Acceptability of Using a Robotic Nursing Assistant in Health Care Environments: Experimental Pilot Study.

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).

Partnering with new mothers to develop a smart phone app to prevent maternal mortality after hospital discharge: A pilot study.

BACKGROUND: In the United States, approximately 700 women die annually from pregnancy-related complications in the first year after birth; a significant number of the deaths occur after hospital discharge. Although postpartum monitoring is important, the standard practice is for one healthcare evaluation at 6 weeks post-birth. Most women are not aware of signs of postpartum complications. AIM: The aim of the pilot study was to develop a prototype of a mobile app aimed at increasing a new mother's ability to monitor her own health after childbirth. DESIGN: The design used mixed methods and procedures from human-centred design in an iterative process. METHODS: Data were collected by the researchers from January - May 2019 in a hospital that serves primarily low income and underserved women in the southern US. Three groups of women provided data related to health education preferences or their reaction to a mock-up or prototype mobile app. Several women completed the Mobile App Rating Scale (MARS; N = 22). RESULTS: Themes from interviews indicated that women (N = 5) preferred electronic health education and that they used apps to monitor their pregnancies. Other new mothers (n-5) described their overall reaction to the proposed features of the app which was incorporated into the design of the app that was tested by the third group of new mothers (N = 22) who were positive about interactions with the app. The MARS scores for the app were positive. CONCLUSIONS: New mothers indicated that they would be willing to use an app to monitor their own postpartum health. IMPACT: Data from the pilot study informed the development of a prototype mobile app that can now be used in a clinical trial with new mothers to monitor their own health and report concerns to healthcare providers.

Intention to Seek Depression Treatment in Latina Immigrant Mothers.

BACKGROUND: Postpartum depression in Latina immigrant mothers can lead to adverse outcomes in both mothers and babies, yet depression treatment remains suboptimal. AIMS: The aims were to determine predictors of intention to seek depression treatment and to determine if intention to seek depression treatment differed in those with significant symptoms of depression. METHODS: Based upon the theory of planned behavior (TPB), a cross-sectional study design was used. A convenience sample of Latina immigrant mothers (n = 50) were interviewed in Spanish. Certified translation services were used to translate study instruments to Spanish. Descriptive analysis and multivariable logistic regression techniques were used for data analysis. RESULTS: While increases in attitudes were associated with intention to seek depression treatment, increased social support and perceived control were associated with a decrease in intention to seek treatment. CONCLUSIONS: The differing role of social support in Latina immigrant mothers should be explored.

Contextual Factors Impacting a Pain Management Intervention.

PURPOSE: To determine if findings from our preliminary study related to patient and nursing satisfaction with a pain management intervention could be replicated in a changed environment, and if contextual factors could impact the effectiveness of a pain management intervention on patient satisfaction with nursing staff's management of pain. METHODS: A prospective, experimental design was used with six monthly assessments before, during, and after the intervention. Data were collected from 540 patients admitted to eight medical surgical and progressive care units and nurses that worked in these units at an academic health sciences center in the southern United States, from March to July 2015. The script-based, pain management communication intervention included three specific tactics: script-based communication, use of white boards, and hourly rounding. The Hospital Consumer Assessment of Healthcare Providers and Systems survey was used to assess two items: "pain is well controlled" and "staff did everything they could to help with pain." Contextual factors focused on the practice setting. FINDINGS: Both scores for "pain is well controlled" (ß = .028, p = 0.651) and scores for "staff did everything they could to help with pain" (ß = .057,p = .385) did not change initially but then increased significantly and were sustained over time. Nurses had high levels of satisfaction with the intervention (M = 7.9, SD = 2.1) and compliance with the intervention (M = 8.0, SD = 1.9), and had little difficulty in implementing the intervention (M = 8.3, SD = 1.4). In terms of contextual factors, the number of beds on the unit and the number of patients being discharged negatively impacted scores for "pain is well controlled" and "staff did everything they could to help with pain." Hospital length of stay positively impacted scores for "pain is well controlled" by staff. CONCLUSIONS: Despite challenging contextual variables, the study extended the findings of an early preliminary study in showing the effectiveness of pain management intervention on patient satisfaction with staff's management of pain. In evaluating the impact of an intervention, it is essential to examine the contextual environment. CLINICAL RELEVANCE: Using simple, clear, and consistent communication between patients and nurses related to pain can positively impact patient satisfaction with pain management over time. The health care environment can enhance nursing practice and patients' outcomes.

