Using mobile learning to enhance nursing students’ competence and confidence in performing basic physical assessment skills: An exploratory sequential mixed methods study

Background: Nurses can use physical assessment skills (PAS) to monitor and assess the patient’s clinical situation, identify care needs, and detect changes, as well as a possible deterioration. Internationally, PAS are acknowledged as an important part of fundamental nursing care and are based on four examination techniques: inspection, auscultation, palpation, and percussion. PAS has not been taught systematically in nursing education in Norway, but in 2015, PAS was implemented at the University of South-Eastern of Norway. Based on empirical research, 30 skills (of a total of 126) were regarded as central to teach at the bachelor’s level. These skills were called ‘basic physical assessment skills’ (B-PAS). A Progression Model – a novel pedagogical approach for teaching B-PAS – was also developed to support students’ learning based on the principles of scaffolding and spaced repetition. In contrast to teaching the skills in a block approach, as is often done internationally, the Progression Model entailed a different approach by teaching B-PAS in each educational year; here, the emphasis is on the importance of nursing students learning to confidently and competently perform B- PAS. In Norway, there is also increased interest in exploring the possibilities for higher education offered by digital technologies, regarding enhancing students’ learning and supporting the transfer of knowledge and skills. Aim: This dissertation is a synthesis of four individual studies and has three overall aims: (a) to explore the role of B-PAS in overall competence in nursing and person-centred fundamental nursing care, (b) to explore how and to what extent a Suite of mLearning Tools may contribute to developing students’ competence and confidence in performing B-PAS, and (c) to evaluate the usefulness of the Progression Model for students’ confidence in performing B-PAS. Methods: This dissertation has a complex mixed methods exploratory sequential design, including convergent and emergent components. Quantitative and qualitative research represent an equal status methods that were applied independently or in combination. Study I was a mixed methods study, in which 363 nursing students from all three educational years participated. Data were collected via a questionnaire and focus group interviews, then analysed with descriptive statistics, effect size, and content analysis. Study II was a qualitative study with a longitudinal participatory design approach. Nursing students (n = 20) from all 3 educational years participated in the co-design of a Suite of mLearning Tools. The data were collected in eight co-design workshops and analysed with content analysis. Study III was a quantitative pre-/post-test cohort study in which 171 nursing students from the second and third educational years participated. The data were collected with a pre–post questionnaire and analysed with descriptive statistics, effect size, and linear regression. Study IV was a convergent mixed methods study, in which both nursing students and faculty members participated. The data were collected with a questionnaire (n = 24), individual interviews (n = 3), and a focus group interview (n = 3). The data were analysed using descriptive statistics and content analysis. In line with the overall mixed methods design, a qualitative synthesis of all four studies was performed, in which the three overall aims guided the integration processes, and the visualization of the synthesized results were presented in new models. Results: Novel results show that overall confidence in performing B-PAS is an important part of overall competence in nursing, measured with the Nurse Professional Competence Scale Sort Form (NPC-SF). B-PAS were also shown to be a part of fundamental care; however, contextual factors in the clinical rotation greatly influenced students’ performance and use of B-PAS. A Suite of mLearning Tools co-designed with the nursing students was experienced as a useful support in learning B-PAS and using the skills in clinical rotation. The research synthesis underlines that the learning and utilization of B-PAS is a complex learning process for the students, due to the transition between academic and clinical contexts. The Suite of mLearning Tools also supports the transfer of skills and knowledge between learning contexts. The virtual simulation as a facilitated learning activity was experienced by both students and faculty members as a meaningful way to explore the coherence between professional knowledge and the students’ own actions, as well as to help students learn to catch clinical cues and develop clinical reasoning skills. The Progression Model seemed to be useful for increasing students’ confidence in performing B-PAS. Discussion: Supporting students in developing confidence and competence during their nursing education is the shared responsibility of key stakeholders in the academic and clinical contexts. This is an important aspect in the learning and use of B-PAS as a systematic approach for patient assessment and to provide fundamental nursing care. By performing B-PAS, nursing students gain a valuable understanding of how these skills can provide the foundation for a good nurse–patient relationship. And increased focus should be on strategies that are suitable for building students’ confidence, such as role modelling and constructive feedback, and on how these can be applied in the academic and clinical contexts. The Suite of mLearning Tools can support seamless learning processes between academic and clinical contexts and thus support students’ performance of B-PAS. Conclusion: This dissertation contributes new knowledge about students’ development of competence and confidence in performing B-PAS. Systematic patient assessment such as B-PAS is an important aspect of overall competence in nursing and fundamental nursing care. Supporting students in developing competence and confidence in performing B-PAS needs to be is the mutual responsibility of key stakeholders in the academic and clinical contexts. The Progression Model for teaching B-PAS seems to hold promise for building student confidence, together with the Suite of mLearning Tools. Also, utilizing digital technology in higher education as new pedagogical strategies are in line with national guidelines and recommendations and can better meet students’ learning preferences.publishedVersio

