Challenges faced by community connectors: lessons learned from a Taiwan public health initiative.

BACKGROUND: Effective solutions that meet the diverse community health needs of older adult populations are of critical importance. To address these needs, a nationwide community connector team-tasked with providing referral support to older adult populations and completing an asset mapping resource inventory initiative centered around the needs of older adult populations-was developed in Taiwan. The purpose of this qualitative study was to explore community connectors' experiences and challenges. METHODS: Community connectors (n = 26) across four diverse sites participated in focus group interviews in July 2020. Interviews explored the challenges community connectors encountered in their roles; the strategies used to address these challenges; the asset mapping process; and on how they conceptualized their roles. Qualitative content analysis was applied. RESULTS: Three themes were uncovered: developing community ties, cross-organization interactions and professional conflicts. The findings show that community connectors face hurdles in uncovering community resources and that they experience considerable professional instability. The findings also shed light on the day-to-day approaches used to navigate on-the-job challenges and the steps taken to develop community partnerships. CONCLUSIONS: The experiences of community connectors provide important insights and can serve to illuminate the development of similar initiatives that seek to use community connectors for community health related purposes.

A pediatric seizure management virtual reality simulator for nursing students: A quasi-experimental design.

BACKGROUND: Seizures are a common neurologic disorder observed in children. A virtual reality (VR) simulator trains nursing students to understand and respond to pediatric seizures. OBJECTIVES: The aim of this study was to examine knowledge acquisition and acceptance of a pediatric seizure management VR simulator. DESIGN: A quasi-experimental design was used to study the effectiveness of VR in nursing education. PARTICIPANTS: Two out of nine possible third-year Pediatric Nursing classes were assigned by the office of academic affairs. A total of 105 students participated. The two classes were randomly allocated into the intervention (n = 53) and control (n = 52) groups. METHODS: The intervention group was taught using a pediatric seizure management simulator; the control group was taught by in-person lecture. The Seizure Management Knowledge Test was administered to all participants before each group underwent their VR simulator and lecture respectively. The Pediatric Seizure Management Virtual Reality Acceptance Questionnaire and the Virtual Reality Sickness Questionnaire were given to participants in the intervention group. Independent t-tests and chi-square tests were used to test differences in knowledge acquisition between the two groups. RESULTS: The posttest knowledge score in the intervention group was significantly higher than that in the control group (t = 5.05, p < .001). The intervention group had a mean cybersickness score of 18.17 of 100. The average score of the acceptance questionnaire for perceived usefulness was 3.26 of 4; ease of use was 3.09 of 4; attitude toward use was 3.26 of 4; and willingness to use was 3.32 of 4. Over 90 % of participants expressed willingness to use the VR simulator. CONCLUSIONS: The newly developed pediatric seizure management VR simulator is acceptable and worthwhile for training nursing students to develop their skills and professionalism. Follow-up research is needed to evaluate the long-term effect of VR education in nursing practice.

A Profile of Novice and Senior Nurses' Communication Patterns during the Transition to Practice Period: An Application of the Roter Interaction Analysis System.

Novice nurses' successful transition to practice is impacted by their interactions with senior nurses. Ensuring that novice nurses are adequately supported during their transition to practice has wide-ranging and significant implications. The aim of this study is to explore the communication patterns between novice and senior nurses by applying an interaction analysis technique. Trimonthly onboarding evaluations between novice and senior nurses were recorded. The Roter Interaction Analysis System was adapted and deployed to identify communication patterns. In total, twenty-two interactions were analyzed. Senior nurses spoke more (64.5%). Task-focused exchange was predominant amongst senior (79.7%) and novice (59.5%) nurses. Senior nurses' talk was concentrated in clusters of information-giving (45%) and advice or instructions (17.2%), while emotional expression (1.4%) and social talk (0.4%) were rare. Novice nurses' talk was concentrated in clusters-information giving (57%) and positive talk (39.5%). The communication patterns between senior and novice nurses during the onboarding period indicate aspects of novice nurse transition that could be addressed, such as encouraging novice nurses to use these interactions to communicate more, or emphasizing the importance of social talk. These insights can be used to inform mentorship and preceptorship training to ensure that senior nurses are able to adequately support novice nurses through all parts of the transition to practice period.

Effects of a simulation-based nursing process educational program: A mixed-methods study.

