%0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68173 %T The Norwegian Version of the Self-Efficacy in Clinical Performance Scale (SECP): Psychometric Validation Study %A Olaussen,Camilla %A Stojiljkovic,Marko %A Zlamal,Jaroslav %A Flølo,Tone Nygaard %A Nes,Andréa Aparecida Gonçalves %K clinical performance %K self-efficacy %K instrument validation %K nursing education %K psychometric analysis %K Norway %K psychometric %K validation study %K competence %K clinical practice %K translate %K translation %K cross-sectional study %K nursing student %K reliability %D 2025 %7 21.4.2025 %9 %J JMIR Form Res %G English %X Background: Previous research has demonstrated a correlation between nursing students’ self-efficacy and their clinical performance, competence, and behavior during clinical practice placements. Assessing students’ self-efficacy in clinical performance could be a valuable method for identifying areas that need reinforcement and for recognizing students who may require additional support during clinical practice placements. Objective: This study aimed to translate the Self-Efficacy in Clinical Performance Scale (SECP) from English into Norwegian and to evaluate the psychometric properties of the Norwegian version. Methods: A cross-sectional study design was used. The SECP was translated into Norwegian following a 6-step process: forward translation, forward translation synthesis, backward translation, backward translation synthesis, cognitive debriefing, and psychometric testing. The validity and reliability of the translated version were assessed using confirmatory factor analysis (CFA), Cronbach α, McDonald ω, and composite reliability. Results: A total of 399 nursing students completed the Norwegian version of the SECP. The CFA goodness-of-fit indices (χ2/df ratio=1.578, comparative fit index=0.98, Tucker-Lewis index=0.98, standardized root mean square residual=0.056, root mean square error of approximation=0.038) indicated an acceptable model fit. Reliability measures, including Cronbach ⍺, McDonald ω, and composite reliability, were high, with factor-level values ranging from 0.94 to 0.98. Conclusion: The Norwegian version of the SECP demonstrated strong potential as an instrument for assessing self-efficacy in both current and required competencies among nursing students in clinical practice within nursing education. Future research should aim to confirm the factor structure of the SECP and evaluate its test-retest reliability. %R 10.2196/68173 %U https://formative.jmir.org/2025/1/e68173 %U https://doi.org/10.2196/68173 %0 Journal Article %@ 2817-1705 %I JMIR Publications %V 4 %N %P e64447 %T Large Language Models for Thematic Summarization in Qualitative Health Care Research: Comparative Analysis of Model and Human Performance %A Castellanos,Arturo %A Jiang,Haoqiang %A Gomes,Paulo %A Vander Meer,Debra %A Castillo,Alfred %K artificial intelligence %K generative AI %K large language models %K ChatGPT %K machine learning %K health care %D 2025 %7 4.4.2025 %9 %J JMIR AI %G English %X Background: The application of large language models (LLMs) in analyzing expert textual online data is a topic of growing importance in computational linguistics and qualitative research within health care settings. Objective: The objective of this study was to understand how LLMs can help analyze expert textual data. Topic modeling enables scaling the thematic analysis of content of a large corpus of data, but it still requires interpretation. We investigate the use of LLMs to help researchers scale this interpretation. Methods: The primary methodological phases of this project were (1) collecting data representing posts to an online nurse forum, as well as cleaning and preprocessing the data; (2) using latent Dirichlet allocation (LDA) to derive topics; (3) using human categorization for topic modeling; and (4) using LLMs to complement and scale the interpretation of thematic analysis. The purpose is to compare the outcomes of human interpretation with those derived from LLMs. Results: There is substantial agreement (247/310, 80%) between LLM and human interpretation. For two-thirds of the topics, human evaluation and LLMs agree on alignment and convergence of themes. Furthermore, LLM subthemes offer depth of analysis within LDA topics, providing detailed explanations that align with and build upon established human themes. Nonetheless, LLMs identify coherence and complementarity where human evaluation does not. Conclusions: LLMs enable the automation of the interpretation task in qualitative research. There are challenges in the use of LLMs for evaluation of the resulting themes. %R 10.2196/64447 %U https://ai.jmir.org/2025/1/e64447 %U https://doi.org/10.2196/64447 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e60543 %T Impact of Bottom-Up Cocreation of Nursing Technological Innovations: Explorative Interview Study Among Hospital Nurses and Managers %A van Steenis,Saskia %A Helder,Onno %A Kort,Helianthe S M %A van Houwelingen,Thijs %+ Research Group Technology for Healthcare Innovations, Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht, 3584 CS, The Netherlands, 31 641097762, thijs.vanhouwelingen@hu.nl %K stakeholder participation %K cocreation %K nursing %K innovation %K bottom-up approach %K diffusion of innovation %K qualitative research %K nurses %D 2025 %7 31.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In health care, the use of nursing technological innovations, particularly technological products, is rapidly increasing; however, these innovations do not always align with nursing practice. An explanation for this issue could be that nursing technological innovations are developed and implemented with a top-down approach, which could subsequently limit the positive impact on practice. Cocreation with stakeholders such as nurses can help address this issue. Nowadays, health care centers increasingly encourage stakeholder participation, which is known as a bottom-up cocreation approach. However, little is known about the experience of nurses and their managers with this approach and the innovations it results in within the field of nursing care. Objective: This study aims to explore nurses’ and their managers’ experiences with a bottom-up cocreation approach in order to assess the impact of this way of working and the resulting nursing technological innovations in an academic hospital. This insight can also inform decisions on whether the bottom-up cocreation approach should be more widely disseminated. Methods: A qualitative study using semistructured interviews was conducted with 15 participants, including cocreator nurses, end-user nurses, and their managers. First, the data were thematically analyzed. In addition, a strengths, weaknesses, opportunities, and threats analysis was conducted. Results: The various experiences of the participants were described in 3 main themes: enhanced attractiveness of the nursing profession, feeling involved due to a cocreation environment, and experienced benefits and challenges in using cocreated products. In addition, numerous strengths and opportunities perceived by the participants were identified as associated with the bottom-up cocreation approach and resulting useful products within nursing care; for example, cocreation contributed to job satisfaction and substantially contributed to the ease of use of the innovations that were developed. Conclusions: The findings underscore that cocreation with nurses enhances the appeal of the nursing profession and aligns nursing technological innovations with practical nursing challenges. Embracing a culture of cocreation has the potential to foster a culture of continuous improvement and innovation in nursing care. %M 40163045 %R 10.2196/60543 %U https://humanfactors.jmir.org/2025/1/e60543 %U https://doi.org/10.2196/60543 %U http://www.ncbi.nlm.nih.gov/pubmed/40163045 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63498 %T Supporting Physical and Mental Health in Rural Veterans Living With Heart Failure: Protocol for a Nurse-Led Telephone Intervention Study %A Graven,Lucinda J %A Abbott,Laurie %A Hodgkins,Josef V %A Ledermann,Thomas %A Howren,M Bryant %+ College of Nursing, Florida State University, 450 Duxbury Hall, 98 Varsity Way, Tallahassee, FL, 32306, United States, 1 850 644 5601, lgraven@fsu.edu %K heart failure %K veterans %K problem-solving %K self-care %K heart failure symptoms %K depression %K anxiety %K HRQOL %K health-related quality of life %K stress %K resilience %K coping %K mental health %K nurse-led intervention %K social support %K telehealth %K chronic disease management %D 2025 %7 26.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Heart failure (HF) remains a disease of notable disparity for rural veterans, despite recent advancements in clinical treatment. Managing HF in the home is stressful and complex for rural veterans who experience unique barriers to optimal physical and mental health, necessitating adequate support and problem-solving skills. Objective: This study aims to (1) adapt, to the rural sociocultural context, a culturally sensitive, tailored, telephone support and problem-solving intervention (CARE-HF [Supporting Physical and Mental Health in Rural Veterans With Heart Failure]) using findings from preliminary qualitative research and (2) evaluate the effects of CARE-HF on problem-solving and physical and mental health outcomes among rural veterans with HF. Methods: This study involves a repeated-measures, single-group design. The intervention content was adapted and tailored to the rural sociocultural context using preliminary qualitative data and guided by the Theories of Social Problem-Solving and Stress, Appraisal, and Coping. Veterans are recruited from Veterans Administration home-based cardiac rehabilitation clinics, cardiology clinics that serve veterans, veterans-based community resource centers, and social media campaigns. Veterans with HF (N=100) receive the CARE-HF intervention. This nurse-led intervention comprises 8 telephone sessions that use a five-step, problem-solving process to manage common HF problems in the home: (1) identifying the problem and viewing it in a positive manner, (2) goal setting, (3) generating potential strategies for problem management, (4) choosing and implementing strategies to manage the problem, and (5) evaluating strategy effectiveness. Veterans receive initial problem-solving training during the first session, with follow-up sessions focusing on problem-solving skill reinforcement and assisting veterans in applying these principles to manage self-identified, HF-related problems experienced in the home. Data are collected at baseline and 3, 6, 12, and 18 months from baseline on problem-solving and outcomes of interest (ie, HF self-care; HF symptoms; health care utilization; depressive symptoms; anxiety; HF-specific, health-related quality of life; stress; resilience; and coping). Demographic data will be analyzed using descriptive statistics and multilevel growth curve modeling with restricted maximum likelihood estimation to compare a series of models using Akaike information criteria and Bayesian information criteria fit indices while controlling for covariates. Results: Recruitment started in April 2023. As of December 2024, we have enrolled 56 veterans. Recruitment is anticipated to end in June 2025, with data collection continuing until all enrolled veterans have completed the 18-month follow-up period. Conclusions: Adapting and testing a culturally sensitive, tailored, telephone intervention to aid support and problem-solving in the home has the potential to provide individualized care to rural veterans where they reside, thereby reducing travel burden while also increasing access to evidence-based care programs. If effective, telephone support and problem-solving interventions could be a low-cost, accessible method to improve physical and mental health in rural veterans with HF. Trial Registration: ClinicalTrials.gov NCT05839067; https://clinicaltrials.gov/study/NCT05839067 International Registered Report Identifier (IRRID): DERR1-10.2196/63498 %M 40138689 %R 10.2196/63498 %U https://www.researchprotocols.org/2025/1/e63498 %U https://doi.org/10.2196/63498 %U http://www.ncbi.nlm.nih.gov/pubmed/40138689 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68906 %T Exploratory Co-Design on Electronic Health Record Nursing Summaries: Case Study %A Park,Suhyun %A Marquard,Jenna L %A Austin,Robin R %A Martin,Christie L %A Pieczkiewicz,David S %A Delaney,Connie W %K electronic health records %K interview %K nurses %K user-computer interface %K co-design %D 2025 %7 11.3.2025 %9 %J JMIR Form Res %G English %X Background: Although electronic health record nursing summaries aim to provide a concise overview of patient data, they often fall short of meeting nurses’ information needs, leading to underutilization. This gap arises from a lack of involvement of nurses in the design of health information technologies. Objective: The purpose of this exploratory co-design case study was to solicit insights from nurses regarding nursing summary design considerations, including key information types and the preferred design prototype. Methods: We recruited clinical nurses (N=33) from 7 inpatient units at a university hospital in the Midwestern United States using a purposive sampling method. We used images from a simulated nursing summary to generate visual card versions of the 46 information types currently included in an electronic health record vendor–generated nursing summary. Participants selected which cards to include and arranged them in their designs based on their perceived relevance of the information types to the summary and their preferred reading layout. The nurses’ perceived relevance of information types to the summary was analyzed by quantifying the frequency of included cards, while the nurses’ preferred reading layout was analyzed by quantifying the occurrence of closely paired cards to identify common groupings. After participants evaluated the information type cards, debriefing interviews were conducted and analyzed thematically to explore their rationales for the desired content and its arrangement. Results: The participants demonstrated a high level of engagement in the activities. On average, all 33 participants included 61% (n=28) of the total information types (n=46). The most frequently included cards were “unit specimen” (results of the analysis of body fluid, tissue, or urine), “activity,” “diet,” and “hospital problems,” each included by 33 participants. Participants most frequently preferred adjacency of the following pairs: “activity” and “diet” (paired by 26 participants; 79%) and “notes to physicians” and “notes to treatment team” (paired by 25 participants; 76%). Participants preferred arranging the cards to improve information accessibility, focusing on key information types. Conclusions: Involving nurses in the co-design process may result in more useful and usable designs, thereby reducing the time required to navigate nursing summaries. Future work should include refining and evaluating prototypes based on the designs created by the nurses. %R 10.2196/68906 %U https://formative.jmir.org/2025/1/e68906 %U https://doi.org/10.2196/68906 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e56671 %T Predicting Readmission Among High-Risk Discharged Patients Using a Machine Learning Model With Nursing Data: Retrospective Study %A Oh,Eui Geum %A Oh,Sunyoung %A Cho,Seunghyeon %A Moon,Mir %K machine learning %K EHR %K electronic health record %K electronic medical record %K EMR %K artificial intelligence %K readmission %K nursing data %K clinical decision support %K prediction %K predictive %K discharge %K admission %K hospitalization %D 2025 %7 5.3.2025 %9 %J JMIR Med Inform %G English %X Background: Unplanned readmissions increase unnecessary health care costs and reduce the quality of care. It is essential to plan the discharge care from the beginning of hospitalization to reduce the risk of readmission. Machine learning–based readmission prediction models can support patients’ preemptive discharge care services with improved predictive power. Objective: This study aimed to develop a readmission early prediction model utilizing nursing data for high-risk discharge patients. Methods: This retrospective study included the electronic medical records of 12,977 patients with 1 of the top 6 high-risk readmission diseases at a tertiary hospital in Seoul from January 2018 to January 2020. We used demographic, clinical, and nursing data to construct a prediction model. We constructed unplanned readmission prediction models by dividing them into