Gerontological educational interventions for student nurses: a systematic review of qualitative findings.

OBJECTIVES: This systematic review of qualitative studies explored interventions to improve student nurses' knowledge, attitudes or willingness to work with older people. Student nurses are likely to encounter older people in all health and aged care settings, however, research demonstrates that few have career aspirations in gerontological nursing. METHODS: Qualitative systematic review method based on the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Search of Medline, Embase, PsycINFO, EBSCOhost and Scopus yielded 1841 articles which were screened to include primary research about educational interventions to improve student nurses' knowledge, attitudes and/or willingness to work with older people. Data extraction was performed on the 14 included studies, and data were analysed using directed content analysis. The Mixed Methods Appraisal Tool (MMAT) was used the assess the quality of the studies. CONCLUSIONS: Educational interventions included theory or practice courses, or a combination of theory and practice. While most interventions changed nursing students' negative attitudes towards older people, few increased their willingness to work with them. Practice courses had the most significant impact on willingness to work with older people. Quality assessment revealed methodical limitations. More research is needed to better understand the elements of practice interventions that enhance student nurses' knowledge, attitudes, and willingness to work with older people, so that they can be replicated.

Basic life support training: Is student confidence enhanced by advanced levels of simulation?

BACKGROUND: Basic life support (BLS) is a mandatory skill for nurses. The confidence of the BLS provider should be enhanced by regular training. Traditionally, BLS training has used low-fidelity manikins, but more recent studies have suggested the use of high-fidelity manikins and alternative levels of simulation such as virtual reality. METHODS: A quasi-experimental study including 125 nursing students. Data on confidence levels in various elements of BLS were collected using pre-validated questionnaires and analysed using SPSSv23. RESULTS: The study revealed that high-fidelity simulation had a significant impact on the BLS learner's confidence levels. CONCLUSION: The study identified the importance of high-fidelity simulation in BLS training in preparing students for clinical practice. This highlights the need for further exploration of simulation technologies, such as virtual reality, to enable students to gain the knowledge, skills, confidence and competence required to enable safe and effective practice.

Analysis of the Effect of High-Simulation Teaching on Nursing Students' Learning of Nursing Knowledge on Double J Tubes after Ureteral Soft Scope Lithotomy.

OBJECTIVE: To study the effect of high-simulation teaching on nursing students' learning knowledge related to stoma tube care after ureteral flexible mirror lithotripsy. METHODS: A total of 80 nursing students who were admitted to our hospital from January 2020 to December 2022 were selected as the study objects. They were divided into the control group (traditional teaching) and observation group (high-simulation teaching based on traditional teaching) in accordance with teaching method. General demographic information and specialty theory, Objective Structured Clinical Examination, Chinese Critical Thinking Disposition Inventory, Teaching Quality Evaluation Scale and System for Evaluation of Teaching Qualities scores were collected from both groups of nursing students. Data were analysed with t- and chi-square tests. RESULTS: The general demographics of the two groups were not statistically significantly different (p > 0.05). No significant differences in examination scores, clinical skills, thinking skills, teaching quality and nursing students' satisfaction were found between the two groups before teaching (p > 0.05). Examination scores, clinical skills, thinking skills, teaching quality and nursing students' satisfaction were higher in the observation group than in the control group after teaching (p < 0.05). CONCLUSIONS: High-simulation teaching can effectively improve theoretical and clinical skill examination results, strengthen critical thinking, and improve teaching quality and nursing students' overall satisfaction with teaching. Therefore, it has application value.

[The bibliography group, between dream and reality in nursing practice]. / Le groupe de bibliographie, entre rêve et réalité de l'exercice infirmier.

The shock of reality that nursing students face when they start out will affect the nursing profession even more in the future, as it faces a recruitment crisis in the midst of renewal. Restoring meaning to the nursing profession is a complex and daunting challenge. By providing access to scientific literature, the bibliography group can contribute to this, based on an Evidence-Based Nursing approach. This initiative, which is beneficial for professionals whose skills development is thus encouraged, is designed to be simple and accessible to as many people as possible.

Implications of clinical simulation in motivation for learning: scoping review.

