Nursing students' learning flow, self-efficacy and satisfaction in virtual clinical simulation and clinical case seminar.

BACKGROUND: Virtual clinical simulations and clinical case seminar become widely utilized to address these constraints and help nursing students acquire clinical competencies as the limitations on practicum opportunities have been intensified by the COVID-19 pandemic. The purpose of this study was to examine learning flow, self-efficacy and satisfaction in virtual clinical simulation and clinical case seminar among nursing students. METHODS: A descriptive cross-sectional study was used. Forty-two junior nursing students completed survey questionnaires after participating in computer-based virtual clinical simulation and clinical case seminar, which aimed at acquiring knowledge and care skills in geriatric nursing. RESULTS: Significant differences in two methods were found in learning flow which included challenge-skill balance (t = -2.24, p < .05) and action-awareness merge (t = -3.32, p < .01). There was no significant difference in learning self-efficacy (t=-1.52, p = .137) and learning satisfaction (t=-0.92, p = .365). CONCLUSIONS: When there's a mismatch between the perceived challenge and the students' skill levels, it can hinder the learning process. Therefore, instructors should evaluate the clinical skill levels of their students and make necessary adjustments to the difficulty levels of simulation and clinical case seminar accordingly.

A concept analysis of fear of falling in older adults: insights from qualitative research studies.

BACKGROUND: Fear of falling is a persistent concern about falls that commonly occur in older adults. Recently, it has been argued that fear of falling doesn't simply mean a state of low falls efficacy, but is a concept distinct from falls efficacy. However, the two concepts are still indistinguishable. Therefore, it is necessary to understand the unique characteristics of the fear of falling. This study aims to analyze the concept of 'fear of falling' faced by older adults. METHODS: This study is designed as a concept analysis. A concept analysis was conducted by Walker & Avant's eight-step concept analysis method. A total of 16 pieces of literature were selected by inclusion and exclusion criteria from those published in Pubmed and Scopus between 1993 and 2022 on 8 November 2022. RESULTS: Two antecedents, four attributes, and five consequences were identified. Apprehension caused by the unpredictable nature of falls, unease related to one's vulnerability, high vigilance-related to the environment, and concern about potential harm after fall events were presented as attributes of fear of falling in older adults. There were two antecedents of fear of falling which were awareness of falls and near falls, and direct/indirect experience about falls and near falls. As consequences of fear of falling, protective effect, activities curtailment, reduction in radius of living, restricted freedom, and limited social activities were reported. CONCLUSION: It was confirmed that falls and the fear-inducing process were fused to constitute the unique characteristics of the fear of falling. This can be presented as an important basis for future research on the fear of falling or dealing with various aspects of the fear of falling in the clinical field.

Effects of Physical Exercise Program for Older Family Caregivers of Persons With Dementia.

Self-efficacy plays a major role in improving health behaviors. The purpose of this study was to examine the effects of a physical activity program that utilized four self-efficacy resources in older family caregivers of persons with dementia. Quasi-experimental pretest-posttest design with control group was used. Study participants were 64 family caregivers aged 60 years or older. The intervention included a 60-minute group session per week for 8 weeks along with individual counseling and text messages. The experimental group showed significantly higher self-efficacy than the control group. In addition, physical function, quality of life related to health, caregiving burden, and depressive symptoms were significantly improved in the experimental group in comparison with those of control group. These findings suggest that a physical activity program with a focus on the resources of self-efficacy may be not only feasible but also effective for older family caregivers of persons with dementia.

Nurses' Perceptions About Smart Beds in Hospitals.

The purpose of this study was to examine nurses' perceptions of the smart mattress equipped with Internet of things, which are incorporated into patients' beds. In addition, their concerns and suggestions about smart mattress were explored. A total of 349 nurses in a tertiary hospital participated in a cross-sectional survey. Data were collected using questionnaires. Descriptive statistical analysis was used for survey data, whereas content analysis was used for qualitative data from open-ended questions. The participants' intention to accept the smart mattresses was 12.5 (SD, 1.73) on average, indicating a high level of acceptance. The participants expected the smart mattresses to decrease their physical work burden, improve work efficiency, and prevent pressure ulcers. However, they were concerned about an increase in other aspects of their workload and in patient safety problems due to false alarms, inaccuracies, and malfunctions of the device. Nurses suggested various features that can be integrated into smart mattress. It is critical to address nurses' perceptions, expectations, and concerns during the conceptual and developmental stage of new technology in order to improve the usability, acceptance, and adoption of smart mattresses and other new innovations in hospital settings.

