Exploring dialogue in virtual simulation in nursing education - An observational study.

Objectives: Simulation is an important learning activity in nursing education. There is little knowledge about dialogue and communication between students and facilitators in a virtual simulation setting. The current study, conducted in Norway, explores the dialogic teaching approaches applied by facilitators in a virtual classroom and adapt an analytic tool from a physical classroom in lower education to a virtual classroom in higher education. Methods: Sixteen virtual simulation sessions of groups with nursing students were video-taped. The videos were coded with a coding scheme developed for physical classrooms and adapted to the virtual setting. The dialogic approaches from the facilitator were analysed using descriptive analysis. Results: The most frequently used approaches from the facilitator were categorised as asking ("Big questions") and listening ("Wait time after a question"). The most frequent pattern seen in the use of dialogic approaches fall under the category listening. Conclusions: The coding scheme is suitable to analyse facilitators' dialogic approaches in a virtual setting in nursing education. Further research should examine how the facilitator can strategically deploy dialogic approaches in other types of simulations with students. Innovation: The coding scheme was developed from lower to higher education, and from a physical to a virtual setting.

Measuring speech intelligibility with deaf and hard-of-hearing children: A systematic review.

There is great variability in the ways in which the speech intelligibility of d/Deaf and hard-of-hearing (DHH) children who use spoken language as part, or all, of their communication system is measured. This systematic review examined the measures and methods that have been used when examining the speech intelligibility of children who are DHH and the characteristics of these measures and methods. A systematic database search was conducted of CENTRAL; CINAHL; Cochrane; ERIC; Joanna Briggs; Linguistics, Language and Behavior Abstracts; Medline; Scopus; and Web of Science databases, as well as supplemental searches. A total of 204 included studies reported the use of many different measures/methods which measured segmental aspects of speech, with the most common being Allen et al.'s (2001, The reliability of a rating scale for measuring speech intelligibility following pediatric cochlear implantation. Otology and Neurotology, 22(5), 631-633. https://doi.org/10.1097/00129492-200109000-00012) Speech Intelligibility Rating scale. Many studies included insufficient details to determine the measure that was used. Future research should utilize methods/measures with known psychometric validity, provide clear descriptions of the methods/measures used, and consider using more than one measure to account for limitations inherent in different methods of measuring the speech intelligibility of children who are DHH, and consider and discuss the rationale for the measure/method chosen.

Exploring facilitation in virtual simulation in nursing education: A scoping review.

Objective: To systematically map existing research regarding the reflective feedback in virtual simulation in undergraduate nursing education. Methods: A scoping review was conducted based on the Arksey and O'Malley framework and the PRISMA-ScR. Results: We included 41 studies from 15 different countries. The simulation interventions allowed for interaction between the student and the virtual patient, the software, faculty, peers, or a combination of two or more of these. Students valued reflective feedback during and after the simulation. Conclusions: Our review emphasizes the importance of a human in the loop. Feedback before, during, and after the simulation is possible in virtual simulation where the facilitator can pause the virtual scenario and stimulate reflections during the simulation to obtain deep learning. Virtual simulation provides opportunities to give feedback from the software, such as cues or direct feedback. Innovation: There is a lack of focus on the feedback process and there is a need to revitalize the role of facilitators in a virtual simulation to determine their relative contribution in this process. Several studies reported the usefulness or the effect of virtual simulation on learning processes, but most lacked emphasis on investigating the significance of including a human in the loop.

Newly graduated nurses use and further development of assessment skills-An in-depth qualitative study.

AIMS: To explore in-depth nurses' use and further development of assessment skills in different nursing contexts in the first 2 years after graduation, and factors that influenced their use and development of assessment skills. DESIGN: The study had explorative qualitative design. METHODS: Eight nurses who previously had been interviewed about their learning of physical assessment skills in clinical rotation as students participated in this follow-up study. Individual in-depth interviews were conducted, where the nurses spoke freely about their experiences after graduation. RESULTS: Four prominent features influencing the nurses' use and development of assessment skills were identified: (a) assessment approaches and readiness for practice, (b) the primacy of communication, (c) recognition related to performing assessments, and (d) the influence of organizational factors on their assessment applications. CONCLUSION: Newly graduated nurses' use of assessment skills is an important part of providing holistic care. This study suggest that assessment skills is not only an assessment task but is central in relationship building and in supporting the professional development of nursing competence. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution, due to study design.

