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AnteayerCIN: Computers, Informatics, Nursing

Optimization of Nursing-Specific Flu Alerts

imageClinical decision support interventions, such as alerts and reminders, can improve clinician compliance with practice guidelines and patient outcomes. Alerts that trigger at inappropriate times are often dismissed by clinicians, reducing desired actions rather than increasing them. A set of nursing-specific alerts related to influenza screening and vaccination were optimized so that they would “trigger” less often but function adequately to maintain institutional flu vaccination compliance. We analyzed the current triggering criteria for six flu vaccine–related alerts and asked nurse end users for suggestions to increase specificity. Using the “five rights” (of clinical decision support) as a framework, alerts were redesigned to address user needs. New alerts were tested and implemented and their activity compared in two different flu seasons, preoptimization and postoptimization. The redesigned alerts resulted in fewer alerts per encounter (P

Development of a Web Exercise Video for Nursing Intervention in Outpatients With Low Back Pain

imageThe purpose of this study was to develop a Web exercise video for nursing intervention among outpatients with low back pain by applying the analysis-design-development-implementation-evaluation model to promote continuous exercise. During the analysis phase, we assessed the needs for the lower back exercise video as well as details of the current situations of the participants. Additionally, we investigated the intervention methods that the medical practitioners thought would be helpful in promoting lower back exercise. After the design and development phase, a lower back exercise video of 5 minutes 46 seconds was developed. The main contents in the video were the stretching and flexing exercises of the spine and muscles, including “One knee to chest,” “Both knees to chest,” “Hip bridge,” “Prone position to erect spine,” “Kneeling back extension,” “Kneeling, opposite arm and leg raised,” and “Sitting rotation stretch.” For the implementation and analysis phase, a pilot test was done. The lower back exercise video was posted on the Web site, and participants watched the video and exercised individually. Participants reported that they were able to use the Web video whenever required, and after following the video a few times, they grew accustomed to the practice and were able to perform it repeatedly to help strengthen the lower back. In the future, experimental research is needed to confirm the effectiveness of exercise using Web video.

Prevalence of Cervical Cancer Overscreening: Review of a Wellness Registry

imageAppropriately matching preventive health services and screenings with patient risk is an important quality indicator. Adherence by both providers and patients to cervical cancer screening guidelines has been inconsistent, resulting in overscreening and increased costs. This study examined the prevalence of cervical cancer overscreening following changes in screening guidelines in a wellness registry database. Cervical cancer overscreening after guideline implementation decreased for 18- to 20-year-old patients from 26.8% to 24.8% (P

Student Nurses' Digital Literacy Levels: Lessons for Curricula

imageThe rapid uptake of technology is changing the way health professionals provide care to patients and communities. While this presents opportunities to improve, enhance, and positively transform care and treatment, graduates must have the requisite knowledge, skills, and attitudes to make effective use of the technology and data available to them. This research explored nursing students' self-reported digital literacy levels. We undertook a student survey at one university in Australia, utilizing the validated Self-Assessment Nursing Informatics Competencies Scale–SF30 instrument. Overall, 90% of students rated their basic computer knowledge and skills as at least “competent” including performing basic troubleshooting, using the Internet, and conducting online literature searches. However, only 55% of students considered their overall applied computer skills as at least “competent,” which included using applications for diagnostic coding and to extract data from clinical data sets. Students have digital literacy in everyday settings; however, their ability to translate this into practice is limited, restricting their access to and use of digital tools in the workplace. Our findings provide the opportunity to address practice issues related to digital literacy and to embed appropriate content in curricula to enable the delivery of improved patient care and the appropriate use of data in various settings.

