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Background: Chronic obstructive pulmonary disease (COPD) is characterized by important extrapulmonary alterations that could affect the performance in dual task (DT) (motor and cognitive tasks executed simultaneously), which is defined as DT interference (DTI). Objective: To compare the performance of DT between individuals with COPD and healthy control subjects (HCSs). Methods: The literature search was conducted in seven databases (Medline, Scopus, Web of Science, PEDro, SciELO, LILACS, and Google Scholar) up to December 2023, including studies published in English, Spanish, or Portuguese. Studies with individuals diagnosed with COPD older than 60 years, who were evaluated with any DT assessment, and compared with HCS were included. The quality of the studies was evaluated using the risk of bias in nonrandomized studies of interventions (ROBINS-I). The meta-analysis was performed with JAMOVI software 5.4. The study protocol was registered on PROSPERO (CRD42023435212). Results: From a total of 128 articles, 5 observational studies were selected in this review, involving 252 individuals aged between 60 and 80 years, from France, Italy, Canada, Turkey, and Belgium. Notable DTI was observed in individuals with COPD compared to HCS (standard mean difference [SMD] = 0.91; 95% confidence interval (CI) 0.06-1.75, p = 0.04). Individuals with COPD had impaired gait speed, balance control, muscle strength, and cognitive interference during DT compared to HCS. DT assessment protocols included different combination of motor and cognitive tasks, using functional test, gait analysis, and muscle strength paired with countdown and verbal fluency tasks. Studies presented low (n = 2), moderate (n = 1), and serious (n = 2) overall risk of bias. Conclusion: Older adults diagnosed with COPD exhibited a significant DTI compared to HCSs, which is characterized by poorer physical and cognitive performance during DT execution. These findings highlight the importance of incorporating DT assessments into clinical practice for individuals with COPD.

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BACKGROUND: Limited data exist on post-severe COVID-19 functional trajectory, particularly considering premorbid status. We characterized 1-year functional recovery post-hospitalization for COVID-19, highlighting predictors of long-term recovery. METHODS: We enrolled adult patients with lab-confirmed SARS-CoV-2 infection and hospitalized for COVID-19 sequelae, from five major Ontario, Canada hospitals in a prospective cohort study. Assessments included telephone interviews on admission followed by telephone and in-person assessments at 3-, 6-, 9-, and 12-months post-discharge. The Activity-Measure for Post-Acute Care (AM-PAC) Mobility and Cognition scales were administered at baseline and every 3 months for 1 year. Secondary outcomes included symptoms, spirometry, physical performance, dyspnea, fatigue, distress, anxiety and depression, and quality of life. RESULTS: A total of 254 patients (57.1% male) with a mean age of 60.0 (±13.1) years and an average hospital stay of 14.3 (±19.7) days agreed to participate. At 12 months, 55.3% demonstrated clinically important deficits in mobility and 38.8% had cognitive deficits compared to premorbid levels. Fatigue was reported in 44.2%, followed by difficulty walking long distances in 35.8% and dyspnea in 33.0%. Almost 40% of patients had an FEV1(% Pred) < 80% at 12 months, 60.3% had impairments in physical performance, and 44.5% had problems with anxiety or depression. Predictors of better mobility at 12 months included higher premorbid mobility status, male sex, shorter hospital stay, fewer comorbidities, and higher FEV1 (% pred) at the 3-month follow-up. CONCLUSIONS: Our study provides compelling evidence of the long-term impact of COVID-19 on functional and cognitive status 1-year post-infection.

