Care Skills Research Articles

Combining storytelling and a scenario re-enactment of Mt. Everest expeditions to practice cognitive and social skills

BackgroundHealthcare teams need cognitive skills and social skills in acute care and routine situations. This article describes the use of storytelling and the re-enactment of a real-life event to teach such skills. MethodWe describe the preparation, conduct, and debriefing of the simulation. ResultsIn our conducts of the simulation most participants found it valuable, but we also saw a low number of participants, who did not engage a lot in simulation. ConclusionThis concept and the principle of combining story-telling with re-enactment can provide valuable learning opportunities for different target groups in healthcare settings.

Chinese Anesthesiology Milestones in Resident Evaluation: Reliability, Validity, and Correlation with Objective Examination Scores: a Cross-sectional Study.

Evaluating competency acquisition during residency training is crucial. The Anesthesiology Milestones have been implemented in the United States. The China Consortium of Elite Teaching Hospitals for Residency Education has also developed the Chinese Resident Core Competency Milestone Evaluation System. Despite this, Milestones tailored for anesthesiology have yet to be implemented in China. To address this gap, we have developed Chinese Anesthesiology Milestones. This study aims to assess the reliability and validity of the Chinese Anesthesiology Milestones and their correlation with objective examinations. In this single-center cross-sectional study, we included anesthesia residents enrolled in the standardized residency training program at our hospital during the academic year 2021 to 2022. The Chinese Anesthesiology Milestones were developed based on the American version of Anesthesiology Milestones 2.0 and the Chinese Resident Core Competency Milestone Evaluation System using the Delphi method. The Delphi panel comprised a diverse group, including education administrators, faculty from teaching hospitals, and anesthesia residents. Five attending anesthesiologists independently assessed the levels achieved by each anesthesia resident based on the Chinese Anesthesiology Milestones. Subsequently, they collaboratively discussed the ratings for each resident until a consensus was reached. The interrater reliability, internal consistency, and construct validity were assessed using Kendall's coefficient, Cronbach's α coefficient/ composite reliability, and average variance extracted, respectively. Higher values indicated better reliability or validity. The correlation between Milestone ratings and objective examination scores, including written examinations and Objective Structured Clinical Examinations, were analyzed using Pearson correlation. The Chinese Anesthesiology Milestones encompassed 6 competencies, including professionalism, medical knowledge and technical skills, patient care, interpersonal and communication skills, teaching ability, and life-long learning. Milestone evaluation data were available and analyzed from 66 residents. The Kendall's coefficient of concordance among raters ranged from 0.799 (95% confidence interval [CI], 0.793-0.918) to 0.942 (95% CI, 0.934-0.982). The average variance extracted, composite reliability, and Cronbach's α coefficient ranged from 0.782 to 0.920, 0.935 to 0.980, and 0.916 to 0.978, respectively. Correlations between objective examination scores and related Milestone subcompetencies were as follows: written examinations: r = 0.52 (95% CI, 0.22-0.71), technical skills stations: r = 0.51 (95% CI, 0.21-0.71), the oral test station: r = 0.66 (95% CI, 0.45-0.79), and the standardized patient station: r = 0.61 (95% CI, 0.36-0.76). The Chinese Anesthesiology Milestones demonstrated satisfactory interrater reliability, internal consistency, construct validity, and correlation with objective examination scores within our hospital.

