Improving Situation Awareness to Advance Patient Outcomes: A Systematic Literature Review.

Improving nurses' situation awareness skills would likely improve patient status recognition and prevent adverse events. Technologies such as electronic health record dashboards can be a promising approach to support nurses' situation awareness. However, the effect of these dashboards on this skill is unknown. This systematic literature review explores the evidence around interventions to improve nurses' situation awareness at the point of care. Current research on this subject is limited. Studies that examined the use of electronic health record dashboards as an intervention had weak evidence to support their effectiveness. Other interventions, including communication interventions and structured nursing assessments, may also improve situation awareness, but more research is needed to confirm this. It is important to carefully consider the design and content of situation awareness interventions, as well as the specific outcomes being measured, when designing situation awareness interventions. Overall, there is a need for higher-quality research in this area to determine the most effective interventions for improving nurse situation awareness. Future studies should focus on developing dashboards that follow a theoretical situation awareness model information and represent all situation awareness levels.

Effect of a Bladder Control Self-Management Program Delivered Through a Health Kiosk.

PURPOSE: The purpose of this study was to examine the feasibility of delivering a bladder control self-management program through a multiuser health kiosk and to evaluate the program's effect on urinary incontinence (UI) and incontinence-specific quality of life (QoL). DESIGN: Secondary analysis of data collected during participants' interactions with the Bladder Control Module (BCM) from the parent study. SUBJECTS AND SETTING: One hundred eleven participants from the parent study were eligible to be included in this secondary analysis. Their mean age was 72.8 years, and most were female (n = 95, 85.6%); 81 (75.7%) identified themselves as Caucasian. Each participant could access the BCM at a health kiosk situated at one of several sites: senior centers, subsidized senior housing, retirement communities, and a public library. METHODS: The BCM comprised 6 sessions self-administered at least 1 week apart. The content focused on lifestyle modification, pelvic floor muscle training, and bladder (habit) retraining, with encouragement of behavioral self-monitoring between sessions. The feasibility of delivering the intervention was measured by the proportion of participants completing each session. The effect of the BCM on incontinence episodes and incontinence-specific QoL was measured, respectively, by a 7-day bladder diary and the Incontinence Impact Questionnaire Short Form. RESULTS: Sixty-one of the 111 eligible participants accessed the BCM. Participants recording incontinence episodes in their baseline bladder diary and completing at least 3 BCM sessions experienced significant decreases in median total UI (P = .01), urge UI (P < .001), and stress UI (P = .02) episodes per day. Incontinence-related QoL significantly improved (P = .03). CONCLUSIONS: Our findings support the potential effectiveness of providing community-based, kiosk-enabled access to a conservative behavioral intervention designed to improve incontinence-related outcomes among older adults with UI. Additional research with a larger sample is warranted.

What's Next for Modernizing Gender, Sex, and Sexual Orientation Terminology in Digital Health Systems? Viewpoint on Research and Implementation Priorities.

In 2021, Canada Health Infoway and the University of Victoria's Gender, Sex, and Sexual Orientation Research Team hosted a series of discussions to successfully and safely modernize gender, sex, and sexual orientation information practices within digital health systems. Five main topic areas were covered: (1) terminology standards; (2) digital health and electronic health record functions; (3) policy and practice implications; (4) primary care settings; and (5) acute and tertiary care settings. In this viewpoint paper, we provide priorities for future research and implementation projects and recommendations that emerged from these discussions.

Digital health systems-let's talk about sex (and gender).

Historically, within digital health information systems, sex and gender have been conflated as a single concept and often have been limited to a binary answer. This has led to inappropriate care, erosion of client trust and avoidance of the healthcare system. Health leaders can improve care for all clients with technical and clinical information practice initiatives. While procurement processes could require digital health systems that utilize modern Gender, Sex, and Sexual Orientation (GSSO) terminology, for most health leaders, technical initiatives will focus on modernizing existing systems to the maximum extent possible. Terminology updates may not be immediately visible to clients, but providing the correct information to clinicians will support respectful client encounters. Simultaneously, clinical information practice initiatives can directly affect clinical encounters. Change management strategies need to include all levels of employees and redesign tools and workflows to support modernized information handling practices.

Bring Your Own Device and Nurse Managers' Decision Making.

The Bring Your Own Device phenomenon is important in the healthcare environment because this trend is changing the workplace in healthcare organizations, such as British Columbia. At present, there is little research that exists in Canada to provide a distinct understanding of the complexities and difficulties unique to this phenomenon within the nursing practice. This study focused on the experiences and perceptions of nurse managers regarding how they make decisions on the use of personal handheld devices in the workplace. Telephone interviews (N = 10) and qualitative descriptive analysis were used. Four major themes emerged: (1) management perspective, (2) opportunities, (3) disadvantages, and (4) solutions. Nurse managers and other executives in healthcare organizations and health information technology departments need to be aware of the practice and organizational implications of the Bring Your Own Device movement.