Nurses' behavioral intention in using virtual clinical simulation training: By structural equation modeling.

AIM: To examine the relationship between the nurses' behavioral intention to use virtual clinical simulation training and study variables, including perceived usefulness, perceived ease of use, self-efficacy, technology anxiety, perceived enjoyment and personal innovativeness. BACKGROUND: Little is known about the nurses' behavioral intentions behind using virtual clinical simulation training. DESIGN: A cross-sectional study. METHODS: A total of 206 registered nurses participated in this survey. Data were collected through online survey from March 20, 2021, to April 2, 2021, since entry into the hospital was strictly controlled due to the COVID-19 outbreak. RESULTS: Structural equation modeling identified that both perceived usefulness and perceived ease of use were the predictors which influenced behavioral intention. Additionally, perceived enjoyment indirectly affected behavioral intention by influencing both perceived usefulness and perceived ease of use. CONCLUSION: The successful introduction of virtual clinical simulation training depends on nurses' willingness and acceptance of its use. The findings of this study show that virtual clinical simulation training should be perceived as useful, easy to use and enjoyable to be accepted by nurses. Virtual clinical simulation programs may have the potential to help improve nurses' clinical skills and competencies in patient care. TWEETABLE ABSTRACT: This study revealed that the usefulness of its contents, ease of use and enjoyment are important to increase nurses' behavioral intention to use virtual clinical simulation training.

Factors of Functional Disability in the Social Participation of Older Adults Living Alone With Fall Experience.

The fall experiences of older adults living alone lead to restrictions in their social participation. This study aimed to examine the factors that influence functional disability in social participation (FSP) among older adults who live alone and have experienced falls. This study used secondary data of 493 older adults living alone who experienced a fall, which were collected from the 2017 National Survey of Older Koreans. Multiple linear regression analyses were performed. Factors, such as old age, sex, economic status, frequency of drinking, and number of acquaintances, significantly related to functional disability in terms of social participation. In addition, poor muscle strength, depression, and cognitive decline comprised predictors of FSP. The findings of this study revealed that it is important to comprehensively evaluate the social participation of older adults who live alone and have experienced falls.

Factors associated with eHealth literacy focusing on digital literacy components: A cross-sectional study of middle-aged adults in South Korea.

Background: Digital technology has dramatically changed the world in which we live, and the ability to access and understand information through these new technologies is becoming increasingly important. eHealth literacy is closely related to digital literacy, and some concepts may overlap to a certain extent. Identifying personal and digital-related factors related to eHealth literacy levels in middle-aged adults would be useful for planning tailored interventions and health promotion strategies. Objective: We aimed to identify the differences in digital literacy and eHealth literacy levels according to demographic features, and to elucidate the factors associated with eHealth literacy in the middle-aged population. Methods: We conducted a cross-sectional, observational study from 4th to 8th February 2021. A total of 320 South Korean participants aged 40-64 years were recruited and completed an online questionnaire, where demographic features, chronic disease status, frequency of Internet use, digital skills, digital competence, and eHealth literacy were measured. eHealth literacy was measured with the eHEALS. We used multiple regression analysis to elucidate the factors associated with eHealth literacy. Results: Multiple regression analysis revealed that digital competence was the highest contributor to an individual's eHealth literacy (ß = 0.330, P < 0.001), while digital skills was not significantly associated with eHealth literacy (ß = 0.086, P = 0.267). In addition, eHealth literacy was positively associated with increasing age (ß = 0.258, P < 0.001), female gender (ß = -0.118, P = 0.022), and higher education levels (ß = 0.114, P = 0.041), while marital state, chronic disease, and frequency of internet use were not significantly associated with eHealth literacy. Conclusions: Our study provides valuable information on digital literacy and eHealth literacy in middle-aged adults and may be used to guide tailored interventions for improving eHealth literacy. Future studies should consider the differences in digital literacy levels across generations when assessing eHealth literacy or planning digital health interventions.

Factors Influencing Transcultural Self-Efficacy Among Nurses With Foreign Patient Care Experience.

