Visual narratives in nursing education: A generative artificial intelligence approach.

AIM: The aim of this paper is to investigate the incorporation of visual narratives, such as comics and graphics, into nursing education using Generative Artificial Intelligence (GAI) models like DALL-E. BACKGROUND: Visual narratives serve as a powerful method for communicating intricate concepts in nursing education. Despite their advantages, challenges in creating effective educational comics persist due to the need for expertise in graphic design and the associated time and resource constraints. DESIGN: This study examines existing literature that highlights the efficacy of visual narratives in education and demonstrates the potential of GAI models, specifically DALL-E, in creating visual narratives for nursing education. METHODS: We analyze the potential of GAI models, specifically DALL-E, to create visual narratives for educational purposes. This was demonstrated through illustrative examples addressing sensitive topics, illustrating research methodology and designing recruitment posters for clinical trials. Additionally, we discussed the necessity of reviewing and editing the text generated by DALL-E to ensure its accuracy and relevance in educational contexts. The method also considered legal concerns related to copyright and ownership of the generated content, highlighting the evolving legal landscape in this domain. RESULTS: The study found that GAI, specifically DALL-E, has significant potential to bridge the gap in creating visual narratives for nursing education. While offering cost-effectiveness and accessibility, GAI tools require careful consideration of challenges such as text-related errors, misinterpretation of user prompts and legal concerns. CONCLUSIONS: GAI models like DALL-E offer promising solutions for enhancing visual storytelling in nursing education. However, their effective integration requires a collaborative approach, where educators engage with these tools as co-pilots, leveraging their capabilities while mitigating potential drawbacks. By doing so, educators can harness the full potential of GAI to enrich the educational experience for learners through compelling visual narratives.

Transforming nursing with large language models: from concept to practice.

Large language models (LLMs) such as ChatGPT have emerged as potential game-changers in nursing, aiding in patient education, diagnostic assistance, treatment recommendations, and administrative task efficiency. While these advancements signal promising strides in healthcare, integrated LLMs are not without challenges, particularly artificial intelligence hallucination and data privacy concerns. Methodologies such as prompt engineering, temperature adjustments, model fine-tuning, and local deployment are proposed to refine the accuracy of LLMs and ensure data security. While LLMs offer transformative potential, it is imperative to acknowledge that they cannot substitute the intricate expertise of human professionals in the clinical field, advocating for a synergistic approach in patient care.

Practice patterns, role and impact of advanced practice nurses in stroke care: A mixed-methods systematic review.

AIM(S): To undertake a systematic review of the practice patterns and roles of advanced practice nurses (APNs) in inpatient and outpatient stroke-care services; and to evaluate the impact of APN-led inpatient and outpatient stroke-care services on clinical and patient-reported outcomes. DESIGN: A mixed-methods systematic review. METHODS: A systematic search was conducted across six electronic databases for primary studies. Data were synthesised using a convergent integrated approach. DATA SOURCES (INCLUDE SEARCH DATES) *FOR REVIEWS ONLY: A systematic search was conducted across PubMed, CINAHL, Cochrane Library, Embase, PsycInfo and ProQuest Dissertations & Theses Global, for primary studies published between the inception of the databases and 3 November 2022. RESULTS: Findings based on the 18 included primary studies indicate that the APNs' roles have been implemented across the continuum of stroke care, including pre-intervention care, inpatient care and post-discharge care. Practicing at an advanced level, the APNs engaged in clinical, operational and educational undertakings across services and disciplines. Positive clinical and patient-reported outcomes have been attributed to their practice. CONCLUSION: The review highlights the critical role of APNs in improving stroke care, especially in the pre-intervention phase. Their clinical expertise, patient-centered approach and collaboration can transform stroke care. Integrating APNs into stroke care teams is essential for better management and outcomes in light of the increasing stroke burden. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Healthcare institutions should integrate APNs to enhance pre-intervention stroke care, improve diagnostic accuracy and expedite treatment. APNs can prioritise patient-centric care, including assessments, coordination and education. Medication reconciliation, timely rehabilitation referrals and lifestyle modifications for secondary stroke prevention are crucial. Implementing advanced practice nursing frameworks ensures successful APN integration, leading to improved stroke care and better patient outcomes in response to the growing stroke burden. IMPACT (ADDRESSING): What problem did the study address? Poor clarity of the role of advanced practice nurses among patients, physicians, healthcare professionals, health policymakers and nurses. What were the main findings? Advanced practice nurses practise across the continuum of stroke care, mainly in pre-intervention care which takes place before initiating treatment, inpatient care and post-discharge care. The implementation of the advanced practice nurse role in stroke care has contributed positively to clinical and patient-reported outcomes. Where and on whom will the research have an impact? Insights from the review are envisioned to inform healthcare policymakers and leaders in the implementation and evaluation of the APN role in stroke care. REPORTING METHOD: Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. TRIAL AND PROTOCOL REGISTRATION: https://figshare.com/ndownloader/files/41606781; Registered on Open Science Framework osf.io/dav8j.

