Perspectives on the implementation of health informatics curricula frameworks.

BACKGROUND: The COVID-19 pandemic highlighted the necessity of equipping health professionals with knowledge and skills to effectively use digital technology for healthcare delivery. However, questions persist about the best approach to effectively educate future health professionals for this. A workshop at the 15th Nursing Informatics International Congress explored this issue. OBJECTIVE: To report findings from an international participatory workshop exploring pre-registration informatics implementation experiences. METHODS: A virtual workshop was held using whole and small group interactive methods aiming to 1) showcase international examples of incorporating health informatics into pre-registration education; 2) highlight essential elements and considerations for integrating health informatics into curricula; 3) identify integration models of health informatics; 4) identify core learning objectives, resources, and faculty capabilities for teaching informatics; and 5) propose curriculum evaluation strategies. The facilitators' recorded data and written notes were content analysed. RESULTS: Fourteen participants represented seven countries and a range of educational experiences. Four themes emerged: 1) Design: scaffolding digital health and technology capabilities; 2) Development: interprofessional experience of and engagement with digital health technology capabilities; 3) implementation strategies; and 4) Evaluation: multifaceted, multi-stakeholder evaluation of curricula. These themes were used to propose an implementation framework. DISCUSSION: Workshop findings emphasise global challenges in integrating health informatics into curricula. While course development approaches may appear linear, the learner-centred implementation framework based on workshop findings, advocates for a more cyclical approach. Iterative evaluation involving stakeholders, such as health services, will ensure that health professional education is progressive and innovative. CONCLUSIONS: The proposed implementation framework serves as a roadmap for successful health informatics implementation into health professional curricula. Prioritising engagement with health services and digital health industry is essential to ensure the relevance of implemented informatics curricula for the future workforce, acknowledging the variability in placement experiences and their influence on informatics exposure, experience, and learning.

Preliminary Results of a Grounded Theory Study on Using Mobile Health for Physical Activity.

As the first stage of substantive theory building, this study explored the behavioral responses of people with long-term weight concerns using mHealth to increase their physical activity within a New Zealand context. A constructivist grounded theory method was adopted. Twenty-two participants with long-term weight concerns and personal experience using mobile health to increase physical activity participated in in-depth interviews. Four themes and eight categories were conceptualized: motivation, physical activity behavioral responses, mobile health evaluation, and social interaction. The role of mobile health in increasing physical activity and improving overall wellness is broadly acknowledged and facilitates, to some extent, the social interactions among family, friends and the wider community.

Nurse prescriber's understanding of their antimicrobial stewardship role: a qualitative study.

Introduction Antimicrobial resistance is an infectious disease threat to public health globally, and antimicrobial stewardship among healthcare professionals is one key way to address this potential problem. Registered nurse designated prescribers are the newest group of health professionals to gain prescribing authority in Aotearoa New Zealand, yet little is known about their understanding of their antimicrobial stewardship role. Aim The aim of this study was to explore registered nurse designated prescribers' understanding of their antimicrobial stewardship role through their prescribing practices and approaches to clinical reasoning. Methods This exploratory descriptive qualitative study used individual semi-structured interviews with six registered nurse designated prescribers. Thematic analysis was used to analyse the interviews. Results Four themes were identified: antibiotic prescribing practices and antimicrobial resistance; clinical indicators for prescribing antibiotics, with the sub-themes of history taking, presence of infection and bacterial versus viral infection; patient education; and safety and monitoring. These themes provide insight into registered nurse designated prescribers' understanding of their antimicrobial stewardship role and prescribing of antibiotics. Discussion This research found that the registered nurse designated prescribers had an awareness of the importance of their antimicrobial stewardship role in relation to antibiotic prescribing and reducing antimicrobial resistance. Education about antimicrobial resistance and antimicrobial stewardship for this professional group can be effective, but further research is needed to understand their ongoing educational needs.

Exploring medicines information needs of mental health service users at a New Zealand hospital.

