Improving malignant fungating wound management among oncology nurses: a best practice implementation project.

INTRODUCTION: Appropriate malignant fungating wound (MFW) care is challenging for oncology nurses, leading to increased stress, compromised care quality, and poor patient outcomes. OBJECTIVE: This study aimed to address best practice barriers and develop evidence-based guidelines for MFW care. METHODS: This project was guided by the JBI Evidence Implementation Framework, which follows a seven-phase process. Both nurses' skills and patient charts were audited to determine compliance with best practices for comprehensive MFW assessment, wound photo records, use of validated wound assessment tools, appropriate wound care, and patient pain and satisfaction. Bandura's social learning theory was used to guide the development of an online education program and an objective structured clinical examination for skill improvement to prompt behavior change in nurses. A follow-up audit was conducted to measure improvements in knowledge, skills, and self-efficacy among nurses to validate the effectiveness of the intervention. RESULTS: The project resulted in improvements in all four evidence-based practice criteria: (1) comprehensive MFW assessments increased from 27% to 98%; (2) the inclusion of wound photos in medical records increased from 50% to 100%; (3) use of a validated wound assessment tool increased from 0% to 100%; and (4) appropriate interventions to manage wounds and maintain patients' quality of life increased from 50% to 90%. CONCLUSIONS: The project integrated a flexible education program, multidisciplinary collaboration, and leadership support to empower nurses to effectively manage MFWs. In addition, Bandura's social learning theory was used to influence nurses' behavior and bring about sustainable changes to organizational culture and practices. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A205.

Effects of early warm water sitz bath on urinary retention and pain after haemorrhoidectomy: A randomized controlled trial.

BACKGROUND: Haemorrhoids are a common chronic anorectal disease, and haemorrhoidectomy is the standard treatment for advanced (grade III and IV) haemorrhoids. Warm water sitz has commonly been used to stimulate urination, cleanse wounds, and decrease pain. Although urinary retention and pain usually occur within the first 24 h after surgery, the warm water sitz bath is provided 24 h after haemorrhoidectomy, which might be a missed opportunity to optimize the quality and efficiency of the care provided. OBJECTIVE: To investigate the effect of early warm water sitz bath on the day of haemorrhoidectomy surgery on preventing urinary retention and reducing wound pain. DESIGN: This was a longitudinal double-blind study with a permuted block randomization design. SETTING(S): This study was conducted in a surgical ward of a medical center. An average of 18 patients receiving hemorrhoid surgery in that ward every month. PARTICIPANTS: A total of 64 participants (32 each in the experimental and control groups) were enrolled. (The first recruitment date is January 16, 2020.) METHODS: Patients who received haemorrhoidectomy for grade III or IV haemorrhoids from January to December 2020 were enrolled. The experimental and control groups received the same conventional treatment and care before the haemorrhoidectomy. The experimental group started warm-water sitz bath 6 h after the surgery, and the control group started warm water sitz bath on post-haemorrhoidectomy day 1 as usual. Urinary retention was defined as use of Foley catheter during the hospital stay or remaining urine volume ≧ 300 ml using the bladder scan. A numerical rating scale was used to rate the pain level. Each participant was evaluated 6 times in total until hospital discharge. The data were analysed by descriptive statistics, chi-square test, and independent samples t test. Generalized estimating equations and intention to treat were used to identify changes in urinary retention and pain over time and missing data, respectively. RESULTS: There was no significant difference in the degree of change in the number of people with urinary retention between groups. A change in the wound pain index was noted; the study group had a statistically significant lower pain score than the control group (B = -0.81, 95 % CI: -1.44 to -0.18). CONCLUSIONS: Early warm water sitz bath was a safe and effective strategy to decrease post-haemorrhoidectomy pain, but not urinary retention. Nurses could provide early warm water sitz bath for post-haemorrhoidectomy patients' comfort. REGISTRATION: ClinicalTrials.gov ID: NCT04535765.

Using "board games" to improve the effectiveness of extracorporeal membrane oxygenation care for nurses in intensive care unit.