Telemedicine-Enabled Otoscopes as Catalysts for Accessible and Preventive Ear Health Care: Systematic Review and Meta-analysis

Background: Maintaining optimal hearing health and preventing ear infections is crucial across all life stages, spanning from before birth and infancy to middle age and beyond. The primary aim of the research was to evaluate and compare the effectiveness of the telemedicine-enabled otoscope (TEO) in diagnosing ear diseases with that of the conventional otoscope. Materials and Methods: The databases PubMed, Cochrane, and Embase were thoroughly searched to find original studies on TEO at the community as well as hospital levels along with meta-analysis for comparison with standard diagnostic methods using traditional otoscopes. Results: The telemedicine-equipped otoscope displays a sensitivity of 82% (confidence interval 0.78–0.95) and a specificity of 95% (confidence interval 0.93–0.96). When employed by physicians, the combined sensitivity and specificity become 84% (confidence interval 0.79–0.88) and 91% (confidence interval 0.87–0.94), respectively. Community Health Workers (CHWs) using telemedicine-enabled otoscopes exhibit a collective sensitivity of 80% (confidence interval 0.72–0.87) and a collective specificity of 97% (confidence interval 0.95–0.98). Snapping multiple photographs and removal of cerumen where necessary in increasing the quality of the photographs for diagnosis. Conclusions: The TEO holds the promise of substantially enhancing the accessibility of audiology services, encompassing evaluation, public outreach, and fundamental care. Its implementation has the potential to fortify primary health care environments, contributing to the prevention of ear diseases and assisting in mitigating the shortage of skilled ear care professionals.

Perceptions regarding attitude towards simulation-based learning among nursing students in Saudi Arabia: A cross-sectional study.

Simulation-based education is essential for preparing nursing students for their professional roles and enhancing their learning experiences and patient care skills. However, there is a gap in understanding how nursing students perceive and engage with simulation-based learning, particularly in the context of Saudi Arabia. This lack of insight limits the ability to develop effective educational strategies. This study aimed to evaluate nursing students' perceptions regarding attitudes toward simulation-based learning in Saudi Arabia. A cross-sectional study was conducted from December 2023 to February 2024, involving 173 nursing students from a single university. Participants completed a structured questionnaire assessing their attitudes toward simulation-based learning, focusing on its relevance, interprofessional education opportunities, communication, situation awareness, and roles and responsibilities. Descriptive statistics were used to analyze the data. Mann-Whitney and Kruskal-Wallis tests were used to examine correlations between variables, with a significance level of p <0.05. The study found that 91.3% of participants had a favorable attitude toward simulation-based learning (Median = 4.43, IQR = 4 - 5). Age and grade level significantly influenced attitudes; younger students (under 20 years) had lower scores (Z = -2.490, p = 0.013), while fourth-year students had higher scores than third-year students, showing a statistically significant difference (H = 8.573, p = 0.014). Additionally, grade point average (GPA) was a significant factor, as students with GPAs between 5.00 and 4.50 scored higher than those in the 3.74-2.75 range (H = 25.893, p <0.001). The study concluded that nursing students in Saudi Arabia have a generally positive attitude toward simulation-based learning, recognizing its importance in enhancing their educational journey and clinical preparedness. These findings highlight the need to integrate simulation-based pedagogical approaches in nursing education to foster critical thinking and improve communication skills, thereby enhancing patient care outcomes.

A study of the correlation between residents’ humanistic care skills and their level of emotional intelligence—A cross-sectional survey

BackgroundThere is variability in the structure of junior doctors’ knowledge of humanistic medicine. The level of residents’ emotional intelligence affects their professional development and the doctor-patient relationship. Currently, there is a paucity of research examining the humanistic competence and emotional intelligence of medical residents, both domestically and internationally.The primary objective of this study was to scrutinize the prevailing status of residents’ humanistic competence and emotional intelligence levels, aiming to assess the correlation between humanistic competence and emotional intelligence.MethodsA cross-sectional survey using the Demographic Characteristics Questionnaire, the Humanistic Care Competence Scale, and the Emotional Intelligence Scale was conducted in September 2022 among residents of a tertiary general hospital in Sichuan Province. The relationship between humanistic care competence scores and emotional intelligence scores among residents was analyzed using Pearson correlation analysis and multiple linear regression analysis.ResultsThe mean score of residents’ humanistic care competence was 188.82 ± 20.80, and the mean score of emotional intelligence was 87.08 ± 13.49.The Pearson correlation results demonstrated a significant correlation (r = 0.400, p = 0.000) between the level of emotional intelligence and humanistic care competence. The results of multiple linear regression analysis indicated that self-emotional appraisal, emotional appraisal of others, emotional control, emotional use, and school community work experience independently predicted humanistic care competence.ConclusionThe scores for residents’ humanistic care competence were notably low, influenced by a multitude of factors that also exhibited varying levels of impact on emotional intelligence development. Emotional intelligence was positively associated with humanistic care competence. Emotional intelligence is an important consideration in the development, implementation, and evaluation of humanistic care interventions. Residency programs should provide education and training in humanistic competencies to improve residents’ levels of emotional intelligence and promote the overall health of society.