Factors associated with changes in students' self-reported nursing competence after clinical rotations: a quantitative cohort study.

BACKGROUND: The quality of nursing care in different healthcare contexts can be associated with the level of available nursing competence. Physical assessment skills are vital in nurses' assessment of patient care needs. However, in nursing education, using physical assessment skills is challenging for nursing students who struggle to apply these skills comprehensively in a clinical rotation. Therefore, this study explores changes in nursing competence, factors associated with changes after clinical rotations, and whether a Suite of Mobile Learning Tools supports changes in confident use of basic physical assessment skills. METHODS: A quantitative cohort study with an explorative pre-and post-test design. During autumn 2019 and spring 2020, 72 s-year nursing students and 99 third-year students participated in the study. The Nurse Professional Competence scale short form was used to investigate students' self-reported changes in nursing competence, and a study-specific questionnaire was used to investigate students' confidence concerning performing physical assessments. The students voluntarily used the Suite of Mobile Learning Tools for the learning of physical assessment. Linear regression analysis was used to identify factors associated with changes in nursing competence after clinical rotation. The STROBE guidelines for cohort studies were followed for study reporting. RESULTS: After the clinical rotation, both student groups reported changes in nursing competence and confidence in performing physical assessment skills, with statistically significant moderate or large changes in all areas. The Suite of Mobile Learning Tools was evaluated as being useful for learning physical assessment. The regression analysis showed that confidence in performing physical assessment skills, the usefulness of the Suite of Mobile Learning Tools, and a higher nursing competence at the start of clinical rotation were positively associated with overall nursing competence. CONCLUSION: Basic physical assessment skills are an important component of nursing competence and can be considered one of the pillars of person-centered care, as proposed by the Fundamentals of Care framework. Spaced repetition and access to digital resources are suggested pedagogical approaches to enhance student confidence in the use of assessment skills within academic and clinical contexts.

Nursing students' development of using physical assessment in clinical rotation-a stimulated recall study.

BACKGROUND: The overall aim of this study was to explore third-year bachelor nursing students' stimulated recall reflections on their physical assessment competence development. The choice of learning strategies in nursing education seems to have great impact on nursing students' use of physical assessment skills while in clinical rotation. There is a need to explore nursing students' learning processes related to the use of physical assessments. METHODS: Explorative qualitative design using a triangulation of data collection methods. Nine final-year nursing students' physical assessment performances during patient encounters were audio-taped and observed. Shortly after, an individual stimulated recall interview based on the audio-recorded patient encounter and observation notes was conducted. A two-fold analysis was conducted: 1) analysis of students' performed assessments, and 2) phenomenological hermeneutical analysis of the stimulated recall interviews. RESULTS: Nursing students assessments shifted from a checklist approach to a symptom-based, more holistic and person-centred approach, emphasizing conversation as part of their assessments. The nursing students also reported that a safe and stimulating learning environment was a prominent feature for their continuing development. Learning from skilled role models with expectations to them using physical assessment skills facilitated their continuing skills appliance, interprofessional communication and reflective practice. CONCLUSIONS: This study contribute with a novel, comprehensive and in-depth description of what influenced nursing students' learning processes experiences of using physical assessment skills during clinical rotation. The results reveal the need for targeted course designs by implementing scaffolded learning activities in practical and theoretical courses aimed at strengthening students' learning of physical assessment skills-building upon and emphasizing their prior knowledge and competence, which may lead to more confident registered nurses and promote patient safety in different health care contexts. We propose using stimulated recall systematically as a novel reflective learning activity in nursing education to foster clinical reasoning and metacognition skills and achieve deep learning.

