The Effect of Game-Based Clinical Nursing Skills Mobile Application on Nursing Students.

Nursing education using mobile devices is emerging as a new educational method showing higher learning achievement than traditional nursing education. This study aimed to develop a game-based mobile application and evaluate nursing students' learning achievement and experiences using a mixed-methods design. The application was developed into eight games on different nursing skills. Thirty nursing students were instructed to use the application for a week in the one-group pretest-posttest study design. Their pretest and posttest knowledge, postlearning efficiency, satisfaction, and convenience were evaluated. The focus group interviews were conducted by dividing 15 students into three groups, and their experience of the application was analyzed using a qualitative thematic analysis. The nursing students' knowledge significantly improved after using the application (t = 4.71, P < .001). The efficiency was the number of days (3.3 ± 2.0), the number of use per login (5.3 ± 4.0), and the number of successes per login (2.7 ± 2.9). Satisfaction and convenience scores were 4.9 ± 1.3 and 4.7 ± 1.2 out of 7. In the thematic analysis, themes through which the students were motivated, made learning plans, and received feedback by efficient game-based interactive educational content were drawn. Game-based mobile nursing education could be an adjunct to traditional clinical education strategies and induce a positive learning effect.

Rivaroxaban for Thromboprophylaxis after Hospitalization for Medical Illness.

BACKGROUND: Patients who are hospitalized for medical illness remain at risk for venous thromboembolism after discharge, but the role of extended thromboprophylaxis in the treatment of such patients is a subject of controversy. METHODS: In this randomized, double-blind trial, medically ill patients who were at increased risk for venous thromboembolism on the basis of a modified International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) score of 4 or higher (scores range from 0 to 10, with higher scores indicating a higher risk of venous thromboembolism) or a score of 2 or 3 plus a plasma d-dimer level of more than twice the upper limit of the normal range (defined according to local laboratory criteria) were assigned at hospital discharge to either once-daily rivaroxaban at a dose of 10 mg (with the dose adjusted for renal insufficiency) or placebo for 45 days. The primary efficacy outcome was a composite of symptomatic venous thromboembolism or death due to venous thromboembolism. The principal safety outcome was major bleeding. RESULTS: Of the 12,024 patients who underwent randomization, 12,019 were included in the intention-to-treat analysis. The primary efficacy outcome occurred in 50 of 6007 patients (0.83%) who were given rivaroxaban and in 66 of 6012 patients (1.10%) who were given placebo (hazard ratio, 0.76; 95% confidence interval [CI], 0.52 to 1.09; P=0.14). The prespecified secondary outcome of symptomatic nonfatal venous thromboembolism occurred in 0.18% of patients in the rivaroxaban group and 0.42% of patients in the placebo group (hazard ratio, 0.44; 95% CI, 0.22 to 0.89). Major bleeding occurred in 17 of 5982 patients (0.28%) in the rivaroxaban group and in 9 of 5980 patients (0.15%) in the placebo group (hazard ratio, 1.88; 95% CI, 0.84 to 4.23). CONCLUSIONS: Rivaroxaban, given to medical patients for 45 days after hospital discharge, was not associated with a significantly lower risk of symptomatic venous thromboembolism and death due to venous thromboembolism than placebo. The incidence of major bleeding was low. (Funded by Janssen Research and Development; MARINER ClinicalTrials.gov number, NCT02111564 .).

Rationale and design for the study of rivaroxaban to reduce thrombotic events, hospitalization and death in outpatients with COVID-19: The PREVENT-HD study.

