@Article{info:doi/10.2196/70640,
author="Li Jung, Lu
and Chou, Chin Pei
and Wu, Yu-Hua",
title="Limited Moderating Effect of Podcast Listening on Work Stress and Emotional Exhaustion Among Nurses During the COVID-19 Pandemic: Cross-Sectional Study",
journal="JMIR Nursing",
year="2025",
month="Apr",
day="16",
volume="8",
pages="e70640",
keywords="work stress",
keywords="emotional exhaustion",
keywords="podcasts",
keywords="nurses",
keywords="COVID-19",
keywords="mental health",
abstract="Background: The COVID-19 pandemic placed unprecedented pressure on health care systems worldwide, significantly impacting frontline health care workers, especially nurses. These professionals faced considerable psychological stress from caring for patients with COVID-19 and the fear of spreading the virus to their families. Studies report that more than 60\% (132/220) of nurses experience anxiety, depression, and emotional exhaustion, which adversely affect their mental health and the quality of care they provide. Objective: This study aimed to investigate the relationship between work-related stress and emotional exhaustion among nurses and to assess whether listening to podcasts moderates this association. Methods: A cross-sectional online survey was conducted between March 1, 2023, and March 31, 2023. A total of 271 clinical nurses, aged 20 years to 65 years, were recruited for the study. Participants were divided into 2 groups: experimental group consisting of regular podcast listeners (n=173) and control group comprising nonlisteners (n=98). Ethical approval for this study was obtained from the local ethics committee (IRB number YGHIRB20230421B). Validated scales were used to measure work stress, emotional dissonance, and emotional exhaustion. Data analysis included descriptive statistics, independent t tests, and structural equation modeling to examine the relationships between variables. Results: No statistically significant differences were found between the experimental and control groups in terms of overall work stress (mean difference=--0.09, 95\% CI --0.31 to 0.13; P=.42) or emotional exhaustion (mean difference=0.07, 95\% CI --0.15 to 0.29; P=.53). Emotional dissonance emerged as a significant predictor of emotional exhaustion in both the experimental ($\beta$=0.476, P<.001) and control ($\beta$=0.321, P=.01) groups. Nurses reporting higher workloads had significantly higher emotional exhaustion levels (experimental group: $\beta$=0.302, P<.001; control group: $\beta$=0.327, P=.002). Podcast listening demonstrated only a slight, nonsignificant moderating effect. Conclusions: Although podcasts alone may not significantly reduce work stress or emotional exhaustion among nurses, there was a potential, albeit limited, moderating effect of podcasts on emotional well-being. They could serve as a supplementary tool for emotional support. However, broader and more comprehensive interventions are required to address the underlying causes of stress and emotional exhaustion in this population. More in-depth exploration and recommendations are possible by analyzing the content and patterns of listening. Further research is needed to examine the long-term benefits of integrating podcasts with other digital tools for holistic stress management in health care settings. ",
doi="10.2196/70640",
url="https://nursing.jmir.org/2025/1/e70640",
url="http://www.ncbi.nlm.nih.gov/pubmed/40159623"
}


@Article{info:doi/10.2196/58951,
author="Zhao, Yanchun
and Huang, Ting
and Chen, Yanli
and Li, Songmei
and Zhao, Juan
and Han, Xu
and Ni, Qing
and Su, Ning",
title="Evaluation of the Clinical Nursing Effects of a Traditional Chinese Medicine Nursing Program Based on Care Pathways for Patients With Type 2 Diabetes: Protocol for a Randomized Controlled Clinical Trial",
journal="JMIR Res Protoc",
year="2025",
month="Mar",
day="31",
volume="14",
pages="e58951",
keywords="type 2 diabetes",
keywords="traditional Chinese medicine",
keywords="TCM nursing program",
keywords="clinical pathway",
keywords="application research",
keywords="diabetes",
keywords="diabetes mellitus",
keywords="research protocol",
keywords="nursing",
keywords="nursing program",
keywords="nursing care",
keywords="chronic disease",
keywords="disease monitoring",
keywords="prevalence",
keywords="China",
keywords="adult",
keywords="patient recovery",
keywords="psychological care",
keywords="health education",
keywords="quality of life",
keywords="blood glucose",
keywords="self-care",
keywords="medication",
keywords="control group",
keywords="patient satisfaction",
abstract="Background: To improve the performance of health care institutions, reduce overmedication, and minimize the waste of medical resources, China is committed to implementing a clinical pathway management model. This study aims to standardize nursing practices, foster clinical thinking in nurses, and promote patient recovery. Objective: The purpose of this study is to evaluate the clinical effects of a traditional Chinese medicine (TCM) nursing program based on nursing pathways for patients with type 2 diabetes mellitus (T2DM). Methods: This study uses a prospective, randomized, single-blind, parallel-controlled design. Based on sample size calculations, the study will include 594 patients with diabetes, with 2 groups of 297 patients: an observation group will receive a TCM nursing program based on clinical pathways, while a control group will receive routine care. Both groups will be evaluated before and after the intervention using assessment indicators. The primary outcome is the quality of life score, measured by a diabetes-specific quality of life questionnaire. Secondary outcomes include hospital stay duration, medical expenses, health knowledge, blood glucose control, symptom scores, and patient satisfaction. Results: This study was funded in August 2021 and has received approval from the Ethics Committee of Guang'anmen Hospital, China Academy of Chinese Medical Sciences (2022-022-KY-01). The trial is ongoing, with the first patient enrolled in September 2022. The study is expected to conclude in April 2025. To date, 380 patients have been recruited, with 202 randomized into the study, though no statistical analysis of the data has yet been conducted. A single-blind method is used; nurses are aware of group assignments and intervention plans, while patients remain blinded. Final results are planned for release in the first quarter of 2025. Conclusions: This study seeks to integrate existing national standardized nursing protocols with clinical pathways to implement more efficient and higher-quality nursing practices. The goal is to standardize nursing procedures, enhance patients' quality of life, and improve self-care and medication adherence after discharge. Trial Registration: International Traditional Medicine Clinical Trial Registry ITMCTR2022000048; https://tinyurl.com/y4jd68h4 International Registered Report Identifier (IRRID): DERR1-10.2196/58951 ",
doi="10.2196/58951",
url="https://www.researchprotocols.org/2025/1/e58951"
}


@Article{info:doi/10.2196/67774,
author="Vanhala, Ville
and Surakka, Outi
and Multisilta, Vilma
and Lundsby Johansen, Mette
and Villinger, Jonas
and Nicolle, Emmanuelle
and Heikkil{\"a}, Johanna
and Korhonen, Pentti",
title="Efficiency Improvement of the Clinical Pathway in Cardiac Monitor Insertion and Follow-Up: Retrospective Analysis",
journal="JMIR Cardio",
year="2025",
month="Mar",
day="21",
volume="9",
pages="e67774",
keywords="insertable cardiac monitor",
keywords="clinical pathway",
keywords="nurse-led service",
keywords="task shifting",
keywords="efficiency improvement",
keywords="remote monitoring",
abstract="Background: The insertable cardiac monitor (ICM) clinical pathway in Tampere Heart Hospital, Finland, did not correspond to the diagnostic needs of the population. There has been growing evidence of delegating the insertion from cardiologists to specially trained nurses and outsourcing the remote follow-up. However, it is unclear if the change in the clinical pathway is safe and improves efficiency. Objective: We aim to describe and assess the efficiency of the change in the ICM clinical pathway. Methods: Pathway improvements included initiating nurse-performed insertions, relocating the procedure from the catheterization laboratory to a procedure room, and outsourcing part of the remote follow-up to manage ICM workload. Data were collected from electronic health records of all patients who received an ICM in the Tampere Heart Hospital in 2018 and 2020. Follow-up time was 36 months after insertion. Results: The number of inserted ICMs doubled from 74 in 2018 to 159 in 2020. In 2018, cardiologists completed all insertions, while in 2020, a total of 70.4\% (n=112) were completed by nurses. The waiting time from referral to procedure was significantly shorter in 2020 (mean 36, SD 27.7 days) compared with 2018 (mean 49, SD 37.3 days; P=.02). The scheduled ICM procedure time decreased from 60 minutes in 2018 to 45 minutes in 2020. Insertions performed in the catheterization laboratory decreased significantly (n=14, 18.9\% in 2018 and n=3, 1.9\% in 2020; P=<.001). Patients receiving an ICM after syncope increased from 71 to 94 patients. Stroke and transient ischemic attack as an indication increased substantially from 2018 to 2020 (2 and 62 patients, respectively). In 2018, nurses analyzed all remote transmissions. In 2020, the external monitoring service escalated only 11.2\% (204/1817) of the transmissions to the clinic for revision. This saved 296 hours of nursing time in 2020. Having nurses insert ICMs in 2020 saved 48 hours of physicians' time and the shorter scheduling for the procedure saved an additional 40 hours of nursing time compared with the process in 2018. Additionally, the catheterization laboratory was released for other procedures (27 h/y). The complication rate did not change significantly (n=2, 2.7\% in 2018 and n=5, 3.1\% in 2020; P=.85). The 36-month diagnostic yield for syncope remained high in 2018 and 2020 (n=32, 45.1\% and n=36, 38.3\%; P=.38). The diagnostic yield for patients who had stroke with a procedure in 2020 was 43.5\% (n=27). Conclusions: The efficiency of the clinical pathway for patients eligible for an ICM insertation can be increased significantly by shifting to nurse-led insertions in procedure rooms and to the use of an external monitoring and triaging service. ",
doi="10.2196/67774",
url="https://cardio.jmir.org/2025/1/e67774"
}


@Article{info:doi/10.2196/65549,
author="Lv, Chen
and Gong, Yi-Hong
and Wang, Xiu-Hua
and An, Jun
and Wang, Qian
and Han, Jing
and Chen, Xiao-Feng",
title="Correlation Between Diagnosis-Related Group Weights and Nursing Time in the Cardiology Department: Cross-Sectional Study",
journal="JMIR Med Inform",
year="2025",
month="Mar",
day="4",
volume="13",
pages="e65549",
keywords="diagnosis-related groups",
keywords="nursing time",
keywords="workload",
keywords="human resources",
keywords="nursing",
abstract="Background: Diagnosis-related group (DRG) payment has become the main form of medical expense settlements, and its application is becoming increasingly extensive. Objective: This study aimed to explore the correlation between DRG weights and nursing time and to develop a predictive model for nursing time in the cardiology department based on DRG weights and other factors. Methods: A convenience sampling method was used to select patients who were hospitalized in the cardiology ward of Beijing Chest Hospital between April 2023 and April 2024. Nursing time was measured by direct and indirect nursing time. To determine the distributions of nursing time based on different demographics, a Pearson correlation was used to analyze the relationship between DRG weight and nursing time, and a multiple linear regression was used to determine the influencing factors of total nursing time. Results: A total of 103 subjects were included in this study. The DRG weights were positively correlated with direct nursing time (r=0.480; P<.001), indirect nursing time (r=0.394; P<.001), and total nursing time (r=0.448; P<.001). Moreover, age was positively correlated with the 3 nursing times (direct: r=0.235; indirect: r=0.192; total: r=0.235; all P<.001). The activities of daily living (ADL) score on admission was negatively correlated with the 3 nursing times (direct: r=?0.316; indirect: r=?0.252; total: r=?0.301; all P<.001). In addition, the nursing level on the first day of admission was positively correlated with the 3 nursing times (direct: r=0.333; indirect: r=0.332; total: r=0.352; all P<.001). Furthermore, the multivariate analysis found that the nursing level on the first day of admission, complications or comorbidities, DRG weight, and ADL score on admission were the influencing factors of nursing time (R2=0.328; F5,97=69.58; P<.001). Conclusions: DRG weight showed a strong correlation with nursing time and could be used to predict nursing time, which may assist in nursing resource allocation in cardiology departments. ",
doi="10.2196/65549",
url="https://medinform.jmir.org/2025/1/e65549"
}


@Article{info:doi/10.2196/63572,
author="Walzer, Stefan
and Sch{\"o}n, Isabel
and Pfeil, Johanna
and Merz, Nicola
and Marx, Helga
and Ziegler, Sven
and Kunze, Christophe",
title="Experiences With an In-Bed Real-Time Motion Monitoring System on a Geriatric Ward: Mixed Methods Study",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="4",
volume="9",
pages="e63572",
keywords="nurses",
keywords="geriatric patients",
keywords="cognitive impairment",
keywords="technology",
keywords="fall prevention",
keywords="hospital",
keywords="mixed methods",
keywords="patient",
keywords="learning process",
keywords="assessment",
keywords="autonomy",
keywords="impairment",
keywords="real-time motion",
keywords="university",
keywords="geriatric ward",
keywords="survey",
keywords="anxiety",
keywords="willingness",
keywords="patient privacy",
keywords="effectiveness",
keywords="monitoring system",
keywords="health care practice",
abstract="Background: Older adults now make up about two-thirds of hospital admissions, with up to 50\% experiencing cognitive impairments such as dementia. These patients often struggle with adherence to care plans and maintaining regular day or night cycles, presenting challenges for nurses. Hospitals are typically unprepared to manage this patient population, resulting in increased nurse workload and challenges like managing motor agitation, which can lead to falls or accidental removal of medical devices. Objective: This study aimed to (1) assess how an in-bed real-time motion monitoring system (IRMS) impacts nurses' perceptions of physical and mental stress, (2) evaluate the IRMS's effect on the care process, (3) explore ethical implications like patient autonomy and privacy, and (4) understand how nurses acquire knowledge about the technology and how this affects their assessment of the IRMS. Methods: The IRMS, which provides real-time motion monitoring and bed edge or exit information, was implemented in the geriatric ward of a university medical center. The study followed a monocentric, explorative evaluation design using a mixed methods approach. It lasted 24 weeks and had two phases. In Phase 0 (6 weeks), patients received standard care. In Phase 1 (18 weeks), the IRMS was introduced. Initial data were gathered through focus groups and participant observations during manufacturer training sessions. At the end of the intervention, a survey, a second focus group, and an interview were conducted to capture nurses' experiences. The study follows the Good Reporting of a Mixed Method Study (GRAMMS) checklist for reporting. Results: Initial training sessions with 12 participants (10 nurses and 2 physiotherapists) showed varying levels of engagement, with the second session demonstrating more optimism and interprofessional collaboration. A total of 10 questionnaires were completed (10/21, 48\%). Survey results showed that 80\% (8/10) of nurses found the IRMS valuable for assessing the quality of work, and 90\% (9/10) were willing to continue using it. The system was regarded as reliable for monitoring bed edge and exit events. Usability was positively rated, with minimal concerns about documentation burden. Focus group discussions (n=3 per session) indicated that nurses viewed the system as reliable and appreciated its role in reducing anxiety related to fall prevention. However, concerns about patient privacy and monitoring were raised. Nurses expressed a willingness to continue using the IRMS but reaffirmed their ability to care for patients without it. Conclusions: Nurses had a generally positive attitude toward the IRMS, recognizing its benefits, particularly for nighttime monitoring. Although its effectiveness in preventing falls remains inconclusive, the system helps reduce nurses' fear of falls and enhances their responsiveness. The study highlights the broader impact of the IRMS beyond fall prevention and stresses the importance of thoughtful integration into health care practice. ",
doi="10.2196/63572",
url="https://formative.jmir.org/2025/1/e63572",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053780"
}


@Article{info:doi/10.2196/64444,
author="Walzer, Stefan
and Sch{\"o}n, Isabel
and Pfeil, Johanna
and Klemm, Sam
and Ziegler, Sven
and Schmoor, Claudia
and Kunze, Christophe",
title="Nurses' Perspectives and Experiences of Using a Bed-Exit Information System in an Acute Hospital Setting: Mixed Methods Study",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="5",
volume="9",
pages="e64444",
keywords="cognitive impairment",
keywords="bed-exit",
keywords="technology",
keywords="fall prevention",
keywords="inpatient",
keywords="hospital",
keywords="mixed methods",
keywords="nurse",
keywords="information system",
keywords="acute hospital",
keywords="support",
keywords="online questionnaire",
keywords="cognitively impaired",
keywords="workload",
abstract="Background: Technology that detects early when a patient at risk of falling leaves the bed can support nurses in acute care hospitals. Objective: To develop a better understanding of nurses' perspectives and experiences with a bed-exit information system (BES) in an acute care hospital setting. Methods: BES was implemented on 3 wards of a university medical center. Nurses completed 2 online surveys at each time point (P0 and P1) and participated in focus groups before (P0) and after (P1) implementation. Additional patient data were collected. Descriptive statistics summarized the survey results, while content analysis was applied to focus group data. Patient rates and adverse events in both phases were compared using negative binomial models. Reporting of this study adhered to the GRAMMS checklist. Results: A total of 30 questionnaires were completed at P0 (30/72, 42\%) and 24 at P1 (24/71, 33\%). Of the participants, 15 completed both questionnaires (complete cases). At P1, 64\% (9/14) of participants agreed that their perceived workload and strain in caring for patients with cognitive impairment was reduced by the use of the BES. The adverse event rate per patient per day was reduced by a factor of 0.61 (95\% CI 0.393-0.955; P=.03). In addition, 11 nurses participated in 4 focus groups before and after the intervention. Participants found it challenging to operationalize the use of the BES due to the heterogeneity of care settings, but certain behaviors of patients with cognitive impairment were recognized as indicating a need for intervention. Negative experiences included information overload and alarm fatigue, leading to occasional removal of the system. Conclusions: While BES provides some support in managing patients with cognitive impairment, its impact remains limited to specific scenarios and does not significantly reduce nurses' workload or strain. Our findings highlight the need to manage expectations of BES performance to ensure alignment between expected and actual benefits. To improve BES effectiveness and long-term implementation, future research should consider both objective measures of patient care and subjective factors such as nurse experience, structural conditions, and technical specifications. Improving information mechanisms within call systems could help reduce alarm fatigue and increase perceived usefulness. Overall, successful integration of BES in acute care settings will require close collaboration with nursing staff to drive meaningful healthcare innovation and ensure that the technology meets the needs of both patients and nurses. Trial Registration: German Register for Clinical Studies DRKS00021720; https://drks.de/search/de/trial/DRKS00021720 ",
doi="10.2196/64444",
url="https://formative.jmir.org/2025/1/e64444"
}


@Article{info:doi/10.2196/60506,
author="Wang, Yingxuan Dorothy
and Wong, Lai-Yi Eliza
and Cheung, Wai-Ling Annie
and Tang, Kam-Shing
and Yeoh, Eng-Kiong",
title="A Comparison of Patient and Provider Perspectives on an Electronic Health Record--Based Discharge Communication Tool: Survey Study",
journal="JMIR Aging",
year="2025",
month="Jan",
day="29",
volume="8",
pages="e60506",
keywords="older adult",
keywords="gerontology",
keywords="geriatric",
keywords="old",
keywords="older",
keywords="elderly",
keywords="aging",
keywords="aged",
keywords="post-acute care",
keywords="communication",
keywords="satisfaction",
keywords="medication information",
keywords="patient-provider comparison",
keywords="technology-based intervention",
keywords="technology acceptance model",
keywords="discharge",
keywords="EHR",
keywords="record",
keywords="portal",
keywords="cross-sectional",
keywords="survey",
keywords="questionnaire",
keywords="experience",
keywords="attitude",
keywords="opinion",
keywords="perception",
keywords="perspective",
keywords="acceptance",
keywords="adoption",
keywords="design",
keywords="user experience",
abstract="Background: Hospital discharge for older adult patients carries risks. Effective patient-provider communication is crucial for postacute care. Technology-based communication tools are promising in improving patient experience and outcomes. However, there is limited evidence comparing patient and provider user experiences on a large-scale basis, hindering the exploration of true patient-provider shared understanding. Objective: This study aimed to evaluate an electronic health record--based discharge communication tool by examining and comparing patient and provider perspectives. Methods: This study comprised a cross-sectional self-administered staff survey and a pre-post cross-sectional patient survey. Physicians, nurses, and older adult patients aged 65 years and older discharged from 4 public hospitals were included. Patient-provider comparison items focused on 3 aspects of the design quality of the tool (information clarity, adequacy, and usefulness) and overall satisfaction with the tool. In addition, patients' experience of discharge information and their medication-taking behaviors before and after the program implementation were compared based on a validated local patient experience survey instrument. Providers' perceived usefulness of this tool to their work and implementation intentions were measured based on the technology acceptance model to enhance understanding of their experiences by conducting structural equation modeling analysis. Results: A total of 1375 and 2353 valid responses were received from providers and patients, respectively. Patients' overall satisfaction with this communication tool is significantly higher than providers', and patients rated the information clarity and usefulness presented by this tool higher as well (P<.001). However, patients rated information adequacy significantly lower than providers (P<.001). Meanwhile, patients reported a significant improvement in their experience of discharge medication information, and fewer patients reported side effects encounters after the program implementation (126/1083, 11.6\% vs 111/1235, 9\%; P=.04). However, providers showed inconsistent implementation fidelity. Providers' perceived quality of the tool design ($\beta$ coefficient=0.24, 95\% CI 0.08-0.40) and perceived usefulness to their work ($\beta$ coefficient=0.57, 95\% CI 0.43-0.71) significantly impacted their satisfaction. Satisfaction can significantly impact implementation intentions ($\beta$ coefficient=0.40, 95\% CI 0.17-0.64), which further impacts implementation behaviors ($\beta$ coefficient=0.16, 95\% CI 0.10-0.23). Conclusions: A notable disparity exists between patients and health care providers. This may hinder the achievement of the tool's benefits. Future research should aim for a comprehensive overview of implementation barriers and corresponding strategies to enhance staff performance and facilitate patient-provider shared understanding. ",
doi="10.2196/60506",
url="https://aging.jmir.org/2025/1/e60506"
}


@Article{info:doi/10.2196/60176,
author="Benjamin, Ellen
and Giuliano, K. Karen",
title="Work Systems Analysis of Emergency Nurse Patient Flow Management Using the Systems Engineering Initiative for Patient Safety Model: Applying Findings From a Grounded Theory Study",
journal="JMIR Hum Factors",
year="2024",
month="Dec",
day="10",
volume="11",
pages="e60176",
keywords="patient flow",
keywords="throughput",
keywords="emergency department",
keywords="nursing",
keywords="emergency nursing",
keywords="organizing work",
keywords="cognitive work",
keywords="human factors",
keywords="ergonomics",
keywords="SEIPS model",
abstract="Background: Emergency nurses actively manage the flow of patients through emergency departments. Patient flow management is complex, cognitively demanding work that shapes the timeliness, efficiency, and safety of patient care. Research exploring nursing patient flow management is limited. A comprehensive analysis of emergency nursing work systems is needed to improve patient flow work processes. Objective: The aim of this paper is to describe the work system factors that impact emergency nurse patient flow management using the System Engineering Initiative for Patient Safety model. Methods: This study used grounded theory methodologies. Data were collected through multiple rounds of focus groups and interviews with 27 emergency nurse participants and 64 hours of participant observation across 4 emergency departments between August 2022 and February 2023. Data were analyzed using coding, constant comparative analysis, and memo-writing. Emergent themes were organized according to the first component of the System Engineering Initiative for Patient Safety model, the work system. Results: Patient flow management is impacted by diverse factors, including personal nursing characteristics; tools and technology; external factors; and the emergency department's physical and socio-organizational environment. Participants raised concerns about the available technology's functionality, usability, and accessibility; departmental capacity and layout; resource levels across the health care system; and interdepartmental teamwork. Other noteworthy findings include obscurity and variability across departments' staff roles titles, functions, and norms; the degree of provider involvement in patient flow management decisions; and management's enforcement of timing metrics. Conclusions: There are significant barriers to the work of emergency patient flow management. More research is needed to measure the impact of these human factors on patient flow outcomes. Collaboration between health care administrators, human factors engineers, and nurses is needed to improve emergency nurse work systems. ",
doi="10.2196/60176",
url="https://humanfactors.jmir.org/2024/1/e60176"
}


@Article{info:doi/10.2196/59442,
author="Kang, Aimei
and Wu, XiuLi",
title="Assessing Visitor Expectations of AI Nursing Robots in Hospital Settings: Cross-Sectional Study Using the Kano Model",
journal="JMIR Nursing",
year="2024",
month="Nov",
day="27",
volume="7",
pages="e59442",
keywords="nursing robot",
keywords="artificial intelligence",
keywords="Kano model",
keywords="demand survey",
keywords="nursing",
keywords="care robots",
keywords="nursing management",
abstract="Background: Globally, the rates at which the aging population and the prevalence of chronic diseases are increasing are substantial. With declining birth rates and a growing percentage of older individuals, the demand for nursing staff is steadily rising. However, the shortage of nursing personnel has been a long-standing issue. In recent years, numerous researchers have advocated for the implementation of nursing robots as a substitute for traditional human labor. Objective: This study analyzes hospital visitors' attitudes and priorities regarding the functional areas of artificial intelligence (AI) nursing robots based on the Kano model. Building on this analysis, recommendations are provided for the functional optimization of AI nursing robots, aiming to facilitate their adoption in the nursing field. Methods: Using a random sampling method, 457 hospital visitors were surveyed between December 2023 and March 2024 to compare the differences in demand for AI nursing robot functionalities among the visitors. Results: A comparative analysis of the Kano attribute quadrant diagrams showed that visitors seeking hospitalization prioritized functional aspects that enhance medical activities. In contrast, visitors attending outpatient examinations focused more on functional points that assist in medical treatment. Additionally, visitors whose purpose was companionship and care emphasized functional aspects that offer psychological and life support to patients. Conclusions: AI nursing robots serve various functional areas and cater to diverse audience groups. In the future, it is essential to thoroughly consider users' functional needs and implement targeted functional developments to maximize the effectiveness of AI nursing robots. ",
doi="10.2196/59442",
url="https://nursing.jmir.org/2024/1/e59442"
}


@Article{info:doi/10.2196/59619,
author="Ware, Anna
and Blumke, Terri
and Hoover, Peter
and Arreola, David",
title="Calculating Optimal Patient to Nursing Capacity: Comparative Analysis of Traditional and New Methods",
journal="JMIR Nursing",
year="2024",
month="Nov",
day="22",
volume="7",
pages="e59619",
keywords="nurse scheduling",
keywords="nurse",
keywords="patient ratio",
keywords="nursing hours per patient day",
keywords="NHPPD",
keywords="nursing administration",
keywords="workload",
keywords="comparative analysis",
keywords="nursing",
keywords="staffing",
keywords="nurse staffing",
keywords="registered nurses",
keywords="nurse assistants",
keywords="staff allocation",
keywords="patient capacity",
abstract="Background: Optimal nurse staffing levels have been shown to impact patients' prognoses and safety, as well as staff burnout. The predominant method for calculating staffing levels has been patient-to-nurse (P/N) ratios and nursing hours per patient day. However, both methods fall short of addressing the dynamic nature of staffing needs that often fluctuate throughout the day as patients' clinical status changes and new patients are admitted or discharged from the unit. Objective: In this evaluation, the Veterans Affairs Palo Alto Health Care System (VAPAHCS) piloted a new dynamic bed count calculation in an effort to target optimal staffing levels every hour to provide greater temporal resolution on nurse staffing levels within the Veterans Health Administration. Methods: The dynamic bed count uses elements from both the nursing hours per patient day and P/N ratio to calculate current and target staffing levels, every hour, while balancing across nurse types (registered nurses to nurse assistants) to provide improved temporal insight into staff allocation. The dynamic bed count was compared with traditional P/N ratio methods of calculating patient capacity at the VAPAHCS, to assess optimal patient capacity within their acute care ward from January 1, 2023, through May 25, 2023. Descriptive statistics summarized patient capacity variables across the intensive care unit (ICU), medical-surgical ICU, and 3 acute care units. Student t tests (2-tailed) were used to analyze differences between patient capacity measures. Results: Hourly analysis of patient capacity information displayed how the dynamic bed count provided improved temporal resolution on patient capacity. Comparing the dynamic bed count to the P/N ratio, we found the patient capacity, as determined by the P/N ratio, was, on average, higher than that of the dynamic bed count across VAPAHCS acute care units and the medical-surgical ICU (P<.001). For example, in acute care unit 3C, the average dynamic bed count was 21.6 (SD 4.2) compared with a P/N ratio of 28.6 (SD 3.2). This suggests that calculating patient capacity using P/N ratios alone could lead to units taking on more patients than what the dynamic bed count suggests the unit can optimally handle. Conclusions: As a new patient capacity calculation, the dynamic bed count provided additional details and timely information about clinical staffing levels, patient acuity, and patient turnover. Implementing this calculation into the management process has the potential to empower departments to further optimize staffing and patient care. ",
doi="10.2196/59619",
url="https://nursing.jmir.org/2024/1/e59619"
}


@Article{info:doi/10.2196/58583,
author="Kim, Heon Jae
and Lee, Cheol Ui
and Jeong, Hun Byeong
and Kang, Uk Byeong
and Shim, Ryul Sung
and Jeong, Gab In",
title="Accuracy of a Smart Diaper System for Nursing Home Residents for Automatically Detecting Voided Volume: Instrument Validation Study",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="24",
volume="8",
pages="e58583",
keywords="smart diaper",
keywords="urinary incontinence",
keywords="medical device",
keywords="voided volume",
keywords="urine output",
keywords="nursing home",
keywords="older adults",
abstract="Background: Diapers are commonly used by older patients with urination disorders. A smart diaper system (SDS) may be able to estimate the weight of urine comparably to conventional measurements made by weighing diapers. Objective: The aim of the current research is to determine the degree of accuracy of an SDS technology specifically designed for the management of urination routines and the use of incontinence pads in older adults. Methods: From January to December 2022, 97 older patients with at least 1 chronic disease from 3 nursing homes were included. In this study, the SDS was used for 1 month per patient after obtaining their consent; all patients originally used traditional diapers in the nursing home. The index test measured the change in electrical resistance of the SDS and the reference test measured the change in actual urine weight. When measuring the actual urine weight, the degree of absorption was directly confirmed with the naked eye because the expression value varied according to pressure changes caused by the user's movement or position. The Pearson correlation was used to determine the correlation between the 2 test methods, the intraclass correlation coefficient (ICC) was used to check the degree of agreement between the evaluators, and the Bland-Altman test was used to confirm whether there was a significant difference between the 2 test methods. Results: The average age of the 97 participants was 86.48 (SD 6.26) years, with 10 men and 87 women. There were 73 patients (75\%) with hypertension, 86 patients (88\%) with dementia, and 86 patients (88\%) with 2 or more comorbidities, accounting for the majority. The Pearson correlation coefficient and ICC were 0.971 and 0.985 (P<.001). In the Bland-Altman figure, the difference in the mean between the 2 tests was evenly scattered without showing a specific pattern, indicating that the SDS and actual urine weight were very consistent. The difference between the mean of the 2 tests was --0.045 of the standardized mean difference, and all measurements were located within the 95\% CI, so this confirms that the 2 test methods are equivalent. Conclusions: Our study showed a fairly high correlation coefficient and ICC for all patient groups, which reveals that the 2 tests were very consistent and that the SDS can replace traditional diapers, even in a real clinical setting. This study shows the possibility that heath care professionals could be alerted by the SDS to the need for pad replacement due to incontinence, thus avoiding the development of dermatological complications. ",
doi="10.2196/58583",
url="https://formative.jmir.org/2024/1/e58583"
}


@Article{info:doi/10.2196/56949,
author="Lazzarino, Runa
and Borek, J. Aleksandra
and Honeyford, Kate
and Welch, John
and Brent, J. Andrew
and Kinderlerer, Anne
and Cooke, Graham
and Patil, Shashank
and Gordon, Anthony
and Glampson, Ben
and Goodman, Philippa
and Ghazal, Peter
and Daniels, Ron
and Costelloe, E. C{\'e}ire
and Tonkin-Crine, Sarah",
title="Views and Uses of Sepsis Digital Alerts in National Health Service Trusts in England: Qualitative Study With Health Care Professionals",
journal="JMIR Hum Factors",
year="2024",
month="Oct",
day="15",
volume="11",
pages="e56949",
keywords="digital alerts",
keywords="electronic health records",
keywords="computerized clinical decision support systems",
keywords="sepsis",
keywords="patient deterioration",
keywords="decision-making",
keywords="secondary care",
keywords="emergency care",
keywords="intensive care",
keywords="England",
keywords="qualitative study",
abstract="Background: Sepsis is a common cause of serious illness and death. Sepsis management remains challenging and suboptimal. To support rapid sepsis diagnosis and treatment, screening tools have been embedded into hospital digital systems to appear as digital alerts. The implementation of digital alerts to improve the management of sepsis and deterioration is a complex intervention that has to fit with team workflow and the views and practices of hospital staff. Despite the importance of human decision-making and behavior in optimal implementation, there are limited qualitative studies that explore the views and experiences of health care professionals regarding digital alerts as sepsis or deterioration computerized clinician decision support systems (CCDSSs). Objective: This study aims to explore the views and experiences of health care professionals on the use of sepsis or deterioration CCDSSs and to identify barriers and facilitators to their implementation and use in National Health Service (NHS) hospitals. Methods: We conducted a qualitative, multisite study with unstructured observations and semistructured interviews with health care professionals from emergency departments, outreach teams, and intensive or acute units in 3 NHS hospital trusts in England. Data from both interviews and observations were analyzed together inductively using thematic analysis. Results: A total of 22 health care professionals were interviewed, and 12 observation sessions were undertaken. A total of four themes regarding digital alerts were identified: (1) support decision-making as nested in electronic health records, but never substitute professionals' knowledge and experience; (2) remind to take action according to the context, such as the hospital unit and the job role; (3) improve the alerts and their introduction, by making them more accessible, easy to use, not intrusive, more accurate, as well as integrated across the whole health care system; and (4) contextual factors affecting views and use of alerts in the NHS trusts. Digital alerts are more optimally used in general hospital units with a lower senior decision maker:patient ratio and by health care professionals with experience of a similar technology. Better use of the alerts was associated with quality improvement initiatives and continuous sepsis training. The trusts' features, such as the presence of a 24/7 emergency outreach team, good technological resources, and staffing and teamwork, favored a more optimal use. Conclusions: Trust implementation of sepsis or deterioration CCDSSs requires support on multiple levels and at all phases of the intervention, starting from a prego-live analysis addressing organizational needs and readiness. Advancements toward minimally disruptive and smart digital alerts as sepsis or deterioration CCDSSs, which are more accurate and specific but at the same time scalable and accessible, require policy changes and investments in multidisciplinary research. ",
doi="10.2196/56949",
url="https://humanfactors.jmir.org/2024/1/e56949"
}


@Article{info:doi/10.2196/58347,
author="Wunderlich, Markus Maximilian
and Frey, Nicolas
and Amende-Wolf, Sandro
and Hinrichs, Carl
and Balzer, Felix
and Poncette, Akira-Sebastian",
title="Alarm Management in Provisional COVID-19 Intensive Care Units: Retrospective Analysis and Recommendations for Future Pandemics",
journal="JMIR Med Inform",
year="2024",
month="Sep",
day="9",
volume="12",
pages="e58347",
keywords="patient monitoring",
keywords="intensive care unit",
keywords="ICU",
keywords="alarm fatigue",
keywords="alarm management",
keywords="patient safety",
keywords="alarm system",
keywords="alarm system quality",
keywords="medical devices",
keywords="clinical alarms",
keywords="COVID-19",
abstract="Background: In response to the high patient admission rates during the COVID-19 pandemic, provisional intensive care units (ICUs) were set up, equipped with temporary monitoring and alarm systems. We sought to find out whether the provisional ICU setting led to a higher alarm burden and more staff with alarm fatigue. Objective: We aimed to compare alarm situations between provisional COVID-19 ICUs and non--COVID-19 ICUs during the second COVID-19 wave in Berlin, Germany. The study focused on measuring alarms per bed per day, identifying medical devices with higher alarm frequencies in COVID-19 settings, evaluating the median duration of alarms in both types of ICUs, and assessing the level of alarm fatigue experienced by health care staff. Methods: Our approach involved a comparative analysis of alarm data from 2 provisional COVID-19 ICUs and 2 standard non--COVID-19 ICUs. Through interviews with medical experts, we formulated hypotheses about potential differences in alarm load, alarm duration, alarm types, and staff alarm fatigue between the 2 ICU types. We analyzed alarm log data from the patient monitoring systems of all 4 ICUs to inferentially assess the differences. In addition, we assessed staff alarm fatigue with a questionnaire, aiming to comprehensively understand the impact of the alarm situation on health care personnel. Results: COVID-19 ICUs had significantly more alarms per bed per day than non--COVID-19 ICUs (P<.001), and the majority of the staff lacked experience with the alarm system. The overall median alarm duration was similar in both ICU types. We found no COVID-19--specific alarm patterns. The alarm fatigue questionnaire results suggest that staff in both types of ICUs experienced alarm fatigue. However, physicians and nurses who were working in COVID-19 ICUs reported a significantly higher level of alarm fatigue (P=.04). Conclusions: Staff in COVID-19 ICUs were exposed to a higher alarm load, and the majority lacked experience with alarm management and the alarm system. We recommend training and educating ICU staff in alarm management, emphasizing the importance of alarm management training as part of the preparations for future pandemics. However, the limitations of our study design and the specific pandemic conditions warrant further studies to confirm these findings and to explore effective alarm management strategies in different ICU settings. ",
doi="10.2196/58347",
url="https://medinform.jmir.org/2024/1/e58347"
}


