Resilience and Overcoming Experiences of Coronavirus Disease 2019 Patients Hospitalized in a Single-Room Isolation Ward: A Mixed-Methods Study.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has caused patients to suffer from various physical and psychological symptoms and social challenges, but the impact was harder for those COVID-19 patients receiving treatment in single-room isolation wards in South Korea. This study aimed to investigate resilience, anxiety, depression, and sleep quality of those patients and the relationships between those variables, and explore the patients' experience of resilience during the COVID-19 treatment in single-room isolation wards. METHODS: This study employed a mixed-methods approach, collecting quantitative data through surveys and qualitative data through semistructured interviews conducted between May and October 2022. Quantitative surveys encompassing disease-specific and demographic information, visual analog scales to assess anxiety, depression, and sleep quality, and the Connor-Davidson resilience scale were administered to patients (N = 153). Qualitative thematic analyses were conducted following interviews with a subset of patients (N = 13) belonging to the high-resilience group. RESULTS: Resilience exhibited a negative correlation with anxiety and depression, while showing a positive correlation with sleep quality. Factors affecting resilience include having a spouse, educational attainment, and depression. The qualitative thematic analysis results were categorized into: (1) facing the reality of being isolated in a room; (2) struggling to accept and adapt to isolation; and (3) seeking connections in isolation. CONCLUSIONS: This research sheds light on the challenges faced by individuals in isolation and underscores the crucial role of resilience in overcoming such challenges. The resilience observed in these patients is grounded in both interpersonal and profound spiritual connections. These findings underscore the necessity for nurses to develop customized strategies to alleviate the impacts of social isolation.

Body Acceptance Scale for Women with Breast Cancer: Development and Validation of a Measurement.

PURPOSE: Breast cancer and its treatment result in drastic physical changes that can negatively affect a woman's body image. Body acceptance in women with breast cancer is crucial in enhancing their body image and overall quality of life. Despite its significance, there are currently no specific tools to measure body acceptance among cancer patients. This study aimed to develop a Body Acceptance Scale for Women with Breast Cancer (BAS-BC). DATA SOURCES: The scale's initial items were generated based on a conceptual framework of body acceptance and were reviewed by three clinical and five experiential experts. A preliminary instrument was developed through a content validity assessment by six clinical experts and a pilot test with 20 women with breast cancer. Validity and reliability were evaluated via an online survey of 411 women who had undergone breast cancer surgery. CONCLUSION: The scale consists of 17 items across six factors (encountering, understanding, adaptation, return to daily life, successful transition, and leap into the future). The scale's validity-including construct validity, cross-validity, known-groups validity, and criterion validity-was satisfactory, exhibiting a Cronbach α of .91. The BAS-BC demonstrated good validity and reliability. IMPLICATIONS FOR NURSING PRACTICE: The BAS-BC will contribute to improving the quality of life of female breast cancer survivors by providing fundamental information for future research. The BAS-BC may enable nurses to provide tailored interventions to promote body acceptance.

Degree of Alarm Fatigue and Mental Workload of Hospital Nurses in Intensive Care Units.

This study aimed to determine the degree of alarm fatigue and mental workload of ICU nurses, and to clarify the relationship between these two variables. A cross-sectional, descriptive research design was used. Data were collected from 90 nurses working in four ICUs in Seoul, Republic of Korea, using a questionnaire determining their degree of alarm fatigue and mental workload. Data were collected from 6 March to 26 April 2021 and were analyzed using a t-test, ANOVA, and Pearson's correlation coefficient. The average alarm-fatigue score was 28.59 out of 44. The item with the highest score was "I often hear a certain amount of noise in the ward", with a score of 3.59 out of 4. The average of the mental workload scores was 75.21 out of 100. The highest mental workload item was effort, which scored 78.72 out of 100. No significant correlation was found between alarm fatigue and mental workload. Although nurses were consistently exposed to alarm fatigue, this was not directly related to their mental workloads, perhaps owing to their professional consciousness as they strived to accomplish tasks despite alarm fatigue. However, since alarm fatigue can affect efficiency, investigations to reduce it and develop appropriate guidelines are necessary. This study was not registered.

Body image alteration in women with breast cancer: A concept analysis using an evolutionary method.

