Protective and risk factors of workplace violence against nurses: A cross-sectional study.

AIMS: To describe how workplace violence (WPV) is experienced by nurses in hospitals and community services and identify protective and risk factors. METHODS: An online cross-sectional national study was conducted from January to April 2021 in Italy. Hospitals and community services were involved in the study. The survey combined the adapted and validated Italian version of the Violence in Emergency Nursing and Triage (VENT) questionnaire, which explores the episodes of WPV experienced during the previous 12 months, the Practice Environment Scale of the Nursing Work Index (PES-NWI) and some additional questions about staffing levels extracted from a previous RN4CAST study. Nurses working in all clinical settings and community services were invited to participate in the survey. Descriptive and inferential statistics were used for data analysis. We adhered to the STROBE reporting guidelines. RESULTS: A total of 6079 nurses completed the survey, 32.4% (n = 1969) had experienced WPV in the previous 12 months, and 46% (n = 920) reported WPV only in the previous week. The most significant protective factors were nurses' age, patients' use of illegal substances, attitude of individual nurses and considering effective the organization's procedures for preventing and managing episodes of violence. The most significant risk factors included workload, recognizing violence as an inevitable part of the job, patients' cultural aspects and patients' agitated behaviour. The frequency of WPV was significantly higher in certain areas, such as the emergency department and in mental health wards. CONCLUSION: Workplace violence (WPV) against nurses is a very frequent and concerning issue, especially in hospitals and community services. Based on our findings, integrated and multimodal programmes for prevention and management of WPV are recommended. More attention and resources need to be allocated to reduce WPV by improving the quality of nurses' workplace environment and implementing violence-free policies for hospitals. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Impact Workplace verbal and physical violence is a widespread phenomenon, both in hospital and community settings, and even during COVID-19 pandemic. This problem is exacerbated by the lack of effective reporting systems, fear of retaliation and the tendency to consider violence as an inevitable part of the job. The characteristics of professionals, patients, work environment and organizational factors are involved in the spread of workplace violence, determining its multifactorial nature. Integrated and multimodal programmes to prevent and manage of workplace violence are probably the only way to effectively counteract workplace violence against nurses. Healthcare policymakers, managers of hospital and community services need to proactively prevent and effectively manage and monitor episodes of violence. Nurses need to feel protected and safeguarded against any form of verbal or physical violence, to provide high-quality care in a totally safe environment. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Efficacy of the DigniCap System in preventing chemotherapy-induced alopecia in breast cancer patients is not related to patient characteristics or side effects of the device.

BACKGROUND: The DigniCap System is an effective scalp cooling device for the prevention of chemotherapy-induced alopecia in early breast cancer patients. AIM: This prospective study was designed to confirm the efficacy and tolerability of the device, to explore potential factors associated with its efficacy and to collect data on patient perceptions and satisfaction. METHODS: Between January 2016 and June 2018, 163 early breast cancer patients eligible for adjuvant chemotherapy were enrolled. Hair loss was assessed using the Dean scale, where a score of 0-2 (hair loss ≤50%) was defined as successful. RESULTS: Hair preservation was successful in 57% of patients in the overall series. The proportion was even higher (81%) in the patient subgroup treated with a paclitaxel and trastuzumab regimen. Side effects (feeling cold, headache, head heaviness, scalp and cervical pain) were mild to moderate and did not correlate with the rate of hair loss. Lifestyle, anthropometric factors and hair characteristics failed to be associated with device efficacy. CONCLUSIONS: The DigniCap System was well tolerated and found to be effective in preventing alopecia in early breast cancer patients. Our study failed to identify factors other than type of chemotherapy regimen associated with hair preservation.

Influence of Free Fatty Acids on Lipid Membrane-Nisin Interaction.

