Development of an electronic nursing records system based on information models and clinical practice guidelines.

The purpose of this study was to test the feasibility of an electronic nursing records system for perinatal care that is based on information models and clinical practice guidelines in perinatal care. We first generated 799 nursing statements describing nursing assessment, diagnoses, interventions, and outcomes using the entities, attributes, and value sets of detailed clinical models for perinatal care that we developed in a previous study. We then extracted 506 detailed recommendations from clinical practice guidelines. Finally, we created sets of nursing statements to be used for nursing documentation by grouping nursing statements based on these detailed recommendations. A prototype electronic nursing records system providing nurses with detailed recommendations for nursing practice and sets of nursing statements based on the detailed recommendations to guide nursing documentation was developed and evaluated.

Development and validation of data specifications for nursing problems in maternal nursing care.

The aims of this study were to develop data specifications for nursing problems related to maternal nursing care and to test the applicability of those data specifications. First, we identified focus concepts and characterizing concepts of nursing problems by analyzing nursing-problem statements from nursing records, reviewing the literature, and interviewing experts. Second, we identified relationships between the focus concepts and characterizing concepts. Third, value sets of characterizing concepts were identified and types and cardinalities of the characterizing concepts were defined based on those value sets. Finally, data specifications were evaluated by a group of experts and by applying them to published case reports. The adequacy of the characterizing concepts and value sets, and the types and cardinalities of the characterizing concepts were validated. In total, 58 data specifications were developed with 53 characterizing concepts, relationships, and value sets. Their validity was established by the experts and by their application to case reports. The data specifications developed in this study can ensure that electronic health records contain meaningful and valid information, and support the semantic interoperability of nursing information.

Development of the Korean Pregnancy Stress Scale.

AIM: This study was conducted in order to develop and evaluate a Pregnancy Stress Scale (PSS). METHODS: The PSS was developed according to Devellis' scale development process. Data that were collected from 388 pregnant women were used to evaluate the validity and reliability of the tool. An item analysis, factor analysis, Pearson's correlation coefficients, and Cronbach's α were used. RESULTS: The PSS comprised seven factors that can be applied to all pregnant women, with one additional factor that is dedicated specifically for working pregnant women, resulting in a total of eight factors with 43 items: physical and psychological changes, coping in daily life, health of the mother and baby, maternal role, family support, healthcare services, social atmosphere, and reconciliation of work life. The criterion validity was supported by the Revised Prenatal Distress Questionnaire and Edinburgh Postnatal Depression Scale. The reliability of the overall scale was adequate. CONCLUSION: This scale would be useful for understanding the complex factors that contribute to pregnant women's stress and also would contribute to the process of developing nursing interventions to reduce pregnancy stress.

A Method to Evaluate the Quality of Clinical Gene-Panel Sequencing Data for Single-Nucleotide Variant Detection.

Customized gene-panel tests, based on next-generation sequencing, have demonstrated their usefulness in a plethora of clinical settings. As with other clinical diagnostic techniques, gene-panel sequencing for clinical purposes requires precise quality control (QC) measures to ensure its reliability. Only detected variants are currently recorded in clinical reports; however, identifying whether a nondetected variant is a true or false negative is regarded essential in a clinical setting and, thus, a comprehensive QC measure is in demand. Conventional QC metrics, such as mean coverage and uniformity, are considered inadequate for such an evaluation. As such, a more specific measure focused on clinically important variants is herein proposed. In this study, we suggest a new scoring method for assessing the quality of clinical gene-panel sequencing data, specifically for the detection of a set of single-nucleotide variants. The performance of the method was analyzed using 2295 clinical samples (1012 formalin-fixed, paraffin-embedded and 1283 fresh-frozen tissues), and was shown to provide additional information that conventional methods do not show, such as mean depth and uniformity. Customized sequencing protocols, which include QC criteria, have been optimized by each genomic laboratory. The pass rate scoring method proposed in this study provides an appropriate QC response variable for the customized panel, which strengthens the reliability of calls on clinically relevant variants implicated in clinical reports.

An experimental study of students' self-learning of the San-Yin-Jiao pressure procedure using CD-ROM or printed materials.

