Adverse Effect of the Duration of Antibiotic Use Prior to Immune Checkpoint Inhibitors on the Overall Survival of Patients with Recurrent Gynecologic Malignancies.

PURPOSE: Antibiotic use preceding immune checkpoint inhibitor (ICI) treatment has been associated with a decreased efficacy of ICI in solid tumors. In this study, we evaluated the effect of antibiotic use before ICI therapy on oncological outcomes. METHODS: We examined patients with recurrent gynecologic malignancies at two academic institutions. The clinical data, including antibiotic use within 60 days of ICI initiation, type of antibiotics, reasons for antibiotic use, body mass index, tumor site, chemotherapy-free interval, prior history of radiotherapy, disease control rate (DCR), and overall survival (OS), were assessed. RESULTS: Of 215 patients, 22.9% (n = 47) received antibiotics before ICI treatment. The most common cancer was ovarian (52.1%, n = 112), followed by cervical (24.7%, n = 53) and endometrial (16.7%, n = 36). When we divided the cohort based on antibiotic use before ICIs, there were no significant differences in the DCR and baseline characteristics between the two groups. On multivariate analyses, the variables associated with poor OS were previous use of antibiotics for a cumulative duration of >14 days (HR 2.286, 95% CI 1.210-4.318; p = 0.011); Eastern Cooperative Oncology Group 2 or 3 (HR 4.677, 95% CI 2.497-8.762; p < 0.001); and chemotherapy-free interval of <6 months (HR 2.007, 95% CI 1.055-3.819; p = 0.034). CONCLUSION: Prior use of antibiotics for a cumulative duration of >14 days was associated with reduced survival in recurrent gynecologic malignancies.

What Are the Challenges of School Nurses in South Korea in Managing Obese Children From Low-Income Households?

Given that the obesity rate among school-age children is increasing, school nurses can play a vital role in managing obesity and encouraging healthy living in school settings. Obese children from low-income backgrounds are more vulnerable than other students and require more careful attention and intervention. This qualitative study aimed to explore and understand the barriers recognized by school nurses in managing obesity in low-income household children. A focus group interview was conducted with 17 school nurses working at an elementary school. Children, home, school, political and structural, and social areas were revealed as intricate factors in obesity management. This study can help understand school nurses' obstacles in managing obese children from low-income families and can help them prepare practical measures to overcome these obstacles.

Assessment of acute and chronic toxicity of cyantraniliprole and sulfoxaflor on honey bee (Apis mellifera) larvae.

BACKGROUND: Recently, cyantraniliprole (CYA) and sulfoxaflor (SUL) have been considered as alternatives to neonicotinoid insecticides. In this study, we evaluated the acute and chronic toxicities of CYA and SUL on honey bee (Apis mellifera L.) larvae reared in vitro. RESULTS: In the acute toxicity test, the following test doses were used to determine the median lethal dose (LD50 ): CYA 0.007, 0.014, 0.028, 0.056 and 0.112 µg larva-1 ; SUL 2.5, 5, 10, 20 and 40 µg larva-1 . In the chronic toxicity test, the following test doses were used to determine the LD50 : CYA 0.00512, 0.0128, 0.032, 0.08 and 0.2 µg larva-1 ; SUL 0.0625, 0.125, 0.25, 0.5 and 1.0 µg larva-1 . The acute LD50 values of CYA and SUL were 0.047 and 11.404 µg larva-1 , respectively. Larvae acutely exposed to SUL had significantly lower body weight than controls, but those exposed to CYA showed no difference. The no observed adverse effect level (NOAEL) and LD50 values of the chronic toxicity tests for each insecticide were 0.00512 and 0.064 µg larva-1 for CYA, and 0.0625 µg larva-1 and 0.212 µg larva-1 for SUL, respectively. Larvae chronically exposed to SUL emerged as bees with deformed wings, reaching adult deformation rates of over 50%; however, CYA had no effect on adult deformation. CONCLUSION: Exposure to CYA increased larval mortality but did not cause any adult deformation, whereas SUL exposure increased pupal mortality and caused wing deformation in newly emerged bees. Our study may be useful for the assessment of pesticide toxicity by providing valuable findings on the effects of these insecticides on honey bee larvae. © 2022 Society of Chemical Industry.

Developmental Toxic Effects of Thiram on Developing Zebrafish (Danio rerio) Embryos.

