Exploring Delays in Cardiac Care Processes Through Electronic Health Records.

Cardiovascular diseases are the leading cause of death globally. Timely health services are fundamental to the appropriate prevention, identification, care and rehabilitation of these diseases. This study aimed to explore the potential of using electronic health records as a data source to help identify health system -related delays in care processes of cardiac patients. This retrospective registry study is based on a sample of electronic health records of 200 cardiac patients admitted to one out of twenty wellbeing services counties in Finland during the years 2021-2022. A total of 426 health system -related delays were identified. All expressions were found in unstructured format and most of these (58.7%) were generated by nurses. These results show that the electronic health records contained a variety of information on health system -related patient care delays, and that most delays were associated with difficulties in finding a bed for the patient in a post-acute care facility (49.8%), but also in-hospital process delays were common (27.7%). These findings show great potential for exploring electronic health record data with natural language processing methods in the future for the development of tools to better identify and monitor different types of delays in care processes. Such tools may support leadership to respond to organisational procedures in need of improvement.

Future Needs in Nursing Informatics - Preliminary Findings from the Global Nursing Informatics Survey.

This study investigates the evolving landscape of nursing informatics by conducting a follow-up survey initiated by the International Medical Informatics Association (IMIA) Students and Emerging Professionals (SEP) Nursing Informatics (NI) group in 2015 and 2019. The participants were asked to describe what they thought should be done in their institutions and countries to advance nursing informatics in the next 5-10 years. For this paper, responses in English acquired by December 2023 were analysed using inductive content analysis. Identified needs covered a) recognition and roles, b) educational needs, c) technological needs, and d) research needs. The initial findings indicate that, despite significant progress in nursing informatics, the current needs closely mirror those identified in the 2015 survey.

Navigating the Global Landscape of Nursing Informatics Research Collaboration: A Blueprint for Success.

International collaboration is crucial in the field of nursing informatics research to enhance our ability to conduct globally relevant research that informs policy and practice. In this case study we describe how we have established an international research collaboration to evaluate nurses' experiences of technology use during the pandemic. We firstly describe how the collaboration was created and the successes associated with our work, before highlighting the facilitators to make an international collaboration work. We also discuss the challenges we have encountered during this collaborative enterprise, to enable other researchers who wish to establish international collaborations and learn from our experiences.

Building Bridges for Federated Learning in Healthcare: Review on Approaches for Common Data Model Development.

Common data models provide a standardized way to represent data used in federated learning tasks. The aim of this review was to explore the development and use of common data models to harmonize electronic health record data in health research. The data search yielded 724 records, of which 19 were included for this study. None of the research focused on nursing specific topics. All studies either utilized the Observational Medical Outcomes Partnership (OMOP) common data model, or developed a model partly based on the OMOP. A roadmap to guide research for the development of common data models for federated learning are warranted.

Information Management in Hospital Unit Daily Operations: A Descriptive Study With Nurses and Physicians.

Operations management of a hospital unit is a shared activity involving nursing and medical professionals, characterized by suddenly changing situations, constant interruptions, and ad hoc decision-making. Previous studies have explored the informational needs affecting decision-making, but only limited information has been collected regarding factors affecting information management related to the daily operations of hospital units. The aim of this study was to describe the experiences of nursing and medical professionals of information management in the daily operations of hospital units. This qualitative study consists of interviews following the critical incidence technique. Twenty-six nurses and eight physicians working in operational leadership roles in hospital units were interviewed, and the data were subjected to thematic analysis. The data analysis showed that strengths of current systems were organizational operational procedures, general instruments supporting information management, and a digital operations dashboard, whereas opportunities for improvement included the information architecture, quality of information, and technology use. The study findings highlight that despite several decades of efforts to provide solutions to support information management in hospital daily operations, further measures need to be taken in developing and implementing information systems with user-centered strategies and systematic approaches to better support healthcare professionals.

A rapid review on current and potential uses of large language models in nursing.