INTRODUCTION: As the cultural diversity among patients increases, it becomes important for nurses to be prepared and efficient in providing culturally congruent care. The purpose of this study is to examine the factors influencing transcultural self-efficacy (TSE) among Korean nurses. METHODOLOGY: A descriptive cross-sectional survey was used, and 131 nurses with foreign patient-care experience were recruited from a university tertiary hospital. RESULTS: The mean TSE score of participants was 5.27 out of 10 (SD = 1.50). The practical subscale of TSE was the lowest, while the affective subscale was the highest. A regression analysis revealed that education level, cultural competence, and intergroup anxiety are predictors explaining 58.8% of its variance (F = 27.5, p < .001). DISCUSSION: A low level of TSE causes avoidant behavior and ineffective communication in foreign patient care, resulting in unsatisfactory clinical performance. Effective education programs and administration guidelines may be critical for nurses to improve their TSE.

[Validity and Reliability of the Korean Version of Person-Centered Practice Inventory-Staff for Nurses].

PURPOSE: The purpose of this study was to evaluate the validity and reliability of the Korean version of Person-Centered Practice Inventory-Staff (PCPI-S) for nurses. METHODS: The English PCPI-S was translated into Korean with forward and backward translation. Data were collected from 338 nurses at one general hospital in Korea. Construct validity was evaluated with confirmatory factor analysis, convergent validity, and discriminant validity. Known-group validity was also evaluated. Cronbach's α was used to assess the reliability. RESULTS: The PCPI-S Korean version consisted of 51 items in three areas: prerequisites, the care environment, and person-centered process. The comparative fit index (CFI) and values of person-centered care process were improved after engagement and having sympathetic presence items were combined as one component. The construct validity of PCPI-S Korean version was verified using four-factor structures (.05 < RMSEA < .10, AGFI > .70, CFI > .70, and AIC). The convergent validity and discriminant validity of the entire PCPI-S question were verified using a two-factor structures (AVE > .50, construct reliability > .70). There was an acceptable known-group validity with a significant correlation between the PCPI-S level and the degree of person-centered care awareness and education. Internal consistency was reliable with Cronbach's α .95. CONCLUSION: The Korean version of PCPI-S is valid and reliable. It can be used as a standardized Korean version of person-centered care measurement tool.

Fear of Falling and Related Factors in Older Adults With Spinal Diseases.

Fear of falling is common among older adults with spinal diseases. The purpose of the current study was to examine fear of falling and related factors in this population. A total of 138 participants were recruited and completed survey questionnaires along with the Timed Up & Go Test. Participants were 73.7 years old on average, 52% had fall experience, and 56% were taking more than four medications. Multivariate regression analyses revealed that the use of sleeping pills, residence type, pain, activities of daily living, gait ability, and gait efficacy were significant predictors of fear of falling. Findings suggest that a fall prevention intervention for older adults with spinal diseases should include pain management, functional improvement, and gait rehabilitation with a focus on gait performance and gait efficacy. In addition, it is important to improve living environment and sleep hygiene, which are conducive to falls. [Journal of Gerontological Nursing, 47(8), 29-35.].

Family Members' Knowledge and Attitude Toward Life-Sustaining Treatment Decisions for Patients in the Intensive Care Unit.

The decision to withhold or withdraw life-sustaining treatment (LST) lies sometimes in the hands of intensive care unit patients' families. Since 2018, family members of dying patients in South Korea have had the legal right to make decisions for the patients. This study aimed to examine knowledge and attitude toward LST among the family members of patients under intensive care since the foundation of the new legislation. Their perceptions of the roles of nurses were also explored. In this cross-sectional study, 89 participants completed survey questionnaires on demographic characteristics, relationship to patient, reason for admission, length of stay, awareness of the new legislation, knowledge and attitude toward LST, and perception of the role of nurses. The results indicated that knowledge was significantly associated with attitude and was, in fact, the only predictor of attitude toward LST (P = .021). Explaining the disease and prognosis in detail and relieving patients of their physical pain were the roles of nurses most valued by family members. The findings suggest that it is crucial for nurses to support family members and provide information about critical changes and medical options for collaborative decision making according to the patients' wishes during the dying process.

In Quest of Tablet Apps for Elders With Alzheimer's Disease: A Descriptive Review.

Caregivers search for mobile device apps that offer meaningful and enjoyable activities to simultaneously enhance the preserved cognitive and functional abilities of those in their care. The purpose of this review article was to describe the current state of tablet apps with which elders with Alzheimer's disease and related forms of dementia may engage as users. Using the keywords "app," "Alzheimer's," and "dementia," a sample of 83 apps was selected from the iTunes Store, Google, and discussion boards of Apple Support Communities. A descriptive content analysis was conducted using a coding scheme on the characteristics of tablet app activity and the requirements for functional abilities of the users. This review found that the activities of the selected apps included games, simple watching and viewing, music and sounds, memory training, learning and information, and social interaction starters. A high-level cognitive and physical ability such as eye-hand coordination is often required to play the majority of the game apps. A few apps are designed specifically for the population. Individuals' variability in cognitive and functional abilities necessitates a person-centered approach in designing and selecting games and activities for apps in order to increase engagement and promote positive experiences in older adults.

