The effects of flipped learning and gamification on nursing students' patient safety education: A mixed method study.

Background: The importance of enhancing education to promote nursing students' patient safety competency is increasing. Hence, implementing diverse educational programs and assessing their outcomes is essential. Objectives: To examine the effects of flipped learning and gamification on nursing students' patient safety education. Design: A mixed-method design employing a quasi-experimental design with a pre-post control group design and qualitative thematic analysis. Methods: The study was conducted at a South Korean university in W City from September to December 2022. It included 55 s-year nursing students. The experimental group (n = 28) participated in a 30-h patient safety education course using flipped learning and gamification, whereas the control group (n = 27) received only written patient safety education materials. Learning motivation, collective efficacy, patient safety competency, and game evaluations were measured. Data were analyzed using the χ2 test, Fisher's exact test, t-test, repeated-measures multivariate analysis of covariance, repeated measure analysis of covariance, and generalized estimating equations. Self-reflection journals on game participation experiences were analyzed using qualitative thematic analysis. Results: Learning motivation scores did not differ significantly between groups for time, or interactions between groups and time, but collective efficacy and patient safety competency scores showed significant differences in the interactions between groups and time. The experimental group showed a high satisfaction score in game evaluation. Qualitative analyses were used to extract four themes-three positives: "fun and immersion differentiated from existing classes," "improved the learning outcomes and learning motivation," and "realized the value of collaboration and communication," and one negative: "feeling down due to unfamiliarity." Conclusions: This program creates positive learning experiences and enhances nursing students' collective efficacy and patient-safety competencies. It is expected to be utilized in various future nursing courses.

Impact of Virtual Reality Mental Health Nursing Simulation on Nursing Students' Competence.

Purpose: This study investigates the impact of a Virtual Reality (VR)-based Mental Health Nursing Practice Simulation (MHNPS) on nursing students' competency in caring for individuals with mental disorders. Nursing students often face fear, anxiety, and helplessness during mental health (MH) rotations, impeding the attainment of learning objectives in the MH nursing practicum. Therefore, innovative strategies offering practice opportunities are crucial for their competence development. Methods: Using a one-group pretest-posttest repeated measures experimental design, 50 nursing students, having completed at least one MH theory course but not yet engaged in MH clinical practicum, were enrolled. Data collection occurred from October 30, 2022, to January 6, 2023. The VR simulation included six modules covering delusion, hallucination, mania, geriatric depression, adolescent depression with suicidal ideation, and obsessive-compulsive disorder. Pre-simulation questionnaires and post-simulation surveys were administered through provided links. Data were analyzed using descriptive statistics and paired t-tests to assess changes over time. Results: Immediate and sustained improvements were observed in mental disorder-related nursing knowledge, communication self-efficacy, critical thinking ability, and MH nursing clinical confidence. Attitudes toward mental illness improved significantly post-intervention (t=-2.22, p=0.031), while the problem-solving process exhibited significant enhancement six weeks later (t=3.87, p<0.001). Conclusion: The findings affirm the simulation intervention's effectiveness in enhancing nursing students' knowledge, self-efficacy, critical thinking, and confidence in MH nursing practice, with no compromise to patient safety. Integrating simulation into MH nursing practicum narrows the gap between theory and clinical practice, elevates MH care quality, and instills confidence in nursing students as professionals. Despite potential subject selection bias in this single-group pre-post intervention study, the program's comprehensive impact on knowledge, skills, and attitudes suggests opportunities for expanding psychiatric nursing practice capabilities through subsequent studies. Caution is warranted in interpreting results, but the developed program lays the groundwork for advancing nursing students' capabilities in psychiatric nursing practice.

Types of Empathy Among Certified Caregivers of Older Adults with Dementia.

