Psychometric Evaluation of the Modes of Health Information Acquisition, Sharing, and Use Questionnaire: Prospective Cross-Sectional Observational Study.

BACKGROUND: Health information is a critical resource for individuals with health concerns and conditions, such as hypertension. Enhancing health information behaviors may help individuals to better manage chronic illness. The Modes of Health Information Acquisition, Sharing, and Use (MHIASU) is a 23-item questionnaire that measures how individuals with health risks or chronic illness acquire, share, and use health information. Yet this measure has not been psychometrically evaluated in a large national sample. OBJECTIVE: The objective of this study was to evaluate the psychometric properties of the self-administered MHIASU in a large, diverse cohort of individuals living with a chronic illness. METHODS: Sharing Information, a prospective, observational study, was launched in August 2018 and used social media campaigns to advertise to Black women. Individuals who were interested in participating clicked on the advertisements and were redirected to a Qualtrics eligibility screener. To meet eligibility criteria individuals had to self-identify as a Black woman, be diagnosed with hypertension by a health care provider, and live in the United States. A total of 320 Black women with hypertension successfully completed the eligibility screener and then completed a web-based version of the MHIASU questionnaire. We conducted a psychometric evaluation of the MHIASU using exploratory factor analysis. The evaluation included item review, construct validity, and reliability. RESULTS: Construct validity was established using exploratory factor analysis with principal axis factoring. The analysis was constricted to the expected domains. Interitem correlations were examined for possible item extraction. There were no improvements in factor structure with the removal of items with high interitem correlation (n=3), so all items of the MHIASU were retained. As anticipated, the instrument was found to have 3 subscales: acquisition, sharing, and use. Reliability was high for all 3 subscales, as evidenced by Cronbach α scores of .81 (acquisition), .81 (sharing), and .93 (use). Factor 3 (use of health information) explained the maximum variance (74%). CONCLUSIONS: Construct validity and reliability of the web-based, self-administered MHIASU was demonstrated in a large national cohort of Black women with hypertension. Although this sample was highly educated and may have had higher digital literacy compared to other samples not recruited via social media, the population captured (Black women living with hypertension) are often underrepresented in research and are particularly vulnerable to this chronic condition. Future studies can use the MHIASU to examine health information behavior in other diverse populations managing health concerns and conditions.

Prevalence, Correlates, and Outcomes of Co-Occurring Depression and Hypertensive Disorders of Pregnancy.

Background: Depression and hypertensive disorders of pregnancy (HDP) are common morbidities during pregnancy. However, our knowledge about the national prevalence, correlates, and outcomes of co-occurring depression and HDP remains unknown. Materials and Methods: Using a multiyear (2002-2014) nationwide inpatient sample, we conducted a population-based, cross-sectional study. Cases, behavioral and clinical covariates, and outcomes were identified using International Classification of Disease, 9th Revision, Clinical Modification Codes. Rates of depression and HDP were calculated across demographics, hospital characteristics, and morbidities. We estimated adjusted odds ratios that represent the unique and joint association of depression and HDP with birth outcomes. Joinpoint regression was used to describe temporal trends in depression and HDP. Results: Among the over 58-million hospitalizations, there were 2,346,619 (3.99%), 1,117,857 (1.90%), and 63,081 (0.11%) cases of HDP, depression, and co-occurring depression and HDP, respectively. Compared to pregnant women without depression and HDP, women with depression and HDP were 3.41 times (confidence interval [95% CI]: 3.15-3.68), 1.94 times (95% CI: 1.65-2.27), and 4.10 times (95% CI: 3.89-4.32) more likely to experience intrauterine growth restriction, stillbirth, and preterm labor, respectively, even after adjusting for potential demographic, socioeconomic, and clinical confounders. Depression- and HDP-related hospitalizations resulted in an additional cost of over $5 billion during the study period. Conclusion: Depression and HDP are associated with increased risk of adverse birth outcomes and significant health care cost, with HDP being the main driving factor. Screening for both HDP and depression followed by multidisciplinary care could alleviate the health and economic burden of HDP and depression.

Mobile Computing Devices in the Perioperative Environment: A Survey Exploring Uses and Experiences Among Certified Registered Nurse Anesthetists.

