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Abstract Background Advancements in digital technologies and the coronavirus disease pandemic have rapidly shifted educational practices towards engaging digital methods, such as serious games, significantly influencing healthcare education. Digital serious games enhance nursing education by effectively overcoming limitations such as limited training time and inadequate resources, thereby improving knowledge and skills. Few high-quality systematic reviews and meta-analyses were focused exclusively on randomized controlled trials (RCTs) of digital serious games to determine their effects in nursing education. Objective To evaluate the effects of digital serious games on nursing education through a systematic review and meta-analysis using the Kirkpatrick model to evaluate learning and behavioral changes. Methods A systematic review and meta-analysis of RCTs was performed. Six databases were searched for articles published before April 2024. Risk of bias was assessed using the Revised Cochrane Risk of Bias tool for randomized trials. A sensitivity analysis was performed. Outcome variables were categorized according to the Kirkpatrick model. Effect sizes were determined using Hedges’ g in a random-effects model. Subgroup analysis was performed. Results The quality appraisal results revealed that all the studies exhibited a low risk of bias across these domains. Eleven studies were included in the systematic review, and eight studies, in the meta-analysis. The intervention group showed significant improvements in knowledge (Hedges’ g = 0.75, 95% confidence interval (CI) = [0.27, 1.22], p = .002, I² = 90.51%), confidence (Hedges’ g = 0.73, 95% CI = [0.23, 1.24], p = .005, I² = 82.71%), and performance (Hedges’ g = 0.49, 95% CI = [0.17, 0.80], p = .003, I² = 56.60%). Subgroup analysis showed a significant improvement in knowledge when the intervention period exceeded 2 weeks (Hedges’ g = 0.53, 95% CI = [0.32, 0.74], p

Abstract Background Nursing handoff competency is the ability of the nurse performing the handoff to select and interpret the necessary information for patient care and to convey it efficiently to the nurse accepting the handoff. Nursing handoff is an important nursing task that ensures nursing care continuity, quality and patient safety. This study aimed to develop a scale to measure nursing handoff competency and verify its validity and reliability. Methods This study adopted a methodological design. A research process included three phases: (1) scale development (literature review and interviews); (2) scale validation (validity and reliability); (3) standard setting. Data were collected from 496 clinical nurses currently working in hospital wards, intensive care units, and emergency rooms, and who independently perform a handoff in South Korea. Results The final scale comprises a self-reported 4-points Ilert scale with 25 items based on four factors: knowledge on handoff methods, identification of patient information, judgment and transfer of nursing situation, and “formation of supportive relationships. Construct validity, criterion-related validity, and discrimination validities were verified and the fitness of the scale revealed good results in confirmatory factor analysis. The Cronbach’s α of the whole tool was.912 and the cut-off score for satisfied/unsatisfied was.72. Conclusions The developed scale can evaluate the nurse’s handoff competencies and determine whether training is necessary. The measurement results of the scale can be used to select training subjects and compose the contents of the education program.

The incidence of cardiovascular diseases, such as high blood pressure, is increasing worldwide, owing to population aging and irregular lifestyle habits. Previous studies have reported the vasorelaxant effects of Prunus yedoensis bark methanol extract. However, various solvent extracts of P. yedoensis bark and their vascular relaxation mechanisms have not been sufficiently studied. We prepared extracts of P. yedoensis bark using various solvents (water, 30% ethanol, and 70% ethanol). P. yedoensis bark 30% ethanol extract (PYB-30E) decreased the expression of vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and E-selectin in human umbilical vein endothelial cells (HUVECs) activated with 200 ng/mL TNF-α. Additionally, PYB-30E showed vasodilatory effects on isolated rat aortic rings. This was confirmed to be the result of the activation of the NO/cGMP pathway, regulation of non-selective calcium-activated K+ channels, and calcium channel blockade. Additionally, PYB-30E significantly reduced systolic and diastolic blood pressure in spontaneously hypertensive rats (SHR). Taken together, our results indicated that PYB-30E is a candidate functional material with preventive and therapeutic effects against hypertension.