Factors associated with registered nurses' academic performance in advanced practice nursing preparatory education: A retrospective cohort study.

AIM: To explore factors associated with academic performance in the Master of Nursing programme. BACKGROUND: Advanced practice nursing preparatory education generally involves completion of the Master of Nursing programme. While prior clinical experiences and on-the-job training are believed to underpin the preparation for such education, studies have suggested only weak or no associations between nurses' academic success in graduate schools and their clinical experiences. METHODS: A retrospective cohort study was conducted in the nursing department of a university in Singapore. Academic and demographic data were extracted in February 2020 from a shared repository of anonymised teaching and learning data. R was used to select and merge data tables into a usable format for subsequent analysis. Students enrolled between 2010 and 2017 were included for the analysis (n = 246). RESULTS: Age was statistically significantly associated with overall cumulative academic performance (p < 0.001). Younger students on average academically outperformed older students. Unmarried students were associated with better cumulative academic performance in the Clinical Practicum 2 module (p = 0.018). CONCLUSION: Younger students have historically outperformed their older counterparts in the Master of Nursing programme. There is a need to reassess the requirement of five years of clinical experience as an admission criterion for the Master of Nursing programme in Singapore. IMPLICATIONS FOR NURSING POLICY: There is a need to re-evaluate the admission criteria to better engage and retain younger nurses interested in advanced nursing practice. Nursing educators and leaders can partner with academics to develop advanced practice-specific education for pre-master nurses with the aptitude and interest in pursuing this track.

Assessment of the general public's knowledge of atrial fibrillation through social media: a cross-sectional study.

BACKGROUND: Early detection and timely treatment of atrial fibrillation (AF) remains pivotal to preventing AF-related complications. Public involvement in recognising potential AF symptoms and managing AF is vital for early detection and treatment of AF. OBJECTIVE: The aim of the study is to assess the general public's knowledge of AF using an online survey, disseminated via social media. METHODS: A cross-sectional online survey of the general public was conducted between November to December 2021. The survey's URL was shared on National University Heart Centre, Singapore's official Facebook page. Digital marketing strategies were employed to recruit members of the public. The 27-item survey assessed public's knowledge across five domains: basic information about AF, risk factors of AF, detection of AF, prevention of AF, and management of AF. RESULTS: The survey involved 620 participants. Approximately two-thirds were between the ages 21 to 40 years (64.5%), female (60%) and had at least a degree (64.7%) as their highest level of education. Participants obtained a mean percentage score of 63.3 ± 26.0 for their AF knowledge. One-way ANOVA was done to examine the associations between the participants' characteristics and their knowledge of AF. There were no statistically significant differences in the AF knowledge scores across the various sociodemographic subgroups. CONCLUSIONS: Members of the public recruited from Facebook and via digital marketing had moderately good knowledge of AF. However, public awareness pertaining to preventing AF has potential for improvement. The utility of social media in reaching the general public was illustrated through this study.

