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AnteayerCIN: Computers, Informatics, Nursing

Quality Evaluation of Visual Display Terminal Syndrome Videos Shared on YouTube

imageVisual display terminal syndrome is a health problem that occurs when an individual looks at a visual display terminal for a long time. This study aimed to evaluate the quality of YouTube videos on visual display terminal syndrome. YouTube was searched using the keywords “visual display terminal syndrome” and “a prolonged user of a computer or smartphone” on October 16, 2019. A total of 45 videos were evaluated using DISCERN and the Journal of the American Medical Association scoring systems. The variables extracted from the videos were the uploading agency; content; presentation format; days since upload; the number of views, likes, dislikes, and comments; and the video power index. The mean DISCERN and Journal of the American Medical Association scores were 35.64 and 3.08 points, respectively, indicating that the information on visual display terminal syndrome in YouTube videos was inaccurate and unreliable. The major reason for the low quality of the videos was that the sources of information presented in the videos were not provided. The DISCERN and Journal of the American Medical Association scores showed significant differences in the uploading agency and presentation format variables. Nurses must be familiar with evaluating the quality of videos presenting health information. Guidelines informing patients that YouTube might provide misinformation about health need to be developed.

Building a Handoff Communication Virtual Experience for Nursing Students Using Virtual Humans

imageEffective communication among healthcare professionals is critical to delivering safe, high-quality patient care. One important real-world skill that nursing students must acquire is generating accurate handoff communication reports. The central aim of this study was to build, assess, and revise a virtual experience simulation that allows nursing students to observe a standardized clinical situation in an immersive environment and then practice the situation-background-assessment-recommendation communication method. This between-groups experimental study, which was modified in light of COVID-19 concerns, evaluated how well 69 prelicensure nursing students understood a handoff communication report after viewing a virtual human patient and nurse interact during a triage assessment scenario. Results indicate student comprehension levels did not differ based on which of two metacognitive learning strategies was used. Participants in both study groups were able to accurately complete a situation-background-assessment-recommendation instrument based on the virtual experience. Further, they believed that watching a virtual nurse perform a triage assessment would help them perform one themselves in a similar virtual environment. There was also an unexpected study finding related to patient safety within the context of the simulation. This finding warrants further research that will lead to revision of the virtual experience used to train future nurses.

Fall Prevention and Injury Reduction Utilizing Virtual Sitters in Hospitalized Patients: A Literature Review

imageFalls and fall-associated injuries continue to occur in hospitals worldwide. Video monitoring using virtual sitters is a novel, cost-effective concept that has emerged as an intervention to address falls and maintain safety for hospitalized patients. This literature review examines the evidence regarding hospital-associated falls and fall-related injuries when video monitoring and virtual sitters were included as an intervention. Ten observational studies and two quasi-experimental studies (N = 12) were identified for inclusion from the Cumulative Index of Nursing and Allied Health Literature, Scopus, and PubMed databases. Overall, current evidence is focused on fall rates and cost savings. Eight studies demonstrated a fall reduction and the remaining three showed no statistical difference in fall rates with the use of video surveillance or virtual sitters. Cost savings for these interventions are based on the transition from 1:1 observation to virtual sitters; all 12 studies reported decreased overall costs transitioning to virtual sitters. Small sample size and limited studies are the primary limitations of current published evidence. As the novel clinical practice evolves and more hospitals are equipped with video capability, future research with virtual sitters should include expanded patient populations, a focus on fall-related injuries, and examinations of staff safety.

Nurse Cognition, Decision Support, and Barcode Medication Administration: A Conceptual Framework for Research, Practice, and Education

imageThis article synthesizes theoretical perspectives related to nurse cognition. We present a conceptual model that can be used by multiple stakeholders to study and contemplate how nurses use clinical decision support systems, and specifically, Barcode-Assisted Medication Administration, to make decisions during the delivery of care. Theoretical perspectives integrated into the model include dual process theory, the Cognitive Continuum Theory, human factors engineering, and the Recognition-Primed Decision model. The resulting framework illustrates the process of nurse cognition during Barcode-Assisted Medication Administration. Additionally, the model includes individual or human and environmental factors that may influence nurse cognition and decision making. It is important to consider the influence of individual, human, and environmental factors on the process of nurse cognition and decision making. Specifically, it is necessary to explore the impact of heuristics and biases on clinician decision making, particularly related to the development of alarm and alert fatigue. Aided by the proposed framework, stakeholders may begin to identify heuristics and cognitive biases that influence the decision of clinicians to accept or override a clinical decision support system alert and whether heuristics and biases are associated with inappropriate alert override.

