The self-assessment of clinical competence and the need for further training: A cross-sectional survey of advanced practice nursing students.

AIMS AND OBJECTIVES: (a) To describe and analyse advanced practice nursing students' self-assessment of their clinical competence and need for further training and (b) to analyse the possible predictive variables in their self-assessment. BACKGROUND: The self-assessment of clinical competence in nursing education is important for identifying professional development and educational needs to improve patient care. DESIGN: A cross-sectional survey following STROBE guidelines was used. METHODS: Ninety-nine students from three universities/university colleges in Norway participated in the study, and data were collected using a revised version of the Professional Nurse Self-Assessment Scale II. Descriptive, correlation and regression analyses were performed. RESULTS: The students gave the highest self-assessment ratings for their clinical competence in taking full responsibility and for their need for further training in medication effects and interactions. Although the students gave themselves low ratings for the use of electronic devices, they assessed their need for further training in this area as average. Clinical work experience as a registered nurse and previous higher education level were not significant predictors of clinical competence nor the need for further training. CONCLUSION: The findings indicate that self-assessment is appropriate for students in advanced practice nursing programmes. This study implies that programmes in advanced practice nursing need to familiarise students with the possibilities of information technology. It questions the entry requirement that stipulates that prospective students must have several years of clinical work experience as registered nurses before entering advanced practice nursing programmes. These programmes need to communicate that competencies other than direct clinical practice are also needed for students' future roles. RELEVANCE TO CLINICAL PRACTICE: The study contributes to the exploration of how students self-assess own clinical competence and need for further training in advanced practice nursing programmes. Further research should evaluate the development of clinical competence.

Older People's Attitudes And Perspectives Of Welfare Technology In Norway.

BACKGROUND: In Norway, as in other European countries, the ageing population is increasing rapidly. Governments seek to enable older people stay in their homes for as long as possible, and welfare technology (WT) has been proposed as a possible solution. Human behaviour modelling (HBM) is a welfare technology that identifies an individual's behaviour patterns and detects abnormal behaviours, including falls and early signs of dementia. However, the successful development of HBM WT requires the consideration of the older people's attitudes on this. AIM: The present study sought to explore attitudes and perspectives about welfare technology among older people living alone in Norway. METHODS: We used an exploratory, qualitative approach in which semi-structured, in-depth interviews were conducted with five women and four men between the ages of 79 and 91. The interviews were analysed using qualitative content analysis. RESULTS: Two categories and four subcategories were identified: 1) preferences and concerns of welfare technology (i) feeling confident-proactive approach of future technology, (ii) concerns and dilemmas, and 2) reflections of today and tomorrow- awareness of own health (i) feeling healthy, independent, self-sufficient and safe, (ii) facing own ageing- preparedness on unpredictable scenarios. The main theme, welfare technology - a valuable addition to tomorrow's homes, represents how the participants held positive and proactive attitudes towards the use of WT in their homes. CONCLUSION: Participants trusted the Norwegian healthcare system and did not rely on their families for care. Independence, autonomy, and feeling safe were essential for all participants, and most participants regarded welfare technology as empowering them to remain in their homes for as long as possible. Participants already confidently used various technologies in their daily lives. Surprisingly, they expressed no concerns about privacy, but some mention concerns about loss of autonomy and dignity. We conclude that a person-centred approach to integrating new WT is necessary.

The Objective Structured Clinical Examination in evolving nurse practitioner education: A study of students' and examiners' experiences.

Assessment of advanced clinical competence is essential for safe practice and achieving international standards for nurse practitioners. It is of particular interest for countries that have recently been introduced to advanced nursing roles to investigate examination forms that ensure quality in nurse practitioner education. The aim of this study was to explore and describe the nurse practitioner students' and examiners' experiences with Objective Structured Clinical Examination, which is an exam form for assessing clinical competence. Five focus groups, consisting of 15 nurse practitioner students (n = 15) and five individual interviews with examiners (n = 5), were conducted in June 2016 and analysed using thematic analysis. The nurse practitioner students and examiners experienced the exam as an appropriate method of assessment for advanced clinical competence, although they experienced some challenges with its form. Consequently, the results of this study advocate for a course design that includes: constructive alignment between the course and the exam, more training with real patients, use of formative and summative assessment and a second exam with a real patient after the student's clinical placement. The lack of a clear nurse practitioner role in countries with evolving advanced nursing roles can challenge the expected level of advanced clinical competence in an educational context.

ETHICS OF SMART HOUSE WELFARE TECHNOLOGY FOR OLDER ADULTS: A SYSTEMATIC LITERATURE REVIEW.

