Structured physical exercise interventions and children and adolescents with attention deficit hyperactivity disorder: A systematic review and meta-analysis.

BACKGROUND: The efficacy of structured physical exercise (SPE) has been examined in empirical studies to treat attention deficit hyperactivity disorder (ADHD). This review aimed (i) to systematically review and quantify the effects of SPE on ADHD symptomology and executive function (primary outcomes) and on physical health, physical fitness and mental health issues (secondary outcomes) in children/adolescents with ADHD; (ii) to evaluate the study quality and explore moderation of the effects of SPE; and (iii) to summarize the design of SPE interventions. METHODS: An extensive literature search in the databases of PubMed, Web of Science and EBSCOhost was conducted to identify eligible intervention studies for meta-analysis. A descriptive account of the features of the studies is provided, including assessment of risk/quality (ROB-2/ROBINS-I). Standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated with random effects models to compare post-intervention effects. RESULTS: A total of 18 studies were included in the review. The majority of the studies examined the effects of SPE lasting for 3-12 weeks. Assessment of bias/quality indicated half of the included studies as high quality. The meta-analysis (pooled n = 627) revealed that SPE had a positive effect on primary and secondary outcomes, that is, inattention (SMD = -1.79), executive function (SMD = 2.19), physical fitness (SMD = 1.39) and mental health issues (SMD = -0.89). Subgroup analysis showed that long-term practice of SPE, featured/tailored SPE, non-Chinese participants, taking methylphenidate and study with low quality had larger effects. CONCLUSIONS: There is emerging evidence that SPE is a promising option to enhance symptom management and physical/mental health in children/adolescents with ADHD.

Effectiveness of a game-based high-intensity interval training on executive function and other health indicators of children with ADHD: A three-arm partially-blinded randomized controlled trial.

Background: Children with ADHD demand for effective intervention with minimum side effect to improve executive function (EF) and health well-being. Method: This study used a three-arm partially-blinded randomized controlled trial to test the effects of two different kinds of 8-week game-based training programs (game-based HIIT program, GameHIIT; and game-based structured aerobic exercise program, GameSAE) on EF and other health indicators of children with ADHD, which was compared with a non-treatment control group. Results: A total of 49 children with ADHD completed the program. Analyses of EF tests and parental survey indicated that (i) there is no significant intragroup difference among all measures between pre-/post-intervention tests for two game-based intervention groups. The only significant intergroup difference was observed in self-monitor score of parent-reported child's EF between GameSAE group and the control (large effect). Similarly, cerebral hemodynamic responses also found no significant group effect for all EF tests. However, the time effects were observed in several channels in the GameHIIT group in two EF tests (Color Words Stroop Test and Tower of London Test). No significant change of participants' overall ADHD symptoms was found in the pre-/post-tests for three groups. Nonetheless, further analyses revealed that both of two game-based training programs exhibited the significant positive effects on child's PA levels and the large effects on levels of physical fitness, when they were compared to the control. Conclusion: By this study, a significant enhancement in physical fitness and PA levels were found in both game-based PA interventions when they were compared with control group. However, the effectiveness of game-based PA interventions on improving EF or reducing ADHD symptoms remains unclear. This implies that a larger intervention dosage or a tailored intervention design may be warranted to improve the EF of children with ADHD.

Associations of Device-Measured Physical Activity, Sedentary Behavior, and Executive Function in Preadolescents: A Latent Profile Approach.

