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

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

Enhancing professional competency in clinical procedures using head-mounted display virtual reality - a mixed method study.

BACKGROUND: The maintenance of nursing professional competency is essential to ensure patients' health outcomes. With the current shortage of nursing workforce, a novel approach is necessary to refresh clinical skills and update practice. OBJECTIVE: This study aims to examine the effectiveness of using head-mounted display virtual reality to refresh knowledge and skills and explore nurses' perceptions towards using this technology for refresher training. DESIGN: A pre-test post-test mixed-method experimental design was employed. RESULTS: Participants (n = 88) were registered nurses with a diploma in nursing. The intravenous therapy and subcutaneous injection procedures were implemented using head-mounted display virtual reality. The study showed significant improvement in knowledge for the procedures, cognitive absorption, online readiness, self-directed learning, and motivation for learning. In the qualitative focus group discussions, three themes were identified using thematic analyses: enjoyable way to refresh clinical knowledge; learning outside classroom and limitations in maneuver. CONCLUSION: Using head-mounted display virtual reality is promising in refreshing clinical skills for nurses. Training and refresher courses can explore using this novel technology, which may be a viable alternative to ensure professional competence with reduced manpower and resources used by the healthcare institution.

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

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

Why are physical assessment skills not practiced? A systematic review with implications for nursing education.

BACKGROUND: Physical assessment skills are taught in pre-registration nursing programs to equip nurses with the competencies to provide holistic nursing care. However, only a fraction of the skills they acquired during training are routinely performed in clinical practice thus highlighting a disconnect between learning and practicing. OBJECTIVE: To better understand the issues surrounding the teaching and practice of physical assessment skills among nurses as described in the literature. DESIGN: A systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was used. REVIEW METHOD: A search of databases including PubMed, EMBASE, CINAHL and Scopus was conducted from January 1970 to December 2019. Two independent researchers performed the methodological quality assessment using the Joanna Briggs Institute's Critical Appraisal Checklists. Twenty-one papers, including two qualitative studies, 17 quantitative studies and two mixed methods study, were selected in this review. Data were synthesised narratively. RESULTS: The review identified six overarching themes: (1) role ambiguity, (2) reliance on technology, (3) collegial support and culture, (4) practice variations across specialties, (5) a lack of confidence and knowledge, and (6) over-teaching using biomedical model. CONCLUSION: This review identified the need to improve the teaching of the physical assessment skills. There is also a need to evaluate the physical assessment content taught within nursing curricula, with emphasis on depth rather than breadth of skills. The ability to interpret physical assessment observations and develop clinical judgement need to be incorporated into the curriculum. To aid in the development of an effective care plan, the physical assessment framework should move away from a biomedical framework to include nursing models such as nursing process and clinical reasoning model. This revised framework can be used in future studies in the development and testing of teaching and evaluation tools for physical assessment skills.

The use of the community of inquiry survey in blended learning pedagogy for a clinical skill-based module.

AIM AND OBJECTIVES: The primary aim of this study was to examine the effectiveness of the blended learning pedagogy in a clinical skill-based module using the Community of Inquiry (CoI) framework. The secondary objectives were to assess the effectiveness of blended learning in improving the nursing knowledge, and students' satisfaction with this approach. BACKGROUND: Blended learning is increasingly adopted in education as more online resources are made available for tutors to use for the benefit of their students. That implied a reduction in the face-to-face contact time in replacement for online teaching, which therefore warrants a need to examine the effectiveness of blended learning approach. The application of CoI framework could evaluate the blended learning approach to assist teaching faculty with evidence-based practices on online teaching. DESIGN: This study used the quasi-experimental, pretest-posttest design, and results were presented according to the Transparent Reporting of Evaluations with Nonrandomised Designs (TREND) guidelines. METHODS: This study was conducted in a university and recruited 219 Year 1 nursing students who completed a clinical-based module. RESULTS: The results of the CoI survey found that teaching presence scored the highest mean, followed by cognitive and social presence. The design of the blended learning was effective in enhancing students' knowledge but they only expressed a moderate level of satisfaction. CONCLUSIONS: Blended learning is a feasible pedagogical strategy for a clinical skill-based module. However, further investigation is required to explore the factors and strategies which could improve students' satisfaction. RELEVANCE TO CLINICAL PRACTICE: Blended learning has become one of the contemporary trends in education. Refining teaching strategies may meet the learning needs of today's generation and improve students' learning outcomes.

Wound healing properties of magnesium mineralized antimicrobial nanofibre dressings containing chondroitin sulphate - a comparison between blend and core-shell nanofibres.

