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AIM: This study aimed to examine the psychological symptoms of distress among nurses in relation to their intention to leave. DESIGN: This study was a secondary data analysis of a cross-sectional survey collected between November 2020 and March 2021. METHODS: Chi-square was used to examine the associations between the demographic characteristics and intention to leave and psychological distress symptoms-feeling depressed, anxious and worried. Multiple linear regression analyses were performed to examine if work settings, position (staff, charge, administrators, educators/researchers and advanced practice registered nurses) and years of experience were associated with psychological distress and intention to leave. A mediation analysis examined if psychological distress mediated the relationship between years of experience and intention to leave. RESULTS: Overall, psychological distress was significantly positively associated with intention to leave and negatively associated with years of experience. Nurses with less than 2 years of experience had increased psychological distress, while nurses with >25 years of experience had decreased psychological distress. Both groups of nurses had increased intention to leave compared to those with 16-25 years of experience. Psychological distress partially mediated intention to leave in nurses with less than 2 years of experience and more so among nurses with >25 years of experience. CONCLUSIONS: This study suggests that nurses encounter psychological distress symptoms, such as feeling anxious, depressed and worried, that contribute to an increased intention to leave. Among the workplace locations, nurses practicing in nursing homes had the highest intention to leave. IMPACT: The study emphasizes that organizations need to focus on mitigating distress across all levels of nurses to promote retention efforts and intention to stay. REPORTING METHOD: The authors adhered to the STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient contribution. Completion of the survey in the original study (NWWS) implied consent from the participating nurses.
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Patient education and self-management are essential for patients with liver cirrhosis. Based on Fisher and Fisher's Information-Motivation-Behavior Skills model, a Cirrhosis Care App was developed to support the education and self-management of these patients. To evaluate the effectiveness of the application, a randomized controlled trial was conducted with patients having liver cirrhosis who were being followed up in the outpatient area of ââa medical center in Taiwan. The experimental group used the app for 1 month, whereas a control group continued to receive conventional patient education. A pretest and posttest questionnaire was used to evaluate the app's effectiveness in improving the knowledge and practice of self-care. In addition, a questionnaire was developed based on the Technology Acceptance Model to understand satisfaction with the app. Results showed that following the implementation of the Cirrhosis Care App, patients' self-care knowledge and ability to promote self-care practice improved. User satisfaction with the app was measured and reflected in its frequency of use. This study confirmed that the Cirrhosis Care App, based on the Information-Motivation-Behavior Skills model, can improve patient knowledge and self-care practice and be actively promoted to benefit patients with cirrhosis.
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As a result of rapid advancements in health information technology, uploading health-related information and records onto an electronic health record system has become a common practice. Photographs of patients' wounds have been uploaded electronically, but widespread acceptance by nurses has been prevented owing to issues such as file size and equipment. This research explores the attitude and satisfaction toward using an electronic health record for uploading wound photos. Through the integration of the Technology Acceptance Model, Information System Success Model, and other study results, this research aims to explore the impact of the following variables: system quality, information quality, perceived usefulness, perceived ease of use, user attitude, user satisfaction, and net benefits. We also tested nurses' understanding regarding the process of taking photographs and explored the photograph quality and the photography uploading rates. The results revealed that users were satisfied with the wound-photography system, but some believed that the system stability, processing time, and image resolution should be improved. In addition, more than 80% of the nurses correctly answered photo-taking questions, the study photos reached 70% of the quality standards, and the average uploading rate was 74%. The results could serve as guidelines for system design in the future.
