Importance sampling within configuration space integration for adsorbate thermophysical properties: a case study for CH3/Ni(111).

A new strategy is presented for computing anharmonic partition functions for the motion of adsorbates relative to a catalytic surface. Importance sampling is compared with conventional Monte Carlo. The importance sampling is significantly more efficient. This new approach is applied to CH3* on Ni(111) as a test case. The motion of methyl relative to the nickel surface is found to be anharmonic, with significantly higher entropy compared to the standard harmonic oscillator model. The new method is freely available as part of the Minima-Preserving Neural Network within the ADTHERM package.

RMG Database for Chemical Property Prediction.

The Reaction Mechanism Generator (RMG) database for chemical property prediction is presented. The RMG database consists of curated datasets and estimators for accurately predicting the parameters necessary for constructing a wide variety of chemical kinetic mechanisms. These datasets and estimators are mostly published and enable prediction of thermodynamics, kinetics, solvation effects, and transport properties. For thermochemistry prediction, the RMG database contains 45 libraries of thermochemical parameters with a combination of 4564 entries and a group additivity scheme with 9 types of corrections including radical, polycyclic, and surface absorption corrections with 1580 total curated groups and parameters for a graph convolutional neural network trained using transfer learning from a set of >130 000 DFT calculations to 10 000 high-quality values. Correction schemes for solvent-solute effects, important for thermochemistry in the liquid phase, are available. They include tabulated values for 195 pure solvents and 152 common solutes and a group additivity scheme for predicting the properties of arbitrary solutes. For kinetics estimation, the database contains 92 libraries of kinetic parameters containing a combined 21 000 reactions and contains rate rule schemes for 87 reaction classes trained on 8655 curated training reactions. Additional libraries and estimators are available for transport properties. All of this information is easily accessible through the graphical user interface at https://rmg.mit.edu. Bulk or on-the-fly use can be facilitated by interfacing directly with the RMG Python package which can be installed from Anaconda. The RMG database provides kineticists with easy access to estimates of the many parameters they need to model and analyze kinetic systems. This helps to speed up and facilitate kinetic analysis by enabling easy hypothesis testing on pathways, by providing parameters for model construction, and by providing checks on kinetic parameters from other sources.

Confronting the unknown-Nursing surveillance of COVID-19-infected patients through remote telephone calls and in an on-site urgent clinic.

AIM: To describe nursing surveillance of coronavirus disease 2019 (COVID-19)-infected patients through remote telephone calls and in an on-site urgent clinic during the first wave of the pandemic as experienced by nurses providing the care. DESIGN: Qualitative descriptive study. METHODS: Data were collected through seven semi-structured, audio-recorded, focus group interviews with 24 nurses. Interviews were conducted in May and June 2020, transcribed and analysed using deductive and inductive content analysis into an overarching category, main categories and subcategories. Reporting followed the COREQ guidelines. RESULTS: Nurses relied on intensive listening when assessing and caring for COVID-19-infected patients. They realized that the patients had complex needs for nursing and healthcare which was beyond the scope of a tentatively prescribed assessment scheme. They designed their care to ensure holistic care, reflected in the overarching category, 'Confronting an unfamiliar health condition in unprecedented circumstances' and the categories: 'Digging into the unknown' and 'Ensuring holistic nursing care'. The category 'Contributing to averting catastrophe' reflects the wealth of knowledge, support and experience that the nurses used to independently deliver care, albeit in interdisciplinary collaboration, working to their greatest potential. They were proud of the significance of their work. CONCLUSION: Novel nursing surveillance through remote telephone calls and in an on-site urgent care clinic delivered to COVID-19 patients self-managing at home resulted in holistic nursing care during the first wave of the pandemic. This has relevance for professionalism in nursing. IMPACT: Findings give a unique insight into nursing surveillance of COVID-19-infected patients provided through telephone calls and in on-site urgent care clinics. The potential of intensive listening as conducted in the study suggests that it may be feasible to assess and holistically take care of COVID-19-infected patients, and other patient groups as well, with this form of healthcare. This has relevance for healthcare beyond crisis management during pandemics. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution as the study only concerned the providers of the service, i.e. the nurses themselves.

