Higher perceived stress and exacerbated motor symptoms in Parkinson's disease during the COVID-19 lockdown in New Zealand.

AIMS: Stress plays a key role in Parkinson's disease (PD) by acting on the dopaminergic system and worsening patients' motor function. The impact of New Zealand's strict lockdown measures to contain COVID-19 on perceived stress and PD motor symptoms remains unknown. Here we examined the relationship between perceived levels of stress, changes in physical activity levels and PD motor symptoms during lockdown. METHODS: During lockdown, 134 participants with PD and 49 controls completed a survey assessing perceived stress, self-reported changes in PD motor symptoms and physical activity duration and intensity prior to and during lockdown. RESULTS: Perceived stress was higher in PD than controls, and in those reporting a worsening of tremor, balance/gait, dyskinesia and bradykinesia compared to those indicating no change during the COVID-19 lockdown. These effects were not modulated by physical activity. CONCLUSIONS: Reducing stressors may be an important adjunct treatment strategy to improve motor function in PD.

The Role of Interdisciplinary Faculty in Nursing Education: A National Survey.

BACKGROUND: The role of interdisciplinary faculty in schools and colleges of nursing has evolved over time. Historically, integration of interdisciplinary faculty into nursing education was as experts in non-nursing content and to fill a gap created by the lack of doctorally prepared nurses. In the 1980s, Lenz and Morton surveyed Departments, Schools and Colleges of Nursing to explore the role of interdisciplinary faculty in nursing education. PURPOSE: Our study adapted Lenz and Morton's work to examine new trends in faculty composition, while also considering the evolution in nursing education, including the integration of doctor of nursing practice (DNP) prepared faculty. RESULTS: Differences in enrollments, programs offered, and number of faculty and faculty composition were observed between 1988 and 2017. In 1988 the most common disciplines represented were nutrition, education and psychology, while in 2017 the most common disciplines were pharmacology, statistics and biological sciences. The current study shows a decrease of 15% in interdisciplinary faculty educating nursing students, although this finding may be related to differences in sampling techniques. CONCLUSIONS: Integration of interdisciplinary faculty has the potential to enrich nursing education by bringing in a depth of specialized knowledge from other disciplines. Further faculty role-modeling successful interdisciplinary collaboration is another way to prepare nurses for team-based patient care which is an imperative skill in today's health care arena.

Towards the TIGER International Framework for Recommendations of Core Competencies in Health Informatics 2.0: Extending the Scope and the Roles.

This paper describes the methodology and developments towards the TIGER International Recommendation Framework of Core Competencies in Health Informatics 2.0. This Framework is meant to augment the scope from nursing towards a series of six other professional roles, i.e. direct patient care, health information management, executives, chief information officers, engineers and health IT specialists and researchers and educators. Health informatics core competency areas were compiled from various sources that had integrated the literature and were grouped into consistent clusters. The relevance of these core competency areas was rated in a survey by 718 professional experts from 51 countries. Furthermore, 22 local case studies illustrated the competencies and gave insight into examples of local educational practice. The Framework contributes to the overall discourse on how to shape health informatics education to improve quality and safety of care by enabling useful and successful health information systems.

The Imperative of Solving Nurses' Usability Problems With Health Information Technology.

BACKGROUND: Health information technology (IT) usability issues are a key concern for nurse executives and nurses. OBJECTIVES: The aims of this study are to understand usability pain points faced by nurses regarding the use of health IT, identify their impact and importance, discuss responsibilities, and develop possible solutions to improve the health IT-user experience for nurses. METHODS: Twenty-seven experts were interviewed including nursing leaders, informaticists, executives, engineers, researchers, and human factors experts across acute care, long-term care, and vendor settings. Semistructured questions guided the interviews, and content analysis was used to identify themes. RESULTS: Four themes emerged: 1) user experience pain points, 2) importance of the issues, 3) the responsibility gap, and 4) acting on usability issues. CONCLUSION: Nurses continue to endure significant health IT-usability issues that negatively impact patients, nurses, and healthcare organizations. Solutions include enhancing the voice of nursing at the national and local levels, creating a digital strategy for nursing, providing incentives to improve usability in health IT, and accelerating the understanding of nurses' work intended to inform and translate nurses' work into health IT design.

