Using Large Language Models to Address Health Literacy in mHealth: Case Report.

The innate complexity of medical topics often makes it challenging to produce educational content for the public. Although there are resources available to help authors appraise the complexity of their content, there are woefully few resources available to help authors reduce that complexity after it occurs. In this case study, we evaluate using ChatGPT to reduce the complex language used in health-related educational materials. ChatGPT adapted content from the SmartSHOTS mobile application, which is geared toward caregivers of children aged 0 to 24 months. SmartSHOTS helps reduce barriers and improve adherence to vaccination schedules. ChatGPT reduced complex sentence structure and rewrote content to align with a third-grade reading level. Furthermore, using ChatGPT to edit content already written removes the potential for unnoticed, artificial intelligence-produced inaccuracies. As an editorial tool, ChatGPT was effective, efficient, and free to use. This article discusses the potential of ChatGPT as an effective, time-efficient, and open-source method for editing health-related educational materials to reflect a comprehendible reading level.

Recruitment Barriers of an mHealth Pediatric Asthma Pilot Study.

Successful participant recruitment for pediatric studies can be challenging and even result in study discontinuation. In conducting a 2-year pilot study for a pediatric mobile health (mHealth) asthma intervention, a group of researchers experienced multiple barriers and failures in all 4 areas of recruitment: generating initial contacts, screening, consenting, and enrollment and retention. The main failures that resulted in minimal participant enrollment were poor participation, communication issues, and difficulties related to recruiting in an emergency department during a pandemic. The following is a report on this study's recruitment efforts, including preliminary and adapted strategies, the results of these strategies, and considerations for researchers who conduct studies with children. The research team concluded that frequent and clear communication, flexibility, and a willingness to alter initial recruitment plans are essential elements for recruitment success in pediatric studies.

Nurses' Roles in mHealth App Development: Scoping Review.

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.

Self-Regulation in Pediatric Nursing Literature: An Evolutionary Concept Exploration.

The concept of self-regulation appears frequently in nursing literature. Although the concept is well developed in nonnursing theories, its application in nursing has not been explored adequately. Most nursing authors address self-regulation in one of two ways. Some publish findings without a strong theoretical understanding of self-regulation. Others publish studies using a conglomeration of theorists' self-regulatory explanations without properly contextualizing the theoretical elements for nursing practice. For this concept exploration, the authors used Rodgers, B. L. (2005). Developing nursing knowledge: Philosophical traditions and influences Lippincott, Williams & Wilkins, evolutionary concept analysis method to determine the current use of self-regulation in pediatric nursing literature and trace the concept's recent development, changes, and expansion. This work provides a representation of self-regulation based on existing healthcare studies and suggests steps for concept clarification that could promote accurate use of the concept in future research.

Using mHealth Applications to Promote Self-Managed Health Behaviors Among Teens.

THEORETICAL PRINCIPLES: As technology use increasingly expands, the opportunity to capitalize on it for healthcare education, monitoring, and assessment has grown rapidly, especially among adolescent patients. As apps are developed, consideration should be given to self-management theory concepts. PHENOMENA ADDRESSED: The proliferation of mobile health (mHealth) applications allows adolescents to access healthcare information in new, innovative ways. Many health applications focus on health promotion, fitness, and nutrition and others help persons with chronic disease. This article offers a compelling case for incorporating mHealth into teen healthcare by reviewing current data on teens' technology use, showing how mHealth aligns with self-management theory concepts, and offering a case scenario on mHealth-enhanced self-management care. RESEARCH LINKAGES: The ability to combine accurate and immediate healthcare information with continual social support could radically improve teen's self-management behaviors, especially when mHealth apps use connectivity, a feedback loop, and concepts known to enhance self-management behaviors.

Obese-Asthma Phenotype Self-Management: A Literature Review.