Model 1 and Model 2. Model 1 used early hospitalization data (up to 1 day after admission), and Model 2 used all the data. To improve the performance of the machine learning method, we performed 5-fold cross-validation and utilized adaptive synthetic sampling to address data imbalance. The 6 algorithms of logistic regression, random forest, decision tree, XGBoost, CatBoost, and multiperceptron layer were employed to develop predictive models. The analysis was conducted using Python Language Reference, version 3.11.3. (Python Software Foundation). Results: In Model 1, among the 6 prediction model algorithms, the random forest model had the best result, with an area under the receiver operating characteristic (AUROC) curve of 0.62. In Model 2, the CatBoost model had the best result, with an AUROC of 0.64. BMI, systolic blood pressure, and age consistently emerged as the most significant predictors of readmission risk across Models 1 and 2. Model 1, which enabled early readmission prediction, showed a higher proportion of nursing data variables among its important predictors compared to Model 2. Conclusions: Machine learning–based readmission prediction models utilizing nursing data provide basic data for evidence-based clinical decision support for high-risk discharge patients with complex conditions and facilitate early intervention. By integrating nursing data containing diverse patient information, these models can provide more comprehensive risk assessment and improve patient outcomes. %R 10.2196/56671 %U https://medinform.jmir.org/2025/1/e56671 %U https://doi.org/10.2196/56671 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 8 %N %P e63335 %T Examining the Role of AI in Changing the Role of Nurses in Patient Care: Systematic Review %A Al Khatib,Inas %A Ndiaye,Malick %+ Department of Industrial Engineering, College of Engineering, American University of Sharjah, University City, Sharjah, 26666, United Arab Emirates, 971 65155555, g00091914@aus.edu %K artificial intelligence %K AI %K nursing practice %K technology %K health care %K PRISMA %D 2025 %7 19.2.2025 %9 Review %J JMIR Nursing %G English %X Background: This review investigates the relationship between artificial intelligence (AI) use and the role of nurses in patient care. AI exists in health care for clinical decision support, disease management, patient engagement, and operational improvement and will continue to grow in popularity, especially in the nursing field. Objective: We aim to examine whether AI integration into nursing practice may have led to a change in the role of nurses in patient care. Methods: To compile pertinent data on AI and nursing and their relationship, we conducted a thorough systematic review literature analysis using secondary data sources, including academic literature from the Scopus database, industry reports, and government publications. A total of 401 resources were reviewed, and 53 sources were ultimately included in the paper, comprising 50 peer-reviewed journal articles, 1 conference proceeding, and 2 reports. To categorize and find patterns in the data, we used thematic analysis to categorize the systematic literature review findings into 3 primary themes and 9 secondary themes. To demonstrate whether a role change existed or was forecasted to exist, case studies of AI applications and examples were also relied on. Results: The research shows that all health care practitioners will be impacted by the revolutionary technology known as AI. Nurses should be at the forefront of this technology and be empowered throughout the implementation process of any of its tools that may accelerate innovation, improve decision-making, automate and speed up processes, and save overall costs in nursing practice. Conclusions: This study adds to the existing body of knowledge about the applications of AI in nursing and its consequences in changing the role of nurses in patient care. To further investigate the connection between AI and the role of nurses in patient care, future studies can use quantitative techniques based on recruiting nurses who have been involved in AI tool deployment—whether from a design aspect or operational use—and gathering empirical data for that purpose. %M 39970436 %R 10.2196/63335 %U https://nursing.jmir.org/2025/1/e63335 %U https://doi.org/10.2196/63335 %U http://www.ncbi.nlm.nih.gov/pubmed/39970436 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e62688 %T Exploring Nursing Students’ Experiences of Empathy and User Experiences in an Immersive Virtual Reality Simulation Game: Cross-Sectional Study %A Koivisto,Jaana-Maija %A Kämäräinen,Sanna %A Mattsson,Katri %A Jumisko-Pyykkö,Satu %A Ikonen,Riikka %A Haavisto,Elina %+ Department of Public Health, Faculty of Medicine, University of Helsinki, PO Box 20, Helsinki, 00014, Finland, 358 503207111, jaana-maija.koivisto@helsinki.fi %K education %K nursing %K learning %K empathy %K virtual reality %K simulation %K user experience %K cross sectional %D 2025 %7 13.2.2025 %9 Original Paper %J JMIR Serious Games %G English %X Background: Empathy is associated with better clinical outcomes and patient-care experiences, and it has been demonstrated that training can improve nursing students’ empathy. The use of virtual reality (VR) as an experiential learning strategy may increase the empathetic behavior of caregivers. Although much research exists on the use of VR in education, there is still little research on learning empathy in nursing education through immersive VR games that include a head-mounted display and hand controllers. In addition, it is important to study both learning and user experiences in nursing education that utilizes VR technology. Objective: This study aims to explore nursing students’ experiences of empathy and user experiences in an immersive VR simulation game. Methods: A cross-sectional design was used. A total of 52 graduating nursing students from 3 universities of applied sciences in Finland participated in the study. The immersive VR simulation game employed in the study was played with a head-mounted display and hand controllers. The instruments used were the Basic Empathy Scale in Adults (BES-A) before the VR simulation gaming session and the Comprehensive State Empathy Scale (CSES) and AttrakDiff 2.0 Scale after the session. Results: The students’ overall level of empathy experienced in the immersive VR simulation game was favorable (CSES; mean 2.9, SD 0.57). Participants who had a higher level of empathy (BES-A) before playing the immersive VR simulation game also experienced slightly more feelings of empathy after playing (CSES). However, the association between the measures was not statistically significant (r=0.187, P=.18). The overall empathy (CSES) experienced in the immersive VR simulation game was positively correlated with its subscales. The use of the VR simulation provided a positive user experience in all 4 factors of the AttrakDiff 2.0 Scale. Overall User Experience and Emotion Sharing correlated negatively (r=−0.248, P=.042), as did Attractiveness and Emotion Sharing (r=−0.327, P=.018). Hedonic Quality Stimulation correlated negatively with Cognitive Empathy (r=–0.279, P=.045). Conclusions: The results of this study indicate that the use of an immersive VR simulation game in nursing education as a means of increasing empathy seems promising and justified. The immersive VR simulation game offered positive user experiences, which further supported the idea of implementing it in education. However, more research is needed on what kinds of VR environments are the most effective in promoting empathy among nursing students. Furthermore, when using VR technology in learning, one should consider that the VR setting must not be too technical but rather simple, straightforward, and predictable. %M 39946691 %R 10.2196/62688 %U https://games.jmir.org/2025/1/e62688 %U https://doi.org/10.2196/62688 %U http://www.ncbi.nlm.nih.gov/pubmed/39946691 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64444 %T Nurses’ Perspectives and Experiences of Using a Bed-Exit Information System in an Acute Hospital Setting: Mixed Methods Study %A Walzer,Stefan %A Schön,Isabel %A Pfeil,Johanna %A Klemm,Sam %A Ziegler,Sven %A Schmoor,Claudia %A Kunze,Christophe %+ Care and Technology Lab, Furtwangen University, Robert-Gerwig-Platz 1, Furtwangen im Schwarzwald, 78120, Germany, 49 7723 920 2957, stefan.walzer@hs-furtwangen.de %K cognitive impairment %K bed-exit %K technology %K fall prevention %K inpatient %K hospital %K mixed methods %K nurse %K information system %K acute hospital %K support %K online questionnaire %K cognitively impaired %K workload %D 2025 %7 5.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Technology that detects early when a patient at risk of falling leaves the bed can support nurses in acute care hospitals. Objective: To develop a better understanding of nurses’ perspectives and experiences with a bed-exit information system (BES) in an acute care hospital setting. Methods: BES was implemented on 3 wards of a university medical center. Nurses completed 2 online surveys at each time point (P0 and P1) and participated in focus groups before (P0) and after (P1) implementation. Additional patient data were collected. Descriptive statistics summarized the survey results, while content analysis was applied to focus group data. Patient rates and adverse events in both phases were compared using negative binomial models. Reporting of this study adhered to the GRAMMS checklist. Results: A total of 30 questionnaires were completed at P0 (30/72, 42%) and 24 at P1 (24/71, 33%). Of the participants, 15 completed both questionnaires (complete cases). At P1, 64% (9/14) of participants agreed that their perceived workload and strain in caring for patients with cognitive impairment was reduced by the use of the BES. The adverse event rate per patient per day was reduced by a factor of 0.61 (95% CI 0.393-0.955; P=.03). In addition, 11 nurses participated in 4 focus groups before and after the intervention. Participants found it challenging to operationalize the use of the BES due to the heterogeneity of care settings, but certain behaviors of patients with cognitive impairment were recognized as indicating a need for intervention. Negative experiences included information overload and alarm fatigue, leading to occasional removal of the system. Conclusions: While BES provides some support in managing patients with cognitive impairment, its impact remains limited to specific scenarios and does not significantly reduce nurses’ workload or strain. Our findings highlight the need to manage expectations of BES performance to ensure alignment between expected and actual benefits. To improve BES effectiveness and long-term implementation, future research should consider both objective measures of patient care and subjective factors such as nurse experience, structural conditions, and technical specifications. Improving information mechanisms within call systems could help reduce alarm fatigue and increase perceived usefulness. Overall, successful integration of BES in acute care settings will require close collaboration with nursing staff to drive meaningful healthcare innovation and ensure that the technology meets the needs of both patients and nurses. Trial Registration: German Register for Clinical Studies DRKS00021720; https://drks.de/search/de/trial/DRKS00021720 %M 39908092 %R 10.2196/64444 %U https://formative.jmir.org/2025/1/e64444 %U https://doi.org/10.2196/64444 %U http://www.ncbi.nlm.nih.gov/pubmed/39908092 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64970 %T Evaluation of the Transition-to-Practice Arrangements for Novice Perioperative Nurses: Protocol for a Mixed Methods Study %A Nijkamp,Nick %A Calleja,Pauline %A Sahay,Ashlyn %A Jack,Leanne %+ School of Nursing, Midwifery, and Social Sciences, CQUniversity, 6 University Dr, Bundaberg, 4670, Australia, 61 4150 7701, n.nijkamp@cqu.edu.au %K transition to practice %K perioperative nursing %K novice nurses %K nurse educators %K mixed methods research %K protocol %K document analysis %K semistructured interviews %K pedagogy %D 2025 %7 23.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Transitioning into the first year of clinical practice as a nurse or changing specialties in the nursing career presents a critical phase for novice nurses characterized by excitement, apprehension, and the phenomenon of “transition shock.” Within perioperative nursing, this transition phase takes on distinctive challenges. However, there is a lack of empirical evidence on transition programs and arrangements. Objective: This study aimed to evaluate the current transition-to-practice (TTP) arrangements available to new graduate and novice nurses within Australian perioperative nursing settings. Methods: This study uses an exploratory mixed-method, multilevel triangulation with a sequential phase design to address 4 research questions. Phases 1 to 3 will use document analysis, surveys, and semistructured interviews to establish the findings of the research questions. Phase 4 will use meta-inference and triangulation to aggregate and analyze the data from all preceding phases. These findings will be the foundation for developing a framework to inform future TTP arrangements. This robust framework will embed empirical evidence, existing literature, and sound learning and teaching pedagogy. Results emerging from this study will be reported using the Good Reporting of Mixed Methods Study guidelines. Results: This project received approval in June 2023. Following this, Human Research Ethics Committee approval was sought for phases 1 and 2, and recruitment began. As of August 2024, phase 1 has collected 50 responses and phase 2 has collected 69 responses. Data collection for phase 3 is projected to commence in May 2025 once data from phases 1 and 2 have been analyzed. Phase 4 is projected to occur in 2026. Each phase is anticipated to have a results manuscript submitted for publication once data are analyzed and written up. Conclusions: The findings of this study will provide an in-depth exploration of TTP arrangements within perioperative nursing in Australia and provide a framework to guide the future development of TTP arrangements. Trial Registration: OSF Registries osf.io/zm432; https://osf.io/54s36 International Registered Report Identifier (IRRID): DERR1-10.2196/64970 %M 39847424 %R 10.2196/64970 %U https://www.researchprotocols.org/2025/1/e64970 %U https://doi.org/10.2196/64970 %U http://www.ncbi.nlm.nih.gov/pubmed/39847424 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60427 %T Digital Teaching and Learning Media for Nursing and Health Care Courses in Germany: Protocol for a Scoping Review %A Vogel,Jann Niklas %A Letzin,Jaqueline %A Schmidt,Stefan %+ , Faculty of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Brodaer Straße 2, Neubrandenburg, 17033, Germany, 49 03955693320, jvogel@hs-nb.de %K digital education %K digital learning %K digital teaching %K e-learning %K nursing %K health care %K digital transformation %K digital technology %K online learning %K distance learning %K health care education %D 2025 %7 17.