The information needs of patients with atrial fibrillation: A scoping review.

AIMS AND OBJECTIVES: To identify the atrial fibrillation (AF)-specific information needs of patients with AF. BACKGROUND: Patients' understanding of AF is pertinent to optimising treatment and outcomes, thus highlighting the need for effective patient education. The information required to deliver effective AF-specific patient education is less examined. METHODS: Guided by Arksey and O'Malley's framework, a scoping review was conducted for studies reporting the AF-specific information needs of patients with AF. Systematic searches were conducted across six databases (Medline, PubMed, CINAHL, Scopus, PsycINFO and ProQuest). All analyses were narrated in prose and outlined in tables. The PRISMA-ScR checklist was used to report this review. RESULTS: The systematic search yielded 3816 articles, of which 22 were included. Three major themes emerged from the thematic analysis. Each theme was supported by three subthemes. First, in 'Understanding AF', patients reported the need for 'Easy-to-understand information', information on the 'Screening and diagnosis' of AF and 'Trajectory of disease and its associated risks'. Second, in 'Treating AF', patients required information on the 'Role of anticoagulation', 'Existing or novel therapeutic options' and 'Monitoring effectiveness of treatment'. Lastly, in 'Living with AF', patients needed education in 'Symptom management', 'Secondary prevention of risks' and 'Recognition of emergency situations'. CONCLUSIONS: This review has identified the key AF-specific information needs of patients with AF. Being cognisant of the information needs of patients with AF, healthcare providers may become more effective in developing person-centred patient education interventions. RELEVANCE TO CLINICAL PRACTICE: Delivering relevant patient education is an important cornerstone for atrial fibrillation care. Nurses by convention play a professional role in patient education. It may be facilitative for nurses to refer to the review findings when developing and implementing patient education interventions. Being in the midst of an ongoing pandemic, patient education strategies may require the use of telecommunication technologies.

Characteristics, methodological, and reporting quality of scoping reviews published in nursing journals: A systematic review.

INTRODUCTION: Given the diversity of the scope for inquiry and methodologies used in nursing research, the synthesis of primary research may not be as straightforward as conducting a meta-analysis or systematic review on clinical trials. Scoping reviews offer an option to nursing academics for inquiries involving a range of applications and interpretations. Given the continual advances in evidence-based research, it is, therefore, crucial for nursing to constantly substantiate its research capabilities and uphold standards in its research inquiry. Accordingly, an updated overview would be timely to characterize scoping reviews in the nursing literature. Hence this review aimed to examine the characteristics of scoping reviews published in nursing journals and evaluate the methodological and reporting quality of the scoping reviews. DESIGN: A systematic review. METHODS: A comprehensive search of three electronic databases (PubMed, CINAHL, and Embase) were conducted. Scoping reviews published in English on or before December 31, 2020 were included, with the criterion that their publication had been in nursing journals indexed in the Journal Citation Reports (2020 Science Edition) of the Web of Science. Two reviewers independently screened the titles and abstracts for eligibility. A standardized data extraction form was used for data collection, and a 29-item checklist was developed to assess the methodological and reporting quality of the scoping reviews. The methodological and reporting quality was assessed independently by four reviewers and subsequently counter-checked by another two reviewers. Descriptive statistics were used to characterize the included papers, and narrative synthesis was undertaken to explain the results. RESULTS: This review included 422 papers from 88 nursing journals. They were published between 2008 and 2021 (median year 2019). Only 15 (3.5%) reviews reported accessible protocols, and 63 (15.0%) presented data on their critical appraisal of the included sources of evidence. Poor reporting of the selection of sources of evidence and data extraction was also identified. Overall, the 422 included reviews had complied with 20 (median [range: 9-27]) of the 29 items on the checklist. CONCLUSIONS: Scoping reviews have garnered wider acceptance in nursing research, of which the scopes and methodologies exhibit much diversity. Our systematic review has provided insights into existing scoping reviews published in nursing journals through our characterization of them and appraisal of their methodological and reporting quality. However, our findings underline several areas needing improvement: the lack of transparency, the absence of critical appraisal, non-compliance to established checklists, and inconsistencies in the data processing. CLINICAL RELEVANCE: Appraising included sources of evidence and maintaining transparency in the conduct and reporting of scoping reviews increases the practical utility of scoping reviews.