OBJECTIVE: To identify, synthesize, and analyze the scientific knowledge produced regarding the implications of using clinical simulation for undergraduate nursing or medical students' motivation for learning. METHODS: The search for articles was conducted between July 28 and August 3, 2022, on the PubMed/MEDLINE, Scopus, Web of Science, and SciELO databases. The following was used for the search: P - undergraduate students attending Nursing or Medicine courses; C - motivation for learning, and C - skills and clinical simulation laboratory. The following research question guided the study: "What are the implications of clinical simulation on the motivation for learning of undergraduate students of nursing and medicine?" Of the 1,783 articles found, 13 were included in the sample for analysis. All stages of the selection process were carried out by two independent evaluators. The results were presented as charts and a discursive report. RESULTS: The studies analyzed indicated the beneficial effects of clinical simulation on students' motivation, in addition to other gains such as competencies, technical and non-technical skills, knowledge, belonging, autonomy, clinical judgment, critical and reflective thinking, self-efficacy and decreased anxiety, self-management, and improvements in learning and learning climate. CONCLUSION: Clinical simulation provides a positive learning environment favorable to the development of technical and interpersonal skills and competencies, and raising the level of motivational qualities.

Design and Implementation of a Nursing Capstone Across a Multisite Health System.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic created profound effects in nursing education. Using a robust academic-practice partnership, a college of nursing and a health care organization collaborated to launch Jefferson Capstone Experience (JCE), an education delivery model that included a one-to-one, 108-hour clinical preceptorship between an experienced RN and an undergraduate nursing student. METHOD: The expedited design, implementation, and evaluation of JCE is described. The mixed-method program evaluation included surveys, interviews, and focus groups with students, faculty, and preceptors. RESULTS: Students and preceptors reported high levels of satisfaction with JCE. All parties emphasized the importance of clear and timely communication, academic practice collaboration, and organization. A significant number of capstone graduates accepted a position with a capstone clinical partner. CONCLUSION: Although the logistics of planning and implementation were challenging, an immersive and largely positive experience was created for undergraduate students, which created a robust hiring pipeline of new-to-practice nurses. [J Nurs Educ. 2024;63(5):292-297.].

The Effect of Interprofessional Education on Student Readiness for Collaborative Practice.

BACKGROUND: Health care reform promotes interprofessional patient-centric health care models associated with improved population health outcomes. Interprofessional education (IPE) programs are necessary to cultivate collaborative care, yet little evidence exists to support IPE pedagogy within nursing and other health science academia. METHOD: This quasiexperimental study examined differences in pre- and posttest Readiness for Interprofessional Learning Scale (RIPLS) scores following an IPE intervention. The IPE intervention consisted of a video presentation and a debriefing session after a simulated interprofessional collaborative patient care conference that introduced baccalaureate nursing and health science students to the roles and responsibilities of clinicians in team-based primary care. Pre- and postintervention RIPLS scores were analyzed. RESULTS: Pre- and postintervention RIPLS scores increased across all subscales, with distinct variation between nursing and health science student subscales. CONCLUSION: This IPE intervention had positive effects on students' readiness for interprofessional learning. Additional research is warranted to support health science pedagogy. [J Nurs Educ. 2024;63(5):304-311.].

Pursuing Success in a Hybrid PhD Nursing Program.

BACKGROUND: Little is known about hybrid PhD nursing students' experiences. METHOD: The purpose of this study was to describe and analyze the experiences of PhD nursing students in a hybrid program using a convergent mixed methods design. Recent nursing PhD alumni (n = 18), and current PhD students (n = 4) were recruited at a research-intensive university in the southwestern United States. RESULTS: Four metainferences were identified: (1) the facilitator of faculty as both advisors and mentors; (2) the facilitator of peers as support, motivation, and a source of advice that preceded advisors; (3) the barrier of receiving conflicting feedback from advisory and dissertation committees; and (4) the barrier of not understanding the PhD student process. CONCLUSION: Peer support is fundamental for hybrid PhD nursing student success; conflicting feedback and not understanding the process are significant barriers. Strategies are recommended to mitigate barriers to facilitate hybrid PhD nursing students' success. [J Nurs Educ. 2024;63(5):328-331.].

Stress perception, coping behaviors and work-privacy conflict of student midwives in times of COVID-19 pandemic: the "Healthy MidStudents" study in Germany.

