Virtual reality simulation can give nursing students a safe clinical experience involving highrisk infants where access to neonatal intensive care units is limited. This study aimed to examine the effects of a virtual reality simulation program on Korean nursing students' knowledge, performance selfefficacy and learner satisfaction. Methods: A nonequivalent control group design was applied. Senior nursing students were divided into an experimental group (n ¼ 25) experiencing virtual reality simulation and routine neonatal intensive care unit practice and a control group (n ¼ 25) having routine neonatal intensive care unit practice. The program consisted of three scenarios: basic care, feeding management and skin care and environmental management for prevention of neonatal infection. The total execution time for the three scenarios was 40 minutes. The simulation created immersive virtual reality experiences using a head-mounted display with hand-tracking technology. Data were collected from December 9, 2019, to January 17, 2020, and were analyzed using descriptive statistics and the t-test, paired t-tests, Mann-Whitney test and Wilcoxon signed-ranks test. Results: Compared to the control group, the experimental group showed significantly greater improvements in high-risk neonatal infection control performance self-efficacy (t ¼ À2.16, p ¼ .018) and learner satisfaction (t ¼ À5.59, p < .001). Conclusion:The virtual reality simulation program can expand the nursing students' practice experience in safe virtual spaces and enhance their performance self-efficacy and learning satisfaction.

Background It is essential that nurses quickly learn the proper methods for preventing and controlling nosocomial infection and managing intensive care patients during the COVID-19 pandemic, including the donning and doffing of personal protective equipment (PPE). Virtual reality (VR) simulation offers the advantage of learning in a safe environment with a sense of realism similar to that of an actual clinical setting and has been reported to enhance self-efficacy in infection control, safety performance, and learning satisfaction among students. Objective This study aims to develop a virtual reality infection control simulation (VRICS) program regarding donning and doffing of PPE and respiratory care for pediatric patients admitted to an isolation unit for COVID-19 and to identify the effects of the program on PPE knowledge, infection control performance, and self-efficacy for nursing students. Additionally, the realism of the VRICS program and the students’ level of satisfaction with the program were assessed. Methods This was a quasi-experimental study based on a controlled pretest-posttest design. Third- and fourth-year nursing students were divided into an experimental group (n=25) who participated in a VRICS program and a control group (n=25) with no participation. Data were collected from November 13 to December 10, 2021, and analyzed using descriptive statistics and the t test, paired t test, Mann-Whitney U test, and Wilcoxon matched-pair signed-rank test. The VRICS program consisted of a prebriefing, including direct practice of donning and doffing PPE, VR simulation, and debriefing. The VR simulation comprised 3 sessions: donning and inspection of PPE in the dressing room before entering the negative-pressure isolation unit; assessing for suction care, nasopharyngeal suctioning, and checking of COVID-19 patients in the negative-pressure isolation unit; and doffing PPE in the dressing room. The total execution time for the program was 180 min. Results Compared with the control group, the experimental group showed significantly greater improvements in PPE knowledge (z=–3.28, P<.001), infection control performance (t48=4.89, P<.001), and self-efficacy (t36.2=4.93, P<.001). The experimental group’s mean scores for realistic immersion and learner satisfaction were 4.49 (SD 0.50) points and 4.75 (SD 0.38) points (on a 5-point Likert scale), respectively. Conclusions The VR simulation training program involving pediatric COVID-19 patients combined skills training effectively and enhanced theoretical knowledge, respiratory care skills, and infectious disease preparedness. Thus, it could be applied to training nurses to respond more effectively to public health situations involving infectious diseases, including the COVID-19 pandemic.

Although the incidence of extrapyramidal reactions associated with metoclopramide has been reported to be approximately 0.2%, such reactions are rare in the anesthetic field. Several anesthetic adjuvants, including ondansetron and pregabalin, have also been associated with extrapyramidal side effect. Here, the authors report the case of a 47-year-old patient, previously administered pregabalin and ondansetron, who developed extrapyramidal side effects after a single injection of metoclopramide (10 mg) in a post-anesthesia care unit.

The purpose of this study was to develop a scale to measure high-risk neonatal infection control competency among nurses in neonatal intensive care units (NICUs). The study participants included 251 nurses working in NICUs at seven hospitals in South Korea. The scale was designed to measure high-risk neonatal infection control competency in terms of performance (HirNICCS_P) and knowledge (HirNICCS_K), which were addressed by 42 and 54 items, respectively, and was initially subjected to content validity testing by a panel of experts in neonatal nursing. The items were divided into five factors: (1) basic care, (2) skin care, (3) feeding management, (4) medication and invasive procedures, and (5) environment management. After participant completion of the scale, construct validity was examined using exploratory and confirmatory factor analyses, and internal reliability tests were also performed. The total variance of validity was 53.7% for HirNICCS_P, and the Cronbach’s alpha values for reliability were .95 for HirNICCS_P and .67 for HirNICCS_K based on a Kuder–Richardson-20 test. We concluded that this scale can be used to assess the performance and knowledge with regard to infection control competency among neonatal nurses and that its application can support strengthening of infection control education for nurses who score low on performance and knowledge competency.

When COVID-19 hit, many people began working, going to school, and living much of their lives from home. The Internet was a gateway to the world. This article uses data from Internet speed tests, consumer complaints, search engine optimization tools, and logs of Internet use from public libraries to understand the effects of the pandemic on Internet use and performance. Despite reports that the Internet handled the surge in traffic well, we find that complaints about Internet speed nearly tripled, and performance was degraded. Downstream data rates changed little, but median upstream data rates at midday dropped by about a third. When discussing Internet performance, people typically focus on downstream. This focus should shift. Internet service providers and policymakers should reduce the asymmetry by changing how infrastructure is designed, how Internet services are advertised, how regulators write transparency rules, and how government defines “broadband” in subsidy programs intended to reduce the digital divide. We also find significant increases in the use of many important categories of online content, including those used for work communications, education, grocery shopping, social media, news, and job searches. This shows the importance of the Internet during the crisis. Many people without Internet at home turned to public Wi-Fi hotspots during the pandemic. We find that this occurred disproportionately in neighborhoods with more students. Future distance learning initiatives should consider the challenges some students face in obtaining Internet access.