Identifying Main Themes in Diabetes Management Interviews Using Natural Language Processing-Based Text Mining.

This study aimed to identify the main themes from exit interviews of adult patients with type 2 diabetes after completion of a diabetes education program. Eighteen participants with type 2 diabetes completed an exit interview regarding their program experience and satisfaction. Semistructured interview questions were used, and the interviews were auto-recorded. The interview transcripts were preprocessed and analyzed using four natural language processing-based text-mining techniques. The top 30 words from the term frequency and term frequency-inverse document frequency each were derived. In the N-gram analysis, the connection strength of "diabetes" and "education" was the highest, and the simultaneous connectivity of word chains ranged from a maximum of seven words to a minimum of two words. Based on the CONvergence of iteration CORrelation (CONCOR) analysis, three clusters were generated, and each cluster was named as follows: participation in a diabetes education program to control blood glucose, exercise, and use of digital devices. This study using text mining proposes a new and useful approach to visualize data to develop patient-centered diabetes education.

Exploring the Knowledge Structures of Korean and International Nursing Research on Premature Infants Using Text Network Analysis.

This study aimed to identify the knowledge structures of Korean and international nursing studies on premature infants using text network analysis, which represents a text as a network graph that describes how keywords are linked. This network graph refers to a knowledge structure. International and Korean journal databases were searched to extract nursing studies regarding premature infants published in academic journals from 1998 to 2020. Abstracts from the selected studies were analyzed using the following four steps: word extraction and refinement, keyword extraction, co-occurrence matrix generation, and text network visualization. The results demonstrated that 182 Korean and 2502 international studies were published. The common keywords of Korean and international studies were "kangaroo mother care," "stress," and "child." The keywords of the international studies had more branches linking to other keywords than those of the Korean studies. Thus, the knowledge structure of international studies included diverse concepts. These findings will serve as important guidance for future research worldwide. Furthermore, studies to develop a more comprehensive knowledge structure of international research on premature infants are needed. The knowledge structure of Korean studies mainly included concepts related to mothers. Korean studies regarding hospitalized premature infants and communication with parents need to be conducted.

Effect of Laughter Therapy on Mood Disturbances, Pain, and Burnout in Terminally Ill Cancer Patients and Family Caregivers.

BACKGROUND: Humor has been commonly used in palliative care and identified as a coping strategy of palliative care patients and family caregivers. However, the use of humor or laughter in palliative care settings is still limited. OBJECTIVE: The aim of this study was to examine the effect of laughter therapy involving spontaneous laughter on mood disturbances and pain in terminally ill patients with cancer and mood disturbances and the levels of burnout in family caregivers. METHODS: This quasi-experimental study used a nonequivalent control group pretest-posttest design. The laughter therapy developed was provided for 20 to 30 minutes a day for 5 consecutive days. Twenty-six pairs of terminally ill cancer patients and family caregivers in the intervention group and 23 pairs in the comparison group from the hospice ward of a tertiary teaching hospital participated in this study. The data were collected using structured questionnaires and analyzed using descriptive statistics and 2-way repeated-measures analysis of variance. RESULTS: There were significant decreases in mood disturbances in the patients ( P < .001) and family caregivers ( P < .001), pain in the patients ( P < .001), and levels of burnout in the caregivers ( P < .001) in the intervention group. CONCLUSION: Laughter therapy can be an alternative intervention to support both terminally ill patients with cancer and their family caregivers experiencing multidimensional distress in palliative care settings. IMPLICATIONS FOR PRACTICE: The appropriate use of laughter or humor therapy needs to be encouraged as a support tool in palliative care. Palliative care teams must be properly trained to provide spontaneous laughter therapy or planned humor therapy.

Health Belief Model Factors and Personal Characteristics Associated With COVID-19 Vaccination Behaviors in Adults.

