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3.
J Nurs Meas ; 26(1): 20-35, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29724276

RESUMO

BACKGROUND AND PURPOSE: Multiple continuity indexes are available; however, their properties are insufficiently understood for examining the influence of nurse staffing patterns on patient outcomes. We conceptually and analytically examined continuity measures to reveal their properties and relationships with each other and identify potential limitations. METHODS: We examined behavior of continuity indexes as applied to clinical practice data that were collected with the HANDS (Hands-On Automated Nursing Data System) and data from computer simulation. RESULTS: Studied continuity measures exhibited very different statistical characteristics. Most importantly, many continuity measures contain a length-of-stay dependent term that is uncorrelated with continuity. CONCLUSION: Findings provide a deep understanding of the conceptual foundations and properties of various continuity measures. Using findings, researchers can select proper measures and better interpret analysis outcomes.


Assuntos
Continuidade da Assistência ao Paciente , Registros Eletrônicos de Saúde , Enfermagem , Gravidade do Paciente , Simulação por Computador , Hospitais , Humanos , Admissão e Escalonamento de Pessoal , Estados Unidos
4.
Int J Nurs Knowl ; 29(4): 242-252, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28926204

RESUMO

PURPOSE: To determine the acceptability, usefulness, and ease of use for four nursing clinical decision support interface prototypes. METHODS: In a simulated hospital environment, 60 registered nurses (48 female; mean age = 33.7 ± 10.8; mean years of experience = 8.1 ± 9.7) participated in a randomized study with four study groups. Measures included acceptability, usefulness, and ease of use scales. FINDINGS: Mean scores were high for acceptability, usefulness, and the ease of use for all four groups. Inexperienced participants (<1 year) reported higher perceived ease of use (p = .05) and perceived usefulness (p = .01) than those with experience of 1 year or more. CONCLUSIONS: Participants completed the protocol and reported that all four interfaces, including the control (HANDS), were acceptable, easy to use, and useful. IMPLICATIONS FOR NURSING KNOWLEDGE: Further study is warranted before clinical implementation within the electronic health record.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Registros Eletrônicos de Saúde , Registros de Enfermagem , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Interface Usuário-Computador , Adulto Jovem
5.
Int J Nurs Knowl ; 29(1): 49-58, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28093877

RESUMO

PURPOSE: To critically evaluate 2014 American Academy of Nursing (AAN) call-to-action plan for generating interoperable nursing data. DATA SOURCES: Healthcare literature. DATA SYNTHESIS: AAN's plan will not generate the nursing data needed to participate in big data science initiatives in the short term because Logical Observation Identifiers Names and Codes and Systematized Nomenclature of Medicine - Clinical Terms are not yet ripe for generating interoperable data. Well-tested viable alternatives exist. CONCLUSIONS: Authors present recommendations for revisions to AAN's plan and an evidence-based alternative to generating interoperable nursing data in the near term. These revisions can ultimately lead to the proposed terminology goals of the AAN's plan in the long term.


Assuntos
Big Data , Registros Eletrônicos de Saúde/estatística & dados numéricos , Processo de Enfermagem , Técnicas de Planejamento , Software , Vocabulário Controlado , Gráficos por Computador , Sociedades de Enfermagem , Terminologia Padronizada em Enfermagem , Systematized Nomenclature of Medicine , Estados Unidos , Fluxo de Trabalho
6.
J Nurs Adm ; 47(12): 592-596, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29135846

RESUMO

Contemporary CNOs are committed to developing the next generation of nurse leaders. At OhioHealth, the nursing strategic vision includes the belief that every nurse will be a leader in improving health across the care continuum. In 2016, the OhioHealth System partnered with AONE to participate in the Care Innovation and Transformation program resulting in bedside nurses living this strategic vision and creating positive changes in quality, safety, and satisfaction for patients and families.