The influence of free fatty acids (FFAs) on the nisin-membrane interaction was investigated through micro-DSC and fluorescence spectroscopy. A simple but informative model membrane was prepared (5.7 DMPC:3.8 DPPS:0.5 DOPC molar ratio) by considering the presence of different phospholipid headgroups in charge and size and different phospholipid tails in length and unsaturation level, allowing the discrimination of the combined interaction of nisin and FFAs with the single phospholipid constituents. The effects of six FFAs on membrane stability were evaluated, namely two saturated FFAs (palmitic acid and stearic acid), two monounsaturated FFAs (cis-unsaturated oleic acid and trans-unsaturated elaidic acid) and two cis-polyunsaturated FFAs (ω-6 linoleic acid and ω-3 docosahexaenoic acid). The results permitted assessment of a thermodynamic picture of such interactions which indicates that the peptide-membrane interaction does not overlook the presence of FFAs within the lipid bilayer since both FFAs and nisin are able to selectively promote thermodynamic phase separations as well as a general lipid reorganization within the host membrane. Furthermore, the magnitude of the effects may be different depending on the FFA chemical structure as well as the membrane lipid composition.

[School nurse in the restrain of pandemics and the re-opening school. An integrative review]. / L'infermiere scolastico, la prevenzione della diffusione delle malattie infettive e la riapertura delle scuole nell'era della pandemia da SARS-Cov2. Revisione integrativa della letteratura.

INTRODUCTION: School nurse is present today in many countries around the world. Its contribution within schools is described in the literature especially with regard to the management of chronic diseases and health education interventions. The Sars-CoV2 pandemic has forced many states to close schools, involving major psycho-social problems. The reopening of schools is a great challenge, in this regard this work has the goal of evaluating the literature that identifies the figure of the school nurse as a strength in containing the spread of contagious diseases and the actions that can be effective for this purpose. METHODS: An integrative literature review was conducted by interrogating the main international medical-nursing databases, all research articles were included, editorials and letters were excluded. Results were screened independently by two investigators. RESULTS: 10 articles were included, the main purpose of which was to describe outbreak cases and strategies for their management. The major nursing interventions highlighted are surveillance, case reporting, education, management of relationships with families, collaboration with other professionals. DISCUSSION: Although the identified literature was quantitatively poor, it is clear that the school nurse is central to syndromic surveillance, educational role, decision making, clinical management, collaboration with the team of experts and management of communication.

Eight-week interval in flushing and locking port-a-cath in cancer patients: A single-institution experience and systematic review.

Port-a-cath (PAC) system is one of the most frequently employed venous accesses for administration of chemotherapy and supportive care. To prevent late complications, the latest guidelines recommend flushing/locking procedures every four weeks. In this retrospective study, we evaluate the frequencies of late complications with a eight-week flushing/locking procedure compared to the standard one. This study retrospectively compares the frequency of complications occurred using standard versus delayed flushing schedules. We performed a systematic review of the published studies about PAC complications associated with longer flushing intervals. Three hundred and ninety fully available patients were enrolled. One hundred and six patients had their PAC flushed/locked every month, 347 patients performed the flushing/locking procedures every eight weeks, 63 patients switched from the four to the eight-week schedule. No difference was seen in the number of occlusions, infections and mechanical dysfunctions between the two patient groups. The systematic literature review confirmed, in a total of 1,347 patients, the absence of an increased proportion of complications with delayed schedules. PAC flushing and locking every eight weeks are feasible and safe. This delayed schedule may improve patients' quality of life and decrease both nursing workload and costs for the national health system.

Caring relationship: a qualitative research through the narratives of the students of the Bachelor of Science in Nursing degree.

