Effects of metaverse-based career mentoring for nursing students: a mixed methods study

A seizure is a transient occurrence of signs and/or symptoms caused by abnormal excessive or synchronous neuronal activity in the brain. Nurses play a critical role in recognizing and managing seizures, which encompasses airway management, hemodynamic monitoring, and safe administration of antiepileptic medications. High-fidelity simulation (HFS) based on flipped learning integrates self-directed pre-learning with realistic clinical scenarios to enhance clinical performance, problem-solving abilities, and clinical reasoning. Clinical nurses have limited access to HFS based on flipped learning for seizure management despite its benefits. This study aimed to develop and evaluate the efficacy of a high-fidelity simulation program based on flipped learning for nurses’ emergency management of seizures (HFS-EMS). This study employed a mixed-methods design combining a one-group pretest-posttest quasi-experimental design and qualitative focus group interviews (FGIs). In the quantitative phase, a convenience sample of 29 clinical nurses was recruited from a tertiary hospital. Inclusion criteria included a minimum of six months of clinical experience and direct involvement in patient care. Changes in knowledge of seizure nursing, self-confidence in seizure nursing, clinical reasoning competence, and clinical performance ability in seizure nursing were assessed using validated instruments. Quantitative data were analyzed using paired t-tests or Wilcoxon signed-rank tests, depending on normality, with SPSS (version 26.0). In the qualitative phase, 10 participants were purposively selected to participate in FGIs exploring their experiences with the HFS-EMS. Qualitative data were analyzed using conventional content analysis, supported by NVivo software (version 12). After the intervention, significant improvements were observed in knowledge of seizure nursing (pre: 8.79 ± 1.76; post: 9.62 ± 1.27, p = 0.026), self-confidence in seizure nursing (pre: 29.21 ± 7.03; post: 42.21 ± 5.51, p < 0.001), and clinical reasoning competence (pre: 52.04 ± 8.21; post: 63.04 ± 8.23, p < 0.001). The participants exhibited minor improvements in their clinical performance ability in seizure nursing, though this improvement was statistically non-significant. Educational satisfaction (46.76 ± 3.93) and simulation effectiveness (53.62 ± 4.06) were significantly high. Qualitative analysis identified four key themes: (1) enhancement of clinical performance skills, (2) areas requiring improvement, (3) self-reflection, and (4) emergency response competence. The HFS-EMS effectively improved the knowledge, self-confidence, and clinical reasoning competence of clinical nurses in managing patients with seizures. The program offered a realistic, reflective, and organized setting for nurses to develop essential clinical skills. Future studies should investigate long-term impacts and extend the program to diverse clinical settings.

Parental authority as a mediator between career decision-making self-efficacy, career decision ambiguity tolerance, and career choice of nursing students: A path analysis.

This study aimed to investigate the potential impact of the Target Management Card on patient safety in the emergency department. A mixed method design was developed, combining a one-group pretest-posttest design with a qualitative study. Target Management Cards were formulated for 32 emergency nurse practitioners and focus group interviews were conducted after the intervention. Wilcoxon's signed rank test was used to compare pre-test and post-test scores. The interview data were subject to content analysis. After developing the Target Management Card, there were significant improvements in safety behaviors (Z = 4.709, p < 0.01) and perception of patient safety (Z = 4.257, p < 0.01) among emergency nurse practitioners. The nurses in the focus group interviews agreed that the Target Management Card could improve patient safety by warning and supervising nursing work in the emergency department, promoting a positive change in nurses' attitudes and behaviors toward patient safety. Our study found that nurses and nursing managers jointly formulating Target Management Cards in emergency departments significantly enhances patient safety.