Purpose: This study identifies the unique phenomena and subjectivity of empathy as exhibited by certified caregivers. Methods: Q-methodology was used to define types and describe the characteristics of empathy in certified caregivers. After in-depth interviews with 10 certified caregivers and a review of the related literature, the final 38 Q-samples were selected by collecting experts' opinions. These Q-samples were sorted by 30 certified caregivers (P-samples). The PC-QUNAL program was used to analyze the Q-sort data. Results: Seven distinctive Q-factors for the empathy of certified caregivers were identified: I. Information-oriented cognition, II. Sensory communication, III. Compassion, IV. Performance-seeking through self-reflection, V. Intuitive empathy, VI. Role-centered sincerity, and VII. Passive obligation. The empathy of certified caregivers caring for older adults with dementia showed various characteristics according to each of their subjective values and judgments. Conclusion: This study's results help identify the empathy types and characteristics of certified caregivers caring for older adults with dementia and may contribute to improving the quality of care.

Factors influencing the learning transfer of nursing students in a non-face-to-face educational environment during the COVID-19 pandemic in Korea: a cross-sectional study using structural equation modeling.

PURPOSE: The aim of this study was to identify factors influencing the learning transfer of nursing students in a non-face-to-face educational environment through structural equation modeling and suggest ways to improve the transfer of learning. METHODS: In this cross-sectional study, data were collected via online surveys from February 9 to March 1, 2022, from 218 nursing students in Korea. Learning transfer, learning immersion, learning satisfaction, learning efficacy, self-directed learning ability and information technology utilization ability were analyzed using IBM SPSS for Windows ver. 22.0 and AMOS ver. 22.0. RESULTS: The assessment of structural equation modeling showed adequate model fit, with normed χ2=1.74 (P<0.024), goodness-of-fit index=0.97, adjusted goodness-of-fit index=0.93, comparative fit index=0.98, root mean square residual=0.02, Tucker-Lewis index=0.97, normed fit index=0.96, and root mean square error of approximation=0.06. In a hypothetical model analysis, 9 out of 11 pathways of the hypothetical structural model for learning transfer in nursing students were statistically significant. Learning self-efficacy and learning immersion of nursing students directly affected learning transfer, and subjective information technology utilization ability, self-directed learning ability, and learning satisfaction were variables with indirect effects. The explanatory power of immersion, satisfaction, and self-efficacy for learning transfer was 44.4%. CONCLUSION: The assessment of structural equation modeling indicated an acceptable fit. It is necessary to improve the transfer of learning through the development of a self-directed program for learning ability improvement, including the use of information technology in nursing students' learning environment in non-face-to-face conditions.

A systematic review and meta-analysis of studies on extended reality-based pediatric nursing simulation program development.

PURPOSE: This systematic literature review and meta-analysis explored extended reality (XR)-based pediatric nursing simulation programs and analyzed their effectiveness. METHODS: A literature search was conducted between May 1 and 30, 2022 in the following electronic databases: MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL. The search period was from 2000 to 2022. In total, 6,095 articles were reviewed according to the inclusion and exclusion criteria, and 14 articles were selected for the final content analysis and 10 for the meta-analysis. Data analysis was performed using descriptive statistics and the Comprehensive Meta- Analysis program. RESULTS: XR-based pediatric nursing simulation programs have increased since 2019. Studies using virtual reality with manikins or high-fidelity simulators were the most common, with six studies. The total effect size was statistically significant at 0.84 (95% confidence interval=0.50-1.19, z=4.82, p<.001). CONCLUSION: Based on the findings, we suggest developing standardized guidelines for the operation of virtual pediatric nursing simulation education and practice. Simultaneously, the application of more sophisticated research designs for effect measurement and the combined applications of various virtual simulation methods are needed to validate the most effective simulation methodology.

Factors Associated with Job Stress among Hospital Nurses: A Meta-Correlation Analysis.

