The impact of COVID-19 on the psychosocial well-being of older adults: A literature review.

INTRODUCTION: The novel coronavirus SARS-CoV2 (COVID-19) was declared a global pandemic in 2020 with the greatest risk to older adults. Prolonged restrictions and isolation threaten the social and emotional welfare of vulnerable groups with concerns focused on the long-term impact of this pandemic on the health and well-being of aging populations. PURPOSE: Using the Socioemotional Selectivity Theory (STT) as a conceptual framework, the purpose of this literature review was to explore the impact of COVID-19 on the psychological and social well-being of older adults. METHODS: Numerous academic and healthcare-related databases were searched to yield 24 relevant primary research articles, published during the pandemic (2020-2022), for analysis. RESULTS/CONCLUSIONS: Overall results indicated the pandemic had a significant negative affect on the psychological and social well-being of older adults to include those with cognitive impairments and dementia despite perceptions of reduced awareness. There were significant differences between age groups with older adults reporting greater emotional stability and coping skills than younger cohorts. Although supportive services and the use of technology-enhanced well-being these resources were reduced during the pandemic due to lack of trained staff, funding, and other socioeconomic or political barriers. The SST proposes that feelings of satisfaction, a sense of belonging, and purpose are important for emotional well-being but the pandemic challenged these goals and, for many, resulted in stress, anxiety, and depression. CLINICAL RELEVANCE: Healthcare providers and policymakers need to be aware of the negative consequences triggered by the prolonged pandemic and take measures to provide services that support the psychosocial well-being of older adults.

Understanding Digital Health Technologies Using Mind Maps.

PURPOSE: The purpose of this project was to explore digital health technologies in the healthcare environment through the use of concept and mind mapping tools in a graduate level informatics practicum course. DESIGN: This descriptive course evaluation project was conducted at a large university school of nursing during the 2019-2020 academic year and included a convenience sample of 163 doctor of nursing practice students. METHODS: Students completed four major deliverables exploring digital health technologies and data sources using mind maps. Project goals were evaluated using detailed rubrics and data from a course evaluation questionnaire (CEQ) then analyzed using descriptive statistics. Comments from the CEQ and reflection documents were reviewed for themes and validated by two experts. FINDINGS: The variety and creativity of the mind maps along with student comments indicated their ability to apply critical thinking skills to the specific content and technologies being examined. Overall CEQ mean scores were high (M = 4.35), indicating that the mind mapping deliverables were logical, relevant, appropriate, and meaningful to learning. CONCLUSIONS: Nurse educators and healthcare professionals should consider using mind mapping techniques because this venue allows for expanded understanding of the complexities of the healthcare environment and integration of related digital health technologies. CLINICAL RELEVANCE: The recent pandemic highlighted the necessity for new technologies to continue providing patient care services. Mind maps are a fast and economical tool for understanding and prioritizing the needs of an organization as well as a unique teaching strategy to promote critical thinking and sharing of ideas related to digital health technologies.

Impact of a Prescription Drug Monitoring Program on Health Information Exchange Utilization, Prescribing Behaviors, and Care Coordination in an Emergency Department.

Timely access to patient data is critical in patient care. The utilization of health information exchange and prescription drug monitoring programs can make pertinent data readily accessible for emergency department providers to coordinate care. A quasi-experimental preintervention-postintervention design, with 62 providers and 53 554 emergency department visits linked to a health information exchange and prescription drug monitoring program, was used to evaluate rates for utilization, laboratory/imaging orders, narcotic prescribing and readmission. Health information exchange utilization increased significantly after the drug monitoring program was implemented (mean = 119.33 to mean = 231.33, t2 = -15.79, P < .001). There was no significant effect postprescription drug monitoring program for laboratory/imaging orders or narcotics at discharge, although narcotic orders during emergency visits increased (F1,23 = 7.953, P = .010), which may suggest the data confirmed the immediate need to control acute or chronic conditions. In addition, readmission rates decreased from 14.64% to 12.58%. Through streamlining processes, health information exchange and prescription drug monitoring program usage were increased, which can improve care. As organizations promote interoperability of health information, the nurse informaticist plays a significant role in managing access to systems that can assist all providers in coordinating care.

Facilitating Adoption of an Electronic Documentation System.

