The DAISY Award: Meaningful Recognition's Impact on Patients, Nurses, and Organizations.

This review demonstrates the impact of The DAISY Award and how meaningful recognition (MR) through gratitude affects nurse engagement, healthy work environments (HWEs), and patient/families' (PFs) experiences. MR has mutual benefits for nurses and PFs, promoting therapeutic healing and resiliency. MR in HWEs can impact organizations' care quality, fiscal health and influence public perceptions. Nurse leaders should create an environment where MR is a core strategic imperative that impacts nurse, patient, and organizational outcomes.

The Design and Testing of the Psychometric Properties of the Adolescent Capacity to Engage Index Instrument to Measure an Adolescent's Capacity to Engage in Healthcare.

Background and Purpose: Engagement in one's healthcare is paramount to improving health outcomes. As adolescents begin their journey into adulthood and increase involvement in their health-care decision-making, it is critical to understand their ability to be involved in their healthcare. The purpose of this instrumentation study was to develop and evaluate the psychometric properties and underlying factors of the Adolescent Capacity to Engage Index (ACEI) tool which measures the construct of an adolescent's capacity to engage in their healthcare. Methods: This study had a two-phase approach. Phase 1 consisted of the pilot and cognitive testing of the items developed based on the literature and content expertise. Phase 2 was the testing of the final 21 item revised instrument among 15- to 17-year-old online teen panel (n = 226). Results: Psychometric testing revealed a valid and reliable 21 item scale with a four-factor solution. The Cronbach's alpha for the total scale was .901. The four subscales and each subscale Cronbach's alpha were: (a) Active Participation In Healthcare with Psychosocial Support to Aid/Foster Good Healthcare Choices, (.826); (b) Transition Readiness to Self-Management with Family Support to Guide/Foster Health/Healthcare Decisions, (.825); (c) Proactivity and Empowerment to Have a Say in Health/Healthcare, (.747); and (d) Technology Use to Seek Health/Healthcare Information (.648). Conclusions: This study demonstrated the ACEI is a psychometrically sound instrument with good internal consistency for the overall scale and subscales. The ACEI can be implemented in clinical practice to measure adolescents' engagement capacity in their healthcare and identify appropriate interventions based on ACEI score. Further research to determine engagement capacity among teens of various populations is warranted.

Impact of Patient Engagement on Tailored Education for Joint Replacement Population Using Technology.

Patient engagement and technology use for healthcare are important for optimal care. This study was designed to leverage technology in education among the adult joint population based on their engagement capacity and utilization of technology for care. A convenience sample of 80 patients undergoing joint replacement surgery and followed in the inpatient setting participated. Comparisons were made between an intervention group who completed the Person Engagement Index to measure their engagement capacity and received a technological educational plan based on their score versus those receiving the standard educational plan. The Person Engagement Index psychometrics were sound and indicated high engagement capacity. Overall, the groups did not differ in utilization, satisfaction, and education comprehension; however, the intervention group reported a higher unit mean for the extent they felt ready for discharge and instructions for care at home. Results of this study informed patients' engagement capacity and technology use for pre-/postoperative education for procedure expectations and self-management throughout the joint replacement process and recovery. Future research includes use of technology for engagement capacity and outcomes with other populations, collecting socio-demographic data to determine differences among groups and examining the patient and provider experience and satisfaction with using technology to enhance care and outcomes.

Predictors of Patient Portal Use Among Community-Dwelling Older Adults.

Older adults lag behind their younger counterparts in the use of patient portals, which may limit their ability to engage in health care. A better understanding of the factors associated with portal use among older adults is needed. We examined the proportion of 100 community-dwelling older adults who reported using a portal, the associations between sociobehavioral factors and portal use, and modeled predictors of portal use. Of the 52% who reported using a portal, 28% used the portal on their own, and 24% received assistance from others or had others access the portal on their behalf. After controlling for confounders, only marital status was significantly associated with any portal use. Marital status and patient activation were significantly associated with independent portal use. Further exploration is warranted to identify additional factors and the possible mechanisms underlying portal use by older adults. [Research in Gerontological Nursing, 14(1), 33-42.].

Working Toward an mHealth Platform for Adolescents with Type 1 Diabetes: Focus Groups With Teens, Parents, and Providers.

