Four-step Approach Research Articles

Characterization of novel L-asparaginases having clinically safe profiles from bacteria inhabiting the hemolymph of the crab, Scylla serrata (Forskål, 1775).

L-asparaginase (ASNase) is the principal chemotherapeutic agent against different blood cancers. The risks associated with current clinical preparations demand screening for novel ASNases. Accordingly, the study was conducted to shortlist ASNases having clinically safer profiles from a novel niche, namely, microbes in the gut and hemolymph of apparently healthy Scylla serrata. A four-step strategic approach incorporating the essential requirements for clinically safer profiles was followed. The initial step through plate assay showed five (9.61%) potential ASNase producers. The relative prevalence of ASNase producers was higher in hemolymph (13.33%) than gut (4.5%). The positive isolates were identified as Priestia aryabhattai, Priestia megaterium, Bacillus altitudinis, Shewanella decolorationis, and Chryseomicrobium amylolyticum. Quantitative profiles revealed high ASNase production (114.29 to 287.36 U/mL) without any optimization, with an added advantage of the extracellular production. The second step for substrate specificity studies revealed the absence of L-glutaminase and urease activities in ASNases from C. amylolyticum and P. megaterium, the most desirable properties for safe clinical applications. This is the first report of glutaminase and urease-free ASNase from these two bacteria. The third step ensured type II nature of selected ASNases, the targeted form in clinical applications. The fourth step confirmed the activity and stability in human physiological conditions. Altogether, the results revealed two potential ASNases with clinically compatible profiles.

Subglandular-to-Subpectoral Conversion with Mastopexy: The Four-Step Approach.

Background:Because of the multiplying number of patients undergoing breast augmentation, nonprimary augmentation mastopexy will be increasingly requested in the future; this operation represents an even more significant challenge than primary augmentation mastopexy. The authors describe a standardized approach for subglandular-to-subpectoral implant pocket conversion in mastopexy that provides a tight neopocket with inferolateral muscular support, which minimizes implant displacement complications and allows operative strategies to reduce the risk of bacterial load on implants.Methods:The authors’ technique proposes the following: (1) modified subpectoral pocket, with muscular inferolateral support for the implant; (2) independent approaches to the submuscular pocket and subglandular (preexisting) pocket; and (3) preestablished four-step surgical sequence. The authors collected data from their private practices for 46 patients who underwent the technique from March of 2017 to April of 2020. Patient perception about aesthetic outcomes, photographs from multiple postoperative follow-ups, and surgical complications/reoperation rates were analyzed.Results:Overall results were positive; 89.1 percent of patients reported satisfaction with their aesthetic outcomes. No major complications occurred. The total revision rate was 15.2 percent, but only 2.1 percent in the last year, as the learning curve progressed.Conclusions:Secondary augmentation mastopexy is a complicated procedure. The four-step sequence approach is one reliable option for subglandular-to-subpectoral pocket conversion, once it produced high levels of patient satisfaction while producing low complication rates. Other surgeons’ experiences with the technique and further studies are necessary to validate these findings.CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, IV.

Development and evaluation of an electronic nursing documentation system

BackgroundNursing documentation is a critical aspect of the nursing care workflow. There is a varying degree in how detailed nursing reports are described in scientific literature and care practice, and no uniform structured documentation is provided. This study aimed to describe the process of designing and evaluating the content of an electronic clinical nursing documentation system (ECNDS) to provide consistent and unified reporting in this context.MethodsA four-step sequential methodological approach was utilized. The Minimum Data Set (MDS) development process consisted of two phases, as follows: First, a literature review was performed to attain an exhaustive overview of the relevant elements of nursing and map the available evidence underpinning the development of the MDS. Then, the data included from the literature review were analyzed using a two-round Delphi study with content validation by an expert panel. Afterward, the ECNDS was developed according to the finalized MDS, and eventually, its performance was evaluated by involving the end-users.ResultsThe proposed MDS was divided into administrative and clinical sections; including nursing assessment and the nursing diagnosis process. Then, a web-based system with modular and layered architecture was developed based on the derived MDS. Finally, to evaluate the developed system, a survey of 150 registered nurses (RNs) was conducted to identify the positive and negative impacts of the system.ConclusionsThe developed system is suitable for the documentation of patient care in nursing care plans within a legal, ethical, and professional framework. However, nurses need further training in documenting patient care according to the nursing process, and in using the standard reporting templates to increase patient safety and improve documentation.