Providing effective medicines information to individuals can improve outcomes, yet little is known about what information mental health service users need and want about their medicines, and how best to deliver this. The aim of this study was to explore the medicines information needs of mental health service users. Adults (n=30) under the care of acute mental health services in a New Zealand hospital were invited to take part in semi-structured interviews or a focus group to explore preferences for medicines information. Interview data were analysed using an inductive thematic approach. Six key themes were identified: 1) personalisation of information, 2) adverse and beneficial effects, 3) relationships and trust, 4) informed choice, 5) use of reliable internet resources and 6) involvement of family and support people. Preferences on content, timing, provider and format of information delivery were highly individualised indicating the need for information to be personalised to the needs of the service user. A trusted relationship with their healthcare provider was essential . Making informed decisions reduced confusion or fear about medicines. Understanding medicines information needs of patients can help improve the education health professionals provide on medicines, thus potentially improving patient engagement and outcomes.

User perceptions of mobile digital apps for mental health: Acceptability and usability - An integrative review.

WHAT IS KNOWN ON THE SUBJECT?: Mobile mental health apps are increasingly being used by both mental health nurses to promote individual self-managemental of mental health conditions and by consumers. Perceptions about specific apps are known, but the overarching acceptability and usability of mental health apps in general less understood. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper identified consumer perceptions of mobile mental health apps. Six key areas were identified that future mobile app developers should consider to maximize consumer engagement with mental health apps. Consumers also highlighted that apps do not replace traditional mental health nursing-rather these supplement existing care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This review found that mental health apps are generally viewed positively by consumers; however, factors such as ease of use, usefulness of content and privacy need to be considered to maximise and sustain app engagement. ABSTRACT: Introduction There is increasing interest in the use of mobile mental health applications (apps) to manage mental health conditions. Understanding user perceptions is key to maximise app engagement and inform how apps can be used to support mental health nursing care. Aim This integrative review explores consumers' perceptions of mobile mental health apps to gain insight into user preferences and acceptability. Methods This integrative review was based on searching four databases: CINAHL, EMBASE, Medline, PsycInfo. Inclusion criteria were: (i) articles published after 2000; (ii) focused on apps for mental health disorders; (iii) explored consumers' perception of using a mental health app. Abstracts were screened and eligible papers reviewed. Data on user perceptions were extracted and analysed thematically. Results Seventeen articles were identified. Overall, consumers did not feel that app use replaced traditional health care. Six themes were identified: "Helpfulness," "Improvements/enhancements," "Technical issues," "Easy to use," "Satisfaction with the app" and "Perceived issues." Consumers indicated a preference for personalization for the app to meet individual needs. Discussion and Implications for Practice Mental health apps are generally viewed positively by consumers; however, factors such as ease of use, usefulness of content and privacy need to be considered to maximise and sustain app engagement.

Identifying How to Support Nurse Educators Nationally to Teach Nursing Informatics.

Preparing nurses for practice and ensuring nursing informatics is included in their curricula is a challenge for many nurse educators. This study asked nurse educators from around New Zealand (n=40) what they perceived as the concerns, barriers and facilitators to implementing nursing informatics within their curricula. Among the findings a key issue is the constantly evolving nature of information and communication technology in healthcare and nursing which results in the ongoing need for professional development to keep up-to-date. Outcomes from this study are recommendations which will inform our next steps in this project to support nurse educators provide the best education possible for new nurses.

Using Technology as a Novel Method to Develop Students' Clinical Reasoning Skills Through Virtual Collaborative Learning in Scriptwriting.

One of the most important skills students need to learn in applying pharmacotherapeutics is clinical reasoning. This study aimed to evaluate the impact of virtual collaboration in scriptwriting as a teaching approach to develop clinical reasoning skills. Data was from student feedback (n=102). Discussing conceptual questions in a collaborative learning environment with peers proved to support the development of clinical reasoning skills as the activity increased interactivity, improved understanding and retention. Findings show that the development of clinical reasoning skills were enhanced with the use of scriptwriting as a virtual collaborative activity.

An Integrative Literature Review on Older Adults, Their eHealth Literacy and Use of Telehealth.

Healthcare is challenged by providing high-quality, equitable and timely access to care for older adults. Telehealth can address these challenges, however, a level of eHealth literacy is required. This integrative literature review sought to understand the experiences of older adult patients with poor eHealth literacy who use telehealth. Results include that older adults with less eHealth literacy have many concerns engaging with telehealth and irrespective of their eHealth literacy, most need support to use telehealth.

Digital professionalism on social media: A narrative review of the medical, nursing, and allied health education literature.

