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Abstract Background In advanced clinical learning labs on campus, high-fidelity simulation has become an essential educational approach in the Bachelor of Nursing Education programme. However, simulation while in clinical placement, in situ, is rarely used in Bachelor of Nursing Education. The aim of the present study was to explore how in situ simulation training at a surgical hospital ward, according to Bachelor of Nursing students, influenced their learning and development process. Methods A qualitative descriptive study was conducted. Data were collected through individual interviews with a sample of 21 s-year Bachelor of Nursing students who completed 40 in situ simulations during their eight-week clinical placement at a Norwegian University Hospital. Data were analysed using inductive content analysis. Results The data analysis generated six subcategories constituting two descriptive categories: building professional confidence and internalising nursing knowledge. Although the students found in situ simulation stressful and uncomfortable for being assessed by student peers, the teacher and preceptor, the process of managing clinical situations in simulation helped build professional confidence. What the students had learned in the simulation was directly transferable to real clinical situations because they were in the hospital setting. The simulation sessions enabled them to connect theoretical knowledge and clinical skills. They could test their skills in a safe environment, performing procedures that made them aware of how their knowledge could be used in real life. Conclusion According to the Bachelor of Nursing students’ own experiences, in situ simulation supported the students’ learning process, connected theory and practice and contributed to developing confidence in the performance of clinical skills. Including simulation in clinical practice could prove to be an effective way of teaching and learning clinical skills in nursing regarding resources and learning outcomes.

BackgroundThere is widespread recognition and acceptance of the need for critical thinking in nursing education, as it is necessary to provide high-quality nursing. The Technology-Supported Guidance Model (TSGM) intervention was conducted during clinical practice among undergraduate nursing students and aimed to support the development of critical thinking. A major element of this newly developed intervention is an app, Technology-Optimized Practice Process in Nursing (TOPP‑N), combined with the daily guidance of nursing students from nurse preceptors and summative assessments based on the Assessment of Clinical Education. ObjectiveThe main objective of this study was to assess the feasibility of a newly developed intervention, TSGM, among undergraduate nursing students, nurse preceptors, and nurse educators. Further objectives were to assess the primary and secondary outcome measures, recruitment strategy, and data collection strategy and to identify the potential causes of dropout and barriers to participant recruitment, retention, intervention fidelity, and adherence to the intervention. MethodsThis study was designed as a concurrent, exploratory, flexible, and multimethod feasibility study of the TSGM intervention that included quantitative and qualitative data from nursing students, nurse preceptors, and nurse educators. The primary outcome measures were the feasibility and acceptability of the intervention. The secondary outcomes included the suitability and acceptance of the outcome measures (critical thinking, self-efficacy, clinical learning environment, metacognition and self-regulation, technology acceptance, and competence of mentors); data collection strategy; recruitment strategy; challenges related to dropouts; and hindrances to recruitment, retention, and intervention fidelity and adherence. ResultsNursing students, nurse preceptors, and nurse educators had varied experiences with the TSGM intervention. We identified factors that make the intervention feasible and challenging and may influence the feasibility, acceptability, dropout rate, adherence, and fidelity of the intervention. We also identified areas for future improvement of the intervention. ConclusionsThe use of a newly developed intervention, TSGM, is feasible and accepted by undergraduate nursing students, nurse preceptors, and nurse educators; however, refinement and improvement of the intervention and the TOPP‑N app, improvement in intervention management, and mitigation of negative factors are necessary before a randomized controlled trial can be performed. International Registered Report Identifier (IRRID)RR2-10.2196/31646

Introduction Knowledge about long-term care services ability, regardless of if the service is home-based or facility-based, to provide an optimal and comprehensive fundamental nursing care (understood as focusing on physical, relational and psychosocial needs) consistently over time is sparse. Research into nursing indicates the presence of a discontinuous and fragmented healthcare service, and that fundamental nursing care such as mobilisation, nutrition and hygiene among older people (65 years and above) seems to be, regardless of reasons, systematically rationed by nursing staff. Thus, our scoping review aims to explore the published scientific literature on fundamental nursing care and continuity of care targeting older people’s needs while also describing identified nursing interventions with the same foci in a long-term care context.Methods and analysis The upcoming scoping review will be conducted in accordance with Arksey and O’Malley’s methodological framework for scoping studies. Search strategies will be developed and adjusted to each database, for example, PubMed, CINAHL and PsychINFO. Searches will be limited to the years 2002–2023. Studies focusing our aim, regardless of study design, will be eligible for inclusion. Included studies will be quality assessed and data will be charted using an extraction form. Textual data will be presented through a thematic analysis and numerical data by a descriptive numerical analysis. This protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol checklist.Ethics and dissemination The upcoming scoping review will take into consideration ethical reporting in primary research as part of the quality assessment. The findings will be submitted to an open-access peer-reviewed journal. Under the Norwegian Act on Medical and Health-related Research, this study does not need ethical clearance by a regional ethical review authority as it will not generate any primary data or obtain sensitive data or biological samples.

