Simulation-based learning in palliative care in postgraduate nursing education: a scoping review.

BACKGROUND: Nurses require advanced competence in palliative care, but they face wide variations in education and a shortage in opportunities for clinical placement. Simulation-based learning (SBL) can enable students to develop clinical skills, critical thinking and confidence. No scoping reviews to date have mapped the use of SBL in palliative care within postgraduate nursing education. METHODS: The aim of this scoping review was to systematically map published studies on the use of SBL in palliative care in postgraduate nursing education. A scoping review was conducted using Arksey and O'Malley's (Int J Soc Res Meth 8(1):19-32, 2005) methodological framework. A systematic and comprehensive search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resources Information Center (ERIC), Ovid MEDLINE, Ovid EMBASE, Allied and Complementary Medicine and PsycINFO was performed for studies published between January 2000 and April 2022. Two authors independently assessed papers for inclusion and extracted data. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The protocol was registered on the Open Science Framework. RESULTS: This review includes 10 studies. Three thematic groupings were identified: enhanced understanding of the importance of teamwork, interdisciplinarity and interpersonal skills; preparedness and confidence in one's ability to communicate during emotionally challenging situations; and impact and relevance to one's own clinical practice. CONCLUSIONS: The use of SBL in palliative care in postgraduate nursing education seems to enhance students' understanding of the importance of teamwork and interdisciplinarity. The review shows contradictory results regarding whether SBL in palliative care increases students' confidence in their communication skills. Postgraduate nursing students experienced personal growth after participating in SBL. Because our findings indicate that limited research has been conducted within this field, future research should (1) explore postgraduate nursing students' experiences with SBL in palliative care with a focus on more practical content such as symptom management, (2) examine the relevance and application of SBL in clinical practice, and (3) be reported in line with recommendations on the reporting of simulation research.

Advantages and Challenges of Using Telehealth for Home-Based Palliative Care: Systematic Mixed Studies Review.

BACKGROUND: Owing to the increasing number of people with palliative care needs and the current shortage of health care professionals (HCPs), providing quality palliative care has become challenging. Telehealth could enable patients to spend as much time as possible at home. However, no previous systematic mixed studies reviews have synthesized evidence on patients' experiences of the advantages and challenges of telehealth in home-based palliative care. OBJECTIVE: In this systematic mixed studies review, we aimed to critically appraise and synthesize the findings from studies that investigated patients' use of telehealth in home-based palliative care, focusing on the advantages and challenges experienced by patients. METHODS: This is a systematic mixed studies review with a convergent design. The review is reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A systematic search was performed in the following databases: Allied and Complementary Medicine Database, CINAHL, Cochrane Central Register of Controlled Trials, Embase, Latin American and Caribbean Health Sciences Literature, MEDLINE, PsycInfo, and Web of Science. The inclusion criteria were as follows: studies using quantitative, qualitative, or mixed methods; studies that investigated the experience of using telehealth with follow-up from HCPs of home-based patients aged ≥18; studies published between January 2010 and June 2022; and studies published in Norwegian, Danish, Swedish, English, Portuguese, or Spanish in peer-reviewed journals. Five pairs of authors independently assessed eligibility of the studies, appraised methodological quality, and extracted data. The data were synthesized using thematic synthesis. RESULTS: This systematic mixed studies review included 41 reports from 40 studies. The following 4 analytical themes were synthesized: potential for a support system and self-governance at home; visibility supports interpersonal relationships and a joint understanding of care needs; optimized information flow facilitates tailoring of remote caring practices; and technology, relationships, and complexity as perpetual obstacles in telehealth. CONCLUSIONS: The advantages of telehealth were that patients experience a potential support system that could enable them to remain at home, and the visual features of telehealth enable them to build interpersonal relationships with HCPs over time. Self-reporting provides HCPs with information about symptoms and circumstances that facilitates tailoring care to specific patients. Challenges with the use of telehealth were related to barriers to technology use and inflexible reporting of complex and fluctuating symptoms and circumstances using electronic questionnaires. Few studies have included the self-reporting of existential or spiritual concerns, emotions, and well-being. Some patients perceived telehealth as intrusive and a threat to their privacy at home. To optimize the advantages and minimize the challenges with the use of telehealth in home-based palliative care, future research should include users in the design and development process.