PURPOSE: The purpose of the study was to explore facilitators and barriers to self-management behaviors in adolescents with type 1 diabetes (T1D) to inform the development of an mHealth platform. METHODS: Eight adolescents with T1D, 9 parents, and 13 health care providers participated in separate focus groups that explored teen self-management behaviors. RESULTS: Adolescents and their parents have distinct preferences for handling diabetes management and use of mHealth technologies. Health care providers support the use of new technologies yet acknowledge concern meeting the potential increased volume of communication requests from teens and families. CONCLUSION: Stakeholders agreed that an ideal mHealth platform would facilitate open communication between teens and their care network and easily integrate with other diabetes technologies. Future directions include incorporating additional feedback from stakeholders to build and modify the mHealth platform. The use of mHealth platforms could be integrated into clinical practice to optimize self-management and support communication between educators, providers, and families in between clinic visits.

Leveraging Technology to Sustain Extraordinary Care: A Qualitative Analysis of Meaningful Nurse Recognition.

OBJECTIVE: Meaningful recognition of nurses submitted by patients and families using interactive patient care (IPC) technology was analyzed using artificial intelligence (AI) to identify the themes and behaviors associated with extraordinary nursing. BACKGROUND: Meaningful recognition positively impacts nursing and organizational outcomes. The use of AI techniques such as natural language processing and machine learning to identify and describe behaviors impacting patient experiences is an emerging science. METHODS: Nurse recognition comments were collected from a convenience sample of 3 organizations via an IPC inpatient platform and analyzed using the AI techniques of natural language processing, machine learning, sentiment analytics, and corollary dictionaries based on rules of linguistics. RESULTS: The top theme of nursing recognition comments was courtesy and respect with the behaviors of empathy/compassion, helpfulness, kindness, attentiveness, and emotional comfort. The theme of skills/knowledge was the 2nd most common, with the behaviors of being professional, knowledgeable, keeping track, competence, dedication, and being thorough. CONCLUSIONS: AI techniques for qualitative analysis of comments collected through IPC reveal nurse themes and behaviors most meaningful to patients and their family members. Nurses can advance the science of AI and guide its evolution so that nurse caring behaviors associated with establishing human connections that positively influence patient and family experience are accurately represented.

Innovative Collaborative Partnerships to Conduct Multisite Research: Strategies for Success.

Multisite nursing research can be a challenging endeavor. A unique partnership between 5 clinical sites and a national research center of a healthcare technology organization led to the successful implementation of a multisite study. Strategies for success, obstacles encountered, benefits, implications for the Magnet journey, and leadership are discussed.

The Design and Testing of the Psychometric Properties of the Person Engagement Index Instrument to Measure a Person's Capacity to Engage in Health Care.

BACKGROUND AND PURPOSE: Patient engagement has been considered a powerful tool to improve health outcomes. A composite instrument to measure the factors that impact a person's capacity to engage in his or her health care was an identified gap in the literature. This study developed and tested the psychometric properties of the Person Engagement Index (PEI) instrument. METHODS: The instrument was tested among 338 medical-surgical inpatients at four health care systems (five facilities), with psychometric evaluation for validity, reliability, and exploratory factor analysis. RESULTS: Exploratory factor analysis revealed a four-factor solution that accounted for 63.9% of the total variance. Internal consistency results were Cronbach's α = .896 for the overall scale and each subscale: Engagement in Health Care = .885, Technology Use in Health Care = .854, Proactive Approach to Health Care = .728, and Psychosocial Support = .880. CONCLUSIONS: The results of the PEI study indicate that it is a valid and reliable instrument among the adult medical-surgical population. Further testing of the instrument is recommended among other populations and across the care continuum.

The Development and Testing of the Psychometric Properties of the Emotional Response and Disclosure of Errors in Clinical Practice Instrument.

BACKGROUND AND PURPOSE: A tool to measure the nurses' emotional response after an error in clinical practice and the potential impact emotion can have on disclosure is lacking. This study tested the psychometric properties of the Emotional Response and Disclosure of Errors in Clinical Practice instrument. METHODS: The instrument was tested among 497 nurses with psychometric evaluation for validity, reliability, and exploratory factor analysis. RESULTS: Exploratory factor analysis revealed a 3-factor solution which accounted for 55.4% of the total variance. Internal consistency results were Cronbach's alpha = .935 for the overall scale and each domain: concern = .907, anxiety = .888, and disbelief = .775. CONCLUSIONS: Use of this valid and reliable instrument in practice and education can assist with patient safety efforts. Further testing of the instrument is recommended among other health care professionals.

Effectiveness of technology use for engaging community dwelling adults with chronic disease in self-care behavior management in health care: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The quantitative objective is to identify the effectiveness of technology use for self-care behavior management and the patient engagement levels in health care.More specifically, the objectives are to identify: 1) the effectiveness of technology use (includes mobile health applications, text messages, telemedicine/video conferences between providers and people with chronic disease, remote monitoring and websites) in health care for engaging community-dwelling adults with chronic disease in self-care management, and 2) the patient engagement levels in health care.

