The experiences of undergraduate nursing students with mental health conditions in the inpatient clinical setting: A qualitative study.

BACKGROUND: The prevalence of mental health conditions in college students is increasing. Due to this rising number, more students with mental health conditions (NSWMHCs) are enrolling in nursing programs. There is a need for nurse educators to discover new ways to foster retention and success for this student population. OBJECTIVES: The purpose of this study was to examine the experiences of undergraduate NSWMHCs in the inpatient clinical setting, particularly related to perceived barriers and changes they would make to their clinical rotations. DESIGN: Qualitative descriptive design. SETTING: The study was conducted at a 4-year public university in the Northeast region of the United States. PARTICIPANTS: A purposeful sample of seven junior and senior undergraduate nursing students diagnosed with mental health conditions. METHODS: Data were collected between November 2021 and February 2022 through in-depth, semi-structured interviews that lasted between 30 and 60 min each. Data were analyzed using thematic analysis. RESULTS: The data analysis identified seven major themes: dealing with internal and external barriers, relating to patients' experiences particularly those with mental health conditions, sharing perceptions with peers to understand interactions and experiences, using particular coping skills, improving over time, inconsistent faculty interactions, and recommended changes. CONCLUSIONS: Findings suggest that while NSWMHCs face multiple challenges in the clinical setting, they also have valuable experiences and possess unique insight that can foster their success.

Guidelines to support newly qualified professional nurses for effective clinical practice.

BACKGROUND:  Transitioning to a professional role is difficult for newly qualified professional nurses. Given the challenges that these nurses experience during the transition to practice, support is essential for them to become efficient, safe, confident, and competent in their professional roles. OBJECTIVES:  The purpose of this study was to explore the transition experiences of newly qualified professional nurses to develop a preceptorship model. METHOD:  This study employed a qualitative approach to purposively collect data. Concept analyses were conducted applying the steps suggested by Walker and Avant, and the related concepts were classified utilising the survey list of Dickoff, James and Wiedenbach's practice theory. RESULTS:  A preceptorship model for the facilitation of guidance and support in the clinical area for newly qualified professional nurses was developed. The model consists of six components, namely, the clinical environment, the operational manager and preceptor, the newly qualified professional nurse, the preceptorship, the assessment of learning, and the outcome. CONCLUSION:  The study revealed that newly qualified professional nurses face many transition challenges when entering clinical practice. They are thrown far in, experience a reality shock, and are not ready to start performing their professional role. The participants agreed that guidance and support are needed for their independent practice role.Contribution: The preceptorship model for newly qualified professional nurses would be necessary for the transition period within hospitals. This preceptorship model may be implemented by nursing education institutions as part of their curriculum to prepare pre-qualifying students for the professional role.

Nursing students' preparedness for the digitalised clinical environment in Australia: An integrative review.

AIM: The aim of this integtrative review is to examine the literature on nursing students preparedness for the digitalised clinical setting. BACKGROUND: Digital literacy skills ensure nursing students can provide quality and safe care to patients in a digitalised clinical setting. DESIGN: Integrative review of the literature. METHODS: The integrative review of the literature incorporated Whittemore and Knafl's (2005) framework and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2021 statement. A review of the literature comprised of a search of the following databases: ERIC, Scopus, CINAHL, Medline, Cochrane Library and Google Scholar from 2010-2022. Data were critically appraised using the Critical Appraisal Skills Programme (CASP), the Mixed Method Tool (MMAT) and Joanna Biggs Institute (JBI). RESULTS: The literature reported on nine studies from 2010 to 2022. The four themes identified using Braun and Clarke's thematic analysis were curriculum design, education and training, digital literacy level and professional digital literacy competency standard framework. Major findings include the need for the development and integration of a professional digital literacy competency standard framework embedded into nursing curricula to equip nursing students with appropriate digital literacy skills to navigate digitalised healthcare settings. CONCLUSION: Current registered nurses and preregistration nurses are required to be upskilled with the understanding and knowledge of health informatics and its role in the clinical setting. This will enable future registered nurses to keep up with the rapidly evolving technological clinical environment.

The Relationship between Clinical Environment and Adverse Events Reporting: Evidence from Lithuania.