Health Care Professionals' Experiences and Perspectives on Using Telehealth for Home-based Palliative Care: Scoping Review.

BACKGROUND: Telehealth seems feasible for use in home-based palliative care (HBPC). It may improve access to health care professionals (HCPs) at patients' homes, reduce hospital admissions, enhance patients' feelings of security and safety, and increase the time spent at home for patients in HBPC. HBPC requires the involvement of various HCPs such as nurses, physicians, allied health professionals, dietitians, psychologists, religious counselors, and social workers. Acceptance of the use of technology among HCPs is essential for the successful delivery of telehealth in practice. No scoping review has mapped the experiences and perspectives of HCPs regarding the use of telehealth in HBPC. OBJECTIVE: The aim of this review was to systematically map published studies on HCPs' experiences and perspectives on the use of telehealth in HBPC. METHODS: A scoping review was conducted using the methodology of Arksey and O'Malley. The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A systematic search was performed in AMED, CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science for studies published in peer-reviewed journals between January 1, 2000, and August 23, 2022. The reference lists of the included papers were hand searched to identify additional studies. The inclusion criteria were (1) studies using qualitative, quantitative, or mixed methods; (2) studies including HCPs using telehealth with patients in HBPC; (3) studies on HCPs' experiences and perspectives on the use of telehealth in HBPC; (4) studies published between January 1, 2000, and August 23, 2022; and (5) studies published in English, Portuguese, Norwegian, Danish, Swedish, or Spanish. Pairs of authors independently included studies and extracted data. The first 2 stages of thematic synthesis were used to thematically organize the data. RESULTS: This scoping review included 29 papers from 28 studies. Four descriptive themes were identified: (1) easy to use but technological issues undermine confidence, (2) adds value but personal and organizational barriers challenge adoption, (3) potential to provide useful and meaningful patient-reported data, and (4) mutual trust as a prerequisite for interpersonal relationships. CONCLUSIONS: Telehealth in HBPC seems to be easy to use and may improve the coordination of care, time efficiency, clinical assessments, and help build and enhance personal and professional relationships. However, the introduction of technology in HBPC is complex, as it may not align well with the overall aim of palliative care from HCPs' point of view. Further, changes in practice and requirements for HCPs may reduce motivation for the use of telehealth in HBPC. HCPs consider themselves to have central roles in implementing telehealth, and a lack of acceptance and motivation is a key barrier to telehealth adoption. Policy makers and telehealth developers should be aware of this potential barrier when developing or implementing new technology for use in HBPC. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/33305.

Patients' Experiences of Telehealth in Palliative Home Care: Scoping Review.

BACKGROUND: Telehealth is increasingly being used in home care and could be one measure to support the needs of home-based patients receiving palliative care. However, no previous scoping review has mapped existing studies on the use of telehealth for patients in palliative home care. OBJECTIVE: The aim of this study was to map and assess published studies on the use of telehealth for patients in palliative home care. METHODS: A scoping review was conducted using the methodological framework of Arksey and O'Malley. Reporting was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A systematic and comprehensive search of Medical Literature Analysis and Retrieval System Online, EMBASE, PsycINFO, and Cumulative Index to Nursing and Allied Health was performed for studies published between January 2000 and October 2018. Two authors independently assessed eligibility and extracted data. RESULTS: The review included 22 papers from 19 studies. Four thematic groupings were identified among the included papers: easy and effortless use of telehealth regardless of the current health condition, visual features that enhance communication and care via telehealth, symptom management and self-management promotion by telehealth, and perceptions of improved palliative care at home. CONCLUSIONS: The use of telehealth in palliative home care seems to be feasible, improving access to health care professionals at home and enhancing feelings of security and safety. The visual features of telehealth seem to allow a genuine relationship with health care professionals. However, there are contradicting results on whether the use of telehealth improves burdensome symptoms and quality of life. Future research should investigate the experiences of using telehealth among patients with life-limiting illness other than cancer and patients aged 85 years or older. More research is needed to increase the body of knowledge regarding the effectiveness of telehealth on symptoms and quality of life.

Do weather changes influence pain levels in women with fibromyalgia, and can psychosocial variables moderate these influences?

