Analysis of adversity quotient of nursing students in Macao:A crosssection and correlation study

Objectives: To investigate the adversity quotient (AQ) of Macao undergraduate nursing students and analyse its influencing factors.Methods:A cross-section design was used,and a convenience sample of nursing students(n=158 valid)was selected from a tertiary institute in Macao.In addition to demographic questions,the Chinese versions of the Adversity Quotient Scale,the Emotional Intelligence(EI)Scale,the Simplified Coping Style Questionnaire and the Parenting Styles Scale were used to assess the students'characteristics.Results:The average AQ score of the students was 116.72±11.39.AQ scores were negatively correlated with coping-negative,and maternal style(excessive interference,excessive protection)(r=-0.332,P<0.001;r=-0.167,P=0.036).Coping-negative entered the regression equation(F=19.154,P<0.001).The female nursing students had higher scores in ownership dimension of AQ than their male counterparts(31.98±3.26 vs.29.21±3.08,t=-4.442,P<0.001).Conclusions:The average AQ scores of Macao undergraduate nursing students were moderate.The female nursing students are more likely to attribute the cause of adversity to themselves,and specific psychosocial and cultural issues may be at play.There is a necessity for Macao nursing students to improve their ability to overcome setbacks.Special attention should be paid to the cultivation of students'positive coping styles.

Validation of Stressors in Nursing Students Scale-Chinese Version (SINS-CN) in a Population of Macao Nursing Students

Objective： To validate the Stressors in Nursing Students Scale-Chinese Version（SINS-CN） in a population of Macao nursing students. Methods： A methodological study was designed with 2 phases. In phase 1, a three-expert panel was invited to evaluate the content validity of SINS-CN, and then its test-retest reliability was examined over a 2-week interval. In phase 2,211 undergraduate nursing students were recruited, and 203 valid responses to the questionnaire were obtained. A principal component analysis with varimax rotation was applied to validate the structure of the instrument. Results： The content validity index（CVI） was 0.89. The correlation coefficient of the test-retest reliability was 0.82 for the overall instrument and 0.70-0.88 for the instrument＇s sub-dimensions. Based on the 43 items of the instrument, five components were identified and accounted for 60. 28% of the variance with eigenvalues ranging from 1.32 to 10. 18. The factor loadings were 0.42-0.79. The internal consistency reliability of Cronbach＇s ot was 0.96 for the overall scale and 0.67-0.94 for its sub-dimensions. Conclusion： The study findings indicated that SINS-CN had acceptable psychometric properties in terms of content validity, stability and internal consistency reliability. The principal component analysis generated a 5-component structure with 43 items; this was slightly different from the origi- nai structure but was more applicable to the studied population, which suggests that this instrument has cross-cultural sensitivity.

An iterative approach to enhance the clinical learning experience in Macao nursing education

Objective: The aim of this study was to reduce or eliminate the stressors to enhance nursing students' clinical learning experience through implementation of an iterative approach that developed a personalised response to student stress.Methods: A prospective cohort research design was applied to collect data from a sample of undergraduate nursing students across the four study years.An iterative approach was employed to improve students' learning experience and the Stressors in Nursing Students Scale-Chinese Version (SINS-CN) was used to measure student stress.Key problems encountered by students were identified,refined and the responding solutions were worked out and implemented among this group of students through their first year to fourth year.Results: The overall SINS-CN mean score (2.17-2.82) of students was declined to a moderate level.Conclusions: Having implemented iterative approach to address factors that led to stressful environments encountered by the nursing students,the overall stress score and each sub-dimension score decreased significantly.Therefore,it is recommended that this approach could be adopted by other colleagues in the nursing arena around the world.

