Post-intervention Test Research Articles

Effectiveness of error-based active learning compared to conventional lecture-based method among undergraduate dental students: A randomized controlled trial.

Dental education assumes an indispensable role in adequately equipping students for a successful career in dentistry. Error-based active learning, an innovative approach in dental education, is a combination of mistake-driven learning (MDL) and case-based learning (CBL) to provide a transformative learning atmosphere for students. While active learning has gained popularity in dental education, the effectiveness of error-based active learning remains unexplored. This study aims to evaluate the effectiveness of error-based active learning among final-year dental undergraduate students in comparison with the conventional lecture-based approach. A parallel-arm single-blind randomized controlled trial was conducted in a dental institute in India from November 2022 to December 2022. A total of 74 students were randomly allocated to two groups: Group A (n = 37) received error-based active learning and group B (n = 37) received conventional lecture-based learning approach. Atraumatic restorative treatment (ART) was chosen as the topic for the study. The knowledge of students was assessed at three intervals: baseline, post-intervention, and 4 weeks after the intervention, using a self-designed and validated questionnaire with Cronbach's alpha of 0.87 and a content validity ratio of 0.84. A standard survey questionnaire was employed to evaluate students' perceptions of the teaching methods. Error-based active learning group outperformed the lecture-based group significantly in the post-intervention test (20.92 ± 1.42 vs 16.97 ± 3.06), with better knowledge retention (18.30 ± 2.02 vs 14.05 ± 4.26) and positive feedback from the students. The error-based active learning approach proved superior to the conventional lecture-based method in enhancing and retaining knowledge regarding ART.

Financial resilience-focused program: A single group pretest–posttest intervention to change financial risk perception among teenagers in an ethnic minority poverty-stricken area in China

PurposeThis study examined the effects of a single-group pretest–posttest intervention in changing the level of financial risk perceptions among teenagers from the perspective of the financial resilience framework. Method37 teenagers completed the six-week nonrandomised intervention with follow-up tests at Weeks 8 and 22. Based on the pretest scores of the Internet Financial Risk Perception Scale, the participants were divided into high- and low-risk perception groups. Bayesian repeated variance analysis was then used to evaluate the influence of the intervention on financial risk perception. ResultsCompared with the baseline level, the low-risk perception group showed an increase in total financial risk perception and each subdimension. Decreased changes were observed in the long term, although no sufficient evidence was found for changes in the high-risk perception group after the intervention. ConclusionsThe financial resilience-focused framework and its corresponding program neutralizes the perceived risk. Furthermore, similar interventions should consider the initial level of risk perception among participants.

The Effects of Physical Exercise on Managing Depression, Anxiety, and Attitude Change among Female College Students

In the past few years, the mental health of students, particularly females, has emerged as a growing concern worldwide. The study was designed to determine the effect between exercise and mental health status among female students. Thirty female students were selected. The research design employed was an experimental research design involving an eight-week training program that was randomly administered to players with symptoms of depression and anxiety. Pretest and post-test intervention readings assessed the players' responses using standardized measures such as the Burns Anxiety Inventory, Burns Depression Inventory, and Attitudes Toward Exercise and Physical Activity. Burns Anxiety Inventory results concluded there were significant score reductions in relation to anxious feelings, anxious thoughts, and physical symptoms with p-values of <.0001. The Burns Depression Inventory also proved that checklist scores for depression had reduced significantly. The attitude toward exercise andphysical activity changed significantly with mean scores increasing.

Evaluation of a program of social intervention for adolescents with autism spectrum disorders (PROSEAR)

Purpose The prevalence of autism spectrum disorders (ASD) surpasses 2% in some regions. However, there is a lack of manualized programs targeting the social skills of adolescents with these disorders, particularly in the Spanish language context. This study aims to introduce PROSEAR, an innovative social skills program for adolescents with ASD implemented in a Day Hospital setting. Design/methodology/approach The evaluation used the Strengths and Difficulties Questionnaire (SDQ) and the Social Skills Scale (EHS) as measures, administering pre- and postintervention tests for each patient. Findings SDQ exhibited the most significant improvement in the domain of peer problems. In terms of EHS, it demonstrated beneficial effects across all evaluated domains, with statistically significant improvements observed specifically in the expression of anger or disagreement. Limitations include a small sample size and lack of a randomized control group. Originality/value The outcomes align with existing literature supporting the intervention as positive in clinical practice. Overall, the PROSEAR intervention shows promise for enhancing social skills in adolescents with ASD. Further research is needed to improve therapeutic approaches for this population.