BACKGROUND: Medical, nursing, and allied health students, and professionals are using online environments such as social media to communicate and share information. However, some have difficulty differentiating between their professional and personal roles and can behave inappropriately online. Better education and training may help prevent these issues from arising. OBJECTIVE: Identify and synthesise literature on educating healthcare students and practitioners about digital professionalism on social media. METHOD: Four databases i.e., CINAHL, ERIC, MEDLINE and PubMed were searched using relevant terms. Five hundred and twenty-two articles were found and screened. Data extraction and critical appraisal were conducted. Analysis followed Braun and Clarke's six phases of thematic analysis. RESULTS: Eleven studies were included in the review. Digital professionalism was taught across medicine, nursing, and allied health education using a number of pedagogical approaches including traditional face-to-face teaching, as well as fully online, and blended methods. Its impact on learning centred on acquiring knowledge about communicating appropriately on social media which appeared to change how some students and practitioners behaved online, while improving confidence and information literacy. Developing and delivering education on digital professionalism tended to be affected by the amount of time faculty and trainers had to create curricula, organise and deliver teaching, and support students and clinicians. The design of the online platform seemed to be important as some had more functionality than others, allowing for greater interaction, which appeared to keep learners engaged. DISCUSSION AND CONCLUSION: This review provides the first synthesis of literature on educating the medical, nursing, and allied health professions on digital professionalism on social media. The results identify potential issues, knowledge gaps, and highlight implications for future educational interventions. Recommendations include setting clear boundaries and pedagogical instructions, understanding and applying privacy settings online, and utilising co-creation approaches with students and practitioners to improve the quality of health education.

What information do patients want about their medicines? An exploration of the perspectives of general medicine inpatients.

BACKGROUND: Medicines are one of the most common healthcare interventions, yet evidence shows patients often do not receive the information they want about their medicines. This affects their adherence and healthcare engagement. There is limited research exploring what information patients want about their medicines, from whom and in what format. The aim of this study was to determine the medicines information needs of patients admitted to the general medical service of a large New Zealand (NZ) hospital, and identify the barriers and enablers to meeting these needs. METHODS: A descriptive exploratory approach using semi-structured interviews was used to understand the needs and preferences of patients for information about their regular medicines and the barriers and facilitators to obtaining this information. Patients admitted to a general medical ward at a large NZ hospital, aged 18 years and over, prescribed one or more regular medicines, and self-managing their own medicines prior to hospitalisation were included. Semi-structured interviews were conducted with each participant (n = 30) and transcribed, then analysed using a general inductive thematic analysis approach. RESULTS: Five overarching themes captured the medicines information needs of patients: (1) autonomy; (2) fostering relationships; (3) access; (4) communication; and (5) minimal information needs. Patients desired information to facilitate their decision-making and self-management of their health. Support people, written information, and having good relationships with health providers enabled this. Having access to information at the right time, communicated in a clear and consistent way with opportunities for follow-up, was important. A significant portion of participants were satisfied with receiving minimal information and had no expectations of needing more medicines information. CONCLUSIONS: Although patients' medicines information needs varied between individuals, the importance of receiving information in an accessible, timely manner, and having good relationships with health providers, were common to most. Considering these needs is important to optimise information delivery in general medical patients.

School-based telemedicine: Perceptions about a telemedicine model of care.

In New Zealand, a store-and-forward telemedicine programme is implemented in schools to address common health conditions. This study aimed to investigate perceptions of the non-clinical school staff involved on this telemedicine model of care. Interviews and analysis were framed by sociotechnical theory under constructs of identities, affiliations, interactions and environments. Findings show that telemedicine aligned with identities of staff as carers. Affiliations via close relationships with children and community support enabled the programme. Delivering telemedicine enhanced interactions with children. Environments related to practices and physical characteristics of the school were viewed as constrainers and enablers for delivery. School-based telemedicine delivered by school staff is perceived as an acceptable model of care. Benefits include empowerment, school cohesion and potential improvement in health literacy, with no major issues perceived. Telemedicine may be effective for treating common health conditions in school children, with potential for community members to be involved in health care.

Education Into Policy: Embedding Health Informatics to Prepare Future Nurses-New Zealand Case Study.