Objective: Women with breast cancer experience changes in body image, a key predictor of overall quality of life. Body image alteration has been recognized in scholarly circles and is actively being researched on; however, a comprehensive conceptualization of body image alteration from an oncological perspective is insufficient. Therefore, this study aimed to analyze the concept of body image alteration in women within the context of breast cancer based on Rodgers' evolutionary method. Methods: A literature search using a combination of the keywords "breast neoplasms" and "body image" was conducted via PubMed, CINAHL, EMbase, PsycInfo, KISS, and RISS. Peer-reviewed journal articles related to body image alteration in women with breast cancer, published from 2001 to 2020, were included in this study. Results: Three critical attributes of body image alteration were identified: "dismantling the existing body image," "transitioning to the altered body," and "re-integrating a new body image." Antecedents included "breast cancer and its treatment," "awakening to the sociocultural norms of a feminine body," and "triggering events for reflecting on one's body." The consequences were "psychological well-being or distress," "strengthening or breakdown of intimate relationships," "enhancement or impairment of social functioning," and "adherence or resistance to breast cancer treatment." Conclusions: This study provides comprehensive conceptualizations that encompass individual, interpersonal, and sociocultural components and cover both negative and positive changes in body image from a long-term perspective. This may offer a useful framework that can be used to develop effective interventions for body image improvement and accelerate further research.

Body acceptance in women with breast cancer: A concept analysis using a hybrid model.

BACKGROUND: Women with breast cancer undergo drastic physical changes which can impact their body image. Accepting the altered body has recently been highlighted as the key to body image improvement, however, there is no clear definition or conceptualization of it. This study clarified the concept of body acceptance in women with breast cancer, using a hybrid model. METHODS: In the theoretical phase, the attributes and working definitions of the concept were identified through an extensive literature review. Individual in-depth interviews were conducted during the fieldwork phase to elucidate the concept and verify the attributes derived from the theoretical phase. Finally, in the final analytic phase, the findings were compared and integrated. RESULTS: The theoretical and fieldwork phases included 20 out of the 579 articles extracted from the literature search and five women who had undergone breast cancer surgery, respectively. Body acceptance was defined as "acknowledging, normalizing, and overcoming changes in body appearance and function caused by breast cancer and its treatment". CONCLUSIONS: Body acceptance has been identified as a key factor directly related to the overall quality of life. This study provides a theoretical basis for developing effective interventions and consequently facilitates their provision in practice.

Outpatient Service Use in Korean Older Adult Women with Degenerative Arthritis Based on Andersen's Model.

To ensure that older adults (aged 65 years or older) can experience a healthy life, they should use medical services that are appropriate, both quantitatively and qualitatively. This study aimed to identify the factors affecting outpatient service use by older adult women with degenerative arthritis using Andersen's model. A survey was conducted among 232 older adult women with degenerative arthritis in two university hospitals in Seoul. The Korean Activities of Daily Living, Korean Instrumental Activities of Daily Living, and the Geriatric Depression Scale Short Form were used. Data were analyzed using descriptive statistics, χ2-test, t-test, and multiple logistic regression analysis. Among the participants, 69.8% used outpatient services and 30.2% did not. In the univariate analyses, age, marital status, residency, household income, chronic diseases, subjective health status, and disability were significant. Age (odds ratio [OR] = 5.53, p < 0.001), annual household income (OR = 5.64, p < 0.001), chronic diseases (OR = 11.06, p < 0.001), and disability (OR = 3.56, p = 0.016) significantly affected outpatient service use. The results suggest that health promotion interventions for Korean older adult women should focus on predicting outpatient service use according to the patient's characteristics.

The Effect of Game-Based Clinical Nursing Skills Mobile Application on Nursing Students.

Nursing education using mobile devices is emerging as a new educational method showing higher learning achievement than traditional nursing education. This study aimed to develop a game-based mobile application and evaluate nursing students' learning achievement and experiences using a mixed-methods design. The application was developed into eight games on different nursing skills. Thirty nursing students were instructed to use the application for a week in the one-group pretest-posttest study design. Their pretest and posttest knowledge, postlearning efficiency, satisfaction, and convenience were evaluated. The focus group interviews were conducted by dividing 15 students into three groups, and their experience of the application was analyzed using a qualitative thematic analysis. The nursing students' knowledge significantly improved after using the application (t = 4.71, P < .001). The efficiency was the number of days (3.3 ± 2.0), the number of use per login (5.3 ± 4.0), and the number of successes per login (2.7 ± 2.9). Satisfaction and convenience scores were 4.9 ± 1.3 and 4.7 ± 1.2 out of 7. In the thematic analysis, themes through which the students were motivated, made learning plans, and received feedback by efficient game-based interactive educational content were drawn. Game-based mobile nursing education could be an adjunct to traditional clinical education strategies and induce a positive learning effect.

