Tikissä

Tutkimus-, kehitys- ja innovaatiotoiminnan sydämessä

Avainsana: nursing students

Behind the Scenes of a Telehealth Innovation Project
http://A%20screenshot%20of%20Singapore%20unlocked%20game%20view,%20with%20graphics%20of%20jungle%20background,%20cartoon%20animals,%20and%20a%20text%20prompt%20box%20with%20icon%20of%20feet%20on%20left%20and%20right%20side%20of%20box
20.6.2022
Aija Ahokas, Hannele Hokkanen, Yu Ni TAN, Raynee JW THAM, Natalie SH YEH Dip, Hong-Yong TAN

With an increasingly dominant role of technology in healthcare delivery, driven by both demand and supply factors, one question that will confront us as we stare into the future is whether the current nursing curriculum is sufficient flexible or holistic to prepare future nurses? This innovation project has again reminded us the profound and rapid changes that technology has brought to healthcare, especially in things related to the internet technology. According to the World Economic Forum (1), the top hard skills expected to be in demand in the future are cloud computing artificial intelligence analytical reasoning people management and UX design, and a long list. Most of these are not part of a traditional nursing curriculum. As the technology world is expanding, we wonder how the nursing curriculum might look like in ten- or twenty-years’ time versus now. It will not be surprising if future nursing students find themselves learning mathematics, entrepreneurial skills, programming, etc., as part of their core curriculum. The only constant is change so who knows? Interdisciplinary collaboration brings in new perspectives from members of different background and this is useful for breaking away from old mind-sets, injecting new ideas and analysis. In this blog post, we describe an interdisciplinary innovation project between Singaporean students and an industry partner, on their journey to co-create a game for professional healthcare setting. The Challenge: Online Content for Dementia Rehabilitation Facilities The current pandemic has shown the drastic switch from physical activities to telehealth to ensure the continuity of quality care to clients. Although physical activities are still the preferred mode of therapy for dementia clients, having digital ones will serve as an extension especially during times where physical sessions are restricted. Clients are homebound but their rehabilitation care must continue. Technology can be used to replace some card and board games such as memory games, which are commonly used in dementia care. Many traditional games like Monopoly® have already gone online so this is approach is not something very new. In geriatric settings, dementia clients generally find it a challenge to sustain concentration while sitting on a chair and staring at the screen. It is important to include meaningful activities for older adults with dementia. (2) Therefore, mini-physical sessions of activities and/or games were included in between the digital games. It not only improves their concentration for the subsequent digital games but also helps to hone the clients’ motor skills! Singaporean students collaborated with HoviCare Singapore to develop an in-house game that can help aid in their rehabilitation programme for their clients with dementia. The centre has always aimed to provide their clients with the individualised quality rehabilitation services. HoviCare currently uses a curated mix of third-party resources. The next step forward for HoviCare would be having more in-house solutions, which would also pave the way for better control of content resources as well as potential to add analytic features and scale up operation in the future with a common digital platform. The same challenge for students in Singapore and Finland The MANPIT project had started in 2019 in collaboration with Ngee Ann and Metropolia. The project wished to share the best practices in innovation studies and students were to start working on the similar kind of innovation projects, first online and then face-to-face. (3) In Metropolia, innovation studies (10 ECTS) are mandatory to all degree students (4). In Singapore, Ngee Ann Polytechnic seeks to develop and support an entrepreneurship ecosystem through a host of initiatives and programs, and start-up projects are organized as Interdisciplinary free choice studies (5) In MANPIT-project, Metropolia students completed an innovation project, in where a staff member at HoviCare could make an online journey in different countries with the clients. The journey included photos, videos, country specific activities and food experiences. The clients made the journey at the premises of HoviCare in Singapore. Ngee Ann students created an online game for HoviCare clients. The theme was also about travelling but this time in a familiar environment in Singapore as a virtual game. The multidisciplinary team comprised students from the School of Health Sciences (HS) and the School of Info-comm Technology (ICT). The team brings to the table both the necessary healthcare nursing knowledge and the technical prowess needed for the challenge. According to Laura-Maija Hero (6) students` learning experience in a multidisciplinary innovation project comprises three categories. These are solvable conflicts and unusual situations; becoming aware of and claiming collaborative agency; and internalising phases of the innovation process. The Solution: Game – Singapore