High CO2 decreases the long-term resilience of the free-living coralline algae Phymatolithon lusitanicum

Maerl/rhodolith beds are protected habitats that may be affected by ocean acidification (OA), but it is still unclear how the availability of CO2 will affect the metabolism of these organisms. Some of the inconsistencies found among OA experimental studies may be related to experimental exposure time and synergetic effects with other stressors. Here, we investigated the long-term (up to 20months) effects of OA on the production and calcification of the most common maerl species of southern Portugal, Phymatolithon lusitanicum. Both the photosynthetic and calcification rates increased with CO2 after the first 11months of the experiment, whereas respiration slightly decreased with CO2. After 20months, the pattern was reversed. Acidified algae showed lower photosynthetic and calcification rates, as well as lower accumulated growth than control algae, suggesting that a metabolic threshold was exceeded. Our results indicate that long-term exposure to high CO2 will decrease the resilience of Phymatolithon lusitanicum. Our results also show that shallow communities of these rhodoliths may be particularly at risk, while deeper rhodolith beds may become ocean acidification refuges for this biological community.Fundacao para a Ciencia e a Tecnologia [PTDC/MAR/115789/2009, SFRH/BD/76762/2011

Navigating the green transition: A qualitative study of sustainable development of SMEs in Viken

The urgency of the green transition is undeniable. As the global climate crisis looms, businesses face mounting pressure to address sustainability. Efforts to promote sustainable development have been steadily increasing since the Brundtland report in 1987. In Norway, companies are coping with new regulations and heightened expectations from stakeholders. Among these businesses, small and medium-sized Enterprises (SMEs) play a crucial role in realizing national sustainability goals. However, despite their significance, SMEs still struggle to fully integrate environmental and social considerations into their operations. The objective of this study is to explore the strategies employed by SMEs in Viken to overcome sustainability-related barriers and, more specifically, to focus on identifying those that surpass mere compliance. It aims to address the following research question: How do SMEs in Viken currently respond to the changing regulatory environment and increased demand from stakeholders, and what are the implications of these responses? To achieve this, an inductive qualitative method was employed, based on an exploratory research design. Eight semi-structed, in-depth interviews were conducted with sustainability officers in SMEs and sustainability advisors in Viken county. The findings indicate that the main barriers that SMEs in Viken face are a lack of specialized expertise in sustainability, as well as a general lack of awareness and understanding throughout the organization. In addition, all the SMEs experience challenges with the regulations due to a perceived lack of standardization and framework. Nevertheless, SMEs are adopting strategies beyond mere compliance, focusing on internal measures such as organizational involvement, collaboration, and investing in sustainability expertise. The role of a dedicated Sustainability Officer emerges as crucial, but challenges remain in securing management support and avoiding unrealistic expectations. Proactive approaches, including sustainable innovation, are highlighted as valuable for SMEs to differentiate themselves and achieve long-term sustainability goals. The study underscores the importance of prioritizing internal measures as a foundation for successful sustainability integration.The urgency of the green transition is undeniable. As the global climate crisis looms, businesses face mounting pressure to address sustainability. Efforts to promote sustainable development have been steadily increasing since the Brundtland report in 1987. In Norway, companies are coping with new regulations and heightened expectations from stakeholders. Among these businesses, small and medium-sized Enterprises (SMEs) play a crucial role in realizing national sustainability goals. However, despite their significance, SMEs still struggle to fully integrate environmental and social considerations into their operations. The objective of this study is to explore the strategies employed by SMEs in Viken to overcome sustainability-related barriers and, more specifically, to focus on identifying those that surpass mere compliance. It aims to address the following research question: How do SMEs in Viken currently respond to the changing regulatory environment and increased demand from stakeholders, and what are the implications of these responses? To achieve this, an inductive qualitative method was employed, based on an exploratory research design. Eight semi-structed, in-depth interviews were conducted with sustainability officers in SMEs and sustainability advisors in Viken county. The findings indicate that the main barriers that SMEs in Viken face are a lack of specialized expertise in sustainability, as well as a general lack of awareness and understanding throughout the organization. In addition, all the SMEs experience challenges with the regulations due to a perceived lack of standardization and framework. Nevertheless, SMEs are adopting strategies beyond mere compliance, focusing on internal measures such as organizational involvement, collaboration, and investing in sustainability expertise. The role of a dedicated Sustainability Officer emerges as crucial, but challenges remain in securing management support and avoiding unrealistic expectations. Proactive approaches, including sustainable innovation, are highlighted as valuable for SMEs to differentiate themselves and achieve long-term sustainability goals. The study underscores the importance of prioritizing internal measures as a foundation for successful sustainability integration