@Article{info:doi/10.2196/56402,
author="Darnell, Doyanne
and Pierson, Andria
and Tanana, J. Michael
and Dorsey, Shannon
and Boudreaux, D. Edwin
and Are{\'a}n, A. Patricia
and Comtois, Anne Katherine",
title="Harnessing Innovative Technologies to Train Nurses in Suicide Safety Planning With Hospital Patients: Formative Acceptability Evaluation of an eLearning Continuing Education Training",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="6",
volume="8",
pages="e56402",
keywords="suicide prevention",
keywords="hospital",
keywords="training",
keywords="e-learning",
keywords="artificial intelligence",
keywords="AI",
keywords="task-shifting",
keywords="quality assessment",
keywords="fidelity",
keywords="acceptability",
keywords="feasibility",
keywords="eLearning",
keywords="suicide",
keywords="quality",
keywords="innovative",
keywords="nurse",
keywords="education training",
keywords="safety planning",
keywords="pilot study",
keywords="virtual patient",
keywords="web-based",
keywords="role-play",
keywords="microcounseling skills",
keywords="United States",
abstract="Background: Suicide is the 12th leading cause of death in the United States. Health care provider training is a top research priority identified by the National Action Alliance for Suicide Prevention; however, evidence-based approaches that target skill building are resource intensive and difficult to implement. Novel computer technologies harnessing artificial intelligence are now available, which hold promise for increasing the feasibility of providing trainees opportunities across a range of continuing education contexts to engage in skills practice with constructive feedback on performance. Objective: This pilot study aims to evaluate the feasibility and acceptability of an eLearning training in suicide safety planning among nurses serving patients admitted to a US level 1 trauma center for acute or intensive care. The training included a didactic portion with demonstration, practice of microcounseling skills with a web-based virtual patient (Client Bot Emily), role-play with a patient actor, and automated coding and feedback on general counseling skills based on the role-play via a web-based platform (Lyssn Advisor). Secondarily, we examined learning outcomes of knowledge, confidence, and skills in suicide safety planning descriptively. Methods: Acute and intensive care nurses were recruited between November 1, 2021, and May 31, 2022, to participate in a formative evaluation using pretraining, posttraining, and 6-month follow-up surveys, as well as observation of the nurses' performance in delivering suicide safety planning via standardized patient role-plays over 6 months and rated using the Safety Plan Intervention Rating Scale. Nurses completed the System Usability Scale after interacting with Client Bot Emily and reviewing general counseling scores based on their role-play via Lyssn Advisor. Results: A total of 18 nurses participated in the study; the majority identified as female (n=17, 94\%) and White (n=13, 72\%). Of the 17 nurses who started the training, 82\% (n=14) completed it. On average, the System Usability Scale score for Client Bot Emily was 70.3 (SD 19.7) and for Lyssn Advisor was 65.4 (SD 16.3). On average, nurses endorsed a good bit of knowledge (mean 3.1, SD 0.5) and confidence (mean 2.9, SD 0.5) after the training. After completing the training, none of the nurses scored above the expert-derived cutoff for proficiency on the Safety Plan Intervention Rating Scale (?14); however, on average, nurses were above the cutoffs for general counseling skills per Lyssn Advisor (empathy: mean 4.1, SD 0.6; collaboration: mean 3.6, SD 0.7). Conclusions: Findings suggest the completion of the training activities and use of novel technologies within this context are feasible. Technologic modifications may enhance the training acceptability and utility, such as increasing the virtual patient conversational abilities and adding automated coding capability for specific suicide safety planning skills. International Registered Report Identifier (IRRID): RR2-10.2196/33695 ",
doi="10.2196/56402",
url="https://formative.jmir.org/2024/1/e56402"
}


@Article{info:doi/10.2196/55466,
author="Herrera, Nierva Claire
and Gimenes, Escobar Fernanda Raphael
and Herrera, Paulo Jo{\~a}o
and Cavalli, Ricardo",
title="Development of Automated Triggers in Ambulatory Settings in Brazil: Protocol for a Machine Learning--Based Design Thinking Study",
journal="JMIR Res Protoc",
year="2024",
month="Aug",
day="12",
volume="13",
pages="e55466",
keywords="machine learning",
keywords="ambulatory care",
keywords="patient safety",
keywords="medical records systems",
keywords="computerized",
keywords="technology",
keywords="quality of care",
keywords="automated triggers",
keywords="limitation",
keywords="predict",
keywords="potential risk",
keywords="outpatient",
keywords="ambulatory patient",
keywords="walk-in",
keywords="adverse events",
keywords="evidence-based",
keywords="preventive",
keywords="low-income countries",
keywords="middle-income countries",
keywords="data",
keywords="scarcity",
keywords="standardization",
keywords="quality intervention",
abstract="Background: The use of technologies has had a significant impact on patient safety and the quality of care and has increased globally. In the literature, it has been reported that people die annually due to adverse events (AEs), and various methods exist for investigating and measuring AEs. However, some methods have a limited scope, data extraction, and the need for data standardization. In Brazil, there are few studies on the application of trigger tools, and this study is the first to create automated triggers in ambulatory care. Objective: This study aims to develop a machine learning (ML)--based automated trigger for outpatient health care settings in Brazil. Methods: A mixed methods research will be conducted within a design thinking framework and the principles will be applied in creating the automated triggers, following the stages of (1) empathize and define the problem, involving observations and inquiries to comprehend both the user and the challenge at hand; (2) ideation, where various solutions to the problem are generated; (3) prototyping, involving the construction of a minimal representation of the best solutions; (4) testing, where user feedback is obtained to refine the solution; and (5) implementation, where the refined solution is tested, changes are assessed, and scaling is considered. Furthermore, ML methods will be adopted to develop automated triggers, tailored to the local context in collaboration with an expert in the field. Results: This protocol describes a research study in its preliminary stages, prior to any data gathering and analysis. The study was approved by the members of the organizations within the institution in January 2024 and by the ethics board of the University of S{\~a}o Paulo and the institution where the study will take place. in May 2024. As of June 2024, stage 1 commenced with data gathering for qualitative research. A separate paper focused on explaining the method of ML will be considered after the outcomes of stages 1 and 2 in this study. Conclusions: After the development of automated triggers in the outpatient setting, it will be possible to prevent and identify potential risks of AEs more promptly, providing valuable information. This technological innovation not only promotes advances in clinical practice but also contributes to the dissemination of techniques and knowledge related to patient safety. Additionally, health care professionals can adopt evidence-based preventive measures, reducing costs associated with AEs and hospital readmissions, enhancing productivity in outpatient care, and contributing to the safety, quality, and effectiveness of care provided. Additionally, in the future, if the outcome is successful, there is the potential to apply it in all units, as planned by the institutional organization. International Registered Report Identifier (IRRID): PRR1-10.2196/55466 ",
doi="10.2196/55466",
url="https://www.researchprotocols.org/2024/1/e55466"
}


@Article{info:doi/10.2196/60116,
author="Chindamorragot, Naruemol
and Suitthimeathegorn, Orawan
and Garg, Amit",
title="Centralized Pump Monitoring System: Perception on Utility and Workflows by Nurses in a Tertiary Hospital",
journal="Asian Pac Isl Nurs J",
year="2024",
month="Jul",
day="24",
volume="8",
pages="e60116",
keywords="infusion management",
keywords="nurse efficiency",
keywords="pump monitoring system",
keywords="nurse attrition",
doi="10.2196/60116",
url="https://apinj.jmir.org/2024/1/e60116"
}


@Article{info:doi/10.2196/55793,
author="Tiase, L. Victoria
and Sward, A. Katherine
and Facelli, C. Julio",
title="A Scalable and Extensible Logical Data Model of Electronic Health Record Audit Logs for Temporal Data Mining (RNteract): Model Conceptualization and Formulation",
journal="JMIR Nursing",
year="2024",
month="Jun",
day="24",
volume="7",
pages="e55793",
keywords="burnout",
keywords="professional",
keywords="nursing",
keywords="nurse",
keywords="electronic health record",
keywords="EHR",
keywords="data modeling",
keywords="data set",
keywords="temporal machine learning",
keywords="machine learning",
keywords="ML",
keywords="artificial intelligence",
keywords="AI",
keywords="algorithm",
keywords="predictive model",
keywords="predictive analytics",
keywords="practical model",
abstract="Background: Increased workload, including workload related to electronic health record (EHR) documentation, is reported as a main contributor to nurse burnout and adversely affects patient safety and nurse satisfaction. Traditional methods for workload analysis are either administrative measures (such as the nurse-patient ratio) that do not represent actual nursing care or are subjective and limited to snapshots of care (eg, time-motion studies). Observing care and testing workflow changes in real time can be obstructive to clinical care. An examination of EHR interactions using EHR audit logs could provide a scalable, unobtrusive way to quantify the nursing workload, at least to the extent that nursing work is represented in EHR documentation. EHR audit logs are extremely complex; however, simple analytical methods cannot discover complex temporal patterns, requiring use of state-of-the-art temporal data-mining approaches. To effectively use these approaches, it is necessary to structure the raw audit logs into a consistent and scalable logical data model that can be consumed by machine learning (ML) algorithms. Objective: We aimed to conceptualize a logical data model for nurse-EHR interactions that would support the future development of temporal ML models based on EHR audit log data. Methods: We conducted a preliminary review of EHR audit logs to understand the types of nursing-specific data captured. Using concepts derived from the literature and our previous experience studying temporal patterns in biomedical data, we formulated a logical data model that can describe nurse-EHR interactions, the nurse-intrinsic and situational characteristics that may influence those interactions, and outcomes of relevance to the nursing workload in a scalable and extensible manner. Results: We describe the data structure and concepts from EHR audit log data associated with nursing workload as a logical data model named RNteract. We conceptually demonstrate how using this logical data model could support temporal unsupervised ML and state-of-the-art artificial intelligence (AI) methods for predictive modeling. Conclusions: The RNteract logical data model appears capable of supporting a variety of AI-based systems and should be generalizable to any type of EHR system or health care setting. Quantitatively identifying and analyzing temporal patterns of nurse-EHR interactions is foundational for developing interventions that support the nursing documentation workload and address nurse burnout. ",
doi="10.2196/55793",
url="https://nursing.jmir.org/2024/1/e55793",
url="http://www.ncbi.nlm.nih.gov/pubmed/38913994"
}


@Article{info:doi/10.2196/53165,
author="Jung, Youn Soo
and Moon, Ja Kyoung",
title="Pressure Ulcer Management Virtual Reality Simulation (PU-VRSim) for Novice Nurses: Mixed Methods Study",
journal="JMIR Serious Games",
year="2024",
month="Jun",
day="24",
volume="12",
pages="e53165",
keywords="virtual reality",
keywords="nursing",
keywords="simulation",
keywords="virtual training",
keywords="pressure ulcer",
keywords="simulation training",
keywords="nurse",
keywords="clinician",
keywords="health care worker",
keywords="ulcer",
keywords="hospital",
keywords="health care center",
keywords="PU-VRSim",
keywords="mixed methods study",
keywords="health professional",
keywords="medical education",
keywords="training",
keywords="games",
keywords="gamification",
keywords="learning",
keywords="decubitus ulcer",
abstract="Background: Pressure ulcers (PUs) are a common and serious complication in patients who are immobile in health care settings. Nurses play a fundamental role in the prevention of PUs; however, novice nurses lack experience in clinical situations. Virtual reality (VR) is highly conducive to clinical- and procedure-focused training because it facilitates simulations. Objective: We aimed to explore the feasibility of a novel PU management VR simulation (PU-VRSim) program using a head-mounted display for novice nurses and to investigate how different types of learning materials (ie, VR or a video-based lecture) impact learning outcomes and experiences. Methods: PU-VRSim was created in the Unity 3D platform. This mixed methods pilot quasi-experimental study included 35 novice nurses categorized into the experimental (n=18) and control (n=17) groups. The PU-VRSim program was applied using VR in the experimental group, whereas the control group received a video-based lecture. The PU knowledge test, critical thinking disposition measurement tool, and Korean version of the General Self-Efficacy Scale were assessed before and after the intervention in both groups. After the intervention, the experimental group was further assessed using the Clinical Judgment Rubric and interviewed to evaluate their experience with PU-VRSim. Results: The results compared before and after the intervention showed significant improvements in PU knowledge in both the experimental group (P=.001) and control group (P=.005). There were no significant differences in self-efficacy and critical thinking in either group. The experimental group scored a mean of 3.23 (SD 0.44) points (accomplished) on clinical judgment, assessed using a 4-point scale. The experimental group interviews revealed that the VR simulation was realistic and helpful for learning about PU management. Conclusions: The results revealed that PU-VRSim could improve novice nurses' learning of PU management in realistic environments. Further studies using VR for clinical training are recommended for novice nurses. ",
doi="10.2196/53165",
url="https://games.jmir.org/2024/1/e53165",
url="http://www.ncbi.nlm.nih.gov/pubmed/38913417"
}


@Article{info:doi/10.2196/54029,
author="Cho, Aram
and Cha, Chiyoung
and Baek, Gumhee",
title="Development of an Artificial Intelligence--Based Tailored Mobile Intervention for Nurse Burnout: Single-Arm Trial",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="21",
volume="26",
pages="e54029",
keywords="artificial intelligence",
keywords="burnout",
keywords="mobile app",
keywords="nurses",
keywords="nurse",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="applications",
keywords="usability",
keywords="satisfaction",
keywords="effectiveness",
keywords="tailored",
keywords="mind-body",
keywords="meditation",
keywords="mindfulness",
keywords="ACT",
keywords="algorithm",
keywords="algorithms",
keywords="occupational health",
keywords="digital health",
keywords="recommender",
keywords="optimization",
keywords="acceptance and commitment therapy",
keywords="job",
keywords="worker",
keywords="workers",
keywords="stress",
keywords="employee",
keywords="employees",
abstract="Background: Nurse burnout leads to an increase in turnover, which is a serious problem in the health care system. Although there is ample evidence of nurse burnout, interventions developed in previous studies were general and did not consider specific burnout dimensions and individual characteristics. Objective: The objectives of this study were to develop and optimize the first tailored mobile intervention for nurse burnout, which recommends programs based on artificial intelligence (AI) algorithms, and to test its usability, effectiveness, and satisfaction. Methods: In this study, an AI-based mobile intervention, Nurse Healing Space, was developed to provide tailored programs for nurse burnout. The 4-week program included mindfulness meditation, laughter therapy, storytelling, reflective writing, and acceptance and commitment therapy. The AI algorithm recommended one of these programs to participants by calculating similarity through a pretest consisting of participants' demographics, research variables, and burnout dimension scores measured with the Copenhagen Burnout Inventory. After completing a 4-week program, burnout, job stress, stress response using the Stress Response Inventory Modified Form, the usability of the app, coping strategy by the coping strategy indicator, and program satisfaction (1: very dissatisfied; 5: very satisfied) were measured. The AI recognized the recommended program as effective if the user's burnout score reduced after the 2-week program and updated the algorithm accordingly. After a pilot test (n=10), AI optimization was performed (n=300). A paired 2-tailed t test, ANOVA, and the Spearman correlation were used to test the effect of the intervention and algorithm optimization. Results: Nurse Healing Space was implemented as a mobile app equipped with a system that recommended 1 program out of 4 based on similarity between users through AI. The AI algorithm worked well in matching the program recommended to participants who were most similar using valid data. Users were satisfied with the convenience and visual quality but were dissatisfied with the absence of notifications and inability to customize the program. The overall usability score of the app was 3.4 out of 5 points. Nurses' burnout scores decreased significantly after the completion of the first 2-week program (t=7.012; P<.001) and reduced further after the second 2-week program (t=2.811; P=.01). After completing the Nurse Healing Space program, job stress (t=6.765; P<.001) and stress responses (t=5.864; P<.001) decreased significantly. During the second 2-week program, the burnout level reduced in the order of participation (r=--0.138; P=.04). User satisfaction increased for both the first (F=3.493; P=.03) and second programs (F=3.911; P=.02). Conclusions: This program effectively reduced burnout, job stress, and stress responses. Nurse managers were able to prevent nurses from resigning and maintain the quality of medical services using this AI-based program to provide tailored interventions for nurse burnout. Thus, this app could improve qualitative health care, increase employee satisfaction, reduce costs, and ultimately improve the efficiency of the health care system. ",
doi="10.2196/54029",
url="https://www.jmir.org/2024/1/e54029"
}


@Article{info:doi/10.2196/55571,
author="Mosch, Lina
and S{\"u}mer, Meltem
and Flint, Rike Anne
and Feufel, Markus
and Balzer, Felix
and M{\"o}rike, Frauke
and Poncette, Akira-Sebastian",
title="Alarm Management in Intensive Care: Qualitative Triangulation Study",
journal="JMIR Hum Factors",
year="2024",
month="Jun",
day="18",
volume="11",
pages="e55571",
keywords="digital health",
keywords="transdisciplinary research",
keywords="technological innovation",
keywords="patient-centered care",
keywords="qualitative",
keywords="ethnographic",
keywords="ethnography",
keywords="intensive care unit",
keywords="ICU",
keywords="intensive care",
keywords="German",
keywords="Germany",
keywords="Europe",
keywords="European",
keywords="interview",
keywords="interviews",
keywords="alarm",
keywords="alarms",
keywords="intelligent",
keywords="artificial intelligence",
keywords="grounded theory",
keywords="experience",
keywords="experiences",
keywords="attitude",
keywords="attitudes",
keywords="opinion",
keywords="opinions",
keywords="perception",
keywords="perceptions",
keywords="perspective",
keywords="perspectives",
abstract="Background: The high number of unnecessary alarms in intensive care settings leads to alarm fatigue among staff and threatens patient safety. To develop and implement effective and sustainable solutions for alarm management in intensive care units (ICUs), an understanding of staff interactions with the patient monitoring system and alarm management practices is essential. Objective: This study investigated the interaction of nurses and physicians with the patient monitoring system, their perceptions of alarm management, and smart alarm management solutions. Methods: This explorative qualitative study with an ethnographic, multimethods approach was conducted in an ICU of a German university hospital. Using triangulation in data collection, 102 hours of field observations, 12 semistructured interviews with ICU staff members, and the results of a participatory task were analyzed. The data analysis followed an inductive, grounded theory approach. Results: Nurses and physicians reported interacting with the continuous vital sign monitoring system for most of their work time and tasks. There were no established standards for alarm management; instead, nurses and physicians stated that alarms were addressed through ad hoc reactions, a practice they viewed as problematic. Staff members' perceptions of intelligent alarm management varied, but they highlighted the importance of understandable and traceable suggestions to increase trust and cognitive ease. Conclusions: Staff members' interactions with the omnipresent patient monitoring system and its alarms are essential parts of ICU workflows and clinical decision-making. Alarm management standards and workflows have been shown to be deficient. Our observations, as well as staff feedback, suggest that changes are warranted. Solutions for alarm management should be designed and implemented with users, workflows, and real-world data at the core. ",
doi="10.2196/55571",
url="https://humanfactors.jmir.org/2024/1/e55571",
url="http://www.ncbi.nlm.nih.gov/pubmed/38888941"
}


@Article{info:doi/10.2196/54996,
author="Stevens, R. Elizabeth
and Xu, Lynn
and Kwon, JaeEun
and Tasneem, Sumaiya
and Henning, Natalie
and Feldthouse, Dawn
and Kim, Ji Eun
and Hess, Rachel
and Dauber-Decker, L. Katherine
and Smith, D. Paul
and Halm, Wendy
and Gautam-Goyal, Pranisha
and Feldstein, A. David
and Mann, M. Devin",
title="Barriers to Implementing Registered Nurse--Driven Clinical Decision Support for Antibiotic Stewardship: Retrospective Case Study",
journal="JMIR Form Res",
year="2024",
month="May",
day="23",
volume="8",
pages="e54996",
keywords="integrated clinical prediction rules",
keywords="EHR",
keywords="electronic health record",
keywords="implementation",
keywords="barriers",
keywords="acute respiratory infections",
keywords="antibiotics",
keywords="CDS",
keywords="clinical decision support",
keywords="decision support",
keywords="antibiotic",
keywords="prescribe",
keywords="prescription",
keywords="acute respiratory infection",
keywords="barrier",
keywords="effectiveness",
keywords="registered nurse",
keywords="RN",
keywords="RN-driven intervention",
keywords="personnel availability",
keywords="workflow variability",
keywords="infrastructure",
keywords="infrastructures",
keywords="law",
keywords="laws",
keywords="policy",
keywords="policies",
keywords="clinical-care setting",
keywords="clinical setting",
keywords="electronic health records",
keywords="RN-driven",
keywords="antibiotic stewardship",
keywords="retrospective analysis",
keywords="Consolidated Framework for Implementation Research",
keywords="CFIR",
keywords="CDS-based intervention",
keywords="urgent care",
keywords="New York",
keywords="chart review",
keywords="interview",
keywords="interviews",
keywords="staff change",
keywords="staff changes",
keywords="RN shortage",
keywords="RN shortages",
keywords="turnover",
keywords="health system",
keywords="nurse",
keywords="nurses",
keywords="researcher",
keywords="researchers",
abstract="Background: Up to 50\% of antibiotic prescriptions for upper respiratory infections (URIs) are inappropriate. Clinical decision support (CDS) systems to mitigate unnecessary antibiotic prescriptions have been implemented into electronic health records, but their use by providers has been limited. Objective: As a delegation protocol, we adapted a validated electronic health record--integrated clinical prediction rule (iCPR) CDS-based intervention for registered nurses (RNs), consisting of triage to identify patients with low-acuity URI followed by CDS-guided RN visits. It was implemented in February 2022 as a randomized controlled stepped-wedge trial in 43 primary and urgent care practices within 4 academic health systems in New York, Wisconsin, and Utah. While issues were pragmatically addressed as they arose, a systematic assessment of the barriers to implementation is needed to better understand and address these barriers. Methods: We performed a retrospective case study, collecting quantitative and qualitative data regarding clinical workflows and triage-template use from expert interviews, study surveys, routine check-ins with practice personnel, and chart reviews over the first year of implementation of the iCPR intervention. Guided by the updated CFIR (Consolidated Framework for Implementation Research), we characterized the initial barriers to implementing a URI iCPR intervention for RNs in ambulatory care. CFIR constructs were coded as missing, neutral, weak, or strong implementation factors. Results: Barriers were identified within all implementation domains. The strongest barriers were found in the outer setting, with those factors trickling down to impact the inner setting. Local conditions driven by COVID-19 served as one of the strongest barriers, impacting attitudes among practice staff and ultimately contributing to a work infrastructure characterized by staff changes, RN shortages and turnover, and competing responsibilities. Policies and laws regarding scope of practice of RNs varied by state and institutional application of those laws, with some allowing more clinical autonomy for RNs. This necessitated different study procedures at each study site to meet practice requirements, increasing innovation complexity. Similarly, institutional policies led to varying levels of compatibility with existing triage, rooming, and documentation workflows. These workflow conflicts were compounded by limited available resources, as well as an implementation climate of optional participation, few participation incentives, and thus low relative priority compared to other clinical duties. Conclusions: Both between and within health care systems, significant variability existed in workflows for patient intake and triage. Even in a relatively straightforward clinical workflow, workflow and cultural differences appreciably impacted intervention adoption. Takeaways from this study can be applied to other RN delegation protocol implementations of new and innovative CDS tools within existing workflows to support integration and improve uptake. When implementing a system-wide clinical care intervention, considerations must be made for variability in culture and workflows at the state, health system, practice, and individual levels. Trial Registration: ClinicalTrials.gov NCT04255303; https://clinicaltrials.gov/ct2/show/NCT04255303 ",
doi="10.2196/54996",
url="https://formative.jmir.org/2024/1/e54996",
url="http://www.ncbi.nlm.nih.gov/pubmed/38781006"
}


@Article{info:doi/10.2196/56262,
author="Bachnick, Stefanie
and Unbeck, Maria
and Ahmadi Shad, Maryam
and Falta, Katja
and Grossmann, Nicole
and Holle, Daniela
and Bartakova, Jana
and Musy, N. Sarah
and Hellberg, Sarah
and Dillner, Pernilla
and Atoof, Fatemeh
and Khorasanizadeh, Mohammadhossein
and Kelly-Pettersson, Paula
and Simon, Michael",
title="TAILR (Nursing-Sensitive Events and Their Association With Individual Nurse Staffing Levels) Project: Protocol for an International Longitudinal Multicenter Study",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="22",
volume="13",
pages="e56262",
keywords="adverse events",
keywords="electronic health record",
keywords="hospital care",
keywords="no-harm incidents",
keywords="nursing care",
keywords="nursing-sensitive events",
keywords="nurse staffing",
keywords="patient safety",
keywords="systematic record review",
abstract="Background: Nursing-sensitive events (NSEs) are common, accounting for up to 77\% of adverse events in hospitalized patients (eg, fall-related harm, pressure ulcers, and health care--associated infections). NSEs lead to adverse patient outcomes and impose an economic burden on hospitals due to increased medical costs through a prolonged hospital stay and additional medical procedures. To reduce NSEs and ensure high-quality nursing care, appropriate nurse staffing levels are needed. Although the link between nurse staffing and NSEs has been described in many studies, appropriate nurse staffing levels are lacking. Existing studies describe constant staffing exposure at the unit or hospital level without assessing patient-level exposure to nurse staffing during the hospital stay. Few studies have assessed nurse staffing and patient outcomes using a single-center longitudinal design, with limited generalizability. There is a need for multicenter longitudinal studies with improved potential for generalizing the association between individual nurse staffing levels and NSEs. Objective: This study aimed (1) to determine the prevalence, preventability, type, and severity of NSEs; (2) to describe individual patient-level nurse staffing exposure across hospitals; (3) to assess the effect of nurse staffing on NSEs in patients; and (4) to identify thresholds of safe nurse staffing levels and test them against NSEs in hospitalized patients. Methods: This international multicenter study uses a longitudinal and observational research design; it involves 4 countries (Switzerland, Sweden, Germany, and Iran), with participation from 14 hospitals and 61 medical, surgery, and mixed units. The 16-week observation period will collect NSEs using systematic retrospective record reviews. A total of 3680 patient admissions will be reviewed, with 60 randomly selected admissions per unit. To be included, patients must have been hospitalized for at least 48 hours. Nurse staffing data (ie, the number of nurses and their education level) will be collected daily for each shift to assess the association between NSEs and individual nurse staffing levels. Additionally, hospital data (ie, type, teaching status, and ownership) and unit data (ie, service line and number of beds) will be collected. Results: As of January 2024, the verification process for the plausibility and comprehensibility of patients' and nurse staffing data is underway across all 4 countries. Data analyses are planned to be completed by spring 2024, with the first results expected to be published in late 2024. Conclusions: This study will provide comprehensive information on NSEs, including their prevalence, preventability, type, and severity, across countries. Moreover, it seeks to enhance understanding of NSE mechanisms and the potential impact of nurse staffing on these events. We will evaluate within- and between-hospital variability to identify productive strategies to ensure safe nurse staffing levels, thereby reducing NSEs in hospitalized patients. The TAILR (Nursing-Sensitive Events and Their Association With Individual Nurse Staffing Levels) study will focus on the optimization of scarce staffing resources. International Registered Report Identifier (IRRID): DERR1-10.2196/56262 ",
doi="10.2196/56262",
url="https://www.researchprotocols.org/2024/1/e56262",
url="http://www.ncbi.nlm.nih.gov/pubmed/38648083"
}


@Article{info:doi/10.2196/47992,
author="Slob, Joeri
and van Houwelingen, Thijs
and Kort, M. Helianthe S.",
title="Health Care Workers' Expectations of the Mercury Advance SMARTcare Solution to Prevent Pressure Injuries: Individual and Focus Group Interview Study",
journal="JMIR Nursing",
year="2024",
month="Apr",
day="18",
volume="7",
pages="e47992",
keywords="digital technology",
keywords="pressure injury",
keywords="health care professionals",
keywords="mobile phone",
keywords="health care workers",
abstract="Background: The transformation in global demography and the shortage of health care workers require innovation and efficiency in the field of health care. Digital technology can help improve the efficiency of health care. The Mercury Advance SMARTcare solution is an example of digital technology. The system is connected to a hybrid mattress and is able to detect patient movement, based on which the air pump either starts automatically or sends a notification to the app. Barriers to the adoption of the system are unknown, and it is unclear if the solution will be able to support health care workers in their work. Objective: This study aims to gain insight into health care workers' expectations of factors that could either hamper or support the adoption of the Mercury Advance SMARTcare unit connected to a Mercury Advance mattress to help prevent patients from developing pressure injuries in hospitals and long-term care facilities. Methods: We conducted a generic qualitative study from February to December 2022. Interviews were conducted, and a focus group was established using an interview guide of health care workers from both the United Kingdom and the Netherlands. Thematic analysis was performed by 2 independent researchers. Results: A total of 14 participants took part in the study: 6 (43\%) participants joined the focus group, and 8 (57\%) participants took part in the individual interviews. We identified 13 factors based on four themes: (1) factors specifically related to SMARTresponse, (2) vision on innovation, (3) match with health care activities, and (4) materials and resources involved. Signaling function, SMARTresponse as prevention, patient category, representatives, and implementation strategy were identified as facilitators. Perception of patient repositioning, accessibility to pressure injury aids, and connectivity were identified as barriers. Conclusions: Several conditions must be met to enhance the adoption of the Mercury Advance SMARTcare solution, including the engagement of representatives during training and a reliable wireless network. The identified factors can be used to facilitate the implementation process. ",
doi="10.2196/47992",
url="https://nursing.jmir.org/2024/1/e47992",
url="http://www.ncbi.nlm.nih.gov/pubmed/38635323"
}


@Article{info:doi/10.2196/51720,
author="Ntiamoah, Mabel
and Xavier, Teenu
and Lambert, Joshua",
title="Sentiment Analysis of Patient- and Family-Related Sepsis Events: Exploratory Study",
journal="JMIR Nursing",
year="2024",
month="Apr",
day="1",
volume="7",
pages="e51720",
keywords="families",
keywords="patients",
keywords="sentiment analysis",
keywords="sepsis",
abstract="Background: Despite the life-threatening nature of sepsis, little is known about the emotional experiences of patients and their families during sepsis events. We conducted a sentiment analysis pertaining to sepsis incidents involving patients and families, leveraging textual data retrieved from a publicly available blog post disseminated by the Centers for Disease Control and Prevention (CDC). Objective: This investigation involved a sentiment analysis of patient- and family-related sepsis events, leveraging text responses sourced from a publicly accessible blog post disseminated by the CDC. Driven by the imperative to elucidate the emotional dynamics encountered by patients and their families throughout sepsis incidents, the overarching aims centered on elucidating the emotional ramifications of sepsis on both patients and their families and discerning potential avenues for enhancing the quality of sepsis care. Methods: The research used a cross-sectional data mining methodology to investigate the sentiments and emotional aspects linked to sepsis, using a data set sourced from the CDC, which encompasses 170 responses from both patients and caregivers, spanning the period between September 2014 and September 2020. This investigation used the National Research Council Canada Emotion Lexicon for sentiment analysis, coupled with a combination of manual and automated techniques to extract salient features from textual responses. The study used negative binomial least absolute shrinkage and selection operator regressions to ascertain significant textual features that correlated with specific emotional states. Moreover, the visualization of Plutchik's Wheel of Emotions facilitated the discernment of prevailing emotions within the data set. Results: The results showed that patients and their families experienced a range of emotions during sepsis events, including fear, anxiety, sadness, and gratitude. Our analyses revealed an estimated incidence rate ratio (IRR) of 1.35 for fear-related words and a 1.51 IRR for sadness-related words when mentioning ``hospital'' in sepsis-related experiences. Similarly, mentions of ``intensive care unit'' were associated with an average occurrence of 12.3 fear-related words and 10.8 sadness-related words. Surviving patients' experiences had an estimated 1.15 IRR for joy-related words, contrasting with discussions around organ failure, which were associated with multiple negative emotions including disgust, anger, fear, and sadness. Furthermore, mentions of ``death'' were linked to more fear and anger words but fewer joy-related words. Conversely, longer timelines in sepsis events were associated with more joy-related words and fewer fear-related words, potentially indicating improved emotional adaptation over time. Conclusions: The study's outcomes underscore the imperative for health care providers to integrate emotional support alongside medical interventions for patients and families affected by sepsis, emphasizing the emotional toll incurred and highlighting the necessity of acknowledgment and resolution, advocating for the use of sentiment analysis as a means to tailor personalized emotional aid, and thereby potentially augmenting both patient and family welfare and overall outcomes. ",
doi="10.2196/51720",
url="https://nursing.jmir.org/2024/1/e51720",
url="http://www.ncbi.nlm.nih.gov/pubmed/38557694"
}


@Article{info:doi/10.2196/51569,
author="Agarwal, K. Anish
and Gonzales, Rachel
and Scott, Kevin
and Merchant, Raina",
title="Investigating the Feasibility of Using a Wearable Device to Measure Physiologic Health Data in Emergency Nurses and Residents: Observational Cohort Study",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="22",
volume="8",
pages="e51569",
keywords="digital health",
keywords="emergency medicine training",
keywords="wearable devices",
keywords="burnout",
keywords="mobile health",
keywords="feasibility",
keywords="wearable device",
keywords="wearable",
keywords="physiologic health data",
keywords="nurse",
keywords="resident",
keywords="emergency department",
keywords="acceptability",
keywords="well-being",
abstract="Background: Emergency departments play a pivotal role in the US health care system, with high use rates and inherent stress placed on patients, patient care, and clinicians. The impact of the emergency department environment on the health and well-being of emergency residents and nurses can be seen in worsening rates of burnout and cardiovascular health. Research on clinician health has historically been completed outside of clinical areas and not personalized to the individual. The expansion of digital technology, specifically wearable devices, may enhance the ability to understand how health care environments impact clinicians. Objective: The primary objective of this pilot study was to assess the feasibility and acceptability of using wearable devices to measure and record physiologic data from emergency nurses and resident physicians. Understanding strategies that are accepted and used by clinicians is critical prior to launching larger investigations aimed at improving outcomes. Methods: This was a longitudinal pilot study conducted at an academic, urban, level 1 trauma center. A total of 20 participants, including emergency medicine resident physicians and nurses, were equipped with a wearable device (WHOOP band) and access to a mobile health platform for 6 weeks. Baseline surveys assessed burnout, mental health, and expectations of the device and experience. Participants provided open-ended feedback on the device and platform, contributing to the assessment of acceptance, adoption, and use of the wearable device. Secondary measures explored early signs and variations in heart rate variability, sleep, recovery, burnout, and mental health assessments. Results: Of the 20 participants, 10 consistently used the wearable device. Feedback highlighted varying experiences with the device, with a preference for more common wearables like the Apple Watch or Fitbit. Resident physicians demonstrated higher engagement with the device and platform as compared with nurses. Baseline mental health assessments indicated mild anxiety and depressive symptoms among participants. The Professional Fulfillment Index revealed low professional fulfillment, moderate workplace exhaustion, and interpersonal disengagement. Conclusions: This pilot study underscores the potential of wearable devices in monitoring emergency clinicians' physiologic data but reveals challenges related to device preferences and engagement. The key takeaway is the necessity to optimize device and platform design for clinician use. Larger, randomized trials are recommended to further explore and refine strategies for leveraging wearable technology to support the well-being of the emergency workforce. ",
doi="10.2196/51569",
url="https://formative.jmir.org/2024/1/e51569",
url="http://www.ncbi.nlm.nih.gov/pubmed/38386373"
}


@Article{info:doi/10.2196/54681,
author="Castiglione, Angela Sonia
and Lavoie-Tremblay, M{\'e}lanie
and Kilpatrick, Kelley
and Gifford, Wendy
and Semenic, Elizabeth Sonia",
title="Exploring Shared Implementation Leadership of Point of Care Nursing Leadership Teams on Inpatient Hospital Units: Protocol for a Collective Case Study",
journal="JMIR Res Protoc",
year="2024",
month="Feb",
day="19",
volume="13",
pages="e54681",
keywords="case study",
keywords="evidence-based practices",
keywords="implementation leadership",
keywords="inpatient hospital units",
keywords="nursing leadership",
keywords="point of care",
abstract="Background: Nursing leadership teams at the point of care (POC), consisting of both formal and informal leaders, are regularly called upon to support the implementation of evidence-based practices (EBPs) in hospital units. However, current conceptualizations of effective leadership for successful implementation typically focus on the behaviors of individual leaders in managerial roles. Little is known about how multiple nursing leaders in formal and informal roles share implementation leadership (IL), representing an important knowledge gap. Objective: This study aims to explore shared IL among formal and informal nursing leaders in inpatient hospital units. The central research question is as follows: How is IL shared among members of POC nursing leadership teams on inpatient hospital units? The subquestions are as follows: (1) What IL behaviors are enacted and shared by formal and informal leaders? (2) What social processes enable shared IL by formal and informal leaders? and (3) What factors influence shared IL in nursing leadership teams? Methods: We will use a collective case study approach to describe and generate an in-depth understanding of shared IL in nursing. We will select nursing leadership teams on 2 inpatient hospital units that have successfully implemented an EBP as instrumental cases. We will construct data through focus groups and individual interviews with key informants (leaders, unit staff, and senior nurse leaders), review of organizational documents, and researcher-generated field notes. We have developed a conceptual framework of shared IL to guide data analysis, which describes effective IL behaviors, formal and informal nursing leaders' roles at the POC, and social processes generating shared leadership and influencing contextual factors. We will use the Framework Method to systematically generate data matrices from deductive and inductive thematic analysis of each case. We will then generate assertions about shared IL following a cross-case analysis. Results: The study protocol received research ethics approval (2022-8408) on February 24, 2022. Data collection began in June 2022, and we have recruited 2 inpatient hospital units and 25 participants. Data collection was completed in December 2023, and data analysis is ongoing. We anticipate findings to be published in a peer-reviewed journal by late 2024. Conclusions: The anticipated results will shed light on how multiple and diverse members of the POC nursing leadership team enact and share IL. This study addresses calls to advance knowledge in promoting effective implementation of EBPs to ensure high-quality health care delivery by further developing the concept of shared IL in a nursing context. We will identify strategies to strengthen shared IL in nursing leadership teams at the POC, informing future intervention studies. International Registered Report Identifier (IRRID): DERR1-10.2196/54681 ",
doi="10.2196/54681",
url="https://www.researchprotocols.org/2024/1/e54681",
url="http://www.ncbi.nlm.nih.gov/pubmed/38373024"
}


@Article{info:doi/10.2196/50703,
author="Hwang, Hyeyoung
and De Gagne, C. Jennie
and Yoo, Leeho
and Lee, Miji
and Jo, Kyung Hye
and Kim, Ju-eun",
title="Exploring Nursing Research Culture in Clinical Practice: Qualitative Ethnographic Study",
journal="Asian Pac Isl Nurs J",
year="2024",
month="Jan",
day="9",
volume="8",
pages="e50703",
keywords="clinical nursing research",
keywords="ethnography",
keywords="evidence-based nursing",
keywords="nursing research",
keywords="qualitative research",
abstract="Background: Cultivating a positive research culture is considered the key to facilitating the utilization of research findings. In the realm of clinical nursing research, nurses conducting research may find the utilization of findings challenging due to the lack of a positive research culture. Objective: This study aims to identify and describe the sociocultural context of nursing research in a clinical setting at a Korean tertiary hospital. Methods: We included participant observation and ethnographic interviews with 6 registered nurses working in a medical-surgical unit in a Korean tertiary hospital who had experience conducting nursing research in clinical settings in this qualitative ethnographic study. The study was conducted from April 2022 to May 2022. Data analysis was conducted using Spradley's ethnographic approach, which includes domain analysis, taxonomic analysis, componential analysis, and theme analysis, and occurred concurrently with data collection. Results: The overarching theme identified for nursing research culture in clinical practice was the development of a driving force for growth within the clinical environment. This theme encompasses (1) balancing positive and negative influences in the research process, (2) fostering transformational change for both nurses and patients, and (3) promoting complementary communication among nurses. Conclusions: Clinical research plays a vital role in nursing practice that requires a balance of supportive elements, such as patient-driven research questions and hospital research support, with practical challenges such as shift work and high work intensity. This study found that a positive clinical nursing research culture can serve as a unifying bridge, connecting researchers, patients, who serve as both the origin and ultimate beneficiaries of research, and hospitals that facilitate research endeavors. Future research should explore whether the themes derived from this study fully reflect a clinical nursing research culture comprising patients, nurses, and the hospital environment and determine what requirements are needed to establish such a nursing research culture. ",
doi="10.2196/50703",
url="https://apinj.jmir.org/2024/1/e50703",
url="http://www.ncbi.nlm.nih.gov/pubmed/38194262"
}


