Teaching and Learning Clinical Reasoning in Nursing Education: A Student Training Course.

Clinical reasoning is an essential component of nursing. It has emerged as a concept that integrates the core competencies of quality and safety education for nurses. In cooperation with five European partners, Instituto Politécnico de Setúbal (IPS) realized the "Clinical Reasoning in Nursing and Midwifery Education and Practice" project as part of the Erasmus+ project. As a partner, our team designed a multiplier event-the student training course. The aim of this report is to describe the construction and development of this clinical reasoning training course for nursing students. We outline the pedagogical approach of an undergraduate training course on clinical reasoning in 2023, which we separated into four stages: (i) welcoming, (ii) knowledge exploration, (iii) pedagogical learning, and (iv) sharing experience. This paper presents the learning outcomes of the collaborative reflection on and integration of the clinical reasoning concept among nursing students. This educational experience fostered reflection and discussion within the teaching team of the nursing department regarding the concept, models, and teaching/learning methods for clinical reasoning, with the explicit inclusion of clinical reasoning content in the nursing curriculum. We highlight the importance of implementing long-term pedagogical strategies in nursing education.

"Learning a Way of Thinking"-World Café on Clinical Reasoning in Nursing and Midwifery Education and Practice across Five European Union Countries.

Clinical reasoning is a key attribute of nursing and midwifery professionals. As a part of the Erasmus plus project, we designed a study with the aim of exploring the understanding of clinical reasoning as a concept, experiences of teaching clinical reasoning and practices related to using clinical reasoning in nursing and midwifery. A qualitative study was carried out using the World Café method, involving 44 participants from five European countries. The participants represented diverse professional backgrounds, including nurses, midwives and lecturers. Our analytical approach was based on a thematic analysis. We categorized the data into three main categories, namely, "Spiral of thinking", "The learning and teaching of a way of thinking" and "Clinical reasoning in real life", all under an overarching theme, "Learning a way of thinking". This study highlighted areas of learning and teaching which can be improved in current nursing and midwifery education. Furthermore, it identified barriers, facilitators and practices from five European countries which can be used in the further development of nursing and midwifery curricula and courses with the aim of enhancing clinical reasoning competence and ultimately improving patient care.

Reporting of adverse events and the fundamental tasks of managers-A qualitative interview study.

AIM: To describe healthcare professionals' experiences of adverse event reporting in relation to the fundamental tasks of managers. DESIGN: Qualitative interview study. METHOD: Twenty-four semi-structured interviews including six managers, six medical doctors, six Registered Nurses and six Enrolled Nurses were carried out in Slovenia from January to May 2019. The data were analysed using a multi-stage qualitative content analysis procedure. The COREQ checklist guided the reporting in this study. RESULTS: The researchers found that all four fundamental tasks of managers, namely planning, organising, leading and controlling, influence the safety culture and thus adverse events reporting by employees. For each function, the researchers have identified the key factors that either promote or inhibit adverse events reporting in a healthcare institution. The results have implications for all those involved in adverse event reporting from the perspective of the fundamental tasks of managers and can contribute to the improvement of the reporting system and subsequently safer treatment.

Autologous Platelet and Extracellular Vesicle-Rich Plasma as Therapeutic Fluid: A Review.

The preparation of autologous platelet and extracellular vesicle-rich plasma (PVRP) has been explored in many medical fields with the aim to benefit from its healing potential. In parallel, efforts are being invested to understand the function and dynamics of PVRP that is complex in its composition and interactions. Some clinical evidence reveals beneficial effects of PVRP, while some report that there were no effects. To optimize the preparation methods, functions and mechanisms of PVRP, its constituents should be better understood. With the intention to promote further studies of autologous therapeutic PVRP, we performed a review on some topics regarding PVRP composition, harvesting, assessment and preservation, and also on clinical experience following PVRP application in humans and animals. Besides the acknowledged actions of platelets, leukocytes and different molecules, we focus on extracellular vesicles that were found abundant in PVRP.

