Sung Ok Chang

Purpose: Nursing homes face a growing demand for high-quality palliative wound care. Nursing home staff require not only knowledge but also clinical judgment to address the complex needs of residents at the end of life. This study aimed to develop and evaluate a web-based palliative wound care education program using a clinical judgment model. Methods: An educational program was developed using the ADDIE model through needs analysis with 10 nursing home staff, program design and development, and pilot implementation and evaluation. Program effectiveness was evaluated in a quasi-experimental study with facility-level random allocation. Four nursing homes were randomly allocated to the experimental or control condition, and 52 nursing home staff were included in the final analysis (n=26 per group). The experimental group received clinical judgment model-based web education, whereas the control group received general web-based palliative wound care education without the clinical judgment model. Clinical judgment was assessed before and after the intervention using nonparametric tests. Results: Both groups showed significant improvements in clinical judgment. However, the experimental group demonstrated greater improvements than the control group in noticing (Z=-3.91, p<.001), interpreting (Z=-3.39, p=.001), responding (Z=-3.64, p<.001), reflecting (Z=-2.30, p=.021), and the total clinical judgment score (Z=-4.62, p<.001). Conclusion: The findings support the effectiveness of clinical judgment model-based education in improving clinical judgment in palliative wound care. This web-based approach supports continuing education and improves care quality in nursing homes.

During the recent global pandemic, nursing home (NH) residents were among the most vulnerable, yet empirical insights into how practitioners conceptualized and implemented infection control in NHs were limited. This study aimed to explore the ways in which interdisciplinary NH practitioners understood and conceptualized infection control in response to emerging infectious diseases and to identify a structural framework derived from their perceptions. A qualitative phenomenographic research design was employed. In-depth interviews were conducted with 21 interdisciplinary practitioners from three NHs. Data were analyzed using the seven-step phenomenographic approach. Two overarching categories were identified: "assessments based on vulnerability" and "interventions focused on prevention," each consisting of sub-categories that reflected practitioners' ways of understanding infection control. A hierarchical outcome space was developed to illustrate the dynamic and cyclical nature of infection control in NHs. The findings highlight the need for a proactive, interdisciplinary approach tailored to the unique environment of NHs. This framework may guide future educational initiatives and provide a practical reference for training new practitioners lacking pandemic experience.

Purpose: End-of-life care is a multifaceted and holistic domain of nursing practice, and strengthening the competencies of nursing home nurses has become increasingly important in the context of a rapidly aging global population. This study aimed to apply the attention, relevance, confidence, and satisfaction (ARCS) model to a web-based end-of-life care education program and to evaluate its effects on learning motivation and end-of-life care competency among nursing home nurses.Methods: The education program was developed using the analysis, design, development, implementation, and evaluation (ADDIE) model. In Phase 1, needs and learner analyses were conducted through interviews with 20 nursing home nurses to inform the development of the educational content. In Phase 2, the effectiveness of the program was evaluated using a multisite, single-blind, quasi-experimental design. A total of 60 nursing home nurses were recruited and assigned to two groups. The experimental group received a web-based end-of-life care education program grounded in the ARCS model, whereas the control group received text-based online education.Results: The analysis demonstrated that all components of learning motivation and end-of-life care competency showed significantly greater improvement in the experimental group than in the control group.Conclusion: These findings support the effectiveness of ARCS-based instructional design in continuing education for nursing home nurses, particularly in addressing the growing demand for high-quality end-of-life care in aging societies.