The aim of this study was to examine the association between fibromyalgia pain and weather, and to investigate whether psychosocial factors influence this relationship. Women with chronic widespread pain/fibromyalgia (N = 50) enrolled in a larger study, were recruited from a 4-week inpatient rehabilitation program in Norway ( 2009-2010), and reported their pain and psychological factors up to three times per day (morning, afternoon, evening) for 5 weeks. These ratings were then related to the official local weather parameters. Barometric pressure recorded simultaneously impacted pain significantly while temperature, relative humidity, and solar flux did not. No psychological variables influenced the weather-pain interaction. No weather parameter predicted change in the subsequent pain measures. The magnitude of the inverse association between pain and barometric pressure was very small, and none of the psychological variables studied influenced the association between pain and barometric pressure. All in all, the evidence for a strong weather-pain association in fibromyalgia seems limited at best.

The Norwegian version of the nursing student mentors' competence instrument (MCI): A psychometric validation study.

Background: Nurse mentors require competence to mentor nursing students in clinical practice, including specific knowledge and skills. Evaluating mentor competence is crucial in developing and ensuring the high-quality mentoring of nursing students. The nursing student mentors' competence instrument is one of the few valid instruments for assessing the competence of nurses as mentors. Objectives: To translate the nursing student mentors' competence instrument into Norwegian and evaluate its psychometric properties. Design: The research employed a cross-sectional study design. Settings: Data were collected from nurse mentors at nursing homes, hospitals, home nursing care and mental health care units in Norway from 2021 to 2022. Participants: A total of 458 registered nurses with experience of mentoring nursing students participated in the study, of which data was used to conduct psychometric testing. Methods: The nursing student mentors' competence instrument was translated and evaluated in six steps: Forward translation, forward translation synthesis, backward translation, backward translation synthesis, cognitive debriefing and psychometric testing. The validity and reliability of the translated instrument were investigated using confirmatory factor analysis (CFA) and Cronbach's alpha. Results: The translated instrument showed acceptability. The CFA goodness-of-fit indices showed acceptable model fit (χ2/df = 2.547, SRMR = 0.051, CFI = 0.919, RMSEA = 0.058), and the Cronbach's alpha values for the instrument's subscales ranged from 0.77 to 0.95. Conclusions: The Norwegian version of the nursing student mentors' competence instrument shows potential as a useful instrument for assessing current and required competencies of nurse mentors in clinical practice in nursing education.

Use of active learning classrooms in health professional education: A scoping review.

Background: Active learning approaches, such as the use of active learning classrooms, can be an important measure to prepare health professional students for work-life. In addition to teaching approaches, the design of the classroom or learning spaces could facilitate learning. Although active learning classrooms are used in health professional education, no previous scoping review has investigated their use and associated outcomes. Objective: A scoping review was conducted to provide an overview of existing studies on the use of active learning classrooms in health professionals' education. Design: Scoping review using the framework of Arksey and O'Malley. Methods: A systematic search was performed in ERIC, CINAHL, PsycINFO, Ovid MEDLINE, and Ovid EMBASE for papers published between January 2012 and January 2023. Hand searches of the reference lists of the included studies were also conducted. Inclusion criteria were as follows: studies using qualitative, quantitative, or mixed methods; studies including undergraduate, graduate, or postgraduate health professional students or teachers; studies that investigated students' and teachers' use of active learning classrooms or similar concepts in higher education; and studies published in English, Swedish, Danish, Norwegian, Spanish, or Portuguese in peer-reviewed journals. Pairs of authors independently assessed the eligibility of the studies and extracted the data, which were thematically grouped. The scoping review protocol was published with the Open Science Framework prior to the study selection process. Results: The review included 11 papers from 10 studies. Most studies were published between 2018 and 2022, exploring students' perspectives. Three thematic groups were identified, suggesting that active learning classrooms (1) enhance a positive atmosphere and engagement but can be challenging; (2) facilitate students' interactions; and (3) have the potential to stimulate active learning and co-construction. Conclusions: The use of active learning classrooms in health professional education can facilitate interactions among students, between students and teachers, and between students and class content. However, the design of active learning classrooms can both enhance and challenge students' engagement and active participation. Teachers do not necessarily change their teaching approaches when compared to teaching in a traditional classroom. Future research should explore how to facilitate teachers' use of the opportunities in active learning classrooms in health professional education and students' learning outcomes, as well as the effect of high-technology active learning classrooms versus low-technology active learning classrooms on the intended learning outcome. Tweetable abstract: The use of active learning classrooms can facilitate active learning, but teachers do not necessarily change their teaching methods.