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Germany, digital transformation and legal regulations are leading to the need to integrate digital technologies into the nursing profession. In addition, to nursing practice, they are also being incorporated into nursing training. Despite comprehensive regulations regarding the use of digital teaching and learning media in nursing education, their specific applicability and implementation vary. Objective: This study aims to map evidence and identify the main concepts, theories, sources, and knowledge gaps in the use of digital teaching and learning formats in nursing and health care education in Germany. Methods: The study is planned as a scoping review. The reporting of the study is based on the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 guidelines. The sources of information for the review include six bibliographic databases (MEDLINE via PubMed, Cochrane Library, Web of Science Core Collection, ERIC, PROSPERO, and APA PsycInfo). The search results will be presented in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The eligibility of studies is based on the population, concept, and context criteria: (1) learners of nursing and health care professions, (2) digital teaching and learning formats, and (3) forms of implementation in Germany since 2007. Results: The literature search is planned for January 2025. The selection of titles, the coding of the data, and the data analysis are expected to be completed by March 2025. Conclusions: In Germany, there is a growing interest in integrating digital teaching and learning formats into nursing and health care education. Our scoping review will map applications of digital teaching and learning media in the education of nursing and health care professions in Germany. In this way, the scoping review provides relevant impulses for fields of application and design aspects of digital teaching or learning media for nursing and health care education. International Registered Report Identifier (IRRID): PRR1-10.2196/60427 %M 39823593 %R 10.2196/60427 %U https://www.researchprotocols.org/2025/1/e60427 %U https://doi.org/10.2196/60427 %U http://www.ncbi.nlm.nih.gov/pubmed/39823593 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66109 %T Teaching in the Digital Age—Developing a Support Program for Nursing Education Providers: Design-Based Research %A Walzer,Stefan %A Barthel,Carolin %A Pazouki,Ronja %A Marx,Helga %A Ziegler,Sven %A Koenig,Peter %A Kugler,Christiane %A Jobst,Stefan %+ Care and Technology Lab, Furtwangen University, Robert-Gerwig-Platz 1, Furtwangen im Schwarzwald, 78120, Germany, 49 7723 920 2957, stefan.walzer@hs-furtwangen.de %K digital competencies %K nursing education %K support program %K needs assessment %K design-based research %K feasibility study %K nursing education provider %K qualitative research %K nurse %K health care %K focus group %K digital age %K expert consultation %K thematic content analysis %K feasibility test %K satisfaction %K competency-based approach %K workplace barrier %K health care digitalization %K digital technology %D 2025 %7 15.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Health care systems and the nursing profession worldwide are being transformed by technology and digitalization. Nurses acquire digital competence through their own experience in daily practice, but also from education and training; nursing education providers thus play an important role. While nursing education providers have some level of digital competence, there is a need for ongoing training and support for them to develop more advanced skills and effectively integrate technology into their teaching. Objective: This study aims to develop a needs-based support program for nursing education providers to foster digital competencies and to test this intervention. Methods: We used a design-based research approach, incorporating iterative development with expert consultation to create and evaluate a support program for nursing education providers. Focus groups were conducted online to assess needs, and thematic content analysis was used to derive key insights. The support program was then refined through expert feedback and subjected to a feasibility and satisfaction test, with participant evaluations analyzed descriptively. Results: Six main categories emerged from the focus groups, highlighting key areas, including the use of digital technology, ongoing support needs, and the current state of digitalization in nursing education. The support program was developed based on these findings, with expert validation leading to adjustments in timing, content prioritization, and platform integration. Preliminary testing showed good overall satisfaction with the support program, although participants suggested improvements in content relevance and digital platform usability. Conclusions: Although the feasibility test showed high satisfaction with the support program, low participation rates and limited perceived knowledge gain were major concerns. The results suggest that while the program was well received, further refinements, including a focus on competency-based approaches and addressing workplace barriers, are needed to increase participation and effectiveness of such interventions. The findings of this research can be used as a basis for the development of similar programs in other educational and health care contexts. %M 39813674 %R 10.2196/66109 %U https://formative.jmir.org/2025/1/e66109 %U https://doi.org/10.2196/66109 %U http://www.ncbi.nlm.nih.gov/pubmed/39813674 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60446 %T Topic Modeling of Nursing Issues in the Media During 4 Emerging Infectious Disease Epidemics in South Korea: Descriptive Analysis %A Kim,Jungok %A Yun,Eun Kyoung %+ , College of Nursing Science, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea, 82 2 961 2348, ekyun@khu.ac.kr %K topic modeling %K news articles %K nursing issues %K text analysis %K emerging infectious disease %D 2025 %7 6.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Emerging infectious disease disasters receive extensive media coverage and public attention. Nurse burnout and attrition peak during health crises such as pandemics. However, there is limited research on nursing issues related to repeated emerging infectious disease crises over time. Objective: The purpose of this study was to analyze and draw implications from changes in key nursing issues reported by the news media during the outbreaks of severe acute respiratory syndrome (SARS; 2003), influenza A (2009), Middle East respiratory syndrome (MERS; 2015), and COVID-19 (2020) in Korea using topic modeling. Methods: A total of 51,489 news articles were extracted by searching for the keywords “nursing” or “nurse” in the title or body of articles published from April 2003 to May 2021 (during new infectious disease outbreaks) in the open integrated database. The selected news articles were preprocessed then analyzed for text and structure using a 3-step keyword analysis method, latent Dirichlet allocation topic modeling, and keyword network analysis. Results: Among the 51,489 news articles collected with the search terms “nursing” and “nurse,” 17,285 (33.6%) were selected based on the eligibility criteria and used in the final analysis. Using topic modeling, we derived 5 topics each for SARS, influenza A, and MERS and 6 topics for COVID-19. The themes commonly identified through topic modeling and keyword network analysis across the 4 epidemics were “response to emerging infectious diseases in Korea,” “demand for nurses,” “vulnerability in the work environment,” and “roles and responsibilities of nurses.” Although the topic names were the same, the meanings implied by the comprehensive keywords for each epidemic varied depending on the epidemic and the times. Conclusions: Analysis of the identified themes and associated keyword network revealed that issues related to nurse shortages, working conditions, and poor treatment were not unique to the COVID-19 pandemic but rather recurring themes from previous epidemics. Our findings can be used to inform strategies to improve the professional roles, work environment, and treatment of nurses during health crises. Suggestions for future nursing-related policy impact and change research are also provided. %M 39761557 %R 10.2196/60446 %U https://www.jmir.org/2025/1/e60446 %U https://doi.org/10.2196/60446 %U http://www.ncbi.nlm.nih.gov/pubmed/39761557 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64871 %T Impact of Psychosocial and Palliative Care Training on Nurses’ Competences and Care of Patients With Cancer in Cameroon: Protocol for Quasi-Experimental Study %A Bassah,Nahyeni %A Tendongfor,Nicholas %A Ebob-Anya,Bachi-Ayukokang %A Eta,Vivian A E %A Esembeson,Malika %A Ngah,Ndzi Eric %A Abdul-Rahim,Salisu Ango %+ Department of Nursing, University of Buea, Molyko, Buea, P.O Box 63, Cameroon, 237 677358661, nahyenibassah@yahoo.com %K palliative care %K psychosocial nursing %K oncology nursing %K nurses %K quality improvement %K training %K competencies %D 2025 %7 3.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer is a leading cause of global mortality, accounting for nearly 10 million deaths in 2020. This is projected to increase by more than 60% by 2040, particularly in low- and middle-income countries. Yet, palliative and psychosocial oncology care is very limited in these countries. Objective: This study describes a protocol for the development, implementation, and evaluation of a psychosocial oncology and palliative care course on Cameroonian practicing nurses’ knowledge, self-perceived competence, and confidence in palliative and psychosocial oncology care provision for patients with cancer. Methods: A single group pre-posttest design, incorporating both quantitative and qualitative methods will be used. First, a psychosocial oncology and palliative care course for practicing nurses in Cameroon will be developed. This course will then be implemented with 50 practicing nurses purposefully selected from 2 oncology units in the Littoral region and 4 hospitals in the Southwest region of Cameroon. Finally, to assess the impact of the training program we will undertake a pre and posttest survey of nurses’ palliative and psychosocial oncology competences, a pre and post training audit of patients’ nursing records to examine nurses’ practice of palliative and psychosocial oncology care and undertake a critical-incident interview of nurses’ transfer of learning to practice. Descriptive and inferential statistics will be used to analysis quantitative data, while qualitative data will be analyzed using the framework approach. Results: This study was funded in September 2023. The training program development was initiated in March 2024 and completed in June 2024. Baseline data collection commenced in May 2024 and as of September 2024, we had collected data from 300 patient record. Training implementation is planned for October-December 2024, and post intervention data will be started in October 2024 and continue till April 2025. Data analysis will commence in October 2024 and we aim to publish study findings in peer review journals by November 2025. Conclusions: This study will improve our understanding of Cameroonian nurses’ palliative and psychosocial oncology competency gaps. It will result in the development of a palliative care and psychosocial oncology course and in the training of 50 nurses in psychosocial oncology and palliative care in Cameroon. This study will inform strategies for future psychosocial oncology and palliative care training initiatives in Cameroon and other low- and middle-income countries. International Registered Report Identifier (IRRID): DERR1-10.2196/64871 %M 39752719 %R 10.2196/64871 %U https://www.researchprotocols.org/2025/1/e64871 %U https://doi.org/10.2196/64871 %U http://www.ncbi.nlm.nih.gov/pubmed/39752719 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e60176 %T Work Systems Analysis of Emergency Nurse Patient Flow Management Using the Systems Engineering Initiative for Patient Safety Model: Applying Findings From a Grounded Theory Study %A Benjamin,Ellen %A Giuliano,Karen K %K patient flow %K throughput %K emergency department %K nursing %K emergency nursing %K organizing work %K cognitive work %K human factors %K ergonomics %K SEIPS model %D 2024 %7 10.12.2024 %9 %J JMIR Hum Factors %G English %X Background: Emergency nurses actively manage the flow of patients through emergency departments. Patient flow management is complex, cognitively demanding work that shapes the timeliness, efficiency, and safety of patient care. Research exploring nursing patient flow management is limited. A comprehensive analysis of emergency nursing work systems is needed to improve patient flow work processes. Objective: The aim of this paper is to describe the work system factors that impact emergency nurse patient flow management using the System Engineering Initiative for Patient Safety model. Methods: This study used grounded theory methodologies. Data were collected through multiple rounds of focus groups and interviews with 27 emergency nurse participants and 64 hours of participant observation across 4 emergency departments between August 2022 and February 2023. Data were analyzed using coding, constant comparative analysis, and memo-writing. Emergent themes were organized according to the first component of the System Engineering Initiative for Patient Safety model, the work system. Results: Patient flow management is impacted by diverse factors, including personal nursing characteristics; tools and technology; external factors; and the emergency department’s physical and socio-organizational environment. Participants raised concerns about the available technology’s functionality, usability, and accessibility; departmental capacity and layout; resource levels across the health care system; and interdepartmental teamwork. Other noteworthy findings include obscurity and variability across departments’ staff roles titles, functions, and norms; the degree of provider involvement in patient flow management decisions; and management’s enforcement of timing metrics. Conclusions: There are significant barriers to the work of emergency patient flow management. More research is needed to measure the impact of these human factors on patient flow outcomes. Collaboration between health care administrators, human factors engineers, and nurses is needed to improve emergency nurse work systems. %R 10.2196/60176 %U https://humanfactors.jmir.org/2024/1/e60176 %U https://doi.org/10.2196/60176 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e65111 %T Nurses’ and Nursing Assistants’ Experiences With Teleconsultation in Small Rural Long-Term Care Facilities: Semistructured Interview Pilot Study %A Nabelsi,Veronique %A Leclerc,Marie Chantal %A Plouffe,Véronique %+ Département des sciences administratives, Université du Québec en Outaouais, 101, rue St-Jean-Bosco, Gatineau, QC, J8X 3X7, Canada, 1 595 3900 ext 1915, veronique.nabelsi@uqo.ca %K teleconsultation %K long-term care facilities %K nursing %K nursing practices %K workflow optimization %K residents %K rural %K telehealth %K Quebec %D 2024 %7 27.11.2024 %9 Original Paper %J JMIR Aging %G English %X Background: In Quebec, the shortage of nurses during night shifts compromises the safety and quality of resident care, particularly in small residential and long-term care centers (“Centres d’hébergement et de soins de longue durée”; CHSLDs) located in rural areas. The need to ensure the continuous presence of nurses 24 hours a day in CHSLDs has become more pressing, forcing some facilities to implement exceptional measures such as on-call telephone services to ensure access to a nurse. In light of these challenging circumstances, the Direction nationale des soins et des services infirmiers of Quebec’s Ministère de la Santé et des Services sociaux has rolled out a teleconsultation pilot project. Objective: This study aims to explore nurses’ and nursing assistants’ experience of integrating teleconsultation during night shifts in rural CHSLDs with ≤50 residents. Methods: The 6-month pilot project was rolled out sequentially in 3 rural CHSLDs located in 2 administrative regions of Quebec between July 2022 and March 2023. A total of 18 semistructured interviews were conducted with 9 nurses and nursing assistants between February and July 2023. Results: Participants’ experiences revealed that teleconsultation provided significant added value by improving clinical, administrative, and organizational practices. Some practices remained unchanged, indicating stable workflows. Workflow optimization through an expanded scope of practice ensured efficient and safe continuity of care. Enhanced collaboration between nurses and nursing assistants led to improved care coordination and communication. The leadership played a significant role in clarifying professionals’ roles and in supporting effective adaptation to teleconsultation. Conclusions: This pilot project represents a significant step forward in improving care for CHSLD residents in Quebec. Teleconsultation not only makes it possible to overcome recruitment challenges and ensure the continuous presence of nurses during night shifts but also optimizes professional practices while ensuring the safety and quality of care provided to residents. %M 39602791 %R 10.2196/65111 %U https://aging.jmir.org/2024/1/e65111 %U https://doi.org/10.2196/65111 %U http://www.ncbi.nlm.nih.gov/pubmed/39602791 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 7 %N %P e59619 %T Calculating Optimal Patient to Nursing Capacity: Comparative Analysis of Traditional and New Methods %A Ware,Anna %A Blumke,Terri %A Hoover,Peter %A Arreola,David %K nurse scheduling %K nurse %K patient ratio %K nursing hours per patient day %K NHPPD %K nursing administration %K workload %K comparative analysis %K nursing %K staffing %K nurse staffing %K registered nurses %K nurse assistants %K staff allocation %K patient capacity %D 2024 %7 22.11.2024 %9 %J JMIR Nursing %G English %X Background: Optimal nurse staffing levels have been shown to impact patients’ prognoses