Abstract The systemic processes involved in the manifestation of life-threatening COVID-19 and in disease recovery are still incompletely understood, despite investigations focusing on the dysregulation of immune responses after SARS-CoV-2 infection. To define hallmarks of severe COVID-19 in acute disease (n = 58) and in disease recovery in convalescent patients (n = 28) from Hannover Medical School, we used flow cytometry and proteomics data with unsupervised clustering analyses. In our observational study, we combined analyses of immune cells and cytokine/chemokine networks with endothelial activation and injury. ICU patients displayed an altered immune signature with prolonged lymphopenia but the expansion of granulocytes and plasmablasts along with activated and terminally differentiated T and NK cells and high levels of SARS-CoV-2-specific antibodies. The core signature of seven plasma proteins revealed a highly inflammatory microenvironment in addition to endothelial injury in severe COVID-19. Changes within this signature were associated with either disease progression or recovery. In summary, our data suggest that besides a strong inflammatory response, severe COVID-19 is driven by endothelial activation and barrier disruption, whereby recovery depends on the regeneration of the endothelial integrity.

We have previously shown that the microRNA (miRNA) processor complex consisting of the RNAse Drosha and the DiGeorge Critical Region (DGCR) 8 protein is essential for B cell maturation. To determine whether miRNA processing is required to initiate T cell-mediated antibody responses, we deleted DGCR8 in maturing B2 cells by crossing a mouse with loxP-flanked DGCR8 alleles with a CD23-Cre mouse. As expected, non-immunized mice showed reduced numbers of mature B2 cells and IgG-secreting cells and diminished serum IgG titers. In accordance, germinal centers and antigen-specific IgG-secreting cells were absent in mice immunized with T-dependent antigens. Therefore, DGCR8 is required to mount an efficient T-dependent antibody response. However, DGCR8 deletion in B1 cells was incomplete, resulting in unaltered B1 cell numbers and normal IgM and IgA titers in DGCR8-knock-out mice. Therefore, this mouse model could be used to analyze B1 responses in the absence of functional B2 cells.

Introduction What nurses do and how they do it can influence older people’s experiences of the quality of long-term care. In addition, a clear role definition for nurses supports them in giving patients appropriate basic care. Despite this, there is a lack of a clear role definition regarding policy, work descriptions and expectations. Therefore, the objective of this scoping review is to map the literature on nurses’ role, function and care activities and/or nursing interventions, as well as to identify nursing interventions (as models of nursing care, patient care pathways and/or clinical practice guidelines) in relation to older people in long-term care. Hence, to explore how nurse’s role, function and care activities in relation to older people’s basic care needs are described and understood by key stakeholders (older people, their next of kin, nurses) in long-term care.Methods and analysis Arksey and O’Malley’s methodologic framework for scoping studies will be used for this upcoming scoping review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist will be followed. Search strategies will be developed in collaboration with the research team and an experienced librarian. Search strategies will be adjusted for each of the databases: PubMed, PsycINFO, CINAHL and Scopus. Data will be charted using a pilot extraction sheet. Quantitative data will be described numerically, and qualitative data will be analysed using thematic analysis. The key stakeholders will be consulted for validation.Ethics and dissemination The upcoming study will follow All European Academies' principles for good research. The findings will be used to inform the design of future studies aiming to develop a nursing intervention targeting older peoples’ basic care needs.

