"They bring the topic [of social justice] but stop there": Nursing students' perceptions of teaching practices that develop awareness and engagement with social justice.

BACKGROUND: Pedagogical frameworks grounded in social justice, such as decolonizing and anti-racist educational practices, are essential in nursing programs. While scholars have begun to examine nurse educators' conceptualizations of social justice, there remains a lack of knowledge about student perspectives regarding nurse educators' approaches to incorporating social justice in education. OBJECTIVE: To understand nursing students' perceptions about educational strategies that develop critical awareness and engagement with social justice and positively influence professional practice. DESIGN: A qualitative study informed by Critical Feminist Pedagogy and guided by Interpretive Description methodology. SETTINGS: A school of nursing in Western Canada. PARTICIPANTS: Ten undergraduate and graduate nursing students recruited through convenience sampling. METHODS: Students participated in one-on-one semi-structured interviews. A set of questions developed to facilitate data analysis allowed the deconstruction of the data to identify broad-based inductive categories. Contrast and comparison methods were also used. Members of the research team provided analytic insights into the categories, and subsequently, all members discussed the findings and developed the interpretive frame. RESULTS: Student participants reported that educational strategies promoting awareness and engagement with social justice need to go beyond superficial engagement and awareness of social justice. Researchers' analysis suggests that cohesiveness between awareness and action in social justice is urgently needed within academia to adopt a decolonizing and anti-racist pedagogy in nursing and better prepare students for professional practice. From the data analysis, teaching strategies that enhance cohesiveness include: embracing personal development, creating community spaces and disrupting knowledge and curriculum hierarchies. CONCLUSIONS: Understanding students' perceptions and incorporating their suggestions is critical to integrating socially just teaching practices that embrace a learner-centred pedagogy. Our findings offer suggestions for teaching strategies that foster critical awareness and engagement with social justice. Combined, these contribute to our understanding of signature pedagogies in nursing with the intention of increasing the adoption of anti-racist and decolonizing approaches.

Virtual simulation in healthcare education: a multi-professional, pan-Canadian evaluation.

BACKGROUND: As we experience a shortage of healthcare providers in Canada, it has become increasingly challenging for healthcare educators to secure quality clinical placements. We evaluated the impact of virtual simulations created for the virtual work-integrated learning (Virtu-WIL) program, a pan-Canadian project designed to develop, test, and offer virtual simulations to enrich healthcare clinical education in Canada. Evaluation was important since the virtual simulations are freely available through creative commons licensing, to the global healthcare community. METHODS: Students self-reported their experiences with the virtual simulations and the impact on their readiness for practice using a survey that included validated subscales. Open-ended items were included to provide insight into the students' experiences. RESULTS: The evaluation included 1715 Nursing, Paramedicine and Medical Laboratory students enrolled in the Virtu-WIL program from 18 post-secondary universities, colleges, and institutions. Results showed most students found the virtual simulations engaging helped them learn and prepare for clinical practice. A key finding was that it is not sufficient to simply add virtual simulations to curriculum, careful planning and applying simulation pedagogy are essential. CONCLUSION: Virtual simulation experiences are increasingly being used in healthcare education. Results from this rigorous, large-scale evaluation identified ways to enhance the quality of these experiences to increase learning and to potentially decrease the number of hours healthcare students need in clinical practice to meet professional competencies. Further research is needed regarding many aspects of virtual simulations and, in particular, curriculum integration and the timing or sequencing of virtual simulations to best prepare students for practice.

Differences in mammography screening attendance among non-Western immigrants in Denmark, Finland, Iceland and Norway.

Several studies have shown that attendance rates are lower among non-Western immigrants than among natives. As the Nordic countries have quite similar health systems and populations but also differences in the organisation of their organised mammography screening programmes, differences in attendance rates could highlight organisational factors that might increase the attendance rates. Mammography screening is offered free of charge in Denmark and Finland, but not in Iceland and Norway. Contrarily to the other countries, Iceland do not send out pre-booked appointment. The study population included natives and non-Western immigrants aged 50-69 years, who had at least one invitation to the national mammography screening programmes in Denmark (2008-2017), Finland (2001-2017), Iceland (2001-2020) or Norway (2001-2015). Relative risks (RRs) of attendance were estimated and adjusted for age group and calendar period. The study population included 116.033 non-Western immigrants and more than 2 million natives. The attendance rates were significantly lower among non-Western immigrants than among natives, with an adjusted relative risk of 0.81/0.80 in Denmark and Finland, 0.62 in Norway, and 0.40 in Iceland. The lower attendance rates among immigrants in Norway and Iceland did not seem to be due to differences in birth country, immigration age, or educational level, but might be explained by organisational factors. Offering free-of-charge mammography screening in Norway and Iceland and/or including a pre-booked appointment in the invitation letters in Iceland might increase the attendance rate among non-Western immigrants.