Health information needs and dissemination methods for individuals living with ischemic heart disease: A systematic review.

OBJECTIVES: This review aimed to identify the health information needs and preferred approaches to receive health information of individuals with Ischaemic Heart Disease (IHD). METHODS: A systematic review was conducted. Relevant literature, published in English (January 2011 to October 2021), was identified across six databases. Guided by Coulter et al.'s framework for developing patient information materials, thematic analysis was performed. The findings were presented in tables and prose. RESULTS: Fifty-nine studies were included. Eleven themes summarised the information needs of individuals with IHD. Each theme was supported with subthemes. Forty-five studies included information on preferred methods of dissemination. CONCLUSIONS: Our review has characterised the diverse information needs of individuals living with IHD and dissemination methods for outreach to this population. Such insights inform healthcare providers in formulating patient-centred educational interventions to empower patients to undertake successful behavioural modification. PRACTICE IMPLICATIONS: Patient education should be personalised and delivered according to individuals' risks for IHD and modifiable risk factors. The use of web-based dissemination of patient education has gained popularity among healthcare providers but sub-optimal adherence to these web-based interventions limits behavioural modification. Adding elements of in-person patient education session to complement web-based interventions may be more propitious to effecting behavioural modification.

Understanding the gender gap in advanced practice nursing: A qualitative study.

AIMS: We aim to explore the perceptions of registered nurses undergoing the advanced practice nurse preparatory programme and of advanced practice nurses towards the recruitment of men into the advanced practice nursing workforce. BACKGROUND: Given the need to expand and diversify the advanced practice nursing workforce, it is important to recognize the potential implications of gender disparity. It is critical to understand why few males are recruited into the advanced practice nursing preparatory programme and to determine whether gender-related bias is present in the professional development of nurses. METHOD: We use a descriptive qualitative design. Semi-structured interviews were conducted via Zoom (April to August 2021). RESULTS: Three themes were generated: 'The odds are eventually in the favour of men', 'The APN career-track is unpopular among men', and 'Balancing the gender gap in the APN workforce'. All themes are supported by three subthemes. CONCLUSIONS: Although males in nursing enjoy opportunistic advantages in entering the advanced practice nursing workforce, they are not interested in the role and not staying long enough in the nursing profession to become advanced practice nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should be more cognizant of the different social stereotypes faced by males and females in nursing. With such awareness, they can be more supportive and less biased in career counselling and job appraisals.

A Nurse-Led Integrated Chronic Care E-Enhanced Atrial Fibrillation (NICE-AF) Clinic in the Community: A Preliminary Evaluation.

The current physician-centric model of care is not sustainable for the rising tide of atrial fibrillation. The integrated model of care has been recommended for managing atrial fibrillation. This study aims to provide a preliminary evaluation of the effectiveness of a Nurse-led Integrated Chronic care E-enhanced Atrial Fibrillation (NICE-AF) clinic in the community. The NICE-AF clinic was led by an advanced practice nurse (APN) who collaborated with a family physician. The clinic embodied integrated care and shifted from hospital-based, physician-centric care. Regular patient education, supplemented by a specially curated webpage, fast-tracked appointments for hospital-based specialised investigations, and teleconsultation with a hospital-based cardiologist were the highlights of the clinic. Forty-three participants were included in the six-month preliminary evaluation. No significant differences were observed in cardiovascular hospitalisations (p-value = 0.102) and stroke incidence (p-value = 1.00) after attending the NICE-AF clinic. However, significant improvements were noted for AF-specific QoL (p = 0.001), AF knowledge (p < 0.001), medication adherence (p = 0.008), patient satisfaction (p = 0.020), and depression (p = 0004). The preliminary evaluation of the NICE-AF clinic demonstrated the clinical utility of this new model of integrated care in providing safe and effective community-based AF care. Although a full evaluation is pending, the preliminary results highlighted its promising potential to be expanded into a permanent, larger-scale service.

