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AnteayerCIN: Computers, Informatics, Nursing

Employing a User-Centered Design to Engage Mothers in the Development of a mHealth Breastfeeding Application

imageBreastfeeding has numerous health benefits; however, many mothers do not continue breastfeeding to the recommended 6 months of age. Breastfeeding support after discharge from the hospital is often lacking in the communities with the greatest need. Therefore, the Mother's Milk Connection mHealth application was designed to improve breastfeeding duration and access to support. This article describes a user-centered design process to engage mothers in the development of the Mother's Milk Connection application. Two phases of stakeholder and user studies were conducted. Phase 1 involved concept generation, prototype development, and usability testing. Phase 2 focused on prototype redesign and usability testing. We used a descriptive mixed-method approach with data collected using a demographic questionnaire, System Usability Scale, exit survey, and focus groups. Final features of the Mother's Milk Connection application included resources and education, peer support, automated activity tracking, and professional support via video conference. Stakeholder and user engagement indicated the integration of four distinct features is acceptable for use as a comprehensive mHealth intervention to improve access to breastfeeding support. mHealth has the potential to be a useful strategy for providing breastfeeding support, and a clinical trial regarding the efficacy of the Mother's Milk Connection application is needed.

Technology-Supported Interventions for Pregnant Women: A Systematic Review

imageTechnology is deeply embedded in daily life; thus, more pregnant women seek information through the Internet and incorporate the use of technological devices during their pregnancies. This systematic review aimed to examine to what extent and how technology-supported interventions were developed and delivered to pregnant women, as well as intervention effects on the targeted outcomes. Electronic data were collected from MEDLINE, CINAHL, and Scopus. Among the 11 selected studies, most were pilot studies to test the feasibility, acceptability, or preliminary effects of technology-supported interventions. The studies included both women with healthy pregnancies and pregnancies complicated by factors including preterm labor, smoking, and alcohol abuse. Most were conducted in the US, and most participants were white or African American. Interventions were primarily developed by research teams and focused on mental health issues including depression, anxiety, and stress. Interventions incorporated the use of technology including computers, mobile phones, and audiovisual aids. The overall interventions were reported to be feasible, acceptable, and beneficial in all the selected studies. Based on the review of literature, suggestions were provided for future research including the need for careful selection of intervention topics and objectives to target women who can benefit more from technology-supported interventions.

Developing and Pilot Testing an Integrated Technology–Moderated Institutional Health Promotion Model Using Operational Research Approach

imageThe study aimed to develop and pilot test an Integrated Technology–Moderated Institutional Health Promotion Model for university staff in Nigeria. An operational research approach using mixed concurrent design was adopted to develop the model, and pretest-posttest method was used to evaluate the utilization and effectiveness of the developed model. The participants in the study were university staff. Health-promoting lifestyle behavior and health status were measured via the adapted Health-Promoting Lifestyle Profile II instrument. The emerging model (an Integrated Technology–Moderated Institutional Health Promotion Model, which is an Android phone app named Tertiary Staff Health Promotion App) was deployed. Data were collected before and 12 weeks after the app deployment. The quantitative and qualitative data findings were combined to develop an integrated technology–moderated institutional health promotion model as a means to enhance health-promoting lifestyle behavior and health status of staff. The result of the pilot testing of the model showed that the model enhances health-promoting lifestyle behaviors and improves the health status of staff. Nurses, especially in community/public health nursing practice, can provide innovative interventions to drive and enhance health-promoting lifestyle behavior and improve health status of workers and other population groups through effective use of information and communication technology.

The Effect of Web-Based Preoperative and Postoperative Patient Care Education on Nursing Students: A Randomized Controlled Study

imageThis study examined the effect of Web-based preoperative and postoperative patient care education among undergraduate nursing students. This was an experimental, randomized controlled study. The study included 305 nursing students (experimental group: n = 155, control group: n = 150), who were assessed with the following instruments: the Preoperative and Postoperative Care Knowledge Test, Preoperative and Postoperative Care Skill Control List, Clinical Decision Making in Nursing Scale, and Nursing Student Clinical Performance Evaluation Scale. t Tests and χ2 tests were used to evaluate the data. There was no statistically significant difference between the students' posttest knowledge levels, clinical performance assessment, or clinical decision-making scores. The experimental group was found to perform the skills of “check patient's documents and prophylactic antibiotics when going to surgery” (χ2 = 4.88; P = .02), “controls the surgical safety checklist (before surgery) before going to surgery” (χ2 = 10.41; P = .00), and “observes surgical site/dressing (χ2 = 7.77; P = .00)” at a statistically significantly higher level. The education provided in the Web-based education was equivalent to that provided in traditional education. Thus, Web-based education appears to be a useful tool to educate student nurses in preoperative and postoperative patient care.