PURPOSE: This study investigated the associations between physical activity (PA), sedentary behavior, and executive function in preadolescents. METHODS: One hundred and twenty preadolescents were recruited from 2 Hong Kong primary schools. PA and sedentary behavior were recorded for 7 consecutive days by accelerometer. Executive function performance, including inhibition (Stroop task and Flanker task) and working memory (Sternberg paradigm task), were measured. Body mass index and cardiorespiratory fitness (multistage fitness test) were tested. Latent profile analysis explored the profiles of PA and sedentary behavior in preadolescents. RESULTS: Three distinct profiles were identified: low activity, average activity, and high activity. Participants in low activity performed worse in the accuracy of Stroop task (vs average activity, P = .03; vs high activity, P < .01), Flanker task (vs average activity, P = .02; vs high activity, P < .001), and Sternberg paradigm task (vs average activity, P < .01; vs high activity, P < .01). No significant difference was observed between participants with average and high activities. No significant association was observed for profiles on body mass index and cardiorespiratory fitness. CONCLUSION: Supplementing the consensus of the literature that moderate to vigorous PA benefits cognition, the authors conclude that light PA may also enhance preadolescents' executive functioning.

Training and Match Demands of Elite Rugby Union.

ABSTRACT: Cousins, BEW, Morris, JG, Sunderland, C, Bennett, AM, Shahtahmassebi, G, and Cooper, SB. Training and match demands of elite rugby union. J Strength Cond Res 37(1): 141-148, 2023-This study aimed to examine training and match demands associated with elite Rugby Union. Eighty-nine elite players were monitored using subjective (session ratings of perceived exertion) and objective (global positioning systems: distance and high-speed running [defined as >70% of individual maximum speed] distance) methods, alongside key performance indicator variables in matches (e.g., number of tackles made). These were compared between positions (forwards vs. backs) and league of competition (Premiership vs. Championship). Statistical significance was accepted as p < 0.05. Analysis revealed that backs covered greater distance (by 704 m, p < 0.001) in training and greater distance (by 7.6 m·min-1, p < 0.001) and high-speed running distance (by 1.22 m·min-1, p < 0.001) in matches, compared with forwards. In matches, the forwards experience greater key performance indicator demand (tackles: 78%; tackle assists: 207%; breakdown entries: 324%; contact events: 117%; all p < 0.001) compared with backs. The number of tackles (53%, p < 0.001) and tackles missed (35%, p = 0.001) were greater, whereas contact carries (12%, p = 0.010) and breakdown entries (10%, p = 0.024) were lower, in the Premiership compared with the Championship. Overall, these findings confirm that the running demands of Rugby Union are higher in backs, whereas contact actions are higher in forwards, with further differences between the Premiership and Championship. This comprehensive examination of the demands of elite Rugby Union could be used to ensure the specificity of training protocols for elite Rugby Union clubs, specific to both playing position (forward or back) and level of competition (Premiership or Championship).

Perceptions of being a registered nurse (PRN): development and validation of a survey tool.

BACKGROUND: Nursing students enter nursing programs with idealistic perceptions of what it is to be a nurse. Upon graduation, many find these perceptions mismatched with the actual nurse's role. This can lead to discontentment in their chosen career. These issues highlight the importance of nursing students developing an understanding of the nurse's role during their undergraduate nursing education. One way to accomplish this is to assess perceptions and address them accordingly during the nursing program. Survey tools assessing perceptions of nursing exist but lack contemporary and multicultural foci. AIM: To develop a feasible, valid, and reliable survey tool to identify nursing students' perceptions of being a nurse. DESIGN/METHODS: In Phase 1, a literature review and Nominal Group Technique meetings were used to generate primary survey items. Phase 2 included a pre-pilot and online pilot testing of the Perceptions of being a Registered Nurse (PRN) survey tool with 797 nursing students across all year levels at three Australian Universities. RESULTS: The 34-item PRN survey tool uses a five-point Likert scale to measure nursing students' perceptions of nursing, including factors influencing a nurse's well-being, attributes and qualities of nurses, the role of the nurse, and nursing professionalism. The Item-Content validity index was high (> 0.78), and the inter-item correlation validity was identified by Pearson's product-moment coefficient of r = .712. Internal reliability was confirmed with a Cronbach's alpha = 0.83. Based upon the participation completion rate, the survey tool was deemed applicable and feasible. The majority of respondents believed that nurses have altruistic attributes; however, perceptions of nursing varied significantly when rating factors influencing the physical, emotional, and social well-being of a nurse. In later stages of training, respondents were more likely to agree that nursing is physically and emotionally demanding and that nurses experience social isolation due to shift work, finding it difficult to achieve a work-life balance. CONCLUSIONS: The PRN survey tool was found to be valid, reliable, and feasible. Future use and outcomes from PRN assessments may lead to changes to nursing curricula that enhance nursing students' perceptions of nursing.