Abstract Background Critical reflection is an effective learning strategy that enhances clinical nurses’ reflective practice and professionalism. Therefore, training programs for nurse educators should be implemented so that critical reflection can be applied to nursing education. This study aimed to investigate the effects of a critical reflection competency program for clinical nurse educators on improving critical thinking disposition, nursing reflection competency, and teaching efficacy. Methods A pilot study was conducted using a pre- and post-test control-group design. Participants were clinical nurse educators recruited using a convenience sampling method. The program was conducted once a week for 90 min, with a total of four sessions. The effectiveness of the developed program was verified by analyzing pre- and post-test results of 26 participants in the intervention group and 27 participants in the control group, respectively. The chi-square test, independent t-test, Mann-Whitney U test, and analysis of covariance with age as a covariate were conducted. Results The critical thinking disposition and teaching efficacy of the intervention group improved after the program, and the differences between the control and intervention groups were statistically significant (F = 14.751, p

Hypertension is the crucial modifiable risk factor for cardiovascular diseases, and efforts to identify functional foods that are effective for hypertension control are increasing. The nutgall tree (NT, Rhus chinensis Mill.) is used in traditional medicine and food because of its medicinal value. However, the role of NT in hypertension has not been investigated. Therefore, the hypotensive effect of NT leaf ethanol extract (NTE) was investigated in spontaneously hypertensive rats (SHRs). SHRs were allocated to three groups (control, 300, or 1000 mg/kg NTE), and blood pressure was measured before and after oral administration. Systolic and diastolic blood pressure significantly decreased in the NTE 1000 mg/kg group and was the lowest at 2 h after administration (−26.4 ± 10.3, −33.5 ± 9.8%, respectively). Daily NTE administration for five days also resulted in a similar effect. Further, the vasorelaxant effects and related mechanisms were investigated in the aortas of Sprague Dawley rats. NTE showed the dose-dependent blood-vessel-relaxing effect, and its mechanism involves the NO-sGC-cGMP pathway, activation of K+ channels, and reduction in the vasoconstrictive action of angiotensin II. Therefore, our study provides basic data indicating the potential use of NTE as a functional food for high blood pressure.

Natural compounds, known for diverse pharmacological properties, have attracted attention as potential sources for hypertension treatment. Previous studies have revealed the hypotensive effect and vascular relaxation of prunetin, a natural compound derived from Prunus yedoensis. However, the potential blood pressure-lowering and vasorelaxant effects of sakuranetin, another representative compound found in plants belonging to the genus Prunus, have remained unexplored. We aimed to fill this gap by investigating the hypotensive and vasorelaxant effects of sakuranetin in rats. Results indicated that sakuranetin, particularly in the sakuranetin 20 mg/kg group, led to significant reductions in systolic blood pressure (SBP) and diastolic blood pressure (DBP) by −14.53 ± 5.64% and −19.83 ± 6.56% at 4 h after administration. In the sakuranetin 50 mg/kg group, the SBP and DBP decreased by −13.27 ± 6.86% and −16.62 ± 10.01% at 2 h and by −21.61 ± 4.49% and −30.45 ± 5.21% at 4 h after administration. In addition, we identified the vasorelaxant effects of sakuranetin, attributing its mechanisms to the inhibition of calcium influx and the modulation of angiotensin II. Considering its hypotensive and vasorelaxant effects, sakuranetin could potentially serve as an antihypertensive agent. However, further research is required to evaluate the safety and long-term efficacy.

Hypertension is one of the most common chronic diseases, and its prevalence is increasing worldwide. Lindera glauca (Siebold & Zucc.) Blume, known as grayblue spicebush (GS), has been used as food and for medicinal purposes; however, studies about its hypotensive or vasorelaxant effects are lacking. Therefore, the hypotensive effect of an ethanolic extract of the GS branch (GSE) was investigated in 15-week-old spontaneously hypertensive rats (SHRs) using the tail cuff method. The GSE administration group (1000 mg/kg SHR body weight) showed a decrease in their systolic and diastolic blood pressure measured 4 h after its administration. In addition, we investigated its vasorelaxant effect using the thoracic aorta dissected from Sprague-Dawley rats. The GSE (0.5, 1, 2, 5, 10, and 20 μg/mL) showed an endothelium-dependent vasorelaxant effect, and its mechanisms were found to be relevant to the inward rectifier, voltage-dependent, and non-selective K+ channels. Moreover, the GSE (20 μg/mL) showed an inhibitory effect on aortic rings constricted with angiotensin II. Considering its hypotensive and vasorelaxant effects, GSE has potential as a functional food to help treat and prevent high blood pressure. However, further studies on the identification of the active components of GSE and safety evaluations of its use are needed.