Quality of Online Information Regarding High-Risk Pregnancies

imageHealth information on the Internet can have a direct effect on healthcare decision-making. However, the quality of information online has seldom been evaluated. This study aimed to assess the quality of online information on high-risk pregnancies provided by English and Korean Web sites. Through a Google search, 30 English and 30 Korean Web sites were selected on January 2 and 3, 2020, respectively, and assessed using DISCERN, a Journal of the American Medical Association, and Health On the Net Foundation code questionnaires. The data assessed were analyzed using descriptive and nonparametric statistical tests. Overall, the information provided by the English Web sites presented higher-quality information than the Korean Web sites. Most Web sites did not provide the sources of the information presented on their Web sites, meet the Journal of the American Medical Association criteria, or provide information on complementarity. Based on our results, nurses need to be competent in assessing the quality of Web sites and the health information presented there, and nursing students need to be prepared to do so as well. Nurses are responsible for educating their patients about the possibility of incorrect information provided by Internet Web sites and informing their patients about reliable Web sites, thus assisting them to make informed decisions regarding their health.

Nursing Documentation Variation Across Different Medical Facilities Within an Integrated Healthcare System

imageThe purpose of this study was to demonstrate nursing documentation variation based on electronic health record design and its relationship with different levels of care by reviewing how various flowsheet measures, within the same electronic health record across an integrated healthcare system, are documented in different types of medical facilities. Flowsheet data with information on patients who were admitted to academic medical centers, community hospitals, and rehabilitation centers were used to calculate the frequency of flowsheet entries documented. We then compared the distinct flowsheet measures documented in five flowsheet templates across the different facilities. We observed that each type of healthcare facility appeared to have distinct clinical care foci and flowsheet measures documented differed within the same template based on facility type. Designing flowsheets tailored to study settings can meet the needs of end users and increase documentation efficiency by reducing time spent on unrelated flowsheet measures. Furthermore, this process can save nurses time for direct patient care.

A Mobile-Assisted Peer Assessment Approach for Evidence-Based Nursing Education

imageStudents who learn evidence-based nursing can assist the healthcare team to make proper medical decisions and provide patients with valuable advice, thus optimizing the quality of patient care in specific situations. In clinical work, nursing staff members participate in decision making by searching for relevant empirical nursing literature, a basic ability required to enter clinical practice. In traditional instruction, nursing students are taught the Problem, Intervention, Comparison, and Outcome method to learn to use library resources and gather empirical nursing knowledge for decision making. However, it is a challenge for most students to have sufficient practice to make decisions correctly and to have opportunities to perceive medical cases from diverse perspectives. Therefore, we propose a peer assessment-based Problem, Intervention, Comparison, and Outcome approach to help nursing students locate correct evidence and make appropriate decisions about patient care. We performed an experiment with our approach in a nursing university training program. The experimental results reveal that the subjects learning with the proposed approach show better evidence-based nursing knowledge, learning attitude, and critical thinking ability than those learning with the traditional approach.

Association Between Symptoms of Patients With Heart Failure and Patient Outcomes Based on Electronic Nursing Records

imageWe examined the association between symptoms (ie, dyspnea and pain) and patient outcomes (ie, length of stay, 30-day readmission, and death in hospital) among patients with heart failure using EMRs. This was a descriptive study that was conducted from July 1, 2014, to November 30, 2017. Participants were 754 hospitalized patients with heart failure (mean age, 70.62 ± 14.78 years; male-to-female ratio, 1:1.1). Data were analyzed using descriptive statistics, χ2 tests, and logistic regression analyses. Patients' average length of stay was 8.92 ± 13.12 days. Thirty-two patients (4.2%) were readmitted, and 100 patients (13.3%) died during hospitalization. Two-thirds (67.7%) experienced dyspnea, and 367 (48.7%) experienced pain. Symptoms and ICU admission were significantly related to patient outcomes. In the regression analyses, dyspnea, pain, and ICU admission were significantly related to higher-than-average lengths of stay. Dyspnea and ICU admission were related to death in hospital. Information regarding patients' symptoms, which was extracted from records, was a valuable resource in examining the relationship between symptoms and patient outcomes. The use of EMRs may be more advantageous than self-reported surveys when examining patients' symptom and utilizing big data.

Stimulating the Involvement of Family Members in the Medication Management Activities of Older Adults Through Ambient Displays: Qualitative Study

imageLittle attention has been paid to how medication management technologies, designed for older adults, modify the participation of family caregivers. We developed a tablet-based ambient display that provides external cues to remind and motivate older adults to take their medications. This study aimed to understand the effect of ambient displays on the involvement of family members in the elderly's medication management. We conducted a 10-week study consisting of interviews administered weekly to nine elderly-caregivers. We identify that new involvement patterns of the family caregivers were provoked through external cues, which made them aware of older adults' medication adherence and encouraged younger relatives to help older adults.

