EATI Island - A virtual-reality-based elder abuse and neglect educational intervention

Development of an Interactive 3D Visualization Tutorial for Pathophysiology in Graduate Nursing Education

BACKGROUND

A recent revision to the Nurse Practitioner Role Core Competencies will lead to robust changes in graduate education. Incorporating innovative technology into the core courses of advanced practice nursing will prepare practice-ready providers with a high level of competence leading to successful health outcomes, improved patient satisfaction, and decreased health care costs.

PROBLEM

Graduate education lacks effective, innovative, and interactive visualization tools to study pathophysiology. There is a lack of evidence for the use of 3-dimensional (3D) augmented reality (AR) and virtual reality in advanced practice core courses.

APPROACH

A collaborative iterative approach was used to design, develop, analyze, update, and reiterate a 3D AR tutorial for advanced pathophysiology.

OUTCOMES

Students had a positive experience and perceive 3D AR as a learning tool that can increase examination scores. The visualization connected the pathophysiologic process of a disease to the pathogenesis, clinical manifestations, and associated treatments.

CONCLUSIONS

3D AR tutorials are an effective solution to facilitate learning difficult concepts in pathophysiology by incorporating following multiple learning techniques: visual, aural, verbal, kinesthetic, and logical.

Global Approaches to Primary, Secondary, and Tertiary Elder Abuse Prevention: A Scoping Review

Public health professionals use a three-pronged approach to address broad-reaching issues of societal concern: primary prevention, secondary prevention, and tertiary prevention. Applying this framework to the study of elder abuse, the purpose of this review is to describe the status of elder abuse prevention research on a global scale. Elder abuse prevention articles published between 2015 and 2021 were identified through electronic bibliographic searches (PubMed, Medline, CINAHL, APA PsycINFO, and AgeLine). After removing articles based on inclusion and exclusion criteria, articles were sorted into the three main prevention types and further divided into subcategories for a more in-depth review. Most of the studies identified were conducted in North America (n = 42). Of the 72 articles identified, 13 articles focused on primary prevention (agism, education, and intervention), 35 articles focused on secondary prevention (developing and evaluating screening tools, identifying and reporting abuse, and barriers to detecting and reporting abuse), and 21 focused on tertiary prevention (professional response to cases of abuse, intervention methods, and impact of policy). Collectively, findings bring greater understanding of elder abuse as a public health problem and identify ways of addressing the complexities of elder abuse. Several gaps were identified in the elder abuse prevention literature including the need for global research that includes older adults as stakeholders, evidence-based education and intervention programs, and cultural sensitive and valid tools to identify elder abuse.

Education program promoting report of elder abuse by nursing students: a pilot study

BACKGROUND

Elder abuse is an important public health concern that requires urgent attention. One main barrier to active responses to elder abuse in clinical settings is a low level of relevant knowledge among nurses. This study aims to develop an educational program to promote an intent to report elder abuse among nursing students and assess its effectiveness, with a focus on the rights of older adults.

METHODS

A mixed method design was used with the Analyze, Design, Develop, Implement, and Evaluate model. Twenty-five nursing students from Chungbuk Province participated in the study. Attitude toward older adults and knowledge of, awareness of, attitude towards, and intent to report elder abuse were assessed quantitatively and analyzed using paired t-test. The feasibility of the program and feedback were collected qualitatively through group interviews and analyzed using content analysis.

RESULTS

After the education program, attitude toward older adults (Cohen's d = 1.08), knowledge of (Cohen's d = 2.15), awareness of (Cohen's d = 1.56), attitude towards (Cohen's d = 1.85), and intent to report elder abuse (Cohen's d = 2.78) increased, confirming the positive effects of this program. Overall, all participants were satisfied with the contents and method of the program.

CONCLUSIONS

The method of program delivery should be improved and tailored strategies to boost program engagement among nursing students should be explored to implement and disseminate the program.