Thiram, an oxidized dimer of dithiocarbamate, has fungicidal and ectoparasiticidal roles. This study aimed to determine the effects of thiram on the development of zebrafish (ZF) embryos. The developmental toxicity test was performed in accordance with the OECD 236 test guidelines, and ZF embryos were subjected to several thiram concentrations and a DMSO (0.01%) control. Subsequently, embryo mortalities and developmental anomalies were evaluated at different hours post fertilization (hpf). Thiram was highly toxic to ZF, with calculated median lethal concentrations (LC50) of thiram at 48 and 96 h as 13.10 ± 2.17 and 8.87 ± 2.09 µg/L, respectively. Thiram-treated embryos/larvae exhibited a variety of deformities, such as abnormal somites, reduced eye pigment, abnormal tail shape, yolk sac edema, hatching defects, and curved spines, with a median effective concentration (EC50) of 3.88 ± 1.23, 5.04 ± 1.82, 6.23 ± 0.92, 5.24 ± 2.22, 1.39 ± 0.25, and 2.60 ± 0.82 µg/L, respectively. Teratogenic index (TI) values ranged from 1.42 to 6.66 for the scored deformities. At 48 hpf, the average heartbeat of the control group was 177.20 ± 5.63 per minute, while the highest thiram-treated group (40 µg/L) was 99.50 ± 18.12 per minute. In addition, cardiac-related issues, such as pericardial edema and abnormal blood flow, were observed in thiram-treated ZF embryos. Overall, these findings suggest that thiram is teratogenic to ZF.

Development and Evaluation of the Course on Global Health Nursing for Indian Nursing Students.

The purpose of this study was to develop and evaluate the effectiveness of the course on Global Health Nursing for Indian nursing students, intended to introduce the course as a selective course in the nursing curriculum. METHODS: A quasi-experimental nonequivalent control group pre- and post-test design was carried out. The study participants were fifty final grade nursing students, considered as an experimental (n = 25) and control group (n = 25). The participants recruited by purposive sampling were fifty 4th grade nursing students (experimental 25, control 25) at St. X College of Nursing, India. The course on Global Health Nursing was developed by using the ADDIE model, and the duration of the course was about 16 h over three weeks. The course was implemented based on Gagné's instructional method. Data were collected by self-perceived scales of Global Health Nursing before and after the course, the participants' opinions, and feedback providing comments about the course. RESULTS: The study results showed improvement in knowledge (F = 8.48; p < 0.001), skills (F = 96.14; p < 0.001), and performance on Global Health Nursing (F = 5.50; p < 0.001) and was statistically significant. Moreover, the participants described that they were satisfied with the quality of teaching-learning and achieved the learning goals. CONCLUSION: The outcome of this study could be extended to the existing nursing curriculum and would be modified to formulate a standard module in the curriculum of the Indian nursing system. The study offers implications for different fields of nursing, including nursing education, research, and practice in India.

Job-Seeking Anxiety and Job Preparation Behavior of Undergraduate Students.

This study attempted to examine and compare the job-seeking anxiety and job preparation behavior of undergraduate students. A descriptive cross-sectional study was employed; the study participants were 360 students (3rd and 4th grade), selected from K' university in G city. Data were collected by structured self-reported questionnaires from November 2020 to February 2021. Variables included general characteristics, job-seeking anxiety and job preparation behavior and were analyzed by descriptive statistics, Pearson's correlation, and multiple regression analysis by using the SPSS/WIN 25.0 program. Of the total population, 70.8% were female in the health and social science group, the age group was 22-24 years (55.2%; 50.2%) and were fourth grade 62%; 59.1%). The level of job-seeking anxiety of students showed a higher proportion in health science (4.45 ± 0.81) than social science (3.73 ± 0.55). The level of job preparation behavior also revealed the same results in health science (4.28 ± 0.76) and social science (4.06 ± 0.81). Job anxiety showed a positive correlation with employment anxiety induction situation (r = 0.32, p < 0.01) and employment anxiety induction causes (r = 0.27, p < 0.01), and social science students showed a positive correlation with employment anxiety induction situation (r = 0.24, p < 0.01) and employment anxiety induction causes (r = 0.23, p < 0.01). The factors of age, gender and desired job position are highly associated with job-seeking anxiety and job preparation behavior. The findings of this study revealed job-seeking anxiety was higher among the undergraduate students and showed a high level of job preparation behavior. There is a need to develop intervention strategies for promoting job preparation behavior and reducing job-seeking anxiety among undergraduate students by providing career planning to improve the positive attitude towards desired job selection.

