Exploring dialogue in virtual simulation in nursing education - An observational study.

Objectives: Simulation is an important learning activity in nursing education. There is little knowledge about dialogue and communication between students and facilitators in a virtual simulation setting. The current study, conducted in Norway, explores the dialogic teaching approaches applied by facilitators in a virtual classroom and adapt an analytic tool from a physical classroom in lower education to a virtual classroom in higher education. Methods: Sixteen virtual simulation sessions of groups with nursing students were video-taped. The videos were coded with a coding scheme developed for physical classrooms and adapted to the virtual setting. The dialogic approaches from the facilitator were analysed using descriptive analysis. Results: The most frequently used approaches from the facilitator were categorised as asking ("Big questions") and listening ("Wait time after a question"). The most frequent pattern seen in the use of dialogic approaches fall under the category listening. Conclusions: The coding scheme is suitable to analyse facilitators' dialogic approaches in a virtual setting in nursing education. Further research should examine how the facilitator can strategically deploy dialogic approaches in other types of simulations with students. Innovation: The coding scheme was developed from lower to higher education, and from a physical to a virtual setting.

Being a patient in the intensive care unit: a narrative approach to understanding patients' experiences of being awake and on mechanical ventilation.

PURPOSE: Intensive care patients often struggle to communicate due to the technical equipment used for mechanical ventilation and their critical illness. The aim of the study was to achieve a deeper understanding of how mechanically ventilated intensive care patients construct meaning in the unpredictable trajectory of critical illness. METHODS: The study was a part of a larger study in which ten patients were video recorded while being in the intensive care. Five patients engaged in interviews about their experiences from the intensive care stay after being discharged and were offered the possibility to see themselves in the video recordings. A narrative, thematic analysis was applied to categorize the patients' experiences from the intensive care. RESULTS: A pattern of shared experiences among intensive care patients were identified. Three main themes capture the patient's experiences: 1) perceiving the intensive care stay as a life-changing turning point, 2) being dependent on and cared for by others, and 3) living with negative and positive ICU experiences. CONCLUSION: The patients' narratives revealed how being critically ill affected them, and how they understood their experiences in relation to themselves and their surroundings. The results can be used to pose important questions about our current clinical practice.

Educating nursing students for sustainable future rural health-care services: An umbrella review.

BACKGROUND: Rural nursing education stands as a way to contribute to a sustainable nurse workforce in rural areas. Different approaches to organizing rural nursing education are described in the existing literature. OBJECTIVE: To explore scientific reviews about rural nursing education and synthesize current knowledge as "best practice" recommendations for rural nursing education regarding the required organization of rural nursing education programs, what are the competencies required to function as a nurse in rural health-care settings, and the key environmental features for learning in rural nursing education programs. DESIGN: An umbrella review. PARTICIPANTS: Nursing students, newly graduated nurses, and clinical supervisors involved in nursing education in rural areas. DATA SOURCES: A systematic literature search was conducted. Of the 276 review articles found, 93 were screened by title and abstract and 27 were screened in full text. The period searched was 2000-2022, and the literature search was peer-reviewed and published. REVIEW METHODS: The Joanna Briggs Institute (JBI) methodology for umbrella reviews guided the design, search, and the reporting of the findings of the included reviews. Four reviewers screened for inclusion and exclusion using Covidence in a double blinded process. The analysis was guided by the JBI guidelines for umbrella review syntheses. Two reviewers conducted the analysis. RESULTS: Sixteen reviews were included; eight scoping reviews, six integrative reviews, one narrative review, and one rapid review. The synthesis of current evidence provides the following "best practice" suggestions: (a) fostering context-sensitive and collaboratively designed education environments is recommended; (b) integrating curricula tailored for the nursing role and rural practice is recommended (c) establishing a supportive learning environment that encourages students' motivation and academic success; and (d) clinical placements in locally developed learning settings address the educational needs required for practice in the rural workforce. CONCLUSIONS: Rural nursing education needs to be properly aligned with the context and health-care development, to educate nurses who can meet the community's needs today and in the future. A well-functioning collaboration between university faculty and local community stakeholders in a co-creation process stands out as vital to build a sustainable, flexible, rural nursing education program. TWEETABLE ABSTRACT: Umbrella review: Flexible, co-created education might be "best practice" in rural undergraduate nursing programs.

