Design and Evaluation of Using Head-Mounted Virtual Reality for Learning Clinical Procedures: Mixed Methods Study.

BACKGROUND: The capacity of health care professionals to perform clinical procedures safely and competently is crucial as it will directly impact patients' outcomes. Given the ability of head-mounted virtual reality to simulate the authentic clinical environment, this platform should be suitable for nurses to refine their clinical skills for knowledge and skills acquisition. However, research on head-mounted virtual reality in learning clinical procedures is limited. OBJECTIVE: The objectives of this study were (1) to describe the design of a head-mounted virtual reality system and evaluate it for education on clinical procedures for nursing students and (2) to explore the experience of nursing students using head-mounted virtual reality for learning clinical procedures and the usability of the system. METHODS: This usability study used a mixed method approach. The stages included developing 3D models of the necessary instruments and materials used in intravenous therapy and subcutaneous injection procedures performed by nurses, followed by developing the procedures using the Unreal Engine (Epic Games). Questionnaires on the perception of continuance intention and the System Usability Scale were used along with open-ended questions. RESULTS: Twenty-nine nursing students took part in this questionnaire study after experiencing the immersive virtual reality (IVR) intervention. Participants reported largely favorable game perception and learning experience. Mean perception scores ranged from 3.21 to 4.38 of a maximum score of 5, while the mean system usability score was 53.53 of 100. The majority found that the IVR experience was engaging, and they were immersed in the game. The challenges encountered included unfamiliarity with the new learning format; technological constraints, such as using hand controllers; and physical discomfort. CONCLUSIONS: The conception of IVR for learning clinical procedures through deliberate practice to enhance nurses' knowledge and skills is promising. However, refinement of the prototypes is required to improve user experience and learning. Future research can explore other ways to use IVR for better education and health care purposes.

Mid-career switch nursing students' perceptions and experiences of using immersive virtual reality for clinical skills learning: A mixed methods study.

BACKGROUND: There has been an increase of mid-career professionals joining nursing. These adult students possess significant expertise in other areas and may benefit substantially in deliberate practice to acquire skills competency using immersive virtual reality (IVR) for clinical procedures before they practise in actual clinical settings. OBJECTIVES: This study aims to (1) examine the impact of IVR clinical procedures on mid-career switch students in knowledge, game perception and user reaction; (2) to explore the mid-career switch students' perceptions and experiences in using the IVR clinical procedures. DESIGN: A mixed methods feasibility study was used. SETTING AND PARTICIPANTS: This study was conducted at a university in Singapore with 34 first-year mid-career switch students. METHODS: This study is a single-group pre-test and post-test experimental study on learning clinical procedures using IVR in the home setting. The study took place from September to November 2021. Focus group discussions were conducted and analysed verbatim using thematic analysis. RESULTS: The students demonstrated significant improvement of knowledge for subcutaneous insulin, but overall, the increase in combined scores for both intravenous therapy and subcutaneous insulin were not statistically significant. Three overarching themes included: 1) Learning and practice, 2) Challenges and barriers, and 3) Personal attributes. Most of the participants found the experiences to be engaging, relevant, and satisfying. Some reported experiencing giddiness, headache, and lack of familiarity with technologies. CONCLUSIONS: IVR simulation can potentially be used as a supplementary learning tool to improve knowledge of clinical procedures in mid-career switch students.

Evaluation of a Theory-Based Virtual Counseling Application in Nursing Education.

