Competent Practice Research Articles

Endocrine surgery fellowship is necessary for competent endocrine surgical practice: perspectives from Australia and New Zealand.

Currently pathways to practice in endocrine surgery vary based on location and surgical training programme. International data highlights the impact of surgeon volume on outcomes, and the importance of understanding the learning curve in developing minimum training competencies. This study aims to explore how surgeons obtain competence in endocrine surgery in Australia and New Zealand, and perceptions around competence and scope of practice. A web-based survey was distributed to fellows practicing endocrine surgery. Participants were invited to complete a semi-structured interview to explore key themes around competence. Thematic analysis was performed. Responses from 87 surgeons, with 30% practicing primarily in a regional or rural area, showed 94% emphasized post-fellowship training to be competent in endocrine surgery. Median primary operator procedural volume learning curves were 50 thyroid, 30 parathyroid and 20 laparoscopic adrenalectomy procedures. Semi-structured interviews with 12 participants identified four major themes: (1) learning opportunities during general surgical education and training programmes alone are insufficient for consultant-level competence; (2) the importance of sufficient training to develop clinical decision-making, insight and judgement to appropriately select patients in the management of endocrine disease; (3) expected standards of clinical and technical performance are independent of practice location or context; (4) the importance of multi-disciplinary teams for complex cases including advanced cancers. Practicing endocrine surgeons acknowledge formal fellowship training is required to achieve competence across technical and non-technical domains. The definition of competence and expectations regarding technical outcomes are independent of practice location or context.

Correlation of nurses' perception of spirituality and spiritual care with spiritual care practices in Indonesia: A cross-sectional survey.

Spiritual care is essential to nursing practice, contributing to holistic patient care. However, the relationship between nurses' perceptions of spirituality and spiritual care with their engagement in spiritual care practices remains underexplored, particularly in Indonesia. Understanding this relationship is crucial for enhancing the quality of care provided to patients. This study aimed to examine the correlation between nurses' perceptions of spirituality and spiritual care with their spiritual care practices in Indonesia. A cross-sectional survey design was employed, involving a total of 300 nurses working in healthcare facilities across Indonesia. Data were collected via an online survey conducted from March to May 2024, using validated questionnaires: the Indonesian adaptation of the Spirituality and Spiritual Care Rating Scale (SSCRS) and the Nurse Spiritual Care Therapeutic Scale (NSCTS). Spearman Rank Correlation was used to assess the relationship between nurses' perceptions of spirituality and their engagement in spiritual care practices. The study found that nurses held a positive perception of spirituality, with a mean score of 3.85 (SD = 0.41) regarding statements related to spirituality and spiritual care. However, they reported providing spiritual care only occasionally, with an average frequency of 3-6 times over a 72 to 80-hour work period. There was a significant positive correlation (r = 0.235, p <0.001) of nurses' perception of spirituality and spiritual care with their engagement in spiritual care practices. The study highlights the need for targeted education and training to enhance nurses' competencies in spiritual care practices. Addressing spiritual needs is vital for holistic patient care, and improving nurses' perceptions and practices in this area can significantly benefit patient well-being.

Stimulating ambulance specialist nurse students' ethical reflections by high-fidelity simulation.

Introduction: Ethical competence in professional practice can be considered essential among nurses and nurses in ambulance care encounter ethical dilemmas frequently. To enhance ethical competence among students in the ambulance specialist nursing program, high-fidelity simulation scenarios including ethical dilemmas were introduced as a learning activity. Research aim: The research aim was to investigate the usefulness of high-fidelity simulation in ambulance specialist nurse education to teach ethical reasoning when caring for children. Research design: This study was conducted as a qualitative interview study, complemented with observations and using field notes and qualitative interviews for data collection. Data was analysed using deductive qualitative content analysis based on a care ethical model. Participants and research context: Participants (n = 35) were recruited from an ambulance nurse educational program at a Swedish university. Data was collected after the students took part in two high-fidelity simulations involving children in an ambulance care setting. Ethical considerations: The study has been vetted and approved by the ethical council at the University of Borås, Sweden. The study follows the Helsinki Declaration's advice on ethical principles. Results: The results showed that most of the students expressed some form of ethical reasoning during the simulation sessions, which were elaborated and reflected upon during the debriefing part of the sessions. The simulation design seemed to have a great impact on the outcome of the student's ethical reasoning, where increased immersion led to deeper emotional engagement among the students which increased awareness of their personal preconceptions. Conclusions: This study aimed to investigate whether high-fidelity simulations could be useful to stimulate ethical reflections and contribute to increased ethical competence among students. In conclusion, a well-designed high-fidelity simulation can be useful as an educational tool to learn and enhance ethical competence among specialist ambulance nursing students.

