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AnteayerJournal of Nursing Scholarship

Mediating Effects of Anger Expression in the Relationship of Work Stress with Burnout among Hospital Nurses Depending on Career Experience

Abstract

Objectives

This study examined the mediating effects of anger expression in the relationship between work stress and burnout among nurses with more than or less than 3 years of career experience.

Methods

A cross‐sectional study was conducted with 454 nurses working at three university hospitals in South Korea. Nurses completed a survey consisting of demographic questions, the Maslach Burnout Inventory, the Work Stress Scale, and the Korean version of the Anger Expression Inventory. A multiple‐group mediation analysis was performed using structural equation modeling. Results: In total (N = 454), work stress directly affected burnout, and all anger expressions indirectly affected the relationship of work stress with burnout. Different mediating effects of anger expression style according to career experience were shown; anger‐out and anger‐in in nurses with less experience (n = 184) and only anger‐in in those with more experience (n = 270) partially mediated the relationship of work stress with burnout.

Conclusions and Clinical Relevance

The indirect effect of anger‐in style was higher than other anger expression styles in all nurses; suppression of anger caused by work stress can increase burnout. Anger‐out played a functional role in the relationship of work stress with burnout among nurses who had less career experience. Therefore, to reduce burnout, creating a work environment with collaborative culture including authentic leadership and providing anger management programs will help to manage nurses’ anger properly. For new nurses, promoting work and life balance, and creating a culturally empowering work environment to help them use anger‐out expression constructively, are important to reduce burnout.

Effectiveness of a Nurse‐Led Tele‐Homecare Program for Patients With Multiple Chronic Illnesses and a High Risk for Readmission: A Randomized Controlled Trial

Abstract

Purpose

Multiple chronic illnesses, such as those associated with advanced age, are leading causes of poor health, disability, death, and high healthcare expenditures. Tele‐homecare is a novel method for providing home care to patients with chronic illnesses. The purpose of this study was to evaluate the effectiveness of an integrated nurse‐led tele‐homecare program for patients with multiple chronic illnesses and a high risk for readmission.

Design

A randomized controlled trial.

Methods

Two hundred patients from a regional hospital who were scheduled to receive home care after discharge were randomly assigned to the intervention group (n = 100) or the control group (n = 100). The patients in the intervention group participated in an integrated tele‐homecare program. For outcome evaluation, primary outcomes included the number of emergency department (ED) visits as well as readmittance and mortality. Secondary outcomes included patients’ medication adherence, activities of daily living, health status, and quality of life (QOL). Data were collected at three time points: pretest baseline (T0), 3 months after intervention (T3), and 6 months after intervention (T6). A generalized estimating equation model was used to compare changes and evaluate the effect of differences between the two groups over time.

Findings

For primary outcome evaluation, we found that the tele‐homecare program significantly reduced mortality and ED visits, whereas no significant effect on readmission was observed. For secondary outcome evaluation, patients’ QOL indicated significant improvement.

Conclusions and Clinical Relevance

The nurse‐led tele‐homecare program involves daily 24‐hr remote monitoring and surveillance. In this study, the system detected patients’ physical changes early and provided timely and appropriate management, consequently reducing ED visits and mortality. Additionally, it improved patients’ QOL. On the basis of our findings, nurses’ independent roles and functions revealed that the effectiveness of this nurse‐led tele‐homecare program strengthened the care of patients with multiple chronic illnesses.

The Transition to Adult Health Care in Youth With Spina Bifida: Theory, Measurement, and Interventions

Abstract

Purpose

This article focuses on the transition to adult health care in youth with spina bifida (SB) from the perspective of theory, measurement, and interventions.

Methods

The purpose of this article is to discuss (a) a theory of linkages between the transfer of medical responsibility from parent to child and the transition from pediatric to adult health care, as mediated by transition readiness; (b) measurement issues in the study of self‐management and the transition to adult health care; and (c) U.S.‐based and international interventions focused on the transition to adult health care in young adults with SB.

Findings

Individuals with SB must adhere to a complex multicomponent treatment regimen while at the same time managing a unique array of cognitive and psychosocial challenges and comorbidities that hinder self‐management, medical adherence, and the transition to adult health care. Moreover, such youth endure multiple transitions to adult health care (e.g., in the areas of urology, orthopedics, neurosurgery, and primary care) that may unfold across different time frames. Finally, three transition‐related constructs need to be assessed, namely, transition readiness, transition completion, and transition success.