Effective communication skills in nursing are necessary for high-quality nursing care, but given the decline in nursing students' attitudes and their low self-confidence in effective communication with patients, a participatory and experiential training method is needed. Therefore, a virtual counseling application was developed using artificial intelligence and a three-dimensional avatar to facilitate learning of communication skills. This study aimed to evaluate the effectiveness of this theory-based virtual intervention on nursing students' learning attitudes, communication self-efficacy, and clinical performance. A longitudinal quasi-experimental study was conducted. Ninety-three undergraduate nursing students received virtual patient trainings with four clinical scenarios over 2 years. Data were analyzed using McNemar test and analysis of variance. Virtual patient training improved students' learning attitudes toward communication skills for scenarios involving the pregnant woman (20.4%, P = .03) and depressed patient (17.1%, P = .01) and enhanced perceived self-efficacy for scenarios involving the pregnant woman (22.6%, P = .002) and stressed nursing student (18.3%, P = .002). Students received lower clinical communication scores for pediatric, obstetric, and medical practicums compared with a previous cohort who received no training. Overall, this virtual counseling application can provide a valuable and cost-effective communication learning resource for the nursing curriculum.

Navigating nursing curriculum change during COVID-19 pandemic: A systematic review and meta-synthesis.

AIM: To consolidate the evidence around the experiences of nursing undergraduates and faculty members navigating through remote and online education during the COVID-19 pandemic. BACKGROUND: The Coronavirus disease 2019 caused by the SARS-CoV-2 Virus (COVID-19) has placed massive pressure on healthcare, economic and education systems globally. Restrictive social distancing policies and public health measures necessitated educational institutions to switch from face-to-face to remote and online education to sustain the learning process. These changes have created an uncertain path and undue stress for healthcare learners and faculty, especially for professional roles that traditionally require more hands-on and access to clinical practice particularly pre-licensure nursing students. As such, there is an urgent need to consolidate evidence on the experiences of nursing undergraduates and faculty members as they navigate the rapid transition from face-to-face to remote and online education to ensure continuity of learning in achieving optimal learning outcomes and to support them during current and future public health crises. DESIGN: A systematic review and meta-synthesis of the qualitative literature was undertaken using Sandelowski and Barroso's approach. METHODS: Six electronic databases, CINAHL, Embase, ERIC, PsycINFO, PubMed and Scopus, were searched systematically using the eligibility criteria from December 2019 to September 2022. The Critical Appraisal Skills Program checklist for qualitative studies was used to conduct the critical appraisal of the selected articles. RESULTS: Forty-seven studies were included in this review, which encapsulates the experiences of 3052 undergraduates and 241 faculty members. An overarching meta-theme 'Remote and online education: a rollercoaster ride', emerged along with three main meta-themes: (1) Transition to remote and online education: A turbulent road, (2) Acceptance of the untravelled road, (3) Hopes and recommendations for the road ahead. CONCLUSION: To improve nursing undergraduates' and faculty member's navigation of remote and online education, more institutions should move towards establishing hybrid education as the new 'normal' and exercise prudence in the organisation and delivery of curriculum, teaching, well-being and clinical attachment contingencies of their healthcare courses.

Salutogenesis and COVID-19 pandemic impacting nursing education across SEANERN affiliated universities: A multi-national study.

BACKGROUND: The COVID-19 pandemic has disrupted the lives of many. Particularly, nursing students experience greater stress as their normal curriculum is interrupted and some of them face the risk of being infected as frontline workers. Nursing faculty members may face similar struggles, in addition to developing teaching materials for online learning. Thus, it is important to examine the faculty members' and students' views on their ability to adapt during the pandemic to obtain a holistic view of how learning and training has been affected. DESIGN: The descriptive cross-sectional quantitative design was used. SETTINGS: Data were collected from Southeast and East Asian Nursing Education and Research Network (SEANERN) affiliated nursing institutions from January 2021 to August 2021. PARTICIPANTS: A total of 1897 nursing students and 395 faculty members from SEANERN-affiliated nursing institutions in Cambodia, Hong Kong, Indonesia, Japan, Laos, Malaysia, Philippines, Singapore, Thailand and Vietnam were recruited for this study. METHODS: Quantitative surveys were used to explore the satisfaction levels in education modalities, confidence levels, psychosocial well-being, sense of coherence and stress levels of nursing students and faculty members during the COVID-19 pandemic. RESULTS: Participants were mostly satisfied with the new education modalities, although most students felt that their education was compromised. Both groups showed positive levels of psychosocial well-being, despite scoring low to medium on the sense of coherence scale and experiencing great stress. The participants' sense of coherence was positively correlated with their psychosocial well-being and negatively correlated with stress levels. CONCLUSIONS: While the COVID-19 pandemic had negatively impacted the lives of nursing students and faculty members, most of them had a healthy level of psychosocial well-being. Having a strong sense of coherence was associated with better psychosocial health and lower stress levels. As such, it may be helpful to develop interventions aimed at improving the sense of coherence of nursing students and staff to help them manage stressors better.