BACKGROUND: COVID-19 is associated with both venous and arterial thrombotic complications. While prophylactic anticoagulation is now widely recommended for hospitalized patients with COVID-19, the effectiveness and safety of thromboprophylaxis in outpatients with COVID-19 has not been established. STUDY DESIGN: PREVENT-HD is a double-blind, placebo-controlled, pragmatic, event-driven phase 3 trial to evaluate the efficacy and safety of rivaroxaban in symptomatic outpatients with laboratory-confirmed COVID-19 at risk for thrombotic events, hospitalization, and death. Several challenges posed by the pandemic have necessitated innovative approaches to clinical trial design, start-up, and conduct. Participants are randomized in a 1:1 ratio, stratified by time from COVID-19 confirmation, to either rivaroxaban 10 mg once daily or placebo for 35 days. The primary efficacy end point is a composite of symptomatic venous thromboembolism, myocardial infarction, ischemic stroke, acute limb ischemia, non-central nervous system systemic embolization, all-cause hospitalization, and all-cause mortality. The primary safety end point is fatal and critical site bleeding according to the International Society on Thrombosis and Haemostasis definition. Enrollment began in August 2020 and is expected to enroll approximately 4,000 participants to yield the required number of end point events. CONCLUSIONS: PREVENT-HD is a pragmatic trial evaluating the efficacy and safety of the direct oral anticoagulant rivaroxaban in the outpatient setting to reduce major venous and arterial thrombotic events, hospitalization, and mortality associated with COVID-19.

Effectiveness of blood glucose control protocol for open heart surgery patients.

AIMS: To evaluate the effectiveness of a tailored blood glucose control protocol for postoperative cardiac surgery patients treated in intensive care. DESIGN: Retrospective study. METHODS: Data for the control group (non-tailored protocol) were collected from medical records at a tertiary hospital in Seoul, Korea between April-July 2015. Data for the experimental group (tailored protocol) were obtained from medical records between April-July 2016. After adjusting the target blood glucose range, eliminating single-dose insulin administration and extending the blood glucose measurement time interval, data for blood glucose measurements, time for reaching and maintaining target blood glucose, mean number of daily blood glucose measurements and insulin dose adjustments for the experimental group were collected. RESULTS: In the experimental group (where the target blood glucose rate was increased) the hypoglycaemia rate and the variation in blood glucose decreased significantly compared with the control group. In particular, the experimental group maintained relatively stable blood glucose levels by retaining a small variation range in glucose, regardless of the presence of diabetes. Time required for maintaining target blood glucose, mean number of daily blood glucose measurements and insulin dose adjustments per patient decreased. CONCLUSION: The tailored protocol contributes to the safe and effective control of blood glucose in critical care patients after cardiac surgery and to the efficiency of nurses administering it. IMPACT: This study has two significant impacts. The application of the tailored protocol has a positive impact on patients' blood glucose management, a critical component of treatment for postoperative cardiac patients in intensive care units. It also has a positive impact on the efficiency of nurses applying it. The results of this study are thus expected to facilitate successful implementation of clinical protocols for critical care after heart surgery.

Development, Application, and Effectiveness of a Smart Device-based Nursing Competency Evaluation Test: A Mixed-Method Study.

We aimed to develop and evaluate the effectiveness of a smart device-based test to assess Korean undergraduate students' clinical nursing competency, named SBT-NURS. The 65-item SBT-NURS comprises questions that simulate clinical situations, are problem solving-oriented, use multimedia (ie, videos/photos/animations), and involve the following topics: medical-surgical nursing, fundamentals of nursing, pediatrics, maternity, management, and psychiatric. We utilized a quantitative method to analyze the effects of the SBT-NURS (ie, via a single-group, post-experimental survey design) and a qualitative method to analyze students' experiences of using the SBT-NURS (ie, via seven focus group interviews [FGIs]). Students' overall adult health nursing paper-based test scores (ie, combining their scores in group activity, presentation, attendance, and attitude toward the midterm and final tests on adult health nursing) (r = 0.552, P < .001) and clinical practicum scores (r = 0.268, P = .040) in the last semester showed a statistically significant positive correlation with their SBT-NURS scores. Their paper-based testing practice average scores (ie, combination between paper-based tests and clinical practicum scores) showed a similar significant correlation (r = 0.506, P < .001). Students deemed the SBT-NURS advantageous, satisfactory, convenient, and useful. The SBT-NURS may be an effective learning and evaluation method for nursing education that help improve students' clinical competency and learning outcomes.

