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Impact of Technology on Physical Activity Levels of Pediatric Cancer Survivors: A Systematic Review
No full textBackground: Pediatric cancer survivors often face long-term health challenges such as muscle weakness and obesity [1, 2, 3]. Physical activity is essential for lessening these effects, and technological interventions have been suggested to promote physical activity among pediatric cancer survivors [3, 4].
Purpose: This systematic review aimed to evaluate technological interventions\u27 impact on pediatric cancer survivors\u27 PA levels.
Methods: The systematic review followed PRISMA guidelines [5] and included studies published until May 2024 from various databases. The Joanna Briggs Institute (JBI) critical appraisal tools were used to assess study quality. The study was registered in PROSPERO under registration number CRD42024564857.
Results: A total of nine studies were included in the review: four were randomized controlled trials (RCT), three were feasibility studies, and two were pilot studies. These studies, involving a total of 417 pediatric cancer survivors, utilized a wide range of technological interventions. Based on JBI quality appraisal tools [6], six of the studies were of good quality, while three were of fair quality. Specifically, three studies utilized mobile applications, two employed web-based platforms, two used m-health solutions, one incorporated a video game, and one utilized a telehealth application. The results revealed that two-thirds of the mobile applications were ineffective in enhancing physical activity. In contrast, one of the m-health applications proved to be effective. Additionally, web-based platforms, telehealth applications, and video games demonstrated effectiveness in increasing physical activity.
Conclusion: Technological interventions show promise for improving physical activity among pediatric cancer survivors, with six studies demonstrating significant benefits. More research is needed to identify effective strategies and optimize intervention designs, focusing on long-term outcomes.
Implications for Cancer Survivors: This systematic review assesses technology-based interventions aimed at promoting physical activity in pediatric cancer survivors. The findings emphasize the potential and variability of digital tools, underscoring the necessity for additional research to refine intervention strategies and facilitate long-term physical activity among this group
Delirium and Catatonia in the CCU: Distinct Conditions Shaping Clinical Outcomes
No full textIntroduction: This study explores the relationship between delirium, as assessed by the Confusion Assessment Method-ICU (CAM-ICU, and catatonia, assessed by the Bush Francis Catatonia Screening Instrument (BFCSI) [2], in cardiac care unit (CCU). Delirium has been shown to worsen clinical outcomes [4]. Catatonia, while less studied in ICU settings, is essential due to its potential overlap with delirium [1,3,5]. The preliminary analysis provides insights into the independent occurrence of delirium and catatonia and their impacts on clinical outcomes.
Methods: Consecutive adult patients (≥ 20 years) admitted to the CCU were enrolled. Delirium was screened daily using CAM-ICU until CCU discharge, while catatonia was assessed using the BFCSI. Clinical outcomes included CCU days and length of stay (LOS). Additional clinical variables included age, gender, BMI, Activities of Daily Living (ADL), Clinical Frailty Scale (CFS), APACHE II scores. Statistical significance was determined using P-values, with \u3c0.05 considered significant.
Results: Our preliminary findings enrolled 26 participants. Delirium developed at 15.4% (4/26), and catatonia at 19.2% (5/26). Participants with delirium were frailer, had lower baselines BMI and ADL, and had higher 48h_APACHE II scores compared to those without delirium. Notably, participants with delirium had significantly longer median ICU days (19.0 days vs. 4.0 days) and LOS (31.0 days vs. 13.5 days) compared to the non-delirium group (p\u3c0.05). Among the five participants with catatonia, no significant differences in clinical outcomes were observed. However, two of the four delirium participants also had catatonia, suggesting that focusing solely on delirium may overlook the presence of catatonia, which could potentially influence clinical outcomes.
Discussion: The preliminary results indicate that delirium is associated with worse ICU outcomes, including higher illness severity and prolonged length of stay. While catatonia may occur independently of delirium, but its impact remains inconclusive based on the current data. The presence of catatonia in patients without delirium (Catatonia [+] but CAM-ICU [-]) emphasizes the need for separate screening to avoid missed diagnoses. More extensive studies are required to clarify catatonia’s role in ICU outcomes and implications for ICU management. These findings suggest the need for comprehensive assessment strategies in CCU setting
Using Arts-Based Learning to Teach Clinical Judgement in an Undergraduate Nursing Leadership Course
No full textBackground: Arts-based learning is a pedagogy that uses art, literature, and writing to enhance listening and observation skills and can be used in nursing education (Lovell, et al., 2021; Raber, & Vermeesch, 2022; Reiger et al., 2016). A core competency of baccalaureate nursing education to apply knowledge from arts and humanities to their nursing practice (American Association of Colleges of Nursing, 2021). However, there is still little known about how this can be practically done in undergraduate nursing curricula to teach clinical judgment and leadership concepts.
