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☐ ☆ ✇ Journal of Advanced Nursing

The Impact of Game‐Based Teaching on Undergraduate Nursing Students' Learning Satisfaction, Clinical Thinking, Clinical Skills and Anxiety: A Systematic Review and Meta‐Analysis

Por: Yuling Luo · Hong Yan · Yan Liu · Yuanyuan Tang · Tingting Zhang · Shijin Wang · Zhehui Yang — Julio 1st 2025 at 13:14

ABSTRACT

Aim

To evaluate the impact of game-based teaching on undergraduate nursing students' learning satisfaction, clinical thinking, clinical skills, and anxiety.

Design

Systematic review and meta-analysis.

Data Sources

China National Knowledge Infrastructure, Wanfang, Weipu, SinoMed, CINAHL, PubMed, Web of Science, Cochrane Library, and Embase. Our systematic literature search was conducted up to 31 October 2024 and included all studies published before this date, with no restrictions on publication year.

Methods

The study quality was appraised using version 1 of the Cochrane risk-of-bias tool and the JBI Critical Appraisal Tools for Quasi-Experimental Studies. A meta-analysis was performed using STATA version 12.

Results

1712 undergraduate nursing students from 19 studies were included. Meta-analysis showed that game-based teaching improved undergraduate nursing students' learning satisfaction, critical thinking, clinical decision-making, and clinical skills. Game-based teaching did not significantly enhance undergraduate nursing students' problem-solving skills.

Conclusions

Our research findings indicated that game-based teaching had more significant potential to enhance undergraduate nursing students' learning satisfaction, critical thinking, clinical decision-making, and clinical skills. However, game-based teaching did not show a substantial advantage in improving problem-solving skills compared to other teaching methods. Limited studies of the effects of game-based teaching on clinical reasoning and anxiety in nursing students cannot be meta-analysed. Future studies could improve how game-based learning is designed to support undergraduate nursing students' development of these competencies.

Impact

This study explores the effects of game-based teaching in nursing education and finds that it promotes learning satisfaction, critical thinking, clinical decision-making, and clinical skills in undergraduate nursing students, while having no significant effect on problem-solving skills. Game-based teaching can be a functional pedagogical approach to guide nursing educators to improve learning outcomes for undergraduate nursing students.

Patient or Public Contribution

Inapplicable.

☐ ☆ ✇ International Wound Journal

Prevention of Intraoperative Acquired Pressure Injury in Patients With Head and Neck Cancer and Its Effect on Skin Microclimate: A Single‐Blind Randomised Controlled Trial

Por: Xueying Xie · Mianmian Chen · Fenfen Wang · Bifang Liao · Xiaohong Yang · Chaoman Zhuang · Jingjing Huang — Marzo 30th 2025 at 09:00

ABSTRACT

This study investigated alterations in the skin microclimate of the sacrococcygeal compression area in patients with malignant head and neck tumours before and after surgery. Additionally, it evaluated the effect of preventive dressings on the skin microclimate in this area and their association with intraoperative acquired pressure injuries (IAPIs), aiming to provide a foundation for preventing and reducing these injuries. Thirty patients were randomly assigned into control and two intervention groups. The sacrococcygeal skin of the control group was not protected by preventive dressing. Intervention group A was protected by silicone foam dressing, and intervention group B received a combination of liquid dressing and silicone foam dressing. Sacrococcygeal skin temperature, skin moisture levels and sebum were measured at admission, before and after surgery, and post-operative skin and pain were evaluated. There were no significant differences in skin temperature, moisture levels or sebum between the three groups before and after the intervention. The incidence of IAPI was significantly different (χ 2 = 6.240, p = 0.044). No significant difference was observed in post-operative pain incidence. Preventive dressings did not significantly alter the skin microclimate but reduced the risk of IAPIs.