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Registros Eletrônicos de Saúde , Fotografação , Ferimentos e Lesões , Humanos , Atitude do Pessoal de Saúde , Adulto , Feminino , Masculino , Inquéritos e Questionários , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/psicologiaRESUMO
Technological developments and nursing shortages have become global trends. To solve the problem of shortage of healthcare professionals, technology may be used as a backup. Nurses constitute the largest working group in the healthcare system. Therefore, nurses are very important to the success of implementing digitization in hospitals. This cross-sectional study used the characteristics and adoption roles of innovation diffusion theory to understand technology use within the organization. Data were collected through structured questionnaires and open-ended questions from March 21 to May 31, 2022, in two hospitals in Taiwan. In total, 159 nurses agreed to participate in the study. The results of this study revealed that observability, simplicity, advantage, trialability, and compatibility positively improved the acceptance of digital nursing technology. In the distribution of users' innovative roles, early adopters had a significant impact on innovation characteristics and technology acceptance. Nurses in acute and critical care units perceived a greater comparative advantage and trial availability of digital nursing technology use than did those in general wards and outpatient clinics. In addition, based on user opinions and suggestions, the development of smart healthcare and the use of digital technology are expected to improve the quality of nursing care.
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The nursing charge system for inpatient accounting has been utilized in healthcare institutions for years. However, the level of its effectiveness in meeting the needs of nursing services, including further development, has not been systematically evaluated. A cross-sectional study based in Delone and McLean's information system success model was applied to explore the level of effective nursing charge system usage across the five dimensions of system quality, information quality, service quality, user satisfaction, and net benefits. We conducted a survey of the inpatient units of a medical center in Taiwan from June 23, 2021, to July 23, 2021. A total of 214 valid questionnaires were collected. Using a 5-point Likert scale, the dimension with the highest score was information quality (3.71), followed by service quality (3.37), user satisfaction (3.36), net benefits (3.31), and system quality (3.23). Older nurses ( r = -0.176) and those with more clinical experience ( r = -0.151) viewed the nursing charge system as having less information quality. The comfort level with using the computer was positively associated with system quality ( r = 0.396), information quality ( r = 0.378), service quality ( r = 0.275), user satisfaction ( r = 0.417), and net benefits ( r = 0.355). The opinions of nurses are vital. User feedback and advice should be investigated regularly to achieve system optimization.
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Recursos Humanos de Enfermagem Hospitalar , Humanos , Estudos Transversais , Taiwan , Inquéritos e Questionários , Feminino , Adulto , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem Hospitalar/psicologiaRESUMO
Nurse leaders face immense organizational pressures exacerbating their distress, which has not been prioritized as much as frontline nurses. This review synthesized the literature to examine theoretical models, measures, contributing factors, outcomes, and coping strategies related to moral distress in nurse leaders. PubMed, Embase, CINAHL, and PsycINFO were searched, and 15 articles-2 quantitative and 13 qualitative studies were extracted. The scoping review identified one study using a theoretical model and two measures-the ethical dilemmas questionnaire and the Brazilian moral distress scale. Contributing factors of moral distress include internal and organizational constraints, increased workload, and lack of support impacting physical and emotional well-being and intention to quit. This review did not yield any intervention studies emphasizing the need for research to identify specific predictors of moral distress and examine their relationship to nurse leader retention, so organizations can explore targeted interventions to promote coping and mitigate distress.
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Princípios Morais , Estresse Psicológico , Humanos , Estresse Psicológico/psicologia , Adaptação Psicológica , Emoções , Inquéritos e QuestionáriosRESUMO
The alarm management of physiological monitoring systems is a key responsibility of critical care nurses. However, the high numbers of false and nonactionable (true but clinically irrelevant) alarms cause distractions to healthcare professionals, interruptions to nursing workflow, and ignoring of crucial tasks. Therefore, understanding how nurses manage large amounts of alarms in their daily work could provide a direction to design interventions to prevent adverse patient care effects. A qualitative design with focus group interviews was conducted with 37 nurses in Taiwan. Content analysis was performed to analyze the interview data, and four main themes were derived: (1) the foundation stone of critical care nursing practice; (2) a trajectory adaptation of alarms management; (3) adverse impacts on the quality of care and patient safety; and (4) a hope for multimodal learning alternatives and wireless technology. Nurses manage alarm parameter settings influenced not only by their knowledge and skills of patient care, but also in accordance with the three dimensions of technology, human, and organization evaluation framework. Customized alarm management training alternatives, patient-centered care values, and application of wireless technology are the suggested approaches to enhance nursing care and minimize the risk of adverse events.