BACKGROUND: Student midwives deliver care for women under challenging job demands, which may affect their mental health- thus creating a high need for health promotion. Given the lack of research addressing this topic, the aim of this study is to examine the links between stress perception, coping behaviors, work-privacy conflict, and perception of COVID-19 pandemic impact on studies of student midwives in northern Germany. METHODS: Data were collected using a cross-sectional online-survey at nine midwifery study sites in northern Germany from October 2022 to January 2023. 342 student midwives (response rate: 61.3%) were surveyed on stress perception, coping behaviors, work-privacy conflict, and perceived impact of the COVID-19 pandemic on their studies. Descriptive, linear regression and moderation analyses were run to test explorative assumptions. RESULTS: Results revealed that higher levels of perceived stress were reported by 13.4% of student midwives. Social support (M = 13.76, SD = 2.19) and active stress coping (M = 10.72, SD = 2.01) were identified as most prevalent coping behaviors in the present sample. It was found that work-privacy conflict was positively associated with stress perception (ß = 0.53, p =.001) and maladaptive coping behaviors (alcohol and cigarette consumption: ß = 0.14, p =.015), and negatively associated with adaptive coping behaviors (positive thinking: ß = - 0.25, p =.001, social support: ß = - 0.23, p =.001). Students with children reported significantly lower levels of social support than students without children. 55.6% of student midwives perceived a negative impact of the COVID-19 pandemic on their studies (mostly on lectures, seminars, and contact with fellow students). CONCLUSIONS: Key findings highlighted moderate stress levels among student midwives during theoretical study stage. Based on current research, prevalence of high stress levels among student midwives remains unclear. Given the overall heterogeneous, limited research on student midwives' stress perception, coping behaviors, work-privacy conflict and perceptions of COVID-19 pandemic impact on studies, implications for research are suggested, e.g. longitudinal studies at different time points and settings and interventional studies. Findings provide a starting point for implementation of workplace health promotion in theoretical and practical stages of midwifery science study programs, e.g. training courses on stress prevention and adaptive coping, and for improvement of working conditions.

Digital proficiency: assessing knowledge, attitudes, and skills in digital transformation, health literacy, and artificial intelligence among university nursing students.

BACKGROUND: Implementing digital transformation and artificial intelligence (AI) in education and practice necessitates understanding nursing students' attitudes and behaviors as end-users toward current and future digital and AI applications. PURPOSE: This study aimed to assess the perceived knowledge, attitudes, and skills of nursing students regarding digital transformation, as well as their digital health literacy (DHL) and attitudes toward AI. Furthermore, we investigated the potential correlations among these variables. METHODS: A descriptive correlational design was employed in a Saudi nursing college utilizing a convenience sample of 266 nursing students. A structured questionnaire consisting of six sections was used, covering personal information, knowledge, skills and attitudes toward digital transformation, digital skills, DHL, and attitudes toward AI. Descriptive statistics and Pearson correlation were employed for data analysis. RESULTS: Nursing students exhibited good knowledge of and positive attitudes toward digital transformation services. They possessed strong digital skills, and their DHL and positive attitude toward AI were commendable. Overall, the findings indicated significant positive correlations between knowledge of digital transformation services and all the digital variables measured (p = < 0.05). Senior students reported greater digital knowledge and a positive attitude toward AI. CONCLUSION: The study recommends an innovative undergraduate curriculum that integrates opportunities for hands-on experience with digital healthcare technologies to enhance their digital literacy and skills.

The predicting factors of chronic pain among nursing students: a national study in Iran.