Development and Evaluation of Cultural Competence Course on Undergraduate Nursing Students in Vietnam.

Cultural competence is a crucial requirement of nursing to promote caring for patients with diverse backgrounds. The purpose of this study was to develop a cultural competence course and to evaluate the effects of the course on undergraduate nursing students in Vietnam. A concurrent triangulation mixed-methods study was adopted using quantitative and qualitative data sources. Sixty-six nursing students were recruited for the following groups: cultural competence course with field experience (n = 22), stand-alone cultural competence course (n = 22), and a control group (n = 22). The findings indicated that significant group by time interactions in total cultural competence score (F = 66.73, p < 0.001) were found. Participants' perceptions reflected on three categories: (a) journey to cultural competence, (b) satisfaction of cultural competence course, and (c) suggestions for improvements. No statistically significant differences between the two experimental groups were revealed, but "obtaining cultural experiences" and "expanding understanding of cultural competence through field experience" were immersed from participants having field experience. It is vital to expand cultural competency education into nursing curricula to enhance nursing students' perspective of culturally competent care.

The Development and Validation of a Perceived Nursing Support Scale for Mothers of Preterm Infants.

PURPOSE: Many studies have maintained that nursing support is necessary and essential for mothers of preterm infants; however, the perceived nursing support for mothers of preterm infants has not been sufficiently measured. This study aimed to develop a perceived nursing support scale for mothers of preterm infants (PNSS-MP). METHODS: The preliminary items of the PNSS-MP were developed through a literature review and in-depth interviews with mothers of preterm infants. Content and face validities were assessed by experts and mothers of preterm infants. A pilot study was conducted to confirm the feasibility and comprehension of the scale. To validate the PNSS-MP, 223 mothers of preterm infants were surveyed. Exploratory factor analyses were performed to confirm construct validity. Convergent and discriminant validities were analyzed using a multitrait-multimethod (MTMM) matrix. Reliability was tested by calculating Cronbach's α and performing split-half testing. RESULTS: The PNSS-MP consisted of 27 items and was categorized into five factors, explaining 65.3% of the total variance. The factors were named: "baby care support" (7 items), "mental care support" (6 items), "maternal role support" (6 items), "introducing resources support" (4 items), and "information delivery support" (4 items). The overall reliability of the scale was .95. CONCLUSION: The PNSS-MP adequately reflected the neonatal intensive care unit (NICU) in South Korea. Additionally, the PNSS-MP proved relatively valid and reliable; therefore, it can be used to measure nursing support in the NICU.

Transcriptome-Based Identification of Genes Responding to the Organophosphate Pesticide Phosmet in Danio rerio.

Organophosphate pesticides (OPPs) are one of the most widely used insecticides. OPPs exert their neurotoxic effects by inhibiting acetylcholine esterase (AChE). Most of the gross developmental abnormalities observed in OPP-treated fish, on the other hand, may not be explained solely by AChE inhibition. To understand the overall molecular mechanisms involved in OPP toxicity, we used the zebrafish (ZF) model. We exposed ZF embryos to an OPP, phosmet, for 96 h, and then analyzed developmental abnormalities and performed whole transcriptome analysis. Phenotypic abnormalities, such as bradycardia, spine curvature, and growth retardation, were observed in phosmet-treated ZF (PTZF). Whole transcriptome analysis revealed 2190 differentially expressed genes (DEGs), with 822 and 1368 significantly up-and downregulated genes, respectively. System process and sensory and visual perception were among the top biological pathways affected by phosmet toxicity. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis revealed significant enrichment of metabolic pathways, calcium signaling pathway, regulation of actin cytoskeleton, cardiac muscle contraction, drug metabolism-other enzymes, and phototransduction. Quantitative real-time PCR results of six DEGs agreed with the sequencing data expression profile trend. Our findings provide insights into the consequences of phosmet exposure in ZF, as well as an estimate of the potential risk of OPPs to off-target species.

Development and Validation of a Self-Efficacy Scale for Nursing Educators' Role in Sri Lanka.

