interventions affected women’s sexual behaviors. Aim: To evaluate the effectiveness of a refined theory-based interactive postpartum sexual health education program (IPSHEP) in enhancing postpartum women’s sexual behavior and health. Methods: For this prospective, randomized controlled trial, 250 participants were randomized to three groups. Experimental group A received our refined theory-based IPSHEP. Experimental group B received only an interactive, self-help pamphlet. The control group received routine education (a 10- to 15-minute educational talk and a sexual health pamphlet without an interactive design). Data were collected at baseline, 3 days, 2 months, and 3 months postpartum. Main Outcome Measure: Postpartum women’s sexual self-efficacy (SSE), diversity of sexual activity (DSA), return to sexual activity, and sexual satisfaction (SS). Results: Women who received our theory-based postpartum sexual health education program had significantly greater SSE (P < 0.05) and greater DSA (P < 0.05), and tended to resume their sexual life earlier than women in the routine teaching and interactive pamphlet-only groups (P < 0.05). However, the SS levels of postpartum women who received our program did not differ significantly from those of women who received routine teaching or the interactive pamphlet only. Conclusions: Our findings suggest that a theory-based postpartum sexual health education program improved women’s sexual health and sexual behavior and that the transtheoretical model can be translated into practice, supporting its use to enhance the sexual health of postpartum women. Despite the lack of a significant effect on SS, women who received our theory-based postpartum sexual health education program tended to maintain their prepregnancy level of SS in early postpartum.

Comfort is an important concept and core value of nursing. The defining attributes, antecedents and consequences of comfort need further analysis and exploration, even though the concept of comfort has been addressed previously in nursing literature. We employed the strategies of concept analysis as described by Walker&Avant (2005) to analyze the concept of comfort. The defining attributes of comfort include: 1) effective communication; 2) family and meaningful relationships; 3) maintaining functionality; 4) self-characteristics; 5) physical symptom relief, states, and interventions; 6) psychological, spiritual activities and states; and 7) a sense of safety and security. Antecedents consist of discomfort, distress and suffering. Consequences consist of (1) met/satisfied needs; (2) increased sense of control; (3) sense of inner peace; (4) a pleasant experience; (5) feeling cared for; (6) relief of symptoms; (7) reduced suffering; (8) decreased disequilibrium; and (9) absence of discomfort. We also outline the construction of cases, empirical references and comfort measurement tools. Analysis found comfort to have multiple dimensions and confirmed it as a clinical issue that should receive greater emphasis and valuation. Findings are hoped to increase nurse understanding of the concept of comfort and enable nurses to evaluate level of comfort and follow up on variations in such using empirical tools. Concept analysis can guide further comfort related interventions and research to benefit patients.