BACKGROUND: Nursing students are faced with a variety of challenges that demand effective cognitive and emotional resources. The physical and psychological well-being of the students plays a key part in the public health of the community. Despite the special lifestyle of nursing students, few studies have addressed chronic pain in this population. Accordingly, the present study aims to identify the predictors of chronic pain among nursing students. METHODS: This cross-sectional study was conducted on 1,719 nursing students aged 18-42 years, between February and November 2019. Sampling was carried out in several stages. Data were collected using seven instruments, namely a demographics survey, the characteristics of chronic pain form, Spielberger State-Trait Anxiety Inventory (STAI), the Patient Health Questionnaire-9 (PHQ-9), the Bar-on Emotional Quotient Inventory, Academic Satisfaction Scale, and Procidano and Heller Social Support Scale. Descriptive statistics, multinomial logistic regression, and regression models were used to describe the characteristics of the pain and its predictive factors. RESULTS: The average age of the participants was 22.4 ± 2.96 years. The results of univariate analysis showed that gender (P = 0.506), mother's education (P = 0.056, P = 0.278, P = 0.278), father's education (P = 0.817, P = 0.597, P = 0.41), place of residence (P = 0.215), depression (P = 0.501), grade point average (P = 0.488), academic satisfaction (P = 0.183) and chronic pain weren't significantly correlated with chronic pain in nursing students. The results of the multiple logistic regression models showed that chronic pain was positively correlated with age, social support, state anxiety, and trait anxiety (OR = 1.07, 95% CI: 1.02-1.12; OR = 0.95, 95% CI: 0.93-0.97; OR = 1.03, 95% CI: 1.02-1.05; and OR = 1.97, 95% CI: 0.95-1.99; respectively). CONCLUSION: The prevalence of chronic pain was relatively high in these students. In addition, age, social support, and anxiety could be important factors in the development or persistence of chronic pain in nursing students. The results also provided basic and essential information about the contributing factors in this area. However, consideration of factors such as referral for treatment, home medications for pain relief, and outcomes of chronic pain are suggested in future longitudinal studies.

Effects of virtual reality OSCE on nursing students' education: a study protocol for systematic review and meta-analysis.

INTRODUCTION: Virtual objective structured clinical examination (OSCE) has been shown to influence the performance of nursing students. However, its specific effects, particularly students' competence, stress, anxiety, confidence, satisfaction with virtual reality OSCE and examiners' satisfaction, remain unclear. METHOD AND ANALYSIS: This study aims to assess the effects of virtual reality OSCE on nursing students' education. The study follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol guidelines. A literature search is performed on electronic databases, namely, PubMed, Web of Science, CINAHL, EBSCO, EMBASE and the Cochrane Library. The inclusion criteria adhere to the PICOS principle, encompassing nursing students, including those studying in school and those engaged in hospital internship. This review includes studies on the use of virtual reality OSCE as an assessment tool, compared with traditional clinical examinations, such as in-person OSCE. The outcome assessments encompass (1) competence, (2) stress, (3) anxiety, (4) confidence, (5) student satisfaction with virtual reality OSCE and (6) examiners' satisfaction. These studies are designed as randomised controlled trials (RCTs) or quasi-experimental research. The search time is from the inception of each database to 30 June 2023, without language restriction. Studies for inclusion are screened by two reviewers for data extraction dependently. Any dispute is resolved through discussion. Unresolved disputes are decided by consulting a third author. For the risk of bias (ROB) assessment, the Cochrane ROB tool for RCTs and the risk of bias in non-randomised studies of intervention tool are used. Moreover, RevMan V.5.3 is used for meta-analysis. ETHICS AND DISSEMINATION: This study protocol does not include any clinical research and thus does not require ethical approval. Research findings are published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42023437685.

Positioning virtual reality as means of clinical experience in mental health nursing education: A quasi-experimental study.

PURPOSE: Virtual reality technology has been used to establish a risk-free environment in which students can practice psychiatric nursing. A quasi-experimental study was conducted to examine the effects of a virtual reality (VR) based mental health nursing simulation on practice performance of undergraduate nursing students. METHODS: A quasi-experimental, pre- and post-test design was used. A total of 68 students were randomly assigned to an experimental group (n = 32) and a control group (n = 36). The control group received conventional simulation using text scenario-based role play. The intervention group received VR software consisting of 360° video clips and related quiz questions. RESULTS: The self-reported perceived competency in nursing performance showed no statistically significant improvement in the experimental group, whereas the control group showed a statistically significant improvement in symptom management (t = 2.84, p = 0.007) and nurse-patient interaction (t = 2.10, p = 0.043). Scores from the assessor showed better performance scores in the experimental group in symptom management (t = -2.62, p = 0.011), violence risk management (t = -3.42, p = 0.001), and nurse-patient interaction (t = -3.12, p = 0.003). CONCLUSIONS: The findings of this study indicate the potential of using VR for optimized mental health nursing simulation. VR technology allowed realistic experiences which may ensure students have a more comprehensive understanding of mentally ill patients and in doing so, overcome barriers of traditional simulation, resulting in better learning outcomes.