Best practice recommends the integration of clinical documentation into the hospital electronic health record to support safe, efficient, and timely patient care. A major barrier to successful adoption and optimization of computerized documentation systems is user satisfaction. The purpose of this descriptive, performance improvement initiative was to implement and evaluate user satisfaction with an electronic documentation system to facilitate successful adoption. The Clinical Procedure Flowsheets application was implemented in a geriatric extended care unit of a large healthcare system. Rogers' Diffusion of Innovation and Davis' Technology Acceptance Model were used to guide system adoption and improve user experience of the innovation. The Perceived Usefulness and Perceived Ease of Use questionnaire was distributed to 24 nursing staff working in the unit 9 weeks after implementation. Results indicated that respondents perceived the Clinical Procedure Flowsheets as easy to use and useful in accomplishing their documentation tasks. The overall mean satisfaction score of 72.17 (SD, 12.13) implied a strong level of user acceptance. The positive perception of the nursing staff in the geriatric extended care unit suggests a high probability of system use that can enhance the documentation of patient care. Further research is recommended to evaluate factors related to system adoption and user satisfaction.

Perceived sense of community, cognitive engagement, and learning outcomes among undergraduate nursing students enrolled in an internet-based learning course.

Internet-based learning environments are a popular instructional delivery method that provides flexibility, easy access, convenience, and self-directed learning. There is concern that Internet-based learning creates a loss of community and lacks the power to fully engage the student, leading to negative learning outcomes. This descriptive, correlational study evaluated the relationship among a perceived sense of community, cognitive engagement, and learner outcomes among undergraduate nursing students enrolled in an Internet-based learning course. A convenience sample of 96 undergraduate nursing students enrolled in an online health informatics course participated in this study. Findings indicated a moderate sense of community and a positive relationship between student engagement and learning outcomes. A variety of group activities such as wikis, blogs, and discussion board were helpful in promoting a sense of community, but students emphasized a desire for more faculty feedback and interaction. Nursing is a collaborative profession where community building is a critical skill; therefore, innovative teaching/learning techniques that promote a sense of belonging and community are needed to improve learning outcomes, prepare students to provide quality patient care, and interact with an interprofessional team.

The informatics nurse specialist role in electronic health record usability evaluation.

Health information technology is revolutionizing the way we interact with health-related data. One example of this can be seen in the rising adoption rates of electronic health records by healthcare providers. Nursing plays a vital role in electronic health record adoption, not only because of their numbers but also their intimate understanding of workflow. The success of an electronic health record also relies on how usable the software is for clinicians, and a thorough usability evaluation is needed before implementing a system within an organization. Not all nurses have the knowledge and skills to perform extensive usability testing; therefore, the informatics nurse specialist plays a critical role in the process. This article will discuss core usability principles, provide a framework for applying these concepts, and explore the role of the informatics nurse specialist in electronic health record evaluation. Health information technology is fundamentally changing the clinical practice environment, and many nurses are seeking leadership positions in the field of informatics. As technology and software become more sophisticated, usability principles must be used under theguidance of the informatics nurse specialist to provide a relevant, robust, and well-designed electronic health record to address the needs of the busy clinician.

Depression is associated with increased mortality 10 years after coronary artery bypass surgery.

OBJECTIVE: To determine if depression is independently associated with cardiac and all-cause mortality 10 years after coronary artery bypass graft (CABG) surgery. Although many studies have examined the relationship of depression and mortality in patients with myocardial infarction, there is less understanding of the relationship between depression and long-term mortality after CABG surgery. METHODS: In a prospective study, we collected data on 309 patients hospitalized after CABG surgery. Before discharge, patients were assessed for depression using the Diagnostic Interview Schedule and the Beck Depression Inventory (BDI). Subsequently, mortality data were obtained from the National Center for Health Statistics and supplemented with phone interviews. RESULTS: Sixty-three (20%) patients met modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for major depressive disorder (MDD) and 87 (28%) had BDI scores of ≥10, indicating elevated depressive symptoms. Time-to-event or last follow-up phone contact ranged from 9 days to 11.5 years (median, 9.3 years). The overall mortality rate was 37.9% (117 of 309), with 20.1% (62 of 309) due to cardiac causes. Cox proportional hazard modeling showed that age (hazard ratio [HR], 1.04; p = .005), left ventricular ejection fraction (EF) (EF <0.35 [HR], 3.9; p < .001; EF, 0.35-0.49 [HR], 1.9; p = .03), and MDD (HR, 1.8; p = .04) were independent predictors of cardiac mortality. The BDI and the cognitive-affective symptoms subset of BDI symptoms were also predictors of cardiac mortality. Age, EF, and diabetes predicted all-cause mortality, but MDD did not. CONCLUSIONS: Depression, assessed both in structured interview and by BDI, was significantly associated with elevated cardiac mortality 10 years after CABG surgery.