Conclusions

SB provides an important exemplar that highlights the complexities of conducting research on the transition to adult health care in youth with chronic health conditions. Many transition trajectories are possible, depending on the functioning level of the child and a host of other factors. Also, no single transition pathway is optimal for all patients with SB.

Clinical Relevance

The success of the process by which a child with SB transitions from pediatric to adult health care can have life‐sustaining implications for the patient.

Characteristics of Advance Care Planning Interventions Across Dementia Stages: A Systematic Review

Abstract

Purpose

Little is known regarding how advance care planning (ACP) interventions change with the progression of dementia. Thus, the primary purpose of this systematic review is to compare characteristics of ACP interventions across dementia stages. We also identify the role of nurses in implementing ACP interventions for persons with dementia and their surrogates.

Design

A systematic review of ACP intervention studies.

Methods

After searching PubMed, Web of Science, EMBASE, PsycArticles, the Cumulative Index to Nursing and Allied Health Literture (CINAHL), and Scopus, the final sample included 11 studies representing 10 interventions. We conducted a quality assessment and extracted data on dementia stage, intervention characteristics, and the role of nurses in the intervention. The extracted data were categorized according to stages of dementia, and analyzed to identify commonalities and differences between intervention characteristics.

Findings

Three ACP interventions focused on mild dementia and seven on advanced dementia. We observed four primary findings. First, we found a major difference in intervention recipients between the two dementia stages. Second, most ACP interventions included structured discussions regarding the person’s life goals and values, goals of care, and preferences concerning future care via individual, face‐to‐face interactions. Third, ACP interventions designed to promote ongoing discussions and documentation were lacking. Finally, nurses played important roles in implementing ACP interventions.

Conclusions

The findings suggest more nurse‐led, dementia‐related ACP interventions. In addition, ACP interventions should promote ongoing discussions and documentation and target persons with dementia and their surrogates in various countries.

Clinical Relevance

Many persons with dementia and their surrogates have limited knowledge about ACP; thus, more nurse‐led ACP programs that reflect dementia stages may help them prepare for the situations in which persons with dementia lack decision‐making capacity.

Contextualization of Psychological First Aid: An Integrative Literature Review

Abstract

Purpose

Contextualization of psychological first aid (PFA) in different cultural, political, and socioeconomic contexts and in different population groups is essential. This review analyzes the efforts that have been made to contextualize PFA in different parts of the world for different disasters and emergencies.

Design

Integrative literature review.

Methods

The major databases that were searched for related literature published until August 2019 included JBI, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), BIOSIS, ISI Web of Knowledge, Scopus, EBSCOhost, and PsycINFO. A total of 17 studies published in peer‐reviewed journals were included. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) model, and the 6W3H tool was applied to synthesize the results.

Findings

PFA has been adapted to various disasters and populations in different countries and regions. The organizations that administer PFA range from community level to national level. Professional or “outside helpers” who enter disaster‐affected locations include psychologists, fire fighters, social workers, and nurses. “Inside helpers,” who live and work in the disaster‐affected areas, include HR staff, teachers, and peer emergency personnel. Only a few studies have reported the exact number of first responders who administered PFA. Some studies revised PFA as group based, and a few reported the classification of groups of victims. Notably, all adaptations adhered to the basic principles of PFA, and the time at which PFA was administered ranged from a few days to months after an incident. PFA was conducted on site in all studies. The selection of the location depended on the type of disaster and local situation with due consideration of safety. Only a few studies specified the rationale for revising the PFA. None of these 17 studies reported the cost, cost‐benefit, or cost‐effectiveness of PFA.

Conclusions

Population‐focused, context‐specific, and group‐based PFA is emerging worldwide. Nurses are actively playing a role in providing PFA. Research gaps exist in differentiating between the roles played by “outside” and “inside” responders, considering vulnerable age groups other than children, incorporating the major PFA concepts such as resilience, and evaluating the cost‐effectiveness of PFA.

Clinical Relevance

It is imperative that nurses and other emergency staff consider the intersection of age, gender, cultural, political, social economic, and spiritual contexts when developing a context appropriate PFA.