Cervical, liver and stomach cancer incidence and mortality in non-Western immigrant women: a retrospective cohort study from four Nordic countries.

BACKGROUND: Cervical, liver and stomach cancers are the most common infection-associated malignancies and the leading cause of morbidity in non-Western regions. We compared the incidence and mortality of these cancers between non-Western immigrant and non-immigrant Nordic female populations. We also analysed the effect of age at immigration, duration of residence and education on cancer burden. MATERIAL AND METHODS: Study population consisted of women residents in Denmark, Finland, Iceland and Norway in 1973-2020. Non-Western women contributed 3.1% of the total 260 million person-years at risk. All women were followed from their 20th birthday, or from the date of immigration if after, until the date of their first primary cancer diagnosis, death, emigration, or the end of the country-specific study period. All data were adjusted for 10-year age groups and calendar periods, and immigrant data was further broken down by region of birth, age at immigration and education level. Country-specific estimates were produced by multivariable Poisson regression and pooled in Finland with a random effects model. RESULTS: Altogether, there were 60 982 cases of cervical, liver and stomach cancer in the study population, causing 36 582 deaths. The immigrant women had significantly higher liver (rate ratio [RR] 1.78, 95% confidence interval (CI) 1.03-3.06) and stomach cancer incidence (RR 1.68, CI 1.29-2.18), and stomach cancer mortality (RR 1.49, CI 1.17-1.92) than non-immigrant women. In the immigrant population, high education was related to lower incidence and mortality of studied cancers. The rate ratio of cervical cancer decreased with duration of residence and increased with rising age at immigration. CONCLUSION: Due to the increased incidence and mortality of infection-related cancers and changes in cancer patterns by age at immigration and duration of residence, attention should be paid to targeted health care services for immigrants. Special efforts should be given to women who have spent their youth in high-risk areas.

A population-based cohort study on changes in breast, lung and colorectal cancer incidence and mortality among non-Western immigrant women.

BACKGROUND: Cancer risk varies geographically, and migrants are influenced by different risk factors before, during and after migration. Increased migration from non-Western countries to the Nordic countries calls for a better understanding of the migrants' cancer risk and the change in risk patterns over time. The aim of this study was to compare the incidence and mortality of breast, colorectal and lung cancer between non-Western immigrant and the native female population in Denmark, Finland, Iceland, and Norway. MATERIAL AND METHODS: Data from national registries were processed and pre-analysed in each country. Multivariate Poisson regression models were used to model the relative differences in incidence and mortality as rate ratios (RR). The country-specific estimates and summary statistics were pooled together using a random effects model. RESULTS: Non-Western immigrant women had significantly lower breast (RR 0.71, 0.65-0.78), colorectal (RR 0.72, 0.57-0.92) and lung (RR 0.55, 0.42-0.72) cancer incidence rates than native women, and the risk of these cancers among immigrant women increased with duration of residence. Differences were parallel in breast, colorectal and lung cancer mortality (RR 0.64, 0.55-0.74; RR 0.66, 0.48-0.92; RR 0.51, 0.34-0.79). Among immigrant women, higher education increased the risk for breast cancer and decreased it for lung cancer. CONCLUSION: The results significantly complement and add to the previous findings of cancer burden and cancer burden transition among migrants and provide evidence of a prolonged cancer risk advantage among non-Western immigrant women. However, the findings show an increasing risk of lifestyle-related cancers with increasing duration of residence in the host country. Further studies are needed to discover underlying reasons for this phenomenon.

Influence of simulation design on stress, anxiety and self-confidence of nursing students: Systematic review with meta-analysis.