팀티칭 보육교사의 교육과정운영 자율성과 동료교사의 사회적지지가 놀이지원역량에 미치는 영향

Objectives The purpose of this study is to examine the effect of team teaching childcare teachers' curriculum operation autonomy and fellow teachers' social support on play support competency. Methods To this end, a survey was conducted among 307 childcare teachers currently operating team-teaching classes at childcare centers in the Busan and Gyeongnam regions. The collected data were analyzed using SPSS 24.0, employing descriptive statistics, correlation analysis, and multiple regression analysis. Results First, team teaching childcare teachers' curriculum management autonomy averaged 4.09 on a 5-point scale, the social support from fellow teachers averaged 4.02, and the ability to support play averaged 4.16. Second, it was found that there are significant correlations between team teaching childcare teachers' curriculum operation autonomy, fellow teachers' social support, overall play support competency, and all its sub-factors. Third, the curriculum operation autonomy of team teaching childcare teachers and fellow teachers' social support explained 49.1% of cognitive competency, 44.1% of affective competency, and 57.7% of practical competency, which are sub-factors of play support competency. Common factors affecting these sub-factors included a child-centered play environment and interactions, collaboration and participation with families and the community, flexible daily routines, and evaluative support, with evaluative support being the most explanatory. Conclusions The meaningful play environment and interactions, along with reflective self-assessment by educators and recognition and praise from peers, indicate the potential for enhancing the play support capabilities of childcare teachers. Therefore, efforts to analyze and support the team-teaching environment of childcare teachers implementing revised educational curricula are necessary to enhance their play support capabilities.

Applying Mentored Blended Learning With Mooc To Improve Preservice Teacher's Teaching Skill and Self-Efficacy

Purpose: The purpose of this study is to assess the effectiveness of the Mentored Blended Learning with MOOC (MBM) model in enhancing the teaching skills and self-efficacy of preservice teachers prior to their internships. By implementing this model, the study aims to provide insights into how a structured combination of mentorship, blended learning, and MOOCs can improve practical teaching competencies and confidence in preservice teachers, thereby informing future approaches in teacher education training programs. Theoretical reference: This study uses constructivist, social learning, self-efficacy, and blended learning models to enhance preservice teachers' teaching skills and self-efficacy, focusing on active learning, self-efficacy, and authentic contexts. Method and material: The study used a mixed-methods approach, involving 120 preservice teachers, 5 preschool teachers, and 5 experts. The MBM model was developed through focus group discussions and evaluated by experts. The experimental group received training through the MBM model, while the control group followed the traditional curriculum. Results and Conclusion: The study found that the Mentored Blended Learning with MOOC (MBM) model significantly improved the teaching skills and self-efficacy of preservice teachers compared to the control group. This suggests the MBM model's potential for improving teacher education by combining mentorship, blended learning, and MOOCs.

Developing a Clinical Service in Interventional Radiology: Results from the 2024 CIRSE Clinical Practice Survey.

