Creating Case Studies for Digital Health and Technology Competency in Nursing.

BACKGROUND: Nursing programs and their faculty must ensure that graduates have the informatics, digital health, and health care technologies competencies needed by health systems. PROBLEM: A gap exists in nursing faculty knowledge, skills, and abilities for incorporating informatics, digital health, and technologies across curricula because of low focus on this area in faculty development initiatives and rapid adoption and evolution of technologies in health care systems. APPROACH: The Nursing Knowledge Big Data Science initiative Education Subgroup used a process to create case studies for including informatics, digital health, and the concomitant clinical reasoning/critical thinking competencies across curricula. OUTCOMES: Three case study examples were created using the process. CONCLUSIONS: The process for creating case studies that incorporate required informatics, digital health, and health care technologies can be used by nursing educators for teaching across their curricula and to assess student competency.

Development of the Leapfrog Group's Bar Code Medication Administration Standard to Address Hospital Inpatient Medication Safety.

ABSTRACT: Medication errors are the most common type of error in hospitals and reflect a leading cause of avoidable harm to patients. Bar code medication administration (BCMA) systems are a technology designed to help intercept medication errors at the point of medication administration. This article describes the process of developing, testing, and refining a standard for BCMA adoption and use in U.S. hospitals, as measured through the Leapfrog Hospital Survey. Building on the published literature and an expert panel's collective experience in studying, implementing, and using BCMA systems, the expert panel recommended a standard with 4 key domains. Leapfrog's BCMA standard provides hospitals with a "how-to guide" on what best practice looks like for using BCMA to ensure safe medication administration at the bedside.

A comparative ethnography of nutrition interventions: Structural violence and the industrialisation of agrifood systems in the Caribbean and the Pacific.

Public health interventions that involve strategies to re-localise food fail in part because they pay insufficient attention to the global history of industrial food and agriculture. In this paper we use the method of comparative ethnography and the concept of structural violence to illustrate how historical and geographical patterns related to colonialism and industrialisation (e.g. agrarian change, power relations and trade dependencies) hinder efforts to address diet-related non-communicable diseases on two small islands. We find comparative ethnography provides a useful framework for cross-country analysis of public health programmes that can complement quantitative analysis. At the same time, the concept of structural violence enables us to make sense of qualitative material and link the failure of such programmes to wider historical and geographical processes. We use ethnographic research carried out from April to August 2013 and from June to July 2014 in Trinidad (with follow-up online interviews in 2018) and in Nauru from February to May 2010 and August 2010 to February 2011. Our island case studies share commonalities that point to similar experiences of colonialism and industrialisation and comparable health-related challenges faced in everyday life.

Nursing, Professional Curiosity and Big Data CoCreating eHealth.

This paper describes work that has taken place over the past three years in the form of an annual deep dive study track within a national conference setting. The work explores the changing influence that big data, and in particular population and social determinants of health data, makes upon the generation of co-created eHealth within a nursing domain. Working with delegates, many of whom returned year after year, the paper reports the discussion themes and ideas that evolved over time. The paper is presented as an example of connected reasoning and personal development by all those involved and is offered as a distributed think tank for further discussion and debate.

Population health: a nursing action plan.

The passage of the Affordable Care Act shifted the focus of health care from individual, patient specific, episodic care, towards health management of groups of people with an emphasis on primary and preventive care. Population health management assists to attain and maintain health while improving quality and lowering costs. The recent Catalyst for Change report creates an urgent call for harnessing the power of nurses-in our communities, schools, businesses, homes and hospitals-to build capacity for population health. Informatics Nurse Specialists are prepared to bridge roles across practice, research, education, and policy to support this call. Each year, the AMIA Nursing Informatics Working Group convenes an expert panel to reflect on the "hot topics" of interest to nursing. Not surprisingly, the 2017 topic was on the current state and challenges of population health. The following summary reflects the panel's perspectives and recommendations for action.

Evaluation of a Postdischarge Call System Using the Logic Model.

This mixed-method study was conducted to evaluate a postdischarge call program for congestive heart failure patients at a major teaching hospital in the southeastern United States. The program was implemented based on the premise that it would improve patient outcomes and overall quality of life, but it had never been evaluated for effectiveness. The Logic Model was used to evaluate the input of key staff members to determine whether the outputs and results of the program matched the expectations of the organization. Interviews, online surveys, reviews of existing patient outcome data, and reviews of publicly available program marketing materials were used to ascertain current program output. After analyzing both qualitative and quantitative data from the evaluation, recommendations were made to the organization to improve the effectiveness of the program.

A Facebook-Based Obesity Prevention Program for Korean American Adolescents: Usability Evaluation.