This study develops a scale that assesses the self-efficacy of Sri Lankan nursing educators in assuming the roles of nursing educators and validates its psychometric properties. This methodological research followed the DeVellis Scale Development Model, which involves six steps of instrument development and evaluation. Preliminary items were determined through a literature review and focus group interviews with nine Sri Lankan nursing experts. The experts, comprising five South Korean and two Sri Lankan nursing professors, tested the scale's content validity. Moreover, 15 nursing educators participated in a pilot study, and 126 educators took part in the main survey. To evaluate the scale's validity and reliability, the data from a preliminary questionnaire were analyzed using SPSS/IBM and AMOS 24.0. Further, construct validity was tested using exploratory and confirmatory factor analyses, and reliability was tested by calculating Cronbach's alpha and performing split-half testing. Finally, 39 items under four themes, "clinical mentorship" (18 items), "research" (10), "teaching" (6), and "advising" (5), explained 63.5% of the total variance. Confirmatory factor analysis results revealed an acceptable model fit for the final scale. The developed scale achieved a Cronbach's alpha value of 0.97. Thus, the psychometrical properties of the scale measuring Sri Lankan nursing educators' self-efficacy were comprehensively evaluated and found acceptable. The developed scale will be useful in guideline development or studies regarding the self-efficacy of nursing educators' roles in developing countries with similar context to Sri Lanka.

DNA barcoding of brackish and marine water fishes and shellfishes of Sundarbans, the world's largest mangrove ecosystem.

The present study aims to apply a DNA barcoding tool through amplifying two mitochondrial candidate genes i.e., COI and 16S rRNA for accurate identification of fish, aquatic molluscs and crustaceans of Sundarbans mangrove wetland, to build a reference library of fish and shellfishes of this unique ecosystems. A total of 185 mitochondrial COI barcode sequences and 59 partial sequences of the 16S rRNA gene were obtained from 120 genera, 65 families and 21 orders of fish, crustaceans and molluscs. The collected samples were first identified by examining morphometric characteristics and then assessed by DNA barcoding. The COI and 16S rRNA sequences of fishes and crustaceans were clearly discriminated among genera in their phylogenies. The average Kimura two-parameter (K2P) distances of COI barcode sequences within species, genera, and families of fishes are 1.57±0.06%, 15.16±0.23%, and 17.79±0.02%, respectively, and for 16S rRNA sequences, these values are 1.74±.8%, 0.97±.8%, and 4.29±1.3%, respectively. The minimum and maximum K2P distance based divergences in COI sequences of fishes are 0.19% and 36.27%, respectively. In crustaceans, the K2P distances within genera, families, and orders are 1.4±0.03%, 17.73±0.15%, and 22.81±0.02%, respectively and the minimum and maximum divergences are 0.2% and 33.93%, respectively. Additionally, the present study resolves the misidentification of the mud crab species of the Sundarbans as Scylla olivacea which was previously stated as Scylla serrata. In case of molluscs, values of interspecific divergence ranges from 17.43% to 66.3% in the barcoded species. The present study describes the development of a molecular and morphometric cross-referenced inventory of fish and shellfish of the Sundarbans. This inventory will be useful in future biodiversity studies and in forming future conservation plan.

Horizontal Honey-Bee Larvae Rearing Plates Can Increase the Deformation Rate of Newly Emerged Adult Honey Bees.

Rearing honey bee larvae in vitro is an ideal method to study honey bee larval diseases or the toxicity of pesticides on honey bee larvae under standardized conditions. However, recent studies reported that a horizontal position may cause the deformation of emerged bees. Accordingly, the purpose of this study was to evaluate the emergence and deformation rates of honey bee (Apis mellifera ligustica) larvae reared in horizontal and vertical positions. The study was conducted under the same laboratory conditions with three experimental groups, non-capped or capped horizontal plates and capped vertical plates. However, our results demonstrated that the exhibited adult deformation rates of the horizontal plates were significantly higher (27.8% and 26.1%) than those of the vertical plates (11.9%). In particular, the most common symptoms were deformed wings and an abnormal abdomen in the horizontal plates. Additionally, adults reared on horizontal plates were substantially smaller (10.88 and 10.82 mm) than those on vertical plates (11.55 mm). Considering these conclusions, we suggest that a vertical rearing method is more suitable when considering the deformation rates of the control groups to verify the sublethal effects of pesticides on honey bees.

Validation of the Korean Version of the Nursing Profession Self-Efficacy Scale: A Methodological Study.