BACKGROUND: The caring relationship is a complex phenomenon, that is considered as a fundamental patient-centred care activity. It is a nursing skill that is neither directly visible nor measurable and can be taught to students only by referring to other equally abstract and com- plex concepts. Issues such as care, communication, counselling, narrative nursing and empathy are addressed within specific modules under the Study Plan and dedicated to the caring relationship. However doubts persist on the experience of the students about caring relationship. OBJECTIVES: The aim of the study was understand caring relationship meanings and experiences in basic nursing education. DESIGN: A qualitative research according to the interpretative theory was conducted. Partecipants: The study involved second-year students of the Bachelor of Science in Nursing degree (BSN): at an University of northern Italy. METHODS: Data were collected through narratives of actual caring relationship experiences that students had during their clinical internships. RESULTS: The themes emerged from the accounts of 24 students were communication and the emotions related thereto. In particular, the perception of the loneliness of the patients, the characteristics associated with the ability of nurses to grasp this state and the feeling of well-being that is established in both people involved in a significant caring relationship, often based on active listening by the students. CONCLUSIONS: This study allowed us to understand the main characteristics of the students' experiences as they develop the ability to relate in a therapeutic way.

Cattle transhumance and agropastoral nomadic herding practices in Central Cameroon.

BACKGROUND: In sub-Saharan Africa, livestock transhumance represents a key adaptation strategy to environmental variability. In this context, seasonal livestock transhumance also plays an important role in driving the dynamics of multiple livestock infectious diseases. In Cameroon, cattle transhumance is a common practice during the dry season across all the main livestock production zones. Currently, the little recorded information of the migratory routes, grazing locations and nomadic herding practices adopted by pastoralists, limits our understanding of pastoral cattle movements in the country. GPS-tracking technology in combination with a questionnaire based-survey were used to study a limited pool of 10 cattle herds from the Adamawa Region of Cameroon during their seasonal migration, between October 2014 and May 2015. The data were used to analyse the trajectories and movement patterns, and to characterize the key animal health aspects related to this seasonal migration in Cameroon. RESULTS: Several administrative Regions of the country were visited by the transhumant herds over more than 6 months. Herds travelled between 53 and 170 km to their transhumance grazing areas adopting different strategies, some travelling directly to their destination areas while others having multiple resting periods and grazing areas. Despite their limitations, these are among the first detailed data available on transhumance in Cameroon. These reports highlight key livestock health issues and the potential for multiple types of interactions between transhumant herds and other domestic and wild animals, as well as with the formal livestock trading system. CONCLUSION: Overall, these findings provide useful insights into transhumance patterns and into the related animal health implications recorded in Cameroon. This knowledge could better inform evidence-based approaches for designing infectious diseases surveillance and control measures and help driving further studies to improve the understanding of risks associated with livestock movements in the region.

[The evaluation of qualitative research published in nursing journals: protocol of a cross-sectional study]. / La valutazione della ricerca qualitativa pubblicata nelle riviste infermieristiche: protocollo di studio.

INTRODUCTION: The nature of nursing has prompted researchers nurses to use a large number of qualitative methodology research. The trend showed a substantial increase in its production between 1997 and 2000 to settle back down in the following years although until recently the qualitative methodology was considered a non-scientific research. The growing number of publications with qualitative design is paid concern to verify the rigor and credibility of studies using this method. The use of the quality assessment tools showed that the methodological precision of studies with a qualitative design has grown over time. AIM: Assessing, using the tool Critical Appraisal Skills Programme, the quality of qualitative studies published in the last five years by international nursing journals with higher impact factor. METHOD: We will search the qualitative articles published on the ten most influential nursing journals that will be submitted by two independent researchers at the Critical Appraisal Skills Programme tool in its original version. EXPECTED RESULTS: The results make it possible to observe whether the qualitative research produced in the field of nursing uses a rigorous methodology in the drafting of the report, assuming that the quality has grown in the past five years than in previous years. CONCLUSION: The study will help researchers assess which level reached nurses in the development of qualitative research.