The use of mobile computing devices (MCDs) such as smartphones, tablet computers, and laptops among Certified Registered Nurse Anesthetists (CRNAs) in the clinical area may provide benefits as well as pose risks. Limited research is available on the use of MCDs in the practice of nurse anesthesia. The purpose of this study was to answer the following questions: (1) What are the clinical and nonclinical uses of mobile computing devices among Michigan CRNAs? and (2) What are the experiences of Michigan CRNAs with regard to the impact of using these devices on patient care? A descriptive survey design was used to answer the research questions. Findings from the study reveal that CRNAs believe there are many important benefits as well as major risks associated with using MCDs while providing direct patient care. In addition, some respondents either personally experienced or witnessed incidents of distraction, performance declines, or serious anesthesia events as the result of MCD use during patient care. This study elucidates the need for the development and adoption of policies that promote safe, appropriate, patient-centered use of MCDs for the specialty of nurse anesthesia.

Exploring the Relationship Between Resilience and Ostomy Adjustment in Adults With a Permanent Ostomy.

PURPOSE: The aims of this study were to describe the relationship between resilience and ostomy adjustment in adults with permanent stomas and to determine if participants who report higher levels of resilience also report higher levels of adjustment to a permanent ostomy. DESIGN: Descriptive, correlational research design utilizing the Roy Adaptation Model as the theoretical framework was used. SUBJECTS AND SETTING: Persons with permanent stomas were recruited from ostomy support groups on the East Coast of the United States. The study sample included 48 respondents. Their mean age was 66 ± 12.7 years (mean ± SD); the majority (60.4%) were women, had an ileostomy (62.5%), and had a history of inflammatory bowel disease (62.5%). METHODS: Respondents completed a questionnaire that queried demographic and pertinent clinical data, along with 2 previously validated instruments, the Resilience Scale and Ostomy Adjustment Inventory-23. The relationships between levels of resilience, levels of adjustment to an ostomy, and demographic characteristics were examined. RESULTS: Participants with higher levels of ostomy adjustment had higher levels of resilience than respondents who reported lower levels of ostomy adjustment (r = 0.65, P ≤ .01). CONCLUSIONS: Findings from this study suggest that higher levels of resilience facilitate adjustment to a permanent ostomy.

Patient Satisfaction With Electronic Health Record Use by Primary Care Nurse Practitioners.

The purpose of this research study was to determine if satisfaction and communication between the patient and the nurse practitioner are affected by allowing patients to view their electronic health records during the history portion of the primary care office visit compared with patients who do not view their records. A cross-sectional, experimental design was utilized for this study. The intervention group was shown several components of the electronic health record during the history portion of the nurse practitioner assessment. This group's scores on a patient satisfaction survey were compared with those of the control group, who were not shown the electronic health record. The study findings suggest that the introduction of the electronic health record does not affect patients' satisfaction related to the office visit by the nurse practitioner.

The current state of e-prescribing: Implications for advanced practice registered nurses.

PURPOSE: The purpose of this study was to review legislation, barriers and challenges, and current state of e-prescribing (eRx) in the United States. DATA SOURCES: Literature search of CINAHL, MEDLINE, PubMed, and Google Scholar was performed. CONCLUSIONS: Challenges to eRx implementation and effective use include transcription, workflow issues, alert fatigue, educational and tangible reminders, and eRx of controlled substances. IMPLICATIONS FOR PRACTICE: Further research could be best focused on user-friendly and interactive software improvements for both patient and provider use, bidirectional communication, and workflow studies to improve efficiency of eRx.

Impact of Healthcare Information Technology on Nursing Practice.

PURPOSE: To report additional mediation findings from a descriptive cross sectional study to examine if nurses' perceptions of the impact of healthcare information technology on their practice mediates the relationship between electronic nursing care reminder use and missed nursing care. DESIGN: The study used a descriptive design. The sample (N = 165) was composed of registered nurses working on acute care hospital units. The sample was obtained from a large teaching hospital in Southeast Michigan in the fall of 2012. All eligible nursing units (n = 19) were included. METHODS: The MISSCARE Survey, Nursing Care Reminders Usage Survey, and the Impact of Healthcare Information Technology Scale were used to collect data to test for mediation. Mediation was tested using the method described by Baron and Kenny. Multiple regression equations were used to analyze the data to determine if mediation occurred between the variables. FINDINGS: Missed nursing care, the outcome variable, was regressed on the predictor variable, reminder usage, and the mediator variable impact of technology on nursing practice. The impact of healthcare information technology (IHIT) on nursing practice negatively affected missed nursing care (t = -4.12, p < .001), explaining 9.8% of variance in missed nursing care. With IHIT present, the predictor (reminder usage) was no longer significant (t = -.70, p = .48). Thus, the reduced direct association between reminder usage and missed nursing care when IHIT was in the model supported the hypothesis that IHIT was at least one of the mediators in the relationship between reminder usage and missed nursing care. CONCLUSIONS: The perceptions of the impact of healthcare information technology mediates the relationship between nursing care reminder use and missed nursing care. The findings are beneficial to the advancement of healthcare technology in that designers of healthcare information technology systems need to keep in mind that perceptions regarding impacts of the technology will influence usage. CLINICAL RELEVANCE: Many times, information technology systems are not designed to match the workflow of nurses. Systems built with redundant or impertinent reminders may be ignored. System designers must study which reminders nurses find most useful and which reminders result in the best quality outcomes.

