Cultural Impact on the Intention to Use Nursing Information Systems of Nurses in Taiwan and China: Survey and Analysis.

BACKGROUND: Nursing workforce shortage has emerged as a global problem. Foreign nurse importation is a popular strategy to address the shortage. The interactions between nursing staff on either side of the Taiwan Strait continue to increase. Since both nurses in Taiwan and nurses in China have adopted nursing information systems to improve health care processes and quality, it is necessary to investigate factors influencing nursing information system usage in nursing practice. OBJECTIVE: This study examined the effects of cultural and other related factors on nurses' intentions to use nursing information systems. The findings were expected to serve as an empirical base for further benchmarking and management of cross-strait nurses. METHODS: This survey was conducted in two case hospitals (one in Taiwan and one in China). A total of 880 questionnaires were distributed (n=440 in each hospital). RESULTS: The results showed effort expectancy had a significant effect on the intention to use nursing information systems of nurses in China (P=.003) but not nurses in Taiwan (P=.16). CONCLUSIONS: Findings suggest nursing managers should adopt different strategies to motivate cross-strait nurses to use nursing information systems. Promoting effort expectancy is more likely to motivate nurses in China than in Taiwan. This discrepancy is probably due to the less hierarchical and more feminine society in Taiwan.

The inhibiting effects of resistance to change of disability determination system: a status quo bias perspective.

BACKGROUND: Information systems implementation projects have been historically plagued by failures for which user resistance has consistently been identified as a salient reason. Most prior studies investigated either the causes or the consequences of Resistance to Change (RTC) of medical related Information Systems. In this study, we simultaneously explore the causes and impacts of RTC of Disability Determination System (DDS). METHODS: This study adopts the Status Quo Bias perspective and combines the information systems usage model and Technology Acceptance Model (TAM) as theoretical foundation to investigates the causes and impacts of users' RTC on their intention to use the DDS. Data were obtained through internet questionnaire survey. Totally, 326 respondents from 22 local governments and 142 hospitals were collected, of which 252 were valid samples and were analyzed using structure model analysis. RESULTS: The research model is proved with eight out of 11 hypotheses being supported. The antecedents of RTC can explain 21.4% of the RTC variation, and the RTC impacts can explain 57.5% of the variation of intention to use DDS. CONCLUSIONS: Combining the Status Quo Bias perspective and key component of TAM provides an adequate explanation of adopting intention of changing systems and extend the existing knowledge of information systems adoption. The results provide as a reference for managing users' RTC and enhance the effects and efficiency of new systems adoption.

Positive Impacts of Electronic hand-off systems designs on Nurses' communication effectiveness.

AIM: Different designs of electronic hand-off systems might have different levels of effectiveness; this study validated the effectiveness of systems with an Identify, Situation, Background, Assessment and Recommendation (ISBAR) design to one without such a design. BACKGROUND: Adverse consequences in hospital commonly occur when there are breakdowns in the transmission of information between team members. To ensure information accuracy and consistency, some Taiwan hospitals implemented electronic hand-off systems. However, the effectiveness of such systems was not investigated. METHODS: A quasi-experiment was conducted to the nurses of two Taiwan case hospitals, one with ISBAR and the other with non-ISBAR design systems and 200 questionnaires were used to collect data. RESULTS: The respondent rate was 72%. Using system with ISBAR design, nurses can enhance their communication effectiveness and further increase their individual benefits at hand-off. Using a non-ISBAR hand-off system, communication effectiveness depends solely on the nurses' individual cognitive and expressive ability. CONCLUSION: System with ISBAR design can ensure effective information transmission among nurses for care continuity and prevention of adverse events. IMPLICATIONS FOR NURSING MANAGEMENT: Ensuring the design of electronic systems is adequate, nursing managers can save nurses' time and effort while using the system to perform their regular work effectively and gain competitive advantage.

Health Knowledge Effects: An Integrated Community Health Promotion Platform.