PROBLEM: Recent identification of the early-onset obese-asthma phenotype has spurred exploration of ways to promote effective, long-term management behaviors for children with this comorbid presentation. Few studies have examined the needs of children with both asthma and obesity and little is known about optimal management options for this unique population. Therefore, the authors aimed to review, critique, and synthesize existing published research on health-management programs designed for children with comorbid asthma and obesity in order to describe the state of the science and recommend next steps in creating pediatric management programs. ELIGIBILITY CRITERIA: Articles selected for a full-text review were pediatric-focused, included children with both asthma and obesity diagnoses, and discussed the implementation and evaluation of a management program or the evaluation of a management behavior. SAMPLE: Fifteen articles were selected for review based on the inclusion criteria. RESULTS: Studies that included current evidence-based elements had better results than those that did not include such elements. CONCLUSIONS: Based on this review, it is recommended that researchers use theory based, multicomponent, multimodal, family-focused, behaviorally-based interventions that address systems-level influences, social determinates of health, and children's developmental needs over time. Additionally, there is a need for studies with sample sizes adequate for power analyses that include the youngest children with asthma and obesity. IMPLICATIONS: The need for effective programs for pediatric obese-asthma phenotype management creates the opportunity for nursing-led research and interventions to foster long-term health promotion for affected children and families.

The efficacy of mobile health interventions used to manage acute or chronic pain: A systematic review.

Chronic pain is a significant health issue that affects approximately 50 million adults in the United States. Traditional interventions are not always an effective treatment strategy for pain control. However, the wide adoption of smartphones and the rapid growth of health information technologies over the past decade have created opportunities to use mobile health (mHealth) applications (apps) for pain tracking and self-management. In this PRISMA-compliant systematic review, we assessed the current U.S.-based research on pain-related mHealth apps to describe the app components and determine the efficacy of these interventions for persons with acute or chronic pain. We conducted a comprehensive search of five databases based on methodological guidelines from the Joanna Briggs Institute. We included articles reporting original data on mHealth interventions with pain intensity as a primary or secondary outcome and excluded articles that utilized multimodal interventions. Of the original 4959 articles, only five studies met the eligibility criteria. Most of the interventions included feasibility or pilot studies, and all studies were published between 2015 and 2018. Two of the five studies used visual analog scales. Only two of the studies reported statistically significant pain intensity outcomes, and considerable heterogeneity between the studies limited our ability to generalize findings or conduct a meta-analysis. Research investigating the components and efficacy of pain-related mHealth apps as interventions is an emerging field. To better understand the potential clinical benefits of mHealth apps designed to manage pain, further research is needed.

Using a Systems Engineering Approach to Design an Interactive Mobile Health Application for Improving Asthma Self-management.

Mobile health applications are in demand. According to the Grand Review Research group, there were US $12.4 billion in mobile health app sales in 2018. Increasingly, providers are seeking new ways to engage their pediatric patients. One approach is through mobile health apps. Nearly 10 000 mobile health apps target youth and teens, especially for children with conditions that require complex treatment and self-management. One such chronic illness is asthma. Children with asthma who lack social support are particularly vulnerable to exacerbations because they often are not focused on self-care. For this reason, successful asthma programs for children engage family members, encouraging them to play an active role on the healthcare team. The Just-in-Time Asthma Self-management Intervention is unique in several ways compared to other asthma management mobile applications. The app uses gold standard, evidence-based asthma care practices and extends the support infrastructure beyond family and healthcare providers to engage the child, their peers, and school personnel. Further, the app was built using a systems engineering approach. This article reviews the basis for developing an asthma care mobile application including the conceptual framework supporting a systems model, how the Just-in-Time Asthma Self-management Intervention is unique, and how it was built using a systems engineering design.

Current Trends in Robotics in Nursing Patents-A Glimpse Into Emerging Innovations.

The purpose of this study was to describe the current evidence found through a patent search about robotics used to assist nurses in providing care. The authors used a modified seven-step strategy of searching patents according to the US Patent and Trademark Office guidelines. The nursing robotic search was performed in four databases including the US Patent and Trademark Office issued patent database, the US Patent and Trademark Office published patent application database, the European Patent Office database, and Relecura. Keywords reflecting the scope of the term "robot" were defined for the purposes of this specific search. This broad search yielded large numbers of patents germane to nursing care. These results were narrowed using keywords and the Cooperative Patent Classification schemes to determine relevance, ensure rigor, and capture the most relevant results. This review of patents suggests robots for nursing care are proliferating. The opportunity for robotics in nursing is emerging in industry. Although nursing will likely benefit from robotics, we must determine the appropriate place to include robots in nursing care delivery.

Nasal Airway Clearance for Bronchiolitis.