Nursing student perspectives of high-fidelity simulation in Macao

Objective The purpose of this study was to explore student perspectives of high-fidelity simulation.Methods A descriptive study with semi-structured focus group interviews was conducted in Macao.Twenty-one focus group interviews were held with 113 baccalaureate nursing students who had experienced 36-hour of simulation.Results Students perceived that simulation created a nonrisk learning environment,and was helpful in knowledge and skill enhancement and nurse role understanding.However,lack of realistic interactions in psychosocial responses made it difficult for students to relate simulation experience to real-working situations,and poor group contributions affected their learning.ConclusionInteracting with a human patient simulator does not replicate the experience of working with a live patient.Tutors need to come up with ideas about how to make scenarios more real and give more forthright responses to improve the realism of psychosocial responses during simulation.Students experienced uncertainty with clinical decision making and commented on the minimal contributions of some group members.Tutors should be prepared to provide students with substantial supports in developing their understanding of simulation and engaging in the learning process.

Perceived stress among Macao nursing students in the clinical learning environment

Objective:This study aimed at investigation of the stress perceived by Macao nursing students in the clinical learning environment.Methods:A cross-sectional research was designed and 203 nursing students in a public higher education institute were recruited.The Stressors in Nursing Students Scale-Chinese Version(SINS-CN)was used to measure nursing students'stress.Data analysis includes descriptive analysis and analysis of variance.Results:The overall SINS-CN mean score was 3.33(SD=0.49),while the scores for different dimensions were:clinical,3.44(SD=0.54),education,3.35(SD=0.62),finance and time,3.31(SD=0.72),confidence,3.21(SD=0.60),and personal problems,3.03(SD=0.68).Among 10 most common stressors,four belong to the clinical dimension,four to the education dimension,one to the confidence dimension,and one to the finance&time dimension.Analysis for factors associated with stress indicated that no statistical significance was found in most demographic variables,except year two students'stress scores were significantly lower than those of students in other years(p values were between 0.000 and 0.026).Conclusions:Macao nursing students,to some extent,experienced stress in clinical learning environment and the stress level was higher than that of Hong Kong nursing students.The most common stressors were related to clinical and educational dimensions.The study suggests that teaching and learning modalities and the workload of nursing students should be reviewed.

Active Learning Improves Nursing Student Clinical Performance in an Academic Institution in Macao

Objective： To assess the outcome of the application of active learning during practicum among nursing students using clinical assessment and evaluation scores as a measurement. Methods： Nursing students were instructed on the basics of active learning prior to the initiation of their clinical experience. The participants were divided into 5groups of nursing students （ n = 56） across three levels （years 2-4） in a public academic institute of a bachelor degree program in Macao. Final clinical evaluation was averaged and compared between groups with and without intervention. Results： These nursing students were given higher appraisals in verbal and written comments than previous students without interventian. The groups with the invention achieved higher clinical assessment and evaluation scores on average than comparable groups without the active learning intervention. One group of sophomore nursing students （year 2） did not receive as high of evaluations as the other groups, receiving an average score of above 80. Conclusions＂ Nursing students must engage in active learning to demonstrate that they are willing to gain knowledge of theory, nursing skills and communication skills during the clinical practicum.

Self-directed learning readiness and social problem solving of nursing students in Macao

Objective The aims of this study were to describe nursing students′self-directed learning readiness and social problem solving and test their correlations in Macao.Methods This descriptive cross-sectional study was conducted on 140baccalaureate nursing students.A stratified random sampling was performed.The Self-directed Learning Readiness(SDLR)Scale and Chinese Social Problem-Solving Inventory-Revised(C-SPSI-R)were used.Results The response rate was 79.3%.Students possessed readiness for self-directed learning(mean 149.09±12.53,51.4%at high level,48.6%at low level).Regarding to social problem solving,the mean scores of each subscale were 9.35±3.25(Rational Problem Solving,RPS),10.26±3.23(Positive Problem Orientation,PPO),8.14±4.06(Negative Problem Orientation,NPO),5.67±4.44(Avoidance Style,AS),and 4.84±3.03(Impulsivity/Carelessness Style,ICS).SDLR was positively related to RPS and PPO,but was negatively related to AS.Conclusion Half of students possessed stronger readiness for self-directed learning.Students had a belief in the ability to solve problems,and adopted relevant strategies in solving problems.However,students still had negative and dysfunctional orientation and defective attempts in solving problems.Self-directed learning was positively related to positive and constructive orientation,but was negatively related to defective problem-solving pattern.Nurse educators should create educational climates for promoting student confidence and mutual responsibility for learning and their thinking process for problem solving.