Engaging in Preferred Computer Activities and Cognitive Outcome.

Valuing an individual's choice in activities is important in person-centered dementia care. This study examined changes in cognitive function among long-term care residents with dementia, following engagement in preferred computer activities. Over a seven-week period, a total of 585 observational activity-monitoring logs from 26 participants were collected. The most frequently selected computer activities were playing computer games and watching audio-visual media. Cognitive function significantly improved more in participants who spent more than 580 minutes on computer activities than those who spent less. A regression analysis showed that time spent in playing computer games was the only predictor to explain changes in cognitive function. The findings suggested that engaging in preferred computer activities may not only be meaningful and enjoyable but also promote cognitive function.

Corrigendum to "Health Status and the Demand for Healthcare among the Elderly in the Rural Quoc-Oai District of Hanoi in Vietnam".

[This corrects the article DOI: 10.1155/2017/4830968.].

The roles of, activities of, and competencies for, community nursing services in rural Vietnam: Implications for policy decisions.

Community health workforce plays a vital role in providing primary health care services as per the needs of residents; however, few studies have examined how nurses work within commune health centers (CHCs). Using qualitative methods including interviews and focus group discussions with key stakeholders, this study explores the roles, activities, and competencies required of community nursing services in rural districts within Vietnam. Two primary roles were identified: CHC nursing and family nursing. For the latter, in addition to providing people with general health care and health communication, they were expected to also deliver psychological care. CHC nursing fulfilled more roles and required four specific competencies: clinical care, communication, management, and planning/coordination activities. Despite these various roles serving people within a community, few ongoing efforts at either the local or national level are aimed at supporting these nurses. The study highlights the need for policy decisions via either developing a new job position policy or adapting the existing policy by integrating new roles into the existing positions of CHC nurses in Vietnam.

Health Status and the Demand for Healthcare among the Elderly in the Rural Quoc-Oai District of Hanoi in Vietnam.

BACKGROUND: Vietnam is experiencing an unprecedented demographic transition. Its proportion of elderly people is growing rapidly. OBJECTIVE: This study explored the health status and health-related quality of life (HRQoL) of rural elderly Vietnamese and assessed their needs for healthcare services. DESIGN: This study used a survey with stratified proportion sampling and quota assignment. In 2016, data was collected from 713 people in the rural Quoc-Oai district of Hanoi aged 60 or older. RESULTS: The mean age of the respondents was 70.9. Both self-rated health status and functional status decreased with age. Women reported more functional limitations than men. Musculoskeletal disorders were the most frequently reported chronic diseases, followed by hypertension, gastrointestinal diseases, and cardiovascular diseases. Age, self-rated health status, BMIs, and the number of noncommunicable diseases (NCDs) were found to be significant determinants of HRQoL, after controlling for socioeconomic effects. More than half the respondents requested more healthcare information, particularly on disease management. CONCLUSIONS: Vietnam's healthcare system is being challenged to make health services easily accessible and meet the growing needs for chronic illness management, risk reduction, promoting healthy lifestyles, and improving the aging population's quality of life.

Mild Cognitive Impairment Is Characterized by Deficient Brainstem and Cortical Representations of Speech.