@Article{info:doi/10.2196/46058,
author="Bakker, J. Caitlin
and Wyatt, H. Tami
and Breth, CS Melissa
and Gao, Grace
and Janeway, M. Lisa
and Lee, A. Mikyoung
and Martin, L. Christie
and Tiase, L. Victoria",
title="Nurses' Roles in mHealth App Development: Scoping Review",
journal="JMIR Nursing",
year="2023",
month="Oct",
day="17",
volume="6",
pages="e46058",
keywords="mobile health",
keywords="mHealth",
keywords="mobile app",
keywords="product development",
keywords="software design",
keywords="scoping",
keywords="search strategy",
keywords="nursing",
keywords="health app",
keywords="nurse",
keywords="allied health",
keywords="development",
keywords="design",
keywords="software",
keywords="scoping literature review",
keywords="scoping review",
keywords="app",
keywords="sensor",
keywords="wearable",
keywords="software development",
keywords="mobile phone",
abstract="Background: Although mobile health (mHealth) apps for both health consumers and health care providers are increasingly common, their implementation is frequently unsuccessful when there is a misalignment between the needs of the user and the app's functionality. Nurses are well positioned to help address this challenge. However, nurses' engagement in mHealth app development remains unclear. Objective: This scoping review aims to determine the extent of the evidence of the role of nurses in app development, delineate developmental phases in which nurses are involved, and to characterize the type of mHealth apps nurses are involved in developing. Methods: We conducted a scoping review following the 6-stage methodology. We searched 14 databases to identify publications on the role of nurses in mHealth app development and hand searched the reference lists of relevant publications. Two independent researchers performed all screening and data extraction, and a third reviewer resolved any discrepancies. Data were synthesized and grouped by the Software Development Life Cycle phase, and the app functionality was described using the IMS Institute for Healthcare Informatics functionality scoring system. Results: The screening process resulted in 157 publications being included in our analysis. Nurses were involved in mHealth app development across all stages of the Software Development Life Cycle but most frequently participated in design and prototyping, requirements gathering, and testing. Nurses most often played the role of evaluators, followed by subject matter experts. Nurses infrequently participated in software development or planning, and participation as patient advocates, research experts, or nurse informaticists was rare. Conclusions: Although nurses were represented throughout the preimplementation development process, nurses' involvement was concentrated in specific phases and roles. ",
doi="10.2196/46058",
url="https://nursing.jmir.org/2023/1/e46058",
url="http://www.ncbi.nlm.nih.gov/pubmed/37847533"
}


@Article{info:doi/10.2196/48583,
author="Baratta, R. Laura
and Harford, Derek
and Sinsky, A. Christine
and Kannampallil, Thomas
and Lou, S. Sunny",
title="Characterizing the Patterns of Electronic Health Record--Integrated Secure Messaging Use: Cross-Sectional Study",
journal="J Med Internet Res",
year="2023",
month="Oct",
day="6",
volume="25",
pages="e48583",
keywords="clinical care",
keywords="clinician burden",
keywords="communication",
keywords="electronic health record",
keywords="EHR",
keywords="interprofessional communication",
keywords="medical assistant",
keywords="messaging",
keywords="nurses",
keywords="observational study",
keywords="physicians",
keywords="secure messaging",
keywords="users",
abstract="Background: Communication among health care professionals is essential for the delivery of safe clinical care. Secure messaging has rapidly emerged as a new mode of asynchronous communication. Despite its popularity, relatively little is known about how secure messaging is used and how such use contributes to communication burden. Objective: This study aims to characterize the use of an electronic health record--integrated secure messaging platform across 14 hospitals and 263 outpatient clinics within a large health care system. Methods: We collected metadata on the use of the Epic Systems Secure Chat platform for 6 months (July 2022 to January 2023). Information was retrieved on message volume, response times, message characteristics, messages sent and received by users, user roles, and work settings (inpatient vs outpatient). Results: A total of 32,881 users sent 9,639,149 messages during the study. Median daily message volume was 53,951 during the first 2 weeks of the study and 69,526 during the last 2 weeks, resulting in an overall increase of 29\% (P=.03). Nurses were the most frequent users of secure messaging (3,884,270/9,639,149, 40\% messages), followed by physicians (2,387,634/9,639,149, 25\% messages), and medical assistants (1,135,577/9,639,149, 12\% messages). Daily message frequency varied across users; inpatient advanced practice providers and social workers interacted with the highest number of messages per day (median 19). Conversations were predominantly between 2 users (1,258,036/1,547,879, 81\% conversations), with a median of 2 conversational turns and a median response time of 2.4 minutes. The largest proportion of inpatient messages was from nurses to physicians (972,243/4,749,186, 20\% messages) and physicians to nurses (606,576/4,749,186, 13\% messages), while the largest proportion of outpatient messages was from physicians to nurses (344,048/2,192,488, 16\% messages) and medical assistants to other medical assistants (236,694/2,192,488, 11\% messages). Conclusions: Secure messaging was widely used by a diverse range of health care professionals, with ongoing growth throughout the study and many users interacting with more than 20 messages per day. The short message response times and high messaging volume observed highlight the interruptive nature of secure messaging, raising questions about its potentially harmful effects on clinician workflow, cognition, and errors. ",
doi="10.2196/48583",
url="https://www.jmir.org/2023/1/e48583",
url="http://www.ncbi.nlm.nih.gov/pubmed/37801359"
}


@Article{info:doi/10.2196/46926,
author="Melbye, Lind Elisabeth
and Bull, Hervik Vibeke
and Hidle, S{\o}llesvik Kristin",
title="Assessment of the SmartJournal Intervention for Improved Oral Care in Nursing Homes: Protocol for a Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="6",
volume="12",
pages="e46926",
keywords="cluster randomized controlled trial",
keywords="digital tool",
keywords="gerodontology",
keywords="intervention",
keywords="nursing homes",
keywords="oral health",
abstract="Background: Poor oral health is common in nursing home residents, and health care professionals report numerous barriers when it comes to the provision of oral care for care-dependent older adults, such as a lack of oral health knowledge and skills, care-resistant behaviors in residents, lack of adequate oral care routines, insufficient systems for documentation of issues related to oral health, a high workload, and unclear responsibilities. An intervention, SmartJournal, has been developed to assist health personnel in preserving older patients' oral health. SmartJournal is a digital tool with three components: (1) documentation of oral hygiene routines; (2) monthly oral health assessment; and (3) education on geriatric oral care. An updated framework for research on complex interventions has been used to guide the various phases in the development of this intervention. This study focuses on the evaluation phase. Objective: We aim to assess (1) the effectiveness of SmartJournal use in enhancing nursing home caregivers' capability, opportunity, motivation, and routines related to oral care; and (2) whether SmartJournal use results in improved oral health for nursing home residents. Methods: We will use a cluster randomized controlled trial to assess impacts of SmartJournal use as specified under study objectives. Nursing homes located in Rogaland, Norway, will be recruited and randomly assigned to an intervention and a control group. The intervention group will be provided with tablets containing SmartJournal and support from research staff, while the control group will continue with existing oral care routines. Both groups will receive oral hygiene packages. The intervention will last for 12 weeks. Measurements will be performed in both groups at baseline, 3 months, and 9 months and include (1) a survey assessing caregivers' capability, opportunity, motivation, and routines related to oral care; and (2) assessment of oral health status in residents using mucosal-plaque score as a primary outcome measure. Analyses will include descriptive statistics and statistical techniques to look for changes and differences in the study variables within and between the intervention and control groups throughout the study period. Associations between study variables will also be investigated. Results: Recruitment of nursing homes for the intervention and control groups was completed in February 2023. Recruitment of individual participants (ie, nursing home residents and caregivers) is ongoing, and baseline measurements are being performed consecutively. Results are expected to be ready for analyses in fall 2024. Conclusions: We aim to assess the effects of SmartJournal use on oral care and oral health in nursing homes. Results from this work may inform further development and implementation of SmartJournal and similar digital tools aiming to enhance health care services offered to care-dependent people. Finally, SmartJournal may have potential as a learning tool in educational programs for nurses and other health care professionals. Trial Registration: ClinicalTrials.gov NCT05724043; https://clinicaltrials.gov/study/NCT05724043 International Registered Report Identifier (IRRID): DERR1-10.2196/46926 ",
doi="10.2196/46926",
url="https://www.researchprotocols.org/2023/1/e46926",
url="http://www.ncbi.nlm.nih.gov/pubmed/37801358"
}


@Article{info:doi/10.2196/51303,
author="Kodama, Kana
and Konishi, Shozo
and Manabe, Shirou
and Okada, Katsuki
and Yamaguchi, Junji
and Wada, Shoya
and Sugimoto, Kento
and Itoh, Sakiko
and Takahashi, Daiyo
and Kawasaki, Ryo
and Matsumura, Yasushi
and Takeda, Toshihiro",
title="Impact of an Electronic Medical Record--Connected Questionnaire on Efficient Nursing Documentation: Usability and Efficacy Study",
journal="JMIR Nursing",
year="2023",
month="Sep",
day="25",
volume="6",
pages="e51303",
keywords="nursing system",
keywords="electronic questionnaire",
keywords="electronic medical record",
keywords="medical informatics",
keywords="EMR",
keywords="medical records",
keywords="EHR",
keywords="health record",
keywords="health records",
keywords="nursing",
keywords="documentation",
keywords="documenting",
keywords="usability",
keywords="self-reported",
keywords="patient data",
keywords="questionnaires",
keywords="data conversion",
keywords="nursing record",
keywords="nursing records",
keywords="data capture",
keywords="information system",
keywords="information systems",
abstract="Background: Documentation tasks comprise a large percentage of nurses' workloads. Nursing records were partially based on a report from the patient. However, it is not a verbatim transcription of the patient's complaints but a type of medical record. Therefore, to reduce the time spent on nursing documentation, it is necessary to assist in the appropriate conversion or citation of patient reports to professional records. However, few studies have been conducted on systems for capturing patient reports in electronic medical records. In addition, there have been no reports on whether such a system reduces the time spent on nursing documentation. Objective: This study aims to develop a patient self-reporting system that appropriately converts data to nursing records and evaluate its effect on reducing the documenting burden for nurses. Methods: An electronic medical record--connected questionnaire and a preadmission nursing questionnaire were administered. The questionnaire responses entered by the patients were quoted in the patient profile for inpatient assessment in the nursing system. To clarify its efficacy, this study examined whether the use of the electronic questionnaire system saved the nurses' time entering the patient profile admitted between August and December 2022. It also surveyed the usability of the electronic questionnaire between April and December 2022. Results: A total of 3111 (78\%) patients reported that they answered the electronic medical questionnaire by themselves. Of them, 2715 (88\%) felt it was easy to use and 2604 (85\%) were willing to use it again. The electronic questionnaire was used in 1326 of 2425 admission cases (use group). The input time for the patient profile was significantly shorter in the use group than in the no-use group (P<.001). Stratified analyses showed that in the internal medicine wards and in patients with dependent activities of daily living, nurses took 13\%-18\% (1.3 to 2 minutes) less time to enter patient profiles within the use group (both P<.001), even though there was no difference in the amount of information. By contrast, in the surgical wards and in the patients with independent activities of daily living, there was no difference in the time to entry (P=.50 and P=.20, respectively), but there was a greater amount of information in the use group. Conclusions: The study developed and implemented a system in which self-reported patient data were captured in the hospital information network and quoted in the nursing system. This system contributes to improving the efficiency of nurses' task recordings. ",
doi="10.2196/51303",
url="https://nursing.jmir.org/2023/1/e51303",
url="http://www.ncbi.nlm.nih.gov/pubmed/37634203"
}


@Article{info:doi/10.2196/49020,
author="Strout, Kelley
and Schwartz-Mette, Rebecca
and McNamara, Jade
and Parsons, Kayla
and Walsh, Dyan
and Bonnet, Jen
and O'Brien, M. Liam
and Robinson, Kathryn
and Sibley, Sean
and Smith, Annie
and Sapp, Maile
and Sprague, Lydia
and Sabegh, Sajedi Nima
and Robinson, Kaitlin
and Henderson, Amanda",
title="Wellness in Nursing Education to Promote Resilience and Reduce Burnout: Protocol for a Holistic Multidimensional Wellness Intervention and Longitudinal Research Study Design in Nursing Education",
journal="JMIR Res Protoc",
year="2023",
month="Sep",
day="8",
volume="12",
pages="e49020",
keywords="nursing workforce",
keywords="academic performance",
keywords="burnout",
keywords="resilience",
keywords="wellness",
keywords="nursing",
keywords="education",
keywords="nursing education",
keywords="protocol",
keywords="nursing students",
keywords="students",
keywords="holistic",
keywords="implementation",
keywords="workforce",
abstract="Background: The United States faces a nursing shortage driven by a burnout epidemic among nurses and nursing students. Nursing students are an integral population to fuel the nursing workforce at high risk of burnout and increased rates of perceived stress. Objective: The aim of this paper is to describe WellNurse, a holistic, interdisciplinary, multidimensional longitudinal research study that examines evidence-based interventions intended to reduce burnout and increase resilience among graduate and undergraduate nursing students. Methods: Graduate and undergraduate nursing students matriculated at a large public university in the northeastern United States are eligible to enroll in this ongoing, longitudinal cohort study beginning in March 2021. Participants complete a battery of health measurements twice each semester during the fourth week and the week before final examinations. The measures include the Perceived Stress Scale, the Satisfaction with Life Scale, the Oldenburg Burnout Inventory, the Brief Resilience Scale, and the Pittsburgh Sleep Quality Index. Participants are eligible to enroll in a variety of interventions, including mindfulness-based stress reduction, mindful eating, fitness training, and massage therapy. Those who enroll in specific, targeted interventions complete additional measures designed to target the aim of the intervention. All participants receive a free Fitbit device. Additional environmental changes are being implemented to further promote a culture that supports academic well-being, including recruiting a diverse student population through evidence-based holistic admissions, inclusive teaching design, targeted resilience and stress reduction workshops, and cultural shifts within classrooms and curricula. The study design protocol is registered at Open Science Framework DOI 10.17605/OSF.IO/NCBPE. Results: The project was funded on January 1, 2022. Data collection started in March 2022. A total of 267 participants have been recruited. Results will be published after each semester starting in December 2023. WellNurse evaluation follows the Rapid Cycle Quality Improvement framework to continuously monitor ongoing project processes, activity outcomes, and progress toward reducing burnout and increasing resilience. Rapid Cycle Quality Improvement promotes the ability to alter WellNurse interventions, examine multiple interventions, and test their effectiveness among the nursing education population to identify the most effective interventions. Conclusions: Academic nursing organizations must address student burnout risk and increase resilience to produce a future workforce that provides high-quality patient care to a diverse population. Findings from WellNurse will support evidence-based implementations for public baccalaureate and master's nursing programs in the United States. International Registered Report Identifier (IRRID): DERR1-10.2196/49020 ",
doi="10.2196/49020",
url="https://www.researchprotocols.org/2023/1/e49020/"
}


@Article{info:doi/10.2196/44483,
author="van Rossum, C. Mathilde
and Bekhuis, M. Robin E.
and Wang, Ying
and Hegeman, H. Johannes
and Folbert, C. Ellis
and Vollenbroek-Hutten, R. Miriam M.
and Kalkman, J. Cornelis
and Kouwenhoven, A. Ewout
and Hermens, J. Hermie",
title="Early Warning Scores to Support Continuous Wireless Vital Sign Monitoring for Complication Prediction in Patients on Surgical Wards: Retrospective Observational Study",
journal="JMIR Perioper Med",
year="2023",
month="Aug",
day="30",
volume="6",
pages="e44483",
keywords="early warning scores",
keywords="vital signs",
keywords="telemedicine",
keywords="physiological monitoring",
keywords="clinical alarms",
keywords="postoperative complications",
keywords="perioperative nursing",
abstract="Background: Wireless vital sign sensors are increasingly being used to monitor patients on surgical wards. Although early warning scores (EWSs) are the current standard for the identification of patient deterioration in a ward setting, their usefulness for continuous monitoring is unknown. Objective: This study aimed to explore the usability and predictive value of high-rate EWSs obtained from continuous vital sign recordings for early identification of postoperative complications and compares the performance of a sensor-based EWS alarm system with manual intermittent EWS measurements and threshold alarms applied to individual vital sign recordings (single-parameter alarms). Methods: Continuous vital sign measurements (heart rate, respiratory rate, blood oxygen saturation, and axillary temperature) collected with wireless sensors in patients on surgical wards were used for retrospective simulation of EWSs (sensor EWSs) for different time windows (1-240 min), adopting criteria similar to EWSs based on manual vital signs measurements (nurse EWSs). Hourly sensor EWS measurements were compared between patients with (event group: 14/46, 30\%) and without (control group: 32/46, 70\%) postoperative complications. In addition, alarms were simulated for the sensor EWSs using a range of alarm thresholds (1-9) and compared with alarms based on nurse EWSs and single-parameter alarms. Alarm performance was evaluated using the sensitivity to predict complications within 24 hours, daily alarm rate, and false discovery rate (FDR). Results: The hourly sensor EWSs of the event group (median 3.4, IQR 3.1-4.1) was significantly higher (P<.004) compared with the control group (median 2.8, IQR 2.4-3.2). The alarm sensitivity of the hourly sensor EWSs was the highest (80\%-67\%) for thresholds of 3 to 5, which was associated with alarm rates of 2 (FDR=85\%) to 1.2 (FDR=83\%) alarms per patient per day respectively. The sensitivity of sensor EWS--based alarms was higher than that of nurse EWS--based alarms (maximum=40\%) but lower than that of single-parameter alarms (87\%) for all thresholds. In contrast, the (false) alarm rates of sensor EWS--based alarms were higher than that of nurse EWS--based alarms (maximum=0.6 alarm/patient/d; FDR=80\%) but lower than that of single-parameter alarms (2 alarms/patient/d; FDR=84\%) for most thresholds. Alarm rates for sensor EWSs increased for shorter time windows, reaching 70 alarms per patient per day when calculated every minute. Conclusions: EWSs obtained using wireless vital sign sensors may contribute to the early recognition of postoperative complications in a ward setting, with higher alarm sensitivity compared with manual EWS measurements. Although hourly sensor EWSs provide fewer alarms compared with single-parameter alarms, high false alarm rates can be expected when calculated over shorter time spans. Further studies are recommended to optimize care escalation criteria for continuous monitoring of vital signs in a ward setting and to evaluate the effects on patient outcomes. ",
doi="10.2196/44483",
url="https://periop.jmir.org/2023/1/e44483",
url="http://www.ncbi.nlm.nih.gov/pubmed/37647104"
}


@Article{info:doi/10.2196/44435,
author="Ronquillo, Esteban Charlene
and Dahinten, Susan V.
and Bungay, Vicky
and Currie, M. Leanne",
title="Differing Effects of Implementation Leadership Characteristics on Nurses' Use of mHealth Technologies in Clinical Practice: Cross-Sectional Survey Study",
journal="JMIR Nursing",
year="2023",
month="Aug",
day="25",
volume="6",
pages="e44435",
keywords="mobile health",
keywords="mHealth applications",
keywords="nursing",
keywords="leadership",
keywords="implementation science",
keywords="nursing informatics",
abstract="Background: Leadership has been consistently identified as an important factor in shaping the uptake and use of mobile health (mHealth) technologies in nursing; however, the nature and scope of leadership remain poorly delineated. This lack of detail about what leadership entails limits the practical actions that can be taken by leaders to optimize the implementation and use of mHealth technologies among nurses working clinically. Objective: This study aimed to examine the effects of first-level leaders' implementation leadership characteristics on nurses' intention to use and actual use of mHealth technologies in practice while controlling for nurses' individual characteristics and the voluntariness of use, perceived usefulness, and perceived ease of use of mHealth technologies. Methods: A cross-sectional exploratory correlational survey study of registered nurses in Canada (n=288) was conducted between January 1, 2018, and June 30, 2018. Nurses were eligible to participate if they provided direct care in any setting and used employer-provided mHealth technologies in clinical practice. Hierarchical multiple regression analyses were conducted for the 2 outcome variables: intention to use and actual use. Results: The implementation leadership characteristics of first-level leaders influenced nurses' intention to use and actual use of mHealth technologies, with 2 moderating effects found. The final model for intention to use included the interaction term for implementation leadership characteristics and education, explaining 47\% of the variance in nurses' intention to use mHealth in clinical practice (F10,228=20.14; P<.001). An examination of interaction plots found that implementation leadership characteristics had a greater influence on the intention to use mHealth technologies among nurses with a registered nurse diploma or a bachelor of nursing degree than among nurses with a graduate degree or other advanced education. For actual use, implementation leadership characteristics had a significant influence on the actual use of mHealth over and above the control variables (nurses' demographic characteristics, previous experience with mHealth, and voluntariness) and other known predictors (perceived usefulness and perceived ease of use) in the model without the implementation leadership {\texttimes} age interaction term ($\beta$=.22; P=.001) and in the final model that included the implementation leadership {\texttimes} age interaction term ($\beta$=?.53; P=.03). The final model explained 40\% of the variance in nurses' actual use of mHealth in their work (F10,228=15.18; P<.001). An examination of interaction plots found that, for older nurses, implementation leadership characteristics had less of an influence on their actual use of mHealth technologies. Conclusions: Leaders responsible for the implementation of mHealth technologies need to assess and consider their implementation leadership behaviors because these play a role in influencing nurses' use of mHealth technologies. The education level and age of nurses may be important factors to consider because different groups may require different approaches to optimize their use of mHealth technologies in clinical practice. ",
doi="10.2196/44435",
url="https://nursing.jmir.org/2023/1/e44435",
url="http://www.ncbi.nlm.nih.gov/pubmed/37624628"
}


@Article{info:doi/10.2196/43692,
author="Boskma, Amber
and van der Braak, Kim
and Ansari, Neda
and Hooft, Lotty
and Wietasch, G{\"o}tz
and Franx, Arie
and van der Laan, Maarten",
title="Assessing the Well-Being at Work of Nurses and Doctors in Hospitals: Protocol for a Scoping Review of Monitoring Instruments",
journal="JMIR Res Protoc",
year="2023",
month="Aug",
day="25",
volume="12",
pages="e43692",
keywords="well-being at work",
keywords="well-being",
keywords="well being",
keywords="health care professionals",
keywords="doctors",
keywords="nurses",
keywords="monitoring",
keywords="assessment",
keywords="measure",
keywords="scale",
keywords="instruments",
keywords="scoping literature review",
keywords="occupational health",
abstract="Background: Well-being at work can be defined as ``creating an environment to promote a state of contentment which allows an employee to flourish and achieve their full potential for the benefit of themselves and their organisation.'' In the health care context, well-being at work of nurses and doctors is important for good patient care. Moreover, it is strongly associated with individual- and organization-level consequences. Relevant literature presents models and concepts of physical, mental, and social well-being. This study uses the 6 elements of the job demands-resources (JD-R) model to interpret well-being at work (job demands, job resources, personal resources, leadership, well-being, and outcomes) as part of a Netherlands Federation of University Medical Hospitals program to find ways to improve and monitor health care professionals' well-being in Dutch hospitals. Many instruments exist to measure well-being at work in terms of population, setting, and other aspects. An overview of available and eligible instruments assessing and monitoring the well-being of nurses and doctors is currently missing. Objective: We will perform a scoping review aiming to provide an overview of validated instruments assessing and monitoring the well-being of nurses and doctors at work. Methods: We will perform a search of published literature in the following databases: Medline, Embase, and CINAHL. Studies will be eligible if they (1) assess well-being at work of nurses and doctors employed in hospitals; (2) describe an evaluation of an instrument or review an instrument; (3) measure well-being at work or aspects of well-being at work according to the elements of the JD-R model, and (4) were published in English from 2011 onwards. Title/abstract screening according to the eligibility criteria will be followed by full-text screening. Data extraction of included studies will be conducted by 3 reviewers independently. Reviewers will use standardized data extraction forms that include study characteristics, sample characteristics, measurement instrument details, and psychometric properties. The analysis will be descriptive. When synthesizing the data, a distinction will be made between comprehensive instruments and common instruments. Results: This scoping review identifies instruments that have been developed and validated for monitoring the well-being of nurses and doctors at work. Studies were searched between September and December 2021 and screened between December 2021 and May 2022. A total of 739 studies were included. Conclusions: Timely screening of well-being at work may be beneficial for individual health care workers, the organization, and patients. There is often a substantial gap and mismatch between employer perceptions of well-being and well-being interventions. It is important to develop and implement suitable interventions adapted to the needs of nurses and doctors and their health or other problems. Well-being screening should be timely to gain insight into these needs and problems. Moreover, to determine the effectiveness of well-being interventions, measurement is mandatory. The results will be critical for organizations to select a monitoring instrument that best fits the needs of employees and organizations. International Registered Report Identifier (IRRID): DERR1-10.2196/43692 ",
doi="10.2196/43692",
url="https://www.researchprotocols.org/2023/1/e43692",
url="http://www.ncbi.nlm.nih.gov/pubmed/37624632"
}


@Article{info:doi/10.2196/45150,
author="AL-Rumhi, Alya
and AL-Rasbi, Samira
and Momani, M. Aaliyah",
title="The Use of Social Media by Clinical Nurse Specialists at a Tertiary Hospital: Mixed Methods Study",
journal="JMIR Nursing",
year="2023",
month="Aug",
day="24",
volume="6",
pages="e45150",
keywords="social media",
keywords="clinical nurse specialist",
keywords="cross-sectional",
keywords="tertiary hospital",
keywords="Oman",
keywords="health education tool",
abstract="Background: Recently, many health care professionals, who use social media to communicate with patients and colleagues, share information about medical research and promote public health campaigns. Objective: This study aimed to examine the motives, barriers, and implementation of social media use among clinical nurse specialists in Oman. Methods: A mixed methods study was conducted among 47 clinical nurse specialists at Sultan Qaboos University Hospital between November and December 2020. Qualitative data were collected using an open-ended questionnaire and analyzed using thematic analysis, and quantitative data were collected with a questionnaire and analyzed using SPSS (version 21.0; IBM Corp). Results: Of the 47 clinical nurse specialists surveyed, 43 (91.5\%) responded. All respondents reported using social media applications, with WhatsApp being the most commonly used platform. Most respondents (n=18, 41.9\%) spent 1-2 hours per day on social media. The main motives for using social media were increasing knowledge, communication, reaching patients easily, and reducing the number of hospital visits. The main barriers to social media use were privacy concerns, time constraints, and a lack of awareness of legal guidelines for social media use in the workplace. All participants requested clear rules and regulations regarding the use of social media among health care providers in the future. Conclusions: Social media has the option to be a powerful institutional communication and health education tool for clinical nurse specialists in Oman. However, several obstacles must be addressed, including privacy concerns and the need for clear guidelines on social media use in the workplace. Our findings suggest that health care institutions and clinical nurse specialists must work together to overcome these impediments and leverage the benefits of social media for health care.Bottom of Form ",
doi="10.2196/45150",
url="https://nursing.jmir.org/2023/1/e45150",
url="http://www.ncbi.nlm.nih.gov/pubmed/37616026"
}


@Article{info:doi/10.2196/45501,
author="Andersson, Susanne
and Scandurra, Isabella
and Nystr{\"o}m, Ulrika
and Varemo, Marika
and Hellstrand Tang, Ulla",
title="Experiences of a Novel Structured Foot Examination Form for Patients With Diabetes From the Perspective of Health Care Professionals: Qualitative Study",
journal="JMIR Nursing",
year="2023",
month="Jul",
day="18",
volume="6",
pages="e45501",
keywords="diabetes",
keywords="foot ulcer",
keywords="prevention",
keywords="primary health care",
keywords="qualitative research",
keywords="structured foot examination",
keywords="validation",
keywords="user experiences",
keywords="participatory design",
abstract="Background: Diabetes is a growing threat to public health, and secondary diseases like foot complications are common. Foot ulcers affect the individual's quality of life and are a great cost to society. Regular foot examinations prevent foot ulcers and are a recommended approach both in Sweden and worldwide. Despite existing guidelines, there are differences in the execution of the foot examination, which results in care inequality. A structured foot examination form based on current guidelines was developed in this study as the first step toward digitalized support in the daily routine, and was validated by diabetes health care professionals. Objective: The study aimed to validate a structured foot examination form by assessing health care professionals' experiences of working with it ``foot side'' when examining patients with diabetes. Methods: Semistructured interviews were held in a focus group and individually with 8 informants from different diabetes professions, who were interviewed regarding their experiences of working with the form in clinical practice. The users' data were analyzed inductively using qualitative content analysis. The study is part of a larger project entitled ``Optimised care of persons with diabetes and foot complications,'' with V{\"a}stra G{\"o}taland Region as the responsible health care authority, where the results will be further developed. Results: Experiences of working with the form were that it simplified the foot examination by giving it an overview and a clear structure. Using the form made differences in work routines between individuals apparent. It was believed that implementing the form routinely would contribute to a more uniform execution. When patients had foot ulcers, the risk categories (established in guidelines) were perceived as contradictory. For example, there was uncertainty about the definition of chronic ulcers and callosities. The expectations were that the future digital format would simplify documentation and elucidate the foot examination, as well as contribute to the accessibility of updated and relevant data for all individuals concerned. Conclusions: The foot examination form works well as a support tool during preventive foot examination, creates a basis for decision-making, and could contribute to a uniform and safer foot examination with more care equality in agreement with current guidelines. Trial Registration: ClinicalTrials.gov NCT05692778; https://clinicaltrials.gov/ct2/show/NCT05692778 ",
doi="10.2196/45501",
url="https://nursing.jmir.org/2023/1/e45501",
url="http://www.ncbi.nlm.nih.gov/pubmed/37463012"
}


@Article{info:doi/10.2196/45342,
author="Yoshioka-Maeda, Kyoko
and Matsumoto, Hiroshige
and Honda, Chikako
and Shiomi, Misa
and Taira, Kazuya
and Hosoya, Noriko
and Sato, Miki
and Sumikawa, Yuka
and Fujii, Hitoshi
and Miura, Takahiro",
title="New Web-Based System for Recording Public Health Nursing Practices and Determining Best Practices: Protocol of an Exploratory Sequential Design",
journal="JMIR Res Protoc",
year="2023",
month="Jun",
day="12",
volume="12",
pages="e45342",
keywords="community-based activity",
keywords="evidence-based practice",
keywords="individual care",
keywords="information and communication technology",
keywords="program development",
keywords="public health nursing",
keywords="quality assurance",
keywords="digitalization",
keywords="eHealth",
keywords="electronic record",
abstract="Background: Digitalization and information and communication technology (ICT) promote effective, efficient individual and community care. Clinical terminology or taxonomy and its framework visualize individual patients' and nursing interventions' classifications to improve their outcomes and care quality. Public health nurses (PHNs) provide lifelong individual care and community-based activities while developing projects to promote community health. The linkage between these practices and clinical assessment remains tacit. Owing to Japan's lagging digitalization, supervisory PHNs face difficulties in monitoring each department's activities and staff members' performances and competencies. Randomly selected prefectural or municipal PHNs collect data on daily activities and required hours every 3 years. No study has adopted these data for public health nursing care management. PHNs need ICTs to manage their work and improve care quality; it may help identify health needs and suggest best public health nursing practices. Objective: We aim to develop and validate an electronic recording and management system for evaluating different public health nursing practice needs, including individual care, community-based activities, and project development, and for determining their best practices. Methods: We used a 2-phase exploratory sequential design (in Japan) comprising 2 phases. In phase 1, we developed the system's architectural framework and a hypothetical algorithm to determine the need for practice review through a literature review and a panel discussion. We designed a cloud-based practice recording system, including a daily record system and a termly review system. The panels included 3 supervisors who were prior PHNs at the prefectural or municipal government, and 1 was the executive director of the Japanese Nursing Association. The panels agreed that the draft architectural framework and hypothetical algorithm were reasonable. The system was not linked to electronic nursing records to protect patient privacy. Phase 2 validated each item through interviews with supervisory PHNs using a web-based meeting system. A nationwide survey was distributed to supervisory and midcareer PHNs across local governments. Results: This study was funded in March 2022 and approved by all ethics review boards from July to September and November 2022. Data collection was completed in January 2023. Five PHNs participated in the interviews. In the nationwide survey, responses were obtained from 177 local governments of supervisory PHNs and 196 midcareer ones. Conclusions: This study will reveal PHNs' tacit knowledge about their practices, assess needs for different approaches, and determine best practices. Additionally, this study will promote ICT-based practices in public health nursing. The system will enable PHNs to record their daily activities and share them with their supervisors to reflect on and improve their performance, and the quality of care to promote health equity in community settings. The system will support supervisory PHNs in creating performance benchmarks for their staff and departments to promote evidence-based human resource development and management. Trial Registration: UMIN-ICDR UMIN000049411; https://tinyurl.com/yfvxscfm International Registered Report Identifier (IRRID): DERR1-10.2196/45342 ",
doi="10.2196/45342",
url="https://www.researchprotocols.org/2023/1/e45342",
url="http://www.ncbi.nlm.nih.gov/pubmed/37307040"
}


@Article{info:doi/10.2196/46673,
author="Olesen, Linnet Mette
and Rossen, Sine
and J{\o}rgensen, Rikke
and Langballe Udbj{\o}rg, Line
and Hansson, Helena",
title="Usefulness of a Digitally Assisted Person-Centered Care Intervention: Qualitative Study of Patients' and Nurses' Experiences in a Long-term Perspective",
journal="JMIR Nursing",
year="2023",
month="May",
day="18",
volume="6",
pages="e46673",
keywords="digital technology",
keywords="digital nursing",
keywords="digitally assisted guided self-determination",
keywords="empowerment",
keywords="self-management",
keywords="person-centered care",
keywords="qualitative",
keywords="service design",
keywords="patient care",
keywords="nurse",
keywords="quality of life",
keywords="interview",
keywords="web-based questionnaire",
keywords="functionality",
keywords="support",
keywords="training",
keywords="implementation",
keywords="self-determination",
keywords="autonomy",
keywords="agency",
keywords="person centered",
keywords="patient centered",
keywords="client focus",
keywords="gynecology",
keywords="oncology",
keywords="health knowledge",
keywords="health care professional",
keywords="health care provider",
keywords="HCP",
keywords="mobile phone",
abstract="Background: Person-centered care responsive to individual preferences, needs, and values is recognized as an important aspect of high-quality health care, and patient empowerment is increasingly viewed as a central core value of person-centered care. Web-based interventions aimed at empowerment report a beneficial effect on patient empowerment and physical activity; however, there is limited information available on barriers, facilitators, and user experiences. A recent review of the effect of digital self-management support tools suggests a beneficial effect on the quality of life in patients with cancer. On the basis of an overall philosophy of empowerment, guided self-determination is a person-centered intervention that uses preparatory reflection sheets to help achieve focused communication between patients and nurses. The intervention was adapted into a digital version called digitally assisted guided self-determination (DA-GSD) hosted by the Sundhed DK website that can be delivered face-to-face, via video, or by the combination of the 2 methods. Objective: We aimed to investigate the experiences of nurses, nurse managers, and patients of using DA-GSD in 2 oncology departments and 1 gynecology department over a 5-year implementation period from 2018 to 2022. Methods: This qualitative study was inspired by action research comprising the responses of 17 patients to an open-ended question on their experience of specific aspects of DA-GSD in a web questionnaire, 14 qualitative semistructured interviews with nurses and patients who initially completed the web questionnaire, and transcripts of meetings held between the researchers and nurses during the implementation of the intervention. The thematic analysis of all data was done using NVivo (QSR International). Results: The analysis generated 2 main themes and 7 subthemes that reflect conflicting perspectives and greater acceptability of the intervention among the nurses over time owing to better familiarity with the increasingly mature technology. The first theme was the different experiences and perspectives of nurses and patients concerning barriers to using DA-GSD and comprised 4 subthemes: conflicting perspectives on the ability of patients to engage with DA-GSD and how to provide it, conflicting perspectives on DA-GSD as a threat to the nurse-patient relationship, functionality of DA-GSD and available technical equipment, and data security. The other theme was what influenced the increased acceptability of DA-GSD among the nurses over time and comprised 3 subthemes: a re-evaluation of the nurse-patient relationship; improved functionality of DA-GSD; and supervision, experience, patient feedback, and a global pandemic. Conclusions: The nurses experienced more barriers to DA-GSD than the patients did. Acceptance of the intervention increased over time among the nurses in keeping with the intervention's improved functionality, additional guidance, and positive experiences, combined with patients finding it useful. Our findings emphasize the importance of supporting and training nurses if new technologies are to be implemented successfully. ",
doi="10.2196/46673",
url="https://nursing.jmir.org/2023/1/e46673",
url="http://www.ncbi.nlm.nih.gov/pubmed/37200076"
}


@Article{info:doi/10.2196/44692,
author="Chang, Fangyuan
and {\"O}stlund, Britt
and Kuoppam{\"a}ki, Sanna",
title="Domesticating Social Alarm Systems in Nursing Homes: Qualitative Study of Differences in the Perspectives of Assistant Nurses",
journal="J Med Internet Res",
year="2023",
month="May",
day="5",
volume="25",
pages="e44692",
keywords="technology implementation",
keywords="nursing care",
keywords="social alarm system",
keywords="domestication",
keywords="nursing home",
keywords="technology integration",
keywords="long-term care",
keywords="social alarm",
keywords="nursing",
keywords="elder",
keywords="older adult",
keywords="aging",
keywords="gerontology",
keywords="geriatric",
keywords="interview",
keywords="qualitative",
abstract="Background: New social alarm solutions are viewed as a promising approach to alleviate the global challenge of an aging population and a shortage of care staff. However, the uptake of social alarm systems in nursing homes has proven both complex and difficult. Current studies have recognized the benefits of involving actors such as assistant nurses in advancing these implementations, but the dynamics by which implementations are created and shaped in their daily practices and relations have received less attention. Objective: Based on domestication theory, this paper aims to identify the differences in the perspectives of assistant nurses when integrating a social alarm system into daily practices. Methods: We interviewed assistant nurses (n=23) working in nursing homes to understand their perceptions and practices during the uptake of social alarm systems. Results: During the four domestication phases, assistant nurses were facing different challenges including (1) system conceptualization; (2) spatial employment of social alarm devices; (3) treatment of unexpected issues; and (4) evaluation of inconsistent competence in technology use. Our findings elaborate on how assistant nurses have distinct goals, focus on different facets, and developed diverse coping strategies to facilitate the system domestication in different phases. Conclusions: Our findings reveal a divide among assistant nurses in terms of domesticating social alarm systems and stress the potential of learning from each other to facilitate the whole process. Further studies could focus on the role of collective practices during different domestication phases to enhance the understanding of technology implementation in the contexts of complex interactions within a group. ",
doi="10.2196/44692",
url="https://www.jmir.org/2023/1/e44692",
url="http://www.ncbi.nlm.nih.gov/pubmed/37145835"
}