INTRODUCTION: Adolescent obesity is one of the most serious global public health challenges. Social networking sites are currently popular among adolescents. Therefore, the obesity prevention program for Korean American adolescents was developed on the most popular social networking site, Facebook. The purpose of this study was to evaluate the usability of a culturally tailored Facebook-based obesity prevention program for Korean American adolescents (Healthy Teens). METHOD: An explorative descriptive design of usability testing was used. Usability testing employing one-on-one observation, the think-aloud method, audio taping, screen activity capture, and surveys was performed. Twenty participants were recruited from two Korean language schools (mean age, 15.40 ± 1.50 years). Recruitment and user testing was performed between February and April 2014. Content analysis, using the inductive coding approach, was performed by three coders to analyze transcriptions. Descriptive statistics were used to analyze quantitative data including demographic characteristics, perceived usability, eHealth literacy, and health behaviors. RESULTS: Testing revealed several usability issues in content, appearance, and navigation. Participants' comments regarding content were positive. Although the Facebook platform provided limited flexibility with respect to building the site, participants described the program's appearance as appropriate. Most participants did not experience difficulty in navigating the program. DISCUSSION: Our preliminary findings indicated that participants perceived the Healthy Teens program as usable and useful. This program could be used as a robust platform for the delivery of health education to adolescents. Further research is required to assess the effects of Facebook-based programs on adolescent obesity prevention.

Using Clinical Decision Support and Dashboard Technology to Improve Heart Team Efficiency and Accuracy in a Transcatheter Aortic Valve Implantation (TAVI) Program.

Heart Team meetings are becoming the model of care for patients undergoing transcatheter aortic valve implantations (TAVI) worldwide. While Heart Teams have potential to improve the quality of patient care, the volume of patient data processed during the meeting is large, variable, and comes from different sources. Thus, consolidation is difficult. Also, meetings impose substantial time constraints on the members and financial pressure on the institution. We describe a clinical decision support system (CDSS) designed to assist the experts in treatment selection decisions in the Heart Team. Development of the algorithms and visualization strategy required a multifaceted approach and end-user involvement. An innovative feature is its ability to utilize algorithms to consolidate data and provide clinically useful information to inform the treatment decision. The data are integrated using algorithms and rule-based alert systems to improve efficiency, accuracy, and usability. Future research should focus on determining if this CDSS improves patient selection and patient outcomes.

Using Dashboard Technology and Clinical Decision Support Systems to Improve Heart Team Efficiency and Accuracy: Review of the Literature.

AIM: This review aimed to provide a comprehensive overview of the current state of evidence for the use of clinical dashboards and clinical decision support systems (CDSS) in multidisciplinary teams. METHODS: A literature search was performed for the dates 2004-2014 on CINAHL, Medline, Embase, and Cochrane Library. A citation search and a hand search of relevant papers were also conducted. RESULTS: (One hundred and twelve full text papers were retrieved of which 22 were included in the review.) There was considerable heterogeneity in setting, users, and indicators utilized. Information on usability and human-computer interaction was thoroughly reviewed. There was evidence that dashboards were associated with improved care processes when end-user input was incorporated and information was concurrent, pertinent and intuitive. CONCLUSION: There is some evidence that implementing clinical dashboards and/or CDSS that provide immediate access to current patient information for clinicians can improve processes and patient outcomes.

Nursing and eHealth: Are We Preparing Our Future Nurses as Automatons or Informaticians?

The Education Working Group of IMIA NI present this thought provoking panel where the changing and challenging role of nursing will be explored within the information intensive eHealth arena. The session will be of interest to any nurse as the discussion will be driven by the objective of trying to understand how best to prepare nurses to be actively engaged in information and communication technology (ICT) developments that enhance care assessment, delivery, evaluation and audit. As a balance, the discussion will consider the increasing emergence of 'nursing by numbers' where risk assessment tools are used in an automatic way leaving little room for individual evidenced based care.

Towards Implementing a Global Competency-Based Nursing and Clinical Informatics Curriculum: Applying the TIGER Initiative.

This workshop will review the history of the TIGER initiative in order to set the framework for an understanding of international informatics competencies. We will include a description of clinical nursing informatics programs in 37 countries as well as the results of a recent survey of nursing competencies in order to further discussions of internationally agreed-upon competency definitions. These two surveys will provide the basis for developing a consensus regarding the integration of core competencies into informatics curriculum developments. Expected outcomes include building consensus on core competencies and developing plans toward implementing intra- and inter-professional informatics competencies across disciplines globally.

Exploring Community Planning Thinking as a Model for Use Case Development.

