Sequential Mixed Methods Design Research Articles

Giving children permission for risky play: teacher variables and reported practices

ABSTRACT This study aimed to examine (a) whether preschool teachers’ risky play attitudes differed in relation to school type, number of children, presence of teachers’ aides, professional experience, age groups, and/or duration of time outdoors, and (b) preschool teachers’ self-reported practices regarding risky play outdoors. An explanatory sequential mixed method design was utilized. 484 preschool teachers were completed the Scale for the Attitudes Towards Risky Play at Early Childhood-Teacher Form. Semi-structured interviews were conducted with 21 preschool teachers. Quantitative results unveiled significant differences in teachers’ risky play attitudes regarding preschool type, presence of teachers’ aides, and daily time spent outdoors. Qualitative results shed light on the way parents and administrators perceived risky play impacted teachers’ practices for allowing or prohibiting children’s risky play outdoors. This study underscores a need for professional training and continuous collaboration among teachers, parents, and administrators to support risky play in educational settings.

Which one? AI-assisted language assessment or paper format: an exploration of the impacts on foreign language anxiety, learning attitudes, motivation, and writing performance

In recent years, language practitioners have paid increasing attention to artificial intelligence (AI)’s role in language programs. This study investigated the impact of AI-assisted language assessment on L2 learners’ foreign language anxiety (FLA), attitudes, motivation, and writing skills. The study adopted a sequential exploratory mixed-methods design. Divided between an experimental group (receiving AI-assisted assessment) and a control group (receiving paper-format assessment), the participants were 70 intermediate English learners from two intact university classes in Bangladesh. The TOEFL iBT writing section measured writing skills, while the study also investigated perceptions and experiences of FLA, attitudes, and motivation using narrative frames. Thematic analysis of the narrative data showed that AI-assisted assessment greatly raised learners’ motivation, improved attitudes about language acquisition, and lowered FLA. According to quantitative analysis, the pretest writing abilities across groups showed no appreciable variation. Even though the difference was not statistically significant on the posttest, the experimental group exceeded the control group. The results of this study imply that AI-assisted assessments can generate a helpful learning environment, lower anxiety, improve attitudes, and increase motivation, thereby delivering useful information. Future studies should investigate long-term consequences, and further improvements to AI tools should optimize educational advantages—attitudes, motivation, and writing skills.

Assessing Age-Friendly Community Initiatives: Developing a Novel Survey Tool for Assessment and Evaluation.

Age-Friendly Community Initiatives (AFCIs) have gained recognition as essential responses to the needs of aging populations. Despite their growing significance, there is a notable lack of effective measurement tools to assess the planning, implementation, and sustainability of AFCIs. The purpose of this study was to develop and validate a survey tool for evaluating AFCIs. A sequential exploratory mixed-method design was used in two phases. First, we identified key themes from interviews with AFCI leads to generate AFCI survey items and regional workshops. Then, we conducted a pilot of the survey and assessed its measurement properties. Thematic analysis of interviews with 68 key informants from 58 AFCIs revealed four main themes: AFCI priorities, enablers, challenges, and benefits. These themes, combined with feedback from AFCI stakeholders at the regional workshops and a AFCI conference, informed the development and refinement of a reliable and valid AFCI survey in 2019, supported by a high Cronbach's Alpha value (α = 0.881). Steps were identified to maintain and sustain the AFCI survey over time. The survey accommodates AFCIs' diverse demographics, governance structures, and priorities with a standardized and flexible approach for effective measurement. This research contributes to the academic understanding of AFCIs and aids community leaders and policymakers in planning, implementing, and evaluating AFCIs.

A Mixed Methods Study of Ethnic Identity and Mental Health Recovery Processes in Minoritized Young Adults.