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Alarmes Clínicos , Enfermagem de Cuidados Críticos , Enfermeiras e Enfermeiros , Cuidados Críticos/métodos , Enfermagem de Cuidados Críticos/métodos , Humanos , Monitorização Fisiológica/métodosRESUMO
The National Academy of Medicine's The Future of Nursing 2020-2030 recommends the expansion of the role of nurses throughout the continuum of health care in an effort to improve the health of the nation while decreasing costs. To accomplish this goal, nursing students and nurses must be well prepared to perform at their highest capacity to meet health care demands. Currently the U.S. health care delivery system is undergoing rapid changes that affect approaches to delivering care services. These changes call for education and practice reforms in nursing. This article introduces an innovative academic-practice partnership model (the University of Maryland Nursing [UMNursing] Care Coordination Implementation Collaborative), including its background, development, and blueprint for a large implementation project. The implementation model integrates nursing education and practice in areas of care co-ordination and population health, which have a significant impact on the Triple Aim of health. The project also uniquely integrates education, practice, and research, with the ultimate outcome of higher quality patient care.
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Centros Médicos Acadêmicos , Continuidade da Assistência ao Paciente , Comportamento Cooperativo , Atenção à Saúde , Saúde da População , Parcerias Público-Privadas , Humanos , Qualidade da Assistência à SaúdeRESUMO
Vital signs are central to the assessment of physiologic functions of patients and must be included in the electronic health record. The purpose of this retrospective and cross-sectional design study was to evaluate use of-and satisfaction with-automated physiological monitoring systems. Usage data from a hospital database were analyzed 3, 6, and 12 months after implementation of the automated system (June 2018 to May 2019). In addition, questionnaires were completed by 168 nurses, and 20 nurses were interviewed between August/September 2020 and October/November 2020, respectively. Results revealed that usage frequency of automated physiological monitoring devices increased steadily with user familiarity. Although respondents indicated general satisfaction with the devices, system downtime, sufficiency of the battery charge, and data transmission speed were identified as needing correction to smooth workflow and boost work efficiency. Although most interviewees considered devices easy to use, some mentioned transmission speed of the gateway, scanner sensitivity, and accuracy of the ear thermometer as needing improvement. For nurses to use automated physiological monitoring devices fully, a user-friendly design in functions and features is vital, and in-service training and a streamlined workflow are recommended to facilitate technology adoption.
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Satisfação Pessoal , Sinais Vitais , Estudos Transversais , Humanos , Monitorização Fisiológica/métodos , Estudos RetrospectivosRESUMO
Clinical decision support systems provide empirical guidance to improve the quality of nursing care. This study aimed to evaluate the outcomes of implementation of decision support functions into the preventive care system as regards nurses' acceptance of technology, documentation completeness, and incidence of hospital-acquired pressure injury. The researchers performed data collection in a regional hospital in northern Taiwan. The study used the Davis Science and Technology Acceptance Model scale to investigate nurses' technology acceptance before and after the introduction of a clinical decision support system and compared documentation compliance of preventive records with the incidence of hospital-acquired pressure injuries. Results showed that nurses' acceptance of the technology was significantly improved, and the completion rate of the pressure injury preventive care record significantly increased from 88.9% to 99.9%. Meanwhile, the incidence of hospital-acquired pressure injury decreased significantly from 0.057% to 0.021%. Therefore, it was concluded that the clinical decision support system provides evidenced-based support to nurses and is effective in identifying patient-specific prevention nursing plans of care.