Skeletal trade-offs in coralline algae in response to ocean acidification

Ocean acidification is changing the marine environment, with potentially serious consequences for many organisms. Much of our understanding of ocean acidification effects comes from laboratory experiments, which demonstrate physiological responses over relatively short timescales. Observational studies and, more recently, experimental studies in natural systems suggest that ocean acidification will alter the structure of seaweed communities. Here, we provide a mechanistic understanding of altered competitive dynamics among a group of seaweeds, the crustose coralline algae (CCA). We compare CCA from historical experiments (1981-1997) with specimens from recent, identical experiments (2012) to describe morphological changes over this time period, which coincides with acidification of seawater in the Northeastern Pacific. Traditionally thick species decreased in thickness by a factor of 2.0-2.3, but did not experience a change in internal skeletal metrics. In contrast, traditionally thin species remained approximately the same thickness but reduced their total carbonate tissue by making thinner inter-filament cell walls. These changes represent alternative mechanisms for the reduction of calcium carbonate production in CCA and suggest energetic trade-offs related to the cost of building and maintaining a calcium carbonate skeleton as pH declines. Our classification of stress response by morphological type may be generalizable to CCA at other sites, as well as to other calcifying organisms with species-specific differences in morphological types

Relating Depth and Diversity of Bivalvia and Gastropoda in Two Contrasting Sub-Arctic Marine Regions

The need to understand species distribution- and biodiversity patterns in high-latitude marine regions is immediate as these marine environments are undergoing rapid environmental changes, including ocean warming and ocean acidification. By the year 2100, the seas north of the Greenland-Iceland-Faroe (GIF) topographic ridge are predicted to become largely corrosive to aragonite, a form of calcium carbonate commonly formed by calcifying molluscs. We examine depth-diversity relationships in bivalves and gastropods north and south of the GIF ridge, between 200 and 2000 m depth. We also identify bivalve and gastropod species that could be monitored to identify early signs of changes in benthic communities north of the GIF ridge, due to ocean acidification. Patterns of α-diversity were estimated through rarefaction, as E(S20). Regional and depth related β-diversity was analyzed and the additive contribution of species replacement (turnover) and species loss/gain (nestedness) to β-diversity calculated. Despite sharing a significant number of species, diversity patterns differed between the study regions. The diversity patterns also differed between bivalves and gastropods. North of the GIF ridge, the relationship between α-diversity and depth was unimodal with a predominant decrease in bivalve and gastropod α-diversity between 300 and 2000 m depth. Species assemblages in the deep bathyal zone were partly nested subsets of the assemblages in the shallow bathyal zone. South of the GIF ridge, patterns in α-diversity were more ambiguous. Alpha diversity decreased between 300 and 2000 m depth in bivalves, with no clear trend observed in gastropods. This finding contradicts the recognized increase in α-diversity in the bathyal zone in the North Atlantic basin, perhaps due to the oceanographic conditions directly south of the GIF ridge. In contrast to that observed north of the GIF ridge, nestedness did not contribute significantly to β-diversity south of the GIF ridge. This comparative study sheds new light on deep-sea diversity patterns of molluscs in the high-latitude North Atlantic and provides baseline data on species occurrences. This information can inform future assessment of the impact of environmental changes in these regions and management efforts