DOKTER KECIL: STUDENT EMPOWERMENT THROUGH LEARNING FIRST AID SKILL AND KNOWLEDGE

Introduction: Knowledge and skills of simple first aid are packaged by the UKS program through the role of Dokter Kecil. Interactive learning using video, demonstration and simulation activities has increased first aid knowledge and skills in primary school students. The aim of this community service program was to increase first aid knowledge and skills of wound care, nosebleed and syncope in school age children. Methods: The community service was conducted at SDN Komplek Kenjeran II in Surabaya, Indonesia, involving 40 students from grades 3 to 5. The intervention was provided in a 4-hour session, using video demonstrations and hands-on simulation. Pre-test and post-test questionnaires measured students' knowledge and attitudes before and after the training. Data were analyzed using descriptive statistics. Results: The demographic characteristics of participants were dominated by the age 10 years (37.5%), in fourth grade (42.5%) and female (62.5%). The average pre-test knowledge score was 65 and pre-test attitude score was 76.4. After doing interactive learning, demonstrations and simulations, the average student post-test score experienced a significant increase, namely 84.5 in the knowledge and 89.7 in the attitude. Conclusion: The Dokter Kecil program significantly improved students’ skills and knowledge in managing wound care, nosebleeds, and syncope. This empowerment program demonstrates the effectiveness of interactive learning in fostering critical first aid skills in school-aged children. Regular updates to the training content are recommended to ensure ongoing relevance and efficacy.

The Friends and Family for Mental Health Program: a pilot study of a cognitive behavioral therapy skills intervention for rural adults.

Limited access to psychological treatment is a pressing problem in the US, especially in more rural areas. One potentially underutilized resource is informal care from friends and family members. Although those in rural areas rely on informal care more than those in urban areas, there is little to guide interested caregivers in how they can be most effective. In this study, we conducted a pilot test of the Friends and Family for Mental Health Program, a mental health skills program we developed to enhance informal care and reduce psychological symptoms among informal caregivers. To provide an initial test of the potential benefits of this program, we evaluated the impact of the program on informal care skills, hope, psychological symptoms, and mental health skills. Informal care skills and hope improved. Participants also reported reduced anxiety. We considered intervention feedback to inform intervention development. Overall, findings provided preliminary support for the program and provide directions for future refinements. Though further research is needed, initial evidence suggests mental health skills programs directed at informal caregivers are both desired and beneficial in rural areas.

The effectiveness of enhanced reality simulation on postmastectomy patient care management provided by nursing students: a quasi-experimental study