Self‐Report Assessment of Nurses’ Risk for Infection After Exposure to Patients With Coronavirus Disease (COVID‐19) in the United Arab Emirates

Abstract

Purpose

Nurses have an increased risk for acquiring COVID‐19 infection. This study assessed levels of risk for exposure to COVID‐19 among nurses, and determined those at the greatest risk.

Design

A cross‐sectional design was used to assess risk for exposure to COVID‐19 in nurses from five randomly selected governmental hospitals in the United Arab Emirates. Participants completed an online survey (including the World Health Organization survey) to assess their risk for exposure to COVID‐19. Descriptive statistics were used to describe classes of risk for exposure, and logistic regression was used to identify factors associated with greater risk.

Findings

Of the 552 participants, 284 nurses (51.4%) were classified at high risk for COVID‐19 exposure as they did not report adherence to infection control and prevention (ICP) guidelines at all times during healthcare interactions and when performing aerosol procedures, or had accidental exposure to biological fluid and respiratory secretions. Compared with adherence to wearing medical masks, gloves, and hand hygiene practices, adherence to wearing face shields or goggles and disposable gowns and decontaminating high‐touch surfaces was less frequent. Shifting to work in critical care units, not having adequate critical care experience, and reporting a need for training in ICP practices were factors that contributed to high‐risk exposure (p values for Ex (Bs) = 2.60, 2.16, 1.75, ≤ 0.05, consecutively).

Conclusions

A considerable number of nurses were classified at high risk for COVID‐19 exposure. Critical care work experience and adequate evidence‐based training in ICP practices related to COVID‐19 must be considered to mitigate the risk for exposure to COVID‐19 in nurses.

Clinical Relevance

This study provided a strong message regarding protecting nurses at high risk for exposure to COVID‐19. Clinical leaders must stay vigilant to ensure nurses’ adherence to ICP practices in the context of COVID‐19, and to proactively address any related deficits.

The Relationship Between Psychological Capital and the Occupational Psychologic Risks of Nurses: The Mediation Role of Compassion Satisfaction

Abstract

Purpose

The aim of the study was to explore the relationship between psychological capital (hope, self‐efficacy, resilience, and optimism) and burnout and compassion fatigue or secondary traumatic stress among general hospital nurses, and the mediating role of compassion satisfaction in this relationship.

Design

Cross‐sectional survey study. Participants were 697 nurses working in different nursing departments in tertiary university hospitals in a metropolitan city in Turkey.

Methods

The semistructured interview form, Professional Quality of Life Scale, and Psychological Capital Scale were used to gather data. Descriptive analysis, the Spearman correlation analyzer, hierarchical multiple linear regression analysis, and mediation analyzer with PROCESS and the Sobel test were used to analyze data.

Findings

There were moderate relationships between psychological capital total score, all subscales, and burnout, and weak negative correlations between these variables and compassion fatigue. For burnout, self‐efficacy and optimism in the first model explained 26% of the variance; when compassion satisfaction was added in the second model, 45% of the total variance was explained. For compassion fatigue, self‐efficacy in the first model explained 5% of the variance; adding compassion satisfaction in the second model, the variance did not change at all.

Conclusions

The findings of the current study may contribute to enhancing the protection of nurses' well‐being in their general hospital settings by developing knowledge about the resources that are needed to prevent or decrease occupational psychological risks. Increasing psychological capital levels of nurses enhances the quality of care and the sustainability of their working conditions.

Clinical Relevance

The findings of this study can be used to design interventions to better assist nurses in addressing their psychological health. Because psychological capital is a malleable resource, nursing managers can invest in the development and improvement of nurses' resources.

Work Schedule Characteristics, Missed Nursing Care, and Organizational Commitment Among Hospital Nurses in Korea

Abstract

Purpose

This study describes Korean nurses’ work schedule characteristics and identifies their components to investigate associations of work schedule components with missed nursing care and organizational commitment.

Design

This cross‐sectional secondary analysis used survey data of 1,057 nurses in 111 units at six hospitals in South Korea. Data were collected between April 2017 and March 2018.

Methods

A self‐administered survey, including seven work schedule characteristic items, the Korean version of the MISSCARE Survey, and the Korean version of the Organizational Commitment Questionnaire, was employed. To construct independent components of work schedule characteristics, a principal component analysis was performed. The associations of work schedule components with missed nursing care and organizational commitment were analyzed using multiple linear regression models with generalized estimating equation methods.