BACKGROUND: Preparing emerging health professionals for practicing in an ever-changing health care environment along with continually evolving technology is an international concern. This is particularly pertinent for nursing because nurses make up the largest part of the health workforce. OBJECTIVE: This study aimed to explore how health informatics can be included in undergraduate health professional education. METHODS: A case study approach was used to consider health informatics within undergraduate nursing education in New Zealand. This has led to the development of nursing informatics guidelines for nurses entering practice. RESULTS: The process used to develop nursing informatics guidelines for entry to practice in New Zealand is described. The final guidelines are based on the literature and are refined using an advisory group and an iterative process. CONCLUSIONS: Although this study describes the development of nursing informatics guidelines for nurses entering practice, the challenge is to move these guidelines from educational rhetoric to policy. It is only by ensuring that health informatics is embedded in the undergraduate education of all health professionals can we be assured that future health professionals are prepared to work effectively, efficiently, and safely with information and communication technologies as part of their practice.

The Barriers and Facilitators for Nurse Educators Using Telehealth for Education.

Telehealth is available world-wide and in addition to clinical uses, it can also be used to provide education for health professionals, supporting e-Networking. However, within New Zealand the uptake and widespread use of telehealth remains low, and why telehealth is not used more is not understood. This study describes nurse educators use of telehealth for education and identifies barriers and facilitators to increase the uptake of telehealth amongst nurse educators. An on-line survey administered using Survey Monkey had a response rate of 57% (n = 19). Equipment that was not user friendly and a lack of initial training were recognised as barriers to their uptake of telehealth. Telehealth training and support, and local champions were identified facilitators to increase the uptake of telehealth. Recommendations include the need for early adopting nurse educators to be recognised and encouraged, to role model good practice in telehealth, and mentor and support others.

Virtual Student Collaboration: Connecting Student Health Professionals.

This pilot study aimed to provide students with a learning activity to develop a global perspective of health care. Senior nursing students from New Zealand and the United Kingdom (n=15) were allocated to eNetwork small-groups. Students met weekly for one month via audio/video-conferencing for discussions. Students reported that this collaborative activity enabled them to engage purposefully with other students. While cultural differences were noted, similarities were also found and multiplestudents expressed interest in working overseas.

In-Service Education: Evolving Internationally to Meet Nurses' Lifelong Learning Needs.

In-service education (ISE) in nursing is teaching that occurs in the workplace. Internationally, ISE activities have been evident in nursing for many years because it has been seen as a convenient and cost-effective way to deliver education to nurses with minimal disruption to staffing levels and the delivery of patient care. ISE-related literature was sought to address the aim of tracing development and focus of nursing ISE in New Zealand. A key finding of this literature review is that ISE has been adapted in New Zealand and internationally to meet the demands of evolving nursing practice, and for this reason it remains relevant and essential to nurses. The embeddedness of ISE within clinical environments also supports its relevance. Future research is called for to establish which aspects of ISE are critical to ensuring its ongoing success. [J Contin Educ Nurs. 2019;50(7):313-318.].

Feasibility of describing community strengths relative to Omaha system concepts.

OBJECTIVES: The purpose was to determine the feasibility of using a standardized language, the Omaha System, to describe community-level strengths. The objectives were: (a) to evaluate the feasibility of using the Omaha System at the community level to reflect community strengths and (b) to describe preliminary results of community strengths observations across international settings. DESIGN AND SAMPLE: A descriptive qualitative design was used. The sample was a data set of 284 windshield surveys by nursing students in 5 countries: Mexico, New Zealand, Norway, Turkey, and the United States. MEASURES: An online survey included a checklist and open-ended questions on community strengths for 11 concepts of the Omaha System Problem Classification Scheme: Income, Sanitation, Residence, Neighborhood/workplace safety, Communication with community resources, Social contact, Interpersonal relationship, Spirituality, Nutrition, Substance use, and Health care supervision. Themes were derived through content analysis of responses to the open-ended questions. RESULTS: Feasibility was demonstrated: Students were able to use the Omaha System terms and collect data on strengths. Common themes were described among the five countries. CONCLUSIONS: The Omaha System appears to be useful in documenting community-level strengths. Themes and exemplar quotes provide a first step in developing operational definitions of strengths at a more granular level.

Nurses developing confidence and competence in telehealth: results of a descriptive qualitative study.