Structure-Function Relationships in l-Amino Acid Deaminase, a Flavoprotein Belonging to a Novel Class of Biotechnologically Relevant Enzymes.

l-Amino acid deaminase from Proteus myxofaciens (PmaLAAD) is a membrane flavoenzyme that catalyzes the deamination of neutral and aromatic l-amino acids into α-keto acids and ammonia. PmaLAAD does not use dioxygen to re-oxidize reduced FADH2 and thus does not produce hydrogen peroxide; instead, it uses a cytochrome b-like protein as an electron acceptor. Although the overall fold of this enzyme resembles that of known amine or amino acid oxidases, it shows the following specific structural features: an additional novel α+ß subdomain placed close to the putative transmembrane α-helix and to the active-site entrance; an FAD isoalloxazine ring exposed to solvent; and a large and accessible active site suitable to bind large hydrophobic substrates. In addition, PmaLAAD requires substrate-induced conformational changes of part of the active site, particularly in Arg-316 and Phe-318, to achieve the correct geometry for catalysis. These studies are expected to pave the way for rationally improving the versatility of this flavoenzyme, which is critical for biocatalysis of enantiomerically pure amino acids.

Rapid identification of bovine MHCI haplotypes in genetically divergent cattle populations using next-generation sequencing.

The major histocompatibility complex (MHC) region contains many genes that are key regulators of both innate and adaptive immunity including the polymorphic MHCI and MHCII genes. Consequently, the characterisation of the repertoire of MHC genes is critical to understanding the variation that determines the nature of immune responses. Our current knowledge of the bovine MHCI repertoire is limited with only the Holstein-Friesian breed having been studied in any depth. Traditional methods of MHCI genotyping are of low resolution and laborious and this has been a major impediment to a more comprehensive analysis of the MHCI repertoire of other cattle breeds. Next-generation sequencing (NGS) technologies have been used to enable high throughput and much higher resolution MHCI typing in a number of species. In this study we have developed a MiSeq platform approach and requisite bioinformatics pipeline to facilitate typing of bovine MHCI repertoires. The method was validated initially on a cohort of Holstein-Friesian animals and then demonstrated to enable characterisation of MHCI repertoires in African cattle breeds, for which there was limited or no available data. During the course of these studies we identified >140 novel classical MHCI genes and defined 62 novel MHCI haplotypes, dramatically expanding the known bovine MHCI repertoire.

[Shared decision making: a scoping review]. / Processo decisionale condiviso: una scoping review.

AIM: This research aimed to explore the literature regarding the model of the Shared Decision Making (SDM) in the field of nursing. METHOD: A scoping review was conducted. The electronic literature research was made on Medline, CINAHL, The Cochrane Library, Google Scholar, using a combination of key words: "Decision Making", "Shared Decision Making", "Nursing", "Nursing Patient relationship". The review was carried out following the Levac model. RESULTS: 29 studies were included, in a time range between 1972 and 2015. The analysis identifies the main characteristics of the SDM model, the tools for its implementation, the patients experience, the fields of application and the integration among SDM e evidence based practice. CONCLUSION: the analysis showed that the Shared Decision Making model is not widespread, especially in the Italian context. This phenomenon could be explained by three fundamental aspects. The concept is not widely disseminated and full scientific maturity. His application also seems to be related to extensive knowledge of gold standard interventions and possible alternatives. Finally, there are cultural barriers to the implementation of the SDM.

Aminoacetone oxidase from Streptococcus oligofermentans belongs to a new three-domain family of bacterial flavoproteins.

