Prediction of hospital-acquired influenza using machine learning algorithms: a comparative study.

BACKGROUND: Hospital-acquired influenza (HAI) is under-recognized despite its high morbidity and poor health outcomes. The early detection of HAI is crucial for curbing its transmission in hospital settings. AIM: This study aimed to investigate factors related to HAI, develop predictive models, and subsequently compare them to identify the best performing machine learning algorithm for predicting the occurrence of HAI. METHODS: This retrospective observational study was conducted in 2022 and included 111 HAI and 73,748 non-HAI patients from the 2011-2012 and 2019-2020 influenza seasons. General characteristics, comorbidities, vital signs, laboratory and chest X-ray results, and room information within the electronic medical record were analysed. Logistic Regression (LR), Random Forest (RF), Extreme Gradient Boosting (XGB), and Artificial Neural Network (ANN) techniques were used to construct the predictive models. Employing randomized allocation, 80% of the dataset constituted the training set, and the remaining 20% comprised the test set. The performance of the developed models was assessed using metrics such as the area under the receiver operating characteristic curve (AUC), the count of false negatives (FN), and the determination of feature importance. RESULTS: Patients with HAI demonstrated notable differences in general characteristics, comorbidities, vital signs, laboratory findings, chest X-ray result, and room status compared to non-HAI patients. Among the developed models, the RF model demonstrated the best performance taking into account both the AUC (83.3%) and the occurrence of FN (four). The most influential factors for prediction were staying in double rooms, followed by vital signs and laboratory results. CONCLUSION: This study revealed the characteristics of patients with HAI and emphasized the role of ventilation in reducing influenza incidence. These findings can aid hospitals in devising infection prevention strategies, and the application of machine learning-based predictive models especially RF can enable early intervention to mitigate the spread of influenza in healthcare settings.

Nursing diagnoses as factors associated with delirium among intensive care unit patients with sepsis: A retrospective correlational study.

AIMS: To examine whether nursing diagnoses were associated with delirium in patients with sepsis. BACKGROUND: Nursing diagnosis is a nurse's clinical judgement about clients' current or potential health conditions. Delirium is regarded as an important nurse-sensitive outcome. Nonetheless, nursing diagnoses associated with delirium have not yet been identified. DESIGN: Retrospective correlational study. METHODS: This study was carried out from December 2021 to January 2023. We analysed electronic health records of patients with sepsis admitted to the intensive care units (ICUs) of a tertiary hospital in Seoul, South Korea. Delirium was defined based on the Intensive Care Delirium Screening Checklist score. Nursing diagnoses established within 24 h of admission to the ICU were included and were based on the North American Nursing Diagnosis Association diagnostic classification. The data were analysed using logistic regression. Demographics, comorbidities, procedures and physiological measures were adjusted. Regression model was evaluated via receiver operating characteristic curve, Nagelkerke R2, accuracy and F1 score. RESULTS: The prevalence of delirium in patients with sepsis was 51.8%. Ineffective breathing patterns, decreased cardiac output and impaired skin integrity were significant nursing diagnoses related to delirium. Age ≥ 65 years, Acute Physiology and Chronic Health Evaluation II score, mechanical ventilation, continuous renal replacement therapy, physical restraint and comatose state were also associated with delirium in patients with sepsis. The area under the receiver operating characteristic curve was 0.806. CONCLUSION: Ineffective breathing patterns, decreased cardiac output and impaired skin integrity could manifest as prodromal symptoms of delirium among patients with sepsis. IMPACT: The prodromal symptoms of delirium revealed through nursing diagnoses can be efficiently used to identify high-risk groups for delirium. The use of nursing diagnosis system should be recommended in clinical practice caring for sepsis patients. REPORTING METHODS: STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public involvement.

Everyday Digital Literacy Questionnaire for Older Adults: Instrument Development and Validation Study.