Evaluating the efficacy of simulation-based training on clinical competency transfer

Introduction. Efficient learning transfer is crucial for training specialists to ensure the provision of quality medical services. This study investigates the impact of simulation-based training on the transfer of medical students' clinical competencies in parenteral drug administration: subcutaneous (SC), intramuscular (IM), and intravenous (IV). Material and methods. Using a quasi-experimental design, the research incorporates pre- and post-intervention testing, observational assessments, and a satisfaction survey to evaluate the educational impact. Results. The results indicate significant improvements in theoretical knowledge and practical skills post-intervention, with notable score increases for all types of injections (SC: from 50% to 83.33%, IM: from 57.14% to 85.71%, IV: from 42.86% to 85.71%; p<0.001). Similarly, improved clinical performance was demonstrated, highlighting the transferability of the learned competencies to real settings. Student satisfaction recorded a score of 4.71 (95% CI 4.64; 4.79), reflecting strong acceptance and appreciation of the training. Conclusions. The study emphasizes the crucial role of simulation in competency-based medical education, bridging the gap between theoretical knowledge and practical application, and advocates for the systematic integration of simulation into the medical curriculum, suggesting future research directions for optimizing the design and implementation of simulations.

The effects of conscious movement investment on inhibiting a golf stroke

Previous studies have suggested an association between conscious movement investment and inhibiting motor actions. However, no within-designs were used in which conscious movement investment was manipulated. The current study compared changes in inhibition after instruction interventions that aimed to expand and limit conscious investment in the execution of a golf putting task. During a baseline and post-intervention test, participants were asked to putt balls in a hole. Randomly, an auditory stop-signal appeared 50 ms after reaching the end of backswing on some trials, signalling them to stop the downswing as quickly as possible. Between the two tests, the participants practiced under different instructions, without the stop-signal. One group (i.e., expanded conscious investment, ECIG) received multiple explicit movement-related instructions along with the internal focus of attention instructions, while the second group (i.e., limited conscious investment, LCIG) received a single analogy instruction paired with external focus of attention instructions. The results did not reveal significant differences in stopping rate and stopping time between the baseline and post-intervention tests and the two groups. However, a mediation analysis highlighted that the ECIG exhibited a greater change in downswing time compared to the LCIG. This change was correlated with a larger increase in stopping rate and stopping time. We conclude that conscious movement investment did not directly influence inhibition. Instead, we discuss how conscious movement investment may indirectly influence inhibition dependent on the putting kinematics.

Personalized Daily Hand Movement Training Methods and Effects: A Case Study

This study proposes a method for personalized daily hand exercise training to address the lack of personalization in rehabilitation training and its disconnect from daily life. This research aims to evaluate the impact of Happiness Memory Therapy on patients’ hand function through gamified daily life training. The methodology integrates Happiness Memory Therapy and Positive Mirror Theory to assist in life game design. Patient interviews and empathy are used to gather life experiences, interests, hobbies, and challenges, which are then incorporated into personalized rehabilitation training. The experimental process includes pre- and post-intervention tests to assess changes in subjective well-being (SWLS), happiness (SHS), positive and negative emotions (PANAS), psychological well-being (PWB), and hand function impairment (DASH). The results show that the intervention significantly enhances patients’ subjective well-being, happiness, positive emotions, and reduces negative emotions and hand function impairments. In conclusion, Happiness Memory Therapy and Positive Mirror Theory are effective in developing personalized daily hand exercise training methods and have a significant impact on improving the psychological health and quality of life of stroke patients, offering new ideas and methods for personalized rehabilitation training.