Unlocked! Singaporean students designed a game around the Singapore Zoological Gardens. With the Singapore Zoological Garden being a popular attraction among Singaporeans, having virtual tours can help give clients a sense of belonging and familiarity! They incorporated both the digital games and physical activities into a single care session. Students wanted to have the option of involving caregivers and the HoviCare staff since they play important roles in the rehabilitation of clients (7). There will be opportunities for self-participation in such activities and games with little supervision to group-participation with caregivers and HoviCare staff together. Caregivers could be untrained family members or even simply be a domestic worker in the context of Singapore. Pre-activity tutorials and interactive sessions embedded within the games are crucial to engage and on-board these caregivers in the journey. Pandemic restrictions The project was held over the course of a COVID-19 pandemic, with restrictions on physical activities and a constantly evolving national policy on pandemic control. It was simply not possible to meet up physically in person within the team and with the industry partners. Significantly, it also curtailed meeting and interactions with clients and end-users. The early adaptation and ‘acclimatisation’ to online technology and a new modus operandi within the team are important in reducing anxiety and getting comfortable with another way of doing the same old thing – meeting up and getting things done – virtually. Moreover, the students did it for the entire duration of the project. Rushing to the school early in the morning or staying back in school for late evening meetings are a thing of the past! Now it could be done any time anywhere, which is both a boom and a bane. Meetings that would no longer be restricted to school hours. Technology has brought convenience but has also blurred the boundaries between school hours and personal life. Students were also not able to visit HoviCare to have a first-hand experience of their ongoing programmes. The information from HoviCare together with the knowledge of dementia care from their nursing program, allowed students to tweak the games and programmes to suit the needs as closely as possible for the dementia clients Interdisciplinary collaboration and important role of users Nursing students commented on interdisciplinary collaboration: “Being nursing students, dementia care is our forte and it is vital that we engage our ICT peers so that they have some ideas about dementia care before embarking on the project. HS nursing students would focus on the physical activities and games ideas while the ICT students focused on game digitalisation and development, including platform optimisation. The ICT students also taught us (nursing students) the importance of perseverance. It is time-consuming and tedious to code the games. When a new suggestion arises, they must change the whole coding and programming system. Yet no complaints are heard, and they focus on producing the best digital solutions to help the clients.” The nursing students also learned something new about colour schemes in the process. In art therapy, dark colours can indicate dampened mood. However, for digital games, dark colours are widely used as a background colour to provide stark contrast in visualisation. Hence, warm colours, as suggested by the ICT team, were used to address the issue of poor eyesight as well as brightening up the mood. Interdisciplinary teamwork can be a double-edged sword and it is vital that students with different expertise and perspective engage each other and work well within the team. (8) Once the team is formed, the students quickly worked to know each other well and to increase common understanding and sharing of expertise, allowing progression and completion of the innovative project successfully. End-users’ role in game development is important and the team’s regret was not being able to directly engage and interact with the elderly clients in-person. The absence of direct contact disrupted the initial plan to engage the clients for testing of the games. By testing the games with the clients under an in-person experience at the centre might have been more advantageous, especially in the early stage to allow to focus on the game design and development, leaving out other factors that may affect the game and system performance and overall experience of users in an out-of-centre remote session. The students’ experience with an inter-disciplinary approach to healthcare innovation highlighted again the importance and benefits of such a strategy and why this approach could or should be widely adopted in the curriculum of institutions of higher learning. MUAS has been an avid champion of such a strategy and NP has in recent years increasingly adopt this practice as well. References 1. World Economic Forum. (2019, January 14). These are the 10 most in-demand skills, according to LinkedIn. (weforum.org) 2. Tierney, L. & Beattie, E. 2020. Enjoyable, engaging and individualised: A concept analysis of meaningful activity for older adults with dementia. International Journal of Older People Nursing. (onlinelibrary.wiley.com) 3. Ahokas, A., Hokkanen, H. & Tan, H-Y. Innovation in pandemic world and beyong. Metropolia University of Applied Sciences. Tikissä Blog. Published 11.3.2021 4. MINNO® Innovation projects - building the future today. 