AimThe aim of this study was to evaluate the effect of enhanced reality simulation on nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care. BackgroundBreast cancer is a common disease with increasing incidence and mastectomy is the treatment of choice. Postmastectomy patient care is a multidimensional and complex process. For various reasons, nursing students today graduate with inadequate clinical skills and do not have experience with many cases. DesignThis quasi-experimental study was conducted using a pretest–posttest design with a nonequivalent control group. MethodsThis study was conducted with fourth-year nursing students (78 students). Students were allocated to each group through a simple random allocation using IBM SPSS Statistics version 24. Research data were collected at the Clinical Simulation Training Center of the university in 2020–2021 academic year. The study group (n=39) learned using a scenario-based learning approach with moulage in a real clinical setting using enhanced reality simulation, while the control group (n=39) learned using the same scenario-based approach with the routine practice adult standard patient care model. The data were collected through the “Student Sociodemographic and Descriptive Characteristics Data Collection Form”, the “Student Satisfaction and Self-Confidence in Learning Scale”, the “Postmastectomy Patient Care Skills Checklist” and the “Pre–Post Knowledge Test on Postmastectomy Patient Care Management”. ResultsAll 78 participants completed the training course. The training significantly increased the Student Satisfaction and Self-Confidence in Learning Scale subdimension scores of both groups (p<0.05). The Postmastectomy Patient Care Management scores of the study group students who received enhanced reality simulation training significantly increased (p<0.05), while there was no significant effect on the scores of the control group students (p>0.05). While most the students in the study group increased their rates of correct answers to Postmastectomy Patient Care Management questions significantly (p<0.05) after the enhanced reality simulation training, the students in the control group showed no significant improvement (p>0.05). The training significantly (p<0.001) increased the mean postmastectomy patient care skills control scores. This increase had a high effect size on the study group. ConclusionEnhanced reality simulation is a learning method that increases nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care. Learning with enhanced reality simulation is an effective approach for nursing education that improves nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care.

Exploring predictors of interaction among low-birth-weight infants and their caregivers: a machine learning–based random forest approach

BackgroundQuality caregiver-infant interaction is crucial for infant growth, health, and development. Traditional methods for evaluating the quality of caregiver-infant interaction have predominantly relied on rating scales or observational techniques. However, rating scales are prone to inaccuracies, while observational techniques are resource-intensive. The utilization of easily collected medical records in conjunction with machine learning techniques offers a promising and viable strategy for accurate and efficient assessment of caregiver-infant interaction quality.MethodsThis study was conducted at a follow-up outpatient clinic at two tertiary maternal and infant health centers located in Shanghai, China. 68 caregivers and their 3-15-month-old infants were videotaped for 3–5 min during playing interactions in non-threatening environment. Two trained experts utilized the Infant CARE-Index (ICI) procedure to assess whether the caregivers were sensitive or not in a dyadic context. This served as the gold standard. Predictors were collected through Health Information Systems (HIS) and questionnaires, which included accessible features such as demographic information, parental coping ability, infant neuropsychological development, maternal depression, parent-infant interaction, and infant temperament. Four classification models with fivefold cross-validation and grid search hyperparameter tuning techniques were employed to yield prediction metrics. Interpretable analyses were conducted to explain the results.ResultsThe score of sensitive caregiver-infant interaction was 6.34 ± 2.62. The Random Forest model gave the best accuracy (83.85%±6.93%). Convergent findings identified infant age, care skills of infants, mother age, infant temperament-regulatory capacity, birth weight, positive coping, health-care-knowledge-of-infants, type of caregiver, MABIS-bonding issues, ASQ-Fine Motor as the strongest predictors of interaction sensitivity between infants and their caregiver.ConclusionsThe proposed method presents a promising and efficient approach that synergistically combines rating scales and artificial technology to detect important features of caregiver-infant interactions. This novel approach holds several implications for the development of automatic computational assessment tools in the field of nursing studies.