☐ ☆ ✇ Journal of Advanced Nursing

Motivations, Capacity Preparations and Development of Specialist Nurses: A Descriptive Phenomenological Qualitative Study

Por: Yu Zhao · Shiyu Wang · Siyu Fan · Na Zhang · Zhi Li · Yifeng Gu · Qun Wei · Bihong Yang · Weijuan Ye · Fengping Liu — Febrero 25th 2025 at 11:58

ABSTRACT

Aim

To explore the motivations, capacity preparations and career development plans of specialist nurses (SNs) to provide insights for promoting further specialisation in nursing and enhancing the quality of nursing services.

Design

A descriptive phenomenological qualitative study was conducted.

Methods

The study was conducted from April to May 2024 at a tertiary hospital in China. A purposive sampling method was used to recruit 35 nurses from various departments of the hospital who had completed specialist nursing training and obtained the necessary qualifications. These SNs participated in face-to-face semi-structured interviews.

Results

Three overarching themes and ten subthemes were extracted. (1) career choices for SNs, included the following subthemes: ‘Social support’, ‘Specialist nursing is charismatic’, ‘Demand for specialized nursing’ and ‘Possessing specialized nursing qualities’. (2) career preparations for SNs, comprised subthemes such as ‘Professional preparation’, ‘Quality requirements’ and ‘Qualification requirements’. (3) career development for SNs, encompassed subthemes like ‘Personal growth’, ‘Team building’ and ‘Disciplinary developments’.

Conclusions

This study explores the motivations and experiences of SNs' career transitions, highlighting social support, the appeal of specialty nursing, industry demand and professional competence. Governments should provide resources for career preparation, while nurses should enhance their knowledge and skills. Becoming a SN marks a new career phase, requiring skill improvement, teamwork and discipline involvement. The study offers insights for general nurses transitioning to specialty nursing and informs SNs' career planning.

Implications for the Profession

These findings provide important guidance for the career development of nurses as specialists, highlighting the crucial role of government, hospitals and nursing advocates in fostering their professional growth.

Reporting Method

The study was reported following the Consolidated Criteria for Reporting Qualitative Research Checklist.

Patient or Public Contribution

No patient or public contribution.

Impact Statement

(1) Impact on patients: this study underscores the significance of specialised nursing care and its potential to improve patient outcomes through enhanced expertise and individualised care. (2) Impact on clinical practice: by identifying the motivations and preparations for SNs' career transitions, the research emphasises the importance of specialised knowledge and continuous professional development to enhance clinical practice and quality of care. (3) Impact on education: the study advocates for more comprehensive educational programs and continuous professional development for SNs, ensuring they stay updated with the latest practices and research. (4) Impact on social and economic issues: Promoting specialty nursing can help address healthcare challenges, particularly with aging populations and chronic diseases, improving healthcare efficiency and reducing costs through targeted care.

Implications for Practice/Policy

(1) Establishing a standardised training and certification system is essential to ensure the professionalism, consistency and quality of specialist nursing practice. (2) Developing well-defined career pathways with research opportunities, leadership training and skill enhancement programs fosters SNs' professional growth, and strengthens their ability to adapt to evolving healthcare demands. (3) Enhancing professional autonomy and interdisciplinary collaboration will maximise the impact of SNs in improving patient care and driving healthcare innovation.

☐ ☆ ✇ Journal of Clinical Nursing

Development of a Deep Learning‐Based Model for Pressure Injury Surface Assessment

Por: Ankang Liu · Hualong Ma · Yanying Zhu · Qinyang Wu · Shihai Xu · Wei Feng · Haobin Liang · Jian Ma · Xinwei Wang · Xuemei Ye · Yanxiong Liu · Chao Wang · Xu Sun · Shijun Xiang · Qiaohong Yang — Enero 15th 2025 at 04:13

ABSTRACT

Aim

To develop a deep learning-based smart assessment model for pressure injury surface.

Design

Exploratory analysis study.