Virtual reality and functional training effect on contractile properties of lower leg muscles and postural stability

Purpose. Tensiomyography is a noninvasive and reliable method to identify the differences in skeletal muscle responses. Poor lower leg muscles cause poor postural stability, leading to the risk of injury in athletes. The study aims to investigate the aftereffect of a six-week virtual reality environment and functional training program on the contractile properties of lower-leg muscles and postural stability index. Material and methods. A comparative pre-test and post-test study design was selected for this study. Twenty-four male athletes were taken part in the study. The participants were randomly divided into a virtual reality intervention-training group (n=12) or a functional training group (n=12). The virtual reality environment training was provided using the CAREN integrated virtual reality system with a D-flow application from Motek. Functional training for static and dynamic postural stability was performed with various open and closed-eye exercises in the physical therapy lab. The contractile properties of lower-leg muscles were measured using tensiomyography. The postural stability index was assessed using a stadiometer. The assessments were performed before and after six weeks of training. A paired sample t-test was used to determine differences between pretest and posttest intervention outcome measures, and sample t-test was also applied to determine differences between groups after six weeks of training. Results. Results indicated significant differences between pretest and posttest measurement in virtual reality training group for displacement (t=2.81, p=.043), (t=-6.92, p=<.001) in gastrocnemius lateral and medial muscle respectively, and sustain time (t=2.29, p=.042) in souls muscle. The postural stability with close eye was significant (t=2.61, p=.024). The functional training group showed significant differences for sustain time (t=-18.86, p=<.001) in gastrocnemius lateral, and relaxation time (=3.24, p=.008), delay time (t=3.07, p=.011), and sustain time (t=-19.74, p=<.001) in gastrocnemius medial, and sustain time (t=3.17, p=.009) in souls muscle. The postural stability was having insignificant differences. Conclusion. The virtual reality environment and functional training, help to improve performance, and tensiomyography could be used to assess and evaluate the parameters that could be helpful for optimizing training load in the performance enhancement process of athletes.

Impact of a psychoeducational intervention on willingness to seek help for depression among African American young adults.

Despite the success of psychoeducational interventions at improving willingness to seek professional help for mental illness, limited research explores the effect of culturally tailored psychoeducational interventions on African American (AA) college students. The objective of this study was to determine if exposure to a culturally relevant psychoeducational intervention impacted AA young adult attitudes, subjective norms, perceived behavioral control, depression stigma, disclosure and willingness to seek help for depression. We conducted a one-group pre- and post-test intervention study of AA college students (N = 75). The 2.5-h intervention featured presentations, large-group discussions, videos, and active learning exercises and was guided by applying a cultural adaptation framework to an existing psychoeducational intervention. The self-administered surveys were created using the Theory of Planned Behavior as a guide. Data were analyzed using paired t-tests. A total of 70 participants completed both pre- and post-test surveys. Overall, willingness, attitude, and disclosure significantly increased after the intervention (p < .001). Additionally, depression stigma significantly decreased after the intervention, indicating fewer stigmatizing beliefs about depression (p < .001). Willingness to seek help for depression among AA college students can be improved through culturally relevant and interactive psychoeducational interventions. These interventions can also improve negative attitudes and perceived behavioral control toward seeking help and decrease stigmatizing beliefs. More research is needed to explore the longitudinal impact of culturally relevant psychoeducational interventions and how they may affect actual help-seeking behavior among AA college students.

Effectiveness of smartphone-based e-health intervention to promote cancer patients' quality of life: A quasi-experimental study

Cancer significantly affects patients' quality of life (QoL), impacting their physical, emotional, and social well-being. Recently, smartphone-based e-health interventions have been investigated as a method to improve QoL for cancer patients by providing customized support. This study assesses the effectiveness of these interventions. Using a quasi-experimental design, the research involved pre- and post-intervention tests. A total of 106 cancer patients were recruited through convenience sampling. A structured questionnaire was used, covering socio-demographic characteristics, medical history, cancer knowledge, and a QoL scale. Data were collected initially and two months after the intervention, which included lectures, group discussions, and scenario-based activities. Results indicated significant improvements in patients’ knowledge and QoL scores post-intervention. There were also notable differences in knowledge scores related to socio-demographic factors before and after the intervention. The findings suggest that smartphone-based e-health interventions effectively enhance cancer patients' knowledge and QoL. Successful implementation of these interventions can lead to better health outcomes. Continuous training for nurses and other healthcare providers is essential to maximize the benefits of e-health. This study highlights the potential of smartphone technology to support continuous care for cancer patients, potentially reducing hospital readmissions and improving self-care and health literacy.

The Effects of Motionless Interventions Based on Visual-Auditory Instructions With Sonification on Learning a Rhythmic Motor Skill.