"Negotiating a new normality" - a longitudinal qualitative exploration of the meaning of living with an open surgical wound.

PURPOSE: Little is known about the experiences of people living with open surgical wounds. These wounds are common and predominantly affect young and actively working people. The aim of this qualitative study was to explore the meaning of living with open surgical wounds. METHODS: A qualitative exploratory study was conducted. We collected data using two individual interviews with each of ten participants (aged between 18-73 years) who had open surgical wounds. Our analytical approach was based on qualitative content analysis. Methods are reported using COREQ guidelines. RESULTS: We found that the meaning of living with open surgical wounds is shaped by five subthemes: "enduring healing", "life disruption", "adapting to a new reality", "striving for healing" and "returning to normal life;" all under an overarching theme of "negotiating a new normality". CONCLUSION: Participants' well-being and everyday living are greatly impacted by open surgical wounds. Findings from this study emphasize that open surgical wounds are a long-term condition with a typical "chronicity" trajectory; this brings a new perspective to previous findings of studies on living with complex wounds. This study has also highlighted areas for further research, related to improving individuals' experience of living with open surgical wounds.

Enrichment of plasma in platelets and extracellular vesicles by the counterflow to erythrocyte settling.

In order to prepare optimal platelet and extracellular vesicle (EV)-rich plasma for the treatment of chronic temporal bone inflammation, we studied effects of centrifugation parameters on redistribution of blood constituents in blood samples of 23 patients and 20 volunteers with no record of disease. Concentrations of blood cells and EVs were measured by flow cytometry. Sample content was inspected by scanning electron microscopy. A mathematical model was constructed to interpret the experimental results. The observed enrichment of plasma in platelets and EVs after a single spin of blood depended on the erythrocyte sedimentation rate, thereby indicating the presence of a flow of plasma that carried platelets and EVs in the direction opposite to settling of erythrocytes. Prolonged handling time correlated with the decrease of concentration of platelets and larger EVs in platelet and EV-rich plasma (PVRP), R = -0.538, p = 0.003, indicating cell fragmentation during the processing of samples. In further centrifugation of the obtained plasma, platelet and EV enrichment depended on the average distance of the sample from the centrifuge rotor axis. Based on the agreement of the model predictions with observations, we propose the centrifugation protocol optimal for platelet and EV enrichment and recovery in an individual sample, adjusted to the dimensions of the centrifuge rotor, volume of blood and erythrocyte sedimentation rate.[Figure: see text].

Stability of Erythrocyte-Derived Nanovesicles Assessed by Light Scattering and Electron Microscopy.

Extracellular vesicles (EVs) are gaining increasing amounts of attention due to their potential use in diagnostics and therapy, but the poor reproducibility of the studies that have been conducted on these structures hinders their breakthrough into routine practice. We believe that a better understanding of EVs stability and methods to control their integrity are the key to resolving this issue. In this work, erythrocyte EVs (hbEVs) were isolated by centrifugation from suspensions of human erythrocytes that had been aged in vitro. The isolate was characterised by scanning (SEM) and cryo-transmission electron microscopy (cryo-TEM), flow cytometry (FCM), dynamic/static light scattering (LS), protein electrophoresis, and UV-V spectrometry. The hbEVs were exposed to various conditions (pH (4-10), osmolarity (50-1000 mOsm/L), temperature (15-60 °C), and surfactant Triton X-100 (10-500 µM)). Their stability was evaluated by LS by considering the hydrodynamic radius (Rh), intensity of scattered light (I), and the shape parameter (ρ). The morphology of the hbEVs that had been stored in phosphate-buffered saline with citrate (PBS-citrate) at 4 °C remained consistent for more than 6 months. A change in the media properties (50-1000 mOsm/L, pH 4-10) had no significant effect on the Rh (=100-130 nm). At pH values below 6 and above 8, at temperatures above 45 °C, and in the presence of Triton X-100, hbEVs degradation was indicated by a decrease in I of more than 20%. Due to the simple preparation, homogeneous morphology, and stability of hbEVs under a wide range of conditions, they are considered to be a suitable option for EV reference material.