@Article{info:doi/10.2196/44061,
author="Leenen, L. Jobbe P.
and Rasing, M. Henri{\"e}tte J.
and Kalkman, J. Cor
and Schoonhoven, Lisette
and Patijn, A. Gijsbert",
title="Process Evaluation of a Wireless Wearable Continuous Vital Signs Monitoring Intervention in 2 General Hospital Wards: Mixed Methods Study",
journal="JMIR Nursing",
year="2023",
month="May",
day="4",
volume="6",
pages="e44061",
keywords="physiological monitoring",
keywords="implementation science",
keywords="clinical deterioration",
keywords="continuous vital sign monitoring",
keywords="wearable wireless devices",
keywords="wearables",
keywords="process evaluation",
keywords="mixed methods",
keywords="intervention fidelity",
abstract="Background: Continuous monitoring of vital signs (CMVS) using wearable wireless sensors is increasingly available to patients in general wards and can improve outcomes and reduce nurse workload. To assess the potential impact of such systems, successful implementation is important. We developed a CMVS intervention and implementation strategy and evaluated its success in 2 general wards. Objective: We aimed to assess and compare intervention fidelity in 2 wards (internal medicine and general surgery) of a large teaching hospital. Methods: A mixed methods sequential explanatory design was used. After thorough training and preparation, CMVS was implemented---in parallel with the standard intermittent manual measurements---and executed for 6 months in each ward. Heart rate and respiratory rate were measured using a chest-worn wearable sensor, and vital sign trends were visualized on a digital platform. Trends were routinely assessed and reported each nursing shift without automated alarms. The primary outcome was intervention fidelity, defined as the proportion of written reports and related nurse activities in case of deviating trends comparing early (months 1-2), mid- (months 3-4), and late (months 5-6) implementation periods. Explanatory interviews with nurses were conducted. Results: The implementation strategy was executed as planned. A total of 358 patients were included, resulting in 45,113 monitored hours during 6142 nurse shifts. In total, 10.3\% (37/358) of the sensors were replaced prematurely because of technical failure. Mean intervention fidelity was 70.7\% (SD 20.4\%) and higher in the surgical ward (73.6\%, SD 18.1\% vs 64.1\%, SD 23.7\%; P<.001). Fidelity decreased over the implementation period in the internal medicine ward (76\%, 57\%, and 48\% at early, mid-, and late implementation, respectively; P<.001) but not significantly in the surgical ward (76\% at early implementation vs 74\% at midimplementation [P=.56] vs 70.7\% at late implementation [P=.07]). No nursing activities were needed based on vital sign trends for 68.7\% (246/358) of the patients. In 174 reports of 31.3\% (112/358) of the patients, observed deviating trends led to 101 additional bedside assessments of patients and 73 consultations by physicians. The main themes that emerged during interviews (n=21) included the relative priority of CMVS in nurse work, the importance of nursing assessment, the relatively limited perceived benefits for patient care, and experienced mediocre usability of the technology. Conclusions: We successfully implemented a system for CMVS at scale in 2 hospital wards, but our results show that intervention fidelity decreased over time, more in the internal medicine ward than in the surgical ward. This decrease appeared to depend on multiple ward-specific factors. Nurses' perceptions regarding the value and benefits of the intervention varied. Implications for optimal implementation of CMVS include engaging nurses early, seamless integration into electronic health records, and sophisticated decision support tools for vital sign trend interpretation. ",
doi="10.2196/44061",
url="https://nursing.jmir.org/2023/1/e44061",
url="http://www.ncbi.nlm.nih.gov/pubmed/37140977"
}


@Article{info:doi/10.2196/43300,
author="Zlamal, Jaroslav
and Roth Gjevjon, Edith
and Fossum, Mariann
and Steindal, A. Simen
and Nes, Gon{\c{c}}alves Andr{\'e}a Aparecida",
title="A Technology-Supported Guidance Model to Support the Development of Critical Thinking Among Undergraduate Nursing Students in Clinical Practice: Concurrent, Exploratory, Flexible, and Multimethod Feasibility Study",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="26",
volume="7",
pages="e43300",
keywords="technology",
keywords="guidance model",
keywords="critical thinking",
keywords="feasibility",
keywords="nursing",
keywords="nursing education",
keywords="medical education",
keywords="nursing student",
keywords="digital intervention",
keywords="mobile app",
keywords="clinical practice",
abstract="Background: There is widespread recognition and acceptance of the need for critical thinking in nursing education, as it is necessary to provide high-quality nursing. The Technology-Supported Guidance Model (TSGM) intervention was conducted during clinical practice among undergraduate nursing students and aimed to support the development of critical thinking. A major element of this newly developed intervention is an app, Technology-Optimized Practice Process in Nursing (TOPP?N), combined with the daily guidance of nursing students from nurse preceptors and summative assessments based on the Assessment of Clinical Education. Objective: The main objective of this study was to assess the feasibility of a newly developed intervention, TSGM, among undergraduate nursing students, nurse preceptors, and nurse educators. Further objectives were to assess the primary and secondary outcome measures, recruitment strategy, and data collection strategy and to identify the potential causes of dropout and barriers to participant recruitment, retention, intervention fidelity, and adherence to the intervention. Methods: This study was designed as a concurrent, exploratory, flexible, and multimethod feasibility study of the TSGM intervention that included quantitative and qualitative data from nursing students, nurse preceptors, and nurse educators. The primary outcome measures were the feasibility and acceptability of the intervention. The secondary outcomes included the suitability and acceptance of the outcome measures (critical thinking, self-efficacy, clinical learning environment, metacognition and self-regulation, technology acceptance, and competence of mentors); data collection strategy; recruitment strategy; challenges related to dropouts; and hindrances to recruitment, retention, and intervention fidelity and adherence. Results: Nursing students, nurse preceptors, and nurse educators had varied experiences with the TSGM intervention. We identified factors that make the intervention feasible and challenging and may influence the feasibility, acceptability, dropout rate, adherence, and fidelity of the intervention. We also identified areas for future improvement of the intervention. Conclusions: The use of a newly developed intervention, TSGM, is feasible and accepted by undergraduate nursing students, nurse preceptors, and nurse educators; however, refinement and improvement of the intervention and the TOPP?N app, improvement in intervention management, and mitigation of negative factors are necessary before a randomized controlled trial can be performed. International Registered Report Identifier (IRRID): RR2-10.2196/31646 ",
doi="10.2196/43300",
url="https://formative.jmir.org/2023/1/e43300",
url="http://www.ncbi.nlm.nih.gov/pubmed/37099377"
}


@Article{info:doi/10.2196/45067,
author="Owusu, Boampong Lydia
and Scheepers, Nicholin
and Tenza, Sabelile Immaculate",
title="Utilization of Research in Clinical Nursing and Midwifery Practice in Ghana: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2023",
month="Apr",
day="7",
volume="12",
pages="e45067",
keywords="clinical practice",
keywords="educators",
keywords="evidence-based practice",
keywords="health facilities",
keywords="managers",
keywords="midwife",
keywords="midwives",
keywords="nurses",
keywords="nursing practice",
keywords="nursing",
keywords="research utilization",
abstract="Background: The International Council of Nurses' 2021 code of ethics mandates nurses to provide evidence-informed care to patients. Globally, using research evidence has led to improvement in nursing and midwifery practice, according to the World Health Organization. A study in Ghana found that 25.3\% (n=40) of nurses and midwives use research in clinical care. Research utilization (RU) increases therapeutic effectiveness, improves health outcomes, and enhances the personal and professional development of clinicians. However, it is uncertain the extent to which nurses and midwives are prepared, skilled, and supported to utilize research in clinical care in Ghana. Objective: This study aims to develop a conceptual framework that can facilitate RU among clinical nurses and midwives in Ghanaian health facilities. Methods: This will be a cross-sectional study with a concurrent mixed methods approach. It will be conducted in 6 hospitals and 4 nursing educational institutions in Kumasi, Ghana. The study has 4 objectives which will be executed in 3 phases. Phase 1 follows a quantitative approach to describe the knowledge, attitudes, and practices of clinical nurses and midwives on the use of research in their practice. Using a web-based survey, 400 nurses and midwives working in 6 health facilities will be recruited. Data analysis will be conducted using SPSS, with statistical significance set at .05. Qualitative methodology, using focus group discussions with clinical nurses and midwives, will be conducted to identify the factors influencing their RU. In phase 2, focus group discussions will be used to examine and describe how nurse educators in 4 nursing and midwifery educational institutions prepare nurses and midwives for RU during their education. Views of nurse managers on the RU in Ghanaian health care facilities will be explored in the second section of this phase through one-on-one interviews. Inductive thematic analysis will be used to analyze the qualitative data, and Lincoln and Guba's principles of trustworthiness will be applied. In phase 3, the stages of model development proposed by Chinn and Kramer; and Walker and Avant will be used to triangulate findings from all objectives and formulate a conceptual framework. Results: Data collection started in December 2022. Publication of the results will begin in April 2023. Conclusions: RU in clinical practice has become an acceptable practice in nursing and midwifery. It is critical that nursing and midwifery professionals in sub-Saharan Africa shift their practice to embrace the global movement. This proposed conceptual framework will empower nurses and midwives to improve their practice of RU. International Registered Report Identifier (IRRID): DERR1-10.2196/45067 ",
doi="10.2196/45067",
url="https://www.researchprotocols.org/2023/1/e45067",
url="http://www.ncbi.nlm.nih.gov/pubmed/37027196"
}


@Article{info:doi/10.2196/37673,
author="Haesum, Emtekaer Lisa Korsbakke
and Hejlesen, Kristian Ole
and Udsen, Witt Flemming",
title="An Interactive Communication Model for Self-Care---Regardless of Health Literacy: Protocol for a Quasi-Experimental Study",
journal="JMIR Res Protoc",
year="2023",
month="Mar",
day="31",
volume="12",
pages="e37673",
keywords="health literacy",
keywords="interactive communication",
keywords="nursing",
keywords="quasi-experimental study",
keywords="economic evaluation",
keywords="economic",
keywords="cost",
keywords="rehabilitation",
keywords="primary care",
keywords="nurse",
keywords="communication",
keywords="health information",
keywords="patient education",
keywords="health resource",
abstract="Background: Clear dialogue-based (interactive) communication that ensures comprehension and recall becomes more important in patient-provider interactions, especially in relation to patients with chronic diseases, where self-management education and counseling are cornerstones in managing these diseases. If patients with chronic disease experience challenges in obtaining, understanding, and applying health-related information (necessary to make informed health decisions and sufficiently manage their health), clear communication and ensuring comprehension become even more critical in the patient-provider interactions. Furthermore, patient-provider communication has been proposed as a potential pathway through which health literacy might influence health outcomes, especially in individuals with chronic diseases. Hence, adjusting communication to the individual level of health literacy might have a positive influence on health outcomes. On this basis, the authors have developed a web-based interactive communication model that both seeks to accommodate health literacy by allowing tailored communication and ensure comprehension and recall between nurses and patients. Objective: This study seeks to examine the use of an IT solution that comprises an interactive communication model that seeks to accommodate health literacy in communication and ensure comprehension and recall between nurses and patients. Methods: A quasi-experimental control group study including full economic evaluation with 6-month follow-up. Based on power calculation, a total of 82 participants will be included. Participants are assigned either the interactive communication model (intervention) or usual nursing care. It will be assessed if the model influences the level of health literacy and participants experience a higher health-related quality of life. Further, cost-effectiveness will be evaluated. Overall, the statistical methods will follow an intention-to-treat principle. Results will be presented in accordance with the Transparent Reporting of Evaluations with Non-randomized Designs guidelines for nonrandomized designs as well as the Consolidated Health Economic Evaluation Reporting Standards. Results: This paper describes a protocol for a clustered quasi-experimental control study that seeks to evaluate the effectiveness of the interactive communicative model. Most studies in the field of health literacy are epidemiological studies that seek to address the effects of poor health literacy in populations and its potential impact on health inequity. A total of 82 participants, who receive community nursing will be included. The final trial day is May 1, 2022, with the first report of results in the final quarter of 2022. Conclusions: The results of the trial can create the base for conducting a large-scale study and inspire the conduction of more studies that seeks to create and evaluate interventions aimed at enhancing the level of health literacy and reducing the usage of health resources. Trial Registration: ClinicalTrials.gov NCT04929314; https://clinicaltrials.gov/ct2/show/NCT04929314 International Registered Report Identifier (IRRID): DERR1-10.2196/37673 ",
doi="10.2196/37673",
url="https://www.researchprotocols.org/2023/1/e37673",
url="http://www.ncbi.nlm.nih.gov/pubmed/37000515"
}


@Article{info:doi/10.2196/42512,
author="Solberg, Trygg Marianne
and S{\o}rensen, Lene Anne
and Clarke, Sara
and Nes, Goncalves Andrea Aparecida",
title="Virtual Reflection Group Meetings as a Structured Active Learning Method to Enhance Perceived Competence in Critical Care: Focus Group Interviews With Advanced Practice Nursing Students",
journal="JMIR Med Educ",
year="2023",
month="Mar",
day="23",
volume="9",
pages="e42512",
keywords="advanced practice nurse",
keywords="nursing education",
keywords="virtual reflection group",
keywords="teaching design",
keywords="critical care",
keywords="active learning approach",
abstract="Background: Advanced practice nurses (APNs) are in high demand in critical care units. In Norway, APNs are educated at the master's degree level and acquire the competence to ensure the independent, safe, and effective treatment of patients in constantly and rapidly changing health situations. APNs' competence embraces expert knowledge and skills to perform complex decision-making in the clinical context; therefore, it is essential that educational institutions in nursing facilitate learning activities that ensure and improve students' achievement of the required competence. In clinical practice studies of APN education, face-to-face reflection group (FFRG) meetings, held on campus with the participation of a nurse educator and advanced practice nursing students (APNSs), are a common learning activity to improve the competence of APNSs. Although FFRG meetings stimulate APNSs' development of required competencies, they may also result in unproductive academic discussions, reduce the time that APNSs spend in clinical practice, and make it impossible for nurse preceptors (NPs) to attend the meetings, which are all challenges that need to be addressed. Objective: This study aimed to address the challenges experienced in FFRG meetings by implementing virtual reflection group (VRG) meetings and to explore the experiences of APNSs, NPs, and nurse educators in VRG meetings as an active learning method supported by technology to stimulate students' development of the required competence to become APNs in critical care. Methods: This study adopted a qualitative explorative design with 2 focus group interviews and used inductive content analysis to explore the collected data. Results: The main finding is that reflection group meetings supported by technology resulted in a better-structured active learning method. The VRG meeting design allowed APNSs to spend more time in clinical practice placements. The APNSs and NPs experienced that they participated actively and effectively in the meetings, which led to a perceived increase in competence. The APNSs also perceived an improved learning experience compared with their prior expectations. Conclusions: Users perceived that the implemented novel teaching design supported by technology, the VRG meeting, was a more effective method than FFRG meetings on campus to develop APNSs' required competence in critical care. The VRG was also perceived as an improved method to solve the challenges encountered in FFRG meetings. Specifically, the APNSs felt that they were prepared to undertake complex decision-making with a higher level of analytic cognition in a clinical context and to lead professional discussions in the ward. This developed teaching design can easily be adapted to diverse educational programs at various levels of professional education. ",
doi="10.2196/42512",
url="https://mededu.jmir.org/2023/1/e42512",
url="http://www.ncbi.nlm.nih.gov/pubmed/36951919"
}


@Article{info:doi/10.2196/40676,
author="Jiang, Haoqiang
and Castellanos, Arturo
and Castillo, Alfred
and Gomes, J. Paulo
and Li, Juanjuan
and VanderMeer, Debra",
title="Nurses' Work Concerns and Disenchantment During the COVID-19 Pandemic: Machine Learning Analysis of Web-Based Discussions",
journal="JMIR Nursing",
year="2023",
month="Feb",
day="6",
volume="6",
pages="e40676",
keywords="text mining",
keywords="machine learning",
keywords="blog data",
keywords="COVID-19",
keywords="pandemic",
keywords="work concerns",
keywords="stressors",
keywords="natural language processing",
abstract="Background: Web-based forums provide a space for communities of interest to exchange ideas and experiences. Nurse professionals used these forums during the COVID-19 pandemic to share their experiences and concerns. Objective: The objective of this study was to examine the nurse-generated content to capture the evolution of nurses' work concerns during the COVID-19 pandemic. Methods: We analyzed 14,060 posts related to the COVID-19 pandemic from March 2020 to April 2021. The data analysis stage included unsupervised machine learning and thematic qualitative analysis. We used an unsupervised machine learning approach, latent Dirichlet allocation, to identify salient topics in the collected posts. A human-in-the-loop analysis complemented the machine learning approach, categorizing topics into themes and subthemes. We developed insights into nurses' evolving perspectives based on temporal changes. Results: We identified themes for biweekly periods and grouped them into 20 major themes based on the work concern inventory framework. Dominant work concerns varied throughout the study period. A detailed analysis of the patterns in how themes evolved over time enabled us to create narratives of work concerns. Conclusions: The analysis demonstrates that professional web-based forums capture nuanced details about nurses' work concerns and workplace stressors during the COVID-19 pandemic. Monitoring and assessment of web-based discussions could provide useful data for health care organizations to understand how their primary caregivers are affected by external pressures and internal managerial decisions and design more effective responses and planning during crises. ",
doi="10.2196/40676",
url="https://nursing.jmir.org/2023/1/e40676",
url="http://www.ncbi.nlm.nih.gov/pubmed/36608261"
}


@Article{info:doi/10.2196/41729,
author="Shi, Yueping
and Gu, Pinhua
and Wang, Qiufeng
and Zhang, Xuelian",
title="The Nurse-Physician Relationship During the COVID-19 Pandemic in Shanghai, China: Cross-sectional Study",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="6",
volume="7",
pages="e41729",
keywords="nurse",
keywords="physician",
keywords="collaboration",
keywords="online survey",
keywords="nursing",
keywords="COVID-19",
keywords="structural equation modeling",
keywords="equation modeling",
keywords="nurse-physician",
keywords="ordinal logistic regression",
abstract="Background: The nurse-physician relationship is important for the stability of collaboration. The COVID-19 pandemic has put unprecedented pressure on the health care system and has placed greater demands on nurse-physician collaboration. Nurses and physicians often struggle to share mutual responsibility and communicate effectively. Objective: This study aimed to evaluate the relationship between nurses and physicians during the COVID-19 pandemic and construct a new model combining the attitude and behaviors of the 2 groups to assess various factors' impacts on job satisfaction and confrontational behavior. Methods: We conducted this quantitative cross-sectional study to assess the relationship between nurses and physicians based on the attitudes and behaviors toward nurse-physician collaboration. We first investigated the satisfaction of nurses and physicians with their relationship and how they thought the COVID-19 pandemic had affected that relationship. We used an adapted and modified Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration questionnaire that consisted of 17 items under 5 dimensions. Structural equation modeling was used to assess the relationships between domains. Ordinal logistic regression was used to evaluate the relationship between different domains of the questionnaire and the satisfaction of the current nurse-physician relationship. Results: We included a total of 176 nurses and 124 physicians in this study. Compared to 7.2\% (9/124) of physicians, 22.7\% (40/176) of nurses were dissatisfied with the current nurse-physician relationship. Most physicians (101/124, 81.5\%) and nurses (131/176, 74.5\%) agreed that the nurse-physician relationship had become better because of the COVID-19 pandemic and that the public had greater respect for them. However, significantly fewer nurses (59/176, 33.5\% vs 79/124, 63.7\%; P<.001) thought that physicians and nurses were treated with the same respect. Nurses scored significantly higher scores in caring versus curing (mean 16.27, SD 2.88 vs mean 17.43, SD 2.50; P<.001) and physician's authority (mean 8.72, SD 3.21 vs mean 7.24, SD 3.32; P<.001) subscales compared with physicians. The shared education and collaboration subscale had a significantly positive relationship with the nurse's autonomy subscale (standardized coefficient=0.98; P<.001). Logistic regression showed that 4 subscales (shared education and collaboration: P<.001; caring versus curing: P<.001; nurse's autonomy: P<.001; and confrontation: P=.01) were significantly associated with the level of satisfaction of the current nurse-physician relationship. Conclusions: This study showed that nurses were more dissatisfied with the current nurse-physician relationship than physicians in Shanghai. Policy makers and managers in the medical and educational system should emphasize an interprofessional collaboration between nurses and physicians. Positive attitudes toward shared collaboration and responsibility may help to improve the relationship between the 2 parties. ",
doi="10.2196/41729",
url="https://formative.jmir.org/2023/1/e41729",
url="http://www.ncbi.nlm.nih.gov/pubmed/36745499"
}


@Article{info:doi/10.2196/41331,
author="Picard, Christopher
and Kleib, Manal
and Norris, Colleen
and O'Rourke, M. Hannah
and Montgomery, Carmel
and Douma, Matthew",
title="The Use and Structure of Emergency Nurses' Triage Narrative Data: Scoping Review",
journal="JMIR Nursing",
year="2023",
month="Jan",
day="13",
volume="6",
pages="e41331",
keywords="nursing",
keywords="artificial intelligence",
keywords="machine learning",
keywords="triage",
keywords="review",
keywords="narrative",
abstract="Background: Emergency departments use triage to ensure that patients with the highest level of acuity receive care quickly and safely. Triage is typically a nursing process that is documented as structured and unstructured (free text) data. Free-text triage narratives have been studied for specific conditions but never reviewed in a comprehensive manner. Objective: The objective of this paper was to identify and map the academic literature that examines triage narratives. The paper described the types of research conducted, identified gaps in the research, and determined where additional review may be warranted. Methods: We conducted a scoping review of unstructured triage narratives. We mapped the literature, described the use of triage narrative data, examined the information available on the form and structure of narratives, highlighted similarities among publications, and identified opportunities for future research. Results: We screened 18,074 studies published between 1990 and 2022 in CINAHL, MEDLINE, Embase, Cochrane, and ProQuest Central. We identified 0.53\% (96/18,074) of studies that directly examined the use of triage nurses' narratives. More than 12 million visits were made to 2438 emergency departments included in the review. In total, 82\% (79/96) of these studies were conducted in the United States (43/96, 45\%), Australia (31/96, 32\%), or Canada (5/96, 5\%). Triage narratives were used for research and case identification, as input variables for predictive modeling, and for quality improvement. Overall, 31\% (30/96) of the studies offered a description of the triage narrative, including a list of the keywords used (27/96, 28\%) or more fulsome descriptions (such as word counts, character counts, abbreviation, etc; 7/96, 7\%). We found limited use of reporting guidelines (8/96, 8\%). Conclusions: The breadth of the identified studies suggests that there is widespread routine collection and research use of triage narrative data. Despite the use of triage narratives as a source of data in studies, the narratives and nurses who generate them are poorly described in the literature, and data reporting is inconsistent. Additional research is needed to describe the structure of triage narratives, determine the best use of triage narratives, and improve the consistent use of triage-specific data reporting guidelines. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-055132 ",
doi="10.2196/41331",
url="https://nursing.jmir.org/2023/1/e41331",
url="http://www.ncbi.nlm.nih.gov/pubmed/36637881"
}


@Article{info:doi/10.2196/39271,
author="Skiba, B. Meghan
and Harker, Graham
and Guidarelli, Carolyn
and El-Gohary, Mahmoud
and Horak, Fay
and Roeland, J. Eric
and Silbermann, Rebecca
and Hayes-Lattin, Brandon
and Winters-Stone, Kerri",
title="Using Wearable Inertial Sensors to Assess Mobility of Patients With Hematologic Cancer and Associations With Chemotherapy-Related Symptoms Before Autologous Hematopoietic Stem Cell Transplant: Cross-sectional Study",
journal="JMIR Cancer",
year="2022",
month="Dec",
day="8",
volume="8",
number="4",
pages="e39271",
keywords="wearable inertial sensor",
keywords="mobility",
keywords="gait",
keywords="induction chemotherapy",
keywords="autologous hematopoietic stem cell transplant",
keywords="autoHSCT",
keywords="chemotherapy-related symptoms",
abstract="Background: Wearable sensors could be a simple way to quantify and characterize mobility in patients with hematologic cancer scheduled to receive autologous hematopoietic stem cell transplant (autoHSCT) and how they may be related to common treatment-related symptoms and side effects of induction chemotherapy. Objective: We aimed to conduct a cross-sectional study comparing mobility in patients scheduled to receive autoHSCT with that in healthy, age-matched adult controls and determine the relationships between patient mobility and chemotherapy-related symptoms. Methods: Patients scheduled to receive autoHSCT (78/156, 50\%) and controls (78/156, 50\%) completed the prescribed performance tests using wearable inertial sensors to quantify mobility including turning (turn duration and number of steps), gait (gait speed, stride time, stride time variability, double support time, coronal trunk range of motion, heel strike angle, and distance traveled), and balance (coronal sway, coronal range, coronal velocity, coronal centroidal frequency, sagittal sway, sagittal range, sagittal velocity, and sagittal centroidal frequency). Patients completed the validated patient-reported questionnaires to assess symptoms common to chemotherapy: chemotherapy-induced peripheral neuropathy (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group--Neurotoxicity subscale), nausea and pain (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), fatigue (Patient-Reported Outcomes Measurement Information System Fatigue Short Form 8a), vertigo (Vertigo Symptom Scale--short form), and depression (Center for Epidemiological Studies--Depression). Paired, 2-sided t tests were used to compare mobility between patients and controls. Stepwise multivariable linear regression models were used to evaluate associations between patient mobility and symptoms. Results: Patients aged 60.3 (SD 10.3) years had significantly worse turning (turn duration; P<.001), gait (gait speed, stride time, stride time variability, double support time, heel strike angle, stride length, and distance traveled; all P<.001), and balance (coronal sway; P<.001, range; P<.001, velocity; P=.02, and frequency; P=.02; and sagittal range; P=.008) than controls. In patients, high nausea was associated with worse stride time variability ({\ss}=.001; P=.005) and heel strike angle ({\ss}=?.088; P=.02). Pain was associated with worse gait speed ({\ss}=?.003; P=.003), stride time variability ({\ss}=.012; P=.02), stride length ({\ss}=?.002; P=.004), and distance traveled ({\ss}=?.786; P=.005). Nausea and pain explained 17\% to 33\% and 14\% to 36\% of gait variance measured in patients, respectively. Conclusions: Patients scheduled to receive autoHSCT demonstrated worse mobility in multiple turning, gait, and balance domains compared with controls, potentially related in part to nausea and pain. Wearable inertial sensors used in the clinic setting could provide granular information about mobility before further treatment, which may in turn benefit from rehabilitation or symptom management. Future longitudinal studies are needed to better understand temporal changes in mobility and symptoms across the treatment trajectory to optimally time, design, and implement strategies, to preserve functioning in patients with hematologic cancer in the long term. ",
doi="10.2196/39271",
url="https://cancer.jmir.org/2022/4/e39271",
url="http://www.ncbi.nlm.nih.gov/pubmed/36480243"
}


@Article{info:doi/10.2196/37562,
author="Hou, Shih-Yen
and Wu, Ya-Lun
and Chen, Kai-Ching
and Chang, Ting-An
and Hsu, Yi-Min
and Chuang, Su-Jung
and Chang, Ying
and Hsu, Kai-Cheng",
title="Code-Switching Automatic Speech Recognition for Nursing Record Documentation: System Development and Evaluation",
journal="JMIR Nursing",
year="2022",
month="Dec",
day="7",
volume="5",
number="1",
pages="e37562",
keywords="nursing records",
keywords="automatic speech recognition",
keywords="code-switching",
keywords="transfer learning",
keywords="meta--transfer learning",
abstract="Background: Taiwan has insufficient nursing resources due to the high turnover rate of health care providers. Therefore, reducing the heavy workload of these employees is essential. Herein, speech transcription, which has various potential clinical applications, was employed for the documentation of nursing records. The requirement of including only one speaker per transcription facilitated data collection and system development. Moreover, authorization from patients was unnecessary. Objective: The aim of this study was to construct a speech recognition system for nursing records such that health care providers can complete nursing records without typing or with only a few edits. Methods: Nursing records in Taiwan are mainly written in Mandarin, with technical terms and abbreviations presented in both Mandarin and English. Therefore, the training set consisted of English code-switching information. Next, transfer learning (TL) and meta-TL (MTL) methods, which perform favorably in code-switching scenarios, were applied. Results: As of September 2021, the China Medical University Hospital Artificial Intelligence Speech (CMaiSpeech) data set was established by manually annotating approximately 100 hours of recordings from 525 speakers. The word error rate (WER) of the benchmark model of syllable-based TL was 29.54\% in code-switching. The WER of the proposed model of syllable-based MTL was 22.20\% in code-switching. The test set comprised 17,247 words. Moreover, in a clinical case, the proposed model of syllable-based MTL yielded a WER of 31.06\% in code-switching. The clinical test set contained 1159 words. Conclusions: This paper has two main contributions. First, the CMaiSpeech data set---a Mandarin-English corpus---has been established. Health care providers in Taiwan are often compelled to use a mixture of Mandarin and English in nursing records. Second, an automatic speech recognition system for nursing record document conversion was proposed. The proposed system can shorten the work handover time and further reduce the workload of health care providers. ",
doi="10.2196/37562",
url="https://nursing.jmir.org/2022/1/e37562",
url="http://www.ncbi.nlm.nih.gov/pubmed/36476781"
}


@Article{info:doi/10.2196/39012,
author="Lima, Souza Vivian Cristina Gama
and Soares, Souza Raquel de
and Santos, dos Willian Alves
and Alves, Paulo
and Fuly, Claro Patricia dos Santos",
title="Scientific Publications on Nursing for COVID-19 in Patients With Cancer: Scoping Review",
journal="JMIR Cancer",
year="2022",
month="Nov",
day="25",
volume="8",
number="4",
pages="e39012",
keywords="COVID-19",
keywords="review",
keywords="nursing",
keywords="coronavirus infection",
keywords="oncology nursing",
abstract="Background: The needs of patients with cancer must be met, especially in times of crisis. The advent of the pandemic triggered a series of strategic actions by the nursing team to preserve the health of patients and professionals---hence the importance of studies on nursing care actions provided to patients with cancer during the COVID-19 pandemic. It is known that these patients are susceptible to severe COVID-19. However, no previous review has summarized the findings of scientific studies on nursing for COVID-19 in patients with cancer. Objective: This study aims to map the topics addressed in scientific studies on nursing for COVID-19 in patients with cancer. Methods: A scoping review was conducted using the methodology described in the Joanna Briggs Institute Reviewers' Manual 2015. The research question was elaborated using the population, concept, and context framework: What topics have been studied in nursing publications about COVID-19 in adult patients with cancer? The searches were carried out in 8 databases between April and November 2021 without time restrictions. Results: In total, 973 publications were identified using the search strategies in the databases, and 12 papers were retrieved by consulting the references. A total of 31 (3.2\%) publications were included in the final analysis, generating 4 thematic categories on the subject: ``restructuring the services: how oncology nursing was adapted during the pandemic,'' ``experiences of patients and performance of the nursing team during the COVID-19 pandemic,'' ``protocols and recommendations for dealing with the COVID-19 pandemic,'' and ``challenges and the role of oncology nurses facing the COVID-19 pandemic.'' Conclusions: Several strategies used by oncology nurses to face the COVID-19 pandemic in the international scenario were identified. Reports about the restructuring of services and the team's reactions to the pandemic predominated. However, there is a lack of reports regarding emotional support strategies for health care professionals. Another gap identified was the scarcity of clinical studies on the activities developed by oncology nurses. Therefore, there is a need for clinical research in the oncology area and emotional coping strategies to support oncology nurses. ",
doi="10.2196/39012",
url="https://cancer.jmir.org/2022/4/e39012",
url="http://www.ncbi.nlm.nih.gov/pubmed/36219752"
}


@Article{info:doi/10.2196/41051,
author="Krupp, Anna
and Steege, Linsey
and Lee, John
and Lopez, Dunn Karen
and King, Barbara",
title="Supporting Decision-Making About Patient Mobility in the Intensive Care Unit Nurse Work Environment: Work Domain Analysis",
journal="JMIR Nursing",
year="2022",
month="Sep",
day="27",
volume="5",
number="1",
pages="e41051",
keywords="clinical decision-making",
keywords="early ambulation",
keywords="intensive care unit",
keywords="nursing",
keywords="qualitative research",
keywords="cognitive work analysis",
abstract="Background: Patient mobility is an evidenced-based physical activity intervention initiated during intensive care unit (ICU) admission and continued throughout hospitalization to maintain functional status, yet mobility is a complex intervention and not consistently implemented. Cognitive work analysis (CWA) is a useful human factors framework for understanding complex systems and can inform future technology design to optimize outcomes. Objective: The aim of this study is to understand the complexity and constraints of the ICU work environment as it relates to nurses carrying out patient mobility interventions, using CWA. Methods: We conducted a work domain analysis and completed an abstraction hierarchy using the CWA framework. Data from documents, observation (32 hours), and interviews with nurses (N=20) from 2 hospitals were used to construct the abstraction hierarchy. Results: Nurses seek information from a variety of sources and integrate patient and unit information to inform decision-making. The completed abstraction hierarchy depicts multiple high-level priorities that nurses balance, specifically, providing quality, safe care to patients while helping to manage unit-level throughput needs. Connections between levels on the abstraction hierarchy describe how and why nurses seek patient and hospital unit information to inform mobility decision-making. The analysis identifies several opportunities for technology design to support nurse decision-making about patient mobility. Conclusions: Future interventions need to consider the complexity of the ICU environment and types of information nurses need to make decisions about patient mobility. Considerations for future system redesign include developing and testing clinical decision support tools that integrate critical patient and unit-level information to support nurses in making patient mobility decisions. ",
doi="10.2196/41051",
url="https://nursing.jmir.org/2022/1/e41051",
url="http://www.ncbi.nlm.nih.gov/pubmed/36166282"
}


@Article{info:doi/10.2196/37297,
author="Ezenwa, Nkolika Beatrice
and Umoren, Rachel
and Fajolu, Bamikeolu Iretiola
and Hippe, S. Daniel
and Bucher, Sherri
and Purkayastha, Saptarshi
and Okwako, Felicitas
and Esamai, Fabian
and Feltner, B. John
and Olawuyi, Olubukola
and Mmboga, Annet
and Nafula, Concepta Mary
and Paton, Chris
and Ezeaka, Chinyere Veronica",
title="Using Mobile Virtual Reality Simulation to Prepare for In-Person Helping Babies Breathe Training: Secondary Analysis of a Randomized Controlled Trial (the eHBB/mHBS Trial)",
journal="JMIR Med Educ",
year="2022",
month="Sep",
day="12",
volume="8",
number="3",
pages="e37297",
keywords="virtual reality",
keywords="mobile learning",
keywords="Helping Babies Breathe",
keywords="neonatal resuscitation",
keywords="mobile Helping Babies Survive powered by District Health Information Software 2",
keywords="neonatal mortality",
keywords="digital education",
keywords="health care education",
keywords="health care worker",
keywords="medical education",
keywords="digital intervention",
abstract="Background: Neonatal mortality accounts for approximately 46\% of global under-5 child mortality. The widespread access to mobile devices in low- and middle-income countries has enabled innovations, such as mobile virtual reality (VR), to be leveraged in simulation education for health care workers. Objective: This study explores the feasibility and educational efficacy of using mobile VR for the precourse preparation of health care professionals in neonatal resuscitation training. Methods: Health care professionals in obstetrics and newborn care units at 20 secondary and tertiary health care facilities in Lagos, Nigeria, and Busia, Western Kenya, who had not received training in Helping Babies Breathe (HBB) within the past 1 year were randomized to access the electronic HBB VR simulation and digitized HBB Provider's Guide (VR group) or the digitized HBB Provider's Guide only (control group). A sample size of 91 participants per group was calculated based on the main study protocol that was previously published. Participants were directed to use the electronic HBB VR simulation and digitized HBB Provider's Guide or the digitized HBB Provider's Guide alone for a minimum of 20 minutes. HBB knowledge and skills assessments were then conducted, which were immediately followed by a standard, in-person HBB training course that was led by study staff and used standard HBB evaluation tools and the Neonatalie Live manikin (Laerdal Medical). Results: A total of 179 nurses and midwives participated (VR group: n=91; control group: n=88). The overall performance scores on the knowledge check (P=.29), bag and mask ventilation skills check (P=.34), and Objective Structured Clinical Examination A checklist (P=.43) were similar between groups, with low overall pass rates (6/178, 3.4\% of participants). During the Objective Structured Clinical Examination A test, participants in the VR group performed better on the critical step of positioning the head and clearing the airway (VR group: 77/90, 86\%; control group: 57/88, 65\%; P=.002). The median percentage of ventilations that were performed via head tilt, as recorded by the Neonatalie Live manikin, was also numerically higher in the VR group (75\%, IQR 9\%-98\%) than in the control group (62\%, IQR 13\%-97\%), though not statistically significantly different (P=.35). Participants in the control group performed better on the identifying a helper and reviewing the emergency plan step (VR group: 7/90, 8\%; control group: 16/88, 18\%; P=.045) and the washing hands step (VR group: 20/90, 22\%; control group: 32/88, 36\%; P=.048). Conclusions: The use of digital interventions, such as mobile VR simulations, may be a viable approach to precourse preparation in neonatal resuscitation training for health care professionals in low- and middle-income countries. ",
doi="10.2196/37297",
url="https://mededu.jmir.org/2022/3/e37297",
url="http://www.ncbi.nlm.nih.gov/pubmed/36094807"
}