"There was no panic"-Nurse managers' organising work for COVID-19 patients in an outpatient clinic: A qualitative study.

AIM: To provide insight into the contribution of nursing to the establishment and running of a hospital-based outpatient clinic for COVID-19 infected patients, and thereby to inform the development of similar nursing care and healthcare more generally. DESIGN: Qualitative descriptive study centred on collaboration between nurse managers and researchers. METHODS: Drawing on Donabedian's model of quality health services and the work of Allen on "Nurses' organising work", data were collected using four semi-structured, audio-recorded, focus group interviews with five nurse managers. The interviews were conducted in May and June 2020, transcribed, and subsequently analysed using deductive and inductive content analysis into an overarching category, main categories, and sub-categories. RESULTS: "There was no panic - challenged by the unprecedented" was a strong thread, which was reflected in two categories: (a) Everyone walked in step, containing the sub-categories: Public officials set the tone, Creating order in disorder, and Mutual respect and teamwork, and (b) Inspired by extraordinary accomplishments, encompassing the sub-categories: Realising one's potential and Unexpectedly rewarding. In exceptional circumstances the nurse managers' decision-making authority grew, material and manpower resources were sufficient, promptly constructed work procedures were in place, and tasks were completed instantly in trusting and respectful interdisciplinary collaboration. With sound support and trust from hospital directors, the nurse managers utilised their expertise to the fullest and they were proud of their work. CONCLUSION: The findings portray the almost invisible work of nurse managers in organising complex care. Although the circumstances were exceptional the findings speak to the accomplishments that can be gained when nurse managers have autonomy and the opportunity to utilise their professional capacity to the fullest. IMPACT: The findings reveal the almost invisible work of nurses in organising complex care and can inform the establishment of outpatient clinics for patients infected with COVID-19 and of healthcare development more generally.

The nurse teacher's pedagogical cooperation with students, the clinical learning environment and supervision in clinical practicum: a European cross-sectional study of graduating nursing students.

BACKGROUND: A supportive clinical practicum experience may enhance the successful transition and socialization to working life of graduating nursing students. Nurse teachers have the main responsibility of supporting and guiding nursing students with their pedagogical expertise during the students' clinical practicum. Thus, the clinical role of nurse teachers is seen as an essential part of a high-quality clinical practicum. Nursing students appreciate the nurse teacher's cooperation with students, but it is often reported to be unattainable. The aim of this study was to explore and compare graduating nursing students' experiences of the nurse teacher's pedagogical cooperation with students, the clinical learning environment and supervision in their final clinical practicum, and to analyze factors associated with these experiences in six European countries. METHODS: A cross-sectional comparative international survey design was used. The modified Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) Scale, with a new subscale measuring the nurse teacher's pedagogical cooperation with students, was used. A convenience sample of graduating nursing students in Finland, Germany, Iceland, Ireland, Lithuania and Spain completed the online survey in 2018-2019. The data were analyzed using a Chi-Square test, Pearson's correlation coefficients, and linear models. RESULTS: A total of 1796 (response rate 49%) nursing students completed the survey. Overall, students had positive experiences of the nurse teacher's pedagogical cooperation, the clinical learning environment and supervision in their final clinical practicum. Students in Spain had the most positive experiences. Educational background factors appeared to be associated with the students' experiences of the nurse teacher's pedagogical cooperation with students, the clinical learning environment and supervision. The relationships between the subscale Nurse teacher's pedagogical cooperation with students and the Clinical Learning Environment and Supervision Scale were perceived as weak to strong depending on the country. CONCLUSIONS: This study reveals that nurse teachers play an essential role in supporting and guiding nursing students' final clinical practicum. In this light, researchers, educators, and leaders should collaborate seamlessly between educational institutions and healthcare organizations to establish the nurse teachers' pedagogical cooperation role within the clinical learning environment.

Reaction Mechanism Generator v3.0: Advances in Automatic Mechanism Generation.