Autologous Platelet- and Extracellular Vesicle-Rich Plasma Is an Effective Treatment Modality for Chronic Postoperative Temporal Bone Cavity Inflammation: Randomized Controlled Clinical Trial.

PURPOSE: To determine the efficacy of autologous platelet- and extracellular vesicle-rich plasma (PVRP) to treat chronic postoperative temporal bone cavity inflammation (CPTBCI) after exhausting surgical and standard conservative therapies. MATERIALS AND METHODS: Patients were randomly allocated to treatment with PVRP (PVRP group) or standard conservative methods (control group) in a setting of four once-monthly checkups and subsequent follow-up. The treatment outcome was measured with the Chronic Otitis Media Questionnaire-12 (COMQ-12), CPTBCI focus surface area, and CPTBCI symptom-free time after the fourth checkup. RESULTS: Eleven patients from each group completed the trial; 95% of patients suffered from chronically discharging mastoid cavity (the type of CPTBCI). Within four checkups, the COMQ-12 score decreased statistically significantly in the PVRP group (p < 0.001) but not in the control group (p = 0.339). The CPTBCI foci surface area decreased statistically significantly between the first and second checkups (p < 0.0005) but not between other checkups (p > 0.05) in the PVRP group. No statistically significant differences in CPTBCI foci surface area were detected between checkups in the control group (p = 0.152). Nine patients from the PVRP group and three patients from the control group were CPTBCI symptom-free at the fourth checkup. The median symptom-free time was 9.2 months (95% CI [7.4, 11.9]) in the PVRP group. Cumulatively, 49% of patients in the PVRP group remained CPTBCI symptom-free for 12.7 months after the fourth checkup. CONCLUSION: Autologous PVRP represents a novel additional and successful treatment modality for a chronically discharging radical mastoid cavity when the surgical and standard conservative treatment methods have been exhausted. TRIAL NUMBER: https://clinicaltrials.gov (NCT04281901).

Decrease in Cellular Nanovesicles Concentration in Blood of Athletes More Than 15 Hours After Marathon.

INTRODUCTION: Cellular nanovesicles (CNVs), that are shed from cells, have been recognized as promising indicators of health status. We analyzed the effect of long-distance running on concentration of CNVs, along with some standard blood parameters, in 27 athletes two days before and >15 hours after physical effort. METHODS: CNVs were isolated by repetitive centrifugation and washing of samples, and assessed by flow cytometry. Cholinesterase (ChE) and glutathione S-transferase (GST) activity were measured spectrophotometrically. Interleukin 6 (IL-6) and tumor necrosis factor-α (TNF-α) concentrations were measured using enzyme-linked immunosorbent assay (ELISA). C-reactive protein (CRP) was measured with immunoturbidimetric determination and lipidogram parameters were measured by enzymatic colorimetric assay. Flow cytometry was used for blood cell count and mean platelet volume (MPV) measurement. RESULTS: More than 15 hours after physical effort a decrease was found in CNVs' concentration in isolates from blood (46%; p<0.05), in ChE activity in whole blood (47%; p<0.001), in plasma (34%; p<0.01), and in erythrocyte suspension (54%; p<0.001), as well as in GST activity in erythrocyte suspension (16%; p<0.01) and in IL-6 concentration in plasma (63%; p<0.05). We found no change in GST activity in plasma and in TNF-α concentration in plasma. Correlations (>0.8; p<0.001) between CNVs' concentration and ChE activity, and GST activity, respectively, in erythrocyte suspension were found. CONCLUSION: We found that >15 hours post-physical effort, CNVs' concentration was below the initial value, concomitant with other measured parameters: ChE and GST activity as well as IL-6 concentration, indicating a favorable effect of physical effort on health status. CNVs' concentration and ChE activity in isolates from peripheral blood proved to have potential as indicators of the response of the human body to inflammation after physical effort. Physical activity should be considered as an important factor in preparation of subjects for blood sampling in procedures focusing on CNV-containing diagnostic and therapeutic compounds.