Identifying and Aligning Ecosystem Services and Beneficiaries Associated with Best Management Practices in Chesapeake Bay Watershed.

Ecosystem restoration may require implementing programs or best management practices (BMPs) in areas that are geographically far from the target ecosystem. Stakeholders in these areas may feel disconnected from the target ecosystem or may not have a clear understanding of local benefits from implemented practices. To achieve widespread participation in restoration efforts, it is important to engage stakeholders located where BMPs need to be implemented to identify and consider their local priorities and impacts. Here, we demonstrate use of a structured decision-making approach to identify ecosystem services associated with BMPs in the Chesapeake Bay watershed and connect them with the priorities of stakeholders they benefit. We follow a four-step approach to define the bounds of the decision context, identify ecosystem services and beneficiaries relevant to that decision context, engage stakeholders to understand priorities, and identify potential metrics and indicators. Our approach highlights the utility of different tools, such as ecosystem service classification systems and the Final Ecosystem Goods and Services (FEGS) Scoping Tool, in engaging stakeholders to identify, communicate, and prioritize ecosystem services. The results demonstrate a method by which to connect large-scale regional restoration efforts, and the managers overseeing such efforts, with the priorities of local communities where programs will be implemented. This work will help Chesapeake Bay restoration partners identify and promote management actions that will provide the most value for communities throughout the watershed, while also benefiting restoration of Chesapeake Bay.

Production, purification, and structural characteristics of extracellular polysaccharides derived from Lactobacillus acidophilus

BackgroundExtracellular polysaccharides (EPSs) derived from Lactobacillus acidophilus BCRC 10695 possess lots of beneficial effects to the host. In seeking to develop a fermentation process to produce EPSs, the culture medium compositions, purification, and structural analysis on EPSs were conducted. MethodsThe effects of carbon sources, nitrogen sources, and surfactants on EPSs production were explored. Response surface methodology (RSM) was applied for optimizing the cultivation medium. A four-step purification approach was carried out. The gas chromatography-mass spectrometry and NMR were applied for the EPSs structural analysis. FindingsThe optimal concentrations of sucrose, yeast extract and polysorbate 80 were 10.15 g/l, 25 g/l and 2 g/l respectively. The best EPS production was 923.7 mg/l in the late stationary phase of cultivation for 96 h, close to that in the experiment of 923.6 mg/l. The purification approach was able to remove 99.9% proteins and 98.5% of nucleic acid. Structural analysis showed EPSs consisted of mannose, ribose, glucose and galactose in ratios of 60.0: 22.8: 15.0: 2.2 and comprised (1→ 2) (1→6)-Mannose as backbone.

Generation of Hepatocyte Organoids from Human iPS Cells.

Human-induced pluripotent stem cells (hiPSCs) constitute a great source to generate specialized cells that can be employed in cell replacement therapy for a number of degenerative diseases. In this chapter, I describe a strategy to mass-produce fully functional hepatocyte organoids using hiPSCs interlaced with human adipose microvascular endothelial cells (HAMEC). Our unique technology employs a two-step strategy, consisting of the scalable generation of nearly spherical uniform-sized human embryoid bodies (hEBs), and the subsequent employment of a four-step hepatocyte differentiation approach for the generation of hepatocyte organoids that display all the characteristics of human primary hepatocytes. In this chapter, wealso describe methodologies to characterize the hepatocyte organoids by using different biomolecular assays.

Improving Clustering-Based Forecasting of Aggregated Distribution Transformer Loadings With Gradient Boosting and Feature Selection