生死教育对本科护生生死态度的影响（英文）

目的探查护生接受生死教育前后生死态度的变化。方法将126例不参加生死教育的本科护生归为对照组,48例接受为期3个月生死教育的护生纳入实验组。对量性研究部分,在接受生死教育前后,使用《生命态度量表》评价护生的生死态度;数据分析采用t检验和一般线性模型单变量分析方法。质性部分,接受生死教育后,采用目的抽样,一对一、半结构法,对实验组护生进行深度访谈;数据分析采用Colaizzi现象学研究七步分析法。结果实验组护生《生命态度量表》的得分显著高于对照组。在访谈到第13位护生时资料达到饱和。资料显示6个主题:生死教育可以帮助护生(1)拓展生与死的相关知识;(2)深化对死亡的理解;(3)引发对生命意义的反思;(4)引发关于生死的积极态度和行为;(5)理解医疗和护理的极限;(6)发展悲伤辅导技能。结论生死教育能够提升护生生死态度的积极程度。

护理仿真模拟学习的设计特征及其与学生信心和满意度的关系(英文)

[目的]描述护理仿真模拟学习的设计特征及其与学生信心和满意度的关系。[方法]对立意选样的85位护理本科生进行问卷调查,采用仿真模拟设计量表与学生满意度与自信心量表。[结果]重要的设计特征包括逼真度、引导性反思、仿真情境的问题解决、学习内容及学习支持。学生融入了支持性的学习环境,认为反思以建构式进行,允许他们分析模拟学习中的表现。设计特征与学生的信心与满意度呈正相关,较好的仿真模拟学习设计会使学生产生较高的自信心与学习满意度。[结论]合适的学习内容、引导性反思和互动学习是提高学生自信心与满意度的关键。

An Efficient Trajectory Planning for Cellular-Connected UAV under the Connectivity Constraint

Unmanned Aerial Vehicles(UAVs)acting as aerial users to access the cellular network form a promising solution to guarantee its safe and efficient operations via the high-quality communication.Due to the flexible mobility of UAVs and the coverage range limits of ground base station(GBS),the signalto-noise ratio(SNR)of the communication link between UAVs and GBS will fluctuate.It is an important requirement to maintain the UAV’s cellular connection to meet a certain SNR requirement during the mission for UAV flying from take off to landing.In this paper,we study an efficient trajectory planning method that can minimize a cellular-connected UAV’s mission completion time under the connectivity requirement.The conventional method to tackle this problem adopts graph theory or a dynamic programming method to optimize the trajectory,which generally incurs high computational complexities.Moreover,there is a nonnegligible performance gap compared to the optimal solution.To this end,we propose an iterative trajectory optimizing algorithm based on geometric planning.Firstly,we apply graph theory to obtain all the possible UAV-GBS association sequences and select the candidate association sequences based on the topological relationship among UAV and GBSs.Next,adopting the triangle inequality property,an iterative handover location design is proposed to determine the shortest flight trajectory with fast convergence and low computation complexity.Then,the best flight trajectory can be obtained by comparing all the candidate trajectories.Lastly,we revealed the tradeoff between mission completion time and flight energy consumption.Numerical results validate that our proposed solution can obtain the effectiveness with set accuracy and outperform against the benchmark schemes with affordable computation time.

