Using *ORA, a network analysis tool, to assess the relationship of handoffs to quality and safety outcomes.

Communication during patient handoffs has been widely implicated in patient safety issues. However, few studies have actually been able to quantify the relationship between handoffs and patient outcomes. We used *ORA, a dynamic network analysis tool, to examine handoffs between day and night shifts on seven units in three hospitals in the Southwest. Using *ORA's visualization and analysis capabilities, we examined the relationships between the handoff communication network metrics and a variety of patient safety quality and satisfaction outcomes. Unique network patterns were observed for different types of outcome variable (eg, safety, symptom management, self-care, and patient satisfaction). This exploratory project demonstrates the power of *ORA to identify communication patterns for large groups, such as patient care units. *ORA's network metrics can then be related to specific patient outcomes.

Simulating nursing unit performance with OrgAhead: strengths and challenges.

In this article, we briefly describe our use of a computational modeling tool, OrgAhead, details of which have been reported previously, then discuss several of the challenges computational modeling presented and our solutions. We used OrgAhead to simulate 39 nursing units in 13 Arizona hospitals and then predict changes to improve overall patient quality and safety outcomes. Creating the virtual units required (1) collecting data from managers, staff, patients, and quality and information services on each of the units; (2) mapping specific data elements (eg, control over nursing practice, nursingworkload, patient complexity, turbulence, orientation/tenure, education) to OrgAhead's parameters and variables; and then (3) validating that the newly created virtual units performed functionally like the actual units (eg, actual patient medication errors and fall rates correlated with the accuracy outcome variable in OrgAhead). Validation studies demonstrated acceptable correspondence between actual and virtual units. For all but the highest performing unit, we generated strategies that improved virtual performance and could reasonably be implemented on actual units to improve outcomes. Nurse managers, to whom we reported the results, responded positively to the unit-specific recommendations, which other methods cannot provide. In the end, resolving the modeling challenges we encountered has improved OrgAhead's functionality and usability.

Necrotizing enterocolitis risk: state of the science.

Necrotizing enterocolitis (NEC) is the most common cause of gastrointestinal-related morbidity and mortality in the neonatal intensive care unit (NICU). Its onset is sudden and the smallest, most premature infants are the most vulnerable. Necrotizing enterocolitis is a costly disease, accounting for nearly 20% of NICU costs annually. Necrotizing enterocolitis survivors requiring surgery often stay in the NICU more than 90 days and are among those most likely to stay more than 6 months. Significant variations exist in the incidence across regions and units. Although the only consistent independent predictors for NEC remain prematurity and formula feeding, others exist that could increase risk when combined. Awareness of NEC risk factors and adopting practices to reduce NEC risk, including human milk feeding, the use of feeding guidelines, and probiotics, have been shown to reduce the incidence of NEC. The purpose of this review is to examine the state of the science on NEC risk factors and make recommendations for practice and research.

Modeling factors that influence personal health records adoption.

The purpose of this article was to describe the Personal Health Records Adoption Model and how it was developed. Older adults who often find themselves managing their own care or the care of their families have expressed interest in using electronic personal health records as a management tool, but few are using them. The literature does not provide a comprehensive model of personal health record adoption among older adults with chronic illness; therefore, essential barriers and facilitators were synthesized from existing literature to create the model. The model derivation and synthesis process drew upon candidate theoretical frameworks, including two behavioral theories, an informatics theory, and a self-management theory, while using the Informatics Research Organizing Model as an organizing framework. The Personal Health Records Adoption Model captures important barriers and facilitators that could predict adoption of personal health records among older adults with chronic illness. The long-term goal is to use this explanatory model to develop interventions that will maximize the facilitators and minimize the barriers to personal health record adoption.

Strengths and limitations of the electronic health record for documenting clinical events.

The purpose of this research was to compare nurses' perceptions of the strengths and limitations of the electronic health record with and without nursing languages for documenting and retrieving patient information regarding a clinical event. The effectiveness of the electronic health record to facilitate nurse-to-nurse communication is not well understood. Furthermore, little is known how nurse-to-nurse communication influences patient safety and failure-to-rescue events. This qualitative study used a descriptive design in which open-ended, semistructured interviews were conducted with 37 registered nurses. Qualitative content analysis produced 260 thematic units from which five categories emerged: usability, legibility, communication, workarounds, and collaboration. Nurses perceived aspects of usability as strengths (retrievability) and limitations (lack of efficiency and barriers) of the electronic health record. Furthermore, within the category communication, lack of relevance of the documentation was also viewed as a limitation by the nurses. Nurses suggested that they be involved in electronic health record decisions and that hospitals try to reduce the identified barriers to electronic health record use.