Simulation-based training for continuing professional development within a primary care context: a systematic review

BACKGROUND

Given the increasing complexity of tasks transferred to primary care, discipline-specific educational opportunities are required for those working within this context. Simulation-based training (SBT) is widely applied within a hospital setting, underpinned by extensive research. However, little is known about the transfer of simulations' utility to primary care. This systematic review sought to determine which SBT approaches are adopted for continuing professional development within primary care and appraise their impact.

METHODS

Medline, Embase, CINAHL and Web of Science databases were searched, with additional articles obtained through secondary searching. Eligible studies employed and evaluated a simulation-based educational intervention for fully qualified healthcare professionals, working within primary care. Included studies were quality assessed using the Mixed Methods Appraisal Tool (v18) and their findings narratively synthesised.

RESULTS

Forty-nine studies were included, sampling 4,601 primary care health professionals. Studies primarily adopted a quantitative design and demonstrated variable quality. Simulation approaches comprised standardised patients (n = 21), role-play (n = 14), virtual (n = 6), manikin (n = 5) and mixed manikin/standardised patients (n = 3). Efficacy was evaluated across Kirkpatrick levels and demonstrated a positive impact for knowledge-, skills- and attitude-based outcomes, though this was limited in select studies.

DISCUSSION

SBT has been adopted in the education of the spectrum of health professionals working within primary care, with the most common approach being standardised patients. Simulation delivers an acceptable and effective educational method, demonstrating a positive impact across various learning objectives. Further research assessing the impact at an organisational- and patient-level is required.

Exploring Key Factors Influencing Nursing Students' Cognitive Load and Willingness to Serve Older Adults: Cross-sectional Descriptive Correlational Study

BACKGROUND

Virtual learning environments (VLEs) use a virtual environment to support learning activities. VLEs are commonly used to overcome the temporal and spatial restrictions of learning activities held in conventional face-to-face classrooms. In VLEs, students can participate in learning activities using the internet, and teachers can provide assistive learning tools during the process.

OBJECTIVE

The purpose of this study was to investigate the relationships among nursing students' mental load, cognitive load, and affective learning outcomes in terms of their willingness to serve older adults in an interaction-based educational virtual reality (VR) learning environment.

METHODS

This study used a cross-sectional method. A total of 130 students participated in interaction-based VR learning and completed related questionnaires. Descriptive and inferential statistics and stepwise regression for data analysis were used.

RESULTS

The research results revealed that in the dimension of willingness to use VR learning materials, perceived usefulness received the highest score (mean 4.42, SD 0.45). In the dimension of nursing ability, students scored the highest in information management and application ability to care for case patients (mean 4.35, SD 0.54). Correlation analysis revealed that cognitive load during learning and willingness to serve older adults were negatively correlated, whereas willingness to use VR learning materials was positively correlated with nursing ability and willingness to serve older adults. Analyzing the regression coefficients of predictor variables revealed that willingness to use VR learning materials (β=.23; t₂=2.89, P=.005) and cognitive load during learning (β=-.35; t₂=-.4.30, P<.001) were predictive factors of nursing students' willingness to serve older adults.

CONCLUSIONS

This study demonstrated that students' willingness to use VR learning materials and their cognitive load during learning affected their willingness to care for older adults. Therefore, the components of mental or cognitive load generate inconsistent predictive effects on affective variables and willingness to serve older adults.

Effectiveness of Nurses' Training in Identifying, Reporting and Handling Elderly Abuse: A Systematic Literature Review