Nursing students' and faculty members' experiences of online education during COVID-19 across Southeast Asia: A Photovoice study.

BACKGROUND: The COVID-19 pandemic has caused extraordinary disruptions to education systems globally, forcing a rapid switch from conventional to online education. Although some qualitative studies have been carried out exploring the online education experiences of nursing students and faculty members during the COVID-19 pandemic, to our knowledge, no study has used the Photovoice approach. OBJECTIVES: To explore the experiences of nursing students and faculty members as related to online education during the COVID-19 pandemic. DESIGN: A descriptive qualitative design using Photovoice was adopted. SETTING: The study took place across five countries and one city in Southeast Asia (Indonesia, Malaysia, the Philippines, Thailand, Vietnam, and Hong Kong). PARTICIPANTS: Fifty-two nursing students and twenty-eight nursing faculty members who participated in online education during the COVID-19 pandemic. METHODS: Each participant submitted one photo substantiated with written reflections. Data were analysed using thematic analysis. Ethical approval was obtained from institution-specific ethics boards. RESULTS: Three themes and eleven sub-themes emerged from the data. The three main themes were: 1) Psychological roadblocks to online education; 2) Developing resilience despite adversities; and 3) Online education: What worked and what did not. CONCLUSION: Through Photovoice, the reflections revealed that nursing students and faculty members were generally overwhelmed with the online education experience. At the same time, participants were satisfied with the flexibility and convenience, opportunities for professional and personal development and safety afforded by online education. However, concerns over academic integrity, practical skills and clinical competencies, engagement and participation, the duality of technology and social isolation out-shadowed the advantages. It is worthwhile to explore the concerns raised to enhance online education across the nursing curriculum.

Translation of an evidence-based virtual reality simulation-based interprofessional education into health education curriculums: An implementation science method.

BACKGROUND: The development of interprofessional competencies through an evidence-based program is paramount to nurture a collaborative practice-ready workforce for patient-centered care and safety. AIMS: To describe an implementation science approach for translation of an evidence-based virtual reality simulation-based interprofessional education (VR-Sim-IPE) program into medical and nursing curriculums, and to evaluate the implementation outcomes. METHODS: Implementation strategies from the "Expert Recommendations for Implementing Change" were used to support implementation of the VR-Sim-IPE program. This included recruiting and training 28 practicing clinicians as facilitators to deliver the program to 599 medical and nursing students. Proctor's conceptual framework for implementation outcomes was applied with multiple data collection methods to evaluate the VR-Sim-IPE program. An online survey was administered to measure the levels of acceptability, appropriateness, feasibility, and adoption. Forty-four sessions of structured observations were carried out to examine the facilitators' implementation fidelity. Individual interviews were conducted with 15 facilitators to identify the facilitators and barriers to the program implementation. An implementation cost analysis was also conducted. RESULTS: Both facilitators and students had positive perceptions of the acceptability, adoption, appropriateness, and feasibility of the VR-Sim-IPE program. Facilitators were observed to implement the program with high fidelity, including program adherence, dosage, quality of delivery, and student responsiveness. While opportunities to contribute and learn, as well as receiving training and support, were identified as facilitators to implementation, the lack of familiarity with the virtual environment, varying levels of student participation, and facilitating interprofessional groups were reported barriers. The implementation costs amounted to USD45,648.50. CONCLUSION: The evaluation of implementation outcomes identifies strategies for future implementation that could potentially enhance program acceptance, reduce implementation cost, improve penetration, and achieve program sustainability. These include increasing facilitation group size, preparing students to be active participants, and incorporating interprofessional facilitation skills in facilitators' training.

