Purpose This study analyzed nursing students’ guided reflective journals following simulation-based practice using standardized patients for the initial care of older adults experiencing falls. It aimed to provide a deeper understanding of how changes in students’ thinking occurred through the learning experience and to describe their levels of reflection.
Methods An eight-hour simulation-based education program was implemented during a geriatric clinical practicum. The program consisted of orientation, pre-learning activities, simulation practice, and a wrap-up session. Reflective journals from 53 third-year nursing students were analyzed using qualitative content analysis.
Results Fifty-three third-year nursing students participated and submitted reflective journals. Three categories emerged from the analysis: “preparing for simulation-based practice,” which involved students setting care plans and employing observation; (2) “experiencing patient fall management through simulation-based practice,” where students actively engaged in realistic fall management scenarios; and (3) “critical reflection after simulation-based practice,” encompassing students’ acquisition of new insights and their personal growth. In the first category, students prepared for patient encounters by developing care plans and conducting observations. The second category highlighted realistic fall management scenarios utilizing standardized patients. The third category focused on personal growth through critical reflection. In the 53 reflective journals (185,021 words), level 3 reflections accounted for 31.6% of the content, while level 5, the highest reflection level, comprised only 8.6%.
Conclusion Post-simulation reflective journaling stimulated critical thinking and self-assessment, enabling nursing students to analyze and reflect deeply on clinical practices. This process reinforced their knowledge base and behavioral foundations essential for clinical practice.
Purpose This study aimed to identify the main keywords, network structures, and topical themes in patient safety incident reports using text network analysis. Methods: The study analyzed patient safety incident reports from a general hospital in Seoul, covering a total of 3,576 cases reported over five years, from 2019 to 2023. Unstructured data were extracted from the text of the incident reports, detailing how the patient safety incidents occurred and how they were managed according to the six-part principles. The analysis was conducted in four steps: 1) word extraction and refinement, 2) keyword extraction and word network generation, 3) network connectivity and centrality analysis, and 4) topic modeling analysis. The NetMiner program was used for data analysis. Results: The analysis of degree, betweenness, and closeness centrality revealed that the most common keywords among the top five were "confirmation," "medication," "inpatient room," "caregiver," and "condition." Topic modeling analysis identified three main topic groups: 1) incidents caused by a lack of awareness of fall risk, 2) incidents of non-compliance with basic medication principles, and 3) incidents due to inaccurate patient identification. Conclusion To prevent patient safety incidents, it is necessary to promote a culture of safety in hospitals, standardize patient identification procedures, and provide basic training in medication safety and fall prevention to healthcare staff. Furthermore, empirical research on patient safety practices is necessary to encourage active participation in patient safety activities by patients and family caregivers.
Purpose This study aimed to investigate the impact of physical performance and fear of falling on fall risk in patients with End-Stage Renal Disease (ESRD) undergoing hemodialysis.
Methods: This study included 132 patients who regularly received hemodialysis treatment at outpatient clinics in B City from January to April 2022. Data were collected on demographic and clinical characteristics, physical performance (the Short Physical Performance Battery [SPPB]), fear of falling (the Korean Falls Efficacy Scale-International [KFES-I]), and fall risk (the Morse Fall Scale [MFS]). The collected data were analyzed using hierarchical multiple regression in the SPSS/WIN 25.0 program.
Results: Thirty-eight patients (28.8%) had experienced accidental falls in the past year, with an average of 1.68 falls per patient. The average SPPB score was 7.89±3.55 (range, 0 to 12), the KFES-I score was 23.18±9.36 (range, 16 to 64), and the MFS score was 45.68±19.52 (range, 0 to 125). Fall risk showed a significant negative correlation with physical function (r=-.72, p<.001) and a significant positive correlation with fear of falling (r=.65, p<.001). Factors affecting the patients' fall risk included the level of serum intact parathyroid hormone (β=.15, p=.004), fear of falling (β=.24, p=.010), number of falls (β=.34, p<.001), and physical performance (β=-.41, p<.001). The regression model was statistically significant (F=22.71, p<.001), with an explanatory power of 64.9%.
Conclusion: To prevent accidental falls in ESRD patients undergoing hemodialysis treatment, it is necessary to develop and apply interventions that can enhance physical performance and reduce the fear of falling.
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