BACKGROUND: The need for digital literacy in aging populations is increasing in the digitalizing society. Digital literacy involves the identification, evaluation, and communication of information through various digital devices or relevant programs. OBJECTIVE: The aims of this study were to develop an Everyday Digital Literacy Questionnaire (EDLQ), a digital literacy assessment scale, and subsequently evaluate its psychometric properties using a population of community-dwelling older adults in South Korea. METHODS: The EDLQ was developed using an instrument development design. A nationwide survey was conducted, and the study included 1016 community-dwelling older adults (age ≥60 years). To evaluate the psychometric properties, the participants were randomly divided into 2 groups (n=508 each), and the internal consistency (Cronbach α and McDonald ω), structural validity (exploratory factor analysis and confirmatory factor analysis), hypothesis-testing construct validity using the eHealth Literacy Scale (eHEALS), and measurement invariance were analyzed. RESULTS: Among the initial 30 items of the EDLQ, 22 items with a 3-factor solution had a total explained variance of 77%. The domains included "information and communication" (9 items), "content creation and management" (4 items), and "safety and security" (9 items). Confirmatory factor analysis was conducted with this 3-factor solution (χ2206=345.1; normed χ2206=1.7; comparative fit index=0.997; Tucker-Lewis index=0.997; root-mean-square error of approximation=0.036; standardized root-mean-square residual=0.050; composite reliability=0.903-0.959; average variance extracted=0.699-0.724; R2=0.616-0.773). Hypothesis-testing construct validity with the eHEALS revealed a strong correlation (r=0.75). Cronbach α and McDonald ω coefficients were .98 and 0.98, respectively. The fit indices for measurement invariance, including the configural, metric, and scalar invariance models, demonstrated a satisfactory fit to the data. Our findings suggest that the psychometric properties of the 22-item EDLQ are valid and reliable for assessing digital literacy among older Korean adults. CONCLUSIONS: In this study, we developed a digital literacy measure with strong psychometric properties that made it suitable for assessing the digital literacy of community-dwelling older adults in Korea. To broaden its applicability, however, further assessment of its feasibility for use with different languages and cultures is necessary. Moreover, more empirical research on digital literacy and related factors in older adults can facilitate the development of personalized digital health care services and educational interventions in the digital society.

Development of the clinical reasoning competency scale for nurses.

BACKGROUND: Clinical reasoning is emphasized as an important component of nursing education, since nurses' lack of clinical reasoning leads to incorrect clinical decision-making. Therefore, a tool for measuring clinical reasoning competency needs to be developed. METHODS: This methodological study was conducted to develop the Clinical Reasoning Competency Scale (CRCS) and examine its psychometric properties. The attributes and preliminary items of the CRCS were developed based on a systematic literature review and in-depth interviews. The validity and reliability of the scale were evaluated among nurses. RESULTS: The exploratory factor analysis was conducted for the construct validation. The total explained variance of the CRCS was 52.62%. The CRCS consists of 8 items for plan setting, 11 items for intervention strategy regulation, and 3 items for self-instruction. The Cronbach's α of the CRCS was 0.92. Criterion validity was verified with the Nurse Clinical Reasoning Competence (NCRC). The correlation between the total NCRC and CRCS scores was 0.78, all of which were significant correlations. CONCLUSION: The CRCS is expected to provide raw scientific and empirical data for various intervention programs to develop and improve nurses' clinical reasoning competency.

Factors affecting the quality of life of gastric cancer survivors.

BACKGROUND: The number of gastric cancer survivors has been increasing, and such survivors experience various changes in their lives post-recovery. Adapting to these changes requires appropriate interventions that can improve their quality of life (QoL). This study was conducted to investigate the factors affecting the QoL of gastric cancer survivors and provide basic data for effective intervention. METHODS: Data were collected between September 8 and September 29, 2017, from the Gastric Cancer Center at a tertiary hospital. Questionnaire surveys were conducted using the EORTC QLQ-C30/STO22, Self-Efficacy-Scale, Multidimensional Scale of Perceived Social Support, and Quality of Life-Cancer Survivors Questionnaire on gastric cancer survivors who were followed up for 3 years after gastrectomy. Data were analyzed using descriptive statistics, t test, ANOVA, Pearson's correlation coefficient, and multiple regression analysis. RESULTS: A total of 136 gastric cancer survivors completed the questionnaire survey. There were significant positive correlations of QoL with self-efficacy, functional status, and social support (r = .35, p < .001; r = .53, p < .001; r = .26, p < .001, respectively). There were significant negative correlations of QoL with general symptoms (r = - .39, p < .001) and gastric cancer-specific symptoms (r = - .51, p < .001). The regression model explained 48.3% of the QoL, and the affecting factors were gastric cancer-specific symptoms (ß = - .397, p < .001), religious belief (ß = .299, p < .001), functional status (ß = .251, p = .003), and self-efficacy (ß = .191, p = .004). CONCLUSION: This study confirmed that gastric cancer-specific symptoms, spiritual well-being, self-efficacy, and functional status affect the QoL of gastric cancer survivors. Hence, these factors should be considered in the interventions to improve the QoL of gastric cancer survivors.