Findings

The average number of daily work hours was 9.7. Nearly half of the study population worked while sick once or more per month. The two components of nurses’ work schedule characteristics were “long work hours” and “lack of rest,” and these components showed variations between units. Unhealthy work schedule components were linked to frequently missed nursing care and decreased organizational commitment.

Conclusions

This study showed that proper work hours and adequate rest are important to reduce missed nursing care tasks and enhance organizational commitment, both of which are critical for better patient care and organizational outcomes.

Clinical Relevance

Healthcare organizations should provide adequate nursing staff and assign reasonable workloads. Furthermore, hospitals should periodically monitor the work schedule characteristics of nurses and actively intervene in cases of scheduling issues to resolve them.

Issue Information

Journal of Nursing Scholarship, Volume 53, Issue 1, Page 1-4, January 2021.

Age at Human Papillomavirus Vaccine Initiation Among Adolescents and Young Adults From 22 Pediatric Practices in the Northeastern United States

Abstract

Purpose

To examine trends in human papillomavirus (HPV) vaccine initiation and its determinants.

Design

This retrospective correlational study involved 12,260 individuals born between 1996 and 2000 receiving care from one of 22 pediatric practices in the northeastern region of the United States between 2016 and 2017.

Methods

We extracted data about HPV vaccination status and date, birth year, race, ethnicity, language, and geographic regions. Mean age at initiation was estimated using descriptive statistics. Multiple linear regression with weighted least squares was used to examine its correlates.

Findings

Of 12,260 individuals, about 76% initiated the HPV vaccination series at 9 to 17 years of age. While the initiation age decreased overall for both females and males (e.g., 14.3 vs. 16.2 years and 13.8 vs. 14.4 years in the 1996 vs. 2000 birth cohorts, respectively), a greater reduction was noted for males. Individuals tended to delay initiation if they were non‐Hispanic or Asian and resided in urban areas.

Conclusions

Most adolescents in our sample started HPV vaccination later than the recommended age, with variations in different demographic groups. Rapid improvement in on‐time HPV vaccination is occurring, especially for males.

Clinical Relevance

The findings of this analysis emphasize continuous efforts to increase on‐time HPV vaccination rates for all groups, including non‐Hispanic whites and female adolescents, to eliminate current and possible disparities.

Implementation Science Meets Software Development to Create eHealth Components for an Integrated Care Model for Allogeneic Stem Cell Transplantation Facilitated by eHealth: The SMILe Study as an Example

Abstract

Purpose

To describe a process of creating eHealth components for an integrated care model using an agile software development approach, user‐centered design and, via the Behavior Change Wheel, behavior theory‐guided content development. Following the principles of implementation science and using the SMILe project (integrated care model for allogeneic stem cell transplantation facilitated by eHealth) as an example, this study demonstrates how to narrow the research‐to‐practice gap often encountered in eHealth projects.

Methods

We followed a four‐step process: (a) formation of an interdisciplinary team; (b) a contextual analysis to drive the development process via behavioral theory; (c) transfer of content to software following agile software development principles; and (d) frequent stakeholder and end user involvement following user‐centered design principles.

Findings

Our newly developed comprehensive development approach allowed us to create a running eHealth component and embed it in an integrated care model. An interdisciplinary team’s collaboration at specified interaction points supported clear, timely communication and interactions between the specialists. Because behavioral theory drove the content development process, we formulated user stories to define the software features, which were prioritized and iteratively developed using agile software development principles. A prototype intervention module has now been developed and received high ratings on the System Usability Scale after two rounds of usability testing.

Conclusions

Following an agile software development process, structured collaboration between nursing scientists and software specialists allowed our interdisciplinary team to develop meaningful, theory‐based eHealth components adapted to context‐specific needs.

Clinical Relevance

The creation of high‐quality, accurately fitting eHealth components specifically to be embedded in integrated care models should increase the chances of uptake, adoption, and sustainable implementation in clinical practice.

Motivations for Family Members’ Visits to Nursing Home Residents With Dementia in Taiwan: A Qualitative Study

Abstract

Purpose

The purpose of this study was to explore what motivates family members to visit a relative with dementia who has been transferred to a nursing home in Taiwan.

Design and Methods

Data were collected for this qualitative descriptive study using audiotaped, semi‐structured, in‐depth, face‐to‐face interviews. A total of 20 family members of elderly nursing home residents participated in the study. Nursing home residents were from four nursing homes in Taiwan and had been diagnosed with probable or possible dementia by a psychiatrist or neurologist. Transcribed audiotaped interviews were analyzed using thematic analysis.