Aim: To systematically synthesise nurses' perspectives on dignified death, providing a culturally informed and comprehensive understanding. Design: Meta‐ethnography. Methods: This study was conducted using Noblit and Hare's approach, which included reciprocal translation, refutational synthesis, and line‐of‐argument synthesis. Methodological rigour and credibility were evaluated using the Critical Appraisal Skills Program (CASP) checklist. The review included peer‐reviewed qualitative studies published in English or Korean that focused on nurses' or nursing students' views on dignified death in end‐of‐life care. Data Sources: A systematic search was conducted in MEDLINE, EMBASE, CINAHL, and the Web of Science in August 2023, with an updated search in August 2024. Seventeen qualitative studies published between 2010 and 2024 met the inclusion criteria. Results: Four interconnected themes emerged: A death that embraces humanity, a death that preserves personal identity, a death that facilitates connection and reconciliation, and a death that affirms acceptance and spiritual serenity. These themes, including eight sub‐themes, highlight cultural influences shaping nurses' approaches to dignified death. Conclusion: The findings emphasise the influence of cultural context in shaping end‐of‐life care and support the development of culturally sensitive nursing education and guidelines to enhance care quality. Implications for the Profession and Patient Care: This research provides culturally grounded strategies to improve end‐of‐life care and strengthen nurses' competencies in delivering holistic support. Impact: This study highlights cultural variations in nurses' approaches to balancing autonomy, family expectations, and spiritual needs, offering practical insights for holistic, patient‐centred, and culturally sensitive care. Reporting Method: This review complies with the Equator and improving reporting of meta‐ethnography (eMERGe) guidelines. Patient or Public Contribution: No patient or public contribution.

Purpose: Infection control is a critical concern in nursing homes, especially in the post-COVID-19 era, due to the frailty and complex health conditions of older adults. This study aimed to develop an educational framework to improve infection control practices in nursing homes. Methods: We interviewed five infection specialists to gain practical insights. Subsequently, we administered three rounds of Delphi surveys to 20 nursing home practitioners to assess the validity and practicality of the selected items, thereby establishing a comprehensive framework. Results: The interview data revealed three key categories: recipient-centered, interaction-centered, and environment-centered. Following the Delphi surveys, we identified seven crucial factors for practicality in nursing homes: the characteristics of residents’ health, detection of subtle changes, identification of nonverbal signs, effective communication among professionals, feedback and assessment among professionals, following infection control principles, education based on problem-solving, and immunization and isolation strategies for creating a safe environment. Conclusion: By integrating expert insights and validating the framework through the Delphi technique, the proposed framework enhances infection control training and education programs in nursing homes, ultimately ensuring resident safety.

Purpose: This study employed Q-methodology to explore frames of reference of nursing home practitioners in managing discomfort of residents with dementia. Methods: In-depth interviews were conducted with eight nursing home practitioners, all of whom had experience caring for residents with dementia. Additionally, a literature review on discomfort, its assessment, and interventions was conducted. Thirty-four practitioners as a P-sample, including nurses, care workers, social workers, and physical therapists, classified 34 Q-samples through Q-sorting. Data analysis was performed using the PQ-method 2.35 program. Results were interpreted based on factor arrays, post-interview data, and distribution of the P-sample. Results: Four Q-factors were identified as practitioners’ frames of references for discomfort management of nursing home residents: exploring possible management based on a synthesis of related clues, an individual assessment-based approach using possible assumptions, linking subtle changes to management direction based on a trusting relationship, and configuration-centered management direction using objective data. Conclusion: Utilizing nursing home practitioners’ frames of reference for managing demented residents’ discomfort can be used for developing strategies that can be used in practitioners’ education and promoting practice that can reduce discomfort of nursing home residents.

Background: Pressure injuries (PIs) are a significant issue in nursing homes (NHs) that affect residents’ physical, psychological, and financial well-being. Despite advancements in prevention and management, PIs remain a critical challenge requiring a comprehensive analysis of research trends to guide future efforts.Methods: We analyzed 1,857 research abstracts published up to December 2023 using text network analysis and topic modeling. Keyword frequency, co-occurrence patterns, and centrality metrics were examined to identify the key terms. Latent Dirichlet allocation was employed for topic modeling, and trends were analyzed over decades to explore the evolution of research priorities.Results: The most frequent keywords were “patient,” “care,” and “wound,” emphasizing the central themes of patient care and wound management. Four main topics were identified: Managing PI Complications, Preventing PIs and Maintaining Skin Integrity, Improving Organizational Strategies for PI Care, and Managing Systemic Conditions in PI Care. Trends revealed a decline in studies on post-injury management, while prevention and organizational strategies have gained prominence. Patient-specific risk factors have consistently attracted attention over the decades, highlighting the importance of individualized care.Conclusion: This study underscores the shift from reactive post-injury management to proactive prevention and organizational strategies in PI research. These findings emphasize the need for integrated approaches that combine patient-centered care with systemic and preventive measures to improve outcomes in NHs.

