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AnteayerCIN: Computers, Informatics, Nursing

Critical Care Nurses' Perceptions of Clinical Alarm Management on Nursing Practice

imageThe alarm management of physiological monitoring systems is a key responsibility of critical care nurses. However, the high numbers of false and nonactionable (true but clinically irrelevant) alarms cause distractions to healthcare professionals, interruptions to nursing workflow, and ignoring of crucial tasks. Therefore, understanding how nurses manage large amounts of alarms in their daily work could provide a direction to design interventions to prevent adverse patient care effects. A qualitative design with focus group interviews was conducted with 37 nurses in Taiwan. Content analysis was performed to analyze the interview data, and four main themes were derived: (1) the foundation stone of critical care nursing practice; (2) a trajectory adaptation of alarms management; (3) adverse impacts on the quality of care and patient safety; and (4) a hope for multimodal learning alternatives and wireless technology. Nurses manage alarm parameter settings influenced not only by their knowledge and skills of patient care, but also in accordance with the three dimensions of technology, human, and organization evaluation framework. Customized alarm management training alternatives, patient-centered care values, and application of wireless technology are the suggested approaches to enhance nursing care and minimize the risk of adverse events.

Caregivers' Technology Acceptance of an In-Home Care Management App: A Mixed-Methods Study

imageTaiwan faces challenges in providing long-term family care as its population rapidly ages. This study aimed to construct a health application that could effectively meet family caregivers' needs in providing home care. Mixed methods were adopted to explore their acceptance of the application, as well as to gather their suggestions for improving the application. A nonrandomized controlled group pretest–posttest design was utilized. The participants were family caregivers who were recruited via purposive sampling at a regional hospital in Taipei, Taiwan. The caregivers used the application to monitor and manage the health of those they were caring for. Elderly family caregivers scored 1.57 and 1.16 points higher than their middle-aged counterparts in terms of performance expectancy (0.61-2.53, P = .01) and effort expectancy (0.25-2.06, P = .01), respectively. The caregivers opined that it was convenient to use the application for managing the health data of their patients, and resources and solutions for overcoming problems when using the application were easily within their reach. They also suggested that relevant information for promoting patient mental health could also be included in the application. Thus, the software is acceptable to all the family caregivers regardless of age, indicating that it can assist family caregivers in the future in performing home care management.

Effect of Telehealth Interventions on Blood Pressure Control: A Meta-analysis

imageThe aim of this study was to find out the effects of telehealth interventions on blood pressure control by conducting a meta-analysis. Six databases were used. The literature review covered the period between December 1, 2020, and January 26, 2021. The meta-analysis was conducted by comprehensive Meta-Analysis Software version 2.2. Categorical variables were analyzed by odds ratios at a confidence interval of 95%. In data formatting and analysis, independent groups (sample size, P value); independent groups (mean, SD); Cohen's d, SE; and paired groups (N, P value) were used. The bias risk was assessed based on the Revised Cochrane Risk-of-Bias Tool for Randomized Trials. Total sample size including 22 studies was 11 120. It was determined that interventions performed through telehealth applications had a significant effect on blood pressure control (odds ratio = −0.14; 95% confidence interval = −0.20 to −0.08; P

Implementing a Novel Interprofessional Clinical Informatics Curriculum

imageA novel interprofessional clinical informatics curriculum was developed, piloted, and implemented, using an academic medical record. Targeted learners included undergraduate, graduate, and professional students across five health science colleges. A team of educators and practitioners representing those five health science colleges was formed in 2016, to design, develop, and refine educational modules covering the essentials of clinical informatics. This innovative curriculum consists of 10 online learning modules and 18 unique imbedded exercises that use standardized patient charts and tailored user views. The exercises allow learners to adopt the role of various providers who document in EMRs. Students are exposed to the unique perspectives of an attending physician, nurse, radiological technician, and health information manager, with the goal of developing knowledge and skills necessary for efficient and effective interprofessional communication within the EMR. The campus-wide clinical informatics curriculum is online, flexible, asynchronous, and well-established within each college, allowing faculty to select and schedule content based on discipline-specific learner and course needs. Program modifications over the past 4 years have correlated with a positive impact on the students' experience.

Data Analytics for Diagnosis and Prediction of Central Line–Associated Bloodstream Infections in Critical Care Units

imageCentral line–associated bloodstream infections are among the leading causes of in-hospital deaths in the United States and are a significant factor for increased morbidity, mortality, and healthcare costs. This study integrates several hospital data systems into a case-controlled database to use data analytics for the identification of significant central line–associated bloodstream infection risk factors and develop time-varying patient risk scores for central line–associated bloodstream infections. A case-control study was performed utilizing patient data collected from various sources then gathered and organized into a case-controlled dataset for analysis examining various patient-specific attributes for central line–associated bloodstream infections. Training and testing sets were created, and multivariate logistic regressions were used to identify risk factors for central line–associated bloodstream infection. Furthermore, the Cox proportional hazards model was used to infer the hazard rate and risk score for central line–associated bloodstream infections for each individual patient during hospitalization. Significant attributes for central line–associated bloodstream infection cases were the ICU location (P = .008), time from insertion (P ≤ .001), number of surgeries (P = .003), and number of central line manipulations (P = .003). Real-time data analytics and point of care at the bedside can facilitate precision care for patients with an elevated central line–associated bloodstream infection risk, subsequently changing the way healthcare prevents hospital-acquired infections.

