Learning via virtual reality simulation in practice is viewed as one strategy of outlining the gap between theory (concepts, features, limitation,…, etc.) and practice (performing skills, and experience in clinical settings) that has several advantages as preventing the probably disastrous consequences of errors occurring in clinical settings.Traditionally, higher education was instructive, providing form of theory-based lectures, with structured clinical hours undertaken in the clinical environment. Whereas, traditional practice happens within physical laboratories, using mannequins, human actors, and task instructors to duplicate procedural tasks and clinical scenarios. While, the transfer into the digital age has seen a move into blended learning methods which have become progressively common since the mid-2000s, and occurs on mixed structure, a constructive, and consisted of several strategies of teaching as audio-visual elements, online learning, self-directed learning modules, lectures and/or workshops, and critical-thinking exercises. Thus, virtual reality simulation plays a vital role within nursing education, with a diversity of software applications a supplement to face-to-face training, and ‘serious games’ being used as a replacement for it. Acquisition of psychomotor skills is an essential portion of nursing education as well as the basis upon which teaching/learning strategies are chosen, it linked with understanding, the cognitive, and affective field features as an attraction for values and attitude. Moreover, the acquisition of skills is directly related to nursing performance to answer the patients' needs. So, nurses should be masters the skills related to nursing interventions. Key words: virtual reality simulation; nursing education; teaching strategy; nursing skills

Background: Most of the existing studies that investigated the self-care of hypertension focused specifically on medication adherence. However, hypertension self-care is a comprehensive concept that includes multiple dimensions. Last year, there was no review carried out assessing the new instruments for hypertension self-care which captured almost all the hypertension selfcare domains. Objective: This systematic review aimed to (1) identify the existing multiple-dimension hypertension self-care assessment scales from 2011 to 2020, (2) describe their characteristics, (3) and evaluate their psychometric and practical considerations. Methods: Database of PubMed, Web of Science, and EBSCO-host were used to identify all studies published between 2011 and 2020. Search limited to full-text, clinical and randomized trial articles, English language, and using terms (self-care AND hypertension). Scales were evaluated for their psychometric and practical considerations using an evaluation criterion for assessing the quality of measures. Results: The search resulted in 29 articles, and they identified five scales; H-SCALE, SCHI, Hypertension self-care questionnaire, HTN-SCP, and HSMBQ. HTN-SCP and HSCALE were the most used scales (11 times). The reliability was tested in different approaches. Overall, internal consistency was well reported with Cronbach ranging from 0.70 to 0.95. At least one type of validity measure was reported for each scale. The scales included multiple-dimensions of all critical domains and all of them were statistically significant (p< 0.05). The SC-HI and HTN-SCP scales were theoretically based on a theory. Conclusion: Although the identified scales well captured all critical domains of HTN self-care, there was a poor understanding of the process underlying the self-care of hypertensive patients. The HTN-SCP scale seems to be the highest psychometric and practical consideration quality of existing HTN self-care measures. Key words: Hypertension, Self-Care, measures, H-SCALE, SC-HI, HTN-SCP, HSMBQ.

Statement of the Problem: Automated Early Warning Scores is a newly developed clinical decision tool that is used to streamline and improve the process of obtaining a patient’s vital signs so a clinical decision can be made at an earlier stage to prevent the patient from further deterioration. This technology provides immediate update on the score and clinical decision to be taken based on the outcome. This paper aims to study the use of an automated early warning score system on whether the technology has assisted the hospital in early detection and escalation of clinical condition and improve patient outcome. Methodology & Theoretical Orientation: The hospital developed and adopted the Modified Early Warning Scores (MEWS) Scoring System (Figure 1) and MEWS Clinical Response (Figure 2) into Philips IntelliVue Guardian Automated Early Warning Score equipment and studied whether the process has been leaned, whether the use of technology improved the usage & experience of the nurses, and whether the technology has improved patient care and outcome. It was found the steps required to obtain vital signs has been significantly reduced. The nurses are using the convenient equipment more frequently to obtain patient vital signs. The number of deaths, and length of stay has significantly decreased as clinical decisions can be made and escalated more quickly with the Automated EWS. Conclusion & Significance: the automated early warning score equipment has helped improve work efficiency by removing the need for documenting into patient’s EMR. The technology streamlines clinical decision-making and allows faster care and intervention to be carried out and improves overall patient outcome. As the use of the technology is simple and convenient, the vital signs is taken more often which translates to better care for patient.