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Scholars have argued that standard physical assessment is based on a medical framework instead of nursing theories and philosophy. We argue that standard physical assessment is task-oriented, lacking emphasis on the whole-person and neglecting a least-to-most invasive assessment process. While holistic health assessment is person-centered and multidimensional; addressing aspects such as physical, emotional, and spiritual well-being, there is not a comprehensive explanation on how to holistically perform the physical examination portion of a holistic health assessment. Proposed is a new framework for holistic physical assessment in the hospital environment, honoring the whole-person, their background, and lived experiences. The framework builds on the holistic nursing philosophy, integrative nursing principles, and trauma-informed approach, and systematically arranges physical assessment from least invasive to most. The seven sequential assessment steps incorporate self-care and awareness into the preparation and closure of the assessment-(1) the self, (2) the space, (3) least invasive, (4) moderate invasive, (5) most invasive, (6) the space, and (7) the self. This framework can have significant implications for nursing practice and education settings, providing valuable guidance for a holistic physical assessment that emphasizes whole-person care.

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BACKGROUND: The incidence of elderly people experiencing falls is currently increasing, which results in serious medical issues, such as fear of falling, limited physical activity, disability, and bone fractures, especially hip fractures. This study aimed to investigate balancing ability using a multi-directional reach test (MDRT) in older adults with and without diabetes mellitus. METHODS: 72 older adults with and without diabetes mellitus were recruited, and divided into two groups, including older adults without diabetes mellitus (n = 36) and older adults with diabetes mellitus (n = 36). All subjects completed all directions of the MDRT. RESULTS: There were no significant differences in MDRT scores in all directions between the two groups (p>0.05). Both groups achieved the highest MDRT scores in the forward direction. In contrast, the two groups had the lowest scores of MDRT in a backward direction. Furthermore, older adults with diabetes mellitus had lower MDRT scores in all directions than older adults without diabetes mellitus. CONCLUSION: The current study indicated that MDRT could be used to investigate the ability of balance in individuals with diabetes mellitus.

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From the time of Galen, examination of the pupillary light reflex has been a standard of care across the continuum of health care. The growing body of evidence overwhelmingly supports the use of quantitative pupillometry over subjective examination with flashlight or penlight. At current time, pupillometers have become standard of care in many hospitals across 6 continents. This review paper provides an overview and rationale for pupillometer use and highlights literature supporting pupillometer-derived measures of the pupillary light reflex in both neurological and non-neurological patients across the health care continuum.

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Postural adaptation is a prominent feature in horses affected by laminitis. Laminitis induces intense pain, especially in the forelimbs, prompting affected horses to assume a caudally displaced trunk posture, resulting in the hyperflexion of the thoracolumbar spine. This study assessed the nature and prevalence of thoracolumbar injuries in horses with chronic laminitis compared to horses without it. Sixty horses were used (thirty laminitic and thirty non-laminitic) of different athletic purposes and ages (2-20 years). The experimental protocol entailed a single assessment of horses' thoracolumbar spines, utilizing physical examination by MACCTORE, a scoring system developed specifically for this study. Additional evaluations included the Grimace Equine Pain Scale (HGS) and ultrasound exams. Statistical tests were used to compare values (Mann-Whitney or t-test) and lesions prevalences (Fisher) between groups (p < 0.05). The results showed a higher pain manifestation (HGS and heart rate, p < 0.0001) and thoracolumbar-spine-injury levels in chronic laminitis horses, both in MACCTORE clinical examinations (11.7 ± 4.8 vs. 4.2 ± 3.3, p < 0.0001) and general ultrasonographic indices (39.6 ± 12.0 vs. 20.7 ± 7.1, p < 0.0001), including specific examination approaches for various spinal elements. Horses with laminitis presented with a 14-fold higher prevalence of ultrasound-relevant lesions in the thoracolumbar spine (CI: 4.4 to 50.6, p < 0.0001) compared to controls. These findings constitute new evidence of an association between chronic laminitis and the presence of thoracolumbar spine injuries in horses, which may be confirmed by more sophisticated study designs.