This study aims to investigate research trends concerning job stress among hospital nurses. Articles about job stress among hospital nurses published in English from 2008 to 2018 were searched. In the first search, 2673 articles were extracted from the MEDLINE, EMBASE, KoreaMed, KERIS, KISS, KISTI, and KMbase databases. Altogether, 154 articles were used in the systematic review and meta-analysis. Thirty-nine variables were explored regarding job stress. Among the major variables, insufficient job control, personal conflict, and burnout had a positive correlation. In contrast, intention to stay, job satisfaction, and personal accomplishment had a negative correlation. In the meta-analysis conducted in relation to a specific conceptual framework, the negative-outcome factors showed significant positive correlations with job stress, whereas the positive-outcome factors showed significant negative correlations with job stress. This study identified factors associated with job stress in nurses through a meta-correlation analysis, and the overall correlation coefficient was relatively high at 0.51. Job factors and moderators had significant meta-correlation coefficients. These results can be utilized in clinical practice and research to help develop intervention programs to relieve job stress among nurses.

Nursing Students' Subjective Happiness: A Social Network Analysis.

Improving nursing students' subjective happiness is germane for efficiency in the nursing profession. This study examined the subjective happiness of nursing students by applying social network analysis (SNA) and developing a strategy to improve the subjective happiness of nursing. The study adopted a cross sectional survey to measure subjective happiness and social network of 222 nursing students. The results revealed that the centralization index, which is a measure of intragroup interactions from the perspective of an entire network, was higher in the senior year compared with the junior year. Additionally, the indegree, outdegree, and centrality of the social network of students with a high level of subjective happiness were all found to be high. This result suggests that subjective happiness is not just an individual's psychological perception, but can also be expressed more deeply depending on the subject's social relationships. Based on the study's results, to strengthen self-efficacy and resilience, it is necessary to utilize strategies that activate group dynamics, such as team activities, to improve subjective happiness. The findings can serve as basic data for future research focused on improving nursing students' subjective happiness by consolidating team-learning social networks through a standardized program approach within a curriculum or extracurricular programs.

A Systematic Review and Meta-Analysis of Fall Prevention Programs for Pediatric Inpatients.

Falls account for a high proportion of the safety accidents experienced by hospitalized children. This study aims to analyze the contents and effects of fall prevention programs for pediatric inpatients to develop more adaptable fall prevention programs. A literature search was performed using PubMed (including Medline), Science Direct, CINAHL, Embase, and Cochrane. We included articles published from the inception of each of the databases up to 31 March 2019. A total of 1725 results were reviewed according to the inclusion and exclusion criteria, and nine studies were selected. Data were analyzed using descriptive statistics and the Comprehensive Meta-Analysis program. Four of the nine studies divided their participants into a high-risk fall group and a low-or medium-risk fall group, and all studies used a high-risk sign/sticker as a common protocol guideline for its high-risk fall group. The odds ratio of 0.95 (95% Cl 0.550-1.640) for the fall prevention program in seven studies was not statistically significant. To develop a standardized fall prevention program in the future, randomized control trial studies that can objectively measure the fall rate reduction effect of the integrated fall prevention program need to be expanded.

Factors Affecting Health-Related Quality of Life in Multimorbidity.

We investigated the effect of predisposing, enabling, need factors, and health behaviors on health-related quality of life (HRQoL) of patients with multimorbidity according to Andersen's model. This study is a secondary analysis of population-based cross-sectional surveys. Data from 328 patients with multimorbidity (≥3 co-occurring chronic diseases) from the 6th/7th Korea National Health and Nutrition Examination Surveys were analyzed using logistic regression. Patients ≥65 years, without private insurance, with poor subjective health, unmet medical needs, and/or limited activity were more likely to experience mobility problems. Self-care problems were more likely among those without private insurance and/or with limited activity. Patients lacking living security, with poor subjective health, limited activity, and/or who smoked were more likely to experience problems performing usual activities. Pain/discomfort was more likely among females, Medicaid beneficiaries, and patients with limited activity and/or with poor subjective health. Patients with poor subjective health, limited activity, and/or unmet medical needs were more likely to experience anxiety/depression. The investigation of HRQoL in multimorbidity should consider predisposing, enabling, need factors, and health behaviors. Interventions addressing movement restrictions and personalized care based on HRQoL domains should be prioritized.