AIM: The purpose of this study was to evaluate the effectiveness of ECMO care board games facilitated teaching approach (ECMO care board games) in enhancing ECMO care knowledge, clinical reasoning and learning engagement among intensive care unit (ICU) nurses. BACKGROUND: ECMO is a highly complex, relatively low-incidence, high-risk clinical life support device system used in the intensive care unit (ICU). Its usage has increased nearly tenfold over the past 30 years. Traditionally, ECMO education has been delivered through classroom teaching, which has demonstrated limited effectiveness in promoting nurses' learning engagement, clinical reasoning competency and confidence. The literature suggests that well-designed board games can enhance learning engagement, stimulate higher-level thinking and improve the effectiveness and confidence of nurses' learning. DESIGN: A quasi-experimental study two-group repeated measure design. METHODS: A purposive sample of 73 ICU nurses from two campuses of one medical center was recruited (37 in the experimental group and 36 in the control group). The experimental group received ECMO care training through ECMO care board games facilitated teaching approach, whereas the control group completed the training through a traditional teaching approach. Instruments used for data collection include a demographic information sheet, ECMO Care Knowledge Scale, Clinical Reasoning Scale (Huang et al., 2023) and Learning Engagement Scale (Ciou , 2020). Both groups completed a pre-test before the training, a post-test one week after the training and a second post-test three weeks after the training. RESULTS: Prior to the intervention, there were no significant differences between the two groups in ECMO care knowledge and learning engagement. However, there was a significant difference in clinical reasoning. One week after the intervention, the experimental group demonstrated significantly higher scores in ECMO care knowledge, clinical reasoning and learning engagement than the control group (p <0.01). Three weeks after the intervention, the experimental group showed significantly higher scores in ECMO care knowledge, clinical reasoning and learning engagement (p <0.001). CONCLUSIONS: The content for ECMO care is complex and difficult. Board games can enhance ECMO care knowledge, clinical reasoning and learning engagement. This teaching strategy may be applied to learning challenging subjects in the future to improve learning effectiveness. The clinical reasoning framework is conducive to guiding nurses' learning. In future continuing education, board games designed based on the clinical reasoning framework and tailored to the focus of in-service education can effectively enhance nurses' learning effectiveness.

Nursing students' critical thinking and associated factors in Vietnam: A multicenter cross-sectional study.

AIMS: This study aimed to evaluate the critical thinking abilities of senior nursing students in Vietnam and determine factors associated with their critical thinking disposition and skills. BACKGROUND: Assessing critical thinking competence is crucial for determining senior nursing students' preparedness for entering the healthcare workforce and can be used to examine current nursing education's ability to cultivate nursing students' critical thinking. However, little research was found on critical thinking among Vietnamese nursing students. DESIGN: A multicenter cross-sectional research design. METHODS: A convenience sample of 533 senior nursing students from six universities in Vietnam participated in this study. All participants completed the online questionnaires, including basic information, a subscale of the Motivated Strategy for Learning Questionnaire (MSLQ), Critical Thinking Disposition Scale (CTDS), and Critical Thinking Self-Assessment Scale (CTSAS). RESULTS: The mean score for the CTDS was 42.81 (standard deviation (SD) = 5.29), while the mean score for the CTSAS was 168.29 (SD = 44.43). Results of the multiple linear-regression analysis showed that an increase in self-study hours per day (B = 0.41, p = 0.007), higher self-efficacy in learning and performance (B = 0.26, p < 0.001), and a more-supportive environment (B = 0.97, p < 0.001) were predictors of critical thinking disposition. Moreover, an increase in self-study hours per day (B = 4.09, p = 0.001), higher self-efficacy in learning and performance (B = 2.65, p < 0.001), a more-supportive environment (B = 7.74, p < 0.001), and more experience with research (B = 7.03, p = 0.03) were predictors of critical thinking skills. CONCLUSIONS: This study revealed that senior nursing students in Vietnam possess a moderate level of critical thinking abilities. Those students who dedicate more hours to self-study, demonstrate higher self-efficacy in learning and performance, experience a supportive environment, and engage in more research activities exhibit better critical thinking disposition and skills. The findings highlight the ongoing need to enhance critical thinking disposition and skills of nursing students in Vietnam. It is suggested that nursing faculty members should develop the appropriate strategies to improve nursing students' critical thinking disposition and skills.

Assertive communication training for nurses to speak up in cases of medical errors: A systematic review and meta-analysis.