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As a result of technological advancements, functional capacity assessments, such as the 6-minute walk test, can be performed remotely, at home and in the community. Current studies, however, tend to overlook the crucial aspect of data quality, often limiting their focus to idealised scenarios. Challenging conditions may arise when performing a test given the risk of collecting poor-quality GNSS signal, which can undermine the reliability of the results. This work shows the impact of applying filtering rules to avoid noisy samples in common algorithms that compute the walked distance from positioning data. Then, based on signal features, we assess the reliability of the distance estimation using logistic regression from the following two perspectives: error-based analysis, which relates to the estimated distance error, and user-based analysis, which distinguishes conventional from unconventional tests based on users' previous annotations. We highlight the impact of features associated with walked path irregularity and direction changes to establish data quality. We evaluate features within a binary classification task and reach an F1-score of 0.93 and an area under the curve of 0.97 for the user-based classification. Identifying unreliable tests is helpful to clinicians, who receive the recorded test results accompanied by quality assessments, and to patients, who can be given the opportunity to repeat tests classified as not following the instructions.

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BACKGROUND: Simulation is a technique being used increasingly in healthcare education which offers opportunities to evaluate nursing proficiencies. The use of valid and reliable instruments is recognised as the foundation for a robust assessment, however competency-based health assessment courses for graduate nurses can consequently become reductionist in measuring proficiencies. OBJECTIVE: The specific review question was: In simulation-based education, what are the criteria that evaluate graduate nursing student's competence in obtaining a health history and performance of patient assessment? METHODS: Eleven studies were included in the review. Papers were critically appraised with The Joanna Briggs Institute quasi-experimental studies checklist. Bloom's taxonomy was used to structure this narrative review. RESULTS: Seven papers evaluated cognition through questionnaires and two papers used a Likert-scale to determine self-perceived knowledge. Six papers evaluated psychomotor skills with a behavioural checklist. Diversity of application was factored into the studies when testing affective skills. Three papers used Likert-scales to evaluate preparedness, six papers used Likert-scales to evaluate self-confidence and one used a Likert-scale to evaluate autonomy. Three papers used a checklist to evaluate professionalism. Four papers used faculty member/ standardised patient feedback. CONCLUSION: Reductionist evaluation instruments create a barrier when evaluating competency. The limited validity and reliability of assessment instruments in simulation, as well as the lack of standardisation of affective skills assessment, presents a challenge in simulation research. Affective skills encompass attitudes, behaviours and communication abilities, which pose a significant challenge for standardised assessments due to their subjective nature. This review of the simulation literature highlights a lack of robustness in the evaluation of the affective domain. This paper proposes that simulation assessment instruments should include the standardisation of affective domain proficiencies such as: adaptation to patients' cognitive function, ability to interpret and synthesise relevant information, ability to demonstrate clinical judgement, readiness to act, recognition of professional limitations and faculty/standardised-simulated patient feedback. The incorporation of the affective domain in standardised assessment instruments is important to ensure comprehensive assessment of simulation particularly in the development of health history and physical assessment proficiencies. Attention to all of the domains in Blooms taxonomy during simulation assessment has the potential to better prepare professionals for the patient care setting.

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PURPOSE: The monitoring of training loads and quantification of physical performance are common practices in youth soccer academies to support coaches in prescribing and programming training for individuals. The interaction between training load and physical performance is unknown during a preseason period in youth soccer players. The current study assessed changes in training load and physical assessments across a 4-week preseason period. The relationship between physical performance and match playing time in youth male soccer players was also investigated. METHODS: The training loads of 25 professional youth academy male soccer players were monitored throughout a 4-week preseason period. Assessments of power, agility, speed, and aerobic capacity were undertaken in the first training session. Session ratings of perceived exertion (sRPE) and well-being questionnaires were collected during all training sessions and preseason matches. Playing time during subsequent competitive matches was recorded. RESULTS: T test and 30-m-sprint assessments, conducted on the first day of preseason, were predictors of sRPE throughout preseason (t test χ2/df = 2.895, poor adjustment; 30-m sprint χ2/df = 1.608, good adjustment). YoYo Test performance was related with changes in perceived fatigue (χ2/df = 0.534, very good adjustment). Faster players reported higher values of sRPE, and players with higher aerobic capacity reported higher levels of fatigue across preseason. Well-being, perceived fatigue and soreness, and sRPE decreased across preseason. Greater match durations were related to higher levels of fatigue during preseason (P < .05). CONCLUSION: The current study highlights the relationship between training load, physical assessments, and playing time. Coaches and practitioners can use physical test data at the start of preseason as an indication of players that report higher sRPE, perceived fatigue, and reduced well-being across preseason, supporting decisions around individualized training prescriptions.