AIM: To evaluate the simulation design characteristics that may influence the stress, anxiety and self-confidence of undergraduate nursing students during learning. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Searchers were conducted in October 2020 and updated in August 2022 in the databases CENTRAL, CINAHL, Embase®, ERIC, LILACS, MEDLINE, PsycINFO®, Scopus and Web of Science, PQDT Open (ProQuest), BDTD, Google Scholar and specific journals on simulation. REVIEW METHODS: This review was conducted according to the recommendations of Cochrane Handbook for Systematic Reviews and reported according to the PRISMA Statement. Experimental and quasi-experimental studies that compared the effect of simulation on stress, anxiety and self-confidence of nursing students were included. The selection of studies and data extraction was performed independently by two reviewers. Simulation information was collected as prebriefing, scenario, debriefing, duration, modality, fidelity and simulator. Data summarization was performed by qualitative synthesis and meta-analytical methods. RESULTS: Eighty studies were included in the review, and most reported in detail the structure of the simulation, contemplating prebriefing, scenario, debriefing and the duration of each step. In subgroup meta-analysis, the presence of prebriefing, duration of more than 60 min and high-fidelity simulations helped reduce anxiety, while the presence of prebriefing and debriefing, duration, immersive clinical simulation modalities and procedure simulation, high-fidelity simulations and use of mannequins, standardised patients and virtual simulators, contributed to greater students' self-confidence. CONCLUSIONS: Different modulations of simulation design components imply reduction of anxiety and increased self-confidence in nursing students, especially highlighting the quality of the methodological report of simulation interventions. RELEVANCE TO CLINICAL PRACTICE: These findings help to support the need of more rigorous methodology in simulation designs and research methods. Consequently, impact on the education of qualified professionals prepared to work in clinical practice. No Patient or Public Contribution.

Impact of the Mobile Game FightHPV on Cervical Cancer Screening Attendance: Retrospective Cohort Study.

BACKGROUND: The wide availability of mobile phones has made it easy to disseminate health-related information and make it accessible. With gamification, mobile apps can nudge people to make informed health choices, including attending cervical cancer screening. OBJECTIVE: This matched retrospective cohort study examined the association between exposure to the FightHPV mobile app gamified educational content and having a cervical exam in the following year. METHODS: Women aged 20 to 69 years who signed an electronic consent form after downloading the FightHPV app in 2017 (intervention group) were matched 1:6 with women of the same age and with the same screening history (reference group) in 2015. To estimate the impact of exposure to the FightHPV app, we estimated cumulative incidence and hazard ratios (HRs) with 95% CIs. We used data from the Norwegian Cervical Cancer Screening Program database and Statistics Norway to determine screening participation and outcomes, respectively. RESULTS: We matched 3860 women in the control group to 658 women in the intervention group; 6 months after enrollment, 29.6% (195/658) of the women in the intervention group and 15.21% (587/3860) of those in the reference group underwent a cervical exam (P<.01). Women exposed to the FightHPV app were 2 times more likely to attend screening (adjusted HR 2.3, 95% CI 2.0-2.7), during which they were 13 times more likely to be diagnosed with high-grade abnormality (adjusted HR 12.7, 95% CI 5.0-32.5) than the women in the reference group. CONCLUSIONS: Exposure to the FightHPV app significantly increased cervical cancer screening attendance across the various analyses and improved detection of women with high risk for cervical cancer. For the first time, we demonstrated the effectiveness of gamification combined with mobile technology in cancer prevention by empowering women to make active health-related decisions. Gamification can significantly improve the understanding of complicated scientific concepts behind interventions and increase the acceptance of proposed cancer control measures.

Authentic learning in healthcare education: A systematic review.

BACKGROUND: The increasing complexity of the clinical environment demands a higher level of clinical performance competency. New pedagogical authentic learning methods have been developed to meet this need by bridging the gap between knowledge and practice. OBJECTIVE: This systematic review aimed to examine authentic learning methods and their effects in healthcare education. DESIGN: Systematic review. DATA SOURCES: Data were obtained from a literature search of Embase, PubMed, MEDLINE, CINAHL, PsycINFO, and Korean databases (e.g., KoreaMed) for studies published until May 2021. This review selected research papers documenting RCTs or quasi-experimental studies targeting undergraduate students training to become healthcare professionals. REVIEW METHODS: This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. The risk of bias assessment utilized the Joanna Briggs Institute (JBI) critical checklist. RESULTS: Of 20 selected studies, 12 studies were randomized controlled trials, while 8 had quasi-experimental designs with a control group. Simulation was identified as an effective educational method for authentic learning. Through authentic learning, undergraduate students cultivated their knowledge and learning motivation. However, divergent conclusions were shown for performance skills. CONCLUSIONS: Authentic pedagogical methodologies effectively enhanced learners' competencies in the cognitive, psychomotor, and affective domains. Integrating technological applications, e.g., e-learning or web-based approaches, facilitated education across academic boundaries. Further studies on combining technology with authentic learning approaches should be conducted to construct realistic educational environments for learners. TRIAL REGISTRATION: CRD42021229350.