Load forecasting is more important than ever to enable new monitor and control functionalities of distribution networks aiming to mitigate the impact of the energy transition. Load forecasting at medium voltage (MV) level is becoming more challenging, because these load profiles become more stochastic due to the increasing penetration of photovoltaic (PV) generation in distribution networks. This work combines medium to low voltage (MV/LV) transformer loadings measured with advanced metering infrastructure (AMI) and machine learning (ML) algorithms to propose a new clustering based day-ahead aggregated load forecasting approach. This four-step approach improves the day-ahead load forecast of a city. First, MV/LV transformer loadings are clustered based on the shape of their load pattern. Second, a gradient boosting algorithm is used to forecast the load of each cluster and calculate the related feature importance. Third, feature selection is applied to improve the forecast accuracy of each cluster. Finally, the day-ahead load forecast of all clusters are aggregated. The case study presented uses 519 measured MV/LV transformer loadings in a city to perform 30 day-ahead load forecasts. Compared against the day-ahead aggregated load forecast without clustering, the average normalized root mean squared error (NRMSE) reduced 12.7 %, the average mean absolute percentage error (MAPE) reduced 18.2 % and the average Pearson Correlation Coefficient (PCC) increased 0.37 %. The 95 % confidence interval of the difference between the average NRMSE, MAPE and PCC without clustering and with the proposed method indicates a statistically significant improvement in accuracy.

Four-step approach to idea management sequencing: redefining or reinventing values in a business model

The purpose of this paper is to create and test an idea management sequence framework to reinvent or redefine the value proposition. Idea management with sequencing activities must be considered as a systematic managerial process and should not be confused with the occasional result of an individual with a design thinking mindset. This paper suggests a new approach—a systematic, 4-step idea management sequence to redefine or reinvent value proposition in a business model, which was validated through an action-based research method involving 20 managers from practice by applying the proposed framework. Based on the idea management approach, authors describe the idea generation and evaluation processes and their possible moderation elements. This research contributes to previous studies of the design thinking and innovation by substantiating a concept of the idea management sequencing and proposing a new 4-step approach that can be applied by organisations to redefine or reinvent value proposition in their business models. Being influenced by pandemic restrictions and the full or partial remote workforce, the 4-step idea management approach is beneficial for virtual group sessions as it increases the quality of outcomes, engagement of individuals, collaborative openness, and confidence.

Smart Sustainable City Roadmap as a Tool for Addressing Sustainability Challenges and Building Governance Capacity

Building smart sustainable cities initiatives requires governance capacity, which is constantly challenged by a diversity of actors and the transformation towards a digital society; however, the process of identifying the conditions for building a smart sustainable city (SSC) is not straightforward. As an attempt to map the key governance conditions, the goal of this study is to suggest guidelines for the development of SSC initiatives in the format of a generic roadmap. This research applies design science research methodology and builds the roadmap based on identified antecedents that may hinder or facilitate the development of SSC initiatives from a systematic literature review and the analysis of key governance aspects from 12 smart city initiatives in Europe and Latin America. This paper builds its results through a four-step approach including: (1) defining the main concepts and dimensions within the smart sustainable city context; (2) identifying sustainability challenges for the development of smart sustainable city initiatives; (3) analysing key governance aspects from smart sustainable city initiatives; and (4) designing an actionable research-based roadmap and practical recommendations. The resulting roadmap contains 11 key governance conditions for developing strategies for smart sustainable city initiatives that were classified into three main phases: (1) planning; (2) implementing; and (3) adopting, monitoring, and evaluating. In terms of contribution, this research provides a tool to support the development of initiatives, addressing sustainability challenges and strengthening governance capacity to ensure the long-term impacts of smart sustainable cities.

Findings From Implementation of the EIT-4-BPSD Trial

Behavioral and psychological symptoms of dementia (BPSD) include aggression, agitation, depression, anxiety, apathy and hallucinations and are exhibited by up to 90% of nursing home (NH) residents with dementia. BPSD result in negative health outcomes, functional decline, high care costs, increased risk for inappropriate use of antipsychotic medications and social isolation. Behavioral approaches are endorsed as the first line of treatment for BPSD. Despite regulatory requirements, less than 2% of nursing homes consistently implement these approaches. The EIT-4-BPSD Trial was done to test a novel implementation approach to assure that staff in nursing homes use non-pharmacologic, behavioral approaches for the management of BPSD. EIT-4-BPSD is a theoretically-based four-step approach that includes: 1. Assessment of the environment and policies; 2. Education of staff; 3. Establishing person-centered care plans; and 4. Mentoring and motivating staff. Implementation of the four-step approach was guided by the Evidence Integration Triangle (EIT). The EIT brings together evidence and key stakeholders from the NH and uses a participatory implementation processes, practical evidence-based interventions, and pragmatic measures of progress toward goals. A total of 55 nursing homes from two states and 553 residents were included in this study. Nursing homes were randomized to EIT-4-BPSD or education only. This symposium will describe the utility of the EIT as an implementation framework based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance model, report detailed effectiveness outcomes of EIT-4-BPSD at the setting and resident levels, and address recruitment and measurement challenges and future solutions to these challenges.