Effects of Serious Games on Depression in Older Adults: Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Depression is a severe psychological concern that negatively affects health in older adults. Serious games applied in various fields are considered appropriate interventions, especially in mental health care. However, there is a lack of evidence regarding the effects of serious games on depression in older adults. OBJECTIVE: This study aimed to investigate the characteristics and effectiveness of serious games for depression in older adults. METHODS: A systematic review and meta-analysis of randomized controlled trials were conducted. In total, 5 electronic databases (PubMed, CINAHL, Embase, PsycINFO, and Cochrane Library) were searched to identify relevant studies published until July 6, 2021. A total of 2 reviewers independently conducted study selection, data extraction, and quality appraisals. The risk of bias in the included studies was assessed using the JBI Critical Appraisal Checklist. For the meta-analysis, the effect size was calculated as the standardized mean difference (SMD) by using a random effects model. RESULTS: A total of 17 studies with 1280 older adults were included in the systematic review, and 15 studies were included in the meta-analysis. Serious game interventions were classified into 3 types: physical activity (PA), cognitive function, and both PA and cognitive function. The meta-analysis demonstrated that serious games reduced depression in older adults (SMD -0.54, 95% CI -0.79 to -0.29; P<.001). Serious games had a more significant effect size in community or home settings (SMD -0.61, 95% CI -0.95 to -0.26; P<.001) than in hospital settings (SMD -0.46, 95% CI -0.85 to -0.08; P=.02); however, the difference between groups was not significant. Among the types of games, games for PA (SMD -0.60, 95% CI -0.95 to -0.25; P<.001) and games for both (SMD -0.73, 95% CI -1.29 to -0.17; P=.01) had a significant effect on reducing depression in older adults. However, no significant correlations were observed between the duration or number of serious games and depression. CONCLUSIONS: Serious games were beneficial in reducing depression in older adults. Regardless of the study setting, serious games appeared to reduce depression. Particularly, serious games including PA had a significant impact on reducing depression. Furthermore, high-quality randomized controlled trials are needed to establish substantial evidence for the effectiveness of serious games on depression in older adults. TRIAL REGISTRATION: PROSPERO CRD42021242573; https://tinyurl.com/26xf7ym5.

Mobile health platform based on user-centered design to promote exercise for patients with peripheral artery disease.

BACKGROUND: Peripheral artery disease (PAD) is a cardiovascular disease that can be improved by risk factor modification. Mobile health (mHealth) intervention is an effective method of healthcare delivery to promote behavior changes. An mHealth platform can encourage consistent involvement of participants and healthcare providers for health promotion. This study aimed to develop an mHealth platform consisting of a smartphone application (app) synchronized with a wearable activity tracker and a web-based portal to support exercise intervention in patients with PAD. METHODS: This study was conducted based on an iterative development process, including analysis, design, and implementation. In the analysis phase, a literature review and needs assessment through semi-structured interviews (n = 15) and a questionnaire-based survey (n = 138) were performed. The initial prototype design and contents were developed based on the users' requirements. In the implementation phase, multidisciplinary experts (n = 4) evaluated the heuristics, following which the mHealth platform was revised. User evaluation of the usability was performed by nurses (n = 4) and patients with PAD (n = 3). RESULTS: Through the development process, the functional requirements of the platform were represented through visual display, reminder, education, self-monitoring, goal setting, goal attainment, feedback, and recording. In-app videos of exercise and PAD management were produced to provide information and in-app automatic text messages were developed for user motivation. The final version of the platform was rated 67.86 out of 100, which indicated "good" usability. CONCLUSIONS: The mHealth platform was designed and developed for patients with PAD and their healthcare providers. This platform can be used to educate and promote individualized exercise among patients with PAD.

Type D personality, cognitive illness perception, depression, approach coping, and self-management among older adults in long-term care hospitals: Structural equation modeling.

This study aimed to construct a structural equation model to explore the relationship between Type D personality, cognitive illness perception, depression, approach-coping, and self-management. The study was conducted at two long-term care hospitals with 300 or more beds in Korea. Participants were 287 older patients from whom data were collected from February 17 to March 10, 2021, using a structured questionnaire comprising items on the following variables: Type D personality, cognitive illness perception, depression, approach coping, and self-management. Type D personality (ß=-.601, p=.001), cognitive illness perception (ß =.692, p <.001), depression (ß =-.204, p =.011), and approach-coping (ß =.326, p <.001) explained 78.8% of the total variance of self-management, highlighting their impact on how patients accept and manage a disease and their relevance to the self-management of older adults in long-term care hospitals.