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Ultrasound hip screening is suitable for the early identification of developmental dysplasia of the hip (DDH). Newborn and infant home visits are good opportunities for hip screening in the community, but studies focusing on nurse-led screenings are lacking. Based on a pre-post design, this study aims to develop and evaluate an ultrasound training program to improve nurses' assessment skills in detecting DDH cases during newborn and infant home visits. Said educational program will include e-learning, hands-on seminars, and clinical training. The primary outcome will be the success rate of imaging standard planes (standardized images for hip assessment) in clinical training. The secondary outcomes will include knowledge test results, objective structured clinical examination scores, time required for imaging, and inter-rater reliability between nurses and physicians. The educational program will address the issue of missed and late detection of DDH cases in resource-limited communities. This study will demonstrate the feasibility of procedures and the effectiveness of the educational program in 2024. The protocol was registered in the University Hospital Medical Information Network Clinical Trial Registry before starting the study (no. UMIN000051929, 16 August 2023).

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Background: Outcome measures can assess the change in the health status of a patient in an intensive care unit (ICU). The Chelsea Critical Care Physical Assessment (CPAx) tool is used to assess the functional outcomes to monitor patient progression or regression in an ICU. Objectives: Our study aimed to identify studies that assess the functional outcomes of patients nursed in ICUs that use the CPAx tool. Method: An integrative review framework was used. Data were analysed in five steps to formulate a conclusion that aligned with the objective of our study. Data were extracted from peer-reviewed articles published online between 2013 and 2022. Databases that were used include Google Scholar, Directory of Open Access Journals (DOAJ) and PubMed for reviewed articles. Keywords were used in the search strategy, and screening of abstracts was done to extract studies that met the inclusion criteria. Results: We retrieved 41 studies, of which 11 matched the inclusion criteria. Data were thematically arranged into studies measuring the validity and reliability of the CPAx tool, using the CPAx tool to measure outcomes in the ICU, the tool used at ICU and hospital discharge. Conclusion: The use of the CPAx tool has no impact on measuring the hospital length of stay or quality of life. Clinical implications: The tool is comprehensive and enhances the accuracy of patient assessment.

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Background: The number of frail patients of advanced age with end-stage kidney disease (ESKD) undergoing hemodialysis is increasing globally. Here we evaluated a frailty screening program of ESKD patients starting hemodialysis, and subsequent multidisciplinary interventions. Methods: This was a prospective observational study of ESKD patients in a hemodialysis program. Patients were evaluated for frailty (Fried frail phenotype) before and after a 12-month period. Patients followed standard clinical practice at our hospital, which included assessment and multidisciplinary interventions for nutritional (malnutrition-inflammation score, protein-energy wasting), physical [short physical performance battery (SPPB)] and psychological status. Results: A total of 167 patients (mean ± standard deviation age 67.8 ± 15.4 years) were screened for frailty, and 108 completed the program. At screening, 27.9% of the patients were frail, 40.0% pre-frail and 32.1% non-frail. Nutritional interventions (enrichment, oral nutritional supplements, intradialytic parenteral nutrition) resulted in stable nutritional status for most frail and pre-frail patients after 12 months. Patients following recommendations for intradialytic, home-based or combined physical exercise presented improved or stable in SPPB scores after 12 months, compared with those that did not follow recommendations, especially in the frail and pre-frail population (P = .025). A rate of 0.05 falls/patient/year was observed. More than 60% of frail patients presented high scores of sadness and anxiety. Conclusions: Frailty screening, together with coordinated interventions by nutritionists, physiotherapists, psychologists and nurses, preserved the health status of ESKD patients starting hemodialysis. Frailty assessment helped in advising patients on individual nutritional, physical or psychological needs.