The Taiwanese government subsidizes healthcare providers offering preventive medicine to patients to help reduce the threats of chronic sickness and halt skyrocketing medical expenditures. Usually, nurses are the primary workers who perform community health promotion; however, because of the chronic shortage of working nurses, many Taiwan hospitals have closed wards and deferred the responsibility of promoting primary prevention. With a community health promotion platform integrating interactive response features and Web sites for community patients and hospital staff, a case hospital efficiently sustained the community health services. The objective of this study was to assess the impact of the integrated community health promotion platform for conducting education. Fifty-four patients/residents were invited to join a quasi-experiment of health education, and a follow-up survey was conducted to assess the acceptance of the community health promotion platform from both the experimental group of learners/users and the hospital staff. The results showed that the community health promotion platform was effective in improving participant health awareness. The experimental group outperformed the control group, with higher posttest scores and longer knowledge retention. Furthermore, users indicated a high acceptance of the community health promotion platform.

Application of an importance-performance analysis approach to evaluate an acupuncture treatment information system.

Acupuncture treatment has become increasingly popular worldwide, but it is not without risk to the patient. Most physicians in Taiwan have adopted a computerized physician order entry system for traditional Chinese medicine. Use of such a system can prevent some adverse events related to a paper-based system but increases other unexpected risks. This study is the first to introduce a patient safety-based acupuncture treatment information system that integrates advanced healthcare devices to reduce the risks associated with acupuncture treatment using a computerized physician order entry system for traditional Chinese medicine. The acupuncture treatment information system considerably improved patient safety and increased clinicians' workflow efficiency. The importance-performance analysis indicated that improvement in the vital sign measurement function was of the highest priority. In conclusion, acupuncture treatment--the demand for which is increasing--can be performed more safely using an acupuncture treatment information system.

Developing a disability determination model using a decision support system in Taiwan: a pilot study.

BACKGROUND/PURPOSE: The aims of our study were to: (1) develop the Disability Grading Decision Support System (DGDSS) and to (2) compare the new International Classification of Functioning, Disability, and Health (ICF)-based disability determination tool (ICF-DDT) with the diagnosis-based disability determination tool (D-DDT). METHODS: A total of 9357 patients recruited from 236 accredited institutions were evaluated using the ICF-DDT and the D-DDT, and the presence, severity, and category of the disability identified using the two determination tools were compared. In the DGDSS, the ICF-DDT consisted of four models comprising nine modules to determine the presence and the severity of the disability. The differences between models (modules) are the different combinations of World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and Scale of Body Functions and Structures. RESULTS: Compared with the D-DDT, more patients were determined to be disability-free when using the ICF-DDT. Module 1-1 had the highest profoundly severe rate, and module 2-2 had the highest mild and moderate disability rates. Module 2-1 had the highest severe disability rate. Module 1-1 resulted in the smallest difference, and module 3-1 resulted in the largest difference, compared with the D-DDT. Feedback from users suggested that the DGDSS is a robust system if the original data are accurate. CONCLUSION: The presence, severity, and category of the disability determined using the ICF-DDT and the D-DDT were significantly different. The results of the DGDSS provide information for policymakers to determine the optimal allocation of social welfare and medical resources for people with disabilities.

Predicting medical staff intention to use an online reporting system with modified unified theory of acceptance and use of technology.

Barriers to report incident events using an online information system (IS) may be different from those of a paper-based reporting system. The nationwide online Patient-Safety Reporting System (PSRS) contains a value judgment behind use of the system, similar to the Value of Perceived Consequence (VPC), which is seldom discussed in ISs applications of other disciplines. This study developed a more adequate research framework by integrating the VPC construct into the well-known Unified Theory of Acceptance and Use of Technology (UTAUT) model as a theoretical base to explore the predictors of medical staff's intention to use online PSRS. The results showed that management support was an important factor to influence medical staff's intention of using PSRS. The effects of factors such as performance expectancy, perceived positive, and perceived negative consequence on medical staff's intention of using PSRS were moderated by gender, age, experience, and occupation. The results proved that the modified UTAUT model is significant and useful in predicting medical staff's intention of using the nationwide online PSRS.

Why would you use medical chatbots? interview and survey.