Abstract Aim This study aimed to identify the nature and meaning of continued smoking in male stroke patients based on a deep understanding of their lived experiences. Design Phenomenological qualitative methodology. Methods In total, 10 male stroke patients participated in this study. We used purposive sampling for recruitment. Data collection was performed through in‐depth interviews and analysis through van Manen's methodology. Results Five essential themes were derived from the analyses and described participants’ experiences with continued smoking, as follows: “Natural relapse into smoking,” “Behaving like a healthy person,” “Believing that smoking will not be a problem,” “Finding consolation in smoking behaviour,” and “Consoling oneself by the rationalization of smoking behaviour.” Conclusion The results showcased the need for the development of a smoking cessation educational programme tailored for male stroke patients who have perceptions towards being “like healthy people” after early recovery and who think that smoking is not a problematic behaviour. Participants’ reports underpinned the necessity for these programmes to have contents focused on the transformation of patients’ awareness toward their own health status.

Purpose This study aimed to develop the examination objectives based on nursing competency of the Korean Nursing Licensing Examination. Methods This is a validity study to develop the examination objectives based on nursing competency. Data were collected in December 2021. We reviewed the literature related to changing nurse roles and on the learning objectives for the Korea Medical Licensing Examination and other health personnel licensing examinations. Thereafter, we created a draft of the nursing problems list for examination objectives based on the literature review, and the content validity was evaluated by experts. A final draft of the examination objectives is presented and discussed. Results A total of 4 domains, 12 classes, and 85 nursing problems for the Korean Nursing Licensing Examination were developed. They included the essentials of objectives, related factors, evaluation goals, related activity statements, related clients, related settings, and specific outcomes. Conclusion This study developed a draft of the examination objectives based on clinical competency that were related to the clinical situations of nurses and comprised appropriate test items for the licensing examination. Above results may be able to provide fundamental data for item development that reflects future nursing practices.

Purpose: This study compares the expected nurse-to-patient ratio, penalties for violating these regulations, and the laws enacted in the medical and nursing fields in Korea and advanced countries like Germany, Australia, the United States, and Japan. Methods: This study deployed an integrative review method and used search terms such as “nursing law,” “nurse ratio,” “nurse,” “nurse staffing,” “health,” and “staffing” to find articles published in English, Korean, German, or Japanese through Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, the Westlaw (International Materials-Jurisdiction) site, US government and state sites (federal parliament, National Conference of State Legislatures), and Google Scholar. Results: Compared with medical laws in other advanced countries, Korean laws are quite crude and its nurse-to-patient ratio does not reflect patients' status. Korea also lacks strict penalties for nurse staffing ratio violations. Conclusion: Korea requires a strong regulatory apparatus for nurse staffing in health-care organizations to improve the quality of its health-care services and patient safety.

Inotodiol, an oxysterol found only in Chaga mushroom, has received attention from the pharmaceutical industry due to its strong antioxidant and anti-allergic activities. However, the production of inotodiol is still challenging, and its fundamental properties have yet to be investigated. This study aims to develop an efficient method to produce high-purity inotodiol from Chaga mushroom. Then, pure inotodiol was used to assess its physicochemical properties and biological activities. By optimizing the solvent used for extraction and purification, a new method to produce inotodiol was developed with high purity (>97%) and purification yield (33.6%). Inotodiol exhibited a melting point (192.06 °C) much higher than lanosterol and cholesterol. However, the solubility of inotodiol in organic solvents was notably lower than those of the other two sterols. The difference in the hydroxyl group at C-22 of inotodiol has shown the distinctive physicochemical properties of inotodiol compared with cholesterol and lanosterol. Based on those findings, a nonionic surfactant-based delivery system for inotodiol was developed to improve its bioavailability. The inotodiol microemulsion prepared with 1–2% Tween-80 exhibited homogenous droplets with an acceptable diameter (354 to 217 nm) and encapsulation efficiency (85.6–86.9%). The pharmacokinetic analysis of inotodiol microemulsion in oral administration of 4.5 mg/kg exhibited AUC0–24h = 341.81 (ng·h/mL), and Cmax = 88.05 (ng/mL). Notably, when the dose increased from 4.5 to 8.0 mg/kg, the bioavailability of inotodiol decreased from 41.32% to 33.28%. In a mouse model of sepsis, the serum level of interleukin-6 significantly decreased, and the rectal temperature of mice was recovered in the inotodiol emulsion group, indicating that inotodiol microemulsion is an effective oral delivery method. These results could provide valuable information for applying inotodiol in functional food, cosmetic, and pharmaceutical industries.