Over-expression of LRIG3 Suppresses Growth and Invasion of Bladder Cancer Cells

The purpose of this study was to investigate the impact of leucine-rich repeats and immu- noglobulin-like domains 3 （LRIG3） on the biological features of bladder cancer cell lines. The plasmids of over-expressed LRIG3 and the blank plasmid serving as control were transfected into the bladder cancer cell lines, T24, EJ and BIU-87, and the expression levels of LRIG3 mRNA and protein were de- tected by using real-time PCR and Western blotting. The changes in the cell cycle and apoptosis were examined by using flow cytometry. The invasive ability was measured by Transwell assay, and CCK-8 assays were used to measure the proliferation of cells. As compared with the control group, the LRIG3 mRNA and protein expression levels in LRIG3 cDNA-transfected group were raised significantly （P〈0.05）. The average number of cells with up-regulated LRIG3 passing through the inserted filter was decreased significantly as compared with the control group （P〈0.05）. Up-regulation of LRIG3 also could inhibit proliferation and induce apoptosis of T24, EJ and BIU-87 cells. Except BIU-87, the T24 and EJ cells transfected with LIRG3 eDNA were arrested in G0/G1 phase compared to the control group （P〈0.05）. In conclusion, the over-expression of LRIG3 could influence the cell cycle and invasion, in- hibit proliferation and induce apoptosis in the three bladder cancer cell lines.

Development of student simulated patient training and evaluation indicators in a high-fidelity nursing simulation:a Delphi consensus study

Objective:This study is aimed to develop student simulated patient(SSP)training content and evaluation indicators,and further explores their validity and reliabilities.Methods:Delphi consultations with 20 nursing exper ts were conducted.The weights of indicators were calculated through the analytic hierarchy process.SSP training was conducted with a high-fidelity nursing simulation.Results:The expert positive coefficients were 0.952 in the first round consultation and 1.00 in the second round consultation.The expert authority coefficient was reported as 0.87.The training included role and responsibility of simulated patient(SP),script interpretation,plot performance,and training for a rater,with a total of 17 indicators.SSP evaluation consisted of disease knowledge,role portrayal,and performance fidelity and since being a rater,it consists of 20 indicators in total.The coordination coefficients of two rounds of consultation ranged from 0.530 to 0.918.The content validity of SSP evaluation indicators was 0.95.The inter-rater reliability was repor ted as 0.866,and the internal consistency established using Cronbach’sαwas 0.727.Conclusions:Students as SPs should have first-hand knowledge and experience within the simulated scenarios.SSP training content and evaluation indicators were determined through the Delphi consensus combined with analytic hierarchy process.The evaluation indicators were valid and reliable,and provided the objective and quantifiable measurements for SSP training in nursing。

Translation,modification and validation of the Chinese version of a knowledge assessment instrument regarding pressure ulcer prevention

Objective： This study sought to translate, modify and validate an instrument developed by Beckman and colleagues to assess the knowledge of clinical nurses regarding pressure ulcers. Methods： A methodological study design was used. The instrument was translated into Chinese and back-translated into English. A six-expert panel was invited to evaluate the content validity, and a pilot test was subsequently performed on the test-retest stability of the translated instrument. A convenience sampling method was used to recruit 240 nurses from a university teaching hospital in the Mainland of China. In total, 186 valid questionnaires were collected with a 77.5% valid return rate. The validity of the multiple-choice test items （item difficulties and discriminating indices） and internal consistency reli- ability were evaluated. Results： The translated and modified instrument demonstrated acceptable psychometric properties, as follows： （1） the overall content validity index （CVI） was 0.91, （2） the overall test-retest reliability was 0.826, （3） the item difficulty indices were between 0.46 and 0.93, （4） the overall values for discrimination were 0.28-0.55, and （5） the Cronbach＇s a for the internal consistency were 0.792 for the overall in- strument and 0.426-0.804 for the sub-themes. Conclusions： This study represents the first trial to translate and modify an existing instrument that measures the knowledge of pressure ulcers in a Chinese Mainland sample. The instrument demonstrated acceptable psychometric properties and could be applied in cross-cultural nursing practices, including nursing education, research and practice, to evaluate knowledge about pressure ulcer prevention.