The development of antimicrobial nanofibre dressings that can protect the injured tissues from commensal pathogens while promoting tissue regeneration finds enormous potential in plastic and reconstructive surgery practices. To achieve this goal, we investigated the effect of chondroitin sulphate on the morphology, mechanical properties, wettability and biocompatibility of polydopamine crosslinked electrospun gelatin nanofibres containing mineralized magnesium. To extend the durability of dressings, we prepared composite dressings containing polycaprolactone (PCL) and gelatin as blend or core-shell nanofibres. Nanofibre blends presented greater tensile strength and stretchability, while core-shell nanofibres displayed superior photoluminescent properties. In a porcine model of cutaneous burn injury, both the blend and core-shell nanofibre dressings displayed improved re-epithelialization, wound closure and clinical outcome in comparison to untreated burns. Histology of the biopsied tissues indicated smooth regeneration and collagen organization of the burns treated with core-shell nanostructures than untreated burns. This study compared the physico-chemical and biological properties of composite nanofibres that are capable of accelerating burn wound healing and possess antimicrobial properties, highlighting their potential as wound dressings and skin substitutes.

Multifunctional Antimicrobial Nanofiber Dressings Containing ε-Polylysine for the Eradication of Bacterial Bioburden and Promotion of Wound Healing in Critically Colonized Wounds.

Bacterial colonization of acute and chronic wounds is often associated with delayed wound healing and prolonged hospitalization. The rise of multi-drug resistant bacteria and the poor biocompatibility of topical antimicrobials warrant safe and effective antimicrobials. Antimicrobial agents that target microbial membranes without interfering with the mammalian cell proliferation and migration hold great promise in the treatment of traumatic wounds. This article reports the utility of superhydrophilic electrospun gelatin nanofiber dressings (NFDs) containing a broad-spectrum antimicrobial polymer, ε-polylysine (εPL), crosslinked by polydopamine (pDA) for treating second-degree burns. In a porcine model of partial thickness burns, NFDs promoted wound closure and reduced hypertrophic scarring compared to untreated burns. Analysis of NFDs in contact with the burns indicated that the dressings trap early colonizers and elicit bactericidal activity, thus creating a sterile wound bed for fibroblasts migration and re-epithelialization. In support of these observations, in porcine models of Pseudomonas aeruginosa and Staphylococcus aureus colonized partial thickness burns, NFDs decreased bacterial bioburden and promoted wound closure and re-epithelialization. NFDs displayed superior clinical outcome than standard-of-care silver dressings. The excellent biocompatibility and antimicrobial efficacy of the newly developed dressings in pre-clinical models demonstrate its potential for clinical use to manage infected wounds without compromising tissue regeneration.

Cord Lining Mesenchymal Stem Cells Have a Modest Positive Effect on Angiogenesis in Hindlimb Ischemia.

Purpose: We investigated the use of human Cord Lining Mesenchymal Stem Cells (CL-MSCs) (US Patent number 9,737,568), in a rabbit hindlimb ischemia model, and evaluated their potential in stimulating neovascularization. Allogenic human CL- MSCs could potentially be used to treat patients with lower limb ischemia and non-healing wounds. Methods: Twenty rabbits were divided into two separate groups. We created a hindlimb ischemia model surgically. At 21 and 49 days post-operatively, animals in the treatment group were injected with CL-MSCs (500,000 cells per 0.2 ml on each site) at 10 different sites (Quadriceps- 4 sites, Hamstrings- 4 sites and Calf--2 sites) in the hindlimb muscles. The control group received only saline injection to the corresponding sites at the same time point as the treatment group. We then evaluated the effects of treatment on neovascularization by angiography, laser doppler perfusion imaging, as well as by histology. We evaluated the tissue samples for any signs of local immune reaction to the cell implantation. We also observed the rabbit clinically for any adverse effects after treatment. Results: We found a higher number of CD31 positive cells in the treatment group, with a greater number of capillaries found in the treated muscles. The Rectus Femoris demonstrated a median vessel count/muscle fiber of 0.121 for the treatment group, compared to 0.076 in the control group (median difference 0.04; 95% CI 0.001-0.11; p = 0.041). The Gastrocnemius demonstrated a median vessel count/muscle fiber of 0.175 for the treatment group, compared to 0.089 in the control group (median difference 0.087; 95% CI -0.006 to 0.234; p = 0.07). Blood perfusion quantification through Laser Doppler Perfusion Imaging (LDPI) also demonstrated a non-statistically significant increase in perfusion in favor of the treatment group. CL-MSCs demonstrated no toxicity associated morbidity and minimal local immune reaction to implantation. Conclusion: CL-MSCs have a positive effect on angiogenesis in a rabbit hindlimb ischemia model. This preliminary data is encouraging and paves the way for future large animal studies or for clinical trials.