Purpose This study explored the possibility of using the Angoff method, in which panel experts determine the cut score of an exam, for the Korean Nursing Licensing Examination (KNLE). Two mock exams for the KNLE were analyzed. The Angoff standard setting procedure was conducted and the results were analyzed. We also aimed to examine the procedural validity of applying the Angoff method in this context. Methods For both mock exams, we set a pass-fail cut score using the Angoff method. The standard setting panel consisted of 16 nursing professors. After the Angoff procedure, the procedural validity of establishing the standard was evaluated by investigating the responses of the standard setters. Results The descriptions of the minimally competent person for the KNLE were presented at the levels of general and subject performance. The cut scores of first and second mock exams were 74.4 and 76.8, respectively. These were higher than the traditional cut score (60% of the total score of the KNLE). The panel survey showed very positive responses, with scores higher than 4 out of 5 points on a Likert scale. Conclusion The scores calculated for both mock tests were similar, and were much higher than the existing cut scores. In the second simulation, the standard deviation of the Angoff rating was lower than in the first simulation. According to the survey results, procedural validity was acceptable, as shown by a high level of confidence. The results show that determining cut scores by an expert panel is an applicable method.

Abstract Background Critical reflection is effective in improving students’ communication abilities and confidence. The aim of this study was to evaluate the effectiveness of a work-based critical reflection program to enhance novice nurses’ clinical critical-thinking abilities, communication competency, and job performance. Methods The present study used a quasi-experimental design. From October 2014 to August 2015, we collected data from 44 novice nurses working in an advanced general hospital in S city in Korea. Nurses in the experimental group participated in a critical reflection program for six months. Outcome variables were clinical critical-thinking skills, communication abilities, and job performance. A non-parametric Mann-Whitney U-test and a Wilcoxon rank sum test were selected to evaluate differences in mean ranks and to assess the null hypothesis that the medians were equal across the groups. Results The results showed that the clinical critical-thinking skills of those in the experimental group improved significantly (p = 0.003). The differences in mean ranks of communication ability between two groups was significantly statistically different (p = 0.028). Job performance improved significantly in both the experimental group and the control group, so there was no statistical difference (p = 0.294). Conclusions We therefore suggest that a critical reflection program be considered an essential tool for improving critical thinking and communication abilities among novice nurses who need to adapt to the clinical environment as quickly as possible. Further, we suggest conducting research into critical reflection programs among larger and more diverse samples.

Detecting objects in synthetic aperture radar (SAR) imagery has received much attention in recent years since SAR can operate in all-weather and day-and-night conditions. Due to the prosperity and development of convolutional neural networks (CNNs), many previous methodologies have been proposed for SAR object detection. In spite of the advance, existing detection networks still have limitations in boosting detection performance because of inherently noisy characteristics in SAR imagery; hence, separate preprocessing step such as denoising (despeckling) is required before utilizing the SAR images for deep learning. However, inappropriate denoising techniques might cause detailed information loss and even proper denoising methods does not always guarantee performance improvement. In this paper, we therefore propose a novel object detection framework that combines unsupervised denoising network into traditional two-stage detection network and leverages a strategy for fusing region proposals extracted from both raw SAR image and synthetically denoised SAR image. Extensive experiments validate the effectiveness of our framework on our own object detection datasets constructed with remote sensing images from TerraSAR-X and COSMO-SkyMed satellites. Extensive experiments validate the effectiveness of our framework on our own object detection datasets constructed with remote sensing images from TerraSAR-X and COSMO-SkyMed satellites. The proposed framework shows better performances when we compared the model with using only noisy SAR images and only denoised SAR images after despeckling under multiple backbone networks.