Qualitative and mixed methods research in trials

BackgroundCommunity health nurses collaborate in teams to address client care, organise services, and conduct preventive activities. Hence, it is crucial for students in this work context, to practise and enhance their collaborative problem-solving (CPS) skills. To facilitate this, a hybrid serious game called "Carion" was developed, immersing second-year nursing students in a semester-long experience of working as district nurses in self-managed teams. The game challenges them to collectively tackle authentic and fictional problems. However, the extent and manner in which this hybrid serious game contributes to students' CPS skill development is unknown. AimThe aim of this study is to explore how students perceive the development of CPS by doing assignments carried out in the learning context of the hybrid serious game Carion. ParticipantsTwo teams each consisting of five second-year nursing students, were selected for the qualitative case study. Two lecturers acting as team coaches also participated in this study. 110 (response rate 61 %) second-year students participated in the quantitative survey at the beginning of the semester, 109 students at the end of the semester. MethodsThe study is a mixed method design. The qualitative component involves a case study while the quantitative component consists of an online survey. Qualitative and quantitative data regarding collaborative problem solving was collected at different time points using focus group interviews, one-on-one interviews, digital logbooks and an online self-assessment tool. ResultsQualitative analysis revealed insights into three key themes: (1) Collaboration, encompassing consulting with each other, and capitalising on each other’s qualities and strengths; (2) Problem solving, encompassing quicker and easier problem solving, allocating assignments, coming to a joint solution, and problem-solving method; and (3) Learning from each other, encompassing learning from each other’s knowledge and experience, and from each other’s ideas. No growth in collaborative problem-solving development was statistically shown in the group. ConclusionsThis study gives an ambiguous view on students' perception of their CPS development through involvement in various Carion assignments. Based on this exploratory investigation, prematurely labelling Carion as a potential educational environment for developing CPS among undergraduate nursing students in community healthcare would be unwarranted. Further research is needed, particularly in scrutinising the interplay between CPS and diverse learning activities, assignments and learning outcomes within this specific hybrid serious game context.

Objectives The purpose of this study was to verify the mediating effect of career decision autonomy in the relationship between social support, career decision autonomy, career decision self-efficacy variables perceived by college students, and social support perceived by college students and career decision self-efficacy.&#x0D; Methods For this study, 285 college students at universities in the metropolitan area were surveyed. The collected data were descriptive statistics and correlation analysis with SPSS 22.0, and a 3-step multi-regression analysis and sobel test by Baron and Kenny (1986) were performed to verify the mediating effect of career decision-making autonomy.&#x0D; Results First, the analysis of the correlation between the social support, career decision-making autonomy, and career decision self-efficacy perceived by college students showed a significant static correlation between all the variables. Second, the social support perceived by college students had an effect on career decision-making self-efficacy and had a positive effect on career decision-making autonomy. Third, in the effect of social support perceived by college students on career decision self-efficacy, career decision-making autonomy showed a partial mediating effect. Based on the above research, it is suggested that college students in career decision-making situations need confidence to feel that they can successfully solve the challenges facing career decision-making.&#x0D; Conclusions Perceiving social support to enhance college students' career decision self-efficacy. We intend to provide basic data to promote career decision-making autonomy.

Effects of cervical cancer prevention education in middle-school girls in Korea: A mixed-method study

This study aimed to investigate the effect of instruction designed according to the ARCS model enriched with Web 2.0 tools on the mathematics achievement and motivation of secondary school students and to examine student opinions regarding the applied instruction process. A mixed-methods approach was employed in the study since both quantitative and qualitative data were collected. To support quantitative data with qualitative data, a sequential explanatory design was chosen from mixed-methods designs. The research was conducted in the 2022–2023 academic year with the participation of 40 7th grade students enrolled in a public school in Niğde province. The research process was planned for 10 weeks, including a pretest administration in the first week, an eight-week intervention, and a posttest administration in the last week. In the experimental group, a mathematics instruction plan designed according to the ARCS model enriched with Web 2.0 tools was implemented, while in the control group, only the existing mathematics instruction plan was implemented. Quantitative data were collected using the ratio, proportion and percentage achievement tests and the mathematics motivation scale. Qualitative data were collected through focus group interviews with experimental group students. Data analysis was conducted, which included independent samples t-tests, paired samples t-tests, MANOVAs, and content analysis. The findings obtained from this study revealed that teaching with the ARCS model enriched with Web 2.0 tools had a positive effect on students' academic achievement. When the sub-dimensions of motivation were analyzed, no significant difference was found between the groups in the posttest motivation scores, but most of the participant students in the focus group interviews expressed positive opinions about the process and mentioned the effectiveness of the process. This study provides important information about the effectiveness of integrating Web 2.0 tools into the ARCS model in secondary school mathematics education in terms of the effectiveness of the teaching process and its contributions to students' achievement.