Findings

Most family members were the children of the residents (n =17, 85%). The theme describing the core motivation for family members’ visits to nursing home residents was “to maintain the unforgotten family affection.” This motivation comprised four relevant categories: hoping to slow degeneration, providing a congruous environment, honoring filial and karmic duty, and ensuring the quality of care.

Conclusions

Motivations for Taiwanese family members’ visits to nursing home residents with dementia were similar to those in Western cultures. However, “hoping to slow degeneration” and “providing a congruous environment” were unique categories.

Clinical Relevance

Nurses and policymakers could use these findings to design interventions that might increase holistic care for both family members and nursing home residents with dementia. Providing programming focused on family members’ unique priorities could address swallowing difficulties, management of dementia symptoms, nutritional needs, and selection of residents’ roommates. These programs could improve the quality of family members’ visits as well as the quality of staff–family relationships.

“Invisible Voices”: A Critical Incident Study of Family Caregivers’ Experience of Nursing Homes After Their Elder Relative’s Death

Abstract

Purpose

The literature provides few examples of family caregivers’ retrospective evaluation of nursing home services. This study aimed at analyzing narratives of Italian family caregivers of elders who experienced nursing home placement.

Design and Methods

Data were gathered through in‐depth interviews with family members after their relatives’ death. The interviews were based on the Critical Incident Technique, which allowed the categorization of the most memorable positive and negative events from the perspective of family members of elders deceased in nursing homes. Interviews were interpreted with a phenomenologically inspired thematic analysis approach. Participants were screened for complicated grief disorder as a confounding variable in relatives’ accounts of the treatment.

Results

Results suggested that positive long‐term recollection of the nursing home was associated with different themes emerging from the interviews: medical reliability and expertise, active demonstrations of care that extend beyond the contract with the facility, individualized attention, responsiveness, openness to dialog with family members about routines, management of the first impression, and family engagement. Lack of professionals’ expertise and medical failures, lack of care for patients’ personal goods, lack of family involvement, lack of individualized attention, lack of responsiveness, poor patient surveillance, and structural limits of the facilities were the themes that were more frequently negatively associated with the nursing home experience.

Implications for Practice

Focusing on the key dimensions connected to the quality of the experience of family members can enrich the quality of existing nursing home services and allow healthcare policymakers and managers to design better facilities for the patients.

Are People With Chronic Diseases Satisfied With the Online Health Information Related to COVID‐19 During the Pandemic?

Abstract

Purpose

A deluge of fake news and misinformation about the coronavirus disease 2019 (COVID‐19) on the Internet poses challenges for the public in their search for reliable and relevant health information for taking protective measures, especially among people with chronic diseases (PWCD). This study aimed to (a) understand the satisfaction level of the online information related to COVID‐19 in people with and without chronic diseases; (b) explore information‐searching behavior and digital health literacy in PWCD; and (3) identify the possible predictors of information satisfaction among PWCD.

Methods

This was a multicity, cross‐sectional study using an online survey with a convenience sample of people who (a) were 15 years of age or older and (b) had access to the Internet in mainland China, Hong Kong, and Macau.

Findings

Four thousand four hundred and seventy‐two subjects completed the survey, of whom less than 50% felt satisfied with the online information. About 20% of respondents (n = 882) were diagnosed with at least one chronic disease and reported a lower level of information satisfaction (p = .003) than the people without chronic diseases. The majority of the PWCD obtained their online health information from social media. Higher digital health literacy (adjusted odds ratio [OR] = 5.07), higher frequency of searches regarding symptoms of COVID‐19 (adjusted OR = 2.07), higher perceived importance of quickly learning from the information searched (adjusted OR = 1.63), and lower frequency of searches on the topic of dealing with psychological stress (adjusted OR = 0.54) were found to be predictors of information satisfaction among PWCD.

Conclusions

The majority of PWCD sought online information related to COVID‐19 from social media, and their level of information satisfaction was significantly lower than among people without chronic diseases. Digital health literacy is a strong and significant predictor of information satisfaction.

Clinical Relevance

To support PWCD, we not only have to provide them with clear and accurate information, but also promote their digital health literacy so that they may seek, understand, and appraise health information from the Internet to make appropriate health‐related judgments and decisions.