BACKGROUND: Chatbots, empowered by artificial intelligence, are becoming increasingly popular in many fields and have much potential for application in real life situations. However, little attention has been paid to medical chatbots and most existing evidence focuses on technical issues while behavioral research is still lacking. OBJECTIVE: This study seeks to examine the key factors that can motivate individuals to use medical chatbots. To that end, we have extended the theory of planned behavior by incorporating pertinent constructs derived after interviews with users. A research model and hypotheses are then proposed and tested. METHODS: Interviews were first conducted to collect qualitative data from 20 participants based on purposive sampling. Content analysis was then used to find evidence supporting important constructs for a research model. A survey methodology based on convenience sampling was then used to collect data. Totally, 205 valid responses were gathered and analyzed by using partial least squares structural equation modeling to validate the research model. RESULTS: Health consciousness and perceived convenience were found positively associated with individuals' attitudes towards the use of medical chatbots. Moreover, attitude and subjective norm were found to be significantly and positively related to individuals' intentions to use medical chatbots. CONCLUSIONS: The proposed model with the extended theory of planned behavior is able to predict individuals' intention to use medical chatbots well. Hospital managers can formulate strategies to improve individuals' health consciousness and perceptions of convenience to develop the desired attitudes among individuals, using medical chatbots. Further, strategies to improve patients' awareness of medical chatbots should also be formulated.

Self-Service System for the Family Members of ICU Patients: A Pilot Study.

Family members of intensive care unit patients are often experience high anxiety and require more information about the patients. However, most Taiwanese healthcare institutions currently face manpower shortages due to the COVID-19 pandemic. Therefore, the task of providing additional services to meet family members' needs and relieve their stress was deferred by some healthcare institutions. The self-service system, known to be effective and efficient in other industries, was recommended for use in the healthcare industry. This study aims to explore an intensive care unit self-service system (ICU-SSS) designed for the family members of ICU patients. This study investigates the feasibility of the system by following a mixed method approach, including qualitative interviews and a quantitative survey. Firstly, interviews with five family members and five ICU staff members of a case hospital were conducted to identify the need to develop an ICU-SSS for the family member. Secondly, a survey was completed by 30 family members to evaluate the system. The interview results reveal nine categories of family members' needs and the survey results show that the ICU family members assigned acceptable scores to all the ICU-SSS functions, except the importance of "Logistical information". Based on these findings, the scientific and practical implications are discussed.

Antecedents and consequences of shared decision making for patients with chronic kidney diseases: A cross-sectional survey.

BACKGROUND: Chronic kidney disease (CKD) has a strong negative impact on patients. Finding ways to improve CKD patients' conditions by shared decision-making is receiving much attention. However, little attention has been paid to influencing antecedents and effects of shared decision-making. Meanwhile, as advanced technologies bring in new communication devices, effects of different types of communications used in shared decision-making need to be addressed. OBJECTIVE: This study proposes a research framework to determine the influencing antecedents of shared decision-making, and to evaluate the effects of shared decision-making on patient outcomes when they are computer-mediated and when the decision-makers communicate face-to-face. METHODS: A cross-section survey was conducted and a total of 48 valid samples were obtained. The participants were CKD Stage III, IV, or V patients who had received medical treatment in a hospital in Taiwan. The collected data were subjected to an independent t-test and partial least squares analysis to validate the research framework. RESULTS: Doctor-patient communication (DPC) and doctor-patient relationship (DPR) have no significant direct impact on patient outcomes. Nevertheless, both DPC and DPR significantly impact shared decision-making which in turn impacts patient outcomes. Moreover, patients who use computer-mediated communication were found to have significantly higher perceptions of shared decision-making than those who did not. CONCLUSIONS: The incidence and prevalence of end-stage renal disease in Taiwan are among the highest in the world. The results of this study can serve as a reference for hospitals to improve CKD patients' outcomes. Meanwhile, during the COVID-19 pandemic, this study suggested hospitals should encourage shared decision-making with computer-mediated communication to ensure that patients receive proper treatment and have the desired outcomes.

The Intention of Retail Stores in Taiwan to Cooperate with the Government in the Establishment of IT Measures for Pandemic Prevention.