Prior studies have mainly examined factors regarding COVID-19 vaccination intentions. This study investigated the factors associated with COVID-19 vaccination behaviors in Korean adults. A total of 620 adults recruited from a survey company between July and August 2021 completed an online survey asking about their personal characteristics, health beliefs, and COVID-19 vaccination status. The collected data were analyzed using descriptive statistics, Pearson's χ2 test, independent-samples t test, and logistic regression analysis. Less than half the participants received COVID-19 vaccinations, whereas 56.3% did not. The full regression model explained 33.3% of the variance in COVID-19 vaccination status. Age older than 60 years, perception of feeling healthy, presence of chronic diseases, past flu shot experiences, and five health belief model factors were significant factors associated with COVID-19 vaccination behaviors. COVID-19 vaccination intention was the most closely related factor (odds ratio, 12.37; 95% confidence interval, 3.54-43.26; P < .001). Vaccinated participants were more likely than unvaccinated to perceive susceptibility to COVID-19 infection, benefits, self-efficacy, moral responsibility, and subjective norms regarding COVID-19 vaccination. Based on the results, vaccinated and unvaccinated individuals showed different attitudes toward COVID-19 infection and vaccination. This study suggests that COVID-19 vaccination intentions lead to actual vaccination behavior.

Identifying Latent Topics and Trends in Premature Infant-Related Nursing Studies Using a Latent Dirichlet Allocation Method.

This study aimed to identify topics and within-topic core keywords in premature infant-related nursing studies published in Korean and international academic journals using topic modeling and to compare and analyze the trends in Korean and international studies. Journal databases were searched to extract nursing studies involving premature infants from 1998 to 2020. Journal databases included MEDLINE, Web of Science, CINAHL, and EMBASE for international studies and DBpia, the National Digital Science Library, the Korea Citation Index, and the Research Information Sharing Service for Korean studies. Abstracts from the selected 182 Korean and 2502 international studies were analyzed using NetMiner4.4.3e. In results, four similar topics (Korean vs international) were "pain intervention" versus "pain management"; "breast feeding practice" versus "breast feeding"; "kangaroo mother care"; and "parental stress" versus "stress & depression." Two topics that appeared only in the international studies were "infection management" and "oral feeding & respiratory care." Overall, the international studies dealt with diverse topics directly associated with premature. Korean studies mainly dealt with topics related to mothers of premature infants, whereas studies related to premature infants were insufficient. Nursing research in Korea needs to be expanded to research topics addressing premature infants.

Public's Experience with an Online Reservation System for Residual COVID-19 Vaccines and the Potential for Increasing the Actual Vaccination Rate.

This study aimed to investigate the public's experience of online reservation of residual COVID-19 vaccines in an additional vaccination program. Online reservation was used to predict the vaccination rate. A sample of 620 participants completed the online survey between July and August 2021. About 38% of the participants made the online reservation. About 91% had a vaccination intention. Online reservations showed significant differences in their distribution according to age group, educational level, past flu shot experience, and COVID-19 vaccination intention. A negative experience was the most common response, which was mostly attributed to the difficulty in making an online reservation due to reservations being full. Positive experiences included updated information and notifications on the residual vaccines available, being able to choose a vaccination clinic, and the ease of making, changing, and canceling a reservation. About 72% reported the positive effect of residual vaccine usage on herd immunity. The results of this study suggest that when developing another online reservation program for vaccination, it is necessary to consider and address the negative experiences of the public with online reservations. The additional vaccinations may have resulted in an increased vaccination rate. Vaccination reservations can be used as an indicator to predict the actual vaccination rate and as a measure of a positive attitude toward COVID-19 vaccination.

Public-Private Partnership: Participants' Experiences of the Web-Based Registration-and-Management System for Patients with Hypertension and Diabetes Mellitus.

