Application of Within-Methods Triangulation to Analyze Hospital System Health.

Qualitative descriptive research can be used when researchers are seeking to find the "how," "what," or "when" of phenomena. The most common qualitative descriptive analysis methods are content and thematic analyses. Data triangulation through content analysis and natural language processing was first described in 2018 for the analysis of nurse-to-nurse communication in an acute care setting. The purpose of this article is to discuss a within-methods data triangulation of interviews done with nurses and nursing leaders in Magnet- and non-Magnet-designated hospitals through integration and application of content analysis, code quantification via the Goodwin statistic, and natural language processing.

Advancing Nursing Science: Deriving a Middle-Range Theory for System-Level Communication Research in Complex Hospital Environments.

Background: Millions of injuries and deaths occur yearly from preventable errors, despite interventions applied at the point of care. Although evidence suggests that system-level factors are responsible for hospital system health and patient safety, research has largely not accounted for hospital complexity. Prior to the authors' research regarding the communication of system-level events that influence hospital system health and patient safety, no nursing-specific communication theories that accounted for hospital complexity were identified. However, theory-guided research holds the potential to boost scientific knowledge through the provision of a robust foundational understanding of phenomena. Purpose: The purpose of this article is to discuss the concept derivation used to create a middle-range theory for the guidance of research involving system-level communication in complex healthcare environments as it relates to hospital system health and patient safety. Methods: Concept derivation as described by Walker and Avant (2018) was conducted using parent concepts from the Effective Nurse-to-Nurse Communication Framework, Symbolic Interactionism, Information Theory, Gerbner's Communication Model, and Complexity Theory. Results: Authentication of the derived Effective System-to-System Communication Theory (ESSCT) was confirmed through identification of coherent relationships between the concepts and conceptual statements, alignment with the nursing metaparadigm, and peer review by a subject matter expert from the nursing discipline. Additionally, research revealed an overall congruency between the research findings and the ESSCT's theoretical statements. Implications: The current healthcare climate necessitates that research involving communication be optimized by a germane theoretical underpinning that accounts for hospital complexity. The authors contend that the use of the derived theory may assist such endeavors.

When to err is inhuman: An examination of the influence of artificial intelligence-driven nursing care on patient safety.

Artificial intelligence, as a nonhuman entity, is increasingly used to inform, direct, or supplant nursing care and clinical decision-making. The boundaries between human- and nonhuman-driven nursing care are blurred with the advent of sensors, wearables, camera devices, and humanoid robots at such an accelerated pace that the critical evaluation of its influence on patient safety has not been fully assessed. Since the pivotal release of To Err is Human, patient safety is being challenged by the dynamic healthcare environment like never before, with nursing at a critical juncture to steer the course of artificial intelligence integration in clinical decision-making. This paper presents an overview of artificial intelligence and its application in healthcare and highlights the implications which affect nursing as a profession, including perspectives on nursing education and training recommendations. The legal and policy challenges which emerge when artificial intelligence influences the risk of clinical errors and safety issues are discussed.

Developing a Preclinical Nurse-Nurse Communication Framework for Clinical Trial Patient-Related Safety Information.

Clinical trial trials have become increasingly complex in their design and implementation. Investigational safety profiles are not easily accessed by clinical nurses and providers when trial participants present for clinical care, such as in emergency or urgent care. Wearable devices are now commonly used as bridging technologies to obtain participant data and house investigational product safety information. Clinical nurse identification and communication of safety information are critical to dissuade adverse events, patient injury, and trial withdrawal, which may occur when clinical care is misaligned to a research protocol. Based on a feasibility study and follow-up wearable device prototype study, this preclinical nurse-nurse communication framework guides clinical nurse verbal and nonverbal communication of safety-related trial information to direct patient care activities in the clinical setting. Communication and information theories are incorporated with Carrington's Nurse-to-Nurse Communication Framework to encompass key components of a clinical nurse's management of a trial participant safety event when a clinical trial wearable device is encountered during initial assessment. Use of the preclinical nurse-nurse communication framework may support clinical nurse awareness of trial-related wearable devices. The framework may further emphasize the importance of engaging with research nurses, patients, and caregivers to acquire trial safety details impacting clinical care decision-making.

Clinical Nurses' Identification of a Wearable Universal Serial Bus Used for Pediatric Oncology Clinical Trial Participant Safety Management.