Methods

Pressure injury images from four Guangzhou hospitals were labelled and used to train a neural network model. Evaluation metrics included mean intersection over union (MIoU), pixel accuracy (PA), and accuracy. Model performance was tested by comparing wound number, maximum dimensions and area extent.

Results

From 1063 images, the model achieved 74% IoU, 88% PA and 83% accuracy for wound bed segmentation. Cohen's kappa coefficient for wound number was 0.810. Correlation coefficients were 0.900 for maximum length (mean difference 0.068 cm), 0.814 for maximum width (mean difference 0.108 cm) and 0.930 for regional extent (mean difference 0.527 cm2).

Conclusion

The model demonstrated exceptional automated estimation capabilities, potentially serving as a crucial tool for informed decision-making in wound assessment.

Implications and Impact

This study promotes precision nursing and equitable resource use. The AI-based assessment model serves clinical work by assisting healthcare professionals in decision-making and facilitating wound assessment resource sharing.

Reporting Method

The STROBE checklist guided study reporting.

Patient or Public Contribution

Patients provided image resources for model training.

☐ ☆ ✇ PLOS ONE Medicine&Health

Risk factors for conversion to thoracotomy in patients with lung cancer undergoing video-assisted thoracoscopic surgery: A meta-analysis

Por: Siyu Wang · Hong Yan · Jun Wen · Zitong Zhou · Jialan Xu — Noviembre 15th 2024 at 15:00

by Siyu Wang, Hong Yan, Jun Wen, Zitong Zhou, Jialan Xu

Objective

To systematically evaluate the risk factors of conversion to thoracotomy in thoracoscopic surgery (VATS) for lung cancer, and to provide a theoretical basis for the development of personalized surgical plans.

Methods

CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, Web of Science, and Embase databases were searched by computer from the establishment of the database to March 2024. Relevant studies on the risk factors of conversion to thoracotomy in VATS for lung cancer were searched. Two reviewers independently performed literature screening, data extraction, and quality evaluation, and Stata16.0 software was used for data analysis.

Results

A total of 14 studies were included in this study, with a total sample size of 10605, and a total of 11 risk factors were obtained. Mate analysis showed that, Age ≥ 65 years old [OR(95%CI) = 2.61(1.67,4.09)], male [OR(95%CI) = 1.46(1.19,1.79)], BMI(Body Mass Index) ≥ 25 [OR(95%CI) = 1.79(1.17,2.74)], tuberculosis history [OR(95%CI) = 7.67(4.25,13.83)], enlarged mediastinal lymph nodes [OR(95%CI) = 2.33(1.50,3.06)], lung door swollen lymph nodes [OR(95%CI) = 6.33(2.07,19.32)], pleural adhesion [OR(95%CI) = 2.50(1.93,3.25)], tumor located in the lung Upper lobe [OR(95%CI) = 4.01(2.87,5.60)], sleeve lobectomy [OR(95%CI) = 3.40(1.43,8.08)], diameter of tumor ≥ 3.5cm [OR(95%CI) = 2.13(1.15,3.95)] associated with lung cancer VATS transit thoracotomy.

Conclusions

Age ≥ 65 years old, male, BMI ≥ 25, tuberculosis history, enlarged mediastinal lymph nodes, lung door swollen lymph nodes, pleural adhesion, tumor located in the lung Upper lobe, sleeve lobectomy, diameter of tumor ≥ 3.5cm are risk factors for conversion to thoracotomy during VATS for lung cancer. Clinicians should pay attention to the above factors before VATS to avoid forced conversion due to the above factors during VATS. Due to the number and limitations of the included studies, the above conclusions need to be validated by additional high-quality studies.

Trail registration

The protocol was registered into the PROSPERO database under the number CRD42023478648.

