Concept analysis of health system resilience.

BACKGROUND: There are several definitions of resilience in health systems, many of which share some characteristics, but no agreed-upon framework is universally accepted. Here, we review the concept of resilience, identifying its definitions, attributes, antecedents and consequences, and present the findings of a concept analysis of health system resilience. METHODS: We follow Schwarz-Barcott and Kim's hybrid model, which consists of three phases: theoretical, fieldwork and final analysis. We identified the concept definitions, attributes, antecedents and consequences of health system resilience and constructed an evidence-informed framework on the basis of the findings of this review. We searched PubMed, PsycINFO, CINAHL Complete, EBSCOhost-Academic Search and Premier databases and downloaded identified titles and abstracts on Covidence. We screened 3357 titles and removed duplicate and ineligible records; two reviewers then screened each title, and disagreements were resolved by discussion with the third reviewer. From the 130 eligible manuscripts, we identified the definitions, attributes, antecedents and consequences using a pre-defined data extraction form. RESULTS: Resilience antecedents are decentralization, available funds, investments and resources, staff environment and motivation, integration and networking and finally, diversification of staff. The attributes are the availability of resources and funds, adaptive capacity, transformative capacity, learning and advocacy and progressive leadership. The consequences of health system resilience are improved health system performance, a balanced governance structure, improved expenditure and financial management of health and maintenance of health services that support universal health coverage (UHC) throughout crises. CONCLUSION: A resilient health system maintains quality healthcare through times of crisis. During the coronavirus disease 2019 (COVID-19) epidemic, several seemingly robust health systems were strained under the increased demand, and services were disrupted. As such, elements of resilience should be integrated into the functions of a health system to ensure standardized and consistent service quality and delivery. We offer a systematic, evidence-informed method for identifying the attributes of health system resilience, intending to eventually be used to develop a measuring tool to evaluate a country's health system resilience performance.

Embodied essentialism in the reconstruction of the animal sign in robot animal design.

Robot animals are important for the interpretation of the biological world. In this paper, I show that specific design solutions for robot animal signs usually privilege the overall perception of biological systems (and animal signs in general) as machinic entities, which ignores the role of identity self-generation and sustainability, the hallmark of biological signs. Animal signs are semiotic systems that operate roughly on three subsystems: affordance mapping (related with niche construction and embeddedness), essence categorization, displaying co-enabling relations within the animal system, and sensorimotor autonomy. Of these interrelated systems, the first two are commonly associated with robot animal design and conceptualization, whereas the third one suffers from the unsolved AI design problem of engineering true context-dependent sensitivity. As a result, a semiotic blindness toward biological organisms has derived in dissociated perceptions of robot animals as objects that emulate their biological counterparts through both biomorphic affordance design (biomorphism) and bioinspired task completion. Robot signs are thus confined to the realm of techno myths populating experimental settings narratives, which contributes to a diminishing awareness of biological diversity and animal uniqueness for the construction and preservation of the Umwelt.

Designing tailored maintenance strategies for systematic reviews and clinical practice guidelines using the Portfolio Maintenance by Test-Treatment (POMBYTT) framework.

BACKGROUND: Organizations face diverse contexts and requirements when updating and maintaining their portfolio, or pool, of systematic reviews or clinical practice guidelines they need to manage. We aimed to develop a comprehensive, theoretical framework that might enable the design and tailoring of maintenance strategies for portfolios containing systematic reviews and guidelines. METHODS: We employed a conceptual approach combined with a literature review. Components of the diagnostic test-treatment pathway used in clinical healthcare were transferred to develop a framework specifically for systematic review and guideline portfolio maintenance strategies. RESULTS: We developed the Portfolio Maintenance by Test-Treatment (POMBYTT) framework comprising diagnosis, staging, management, and monitoring components. To illustrate the framework's components and their elements, we provided examples from both a clinical healthcare test-treatment pathway and a clinical practice guideline maintenance scenario. Additionally, our literature review provided possible examples for the elements in the framework, such as detection variables, detection tests, and detection thresholds. We furthermore provide three example strategies using the framework, of which one was based on living recommendations strategies. CONCLUSIONS: The developed framework might support the design of maintenance strategies that could contain multiple options besides updating to manage a portfolio (e.g. withdrawing and archiving), even in the absence of the target condition. By making different choices for variables, tests, test protocols, indications, management options, and monitoring, organizations might tailor their maintenance strategy to suit specific contexts and needs. The framework's elements could potentially aid in the design by being explicit about the operational aspects of maintenance strategies. This might also be helpful for end-users and other stakeholders of systematic reviews and clinical practice guidelines.