BACKGROUND: The clinical environment plays a crucial role in patient safety, as it encompasses the physical, organizational, and cultural aspects of healthcare delivery. Adverse events, such as active errors, can often be attributed to systemic issues within the clinical environment. Addressing and improving environmental factors is essential for minimizing adverse events and enhancing overall patient care quality. METHODS: A descriptive, cross-sectional design was applied. The study utilized two questionnaires: the Reporting of Clinical Adverse Events Scale (RoCAES) and the Revised Professional Practice Environment (RPPE) scale. A total of 1388 questionnaires were fully filled out, with a response rate of 71 percent. RESULTS: Nurses who expressed higher levels of satisfaction with various aspects of the clinical environment were more inclined to indicate their intention to report adverse events in the future. These positive relationships suggest that a contented clinical environment fosters a greater willingness among nurses to report adverse event occurrences. CONCLUSION: The findings of our study support the evidence that demonstrated that the clinical environment plays a significant role in influencing the reporting of adverse events in healthcare settings. It significantly influences nurses' attitudes, quality of care, and adverse event reporting rate.

Clinical preparedness programme as perceived by first-year diagnostic radiography students in South Africa.

INTRODUCTION: There is an increasing emphasis on exploring ways to improve students' transition from the classroom into the clinical environment. Diagnostic radiography (DR) students undergo rigorous theoretical and practical training before they are exposed to the clinical environment. It has been found that when DR students commence clinical learning in the workplace for the very first time, they experience difficulties in this transition. At the site of investigation, a newly integrated and dedicated clinical preparedness (CP) programme was offered; however, little is known about the DR students' perceptions of this programme. METHODS: A qualitative approach coupled with a self-developed, cross-sectional research tool was employed. First-year DR students were purposefully sampled against the inclusion and exclusion criteria. The principle of voluntary participation was upheld throughout the data collection process. The data were analysed using Braun and Clarke's six steps of thematic analysis. RESULTS: Forty-two responses were collected. Following a thematic analysis, two overarching themes were developed, namely: (1) reflections on the CP programme and (2) suggestions for future CP programmes. CONCLUSION: This study demonstrated the need for effective CP programmes as an approach to ease the transition of first-year DR students from the classroom into the clinical environment. Several suggestions, for example, an extended CP programme and a clinical information pack were made for the offering of similar programmes in the future.

Understanding Human-Computer Interactions in Restricted Clinical Environments.

INTRODUCTION: Conducting research on human-computer interaction and information retrieval requires unobtrusive observations within existing network architectures. STATE OF THE ART: Most of the available tools are not suitable to be applied within restricted clinical systems. The specific requirements hinder analysis of the human factors in health sciences. CONCEPT: We identified extensions for popular web browsers as a suitable way to conduct studies in highly regulated environments. IMPLEMENTATION: Considering the specialized requirements and an adequate level of transparency for the recorded clinician, we developed an open-source Web Extension compatible with major web browsers. LESSONS LEARNED: We identified the challenges associated with the specific tool and are preparing its use to understand clinical reasoning in personalized oncology.

Human-centred health-care environments: a new framework for biophilic design.

Increasing research corroborates that the qualities of the setting in which a patient receives healthcare positively influence health outcomes. Therefore, it has become progressively important to review the concept of therapeutic environments, as places where patients are treated with the most advanced medicine and technology, but also support their users in psychological, emotional and social terms. This quest for the optimal healing environment brings to the forefront the need to include other parameters in our design briefs, where the application of biophilic design proves to be paramount, as exposure to nature is associated with multiple health benefits. However, current biophilic design frameworks fail to provide efficient guidance, as their design recommendations don't differentiate the level of value of each design parameter for each building programme and context. Our position is that a biophilic design framework can only be efficient if it is adapted to specific building functions and is geographically and culturally contextualized. This study assessed the application of biophilic design in therapeutic environments for cancer patients in the UK, and provided a revised conceptual framework that can more efficiently guide designers and policies in future interventions. This framework was informed by synthesised analyses from healthcare environments on the user's experiences, and primary data obtained from semi-structured interviews with architects and managers, which was then benchmarked against scientific data about the impact of biophilic design on humans. This comprehensive approach helped to identify and rank those biophilic design parameters that appear the most critical for promoting and supporting health and wellbeing in cancer healthcare settings and provided an up-to-date compilation of crucial design actions to enact the necessary change in future research and design practice.

Praxis-Informed Pointers: A Student Guide for Optimizing Clinical Learning in a Resource-Constrained Setting.