Our aim in this study was to investigate the effects of motionless interventions, based on visual-auditory integration with a sonification technique, on the learning a complex rhythmic motor skill. We recruited 22 male participants with high physical fitness and provided them four acquisition sessions in which to practice hurdle running, based on a visual-auditory instructional pattern. Next, we divided participants into three groups: visual-auditory, auditory, and control. In six sessions of motionless interventions, with no physical practice, participants in the visual-auditory group received a visual-auditory pattern similar to their experience during the acquisition period. The auditory group only listened to the sound of sonified movements of an expert hurdler, and the control group received no instructional interventions. Finally, participants in all three groups underwent post-intervention and transfer tests to determine their errors in the spatial and relative timing of their leading leg's knee angular displacement. Both visual-auditory and auditory groups had significantly less spatial error than the control group. However, there were no significant group differences in relative timing in any test phase. These results indicate that the use of the sonification technique in the form of visual-auditory instruction adapted to the athletes' needs benefitted perception-sensory capacities to improve motor skill learning.

A Proposed Educational Program Based on Project-Based Learning (PBL) for Teaching Home Economics and its Impact on Developing Creative Thinking and Problem-solving Skills of Third-grade Intermediate Female Students

This study examined the effectiveness of using project-based learning (PBL) for the teaching of home economics and determine its impact on the development of students’ creative thinking and problem-solving skills. To achieve the objectives of the study, the researchers used the quasi-experimental approach. Pre- and post-intervention tests were conducted with two (experimental and control) groups of third-grade intermediate female students. Two tests were administered: one to test the students’ creative thinking skills, and the other to test their problem-solving skills. The control group were taught a home economics unit by conventional teaching methods; the experimental group were taught using the PBL approach. The following materials and tools have been prepared by the researchers: a proposed educational program based on project-based learning (PBL), a test of creative thinking skills, and a test of problem-solving skills. The findings revealed that there were statistical differences (0.05) between the mean scores for the pre-PBL and post-PBL tests, indicating that PBL significantly improved the students’ creative thinking and problem-solving skills. Several recommendations and suggestions are offered based on the findings.

Utilization of android-based paediatric assessment triangle application as an emergency detection tool for children.

To identify the effectiveness of an android-based paediatric assessment triangle application in emergency diagnostics. The action research study was conducted in the emergency department of a hospital under the Ministry of Defence, Indonesia, located within the Ministry of Defence Rehabilitation Centre Complex, from April to December 2020 after approval from the ethics review committee of the Faculty of Nursing, Universitas Indonesia, Indonesia, employing quantitative and qualitative methods consisting of planning, acting, observing and reflecting stages. Emergency department nurses with at least D3 nursing graduation who were able to identify emergency status in children were included. The subjects were given training on paediatric assessment triangle application before using it in their professional life. The difference was noted through pre- and post-intervention tests. Qualitative data was collected using focus group discussion and system usability scale. Of the 9 nurses, 5(55.6%) were males, 4(44.4%) were females, 8(88.9%) were aged 26-35 years, and 2(22.2%) had professional experience 1-2 years. The mean baseline score was 36.1±11.4, while the mean post-intervention score was 70.9±14.4. The fastest application completion time was 13 seconds, while the slowest was 52 seconds. Qualitative data led to the emergence of 4 themes: time required to complete the application; preference for connectivity with the hospital's electronic record system; assessment of children's clinical status; and, unfamiliarity with the computerised system. The mean system usability scale score was 72.22±11.35 (range: 52.5-92.5). Paediatric assessment triangle application could be a valid tool for identifying emergency severity in patients during the triage process.

Impact of the heartfulness program on stress and sleep among healthcare professionals: Pre experimental study.

Healthcare professionals (HCPs) worldwide suffer from stress and poor sleep and the COVID-19 pandemic has further raised these issues. This study sought to determine whether HCPs had reduced stress and increased sleep quality while participating in a heartfulness meditation program. For a 2-month (8 weeks) heartfulness meditation program, we included 41 individuals in a prospective one-group pretest post-test intervention design from February 2023 to April 2023. Scores on the Perceived Stress Scale and Pittsburgh Sleep Quality Index were gathered at baseline and 8 weeks. Forty-one (76%) of the 54 participants completed this study for 8 weeks. Results showed a substantial decline in stress (preintervention mean ± standard deviation [SD] = 20.54 ± 4.46; postintervention mean ± SD = 18.42 ± 6.14; t-value = -1.947 [0.05*]) and improvement in sleep quality (preintervention mean ± SD = 6.63 ± 3.82; postintervention mean ± SD = 5.29 ± 2.44) among HCPs after following this 8-week heartfulness meditation program. In the end, a substantial decrease in perceived stress score and an improvement in the sleep quality index was found. Additionally, practicing heartfulness meditation may aid in developing the traits of empathy, acceptance, and inner serenity. We draw the conclusion that more extensive research is required to fully understand the impact of heartfulness meditation practice.