Characterizing the Urban Temperature Trend Using Seasonal Unit Root Analysis:Hong Kong from 1970 to 2015

This paper explores urban temperature in Hong Kong using long-term time series. In particular, the characterization of the urban temperature trend was investigated using the seasonal unit root analysis of monthly mean air temperature data over the period January 1970 to December 2013. The seasonal unit root test makes it possible to determine the stochastic trend of monthly temperatures using an autoregressive model. The test results showed that mean air temperature has increased by 0.169~ C （10 yr） - 1 over the past four decades. The model of monthly temperature obtained from the seasonal unit root analysis was able to explain 95.9% of the variance in the measured monthly data -- much higher than the variance explained by the ordinary least-squares model using annual mean air temperature data and other studies alike. The model accurately predicted monthly mean air temperatures between January 2014 and December 2015 with a root-mean-square percentage error of 4.2%. The correlation between the predicted and the measured monthly mean air temperatures was 0.989. By analyzing the monthly air temperatures recorded at an urban site and a rural site, it was found that the urban heat island effect led to the urban site being on average 0.865~C warmer than the rural site over the past two decades. Besides, the results of correlation analysis showed that the increase in annual mean air temperature was significantly associated with the increase in population, gross domestic product, urban land use, and energy use, with the R2 values ranging from 0.37 to 0.43.

Nursing students’ experiences of caring for dying patients and their families: a systematic review and meta-synthesis

Objective: Nurses play important roles in caring for dying patients and their families. Difficulties students confronted when facing dying patients challenge the quality of nursing education. A better understanding of students' experiences would enhance teachers' ability in helping students. This study aims to describe available evidence about nursing students' experiences when caring for dying patients and their families.Methods: A review of qualitative studies published between 2005 and 2017 was undertaken using the following databases: MEDLINE, CINAHL, ProQuest Central, ScienceDirect, and CNKI. The keywords included were nursing students, experience, care, end-of-life, and dying. Qualitative Assessment and Review Instrument was used to assess the quality of the studies by two independent reviewers. The data from the studies were analyzed by meta-synthesis.Results: Eighteen English and two Chinese studies were selected in this review. Four themes were emerged:(1) Students with dying patients: students did not have enough ability in symptoms control, comfort supply, and therapeutic communication for dying patients.(2) Students with the patients' families: students advocated more caring for patients' families.(3) Students with the surroundings: professional medical staffs, especially the nursing preceptors, were key roles in constructing a supporting system for students.(4) Students with themselves: nursing students underwent various negative feelings and adopted both negative and positive strategies to cope with such feelings;students experienced professional and personal development during the caring for dying patients.Conclusions: Nursing students' abilities in terminal symptom control, comfort supply, and therapeutic communication should be improved by more theoretic learning and simulation practice. The nursing preceptors were key roles in constructing a supporting system for students and helping them to control the negative emotions when facing dying patients.

Evaluation of undergraduate students’nursing assessment and communication skills through an objective structured clinical examination within a high-fidelity simulation using a student-simulated patient

Objective:To evaluate nursing students’assessment and communication skills through an objective structured clinical examination(OSCE)within a high-fidelity simulation using a student-simulated patient(SSP)and analyze the validity,reliability,degree of difficulty,and discriminability of the OSCE.Methods:A descriptive study was conducted at one nursing school in Macao.All scenarios were designed using a high-fidelity simulator combined with SSPs.A convenience sample of 54 baccalaureate nursing students completed the OSCE.The nursing assessment OSCE checklist(NAOC)and the communication evaluation rubric(CER)were used as observational measurements with three-point Likert scales(2=Achieved,1=Partly achieved,0=Not completed/Incorrect).Results:Difficulty coefficients of the exam were 0.63 for nursing assessment skills and 0.56 for communication skills.The discrimination index of the majority items of the NAOC(86.4%)was>0.20,showing a better to good discriminability.The items of the CER had satisfactory indexes of item discrimination(from 0.38 to 0.84).Students received high scores in conducting blood oxygen saturation and cardiac and lung auscultation but low scores in vomiting and diarrhea assessment.Students presented good communication skills in eye contacting and listening,but culture assessment needs to be improved.The students with experiences in simulation or simulated patient(SP)interactions had better assessment and communication skills than students without those experiences.There was a positive relationship between nursing assessment and communication skills(r=0.67,P=0.000).Conclusions:SSPs were involved in enhancing the realism of interactions in simulated scenarios.Nursing students can conduct nursing assessments specific to patient conditions,explain the conditions to the patient,and ensure that the patient remains informed at all times of the precautions to be taken.However,students’cultural awareness and some communication skills need further training.With moderate difficulty and high discrimination index,OSCE showed satisfactory reliability and validity.