Issue: Health professions education (HPE) is intimately linked with teaching and learning in the clinical environment. While the value of authentic clinical experiences is acknowledged, whether learning actually occurs is to a large extent dependent on students' behaviors and attitudes. The kinds of student behaviors and attitudes that are necessary to optimize learning in the clinical environment thus becomes relevant. Evidence: Tips and recommendations to maximize clinical learning in a variety of settings have been well documented. There is, however, a dearth of literature which takes a narrative-based praxis approach focused on resource-constrained environments. We developed this praxis-orientated article as a means to translate the available literature and theory into a simple, practical guide, focused on optimizing clinical learning from a student perspective, remaining cognizant of the particular challenges present in a resource-constrained setting. Implications: Based on the resource-constrained environments our students are exposed to, we outline the following six key aspects: student-driven learning, integration into the community of practice, student engagement, empathy, interprofessional learning opportunities, and feedback for learning. These aspects provide useful pointers for students in general. Furthermore, exploration into what strategies students may utilize in resource-constrained clinical contexts is addressed.

Nursing students' experiences and expectations of clinical learning: A qualitative study.

BACKGROUND: Clinical learning is an important component of nursing education that can support the development of competence. Nursing students have expectations before clinical learning, however if these expectations are not matched with their experiences, then development can be hampered. OBJECTIVE: To explore nursing students' expectations and experiences of their clinical learning experiences. DESIGN: Qualitative descriptive design. SETTINGS: The study was conducted at a large teaching hospital in Namibia. PARTICIPANTS: Fifteen first to fourth year undergraduate nursing students who were allocated to a teaching hospital in Namibia. METHODS: The participants were purposively sampled among the teaching hospital's undergraduate nursing students. Data were collected between June to November 2021 through in-depth, semi-structured interviews that lasted between 35 and 45 min each. Data were analyzed using thematic analysis. RESULTS: The data analysis identified four themes: clinical outlook and role, supporting/role modelling, clinical teaching and learning, and linking theory and practice. CONCLUSION: The expectations and experiences of nursing students regarding the clinical environment were mixed. The findings demonstrated the need to moderate students' expectations, as well as to reorganize the clinical learning environment to enhance students' learning. Further studies should look at the standardization of student expectations based on the context of their clinical learning environment, and how this can improve learning experiences.

Supporting Bystanders and Other Staff Exposed to Negative Workplace Behaviour: Developing and Testing the IMO Intervention Framework in the Clinical Workplace.

Background: Medical student and health-care staff bullying remain international concerns. Our understanding about what might solve such problems is still developing. A common approach suggested for bystanders to bullying is that they challenge or "stand up" to the bully. At the same time, the considerable risks should they act (eg, verbal rebuke) are rarely acknowledged, and neither is the potential for considerable cognitive dissonance should they choose not to. Methods: Drawing on a substantial literature review, we developed an interventional program, initially with medical student bullying in mind, that generally employed a discourse for values cultivation. We implemented and evaluated this program through 6 cycles of action research methodology in 6 different departments of one tertiary teaching hospital. Data include individual interviews, discussions with key participants plus freehand comments from wider staff's workshop evaluations. Results: Alongside others, an early serendipitous finding was the "IMO" [Indirect, focus on Me, focus on Outcome] framework, intended for bystanders to student bullying. From using this framework, participants reported developing confidence in tackling negative behaviours, that interactions had better outcomes and that the workplace atmosphere felt more relaxed. It's use also significantly reduced cognitive dissonance. Encouragingly, participants went on to use IMO for staff-staff bullying incidents, and other common negative behaviours. We attribute IMO's utility to its memorability, simplicity and for catering to the many possible causes of bullying, including values issues, without perpetuating or creating conflict. Conclusion: The IMO framework is offered as a widely usable framework for all staff in a clinical environment - a useful addition to popular frameworks used in the clinical workplace, ideas from which might also help these be further refined. Further evaluation would establish whether IMO invites long-term change and its utility in other contexts.

Wearable Heart Rate Monitoring Device Communicating in 5G ISM Band for IoHT.

Advances in wearable device technology pave the way for wireless health monitoring for medical and non-medical applications. In this work, we present a wearable heart rate monitoring platform communicating in the sub-6GHz 5G ISM band. The proposed device is composed of an Aluminium Nitride (AlN) piezoelectric sensor, a patch antenna, and a custom printed circuit board (PCB) for data acquisition and transmission. The experimental results show that the presented system can acquire heart rate together with diastolic and systolic duration, which are related to heart relaxation and contraction, respectively, from the posterior tibial artery. The overall system dimension is 20 mm by 40 mm, and the total weight is 20 g, making this device suitable for daily utilization. Furthermore, the system allows the simultaneous monitoring of multiple subjects, or a single patient from multiple body locations by using only one reader. The promising results demonstrate that the proposed system is applicable to the Internet of Healthcare Things (IoHT), and particularly Integrated Clinical Environment (ICE) applications.

