Exploring Simulation Utilization and Simulation Evaluation Practices and Approaches in Undergraduate Nursing Education

Simulation-based learning (SBL) is rapidly becoming one of the most significant teaching-learning-evaluation strategies available in undergraduate nursing education. While there is indication within the literature and anecdotally about the benefits of simulation, abundant and strong evidence that supports the effectiveness of simulation for learning and evaluation in nursing education is slow to emerge and has yet to be fully established. As the use of SBL increases in nursing education, the need to evaluate students appropriately, accurately, and in reliable ways intensifies. Furthermore, as nursing programs increasingly consider SBL as direct clinical replacement in the context of increased student enrolment and dwindling clinical placements, standardized evaluation must play a vital role. Our study investigated simulation utilization and simulation evaluation practices and approaches employed among undergraduate nursing educational programs in Ontario, Canada, using a mixed methods approach. Both quantitative and qualitative data were collected through a confidential online survey. The goal of our study is to establish a “picture” of current trends, practices, and approaches related to simulation that is employed within this entire province. An overview of the study findings and recommendations that have potential to make a substantial contribution to the growing evidence for best practices in the science of simulation will be discussed. Keywords: Simulation; Simulation-based Learning, Evaluation; Undergraduate Nursing Educatio

The Feasibility and Acceptability of a Behavioral-educational Intervention - the Relax to Sleep Program - to Increase Pediatric Sleep during Hospitalization: A Pilot Randomized Controlled Trial

Background: Hospitalization can contribute to common sleep difficulties related to environmental, physiological, and psychological factors. Interventions aimed at hospitalized children need to be developed and piloted with rigorous evaluative methods. The primary purpose of this study was to examine the feasibility and acceptability of a behavioral-educational intervention - the RELAX TO SLEEP program - aimed at increasing nighttime sleep for hospitalized children. Methods: This study was a pilot randomized controlled trial. Children between the ages of 4 and 10 years, expected to stay for 3 nights in hospital, with a parent staying overnight were included. Children were excluded if they were receiving palliative care; were diagnosed with a sleep or anxiety disorder; had limited movements of extremities or had cognitive impairment; or received sedation. Forty-eight children and their caregivers consented and were randomized to either the RELAX TO SLEEP intervention group (n=24) or the Usual Care control group (n=24). The RELAX TO SLEEP program consisted of a one-on-one discussion with the researcher about sleep and sleep hygiene, a standardized educational booklet about sleep, and a relaxation breathing (RB) exercise for the child. Usual Care participants received no information about sleep or relaxation. Children wore actigraphs for 3 days and nights and completed sleep diaries. Sleep outcomes included: total nocturnal sleep (19h30-07h29), number of nighttime awakenings, longest period of uninterrupted nocturnal sleep, and total daytime (07h30-19h29) sleep. Other outcomes measured at baseline and at 7 days post-discharge, included anxiety (Spence Pre-school/Children Anxiety Subscales), sleep habits (Children's Sleep Habits Questionnaire [CSHQ]), and post-hospital maladaptive behaviours (Post-Hospital Behaviour Questionnaire [PHBQ]). Results: Of the 68 eligible families approached, 71% (n=48) agreed to participate. Both the RELAX TO SLEEP and Usual Care group were compliant in wearing the actigraph and completing sleep diaries. Eighty-five per cent (n=19/22) of the Relax to Sleep participants reported using the RB at least once per day in hospital, and over half used it 2-3 times per day. Parental reports indicated that their child enjoyed using RB (18/22; 82%), that it was easy to use (21/22; 95%), and would use it again in the future (18/22; 82%). Parents also reported that they enjoyed the discussion about sleep and found the information helpful (21/22; 95%). Children in the RELAX TO SLEEP group obtained a mean of 50 minutes more nighttime sleep compared to the UC group (419 Âą 7.84 min vs. 369.7 Âą 106.4 min, group difference 49.64 min, t= 1.76, p=0.085), despite having the same number of nighttime awakenings (14.7 [SD 5.83) and 14.7 [SD 4.7] respectively). Improved CSHQ scores at follow-up were noted for the RELAX TO SLEEP group (baseline score 44.04 [SD 7.17] to follow-up 42.38 [SD 5.41]) compared to the increase in sleep disturbance behaviour noted in the Usual Care group (baseline score 45.58 [7.82] to follow-up 47.52 [7.47]). There were no notable differences in anxiety or PHBQ scores; however, the majority of children in this sample (73%, n=32/44) scored 81 or higher on the PHBQ indicating the development of at least one new-onset maladaptive behaviour during the post-discharge period. Conclusion: The RELAX TO SLEEP program proposed in this study was feasible and acceptable to children and their caregivers. Further evaluation of the intervention with a large scale, multicenter RCT is needed.Ph.D