@Article{info:doi/10.2196/36811,
author="Lim, Xiang Wei
and Fook-Chong, Stephanie
and Lim, Wah John
and Gan, Hoe Wee",
title="The Outcomes of App-Based Health Coaching to Improve Dietary Behavior Among Nurses in a Tertiary Hospital: Pilot Intervention Study",
journal="JMIR Nursing",
year="2022",
month="Jul",
day="15",
volume="5",
number="1",
pages="e36811",
keywords="smartphone app",
keywords="weight loss",
keywords="dietary behavior",
keywords="nurse",
keywords="app",
keywords="mobile health",
keywords="mHealth",
keywords="app-based health",
keywords="health coaching",
keywords="diet",
keywords="dietary choice",
abstract="Background: At the workplace, health care workers face multiple challenges in maintaining healthy dietary behaviors, which is the major factor behind obesity. A hospital-wide mass health screening exercise showed an increasing trend in the prevalence of obesity and median BMI from 2004 to 2019, as well as a higher crude obesity rate among shift workers. Objective: We aimed to evaluate the effectiveness of mobile app--based health coaching and incentives for achieving weight loss from better dietary choices among hospital nurses. Methods: We conducted a pilot study from June 2019 to March 2020, involving the use of a health-coaching app by 145 hospital nurses over 6 months. Weight and BMI were self-reported, and food scores were calculated. Data among overweight nurses, shift work nurses, and incentive groups were analyzed. Results: A total of 61 nurses were included in the final analysis. Of these 61 nurses, 38 (62\%) lost weight. The median percentage weight loss was 1.2\% (IQR 0\%-2.9\%; P<.001), and the median decrease in BMI was 0.35 (IQR ?0.15 to 0.82; P<.001), but they were not clinically significant. The median improvement in the food score was 0.4 (IQR 0-0.8). There was no difference between the incentive and nonincentive groups. A total of 49 (34\%) participants engaged for ?8 weeks. Conclusions: The study demonstrated an association between the use of app-based health coaching and the attainment of some weight loss in nurses, without a significant improvement in the food score. Incentives may nudge on-boarding, but do not sustain engagement. ",
doi="10.2196/36811",
url="https://nursing.jmir.org/2022/1/e36811",
url="http://www.ncbi.nlm.nih.gov/pubmed/35838811"
}


@Article{info:doi/10.2196/36930,
author="Swan, A. Marilyn
and Gietzen, J. Luke
and Hobbs, B. Barbara",
title="Familiarity in Rural Life: Protocol for a Scoping Review and Concept Analysis",
journal="JMIR Res Protoc",
year="2022",
month="Jun",
day="22",
volume="11",
number="6",
pages="e36930",
keywords="familiarity",
keywords="scoping review",
keywords="rural",
keywords="nursing",
keywords="nurse",
keywords="healthcare professional",
keywords="health care professional",
keywords="healthcare worker",
keywords="health care worker",
abstract="Background: Familiarity is a concept often used in literature but is not well defined or understood. As a key concept in rural nursing theory, the conceptual understanding of familiarity is currently incomplete. The findings from this scoping review will inform a concept analysis using Walker and Avant's method and to identify and define the missing key components of familiarity. Objective: The objective of this scoping review is to examine and analyze what is known in the existing literature about the concept of familiarity. Methods: The Joanna Briggs Institute scoping review framework guided the identification of literature published from 2016 to 2022 on familiarity. Following the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) reporting standard, the familiarity scoping review is registered on Open Science Framework (registration digital object identifier: 10.17605/OSF.IO/ZB8VF). A total of 8 databases, including PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus with full text, APA PsychInfo, Communication Source, EBSCO MegaFILE, Medline, Nursing \& Allied Health Database, and ScienceDirect, will be searched for 22 search terms. Covidence software will be used to manage the scoping review with each citation independently reviewed by 2 research team members for eligibility. Eligibility will be determined using a 2-level process. Each title and abstract will be screened for eligibility; for citations deemed eligible, a full-text article review will be conducted. The scoping review is expected to locate a large body of literature, and eligibility criteria will be refined during the title and abstract screening process. In addition, reference list scanning will be performed to locate relevant literature. Results: Familiarity data will be collected beginning October 2021 with anticipated completion in March 2022. Dissemination of findings will occur through scholarly presentations and in rural-focused and nursing publications in 2022 or 2023. The findings from this review will further the understanding of familiarity and how it affects rural life and nursing practice. Conclusions: This review will support a full understanding and add clarity to the concept of familiarity as a component of rural life. These new insights will advance the understanding of how familiarity influences rural health care practice. The concept analysis will provide theoretical support for rural nursing theory and promote an understanding of the interrelationships of rural concepts. International Registered Report Identifier (IRRID): PRR1-10.2196/36930 ",
doi="10.2196/36930",
url="https://www.researchprotocols.org/2022/6/e36930",
url="http://www.ncbi.nlm.nih.gov/pubmed/35731573"
}


@Article{info:doi/10.2196/38044,
author="Sowan, Azizeh
and Heins, Jenny
and Dayton, Christopher
and Scherer, Elizabeth
and Tam, Sun Wing
and Saikumar, Haritha",
title="Developing and Testing a Protocol for Managing Cardiopulmonary Resuscitation of Patients with Suspected or Confirmed COVID-19: In Situ Simulation Study",
journal="JMIR Nursing",
year="2022",
month="Jun",
day="16",
volume="5",
number="1",
pages="e38044",
keywords="in situ simulation",
keywords="critical care",
keywords="COVID",
keywords="cardiopulmonary",
keywords="resuscitation",
keywords="COVID-19",
keywords="treatment",
keywords="health care",
keywords="nursing",
keywords="health care equipment",
keywords="health care resources",
keywords="health care training",
keywords="health care staff",
abstract="Background: Resuscitating patients with suspected or confirmed COVID-19 imposes unique challenges to organizations and code blue teams. Studies that applied the American Heart Association (AHA) COVID-19--related Interim Resuscitation Guideline and similar European guidelines are scarce. Objective: This study aimed to develop and test a cardiopulmonary resuscitation protocol based on the AHA COVID-19--related Interim Resuscitation Guideline. Methods: The study was conducted as an in situ simulation in a medical intensive care unit. The COVID-19 cardiopulmonary resuscitation protocol was created and validated by 11 health care team members and tested using 4 simulation sessions where 46 code blue team members participated. During the simulation, we observed role clarity, the effectiveness of communication, team dynamics, infection control measures, and the availability of essential supplies and equipment. Results: The main issues identified in each simulation session were debriefed to the code blue teams and used to further revise the protocol. These include the assignment of tasks, availability of equipment and supplies, and failure of communication between the in-room and out-of-room teams. Solutions included changes in the placement of team members and roles and responsibilities; the creation of an isolation code medication package, a respiratory therapy kit, and an isolation code blue bag; and the use of two-way radios and N-95 masks with eye goggles to enhance communication between the teams. Conclusions: This study shed light on the challenges to implement the AHA COVID-19--related Interim Resuscitation Guideline. The in situ simulation was an effective approach for rapid training, identifying unreliable equipment and ineffective and inefficient workflow, and managing the complexity of the physical environment. ",
doi="10.2196/38044",
url="https://nursing.jmir.org/2022/1/e38044",
url="http://www.ncbi.nlm.nih.gov/pubmed/35675629"
}


@Article{info:doi/10.2196/35929,
author="Singh, Hardeep
and Tang, Terence
and Steele Gray, Carolyn
and Kokorelias, Kristina
and Thombs, Rachel
and Plett, Donna
and Heffernan, Matthew
and Jarach, M. Carlotta
and Armas, Alana
and Law, Susan
and Cunningham, V. Heather
and Nie, Xin Jason
and Ellen, E. Moriah
and Thavorn, Kednapa
and Nelson, LA Michelle",
title="Recommendations for the Design and Delivery of Transitions-Focused Digital Health Interventions: Rapid Review",
journal="JMIR Aging",
year="2022",
month="May",
day="19",
volume="5",
number="2",
pages="e35929",
keywords="transitions",
keywords="health",
keywords="medical informatics",
keywords="aged",
keywords="mobile phone",
abstract="Background: Older adults experience a high risk of adverse events during hospital-to-home transitions. Implementation barriers have prevented widespread clinical uptake of the various digital health technologies that aim to support hospital-to-home transitions. Objective: To guide the development of a digital health intervention to support transitions from hospital to home (the Digital Bridge intervention), the specific objectives of this review were to describe the various roles and functions of health care providers supporting hospital-to-home transitions for older adults, allowing future technologies to be more targeted to support their work; describe the types of digital health interventions used to facilitate the transition from hospital to home for older adults and elucidate how these interventions support the roles and functions of providers; describe the lessons learned from the design and implementation of these interventions; and identify opportunities to improve the fit between technology and provider functions within the Digital Bridge intervention and other transition-focused digital health interventions. Methods: This 2-phase rapid review involved a selective review of providers' roles and their functions during hospital-to-home transitions (phase 1) and a structured literature review on digital health interventions used to support older adults' hospital-to-home transitions (phase 2). During the analysis, the technology functions identified in phase 2 were linked to the provider roles and functions identified in phase 1. Results: In phase 1, various provider roles were identified that facilitated hospital-to-home transitions, including navigation-specific roles and the roles of nurses and physicians. The key transition functions performed by providers were related to the 3 categories of continuity of care (ie, informational, management, and relational continuity). Phase 2, included articles (n=142) that reported digital health interventions targeting various medical conditions or groups. Most digital health interventions supported management continuity (eg, follow-up, assessment, and monitoring of patients' status after hospital discharge), whereas informational and relational continuity were the least supported. The lessons learned from the interventions were categorized into technology- and research-related challenges and opportunities and informed several recommendations to guide the design of transition-focused digital health interventions. Conclusions: This review highlights the need for Digital Bridge and other digital health interventions to align the design and delivery of digital health interventions with provider functions, design and test interventions with older adults, and examine multilevel outcomes. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-045596 ",
doi="10.2196/35929",
url="https://aging.jmir.org/2022/2/e35929",
url="http://www.ncbi.nlm.nih.gov/pubmed/35587874"
}


@Article{info:doi/10.2196/36959,
author="McDonall, Jo
and Redley, Bernice
and Livingston, Patricia
and Hutchinson, Ana
and de Steiger, Richard
and Botti, Mari",
title="A Nurse-Led Multimedia Intervention to Increase Patient Participation in Recovery After Knee Arthroplasty: Hybrid Type II Implementation Study",
journal="JMIR Hum Factors",
year="2022",
month="May",
day="19",
volume="9",
number="2",
pages="e36959",
keywords="patient participation",
keywords="multimedia",
keywords="nurse-facilitated",
keywords="knee arthroplasty",
keywords="orthopedic surgery",
keywords="acute care",
keywords="nurse",
keywords="participatory medicine",
keywords="digital technology",
abstract="Background: Advances in digital technology and the use of multimedia platforms to deliver information provide clinicians with a unique opportunity to develop innovative ways to consistently provide high-quality, accessible, and evidence-based information to support patient participation. Introducing new technologies into everyday acute care clinical practice can be difficult. Objective: The aim of this paper was to provide a description of an implementation strategy and the subsequent evaluation undertaken to examine the contextual factors important to the successful adoption of new technology by nurses in the context of acute postoperative care. Methods: Implementation of the intervention and process evaluation was undertaken in 3 phases: phase 1, preimplementation stakeholder engagement and identification of barriers and enablers to implementation; phase 2, supported implementation of the intervention; and phase 3, evaluation of uptake, usability, and acceptability of the intervention in clinical practice. Results: The outcomes of the implementation of the multimedia intervention in the context of acute postoperative care were positive. Of the 104 patients in the intervention group, 103 (99\%) received the intervention. All 103 patients completed the 8-item intervention questionnaire and 93.3\% (97/103) were interviewed on day 3 to evaluate usability, uptake, and acceptability. Of these 97 patients, almost all (n=94, 91\%) found the program easy to use and most (n=64, 62\%) could view the MyStay Total Knee Replacement program as often as they wanted. The findings also suggest that the time to implement the program was minimal (5-10 minutes). Collaboration with nurses and patients before and during implementation to identify potential barriers to successful implementation of the intervention was essential to develop timely strategies to overcome these barriers. To ensure end-user engagement, careful consideration was given to nurses' views on who was responsible for facilitating this intervention. Conclusions: The findings provide evidence that the structured implementation of the multimedia intervention was robust and successful in terms of patient participant recruitment and application; however, it was difficult to assess the level of engagement by nurse clinicians with the program. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614000340639; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000340639 ",
doi="10.2196/36959",
url="https://humanfactors.jmir.org/2022/2/e36959",
url="http://www.ncbi.nlm.nih.gov/pubmed/35588363"
}


@Article{info:doi/10.2196/36654,
author="Mangsbacka, Maria
and Gustavell, Tina",
title="Nurses' Experiences Using an Interactive System to Assess and Manage Treatment-Related Symptoms of Patients With Pancreatic Cancer: Interview Study",
journal="JMIR Nursing",
year="2022",
month="May",
day="16",
volume="5",
number="1",
pages="e36654",
keywords="app",
keywords="health care professionals",
keywords="mobile health",
keywords="mHealth",
keywords="nurses",
keywords="pancreatic cancer",
keywords="person-centered care",
keywords="symptom-management",
keywords="qualitative interview",
keywords="nursing",
keywords="interview",
abstract="Background: Treatment for pancreatic cancer entails symptom distress and a high burden of self-care. Patient-reported outcomes, collected with the support of mobile health (mHealth), have shown positive effects on symptom management, patient satisfaction, and quality of life for patients with cancer. For mHealth tools to become an integral part of clinical routine, experiences from health care professionals are needed. Objective: The aim of this paper is to describe nurses' experiences of integrating an interactive system (Interaktor) for symptom assessment and management into daily practice, when caring for patients following pancreaticoduodenectomy and during chemotherapy treatment due to pancreatic cancer. Methods: Patients reported symptoms via the Interaktor app daily for 6 months. In the event of alarming symptoms, an alert was triggered to the patient's nurse who then called the patient to offer advice and support. All nurses (n=8) who assessed patients were interviewed either individually or in a group. Transcribed interviews were analyzed using qualitative thematic analysis. Results: mHealth can facilitate person-centered care by offering nurses a way to gain knowledge about patients and to build relationships. Further, obstacles to implementation could be seen due to a lack of structural prerequisites and uncertainty about multiple ways to interact with patients. Conclusions: The Interaktor system can provide person-centered care. However, to implement mHealth tools as a clinical routine, focus needs to be placed on creating the necessary organizational conditions. ",
doi="10.2196/36654",
url="https://nursing.jmir.org/2022/1/e36654",
url="http://www.ncbi.nlm.nih.gov/pubmed/35576577"
}


@Article{info:doi/10.2196/36346,
author="Gordon, Kayleigh
and Dainty, N. Katie
and Steele Gray, Carolyn
and DeLacy, Jane
and Shah, Amika
and Seto, Emily",
title="Normalizing Telemonitoring in Nurse-Led Care Models for Complex Chronic Patient Populations: Case Study",
journal="JMIR Nursing",
year="2022",
month="Apr",
day="28",
volume="5",
number="1",
pages="e36346",
keywords="telemonitoring",
keywords="TM",
keywords="nurse practitioner",
keywords="NP-led care",
keywords="models of care",
keywords="integrated care",
keywords="disease care model",
keywords="disease",
keywords="nurse",
keywords="nurse-led implementation",
keywords="complex chronic conditions",
keywords="CCC",
keywords="clinical team",
keywords="mobile phone",
abstract="Background: The implementation of telemonitoring (TM) has been successful in terms of the overall feasibility and adoption in single disease care models. However, a lack of available research focused on nurse-led implementations of TM that targets patients with multiple and complex chronic conditions (CCC) hinders the scale and spread to these patient populations. In particular, little is known about the clinical perspective on the implementation of TM for patients with CCC in outpatient care. Objective: This study aims to better understand the perspective of the clinical team (both frontline clinicians and those in administrative positions) on the implementation and normalization of TM for complex patients in a nurse-led clinic model. Methods: A pragmatic, 6-month implementation study was conducted to embed multicondition TM, including heart failure, hypertension, and diabetes, into an integrated nurse-led model of care. Throughout the study, clinical team members were observed, and a chart review was conducted of the care provided during this time. At the end of the study, clinical team members participated in qualitative interviews and completed the adapted Normalization Measure Development questionnaires. The Normalization Process Theory guided the deductive data analysis. Results: Overall, 9 team members participated in the study as part of a larger feasibility study of the TM program, of which 26 patients were enrolled. Team members had a shared understanding of the purpose and value of TM as an intervention embedded within their practice to meet the diverse needs of their patients with CCC. TM aligned well with existing chronic care practices in several ways, yet it changed the process of care delivery (ie, interactional workability subconstruct). Effective TM normalization in nurse-led care requires rethinking of clinical workflows to incorporate TM, relationship development between the clinicians and their patients, communication with the interdisciplinary team, and frequent clinical care oversight. This was captured well through the subconstructs of skill set workability, relational integration, and contextual integration of the Normalization Process Theory. Conclusions: Clinicians successfully adopted TM into their everyday practice such that some providers felt their role would be significantly and negatively affected without TM. This study demonstrated that smartphone-based TM systems complemented the routine and challenging clinical work caring for patients with CCC in an integrated nurse-led care model. ",
doi="10.2196/36346",
url="https://nursing.jmir.org/2022/1/e36346",
url="http://www.ncbi.nlm.nih.gov/pubmed/35482375"
}


@Article{info:doi/10.2196/35058,
author="Chua, Ling Wei
and Ooi, Leng Sim
and Chan, Han Gene Wai
and Lau, Ching Tang
and Liaw, Ying Sok",
title="The Effect of a Sepsis Interprofessional Education Using Virtual Patient Telesimulation on Sepsis Team Care in Clinical Practice: Mixed Methods Study",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="18",
volume="24",
number="4",
pages="e35058",
keywords="sepsis",
keywords="interprofessional education",
keywords="team training",
keywords="nurse-physician communication",
keywords="simulation",
keywords="telesimulation",
abstract="Background: Improving interprofessional communication and collaboration is necessary to facilitate the early identification and treatment of patients with sepsis. Preparing undergraduate medical and nursing students for the knowledge and skills required to assess, escalate, and manage patients with sepsis is crucial for their entry into clinical practice. However, the COVID-19 pandemic and social distancing measures have created the need for interactive distance learning to support collaborative learning. Objective: This study aimed to evaluate the effect of sepsis interprofessional education on medical and nursing students' sepsis knowledge, team communication skills, and skill use in clinical practice. Methods: A mixed methods design using a 1-group pretest-posttest design and focus group discussions was used. This study involved 415 undergraduate medical and nursing students from a university in Singapore. After a baseline evaluation of the participants' sepsis knowledge and team communication skills, they underwent didactic e-learning followed by virtual telesimulation on early recognition and management of sepsis and team communication strategies. The participants' sepsis knowledge and team communication skills were evaluated immediately and 2 months after the telesimulation. In total, 4 focus group discussions were conducted using a purposive sample of 18 medical and nursing students to explore their transfer of learning to clinical practice. Results: Compared with the baseline scores, both the medical and nursing students demonstrated a significant improvement in sepsis knowledge (P<.001) and team communication skills (P<.001) in immediate posttest scores. At the 2-month follow-up, the nursing students continued to have statistically significantly higher sepsis knowledge (P<.001) and communication scores (P<.001) than the pretest scores, whereas the medical students had no significant changes in test scores between the 2-month follow-up and pretest time points (P=.99). A total of three themes emerged from the qualitative findings: greater understanding of each other's roles, application of mental models in clinical practice, and theory-practice gaps. The sepsis interprofessional education---particularly the use of virtual telesimulation---fostered participants' understanding and appreciation of each other's interprofessional roles when caring for patients with sepsis. Despite noting some incongruities with the real-world clinical practice and not encountering many sepsis scenarios in clinical settings, participants shared the application of mental models using interprofessional communication strategies and the patient assessment framework in their daily clinical practice. Conclusions: Although the study did not show long-term knowledge retention, the use of virtual telesimulation played a critical role in facilitating the application of mental models for learning transfer and therefore could serve as a promising education modality for sepsis training. For a greater clinical effect, future studies could complement virtual telesimulation with a mannequin-based simulation and provide more evidence on the long-term retention of sepsis knowledge and clinical skills performance. ",
doi="10.2196/35058",
url="https://www.jmir.org/2022/4/e35058",
url="http://www.ncbi.nlm.nih.gov/pubmed/35436237"
}


@Article{info:doi/10.2196/30130,
author="Strauss, T. Alexandra
and Morgan, Cameron
and El Khuri, Christopher
and Slogeris, Becky
and Smith, G. Aria
and Klein, Eili
and Toerper, Matt
and DeAngelo, Anthony
and Debraine, Arnaud
and Peterson, Susan
and Gurses, P. Ayse
and Levin, Scott
and Hinson, Jeremiah",
title="A Patient Outcomes--Driven Feedback Platform for Emergency Medicine Clinicians: Human-Centered Design and Usability Evaluation of Linking Outcomes Of Patients (LOOP)",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="23",
volume="9",
number="1",
pages="e30130",
keywords="emergency medicine",
keywords="usability",
keywords="human-centered design",
keywords="health informatics",
keywords="feedback",
keywords="practice-based learning and improvement",
keywords="emergency room",
keywords="ER",
keywords="platform",
keywords="outcomes",
keywords="closed-loop learning",
abstract="Background: The availability of patient outcomes--based feedback is limited in episodic care environments such as the emergency department. Emergency medicine (EM) clinicians set care trajectories for a majority of hospitalized patients and provide definitive care to an even larger number of those discharged into the community. EM clinicians are often unaware of the short- and long-term health outcomes of patients and how their actions may have contributed. Despite large volumes of patients and data, outcomes-driven learning that targets individual clinician experiences is meager. Integrated electronic health record (EHR) systems provide opportunity, but they do not have readily available functionality intended for outcomes-based learning. Objective: This study sought to unlock insights from routinely collected EHR data through the development of an individualizable patient outcomes feedback platform for EM clinicians. Here, we describe the iterative development of this platform, Linking Outcomes Of Patients (LOOP), under a human-centered design framework, including structured feedback obtained from its use. Methods: This multimodal study consisting of human-centered design studios, surveys (24 physicians), interviews (11 physicians), and a LOOP application usability evaluation (12 EM physicians for ?30 minutes each) was performed between August 2019 and February 2021. The study spanned 3 phases: (1) conceptual development under a human-centered design framework, (2) LOOP technical platform development, and (3) usability evaluation comparing pre- and post-LOOP feedback gathering practices in the EHR. Results: An initial human-centered design studio and EM clinician surveys revealed common themes of disconnect between EM clinicians and their patients after the encounter. Fundamental postencounter outcomes of death (15/24, 63\% respondents identified as useful), escalation of care (20/24, 83\%), and return to ED (16/24, 67\%) were determined high yield for demonstrating proof-of-concept in our LOOP application. The studio aided the design and development of LOOP, which integrated physicians throughout the design and content iteration. A final LOOP prototype enabled usability evaluation and iterative refinement prior to launch. Usability evaluation compared to status quo (ie, pre-LOOP) feedback gathering practices demonstrated a shift across all outcomes from ``not easy'' to ``very easy'' to obtain and from ``not confident'' to ``very confident'' in estimating outcomes after using LOOP. On a scale from 0 (unlikely) to 10 (most likely), the users were very likely (9.5) to recommend LOOP to a colleague. Conclusions: This study demonstrates the potential for human-centered design of a patient outcomes--driven feedback platform for individual EM providers. We have outlined a framework for working alongside clinicians with a multidisciplined team to develop and test a tool that augments their clinical experience and enables closed-loop learning. ",
doi="10.2196/30130",
url="https://humanfactors.jmir.org/2022/1/e30130",
url="http://www.ncbi.nlm.nih.gov/pubmed/35319469"
}


@Article{info:doi/10.2196/19641,
author="Itoh, Sakiko
and Tan, Hwee-Pink
and Kudo, Kenichi
and Ogata, Yasuko",
title="Comparison of the Mental Burden on Nursing Care Providers With and Without Mat-Type Sleep State Sensors at a Nursing Home in Tokyo, Japan: Quasi-Experimental Study",
journal="JMIR Aging",
year="2022",
month="Mar",
day="23",
volume="5",
number="1",
pages="e19641",
keywords="long-term care",
keywords="caregiver burden",
keywords="nursing homes",
keywords="aged",
keywords="information technology",
keywords="sensors",
abstract="Background: Increasing need for nursing care has led to the increased burden on formal caregivers, with those in nursing homes having to deal with exhausting labor. Although research activities on the use of internet of things devices to support nursing care for older adults exist, there is limited evidence on the effectiveness of these interventions among formal caregivers in nursing homes. Objective: This study aims to investigate whether mat-type sleep state sensors for supporting nursing care can reduce the mental burden of formal caregivers in a nursing home. Methods: This was a quasi-experimental study at a nursing home in Tokyo, Japan. The study participants were formal caregivers who cared for residents in private rooms on the fourth and fifth floors of the nursing home. In the intervention group, formal caregivers took care of residents who used sleep state sensors on the fourth floor of the nursing home. The sleep state sensors were mat types and designed to detect body motion such as the frequency of toss and turning and to measure heartbeat and respiration. One sensor was placed on a bed in a private room. When body motion is detected, the information is instantly displayed on a monitor at a staff station. In addition, the mental condition of the formal caregivers was measured using a validated self-reported outcome measure---the Profile of Mood States (POMS), Short-Form, 2nd edition. Formal caregivers in both groups received the POMS at baseline, midpoint (week 4), and endpoint (week 8) to identify changes in these domains. The primary outcome was the difference in total mood disturbance (TMD) of the POMS at baseline and week 8. Results: Of the 22 eligible formal caregivers, 12 (intervention group) utilized sleep state sensors for 8 weeks. The remaining 10 formal caregivers (control group) provided nursing care as usual. As for the primary outcome of the difference between TMD at baseline and week 8, TMD in the intervention group improved by --3.67 versus 4.70 in the control group, resulting in a mean difference of --8.37 (95\% CI --32.02 to 15.29; P=.48) in favor of the intervention. Conclusions: The present 8-week study showed that sleep state sensing for elderly residents might not be associated with reduced mental burdens on formal caregivers in nursing homes. ",
doi="10.2196/19641",
url="https://aging.jmir.org/2022/1/e19641",
url="http://www.ncbi.nlm.nih.gov/pubmed/35319474"
}


@Article{info:doi/10.2196/32075,
author="Nwosu, Callistus Amara
and McGlinchey, Tamsin
and Sanders, Justin
and Stanley, Sarah
and Palfrey, Jennifer
and Lubbers, Patrick
and Chapman, Laura
and Finucane, Anne
and Mason, Stephen",
title="Identification of Digital Health Priorities for Palliative Care Research: Modified Delphi Study",
journal="JMIR Aging",
year="2022",
month="Mar",
day="21",
volume="5",
number="1",
pages="e32075",
keywords="palliative care",
keywords="terminal care",
keywords="supportive care",
keywords="quality of life",
keywords="symptom management",
keywords="digital health",
keywords="technology",
abstract="Background: Developments in digital health have the potential to transform the delivery of health and social care to help citizens manage their health. Currently, there is a lack of consensus about digital health research priorities in palliative care and a lack of theories about how these technologies might improve care outcomes. Therefore, it is important for health care leaders to identify innovations to ensure that an increasingly frail population has appropriate access to palliative care services. Consequently, it is important to articulate research priorities as the first step in determining how finite resources should be allocated to a field saturated with rapidly developing innovation. Objective: The aim of this study is to identify research priority areas for digital health in palliative care. Methods: We selected digital health trends, most relevant to palliative care, from a list of emerging trends reported by a leading institute of quantitative futurists. We conducted 2 rounds of the Delphi questionnaire, followed by a consensus meeting and public engagement workshop to establish a final consensus on research priorities for digital technology in palliative care. We used the views of public representatives to gain their perspectives on the agreed priorities. Results: A total of 103 experts (representing 11 countries) participated in the first Delphi round. Of the 103 experts, 55 (53.3\%) participated in the second round. The final consensus meetings were attended by 10.7\% (11/103) of the experts. We identified 16 priority areas, which involved many applications of technologies, including care for patients and caregivers, self-management and reporting of diseases, education and training, communication, care coordination, and research methodology. We summarized the priority areas into eight topics: big data, mobile devices, telehealth and telemedicine, virtual reality, artificial intelligence, smart home, biotechnology, and digital legacy. Conclusions: The priorities identified in this study represent a wide range of important emerging areas in the fields of digital health, personalized medicine, and data science. Human-centered design and robust governance systems should be considered in future research. It is important that the risks of using these technologies in palliative care are properly addressed to ensure that these tools are used meaningfully, wisely, and safely and do not cause unintentional harm. ",
doi="10.2196/32075",
url="https://aging.jmir.org/2022/1/e32075",
url="http://www.ncbi.nlm.nih.gov/pubmed/35311674"
}


@Article{info:doi/10.2196/35936,
author="Sutton, Lynsey
and Bell, Elliot
and Every-Palmer, Susanna
and Weatherall, Mark
and Skirrow, Paul",
title="Survivorship of Patients After Long Intensive Care Stay With Exploration and Experience in a New Zealand Cohort (SPLIT ENZ): Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2022",
month="Mar",
day="17",
volume="11",
number="3",
pages="e35936",
keywords="COVID-19",
keywords="critical illness",
keywords="disability",
keywords="intensive care unit",
keywords="survivorship",
keywords="Post Intensive Care Syndrome",
abstract="Background: Post Intensive Care Syndrome (PICS) was defined by the Society of Critical Care Medicine in 2012 with subsequent international research highlighting poor long-term outcomes; reduced quality of life; and impairments, for survivors of critical illness. To date, there has been no published research on the long-term outcomes of survivors of critical illness in New Zealand. Objective: The aim of this study is to explore long-term outcomes after critical illness in New Zealand. The primary objectives are to describe and quantify symptoms and disability, explore possible risk factors, and to identify unmet needs in survivors of critical illness. Methods: This will be a mixed methods study with 2 components. First, a prospective cohort study of approximately 100 participants with critical illness will be followed up at 1, 6, and 12 months after hospital discharge. The primary outcome will be disability assessed using the World Health Organization Disability Assessment Scale 2.0. Secondary outcomes will focus on mental health using the Hospital Anxiety and Depression Scale and the Impact of Events Scale-revised, cognitive function using the Montreal Cognitive Assessment (Montreal Cognitive Assessment--BLIND), and health-related quality of life using the European Quality of Life-Five Dimension-Five Level. The second element of the study will use qualitative grounded theory methods to explore participants experiences of recovery and highlight unmet needs. Results: This study was approved by the New Zealand Northern A Health and Disability Ethics Committee on August 16, 2021 (21/NTA/107), and has been registered with the Australian New Zealand Clinical Trials Registry on October 5, 2021. SPLIT ENZ is due to start recruitment in early 2022, aiming to enroll 125 patients over 2 years. Data collection is estimated to be completed by 2024-2025 and will be published once all data are available for reporting. Conclusions: Although international research has identified the prevalence of PICS and the extent of disability in survivors of critical illness, there is no published research in New Zealand. Research in this field is particularly pressing in the context of COVID-19, an illness that may include PICS in its sequelae. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN1262100133588; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382566\&showOriginal=true\&isReview=true International Registered Report Identifier (IRRID): PRR1-10.2196/35936 ",
doi="10.2196/35936",
url="https://www.researchprotocols.org/2022/3/e35936",
url="http://www.ncbi.nlm.nih.gov/pubmed/35297773"
}


@Article{info:doi/10.2196/30655,
author="Poncette, Akira-Sebastian
and Mosch, Katharina Lina
and Stablo, Lars
and Spies, Claudia
and Schieler, Monique
and Weber-Carstens, Steffen
and Feufel, A. Markus
and Balzer, Felix",
title="A Remote Patient-Monitoring System for Intensive Care Medicine: Mixed Methods Human-Centered Design and Usability Evaluation",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="11",
volume="9",
number="1",
pages="e30655",
keywords="digital health",
keywords="patient monitoring",
keywords="intensive care medicine",
keywords="intensive care unit",
keywords="technological innovation",
keywords="user-centered design",
keywords="usability",
keywords="user experience",
keywords="implementation science",
keywords="qualitative research",
keywords="interview",
keywords="mixed methods",
keywords="mobile phone",
abstract="Background: Continuous monitoring of vital signs is critical for ensuring patient safety in intensive care units (ICUs) and is becoming increasingly relevant in general wards. The effectiveness of health information technologies such as patient-monitoring systems is highly determined by usability, the lack of which can ultimately compromise patient safety. Usability problems can be identified and prevented by involving users (ie, clinicians). Objective: In this study, we aim to apply a human-centered design approach to evaluate the usability of a remote patient-monitoring system user interface (UI) in the ICU context and conceptualize and evaluate design changes. Methods: Following institutional review board approval (EA1/031/18), a formative evaluation of the monitoring UI was performed. Simulated use tests with think-aloud protocols were conducted with ICU staff (n=5), and the resulting qualitative data were analyzed using a deductive analytic approach. On the basis of the identified usability problems, we conceptualized informed design changes and applied them to develop an improved prototype of the monitoring UI. Comparing the UIs, we evaluated perceived usability using the System Usability Scale, performance efficiency with the normative path deviation, and effectiveness by measuring the task completion rate (n=5). Measures were tested for statistical significance using a 2-sample t test, Poisson regression with a generalized linear mixed-effects model, and the N-1 chi-square test. P<.05 were considered significant. Results: We found 37 individual usability problems specific to monitoring UI, which could be assigned to six subcodes: usefulness of the system, response time, responsiveness, meaning of labels, function of UI elements, and navigation. Among user ideas and requirements for the UI were high usability, customizability, and the provision of audible alarm notifications. Changes in graphics and design were proposed to allow for better navigation, information retrieval, and spatial orientation. The UI was revised by creating a prototype with a more responsive design and changes regarding labeling and UI elements. Statistical analysis showed that perceived usability improved significantly (System Usability Scale design A: mean 68.5, SD 11.26, n=5; design B: mean 89, SD 4.87, n=5; P=.003), as did performance efficiency (normative path deviation design A: mean 8.8, SD 5.26, n=5; design B: mean 3.2, SD 3.03, n=5; P=.001), and effectiveness (design A: 18 trials, failed 7, 39\% times, passed 11, 61\% times; design B: 20 trials, failed 0 times, passed 20 times; P=.002). Conclusions: Usability testing with think-aloud protocols led to a patient-monitoring UI with significantly improved usability, performance, and effectiveness. In the ICU work environment, difficult-to-use technology may result in detrimental outcomes for staff and patients. Technical devices should be designed to support efficient and effective work processes. Our results suggest that this can be achieved by applying basic human-centered design methods and principles. Trial Registration: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173 ",
doi="10.2196/30655",
url="https://humanfactors.jmir.org/2022/1/e30655",
url="http://www.ncbi.nlm.nih.gov/pubmed/35275071"
}


@Article{info:doi/10.2196/30512,
author="P{\'e}rez-Mart{\'i}, Montserrat
and Casad{\'o}-Mar{\'i}n, Lina
and Guill{\'e}n-Villar, Abraham",
title="Electronic Records With Tablets at the Point of Care in an Internal Medicine Unit: Before-After Time Motion Study",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="10",
volume="9",
number="1",
pages="e30512",
keywords="electronic health records",
keywords="nursing",
keywords="computer handheld",
keywords="equipment and supplies (devices tablets mobile phones, devices and technologies)",
keywords="workflow",
abstract="Background: There are many benefits of nursing professionals being able to consult electronic health records (EHRs) at the point of care. It promotes quality and patient security, communication, continuity of care, and time dedicated to records. Objective: The aim of this study was to evaluate whether making EHRs available at the point of care with tablets reduces nurses' time spent on records compared with the current system. The analysis included sociodemographic and qualitative variables, time spent per patient, and work shift. This time difference can be used for direct patient care. Methods: A before-after time motion study was carried out in the internal medicine unit. There was a total of 130 observations of 2 hours to 3 hours in duration of complete patient records that were carried out at the beginning of the nurses' work shifts. We calculated the time dedicated to measuring vital signs, patient evaluation, and EHR recording. The main variable was time spent per patient. Results: The average time spent per patient (total time/patients admitted) was lower with the tablet group (mean 4.22, SD 0.14 minutes) than with the control group (mean 4.66, SD 0.12 minutes); there were statistically significant differences (W=3.20, P=.001) and a low effect (d=.44) between groups. The tablet group saved an average of 0.44 (SD 0.13) minutes per patient. Similar results were obtained for the afternoon shift, which saved an average of 0.60 (SD 0.15) minutes per patient (t34=3.82, P=.01) and high effect (d=.77). However, although there was a mean difference of 0.26 (SD 0.22) minutes per patient for the night shift, this was not statistically significant (t29=1.16, P=.25). The ``nonparticipating'' average age was higher (49.57, SD 2.92 years) compared with the ``afternoon shift participants'' and ``night shift participants'' (P=.007). ``Nonparticipants'' of the night shift had a worse perception of the project. Conclusions: This investigation determined that, with EHRs at the point of care, the time spent for registration by the nursing staff decreases, because of reduced movements and avoiding data transcription. It eliminates unnecessary work that does not add value, and therefore, care is improved. So, we think EHRs at the point of care should be the future or natural method for nursing to undertake. However, variables that could have a negative effect include age, night shift, and nurses' perceptions. Therefore, it is proposed that training in the different work platforms and the participation of nurses are fundamental axes that any institution should consider before their implementation. ",
doi="10.2196/30512",
url="https://humanfactors.jmir.org/2022/1/e30512",
url="http://www.ncbi.nlm.nih.gov/pubmed/35142624"
}


@Article{info:doi/10.2196/27096,
author="Heponiemi, Tarja
and Gluschkoff, Kia
and Vehko, Tuulikki
and Kaihlanen, Anu-Marja
and Saranto, Kaija
and Nissinen, Sari
and Nadav, Janna
and Kujala, Sari",
title="Electronic Health Record Implementations and Insufficient Training Endanger Nurses' Well-being: Cross-sectional Survey Study",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="23",
volume="23",
number="12",
pages="e27096",
keywords="electronic health records",
keywords="implementation",
keywords="information systems",
keywords="training",
keywords="stress",
keywords="cognitive failures",
keywords="time pressure",
keywords="registered nurses",
abstract="Background: High expectations have been set for the implementations of health information systems (HIS) in health care. However, nurses have been dissatisfied after implementations of HIS. In particular, poorly functioning electronic health records (EHRs) have been found to induce stress and cognitive workload. Moreover, the need to learn new systems may require considerable effort from nurses. Thus, EHR implementations may have an effect on the well-being of nurses. Objective: This study aimed to examine the associations of EHR-to-EHR implementations and the sufficiency of related training with perceived stress related to information systems (SRIS), time pressure, and cognitive failures among registered nurses. Moreover, we examined the moderating effect of the employment sector (hospital, primary care, social services, and others) on these associations. Methods: This study was a cross-sectional survey study of 3610 registered Finnish nurses in 2020. EHR implementation was measured by assessing whether the work unit of each respondent had implemented or will implement a new EHR (1) within the last 6 months, (2) within the last 12 months, (3) in the next 12 months, and (4) at no point within the last 12 months or in the forthcoming 12 months. The associations were examined using analyses of covariance adjusted for age, gender, and employment sector. Results: The highest levels of SRIS (adjusted mean 4.07, SE 0.05) and time pressure (adjusted mean 4.55, SE 0.06) were observed among those who had experienced an EHR implementation within the last 6 months. The lowest levels of SRIS (adjusted mean 3.26, SE 0.04), time pressure (adjusted mean 4.41, SE 0.05), and cognitive failures (adjusted mean 1.84, SE 0.02) were observed among those who did not experience any completed or forthcoming implementations within 12 months. Nurses who perceived that they had received sufficient implementation-related training experienced less SRIS (F1=153.40, P<.001), time pressure (F1=80.95, P<.001), and cognitive failures (F1=34.96, P<.001) than those who had received insufficient training. Recent implementations and insufficient training were especially strongly associated with high levels of SRIS in hospitals. Conclusions: EHR implementations and insufficient training related to these implementations may endanger the well-being of nurses and even lead to errors. Thus, it is extremely important for organizations to offer comprehensive training before, during, and after implementations. Moreover, easy-to-use systems that allow transition periods, a re-engineering approach, and user involvement may be beneficial to nurses in the implementation process. Training and other improvements would be especially important in hospitals. ",
doi="10.2196/27096",
url="https://www.jmir.org/2021/12/e27096",
url="http://www.ncbi.nlm.nih.gov/pubmed/34941546"
}