Predictors of Entrepreneurial Intention of Nursing Students Based on Theory of Planned Behavior.

PURPOSE: The theory of planned behavior has previously been applied as a theoretical framework for improving entrepreneurial intention in nurses. Our study aimed to draw major variables from these studies and establish a structural equation model that defines predictors explaining nursing entrepreneurial intention. PARTICIPANTS AND METHODS: Participants included 252 nursing students from four nursing colleges in urban cities of South Korea. The structural equation model was constructed using six variables. Entrepreneurial-personal attitude, entrepreneurial-subjective norm, and entrepreneurial-perceived behavioral control from the theory of planned behavior model were used as exogenous variables, and entrepreneurial education demand, entrepreneurial self-efficacy, and entrepreneurial intention were used as endogenous variables. The data were analyzed using the SAS and LISREL programs. RESULTS: Entrepreneurial perceived behavioral control, entrepreneurial education demand, and entrepreneurial self-efficacy directly affected entrepreneurial intention, whereas entrepreneurial personal attitude and entrepreneurial subjective norm had indirect effects. The explanatory power of the modified model for entrepreneurial intention was 76.0%. These results suggested that expanding entrepreneurial education opportunities and developing interventions for enhancing entrepreneurial self-efficacy are necessary to improve entrepreneurial intention in nursing students. CONCLUSION: The results of this study will be used as basic data for developing curriculums and intervention programs to increase entrepreneurial intention in nursing students. To do this, we suggest that new pedagogies involving entrepreneurial project-based classes, business idea contests, and research and technology are useful tools to facilitate the next step of practical entrepreneurial preparation. Furthermore, an entrepreneurship-oriented culture needs to be fostered and include entrepreneur mentoring, team building, cooperative communication techniques, funding support, and a college-level support system.

[Types of Perception Toward Quarantine Measures among Patients Infected with COVID-19].

PURPOSE: This study was conducted to identify the types of perception toward quarantine measures at hospitals or community treatment centers among patients infected with COVID-19. METHODS: This study applied Q-methodology. Two hundred and nineteen Q populations were constructed based on related literature and in-depth interviews with 5 adults infected with COVID-19 and who experienced quarantine and hospitalization. Interviews were performed from November 14 to 29, 2020. A total of 45 Q samples were extracted and Q sorting was performed using a 9-point scale for 30 adult subjects who experienced quarantine at hospitals and community treatment centers. The data were analyzed using the PC-QUANL program. RESULTS: The perception of subjects toward quarantine measures was classified into the following six types: 'passive acceptance', 'social stigma perception', 'appreciation of daily life through awareness of the realities of illness', 'why me?', 'fearful perception', and 'positive meaning'. CONCLUSION: The perception of quarantine measure among patients with COVID-19 is identified as six types with positive and negative emotional characteristics. This result will contribute to the development of individualized strategies to address psychosocial health problems among patients with infectious diseases.

An electronic medical record-based fall risk assessment tool for pediatric inpatients in South Korea: Improved sensitivity and specificity.

PURPOSE: To develop a fall risk assessment tool to predict fall risk in pediatric inpatients. METHODS: Three tools widely used in clinical practice (Humpty Dumpty Fall Scale, General Risk Assessment for Pediatric Inpatient Falls, and Seoul National University Hospital Pediatric Fall Risk Scale) were examined, and assessment items were extracted. Employing a case-control design, 29 children who experienced falls during hospital stays were selected as the "fall" group, and a control group (93 children) was selected based on age and sex matching. The sensitivity, specificity, and positive and negative predictive values of the newly developed tool (Newfs-PI) were analyzed. RESULTS: The Newfs-PI consisted of seven items: age, activity, history of falls, length of hospital stay, and medication. The total score ranged from 0 to 15. Its sensitivity and specificity were 62.07% and 74.19%, respectively. CONCLUSION: The Newfs-PI has high specificity and sensitivity, which are essential for a fall risk assessment tool that complements existing tools. These values are high relative to those of existing assessment tools and satisfy both sensitivity and specificity criteria. As the EMR enables monitoring of the components of the Newfs-PI, the tool can be used as a fall risk assessment and prevention scale for pediatric inpatients.