and safety, as well as staff burnout. The predominant method for calculating staffing levels has been patient-to-nurse (P/N) ratios and nursing hours per patient day. However, both methods fall short of addressing the dynamic nature of staffing needs that often fluctuate throughout the day as patients’ clinical status changes and new patients are admitted or discharged from the unit. Objective: In this evaluation, the Veterans Affairs Palo Alto Health Care System (VAPAHCS) piloted a new dynamic bed count calculation in an effort to target optimal staffing levels every hour to provide greater temporal resolution on nurse staffing levels within the Veterans Health Administration. Methods: The dynamic bed count uses elements from both the nursing hours per patient day and P/N ratio to calculate current and target staffing levels, every hour, while balancing across nurse types (registered nurses to nurse assistants) to provide improved temporal insight into staff allocation. The dynamic bed count was compared with traditional P/N ratio methods of calculating patient capacity at the VAPAHCS, to assess optimal patient capacity within their acute care ward from January 1, 2023, through May 25, 2023. Descriptive statistics summarized patient capacity variables across the intensive care unit (ICU), medical-surgical ICU, and 3 acute care units. Student t tests (2-tailed) were used to analyze differences between patient capacity measures. Results: Hourly analysis of patient capacity information displayed how the dynamic bed count provided improved temporal resolution on patient capacity. Comparing the dynamic bed count to the P/N ratio, we found the patient capacity, as determined by the P/N ratio, was, on average, higher than that of the dynamic bed count across VAPAHCS acute care units and the medical-surgical ICU (P<.001). For example, in acute care unit 3C, the average dynamic bed count was 21.6 (SD 4.2) compared with a P/N ratio of 28.6 (SD 3.2). This suggests that calculating patient capacity using P/N ratios alone could lead to units taking on more patients than what the dynamic bed count suggests the unit can optimally handle. Conclusions: As a new patient capacity calculation, the dynamic bed count provided additional details and timely information about clinical staffing levels, patient acuity, and patient turnover. Implementing this calculation into the management process has the potential to empower departments to further optimize staffing and patient care. %R 10.2196/59619 %U https://nursing.jmir.org/2024/1/e59619 %U https://doi.org/10.2196/59619 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58190 %T Exploring the Experiences of Times Without Care and Encounters in Persons With Dementia in the Swiss and German Nursing Home and Domiciliary Care Settings: Protocol for an Ethnographic Multimethods Study %A Beer,Thomas %A Hirt,Julian %A Adlbrecht,Laura %A Lindwedel,Ulrike %A Dammert,Matthias %A Maurer,Carola %A Kliegel,Matthias %A König,Peter %A Bleses,Helma M %+ Department of Health, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, St.Gallen, 9000, Switzerland, 41 58 257 15 18, thomas.beer@ost.ch %K dementia %K nursing homes %K home nursing %K home care services %K nursing %K ethnography %K formal caregivers %K informal caregivers %D 2024 %7 18.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Persons with dementia spend a large part of the day without care and encounters, often without activity, as confirmed by numerous studies. However, no scientific analysis has examined how persons with dementia experience these periods. Such knowledge would be highly relevant for health care professionals and relatives to develop adequate strategies for dealing with times without care. Objective: We aim to reconstruct times without care and encounters in persons with dementia in the nursing home and domiciliary care settings and develop a typology. This typology will address the lifeworld understandings of time and the ways of arranging the time of persons with dementia. Methods: Our study is designed as an explorative, sequential multimethods investigation. We aim to systematically reconstruct times without care and encounters over a period of 36 months using ethnographic methods. Afterward, we will examine the resulting typology using a survey. To describe different social and caring cultures, practices, and arrangements, we will analyze time periods across all phases of dementia in (1) institutions exclusively caring for persons with dementia, (2) institutions where persons with dementia and those without live together, and (3) domiciliary care. For each type of care, our target is 10 intensive case observations. These observations will occur in both participatory and nonparticipatory ways. We video record selected situations and conduct situational conversations and interviews with persons with dementia and nurses. We are aiming for a minimum sample of 30 persons with dementia plus their caregivers (ie, relatives of people with dementia and professional caregivers). We will analyze data according to grounded theory methodology. Furthermore, we will perform a hermeneutic sequence analysis of selected text passages. To interpret the video material, we will conduct a video interaction analysis. To obtain complementary information about the newly developed typology, we will survey approximately 400 formal and 150 informal caregivers. We will summarize the ethnography and survey findings into an overall concept of times without care and encounters in persons with dementia. To fulfill the research objectives, our cross-disciplinary and cross-country team comprises researchers with expertise in nursing sciences, gerontology, sociology, psychology, and ethnography. Results: Our approach allows formulating statements about the nature, frequency, and prevalence of times without care and encounters in people with dementia across countries and types of care. Thus, we will contribute to making visible the lifeworld of persons with dementia. Our study commenced in March 2022 and will conclude in May 2025. The results are expected to be published in the fall of 2025. Conclusions: Our research offers points of departure for the representative investigation of times without care and encounters in persons with dementia, for the development of diagnostic instruments, and for dealing critically with possibilities of interruption (eg, by developing targeted interventions). International Registered Report Identifier (IRRID): DERR1-10.2196/58190 %M 39556815 %R 10.2196/58190 %U https://www.researchprotocols.org/2024/1/e58190 %U https://doi.org/10.2196/58190 %U http://www.ncbi.nlm.nih.gov/pubmed/39556815 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51527 %T Implementation of a Mobile Health Approach to a Long-Lasting Insecticidal Net Uptake Intervention for Malaria Prevention Among Pregnant Women in Tanzania: Process Evaluation of the Hati Salama (HASA) Randomized Controlled Trial Study %A Vey,Trinity %A Kinnicutt,Eleonora %A West,Nicola %A Sleeth,Jessica %A Nchimbi,Kenneth Bernard %A Yeates,Karen %+ Department of Medicine, Queen's University, 99 University Avenue, Kingston, ON, K7L 3P5, Canada, 1 6135332000, 16tv7@queensu.ca %K mHealth %K short message service %K behavior change communication %K pregnancy %K long-lasting insecticidal nets %K malaria %K protozoan infections %K parasitic diseases %K vector borne diseases %K insecticide %K intervention %K malaria prevention %D 2024 %7 5.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Malaria infection is associated with many adverse outcomes for pregnant women and neonates, yet pregnant women in East and Southern Africa remain frequently exposed to malaria. Long-lasting insecticidal nets (LLINs) can help prevent malarial infections and the associated adverse events. The Hati Salama (HASA) study was a cluster-randomized controlled trial implemented in 100 antenatal health facilities in urban and rural settings of Tanzania that provided pregnant women in both intervention and control groups with e-vouchers to redeem for LLINs for malaria prevention. The intervention group received behavior change communication mobile messages across a 14-day period while the e-voucher was active, and no significant difference between the rates of e-voucher redemption was found across the two groups. Objective: This study was a process evaluation of the HASA randomized controlled trial to determine barriers and facilitators to e-voucher reception and LLIN acquisition for pregnant women enrolled in the trial, as well as challenges and lessons learned by nurses who worked at the antenatal health facilities supporting the trial. Methods: Following the e-voucher’s expiration at 14 days, voluntary phone follow-up surveys were conducted for nurses who supported the trial, as well as participants in both intervention and control groups of the trial who did not redeem their e-vouchers. Survey questions asked nurses about workflow, training sessions, network connectivity, proxy phone use, and more. Surveys asked participants about reasons for not redeeming e-vouchers. Both surveys provided lists of preset answers to questions, as well as the option to provide open-ended responses. Nurses and trial participants were contacted between January and June 2016 on up to three occasions. Results: While nurses who supported the HASA trial seemed to recognize the value of the program in their communities, some barriers identified by nurses included network connectivity, workload increase, inadequate training and on-the-ground support, and difficulty following the workflow. Several barriers identified by trial participants included personal obligations preventing them from redeeming the e-voucher on time, network connectivity issues, losing the e-voucher number, no stock of LLINs at retailers when attended, inadequate explanation of where or how to redeem the e-voucher, or not receiving an SMS text message with the e-voucher number promptly or at all. Conclusions: Large-scale e-voucher platforms for health-related commodity interventions, such as LLIN distribution in sub-Saharan Africa, are feasible, but challenges, including network connectivity, must be addressed. Nurses identified issues to be considered in a future scale-up, such that the number of nurses trained should be increased and the e-voucher issuance workflow should be simplified. To address some of the key barriers impacting e-voucher redemption for trial participants, the network of retailers could be expanded and the e-voucher expiration period should be extended. Trial Registration: ClinicalTrials.gov NCT02561624; https://clinicaltrials.gov/ct2/show/NCT02561624 %M 39499551 %R 10.2196/51527 %U https://www.jmir.org/2024/1/e51527 %U https://doi.org/10.2196/51527 %U http://www.ncbi.nlm.nih.gov/pubmed/39499551 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58030 %T Advancing Digital Education Technologies by Empowering Nurses With Point-of-Care Ultrasound: Protocol for a Mixed Methods Study %A Gimenes,Fernanda Raphael Escobar %A Stabile,Angelita Maria %A Bernardes,Rodrigo Magri %A Santos,Vinicius Batista %A Menegueti,Mayra Gonçalves %A do Prado,Patricia Rezende %A Ribeiro,Mauricio Serra %A Camerini,Flavia Giron %A Rabeh,Soraia Assad Nasbine %+ Ribeirão Preto College of Nursing, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, 14095020, Brazil, 55 1633153420, fregimenes@eerp.usp.br %K ultrasound %K bedside ultrasound %K patient safety %K advanced practice nursing %K digital technology in education %K empowerment %K nurses %K Point-of-Care Ultrasound %K PoCUS %K quality care %K decision-making %K nursing assessment %D 2024 %7 23.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Bedside ultrasonography, also known as point-of-care ultrasound (PoCUS), is a promising technological tool that enhances clinical assessment, enriching diagnostic capabilities and clinical reasoning. Its use in nursing spans various patient populations and health care settings, providing nurses with a valuable health assessment tool to improve care quality and patient safety. Despite its growing integration into clinical practice, PoCUS training has mainly focused on physicians, leaving a gap for trained nurses who demonstrate similar proficiency in conducting scans and interpreting images. Previous research highlights the value of digital tools in PoCUS training, showing their role in improving professionals’ and students’ knowledge, image interpretation skills, and clinical acumen. Objective: This study aimed to (1) establish an assessment instrument gauging nurses’ competency milestones in PoCUS and evaluate its content and appearance validity, (2) develop a series of 5 educational videos focused on PoCUS and assess their content and appearance validity, and (3) construct an online learning environment tailored to nurses’ PoCUS training needs and evaluate its content and appearance validity. Methods: We will conduct a methodological study of technological production guided by Rogers’ diffusion of innovations theory. Subproject 1 will design and validate a comprehensive assessment tool for evaluating nurses’ competency milestones in PoCUS use. For this purpose, a scoping review will be conducted. The review will be based on JBI Collaboration guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extended for Scoping Reviews (PRISMA-ScR) checklist. Subproject 2 involves an evaluation of content and appearance validity for a series of 5 educational videos on PoCUS, designed specifically for nurses about applying peripherally inserted central catheter lines, inserting nasogastric feeding tubes, assessing gastric residual volume, assessing pressure injuries and soft tissue conditions, and assessing muscle mass to monitor patient nutritional status. In subproject 3, a comprehensive online learning environment dedicated to PoCUS training for nurses will be developed and validated. The launch of an online learning environment represents a cornerstone of our dissemination strategy, scheduled to coincide with the inaugural Brazilian PoCUS symposium for nurses, an event organized by the project members. This platform will serve as a pivotal resource for continuous learning and professional development. Results: Subproject 1 will start in the second half of 2024 and is expected to be completed by mid-2025. Subproject 2 is currently ongoing and is expected to be completed in early 2026. Subproject 3 is set to begin in early 2025 and is planned to be completed by 2026. Conclusions: Through these concerted efforts, the project aims to bridge the existing gap in PoCUS training for nurses, thereby fostering their proficiency and enhancing patient care outcomes. International Registered Report Identifier (IRRID): PRR1-10.2196/58030 %M 39441654 %R 10.2196/58030 %U https://www.researchprotocols.org/2024/1/e58030 %U https://doi.org/10.2196/58030 %U http://www.ncbi.nlm.nih.gov/pubmed/39441654 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e54083 %T Integrating Digital Assistive Technologies Into Care Processes: Mixed Methods Study %A Hofstetter,Sebastian %A Zilezinski,Max %A Behr,Dominik %A Kraft,Bernhard %A Buhtz,Christian %A Paulicke,Denny %A Wolf,Anja %A Klus,Christina %A Stoevesandt,Dietrich %A Schwarz,Karsten %A Jahn,Patrick %+ AG Versorgungsforschung Pflege im Krankenhaus, Departement of Internal Medicine, University Medicine Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Halle (Saale), Germany, 49 345 557 4064, sebastian.hofstetter@medizin.uni-halle.de %K digital assistive technologies %K education concept %K intention to use %K learning effects %K digital transformation %D 2024 %7 9.10.