@Article{info:doi/10.2196/33695,
author="Darnell, Doyanne
and Are{\'a}n, A. Patricia
and Dorsey, Shannon
and Atkins, C. David
and Tanana, J. Michael
and Hirsch, Tad
and Mooney, D. Sean
and Boudreaux, D. Edwin
and Comtois, Anne Katherine",
title="Harnessing Innovative Technologies to Train Nurses in Suicide Safety Planning With Hospitalized Patients: Protocol for Formative and Pilot Feasibility Research",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="15",
volume="10",
number="12",
pages="e33695",
keywords="suicide prevention",
keywords="hospital",
keywords="training",
keywords="e-learning",
keywords="artificial intelligence",
keywords="implementation science",
keywords="user-centered design",
keywords="task-shifting",
keywords="quality assessment",
keywords="fidelity",
abstract="Background: Suicide is the 10th leading cause of death in the United States, with >47,000 deaths in 2019. Most people who died by suicide had contact with the health care system in the year before their death. Health care provider training is a top research priority identified by the National Action Alliance for Suicide Prevention; however, evidence-based approaches that target skill-building are resource intensive and difficult to implement. Advances in artificial intelligence technology hold promise for improving the scalability and sustainability of training methods, as it is now possible for computers to assess the intervention delivery skills of trainees and provide feedback to guide skill improvements. Much remains to be known about how best to integrate these novel technologies into continuing education for health care providers. Objective: In Project WISE (Workplace Integrated Support and Education), we aim to develop e-learning training in suicide safety planning, enhanced with novel skill-building technologies that can be integrated into the routine workflow of nurses serving patients hospitalized for medical or surgical reasons or traumatic injury. The research aims include identifying strategies for the implementation and workflow integration of both the training and safety planning with patients, adapting 2 existing technologies to enhance general counseling skills for use in suicide safety planning (a conversational agent and an artificial intelligence--based feedback system), observing training acceptability and nurse engagement with the training components, and assessing the feasibility of recruitment, retention, and collection of longitudinal self-report and electronic health record data for patients identified as at risk of suicide. Methods: Our developmental research includes qualitative and observational methods to explore the implementation context and technology usability, formative evaluation of the training paradigm, and pilot research to assess the feasibility of conducting a future cluster randomized pragmatic trial. The trial will examine whether patients hospitalized for medical or surgical reasons or traumatic injury who are at risk of suicide have better suicide-related postdischarge outcomes when admitted to a unit with nurses trained using the skill-building technology than those admitted to a unit with untrained nurses. The research takes place at a level 1 trauma center, which is also a safety-net hospital and academic medical center. Results: Project WISE was funded in July 2019. As of September 2021, we have completed focus groups and usability testing with 27 acute care and 3 acute and intensive care nurses. We began data collection for research aims 3 and 4 in November 2021. All research has been approved by the University of Washington institutional review board. Conclusions: Project WISE aims to further the national agenda to improve suicide prevention in health care settings by training nurses in suicide prevention with medically hospitalized patients using novel e-learning technologies. International Registered Report Identifier (IRRID): DERR1-10.2196/33695 ",
doi="10.2196/33695",
url="https://www.researchprotocols.org/2021/12/e33695",
url="http://www.ncbi.nlm.nih.gov/pubmed/34914618"
}


@Article{info:doi/10.2196/30238,
author="Rossetti, Collins Sarah
and Dykes, C. Patricia
and Knaplund, Christopher
and Kang, Min-Jeoung
and Schnock, Kumiko
and Garcia Jr, Pedro Jose
and Fu, Li-Heng
and Chang, Frank
and Thai, Tien
and Fred, Matthew
and Korach, Z. Tom
and Zhou, Li
and Klann, G. Jeffrey
and Albers, David
and Schwartz, Jessica
and Lowenthal, Graham
and Jia, Haomiao
and Liu, Fang
and Cato, Kenrick",
title="The Communicating Narrative Concerns Entered by Registered Nurses (CONCERN) Clinical Decision Support Early Warning System: Protocol for a Cluster Randomized Pragmatic Clinical Trial",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="10",
volume="10",
number="12",
pages="e30238",
keywords="nursing documentation",
keywords="prediction",
keywords="early warning system",
keywords="deterioration",
keywords="clinical trial",
keywords="clinical decision support system",
keywords="natural language processing",
abstract="Background: Every year, hundreds of thousands of inpatients die from cardiac arrest and sepsis, which could be avoided if those patients' risk for deterioration were detected and timely interventions were initiated. Thus, a system is needed to convert real-time, raw patient data into consumable information that clinicians can utilize to identify patients at risk of deterioration and thus prevent mortality and improve patient health outcomes. The overarching goal of the COmmunicating Narrative Concerns Entered by Registered Nurses (CONCERN) study is to implement and evaluate an early warning score system that provides clinical decision support (CDS) in electronic health record systems. With a combination of machine learning and natural language processing, the CONCERN CDS utilizes nursing documentation patterns as indicators of nurses' increased surveillance to predict when patients are at the risk of clinical deterioration. Objective: The objective of this cluster randomized pragmatic clinical trial is to evaluate the effectiveness and usability of the CONCERN CDS system at 2 different study sites. The specific aim is to decrease hospitalized patients' negative health outcomes (in-hospital mortality, length of stay, cardiac arrest, unanticipated intensive care unit transfers, and 30-day hospital readmission rates). Methods: A multiple time-series intervention consisting of 3 phases will be performed through a 1-year period during the cluster randomized pragmatic clinical trial. Phase 1 evaluates the adoption of our algorithm through pilot and trial testing, phase 2 activates optimized versions of the CONCERN CDS based on experience from phase 1, and phase 3 will be a silent release mode where no CDS is viewable to the end user. The intervention deals with a series of processes from system release to evaluation. The system release includes CONCERN CDS implementation and user training. Then, a mixed methods approach will be used with end users to assess the system and clinician perspectives. Results: Data collection and analysis are expected to conclude by August 2022. Based on our previous work on CONCERN, we expect the system to have a positive impact on the mortality rate and length of stay. Conclusions: The CONCERN CDS will increase team-based situational awareness and shared understanding of patients predicted to be at risk for clinical deterioration in need of intervention to prevent mortality and associated harm. Trial Registration: ClinicalTrials.gov NCT03911687; https://clinicaltrials.gov/ct2/show/NCT03911687 International Registered Report Identifier (IRRID): DERR1-10.2196/30238 ",
doi="10.2196/30238",
url="https://www.researchprotocols.org/2021/12/e30238",
url="http://www.ncbi.nlm.nih.gov/pubmed/34889766"
}


@Article{info:doi/10.2196/26522,
author="Seibert, Kathrin
and Domhoff, Dominik
and Bruch, Dominik
and Schulte-Althoff, Matthias
and F{\"u}rstenau, Daniel
and Biessmann, Felix
and Wolf-Ostermann, Karin",
title="Application Scenarios for Artificial Intelligence in Nursing Care: Rapid Review",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="29",
volume="23",
number="11",
pages="e26522",
keywords="nursing care",
keywords="artificial intelligence",
keywords="machine learning",
keywords="expert system",
keywords="hybrid system",
abstract="Background: Artificial intelligence (AI) holds the promise of supporting nurses' clinical decision-making in complex care situations or conducting tasks that are remote from direct patient interaction, such as documentation processes. There has been an increase in the research and development of AI applications for nursing care, but there is a persistent lack of an extensive overview covering the evidence base for promising application scenarios. Objective: This study synthesizes literature on application scenarios for AI in nursing care settings as well as highlights adjacent aspects in the ethical, legal, and social discourse surrounding the application of AI in nursing care. Methods: Following a rapid review design, PubMed, CINAHL, Association for Computing Machinery Digital Library, Institute of Electrical and Electronics Engineers Xplore, Digital Bibliography \& Library Project, and Association for Information Systems Library, as well as the libraries of leading AI conferences, were searched in June 2020. Publications of original quantitative and qualitative research, systematic reviews, discussion papers, and essays on the ethical, legal, and social implications published in English were included. Eligible studies were analyzed on the basis of predetermined selection criteria. Results: The titles and abstracts of 7016 publications and 704 full texts were screened, and 292 publications were included. Hospitals were the most prominent study setting, followed by independent living at home; fewer application scenarios were identified for nursing homes or home care. Most studies used machine learning algorithms, whereas expert or hybrid systems were entailed in less than every 10th publication. The application context of focusing on image and signal processing with tracking, monitoring, or the classification of activity and health followed by care coordination and communication, as well as fall detection, was the main purpose of AI applications. Few studies have reported the effects of AI applications on clinical or organizational outcomes, lacking particularly in data gathered outside laboratory conditions. In addition to technological requirements, the reporting and inclusion of certain requirements capture more overarching topics, such as data privacy, safety, and technology acceptance. Ethical, legal, and social implications reflect the discourse on technology use in health care but have mostly not been discussed in meaningful and potentially encompassing detail. Conclusions: The results highlight the potential for the application of AI systems in different nursing care settings. Considering the lack of findings on the effectiveness and application of AI systems in real-world scenarios, future research should reflect on a more nursing care--specific perspective toward objectives, outcomes, and benefits. We identify that, crucially, an advancement in technological-societal discourse that surrounds the ethical and legal implications of AI applications in nursing care is a necessary next step. Further, we outline the need for greater participation among all of the stakeholders involved. ",
doi="10.2196/26522",
url="https://www.jmir.org/2021/11/e26522",
url="http://www.ncbi.nlm.nih.gov/pubmed/34847057"
}


@Article{info:doi/10.2196/26456,
author="Cho, Insook
and Jin, sun In
and Park, Hyunchul
and Dykes, C. Patricia",
title="Clinical Impact of an Analytic Tool for Predicting the Fall Risk in Inpatients: Controlled Interrupted Time Series",
journal="JMIR Med Inform",
year="2021",
month="Nov",
day="25",
volume="9",
number="11",
pages="e26456",
keywords="clinical effectiveness",
keywords="data analytics",
keywords="event prediction",
keywords="inpatient falls",
keywords="process metrics",
abstract="Background: Patient falls are a common cause of harm in acute-care hospitals worldwide. They are a difficult, complex, and common problem requiring a great deal of nurses' time, attention, and effort in practice. The recent rapid expansion of health care predictive analytic applications and the growing availability of electronic health record (EHR) data have resulted in the development of machine learning models that predict adverse events. However, the clinical impact of these models in terms of patient outcomes and clinicians' responses is undetermined. Objective: The purpose of this study was to determine the impact of an electronic analytic tool for predicting fall risk on patient outcomes and nurses' responses. Methods: A controlled interrupted time series (ITS) experiment was conducted in 12 medical-surgical nursing units at a public hospital between May 2017 and April 2019. In six of the units, the patients' fall risk was assessed using the St. Thomas' Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) system (control units), while in the other six, a predictive model for inpatient fall risks was implemented using routinely obtained data from the hospital's EHR system (intervention units). The primary outcome was the rate of patient falls; secondary outcomes included the rate of falls with injury and analysis of process metrics (nursing interventions that are designed to mitigate the risk of fall). Results: During the study period, there were 42,476 admissions, of which 707 were for falls and 134 for fall injuries. Allowing for differences in the patients' characteristics and baseline process metrics, the number of patients with falls differed between the control (n=382) and intervention (n=325) units. The mean fall rate increased from 1.95 to 2.11 in control units and decreased from 1.92 to 1.79 in intervention units. A separate ITS analysis revealed that the immediate reduction was 29.73\% in the intervention group (z=--2.06, P=.039) and 16.58\% in the control group (z=--1.28, P=.20), but there was no ongoing effect. The injury rate did not differ significantly between the two groups (0.42 vs 0.31, z=1.50, P=.134). Among the process metrics, the risk-targeted interventions increased significantly over time in the intervention group. Conclusions: This early-stage clinical evaluation revealed that implementation of an analytic tool for predicting fall risk may to contribute to an awareness of fall risk, leading to positive changes in nurses' interventions over time. Trial Registration: Clinical Research Information Service (CRIS), Republic of Korea KCT0005286; https://cris.nih.go.kr/cris/search/detailSearch.do/16984 ",
doi="10.2196/26456",
url="https://medinform.jmir.org/2021/11/e26456",
url="http://www.ncbi.nlm.nih.gov/pubmed/34626168"
}


@Article{info:doi/10.2196/33158,
author="Chaudhari, Hanu
and Schneeweiss, Michelle
and Rebinsky, Reid
and Rullo, Enrico
and Eltorki, Mohamed",
title="An Advanced Nursing Directive for Children With Suspected Appendicitis: Protocol for a Quality Improvement Feasibility Study",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="20",
volume="10",
number="10",
pages="e33158",
keywords="quality improvement",
keywords="pediatric",
keywords="nursing",
keywords="medical directive",
keywords="appendicitis",
keywords="emergency department flow",
keywords="nursing directive",
abstract="Background: Pediatric appendicitis accounts for an estimated 7\% to 10\% of abdominal pain cases in the emergency department (ED). The diagnosis is time-consuming, and the investigative process depends on physician assessment, resulting in delays in diagnosis and therapeutic management. The utility of an advanced nursing directive (AND) to expedite this process is unclear and needs further exploration. Objective: This study aims to describe key components of ED flow in patients with suspected appendicitis seen at a pediatric ED and pilot a directive that allows ED nurses to perform an order set that includes blood work, urine tests, analgesics, fluids, and an abdominal-pelvis ultrasound prior to physician assessment. Methods: This study involves conducting a retrospective chart review alongside a quality improvement initiative to compare key ED flow metrics before and after AND implementation. Primary outcome measures include median time from ED triage assessment to ultrasound completion, analgesia administration, blood work results, and time to disposition (consult or discharge), alongside other key ED flow metrics for suspected appendicitis. Secondary outcomes will involve patient and caretaker satisfaction surveys. Descriptive statistics will be used to summarize the data. For differences in proportions, a chi-square test will be used. The Student t test will be used for continuous variables. A variable-controlled run chart will be performed to assess impact on ED flow metrics. Patient and family satisfaction surveys are administered immediately after the directive encounter and 7 days afterward. Results: There are currently 3900 patients who have been screened, 344 patients who have been enrolled, and 90 patients who have received the medical directive since implementation in June 2020. Interim results on reduction of time to diagnostic and therapeutic ED flow parameters and satisfaction surveys are expected to be published in February 2022. The final study endpoint will be in June 2022. Conclusions: This study proposes a novel protocol for improving the diagnosis and treatment of suspected pediatric appendicitis through implementation of an evidence-based AND. This model may provide a standardized, international pathway for management of common pediatric and adult emergencies. International Registered Report Identifier (IRRID): RR1-10.2196/33158 ",
doi="10.2196/33158",
url="https://www.researchprotocols.org/2021/10/e33158",
url="http://www.ncbi.nlm.nih.gov/pubmed/34668867"
}


@Article{info:doi/10.2196/29200,
author="Conway, Aaron
and Jungquist, R. Carla
and Chang, Kristina
and Kamboj, Navpreet
and Sutherland, Joanna
and Mafeld, Sebastian
and Parotto, Matteo",
title="Predicting Prolonged Apnea During Nurse-Administered Procedural Sedation: Machine Learning Study",
journal="JMIR Perioper Med",
year="2021",
month="Oct",
day="5",
volume="4",
number="2",
pages="e29200",
keywords="procedural sedation and analgesia",
keywords="conscious sedation",
keywords="nursing",
keywords="informatics",
keywords="patient safety",
keywords="machine learning",
keywords="capnography",
keywords="anesthesia",
keywords="anaesthesia",
keywords="medical informatics",
keywords="sleep apnea",
keywords="apnea",
keywords="apnoea",
keywords="sedation",
abstract="Background: Capnography is commonly used for nurse-administered procedural sedation. Distinguishing between capnography waveform abnormalities that signal the need for clinical intervention for an event and those that do not indicate the need for intervention is essential for the successful implementation of this technology into practice. It is possible that capnography alarm management may be improved by using machine learning to create a ``smart alarm'' that can alert clinicians to apneic events that are predicted to be prolonged. Objective: To determine the accuracy of machine learning models for predicting at the 15-second time point if apnea will be prolonged (ie, apnea that persists for >30 seconds). Methods: A secondary analysis of an observational study was conducted. We selected several candidate models to evaluate, including a random forest model, generalized linear model (logistic regression), least absolute shrinkage and selection operator regression, ridge regression, and the XGBoost model. Out-of-sample accuracy of the models was calculated using 10-fold cross-validation. The net benefit decision analytic measure was used to assist with deciding whether using the models in practice would lead to better outcomes on average than using the current default capnography alarm management strategies. The default strategies are the aggressive approach, in which an alarm is triggered after brief periods of apnea (typically 15 seconds) and the conservative approach, in which an alarm is triggered for only prolonged periods of apnea (typically >30 seconds). Results: A total of 384 apneic events longer than 15 seconds were observed in 61 of the 102 patients (59.8\%) who participated in the observational study. Nearly half of the apneic events (180/384, 46.9\%) were prolonged. The random forest model performed the best in terms of discrimination (area under the receiver operating characteristic curve 0.66) and calibration. The net benefit associated with the random forest model exceeded that associated with the aggressive strategy but was lower than that associated with the conservative strategy. Conclusions: Decision curve analysis indicated that using a random forest model would lead to a better outcome for capnography alarm management than using an aggressive strategy in which alarms are triggered after 15 seconds of apnea. The model would not be superior to the conservative strategy in which alarms are only triggered after 30 seconds. ",
doi="10.2196/29200",
url="https://periop.jmir.org/2021/2/e29200",
url="http://www.ncbi.nlm.nih.gov/pubmed/34609322"
}


@Article{info:doi/10.2196/27854,
author="Hedenstrom, Lisa Margot
and Sneha, Sweta
and Nalla, Anusha
and Wilson, Barbara",
title="Nursing Student Perceptions and Attitudes Toward Patients With Cancer After Education and Mentoring: Integrative Review",
journal="JMIR Cancer",
year="2021",
month="Sep",
day="24",
volume="7",
number="3",
pages="e27854",
keywords="nursing students",
keywords="nurse",
keywords="cancer",
keywords="attitudes",
keywords="health care professionals",
keywords="nursing",
keywords="cancer patients",
keywords="oncology",
keywords="patient support",
keywords="continuing education",
keywords="mentoring",
abstract="Background: Knowledge about nursing student attitudes toward patients with cancer after an educational intervention and mentoring support is limited. This review examined the literature on this topic. Objective: This integrative review aims to explore the literature on the experiences of students who participate in an oncology elective or educational course on cancer and their attitudes toward cancer. Methods: A comprehensive search was conducted using PubMed, CINAHL, and MEDLINE databases. Each study was systematically assessed. An evidence table was completed to identify the key aspects of each study that was reviewed. Results: There is insufficient information on the impact of nursing student education on the attitudes and skills of nursing students caring for patients with cancer. An integrative review was completed on the impact of education and mentoring for nursing students on cancer care, which yielded 10 studies that were reviewed. These studies indicate that educational intervention and mentoring improve the confidence and ability of nursing students to care for patients with cancer. Conclusions: Student nurses need to be armed with knowledge, skills, and positive attitudes while caring for patients with cancer. Nursing students perform best when they have accurate information, positive role models, and mentoring by experienced oncology professionals, to support proficiency in caring for patients with cancer. The lack of knowledge of nursing students in the areas of cancer care, treatment, and patient support requires additional education and research to promote expertise and positive attitudes toward cancer and treating patients with cancer. This will support nursing students' ability to care for patients with cancer as well as develop future educational interventions to shape nursing student attitude and knowledge. This integrative review also identifies the positive impact on the attitudes of other health care professionals who have received training or education on cancer. ",
doi="10.2196/27854",
url="https://cancer.jmir.org/2021/3/e27854",
url="http://www.ncbi.nlm.nih.gov/pubmed/34559056"
}


@Article{info:doi/10.2196/24542,
author="Wang, Yi-Chen
and Tsan, Chin-Yuan
and Chen, Meng-Chun",
title="Implementation of an Automated Dispensing Cabinet System and Its Impact on Drug Administration: Longitudinal Study",
journal="JMIR Form Res",
year="2021",
month="Sep",
day="17",
volume="5",
number="9",
pages="e24542",
keywords="automated dispensing cabinets",
keywords="medication administration system",
keywords="medication errors",
keywords="dispensing",
keywords="medication",
keywords="nursing",
keywords="Taiwan",
abstract="Background: A technology that has been widely implemented in hospitals in the United States is the automated dispensing cabinet (ADC), which has been shown to reduce nurse drug administration errors and the time nurses spend administering drugs. Objective: This study aimed to determine the impact of an ADC system on medication administration by nurses as well as safety before and after ADC implementation. Methods: We conducted a 24-month-long longitudinal study at the National Taiwan University Hospital in Taipei, Taiwan. Clinical observations and questionnaires were used to evaluate the time differences in drug preparation, delivery, and returns in the inpatient ward by nurses before and after using the ADC. Drug errors recorded in the Medical Incident Events system were assessed the year before and after ADC implementation. Results: The drug preparation time of the wards increased significantly (all P<.005). On average, 2 minutes of preparation time is needed for each patient. Only 1 unit showed an increase in the drug return time, but this was not significant. There were 9 (45\%) adverse events during the drug administration phase, and 11 (55\%) events occurred during the drug-dispensing phase. Although a decrease in the mean number of events reported was observed during the ADC implementation period, this difference was not significant. As for the questionnaire that were administered to the nurses, the overall mean score was 3.90; the highest score was for the item ``I now spend less time waiting for medications that come from the pharmacy than before the ADC was implemented'' (score=4.24). The item with the lowest score was ``I have to wait in line to get my patient medications'' (score=3.32). Conclusions: The nurses were generally satisfied with ADC use over the 9 months following complete implementation and integration of the system. It was acknowledged that the ADC offers benefits in terms of pharmaceutical stock management; however, this comes at the cost of increased nursing time. In general, the nurses remained supportive of the benefits for their patients, despite consequences to their workflows. Their acceptance of the ADC system in this study demonstrates this. ",
doi="10.2196/24542",
url="https://formative.jmir.org/2021/9/e24542",
url="http://www.ncbi.nlm.nih.gov/pubmed/34533467"
}


@Article{info:doi/10.2196/26700,
author="Gehri, Beatrice
and Bachnick, Stefanie
and Schwendimann, Ren{\'e}
and Simon, Michael",
title="Matching Registered Nurse Services With Changing Care Demands in Psychiatric Hospitals: Protocol for a Multicenter Observational Study (MatchRN Psychiatry Study)",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="17",
volume="10",
number="8",
pages="e26700",
keywords="quality of care",
keywords="psychiatric hospitals",
keywords="nurses",
keywords="patient routine data",
keywords="work environment",
keywords="Switzerland",
abstract="Background: The quality of care is often poorly assessed in mental health settings, and accurate evaluation requires the monitoring and comparison of not only the outcomes but also the structures and processes. The resulting data allow hospital administrators to compare their patient outcome data against those reported nationally. As Swiss psychiatric hospitals are planned and coordinated at the cantonal level, they vary considerably. In addition, nursing care structures and processes, such as nurse staffing, are only reported and aggregated at the national level, whereas nurse outcomes, such as job satisfaction or intention to leave, have yet to be assessed in Swiss psychiatric hospitals. Because they lack these key figures, psychiatric hospitals' quality of care cannot be reasonably described. Objective: This study's purpose is to describe health care quality by exploring hospital structures such as nurse staffing and the work environment; processes such as the rationing of care; nurse outcomes, including job satisfaction and work-life balance; and patients' symptom burden. Methods: MatchRN Psychiatry is a multicenter observational study of Swiss psychiatric hospitals. The sample for this study included approximately 1300 nurses from 113 units of 13 psychiatric hospitals in Switzerland's German-speaking region. In addition, routine patient assessment data from each participating hospital were included. The nurse survey consisted of 164 items covering three dimensions---work environment, patient safety climate, and the rationing of care. The unit-level questionnaire included 57 items, including the number of beds, number of nurses, and nurses' education levels. Routine patient data included items such as main diagnosis, the number and duration of freedom-restrictive measures, and symptom burden at admission and discharge. Data were collected between September 2019 and June 2021. The data will be analyzed descriptively by using multilevel regression linear mixed models and generalized linear mixed models to explore associations between variables of interest. Results: The response rate from the nurse survey was 71.49\% (1209/1691). All data are currently being checked for consistency and plausibility. The MatchRN Psychiatry study is funded by the participating psychiatric hospitals and the Swiss Psychiatric Nursing Leaders Association (Vereinigung Pflegekader Psychiatrie Schweiz). Conclusions: For the first time, the MatchRN Psychiatry study will systematically evaluate the quality of care in psychiatric hospitals in Switzerland in terms of organizational structures, processes, and patient and nurse outcomes. The participating psychiatric hospitals will benefit from findings that are relevant to the future planning of nurse staffing. The findings of this study will contribute to improvement strategies for nurses' work environments and patient experiences in Swiss psychiatric hospitals. International Registered Report Identifier (IRRID): DERR1-10.2196/26700 ",
doi="10.2196/26700",
url="https://www.researchprotocols.org/2021/8/e26700",
url="http://www.ncbi.nlm.nih.gov/pubmed/34402796"
}


@Article{info:doi/10.2196/19709,
author="Silvera-Tawil, David
and Pocock, Courtney
and Bradford, DanaKai
and Donnell, Andrea
and Freyne, Jill
and Harrap, Karen
and Brinkmann, Sally",
title="Enabling Nurse-Patient Communication With a Mobile App: Controlled Pretest-Posttest Study With Nurses and Non--English-Speaking Patients",
journal="JMIR Nursing",
year="2021",
month="Jul",
day="30",
volume="4",
number="3",
pages="e19709",
keywords="nursing",
keywords="interpersonal communication",
keywords="mobile app",
keywords="information technology",
keywords="communication barrier",
keywords="diversity",
keywords="interpreters",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: There is growing concern regarding the implications of miscommunication in health care settings, the results of which can have serious detrimental impacts on patient safety and health outcomes. Effective communication between nurses and patients is integral in the delivery of timely, competent, and safe care. In a hospital environment where care is delivered 24 hours a day, interpreters are not always available. In 2014, we developed a communication app to support patients' interactions with allied health clinicians when interpreters are not present. In 2017, we expanded this app to meet the needs of the nursing workforce. The app contains a fixed set of phrases translated into common languages, and communication is supported by text, images, audio content, and video content. Objective: This study aims to evaluate the efficacy of the communication app to support nursing staff during the provision of standard care to patients from non--English-speaking backgrounds when an interpreter is not available. Methods: This study used a one-group pretest-posttest sequential explanatory mixed methods research design, with quantitative data analyzed using inferential statistics and qualitative data analyzed via thematic content analysis. A total of 134 observation sessions (82 pretest and 52 posttest) of everyday nurse-patient interactions and 396 app use sessions were recorded. In addition, a total of 134 surveys (82 pretest and 52 posttest) with nursing staff, 7 interviews with patients, and 3 focus groups with a total of 9 nursing staff participants were held between January and November 2017. Results: In the absence of the app, baseline interactions with patients from English-speaking backgrounds were rated as more successful (t80=5.69; P<.001) than interactions with patients from non--English-speaking backgrounds. When staff used the app during the live trial, interactions with patients from non--English-speaking backgrounds were rated as more successful than interactions without the app (F2,119=8.17; P<.001; $\eta$2=0.37). In addition, the level of staff frustration was rated lower when the app was used to communicate (t80=2.71; P=.008; r=0.29). Most participants indicated that the app assisted them in communicating. Conclusions: Through the use of the app, a number of patients from non--English-speaking backgrounds experienced better provision of standard care, similar to their English-speaking peers. Thus, the app can be seen as contributing to the delivery of equitable health care. ",
doi="10.2196/19709",
url="https://nursing.jmir.org/2021/3/e19709",
url="http://www.ncbi.nlm.nih.gov/pubmed/34406964"
}


@Article{info:doi/10.2196/24974,
author="Shorr, I. Ronald
and Ahrentzen, Sherry
and Luther, L. Stephen
and Radwan, Chad
and Hahm, Bridget
and Kazemzadeh, Mahshad
and Alliance, Slande
and Powell-Cope, Gail
and Fischer, M. Gary",
title="Examining the Relationship Between Environmental Factors and Inpatient Hospital Falls: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2021",
month="Jul",
day="13",
volume="10",
number="7",
pages="e24974",
keywords="falls",
keywords="accidental falls",
keywords="hospital design and construction",
keywords="health facility environment",
keywords="hospital units",
keywords="evidence-based facility design",
keywords="nursing",
keywords="environmental factors",
keywords="well-being",
keywords="accident",
abstract="Background: Patient falls are the most common adverse events reported in hospitals. Although it is well understood that the physical hospital environment contributes to nearly 40\% of severe or fatal hospital falls, there are significant gaps in the knowledge about the relationship between inpatient unit design and fall rates. The few studies that have examined unit design have been conducted in a single hospital (non-Veterans Health Administration [VHA]) or a small number of inpatient units, limiting generalizability. The goal of this study is to identify unit design factors contributing to inpatient falls in the VHA. Objective: The first aim of the study is to investigate frontline and management perceptions of and experiences with veteran falls as they pertain to inpatient environmental factors. An iterative rapid assessment process will be used to analyze the data. Interview findings will directly inform the development of an environmental assessment survey to be conducted as part of aim 2 and to contribute to interpretation of aim 2. The second aim of this study is to quantify unit design factors and compare spatial and environmental factors of units with higher- versus lower-than-expected fall rates. Methods: We will first conduct walk-through interviews with facility personnel in 10 medical/surgical units at 3 VHA medical centers to identify environmental fall risk factors. Data will be used to finalize an environmental assessment survey for nurse managers and facilities managers. We will then use fall data from the VA Inpatient Evaluation Center and patient data from additional sources to identify 50 medical/surgical nursing units with higher- and lower-than-expected fall rates. We will measure spatial factors by analyzing computer-aided design files of unit floorplans and environmental factors from the environmental assessment survey. Statistical tests will be performed to identify design factors that distinguish high and low outliers. Results: The VA Health Services Research and Development Service approved funding for the study. The research protocol was approved by institutional review boards and VA research committees at both sites. Data collection started in February 2018. Results of the data analysis are expected by February 2022. Data collection and analysis was completed for aim 1 with a manuscript of results in progress. For aim 2, the medical/surgical units were categorized into higher- and lower-than-expected fall categories, the environmental assessment surveys were distributed to facility managers and nurse managers. Data to measure spatial characteristics are being compiled. Conclusions: To our knowledge, this study is the first to objectively identify spatial risks for falls in hospitals within in a large multihospital system. Findings can contribute to evidence-based design guidelines for hospitals such as those of the Facility Guidelines Institute and the Department of Veterans Affairs. The metrics for characterizing spatial features are quantitative indices that could be incorporated in larger scale contextual studies examining contributors to falls, which to date often exclude physical environmental factors at the unit level. Space syntax measures could be used as physical environmental factors in future research examining a range of contextual factors---social, personal, organizational, and environmental---that contribute to patient falls. International Registered Report Identifier (IRRID): DERR1-10.2196/24974 ",
doi="10.2196/24974",
url="https://www.researchprotocols.org/2021/7/e24974",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255724"
}


@Article{info:doi/10.2196/26494,
author="Poncette, Akira-Sebastian
and Wunderlich, Markus Maximilian
and Spies, Claudia
and Heeren, Patrick
and Vorderw{\"u}lbecke, Gerald
and Salgado, Eduardo
and Kastrup, Marc
and Feufel, A. Markus
and Balzer, Felix",
title="Patient Monitoring Alarms in an Intensive Care Unit: Observational Study With Do-It-Yourself Instructions",
journal="J Med Internet Res",
year="2021",
month="May",
day="28",
volume="23",
number="5",
pages="e26494",
keywords="digital health",
keywords="patient monitoring",
keywords="intensive care unit",
keywords="technological innovation",
keywords="data science",
keywords="alarm fatigue",
keywords="alarm management",
keywords="patient safety",
keywords="ICU",
keywords="alarm system",
keywords="alarm system quality",
keywords="medical devices",
keywords="clinical alarms",
abstract="Background: As one of the most essential technical components of the intensive care unit (ICU), continuous monitoring of patients' vital parameters has significantly improved patient safety by alerting staff through an alarm when a parameter deviates from the normal range. However, the vast number of alarms regularly overwhelms staff and may induce alarm fatigue, a condition recently exacerbated by COVID-19 and potentially endangering patients. Objective: This study focused on providing a complete and repeatable analysis of the alarm data of an ICU's patient monitoring system. We aimed to develop do-it-yourself (DIY) instructions for technically versed ICU staff to analyze their monitoring data themselves, which is an essential element for developing efficient and effective alarm optimization strategies. Methods: This observational study was conducted using alarm log data extracted from the patient monitoring system of a 21-bed surgical ICU in 2019. DIY instructions were iteratively developed in informal interdisciplinary team meetings. The data analysis was grounded in a framework consisting of 5 dimensions, each with specific metrics: alarm load (eg, alarms per bed per day, alarm flood conditions, alarm per device and per criticality), avoidable alarms, (eg, the number of technical alarms), responsiveness and alarm handling (eg alarm duration), sensing (eg, usage of the alarm pause function), and exposure (eg, alarms per room type). Results were visualized using the R package ggplot2 to provide detailed insights into the ICU's alarm situation. Results: We developed 6 DIY instructions that should be followed iteratively step by step. Alarm load metrics should be (re)defined before alarm log data are collected and analyzed. Intuitive visualizations of the alarm metrics should be created next and presented to staff in order to help identify patterns in the alarm data for designing and implementing effective alarm management interventions. We provide the script we used for the data preparation and an R-Markdown file to create comprehensive alarm reports. The alarm load in the respective ICU was quantified by 152.5 (SD 42.2) alarms per bed per day on average and alarm flood conditions with, on average, 69.55 (SD 31.12) per day that both occurred mostly in the morning shifts. Most alarms were issued by the ventilator, invasive blood pressure device, and electrocardiogram (ie, high and low blood pressure, high respiratory rate, low heart rate). The exposure to alarms per bed per day was higher in single rooms (26\%, mean 172.9/137.2 alarms per day per bed). Conclusions: Analyzing ICU alarm log data provides valuable insights into the current alarm situation. Our results call for alarm management interventions that effectively reduce the number of alarms in order to ensure patient safety and ICU staff's work satisfaction. We hope our DIY instructions encourage others to follow suit in analyzing and publishing their ICU alarm data. ",
doi="10.2196/26494",
url="https://www.jmir.org/2021/5/e26494",
url="http://www.ncbi.nlm.nih.gov/pubmed/34047701"
}


@Article{info:doi/10.2196/27963,
author="Pereira, Filipa
and Querido, Isabel Ana
and Bieri, Marion
and Verloo, Henk
and Laranjeira, Ant{\'o}nio Carlos",
title="Presenteeism Among Nurses in Switzerland and Portugal and Its Impact on Patient Safety and Quality of Care: Protocol for a Qualitative Study",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="13",
volume="10",
number="5",
pages="e27963",
keywords="healthcare",
keywords="nurses",
keywords="predictors",
keywords="presenteeism",
keywords="quality of care",
keywords="frontline",
keywords="managers",
keywords="Portugal",
keywords="Switzerland",
keywords="patient safety",
keywords="patients",
keywords="safety",
keywords="stress",
keywords="emotion",
keywords="knowledge transfer",
keywords="acute care",
keywords="long-term care",
abstract="Background: Nurses dispense direct care in a wide variety of settings and are considered the backbone of the health care system. They often work long hours, face emotional stress, and are at a high risk of psychosocial and somatic illnesses. Nurses sometimes fall sick but work regardless, leading to presenteeism and subsequent risks to quality of care and patient safety due to the increased likelihood of patients falling, medication errors, and staff-to-patient disease transmission. Objective: This study aims to understand presenteeism among frontline nurses and nurse managers in acute, primary, and long-term health care settings and to contribute to the development of future interventional studies and recommendations. Methods: A qualitative study based on online focus group discussions will explore the perceptions of, attitudes to, and experiences with presenteeism among frontline nurses and nurse managers. Using a pilot-tested interview guide, 8 focus group discussions will involve nurses working in acute care hospitals, primary care settings, and long-term residential care facilities in Switzerland's French-speaking region and Portugal's Center region. The data collected will be examined using a content analysis approach via NVivo 12 QSR International software. Results: The University of Applied Sciences and Arts Western Switzerland's School of Health Sciences and the Polytechnic of Leiria's School of Health Sciences in Portugal have both approved funding for the study. The research protocol has been approved by ethics committees in both countries. Study recruitment commenced in February 2021. The results of the data analysis are expected by September 2021. Conclusions: This present study aims to gain more insight into the dilemmas facing nurses as a result of all causes of presenteeism among frontline nurses and nurse managers in different health care settings. The researchers will prepare manuscripts on the study's findings, publish them in relevant peer-reviewed journals, exhibit them in poster presentations, and give oral presentations at appropriate academic and nonscientific conferences. Regarding further knowledge transfer, researchers will engage with stakeholders to craft messages focused on the needs of nurses and nurse managers and on disseminating our research findings to deal with the issue of nursing presenteeism. International Registered Report Identifier (IRRID): PRR1-10.2196/27963 ",
doi="10.2196/27963",
url="https://www.researchprotocols.org/2021/5/e27963",
url="http://www.ncbi.nlm.nih.gov/pubmed/33983134"
}


