REDUCE missed oral healthcare: The outcomes of and learnings from an implementation project in an acute geriatric unit.

Oral healthcare is one of the most missed aspects of fundamental care. Failure to provide reliable and effective daily oral healthcare for older patients can lead to hospital-acquired pneumonias, longer hospital stays, increased health costs, and poor patient experience. The objective of this study was to codesign, implement, and evaluate an oral healthcare intervention for older adults in a geriatric unit. This mixed methods implementation project combined the hospital's quality improvement processes with the i-PARIHS knowledge translation framework. Multilevel facilitation guided the development of multidisciplinary implementation strategies, which were co-designed, tailored, and implemented at the ward and organizational level, targeting: awareness/engagement; clinical guideline development; building workforce capacity; access to appropriate products; patient awareness and support; utilization of multidisciplinary/dental referral pathways; and systematizing oral healthcare documentation. Gaps between evidence-based and current oral healthcare practice were identified through audits of practice and interviews with patients. Interviews and surveys with staff evaluated the feasibility and acceptability of the oral healthcare intervention and the success of implementation strategies. At the conclusion of the project, awareness, attitudes, and capacity of staff had increased, however, we could not demonstrate change in multidisciplinary oral healthcare practices or improvements for individual patients. Despite mixed success, the project informed discussions about including oral healthcare as a national healthcare standard for the acute care sector in Australia. Attempts to address oral healthcare may have started locally, but its impact was through policy change, which will empower health practitioners and managers to support practice change more widely.

Primary, allied health, geriatric, pain and palliative healthcare service utilisation by aged care residents, 2012-2017.

OBJECTIVES: To examine the incidence and trends in primary care, allied health, geriatric, pain and palliative care service use by permanent residential aged care (PRAC) residents and the older Australian population. METHODS: Repeated cross-sectional analyses on PRAC residents (N = 318,484) and the older (≥65 years) Australian population (N ~ 3.5 million). Outcomes were Medicare Benefits Schedule (MBS) subsidised primary care, allied health, geriatric, pain and palliative services between 2012-13 and 2016-17. GEE Poisson models estimated incidence rates and incidence rate ratios (IRR). RESULTS: In 2016-17, PRAC residents had a median of 13 (interquartile range [IQR] 5-19) regular general medical practitioner (GP) attendances, 3 (IQR 1-6) after-hours attendances and 5% saw a geriatrician. Highlights of utilisation changes from 2012-13 to 2016-17 include the following: GP attendances increased by 5%/year (IRR = 1.05, 95% confidence interval [CI] 1.05-1.05) for residents compared to 1%/year (IRR = 1.01, 95%CI 1.01-1.01) for the general population. GP after-hours attendances increased by 15%/year (IRR = 1.15, 95%CI 1.14-1.15) for residents and 9%/year (IRR = 1.08, 95%CI 1.07-1.20) for the general population. GP management plans increased by 12%/year (IRR = 1.12, 95%CI 1.11-1.12) for residents and 10%/year (IRR = 1.10, 95%CI 1.09-1.11) for the general population. Geriatrician consultations increased by 28%/year (IRR = 1.28, 95%CI 1.27-1.29) for residents compared to 14%/year (IRR = 1.14, 95%CI 1.14-1.15) in the general population. CONCLUSIONS: The utilisation of most examined services increased in both cohorts over time. Preventive and management care, by primary care and allied health care providers, was low and likely influences the utilisation of other attendances. PRAC residents' access to pain, palliative and geriatric medicine services is low and may not address the residents' needs.

Description of the Process to Validate the Mexican Nurse Informatics Competency Self-Assessment Scale.

Nurses need to have sufficient competencies in nursing informatics to be able to provide safe and efficient care. The Self-Assessment of Nursing Informatics Competencies Scale (SANICS) has been developed and validated as a self-report measure of informatics competencies in Western settings. In this work, we describe the ongoing study that aims to validate and translate SANICS into the Mexican setting.