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The Brazilian Air Force (BAF) has developed physical evaluations focused on the demands required in combat scenarios, giving rise to the Simulated Tasks (STs). Therefore, the purpose of the present study was to determine test-retest reliability and investigate learning effects of the five STs established among the BAF. Fifty-six subjects performed five STs three times, after completing a previous familiarisation session. Repeated measures analysis of variance (ANOVA) was used to determine the occurrence of learning effects, and the intraclass correlation coefficient (ICC) was used to identify the reliability of each ST. ANOVA revealed no significant differences in the subject's scores across trials for all the STs, and the ICCs ranged from 0.75 to 0.92 (p < 0.01). In conclusion, this study identified that the five STs showed no learning effects across three successive trials and exhibited high levels of reliability.

Understanding the reliability and learning effects of the STs established among the Brazilian Air Force is crucial for their potential implementation. The subjects performed five STs three times, over the course of seven days. The results highlighted no evidence of learning effects, and high levels of reliability.

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This study aimed to analyze within- and between-player variations of peak speed and sprinting actions occurring in small-sided games (SSGs: 1 v 1 and 5 v 5). The study followed a cohort study design. Twenty male youth soccer players (age: 17 years old) from the same team were observed over four consecutive weeks. Each week, the players participated in two sessions (day one and day two) during which SSGs were applied. The 1 vs. 1 format was employed with four repetitions of thirty seconds interspaced with two-minute rest intervals, while the 5 vs. 5 format with four repetitions of four minutes and two-minute rest intervals between them. The players were monitored during all training sessions with the Polar Team Pro. The peak speed attained in each game, and the number of sprints were extracted as the primary outcomes. The between-player variability revealed a lower coefficient of variations for peak speed in the 1 vs. 1 (13.9%) and 5 vs. 5 (10.9%) formats than for sprints (1 v 1: 64.7%; 5 v 5: 65.5%). Considering the within-player variability, it was observed that sprints were more variable (1 vs. 1: 62.1%; 5 v 5: 65.7%) than peak speed (1 vs. 1: 16.4%; 5 v 5: 14.0%). The between-session analysis revealed that during week 1 (day 1), peak speed was significantly higher than during week 3 (day 1) in the 1 vs. 1 format (+3.0 km/h; p = 0.031; d = 1.296). Moreover, peak speed during week 3 (day 2) was considerably lower than during week 1 (-5.9 km/h; p < 0.001; d = 1.686) and week 2 (-5.0 km/h; p = 0.001; d = 1.639). The between-session analysis showed no significant differences in the sprint between the sessions on day 1 (p > 0.05). However, on day two, the sprint was substantially higher during week one than during week four in the 5 vs. 5 format (+5.40 n; p = 0.002; d = 2.571). In conclusion, this study revealed that peak speed presents lower within- and between-player variability than the number of sprints. Considering these two measures, there are no considerable variations between the weeks. Coaches should consider identifying strategies to stabilize the stimulus regarding the number of sprints if this represents one of the targets for employing SSGs.

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BACKGROUND: Newly qualified nurses are often considered inadequately prepared for practice. During nursing students' educational preparation, clinical learning environments are intended to provide experiences for students to develop skills and clinical judgments needed for safe practice. Yet, a recent systematic review found no quantitative evidence that clinical education models facilitate student learning. In addition, little is known about the frequency and type of skills students perform when in clinical settings. OBJECTIVE: To investigate undergraduate nursing student experiences with skills and the quality of supervision and feedback received when performing skills in clinical settings. DESIGN: Retrospective descriptive. SETTING: A mid-sized private university in the Midwestern part of the United States. METHODS: Students completed an online survey after clinical days during one semester. Students self-reported their experiences with medication administration, psychomotor skills and physical assessments via multiple choice items. Descriptive statistics were calculated using Microsoft 365 Excel. Content analysis was performed of one open-response survey item. RESULTS: A total of 496 surveys were completed. On average, during one clinical day, 13.5 % of students administered medication, 20.5 % performed a psychomotor skill, and 64 % completed a physical assessment. Students were most frequently supervised by bedside nurses and reported the quality of their supervision and feedback as "very good" or "good". Some students reported being restricted from administering medication and performing other skills due to a clinical site policy. CONCLUSIONS: In this study, students performed few skills and assessments when in clinical settings. Increased clinical experiences are needed for students to develop competencies to better prepare them for safe practice. The findings contribute to the dearth of knowledge related to the clinical learning experiences of undergraduate nursing students, and can guide strategies to improve new nurse preparedness.