@Article{info:doi/10.2196/25114,
author="Acquaviva, Kimberly",
title="Comparison of Intercom and Megaphone Hashtags Using Four Years of Tweets From the Top 44 Schools of Nursing: Thematic Analysis",
journal="JMIR Nursing",
year="2021",
month="Apr",
day="20",
volume="4",
number="2",
pages="e25114",
keywords="Twitter",
keywords="hashtag",
keywords="nurses",
keywords="media",
keywords="intercom hashtag",
keywords="megaphone hashtag",
abstract="Background: When this study began in 2018, I sought to determine the extent to which the top 50 schools of nursing were using hashtags that could attract attention from journalists on Twitter. In December 2020, the timeframe was expanded to encompass 2 more years of data, and an analysis was conducted of the types of hashtags used. Objective: The study attempted to answer the following question: to what extent are top-ranked schools of nursing using hashtags that could attract attention from journalists, policy makers, and the public on Twitter? Methods: In February 2018, 47 of the top 50 schools of nursing had public Twitter accounts. The most recent 3200 tweets were extracted from each account and analyzed. There were 31,762 tweets in the time period covered (September 29, 2016, through February 22, 2018). After 13,429 retweets were excluded, 18,333 tweets remained. In December 2020, 44 of the original 47 schools of nursing still had public Twitter accounts under the same name used in the first phase of the study. Three accounts that were no longer active were removed from the 2016-2018 data set, resulting in 16,939 tweets from 44 schools of nursing. The Twitter data for the 44 schools of nursing were obtained for the time period covered in the second phase of the study (February 23, 2018, through December 13, 2020), and the most recent 3200 tweets were extracted from each of the accounts. On excluding retweets, there were 40,368 tweets in the 2018-2020 data set. The 2016-2018 data set containing 16,939 tweets was merged with the 2018-2020 data set containing 40,368 tweets, resulting in 57,307 tweets in the 2016-2020 data set. Results: Each hashtag used 100 times or more in the 2016-2020 data set was categorized as one of the following seven types: nursing, school, conference or tweet chat, health, illness/disease/condition, population, and something else. These types were then broken down into the following two categories: intercom hashtags and megaphone hashtags. Approximately 83\% of the time, schools of nursing used intercom hashtags (inward-facing hashtags focused on in-group discussion within and about the profession). Schools of nursing rarely used outward-facing megaphone hashtags. There was no discernible shift in the way that schools of nursing used hashtags after the publication of The Woodhull Study Revisited. Conclusions: Top schools of nursing use hashtags more like intercoms to communicate with other nurses rather than megaphones to invite attention from journalists, policy makers, and the public. If schools of nursing want the media to showcase their faculty members as experts, they need to increase their use of megaphone hashtags to connect the work of their faculty with topics of interest to the public. ",
doi="10.2196/25114",
url="https://nursing.jmir.org/2021/2/e25114",
url="http://www.ncbi.nlm.nih.gov/pubmed/34345795"
}


@Article{info:doi/10.2196/22974,
author="Ausserhofer, Dietmar
and Favez, Lauriane
and Simon, Michael
and Z{\'u}{\~n}iga, Franziska",
title="Electronic Health Record Use in Swiss Nursing Homes and Its Association With Implicit Rationing of Nursing Care Documentation: Multicenter Cross-sectional Survey Study",
journal="JMIR Med Inform",
year="2021",
month="Mar",
day="2",
volume="9",
number="3",
pages="e22974",
keywords="electronic health records",
keywords="nursing homes",
keywords="nursing care",
keywords="health care rationing",
keywords="rationing of nursing care",
keywords="unfinished care",
keywords="documentation",
keywords="patient care planning",
keywords="mobile phone",
abstract="Background: Nursing homes (NHs) are increasingly implementing electronic health records (EHRs); however, little information is available on EHR use in NH settings. It remains unclear how care workers perceive its safety, quality, and efficiency, and whether EHR use might ease the burden of documentation, thereby reducing its implicit rationing. Objective: This study aims to describe nurses' perceptions regarding the usefulness of the EHR system and whether sufficient numbers of computers are available in Swiss NHs, and to explore the system's association with implicit rationing of nursing care documentation. Methods: This was a multicenter cross-sectional study using survey data from the Swiss Nursing Homes Human Resources Project 2018. It includes a convenience sample of 107 NHs, 302 care units, and 1975 care workers (ie, registered nurses and licensed practical nurses) from Switzerland's German- and French-speaking regions. Care workers completed questionnaires assessing the level of implicit rationing of nursing care documentation, their perceptions of the EHR system's usefulness and of how sufficient the number of available computers was, staffing and resource adequacy, leadership ability, and teamwork and safety climate. For analysis, we applied generalized linear mixed models, including individual-level nurse survey data and data on unit and facility characteristics. Results: Overall, the care workers perceived the EHR systems as useful; ratings ranged from 69.42\% (1362/1962; guarantees safe care and treatment) to 78.32\% (1535/1960; allows quick access to relevant information on the residents). However, less than half (914/1961, 46.61\%) of the care workers reported sufficient computers on their unit to allow timely documentation. Half of the care workers responded that they sometimes or often had to ration the documentation of care. After adjusting for work environment factors and safety and teamwork climate, both higher care worker ratings of the EHR system's usefulness ($\beta$=?.12; 95\% CI ?0.17 to ?0.06) and sufficient numbers of computers ($\beta$=?.09; 95\% CI ?0.12 to ?0.06) were consistently associated with lower implicit rationing of nursing care documentation. Conclusions: Both the usefulness of the EHR system and the number of computers available were important explanatory factors for care workers leaving care activities (eg, developing or updating nursing care plans) unfinished. NH managers should carefully select and implement their information technology infrastructure with greater involvement and attention to the needs of their care workers and residents. Further research is needed to develop and implement user-friendly information technology infrastructure in NHs and to evaluate their impact on care processes as well as resident and care worker outcomes. ",
doi="10.2196/22974",
url="https://medinform.jmir.org/2021/3/e22974",
url="http://www.ncbi.nlm.nih.gov/pubmed/33650983"
}


@Article{info:doi/10.2196/20445,
author="Sasaki, Natsu
and Imamura, Kotaro
and Tran, Thu Thuy Thi
and Nguyen, Thanh Huong
and Kuribayashi, Kazuto
and Sakuraya, Asuka
and Bui, Minh Thu
and Nguyen, Thuy Quynh
and Nguyen, Thi Nga
and Nguyen, Huong Giang Thi
and Zhang, Weibin Melvyn
and Minas, Harry
and Sekiya, Yuki
and Watanabe, Kazuhiro
and Tsutsumi, Akizumi
and Shimazu, Akihito
and Kawakami, Norito",
title="Effects of Smartphone-Based Stress Management on Improving Work Engagement Among Nurses in Vietnam: Secondary Analysis of a Three-Arm Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="23",
volume="23",
number="2",
pages="e20445",
keywords="stress management",
keywords="mental health",
keywords="occupational health",
keywords="digital health",
keywords="workplace",
keywords="LMICs",
keywords="South-East Asia",
keywords="health care professionals",
abstract="Background: Work engagement is important for employee well-being and work performance. However, no intervention study has investigated the effect of an eMental Health intervention on work engagement among workers in low- and middle-income countries (LMICs). Objective: The aim of the study was to examine the effects of a newly developed smartphone-based stress management program (ABC Stress Management) on improving work engagement among hospital nurses in Vietnam, an LMIC. Methods: Full-time registered nurses (n=949) were randomly assigned to one of 2 intervention groups or a control group. The intervention groups were a 6-week, 6-lesson program offering basic cognitive behavioral therapy (CBT-based stress management skills), provided in either free-choice (program A) or fixed order (program B). Work engagement was assessed at baseline and 3-month and 7-month follow-ups in each of the 3 groups. Results: The scores of work engagement in both intervention groups improved from baseline to 3-month follow-up, and then decreased at the 7-month follow-up, while the score steadily increased from baseline to 7-month follow-up in the control group. Program B showed a significant intervention effect on improving work engagement at the 3-month follow-up (P=.049) with a small effect size (Cohen d= 0.16; 95\% CI 0.001 to 0.43]). Program A showed nonsignificant trend (d=0.13; 95\% CI --0.014 to 0.41; P=.07) toward improved engagement at 3 months. Neither program achieved effectiveness at the 7-month follow-up. Conclusions: The study demonstrated that a fixed order (program B) delivery of a smartphone-based stress management program was effective in improving work engagement in nurses in Vietnam. However, the effect was small and only temporary. Further improvement of this program is required to achieve a greater effect size and more sustained, longer lasting impact on work engagement. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000033139; tinyurl.com/55gxo253 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-025138 ",
doi="10.2196/20445",
url="https://www.jmir.org/2021/2/e20445",
url="http://www.ncbi.nlm.nih.gov/pubmed/33620328"
}


@Article{info:doi/10.2196/22902,
author="Marsden, Lesley Dianne
and Boyle, Kerry
and Jordan, Louise-Anne
and Dunne, Anne Judith
and Shipp, Jodi
and Minett, Fiona
and Styles, Amanda
and Birnie, Jaclyn
and Ormond, Sally
and Parrey, Kim
and Buzio, Amanda
and Lever, Sandra
and Paul, Michelle
and Hill, Kelvin
and Pollack, P. Michael R.
and Wiggers, John
and Oldmeadow, Christopher
and Cadilhac, Ann-Michele Dominique
and Duff, Jed
and ",
title="Improving Assessment, Diagnosis, and Management of Urinary Incontinence and Lower Urinary Tract Symptoms on Acute and Rehabilitation Wards That Admit Adult Patients: Protocol for a Before-and-After Implementation Study",
journal="JMIR Res Protoc",
year="2021",
month="Feb",
day="4",
volume="10",
number="2",
pages="e22902",
keywords="urinary incontinence",
keywords="lower urinary tract symptoms",
keywords="inpatient",
keywords="practice-gap",
keywords="practice improvement",
keywords="protocol",
abstract="Background: Urinary incontinence (UI) and lower urinary tract symptoms (LUTS) are commonly experienced by adult patients in hospitals (inpatients). Although peak bodies recommend that health services have systems for optimal UI and LUTS care, they are often not delivered. For example, results from the 2017 Australian National Stroke Audit Acute Services indicated that of the one-third of acute stroke inpatients with UI, only 18\% received a management plan. In the 2018 Australian National Stroke Audit Rehabilitation Services, half of the 41\% of patients with UI received a management plan. There is little reporting of effective inpatient interventions to systematically deliver optimal UI/LUTS care. Objective: This study aims to determine whether our UI/LUTS practice-change package is feasible and effective for delivering optimal UI/LUTS care in an inpatient setting. The package includes our intervention that has been synthesized from the best-available evidence on UI/LUTS care and a theoretically informed implementation strategy targeting identified barriers and enablers. The package is targeted at clinicians working in the participating wards. Methods: This is a pragmatic, real-world, before- and after-implementation study conducted at 12 hospitals (15 wards: 7/15, 47\% metropolitan, 8/15, 53\% regional) in Australia. Data will be collected at 3 time points: before implementation (T0), immediately after the 6-month implementation period (T1), and again after a 6-month maintenance period (T2). We will undertake medical record audits to determine any change in the proportion of inpatients receiving optimal UI/LUTS care, including assessment, diagnosis, and management plans. Potential economic implications (cost and consequences) for hospitals implementing our intervention will be determined. Results: This study was approved by the Hunter New England Human Research Ethics Committee (HNEHREC Reference No. 18/10/17/4.02). Preimplementation data collection (T0) was completed in March 2020. As of November 2020, 87\% (13/15) wards have completed implementation and are undertaking postimplementation data collection (T1). Conclusions: Our practice-change package is designed to reduce the current inpatient UI/LUTS evidence-based practice gap, such as those identified through national stroke audits. This study has been designed to provide clinicians, managers, and policy makers with the evidence needed to assess the potential benefit of further wide-scale implementation of our practice-change package. International Registered Report Identifier (IRRID): DERR1-10.2196/22902 ",
doi="10.2196/22902",
url="https://www.researchprotocols.org/2021/2/e22902",
url="http://www.ncbi.nlm.nih.gov/pubmed/33538703"
}


@Article{info:doi/10.2196/20584,
author="Sowan, K. Azizeh
and Staggers, Nancy
and Berndt, Andrea
and Austin, Tommye
and Reed, C. Charles
and Malshe, Ashwin
and Kilger, Max
and Fonseca, Elma
and Vera, Ana
and Chen, Qian",
title="Improving the Safety, Effectiveness, and Efficiency of Clinical Alarm Systems: Simulation-Based Usability Testing of Physiologic Monitors",
journal="JMIR Nursing",
year="2021",
month="Feb",
day="3",
volume="4",
number="1",
pages="e20584",
keywords="usability testing",
keywords="clinical alarms",
keywords="fatigue",
keywords="critical care",
keywords="patient safety",
keywords="nursing",
abstract="Background: Clinical alarm system safety is a national patient safety goal in the United States. Physiologic monitors are associated with the highest number of device alarms and alarm-related deaths. However, research involving nurses' use of physiologic monitors is rare. Hence, the identification of critical usability issues for monitors, especially those related to patient safety, is a nursing imperative. Objective: This study examined nurses' usability of physiologic monitors in intensive care units with respect to the effectiveness and efficiency of monitor use. Methods: In total, 30 nurses from 4 adult intensive care units completed 40 tasks in a simulation environment. The tasks were common monitoring tasks that were crucial for appropriate monitoring and safe alarm management across four categories of competencies: admitting, transferring, and discharging patients using the monitors (7 tasks); managing measurements and monitor settings (23 tasks); performing electrocardiogram (ECG) analysis (7 tasks); and troubleshooting alarm conditions (3 tasks). The nurse-monitor interaction was video-recorded. The principal investigator and two expert intensive care units nurse educators identified, classified, and validated task success (effectiveness) and the time of task completion (efficiency). Results: Among the 40 tasks, only 2 (5\%) were successfully completed by all the nurses. At least 1-27 (3\%-90\%) nurses abandoned or did not correctly perform 38 tasks. The task with the shortest completion time was ``take monitor out of standby'' (mean 0:02, SD 0:01 min:s), whereas the task ``record a 25 mm/s ECG strip of any of the ECG leads'' had the longest completion time (mean 1:14, SD 0:32 min:s). The total time to complete 37 navigation-related tasks ranged from a minimum of 3 min 57 s to a maximum of 32 min 42 s. Regression analysis showed that it took 6 s per click or step to successfully complete a task. To understand the nurses' thought processes during monitor navigation, the authors analyzed the paths of the 2 tasks with the lowest successful completion rates, where only 13\% (4/30) of the nurses correctly completed these 2 tasks. Although 30\% (9/30) of the nurses accessed the correct screen first for task 1 and task 2, they could not find their way easily from there to successfully complete the 2 tasks. Conclusions: Usability testing of physiologic monitors revealed major ineffectiveness and inefficiencies in the current nurse-monitor interactions. The results indicate the potential for safety and productivity issues in completing routine tasks. Training on monitor use should include critical monitoring functions that are necessary for safe, effective, efficient, and appropriate monitoring to include knowledge of the shortest navigation path. It is imperative that vendors' future monitor designs mimic clinicians' thought processes for successful, safe, and efficient monitor navigation. ",
doi="10.2196/20584",
url="https://nursing.jmir.org/2021/1/e20584/",
url="http://www.ncbi.nlm.nih.gov/pubmed/34345793"
}


@Article{info:doi/10.2196/18643,
author="Hawkins, Natasha
and Jeong, Sarah
and Smith, Tony",
title="Creating Respectful Workplaces for Nurses in Regional Acute Care Settings: Protocol for a Sequential Explanatory Mixed Methods Study",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="11",
volume="10",
number="1",
pages="e18643",
keywords="bullying",
keywords="culture",
keywords="negative behavior",
keywords="nurses",
keywords="methods",
keywords="workforce",
abstract="Background: Negative workplace behaviour among nurses is an internationally recognised problem, despite the plethora of literature spanning several decades. The various forms of mistreatments and uncaring attitudes experienced by nurses include workplace aggression, incivility, bullying, harassment and horizontal violence. Negative behaviour has detrimental effects on the individual nurse, the organisation, the nursing profession and patients. Multi-level organisational interventions are warranted to influence the ``civility norms'' of the nursing profession. Objective: The aim of this study is to investigate the self-reported exposure to and experiences of negative workplace behaviours of nursing staff and their ways of coping in regional acute care hospitals in one Local Health District (LHD) in NSW before and after Respectful Workplace Workshops have been implemented within the organisation. Methods: This study employs a mixed methods sequential explanatory design with an embedded experimental component, underpinned by Social World's Theory. This study will be carried out in four acute care regional hospitals from a Local Health District (LHD) in New South Wales (NSW), Australia.  The nurse unit managers, registered nurses and new graduate nurses from the medical and surgical wards of all four hospitals will be invited to complete a pre-survey examining their experiences, perceptions and responses to negative workplace behaviour, and their ways of coping when exposed.  Face-to-face educational workshops will then be implemented by the organisation at two of the four hospitals. The workshops are designed to increase awareness of negative workplace behaviour, the pathways to seek assistance and aims to create respectful workplaces. Commencing 3 months after completion of the workshop implementation, follow up surveys and interviews will then be undertaken at all four hospitals. Results: The findings from this research will enhance understanding of negative workplace behaviour occurring within the nursing social world and assess the effectiveness of the LHD's Respectful Workplace Workshops upon the levels of negative workplace behaviour occurring.  By integrating qualitative and quantitative findings it will allow for a dual perspective of the social world of nurses where negative and/or respectful workplace behaviours occur, and provide data grounded in individuals lived experiences, positioned in a macro context Conclusions: It is expected that evidence from this study will inform nursing practice, and future policy development aimed at creating respectful workplaces. Trial Registration: Australian New Zealand Clinical Trials Registry (Registration No. ACTRN12618002007213; 14 December 2018). International Registered Report Identifier (IRRID): PRR1-10.2196/18643 ",
doi="10.2196/18643",
url="http://www.researchprotocols.org/2021/1/e18643/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33427678"
}


@Article{info:doi/10.2196/23184,
author="Kawamoto, Eiji
and Ito-Masui, Asami
and Esumi, Ryo
and Ito, Mami
and Mizutani, Noriko
and Hayashi, Tomoyo
and Imai, Hiroshi
and Shimaoka, Motomu",
title="Social Network Analysis of Intensive Care Unit Health Care Professionals Measured by Wearable Sociometric Badges: Longitudinal Observational Study",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="31",
volume="22",
number="12",
pages="e23184",
keywords="wearable",
keywords="interprofessional communication",
keywords="clinician interaction",
keywords="social network analysis",
abstract="Background: Use of wearable sensor technology for studying human teamwork behavior is expected to generate a better understanding of the interprofessional interactions between health care professionals. Objective: We used wearable sociometric sensor badges to study how intensive care unit (ICU) health care professionals interact and are socially connected. Methods: We studied the face-to-face interaction data of 76 healthcare professionals in the ICU at Mie University Hospital collected over 4 weeks via wearable sensors. Results: We detail the spatiotemporal distributions of staff members' inter- and intraprofessional active face-to-face interactions, thereby generating a comprehensive visualization of who met whom, when, where, and for how long in the ICU. Social network analysis of these active interactions, concomitant with centrality measurements, revealed that nurses constitute the core members of the network, while doctors remain in the periphery. Conclusions: Our social network analysis using the comprehensive ICU interaction data obtained by wearable sensors has revealed the leading roles played by nurses within the professional communication network. ",
doi="10.2196/23184",
url="http://www.jmir.org/2020/12/e23184/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33258785"
}


@Article{info:doi/10.2196/17485,
author="Verot, Elise
and Bouleftour, Wafa
and Macron, Corinne
and Rivoirard, Romain
and Chauvin, Franck",
title="Effect of PARACT (PARAmedical Interventions on Patient ACTivation) on the Cancer Care Pathway: Protocol for Implementation of the Patient Activation Measure-13 Item (PAM-13) Version",
journal="JMIR Res Protoc",
year="2020",
month="Dec",
day="8",
volume="9",
number="12",
pages="e17485",
keywords="oncology",
keywords="nursing",
keywords="implementation science",
keywords="PAM-13",
keywords="patient activation",
keywords="REALM-R",
keywords="health literacy",
keywords="mixed method",
abstract="Background: The increase in the number of cancer cases and the evolution of cancer care management have become a significant problem for the French health care system, thereby making patient empowerment as a long sought-after goal in chronic pathologies. The implementation of an activation measure via the Patient Activation Measure-13 item (PAM-13) in the course of cancer care can potentially highlight the patient's needs, with nursing care adapting accordingly. Objective: The objectives of this PARACT (PARAmedical Interventions on Patient ACTivation) multicentric study were as follows: (1) evaluate the implementation of PAM-13 in oncology nursing practices in 5 comprehensive cancer centers, (2) identify the obstacles and facilitators to the implementation of PAM-13, and (3) produce recommendations for the dissemination of such interventions in other comprehensive cancer centers. Methods: This study will follow the ``Reach, Effectiveness, Adoption, Implementation, and Maintenance'' framework and will consist of 3 stages. First, a robust preimplementation analysis will be conducted using the Theoretical Domains Framework (TDF) linked to the ``Capability, Opportunity, Motivation, and Behavior'' model to identify the obstacles and facilitators to implementing new nursing practices in each context. Then, using the Behavior Change Wheel, we will personalize a strategy for implementing the PAM-13, depending on the specificities of each context, to encourage acceptability by the nursing staff involved in the project. This analysis will be performed via a qualitative study through semistructured interviews. Second, the patient will be included in the study for 12 months, during which the patient care pathway will be studied, particularly to collect all relevant contacts of oncology nurses and other health professionals involved in the pathway. The axes of nursing care will also be collected. The primary goal is to implement PAM-13. Secondary factors to be measured are the patient's anxiety level, quality of life, and health literacy level. The oncology nurses will be responsible for completing the questionnaires when the patient is at the hospital for his/her intravenous chemotherapy/immunotherapy treatment. The questionnaires will be completed thrice in a year: (1) at the time of the patient's enrollment, (2) at 6 months, and (3) at 12 months. Third, a postimplementation analysis will be performed through semistructured interviews using the TDF to investigate the implementation problems at each site. Results: This study was supported by a grant from the French Ministry of Health (PHRIP PARACT 2016-0405) and the Lucien Neuwirth Institute of Cancerology of Saint-Etienne, France. Data collection for this study is ongoing. Conclusions: This study would improve the implemented targeted nursing interventions in cancer centers so that a patient is offered a personalized cancer care pathway. Furthermore, measuring the level of activation and the implementation of measures intended to increase such activation could constitute a significant advantage in reducing social health inequalities. Trial Registration: ClinicalTrials.gov NCT03240341; https://clinicaltrials.gov/ct2/show/NCT03240341 International Registered Report Identifier (IRRID): DERR1-10.2196/17485 ",
doi="10.2196/17485",
url="https://www.researchprotocols.org/2020/12/e17485",
url="http://www.ncbi.nlm.nih.gov/pubmed/33289495"
}


@Article{info:doi/10.2196/23626,
author="Rantala, Arja
and Jansson, M. Miia
and Helve, Otto
and Lahdenne, Pekka
and Pikkarainen, Minna
and P{\"o}lkki, Tarja",
title="Parental Experiences of the Pediatric Day Surgery Pathway and the Needs for a Digital Gaming Solution: Qualitative Study",
journal="JMIR Med Inform",
year="2020",
month="Nov",
day="13",
volume="8",
number="11",
pages="e23626",
keywords="anxiety",
keywords="children",
keywords="day surgery",
keywords="delivery of health care",
keywords="digital solution",
keywords="gamification",
keywords="nursing",
keywords="pain",
keywords="qualitative study",
keywords="technology",
abstract="Background: The parents of hospitalized children are often dissatisfied with waiting times, fasting, discharge criteria, postoperative pain relief, and postoperative guidance. Parents' experiences help care providers to provide effective, family-centered care that responds to parents' needs throughout the day surgery pathway. Objective: The objective of our study was to describe parental experiences of the pediatric day surgery pathway and the needs for a digital gaming solution in order to facilitate the digitalization of these pathways. Methods: This was a descriptive qualitative study. The participants (N=31) were parents whose children were admitted to the hospital for the day surgical treatments or magnetic resonance imaging. The data were collected through an unstructured, open-ended questionnaire; an inductive content analysis was conducted to analyze the qualitative data. Reporting of the study findings adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: Parental experiences of the children's day surgery pathway included 3 main categories: (1) needs for parental guidance, (2) needs for support, and (3) child involved in his or her own pathway (eg, consideration of an individual child and preparation of child for treatment). The needs for a digital gaming solution were identified as 1 main category---the digital gaming solution for children and families to support care. This main category included 3 upper categories: (1) preparing children and families for the day surgery via the solution, (2) gamification in the solution, and (3) connecting people through the solution. Conclusions: Parents need guidance and support for their children's day surgery care pathways. A digital gaming solution may be a relevant tool to support communication and to provide information on day surgeries. Families are ready for and are open to digital gaming solutions that provide support and guidance and engage children in the day surgery pathways. ",
doi="10.2196/23626",
url="http://medinform.jmir.org/2020/11/e23626/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33185556"
}


@Article{info:doi/10.2196/17509,
author="Saadatzi, Nasser Mohammad
and Logsdon, Cynthia M.
and Abubakar, Shamsudeen
and Das, Sumit
and Jankoski, Penelope
and Mitchell, Heather
and Chlebowy, Diane
and Popa, O. Dan",
title="Acceptability of Using a Robotic Nursing Assistant in Health Care Environments: Experimental Pilot Study",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="12",
volume="22",
number="11",
pages="e17509",
keywords="robot-assisted healthcare",
keywords="robotic nurse assistant",
keywords="technology acceptance model",
keywords="user acceptability",
keywords="patient walking",
abstract="Background: According to the US Bureau of Labor Statistics, nurses will be the largest labor pool in the United States by 2022, and more than 1.1 million nursing positions have to be filled by then in order to avoid a nursing shortage. In addition, the incidence rate of musculoskeletal disorders in nurses is above average in comparison with other occupations. Robot-assisted health care has the potential to alleviate the nursing shortage by automating mundane and routine nursing tasks. Furthermore, robots in health care environments may assist with safe patient mobility and handling and may thereby reduce the likelihood of musculoskeletal disorders. Objective: This pilot study investigates the perceived ease of use and perceived usefulness (acceptability) of a customized service robot as determined by nursing students (as proxies for nursing staff in health care environments). This service robot, referred to as the Adaptive Robotic Nurse Assistant (ARNA), was developed to enhance the productivity of nurses through cooperation during physical tasks (eg, patient walking, item fetching, object delivery) as well as nonphysical tasks (eg, patient observation and feedback). This pilot study evaluated the acceptability of ARNA to provide ambulatory assistance to patients. Methods: We conducted a trial with 24 participants to collect data and address the following research question: Is the use of ARNA as an ambulatory assistive device for patients acceptable to nurses? The experiments were conducted in a simulated hospital environment. Nursing students (as proxies for nursing staff) were grouped in dyads, with one participant serving as a nurse and the other acting as a patient. Two questionnaires were developed and administrated to the participants based on the Technology Acceptance Model with respect to the two subscales of perceived usefulness and perceived ease of use metrics. In order to evaluate the internal consistency/reliability of the questionnaires, we calculated Cronbach alpha coefficients. Furthermore, statistical analyses were conducted to evaluate the relation of each variable in the questionnaires with the overall perceived usefulness  and perceived ease of use  metrics. Results: Both Cronbach alpha values were acceptably high (.93 and .82 for perceived usefulness  and perceived ease of use  questionnaires, respectively), indicating high internal consistency of the questionnaires. The correlation between the variables and the overall perceived usefulness  and perceived ease of use  metrics was moderate. The average perceived usefulness  and perceived ease of use metrics among the participants were 4.13 and 5.42,  respectively, out of possible score of 7, indicating a higher-than-average acceptability of this service robot. Conclusions: The results served to identify factors that could affect nurses' acceptance of ARNA and aspects needing improvement (eg, flexibility, ease of operation, and autonomy level). ",
doi="10.2196/17509",
url="http://www.jmir.org/2020/11/e17509/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33180024"
}


@Article{info:doi/10.2196/21621,
author="Araujo, Magalhaes Sabrina
and Sousa, Paulino
and Dutra, In{\^e}s",
title="Clinical Decision Support Systems for Pressure Ulcer Management: Systematic Review",
journal="JMIR Med Inform",
year="2020",
month="Oct",
day="16",
volume="8",
number="10",
pages="e21621",
keywords="pressure ulcer",
keywords="decision support systems, clinical",
keywords="systematic review",
abstract="Background: The clinical decision-making process in pressure ulcer management is complex, and its quality depends on both the nurse's experience and the availability of scientific knowledge. This process should follow evidence-based practices incorporating health information technologies to assist health care professionals, such as the use of clinical decision support systems. These systems, in addition to increasing the quality of care provided, can reduce errors and costs in health care. However, the widespread use of clinical decision support systems still has limited evidence, indicating the need to identify and evaluate its effects on nursing clinical practice. Objective: The goal of the review was to identify the effects of nurses using clinical decision support systems on clinical decision making for pressure ulcer management. Methods: The systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. The search was conducted in April 2019 on 5 electronic databases: MEDLINE, SCOPUS, Web of Science, Cochrane, and CINAHL, without publication date or study design restrictions. Articles that addressed the use of computerized clinical decision support systems in pressure ulcer care applied in clinical practice were included. The reference lists of eligible articles were searched manually. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. Results: The search strategy resulted in 998 articles, 16 of which were included. The year of publication ranged from 1995 to 2017, with 45\% of studies conducted in the United States. Most addressed the use of clinical decision support systems by nurses in pressure ulcers prevention in inpatient units. All studies described knowledge-based systems that assessed the effects on clinical decision making, clinical effects secondary to clinical decision support system use, or factors that influenced the use or intention to use clinical decision support systems by health professionals and the success of their implementation in nursing practice. Conclusions: The evidence in the available literature about the effects of clinical decision support systems (used by nurses) on decision making for pressure ulcer prevention and treatment is still insufficient. No significant effects were found on nurses' knowledge following the integration of clinical decision support systems into the workflow, with assessments made for a brief period of up to 6 months. Clinical effects, such as outcomes in the incidence and prevalence of pressure ulcers, remain limited in the studies, and most found clinically but nonstatistically significant results in decreasing pressure ulcers. It is necessary to carry out studies that prioritize better adoption and interaction of nurses with clinical decision support systems, as well as studies with a representative sample of health care professionals, randomized study designs, and application of assessment instruments appropriate to the professional and institutional profile. In addition, long-term follow-up is necessary to assess the effects of clinical decision support systems that can demonstrate a more real, measurable, and significant effect on clinical decision making. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019127663; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=127663 ",
doi="10.2196/21621",
url="http://medinform.jmir.org/2020/10/e21621/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33064099"
}


@Article{info:doi/10.2196/15630,
author="De Leeuw, A. Jacqueline
and Woltjer, Hetty
and Kool, B. Rudolf",
title="Identification of Factors Influencing the Adoption of Health Information Technology by Nurses Who Are Digitally Lagging: In-Depth Interview Study",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="14",
volume="22",
number="8",
pages="e15630",
keywords="qualitative research",
keywords="semi-structured interview",
keywords="purposive sampling",
keywords="health information systems",
keywords="computer user training",
keywords="professional education",
keywords="professional competence",
keywords="registered nurses",
keywords="nursing informatics",
abstract="Background: The introduction of health information technology (HIT) has drastically changed health care organizations and the way health care professionals work. Some health care professionals have trouble coping efficiently with the demands of HIT and the personal and professional changes it requires. Lagging in digital knowledge and skills hampers health care professionals from adhering to professional standards regarding the use of HIT and may cause professional performance problems, especially in the older professional population. It is important to gain more insight into the reasons and motivations behind the technology issues experienced by these professionals, as well as to explore what could be done to solve them. Objective: Our primary research objective was to identify factors that influence the adoption of HIT in a sample of nurses who describe themselves as digitally lagging behind the majority of their colleagues in their workplaces. Furthermore, we aimed to formulate recommendations for practice and leadership on how to help and guide these nurses through ongoing digital transformations in their health care work settings. Methods: In a Dutch university medical center, 10 face-to-face semi-structured interviews were performed with registered nurses (RN). Ammenwerth's FITT-framework (fit between the Individual, Task, and Technology) was used to guide the interview topic list and to formulate themes to explore. Thematic analysis was used to analyze the interview data. The FITT-framework was also used to further interpret and clarify the interview findings. Results: Analyses of the interview data uncovered 5 main categories and 12 subthemes. The main categories were: (1) experience with digital working, (2) perception and meaning, (3) barriers, (4) facilitators, and (5) future perspectives. All participants used electronic devices and digital systems, including the electronic health record. The latter was experienced by some as user-unfriendly, time-consuming, and not supportive in daily professional practice. Most of the interviewees described digital working as ``no fun at all,'' ``working in a fake world,'' ``stressful,'' and ``annoying.'' There was a lack of general digital knowledge and little or no formal basic digital training or education. A negative attitude toward computer use and a lack of digital skills contributed to feelings of increased incompetency and postponement or avoidance of the use of HIT, both privately and professionally. Learning conditions of digital training and education did not meet personal learning needs and learning styles. A positive impact was seen in the work environment when colleagues and nurse managers were aware and sensitive to the difficulties participants experienced in developing digital skills, and when there was continuous training on the job and peer support from digitally savvy colleagues. The availability of a digital play environment combined with learning on the job and support of knowledgeable peers was experienced as helpful and motivating by participants. Conclusions: Nurses who are digitally lagging often have had insufficient and ineffective digital education. This leads to stress, frustration, feelings of incompetency, and postponement or avoidance of HIT use. A digital training approach tailored to the learning needs and styles of these nurses is needed, as well as an on-the-job training structure and adequate peer support. Hospital management and nurse leadership should be informed about the importance of the fit between technology, task, and the individual for adequate adoption of HIT. ",
doi="10.2196/15630",
url="http://www.jmir.org/2020/8/e15630/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32663142"
}


@Article{info:doi/10.2196/18078,
author="Chang, I-Chiu
and Lin, Po-Jin
and Chen, Ting-Hung
and Chang, Chia-Hui",
title="Cultural Impact on the Intention to Use Nursing Information Systems of Nurses in Taiwan and China: Survey and Analysis",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="12",
volume="22",
number="8",
pages="e18078",
keywords="Nursing information system",
keywords="intention to use",
keywords="cultural differences",
keywords="information literacy",
abstract="Background: Nursing workforce shortage has emerged as a global problem. Foreign nurse importation is a popular strategy to address the shortage. The interactions between nursing staff on either side of the Taiwan Strait continue to increase. Since both nurses in Taiwan and nurses in China have adopted nursing information systems to improve health care processes and quality, it is necessary to investigate factors influencing nursing information system usage in nursing practice. Objective: This study examined the effects of cultural and other related factors on nurses' intentions to use nursing information systems. The findings were expected to serve as an empirical base for further benchmarking and management of cross-strait nurses. Methods: This survey was conducted in two case hospitals (one in Taiwan and one in China). A total of 880 questionnaires were distributed (n=440 in each hospital). Results: The results showed effort expectancy had a significant effect on the intention to use nursing information systems of nurses in China (P=.003) but not nurses in Taiwan (P=.16). Conclusions: Findings suggest nursing managers should adopt different strategies to motivate cross-strait nurses to use nursing information systems. Promoting effort expectancy is more likely to motivate nurses in China than in Taiwan. This discrepancy is probably due to the less hierarchical and more feminine society in Taiwan. ",
doi="10.2196/18078",
url="https://www.jmir.org/2020/8/e18078",
url="http://www.ncbi.nlm.nih.gov/pubmed/32784174"
}


@Article{info:doi/10.2196/13996,
author="Khairat, Saif
and Xi, Lin
and Liu, Songzi
and Shrestha, Shilpa
and Austin, Charles",
title="Understanding the Association Between Electronic Health Record Satisfaction and the Well-Being of Nurses: Survey Study",
journal="JMIR Nursing",
year="2020",
month="Jun",
day="23",
volume="3",
number="1",
pages="e13996",
keywords="electronic health record",
keywords="nursing",
keywords="satisfaction",
keywords="critical care",
abstract="Background: Intensive care unit (ICU) nurses experience high levels of burnout related to the high-stress environment. Management of electronic health records (EHR) is a contributing factor to physician burnout. However, limited research has established the relationship between the nurse's well-being and EHR use. Objective: The objective of this study was to examine the association between EHR use and the well-being of nurses. Methods: We surveyed registered nurses employed at a major Southeastern medical center in the United States about their demographics, experience with EHRs, satisfaction with EHRs, and elements of well-being. The correlation between subgroup demographics and survey questions was examined using Kendall and Fisher tests. Results: A total of 113 ICU registered nurses responded to the survey, of which 93 (82.3\%) were females. The population had a mean age of 35.18 years (SD 10.65). A significant association was found between satisfaction and well-being scores, where higher EHR satisfaction was associated with higher self-reported well-being (correlation 0.35, P<.001). Nurses who were unhappy with the time spent in EHR use compared with direct patient care reported higher levels of stress (P<.001) and isolation (P=.009). Older nurses reported higher dissatisfaction with the amount of time spent on EHR tasks related to direct patient care compared to younger nurses (P<.001). Conclusions: Although nurses reported acceptable satisfaction scores with EHR use, deeper analysis suggests that EHR indirectly affects the well-being of nurses. These findings strongly indicate that lower EHR satisfaction can impact the well-being of nurses. More research is needed to optimize the nurse-EHR experience through more user-centered design approaches. ",
doi="10.2196/13996",
url="https://nursing.jmir.org/2020/1/e13996/",
url="http://www.ncbi.nlm.nih.gov/pubmed/34345776"
}