Retrieving Rare Cases: A Protocol for Searching Complex Medical Cases.

This study sought to provide a protocol for searching complex medical cases of grand rounds. A clinical informationist was embedded in gastroenterology grand rounds to use comprehensive search strategies and summarize patients' information through concept mapping. Our proposed protocol classifies into three categories: (1) The general search strategy, (2) The protocol for searching for evidence about rare diseases, and (3) Identifying other resources more than routine medical databases. This approach represents a novel method beyond previous studies which were focused on usual ward rounds to facilitate evidence-based decision-making by providing and simplifying a comprehensive summary view of complex medical cases.

Causal Influence of Linguistic Learning on Perceptual and Conceptual Processing: A Brain-Constrained Deep Neural Network Study of Proper Names and Category Terms.

Language influences cognitive and conceptual processing, but the mechanisms through which such causal effects are realized in the human brain remain unknown. Here, we use a brain-constrained deep neural network model of category formation and symbol learning and analyze the emergent model's internal mechanisms at the neural circuit level. In one set of simulations, the network was presented with similar patterns of neural activity indexing instances of objects and actions belonging to the same categories. Biologically realistic Hebbian learning led to the formation of instance-specific neurons distributed across multiple areas of the network, and, in addition, to cell assembly circuits of "shared" neurons responding to all category instances-the network correlates of conceptual categories. In two separate sets of simulations, the network learned the same patterns together with symbols for individual instances ["proper names" (PN)] or symbols related to classes of instances sharing common features ["category terms" (CT)]. Learning CT remarkably increased the number of shared neurons in the network, thereby making category representations more robust while reducing the number of neurons of instance-specific ones. In contrast, proper name learning prevented a substantial reduction of instance-specific neurons and blocked the overgrowth of category general cells. Representational similarity analysis further confirmed that the neural activity patterns of category instances became more similar to each other after category-term learning, relative to both learning with PN and without any symbols. These network-based mechanisms for concepts, PN, and CT explain why and how symbol learning changes object perception and memory, as revealed by experimental studies.

A multidisciplinary evaluation, exploration, and advancement of the concept of a traumatic birth experience.

BACKGROUND: Understanding a woman's traumatic birth experience benefits from an approach that considers perspectives from various fields of healthcare and social sciences. AIM: To evaluate and explore the multidisciplinary perspectives surrounding a traumatic birth experience to form a theory and to capture its structure. METHODS: A multidisciplinary advanced principle-based concept analysis was conducted, including the following systematic steps: literature review, assessment of concept maturity, principle-based evaluation, concept exploration and advancement, and formulating a multidisciplinary concept theory. We drew on knowledge from midwifery, psychology, childbirth education, bioethics, obstetric & gender violence, sociology, perinatal psychiatry, and anthropology. RESULTS: Our evaluation included 60 records which were considered as 'mature'. Maturity was determined by the reported concept definition, attributes, antecedents, outcomes, and boundaries. The four broad principles of the philosophy of science epistemology, pragmatics, linguistics, and logic illustrated that women live in a political, and cultural world that includes social, perceptual, and practical features. The conceptual components antecedents, attributes, outcomes, and boundaries demonstrated that a traumatic birth experience is not an isolated event, but its existence is enabled by social structures that perpetuate the diminished and disempowered position of women in medical and institutionalised healthcare regulation and management. CONCLUSION: The traumatic childbirth experience is a distinctive experience that can only occur within a socioecological system of micro-, meso-, and macro-level aspects that accepts and allows its existence and therefore its sustainability - with the traumatic experience of the birthing woman as the central construct.

Oral hygiene self-care: Concept analysis for the development of a new nursing diagnosis.