BACKGROUND: Several authors have previously assessed the effects of assertive communication training for nurses to speak up in cases of medical errors. Inconsistent results regarding the nurses' attitudes, behaviors, and confidence levels were noticed. OBJECTIVE: To identify the effectiveness of assertive communication training on nurses' behaviors, attitudes, and confidence levels for speaking up in cases of medical errors and to identify vital components for success. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, ERIC, Embase, Scopus, and CINAHL were searched up for studies published from the inception of the database to December 16, 2022. METHODS: Two researchers independently performed a primary screening of titles and abstracts for relevant studies, followed by a review of full texts if the references met inclusion criteria and quality assessment. Data were retrieved for nurses and nursing students who received medical error-related assertive communication training for speaking up, and learning outcomes for attitudes, behaviors, and confidence levels were reported based on pooled data. Pooled estimates were calculated using a random-effects model. RESULTS: A total of eleven studies with 1299 participants were included in systematic review, and among them nine studies with 804 participants were analyzed in meta-analysis. From the pooled results, the intervention group, which received assertive communication training, exhibited substantially improved speaking-up behaviors compared with the control group (SMD = 0.58; 95 % CI, 0.14-1.03). Considerable differences were noted in the nurses' times of speaking up in cases of medical errors between pretest (38 %; 95 % CI, 0.14-0.68) and posttest (78 %; 95 %CI, 0.70-0.85) based on the pooled data. The nurses' attitudes and confidence levels for speaking up varied markedly between pretest and posttest. CONCLUSION: Structured assertive communication training may improve nurses' speaking-up behaviors in cases of medical errors. To conduct effective assertive communication training, nursing educators should incorporate multiple teaching approaches into structured training and ensure an adequate training duration.

Association between lifestyle-related, psychosocial factors and obesity among female adolescents in Taiwan.

PURPOSE: To examine a wide range of potential contributors to the risk of obesity in female adolescents. DESIGN AND METHODS: Data for this study were collected using a cross-sectional design. A group of 175 female adolescents were recruited, and information on their demographic characteristics, lifestyle-related behaviors, and psychosocial factors was collected using a self-administered questionnaire during September 2018 to January 2019. Data were analyzed using SPSS 24.0. RESULTS: An overestimation of body weight was negatively correlated with overweight in the female adolescents. Age at menarche was negatively correlated with the arisk of overweight. Adolescents who slept for >7 h on weekend nights were less likely to be overweight. Eating more cheese, fish, seafood, and organ meats was negatively correlated with obesity risk. The female adolescents were more likely to become overweight if they ate dinners prepared by family and experienced more disturbances from parents and other family members. CONCLUSIONS: Female adolescents are a unique population affected by obesity. Although incorporating both lifestyle-related behavioral and psychosocial factors in future investigations and developing multicomponent interventions for obesity prevention are crucial, female adolescents should receive the utmost attention from researchers to alleviate the health burden of obesity. PRACTICE IMPLICATIONS: The intertwined nature of obesity-related factors warrants future investigations to elaborate their roles interplaying with the risk of obesity. Multicomponent interventions should be developed, and nurses and health-care providers should target their efforts on obesity prevention for this specific population.

Prevalence of depressive symptoms and associated factors among foreign caregivers: A cross-sectional study.

AIM: To understand the prevalence of depressive symptoms among foreign caregivers and the associated factors. DESIGN: A cross-sectional study. METHODS: Data from 178 Indonesian foreign caregivers, selected based on convenience and snowball sampling in Taiwan, were collected between July 2019 and February 2020 using questionnaires. Stepwise multiple linear regression was used to identify the factors associated with depressive symptoms. RESULTS: Approximately 30.3% of the foreign caregivers displayed depressive symptoms. The symptoms were more prevalent among the participants who were younger; had more social support; shared a bed with others; and experienced higher work-related stress, more loneliness and physical discomfort. The findings suggest that nurses or nurse practitioners visiting patients at home should not only deliver care for them but also show concern for the psychological well-being of the foreign caregivers of these patients. Moreover, interventions should be developed to alleviate or prevent the emergence of depressive symptoms among foreign caregivers.

Fatigue following type 2 diabetes: Psychometric testing of the Indonesian version of the multidimensional fatigue Inventory-20 and unmet fatigue-related needs.

