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Background: Didactic clinical skills training employing low fidelity simulation has been the traditional approach to teaching undergraduate nursing students the insertion of an indwelling urinary catheter. This approach, however, does not adequately prepare students for the intricacies and complexity of this procedure in the real world, which is associated with high rates of infection secondary to procedural contamination., Objectives: To explore students' confidence levels in developing clinical psychomotor skills associated with the insertion of an indwelling urinary catheter in a high-fidelity simulation using Mask-Ed., Methods: A mixed methods study was conducted involving final year Bachelor of Nursing students. Preproceduraland postprocedural confidence was rated by students using a 5-point Likert scale. A focus group consisting of eleven students was conducted to further explore student's experience of engaging with a Mask-Ed character and the procedural experience from a learning perspective., Results: The findings indicated that students increased their procedure confidence when engaging with the Mask-Ed simulation (P=0.025). The ability to maintain procedural asepsis and ability to accurately identify the correct anatomical structures related to indwelling urinary catheter insertion were found to be related ( r s = 0.71, P<0.05). Three primary themes were identified: caring of a person, intimate care and communication., Conclusion: Psychomotor skills related to communication, support and maintaining procedural asepsis were areas that required further clinical development, which are not concurrently integrated into the simulation approach using manikin based simulation. Mask-Ed provided a unique learning opportunity to replicate a clinically and anatomically realistic experience., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Introduction: Sleep is a state of quiescence that facilitates the significant restorative processes that enhance individuals' physiological and psychological well-being. Patients admitted to the intensive care unit (ICU) experience substantial sleep disturbance. Despite the biological importance of sleep, sleep monitoring does not form part of standard clinical care for critically ill patients. There exists an unmet need to assess the feasibility and accuracy of a range of sleep assessment techniques that have the potential to allow widespread implementation of sleep monitoring in the ICU., Key Measures: The coprimary outcome measures of this study are to: determine the accuracy and feasibility of motion accelerometer monitoring (ie, actigraphy) and subjective assessments of sleep (nursing-based observations and patient self-reports) to the gold standard of sleep monitoring (ie, polysomnography) in evaluating sleep continuity and disturbance. The secondary outcome measures of the study will include: (1) the association between sleep disturbance and environmental factors (eg, noise, light and clinical interactions) and (2) to describe the sleep architecture of intensive care patients., Methods and Analysis: A prospective, single centre observational design with a within subjects' assessment of sleep monitoring techniques. The sample will comprise 80 adults (aged 18 years or more) inclusive of ventilated and non-ventilated patients, admitted to a tertiary ICU with a Richmond Agitation-Sedation Scale score between +2 (agitated) and -3 (moderate sedation) and an anticipated length of stay >24 hours. Patients' sleep quality, total sleep time and sleep fragmentations will be continuously monitored for 24 hours using polysomnography and actigraphy. Behavioural assessments (nursing observations) and patients' self-reports of sleep quality will be assessed during the 24-hour period using the Richards-Campbell Sleep Questionnaire, subjective sleepiness evaluated via the Karolinska Sleepiness Scale, along with a prehospital discharge survey regarding patients' perception of sleep quality and disturbing factors using the Little Sleep Questionnaire will be undertaken. Associations between sleep disturbance, noise and light levels, and the frequency of clinical interactions will also be investigated. Sound and luminance levels will be recorded at 1 s epochs via Extech SDL600 and SDL400 monitoring devices. Clinical interactions will be logged via the electronic patient record system Metavision which documents patient monitoring and clinical care., Ethics and Dissemination: The relevant institutions have approved the study protocol and consent procedures. The findings of the study will contribute to the understanding of sleep disturbance, and the ability to implement sleep monitoring methods within ICUs. Understanding the contribution of a clinical environment on sleep disturbance may provide insight into the need to address clinical environmental issues that may positively influence patient outcomes, and could dispel notions that the environment is a primary factor in sleep disturbance. The research findings will be disseminated via presentations at national and international conferences, proceedings and published articles in peer-reviewed journals., Trial Registration Number: ACTRN12615000945527; Pre-results., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)