Use of Gaming in Self-Management of Diabetes in Teens.

With the growing prevalence of diabetes in teens and frequent concomitant problems with adherence, adolescents are a frequent target for diabetes self-management support and education. Due to widespread use of technology among teens in general, the use of serious games, games used for purposes beyond entertainment with the intention to educate and support health behavior for teens with diabetes self-management, is an emerging and promising practice. This report explores games intended for teens with diabetes, how the use of games may enhance clinical practice, and provides suggestions for future research and better utilization of these technologies. Current research on the use of gaming for promoting diabetes management in teens is fairly limited, with some initial support for improvements in both behavioral and clinical outcomes among teens. More research is clearly needed in order to further determine how gaming can best be utilized to impact health outcomes in these teens, as well as potential mechanisms of change.

Patient and Family Engagement Summit: Needed Changes in Clinical Practice.

Patient and family engagement is a strategy to enhance healthcare outcomes through strong clinician-patient partnerships. A new care delivery process, in which the patient is the driver of the healthcare team, is required to achieve optimal health. A summit partially funded by a seed grant from the Robert Wood Johnson Executive Nurse Fellow Alumni Foundation was held with interprofessional colleagues and patient representatives to identify needed clinical competencies and future practice changes. Recommended shifts in the care delivery process included a focus on patient strengths, including the patient as a valued team member, doing care "with me" and not "to me," and considering all entities or providers including the patient, as equal partners.

Nurse Manager Competencies Supporting Patient Engagement.

Patient engagement is an important element in transitioning care delivery to achieve population health management goals. Providers are challenged to develop care delivery processes that better engage patients in their life journey across the healthcare continuum. Nurse leaders are central to this process. Building upon the American Organization of Nurse Executives competencies for nurse executives, the nurse manager role requires specific skills to translate the vision of patient engagement into practice.

Interactive Care Model: A Framework for More Fully Engaging People in Their Healthcare.

Transformation of care delivery requires rethinking the relationship between the person and clinician. The model described provides a process to more fully engage patients in their care. Five encounters include assessing capacity for engagement, exchanging information and choices, planning, determining interventions, and evaluating the effectiveness of engagement interventions. Created by researchers and validated by experts, implications for practice, education, and policy are explored.

Interactive Care Model: A Framework for More Fully Engaging People in Their Healthcare.

Transformation of care delivery requires rethinking the relationship between the person and clinician. The model described provides a process to more fully engage patients in their care. Five encounters include assessing capacity for engagement, exchanging information and choices, planning, determining interventions, and evaluating the effectiveness of engagement interventions. Created by researchers and validated by experts, implications for practice, education, and policy are explored.

The Application of Gaming Theory in Health Care.

As the US health care system moves rapidly toward a population health management focus in communities and care settings, the chief nursing officer has an opportunity to lead innovation efforts for patient care. One innovative strategy for use to influence patient behavior change, ongoing clinical education, and prelicensure education is the application of gaming theory into learning strategies. With the ever-increasing emphasis the general public is placing on social media and online gaming, there has been a significant push by the health sector in recent years to harness this medium for use in health management, education, and behavior change. A number of organizations and insurers have dedicated significant resources to researching and developing games and apps to help patients manage diseases, track self-management activities, and motivate behavior change for healthy lifestyles. This article shares information about gaming theory and its application to health care including a review of the science behind the theory, the use of technology, and gaming education strategies for both patients and clinicians.

Diffusing QSEN competencies across schools of nursing: the AACN/RWJF Faculty Development Institutes.

A series of regional Quality and Safety Education for Nurses (QSEN) Faculty Development Institutes were held in 2010 and 2011 to provide nursing faculty with strategies to integrate quality and safety content into their curricula. The interactive coursework focused on the 6 core QSEN competencies. Using a train-the-trainer approach, the QSEN Faculty Development Institute Directors enabled nursing faculty attendees to (a) lead their institution's faculty to incorporate quality and safety content into the curriculum for students; (b) teach and mentor students to deliver high quality and safe patient care; and (c) train other faculty to accomplish these goals. Over 1,100 nursing faculty from across the United States attended the institutes. All types of prelicensure programs were represented including diploma, associate, and baccalaureate degree. In a preinstitute survey, faculty identified multiple opportunities to improve the integration of quality and safety content into curricula including the need for specific content on quality improvement, teamwork and collaboration, and informatics and the need for interprofessional experiences and electronic health record access. Postinstitute evaluations indicated that participants found the content clear, specific, usable, and presented in a format that facilitated thought, reflection, and application. The regional institutes served as a very effective strategy for engaging large numbers of faculty across the country in the QSEN work and for disseminating vital tactics to improve the teaching of quality and safety content.