The impact of a three-phase video-assisted debriefing on nursing students' debriefing experiences, perceived stress and facilitators' practices: A mixed methods study.

BACKGROUND: As an integral part of simulation, debriefing helps learners to construct knowledge through reflecting, internalizing, and relating. Video-assisted debriefing (VAD) adds audio-visual captures and reviews to support traditional verbal debriefing (VD), but evidence evaluating its educational effects has been mixed, with limited attention focusing on its structure development. AIMS: This study aimed to 1) investigate the effects of a three-phase VAD in enhancing nursing students' debriefing experiences and perceived stress compared to VD and 2) to explore its impact on facilitators' debriefing practices. METHODS: A mixed-methods design was adopted. The quantitative phase involved a prospective controlled trial on 145 nursing students from a university in Singapore who were randomized into the intervention cluster (n = 72) and the control cluster (n = 73). The debriefing experience scale (DES), the stress visual analogue scale (Stress VAS), and the debriefing assessment for simulation in healthcare (DASH© student version) were used as outcome measures. For the qualitative component, a purposive sample of eight facilitators evaluated their own debriefing practices using the DASH© instructor version and each completed an open-ended question survey. Qualitative data were analyzed using content analysis. RESULTS: Students from the intervention cluster significantly improved their debriefing experiences (p = 0.01), experienced comparable stress, and had better impressions of VAD facilitators' practices (p < 0.001) compared to those in the control cluster. Repeated VAD significantly reduced students' stress (p < 0.001). Students viewed the VAD facilitators as more effective than the VD facilitators. Three categories were derived from the qualitative comments: the act of debriefing, the crux of VAD, and debriefing for success. CONCLUSION: The three-phase VAD significantly improved nursing students' debriefing experiences without adding extra stress. It also helped to improve facilitators' practices. Future research will benefit from exploring how experts facilitate the three-phase VAD "on the ground" and its effect on learning transfer and cost-effectiveness.

Prelicensure nursing students' perspectives on video-assisted debriefing following high fidelity simulation: A qualitative study.

BACKGROUND: Video-assisted debriefing has not attracted sufficient attention on exploring learners' perceptions. A full understanding of learners' attitudes and perceptions towards video-assisted debriefing sets the foundation for effective learning, which should be considered when integrating video-assisted debriefing to the nursing curricula. However, limited evidence on learners' perspectives makes it difficult to fully understand this phenomenon. OBJECTIVES: To explore prelicensure nursing students' experiences and perspectives on video-assisted debriefing following a high-fidelity simulation. DESIGN: An exploratory qualitative approach using focus groups. SETTING: This study was conducted at a local university in Singapore. PARTICIPANTS: A purposive sample of 27 prelicensure nursing students in Singapore were recruited. METHODS: Six focus group interviews were conducted. Thematic analysis was used to analyze the transcribed data. RESULTS: Three themes and eight subthemes were derived from the data analysis. The themes included journey from traditional verbal debriefing to video-assisted debriefing, praise and criticism of video-assisted debriefing, and the road to successful video-assisted debriefing. CONCLUSIONS: Nursing students revealed that video-assisted debriefing not only complemented the drawback of verbal debriefing by offering objective evidence but also improved their attitudes and behaviors through the unique experience of an emotional roller coaster. Learners should be desensitized to the fear of video and their discriminating capabilities should be developed prior to video-assisted debriefing. The findings can serve as a reference when designing and integrating video-assisted debriefing interventions into simulation-based education.

Biochemical and physiological effects of copper compounds/nanoparticles on sugarcane (Saccharum officinarum).

The widespread use of copper based nanomaterials has been accompanied by an increasing interest in understanding their potential risks. It is essential to understand the effects of these nanoparticles on edible crops by performing long-term experiments at relevant exposure concentrations. Sugarcane is the source of 70% of the world's sugar supply and the widespread use of refined sugar and the consumption of raw sugarcane can provide a route for nanoparticles to enter the food supply. In order to evaluate the biochemical and physiological effects of copper nanoparticle exposure, sugarcane was grown for one year in soil amended with 20, 40, and 60 mg/kg of Kocide 3000 (a copper based fungicide), copper metal nanoparticles, micro-sized CuO, and CuCl2. The results show that stress indicators such as catalase and ascorbic peroxidase enzymatic activity in the sugarcane plant were activated by all the copper based materials at different concentrations. Sugarcane plants exposed to nearly all copper treatments showed dosage dependent increases in copper concentrations in root tissues. Translocation of copper to aerial tissues was minimal, with copper concentrations not being significantly different from controls. In addition, Chlorophyll A content was higher in plants treated with Kocide 3000 at 20 and 60 mg/kg, µCuO at 20 mg/kg, and CuCl2 at 20 and 60 mg/kg. To our knowledge, this is the first report on the effects of nano-copper compounds in sugarcane crop.

Expectation prior to human papilloma virus vaccination: 11 to 12-Year-old girls' written narratives.

Expectations prior to needle-related procedures can influence individuals' decision making and compliance with immunization programmes. To protect from human papilloma virus (HPV) and cervical cancer, the immunization needs to be given before sexual debut raising interest for this study's aim to investigate how 11 to 12-year-old girls narrate about their expectations prior to HPV vaccination. A total of 27 girls aged 11 to 12 years participated in this qualitative narrative study by writing short narratives describing their expectations. The requirement for inclusion was to have accepted HPV vaccination. Data were subjected to qualitative content analysis. Findings showed the following expectations: going to hurt, going to be scared and going to turn out fine. The expectations were based on the girls' previous experiences, knowledge and self-image. The latent content revealed that the girls tried to transform uneasiness to confidence. The conclusion drawn from this study is that most girls of this age seem confident about their ability to cope with possible unpleasantness related to vaccinations. However, nurses need to find strategies to help those children who feel uneasy about needle-related procedures.