Ethnic identity development is associated with positive mental health in young adults from ethnic minority groups. How a sense of belonging and attachment to one's ethnic culture is related to personal mental health recovery remains unexplained. This study examines the experiences of ethnic minority young adults in the U.S. to understand the aspects of culture and identity development that are relevant to their recovery processes. Young adults who were living with chronic mental disorders were recruited from four rehabilitation programs. Interviews produced quantitative and qualitative data. An explanatory sequential mixed methods design was used to integrate the qualitative findings from a sub-group of young adults (n = 44) with the results from the quantitative study. Directed content analysis was used to analyze the qualitative data, and the integrated data were analyzed in joint displays. The prominent themes characterizing ethnic identity development in personal recovery were (a) cultural history, traditions, and values; (b) mental illness stigma within the ethnic community; and (c) bias and discrimination in mental health services. Young adults with high ethnic identity development reported having more support from family, but they also described experiences with stigma and racism. The integrated results suggest that ethnic identity development promotes mental health recovery in minoritized young adults through social support and improved well-being and resilience. Experiences of intersectional stigma and structural racism associated with ethnic identity can interfere with self-determination and access to care among minoritized Hispanic/Latine, Black, and multiracial young adults in the U.S.

Preparing Graduate Registered Nurses for Independence in Aged Care.

Graduate registered nurses (RNs) start their careers working in a variety of clinical areas including aged care. However, they may not be fully prepared to work in aged care settings that often require them to work independently as the only RN on the premises. A list of essential clinical skills is crucial for supporting the development and effective transition of graduate nurses into aged care. To identify and rank a list of essential clinical skills for graduate RNs working in aged care settings on commencement of practice. An explanatory sequential mixed-methods design was applied and included a modified Delphi Study and semi-structured interviews. Five expert aged care RNs engaged in the three iterative Delphi rounds and five graduate aged care RNs were interviewed to confirm the clinical skills and ranking from their perspective. Quantitative data were presented through descriptive statistics. Qualitative data were analysed using thematic analysis. Thirty-six essential clinical skills for graduate RNs working in aged care settings were identified and ranked by the experienced aged care RNs. Graduate RNs supported this list of essential clinical skills on commencement and identified palliative care as an additional skill required by graduate RNs working in aged care. The derived essential skills offer aged care a guided approach to ensure that graduate RNs are work-ready, safe practitioners and supported to work independently. The study recommends the essential clinical skills for graduate nurses transitioning in their role as RNs in aged care that will support safe, quality clinical care.

Public Youth Services Librarians’ Perceptions Towards and Experiences in Promoting Teens’ Positive Mental Health: A Mixed Methods Study

Over the last decade, teen mental health has declined rapidly. In Florida, high rates of youth mental health concerns and lowered access to care led to its ranking as the 19th worst in the nation. To help address these issues, a “whole community” approach to mental health promotion has been advocated, with public libraries identified as potential partners. But research exploring public youth librarians’ perceptions and experiences related to this agenda is lacking. Informed by Seligman’s well-being theory, this study addresses that gap by exploring public youth librarians’ perceptions towards and experiences in promoting teens’ positive mental health through an explanatory sequential mixed-methods design consisting of surveys of and interviews with Florida public librarians responsible for teen services. Survey results (n=183) showed that most librarians viewed promoting teens’ positive mental health as an important part of their role and engaged in a variety of related activities. But challenges in carrying out these activities were identified as well as concerns related to professional boundaries and training. Interviews (n=30) further explored how librarians define the scope of their role and their experiences, including any training and support received and challenges related to promoting teens’ positive mental health. Findings provide greater understanding of what members of the profession are doing and what they perceive as their role in response to declining teen mental health, thus improving service provision by informing future education and training efforts and the development of new models for how to best promote teens’ mental health through a holistic lens.