The aaoSo gene from Streptococcus oligofermentans encodes a 43 kDa flavoprotein, aminoacetone oxidase (SoAAO), which was reported to possess a low catalytic activity against several different L-amino acids; accordingly, it was classified as an L-amino acid oxidase. Subsequently, SoAAO was demonstrated to oxidize aminoacetone (a pro-oxidant metabolite), with an activity ~25-fold higher than the activity displayed on L-lysine, thus lending support to the assumption of aminoacetone as the preferred substrate. In the present study, we have characterized the SoAAO structure-function relationship. SoAAO is an FAD-containing enzyme that does not possess the classical properties of the oxidase/dehydrogenase class of flavoproteins (i.e. no flavin semiquinone formation is observed during anaerobic photoreduction as well as no reaction with sulfite) and does not show a true L-amino acid oxidase activity. From a structural point of view, SoAAO belongs to a novel protein family composed of three domains: an α/ß domain corresponding to the FAD-binding domain, a ß-domain partially modulating accessibility to the coenzyme, and an additional α-domain. Analysis of the reaction products of SoAAO on aminoacetone showed 2,5-dimethylpyrazine as the main product; we propose that condensation of two aminoacetone molecules yields 3,6-dimethyl-2,5-dihydropyrazine that is subsequently oxidized to 2,5-dimethylpyrazine. The ability of SoAAO to bind two molecules of the substrate analogue O-methylglycine ligand is thought to facilitate the condensation reaction. A specialized role for SoAAO in the microbial defence mechanism related to aminoacetone catabolism through a pathway yielding dimethylpyrazine derivatives instead of methylglyoxal can be proposed.

L-amino acid oxidase as biocatalyst: a dream too far?

L-amino acid oxidase (LAAO) is a flavoenzyme containing non-covalently bound flavin adenine dinucleotide, which catalyzes the stereospecific oxidative deamination of l-amino acids to α-keto acids and also produces ammonia and hydrogen peroxide via an imino acid intermediate. LAAOs purified from snake venoms are the best-studied members of this family of enzymes, although a number of LAAOs from bacterial and fungal sources have been also reported. From a biochemical point of view, LAAOs from different sources are distinguished by molecular mass, substrate specificity, post-translational modifications and regulation. In analogy to the well-known biotechnological applications of d-amino acid oxidase, important results are expected from the availability of suitable LAAOs; however, these expectations have not been fulfilled yet because none of the "true" LAAOs has successfully been expressed as a recombinant protein in prokaryotic hosts, such as Escherichia coli. In enzyme biotechnology, recombinant production of a protein is mandatory both for the production of large amounts of the catalyst and to improve its biochemical properties by protein engineering. As an alternative, flavoenzymes active on specific l-amino acids have been identified, e.g., l-aspartate oxidase, l-lysine oxidase, l-phenylalanine oxidase, etc. According to presently available information, amino acid oxidases with "narrow" or "strict" substrate specificity represent as good candidates to obtain an enzyme more suitable for biotechnological applications by enlarging their substrate specificity by means of protein engineering.

[Progressive Patient Care Model and its application into hospital organization: a narrative review]. / Progressive Patient Care e organizzazione ospedaliera per intensità di cure: revisione narrativa della letteratura.

Aim of this article is to review the literature about the Progressive Patient Care Model, in particular its conceptual and practical characteristics, its implementation and effects on the current health care organization. Was conducted by an integrative-narrative literature review. The Progressive Patient Care is a model which aims at group patients according to their complexity in order to place patients in the most appropriate care setting. The original model consists on five care levels: intensive care, intermediate care, self-care, long term care, home care.In Italy the above mentioned model can be considered as a contextualization of Progressive Patient Care in the light of similarities both in terms of model purposes and care levels classification. The organization for intensive care levels is an opportunity for Italian healthcare facilities to reach continuity of care. This model emphazises care processes looking to patients' needs rather than a division according to criteria of specialties.

Unraveling the epidemiology of Mycobacterium bovis using whole-genome sequencing combined with environmental and demographic data.

