Effectiveness of educational interventions for nurses caring for patients with chronic kidney disease in improving nurse outcomes: A systematic review.

AIM: The aim of the study was to evaluate the effectiveness of educational interventions for nurses caring for patients with chronic kidney disease in improving knowledge, nurse-patient interaction, performance, skills competence and clinical decision-making. DESIGN: Systematic review. METHODS: Search of literature for randomised controlled trials, quasi-experimental studies and pre-experimental studies on chronic kidney disease-related educational interventions for nurses was conducted across 10 databases. Two reviewers independently screened articles, appraised studies and extracted data. DATA SOURCES: PubMed, Cochrane, Embase, CINAHL Complete, ERIC, Social Science Database, ASSIA, Scopus, Web of Science and ProQuest Thesis and Dissertations Global databases were searched from date of inception to 21 December 2022. RESULTS: Three randomised controlled trials and eight pre-experimental studies were included in this review. Synthesis without meta-analysis was conducted due to high heterogeneity among studies. Interventions with teaching sessions, learning activities, self-study modules, discussion and a web-based training system were effective in improving nurses' knowledge, nurse-patient interaction, performance, skills competence and clinical decision-making. Patients experienced an improvement in nurse-patient interaction and no significant decrease in overall quality of life. CONCLUSION: This review has shown the effectiveness of educational interventions for nurses caring for people with chronic kidney disease in improving outcomes for both nurses and patients, with sustained improvements up to a period of 1 year. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Study findings can guide the scope of future training for nurses caring for patients with chronic kidney disease. IMPACT: Nurses often lack in-service training on how to improve care for patients with chronic kidney disease. This study found that training nurses on how to care for such patients can improve outcomes for nurses, which can translate to higher quality of patient care. REPORTING METHOD: This paper adhered to the synthesis without meta-analysis (SWiM) reporting guideline.

Facilitators and barriers to implementation of telemedicine in nursing homes: A qualitative systematic review and meta-aggregation.

BACKGROUND: Telemedicine is an effective way to provide nursing home residents ease of access to consultations with healthcare professionals. It is safe, effective, and time- and cost-efficient, and can be used when there are movement restrictions, such as during the COVID-19 pandemic. This literature focuses only on healthcare professionals' experiences and perspectives on the use of telemedicine in long-term care facilities. OBJECTIVES: This review concentrated on telemedicine programs that did not involve remote monitoring. It aimed to comprehensively appraise existing literature examining the facilitators and barriers in implementing telemedicine services in nursing homes. METHODS: A systematic qualitative review was conducted with content analysis. Database searching was conducted in PubMed, Embase, Cochrane, Scopus, and CINAHL. Hand searching for gray literature and reference lists of included papers was also performed. Qualitative studies or mixed-method studies with a qualitative analysis addressing implementation of telemedicine in any long-term care facilities were included. The Critical Appraisal Skills Programme qualitative checklist was used to assess the quality of the included studies. The data were extracted and cross-checked between two reviewers. A third reviewer was consulted for any disagreements. Meta-aggregation was used to synthesize the results. RESULTS: Eighty-one findings were extracted, which informed 16 categories and 13 synthesized findings. The synthesized findings were related to the innovation domain, infrastructure, work processes, individuals, and implementation processes. LINKING EVIDENCE TO ACTION: This review highlighted factors that affect the successful implementation of a telemedicine service in nursing homes. These findings provide evidence to support the future utilization of this service in the nursing home setting. Further research should explore the best approach to address these barriers and facilitators.

Desktop Virtual Reality Versus Face-to-Face Simulation for Team-Training on Stress Levels and Performance in Clinical Deterioration: a Randomised Controlled Trial.