Electronic nursing care reminders: implications for nursing leaders.

OBJECTIVE: The aim of this study is to report the results of a replication study of the relationship between self-reported nursing care reminder (NCR) use and missed nursing care. DESIGN: A descriptive cross-sectional correlational design was used. The sample (N = 124) was composed of medical/surgical and ICU RNs working on acute care hospital units in a large Midwestern teaching hospital. METHODS: The MISSCARE Survey, Nursing Care Reminders Usage Survey, and the Impact of Health Care Information Technology Survey were used to collect data. Adjusted hierarchical multiple regression was used to determine study outcomes. RESULTS: Nurses who use NCRs more frequently have decreased reports of missed nursing care. Nurses who perceive the impact of healthcare technology as positive on their practice also have decreased missed nursing care. CONCLUSION: The results of this study suggest that NCRs are an effective intervention to decrease missed nursing care in acute care hospitals.

Nurses' use of clinical decision support: a literature review.

Little is known regarding nurses' usage of clinical decision support systems. A review of the literature was conducted to understand the extant knowledge surrounding the topic of nurses' usage of clinical decision support systems. The common themes that emerged from the review of literature on clinical decision support systems usage by nurses include (1) nurse factors affecting usage, (2) patient factors affecting usage, (3) technology and design factors affecting usage, and (4) organizational factors affecting usage. Two major implications are that these systems may not be designed to support nursing practice and may not be having the intended effect on patient care and quality.

Lost opportunities...the challenges of "missed nursing care".

Learn how to define, identify, and ultimately avoid missed nursing care within your organization.

The relationship between electronic nursing care reminders and missed nursing care.

The purpose of the study was to explore relationships between nurses' perceptions of the impact of health information technology on their clinical practice in the acute care setting, their use of electronic nursing care reminders, and episodes of missed nursing care. The study aims were accomplished with a descriptive design using adjusted correlations. A convenience sample (N = 165) of medical and/or surgical, intensive care, and intermediate care RNs working on acute care hospital units participated in the study. Nurses from 19 eligible nursing units were invited to participate. Adjusted relationships using hierarchical multiple regression analyses indicated significant negative relationships between missed nursing care and nursing care reminders and perceptions of health information technology. The adjusted correlations support the hypotheses that there is a relationship between nursing care reminder usage and missed nursing care and a relationship between health information technology and missed nursing care. The relationships are negative, indicating that nurses who rate higher levels of reminder usage and health information technology have decreased reports of missed nursing care. The study found a significant relationship between nursing care reminders usage and decreased amounts of missed nursing care. The findings can be used in a variety of improvement endeavors, such as encouraging nurses to utilize nursing care reminders, aid information system designers when designing nursing care reminders, and assist healthcare organizations in assessing the impact of technology on nursing practice.

Perceptions of weight loss experience between African-Americans and Caucasians: a pilot study.

BACKGROUND: Obesity is a growing epidemic in the USA, which leads to comorbidities associated with diseases such as hypertension, diabetes, sleep apnea, cardiovascular disease, osteoarthritis, cancer, gallbladder disease, and dyslipidemia. The purpose of this study is to identify perceptions of weight loss experience between African-American (AA) and Caucasian patients undergoing bariatric surgery. METHODS: A convenience sample of 31 patients participated in this study from May to June 2013. The sample size consisted of 16 AA and 15 Caucasians from two fully accredited and licensed bariatric clinics in metropolitan Detroit. RESULTS: The sample (N = 31) consists of eligible AA and Caucasian presurgical bariatric patients on their first preoperative appointment. Snacking and sexual satisfaction showed a significant difference (p < 0.05), lower amongst Caucasians than amongst the AA. The results revealed that salary within the AA population was significantly lower than that of the Caucasians, especially in the $26.000 to $36,000 category as well as in the over $40,000 category. CONCLUSIONS: The discrepancy widened as the variables of snacks, sexual satisfaction, and salary revealed a significant difference for Caucasians than AA. It is prudent that health-care providers become part of the obesity management solution by examining these variables when planning weight loss interventions.