☐ ☆ ✇ Journal of Clinical Nursing

Evaluation of the risk prediction model of pressure injuries in hospitalized patient: A systematic review and meta‐analysis

Por: Yuxia Ma · Xiang He · Tingting Yang · Yifang Yang · Ziyan Yang · Tian Gao · Fanghong Yan · Boling Yan · Juan Wang · Lin Han — Julio 29th 2024 at 13:25

Abstract

Aims and Objectives

The main aim of this study is to synthesize the prevalent predictive models for pressure injuries in hospitalized patients, with the goal of identifying common predictive factors linked to pressure injuries in hospitalized patients. This endeavour holds the potential to provide clinical nurses with a valuable reference for providing targeted care to high-risk patients.

Background

Pressure injuries (PIs) are a frequently occurring health problem throughout the world. There are mounting studies about risk prediction model of PIs reported and published. However, the prediction performance of the models is still unclear.

Design

Systematic review and meta-analysis: The Cochrane Library, PubMed, Embase, CINAHL, Web of Science and Chinese databases including CNKI (China National Knowledge Infrastructure), Wanfang Database, Weipu Database and CBM (China Biology Medicine).

Methods

This systematic review was conducted following PRISMA recommendations. The databases of Cochrane Library, PubMed, Embase, CINAHL, Web of Science, and CNKI, Weipu Database, Wanfang Database and CBM were searched for all studies published before September 2023. We included studies with cohort, case–control designs, reporting the development of risk model and have been validated externally and internally among the hospitalized patients. Two researchers selected the retrieved studies according to the inclusion and exclusion criteria, and critically evaluated the quality of studies based on the CHARMS checklist. The PRISMA guideline was used to report the systematic review and meta-analysis.

Results

Sixty-two studies were included, which contained 99 pressure injuries risk prediction models. The AUC (area under ROC curve) of modelling in 32 prediction models were reported ranged from .70 to .99, while the AUC of verification in 38 models were reported ranged from .70 to .98. Gender (OR = 1.41, CI: .99 ~ 1.31), age (WMD = 8.81, CI: 8.11 ~ 9.57), diabetes mellitus (OR = 1.64, CI: 1.36 ~ 1.99), mechanical ventilation (OR = 2.71, CI: 2.05 ~ 3.57), length of hospital stay (WMD = 7.65, CI: 7.24 ~ 8.05) were the most common predictors of pressure injuries.

Conclusion

Studies of PIs risk prediction model in hospitalized patients had high research quality, and the risk prediction models also had good predictive performance. However, some of the included studies lacked of internal or external validation in modelling, which affected the stability and extendibility. The aged, male patient in ICU, albumin, haematocrit, low haemoglobin level, diabetes, mechanical ventilation and length of stay in hospital were high-risk factors for pressure injuries in hospitalized patients. In the future, it is recommended that clinical nurses, in practice, select predictive models with better performance to identify high-risk patients based on the actual situation and provide care targeting the high-risk factors to prevent the occurrence of diseases.

Relevance to Clinical Practice

The risk prediction model is an effective tool for identifying patients at the risk of developing PIs. With the help of risk prediction tool, nurses can identify the high-risk patients and common predictive factors, predict the probability of developing PIs, then provide specific preventive measures to improve the outcomes of these patients.

Registration Number (PROSPERO)

CRD42023445258.

☐ ☆ ✇ Journal of Clinical Nursing

Family resilience, patient‐reported symptoms in young stroke dyads: The effect of caregiver readiness and social support

Por: Huijuan Wang · Lili Zhu · Wen Cao · Weihong Yang · Yutong Gao · Guiying Yao · Huimin Zhang · Genqiang Li — Febrero 13th 2024 at 10:11

Abstract

Aims and Objectives

To investigate empirically the direct effect and potential mechanism of family resilience on patient-reported outcomes among young stroke dyads in China.

Background

Young patients with stroke have been becoming an important public health issue. According to relevant theories and previous studies, we found that family resilience might play an important role in patient's symptoms. However, it is less clear about the specific relationship and potential mechanisms of these two variables.