Physical fitness, physical activity and adiposity: associations with risk factors for cardiometabolic disease and cognitive function across adolescence.

BACKGROUND: The cross-sectional associations between physical activity, physical fitness and adiposity with risk factors for cardiometabolic disease (particularly novel ones such as inflammatory cytokines) and cognitive function across the period of adolescence are not well understood. Additionally, novel physical activity metrics that summarise activity volume and intensity in a continuous manner have not been investigated in this context. Therefore, this study investigated the cross-sectional associations between physical activity, physical fitness and adiposity with risk factors for cardiometabolic disease and cognitive function. These associations were compared between younger and older adolescents. METHODS: Seventy younger (11-12y, 35 girls) and 43 older (14-15y, 27 girls) adolescents volunteered to take part in the study. Physical fitness (multi-stage fitness test, MSFT) and adiposity (waist circumference) were determined, followed 7d later by resting blood pressure, a fasted blood sample (glucose, plasma insulin, IL6, IL10, IL15 and IL-1ß concentrations) and a cognitive function test battery. Habitual physical activity was monitored via hip-worn accelerometers over this 7-d period and the average acceleration (activity volume), and intensity gradient (intensity distribution of activity) were determined. RESULTS: Average acceleration and intensity gradient were negatively associated with mean arterial blood pressure (ß = -0.75 mmHg, p = 0.021; ß = -10 mmHg, p = 0.006, respectively), and waist circumference was positively associated with IL-6 concentration (ß = 0.03%, p = 0.026), with stronger associations observed in older adolescents. Higher physical fitness (MSFT distance) was positively associated with anti-inflammatory IL-15 concentration (ß = 0.03%, p = 0.038) and faster response times on the incongruent Stroop task (ß = -1.43 ms, p = 0.025), the one-item level of the Sternberg paradigm (ß = -0.66 ms, p = 0.026) and the simple (ß = 0.43 ms, p = 0.032) and complex (ß = -2.43 ms, p = 0.020) levels of the visual search test, but these were not moderated by age group. CONCLUSIONS: The present study highlights the important role of physical activity (both the volume and intensity distribution) and physical fitness for cardio-metabolic health. Furthermore, the present study highlights the importance of physical fitness for a variety of cognitive function domains in adolescents, irrespective of age.

Agreement and equivalence of estimated physical activity behaviours, using ENMO- and counts-based processing methods, for wrist-worn accelerometers in adolescents.

The present study examined the agreement and equivalence between two physical activity processing methods. Data were obtained from 161 Hong-Kong adolescents (74 girls, age: 12.6 ± 1.7y). Participants wore an Actigraph GT3XBT on their non-dominant wrist for 7d. Time spent sedentary, and in light-(LPA), moderate-(MPA), vigorous-(VPA), and moderate-to-vigorous physical activity (MVPA) were calculated using different processing methods (proprietary counts and Euclidean Norm Minus One (ENMO)). Intraclass correlation coefficients (ICC) were used to examine absolute agreement (ICC2) and consistency (ICC3), and equivalence was assessed using pairwise equivalence tests. Using ENMO, sedentary time and VPA were higher, whereas all other behaviours were lower (compared to counts processing). Agreement ranged from poor (ICC2:0.42(Sedentary)) to moderate (ICC2:0.86(LPA)) and consistency ranged from moderate (ICC3:0.71(sedentary)) to good (ICC3:0.91(LPA)). Methods were not considered equivalent (all p > 0.05). Due to differences in the wear-time validation of processing methods, a sensitivity analyses (sub-sample with the same valid wear time for both methods (n = 56)), resulted in minimal change. Lack of agreement and equivalence between ENMO and counts processing methods suggests that the processing method significantly affects youth physical activity estimates.