Development of a Mobile App-Based Self-care Health Diary for Heart Transplant Recipients: A Pilot Study.

Self-care is an essential concept in health maintenance for patients with heart problems. Mobile applications have received significant attention for their efficacy in facilitating lifestyle management. This study aimed to develop a practical mobile application for Android smartphones to aid in the self-care of heart transplant recipients. Development followed the five stages of the ADDIE model (analysis, design, development, implementation, and evaluation). The developed self-care health diary application provides users with a detailed guide to information and behaviors necessary for self-care through two main components: "Health information" and "Health diary." We conducted a 5-day pilot test with six subject experts and four heart transplant recipients. The participants were unanimously satisfied with the application's content, but experienced difficulty with its functionality, such as screen display and button operation. The feedback was used to revise and update the application, leading to the development of the final version. This study and application significantly contribute to the creation of a sustainable healthcare environment for the growing number of heart transplant recipients by enabling them to perform daily self-care. In future, education and promotion are required for encouraging heart transplant recipients to use the application regularly and proactively.

Effects of a smartphone-based self-care health diary for heart transplant recipients: A mixed methods study.

AIM: This study evaluated the effectiveness of a smartphone-based self-care health diary based on the Information-Motivation-Behavioral Skills model, designed to enable transplant recipients to self-manage their health and increase their adherence to medical advice. BACKGROUND: Heart transplant recipients must take immunosuppressants to prevent rejection for the rest of their lives. As immunosuppressant drugs suppress the immune system, transplant recipients are like individuals battling chronic diseases and must be diligent about self-care to keep healthy. METHODS: This was a quasi-experimental study using a nonequivalent control group pretest-posttest non-synchronized design and mixed methods. The sample comprised of 56 patients, with 28 each in the experimental and control groups. The control group was recruited from May 25-June 19, 2018, and the experimental group from September 1-13, 2018. Self-efficacy and self-care adherence were assessed via questionnaires; user experiences were assessed via interviews after the application was used for 4 weeks. RESULTS: After four weeks of use, transplant recipients reported significantly higher self-efficacy (F = 55.87, p < 0.001) and self-care adherence (F = 9.68, p = 0.003). Five themes were derived for the user experiences: (1) taking initiative for self-care, (2) utilizing a novel tool for self-care, (3) experiencing obstacles in ongoing self-care, (4) focusing on self-care adherence through the tool, and (5) expecting the application to serve as a personal medical assistant. CONCLUSIONS: The health diary application is expected to motivate heart transplant recipients to perform self-care and improve adherence to medical advice.

Development and Evaluation of "Chronic Illness Care Smartphone Apps" on Nursing Students' Knowledge, Self-efficacy, and Learning Experience.

This study developed smartphone-based virtual experiential nursing applications to care for patients with chronic illness, especially patients with hypertension and diabetes, and evaluated the effect of the applications on nursing students' knowledge, self-efficacy, and learning experiences. Applications using gamification elements were developed according to the steps of assessment, design, development, implementation, and evaluation. Knowledge and self-efficacy were assessed via questionnaires, while learning experiences were assessed via six focus group interviews after the applications were used for 1 week. Quantitative data were analyzed using descriptive analysis, χ test, Fisher's exact test, t test for the homogeneity of participants (experimental, 49; control, 43), an independent t test, and a paired t test for effectiveness in each group. Qualitative data were analyzed using qualitative thematic analysis. Knowledge on hypertension (t = 4.41, P < .001) and diabetes (t = 2.45, P < .009), as well as self-efficacy for hypertension (t = 3.08, P < .002) and diabetes (t = 1.75, P < .043), significantly improved in the experimental group compared to the control group. Students may use the applications as complementary learning resources without the limitations of time and space, and students were satisfied overall with their use. The chronic illness care smartphone applications are effective learning resources that assist students in assessing patients' health problems and implementing nursing care plans to improve patient conditions.