Introduction Older people receiving healthcare in long-term care contexts (eg, home healthcare, sheltered housing and nursing home contexts) are especially vulnerable to developing frailty and functional decline. Considering the negative effects associated with these conditions and the possibility of preventing them from progressing, it is vital that nurses possess a broad knowledge base related to them. Particularly as prevention related to these conditions lies well within their remit. Such knowledge could guide the development of effective models of care, ensuring continuity and, hence, quality of care. Our objective will be to review published literature on existing models of care targeting frailty and/or functional decline and how these conditions are described by older people themselves, significant others and nurses in relation to long-term care.Methods and analysis The scoping review will be conducted in accordance with Arksey and O’Malley’s methodological framework. Recent methodological developments will be considered. PubMed, CINAHL and PsycINFO will be searched. Eligibility criteria will be peer-reviewed papers and written in English. All types of study designs will be eligible and included papers will be quality and ethically assessed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-Protocol checklist for protocols and the PRISMA for Scoping Reviews checklist were followed in this paper.Ethics and dissemination As the study outlined in this protocol is a scoping review, no ethics approval was needed for this protocol nor for the upcoming study. The findings will be published in an open-access, peer-reviewed journal. Additionally, the findings will guide a research project following the Medical Research Council’s framework for developing and evaluating complex interventions. Thus, supporting us in developing a model of care related to the detection and prevention of frailty and/or functional decline among older people in a long-term care context.

BackgroundNursing education has increasingly focused on critical thinking among nursing students, as critical thinking is a desired outcome of nursing education. Particular attention is given to the potential of technological tools in guiding nursing students to stimulate the development of critical thinking; however, the general landscape, facilitators, and challenges of these guidance models remain unexplored, and no previous mixed methods systematic review on the subject has been identified. ObjectiveThis study aims to synthesize existing evidence on technology-supported guidance models used in nursing education to stimulate the development of critical thinking in nursing students in clinical practice. MethodsThis mixed methods systematic review adopted a convergent, integrated design to facilitate thematic synthesis. This study followed the guidelines of the Joanna Briggs Institute Manual for Evidence Synthesis. ResultsWe identified 3 analytical themes: learning processes implemented to stimulate critical thinking, organization of the learning process to stimulate critical thinking, and factors influencing the perception of the learning process. We also identified 4 guidance models, all based on facilitator or preceptorship models using tailored instructional or learning strategies and one or several technological tools that were either generic or custom-made for specific outcomes. The main facilitators of these technology-supported guidance models were nurse educators or nurse preceptors, and the main challenges in using technology-supported guidance models were the stress associated with technical difficulties or increased cognitive load. ConclusionsAlthough we were able to identify 4 technology-supported guidance models, our results indicate a research gap regarding the use of these models in nursing education, with the specific aim of stimulating the development of critical thinking. Both nurse preceptors and nurse educators play a crucial role in the development of critical thinking among nursing students, and technology is essential for such development. However, technology-supported guidance models should be supervised to mitigate the associated stress. International Registered Report Identifier (IRRID)RR2-10.2196/25126

BackgroundCritical thinking is an essential set of skills in nursing education, and nursing education therefore needs a sharper focus on effective ways to support the development of these skills, especially through the implementation of technological tools in nursing education. ObjectiveThe aim of this study protocol is to assess the feasibility of a technology-supported guidance model grounded in the metacognition theory for nursing students in clinical practice. MethodsBoth quantitative (research questionnaires) and qualitative (focus group interviews) approaches will be used to collect data for a feasibility study with an exploratory, flexible mixed methods design to test a newly developed intervention in clinical practice. ResultsThe intervention development was completed in December 2020. The intervention will be tested in 3 independent nursing homes in Norway. ConclusionsBy determining the feasibility of a technology-supported guidance model for nursing students in clinical practice, the results will provide information on the acceptability of the intervention and the suitability of the outcome measures and data collection strategy. They will also identify the causes of dropout and obstacles to retention and adherence. International Registered Report Identifier (IRRID)DERR1-10.2196/31646

Kontinuitet er en forutsetning for kvalitet i helsetjenestene våre, og et politisk og faglig mål. I denne artikkelen diskuteres kontinuitetens vilkår, og mulighetene for å oppnå kontinuitet i hjemmesykepleien med bakgrunn i tre vitenskapelige og empirisk baserte artikler. Artiklene beskriver en mangel på kontinuitet med hensyn til personkontinuitet og informasjonskontinuitet, og at ledere i hjemmesykepleien må gjøre motstridende prioriteringer som går på bekostning av kontinuitet. Utfordringer for kontinuitet som er knyttet til hjemmesykepleiens natur beskrives og diskuteres. Til slutt diskuteres ulike muligheter for å oppnå kontinuitet i hjemmesykepleien. Det argumenteres for at ikke alle pasienter har like stort behov for personkontinuitet, og at det derfor er behov for fleksibilitet med hensyn til når, og hvem ledere og fagpersonale reduserer antallet helsepersonell til. Fleksibel personkontinuitet fordrer stabil informasjonskontinuitet. Systematisk og strukturert dokumentasjon i pasientjournalen er avgjørende for å sikre kontinuitet uavhengig av grad av personkontinuitet. Ledere må gjøre bevisste og begrunnede valg og prioriteringer for å sikre kontinuitet og kvalitet i hjemmesykepleien. Nøkkelord: Hjemmesykepleie, kontinuitet, kvalitet, prioritering, organisering