Exploring facilitation in virtual simulation in nursing education: A scoping review.

Objective: To systematically map existing research regarding the reflective feedback in virtual simulation in undergraduate nursing education. Methods: A scoping review was conducted based on the Arksey and O'Malley framework and the PRISMA-ScR. Results: We included 41 studies from 15 different countries. The simulation interventions allowed for interaction between the student and the virtual patient, the software, faculty, peers, or a combination of two or more of these. Students valued reflective feedback during and after the simulation. Conclusions: Our review emphasizes the importance of a human in the loop. Feedback before, during, and after the simulation is possible in virtual simulation where the facilitator can pause the virtual scenario and stimulate reflections during the simulation to obtain deep learning. Virtual simulation provides opportunities to give feedback from the software, such as cues or direct feedback. Innovation: There is a lack of focus on the feedback process and there is a need to revitalize the role of facilitators in a virtual simulation to determine their relative contribution in this process. Several studies reported the usefulness or the effect of virtual simulation on learning processes, but most lacked emphasis on investigating the significance of including a human in the loop.

Practice education facilitators perceptions and experiences of their role in the clinical learning environment for nursing students: a qualitative study.

BACKGROUND: Clinical placement is recognised as essential for nursing students' development of clinical competence. However, difficulties in providing supportive clinical learning environments are a well-known challenge in nursing education. In Norway, the use of nurse educators in joint university and clinical roles has been recommended as an initiative to strengthen the clinical learning environment and enhance the educational quality. In this study we use the term practice education facilitator in a generic sense for these roles. The aim of this study was to explore how practice education facilitators can contribute to strengthen the clinical learning environments for nursing students. METHODS: This study has a qualitative explorative design with a purposive sample of practice education facilitators affiliated to three different universities located in southeast, mid-, and northern Norway. Individual in-depth interviews with 12 participants were conducted during spring 2021. RESULTS: A thematic analysis resulted in four themes: "coherence between theory and practice"; "student support and guidance during placement"; "supporting the supervisors to support the students" and "factors influencing the practice education facilitators' performance in their role". The participants experienced that the practice education facilitator role contributed to strengthened clinical learning environments. However, their performance in the role was found to be contingent upon factors such as time allocated for the role, personal and professional attributes of the post holder, and a common understanding within the organisations regarding practice learning and role remits for the practice education facilitator. CONCLUSIONS: Findings indicate that the practice education facilitator role can be a valuable resource for clinical supervisors and nursing students in clinical placement. Moreover, nurse educators who are familiar with the clinical area, and who are insiders in both settings, are ideally placed to contribute to bridge the theory-practice gap. The benefits of using these roles, however, were influenced by personal attributes of the post holder, time allocated for the role and the number of practice education facilitators positions, and management anchorage. Thus, to achieve the full potential of these roles, efforts to reduce these barriers should be considered.

Newly graduated nurses use and further development of assessment skills-An in-depth qualitative study.

AIMS: To explore in-depth nurses' use and further development of assessment skills in different nursing contexts in the first 2 years after graduation, and factors that influenced their use and development of assessment skills. DESIGN: The study had explorative qualitative design. METHODS: Eight nurses who previously had been interviewed about their learning of physical assessment skills in clinical rotation as students participated in this follow-up study. Individual in-depth interviews were conducted, where the nurses spoke freely about their experiences after graduation. RESULTS: Four prominent features influencing the nurses' use and development of assessment skills were identified: (a) assessment approaches and readiness for practice, (b) the primacy of communication, (c) recognition related to performing assessments, and (d) the influence of organizational factors on their assessment applications. CONCLUSION: Newly graduated nurses' use of assessment skills is an important part of providing holistic care. This study suggest that assessment skills is not only an assessment task but is central in relationship building and in supporting the professional development of nursing competence. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution, due to study design.