Aim: Exploring how nursing home nurses who care for residents with dementia experience moral distress.Design: A qualitative phenomenography design.Methods: Phenomenography was used in this qualitative study. In‐depth interviews were conducted with 20 nurses caring for residents with dementia at three nursing homes using phenomenographic analysis.Results: Six categories were divided into two groups. The ‘reflection on my nursing’ group included the categories ‘anguish over qualifications to care for residents’, ‘uncertainty about the adequacy of the care provided’, and ‘internal conflict over whether to compromise with unsatisfactory outcomes’. The ‘moral awareness’ group included ‘being aware of deviations from the standards I set and the care I provide’, ‘recognising when I become insensitive to things I should not do’, and ‘ruminating about whether it would be okay if I have no choice’. Comprehensively, it was found that moral distress occurs when reflecting on nursing and moral awareness conflicts.Conclusion: This study provides insight into the various ways in which nursing home nurses experience moral distress when caring for residents with dementia. This study can provide a basis and direction for various strategies to reduce moral distress.Implication for the Profession and/or Patient Care: Considering the growing interest in the moral distress experienced by nurses, along with the importance of the human rights of residents with dementia in an aging society, these research results will have a positive impact on improving the quality of care provided by nursing home nurses to residents with dementia.Patient or Public Contribution: No patient or public contribution.Reporting Method: We have adhered to relevant COREQ guidelines.

Continuing education in nursing homes (NHs) is facing a transition to distance learning, such as web-based education, as demonstrated during the COVID-19 pandemic. Since behavioral and psychological symptoms of dementia (BPSD) are managed through integrative direct care by nursing staff, including nurses, nursing assistants, and care workers with diverse educational backgrounds and needs, an effective and efficient web-based education program with a concrete pedagogical and theoretical basis is essential. Therefore, this study aimed to develop an adaptive learning web-based BPSD education system for NH nursing staff. The adaptive learning web-based BPSD education program, with an embedded artificial intelligence chatbot, was developed based on the frameworks of BPSD education and adaptive learning models. The educational program was evaluated using a multisite, single-blinded, quasi-experimental design. Fifty-eight nursing staff were recruited from five different NHs. The experimental group received an adaptive learning system that tailored content to prior knowledge, while the control group received a non-adaptive web-based system. The results from the analysis indicated that all components of learning effectiveness, including BPSD competence, BPSD knowledge, and self-efficacy, were significantly improved in the experimental group compared with the control group. System satisfaction was significantly higher in the experimental group than in the control group, and 75% of the participants in the experimental group actively adapted their individual educational content. These findings indicate that the adaptive learning system had positive outcomes on learning and system effectiveness, suggesting an innovative strategy toward a “new normal” education for NH nursing staff in the post-COVID-19 era.

Aim: To identify a frame of reference for resident safety management in nursing homes. Design: Q‐methodology. Methods: This study was conducted using Q‐methodology to identify shared perspectives about resident safety management among nursing home professionals. Data were collected from 13 May 2023, through 29 August 2023. Thirty‐four professionals, including nurses, care workers, social workers and physical therapists, classified Q‐samples into a normal distribution grid through Q‐sorting. Data analysis was performed using the PQmethod programme. Q‐factors were interpreted by integrating interview transcripts, demographic data and factor arrays that organised the analysis results. Results: The analysis included the Q‐sort of 33 professionals, with an average age of 46.03 years and 6.53 years of nursing home experience, after excluding one individual who did not fit any Q‐factor. Four Q factors explaining 63% of the total variance were identified: constructing individualised possible risk trajectories, utilising ingrained safety principles, creating supportive safety environments and coordinating safety principles with individual needs. Conclusion: Understanding the diverse subjectivities of professionals can help develop strategies that promote collaboration among nursing home professionals and support preventive safety management practices. Implications for Profession and/or Patient Care: The frame of reference derived from nursing home professionals' perspectives suggests a resident‐tailored framework. Impact: This study supports the development of interprofessional education tailored to the specific needs of nursing home settings by identifying shared perspectives among nursing home professionals. The findings highlight the need for clear guidelines to help professionals balance resident autonomy with safety and assess the impact of family involvement. Reporting Method: Reporting involved qualitative and quantitative approaches, in compliance with the MMAT criteria for mixed‐method research. Patient or Public Contribution: No Patient or Public Contribution.