Data Preparation for Supervised Learning: Improving Nursing Situation Awareness to Reduce Healthcare-Acquired Urinary Tract Infection.

Situation awareness (SA) is an important non-technical skill for nurses. Nurses interact directly with patients and review their clinical signs. If we improve nurses' SA, they will likely detect clinical changes and prevent patient harm. A clinical endeavor that can benefit from improved nurses' SA is the prevention of Healthcare-Acquired Urinary Tract Infection (HAUTI). Electronic Health Records contain comprehensive nursing assessment data that researchers can use to analyze trends and provide a context-based understanding of the infection risk factors. We conducted a study that involved extracting nursing assessment data and preparing it for supervised learning algorithms and predicting HAUTI. In this paper, we share the methods we used to prepare the data for supervised learning algorithms and present the challenges related to data missingness.

Gender Harmony: A Case for Nursing Informatics.

The design of digital health information systems around a conflated gender/sex binary contributes to health inequities. Lack of specific information that supports affirming communication lead to inappropriate care, disrespectful encounters with healthcare staff, and avoidance of health services by clients who have been harmed by misgendering, deadnaming and being outed. The HL7 International Gender Harmony Model (HL7 GHM) supports the design, implementation and use of DHIS that enable affirming clinical interactions and care. This case study will demonstrate how applying the HL7 GHM can address the harms reported in a recently published account of one patient in Canada.

Canadian employers' perspectives on a new framework for health informatics competencies.

Competencies are the knowledge, skills, and abilities needed to operate and perform successfully in the workplace. Due to the evolving nature of health informatics, it is important continuously examine and refine competencies in this field. In this study, we administered a questionnaire to Canadian employers (N = 29) of health informatics cooperative education (co-op) students to garner their feedback on competencies within a New Health Informatics Professional Competencies Framework. Overall, the findings supported this new framework. An average of ratings within each of the four competency categories revealed that participants perceived Management Science to be the most important, followed by Information & Computer Science, then Health Science and finally Data Science. Further, at least 20 (69 %) respondents rated nine of the 12 competencies as important. Of the 12 competencies, Biological and Clinical Science was rated the lowest. Findings from this study can potentially be used to inform curricula, career progression, and hiring practices in health informatics. Future work includes refining the questionnaire to assess the competencies more comprehensively and potentially exploring the importance of more transferable skills or general competencies (e.g., communication, problem-solving). Additionally, we want to survey a broader sample of health informatics professionals and integrate recent national and international work on health informatics competencies. Future work is also recommended towards the development of a maturity model for competencies of more experienced health informatics professionals.

Designing the community multi-user health kiosk.

This paper discusses the design and development of a multi-user health kiosk intended for independent use by underserved populations. The modular integration of physiological sensors and psycho-social assessments provides an extensible, customizable platform for research. We present the development of the kiosk's feature set and user interaction mechanisms through iterative user testing, in addition to some technical challenges and solutions resulting from our design choices.

Clinician variations in data trust and use.

This study examined how variations in the source and type of patient health data affected health care providers' perceptions of the trustworthiness and usefulness of the data. Overall, respondents (n=107) reported moderate to high levels of trust and usefulness of health status data from all sources. Technology sources were rated as more trustworthy than traditional, non-technology sources (paired t=-2.84, p<0.006). However, there was no significant difference between technology sources and non-technology sources (paired t=-1.63, p<0.108) in perceived usefulness for clinical decision making.

Updating professional competencies in health informatics: A scoping review and consultation with subject matter experts.

INTRODUCTION: The discipline of health informatics emerged to address the need for uniquely skilled professionals to design, develop, implement, and evaluate health information technology. Core competencies are an essential pre-requisite for establishing a professional discipline such as health informatics. In 2012, Digital Health Canada released a framework (DHC Framework) for Canadian health informatics competencies. Multiple perspectives on health informatics competencies have evolved to reflect global and unique country contexts. In this paper, we will describe a two-phase study in which we ultimately developed a new framework for health informatics competencies. METHODS: In Phase 1, we conducted a scoping review of to identify health informatics competencies from research articles and grey literature from professional associations. Of 1038 articles identified in the search, ultimately 38 met our inclusion criteria and were subject to in-depth analysis. We summarized our findings from this phase into a preliminary framework of health informatics competencies and then in Phase 2, we shared these findings with subject matter experts (SMEs; N = 5) to garner their feedback. The SMEs were all instructors in health informatics in Canada and held various roles (director, professor, advisor, and co-operative education coordinator). We used their insights into the current and forecasted Canadian health informatics landscape to iteratively develop a new framework until we achieved consensus amongst the subject matter experts. RESULTS: In Phase 1, all competencies of the DHC Framework were supported by the literature. However, we also identified two emergent competencies: Human Factors and Data Science. In Phase 2, consultations with SMEs guided the introduction of one new competency category and seven new competencies. One competency was renamed and two were removed from the DHC Framework. Additionally, we added new terms that encompass the framework and labelled the core of the framework Health Informatics Professionalism. DISCUSSION: We found that the DHC Framework did not capture all necessary competencies required by health informatics professionals. Based on the literature and consultations with SMEs, we extended the DHC Framework to better reflect the current Canadian context and propose a new Health Informatics Core Competencies Framework. The new framework can be used to inform Canadian health informatics programs to ensure graduates are equipped for careers in health informatics. Future work includes validating the new framework with Canadian health informatics employers to assess whether this new framework adequately reflects their needs, and more detail may be required to define specific skills necessary in each competency.