Factors associated with changes in students' self-reported nursing competence after clinical rotations: a quantitative cohort study.

BACKGROUND: The quality of nursing care in different healthcare contexts can be associated with the level of available nursing competence. Physical assessment skills are vital in nurses' assessment of patient care needs. However, in nursing education, using physical assessment skills is challenging for nursing students who struggle to apply these skills comprehensively in a clinical rotation. Therefore, this study explores changes in nursing competence, factors associated with changes after clinical rotations, and whether a Suite of Mobile Learning Tools supports changes in confident use of basic physical assessment skills. METHODS: A quantitative cohort study with an explorative pre-and post-test design. During autumn 2019 and spring 2020, 72 s-year nursing students and 99 third-year students participated in the study. The Nurse Professional Competence scale short form was used to investigate students' self-reported changes in nursing competence, and a study-specific questionnaire was used to investigate students' confidence concerning performing physical assessments. The students voluntarily used the Suite of Mobile Learning Tools for the learning of physical assessment. Linear regression analysis was used to identify factors associated with changes in nursing competence after clinical rotation. The STROBE guidelines for cohort studies were followed for study reporting. RESULTS: After the clinical rotation, both student groups reported changes in nursing competence and confidence in performing physical assessment skills, with statistically significant moderate or large changes in all areas. The Suite of Mobile Learning Tools was evaluated as being useful for learning physical assessment. The regression analysis showed that confidence in performing physical assessment skills, the usefulness of the Suite of Mobile Learning Tools, and a higher nursing competence at the start of clinical rotation were positively associated with overall nursing competence. CONCLUSION: Basic physical assessment skills are an important component of nursing competence and can be considered one of the pillars of person-centered care, as proposed by the Fundamentals of Care framework. Spaced repetition and access to digital resources are suggested pedagogical approaches to enhance student confidence in the use of assessment skills within academic and clinical contexts.

Understanding the role of positive emotions in healthcare communication - A realist review.

AIM: To explore how the expression of positive emotions during the interaction between patients and providers can cultivate the patient-provider relationship. DESIGN: We conducted a realist review guided by the Realist and Meta-narrative Evidence Syntheses: Evolving Standards. METHODS: We systematically searched CINAHL, MEDLINE, PsychINFO and Scopus from inception to March 2019. Study selection and data extraction were performed blinded in pairs. From 3146 abstracts blinded in pairs, 15 papers were included and analysed. From each included paper, we extracted contexts, mechanisms and outcomes that were relevant to answer our research questions, creating a configuration between these elements (CMO configuration). RESULTS: Our findings suggest that in the contexts of person orientation and positive outlook, patient-provider relationships improve by communication conveying and eliciting positive emotions. We found six underlying mechanisms for this that form either direct or indirect pathways between the context and the outcome.

Communication with mechanically ventilated patients in intensive care units: A concept analysis.

AIMS: The aim of this study was to perform a concept analysis of communication with mechanically ventilated patients in intensive care units and present a preliminary model for communication practice with these patients. DESIGN: The Im & Meleis approach for concept analysis guided the study. SEARCH METHODS: A literature search was performed in January 2022 in MEDLINE, Embase, CINAHL, psycINFO and Scopus, limited to 1998-2022. The main medical subject headings search terms used were artificial respiration, communication and critical care. The search resulted in 10,698 unique references. REVIEW METHODS: After a blinded review by two authors, 108 references were included. Core concepts and terminology related to communication with mechanically ventilated patients were defined by content analytic methods. The concepts were then grouped into main categories after proposing relationships between them. As a final step, a preliminary model for communication with mechanically ventilated patients was developed. RESULTS: We identified 39 different phrases to describe the mechanically ventilated patient. A total of 60 relevant concepts describing the communication with mechanically ventilated patients in intensive care were identified. The concepts were categorized into five main categories in a conceptual map. The preliminary model encompasses the unique communication practice when interacting with mechanically ventilated patients in intensive care units. CONCLUSION: Highlighting different perspectives of the communication between mechanically ventilated patients and providers through concept analysis has contributed to a deeper understanding of the phenomena and the complexity of communication when the patients have limited possibilities to express themselves. IMPACT: A clear definition of concepts is needed in the further development of guidelines and recommendations for patient care in intensive care, as well as in future research. The preliminary model will be tested further. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution, as this is a concept analysis of previous research.