Understanding Burn Management For Nursing Students

Background: Managing burn injuries, particularly in mass-burn scenarios, requires immediate first aid and early care, which are critical for improving outcomes. The quality of burn treatment is highly dependent on the knowledge and practical skills of nursing students, particularly those assigned to burn units. Knowledge Gap: Despite the critical nature of burn care, limited research has been conducted on the level of knowledge nursing students possess in this area, especially in regions like Basra, Iraq. Aims: This study aimed to assess the knowledge of burn management among nursing students at Basrah University, identifying gaps and correlations with sociodemographic factors. Methodology: A descriptive cross-sectional study was conducted among 150 nursing students at Basrah College of Nursing. Data was collected using a structured questionnaire divided into two sections: (1) sociodemographic information, and (2) burn management knowledge, assessed through a standardized 3-point Likert scale. Results: The majority of respondents (78% female, 22% male) were aged 19-28 years. The results revealed that students demonstrated a good level of knowledge regarding burn management. Furthermore, there was a highly significant correlation between the academic stage of the students and their test scores, suggesting that academic progression improves burn management understanding. Novelty: This study provides one of the first comprehensive assessments of burn care knowledge among nursing students in southern Iraq, highlighting the critical role of academic progression in enhancing practical burn care skills. Implications: The study suggests that incorporating practical burn care training into nursing education can significantly improve clinical outcomes in mass-burn scenarios. Highlights: Knowledge of burn care improves with academic progression among nursing students. Majority of participants were female, aged 19-28 years. Enhanced burn care training is essential in nursing education curricula. Keywords: Burn management, Nursing students, Knowledge assessment, Basrah University, Cross-sectional study

Maternity waiting home utilization and associated factors in the rural community of Dangur District, Northwestern Ethiopia: results from a community-based cross-sectional household survey

BackgroundApproximately 80% of people in Ethiopia live in rural areas, where poor access to maternity services, accounts for the majority of maternal and perinatal deaths. Maternity waiting homes are residential facilities for women who come from remote areas to stay and wait before giving birth at health facilities, particularly in hospitals and health centers. It is a new initiative and one of the strategies that increase skilled care utilization at birth. However, there is no evidence on the status of maternity waiting home utilization in the study area. Therefore, this study aimed to generate evidence on the status of maternity waiting home utilization and its associated factors.MethodsA community-based cross-sectional household survey was conducted from June 5–30, 2022. The sample size was calculated using the single population proportion formula, which resulted in 354 participants. The study population included mothers who gave birth within 12 months before the survey were selected by using a systematic sampling method. The data were coded, edited, cleaned, and entered into Epi Data version 3.1. The data were subsequently exported to SPSS version 25 for analysis. Descriptive, bivariable, and multivariable binary logistic regression analyses were performed. The results are presented in the text, figures, and tables. Finally, variables with a p value < 0.05 in the multivariable analysis were reported as significantly associated with the independent variables and outcome variable.ResultsThe magnitude of maternity waiting home utilization was 36.4% (95% CI = 31.4, 41.8). Being knowledgeable about the presence of maternity waiting home (AOR = 3.9; 95% CI: 1.0-15.2), being able to afford transportation (AOR = 2.4; 95% CI: 1.01–5.9), being home delivery (AOR = 0.007; 95% CI: 0.002–0.031) and being acess to transportation services (AOR = 3.0; 95% CI: 1.2–7.5) were significantly associated with maternity waiting home utilization.ConclusionThe magnitude of maternity waiting home utilization in the study area was found to be low. Access to and affordability of transportation services, being knowledgeable and being home delivery were associated factors for the use of maternity waiting homes. Therefore, increasing maternal knowledge, economically empowering women and respecting care while waiting at maternity homes are important for improving the utilization of maternity waiting homes.

Access and care for people with opioid use disorder in U.S. skilled nursing facilities: A policy commentary