Resilience of patients with chronic diseases: A systematic review.

The purpose of this research was to contribute to the development of a resilience-promoting programme for patients with chronic diseases. A systematic review of literature concerning resilience interventions for patients with chronic diseases was conducted by searching PubMed (including Medline), Science Direct, Web of Science, PsycARTICLES, CINAHL Plus, Embase, and the Cochrane Database for articles featuring the terms "resilience," "resiliency," "resilient," "cancer," "stroke," "heart disease," "diabetes" and "COPD" and published between 8 January 2017 and 15 January 2017. We included all English studies relevant to the topic; however, we excluded: (1) nonrandomised controlled trials and (2) those that mentioned the term "resilience" but did not apply it in their analysis. Seventeen studies-10 on cancer, four on cardiovascular diseases and three on diabetes-were deemed suitable for analysis. We found that, in these studies, (1) diverse definitions of resilience were applied, (2) various intervention durations were used and (3) complex programmes were applied within the resilience-improving programmes. Our research encourages efforts to operationalise the construct of resilience, so it can be applied in clinical settings, and for the development of more systematic intervention programmes.

Meta-analysis of the Diagnostic Test Accuracy of Pediatric Inpatient Fall Risk Assessment Scales.

PURPOSE: This study was conducted to obtain data for the development of an effective fall risk assessment tool for pediatric inpatients through a systematic review and meta-analysis of the diagnostic test accuracy of existing scales. METHODS: A literature search using Medline, Science Direct, CINAHL, EMBASE, and the Cochrane Library was performed between March 1 and 31, 2018. Of 890 identified papers, 10 were selected for review. Nine were used in the meta-analysis. Stata version 14.0 was used to create forest plots of sensitivity and specificity. A summary receiver operating characteristic curve was used to compare all diagnostic test accuracies. RESULTS: Four studies used the Humpty Dumpty Falls Scale. The most common items included the patient's diagnoses, use of sedative medications, and mobility. The pooled sensitivity and specificity of the nine studies were .79 and .36, respectively. CONCLUSION: Considering the low specificity of the pediatric fall risk assessment scales currently available, there is a need to subdivide scoring categories and to minimize items that are evaluated using nurses' subjective judgment alone. Fall risk assessment scales should be incorporated into the electronic medical record system and an automated scoring system should be developed.

Factors affecting the health-related quality of life in community-dwelling elderly people.

OBJECTIVE: The purpose of this study was to investigate the determinants of the health-related quality of life of elderly people in Korea by applying the Andersen model. DESIGN AND SAMPLE: This study was a descriptive survey. Participants were 240 elderly people over 65 years of age living in a community. MEASURES: A hierarchical multiple regression was performed to analyze the factors related to the health-related quality of life, including predisposing, enabling, and need factors, and health behaviors. RESULTS: Need factors, that is, self-reported health status, were the most significant in influencing the health-related quality of life of the elderly people; predisposing factors were age and education level, and enabling factors were income and activities of daily living. CONCLUSION: The findings of this study can be used to develop a community-based intervention program and to establish a policy for improving the quality of life of elderly people.

Korean Nursing Students' Acquisition of Evidence-Based Practice and Critical Thinking Skills.