Assuntos
Liderança , Serviço Hospitalar de Enfermagem/organização & administração , Supervisão de Enfermagem/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Desenvolvimento de Pessoal/organização & administração , Humanos , Melhoria de Qualidade , Estados Unidos
7.
Nurs Res ; 66(5): 388-398, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28858147

RESUMO

BACKGROUND: Clinical decision support (CDS) tools-with easily understood and actionable information, at the point of care-are needed to help registered nurses (RNs) make evidence-based decisions. Not clear are the optimal formats of CDS tools. Thorough, preclinical testing is desirable to avoid costly errors associated with premature implementation in electronic health records. OBJECTIVE: The aims of this study were to determine feasibility of the protocol designed to compare multiple CDS formats and evaluate effects of numeracy and graph literacy on RN adoption of best practices and care planning time in a simulated environment. METHODS: In this pilot study, 60 RNs were randomly assigned to one of four CDS conditions (control, text, text + graph, and text + table) and asked to adjust the plan of care for two patient scenarios over three shifts. Fourteen best practices were identified for the two patients and sent as suggestions with evidence to the three CDS groups. Best practice adoption rates, care planning time, and their relationship to the RN's numeracy and graph literacy scores were assessed. RESULTS: CDS groups had a higher adoption rate of best practices (p < .001) across all shifts and decreased care planning time in shifts 2 (p = .01) and 3 (p = .02) compared with the control group. Higher numeracy and graph literacy were associated with shorter care planning times under text + table (p = .05) and text + graph (p = .01) conditions. No significant differences were found between the three CDS groups on adoption rate and care planning time. DISCUSSION: This pilot study shows the feasibility of our protocol. Findings show preliminary evidence that CDS improves the efficiency and effectiveness of care planning decisions and that the optimal format may depend on individual RN characteristics. We recommend a study with sufficient power to compare different CDS formats and assess the impact of potential covariates on adoption rates and care planning time.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Registros Eletrônicos de Saúde/normas , Enfermagem Baseada em Evidências/normas , Recursos Humanos de Enfermagem no Hospital/educação , Planejamento de Assistência ao Paciente/normas , Guias de Prática Clínica como Assunto , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
9.
Int J Nurs Knowl ; 28(4): 211-218, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27337939

RESUMO

PURPOSE: To develop methods for rapid and simultaneous design, testing, and management of multiple clinical decision support (CDS) features to aid nurse decision-making. METHODS: We used quota sampling, think-aloud and cognitive interviews, and deductive and inductive coding of synchronized audio video data and archival libraries. FINDINGS: Our methods and organizational tools allowed us to rapidly improve the usability, understandability, and usefulness of CDS in a generalizable sample of practicing nurses. CONCLUSIONS: The method outlined allows the rapid integration of nursing terminology based electronic health record data into routine workflow and holds strong potential for improving patient outcomes. IMPLICATIONS FOR NURSING PRACTICE: The methods and organizational tools for development of multiple CDS system features can be used to translate knowledge into practice.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Registros Eletrônicos de Saúde , Registros de Enfermagem , Humanos , Processo de Enfermagem , Interface Usuário-Computador
10.
J Nurs Care Qual ; 31(2): 124-30, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26323050

RESUMO

We present findings of a comparative study of numeracy and graph literacy in a representative group of 60 practicing nurses. This article focuses on a fundamental concern related to the effectiveness of numeric information displayed in various features in the electronic health record during clinical workflow. Our findings suggest the need to consider numeracy and graph literacy when presenting numerical information as well as the potential for tailoring numeric display types to an individual's cognitive strengths.


Assuntos
Compreensão , Alfabetização Digital , Sistemas de Apoio a Decisões Clínicas , Alfabetização em Saúde , Matemática , Adulto , Idoso , Tomada de Decisões , Registros Eletrônicos de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Resolução de Problemas
11.
Comput Inform Nurs ; 33(10): 465-72, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26361268

RESUMO

Our long-term goal was to ensure nurse clinical decision support works as intended before full deployment in clinical practice. As part of a broader effort, this pilot project explored factors influencing acceptance/nonacceptance of eight clinical decision support suggestions displayed in an electronic health record-based nursing plan of care software prototype. A diverse sample of 21 nurses participated in this high-fidelity clinical simulation experience and completed a questionnaire to assess reasons for accepting/not accepting the clinical decision support suggestions. Of 168 total suggestions displayed during the experiment (eight for each of the 21 nurses), 123 (73.2%) were accepted, and 45 (26.8%) were not accepted. The mode number of acceptances by nurses was seven of eight, with only two of 21 nurses accepting all. The main reason for clinical decision support acceptance was the nurse's belief that the suggestions were good for the patient (100%), with other features providing secondary reinforcement. Reasons for nonacceptance were less clear, with fewer than half of the subjects indicating low confidence in the evidence. This study provides preliminary evidence that high-quality simulation and targeted questionnaires about specific clinical decision support selections offer a cost-effective means for testing before full deployment in clinical practice.