Effect of simulation on stress, anxiety, and self-confidence in nursing students: Systematic review with meta-analysis and meta-regression.

INTRODUCTION: Simulation is a promising strategy in health education, with evidence of importance for learning, but the available systematic reviews are still inconclusive about the effect of the strategy on stress, anxiety, and self-confidence of nursing students, which impact the adherence to and sustainment of this strategy. Thus, better evidence is needed of the impact of simulation on these competences, essential for health professional education. OBJECTIVE: To evaluate the effect of simulation-based experiences on stress, anxiety, self-confidence and learning of undergraduate nursing students compared to conventional teaching strategies or no intervention. DESIGN: Systematic review with meta-analysis and meta-regression. DATA SOURCES: The databases used included: CENTRAL, CINAHL, Embase®, ERIC, LILACS, MEDLINE, PsycINFO®, SCOPUS and Web of Science. Additional searches occurred in PQDT Open (ProQuest), BDTD, Google Scholar and journals with a specific scope in clinical simulation. REVIEW METHODS: This study was conducted by the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Experimental and quasi-experimental studies that compared the effects of simulation on stress, anxiety, and self-confidence of nursing students were included. Study selection and data extraction steps were performed independently by two reviewers. Critical appraisal of the studies was managed by means of the risk of bias tools RoB 2 and ROBINS-I, and quality of evidence by means of the GRADE tool. Data summarization was performed by qualitative synthesis with descriptive analysis and quantitative synthesis by meta-analytic methods and meta-regression. RESULTS: Sixty-two studies were included covering an overall sample of 4570 undergraduate nursing students. When comparing simulation with other teaching strategies, simulation showed small effect size for anxiety (d = -0.33; 95% CI: -0.66-0.002; p = 0.051) and medium effect size for self-confidence (d = 0.71; 95% CI: 0.46-0.95; p < 0.001); there was no difference in the effect-size for stress (d = 0.04; 95% CI:-0.91-0.99; p = 0.90). Subgroup analyses showed an effect of methodological characteristics of the studies on students' anxiety and self-confidence. A positive relationship between self-confidence and learning was identified by meta-regression (p = 0.018; R2 = 20.96%). CONCLUSION: Simulation is an effective strategy for reducing anxiety and increasing self-confidence compared to conventional teaching strategies. Results are still inconclusive for stress. The use of simulation-based experiences in nursing education obtains positive results on anxiety and self-confidence in students, providing support for its implementation in undergraduate curricula to improve the education of qualified nurses. REGISTRATION NUMBER: CRD42020206077. TWEETABLE ABSTRACT: Simulation is an effective teaching strategy for reducing anxiety and increasing self-confidence in learning.

Breast shells for pain and nipple injury prevention: A non-randomized clinical trial.

Objective: This study aimed to analyze the effectiveness of breast shells in preventing pain and nipple injury during breastfeeding. Method: A non-randomized clinical trial was carried out with blinding to the evaluators of the study results. The study included women with ≥35 weeks of singleton pregnancy, no nipple changes, and a desire to breastfeed. Resulting in 62 lactating women. The experimental group used breast shells and health education with clinical demonstration (n = 29), whereas the control group used no breast shells (n = 33). Pain and nipple injury were assessed three times, twice prenatally and once up to 14 days postpartum. Results: Nipple injury (50.0%) and nipple pain (67.7%) presented with similar frequency in both groups (p = 1). Breast engorgement (35,5%) was associated with nipple pain (p = 0.019) and its onset was delayed in the experimental group (p = 0.001). Health education contributes to breast and nipple care and increases favorable breastfeeding patterns. Conclusion: Breast shells do not prevent nipple pain or injury. Innovation: As far as we know, this is the first clinical research evaluating the use of breast shells since the antenatal care to prevent the occurrence of nipple pain and injury.