The impact of small-group virtual patient simulator training on perceptions of individual learning process and curricular integration: a multicentre cohort study of nursing and medical students.

BACKGROUND: The COVID-19 pandemic has precipitated rapid changes in medical education to protect students and patients from the risk of infection. Virtual Patient Simulators (VPS) provide a simulated clinical environment in which students can interview and examine a patient, order tests and exams, prioritize interventions, and observe response to therapy, all with minimal risk to themselves and their patients. Like high-fidelity simulators (HFS), VPS are a tool to improve curricular integration. Unlike HFS, VPS require limited infrastructure investment and can be used in low-resource settings. Few studies have examined the impact of VPS training on clinical education. This international, multicenter cohort study was designed to assess the impact of small-group VPS training on individual learning process and curricular integration from the perspective of nursing and medical students. METHODS: We conducted a multi-centre, international cohort study of nursing and medical students. Baseline perceptions of individual learning process and curricular integration were assessed using a 27-item pre-session questionnaire. Students subsequently participated in small-group VPS training sessions lead by a clinical tutor and then completed a 32-item post-session questionnaire, including 25 paired items. Pre- and post-session responses were compared to determine the impact of the small-group VPS experience. RESULTS: Participants included 617 nursing and medical students from 11 institutions in 8 countries. At baseline, nursing students reported greater curricular integration and more clinical and simulation experience than did medical students. After exposure to small-group VPS training, participants reported significant improvements in 5/6 items relating to individual learning process and 7/7 items relating to curricular integration. The impact of the VPS experience was similar amongst nursing and medical students. CONCLUSIONS: In this multi-centre study, perceptions of individual learning process and curricular integration improved after exposure to small-group VPS training. Nursing and medical students showed similar impact. Small-group VPS training is an accessible, low-risk educational strategy that can improve student perceptions of individual learning process and curricular integration.

The value of a redesigned clinical course during COVID-19 pandemic: an explorative convergent mixed-methods study.

BACKGROUND: The COVID-19 lockdown in March 2020 had a significant consequence for nursing students worldwide including limited access to learning situations in clinical rotation. Therefore, this study aims to explore how an innovative redesign of a clinical course in a time of pandemic supported nursing students in learning the fundamentals of care in their first year. The redesign involved the transformation of a traditional hands-on clinical course into a technology-enhanced learning environment. DESIGN: This was an explorative convergent mixed-methods study using both quantitative and qualitative methods. METHODS: Twenty-four first-year nursing students responded to an online questionnaire with open-ended questions. Two nursing students and one faculty member participated in individual online interviews, and three faculty members participated in an online focus group interview. All the data were collected in June 2020. The quantitative data were analyzed using descriptive statistics and the qualitative data using content analysis. The GRAMMS guideline was applied. RESULTS: The students achieved the learning outcomes regarding fundamental care, basic physical assessment skills, and clinical reasoning with the help of academic assignments, multimedia learning resources, and virtual patients. Further, six central aspects of the facilitator role in the virtual simulation were identified. The aspect that was considered most valuable involved uncovering the "red thread" between different areas of knowledge in the first year of nursing education; this supported the students to better understand how to think and talk like a nurse. CONCLUSION: This study offers insight into how a technology-enhanced clinical course can foster the learning of fundamental nursing care, basic physical assessment skills, and clinical reasoning skills; enhancing students' preparedness for clinical hours. Virtual patients' scenarios contributed to integrating different types of knowledge and skills that are important when providing nursing care for patients in clinical practice. This study also highlighted a gap in pedagogical competence among faculty members with regards to facilitating learning in a technology-enhanced learning environment. Study findings suggest promising pedagogical strategies that should be further developed post-pandemic, in response to the call for a renewal of nursing education using more technologically supported learning designs.

Nursing students' experiences of virtual simulation when using a video conferencing system - a mixed methods study.