As boundaryless careers become mainstream, individuals need to enhance career decision-making self-efficacy (CDSE) during career transitions to secure better employment outcomes and sustainable career development, especially when moving from a school to a work environment. Drawing on social cognitive career theory, this study empirically proposed a moderated mediation model to examine whether proactive personality (measured at Time 1), career success criteria clarity (CSCC, measured at Time 2), and family socioeconomic status (including family income, parents’ educational level, and parents’ occupational level; measured at Time 1) would contribute to CDSE (measured at Time 2). Results based on a two-wave survey of 235 college students showed that: (1) proactive personality positively predicted CDSE; (2) CSCC positively predicted CDSE; (3) CSCC partly mediated the relation between proactive personality and CDSE; (4) the positive effect of CSCC on CDSE was stronger among students with a lower family socioeconomic status. Individuals with strong proactive personalities were more likely to develop salience in career success criteria and in turn became more confident in making career decisions. Therefore, vocational educators in higher education could help to improve students’ CDSE by promoting training programs for proactive thinking, providing successful role models, and encouraging family involvement, especially for students with a lower family socioeconomic status.

This study was conducted to determine the effect of the storytelling technique on the attitudes of nursing students toward death as a mixed research design. The study sample consisted of 94 senior students attending the nursing department of a university in Turkey. Quantitative data were collected by using the introductory characteristics form and the Death Attitude Profile-Revised, while qualitative data were collected through focus group interviews with the semistructured interview form. The data were analyzed according to number, percentage, Wilcoxon test, paired samples ttest, and descriptive analysis method. The mean Death Attitude Profile-Revised Scale score of the students before receiving the relevant education was 4.17 ± 0.21. This score increased to 4.25 ± 0.24 after the students received the education and the difference was found to be statistically significant (p < .05). In the qualitative section of the study, the data obtained from the attitudes of the students toward death were coded, and four themes were determined. The qualitative data obtained from the focus group interviews with the participating students were presented under four themes: the contribution of the storytelling technique to learning, the effect of the storytelling technique on the attitude toward death, thoughts about the storytelling technique, and contribution of the course to knowledge, skills and attitude in giving care to the dying patient. As a result of the study, explaining the subject of death with the storytelling technique was determined to positively affect the attitudes of the students toward death.

Background Technological advances and societal expectations are transforming professional-patient relationships, while interpersonal therapeutic interactions remain essential to palliative care.1,2,3 Harm can be experienced as an ‘unfolding series of negative events…inextricably linked with feeling unsafe’.4 Negotiating safe care that remains sensitive to patients’ priorities can create tensions with safety standards, while failure to consider these can result in avoidable harms including worsened symptoms and disrupted dying.5,6 Aims Demonstrate how QHR can deepen understanding of safety and risk in palliative care. Showcase use of social research methods to identify implications for professional learning by integrating incident analysis with multi-voiced constructions of interpersonal safety work.4,7 Methods We developed innovative mixed method combinations of systematic review techniques with cross-sectional quantitative descriptive analysis and interpretative qualitative meta-syntheses of data from UK National incident reporting systems, stakeholder perspectives and published literature.8,9 Details will be given with each case study presented. Results QHR enables professional learning about insights into everyday safety challenges and realities for patients, informal carers and professional working practices. Patients are vulnerable not only to generic safety risks but also additional risks specific to the last phase of life. For example, many harms are mediated through medication work with problematic consequences. Advance care planning (ACP) is often postulated as a solution to care challenges. Our qualitative analysis of ACP incidents demonstrates safe ACP requires not simply theoretical knowledge but acceptance of socially constructed roles and responsibilities with applied metacognitive skills and emotional intelligence. We present a new analysis of intersectionality between enactment of patient, carer and professional medication management, contributing factors to unsafe care, and professional reporter’s perceptions and patient constructions of safety. Conclusion QHR can drive a holistic approach to interpersonal patient safety in palliative care. Mixed methods QHR using social theories to develop multi-voiced perspectives of safety generates ‘real world’ learning. References den Herder-van der Eerden M, van Wijngaarden J, Payne S, et al. Integrated palliative care is about professional networking rather than standardisation of care: A qualitative study with healthcare professionals in 19 integrated palliative care initiatives in five European countries. Palliative Medicine2018;32:1091–1102. den Herder-van der Eerden M, Ebenau A, Payne S, et al. Integrated palliative care networks from the perspectives of patients: A cross-sectional explorative study in five European countries, Palliative Medicine2018;32:1103–1113. Sampson C, Finlay I, Byrne A, et al. The practice of palliative care from the „perspective of patients and carers BMJ Supportive & Palliative Care2014;4:291–298. Collier A, Sorensen R, Iedema R. Patients’ and families’ perspectives of patient safety at the end of life: a video-reflexive ethnography study. Int J Qual Health Care2016;28:66–73. Williams H, Donaldson L, Noble S, et al. Quality improvement priorities for safer out-of-hours palliative care: lessons from a mixed methods analysis of a national incident reporting database. Palliative Medicine, in review 2019;33:346–356. Yardley I, Yardley S, Williams H, et al. Patient safety in palliative care: A mixed methods study of reports to a national database of serious incidents. Palliative Medicine, 2018;32:1353–1362. Pound P, Britten N, Morgan M, et al. Resisting medicines: A synthesis of qualitative studies of medicine taking. Social Science & Medicine2005;61:133–155. Carson-Stevens A, Hibbert P, Williams H, et al. Characterising the nature of primary care patient safety incident reports in the England and wales national reporting and learning system: A mixed-methods agenda-setting study for general practice. Southampton (UK): NIHR Journals Library 2016. Carson-Stevens A, Hibbert P, Avery A, et al. A cross-sectional mixed methods study protocol to generate learning from patient safety incidents reported from general practice. BMJ Open5:e009079. doi:10.1136/bmjopen-2015-009079.