Effects of Work Environments and Occupational Fatigue on Care Left Undone in Rotating Shift Nurses

Abstract

Purpose

This study aimed to examine the effects of work environments and occupational fatigue on care left undone in rotating shift nurses, and to identify the indirect (mediation) effect of work environments on care left undone through nurses’ occupational fatigue in South Korean acute care hospitals.

Design

This study employed a cross‐sectional design using an online survey to collect data from 488 rotating shift nurses of acute care hospitals in Korea between November and December 2018.

Methods

A mobile schedule management application for shift nurses was used to advertise the study and to send a link to the online survey. The survey included questions on the nurses’ work environment characteristics, care left undone activities, and the Korean version of the Occupational Fatigue Exhaustion/Recovery scale. Poisson regression was used to explore the relationships among work environments, occupational fatigue, and care left undone. Hayes’ Model 4 and a bootstrapping analysis were used to identify the mediating effect of occupational fatigue on the relationship between work environments and care left undone.

Findings

The average number of tasks left undone was 3.45 (SD = 2.19). The higher the acute and chronic fatigue levels noted among nurses, the higher were the occurrences of care left undone. Conversely, the higher the intershift recovery level, the lower were the occurrences of care left undone. The results showed a positive relationship between care left undone and overtime hours and the number of patients per nurse. Moreover, nurses’ occupational fatigue mediated the relationship between work environments and care left undone. Night shifts per month and the number of consecutive days off had an indirect effect on care left undone through occupational fatigue.

Conclusions

High levels of occupational fatigue and poor intershift recovery among nurses can lead to care left undone. Nurses’ occupational fatigue mediates the effect of work environment on care left undone.

Clinical Relevance

It is crucial for healthcare administrators and leaders to develop policies and mandatory regulations to facilitate better working conditions for nurses, consequently reducing their occupational fatigue and decreasing the occurrence of care left undone in acute care hospitals.

Nursing in the Digital Health Era

Journal of Nursing Scholarship, Volume 53, Issue 1, Page 5-6, January 2021.

Older Adults’ Engagement in Technology‐Mediated Self‐Monitoring of Diet: A Mixed‐Method Study

Abstract

Purpose

This feasibility study explored older adults’ use of a nutrition app called Appetitus (https://apps.apple.com/us/app/appetitt/id1001936854?ign‐mpt=uo%3D2; https://play.google.com/store/apps/details?id=no.nr.appetitt&hl=e) and addressed their engagement in technology‐mediated self‐monitoring of diet. Undernutrition is a significant challenge among older adults and is associated with poorer health experiences. Digital health for self‐monitoring of diet has the potential to increase awareness of personal nutrition, and the scarcity of research reporting older adults’ ability and willingness to engage in technology‐mediated dietary self‐monitoring warranted this study.

Design and Methods

An explorative mixed‐methods design combining descriptive analysis of log data with qualitative analysis of interviews with Appetitus users was implemented.

Findings

Twenty‐five older adults self‐monitored their diet using Appetitus over an 8‐week trial period. Eighty percent of the participants used the app regularly in the trial period. The most engaged users recorded their food consumption daily for 8 weeks. Personal interest in nutrition and commitment to the project facilitated regular use of Appetitus. Poor health and the perception that using a nutrition app lacked personal relevance contributed to irregular self‐monitoring. For inexperienced technology users, participation in this project became a springboard to using tablet technology and the Internet beyond the Appetitus app.

Conclusions

The majority of the participants regularly used Appetitus for self‐monitoring of diet; they found the tablet technology and Appetitus app easy to use.

Clinical Relevance

Older adults are able and willing to use self‐monitoring tools. Nutrition apps can empower older adults to make better informed decisions about their diet. Patients’ self‐monitoring can provide valuable and detailed health‐related information to healthcare professionals and mediate patient‐centered care practices.

Utilizing an Artificial Neural Network to Predict Self‐Management in Patients With Chronic Obstructive Pulmonary Disease: An Exploratory Analysis

Abstract

Purpose

The main objective of this study was to utilize an artificial neural network in an exploratory fashion to predict self‐management behaviors based on reported symptoms in a sample of stable patients with chronic obstructive pulmonary disease (COPD).