The elderly population globally is estimated to grow by one-third of the world’s population by the year 2050. At the same time, elder abuse and neglect have been acknowledged as major growing concerns. With the growing elderly population and increasing concerns about elder abuse, understanding the ways to deal with elder abuse is important. The healthcare professionals, especially nurses, are among the first groups who come in contact with the elderly population and can identify and assess cases of elder abuse. There is evidence to suggest that nurses lack knowledge in the assessment, identification, management, and reporting of an elder abuse case. This study aims to explore the available literature in the effectiveness of training programs for nurses in elder abuse management. The search strategy included the electronic databases CINHAL, Medline, and Health Source. A total of 646 research articles published between 2010 and 2021 were screened against inclusion and exclusion criteria. After reviewing and removing duplicates and irrelevant studies, 14 articles were included in this review. The findings of this literature review revealed that providing education and training for nurses in elder abuse can enhance their knowledge and increase identification and reporting of elder abuse cases. It also indicated that mixed teaching methods, such as face-to-face lectures, simulation, or case scenarios and debriefings or feedback can strengthen the learning process of nurses. In conclusion, educational programs for nurses can significantly improve the identification, reporting, and handling skills of elder abuse incidents. This finding can help in developing accurate strategies for minimizing and preventing elder abuse cases. From the results of this systematic review, we propose the ECLiPSE pathway for the effective training of nurses and handling of elder abuse cases, eventually contributing to decreasing the incidents.

Testing an educational intervention to improve health care providers' preparedness to care for victims of elder abuse: a mixed method pilot study

BACKGROUND

Elder abuse is prevalent and associated with ill-health. However, health care providers often lack education about elder abuse and older patients' victimization often remains unknown to them. In this pilot study we performed initial testing of an educational model aiming at improving health care providers' preparedness to care for older adults subjected to abuse, or more specifically their self-reported propensity to ask older patients questions about abuse and perceived ability to manage the response.

METHODS

The educational model consisted of a full training day about elder abuse, including theory, group discussions and forum theatre. Forum theatre is an interactive form of drama in which participants are not only observers, but rather spect-actors, urged to participate in the scene. They are thereby given the opportunity to discuss and practise difficult health care encounters. Medical interns (intervention group n = 16, control group n = 14) in Sweden participated in the study and a mixed method convergent parallel design was used. Quantitative data was collected at baseline and 6 months post-intervention using a questionnaire (the REAGERA-P). Qualitative interviews were conducted with four of the participants in the intervention group and data was analysed using qualitative content analysis.

RESULTS

The reported frequency of asking older patients questions about abuse increased in the intervention group (p = 0.047), but not the control group (p = 0.38) post-intervention. Potential mediators for the improvement were an increased awareness of elder abuse and higher self-efficacy for asking questions about elder abuse. Participants also reported a higher perceived ability to manage cases of elder abuse, even though uncertainties concerning how to provide the best possible care remained. The qualitative interviews indicated that learning from each other in group discussions and forum theatre likely was an important contributor to the positive results.

CONCLUSION

This pilot test indicated that the educational model may be effective in improving health care providers' preparedness to care for older adults subjected to abuse. However, uncertainties about how to handle elder abuse cases remained post-intervention. In a future full-scale test of the model more focus needs to be put on how to manage cases of elder abuse.

Responding to Elder Abuse in GERiAtric care (REAGERA) educational intervention for healthcare providers: a non-randomised stepped wedge trial

INTRODUCTION

Elder abuse is prevalent and associated with different forms of ill health. Despite this, healthcare providers are often unaware of abusive experiences among older patients and many lack training about elder abuse. The overall aim of this study is to determine the effectiveness of an educational intervention on healthcare providers' propensity to ask older patients questions about abusive experiences.

METHODS AND ANALYSIS

Healthcare providers at hospital clinics and primary healthcare centres in Sweden will undergo full-day education about elder abuse between the fall of 2021 and spring of 2023. The education consists of (1) theory and group discussions; (2) forum theatre, a form of interactive theatre in which participants are given the opportunity to practise how to manage difficult patient encounters; and (3) post-training reflection on changing practices.The design is a non-randomised cluster, stepped wedge trial in which all participants (n=750) gradually transit from control group to intervention group with 6-month interval, starting fall 2021. Data are collected using the Responding to Elder Abuse in GERiAtric care-Provider questionnaire which was distributed to all clusters at baseline. All participants will also be asked to answer the questionnaire in conjunction with participating in the education as well as at 6-month and 12-month follow-up. Main outcome is changes in self-reported propensity to ask older patients questions about abuse post-intervention compared with pre-intervention. Linear mixed models including cluster as a random effect will be used to statistically evaluate the outcome.