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Mexico City is the location with the largest number of boxers in Mexico; in fact, it is the first city in the country to open a Technological Baccalaureate in Education and Sports Promotion with a pugilism orientation. This cross-sectional study aimed to determine the physical-functional profile of applicants for admission to the baccalaureate in sports. A total of 227 young athletes (44F; 183M; 15.65 (1.79) years; 63.66 (14.98) kg; >3 years of boxing experience) participated in this study. Body mass (BM), maximal isometric handgrip (HG) strength, the height of the countermovement jump (CMJ), the velocity of straight boxing punches (PV), and the rear hand punch impact force (PIF) were measured. The young boxers were profiled using unsupervised machine learning algorithms, and the probability of superiority (ρ) was calculated as the effect size of the differences. K-Medoids clustering resulted in two sex-independent significantly different groups: Profile 1 (n = 118) and Profile 2 (n = 109). Except for BM, Profile 2 was statistically higher (p < 0.001) with a clear distinction in terms of superiority on PIF (ρ = 0.118), the PIF-to-BM ratio (ρ = 0.017), the PIF-to-HG ratio (ρ = 0.079) and the PIF-to-BM+HG ratio (ρ = 0.008). In general, strength levels explained most of the data variation; therefore, it is reasonable to recommend the implementation of tests aimed at assessing the levels of isometric and applied strength in boxing gestures. The identification of these physical-functional profiles might help to differentiate training programs during sports specialization of young boxing athletes.

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PURPOSE: Implement STEAM-DTI to model time-dependent diffusion eigenvalues using the random permeable barrier model (RPBM) to study age-related differences in the medial gastrocnemius (MG) muscle. Validate diffusion model-extracted fiber diameter for histological assessment. METHODS: Diffusion imaging at different diffusion times (Δ) was performed on seven young and six senior participants. Time-dependent diffusion eigenvalues (λ2 (t), λ3 (t), and D⊥ (t); average of λ2 (t) and λ3 (t)) were fit to the RPBM to extract tissue microstructure parameters. Biopsy of the MG tissue for histological assessment was performed on a subset of participants (four young, six senior). RESULTS: λ3 (t) was significantly higher in the senior cohort for the range of diffusion times. RPBM fits to λ2 (t) yielded fiber diameters in agreement to those from histology for both cohorts. The senior cohort had lower values of volume fraction of membranes, ζ, in fits to λ2 (t), λ3 (t), and D⊥ (t) (significant for fit to λ3 (t)). Fits of fiber diameter from RPBM to that from histology had the highest correlation for the fit to λ2 (t). CONCLUSION: The age-related patterns in λ2 (t) and λ3 (t) could tentatively be explained from RPBM fits; these patterns may potentially arise from a decrease in fiber asymmetry and an increase in permeability with age.