The use of practice education facilitators to strengthen the clinical learning environment for nursing students: A realist review.

BACKGROUND: Research suggests that the interventions of practice education facilitators, who liaise between the higher education institution and the clinical placement sites, may strengthen the clinical learning environment for nursing students. However, there is a lack of evidence concerning the value of these roles in nursing education. OBJECTIVE: The objective of this study was to explore how, under what circumstances and why the practice education facilitator role can strengthen the clinical learning environment for nursing students. DESIGN: A realist review was conducted to understand the contextual factors and mechanisms that support or hinder the capacity of the practice education facilitator to strengthen the clinical learning environment for nursing students. SETTING: The settings are clinical areas where nursing students are directly involved with patient care. PARTICIPANTS: The participants comprised academic and clinical staff involved in clinical nursing education. METHODS: This realist review was conducted in three overlapping and iterative phases: (1) the development of an initial programme theory explaining how the practice education facilitator role is thought to strengthen the clinical learning environment; (2) structured searches, screening and data extraction; and (3) analysis and synthesis to develop and refine the programme theory. RESULTS: The review included 27 research papers. Evidence from these studies led to the development of five context-mechanism-outcome configurations that explain how, under what circumstances and why practice education facilitators can (or can fail to) strengthen the clinical learning environment. Factors such as practice education facilitators' visibility and accessibility in the clinical area and their clinical credibility were found to influence whether clinical supervisors took the opportunity to seek support and guidance from them. Moreover, ward culture regarding student learning and opportunities to prepare for the role were found to influence clinical supervisors' motivation to carry out the functions of the role and develop professionally; this in turn further influenced whether they used the resources provided by the practice education facilitator. CONCLUSIONS: Theory-based explanations of how, under what circumstances and why the practice education facilitator role may strengthen the clinical learning environment of nursing students may support further development of this role in the future.

Nursing students' development of using physical assessment in clinical rotation-a stimulated recall study.

BACKGROUND: The overall aim of this study was to explore third-year bachelor nursing students' stimulated recall reflections on their physical assessment competence development. The choice of learning strategies in nursing education seems to have great impact on nursing students' use of physical assessment skills while in clinical rotation. There is a need to explore nursing students' learning processes related to the use of physical assessments. METHODS: Explorative qualitative design using a triangulation of data collection methods. Nine final-year nursing students' physical assessment performances during patient encounters were audio-taped and observed. Shortly after, an individual stimulated recall interview based on the audio-recorded patient encounter and observation notes was conducted. A two-fold analysis was conducted: 1) analysis of students' performed assessments, and 2) phenomenological hermeneutical analysis of the stimulated recall interviews. RESULTS: Nursing students assessments shifted from a checklist approach to a symptom-based, more holistic and person-centred approach, emphasizing conversation as part of their assessments. The nursing students also reported that a safe and stimulating learning environment was a prominent feature for their continuing development. Learning from skilled role models with expectations to them using physical assessment skills facilitated their continuing skills appliance, interprofessional communication and reflective practice. CONCLUSIONS: This study contribute with a novel, comprehensive and in-depth description of what influenced nursing students' learning processes experiences of using physical assessment skills during clinical rotation. The results reveal the need for targeted course designs by implementing scaffolded learning activities in practical and theoretical courses aimed at strengthening students' learning of physical assessment skills-building upon and emphasizing their prior knowledge and competence, which may lead to more confident registered nurses and promote patient safety in different health care contexts. We propose using stimulated recall systematically as a novel reflective learning activity in nursing education to foster clinical reasoning and metacognition skills and achieve deep learning.