The expanded access to clinical trials has provided more patients the opportunity to participate in novel therapeutics research. There is an increased likelihood of a patient, as a pediatric oncology clinical trial participant, to present for clinical care outside the research site, such as at an emergency room or urgent care center. A novel wearable universal serial bus device is a proposed technology to bridge potential communication gaps, pertaining to critical information such as side effects and permitted therapies, between research teams and clinical teams where investigational agents may be contraindicated to standard treatments. Fifty-five emergency and urgent care nurses across the United States were presented, via online survey without priming to the context of clinical trials or the device, a picture of a pediatric patient wearing the novel wearable device prompted to identify significant, environmental cues important for patient care. Of the 40 nurses observing the patient photo, three identified the wearable device within Situational Awareness Global Assessment Tool formatted narrative response fields. Analysis of the narrative nurse-participant responses of significant clinical findings upon initial assessment of the pediatric patient photo is described, as well as the implications for subsequent prototyping of the novel universal serial bus prototype.

An evaluation of copy and paste events in electronic notes of patients with hospital acquired conditions.

BACKGROUND: The increased use of the copy and paste function (CPF) in Electronic Health Records (EHRs) has raised concerns about possible clinician miscommunication and adverse patient outcomes. OBJECTIVE: This study investigated the prevalence and extent of CPF in the EHRs of patients diagnosed with Hospital-acquired Conditions (HACs). We also examined the association between the use of CPF and patient characteristics. MATERIALS AND METHODS: The prevalence and extent of CPF were investigated using electronic clinical notes of 50 patients hospitalized with HACs between 2017 and 2021 at a large academic medical center. Study patients were adults aged 21 and older with a length of stay greater than three days. ANOVA analysis was used to examine the differences in CPF use between patients with different characteristics. RESULTS: A total of 7,844 clinical notes across seven note types are compared in the study. The mean patient age was 63.7, with an average length of stay of 15.6 days. 54% of Discharge Summaries, 53% of Consults, and 47% of history and physical (H&P) notes had duplications with the same type of notes. In the Discharge Summary, ED notes, and Plan of Care, duplications accounted for 40% or higher of the full text. H&P and Consults, H&P and Discharge Summary, and Discharge Summary and Consults were more likely to have duplications than between other types of notes. Duplications accounted for 15.5% of the information provided in H&P and Consults. The prevalence of CPF was higher in the Discharge Summary of patients who were younger, female, and had longer hospital stays. CONCLUSION: Both prevalence and extent of duplication were high in the Discharge Summary, Consults, and H&P notes of patients with HACs. Future studies are needed to examine the intention and appropriateness of CPF use and its impact on patient outcomes.

Revisiting the nursing metaparadigm: Acknowledging technology as foundational to progressing nursing knowledge.

The nursing metaparadigm, as described by Fawcett in 1984, includes human, health, nursing, and the environment, all of which support theory development by giving direction to our focus as a scientific body. Nursing scientists make their mark in biotechnological applications, mobile health, informatics, and human factors research. We give voice to the patient through design feedback and incorporating technological advancements in our evolving nursing knowledge; however, we have not formally acknowledged technology in our metaparadigm. To continue patient-centered care in this age where machines are enmeshed in daily human life, we propose technology must be a domain of the metaparadigm to continue advancing nursing science and knowledge. In this paper, we propose a separate domain of technology within the metaparadigm to challenge nurses to consider approaches within their research and practice of how technology will impact patient care and their personal development within the profession. A technology-specific domain within the metaparadigm also is a signal to other bodies of science of our willingness and ability to run at pace with novel, exciting new discoveries while adding our perspective. Nurses may become active agents in novel developments rather than passive adopters, continuing our legacy of patient advocacy through new knowledge generation. Emerging and continuing nurse leadership has set the stage for the next era of nurse-led innovation and technology development, which provides an opportunity to embed technology as a core aspect of the nursing metaparadigm.

The current state of patient-to-provider communication of childhood adversity in primary care.

