Older Adults' Perception on and Use of Patient Portals: A Comparative Analysis of Two Samples.

Older adults can benefit from using patient portals. Little is known whether perception of and use of patient portals differ among older adults in diverse healthcare contexts. This study analyzed the difference in perceived usability, self-efficacy, and use of patient portals between older adults recruited from a healthcare system (n = 174) and older adults recruited from nationwide communities (n = 126). A secondary data analysis was conducted using the data sets of two independent studies. A series of linear and ordinal logistic regression analyses were performed. The healthcare system sample had more health issues, higher levels of perceived usability and self-efficacy, and frequent use of patient portals compared with the community sample. This study indicates that efforts to improve usability of patient portals and self-efficacy are essential for all older adult users. The association between perceived usability and patient portal use was stronger in the community sample than in the healthcare system sample, suggesting that approaches to support older adults' efficient use of patient portals should be tailored to their health status and care needs. Future studies may include inpatient and outpatient portals and investigate the impact on health outcomes of older adults across care settings.

Understanding Digital Health Technologies Using Mind Maps.

PURPOSE: The purpose of this project was to explore digital health technologies in the healthcare environment through the use of concept and mind mapping tools in a graduate level informatics practicum course. DESIGN: This descriptive course evaluation project was conducted at a large university school of nursing during the 2019-2020 academic year and included a convenience sample of 163 doctor of nursing practice students. METHODS: Students completed four major deliverables exploring digital health technologies and data sources using mind maps. Project goals were evaluated using detailed rubrics and data from a course evaluation questionnaire (CEQ) then analyzed using descriptive statistics. Comments from the CEQ and reflection documents were reviewed for themes and validated by two experts. FINDINGS: The variety and creativity of the mind maps along with student comments indicated their ability to apply critical thinking skills to the specific content and technologies being examined. Overall CEQ mean scores were high (M = 4.35), indicating that the mind mapping deliverables were logical, relevant, appropriate, and meaningful to learning. CONCLUSIONS: Nurse educators and healthcare professionals should consider using mind mapping techniques because this venue allows for expanded understanding of the complexities of the healthcare environment and integration of related digital health technologies. CLINICAL RELEVANCE: The recent pandemic highlighted the necessity for new technologies to continue providing patient care services. Mind maps are a fast and economical tool for understanding and prioritizing the needs of an organization as well as a unique teaching strategy to promote critical thinking and sharing of ideas related to digital health technologies.

Testing a Model of Patient Portal Use in Adult Patients.

PURPOSE: The aim of this study was to test a modified version of the Technology Acceptance Model, which describes users' technology adoption, to examine the relations between patient portal use and potential influencing factors in adult patients who have used patient portals. The modified model posits that patient portal use can be explained by attitude and self-efficacy for using patient portals, perceived usefulness and ease of use, data privacy and security concerns, eHealth literacy, education level, and age. DESIGN: A cross-sectional anonymous online survey was conducted for adult patients who had used their patient portals in the past 12 months. METHODS: Participants were recruited from 20 settings selected in a large integrated health care system. Data from 743 patients were subject to structural equation modeling for model testing. FINDINGS: Sixty-eight percent were White and female, with a mean age of 53.1 years (SD = 15.34). Forty-seven percent used patient portals about monthly or more frequently. Scores for perceived usefulness and ease of use of patient portals were relatively high (as measured using the modified Perceived Health Web Site Usability Questionnaire; each item mean, 6.0-6.2; range, 1-7). The final model adequately fit the data (comparative fit index = .983, standardized root mean square residual = .064, root mean square error of approximation = .059). Patient portal self-efficacy and data privacy and security concerns had a direct impact on patient portal use. Perceived usefulness and ease of use, eHealth literacy, education level, and age indirectly influenced patient portal use. CONCLUSIONS: This study contributes to expanding a theoretical understanding of adult patients' patient portal use in a real health care environment. Future studies need to include more diverse populations in various settings. CLINICAL RELEVANCE: Knowledge gained from this study can be used by technology experts to make patient portals more user friendly and by administrators to implement patient portals more effectively.

A Physical Activity Mobile Game for Hematopoietic Stem Cell Transplant Patients: App Design, Development, and Evaluation.

BACKGROUND: Physical activity mobile apps may encourage patients with cancer to increase exercise uptake, consequently decreasing cancer-related fatigue. While many fitness apps are currently available for download, most are not suitable for patients with cancer due to the unique barriers these patients face, such as fatigue, pain, and nausea. OBJECTIVE: The aim of this study is to design, develop, and perform alpha testing of a physical activity mobile health game for hematopoietic stem cell transplant (HSCT) patients. The ultimate future goal of this project is to motivate HSCT patients to increase physical activity and provide them with a safe and fun way to exercise. METHODS: A mobile health game called Walking Warrior was designed as a puzzle game where tiles are moved and matched. Walking Warrior interfaces with an open-source step counter and communicates with a central online MySQL database to record game play and walking performance. The game came to fruition after following an iterative process model with several prototypes. Game developers and bone marrow transplant nurses were recruited to perform an expert usability evaluation of the Walking Warrior prototype by completing a heuristic questionnaire and providing qualitative suggestions for improvement. Experts also made qualitative recommendations for improvements on speed, movement of tiles, appearance, and accuracy of the step counter. We recruited 5 additional usability evaluators who searched for and compared 4 open-source step counter programs, then qualitatively compared them for accuracy, robustness, cheat proofing, ease of use, and battery drain issues. Patient recruitment is planned at a later stage in this project. This paper only describes software design, development, and evaluation, rather than behavioral evaluation (ie, impact on physical activity), which is the long-term goal of this project. RESULTS: Internal consistency and the instrument's reliability evaluation results from 1 clinical expert and 4 technical experts were deemed excellent (Cronbach α=.933). A hierarchical cluster analysis of the questionnaire item responses for similarity/dissimilarity among the experts indicated that the two expert groups were not clustered into two separate groups in the dendrogram. This indicates that the item responses were not affected by profession. Factor analyses indicate that responses from the 40-item questionnaire were classified into five primary factors. The associated descriptive statistics for each of these categories were as follows (on a scale of 1 to 5): clarity and ease (median 4; mean 3.7, SD 0.45), appropriateness (median 4; mean 3.7, SD 0.49), game quality (median 3.5; mean 3.3, SD 0.42), motivation to walk (median 3; mean 3.1, SD 0.58), and mental effort (median 3.5; mean 3.1, SD 1.27). CONCLUSIONS: The evaluation from experts and clinicians provided qualitative information to further improve game design and development. Findings from the expert usability evaluation suggest the game's assets of clarity, ease of use, appropriateness, quality, motivation to walk, and mental effort were all favorable. This mobile game could ultimately help patients increase physical activity as an aid to recovery.