Referrals for people with opioid use disorder (OUD) to skilled nursing facilities (SNFs) are increasing in the United States (U.S.). Further, legal guidance from the U.S. Department of Justice states that people with OUD cannot be discriminated against by health care institutions because of OUD or treatment with medications for OUD (MOUD). As such, SNFs are an important touchpoint for initiating or continuing MOUD, particularly amid rising drug-related overdose deaths among older adults and because people with OUD experience frailty and other geriatric syndromes at younger chronological ages. Informed by research, clinical expertise, and lived experience, this commentary describes policy and practice opportunities to help address challenges faced by people with OUD in gaining access to care and MOUD in SNFs. We propose opportunities to intervene against barriers that impede SNF placement and access to MOUD for people with OUD, including further revisions to 42 CFR Part 8 regulations to extend waivers for certification as opioid treatment programs (OTPs) to SNFs, allowing them to administer and dispense methadone in the same way as hospitals. If passed, proposed federal changes under the Modernizing Opioid Treatment Act would eliminate the requirement for methadone to be dispensed through OTPs, offering another opportunity to improve access to methadone for SNF residents. Also, we propose national and state-level investment in mobile substance use disorder services and partnerships with OTPs and hospital-based addiction consult services. We also recognize the need for more compassionate attitudes toward people with OUD in healthcare settings and discuss opportunities to address stigma. Although people with OUD are referred to SNFs for skilled care needs and not specifically for OUD care, it is essential for SNFs to be prepared to continue MOUD. It is both legally mandated and imperative that people with OUD have access to high quality and equitable SNF care.

The effectiveness of simulation-based learning (SBL) on students’ knowledge and skills in nursing programs: a systematic review

BackgroundSimulation-Based Learning (SBL) serves as a valuable pedagogical approach in nursing education, encompassing varying levels of fidelity. While previous reviews have highlighted the potential effectiveness of SBL in enhancing nursing students’ competencies, a gap persists in the evidence-base addressing the long-term retention of these competencies. This systematic review aimed to evaluate the impact of SBL on nursing students’ knowledge and skill acquisition and retention.MethodA comprehensive search of electronic databases, including CINAHL, PubMed, Embase, Scopus, and Eric, was conducted from 2017 to 2023 to identify relevant studies. The Joanna Briggs critical appraisal tools were used to assess the methodological quality of the included studies. A total of 33 studies (15 RCTs and 18 quasi-experimental) met the inclusion criteria and were included in the review. A descriptive narrative synthesis method was used to extract relevant data.ResultsThe cumulative sample size of participants across the included studies was 3,670. Most of the studies focused on the impact of SBL on life-saving skills like cardiopulmonary resuscitation (CPR) or other life-support skills. The remaining studies examined the impact of SBL on critical care skills or clinical decision-making skills. The analysis highlighted consistent and significant improvements in knowledge and skills. However, the evidence base had several limitations, including the heterogeneity of study designs, risk of bias, and lack of long-term follow-up.ConclusionThis systematic review supports the use of SBL as a potent teaching strategy within nursing education and highlights the importance of the ongoing evaluation and refinement of this approach. While current evidence indicates enhancing knowledge and skill acquisition, limited studies evaluated the retention beyond five months, constraining generalisable claims regarding durability. Further research is essential to build on the current evidence and address gaps in knowledge related to the retention, optimal design, implementation, and evaluation of SBL interventions in nursing education.

Anti-Maintenance of Certification laws and older physician supply

The American Board of Medical Specialties (ABMS) mandates Maintenance of Certification (MOC) exams every ten years to improve patient care and physician skills, but some states consider it expensive and burdensome and have introduced anti-MOC laws. We exploited state-level staggered adoption of anti-MOC laws and found an additional 1.4–1.9 percentage point biannual increase in older physicians aged 60+ in states with anti-MOC laws, with no effect on younger physicians under 60. Our study suggests that anti-MOC laws improve the supply of older physicians.

Development and evaluation of a spaced eLearning intervention for nurses in enhancing urinary catheter management - A co-design study in partnership with research end-users