BACKGROUND: The application of large language models across commercial and consumer contexts has grown exponentially in recent years. However, a gap exists in the literature on how large language models can support nursing practice, education, and research. This study aimed to synthesize the existing literature on current and potential uses of large language models across the nursing profession. METHODS: A rapid review of the literature, guided by Cochrane rapid review methodology and PRISMA reporting standards, was conducted. An expert health librarian assisted in developing broad inclusion criteria to account for the emerging nature of literature related to large language models. Three electronic databases (i.e., PubMed, CINAHL, and Embase) were searched to identify relevant literature in August 2023. Articles that discussed the development, use, and application of large language models within nursing were included for analysis. RESULTS: The literature search identified a total of 2028 articles that met the inclusion criteria. After systematically reviewing abstracts, titles, and full texts, 30 articles were included in the final analysis. Nearly all (93 %; n = 28) of the included articles used ChatGPT as an example, and subsequently discussed the use and value of large language models in nursing education (47 %; n = 14), clinical practice (40 %; n = 12), and research (10 %; n = 3). While the most common assessment of large language models was conducted by human evaluation (26.7 %; n = 8), this analysis also identified common limitations of large language models in nursing, including lack of systematic evaluation, as well as other ethical and legal considerations. DISCUSSION: This is the first review to summarize contemporary literature on current and potential uses of large language models in nursing practice, education, and research. Although there are significant opportunities to apply large language models, the use and adoption of these models within nursing have elicited a series of challenges, such as ethical issues related to bias, misuse, and plagiarism. CONCLUSION: Given the relative novelty of large language models, ongoing efforts to develop and implement meaningful assessments, evaluations, standards, and guidelines for applying large language models in nursing are recommended to ensure appropriate, accurate, and safe use. Future research along with clinical and educational partnerships is needed to enhance understanding and application of large language models in nursing and healthcare.

User Needs and Factors Associated With the Acceptability of Audiovisual Feedback Devices for Chest Compression Monitoring in Cardiopulmonary Resuscitation.

The use of audiovisual feedback devices to guide the quality of chest compressions during cardiopulmonary resuscitation has increased in recent years. Audiovisual feedback devices can be classified as integrated (eg, Zoll AED Plus defibrillator) or standalone (eg, CPRmeter). This study aimed to explore users' needs and factors affecting the acceptability of audiovisual feedback devices. Semistructured interviews were conducted with healthcare professionals involved in lifesaving activities. The Unified Theory of Acceptance and Use of Technology was used as a theoretical framework for the study. The Unified Theory of Acceptance and Use of Technology model has four constructs: performance expectancy, effort expectancy, social influence, and facilitating factors. Ten themes were identified under the four constructs. The performance expectancy constructs include three themes: perceived usefulness, outcome expectation, and applicability in diverse situations. The effort expectancy construct encompasses two themes: user-friendliness and complexity. The social influence construct has two themes: social and organizational factors. Lastly, the facilitating factors construct includes three themes: staff competence, perceived cost, and compatibility of devices. Exploring the needs and factors influencing the acceptability of audiovisual feedback devices used during cardiopulmonary resuscitation will inform healthcare providers, managers, manufacturers, and procurers on how to improve the efficiency and use of these devices.

The ChatGPT Effect: Nursing Education and Generative Artificial Intelligence.

This article examines the potential of generative artificial intelligence (AI), such as ChatGPT (Chat Generative Pre-trained Transformer), in nursing education and the associated challenges and recommendations for their use. Generative AI offers potential benefits such as aiding students with assignments, providing realistic patient scenarios for practice, and enabling personalized, interactive learning experiences. However, integrating generative AI in nursing education also presents challenges, including academic integrity issues, the potential for plagiarism and copyright infringements, ethical implications, and the risk of producing misinformation. Clear institutional guidelines, comprehensive student education on generative AI, and tools to detect AI-generated content are recommended to navigate these challenges. The article concludes by urging nurse educators to harness generative AI's potential responsibly, highlighting the rewards of enhanced learning and increased efficiency. The careful navigation of these challenges and strategic implementation of AI is key to realizing the promise of AI in nursing education. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Technological Challenges and Solutions in Emergency Remote Teaching for Nursing: An International Cross-Sectional Survey.