Development and application of a mobile-based multimedia nursing competency evaluation system for nursing students: A mixed-method randomized controlled study.

AIM: To develop a mobile-based multimedia Nursing Competency Evaluation (NCE) system based on the Attention, Relevance, Confidence, Satisfaction model and verify its effectiveness. BACKGROUND: In education, mobile devices can enable the delivery of learning content without time and spatial constraints. Mobile-based test is emerging as a novel method using technologies to appraise students' performance on practicum. This mobile-based test go beyond the simple evaluation of memorised knowledge, a limitation common to paper-based tests. They are useful because they can include multimedia items such as videos, animations and pictures to comprehensively evaluate students' clinical competencies. METHODS: This study was conducted in a nursing university in Seoul, South Korea in September 2021. A mixed method randomised controlled design was employed to evaluate its usability. The participants in the experimental group used the Nursing Competency Evaluation system and joined in focus group interviews for verifying the effects of the Nursing Competency Evaluation system qualitatively. Those in the control group responded to the mobile-based test, but which has only text-based test items. The system usability, effectiveness and learning satisfaction in both groups were measured after the mobile-based test experience. Quantitative and qualitative data were analysed using t-tests and thematic analysis using focus group interviews, respectively. RESULTS: Sixty nursing students participated, with 30 each in the experimental and control groups. There were no significant differences in nursing competency scores between the two groups. However, average scores for effectiveness and learning satisfaction were significantly higher in the experimental than in the control group. Nineteen experimental group participants partook in the interviews, with many describing that the Nursing Competency Evaluation system allowed them to experience new learning contents and efficiently learn practical nursing skills that can be useful in clinical settings. CONCLUSIONS: The Nursing Competency Evaluation system is a promising method because it used mobile technologies and multimedia to appraise students' performance on nursing practicum. It was found that the Nursing Competency Evaluation system with multimedia items is more realistic, interactive and satisfactory compared with text-based mobile test. Thus, we expect it to be used in future nursing curriculums to improve students' nursing competencies.

Comparison of objective and subjective sleep time and quality in hospitalized recipients of hematopoietic stem cell transplantation.

Objective: In this study, the sleep time and efficiency of recipients of hematopoietic stem cell transplantation (HSCT) were investigated throughout treatment and compared objective measurements with subjective self-reported data. Methods: Sleep time and efficiency were measured using both objective and subjective methods throughout the treatment period in inpatients receiving HSCT. The participants were recruited among HSCT inpatients at a tertiary hospital in Seoul, South Korea, between August 2019 and August 2020. Actigraphy was used to measure objective sleep time and efficiency. Subjective sleep time and quality were measured using the sleep diary and Insomnia Severity Index. Measurement data from 40 patients were analyzed. Repeated-measures analysis of variance was used to compare the differences between objective and subjective values in total sleep time and sleep efficiency. Results: The total sleep time was the lowest during the administration of anticancer drugs before stem cell transplantation. The total sleep time of patients with HSCT differed significantly over time when offsetting the difference in the measurement method. There were no significant differences between subjective and objective results for sleep time, and the interaction between the two methods over time was not significant. However, meaningful differences were found among the groups in sleep efficiency throughout the treatment period and between objective and subjective methods, as well as a statistically significant interaction between the two methods over time. Conclusions: Actigraphy misclassified patients' low-energy state with little movement due to immune system impairment during treatment as sleep, resulting in high measured sleep efficiency, whereas their self-reported sleep efficiency was very low. Therefore, subjective measures might be more accurate for measuring sleep efficiency in HSCT patients.

Health Status, Health-Related Factors and Work Environment in Korean Semiconductor Workers between 1984-2012: A Qualitative Study and a Cross-Sectional Study.