Is There an Association between Physical Activity and Sleep in Community-Dwelling Persons with Dementia: An Exploratory Study Using Self-Reported Measures?

Sleep disturbances are common in persons with dementia (PWD). While pharmacotherapy is widely used, non-pharmacological interventions are beginning to surface as first-line management strategies. This study sought to investigate if physical activity was associated with more favourable sleep patterns in PWD, and to compare the sleep quantity and quality between active and inactive PWD. We conducted an exploratory study to tackle these research questions. Self-reported telephone questionnaires were administered to 40 caregivers of PWD, who answered questions as proxies on behalf of their care recipient. Just over half (55%) of our participants met the criteria for being active. Walking was the most popular form of physical activity for both active and inactive PWD. Active PWD also preferred exercise classes and gardening, whereas inactive PWD favoured chair exercises. Compared to their inactive counterparts, active PWD were more likely to experience appropriate sleep quantity (p = 0.00). The active group also reported significantly better overall sleep quality (p = 0.003). Together, our findings suggest that physical activity may be associated with improved sleep in PWD. Future studies are warranted to investigate whether physical activity can be promoted as a safe and effective means to improve quality-of-life in this population

What is the association between injury and sleep quality among adult athletes?

This is the protocol for a systematic review to examine published literature highlighting the association between injury and sleep quality among adult athletes utilizing both subjective and objective assessment tools

Outcomes and follow-up for children intubated in an adult-based community hospital system: A retrospective chart review

Objectives Emergency intubation is a high-risk procedure in children. Studies describing intubation practices in locations other than pediatric centres are scarce and varied. This study described pediatric intubations in adult-based community emergency departments (EDs) and determined what factors were associated with intubated-related adverse events (AEs) and described outcomes of children transferred to a quaternary care pediatric institution. Methods This is a retrospective review of data collected between January 2006 and March 2017 at Lakeridge Health and Hospital for Sick Children (SickKids). Patients were \<18 years and intubated in Lakeridge Health EDs; those intubated prior to ED arrival were excluded. Primary outcomes were intubation first-pass success (FPS) and AEs secondary to intubation. Results Patients (n = 121) were analyzed, and median (interquartile range (IQR)) age was 3.7 (0.4--14.3) years. There were 76 (62.8%) FPS, with no difference between pediatricians (n = 25, 23%) or anaesthetists (n = 12, 11%), versus all other providers (paramedic n = 13 (12%), ED physician n = 37 (34%), respiratory therapist n = 20 (18%), transfer team n = 2 (2%)). The proportion of AEs was 24 (19.8%, n = 21 minor, n = 3 major), with no significant difference between pediatricians or anaesthetists versus all other providers. Data from 68 children transferred to SickKids were available, with the majority extubated within a short median (IQR) time of admission, 1.2 (0.29--3.8) days. Conclusions Pediatric intubations were rare in a Canadian adult-based community hospital system. Most intubations demonstrated FPS with relatively few AEs and no significant differences between health provider type. Future investigations should utilize multi-centred data to inform strategies suited for organizations' unique practice cultures, including training programs

Effectiveness of virtually delivered sleep interventions on sleep and mental health outcomes in post-secondary students: A systematic review

This systematic review aims to assess the effectiveness of virtually delivered sleep interventions on sleep and mental health outcomes in post-secondary students. A sequential approach is used to analyze and integrate quantitative findings of effectiveness with qualitative findings on the views, experiences, and beliefs of students receiving virtually delivered sleep interventions

Effectiveness of non-pharmacological interventions on sleep characteristics among adults with musculoskeletal pain and a comorbid sleep problem: a systematic review