Methods: In an undergraduate nursing leadership course, art, poetry, short stories, and creative writing were used to teach clinical judgment within the context of learning about organizational culture and nursing leadership. In the clinical portion of the course, learning activities aligned with the components of Tanner’s Clinical Judgment Model: background, noticing, interpreting, responding, and reflecting, and were used in student-led conferences (Tanner et al., 2022). Students were given specific prompts to help facilitate discussion and connect their learning to their clinical placements and leadership concepts such as effective communication and ethics. After completion of the course, students (n=29) completed a survey to rate their satisfaction with the arts-based learning activities and how these activities supported their clinical judgment.
Results: The majority of students reported that the arts-based learning activities helped improve their clinical judgment. Students also recommended the continued use and expansion of arts-based learning to teach clinical judgment in both clinical and theory portions of courses.
Implications: Arts-based learning is an innovative and creative way to teach clinical judgment and offers an alternative to traditional teaching modalities and can be used to teach nursing leadership concepts. Further research is needed to evaluate the efficacy of arts-based learning throughout the nursing curricula, in both theory and clinical courses
Exercise Dependence: A Qualitative Study of Fitness Enthusiasts’ Motivations for Excessive Workouts
No full textMore and more people around the globe are motivated to be physically fit and healthy. While a lack of regular physical activity can be a barrier to a healthier lifestyle, too much or excessive exercise may lead to exercise dependence and may pose serious health concerns. Excessive exercise or exercise dependence refers to a maladaptive pattern of exercise which can lead to clinically significant impairment or distress. This qualitative study explores the motivations for excessive exercise and contributing factors to exercise dependence among at-risk Filipino fitness enthusiasts. Using descriptive qualitative research, we conducted in-depth interviews with ten gym regular members from Alabang, Muntinlupa City, and Mandaluyong City, aged 18 years old and above. The ten participants were identified as at-risk based on their high scores on the Exercise Dependence Scale-Revised and were purposively chosen to participate in the study. A thematic analysis was used to identify three key themes: 1) motivations for exercise, 2) lack of awareness regarding negative effects of excessive exercise, and 3) maladaptive behaviors. Subthemes included health-related motivations, weight management, and misconceptions about exercise outcomes. Consistent with previous studies, participants are motivated to exercise to avoid health problems, weight management, and benefit from the positive effects of exercise (e.g. “relieve stress”, “develop confidence’, “look younger”). Findings from this study offer insights into the risks associated with exercise dependence and highlight the need for awareness to mitigate its potential impact on health and well-bein
Implementing Emerging Technology in Global Healthcare: An Integrative Review on Virtual Nursing
No full textBackground: The COVID-19 pandemic catalyzed many changes in global healthcare and the nursing workforce (1). Among these evolutions were the rapid advances in the use of technology to facilitate patient care. Many patients and providers have had experience with tele-health for outpatient visits or specialty consultations, but truly embedding technology, in the form of virtual nursing to support the provision of in-patient, non-ICU nursing care, is a newer phenomenon. Virtual nursing may be able to address many issues at the patient, staff and organizational level, however the best practices for implementing this staffing model are unknown (2).
Purpose: This presentation will review the findings of a structured integrative review to address the question, “what are best practices for implementing virtual nursing in a non-ICU setting?”
Methods: To answer the review question, the team performed a systematic search and screening of the literature, evidence appraisal and generated recommendations using the Johns Hopkins EBP model (3). Evidence published since 2019 was included.Findings: Of an initial 337 search results, 6 articles answered the EBP question (5 single studies and 1 programmatic experience). All evidence was generated in the USA. The most common tasks performed by the virtual nurse (ViRN) were monitoring for patient deterioration or other missed cares, discharges, and education for nurses or patients.There is not a single set of skills or experiences required for the ViRN, however the evidence suggests critical thinking, leadership, communication, and ability to navigate policies and procedures is important. Implementation should involve a phased-in approach with set workflows and provide education to all unit staff and patients. Leadership plays a core role, and shared governance models should be leveraged.
Evidence is mixed on optimal staffing ratios, the location of the ViRN, and the level of experience needed (4, 5, 6, 7, 8, 9)
The SimComp Tool for Simulation-Based Learning: Advancing Competency-Based Nursing Simulation
No full textBackground: Simulation-based learning experiences allow undergraduate nursing students to develop competence and confidence through deliberate practice with immediate feedback on the learner\u27s performance. As nursing education shifts towards a competency-based framework, faculty require robust tools to evaluate student performance in simulation settings effectively. The purpose of this Delphi study was to develop the SimComp Tool – a competency-based evaluation tool aligned with the AACN (2021) Essentials: Core Competencies for Professional Nursing Education.