Larval development of the barnacle Amphibalanus improvisus responds variably but robustly to near-future ocean acidification

Increasing atmospheric CO2 decreases seawater pH in a phenomenon known as ocean acidification. In two separate experiments we found that larval development of the barnacle Amphibalanus (Balanus) improvisus was not significantly affected by the level of reduced pH that has been projected for the next 150 years. After 3 and 6 days of incubation, we found no consistent effects of reduced pH on developmental speed or larval size at pH 7.8 compared with the control pH of 8.1. After 10 days of incubation, there were no net changes in survival or overall development of larvae raised at pH 7.8 or 7.6 compared with the control pH of 8.0. In all cases, however, there was significant variation in responses between replicate batches (parental genotypes) of larvae, with some batches responding positively to reduced pH. Our results suggest that the non-calcifying larval stages of A. improvisus are generally tolerant to near-future levels of ocean acidification. This result is in line with findings for other barnacle species and suggests that barnacles do not show the greater sensitivity to ocean acidification in early life history reported for other invertebrate species. Substantial genetic variability in response to low pH may confer adaptive benefits under future ocean acidification

It's not the task, it's the shifting: exploring physicians' and leaders' perspectives on task shifting in emergency departments in Norway

Background: Task shifting is an approach where specific tasks are transferred, when convenient, from health work- ers with high qualifications to health workers with less training and lower qualifications. This approach is mainly used to utilize the available human resources for health. Tasks that are traditionally linked to the physician role have increas- ingly been transferred to registered nurses during the last decade. Knowledge regarding the experiences and reflec- tions of physicians and their leaders related to giving up tasks or how such policies can best be implemented is lim- ited. This study aimed to explore physicians’ and their leaders’ perspectives on task shifting, especially to registered nurses, in different Norwegian emergency departments. Methods: The study was carried out from June to October 2022. It had an explorative and descriptive qualitative design and an inductive approach, semi-structured interviews was used. The study involved ten physicians and lead- ers from three different regional hospitals in south-eastern Norway. Manifest and latent content analysis were used to analyse the data. The COREQ guidelines were applied in the study. Results From the three categories 1) The rationale for task shifting, 2) Teambuilding and 3) Implementation of task shifting, with nine subcategories. One overall main theme emerged: It is not the task, it is the shifting – moving towards a person-centred culture. Conclusions: The study indicates that developing a person-centred culture and fostering a team approach in emer- gency departments is more important than simply shifting tasks, as task shifting may lead to fragmented care and resistance from physicians. Hospital leaders must invest time and effort into organising teams and providing clear leadership to support the redesign of professional roles, recognising the cultural and traditional challenges involved. Policymakers should promote guideline development, team training programs, and cooperation methods to support a person-centred culture and effective task shifting in emergency departmentspublishedVersio

Metabolic responses to high pCO2 conditions at a CO2 vent site in juveniles of a marine isopod species assemblage