Purpose: The purpose of this study was to develop a revised version of the clinical critical thinking skills test (CCTS) and to subsequently validate its performance. Methods: This study is a secondary analysis of the CCTS. Data were obtained from a convenience sample of 284 college students in June 2011. Thirty items were analyzed using item response theory and test reliability was assessed. Test-retest reliability was measured using the results of 20 nursing college and graduate school students in July 2013. The content validity of the revised items was analyzed by calculating the degree of agreement between instrument developer intention in item development and the judgments of six experts. To analyze response process validity, qualitative data related to the response processes of nine nursing college students obtained through cognitive interviews were analyzed. Results: Out of initial 30 items, 11 items were excluded after the analysis of difficulty and discrimination parameter. When the 19 items of the revised version of the CCTS were analyzed, levels of item difficulty were found to be relatively low and levels of discrimination were found to be appropriate or high. The degree of agreement between item developer intention and expert judgments equaled or exceeded 50%. Conclusion: From above results, evidence of the response process validity was demonstrated, indicating that subjects respondeds as intended by the test developer. The revised 19-item CCTS was found to have sufficient reliability and validity and will therefore represents a more convenient measurement of critical thinking ability.

Purpose: The purpose of the study was to examine the attitudes of acute care nurses towards dementia, their critical reflection competency, and the level of nursing work environment and to identify the factors relating to person-centered nursing. Methods: The study was conducted for 149 nurses with at least 1 year of experience working in acute care hospitals and providing nursing care to hospitalized elderly patients. The measurements used were the Dementia Attitude Scale Korean version, the Critical Reflection Competency Scale, the Nursing Work Environment Scale, and the Person-Centered Nursing Assessment Tool. The collected data were analyzed with frequency analysis, descriptive statistics, independent t-test, ANOVA test, Pearson’s correlation, and multiple regression using IBM SPSS 29.0 software. Results: The factors influencing person-centered nursing performance were critical reflection competency (β=.49, p<.001), attitudes towards dementia (β=.29, p<.001), and clinical career (β=-.26, p=.024), having the explanation power of 59.6%. Conclusion: The results of this study indicate that critical reflection competency, attitudes towards dementia, and clinical career have an impact on person-centered nursing performance. Specifically, higher levels of critical reflection competency and positive attitudes towards dementia were predictors with higher levels of person-centered nursing performance. Therefore, to enhance person-centered nursing performance among acute care nurses, it is important to prioritize critical reflection training programs for experienced nurses to enhance their critical reflection competency. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the moderating role of positive psychological capital on the effects of clinical nurses' responses to violence on burnout and to provide basic date for an intervention program that reduces nurse burnout. Methods: The participants in this study were 172 nurses recruited through convenience sampling at one general hospital in Seoul. Data were collected from June 5 to 10, 2023 using structured questionnaires. The collected data were analyzed using SPSS/WIN 26.0. Results: Burnout was positively correlated with violence responses and negatively correlated with positive psychological capital among clinical nurses. Verbal violence experience (β=.14, p=.014), job satisfaction (β=.31, p<.001), social violence response (β=.15, p=.035) and positive psychological capital (β=-.39, p<.001) were identified as factors significantly influencing clinical nurses' burnout. The interaction term between social violence response and positive psychological capital significantly influenced burnout (β=.18, p=.044). Conclusion: Social violence response affected burnout among clinical nurses, and positive psychological capital was identified as a moderating factor in burnout. Therefore, hospital and nursing organizational efforts such as fostering an appropriate organizational atmosphere, providing social support that encourages trust and creativity among organizational members, and implementing various educational and mentoring programs are required to reduce nurses' social violence response and enhance positive psychological capital. [ABSTRACT FROM AUTHOR]