OBJECTIVE: This study aims to analyze the concept of oral hygiene self-care and develop a new problem-focused nursing diagnosis (ND) based on the NANDA-I terminology. METHOD: A concept analysis was performed based on the Walker and Avant framework, including a scoping review phase according to the Joanna Briggs Institute guidelines. Searches were performed in PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Virtual Health Library, and specific gray literature databases. The development of the diagnostic structure followed the NANDA-I guidelines with a focus on Orem's self-care theory. RESULTS: Including 51 studies, the analysis facilitated the formulation of attributes, antecedents, and consequences of oral hygiene self-care. The ND "Oral hygiene self-care deficit" was created and included 17 defining characteristics, 9 related factors, 5 associated conditions, and 5 high-risk populations. Two cases were constructed to illustrate the use of key terms. CONCLUSIONS: The conceptual analysis provided insight into the concept of oral hygiene self-care and supported the structure of a new ND. IMPLICATIONS FOR NURSING PRACTICE: This study contributes to the implementation of the nursing process by focusing on the identification of individuals with oral hygiene self-care deficit. It will facilitate the promotion of oral health, thereby impacting the individual's quality of life. In addition, it will aid in the development of public policy for the prevention of oral diseases.

Entering aesthetic concept into the field of patient education: A protocol for an interdisciplinary study to develop a conceptual model.

BACKGROUND: According to the significance of patient education, new conceptual models are constantly required to promote pedagogical competences of health educators. In the field of educational sciences, aesthetic-based education is known as one of the effective types of curriculum planning which has shown many positive pedagogical outcomes. Thus, the researcher's assumption is that, the concept of "aesthetic education" could be transposed from educational sciences to health sciences in order to develop a new formula in the patient education process. The purpose of this study is to explain methods in detail, to develop an aesthetic-based patient education conceptual model through the concept derivation strategy. MATERIALS AND METHODS: 1. Scoping review and inductive data analysis using Walker and Avant's approach to achieve conceptual categories of the concept "aesthetic education." 2. Semi-structured qualitative interviews and directed content analysis to extract the main categories of the concept "aesthetics in the patient education process." 3. Drawing an aesthetic-based patient education conceptual model by allocating new conceptual components to each general step of the patient education process, including needs assessment, goal setting, implementation, and evaluation. 4. Modified Delphi technique to validate the final conceptual model. RESULTS: The first phase will represent the main categories and subcategories of attributes, antecedents, and consequences of "aesthetic education." The second phase will show the main categories and subcategories of attributes, antecedents, and consequences of the new concept named "aesthetic-based patient education." In the third phase, it is expected to achieve a new conceptual model representing the components of aesthetics in the general steps of the patient education process. The fourth phase will propose the final validated conceptual model. CONCLUSIONS: The provided study protocol can be a road map to developing derivative models through concept derivation strategy in health sciences.

Nursing students' rights in clinical practice in South Korea: a hybrid concept-analysis study.

PURPOSE: This study aimed to derive a conceptual definition and attributes for nursing students' rights in clinical practice in South Korea. METHODS: This concept-analysis study was conducted at a nursing school in South Korea. The participants were recruited using purposive sampling. The inclusion criteria were being a fourth-year nursing student and having two or more semesters of practical experience. The hybrid model used in this study had three stages. First, 12 studies were reviewed during the theoretical stage. Second, 10 in-depth interviews were conducted during the fieldwork stage. Third, in the analytical stage, the concept of nursing students' rights related to clinical practice was defined and the attributes were derived. RESULTS: The analysis established five attributes of nursing students' rights: the right to learn, the right to be protected from infections and accidents, the right to be cared for and supported, the right to be respected, and the right to be recognized as a member of a nursing team. A key theme that emerged from this study was having the right to learn in a safe and supportive environment. CONCLUSION: It is necessary to develop a measurement tool based on the above five attributes and to verify its effectiveness.

Beyond the classics: A comprehensive look at concept analysis methods in nursing education and research.