Contextual factors influencing patients' experiences of acute deterioration and medical emergency team (MET) encounter: A grounded theory study.

AIM: This paper explores the personal, social and structural factors that influence patients' experiences of acute deterioration and medical emergency team (MET) encounter. BACKGROUND: Patient experience is recognized as a means of assessing healthcare delivery with a positive experience being linked to high-quality healthcare, improved patient safety and reduced length of stay. The experience of acute deterioration is unique, extensive and complex. However, little is known about this experience from the patient's perspective. DESIGN: Constructivist grounded theory, informed by Kathy Charmaz, was used to explore the personal, social and structural factors that influence patients' experiences of acute deterioration and MET encounter. METHODS: Using a semi-structured interview guide, in-depth individual interviews were conducted with 27 patients from three healthcare services in Victoria, Australia. Data were collected over a 12-month period from 2018 to 2019. Interview data were analysed using grounded theory processes. FINDINGS: Contextual factors exert a powerful influence on patients' experiences of acute deterioration and MET encounter. The most significant factors identified include patients' expectations and illness perception, relationship with healthcare professionals during MET call and past experiences of acute illness. The expectations and perceptions patients had about their disease can condition their overall experience. Healthcare professional-patient interactions can significantly impact quality of care, patient experience and recovery. Patients' experiences of illness and healthcare can impact a person's future health-seeking behaviour and health status. CONCLUSION: Patients' actions and processes about their experiences of acute deterioration and MET encounter are the result of the complex interface of contextual factors. IMPACT: The findings from this study have highlighted the need for revised protocols for screening and management of patients who experience acute deterioration.

Associations of Self-Control with Physical Activity, Physical Fitness, and Adiposity in Adolescents.

The associations between self-control and objective measures of physical activity, physical fitness, and adiposity are yet to be explored in young people; this is a gap in the literature that the present study aimed to address. The study employed a cross-sectional design. A total of 101 young people participated in the study. Participants completed the Brief Self-Control Scale as a measure of trait self-control. Free-living physical activity was assessed using an ActiGraph GT3X + triaxial accelerometer, which was worn for 7 days. Participants also completed the 15-meter version of the multistage fitness test as a measure of physical fitness. For the assessment of adiposity, three criterion measures were used: body mass index (BMI), sum of skinfolds, and waist circumference. Data were analyzed using the glm function in the open access software R. Higher levels of trait self-control were associated with higher levels of physical fitness (measured by distance run on the multistage fitness test) and lower adiposity (BMI, waist circumference, and sum of skinfolds) in adolescents. There was a tendency for a positive association between self-control and time spent in vigorous physical activity, although this did not reach statistical significance. In a combined model, self-control was also associated with both physical fitness and waist circumference, with these effects independent of each other. These findings suggest that self-control is associated with healthy behaviors and characteristics in adolescents and is thus potentially an attractive target for future interventions aimed at increasing physical activity and physical fitness and reducing adiposity in this population.

Using virtual simulation to teach evidence-based practice in nursing curricula: A rapid review.