The combined effect of thermal-acid hydrolysis, periodate oxidation, and iodine species removal on the properties of native tapioca (Manihot esculenta Crantz) starch

Through a four-step top-down approach, native tapioca starch (NTS) was thermally acid-hydrolyzed, periodate-oxidized with subsequent removal of iodine species (i.e., IO4(−), IO3(−), I(−), and I2), and dialdehyde tapioca starch (DTS) alcohol-precipitation. The percent yield was ∼91%. Analyses confirmed the presence of aldehydic functionalities (∼71%), effectual iodine species removal (∼98%), and enhanced water-solubility (∼96.57%). Besides, the combined treatment significantly reduced the Mw (∼57.81 kDa) and ameliorated homogeneity as well as thermal stability (Tmax ∼ 667.15 °C). Structural-spectral characterization also confirmed the presence of aldehydic functionality, polymorphic transition (C- to A-type), and a higher degree of crystallinity (∼91.77%), the latter further corroborated by thermal analysis. The morphological study revealed that the combined treatment reduced size (∼393.55-nm-diameter and ∼5.22-μm-length) and changed shape into rod-like crystals. DTS showed considerably and significantly low cytotoxicity to HaCaT cells in vitro at the concentrations assayed over the test period (24 h). DTS's conformation was most stable at −289 kcal/mol and −151.7 au heat formation and minimum potential energies, respectively. Overall, these results demonstrated that the combined treatment had no deleterious effects on NTS's properties, thus yielded DTS with ideal properties for multifarious uses.

Identifying and managing patients with disease-related malnutrition in primary care

Disease-related malnutrition can be challenging to treat. A disease, its treatment or the consequences of treatment can cause patients to experience a reduction in appetite and the desire to eat, resulting in an inability to consume sufficient food and drink to maintain or improve nutritional status. This article summarises a four-step approach to identifying and managing patients with disease-related malnutrition, and details how community and primary care nurses can effectively identify and manage the underlying causes of malnutrition and assist in advising on dietary modifications to enable enhanced patient outcomes.

A Four-Component Framework Toward Patient-Centered, Integrated Mental Healthcare in Kenya.

Background: How can we fast-track the global agenda of integrated mental healthcare in low- and middle-income countries (LMICs) such as Kenya? This is a question that has become increasingly important for individuals with lived experiences, policymakers, mental health advocates and health care providers at the local and international levels.Discussion: This narrative synthesis and perspective piece encompasses an overview of mental health care competencies, best practices and capacity building needed to fast track patient responsive services. In that vein we also review key policy developments like UHC to make a case for fast-tracking our four-step framework.Results: While there is an increasingly global impetus for integrated mental healthcare, there is a lack of clarity around what patient-responsive mental healthcare services should look like and how to measure and improve provider readiness appropriately. Here, our collaborative team of local and international experts proposes a simple four-step approach to integrating responsive mental healthcare in Kenya. Our recommended framework prioritizes a clear understanding and demonstration of multidimensional skills by the provider. The four steps are (1) provider sensitization, (2) continuous supervision, (3) continuous professional training, and (4) leadership empowerment.Conclusion: Our proposed framework can provide pointers to embracing patient-centered and provider empowerment focused quality of care improvements. Though elements of our proposed framework are well-known, it has not been sufficiently intertwined and therefore not been integrated. We think in the current times our integrated framework offers an opportunity to “building back better” mental health for all.

Computational Studies of Air-Mist Spray Cooling in Continuous Casting

Due to the significant reduction in water droplet size caused by the strong air-water interaction in the spray nozzle, air-mist spray is one of the promising technologies for achieving high-rate heat transfer. This study numerically analyzed air-mist spray produced by a flat-fan atomizer using three-dimensional computational fluid dynamics simulations, and a multivariable linear regression was used to develop a correlation to predict the heat transfer coefficient using the casting operating conditions such as air-pressure, water flow rate, casting speed, and standoff distance. A four-step simulation approach was used to simulate the air-mist spray cooling capturing the turbulence and mixing of the two fluids in the nozzle, droplet formation, droplet transport and impingement heat transfer. Validations were made on the droplet size and on the VOF-DPM model which were in good agreement with experimental results. A 33% increase in air pressure increases the lumped HTC by 3.09 ± 2.07% depending on the other casting parameters while an 85% increase in water flow rate reduces the lumped HTC by 4.61 ± 2.57%. For casting speed, a 6.5% decrease in casting speed results in a 1.78 ± 1.42% increase in the lumped HTC. The results from this study would provide useful information in the continuous casting operations and optimization.