Technology-Supported Guidance Models to Stimulate Nursing Students' Self-Efficacy in Clinical Practice: Scoping Review.

BACKGROUND: In nursing education, bridging the gap between theoretical knowledge and practical skills is crucial for developing competence in clinical practice. Nursing students encounter challenges in acquiring these essential skills, making self-efficacy a critical component in their professional development. Self-efficacy pertains to individual's belief in their ability to perform tasks and overcome challenges, with significant implications for clinical skills acquisition and academic success. Previous research has underscored the strong link between nursing students' self-efficacy and their clinical competence. Technology has emerged as a promising tool to enhance self-efficacy by enabling personalized learning experiences and in-depth discussions. However, there is a need for a comprehensive literature review to assess the existing body of knowledge and identify research gaps. OBJECTIVE: The aim of this study is to systematically map and identify gaps in published studies on the use of technology-supported guidance models to stimulate nursing students' self-efficacy in clinical practice. METHODS: This scoping review followed the framework of Arksey and O'Malley and was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR). A systematic, comprehensive literature search was conducted in ERIC, CINAHL, MEDLINE, Embase, PsycINFO, and Web of Science for studies published between January 2011 and April 2023. The reference lists of the included papers were manually searched to identify additional studies. Pairs of authors screened the papers, assessed eligibility, and extracted the data. The data were thematically organized. RESULTS: A total of 8 studies were included and four thematic groups were identified: (1) technological solutions for learning support, (2) learning focus in clinical practice, (3) teaching strategies and theoretical approaches for self-efficacy, and (4) assessment of self-efficacy and complementary outcomes. CONCLUSIONS: Various technological solutions were adopted in the guidance models to stimulate the self-efficacy of nursing students in clinical practice, leading to positive findings. A total of 7 out of 8 studies presented results that were not statistically significant, highlighting the need for further refinement of the applied interventions. Nurse educators play a pivotal role in applying learning strategies and theoretical approaches to enhance nursing students' self-efficacy, but the contributions of nurse preceptors and peers should not be overlooked. Future studies should consider involving users in the intervention process and using validated instruments tailored to the studies' intervention objectives, ensuring relevance and enabling comparisons across studies.

Virtual Reflection Group Meetings as a Structured Active Learning Method to Enhance Perceived Competence in Critical Care: Focus Group Interviews With Advanced Practice Nursing Students.

BACKGROUND: Advanced practice nurses (APNs) are in high demand in critical care units. In Norway, APNs are educated at the master's degree level and acquire the competence to ensure the independent, safe, and effective treatment of patients in constantly and rapidly changing health situations. APNs' competence embraces expert knowledge and skills to perform complex decision-making in the clinical context; therefore, it is essential that educational institutions in nursing facilitate learning activities that ensure and improve students' achievement of the required competence. In clinical practice studies of APN education, face-to-face reflection group (FFRG) meetings, held on campus with the participation of a nurse educator and advanced practice nursing students (APNSs), are a common learning activity to improve the competence of APNSs. Although FFRG meetings stimulate APNSs' development of required competencies, they may also result in unproductive academic discussions, reduce the time that APNSs spend in clinical practice, and make it impossible for nurse preceptors (NPs) to attend the meetings, which are all challenges that need to be addressed. OBJECTIVE: This study aimed to address the challenges experienced in FFRG meetings by implementing virtual reflection group (VRG) meetings and to explore the experiences of APNSs, NPs, and nurse educators in VRG meetings as an active learning method supported by technology to stimulate students' development of the required competence to become APNs in critical care. METHODS: This study adopted a qualitative explorative design with 2 focus group interviews and used inductive content analysis to explore the collected data. RESULTS: The main finding is that reflection group meetings supported by technology resulted in a better-structured active learning method. The VRG meeting design allowed APNSs to spend more time in clinical practice placements. The APNSs and NPs experienced that they participated actively and effectively in the meetings, which led to a perceived increase in competence. The APNSs also perceived an improved learning experience compared with their prior expectations. CONCLUSIONS: Users perceived that the implemented novel teaching design supported by technology, the VRG meeting, was a more effective method than FFRG meetings on campus to develop APNSs' required competence in critical care. The VRG was also perceived as an improved method to solve the challenges encountered in FFRG meetings. Specifically, the APNSs felt that they were prepared to undertake complex decision-making with a higher level of analytic cognition in a clinical context and to lead professional discussions in the ward. This developed teaching design can easily be adapted to diverse educational programs at various levels of professional education.