BACKGROUND: Virtual simulation is an interactive teaching and learning strategy used in undergraduate nursing student education, especially since the onset of the COVID-19 pandemic. Few published studies have reviewed the impact of virtual simulation as a strategy for teaching nursing students the elements of evidence-based practice. AIM: To describe types of virtual simulation that are relevant to nursing student education and examine how these modalities are applied to teach elements of evidence-based practice. METHODS: A rapid review of literature was conducted to discern the use and impact of virtual simulation. Thirty-seven studies published between 2017 and May 2021 that addressed nursing students' educational outcomes were reviewed and summarized as a narrative analysis. RESULTS: Virtual simulation and virtual reality simulation engage learners in role-plays via a computer screen or hand-held phone. Various levels of realism and immersion were apparent across different modalities and with the utilization of educational games. Most studies related to the teaching of best practice evidence-based clinical nursing topics. Twenty primary studies reported objective measures of students' improvement such as knowledge, performance, better documentation, or communication accuracy. Sixteen studies that measured knowledge identified significant knowledge gains. All studies endorsed virtual simulation as a teaching method. LINKING EVIDENCE TO ACTION: Virtual simulation approaches offer an innovative and feasible option for teaching nursing students. Such approaches should be included in undergraduate nursing curricula. While it is apparent that evidence-based practice guidelines inform the design of the virtual simulation scenarios, the effectiveness of the modality for teaching specific elements of evidence-based practice to nursing students is not yet confirmed. Nursing curricula need to include ways of teaching nursing students to search for and critically appraise trustworthy sources of knowledge for clinical practice.

Quaternary Charge-Transfer Complex Enables Photoenzymatic Intermolecular Hydroalkylation of Olefins.

Intermolecular C-C bond-forming reactions are underdeveloped transformations in the field of biocatalysis. Here we report a photoenzymatic intermolecular hydroalkylation of olefins catalyzed by flavin-dependent 'ene'-reductases. Radical initiation occurs via photoexcitation of a rare high-order enzyme-templated charge-transfer complex that forms between an alkene, α-chloroamide, and flavin hydroquinone. This unique mechanism ensures that radical formation only occurs when both substrates are present within the protein active site. This active site can control the radical terminating hydrogen atom transfer, enabling the synthesis of enantioenriched γ-stereogenic amides. This work highlights the potential for photoenzymatic catalysis to enable new biocatalytic transformations via previously unknown electron transfer mechanisms.

Predictors of postprandial glycaemia, insulinaemia and insulin resistance in adolescents.

Postprandial glycaemia and insulinaemia are important risk factors for type 2 diabetes. The prevalence of insulin resistance in adolescents is increasing, but it is unknown how adolescent participant characteristics such as BMI, waist circumference, fitness and maturity offset may explain responses to a standard meal. The aim of the present study was to examine how such participant characteristics affect the postprandial glycaemic and insulinaemic responses to an ecologically valid mixed meal. Data from the control trials of three separate randomised, crossover experiments were pooled, resulting in a total of 108 participants (fifty-two boys, fifty-six girls; aged 12·5 (SD 0·6) years; BMI 19·05 (SD 2·66) kg/m2). A fasting blood sample was taken for the calculation of fasting insulin resistance, using the homoeostatic model assessment of insulin resistance (HOMA-IR). Further capillary blood samples were taken before and 30, 60 and 120 min after a standardised lunch, providing 1·5 g/kg body mass of carbohydrate, for the quantification of blood glucose and plasma insulin total AUC (tAUC). Hierarchical multiple linear regression demonstrated significant predictors for plasma insulin tAUC were waist circumference, physical fitness and HOMA-IR (F(3,98) = 36·78, P < 0·001, adjusted R2 = 0·515). The variance in blood glucose tAUC was not significantly explained by the predictors used (F(7,94) = 1·44, P = 0·198). Significant predictors for HOMA-IR were BMI and maturity offset (F(2,102) = 14·06, P < 0·001, adjusted R2 = 0·021). In summary, the key findings of the study are that waist circumference, followed by physical fitness, best explained the insulinaemic response to an ecologically valid standardised meal in adolescents. This has important behavioural consequences because these variables can be modified.

Developing clinical indicators for oncology: the inaugural cancer care indicator set for the Australian Council on Healthcare Standards.