OBJECTIVES: With the sudden global shift to online learning modalities, this study aimed to understand the unique challenges and experiences of emergency remote teaching (ERT) in nursing education. METHODS: We conducted a comprehensive online international cross-sectional survey to capture the current state and firsthand experiences of ERT in the nursing discipline. Our analytical methods included a combination of traditional statistical analysis, advanced natural language processing techniques, latent Dirichlet allocation using Python, and a thorough qualitative assessment of feedback from open-ended questions. RESULTS: We received responses from 328 nursing educators from 18 different countries. The data revealed generally positive satisfaction levels, strong technological self-efficacy, and significant support from their institutions. Notably, the characteristics of professors, such as age (p = 0.02) and position (p = 0.03), influenced satisfaction levels. The ERT experience varied significantly by country, as evidenced by satisfaction (p = 0.05), delivery (p = 0.001), teacher-student interaction (p = 0.04), and willingness to use ERT in the future (p = 0.04). However, concerns were raised about the depth of content, the transition to online delivery, teacher-student interaction, and the technology gap. CONCLUSIONS: Our findings can help advance nursing education. Nevertheless, collaborative efforts from all stakeholders are essential to address current challenges, achieve digital equity, and develop a standardized curriculum for nursing education.

Towards Automated Evaluation of Patient Centered Care-Assessing the Potential of Electronic Health Records.

Providing patient centered care is a crucial element of high quality care. It can be defined as a responsive way of caring for and empowering patients, embodying compassion, empathy, and responsiveness to the patient's needs. The aim of this study was to assess the potential of using EHRs as information source in the development of tools for assessing PCC. An annotation guide following the Person-centred Practice Framework proposed by McCance and McCormack was developed for the purpose of this study. Twenty patients' documents were manually annotated, resulting in 539 expressions. All dimensions of the framework were covered in the documents, with 61.3% of expressions describing the activity of engaging authentically with the patient. The results of this study indicate that electronic health records are one potential source of information in automated evaluation of patient centered care, however more information is still needed on how to interpret this information.

The effect of standalone audio-visual feedback devices on the quality of chest compressions during laypersons' cardiopulmonary resuscitation training: a systematic review and meta-analysis.

AIMS: Individual studies that investigated the effect of standalone audio-visual feedback (AVF) devices during laypersons' cardiopulmonary resuscitation (CPR) training have yielded conflicting results. This review aimed to evaluate the effect of standalone AVF devices on the quality of chest compressions during laypersons' CPR training. METHOD AND RESULT: Randomized controlled trials of simulation studies recruiting participants without actual patient CPR experience were included. The intervention evaluated was the quality of chest compressions with standalone AVF devices vs. without AVF devices. Databases, such as PubMed, Cochrane Central, Embase, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Web of Science, and PsycINFO, were searched from January 2010 to January 2022. The risk of bias was assessed using the Cochrane risk of bias tool. A meta-analysis alongside a narrative synthesis was used for examining the effect of standalone AVF devices.Sixteen studies were selected for this systematic review. A meta-analysis revealed an increased compression depth of 2.22 mm [95% CI (Confidence Interval), 0.88-3.55, P = 0.001] when participants performed CPR using the feedback devices. Besides, AVF devices enabled laypersons to deliver compression rates closer to the recommended range of 100-120 per min. No improvement was noted in chest recoil and hand positioning when participants used standalone AVF devices. CONCLUSION: The quality of the included studies was variable, and different standalone AVF devices were used. Standalone AVF devices were instrumental in guiding laypersons to deliver deeper compressions without compromising the quality of compression rates. However, the devices did not improve the quality of chest recoil and placement of the hands. REGISTRATION: PROSPERO: CRD42020205754.

Exploring the Documentation of Delirium in Patients After Cardiac Surgery: A Retrospective Patient Record Study.

Delirium is a common disorder for patients after cardiac surgery. Its manifestation and care can be examined through EHRs. The aim of this retrospective, comparative, and descriptive patient record study was to describe the documentation of delirium symptoms in the EHRs of patients who have undergone cardiac surgery and to explore how the documentation evolved between two periods (2005-2009 and 2015-2020). Randomly selected care episodes were annotated with a template, including delirium symptoms, treatment methods, and adverse events. The patients were then manually classified into two groups: nondelirious (n = 257) and possibly delirious (n = 172). The data were analyzed quantitatively and descriptively. According to the data, the documentation of symptoms such as disorientation, memory problems, motoric behavior, and disorganized thinking improved between periods. Yet, the key symptoms of delirium, inattention, and awareness were seldom documented. The professionals did not systematically document the possibility of delirium. Particularly, the way nurses recorded structural information did not facilitate an overall understanding of a patient's condition with respect to delirium. Information about delirium or proposed care was seldom documented in the discharge summaries. Advanced machine learning techniques can augment instruments that facilitate early detection, care planning, and transferring information to follow-up care.