A Technology-Supported Guidance Model to Support the Development of Critical Thinking Among Undergraduate Nursing Students in Clinical Practice: Concurrent, Exploratory, Flexible, and Multimethod Feasibility Study.

BACKGROUND: There is widespread recognition and acceptance of the need for critical thinking in nursing education, as it is necessary to provide high-quality nursing. The Technology-Supported Guidance Model (TSGM) intervention was conducted during clinical practice among undergraduate nursing students and aimed to support the development of critical thinking. A major element of this newly developed intervention is an app, Technology-Optimized Practice Process in Nursing (TOPP­N), combined with the daily guidance of nursing students from nurse preceptors and summative assessments based on the Assessment of Clinical Education. OBJECTIVE: The main objective of this study was to assess the feasibility of a newly developed intervention, TSGM, among undergraduate nursing students, nurse preceptors, and nurse educators. Further objectives were to assess the primary and secondary outcome measures, recruitment strategy, and data collection strategy and to identify the potential causes of dropout and barriers to participant recruitment, retention, intervention fidelity, and adherence to the intervention. METHODS: This study was designed as a concurrent, exploratory, flexible, and multimethod feasibility study of the TSGM intervention that included quantitative and qualitative data from nursing students, nurse preceptors, and nurse educators. The primary outcome measures were the feasibility and acceptability of the intervention. The secondary outcomes included the suitability and acceptance of the outcome measures (critical thinking, self-efficacy, clinical learning environment, metacognition and self-regulation, technology acceptance, and competence of mentors); data collection strategy; recruitment strategy; challenges related to dropouts; and hindrances to recruitment, retention, and intervention fidelity and adherence. RESULTS: Nursing students, nurse preceptors, and nurse educators had varied experiences with the TSGM intervention. We identified factors that make the intervention feasible and challenging and may influence the feasibility, acceptability, dropout rate, adherence, and fidelity of the intervention. We also identified areas for future improvement of the intervention. CONCLUSIONS: The use of a newly developed intervention, TSGM, is feasible and accepted by undergraduate nursing students, nurse preceptors, and nurse educators; however, refinement and improvement of the intervention and the TOPP­N app, improvement in intervention management, and mitigation of negative factors are necessary before a randomized controlled trial can be performed. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/31646.

A Technology-Supported Guidance Model to Increase the Flexibility, Quality, and Efficiency of Nursing Education in Clinical Practice in Norway: Development Study of the TOPP-N Application Prototype.

BACKGROUND: The challenges of nursing shortage in the nursing profession and of limited nursing educational capacity in nursing education in clinical practice need to be addressed to ensure supply according to the demand of these professionals. In addition, communication problems among nursing students, nurse educators, and nurse preceptors; variations in the guidance competence of nurse preceptors; and limited overview from nurse educators on nursing students' clinical practice are common challenges reported in several research studies. These challenges affect the quality of nursing education in clinical practice, and even though these problems have been highlighted for several years, a recent study showed that these problems are increasing. Thus, an approach is required to ensure the quality of nursing education in clinical practice. OBJECTIVE: We aimed to develop a guidance and assessment application to meet the challenges reported in clinical practice. The application intended to increase the flexibility, quality, and efficiency of nursing education in clinical practice. Furthermore, it intended to increase interactive communication that supports guidance and ensure structured evaluation of nursing students in clinical practice. METHODS: This study employed a multidisciplinary user-participatory design. Overall, 23 stakeholders from the project team (ie, 5 researchers, 2 software developers, 1 pedagogical advisor, and 15 user representatives [4 educators, 6 preceptors, and 5 students]) participated in a user-centered development process that included workshops, intervention content development, and prototype testing. RESULTS: This study resulted in the creation of the Technology-Optimized Practice Process in Nursing (TOPP-N) guidance and assessment application for use as a supportive tool for nursing students, nurse preceptors, and nurse educators in clinical practice. The development process included the application's name and logo, technical architecture, guidance and assessment module, and security and privacy. CONCLUSIONS: This study offers insights into the development of an evidence-based technological tool to support nursing students, nurse preceptors, and nurse educators in clinical practice. Furthermore, the developed application has the potential to meet several challenges reported in nursing education in clinical practice. After a rigorous development process, we believe that the TOPP-N guidance and assessment application prototype is now ready to be tested in further intervention studies.