Will Artificial Intelligence Replace Nurses? A Debate.

Technological development has enabled Artificial Intelligence (AI) to better support health care delivery and nursing. The need for nurses to be involved and steer the development and implementation of AI in health care is recognized. A 60-minute scientific debate is organized to explore if AI will replace nursing.

Nursing Informatics Research Trends: Findings from an International Survey.

This follow-up survey on trends in Nursing Informatics (NI) was conducted by the International Medical Informatics Association (IMIA) Student and Emerging Professionals (SEP) group as a cross-sectional study in 2019. There were 455 responses from 24 countries. Based on the findings NI research is evolving rapidly. Current ten most common trends include: clinical quality measures, clinical decision support, big data, artificial intelligence, care coordination, education and competencies, patient safety, mobile health, description of nursing practices and evaluation of patient outcomes. The findings help support the efforts to efficiently use resources in the promotion of health care activities, to support the development of informatics education and to grow NI as a profession.

How to Improve Information Technology to Support Healthcare to Address the COVID-19 Pandemic: an International Survey with Health Informatics Experts.

OBJECTIVES: To identify the ways in which healthcare information and communication technologies can be improved to address the challenges raised by the COVID-19 pandemic. METHODS: The study population included health informatics experts who had been involved with the planning, development and deployment of healthcare information and communication technologies in healthcare settings in response to the challenges presented by the COVID-19 pandemic. Data were collected via an online survey. A non-probability convenience sampling strategy was employed. Data were analyzed with content analysis. RESULTS: A total of 65 participants from 16 countries responded to the conducted survey. The four major themes regarding recommended improvements identified from the content analysis included: improved technology availability, improved interoperability, intuitive user interfaces and adoption of standards of care. Respondents also identified several key healthcare information and communication technologies that can help to provide better healthcare to patients during the COVID-19 pandemic, including telehealth, advanced software, electronic health records, remote work technologies (e.g., remote desktop computer access), and clinical decision support tools. CONCLUSIONS: Our results help to identify several important healthcare information and communication technologies, recommended by health informatics experts, which can help to provide better care to patients during the COVID-19 pandemic. The results also highlight the need for improved interoperability, intuitive user interfaces and advocating the adoption of standards of care.

Emerging Professionals' Observations of Opportunities and Challenges in Nursing Informatics.

The importance of nursing informatics (NI) is highlighted because of changing healthcare landscapes in response to rising digital health and technology integration and use. However, NI education, competency requirements and roles are not standardized across the world, and the potential of NI is modestly understood internationally. This paper explores opportunities and challenges in NI discussed in a panel at the 14th International Congress on Nursing and Allied Health Informatics. The panel was organized by the International Medical Informatics Association's - Nursing Informatics Working Group's Student and Emerging Professionals group. Discussions during the panel session were synthesized and analyzed using content analysis. Results indicate that challenges in NI education, career opportunities and roles continue to exist across healthcare settings and regions. Findings suggest that the following issues need attention: (1) collaboration to build stronger infrastructure to guide NI education, research and practice; (2) improved visibility and appreciation of NI; and (3) greater dissemination of evidence of NI in various health settings. This paper offers recommendations for nurse leaders on strategies to address these issues in NI at the local, regional and global levels.

Can oral healthcare for older people be embedded into routine community aged care practice? A realist evaluation using normalisation process theory.