BACKGROUND: The University College of Southeast Norway has an on-going project to develop a smart house welfare system to allow older adults and people with disabilities to remain in their homes for as long as they wish in safe, dignified, living conditions. OBJECTIVES: This article reviews reported ethical challenges to implementing smart houses for older adults. METHODS: A systematic literature review identified twenty-four articles in English, French, Spanish, and Norwegian, which were analyzed and synthesized using Hofmann's question list to investigate the reported ethical challenges. RESULTS: Smart houses offer a promising way to improve access to home care for older adults and people with disabilities. However, important ethical challenges arise when implementing smart houses, including cost-effectiveness, privacy, autonomy, informed consent, dignity, safety, and trust. CONCLUSIONS: The identified ethical challenges are important to consider when developing smart house systems. Due to the limitations of smart house technology, designers and users should be mindful that smart houses can achieve a safer and more dignified life-style but cannot solve all the challenges related to ageing, disabilities, and disease. At some point, smart houses can no longer help persons as they develop needs that smart houses cannot meet.

The Role of Mitochondria, Oxidative Stress, and the Radical-binding Protein A1M in Cultured Porcine Retina.

PURPOSE: The purpose of this study was to explore the relationship between oxidative stress, antioxidant defense, mitochondrial structure, and biomechanical tissue support in the isolated porcine retina. METHODS: Full-thickness retinal sheets were isolated from adult porcine eyes. Retinas were cultured for 2 or 48 h using (1) a previously established low-support explant protocol with photoreceptors positioned against the culture membrane (porous polycarbonate) or (2) a high-support procedure developed by our group, apposing the Müller cell endfeet and inner limiting membrane against the membrane. The grafts were analyzed by quantitative polymerase chain reaction (PCR), immunohistochemistry, and transmission electron microscopy (TEM), and culture medium was assayed for the cell damage and oxidative stress markers lactate dehydrogenase and protein carbonyls. RESULTS: In explants cultured with physical support to the inner border, cone photoreceptors were preserved and lactate dehydrogenase levels were reduced, although an initial (2 h), transient, increased oxidative stress was observed. Elevated expression of the antioxidants α1-microglobulin and heme oxygenase-1 was seen in the mitochondria-rich inner segments after 48 h compared to low-support counterparts. Housekeeping gene expression suggested a higher degree of structural integrity of mitochondria in high-support explants, and TEM of inner segments confirmed preservation of a normal mitochondrial morphology. CONCLUSION: Providing retinal explants with inner retinal support leads to mobilization of antioxidant proteins, preservation of mitochondrial function, and increased cell viability. Consequently, the failure of low-support retinal cultures to mobilize an adequate response to the oxidative environment may play a key role in their rapid demise. These findings shed new light on pathological reactions in biomechanically related conditions in vivo.

Feet on the ground: Physical support of the inner retina is a strong determinant for cell survival and structural preservation in vitro.

PURPOSE: The purpose of this study was to explore the importance of local physical tissue support for homeostasis in the isolated retina. METHODS: Full-thickness retinal sheets were isolated from adult porcine eyes. Retinas were cultured for 5 or 10 days using the previously established explant protocol with photoreceptors positioned against the culture membrane (porous polycarbonate) or the Müller cell endfeet and inner limiting membrane (ILM) apposed against the membrane. The explants were analyzed morphologically using hematoxylin and eosin staining, immunohistochemistry, TUNEL labeling, and transmission electron microscopy (TEM). RESULTS: Standard cultures displayed a progressive loss of retinal lamination and extensive cell death, with activated, hypertrophic Müller cells. In contrast, explants cultured with the ILM facing the membrane displayed a maintenance of the retinal laminar architecture, and a statistically significant attenuation of photoreceptor and ganglion cell death. Transmission electron microscopy revealed intact synapses as well as preservation of normal cellular membrane structures. Immunohistochemistry showed no signs of Müller cell activation (glial fibrillary acidic protein [GFAP]), with maintained expression of important metabolic markers (glutamine synthetae [GS], bFGF). CONCLUSIONS: Providing physical support to the inner but not the outer retina appears to prevent the tissue collapse resulting from perturbation of the normal biomechanical milieu in the isolated retinal sheet. Using this novel paradigm, gliotic reactions are attenuated and metabolic processes vital for tissue health are preserved, which significantly increases neuronal cell survival. This finding opens up new avenues of adult retinal tissue culture research and increases our understanding of pathological reactions in biomechanically related conditions in vivo.

Uremic optic neuropathy with severe epiretinal membrane formation.

PURPOSE: The purpose of this study was to describe a patient with uremic optic neuropathy and concomitant epiretinal membrane formation. METHODS: The patient was investigated by standard ophthalmoscopy, blood samples, and by radiography. PATIENT: A 24-year-old woman with renal failure. RESULTS: Severe optic nerve head edema and massive epiretinal fibrosis with central retinal tractional detachment were found in both eyes. Surgical intervention resulted in attachment of the right retina, whereas the condition resulted in chronic detachment of the left retina despite repeated treatment. CONCLUSION: To our knowledge, the combination of uremic optic neuropathy and massive epiretinal membrane formation has not been described previously. Strategies for managing this severe visually threatening condition are discussed.