Patients with type 2 diabetes mellitus (T2DM) often experience fatigue. The Multidimensional Fatigue Inventory (MFI-20) is a valid tool for evaluating fatigue; however, its psychometric properties have not been examined in Indonesian-speaking patients with T2DM. This study assessed the psychometric properties of the Indonesian version of the Multidimensional Fatigue Inventory-20 (IMFI-20) in patients with T2DM and investigated fatigue in a health-care setting. A cross-sectional design was adopted. Two hundred patients with T2DM were interviewed in clinics. Five self-structured measures were used to assess the frequency and duration of fatigue and the health-care utilization of patients with fatigue. Cronbach's alpha and intraclass correlation (ICC) were used to evaluate the internal consistency and test-retest reliability of the Indonesian version of the MFI-20 (IMFI-20). The criterion, convergent, and known-group validity of the IMFI-20 were also examined, and its underlying structure was determined using explanatory factor analysis. The STROBE checklist was used. The results revealed that approximately half of the patients experienced fatigue. Among those with fatigue, 62% reported that their fatigue was rarely or never treated by their physicians. The IMFI-20 exhibited satisfactory model fit, excellent internal consistency (Cronbach's alpha of 0.92), and test-retest ICC of 0.93. The IMFI-20 was significantly associated with the Functional Assessment of Chronic Illness Therapy-Fatigue, Beck Depression Inventory-Second Edition, and Pittsburgh Sleep Quality Index (r = 0.705, 0.670, and 0.581, respectively). The IMFI-20 exhibited known-group validity for unfavorable sleep quality and HbA1C ≥ 6.5%. Our findings suggest that patients with T2DM who experience fatigue are often overlooked by health-care providers, and that the IMFI-20, which exhibits excellent psychometric properties, can be adopted by studies that use fatigue as an endpoint in Indonesian-speaking populations.

Newly graduated nurses' stress, coping, professional identity and work locus of control: Results of a cross-sectional study in Shanghai, Hong Kong and Taipei.

AIM: The study aimed to explore and compare stress, coping, professional identity and work locus of control of new graduate nurses among Shanghai, Hong Kong and Taipei. BACKGROUND: The transition from a student to a staff nurse role is recognized as a stressful experience and can be a rough journey. Many newly graduated nurses find it challenging to cope with their new roles in their first few months. METHODS: A cross-sectional research was used in the study. This study was completed in Shanghai, Hong Kong and Taipei with newly graduated nurses working in hospitals. A total of 591 graduate nurses who had worked within 1 year in hospitals were recruited using convenient sampling. Data were collected using a structured questionnaire, including demographics, the occupational stress scale, the Chinese trait coping style questionnaire, the nurse professional identity scale and the work locus of control scale (Chinese version). RESULTS: The newly graduated nurses in Shanghai had significantly lower (p < 0.05) work stress score (2.65 ± 0.67) compared with their counterparts in Hong Kong (2.99 ± 0.69) and Taipei (2.94 ± 0.60). Newly graduated nurses in Shanghai tended to choose positive coping to deal with stressful situations, whereas those in Hong Kong would be more likely to adopt negative attitudes (p < 0.05). The newly graduated nurses in Taipei had the lowest level of professional identity (3.25 ± 0.55, p < 0.05), and their work control tended to be external (46.13 ± 6.20). In contrast, those in Shanghai (52.75 ± 6.04) and Hong Kong (59.41 ± 7.29) tended to be controlled internally. CONCLUSIONS: The study findings revealed the differences among newly graduated nurses in Shanghai, Hong Kong and Taipei with their level of stress, coping, professional identity and work locus of control. Proper leadership, mentoring for newly graduated nurses, and emphasis on first aid nursing training, emotional management and management of stress in newly graduated nurse transition programmes were suggested. IMPLICATIONS FOR NURSING MANAGEMENT: By comparing the results in the three regions, we recommend that nursing managers promote the right leadership style. In addition to coaching, nursing managers can assign additional mentors to newly graduated nurses to help them supplement their clinical knowledge and skills with psychological support. These mentors can come from senior nurses or nursing managers working on less demanding tasks. In addition to the existing post transfer training programmes, new graduate nurses should also focus on emergency nursing training, emotional management training and stress management training.