Immersion in an emergency department triage center during the Covid-19 outbreak: first report of the Liège University hospital experience.

OBJECTIVES: Since the beginning of the novel coronavirus outbreak, different strategies have been explored to stem the spread of the disease and appropriately manage patient flow. Triage, an effective solution proposed in disaster medicine, also works well to manage Emergency Department (ED) flow. The aim of this study was to describe the role of an ED Triage Center for patients with suspected novel coronavirus disease (Covid-19) and characterize the patient flow. METHODS: In March 2020, we established a Covid-19 triage center close to the Liège University EDs. From March 2 to March 23, we planned to analyze the specific flow of patients admitted to this triage zone and their characteristics in terms of inner specificities, work-up and management. During this period, all patients presented to the ED with symptoms suggestive of Covid-19 were included in the study. RESULTS: A total amount of 1071 patients presented to the triage center during the study period. 41.50% of the patients presented with flu-like symptoms. In 82.00% of the cases, no risk factor of virus transmission was found. The SARS-Cov2 positive patients represented 29.26% of the screened patients. 83.00% of patients were discharged home while 17.00% were admitted to the hospital. CONCLUSION: Our experience suggests that triage centers for the assessment and management of Covid-19 suspected patients is an essential key strategy to prevent the spread of the disease among non-symptomatic patients who present to the EDs for care. This allows for a disease-centered work-up and safer diversion of Covid-19 patients to specific hospital units.

Educational Resources and Curriculum on Lactation for Health Undergraduate Students: A Scoping Review.

BACKGROUND: Breastfeeding is a fundamental component of health care, and health professionals need to be adequately prepared. As part of the system, health care professionals have the ability to influence the establishment and maintenance of breastfeeding. The global literature regarding the curricular approach or established best practices for health professional education in lactation is inconclusive and lacking in rigor. RESEARCH AIM: To explore the literature for the educational resources, methods, and curriculum used in the education of undergraduate health students related to lactation. METHODS: A scoping review examining the curricular programs of health professional students in lactation was undertaken exploring and summarizing evidence from peer reviewed and grey literature. A scoping review with a five-stage review process was followed. The database search between 1982-2018 generated 625 results, 79 full-text articles were reviewed, and 29 articles published in English met the inclusion criteria. RESULTS: In general, educational resources, methods, curricular approaches, and foundational topics were based on best practice standards. Some authors incorporated a variety of learning methods and provided experiential learning, with evidence of translation of knowledge into clinical practice. In the studies examined, researchers reported that students had improved their: knowledge and attitudes (59%); breastfeeding support skills (45%); and confidence (10%). However, even in programs that focused on developing students' breastfeeding support skills, authors reported a lack of change in students' confidence. CONCLUSIONS: Although only English articles met the inclusion criteria, this review was unique in its search of multidisciplinary, multilingual, and international studies. Consistency in teaching across disciplines is key and not evident in the studies reviewed.

Regional differences in cervical cancer incidence and associated risk behaviors among Norwegian women: a population-based study.

BACKGROUND: Cervical cancer incidence is influenced by screening and risk factors in the population. The main risk factor for cervical cancer is sexually transmitted human papillomavirus (HPV), which is sexually transmitted and thus associated with sexual behavior. Smoking, parity and hormonal contraceptive use may also be associated with cervical cancer risk. We compared incidence, screening coverage and risk behaviors for cervical cancer between health regions in Norway. METHODS: We obtained data on incidence of cervical cancer among Norwegian women during 1992-2016 and data on screening coverage from the Cancer Registry of Norway. We obtained data on sexual behavior and smoking from a population-based survey of 16,575 Norwegian women who were 18-45 years old in 2005. RESULTS: Cervical cancer incidence was higher in the northern and southeastern region than in the middle and western region (range in incidence per 100,000 person-years during 1992-2016; north: 10.5 to 14.6; southeast: 9.3 to 12.9; mid: 6.8 to 9.5; west: 8.4 to 10.0). The incidence decreased modestly in the north (average annual percentage change (95% confidence interval) - 1.0 (- 1.2 to - 0.7)) and southeast (- 0.7 (- 1.0 to - 0.3)), but did not change significantly in the mid (- 0.3 (- 1.0 to 0.4)) and west (- 0.3 (- 0.6 to 0.0)). Compared to the national average, women in the north had earlier sexual debut, more partners and higher prevalence of ever having had a sexually transmitted infection (STI), while the opposite was observed among women in the west. Women in the middle and southeastern regions tended to be similar to the national average for sexual behaviors. Although less pronounced, the prevalence of smoking showed regional patterns similar to that observed for sexual behaviors, while ever-use of hormonal contraceptives and cervical screening coverage was similar between regions. CONCLUSIONS: There were regional differences in cervical cancer incidence during the era of nationally organized cervical screening in Norway. To some extent, these differences corresponded to regional differences in risk behavior for cervical cancer in the Norwegian female population.

