Social determinants of health and their relation to suboptimal health status in the context of 3PM: a latent profile analysis.

Background: Suboptimal health is identified as a reversible phase occurring before chronic diseases manifest, emphasizing the significance of early detection and intervention in predictive, preventive, and personalized medicine (PPPM/3PM). While the biological and genetic factors associated with suboptimal health have received considerable attention, the influence of social determinants of health (SDH) remains relatively understudied. By comprehensively understanding the SDH influencing suboptimal health, healthcare providers can tailor interventions to address individual needs, improving health outcomes and facilitating the transition to optimal well-being. This study aimed to identify distinct profiles within SDH indicators and examine their association with suboptimal health status. Method: This cross-sectional study was conducted from June 16 to September 23, 2023, in five regions of China. Various SDH indicators, such as family health, economic status, eHealth literacy, mental disorder, social support, health behavior, and sleep quality, were examined in this study. Latent profile analysis was employed to identify distinct profiles based on these SDH indicators. Logistic regression analysis by profile was used to investigate the association between these profiles and suboptimal health status. Results: The analysis included 4918 individuals. Latent profile analysis revealed three distinct profiles (prevalence): the Adversely Burdened Vulnerability Group (37.6%), the Adversity-Driven Struggle Group (11.7%), and the Advantaged Resilience Group (50.7%). These profiles exhibited significant differences in suboptimal health status (p < 0.001). The Adversely Burdened Vulnerability Group had the highest risk of suboptimal health, followed by the Adversity-Driven Struggle Group, while the Advantaged Resilience Group had the lowest risk. Conclusions and relevance: Distinct profiles based on SDH indicators are associated with suboptimal health status. Healthcare providers should integrate SDH assessment into routine clinical practice to customize interventions and address specific needs. This study reveals that the group with the highest risk of suboptimal health stands out as the youngest among all the groups, underscoring the critical importance of early intervention and targeted prevention strategies within the framework of 3PM. Tailored interventions for the Adversely Burdened Vulnerability Group should focus on economic opportunities, healthcare access, healthy food options, and social support. Leveraging their higher eHealth literacy and resourcefulness, interventions empower the Adversity-Driven Struggle Group. By addressing healthcare utilization, substance use, and social support, targeted interventions effectively reduce suboptimal health risks and improve well-being in vulnerable populations. Supplementary Information: The online version contains supplementary material available at 10.1007/s13167-024-00365-5.

The effects of simulation-based education on undergraduate nursing students' competences: a multicenter randomized controlled trial.

BACKGROUND: Education in nursing has noticed a positive effect of simulation-based education. There are many studies available on the effects of simulation-based education, but most of those involve a single institution, nonrandomized controlled trials, small sample sizes and subjective evaluations of the effects. The purpose of this multicenter randomized controlled trial was to evaluate the effects of high-fidelity simulation, computer-based simulation, high-fidelity simulation combined with computer-based simulation, and case study on undergraduate nursing students. METHODS: A total of 270 nursing students were recruited from five universities in China. Participants were randomly divided into four groups at each institution: the high-fidelity simulation group, the computer-based simulation group, the high-fidelity simulation combined with computer-based simulation group, and the case study group. Finally, 239 participants completed the intervention and evaluation, with 58, 67, 57, and 57 participants in each group. The data were collected at three stages: before the intervention, immediately after the intervention, and three months after the intervention. RESULTS: The demographic data and baseline evaluation indices did not significantly differ among the four groups. A statistically significant difference was not observed between the four methods for improving knowledge, interprofessional collaboration, critical thinking, caring, or interest in learning. While skill improvement differed significantly among the different groups after the intervention (p = 0.020), after three months, no difference was observed (p = 0.139). The improvement in skill in the computer-based simulation group was significantly lower at the end of the intervention than that in the high-fidelity simulation group (p = 0.048) or the high-fidelity simulation combined with computer-based simulation group (p = 0.020). CONCLUSIONS: Nursing students benefit equally from four methods in cultivating their knowledge, interprofessional collaboration, critical thinking, caring, and interest in learning both immediately and over time. High-fidelity simulation and high-fidelity simulation combined with computer-based simulation improve skill more effectively than computer-based simulation in the short term. Nursing educators can select the most suitable teaching method to achieve the intended learning outcomes depending on the specific circumstances. TRIAL REGISTRATION: This clinical trial was registered at the Chinese Clinical Trial Registry (clinical trial number: ChiCTR2400084880, date of the registration: 27/05/2024).