ICT in biology education: teachers’ readiness and implementation challenges in the context of Bangladesh

Information and Communication Technology (ICT) is commonly employed in biology classes to facilitate students' comprehensive comprehension of biological processes and enable them to see living phenomena. The purpose of the study was to explore the use of ICT in enhancing the teaching and learning process of biology in the secondary schools of Bangladesh. In our study, sequential explanatory mixed method design has been followed. Data was collected from purposively selected ten secondary schools of Dhaka city. The study reveals that teachers have a positive attitude towards incorporating ICT in biology lessons and possess operational understanding of data processing tools and online browsing. Nevertheless, it also emphasizes the fact that teachers are devoid of personal computers in their houses and have restricted availability to school computers. Furthermore, the existing curriculum and teachers' guides lack adequate instructions for integrating ICT into biology lectures. The study also suggests that the process of developing ICT-based curriculum is complicated, which deters teachers from incorporating ICT into their classes. Furthermore, there is a limited availability of educational materials related to ICT in the Bangla language. This study recommends continuous in-servicing training on ICT to teachers, interest free loan to teachers for purchasing laptops, developing interactive biology educational ICT contents in Bangla and include specific instructions in the curriculum and teachers’ guide on how to use ICT in biology classes. These findings have important implications for policy makers, educators, and researchers who are dedicated to expanding the use of ICT in education.

Practices and Perception of Paediatric Obstructive Sleep Apnea Among Orthodontists and Paediatric Dentists in Brazil: A Mixed-Methods Study.

To explore orthodontists' (OTs) and paediatric dentists' (PDs) practices and perceptions regarding the screening and management of paediatric obstructive sleep apnea (OSA). This explanatory sequential mixed methods design included OTs and PDs with active clinical practice in Brazil and encompassed a quantitative phase followed by a qualitative phase. In the quantitative phase, a survey assessing OSA screening and management practices was administered to OTs and PDs practicing in Brazil. Information-rich OTs and PDs were interviewed in the qualitative phase. Descriptive statistics and the chi-square test were used to analyse the survey data, while inductive content analysis was applied to the interview data. The results from both phases were integrated and reported narratively. Three hundred eighty-one OTs and PDs completed the survey, and ten of them were interviewed. Nearly half of OTs and PDs administered sleep questionnaires and demonstrated some knowledge about paediatric OSA signs and symptoms. PDs and OTs primarily offered rapid maxillary expansion and functional mandibular advancement for managing selected children with OSA, with OTs being more frequently involved in this task than PDs. OTs and PDs identified several barriers and expressed the need for support regarding access to reliable screening tools and interprofessional care. Brazilian OTs and PDs were aware of the main signs and symptoms of paediatric OSA and were somewhat involved in offering oral appliance management options. To further define the role of these professionals, increasing support for dental professionals in OSA management and updating existing clinical guidelines is warranted.

Preventing occupational injuries in the informal construction industry: a study protocol for the development of a safety education intervention for bricklayers and carpenters in Osun State, Nigeria.

Occupational injuries are a growing public health problem. Approximately 1,000 workers die daily from occupational injuries globally. Artisans working in the informal sector of the construction industry in many low/middle income countries like Nigeria have a higher injury predisposition. This study will assess the determinants of occupational injuries and design a safety intervention for informal sector artisans in the Nigerian construction industry. A sequential mixed-methods design will be employed to study 840 bricklayers and carpenters (420 per artisan group) in Osun State, Nigeria. Quantitative data will be collected first while qualitative data will be collected thereafter. Thirdly, a modified Delphi-technique will be employed to co-design a safety education intervention. For the quantitative study, artisans will be recruited via multi-stage sampling and a semi-structured questionnaire will be administered to obtain information on artisans' socio-demographics, work-patterns and occupational injuries. A multivariable regression model will be used to determine the association between injury occurrence and independent variables. Twelve to sixteen focus group discussion (FGD) sessions will be conducted for artisans to obtain group perspectives about injuries and preferred safety training topics. From the FGD and quantitative study findings, a list of items for the safety training module will be compiled for the modified-Delphi process. Thereafter, the content validation index (CVI) will be derived and items with CVI of ≥0.80 will be included in the final safety training module. This paper describes the process required to assess the determinants of occupational injuries among artisans in the informal sector of the construction industry in Nigeria and further proposes the design of a context-relevant safety training intervention. The information from this study will be essential in promoting safe working environments for construction artisans.