Background: Primary healthcare (PHC) in South Africa often experiences crucial challenges that lead to patients’ negative experiences regarding their care, compromising the significant role that PHC services could play in health promotion and disease prevention. The primary purpose of implementing the Ideal Clinic (IC) in South Africa was to improve patients’ care quality at the clinics. There seems to be a paucity of studies determining professional nurses’ experiences when implementing the IC. Purpose: This study aimed to explore and describe professional nurses’ experiences regarding implementing the IC at three selected clinics in the Makhado local area. Study method: A qualitative phenomenological research design was used to explore professional nurses’ experiences regarding IC implementation. Purposive sampling was used to select 15 professional nurses working at the three selected clinics. Data were collected using semi-structured one-on-one interviews. Interviews were conducted until saturation was reached. Trustworthiness was ensured by applying Lincoln and Guba’s four criteria, i.e., credibility, transferability, dependability, and confirmability. Ethical clearance was obtained from the University of Limpopo Turfloop Research and Ethics Committee, and permission to conduct the study was obtained from Limpopo Province Department of Health Research and Ethics Committee. Thematic analysis was used to analyze data. Results: The following themes emerged from the study findings: perceived benefits of the IC on the primary healthcare services provided to the community, challenges experienced by professional nurses when implementing the IC program, and challenges related to the supply of resources for implementing the IC. The study results revealed that, although the IC aimed to improve the overburdened PHC facilities in SA, the professional nurses still experienced some challenges when implementing the IC program. Some of the challenges faced were a lack of knowledge and training in the IC program, poor infrastructure and the shortage of equipment, and inadequate provision of support by line managers, all of which resulted in poor-quality patient care. Conclusion: This study revealed that the introduction and implementation of the IC can have potential benefits to the community and the primary healthcare system. However, it was not introduced and appropriately implemented, which resulted in professional nurses experiencing several challenges. The national department of health needs to strengthen the program’s implementation through proper training, consultation, and continuous support of the nurses. Provision of quality equipment and supplies is also recommended.

Background: Physical activity is essential to delaying cognitive decline and preventing cognitive impairment in older adults. We used the Social Ecological Model as the framework for designing an interpersonal-level and individual-level multicomponent PA intervention, 4Active, to increase PA participation and cognitive function in older adults living in retirement communities. The purpose of this study was to examine the effectiveness of the 4Active intervention to promote physical activity and cognitive function in older adults. Methods: Fifty-eight eligible older adults with a mean age of 83.83 years (76.3% females) living in two retirement communities voluntarily participated in this study. Forty subjects participated in the two-level 4Active intervention for 12 weeks and 18 subjects were in the control group. Each participant was pre- and posted tested on physical activity (PA) and cognitive flexibility. Data were analyzed by means of descriptive statistics, independent sample t-tests, and Analysis of Covariance (ANCOVA) with repeated measures Results: ANCOVA with repeated measures indicated that the intervention group had overall higher levels of the total PA and the moderate PA than the control group (F = 8.71, p = 0.005, η2 =0.141; F = 8.85, p = 0.004, η2=0.143). In addition, the intervention group showed pronounced increases in light PA (walking) over time, while the control group decreased light PA from baseline to the post-test (F = 6.91, p = 0.011, η2 =0.115). Regarding the results of cognitive flexibility, the ANCOVA with repeated measures revealed that intervention group had overall higher levels of cognitive function compared to the control group (F = 7.88, p = 0.007, η2 =0.129). Both groups showed significant increases in cognitive flexibility over time (F = 6.68, p = 0.013, η2 =0.112), but the intervention group had a smaller change in cognitive flexibility over time compared to the control group (F = 6.75, p = 0.012, η2 =0.113). Conclusions: The study indicated that engaging in technology-enhanced multicomponent exercises is an effective approach to contributing to physically active and cognitively competent aging. Keywords: Ideal Clinic; infrastructure; professional nurses