Barcode medication administration work-arounds: a systematic review and implications for nurse executives.

Safe medication administration is necessary to ensure quality healthcare. Barcode medication administration systems were developed to reduce drug administration errors and the related costs and improve patient safety. Work-arounds created by nurses in the execution of the required processes can lead to unintended consequences, including errors. This article provides a systematic review of the literature associated with barcoded medication administration and work-arounds and suggests interventions that should be adopted by nurse executives to ensure medication safety.

Initial psychometric evaluation of the nursing quality and safety self-inventory.

Few instruments are available to measure nursing students' quality and safety competencies. The authors developed and tested the psychometric properties of the Nursing Quality and Safety Self-Inventory (NQSSI), an 18-item, self-rated instrument to measure nursing students' quality and safety knowledge, skills, and attitudes. All pre-licensure baccalaureate nursing students (N = 176) enrolled in a leadership and management course at a midwestern school of nursing completed the self-inventory. Construct validity was established with exploratory factor analysis using principal axis factoring with direct oblimin rotation. The instrument was found to be composed of two subscales, knowledge and attitudes, which explained 53.8% of total variance. The internal consistency coefficient (Cronbach's alpha) was 0.93 for the total inventory and ranged from 0.88 to 0.92 for the two subscales. Contrast validity and effectiveness of the NQSSI for measuring nursing students' self-rated quality and safety competencies was supported.

Empirical review supporting the application of the "pain assessment as a social transaction" model in pediatrics.

Despite decades of research, national mandates, and widespread implementation of guidelines, recent reports suggest that the quality of pain assessment and management in hospitalized children remains suboptimal. The mismatch between what is advocated and what is done in practice has led experts to argue for a conceptual shift in thinking, where the pain assessment process is viewed from a complex social communication or transaction framework. This article examines the empirical evidence from the recent pediatric pain assessment and decision-making literature that supports adaptation of Schiavenato and Craig's "Pain Assessment as a Social Transaction" model in explaining pediatric acute pain management decisions. Multiple factors contributing to children's pain experiences and expressions are explored, and some of the difficulties interpreting their pain scores are exposed. Gaps in knowledge related to nurses' clinical pain management decisions are identified, and the importance of children's and parents' preferences and roles and the influence of risks and adverse events on decision making are identified. This review highlights the complexity of pediatric nurses' pain management decisions toward the clinical goal of improving comfort while minimizing risk. Further study evaluating the propositions related to nurses' decisions to intervene is needed in pediatric clinical settings to better synthesize this model for children.

Integrating quality and safety competencies into undergraduate nursing using student-designed simulation.

The purpose of this study was to determine whether an innovative teaching approach, a student-led simulation, was effective in increasing students' quality and safety knowledge, skills, and attitudes in the six Quality and Safety Education for Nurses competency areas. The sample included students (N = 141) enrolled in a traditional and accelerated leadership course in the baccalaureate-nursing program at a midwestern public university during the fall 2009 semester. A quasi-experimental pretest and posttest design was used. Paired-samples t tests were used to analyze the data. Overall scores on the self-inventory in the traditional (p < 0.001) and accelerated (p = 0.011) groups significantly increased. Knowledge and safety test scores in both the traditional (knowledge: p < .001; safety: p = 0.028) and accelerated (knowledge: p = 0.027; safety: p = 0.03) groups increased significantly. The innovation significantly improved students' self-efficacy and knowledge related to the quality and safety competencies.

Exploring the clinical information system implementation readiness activities to support nursing in hospital settings.

The implementation of clinical information systems can have a profound impact on nurses and their productivity. Poorly implemented systems can lead to unintended consequences that may have a negative impact on clinical processes and patient outcomes. Executives must have adequate knowledge to address nurses' concerns related to implementation. This study explored the clinical information system implementation readiness activities adopted by chief nurse executivesin hospital settings. A descriptive qualitative design was used, including interviews with six chief nurse executives, held from December 2003 through March 2004. The constant comparative method was used to analyze the interviews to extract readiness activity themes and compare these to the literature. The synthesized themes showed that the executives were knowledgeable about and engaged in several key areas, but not all, of the implementation readiness process. The majority of responses were classified into the thematic areas of champion support, staff preparation for change, training, organizational alignment, planning, and vendor support. The theme of a lack of vendor support was not identified in previous studies but was clear in the responses of the chief nurse executives interviewed.