BACKGROUND: The widespread use of telehealth brings benefits to improve access to healthcare for rural and remote populations. OBJECTIVE: This study explores what nurses considered important to confidently and competently participate in telehealth. DESIGN: A descriptive qualitative approach was selected. METHODS: Nine New Zealand Registered Nurses who worked in different clinical settings who use telehealth were identified through snowball sampling, and participated in single semi-structured interviews, which were thematically analysed using a general inductive approach. FINDINGS: The nurses' experience of using telehealth, from novice to becoming more proficient, was the main theme identified, with sub-themes of: Initial use of telehealth, hands-on training, specialty experience, mentorship and technological know-how. The confidence of nurses using telehealth in this study may reflect their clinical nursing experience. CONCLUSION: Recommendations include the need for more telehealth education and preparation, including incorporating telehealth in under and postgraduate nursing programmes. Additionally, specific telehealth nursing competencies are warranted.

Trends in the primary health care nursing workforce providing diabetes care in Auckland, New Zealand: A cross-sectional survey.

AIMS: To describe trends from 2006-8 to 2016 in demographic, education and work settings of the primary health care nursing workforce who provide diabetes care in the Auckland region. METHODS: A total of 1416 practice, Accident and Medical, district and diabetes specialist nurses were identified who provide community-based care. Of those, 459 were randomly selected and 336 were interviewed in 2016, and were compared with 287 nurses interviewed in 2006-8. RESULTS: A 73% response rate was attained in 2016. Compared with nurses in 2006-8, primary health care nurses in 2016 were younger, less experienced, more likely to be Asian, undertook more post-graduate education, worked more in Accident and Medical Clinics and worked in larger practices with ≥4 doctors. However, less worked with a dietitian or received visits from specialist nurses compared with nurses in 2006-8. Significantly more nurses in 2016 had their own room for administrative work and the ability to email patients suggesting greater autonomy. CONCLUSIONS: Major demographic, educational and workplace changes have occurred in the Auckland primary health care nursing workforce from 2006-8 to 2016. A significant increase in practice nurses and a large decrease in the number of diabetes specialist nurses were evident, in the Auckland region.

Technology Informatics Guiding Education Reform - TIGER.

BACKGROUND: While health informatics recommendations on competencies and education serve as highly desirable corridors for designing curricula and courses, they cannot show how the content should be situated in a specific and local context. Therefore, global and local perspectives need to be reconciled in a common framework. OBJECTIVES: The primary aim of this study is therefore to empirically define and validate a framework of globally accepted core competency areas in health informatics and to enrich this framework with exemplar information derived from local educational settings. METHODS: To this end, (i) a survey was deployed and yielded insights from 43 nursing experts from 21 countries worldwide to measure the relevance of the core competency areas, (ii) a workshop at the International Nursing Informatics Conference (NI2016) held in June 2016 to provide information about the validation and clustering of these areas and (iii) exemplar case studies were compiled to match these findings with the practice. The survey was designed based on a comprehensive compilation of competencies from the international literature in medical and health informatics. RESULTS: The resulting recommendation framework consists of 24 core competency areas in health informatics defined for five major nursing roles. These areas were clustered in the domains "data, information, knowledge", "information exchange and information sharing", "ethical and legal issues", "systems life cycle management", "management" and "biostatistics and medical technology", all of which showed high reliability values. The core competency areas were ranked by relevance and validated by a different group of experts. Exemplar case studies from Brazil, Germany, New Zealand, Taiwan/China, United Kingdom (Scotland) and the United States of America expanded on the competencies described in the core competency areas. CONCLUSIONS: This international recommendation framework for competencies in health informatics directed at nurses provides a grid of knowledge for teachers and learner alike that is instantiated with knowledge about informatics competencies, professional roles, priorities and practical, local experience. It also provides a methodology for developing frameworks for other professions/disciplines. Finally, this framework lays the foundation of cross-country learning in health informatics education for nurses and other health professionals.

Undergraduate Student Nurses' Use of Information and Communication Technology in Their Education.

Students expect to use technology in their study just as they use technology in other aspects of their life. Technology is embedded in the day-to-day work of nursing, and therefore needs to be integrated in education to prepare students to assume professional roles and develop skills for lifelong learning. A quantitative descriptive study, using an anonymous survey, explored how undergraduate student nurses from one New Zealand school of nursing, access information and communication technologies for their learning. In total 226 completed questionnaires were returned (75%). Nearly all students (96%) have smart phones, all students have a computer and 99% use the university learning management system daily or several times a week. The search engine most commonly used to find information for assignments was Google Scholar (91%), with only 78% using subject specific academic databases. Implications from this study include the need for charging stations and further education on information searching.