Transgenic expression of B- and T-cell receptors (BCRs and TCRs, respectively) has been a standard tool to study lymphocyte development and function in vivo. The generation of transgenic mice is time-consuming and, therefore, a faster method to study the biology of defined lymphocyte receptors in vivo would be highly welcome. Using 2A peptide-linked multicistronic retroviral vectors to transduce stem cells, TCRs can be expressed rapidly in mice of any background. We aimed at adopting this retrogenic technology to the in vivo expression of BCRs. Using a well characterised BCR specific for hen egg lysozyme (HEL), we achieved surface expression of the retrogenically encoded BCR in a Rag-deficient pro B-cell line in vitro. In vivo, retrogenic BCRs were detectable only intracellularly but not on the surface of B cells from wild type or Rag2-deficient mice. This data, together with the fact that no BCR retrogenic mouse model has been published in the 7 years since the method was originally published for TCRs, strongly suggests that achieving BCR-expression in vivo with retrogenic technology is highly challenging if not impossible.

Activation-induced cytidine deaminase (AID) is a B-cell-specific DNA mutator that plays a key role in the formation of the secondary antibody repertoire in germinal center B cells. In the search for binding partners, protein coimmunoprecipitation assays are often performed, generally with agarose beads.We found that, regardless of whether cell lysates containing exogenous or endogenous AID were examined, one of two mouse AID forms bound to agarose alone.These binding characteristics may be due to the known post-translational modifications of AID; they may also need to be considered in coimmunoprecipitation experiments to avoid false-positive results.

Early identification and follow-up of sub-acute and acute functional decline in older persons living with multimorbidity at home require integrated and proactive care by interdisciplinary health personnel. Yet, in the context of the task-oriented and fragmented home healthcare services, early identification is challenging. Therefore, the aim of this study was to identify preconditions for the success of a proactive and interdisciplinary follow-up of older recipients of home healthcare. We conducted a qualitative secondary analysis of data from 6 focus group interviews with registered nurses and nurse leaders. In addition, we performed and analyzed data from 2 new focus group interviews with general practitioners and RNs who had a role as super users in a developmental project which introduced a clinical instrument for early identification of sub-acute and acute functional decline (sub-acute functional decline in the elderly—SAFE). Their experiences with using SAFE constituted the backdrop for the study. In total, 41 representatives of the interprofessional primary care staff of 3 city districts participated. Having a common goal, sharing tasks and having reciprocal understanding of each health profession's contribution, systems and tools and clinical leadership were all seen as important factors for succeeding in the proactive and interdisciplinary follow-up of older recipients of home healthcare. Clinical leadership was deemed the strongest precondition, and clear leadership which promotes integrative and proactive care by facilitating interdisciplinary collaboration appears to be the main key for success. [ABSTRACT FROM AUTHOR]

This paper answers a call from Nordic colleagues for new strategies in education to meet the needs of a new generation of bachelor nursing students regarding the development of clinical skills. We, as they, believe that educational models targeting the development of clinical skills must be customised to meet the learning style of the current and future generations of bachelor nursing students. In this paper we put forward that using a comprehensive, collaborative, student-centred approach will assist younger generations' learning processes. We describe a pedagogical model of peer learning that combines collaboration, reflection and assessment aligned with learning outcomes. Such an approach, we believe, is likely to be in line with expectations, needs and preconditions of the current and future generations of nursing students. [ABSTRACT FROM AUTHOR]