AIMS: To examine the effects of a simulation-based nursing process educational program on nursing students' confidence in communication and foundational understanding of the nursing process. BACKGROUND: The nursing process is a core component of patient-centered nursing care that is underpinned by effective communication. However, learning how to engage patients and carry out the distinct steps of the nursing process can be challenging if students are not able to apply knowledge to practice. Simulation-based learning programs can provide an immersive opportunity for students to enhance their understanding of the nursing process as well as improve their communication skills. DESIGN: A mixed methods randomized controlled trial METHODS: Two Fundamentals of Nursing classes were recruited from a university in northern Taiwan. The experimental group (n = 58) engaged with the simulation-based nursing process educational program, which consisted of an online interactive animation and a standardized patient simulation. The control group (n = 49) was assigned a case-study. Confidence in Communication surveys, assignment and examination scores, satisfaction questionnaires and post-simulation reflection logs were used for data collection. Data were analyzed using SPSS 22.0 and qualitative content analysis. RESULTS: Both groups showed statistically significant improvement in Confidence in Communication (p < .001). The experimental group performed better on the assignment than the control group (p < .001). No significant difference was seen between either groups' examination performances. The animation's high usage rate (mean 5.91 interactions per-user) and the results of the satisfaction questionnaires indicate the program's positive reception from the experimental group. The following themes emerged: effective communication skills, problem solving, confidence, feeling prepared and novel learning experience. CONCLUSION: The results demonstrate that the simulation-based nursing process educational program increased students' self-confidence in communication and non-verbal communication skills as well as foundational understanding of how to carry out the nursing process. The use of interactive simulation-based learning experiences is recommended to improve nursing students' understanding of how to apply abstract concepts into practice.

[Challenges to the Nursing Practicum During the COVID-19 Pandemic].

The COVID-19 pandemic has greatly impacted first-line medical staff as well as nursing-student clinical practicum programs. How to cooperate with the government's pandemic-prevention policies and reduce the gap between education and clinical practice represent significant challenges. In this paper, Chang Gung University of Science and Technology (CCUST) is used as an example to show how schools in Taiwan have effectively adapted the fundamentals of nursing practicum programs to the current pandemic using e-learning, group discussions, case analysis, clinical skill practice, and clinical case simulation scenario exercises. The program at CCUST both takes into account the safety of students and has achieved all critical nursing practice goals. After implementation of these adjustments, satisfaction among nursing students with the practicum environment and the clinical instructors was found to be significantly higher for the on-campus clinical practicum than for the off-campus clinical practicum. Furthermore, the results of qualitative data analyses show that nursing students in the on-campus practicum gained significant knowledge and experience and commented positively on their experience. For example, the students indicated that they were satisfied with the simulated clinical environment of the CCC, the teaching strategies and adaptability of the instructor, and the application of virtual reality scenario cases to enhance skill proficiency and learning outcomes. The adjusted nursing clinical practicum described in this paper may be used as a reference to ensure the quality of nursing clinical practicum programs is maintained during epidemics.

Learning outcomes of a flipped classroom teaching approach in an adult-health nursing course: a quasi-experimental study.

BACKGROUND: New teaching strategies must be developed not only to enhance nurse's competence but also to allow nurses to respond to the complex health care needs of today's society. The purpose of this study was to explore the learning outcomes of a flipped classroom teaching approach in an adult-health nursing course for students in a two-year Bachelor of Science in Nursing program. METHODS: The study had a quasi-experimental design. An 18-week flipped classroom teaching approach was applied in an adult-health nursing course. In total, 485 nursing students enrolled in the study, with 287 in the experimental group and 198 in the control group. The Self-Evaluated Core Competencies Scale, Metacognitive Inventory for Nursing Students, Self-Directed Learning Readiness Scale, and self-designed learning satisfaction questionnaire were used to evaluate the students' learning outcomes. RESULTS: The experimental group showed a statistically significant increase in the overall scores for self-evaluated core competencies, the "self-modification" subscale of the Metacognitive Inventory for Nursing Students, and in overall self-directed learning readiness; further, they also showed high levels of course satisfaction. CONCLUSIONS: A flipped classroom teaching approach had a positive impact on student's learning motivation and contributed to better learning outcomes in an adult-health nursing course. The flipped classroom combined with hybrid teaching methods is a suitable and effective learning strategy for a registered nurse (RN) to Bachelor of Science in Nursing (BSN) program to tackle today's complex revolution in nursing curricula, and may enhance nursing students' abilities to address numerous challenges.

Association between neutrophil-to-lymphocyte ratio and parathyroid hormone in patients with primary hyperparathyroidism.

INTRODUCTION: Primary hyperparathyroidism (PHPT) is associated with adverse cardiovascular outcomes which may result from an increase in systemic inflammation. Previously we have shown that serum parathyroid hormone (PTH) levels are independently associated with inflammatory indicators. The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive, widely available marker of inflammation. In the present study, we aimed to assess the longitudinal changes in NLR before and after parathyroidectomy. MATERIAL AND METHODS: This retrospective study included 95 patients diagnosed with PHPT who underwent parathyroidectomy between 2006 and 2016. Follow-up complete blood counts were available in 31 patients. RESULTS: At diagnosis, 43 (45%) patients presented with overt clinical symptoms and had higher serum calcium and PTH levels. Preoperative NLR was positively correlated with total white blood cell count (p = 0.001), serum calcium (p = 0.001), and PTH level (p = 0.013). The NLR was not associated with sex, age, comorbidities, or parathyroid weight. Among patients who were cured of PHPT, the median NLR decreased from 2.26 to 1.77 after parathyroidectomy (p = 0.037). There was no difference in hemoglobin, total white blood cells, or platelet count before and after surgery. CONCLUSIONS: We found a positive correlation of preoperative NLR with calcium and PTH levels in PHPT patients. After curative parathyroidectomy, NLR modestly decreased without changes in other hematological parameters.