BACKGROUND: There is a wealth of literature focused on the task of adverse childhood experiences (ACEs) screening; however, little literature exists describing the broader process of ACE-related communication, specifically between nurse practitioners (NPs) and adult primary care patients. Consequently, there is no standardized process for communicating about ACEs in primary care and significant gaps remain related to how, when, and where these conversations occur. OBJECTIVES: To systematically examine peer-reviewed published literature from 2011 to 2021 to describe the current state of patient-to-provider communication about ACEs in primary care. DATA SOURCES: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a focused literature search for the dates January 1, 2011 through January 1, 2021 using the search engines CINAHL, PubMed, Ovid, and PsycINFO with inclusion criteria of "adverse childhood experiences," "communication," and "primary care" provided boundaries for this systematic review. CONCLUSIONS: Findings revealed that effective communication about childhood adversity is an integral and understated element when addressing ACE exposure among adult primary care patients. Further research focused on how primary care NPs apply the concepts of effective communication while providing clinical care to adults with histories of childhood adversity is warranted. IMPLICATIONS FOR PRACTICE: This systematic review will serve as a catalyst for informing future research, theory development, and curricular initiatives focused on enhancing communication between primary care NPs and adult patients with histories of childhood adversity. From a clinical perspective, this will illuminate opportunities to develop NP-centered approaches that emphasize identification, interpretation, documentation, and development of individual, ACE-specific interventions among adults with ACE exposure in primary care.

Communicating Data, Information, and Knowledge in the Nursing Handoff.

Miscommunication occurring during the nursing handoff continues to be a primary cause of sentinel events and adverse patient outcomes. The primary purpose of the nursing handoff is to communicate essential patient data, information, and knowledge to ensure the safe continued continuity of care. The aim of this study was to examine the content of the nurse-to-nurse change-of-shift handoff communication in terms of data, information, and knowledge for both bedside and nonbedside handoffs of a patient who has experienced a clinical event. The setting was an urban medical center on a medical-surgical floor. The sample consisted of one nurse giving and one nurse receiving the handoff (n = 19 registered nurses). Five bedside and five nonbedside handoffs were audio recorded and analyzed using content analysis. The handoff overall contained 34.7% data, 51.7% information, and 13.6% knowledge. The nonbedside handoff compared with the bedside handoff contained a substantially higher percentage of data and less information. The percentage of knowledge being communicated in both the nonbedside and bedside handoff was low at 13.6% and 13.7%, respectively. The percentage of data compared with the percentage of knowledge in the handoff places the nurses at greater risk of experiencing cognitive lapses due to cognitive overload.

A Model to Guide Telehealth Research Quality Improvement, Practice and Education.

Telehealth is a means for providing care to our rural patients. This mode of healthcare delivery is not without challenges with technology, research, quality improvement, practice and education. Here we present the TRIP-E Meta Model. This model was derived from a two phased process. First, we performed a review of literature and from this developed the first attempt at model development. Second, we took student evaluations from a telehealth education program for Doctor of Nursing Practice students. Based on their feedback, we then further advanced the first model to the TRIP-E Meta Model. This model is a comprehensive guide to research, quality improvement, practice and education. As a meta model, the TRIP-E can have other theories applied for projects. This feature of meta models provide flexibility for the model. We invite others to test this model for its flexibility and usability.

Testing the Use of Natural Language Processing Software and Content Analysis to Analyze Nursing Hand-off Text Data.

Natural language processing software programs are used primarily to mine both structured and unstructured data from the electronic health record and other healthcare databases. The mined data are used, for example, to identify vulnerable at-risk populations and predicting hospital associated infections and complications. Natural language processing programs are seldomly used in healthcare research to analyze the how providers are communicating essential patient information from one provider to another or how the language that is used impacts patient outcomes. In addition to analyzing how the message is being communicated, few studies have analyzed what is communicated during the exchange in terms of data, information, and knowledge. The analysis of the "how" and "what" of healthcare provider communication both written and verbal has the potential to decrease errors and improve patient outcomes. Here, we will discuss the feasibility of using an innovative within-methods triangulation data analysis to uncover the contextual and linguistic meaning of the nurse-to-nurse change-of-shift hand-off communication. The innovative within-methods triangulation data analysis uses a natural language processing software program and content analysis to analyze the nursing hand-off communication.

Examining the meaning of the language used to communicate the nursing hand-off.

The miscommunication and inconsistent recall of patient information due to cognitive lapses that occur during the hand-off between healthcare providers account for 80% of sentinel events in acute care. Cognitive lapses are a consequence of the nurse experiencing cognitive overload, which impedes the nurse's ability to recall relevant information during and after the hand-off communication. The primary cognitive and human factor contributing to cognitive overload in the hand-off is language. The purpose of this study was to examine the meaning of the language used to communicate the nurse-to-nurse change of shift hand-off occurring at bedside and nonbedside on a medical-surgical unit in an urban medical center. A qualitative descriptive design was used. The sample was 10 audio-recorded hand-offs (five bedside and five nonbedside), with a total of 19 nurses participating. A natural language process program was used to analyze the data. The hand-off is a narrative story centered on communicating patient information delivered with a high degree of confidence. The hand-off is focused on past and current events with minimal focus on future or anticipated events. The drive to communicate is minimally based on concern, fear, or danger. There is a difference in the language used to communicate the nursing hand-off message at bedside as compared to the nonbedside hand-off.