Engaging in clinical service development is a prerequisite for Interventional Radiology (IR) to prosper as a full clinical discipline. The CIRSE Clinical Services in IR Task Force conducted a survey of CIRSE members worldwide to assess the current status of their clinical practice and to identify areas of practice requiring further support. An online questionnaire with 63 structured items was sent to 7,501 CIRSE members in November 2023. The survey was closed in January 2024 and a statistical data analysis was performed. A total of 520 complete responses were collected. 49.6% of respondents have an IR outpatient clinic, 34.5% have a dedicated IR day-case ward and 19.8% have dedicated inpatient beds. While 62% of respondents treat patients as the primary consultant responsible for their patients' care, 40.3% of respondents currently without their own beds have admitting rights to the hospital. Clinical practice activities are itemised in the work schedule of 41.3% of respondents and 45% routinely perform ward rounds. A total of 40% feel very positive with their personal clinical practice competency. With half of responding IRs having primary patient access and clinical services in place, the results are encouraging; however further engagement by those who are not yet involved is required. The authors advocate a step-wise approach towards clinical services starting with ward rounds, and subsequently taking increasing responsibility for each step in the IR patient pathway.

Evolving trends and challenges in sustainable architectural design; a practice perspective

Architects play a crucial role in shaping sustainable built environments that balance utility and aesthetics without compromising ecological integrity. Hence embracing sustainability remains an urgent imperative as construction activities expand to meet Nigeria’s development needs. This research examines how architects in Enugu Metropolis, Nigeria are assimilating principles of sustainability within their design practices against a transforming professional backdrop. The study utilized primary data targeting 126 registered architectural firms in the study area through a questionnaire survey and achieved 88.9% response rate. Data were analyzed using JASP and Pearson product moment correlation. Results revealed high conceptual awareness of sustainability among architects, with 32.2% consistently applying strategies like renewable energy systems in designs. Economic considerations and supportive regulations emerged as key assimilation motivators. However, uneven integration levels underline lingering barriers. While 40.6% rated sustainability incorporation in education as very good, 13.5% perceived it as moderate, indicating gaps in practical competencies. Statistical analysis (P-value = 0.001) showed a significant positive relationship between architects' awareness of sustainability concepts and their implementation of sustainable design practices. These findings highlight the need for strengthened educational programs, policy incentives, and industry collaborations to accelerate sustainable architecture adoption. Recommendations include updating curricula, mandating green ratings for public projects, incentivizing developers, and promoting interdisciplinary knowledge transfer. By addressing identified gaps, it implies that architects can lead the sustainability transition while meeting local built environment needs, ensuring a more climate-compatible and socially equitable habitat creation.

Medical practice in classical Greece : The neurological and psychiatric case reports of the Hippocratic Corpus

Which theoretical and practical competences do the neurological and psychiatric case histories of the Hippocratic Corpus convey? The 431 Hippocratic case histories have been studied for reports and communication on the diagnostics, treatment and prognosis of single persons and groups of patients suffering from neurological and psychiatric diseases. In the 7books of the Hippocratic Epidemics, atotal of 128 patients with neurological and psychiatric symptoms are described. Epidemic fever and its variants were the leading predisposing conditions and the main symptoms were delirium, coma, insomnia, headache, speech disorders and convulsions. Anumber of patients with phrenitis and opisthotonos are also reported. The majority of the sick persons were male, were teenagers or adults and 47of them are mentioned by name. The patient's information about the course is often just as informative as the doctor's observations. Treatment was limited to physical and dietary measures. The Hippocratic physician diagnosed and attempted to treat alarge number of neurological and psychiatric diseases. The often almost continuous observations of the patients led to astonishingly precise predictions of the course and the prospects of recovery. Numerous symptoms described in the case studies, including carphologia and opisthotonus, have entered the neurological vocabulary. The retrospective etiological analysis of the reports leads to the almost explicit identification of neurosyphilis and encephalitis lethargica. The therapeutic measures described by the author were, as the changeable course of the diseases shows, only of limited effectiveness despite a very differentiated application over time, both against the underlying diseases and the neurological and psychiatric complications.