Effects of board game play on nursing students' medication knowledge: A randomized controlled trial.

AIM: This study aimed to examine the effectiveness of an educational board game in improving nursing students' medication knowledge. BACKGROUND: Maintaining patient safety is a core practice for nurses. Medication management is a central principle of patient safety. Nurses acquire pharmacology knowledge and medication safety skills in the classroom training. Thus, solidifying and strengthening nursing students' medication knowledge are crucial tasks for nursing faculty members. In recent years, board games, which offer both entertainment and competitive play, have been employed to educate students in a variety of disciplines and settings. Through board game play, students can learn in an enjoyable and fun atmosphere. DESIGN: A randomized controlled trial design. METHODS: A convenience sample of 69 nursing students was obtained from a university in Taiwan. Participants were randomly assigned either to an experimental (board game) group (n = 35) or a comparison group (n = 34) using block randomization. The experimental group engaged in board game play to learn about medications, whereas the comparison group attended a one-hour didactic lecture. Using questionnaires, data were collected before the intervention, immediately post intervention and one month post intervention. RESULTS: Following the intervention, regardless of the learning method, both groups showed significant improvements in their immediate recall of medication information. However, when retested after one month, the experimental group obtained significantly higher scores than the comparison group. Moreover, students in the experimental group reported more satisfaction with the learning method than those in the comparison group. CONCLUSIONS: The study results suggest that learning through board games could enhance nursing students' retention of knowledge. Students reported favorable reactions to using a board game learning method for increasing knowledge of medication. With respect to this finding, faculty members may consider employing board games as teaching tools in nursing and other health science courses. Moreover, the findings of this study can also provide additional information for nursing managers in hospital wards or long-term care facilities where nurses are trained to familiarize themselves with frequently administered medications. TWEETABLE ABSTRACT: Board game play can enhance nursing students' retention of knowledge; students reported positive reactions to game-based learning for medication training.

Prevalence of Loneliness and Associated Factors among Community-Dwelling Older Adults in Indonesia: A Cross-Sectional Study.

Loneliness has become one of the most common psychological problems experienced by older adults. Previous studies have indicated that loneliness is correlated with poor physical and psychological health outcomes; therefore, it is important to pay attention to people experiencing loneliness. However, there is a lack of information regarding the prevalence of loneliness, and its associated factors, among community-dwelling older adults in Indonesia, which this study aimed to understand. This study used a cross-sectional, descriptive, and correlational research design. Stratified random sampling was applied to 1360 participants, aged ≥ 60 years, in 15 community health centers in Kendari City, Indonesia. The following questionnaires were used to collect data, including demographic and characteristic information, Short Portable Mental Status Questionnaire, Multidimensional Scale of Perceived Social Support, Geriatric Depression Scale Short Form, and a single-item loneliness question. The prevalence of loneliness among older adults was 64.0%. The multivariate logistic regression showed that older adults who were female, lived with family, had fewer children, had a poor health status, had a poor oral status, had more chronic diseases, had no hearing problems, had poor cognitive function, and had depression had a higher chance of feeling lonely. Loneliness is a serious health issue among the older population in Indonesia. The government, social workers, and healthcare professionals should pay immediate attention to this psychological problem. The study also suggests that appropriate strategies for the prevention of loneliness should be developed in the near future.

Older residents' perceptions of loneliness in long-term care facilities: A qualitative study.

Loneliness is a negative emotional feeling often experienced by older residents in long-term care facilities (LTCFs). Previous studies have shown that loneliness is related to depression, inferior quality of life, cardiovascular disease, and suicidal thoughts. Thus, it is important to understand older residents' viewpoints about loneliness to provide better care in the long-term care context. This study aimed to explore residents' perceptions of loneliness in LTCFs. For this qualitative research, data were collected from two LTCFs in northern Taiwan, and purposive sampling was used. In-depth interviews with 16 older residents were conducted using a semi-structured interview guide. Content analysis was performed to analyse the data. Four themes with nine subthemes were generated. The themes were: being cut off from continually meaningful relationships, experiencing tears of pain, feeling alone, and lacking a sense of belonging. The findings of this study can provide information for health care professionals to better understand older residents' views on loneliness and remind them to re-examine care protocols for psychological health care. Thus, this study found that in order to prevent or alleviate older residents' feelings of loneliness, the LTCFs should maintain continually meaningful relationships, accompany them, and give them a sense of belonging. The consolidated criteria for reporting qualitative research (COREQ) guidelines were used to report this study.