The treatment of missing data in a large cardiovascular clinical outcomes study.

BACKGROUND: The potential impact of missing data on the results of clinical trials has received heightened attention recently. A National Research Council study provides recommendations for limiting missing data in clinical trial design and conduct, and principles for analysis, including the need for sensitivity analyses to assess robustness of findings to alternative assumptions about the missing data. A Food and Drug Administration advisory committee raised missing data as a serious concern in their review of results from the ATLAS ACS 2 TIMI 51 study, a large clinical trial that assessed rivaroxaban for its ability to reduce the risk of cardiovascular death, myocardial infarction or stroke in patients with acute coronary syndrome. This case study describes a variety of measures that were taken to address concerns about the missing data. METHODS: A range of analyses are described to assess the potential impact of missing data on conclusions. In particular, measures of the amount of missing data are discussed, and the fraction of missing information from multiple imputation is proposed as an alternative measure. The sensitivity analysis in the National Research Council study is modified in the context of survival analysis where some individuals are lost to follow-up. The impact of deviations from ignorable censoring is assessed by differentially increasing the hazard of the primary outcome in the treatment groups and multiply imputing events between dropout and the end of the study. Tipping-point analyses are described, where the deviation from ignorable censoring that results in a reversal of significance of the treatment effect is determined. A study to determine the vital status of participants lost to follow-up was also conducted, and the results of including this additional information are assessed. RESULTS: Sensitivity analyses suggest that findings of the ATLAS ACS 2 TIMI 51 study are robust to missing data; this robustness is reinforced by the follow-up study, since inclusion of data from this study had little impact on the study conclusions. CONCLUSION: Missing data are a serious problem in clinical trials. The methods presented here, namely, the sensitivity analyses, the follow-up study to determine survival of missing cases, and the proposed measurement of missing data via the fraction of missing information, have potential application in other studies involving survival analysis where missing data are a concern.

Resilience and Overcoming Experiences of Coronavirus Disease 2019 Patients Hospitalized in a Single-Room Isolation Ward: A Mixed-Methods Study.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has caused patients to suffer from various physical and psychological symptoms and social challenges, but the impact was harder for those COVID-19 patients receiving treatment in single-room isolation wards in South Korea. This study aimed to investigate resilience, anxiety, depression, and sleep quality of those patients and the relationships between those variables, and explore the patients' experience of resilience during the COVID-19 treatment in single-room isolation wards. METHODS: This study employed a mixed-methods approach, collecting quantitative data through surveys and qualitative data through semistructured interviews conducted between May and October 2022. Quantitative surveys encompassing disease-specific and demographic information, visual analog scales to assess anxiety, depression, and sleep quality, and the Connor-Davidson resilience scale were administered to patients (N = 153). Qualitative thematic analyses were conducted following interviews with a subset of patients (N = 13) belonging to the high-resilience group. RESULTS: Resilience exhibited a negative correlation with anxiety and depression, while showing a positive correlation with sleep quality. Factors affecting resilience include having a spouse, educational attainment, and depression. The qualitative thematic analysis results were categorized into: (1) facing the reality of being isolated in a room; (2) struggling to accept and adapt to isolation; and (3) seeking connections in isolation. CONCLUSIONS: This research sheds light on the challenges faced by individuals in isolation and underscores the crucial role of resilience in overcoming such challenges. The resilience observed in these patients is grounded in both interpersonal and profound spiritual connections. These findings underscore the necessity for nurses to develop customized strategies to alleviate the impacts of social isolation.

Development of a nurse navigation program for cancer pain.