Virtual reality-based simulation learning on geriatric oral health care for nursing students: a pilot study.

BACKGROUND: There is a great need for training and education in the nursing curriculum to improve nurses' knowledge and skills to provide oral health care. METHODS: A pilot study was conducted to evaluate the use of a virtual reality (VR)-based Oral Health Care Learning System to train geriatric oral health care among nursing students. Fifty undergraduate nursing students were randomly assigned to experimental (n = 25) and control (n = 25) groups. The experimental group received the VR-based simulation training on geriatric oral health care and the training was implemented twice at two weeks apart from March to November 2021. The control group did not receive the training intervention. Knowledge, attitude, and self-efficacy of geriatric oral health care as well as the intention to assist oral health care for older adults were assessed at the beginning, second, and fourth weeks. Generalized estimating equations were used to analyze the effectiveness of the VR-based simulation training. RESULTS: After the first round of training, students in the experimental group had significantly greater improvements in knowledge and self-efficacy of geriatric oral health care than in the control group. After the second round of training, students in the experimental group had significantly greater improvements in knowledge, attitude, and self-efficacy of geriatric oral health care as well as the intention to assist oral health care for older adult than in the control group. CONCLUSIONS: The VR-based simulation training was effective to improve undergraduate nursing students' knowledge, attitudes and self-efficacy of geriatric oral health as well as the intention to assist oral health care for older adults. The VR-based simulation learning system is an effective tool to provide practice experiences to build confidence and skills and to bridge the gap of understudied geriatric oral health content in entry-level nursing curricula. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05248542; registration date 21/02/2022).

Design and practice of blended teaching of internal medicine nursing based on O-AMAS effective teaching model.

BACKGROUND: Self-directed learning (SDL) ability is the basis for cultivating nursing students' ability to find and solve problems, lifelong learning, and providing high-quality nursing talents for healthcare. The O-AMAS (Objective, Activation, Multi-learning, Assessment, Summary) model adheres to the teaching philosophy of student-centered, result-oriented, combines the advantages of online and offline teaching, enriching teaching resources and learning channels, diversifying teaching and evaluation methods, and emphasizing integrating and applying knowledge conducive to improving students' SDL ability and achieving teaching objectives. This study explored the course design, practical, and application effects under the O-AMAS effective teaching model in internal medicine nursing to provide a basis and reference for combining effective teaching models with blended teaching in future nursing courses. METHODS: This study is a self-controlled before-after trial. The participants were 76 nursing undergraduates from Hunan Normal University. This study utilizes the O-AMAS effective teaching model to design internal medicine nursing courses and implement blended online and offline teaching. Main links: The overall course design and application are student-centered, after clarifying macro and micro multi-dimensional learning objectives, with online and offline blended teaching environments activated students' learning behavior and diversified teachers' teaching activities, then based on instant and dynamic provide effective feedback; finally, students take the initiate to make a brief and potent summary under the teacher guidance. After the course, a unified assessment of the learning effect of nursing students was conducted, including the evaluation of the SDL ability of nursing students, a final comprehensive evaluation grade, and a teaching satisfaction survey. RESULTS: The nursing students' SDL ability scores are higher than before teaching, and the results were statistically significant (P < 0.05). The final average comprehensive evaluation grade of nursing students was 78.38 ± 7.12. More than 96% of the students are satisfied with this course. CONCLUSION: Applying for internal medicine nursing blended teaching integrated with the O-AMAS effective teaching model is conducive to improving nursing students' SDL ability, academic grades, and teaching satisfaction.

Caring: The heart of online nursing education- An integrative review.