In chemical kinetics research, kinetic models containing hundreds of species and tens of thousands of elementary reactions are commonly used to understand and predict the behavior of reactive chemical systems. Reaction Mechanism Generator (RMG) is a software suite developed to automatically generate such models by incorporating and extrapolating from a database of known thermochemical and kinetic parameters. Here, we present the recent version 3 release of RMG and highlight improvements since the previously published description of RMG v1.0. Most notably, RMG can now generate heterogeneous catalysis models in addition to the previously available gas- and liquid-phase capabilities. For model analysis, new methods for local and global uncertainty analysis have been implemented to supplement first-order sensitivity analysis. The RMG database of thermochemical and kinetic parameters has been significantly expanded to cover more types of chemistry. The present release includes parallelization for faster model generation and a new molecule isomorphism approach to improve computational performance. RMG has also been updated to use Python 3, ensuring compatibility with the latest cheminformatics and machine learning packages. Overall, RMG v3.0 includes many changes which improve the accuracy of the generated chemical mechanisms and allow for exploration of a wider range of chemical systems.

The content of nurse unit managers' work: a descriptive study using daily activity diaries.

BACKGROUND: NUMs' job description in Icelandic hospitals has been revised and now also includes managerial and financial responsibilities. AIM: To describe the actual work activities of nurse unit managers (NUMs) in surgical and internal medicine services as self-documented and reflected in their job description. DESIGN: Prospective exploratory study. METHOD: The study's setting was the largest hospital in Iceland. Data were collected over 7 days from NUMs working on surgical and medical units with an activity diary listing five domains and 41 activities: 'management and planning' (seven activities), 'staff responsibility (seven activities), 'direct clinical work' (five activities), 'service' (12 activities) and 'other' (nine activities). RESULTS: The managers' spent most of their time within the 'other' domain (32% of their time), then the next significant amount of time on 'management and planning' and 'clinical nursing' (19%), and the least amount of time on 'service' (14%). All reported working on two or more activities simultaneously. NUMs made erroneous estimations approximately half of the time about the domain they spent most of their time in and their satisfaction with their work each day varied greatly. CONCLUSION: The work of NUMs is highly diverse, including undefined miscellaneous tasks and clinical work beyond their job description.

The effect of a short educational intervention on the use of urinary catheters: a prospective cohort study.

OBJECTIVE: To assess the effectiveness of implementation of evidence-based recommendations to reduce catheter-associated urinary tract infections (CAUTIs). DESIGN: Prospective cohort study, conducted in 2010-12, with a before and after design. SETTING: A major referral university hospital. PARTICIPANTS: Data were collected before (n = 244) and 1 year after (n = 255) the intervention for patients who received urinary catheters. INTERVENTION: The intervention comprised two elements: (i) aligning doctors' and nurses' knowledge of indications for the use of catheters and (ii) an educational effort consisting of three 30- to 45-minute sessions on evidence-based practice regarding catheter usage for nursing personnel on 17 medical and surgical wards. MAIN OUTCOME MEASURES: The main outcome measures were the proportion of (i) admitted patients receiving urinary catheters during hospitalization, (ii) catheters inserted without indication, (iii) inpatient days with catheter and (iv) the incidence of CAUTIs per 1000 catheter days. Secondary outcome measures were the proportion of (i) catheter days without appropriate indication and (ii) patients discharged with a catheter. RESULTS: There was a reduction in the proportion of inpatient days with a catheter, from 44% to 41% (P = 0.006). There was also a reduction in the proportion of catheter days without appropriate indication (P < 0.001) and patients discharged with a catheter (P = 0.029). The majority of catheters were inserted outside the study wards. CONCLUSIONS: A short educational intervention was feasible and resulted in significant practice improvements in catheter usage but no reduction of CAUTIs. Other measures than CAUTI may be more sensitive to detecting important practice changes.

Praise matters: the influence of nurse unit managers' praise on nurses' practice, work environment and job satisfaction: a questionnaire study.