BACKGROUND: Simulation-based education can equip healthcare providers with the ability to respond to and manage stressors associated with rapidly deteriorating patient situations. However, little is known about the benefits of using virtual reality (VR) for this purpose. OBJECTIVE: To compare between desktop VR and face-to-face simulation in stress responses and performance outcomes of a team-based simulation training in managing clinical deterioration. DESIGN: A randomised controlled study METHOD: The study was conducted on 120 medical and nursing students working in interprofessional teams. The teams were randomly assigned to participate in a 2-h simulation using either the desktop VR or face-to-face simulation with simulated patient (SP). Biophysiological stress response, psychological stress, and confidence levels were measured before and after the simulation. Performance outcomes were evaluated after the simulation using a deteriorating patient scenario. RESULTS: The systolic blood pressure and psychological stress response were significantly increased among participants in VR and SP groups; however, no significant differences were found between the groups. There was also no significant difference in confidence and performance outcomes between participants in the VR and SP groups for both medical and  nursing students. Although the psychological stress response was negatively correlated (r = -0.43; p < 0.01) with confidence levels, there was no association between stress response and performance score. CONCLUSION: Despite being less immersive, the desktop VR was capable of inducing psychological and physiological stress responses by placing emotional, social, and cognitive demands on learners. Additionally, by ensuring close alignment between the simulation tasks and the clinical tasks (i.e. functional fidelity), the desktop VR may provide similar performance outcomes as conventional simulation training. This evidence is timely given the rise in the use of virtual learning platforms to facilitate training during the COVID-19 pandemic where face-to-face training may not be feasible. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov NCT04330924.

Qualitative systematic review: The lived experiences of males in the nursing profession on gender discrimination encounters.

AIMS: This review aims to synthesise the best available evidence exploring the lived experiences of males in the nursing profession on gender discrimination encounters. BACKGROUND: The underrepresentation of males within the nursing profession could potentially cause discrimination and stereotypes against them, causing barriers to entry into, and retention within, the profession. With a shortage in manpower, the deterrence of males to nursing might exacerbate the existing manpower shortage. This review consolidates and highlights the lived experiences of males in the profession. METHODS: The review was synthesised according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Employing the meta-synthesis approach, two independent reviewers conducted critical appraisal and data extraction of included studies, using the standard Joanna Briggs Institute (JBI) Critical Appraisal Instrument for Qualitative Research and a standardised data extraction form, respectively. RESULTS: Twenty-three studies were included. Extracted findings were aggregated into 14 categories and synthesised into three themes: stereotypes, discrimination and challenges faced by males. DISCUSSION: The synthesised findings showed that male nurses faced gender discrimination in multiple facets. These caused them to have difficulty in carrying out their nursing duties, missing out of clinical opportunities and causing them multiple social and mental stressors. CONCLUSION: This review informed the discriminatory experiences faced by males within the nursing profession. With males already underrepresented within this profession, it is imperative for interventions, policies and research to be made to address this issue to improve experiences of male nurses, thereby limiting the deterrence of males into the profession. IMPLICATIONS: Findings of this study showed that males are being stereotyped and discriminated, resulting in challenges faced solely because of their gender. Effective interventions and policies could be implemented to alleviate the negative experiences.

Advantages and challenges of fostering cognitive integration through virtual collaborative learning: a qualitative study.