Improving clinical reasoning and communication during handover: An intervention study of the BRIEF-C tool

BackgroundExisting handover communication tools often lack a clear theoretical foundation, have limited psychometric evidence, and overlook effective communication strategies for enhancing diagnostic reasoning. This oversight becomes critical as communication breakdowns...

Overcoming implementation challenges through using a train-the-trainer approach to teach numeracy in a special school setting

PurposeThere is a sparsity of research that considers how to overcome implementation challenges for interventions in special school settings where specialist teaching methods are involved. Successful implementation has often relied on considerable researcher involvement, making them inaccessible and not sustainable for the majority of special schools. The purpose of this study was to implementa train-the-trainer approach to train teaching staff to use the Teaching Early Numeracy to Children with Developmental Disabilities (TEN-DD) programme in a large special school in the UK, thereby significantly reducing researcher involvement in its implementation.Design/methodology/approachOne staff member was trained to become the school lead for TEN-DD and trained other teaching staff in the school on implementation. This study recruited 13 students aged between 12 and 16 years of age with developmental disabilities to receive TEN-DD. Pre- and post-intervention tests on a standardised numeracy measure were conducted.FindingsA train-the-trainer model was developed and successfully delivered to train teaching staff in TEN-DD. A standardised outcome measure indicated that ten students made improvements to their numeracy skills after teachers trained using this approach delivered TEN-DD for between 3 and 10 months.Originality/valueVery little research has been carried out to better understand methods for overcoming implementation challenges for delivering evidence-based teaching programmes at scale to students with developmental disabilities who attend special schools. To the best of the authors’ knowledge, this study reports the results of the first evaluation of using a train-the-trainer model for the delivery of a numeracy intervention (TEN-DD), whereby there was no involvement of researchers in implementation beyond the initial training of the school lead. This model of training for interventions may be more sustainable for special schools and help improve the uptake of evidence-based interventions.

Efficacy of acupuncture for a cough-related symptom cluster in patients with lung cancer: A randomized controlled trial

PurposeThis study was designed to evaluate the effect of acupuncture on cough, expectoration, and shortness of breath in lung cancer patients. MethodsBetween December 2021 and June 2022, a total of 130 lung cancer patients were recruited, and they were split into control and intervention groups at random. Routine nursing was provided to the control group, whereas routine nursing with acupuncture using LU7 (Lie Que), LU9 (Tai Yuan), BL13 (Fei Shu), and BL20 (Pi Shu) was administered to the intervention group for 7 days. The severity of cough, expectoration, and shortness of breath was assessed 1 day before and after the interventions using the lung cancer-specific module of the MDASI. A two-way ANOVA was performed for group comparisons. ResultsCompared with the control group, the symptoms of cough in the intervention group were significantly improved (F = 5.095, MD = −0.32, 95% CI, −0.59 to 0.04, P = 0.025), while expectoration (F = 0.626, MD = −0.11, 95% CI, −0.38 to 0.16, P = 0.430) and shortness of breath (F = 0.165, MD = −0.05, 95% CI, −0.27 to 0.18, P = 0.685) had no significant change. Cough also identified an obvious interaction effect (P = 0.014), and the post-intervention simple main effect test demonstrated a tangible difference between the two groups (MD = −0.66, 95% CI, −0.99 to 0.33, P < 0.001) post-intervention. ConclusionsAcupuncture using LU7, LU9, BL13, and BL20 can relieve the cough of lung cancer patients, but not relieve expectoration and shortness of breath.