AIM: The aim of this study was to investigate the associations between praise from nurse unit managers and job satisfaction, professional practice, workload, work climate and organizational commitment of nurses caring for surgical patients. BACKGROUND: Praise influences experiences of employees. DESIGN: Web-based, cross-sectional explorative survey design. METHODS: A structured questionnaire was used to measure praise given by nurse unit managers as perceived by nurses (n = 383; 49% response rate) working with surgical patients. Data were collected between December 2009-January 2010. Several variables assessed the major concepts under study. Binary logistic regression analysis was employed to compare nurses who receive praise very rarely/rarely as compared with very often/rather often. RESULTS: Praise was received often/very often by 31·6% of participants. Compared with nurses receiving praise rarely/very rarely those who received it often/rather showed more job satisfaction, stated they had more opportunities to practice professionally, described a more positive work climate and were more committed to the organization such as being proud to work at and willing to make effort for the unit and hospital. There was no difference between the groups regarding workload. Main findings of the regression analysis were that nurses display their organizational commitment by not thinking about leaving the current workplace and those who value professional recognition are likelier to receive praise than their counterparts. CONCLUSION: Nurse unit managers should praise their staff in a realistic fashion. Such praise is cost-effective, takes short time, produces positive influences on members of their staff and may improve patient safety.

Perceptions about traditional and novel methods to learn about postoperative pain management: a qualitative study.

AIM: The aim of this study was to explore the perceptions of surgical patients about traditional and novel methods to learn about postoperative pain management. BACKGROUND: Patient education is an important part of postoperative care. Contemporary technology offers new ways for patients to learn about self-care, although face-to-face discussions and brochures are the most common methods of delivering education in nursing practice. DESIGN: A qualitative design with a vignette and semi-structured interviews used for data collection. METHODS: A purposeful sample of 13 postsurgical patients, who had been discharged from hospital, was recruited during 2013-2014. The patients were given a vignette about anticipated hospital discharge after surgery with four different options for communication (face-to-face, brochure, website, serious game) to learn about postoperative pain management. They were asked to rank their preferred method of learning and thereafter to reflect on their choices. Data were analysed using an inductive content analysis approach. FINDINGS: Patients preferred face-to-face education with a nurse, followed by brochures and websites, while games were least preferred. Two categories, each with two sub-categories, emerged from the data. These conceptualized the factors affecting patients' perceptions: (1) 'Trusting the source', sub-categorized into 'Being familiar with the method' and 'Having own prejudgments'; and (2) 'Being motivated to learn' sub-categorized into 'Managing an impaired cognition' and 'Aspiring for increased knowledge'. CONCLUSION: To implement successfully novel educational methods into postoperative care, healthcare professionals need to be aware of the factors influencing patients' perceptions about how to learn, such as trust and motivation.

The process of translating family nursing knowledge into clinical practice.

PURPOSE: To report on approaches that were used to assist with implementation of family systems nursing (FSN) at a university hospital level in Northern Europe. DESIGN AND METHODS: A quasi-experimental research design was used for the first phase of the study. For the second phase, a cross-sectional research design was used. Data were collected in the first phase of the study from 457 nurses in all except one of the divisions of the hospital regarding their attitudes towards involving families into their care before and after having participated in the education and training intervention (ETI) program in FSN. Furthermore, in the second phase, data were collected from 812 nurses, after FSN had been implemented in all divisions at Landspitali University Hospital, regarding the nurses' knowledge of FSN and their evaluation of the quality of the ETI program (i.e., theoretical lectures on FSN as well as the benefit of the skill lab training regarding applying FSN into their clinical practices). Graham and colleagues' Knowledge to Action framework was used as the conceptual framework for the research. RESULTS: Nurses who had taken a course in FSN reported a significantly more positive attitude towards involving families in their care after the ETI program compared to those who had not taken such a course. Furthermore, a majority of the nurses who participated in the ETI program reported that the program was a favorable experience and indicated readiness for applying FSN in clinical practice. CONCLUSIONS: Further research is needed regarding the benefits of offering FSN at an institutional level, but focusing international attention on effective strategies to implement FSN into nursing practice may result in better health care for individuals and families around the globe. CLINICAL RELEVANCE: Providing clinically meaningful education and training in family nursing through programs such as the ETI program for practicing nurses at a university hospital is essential in supporting nurses applying new knowledge, when providing evidence-based health care services, to individuals and their family members. Such training can facilitate integration of new and needed information in clinical practice.