Demonstration of facial communication of emotion through telehospice videophone contact.

PURPOSE: The purpose of this study was to demonstrate the range of emotional expressions that can be displayed by nurse and family caregiver during a telehospice videophone consultation. We hypothesized that a nurse providing telehospice care via videophone would gain access to rich nonverbal emotional signals from the caregiver and communicate her own social presence to the caregiver, to potentially enhance the building of empathy between nurse and caregiver. METHODOLOGY: Videorecording of a case exemplar of videophone contact was obtained using the Beamer, a commercially available product that allows display of both caller and receiver on an available television through standard telephone lines. Nonverbal communication through facial expressions of emotion was quantified using detailed coding of facial movement and expression (facial action coding system). RESULTS: In this study, we demonstrated the presence of visual nonverbal information in the form of facial expressions of emotion during a videophone interaction between nurse and family caregiver. Over the course of a typical after-hours telehospice call, a variety of facial expressions of emotion were displayed by both nurse and family caregiver. Expression of positive and negative emotions, as well as mixed emotions, was apparent. Through detailed analysis of this case of videophone interaction, we have demonstrated the potential value of videophone contact for providing access to visual nonverbal emotional communication.

Evaluating a post-implementation electronic medical record training intervention for diabetes management in primary care.

OBJECTIVE: This study evaluated the potential for electronic medical record (EMR) video tutorials to improve diabetes (type 1 and 2) care processes by primary care physicians (PCP) using OSCAR EMR. DESIGN: A QUAN(qual) mixed methods approach with an embedded design was used for the overall research study. EMR video tutorials were developed based on the chronic care model (CCM), value-adding EMR use, best practice guidelines for designing software video tutorials and clinician-led EMR training. RESULTS: In total, 18 PCPs from British Columbia, Canada, participated in the study. The video EMR intervention elicited a statistically significant increase in EMR advanced feature use for diabetes care, with a large effect size (ie, F(1,51)=6.808, p<0.001, partial η2=0.286). CONCLUSION: This small-scale efficacy study demonstrates the potential of CCM-based EMR video tutorials to improve EMR use for chronic diseases, such as diabetes. A larger-scale effectiveness study with a control group is needed to further validate the study findings and determine their generalisability. The demonstrated efficacy of the intervention suggests that EMR video tutorials may be a cost-effective, sustainable and scalable strategy for supporting EMR optimisation and the continuous learning and development of PCPs. Health informatics practitioners may develop video tutorials for their respective EMR/electronic health record software based on theory and best practices for video tutorial design. For patients, EMR video tutorials may lead to improved tracking of processes of care for diabetes, and potentially other chronic conditions.

Applying the Behavior Change Technique Taxonomy to Mobile Health Applications: A Protocol.

The lack of standardized descriptors of behavior change facilitators in mobile health apps makes it difficult for clinicians and consumers to quickly evaluate the potential of a mobile health app. The Behavior Change Technique Taxonomy (BCTT) was developed to evaluate health interventions for the presence of behavior change techniques. This paper describes the methods used and methodological results in applying the BCTT to commercially available mobile health apps in the respiratory and sleep domains.

System Dynamics in Remote Monitoring Service for Cardiovascular Implantable Electronic Devices.

This methodological paper describes how system dynamics was applied in evaluating the effect of remote monitoring (RM) of cardiovascular implantable electronic device (CIED) workload on clinical resource utilization. The development of a causal loop diagram and a stock and flow diagram and the construction of the simulation model for comparison of an in-person clinic group and RM clinic group are described.

Tailored mobile text messaging interventions targeting type 2 diabetes self-management: A systematic review and a meta-analysis.