Shared medical appointments: balancing efficiency with patient satisfaction and outcomes.

The shared medical appointment (SMA) is one model of care that holds promise for achieving the goal of balancing efficiency, cost, and quality. The results of recent studies of SMAs suggest that improved physiologic health, self-efficacy, and patient education and feasibility emerge as positive outcomes. In order to discover the potential applicability of the SMA format to otolaryngology, a pilot nasal symptoms SMA (NSSMA) model was implemented. The NSSMA was piloted in a private otolaryngology practice serving a metropolitan area in the Mid-Atlantic region. The Wilcoxon Signed Rank test demonstrated a significant improvement in the SNOT-20 score (T = -2.073; P = .019). Descriptive analyses for patient satisfaction results indicate high levels of patient satisfaction with the NSSMA. Also, Wilcoxon Signed Rank test for posttest knowledge scores were significantly higher than pretest scores (T = 1.667; P = .048). For busy practices managing large panels, the SMA serves as an opportunity to balance cost and quality.

Evolving the PICOT Method for the Digital Age: The PICOT-D.

BACKGROUND: Many articles written about the PICOT (Population, Intervention, Comparison, Outcome, Time) method for developing research questions focus on searching the existing evidence base to review the impact of interventions. The PICOT method evolved to craft questions that yield operative search terms. Currently, the PICOT method falls short in its utility for health care and doctoral education. For example, the Doctor of Nursing Practice scholarly practice projects evaluate the existing evidence base and compare the current real-world state with the evidence base, for which the current conceptualization of the PICOT method has limited applicability. METHOD: The PICOT-D adds digital data (D) components to the traditional PICOT, allowing for the explicit identification of data measures that form the basis of the evaluation of an intervention. RESULTS: the PICOT-D has the potential to improve student efficiency, efficacy, and confidence in the development of truly answerable questions that fully support improved patient care and systems-level change. CONCLUSION: This article demonstrates the need for the evolution of the PICOT format to the PICOT-D format.

Implementation of an electronic health records system within an interprofessional model of care.

Implementation of electronic health records (EHR) systems is challenging even in traditional healthcare settings, where administrative and clinical roles and responsibilities are clearly defined. However, even in these traditional settings the conflicting needs of stakeholders can trigger hierarchical decision-making processes that reflect the traditional power structures in healthcare today. These traditional processes are not structured to allow for incorporation of new patient-care models such as patient-centered care and interprofessional teams. New processes for EHR implementation and evaluation will be required as healthcare shifts to a patient-centered model that includes patients, families, multiple agencies, and interprofessional teams in short- and long-term clinical decision-making. This new model will be enabled by healthcare information technology and defined by information flow, workflow, and communication needs. We describe a model in development for the configuration and implementation of an EHR system in an interprofessional, interagency, free-clinic setting. The model uses a formative evaluation process that is rooted in usability to configure the EHR to fully support the needs of the variety of providers working as an interprofessional team. For this model to succeed, it must include informaticists as equal and essential members of the healthcare team.

Development of a simulated smart pump interface.

Medical device user interfaces are increasingly complex, resulting in a need for evaluation in clinicallyaccurate settings. Simulation of these interfaces can allow for evaluation, training, and use for research without the risk of harming patients and with a significant cost reduction over using the actual medical devices. This pilot project was phase 1 of a study to define and evaluate a methodology for development of simulated medical device interface technology to be used for education, device development, and research. Digital video and audio recordings of interface interactions were analyzed to develop a model of a smart intravenous medication infusion pump user interface. This model was used to program a high-fidelity simulated smart intravenous medication infusion pump user interface on an inexpensive netbook platform.

Mobile apps for psychiatric nurses.

