Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial.

BACKGROUND: In the field of health care, knowledge and clinical reasoning are key with regard to quality and confidence in decision making. The development of knowledge and clinical reasoning is influenced not only by students' intrinsic factors but also by extrinsic factors such as satisfaction with taught content, pedagogic resources and pedagogic methods, and the nature of the objectives and challenges proposed. Nowadays, professors play the role of learning facilitators rather than simple "lecturers" and face students as active learners who are capable of attributing individual meanings to their personal goals, challenges, and experiences to build their own knowledge over time. Innovations in health simulation technologies have led to clinical virtual simulation. Clinical virtual simulation is the recreation of reality depicted on a computer screen and involves real people operating simulated systems. It is a type of simulation that places people in a central role through their exercising of motor control skills, decision skills, and communication skills using virtual patients in a variety of clinical settings. Clinical virtual simulation can provide a pedagogical strategy and can act as a facilitator of knowledge retention, clinical reasoning, improved satisfaction with learning, and finally, improved self-efficacy. However, little is known about its effectiveness with regard to satisfaction, self-efficacy, knowledge retention, and clinical reasoning. OBJECTIVE: This study aimed to evaluate the effect of clinical virtual simulation with regard to knowledge retention, clinical reasoning, self-efficacy, and satisfaction with the learning experience among nursing students. METHODS: A randomized controlled trial with a pretest and 2 posttests was carried out with Portuguese nursing students (N=42). The participants, split into 2 groups, had a lesson with the same objectives and timing. The experimental group (n=21) used a case-based learning approach, with clinical virtual simulator as a resource, whereas the control group (n=21) used the same case-based learning approach, with recourse to a low-fidelity simulator and a realistic environment. The classes were conducted by the usual course lecturers. We assessed knowledge and clinical reasoning before the intervention, after the intervention, and 2 months later, with a true or false and multiple-choice knowledge test. The students' levels of learning satisfaction and self-efficacy were assessed with a Likert scale after the intervention. RESULTS: The experimental group made more significant improvements in knowledge after the intervention (P=.001; d=1.13) and 2 months later (P=.02; d=0.75), and it also showed higher levels of learning satisfaction (P<.001; d=1.33). We did not find statistical differences in self-efficacy perceptions (P=.9; d=0.054). CONCLUSIONS: The introduction of clinical virtual simulation in nursing education has the potential to improve knowledge retention and clinical reasoning in an initial stage and over time, and it increases the satisfaction with the learning experience among nursing students.

Correction: Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial.

[This corrects the article DOI: 10.2196/11529.].

Easiness, usefulness and intention to use a MOOC in nursing.

BACKGROUND: The growing ageing population and the increasing prevalence of non-communicable diseases call for innovation and healthcare mastered professional skills. Emerging digital learning contents envisioning to complement education, lifelong learning and in-service training. The use of digital platforms allows nurses to access contents in several formats, enabling the required pedagogical autonomy and personal time management. This allows nurses to enrol in education wherever accessible, reducing personal and professional costs and ensuring high-quality standards. OBJECTIVES: To assess students and nurses' easiness, usefulness and intention to use a Massive Open Online Course (MOOC) as an educational resource to enhance self-management intervention skills in COPD patients. METHODS: An exploratory, descriptive and transversal study was conducted. Participants were nursing students, registered nurses and rehabilitation nurses. A questionnaire supported by Davis Technology Acceptance Model and on the determinants of the ease-of-use perception of Venkatesh was applied. An EFA was performed and two dimensions were obtained (perceived easiness and global quality of the course and perceived usefulness and intention to use the MOOC) and groups were compared in these dimensions. RESULTS: From the total participants (n = 93), 65.6% were nursing students, 15.1% were Portuguese nurses and 19.4% were Portuguese rehabilitation nurses. The perceived easiness and global quality score of the course were 4.70 (SD = 0.314) and the perceived usefulness and intention to use the MOOC was 4.73 (SD = 0.346). Rehabilitation nurses, who are older, scored higher than nurses and students (χ2(2, n = 93) = 8.43, p = .015, ε2 = 0.092). The dropout rate was 25%. CONCLUSIONS: The MOOC showed usefulness and nurses' intention to use this educational resource in future education and yielded high average rates of perceived easiness and global quality. These massive courses unlock new opportunities for nursing education and to lifelong learning in nursing, enhancing safety and quality of the healthcare services in supporting patients to achieve a better quality of life.

The link between cognitive state and general self-esteem among institutionalized elderly persons: can health condition serve as a mediating factor? / Associação entre estado cognitivo e autoestima global em idosos institucionalizados: será a condição de saúde um mediador?

Abstract Objective: to assess whether the health condition of an elderly person can serve as a mediating factor between the cognitive state and general self-esteem of the institutionalized elderly. Method: a quantitative, cross-sectional correlational study was performed, based on the path analysis technique.The following instruments were used for data collection: the Mini-Mental State Examination, the Tinetti Performance Oriented Mobility Assessment, the Mini Nutritional Evaluation and the Rosenberg Self-Esteem Scale. Results: the sample was composed of 312 elderly patients of both genders (112 men and 200 women), with an average age of 83.39 (+7.09) years. Most of the elderly persons were widowed, with a low educational level, and had been institutionalized in Residential Care Facilities for the Elderly for on average 54.6 (+51.69) months. The mediating factor of health condition renders the link between the cognitive state and self-esteem of the elderly null. However, the analysis of the decomposition of the effects showed a significant indirect effect between the cognitive state and health condition. The total effect of cognitive state on the health condition of the elderly is significant, positive and direct. Conclusion: based on the results of this study we maintain that cognitive changes can affect the nutritional state and physical balance of the institutionalized elderly. AU

Resumo Objetivo: testar se a condição de saúde da pessoa idosa é mediadora na associação entre o estado cognitivo e a autoestima global de idosos institucionalizados. Método: estudo de natureza quantitativa, transversal do tipo correlacional, recorreu à análise de caminhos. Na recolha de dados utilizaram-se as versões portuguesas dos seguintes instrumentos: Mini-Mental State Examination, Tinetti Performance Oriented Mobility Assessement, Miniavaliação Nutricional e a Rosenberg Self-Esteem Scale. Resultados: a amostra foi constituída por 312 idosos de ambos os gêneros (112 homens e 200 mulheres), com média etária de 83,39 (±7,09) anos. A maioria dos idosos eram viúvos, com baixa escolaridade, institucionalizados em Equipamentos Residenciais para Pessoas Idosas em média há 54,60 (±51,69) meses. Não se confirmou a mediação da condição de saúde na associação entre estado cognitivo e autoestima nos idosos. Contudo, a análise da decomposição dos efeitos indicou a existência de um efeito significativo indireto do estado cognitivo na autoestima e na condição de saúde. O efeito total do estado cognitivo na condição de saúde dos idosos é significativo, positivo e direto. Conclusão: os resultados desse estudo permitem-nos afirmar que as alterações cognitivas podem afetar o estado nutricional e o equilíbrio corporal dos idosos institucionalizados. AU