Surgical nurses' intention to leave a workplace in Iceland: a questionnaire study.

AIM: To explore surgical nurses' reported determinants of intention to leave a workplace. BACKGROUND: Nurses' work environment influences nurses' intent to leave the workplace. METHODS: A descriptive, quantitative study design using a structured questionnaire was used to measure the intention of all nurses (n = 383; 49% response rate) working at the surgical division at Landspítali-The National University Hospital of Iceland to leave a practice. RESULTS: Low general job satisfaction, followed by little praise from nurse managers and having to perform unprofessional work had the greatest influence on nurses' intention to leave a workplace. In addition, nurses who found their own knowledge respected, but were not pleased with the work were more likely to consider leaving. CONCLUSION: A lack of praise by unit managers, engagement in unprofessional work, low job satisfaction coupled with having ones' knowledge respected and a non-competitive work climate are factors contributing to nurses' intention to leave. Factors contributing to nurses' intention to leave may result in a lack of interest in work, low morale and may ultimately lead to unsafe patient care. IMPLICATIONS FOR NURSING MANAGEMENT: Managers benefit from building and supporting a work morale that fosters nurses' intentions to stay in a professional work environment. This includes providing nurses with regular feedback about clinical work.

Attitudes of Registered and Licensed Practical Nurses About the Importance of Families in Surgical Hospital Units: Findings From the Landspitali University Hospital Family Nursing Implementation Project.

The purpose of this study was to examine attitudes of registered nurses and licensed practical nurses about the importance of the family in surgical hospital units before (T1) and after (T2) implementation of a Family Systems Nursing educational intervention based on the Calgary Family Assessment and Intervention Models. This study was part of the Landspitali University Hospital Family Nursing Implementation Project and used a nonrandomized, quasi-experimental design with nonequivalent group before and after and without a control group. There were 181 participants at T1 and 130 at T2. No difference was found in nurses' attitudes as measured by the Families Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire, before and after the educational intervention. Attitudes toward families were favorable at both times. Analysis of demographic variables showed that age, work experience, and workplace (inpatient vs. outpatient units) had an effect on the nurses' attitudes toward families. The influence of work experience on attitudes toward family care warrants further exploration.

Sense of security during COVID-19 isolation improved with better health literacy - A cross-sectional study.

OBJECTIVE: To assess sense of security, health literacy, and the association between sense of security and health literacy during COVID-19 self-isolation. METHODS: In this cross-sectional survey all adults who caught COVID-19 from the onset of the pandemic until June 2020 in Iceland and received surveillance from a special COVID-19 outpatient clinic, were eligible. Participants retrospectively answered the Sense of Security in Care - Patients' Evaluation and the European Health Literacy Survey Questionnaire. Data were analysed with parametric and non-parametric tests. RESULTS: Participants' (N = 937, 57% female, median age 49 (IQR=23)) sense of security during isolation was Med 5.5 (IQR=1) and 90% had sufficient health literacy. The proposed regression model (R2 =.132) indicated that those with sufficient health literacy had, on average, higher sense of security than those with inadequate health literacy. CONCLUSION: Sense of security was high among individuals who received surveillance from an outpatient clinic during isolation and was associated with health literacy. The high health literacy rate may be an indication of a high COVID-19 specific health literacy rather than general health literacy. PRACTICE IMPLICATIONS: Healthcare professionals can improve the sense of security of patients through measures to improve their health literacy, including their navigation health literacy, by practising good communication, and providing effective patient education.

Patients' expectations and experiences of provided surgery-related patient education: A descriptive longitudinal study.

AIMS: The aim of this study was to explore the educational expectations and experiences of surgical patients. DESIGN: Prospective, longitudinal, descriptive and two-centre study. Data were collected with questionnaires at the hospital and 6 weeks and 6 months postsurgery. METHODS: Patients undergoing elective surgery and hospitalized overnight from January to July 2016 answered questions about the content of received pre-operative and pre-discharge education, topics they wanted more information on, sources of information, satisfaction with and usefulness of the information and if their recovery was as expected. RESULTS: Patients (N = 697, 49% male, mean age 64.1 [SD 12.6] years) perceived the provided education as useful and satisfactory but less so after discharge. Most common topics which they expected more education about were postoperative complications, pain management, fatigue, lack of stamina and expected recovery time. Most patients received information through face-to-face teaching (79.7%) and in writing (78.4%). Expectations on recovery were related to patients' satisfaction with the education and how useful they evaluated it.