Objective: Cancer pain significantly impacts the overall quality of life of cancer patients, necessitating proactive management. The manifestations of cancer pain vary individually and require tailored interventions to address each patient's unique characteristics. Therefore, this study aims to develop a nurse navigation program for cancer pain (NNP-CP) tailored to the needs of cancer patients requiring pain control, aiming to establish evidence-based clinical nursing practices and promote effective cancer pain management. Methods: This study is a methodological research into developing a pain management program led by nurses for cancer patients requiring pain control, based on a professional navigation framework. The development of the program relied on three out of the five stages of the ADDIE (Analysis, Design, Development, Implementation, Evaluation) model. Results: A literature review was conducted to select the content and rationale to be included in the intervention program. Publications within the last 10 years in English or Korean were identified and screened based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 literature selection flow, 17 articles were included. Standardized information regarding cancer pain control was based on the 7th edition of 'Cancer Pain Management Guidelines'. The initial draft of the pain management intervention program was developed by organizing and structuring the derived content based on the professional navigation framework. Subsequently, the final intervention program was confirmed through the review by six clinical experts specializing in cancer pain. Conclusions: Cancer pain is a significant factor that profoundly influences the quality of life and survival duration of cancer patients. While appropriate management methods offer the prospect of control, insufficient intervention is the current reality. Through the pain management intervention program based on the expert navigation framework that promotes continuity of care and empowers the recipients, this study anticipates not only pain reduction in cancer patients but also an enhancement in their quality of life.

Outcomes of a culturally responsive health promotion program for elderly Korean survivors of gastrointestinal cancers: a randomized controlled trial.

This single-blind, prospective, randomized controlled trial was designed to evaluate the effects of a culturally responsive health promotion program for elderly Korean (CHP-K) survivors of gastrointestinal (GI) cancers. The program consisted of 8 weeks of Qi exercise and face-to-face counseling on physical and psychological factors. A total of 63 Korean GI cancer survivors, aged ≥65 years, who had completed their active cancer treatment, were recruited from a cancer center in South Korea. Outcomes included the amount of exercise, body weight, BMI, the Patient Generated Subjective Global Assessment scale, the M.D. Anderson Symptom Inventory, and self-efficacy and self-esteem scales. Repeated measures MANCOVA revealed a significant difference over time between the groups (Wilks' Lambda F1,62 = 5.361, p = 0.007). Univariate RM-ANCOVA for each outcome measure revealed statistically significant differences between groups. These results suggested that the participation in the CHP-K may have enhanced the health of elderly Korean GI cancer survivors.

Body Acceptance Scale for Women with Breast Cancer: Development and Validation of a Measurement.

PURPOSE: Breast cancer and its treatment result in drastic physical changes that can negatively affect a woman's body image. Body acceptance in women with breast cancer is crucial in enhancing their body image and overall quality of life. Despite its significance, there are currently no specific tools to measure body acceptance among cancer patients. This study aimed to develop a Body Acceptance Scale for Women with Breast Cancer (BAS-BC). DATA SOURCES: The scale's initial items were generated based on a conceptual framework of body acceptance and were reviewed by three clinical and five experiential experts. A preliminary instrument was developed through a content validity assessment by six clinical experts and a pilot test with 20 women with breast cancer. Validity and reliability were evaluated via an online survey of 411 women who had undergone breast cancer surgery. CONCLUSION: The scale consists of 17 items across six factors (encountering, understanding, adaptation, return to daily life, successful transition, and leap into the future). The scale's validity-including construct validity, cross-validity, known-groups validity, and criterion validity-was satisfactory, exhibiting a Cronbach α of .91. The BAS-BC demonstrated good validity and reliability. IMPLICATIONS FOR NURSING PRACTICE: The BAS-BC will contribute to improving the quality of life of female breast cancer survivors by providing fundamental information for future research. The BAS-BC may enable nurses to provide tailored interventions to promote body acceptance.

Body image alteration in women with breast cancer: A concept analysis using an evolutionary method.