Confidentiality of Information Stored on the Desktop of Computers in a Psychiatric Hospital: Before and After an Intervention

imageThe aim of this before-after study was to evaluate the effect of an educational intervention on the confidentiality status of unprotected information stored on computer desktop in a psychiatric hospital. All switched-on computer systems were inspected in 2017-2018 at the baseline and 7 months after placing an educational poster. The log-in conditions and files stored on the desktop were reviewed using a researcher-made checklist; moreover, users answered questions about the possible mechanism of deleting information stored on the desktop. The number of files stored on desktops, the number of systems left switched on and unused, and the number of systems without a log-in password decreased in the second phase than the first phase of this study. Furthermore, automatic locking of computers after a specified period increased. The educational intervention reduced significantly the storage of information on desktops and improved security mechanisms such as using passwords and autolock. This study showed using an educational poster can encourage users to preserve the security of information, comply with security guidelines such as locking unused computers, and prevent access to confidential information.

Exploring Nursing Students' Perspectives on Telenursing Using Q-methodology

imageWith the rapid development of information and communications technologies, the medical care paradigm has been transformed, making telenursing a reality. Along with the introduction of telenursing, new changes are anticipated in the following central nursing domains: “human,” “environment,” “nursing,” and “health.” Current nursing students living in a hyperconnected world are expected to expand telenursing and foster changes in nursing. Therefore, it is important to understand nursing students' perceptions about telenursing to prepare innovatively for this changing field. This study explored nursing students' subjective perceptions about telenursing in South Korea using Q-methodology. Forty Q-statements, which reflected the nursing metaparadigm, were extracted from 175 generated statements; then, 40 nursing students—recruited purposively through snowball sampling—ranked the set of Q-statements. The data were analyzed using the PQMethod program. Five perceptions concerning telenursing were identified: “concerns and suggestions for telenursing,” “complete support for telenursing,” “inevitable acceptance of telenursing,” “distrust and criticism regarding telenursing,” and “optional acceptance of telenursing.” This study provides strategies for introducing and implementing telenursing services in countries with commercial 5G coverage and informs policies related to nursing education.

E-Health Decision Support Technologies in the Prevention and Management of Pressure Ulcers: A Systematic Review

imagePressure ulcers are problematic across clinical settings, negatively impacting patient morbidity and mortality while resulting in substantial costs to the healthcare system. E-health clinical decision support technologies can play a key role in improving pressure ulcer–related outcomes. This systematic review aimed to assess the impact of electronic health decision support interventions on pressure ulcer management and prevention. A systematic search was conducted in PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, and Cochrane. Nineteen articles, published from 2010 to 2020, were included for review. The findings of this review showed promising results regarding the usability and accuracy of electronic health decision support tools to aid in pressure ulcer prevention and management. Evidence indicated improved clinician adherence to pressure ulcer prevention practices and decreased healthcare costs postimplementation of an electronic health decision support intervention. However, the studies included in this review did not consistently show reductions in pressure ulcer prevalence, incidence, or risk. Most of the articles included in the review were limited by small sample sizes drawn from single hospitals or long-term care homes. More high-quality studies are needed to determine the types of electronic health decision support tools that can drive sustainable improvements to patient outcomes.

“Shared Decision Making Assistant”: A Smartphone Application to Meet the Decision-Making Needs of Patients With Primary Liver Cancer

imageThe development of medical technology provides medical specialists with a variety of choices for their primary liver cancer patients, including partial liver resection, transcatheter arterial chemoembolization, liver transplantation, and so on. However, in this context, because patients with primary liver cancer frequently do not receive adequate information to help make complicated medical decisions, those patients, who are usually otherwise ignorant about their disease, are facing multiple difficult choices. The problem might be alleviated with a process called “shared decision making.” Accordingly, researchers developed a smartphone application named “Shared Decision Making Assistant” for primary liver cancer patients in China, and in this article, we report the process of its development. First, individual interviews were conducted to identify the specific needs and status of primary liver cancer patients participating in shared decision making. Next, expert group discussions were held among primary liver cancer medical experts, nurses, and software engineers, using a decision-making process called the Delphi method, which was used to arrive at a group opinion or decision by surveying a panel of experts, to draft the framework and decide on the contents of the mobile health–based decision aids program. Feedbacks and suggestions were collected to optimize the workflow of “Shared Decision Making Assistant.” The resulting application consisted of seven modules: personal information, primary liver cancer treatment knowledge center, decision aids path, continuing care, interactive platform, health education, and backstage management.