A European evaluation of the patients' role in clinical education: A six-country cross sectional study.

AIM: The aim of this study was to analyse the patients' role in clinical education in terms of facilitative student-patient relationship in Finland, Germany, Iceland, Ireland, Lithuania and Spain and factors promoting a more facilitative relationship in clinical education. BACKGROUND: Nursing students' bedside learning is reliant on patients and the establishment of a person-centred approach develops from the relationships with patients. DESIGN: A multi-country, cross-sectional design was implemented. METHODS: Survey data were collected from graduating nursing students and patients between May 2018 and March 2019. The survey consisted of a 13-item facilitative sub-scale of the Student-Patient Relationship Scale as the main outcome measure, which was identical for both populations. In addition, background factors were surveyed with single questions and other scales. Associations between facilitative relationship and background factors were studied with linear models. RESULTS: Altogether, 1796 students and 1327 patients answered the survey. Overall, both students and patients regarded their relationship as facilitative, but students' (median 4.23, 95% confidence interval 4.15-4.23) evaluations were higher than patients' (median 3.75, 95% confidence interval 3.69-3.77). The students' and patients' evaluations differed from each other significantly in all other countries except in Ireland and Lithuania. Corresponding associations for both populations were found in terms of the country and students' cultural confidence. CONCLUSIONS: Results signal favourable grounds for students' bedside learning and patient participation in clinical education with the potential to foster a person-centred approach.

Symptoms of anxiety and depression in surgical patients at the hospital, 6 weeks and 6 months postsurgery: A questionnaire study.

Aims: To describe prevalence of symptoms of anxiety and depression in surgical patients at three time points: at hospital postsurgery (T1), 6 weeks (T2) and 6 months (T3) postdischarge from hospital; and detect situations and experiences that predict symptoms of anxiety and depression at T2 and T3. Design: Prospective, explorative two-site follow-up study. Methods: Patients having selected surgeries from January-July 2016 were invited to participate. Final participation was 390 patients. Participation involved answering questionnaires, including the Hospital Anxiety and Depression Scale (HADS). A stepwise multiple linear regression model was employed to calculate predictors of anxiety and depression. Results: The proportion of patients presenting with moderate-to-severe anxiety or depression ranged from 5.4%-20.2% at different times. Major predictors of anxiety at both times were not feeling rested upon awakening and higher scores on HADS-Anxiety at T1 and T2 and at T2 also experiencing more distressing postoperative symptoms. For depression, the major predictors were at both times higher scores on HADS-Depression at T2 and T3 and also at T2 not feeling rested upon awakening and at T3 reporting delayed or very delayed recovery.The four models explained from 43.9%-55.6% of the variance in symptoms of anxiety and depression. Our findings show that patients presenting with psychological distress at the hospital are in a vulnerable position. Also, that benefits of good sleep during the recovery should be emphasized during hospital stay.

Quantifying the Impact of Parametric Uncertainty on Automatic Mechanism Generation for CO2 Hydrogenation on Ni(111).

Automatic mechanism generation is used to determine mechanisms for the CO2 hydrogenation on Ni(111) in a two-stage process while considering the correlated uncertainty in DFT-based energetic parameters systematically. In a coarse stage, all the possible chemistry is explored with gas-phase products down to the ppb level, while a refined stage discovers the core methanation submechanism. Five thousand unique mechanisms were generated, which contain minor perturbations in all parameters. Global uncertainty assessment, global sensitivity analysis, and degree of rate control analysis are performed to study the effect of this parametric uncertainty on the microkinetic model predictions. Comparison of the model predictions with experimental data on a Ni/SiO2 catalyst find a feasible set of microkinetic mechanisms within the correlated uncertainty space that are in quantitative agreement with the measured data, without relying on explicit parameter optimization. Global uncertainty and sensitivity analyses provide tools to determine the pathways and key factors that control the methanation activity within the parameter space. Together, these methods reveal that the degree of rate control approach can be misleading if parametric uncertainty is not considered. The procedure of considering uncertainties in the automated mechanism generation is not unique to CO2 methanation and can be easily extended to other challenging heterogeneously catalyzed reactions.

