Evaluation of a Postdischarge Call System Using the Logic Model.

This mixed-method study was conducted to evaluate a postdischarge call program for congestive heart failure patients at a major teaching hospital in the southeastern United States. The program was implemented based on the premise that it would improve patient outcomes and overall quality of life, but it had never been evaluated for effectiveness. The Logic Model was used to evaluate the input of key staff members to determine whether the outputs and results of the program matched the expectations of the organization. Interviews, online surveys, reviews of existing patient outcome data, and reviews of publicly available program marketing materials were used to ascertain current program output. After analyzing both qualitative and quantitative data from the evaluation, recommendations were made to the organization to improve the effectiveness of the program.

Second Life simulation as a strategy to enhance decision-making in diabetes care: a case study.

AIMS AND OBJECTIVES: The case study evaluated the Second Life perceived usability and the decision-making of insulin administration via situational awareness at two different simulation freezes during Second Life simulation. BACKGROUND: Due to safety issues stemming from nursing knowledge deficits of insulin administration, the use of simulation via practice in a virtual immersive environment, Second Life was evaluated in a case study of practicing nurses. DESIGN: This case study used a single convenience group, post-test design. METHODS: Perceived usability was evaluated using the System Usability Scale. Evaluation of decision-making was evaluated via Situational Awareness Score at two simulation freezes in the Second Life simulation with practicing nurses (n = 12). RESULTS: Nurses with more years of practice reported difficulty in using Second Life. As age increased, the total Situational Awareness Score decreased. Day shift nurses were more likely to obtain a High Situational Awareness Score. CONCLUSIONS: Although usability was nearly obtained, virtual immersive environments for nurses has promise to provide practice in aiding clinical decision-making. RELEVANCE TO CLINICAL PRACTICE: Finding a new platform to allow all nurses to practice difficult clinical decisions is key. A virtual immersive environment, like Second Life, can provide simulation for nurses to practice making such difficult decisions.

Electronic Personal Health Record Use Among Nurses in the Nursing Informatics Community.

An electronic personal health record is a patient-centric tool that enables patients to securely access, manage, and share their health information with healthcare providers. It is presumed the nursing informatics community would be early adopters of electronic personal health record, yet no studies have been identified that examine the personal adoption of electronic personal health record's for their own healthcare. For this study, we sampled nurse members of the American Medical Informatics Association and the Healthcare Information and Management Systems Society with 183 responding. Multiple logistic regression analysis was used to identify those factors associated with electronic personal health record use. Overall, 72% were electronic personal health record users. Users tended to be older (aged >50 years), be more highly educated (72% master's or doctoral degrees), and hold positions as clinical informatics specialists or chief nursing informatics officers. Those whose healthcare providers used electronic health records were significantly more likely to use electronic personal health records (odds ratio, 5.99; 95% confidence interval, 1.40-25.61). Electronic personal health record users were significantly less concerned about privacy of health information online than nonusers (odds ratio, 0.32; 95% confidence interval, 0.14-0.70) adjusted for ethnicity, race, and practice region. Informatics nurses, with their patient-centered view of technology, are in prime position to influence development of electronic personal health records. Our findings can inform policy efforts to encourage informatics and other professional nursing groups to become leaders and users of electronic personal health record; such use could help them endorse and engage patients to use electronic personal health records. Having champions with expertise in and enthusiasm for the new technology can promote the adoptionof electronic personal health records among healthcare providers as well as their patients.

Electronic personal health record use among registered nurses.

INTRODUCTION: Nurses promote self-care and active participation of individuals in managing their health care, yet little is known about their own use of electronic personal health records (ePHRs). The purpose of this study was to examine factors associated with ePHR use by nurses for their own health management. METHODS: A total of 664 registered nurses working in 12 hospitals in the Maryland and Washington DC area participated in an online survey from December 2013 to January 2014. Multiple logistic regression models identified factors associated with ePHR use. RESULTS: More than a third (41%; 95% confidence interval [CI], 0.37-0.44) of the respondents were ePHR users. There was no variation between ePHR users and nonusers by demographic or job-related information. However, ePHR users were more likely to be active health care consumers (i.e., have a chronic medical condition and take prescribed medications; odds ratio [OR] = 1.64; 95% CI, 1.06-2.53) and have health care providers who used electronic health records for care (OR = 3.62; 95% CI, 2.45-5.36). CONCLUSIONS: Nurses were proactive in managing their chronic medical conditions and prescribed medication use with ePHRs. ePHR use by nurses can be facilitated by increasing use of electronic health records.

Creating Case Studies for Digital Health and Technology Competency in Nursing.