Objective: Women with breast cancer experience changes in body image, a key predictor of overall quality of life. Body image alteration has been recognized in scholarly circles and is actively being researched on; however, a comprehensive conceptualization of body image alteration from an oncological perspective is insufficient. Therefore, this study aimed to analyze the concept of body image alteration in women within the context of breast cancer based on Rodgers' evolutionary method. Methods: A literature search using a combination of the keywords "breast neoplasms" and "body image" was conducted via PubMed, CINAHL, EMbase, PsycInfo, KISS, and RISS. Peer-reviewed journal articles related to body image alteration in women with breast cancer, published from 2001 to 2020, were included in this study. Results: Three critical attributes of body image alteration were identified: "dismantling the existing body image," "transitioning to the altered body," and "re-integrating a new body image." Antecedents included "breast cancer and its treatment," "awakening to the sociocultural norms of a feminine body," and "triggering events for reflecting on one's body." The consequences were "psychological well-being or distress," "strengthening or breakdown of intimate relationships," "enhancement or impairment of social functioning," and "adherence or resistance to breast cancer treatment." Conclusions: This study provides comprehensive conceptualizations that encompass individual, interpersonal, and sociocultural components and cover both negative and positive changes in body image from a long-term perspective. This may offer a useful framework that can be used to develop effective interventions for body image improvement and accelerate further research.

Body acceptance in women with breast cancer: A concept analysis using a hybrid model.

BACKGROUND: Women with breast cancer undergo drastic physical changes which can impact their body image. Accepting the altered body has recently been highlighted as the key to body image improvement, however, there is no clear definition or conceptualization of it. This study clarified the concept of body acceptance in women with breast cancer, using a hybrid model. METHODS: In the theoretical phase, the attributes and working definitions of the concept were identified through an extensive literature review. Individual in-depth interviews were conducted during the fieldwork phase to elucidate the concept and verify the attributes derived from the theoretical phase. Finally, in the final analytic phase, the findings were compared and integrated. RESULTS: The theoretical and fieldwork phases included 20 out of the 579 articles extracted from the literature search and five women who had undergone breast cancer surgery, respectively. Body acceptance was defined as "acknowledging, normalizing, and overcoming changes in body appearance and function caused by breast cancer and its treatment". CONCLUSIONS: Body acceptance has been identified as a key factor directly related to the overall quality of life. This study provides a theoretical basis for developing effective interventions and consequently facilitates their provision in practice.

Outpatient Service Use in Korean Older Adult Women with Degenerative Arthritis Based on Andersen's Model.

To ensure that older adults (aged 65 years or older) can experience a healthy life, they should use medical services that are appropriate, both quantitatively and qualitatively. This study aimed to identify the factors affecting outpatient service use by older adult women with degenerative arthritis using Andersen's model. A survey was conducted among 232 older adult women with degenerative arthritis in two university hospitals in Seoul. The Korean Activities of Daily Living, Korean Instrumental Activities of Daily Living, and the Geriatric Depression Scale Short Form were used. Data were analyzed using descriptive statistics, χ2-test, t-test, and multiple logistic regression analysis. Among the participants, 69.8% used outpatient services and 30.2% did not. In the univariate analyses, age, marital status, residency, household income, chronic diseases, subjective health status, and disability were significant. Age (odds ratio [OR] = 5.53, p < 0.001), annual household income (OR = 5.64, p < 0.001), chronic diseases (OR = 11.06, p < 0.001), and disability (OR = 3.56, p = 0.016) significantly affected outpatient service use. The results suggest that health promotion interventions for Korean older adult women should focus on predicting outpatient service use according to the patient's characteristics.

Degree of Alarm Fatigue and Mental Workload of Hospital Nurses in Intensive Care Units.

This study aimed to determine the degree of alarm fatigue and mental workload of ICU nurses, and to clarify the relationship between these two variables. A cross-sectional, descriptive research design was used. Data were collected from 90 nurses working in four ICUs in Seoul, Republic of Korea, using a questionnaire determining their degree of alarm fatigue and mental workload. Data were collected from 6 March to 26 April 2021 and were analyzed using a t-test, ANOVA, and Pearson's correlation coefficient. The average alarm-fatigue score was 28.59 out of 44. The item with the highest score was "I often hear a certain amount of noise in the ward", with a score of 3.59 out of 4. The average of the mental workload scores was 75.21 out of 100. The highest mental workload item was effort, which scored 78.72 out of 100. No significant correlation was found between alarm fatigue and mental workload. Although nurses were consistently exposed to alarm fatigue, this was not directly related to their mental workloads, perhaps owing to their professional consciousness as they strived to accomplish tasks despite alarm fatigue. However, since alarm fatigue can affect efficiency, investigations to reduce it and develop appropriate guidelines are necessary. This study was not registered.