This editorial presents eight concept analysis methods for use in nursing research and education. In addition to the two classical methods of Walker and Avant's and Rodgers' concept analysis approaches that are typically utilized in nursing education and briefly discussed within this editorial, six additional methods are also presented including Schwartz-Barcott and Kim's Hybrid model, Chinn and Kramer's approach, Simultaneous Concept Analysis, Pragmatic Utility, Principle-Based Concept Analysis, and Semantic Concept Analysis. By familiarizing nursing educators, researchers, and students with these methods, educators can enhance their critical thinking and understanding of complex nursing concepts, preparing them for enhanced, multi-faceted contributions to nursing science.

A concept analysis of cultural competence in nursing: A hybrid model approach.

BACKGROUND: Cultural competence is considered one of the criteria for high-quality nursing care. AIM: This study aimed to analyse cultural competence in nursing. METHODS: This study was performed using the hybrid concept analysis approach in three phases. In the theoretical phase, literature was reviewed by searching Persian and English language databases, and 94 articles were included. In the second or fieldwork phase, 11 semi-structured interviews were conducted with purposefully selected nurses. The results of both theoretical and fieldwork phases were analysed using conventional content analysis, and in the final analysis phase, the results of the previous phases were triangulated. RESULTS: The attributes of cultural competence were obtained in the theoretical phase in six and the fieldwork phase in three categories. In the final phase, the categories obtained in both previous phases were triangulated: cultural competence in nursing is a continuous, developmental, flexible, extensive and complex process that is patient- and justice-oriented and emerges through learning and skills acquisition, including cultural knowledge, attitudes and practices. CONCLUSION: Managers and planners of nursing education can use the results of this study to educate nursing students and nurses and evaluate outcomes as one of the criteria for quality care.

Resilience in Older People: A Concept Analysis.

(1) Background: Resilience has been presented as a potential protective factor to be promoted in difficult experiences in older people. However, further clarification of the concept of resilience for this population is required, as this is of critical interest for nursing care. (2) Aim: To develop the concept of resilience in older people to establish the elements that refer to the nursing outcome. Personal resilience (1309) from the Nursing Outcomes Classification (NOC), specifically in older people. (3) Methods: Concept analysis using Beth Rodgers' evolutionary model. The attributes, antecedents, consequents, and empirical elements were described in the integrative review, with searches in PubMed, CINAHL, PsycINFO, LILACS, and Embase databases. A total of 2431 citations have been identified, and 110 studies were included. (4) Results: The concept of "resilience in older people" is composed of two attributes, available resources and positive behaviors, and is defined as positive attitudes of older people with the assistance of resources available from experiences of adversity. Conclusion: This analysis and concept development of resilience in older people provided sensitive indicators for nursing care in the context of adversity, considering available resources and with positive attitudes during this phase of life span.

Analysis of the concept of nurses' autonomy in intensive care units: A hybrid model / Análisis del concepto de autonomía de las Unidades de Cuidado Intensivo. Un modelo hídrido / Análise do conceito de autonomia das Unidades de Terapia Intensiva. Um modelo híbrido

Objective. To analyze the concept of autonomy of nurses in Intensive Care Units (ICU). Methods. The hybrid model approach proposed by Schwartz-Barcott and Kim, which includes theoretical, fieldwork and analytical phases, was used for this study. For the theoretical and fieldwork phases, the Graneheim and Lundman stages and the CORE-Q checklist were used, and the results were combined in the final analysis phase. For the theoretical phase, 46 related articles, two instruments and four books were identified after using a search strategy in 7 bibliographic databases in English and one in Persian with the terms MESH: 'nursing', 'autonomy' and 'intensive care'. The information extracted in the theoretical phase served as the basis for the design of the questions used in the semi-structured interviews in the fieldwork phase. Eight nurses with ICU experience working in hospitals affiliated to Isfahan University of Medical Sciences (Iran) participated in the fieldwork phase. Results. The antecedents of the concept of nurse autonomy in ICUs were: empowerment of the workforce, organizational platform, and social and individual views of the profession. Its attributes were professionalism and high personal capabilities. Finally, increased personal competencies, promotion of quality of care, improved attitudes towards the profession and professional outcomes were noted as consequences. Conclusion. The autonomy of nurses in the ICU can facilitate their empowerment, which translates into the promotion of their caring behaviours, followed by the improvement of patient outcomes and quality of care.