5. NP: The Poly for Budding Entrepreneurs. Cultivating an innovation mindset, leading the entrepreneurial spirit. (np.edu.sg) 6. Hero, L-M 2019. Learning to develop innovations. Individual competence, multidisciplinary activity systems and student experience (Doctoral dissertation). Annales universitatis Turkuensis, 475, Faculty of Education, University of Turku, Finland. 7. The Caregiver Space. (2017, October 5). How Social Interaction Plays a Principal Role in Dementia. (caregiverspace.org) 8. Vestal, A., & Mesmer-Magnus, J. (2020). Interdisciplinarity and Team Innovation: The Role of Team Experiential and Relational Resources, 51(6), 738–755. Authors Aija Ahokas, Manager of Education Export / Senior Lecturer (MEd, RN, Specialist Qualification in Product Design). Ms Ahokas has many years of working experience abroad. Her core competencies are in different international activities, networks & partnerships. Transnational education is close to her heart. Ms Ahokas is the project manager of MANPIT-project. Hannele Hokkanen, Senior Lecturer (MSc (health care), RN, Specialist Qualification in Product Design). Ms Hokkanen teaches gerontological nursing and she is the coordinator of innovation projects in health care. Yu Ni TAN Dip (NSG), Alumni, School of Health Sciences, Ngee Ann Polytechnic, Singapore. Yu Ni graduated from Ngee Ann Polytechnic in 2022 and is eagerly waiting for her nursing degree program to start in the summer. She is ever positive and optimistic about everything. Raynee JW THAM Dip (HSN), Alumni, School of Health Sciences, Ngee Ann Polytechnic, Singapore. Raynee participated in the project as a final-year diploma nursing student and graduated from Ngee Ann Polytechnic in 2021. Driven by her enthusiasm and interest for the project, she remained intimately involved with the team despite her earlier graduation. She is currently an undergraduate nursing student. Natalie SH YEH Dip (NSG), Alumni, School of Health Sciences, Ngee Ann Polytechnic, Singapore. Natalie was an enthusiastic second-year nursing diploma student when she became involved in the project. She graduated from Ngee Ann Polytechnic in 2022 and is looking forward on embarking on her new journey as an undergraduate nursing student in the summer. Hong-Yong TAN, Senior Manager for Timetabling / Lecturer (MBBS). Dr Tan has previously worked at different public hospitals and healthcare organisations in Singapore, in various clinical and administrative roles. He is currently a lecturer with the School of Health Sciences in Ngee Ann Polytechnic where he teaches at both the diploma and post-diploma levels. He is always curious and eager to explore and learn, traits that he hopes to rub off on his students.

Lue lisää

Comparison of nursing students’ health behaviour in four countries: China, Finland, Japan and Sri Lanka
4.11.2021
Aija Ahokas, Eila-Sisko Korhonen, Anita Näslindh-Ylispangar, Wu Xue, Shaomei Shang, Kithsiri Edirisinghe, Reiko Okahisa, Leena Rekola

Health behaviour is a basis for human being’s health and health promotion is a global focus area of the health policy. The rising prevalence of lifestyle related diseases and aging population highlight the need to add knowledge of health behaviour and activities in health promotion. Nursing students are role models, health educators and they are going to motivate the clients and patients to healthy lifestyle and health behaviour. In this blog post, we focus on the comparison of health behaviour of nursing students in China, Japan, Sri Lanka and Finland. How do they feel about their own lifestyle choices? Factors and barriers of healthy lifestyle Students experience studying at university stressful and it can lead to unhealthy lifestyle. Also in nursing education the practical training in hospitals is experienced to be stressful. In the study of Thwaite et al (1) nursing students named the factors of healthy lifestyle to be eating well regular physical activity limiting alcohol, nicotine and caffeine use good sleep stress management social interaction and support. They named the barriers of healthy lifestyle on individual level to be lack of motivation, exiting bad habits and lack of knowledge. The environmental barriers were identified to be lack of time, finances, limited access to healthy food and physical activities. On psychosocial level, the barriers were competing priorities, increasing study load, lack of social interaction and support, compassion fatigue and sift work. Students find it difficult to stick to healthy life style. This blog post is based on the study, where the aim was to produce knowledge in health behavior and self-rated health of the nursing students. The study was part of the joint project: Health status, health behavior, health counselling and vocation among nursing students in Finland, China, Japan, and Sri Lanka - Comparison of nursing students in four countries. The results of the study related to motivation are described in blogpost (2). Study about health behaviour of nursing students Health promotion and health behaviour are the key content of nursing education (3, 4, 5 and 6). Healthy students have the strength to complete their studies and they will be healthy nurses, who have the strength to commit to the challenging nursing profession (7). The purpose of the study was to describe nursing students´ health behavior and the differences between the participating