@Article{info:doi/10.2196/19091,
author="Poncette, Akira-Sebastian
and Mosch, Lina
and Spies, Claudia
and Schmieding, Malte
and Schiefenh{\"o}vel, Fridtjof
and Krampe, Henning
and Balzer, Felix",
title="Improvements in Patient Monitoring in the Intensive Care Unit: Survey Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="19",
volume="22",
number="6",
pages="e19091",
keywords="digital health",
keywords="patient monitoring",
keywords="monitoring",
keywords="intensive care medicine",
keywords="intensive care unit",
keywords="technological innovation",
keywords="user-centered",
keywords="usability",
keywords="online survey",
keywords="transdisciplinary",
keywords="REDCap",
keywords="email",
abstract="Background: Due to demographic change and, more recently, coronavirus disease (COVID-19), the importance of modern intensive care units (ICU) is becoming apparent. One of the key components of an ICU is the continuous monitoring of patients' vital parameters. However, existing advances in informatics, signal processing, or engineering that could alleviate the burden on ICUs have not yet been applied. This could be due to the lack of user involvement in research and development. Objective: This study focused on the satisfaction of ICU staff with current patient monitoring and their suggestions for future improvements. We aimed to identify aspects of monitoring that interrupt patient care, display devices for remote monitoring, use cases for artificial intelligence (AI), and whether ICU staff members are willing to improve their digital literacy or contribute to the improvement of patient monitoring. We further aimed to identify differences in the responses of different professional groups. Methods: This survey study was performed with ICU staff from 4 ICUs of a German university hospital between November 2019 and January 2020. We developed a web-based 36-item survey questionnaire, by analyzing a preceding qualitative interview study with ICU staff, about the clinical requirements of future patient monitoring. Statistical analyses of questionnaire results included median values with their bootstrapped 95\% confidence intervals, and chi-square tests to compare the distributions of item responses of the professional groups. Results: In total, 86 of the 270 ICU physicians and nurses completed the survey questionnaire. The majority stated they felt confident using the patient monitoring equipment, but that high rates of false-positive alarms and the many sensor cables interrupted patient care. Regarding future improvements, respondents asked for wireless sensors, a reduction in the number of false-positive alarms, and hospital standard operating procedures for alarm management. Responses to the display devices proposed for remote patient monitoring were divided. Most respondents indicated it would be useful for earlier alerting or when they were responsible for multiple wards. AI for ICUs would be useful for early detection of complications and an increased risk of mortality; in addition, the AI could propose guidelines for therapy and diagnostics. Transparency, interoperability, usability, and staff training were essential to promote the use of AI. The majority wanted to learn more about new technologies for the ICU and required more time for learning. Physicians had fewer reservations than nurses about AI-based intelligent alarm management and using mobile phones for remote monitoring. Conclusions: This survey study of ICU staff revealed key improvements for patient monitoring in intensive care medicine. Hospital providers and medical device manufacturers should focus on reducing false alarms, implementing hospital alarm standard operating procedures, introducing wireless sensors, preparing for the use of AI, and enhancing the digital literacy of ICU staff. Our results may contribute to the user-centered transfer of digital technologies into practice to alleviate challenges in intensive care medicine. Trial Registration: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173 ",
doi="10.2196/19091",
url="http://www.jmir.org/2020/6/e19091/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32459655"
}


@Article{info:doi/10.2196/17876,
author="Tacchini-Jacquier, Nadine
and Hertzog, H{\'e}l{\`e}ne
and Ambord, Kilian
and Urben, Peter
and Turini, Pierre
and Verloo, Henk",
title="An Evidence-Based, Nursing Handover Standard for a Multisite Public Hospital in Switzerland: Web-Based, Modified Delphi Study",
journal="JMIR Nursing",
year="2020",
month="Jun",
day="15",
volume="3",
number="1",
pages="e17876",
keywords="Delphi survey",
keywords="consensus",
keywords="nursing",
keywords="shift",
keywords="nursing handover",
keywords="standard",
keywords="patient transfers",
keywords="peripheral hospital",
abstract="Background: Ineffective communication procedures create openings for errors when health care professionals fail to transfer complete, consistent information. Deficient or absent clinical handovers, or failures to transfer information, responsibility, and accountability, can have severe consequences for hospitalized patients. Clinical handovers are practiced every day, in many ways, in all institutional health care settings. Objective: This study aimed to design an evidence-based, nursing handover standard for inpatients for use at shift changes or internal transfers between hospital wards. Methods: We carried out a modified, multiround, web-based, Delphi data collection survey of an anonymized panel sample of 264 nurse experts working at a multisite public hospital in Switzerland. Each survey round was built on responses from the previous one. The surveys ended with a focus group discussion consisting of a randomly selected panel of participants to explain why items for the evidence-based clinical nursing handover standard were selected or not selected. Items had to achieve a consensus of ?70\% for selection and inclusion. Results: The study presents the items selected by consensus for an evidence-based nursing handover standard for inpatients for use at shift changes or internal transfers. It also presents the reasons why survey items were or were not included. Conclusions: This modified Delphi survey method enabled us to develop a consensus- and evidence-based nursing handover standard now being trialed at shift changes and the internal transfers of inpatients at our multisite public hospital in Switzerland. ",
doi="10.2196/17876",
url="https://nursing.jmir.org/2020/1/e17876/",
url="http://www.ncbi.nlm.nih.gov/pubmed/34345783"
}


@Article{info:doi/10.2196/18788,
author="Akram, Hammad
and Andrews-Paul, Alison
and Washburn, Rachel",
title="Assessing Hand Hygiene and Low-Level Disinfection of Equipment Compliance in an Acute Care Setting: Mixed Methods Approach",
journal="JMIR Nursing",
year="2020",
month="Jun",
day="5",
volume="3",
number="1",
pages="e18788",
keywords="compliance",
keywords="hand hygiene",
keywords="low-level disinfection",
keywords="patient safety",
keywords="qualitative",
keywords="quality improvement",
keywords="infection prevention",
keywords="infection control",
keywords="nursing",
keywords="mixed-methods",
keywords="HAI",
keywords="health care-associated infections",
keywords="hand washing",
keywords="hand sanitizers",
abstract="Background: Hand hygiene and low-level disinfection of equipment behaviors among hospital staff are some of the leading cost-effective methods to reduce hospital-acquired infections (HAI) among patients. Objective: The aim of this study is to examine hand hygiene and low-level disinfection of equipment practices in a central Texas hospital and to explore pertaining gaps, perceptions, and challenges. Methods: Data were collected using a multipronged mixed methods approach that included the following: (1) observation of hand hygiene and low-level disinfection practices (12 and 8 units during morning and evening shifts, respectively); (2) observation of usability/placement of hand sanitizer dispensers; (3) semistructured interviews; and (4) a follow-up email survey. Results: In total, 222 (156 morning shift and 66 evening shift) staff members were observed. Of 526 hand hygiene and 33 low-level disinfection opportunities, compliance was observed 410 (78\%) and 17 (51\%) times, respectively. Overall, 6 units (50\%) had ?0.80 (favorable) hand hygiene compliance during the morning shift and 2 units (25\%) had ?0.80 hand hygiene compliance during the evening shift. Aggregated low-level disinfection compliance was 0.54 during the morning and 0.33 during the evening. Overall, the odds of noncompliant hand hygiene behavior were 1.4 times higher among staff who worked during night shifts compared to day shifts; however, this relationship was not statistically significant (95\% CI 0.86-2.18; P=.18). Noncompliant behavior was most likely among unit B staff during the evening; however, this relationship was not statistically significant (OR 5.3, 95\% CI 0.84-32.9; P=.07) All units, except one, had similar hand sanitizer dispenser usability characteristics. In the qualitative part of the study, the following challenges were identified: ``shortage of time while seeing patients,'' ``sometimes the staff forgets,'' ``concern about drying hands,'' ``behavior is difficult or requires reminders,'' and ``there may be issues with resources or access to supplies to perform these behaviors.'' Staff also stated that ``a process that is considered effective is the Stop the Line program,'' and that the ``behavior is easy and automatic.'' Conclusions: Hand hygiene and low-level disinfection compliance is dependent on several personal and nonpersonal factors. Issues such as time constraints, peer pressure, work culture, available resources, and understanding of guidelines could influence staff behavior. The information collected through this study can be used to re-examine similar or related issues at a larger scale. ",
doi="10.2196/18788",
url="https://nursing.jmir.org/2020/1/e18788",
url="http://www.ncbi.nlm.nih.gov/pubmed/34345785"
}


@Article{info:doi/10.2196/18914,
author="Sule, Ashutosh Anupam
and Caputo, Dean
and Gohal, Jaskaren
and Dascenzo, Doug",
title="Desirable Features of an Interdisciplinary Handoff",
journal="JMIR Nursing",
year="2020",
month="May",
day="22",
volume="3",
number="1",
pages="e18914",
keywords="handoff",
keywords="transition",
keywords="sign-out",
keywords="electronic",
keywords="interdisciplinary",
keywords="interprofessional",
keywords="communication",
keywords="patient safety",
doi="10.2196/18914",
url="https://nursing.jmir.org/2020/1/e18914/",
url="http://www.ncbi.nlm.nih.gov/pubmed/34345786"
}


@Article{info:doi/10.2196/16970,
author="Nakatani, Hayao
and Nakao, Masatoshi
and Uchiyama, Hidefumi
and Toyoshiba, Hiroyoshi
and Ochiai, Chikayuki",
title="Predicting Inpatient Falls Using Natural Language Processing of Nursing Records Obtained From Japanese Electronic Medical Records: Case-Control Study",
journal="JMIR Med Inform",
year="2020",
month="Apr",
day="22",
volume="8",
number="4",
pages="e16970",
keywords="fall",
keywords="risk factor",
keywords="prediction",
keywords="nursing record",
keywords="natural language processing",
keywords="machine learning",
abstract="Background: Falls in hospitals are the most common risk factor that affects the safety of inpatients and can result in severe harm. Therefore, preventing falls is one of the most important areas of risk management for health care organizations. However, existing methods for predicting falls are laborious and costly. Objective: The objective of this study is to verify whether hospital inpatient falls can be predicted through the analysis of a single input---unstructured nursing records obtained from Japanese electronic medical records (EMRs)---using a natural language processing (NLP) algorithm and machine learning. Methods: The nursing records of 335 fallers and 408 nonfallers for a 12-month period were extracted from the EMRs of an acute care hospital and randomly divided into a learning data set and test data set. The former data set was subjected to NLP and machine learning to extract morphemes that contributed to separating fallers from nonfallers to construct a model for predicting falls. Then, the latter data set was used to determine the predictive value of the model using receiver operating characteristic (ROC) analysis. Results: The prediction of falls using the test data set showed high accuracy, with an area under the ROC curve, sensitivity, specificity, and odds ratio of mean 0.834 (SD 0.005), mean 0.769 (SD 0.013), mean 0.785 (SD 0.020), and mean 12.27 (SD 1.11) for five independent experiments, respectively. The morphemes incorporated into the final model included many words closely related to known risk factors for falls, such as the use of psychotropic drugs, state of consciousness, and mobility, thereby demonstrating that an NLP algorithm combined with machine learning can effectively extract risk factors for falls from nursing records. Conclusions: We successfully established that falls among hospital inpatients can be predicted by analyzing nursing records using an NLP algorithm and machine learning. Therefore, it may be possible to develop a fall risk monitoring system that analyzes nursing records daily and alerts health care professionals when the fall risk of an inpatient is increased. ",
doi="10.2196/16970",
url="http://medinform.jmir.org/2020/4/e16970/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32319959"
}


@Article{info:doi/10.2196/15554,
author="Musy, N. Sarah
and Endrich, Olga
and Leichtle, B. Alexander
and Griffiths, Peter
and Nakas, T. Christos
and Simon, Michael",
title="Longitudinal Study of the Variation in Patient Turnover and Patient-to-Nurse Ratio: Descriptive Analysis of a Swiss University Hospital",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="2",
volume="22",
number="4",
pages="e15554",
keywords="patient safety",
keywords="electronic health records",
keywords="nurse staffing",
keywords="workload",
keywords="routine data",
abstract="Background: Variations in patient demand increase the challenge of balancing high-quality nursing skill mixes against budgetary constraints. Developing staffing guidelines that allow high-quality care at minimal cost requires first exploring the dynamic changes in nursing workload over the course of a day. Objective: Accordingly, this longitudinal study analyzed nursing care supply and demand in 30-minute increments over a period of 3 years. We assessed 5 care factors: patient count (care demand), nurse count (care supply), the patient-to-nurse ratio for each nurse group, extreme supply-demand mismatches, and patient turnover (ie, number of admissions, discharges, and transfers). Methods: Our retrospective analysis of data from the Inselspital University Hospital Bern, Switzerland included all inpatients and nurses working in their units from January 1, 2015 to December 31, 2017. Two data sources were used. The nurse staffing system (tacs) provided information about nurses and all the care they provided to patients, their working time, and admission, discharge, and transfer dates and times. The medical discharge data included patient demographics, further admission and discharge details, and diagnoses. Based on several identifiers, these two data sources were linked. Results: Our final dataset included more than 58 million data points for 128,484 patients and 4633 nurses across 70 units. Compared with patient turnover, fluctuations in the number of nurses were less pronounced. The differences mainly coincided with shifts (night, morning, evening). While the percentage of shifts with extreme staffing fluctuations ranged from fewer than 3\% (mornings) to 30\% (evenings and nights), the percentage within ``normal'' ranges ranged from fewer than 50\% to more than 80\%. Patient turnover occurred throughout the measurement period but was lowest at night. Conclusions: Based on measurements of patient-to-nurse ratio and patient turnover at 30-minute intervals, our findings indicate that the patient count, which varies considerably throughout the day, is the key driver of changes in the patient-to-nurse ratio. This demand-side variability challenges the supply-side mandate to provide safe and reliable care. Detecting and describing patterns in variability such as these are key to appropriate staffing planning. This descriptive analysis was a first step towards identifying time-related variables to be considered for a predictive nurse staffing model. ",
doi="10.2196/15554",
url="https://www.jmir.org/2020/4/e15554",
url="http://www.ncbi.nlm.nih.gov/pubmed/32238331"
}


@Article{info:doi/10.2196/16381,
author="Liao, Min-Chi
and Lin, I-Chun",
title="Performance Evaluation of an Information Technology Intervention Regarding Charging for Inpatient Medical Materials at a Regional Teaching Hospital in Taiwan: Empirical Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="25",
volume="8",
number="3",
pages="e16381",
keywords="Information System Success Model",
keywords="information technology intervention",
keywords="charging",
keywords="medical materials",
keywords="work performance",
abstract="Background: The process of manually recording the consumption of medical materials can be time consuming and prone to omission owing to its detailed and complicated nature. Implementing an information system will better improve work performance. Objective: The Information System Success Model was adopted as the theoretical foundation. The opinions of nursing staff were collected to verify the impact of the system intervention on their work performance. Methods: This cross-sectional study was conducted at a regional teaching hospital. Nursing staff were invited to participate in the field survey. A total of 296 questionnaires were collected, and of these, 284 (95.9\%) were valid and returned. Results: The key findings showed that two critical factors (``subjective norm'' and ``system quality'') had significant positive effects (both P<.001) on user satisfaction (R2=0.709). The path of ``service quality'' to ``user satisfaction'' showed marginal significance (P=.08) under the 92\% CI. Finally, the explanatory power of the model reached 68.9\%. Conclusions: Support from the top management, appointment of a nurse supervisor as the change agent, recruitment of seed members to establish a pioneer team, and promotion of the system through the influence of opinion leaders in small groups were critical success factors needed for implementing the system in the case hospital. The target system was proven to be able to improve work performance, and the time saved could be further used for patient care, thereby increasing the value of nursing work. The positive experiences gained from this study could lay the foundation for the further promotion of the new system, and this is for future studies to replicate. The example of the successful experience of the case hospital could also serve as a reference for other hospitals in developing countries like Taiwan with regard to the promotion of nursing informatization. ",
doi="10.2196/16381",
url="http://mhealth.jmir.org/2020/3/e16381/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32209534"
}


@Article{info:doi/10.2196/17040,
author="Bautista, Robert John
and Lin, C. Trisha T.
and Theng, Yin-Leng",
title="Influence of Organizational Issues on Nurse Administrators' Support to Staff Nurses' Use of Smartphones for Work Purposes in the Philippines: Focus Group Study",
journal="JMIR Nursing",
year="2020",
month="Jan",
day="10",
volume="3",
number="1",
pages="e17040",
keywords="BYOD",
keywords="IT consumerization",
keywords="nurse administrators",
keywords="organizational support",
keywords="Philippines",
keywords="smartphone",
abstract="Background: Studies show that nurses use their own smartphones for work purposes, and there are several organizational issues related to this. However, it is unclear what these organizational issues are in the Philippines and the influence they have on nurse administrators' (ie, superiors) support to staff nurses' (ie, subordinates) use of smartphones for work purposes. Objective: Drawing from the Organizational Support Theory (OST), this study aimed to identify organizational issues that influence nurse administrators' support to staff nurses' use of smartphones for work purposes. Methods: Between June and July 2017, 9 focus groups with 43 nurse administrators (ie, head nurses, nurse supervisors, and nurse managers) were conducted in 9 tertiary-level general hospitals in Metro Manila, the Philippines. Drawing from OST, issues were classified as those that encouraged or inhibited nurse administrators to support nurses' use of smartphones for work purposes. Results: Nurse administrators were encouraged to support nurses' use of smartphones for work purposes when (1) personal smartphones are superior to workplace technologies, (2) personal smartphones resolve unit phone problems, and (3) policy is unrealistic to implement. Conversely, issues that inhibited nurse administrators to support nurses' use of smartphones for work purposes include (1) smartphone use for nonwork purposes and (2) misinterpretation by patients. Conclusions: Nurse administrators in the Philippines faced several organizational issues that encouraged or inhibited support to staff nurses' use of smartphones for work purposes. Following OST, the extent of their support can influence staff nurses' perceived organizational support on the use of smartphones for work purposes, Overall, the findings highlight the role and implication of organizational support in the context of smartphone consumerization in hospital settings, especially in developing countries. ",
doi="10.2196/17040",
url="https://nursing.jmir.org/2020/1/e17040",
url="http://www.ncbi.nlm.nih.gov/pubmed/34345781"
}


@Article{info:doi/10.2196/15785,
author="Chang, I-Chiu
and Cheng, Wei-Chen
and Kung, Wen-Chuan",
title="A Stress Relief App Intervention for Newly Employed Nursing Staff: Quasi-Experimental Design",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Dec",
day="18",
volume="7",
number="12",
pages="e15785",
keywords="nursing staff",
keywords="occupational stress",
keywords="mobile app",
abstract="Background: Most newly employed nurses have limited practical experience, lack problem-solving abilities, and have low resistance to stress, and therefore often opt to resign from the nursing profession. Objective: This study aimed to assess the effectiveness of a stress relief app (SR\_APP) to monitor the stress levels of newly employed nurses. Methods: We conducted a quasi-experiment to assess changes in stress levels of newly employed nurses at a case hospital, in which the experimental group used the SR\_APP and the control group did not. In-depth interviews were conducted to reveal insights regarding their stress. The app usage experiences of experimental group members were assessed via a questionnaire. Results: All the participants appreciated the experiment and were interested to know more about managing their stress. The experimental group members showed significant differences in heart rate variability scores before and after using the SR\_APP, and they reported high levels of intention to use and satisfaction with regard to the SR\_APP. Conclusions: The SR\_APP can be effective in helping newly employed nurses to manage their stress. ",
doi="10.2196/15785",
url="https://mhealth.jmir.org/2019/12/e15785",
url="http://www.ncbi.nlm.nih.gov/pubmed/31850848"
}


@Article{info:doi/10.2196/14985,
author="de Wit, Matthijs
and Kleijnen, Mirella
and Lissenberg-Witte, Birgit
and van Uden-Kraan, Cornelia
and Millet, Kobe
and Frambach, Ruud
and Verdonck-de Leeuw, Irma",
title="Understanding Drivers of Resistance Toward Implementation of Web-Based Self-Management Tools in Routine Cancer Care Among Oncology Nurses: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2019",
month="Dec",
day="17",
volume="21",
number="12",
pages="e14985",
keywords="psycho-oncology",
keywords="health-related quality of life",
keywords="self-management",
keywords="eHealth",
keywords="implementation science",
keywords="resistance to innovations",
abstract="Background: Supporting patients to engage in (Web-based) self-management tools is increasingly gaining importance, but the engagement of health care professionals is lagging behind. This can partly be explained by resistance among health care professionals. Objective: The aim of this study was to investigate drivers of resistance among oncology nurses toward Web-based self-management tools in cancer care. Methods: Drawing from previous research, combining clinical and marketing perspectives, and several variables and instruments, we developed the Resistance to Innovation model (RTI-model). The RTI-model distinguishes between passive and active resistance, which can be enhanced or reduced by functional drivers (incompatibility, complexity, lack of value, and risk) and psychological drivers (role ambiguity, social pressure from the institute, peers, and patients). Both types of drivers can be moderated by staff-, organization-, patient-, and environment-related factors. We executed a survey covering all components of the RTI-model on a cross-sectional sample of nurses working in oncology in the Netherlands. Structural equation modeling was used to test the full model, using a hierarchical approach. In total, 2500 nurses were approached, out of which 285 (11.40\%) nurses responded. Results: The goodness of fit statistic of the uncorrected base model of the RTI-model (n=239) was acceptable ($\chi$21=9.2; Comparative Fit Index=0.95; Tucker Lewis index=0.21; Root Mean Square Error of Approximation=0.19; Standardized Root Mean Square=0.016). In line with the RTI-model, we found that both passive and active resistance among oncology nurses toward (Web-based) self-management tools were driven by both functional and psychological drivers. Passive resistance toward Web-based self-management tools was enhanced by complexity, lack of value, and role ambiguity, and it was reduced by institutional social pressure. Active resistance was enhanced by complexity, lack of value, and social pressure from peers, and it was reduced by social pressure from the institute and patients. In contrast to what we expected, incompatibility with current routines was not a significant driver of either passive or active resistance. This study further showed that these drivers of resistance were moderated by expertise (P=.03), managerial support (P=.004), and influence from external stakeholders (government; P=.04). Conclusions: Both passive and active resistance in oncology nurses toward Web-based self-management tools for patients with cancer are driven by functional and psychological drivers, which may be more or less strong, depending on expertise, managerial support, and governmental influence. ",
doi="10.2196/14985",
url="http://www.jmir.org/2019/12/e14985/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31845900"
}


@Article{info:doi/10.2196/15658,
author="Baker, M. Kelley
and Magee, F. Michelle
and Smith, M. Kelly",
title="Understanding Nursing Workflow for Inpatient Education Delivery: Time and Motion Study",
journal="JMIR Nursing",
year="2019",
month="Nov",
day="1",
volume="2",
number="1",
pages="e15658",
keywords="nursing",
keywords="workflow",
keywords="time and motion studies",
keywords="patient education",
keywords="type 2 diabetes mellitus",
abstract="Background: Diabetes self-management education and support improves diabetes-related outcomes, but many persons living with diabetes do not receive this. Adults with diabetes have high hospitalization rates, so hospital stays may present an opportunity for diabetes education. Nurses, supported by patient care technicians, are typically responsible for delivering patient education but often do not have time. Using technology to support education delivery in the hospital is one potentially important solution. Objective: The aim of this study was to evaluate nurse and patient care technician workflow to identify opportunities for providing education. The results informed implementation of a diabetes education program on a tablet computer in the hospital setting within existing nursing workflow with existing staff. Methods: We conducted a time and motion study of nurses and patient care technicians on three medical-surgical units of a large urban tertiary care hospital. Five trained observers conducted observations in 2-hour blocks. During each observation, a single observer observed a single nurse or patient care technician and recorded the tasks, locations, and their durations using a Web-based time and motion data collection tool. Percentage of time spent on a task and in a location and mean duration of task and location sessions were calculated. In addition, the number of tasks and locations per hour, number of patient rooms visited per hour, and mean time between visits to a given patient room were determined. Results: Nurses spent approximately one-third of their time in direct patient care and much of their time (60\%) on the unit but not in a patient room. Compared with nurses, patient care technicians spent a significantly greater percentage of time in direct patient care (42\%; P=.001). Nurses averaged 16.2 tasks per hour, while patient care technicians averaged 18.2. The mean length of a direct patient care session was 3:42 minutes for nurses and 3:02 minutes for patient care technicians. For nurses, 56\% of task durations were 2 minutes or less, and 38\% were one minute or less. For patient care technicians, 62\% were 2 minutes or less, and 44\% were 1 minute or less. Nurses visited 5.3 and patient care technicians 9.4 patient rooms per hour. The mean time between visits to a given room was 37:15 minutes for nurses and 33:28 minutes for patient care technicians. Conclusions: The workflow of nurses and patient care technicians, constantly in and out of patient rooms, suggests an opportunity for delivering a tablet to the patient bedside. The average time between visits to a given room is consistent with bringing the tablet to a patient in one visit and retrieving it at the next. However, the relatively short duration of direct patient care sessions could potentially limit the ability of nurses and patient care technicians to spend much time with each patient on instruction in the technology platform or the content. ",
doi="10.2196/15658",
url="https://nursing.jmir.org/2019/1/e15658/",
url="http://www.ncbi.nlm.nih.gov/pubmed/34345775"
}


@Article{info:doi/10.2196/14603,
author="Harsha, Prathiba
and Paul, E. James
and Chong, A. Matthew
and Buckley, Norm
and Tidy, Antonella
and Clarke, Anne
and Buckley, Diane
and Sirko, Zenon
and Vanniyasingam, Thuva
and Walsh, Jake
and McGillion, Michael
and Thabane, Lehana",
title="Challenges With Continuous Pulse Oximetry Monitoring and Wireless Clinician Notification Systems After Surgery: Reactive Analysis of a Randomized Controlled Trial",
journal="JMIR Med Inform",
year="2019",
month="Oct",
day="28",
volume="7",
number="4",
pages="e14603",
keywords="continuous pulse oximetry",
keywords="wireless notification",
keywords="issues",
keywords="evaluation of issues",
keywords="clinical adoption framework",
keywords="remote monitoring",
keywords="postoperative monitoring",
keywords="false alarm",
abstract="Background: Research has shown that introducing electronic Health (eHealth) patient monitoring interventions can improve healthcare efficiency and clinical outcomes. The VIGILANCE (VItal siGns monItoring with continuous puLse oximetry And wireless cliNiCian notification aftEr surgery) study was a randomized controlled trial (n=2049) designed to assess the impact of continuous vital sign monitoring with alerts sent to nursing staff when respiratory resuscitations with naloxone, code blues, and intensive care unit transfers occurred in a cohort of postsurgical patients in a ward setting. This report identifies and evaluates key issues and challenges associated with introducing wireless monitoring systems into complex hospital infrastructure during the VIGILANCE eHealth intervention implementation. Potential solutions and suggestions for future implementation research are presented. Objective: The goals of this study were to: (1) identify issues related to the deployment of the eHealth intervention system of the VIGILANCE study; and (2) evaluate the influence of these issues on intervention adoption. Methods: During the VIGILANCE study, issues affecting the implementation of the eHealth intervention were documented on case report forms, alarm event forms, and a nursing user feedback questionnaire. These data were collated by the research and nursing personnel and submitted to the research coordinator. In this evaluation report, the clinical adoption framework was used as a guide to organize the identified issues and evaluate their impact. Results: Using the clinical adoption framework, we identified issues within the framework dimensions of people, organization, and implementation at the meso level, as well as standards and funding issues at the macro level. Key issues included: nursing workflow changes with blank alarm forms (24/1030, 2.33\%) and missing alarm forms (236/1030, 22.91\%), patient withdrawal (110/1030, 10.68\%), wireless network connectivity, false alarms (318/1030, 30.87\%), monitor malfunction (36/1030, 3.49\%), probe issues (16/1030, 1.55\%), and wireless network standards. At the micro level, these issues affected the quality of the service in terms of support provided, the quality of the information yielded by the monitors, and the functionality, reliability, and performance of the monitoring system. As a result, these issues impacted access through the decreased ability of nurses to make complete use of the monitors, impacted care quality of the trial intervention through decreased effectiveness, and impacted productivity through interference in the coordination of care, thus decreasing clinical adoption of the monitoring system. Conclusions: Patient monitoring with eHealth technology in surgical wards has the potential to improve patient outcomes. However, proper planning that includes engagement of front-line nurses, installation of appropriate wireless network infrastructure, and use of comfortable cableless devices is required to maximize the potential of eHealth monitoring. Trial Registration: ClinicalTrials.gov NCT02907255; https://clinicaltrials.gov/ct2/show/NCT02907255 ",
doi="10.2196/14603",
url="http://medinform.jmir.org/2019/4/e14603/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31661079"
}


@Article{info:doi/10.2196/14797,
author="Danak, U. Shivang
and Guetterman, C. Timothy
and Plegue, A. Melissa
and Holmstrom, L. Heather
and Kadri, Reema
and Duthler, Alexander
and Yoo, Anne
and Buis, R. Lorraine",
title="Influence of Scribes on Patient-Physician Communication in Primary Care Encounters: Mixed Methods Study",
journal="JMIR Med Inform",
year="2019",
month="Jul",
day="11",
volume="7",
number="3",
pages="e14797",
keywords="electronic health records",
keywords="documentation",
keywords="medical informatics",
abstract="Background: With the increasing adoption of electronic health record (EHR) systems, documentation-related burdens have been increasing for health care providers. Recent estimates indicate that primary care providers spend about one-half of their workdays interacting with the EHR, of which about half is focused on clerical tasks. To reduce documentation burdens associated with the EHR, health care systems and physician practices are increasingly implementing medical scribes to assist providers with real-time documentation. Scribes are typically unlicensed paraprofessionals who assist health care providers bydocumenting notes electronically under the direction of a licensed practitioner or physician in real time. Despite the promise of scribes, few studies have investigated their effect on clinical encounters, particularly with regard to patient-provider communication. Objective: The purpose of this quasi-experimental pilot study was to understand how scribes affect patient-physician communication in primary care clinical encounters. Methods: We employed a convergent mixed methods design and included a sample of three physician-scribe pairs and 34 patients. Patients' clinical encounters were randomly assigned to a scribe or nonscribe group. We conducted patient surveys focused on perceptions of patient-provider communication and satisfaction with encounters, video recorded clinical encounters, and conducted physician interviews about their experiences with scribes. Results: Overall, the survey results revealed that patients across both arms reported very high satisfaction of communication with their physician, their physician's use of the EHR, and their care, with very little variability. Video recording analysis supported patient survey data by demonstrating high measures of communication among physicians in both scribed and nonscribed encounters. Furthermore, video recordings revealed that the presence of scribes had very little effect on the clinical encounter. Conclusions: From the patient's perspective, scribes are an acceptable addition to clinical encounters. Although they do not have much impact on patients' perceptions of satisfaction and their impact on the clinical encounter itself was minimal, their potential to reduce documentation-related burden on physicians is valuable. Physicians noted important issues related to scribes, including important considerations for implementing scribe programs, the role of scribes in patient interactions, how physicians work with scribes, characteristics of good scribes, and the role of scribes in physician workflow. ",
doi="10.2196/14797",
url="http://medinform.jmir.org/2019/3/e14797/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31298218"
}


@Article{info:doi/10.2196/11499,
author="Zhou, Liyuan
and Suominen, Hanna
and Gedeon, Tom",
title="Adapting State-of-the-Art Deep Language Models to Clinical Information Extraction Systems: Potentials, Challenges, and Solutions",
journal="JMIR Med Inform",
year="2019",
month="Apr",
day="25",
volume="7",
number="2",
pages="e11499",
keywords="computer systems",
keywords="artificial intelligence",
keywords="deep learning",
keywords="information storage and retrieval",
keywords="medical informatics",
keywords="nursing records",
keywords="patient handoff",
abstract="Background: Deep learning (DL) has been widely used to solve problems with success in speech recognition, visual object recognition, and object detection for drug discovery and genomics. Natural language processing has achieved noticeable progress in artificial intelligence. This gives an opportunity to improve on the accuracy and human-computer interaction of clinical informatics. However, due to difference of vocabularies and context between a clinical environment and generic English, transplanting language models directly from up-to-date methods to real-world health care settings is not always satisfactory. Moreover, the legal restriction on using privacy-sensitive patient records hinders the progress in applying machine learning (ML) to clinical language processing. Objective: The aim of this study was to investigate 2 ways to adapt state-of-the-art language models to extracting patient information from free-form clinical narratives to populate a handover form at a nursing shift change automatically for proofing and revising by hand: first, by using domain-specific word representations and second, by using transfer learning models to adapt knowledge from general to clinical English. We have described the practical problem, composed it as an ML task known as information extraction, proposed methods for solving the task, and evaluated their performance. Methods: First, word representations trained from different domains served as the input of a DL system for information extraction. Second, the transfer learning model was applied as a way to adapt the knowledge learned from general text sources to the task domain. The goal was to gain improvements in the extraction performance, especially for the classes that were topically related but did not have a sufficient amount of model solutions available for ML directly from the target domain. A total of 3 independent datasets were generated for this task, and they were used as the training (101 patient reports), validation (100 patient reports), and test (100 patient reports) sets in our experiments. Results: Our system is now the state-of-the-art in this task. Domain-specific word representations improved the macroaveraged F1 by 3.4\%. Transferring the knowledge from general English corpora to the task-specific domain contributed a further 7.1\% improvement. The best performance in populating the handover form with 37 headings was the macroaveraged F1 of 41.6\% and F1 of 81.1\% for filtering out irrelevant information. Performance differences between this system and its baseline were statistically significant (P<.001; Wilcoxon test). Conclusions: To our knowledge, our study is the first attempt to transfer models from general deep models to specific tasks in health care and gain a significant improvement. As transfer learning shows its advantage over other methods, especially on classes with a limited amount of training data, less experts' time is needed to annotate data for ML, which may enable good results even in resource-poor domains. ",
doi="10.2196/11499",
url="http://medinform.jmir.org/2019/2/e11499/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31021325"
}


@Article{info:doi/10.2196/11425,
author="Benham-Hutchins, Marge
and Carley, M. Kathleen
and Brewer, B. Barbara
and Effken, A. Judith
and Reminga, Jeffrey",
title="Nursing Unit Communication During a US Public Health Emergency: Natural Experiment",
journal="JMIR Nursing",
year="2018",
month="Dec",
day="06",
volume="1",
number="1",
pages="e11425",
keywords="social network analysis",
keywords="nursing unit communication",
keywords="Ebola virus disease",
keywords="public health emergency",
keywords="natural experiment",
keywords="nursing",
abstract="Background: In the second half of 2014, the first case of Ebola virus disease (EVD) was diagnosed in the United States. During this time period, we were collecting data for the Measuring Network Stability and Fit (NetFIT) longitudinal study, which used social network analysis (SNA) to study relationships between nursing staff communication patterns and patient outcomes. One of the data collection sites was a few blocks away from where the initial EVD diagnosis was made. The EVD public health emergency during the NetFIT data collection time period resulted in the occurrence of a natural experiment. Objective: The objectives of the NetFIT study were to examine the structure of nursing unit decision-making and information-sharing networks, identify a parsimonious set of network metrics that can be used to measure the longitudinal stability of these networks, examine the relationship between the contextual features of a unit and network metrics, and identify relationships between key network measures and nursing-sensitive patient-safety and quality outcomes. This paper reports on unit communication and outcome changes that occurred during the EVD natural disaster time period on the 10 hospital units that had data collected before, during, and after the crisis period. Methods: For the NetFIT study, data were collected from nursing staff working on 25 patient care units, in three hospitals, and at four data collection points over a 7-month period: Baseline, Month 1, Month 4, and Month 7. Data collection was staggered by hospital and unit. To evaluate the influence of this public health emergency on nursing unit outcomes and communication characteristics, this paper focuses on a subsample of 10 units from two hospitals where data were collected before, during, and after the EVD crisis period. No data were collected from Hospital B during the crisis period. Network data from individual staff were aggregated to the nursing unit level to create 24-hour networks and three unit-level safety outcome measures---fall rate, medication errors, and hospital-acquired pressure ulcers---were collected. Results: This analysis includes 40 data collection points and 608 staff members who completed questionnaires. Participants (N=608) included registered nurses (431, 70.9\%), licensed vocational nurses (3, 0.5\%), patient care technicians (133, 21.9\%), unit clerks (28, 4.6\%), and monitor watchers (13, 2.1\%). Changes in SNA metrics associated with communication (ie, average distance, diffusion, and density) were noted in units that had changes in patient safety outcome measures. Conclusions: Units in the hospital site in the same city as the EVD case exhibited multiple changes in patient outcomes, network communication metrics, and response rates. Future research using SNA to examine the influence of public health emergencies on hospital communication networks and relationships to patient outcomes is warranted. ",
doi="10.2196/11425",
url="https://nursing.jmir.org/2018/1/e11425/",
url="http://www.ncbi.nlm.nih.gov/pubmed/34345768"
}


@Article{info:doi/10.2196/humanfactors.5098,
author="Sowan, Khaled Azizeh
and Gomez, Michelle Tiffany
and Tarriela, Fajardo Albert
and Reed, Calhoun Charles
and Paper, Michael Bruce",
title="Changes in Default Alarm Settings and Standard In-Service are Insufficient to Improve Alarm Fatigue in an Intensive Care Unit: A Pilot Project",
journal="JMIR Human Factors",
year="2016",
month="Jan",
day="11",
volume="3",
number="1",
pages="e1",
keywords="cardiac monitors",
keywords="default alarm settings",
keywords="alarm fatigue",
keywords="intensive care unit",
keywords="nursing",
keywords="in-service",
keywords="survey",
abstract="Background: Clinical alarm systems safety is a national concern, specifically in intensive care units (ICUs) where alarm rates are known to be the highest. Interventional projects that examined the effect of changing default alarm settings on overall alarm rate and on clinicians' attitudes and practices toward clinical alarms and alarm fatigue are scarce. Objective: To examine if (1) a change in default alarm settings of the cardiac monitors and (2) in-service nursing education on cardiac monitor use in an ICU would result in reducing alarm rate and in improving nurses' attitudes and practices toward clinical alarms. Methods: This quality improvement project took place in a 20-bed transplant/cardiac ICU with a total of 39 nurses. We implemented a unit-wide change of default alarm settings involving 17 parameters of the cardiac monitors. All nurses received an in-service education on monitor use. Alarm data were collected from the audit log of the cardiac monitors 10 weeks before and 10 weeks after the change in monitors' parameters. Nurses' attitudes and practices toward clinical alarms were measured using the Healthcare Technology Foundation National Clinical Alarms Survey, pre- and postintervention. Results: Alarm rate was 87.86 alarms/patient day (a total of 64,500 alarms) at the preintervention period compared to 59.18 alarms/patient day (49,319 alarms) postintervention (P=.01). At baseline, Arterial Blood Pressure (ABP), Pair Premature Ventricular Contractions (PVCs), and Peripheral Capillary Oxygen Saturation (SpO2) alarms were the highest. ABP and SpO2 alarms remained among the top three at the postproject period. Out of the 39 ICU nurses, 24 (62\%) provided complete pre- and postproject survey questionnaires. Compared to the preintervention survey, no remarkable changes in the postproject period were reported in nurses' attitudes. Themes in the narrative data were related to poor usability of cardiac monitors and the frequent alarms. The data showed great variation among nurses in terms of changing alarm parameters and frequency of replacing patients' electrodes. Despite the in-service, 50\% (12/24) of the nurses specified their need for more training on cardiac monitors in the postproject period. Conclusions: Changing default alarm settings and standard in-service education on cardiac monitor use are insufficient to improve alarm systems safety. Alarm management in ICUs is very complex, involving alarm management practices by clinicians, availability of unit policies and procedures, unit layout, complexity and usability of monitoring devices, and adequacy of training on system use. The complexity of the newer monitoring systems requires urgent usability testing and multidimensional interventions to improve alarm systems safety and to attain the Joint Commission National Patient Safety Goal on alarm systems safety in critical care units. ",
doi="10.2196/humanfactors.5098",
url="http://humanfactors.jmir.org/2016/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27036170"
}