A web-based clinical pedagogy program to promote professional development for nurse preceptors: A quasi-experimental study.

OBJECTIVE: To examine the effectiveness of a web-based clinical pedagogy program on nurse preceptors' clinical teaching competency, self-efficacy, and attitudes toward web-based learning in comparison to face-to-face course. BACKGROUND: Preceptorship is a dynamic educational process that requires designing, and implementing various teaching strategies, evaluation, assessment and feedback. Web-based learning has been recognized as an effective learning approach for nursing professional development. DESIGN: A prospective quasi-experimental approach with two-group pre-test and post-test repeated measures was adopted. METHODS: The web-based clinical pedagogy program was provided to the preceptors in the experimental group, while control group received the face-to-face preceptorship course. Clinical Teaching Competence Inventory (CTCI), Preceptor Self-efficacy Assessment Instrument (PSEQ), and Attitudes toward Web-based Continuing Learning Survey (AWCLS) were used to evaluate preceptors' learning outcomes. Data were collected at three time points - before, immediately after the learning program, and after 6 months of the clinical teaching experience. RESULTS: A total of 150 nurses (75 participants/group) were recruited from a tertiary hospital in Singapore from July 2018 to June 2020. The results from the repeated measures analysis of covariance showed that there was a significant interaction effect (group x time) on the overall CTCI score after adjusting for covariate (F = 5.390, p = 0.005). However, there were no significant interaction effect (group x time) on PSEQ (F = 2.693, p = 0.070) and overall AWCLS score (F = 1.341, p = 0.264) between the two groups across the three time points. CONCLUSION: The web-based clinical pedagogy program produced outcomes comparable to the face-to-face program in terms of preceptors' clinical teaching competence and self-efficacy. The innovative and cost-effective web-based clinical pedagogy program provided professional development and the flexibility to accommodate preceptors' busy work schedules. Online learning has become increasingly popular during the COVID-19 pandemic and the web-based clinical pedagogy program was implemented when face-to-face workshop was not feasible.

Coaching interventions among healthcare students in tertiary education to improve mental well-being: A mixed studies review.

OBJECTIVES: To consolidate the available evidence regarding healthcare students' experiences of coaching interventions' effect on their mental well-being in tertiary educational institutions. DESIGN: A mixed studies review. DATA SOURCES: Seven electronic databases were searched for relevant studies from their inception dates until July 2021: PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus and ProQuest Dissertations and Theses Global. REVIEW METHODS: This review observed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and was guided by Pluye and Hong's (2014) framework for mixed studies review. Quality appraisal of included studies was conducted using the Mixed Methods Appraisal Tool. A convergent qualitative synthesis design for mixed studies reviews was adopted to analyze all findings and thematic analysis was conducted according to Braun and Clarke's (2006) framework. RESULTS: Three themes and seven subthemes are generated from the 12 included studies. The main themes are: 1) Receiving much-needed help, 2) Unlocking the secrets of success, and 3) Way forward for coaching in healthcare education. CONCLUSIONS: Many students benefited from the coaching interventions in terms of academic, emotional and psychological support and received guidance in professional development. However, careful preparation of both coaches and students is needed to improve the success of coaching interventions. Future coaching interventions could incorporate both group and individual sessions, assign students to coaches based on their clinical interests and consider conducting online coaching sessions using video calls. Improvement of study rigor would be required to achieve more accurate results. Lastly, future studies should be conducted on healthcare students of more diverse disciplines and cultures to increase results' generalizability.

Perspectives of nurse preceptors on a web-based clinical pedagogy program and clinical teaching: A descriptive qualitative study.