Effects of daily sedation interruption in intensive care unit patients undergoing mechanical ventilation: A meta-analysis of randomized controlled trials.

AIM: This study aimed to assess the effects of daily sedation interruption on the mechanical ventilation duration and relevant outcomes in mechanically ventilated patients in the intensive care unit (ICU). BACKGROUND: Previously, three meta-analyses on the association of daily sedation interruption with the mechanical ventilation duration have reported conflicting findings, and these did not support current guideline recommendations that daily sedation interruption can be routinely used in mechanically ventilated adult ICU patients. DESIGN: This was a systematic review and meta-analysis of randomized controlled studies. DATA SOURCES: Data were from PubMed, Embase, Cochrane Library, CINAHL, ProQuest dissertation and theses, Airiti Library, China National Knowledge Infrastructure, Wanfang Data Chinese, Science Direct and PsycINFO databases. REVIEW METHODS: Two reviewers independently assessed, extracted and appraised the included studies. Then, pooled estimates were calculated using a random-effects model. RESULTS: In total, 45 studies involving 5493 participants were included. Compared with controls, daily sedation interruption significantly reduced the mechanical ventilation duration, ICU stay length, sedation duration, and tracheostomy and ventilator-associated pneumonia risks (all p ≤ 0.001). Moreover, the Acute Physiology and Chronic Health Evaluation II score and study quality were significant moderators. CONCLUSION: Daily sedation interruption could substantially reduce the duration of mechanical ventilation, particularly when it was applied to patients with high disease severity.

Validation of the prophylactic efficacy of urea-based creams on sorafenib-induced hand-foot skin reaction in patients with advanced hepatocellular carcinoma: A randomised experiment study.

BACKGROUND: Hand-foot skin reaction may influence the effectiveness of patients' treatment, patient quality of life, and the economics of health care. An effective prophylactic dermatological cream for preventing sorafenib-induced hand-foot skin reaction (HFSR) is yet to be identified. AIM: The aim of this study is validated the prophylactic efficacy of urea-based creams on sorafenib-induced hand-foot skin reaction in patients with advanced hepatocellular carcinoma. METHODS: This was a randomised double-blind experimental study. A total of 129 patients with advanced HCC were randomly assigned to three groups. The comparison group received best supportive care (BSC), group A received BSC plus a moisturising cream, and group B received BSC plus a 10% urea-based cream. Incidence of HFSR and cutaneous wetness were assessed 3 days before starting sorafenib and each week after starting sorafenib for 8 weeks. RESULTS: No significant difference was observed in the incidence density of sorafenib-induced HFSK (comparison group/A group, p > .05; comparison group/B group, p > .05). Group B reported significantly better cutaneous wetness of hands in the seventh week after starting sorafenib (p < .05) and of feet during the first 6 weeks (p < .05-.001). CONCLUSION: This study found a nut size amount of a 10% urea-based cream applied twice a day can maintain patients' cutaneous wetness in the first 6 weeks after starting sorafenib than moisturising-alone cream. But it cannot reduce the occurrence of HFSR. Thus, the result supports nut-size dose of the 10% urea-based cream three times a day may be an appropriate dose to prevent HFSR. Clinical Trail Registration Number: NCT04568330.

Types of medication administration errors and comparisons among nursing graduands in Indonesia, Taiwan, and Thailand: A cross-sectional observational study.