BACKGROUND: The environment of semiconductor facilities and exposure status has undergone changes. To identify changes in the work environment, health status, and risk factors, a qualitative and cross-sectional study was conducted. METHODS: For the qualitative study, 38 current and retired workers who worked for at least 10-years were studied; for the cross-sectional study, 306 current workers who worked for at least 5-years based on JEM strata from Samsung Electronics were selected. Participants were asked about occupational history, cancer-relating risk factors during the working period, medical history, dietary habits for the past year, and hematological cancer-relating infection. RESULTS: In the qualitative study, fabrication workers reported bladder cystitis, dermatitis in hands, gastritis/ulcer, and dry eye as frequent symptoms during work environment changes (manual to automatic process). In the cross-sectional study, there were no abnormal findings for infection biomarkers related to hematological cancer and spontaneous abortion, and their general health status was no different from the general population. Also, questionnaire feasibility was evaluated for the applicability in the prospective cohort. CONCLUSION: Current semiconductor workers' health status was good compared to other populations. For lifelong health assessment, a cohort study is needed which considers health worker effects and current environments.

Development of a Health Promotion Application on Cancer Survivorship as an Educational Content for Nursing Students.

PURPOSE: This study aimed to develop a health promotion application for cancer survivorship (CS app) based on the adult learning and self-efficacy theories and evaluated its usability as an educational tool for nursing students. METHODS: The CS app was developed according to ADDIE (analysis, design, development, implementation, and evaluation) model. It consisted of interventions involving medication, diet, exercise, stress management, symptom management, and regular medical checkup for cancer survivors on three different levels in terms of difficulty and complexity. It was designed to teach nursing students how to provide tailored care to cancer survivors as well as help survivors with their repetitive and regular health management. The Mobile App Rating Scale and the user version of the Mobile App Rating Scale were used for a heuristic evaluation of the CS app by the experts and student users. RESULTS: The CS app was developed based on literature reviews and cancer survivorship guidelines. It was evaluated by 20 student users and five experts based on a 5-point scale and obtained a score of 3.97 and 3.66, respectively. Nursing students rated the CS app positively, mentioning that they were able to "learn about appropriate nursing interventions for patients in various cases" and that they became interested in caring cancer survivors' health using the CS app. CONCLUSIONS: The CS app is an effective and user-friendly educational tool to increase the motivation of nursing students in learning cancer survivorship care. This highlights the potential of CS app as a useful learning tool for nursing students.

Benefit-Risk of Rivaroxaban for Extended Thromboprophylaxis After Hospitalization for Medical Illness: Pooled Analysis From MAGELLAN and MARINER.

Background Thromboprophylaxis extended after hospital discharge in medically ill patients currently is not recommended by practice guidelines because of uncertainty about the benefit for preventing major or fatal thromboembolic events, and the risk of bleeding. Methods and Results We assessed the benefit and risk of thromboprophylaxis with rivaroxaban 10 mg once daily extended for 25 to 45 days after hospitalization for preventing major thromboembolism in medically ill patients using the pooled data in 16 496 patients from 2 randomized trials, MARINER (Medically Ill Patient Assessment of Rivaroxaban Versus Placebo in Reducing Post-Discharge Venous Thrombo-Embolism Risk) and MAGELLAN (Multicenter, randomized, parallel-group efficacy and safety study for the prevention of venous thromboembolism in hospitalized medically ill patients comparing rivaroxaban with enoxaparin). The data from the MARINER trial were pooled with the data from the MAGELLAN trial in patients who were free of thrombotic or bleeding events up to the last dose of enoxaparin/placebo and who continued in the outpatient phase of thromboprophylaxis. The composite outcome of major thromboembolic events (symptomatic deep vein thrombosis, nonfatal pulmonary embolism, myocardial infarction, and nonhemorrhagic stroke) and all-cause mortality was used to assess benefit and was compared with the risk of the composite of fatal and critical site bleeding. The incidence of the composite efficacy outcome was 1.80% (148 of 8222 patients) in the rivaroxaban group, compared with 2.31% (191 of 8274 patients in the placebo group) (HR, 0.78 [95% CI, 0.63-0.97], P=0.024). Fatal or critical site bleeding events were infrequent and occurred in <0.1% of patients in both groups (rivaroxaban 0.09%; placebo 0.04%; HR, 2.36; P=0.214). Conclusions The results suggest a benefit for reducing major thromboembolic outcomes (number needed to treat: 197), with a favorable trade-off to fatal or critical site bleeding (number needed to harm: 2045). Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT00571649 and NCT02111564.

Development of a Mobile App-Based Self-care Health Diary for Heart Transplant Recipients: A Pilot Study.