Assuntos
Atitude Frente aos Computadores , Sistemas de Apoio a Decisões Clínicas/estatística & dados numéricos , Informática em Enfermagem , Recursos Humanos de Enfermagem no Hospital/psicologia , Treinamento por Simulação/métodos , Adulto , Idoso , Atitude do Pessoal de Saúde , Competência Clínica , Registros Eletrônicos de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Metodológica em Enfermagem , Projetos Piloto , Inquéritos e Questionários
12.
Nurs Res ; 64(5): 361-71, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26325278

RESUMO

BACKGROUND: Little research demonstrating the association between nurse continuity and patient outcomes exists despite an intuitive belief that continuity makes a difference in care outcomes. OBJECTIVE: The aim of this study was to examine the association of nurse continuity with the prevention of hospital-acquired pressure ulcers (HAPU). METHODS: A secondary use of data from the Hands on Automated Nursing Data System (HANDS) was performed for this comparative study. The HANDS is a nursing plan of care data set containing 42,403 episodes documented by 787 nurses, on nine units, in four hospitals and includes nurse staffing and patient characteristics. The HANDS data set resides in a "big data" relational database consisting of 89 tables and 747 columns of data. Via data mining, we created an analytic data set of 840 care episodes, 210 with and 630 without HAPUs, matched by nursing unit, patient age, and patient characteristics. Logistic regression analysis determined the association of nurse continuity and additional nurse-staffing variables on HAPU occurrence. RESULTS: Poor nurse continuity (unit mean continuity index = .21-.42 [1.0 = optimal continuity]) was noted on all nine study units. Nutrition, mobility, perfusion, hydration, and skin problems on admission, as well as patient age, were associated with HAPUs (p < .001). Controlling for patient characteristics, nurse continuity, and the interactions between nurse continuity and other nurse-staffing variables were not significantly associated with HAPU development. DISCUSSION: Patient characteristics including nutrition, mobility, and perfusion were associated with HAPUs, but nurse continuity was not. We demonstrated a high level of variation in the degree of continuity between patient episodes in the HANDS data, showing that it offers rich potential for future study of nurse continuity and its effect on patient outcomes.


Assuntos
Recursos Humanos de Enfermagem no Hospital/provisão & distribução , Lesão por Pressão/epidemiologia , Fatores Etários , Idoso , Circulação Sanguínea , Estudos de Casos e Controles , Mineração de Dados , Bases de Dados Factuais , Humanos , Modelos Logísticos , Limitação da Mobilidade , Estado Nutricional , Lesão por Pressão/prevenção & controle , Qualidade da Assistência à Saúde , Fatores de Risco , Estados Unidos/epidemiologia
13.
ANS Adv Nurs Sci ; 38(3): 241-51, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26244480

RESUMO

The influence of the staffing variable relational nurse continuity on patient outcomes has been rarely studied and with inconclusive results. Multiple definitions and an absence of systematic methods for measuring the influence of continuity have resulted in its exclusion from nurse-staffing studies and conceptual models. We present a new conceptual model and an innovative use of health information technology to measure relational nurse continuity and to demonstrate the potential for bringing the results of big data science back to the bedside. Understanding the power of big data to address critical clinical issues may foster a new direction for nursing administration theory development.


Assuntos
Continuidade da Assistência ao Paciente/normas , Cuidados de Enfermagem/normas , Recursos Humanos de Enfermagem no Hospital/normas , Admissão e Escalonamento de Pessoal/normas , Lesão por Pressão/enfermagem , Qualidade da Assistência à Saúde/normas , Hospitalização , Humanos , Modelos de Enfermagem , Teoria de Enfermagem
14.
Palliat Support Care ; 13(5): 1427-34, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25711431