Professional competence required in advanced practice nursing in critical care: An exploratory qualitative study.

AIM: To identify the required competencies of advanced practice nurses (APNs) working with patients in critical care units in Norway. DESIGN: An exploratory qualitative design. METHODS: Four focus group interviews were performed with 18 nurses who worked in critical care units. The data were examined by inductive content analysis following Graneheim and Lundman's approach. FINDINGS: Our study found that APNs in critical care require the following professional competencies to meet the needs of patients characterised by greater age, comorbidities and increased complexity: (1) intrapersonal skills as revealed in the subthemes of self-awareness; motivation and commitment; strong mental health and upholding ethical standards, (2) advanced clinical decision-making skills as identified in the subthemes of integration of theory and practice; complex practical and technical skills; dealing with increased delegated responsibility and taking the lead in managing increased practice complexity and (3) interpersonal skills, including peer guidance, practising collaboratively and the ability to position oneself.

Sociodemographic profile, diagnoses and nursing care in post-COVID-19 patients in a Brazilian university hospital.

OBJECTIVES: to analyze the sociodemographic profile, diagnoses and nursing care of post-COVID-19 patients admitted to a university hospital in southern Brazil. METHODS: a retrospective cohort study. The sample consisted of 1,467 medical records, from January 2020 to January 2021. RESULTS: from the analyzed medical records, the most prevalent profiles, respectively, included: males (52.9%); white (81.1%); with Impaired Physiological Balance Syndrome* Nursing Diagnosis (77.3%); nursing care implementing aerosol precautions (94.5%); implementing droplet precautions (93.4%); checking vital signs (91.9%); applying standard disinfectant to equipment and surfaces (89.6%). CONCLUSIONS: the analysis of the sociodemographic profile, diagnoses and nursing care of patients in this study may contribute to implementing the Nursing Process in the coronavirus pandemic context.

Postgraduate nursing students' experiences with simulation-based learning in palliative care education: A qualitative study.

AIM: The aim of this study was to explore postgraduate palliative care nursing students' experiences with simulation-based learning focusing on communication skills, as a learning method in palliative care education. BACKGROUND: Communication is one of several important competencies in palliative care and found to be challenging. Developing appropriate communication skills in palliative care requires education and practice. To provide postgraduate palliative care nursing students with the required knowledge and experience, practical and active learning approaches, such as simulation-based learning, can be applied. Several studies have explored undergraduate nursing students' experiences with simulation-based learning in palliative care. However, to our knowledge no studies have explored postgraduate palliative care nursing students` experiences with simulation-based learning focusing on communication skills in palliative care education. DESIGN: An exploratory descriptive design. METHODS: A qualitative method was employed. Three focus group interviews were conducted in May 2022 using videoconferencing (Zoom) with 11 postgraduate palliative care nursing students, eight of whom wrote reflective notes. Data were analysed using systematic text condensation. RESULTS: Three categories were identified in the data analysis: 1) from uncertain expectations to the real experience of simulation-based learning; 2) being a skilled professional in everyday life versus being observed in the scenarios; and 3) the balance between self-confidence and challenges in experiencing professional development and mastery. CONCLUSIONS: Postgraduate palliative care nursing students seemed to experience anxiety towards simulation-based learning in palliative care education, as well as variable expectations for the approach. This could be due to their unfamiliarity with the learning method. The need for repetition was underlined and the students indicated that they would like to be able to participate in several simulation sessions to familiarise themselves with the approach. The contrast between being a skilled professional in everyday life and the pressure of being observed and judged in the scenarios was an important finding. Students outlined the desire to feel safe, but also highlighted the importance of being challenged to experience professional development and enhanced mastery. Generally, the findings indicate that academic and psychological safety should be a focus during simulation-based learning and instructors should understand that students may have varied learning strategies, divergent learning experiences and shifting beliefs in their own competencies.