The value of a redesigned clinical course during COVID-19 pandemic: an explorative convergent mixed-methods study.

BACKGROUND: The COVID-19 lockdown in March 2020 had a significant consequence for nursing students worldwide including limited access to learning situations in clinical rotation. Therefore, this study aims to explore how an innovative redesign of a clinical course in a time of pandemic supported nursing students in learning the fundamentals of care in their first year. The redesign involved the transformation of a traditional hands-on clinical course into a technology-enhanced learning environment. DESIGN: This was an explorative convergent mixed-methods study using both quantitative and qualitative methods. METHODS: Twenty-four first-year nursing students responded to an online questionnaire with open-ended questions. Two nursing students and one faculty member participated in individual online interviews, and three faculty members participated in an online focus group interview. All the data were collected in June 2020. The quantitative data were analyzed using descriptive statistics and the qualitative data using content analysis. The GRAMMS guideline was applied. RESULTS: The students achieved the learning outcomes regarding fundamental care, basic physical assessment skills, and clinical reasoning with the help of academic assignments, multimedia learning resources, and virtual patients. Further, six central aspects of the facilitator role in the virtual simulation were identified. The aspect that was considered most valuable involved uncovering the "red thread" between different areas of knowledge in the first year of nursing education; this supported the students to better understand how to think and talk like a nurse. CONCLUSION: This study offers insight into how a technology-enhanced clinical course can foster the learning of fundamental nursing care, basic physical assessment skills, and clinical reasoning skills; enhancing students' preparedness for clinical hours. Virtual patients' scenarios contributed to integrating different types of knowledge and skills that are important when providing nursing care for patients in clinical practice. This study also highlighted a gap in pedagogical competence among faculty members with regards to facilitating learning in a technology-enhanced learning environment. Study findings suggest promising pedagogical strategies that should be further developed post-pandemic, in response to the call for a renewal of nursing education using more technologically supported learning designs.

Caught between ideals and reality: Phenomenological-hermeneutic study of healthcare providers' experiences while interacting with mechanically ventilated patients.

This study aimed to explore healthcare providers' experiences of their communication and interaction with conscious patients on mechanical ventilation in intensive care. Nurses, physicians, and physiotherapists were interviewed after they had been video recorded in naturally occurring interactions with patients. The interviews were analyzed using a phenomenological-hermeneutical approach. Three themes were identified: The willingness to engage and understand the mechanically ventilated patient, the potential risk of neglecting the patient in the encounters, and provider interdependence as the core of intensive care. The themes elicited how providers handled the dissonance between their own personal ideals of care and their real-world encounters with patients and other professionals. The healthcare providers were aware of how easily patients could be neglected while being non-vocal, and therefore invested time and effort communicating with the patients. Based on their personal ideals of patient participation and autonomy, it was difficult to perform procedures, such as weaning off the ventilator or mobilization, to which the patient was opposed. Interprofessional collaboration was valued by the providers in such situations. The study revealed that providers need to consider the communication barriers that exist on the individual and team levels when interacting with patients on mechanical ventilation.

Effects of Physicians' Information Giving on Patient Outcomes: a Systematic Review.