Hypertension and diabetes mellitus, which induce cardiovascular and cerebrovascular diseases, require government intervention. In South Korea, the web-based registration-and-management system for patients with hypertension and diabetes mellitus was operated as a pilot program. This study explored the experiences of the 71 participating medical centers in G city, South Korea, of using the web-based registration-and-management system for preventing and managing hypertension and diabetes mellitus. After the survey, 40 physicians participated in interviews, and the recorded interviews were analyzed and classified into three categories: participation motivation, participation experiences, and suggestions. The study participants participated in a national pilot project with different expectations. Similar to the survey results on participation experiences, the satisfaction from a patient-care perspective was high, but there was an excessive burden of administrative work from the perspective of primary-medical-center operations. In addition, the suggestions included strengthening systematic education, continuous maintenance, broad project application, and improvements to the system. The system needs to be unified and simplified, the project continuity needs to be secured, and the application of the system to other regions and medical centers needs to be considered to induce public-private cooperation to reduce the amount of administrative work, which is currently excessive.

Use of Smartphone-Based Electronic Medical Records by Nurses in Tertiary Teaching Hospitals.

The adoption of smartphone-based electronic medical records is increasing in the healthcare sector. Nurses are the largest group using mobile electronic medical records. This study examined the system quality, information quality, service quality, usefulness, and ease of using mobile electronic medical records, the effects of the three qualities of the mobile electronic medical records on the usefulness and ease of use, and nurses' preference for using mobile electronic medical records. The participants were 210 nurses using a mobile electronic medical record system for over a month. An instrument modified from existing instruments was used. The data were analyzed using descriptive statistics and multiple regression analysis. The participants perceived the system and information quality more positively than the service quality of the mobile electronic medical records. They perceived the mobile electronic medical records as being useful and easy to use. System quality and information quality significantly affected the perception of the usefulness and ease of using the mobile electronic medical record. They preferred to use it as a means to identify patients' conditions at any time. For user satisfaction and the implications for nursing practice, the usability and functionality of a mobile electronic medical record system should be continuously assessed.

Computed tomographic findings may be useful for differentiating small intestinal adenocarcinomas, lymphomas, and spindle cell sarcomas in dogs.

An improved understanding of the CT characteristics for histologically confirmed primary intestinal tumors would be helpful for guiding prognosis and treatment plans in affected dogs. This retrospective, multi-center, analytical study aimed to evaluate the CT characteristics for the differentiation of adenocarcinoma, lymphoma, and spindle cell sarcoma (SCS) in dogs. Thirty-seven dogs who underwent contrast CT and histopathological examinations were included (adenocarcinomas, n = 11; lymphomas, n = 12; SCS, n = 14). Quantitative and qualitative CT parameters, including tumor morphology, contrast enhancement pattern, Hounsfield unit (HU) value, and presence or absence of intraabdominal lymphadenopathy, were evaluated for each included small intestine tumor CT case. Adenocarcinomas tended to show endophytic growth, intestinal obstruction, and a heterogeneous enhancement pattern. Lymphomas tended to show exophytic growth, contrast enhancement of the intestinal tumor mucosal layer, a homogeneous enhancement pattern, and the presence of lymphadenopathies in the abdominal cavity. SCSs tended to show lobulated growth, a large cystic portion within the tumor, a heterogeneous enhancement pattern, a large size with fat stranding sign, and lower HU values in postcontrast images. Cut-off values of the minimum diameter/fifth lumbar vertebral mid-body height (≥5.80; area under the curve [AUC] = 0.97, P < 0.001) and minimum HU value/HU value of the aorta (≤0.26; AUC = 0.96, P < 0.001) were derived to discriminate SCS from the two other tumor types. In conclusion, contrast CT characteristics may be useful in differentiating small intestinal adenocarcinomas, lymphomas, and SCSs in dogs.

Development of a Standardized Curriculum for Nursing Informatics in Korea.