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: Current challenges in patient care have increased research on technology use in nursing and health care. Digital assistive technologies (DATs) are one option that can be incorporated into care processes. However, how the application of DATs should be introduced to nurses and care professionals must be clarified. No structured and effective education concepts for the patient-oriented integration of DATs in the nursing sector are currently available. Objective: This study aims to examine how a structured and guided integration and education concept, herein termed the sensitization, evaluative introduction, qualification, and implementation (SEQI) education concept, can support the integration of DATs into nursing practices. Methods: This study used an explanatory, sequential study design with a mixed methods approach. The SEQI intervention was run in 26 long-term care facilities oriented toward older adults in Germany after a 5-day training course in each. The participating care professionals were asked to test 1 of 6 DATs in real-world practice over 3 days. Surveys (n=112) were then administered that recorded the intention to use DATs at 3 measurement points, and guided qualitative interviews with care professionals (n=12) were conducted to evaluate the learning concepts and effects of the intervention. Results: As this was a pilot study, no sample size calculation was carried out, and P values were not reported. The participating care professionals were generally willing to integrate DATs—as an additional resource—into nursing processes even before the 4-stage SEQI intervention was presented. However, the intervention provided additional background knowledge and sensitized care professionals to the digital transformation, enabling them to evaluate how DATs fit in the health care sector, what qualifies these technologies for correct application, and what promotes their use. The care professionals expressed specific ideas and requirements for both technology-related education concepts and nursing DATs. Conclusions: Actively matching technical support, physical limitations, and patients’ needs is crucial when selecting DATs and integrating them into nursing processes. To this end, using a structured process such as SEQI that strengthens care professionals’ ability to integrate DATs can help improve the benefits of such technology in the health care setting. Practical, application-oriented learning can promote the long-term implementation of DATs. %M 39383526 %R 10.2196/54083 %U https://mededu.jmir.org/2024/1/e54083 %U https://doi.org/10.2196/54083 %U http://www.ncbi.nlm.nih.gov/pubmed/39383526 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58692 %T Psychoeducational Burnout Intervention for Nurses: Protocol for a Systematic Review %A Abdullah Sharin,Ili %A Jinah,Norehan %A Bakit,Pangie %A Adnan,Izzuan Khirman %A Zakaria,Nor Haniza %A Mohmad,Shazwani %A Ahmad Subki,Siti Zubaidah %A Zakaria,Nursyahda %A Lee,Kun Yun %+ Centre of Leadership & Professional Development (CLPD), Institute for Health Management (IHM), National Institutes of Health (NIH), Ministry of Health Malaysia, Block B1, NIH Complex, No. 1 Jalan Setia Murni U13/52, Section U13, Setia Alam, Shah Alam, 40170, Malaysia, 60 33628314, ppilias@moh.gov.my %K burnout intervention %K burnout %K psychoeducation %K nurse %K systematic review %K protocol %K evidence-based intervention %K effectiveness %K psychoeducational intervention %K mental health. %D 2024 %7 30.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Nurses face high levels of stress and emotional exhaustion due to heavy workloads and demanding work environments. Prolonged exposure to these stressors predisposes nurses to burnout, which can adversely affect patient care. Addressing burnout among nurses requires a multifaceted approach, involving both personal and organizational strategies. While organizational strategies target systemic workplace issues, personal interventions are often favored for their ease of implementation, immediate benefits, and empowerment of health care workers through stress management and resilience-building. Prioritizing evidence-based interventions to mitigate burnout among nurses is crucial for managing occupational stress and promoting well-being. Person-directed psychoeducation is an effective personal intervention strategy used to equip nurses with the appropriate knowledge and skills to handle stressors, thereby safeguarding their mental health and ensuring high-quality patient care. Objective: This protocol proposes a systematic review that aims to identify and assess the effectiveness of person-directed psychoeducational interventions for nurses. The review aims to pinpoint effective interventions that can be implemented to manage burnout and support the mental health of nurses. Methods: This systematic review will follow the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. In total of 5 electronic databases (PubMed-MEDLINE, EBSCOhost, Ovid MEDLINE, Scopus, and ScienceDirect) will be searched for studies published between January 1, 2014, and December 31, 2023. The search will encompass 3 main keywords: “nurses,” “burnout intervention,” and “burnout.” Predefined eligibility criteria will guide the screening process. Data will be extracted to address the objectives of the review. The risk of bias for each study will be assessed using Joanna Briggs Institute Critical Appraisal Tools. Results: Preliminary searches have been initiated since February 2024, with the review expected to be completed by June 2024. The expected results will include a comprehensive list of psychoeducational interventions and their effectiveness in reducing burnout among nurses. The review will highlight interventions that demonstrate significant impact in published studies from various countries. Conclusions: Given the rising prevalence of burnout among nurses and its detrimental effects on individuals and health care organizations, the findings from this systematic review are expected to inform health care policy and practice. By evaluating different interventions, it will provide insights into the most effective strategies, contributing to evidence-based practices that support nurses’ mental health and well-being. The findings can support stakeholders in developing and implementing targeted strategies to combat nurse burnout, ultimately enhancing the quality of patient care and health care delivery. In addition, the findings will also offer valuable information for researchers, guiding future practice and research in this area. Trial Registration: PROSPERO CRD42024505762; https://tinyurl.com/4p84dk3d International Registered Report Identifier (IRRID): DERR1-10.2196/58692 %M 39348680 %R 10.2196/58692 %U https://www.researchprotocols.org/2024/1/e58692 %U https://doi.org/10.2196/58692 %U http://www.ncbi.nlm.nih.gov/pubmed/39348680 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55099 %T Triage Accuracy and the Safety of User-Initiated Symptom Assessment With an Electronic Symptom Checker in a Real-Life Setting: Instrument Validation Study %A Liu,Ville %A Kaila,Minna %A Koskela,Tuomas %+ Faculty of Medicine, University of Helsinki, Ruusulankatu 21 B 32, Helsinki, 00250, Finland, 358 400642104, villeliu@hotmail.com %K nurse triage %K emergency department triage %K triage %K symptom assessment %K health services accessibility %K telemedicine %K eHealth %K remote consultation %K eHealth %K primary health care %K primary care %K urgent care %K health services research %K health services %D 2024 %7 26.9.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Previous studies have evaluated the accuracy of the diagnostics of electronic symptom checkers (ESCs) and triage using clinical case vignettes. National Omaolo digital services (Omaolo) in Finland consist of an ESC for various symptoms. Omaolo is a medical device with a Conformité Européenne marking (risk class: IIa), based on Duodecim Clinical Decision Support, EBMEDS. Objective: This study investigates how well triage performed by the ESC nurse triage within the chief symptom list available in Omaolo (anal region symptoms, cough, diarrhea, discharge from the eye or watery or reddish eye, headache, heartburn, knee symptom or injury, lower back pain or injury, oral health, painful or blocked ear, respiratory tract infection, sexually transmitted disease, shoulder pain or stiffness or injury, sore throat or throat symptom, and urinary tract infection). In addition, the accuracy, specificity, sensitivity, and safety of the Omaolo ESC were assessed. Methods: This is a clinical validation study in a real-life setting performed at multiple primary health care (PHC) centers across Finland. The included units were of the walk-in model of primary care, where no previous phone call or contact was required. Upon arriving at the PHC center, users (patients) answered the ESC questions and received a triage recommendation; a nurse then assessed their triage. Findings on 877 patients were analyzed by matching the ESC recommendations with triage by the triage nurse. Results: Safe assessments by the ESC accounted for 97.6% (856/877; 95% CI 95.6%-98.0%) of all assessments made. The mean of the exact match for all symptom assessments was 53.7% (471/877; 95% CI 49.2%-55.9%). The mean value of the exact match or overly conservative but suitable for all (ESC’s assessment was 1 triage level higher than the nurse’s triage) symptom assessments was 66.6% (584/877; 95% CI 63.4%-69.7%). When the nurse concluded that urgent treatment was needed, the ESC’s exactly matched accuracy was 70.9% (244/344; 95% CI 65.8%-75.7%). Sensitivity for the Omaolo ESC was 62.6% and specificity of 69.2%. A total of 21 critical assessments were identified for further analysis: there was no indication of compromised patient safety. Conclusions: The primary objectives of this study were to evaluate the safety and to explore the accuracy, specificity, and sensitivity of the Omaolo ESC. The results indicate that the ESC is safe in a real-life setting when appraised with assessments conducted by triage nurses. Furthermore, the Omaolo ESC exhibits the potential to guide patients to appropriate triage destinations effectively, helping them to receive timely and suitable care. International Registered Report Identifier (IRRID): RR2-10.2196/41423 %M 39326038 %R 10.2196/55099 %U https://humanfactors.jmir.org/2024/1/e55099 %U https://doi.org/10.2196/55099 %U http://www.ncbi.nlm.nih.gov/pubmed/39326038 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55324 %T Design and Psychometric Evaluation of Nurses’ Mobile Health Device Acceptance Scale (NMHDA-Scale): Application of the Expectation-Confirmation Theory %A Mirabootalebi,Narjes %A Meidani,Zahra %A Akbari,Hossein %A Rangraz Jeddi,Fatemeh %A Tagharrobi,Zahra %A Swoboda,Walter %A Holl,Felix %+ Trauma Nursing Research Centre, Kashan University of Medical Sciences, Isfahan Province, Kashan, 2C74+M7F, Iran, 98 9131613899, Tagharrobi_z@kaums.ac.ir %K mobile health %K acceptance %K psychometric evaluation %K nursing %K Expectation-Confirmation Theory %K smartphone %D 2024 %7 17.9.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The use of mobile tools in nursing care is indispensable. Given the importance of nurses’ acceptance of these tools in delivering effective care, this issue requires greater attention. Objective: This study aims to design the Mobile Health Tool Acceptance Scale for Nurses based on the Expectation-Confirmation Theory and to evaluate it psychometrically. Methods: Using a Waltz-based approach grounded in existing tools and the constructs of the Expectation-Confirmation Theory, the initial version of the scale was designed and evaluated for face and content validity. Construct validity was examined through exploratory factor analysis, concurrent validity, and known-group comparison. Reliability was assessed using measures of internal consistency and stability. Results: The initial version of the scale consisted of 33 items. During the qualitative and quantitative content validity stage, 1 item was added and 1 item was removed. Exploratory factor analysis, retaining 33 items, identified 5 factors that explained 70.53% of the variance. A significant positive correlation was found between the scores of the designed tool and nurses’ attitudes toward using mobile-based apps in nursing care (r=0.655, P<.001). The intraclass correlation coefficient, Cronbach α, and ω coefficient were 0.938, 0.953, and 0.907, respectively. Conclusions: The 33-item scale developed is a valid and reliable instrument for measuring nurses’ acceptance of mobile health tools. %M 39288375 %R 10.2196/55324 %U https://humanfactors.jmir.org/2024/1/e55324 %U https://doi.org/10.2196/55324 %U http://www.ncbi.nlm.nih.gov/pubmed/39288375 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 7 %N %P e48810 %T Experiences of Using a Digital Guidance and Assessment Tool (the Technology-Optimized Practice Process in Nursing Application) During Clinical Practice in a Nursing Home: Focus Group Study Among Nursing Students %A Johnsen,Hege Mari %A Nes,Andréa Aparecida Gonçalves %A Haddeland,Kristine %+ Department of Health and Nursing Science, University of Agder, Jon Lilletuns vei 9, Grimstad, 4879, Norway, 47 97515773, hege.mari.johnsen@uia.no %K application %K assessment of clinical education %K AssCE %K clinical education assessment tool %K electronic reports %K feedback %K guidance model %K smartphone %K Technology-Optimized Practice Process in Nursing %K TOPP-N %K information system success model %K nurse %K nursing %K allied health %K education %K focus group %K focus groups %K technology enhanced learning %K digital health %K content analysis %K student %K students %K nursing home %K long-term care %K learning management %K mobile phone %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Nursing %G English %X Background: Nursing students’ learning during clinical practice is largely influenced by the quality of the guidance they receive from their nurse preceptors. Students that have attended placement in nursing home settings have called for more time with nurse preceptors and an opportunity for more help from the nurses for reflection and developing critical thinking skills. To strengthen students’ guidance and assessment and enhance students’ learning in the practice setting, it has also been recommended to improve the collaboration between faculties and nurse preceptors. Objective: This study explores first-year nursing students’ experiences of using the Technology-Optimized Practice Process in Nursing (TOPP-N) application in 4 nursing homes in Norway. TOPP-N was developed to support guidance and assessment in clinical practice in nursing education. Methods: Four focus groups were conducted with 19 nursing students from 2 university campuses in Norway. The data collection and directed content analysis were based on DeLone and McLean’s information system success model. Results: Some participants had difficulties learning to use the TOPP-N tool, particularly those who had not attended the 1-hour digital course. Furthermore, participants remarked that the content of the TOPP-N guidance module could be better adjusted to the current clinical placement, level of education, and individual achievements to be more usable. Despite this, most participants liked the TOPP-N application’s concept. Using the TOPP-N mobile app for guidance and assessment was found to be very flexible. The frequency and ways of using the application varied among the participants. Most participants perceived that the use of TOPP-N facilitated awareness of learning objectives and enabled continuous reflection and feedback from nurse preceptors. However, the findings indicate that the TOPP-N application’s perceived usefulness was highly dependent on the preparedness and use of the app among nurse preceptors (or absence thereof). Conclusions: This study offers information about critical success factors perceived by nursing students related to the use of the TOPP-N application. To develop similar learning management systems that are usable and efficient, developers should focus on personalizing the content, clarifying procedures for use, and enhancing the training and motivation of users, that is, students, nurse preceptors, and educators. %M 39255477 %R 10.2196/48810 %U https://nursing.jmir.org/2024/1/e48810 %U https://doi.org/10.2196/48810 %U http://www.ncbi.nlm.nih.gov/pubmed/39255477 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 8 %N %P e57187 %T Examining the Evidence on the Statistics Prerequisite for Admission to Doctor of Nursing Practice Programs: Retrospective Cohort Study %A Byon,Ha Do %A Park,Sunbok %A Quatrara,Beth A %A Taggart,Jessica %A Wheeler,Lindsay Buford %+ School of Nursing, University of Virginia, 225 Jeanette Lancaster Way, Charlottesville, VA, 22903, United States, 1 434 243 3973, hb7ze@virginia.edu %K Doctor of Nursing Practice %K admission prerequisite %K statistics requirement %K biostatistics %K nursing education %D 2024 %7 9.9.2024 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: Doctor of Nursing Practice (DNP) programs in the United States confer the highest practice degree in nursing. The proportion of racial and ethnic minority DNP students, including those of Asian descent, keeps increasing in the United States. Statistics is commonly required for DNP programs. However, there is insufficient evidence regarding the number of years within which statistics should be taken and the minimum grade required for admission to the program. Objective: This study aimed to examine the associations of statistics prerequisite durations and grades for admission with the course performances within the DNP program. We also explored whether a postadmission statistics overview course can prepare students for a DNP statistics course as well as a required statistics prerequisite course. Methods: A retrospective cohort study was conducted with a sample of 31 DNP students at a large university in the Mid-Atlantic region. Statistical analysis of data collected over 5 years, between 2018 and 2022, was performed to examine the associations, using Spearman rank correlation analysis and Mann-Whitney U test (U). Results: The performance of students in a DNP statistics course was not associated with prerequisite duration. There was no significant association between the duration and the DNP statistics course letter grades (ρ=0.12; P=.66), neither with exam 1 (ρ=0.03; P=.91) nor with exam 2 scores (ρ=0.01; P=.97). Prerequisite grades were positively associated with exam 1 grades (ρ=0.59; P=.02), but not exam 2 (ρ=0.35; P=.19) or course grades (ρ=0.40; P=.12). In addition, no difference was found in the performance of students whether meeting the prerequisite requirements or taking a 1-month, self-paced overview course (exam 1: U=159, P=.13; exam 2: U=102, P=.50; course letter grade: U=117, P=.92). Conclusions: No evidence was found to support the need for limits on when prerequisites are completed or grade requirements. Opting for a statistics overview course after admission can serve as a viable alternative to the statistics prerequisite, effectively preparing students for advanced quantitative data analysis in a DNP program. %M 39250220 %R 10.2196/57187 %U https://apinj.jmir.org/2024/1/e57187 %U https://doi.org/10.2196/57187 %U http://www.ncbi.nlm.nih.gov/pubmed/39250220 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e53258 %T Newly Qualified Canadian Nurses’ Experiences With Digital Health in the Workplace: Comparative Qualitative Analysis %A Kleib,Manal %A Arnaert,Antonia %A Nagle,Lynn M %A Sugars,Rebecca %A da Costa,Daniel %+ Faculty of Nursing, University of Alberta, 5-112 Edmonton Clinic Health Academy, Edmonton, AB, T6G1C9, Canada, 1 7802481422, manal.kleib@ualberta.ca %K digital health %K new graduate nurses %K nursing practice %K workplace %K informatics %D 2024 %7 19.8.