RESUMO

OBJECTIVE: Electronic health records (EHRs) may contain infomarkers that identify patients near the end of life for whom it would be appropriate to shift care goals to palliative care. Discovery and use of such infomarkers could be used to conduct effectiveness research that ultimately could help to reduce the monumental cost of caring for the dying. The aim of our study was to identify changes in the plans of care that represent infomarkers, which signal a transition of care goals from nonpalliative care ones to those consistent with palliative care. METHOD: Using an existing electronic health record database generated during a two-year longitudinal study of nine diverse medical-surgical units from four Midwest hospitals and a known group approach, we evaluated patient care episodes for 901 patients who died (mean age = 74.5 ± 14.6 years). We used ANOVA and Tukey's post-hoc tests to compare patient groups. RESULTS: We identified 11 diagnoses, including Death Anxiety and Anticipatory Grieving, whose addition to the care plan, some of which also occurred with removal of nonpalliative care diagnoses, represent infomarkers of transition to palliative care goals. There were four categories of patients, those who had: no infomarkers on plans (n = 507), infomarkers added on the admission plan (n = 194), infomarkers added on a post-admission plan (minor transitions, n = 109), and infomarkers added and nonpalliative care diagnoses removed on a post-admission plan (major transition, n = 91). Age, length of stay, and pain outcomes differed significantly for these four categories of patients. SIGNIFICANCE OF RESULTS: EHRs contain pertinent infomarkers that if confirmed in future studies could be used for timely referral to palliative care for improved focus on comfort outcomes and to identify palliative care subjects from data repositories in order to conduct big-data research, comparative effectiveness studies, and health-services research.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Gestão da Informação em Saúde/estatística & dados numéricos , Diagnóstico de Enfermagem/estatística & dados numéricos , Cuidados Paliativos/normas , Planejamento de Assistência ao Paciente/normas , Doente Terminal , Adulto , Idoso , Idoso de 80 Anos ou mais , Interpretação Estatística de Dados , Bases de Dados Factuais , Gestão da Informação em Saúde/métodos , Mortalidade Hospitalar , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos/epidemiologia , Adulto Jovem
15.
Adv Data Min ; 9165: 56-68, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27500287

RESUMO

Electronic health record (EHR) systems are being widely used in the healthcare industry nowadays, mostly for monitoring the progress of the patients. EHR data analysis has become a big data problem as data is growing rapidly. Using a nursing EHR system, we built predictive models for determining what factors influence pain in end-of-life (EOL) patients. Utilizing different modeling techniques, we developed coarse-grained and fine-grained models to predict patient pain outcomes. The coarse-grained models help predict the outcome at the end of each hospitalization, whereas fine-grained models help predict the outcome at the end of each shift, thus providing a trajectory of predicted outcomes over the entire hospitalization. These models can help in determining effective treatments for individuals and groups of patients and support standardization of care where appropriate. Using these models may also lower the cost and increase the quality of end-of-life care. Results from these techniques show significantly accurate predictions.

16.
Int J Nurs Knowl ; 26(1): 19-25, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24674040

RESUMO

PURPOSE: To assess the reliability and validity of Quality of Diagnoses, Interventions, and Outcomes (Q-DIO) in Brazil and in the United States. METHODS: The sample comprised 180 records: centers 1 (electronic records and standardized language) and 2 (paper-based records without standardized language in Brazil, and center 3 (electronic records without standardized language) in the United States. Reliability and discriminant construct validity was analyzed. FINDINGS: Cronbach's alpha for all 29 Q-DIO items were greater than or equal to 0.70 for all centers; construct validity was significantly different between the three study centers. CONCLUSIONS: These results indicate that Q-DIO is valid and reliable for assessing the quality of nursing records. IMPLICATIONS FOR NURSING PRACTICE: The Q-DIO may be useful to assess the quality and accuracy of nursing records.


Assuntos
Diagnóstico , Garantia da Qualidade dos Cuidados de Saúde , Brasil , Estados Unidos
17.
Res Gerontol Nurs ; 7(5): 224-34, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25157534

RESUMO

The nursing outcomes of hospitalized patients whose plans of care include death anxiety, which is a diagnosis among patients at the end-of-life, are obscure. The authors of the current article applied data mining techniques to nursing plan-of-care data for patients diagnosed with death anxiety, as defined by North American Nursing Diagnosis Association International, from four different hospitals to examine nursing care outcomes and associated factors. Results indicate that <50% of patients met the expected outcome of comfortable death. Gerontology unit patients were more likely to meet the expected outcome than patients from other unit types, although results were not statistically significant. Younger patients (i.e., age <65) had a lower chance of meeting the outcome compared with older patients (i.e., age ≥65) (χ(2)(1) = 9.266, p < 0.004). Longer stays improved the chances of meeting the outcome (χ(2)(2) = 6.47, p < 0.04). Results indicate that death anxiety outcomes are suboptimal and suggest the need to better educate clinicians about diagnosing and treating death anxiety among patients who face the end-of-life transition.