The accuracy of simple, feasible alternatives to polysomnography for assessing sleep in intensive care: An observational study.

BACKGROUND: Sleep disturbance is common in intensive care patients. Understanding the accuracy of simple, feasible sleep measurement techniques is essential to informing their possible role in usual clinical care. OBJECTIVE: The aim of the study was to investigate whether sleep monitoring techniques such as actigraphy (ACTG), behavioural assessments, and patient surveys are comparable with polysomnography (PSG) in accurately reporting sleep quantity and quality among conscious, intensive care patients. METHODS: An observational study was conducted in 20 patients admitted to the intensive care unit (ICU) for a minimum duration of 24 h, who underwent concurrent sleep monitoring via PSG, ACTG, nursing-based observations, and self-reported assessment using the Richards-Campbell Sleep Questionnaire. RESULTS: The reported total sleep time (TST) for the 20 participants measured by PSG was 328.2 min (±106 min) compared with ACTG (362.4 min [±62.1 min]; mean difference = 34.22 min [±129 min]). Bland-Altman analysis indicated that PSG and ACTG demonstrated clinical agreement and did not perform differently across a number of sleep variables including TST, awakening, sleep-onset latency, and sleep efficiency. Nursing observations overestimated sleep duration compared to PSG TST (mean difference = 9.95 ± 136.3 min, p > 0.05), and patient-reported TST was underestimated compared to PSG TST (mean difference = -51.81 ± 144.1 7, p > 0.05). CONCLUSIONS: Amongst conscious patients treated in the ICU, sleep characteristics measured by ACTG were similar to those measured by PSG. ACTG may provide a clinically feasible and acceptable proxy approach to sleep monitoring in conscious ICU patients.

An exploration of the impact of working in pairs on the dental clinical learning environment: Students' views.

INTRODUCTION: The aims of this study were to explore the undergraduate dental clinical students' experiences and perspectives of paired working in the clinical learning environment. MATERIALS AND METHODS: An interpretivist methodological approach with a socio-cultural lens was used. A stratified purposeful sampling strategy was chosen. Students digitally recorded three audio-diaries using Gibbs' cycle to guide reflection on collaborating clinically with a peer. 1:1 semi-structured interviews were held using a topic guide. Inductive thematic data analysis was undertaken. RESULTS: Eight participants were recruited. Main themes related to individual characteristics (motivation, professionalism, knowledge and experience) and relational features (feeling safe, attaching value, positive working relationships) that contributed to effective collaborative partnerships. The social setting is important for learning in the dental clinical environment. Benchmarking is used by students to motivate and reassure. Students learnt from their peers, particularly when they felt safe and supported and had developed good relationships. A lesser quality learning experience was highlighted in the assistant role. CONCLUSION: Paired working for clinical training was viewed mostly positively. Working with a variety of peers was beneficial and enabled development of interpersonal skills and professionalism. More effective collaborative learning partnerships were described when students felt they belonged and had affective support. Disadvantages of paired working were noted as reduced hands-on experience, particularly for senior students and when working in the assistant role. Ground rules and setting learning goals to change the mind-set about the assistant role were recommended. Emotional and practical support of students is needed in the clinical setting.

Risk factors for suicidal behavior: A Romanian mixed methods study.

OBJECTIVES: This study had two purposes: to explore the main socio-demographic and medical characteristics of the psychiatric patients with a history of suicidal behavior, and to identify the main risk factors underlying the suicidal ideation and acts among psychiatric patients, in the light of two recent theories of suicidal behavior. METHODS: The study is based on a mixed methodological design. During 2019 to 2021, 65 hospitalized psychiatric patients, who committed at least one non-lethal suicide attempt, were investigated using a questionnaire a scales for data collection. Medical records were used to gather data about certain socio-demographic characteristics and the health status of the respondents. Patients also participated in a narrative interview aimed at disclosing their subjective experiences about their past suicidal behavior. RESULTS: The typical psychiatric patient with a history of suicidal behavior, as highlighted by the quantitative analysis, portraits a young old male from an urban environment, childless, educated, having experienced employment problems, being involved in religious activities. The clinical picture of the patient with suicidal antecedents included a moderate or severe level of depression, the presence of socio-emotional loneliness, the manifestation of frequent and long episodes of suicidal ideation, and the intention of committing suicide in order to stop the pain, whose acts resulted in minor injuries. Findings from the qualitative data revealed four major risk factors for the non-lethal suicidal attempts: family disruptions and social problems; economic burdens; a mixture of psychiatric pathologies; and, to a lesser extent, somatic pathologies. CONCLUSION: This study is the first to explore the triggers of suicide acts conducted in a clinical environment in the Balkan region. Implications of the pandemic are also discussed. The findings are useful for designing prevention strategies based on individual psychotherapy and therapeutic or support groups, addressing the main risk factors behind the suicidal ideation and gestures.