Factors influencing medication adherence in patients with gout: A descriptive correlational study.

AIMS AND OBJECTIVES: To examine the factors influencing adherence to urate-lowering therapy in patients with gout in Singapore. BACKGROUND: Gout is the most common type of chronic inflammatory arthritis. Urate-lowering therapy is used to treat gout by reducing serum uric acid levels. However, adherence to urate-lowering therapy among patients remains poor. To date, there have been no available studies based on a conceptual framework that examined factors influencing medication adherence in patients with gout. DESIGN: Cross-sectional, descriptive correlational study. METHODS: A convenience sample of outpatients (n = 108) was recruited between October 2014-January 2015 from a tertiary hospital in Singapore. Outcomes were measured by relevant valid and reliable instruments. Descriptive statistics and parametric tests including multiple linear regression were used to analyse the data. RESULTS: Although 44.4% of the participants were high adherers to urate-lowering therapy, the mean adherence level was moderate. Significant differences in medication adherence scores were found among the subgroups of gender, ethnicity, marital status, employment status and presence of comorbidity. Medication adherence was positively significantly correlated with age, number of comorbidities and beliefs about medicines. Linear regression showed that higher level of beliefs about medicines, presence of comorbidity and being married were factors positively influencing medication adherence. CONCLUSIONS: This study revealed moderate adherence to urate-lowering therapy in patients with gout in Singapore, indicating the need for strategies to improve adherence by considering its main influencing factors. Future research should be conducted to develop interventions targeted at modifying patients' beliefs about medicines in order to improve medication adherence. RELEVANCE TO CLINICAL PRACTICE: Findings from this study allow healthcare providers to quickly and easily identify patients who may have low adherence. Nurses should take the lead in educating patients on the mechanism of urate-lowering therapy and highlight the importance of adhering to it.

Self-efficacy and depression predicting the health-related quality of life of outpatients with chronic heart failure in Singapore.

BACKGROUND: Chronic heart failure (CHF) remains as a debilitating disease that has high mortality among adults worldwide. CHF negatively impacts an individual's health-related quality of life (HRQoL), but only few studies have investigated such an impact in the Asian population. AIMS: This study aims to investigate the HRQoL of outpatients with CHF and identify its predictors among this group of patients in Singapore. METHODS: This was a cross-sectional, descriptive correlational study. A convenience sampling of 121 outpatients with CHF was recruited from a public hospital over 5 months. The Minnesota Living with Heart Failure Questionnaire (MLHFQ), Short Form-Cardiac Depression Scale, Cardiac Self-Efficacy Scale, and Medical Outcomes Study Social Support Survey were used to measure the study variables. RESULTS: There were significant differences in the HRQoL as assessed using the MLHFQ between gender, educational level, and primary caregiver status (p<0.05). Self-efficacy (ß=0.637, p<0.001) and depression (ß=-0.220, p<0.001) were found to be the predictors of the HRQoL in outpatients with CHF, accounting for 67.9% of variance. CONCLUSION: The results of the study indicated that lower levels of self-efficacy and depression predicted poor HRQoL. Nursing care should focus on detecting depressive symptoms in patients with CHF. A program facilitating better self-care is important in CHF management.

Using simulation learning through academic-practice partnership to promote transition to clinical practice: a qualitative evaluation.

AIM: To explore the effect of an innovative simulation education programme on nursing students' transition-to-practice experiences. BACKGROUND: Academic-practice partnership is emerging as an important vehicle for improving nursing students' transition-to-practice. Using existing university resources, academic educators and alumni developed an innovative simulation educational programme known as the Simulated Professional Learning Environment (SIMPLE) to align the educational process with the realities of nursing practice. Educators and alumni collaborated to create and facilitate 15 hours of simulation sessions that comprised the learning platform for the SIMPLE programme. DESIGN: This was a descriptive qualitative study. METHOD: Focus groups were conducted in 2012 with 22 final-year nursing students completing their transition-to-practice clinical practicum. The interview transcripts were analysed using content analysis. RESULTS: Three themes were identified from the analysis: 'experiencing the role of staff nurse'; 'knowing how to'; and 'learning from the 'seniors'. Experiencing the role of staff nurse in the programme showed the nursing students what to expect and how to prepare for their roles. Knowing how to focus on holistic patient care, manage 'difficult' clients and communicate with other healthcare professionals were the learning outcomes gained from the programme. Learning from the 'seniors' about hospital work processes positively influenced the nurses' transition-to-practice experiences. CONCLUSION: This study provides support for introducing the simulation education programme as an enhancement during nursing students' final year to improve their transition-to-practice experiences. A stronger collaborative relationship between academic educators and practising nurses could be further fostered by expanding this learning platform.