BACKGROUND: An intervention 'Better Oral Health in Home Care' was introduced (2012-2014) to improve the oral health of older people receiving community aged care services. Implementation of the intervention was theoretically framed by the Promoting Action on Research Implementation in Health Services framework. Process outcomes demonstrated significant improvements in older people's oral health. OBJECTIVE: To evaluate the extent to which the intervention has been embedded and sustained into routine community aged care practice 3 years after the initial implementation project. DESIGN: A Realist Evaluation applying Normalisation Process Theory within a single case study setting. SETTING: Community aged care (home care) provider in South Australia, Australia. PARTICIPANTS: Purposeful sampling was undertaken. Twelve staff members were recruited from corporate, management and direct care positions. Two consumers representing high and low care recipients also participated. METHODS: Qualitative methods were applied in two subcases, reflecting different contextual settings. Data were collected via semi-structured interviews and analysed deductively by applying the Normalisation Process Theory core constructs (with the recommended phases of the Realist Evaluation cycle). Retrospective and prospective analytic methods investigated how the intervention has been operationalised by comparing two timeframes: Time 1 (Implementation June 2012-December 2014) and Time 2 (Post-implementation July 2017-July 2018). RESULTS: At Time 1, the initial program theory proposed that multi-level facilitation contributed to a favourable context that triggered positive mechanisms supportive of building organisational and workforce oral healthcare capacity. At Time 2, an alternative program theory of how the intervention has unfolded in practice described a changed context following the withdrawal of the project facilitation processes with the triggering of alternative mechanisms that have made it difficult for staff to embed sustainable practice. CONCLUSION: Findings concur with the literature that successful implementation outcomes do not necessarily guarantee sustainability. The study has provided a deeper explanation of how contextual characteristics have contributed to the conceptualisation of oral healthcare as a low priority, basic work-ready personal care task and how this, in turn, hindered the embedding of sustainable oral healthcare into routine community aged care practice. This understanding can be used to better inform the development of strategies, such as multi-level facilitation, needed to navigate contextual barriers so that sustainable practice can be achieved.

Emerging Professional's View of the Landscape: Nursing Informatics Curriculum, Competencies, and Career Opportunities.

The curriculum associated with nursing informatics (NI) education is not standardized, therefore the perspectives of new and emerging nurse informaticians is important. How these curricula differences affect career opportunities of new nursing informaticians, and in turn influenced current career choices will be explored. Synthesizing opinions with themes extracted from a 2014 international study-Advancing nursi informatics in the next decade: Recommendations from an international survey will be summarized.

Building Capacity in Student and Emerging Nursing Informatics Professionals Through Participation in an International Community of Practice.

In nursing, a community of practice have been recognized as an important construct to build capacity and support knowledge dissemination activities. The purpose of this poster is to use a community of practice framework to describe the collaborative work of an international nursing informatics, graduate student and emerging professional group.

Evaluating student learning outcomes in oral health knowledge and skills.

AIMS AND OBJECTIVES: To evaluate whether a set of oral health resources designed for workforce training was relevant for students undertaking an entry-level nursing or aged care qualification. BACKGROUND: Oral health is one of the most neglected aspects of nursing care experienced by older people. Despite efforts to improve aged care worker oral health knowledge and skills, one-off training and rapid staff turnover have hindered the success of workplace programmes. Inadequate oral health content in entry-level nursing and aged care qualifications has perpetuated this. DESIGN: Kirkpatrick's training and evaluation model was used to evaluate the resources developed by a project called Building Better Oral Health Communities. Students used them as prescribed study materials and completed pre- and postintervention questionnaires. Educators were interviewed to obtain their feedback. Quantitative data were analysed using descriptive and inferential statistics. Qualitative data were collated according to relevance to learning, presentation style and interest. RESULTS: Evaluation showed high levels of student and educator satisfaction. Student learning outcomes demonstrated consistently positive attitudes and significant self-reported improvements in oral health knowledge and skills. Irrespective of course type, students gained similar levels of oral health knowledge and skills following use of the resources. CONCLUSION: Nurses and care workers must be able to provide consistent standards of oral health care as a fundamental part of caring for patients. Validated as an effective learning and teaching package, it is recommended that these resources be used to strengthen the oral health content of entry-level nursing and aged care qualifications. RELEVANCE TO CLINICAL PRACTICE: Building the oral health capacity of nurses and care workers is one way of reversing oral health neglect and improving the quality of care provided to older people.