countries (Finland, China, Japan and Sri Lanka). The study was implemented as a quantitative questionnaire study. The themes of the questionnaire were Lifestyles Health and life situation Health services and counselling Social support We also asked some background information, such as Country of home university Age Gender Marital status Living with family Multicultural family background Basic education Semesters studied so far Employment Differences in nursing students` health behavior On average, students’ health and life situation were good in all the four countries in this study. Statistically very significant differences were seen in physical health, economic situation, study success, and work situation. Statistically significant difference was in students’ experiences of social relations and almost statistically significant difference was in students’ experiences of mental health. Students’ motivation in nursing education was in general good; nevertheless, the differences between different countries were statistically very significant. In Finland, the students’ motivation was higher than in the other countries. Not using alcohol, but spending time in social media When inspecting the differences of the students’ from different countries, it can be seen that students from Finland used alcohol more often than students from other countries and they also smoked more often than others. Nutrition and dietary habits of Chinese students have changed to become healthier than in the other countries. In weight management, the biggest change had taken place in Sri Lanka. Students did physical exercise more often in China than in the other countries. All students used a lot of time in social media, but the students in Sri Lanka spent the most time in social media compared to others. Good mental and physical health - but lack of support from professors Health and life situation was evaluated by students´ own assessment of their physical and mental health, economic situation, study situation, work situation and relationship situation. When inspecting the differences between four countries, the students from Japan assessed their physical health as best and the Chinese students assessed their mental health to be better than students in other countries. The economic situation was assessed to be the best by the students in Sri Lanka. The Finnish students assessed their study situation and work situation to be better than students from the other countries. In addition, the human relationships were assessed to be better in Finland than in other countries. In addition, Finnish students assessed their health and life situation a bit better than students from other countries. Students experiences of the use of health services and councelling Use of health services and counselling was investigated by asking the students’ experiences of the use of health services and health counselling. When inspecting the differences between four countries, the following results were found. In Finland and Sri Lanka, students assess health services and counselling to be better than in China and Japan. Students' experiences of use of the health services and health counselling were good on average but in Japan, students’ experiences were worse than in other countries. Data collection from Japan, China, Sri Lanka and Finland Data were collected through an e-form in 2018 in Japan (N=193), China (N=200), Sri Lanka (N=200) and Finland (N=202), in total N=795 (668 female and 127 male students answered the questionnaire). The age of the students were between 18-22 years (64%, n=508) 23-27 years (27%, n=215) 28-32 years (5%, n=38) 33 years or more 4 % of the students (n=35) E-form was modified from the questionnaire based on Dr Anita Näslindh-Ylispangar doctoral dissertation (8) to focus on health behaviour and self-rated health status, and it was modified in co-operation with all participating four countries representatives responding to the differences in cultural issues. The study was conducted in accordance with ethical principles of research (9). All participants were informed about all aspects of the study and confidentiality of data before the data collection. Answering to the questionnaire was voluntary and the data was collected without identification of person. (10) Comparison of background of the nursing students and reflections by experts in each country are described in more detailed in the edited research blog of Metropolia University of Applied Sciences “Tikissä” (11). Lessons learned from this study According to study results, there were significant differences between the countries. In Finland, nursing students were older than in the other three countries and many of them worked during the studies. Also in Japan, many Japanese nursing college students worked part-time because of their economic conditions. The partners from four countries designed the questionnaire together. However, there might be cultural differences in what way the students answered to the different questions. It is not sure, if the students answered honestly to the questions related to the use of alcohol and smoking. In some countries, it is not considered culturally appropriate to drink or smoke as a nursing student. In Finland, the students were significantly older than the students in other countries were and the use of alcohol is culturally more acceptable. Some of the differences may be related to cultural