The construction of the index system for nurses' innovation competence evaluation in China: A Delphi study

BackgroundScientific and technological innovation has become the "key variable" of national social and economic development. Nurses' innovation ability can improve the quality of patient care, thus shorten the hospital stay, reduce the medical costs, and promote the rapid development of the nursing industry. Nowadays nurses have gradually involved in various innovation, but less concerns are focus on the evaluation of nurse’s innovation competence. ObjectiveTo develop evaluation index system for nurse's innovation competence. ParticipantsEleven experts with innovation experience from different regions in China. MethodsLiterature review and qualitative interview were used to establish first version of index system. Then, a two-round Delphi expert consultation was conducted to collect opinions from 11 experts. Then the final version of nurses' innovation competence evaluation index was used in one tertiary hospital for preliminary application. ResultsThe response rate of the two rounds was more than 90%, the expert familiarity coefficient was 0.818, the judgment coefficient was 0.918, and the authority coefficient was 0.868. The two rounds of expert coordination coefficient test showed P < 0.05. The evaluation index system of nurses' innovation competence includes 4 first-level indicators, 9 second-level indicators and 36 third-level indicators. The scores of innovation production and innovation subject were the lowest among all the first-level indicators when use this index for preliminary application. ConclusionThe constructed evaluation index system of nurses' innovation competence are scientific, reliable and practical, and can be used to promote nurse's innovation competence and innovation conversion competence in clinical practice. Hospital managers should pay more attention on cultivate nurse’s innovation competence and provide resources and multi-form platforms to support the nurses with innovative ideas and willingness.

Assessing Emergency Department Staff Knowledge, Competency, and Implementation of Pre- and Post-Trauma-Informed Care Training

IntroductionTrauma-informed care has been posited as a framework for creating ideal and safe environments for patients to participate in treatment. However, there are limited studies that demonstrate the impact of a focused trauma-informed care training on ED staff. We implemented a 4-hour trauma-informed care training in a general emergency department. We aimed to measure changes in knowledge, opinions, self-rated competency, barriers, and recent practices before and after implementing trauma-informed care training. We hypothesized that the training would result in significant self-reported improvement in all domains. MethodsWe performed a pre/post interventional study with the intervention being a trauma-informed care training adapted for ED clinical care staff. A validated, publicly available survey tool (Center for Pediatric Stress Trauma-Informed Care [TIC] Provider Survey) was used to assess knowledge, opinions, competency, and utilization of and perceived barriers to trauma-informed care. Pre- and post-training surveys were collected. Responses were stratified by role. Continuous variables were compared using analysis of variance; categorical variables compared using Pearson’s chi-square. ResultsParticipants demonstrated a high level of perceived knowledge and opinions of trauma-informed care before and after training. We observed significant increases in self-reported competence for all ED staff, some increase in utilization of trauma-informed care in recent practice, and significant decreases in perceived barriers to providing trauma-informed care. DiscussionTrauma-informed care training is an effective means to improving ED staff self-perceived competence and practice of trauma-informed care even among those with high self-perceived knowledge and opinions of trauma-informed care before the training. Future study should explore the patient-level impact of trauma-informed care training, as well as how to continue to reduce barriers to system-wide implementation of trauma-informed care practices.

Effective blended learning instructional design strategies in medical education

With the rapid development of technology and societal change, a shift from traditional classroom instruction to more diverse educational methods in medical education is necessary. As an effective approach to providing flexibility and accessibility while maintaining the benefits of face-to-face interactions, blended learning, which integrates online and offline learning, has gained attention. This study examines the current status and best practices of the aforementioned blended learning, analyzes its application in domestic and international contexts, and derives effective instructional design strategies. A comprehensive review of previous research and empirical cases reveals a conceptual framework and core principles for designing such blended learning. Key considerations include strategic integration of online and offline activities, facilitation of self-directed learning and interaction, effective use of technology, and continuous quality improvement. Furthermore, we suggest contextually relevant strategies, such as designing curricula focused on clinical reasoning, providing iterative practice opportunities, enhancing reflection, and fostering future competencies. The case analysis establishes that blended learning is implemented in various forms across different medical schools and curricula. Common features include the linkage of online and offline learning, incorporation of learner-centered methods, and emphasis on practical competencies. However, the limited number of cases suggests that generalizations may be premature. Successful implementation requires multifaceted efforts, including gradual introduction, faculty support, flexible curricula, safety measures, and institutional support. Accumulating empirical research and evidence of their effectiveness can facilitate their wider dissemination. This study provides implications and future directions for innovative medical education using hybrid learning.