UPAYA MENINGKATKAN KECERDASAN EMOSIONAL SISWA SMB VIHARA VAJRA BODHI MANGGALA MENGGUNAKAN METODE DISCOVERY-INQUIRY LEARNING

This research aims to describe the increase in emotional intelligence through the discovery inquiry learning method to students Buddhist Vihara Vajra Bodhi Manggala Sunday School Kudus. This is a type of classroom action research, this research consists of 2 cycles with a four-step approach, namely planning, action, observation, and reflection. Data collection techniques using questionnaires, observation, evaluation, and documentation. The results can be proven by the evaluation of students' emotional intelligence 649 or 81.12% in cycle 1 increasing to 684 or 85.5% in cycle 2. 59 or 73.75% in cycle 1 and 76 or 95% in cycle 2. Meanwhile, based on individual observations 552 or 69% in cycle 1 increased to 778 or 97.25 in cycle 2. Based on the results of increasing students' emotional intelligence, it can be concluded that discovery inquiry learning method can improve the emotional intelligence of Vihara Vajra Bodhi Manggala Sunday School students in Kudus.

Clinical Reasoning Needs to Be Explicitly Addressed in Health Professions Curricula: Recommendations from a European Consortium.

Clinical reasoning entails the application of knowledge and skills to collect and integrate information, typically with the goal of arriving at a diagnosis and management plan based on the patient’s unique circumstances and preferences. Evidence-informed, structured, and explicit teaching and assessment of clinical reasoning in educational programs of medical and other health professions remain unmet needs. We herein summarize recommendations for clinical reasoning learning objectives (LOs), as derived from a consensus approach among European and US researchers and health professions educators. A four-step consensus approach was followed: (1) identification of a convenience sample of the most relevant and applied national LO catalogues for health professions educational programs (N = 9) from European and US countries, (2) extraction of LOs related to clinical reasoning and translation into English, (3) mapping of LOs into predefined categories developed within the Erasmus+ Developing, implementing, and disseminating an adaptive clinical reasoning curriculum for healthcare students and educators (DID-ACT) consortium, and (4) synthesis of analysis findings into recommendations for how LOs related to clinical reasoning could be presented and incorporated in LO catalogues, upon consensus. Three distinct recommendations were formulated: (1) make clinical reasoning explicit, (2) emphasize interprofessional and collaboration aspects of clinical reasoning, and (3) include aspects of teaching and assessment of clinical reasoning. In addition, the consortium understood that implementation of bilingual catalogues with English as a common language might contribute to lower heterogeneity regarding amount, structure, and level of granularity of clinical reasoning LOs across countries. These recommendations will hopefully motivate and guide initiatives towards the implementation of LOs related to clinical reasoning in existing and future LO catalogues.

Transferring and piloting the Belgian best practice of community-based mental health networks in participating countries to the JA ImpleMENTAL

Abstract Community-based mental health services are key to improving mental health systems and health outcomes. Across Europe, mental health systems still stand at different levels of a change process that involves elaborating, testing and refining diverse models of interorganisational collaboration for mental health service delivery in local settings. Central to these endeavours are the principles that community-based mental health service delivery is patient-centred, integrates medical, psychological and social interventions, including prevention, health promotion and rehabilitation, and contributes to improving continuity of care. The transfer and piloting of the Belgian practice of community-based service networks is the focus of a specific work package which involves 14 countries working together under the leadership of the German Federal Centre for Health Education and the Italian Lombardy Region. The presentation gives an overview of main features and lessons learned from the Belgian practice and presents the work package activities conducted within a four-step approach entailing a preparatory, analysis, piloting and evaluation phase. The whole process is supported by a training action and the use of indicators for assessing networks and services. The six-months preparatory phase involves mobilising relevant stakeholders at various levels and elaborating a conceptual framework for transfer and piloting of selected elements of the Belgian practice in a wide variety of countries and regions in terms of socio-economic, cultural and political context and stages of transition towards deinstitutionalisation of mental health service delivery. This will help identifying challenges and facilitators of network development and collaboration across sectors and framing a tailored approach that allows for flexibility in addressing the heterogeneity of pre-existing practices, implementation scale and field preparation. Early findings of this phase will be shared with the audience.