Assuntos
Transtornos de Ansiedade/psicologia , Atitude Frente a Morte , Enfermagem Geriátrica/métodos , Recursos Humanos de Enfermagem no Hospital/psicologia , Assistência Terminal/métodos , Assistência Terminal/psicologia , Adaptação Psicológica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos de Ansiedade/enfermagem , Registros Eletrônicos de Saúde , Hospitalização , Humanos , Pacientes Internados/psicologia , Pessoa de Meia-Idade , Relações Enfermeiro-Paciente , Adulto Jovem
18.
Int J Nurs Stud ; 51(8): 1160-70, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24412062

RESUMO

OBJECTIVE: To determine the state of the science for the five standardized nursing terminology sets in terms of level of evidence and study focus. DESIGN: Systematic review. DATA SOURCES: Keyword search of PubMed, CINAHL, and EMBASE databases from 1960s to March 19, 2012 revealed 1257 publications. REVIEW METHODS: From abstract review we removed duplicate articles, those not in English or with no identifiable standardized nursing terminology, and those with a low-level of evidence. From full text review of the remaining 312 articles, eight trained raters used a coding system to record standardized nursing terminology names, publication year, country, and study focus. Inter-rater reliability confirmed the level of evidence. We analyzed coded results. RESULTS: On average there were 4 studies per year between 1985 and 1995. The yearly number increased to 14 for the decade between 1996 and 2005, 21 between 2006 and 2010, and 25 in 2011. Investigators conducted the research in 27 countries. By evidence level for the 312 studies 72.4% were descriptive, 18.9% were observational, and 8.7% were intervention studies. Of the 312 reports, 72.1% focused on North American Nursing Diagnosis-International, Nursing Interventions Classification, Nursing Outcome Classification, or some combination of those three standardized nursing terminologies; 9.6% on Omaha System; 7.1% on International Classification for Nursing Practice; 1.6% on Clinical Care Classification/Home Health Care Classification; 1.6% on Perioperative Nursing Data Set; and 8.0% on two or more standardized nursing terminology sets. There were studies in all 10 foci categories including those focused on concept analysis/classification infrastructure (n=43), the identification of the standardized nursing terminology concepts applicable to a health setting from registered nurses' documentation (n=54), mapping one terminology to another (n=58), implementation of standardized nursing terminologies into electronic health records (n=12), and secondary use of electronic health record data (n=19). CONCLUSIONS: Findings reveal that the number of standardized nursing terminology publications increased primarily since 2000 with most focusing on North American Nursing Diagnosis-International, Nursing Interventions Classification, and Nursing Outcome Classification. The majority of the studies were descriptive, qualitative, or correlational designs that provide a strong base for understanding the validity and reliability of the concepts underlying the standardized nursing terminologies. There is evidence supporting the successful integration and use in electronic health records for two standardized nursing terminology sets: (1) the North American Nursing Diagnosis-International, Nursing Interventions Classification, and Nursing Outcome Classification set; and (2) the Omaha System set. Researchers, however, should continue to strengthen standardized nursing terminology study designs to promote continuous improvement of the standardized nursing terminologies and use in clinical practice.


Assuntos
Sociedades de Enfermagem , Terminologia como Assunto , Variações Dependentes do Observador , Estados Unidos
19.
Artigo em Inglês | MEDLINE | ID: mdl-27453959

RESUMO

Clinical Decision Support Systems (CDSS) are tools that assist healthcare personnel in the decision-making process for patient care. Although CDSSs have been successfully deployed in the clinical setting to assist physicians, few CDSS have been targeted at professional nurses, the largest group of health providers. We present our experience in designing and testing a CDSS interface embedded within a nurse care planning and documentation tool. We developed four prototypes based on different CDSS feature designs, and tested them in simulated end-of-life patient handoff sessions with a group of 40 nurse clinicians. We show how our prototypes directed nurses towards an optimal care decision that was rarely performed in unassisted practice. We also discuss the effect of CDSS layout and interface navigation in a nurse's acceptance of suggested actions. These findings provide insights into effective nursing CDSS design that are generalizable to care scenarios different than end-of-life.

20.
Des User Exp Usability ; 8012: 232-241, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27478882

RESUMO

In this paper we present our experience in designing and applying an evaluation protocol for assessing usability of a clinical decision support (CDS) system. The protocol is based on component-based usability testing, cognitive interviewing, and a rigorous coding scheme cross-referenced to a component library. We applied this protocol to evaluate alternate designs of a CDS interface for a nursing plan of care tool. The protocol allowed us to aggregate and analyze usability data at various granularity levels, supporting both validation of existing components and providing guidance for targeted redesign.

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