Development of Research Core Competencies for Academic Practice Among Health Professionals: A Mixed-Methods Approach.

Of the 4 pillars of academic practice for nursing and allied health, research has been the least developed and no standard competency framework exists that is embedded in health professional scopes of practice. The objective of this article is to report on the preliminary development and pilot-testing of research and academic scholarship core competencies for nonphysician health professionals working within a large urban academic health sciences center. We conducted an internal and external environmental scan and multiphase consultation process to develop research and academic core competencies for health professionals working within an interprofessional setting. The final framework outlines 3 levels of research proficiency (novice, proficient, and advanced) and the relevant roles, specific competencies, and observable actions and/or activities for each proficiency level. Organizations should consider the integration of the framework within performance management processes and the development of a road map and self-assessment survey to track progress over time and support health professionals with their academic practice goals.

Analyzing the Educational Needs of Dental Hygiene Students Using the Borich Needs Assessment and Locus for Focus Models

Objective: This study aimed to develop a standard for a practice-based curriculum that reflects the needs of dental hygiene students’ clinical practice education and to provide basic data that can contribute to improving dental hygienists’ competence in clinical practice. Methods: A survey of 132 dental hygiene students from selected universities was conducted. The Borich Needs Assessment model and The Locus for Focus models were used to evaluate the students’ educational needs for clinical practice content. Results: The highest level of present educational needs was for ‘fluoride application,’ while the greatest requirement was for ‘preparing surgical dental treatment’. Using The Locus for Focus model, 33 items in the first quadrant were identified as common to the Borich Needs Assessment priorities. These items include ‘dental insurance claims’, ‘patient reception’, ‘dental materials counseling’, ‘making a temporary crown’, ‘setting a temporary crown’, ‘document management’ and ‘prepare of dental emergencies’. Conclusions: The analysis of the clinical practice needs of dental hygiene students identified the needs for practice-oriented education. These findings suggest that future curriculum revisions should reflect not only the needs of students, but also the perspectives of educators and clinical dental hygienists.

Role of Nurse Instructor in Integrating Theory-Practice Gap: A Cross-Sectional Study in Teaching Hospitals of Peshawar

Background: Bridging the gap between theory and practice in nursing education is essential for ensuring competent clinical practice. However, this gap remains a challenge in nursing programs worldwide.Objective: This study aimed to evaluate the perceptions of BSN students regarding the role of clinical instructors in integrating theory and practice in teaching hospitals in Peshawar, Pakistan.Methods: A descriptive cross-sectional study was conducted in three institutions in Peshawar. A total of 203 BSN students from semesters 4, 5, 6, and 7 were randomly selected. Data were collected using a structured questionnaire adapted from validated tools. Statistical analysis was performed using SPSS version 25, with an ANOVA test to compare mean scores across semesters, and a post-hoc Tukey test to identify significant differences.Results: The mean score for the role of clinical instructors varied significantly across semesters (F = 4.646, p = 0.004). Semester 4 had the highest mean score (75.73), while semester 5 had the lowest (67.00). Group 1 (25.1%) believed the role was not fulfilled, while Group 4 (23.6%) believed it was completely fulfilled.Conclusion: Clinical instructors play a critical role in addressing the theory-practice gap. Tailored teaching strategies are recommended to meet students' evolving needs.