Abstract: Background: The Public Health Intervention Wheel (PHIW) is a population‐based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. Public health nurses (PHNs) provide care at the three levels of practice. Prevention of falls is a public health issue and the majority of falls happen at home. Therefore, prevention and management of falls in the community could benefit from a public health systems approach by PHNs underpinned by the PHIW. Case Presentation: A hypothetical case is presented of a 78‐year‐old gentleman who had a fall which resulted in a fractured right acetabulum and surgery before being discharged home. Methods: The aim of this paper was to use a case summary to illustrate PHN practice in the context of the PHIW as applied to falls management and prevention. This paper focuses on fall incidence and PHN response in Ireland and Norway. The PHIW is described and relevant interventions from the PHIW are applied to PHN practice in managing the case. Conclusions: The PHIW model provides insight into the potential scope of public health nursing in falls, articulating PHN practice in the community. [ABSTRACT FROM AUTHOR]

The study explores how older adults with limited digital experience become users of tablet computers (iPad) with Internet access, and how the tablet computers become part of their daily life facilitating active aging and thriving. Volunteer adolescents were mobilised to teach and follow up the participants regularly. [ABSTRACT FROM AUTHOR]

Research on the digital divide has moved beyond connectivity to skills and usage disparities. Yet for many older people lack of connectivity remains a challenge, and for those who do have access, skills and usage remain an issue. We report findings of an in-depth qualitative study of older people,s perceptions of online communications and also their actual experiences. Findings indicate that older people who are already socially well connected benefit from online communication more than those who are not. [ABSTRACT FROM AUTHOR]

The study explored how 125 older patients and 92 next of kin experienced and assessed continuity in long-term home health care. Data were collected by means of structured interviews. A majority of the patients indicated that having a high number of health care personnel involved in their care was not problematic. For patients, informed and skilled health personnel along with knowing the visiting personnel may compensate for a high number of personnel. For next of kin, accepting a high number of personnel was related to the carers being informed about the patient’s situation. This study indicates that, in terms of patient satisfaction, the overall quality of care is more important than the number of people providing the care. [ABSTRACT FROM AUTHOR]

This paper outlines an emerging typology of older users of information and communication technology (ICT) to facilitate active aging. Through inductive data analysis from focus groups, iterative workshops, and personal interviews, we suggest three types of technology users. These types are “the Excluded,” “the Entertained,” and “the Networker.” Clearly, ICT offers several benefits to those who are enthusiastic and frequent users, exemplified as the Entertained and the Networker. Hence, our findings support the notion of technology as a tool to maintain or increase an older person’s engagement and activity level. Conversely, for those reluctant, uninterested, or incapable of using ICT, such potentials are limited and imply fewer opportunities for participation in activities. [ABSTRACT FROM AUTHOR]

Background: Critical thinking is an essential skill that nursing students need to develop. Technological tools have opened new avenues for technology-supported guidance models, but the challenges and facilitators of such guidance models, as well as how they stimulate the development of critical thinking, remain unclear. Objective: We developed a protocol for a mixed methods systematic review to investigate the use of technology-supported guidance models that stimulate the development of critical thinking in nursing education clinical practice. Methods: A convergent integrated design following the Joanna Briggs Institute Manual for Evidence Synthesis will be employed. A pair of authors will select the articles by screening titles and abstracts, and the methodological quality of the articles included in the review will be assessed by a pair of authors according to checklists for specific study designs. The data will be extracted using the standardized Joanna Briggs Institute mixed methods data extraction form and following a convergent integrated approach. The thematic synthesis for data transformation will be used. Results: Development of a comprehensive systematic search strategy was completed in October 2020. The database searches were performed on October 21, 2020. As of January 2021, analysis and synthesis is ongoing. Completion of this review is expected by January 2021. Conclusions: By combining evidence from studies with varied methodological approaches, the results should provide broad insight into the use of technology-supported guidance models for clinical practice in nursing education with a focus on the development of nursing students' critical thinking. The results of this mixed methods systematic review can also be used to develop or improve current technology-supported guidance models for clinical practice in nursing education. International Registered Report Identifier (IRRID): PRR1-10.2196/25126 JMIR Res Protoc 2021;10(1):e25126 doi:10.2196/25126 We help JMIR researchers to raise funds to pursue their research and development aimed at tackling important health and technology challenges. If you would like to show your support for this author, please donate using the button below. The funds raised will directly benefit the corresponding author of this article (minus 8% admin fees). Your donations will help this author to continue publishing open access papers in JMIR journals. Donations of over $100 may also be acknowledged in future publications. Suggested contribution levels: $20/$50/$100 [ABSTRACT FROM AUTHOR]