BACKGROUND: The Nursing Profession Self-Efficacy (NPSE) scale was developed to reflect the characteristics of nursing tasks. This study was conducted to validate the Korean version of the NPSE (K-NPSE) scale. METHODS: The NPSE scale with nineteen items was translated into Korean after forward and backward translation according to Devellis' guideline. For the exploratory factor analysis (EFA), 298 nurses participated and criterion-related validity and reliability were verified. For the confirmatory factor analysis (CFA), 218 other nurses participated. Content validity, criterion-related validity, and internal consistency reliability were examined. Additionally, construct validity was examined. SPSS and AMOS were used for the data analyses. RESULTS: Nineteen items were selected after evaluating the content and cognitive validity and comprised three factors: "Professional (10 items)", "Advocating (4)", and "Caring (5)". Construct validity was supported by the CFA. Criterion-related validity was supported by comparison with the General Self-Efficacy Test (r = 0.43, p < 0.001). Cronbach's alpha of the K-NPSE was 0.93. CONCLUSIONS: Study findings indicate that the K-NPSE could be useful for assessing nurses' self-efficacy. The K-NPSE may be used as a valuable reference for developing programs or policies that promote nursing professionals. It is expected that continued use of this scale in various clinical settings to further generalize and validate the scale.

Nursing support perceived by mothers of preterm infants in a neonatal intensive care unit in South Korea.

PURPOSE: The aim of this study was to clarify and define the concept of nursing support as perceived by mothers of preterm infants. METHODS: The research was conducted using Schwartz-Barcott and Kim's hybrid model. Sixteen articles were analyzed during the theoretical phase. In-depth interviews were conducted with 10 mothers of preterm infants in the fieldwork phase. In the final analytical phase, the attributes of nursing support were defined. RESULTS: There were four themes and 10 attributes of nursing support as perceived by mothers of preterm infants. Professional care and emotional care for the baby were identified as attributes of baby care support. Information related to the disease, inpatient environment, baby's daily hospital life, and mother-centered care were identified as attributes of information delivery support. Empathy for mothers and therapeutic communication with the mother were identified as attributes for mental care support. Lastly, providing a chance for the mother to take care of the baby and reinforcement of the maternal role were identified as attributes of maternal role support. CONCLUSION: The 10 attributes of this study could provide a base for the development of a nursing support instrument and practical guidelines for mothers in neonatal intensive care units.

Nitrogen Stimulates Microcystis-Dominated Blooms More than Phosphorus in River Conditions That Favor Non-Nitrogen-Fixing Genera.

Despite the implementation of intensive phosphorus reduction measures, periodic outbreaks of cyanobacterial blooms in large rivers remain a problem in Korea, raising the need for more effective solutions to reduce their occurrence. This study sought to evaluate whether phosphorus or nitrogen limitation is an effective approach to control cyanobacterial (Microcystis) blooms in river conditions that favor this non-nitrogen-fixing genus. These conditions include nutrient enrichment, high water temperature, and thermal stratification during summer. Mesocosm bioassays were conducted to investigate the limiting factors for cyanobacterial blooms in a river reach where severe Microcystis blooms occur annually. We evaluated the effect of five different nitrogen (3, 6, 9, 12, and 15 mg/L) and phosphorus (0.01, 0.02, 0.05, 0.1, and 0.2 mg/L) concentrations on algae growth. The results indicate that nitrogen treatments stimulated cyanobacteria (mostly Microcystis aeruginosa) more than phosphorus. Interestingly, phosphorus additions did not stimulate cyanobacteria, although it did stimulate Chlorophyceae and Bacillariophyceae. We conclude that phosphorus reduction might have suppressed the growth of Chlorophyceae and Bacillariophyceae more than that of cyanobacteria; therefore, nitrogen or at least both nitrogen and phosphorus control appears more effective than phosphorus reductions alone for reducing cyanobacteria in river conditions that are favorable for non-nitrogen-fixing genera.

Effects of Balneotherapy in Jeju Magma-Seawater on Knee Osteoarthritis Model.

Balneotherapy is a common non-pharmacological treatment for osteoarthritis (OA), however, the efficacy is controversial in knee OA. Jeju magma-seawater (JMS) has high contents of various minerals, which has anti-inflammatory and antioxidant properties via an oral route. Thus, we examined the effects of JMS bathing on knee OA and the combination effects with diclofenac sodium as an anti-inflammatory drug. Knee OA was induced by transection of the anterior cruciate ligament and the partial meniscectomy in rat. The rats were administered subcutaneously saline or diclofenac sodium in saline, followed by bathing in thermal distilled water or JMS for 8 weeks. The model represented the characteristic changes of the cartilage degradation, osteophyte formation and synovial inflammation, and the relevant symptoms of the joint swelling and stiffness. However, the JMS bathing reduced the joint thickness and improved the mobility. It also contributed to a well-preserved tissue supported by increases in bone mineral density of the joint and decreases in Mankin scores in the cartilages. The effects involved anti-inflammation, chondroprotection, anti-apoptosis, and chondrogenesis. Overall, the JMS bathing in combination with diclofenac sodium showed a similar trend associated with synergic effects. It suggests that JMS bathing can be promising for a clinical use in knee OA.