Nurse preceptors are key stakeholders in providing quality clinical education. This study aimed to explore the perspectives of nurse preceptors on a web-based clinical pedagogy program and clinical teaching. A descriptive qualitative design was adopted. The program was made accessible to the nurse preceptors who were assigned nursing students from July 2019 to June 2020. Upon completion of clinical teaching, a total of 19 nurse preceptors participated in four focus group discussions. The discussions were audio recorded and transcribed verbatim, and thematic analysis was conducted. Five themes, with 11 subthemes, emerged: (i) Undergoing the process of self-awareness and development; (ii) Mastering newly acquired skills to refine own teaching approach; (iii) Implementing consistent evaluation and constructive feedback; (iv) Dual roles and responsibilities of preceptor; and (v) Benefits and barriers of the program. This study highlighted the knowledge and skills preceptors gained through the program which gave them newfound confidence and facilitated their clinical teaching and evaluation. As the shift towards online learning progresses, web-based learning can be a useful platform for professional development of nurse preceptors.

Learning styles, preferences and needs of generation Z healthcare students: Scoping review.

AIM: This scoping review aimed to consolidate evidence of the learning styles, preferences and needs of Generation (Gen) Z healthcare students. BACKGROUND: It is essential to update the educational framework and pedagogy to meet each generation's distinct learning styles and preferences. DESIGN: A scoping review of published and unpublished data. METHODS: Six electronic databases (PubMed, Embase, CINAHL, PsycINFO, ProQuest and Scopus) were searched for studies written in English from June 2016 to July 2021. The Arksey and O'Malley (2005) five-stage framework was adopted to guide this review: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; and (5) collating, summarising and reporting the results using a thematic analysis. RESULTS: Seventeen studies were included and based on the thematic analysis, four themes were identified: (1) attributes of Gen Z healthcare students; (2) learning styles of Gen Z healthcare students; (3) learning preferences and needs of Gen Z healthcare students; and (4) teaching the Gen Z healthcare students: future directions and recommendations for educators. The findings implied more culturally diverse studies that adopt the mixed-methods or qualitative design are needed to capture deeper insights about Gen Z and in examining the effectiveness of technology integration and digital storytelling to boost students' learning and confidence in their future careers. CONCLUSIONS: Technology, campus resources and self-care strategies must be carefully integrated and planned to ensure an optimal and a safe learning environment for the students. The specific preferences and needs of the unique healthcare disciplines and educational subjects could be examined. A theory-based framework could be considered in designing future pedagogy. These future directions could allow educators to initiate vital change agents in guiding, supporting and nurturing students across generations.

To Volunteer or Not? Perspectives towards Pre-Registered Nursing Students Volunteering Frontline during COVID-19 Pandemic to Ease Healthcare Workforce: A Qualitative Study.

COVID-19 has caused a shortage of healthcare workers and has strained healthcare systems globally. Pre-registered healthcare students with training have a duty of care and can support the healthcare workforce. This study explored factors influencing the willingness of final-year nursing students to volunteer during the COVID-19 pandemic, the role of professional identity in volunteering as healthcare workers, and strategies to improve future volunteering uptakes and processes. A qualitative study using focus-group discussions was conducted. Final-year nursing students who volunteered, students who did not volunteer, and lecturers who supervised student volunteers were recruited. Interviews were conducted online, video-recorded, and transcribed verbatim. A thematic analysis was used. The themes were "wavering thoughts on volunteering", "bringing out 'the nurse' in students through volunteering" and "gearing up to volunteer". Findings suggested the need to look beyond the simplicity of altruism to the role of professional identity, operational, and motivational factors to explain nursing students' decision to volunteer and their volunteer behavior. Providing accommodation, monetary and academic-related incentives, supporting the transitionary phase from students to "professional volunteers", promoting cohesive and positive staff-student volunteer relationships, and establishing a volunteer management team are strategies identified to improve volunteering uptake and operational processes. Our findings advocate strategic partnerships between hospitals/communities and academic institutions in providing various healthcare services during pandemics.

Effectiveness of simulation-based interventions at improving empathy among healthcare students: A systematic review and meta-analysis.