Anatomy of Connected Cars

The National Highway Traffic Safety Administration in the US and the European Commission are drafting a regulatory framework that will make the goal of connected vehicles possible by 2020, Control, embedded systems, and communication technologies have devel- oped over the past 10 plus years and are approaching maturity. These will spark a revolution in how we approach driving. Cars will no longer need human drivers; they will be connected and exchange information about navigation, road hazards, traffic conditions, and safety. Travelers will be connected more than ever. Today＇ s car will become tomorrow＇ s office and the act of driving will become a leisure activity rather than a necessity. The emerging Internet of Vehicle enables application scenarios unimaginable just few years ago. The main challenges are Internet access spectrum scarcity, mobility, intermittent connectivity and scalability. In this article, we discuss the evolution from intelligent vehicle grid to autonomous, internet-conneeted vehicles and vehicular cloud.

Reviewing the Service Profit Chain： From Consumers＇ Perspective

This paper aims to show the change in mindset, showing the shift from selling in 1950s to the marketing concept and societal marketing concept today. The value of the Service Profit Chain （SPC） is also considered and looks not only at the importance to the customers but also the employees to the success of a business in ultimately winning over the consumer.

Antimicrobial resistance, genotypic characterization and pulsed-field gel electrophoresis typing of extended spectrum β-lactamases-producing clinical Escherichia coli strains in Macao, China

Background The rise of the production of CTX-M class extended spectrum β-lactamases （ESBLs） has been well documented in traveling countries but no data are found for Macao, an international travel city. The objectives of this study were to identify the antimicrobial resistance pattern, and determine the prevalence, genotype and clonal relationship of ESBLs in 209 clinical Escherichia coli strains from Macao, China. Methods Antimicrobial susceptibility test was performed to determine the resistance patterns of the isolates using the disk diffusion method with 17 antimicrobial agents. Phenotypic detection was screened and confirmed according to the Clinical and Laboratory Standards Institute. Genotypic characterization was detected by isoelectric focusing analysis, polymerase chain reaction and sequencing. The clonal relationship between the different ESBL isolates was studied by pulsed-field gel electrophoresis （PFGE）. Results Imipenem and meropenem exhibited 100% susceptible among 209 strains. Overall, 82.3%, 67.3%, 52.9%, 51.2% and 51.0% of the isolates displayed resistance to ampicillin, tetracylcline, ciprofloxacin, sulfamethoxazole trimethoprin and gentamycin. The prevalence rate of ESBLs was 30.1%. Antibiotic resistances were found to be significantly higher among the ESBL producing group compared to non-ESBL producing group. We detected CTX-M-14 to be the major genotypic characterization of ESBLs （76.2%）. Two strains showed indistinguishable patterns by PFGE. Conclusions The prevalence of antimicrobial resistance is alarming high in Macao. Antimicrobial resistance is significantly higher among the ESBL producing group. This study documented CTX-M-14 as the predominant ESBL type. Although indistinguishable pattern was found between two strains, it was too small to decide whether any of the investigated strains was epidemic. Our findings may be also pertinent for other geographic areas undergoing similar travel characteristics to understand the corresponding effects on bacterial populations.

Difference Among Similarity:A Study on Macao Students’Adjustment Experiences in Taiwan’s Higher Education Systems

Purpose:This study focused on cross-region student mobility to explore whether Macao students have adjustment issues while studying and living in Taiwan.Design/Approach/Methods:A total of 663 Macao students were surveyed in Taiwan,and the statistical methods,including correlation,t-test,analysis of variance,and hierarchical regression analysis were addressed to analyze the data.Findings:Macao students,even while studying in a Chinese context,did have social and psychological adjustment issues(i.e.,social support and self-efficacy).Originality/Value:This study could shed some light on understanding cross-region students as well as providing practical guides for relevant governmental departments in their policy regarding outbound students.