The challenge of caring for patients in pain: from the nurse's perspective.

AIM: To increase understanding of what it is like for nurses to care for patients in pain. BACKGROUND: Hospitalised patients are still suffering from pain despite increased knowledge, new technology and a wealth of research. Since nurses are key figures in successful pain management and research findings indicate that caring for suffering patients is a stressful and demanding experience where conflict often arises in nurses' relations with patients and doctors, it may be fruitful to study nurses' experience of caring for patients in pain to increase understanding of the above problem. DESIGN: A phenomenological study involved 20 dialogues with 10 experienced nurses. RESULTS: The findings indicate that caring for a patient in pain is a 'challenging journey' for the nurse. The nurse seems to have a 'strong motivation to ease the pain' through moral obligation, knowledge, personal experience and conviction. The main challenges that face the nurse are 'reading the patient', 'dealing with inner conflict of moral dilemmas', 'dealing with gatekeepers' (physicians) and 'organisational hindrances'. Depending upon the outcome, pain management can have positive or negative effects on the patient and the nurse. CONCLUSIONS: Nurses need various coexisting patterns of knowledge, as well as a favourable organisational environment, if they are to be capable of performing in accord with their moral and professional obligations regarding pain relief. Nurses' knowledge in this respect may hitherto have been too narrowly defined. RELEVANCE TO CLINICAL PRACTICE: The findings can stimulate nurses to reflect critically on their current pain management practice. By identifying their strengths as well as their limitations, they can improve their knowledge and performance on their own, or else request more education, training and support. Since nurses' clinical decisions are constantly moulded and stimulated by multiple patterns of knowledge, educators in pain management should focus not only on theoretical but also on personal and ethical knowledge.

Development, Usability, and Efficacy of a Serious Game to Help Patients Learn About Pain Management After Surgery: An Evaluation Study.

BACKGROUND: Postoperative pain is a persistent problem after surgery and can delay recovery and develop into chronic pain. Better patient education has been proposed to improve pain management of patients. Serious games have not been previously developed to help patients to learn how to manage their postoperative pain. OBJECTIVE: The aim of this study was to describe the development of a computer-based game for surgical patients to learn about postoperative pain management and to evaluate the usability, user experience, and efficacy of the game. METHODS: A computer game was developed by an interdisciplinary team following a structured approach. The usability, user experience, and efficacy of the game were evaluated using self-reported questionnaires (AttrakDiff2, Postoperative Pain Management Game Survey, Patient Knowledge About Postoperative Pain Management questionnaire), semi-structured interviews, and direct observation in one session with 20 participants recruited from the general public via Facebook (mean age 48 [SD 14]; 11 women). Adjusted Barriers Questionnaire II and 3 questions on health literacy were used to collect background information. RESULTS: Theories of self-care and adult learning, evidence for the educational needs of patients about pain management, and principles of gamification were used to develop the computer game. Ease of use and usefulness received a median score between 2.00 (IQR 1.00) and 5.00 (IQR 2.00) (possible scores 0-5; IQR, interquartile range), and ease of use was further confirmed by observation. Participants expressed satisfaction with this novel method of learning, despite some technological challenges. The attributes of the game, measured with AttrakDiff2, received a median score above 0 in all dimensions; highest for attraction (median 1.43, IQR 0.93) followed by pragmatic quality (median 1.31, IQR 1.04), hedonic quality interaction (median 1.00, IQR 1.04), and hedonic quality stimulation (median 0.57, IQR 0.68). Knowledge of pain medication and pain management strategies improved after playing the game (P=.001). CONCLUSIONS: A computer game can be an efficient method of learning about pain management; it has the potential to improve knowledge and is appreciated by users. To assess the game's usability and efficacy in the context of preparation for surgery, an evaluation with a larger sample, including surgical patients and older people, is required.