The purpose of this study is to empirically verify the relationship between the effect of local university education service quality on university adjustment and career decision self-efficacy. Based on previous studies, the factors of faculty, educational facilities, educational programs, and administrative support were classified to measure the quality of university education services, and university adaptation and career decision self-efficacy were divided into single items to verify the influence relationship of each. As a result of the test, 280 college students of H University, Gangwon-do, confirmed the positive (+) effect of educational programs and administrative support, which are subfactors of university education service quality, on university adaptation, and revealed that university adaptation had a positive (+) effect on career decision self-efficacy. The significance of this study is to suggest a viable strategy for university education service quality that is conducive to university adaptation and the achievement of students' desired career goals.

The complexity and uncertainty of modern society changing every minute have enormous impacts on the lives and careers of individuals living in this era. The major changes to the structure of the occupational society driven by the COVID-19 pandemic and the Fourth Industrial Revolution are increasing uncertainty about careers. In this situation, how college students deal with the career uncertainty they experience works as an important element in their career decisions. This study thus sets out to verify the effects of reduced career uncertainty of college students on their career decision-making self-efficacy.&#x0D; In order to reduce career uncertainty, the investigator implemented a group counseling program for careers whose effectiveness on the reduced career uncertainty of college students was verified. The study selected college students in lower graders(freshmen and sophomores) to participate in the program for the research purpose at S University in Chungcheongnam Province. They were divided into 163 experimental groups and 159 control groups. While the experiment group participated in an 11-session program with a 50-minute session once or twice per week, the control group participated in no programs. A survey was conducted before and after the program, and collected data was put into the paired-sample t-test and covariance analysis with the SPSS Win 23.0 program.&#x0D; The findings show that the experiment group had reduction effects in all the subfactors of career uncertainty and that the control group showed no statistically significant effects. The experiment group that had reduction effects for career uncertainty made a statistically significant increase in career decision-making self-efficacy, but there were no significant changes to that of the control group. The present study demonstrated that the reduction of career uncertainty as the first measure for the career uncertainty of individuals had positive effects on the enhancement of career decision-making self-efficacy and shed light on causal relations between the reduction of career uncertainty and career decision-making self-efficacy, thus holding its significance. The findings of the study are expected to serve as grounds for plans to provide more effective career decision counseling by examining the relations of psychological factors in college students that have difficulties with their career decisions due to the uncertainty of their future.

Chapter 28 - Best practices in mixed methods for pharmacy and health services research

The Coming of Age for Qualitative Research: Embracing the Diversity of Qualitative Methods