***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Nursing students ' disinterest in caring for elders presents health care challenges . As the aged population increases , nursing faculty are challenged to improve students ' attitudes toward elder care . Reed 's self-transcendence theory guided this pilot study with nursing students ( n=22 ) who implemented either a Creative-Bonding Intervention ( CBI ) or a Friendly Visit ( FV ) at senior citizen centers to test the effect of creative approaches on student self-transcendence and attitudes toward elders . Demographic data , a revised Kogan 's Attitudes toward Old People statements , and Reed 's Self-transcendence Scale were analyzed with descriptive , paired t test , ANCOVA , and Pearson correlation statistics . Results demonstrated significant differences in attitudes in the FV and changes in the expected directions in the CBI group . Self-transcendence had no significant changes . Valuable information was provided by students ' comments about the interventions . Reed 's belief that self-transcendence is present regardless of age was supported . Future studies are suggested with an increased sample size , a combined CBI/FV intervention , and supportive help during students ' intervention delivery Recent studies encourage educators in nursing to use innovative and non-traditional teaching methods , such as using popular movies , posters , portfolios and surfing the internet , to stimulate students ' interest , participation and interaction to enhance academic performance as well as knowledge retention . In this , descriptive cross-sectional study , we used self-administered question naires  with statements grade d on 5-points Likert scale ( quantitative measures ) and open-ended questions ( qualitative measures ) , to assess the feasibility and students ' perceptions regarding the use of Lance Armstrong 's autobiography of surviving against cancer as a teaching tool . At the beginning of the lecture copies of selected chapters from : " It 's Not About the Bike ; My Journey Back to Life " [ Armstrong , L. , Jenkins , S. 2001 . It 's Not About The Bike : My Journey Back To Life . Yellow Jersey Press , R and om House ( Pty ) Limited , Great Britain ] , were given to students . Willing students were requested to read for the whole class while the lecturer interjected periodically to explain and expound on certain pharmacological concepts . Eighty percent ( 80 % ) of participants felt that the use of an autobiography stimulated their interesting in cancer drugs and 84 % agreed/strongly agreed that it contributed to their knowledge of pharmacology . Using Lance Armstrong 's autobiography of survival to teach cytotoxic drugs is a worthwhile and rewarding exercise from the student nurses ' perspective In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias The challenges of providing exemplary undergraduate nursing education can not be underestimated in an era when burnout and negative mood states predictably lead to alarming rates of academic as well as career attrition . While the multi-dimensional nature of this complex issue has been extensively eluci date d , few rational strategies exist to reverse a disheartening trend recognizable early in the educational process that subsequently threatens to undermine the future viability of quality healthcare . This controlled prospect i ve crossover study examined the impact of a 6-session Recreational Music-making ( RMM ) protocol on burnout and mood dimensions as well as Total Mood Disturbance ( TMD ) in first year associate level nursing students . A total of 75 first year associate degree nursing students from Allegany College of Maryl and ( ACM ) participated in a 6-session RMM protocol focusing on group support and stress reduction utilizing a specific group drumming protocol .  Burnout and mood dimensions were assessed with the Maslach Burnout Inventory and the Profile of Mood States respectively . Statistically significant reductions of multiple burnout and mood dimensions as well as TMD scores were noted . Potential annual cost savings for the typical associate degree nursing program ( $ 16,800 ) and acute care hospital ( $ 322,000 ) were projected by an independent economic analysis firm . A cost-effective 6-session RMM protocol reduces burnout and mood dimensions as well as TMD in associate degree nursing students Undergraduate students often request " h and s-on " research experience but seldom have the time and opportunity during a one-semester introductory course to participate in such a project . The purpose s of this educational approach , implemented during a beginning research class for baccalaureate nursing students , were to provide an opportunity for students to participate in an experimental research study , and test the effect of a creative arts intervention on students ' stress , anxiety , and emotions .  Students design ed , participated in , and analyzed the results of the project . The intervention significantly reduced stress and anxiety and increased positive emotions in this student population , while providing a creative research experience . For future use , the intervention may be helpful with a variety of vulnerable groups The effects of a creative reflective clinical experience on psychiatric nursing students '  empathy was examined using a mixed- method approach . The Interpersonal Reactivity Index ( IRI ) was used to measure empathy in students ( N = 73 ) in a baccalaureate nursing program . The control group ( n = 44 ) completed a conventional 14-week clinical experience , whereas the comparison group ( n = 29 ) experienced a community psychosocial program for 4 of the weeks . Comparison group participants completed a creative reflective assignment to represent the life experience of a client with mental illness . To further underst and empathy , a constructivist approach with purposive sampling was used to examine students ' perceptions . Four themes emerged : having expectations , building relationships , changing perceptions , and gaining underst and ing through creative expression . Trends were noted , although no statistically significant