Gendered responsibilities of household members in securing livelihoods through mat making in the Barak Valley, Assam

ABSTRACT Artisans face various obstacles owing to the lack of handicraft-related livelihood capital. This study highlights the significance of traditional skills and collaborative efforts of household members in ensuring a sustainable livelihood through mat making in the Barak Valley, Assam, India, despite facing multiple challenges. It employs a sequential exploratory mixed-method design and the Department for International Development’s sustainable livelihoods approach to examine the gendered responsibilities of household members earning a livelihood through mat making. The quantitative and qualitative findings reveal that the responsibilities of the women, men, and children in households are significant for earning their livelihoods from mat making. It recommends an immediate policy focus on bolstering the types of livelihood capital to sustain the livelihoods of mat makers and avoid decreasing their quality of life owing to the excessive utilisation of human capital.

Post-16 students’ experience of practical science during the COVID-19 pandemic and the impact on students’ self-efficacy in practical work

This paper presents the findings from a detailed study investigating UK undergraduate students’ experience of practical science in their post-16 studies during the COVID-19 pandemic. It also examines their perceived confidence and preparedness in relation to areas of practical science skills at the start of their undergraduate courses. The study employed an exploratory sequential mixed methods design. Findings from student focus groups held at the end of their post-16 studies were used to support the development of a comprehensive skills audit and quantitative survey for incoming undergraduate students. Survey data were collected in September and October 2021 from 275 students commencing Biosciences, Chemistry, Physics and Natural Science degrees at two universities in England. The research is important because although almost all students had the opportunity to undertake practical work as part of their post-16 studies during the COVID-19 pandemic, there was considerable variation in students’ experiences. The data indicate that COVID-19-related closures of post-16 education establishments, ongoing social distancing requirements and the consequent removal of the assessment criteria for students to have ‘routinely and consistently’ undertaken each of the practical assessment requirements had implications for the development of students’ self-efficacy in relation to practical science. The research presents important considerations which are relevant for educators supporting students’ transition from post-16 to Higher Education and have the potential to impact on incoming students over many years to come.

Responding to COVID-19: an exploration of EU country responses and directions for further research.

During COVID-19, scientists advising policymakers were forced to deal with high uncertainty and risks in an environment of unknowns. Evidence on which policies and measures were effective in responding to the pandemic remains underdeveloped to answer the key question 'what worked and why?'. This study aims to provide a basis for studies to go further to answer this critical question, by starting to look efficacy or how countries ensured that health services remained available and what measures were enacted to protect and treat their populations and workers. We applied a three-phase sequential mixed methods design. In phase one, we started with a qualitative content analysis of the EU Country Profile reports to retrieve and analyse data on COVID-19 responses taken by 29 countries in the European region. Phase two is the step of data transformation, converting qualitative data into numerical codes that can be statistically analysed, which are then used in a quantitative cross-national comparative analysis that comprises phase three. The quantifying process resulted in a numerical indicator to measure the 'response efficacy' of the 29 countries, which is used in phase three's association of the response measure with country performance indicators that were derived from European Centre for Disease Control (ECDC) COVID-19 case and death rate data. Through comparing the frequency of COVID-19 measures taken, we found that many countries in the European region undertook similar actions but with differing effects. The cross-national analysis revealed an expected relationship: a lower COVID-19 response efficacy appeared to be related to a higher case and death rates. Still, marked variation for countries with similar response efficacy indicators was found, signalling that the combination and sequence of implementation of COVID-19 responses is possibly just as important as their efficacy in terms of which response measures were implemented. Many European countries employed similar COVID-19 measures but still had a wide variation in their case and death rates. To unravel the question 'what worked and why?', we suggest directions from which more refined research can be designed that will eventually contribute to mitigate the impact of future pandemics and to be better prepared for their economic and human burden.