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: Clinical practice settings have increasingly become dependent on the use of digital or eHealth technologies such as electronic health records. It is vitally important to support nurses in adapting to digitalized health care systems; however, little is known about nursing graduates’ experiences as they transition to the workplace. Objective: This study aims to (1) describe newly qualified nurses’ experiences with digital health in the workplace, and (2) identify strategies that could help support new graduates’ transition and practice with digital health. Methods: An exploratory descriptive qualitative design was used. A total of 14 nurses from Eastern and Western Canada participated in semistructured interviews and data were analyzed using inductive content analysis. Results: Three themes were identified: (1) experiences before becoming a registered nurse, (2) experiences upon joining the workplace, and (3) suggestions for bridging the gap in transition to digital health practice. Findings revealed more similarities than differences between participants with respect to gaps in digital health education, technology-related challenges, and their influence on nursing practice. Conclusions: Digital health is the foundation of contemporary health care; therefore, comprehensive education during nursing school and throughout professional nursing practice, as well as organizational support and policy, are critical pillars. Health systems investing in digital health technologies must create supportive work environments for nurses to thrive in technologically rich environments and increase their capacity to deliver the digital health future. %M 39159452 %R 10.2196/53258 %U https://mededu.jmir.org/2024/1/e53258 %U https://doi.org/10.2196/53258 %U http://www.ncbi.nlm.nih.gov/pubmed/39159452 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56436 %T Socioemotional Skills in the Teaching-Learning Process Mediated by Medium- and High-Fidelity Clinical Simulation in Nursing Students: Protocol for a Scoping Review %A Contreras-Ramos,Luz Mery %A Laguado Jaimes,Elveny %A Jaimes Carvajal,Nelly Esperanza %A Pico Ferreira,Marleny %A Villamizar-Osorio,Magda Liliana %+ Faculty of Nursing, Universidad Cooperativa de Colombia, Carrera 33 # 30A -05, Bucaramanga, 680001, Colombia, 57 607 685 45 00 ext 7060, luz.contrerasr@campusucc.edu.co %K social skills %K nursing students %K high-fidelity simulation training %D 2024 %7 19.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In nursing education, contact with real scenarios implies the design of favorable experiences to develop prioritization, reasoning, critical thinking, and management skills that support future practice. In the context of the teaching-learning process, simulation emerges as a support strategy, but its use and management require the knowledge and appropriation of teachers. Clinical simulation during education promotes growth in technical skills and aptitudes such as critical thinking, emotional management, organization, delegation, and teamwork. The culmination positively impacts the student, reflecting on their confidence, security, and adaptability to unexpected or unknown situations and risks. Objective: The aim of this scoping review is to determine the socioemotional skills described during the teaching-learning process mediated by medium- and high-fidelity clinical simulation in nursing students. Methods: The main concepts and limits of the research area will be determined according to the 5 phases of a scoping review proposed by Arksey and O’Malley. Research articles and postgraduate theses published between 2010 and 2023 in English and Spanish will be considered. Dissertation-type documents, book chapters, editorials, abstracts, and articles focused on clinical simulation among nursing professionals will be excluded. The articles will be retrieved from databases available at the Universidad Cooperativa de Colombia, along with CINAHL, Scielo, and PubMed. The search strategy will be based on the Population-Concept-Context framework. Article selection will be carried out by 2 independent evaluators who will review titles and abstracts in stage 1 and the full text in stage 2. A database of retrieved articles will be built with the variables of interest. A qualitative thematic analysis will be conducted by 5 independent reviewers to provide an overview of the literature, focusing on identifying similarities and contrasts between studies and contributions related to the aspects of social skills described in nursing students. Results: The investigation has not yet started. The findings aim to focus on variables within the academic environment that, when correlated with the clinical simulation experience, may determine student learning. The working hypothesis is that students who experience greater satisfaction or possess better communication skills also demonstrate superior performance during high-fidelity simulation activities. The most relevant results will be contrasted considering the stated objective and knowledge gaps. Key aspects will also be compared with other reviews addressing related topics such as communication, self-efficacy, and self-confidence. Skills described by other authors that were not considered in the initial literature review will also be mentioned. Conclusions: Educational institutions are responsible for including learning experiences in controlled environments such as medium- and high-fidelity simulation to ensure the acquisition of technical capabilities and additional socioemotional skills. Recognizing and managing emotions is necessary to provide adequate care for users of health care services and for the increased effectiveness of professionals. Trial Registration: Open Science Framework p4ays; https://osf.io/p4ays International Registered Report Identifier (IRRID): PRR1-10.2196/56436 %M 39158944 %R 10.2196/56436 %U https://www.researchprotocols.org/2024/1/e56436 %U https://doi.org/10.2196/56436 %U http://www.ncbi.nlm.nih.gov/pubmed/39158944 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e50980 %T An Ontology-Based Decision Support System for Tailored Clinical Nutrition Recommendations for Patients With Chronic Obstructive Pulmonary Disease: Development and Acceptability Study %A Spoladore,Daniele %A Colombo,Vera %A Fumagalli,Alessia %A Tosi,Martina %A Lorenzini,Erna Cecilia %A Sacco,Marco %+ Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing, National Research Council of Italy, Via G. Previati 1E, Lecco, 23900, Italy, 39 03412350202, daniele.spoladore@stiima.cnr.it %K ontology-based decision support system %K nutritional recommendation %K chronic obstructive pulmonary disease %K clinical decision support system %K pulmonary rehabilitation %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Med Inform %G English %X Background: Chronic obstructive pulmonary disease (COPD) is a chronic condition among the main causes of morbidity and mortality worldwide, representing a burden on health care systems. Scientific literature highlights that nutrition is pivotal in respiratory inflammatory processes connected to COPD, including exacerbations. Patients with COPD have an increased risk of developing nutrition-related comorbidities, such as diabetes, cardiovascular diseases, and malnutrition. Moreover, these patients often manifest sarcopenia and cachexia. Therefore, an adequate nutritional assessment and therapy are essential to help individuals with COPD in managing the progress of the disease. However, the role of nutrition in pulmonary rehabilitation (PR) programs is often underestimated due to a lack of resources and dedicated services, mostly because pneumologists may lack the specialized training for such a discipline. Objective: This work proposes a novel knowledge-based decision support system to support pneumologists in considering nutritional aspects in PR. The system provides clinicians with patient-tailored dietary recommendations leveraging expert knowledge. Methods: The expert knowledge—acquired from experts and clinical literature—was formalized in domain ontologies and rules, which were developed leveraging the support of Italian clinicians with expertise in the rehabilitation of patients with COPD. Thus, by following an agile ontology engineering methodology, the relevant formal ontologies were developed to act as a backbone for an application targeted at pneumologists. The recommendations provided by the decision support system were validated by a group of nutrition experts, whereas the acceptability of such an application in the context of PR was evaluated by pneumologists. Results: A total of 7 dieticians (mean age 46.60, SD 13.35 years) were interviewed to assess their level of agreement with the decision support system’s recommendations by evaluating 5 patients’ health conditions. The preliminary results indicate that the system performed more than adequately (with an overall average score of 4.23, SD 0.52 out of 5 points), providing meaningful and safe recommendations in compliance with clinical practice. With regard to the acceptability of the system by lung specialists (mean age 44.71, SD 11.94 years), the usefulness and relevance of the proposed solution were extremely positive—the scores on each of the perceived usefulness subscales of the technology acceptance model 3 were 4.86 (SD 0.38) out of 5 points, whereas the score on the intention to use subscale was 4.14 (SD 0.38) out of 5 points. Conclusions: Although designed for the Italian clinical context, the proposed system can be adapted for any other national clinical context by modifying the domain ontologies, thus providing a multidisciplinary approach to the management of patients with COPD. %M 38922666 %R 10.2196/50980 %U https://medinform.jmir.org/2024/1/e50980 %U https://doi.org/10.2196/50980 %U http://www.ncbi.nlm.nih.gov/pubmed/38922666 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55571 %T Alarm Management in Intensive Care: Qualitative Triangulation Study %A Mosch,Lina %A Sümer,Meltem %A Flint,Anne Rike %A Feufel,Markus %A Balzer,Felix %A Mörike,Frauke %A Poncette,Akira-Sebastian %+ Institute of Medical Informatics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30450581 016, lina.mosch@charite.de %K digital health %K transdisciplinary research %K technological innovation %K patient-centered care %K qualitative %K ethnographic %K ethnography %K intensive care unit %K ICU %K intensive care %K German %K Germany %K Europe %K European %K interview %K interviews %K alarm %K alarms %K intelligent %K artificial intelligence %K grounded theory %K experience %K experiences %K attitude %K attitudes %K opinion %K opinions %K perception %K perceptions %K perspective %K perspectives %D 2024 %7 18.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The high number of unnecessary alarms in intensive care settings leads to alarm fatigue among staff and threatens patient safety. To develop and implement effective and sustainable solutions for alarm management in intensive care units (ICUs), an understanding of staff interactions with the patient monitoring system and alarm management practices is essential. Objective: This study investigated the interaction of nurses and physicians with the patient monitoring system, their perceptions of alarm management, and smart alarm management solutions. Methods: This explorative qualitative study with an ethnographic, multimethods approach was conducted in an ICU of a German university hospital. Using triangulation in data collection, 102 hours of field observations, 12 semistructured interviews with ICU staff members, and the results of a participatory task were analyzed. The data analysis followed an inductive, grounded theory approach. Results: Nurses and physicians reported interacting with the continuous vital sign monitoring system for most of their work time and tasks. There were no established standards for alarm management; instead, nurses and physicians stated that alarms were addressed through ad hoc reactions, a practice they viewed as problematic. Staff members’ perceptions of intelligent alarm management varied, but they highlighted the importance of understandable and traceable suggestions to increase trust and cognitive ease. Conclusions: Staff members’ interactions with the omnipresent patient monitoring system and its alarms are essential parts of ICU workflows and clinical decision-making. Alarm management standards and workflows have been shown to be deficient. Our observations, as well as staff feedback, suggest that changes are warranted. Solutions for alarm management should be designed and implemented with users, workflows, and real-world data at the core. %M 38888941 %R 10.2196/55571 %U https://humanfactors.jmir.org/2024/1/e55571 %U https://doi.org/10.2196/55571 %U http://www.ncbi.nlm.nih.gov/pubmed/38888941 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49450 %T Investigating Health and Well-Being Challenges Faced by an Aging Workforce in the Construction and Nursing Industries: Computational Linguistic Analysis of Twitter Data %A Li,Weicong %A Tang,Liyaning Maggie %A Montayre,Jed %A Harris,Celia B %A West,Sancia %A Antoniou,Mark %+ The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Locked Bag 1797, Penrith, 2751, Australia, 61 61 2 97726673, m.antoniou@westernsydney.edu.au %K social media %K construction %K nursing %K aging %K health and well-being %K Twitter %D 2024 %7 5.