Methods: Utilizing the Delphi technique, we engaged a diverse panel of experts to refine and reach consensus on competency-based simulation evaluations. Panelists rated aggregated responses using a Likert scale and open-ended feedback. Open-ended questions were analyzed using traditional content analysis methods, while quantitative data were analyzed using IBM SPSS Statistics 27.
Results: Despite the varied backgrounds and experiences of the expert panel, a consensus of 80% was achieved after four rounds, identifying 111 critical items for assessing competency in simulation-based learning. These items were systematically categorized by domains and observable behaviors, ensuring a comprehensive evaluation framework.
Conclusion: This study addresses a significant gap in the literature regarding competency-based simulation evaluations for nursing, presenting a call to action for institutions to adopt and enhance simulation methodologies. By incorporating expert insights, we lay the groundwork for developing a competency-based tool for nursing simulation.
Implications for Nursing Practice: Further research is essential for refining the SimComp Tool, ensuring its psychometric validity, and facilitating curriculum integration. The AACN (2021) toolkit will benefit from these simulation resources, ultimately advancing nursing education. Our vision is for the SimComp Tool to transform nursing simulation and practice, fostering a new generation of highly competent and confident nursing professionals
Addressing Provider Burnout with AI Scribe Technology in Mental Health Practice Settings
No full textBackground: Burnout is on the rise and contributes to critical patient care errors, poor patient perception of care, and a reduction in provider life satisfaction1,2. Some primary causes of burnout among healthcare providers are the escalating administrative burdens and extensive screen time associated with electronic health records (EHR) and other documentation tasks3. AI-assisted charting has shown promising results in improving provider satisfaction, increasing time with patients, reducing administrative workload, reducing EHR interface time, increasing patient satisfaction, and reducing provider self-reports of fatigue and dread5.Purpose: This project aims to examine the effect of the AI-assisted scribe technology on provider burnout in an inpatient and an outpatient mental healthcare care facility over the course of a month.Methods: Utilizing the ADKAR model of change, the project offers a structured adoption of new technology. Mobius Conveyer AI scribe will be deployed in a mental healthcare setting with voice-to-text capabilities and automated encounter summarization, allowing providers to capture therapeutic interactions in a HIPAA-compliant and encrypted manner. A quasi-experimental design will assess the impact of the AI-assisted documentation, evaluating provider burnout before and after the intervention using the Maslach Burnout Inventory (MBI). Additional measures include onboarding surveys to assess the demographic and technological comfortability of each participant.Outcomes: Data from the MBI and onboarding surveys will undergo statistical analysis to compare pre- and post-intervention scores, with descriptive statistics summarizing demographic information, baseline characteristics, and feasibility data.Implications: The successful adoption of AI-assisted documentation could transform DNP practice by streamlining workflows and improving the quality of patient care. It is anticipated that the use of the AI scribe to generate automated clinic notes will decrease administrative workload and reduce provider burnout
The Explorative of Eating Behavior, Quality of Life and Related Factor in Bariatric Surgery Patients
No full textBackground: Obesity is now recognized as one of the most important public health issues worldwide. Bariatric surgery is the most durable weight-loss solution for patients with morbid obesity. However, adopting healthy eating behaviors is essential for successful weight loss and improving health-related quality of life.
Purpose: This study aimed to assess the association between eating behaviors and health-related quality of life (HRQOL) and examined influencing factors among patients after bariatric surgery.
Methods: The cross-sectional study design was adopted with convenience sampling conducted at bariatric center in Southern Taiwan. A total of 296 morbid obesity patients were recruited. Data were collected from August 2023 to January 2024. The data was collected using structured questionnaires, including demographic and medical-related variables, the Dutch Eating Behavior Questionnaire (DEBQ), and the Impact of Weight on Quality of Life-Lite scale (IWQOL-Lite). Statistical analyses were conducted using SPSS statistical package version 25.
Results: The results indicated significant positive correlations between IWQOL-Lite and postoperative months (r= .130 ~ .270, p= .026 ~ \u3c .001) but negative correlations between emotional eating behavior (r= -.135, p= .021 ~ \u3c .001), external eating behavior (r= -.174, p= .003) and postoperative months. The postoperative BMI decline rate and total weight loss were significantly positively correlated with IWQOL-Lite subscale (including physical function dimension, self-esteem dimension), but significantly negatively correlated with emotional eating behavior. Furthermore, there were significant negative correlations between restrained eating behavior, emotional eating behavior, external eating behavior and HRQOL subscales (r= -.172 ~ -.293, p \u3c .001) and overall HRQOL (r= -.250 ~ -.406, p \u3c .001). A hierarchical regression model identified 6 predictors of overall HRQOL. These predictors were: postoperative months, BMI, and body weight (7.1%), restrained eating behavior (5.7%), emotional eating behavior (2.3%), external eating behavior (7.6%). These predictors accounted for 22.7% of total variance.