Design

We used a prospective cross-sectional design.

Methods

A multi-item questionnaire was used to assess the constructs of interest. Researchers progressively constructed and validated conditional process models. The PROCESS macro was used to verify the research hypotheses.

Results

A total of 560 questionnaires were collected in this study. We found that family resilience of stroke patients and their spouses had a direct effect on the physical, psychological and social aspects of patient-reported symptoms. We further revealed that caregiver preparedness partially mediated the relationship between family resilience and patient's symptoms in stroke patient-spouse dyads, while perceived social support moderated the relationship between caregiver preparedness and patient's symptoms. Finally, we observed that the impact of caregiver readiness and social support on patients' symptoms predominantly manifested in physical and physiological outcomes.

Conclusions

Our research provides evidence about the positive impact of family resilience on patient-reported symptoms in young stroke dyads. Meanwhile, it further revealed how caregiver preparedness and perceived social support may play out in the relationship.

Practice Implications

Our research introduces a novel perspective and pathway to enhance short-term recovery outcomes for patients. It also furnishes clinicians and nurses with evidence to guide the implementation of interventions aimed at improving patient health outcomes and facilitating smoother transitions from the hospital to home.

Impact

What problem did the study address?

Families play a crucial role in a patient's recovery process from illness, with family resilience serving as an important force for families to overcome adversity. However, the impact on patient symptoms and the underlying mechanisms of this relationship are uncertain. Empirical research is required to validate these aspects.

What were the main findings?

Family resilience has a positive impact on the physical, psychological and social aspects of patient-reported symptoms in young stroke dyads. Both the actor effect and partner effect are supported. The impact of caregiver readiness and social support on patient-reported symptoms is primarily observed in physical and physiological outcomes.

Where and on whom will the research have an impact?

This study offers a novel approach to enhance the short-term recovery of stroke patients. The researchers believe that the findings of this study will play an even more significant role during patients' transition from the hospital to home.

Reporting Method

This study followed the STROBE statement of cross-sectional studies.

Patient or Public Contribution

The study was conducted by patients, their spouses, healthcare professionals and the research team.

☐ ☆ ✇ Journal of Clinical Nursing

Factors associated with the intrinsic capacity in older adults: A scoping review

Por: Xiaoqin Wei · Yajing Chen · Jiangxia Qin · Yiyi Yang · Tingting Yang · Fanghong Yan · Ziyao Zhang · Lin Han · Yuxia Ma — Febrero 12th 2024 at 13:13

Abstract

Introduction

In 2015, the term ‘intrinsic capacity’ (IC) was proposed by the World Health Organisation to promote healthy aging. However, the factors associated with IC are still discrepant and uncertain.

Aim

We aim to synthesise the factors connected with IC.

Methods

This scoping review followed the five-stage framework of Arksey and O'Malley and was reported using PRISMA-ScR guidelines.

Results

In all, 29 articles were included. IC of older adults is associated with demographic characteristics, socioeconomic factors, disease conditions, behavioural factors, and biomarkers. Age, sex, marital status, occupation status, education, income/wealth, chronic diseases, hypertension, diabetes, disability, smoking status, alcohol consumption, and physical activity were emerged as important factors related to the IC of older adults.

Conclusions

This review shows that IC is related to multiple factors. Understanding these factors can provide the healthcare personnel with the theoretical basis for intervening and managing IC in older adults.

Relevance to Clinical Practice

The influencing factors identified in the review help to guide older adults to maintain their own intrinsic capacity, thereby promoting their health and well-being. The modifiable factors also provide evidence for healthcare personnel to develop targeted intervention strategies to delay IC decline.

No Patient or Public Contribution

As this is a scoping review, no patient or public contributions are required.