The impact of resilience on academic performance with a focus on mature learners

BackgroundResilience is an essential psychological trait that empowers individuals to adapt and thrive in the face of challenges. Although it is acknowledged that health professionals need to possess high levels of resilience, there has been limited research comparing how different groups of health students, particularly school leaver undergraduates and mature age graduate entry students, develop resilience in their coursework.MethodsThis study combines both objective (academic grades with validated survey results) and subjective data (interviews) to compare how resilience is related to academic coursework performance for two groups of pharmacy students: the mature age graduate entry (GE, N = 64) learners and school leaver undergraduate (UG, N = 208) learners. We employed a sequential explanatory mixed methods design using surveys, academic performance data and semi-structured interviews. The survey tapped constructs related to resilience (burnout, stressors and coping methods) while the interviews elicited a more nuanced understanding of individual and environmental factors.ResultsAlthough there was no statistical difference in burnout experience between the two groups, GE students exhibited more positive resilience attitudes than UG when selecting resilience statements on the survey. Both cohorts indicated in the survey that engaging in distraction activities (physical exercise, sleeping, listening to music, anything other than the stressor) was their most preferred method of relieving stress. Within UG student survey responses, those who indicated support from partners, friends and family had better academic performance, while those who did not report coping methods did worse academically. The three key environmental factors we identified that contributed to both undergraduate and graduate entry resilience were workload, feedback provision and psychosocial support.ConclusionsCurrently, there is still a need for resilience programs geared at academic success to be implemented in higher education. This study provides objective evidence of academic success coupled with exploration into the nuances of resilience amongst different student groups. It not only highlights the differing resilience development strategies and burnout coping mechanisms in emerging health professionals, but showcases the juxtaposition of two different learner groups (UG and GE students) within a discipline. The cross-cohort facilitation of learning as in the discipline-specific strategies identified can help both groups develop resilience and inform future innovations. By comparing mature-age graduate students and younger-in-age undergraduate students, we identified a wider range of strategies and more positive attitudes to burnout in mature-age students. Health and clinical educators in university health degrees, clinical placements and clinical workplaces can develop effective training materials based on findings from this study to 1) assist undergraduate younger-age health students with developing resilience and 2) further refine mature-age health students’ and practicing health professionals’ resilience in today’s fast-paced clinical workplaces.

Economics of Intergenerational Volunteering: A Mixed-Methods Study of Snow-Buddies Program in Niagara Region, Canada

ABSTRACT This study examines the financial costs and savings of a community-based intergenerational volunteer program (i.e. Snow-buddies) that pairs youth with older adults for snow removal. From March 2020 to May 2023, Snow-buddies completed 106 volunteer-matches and 486 snow removal events. Using a sequential exploratory mixed-method design, 14 semi-structured interviews were conducted with youth volunteers and older adults. The majority of participants revealed minimal out-of-pocket (OOP) expenses and time/productivity losses for snow removal. Increased mobility, fall prevention, and social connections were perceived benefits of the program. A survey (n = 55, 52% of matched participants) reported an average CAD$123 OOP spending per snow removal event. Applying the rate of fall injuries among older adults due to snow, an estimated 1.12 fall injuries per 486 person-events were prevented translating into a total of $81,398 financial savings from averted hospitalization (i.e. a benefit–cost ratio of ~$662 for every dollar spent on snow removal).

Co-creation and evaluation of an algorithm for the development of a mobile application for wound care among new graduate nurses: A mixed methods study.