issues. In the questions related to life style of students, the following differences were noted: The students in Finland used alcohol more often than the students in other countries. For example, in Japan, under-aged (persons under the age of 20) drinking and smoking is prohibited by law. In China, the students had better dietary habits and they did more physical exercises than the students in Finland, Japan and Sri Lanka. However, the students in Sri Lanka spent the most time in social media and they had the most changes in weight management. An open question remains, what is the correlation between the time spent in social media and lack of physical exercise. In addition, what is the correlation between online studies and physical exercise and time used in social media? According to the study, the use of internet and social media was huge. Nutrition and exercise plays a significant role in China and Japan According to the Chinese partner, confidence in Traditional Chinese Medicine (TCM) has been boosted in China. Theories in health preserving are also an important part of TCM, as they are more comprehensible to ordinary Chinese people than modern nutrition theories. Nursing students, who are deeply influenced by TCM health practices from childhood, learn modern health science theories and are encouraged to compare them to their daily practice. As a result, students actively adjust their dietary habits and therefore feel more satisfied with them. In Japan, 42,5 % of Japanese nursing students lived with their childhood family, and because of that many of them have the same good eating habits as their families. College students in China are required to earn college credits in physical education. They choose a sport they prefer and attend weekly training. The credit requirement guarantees time and motivation for physical exercise. Also, online fitness mobile applications (apps) have become popular in China during recently years. So-called ‘mind and body practices’ like Yoga and Tai Chi compensate for not being able to hit gyms during busy days. Some Japanese nursing students are in the college circles or club activities (such as tennis, badminton, basketball and volleyball). The students practice 1-3 times a week. Mental health and good economic situation supports the well-being of the students In the questions about health and life situation, the Chinese students assessed their mental health to be better than students in other countries. Sri Lankan students assessed their economic situation to be better than in the other countries. The Finnish students assessed their study and work situation and human relations being better than in China, Japan and Sri Lanka. However, according to this study, most of the students were in good mental health. In addition, their financial situation was good. In Sri Lanka, students studying in government sector nurses’ training schools are provided with monthly allowances during the entire period of their studies. This has led to the stable economic status of Sri Lankan student nurses. Students enrolled in to private sector nursing schools are mainly the one who have an idea of moving to the western world through pathway programs. Students with this type of intention mainly are from middle or upper class family background. Hence, it is obvious that the students in the private sector also have good economic status. Chinese students typically live on campus and share a room with other people and with that they will get social support. Also the family support in China is strong, as being the only child in the family, children are deeply attached to their families. In addition, healthy lifestyle choices are related to improvements in mental health. It should be noted that in this study, the sample data of Chinese students shows good physical activity, as well as low frequency of alcohol assumption and smoking. These are in line with better mental health results. There were differences in answers related to health services and counselling. The study showed that Finnish and Sri Lankan nursing students assessed this question in the same way, versus the answers from Japan and China. What is the reason for this? Are the Japanese and Chinese nursing students shy to ask help when needed? Or are there limited health services and counselling available at the university? In this study, we did not get answers to these questions. Support services available in Japan, China and Sri Lanka In Japan, students’ experiences were worse than in other countries. Tokushima University has the Tokushima University Campus Life Health Support Center. There is a health management department for physical and mental health, and a general counseling department for student counseling. In addition, faculty members in charge of each grade and faculty members in charge of graduation research are also assigned, and the grade teacher holds interviews at least once a year. Despite there are resources for the student's support, the student's evaluation were poor. Possible causes include insufficient information provision in those resources, lack of resources that can be easily consulted, and the characteristics of Japanese university students who have problems on their own and they do not seek help from themselves. Further investigation is needed in the future. Nurses training schools in Sri Lanka have well established protocols in handling students’ concerns related