INTRODUCTION: The Australian Council on Healthcare Standards (ACHS) sponsored an expert-led, consensus-driven, four-stage process, based on a modified Delphi methodology, to determine a set of clinical indicators as quality measures of cancer service provision in Australia. This was done in response to requests from institutional health care providers seeking accreditation, which were additional and complementary to the existing radiation oncology set. The steering group members comprised multidisciplinary key opinion leaders and a consumer representative. Five additional participants constituted the stakeholder group, who deliberated on the final indicator set. METHODS AND RECOMMENDATIONS: An initial meeting of the steering group scoped the high level nature of the desired set. In stage 2, 65 candidate indicators were identified by a literature review and a search of international metrics. These were ranked by survey, based on ease of data accessibility and collectability and clinical relevance. The top 27 candidates were debated by the stakeholder group and culled to a final set of 16 indicators. A user manual was created with indicators mapped to clinical codes. The indicator set was ratified by the Clinical Oncology Society of Australia and is now available for use by health care organisations participating in the ACHS Clinical Indicator Program. This inaugural cancer clinical indicator set covers high level assessment of various critical processes in cancer service provision in Australia. Regular reviews and updates will ensure usability. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: This is the inaugural indicator set for cancer care for use across Australia and internationally under the ACHS Clinical Indicator Program. Multidisciplinary involvement through a modified Delphi process selected indicators representing both generic and specific aspects of care across the cancer journey pathway and will provide a functional tool to compare health care delivery across multiple settings. It is anticipated that this will drive continual improvement in cancer care provision.

Detrimental effects of prior self-control exertion on subsequent sporting skill performance.

The prior exertion of self-control has previously been shown to negatively affect physical performance, yet the effects on complex sporting skill performance have not been examined. Therefore, this study examined whether prior self-control exertion influences performance on a field hockey task, alongside measuring plasma cortisol concentration and attention as potential mechanisms to explain any effects. Following familiarization, 13 male hockey players (20 ± 1 years) participated in a randomized, order-balanced, crossover design. For the manipulation of self-control, participants completed an incongruent (self-control exertion trial) or a congruent (control trial) Stroop task. Skill performance was assessed using a field hockey skills task. Capillary blood samples, for the determination of plasma cortisol concentration, were taken at baseline, post-Stroop task, and post-field hockey skills task. Cognitive tests of attention (RVIP and Flanker tasks) were completed following the field hockey skills task. Participants made more errors in the latter stages of the field hockey skills task following self-control exertion (trial*time interaction, p = 0.041). Participants also made more errors on the RVIP task following self-control exertion (p = 0.035); yet the time taken to complete the hockey skills task, performance on the flanker task, and plasma cortisol concentrations were unaffected (all p > 0.05). Overall, these findings suggest that prior self-control exertion has detrimental effects on subsequent sporting skill performance (more errors made on the field hockey task), which may be explained by poorer sustained attention (lower accuracy on the RVIP task). This suggests that athletes should aim to avoid self-control exertion before a competitive match to optimize performance.

Effect of acute football activity and physical fitness on glycaemic and insulinaemic responses in adolescents.

The present study examined the metabolic responses to an acute bout of football and the overall and moderating role of physical fitness on these responses, in adolescents. Thirty-six adolescents (16 girls, 20 boys; 12.6±0.5 y) completed two trials (60-min football and 60-min seated rest) separated by 7-d. Capillary blood samples were taken at baseline (60-min prior to exercise/rest), immediately, 30- and 60-min post-exercise and 30-, 60- and 120-min following a standardised lunch (1.5-, 2- and 3-h post-exercise), for the determination of blood glucose and plasma insulin concentrations. The median split of distance covered on the multi-stage fitness test was used to define high- and low-fit groups. Overall plasma insulin tAUC following lunch was lower in high-fit participants compared to low-fit (high-fit: 3784.2±1653.1 pmol·L-1x120min, low-fit: 6457.3±3290.7 pmol·L-1x120min; p<0.001), although there was no acute effect of the football session (p>0.05). Football reduced blood glucose concentration 1-h post-exercise compared to control (exercise: 3.8±0.6 mmol·L-1, rest: 4.6±0.8 mmol·L-1; p<0.001), but this was similar for the high- and low-fit participants (p>0.05). Blood glucose tAUC was not affected by exercise or physical fitness (p>0.05). These data emphasise the importance of physical fitness for metabolic health in adolescents, as well as the utility of football as a popular form of games-based activity for improving glucose regulation.