BACKGROUND: Providing diagnostic and treatment information to patients is a core clinical skill, but evidence for the effectiveness of different information-giving strategies is inconsistent. This systematic review aimed to investigate the reported effects of empirically tested communication strategies for providing information on patient-related outcomes: information recall and (health-related) behaviors. METHODS: The databases MEDLINE, Embase, PsycINFO (Ovid), Cochrane Central Register of Controlled Trials, and relevant bibliographies were systematically searched from the inception to April 24, 2020, without restrictions, for articles testing information-giving strategies for physicians (PROSPERO ID: CRD42019115791). Pairs of independent reviewers identified randomized controlled studies with a low risk of selection bias as from the Cochrane risk of bias 2 tool. Main outcomes were grouped into patient information recall and behavioral outcomes (e.g., alcohol consumption, weight loss, participation in screening). Due to high heterogeneity in the data on effects of interventions, these outcomes were descriptively reported, together with studies', interventions', and information-giving strategies' characteristics. PRISMA guidelines were followed. RESULTS: Seventeen of 9423 articles were included. Eight studies, reporting 10 interventions, assessed patient information recall: mostly conducted in experimental settings and testing a single information-giving strategy. Four of the ten interventions reported significant increase in recall. Nine studies assessed behavioral outcomes, mostly in real-life clinical settings and testing multiple information-giving strategies simultaneously. The heterogeneity in this group of studies was high. Eight of the nine interventions reported a significant positive effect on objectively and subjectively measured patients' behavioral outcomes. DISCUSSION: Using specific framing strategies for achieving specific communication goals when providing information to patients appears to have positive effects on information recall and patient health-related behaviors. The heterogeneity observed in this group of studies testifies the need for a more consistent methodological and conceptual agenda when testing medical information-giving strategies. TRIAL REGISTRATION: PROSPERO registration number: CRD42019115791.

Nursing students' experiences of virtual simulation when using a video conferencing system - a mixed methods study.

OBJECTIVES: There is limited knowledge about students' experiences with virtual simulation when using a video conferencing system. Therefore, the aim of this study was to explore how second-year undergraduate nursing students experienced learning through virtual simulations during the COVID-19 pandemic. METHODS: The study had an exploratory design with both quantitative and qualitative approaches. In total, 69 nursing students participated in two sessions of virtual simulation during spring 2020, and 33 students answered online questionnaires at session 1. To further explore students' experiences, one focus group interview and one individual interview were conducted using a video conferencing system after session 2. In addition, system information on use during both sessions was collected. RESULTS: Changes in the students' ratings of their experiences of virtual simulation with the Body Interact™ system were statistically significant. The virtual simulation helped them to bridge gaps in both the teaching and learning processes. Four important aspects of learning were identified: 1) learning by self-training, 2) learning from the software (Body Interact™), 3) learning from peers, and 4) learning from faculty. CONCLUSIONS: We conclude that virtual simulation through a video conferencing system can be useful for student learning and feedback from both peers and faculty is important.

Advancing communication skills in intensive care: Caring for relatives of critically ill patients.

OBJECTIVE: The aim of this study was to explore critical care nursing students' experiences with simulation-based communication skills training focusing on relatives. METHODS: Two complex scenarios were developed using professional actors in the role as relatives. A survey was conducted with critical care nursing students from 2017 to 2020. We performed descriptive and correlational analysis of the quantitative data and thematic analysis of the open-ended questions. RESULTS: The total learning outcome was 4.10 (SD = 0.79, N = 98) on a Likert scale from 1 to 5. The learning outcome with the use of a professional actor was 4.65 (SD = 0.6, N = 118), and the experience of realism was 4.16 (SD = 0.85, N = 67). The students rated the debriefing as 4.38 (SD = 0.73, N = 118), and they experienced more positive emotions than negative during the simulation. CONCLUSION: High learning outcomes were reported. The use of professional actors with fine-tuned improvisational skills enhanced the sense of realism in the scenarios. However, the impact of emotions on learning outcomes should be further investigated. PRACTICE IMPLICATIONS: By obtaining advanced communication skills focusing on relatives during their nursing education, critical care nursing students can improve the care they give.

Older persons' expressed worries during nursing care at home: Do health complexity and nature of nursing care in the visit matter?

OBJECTIVE: Older persons receiving home care express more cues and concerns compared to other clinical contexts. Increased health condition complexity requires a corresponding increase in nursing competence. The aim of this study was to explore how complexity of older persons' health and nature of the visit influenced their expressed worries. METHODS: In this cross-sectional explorative study, we analysed older persons' expressed worries (n = 508) identified by the Verona Coding Definitions of Emotional Sequences (VR-CoDES) in 129 audio-recorded home care visits with older persons (≥65 years), collected in 3 city districts and 1 rural area in Norway. RESULTS: Expressed worries of 45 older persons were included in the analysis: 18 had low health complexity, 5 moderate and 22 high health complexity. The nature of the visit affected the number of expressed worries, health complexity did not. Most of the worries were expressed during basic nursing care visits and/or medication administration. CONCLUSION: Findings suggest that home visit type may influence the older persons' expressed worries. The complexity of the older persons' health condition seems to have little impact on the expressed worries. PRACTICE IMPLICATIONS: Knowledge about communication in different complexity of visits is important when planning care for older persons.