Description of Nurse Scientists in a Large Health Care System.

Replicating a research study that described the work of nurse scientists in children's hospitals, the purpose of the study was to describe the role, activities, and outcomes of nurse scientists employed in a national health care organization. The characteristics of nurses filling the nurse scientist role in clinical settings and outcomes associated with the role have not been extensively described. The setting of this study is ideal since the organization includes facilities of various sizes located in rural, urban, and suburban areas in 18 states. Names and contact information of nurse scientists were obtained from nurse executives at each of the 110 affiliated organizations. Nurse scientists completed an anonymous survey. The primary role of the nurse scientists is to facilitate the work of others. Recommendations to strengthen the research infrastructure are provided.

Health Literacy and Preferences for Sources of Child Health Information of Mothers With Infants in the Neonatal Intensive Care Unit.

BACKGROUND: Parents of infants hospitalized in the neonatal intensive care unit (NICU) frequently need guidance to prepare them for the care and health promotion of their child after hospital discharge. The health literacy of the parents should be considered so that education can be tailored to meet their needs. It is also important to understand the parents' preferences for how, and from whom, they receive education. PURPOSE: The purpose of this study was to identify health literacy levels of parents of infants in an NICU and preferences for who they want to provide them with education. METHODS: An exploratory, descriptive design was used to assess participant health literacy and preferences for obtaining child health information. Only mothers (no fathers) with babies in the NICU were available to complete the survey. Mean participant age was 26.4 years (SD = 6.7). RESULTS: Participants had a mean Rapid Estimate of Adult Literacy in Medicine, Revised, score of 5.64 (SD = 2.4), indicating a low level of health literacy. Questions regarding when to administer medication were correctly answered by 69% of participants. Proper medication dosage was understood by 92% of participants; however, only 30% were able to correctly convert measurements. One-on-one discussions with a physician were the preferred source of health information for 80% of participants. IMPLICATIONS FOR PRACTICE/RESEARCH: The current exploratory study provides new information that will help inform the development of future studies and increase awareness of nurses regarding health literacy and the specific types of skills for which parents need the most help.

Development and Initial Testing of the Parent Beliefs about Early Childhood Social-Emotional Development Instrument.

BACKGROUND: No instrument exists to measure parent beliefs about early social-emotional development, which is foundational for child outcomes. We developed and tested an instrument to measure parent beliefs. METHODS: Positive parenting was defined from the literature and 84 items were developed based on the theory of planned behavior (TPB). The instrument was tested with mothers (N=200) from the United States. RESULTS: Data support our initial supposition of five factors based upon the TPB, which accounted for 65.5% of the total variance. CONCLUSION: The instrument demonstrates strong initial psychometric properties and is ready for further testing.

Lessons Learned From Adolescent Mothers: Advice on Recruitment.

PURPOSE: Adolescent mothers have high rates of depressive symptoms and inadequate rates of depression evaluation and treatment. The purpose of this qualitative study was to identify characteristics of effective recruitment ads for an Internet-based depression intervention for pregnant and parenting adolescents. METHODS: Using focus group methods, participants (N = 35) were recruited and enrolled at a teen parent program, part of the public school system. Focus group sessions were analyzed for participant preferences, rationale for choices, key words, and the frequency of words within the videotapes and audiotapes. RESULTS: Findings indicated that adolescent mothers preferred pictures in which everyone looked happy, narrative that clearly indicated cost and eligibility, and words that they would use in conversation. CLINICAL RELEVANCE: The study filled an important gap in the literature by soliciting from pregnant and parenting adolescents their preferences regarding visual appeal, content adequacy, and message clarity of advertisements that would motivate them to visit an Internet intervention for depression. Results could be extrapolated to education of pregnant and parenting adolescents in clinical settings.