Chronic wounds are a growing concern due to aging populations, sedentary lifestyles and increasing rates of obesity and chronic diseases. The impact of such wounds is felt worldwide, posing a considerable clinical, environmental and socioeconomic challenge and impacting the quality of life. The increasing complexity of care requires a holistic approach, along with extensive knowledge and skills. The challenge experienced by health-care professionals is particularly significant for newly graduate nurses, who face a gap between theory and practice. Digital tools, such as mobile applications, can support wound care by facilitating more precise assessments, early treatment, complication prevention and better outcomes. They also aid in clinical decision-making and improve healthcare delivery in remote areas. Several mobile applications have emerged to enhance wound care. However, there are no applications dedicated to newly graduate nurses. The aim of this study was to co-create and evaluate an algorithm for the development of a wound care mobile application supporting clinical decisions for new graduate nurses. The development of this mobile application is envisioned to improve knowledge application and facilitate evidence-based practice. This study is part of a multiphase project that adopted a pragmatic epistemological approach, using the 'Knowledge-to-Action' conceptual model and Duchscher's Stages of Transition Theory. Following a scoping review, an expert consensus, and stakeholder meetings, this study was pursued through a sequential exploratory mixed methods design carried out in two phases. In the initial phase, 21 participants engaged in semi-structured focus groups to explore their needs regarding clinical decision support in wound care, explore their perceptions of the future mobile application's content and identify and categorize essential components. Through descriptive analysis, five overarching themes emerged, serving as guiding principles for conceptual data model development and refinement. These findings confirmed the significance of integrating a comprehensive glossary complemented by photos, ensuring compatibility between the mobile application and existing documentation systems, and providing quick access to information to avoid burdening work routines. Subsequently, the algorithm was created from the qualitative data collected. The second phase involved presenting an online SurveyMonkey® questionnaire to 34 participants who were not part of the initial phase to quantitatively measure the usability of this algorithm among future users. This phase revealed very positive feedback regarding the usability [score of 6.33 (±0.19) on a scale of 1-7], which reinforces its quality. The technology maturation process can now continue with the development of a prototype and subsequent validation in a laboratory setting.

The use of community-engagement approaches to identify strategies for increasing workplace well-being among LGBTQ+ adults

BackgroundLGBTQ+ individuals often face social stigma and workplace discrimination, negatively impacting their well-being. However, limited research exists on the factors and strategies that enhance their positive workplace experiences. This study was a sequential qualitative mixed-method design conducted in three phases. The study had the following objectives: identifying factors associated with workplace well-being, generating strategies for improving workplace well-being, and obtaining feedback on the identified strategies' acceptability. MethodsIn Phase 1, in-depth interviews were conducted with 10 LGBTQ+ who described factors that improved their satisfaction at work. In Phase 2, two focus group discussions were held with 13 participants, including LGBTQ+ adults, scholars in positive psychology, human resource development, and civil rights advocates, to develop strategies for improving workplace well-being based on Phase 1 data. In Phase 3, a survey was sent to a subset of the focus group participants (N = 7) to ascertain the acceptability of the developed strategies. Data analysis was performed using deductive and inductive approaches. ResultsThe study's first phase identified the factors contributing to workplace well-being. These factors were categorized into intrapersonal, interpersonal, and social-ecological. In the second phase and third phase, 11 strategies were developed to improve workplace well-being. These strategies were divided into two sections. The first section includes strategies organizations and agencies can implement to promote employee well-being (such as emphasizing diversity and equity as core values). The second section outlines strategies for government and civil society sectors (such as establishing laws addressing LGBTQ+ equal rights). The Index of Congruence (IOC) assessed the relationship between strategies and workplace well-being improvement. Results showed IOC values from 0.8 to 1 for 11 strategies, indicating high content validity. ConclusionsStrategies to enhance LGBTQ+ workplace well-being were identified through community engagement, but further research is needed for implementation and evaluation.