Self-care is an essential concept in health maintenance for patients with heart problems. Mobile applications have received significant attention for their efficacy in facilitating lifestyle management. This study aimed to develop a practical mobile application for Android smartphones to aid in the self-care of heart transplant recipients. Development followed the five stages of the ADDIE model (analysis, design, development, implementation, and evaluation). The developed self-care health diary application provides users with a detailed guide to information and behaviors necessary for self-care through two main components: "Health information" and "Health diary." We conducted a 5-day pilot test with six subject experts and four heart transplant recipients. The participants were unanimously satisfied with the application's content, but experienced difficulty with its functionality, such as screen display and button operation. The feedback was used to revise and update the application, leading to the development of the final version. This study and application significantly contribute to the creation of a sustainable healthcare environment for the growing number of heart transplant recipients by enabling them to perform daily self-care. In future, education and promotion are required for encouraging heart transplant recipients to use the application regularly and proactively.

Tablet PC-based competency evaluation for nursing students in three Asian countries: Cross-sectional comparative study.

AIM: This study evaluated a practical competency evaluation for nursing students in three Asian countries using tablet PC-based tests. The need to evaluate practical competencies in a non-face-to-face manner continues to pose challenges in nursing education. DESIGN: This study presents descriptive comparative research on a tablet PC-based evaluation of practical competencies in three countries. METHODS: tablet PC-based clinical practice competency evaluation was conducted among nursing college students in Korea, Vietnam and Mongolia. In total, 124 students answered 65 questions for practical competency evaluation and items on its usefulness. RESULTS: Students from Korea had the highest score of nursing competencies (41.6 points; n = 59, SD 6.02), followed by those from Vietnam (26.3 points; n = 30, SD 4.97) and Mongolia (18.4 points; n = 35, SD 5.36). Scores for usability showed an inverse relationship with competency scores. Questions incorporating video showed the lowest proportion of low-discrimination items. CONCLUSIONS: This research recognized that using video which provides contextual elements can increase item discrimination. These findings suggest that incorporating video into evaluation items in tablet-PC-based tests is useful for international comparison.

The Development and Application of Drama-Combined Nursing Educational Content for Cancer Care.

With the recent increase in the number of cancer patients, it is important to educate nursing students using pedagogical techniques that nurture understanding and empathy for cancer patients. This study examined nursing students' experiences caring for cancer patients after receiving drama-combined nursing education for cancer care (DCC), which consisted of three elements: lectures, dramatic scenarios, and debriefing. The lectures dealt with cancer statistics, diseases, and nursing, and the dramatic scenarios depicted both breast cancer patients and lung cancer patients. Sixty-seven junior-year nursing students attended a 90 min DCC session developed by the authors. Focus group interviews were conducted to explore students' educational experiences, and the following three themes were derived using the thematic analysis method: 'understanding the lives of patients with severe diseases and their families', 'seeing a nursing role model provide patient-centered care', and 'projecting an image of oneself as a future nurse'. Using drama in nursing education for cancer patients provided an opportunity for students to imagine the clinical experiences of cancer patients, helping them to understand patients' points of view and reflect on their self-images as future nurses. The DCC developed for nursing students in this study is a promising way to deliver distinctive and meaningful learning experiences.

Comparison of Fatigue, Quality of Life, Turnover Intention, and Safety Incident Frequency between 2-Shift and 3-Shift Korean Nurses.

This study aimed to compare the fatigue, quality of life, turnover intention, and safety incident frequency between 2- and 3-shift nurses, and analyze their perceptions of the 2-shift system. Participants were 227 nurses working for one year or more in a tertiary hospital in Seoul, South Korea (113 were 2-shift nurses for two months or longer, and 114 were 3-shift nurses with no experience of 2-shift work). The Occupational Fatigue Exhaustion Recovery Scale (OFER) and Quality of Life Scale were used. Turnover intention, safety incident frequency, and perceptions of the 2-shift system were surveyed by questionnaires developed by the researchers. Results showed that 2-shift nurses had lower chronic fatigue (t = -2.38, p = 0.018) and higher recovery between shifts (t = 3.90, p < 0.001) and quality of life scores than 3-shift nurses (t = 3.69, p < 0.001). There were no significant differences for turnover intention (t = -1.48, p = 0.140), frequency of needlestick accidents (t = 0.30, p = 0.763), medication errors (t = -1.46, p = 0.146), or near-miss medication errors (t = 0.78, p = 0.437). Two-shift nurses found it easier to secure rest and personal leisure time, and their shift system was shown to improve work satisfaction by increasing the continuity of care. Additional research is necessary to examine how nurses' health status and emotional satisfaction vary by shift type.