Patient perspectives of the Self-management and Educational Technology tool for Atrial Fibrillation (SETAF): A mixed-methods study in Singapore.

BACKGROUND: Atrial fibrillation (AF) is the most common arrythmia and is associated with costly morbidity such as stroke and heart failure. Mobile health (mHealth) has potential to help bridge the gaps of traditional healthcare models that may be poorly suited to the sporadic nature of AF. The Self-management and Educational technology support Tool for AF patients (SETAF) was designed based on the preferences and needs of AF patients but more study is required to assess the acceptance of this novel tool. OBJECTIVE: Explore the usability and acceptance of SETAF among AF patients in Singapore. METHODS: A mixed methods study was conducted with AF patients who were purposively sampled from an outpatient cardiology clinic in Singapore. After 6 weeks of using SETAF, semi-structured interviews were performed, and data were analyzed inductively following a thematic analysis approach. Results from a short 4-item survey and application usage data were also analyzed descriptively. Both qualitative and quantitative results were organized and presented following the Technology Acceptance Model (TAM) framework. RESULTS: A total of 37 patients participated in the study and 19 were interviewed. Participants perceived SETAF as useful for improving AF knowledge, self-management and access to healthcare providers and was easy to use due to the guided tutorial and user-friendly interface. They also identified the need for better personalization of content, psychosocial support features and reduction of language barriers. Application usage data revealed preference for AF related content and decreased interaction with the motivational message component of SETAF over time. Overall, most of the participants would continue using SETAF and were willing to pay for it. CONCLUSIONS: AF patients in Singapore found SETAF useful and acceptable as a tool for AF management. The insights from this study not only support the potential of mHealth but may also inform the design and implementation of future mHealth tools for AF patients.

The impact of COVID19 on advanced practice nursing education and practice: A qualitative study.

AIM: To explore Master of Nursing students' perspectives toward the impact of coronavirus disease 2019 (COVID-19) on the advanced practice nurse preparatory education and practice. BACKGROUND: Like many nursing education programmes, the advanced practice nurse preparatory training was greatly affected and had to radically change to adapt to the disruptions caused by the pandemic. The COVID-19 pandemic has created a strain on the healthcare system and advanced practice nurses have been expected to modify their normal practice to provide care in unprecedented ways. METHODS: The study used a descriptive qualitative design. Semi-structured video-conference interviews were conducted in an autonomous university (June-July 2020). The recruitment of participants (n = 14) concluded upon data saturation. A thematic analysis was conducted. The COnsolidated criteria for REporting Qualitative research (COREQ) guidelines were used. FINDINGS: Three main themes were identified: (1) overcome adversity through innovation, (2) acceptance of remote learning and (3) versatility of advanced practice nurses in an ongoing pandemic. Each theme was further explained by two subthemes to further elucidate the impact of COVID-19 on the advanced practice nurse preparatory training and practice. DISCUSSION: The evolution of the advanced practice nurse preparatory education catalysed by the COVID-19 pandemic brought on innovation. The ability of advanced practice nurses to adapt to evolving healthcare needs was also highlighted. CONCLUSION: Although face-to-face teaching and services are gradually returning, some innovations that arose during the pandemic may be worth keeping. IMPLICATIONS FOR NURSING: Nursing educators in higher education institutions can benefit from adopting technology to mitigate the challenges posed by the ongoing pandemic IMPLICATIONS FOR NURSING POLICY: Nurse leaders should review the role of advanced practice nurses to determine how best to capitalise on their practice to meet rising healthcare needs.

Understanding the role of an advanced practice nurse through the perspectives of patients with cardiovascular disease: A qualitative study.