ETHICS AND DISSEMINATION

The study has been approved by the Swedish Ethical Review Authority. The results will be published in peer-reviewed journals and conference proceedings. If the intervention is successful, a manual of the course content will be published so that the education can be disseminated to other clinics.

TRIAL REGISTRATION NUMBER

NCT05065281.

Two Immersive Virtual Reality Tasks for the Assessment of Spatial Orientation in Older Adults with and Without Cognitive Impairment: Concurrent Validity, Group Comparison, and Accuracy Results

OBJECTIVE

Spatial disorientation is common in Alzheimer's disease (AD), Mild Cognitive Impairment (MCI), and preclinical individuals with AD biomarkers. However, traditional neuropsychological tests lack ecological validity for the assessment of spatial orientation and to date, there is still no gold standard. The current study aimed to determine the validity and accuracy of two virtual reality tasks for the assessment of spatial orientation.

METHODS

We adapted two spatial orientation tasks to immersive virtual environments: a "survey to route" task in which participants had to transfer information from a map to their body position within a maze [Spatial Orientation in Immersive Virtual Environment Test (SOIVET) Maze], and an allocentric-type, route learning task, with well-established topographic landmarks (SOIVET Route). A total of 19 MCI patients and 29 cognitively healthy older adults aged 61-92 participated in this study. Regular neuropsychological assessments were used for correlation analysis and participant performances were compared between groups. Receiver Operating Characteristic (ROC) curve analysis was performed for accuracy.

RESULTS

The SOIVET Maze correlated with measures of visuoperception, mental rotation, and planning, and was not related to age, educational level, or technology use profile. The SOIVET Route immediate correlated with measures of mental rotation, memory, and visuoconstruction, and was influenced only by education. Both tasks significantly differentiated MCI and control groups, and demonstrated moderate accuracy for the MCI diagnosis.

CONCLUSION

Traditional neuropsychological assessment presents limitations and immersive environments allow for the reproduction of complex cognitive processes. The two immersive virtual reality tasks are valid tools for the assessment of spatial orientation and should be considered for cognitive assessments of older adults.

Effectiveness of Immersive Virtual Reality in Nursing Education: Systematic Review

BACKGROUND

Digital education using immersive virtual reality (VR) technology is available in nursing. Evidence of its effectiveness is essential.

PURPOSE

This review analyzed the effectiveness of and barriers to using immersive VR in nursing education.

METHODS

A structured search was performed in PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, PsycINFO, Web of Science, and ProQuest Nursing & Allied Health Database. The Medical Education Research Study Quality Instrument was used to assess the quality of studies.

RESULTS

The final review was composed of 9 studies of moderate to high quality published between 2018 and 2020. The review indicated that immersive VR increased learning, cognitive, and psychomotor performance. Most participants of the studies preferred using immersive VR in education and with a variety of experiential scenarios. Barriers were associated with technological hardware and software (eg, simulation sickness, lack of visual comfort).

CONCLUSION

The review supports the viability of immersive VR technology in nursing education.

How, for Whom, and in Which Contexts or Conditions Augmented and Virtual Reality Training Works in Upskilling Health Care Workers: Realist Synthesis

Background

Using traditional simulators (eg, cadavers, animals, or actors) to upskill health workers is becoming less common because of ethical issues, commitment to patient safety, and cost and resource restrictions. Virtual reality (VR) and augmented reality (AR) may help to overcome these barriers. However, their effectiveness is often contested and poorly understood and warrants further investigation.

Objective

The aim of this review is to develop, test, and refine an evidence-informed program theory on how, for whom, and to what extent training using AR or VR works for upskilling health care workers and to understand what facilitates or constrains their implementation and maintenance.