Effectiveness of Integrated Education to Reduce Postoperative Nausea, Vomiting, and Dizziness after Abdominal Surgery under General Anesthesia.

This study presents an anticipatory integrated education program for nausea, vomiting, and dizziness prevention (anti-NVD education program) for patients undergoing abdominal surgery under general anesthesia. The anti-NVD education program for nephrectomy patients consisted of the following: the causes of postoperative nausea, vomiting, and dizziness; effective deep breathing and how to use an inspirometer; postoperative nausea and vomiting; effective methods of patient-controlled analgesia; and the stepwise standing up method to prevent dizziness. A study was conducted among 79 adults (experimental group: n = 40, control group: n = 39). The degree of nausea and dizziness was measured using a numerical rating scale (NRS), and vomiting and the frequency of antiemetic use were measured in terms of the number of patients. The experimental group, which received the anti-NVD education, showed remarkably lower levels of nausea (p = 0.013) and dizziness (p < 0.001) than the control group. The frequency of antiemetic use 48 hours after surgery was significantly lower in the experimental group (p = 0.03). This study proved the efficacy of the anti-NVD education program for reducing postoperative nausea and dizziness. This program can be used as a noninvasive nursing intervention to prevent nausea, vomiting, and dizziness among patients undergoing abdominal surgery.

Rivaroxaban for extended thromboprophylaxis in acutely ill medical patients 75 years of age or older.

BACKGROUND: Although older patients are at increased risk for venous thromboembolism (VTE), thromboprophylaxis is underused because of bleeding concerns. The MARINER trial evaluated whether rivaroxaban reduced symptomatic postdischarge VTE in acutely ill medical patients. OBJECTIVES: We hypothesized that rivaroxaban would have a favorable benefit/risk profile in patients ≥75 years of age. METHODS: Patients were randomized in a double-blind manner at hospital discharge to rivaroxaban (10 mg/day for creatinine clearance ≥50 ml/min; 7.5 mg/day for ≥30-<50 ml/min) or placebo for 45 days. Using a Cox proportional hazard model including treatment as a covariate, we compared the risk of the primary efficacy outcome (symptomatic VTE plus VTE-related death in the intention-to-treat population) and safety outcome (International Society on Thrombosis and Haemostasis major bleeding in the safety population) in the prespecified subgroups of patients ≥ and <75 years of age. RESULTS: The primary event rate in patients ≥75 years of age was 2-fold higher than that in those <75 years. The incidence of the primary efficacy outcomes in both age groups was numerically lower with rivaroxaban than with placebo (≥75: 1.2% and 1.6%, HR 0.73, 95% CI 0.43-1.22; <75 0.6% and 0.8%, HR 0.78, 95% CI 0.46-1.32; interaction p-value for age group = .85). The incidence of major bleeding was low and similar in the two age and treatment groups (interaction p value for age group = .35). CONCLUSION: Symptomatic VTE and VTE-related death occur frequently in older patients with acute medical illness. The benefit/risk profile of rivaroxaban in patients ≥75 years of age appears consistent with that observed in the general population.

Development, Application, and Effectiveness of a Smart Device-based Nursing Competency Evaluation Test: A Mixed-Method Study.

We aimed to develop and evaluate the effectiveness of a smart device-based test to assess Korean undergraduate students' clinical nursing competency, named SBT-NURS. The 65-item SBT-NURS comprises questions that simulate clinical situations, are problem solving-oriented, use multimedia (ie, videos/photos/animations), and involve the following topics: medical-surgical nursing, fundamentals of nursing, pediatrics, maternity, management, and psychiatric. We utilized a quantitative method to analyze the effects of the SBT-NURS (ie, via a single-group, post-experimental survey design) and a qualitative method to analyze students' experiences of using the SBT-NURS (ie, via seven focus group interviews [FGIs]). Students' overall adult health nursing paper-based test scores (ie, combining their scores in group activity, presentation, attendance, and attitude toward the midterm and final tests on adult health nursing) (r = 0.552, P < .001) and clinical practicum scores (r = 0.268, P = .040) in the last semester showed a statistically significant positive correlation with their SBT-NURS scores. Their paper-based testing practice average scores (ie, combination between paper-based tests and clinical practicum scores) showed a similar significant correlation (r = 0.506, P < .001). Students deemed the SBT-NURS advantageous, satisfactory, convenient, and useful. The SBT-NURS may be an effective learning and evaluation method for nursing education that help improve students' clinical competency and learning outcomes.