Partnerships to Improve Oral Hygiene Practices: Two Complementary Approaches.

The omission of oral care is linked to increased nurse workload and may contribute to serious patient infection and growing healthcare costs. Therefore, ineffective oral care comprises a significant patient safety issue across healthcare settings internationally. As studies have demonstrated a positive relationship between Nurs Leadersh (Tor Ont) and improved patient outcomes, it is imperative that leaders seek effective approaches to facilitate contextual exploration of barriers and facilitators for resolution of oral care delivery problems. One approach to improved processes of oral care is the creative engagement of front-line clinicians in the problems they confront in everyday practice. By drawing upon the role and process of facilitation, we outline two projects, located in Australia and Canada, that engaged front-line nurses, health leaders, and researchers as partners to identify a path to improved oral care delivery. In this paper, we summarize key learnings for nursing leaders about strategies to facilitate delivery of fundamental oral care. We found that facilitation, contextual knowledge and academic-clinician partnerships were essential to the detection and evaluation of oral care delivery problems and the identification of priorities for practice improvement. As collaboration is imperative for sustainable innovation, we summarize strategies of effective leadership for improving oral care delivery.

Advancing Nursing Informatics in the Next Decade: Recommendations from an International Survey.

In the summer of 2015, the International Medical Informatics Association Nursing Informatics Special Interest Group (IMIA NISIG) Student Working Group developed and distributed an international survey of current and future trends in nursing informatics. The survey was developed based on current literature on nursing informatics trends and translated into six languages. Respondents were from 31 different countries in Asia, Africa, North and Central America, South America, Europe, and Australia. This paper presents the results of responses to the survey question: "What should be done (at a country or organizational level) to advance nursing informatics in the next 5-10 years?" (n responders = 272). Using thematic qualitative analysis, responses were grouped into five key themes: 1) Education and training; 2) Research; 3) Practice; 4) Visibility; and 5) Collaboration and integration. We also provide actionable recommendations for advancing nursing informatics in the next decade.

Nursing Informatics Research Priorities for the Future: Recommendations from an International Survey.

We present one part of the results of an international survey exploring current and future nursing informatics (NI) research trends. The study was conducted by the International Medical Informatics Association Nursing Informatics Special Interest Group (IMIA-NISIG) Student Working Group. Based on findings from this cross-sectional study, we identified future NI research priorities. We used snowball sampling technique to reach respondents from academia and practice. Data were collected between August and September 2015. Altogether, 373 responses from 44 countries were analyzed. The identified top ten NI trends were big data science, standardized terminologies (clinical evaluation/implementation), education and competencies, clinical decision support, mobile health, usability, patient safety, data exchange and interoperability, patient engagement, and clinical quality measures. Acknowledging these research priorities can enhance successful future development of NI to better support clinicians and promote health internationally.

Current Trends in Nursing Informatics: Results of an International Survey.

Nursing informatics (NI) can help provide effective and safe healthcare. This study aimed to describe current research trends in NI. In the summer 2015, the IMIA-NI Students Working Group created and distributed an online international survey of the current NI trends. A total of 402 responses were submitted from 44 countries. We identified a top five NI research areas: standardized terminologies, mobile health, clinical decision support, patient safety and big data research. NI research funding was considered to be difficult to acquire by the respondents. Overall, current NI research on education, clinical practice, administration and theory is still scarce, with theory being the least common. Further research is needed to explain the impact of these trends and the needs from clinical practice.

Improving oral health for older people in the home care setting: An exploratory implementation study.

AIM: To explore how home care providers can support older people to maintain good oral health through implementing a model called Better Oral Health in Home Care (BOHHC). METHODS: A mixed method, pre- to post-implementation design was used. The Promoting Action on Research Implementation in Health Services framework informed the model's implementation process. RESULTS: High levels of dental need were identified at pre-implementation. Older people self-reported significant oral health improvements following the introduction of tailored home care strategies by care workers, who in turn reported a better understanding and knowledge of the importance of oral care for older people. CONCLUSION: The BOHHC Model provided an evidence-based approach for community-based prevention and early detection of oral health problems. Improving oral health for older people in the home care setting has significant practice and policy implications which require ongoing intersectoral facilitation involving aged care, vocational health education and dental sectors.