Nurse performed bladder ultrasound: a clinical quality improvement initiative

Background: Bladder ultrasound (BUS) provides an accurate measurement of post-void residual (PVR) volume and bladder assessment. Access to BUS is dependent on practitioner availability with delays resulting in poor symptom management, delayed discharge and dissatisfaction. Developing nursing practice to perform BUS can address these patient’s needs. Aims: Through a quality improvement initiative the aims were (1) to develop theoretical knowledge and practical competence of nurses to perform BUS, (2) to evaluate nursing activity in relation to BUS, (3) to evaluate stakeholders perceptions of the initiative. Methods: Based on the Deming Plan-Do-Study-Act (PDSA) cycle, an interprofessional team was created and a theoretical/practical based education program was devised. Activity in relation to the nurse-performed BUS was collected and analysed descriptively. Stakeholder perceptions were evaluated via patient and physician questionnaires subject to descriptive analysis and a focus group with nurses analysed descriptively. Results: The team developed a training program to perform BUS, certifying 11 nurses. Investigation of nursing activity related to BUS (n = 202) showed its use for PVR evaluation, and symptom and catheter assessment. It aided decision-making and nurse-physician communication. Stakeholders were satisfied with the initiative. Patients (n = 30) felt nurses were competent, clearly explaining the procedure, results and inspiring confidence. Physicians (n = 2) saw BUS as enhancing efficiency and care quality, while nurses (n = 7) felt this new skill enhanced nursing care providing a more holistic approach. Team reflection on the results of the evaluation confirmed BUS utility and activity, while nurses requested continuing education and a post-certification refresher course. Conclusion: Through reflection on clinical practice areas for improvement to enhance patient care were identified by the nursing team. Application of the PDSA cycle provided a structured approach to guide the quality improvement initiative. Improvements in nursing care and patient care processes have been observed and this has been a positive experience for stakeholders.

Entrepreneurial Competences Development of University Students in the Czech Republic

Entrepreneurship and entrepreneurial activities represent driving force of developed economies from national economic point of view. From individual point of view of each entrepreneur, it mainly represents possibilities of applying and developing potential innovative business ideas and ensuring independent and freer future existence of individuals. Small and medium-sized enterprises form a significant part of the economy in developed economies and are characterized by many positives in the current turbulent world. Also, for these reasons, European Union support the development of entrepreneurial activities and the development of entrepreneurship appears as an important topic in the educational environment as well. Today, there are already identified approaches to the development of entrepreneurship at the European level, which enable the effective development of relevant entrepreneurship competence, especially in primary and secondary education level. Entrepreneurship Competence Framework - EntreComp, is interconnected with other frameworks for the development of wide range of competences among pupils. From theoretical point of view, pull and push factors can be identified to support entrepreneurship among future entrepreneurs, which motivate future entrepreneurs to enter business. In our paper, we focus on identification of the situation in implementation of entrepreneurship support in the Czech Republic in the broader concept of education policy, with subsequent focus on possibilities of developing entrepreneurship among university students in Brno. We analyse the motivation of students for entering a university course focused on the development of practical competences leading to the possibility of active action in the role of entrepreneur. We connect the results of the analysis with the theoretical approach to the development of entrepreneurship and with the approaches of the official education policy in the Czech Republic. We hope that this will confirm the correctness of our approach to the development of entrepreneurship competence and support the development of other activities in this area.

일 지역 간호대학생의 감성지능과 공감역량 및 임상실습 만족도 간의 관계

Objectives The purpose of this study was to identify the emotional intelligence, compassion competence and clinical practice satisfaction among nursing students. Methods The study participants included 235 nursing students located in J province, and the data were collected from November 9 to December 6, 2023, using self-report questionnaires. Data analysis employed Cronbach's α, t-test, ANOVA, Pearson’s correlation coefficients, and Scheffé test conducted for post-hoc analysis, using SPSS/WIN 24.0 program. Results The mean score of emotional intelligence and compassion competence was 4.75 and 3.78 respectively, and clinical practice satisfaction was 3.41. Emotional intelligence showed significant differences on gender and peer relationship. Compassion competence showed significant differences on school life and peer relationship. Clinical practice satisfaction showed a significant difference on application motivation and satisfaction with nursing as a major. There were significant positive correlation among emotional intelligence, compassion competence and clinical practice satisfaction. Conclusions The findings suggest that improving emotional intelligence and empathy capacity among nursing students can contribute to healthier resolution of conflicts and emotional challenges during clinical practice and better adaptation to clinical situations through increased satisfaction with clinical practice experiences. Therefore it is necessary to develop programs focusing on enhancing emotional intelligence and empathy capacity among nursing students.