Feasibility of Wearable Universal Serial Bus Utilization to Support Clinical Trial Participant Safety Management: A Pilot, Qualitative Descriptive Study.

Clinical trials are exploratory in nature and thus present a degree of risk for those individuals who participate in the trial. Risks include adverse events, which are undesirable experiences that arise from use of investigational products or devices that may cause participant injury or withdrawal from the clinical trial. The prevention of adverse events is a challenge given the lack of interoperability among organizational electronic health records and reliance on wallet cards to communicate safety-related information, leaving the burden of describing research-related information to external providers on the trial participant. This potential for ineffective communication propagates further risk of contraindicated medication administration and misaligned care management, which can negatively impact the trial participant's opportunity to safely engage in novel therapeutic research. This pilot, qualitative descriptive study explores a mobile, low-technology solution in the form of a wearable universal serial bus device to house deidentified, critical research-related information for clinical trial participants to wear and give external providers such that trial constraints on care management are effectively communicated. Eight participants wore a commercial universal serial bus device for 72 hours and described the meaning surrounding the participants' daily wearing of the universal serial bus bracelet via semistructured interviews. Four themes emerged: application to clinical trial participants, societal perception of wearing device, healthcare operations/workflow impact, and wearability of the universal serial bus device. Thematic findings included recommendations for device design improvements as well as key considerations for provider identification of the device.

Introducing telehealth skills into the Doctor of Nursing Practice curriculum.

ABSTRACT: Telehealth training was important for nurse practitioner (NP) students prior to the COVID-19 pandemic, but now it is essential. Training in telehealth allows access to health care for vulnerable populations in rural health areas and beyond. As the future of health care delivery changes, providers will be required to use this technology. Therefore, it is imperative that such training become part of NP education to prepare students to be technologically competent providers in the 21st century. The objective of this educational pilot project was to educate Doctor of Nursing Practice nurse practitioner students to conduct patient interviews and provide interprofessional collaboration using telehealth. The project addressed a gap in the literature on planning for simulations from varying NP specialties and provided feedback from standardized patients on their experiences. A total of 83 students from four specialty tracks received telehealth education. Students then interviewed simulated patients and provided a collaborating report. The students and patients were asked to complete questionnaires to assess the modules and the experience itself. Quantitative descriptive data were gathered, and qualitative themes were obtained from open-ended questions. Both the students and simulated patients indicated that they appreciated the ease and convenience of interviewing patients through technology. Both struggled with issues related to the technology and the need to have backup systems available. The students demonstrated that they were very capable of using telehealth and were generally very positive about the experience.

The elephant in the room: A concept analysis of communication and childhood adversity among adults.

BACKGROUND: Effective communication by those providing clinical care to adult patients is required to identify and address health disparities associated with childhood adversity. Many primary care NPs are unaware of these relationships, often lacking the communication skills and training needed to elicit this clinically relevant information. OBJECTIVES: A systematic review in the form of a concept analysis was undertaken to increase our understanding about patient-to-provider communication of childhood adversity in the context of the primary care setting. Two key concepts, communication and childhood adversity, were examined using the procedures outlined by Walker and Avant. DATA SOURCES: A focused literature search using the search engines CINAHL, PubMed, and PsycINFO with inclusion criteria of "adverse childhood experiences (ACE)," "childhood adversity," and "communication" provided boundaries for this analysis. No results were found using the defined conceptual terms. Therefore, concept synthesis was driven by the exploration of seminal and current literature from several disciplines. CONCLUSIONS: Findings revealed that effective communication about childhood adversity is an integral and understated element when addressing ACE-related health disparities among adults. Further synthesis is warranted to explore how primary care NPs apply the concepts of effective communication when providing clinical care to adult patients with histories of childhood adversity. IMPLICATIONS FOR PRACTICE: This concept analysis will serve as a catalyst for informing future research and theory development focused on enhancing ACE-specific communication between NPs and adult patients, which will lead to more personalized approaches to developing novel, ACE-specific interventions, a reduction in health disparities, and improved health outcomes.

Development of an Innovative Tool to Appraise Big Data for Best Evidence.