BACKGROUND: Nursing programs and their faculty must ensure that graduates have the informatics, digital health, and health care technologies competencies needed by health systems. PROBLEM: A gap exists in nursing faculty knowledge, skills, and abilities for incorporating informatics, digital health, and technologies across curricula because of low focus on this area in faculty development initiatives and rapid adoption and evolution of technologies in health care systems. APPROACH: The Nursing Knowledge Big Data Science initiative Education Subgroup used a process to create case studies for including informatics, digital health, and the concomitant clinical reasoning/critical thinking competencies across curricula. OUTCOMES: Three case study examples were created using the process. CONCLUSIONS: The process for creating case studies that incorporate required informatics, digital health, and health care technologies can be used by nursing educators for teaching across their curricula and to assess student competency.

Data analytics: making the most of input with strategic output.

In this department, Drs Murphy, Wilson, and Newhouse highlight hot topics in nursing outcomes, research, and evidence-based practice relevant to the nurse administrator. The goal is to discuss the practical implications for nurse leaders in diverse healthcare settings. Content includes evidence-based projects and decision making, locating measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demonstrate innovative approaches to organizational problems. In this article, the authors will describe data analytics and explore the potential for data analytics in meaningful use implementation to enhance executive decision making.

Improving care transitions through meaningful use stage 2: continuity of care document.

In this department, Drs Murphy, Wilson, and Newhouse highlight hot topics in nursing outcomes, research, and evidence-based practice relevant to the nurse administrator. The goal is to discuss the practical implications for nurse leaders in diverse healthcare settings. Content includes evidence-based projects and decision making, locating measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demon strate innovative approaches to organizational problems. In this article, the authors describe the elements of continuity of care documentation, how sharing information can improve the quality and safety of care transitions and the implications for nurse executives.

Medication reconciliation across the continuum of care: a meaningful use mandate.

In this department, the authors highlight hot topics in nursing outcomes, research, and evidence-based practice relevant to the nurse administrator. The goal is to discuss the practical implications for nurse leaders in diverse healthcare settings. Content includes evidence-based projects and decision making, locating measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demonstrate innovative approaches to organizational problems. In this article, Drs Wilson, Murphy, and Newhouse discuss use of information technology to support the process of medication reconciliation as mandated by Meaningful Use Stage 2 and The Joint Commission.

Meaningful use: intersections with evidence-based practice and outcomes.

In this department, Drs Newhouse and Wilson highlight hot topics in nursing outcomes, research, and evidence-based practice relevant to the nurse administrator. Content includes evidence-based projects and decision making, locating measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demonstrate innovative approaches to organizational problems. In this article, the authors describe the implications of meaningful use implementation to evidence-based practice and outcome measurement and discuss issues facing nurse executives in planning for these changes.

Patients' access to their health information: a meaningful-use mandate.

This department highlights topics in nursing outcomes, research, and evidence-based practice relevant to nurse administrators. In this article, the authors describe patient access to personal health information as it relates to the meaningful-use requirement, technologies that have been used to enhance patient engagement, and the nursing leadership implications.

Building health information technology capacity: they may come but will they use it?

Medical errors remain a major safety problem more than a decade after the Institute of Medicine reported 98 000 related deaths occur yearly in US hospitals. Medication errors account for one-third of these errors. Although medication reconciliation is an accepted care standard for patient safety, little evidence is available to make practice recommendations for primary care. The purpose of this study was to evaluate the effectiveness of using secure e-mail alerts within the reconciliation process on patient medication safety in clinics where electronic and personal health records are used. A nonexperimental, descriptive design with a convenience sample of 62 patients from two Veterans Health Administration clinics was used. Patients received secure e-mail instructing them to review their online medication list, update it based on home medications, and bring it to the appointment for discussion with their provider. A retrospective chart review was conducted examining changes made to medication lists in the electronic record after reconciliation. Data revealed the organization's adoption of secure e-mail did not guarantee its meaningful use by providers and patients, a clear barrier to implementing technology as an adjunct to care in context of complex clinical processes such as medication reconciliation. Lessons learned from the project's implementation are discussed.

Development of the Leapfrog Group's Bar Code Medication Administration Standard to Address Hospital Inpatient Medication Safety.

ABSTRACT: Medication errors are the most common type of error in hospitals and reflect a leading cause of avoidable harm to patients. Bar code medication administration (BCMA) systems are a technology designed to help intercept medication errors at the point of medication administration. This article describes the process of developing, testing, and refining a standard for BCMA adoption and use in U.S. hospitals, as measured through the Leapfrog Hospital Survey. Building on the published literature and an expert panel's collective experience in studying, implementing, and using BCMA systems, the expert panel recommended a standard with 4 key domains. Leapfrog's BCMA standard provides hospitals with a "how-to guide" on what best practice looks like for using BCMA to ensure safe medication administration at the bedside.

Structured terminologies in clinical information systems: implementation through collaboration.

The structure and content of the dialog with a clinical end-user is a critical aspect of clinical information system use, data capture and retrieval, and efficient and effective health care. This dialog is driven ultimately by embedded structures and processes that: a) provide functional models of clinical expression in support of professional practice, and b) determine how structured terminologies ought to populate these models. Based on diverse practical experience, this study identifies challenges to implementing structured clinical terminologies, categorizing them by both stakeholder group and application area. Collaboration across all stakeholders and across a wide range of application areas is identified as a key ingredient to successful terminology implementation and use.