Nurses in advanced roles as a strategy for equitable access to healthcare in the WHO Western Pacific region: a mixed methods study.

BACKGROUND: The Western Pacific region constitutes one-quarter of the world's population and has diverse health needs. While dialogue on and promotion of advanced practice nurses are ongoing, this study investigated the current responsibilities of nurses in advanced roles, future healthcare needs, and the implications of these components for nurses' professional development within the Western Pacific region. METHODS: This study employed three phases, a descriptive survey on the current status of nurses in advanced roles in the Western Pacific region, followed by a Delphi survey, and exploratory interviews. A total of 55 national experts with clinical, academic, and/or government-related backgrounds from 18 countries participated from December 2017 - December 2018. The descriptive survey via email to identify the status of nurses in advanced roles and a working definition was developed. This formed the basis for the Delphi survey, which identified key barriers and challenges for enhancing the development of nurses in advanced roles within the country (round 1) and for the region (rounds 2 and 3). Lastly, semi-structured individual interviews were conducted to identify strategies for establishing nurses in advanced roles to improve equitable access to healthcare. RESULTS: Thirty-seven roles and characteristics were identified and categorized for nurses performing advanced roles. Emergency care, critical care, elderly health, child health, and rural/remote communities were identified as fields with particular need for nurses in advanced roles in the Western Pacific region. Providing effective services, influencing government leadership, and advocating for health system sustainability were deemed necessary to improve equitable healthcare access. We found that nurses in advanced roles are not limited to clinical tasks within the hospital but are poised for active participation in primary healthcare, education/teaching, professional leadership, quality management, and research. CONCLUSIONS: Demand for nurses in advanced roles is high in the Western Pacific region and 15 items were identified across five core strategic areas to enhance development of nurses in advanced roles. Governmental-level recommendations include establishing legislative protection, improving systems for remuneration, strengthening supportive channels, and conducting national needs assessments.

Factors associated with nurses' user resistance to change of electronic health record systems.

BACKGROUND: Electronic health record (EHR) systems often face user resistance in hospitals, which results in a failure to acquire their full benefits. To implement the EHR successfully, it is crucial to reduce nurses' resistance to use the system. This study aimed to investigate the factors associated with nurses' resistance to use the EHR system. METHODS: A descriptive correlational study was conducted with nurses working at four university hospitals in Korea using self-administered questionnaires to measure user resistance behavior, resistance to change, perceived usefulness, perceived ease of use, perceived value, colleagues' opinions, self-efficacy for change, and organizational support for change. Path analysis was performed to examine direct and indirect association with user resistance behavior. RESULTS: A total of 223 nurses completed the questionnaires. All seven factors were found to be significantly associated with user resistance, either directly or indirectly. The total effect on user resistance behavior was highest in resistance to change (0.65), followed by perceived usefulness (- 0.33); both had direct but no indirect effects. Conversely, self-efficacy for change (- 0.25), perceived value (- 0.21), colleagues' opinions (- 0.16), perceived ease of use (- 0.16), and organizational support for change (- 0.05) had indirect but no direct effects. CONCLUSIONS: The study examined the factors associated with nurses' user resistance behavior after the implementation of a new EHR system. These findings could help hospitals develop better EHR implementation strategies to reduce user resistance behavior among the nursing staff.

Association Between Symptoms of Patients With Heart Failure and Patient Outcomes Based on Electronic Nursing Records.

We examined the association between symptoms (ie, dyspnea and pain) and patient outcomes (ie, length of stay, 30-day readmission, and death in hospital) among patients with heart failure using EMRs. This was a descriptive study that was conducted from July 1, 2014, to November 30, 2017. Participants were 754 hospitalized patients with heart failure (mean age, 70.62 ± 14.78 years; male-to-female ratio, 1:1.1). Data were analyzed using descriptive statistics, χ2 tests, and logistic regression analyses. Patients' average length of stay was 8.92 ± 13.12 days. Thirty-two patients (4.2%) were readmitted, and 100 patients (13.3%) died during hospitalization. Two-thirds (67.7%) experienced dyspnea, and 367 (48.7%) experienced pain. Symptoms and ICU admission were significantly related to patient outcomes. In the regression analyses, dyspnea, pain, and ICU admission were significantly related to higher-than-average lengths of stay. Dyspnea and ICU admission were related to death in hospital. Information regarding patients' symptoms, which was extracted from records, was a valuable resource in examining the relationship between symptoms and patient outcomes. The use of EMRs may be more advantageous than self-reported surveys when examining patients' symptom and utilizing big data.