BACKGROUND: The drastic shift from face-to-face classes to online learning due to the COVID-19 pandemic has enabled educators to ensure the continuity of learning for health professions students in higher education. Collaborative learning, a pedagogy used to facilitate knowledge integration by helping students translate theory from basic sciences to clinical application and practice, has thus been transformed from a face-to-face to a virtual strategy to achieve the learning objectives of a multi-disciplinary and integrated module. OBJECTIVES: This study aimed to describe and evaluate, through focus group discussions, a virtual collaborative learning activity implemented to assist first year undergraduate nursing students to develop cognitive integration in a module consisting of pathophysiology, pharmacology, and nursing practice. METHODS: Fourteen first year undergraduate students and four faculty involved in facilitating the virtual collaboration participated in the study. Focus group discussions were conducted to elicit the perceptions of students and staff on the virtual collaborative learning session conducted at the end of the semester. RESULTS: Three themes were generated from the thematic analysis of the students' focus group scripts. These were: (1) achieving engagement and interaction, (2) supporting the collaborative process, and (3) considering practical nuances. The three themes were further subdivided into subthemes to highlight noteworthy elements captured during focus group discussions. Three themes also emerged from the focus group discussion scripts of faculty participants: (1) learning to effectively manage, (2) facing engagement constraints, and (3) achieving integration. These themes were further sectioned into salient subthemes. CONCLUSION: The virtual collaborative learning pedagogy is valuable in fostering cognitive integration. However, meticulous planning considering various variables prior to implementation is needed. With better planning directed at addressing the learners' needs and the faculty's capabilities and readiness for online learning pedagogies, and with a strong institutional support to help mitigate the identified constraints of virtual collaborative learning, students and faculty will benefit.

Finding the Right Blend of Technologically Enhanced Learning Environments: Randomized Controlled Study of the Effect of Instructional Sequences on Interprofessional Learning.

BACKGROUND: With the availability and capabilities of varied technologically enhanced learning activities, the blended learning approach has become increasingly popular in interprofessional education. The combined use of different technologically enhanced learning activities has not been fully examined, particularly to determine the effects of instructional sequences for effective learning outcomes. OBJECTIVE: The objective of this study was to investigate whether the instructional sequences of a blended learning approach can improve students' learning outcomes on interprofessional competencies. METHODS: A randomized controlled study was conducted with 40 interprofessional health care teams. These teams undertook three technologically enhanced learning activities-Web-based instruction (WI), virtual reality (VR), and simulation exercise (SE)-after random assignment to three groups based on three different instructional sequences (WI-VR-SE, WI-SE-VR, and SE-WI-VR). Pretests and posttests were conducted to evaluate the students' learning outcomes on interprofessional competencies. RESULTS: A total of 198 participants from the three groups completed the questionnaires. All three groups reported significant improvement in their levels of self-efficacy (P<.05) and attitudes (P<.001) toward interprofessional team care about 1 month after the interprofessional learning activity. Although no significant difference was found (P=.06) between the WI-VR-SE and WI-SE-VR groups in the self-efficacy posttests, participants in the SE-WI-VR group reported significantly lower (P<.05) posttest scores than those in the WI-SE-VR group. The majority of the participants (137/198, 69.1%) selected the instructional sequence "WI-VR-SE" as their top preference. CONCLUSIONS: This study shows that the instructional sequence of a blended learning approach can have a significant impact on students' learning outcomes. The learning of concepts from WI followed by problem-solving activity in the SE was found to be a more effective learning sequence than the reverse sequence. We recommend that future studies focus on scaffolding students' learning when planning instructional sequences for technologically enhanced learning activities within blended learning environments.

Exploring new healthcare professionals' roles through interprofessional education.

This article presents findings from a simulation-based interprofessional education (IPE) program involving trainee advanced practice nurses (APNs) and internal medicine residents (IMRs) based in Singapore. Trainee APNs and IMRs participated in a semester-long series of high-fidelity simulations of medical emergencies. Learners' attitudes toward the IPE intervention were assessed using validated Likert scaled surveys and written comments. Overall satisfaction was high among learners, with strongly positive attitudes toward teamwork, collaboration and patient centredness. Of most interest, written comments highlight the utility of IPE in defining the professional scope and boundaries of APNs. Comments from both professions observed that participation in the IPE scenarios greatly aided their understanding of the scope and role of APN's practice within the health care team. This aspect of IPE may find further application in other similarly novel roles in healthcare.

Ethical issues in health-care inquiry: a discussion paper.