The effect of family health on suboptimal health status: The parallel mediation role of sleep quality and health behaviour.

Background: The prevalence of suboptimal health status has been increasing worldwide, posing a significant challenge to public health. Meanwhile, family health has been recognised as an important factor influencing individual health outcomes. However, the mechanisms through which family health affects suboptimal health status remain unclear. We aimed to investigate the parallel mediation role of sleep quality and health behaviour in the relationship between family health and suboptimal health status. Methods: We conducted a cross-sectional online survey with a sample of adults >18 years old from four provinces in China. The survey questionnaires queried their demographic characteristics, family health, suboptimal health status, sleep quality, and health behaviour. We assessed family health by the Family Health Scale-Short Form and suboptimal health status using the Suboptimal Health Status Questionnaire. We employed structural equation modelling to analyse the data and test the proposed mediation model. Results: we collected 4918 valid questionnaires. The mean age of the participants was 30.1 years (standard deviation = 12.5). The correlation analysis demonstrated a significant negative association between family health and suboptimal health status (r = -0.44; P < 0.001). The results of the parallel mediation analysis showed that family health had a significant indirect effect on suboptimal health status through both sleep quality (ß = -0.350; P < 0.001) and health behaviour (ß = -0.137; P < 0.001). The total indirect effect of family health on suboptimal health status through both sleep quality and health behaviour was also significant (ß = -0.569, P < 0.001). Conclusions: This study highlights the significance of family health as a predictor of suboptimal health status and suggests that sleep quality and health behaviour are parallel mediators in this relationship. By understanding the role of family health, sleep quality, and health behaviour, interventions can be targeted to improve overall health outcomes.

Chinese version of Yoon Critical Thinking Disposition Instrument: validation using classical test theory and Rasch analysis.

BACKGROUND: Despite the availability of a wide range of critical thinking instruments, there was no original design for nurses that has been translated into Chinese. However, only instruments designed specifically for the nursing discipline would be reliable. This study aimed to translate, culturally adapt, and validate the Yoon Critical Thinking Disposition Instrument in the Chinese context. METHODS: A four-step translation process was implemented according to Word Health Organization guidelines, which included forward translation, expert panel review, backward translation, and pre-testing. Experts and nursing students participated in testing the validity and reliability of the Chinese version. RESULTS: The translation of the instrument went smoothly. According to a confirmatory factor analysis, there was an acceptable fit for the seven-factor model. Content validity indices ranged from 0.6 to 1 at item level, and 0.94 at scale level. In addition, there was extremely high internal consistency and test-retest reliability in the translated instrument. There was a good fit for the items with both person and item reliabilities greater than 0.6 and a separation index of 2.19, respectively. The item location was identified from the wright map as not covering person ability, but the scale did not have a gender-related differential item functioning. CONCLUSIONS: In this study, a critical thinking disposition instrument for nursing students was translated into Chinese for the first time. This translated instrument is a reliable tool with satisfactory validity and reliability. It could provide opportunities for building a cross-cultural understanding of critical thinking disposition.

The mediating effect of critical thinking between interest in learning and caring among nursing students: a cross-sectional study.

BACKGROUND: Previous studies have explored the influence of interest in learning on caring and critical thinking, as well as the relationship between caring and critical thinking. However, the mediating effect of critical thinking in interest learning and caring among nursing students has not been clarified. METHODS: Nursing students who enrolled for the 2021/2022 academic year in diploma, undergraduate, or graduate programs in five provinces of China (Guangdong, Sichuan, Jiangsu, Hunan and Macao). An online survey with a convenience sampling method was employed to collect data. The questionnaires were administered to 692 participants between January 20 and 26, 2022. Amos 26.0 was employed to establish the structural equation modelling and analyze the mediating effect of critical thinking on interest in learning and caring. RESULTS: The first regression equation showed that interest in learning significantly influenced caring (ß = 0.339, p <  0.001). The third regression equation showed that critical thinking significantly influenced caring (ß = 0.494, p <  0.001). The effect of interest in learning on caring was less in the third equation than in the first equation (ß = 0.154 vs ß = 0.339), which indicates partial mediation. Furthermore, interest in learning had an indirect positive effect (ß = 0.186, p <  0.001) on caring mediated by critical thinking, with 95% confidence interval of 0.142 to 0.233. CONCLUSIONS: Critical thinking was a significant mediator of the relationship between interest in learning and caring. It is suggested that nursing colleges and instructors should take into account students' interest in learning and critical thinking as potential intervention elements to enhance caring.