There are many vetted technical and semantic standards promulgated within the United States and the United Kingdom to operationalize eHealth interoperability in order to improve care outcomes, manage population health, and provide efficient information exchange between providers, services, patients and consumers. However, consideration must be given to the complex real world use cases in which the data and information will be exchanged between a wide variety of interested parties, including the consumer or patient. In many instances, community based use cases need development in order to serve as the model. These use cases can only be accurately described and created by using a wide lens viewpoint such as community-planning engages, which requires that all interested parties be actively involved. This poster will introduce models of community planning that can be developed and led by the Nurse Informatician.

Electronic Personal Health Record Use Among Nurses in the Nursing Informatics Community.

An electronic personal health record is a patient-centric tool that enables patients to securely access, manage, and share their health information with healthcare providers. It is presumed the nursing informatics community would be early adopters of electronic personal health record, yet no studies have been identified that examine the personal adoption of electronic personal health record's for their own healthcare. For this study, we sampled nurse members of the American Medical Informatics Association and the Healthcare Information and Management Systems Society with 183 responding. Multiple logistic regression analysis was used to identify those factors associated with electronic personal health record use. Overall, 72% were electronic personal health record users. Users tended to be older (aged >50 years), be more highly educated (72% master's or doctoral degrees), and hold positions as clinical informatics specialists or chief nursing informatics officers. Those whose healthcare providers used electronic health records were significantly more likely to use electronic personal health records (odds ratio, 5.99; 95% confidence interval, 1.40-25.61). Electronic personal health record users were significantly less concerned about privacy of health information online than nonusers (odds ratio, 0.32; 95% confidence interval, 0.14-0.70) adjusted for ethnicity, race, and practice region. Informatics nurses, with their patient-centered view of technology, are in prime position to influence development of electronic personal health records. Our findings can inform policy efforts to encourage informatics and other professional nursing groups to become leaders and users of electronic personal health record; such use could help them endorse and engage patients to use electronic personal health records. Having champions with expertise in and enthusiasm for the new technology can promote the adoptionof electronic personal health records among healthcare providers as well as their patients.

Electronic personal health record use among registered nurses.

INTRODUCTION: Nurses promote self-care and active participation of individuals in managing their health care, yet little is known about their own use of electronic personal health records (ePHRs). The purpose of this study was to examine factors associated with ePHR use by nurses for their own health management. METHODS: A total of 664 registered nurses working in 12 hospitals in the Maryland and Washington DC area participated in an online survey from December 2013 to January 2014. Multiple logistic regression models identified factors associated with ePHR use. RESULTS: More than a third (41%; 95% confidence interval [CI], 0.37-0.44) of the respondents were ePHR users. There was no variation between ePHR users and nonusers by demographic or job-related information. However, ePHR users were more likely to be active health care consumers (i.e., have a chronic medical condition and take prescribed medications; odds ratio [OR] = 1.64; 95% CI, 1.06-2.53) and have health care providers who used electronic health records for care (OR = 3.62; 95% CI, 2.45-5.36). CONCLUSIONS: Nurses were proactive in managing their chronic medical conditions and prescribed medication use with ePHRs. ePHR use by nurses can be facilitated by increasing use of electronic health records.

Second Life simulation as a strategy to enhance decision-making in diabetes care: a case study.

AIMS AND OBJECTIVES: The case study evaluated the Second Life perceived usability and the decision-making of insulin administration via situational awareness at two different simulation freezes during Second Life simulation. BACKGROUND: Due to safety issues stemming from nursing knowledge deficits of insulin administration, the use of simulation via practice in a virtual immersive environment, Second Life was evaluated in a case study of practicing nurses. DESIGN: This case study used a single convenience group, post-test design. METHODS: Perceived usability was evaluated using the System Usability Scale. Evaluation of decision-making was evaluated via Situational Awareness Score at two simulation freezes in the Second Life simulation with practicing nurses (n = 12). RESULTS: Nurses with more years of practice reported difficulty in using Second Life. As age increased, the total Situational Awareness Score decreased. Day shift nurses were more likely to obtain a High Situational Awareness Score. CONCLUSIONS: Although usability was nearly obtained, virtual immersive environments for nurses has promise to provide practice in aiding clinical decision-making. RELEVANCE TO CLINICAL PRACTICE: Finding a new platform to allow all nurses to practice difficult clinical decisions is key. A virtual immersive environment, like Second Life, can provide simulation for nurses to practice making such difficult decisions.

Data analytics: making the most of input with strategic output.

In this department, Drs Murphy, Wilson, and Newhouse highlight hot topics in nursing outcomes, research, and evidence-based practice relevant to the nurse administrator. The goal is to discuss the practical implications for nurse leaders in diverse healthcare settings. Content includes evidence-based projects and decision making, locating measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demonstrate innovative approaches to organizational problems. In this article, the authors will describe data analytics and explore the potential for data analytics in meaningful use implementation to enhance executive decision making.