to their health. Individual records on students’ health status being maintained at the school. In addition, one staff member has been appointed as the in charge for students’ medical concerns and the respective staff member take necessary actions by liaising with the hospital/hospitals to handle any medical condition. This has led to the easy access to the health services in Sri Lankan setting. In China, students may feel uncomfortable with visiting professional consultants especially when it comes to psychiatric illness. They may prefer to get support from people they know, such as parents or friends first, rather than strangers even if they could be more professional. Besides, self-treat and self-care may be another option for nursing students, which could be explored in future studies. The need to support nursing students during their studies Most of the students did well. However, there was always a small group of students, who would have needed more support. It was quite surprising, that students reported they had only limited support from their professors or lecturers. The question is how to recognize these students and how to help them to get support. We would need a simple questionnaire by e.g. smart telephone application, and with it regularly follow up students´ wellbeing and health. This would help finding them and advising different options in receiving support in studies and personal life. In many Asian countries, students start university studies straight after the high school. At that phase of life, it might not yet be possible to know, what they would like to become and which profession to choose. Maybe that is the reason, why Finnish students were most satisfied with their studies and work, as they were already older and had more experiences in working life. This study shows that there is a need to investigate regularly the health and wellbeing of students. Even though, most of the students were doing well, we cannot afford losing any students. When students feel well, they are able to complete their studies in time and they are able to graduate to become competent professionals to help other people. Lack of number of nursing professional is a global challenge. During the nursing studies, it is important to support the future graduates to build their resilience to face multiple challenges in their working life, as nursing profession is a demanding profession in many ways. If we were to repeat this study now, the results might be different because of the current pandemic. Especially during the COVID-19, many institutions have moved to online teaching, and students are studying at home without social contacts. References: Thwaite, T L, Heidke P, Williams S. L, Vandelanotte C, Rebar, A L, Khalesi S: Barriers to healthy lifestyle behaviors in Australian nursing students: A qualitative study. Nursing & Health Sciences. 22(4), 921-928, 2020. Näslindh-Ylispangar A: Onko sairaanhoitajan ammatti kutsumusammatti? Tikissä. Metropolia blog, 2019. Shiriver, C B, Scott-Stiles A: Health Habits of Nursing versus Non-nursing Students: A Longitudinal Study. Journal of Nursing Education. Vol. 39 (7), 308-314, 2000. Bryer J, Cherkis F, Raman J: Health-Promotion Behaviour of Undergraduate Nursing Students: A Survey Analysis. Nursing Education Perspectives. Vol. 34(6), 410-415, 2013. Wills J, Keely M: What works to encourage student nurses to adopt healthier lifestyles? Findings from an intervention study. Nurse Education Today. 48, 180-184, 2017. Perry L, Xu X, Gallagher R, Nicholls R, Sibbritt D, Duffield C: Lifestyle health Behaviours and Midwives: The ‘Fit for the Future’ Study. International Journal of Environmental Research and Public Health. 15, 945, 2018. Klaining-Yobas P, He H-G, Lau Y: Physical fitness, health behavior and health among nursing students: A descriptive correlation study. Nurse Education Today. 35 (12), 1199-1205, 2015. Näslindh-Ylispangar A: Men’s Health Behaviour, Health Believes and Need for Health Counselling. A study amongst 40-year-old males from one Helsinki City region. University of Helsinki. Department of General Practice and Primary Health Care. Academic Dissertation. Helsinki University Printing House, 2008. TENK: Responsible conduct of research and procedures for handling allegations of misconduct in Finland. Guidelines of the Finnish Advisory Board on Research Integrity. https://tenk.fi/fi/tiedevilppi/hyva-tieteellinen-kaytanto-htk, Accessed date: 8. June 2021. Burns N, Grove S.K: The Practice of Nursing Research. Appraisal, Synthesis, and Generation of Evidence. 6th Edition. Elsevier Saunders, St. Louis, MO, 2009. Ahokas A, Korhonen E-S, Rekola L: Sairaanhoitajaopiskelijat eri puolilla maailmaa – samanlaisia, mutta silti niin erilaisia. Tikissä. Metropolia blog, 2019 Authors: Aija Ahokas, Senior Lecturer, Metropolia University of Applied Sciences, Helsinki, Finland Eila-Sisko Korhonen, Metropolia University of Applied Sciences, Helsinki, Finland (Free Researcher) Anita Näslindh-Ylispangar, Freelance writer, Helsinki, Finland Wu Xue, School of Nursing, Peking University, China Shaomei Shang, School of Nursing, Peking University, China Kithsiri Edirisinghe, International Institute of Health Sciences, Sri Lanka Reiko Okahisa, Department of Community Health Nursing, Tokushima University, Japan Leena Rekola, Principal lecturer, School of Health care, Metropolia University of Applied Sciences, Helsinki, Finland

Lue lisää