Parents of children with physical disabilities - perceived health in parents related to the child's sleep problems and need for attention at night.

BACKGROUND: Approximately half of all children with moderate to severe physical disabilities have persistent sleep problems and many of these children need parental attention at night. AIM: To study whether sleep problems and need for night-time attention among children with physical disabilities are associated with perceived parental health, headache, psychological exhaustion, pain due to heavy lifting, night-time wakefulness and disrupted sleep. METHODS: We asked parents of 377 children with physical disabilities aged 1-16 years to complete a questionnaire about their own health. The children all lived at home with both parents. RESULTS: Both parents reported poor health, psychological exhaustion, more night-time wakefulness and disrupted sleep when the child had sleep problems (P < 0.05). Mothers also reported more headache when the child had sleep problems (P = 0.001). Both parents reported more night-time wakefulness and disrupted sleep when the child needed night-time attention (P < 0.01). In general, mothers reported significantly poorer health, more night-time wakefulness, disrupted sleep, headache and psychological exhaustion than fathers (P < 0.001). CONCLUSIONS: Sleep problems need to be acknowledged within the paediatric setting in order to prevent psychological exhaustion and poor health in mothers and fathers of children with physical disabilities.

Salivary cortisol response in mother-infant dyads at high psychosocial risk.

OBJECTIVES: The aim of the present study was to investigate the adrenocortical response to diaper change in mother-infant dyads with psychosocial risk factors. MATERIAL AND METHODS: Twenty-two mother-infant pairs with well-defined psychosocial problems were included. The mother-infant pairs were treated for 6 weeks in a daycare programme to improve attachment. Salivary cortisol was measured before and after a diaper change during the first and last weeks of enrollment in the programme. Mothers' sensitivity towards their infants' signals was measured using a scale from 1 (highly insensitive) to 9 (highly sensitive) according to Ainsworth. RESULTS: Median salivary cortisol increased in 15 out of 22 infants after the first diaper change. The increase was most pronounced in the group of infants below 3 months of age (n = 15) where median salivary cortisol increased 170% after the first diaper change (P < 0.05) and decreased 19% after the last diaper change (not significant). Out of these 15 infants, 11 showed an increase in salivary cortisol in response to the first diaper change while four out of 15 did so in response to the last diaper change (P < 0.05). The salivary cortisol response did not change over time in infants aged 3 months or above. A mother's sensitivity to her child increased significantly (P < 0.001) from the first to the last week. In mothers, median salivary cortisol decreased 38% after the first diaper change (P < 0.05) and 57% after the last diaper change (P = 0.001). DISCUSSION: A diaper change is normally not perceived as stressful. The stress response caused by a diaper change may illustrate an insufficiency in the mother-infant relationship before treatment. Professional support improved the mothers' sensitivity and stabilized the stress response to diaper change in the youngest infants.

Saliva collection using cotton buds with wooden sticks: a note of caution.

The aims of the present study were to investigate whether the cotton-tipped applicators (cotton buds) used to collect saliva in infants can be stored un-centrifuged prior to cortisol analysis, and to test whether there is any difference in results between wooden and plastic-shafted sticks. Saliva was collected from 10 healthy adults using 6 cotton buds, i.e. 3 with wooden sticks and 3 with plastic sticks. The samples were then centrifuged at three different time-points: immediately after collection, after 24 h and after 48 h. Using cotton buds with wooden sticks, median salivary cortisol was significantly lower after 24 h (40 %) (p<0.001) and after 48 h (49 %) (p<0.001) of storage than it was of the samples centrifuged immediately. There was no significant difference between the samples centrifuged immediately and those centrifuged after 24 h and 48 h when saliva was collected using the cotton buds with plastic sticks. It is concluded that cotton buds with wooden sticks should not be used in studies of salivary cortisol unless it is possible to centrifuge the saliva immediately. Moreover, it is inadvisable to alternate between cotton buds with wooden and plastic sticks in the same study when collecting saliva for analysis of cortisol.

Salivary cortisol and administration of concentrated oral glucose in newborn infants: improved detection limit and smaller sample volumes without glucose interference.

Newborn infants are subject to repetitive painful and stressful events during neonatal intensive care. When the baby attempts to cope with a stressful situation the hypothalamus-pituitary-adrenal axis is activated, releasing cortisol. The free cortisol response is optimally measured in saliva and saliva samples can be taken easily and without pain. However, saliva is very scarce in infants and saliva stimulants can interfere with analytical methods. Nowadays, sweet solutions are frequently administered to neonates prior to a disturbing procedure in order to reduce pain. The possible interference of sweet solutions with the measurement of salivary cortisol has not yet been documented. The aims of the present study were to further improve the detection limit of the radioimmunoassay used for cortisol analysis and to determine the degree of interference of high concentrations of glucose with the analytical method. By decreasing incubation temperature and prolonging the incubation time it was possible to improve the detection limit of the radio immunoassay (RIA) to 0.5 nmol/L at the same time as the sample volume was decreased to 10 microL saliva. Saliva was collected from full-term and preterm babies and was sufficient for analysis in 113 out of 116 (97%) samples. Glucose in the concentrations and amounts commonly used for pain relief did not interfere with the RIA method. In conclusion, it is feasible to collect microlitre volumes of saliva and analyse even very low concentrations of cortisol in newborns. It is also possible to offer the baby oral glucose prior to a painful procedure and still reliably measure salivary cortisol.