OBJECTIVES: This study explored the current status of nursing informatics education in South Korea and developed a standardized curriculum for it. METHODS: Data were collected in two stages: first, an online survey conducted from December 2020 to February 2021 among 60 nursing schools to analyze the current status of nursing informatics education; and second, a two-round Delphi survey with 15 experts from March to April 2021 to determine the mean and standard deviation of the demand for each learning objective in nursing informatics education. A standardized curriculum proposal was developed based on the results of the two-round Delphi survey. RESULTS: Nursing informatics was most commonly taught in the fourth year (34%), with two credits. The proportion of elective major subjects was high in undergraduate and graduate programs (77.4% and 78.6%, respectively), while the proportion of nursing informatics majors was low (21.4%). The curriculum developed included topics such as nursing information system-related concepts, definitions and components of healthcare information systems, electronic medical records, clinical decision support systems, mobile technology and health management, medical information standards, personal information protection and ethics, understanding of big data, use of information technology in evidence-based practice, use of information in community nursing, genome information usage, artificial intelligence clinical information systems, administrative management systems, and information technology nursing education. CONCLUSIONS: Nursing informatics professors should receive ongoing training to obtain recent medical information. Further review and modification of the nursing informatics curriculum should be performed to ensure that it remains up-to-date with recent developments.

Validity and Reliability Testing of an Instrument Measuring Nurses' Experiences With Electronic Medical Record-Related Unintended Adverse Consequences and Statistical Interpretations of Exploratory Factor Analysis Outputs.

Background and Purpose: Nurses frequently experience unintended consequences of health information technology implementation. The study aimed to test the validity and reliability of a new instrument to measure nurses' experiences with the unintended adverse consequences of electronic medical record use. Methods: The psychometric properties of the developed 21 items were examined using a convenience purposive sample of 287 nurses from eight hospitals. Results: The content validity index was 1.00. The sample was adequate to proceed with exploratory factor analysis. Four factors were clustered with factor loadings between 0.43 and 0.82. The variance explanatory proportion was 63.1%. Cronbach's alpha was .93. Conclusions: The psychometric testing results indicated that the instrument was valid and reliable. The instrument can serve as an indicator of unintended consequences of health information technology implementation.

Nurses' Perceptions of Using Personal Digital Assistants in Tertiary Hospitals.

Personal digital assistants can perform multiple functions such as Internet search, documentation, calculating, and barcode scanning. This study examined nurses' perceptions of personal digital assistants used as a barcode scanner for medication administration, blood transfusions, and blood collection. A total of 236 nurses participated in the survey using the instrument developed by the researchers. The data collected were analyzed using descriptive statistics, one-way analysis of variance, and the Scheffe test. Written responses to the advantages and drawbacks of using personal digital assistants were categorized by meaning. The results showed that the nurses perceived more drawbacks than advantages in using personal digital assistants because of nonworking barcodes, prescription practice requiring additional scanning, poor interfacing between personal digital assistants and the EMR, and frequent Wi-Fi disconnection. The drawbacks resulted in delays in nursing workflow for patient care. Therefore, increasing the availability of barcode scanning for all medications applicable to personal digital assistant use, redesigning the practice of current prescriptions to eliminate additional scanning, and seamless interfacing between personal digital assistants and EMRs should be considered. This enables the nurses to use personal digital assistants more efficiently and effectively for patient care.

Effect of Electronic Medical Record Quality on Nurses' Perceived Usefulness and Ease of Use.

Electronic medical records have been adopted in Korean clinical settings for a few decades. However, there is a lack of studies on the quality, usefulness, and easy use of electronic medical records examined from the perspective of nurses. This study sought the effect of the system quality, information quality, and service quality of an electronic medical record on nurses' perceived usefulness and ease of use of the electronic medical record. A total of 278 nurses from four hospitals completed a self-administered questionnaire using a 5-point Likert scale. The data were analyzed using descriptive statistics and hierarchical multiple regression methods. The results showed that the system, information, and service quality of the electronic medical records explained 36.2% of the variance in perceived usefulness ( F = 51.760, P < .001) and 43.4% of the variance in perceived ease of use ( F = 70.019, P < .001). Thus, these three qualities were significant factors predicting perceived usefulness and ease of use. The close cooperation of stakeholders including administrators, healthcare providers including nurses, and researchers involved in clinical practice will improve electronic medical record quality leading to user-friendly electronic medical record implementation. This study provided statistical interpretations to help in understanding regression analysis.