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AIMS: To describe the perceived barriers to nurses performing physical assessments of patients in rehabilitation wards. Secondarily, to investigate how sociodemographic and professional characteristics influence the use and frequency of physical assessments by nurses and their perceptions of barriers to their practice. DESIGN: A multicentre, cross-sectional, observational study. METHODS: Data were collected from September to November 2020 among nurses working with inpatients in eight rehabilitation care institutions in French-speaking Switzerland. Instruments included the Barriers to Nurses' use of Physical Assessment Scale. RESULTS: Almost half of the 112 nurses who responded reported performing physical assessments regularly. The predominant perceived barriers to performing physical assessments were 'specialty area', 'lack of nursing role models' and 'lack of time and interruptions'. Greater clinical nursing experience in rehabilitation wards and more senior nurse specialist positions were associated with significantly lower use of physical assessment procedures by nurses. CONCLUSION: The present study revealed heterogeneity in the use of physical assessment by nurses practicing in rehabilitation units and highlighted their perceived barriers to this. IMPACT STATEMENT: Most nurses working in rehabilitation care units did not routinely perform physical assessments as part of their daily clinical practice. These results should raise stakeholders' awareness of this fact. Effective interventions to increase the use of physical assessments in nursing practice are to be recommended, including continuing education or hiring enough highly qualified nurses as role models in wards. This will promote quality of care and patient safety in rehabilitation care units. PUBLIC AND PATIENT ENGAGEMENT AND INVOLVEMENT: There was no patient or public involvement in the present study.

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BACKGROUND: Scars affect patients after trauma, burns, or surgical procedures and can generate both physical and psychosocial changes. The aesthetic damage represents the modification of a person's physical appearance, in its bodily integrity, causing numerous sufferings and determining social or economic consequences. The aim of this research is to evaluate the advantages and disadvantages offered by the available psychosocial and physical scar scales in assessing the physical, aesthetic, psychosocial, and juridical consequences of scars. This will aid to inform medical examiners about the most valued existing scales to allow them to select the most appropriate instrument to manage their patient. METHODS: A broad search of relevant scientific studies on the psychosocial determinants of post-traumatic and surgical scars was conducted by using the following international database tools: PsycINFO, MedLine Social Science Index, Scopus, Web of Science, published from 1960 until 2022. RESULTS: We analyzed 63 scientific studies to assess the advantages and limits of several psychometric and physical scar evaluation scales. CONCLUSIONS: The researchers analyzed in this review highlight the advantages and limitation of existing instruments, evidencing the demand for future scar evaluation instruments and a scar-assessing algorithm that takes into account the physical, aesthetic, psychosocial, and legal consequences of scars.

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BACKGROUND: The quality of nursing care in different healthcare contexts can be associated with the level of available nursing competence. Physical assessment skills are vital in nurses' assessment of patient care needs. However, in nursing education, using physical assessment skills is challenging for nursing students who struggle to apply these skills comprehensively in a clinical rotation. Therefore, this study explores changes in nursing competence, factors associated with changes after clinical rotations, and whether a Suite of Mobile Learning Tools supports changes in confident use of basic physical assessment skills. METHODS: A quantitative cohort study with an explorative pre-and post-test design. During autumn 2019 and spring 2020, 72 s-year nursing students and 99 third-year students participated in the study. The Nurse Professional Competence scale short form was used to investigate students' self-reported changes in nursing competence, and a study-specific questionnaire was used to investigate students' confidence concerning performing physical assessments. The students voluntarily used the Suite of Mobile Learning Tools for the learning of physical assessment. Linear regression analysis was used to identify factors associated with changes in nursing competence after clinical rotation. The STROBE guidelines for cohort studies were followed for study reporting. RESULTS: After the clinical rotation, both student groups reported changes in nursing competence and confidence in performing physical assessment skills, with statistically significant moderate or large changes in all areas. The Suite of Mobile Learning Tools was evaluated as being useful for learning physical assessment. The regression analysis showed that confidence in performing physical assessment skills, the usefulness of the Suite of Mobile Learning Tools, and a higher nursing competence at the start of clinical rotation were positively associated with overall nursing competence. CONCLUSION: Basic physical assessment skills are an important component of nursing competence and can be considered one of the pillars of person-centered care, as proposed by the Fundamentals of Care framework. Spaced repetition and access to digital resources are suggested pedagogical approaches to enhance student confidence in the use of assessment skills within academic and clinical contexts.

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