This paper is a discussion of the possible ethical dilemmas that may arise in both qualitative and quantitative research despite stringent methodological protocols. Three categories of ethical issues will be elaborated on, namely, researcher-participant relations, informed consent and confidentiality and privacy. These are of note because ethical dilemmas most often arise in these areas. Both qualitative and quantitative research types may thus present with problems associated with any, or a combination, of these categories. Methodological rigour will also be discussed as a vital component of any research study. Critics of the qualitative approach have often suggested that the innate lack of methodological rigour has resulted in the preponderance of ethical issues in qualitative studies. Qualitative studies, similar to quantitative studies, have mechanisms that guarantee rigour, quality and trustworthiness. These checks are at par with those of quantitative research but based on different criteria. Both types of research, then, can be considered equal in terms of methodological rigour, regardless of the nature. As no research approach can be perfectly free from threats of ethical issues, it is the researcher's responsibility to address these in ways that will be less harmful to the participants, bearing in mind ethical problems can arise at any time during the research endeavour.

Effectiveness of aromatherapy on anxiety and sleep quality among adult patients admitted into intensive care units: A systematic review.

PURPOSE: This review aims to evaluate the effectiveness of aromatherapy on anxiety and sleep quality among adult patients admitted to an intensive care unit. MATERIALS AND METHODS: A systematic search for published and unpublished studies across nine databases and sources were conducted. Randomised Controlled Trials and Controlled Clinical Trials, which assessed the effectiveness of aromatherapy on anxiety and sleep quality among intensive care unit patients, were included in this review. Only studies that used aromatherapy as a single intervention were included. Narrative synthesis was conducted across all outcomes due to high heterogeneity across studies. RESULTS: A total of 26 studies involving 2176 participants across six countries were included in this review. Most studies had an overall high risk of bias. Publication bias was detected in the studies. Findings have shown that aromatherapy may be effective in reducing anxiety based on the low GRADE certainty of evidence, and improving sleep quality based on the very low GRADE certainty of evidence. Inconsistencies in findings were also observed. CONCLUSION: Aromatherapy might be beneficial on anxiety and sleep quality among intensive care unit patients, however, the level of evidence is very low, based on the low quality of studies. Considerations can be made to incorporate aromatherapy into existing interventions that improve anxiety and sleep quality in the intensive care unit. Due to inconsistencies in findings, further research can be done to investigate and strengthen these evidence. IMPLICATION FOR CLINICAL PRACTICE: This review has demonstrated that aromatherapy may have benefits on anxiety and sleep quality. Despite uncertain evidence, aromatherapy may still be considered as a complementary or alternative option to improve anxiety and sleep quality among intensive care patients as it is relatively safe, cost-effective and easy to implement (Buckle, 2014). However, proper training by a professional clinical aromatherapist is needed to ensure there is screening of patients for suitability, proper technique for administering aromatherapy, safe handling of essential oils and monitoring for adverse events (Farrar & Farrar, 2020).

The experiences and needs of people with dysvascular lower extremity amputations: a qualitative systematic review and meta-synthesis.

PURPOSE: The aim of this review is to synthesise the experiences and needs of people who had undergone dysvascular lower extremity amputations. Given the increasing global prevalence of vascular diseases like diabetes mellitus and peripheral arterial disease, the risk of requiring an amputation remains high. MATERIALS AND METHODS: This systematic review follows the PRISMA and ENTREQ reporting guidelines. Seven databases were searched for qualitative studies from January 2011 to October 2023. In total 6435 studies were obtained, where 1146 were duplicates and 5271 studies failed to meet the eligibility criteria. The remaining 18 studies were synthesised using Sandelowski and Barroso's approach and appraised using the CASP checklist. RESULTS: Four themes emerged from the meta-synthesis: (1) making the decision to amputate, (2) difficulties in the physical adaptation to limb loss, (3) psychosocial consequences of living with an amputation, and (4) regaining control and building hope. CONCLUSIONS: Having dysvascular lower extremity amputations is a complicated experience as not only was the pre-amputation pain relieved, but a new set of physical, emotional and social challenges would surface after the amputation. These synthesised findings serve as a platform to explore the factors behind the various experiences faced by these people and how healthcare professionals can help them in their adjustment.

