Nurses' experiences of their decision-making process when participating in clinical trials during the 2014-2016 West African Ebola crisis.

OBJECTIVE: Due to the absence of a licenced vaccine or drug for treatment of Ebola patients during the 2014-2016 West Africa outbreak, frontline nurses were at increased risk of exposure. Hence, they were prioritized to participate in clinical trials to receive experimental therapeutics. To our knowledge no study has explored the nurses' experiences of their decision-making process when volunteering in clinical trials using unproven agents, which is the purpose of this qualitative study. METHODS: This study, part of a larger Ebola study, thematically analyzed the interview data of nine nurses recruited from Sierra Leone, Guinea and Liberia; of which four joined a convalescent plasma trial and five a vaccine trial. RESULTS: In their decision-making process to partake in a clinical trial, nurses identified two distinct decision points: the initial commitment followed by the point of no return when they presented themselves to participate. Each of these decisions were influenced by risk versus benefits calculations, and contextual factors. CONCLUSION: Results showed the need for more health education and communication around the unproven agents in order for nurses to make informed decisions.

Experiences of women receiving mhealth-supported antenatal care in the village from community health workers in rural Burkina Faso, Africa.

OBJECTIVE: This qualitative study explored the experiences of women receiving mhealth-supported antenatal care in a village, from community health workers (CHWs) in rural Burkina Faso, Africa. INTERVENTION: CHWs entered patient clinical data manually in their smartphone during their home visits. All wireless transferred data was monitored by the midwives in the community clinic for arising medical complications. METHODS: Semi-structured interviews were conducted with 19 pregnant women, who were housewives, married and their age ranged from 18 to 39 years. None had completed their formal education. Depending on the weeks of gestation during their first antenatal care visit, length of enrollment in the project varied between three and eight months. Transcripts were content-analyzed. RESULTS: Despite the fact that mhealth was a novel service for all participants, they expressed appreciation for these interventions, which they found beneficial on three levels: 1) it allowed for early detection of pregnancy-related complications, 2) it was perceived as promoting collaboration between CHWs and midwives, and 3) it was a source of reassurance during a time when they are concerned about their health. Although not unanimous, certain participants said their husbands were more interested in their antenatal care as a result of these services. CONCLUSION: Findings suggested that mhealth-supported visits of the CHWs have the potential to increase mothers' knowledge about their pregnancy and, as such, motivate them to attend more ANC visits. In response to this increased patient engagement, midwives approached women differently, which led to the mothers' perception of improvement in the patient-provider relationship. Results also indicated that mhealth may increase spousal involvement, as services are offered at home, which is an environment where spouses feel more comfortable.

The educational gaps of nurses in entrepreneurial roles: An integrative review.

Nurse entrepreneurship remains a foreign concept in education, forcing nurses to turn to graduate degrees in business and finance or otherwise, learn 'as they go'. Before addressing the question 'Why does nursing curricula exclude business content and skill development?', one must evaluate the perceived educational gaps of current nurse entrepreneurs; the purpose of this integrative review. An initial total of 2485 articles was generated in September 2016, of which 15 methodologically-diverse studies, published between 1977 and 2015, were appraised using the QATSSD tool. Perceptions of business-related educational gaps were categorized into 4 leadership skillsets: cognitive, interpersonal, business and strategic. Cognitive skills were further subdivided into self-regulation, professional know-how, and grasping the larger context; Interpersonal skills consisted of networking and selling your services, dealing with contextual resistance, and communicating clearly; Business skills were regrouped into mitigating and managing risk, marketing, financial and operations management; and lastly, Strategic skills were all related to knowing how to start a business. Business mindedness is not readily integrated into our collective professional identity resulting in an exclusion of this content from nursing curricula. To address service gaps, nurses should be introduced to entrepreneurial concepts during initial training with an option of further specialization for those considering a business career.

Determining the cost of implementing and operating a remote patient monitoring programme for the elderly with chronic conditions: A systematic review of economic evaluations.

Introduction Remote patient monitoring (RPM) in conjunction with home nursing visits is becoming increasingly popular for the follow-up of patients with chronic conditions and evidence exists that it improves patients' health outcomes. Current cost data is reported inconsistently and often gathered from studies of poor methodological quality, making it difficult for decision-makers who consider implementing this service in their organizations. This study reviewed the cost of RPM programmes targeting elderly patients with chronic conditions. Methods After evaluation against the inclusion and exclusion criteria and appraisal against two criteria which are important for economic evaluations, data from selected studies were extracted and grouped into meaningful cost categories, then adjusted to reflect November 2015 US dollars. Results In the 13 selected studies, the newly-created cost category 'Combined intervention cost' (reflecting equipment purchasing, servicing and monitoring cost) for the various RPM programmes ranged from US$275-US$7963 per patient per year. The three main findings are: (a) RPM programme costs have decreased since 2004 due to cheaper technology; (b) monitoring a single vital sign is likely to be less costly than monitoring multiple vital signs; and (c) programmes targeting hypertension or congestive heart failure are less costly than those targeting respiratory diseases or multiple conditions. Conclusions This review recommends that future studies present their cost data with more granularity, that grouping of costs should be minimized and that any assumptions, such as amortization, should be made explicit. In addition, studies should compare programmes with similar characteristics in terms of type of conditions, number of vital signs monitored, etc. for more generalizable results.

Nursing students' perceptions of using smartphones in the community practicum: A qualitative study.

BACKGROUND: Smartphones have the potential to revolutionize the way in which nurses practice by facilitating access to evidence-based resources, however their integration in nursing practice remain variable. Millennials tend to be more comfortable with technology, yet find themselves limited in their ability to use smartphones within the context of clinical practice. METHODS/DATA SOURCES: Using a qualitative descriptive design, we explored nursing students' perceptions of using smartphones in the community practicum. Individual semi-structured interviews were conducted and verbatim transcripts were subjected to data analysis. PARTICIPANTS: The sample consisted of 8 undergraduate and graduate nursing students. Participants were recruited using a purposive sampling strategy. RESULTS: Students' narratives describe unclear expectations regarding the use of smartphones that force them to adopt individualized strategies to maintain their professional image and avoid negative consequences. CONCLUSION: A cultural shift will be required at the academic and organizational levels if we are to foster acceptance of smartphones in community practice going forward.