Methods

We conducted a realist synthesis using the following 3-step process: theory elicitation, theory testing, and theory refinement. We first searched 7 databases and 11 practitioner journals for literature on AR or VR used to train health care staff. In total, 80 papers were identified, and information regarding context-mechanism-outcome (CMO) was extracted. We conducted a narrative synthesis to form an initial program theory comprising of CMO configurations. To refine and test this theory, we identified empirical studies through a second search of the same databases used in the first search. We used the Mixed Methods Appraisal Tool to assess the quality of the studies and to determine our confidence in each CMO configuration.

Results

Of the 41 CMO configurations identified, we had moderate to high confidence in 9 (22%) based on 46 empirical studies reporting on VR, AR, or mixed simulation training programs. These stated that realistic (high-fidelity) simulations trigger perceptions of realism, easier visualization of patient anatomy, and an interactive experience, which result in increased learner satisfaction and more effective learning. Immersive VR or AR engages learners in deep immersion and improves learning and skill performance. When transferable skills and knowledge are taught using VR or AR, skills are enhanced and practiced in a safe environment, leading to knowledge and skill transfer to clinical practice. Finally, for novices, VR or AR enables repeated practice, resulting in technical proficiency, skill acquisition, and improved performance. The most common barriers to implementation were up-front costs, negative attitudes and experiences (ie, cybersickness), developmental and logistical considerations, and the complexity of creating a curriculum. Facilitating factors included decreasing costs through commercialization, increasing the cost-effectiveness of training, a cultural shift toward acceptance, access to training, and leadership and collaboration.

Conclusions

Technical and nontechnical skills training programs using AR or VR for health care staff may trigger perceptions of realism and deep immersion and enable easier visualization, interactivity, enhanced skills, and repeated practice in a safe environment. This may improve skills and increase learning, knowledge, and learner satisfaction. The future testing of these mechanisms using hypothesis-driven approaches is required. Research is also required to explore implementation considerations.

The Relationship Between Family Support and e-Learning Engagement in College Students: The Mediating Role of e-Learning Normative Consciousness and Behaviors and Self-Efficacy

Due to the current COVID-19 pandemic, colleges and universities have implemented network teaching. E-learning engagement is the most important concern of educators and parents because this will directly affect student academic performance. Hence, this study focuses on students’ perceived family support and their e-learning engagement and analyzes the effects of e-learning normative consciousness and behaviors and self-efficacy on the relationship between family support and e-learning engagement in college students. Prior to this study, the relationship between these variables was unknown. Four structural equation models revealed the multiple mediating roles of e-learning normative consciousness and behaviors and self-efficacy in the relationship between family support and e-learning engagement. A total of 1,317 college students (mean age=19.51; 52.2% freshman) voluntarily participated in our study. The results showed that e-learning normative consciousness and behaviors and self-efficacy played significant and mediating roles between students’ perceived family support and e-learning engagement. Specifically, these two individual variables fully mediated the relationship between students’ perceived family support and e-learning engagement. The multiple mediation model showed that family members can increase family support of their children by creating a household environment conducive to learning, displaying positive emotions, demonstrating the capability to assist their children, advocating the significance of learning normative consciousness and behaviors, and encouraging dedicated and efficient learning. The findings complement and extend the understanding of factors influencing student e-learning engagement.

Elder Abuse Assessment Tools and Interventions for use in the Home Environment: a Scoping Review

Background and Aim

Caregivers in the home environment have an important role in timely detecting and responding to abuse. The aim of this review was to provide insight into both the existing tools for the assessment of and interventions for elder abuse by formal and informal caregivers in the home environment, and to categorize them according to a public health perspective, into primary, secondary, tertiary or quaternary prevention.

Methods

We selected the assessment tools and interventions that can be used by caregivers in the home environment included in previous reviews by Gallione et al (2017) and Fearing et al (2017). To identify published studies after these reviews, a search was performed using PubMed, Cochrane Database, CINAHL and Web of Science.

Results

In total, fifteen assessment tools and twelve interventions were included. The number of assessment tools for elder abuse for use in the home environment is increasing; however, tools must be validated over different cultures and risk groups. In addition, the tools lack attention for the needs of vulnerable older persons such as persons with dementia. Existing interventions for caregivers in the home environment lack evidence for addressing elder abuse and do not address potential adverse effects (quaternary prevention).