Exploring the Impact of Virtual Reflection Groups on Advanced Practice Nurse Students During the COVID-19 Pandemic: Focus Group Study With Master's Students.

BACKGROUND: In the master's program of advanced practice nursing at a Norwegian university college, the learning activity reflection groups were converted into virtual reflection group (VRG) meetings during the COVID-19 pandemic. Regardless of the students' clinical practices in different hospitals, they could participate in the same VRG meeting on the web together with the educator from the university college, and the clinical supervisors were invited to participate. The students were in the process of developing the core competence required in their role as advanced practice nurses (APNs), and they had increased responsibility in the implementation of the VRG meetings. OBJECTIVE: In this study, we aimed to explore how master's students of advanced practice nursing experienced VRG meetings during the COVID-19 pandemic. METHODS: A qualitative exploratory design was adopted using focus group interviews. A group of students in the master's program of advanced practice nursing participated in an interview that lasted for 60 minutes. They had experienced participating in the VRG meetings following a rigorous guide during their clinical practice. The data from the focus group were analyzed using qualitative content analysis. RESULTS: The main findings of this study highlighted the importance of structure in VRG meetings, the role of increased responsibility in students' learning processes, the development of APN students' competencies, and increased professional collaboration with clinical supervisors. The APN students and clinical supervisors also continued their discussions in the clinical setting afterward, which strengthened the collaboration between students' education in the master's program and their clinical practice. CONCLUSIONS: VRG meetings gave the students the opportunity to lead professional discussions while reflecting thoroughly on the chosen patient cases from clinical practice. They experienced receiving feedback from fellow students, supervisors, and educators as stimulating their critical thinking development.

Technology-Supported Guidance Models Stimulating the Development of Critical Thinking in Clinical Practice: Mixed Methods Systematic Review.

BACKGROUND: Nursing education has increasingly focused on critical thinking among nursing students, as critical thinking is a desired outcome of nursing education. Particular attention is given to the potential of technological tools in guiding nursing students to stimulate the development of critical thinking; however, the general landscape, facilitators, and challenges of these guidance models remain unexplored, and no previous mixed methods systematic review on the subject has been identified. OBJECTIVE: This study aims to synthesize existing evidence on technology-supported guidance models used in nursing education to stimulate the development of critical thinking in nursing students in clinical practice. METHODS: This mixed methods systematic review adopted a convergent, integrated design to facilitate thematic synthesis. This study followed the guidelines of the Joanna Briggs Institute Manual for Evidence Synthesis. RESULTS: We identified 3 analytical themes: learning processes implemented to stimulate critical thinking, organization of the learning process to stimulate critical thinking, and factors influencing the perception of the learning process. We also identified 4 guidance models, all based on facilitator or preceptorship models using tailored instructional or learning strategies and one or several technological tools that were either generic or custom-made for specific outcomes. The main facilitators of these technology-supported guidance models were nurse educators or nurse preceptors, and the main challenges in using technology-supported guidance models were the stress associated with technical difficulties or increased cognitive load. CONCLUSIONS: Although we were able to identify 4 technology-supported guidance models, our results indicate a research gap regarding the use of these models in nursing education, with the specific aim of stimulating the development of critical thinking. Both nurse preceptors and nurse educators play a crucial role in the development of critical thinking among nursing students, and technology is essential for such development. However, technology-supported guidance models should be supervised to mitigate the associated stress. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/25126.

Brazilian undergraduate nursing students' critical thinking need to be increased: a cross-sectional study.