OBJECTIVES: There is limited knowledge about students' experiences with virtual simulation when using a video conferencing system. Therefore, the aim of this study was to explore how second-year undergraduate nursing students experienced learning through virtual simulations during the COVID-19 pandemic. METHODS: The study had an exploratory design with both quantitative and qualitative approaches. In total, 69 nursing students participated in two sessions of virtual simulation during spring 2020, and 33 students answered online questionnaires at session 1. To further explore students' experiences, one focus group interview and one individual interview were conducted using a video conferencing system after session 2. In addition, system information on use during both sessions was collected. RESULTS: Changes in the students' ratings of their experiences of virtual simulation with the Body Interact™ system were statistically significant. The virtual simulation helped them to bridge gaps in both the teaching and learning processes. Four important aspects of learning were identified: 1) learning by self-training, 2) learning from the software (Body Interact™), 3) learning from peers, and 4) learning from faculty. CONCLUSIONS: We conclude that virtual simulation through a video conferencing system can be useful for student learning and feedback from both peers and faculty is important.

Configuration of Mobile Learning Tools to Support Basic Physical Assessment in Nursing Education: Longitudinal Participatory Design Approach.

BACKGROUND: As many students in higher education are skilled users of mobile technology, mobile learning (mLearning) can be a promising educational strategy to enhance their learning experience. mLearning might also be well suited for nursing students as they navigate between multiple learning contexts in their educational curriculum. As an educational strategy, mLearning may also reduce challenges caused by the theory-practice gap in nursing by supporting skills and knowledge transfer between the university and clinical settings. As the introduction of basic physical assessment skills (B-PASs) into Norwegian bachelor's degree education in nursing occurred quite recently, there is a lack of competence in supervision and teaching in both university and clinical settings. As such, mLearning appears to be a good strategy to support student B-PAS learning and knowledge transfer across learning contexts. OBJECTIVE: This study aims to explore and elicit the perspectives of students regarding the way in which a selection of digital learning resources supports B-PAS learning and application in clinical rotation, which of the selected digital learning resources are beneficial to include in a suite of mLearning tools, and how the selected digital learning resources could support the transfer of skills and knowledge from the academic to clinical context. METHODS: We used a longitudinal participatory design approach to co-design a suite of mLearning tools. The co-design processes took place in several workshops (WSs) over a period of 3 months: 2 WSs with first-year students (n=6), 3 WSs with second-year students (n=6), and 3 WSs with third-year students (n=8). The students evaluated several digital learning resources in both academic and clinical contexts. The digital learning resources included digital simulation with virtual patients, massive open online courses, and multimedia learning material. In the co-design WS, the potential and benefits of these digital learning resources for the learning and application of B-PASs were explored. RESULTS: The students reported that the digital learning resources stimulated learning in 7 different ways. They also emphasized the importance of including all selected and tested digital learning resources. Moreover, students supported the inclusion of additional learning material, such as multiple-choice tests and written assignments, aimed at providing feedback and contributing to knowledge development. CONCLUSIONS: The co-design processes and collaboration with the nursing students provided insight into how a suite of mLearning tools may support the learning and application of B-PASs and human bioscience knowledge in clinical rotation. From the students' perspective, one of the strengths of the suite of mLearning tools was the range of content, as this met a broader range of student learning preferences regarding learning B-PASs. The suite of mLearning tools contributes to and supports skills training and knowledge transfer between multiple learning contexts.

Keratinocytes secrete multiple inflammatory and immune biomarkers, which are regulated by LL-37, in a psoriasis mimicking microenvironment.