Bronchiolitis is a leading cause of emergency department visits and hospitalization in the first year of life with estimated costs to the healthcare system in the United States of $1.73 billion annually. The highest rates of admission occur in the first 3 to 6 months of life. Traditional therapies such as bronchodilators and antibiotics have repeatedly been shown to be ineffective. Thickened nasal secretions cause decreased oxygenation, difficulty sleeping, poor feeding, and respiratory distress symptoms. Bronchiolitis guidelines recommend supportive care such as noninvasive nasal airway clearance with saline to clear obstructed airways, improve oxygenation, and promote optimal infant eating and sleeping. Evidence on the safety and efficacy of use of noninvasive nasal airway clearance as supportive care for infants with bronchiolitis in the acute care setting is presented.

Feasibility of a computer application to develop social workers knowledge of integrated healthcare concepts.

Disseminating evidence-based knowledge and strengthening the education program of the healthcare workforce is an essential step toward achieving transformation of the U.S. healthcare delivery system to integrated healthcare. Computer applications may be an effective approach for social workers to learn integrated concepts. A feasibility study using an experimental research design was used to compare instructional approaches among MSW students (N = 15) composed of experimental (N = 7) and control (N = 8) group participants. Students completed a pre-test on integrated healthcare concepts and screening measures along with a post-test on screening measures. While ANCOVA results suggest no significant differences on post-test scores between the two groups, dependent sample t-test revealed a significant increase for both groups. Results suggest training on an integrated healthcare topic using a computer application is feasible. Future research should be conducted to determine if the computer application is comparable to other instructional methods.

Developing a Computer Application to Prepare Social Workers for Integrated Health Care: Integrated Healthcare (Version 1.0).

Integrated health care (IHC) is a proposed change to the U.S. health care system to address health care disparities for individuals with mental and physical health conditions. Computer applications may provide an effective strategy to prepare social workers for the transition to IHC. An Internet-based tool, Integrated Healthcare (Version 1.0) was developed and tested through rapid prototyping to access knowledge required for behavioral health providers to practice in IHC settings. Two focus groups (N = 5, N = 7) and individual interviews (N = 5) were conducted with social work professors and students. Nielsen's usability heuristics were used to evaluate data from focus groups and interviews, and changes were incorporated in development. The final computer application is an introduction to IHC concepts, reinforces the integrated nature of physical and behavioral health, and puts evidence-based knowledge at the point of care.

Holistic Comfort Interventions for Pediatric Nursing Procedures: A Systematic Review.

Comfort interventions for children during invasive nursing procedures have been well documented in the literature. It is important, however, to distinguish between the provision of holistic comfort management and pain alleviation. Holistic comfort focuses on treating the child's whole procedural experience and includes more than simply reducing pain. In this literature review, 33 intervention studies were examined. These studies focused on evaluating comfort effects from nursing interventions on pain, anxiety, fear, and distress. Four themes of procedural comfort intervention emerged: music therapy, amusement and entertainment, caregiver facilitation, and a multifaceted approach. Important findings of this review, gaps in the literature, and implications for future research are discussed.

Use of Social Media by Fathers of Premature Infants.

Although parents of premature infants experience many challenges when transitioning home from the neonatal intensive care unit, healthcare providers and social support systems tend to focus on mothers and infants rather than fathers. Unfortunately, very little is known about paternal concerns and needs as compared with maternal ones. The lack of understanding about paternal needs may lead to inadequate designs of neonatal intensive care unit family support programs with less involved fathers, all of which contribute to increased burdens on mothers and poor health outcomes for their infants. Although information technology (IT) might have the potential to increase support for the fathers of preterm infants, only a few studies have examined systematically how IT applications can be beneficial. This study aims to advance the understanding of needs and concerns of fathers with preterm infants and how fathers use the IT applications (eg, social networking Web sites) to support themselves. We observed qualitatively various social networking Web sites (ie, 29 Web sites) where fathers share their experiences about preterm infants. We discovered that fathers used various social media to discuss their concerns and, in turn, obtained informational, companionship, and emotional supports. On the basis of our analysis, we provide insights into a father-centered technology intervention design.

The effect of reflective writing interventions on the critical thinking skills and dispositions of baccalaureate nursing students.