Dysvascular lower extremity amputations can affect the physical and mental well-being of people who have experienced them.Healthcare professionals (HCPs) are encouraged to individualise care that meets the physical and emotional needs of patients.Sufficient time and information should be provided before the operation for these people to be better prepared for the changes following the amputation.Physical support by HCPs should include physical rehabilitation, checking on the wound healing and managing any existing co-morbidities.Emotional support can be given through additional referral to medical social workers or psychologists and the involvement of support groups.

Nurses' experiences in the management of delirium among older persons in acute care ward settings: A qualitative systematic review and meta-aggregation.

BACKGROUND: Delirium is a multifactorial syndrome closely associated with negative hospitalisation outcomes. Given the global growth of the ageing population, delirium becomes increasingly prevalent among older persons. Nurses play a pivotal role in delirium management and receive direct impacts of delirious presentations. Yet, there is a dearth of literature reviewing nurses' experiences. OBJECTIVE: To synthesise the best available evidence exploring nurses' experiences in managing delirium of older persons in acute care wards. DESIGN: Systematic review of qualitative studies and meta-aggregation. DATA SOURCES: Published and unpublished literature between January 2010 and December 2020 were identified from PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, PsycINFO and ProQuest. REVIEW METHODS: A systematic search strategy was applied in October 2020, with an update in January 2021. Two reviewers independently screened the titles and abstracts and selected the eligible studies after reading the full texts. This review included studies focusing on licensed nurses providing care to patients aged 65 and above, having any type of delirium during their hospitalisation stays in acute care settings. Studies included are qualitative papers with research designs such as phenomenology, ethnography, qualitative descriptive and grounded theory. The eligible studies were appraised independently using The JBI Critical Appraisal Checklist for Qualitative Research. Data of included studies were extracted by two independent reviewers using a standardised form. Findings were synthesised by the meta-aggregative approach. RESULTS: Thirty-one papers that considered nurses' (n = 464) experiences in managing older persons' delirium were included. A total of 375 findings were extracted, aggregated into 23 categories, and developed 5 synthesised findings: (i) delirium detection could be hindered when nurses possess a narrowed view of delirium, (ii) nurses navigate through complexity when providing multi-faceted care, (iii) nurses carry personal emotions, assumptions, and identities, (iv) various stakeholders have double-edged influences, and (v) nurses display preferences in their learning needs. CONCLUSION: This review informed about nurses' perceptions of delirium, delirious older persons, and their nursing management which were specific to older persons and acute care settings. Nurses should practise self-awareness regarding their own knowledge and attitudes while performing delirium management in older adults. Meanwhile, healthcare professionals and policymakers should make a concerted effort in cultivating a better working environment. Future research of delirium care that specifically investigates with a geriatric perspective would better contribute to the improvement of evidence-based nursing practices for older persons.

The impact of antipsychotic side effects on attitudes towards medication in people with schizophrenia and related disorders.