Representation of Environmental Concepts Associated with Health Impacts in Computer Standardized Clinical Terminologies.

OBJECTIVE: To evaluate the representation of environmental concepts associated with health impacts in standardized clinical terminologies. METHODS: This study used a descriptive approach with methods informed by a procedural framework for standardized clinical terminology mapping. The United Nations Global Indicator Framework for the Sustainable Development Goals and Targets was used as the source document for concept extraction. The target terminologies were the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) and the International Classification for Nursing Practice (ICNP). Manual and automated mapping methods were utilized. The lists of candidate matches were reviewed and iterated until a final mapping match list was achieved. RESULTS: A total of 119 concepts with 133 mapping matches were added to the final SNOMED CT list. Fifty-three (39.8%) were direct matches, 37 (27.8%) were narrower than matches, 35 (26.3%) were broader than matches, and 8 (6%) had no matches. A total of 26 concepts with 27 matches were added to the final ICNP list. Eight (29.6%) were direct matches, 4 (14.8%) were narrower than, 7 (25.9%) were broader than, and 8 (29.6%) were no matches. CONCLUSION: Following this evaluation, both strengths and gaps were identified. Gaps in terminology representation included concepts related to cost expenditures, affordability, community engagement, water, air and sanitation. The inclusion of these concepts is necessary to advance the clinical reporting of these environmental and sustainability indicators. As environmental concepts encoded in standardized terminologies expand, additional insights into data and health conditions, research, education, and policy-level decision-making will be identified.

Nursing Informatics' Contribution to One Health.

OBJECTIVES: To summarise contemporary knowledge in nursing informatics related to education, practice, governance and research in advancing One Health. METHODS: This descriptive study combined a theoretical and an empirical approach. Published literature on recent advancements and areas of interest in nursing informatics was explored. In addition, empirical data from International Medical Informatics Association (IMIA) Nursing Informatics (NI) society reports were extracted and categorised into key areas regarding needs, established activities, issues under development and items not current. RESULTS: A total of 1,772 references were identified through bibliographic database searches. After screening and assessment for eligibility, 146 articles were included in the review. Three topics were identified for each key area: 1) education: "building basic nursing informatics competence", "interdisciplinary and interprofessional competence" and "supporting educators competence"; 2) practice: "digital nursing and patient care", "evidence for timely issues in practice" and "patient-centred safe care"; 3) governance: "information systems in healthcare", "standardised documentation in clinical context" and "concepts and interoperability", and 4) research: "informatics literacy and competence", "leadership and management", and "electronic documentation of care". 17 reports from society members were included. The data showed overlap with the literature, but also highlighted needs for further work, including more strategies, methods and competence in nursing informatics to support One Health. CONCLUSIONS: Considering the results of this study, from the literature nursing informatics would appear to have a significant contribution to make to One Health across settings. Future work is needed for international guidelines on roles and policies as well as knowledge sharing.

Videoconferencing Applications for Training Professionals on Nonverbal Communication in Online Clinical Consultations.

OBJECTIVES: The use of videoconferencing technologies for clinician-patient online consultations has become increasingly popular. Training on online communication competence through a videoconferencing application that integrates nonverbal communication detection with feedback is one way to prepare future clinicians to conduct effective online consultations. This case report describes and evaluates two such applications designed for healthcare professionals and students in healthcare-related fields. METHODS: We conducted a literature review using five databases, including the Web of Science, Scopus, PubMed, ACM, IEEE, and CINAHL in the spring of 2022. RESULTS: We identified seven studies on two applications, ReflectLive and EQClinic. These studies were conducted by two research groups from the USA and Australia and were published between 2016 and 2020. Both detected nonverbal communication from video and audio and provided computer-generated feedback on users' nonverbal communication. The studies evaluated usability, effectiveness in learning communication skills, and changes in the users' awareness of their nonverbal communication. The developed applications were deemed feasible. However, the feedback given by the applications needs improvement to be more beneficial to the user. The applications were primarily evaluated with medical students, with limited or no attention given to questions regarding ethics, information security, privacy, sustainability, and costs. CONCLUSIONS: Current research on videoconferencing systems for training online consultation skills is very limited. Future research is needed to develop more user-centered solutions, focusing on a multidisciplinary group of students and professionals, and to explore the implications of these technologies from a broader perspective, including ethics, information security, privacy, sustainability, and costs.