With the widespread adoption of online education, nursing educators have observed significant challenges related to learner engagement and participation. Over the past decade, the implementation of Caring has consistently displayed a beneficial influence on creating and maintaining a sustainable online learning environment. However, existing online nursing curricula often lack a Caring and learner-centered approach. The aim of this integrative review is to analyze existing research and gain a comprehensive understanding of the factors that promote a sense of Caring in online nursing education programs. A systematic search for published peer reviewed, English language literature identifying the factors that contribute to Caring in online nursing education was conducted utilizing five databases. Findings from 18 included articles suggest that a combination of Caring strategies implemented by faculty and students, and the utilization of institutional resources contribute to enhanced student outcomes. Faculty driven strategies that promote an online Caring environment are Caring communication, role modeling, building personal connections, demonstrating teaching passion, and embodying emotional intelligence. Student behaviors that promote a Caring online environment include deliberate commitment to learning, genuine presence, active listening, and meaningful interactions with peers. Furthermore, incorporating instructional design to develop a Caring learning platform provides synergy to the student and faculty strategies to produce a Caring environment.

The association between undergraduate nursing students' health literacy and bullying and cyberbullying victimization.

BACKGROUND: Bullying and cyberbullying victimization are common among undergraduate nursing students. However, evidence regarding health literacy association with bullying and cyberbullying victimization is lacking. PURPOSE: To investigate the association between health literacy and bullying and cyberbullying victimization in undergraduate nursing students. METHODS: A cross-sectional design was used with a sample of undergraduate nursing students (N = 397). The students completed three data collection scales (Forms of Peer Victimization Scale, Florence Cyberbullying-Cybervictimization Scales, and Health Literacy Questionnaire) and a demographics questionnaire. Data analysis was performed using cluster analysis and independent samples t-test. RESULTS: The mean age of students was 20.93 (SD = 2.16). Cluster analysis revealed that there were two clusters; undergraduate nursing students in cluster 1 had lower scores on health literacy and higher scores on bullying and cyberbullying victimization. The t-test results showed that undergraduate nursing students with a history of bullying victimization had lower scores on health literacy scales than those who reported no exposure to bullying victimization (p < .05). The largest mean difference was found in the "social support for health" scale. CONCLUSION: The findings of this study provide evidence that health literacy is a key determinant of mitigating bullying and cyberbullying victimization in undergraduate nursing students.

Nursing students' and faculty's experiences of first medication administration: A phenomenological inquiry.

BACKGROUND: Learning medication administration is essential for nursing students, but the first time can be stressful and shape their clinical development. Previous research primarily focused on student knowledge and technical aspects. PURPOSE: This phenomenological study helped explore the lived experiences of nursing students and faculty during student's first medication administration in the clinical setting to gain a deeper understanding of their thoughts, feelings, and perspectives. METHOD: Semi-structured interviews were conducted with female student and faculty informants (N = 12). Using a phenomenological study, data were analyzed using van Manen's hermeneutic six-step research activity method. RESULTS: Five overarching themes were found: administrating medication, (un)preparedness for complexities in the clinical environment, transformative experience, overcoming fears, and reaping the rewards. CONCLUSION: First-time medication experiences are greater than an exercise in skill proficiency and may be improved if faculty provides more structured learning experiences and take sufficient time for student preparation in relating medication knowledge to the skill, technology usage, and supporting students' attitudes toward nurse-patient interactions. These are essential aspects of the medication administration learning process as nursing programs shift toward competency-based education. Clinical faculty also need support in their role as educators and to be facilitated to find this time, considering their multiple responsibilities.

A stepwise approach to integrating the new essentials into a master's entry nursing curriculum.

The American Association of Colleges of Nursing (AACN) released updated nursing curriculum Essentials in 2021. The new Essentials document reflects an innovative and unique approach to nursing education and provides a framework for competency-based education and assessment to prepare students to work in a profession that is ever-changing. The first in the state of Oregon, a Masters Entry into Professional Nursing program was launched with a curriculum based on the new Essentials with the goal to remain true to the program's current concept-based approach while incorporating elements of a competency-based curriculum. As with all new programs, curricular design is paramount and requires careful planning to ensure the curriculum aligns with education trends, meets the needs of diverse learners, adheres to regulatory requirements and standards, and has strong faculty buy-in. Curriculum development done in a systematic fashion with faculty input is imperative. All current faculty were invited by the school of nursing (SON) leadership to participate in the curriculum development process. Regularly scheduled meetings were held, and all interested faculty participants were able to provide input. This process also included the SON Curriculum Committee and SON Faculty Council, to ensure all faculty were included in the process and appraised of the curriculum development. The faculty members who participated in the systematic development process then served as advocates for the new curriculum and helped create a smooth transition when the new MEPN program was introduced.