Mild cognitive impairment (MCI) is recognized as a transitional phase in the progression toward more severe forms of dementia and is an early precursor to Alzheimer's disease. Previous neuroimaging studies reveal that MCI is associated with aberrant sensory-perceptual processing in cortical brain regions subserving auditory and language function. However, whether the pathophysiology of MCI extends to speech processing before conscious awareness (brainstem) is unknown. Using a novel electrophysiological approach, we recorded both brainstem and cortical speech-evoked brain event-related potentials (ERPs) in older, hearing-matched human listeners who did and did not present with subtle cognitive impairment revealed through behavioral neuropsychological testing. We found that MCI was associated with changes in neural speech processing characterized as hypersensitivity (larger) brainstem and cortical speech encoding in MCI compared with controls in the absence of any perceptual speech deficits. Group differences also interacted with age differentially across the auditory pathway; brainstem responses became larger and cortical ERPs smaller with advancing age. Multivariate classification revealed that dual brainstem-cortical speech activity correctly identified MCI listeners with 80% accuracy, suggesting its application as a biomarker of early cognitive decline. Brainstem responses were also a more robust predictor of individuals' MCI severity than cortical activity. Our findings suggest that MCI is associated with poorer encoding and transfer of speech signals between functional levels of the auditory system and advance the pathophysiological understanding of cognitive aging by identifying subcortical deficits in auditory sensory processing mere milliseconds (<10 ms) after sound onset and before the emergence of perceptual speech deficits.SIGNIFICANCE STATEMENT Mild cognitive impairment (MCI) is a precursor to dementia marked by declines in communication skills. Whether MCI pathophysiology extends below cerebral cortex to affect speech processing before conscious awareness (brainstem) is unknown. By recording neuroelectric brain activity to speech from brainstem and cortex, we show that MCI hypersensitizes the normal encoding of speech information across the hearing brain. Deficient neural responses to speech (particularly those generated from the brainstem) predicted the presence of MCI with high accuracy and before behavioral deficits. Our findings advance the neurological understanding of MCI by identifying a subcortical biomarker in auditory-sensory processing before conscious awareness, which may be a precursor to declines in speech understanding.

Chief Complaints of Elderly Individuals on Presentation to Emergency Department: A Retrospective Analysis of South Korean National Data 2014.

PURPOSE: We aimed to assess the chief complaints (CCs) of elderly individuals on presentation to the emergency department (ED) according to gender, age, and disease-related and injury-related visits. METHODS: The 2014 registry database of the National Emergency Department Information System in South Korea, which included data on 908,761 ED visits by individuals aged 65 years and over, was reviewed. RESULTS: We found that 80.7% ED visits were related to disease, whereas the remaining visits were related to injury. The most common CCs presented by elderly male and female individuals with disease-related visits were dyspnea and dizziness, respectively. The 10 most common CCs accounted for 45.5% and 49.2% of the total disease-related visits for male and female individuals, respectively. The most common CC in male and female individuals with injury-related visits was headache and hip pain, respectively. The CC rank showed minimal variance among the different age groups, but a difference was observed between male and female individuals. The most common mechanism of injury in elderly male and female individuals was slipping, wherein females showed a higher occurrence rate than their male counterparts. CONCLUSIONS: These findings can be used to establish an ED training curriculum for nursing students and ED nurses, particularly for ED triage in the elderly.

Computer Activities for Persons With Dementia.

PURPOSE OF THE STUDY: The study examined participant's experience and individual characteristics during a 7-week computer activity program for persons with dementia. DESIGN AND METHODS: The descriptive study with mixed methods design collected 612 observational logs of computer sessions from 27 study participants, including individual interviews before and after the program. Quantitative data analysis included descriptive statistics, correlational coefficients, t-test, and chi-square. Content analysis was used to analyze qualitative data. RESULTS: Each participant averaged 23 sessions and 591min for 7 weeks. Computer activities included slide shows with music, games, internet use, and emailing. On average, they had a high score of intensity in engagement per session. Women attended significantly more sessions than men. Higher education level was associated with a higher number of different activities used per session and more time spent on online games. Older participants felt more tired. Feeling tired was significantly correlated with a higher number of weeks with only one session attendance per week. More anticholinergic medications taken by participants were significantly associated with a higher percentage of sessions with disengagement. The findings were significant at p < .05. Qualitative content analysis indicated tailoring computer activities appropriate to individual's needs and functioning is critical. All participants needed technical assistance. IMPLICATIONS: A framework for tailoring computer activities may provide guidance on developing and maintaining treatment fidelity of tailored computer activity interventions among persons with dementia. Practice guidelines and education protocols may assist caregivers and service providers to integrate computer activities into homes and aging services settings.

Preferred computer activities among individuals with dementia: a pilot study.

Computers offer new activities that are easily accessible, cognitively stimulating, and enjoyable for individuals with dementia. The current descriptive study examined preferred computer activities among nursing home residents with different severity levels of dementia. A secondary data analysis was conducted using activity observation logs from 15 study participants with dementia (severe = 115 logs, moderate = 234 logs, and mild = 124 logs) who participated in a computer activity program. Significant differences existed in preferred computer activities among groups with different severity levels of dementia. Participants with severe dementia spent significantly more time watching slide shows with music than those with both mild and moderate dementia (F [2,12] = 9.72, p = 0.003). Preference in playing games also differed significantly across the three groups. It is critical to consider individuals' interests and functional abilities when computer activities are provided for individuals with dementia. A practice guideline for tailoring computer activities is detailed.