Pediatric Nurses' Perspectives on Family-Centered Care in Sri Lanka: A Mixed-Methods Study.

PURPOSE: This study was conducted to investigate nurses' perceptions and performance of family-centered care (FCC) at a children's hospital in Sri Lanka and to explore the feasibility of implementing FCC in the context of the Sri Lankan healthcare system. METHODS: A convergent, parallel, mixed-methods design was applied to understand Sri Lankan nurses' perspectives on FCC. In total, 157 nurses working at a large teritagy children's hospital responded to a self-report survey and 18 nurses participated in focus group interviews. RESULTS: Of the factors of FCC, family participation in caring for children received the highest score (4.09±0.51) for perceptions, and information-sharing received the highest score (3.54±0.55) for performance. The qualitative data revealed the following five themes: (a) importance of the family in caring for children; (b) helping families during children's hospitalization; (c) taking steps to implement FCC, even with imperfect knowledge; (d) barriers in the current situation; and (e) suggested strategies to promote FCC. CONCLUSION: Participants endorsed the concept of FCC and demonstrated some aspects of it in their day-to-day practice. The results indicate a clear knowledge deficit and several challenges, which need to be addressed to effectively implement FCC.

Self-Directed Learning Among Nurse Learners in Sri Lanka.

BACKGROUND: Although self-directed learning (SDL) has become an essential instrument for educating nursing professionals, little is known about SDL among nurses in a developing country. METHOD: Data were collected using a structured self-reporting survey, which included Fisher's Self-Directed Learning Readiness (SDLR) scale, and a multiple linear regression analysis was conducted. RESULTS: The mean score per item on the SDLR was 4.31 of 5. The learning-related factors that influenced SDLR were motivation for learning and self-efficacy in English proficiency, and the working-related factor was job satisfaction. These variables accounted for 17.6% of the variance in SDLR scores. CONCLUSION: The SDLR of nurse learners in Sri Lanka was influenced not only by learning-related factors but also by working-related factors. Therefore, it is necessary to develop multidimensional strategies to strengthen nurses' SDLR. [J Contin Educ Nurs. 2019;50(1):41-48.].

Influence of Perceptions of Death, End-of-Life Care Stress, and Emotional Intelligence on Attitudes towards End-of-Life Care among Nurses in the Neonatal Intensive Care Unit.

PURPOSE: The purpose of this study was to investigate the influence of perceptions of death, end-of-life (EOL) care stress, and emotional intelligence on attitudes toward EOL care among nurses in the neonatal intensive care unit (NICU). METHODS: The participants were 111 nurses working in a NICU who had experienced EOL care at least once. Data were analyzed using the t-test, Pearson correlation coefficient, and stepwise multiple regression analysis in SPSS for Windows. RESULTS: The mean score for perceptions of death was 3.16 out of 5, the mean score for EOL care stress was 3.61 out of 5, the mean emotional intelligence score was 4.66 out of 7, and the average score for EOL care attitudes was 2.77 out of 4. The factors affecting attitudes towards EOL care were academic degree, anxiety regarding death, negativity towards death, experiences of patient death, and emotional intelligence. The explanatory power of these variables for attitudes towards EOL care was 24.7%. CONCLUSION: The results of this study are expected to serve as a basic reference for the development of nursing education programs and EOL care protocols to improve attitudes toward EOL care among NICU nurses.

Development and evaluation of flipped learning using film clips within a nursing informatics course.

AIM: To develop flipped learning classes by using film clips for undergraduate nursing students in an online nursing informatics course, based on the Analysis, Design, Development, Implementation, and Evaluation model, and to evaluate the effectiveness and students' responses to this method of teaching. METHODS: Sixty-four second-year nursing students participated in the course. The nursing students' knowledge was assessed at the beginning and end of each of the five classes. Moreover, their intention to recommend the classes to other students and additional comments were elicited by using semistructured questionnaires. RESULTS: Knowledge about each core concept of nursing informatics reflected significant improvement. Regarding the intention to recommend the class to others, 62 (96.8%) students answered "strongly recommend" or "recommend." CONCLUSION: Integrating flipped learning classes by using film clips in an online nursing informatics course improved the nursing students' knowledge and is a format that is desired by students.