AIMS AND OBJECTIVES: This research aimed to: (i) investigate the prevalence and perceived severity of antipsychotic side effects in people with schizophrenia and related disorders living in communities in Singapore; (ii) examine the relationship between antipsychotic variables (type, dose, route, prescription duration) and side effects; and (iii) examine the relationship between side effects and attitudes towards medication. BACKGROUND: Antipsychotics are the mainstay treatment in schizophrenia and other psychotic disorders. However, antipsychotics are associated with a wide range of side effects, which potentially have adverse effects on patients' functioning. A lack of studies comparing the frequency of side effects and their associated levels of distress across multiple antipsychotics and different medication variables has been noted. Additionally, it is essential to assess patients' attitudes towards antipsychotics in relation to their experience of side effects. DESIGN: A cross-sectional, non-experimental research design was used. METHOD: A convenience sample of 96 adults with schizophrenia and related disorders on antipsychotic treatment and attending the hospital's outpatient clinic was recruited. Variables collected included antipsychotic type, dose, route, prescription duration and side effects, attitudes towards medication and demographic and clinical variables. They were analysed with descriptive statistics and correlational analyses. RESULTS: Many participants experienced psychic (80·2%), extrapyramidal (69·8%) and miscellaneous side effects (61·5%). Side effects positively correlated with dose (p = 0·016) and negatively correlated with prescription duration (p = 0·014). Negative attitudes towards medication were positively correlated with side effects in general (p = 0·023), along with hormonal (p = 0·013) and psychic side effects (p = 0·008). CONCLUSION: Findings revealed that majority of the participants experienced and were distressed over psychic, extrapyramidal and weight gain, which may be related to high doses and treatment duration. Additionally, patients experiencing psychic and hormonal side effects are at risk of developing negative attitudes towards medication. RELEVANCE TO CLINICAL PRACTICE: Findings guide the development of appropriate nursing interventions that aim to alleviate side effects, reduce negative attitudes towards medication and prevent compliance problems.

The effectiveness of collaborative teaching in an introductory online radiology session for master of nursing students.

AIM: The study aimed to evaluate the effectiveness of the collaborative teaching of a multi- disciplinary team on the introductory online radiology session for the Master of Nursing students. BACKGROUND: The teaching method for basic radiology reading for the Master of Nursing program was delivered via a 4-hour didactic face-to-face lesson and was ineffective as evidenced by the students' feedback and evaluation. Therefore, a multi-disciplinary team consisting of nursing, medical and radiology staff developed a 4-week online radiology session to enhance knowledge, attitudes and confidence of the Master of Nursing students in interpreting basic chest radiographs, abdominal radiographs and computed tomographic brain scans. METHODS: A quasi-experimental study design using pre-test and post-test was adopted. The effectiveness of the online radiology session was evaluated on the students' knowledge, attitudes, and confidence. Forty Master of Nursing program students completed the pre-test and post-test questionnaires (response rate 74%) and responded to the open-ended questions in the post-test. IBM-SPSS was used to analyse the quantitative data and quantifying qualitative data technique was used to analyse the qualitative data. RESULTS: The participants demonstrated an improvement in knowledge and confidence mean scores of the post-test compared to pre-test. There was improved self-rated proficiency in reading and interpreting a film radiograph but no difference in the way they perceived the importance of radiological investigations vis-à-vis the physical examination and routine laboratory testing. Quantifying quantitative data technique showed that majority of participants appreciated the learning process as it could be done at their own pace and the lectures could be replayed again. However, participants hoped for improved interaction with the tutor during learning and the use of real-life cases in the scenarios. CONCLUSION: Collaborative teaching using an online radiology session shows promise over a traditional didactic method of teaching but requires further refinement in terms of participant interaction and the use of case examples.

The use of web-based classroom gaming to facilitate cognitive integration in undergraduate nursing students: A mixed methods study.

BACKGROUND: Classroom gaming is a promising teaching and learning strategy that has been shown to facilitate engagement and meaningful learning. This paper aimed to determine whether classroom gaming using a web-based platform can facilitate cognitive integration to prepare undergraduate nursing students for clinical practice. METHODS: A sequential explanatory design mixed-methods study was conducted. A randomized controlled design study, with knowledge and simulation performance as outcome measures, was conducted. This was followed by focus group discussions. RESULTS: There is a significant improvement in pre- and post-test scores (t=-4.47). However, there was no statistically significant difference between the pre-test scores (t=1.50) of the intervention group and those of the control group. Similarly, the post-test scores of these groups were also not significantly different statistically (t=-0.15). Skills assessment results also showed no difference between the scores of those in the intervention group and of those in the control group (t=1.19). Themes generated were: useful for revision, linking of concepts, and gaming as a challenge. CONCLUSION: The use of classroom gaming to facilitate integration of knowledge based on knowledge and performance tests did not yield positive results. However, focus group interviews demonstrated that the study's participants perceived strategy to be helpful in their learning.