Development of a DNP measurement grid to increase the rigor of doctor of nursing practice students' data collection and analysis methods.

A key component of the DNP project rigor is the collection and analysis of data or measurement. A Steering Committee at the University of Maryland formed to improve the quality of DNP projects established a workgroup to evaluate the current measurement content in four DNP core courses with the goal of establishing DNP project measurement criteria across the curriculum. The steps included: Step 1: Identify QI Measurement Methods and Tools. Identify the essential QI measurement methods and tools recommended by national organizations. Step 2: Create a DNP Measurement Grid. Define main data methods topics with subtopics. Step 3: Map the DNP core courses. Using the DNP Measurement Grid criteria determine the measurement content included in each course and student mastery level. The level of mastery was ranked from introduced (awareness), to reinforced (knowledge), to demonstrated (application). Step 4: Evaluate and Refine the DNP Measurement Grid Criteria. Adjustments were made in the DNP curriculum to include topics and subtopics at the desired mastery level. The rigor of data measurement and analysis will be evaluated in future DNP projects. The workgroup's four-step process provides a path that facilitated improving curriculum measurement content. This process may provide guidance for others undertaking similar work.

Impact of Interactive Video Communication Versus Text-Based Feedback on Teaching, Social, and Cognitive Presence in Online Learning Communities.

A key element to online learning is the ability to create a sense of presence to improve learning outcomes. This quasi-experimental study evaluated the impact of interactive video communication versus text-based feedback and found a significant difference between the 2 groups related to teaching, social, and cognitive presence. Recommendations to enhance presence should focus on providing timely feedback, interactive learning experiences, and opportunities for students to establish relationships with peers and faculty.

Organizational Readiness for Nurse Residency Accreditation.

Professional development nurses assume a principal role in establishing a state of readiness for accreditation of an organization's nurse residency program. This quality improvement project engaged a professional development department in self-study of their nurse residency program to determine readiness for accreditation by the Commission on Collegiate Nursing Education. The outcomes demonstrate a favorable state of organizational readiness, with minor program gaps in 19/45 accreditation criteria, requiring corrective action to optimize readiness for success.

Continual development of a personalized decision support system.

Improving the safety, quality, and efficiency of care with the help of clinical decision support tools is one of the core objectives in the meaningful use of Electronic Health Records. Successful adoption of support systems depends on the quality of delivered information, its relevance to the clinical task and individual patient, integration of the system with the entire clinical workplace, and ease of use of the system. This paper presents continuous development and evaluation, as well as lessons learned in development and maintenance of an evidence-based system that supports development of individualized patient care plans. Since its deployment in August 2009, the Evidence-Based Practice InfoBot (EBP InfoBot) system is in daily use at the NIH Clinical Center and responds to 21 requests a day, on average.

A prototype system to support evidence-based practice.

Translating evidence into clinical practice is a complex process that depends on the availability of evidence, the environment into which the research evidence is translated, and the system that facilitates the translation. This paper presents InfoBot, a system designed for automatic delivery of patient-specific information from evidence-based resources. A prototype system has been implemented to support development of individualized patient care plans. The prototype explores possibilities to automatically extract patients problems from the interdisciplinary team notes and query evidence-based resources using the extracted terms. Using 4,335 de-identified interdisciplinary team notes for 525 patients, the system automatically extracted biomedical terminology from 4,219 notes and linked resources to 260 patient records. Sixty of those records (15 each for Pediatrics, Oncology & Hematology, Medical & Surgical, and Behavioral Health units) have been selected for an ongoing evaluation of the quality of automatically proactively delivered evidence and its usefulness in development of care plans.