[The Establishment and Examination of the Reliability, Validity, Discrimination, and Difficulty of Nursing Objective Structured Clinical Examination (OSCE)].

BACKGROUND: The objective structured clinical examination (OSCE) is one of the evaluation strategies used to examine the clinical competence of nursing students. More attention needs to be paid to establishing an examination that is based on the standardized protocol and on reliability and validity. PURPOSE: The aims of this study were to develop an OSCE that is based on a standardized protocol and to analyze the content validity and predictive validity, inter-rater consistency, internal consistency, item-to-total correlation, and the degree of discrimination and difficulty of this OSCE. METHODS: Based on the blueprint for OSCEs that use an 8-station format, this study used a descriptive, cross-sectional design and a sample population of 207 senior students who were preparing for their last-mile practicum at a nursing technology university in northern Taiwan. The study period lasted from September 2015 to October 2016. Furthermore, the validity, reliability, degree of discrimination, and difficulty of the OSCE were examined. RESULTS: An OSCE with an eight-station format was developed. The content validity index (CVI) was .85-1.0, inter-rater reliability was .80-1.0, Cronbach' alpha internal consistency was .53-.82, and item-to-total correlation was .36-.63. In addition, the level of difficulty of the OSCE was easy to moderate and the discrimination of the OSCE ranged from fair to excellent. Meanwhile, the OSCE scores of the participants appeared to be a valid predictor of scores on the last mile practicum. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: According to the standardized protocol of OSCE development, an 8- station nursing OSCE format is reliable and valid, providing fair levels of difficulty and discrimination. The developed OSCE may be applied to evaluate the clinical competence of nursing students prior to beginning their last mile practicum. The results from the present study may provide a reference for nursing educators who are responsible for developing OSCE evaluation strategies.

[Construction and Application of Innovative Education Technology Strategies in Nursing].

The evolution of information and communication technologies has deeply impacted education reform, promoted the development of digital-learning models, and stimulated the development of diverse nursing education strategies in order to better fulfill needs and expand in new directions. The present paper introduces the intelligent-learning resources that are available for basic medical science education, problem-based learning, nursing scenario-based learning, objective structured clinical examinations, and other similar activities in the Department of Nursing at Chang Gung University of Science and Technology. The program is offered in two parts: specialized classroom facilities and cloud computing / mobile-learning. The latter includes high-fidelity simulation classrooms, online e-books, and virtual interactive simulation and augmented reality mobile-learning materials, which are provided through multimedia technology development, learning management systems, web-certificated examinations, and automated teaching and learning feedback mechanisms. It is expected that the teaching experiences that are shared in this article may be used as a reference for applying professional wisdom teaching models into nursing education.

Performance evaluation of nursing students following competency-based education.

BACKGROUND: Competency-based education is known to improve the match between educational performance and employment opportunities. OBJECTIVES: This study examined the effects of competency-based education on the learning outcomes of undergraduate nursing students. DESIGN: The study used a quasi-experimental design. PARTICIPANTS: A convenience sample of 312 second-year undergraduate nursing students from northern and southern Taiwan participated in the study. METHODS: The experimental group (n=163) received competency-based education and the control group received traditional instruction (n=149) in a medical-surgical nursing course. Outcome measures included students' scores on the Objective Structured Clinical Examination, Self-Evaluated Core Competencies Scale, Metacognitive Inventory for Nursing Students questionnaire, and academic performance. RESULTS: Students who received competency-based education had significantly higher academic performance in the medical-surgical nursing course and practicum than did the control group. Required core competencies and metacognitive abilities improved significantly in the competency-based education group as compared to the control group after adjusting for covariates. CONCLUSIONS: Competency-based education is worth implementing and may close the gap between education and the ever-changing work environment.

Monitoring patient-centered outcomes through the progression of breast reconstruction: a multicentered prospective longitudinal evaluation.