BackgroundNurses play a critical role in supporting patients in self-managing their indwelling urinary catheters and preventing avoidable hospital presentations. This study aimed to explore the effectiveness of a co-designed educational approach developed to enhance nurses' ability to provide optimal care for patients with catheters. AimThe primary aim of this study was to enhance nurses' knowledge and skills in urinary catheterisation, care, and management. The secondary aim was to transform their current catheter management practices to improve patient outcomes. SettingNurses (n = 127) from one New South Wales, Australia region participated in the study. These nurses provided healthcare across various community settings. Ethics approval was received from the Local Health District (HREC/2019/ETH12575) and the study was registered in ANZCTR (ACTRN12621000683831). MethodsA mixed-methods approach was used, collecting data at baseline and after the intervention. Quantitative data were analysed using descriptive statistics, tests for normality, and bivariate analysis with the Wilcoxon Signed Ranks test to identify differences between variables. Qualitative data were analysed using a directed content analysis approach to categorise occurrences of specific phenomena. ResultsThe composite mean knowledge score increased from 65.03 to 84.30 following the intervention (p < 0.001). In addition, the magnitude of knowledge score improvement in seven out of eight questions following the intervention were: Financial support: 1.1 %; Bladder spasm/urine leakage: 3.3 %; Blockage: 3.5 %; Catheter-Associated Urinary Tract Infection (CAUTI): 4.4 %; Self-management: 6.1 %; Sexuality: 7.9 %; and Urinary catheterisation: 11.3 %. Qualitative findings confirmed that the eLearning module was effective in transforming participants' clinical practice, towards improving patient outcomes. ConclusionsThe co-designed eLearning module effectively addressed the learning needs of nurses, enhancing their knowledge and skills in urinary catheter management. Incorporating a theoretical model and contextual approach in the intervention delivery increased relevance, personalisation, and engagement, facilitating the behaviour change required to transform current practices.

Infection control nursing competency model for nurses in intensive care units: A Delphi study

Intensive care unit (ICU) nurses require advanced expertise and skills in critical care and need infection control nursing competency (ICNC). Given the lack of research on it, this study aimed to develop a model of ICU nurses' ICNC. A Delphi panel consisting of experts in intensive care nursing and infection control was organized to provide discerning and professional perspective on ICNC. Approved by the Institutional Review Board, a 3-round Delphi survey was conducted via email from July to December 2023. The content validity ratio and the coefficient of variation were calculated for panel responses. Among 17, 15 nurses (88.2%) participated and completed the surveys. About80% were female, and the panel had an average working experience of 14.2years specifically in theICUs or infection control departments at hospitals. After the initial round, a preliminary model was developed, consisting of 10 main components and 59 subelements. After eliminating 5 elements with content validity ratio values below 0.49 in the second survey, the final model, consisting of 10 main components and 54 subelements, was confirmed in the third survey. ICU nurses' ICNC can be understood based on this study's results, and further research can be designed to improve this competency.

Translating and validating the gay affirmative practice scale for nurses in mainland China.

The gay affirmative practice (GAP) scale is an effective tool for evaluating the beliefs and behaviors of health care professionals toward gay and lesbian clients. This study aimed to examine the reliability and validity of the GAP scale among Chinese nurses. A quantitative cross-sectional study was conducted to evaluate the Chinese version of the GAP (C-GAP) scale after translation and cross-cultural adaptation and to examine its psychometric characteristics. The reliability and validity of the C-GAP scale were determined by item analysis, factor analysis, internal consistency, test-retest reliability, and discriminant construct validity. The GAP scale was translated and adapted specifically for China. A total of 1440 participants completed the C-GAP scale, sociodemographic questionnaire, and Marlowe-Crowne social desirability scale. The C-GAP scale exhibited a Cronbach α of 0.95, with a high test-retest reliability coefficient of 0.92. Exploratory factor analysis identified 2 factors that accounted for 59.91% of the total variance. The results of the confirmatory factor analysis were as follows: χ2/df = 1.09, goodness-of-fit index = 0.98, adjusted goodness-of-fit index = 0.97, root mean square error of approximation = 0.01, Tucker-Lewis index = 1.00, comparative fit index = 1.00, incremental fit index = 1.00, parsimony goodness-of-fit index = 0.85, and parsimony normed fit index = 0.91. These findings confirm that all goodness-of-fit indices were satisfactory. The C-GAP scale can be an effective tool for health care professionals and managers and for education and research; it can also identify the beliefs and behaviors of health care professionals toward gay and lesbian clients, facilitating cultural competence development and enhancing care quality awareness and skills. The C-GAP scale demonstrates reliability and validity; however, because the sample consisted only of nurses, the findings may not be generalizable to other professional groups, such as counselors and therapists. Therefore, the occupational focus of the sample limited the broader applicability of the results. The C-GAP scale is a reliable and valid tool suitable for assessing the practice attitudes and behaviors of Chinese nurses toward gay and lesbian clients.