Conclusion

Assessment tools for elder abuse need further testing for validity and reliability for use by caregivers in the home environment. For interventions, meaningful outcome measures are needed. Important to note is that quaternary prevention requires more attention. This argues for taking into account perspectives of (abused) older persons and caregivers in the development of assessment tools and interventions protocols.

The Role of Attachment Styles and Communication Skills in Predicting Nursing and Medical Students' Perception of Elder Abuse

Background

The knowledge and abilities of nurses and physicians in perceiving and dealing with abuse are necessary for the improvement of older people’s health. Therefore, the aim of this study was to investigate the role of attachment styles and communication skills in predicting nursing and medical students’ perception of elder abuse in Yazd, Iran.

Methods

The present study was a descriptive cross-sectional design that was conducted in the form of multistage sampling on 397 nursing and medical students at Shahid Sadoughi University of Medical Sciences in Yazd, Iran. The Elderly Caregiving Questionnaire (ECQ), Adults’ Attachment Styles Inventory (AAI), and the revised version of the Communication Skills Questionnaire were used for data collection. Data were analyzed using the SPSS version 22 software.

Results

The findings revealed that the participants had an appropriate understanding of elder abuse. The highest level of perception of elder abuse was in the dimension of psychological abuse (24.5± 5.22) and the lowest level was related to the dimension of physical abuse (21.7± 4.74). Additionally, a positive significant relationship was found between the score of students’ perception of abuse, and secure and avoidant attachment styles as well as students’ communication skills (p<0.01). According to regression analysis, these predictors explained 8.6% of the observed variance in the students’ perception of elder abuse.

Conclusion

These findings indicate that attachment styles influenced the individual’s perception of elder abuse. Therefore, in future planning and research, this should be given more attention.

Identifying elder abuse & neglect among family caregiving dyads: A cross sectional study of psychometric properties of the QualCare scale

BACKGROUND/OBJECTIVES

Universal screening for elder abuse and neglect is a current controversy in geriatrics, fueled by the lack of evidence on valid and reliable instruments. Since each U.S. State and many other countries have their own legal definitions of what constitutes elder abuse and neglect, this further complicates instrument development and clinical assessment. The purpose of this paper is to present data on the sensitivity and specificity of the QualCare Scale, an instrument with utility in detecting clinically significant elder abuse and neglect among older adults receiving care at home.

DESIGN

Data used in this analysis were collected during a training program in which trainees completed assessments (N=80) of standardized case scenarios of caregiving dyads. Trainees completed the QualCare Scale during each assessment.

SETTING

This training program, including the assessments of the standardized case scenarios, was completed using a custom designed virtual-reality platform. Trainees were able to interact with the environment, older adult and caregiver within the case scenario.

PARTICIPANTS

Thirty-six nurses and social workers from two Michigan Medicaid Waiver Sites participated in the training program. Each participant assessed between one and five scenarios, yielding the sample of 80 assessments used in this analysis.

MEASUREMENTS

The research team designed each standardized case scenario to reflect whether or not the QualCare Scale subscale score should indicate reportable elder abuse and neglect per the State statute. Accordingly, the research team's QualCare Scale scores for each scenario were used as the gold standard criterion of clinical significance for comparison against the participant's assessment scores.

RESULTS

Sensitivity and specificity for each of the six QualCare subscales was determined. Overall, the subscales had high sensitivity (≥0.811) but a wide range for specificity (0.167-1.000).

CONCLUSION

The QualCare Scale can be an effective tool in detecting clinically significant elder abuse and neglect among older adults receiving care at home. This tool is suitable and feasible for use by practitioners working in home care. The QualCare Scale score indicating clinically significant or reportable elder abuse and neglect can be raised or lowered to be consistent with State or Country statutes, or simply used to create appropriate care plans to support caregiving. Findings from the QualCare Scale can support the multidisciplinary team in planning for and evaluating preventative interventions.