Developing an integrated curriculum for patient safety in an undergraduate nursing program: a case study.

BACKGROUND: Nursing students' practical training should begin when students can apply core knowledge, skills, and attitudes related to patient safety. This necessitates an integrated curriculum in nursing education that links practice to the theory concerning patient safety to enhance patient safety competencies and quality in nursing care. This study aimed to develop an integrated curriculum that incorporates patient safety factors in the existing curriculum to increase patient safety competencies in nursing students. METHOD: A case study approach was adopted to explain the development processes of a new curriculum integrating patient safety in the existing outcome-based curriculum of a nursing college. Based on the existing outcome-based curriculum of a nursing college, a four-step process was performed to integrate patient safety component, including quality improvement, into the curriculum: 1) literature review, 2) analysis of course syllabus, 3) selection of courses related to patient safety topics, and 4) development of evaluation tool. RESULTS: The integrated patient safety curriculum was based on six topics: patient safety principles, teamwork, communication, patient engagement, risk management and, quality improvement, and International Patient Safety Goals. Based on the characteristics of the course according to the level of students in each year, the curriculum was integrated to address patient safety topics in seven courses (four theoretical and three practical). A Patient safety Competency self-assessment checklist was developed for students to naturally acquire patient safety competencies in clinical settings. CONCLUSIONS: This study demonstrated that patient safety topics should be addressed in both theoretical and practical settings across the entire nursing curriculum per the continuity and sequence of education principles.

Development and evaluation of myofunctional therapy support program (MTSP) based on self-efficacy theory for patients with obstructive sleep apnea.

PURPOSE: The aim of this study is to determine the impact of myofunctional therapy support program (MTSP) based on self-efficacy theory compared to no support during myofunctional therapy (MT) in patients with obstructive sleep apnea (OSA). METHODS: Thirty-one patients with OSA were randomized into two groups: 12 weeks of treatment with the MTSP developed in this study (experimental group) and one education session of MT (control group). Patients were evaluated at the beginning and the end of the study using questionnaires (self-efficacy scale, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, snoring intensity and frequency, dry mouth) and polysomnography. RESULTS: The control (n = 15) and experimental (n = 16) groups had similar results for all variables at study entry. The control group showed no significant change in any variables during the study period. In contrast, the experimental group showed a significant increase in self-efficacy 61.38 ± 9.50 to 65.56 ± 10.89 (p = 0.020) and a significant decrease in apnea-hypopnea index (AHI) 19.51 ± 11.41 to 14.11 ± 9.13 (p = 0.039), daytime sleepiness 9.88 ± 3.84 to 7.56 ± 3.42 (p = 0.028), snoring intensity 5.57 ± 3.13 to 4.44 ± 2.68 (p = 0.008), and dry mouth 6.44 ± 3.14 to 3.63 ± 2.33 (p = 0.005), compared to the baseline. No significant change in lowest SaO2 (p = 0.969), sleep quality (p = 0.307), and snoring frequency (p = 0.321) during the study period. CONCLUSIONS: The intensive and interactive intervention of MTSP improved the self-efficacy of OSA patients, and consequently, resulted in sign and symptom relief, such as AHI, daytime sleepiness, snoring and dry mouth. The MTSP was dedicated to the nurse practitioner to improve the way to dispense the MT. This research has implications for the successful treatment of OSA.

Mediating role of coping style on the relationship between job stress and subjective well-being among Korean police officers.