Cognitive integration in health professions education: Development and implementation of a collaborative learning workshop in an undergraduate nursing program.

Cognitive integration is integral to health professions education as it facilitates the ability to synthesize various types of knowledge and apply them in a clinical context. Nursing education is one main field of study that is subsumed under the umbrella of health professions education. Future nurses require learning, not just of skills but also of the knowledge that underpins those skills. They need to be able to cognitively integrate various forms of content and skills so that they can translate them to actual patient management and care during clinical practice. Several educational strategies have been implemented and have been shown to be effective in promoting cognitive integration in health professions learners, both individually and as a group. One of these strategies is collaborative learning. This study describes how a developed collaborative learning workshop was implemented to aid cognitive integration in year 1 undergraduate nursing students prior to their clinical postings. It also looks into the perceptions of students through qualitative findings from focus group discussions. Generated themes include 'integrating and bridging knowledge for practice', 'having tutors with different and complementing expertise', 'preparing mindsets by clear objectives' and 'timing and case variability'.

Evaluation of the symptom-focused health assessment and empathy program for undergraduate nursing students: A randomized controlled trial.

BACKGROUND: Health assessments are a vital competency required of nurses. The more traditional ways of teaching and learning this skill require practice and are often limited by time constraints. With the rise of technology-based platforms, students can supplement their learning health assessment skills through other means, such as videos, that not only teach the steps but also allow them to learn in context. OBJECTIVES: This study describes how a symptom-focused health assessment and empathy (SHAE) program, which primarily involves the use of a case-based health assessment video, was implemented and evaluated. DESIGN: The study involved a single-centre, single-blind, parallel randomized controlled trial. SETTINGS: The study was conducted at a university in Singapore. PARTICIPANTS: Year one undergraduate nursing students enrolled in the Comprehensive Health Assessment (CHA) module during semester two of the academic year 2018/2019 participated in the study. METHODS: Participants were randomized into one of the two parallel groups: the experimental group or the waitlisted control (WL) group. The experimental group received the SHAE program in addition to conventional learning methods (e-lectures, lab demonstration, and pair practice). The WL group received only the conventional learning methods. Pre- and post-test measures of the study variables such as knowledge, health assessment skills, confidence, empathy, and intention to learn were conducted. The WL group was given access to the SHAE program after the post-test. Analyses of covariance (ANCOVA) were used to compare the means of the study variables between the intervention and WL groups. RESULTS: Participants in the intervention group had significantly higher scores on knowledge (p = 0.016), confidence (p = 0.03), and health assessment skills (p = 0.004). No significant differences in intention to learn and empathy between the two groups were found. CONCLUSION: The use of a case-based video has the potential to be a valuable method of teaching health assessments in context to nursing students. The SHAE program has shown beneficial effects on students' knowledge, health assessment skills, and confidence. However, there was no effect on students' intentions to learn and their empathy. Further refinements of the program will need to focus on improving these domains.

Design and evaluation of a 3D virtual environment for collaborative learning in interprofessional team care delivery.