OBJECTIVES: This study aimed to identify, assess and summarize available scientific evidence on tailored text messaging interventions focused on type 2 diabetes self-management. The systematic review concentrated on message design and delivery features, and tailoring strategies. The meta-analysis assessed the moderators of the effectiveness of tailored text messaging interventions. METHODS: A comprehensive search strategy included major electronic databases, key journal searches and reference list searching for related studies. PRISMA and Cochrane Collaboration's guidelines and recommended tools for data extraction, quality appraisal and data analysis were followed. Data were extracted on participant characteristics (age, gender, ethnicity), and interventional and methodological characteristics (study design, study setting, study length, choice of modality, comparison group, message type, format, content, use of interactivity, message frequency, message timing, message delivery, tailoring strategies and theory use). Outcome measures included diet, physical activity, medication adherence and glycated hemoglobin data (HbA1C). Where possible, a random effects meta-analysis was performed to pool data on the effectiveness of the tailored text messaging interventions and moderator variables. RESULTS: The search returned 13 eligible trials for the systematic review and 11 eligible trials for the meta-analysis. The majority of the studies were randomized controlled trials, conducted in high-income settings, used multi-modalities, and mostly delivered informative, educational messages through an automated message delivery system. Tailored text messaging interventions produced a substantial effect (g = 0.54, 95% CI = 0.08-0.99, p < 0.001) on HbA1C values for a total of 949 patients. Subgroup analyses revealed the importance of some moderators such as message delivery (Q B = 18.72, df = 1, p = 0.001), message direction (Q B = 5.26, df = 1, p = 0.022), message frequency (Q B = 18.72, df = 1, p = 0.000) and using multi-modalities (Q B = 6.18, df = 1, p = 0.013). CONCLUSIONS: Tailored mobile text messaging interventions can improve glycemic control in type 2 diabetes patients. However, more rigorous interventions with larger samples and longer follow-ups are required to confirm these findings and explore the effects of tailored text messaging on other self-management outcomes.

Patient-centered applications: use of information technology to promote disease management and wellness. A white paper by the AMIA knowledge in motion working group.

Advances in information technology (IT) enable a fundamental redesign of health care processes based on the use and integration of electronic communication at all levels. New communication technologies can support a transition from institution centric to patient-centric applications. This white paper defines key principles and challenges for designers, policy makers, and evaluators of patient-centered technologies for disease management and prevention. It reviews current and emerging trends; highlights challenges related to design, evaluation, reimbursement and usability; and reaches conclusions for next steps that will advance the domain.

Needing smart home technologies: the perspectives of older adults in continuing care retirement communities.

BACKGROUND: At present, the vast majority of older adults reside in the community. Though many older adults live in their own homes, increasing numbers are choosing continuing care retirement communities (CCRCs), which range from independent apartments to assisted living and skilled-nursing facilities. With predictions of a large increase in the segment of the population aged 65 and older, a subsequent increase in demand on CCRCs can be anticipated. With these expectations, researchers have begun exploring the use of smart home information-based technologies in these care facilities to enhance resident quality of life and safety, but little evaluation research exists on older adults' acceptance and use of these technologies. OBJECTIVE: This study investigated the factors that influence the willingness of older adults living in independent and assisted living CCRCs to adopt smart home technology. SUBJECTS AND SETTING: Participants (n = 14) were recruited from community-dwelling older adults, aged 65 or older, living in one of two mid-western US CCRC facilities (independent living and assisted living type facilities). METHODS: This study used a qualitative, descriptive approach, guided by principles of grounded theory research. Data saturation (or when no new themes or issues emerged from group sessions) occurred after four focus groups (n = 11 unique respondents) and was confirmed through additional individual interviews (n = 3). RESULTS: The findings from this study indicate that although privacy can be a barrier for older adults' adoption of smart home technology their own perception of their need for the technology can override their privacy concerns. CONCLUSIONS: Factors influencing self-perception of need for smart home technology, including the influence of primary care providers, are presented. Further exploration of the factors influencing older adults' perceptions of smart home technology need and the development of appropriate interventions is necessary.

Information technology from novice to expert: implementation implications.

AIMS: This paper explores how the Novice-to-Expert Nursing Practice framework can illuminate the challenges of and opportunities in implementing information technology (IT), such as clinical decision support systems (CDSS), in nursing practice. BACKGROUND: IT implementation in health care is increasing; however, substantial costs and risks remain associated with these projects. EVALUATION: The theoretical framework of Novice-to-Expert Nursing Practice was applied to current design and implementation literature for CDSS. KEY ISSUES: Organizational policies and CDSS design affect implementation and user adoption. CONCLUSIONS: Nursing CDSS can improve the overall quality of care when designed for the appropriate end-user group and based on a knowledge base reflecting nursing expertise. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse administrators can positively influence CDSS function and end-user acceptance by participating in and facilitating staff nurse involvement in IT design, planning and implementation. Specific steps for nurse administrators and managers are included in this paper.