Impact of a Script-based Communication Intervention on Patient Satisfaction with Pain Management.

Pain is a common complaint among hospitalized patients no matter the diagnosis. Pain has a negative effect on many aspects of a patient's life, including quality of life, sleep, and activities of daily living as well as increased health care expenses. The aim of this study was to evaluate the effectiveness of an intervention (script-based communication, use of white boards, and hourly rounding) related to pain management on patient satisfaction with nurses' management of pain. A prospective, quasi-experimental pretest-posttest design was used. Data were collected from two units that provided care for patients with a variety of medical-surgical diagnoses in a hospital located in an academic health sciences center in the southern United States. When nurses used clear and consistent communication with patients in pain, a positive effect was seen in patient satisfaction with pain management over time. This intervention was simple and effective. It could be replicated in a variety of health care organizations.

Use of social media and internet to obtain health information by rural adolescent mothers.

BACKGROUND: Adolescent mothers residing in rural areas need accurate health information to care for themselves and their babies. The purpose of this study was to determine the use of social media and Internet by adolescent mothers residing in rural areas, particularly in regard to obtaining health information. METHODS: Using a cross-sectional design, a convenience sample of adolescent mothers living in a rural county in a state located in the southern U.S. (n = 15), completed the Pew Internet Survey during home visits with nurses from a community health agency. RESULTS: All adolescent mothers accessed Internet using cell phones (93%) or computers (100%). Many adolescent mothers sent or received over 50 text messages per day. Thirty-three percent of adolescent mothers searched for health information on the Internet every few weeks; 27% received health information from Facebook. CONCLUSIONS: Communication of health information using the Internet and social media may be effective with adolescent mothers residing in rural areas.

Maternal-Infant interaction in women with unipoloar and bipolar depression.

BACKGROUND: One percent of women experience bipolar disorder and are likely to suffer from mood disorders during the postpartum period, potentially impacting interaction with their infants. The purpose of this study was to describe maternal-infant interactions in women with bipolar depression at 12 months postpartum and to compare interactions to women with unipolar depression and a control group. METHODS: Using a descriptive design, maternal-infant interactions in women with bipolar disorder (n=40) were videotaped, coded, and analyzed for maternal sensitivity and maternal-infant reciprocity and compared to maternal-infant interaction in women with unipolar depression (n=50) and women without depression (n=40). RESULTS: Women with bipolar depression had lower scores on both maternal sensitivity and infant reciprocity, but differences were nonsignificant. CONCLUSIONS: This research is the first study to examine maternal-infant interaction in women with bipolar disorder, and important trends were noted. Future research should examine maternal-infant interaction at earlier time periods.

Evaluation of printed health education materials for use by low-education families.

PURPOSE: Millions of adults lack adequate reading skills and many written patient education materials do not reflect national guidelines for readability and suitability of materials, resulting in barriers to patients being partners in their own health care. The purpose of this study was to evaluate commonly used printed health materials for readability and suitability for patients with limited general or health literacy skills, while providing easy recommendations to health care providers for how to improve the materials. METHODS: Materials (N = 97) from three clinical areas that represented excellence in nursing care in our organization (stroke, cancer, and maternal-child) were reviewed for a composite reading grade level and a Suitability Assessment of Materials (SAM) score. RESULTS: Twenty-eight percent of the materials were at a 9th grade or higher reading level, and only 23% were 5th grade or below. The SAM ratings for not suitable, adequate, and superior were 11%, 58%, and 31%, respectively. Few materials were superior on both scales. The SAM scale was easy to use and required little training of reviewers to achieve interrater reliability. CONCLUSIONS: Improving outcomes and reducing health disparities are increasingly important, and patients must be partners in their care for this to occur. One step to increasing patient understanding of written instructions is improving the quality of the materials in the instruction for all patients and their families, especially those with limited literacy skills. CLINICAL RELEVANCE: Using materials that are written in a manner that facilitates the uptake and use of patient education content has great potential to improve the ability of patients and families to be partners in care and to improve outcomes, especially for those patients and families with limited general literacy or health literacy skills.