BACKGROUND: Police officers have long been known to have one of the most stressful occupations. This study investigates their stress levels, coping styles, and subjective well-being, including affect and life satisfaction. We also explore the interrelationships of these factors to determine how coping style influences a police officer's subjective well-being. METHODS: We used a convenience sampling method for 112 police officers in a metropolitan area in South Korea. Data were collected using self-administered questionnaires. The questionnaires consisted of the following scales: job stress, coping style, positive/negative affect, and life satisfaction that measured subjective well-being. Descriptive statistics, a correlation analysis and Hayes' PROCESS macro, and bootstrap analysis were performed. RESULTS: The level of job stress for the participants was moderate, with an average of 43.57 out of 100. The mean scores of positive affect was 17.38 out of 40, 8.50 out of 40 for negative affect, and 20.76 out of 35 for life satisfaction. Job stress and coping were significantly correlated with subjective well-being, and problem-solving style mediated stress, positive affect, and life satisfaction. Lastly, assistance pursuit style mediated stress and positive affect. CONCLUSIONS: Participants' problem-solving and assistance pursuit coping styles were shown as important mediating factors for stress and subjective well-being, especially positive affect. These findings need to be considered when planning interventions and implementing strategies focusing on the psychosocial health of the improvement of police officers' well-being.

Evaluating real-time momentary stress and affect in police officers using a smartphone application.

BACKGROUND: Police officers work under stressful conditions, and the resulting occupational stress may impact their health and well-being through changes in positive affect (PA) and negative affect (NA). It is therefore important to assess officers' stress, PA, and NA while it is experienced. This study evaluates police officers' momentary stress and affect in real-world settings using an ecological momentary assessment, and examines the within-person (W) and between-person (B) factors that influence momentary affect. METHODS: Eighty-nine police officers were recruited in South Korea. Participants completed questionnaires about their momentary stress and affect using a smartphone application. The associations between momentary stress, momentary contextual environment, momentary PA, and momentary NA were examined using mixed modeling. RESULTS: Social overload (W: -.37), work discontent (W: -.45, B: -.73), social tension (W: -.79, B: -.67), and pressure to perform (W: -.29, B: -.49) were significantly associated with lower PA. Work overload (B: .33) and social isolation(W: .48, B: .31) were significantly associated with higher PA. Being with family (W: .71, B: .91) and friends (W: 1.89, B: 2.45) were significantly associated with higher PA. Being at home or other places away from the work place were significantly associated with higher PA (W: 1.01) and when patrolling or investigating were associated with lower PA (B: - 1.13). Lack of social recognition (W: 1.74, B: 2.33), work discontent (W: 1.59, B: 1.88), social tension (W: 1.74, B: 2.92), and pressure to perform (W: .78, B: 1.92) were significantly associated with higher NA. Being with colleagues (W: - 1.43), family (W: -1.38, B: - 2.66) and friends (W: -1.78, B: - 2.45) were associated with lower NA. CONCLUSIONS: Momentary within-person and between-person stress factors and contextual factors influenced police officers' momentary affect. These factors should be considered when developing interventions to mitigate stress and improve affect in police officers.

Stress and mood of adults with moyamoya disease: A cross-sectional study.

Moyamoya disease in adults is a chronic, progressive disorder characterized by fine collateral vessel networks in the brain. The disorder can lead to negative mood and stress, which, left unresolved, may increase adverse health outcomes. We conducted a cross-sectional survey to examine stress and mood of adults with moyamoya disease. Participants were recruited at a university hospital in Seoul, Korea. Data were collected through questionnaires and review of participants' electronic medical records. A total of 109 adults participated. Significant correlations were found between perceived stress, anxiety, and depression. Adults with moyamoya disease experience anxiety, depression, and stress related to the risk of cerebral hemorrhage or ischemia, similar to those with other cerebrovascular disease. If negative mood and stress were uncontrolled, those can cuase adverse health outcomes. Health professionals caring for people with moyamoya disease should carefully observe their stress and mood and develop interventions tailored to stages of disease to help them manage. The study results provide baseline information for understanding the level of, and the factors associated with, stress and mood.

Nurses' perceived barriers and educational needs for early mobilisation of critical ill patients.