Training interventions for healthcare providers offering group-based patient education. A scoping review.

OBJECTIVES: To provide overview of research on training interventions for healthcare providers aimed at promoting competencies in delivering group-based patient education. METHODS: A systematic literature search identified relevant studies. Data was extracted on training details, study design, outcomes and experiences. Results were summarized and qualitative data analyzed using content analysis. RESULTS: Twenty-seven studies exploring various training interventions were included. Ten studies used qualitative methods, eight quantitative and nine mixed methods. Use of a comparison group, validated instruments and follow-up measures was rare. Healthcare providers' reactions to training were mostly positive. Several studies indicated positive short-term effects on self-efficacy and knowledge. Results on observed skills and patient outcomes were inconclusive. Results on healthcare providers' experience of delivery of group-based patient education following training were categorized into 1) Benefits of training interventions, 2) Barriers to implementation and 3) Delivery support. CONCLUSIONS: Further evaluation of training for healthcare providers delivering group-based patient education is needed before conclusions on training efficacy can be drawn. The results indicate an expanding research field still in maturation. PRACTICE IMPLICATIONS: Efficacy studies evaluating theoretically grounded training with clear attention on group facilitation and follow-up support are needed. Inclusion of validated instruments and long-term outcomes is encouraged.

Configuration of Mobile Learning Tools to Support Basic Physical Assessment in Nursing Education: Longitudinal Participatory Design Approach.

BACKGROUND: As many students in higher education are skilled users of mobile technology, mobile learning (mLearning) can be a promising educational strategy to enhance their learning experience. mLearning might also be well suited for nursing students as they navigate between multiple learning contexts in their educational curriculum. As an educational strategy, mLearning may also reduce challenges caused by the theory-practice gap in nursing by supporting skills and knowledge transfer between the university and clinical settings. As the introduction of basic physical assessment skills (B-PASs) into Norwegian bachelor's degree education in nursing occurred quite recently, there is a lack of competence in supervision and teaching in both university and clinical settings. As such, mLearning appears to be a good strategy to support student B-PAS learning and knowledge transfer across learning contexts. OBJECTIVE: This study aims to explore and elicit the perspectives of students regarding the way in which a selection of digital learning resources supports B-PAS learning and application in clinical rotation, which of the selected digital learning resources are beneficial to include in a suite of mLearning tools, and how the selected digital learning resources could support the transfer of skills and knowledge from the academic to clinical context. METHODS: We used a longitudinal participatory design approach to co-design a suite of mLearning tools. The co-design processes took place in several workshops (WSs) over a period of 3 months: 2 WSs with first-year students (n=6), 3 WSs with second-year students (n=6), and 3 WSs with third-year students (n=8). The students evaluated several digital learning resources in both academic and clinical contexts. The digital learning resources included digital simulation with virtual patients, massive open online courses, and multimedia learning material. In the co-design WS, the potential and benefits of these digital learning resources for the learning and application of B-PASs were explored. RESULTS: The students reported that the digital learning resources stimulated learning in 7 different ways. They also emphasized the importance of including all selected and tested digital learning resources. Moreover, students supported the inclusion of additional learning material, such as multiple-choice tests and written assignments, aimed at providing feedback and contributing to knowledge development. CONCLUSIONS: The co-design processes and collaboration with the nursing students provided insight into how a suite of mLearning tools may support the learning and application of B-PASs and human bioscience knowledge in clinical rotation. From the students' perspective, one of the strengths of the suite of mLearning tools was the range of content, as this met a broader range of student learning preferences regarding learning B-PASs. The suite of mLearning tools contributes to and supports skills training and knowledge transfer between multiple learning contexts.