differences in IRI scores were found for either group . However , this article argues that the use of a creative reflective assignment reduces stigma and promotes empathy The purpose of this project was to examine the effect of Narrative Pedagogy in nursing education on students ' ability to move toward cognitive and ethical maturity and thereby increase their autonomy in nursing practice . Students taking a class using Narrative Pedagogy  demonstrated " entry " and " exit " mean scores that showed marginal and statistically significant ( p < 0.05 ) improvement on the Measure of Intellectual Development and the California Critical Thinking Disposition Inventory . Using nonparametric and parametric analyses of variance , there was minor improvement on both scales in cognitive and ethical maturity and the disposition to think critically in the intervention group . For all variables , there were no significant differences between the control group and the intervention group , with or without adjustment for age , the only significant covariate . The cognitive and ethical growth documented by either instrument is probably not large enough to be considered practically significant in terms of movement toward autonomous practice This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence The aim of the study was to develop an educational tool consisting of selection s of paintings in order to complement theoretical knowledge regarding non-verbal communication . Another aim was to investigate students '  opinions of the educational tool . A visual art programme which introduced student nurses to varying facial expressions in art reproductions was developed as a complement to textbooks on nonverbal communication .  Participants were student nurses from two nursing schools in Sweden . Data were collected over a period of two years ( 1998 - 2000 ) in the second year of the 3-year undergraduate programme . Participants were able to infer whether a positive or negative message had been given to the depicted person . Participants ' evaluations of the programme were expressed in positive terms In an effort to bridge the gap in learning in the affective domain , nurse educators must underst and and develop meaningful teaching strategies . Specific strategies design ed to facilitate cognitive underst and ing of the affective response can be found in entertainment films . The findings of this study suggest that the use of entertainment films with guidance is effective in teaching empathetic responses . The continued study of the complex phenomenon in developing an underst and ing of the many variables that comprise not only the experience of empathy , but also the transference of the experience into helping interventions A r and omized study was performed to investigate whether a teaching intervention program using a reproduction of Edvard Munch 's painting , " The Sick Girl , " stimulated student nurses to engage in learning about empathy . A control group was used to control for effects of the visual art dialogues in the intervention group . The study was undertaken at a university college of health science in Sweden . Data were collected from student nurses ( n = 144 ) during their first study year . The result showed a significant improvement in the visual art group compared with the matched control group . Students in the visual art group were more engaged in learning about empathy when measured with the Wheel Question naire parameters of structure , motivation , and emotional investment . The present study supported the idea that Edvard Munch 's painting could be used in nurse education complementary to theoretical knowledge on empathy to stimulate student nurses to engage in empathy learning Visual art dialogues were used in student nurses ' education as a teaching and learning complement to theoretical knowledge of nursing care . An intervention group as well as a control group discussed what was characteristic of good nursing care . The control group was used to control for the effects of visual art dialogues in the intervention group . The study was undertaken at two university colleges of health sciences in Sweden . Data were collected from student nurses ( n = 267 ) during their first year of study . The Wheel Question naire was used in the intervention group and control group . It measured three aspects of student nurses '  perception of nursing situations : structure , the extent of emotional involvement , and motivation . The results showed statistical differences ( one way ANOVA ) between the intervention group in which visual art dialogues were implemented and the control group . Students in the intervention group , compared to the control group , were more structured , motivated and emotionally balanced when they expressed the elements most typical of good nursing care . They showed personal readiness in caring situations 
    Output:
    
The two synthesized findings revealed that art forms could create meaning and inspire learning in undergraduate nursing education and that ABP can develop important learner outcomes /competencies for professional nursing .
The narrative synthesis suggested that ABP improved  nursing students '  knowledge acquisition , level of empathy , attitude toward others , emotional states , level of reflective practice , learning behaviors and aspects of cognitive/ethical maturity .
When the QL and QN findings were interpreted as a whole , ABP appeared to facilitate learning in the cognitive and affective domains and may be especially useful in addressing the affective domain .
Nurse educators should consider using ABP as students found that this approach offered a meaningful way of learning and result ed in the development of important competencies for professional nursing .
The QN studies provide a very low level of evidence that ABP improved students ' knowledge acquisition , level of empathy , attitude toward others , emotional states , level of reflective practice , learning behaviors and aspects of cognitive/ethical maturity .
Although the QN findings can inform future research , the evidence is not robust enough to demonstrate improved outcomes