Design and Methods

Patient symptom data were collected over 21 consecutive days. Symptoms included distress due to cough, chest tightness, distress due to mucus, dyspnea with activity, dyspnea at rest, and fatigue. Self‐management abilities were measured and recorded periodically throughout the study period and were the dependent variable for these analyses. Self‐management ability scores were broken into three equal tertiles to signify low, medium, and high self‐management abilities. Data were entered into a simple artificial neural network using a three‐layer model. Accuracy of the neural network model was calculated in a series of three models that respectively used 7, 14, and 21 days of symptom data as input (independent variables). Symptom data were used to determine if the model could accurately classify participants into their respective self‐management ability tertiles (low, medium, or high scores). Through analysis of synaptic weights, or the strength or amplitude of a connection between variables and parts of the neural network, the most important variables in classifying self‐management abilities could be illuminated and served as another outcome in this study.

Findings

The artificial neural network was able to predict self‐management ability with 93.8% accuracy if 21 days of symptom data were included. The neural network performed best when predicting the low and high self‐management abilities but struggled in predicting those with medium scores. By analyzing the synaptic weights, the most important variables determining self‐management abilities were gender, followed by chest tightness, age, cough, breathlessness during activity, fatigue, breathlessness at rest, and phlegm.

Conclusions

The results of this study suggest that self‐management abilities could potentially be predicted through understanding and reporting of patient’s symptoms and use of an artificial neural network. Future research is clearly needed to expand on these findings.

Clinical Relevance

Symptom presentation in chronically ill patients directly impacts self‐management behaviors. Patients with COPD experience a number of symptoms that have the potential to impact their ability to manage their chronic disease, and artificial neural networks may help clinicians identify patients at risk for poor self‐management abilities.

Understanding Digital Health Technologies Using Mind Maps

Abstract

Purpose

The purpose of this project was to explore digital health technologies in the healthcare environment through the use of concept and mind mapping tools in a graduate level informatics practicum course.

Design

This descriptive course evaluation project was conducted at a large university school of nursing during the 2019–2020 academic year and included a convenience sample of 163 doctor of nursing practice students.

Methods

Students completed four major deliverables exploring digital health technologies and data sources using mind maps. Project goals were evaluated using detailed rubrics and data from a course evaluation questionnaire (CEQ) then analyzed using descriptive statistics. Comments from the CEQ and reflection documents were reviewed for themes and validated by two experts.

Findings

The variety and creativity of the mind maps along with student comments indicated their ability to apply critical thinking skills to the specific content and technologies being examined. Overall CEQ mean scores were high (M = 4.35), indicating that the mind mapping deliverables were logical, relevant, appropriate, and meaningful to learning.

Conclusions

Nurse educators and healthcare professionals should consider using mind mapping techniques because this venue allows for expanded understanding of the complexities of the healthcare environment and integration of related digital health technologies.

Clinical Relevance

The recent pandemic highlighted the necessity for new technologies to continue providing patient care services. Mind maps are a fast and economical tool for understanding and prioritizing the needs of an organization as well as a unique teaching strategy to promote critical thinking and sharing of ideas related to digital health technologies.

Longitudinal Outcomes of Children Exposed to Opioids In‐utero: A Systematic Review

Abstract

Purpose

The purpose was to summarize evidence of long‐term outcomes of children, 2 years and older, exposed to opioids in‐utero.

Design

This was a systematic review. Studies were identified by searching the following electronic databases: PubMed, EBSCO HOST/Medline, and Web of Science. Articles were published between 1979 and 2019.

Methods

This systematic review was reported according to the Preferred Reporting Items for Systematic Review and Meta‐Analysis. Two sets of two independent reviewers extracted data and assessed study quality according to National Institutes of Health quality assessment tools.

Results

Forty‐three articles met inclusion criteria. Synthesis of articles identified trends toward worse outcomes for children with in‐utero opioid exposure in all areas, most notably related to academic success, behavior, cognition, hospitalizations, and vision.

Conclusions

Findings reinforce the necessity of continued research in this area with improved study design. Despite limitations in the current body of evidence, findings from this review are vital knowledge for clinicians, because children exposed to opioids in‐utero are clearly vulnerable to a wide variety of suboptimal health and developmental outcomes.

Clinical Relevance

Recognition of all outcomes across childhood associated with in‐utero opioid exposure will inform improved identification and interventions tailored to the most pressing needs of affected children. Despite the need for continued research, there is sufficient evidence to necessitate close, individualized follow‐up throughout childhood.

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