OBJECTIVE: To examine the effectiveness of simulation-based interventions in improving empathy among healthcare students. DESIGN: A systematic review and meta-analysis of randomized controlled trials and clinical controlled trials. DATA SOURCES: Studies in English language were sourced from seven electronic databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus and ProQuest Dissertations & Theses Global) from their respective inception dates until October 2020. REVIEW METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random-effect meta-analyses were conducted. Heterogeneity was assessed using the I2 statistics and Cochran's Q chi-squared test. Quality appraisal was conducted using the Cochrane risk of bias tool and the Grades of Recommendation, Assessment, Development, and Evaluation approach. Publication bias was assessed using funnel plots. RESULTS: Sixteen studies were included in this review. Meta-analysis reported statistically significant small, medium and very large effect sizes for empathy reported by healthcare students (SMD = 0.46, 95% CI: 0.25 to 0.66), simulated patients (SMD = 0.65, 95% CI: 0.41 to 0.89) and other personnel (independent observers, faculty members and examiners) (SMD = 1.27, 95% CI: 0.64 to 1.90) respectively, showing the effectiveness of simulation-based interventions in improving empathy among healthcare students. Subgroup analyses found that role-play was more effective than simulated patient and disease-state simulations. Multi-sessional interventions conducted for up to seven months and group-based simulation delivery were found to be more effective. CONCLUSION: Educational institutions should conduct regular simulation-based interventions to continuously develop healthcare students' empathy during their academic journey. Future trials should involve students from more diverse healthcare disciplines. Empathy should be measured in a standardized manner and rely less on self-reported measures. Role-play segments and group-based simulations could be added to increase interventions' effectiveness. Studies should conduct longer follow-up assessments to determine the sustainability of students' empathy following intervention. Future research is needed to corroborate the current findings.

Entrustable professional activity assessment tool for clinical procedures: A psychometric study.

AIM AND OBJECTIVE: To test the psychometric properties of the entrustable professional activity assessment tool for clinical procedures to be administered to clinical trainers and students. BACKGROUND: Students' ability to perform clinical procedures professionally and safely is a key concern for healthcare educators. The assessment of professional activities, in which entrustment is a key outcome, is crucial for determining the level of training and supervision of work-based assessments. The entrustable professional activities for clinical procedures (EPA-CP) have been used among clinical trainers, but it needs more psychometric testing. DESIGN: The psychometric study used a cross-sectional design. METHODS: Students' self-assessment (n = 302) and the supervisors' ratings on the students' performance in clinical procedures (n = 266) were used to evaluate the psychometric properties of the six-item EPA-CP assessment tool. Internal consistency and test-retest reliabilities of the assessment tool were examined. Convergent, known-groups, analysis of structural validity were conducted to investigate the tool's construct and factorial structure. The STROBE checklist for cross-sectional studies was followed. RESULTS: The EPA-CP assessment tool demonstrated good reliability, satisfactory convergent validity and significant differences in the known-group comparison. The exploratory factor and confirmatory factor analyses indicated the cogent constructs of the assessment tool when administered to students and their supervisors. CONCLUSION: The EPA-CP assessment tool is a valid, reliable and user-friendly tool for evaluating healthcare students' capability to perform clinical procedures. This tool makes it possible for the precise assessment of learners in performing procedures in busy and dynamic clinical settings. RELEVANCE TO CLINICAL PRACTICE: Reliable instruments are needed to effectively assess healthcare students' ability to perform clinical procedures and enable trainers to entrust students with the tasks. The results indicate that the EPA-CP assessment is promising and may be used in the healthcare settings.

Achieving healthy ageing through the perspective of sense of coherence among senior-only households: a qualitative study.