Psoriasis is an autoimmune disease driven by a Th17 response linked to the antimicrobial peptide (AMP) LL-37 that has been connected to the induction and chronicity of psoriasis. We show that keratinocytes secrete various immune biomarkers with a direct link to psoriasis immunopathogenesis. Under pro-inflammatory microenvironmental conditions, LL-37 was found to regulate keratinocyte secretion of various immune biomarkers (eg C-X-C motif chemokine ligand (CXCL)8 and interleukin (IL)-1ß) and alter extracellular signal-regulated kinase (ERK)1/2 signalling. However, during neutral conditions LL-37 induced a different pattern of keratinocyte immune biomarker secretion (eg vascular endothelial growth factor, CXCL8 and IL-6). Thus, an interesting pattern emerged regarding the immunomodulatory effects of LL-37 on keratinocytes; in general, expression of immune biomarkers that were upregulated in a Th1-like microenvironment was downregulated in the presence of LL-37. In contrast, LL-37 reinforced the Th17 response. In active psoriatic skin lesions, LL-37 expression was found to be significantly upregulated, which was also evident from the unique diffuse epidermic expression pattern not found in healthy skin. Finally, successful phototherapy of psoriasis patients converted this LL-37 inflammatory psoriatic skin pattern into a more localized basal layer expression as found in healthy controls. Thus, these findings demonstrate that LL-37 has a significant role in skin immune homeostasis and that its interplay with keratinocytes may have a more direct role in the immunopathogenesis of psoriasis than previously thought.

Reflection on actions: Identifying facilitators of and barriers to using physical assessment in clinical practice.

Current research suggests that nursing students do not apply all sets of physical assessment skills (PAS) learned in their nursing education. The aim of this study was to evaluate third-year nursing students' process of clinical judgment using PAS in clinical rotation. Specific focus was on how the process of clinical judgment affected when the nursing students performed physical assessment, and which types of knowledge were implied in their practice. Ten nursing students performed PAS independently while in clinical rotation; these performances were audiotaped and observed. Shortly after, individual semi-structured stimulated recall interviews (SRI) took place. Regardless of the nursing students' stated level of PAS utilization, self-efficacy or scientific knowledge, clinical judgment was primarily based on contextual factors and personal prerequisites. This study contributes to in-depth knowledge about how nursing students perform physical assessment, how they describe their clinical judgment process and their strategies towards systematically and confidently using PAS. We conclude the paper with pedagogical strategies and learning activities that can facilitate reflection-in-action and reflection-on-action.

Revitalizing physical assessment in undergraduate nursing education - what skills are important to learn, and how are these skills applied during clinical rotation? A cohort study.

BACKGROUND: The preparedness of newly graduated registered nurses for a demanding work environment and care practices takes form during nursing education. Norwegian nursing education at one university has implemented a selection of basic physical assessment skills (B-PAS) in the nursing curriculum in order to prepare nursing students for a demanding work environment post-graduation. METHODS: A mixed-method cohort design. We evaluated nursing students' self-reported use of B-PAS during their clinical rotation using the "Survey of Examination Techniques Performed by Nurses" questionnaire (30 items). In addition, two focus group interviews elicited factors that hinder or facilitate the actual use of B-PAS during clinical rotation. We recruited students from a bachelor's degree programme for nursing at a Norwegian university. Three hundred and sixty-three of 453 eligible nursing students in the first, second, and third year of the bachelor's degree programme participated in the study (80%). RESULTS: ANOVA showed a significant progression (p < 0.016) in students' self-reported use of B-PAS. Auscultation and percussion skills were graded below the median score of 3, which indicates that these skills were less used throughout the programme. The nursing students highlighted contextual factors for their use of B-PAS when in clinical rotation. Preceptors are important gatekeepers for successful implementation, and there is a need for close collaboration between the university and clinical practice. CONCLUSION: Despite the reduced PAS taught in the curricula, there is still a lack of application of such skills in clinical rotations. This study highlights that research should explore how different work environments influence the utilisation of learned skills, and which learning strategies are appropriate or most successful for stimulating clinical reasoning and the extensive use of physical assessment.

Putting the cart before the horse: A cost effectiveness analysis of treatments for stuttering in young children requires evidence that the treatments analyzed were effective.