☐ ☆ ✇ International Wound Journal

Effects of different dressings in the prevention of facial skin pressure injury related to non‐invasive ventilation: Systematic review and network meta‐analysis

Por: Guoli Zhang · Fanghong Yan · Ruiyi Sun · Guotian Peng · Juhong Pei · Hongyan Zhang · Yuxia Ma · Lin Han — Febrero 1st 2024 at 07:13

Abstract

To investigate the preventive effect of different dressings on pressure injuries related to non-invasive ventilation equipment and to screen the efficacy of dressings. Systematic review and network meta-analysis. PubMed, the Cochrane Library, Web of Science, EMBASE, Cumulative Index to Nursing & Allied Health Literature (CINAHL), China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Chinese Biomedical Database (CBM) and Weipu Database (VIP) were used for the search from the date of inception of each database to 15 October 2023. The quality of the data was assessed using the Cochrane Risk of Bias tool. Stata 16.0 Software was used to analysis and ranking of different types of dressings. A total of 23 randomized controlled trials on 7 interventions were included in the final analysis. The effectiveness of these in preventing the overall incidence of pressure injuries is ranked from best to worst as follows: hydrogel dressing > foam dressing > petroleum jelly gauze dressing > hydrocolloid dressing > film dressing > clean gauze dressing > sterile gauze. Sixteen studies reported the incidence of Stage I pressure injuries, the effectiveness in preventing the incidence of Stage I pressure injuries was ranked from best to least effective: foam dressing > hydrogel dressing > petroleum jelly gauze dressing > hydrocolloid dressing > film dressing > clean gauze dressing > sterile gauze dressing. Fourteen studies reported the incidence of Stages I/II pressure injuries, the effective in preventing the incidence of Stages I and II pressure injuries was ranked from best to least effective: foam dressing > hydrogel dressing > petroleum jelly gauze dressing > hydrocolloid dressing > clean gauze dressing > sterile gauze dressing. Considering the advantages and disadvantages of different dressings, both hydrogel and foam dressings are effective in preventing pressure injuries related to non-invasive ventilation equipment.

☐ ☆ ✇ Journal of Clinical Nursing

Validity and reliability of the Waterlow scale for assessing pressure injury risk in critical adult patients: A multi‐centre cohort study

Por: Lin Han · Jiali Guo · Hongyan Zhang · Lin Lv · Jianhui Dong · Tong Zhang · Fanghong Yan · Yuxia Ma — Enero 11th 2024 at 10:04

Abstract

Aim

To evaluate the predictive validity and reliability of the Waterlow scale in critically adult hospitalised patients.

Design

A multi-centre cohort study.

Methods

This study was conducted in 72 intensive care units (ICUs) in 38 tertiary hospitals in Gansu Province, China. All adults admitted to the ICU for greater than or equal to 24 h without pressure injury (PI) on admission were screened by the Waterlow scale on admission, during ICU stay and ICU discharge from April 2021 to February 2023. Receiver operating characteristic (ROC) curves were used to determine a potential cut-off value for critical adult hospitalised patients. Cut-off values were then determined using Youden's index, and sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated based on these cut-off values. Test–retest reliability was used to evaluate inter-rater reliability.

Results

A total of 5874 critical patients on admission were included, and 5125 of them were assessed regularly. The area under curve (AUC) was 0.623 (95% CI, 0.574–0.690), with a cut-off score of 19 showing the best balance among sensitivity of 62.7%, specificity of 57.4%, positive predictive value of 2.07% and negative predictive value of 99.08%. The test–retest reliability between the first assessment and the regular assessment was 0.447.

Conclusions

The Waterlow scale shows insufficient predictive validity and reliability in discriminating critical adults at risk of PI development. To further modify the items of the Waterlow scale, exploring specific risk factors for PI in the ICU and clarifying their impact degree was necessary. Risk predictive models or better tools are inevitable in the future.

Patient or Public Contribution

Patients or family members supported nurses with PI risk assessment, skin examination and other activities during the inquiry.

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