Studies have shown that having breast reconstruction has a positive influence on patient satisfaction and health-related quality of life (HRQoL) at the conclusion of treatment. However, no study has critically evaluated changes to these patient-reported outcomes during the process of undergoing breast reconstruction. This study was to prospectively evaluate changes to patient-centered metrics through the progression of breast reconstruction. An IRB-approved prospective, multi-institutional study was performed for all patients undergoing breast reconstruction between 2009 and 2011. The Breast-Q reconstruction questionnaire was used for evaluation of HRQoL and was administered at five intervals in the perioperative period. Longitudinal evaluation was performed to assess changes to HRQoL metrics during this perioperative interval. One hundred and ten patients were enrolled, and 100 patients (91.9 %) completed appropriate follow-up. Preoperative HRQoL scores were higher in patients electing to forgo reconstruction (P < 0.004), while postoperative HRQoL scores consistently deteriorated at multiple time points following mastectomy as compared to reconstructed patients. On subgroup analysis, results indicated lower initial HRQoL scores in delayed reconstruction (P < 0.05) as compared to immediate reconstruction. These scores did, however, merge at approximately 9 months postoperatively. Changes to HRQoL outcomes occur through progression of breast reconstruction. Within the first year of surgery, early decreases are mirrored by significant increases at later time points above baseline levels when evaluating most forms of reconstruction. Choosing against reconstruction will likely result in continued deterioration of HRQoL for patients undergoing cancer surgery, but steady improvements can be expected if delayed reconstruction is chosen.

Simultaneous scarless contralateral breast augmentation during unilateral breast reconstruction using bilateral differentially split DIEP flaps.

BACKGROUND: : Simultaneous contralateral augmentation is performed with unilateral breast reconstruction to achieve pleasing and symmetric breast mounds. This prospective study investigated the outcome of simultaneous scarless contralateral augmentation with unilateral breast reconstruction using bilateral differentially split deep inferior epigastric perforator (DIEP) flaps. METHODS: : Between August of 2009 and May of 2010, six patients with a mean age of 46.2 ± 7 years underwent unilateral breast reconstruction and simultaneous contralateral augmentation using bilateral differentially split DIEP flaps. The ipsilateral internal mammary vessels served as the recipient vessels for the reconstruction split flap. The pedicle of the augmentation split flap was anastomosed to that of the reconstruction split flap in a flow-through manner. The augmentation split flap was inset through the midline with endoscopic assistance. The Modified BREAST-Q questionnaire was administered preoperatively and at the 1- and 3-month follow-up visits. RESULTS: : All flaps survived, giving a success rate of 100 percent. One reconstruction split flap required reexploration and was salvaged successfully. Mean flap weights used for reconstruction and augmentation were 410 ± 145 and 192 ± 58 g, respectively. At a mean follow-up of 12.7 ± 3.6 months, all patients were satisfied with the outcome of both reconstructed and augmented breast mounds. There were statistical improvements in breast satisfaction (p = 0.004), psychosocial function (p = 0.000), and sexual well-being (p = 0.004) postoperatively, as assessed by the Modified BREAST-Q. CONCLUSION: : Simultaneous scarless contralateral breast augmentation can be performed safely during unilateral breast reconstruction using bilateral differentially split DIEP flaps with satisfactory outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE: : Therapeutic, IV.

The efficacy of acupoint stimulation for the management of therapy-related adverse events in patients with breast cancer: a systematic review.

The aim of the present study was to scrutinize the evidence on the use of acupoint stimulation for managing therapy-related adverse events in breast cancer. A comprehensive search was conducted on eight English and Chinese databases to identify clinical trials designed to examine the efficacy of acupressure, acupuncture, or acupoint stimulation (APS) for the management of adverse events due to treatments of breast cancer. Methodological quality of the trials was assessed using a modified Jadad scale. Using pre-determined keywords, 843 possibly relevant titles were identified. Eventually 26 papers, 18 in English and eight in Chinese, satisfied the inclusion criteria and entered the quality assessment stage. The 26 articles were published between 1999 and 2008. They assessed the application of acupoint stimulation on six disparate conditions related to anticancer therapies including vasomotor syndrome, chemotherapy-induced nausea and vomiting, lymphedema, post-operation pain, aromatase inhibitors-related joint pain and leukopenia. Modalities of acupoint stimulation used included traditional acupuncture, acupressure, electroacupuncture, and the use of magnetic device on acupuncture points. Overall, 23 trials (88%) reported positive outcomes on at least one of the conditions examined. However, only nine trials (35%) were of high quality; they had a modified Jadad score of 3 or above. Three high quality trials revealed that acupoint stimulation on P6 (NeiGuang) was beneficial to chemotherapy-induced nausea and vomiting. For other adverse events, the quality of many of the trials identified was poor; no conclusive remarks can be made. Very few minor adverse events were observed, and only in five trials. APS, in particular acupressure on the P6 acupoint, appears beneficial in the management of chemotherapy-induced nausea and vomiting, especially in the acute phase. More well-designed trials using rigorous methodology are required to evaluate the effectiveness of acupoint stimulation interventions on managing other distress symptoms.