Applying Lean Healthcare to Improve the Discharge Process in a Mexican Academic Medical Center

Lean Thinking has been one of the preferred approaches to improve healthcare processes in developed countries; however, it has been barely used in Latin America. This study presents a Lean implementation in a Mexican public academic medical center. The goal was to reduce the time required to discharge patients from the Internal Medicine Department. This non-experimental intervention study measured, analyzed, and improved the process flow through a time study, value-added/non-value-added analysis, and the four-step quick changeover approach. Once changes were implemented, inferential statistics were used to compare results. Lean implementation allowed reducing the time to discharge patients from 6 to 3 h by eliminating 57% of non-value-added activities and 70% of errors found in discharge orders. This represents a 2% annual capacity increase and a 6.423 h bed made available without investment. Other findings include barriers regarding untrained staff about process improvement and departmental barriers and a successful quick changeover implementation. This is one of the handful of implementations of Lean Healthcare in Latin America. Furthermore, this is one of the very first studies that showcase the implementation of the quick changeover approach in healthcare. Further research should focus on the long-term impact and how the specific environment encourages/discourages future implementations.

Towards a conceptual definition of intangible Olympic legacy

PurposeIntangible legacy encapsulates the essence of Olympism and its manifestation, the Olympic Games. Despite significant interest in the capacity of the Olympics to produce notable changes in society, conceptual difficulties in defining and measuring intangible legacy persist. The study develops a conceptual definition of intangible Olympic legacy.Design/methodology/approachThe study follows a four-step concept definition approach. It examines and integrates three strands of literature including intangibles, social interactions and public value, which is combined with insights from a longitudinal empirical investigation of intangible Olympic legacy for National Sport Organisations (NSO).FindingsThe proposed concept of intangible legacy defines it an emerging combination of attributes, interactions, processes and technology, with the goal of creating public value which is the ultimate goal of the Olympic Games. Since intangible legacy is qualitative rather than quantitative, a reconsideration of the current research paradigm is also proposed.Research limitations/implicationsThe study develops a new analytical device for the investigation of intangible legacies for specific publics such as NSO.Practical implicationsThe study carries practical implications for Olympic and events/festival promoters as it allows defining and operationalising the key attributes of the concept.Originality/valueThis is the first study to conceptualise intangible legacy of mega events.

Implementation of active learning methods by nurse educators in undergraduate nursing students\u2019 programs \u2013 a group interview

BackgroundModern and active learning methods form an important part in the education of Nursing students. They encourage the development of communication and critical thinking skills, and ensure the safe health care of patients. Our aim was to obtain naturalistic data from nurse educators regarding want the use and effects of implementing active learning methods (Peyton’s Four-Step Approach, Mind Mapping, Debriefing and Objective Structured Clinical Examination methods) in the study process of students of Nursing after a completed education module, Clinical skills of mentors, as part of the Strengthening Nursing in Bosnia and Herzegovina Project. We wish to learn about the perception of nurse educators regarding the use of active learning methods in the study process of Nursing in the future.MethodsQualitative research was conducted and a group interview technique was used for data collection. Beforehand, research participants were included in a two-day education module, Clinical skills of mentors, as part of the Strengthening Nursing in Bosnia and Herzegovina Project. Content analysis of the discussion transcriptions was conducted.ResultsFourteen nurse educators participated. Group interviews were conducted in September 2019. The obtained categories form four topics: (1) positive effect on the development of students’ communication skills (2) positive effect of learning methods on the development of students’ critical thinking skills (3) ensuring a safe learning environment (4) implementation of active learning methods.ConclusionsThe use of various active learning methods in simulation settings improves the Nursing students’ critical thinking and communication skills. Therefore, we believe that Peyton’s Four-Step Approach, Mind Mapping and Debriefing methods should be included as tools for effective student learning and as preparation for directly performing safe nursing interventions with a patient. Effective approaches to the assessment of Nursing students may ensure quality patient health care in accordance with the vision of the nursing profession.