Barcode Medication Administration Software Technology Use in the Emergency Department and Medication Error Rates

imageHigh-quality care during and after a medication process requires complete and accurate medication administration documentation. Veterans Affairs Medical Centers use barcode medication administration technology to document medication administered to Veterans throughout the inpatient and long-term care areas of the hospital. Barcode medication administration has demonstrated a reduction in medication administration errors; however, it is not commonly used in Veterans Affairs Medical Center clinical areas or emergency departments. During this study, only 39% of the recorded 165 Veterans Affairs Medical Centers that use barcode medication administration technology in their inpatient areas stated that barcode medication administration was also used in clinical areas of the hospital. Of these facilities, only 14% had implemented barcode medication administration in their emergency department. This study evaluated medication error rates before and after barcode medication administration technology was implemented in the emergency department of a Veterans Affairs Medical Center located in the Southeastern region of the United States. A total of 258 charts, 129 before and 129 after barcode medication administration technology implementation in the emergency department, were reviewed for Veterans who were evaluated and ordered to receive medication in the emergency department before transferring to an inpatient unit at the Veterans Affairs Medical Center where this study was conducted. A quantitative nonexperimental descriptive comparison demonstrated a 10.8% reduction in medication error rates and 21% reduction in the average number of medications given in error per chart after barcode medication administration technology was implemented in the emergency department. In addition to the study outcome, a potentially unsafe workaround was identified. Stakeholders that use barcode medication administration technology in their emergency departments would benefit from assessing the association between barcode medication administration use and medication administration error rates. However, assessing whether barcode medication administration technology remains useful and continues to provide safe medication administration practices for our Veterans is also recommended.

Effect of Digital Learning With an Interactive eBook on Electrocardiogram Interpretation Among Clinical Nurses: A Repeated-Measures Analysis

imageIn digital learning, the use of an interactive eBook is perceived as helpful for students. However, the effect of interactive eBooks on learning among clinical nurses has not been explored yet. This study used an interactive electrocardiogram eBook to explore the effect of digital learning on the promotion of electrocardiogram interpretation competence, confidence, knowledge retention, and learning satisfaction among clinical nurses. A single-group quasi-experimental study with three repeated measures was conducted. A total of 80 nurses from the emergency room, critical units, and medical-surgical units completed the measures. The results showed that digital learning is an effective method that significantly improved nurses' electrocardiogram competence, learning retention, confidence, and learning satisfaction. Most nurses were satisfied with the convenience and content design of this eBook. Few nurses reported drawbacks regarding loading speed and individual learning habits. It is recommended that more preset learning exercise questions should be created for trial and error so that nurses can have repeated practice for self-assessment. Specific feedback mechanisms should be established to promote motivation for digital self-learning.

Regulation and Use of Health Information Systems in Brazil and Abroad: Integrative Review

imageThere is increasing debate about the importance of using information and communication technologies to strengthen health systems. Information systems are one of the most widespread technologies for this end in different healthcare contexts. The primary objective of this study was to highlight and discuss the main characteristics of the regulation and use of health information systems in Brazil and abroad. As a secondary objective, the main characteristics identified in Brazil were compared with the findings for other countries. A robust search strategy incorporated five electronic databases. The research question was defined using the SPIDER strategy, and thematic content analysis was applied. Fourteen articles composed the final sample, and three analytic categories were identified: “Use in the Context of Health Systems”; “Implications for Health Management”; and “Communication and Interoperability.” The regulation and use of health information systems in different countries was directly related to their socioeconomic context. In Latin America and Africa, policy strengthening and implementation possibilities for health management were discussed. In the United States, Europe, and Asia, the discussions on interoperability between different services was emphasized. The complexity of the Brazilian health system leads to similarities in the data analysis with several countries from different regions and with distinct political configurations.

Usability Evaluation by Nurses of a Knowledge-Based System of Care Plans for People Hospitalized by COVID-19

imageThe aim of this study is to analyze the usability by nurses of the Knowledge-Based System “Diagnostics care for COVID-19.” A convenience sample of 16 nurses was selected, among hospital workers and external experts. The group was divided into three subgroups intentionally to obtain different usability perspectives. Usability was evaluated by the System Usability Scale questionnaire. The participants completed the questionnaire on general usability, data inputs, and information output, after completing a minimum of 12 care plans. The first subgroup used real cases and the “think aloud” technique, the second simulated cases from the same hospital, and the third subgroup performed the external simulation. The highest scores were obtained in data inputs (94.38–97.50); and the lowest, in general usability (90.00–95.00). The subgroup of external experts scored the highest (93.13–95.63), and the first subgroup, which carried out real cases, gave the lowest score (90.00–94.38). The “think aloud” technique found an improvement in including more diagnoses and being able to carry out several plans for one person at the same time. The usability obtained was “excellent” in all subgroups and questionnaires, although the application showed limitations related to its characteristics imposed in the requirements specification.