AIMS AND OBJECTIVES: To explore patients' understanding of the role of an advanced practice nurse (APN). BACKGROUND: The increasing prevalence of multimorbidities among people living with cardiovascular disease (CVD) has increased the complexity of their clinical care. Implementing the role of APNs in new models of care has been shown to improve outcomes in the CVD population. However, the CVD population's understanding of and experiences with the APN role have not been examined in Singapore. METHODS: An exploratory descriptive qualitative design using semi-structured face-to-face individual interviews was undertaken (November 2017-March 2018). Fourteen participants were purposively sampled from an outpatient clinic in one of Singapore's national heart centres. Thematic analysis was undertaken. The COREQ guidelines were adhered to. FINDINGS: The multi-ethnic sample included ten males and four females. Two main themes were identified: (1) APNs play a complementary role to doctors and (2) the acceptance of the APN role takes time. Each theme was supported by three subthemes to further elucidate the role and acceptance of APNs. CONCLUSION: A lack of understanding of the role of APNs is present, thereby causing the less than optimal patient acceptance of APNs. As patients with CVD experience improvements to their health through APN-led services, they may gain confidence in APNs' skills and knowledge. RELEVANCE TO CLINICAL PRACTICE: When introducing new roles, fully explaining these roles to the target population is pertinent as it will be facilitative to patient engagement and optimisations of care. The findings support the call for APNs to explain the value and essence of advanced practice nursing more effectively. There should be a greater emphasis on teaching APNs to introduce and explain the role of APNs through APN preparatory education and incorporating this practice in APN practice standards, especially in contexts where APN development is premature.

Registered nurses' perceptions towards advanced practice nursing: A nationwide cross-sectional study.

AIMS: To explore registered nurses' perceptions towards the role of advanced practice nurses and to examine registered nurses' interests in becoming advanced practice nurses. BACKGROUND: Globally, the development and implementation of advanced practice nurses have been deemed propitious. Advanced practice nurses are recruited and developed from the current pool of registered nurses. Empirical research is needed to inform practice on ensuring the sustainability of the advanced practice nurse workforce through the recruitment and development of the current population of registered nurses. METHODS: A nationwide cross-sectional online survey was conducted in Singapore. Registered nurses from all public health care institutions were surveyed. RESULTS: Respondents (n = 1,025) displayed optimism and acceptance towards advanced practice nurses. However, only 30.7% hoped to become advanced practice nurses. Nursing leaders were reported to have a low success rate in identifying registered nurses who were both suitable and interested in the advanced practice nurse role. CONCLUSIONS: Registered nurses' positive perspectives towards the role of advanced practice nurses do not translate into interests in the role. The study offers pragmatic applicability in ensuring the sustainability of the advanced practice nurse workforce. IMPLICATIONS FOR NURSING MANAGEMENT: Advanced practice nurse-specific residency programmes for pre-master registered nurses may be facilitative to retaining and recruiting registered nurses for the advanced practice nurse workforce.

Reporting sample size calculations for randomized controlled trials published in nursing journals: A cross-sectional study.

BACKGROUND: Prior sample size calculation is essential to ensure that a randomized controlled trial (RCT) has enough power to detect any statistical differences between two groups while not over-recruiting participants. However, the compliance among RCTs published in nursing field is unknown. OBJECTIVE: To describe the reporting of sample size methodology and parameters used in RCTs published in nursing journals. DESIGN: A cross-sectional database search of all RCTs published in nursing journals was conducted. SETTING: 116 journals in the category of nursing. PARTICIPANTS: Not applicable. METHODS: A database search was conducted to identify all RCTs published in nursing journals from January 2016 to December 2016. Two-arm RCTs were reviewed to see if sample size estimation was mentioned in the text and if the parameters were sufficient for the estimation. For RCTs with effect size, sample sizes were recomputed and compared with the reported size. RESULTS: Two hundred and twenty-three RCTs were included in this study, and 143 (64.1%) studies mentioned how they obtained their sample sizes. Among these 143 studies, 132 (92.3%), 133 (93.0%), 33 (23.1%), and 84 (58.7%) specified their levels of significance (α), powers, tails of the test, and effect size related information, respectively. Only 22 (15.4%) provided all the necessary parameters to compute their sample sizes. Out of the 84 RCTs with effect size information, 49 (58.3%) had a relative difference of less than 25%. DISCUSSION: Around 36% of the RCTs published in nursing journals did not report how they reached their sample sizes. For those that had reported, only 15% provided all the necessary parameters to re-compute their sizes. It is concluded that the methodology and parameters used for sample size determination are inadequately reported in RCTs published in nursing journals.