Effects of Government-Driven Smartphone Text Messages on Public Compliance With COVID-19 Preventative Measures.

The new pandemic situation caused by a highly infectious virus has prompted the government of many countries to strengthen epidemic prevention measures. An unprecedented action was taken by the Korean government by sending text messages on COVID-19 preventative measures and the movement routes of confirmed-positive persons to the entire nation's smartphones. This study aimed to examine how effective the government-driven smartphone text messages were for public compliance with the measures. A total of 489 participants completed an online questionnaire or a pencil-and-paper questionnaire between September and October 2020. A self-reported questionnaire was used to measure the degree of compliance with the measures, the perceptions of the role of smartphone text messages in compliance with the measures, and the overall feelings toward smartphone text messages. The data were analyzed using descriptive statistics and two-way analysis of variance. The written responses were grouped by meaning. The participants presented a high degree of compliance with the measures and perceived the importance of the role of continuous smartphone text messages in complying with the measures. Positive feelings toward smartphone text messages predominated over negative feelings. Using smartphone text messages in nursing practice is recommended for patients requiring the continuous management of their disease.

Nurses' Electronic Medical Record Workarounds in Mental Healthcare Settings.

This study aimed to examine nurses' EMR workarounds in mental healthcare settings. Of the 52 nurses invited to participate in this study, 50 nurses (96.1%) completed the survey using the EMR nursing workaround instrument and open-ended questions. The data collected were analyzed using descriptive statistics and Pearson's correlation coefficients. The descriptive data were grouped into four units including the cases, contributing causes, and consequences of EMR workarounds, and suggestions for improving EMR implementation. The results showed scores above an average of 3.0 in all of the EMR workaround items, indicating the considerable involvement of nurses in EMR workarounds. The workarounds related to EMR use were using the physician's login account for medication access, performing retrospective documentation, performing documentation before an expected busy situation, and seeking and entering information on external medications. The workarounds associated with colleagues unfamiliar with EMR use included waiting for, filling in for, teaching, and assisting unskilled colleagues. This study identified the problems, consequences, and suggestions associated with EMR implementation for psychiatric patient care. This study added useful information for the administrative, technical, and clinical improvement of EMR implementation in mental healthcare practice.

Measuring Nurses' Experiences With Unintended Adverse Consequences in EMR Use in Acute Care Settings.

Adverse effects of EMR use have been rarely reported in South Korea. This study examined nurses' experiences with unintended adverse consequences associated with EMR implementation. The participants were 155 nurses using the EMR for patient care in three public hospitals. The statistically tested 21-item instrument and the same 21 open-ended questions were used for data collection. The data collected were analyzed using descriptive statistics and two-way analysis of variance, and the descriptions were grouped by meaning. The participants frequently experienced unintended adverse consequences that resulted from EMR use, and their experiences were organized into 11 subgroups under four dimensions of the unintended consequences instrument including the malfunction and inefficient design of EMR screens dimension (two groups), extra work from EMR implementation dimension (three groups), EMR incompatibility and changes in the prescription pattern dimension (three groups), and patient safety and EMR dependence (three groups). Successful implementation of EMRs is possible when unintended adverse consequences identified by the users are corrected and EMRs are tailored to user needs. Healthcare organizations should provide administrative support, timely technical remedy, and user training to increase user acceptance on a system.

Quality of Online Information Regarding High-Risk Pregnancies.

Health information on the Internet can have a direct effect on healthcare decision-making. However, the quality of information online has seldom been evaluated. This study aimed to assess the quality of online information on high-risk pregnancies provided by English and Korean Web sites. Through a Google search, 30 English and 30 Korean Web sites were selected on January 2 and 3, 2020, respectively, and assessed using DISCERN, a Journal of the American Medical Association, and Health On the Net Foundation code questionnaires. The data assessed were analyzed using descriptive and nonparametric statistical tests. Overall, the information provided by the English Web sites presented higher-quality information than the Korean Web sites. Most Web sites did not provide the sources of the information presented on their Web sites, meet the Journal of the American Medical Association criteria, or provide information on complementarity. Based on our results, nurses need to be competent in assessing the quality of Web sites and the health information presented there, and nursing students need to be prepared to do so as well. Nurses are responsible for educating their patients about the possibility of incorrect information provided by Internet Web sites and informing their patients about reliable Web sites, thus assisting them to make informed decisions regarding their health.

