Positioning virtual reality as means of clinical experience in mental health nursing education: A quasi-experimental study.

PURPOSE: Virtual reality technology has been used to establish a risk-free environment in which students can practice psychiatric nursing. A quasi-experimental study was conducted to examine the effects of a virtual reality (VR) based mental health nursing simulation on practice performance of undergraduate nursing students. METHODS: A quasi-experimental, pre- and post-test design was used. A total of 68 students were randomly assigned to an experimental group (n = 32) and a control group (n = 36). The control group received conventional simulation using text scenario-based role play. The intervention group received VR software consisting of 360° video clips and related quiz questions. RESULTS: The self-reported perceived competency in nursing performance showed no statistically significant improvement in the experimental group, whereas the control group showed a statistically significant improvement in symptom management (t = 2.84, p = 0.007) and nurse-patient interaction (t = 2.10, p = 0.043). Scores from the assessor showed better performance scores in the experimental group in symptom management (t = -2.62, p = 0.011), violence risk management (t = -3.42, p = 0.001), and nurse-patient interaction (t = -3.12, p = 0.003). CONCLUSIONS: The findings of this study indicate the potential of using VR for optimized mental health nursing simulation. VR technology allowed realistic experiences which may ensure students have a more comprehensive understanding of mentally ill patients and in doing so, overcome barriers of traditional simulation, resulting in better learning outcomes.

Constructing a Mixed Simulation With 360° Virtual Reality and a High-Fidelity Simulator: Usability and Feasibility Assessment.

Virtual reality technology has been adopted to overcome barriers of conventional simulation. This study was conducted to determine the impact of mixed simulation (a 360° virtual reality and a high-fidelity simulator) on learning how to provide nursing care for patients with arrhythmia. A total of 49 students were randomly assigned to intervention (n = 25) and control (n = 23) groups. They were given four arrhythmia cases with a 360° virtual reality system first followed by a manikin-based simulation. The mixed simulation group showed greater improvement in knowledge, higher decision-making competency in "knowing and acting" ( P = .025) and "seeking information from instructors" ( P = .049), and lower anxiety in "using resources to gather information" ( P = .031). Study participants achieved a good level of empathy (3.28 ± 0.72) and liked the program (4.56 ± 0.60). They were satisfied with the program (4.48 ± 0.65). These findings provide new insight into learning through blending of new technology. When the 360° virtual reality was used with existing manikin-based simulation, they effectively reinforced one another. The 360° virtual reality can be an effective strategy to ensure active participation to gain a comprehensive understanding of and empathy for patients.

Effects of App-Based Mobile Interventions for Dementia Family Caregivers: A Systematic Review and Meta-Analysis.

BACKGROUND: Dementia was caregivers experience tremendous difficulties both physically and psychologically, leading to high levels of depression and caregiver burden. The advantage of mobile interventions has been recognized due to its freedom from time and space restrictions. OBJECTIVES: A systematic review and meta-analysis was conducted to evaluate effectiveness of app-based mobile interventions for dementia caregivers. METHOD: We searched nine different databases including CINAHL, the Cochrane Library, Embase, MEDLINE, PsycINFO, the ACM digital library, IEEE Xplore, KoreaMed, and RISS for publications on app-based mobile interventions targeting dementia caregivers published in English or Korean. Meta-analysis was conducted using Comprehensive Meta-Analysis (CMA) version 3.0. Standard mean difference (SMD) was used to estimate the effectiveness of the intervention on caregiver-related outcomes of caregiver burden, depression, stress, caregiving competency, and quality of life (QoL). RESULTS: Five studies (three randomized controlled trials and two quasi-experimental studies) with a total of 230 participants were included. Using a mobile device, interventions were used to provide information and feedback, perform monitoring, and conduct skill training. Pooled analysis showed favorable effects of app-based mobile interventions for caregivers on caregiver burden (SMD = -0.315, 95% CI: -0.681 to 0.052), depression (SMD = -0.236, 95% CI: -0.517 to 0.046), stress (SMD = -0.295, 95% CI: -0.708 to 0.118), competency (SMD = 0.434, 95% CI: 0.093-0.775), and QoL (SMD = 0.794, 95% CI: 0.310-1.278). CONCLUSION: Types of mobile devices, lengths, and contents of interventions varied between included studies. Given that only five studies were included, the current meta-analysis could not confirm the effectiveness of app-based mobile interventions. However, this study suggests that app-based mobile interventions for dementia caregivers might have positive effects on diverse caregiving-related issues such as caregiver burden, depression, stress, competency, and QoL.

Dissemination of person-centered community care for mild dementia using local cooperatives in Korea during the COVID-19 pandemic.

BACKGROUND: To promote aging in place and improve the quality of life for persons with mild dementia during COVID-19 pandemic, there is a need to support them in their community in-person approach. Therefore, person-centered community care for individual service and support in the community is an urgent priority. This study aimed to develop a person-centered community service for mild dementia patient to collaborate with local cooperatives and test its feasibility. METHODS: This study was done from March to December, 2020. The person centered community service manual was developed based on previous guidelines and studies. The manual guided person-centered assessment, tailored intervention, and outcome evaluation based on six domains; person-hood, daily life, cognitive health, physical activity, safety, and community support. The local cooperatives for community care participated to provide comprehensive needs assessment and individualized service to the community residents with mild dementia. The staff visited the patient's home and provide individual service. The feasibility study was tested with the staff and patients. RESULTS: This study found that the service was effective for initial rapport, comprehensive assessment, individualized planning, person-centered service provision, referral to community service, and outcome evaluation. However, service provider's increased workloads and the time for home visiting and completing the service were identified as barriers during pandemic period. In addition, service providers still experienced lack of knowledge and skills in enhancing safety such as precaution and social distancing. CONCLUSION: The person-centered community service can be useful to enhance the safe and sustainable community services during COVID-19 pandemics. Collaboration with local cooperatives can be the best practices through the well-designed manual.