Theoretical approaches to maternal-infant interaction: which approach best discriminates between mothers with and without postpartum depression?

OBJECTIVE: The purpose of this study was to determine which of the four common approaches to coding maternal-infant interaction best discriminates between mothers with and without postpartum depression. METHODS: After extensive training, four research assistants coded 83 three minute videotapes of maternal infant interaction at 12month postpartum visits. Four theoretical approaches to coding (Maternal Behavior Q-Sort, the Dyadic Mini Code, Ainsworth Maternal Sensitivity Scale, and the Child-Caregiver Mutual Regulation Scale) were used. Twelve month data were chosen to allow the maximum possible exposure of the infant to maternal depression during the first postpartum year. The videotapes were created in a laboratory with standard procedures. Inter-rater reliabilities for each coding method ranged from .7 to .9. The coders were blind to depression status of the mother. RESULTS: Twenty-seven of the women had major depressive disorder during the 12month postpartum period. Receiver operating characteristics analysis indicated that none of the four methods of analyzing maternal infant interaction discriminated between mothers with and without major depressive disorder. CONCLUSION: Limitations of the study include the cross-sectional design and the low number of women with major depressive disorder. Further analysis should include data from videotapes at earlier postpartum time periods, and alternative coding approaches should be considered. Nurses should continue to examine culturally appropriate ways in which new mothers can be supported in how to best nurture their babies.

Perceived Usefulness of Robotic Technology for Patient Fall Prevention.

BACKGROUND: Technology has the potential to prevent patient falls in healthcare settings and to reduce work-related injuries among healthcare providers. However, the usefulness and acceptability of each technology requires careful evaluation. Framed by the Technology Acceptance Model (TAM) and using the Adaptive Robotic Nursing Assistant (ARNA) to assist with patient ambulation, the present study examined the perceived usefulness of robots in patients' fall prevention with implications for preventing associated work-related injuries among healthcare providers. METHODS: Employing an experimental design, subjects were undergraduate nursing students (N = 38) and one external subject (not a nursing student) who played the role of the patient. Procedures included subjects ambulating a simulated patient in three ways: (a) following the practice of a nurse assisting a patient to walk with the patient wearing a gait belt; (b) an ARNA-assisted process with the gait belt attached to ARNA; (c) an ARNA-assisted process with a subject walking a patient wearing a harness that is attached to ARNA. Block randomization was used with the following experimental scenarios: Gait Belt (human with a gait belt), "ARNA + Gait Belt" (a robot with a gait belt), and "ARNA + Harness" (a robot with a harness). Descriptive statistics and a multiple regression model were used to analyze the data and compare the outcome described as the Perceived Usefulness (PU) of a robot for patient walking versus a human "nurse assistant" without a robot. The independent variables included the experimental conditions of "Gait Belt," "ARNA + Gait Belt," and "ARNA + Harness," the subject's age, race, and previous videogame playing experience. FINDINGS: Results indicated that PU was significantly higher in the Gait Belt + ARNA and Harness + ARNA conditions than in the Gait Belt condition (p-value <.01 for both variables). In examining potential influencing factors, the effects of race (White, African American, and Asian), age, and previous video-playing experience were not statistically significant (p-value >.05). DISCUSSION: Results demonstrated that using robot technology to assist in walking patients was perceived by subjects as more useful in preventing falls than the gait belt. Patient fall prevention also has implications for preventing associated work-related injuries among healthcare providers. IMPLICATIONS: Understanding the effects of a subject's perceptions can guide further development of assistive robots in patient care. Robotic engineers and interdisciplinary teams can design robots to accommodate worker characteristics and individual differences to improve worker safety and reduce work injuries.