Brazilian Mobile Phone Applications Related to Hand Hygiene and Their Applicability for Healthcare Professionals

imageThe objective of this study was to identify available mobile applications regarding education for hand hygiene and their applicability as a resource for nurses and other healthcare professionals. The aim was to assess the quality of the mobile apps for education on hand hygiene for health professionals. A review of mobile apps available from Apple App Store and Google Play Store in Brazil was conducted. The World Health Organization recommendations and the Mobile Application Rating Scale for evaluating quality were used. Six applications were selected, only three presented gamification elements incorporated into the learning method and only two of them—SureWash Pocket and Give Me 5—used the international recommendations to improve hand hygiene compliance in a more substantial and interactive way. The mean quality total score for the five rated apps was 3.41, indicating poor to acceptable quality. SureWash Pocket was the only application that reached Mobile Application Rating Scale ≥4 in all dimensions. These mobile applications can be used as complementary alternatives in addition to other available education strategies to improve the standards of hand hygiene and change the behavior of health professionals.

The Effect of Computer-Based Training on Self-care and Daily Living Activities in Patients With Lumbar Discectomy Surgery: A Randomized Controlled Study

imageThis research was conducted to determine the effect of computer-based discharge training on patients with lumbar disc surgery on self-care agency and independence in daily living activities. A randomized controlled study was conducted on 60 patients, 30 in the intervention group and 30 in the control group. Computer-based lumbar disc surgery discharge training and a CD containing the training content were given to the intervention group after the surgery, whereas the control group received routine discharge training in the ward. The data of the study were collected using a Patient Information Form, the modified Barthel Index, and the Exercise of Self-Care Agency Scale. The increase in the modified Barthel Index and Exercise of Self-Care Agency Scale scores after training in the intervention and control groups were statistically significant (P .05). Computer-based discharge training improved the participants' independence in their daily living activities and increased the self-care power of the patients compared with the control group.

Exploring the Outcomes and Satisfaction of Automated Physiological Monitoring Systems Among Nurses

imageVital signs are central to the assessment of physiologic functions of patients and must be included in the electronic health record. The purpose of this retrospective and cross-sectional design study was to evaluate use of—and satisfaction with—automated physiological monitoring systems. Usage data from a hospital database were analyzed 3, 6, and 12 months after implementation of the automated system (June 2018 to May 2019). In addition, questionnaires were completed by 168 nurses, and 20 nurses were interviewed between August/September 2020 and October/November 2020, respectively. Results revealed that usage frequency of automated physiological monitoring devices increased steadily with user familiarity. Although respondents indicated general satisfaction with the devices, system downtime, sufficiency of the battery charge, and data transmission speed were identified as needing correction to smooth workflow and boost work efficiency. Although most interviewees considered devices easy to use, some mentioned transmission speed of the gateway, scanner sensitivity, and accuracy of the ear thermometer as needing improvement. For nurses to use automated physiological monitoring devices fully, a user-friendly design in functions and features is vital, and in-service training and a streamlined workflow are recommended to facilitate technology adoption.

Learning Outcomes of Digital Learning Interventions in Higher Education: A Scoping Review

imageImplementing digital technologies has become a policy priority worldwide among all types of education. The COVID-19 pandemic has further accelerated educational institutions' efforts to reorganize their teaching and introduce new digital learning technologies. Although using digital technologies in higher education, including nursing, is considered a modern and innovative way of teaching and learning, uncertainty exists concerning these technologies' actual usefulness in achieving positive learning outcomes. The aim of this scoping review was to examine the current evidence related to the effects of using digital technologies on learning outcomes in higher education. The authors searched five electronic databases for relevant studies and used a scoping review method to analyze and synthesize the evidence. Eighty-six articles from six disciplines met the selection criteria. As a key finding, the outcomes of the interventions were mainly positive. Increased professional knowledge, skills, and attitudes reflect the advancement of professional competence. Academic, collaborative, and study skills, in turn, contribute to general competence development. Our findings suggest that digital technology has the potential to improve learning in various disciplines.

Education to Improve Point of Care Documentation in Home Care Nurses: A Quality Improvement Project

Home care nurses are expected to document their care delivery while in the patients' homes. Point of care documentation ensures that information in the EHR is accurate, timely, and accessible to all care team members. Standard training emphasized the features and functions of the different tabs within the electronic record. Managers and nurses reported standard training was not effective. The purpose of this project was to perform a post-implementation evaluation of the incorporation of point of care documentation, using case study scenarios, into the EHR training to determine if there was improved timeliness of documentation by new home care nurses. Quantitative data showed no statistical difference between the pre-implementation and post-implementation participants on completion of documentation within 24 hours from the small sample groups. Quantitative data from training evaluations showed a positive impact on learners' confidence and willingness to complete point of care documentation. Qualitative results showed participants viewed scenario-based training as interactive, meaningful, and indicative of a change in practice to include point of care documentation in the patients' home. The results suggest continued evaluation of the use of scenario-based education with point of care documentation as a format for more effective EHR training.
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