Abstract Sleep problems are common and may be associated with persistent pain. It is unclear whether non-pharmacological interventions improve sleep and pain in adults with comorbid sleep problems and musculoskeletal (MSK) pain. We conducted a systematic review on the effectiveness of non-pharmacological interventions on sleep characteristics among adults with MSK pain and comorbid sleep problems. We searched MEDLINE, EMBASE, CINAHL, Cochrane Central and PsycINFO from inception to April 2, 2021 for randomized controlled trials (RCTs), cohort, and case-control studies. Pairs of independent reviewers critically appraised and extracted data from eligible studies. We synthesized the findings qualitatively. We screened 8459 records and identified two RCTs (six articles, 467 participants). At 9 months, in adults with insomnia and osteoarthritis pain, cognitive behavioral therapy for pain and insomnia (CBT-PI) was effective at improving sleep (Insomnia Severity Index, ISI) when compared to education (OR 2.20, 95% CI 1.25, 3.90) or CBT for pain (CBT-P) (OR 3.21, 95% CI 1.22, 8.43). CBP-P vs. education was effective at increasing sleep efficiency (wrist actigraphy) in a subgroup of participants with severe pain at baseline (mean difference 5.45, 95% CI 1.56, 9.33). At 18 months, CBT-PI, CBT-P and education had similar effectiveness on sleep and pain or health outcomes. In adults with insomnia and knee osteoarthritis, CBT-I improved some sleep outcomes including sleep efficiency (diary) at 3 months (Cohen’s d 0.39, 95% CI 0.24, 1.18), and self-reported sleep quality (ISI) at 6 months (Cohen’s d − 0.62, 95% CI -1.01, − 0.07). The intervention was no better than placebo (behavioural desensitization) for improving other sleep outcomes related to sleep onset or pain outcomes. Short-term improvement in sleep was associated with pain reduction at 6 months (WOMAC pain subscale) (sensitivity 54.8%, specificity 81.4%). Overall, in two acceptable quality RCTs of adults with OA and comorbid insomnia, CBT-PI/I may improve some sleep outcomes in the short term, but not pain outcomes in the short or long-term. Clinically significant improvements in sleep in the short term may improve longer term pain outcomes. Further high-quality research is needed to evaluate other non-pharmacological interventions for people with comorbid sleep problems and a range of MSK conditions

Rehabilitative management of back pain in children: protocol for a mixed studies systematic review

Little is known about effective, efficient and acceptable management of back pain in children. A comprehensive and updated evidence synthesis can help to inform clinical practice. Objective: To inform clinical practice, we aim to conduct a systematic review of the literature and synthesise the evidence regarding effective, cost-effective and safe rehabilitation interventions for children with back pain to improve their functioning and other health outcomes. Prospero registration number: CRD42019135009

Rehabilitation of back pain in the pediatric population: a mixed studies systematic review

Abstract Background A significant proportion of children and adolescents experience back pain. However, a comprehensive systematic review on the effectiveness of rehabilitation interventions is lacking. Objectives To evaluate benefits and harms of rehabilitation interventions for non-specific low back pain (LBP) or thoracic spine pain in the pediatric population. Methods Seven bibliographic electronic databases were searched from inception to June 16, 2023. Moreover, reference lists of relevant studies and systematic reviews, three targeted websites, and the WHO International Clinical Trials Registry Platform were searched. Paired reviewers independently conducted screening, assessed risk of bias, and extracted data related to study characteristics, methodology, subjects, and results. Certainty of evidence was evaluated based on the GRADE approach. Results We screened 8461 citations and 307 full-text articles. Ten quantitative studies (i.e., 8 RCTs, 2 non-randomized clinical trials) and one qualitative study were included. With very low to moderate certainty evidence, in adolescents with LBP, spinal manipulation (1–2 sessions/week over 12 weeks, 1 RCT) plus exercise may be associated with a greater likelihood of experiencing clinically important pain reduction versus exercise alone; and group-based exercise over 8 weeks (2 RCTs and 1 non-randomized trial) may reduce pain intensity. The qualitative study found information provided via education/advice and compliance of treatment were related to effective treatment. No economic studies or studies examining thoracic spine pain were identified. Conclusions Spinal manipulation and group-based exercise may be beneficial in reducing LBP intensity in adolescents. Education should be provided as part of a care program. The overall evidence is sparse. Methodologically rigorous studies are needed. Trial registration CRD42019135009 (PROSPERO