Objetivo. Analizar el concepto de autonomía entre las enfermeras de la Unidad de Cuidados Intensivos (UCI).Métodos. Para este estudio se utilizó el enfoque de modelo híbrido propuesto por Schwartz-Barcott y Kim que incluye las fases: teórica, de trabajo de campo y analítica. Para las fases teórica y de trabajo de campo se utilizaron las etapas de Graneheim y Lundman y la lista de comprobación CORE-Q, y los resultados se combinaron en la fase de análisis final. Para la fase teórica se identificaron 46 artículos relacionados, dos instrumentos y cuatro libros tras utilizar una estrategia de búsqueda en 7 bases de datos bibliográficas en inglés y otra en persa con los términos MESH: 'nursing', 'autonomy' e 'intensive care'. La información extraída en la fase teórica sirvió de base para el diseño de las preguntas que se utilizaron en las entrevistas semiestructuradas de la fase de trabajo de campo. En esta última fase participaron ocho enfermeras con experiencia en UCI que trabajaban en hospitales afiliados a la Universidad de Ciencias Médicas de Isfahan (Irán). Resultados. Los antecedentes del concepto de autonomía de las enfermeras en las Unidades de UCI fueron: el empoderamiento de la fuerza de trabajo, la plataforma organizativa y las opiniones sociales e individuales acerca de la profesión. Sus atributos fueron el profesionalismo y las grandes capacidades personales. Por último, se señalaron como consecuencias: el incremento de las competencias personales, la promoción de la calidad de los cuidados, la mejoría de las actitudes hacia la profesión y los resultados profesionales. Conclusión. La autonomía de las enfermeras en las UCI puede facilitar su empoderamiento, lo que se traduce en la promoción de sus conductas asistenciales, seguida de la mejora de los resultados de los pacientes y de la calidad asistencial.

Objetivo. Analisar o conceito de autonomia dos enfermeiros da Unidade de Terapia Intensiva (UTI). Métodos. Este estudo foi realizado utilizando a abordagem do modelo híbrido proposto por Schwartz- Barcott e Kim, que inclui as fases teórica, de campo e analítica. As etapas de Graneheim e Lundman e o checklist CORE-Q foram utilizados nas fases teórica e de trabalho de campo, e os resultados foram combinados na fase de análise final. Para a fase teórica, foram identificados 46 artigos relacionados, dois instrumentos e quatro livros após a utilização de uma estratégia de busca em 7 bases bibliográficas em inglês e outra em persa com os termos MESH: 'nursing', 'autonomy' e 'intensive care'. As informações extraídas na fase teórica serviram de base para o desenho das questões que foram utilizadas nas entrevistas semiestruturadas da fase de trabalho de campo. Participaram desta última fase, oito enfermeiras experientes em UTI trabalhando em hospitais afiliados à Universidade de Ciências Médicas de Isfahan, no Irã.Resultados. Os antecedentes do conceito de autonomia dos enfermeiros nas Unidades de Terapia Intensiva foram: o empoderamento da força de trabalho, a plataforma organizacional e as opiniões sociais e individuais sobre a profissão. Seus atributos eram profissionalismo e grandes habilidades pessoais. Por fim, foram apontadas as seguintes consequências: o aumento das competências pessoais, a promoção da qualidade dos cuidados, a melhoria das atitudes perante a profissão e os resultados profissionais. Conclusão. A autonomia dos enfermeiros na UTI pode facilitar seu empoderamento, que se traduz na promoção de seus comportamentos assistenciais, seguida da melhoria dos resultados dos pacientes e da qualidade da assistência.

How a Minimal Learning Agent can Infer the Existence of Unobserved Variables in a Complex Environment.

According to a mainstream position in contemporary cognitive science and philosophy, the use of abstract compositional concepts is amongst the most characteristic indicators of meaningful deliberative thought in an organism or agent. In this article, we show how the ability to develop and utilise abstract conceptual structures can be achieved by a particular kind of learning agent. More specifically, we provide and motivate a concrete operational definition of what it means for these agents to be in possession of abstract concepts, before presenting an explicit example of a minimal architecture that supports this capability. We then proceed to demonstrate how the existence of abstract conceptual structures can be operationally useful in the process of employing previously acquired knowledge in the face of new experiences, thereby vindicating the natural conjecture that the cognitive functions of abstraction and generalisation are closely related.