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Construction and nursing are critical industries. Although both careers involve physically and mentally demanding work, the risks to workers during the COVID-19 pandemic are not well understood. Nurses (both younger and older) are more likely to experience the ill effects of burnout and stress than construction workers, likely due to accelerated work demands and increased pressure on nurses during the COVID-19 pandemic. In this study, we analyzed a large social media data set using advanced natural language processing techniques to explore indicators of the mental status of workers across both industries before and during the COVID-19 pandemic. Objective: This social media analysis aims to fill a knowledge gap by comparing the tweets of younger and older construction workers and nurses to obtain insights into any potential risks to their mental health due to work health and safety issues. Methods: We analyzed 1,505,638 tweets published on Twitter (subsequently rebranded as X) by younger and older (aged <45 vs >45 years) construction workers and nurses. The study period spanned 54 months, from January 2018 to June 2022, which equates to approximately 27 months before and 27 months after the World Health Organization declared COVID-19 a global pandemic on March 11, 2020. The tweets were analyzed using big data analytics and computational linguistic analyses. Results: Text analyses revealed that nurses made greater use of hashtags and keywords (both monograms and bigrams) associated with burnout, health issues, and mental health compared to construction workers. The COVID-19 pandemic had a pronounced effect on nurses’ tweets, and this was especially noticeable in younger nurses. Tweets about health and well-being contained more first-person singular pronouns and affect words, and health-related tweets contained more affect words. Sentiment analyses revealed that, overall, nurses had a higher proportion of positive sentiment in their tweets than construction workers. However, this changed markedly during the COVID-19 pandemic. Since early 2020, sentiment switched, and negative sentiment dominated the tweets of nurses. No such crossover was observed in the tweets of construction workers. Conclusions: The social media analysis revealed that younger nurses had language use patterns consistent with someone experiencing the ill effects of burnout and stress. Older construction workers had more negative sentiments than younger workers, who were more focused on communicating about social and recreational activities rather than work matters. More broadly, these findings demonstrate the utility of large data sets enabled by social media to understand the well-being of target populations, especially during times of rapid societal change. %M 38838308 %R 10.2196/49450 %U https://www.jmir.org/2024/1/e49450 %U https://doi.org/10.2196/49450 %U http://www.ncbi.nlm.nih.gov/pubmed/38838308 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53255 %T Family Involvement in the Care of Hospitalized Older Adults: Protocol for a Qualitative Evidence Synthesis %A Vick,Judith B %A Golden,Blair P %A Cantrell,Sarah %A Harris-Gersten,Melissa Louise %A Selmanoff,Mollie R %A Hastings,Susan Nicole %A Oyesanya,Tolu O %A Goldstein,Karen M %A Van Houtven,Courtney %+ Durham VA Health Care System, 701 W. Main Street, Durham, NC, 27701, United States, 1 410 236 0650, judith.vick@duke.edu %K systematic review %K family %K patient participation %K hospital medicine %K aged %K geriatrics %K qualitative research %D 2024 %7 10.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older adults are frequently hospitalized. Family involvement during these hospitalizations is incompletely characterized in the literature. Objective: This study aimed to better understand how families are involved in the care of hospitalized older adults and develop a conceptual model describing the phenomenon of family involvement in the care of hospitalized older adults. Methods: We describe the protocol of a qualitative evidence synthesis (QES), a systematic review of qualitative studies. We chose to focus on qualitative studies given the complexity and multifaceted nature of family involvement in care, a type of topic best understood through qualitative inquiry. The protocol describes our process of developing a research question and eligibility criteria for inclusion in our QES based on the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) tool. It describes the development of our search strategy, which was used to search MEDLINE (via Ovid), Embase (via Elsevier), PsycINFO (via Ovid), and CINAHL Complete (via EBSCO). Title and abstract screening and full-text screening will occur sequentially. Purposive sampling may be used depending on the volume of studies identified as eligible for inclusion during our screening process. Descriptive data regarding included individual studies will be extracted and summarized in tables. The results from included studies will be synthesized using qualitative methods and used to develop a conceptual model. The conceptual model will be presented to community members via engagement panels for further refinement. Results: As of September 2023, we have assembled a multidisciplinary team including physicians, nurses, health services researchers, a librarian, a social worker, and a health economist. We have finalized our search strategy and executed the search, yielding 8862 total citations. We are currently screening titles and abstracts and anticipate that full-text screening, data extraction, quality appraisal, and synthesis will be completed by summer of 2024. Conceptual model development will then take place with community engagement panels. We anticipate submitting our manuscript for publication in the fall of 2024. Conclusions: This paper describes the protocol for a QES of family involvement in the care of hospitalized older adults. We will use identified themes to create a conceptual model to inform further intervention development and policy change. Trial Registration: PROSPERO 465617; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023465617 International Registered Report Identifier (IRRID): PRR1-10.2196/53255 %M 38457771 %R 10.2196/53255 %U https://www.researchprotocols.org/2024/1/e53255 %U https://doi.org/10.2196/53255 %U http://www.ncbi.nlm.nih.gov/pubmed/38457771 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e50297 %T Nursing Students’ Attitudes Toward Technology: Multicenter Cross-Sectional Study %A Dallora,Ana Luiza %A Andersson,Ewa Kazimiera %A Gregory Palm,Bruna %A Bohman,Doris %A Björling,Gunilla %A Marcinowicz,Ludmiła %A Stjernberg,Louise %A Anderberg,Peter %+ Department of Health, Blekinge Institute of Technology, Valhallavägen 1, Karlskrona, 371 41, Sweden, 46 073 422 3667, ana.luiza.moraes@bth.se %K nursing education %K technophilia %K eHealth %K technology anxiety %K technology enthusiasm %K mobile phone %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: The growing presence of digital technologies in health care requires the health workforce to have proficiency in subjects such as informatics. This has implications in the education of nursing students, as their preparedness to use these technologies in clinical situations is something that course administrators need to consider. Thus, students’ attitudes toward technology could be investigated to assess their needs regarding this proficiency. Objective: This study aims to investigate attitudes (enthusiasm and anxiety) toward technology among nursing students and to identify factors associated with those attitudes. Methods: Nursing students at 2 universities in Sweden and 1 university in Poland were invited to answer a questionnaire. Data about attitudes (anxiety and enthusiasm) toward technology, eHealth literacy, electronic device skills, and frequency of using electronic devices and sociodemographic data were collected. Descriptive statistics were used to characterize the data. The Spearman rank correlation coefficient and Mann-Whitney U test were used for statistical inferences. Results: In total, 646 students answered the questionnaire—342 (52.9%) from the Swedish sites and 304 (47.1%) from the Polish site. It was observed that the students’ technology enthusiasm (techEnthusiasm) was on the higher end of the Technophilia instrument (score range 1-5): 3.83 (SD 0.90), 3.62 (SD 0.94), and 4.04 (SD 0.78) for the whole sample, Swedish students, and Polish students, respectively. Technology anxiety (techAnxiety) was on the midrange of the Technophilia instrument: 2.48 (SD 0.96), 2.37 (SD 1), and 2.60 (SD 0.89) for the whole sample, Swedish students, and Polish students, respectively. Regarding techEnthusiasm among the nursing students, a negative correlation with age was found for the Swedish sample (P<.001; ρSwedish=−0.201) who were generally older than the Polish sample, and positive correlations with the eHealth Literacy Scale score (P<.001; ρall=0.265; ρSwedish=0.190; ρPolish=0.352) and with the perceived skill in using computer devices (P<.001; ρall=0.360; ρSwedish=0.341; ρPolish=0.309) were found for the Swedish, Polish, and total samples. Regarding techAnxiety among the nursing students, a positive correlation with age was found in the Swedish sample (P<.001; ρSwedish=0.184), and negative correlations with eHealth Literacy Scale score (P<.001; ρall=−0.196; ρSwedish=−0.262; ρPolish=−0.133) and with the perceived skill in using computer devices (P<.001; ρall=−0.209; ρSwedish=−0.347; ρPolish=−0.134) were found for the Swedish, Polish, and total samples and with the semester only for the Swedish sample (P<.001; ρSwedish=−0.124). Gender differences were found regarding techAnxiety in the Swedish sample, with women exhibiting a higher mean score than men (2.451, SD 1.014 and 1.987, SD 0.854, respectively). Conclusions: This study highlights nursing students’ techEnthusiasm and techAnxiety, emphasizing correlations with various factors. With health care’s increasing reliance on technology, integrating health technology–related topics into education is crucial for future professionals to address health care challenges effectively. International Registered Report Identifier (IRRID): RR2-10.2196/14643 %M 38683660 %R 10.2196/50297 %U https://mededu.jmir.org/2024/1/e50297 %U https://doi.org/10.2196/50297 %U http://www.ncbi.nlm.nih.gov/pubmed/38683660 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56262 %T TAILR (Nursing-Sensitive Events and Their Association With Individual Nurse Staffing Levels) Project: Protocol for an International Longitudinal Multicenter Study %A Bachnick,Stefanie %A Unbeck,Maria %A Ahmadi Shad,Maryam %A Falta,Katja %A Grossmann,Nicole %A Holle,Daniela %A Bartakova,Jana %A Musy,Sarah N %A Hellberg,Sarah %A Dillner,Pernilla %A Atoof,Fatemeh %A Khorasanizadeh,Mohammadhossein %A Kelly-Pettersson,Paula %A Simon,Michael %+ Department of Nursing Science, University of Applied Sciences, Gesundheitscampus 6 – 8, Bochum, 44801, Germany, 49 234 77727 748, stefanie.bachnick@hs-gesundheit.de %K adverse events %K electronic health record %K hospital care %K no-harm incidents %K nursing care %K nursing-sensitive events %K nurse staffing %K patient safety %K systematic record review %D 2024 %7 22.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Nursing-sensitive events (NSEs) are common, accounting for up to 77% of adverse events in hospitalized patients (eg, fall-related harm, pressure ulcers, and health care–associated infections). NSEs lead to adverse patient outcomes and impose an economic burden on hospitals due to increased medical costs through a prolonged hospital stay and additional medical procedures. To reduce NSEs and ensure high-quality nursing care, appropriate nurse staffing levels are needed. Although the link between nurse staffing and NSEs has been described in many studies, appropriate nurse staffing levels are lacking. Existing studies describe constant staffing exposure at the unit or hospital level without assessing patient-level exposure to nurse staffing during the hospital stay. Few studies have assessed nurse staffing and patient outcomes using a single-center longitudinal design, with limited generalizability. There is a need for multicenter longitudinal studies with improved potential for generalizing the association between individual nurse staffing levels and NSEs. Objective: This study aimed (1) to determine the prevalence, preventability, type, and severity of NSEs; (2) to describe individual patient-level nurse staffing exposure across hospitals; (3) to assess the effect of nurse staffing on NSEs in patients; and (4) to identify thresholds of safe nurse staffing levels and test them against NSEs in hospitalized patients. Methods: This international multicenter study uses a longitudinal and observational research design; it involves 4 countries (Switzerland, Sweden, Germany, and Iran), with participation from 14 hospitals and 61 medical, surgery, and mixed units. The 16-week observation period will collect NSEs using systematic retrospective record reviews. A total of 3680 patient admissions will be reviewed, with 60 randomly selected admissions per unit. To be included, patients must have been hospitalized for at least 48 hours. Nurse staffing data (ie, the number of nurses and their education level) will be collected daily for each shift to assess the association between NSEs and individual nurse staffing levels. Additionally, hospital data (ie, type, teaching status, and ownership) and unit data (ie, service line and number of beds) will be collected. Results: As of January 2024, the verification process for the plausibility and comprehensibility of patients’ and nurse staffing data is underway across all 4 countries. Data analyses are planned to be completed by spring 2024, with the first results expected to be published in late 2024. Conclusions: This study will provide comprehensive information on NSEs, including their prevalence, preventability, type, and severity, across countries. Moreover, it seeks to enhance understanding of NSE mechanisms and the potential impact of nurse staffing on these events. We will evaluate within- and between-hospital variability to identify productive strategies to ensure safe nurse staffing levels, thereby reducing NSEs in hospitalized patients. The TAILR (Nursing-Sensitive Events and Their Association With Individual Nurse Staffing Levels) study will focus on the optimization of scarce staffing resources. International Registered Report Identifier (IRRID): DERR1-10.2196/56262 %M 38648083 %R 10.2196/56262 %U https://www.researchprotocols.org/2024/1/e56262 %U https://doi.org/10.2196/56262 %U http://www.ncbi.nlm.nih.gov/pubmed/38648083 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 7 %N %P e51720 %T Sentiment Analysis of Patient- and Family-Related Sepsis Events: Exploratory Study %A Ntiamoah,Mabel %A Xavier,Teenu %A Lambert,Joshua %+ University of Cincinnati, 3110 Vine St, Cincinnati, OH, 45221, United States, 1 (513) 558 5500, joshua.lambert@uc.edu %K families %K patients %K sentiment analysis %K sepsis %D 2024 %7 1.4.2024 %9 Original Paper %J JMIR Nursing %G English %X Background: Despite the life-threatening nature of sepsis, little is known about the emotional experiences of patients and their families during sepsis events. We conducted a sentiment analysis pertaining to sepsis incidents involving patients and families, leveraging textual data retrieved from a publicly available blog post disseminated by the Centers for Disease Control and Prevention (CDC). Objective: This investigation involved a sentiment analysis of patient- and family-related sepsis events, leveraging text responses sourced from a publicly accessible blog post disseminated by the CDC. Driven by the imperative to elucidate the emotional dynamics encountered by patients and their families throughout sepsis incidents, the overarching aims centered on elucidating the emotional ramifications of sepsis on both patients and their families and discerning potential avenues for enhancing the quality of sepsis care. Methods: The research used a cross-sectional data mining methodology to investigate the sentiments and emotional aspects linked to sepsis, using a data set sourced from the CDC, which encompasses 170 responses from both patients and caregivers, spanning the period between September 2014 and September 2020. This investigation used the National Research Council Canada Emotion Lexicon for sentiment analysis, coupled with a combination of manual and automated techniques to extract salient features from textual responses. The study used negative binomial least absolute shrinkage and selection operator regressions to ascertain significant textual features that correlated with specific emotional states. Moreover, the visualization of Plutchik’s Wheel of Emotions facilitated the discernment of prevailing emotions within the data set. Results: The results showed that patients and their families experienced a range of emotions during sepsis events, including fear, anxiety, sadness, and gratitude. Our analyses revealed an estimated incidence rate ratio (IRR) of 1.35 for fear-related words and a 1.51 IRR for sadness-related words when mentioning “hospital” in sepsis-related experiences. Similarly, mentions of “intensive care unit” were associated with an average occurrence of 12.3 fear-related words and 10.8 sadness-related words. Surviving patients’ experiences had an estimated 1.15 IRR for joy-related words, contrasting with discussions around organ failure, which were associated with multiple negative emotions including disgust, anger, fear, and sadness. Furthermore, mentions of “death” were linked to more fear and anger words but fewer joy-related words. Conversely, longer timelines in sepsis events were associated with more joy-related words and fewer fear-related words, potentially indicating improved emotional adaptation over time. Conclusions: The study’s outcomes underscore the imperative for health care providers to integrate emotional support alongside medical interventions for patients and families affected by sepsis, emphasizing the emotional toll incurred and highlighting the necessity of acknowledgment and resolution, advocating for the use of sentiment analysis as a means to tailor personalized emotional aid, and thereby potentially augmenting both patient and family welfare and overall outcomes. %M 38557694 %R 10.2196/51720 %U https://nursing.jmir.org/2024/1/e51720 %U https://doi.org/10.2196/51720 %U http://www.ncbi.nlm.nih.gov/pubmed/38557694 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e51084 %T Development of a Core Outcome Set for Family and Community Nursing: Protocol for a Delphi Study %A Russo,Sara %A Caruso,Rosario %A Conte,Gianluca %A Magon,Arianna %A Vangone,Ida %A Bascape',Barbara %A Maga,Giulia %A Pasek,Malgorzata %A Arrigoni,Cristina %+ Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome, 00133, Italy, 39 0382433709, sara.russo@grupposandonato.it %K clinical knowledge %K core outcomes set %K Delphi survey %K family and community nurse %K health interventions %K health promotion %K primary care %K stakeholder engagement %D 2024 %7 29.