PURPOSE: To investigate the validity of findings from a recent study reported in this journal by de Sonneville-Koedoot, Bouwmans, Franken, and Stolk (2015) on the cost effectiveness of two programs for treating young children who stutter. METHODS: The de Sonneville-Koedoot, Bouwmans et al. study was based directly on the results obtained in an earlier study, known as the RESTART-study, which compared the outcomes from the Lidcombe Program and a Demands and Capacities Model program. The methodology of the RESTART-study was critically reviewed. RESULTS: The absence of an untreated control group in the RESTART-study makes the results of that study uninterpretable. An inappropriate comparison made with the Yairi and Ambrose (2005) Illinois Study findings failed to resolve the control group problem. Furthermore, the criteria used to classify treated children as "non-stuttering" was also shown to be confounded. The foregoing problems meant that neither treatment program could be shown to be more effective than no treatment. CONCLUSION: de Sonneville-Koedoot, Bouwmans et al's findings, which compared the cost effectiveness of two treatments for young children who stutter, have no value for clinical management because the treatments investigated were not shown to be more effective than no treatment.

[Energy and protein intake of patients at the Department of Cardiothoracic surgery, Landspítali - the National University Hospital of Iceland]. / Orku - og próteinneysla sjúklinga á hjarta- og lungnaskurddeild Landspítala.

OBJECTIVE: The aim was to estimate energy and protein intake of patients at the Department of Cardiothoracic surgery, Landspítali the National University Hospital of Iceland. Another aim was also to assess their nutritional status. METHODS: The energy and protein content of meals served by the hospital's kitchen is known. Starting at least 48 hours after surgery, all left over food and drinks were weighed and recorded for three consecutive days. Energy and protein requirements were estimated according to clinical guidelines for hospital nutrition at Landspítali (25-30 kcal/kg/day and 1.2-1.5 g/kg/day, respectively). Nutritional status was estimated using a validated seven question screening sheet. RESULTS: Results are presented for 61 patients. The average energy intake was 19±5.8 kcal/kg/day. Protein intake was on average 0.9±0.3 g/kg/day. Most patients (>80%) had an energy and protein intake below the lower limit of estimated energy and protein needs, even on the fifth day after sugery. According to the nutritional assessment 14 patients (23%) were defined as either malnourished or at risk for malnutrition. This group was closer than the well-nourished group to meeting their estimated energy- and protein needs. The use of nutrition drinks was more common among malnourished patients and those at risk of malnutrition than the well-nourished patients. CONCLUSION: The results suggest that the energy and protein intake of patients is below estimated requirements, even on the fifth day after surgery. Attention must be paid to malnutrition and nutrition in general in the hospital wards.

Operación y mantenimiento de lagunas de estabilización

El presente documento tiene como objetivo lograr: Suministrar información al personal técnico y encargados de plantas de mantenimiento sobre el arranque, mantenimiento y operación, minimas para el buen funcionamiento de las lagunas de estabilización; presentación de los parámetros de control que deben efectuarse en cada una de las unidades y finalmente capacitación a los operadores en la administración de la planta de tratamiento, de modo que adicionalmente requieran sólo de instrucciones específicas sobre el funcionamiento de las unidades

Criterio para el dimensionamiento de lagunas aeradas

El autor presenta distintos cálculos sobre el dimensionamiento, remoción de patógenos, potencia de aeración y una solución al problema

Uso de aguas residuales tratadas en agricultura y forestación

El autor nos expone que la experiencia acumulada a nivel mundial demuestra la factibilidad técnica y económica del uso de las aguas residuales, lo que contribuye a proteger la salud y el ambiente. Sin embargo, es necesario tener presente que se trata de procesos que, de hecho, implican riesgos de suma responsabilidad y que se deben asumir

Criterios para el dimensionamiento de lagunas de estabilización. Modelos matemáticos para predecir calidad de efluentes

El autor nos expone estudios realizados sobre aspectos de las lagunas de estabilización: formas de las mismas; diseño y ubicación de las estructuras de entrada y salida; dispositivos para medición y distribución de flujos; remoción de flotantes; diseño y mantenimiento de los diques; problemas con pérdidas excesivas de agua; problemas con vectores y olores y acumulación, manejo y remoción de lodos