This study focuses on the cooperative attitude and intention of retail stores in Taiwan to cooperate with the government's related pandemic prevention measures. The study is based on the Theory of Planned Behavior (TPB). The study includes factors such as perceived risk of infection, job stress, pandemic prevention IT (information technology) convenience, pandemic prevention attitude, and pandemic prevention intention. Pandemic prevention attitude is used as a mediating variable to establish the research framework. This study collected research data through a questionnaire survey. A total of 457 valid questionnaires were collected through an electronic questionnaire platform. The findings showed that perceived risk of infection and pandemic prevention IT convenience had a positive and significant effect on pandemic prevention attitude (ß = 0.567; ß = 0.422) and pandemic prevention intention (ß = 0.424; ß = 0.296). Job stress has a significant negative effect on attitude (ß = -0.173). In addition, job stress influenced intention through attitudes. Finally, perceived risk, job stress, and IT convenience had high explanatory power (R2 = 0.706) on attitudes. Perceived risk, IT convenience, and attitude also had moderate explanatory power (R2 = 0.588) on prevention intention. The study also suggests practical recommendations to improve and cooperate with pandemic prevention intention.

Predicting Unscheduled Emergency Department Return Visits Among Older Adults: Population-Based Retrospective Study.

BACKGROUND: Unscheduled emergency department return visits (EDRVs) are key indicators for monitoring the quality of emergency medical care. A high return rate implies that the medical services provided by the emergency department (ED) failed to achieve the expected results of accurate diagnosis and effective treatment. Older adults are more susceptible to diseases and comorbidities than younger adults, and they exhibit unique and complex clinical characteristics that increase the difficulty of clinical diagnosis and treatment. Older adults also use more emergency medical resources than people in other age groups. Many studies have reviewed the causes of EDRVs among general ED patients; however, few have focused on older adults, although this is the age group with the highest rate of EDRVs. OBJECTIVE: This aim of this study is to establish a model for predicting unscheduled EDRVs within a 72-hour period among patients aged 65 years and older. In addition, we aim to investigate the effects of the influencing factors on their unscheduled EDRVs. METHODS: We used stratified and randomized data from Taiwan's National Health Insurance Research Database and applied data mining techniques to construct a prediction model consisting of patient, disease, hospital, and physician characteristics. Records of ED visits by patients aged 65 years and older from 1996 to 2010 in the National Health Insurance Research Database were selected, and the final sample size was 49,252 records. RESULTS: The decision tree of the prediction model achieved an acceptable overall accuracy of 76.80%. Economic status, chronic illness, and length of stay in the ED were the top three variables influencing unscheduled EDRVs. Those who stayed in the ED overnight or longer on their first visit were less likely to return. This study confirms the results of prior studies, which found that economically underprivileged older adults with chronic illness and comorbidities were more likely to return to the ED. CONCLUSIONS: Medical institutions can use our prediction model as a reference to improve medical management and clinical services by understanding the reasons for 72-hour unscheduled EDRVs in older adult patients. A possible solution is to create mechanisms that incorporate our prediction model and develop a support system with customized medical education for older patients and their family members before discharge. Meanwhile, a reasonably longer length of stay in the ED may help evaluate treatments and guide prognosis for older adult patients, and it may further reduce the rate of their unscheduled EDRVs.

Factors Influencing Physicians' Continuous Blogging: A Survey.

BACKGROUND: Health information can be more easily transmitted and diffused through the Internet, but questionable online health information often misinforms patients. Physicians have a duty to inform patients how to achieve positive health outcomes. Many physicians often write blogs to provide patients with the right health information. However, most articles available on this subject only describe the blog phenomena without providing a theoretical background and an empirical analysis of doctors using blogs. METHODS: This study based on social cognitive theory (SCT) explores the factors influencing physicians' intention of continuously blogging. A total of 887 physician bloggers were invited to participate in an online survey and 128 valid responses were received. RESULTS: The SCT was proven to be useful in explaining 36.8% of the variation in physicians' continuous intention to blog. CONCLUSIONS: We provide references for platform developers with different strategies to motivate doctors to blog, and the implications and limitations of this study are discussed.

Why Nursing Home Residents Use Social Network Systems: An Attachment Perspective.