Gamification in Nursing Education: An Integrative Literature Review.

The objective of this literature review and evaluation project was to determine what evidence exists on the use of interactive digital learning and gamification for adult learners in nursing, for the purpose of guiding a redesign of our organization's online clinical education courses. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used in the literature search, with the critical analysis and leveling of evidence. After determining the search terms, four electronic databases (PubMed, CINAHL, ERIC, and Cochrane) were searched with the guidance of a medical librarian. Eight reviewers participated, and an evidence-based practice specialist served as auditor. Twenty-three articles were included in the review, which revealed overall support for the gamification process with specific findings about optimizing the process. The review further suggested that interactive digital learning in the form of games, gamification, or scenario-based learning has a positive effect on learner engagement and satisfaction; however, none of the studies were able to quantify objective data about knowledge retention. Further research is needed to test different modalities that improve both learner engagement and knowledge retention. [J Contin Educ Nurs. 2020;51(11):509-515.].

Dynamic Brain Activity Following Auricular Point Acupressure in Chemotherapy-Induced Neuropathy: A Pilot Longitudinal Functional Magnetic Resonance Imaging Study.

BACKGROUND: The objective of this study was to investigate the dynamic brain activity following auricular point acupressure (APA) in chemotherapy-induced neuropathy (CIN). METHODS: Participants received 4 weeks of APA in an open-pilot trial with repeated observation. Along with the clinical self-reported CIN outcomes, objective outcomes were measured over the course of the treatment by physiological changes in pain sensory thresholds from quantitative sensory testing (QST) and repeated functional magnetic resonance imaging scans. RESULTS: After 4 weeks of APA, participants had reported clinically significant improvements (ie, ≥30%) in a reduction of CIN symptoms (including pain, numbness, tingling, and stiffness) in lower extremity stiffness (32%), reduced foot sensitivity (13%), and higher pain threshold (13%). Across the 11 intrinsic brain networks examined, there was a trend toward significance of the connectivity of the basal ganglia network (BGN) to the salience network (SAL), which was decreased pre-APA versus immediate-APA (effect size [ES] = 1.04, P = .07). The BGN also demonstrated decreased connectivity with the language network pre-APA versus delayed imaging post-APA (ES = -0.92, P = .07). Furthermore, there was increased executive control network (ECN) and SAL within-network connectivity comparing pre-APA to delayed imaging post-APA, trending toward significance (ES = 0.41, P = .09 and ES = 0.17, P = .09, respectively). CONCLUSION: The changes in connectivity and activity within or between the ECN, SAL, and BGN from pre- to post-APA suggest ongoing alterations in brain functional connectivity following APA, particularly in the insula, anterior cingulate, and dorsolateral prefrontal cortices, which play significant roles in pain, memory, and cognitive function.

The perfect role for nursing informatics: Nursing staff development.

This is an opinion paper on the role of the hospital-l based nurse educator and the relevance of Informatics training for that position. The term "Nurse Educator" (NE) is used here describing a non-faculty position in a hospital or facility that deals with staff development of nurses. The standard roles for Informatics Nurses tend to be in the Information Technology (IT) department where exposure to practicing nurses is limited and decisions can be made without nursing practice input. The standard roles for the nurse staff educators tend to be involved with nursing decisions and nursing practice on various levels. This paper will discuss how having nurse educators prepared in informatics can strengthen nursing and patient care. Examples of problems where the nurse educator can use appropriate informatics solutions are outlined.

Information technology and patient safety in nursing practice: an international perspective.

When people become patients, they place their trust in their health care providers. As providers assume responsibility for their diagnosis and treatment, patients have a right to expect that this will include responsibility for their safety during all aspects of care. However, increasing epidemiological data make it clear that patient safety is a global problem. Improved nursing care may prevent many adverse events, and nursing must take a stronger leadership role in this area. Although errors are almost inevitable, safety can be improved, and health care institutions are increasingly making safety a top priority. Information technology provides safety benefits by enhancing communication and delivering decision-support; its use will likely be a cornerstone for improving safety. This paper will discuss the status of patient safety from an international viewpoint, provide case studies from different countries, and discuss information technology solutions from a nursing perspective.

A+ Asthma Rural Partnership coloring for health: an innovative rural asthma teaching strategy.

Asthma is the leading chronic illness in children, affecting about 4.8 million children in the United States. Recent reports indicate a lack of asthma educational resources for rural school health nurses to use in their practice. This article describes the development of the My Asthma Coloring Book educational tool for children and their families living in rural communities. My Asthma Coloring Book was developed to provide asthma information in a short-story format for children with asthma. The coloring book content is described, including its utilization as part of the A+ Asthma Rural Partnership research project funded by the National Institute of Nursing Research (R01NR05062-01).