OBJECTIVES: to map Brazilian undergraduate nursing students' critical thinking level and investigate the correlation between selected sociodemographic data and critical thinking domains. METHODS: in this descriptive cross-sectional study, participants' (N=89) critical thinking was assessed using the Health Science Reasoning Test. Correlation between critical thinking domains and sociodemographic data was assessed using the Pearson correlation coefficient. RESULTS: the overall results showed a moderate level of participants' critical thinking (mean = 70.7; standard deviation 5.7). A poor performance was identified in 5 of the 8 critical thinking domains. A significant positive correlation was found between education period and critical thinking (p<.001). CONCLUSIONS: poor level in students critical thinking domains may lead to negative consequences for their learning outcomes. Further studies should be carried out to confirm our results, in addition to investigation of teaching methods that encourage and ensure the development of students' critical thinking skills during nursing education.

Simulation-Based Learning Supported by Technology to Enhance Critical Thinking in Nursing Students: Protocol for a Scoping Review.

BACKGROUND: Critical thinking is a crucial skill in the nursing profession, so teaching strategies and methodology must be carefully considered when training and preparing nursing students to think critically. Studies on simulation-based learning supported by technology are increasing in nursing education, but no scoping reviews have mapped the literature on simulation-based learning supported by technology to enhance critical thinking in nursing students. OBJECTIVE: The proposed scoping review aims to systematically map research on the use of simulation-based learning supported by technology to enhance critical thinking in nursing students. METHODS: The proposed scoping review will use the framework established by Arksey and O'Malley and will be reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. A systematic, comprehensive literature search was performed in the LILACS, ERIC, MEDLINE, EMBASE, PsycINFO, and Web of Science databases. Pairs of authors independently selected the articles by screening titles, abstracts, full-text papers, and extract data. The data will be analyzed and thematically categorized. RESULTS: The development of a comprehensive and systematic search strategy was completed in June 2021. The database searches were performed in July 2021, and the screening of titles and abstracts was completed in September 2021. Charting the data began in February 2022. Analysis and synthesis will be performed sequentially, and the scoping review is expected to be complete by May 2023. CONCLUSIONS: The results of this proposed scoping review may identify gaps in the literature and provide an overview of research on the topic of simulation-based learning supported by technology to enhance critical thinking in nursing students. The research may identify nursing students' reported barriers and enablers for learning critical thinking skills through simulation-based learning supported by technology, and the results may help educators enhance their educational approach through knowledge of students' firsthand experiences and further development of successful teaching strategies in nursing education. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/36725.

Technology-Supported Guidance Model to Support the Development of Critical Thinking Among Undergraduate Nursing Students in Clinical Practice: Protocol of an Exploratory, Flexible Mixed Methods Feasibility Study.

BACKGROUND: Critical thinking is an essential set of skills in nursing education, and nursing education therefore needs a sharper focus on effective ways to support the development of these skills, especially through the implementation of technological tools in nursing education. OBJECTIVE: The aim of this study protocol is to assess the feasibility of a technology-supported guidance model grounded in the metacognition theory for nursing students in clinical practice. METHODS: Both quantitative (research questionnaires) and qualitative (focus group interviews) approaches will be used to collect data for a feasibility study with an exploratory, flexible mixed methods design to test a newly developed intervention in clinical practice. RESULTS: The intervention development was completed in December 2020. The intervention will be tested in 3 independent nursing homes in Norway. CONCLUSIONS: By determining the feasibility of a technology-supported guidance model for nursing students in clinical practice, the results will provide information on the acceptability of the intervention and the suitability of the outcome measures and data collection strategy. They will also identify the causes of dropout and obstacles to retention and adherence. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/31646.

Florence Nightingale's theory and her contributions to holistic critical thinking in nursing.

OBJECTIVE: to reflect on Florence Nightingale's legacy and describe her contributions to critical holistic thinking in nursing. METHODS: this is a theoretical reflection, for which scientific productions on Florence Nightingale's environmental theory, as published in national and international journals, were based. RESULTS: Florence Nightingale's philosophy and teachings emphasize that the nurse must use her brain, heart and hands to create healing environments to care for the patient's body, mind and spirit. Nursing, since the time of Nightingale, has been building the holistic paradigm, in all schools of thought, with a view to a humanistic approach to the human being in their indivisible relationship with the environment. FINAL CONSIDERATIONS: Florence's contributions to holistic critical thinking in nursing are evident, constituting nurses' differential in clinical practice.