A cross-sectional survey of patients with open surgical wounds in Slovenia.

Most surgical wounds heal by primary intention, that is, the wound is closed with sutures, clips, or glue. However, some surgical wounds are either left open to heal from the bottom up ("healing by secondary intention") or break open partially or fully after primary closure. There is little basic knowledge about the occurrence and natural history of surgical wounds healing by secondary intention (SWHSI); therefore, the aim of this survey was to estimate the number of people with SWHSI in Slovenia, the nature of these wounds, and to investigate how they are managed. A multiservice, cross-sectional survey was carried out over a 2-week period in the city of Ljubljana, Slovenia (population 288,919). Healthcare professionals across health and social care settings completed one anonymised form for each patient with a SWHSI. Forms were completed for 110 patients. The point prevalence of SWHSI was 0.38 per 1,000 of the population (95% CI: 0.33-0.44). Patients' mean age was 50.5 years. The majority of SWHSI were planned to heal by secondary intention before surgery (76/110, 69%). Of SWHSI, 83% (92/110) were treated with wound dressings, and 6% were treated with negative pressure wound therapy. Data were missing for 11 cases. This survey is the first to provide essential information about the extent, nature, and treatment of SWHSI in Slovenia. Furthermore, it is one of the latest of a very small number of studies to have contributed to knowledge about SWHSI globally. The results from the survey can be used for planning future research, health resources management, and policy development.

Effect of shear stress in the flow through the sampling needle on concentration of nanovesicles isolated from blood.

During harvesting of nanovesicles (NVs) from blood, blood cells and other particles in blood are exposed to mechanical forces which may cause activation of platelets, changes of membrane properties, cell deformation and shedding of membrane fragments. We report on the effect of shear forces imposed upon blood samples during the harvesting process, on the concentration of membrane nanovesicles in isolates from blood. Mathematical models of blood flow through the needle during sampling with vacuumtubes and with free flow were constructed, starting from the Navier-Stokes formalism. Blood was modeled as a Newtonian fluid. Work of the shear stress was calculated. In experiments, nanovesicles were isolated by repeated centrifugation (up to 17,570×g) and washing, and counted by flow cytometry. It was found that the concentration of nanovesicles in the isolates positively corresponded with the work by the shear forces in the flow of the sample through the needle. We have enhanced the effect of the shear forces by shaking the samples prior to isolation with glass beads. Imaging of isolates by scanning electron microscopy revealed closed globular structures of a similar size and shape as those obtained from unshaken plasma by repetitive centrifugation and washing. Furthermore, the sizes and shapes of NVs obtained by shaking erythrocytes corresponded to those isolated from shaken platelet-rich plasma and from unshaken platelet rich plasma, and not to those induced in erythrocytes by exogenously added amphiphiles. These results are in favor of the hypothesis that a significant pool of nanovesicles in blood isolates is created during their harvesting. The identity, shape, size and composition of NVs in isolates strongly depend on the technology of their harvesting.

Adverse event reporting in Slovenia - the influence of safety culture, supervisors and communication.

Background/Aim: The provision of safe healthcare is considered a priority in European Union (EU) member states. Along with other preventative measures in healthcare, the EU also strives to eliminate the "causes of harm to human health". The aim of this survey was to determine whether safety culture, supervisors and communication between co-workers influence the number of adverse event reports submitted to the heads of clinical departments and to the management of an institution. Methods: This survey is based on cross-sectional analysis. It was carried out in the largest Slovenian university hospital. We received 235 completed questionnaires. Respondents included professionals in the fields of nursingcare, physiotherapy, occupational therapy and radiological technology. Results: Safety culture influences the number of adverse event reports submitted to the head of a clinical department from the organizational point of view. Supervisors and communication between co-workers do not influence the number of adverse event reports. Conclusion: It can be concluded that neither supervisors nor the level of communication between co-workers influence the frequency of adverse event reporting, while safety culture does influence it from an organizational point of view. The presumed factors only partly influence the number of submitted adverse event reports, thus other causes of under-reporting must be sought elsewhere.