Nurse Informaticians Report Low Satisfaction and Multi-level Concerns with Electronic Health Records: Results from an International Survey.

This study presents a qualitative content analysis of nurses' satisfaction and issues with current electronic health record (EHR) systems, as reflected in one of the largest international surveys of nursing informatics. Study participants from 45 countries (n=469) ranked their satisfaction with the current state of nursing functionality in EHRs as relatively low. Two-thirds of the participants (n=283) provided disconcerting comments when explaining their low satisfaction rankings. More than one half of the comments identified issues at the system level (e.g., poor system usability; non-integrated systems and poor interoperability; lack of standards; and limited functionality/missing components), followed by user-task issues (e.g., failure of systems to meet nursing clinical needs; non nursing-specific systems) and environment issues (e.g., low prevalence of EHRs; lack of user training). The study results call for the attention of international stakeholders (educators, managers, policy makers) to improve the current issues with EHRs from a nursing perspective.

Visual efference neuromodulates retinal timing: in vivo roles of octopamine, substance P, circadian phase, and efferent activation in Limulus.

Efferent nerves coursing from the brain to the lateral eye of the horseshoe crab, Limulus polyphemus, increase its nighttime sensitivity to light. They release octopamine, which produces a categorical increase of photoreceptor response duration in vitro. Analogous in vivo timing effects on the electroretinogram (ERG) were demonstrated when octopamine was infiltrated into the eye of an otherwise intact animal; nighttime ERGs were longer than daytime ERGs. Related effects on the ERG were produced by daytime electrical stimulation of efferent fibers. Surprisingly, in a departure from effects predicted solely from in vitro octopamine data, nighttime ERG onsets were also accelerated relative to daytime ERG onsets. Drawing on earlier reports, these remarkable accelerations led to an examination of substance P as another candidate neuromodulator. It demonstrated that infiltrations of either modulator into the lateral eyes of otherwise intact crabs increased the amplitude of ERG responses but that each candidate modulator induced daytime responses that specifically mimicked one of the two particular aspects of the timing differences between day- and nighttime ERGs: octopamine increased the duration of daytime ERGs and substance P infiltrated during the day accelerated response onset. These results indicate that, in addition to octopamine's known role as an efferent neuromodulator that increases nighttime ERG amplitudes, octopamine clearly also affects the timing of photoreceptor responses. But these infiltration data go further and strongly suggest that substance P may also be released into the lateral eye at night, thereby accelerating the ERG's onset in addition to increasing its amplitude.

Stable bellows cup electrode demonstrates low-frequency properties of long-term electroretinographic recordings in the Limulus lateral eye.

Conventional methods have long been used to record electroretinograms (ERGs) from the surface of the lateral eye of Limulus, the horseshoe crab. But, using these methods, the convexity of this eye has sometimes led to electrode problems that deterred acceptance of the validity of unexpected and unfamiliar phenomena. To deal with the electrode problem, a new gel/bellows cup electrode has been devised which was created from a small bellows suction cup. Coated with a recording gel and positioned by a massive apparatus arrangement, it maintains a secure connection to the convexity of the lateral eye for many days without requiring any attention after its placement. This new electrode has now been used for thousands of hours of ERG research during which crabs have often been left undisturbed in the apparatus for many days. This new method has revealed the existence of a novel low-frequency phenomenon demonstrated by the occurrence of noise-like fluctuations in successive ERGs. The frequency of these fluctuations is low relative to the properties of the ERG itself. Several converging tests of this new electrode system indicated that this new phenomenon is not an artifact but rather a genuine expression of endogenous bioelectric events.