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Sistemas de Apoio a Decisões Clínicas , Documentação , Enfermagem Baseada em Evidências , Planejamento de Assistência ao Paciente , Úlcera por Pressão/prevenção & controle , Difusão de Inovações , Humanos , Úlcera por Pressão/epidemiologia , Reprodutibilidade dos Testes , Taiwan/epidemiologiaRESUMO
AIMS AND OBJECTIVES: To explore factors affecting self-management experiences of patients with chronic hepatitis B within their social and cultural environments. BACKGROUND: Many cases of hepatitis B are not detected until they are in end-stage liver disease. Despite an increasing trend of indicating a lack of health awareness as the reason, studies have rarely referred to the personal, social and cultural environmental constraints from patients' perspectives. DESIGN: A descriptive qualitative study. METHODS: Forty-seven adults diagnosed with chronic hepatitis B were interviewed in a private area of a hospital clinic in Taiwan in 2018. Four open-ended questions relating to care self-management included the following: disease detection; disease control; preventive care; and perceptions of screening and follow-ups. Data were examined using content analysis. This study also adhered to the consolidated COREQ guidelines. RESULTS: Five main themes emerged: personal experiences, awareness of occupational health, the availability of conventional treatment, cultural beliefs about health care and family roles. Findings of note were that some participants became aware that they had never known the difference between follow-up for hepatitis B and regular adult/labourer health checks due to a lack of information within their living environment. Many participants added alternative treatments to their self-management strategies and others frequently ignored follow-up appointments because of different cultural health beliefs. CONCLUSIONS: Patients' disease self-management perceptions are driven by dynamic influences suggesting that development of policies integrating personal, family, social and cultural environmental factors could enhance individual screening and subsequent health behaviours of patients with chronic hepatitis B. RELEVANCE TO PRACTICE: Adding person-centred case management of hepatitis B could enhance patients' adherence to follow-up. Attention should be given to increasing provider awareness of the influence of their own attitude and communication on patients' participation in self-management.
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Conhecimentos, Atitudes e Prática em Saúde , Hepatite B Crônica/terapia , Autogestão/psicologia , Adulto , Feminino , Hepatite B Crônica/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , TaiwanRESUMO
When a medication administration error occurs, patient safety is endangered. Barcode medication administration system usage has been implemented to reduce medication errors. The purpose of this study was to evaluate barcode medication administration system usage outcomes. A survey based on DeLone and McLean's model of information systems success was utilized. The questionnaire, composed of 27 items, explored system quality, information quality, service quality, user satisfaction, and usage benefits. It was completed by 232 nurses. User satisfaction received the highest average score, and quality of information was the most critical factor related to this result (r = 0.83, P < .01). Medication errors occurring before and after barcode medication administration use were collected, and the reasons for errors related to work process were explored. Medication errors decreased from 405 at preimplementation to 314 at postimplementation (t = 77.62, P < .001). The main reason for medication errors related to work process was "not following the standard procedure," followed by "other factors." While technology is deployed to support individual practice, organizational elements also remain important to technology adoption.
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Processamento Eletrônico de Dados/normas , Erros de Medicação/estatística & dados numéricos , Sistemas de Medicação no Hospital/organização & administração , Adulto , Atenção à Saúde , Feminino , Humanos , Masculino , Erros de Medicação/prevenção & controle , Segurança do Paciente , Garantia da Qualidade dos Cuidados de Saúde , Inquéritos e QuestionáriosRESUMO
The incidence of diabetes, a common chronic disease among older adults, is increasing annually. The lack of blood glucose regulation can result in severe diabetes-related complications and substantial healthcare costs, making self-care programs specific to this population especially important. Combined with reduced numbers of healthcare professionals, the integration of healthcare and information technology and the older adults' adoption of telehealth services have become increasingly important. This study used a qualitative method to interview 18 older study participants who used a telehealth service. Subject perceptions and suggestions regarding using such a service for diabetes management were investigated. Content analysis was used to examine the interview data and determine the older patients' acceptance and perceived benefits of telehealth service. Four main themes emerged: (1) initial trial encouragement from the doctors, nurses, and financial incentives; (2) enhanced self-management capability through continuous device use for better outcomes; (3) ambivalent feelings regarding dependence on others for problem solving; and (4) consideration for continual technology use for an uncertain future. These results serve as a reference for promoting, assessing, and verifying telehealth models for older patients with diabetes.