Narrativas sobre competição esportiva: reflexões e perspectivas / Narratives about sports competition: reflections and perspectives / Narrativas sobre la competición deportiva: reflexiones y perspectivas

Analisar as concepções sobre competição esportiva em publicações acadêmicas brasileiras é o foco deste trabalho. Utilizando-se da revisão sistemática, do tipo estado da arte, foram analisados 175 artigos no recorte temporal 2010-2020 (11 anos) em 14 revistas da área da Educação Física. Há parcimônia dos/as autores/as quanto a complexidade da competição e foram salutares indicativas do rememorar a essência do tema; independente da área de conhecimento específico, foram recorrentes indicativos de um processo respeitoso e pedagógico da competição aos praticantes. Ademais, confirmam que amadores e profissionais; homens e mulheres; idosos e jovens, todos podem (e devem) ter a opção da experiência esportiva no âmbito competitivo (AU).

Analyzing the concepts about sports competition in Brazilian academic publication is the objective of this paper. Using the state-of-art systematic review, 175 articles were considered from 14 Physical Education Journals from 2010 to 2020 (11 years). There is parsimony by the authors regarding the complexity of the competition and greetings indicative of remembering the essence of the theme; regardless of the area of specific knowledge, there were recurrent indicators of a respectful and pedagogical process of the competition for practitioners. Also, it was confirmed that amateurs and professionals; men and women; elderly and young; everyone can (and should) have the possibility of sporting experience in the competitive environment (AU).

Analizar las concepciones sobre la competición deportiva en las publicaciones académicas brasileñas es el foco de este trabajo. Utilizando la revisión sistemática del tipo estado del arte, se buscarán 175 artículos en el período de 2010-2020 en 14 revistas del área de Educación Física. Hay parcimônia a la complejidad de la competición y fueron saludos indicativos de recordar la esencia del tema; independientemente del área de conocimiento específico, fueron recurrentes indicativos para un proceso respetuoso y pedagógico de la competencia por practicantes. También confirman que los atletas aficionados y profesionales; hombres y mujeres; ancianos y jóvenes, todos pueden (y deben) tener la opción de la experiencia deportiva en el entorno competitivo

Concept Mapping in Simulation within Nursing Education: A Scoping Review Protocol.

BACKGROUND: Simulation has been found to enhance nursing student knowledge and confidence, as well as to improve clinical performance. The use of concept maps during simulation has been found to play a key role in student learning. There is a need to understand what is known to date about the use of concept mapping in simulation within nursing education. This will help determine the most effective ways to use concept mapping in simulation to foster learning in nursing students. Scoping review question: What is known about the context, processes, and outcomes of concept mapping in simulation within nursing education? METHODS: The scoping review will be conducted in accordance with JBI methodology for scoping reviews and will search the following databases: MEDLINE, CINAHL, PsycMED, EMBASE, and ERIC. This review will consider studies that explore the use of concept mapping in simulation within undergraduate nursing education and will include studies that have used qualitative, quantitative, and mixed methods, as well as literature reviews. Editorials, commentaries, and gray literature will be excluded. Studies published from 1992 onward will be included. The data extracted will include details about the participants, how concept mapping was used within simulation, methods, key findings, and research gaps.

Concept analysis of recovery from substance use.

In this paper, we provide an analysis of the concept of recovery from substance use. We performed a literature search in CINAHL Plus, PsycINFO, MEDLINE, and Embase using key terms that focused on the concept of recovery from substance use. We also conducted a grey literature search and included select resources. Inclusive years for the search ranged from January 1, 2000 to March 10, 2022. Records were screened for eligibility by two independent reviewers; data were extracted by one reviewer and confirmed by a second. A total of 22 literature sources were included. Identified core attributes of recovery include: (i) recovery as a process, (ii) recovery as more than managing substance use, (iii) recovery as life improvements, and (iv) recovery as a person-centred, individual concept. Antecedents, consequences, and empirical referents are identified, and model and contrary cases are presented. We propose the following definition for recovery: Recovery from substance use is defined by the affected individual, who sets goals and objectives for life improvements that include managing their substance use, but this is not the sole focus. Recovery is a person-centred, individualized process that can be measured by referents that suit the individual's own goals and objectives. What may constitute "recovery" and "recovered" requires definition by each individual.