Objectives: Explore perceptions towards healthy ageing through the perspective of sense of coherence among older adults residing in senior-only households.Methods: A qualitative study using focus group interviews was conducted and appreciative inquiry was adopted as a strengths-based interviewing approach. 27 older adults who either live alone or with their spouses only were involved in six focus group discussions at a community centre in Singapore. Data saturation was achieved and thematic analysis was performed to analyse the data.Results: The four emerging themes were (1) contending evolving vulnerabilities, (2) intrinsic value of health, (3) taking care of oneself is a personal responsibility, and (4) taking one day at a time: outlook towards later part of life. Older adults' underlying pathogenic orientation towards health contributed to their perceived unpredictable confrontations with vicissitudes including illness and death. This played a part to their short outlook towards old age. Consequently, this could limit their will and abilities to seek meaningful pursuits or valued aspirations and movement towards the salutogenic health pole.Conclusion: By reframing the definition of health to pursuing and fulfilling valued accomplishments, optimal health can be achieved regardless of physical health state. This study suggested that sense of coherence towards the pursuit of healthy ageing can be addressed by reducing the unpredictability of ageing-related processes and vulnerabilities (comprehensibility), supporting active adoption of actions which promotes physical, mental and social health (manageability) and individual reflection in making sense of old age to seek motivation in living each day purposefully (meaningfulness).

Supporting the mobilization of health assets among older community dwellers residing in senior-only households in Singapore: a qualitative study.

BACKGROUND: Care activities provided by community health practitioners for older adults primarily focused on disease prevention and management. However, healthy longevity can go beyond disease prevention and management and promote greater well-being by tapping into the accrual of resources that older adults possess using the salutogenic approach. This study explored how health resources are used among older adults who are residing in senior-only households to promote and maintain health, with the intent of providing insights into how community health practitioners can support these older adults via asset-based strategies. METHODS: We adopted a descriptive qualitative study design using focus group discussions. Twenty-seven older adults who either lived alone or with their spouses were purposively sampled from an elderly populated residential estate in Singapore. Six focus group discussions, conducted from December 2016 to May 2017, were audio-recorded, transcribed, and analyzed using thematic analysis. RESULTS: The themes that emerged were 'tapping on internal self-care repository', 'maintaining and preserving informal social support', and 'enabling self by using environmental aids', and an eco-map of aging assets was used to capture an overview of internal and external resources. With the repository of personal strengths, knowledge, and experiences, these older adults were generally resourceful in navigating around their resource-rich environments to cope with everyday life stressors and promote health. However, they were occasionally limited by individual factors that affected their comprehension, access, maintenance, and utilization of resources. CONCLUSION: The eco-map of aging assets can be used as an assessment framework by community health practitioners to recognize, consider, and build a repertoire of resources among these older adults. It serves as a gentle reminder to adopt an ecological approach in considering and tapping into older adults' wide-ranging personal, social, and environmental resources. Community health practitioners can support resource integration as resource facilitators via cognitive, behavioral, and motivational salutogenic pathways to overcome resource mobilization barriers faced by older adults. Such an approach helps older adults to find their internal capabilities and abilities to know who, where, what, and how to seek external resources to identify solutions, creating the intrinsic value to sustain their actions on resource utility.

Evaluation of Psychometric Properties of Professional Quality of Life Scale Among Nurses in Singapore.

BACKGROUND AND PURPOSE: Nurses experience compassion fatigue (CF), depression, burnout (BO), and even signs of post-traumatic stress disorder. This study aimed to evaluate the psychometric properties of the Professional Quality of Life Scale (ProQOL) among nurses in the Southeast Asia context. METHODS: Psychometric testing of interitem correlations and reliability, and both convergent and discriminant validity, as well as construct validity analyses was conducted among 1,338 nurses from two academic centers in Singapore. RESULTS: Findings demonstrated significant interconstruct correlations among the three subscales of ProQOL, namely compassion satisfaction (CS), BO, and secondary traumatic stress (STS). ProQOL displayed satisfactory internal consistency and discriminant validity. CONCLUSIONS: Psychometric properties of the CS component were found to be satisfactory. ProQOL may be integrated into strategies in supporting and improving nurses' QoL which could focus to lessen BO and CF at work, as well as improving individual satisfaction in the care of patients.