Lanolin and prenatal health education for prevention of nipple pain and trauma: Randomized clinical trial. / Lanolina y educación para la salud en la prevención de dolor y lesiones en los pezones: ensayo clínico aleatorizado.

OBJECTIVE: To investigate the effect of lanolin on nipple pain and trauma in breastfeeding after application of a health education. METHOD: Randomized controlled clinical trial, with two arms, open, with 66 participants during prenatal care in the primary health care network in Goiania - Goias, Brazil. Participants were randomized (1:1) using computer generated numbers in both experimental group (EG) and control group (CG). The EG received lanolin and health education on breastfeeding at two different times with clinical demonstration using cloth didactic breast and illustrative album as the intervention, while the CG received standard health education. Health education was carried out by the same researchers in both groups. Measurement of pain, nipple trauma, and breastfeeding technique occurred on postpartum day eight. The analysis included descriptive statistics and inferential analysis by means chi-square or Fisher test, and Student's t-test, significance level set at 0.05. RESULTS: A majority of the participants experienced no nipple trauma (59.1%) in both groups, and 60.6% of women experienced pain. In both groups, women showed favorable breastfeeding behaviors, except in the condition of the breasts. There were no significant differences between groups in pain prevention (p=0.61), nipple lesions (p=0.21), and breastfeeding technique (p>0.05). CONCLUSION: It is not clear whether the intervention, lanolin combined with health education, has a positive effect on the prevention of nipple pain and trauma. Further research is needed to elucidate this question. Registration number: RBR-7tvhq8. Registry website: http://www.ensaiosclinicos.gov.br/.

Human papillomavirus genotype-specific risks for cervical intraepithelial lesions.

Prevalence of different HPV genotypes is changing after HPV vaccination. The associated risks are needed for optimizing cervical cancer screening.To estimate HPV type-specific prevalence, odds ratio (OR), and positive predictive value (PPV) for cervical cytological abnormalities, we determined 41 different HPV genotypes in cervical samples from a population-based sample of 8351 women aged 18-51 years before HPV vaccination era (V501-033; NCT01077856).Prevalence of HPV16 was 4.9% (95% CI: 4.4-5.5) with the PPV for high-grade cytology 11.2%, and OR 11.9 (95% CI: 8.5-16.5). Carcinogenic HPVs included in the nonavalent vaccine (HPV16,18,31,33,45,52,58) had a population prevalence of 14.4% (95% CI: 13.5-15.4), with PPV of 8.0% (95% CI: 6.8-9.3) and OR 23.7 (95% CI: 16.0-63.5) for high-grade cytology. HPV types currently included in most screening tests, but not vaccinated against (HPV35,39,51,56,59,66,68) had a joint prevalence of 8.5% (95% CI: 7.8-9.2) with PPV of 4.4% (95% CI: 3.3-5.7) and OR of 2.9 (95% CI: 2.0-4.0) for high-grade cytology. The other 27 non-carcinogenic genotypes had a prevalence of 11.8%, PPV of 2.9% (95% CI:2.1-3.9), and OR 1.5 (95% CI: 1.1-2.2.) for high-grade cytology.These results suggest that HPV screening tests in the post-vaccination era might perform better if restricted to the HPV types in the nonavalent vaccine and screening for all 14 HPV types might result in suboptimal balance of harms and benefits.

Serious Game e-Baby Família: an educational technology for premature infant care.

OBJECTIVES: to develop and assess the serious game e-Baby Família with parents of premature infants. METHODS: a methodological study regarding the development of the serious game, with participatory design in scope definition, starting from parents' learning needs about premature infant care. A qualitative approach was performed in the assessment stage with parents, with content analysis of the speech of the eight participants. RESULTS: the following categories emerged: Realistic appearance of the virtual setting and game content and Gameplay implications for the use of e-Baby Família. The game was satisfactorily assessed regarding content, appearance and dynamics use, motivating participants to learn. FINAL CONSIDERATIONS: in the context of prematurity as a public health problem in Brazil and the need to strengthen family health education for care, the serious game was assessed as motivating and appropriate for health learning.