BACKGROUND: Despite medication administration safety having been introduced, practiced, and examined in nursing schools for many years, errors are commonly reported among new nurses. Understanding medication errors that nursing graduands might commit is essential for patient safety and fostering collaboration among neighboring countries. OBJECTIVES: To assess and compare types of medication administration errors identified by nursing graduands in Asian countries using a medication errors scenario. DESIGN: A cross-sectional observational study. SETTINGS: One university four-year nursing program each in Indonesia, Taiwan, and Thailand. PARTICIPANTS: A total of 145 baccalaureate nursing graduands in their last semester, including 42 from Indonesia, 35 from Taiwan, and 68 from Thailand. METHODS: The medication errors scenario contained 11 errors. The faculty examiner directly observed and graded the graduands' performance in identifying medication errors using an objective structured medication administration checklist. Descriptive and inferential analyses were used. RESULTS: Overall, 4.4 ± 1.8 errors on average were identified in the medication errors scenario. The most common types of errors differed among the three countries. More than half of the graduands did not check the patient's wristband (n = 75; 51.7%) or discovered the wrong name on it (n = 88; 60.7%). Giving medication without an indication (n = 129; 89.0%) and giving medication with potential for an allergic reaction (n = 111; 76.6%) were the most common errors. CONCLUSIONS: Medication administration errors are common in nursing graduands. Specific types and various frequencies of errors were noted across three countries. Nursing faculties should investigate possible reasons for common types of errors and develop effective education strategies for graduands to prevent errors. Collaboration among neighboring countries is encouraged to improve overall global medication safety.

The effects of an immersive 3d interactive video program on improving student nurses' nursing skill competence: A randomized controlled trial study.

BACKGROUND AND OBJECTIVE: Acquired accurate clinical nursing skills are among the most important core nursing competencies for nursing students, as nursing students' inadequate skill capacities might endanger patients safety. Therefore, it is essential to develop teaching strategies to strengthen students' nursing skills. This study examined the effects of an immersive three-dimensional (3D) interactive video program on improving nursing students' nasogastric tube feeding skill competence. DESIGN: A randomized controlled trial research design. SETTINGS AND PARTICIPANTS: Forty-five nursing students from a university in northern Taiwan. METHODS: The students were randomly assigned to an intervention group (n = 22) and a comparison group (n = 23). The intervention group received the immersive 3D interactive video program on nasogastric tube feeding, whereas the comparison group watched a regular demonstration video. The questionnaire was used to collect data before the intervention, immediately after the intervention, and one month after the intervention. RESULTS: Nursing students' knowledge and confidence in nasogastric tube feeding were significantly improved after the intervention in both groups. Although there were no significant differences in students' knowledge, skill, and confidence between the two groups, participants' average satisfaction score with the immersive 3D interactive video program in the intervention group was significantly higher than in the comparison group that watched a regular video (t = 2.302, p = 0.026). CONCLUSIONS: The findings of this study showed that both immersive 3D interactive video program and regular demonstration video could improve nursing students' learning outcomes. The higher satisfaction score in the intervention group indicates that learning through immersive 3D interactive video is acceptable and satisfactory. This study provides useful information for nursing faculty members for designing and developing teaching methods for the acquisition of nursing skills. It can also serve as a reference for further studies relating to AR, VR, or immersive learning materials.

Develop and validate family nurse practitioner transition program in Taiwan by using modified Delphi method.

BACKGROUND: Previous studies have shown that family nurse practitioners (FNPs) provide an important contribution to health promotion and disease management in primary care. Nevertheless, the position of FNP does not exist in Taiwan. In Taiwan, the leading cause of most disability and death is diabetes, for which an FNP has great potential to fulfill healthcare needs. Therefore, establishing how to cultivate competent FNPs is an important issue. It is feasible to train current acute care nurse practitioners (NPs) to become FNPs through enrollment in a transition program. OBJECTIVES: The purpose of this study is to develop an FNP transition program, including the necessary competencies and curriculum. DESIGN: A modified Delphi method (use of an expert panel) is used to validate the preliminary curriculum of an FNP transition program. SETTINGS: The Delph method conducted through email and physical meetings. PARTICIPANTS: Four expert panel groups involve in this project with different group has its own mission. Totally, there were 14 experts completed the transition program. METHODS: A modified Delphi method was used to validate the competencies and curriculum. Descriptive data analysis was used to evaluate the target consensus of 80%. RESULTS: This study provided the first FNP transition program design in Taiwan, based on the global literature and a local gap analysis. CONCLUSIONS: Nursing faculty, healthcare delivery system administration leaders, and policymakers can use the curriculum to train current NPs to become competent FNPs to provide optimal quality of care in the community.