Most long-term care facilities can offer residents' with sufficiently material and physical care, but psychological support may not be always provided due to the tight financial budget or labor resources. Residents' isolation and loneliness then become a big issue, especially for the residents. Social network systems (SNS) have been proved to be a more effective information transmission channel for thoughts, perspectives, and information sharing than traditional channels such as microblogging, e-mails, or telephones. This study conducted a quasi-experiment to identify factors that influence residents' intention of using SNS and the impacts of SNS on them in a long-term care facility. The results showed that residents' attached motivation of personal interacting is a significant factor that influences their intention to use the social network platform. Meanwhile, both the loneliness and depression scales of the participants were decreased significantly.

Critical Predictors for the Early Detection of Conversion From Unipolar Major Depressive Disorder to Bipolar Disorder: Nationwide Population-Based Retrospective Cohort Study.

BACKGROUND: Unipolar major depressive disorder (MDD) and bipolar disorder are two major mood disorders. The two disorders have different treatment strategies and prognoses. However, bipolar disorder may begin with depression and could be diagnosed as MDD in the initial stage, which may later contribute to treatment failure. Previous studies indicated that a high proportion of patients diagnosed with MDD will develop bipolar disorder over time. This kind of hidden bipolar disorder may contribute to the treatment resistance observed in patients with MDD. OBJECTIVE: In this population-based study, our aim was to investigate the rate and risk factors of a diagnostic change from unipolar MDD to bipolar disorder during a 10-year follow-up. Furthermore, a risk stratification model was developed for MDD-to-bipolar disorder conversion. METHODS: We conducted a retrospective cohort study involving patients who were newly diagnosed with MDD between January 1, 2000, and December 31, 2004, by using the Taiwan National Health Insurance Research Database. All patients with depression were observed until (1) diagnosis of bipolar disorder by a psychiatrist, (2) death, or (3) December 31, 2013. All patients with depression were divided into the following two groups, according to whether bipolar disorder was diagnosed during the follow-up period: converted group and nonconverted group. Six groups of variables within the first 6 months of enrollment, including personal characteristics, physical comorbidities, psychiatric comorbidities, health care usage behaviors, disorder severity, and psychotropic use, were extracted and were included in a classification and regression tree (CART) analysis to generate a risk stratification model for MDD-to-bipolar disorder conversion. RESULTS: Our study enrolled 2820 patients with MDD. During the follow-up period, 536 patients were diagnosed with bipolar disorder (conversion rate=19.0%). The CART method identified five variables (kinds of antipsychotics used within the first 6 months of enrollment, kinds of antidepressants used within the first 6 months of enrollment, total psychiatric outpatient visits, kinds of benzodiazepines used within one visit, and use of mood stabilizers) as significant predictors of the risk of bipolar disorder conversion. This risk CART was able to stratify patients into high-, medium-, and low-risk groups with regard to bipolar disorder conversion. In the high-risk group, 61.5%-100% of patients with depression eventually developed bipolar disorder. On the other hand, in the low-risk group, only 6.4%-14.3% of patients with depression developed bipolar disorder. CONCLUSIONS: The CART method identified five variables as significant predictors of bipolar disorder conversion. In a simple two- to four-step process, these variables permit the identification of patients with low, intermediate, or high risk of bipolar disorder conversion. The developed model can be applied to routine clinical practice for the early diagnosis of bipolar disorder.

Do Patients' Privacy Concerns Influence Their Intention toward Medical Image Exchange Consent in Taiwan?

The primary purpose of this study was to examine patients' concerns surrounding information privacy and their intention toward medical image exchange consent. Patients' concerns about information privacy in terms of collection, unauthorized access, errors and secondary use all have significant relationships with patients' intention toward medical image exchange consent in Taiwan. Trust is the foundation for both parties. In this study, we aimed to determine the moderating effect of trust in order to examine patients' intention toward medical image exchange consent under the influence of their information privacy concerns. Three hundred and fifty patients responded to the survey, which yielded a 92.3% response rate. The results of data analysis revealed that patients' information privacy concerns had no significant relationship with patients' intention toward medical image exchange consent. After considering the moderating effect of trust, patients' information privacy concerns do have a significant relationship with patients' intention toward medical image exchange consent, however, the R-square was only 4.5%. Based on this research result, we modified the research framework in order to examine patients' information privacy concerns in terms of collection/non-collection. The R-square of the modified framework was 18.6%, and both collection and non-collection had significant relationships with patients' intention toward medical image exchange consent. Finally, the implications, limitations and future research have been discussed.