When studying the dynamics of a pathogen in a host population, one crucial question is whether it transitioned from an epidemic (i.e., the pathogen population and the number of infected hosts are increasing) to an endemic stable state (i.e., the pathogen population reached an equilibrium). For slow-growing and slow-evolving clonal pathogens such as Mycobacterium bovis, the causative agent of bovine (or animal) and zoonotic tuberculosis, it can be challenging to discriminate between these two states. This is a result of the combination of suboptimal detection tests so that the actual extent of the pathogen prevalence is often unknown, as well as of the low genetic diversity, which can hide the temporal signal provided by the accumulation of mutations in the bacterial DNA. In recent years, the increased availability, efficiency, and reliability of genomic reading techniques, such as whole-genome sequencing (WGS), have significantly increased the amount of information we can use to study infectious diseases, and therefore, it has improved the precision of epidemiological inferences for pathogens such as M. bovis. In this study, we use WGS to gain insights into the epidemiology of M. bovis in Cameroon, a developing country where the pathogen has been reported for decades. A total of 91 high-quality sequences were obtained from tissue samples collected in four abattoirs, 64 of which were with complete metadata. We combined these with environmental, demographic, ecological, and cattle movement data to generate inferences using phylodynamic models. Our findings suggest M. bovis in Cameroon is slowly expanding its epidemiological range over time; therefore, endemic stability is unlikely. This suggests that animal movement plays an important role in transmission. The simultaneous prevalence of M. bovis in co-located cattle and humans highlights the risk of such transmission being zoonotic. Therefore, using genomic tools as part of surveillance would vastly improve our understanding of disease ecology and control strategies.

Development of core competencies for field veterinary epidemiology training programs.

A workforce with the adequate field epidemiology knowledge, skills and abilities is the foundation of a strong and effective animal health system. Field epidemiology training is conducted in several countries to meet the increased global demand for such a workforce. However, core competencies for field veterinary epidemiology have not been identified and agreed upon globally, leading to the development of different training curricula. Having a set of agreed core competencies can harmonize field veterinary epidemiology training. The Food and Agriculture Organization of the United Nations (FAO) initiated a collective, iterative, and participative process to achieve this and organized two expert consultative workshops in 2018 to develop core competencies for field veterinary epidemiology at the frontline and intermediate levels. Based on these expert discussions, 13 competencies were identified for the frontline and intermediate levels. These competencies were organized into three domains: epidemiological surveillance and studies; field investigation, preparedness and response; and One Health, communication, ethics and professionalism. These competencies can be used to facilitate the development of field epidemiology training curricula for veterinarians, adapted to country training needs, or customized for training other close disciplines. The competencies can also be useful for mentors and employers to monitor and evaluate the progress of their mentees, or to guide the selection process during the recruitment of new staff.

Environmental sampling for the detection of foot-and-mouth disease virus and peste des petits ruminants virus in a live goat market, Nepal.

Livestock markets are considered vital parts of the agricultural economy, particularly in developing countries where livestock keeping contributes to both food security and economic stability. Animals from diverse sources are moved to markets, they mix while they are there and are subsequently redistributed over wide geographic areas. Consequently, markets provide an opportunity for targeted surveillance for circulating pathogens. This study investigated the use of environmental sampling at a live goat market in Nepal for the detection of foot-and-mouth disease virus (FMDV) and peste des petits ruminants virus (PPRV), both of which are endemic. Five visits to the market were carried out between November 2016 and April 2018, with FMDV RNA detected on four visits and PPRV RNA detected on all five visits. Overall, 4.1% of samples (nine out of 217) were positive for FMDV RNA and 60.8% (132 out of 217) were positive for PPRV RNA, though the proportion of positive samples varied amongst visits. These results demonstrate that non-invasive, environmental sampling methods have the potential to be used to detect circulation of high priority livestock diseases at a live animal market and, hence, to contribute to their surveillance and control.

Ranging patterns and factors associated with movement in free-roaming domestic dogs in urban Malawi.