Purpose: This study was conducted to provide fundamental data for improving the quality of care by investigating the relationships of critical reflection competency, nursing practice environment, job crafting, and person-centered care among tertiary hospital nurses. Additionally, the study sought to identify the factors influencing person-centered care. Methods: Data were collected from 132 tertiary hospital nurses with at least 1 year of work experience via an online survey conducted in January 2023. Results: Person-centered care varied significantly according to age, clinical experience, and department. Significant correlations of person-centered care with critical reflection competency (r=.77, p<.001), nursing practice environment (r=.46, p<.001), and job crafting (r=.71, p<.001) were observed. Factors contributing to person-centered care among tertiary hospital nurses included critical reflection competency (β=.46, p<.001) and job crafting (β=.40, p<.001), with an explanatory power of 70.2%. Conclusion: To provide ethically enhanced person-centered care in tertiary hospitals, various training programs must be developed to strengthen nurses' critical reflection competency and job crafting skills. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to review the outcomes of nurse residency programs for new graduate nurses. Methods: The inclusion criteria were peer-reviewed articles on the outcomes of nurse residency programs for new graduate nurses published in English from 2010 to 2019. A literature search was conducted in the PubMed, CINAHL, Science Direct, EMBASE, and PsycINFO databases using the search terms "nurse residency program," "new graduate nurse," and "transition to practice program." A qualitative appraisal of studies was conducted using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Results: Twenty-five studies were selected. The systematic review found that nurse residency programs effectively increased the competence and confidence of new graduate nurses in 14 studies. Job satisfaction, job stress and anxiety, and support showed different results, which were increased, decreased, or statistically insignificant after the programs. In three studies, institutional outcomes, including the retention rate in 16 surveys and hospital cost savings, were improved. Patient safety had different results depending upon the study. Conclusion: This study's results can provide evidence for the necessity of a standardized nursing education program and for developing a system for evaluating its effectiveness to improve the quality of nursing education. [ABSTRACT FROM AUTHOR]

Purpose: Comprehensive nursing care services are provided for patient-centered nursing care in Korea. This study was conducted to compare differences in the frequency and elapsed time of nursing activities between comprehensive nursing care units and general medical-surgical units. Methods: This is a descriptive study design using direct observation of nursing care activities. A time and motion study on the frequency and elapsed time of nursing activities provided by nurses was conducted in the comprehensive nursing care units and general units of two small-to-medium sized hospitals. Data were collected for 64 hours in each hospital, through a two-way method using a checklist and a camera recorder. Results: The total number of nursing activities, activities provided per patient and patient safety care including clinical assessment and treatment were higher in the comprehensive nursing care units compared to general units. We found similar findings regarding the duration of nursing activities. Conclusion: Comprehensive nursing care units provide patient-centered nursing care and have a broader range of nursing activities for patient safety than general units. Assessments conducted to meet nursing needs and to promote safe nurse staffing should reflect the characteristics of the nursing tasks performed in comprehensive nursing care units. [ABSTRACT FROM AUTHOR]

Background: Simulation-based nursing education is an increasingly popular pedagogical approach. It provides students with opportunities to practice their clinical and decision-making skills through various real-life situational experiences. However, simulation approaches fall along a continuum ranging from low-fidelity to high-fidelity simulation. The purpose of this study was to determine the effect size of simulation-based educational interventions in nursing and compare effect sizes according to the fidelity level of the simulators through a meta-analysis. Method: This study explores the quantitative evidence published in the electronic databases EBSCO, Medline, ScienceDirect, ERIC, RISS, and the National Assembly Library of Korea database. Using a search strategy including the search terms "nursing," "simulation," "human patient," and "simulator," we identified 2279 potentially relevant articles. Forty studies met the inclusion criteria and were retained in the analysis. Results: This meta-analysis showed that simulation-based nursing education was effective in various learning domains, with a pooled random-effects standardized mean difference of 0.70. Subgroup analysis revealed that effect sizes were larger for high-fidelity simulation (0.86), medium-fidelity simulation (1.03), and standardized patients (0.86) than they were for low-fidelity and hybrid simulations. In terms of cognitive outcomes, the effect size was the largest for high-fidelity simulation (0.50). Regarding affective outcome, high-fidelity simulation (0.80) and standardized patients (0.73) had the largest effect sizes. Conclusions: These results suggest that simulation-based nursing educational interventions have strong educational effects, with particularly large effects in the psychomotor domain. Since the effect is not proportional to fidelity level, it is important to use a variety of educational interventions to meet all of the educational goals. [ABSTRACT FROM AUTHOR]