Effect of football activity and physical fitness on information processing, inhibitory control and working memory in adolescents.

BACKGROUND: Whilst an acute bout of exercise has been shown to enhance subsequent cognition, including in adolescents, the effects of team games (of which Football is the most popular) has received little attention. Therefore, this study examined: the effect of an acute bout of outdoor Football activity on information processing, inhibitory control, working memory and circulating brain-derived neurotrophic factor (BDNF) in adolescents; the effect of physical fitness on cognition and; the moderating effect of physical fitness on the acute exercise responses. METHODS: Following familiarisation, 36 adolescents (16 girls) took part in two trials (60-min Football and 60-min seated rest) separated by 7-d in a counterbalanced, crossover design. Information processing and inhibitory control (Stroop Test), and working memory (Sternberg Paradigm) were assessed 30-min before exercise/rest and immediately, 45- and 90-min post-exercise/rest. Capillary blood samples were obtained before exercise/rest and up to 120-min post-exercise/rest. The median split of distance covered on the MSFT was used to divide the group into high- and low-fit groups. RESULTS: Performance on the cognitive function tasks was similar between Football and seated rest (trial*time interactions; all p > .05). However, the high-fit group had overall quicker response times on both levels of the Stroop Task and all three levels of the Sternberg Paradigm (main effect of fitness; all p < .001). Furthermore, the exercise-cognition relationship was moderated by physical fitness, with improvements in working memory response times seen post-exercise, only in the high-fit group (trial*time*fitness interaction, p < .05). Circulating BDNF was unaffected by the Football activity and physical fitness (p > .05). CONCLUSION: The present study shows that higher levels of physical fitness are beneficial for cognitive function and provides novel evidence that an ecologically valid, and popular, form of exercise is beneficial for working memory following exercise, in high-fit participants only.

Nursing teamwork in general ward settings: A mixed-methods exploratory study among enrolled and registered nurses.

AIM: To examine the perceived level of nursing teamwork and factors influencing teamwork among enrolled nurses (ENs) and registered nurses (RNs) in general ward settings. BACKGROUND: The nursing care delivery model includes RNs, ENs and others who work as a team to deliver patient care. The potential impact of teamwork on nursing care highlights the need to explore the work of nursing teams. DESIGN: A mixed-methods exploratory study. METHOD: Quantitative and qualitative data were collected concurrently from ENs and RNs in 2018. Two hundred and forty-eight (n = 248) nurses completed the Nursing Teamwork Survey. Sixteen nurses participated in focus group discussions. Qualitative data were reported following COREQ guidelines, while quantitative data followed the STROBE guidelines. RESULTS: Both ENs and RNs scored highest for the shared mental model subscale but lowest for the team orientation subscale. Factors including qualification level, years of working experience, perceived job staffing adequacy and job satisfaction were found to influence teamwork. Three themes emerged from the qualitative findings: expectations of each other's role, delegation practices and interpersonal relationships. ENs and RNs differed in their expectations of their role in basic patient care activities and faced power struggles related to delegation practices. Open and structured communication was deemed essential in building interpersonal relationships. CONCLUSION: The ENs and RNs have clear understanding of their personal roles and responsibilities towards achieving a common goal. However, teamwork may be improved with a shared mental model in performing basic nursing care tasks, mutual support for workload management, better delegation practices, effective communication, enhanced interpersonal relationships and better team orientation. RELEVANCE TO CLINICAL PRACTICE: Nurse managers and educators need to work collaboratively to foster positive delegation practices in clinical practice supported by applicable team training that enhances mutual trust, backup behaviours and collective orientation in nursing teams.