Terminology use in electronic health records: basic principles.

Electronic health records (EHRs) are a cost-saving and environmentally friendly means for documenting patient care and improving patient safety, quality, and evidence-based practice. Standardized clinical classification systems and terminologies are essential ingredients of the EHR. Their selection must be driven by a clear understanding of requirements for their use and application. This article describes the principle uses of clinical information and motives for consistency in practice, and provides a distinction between classification systems and reference terminologies for clinical settings.

A comparative ethnography of nutrition interventions: Structural violence and the industrialisation of agrifood systems in the Caribbean and the Pacific.

Public health interventions that involve strategies to re-localise food fail in part because they pay insufficient attention to the global history of industrial food and agriculture. In this paper we use the method of comparative ethnography and the concept of structural violence to illustrate how historical and geographical patterns related to colonialism and industrialisation (e.g. agrarian change, power relations and trade dependencies) hinder efforts to address diet-related non-communicable diseases on two small islands. We find comparative ethnography provides a useful framework for cross-country analysis of public health programmes that can complement quantitative analysis. At the same time, the concept of structural violence enables us to make sense of qualitative material and link the failure of such programmes to wider historical and geographical processes. We use ethnographic research carried out from April to August 2013 and from June to July 2014 in Trinidad (with follow-up online interviews in 2018) and in Nauru from February to May 2010 and August 2010 to February 2011. Our island case studies share commonalities that point to similar experiences of colonialism and industrialisation and comparable health-related challenges faced in everyday life.

Nursing resource considerations for implementing an electronic documentation system.

Implementation of an or management information system (ORMIS) requires a significant commitment of human resources. The experiences of the personnel at The Johns Hopkins Hospital, Baltimore, MD, as they transitioned to using a single, unified, computerized ORMIS are detailed in this article. Included are discussions of the nursing resources involved in the process, the lessons learned, and the work that remains to be completed for the hospital to fully utilize the system.

Nursing, Professional Curiosity and Big Data CoCreating eHealth.

This paper describes work that has taken place over the past three years in the form of an annual deep dive study track within a national conference setting. The work explores the changing influence that big data, and in particular population and social determinants of health data, makes upon the generation of co-created eHealth within a nursing domain. Working with delegates, many of whom returned year after year, the paper reports the discussion themes and ideas that evolved over time. The paper is presented as an example of connected reasoning and personal development by all those involved and is offered as a distributed think tank for further discussion and debate.

Population health: a nursing action plan.

The passage of the Affordable Care Act shifted the focus of health care from individual, patient specific, episodic care, towards health management of groups of people with an emphasis on primary and preventive care. Population health management assists to attain and maintain health while improving quality and lowering costs. The recent Catalyst for Change report creates an urgent call for harnessing the power of nurses-in our communities, schools, businesses, homes and hospitals-to build capacity for population health. Informatics Nurse Specialists are prepared to bridge roles across practice, research, education, and policy to support this call. Each year, the AMIA Nursing Informatics Working Group convenes an expert panel to reflect on the "hot topics" of interest to nursing. Not surprisingly, the 2017 topic was on the current state and challenges of population health. The following summary reflects the panel's perspectives and recommendations for action.

A Facebook-Based Obesity Prevention Program for Korean American Adolescents: Usability Evaluation.

INTRODUCTION: Adolescent obesity is one of the most serious global public health challenges. Social networking sites are currently popular among adolescents. Therefore, the obesity prevention program for Korean American adolescents was developed on the most popular social networking site, Facebook. The purpose of this study was to evaluate the usability of a culturally tailored Facebook-based obesity prevention program for Korean American adolescents (Healthy Teens). METHOD: An explorative descriptive design of usability testing was used. Usability testing employing one-on-one observation, the think-aloud method, audio taping, screen activity capture, and surveys was performed. Twenty participants were recruited from two Korean language schools (mean age, 15.40 ± 1.50 years). Recruitment and user testing was performed between February and April 2014. Content analysis, using the inductive coding approach, was performed by three coders to analyze transcriptions. Descriptive statistics were used to analyze quantitative data including demographic characteristics, perceived usability, eHealth literacy, and health behaviors. RESULTS: Testing revealed several usability issues in content, appearance, and navigation. Participants' comments regarding content were positive. Although the Facebook platform provided limited flexibility with respect to building the site, participants described the program's appearance as appropriate. Most participants did not experience difficulty in navigating the program. DISCUSSION: Our preliminary findings indicated that participants perceived the Healthy Teens program as usable and useful. This program could be used as a robust platform for the delivery of health education to adolescents. Further research is required to assess the effects of Facebook-based programs on adolescent obesity prevention.