Differences in clinical nurses’ and nurse leaders’ perceived needs for digital twin–based ward management systems: cross-sectional network analysis

Abstract

Digital twin (DT) technology may support intelligent ward management by integrating real-time data, simulation, and decision support. However, clinically useful DT systems must reflect the priorities of both frontline and managerial users. Evidence comparing the perspectives of these stakeholder groups remains limited. This study aimed to compare clinical nurses’ and nurse leaders’ perceived needs for DT-based ward management systems and identify role-specific priority structures using network analysis. We conducted a multicenter cross-sectional web-based survey in China from April to August 2025. Clinical nurses and nurse leaders completed the 15-item Digital Twin-Based Intelligent Ward Management Needs Scale (DT-IWMNS). We summarized between-group differences in item and domain scores and estimated separate regularized Gaussian graphical models for the two groups. Network stability was evaluated using case-dropping bootstrap procedures, and network structure and global strength were compared using permutation tests. Of 1526 eligible nurses, 1329 provided valid questionnaires, including 1024 clinical nurses and 305 nurse leaders. Clinical nurses had a higher observed mean overall DT-IWMNS score than nurse leaders (4.42 [SD 0.71] vs. 4.18 [SD 0.75]; Hedges’ g = 0.33). In exploratory comparisons, the network structures differed ( P < 0.001), whereas global strength did not ( P = 0.320). Patient-condition alerts (item 7; standardized strength = 1.13) and workforce optimization (item 2; standardized strength = 1.11) were the most central needs among clinical nurses. Workforce optimization (item 2; standardized strength = 1.29) and ward air-quality monitoring (item 14; standardized strength = 1.26) were the most central needs among nurse leaders. Strength centrality showed acceptable stability in both networks (correlation stability coefficients were 0.44 and 0.36, respectively), whereas closeness and betweenness were unstable and were not interpreted. Clinical nurses and nurse leaders reported high overall demand for DT-based ward management systems but differed in how they prioritized and interconnected specific functions. Participatory, role-sensitive development should integrate frontline priorities for real-time patient support with managerial priorities for workforce and environmental oversight. Prospective usability and implementation studies are needed before these perceived needs can be translated into claims of clinical effectiveness. Not applicable.

The authors' abstract, as published at the source. BMC Nursing, 2026 · DOI ↗