Impact of scenario validity and group size on learning outcomes in high-fidelity simulation: A systematics review and meta-analysis.

OBJECTIVES: To determine the effects related to scenario validity and group size in high-fidelity simulation among undergraduate nursing students. DESIGN: A systematic review and meta-analysis of randomized controlled trials and quasi-experiment. DATA SOURCES: Embase, PubMed, Web of Science, Wangfang database, and Cochrane Library, China National Knowledge Infrastructure were searched from the start of each database to February 22, 2022. The references and citations lists were manually screened to find additional references. REVIEW METHODS: Screening and quality assessment of the retrieved studies were conducted independently by two authors. Discussions with a third author sorted out any discrepancies between the two authors. Using meta-analysis procedures based on a random-effect model, outcome data were synthesized and standard mean difference was computed with a 95 % confidence interval. RESULTS: Thirty-three studies were included. A total 4077 undergraduate nursing students were recruited, of which 2068 participated in experimental groups. High-fidelity simulation with scenario validity was better than high-fidelity simulation without scenario validity in cultivating undergraduate nursing students' knowledge (p = 0.03), and they were equivalent in improving students' skills (p = 0.75). Groups of six or fewer students in each high-fidelity simulation tend to be more effective at promoting knowledge (standard mean difference = 0.98) and skill (standard mean difference = 1.00), but the differences were not statistically significant. CONCLUSIONS: High-fidelity simulation with scenario validity and with less than six students in each group can be more effective in cultivating knowledge and skills among undergraduate nursing students. For high-fidelity simulation to be as effective as possible, nursing instructors should ensure scenario validity and limit the number of students in each group to under six.

Prebriefing for high-fidelity simulation in nursing education: A meta-analysis.

BACKGROUND: Briefing, scenario development, and debriefing of high-fidelity simulation (HFS) have been widely discussed in the past, but less attention is given to prebriefing, and its role in learning outcomes. The prebriefing engages students and equips them with the knowledge and skills they need for a successful simulation. OBJECTIVES: To identify the effectiveness of prebriefing of HFS in Bachelor of Science in Nursing (BSN) students. DESIGN: A meta-analysis of randomized controlled trials and quasi-experiment. DATA SOURCES: The Web of Science, PubMed, Embase, Cochrane Library, WANFANG, and CNKI were for randomized controlled and quasi-experimental studies published in English or Chinese up to June 26, 2022. REVIEW METHODS: Two authors independently screened the literature, extracted data and evaluated the quality of the included studies. The standardized mean difference with a 95 % confidence interval was used to facilitate direct comparisons between studies. All statistical tests were conducted with Review Manager 5.4 software. RESULTS: This meta-analysis included 17 randomized controlled studies and 25 quasi-experimental studies involving 4926 BSN students. No significant differences in knowledge (p = 0.58), skill (p = 0.67), satisfaction (p = 0.84), critical thinking (p = 0.56), caring (p = 0.11), learning interest (p = 0.85), and self-confidence (p = 0.21) between HFS with and without prebriefing were found in subgroup analyses. HFS with prebriefing generated larger effect for collaboration (0.82 vs 0.27, p = 0.004). CONCLUSION: HFS with prebriefing facilitates collaboration of BSN students more effectively, and it has an equivalent effect to HFS without prebriefing on fostering BSN students' knowledge, skills, critical thinking, caring, learning interest, and self-confidence.

High-fidelity simulation duration and learning outcomes among undergraduate nursing students: A systematic review and meta-analysis.

OBJECTIVES: To explore the effects of different lengths of the three key steps (prebriefing, simulation, and debriefing) of high-fidelity simulation (HFS) on the knowledge and skills of undergraduate nursing students. DESIGN: A systematic review and meta-analysis. DATA SOURCES: A systematic search was conducted for Chinese and English publications from the Web of Science, PubMed, Embase, Cochrane, and two Chinese databases (Wanfang and CNKI) up to November 24, 2021. REVIEW METHODS: Two independent raters screened the retrieved studies and extracted data based on a coding protocol from the studies that met the inclusion criteria. Data were synthesized using meta-analytic procedures based on a random-effect model and computing effect sizes by standard mean differences (SMD) with a 95% confidence interval (CI). RESULTS: Forty-four studies were included, and 23 studies were analyzed. High-fidelity simulation (HFS) with debriefing of 10 min or less (SMD = 1.18), simulation of 15-20 min (SMD = 1.43), and debriefing of 11-30 min (SMD = 1.19) showed larger effect sizes for knowledge, while HFS with debriefing of >10 min (SMD = 0.91), simulation of 15 min or less (SMD = 0.89), and over 30 min of debriefing cultivation (SMD = 0.84) showed larger effect sizes for skill. CONCLUSIONS: During the prebriefing, simulation, and debriefing, shorter sessions are more effective for improving knowledge in BSN students, whereas longer sessions are most effective for improving skills in BSN students. Nurse educators can schedule HFS to meet the expectations of learning outcomes based on the actual situation.