BACKGROUND: Datum from electronic sources has accumulated and resulted in the establishment of big data and data science. Big data consists of data sets that are larger than traditional data processing applications can manage. Data science is the research method used to analyze big data. Researchers are applying research methods to harness large and complex data sets to increase our understanding of population health by creating predictive models of patients using a variety of key variables or characteristics. Evidence-based practice relies on the appraisal of research to ensure rigor prior to implementation in clinical settings. Consistent with other research methods, papers based on data science should be subject to appraisal for determination of best evidence. The purpose of this paper is to present a tool that can be used to appraise research papers based on large data sets and data science research methods. METHODS: The following approach was used to develop the Data Science Appraisal Tool (DSAT). Despite an exhaustive search, we were unable to locate an appraisal tool for papers based on data science research methods. We then synthesized the extant literature to form the tool. The tool is based on the common characteristics of big data: (a) verification that the data set is representative of big data; (b) preparation of the data for analysis; (c) methodology used for data analysis; (d) results; and (e) theoretically based. LINKING EVIDENCE TO ACTION: Appraisal tools currently exist for traditional and well-known research methods. The DSAT provides a method to appraise papers based in data science for best evidence.

Clinical Research Integration Within the Electronic Health Record: A Literature Review.

Clinical trials have become commonplace as a treatment option. As clinical trial participants are integrated into all healthcare delivery settings, organizations are tasked with sustaining specific care regimens with appropriate documentation and maintenance of participant protections within electronic health records. Our aim was to identify the common elements necessary for electronic health record integration of clinical research for optimal trial conduct and participant management. Review of literature was conducted utilizing PubMed and CINAHL to identify relevant publications that described use of the electronic health record to directly support trial conduct, with a total of 15 publications ultimately meeting inclusion criteria. Three thematic groupings emerged that categorized common aspects of clinical research integration: functional, structural, and procedural components. These components include technological requirements (platform/system), regulatory and legal compliance, and stakeholder involvement with clinical trial procedures (recruitment of participants). Without a centralized means of providing clinicians with current treatment and adverse event management information, participant injury or likelihood of withdrawal will increase. Further research is required to develop an optimal model of research-related integration within commercial electronic health records.

Postpartum Depression: Are You Listening?

Postpartum depression (PPD) affects10% to 20% of women within the first year after birth and 25% beyond the first year. PPD, despite advances in diagnosis and treatment, remains underdiagnosed and misunderstood. Women do not always display signs of PPD while in care for delivery of the infant and may not discuss mood changes to their primary care provider at discharge and first post-delivery appointment. Identifying screening and treatment options for non-mental health providers was the purpose of this article.

Nurse Decision Making in Acute Care.

Effective nurse decision making is essential for best patient outcomes in the acute care nurse practice environment. The purpose of this study was to explore acute care RNs' perceptions of clinical decision making for a patient who experienced a clinical event. Clinical events include changes in patient condition and are manifested by fever, pain, bleeding, changes in output, changes in respiratory status, and changes in level of consciousness. Naturalistic decision making framework supported the exploration of important contextual factors associated with decision making, provided new information for nursing science, and served as the conceptual framework for this research. Data collected from interviews of 20 acute care nurses were analyzed using qualitative content analysis. The emergent categories included Awareness of Patient Status, Experience and Decision Making, Following Established Routine, Time Pressure, Teamwork/Support From Staff, Goals, Education, Resources, Patient Education, Consideration of Options to Meet Goals, and Nursing Roles. Acute care nurses incorporated a wide variety of complex factors when decision making. This study sought to improve understanding of the factors nurses found important to their decision making for the potential development of improved decision support in the electronic health record.

A model to evaluate data science in nursing doctoral curricula.

BACKGROUND: Building on the efforts of the American Association of Colleges of Nursing, we developed a model to infuse data science constructs into doctor of philosophy (PhD) curriculum. Using this model, developing nurse scientists can learn data science and be at the forefront of data driven healthcare. PURPOSE: Here we present the Data Science Curriculum Organizing Model (DSCOM) to guide comprehensive doctoral education about data science. METHODS: Our team transformed the terminology and applicability of multidisciplinary data science models into the DSCOM. FINDINGS: The DSCOM represents concepts and constructs, and their relationships, which are essential to a comprehensive understanding of data science. Application of the DSCOM identified areas for threading as well as gaps that require content in core coursework. DISCUSSION: The DSCOM is an effective tool to guide curriculum development and evaluation towards the preparation of nurse scientists with knowledge of data science.