Comparison of objective and subjective sleep time and quality in hospitalized recipients of hematopoietic stem cell transplantation.

Objective: In this study, the sleep time and efficiency of recipients of hematopoietic stem cell transplantation (HSCT) were investigated throughout treatment and compared objective measurements with subjective self-reported data. Methods: Sleep time and efficiency were measured using both objective and subjective methods throughout the treatment period in inpatients receiving HSCT. The participants were recruited among HSCT inpatients at a tertiary hospital in Seoul, South Korea, between August 2019 and August 2020. Actigraphy was used to measure objective sleep time and efficiency. Subjective sleep time and quality were measured using the sleep diary and Insomnia Severity Index. Measurement data from 40 patients were analyzed. Repeated-measures analysis of variance was used to compare the differences between objective and subjective values in total sleep time and sleep efficiency. Results: The total sleep time was the lowest during the administration of anticancer drugs before stem cell transplantation. The total sleep time of patients with HSCT differed significantly over time when offsetting the difference in the measurement method. There were no significant differences between subjective and objective results for sleep time, and the interaction between the two methods over time was not significant. However, meaningful differences were found among the groups in sleep efficiency throughout the treatment period and between objective and subjective methods, as well as a statistically significant interaction between the two methods over time. Conclusions: Actigraphy misclassified patients' low-energy state with little movement due to immune system impairment during treatment as sleep, resulting in high measured sleep efficiency, whereas their self-reported sleep efficiency was very low. Therefore, subjective measures might be more accurate for measuring sleep efficiency in HSCT patients.

Development and application of a mobile-based multimedia nursing competency evaluation system for nursing students: A mixed-method randomized controlled study.

AIM: To develop a mobile-based multimedia Nursing Competency Evaluation (NCE) system based on the Attention, Relevance, Confidence, Satisfaction model and verify its effectiveness. BACKGROUND: In education, mobile devices can enable the delivery of learning content without time and spatial constraints. Mobile-based test is emerging as a novel method using technologies to appraise students' performance on practicum. This mobile-based test go beyond the simple evaluation of memorised knowledge, a limitation common to paper-based tests. They are useful because they can include multimedia items such as videos, animations and pictures to comprehensively evaluate students' clinical competencies. METHODS: This study was conducted in a nursing university in Seoul, South Korea in September 2021. A mixed method randomised controlled design was employed to evaluate its usability. The participants in the experimental group used the Nursing Competency Evaluation system and joined in focus group interviews for verifying the effects of the Nursing Competency Evaluation system qualitatively. Those in the control group responded to the mobile-based test, but which has only text-based test items. The system usability, effectiveness and learning satisfaction in both groups were measured after the mobile-based test experience. Quantitative and qualitative data were analysed using t-tests and thematic analysis using focus group interviews, respectively. RESULTS: Sixty nursing students participated, with 30 each in the experimental and control groups. There were no significant differences in nursing competency scores between the two groups. However, average scores for effectiveness and learning satisfaction were significantly higher in the experimental than in the control group. Nineteen experimental group participants partook in the interviews, with many describing that the Nursing Competency Evaluation system allowed them to experience new learning contents and efficiently learn practical nursing skills that can be useful in clinical settings. CONCLUSIONS: The Nursing Competency Evaluation system is a promising method because it used mobile technologies and multimedia to appraise students' performance on nursing practicum. It was found that the Nursing Competency Evaluation system with multimedia items is more realistic, interactive and satisfactory compared with text-based mobile test. Thus, we expect it to be used in future nursing curriculums to improve students' nursing competencies.