Many health care professionals, including psychiatric nurses, are faced with increasing questions from patients about mobile applications (apps). The purpose of this article is to give psychiatric-mental health nurses (PMHNs) an overview of the world of mobile health and medical apps to answer their own questions as well as those of their patients. Mobile apps will continue to evolve; thus, this article will serve as a base for PMHNs to build knowledge and understanding to help their patients.

Smart pump technology: what we have learned.

Intravenous infusion may present the greatest preventable medication administration error risk to hospitalized patients. Smart pumps can provide clinical decision support at the bedside for nurses who are administering intravenously administered medications with the potential to significantly reduce medication errors and subsequent patient harm. However, implementations of smart pumps have yielded mixed results and mixed perceptions of their ability to actually decrease error. To realize the potential of smart pumps, there must exist a clear understanding of how these devices are being integrated into healthcare organizations, specifically nursing practice. The purpose of this article was to describe current smart pump evaluation studies and to suggest areas of future evaluation focus.

Smart pump technology: what we have learned.

Intravenous infusion may present the greatest preventable medication administration error risk to hospitalized patients. Smart pumps can provide clinical decision support at the bedside for nurses who are administering intravenously administered medications with the potential to significantly reduce medication errors and subsequent patient harm. However, implementations of smart pumps have yielded mixed results and mixed perceptions of their ability to actually decrease error. To realize the potential of smart pumps, there must exist a clear understanding of how these devices are being integrated into healthcare organizations, specifically nursing practice. The purpose of this article was to describe current smart pump evaluation studies and to suggest areas of future evaluation focus.

Diabetes and hyperglycemia quality improvement efforts in hospitals in the United States: current status, practice variation, and barriers to implementation.

OBJECTIVE: To determine the status of diabetes and hyperglycemia quality improvement efforts in hospitals in the United States. METHODS: We designed and administered a survey to a convenience sample of hospitals, and the responses were analyzed statistically. RESULTS: We received 269 responses from 1,151 requested surveys. The sample was similar to hospitals in the United States on the basis of hospital type and geographic region (P = no significant difference) but not on the basis of number of beds (P<.001). Among responding hospitals, 39%, 21%, and 15% had fully implemented inpatient diabetes and hyperglycemia quality improvement programs for critically ill, non-critically ill, and perioperative patients, respectively. Moreover, 77%, 44%, and 49% had fully implemented protocols for hypoglycemia, hyperglycemic crises, and diabetic ketoacidosis, respectively. Variations in glucose target ranges were noted. The responding hospitals had no standard biochemical definition of hypoglycemia; 47% defined hypoglycemia as a glucose level

Information networks in intensive care: a network analysis of information exchange patterns.

The communication and delivery of clinical information is the basis for coordination of patient care. Information exchange in acute care practice, however, is becoming increasingly complex, in part due to the expansion of electronic sources of information. In this study, we attempted to describe this complexity by using Network Analysis (NA) to depict information use patterns among ICU nurses with information technology tools as full nodes in the network rather than as mediators of information exchange between nodes. Including information technology tools as full nodes, enabled an examination of their direct role in the information-sharing network. Analysis of these data using NA allowed the explication of three dominant information use patterns, corresponding to three phases of care experienced by patients in this unit: admission phase, monitoring phase, and discharge phase.

Glycemic control and insulin safety: the impact of computerized intravenous insulin dosing.

The aim of this work was to evaluate our Glycemic Control Initiative that was put in place to improve blood glucose control in hyperglycemic intensive care patients and improve insulin safety by minimizing the risk of hypoglycemia. A computerized decision-support tool was developed for intravenous insulin dosing that provided an automated and standardized approach across the organization's intensive care units (ICUs). As a result of this, at 3 years post implementation, ICU patients are 2.28 times more likely to have blood glucose levels <150 mg/dL (odds ratio = 2.28; 95% confidence interval = 2.25-2.30; P < .001) compared with the baseline period. Although glycemic control was significantly improved, the patient safety risk from hypoglycemia did not increase, as rates of blood glucose <50 mg/dL decreased from 0.68% at baseline to 0.64% in 2007.