Effects and safety of body positioning on back pain after transcatheter arterial chemoembolization in people with hepatocellular carcinoma: A randomized controlled study.

BACKGROUND: People with hepatocellular carcinoma who undergo transcatheter arterial chemoembolization usually experience back pain due to lie supine for at least 4 hours to avoid bleeding and hematoma. Body positioning is an effective and safe method for decreasing back pain in people with transfemoral cardiac catheterization; however, its effects and safety among patients with high bleeding tendency are unknown. OBJECTIVE: To investigate whether body positioning could decrease back pain without increasing the chance of bleeding after transcatheter arterial chemoembolization. DESIGN: A single-blind randomized controlled trial (ClinicalTrials.gov No.: NCT03784469). METHODS: A total of 78 people with liver cancer who had undergone chemoembolization through the femoral artery were enrolled. Each person was randomly assigned to either the control or intervention group (each consisted of 39 participants). The control group received the usual care, remaining flat and lying in a supine position, whereas the intervention group had their positions changed in the second and fourth hour after chemoembolization. Participants' pain level was rated by using numerical rating scale -11 (score from 0 to 10), bleeding was measured by using volume of blood (cc.) in gauze and hematoma size in diameter (cm), and satisfaction was self-rated from 1 to 5. Repeated-measure analysis of variance (ANOVA) was used to compare the difference in pain levels over time within each group and independent t test to compare the mean difference of pain between groups at 5 endpoints, both methods with Bonferroni adjustment. Independent t test, chi-squared test, and Fisher's exact test compared postembolization discomfort, puncture sites bleeding, satisfaction between groups. RESULTS: Significant changes of pain levels over time in both intervention [F(2.93, 111.20)=7.64, p<.001] and control groups [F(2.66, 101.17)=20.55, p<.001]. The intervention group had a significantly lower mean pain score in the second hour (t = -2.838, p = .006) and fourth hour (t = -4.739, p < .001) when patients turning to the side than did the control group lying supine. Furthermore, patients in the intervention group had significantly higher satisfaction than did those in the control group (t = -2.422, p = .018). No hematoma and significant difference of post-procedural bleeding between groups. CONCLUSION: Changing patients' body positions in bed after transcatheter arterial chemoembolization is a safe and effective method of decreasing back pain, and increasing patients' satisfaction, without increasing the complications of bleeding and hematoma. Clinicians should change the positions of people with hepatocellular carcinoma 2 hours after they receive transcatheter arterial chemoembolization.

Comparison of the effects of simulation training and problem-based scenarios on the improvement of graduating nursing students to speak up about medication errors: A quasi-experimental study.

BACKGROUND: Medication administration errors are common among new nurses. Nursing students might be less willing to speak up about errors because of a lack of knowledge and experience. OBJECTIVES: To examine the effects of simulation training and problem-based scenarios on speaking up about medication errors among graduating nursing students. DESIGN: Prospective, controlled experimental study design. SETTING: A university four-year nursing program in Taiwan. PARTICIPANTS: In total, 93 graduating nursing students in their last semester were recruited. Sixty-six students who received both a problem-based scenario and medication administration simulation training comprised the experimental group, while 27 students who received problem-based scenarios alone comprised the control group. METHODS: Experimental group students underwent 2 h of simulation training. This training class was designed based on Kolb's experiential learning theory for knowledge development and speaking up about errors. Students in both groups administered medications in problem-based scenarios with eight embedded errors. Students' performance in speaking up about medication errors was directly observed and graded using an objective structured checklist. The McNeamer Chi-squared test, paired t-test, Z test, t-test, and Hedges' g effect size were conducted. RESULTS: The number of times participants spoke up about medication errors significantly improved in both the experimental group (pre-test: 2.05 ± 1.12 and post-test 6.14 ± 1.25, t = 22.85, p<0.001) and control group (pretest: 2.04 ± 1.16 and post-test: 4.26 ± 1.63, t = 6.33, p<0.001). However, after the intervention, the mean number of times participants spoke up about medication errors in the experimental group was significantly higher than that in the control group (t = 5.99, p<0.001) in the post-test. CONCLUSIONS: Simulation training exhibited more-significant improvements than problem-based scenarios. Nursing schools and hospitals should incorporate simulation training or at least problem-based scenarios to improve medication safety.