Questionnaires Designed to Assess Knowledge of Atrial Fibrillation: A Systematic Review.

BACKGROUND: Atrial fibrillation (AF) is associated with high mortality and morbidity. Approximately half of patients with AF and at risk of stroke do not receive oral anticoagulation, despite its demonstrable reduction of stroke risk. Low adherence to anticoagulation medications may be a result of limited knowledge of AF among patients; hence, a validated instrument to assess AF knowledge is warranted. Cross-sectional surveys evaluating AF knowledge revealed the availability of instruments in the literature, but no systematic review has hitherto been conducted to characterize them. OBJECTIVE: The objective of this study is to collate all validated instruments assessing AF knowledge. METHODS: A systematic review was conducted. CINAHL, EMBASE, MEDLINE, and PsycINFO were searched from inception to May 25, 2018. Study selection and data extraction were conducted by 2 reviewers, from which results are presented narratively. RESULTS: Based on 407 records retrieved from the databases, 15 studies were included, from which 7 questionnaires assessing AF knowledge were identified. The number of items ranged from 8 to 58. All the questionnaires were content validated, and some also examined other validities and reliabilities. CONCLUSION: In the literature, 7 validated questionnaires are available for assessing AF knowledge, in which the items often cover knowledge of AF in general, symptoms, treatments, and complications.

Perception of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement of authors publishing reviews in nursing journals: a cross-sectional online survey.

OBJECTIVE: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement has been developed as a guideline for reporting systematic reviews and meta-analyses. Despite the prevalent use of the PRISMA statement in medicine and nursing, no studies have examined authors' perception of it. The purpose of this study is to explore the perception of the PRISMA statement of authors who published reviews, meta-analyses, or both in nursing journals. DESIGN: Cross-sectional descriptive study. METHODS: An online survey was conducted among authors who published reviews, meta-analyses, or both in nursing journals between 2011 and 2017. The selected authors' email addresses were extracted from the PUBMED database. A questionnaire-with a 10-point Likert scale (1-not important at all to 10-very important)-was developed to elicit their responses regarding their perception of not only the PRISMA statement as a whole, but also the individual items therein. RESULTS: Invitations were sent to 1960 valid email addresses identified, with 230 responses (response rate: 11.7%) and 181 completed responses (completion rate: 9.2%). The average perceived importance of the PRISMA statement was 8.66 (SD=1.35), while the perceived importance for the individual items ranged from 7.74 to 9.32. Six items were rated significantly higher than the average rating, whereas one item was rated significantly lower. CONCLUSION: Most respondents perceived the PRISMA statement as important. Items related to information sources, selection, search-flow presentation, summary of findings, limitations and interpretation were deemed more important while the registration was deemed less so.

Practice patterns and role perception of advanced practice nurses: A nationwide cross-sectional study.

AIMS: To provide an overview of the practice patterns of advanced practice nurses and to explore their perceptions of their role in Singapore. BACKGROUND: Role expansion of advanced practice nurses is increasingly popular in healthcare systems. However, their practice patterns remain variable, thereby introducing role ambiguity. Uncertainty revolves around how advanced practice nurses perceive their practice, competency and readiness for role expansion. METHODS: A nationwide survey of advanced practice nurses was conducted in Singapore. Statistical analyses of closed-ended responses and content analysis of open-ended responses were undertaken. RESULTS: A total of 87 participants were surveyed (42.8% response rate). Significant discrepancies existed between current practices and their expectations. Readiness for and acceptance of role expansion were discerned but multiple barriers to practice have remained. CONCLUSION: This pioneering study in Asia provides important evidence to support the call for greater clarity in the role of APNs and for review of existing institutional practice restrictions. It provides insights into healthcare systems in similar developmental stages of advanced practice nursing. IMPLICATIONS FOR NURSING MANAGEMENT: When outlining the goals and role priorities of advanced practice nurses APNs, nurse administrators can consider their best contributions in practice. This allows for long-term sustainability of their role.