Biomedical students’ self-efficacy and academic performance by gender in a flipped learning haematology course

IntroductionThis study investigated the impact of flipped learning versus traditional instruction on medical students’ academic performance and self-efficacy in a haematology course, and examined gender differences. Flipped learning is an instructional approach where students review pre-recorded lecture content at home, and active learning occurs in the classroom. Self-efficacy refers to students’ beliefs in their ability to succeed and accomplish learning goals.MethodsA quasi-experimental study was conducted with 86 third-year Saudi medical students (46 males, 40 females) in a 10-week haematology course. Students were assigned to flipped learning group (n = 41) or traditional lecture group (n = 45). Both groups completed pre- and post-intervention academic tests and self-efficacy surveys. Data were analyzed using descriptive statistics and t-tests.ResultsThe flipped learning group showed an increase in academic scores (p <.05) and self-efficacy scores (p <.05) compared to the traditional group, but between group differences were not statistically significant. Female students in the flipped learning group showed the greatest increase in academic scores and self-efficacy. Most students perceived flipped learning positively for enhancing learning and preparation for class.ConclusionFlipped learning promoted self-efficacy compared to traditional lectures in medical students. Gender-specific benefits were observed, highlighting the need to design instruction to meet diverse student needs.

The Development of Computer Assisted Vocabulary Learning (CAVL) to Improve English Lexical Retention of Nursing Students

Vocabulary mastery is crucial for nursing students to effectively communicate in English. This study aimed to develop and validate a tailored computer-assisted vocabulary learning (CAVL) intervention to improve nursing students' retention of English lexicon, which is essential for healthcare communications. The CAVL program was designed using the Moodle platform and focused on four thematic units that targeted essential nursing vocabulary. The learning process followed research-based principles of vocabulary instruction, including multimodal introduction, reinforced retrieval, and contextual repetition. This study utilized a research and development methodology to conduct iterative needs analyses, design refinement, and rigorous evaluation protocols. Expert reviews, prototype testing, post-intervention vocabulary tests, and delayed assessments were used to gather data and make data-driven improvements. Quantitative analysis evaluated the effectiveness of this approach for 100 Indonesian nursing students. Vocabulary assessments were administered before, immediately after, and two weeks after the intervention, revealing significant improvements in terminology knowledge following the implementation of CAVL. Importantly, scores remained stable during the delayed assessment, demonstrating durable retention. These results are consistent with previous literature on the benefits of contextual and multimodal vocabulary learning. The CAVL prototype facilitated learning and effectively improved vocabulary retention outside of the classroom. This research provides an adaptable framework for technologically-assisted language mastery, which is essential for the next generation of nursing education. Further studies can explore the application of this framework in allied healthcare fields and the transition to practice in nursing education.

A Toolkit for Delirium Identification and Promoting Partnerships Between Carers and Nurses: A Pilot Pre–Post Feasibility Study

BackgroundDelirium is frightening for people experiencing it and their carers, and it is the most common hospital-acquired complication worldwide. Delirium is associated with higher rates of morbidity, mortality, residential care home admission, dementia, and carer stress and burden, yet strategies to embed the prevention and management of delirium as part of standard hospital care remain challenging. Carers are well placed to recognize subtle changes indicative of delirium, and partner with nurses in the prevention and management of delirium.ObjectiveTo evaluate a Prevention & Early Delirium Identification Carer Toolkit (PREDICT), to support partnerships between carers and nurses to prevent and manage delirium.DesignA pre–post-test intervention and observation study.Main MeasuresChanges in carer knowledge of delirium; beliefs about their role in partnering with nurses and intended and actual use of PREDICT; carer burden and psychological distress. Secondary measures were rates of delirium.ParticipantsParticipants were carers of Indigenous patients aged 45 years and older and non-Indigenous patients aged 65 years and older.InterventionNurses implemented PREDICT, with a view to provide carers with information about delirium and strategies to address caregiving stress and burden.Key ResultsParticipants included 25 carers (43% response rate) (n = 17, 68% female) aged 29–88 (M = 65, SD = 17.7 years). Carer delirium knowledge increased significantly from pre-to-post intervention (p = < .001; CI 2.07–4.73). Carers’ intent and actual use of PREDICT was (n = 18, 72%; and n = 17, 68%). Carer burden and psychological distress did not significantly change. The incidence of delirium in the intervention ward although not significant, decreased, indicating opportunity for scaling up.ConclusionThe prevention and management of delirium are imperative for safe and quality care for patients, carers, and staff. Further comprehensive and in-depth research is required to better understand underlying mechanisms of change and explore facets of nursing practice influenced by this innovative approach.