A Stress Relief App Intervention for Newly Employed Nursing Staff: Quasi-Experimental Design.

BACKGROUND: Most newly employed nurses have limited practical experience, lack problem-solving abilities, and have low resistance to stress, and therefore often opt to resign from the nursing profession. OBJECTIVE: This study aimed to assess the effectiveness of a stress relief app (SR_APP) to monitor the stress levels of newly employed nurses. METHODS: We conducted a quasi-experiment to assess changes in stress levels of newly employed nurses at a case hospital, in which the experimental group used the SR_APP and the control group did not. In-depth interviews were conducted to reveal insights regarding their stress. The app usage experiences of experimental group members were assessed via a questionnaire. RESULTS: All the participants appreciated the experiment and were interested to know more about managing their stress. The experimental group members showed significant differences in heart rate variability scores before and after using the SR_APP, and they reported high levels of intention to use and satisfaction with regard to the SR_APP. CONCLUSIONS: The SR_APP can be effective in helping newly employed nurses to manage their stress.

Factors affecting the adoption of electronic signature: Executives' perspective of hospital information department.

The healthcare industry is experiencing a major transformation towards e-healthcare, which delivers and enhances related information through the Internet among healthcare stakeholders and makes the electronic signature (e-signature) more and more important. This paper uses a mature framework, Technology-Organization-Environment (TEO), in information system discipline to identify factors that affect hospitals in adopting e-signature. A survey was conducted on regional hospitals and medical centers in Taiwan to verify the validity of the research framework. The results show that TEO framework is useful in distinguishing hospitals as adopters and non-adopters of e-signature. Based on the research findings, implications and limitations are discussed.

Quality evaluation on an e-learning system in continuing professional education of nurses.

Maintaining high quality in Web-based learning is a powerful means of increasing the overall efficiency and effectiveness of distance learning. Many studies have evaluated Web-based learning but seldom evaluate from the information systems (IS) perspective. This study applied the famous IS Success model in measuring the quality of a Web-based learning system using a Web-based questionnaire for data collection. One hundred and fifty four nurses participated in the survey. Based on confirmatory factor analysis, the variables of the research model fit for measuring the quality of a Web-based learning system. As Web-based education continues to grow worldwide, the results of this study may assist the system adopter (hospital executives), the learner (nurses), and the system designers in making reasonable and informed judgments with regard to the quality of Web-based learning system in continuing professional education.

Physicians' perspectives of adopting computer-assisted navigation in orthopedic surgery.

OBJECTIVES: Using Computer-assisted orthopedic navigation surgery system (CAOS) has many advantages but is not mandatory to use during an orthopedic surgery. Therefore, opinions obtained from clinical orthopedists with this system are valuable. This paper integrates technology acceptance model and theory of planned behavior to examine the determinants of continued CAOS use to facilitate user management. METHODS: Opinions from orthopedists who had used a CAOS for at least two years were collected through a cross-sectional survey to verify the research framework. Follow-up interviews with an expert panel based on their experiences of CAOS were conducted to reason the impacts of factors of the research framework. RESULTS: The results show that factors of "perceived usefulness" and "facilitating condition" determine the intention to continue using CAOS, and "perceived usefulness" was driving by "complexity of task" and "social influence". Additionally, support in practice from high-level managers had an influence on orthopedists' satisfaction after using a CAOS. CONCLUSIONS: The aging population is accompanied by the increasing requirements for medical care and medical care attendant expenses, especially in total knee replacement. More precision and improvements on survivorship of patients' artificial joints are needed. This study facilitates suggestions in user management when encountering an obstacle in implementing a CAOS. Based on these findings, scientific and practical implications are then discussed.