The Translation of Knowledge Into Practice in the Management of Atrial Fibrillation in Singapore.

BACKGROUND: Atrial fibrillation (AF) is a clinically significant cardiac arrhythmia known to increase the risk of stroke by at least four times. Stroke-risk assessment and thromboprophylaxis are vital components in AF management. Guidelines are available to standardise AF management, but physicians' adherence to the recommended guidelines has been low. The aims were to: 1. Examine and compare the level of knowledge and current practice in AF management between cardiologists and non-cardiologist physicians in Singapore; 2. Identify physicians' perceived barriers to prescribing oral anticoagulants (OACs) when indicated; 3. Identify strategies to optimise AF management. METHODS: From June 2017 to August 2017, a cross-sectional online survey involving physicians was conducted in Singapore. The survey instrument was adapted from a previously developed instrument, and validated locally by five cardiologists. It explored the physicians' stroke-risk assessment practices, estimation of stroke risk and benefits of anticoagulation, likelihood of prescribing anticoagulation when indicated, perceived barriers to anticoagulation, and strategies to optimise AF management. RESULTS: Sixty-three (63) physicians completed the survey (14 cardiologists and 49 non-cardiologist physicians). No significant difference was found between cardiologists and non-cardiologist physicians in their assessment and estimation of stroke risk for stable AF patients. However, when presented with an AF patient with stroke risk, cardiologists were more likely than non-cardiologist physicians to prescribe novel OACs (93% vs. 51%; χ2=7.933, p=0.004). Compared to cardiologists, the majority of the non-cardiologist physicians thought the risk of falls were usually or always barriers to prescribing OACs (29% vs 69%; χ2=7.579, p=0.006). Among the suggested strategies to support them in AF management, physicians have overwhelmingly rated two as "quite useful" and "very useful": the establishment of clinics for monitoring anticoagulated patients (100%); and involvement of pharmacists in managing patients on warfarin (98.4%). CONCLUSIONS: Physicians possess good knowledge about stroke-risk assessment in AF patients yet it is not translated into effective measures for stroke prevention. Physicians, especially non-cardiologist ones, were not anticoagulating AF patients when indicated. Although novel OACs are safer alternatives to warfarin, non-cardiologist physicians were less inclined to use them for stroke prevention. All physicians opined that establishing anticoagulation clinics and collaborating with pharmacists were useful strategies to optimise AF management. Existing barriers to anticoagulation impeded the translation of knowledge into practice in the management of AF patients in Singapore, for which optimal strategies to optimise AF management are ascertained.

Subjective sleep quality, blood pressure, and hypertension: a meta-analysis.

Sleep quality is an important aspect of sleep, but no meta-analysis has elucidated its relationship with blood pressure (BP) and hypertension. A meta-analysis was conducted in October 2016 using multiple databases, including Embase and Medline. Studies that assessed subjective sleep quality and BP or hypertension were included. Upon full-text evaluation, 29 articles from 45 041 patients were selected, of which 22 articles were included in the meta-analysis and seven were presented narratively. Poor sleep quality was significantly associated with a greater likelihood of hypertension (odds ratio, 1.48; P value = .01). Poor sleepers had higher average systolic BP (mean difference = 4.37, P value = .09) and diastolic BP (mean difference = 1.25, P value = .32) than normal sleepers without statistical significance. Patients with hypertension had significantly worse sleep quality scores (mean difference = 1.51, P value < .01), while BP dippers had significantly better scores (mean difference = -1.67, P value < .01). The findings highlight the relationship between sleep quality and hypertension.