“So, That Would Have Been Useful”: Curriculum in LIS in Support of Liaison Librarian Preparation

LIS education has historically come under fire for what some perceive as a disconnect between what is taught in the classroom and what the job really entails. This study is part of a larger research study that used a sequential explanatory mixed-methods design to investigate liaison librarians’ perceptions of their academic preparation to take on the liaison role, specifically whether and how their LIS program curriculum prepared them for this role. This qualitative strand of the study relied on in-depth semi-structured interviews of survey participants to explore two research questions: What are the perceptions of academic liaison librarians regarding the degree to which their programs prepared them for their current role? And which factors influenced these perceptions? This research identified the main reasons hindering the effectiveness of LIS education for preparing librarians for the liaison role to be a range of complex issues that LIS programs and educators should consider, such as changing career plans among students who did not initially plan to become liaison librarians, students not taking certain courses due to scheduling or course timing issues, and the abstract nature of some course content which obscures connections to real-world practice. Participants also identified courses in collection development, reference, instruction, and research methods as those that should take center stage when preparing liaison librarians. These results have the potential to inform various aspects of LIS program curriculum planning and design and provide course-selection guidance for LIS students considering a career in academic libraries.

Development and testing of a videogame intervention for symptom management among 8–18 years old children with cancer: a study protocol

IntroductionEvidence shows that cancer treatment-related symptoms could be managed effectively in 8–18 years old children through Digital Health Interventions (DHIs), consequently improving their health-related quality of life (HRQOL). However, limited...

Mabrouk's Measure of Adolescent Optimism: Development and Validation of a New Scale of Adolescent Optimism.

Several measures of adolescent optimism exist. However, none of these measures have been developed in the African setting, and only a few of the available measures have been validated for use in this setting. We aimed to develop and validate a culturally appropriate measure for this context. We employed an exploratory sequential mixed methods design using a five-step approach to tool development, comprising literature reviews, construct clarification, item development, piloting, and scale evaluation. We constructed a six-item scale, the Mabrouk's Measure of Adolescent Optimism (MMAO). In a sample of 1616 adolescents from Kenya, the MMAO demonstrated adequate internal consistency (both Cronbach's alpha and McDonald's Omega > 0.80) and test-retest reliability (ICC = 0.46). Factor analysis supported a unidimensional scale with adequate criterion and divergent validity as well as measurement invariance across sex, age (younger vs. older adolescents), residence (rural vs. urban), schooling status (in-school vs. out-of-school adolescents), and language of administration (Swahili vs. English). We report on the development and validation of a new scale of adolescent optimism that can be used to assess optimism among adolescents in Kenya and similar contexts. Preliminary evidence shows support for this new measure's reliability and validity, although additional tests are needed.

Educational needs for virtual reality-based simulation training in the nursing care of adult respiratory patients: an explanatory sequential mixed-methods study.

We aimed to ascertain the current state of and needs for virtual reality (VR)-based simulation training in the care of adult respiratory patients. Learning to care for patients with infectious respiratory disease is crucial in nurses' practical education. Thus, studies on the state of VR-based simulation-training are required. We used an explanatory sequential mixed-methods design. The sample included 122 new nurses at two advanced general hospitals and five educators at a nursing college. The educational needs of virtual reality-based simulation education were measured by the tool developed in this study. Research data were collected from August 31 to September 26, 2022. Quantitative data were subjected to a descriptive analysis, while qualitative data were subjected to content analysis. The new nurses in this study had a mean age of 24.51 years and total clinical experience of 11.18 months; 82.8% of the participants had experience in adult respiratory patient care, and 94.3% were aware of the need for this training. In the qualitative data analysis of six new nurses, all participants had experience with simulation training and were aware of its need. Moreover, all participants wanted repeated VR-based simulation training using real clinical cases. Regarding the qualitative data analysis of five nursing college educators, most of them had experience providing and receiving simulation training, and they were aware of its need in caring for respiratory patients. They reported the need for VR learning spaces that reflect the clinical environment, alongside sufficient duration and frequency of learning. Our findings could help develop simulation training programs for nursing students to assist adult respiratory patients. We provide a basis for developing VR-based simulation training for respiratory care by studying the current state of and demand for nurses' VR-based simulation training. The results can contribute to improving the quality of nursing for adult respiratory patients.