Structural and Psychological Empowerment of Learners Enrolled in Continuing Nursing Leadership Education in Finland: A Quasi-Experimental Longitudinal Study.

BACKGROUND: This study was conducted to assess structural and psychological empowerment among learners enrolled in a continuing leadership education program. Although the number of nurse leadership development interventions has increased, there is little evidence on how they influence leaders' empowerment. METHOD: A longitudinal study was employed, with learners (N = 85) enrolled in a continuing leadership education program as the participants. Data were collected in the beginning, at the end, and 8 months after the completion of the program using internationally validated instruments. Data were analyzed statistically. RESULTS: A total of 25 learners (29%) responded to the questionnaire at all three data collection points. The education significantly increased psychological and structural empowerment across all dimensions except formal power. These increased levels of empowerment were partially sustained at the 8-month follow-up time point. CONCLUSION: Continuing education seems to benefit nurse leaders, and the continuing nursing leadership education program was positively associated with learners' perceived empowerment. [J Contin Educ Nurs. 2023;54(10):462-471.].

Evaluating the representation of disaster hazards in SNOMED CT: gaps and opportunities.

OBJECTIVE: Climate change, an underlying risk driver of natural disasters, threatens the environmental sustainability, planetary health, and sustainable development goals. Incorporating disaster-related health impacts into electronic health records helps to comprehend their impact on populations, clinicians, and healthcare systems. This study aims to: (1) map the United Nations Office for Disaster Risk Reduction and International Science Council (UNDRR-ISC) Hazard Information Profiles to SNOMED CT International, a clinical terminology used by clinicians, to manage patients and provide healthcare services; and (2) to determine the extent of clinical terminologies available to capture disaster-related events. MATERIALS AND METHODS: Concepts related to disasters were extracted from the UNDRR-ISC's Hazard Information Profiles and mapped to a health terminology using a procedural framework for standardized clinical terminology mapping. The mapping process involved evaluating candidate matches and creating a final list of matches to determine concept coverage. RESULTS: A total of 226 disaster hazard concepts were identified to adversely impact human health. Chemical and biological disaster hazard concepts had better representation than meteorological, hydrological, extraterrestrial, geohazards, environmental, technical, and societal hazard concepts in SNOMED CT. Heatwave, drought, and geographically unique disaster hazards were not found in SNOMED CT. CONCLUSION: To enhance clinical reporting of disaster hazards and climate-sensitive health outcomes, the poorly represented and missing concepts in SNOMED CT must be included. Documenting the impacts of climate change on public health using standardized clinical terminology provides the necessary real time data to capture climate-sensitive outcomes. These data are crucial for building climate-resilient healthcare systems, enhanced public health disaster responses and workflows, tracking individual health outcomes, supporting disaster risk reduction modeling, and aiding in disaster preparedness, response, and recovery efforts.

Relationships between nursing leadership and organizational, staff and patient outcomes: A systematic review of reviews.

AIM: To assess and describe reviews of nursing leadership styles associated with organizational, staff and patient outcomes. DESIGN: A systematic review of reviews. METHODS: Reviews describing a search strategy and quality assessment. The review followed the PRISMA statement. Nine databases were searched in February 2022. RESULTS: After screening 6992 records, 12 reviews were included reporting 85 outcomes for 17 relational, nine task-oriented, five passive and five destructive leadership styles. Transformational leadership, which is one of the relational styles, was the most studied among all the styles. Of the outcomes, staff outcomes were the most reported, notably job satisfaction, and patient outcomes were less reported. Also, mediating factors between relational leadership styles and staff and patient outcomes were identified. CONCLUSION: Extensive research shows the beneficial impacts of relational leadership; however, destructive leadership research is lacking. Relational leadership styles should be conceptually assessed. More research is needed on how nurse leadership affects patients and organizations.

Electronic Health Records as Information Source in Assessment of the Effectiveness of Delivered Care - A Pilot Study.

Effectiveness is a key element of high quality health services. The aim of this pilot study was to explore the potential of electronic health records (EHR) as an information source for assessing the effectiveness of nursing care by investigating the appearance of nursing processes in the documentation of care. Deductive and inductive content analysis were used in a manual annotation of ten patients' EHRs. The analysis resulted in the identification of 229 documented nursing processes. The results indicate that EHRs can be used in decision support systems for assessing effectiveness of nursing care, however, future work is needed to verify these findings in a larger data set and extend to other dimensions related to care quality.