Rabies is a neglected zoonotic disease that causes around 59,000 deaths per year globally. In Africa, rabies virus is mostly maintained in populations of free-roaming domestic dogs (FRDD) that are predominantly owned. Characterizing the roaming behavior of FRDD can provide relevant information to understand disease spread and inform prevention and control interventions. To estimate the home range (HR) of FRDD and identify predictors of HR size, we studied 168 dogs in seven different areas of Blantyre city, Malawi, tracking them with GPS collars for 1-4 days. The median core HR (HR50) of FRDD in Blantyre city was 0.2 ha (range: 0.08-3.95), while the median extended HR (HR95) was 2.14 ha (range: 0.52-23.19). Multivariable linear regression models were built to identify predictors of HR size. Males presented larger HR95 than females. Dogs living in houses with a higher number of adults had smaller HR95, while those living in houses with higher number of children had larger HR95. Animals that received products of animal origin in their diets had larger HR95, and only in the case of females, animals living in low-income areas had larger HR50 and HR95. In contrast, whether male dogs were castrated or not was not found to be associated with HR size. The results of this study may help inform rabies control and prevention interventions in Blantyre city, such as designing risk-based surveillance activities or rabies vaccination campaigns targeting certain FRDD subpopulations. Our findings can also be used in rabies awareness campaigns, particularly to illustrate the close relationship between children and their dogs.

The effectiveness of team-based learning in nursing education: A systematic review.

AIM: Team-Based Learning (TBL) is an active teaching methodology, recently implemented also in the field of nursing education. The main objective of this study was to identify, appraise and summarize primary studies on the effectiveness of TBL in achieving learning outcomes in undergraduate nursing students. The secondary objective was to explore the generic competencies the students developed, and their reactions and attitudes. STUDY DESIGN: A systematic review of experimental and quasi-experimental studies. DATABASES SOURCES: Cochrane Library, Pubmed/Medline, Cinahl, PsycINFO, and Eric; Google Scholar was used to search for grey literature and the reference lists of the retrieved papers. REVIEW METHODS: A research protocol was developed according to the PRISMA-P guidelines. Two reviewers conducted the selection process. The "JBI Critical Appraisal Checklist" was used to check the quality of the selected studies. RESULTS: We included 12 studies: 2 monocentric randomized controlled trials and 10 quasi-experimental studies. Nine out of 12 studies produced significant results in favour of TBL in terms of academic performance and skills development, however results were divergent when TBL was compared with other teaching methods. The results of 7 studies highlighted the effectiveness of TBL in improving the development of communication skills, interprofessional learning, and self-directed learning. Divergent results were obtained with regard to problem solving and critical thinking skills. TBL promoted classroom engagement, however it did not seem to be associated with better learning outcomes. CONCLUSIONS: Overall, TBL was found to be effective in achieving undergraduate nursing students' learning outcomes, but evidence was not sufficiently strong to warrant that it is more effective than other teaching methods. The results of this review are in favour of the implementation of TBL in nursing education, however studies with more rigorous methods and with a mixed method design are required to improve the transferability of results.

Diabetic education in nursing: A Rodgers' evolutionary concept analysis.

AIM: This concept analysis aims to clarify the concept of diabetic education in nursing to provide guidance for the further conceptualization and clarification of diabetic education in nursing. BACKGROUND: Patient education is a fundamental component of diabetes care. Nurses have taken up a major role in educating people with diabetes to manage their conditions. However, the exact meaning of diabetic education in nursing remains challenging. DESIGN: Rodgers' evolutionary method of concept analysis was performed to explore the concept of diabetic education in nursing. DATA SOURCE: We conducted a literature search on Cumulative Index to Nursing and Allied Health Literature (CINAHL), MedLine, and PsycInfo for works published until October 2020 using "patient education," "diabetes," and "nursing" as key terms. RESULTS: The concept analysis revealed that key attributes of diabetic education in nursing include patient-centered and interactive approaches, planning, and problem solving. Antecedents related to individuals with diabetes are their backgrounds, needs, and motivations, while the antecedents related to nurses are experience and attitude. Finally, three different consequences of the concept emerged: an increase in knowledge and skills, a behavioral change, and the improvement of clinical outcomes.