Hybrid Work from Home Clinical Academic Environment: A One-Year Follow-Up Survey of Attitudes and Beliefs of Members of a Department of Palliative Care, Rehabilitation, and Integrative Medicine.

Context: Palliative, Rehabilitation, and Integrative Medicine (PRIM) department members anonymously reported a positive experience with work from home (WFH) two months after its rapid pandemic transition in March 2020. Data are limited on the stability of such preferences and experiences over time. Objectives: The objectives of this study were to survey the attitudes and beliefs of PRIM employees toward remote work 16 months after the start of the coronavirus disease 2019 (COVID-19) pandemic since vaccines and to determine changes in perceptions of WFH. Methods: All 138 PRIM employees were invited to participate in an anonymous survey from mid-July to mid-August 2021. The 30-question survey included demographics, perceptions toward WFH, and the pandemic. Results: One hundred fifteen (83%) employees completed the survey: 29 (74%) research, 62 (83%) clinicians, and 24 (100%) administrative personnel. Most were female (76%), 30-59 years old (88%), PRIM employees before May 2020 (89%), shared office space (52%), and had received either first or second dose of the COVID-19 vaccine (88%). Overall experience (86%) and emotional response (74%) with WFH were positive and not significantly different from 2020 (p = 0.128 and 0.782, respectively). Positive experience was associated with having adequate equipment (p = 0.002), perception of productivity (p = 0.002), financial advantage (p = 0.002), and time demands caring for dependents (p = 0.038). Clinicians reported less positive response (78%, p = 0.002) and less productivity (49%, p = 0.002) with WFH and higher level of stress (54%, p = 0.026) since COVID-19. Employees continued to support WFH permanently (79%) for two or more days/week (82%). There was continued increased emotional exhaustion (71%) similar to 2020 (p = 0.868), and being asked to work partially or completely from home permanently was favored by 64% versus 97% and 96% of clinicians, research, and administrative, respectively (p = 0.002). Conclusions: Support for WFH was sustained a year later and after three pandemic waves. These findings serve as a model for future rapid work transitions and can help elucidate factors associated with stress and emotional exhaustion in a new post-COVID-19 work environment.

Interprofessional On-floor Education on Oxygen Therapy in COVID-19 Patients, Cardiac Arrest, and Procedural Sedation: Perception of Health-care Workers in Emergency Setting.

Objective: There is paucity of evidence for interprofessional education (IPE) conducted within the working environment of emergency departments (EDs). This study demonstrates favorable perception of on-floor IPE sessions conducted in a busy emergency department. Materials and Methods: Between January and December 2020, IPE was conducted in EDs using low fidelity manikins and involved nurses, doctors, respiratory therapists, and medical students already present on floor. The three key areas were, taught cardiac arrest, escalating oxygen therapy for COVID-19 patients, and procedural sedation. Each session lasted 30 min, and feedback was obtained immediately after the session in both transcribed and written forms through scannable survey monkey links. Results: Forty-seven sessions were conducted covering the three topics for 141 participants. The majority of the participants benefited from on-floor IPE and preferred this approach in the future. Both participant and faculty recommended to have some protected time to maximize the learnings. Conclusion: IPE in the clinical environment is feasible, with careful planning it can enhance collaborative learning in the ED.

Integrated Clinical Environment Security Analysis Using Reinforcement Learning.

Many communication standards have been proposed recently and more are being developed as a vision for dynamically composable and interoperable medical equipment. However, few have security systems that are sufficiently extensive or flexible to meet current and future safety requirements. This paper aims to analyze the cybersecurity of the Integrated Clinical Environment (ICE) through the investigation of its attack graph and the application of artificial intelligence techniques that can efficiently demonstrate the subsystems' vulnerabilities. Attack graphs are widely used for assessing network security. On the other hand, they are typically too huge and sophisticated for security administrators to comprehend and evaluate. Therefore, this paper presents a Q-learning-based attack graph analysis approach in which an attack graph that is generated for the Integrated Clinical Environment system resembles the environment, and the agent is assumed to be the attacker. Q-learning can aid in determining the best route that the attacker can take in order to damage the system as much as possible with the least number of actions. Numeric values will be assigned to the attack graph to better determine the most vulnerable part of the system and suggest this analysis to be further utilized for bigger graphs.