The Adoption of Electronic Health Records in Primary Healthcare Settings

Por: Tubaishat · Ahmad
imageLittle is known about the adoption rate of electronic health records in primary healthcare settings. This study aimed to estimate this adoption rate in Jordan, using a national survey with a descriptive cross-sectional design. The first step was to review the annual report of the Jordanian Ministry of Health as a basis for identifying the sample, which are primary healthcare settings. Then, Electronic Health Solutions, the company that vends electronic health record systems in Jordan, was used to determine which primary healthcare settings were using these electronic record systems. The final task was to determine which functionalities of the system were being used in these settings, and for this, a telephone survey of key personnel was conducted. It was found that 21.6% of the primary healthcare settings were using electronic health records, while the other 78.4% were still relying on paper records. The results also showed that the adoption rate of electronic health records was significantly associated with the type of the setting (P

Evaluating Systemized Nomenclature of Medicine Clinical Terms Coverage of Complementary and Integrative Health Therapy Approaches Used Within Integrative Nursing, Health, and Medicine

imageThe use of complementary and integrative health therapy strategies for a wide variety of health conditions is increasing and is rapidly becoming mainstream. However, little is known about how or if complementary and integrative health therapies are represented in the EHR. Standardized terminologies provide an organizing structure for health information that enable EHR representation and support shareable and comparable data; which may contribute to increased understanding of which therapies are being used for whom and for what purposes. Use of standardized terminologies is recommended for interoperable clinical data to support sharable, comparable data to enable the use of complementary and integrative health therapies and to enable research on outcomes. In this study, complementary and integrative health therapy terms were extracted from multiple sources and organized using the National Center for Complementary and Integrative Health and former National Center for Complementary and Alternative Medicine classification structures. A total of 1209 complementary and integrative health therapy terms were extracted. After removing duplicates, the final term list was generated via expert consensus. The final list included 578 terms, and these terms were mapped to Systemized Nomenclature of Medicine Clinical Terms. Of the 578, approximately half (48.1%) were found within Systemized Nomenclature of Medicine Clinical Terms. Levels of specificity of terms differed between National Center for Complementary and Integrative Health and National Center for Complementary and Alternative Medicine classification structures and Systemized Nomenclature of Medicine Clinical Terms. Future studies should focus on the terms not mapped to Systemized Nomenclature of Medicine Clinical Terms (51.9%), to formally submit terms for inclusion in Systemized Nomenclature of Medicine Clinical Terms, toward leveraging the data generated by use of these terms to determine associations among treatments and outcomes.

Nursing Informatics in Israel From a Historical Perspective

imageThe field of nursing informatics is expanding in Israel, which is known as a start-up nation. This study is a systematic literature review aimed to obtain a historical perspective of the Israel's nursing informatics development. To study how nursing informatics has evolved in Israel over the past 20 years, we analyzed two major issues: (1) the development of the nursing informatics field over these years; and (2) nursing informatics studies that were carried out by nurses. The main criteria for choosing these studies were: (1) nursing informatics research conducted in Israel; (2) investigated by nurses; and (3) published in academic international journals, including PhD dissertations. Thirty studies were located, and two main issues were identified: nurse managers who were engaged in health information technology were not recognized as nursing informatics practitioners, and a minority of nurses performed nursing informatics researches. Although many health information technology projects were and are performed in Israel, the nursing informatics field is not fully recognized by Israeli nurses. Therefore, it is essential for Israeli nurses to understand the importance of advancing the nursing informatics body of knowledge, which will give nurses the authorization to become influential as health information technology professionals in areas such as health education, practice, and research—for the benefit of patients.

Impact of Patient Engagement on Tailored Education for Joint Replacement Population Using Technology

imagePatient engagement and technology use for healthcare are important for optimal care. This study was designed to leverage technology in education among the adult joint population based on their engagement capacity and utilization of technology for care. A convenience sample of 80 patients undergoing joint replacement surgery and followed in the inpatient setting participated. Comparisons were made between an intervention group who completed the Person Engagement Index to measure their engagement capacity and received a technological educational plan based on their score versus those receiving the standard educational plan. The Person Engagement Index psychometrics were sound and indicated high engagement capacity. Overall, the groups did not differ in utilization, satisfaction, and education comprehension; however, the intervention group reported a higher unit mean for the extent they felt ready for discharge and instructions for care at home. Results of this study informed patients' engagement capacity and technology use for pre-/postoperative education for procedure expectations and self-management throughout the joint replacement process and recovery. Future research includes use of technology for engagement capacity and outcomes with other populations, collecting socio-demographic data to determine differences among groups and examining the patient and provider experience and satisfaction with using technology to enhance care and outcomes.

Factors Affecting Nursing Students' Practice of Medical Information Protection

imageInfringement of personal medical information can lead to psychological, social, and economic damages; legal repercussions; information abuse; and invasion of patients' privacy. This study identified the effects of nursing students' ethical inclination, knowledge, and perception on their medical information protection practice. Participants were third- and fourth-year students of one nursing college in a city in South Korea. Participants' perception of the importance of medical information protection was correlated with their practice of medical information protection (r = 0.62, P
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