BACKGROUND: Collaborative learning in interprofessional team care delivery across different healthcare courses and institutions is constrained by geographical locations and tedious scheduling. Three dimensional virtual environments (3D-VE) are a viable and innovative tool to bring diverse healthcare students to learn together. AIM: The aim of this study is to describe the development of a 3D-VE and to evaluate healthcare students' experiences of their collaborative learning in the environment. METHOD: A mixed methods study design was employed. Participants from six healthcare courses (Medicine, Nursing, Pharmacy, Physiotherapy, Occupational Therapy, and Medical Social Work) were recruited from three institutions to form six interprofessional teams to participate in team care delivery via a 3D-VE. Pre- and post-tests were conducted to evaluate the students' attitudes toward healthcare teams and interprofessional collaboration. Four focus groups were conducted with 27 healthcare students after they completed questionnaires to evaluate their perceived usability, the sociability of computer-supported collaborative learning, and senses of presence. Interview transcripts were analyzed using thematic analysis. RESULT: The students demonstrated significant improvements in their attitudes toward healthcare teams (p < 0.05) and interprofessional collaboration (p < 0.001) after the collaborative learning. Four themes emerged from the focus group discussions: "feeling real", whereby the students felt immersed in their own roles; the virtual environment was perceived as "less threatening" compared to face-to-face interactions; "understanding each other's roles" among different healthcare professionals; and there were some "technical hiccups" related to sound quality and navigation. The participants reported positively on the usability (mean 3.48, SD 0.64), feasibility (mean 3.39, SD 0.60) and perceived sense of presence (mean 107.24, SD 17.78) of the 3D-VE in supporting collaborative learning. CONCLUSION: Given its flexibility, practicality, and scalability, this 3D-VE serves as a promising tool for collaborative learning across different healthcare courses and institutions in preparing for future collaborative-ready workforces.

The validity and reliability of four measures of gambling behaviour in a sample of Singapore University students.

The primary aim of this study was to determine the reliability and validity of measures for detecting problem gamblers for use with university students in a Singapore context. The four instruments commonly used in gambling research, the DSM-IV, GA-20, SOGS and CPGI were administered to a sample of students (n = 193) from a representative cross section of faculties from one university. The CPGI was found to be the most reliable (alpha = 0.922) and valid in terms of construct validity as demonstrated by factor analysis. Despite being a lengthy instrument it is recommended that future studies such as randomized controlled trials of problem gambling interventions in Singapore adopt a modified version of the CPGI, made simpler and easier to use with fewer items and more appropriate terminology.

Development and psychometric testing of a Clinical Reasoning Evaluation Simulation Tool (CREST) for assessing nursing students' abilities to recognize and respond to clinical deterioration.

BACKGROUND: The development of clinical reasoning skills in recognising and responding to clinical deterioration is essential in pre-registration nursing education. Simulation has been increasingly used by educators to develop this skill. OBJECTIVE: To develop and evaluate the psychometric properties of a Clinical Reasoning Evaluation Simulation Tool (CREST) for measuring clinical reasoning skills in recognising and responding to clinical deterioration in a simulated environment. DESIGN: A scale development with psychometric testing and mixed methods study. PARTICIPANTS/SETTINGS: Nursing students and academic staff were recruited at a university. METHOD: A three-phase prospective study was conducted. Phase 1 involved the development and content validation of the CREST; Phase 2 included the psychometric testing of the tool with 15 second-year and 15 third-year nursing students who undertook the simulation-based assessment; Phase 3 involved the usability testing of the tool with nine academic staff through a survey questionnaire and focus group discussion. RESULTS: A 10-item CREST was developed based on a model of clinical reasoning. A content validity of 0.93 was obtained from the validation of 15 international experts. The construct validity was supported as the third-year students demonstrated significantly higher (p<0.001) clinical reasoning scores than the second-year students. The concurrent validity was also supported with significant positive correlations between global rating scores and almost all subscale scores, and the total scores. The predictive validity was supported with an existing tool. The internal consistency was high with a Cronbach's alpha of 0.92. A high inter-rater reliability was demonstrated with an intraclass correlation coefficient of 0.88. The usability of the tool was rated positively by the nurse educators but the need to ease the scoring process was highlighted. CONCLUSIONS: A valid and reliable tool was developed to measure the effectiveness of simulation in developing clinical reasoning skills for recognising and responding to clinical deterioration.