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Diabetes Mellitus/terapia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Satisfação do Paciente , Avaliação da Tecnologia Biomédica/métodos , Telemedicina/normas , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus/psicologia , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Taiwan , Telemedicina/métodosRESUMO
In the United States, home care clinicians often start the episode of care devoid of relevant fall-risk information. By collecting and analyzing qualitative data from 30 clinicians in one home health agency, this case study aimed to understand how the currently adopted information technology solutions supported the clinicians' fall-risk management (FRM) information domains, and explored opportunities to adopt other solutions to better support FRM. The currently adopted electronic health record system and fall-reporting application served only some information domains with a limited capacity. Substantial improvement in addressing the FRM information domains is possible by effectively modifying the existing solutions and purposefully adopting new solutions.
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Acidentes por Quedas/prevenção & controle , Serviços de Assistência Domiciliar/estatística & dados numéricos , Informática Médica/métodos , Gestão de Riscos/métodos , Acidentes por Quedas/estatística & dados numéricos , Adulto , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Grupos Focais , Humanos , Masculino , Informática Médica/tendências , Mid-Atlantic Region , Pessoa de Meia-Idade , Pesquisa Qualitativa , Estados UnidosRESUMO
The electronic health record is a key component of healthcare information systems. Currently, numerous hospitals have adopted electronic health records to replace paper-based records to document care processes and improve care quality. Integrating healthcare information system into traditional nursing daily operations requires time and effort for nurses to become familiarized with this new technology. In the stages of electronic health record implementation, smooth adoption can streamline clinical nursing activities. In order to explore the adoption process, a descriptive qualitative study design and focus group interviews were conducted 3 months after and 2 years after electronic health record system implementation (system aborted 1 year in between) in one hospital located in southern Taiwan. Content analysis was performed to analyze the interview data, and six main themes were derived, in the first stage: (1) liability, work stress, and anticipation for electronic health record; (2) slow network speed, user-unfriendly design for learning process; (3) insufficient information technology/organization support; on the second stage: (4) getting used to electronic health record and further system requirements, (5) benefits of electronic health record in time saving and documentation, (6) unrealistic information technology competence expectation and future use. It concluded that user-friendly design and support by informatics technology and manpower backup would facilitate this adoption process as well.
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Atitude do Pessoal de Saúde , Registros Eletrônicos de Saúde/estatística & dados numéricos , Recursos Humanos de Enfermagem Hospitalar/psicologia , Adulto , Feminino , Grupos Focais , Humanos , Informática em Enfermagem , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Pesquisa Qualitativa , Taiwan , Adulto JovemRESUMO
Electronic portfolios can be used to record user performance and achievements. Currently, clinical learning systems and in-service education systems lack integration of nurses' clinical performance records with their education or training outcomes. For nurses with less than 2 years' work experience (nursing postgraduate year), use of an electronic portfolio is essential. This study aimed to assess the requirements of using electronic portfolios in continuing nursing education for clinical practices. Fifteen nurses were recruited using a qualitative purposive sampling approach between April 2013 and May 2013. After obtaining participants' consent, data were collected in a conference room of the study hospital by one-on-one semistructured in-depth interviews. Through data analyses, the following five main themes related to electronic learning portfolios were identified: instant access to in-service education information, computerized nursing postgraduate year training manual, diversity of system functions and interface designs, need for sufficient computers, and protection of personal documents. Because electronic portfolios are beginning to be used in clinical settings, a well-designed education information system not only can meet the needs of nurses but also can facilitate their learning progress.