Development of MyREADY Transition BBD Mobile App, a Health Intervention Technology Platform, to Improve Care Transition for Youth With Brain-Based Disabilities: User-Centered Design Approach.

Transition from pediatric to adult health care varies and is resource intensive. Patient-centered health information technology (HIT) interventions are increasingly being developed in partnership with patients. This study aims to develop an internet-based mobile app intervention for patients with brain-based disabilities to improve transition in care readiness. The app was designed for patients aged 15 to 17 years with brain-based disabilities having the ability to use a mobile app. A multidisciplinary team, an industry partner, and a patient and family advisory council was assembled. We hypothesized that existing tools could be migrated into the app to address education, empowerment, and navigation. We used cognitive learning theory to support chapters targeting transition in care skill sets. We used the agile iterative methodology to engage stakeholders. We developed a novel MyREADY Transition HIT platform. An electronic mentor supported cognitive learning with messaging, quizzes, rewards, and videos. We used gaming to guide navigation through a fictitious health care city. Adapting existing tools was achieved by the patient and family advisory council requesting personalization. Our iterative design required time-consuming back-end technology management. Developing the platform took 24 months instead of our grant-approved 12 months, impacting the onset of the planned trial within the allotted budget. A novel patient-centered HIT platform to improve health care transition was successfully developed in partnership with patients and industry. Careful resource management was needed to achieve timely delivery of the end product, flagging the cautious planning required to deliver HIT tools in time for the much-needed trials informing their clinical application. ClinicalTrials.gov NCT03852550; https://clinicaltrials.gov/study/NCT03852550.

A Study on the Life Attitudes, Fear of Death, and Dying Care Abilities of Nursing Assistants in Long-Term Care Institutions

End-of-life care in long-term care institutions is increasingly important. Nursing assistants are the primary care workforce, and their end-of-life care capabilities affect the quality of care provided to residents as well as residents' physical and mental health. This study was designed to explore the life attitudes, fear of death status, end-of-life care abilities and experience, and coping styles of nursing assistants in long-term care institutions in the eastern region and the effects of these variables on care. A cross-sectional, mixed-methods research design was used. The study included 165 nursing assistants working in long-term care facilities in Taitung and Hualien counties. The study questionnaire included items covering life attitudes, fear of death, and dying care abilities. In addition, in-depth interviews were conducted with 12 of the participants. Most of the participants held positive attitudes toward life and reported having a low to moderate fear of death. A significant and positive correlation between life attitude and dying care ability was identified (r = .426, p < .001). Although average ability to provide physical care to residents at end of life was found to be relatively good, ability to provide emotional support and allow residents to express their emotions was generally poor. The scales of fear of death, life attitude toward love and care, ideals, and high school education were identified as significant predictors of dying care ability, together explaining 22.8% of the variance. The interview results were summarized into five major themes that also echoed the quantitative results. Attitudes toward life and fear of death partially were shown to influence the dying care ability of the nursing assistants in this study. Dying care skills should be strengthened in nursing assistants, and they should be encouraged to explore the meanings of life and death through on-the-job education. Also, long-term care institutions should show concern for and support their nursing assistants by sponsoring case discussions, care experience sharing sessions, and support groups.

A simulation-based training model to improve percutaneous endoscopic gastrostomy care skills of family caregivers: a randomized controlled study

A simulation-based training model to improve percutaneous endoscopic gastrostomy care skills of family caregivers: a randomized controlled study