BACKGROUND: Early mobilisation (EM) of critically ill patients is an evidence-based intervention designed to improve treatment outcomes and enhance the quality of life after intensive care. However, several barriers exist to its establishment in clinical practice. Thus, the objective of the present study was to identify barriers perceived by critical care nurses, corresponding educational needs, and provide useful information for program implementation in Korea. METHODS: A cross-sectional study was conducted from April to June 2017 using a structured, self-administered questionnaire that was completed by 151 critical care nurses from three tertiary hospitals and four secondary hospitals located in Seoul. The survey was designed to rate experiences with EM, identify educational experiences, and measure perceived barriers regarding attitudes, knowledge, behaviours, and educational needs. Data were analysed using descriptive statistics, t-tests, and analyses of variance. RESULTS: The mean number of perceived barriers was 3.13 ± 0.38 out of 5 on a Likert scale. Attitude-related barriers (3.25 ± 0.49) were higher than behaviour-related (3.21 ± 0.44) and knowledge-related (2.94 ± 0.59) barriers. The top five barrier items were high workload, patients' inability to exercise, lack of time, inappropriate nurse/patient ratio, and absence of relevant education. Educational needs for early mobilisation were rated 3.74 ± 0.78 out of 5. Educational items were prioritised as identifying potential problems in EM and possible solutions, related protocols and guidelines, and procedures for special conditions. CONCLUSIONS: The present study revealed that critical care nurses in Korea perceive various barriers to successfully implementing evidence-based EM interventions for critically ill patients, as well as the educational needs necessary to overcome such challenges. Accordingly, an educational program should be developed based on the educational needs revealed in the present study. In parallel, organisational efforts should also be made to meet environmental conditions.

Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review.

BACKGROUND: Mobile health (mHealth) has continuously been used as a method in behavioral research to improve self-management in patients with chronic diseases. However, the evidence of its effectiveness in chronic disease management in the adult population is still lacking. We conducted a systematic review to examine the effectiveness of mHealth interventions on process measures as well as health outcomes in randomized controlled trials (RCTs) to improve chronic disease management. METHODS: Relevant randomized controlled studies that were published between January 2005 and March 2016 were searched in six databases: PubMed, CINAHL, EMBASE, the Cochrane Library, PsycINFO, and Web of Science. The inclusion criteria were RCTs that conducted an intervention using mobile devices such as smartphones or tablets for adult patients with chronic diseases to examine disease management or health promotion. RESULTS: Of the 12 RCTs reviewed, 10 of the mHealth interventions demonstrated statistically significant improvement in some health outcomes. The most common features of mHealth systems used in the reviewed RCTs were real-time or regular basis symptom assessments, pre-programed reminders, or feedbacks tailored specifically to the data provided by participants via mHealth devices. Most studies developed their own mHealth systems including mobile apps. Training of mHealth systems was provided to participants in person or through paper-based instructions. None of the studies reported the relationship between health outcomes and patient engagement levels on the mHealth system. CONCLUSIONS: Findings from mHealth intervention studies for chronic disease management have shown promising aspects, particularly in improving self-management and some health outcomes.

Association of Electronic Health Literacy With Health-Promoting Behaviors in Patients With Type 2 Diabetes: A Cross-sectional Study.

It is important to know how well patients with type 2 diabetes understand and use health information available online in relation to health-promoting behaviors. Thus, the purposes of this study were to examine the association among electronic health literacy, perceived benefits, self-efficacy, and health-promoting behaviors in patients with type 2 diabetes, and to identify factors that affect health-promoting behaviors. A cross-sectional survey was conducted in a diabetes center in Seoul, South Korea. It was found that health-promoting behaviors were significantly correlated with electronic health literacy (r = 0.15, P < .05), perceived benefits (r = 0.15, P < .05), and self-efficacy (r = 0.47, P < .01). In the multiple linear regression analysis to identify the factors influencing health-promoting behaviors, electronic health literacy (ß = .13, P = .040) and self-efficacy (ß = .38, P < .001) were found to be significant factors, even after adjusting for general and disease-related characteristics. Strategies to improve health-promoting behaviors in patients with type 2 diabetes should focus on analyzing levels of electronic health literacy and deepening their understanding of online information accordingly.

Assessment of the Need to Integrate Academic Electronic Medical Records Into the Undergraduate Clinical Practicum: A Focus Group Interview.

As healthcare systems demand that nurses be competent in using electronic medical records for patient care, the integration of electronic medical records into nursing curricula has become necessary. The purpose of this study was to explore how students, new nurses, clinical instructors, and faculty perceive the integration of academic electronic medical records into the undergraduate clinical practicum. From January to February 2014, four focus group interviews with 18 participants were conducted based on purposive sampling. Content analysis was used on the unabridged transcripts to extract themes and develop meaningful categories. Three major themes and eight subthemes were revealed from the focus group interviews. The major themes were "electronic medical record as a learning tool for clinical practicum," "essential functions of academic electronic medical records," and "expected outcomes of academic electronic medical record." Participants expected academic electronic medical records to enhance students' nursing informatics competencies. The findings of this study can inform the process of developing academic electronic medical records for clinical practicum, which will then augment students' informatics competencies.