Designing a tailored Web-based educational mammography program.

Breast cancer has become increasingly prevalent in Taiwanese women, especially in younger women. Unfortunately, early breast cancer detection may be hampered by Taiwanese women's beliefs about breast cancer, risk factors, and mammography. The Internet has become a powerful way to disseminate health information, but health education Web sites are frequently neither patient-centered nor theoretically based. We used the Transtheoretical Model as the theoretical basis for the design of a tailored Web-based educational program aimed at correcting Taiwanese women's misconceptions about breast cancer and mammography and increasing their intent to obtain routine mammography. In this article, we describe the Web-based educational intervention and the results of an initial preliminary evaluation study.

Effects of a tailored web-based educational intervention on women's perceptions of and intentions to obtain mammography.

AIMS AND OBJECTIVES: Breast cancer is the fourth leading cause of death in Taiwanese women. Mammography has been recognised as a powerful tool for breast cancer detection. This study compared the effectiveness of a web-based tailored educational intervention based on Transtheoretical Model concepts with currently available educational information for improving Taiwanese women's perceptions and intentions to obtain mammography. BACKGROUND: Despite the wide use of the Internet for health information dissemination, health information found on the web frequently is very general and not individualised or tailored to meet specific individual needs. This has produced unsatisfactory outcomes such as little to no increase in individuals' knowledge or behaviour changes. DESIGN: A pretest-posttest study. Tailored intervention was hypothesised to be significantly different from standard intervention in perceptions of and intentions for Taiwanese women to receive mammography. METHODS: One hundred and twenty-eight Taiwanese women were randomly assigned to one of two groups: tailored intervention or standard intervention. The tailored intervention group received a variety of educational programme tailored to the precontemplation stage for mammography based on Transtheoretical Model concepts. The standard intervention group obtained standardised mammography brochures. Interventions were given online and online questionnaires were completed by subjects at baseline and completion of interventions. RESULTS: The tailored intervention group had significantly more positive perceptions of mammography and significantly more intention to obtain mammography than the standard intervention group postintervention. CONCLUSIONS: This study contributes to our knowledge of how a health education website can enhance women's mammography-related positive perceptions and intentions if tailored to their readiness for change. RELEVANCE TO CLINICAL PRACTICE: Increasingly, people get their health information from the web. If that education is also tailored to individual needs, it can have a greater impact on their health care decisions.

Enhancing patients' trust in the virtual home healthcare nurse.

Typically, patients develop trusting relationships with their nurses through a variety of face-to-face, often hands-on, interpersonal interactions that convey the nurse's ability, integrity, and benevolence. However, in telehome care, face-to-face interaction is limited, so nurses must learn to use different strategies to convey those professional characteristics that promote patients' trust. This study explores the nature of trust and the way it develops, and suggests strategies that can be used by telehome care nurses to counter any barriers to trust imposed by the technology.

Using OrgAhead, a computational modeling program, to improve patient care unit safety and quality outcomes.

As part of ongoing research to investigate the impact of patient characteristics, organization characteristics and patient unit characteristics on safety and quality outcomes, we used a computational modeling program, OrgAhead, to model patient care units' achievement of patient safety (medication errors and falls) and quality outcomes. We tuned OrgAhead using data we collected from 32 units in 12 hospitals in Arizona. Validation studies demonstrated acceptable levels of correspondence between actual and virtual patient units. In this paper, we report how we used OrgAhead to develop testable hypotheses about the kinds of innovations that nurse managers might realistically implement on their patient care units to improve quality and safety outcomes. Our focus was on unit-level innovations that are likely to be easier for managers to implement. For all but the highest performing unit (for which we encountered a ceiling effect), we were able to generate practical strategies that improved performance of the virtual units that could be implemented by actual units to improve safety and quality outcomes. Nurse managers have responded enthusiastically to the additional decision support for quality improvement.

An organizing framework for nursing informatics research.

Because nursing informatics is a young specialty, perhaps it is not surprising that much of the research done to date has been problem-driven, as opposed to model-driven. Continuing to struggle with definitions, nursing informatics lacks a theoretical base on which to build its science. When models or theories have been used to guide research, they typically have been applied to a single, or to very few, studies. In this paper, I describe and evaluate several of the models that have been described in nursing informatics literature and then propose an organizing model that may be used as an overarching framework to guide research.