High-fidelity simulation in undergraduate nursing education: A meta-analysis.

OBJECTIVES: To explore the effectiveness of high-fidelity simulation (HFS) in undergraduate nursing education. DESIGN: A meta-analysis of randomized controlled trials and quasi-experiment. DATA SOURCES: Web of Science, PubMed, Embase, Cochrane Library, WANFANG, and CNKI were searched for eligible articles published in English and Chinese until May 28, 2021. REVIEW METHODS: The Quality Appraisal Check-list for Quantitative Intervention Studies was applied to the quality evaluation. Standard mean differences (SMD) were pooled using a random effects model. The results of the individual and combined intervention effects estimation of was displayed in a forest plot, with weight, SMD, its corresponding 95% confidence interval (CI), Z-test, p, I2. RESULTS: Thirty-eight studies were included and 37 were analyzed. High-fidelity simulation (HFS) revealed significantly larger effect sizes for knowledge (SMD = 0.89, 95% CI [0.54 to 1.23]), skill (SMD = 0.93, 95% CI [0.69 to 1.17]), collaboration (SMD = 0.52, 95% CI [0.26 to 0.78]), caring (SMD = 1.40, 95% CI [0.23 to 2.58]) and learning interest (SMD = 0.85, 95% CI [0.00 to 2.04]) when compared with other teaching methods. However, no significant difference between HFS and other teaching methods in critical thinking (SMD = 0.46, 95% CI [-1.12 to 1.58]), self-confidence (SMD = 0.22, 95% CI [-0.32 to 0.75]) and learning satisfaction (SMD = 0.58, 95% CI [-0.25 to 1.41]) was shown. CONCLUSIONS: High-fidelity simulation (HFS) can more effectively cultivate knowledge, skills, collaboration, caring, and learning interest of undergraduate nursing students. Since the effect of HFS is equivalent to other teaching methods in cultivating undergraduate nursing students' critical thinking, self-confidence and learning satisfaction, nursing educators can choose the most appropriate methods to achieve the intended learning outcomes according to the actual situation.

Nursing students' perception of high-fidelity simulation activity instead of clinical placement: A qualitative study.

BACKGROUND: The high-fidelity simulation (HFS) has been utilized in nursing education for more than 20 years. Advantages of the use of high-fidelity simulation in nursing education have been documented in the literature. Based on the advantages, it has been arranged as a part of the clinical study course of the first year baccalaureate nursing program in one of the nursing colleges in Macau recently. OBJECTIVE: The aim of this study is to explore undergraduate nursing students' perception of using high-fidelity simulation as part of their clinical study course in Macau. DESIGN: This is a qualitative study using open-ended questionnaire. SETTING: This study was implemented at the nursing laboratory between 1 April and 17 April 2015, which was the period of preliminary clinical study course of year one nursing students. PARTICIPANTS: A purposive sample was sought from the voluntary year one undergraduate nursing students who participated in the clinical study course. METHODS: Students received two high-fidelity simulation sections during the course, while a self-administered open-ended questionnaire was allocated afterward. Qualitative content analysis was performed after data collection. RESULTS: Two themes emerged in this study, which included "appreciation" and "misunderstanding". They were further divided into five categories; as "positive feelings", "gaining a suitable atmosphere for learning", "assist of adequate emergency preparation: resourceful ability", "contempt", and "rote learning". CONCLUSION: This was the first time to utilize HFS activities as a part of the clinical study course in one nursing college in Macau. These HFS activities instead of a part of real clinical placement were appreciated by nursing students. And it mainly contributed to the resourceful ability in students' view. During the HFS activities, nursing educators should consider the misunderstanding of HFS activities of students that a few nursing students despised simulator's life and got rote learning method.