We are starting to understand the relationship between metabolic rate responses and species' ability to respond to exposure to high pCO2. However, most of our knowledge has come from investigations of single species. The examination of metabolic responses of closely related species with differing distributions around natural elevated CO2 areas may be useful to inform our understanding of their adaptive significance. Furthermore, little is known about the physiological responses of marine invertebrate juveniles to high pCO2, despite the fact they are known to be sensitive to other stressors, often acting as bottlenecks for future species success. We conducted an in situ transplant experiment using juveniles of isopods found living inside and around a high pCO2 vent (Ischia, Italy): the CO2 'tolerant' Dynamene bifida and 'sensitive' Cymodoce truncata and Dynamene torelliae. This allowed us to test for any generality of the hypothesis that pCO2 sensitive marine invertebrates may be those that experience trade-offs between energy metabolism and cellular homoeostasis under high pCO2 conditions. Both sensitive species were able to maintain their energy metabolism under high pCO2 conditions, but in C. truncata this may occur at the expense of [carbonic anhydrase], confirming our hypothesis. By comparison, the tolerant D. bifida appeared metabolically well adapted to high pCO2, being able to upregulate ATP production without recourse to anaerobiosis. These isopods are important keystone species; however, given they differ in their metabolic responses to future pCO2, shifts in the structure of the marine ecosystems they inhabit may be expected under future ocean acidification conditions

Coralline algae (Rhodophyta) in a changing world: integrating ecological, physiological, and geochemical responses to global change

Coralline algae are globally distributed benthic primary producers that secrete calcium carbonate skeletons. In the context of ocean acidification, they have received much recent attention due to the potential vulnerability of their high-Mg calcite skeletons and their many important ecological roles. Herein, we summarize what is known about coralline algal ecology and physiology, providing context to understand their responses to global climate change. We review the impacts of these changes, including ocean acidification, rising temperatures, and pollution, on coralline algal growth and calcification. We also assess the ongoing use of coralline algae as marine climate proxies via calibration of skeletal morphology and geochemistry to environmental conditions. Finally, we indicate critical gaps in our understanding of coralline algal calcification and physiology and highlight key areas for future research. These include analytical areas that recently have become more accessible, such as resolving phylogenetic relationships at all taxonomic ranks, elucidating the genes regulating algal photosynthesis and calcification, and calibrating skeletal geochemical metrics, as well as research directions that are broadly applicable to global change ecology, such as the importance of community-scale and long-term experiments in stress response

Factors associated with changes in students' self-reported nursing competence after clinical rotations: A quantitative cohort study

Background The quality of nursing care in different healthcare contexts can be associated with the level of available nursing competence. Physical assessment skills are vital in nurses' assessment of patient care needs. However, in nursing education, using physical assessment skills is challenging for nursing students who struggle to apply these skills comprehensively in a clinical rotation. Therefore, this study explores changes in nursing competence, factors associated with changes after clinical rotations, and whether a Suite of Mobile Learning Tools supports changes in confident use of basic physical assessment skills. Methods A quantitative cohort study with an explorative pre-and post-test design. During autumn 2019 and spring 2020, 72 s-year nursing students and 99 third-year students participated in the study. The Nurse Professional Competence scale short form was used to investigate students’ self-reported changes in nursing competence, and a study-specific questionnaire was used to investigate students’ confidence concerning performing physical assessments. The students voluntarily used the Suite of Mobile Learning Tools for the learning of physical assessment. Linear regression analysis was used to identify factors associated with changes in nursing competence after clinical rotation. The STROBE guidelines for cohort studies were followed for study reporting. Results After the clinical rotation, both student groups reported changes in nursing competence and confidence in performing physical assessment skills, with statistically significant moderate or large changes in all areas. The Suite of Mobile Learning Tools was evaluated as being useful for learning physical assessment. The regression analysis showed that confidence in performing physical assessment skills, the usefulness of the Suite of Mobile Learning Tools, and a higher nursing competence at the start of clinical rotation were positively associated with overall nursing competence. Conclusion Basic physical assessment skills are an important component of nursing competence and can be considered one of the pillars of person-centered care, as proposed by the Fundamentals of Care framework. Spaced repetition and access to digital resources are suggested pedagogical approaches to enhance student confidence in the use of assessment skills within academic and clinical contexts.publishedVersio