Kick-starting concept formation with intrinsically motivated learning: the grounding by competence acquisition hypothesis.

Although the spontaneous origins of concepts from interaction is often given for granted, how the process can start without a fully developed sensorimotor representation system has not been sufficiently explored. Here, we offer a new hypothesis for a mechanism supporting concept formation while learning to perceive and act intentionally. We specify an architecture in which multi-modal sensory patterns are mapped in the same lower-dimensional representation space. The motor repertoire is also represented in the same space via topological mapping. We posit that the acquisition of these mappings can be mutually constrained by maximizing the convergence between sensory and motor representations during online interaction. This learning signal reflects an intrinsic motivation of competence acquisition. We propose that topological alignment via competence acquisition eventually results in a sensorimotor representation system. To assess the consistency of this hypothesis, we develop a computational model and test it in an object manipulation task. Results show that such an intrinsically motivated learning process can create a cross-modal categorization system with semantic content, which supports perception and intentional action selection, which has the resources to re-enact its own multi-modal experiences, and, on this basis, to kick-start the formation of concepts grounded in the external environment. This article is part of the theme issue 'Concepts in interaction: social engagement and inner experiences'.

Analysis of the concept of nurses' autonomy in intensive care units: A hybrid model.

Objective: To analyze the concept of autonomy of nurses in Intensive Care Units (ICU). Methods: The hybrid model approach proposed by Schwartz-Barcott and Kim, which includes theoretical, fieldwork and analytical phases, was used for this study. For the theoretical and fieldwork phases, the Graneheim and Lundman stages and the CORE-Q checklist were used, and the results were combined in the final analysis phase. For the theoretical phase, 46 related articles, two instruments and four books were identified after using a search strategy in 7 bibliographic databases in English and one in Persian with the terms MESH: 'nursing', 'autonomy' and 'intensive care'. The information extracted in the theoretical phase served as the basis for the design of the questions used in the semi-structured interviews in the fieldwork phase. Eight nurses with ICU experience working in hospitals affiliated to Isfahan University of Medical Sciences (Iran) participated in the fieldwork phase. Results: The antecedents of the concept of nurse autonomy in ICUs were: empowerment of the workforce, organizational platform, and social and individual views of the profession. Its attributes were professionalism and high personal capabilities. Finally, increased personal competencies, promotion of quality of care, improved attitudes towards the profession and professional outcomes were noted as consequences. Conclusion: The autonomy of nurses in the ICU can facilitate their empowerment, which translates into the promotion of their caring behaviours, followed by the improvement of patient outcomes and quality of care.

Innovative concept of following the "pain" to get the melon and its application in orthopedic trauma / 中华创伤杂志

Pain is a defensive response to body injury or potential injury, and is also the most common clinical manifestations in orthopedic trauma. Pain is critical to determine the causes of injury and therapeutic plans in the diagnosis and treatment of orthopedic trauma. Post-traumatic acute and chronic pain not only brings physical pain to patients, but also induces a variety of complications. Moreover, improper evaluation and management of pain can easily lead to missed diagnosis and misdiagnosis, thus prolonging the treatment cycle and affecting the quality of life. At present, the management of pain has no normative standard in the diagnosis and management of orthopedic trauma. Academician Zhang Yingze′s team has summarized the pain characteristics of various orthopedic trauma patients, traced back to the sources, and conduced the innovative concept of "pain" to get the melon to address issues such as insufficient pain assessment, incomplete etiology analysis and inadequate diagnostic thinking, hoping to achieve rapid and accurate diagnosis and early treatment. The authors elaborate on the connotation of the innovative concept of "pain" to get the melon and its application in clinical orthopedic trauma, aiming to explore the application value of this innovative concept, achieve rapid and accurate diagnosis of orthopedic trauma and provide a reference for formulating reasonable diagnosis and treatment programs.