BACKGROUND: The importance of critical thinking is well-documented by the American Association of Colleges of Nursing and the National League for Nursing. Reflective writing is often used to increase understanding and analytical ability. The lack of empirical evidence about the effect of reflective writing interventions on critical thinking supports the examination of this concept. OBJECTIVES: Study objectives were: DESIGN: This study used an experimental, pretest-posttest design. SETTINGS: The setting was two schools of nursing at universities in the southern United States. PARTICIPANTS: The convenience sample included 70 fourth-semester students in baccalaureate nursing programs. METHODS: Randomly assigned control and experimental groups completed the California Critical Thinking Skills Test (CCTST) and the California Critical Thinking Dispositions Inventory Test (CCTDI). The experimental group completed six reflective writing assignments. Both groups completed the two tests again. RESULTS: Results showed that the experimental group had a significant increase (p=0.03) on the truthseeking subscale of the CCTDI when compared to the control group. The experimental group's scores increased on four CCTST subscales and were higher than the control group's on three CCTST subscales. CONCLUSIONS: The results of this study make it imperative for nursing schools to consider including reflective writing-especially assignments based on Paul's (1993) model-in nursing courses. If future studies, testing over longer periods of time, show significant increases in critical thinking, those interventions could be incorporated into nursing curriculum and change the way nurse educators evaluate students.

Developing an interactive story for children with asthma.

Despite advancements in asthma treatment and diagnosis, asthma still remains the number 1 cause for hospitalizations in school-aged children. This usability study aimed to develop a child-friendly interactive narrative, Okay with Asthma v2.0, based on the Biopsychosocial Family Model using feedback from children. This fun and kid-friendly program encourages children to manage their own asthma with the help of peers, families, communities, and health care services. With these support structures, children can identify and avoid triggers, monitor their asthma, manage their condition with medications based on an action plan, and learn to live happily with asthma.

Testing computer-based simulation to enhance clinical judgment skills in senior nursing students.

Expert clinical judgment is the culmination of knowledge and experiential learning that includes reflections on immediate problems and past experience. In nursing education, experiential learning is augmented through the use of simulated clinical experiences provided in simulation laboratories. Various simulations have been reported; however, few studies target the effectiveness of experiential learning using a computer-based simulation available to the individual user. An educational intervention based on Kolb's Experiential Learning Theory (ELT) is examined in this pilot study, to determine the feasibility of conducting a future larger-scale research project on the effectiveness of ELT in enhancing development of clinical judgment skills.

Developing iCare v.1.0: an academic electronic health record.

An electronic health record application, iCare v.1.0, was developed and tested that allows data input and retrieval while tracking student performance over time. The development and usability testing of iCare v.1.0 followed a rapid prototyping software development and testing model. Once the functionality was tested by engineers, the usability and feasibility testing began with a convenience sample of focus group members including undergraduate and graduate students and faculty. Three focus groups were created, and four subjects participated in each focus group (n = 12). Nielsen's usability heuristics and methods of evaluation were used to evaluate data captured from each focus group. Overall, users wanted a full-featured electronic health record with features that coached or guided users. The earliest versions of iCare v.1.0 did not provide help features and prompts to guide students but were later added. Future versions will incorporate a full-featured help section. The interface and design of iCare v.1.0 are similar to professional electronic health record applications. As a result of this usability study, future versions of iCare will include more robust help features along with advanced reporting and elements specific to specialty populations such as pediatrics and mental health services.

Dexmedetomidine as a pediatric anesthetic premedication to reduce anxiety and to deter emergence delirium.

Presurgery anxiety in children may result in preoperative and postoperative complications. Emergence delirium (ED) is a mental disturbance common in children during recovery from general anesthesia. This study investigated the role of preoperative dexmedetomidine on parental separation anxiety and acceptance of wearing an anesthesia mask, and its effectiveness in reducing the incidence and severity of ED. A double-blind study was conducted in 41 children, aged 1 to 6 years, undergoing dental restoration and/or extractions. Subjects received 4 microg/kg of dexmedetomidine or 0.5 mg/kg of midazolam orally prior to anesthesia induction. Subjects' anxiety over parental separation, acceptance of anesthesia masks, and presence and severity of ED were evaluated. There were no statistically significant differences in parental separation anxiety or mask acceptance between the 2 groups. There were also no significant differences in ED occurrence. In this study, dexmedetomidine produced no common side effects (blood pressure and heart rate fluctuation), which may indicate that oral administration with a 76% bioavailability versus 82% in buccal preparations results in fewer side effects but requires higher dosing to gain therapeutic effects. Future studies should examine the use of higher doses of oral dexmedetomidine in reducing presurgical anxiety and postsurgical ED.