Improved Patient Flow and Provider Efficiency After the Implementation of an Electronic Health Record

imageElectronic health records are used widely across the nation in many different types of healthcare facilities. Electronic health record systems can provide more accurate and complete information about a patient's health, improve patient safety, and improve patient care. The purpose of this project is to evaluate a provider efficiency and workflow program at a hospital-owned, freestanding urgent care system after implementation of an electronic health record. A retrospective, longitudinal approach was used to evaluate the implementation of an electronic health record system among six freestanding urgent care clinics. The logic model was used as a guiding framework to determine whether provider efficiency and patient flow were improved. Data were collected from participants via an online survey, electronic health record data review, paper chart review, and direct observation of providers. An evaluation of a provider efficiency program using door-to-triage, door-to-provider, door-to-discharge, and average length of stay at each urgent care clinic was collected. The results indicate improvement in all areas after implementation of the electronic health record in all six urgent care settings. The average length of stay decreased from 109 minutes in 2014 to 73 minutes in 2016.

Recruitment and Retention of Asian Americans in Web-Based Physical Activity Promotion Programs: A Discussion Paper

imageWeb-based interventions that promote physical activity have been tested in various populations and proven effective. However, information on recruiting and retaining ethnic minorities in these interventions is limited. This study discusses practical issues in recruitment and retention of Asian Americans using three strategies: (1) only Web-based intervention (Group 1), (2) one with Fitbit Charge HR (Group 2), and (3) one with Fitbit Charge HR and office visits (Group 3). Recruitment and retention rates, minutes of weekly research team meetings, and the researchers' memos were collected. Retention rates were analyzed using descriptive statistics, and the minutes and memos were content analyzed following Weber's methods. Retention rates varied by the end of the first (12% in Group 3, 36.9% in Group 2) and third month (0% in Group 3, 36.9% in Group 2). The practical issues were (1) difficulties in recruitment across strategies, (2) the necessity of using community consultants/leaders across strategies, (3) subethnic differences across strategies, (4) timing issues across strategies, (5) Fitbit as a facilitator with several hindrances, and (6) office visits as an inhibitor. Fitbits with user guidelines and community consultants'/leaders' involvement are proposed for future Web-based interventions to promote physical activity in Asian Americans.

Evaluation of Nursing Practice in Patients With HIV/AIDS With the Omaha System Electronic-Based Information Program: A Retrospective Study

imageThe Omaha System is a standardized health care terminology that has been used in many different settings for nursing care worldwide for more than 20 years. In Turkey, it has been used mainly in nursing education and research. In this context, the purpose of this study was to examine paper-based nursing care plans of inpatients with HIV/AIDS according to the Omaha System and to assess the clinical suitability of the Omaha System. The study has a descriptive-retrospective design and was carried out at the Department of Infectious Diseases and Clinical Microbiology in a hospital. The sample consisted of 30 patients with HIV/AIDS who were chosen randomly from patients hospitalized between January 2007 and April 2017. Nursing care plans were reevaluated and encoded according to the Omaha System. The five most frequently diagnosed problems were oral health (27.2%), neuromusculoskeletal function (20.2%), communicable/infectious condition (19.4%), skin condition (13.2%), and circulation (5.7%). A total of 4409 nursing interventions were applied to solve the problems, and almost 74% of the interventions were categorized in the surveillance. Among the targets, physical signs/symptoms were indicated for more than 68% (3.026). The results confirmed the clinical suitability of the Omaha System.

Development and Evaluation of the Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection

imageCatheter-associated urinary tract infection is one of the most common healthcare-acquired infections. It is important to institute preventive measures such as surveillance of the appropriate use of indwelling urinary catheters and timely removal by identifying patients at high risk for catheter-associated urinary tract infection. The purpose of this study was to develop an Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection and evaluate its predictive validity. This study involved secondary data analysis based on a case-control study and used the data extracted from electronic health records. The Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection was developed using a risk-scoring algorithm that was based on a logistic regression model and integrated into the electronic health records. The following eight risk factors for urinary tract infection were included in the logistic regression model: length of stay, admission to the Intensive Care Unit, dependent physical activity, highest neutrophil level (%), lowest blood sodium level of less than 136 mEq/L, lowest blood albumin level of less than 3.5 g/dL, highest blood urea nitrogen level of greater than 20 mg/dL, and indwelling urinary catheter application period (days). The risk groups classified by the Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection were automatically displayed on the patient summary screen of the electronic health record. The predictive validity of the Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection gradually increased up to the fifth and sixth assessment data after patients' admission; then, it leveled. It is possible to allocate nurses' time and effort for catheter-associated urinary tract infection risk assessment to surveillance of the use, removal, and management of indwelling urinary catheters and education and training by using the Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection in clinical settings.