Nursing practice environment and employee silence about patient safety: The mediating role of professional discrimination experienced by nurses.

AIMS: To examine the associations between nurse work environment with nurses' silence about patient safety and the mediating effects of professional discrimination experienced by nurses. DESIGN: Multicentre cross-sectional study. METHODS: Between January and April 2019, 607 nurses and nursing assistants from seven hospitals in Greece assessed their clinical environment using the 'Practice Environment Scale of the Nursing Work Index Revised-PES-NWIR', and the silence about patient safety. The 'Experiences of Discrimination Index' was adapted to specifically address experienced discrimination based on the nursing profession. The PROCESS macros for SPSS were used to examine the above associations. FINDINGS: Better nurse practice environment, with the exception of 'staffing and resource adequacy' dimension, was directly associated with less experienced professional discrimination, and directly and indirectly associated with less silence about patient safety, through the mediating role of professional discrimination experienced by nurses. CONCLUSIONS: Silence about patient safety is dependent on the clinical work environment and may be a response of nurses to discrimination in the work context. Both an improvement in the nurse work environment and a decrease in professional discrimination would minimize silence about patient safety. IMPACT: On many occasions, nurses are directly or indirectly discouraged from voicing their concerns about patient safety or are ignored when they do, leading to employee silence and decreasing the standard of care (Alingh et al., BMJ Quality & Safety, 2019, 28, 39; Pope, Journal of Change Management, 2019, 19, 45). Nurses' work-related determinants for silence are not clearly understood in the patient safety context. A favourably evaluated nurse practice environment is associated with less experienced professional discrimination and less silence about patient safety. To minimize silence about patient safety, both the nurse work environment and the experienced professional discrimination should be taken into consideration by nurse and healthcare managers.

Student satisfaction level, clinical learning environment, and tutor participation in primary care clinical placements: An observational study.

BACKGROUND: Competence evaluations in the clinical setting represent approximately 50% of the nurse training process. Factors, such as perceived learning environment and clinical nurse participation, may influence nursing student satisfaction during clinical placements. OBJECTIVE: To evaluate the relationship between the levels of nursing student satisfaction with clinical placements, the clinical learning environment, and the level of nurse tutor participation. DESIGN: A cross-sectional study. SETTING AND PARTICIPANTS: We included 61 nursing students and 45 clinical nurses from 35 primary care centres assigned to the Universitat Jaume I. VARIABLES AND DATA COLLECTION: We assessed the overall level of student satisfaction with clinical placements, students' perception of the learning environment, tutors' level of participation, and socio-demographic variables. DATA ANALYSIS: We performed a descriptive analysis of the study sample, as well as correlation and simple linear regression analyses. Questionnaire results were analysed depending on the nature of the variables. RESULTS: The students' perception of the learning environment was 4.39 ± 0.48 points out of 5. The overall satisfaction level was 8.89 ± 1.22 points out of 10. Tutor participation level in students learning was 3.91 ± 0.58 points out of 5. CONCLUSIONS: Both student perception of the learning environment in the clinical setting and their overall level of satisfaction with clinical placements in the primary care centres were considered high. Tutors were participative, but poorly satisfied.

Robot-Assisted Gait Self-Training: Assessing the Level Achieved.

This paper presents the technological status of robot-assisted gait self-training under real clinical environment conditions. A successful rehabilitation after surgery in hip endoprosthetics comprises self-training of the lessons taught by physiotherapists. While doing this, immediate feedback to the patient about deviations from the expected physiological gait pattern during training is important. Hence, the Socially Assistive Robot (SAR) developed for this type of training employs task-specific, user-centered navigation and autonomous, real-time gait feature classification techniques to enrich the self-training through companionship and timely corrective feedback. The evaluation of the system took place during user tests in a hospital from the point of view of technical benchmarking, considering the therapists' and patients' point of view with regard to training motivation and from the point of view of initial findings on medical efficacy as a prerequisite from an economic perspective. In this paper, the following research questions were primarily considered: Does the level of technology achieved enable autonomous use in everyday clinical practice? Has the gait pattern of patients who used additional robot-assisted gait self-training for several days been changed or improved compared to patients without this training? How does the use of a SAR-based self-training robot affect the motivation of the patients?