Measuring the quality of nursing clinical placements and the development of the Placement Evaluation Tool (PET) in a mixed methods co-design project.

BACKGROUND: The quality of nursing clinical placements has been found to vary. Placement evaluation tools for nursing students are available but lack contemporary reviews of clinical settings. Therefore, the aim of this study was to develop a feasible, valid and reliable clinical placement evaluation tool applicable to nursing student placements in Australia. METHODS: An exploratory mixed methods co-design project. Phase 1 included a literature review; expert rating of potential question items and Nominal Group Technique meetings with a range of stakeholders for item development. Phase 2 included on-line pilot testing of the Placement Evaluation Tool (PET) with 1263 nursing students, across all year levels at six Australian Universities and one further education college in 2019-20, to confirm validity, reliability and feasibility. RESULTS: The PET included 19-items (rated on a 5-point agreement scale) and one global satisfaction rating (a 10-point scale). Placements were generally positively rated. The total scale score (19 items) revealed a median student rating of 81 points from a maximum of 95 and a median global satisfaction rating of 9/10. Criterion validity was confirmed by item correlation: Intra-class Correlation Co-efficient ICC = .709; scale total to global score r = .722; and items to total score ranging from .609 to .832. Strong concurrent validity was demonstrated with the Clinical Learning Environment and Supervision Scale (r = .834). Internal reliability was identified and confirmed in two subscale factors: Clinical Environment (Cronbach's alpha = .94) and Learning Support (alpha = .96). Based on the short time taken to complete the survey (median 3.5 min) and students' comments, the tool was deemed applicable and feasible. CONCLUSIONS: The PET was found to be valid, reliable and feasible. Use of the tool as a quality assurance measure is likely to improve education and practice in clinical environments. Further international evaluation of the instrument is required to fully determine its psychometric properties.

Nurses' cognitive and perceptual bias in the identification of clinical deterioration cues.

BACKGROUND: Perception and processing of clinical cues have rarely been investigated in the nursing literature despite their relevance to the early identification and management of clinical deterioration. AIM: This study used a hypovolemic shock scenario from the Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACT) virtual simulation program, equipped with an eye tracker, to investigate cue processing during the management of patient deterioration. RESULT: The study revealed that attention deviation distorted interpretation of subsequent cues, causing 63% of participants to exhibit a cognitive bias (heightened sensitivity to specific but noncritical cues) and 65% to exhibit at least one episode of nonfixation on clinically relevant cues. Attention deviation and distorted interpretations of clinical cues will have an impact on patient safety. CONCLUSION: The findings are likely to have important implications for understanding error and associated training implications.

Effects of different solutions consumed during exercise on cognitive function of male college soccer players.

Background/Objectives: The present study aimed to investigate the effects of three solutions, i.e. carbohydrate-electrolyte-solution (CES), carbohydrate-electrolyte-protein-solution (CEPS), and placebo (PLA), on cognitive function of college soccer players. METHODS: Sixteen male college soccer players completed three main trials in a randomized cross-over study design. In each main trial, participants completed 90 min Loughborough Intermittent Shuttle Test (LIST) protocol and consumed one of three solutions. The cognitive function tests were performed; blood glucose and lactate concentrations, and several subjective measurements were also recorded in each trial. RESULTS: Compared with pre-exercise level, the accuracy of Rapid Visual Information Processing test (RVIPT) and the response time in Visual Search Test (VST, complex level) after LIST improved in CES and CEPS trials, but not in PLA trial. However, the accuracy of VST (complex level) decreased in both CES and CEPS trials, compared with PLA trial. CEPS consumption improved accuracy in VST (simple level), compared with CES consumption. Blood glucose concentrations were well maintained in CEPS trial, but not in CES and PLA trials. CONCLUSION: It seems that both CES and CEPS consumption show certain benefits on some aspects of cognitive function in male college soccer players in Hong Kong. However, these effects may be specific to the cognitive domain tested.