Patient Portals and Patient Engagement: A State of the Science Review.

BACKGROUND: Patient portals (ie, electronic personal health records tethered to institutional electronic health records) are recognized as a promising mechanism to support greater patient engagement, yet questions remain about how health care leaders, policy makers, and designers can encourage adoption of patient portals and what factors might contribute to sustained utilization. OBJECTIVE: The purposes of this state of the science review are to (1) present the definition, background, and how current literature addresses the encouragement and support of patient engagement through the patient portal, and (2) provide a summary of future directions for patient portal research and development to meaningfully impact patient engagement. METHODS: We reviewed literature from 2006 through 2014 in PubMed, Ovid Medline, and PsycInfo using the search terms "patient portal" OR "personal health record" OR "electronic personal health record". Final inclusion criterion dictated that studies report on the patient experience and/or ways that patients may be supported to make competent health care decisions and act on those decisions using patient portal functionality. RESULTS: We found 120 studies that met the inclusion criteria. Based on the research questions, explicit and implicit aims of the studies, and related measures addressed, the studies were grouped into five major topics (patient adoption, provider endorsement, health literacy, usability, and utility). We discuss the findings and conclusions of studies that address the five topical areas. CONCLUSIONS: Current research has demonstrated that patients' interest and ability to use patient portals is strongly influenced by personal factors such age, ethnicity, education level, health literacy, health status, and role as a caregiver. Health care delivery factors, mainly provider endorsement and patient portal usability also contribute to patient's ability to engage through and with the patient portal. Future directions of research should focus on identifying specific populations and contextual considerations that would benefit most from a greater degree of patient engagement through a patient portal. Ultimately, adoption by patients and endorsement by providers will come when existing patient portal features align with patients' and providers' information needs and functionality.

Building a virtual community for nursing education: the town of Mirror Lake.

RNs take pride in delivering high-quality individualized care to their patients. However, how do nursing students learn the principles of professional nursing or develop the competencies necessary to individualize patient care? At the Ohio State University College of Nursing, we embarked on deploying a virtual community of patients to enhance our students' learning experience. Our community, the town of Mirror Lake, contains 165 people and 62 households, with an apartment complex, a medical center, and a retirement center with assisted and skilled nursing care. This community serves as the main source of patients for Mirror Lake Medical Center, our virtual hospital. We think we can teach many key principles of sound nursing care using this virtual community of patients. This article presents the rationale behind the decision to take on this endeavor, as well as the processes used for development of our community.

Use of buffered lidocaine in bone marrow biopsies: a randomized, controlled trial.

PURPOSE/OBJECTIVES: To determine whether a difference exists in perceived pain during preprocedure anesthetic injection for bone marrow biopsy between buffered and unbuffered lidocaine, to determine whether pain levels change over time, and to investigate relationships between perceived pain scores and other variables. DESIGN: A double-blind, randomized, experimental, crossover design. SETTING: A large hospital in the midwestern region of the United States. SAMPLE: 48 patients undergoing bone marrow biopsy. METHODS: The patients served as their own controls for the bilateral procedure. A 100 mm visual analog scale measured pain. A demographic questionnaire gathered the between-subjects exploratory variables. MAIN RESEARCH VARIABLES: Perceived pain scores and type of lidocaine anesthetic solution (buffered versus unbuffered). FINDINGS: Participants reported significantly lower pain scores on the side anesthetized with buffered lidocaine compared with the side anesthetized with unbuffered lidocaine. Higher pain scores were reported on the treatment side for participants who had received more than two surgical procedures. Patients who were members of a minority group had higher mean pain scores than Caucasians on the control side. CONCLUSIONS: Buffered lidocaine is superior to unbuffered lidocaine as an anesthetic for bone marrow biopsy procedures. IMPLICATIONS FOR NURSING: Advanced practice nurses perform a significant number of bone marrow biopsies and aim to improve patient comfort during invasive procedures. Use of unbuffered lidocaine should be questioned.

Implementation of handheld devices.