Role, education, policies and competencies for advanced practice in paediatric haematology-oncology nursing in Europe: A scoping review.

The aim of this scoping review is to describe the role, education, policies/regulation, skills and competencies required for advanced practice in paediatric haematology-oncology nursing in Europe, highlighting the differences in development between the different European countries. A scoping review was conducted following the methodological framework of guidelines by Arksey and O'Malley and the recommendations for advancing the methodology by Levac etal. We searched MEDLINE/PubMed, EMBASE, CINAHL, Cochrane Library, Scopus, grey literature, webpages, reference lists and performed a manual search, without any restrictions on language or time. The intersection between databases, grey literature and evidence documents traced from the sites of the most authoritative European organisations in the field made it possible to identify the regulatory and training differences between the various countries that were examined. This scoping review highlights how advanced knowledge and competences are used in the care of paediatric haematology-oncology patients, which are strictly necessary for implementing quality care. At present these competences are not recognised in policies and regulation in most of the countries that were examined. It is desirable that all EU member states work to implement a radical change and allow these more competent figures to assist patients in the best possible way.

Medical practice in Ancient Greece : The orthopaedic and trauma surgery case reports of the Hippocratic Corpus

Which theoretical and practical competences do the orthopaedic and trauma surgery reports of the Hippocratic Corpus reveal? The 431 Hippocratic case histories have been studied for reports and communication on diagnostics, therapy and prognosis of orthopaedic diseases and traumatic lesions. The seven books of the Hippocratic "Epidemics" describe atotal of 26patients with orthopaedic diseases and traumatic lesions. In the field of orthopaedic diseases, arthritis, myo- and tenopathia and gangrene play aprominent role, among the consequences of injury the fracture of the skull (n = 10) is in first place. Mainly individuals, but also groups of patients are reported. The clients' information on the course of the disease was often cautious. Diagnostics were limited to inspection and palpation. In addition to the measures of conservative treatment, four trepanations are described. The majority of traumatic brain lesions resulted in death. The Hippocratic doctor was faced with avariety of orthopaedic disases and traumatic lesions. Within the case reports, the subjective complaints, the objective findings and the course of the treatment are described in detail. Among the ailments of the musculoskeletal system, spinal disorders, especially hypercyphosis and scoliosis play an important role. The variety of reduction techniques reported suggests that most of the fractures detected were dislocated. Post-traumatic tetanus can be readily identified in several followup observations due to the development of opisthotonus. No other surgical intervention is discussed by Hippocrates as often and as variously as trepanation. It can be concluded with some certainty that perforating injuries of the skull were acommon challenge in the life of asurgeon of classic antiquity.

What it takes to develop self-confidence and competence in midwifery students for midwifery practice

BackgroundMidwifery practice is multidimensional and complex in supporting women's reproductive health. Midwives provide care through pregnancy, birth, and the puerperium and may extend to sexual and reproductive health. Midwifery education must develop self-confidence and competence within each midwifery student. This must be learned before registering as a midwife and entering midwifery practice. Little is known about how educational experiences influence midwifery students' confidence. AimThe aim of this study was to understand the educational experiences that influence self-confidence and competence development among midwifery students. Design and methodsA qualitative descriptive design was used in this study. Data were collected through seven focus group discussions with 37 midwifery students. The discussions were recorded and professionally transcribed. Data were analysed using thematic analysis. ResultsThe analysis resulted in four themes: (1) Understanding the concept of competence, (2) developing competence in midwifery practice, (3) obstacles to developing competence, and (4) the importance of self-confidence to be competent. The development of self-confidence and competence is gained through acquiring knowledge and skills, participating in research, undertaking clinical and simulated practice, attending seminars, and engaging in independent learning. ConclusionMidwifery students described how the increase in self-confidence can lead to an increase in competence, enabling the provision of high-quality midwifery services.