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Competência Clínica/normas , Capacitação em Serviço/métodos , Informática Médica , Recursos Humanos de Enfermagem Hospitalar/educação , Atitude do Pessoal de Saúde , Atitude Frente aos Computadores , Documentação , Educação Continuada em Enfermagem/métodos , Feminino , Humanos , Entrevistas como Assunto , Aprendizagem , Masculino , Pesquisa Qualitativa , TaiwanRESUMO
The increasing complexity of healthcare systems is driving changes in the academic preparation of nurse leaders. The number of doctorate of nursing practice programs has increased. Leaders in the Council on Graduate Education for Administration in Nursing (CGEAN) were interested in learning how graduate nursing leadership programs have responded. An electronic survey was administered to CGEAN members to understand the emphasis of their graduate curricula. Results demonstrate good alignment between academic programs, American Association of College of Nursing essentials, and American Organization of Nurse Executives competencies.
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Currículo , Educação de Pós-Graduação em Enfermagem/normas , Educação de Pós-Graduação em Enfermagem/tendências , Liderança , Enfermeiros Administradores/educação , Sociedades de Enfermagem/normas , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados UnidosRESUMO
Supported by visionary leadership, a unique strategic-academic partnership model was established with grant support between the University of Maryland School of Nursing, Baltimore, and 13 Maryland hospitals to prepare hospital-based staff nurses as clinical instructors. Participating hospitals gained masters' degree-prepared nurses able to lead the achievement of clinical and organizational goals. The schools of nursing gained additional access to clinical education resources to enable increased undergraduate enrollment.
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Bacharelado em Enfermagem/organização & administração , Modelos Organizacionais , Papel do Profissional de Enfermagem , Prática do Docente de Enfermagem/organização & administração , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Parcerias Público-Privadas , Escolas de Enfermagem/organização & administração , Baltimore , Humanos , Relações Interinstitucionais , Maryland , Modelos Educacionais , Objetivos Organizacionais , Desenvolvimento de ProgramasRESUMO
Diabetes is a metabolic disorder that, if not treated promptly and appropriately, can cause complex health complications and mortality. Care models that apply technology, such as telehealth, may be useful in working with diabetes patients. The development and application of wireless communication telehealth have significantly affected healthcare in recent years. Thus, the purpose of this study was to evaluate diabetic patients' use of a telehealth program by using questionnaire survey and laboratory data results. A quantitative study, 1-group pretest-posttest design, was conducted. This study recruited 20 diabetic patients who received telehealth service to measure their glucose, heart rate, and blood pressure, with data uploaded back to the hospital daily. A questionnaire survey was conducted in May 2012 and between August and January 2013 with 20 participants. The test values (blood pressure, heart rate, and blood glucose) of subjects were obtained from the hospital telecare platform and the outpatient monthly reporting system. Study findings showed an overall satisfaction rating of 91% by telehealth participants. Nonparametric statistical analysis demonstrated a significant difference (P < .01) in participants' glycosylated hemoglobin and resultant effective control. These findings indicated that participants accepted this care model, and telehealth could improve participants' glucose control.
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Diabetes Mellitus Tipo 2/terapia , Telemedicina/estatística & dados numéricos , Idoso , Tecnologia Biomédica , Glicemia/análise , Administração de Caso , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Feminino , Hemoglobinas Glicadas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Avaliação de Programas e Projetos de Saúde , Autocuidado , Inquéritos e Questionários , Telemedicina/métodosRESUMO
Advances in science, technology, and healthcare have contributed to the global growth of an aging population. With a concomitant decline in birth rate, the increasing need for elder care cannot be met effectively by traditional care models as fewer caregivers are available. This study adopted a qualitative research method, and 13 nurses who have experiences in telecare were interviewed in a regional hospital in northern Taiwan. Data were content analyzed to explore nurses' perceptions of telecare services. Five major themes were identified: (1) provision of individualized care, (2) increasing job requirements and stress, (3) working with a collaborative care model, (4) understanding concerns of the elderly, and (5) foreseeing future challenges. The participants identified the advantages of telecare services for the elderly and recognized a new opportunity for health management in the future population and social changes. The use of technology to provide telecare may offer an effective supplement for elder care services.