Conclusions/Discussion: This study can assist healthcare professionals understand patients\u27 eating behaviors and provide targeted care interventions to modify adverse eating habits, thereby improving the health-related quality of life for patients with morbid obesity following bariatric surgery
Creating Practice-Ready Nurse Practitioners Through the Clinical Expert Model
No full textBackground: In today\u27s dynamic healthcare landscape, nurse educators are pivotal in preparing practice-ready Nurse Practitioners (NPs) (Dumphy et al., 2019). This abstract examines the clinical expert model\u27s role in equipping NP students with essential skills and readiness for autonomous practice. Educators are instrumental in transitioning students from registered nurses to advanced practice roles, a shift that demands new competencies, in-depth clinical knowledge, and a mindset for autonomous decision-making (Finneran & Kreye, 2019). This transition presents significant challenges, as NP students must master advanced skills and embrace leadership in patient care (Faraz, 2019). As the demand for practice-ready graduates grows, educators increasingly adopt expert-based models that scaffold learning through immersive clinical experiences (Hollander et al., 2024). These models foster proficiency progressively, providing exposure to simulated scenarios that promote current best practices (Haerling & Prion, 2021). This approach enhances students\u27 confidence and autonomy, addressing the need for skilled NPs (Kostas-Polston et al., 2018).
Method: The clinical expert model is critical in preparing practice-ready NPs, embedding student-centered assessments across clinical semesters to develop competence and readiness. This model includes activities that progressively enhance clinical judgment, decision-making, and collaboration. A key component, the Clinical Expert Assignment, allows students to become subject matter experts on specific diagnoses, engaging in discussions that deepen clinical insight and critical thinking. Evidence-based pathways guide students through simulated scenarios, reinforcing best practices. Peer-led activities further foster a collaborative learning environment where students mentor each other, building confidence.
Key Learning and Implications: Clinical expert assessments effectively prepare NP graduates by fostering professionalism, accountability, and confidence. Active faculty engagement also plays a vital role in empowering students and shaping their skills and professional identity. This model supports rigorous evaluation through reliable assessment methods and comprehensive portfolios, aligning with modern healthcare needs. It ensures that NPs are equipped to impact patient outcomes and contribute meaningfully to nursing practice, education, and policy
Performance of an Online Mobility Module: Implications for Education in Hospital Nursing Practice
No full textBackground: There is a significant gap in nursing science regarding transformational leadership within nursing education, particularly in its application to education and online learning modules. In response an online mobility module was implemented to support an institution-wide shift toward improved mobility. Nursing leaders across management, quality, and education collaborated to develop, review, and test module content.
Purpose: This study evaluates the test performance of nursing staff and identifies implications for future education similar to other nursing leadership interventions (Melnyk et al., 2020).
Participants/Subjects: A total of 7,596 test scores from nurses (RNs) and patient care associates (PCAs) were analyzed retrospectively, representing various hospital departments.
Methods: The mobility module was assigned to all nursing staff and required viewing a video in order to pass. Feedback was disabled. Data collected included attempt number, test scores, and job code. Descriptive statistics and T-tests were completed. This design parallels studies that utilize analytics to identify educational needs within nursing programs (Ayodugu, 2023).
Results: Only 24% of module attempts resulted in a passing score, indicating significant lack of retention of module content. Over 88% of attempts were the third or more test or resulted in non-passing scores, suggesting limited engagement with content. This finding is consistent with trends in nursing education, where low pass rates may indicate the need for increased interactivity and personalized feedback mechanisms (Scott-Richardson et al., 2022). T-test results reported that RNs had significantly higher average scores than PCAs (p \u3c0.01) and take fewer attempts than PCAs (p\u3c0.01). The results align with recent insights into education, which emphasize interactive, adaptive learning methods for retention and skill mastery (Bryan & Asghar Ali, 2019).
Conclusions: While the mobility module served as a tool for initial learning, future modules should integrate interactive elements to enhance engagement, improve education outcomes related to patient safety and quality improvement, and align with nursing staff\u27s experiential learning needs. The current study highlights the importance of refining online modules to promote sustainable learning outcomes within hospital education (Jorge et al., 2021)