The roles of unmet needs and formal support in the caregiving satisfaction and caregiving burden of family caregivers for persons with dementia.

ABSTRACTBackground:A growing number of studies are emphasizing the importance of positive and negative appraisals of caregiving and the utilization of social resources to buffer the negative effects of caring for persons with dementia. By assessing the roles of unmet needs and formal support, this study tested a hypothesized model for Korean family caregivers' satisfaction and burden in providing care for persons with dementia. METHODS: The stress process model and a two-factor model were used as the conceptual framework for this study. Data for 320 family caregivers from a large cross-sectional survey, the Seoul Dementia Management study, were analyzed using structural equation modeling. In the hypothesized model, the exogenous variables were patient symptoms, including cognitive impairment, behavioral problems, and dependency on others to help with activities of daily living and with instrumental activities of daily living. The endogenous variables were the caregiver's perception of the unmet needs of the patient, formal support, caregiving satisfaction, and caregiving burden. RESULTS: The adjusted model explained the mediating effect of unmet needs on the relationship between patient symptoms or formal support and caregiving satisfaction. Formal support also had a mediating effect on the relationship between patient symptoms and unmet needs. Patient symptoms and caregiving satisfaction had a significant direct effect on caregiving burden. CONCLUSION: The level of unmet needs of persons with dementia and their family caregivers must be considered in the development of support programs focused on improving caregiving satisfaction.

Smart glasses and telehealth services by professionals in isolated areas in Korea: Acceptability and concerns.

BACKGROUND: Smart glass technology offers remote interaction between health professionals for telehealth, alleviating healthcare disparities in isolated areas. OBJECTIVE: To evaluate the professionals' perceptions of smart glass technology as a tool for telehealth and distance learning. METHOD: This mixed-method study on health professionals in 10 different island areas in Korea involved participants experiencing a smart glass-based telehealth system using the scenario of clinical consultation with remote specialists. A group pre- and post-test design was used to examine the change in attitude and perceived importance among health professionals about using smart glasses in telehealth. RESULTS: Forty-seven participants completed both pre-and post-evaluation of smart glasses. A positive, statistically significant change in participants' perceptions of smart glasses regarding their implications for telehealth and distance learning (p< 0.05) was found. Fifty-one health workers provided feedback on smart glasses, and a majority expressed their expectations of quality care with telehealth using advanced technology. The main concerns were patients' privacy issues and inadequate technology for seamless application. CONCLUSION: The incorporation of smart glass technology offers great potential to enrich telehealth as well as distance learning for unskilled health professionals in isolated areas. Future studies are needed to increase efforts to secure a high level of acceptance for clinical consultation with remote specialists on this newly developed device.

Patient- and family-centered care interventions for improving the quality of health care: A review of systematic reviews.

BACKGROUND: Patient- and family-centered care interventions are increasingly being implemented in various settings for improving the quality of health care. However, the huge amounts of information coming from both primary studies and reviews on patient- and family-centered care interventions have made it difficult to identify and use the available evidence effectively. OBJECTIVES: This review aimed to synthesize and evaluate the evidence from published systematic reviews on the effects of patient- and family-centered care interventions. It also aimed to assess the quality of the systematic reviews in order to formulate recommendations for improving the quality of future systematic reviews. DESIGN: Review of systematic reviews. DATA SOURCES: Six databases were searched for relevant published reviews that assessed patient- and family-centered care interventions and were reported on in English in peer-reviewed journals up to September 18, 2017. The reference lists of all selected publications were also used to identify additional eligible studies. REVIEW METHODS: Reviewers independently selected reviews, extracted data, and assessed the methodological quality of the included reviews using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) checklist. These results were presented and discussed among researchers to resolve disagreements and reach a consensus. A narrative approach was adopted to pool the constituent elements of interventions. The review protocol was registered with PROSPERO (registration number CRD42017080427). RESULTS: Twenty-eight reviews published between 2011 and 2017 met the inclusion criteria. The interventions targeted the patients, their family members, and the health-care. The interventions involved the following core outcomes: Regarding patients, they were improving knowledge about their health, increasing skills to manage self-care behaviors, enhancing satisfaction, increasing quality of life, and reducing admissions, readmissions, and length of the hospital stay. Regarding family members, they were reducing the intensity of stress, anxiety, depression, and increasing the satisfaction and relationship with health-care providers. Regarding health-care providers, the interventions could improve job satisfaction and confidence, quality of care, and reduce stress and burnout. The overall methodological quality of the 28 reviews was moderate, with a mean AMSTAR score of 6.79 (SD 1.45). CONCLUSION: This review has provided evidence for the effects of patient- and family-centered care interventions applied to diverse patients, family members, and health-care providers. The evidence indicates that patient- and family-centered care could be a critical approach for improving the quality of health care. Additionally, the quality of future reviews needs to be improved in order to produce reliable evidence in the current era of evidence-based practice.