With the rapid introduction of technology in nursing education, information regarding its implementation in undergraduate curricula is emerging. The authors describe the implementation process used to integrate personal digital assistants into an undergraduate nursing curriculum. Barriers such as potential for device loss, issues related to patient confidentiality, and infection control are addressed.

Faculty development initiatives for the integration of informatics competencies and point-of-care technologies in undergraduate nursing education.

Faculty members have a critical role in deciding the content that is taught to their nursing students. They must grasp the importance of using technology to facilitate learning and knowledge of informatics concepts and skills. This article describes a successful faculty development program that was aimed at upgrading the technology and informatics skills of the faculty while at the same time developing and threading informatics skills across the baccalaureate nursing curriculum.

Improving the safety of medication administration using an interactive CD-ROM program.

PURPOSE: The impact of an interactive CD-ROM program on the rate of medication administration errors made by nurses was studied. METHODS: This randomized, controlled, nonblinded study was conducted at three community hospitals. Study participants included 30 registered nurses who had at least one year of nursing experience in acute care and who worked on medical or medical-surgical units. Nurses were randomized to an intervention group that completed an interactive CD-ROM program on safe medication practices or to a control group. Direct observation was used to determine the baseline (preintervention) and postintervention error rates for both study and control groups. Three categories of errors were defined: deviation from safe administration practices (core 1), preparation and administration errors (core 2), and deviations from prescribed therapy (core 3). An error rate was calculated for each nurse, and the error rates for the study and control groups were based on the average error rate for the nurses in each group. RESULTS: The majority of errors made were core 1 errors. The nurse-level data showed a significant decrease in core 1 error rates between baseline and postintervention periods. Core 2 error rates were higher in the postintervention period, but the increase was not significant. Very few core 3 errors were made by either group during either period. CONCLUSION: An interactive CD-ROM enabled nurses to apply the information learned to identify errors in medication administration and improved adherence to safe medication administration practices.

Informatics competencies for nurse practitioners.

Informatics knowledge and skills are essential if clinicians are to master the large volume of information generated in healthcare today. Thus, it is vital that informatics competencies be defined for nursing and incorporated into both curricula and practice. Staggers, Gassert, and Curran have defined informatics competencies for four general levels of nursing practice. However, informatics competencies by role (eg, those specific for advanced practice nursing) have not been defined and validated. This article presents an initial proposed list of informatics competencies essential for nurse practitioner education and practice. To this list, derived from the work of Staggers et al., 1 has been added informatics competencies related to evidence-based practice. Two nurse informaticists and six nurse practitioners, who are program directors, were involved in the development of the proposed competencies. The next step will be to validate these competencies via research.

Columbia University's competency and evidence-based Acute Care Nurse Practitioner Program.

New clinical information is being generated faster than practicing clinicians can effectively assimilate it. Since the gold standard of clinical information is evidence-based information, tools and techniques that facilitate both the building of evidence for practice and the application of evidence to practice are essential for practicing clinicians. As such, the Acute Care Nurse Practitioner (ACNP) program at Columbia University's School of Nursing was reconfigured to incorporate both theoretically based competency evaluation standards and strategies to foster an evidence-based practice approach to clinical care. The purpose of this article is to describe a curriculum and set of learning activities used to foster both development of clinical competency and evidence-based practice in students in the Acute Care Nurse Practitioner program.

Economic evidence for evidence-based practice.

PURPOSE: To explicate (a) the types of economic analyses available to nurses, (b) the measurement of costs in different types of economic evaluations, (c) recommendations for standardization, and (d) the assessment of economic evaluations for evidence-based practice. METHODS: Five types of economic analyses are reviewed. Recommendations for standardization of cost-effectiveness analyses are included as well as a worksheet for use in critiquing economic evaluations for validity and applicability to clinical settings. FINDINGS: Limited knowledge and a lack of consistent approaches to economic analyses are evident in the nursing and health care literature. However, nurses have not contributed to the conduct of rigorous economic evaluations or research to the extent found in other health care disciplines. CONCLUSIONS: Basing nursing practice on the best available evidence is now the expected standard of care. Applying economic evidence to practice requires understanding the methods used to conduct economic evaluations and to analyze the rigor of such evaluations.