Unintended Consequences and Workarounds of Electronic Medical Record Implementation in Clinical Nursing Practice.

Nurses have experienced unintended consequences and workarounds associated with health information technology implementation. However, examination of this occurrence is rare. This study aimed to examine the unintended consequences and workarounds produced by the implementation of electronic medical record systems in clinical nursing practice. A total of 143 nurses participated in a survey using statistically tested instruments. The data were analyzed using descriptive statistics and a nonparametric test. The descriptive data were analyzed by meaning. The participants experienced unintended consequences and workarounds related to electronic medical record implementation at moderate or high levels based on the responses to questions scored on 5-point Likert scales. The unintended consequences were closely associated with workarounds. The degree of experience with unintended consequences and the use of workarounds differed significantly according to the level of education, job position, and years in nursing practice. The nursing examples of unintended consequences and workarounds were organized into four categories of unintended consequences. By presenting unintended consequences and workarounds together, this study enhances the understanding of the problems encountered in EMR implementation and the action of nurses. Nurses' needs should be considered as an important resource in developing, redesigning, or purchasing and implementing health information technology in healthcare settings.

Quality Evaluation of Visual Display Terminal Syndrome Videos Shared on YouTube.

Visual display terminal syndrome is a health problem that occurs when an individual looks at a visual display terminal for a long time. This study aimed to evaluate the quality of YouTube videos on visual display terminal syndrome. YouTube was searched using the keywords "visual display terminal syndrome" and "a prolonged user of a computer or smartphone" on October 16, 2019. A total of 45 videos were evaluated using DISCERN and the Journal of the American Medical Association scoring systems. The variables extracted from the videos were the uploading agency; content; presentation format; days since upload; the number of views, likes, dislikes, and comments; and the video power index. The mean DISCERN and Journal of the American Medical Association scores were 35.64 and 3.08 points, respectively, indicating that the information on visual display terminal syndrome in YouTube videos was inaccurate and unreliable. The major reason for the low quality of the videos was that the sources of information presented in the videos were not provided. The DISCERN and Journal of the American Medical Association scores showed significant differences in the uploading agency and presentation format variables. Nurses must be familiar with evaluating the quality of videos presenting health information. Guidelines informing patients that YouTube might provide misinformation about health need to be developed.

Nurses' Electronic Medical Record Workarounds in a Tertiary Teaching Hospital.

The objective of this study was to identify nurses' workarounds related to the use of electronic medical records in a tertiary teaching hospital. A total of 106 nurses (84.8%) using the electronic medical records completed 10-item questionnaires scored on a Likert scale and five open-ended questions with written responses. The numerical data were analyzed by descriptive statistics, and the written descriptions were categorized by meaning. The mean of the scored items ranged from 3.29 to 3.74. Approximately 38% to 50% of the participants reported (very) frequent workflow delays due to the use of the electronic medical records, and 46% to 64% reported (very) frequently using workarounds. Twenty-nine workarounds of the electronic medical records were due to electronic documentation, difficulty accessing the electronic medical records, medication administration, covering physician responsibilities, electronic communication with the physicians, respondents and physicians not skilled in using the electronic medical records, and connection failures between devices or machines and the electronic medical records. Although none of these identified workarounds were intended to be harmful, and certain workarounds were efficient for patient care and workflow, whether patient safety can be jeopardized by workarounds should be considered. This study contributes to the understanding of why and how workarounds occur in the hospital. It will be useful for achieving greater alignment between work contexts and the electronic medical record in the future.