A CD-ROM and printed material on San-Yin-Jiao pressure to lessen labor pain for women were developed as formal didactic instruction using the same content. A prospective, randomized, double-blind study was conducted to compare self-learning outcomes using the software and the printed materials. Eighty third-year student nurses were randomly allocated to either the CD-ROM group or printed material group. A test was administered after 1 week of study time. A p value of < .05 was considered statistically significant. Results showed no significant differences between the two groups in self-learning measures. Text-based learning seems to be a convenient educational method because it can be used at any time in any place. However, with more time and facilities available, CD-ROMs may be as effective as traditional learning methods and can be an alternative tool.

Factors of Prenatal Depression by Stress-vulnerability and Stress-coping Models.

PURPOSE: This study aimed to identify related factors of prenatal depression by stress-vulnerability and stress-coping models for pregnant women. METHODS: A cross-sectional survey design with a convenience sampling was used. A total of 107 pregnant women who visited a general hospital in a metropolitan city were recruited from August to October, 2013. A structured questionnaire included the Korean version of Beck Depression Inventory II, and the instruments measuring Self-Esteem, Marital Satisfaction, Pregnancy Stress, Stressful Life Events, and Coping. The data were analyzed using descriptive statistics, t-test, Parson's correlation analysis, and stepwise multiple regression. RESULTS: The mean score of prenatal depression was 11.95+/-6.2, then showing 19.6% with mild depression, 15.0% with moderate depression, and 0.9% with severe depression on BDI II scale. Prenatal depression had positive correlation with pregnancy stress (r=.55, p<.01), stressful life events (r=.26, p<.01) and negative correlation with self-esteem (r=-.38, p<.01), marital satisfaction (r=-.40, p<.01), and coping (r=-.21, p<.05). Factors of pregnancy stress, self-esteem, stressful life events, and planned pregnancy explained 38% of the total variance of prenatal depression. CONCLUSION: These findings show that health providers need to assess prenatal depression and to control the influencing factors.

Development of detailed clinical models for nursing assessments and nursing interventions.

OBJECTIVES: The aim of this study was to develop and validate Detailed Clinical Models (DCMs) for nursing assessments and interventions. METHODS: First, we identified the nursing assessment and nursing intervention entities. Second, we identified the attributes and the attribute values in order to describe the entities in more detail. The data type and optionality of the attributes were then defined. Third, the entities, attributes and value sets in the DCMs were mapped to the International Classification for Nursing Practice Version 2 concepts. Finally, the DCMs were validated by domain experts and applied to case reports. RESULTS: In total 481 DCMs, 429 DCMs for nursing assessments and 52 DCMs for nursing interventions, were developed and validated. The DCMs developed in this study were found to be sufficiently comprehensive in representing the clinical concepts of nursing assessments and interventions. CONCLUSIONS: The DCMs developed in this study can be used in electronic nursing records. These DCMs can be used to ensure the semantic interoperability of the nursing information documented in electronic nursing records.

Evaluation of the Clinical Data Dictionary (CiDD).

OBJECTIVES: The purpose of the study was to evaluate content coverage and data quality of the Clinical Data Dictionary (CiDD) developed by the Center for Interoperable EHR (CiEHR). METHODS: A total of 12,994 terms were collected from 98 clinical forms of a tertiary cancer center hospital with 500 beds. After data cleaning, 9,418 terms were mapped with the data items of the CiDD by the research team, and validated by 30 doctors and nurses at the research hospital. RESULTS: MAPPING RESULTS WERE CLASSIFIED INTO FIVE CATEGORIES: lexically mapped; semantically mapped; mapped to either a broader term or a narrower term; mapped to more than one term and not mapped. In terms of coverage, out of 9,418 terms, 6,750 (71.7%) terms were mapped; 4,319 (45.9%) terms were lexically mapped; 2,431 (25.8%) were semantically mapped; 281 (3.0%) terms were mapped to a broader term; 43 (0.5%) were mapped to a narrower term; and 550 (5.8%) were mapped to more than one term. In terms of data quality, the CiDD has problems such as errors in concept namingand representation, redundancy in synonyms, inadequate synonyms, and ambiguity in meaning. CONCLUSIONS: Although the CiDD has terms covering 72% of local clinical terms, the CiDD can be improved by cleaning up errors and redundancies, adding textual definitions or use cases of the concept, and arranging the concepts in a hierarchy.