Comparative Cost of Virtual Reality Training and Live Exercises for Training Hospital Workers for Evacuation

imageAdoption of virtual reality technology may be delayed due to high up-front costs with unknown returns on that investment. In this article, we present a cost analysis of using virtual reality as a training tool. Virtual reality was used to train neonatal intensive care workers in hospital evacuation. A live disaster exercise with mannequins was also conducted that approximated the virtual experience. Comparative costs are presented for the planning, development, and implementation of both interventions. Initially, virtual reality is more expensive, with a cost of $229.79 per participant (total cost $18 617.54 per exercise) for the live drill versus $327.78 (total cost $106 951.14) for virtual reality. When development costs are extrapolated to repeated training over 3 years, however, the virtual exercise becomes less expensive with a cost of $115.43 per participant, while the cost of live exercises remains fixed. The larger initial investment in virtual reality can be spread across a large number of trainees and a longer time period with little additional cost, while each live drill requires additional costs that scale with the number of participants.

Sequential Two-Stage Network and Thematic Analysis for Exploring an Interdisciplinary Care Approach in Nursing Homes

imageSince various groups of older adults with different conditions and levels of function coexist in nursing homes, it is necessary to develop integrated care strategies through collaboration among experts across related fields. The purposes of this study are to identify the regularity of information sharing in managing daily function for older adults, with a special focus on interdisciplinary cooperation, and to explore a practical care strategy for nursing home residents. The collaborative methods of network and thematic analysis were done by conducting in-depth interviews with 33 interdisciplinary experts working at seven nursing homes. This study proposed three relationships and three themes as interrelated key factors for providing interdisciplinary care to the elderly at various levels of function based on the experiences accumulated by the practitioners. First, independent sharing is required to make professional judgments about how daily function in older adults changes from reported baselines. Second, practitioners accurately judge clinical situations and supplement experts' judgments through partial sharing. Finally, all interdisciplinary consensus through complete sharing achieves the ultimate goal of maintaining remaining function in older adults. These findings can be the first step in developing practical care guidelines for interdisciplinary use, and the results can be used to develop integrated assessment and intervention strategies.

Usability of a Disease Management Mobile Application as Perceived by Patients With Diabetes

imageThe use of mobile applications in chronic disease management has grown significantly over the past decade. When properly designed, these apps provide a convenient, safe, high-quality service to patients. In this study, a health management app was developed, and its usability among patients with diabetes mellitus was examined. A convenience sample of 136 patients, referred to two academic centers from December 2016 to July 2017, was enrolled. Upon completion of informed consent, the participants were asked to install the app on their smartphone. Two weeks later, they were required to complete a postapplication usability questionnaire, comprising 21 questions classified into six domains. The response rate was 89%. The highest scores were given for “ease of use and learnability”; the lowest-scored domains were “interaction quality” and “reliability.” Urban residents, participants with lower educational qualifications, and retirees were significantly more satisfied with the app. Overall, patients with diabetes mellitus perceived the app as useful for disease management. However, the overall usability of health apps is expected to improve when a multidisciplinary team (health professionals, computer engineers, art designers) is involved in the development process.

Factors Related to Health Informatics Competencies for Nurses—Results of a National Electronic Health Record Survey

imageIn 2015, the Finnish Ministry of Social Affairs and Health published an eHealth and eSocial strategy with key objectives that by 2020 health information systems will be smart and providers will be able to maximize their use. Measures include improving system usability and decision support, involving professionals in system and service development, and increasing professionals' training in information management, electronic documentation, data protection, and data security. The aim of this study was to explore the level of nurses' informatics competencies and sufficiency of in-house training regarding technology-induced changes in work practices. An electronic questionnaire produced by the National Institute of Health and Welfare was sent in February to April 2017 to 29 283 Finnish working-age nurses, community nurses, and midwives; 3607 replies were received. Respondents rated their overall informatics competency relatively high, with the lowest competency scores on terminology-based documentation (Finnish Care Classification) and patient-related digital work. Education, electronic health record system used, experience using electronic health record systems, sufficiency of training, higher levels of technical functionality, ease of use, and usefulness were all associated with competency and remained significant after all adjustments. One-third of the respondents felt that they had not received sufficient training. Age and participation in system development were associated with experiences of sufficiency of training.