The effectiveness on health education to prevent nipple trauma from breastfeeding: a systematic review / A eficácia da educação em saúde na prevenção do trauma mamilar na amamentação: revisão sistemática

Abstract Objectives: to analyze the effectiveness on health education to prevent nipple trauma in breastfeeding compared to other interventions. Methods: systematic literature review was carried out in January 2019, according to PRISMA recommendations. The searches were conducted in Cinahl, PubMed, Web of Science, Scopus, and in the references cited in the selected articles. The studies were assessed for quality and level of evidence according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results: twelve studies were selected, all conducted at the maternities. The interventions were classified in two categories: health education on breastfeeding and the use of nipple covers. Health education on breastfeeding presents a moderate level of evidence on the prevention of nipple trauma. There is a moderate to high level of evidence on the positive effects of guaiazulene, gel or peppermint water applied in the postpartum period to prevent nipple trauma. Conclusion: health education on breastfeeding with clinical demonstration is an important strategy to prevent nipple trauma and requires more than one educational approach. The use of nipple covers requires some consideration, since they must be removed prior to breastfeeding. All interventions were conducted in the postpartum period, which points out for the necessity of clinical research to prevent nipple trauma in prenatal care.

Resumo Objetivos: analisar a eficácia da educação em saúde para a prevenção do trauma mamilar na amamentação comparado a outras intervenções. Métodos: revisão sistemática realizada em janeiro de 2019, segundo recomendações PRISMA. As buscas foram realizadas na Cinahl, PubMed, Web of Science, Scopus e referências citadas nos artigos selecionados. Os estudos foram avaliados quanto à qualidade e nível de evidência conforme o sistema Grading of Recommendations, Assessment, Development and Evaluation. Resultados: foram selecionados 12 estudos, todos executados em maternidades. As intervenções foram representadas em duas categorias: educação em saúde sobre amamentação e uso de coberturas mamilares. A educação em saúde sobre amamentação apresenta moderada evidência na prevenção do trauma mamilar. As coberturas de gel ou água de hortelã-pimenta, de guaiazulene, aplicadas no pós-parto, têm efeito positivo na prevenção do trauma mamilar, com moderada a alta evidência. Conclusão: a educação em saúde sobre amamentação, com demonstração clínica, configura-se importante estratégia para prevenção do trauma mamilar, devendo ser realizada mais de uma abordagem educativa. A implementação de coberturas mamilares precisa ser ponderada, pois todas exigiram remoção antes da mamada. Todas as intervenções foram conduzidas no pós-parto, o que aponta para a necessidade de pesquisas clínicas sobre a prevenção do trauma mamilar no pré-natal.

Iranian Nurses' Experiences of Workplace Violence in Prehospital Emergency Care: A Qualitative Study.

Prehospital emergency care nurses experience severe workplace violence. However, despite the widespread violence they experience, this phenomenon has not been well studied among these nurses. Therefore, the purpose of this study was to explore the experiences of Iranian nurses working in prehospital setting regarding workplace violence with a focus on the factors leading to such violence. In this qualitative descriptive study, 23 prehospital nurses participated purposefully. The data were collected by individual face-to-face semistructured interviews and analyzed using content analysis methodology. Data analysis led to the identification of 4 main themes, including job competency mismatch, inadequate resources, criticality of the situation and circumstances, and inadequate awareness and misplaced expectations of society. These nurses have not completed specialized training courses, work in a system that is in a critical situation, and face many barriers and deficiencies in terms of intra- and interorganizational coordination. On the other hand, people in the community do not have sufficient awareness about the duties and services provided by prehospital nurses and thus have unrealistic expectations to receive services. The results showed that there was a deep gap between the prehospital emergency realities and public expectations, leading to workplace violence. Therefore, efforts to improve the working conditions of nurses with an emphasis on teaching specialized prehospital emergency courses, especially violence control courses, promoting intra- and interorganizational coordination, and increasing the equipment and personnel of ambulances for special missions, as well as raising the public awareness and outlining more realistic expectations, may reduce the prevalence of violence against prehospital nurses.