Success Factors for and Barriers to Integration of Electronic Mental Health Screening in Primary Care

imageCurrently, only a third of primary care providers screen for substance use, which is a growing epidemic. This quality improvement study aimed to improve the screening process by integrating the Drug Abuse Screening Test without information systems support into the electronic health record to increase completed screenings and provider interventions for positive screenings in adult patients at an urban primary care clinic. Electronic drug abuse screening should include a prescreen followed by the Drug Abuse Screening Test, interprofessional approach, comprehensive education, and utilization of generic tools to create new screening forms. Staff participated in a new drug abuse screening process, and chart audits and staff interviews were conducted. There was a 9% increase in completed screenings by medical assistants with electronic versus paper screening (30% vs 21%, respectively; P

A Portal Adoption Program to Enhance Patient Satisfaction in Primary Care

imagePatient engagement technologies have become a focal point for defining quality in government and medical practice arenas. Patient portals are recognized as a promising mechanism to foster patient engagement and, as such, have become embedded in major healthcare reform initiatives. Despite sweeping implementation endeavors, portal adoption rates among patients remain low and create a significant gap in quality-based reimbursement. The purpose of this research was to evaluate a 12-week portal adoption program in the primary care setting featuring customized tablets with a patient-centric design for targeted point-of-contact portal registration. This project focused on three objectives: (1) achieve a 75% metric for portal adoption to align with highest tier adopters; (2) evaluate patient satisfaction for measuring perceived ease-of-use and usefulness of system; and (3) assess cost-effectiveness in determining sustainability and potential to replicate the initiative throughout other primary care settings. An outcome evaluation of the program revealed a 90% portal utilization rate, 94% new patient portal adoption rate, and 79% existing patient portal adoption rate during the data collection period. A χ2 analysis revealed a statistically significant difference in patient satisfaction scoring relative to efficiency, quality of care, and safety of information based on sex and insurance carrier demographics.

Constructing Inpatient Pressure Injury Prediction Models Using Machine Learning Techniques

imageThe incidence rate of pressure injury is a critical nursing quality indicator in clinic care; consequently, factors causing pressure injury are diverse and complex. The early prevention of pressure injury and monitoring of these complex high-risk factors are critical to reduce the patients' pain, prevent further surgical treatment, avoid prolonged hospital stay, decrease the risk of wound infection, and lower associated medical costs and expenses. Although a number of risk assessment scales of pressure injury have been adopted in various countries, their criteria are set for specific populations, which may not be suitable for the medical care systems of other countries. This study constructs three prediction models of inpatient pressure injury using machine learning techniques, including decision tree, logistic regression, and random forest. A total of 11 838 inpatient records were collected, and 30 sets of training samples were adopted for data analysis in the experiment. The experimental results and evaluations of the models suggest that the prediction model built using random forest had most favorable classification performance of 0.845. The critical risk factors for pressure injury identified in this study were skin integrity, systolic blood pressure, expression ability, capillary refill time, and level of consciousness.

The Effect of Cell Phones on Attention and Learning in Nursing Students

imageThe use of cell phones can have a negative effect on nursing students' academic performance. The purpose of this study was to identify the effects that problematic cell phone use and nomophobia have on learning in nursing students. A quasi-experimental study was carried out among nursing students, with a control group (n = 61, 49.2%) and an experimental group (n = 63, 50.8%). The experimental group left their cell phones, in sound or vibration mode, as they normally kept them, on a table located in the corner of the classroom. Both groups showed higher-than-average levels of nomophobia at the beginning of the class. As for problematic cell phone use and attention, it was found that there were statistically significant differences in both cases (U = 1355.500, Z = −2.830, P = .005; U = 1449.000, Z = −2.363, P = .018, respectively), and the experimental group had higher average scores, as well as in those related to knowledge. A relationship has been found between nomophobia and problematic cell phone use. Students who do not have access to their cell phones during class perceive more problematic cell phone usage, in addition to paying closer attention during class. Because of this, it is important to create policies and norms restricting cell phone use during all types of academic training among nursing students.