BACKGROUND: Evidence-based practice (EBP) is essential for enhancing nurses' quality of care. We identified Korean nursing students' practices, attitudes, and knowledge concerning EBP, as well as their critical thinking disposition (CTD). METHOD: The EBP Questionnaire (EBPQ) was administered to a convenience sample of 266 nursing students recruited from four nursing schools in Seoul and its metropolitan area. RESULTS: Average EBPQ and CTD total scores were 4.69 ± 0.64 and 3.56 ± 0.32, respectively. Students who were ages ⩾23 years, male, and satisfied with their major demonstrated higher EBPQ and CTD scores. EBPQ scores were significantly correlated with CTD scores (r = .459, p < .01), and CTD was an explanatory factor of EBP (adjusted R2 = 0.200). CONCLUSION: It is necessary to develop comprehensive teaching strategies to help nursing students improve their CTD and information utilization skills, as well as integrate EBP in undergraduate programs to enhance nurses' EBP abilities. [J Nurs Educ. 2018;57(1):21-27.].

A model of adaptation for families of elderly patients with dementia: focusing on family resilience.

OBJECTIVES: We constructed a model explaining families' positive adaptation in chronic crisis situations such as the problematic behavior of elderly patients with dementia and attendant caregiving stress, based on the family resilience model. Our aim was to devise an adaptation model for families of elderly patients with dementia. METHOD: A survey of problematic behavior in elderly patients with dementia, family stress, family resilience, and family adaptation was conducted with 292 consenting individuals. The collected data were analyzed using structural equation modeling. RESULTS: The communication process, family stress, and problematic behavior of elderly patients with dementia had direct and indirect effects on family adaptation, while belief system, organization pattern, and social support had indirect effects. Specifically, family stress and more severe problematic behavior by elderly patients with dementia negatively influenced family adaptation, while greater family resilience improved such adaptation. CONCLUSION: Interventions aiming to enhance family resilience, based on the results of this study, are required to help families with positive adaptation. Such family programs might involve practical support such as education on the characteristics of elderly persons with dementia and coping methods for their problematic behavior; forming self-help groups for families; revitalizing communication within families; and activating communication channels with experts.

The effects of community-based visiting care on the quality of life.

This study explored factors contributing to the quality of life of community-based home visiting care service users in Korea through a two-level multilevel model. The community health care center's organizational factors including the total number of visiting nurses and visiting nurses' rehire rate were treated as covariates. For participant's individual factors (Level 1), only subjective health status and the presence of cerebral vascular disease significantly explained the quality of life. Visiting nurses' demographic factors (Level 2) were not statistically significant. However, the total number of visiting nurses and visiting nurses' rehire rate were significant. Therefore, to increase an elderly adult's quality of life through community-based home visiting care services, a community health care center's organizational factors should be considered in addition to patient characteristics. This result may prove useful not only for Korea but also for other countries that intend to reform their community-based home visiting care services.

Patterns of anger expression among middle-aged Korean women: Q methodology.

PURPOSE: The purpose of this study was to identify the characteristics of anger expression in middle-aged Korean women by categorizing their patterns of expression while considering the complexity and multidimensionality of anger, and by investigating the characteristics relative to the patterns. METHODS: The research design was a descriptive design using Q methodology, which is a method of measuring subjectivity. A convenience sample of 42 participants aged 40-60 years and living in the community in Korea was recruited. The PC-QUANL software program (a factor analysis program for the Q technique) was used to analyze the Q-sort data. RESULTS: Four factors were extracted that described different expressions of anger among middle-aged Korean women; these factors explained 50.1% of the total variance. The frames of reference of the four factors were a) direct diversion, b) silent masking with remaining anger, c) self digestion, and d) controlling anger with objectification. CONCLUSION: In this study has identified patterns and characteristics of anger expression among middle-aged Korean women were identified, which will aid the development of effective anger-management programs for controlling anger in this population. In future studies, it would be helpful to investigate how the patterns of anger expression established herein are associated with specific health problems such as cardiovascular disorder and cancer.