Development and Feasibility of a Safety Plan Mobile Application for Adolescent Suicide Attempt Survivors

imagePast suicide attempts are a powerful predictor of suicide. This study developed and evaluated the feasibility of a mobile application for creating safety plans, which include coping strategies that can be immediately accessed and used by suicide attempt survivors during a crisis. A safety plan mobile application, called Brake of My Mind, was developed (study 1). Heuristic evaluation (for experts) and user evaluations (for health professionals and adolescent suicide attempt survivors) were performed. A pilot test was then conducted based on the theory of planned behavior to evaluate the feasibility of Brake of My Mind (study 2). Three adolescent suicide attempt survivors used a pilot version of Brake of My Mind. Attitude toward suicide attempts, subjective norms, perceived behavioral control, and suicide intentions were assessed before, immediately after, and 1 week after using Brake of My Mind. Brake of My Mind showed very few low-priority usability problems, and it was considered a “good” and “acceptable” application. In study 2, median scores for attitudes toward suicide attempts, perceived behavioral control, and suicide intentions decreased over time after using Brake of My Mind. The subjective norm scores did not change. Brake of My Mind is an acceptable application for adolescent suicide attempt survivors that appears effective in decreasing their positive attitude toward suicide attempts.

Maintaining Intervention Fidelity When Using Technology Delivery Across Studies

imageThe current standard in healthcare research is to maintain scientific fidelity of any intervention being tested. Fidelity is defined as the consistent delivery of interventions that ensures that all participants are provided the same information, guidance, and/or materials. Notably, the methods for ensuring fidelity of intervention delivery must also be consistent. This article describes our Intervention and Technology Delivery Fidelity Checklists used to ensure consistency. These checklists were completed by trained nurse observers who rated the intervention implementation and the technology delivery. Across our clinical trials and pilot studies, the fidelity scores were tabulated and compared. Intervention information and materials were delivered by a variety of devices including telehealth monitors, videophones, and/or iPads. Each of the devices allows audiovisual connections between health professionals from their offices and patients and participants in their homes. Our checklists guide the monitoring of fidelity of technology delivery. Overall checklist ratings across our studies demonstrate consistent intervention, implementation, and technology delivery approaches. Uniquely, the fidelity checklist verifies the interventionist's correct use of the technology devices to ensure consistent audiovisual delivery. Checklist methods to ensure intervention fidelity and technology delivery are essential research procedures, which can be adapted for use by researchers across multiple disciplines.

The Effects of Simulation-Based Advanced Life Support Education for Nursing Students

imageAdvanced life support education for nursing students is very important because nurses are first responders in emergency situations. The purpose of this study was to identify the effects of simulation-based advanced life support education on nursing students' knowledge, performance, self-efficacy, and teamwork. A nonequivalent control group posttest-only design was used. Fourth-year nursing students were randomly assigned to either simulation-based Korean Advanced Life Support (n = 30) or lecture-based education (n = 30) groups. Data were analyzed using descriptive statistics and the Mann-Whitney U test. The experimental group showed statistically significant higher scores in knowledge (P

Competency Assessment in Simulation of Electronic Health Records Tool Development

imageRapid deployment of electronic health records has resulted in a need for simulation centers to integrate the use of electronic health records into simulation-based learning activities within the clinical workflow. To assess the quality of the documentation in the electronic health record, the Competency Assessment in Simulation of Electronic Health Records Tool was developed. Lynn's method of content validity, combined with nominal group and Delphi techniques, was used to identify 15 domains of best practice in documentation. Participants with expertise in academic education, simulation, and informatics provided input into the development of the tool. The tool evolved over three rounds of Delphi that refined the language and provided anchors to promote accurate assessment of student and nurse documentation. The results of the Delphi narrowed the 15 domains down to 10 domains for scoring best practices in electronic documentation within simulation-based learning activities. The Competency Assessment in Simulation of Electronic Health Records Tool was developed to address the electronic health record competencies of both nursing students and practicing nurses in a simulation environment.