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Family and community nurses (FCNs) play a crucial role in delivering primary care to patients within their homes and communities. A key aspect of their role involves various health interventions, which are influenced by their unique competencies, such as health promotion, advanced clinical knowledge, and strong interpersonal skills. However, it is essential to understand which specific health outcomes these interventions impact to better understand the relationship between FCNs’ skills and the health results. Objective: This study aims to outline the steps we will take to develop a set of core outcomes. These outcomes will be particularly sensitive to the health interventions carried out by FCNs, providing a clearer picture of their practice’s impact. Methods: A Delphi survey will be used for this research, conducted from January to December 2024. The process will involve 5 steps and input from 3 stakeholder categories. These stakeholders will help identify a preliminary list of outcomes that will form the basis of our core outcome set (COS). Results: This guideline will be beneficial for a wide range of stakeholders involved in COS development, including COS developers, trialists, systematic reviewers, journal editors, policy makers, and patient groups. As of January 2024, we have successfully completed the first stage of the study, with the stakeholder group approving the reported outcomes and assigning participant lists for each stakeholder group. Conclusions: This study will provide a roadmap for identifying the key health outcomes influenced by the interventions of FCNs. The multistakeholder, multiphase approach will ensure a comprehensive and inclusive process. Ultimately, the findings will enhance our understanding of FCNs’ impact on health outcomes, leading to more effective primary care strategies and policies. International Registered Report Identifier (IRRID): PRR1-10.2196/51084 %M 38551623 %R 10.2196/51084 %U https://www.researchprotocols.org/2024/1/e51084 %U https://doi.org/10.2196/51084 %U http://www.ncbi.nlm.nih.gov/pubmed/38551623 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50518 %T Agendas on Nursing in South Korea Media: Natural Language Processing and Network Analysis of News From 2005 to 2022 %A Park,Daemin %A Kim,Dasom %A Park,Ah-hyun %+ Home Visit Healthcare Team, Expert Group on Health Promotion for Seoul Metropolitan Government, #410, Life Science Building.Annex, 120, Neungdong-ro, Gwangjin-gu, Seoul, 05029, Republic of Korea, 82 1072040418, dudurdaram@naver.com %K nurses %K news %K South Korea %K natural language processing %K NLP %K network analysis %K politicization %D 2024 %7 19.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, Korean society has increasingly recognized the importance of nurses in the context of population aging and infectious disease control. However, nurses still face difficulties with regard to policy activities that are aimed at improving the nursing workforce structure and working environment. Media coverage plays an important role in public awareness of a particular issue and can be an important strategy in policy activities. Objective: This study analyzed data from 18 years of news coverage on nursing-related issues. The focus of this study was to examine the drivers of the social, local, economic, and political agendas that were emphasized in the media by the analysis of main sources and their quotes. This analysis revealed which nursing media agendas were emphasized (eg, social aspects), neglected (eg, policy aspects), and negotiated. Methods: Descriptive analysis, natural language processing, and semantic network analysis were applied to analyze data collected from 2005 to 2022. BigKinds were used for the collection of data, automatic multi-categorization of news, named entity recognition of news sources, and extraction and topic modeling of quotes. The main news sources were identified by conducting a 1-mode network analysis with SNAnalyzer. The main agendas of nursing-related news coverage were examined through the qualitative analysis of major sources’ quotes by section. The common and individual interests of the top-ranked sources were analyzed through a 2-mode network analysis using UCINET. Results: In total, 128,339 articles from 54 media outlets on nursing-related issues were analyzed. Descriptive analysis showed that nursing-related news was mainly covered in social (99,868/128,339, 77.82%) and local (48,056/128,339, 48.56%) sections, whereas it was rarely covered in economic (9439/128,339, 7.35%) and political (7301/128,339, 5.69%) sections. Furthermore, 445 sources that had made the top 20 list at least once by year and section were analyzed. Other than “nurse,” the main sources for each section were “labor union,” “local resident,” “government,” and “Moon Jae-in.” “Nursing Bill” emerged as a common interest among nurses and doctors, although the topic did not garner considerable attention from the Ministry of Health and Welfare. Analyzing quotes showed that nurses were portrayed as heroes, laborers, survivors of abuse, and perpetrators. The economic section focused on employment of youth and women in nursing. In the political section, conflicts between nurses and doctors, which may have caused policy confusion, were highlighted. Policy formulation processes were not adequately reported. Media coverage of the enactment of nursing laws tended to relate to confrontations between political parties. Conclusions: The media plays a crucial role in highlighting various aspects of nursing practice. However, policy formulation processes to solve nursing issues were not adequately reported in South Korea. This study suggests that nurses should secure policy compliance by persuading the public to understand their professional perspectives. %M 38393293 %R 10.2196/50518 %U https://www.jmir.org/2024/1/e50518 %U https://doi.org/10.2196/50518 %U http://www.ncbi.nlm.nih.gov/pubmed/38393293 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51569 %T Investigating the Feasibility of Using a Wearable Device to Measure Physiologic Health Data in Emergency Nurses and Residents: Observational Cohort Study %A Agarwal,Anish K %A Gonzales,Rachel %A Scott,Kevin %A Merchant,Raina %+ Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 410 Blockley Hall, Philadelphia, PA, 19104, United States, 1 2157465610, anish.agarwal@pennmedicine.upenn.edu %K digital health %K emergency medicine training %K wearable devices %K burnout %K mobile health %K feasibility %K wearable device %K wearable %K physiologic health data %K nurse %K resident %K emergency department %K acceptability %K well-being %D 2024 %7 22.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Emergency departments play a pivotal role in the US health care system, with high use rates and inherent stress placed on patients, patient care, and clinicians. The impact of the emergency department environment on the health and well-being of emergency residents and nurses can be seen in worsening rates of burnout and cardiovascular health. Research on clinician health has historically been completed outside of clinical areas and not personalized to the individual. The expansion of digital technology, specifically wearable devices, may enhance the ability to understand how health care environments impact clinicians. Objective: The primary objective of this pilot study was to assess the feasibility and acceptability of using wearable devices to measure and record physiologic data from emergency nurses and resident physicians. Understanding strategies that are accepted and used by clinicians is critical prior to launching larger investigations aimed at improving outcomes. Methods: This was a longitudinal pilot study conducted at an academic, urban, level 1 trauma center. A total of 20 participants, including emergency medicine resident physicians and nurses, were equipped with a wearable device (WHOOP band) and access to a mobile health platform for 6 weeks. Baseline surveys assessed burnout, mental health, and expectations of the device and experience. Participants provided open-ended feedback on the device and platform, contributing to the assessment of acceptance, adoption, and use of the wearable device. Secondary measures explored early signs and variations in heart rate variability, sleep, recovery, burnout, and mental health assessments. Results: Of the 20 participants, 10 consistently used the wearable device. Feedback highlighted varying experiences with the device, with a preference for more common wearables like the Apple Watch or Fitbit. Resident physicians demonstrated higher engagement with the device and platform as compared with nurses. Baseline mental health assessments indicated mild anxiety and depressive symptoms among participants. The Professional Fulfillment Index revealed low professional fulfillment, moderate workplace exhaustion, and interpersonal disengagement. Conclusions: This pilot study underscores the potential of wearable devices in monitoring emergency clinicians’ physiologic data but reveals challenges related to device preferences and engagement. The key takeaway is the necessity to optimize device and platform design for clinician use. Larger, randomized trials are recommended to further explore and refine strategies for leveraging wearable technology to support the well-being of the emergency workforce. %M 38386373 %R 10.2196/51569 %U https://formative.jmir.org/2024/1/e51569 %U https://doi.org/10.2196/51569 %U http://www.ncbi.nlm.nih.gov/pubmed/38386373 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54681 %T Exploring Shared Implementation Leadership of Point of Care Nursing Leadership Teams on Inpatient Hospital Units: Protocol for a Collective Case Study %A Castiglione,Sonia Angela %A Lavoie-Tremblay,Mélanie %A Kilpatrick,Kelley %A Gifford,Wendy %A Semenic,Sonia Elizabeth %+ Ingram School of Nursing, McGill University, #1800, 680 Rue Sherbrooke O, Montreal, QC, H3A 2M7, Canada, 1 514 398 4144, sonia.castiglione@mcgill.ca %K case study %K evidence-based practices %K implementation leadership %K inpatient hospital units %K nursing leadership %K point of care %D 2024 %7 19.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Nursing leadership teams at the point of care (POC), consisting of both formal and informal leaders, are regularly called upon to support the implementation of evidence-based practices (EBPs) in hospital units. However, current conceptualizations of effective leadership for successful implementation typically focus on the behaviors of individual leaders in managerial roles. Little is known about how multiple nursing leaders in formal and informal roles share implementation leadership (IL), representing an important knowledge gap. Objective: This study aims to explore shared IL among formal and informal nursing leaders in inpatient hospital units. The central research question is as follows: How is IL shared among members of POC nursing leadership teams on inpatient hospital units? The subquestions are as follows: (1) What IL behaviors are enacted and shared by formal and informal leaders? (2) What social processes enable shared IL by formal and informal leaders? and (3) What factors influence shared IL in nursing leadership teams? Methods: We will use a collective case study approach to describe and generate an in-depth understanding of shared IL in nursing. We will select nursing leadership teams on 2 inpatient hospital units that have successfully implemented an EBP as instrumental cases. We will construct data through focus groups and individual interviews with key informants (leaders, unit staff, and senior nurse leaders), review of organizational documents, and researcher-generated field notes. We have developed a conceptual framework of shared IL to guide data analysis, which describes effective IL behaviors, formal and informal nursing leaders’ roles at the POC, and social processes generating shared leadership and influencing contextual factors. We will use the Framework Method to systematically generate data matrices from deductive and inductive thematic analysis of each case. We will then generate assertions about shared IL following a cross-case analysis. Results: The study protocol received research ethics approval (2022-8408) on February 24, 2022. Data collection began in June 2022, and we have recruited 2 inpatient hospital units and 25 participants. Data collection was completed in December 2023, and data analysis is ongoing. We anticipate findings to be published in a peer-reviewed journal by late 2024. Conclusions: The anticipated results will shed light on how multiple and diverse members of the POC nursing leadership team enact and share IL. This study addresses calls to advance knowledge in promoting effective implementation of EBPs to ensure high-quality health care delivery by further developing the concept of shared IL in a nursing context. We will identify strategies to strengthen shared IL in nursing leadership teams at the POC, informing future intervention studies. International Registered Report Identifier (IRRID): DERR1-10.2196/54681 %M 38373024 %R 10.2196/54681 %U https://www.researchprotocols.org/2024/1/e54681 %U https://doi.org/10.2196/54681 %U http://www.ncbi.nlm.nih.gov/pubmed/38373024 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50735 %T Evaluating the Appropriateness of Podcasts to Improve the Knowledge and Awareness of Selected Health Topics Among Undergraduate General Nursing Students: Protocol for an International Feasibility Study %A Denny,Alanna %A Curtin,Brian %A Taylor-Robinson,Simon %A Chirambo,Griphin Baxter %A Cilliers,Liezel %A Wu,Tsung-Shu Joseph %A O'Meara,Ciara %A Booth,Richard %A O'Donoghue,John %+ Imperial College London, Electrical Engineering, South Kensington Campus, London, SW7 2AZ, United Kingdom, 44 203 312 6199, s.taylor-robinson@imperial.ac.uk %K podcasting %K podcast %K nursing student %K gestational diabetes %K mental health %K health %K knowledge %D 2024 %7 6.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Podcasts have proven to be a successful alternative source of educational material for students. Given the ability to listen to podcasts 24/7 and while on the go, this technology has the potential to provide informative and educational material to a large number of people at any given time. Podcasts are usually freely available on commonly used mobile devices, such as smartphones, laptops, and tablets. Objective: This paper describes the impact of health-related podcasts as an intervention tool to support the knowledge and awareness of nursing students on a given topic. Methods: Pre- and postpodcast questionnaires will gather data regarding the participants’ knowledge and awareness of two topics—gestational diabetes and mental health. This intervention will be tested on general nursing undergraduate students. The total number of students (N=2395) from the participating universities are broken down as follows: (1) University College Cork (n=850) and the University of Galway (n=450) in Ireland, (2) Mzuzu University in Malawi (n=719), and (3) University of Fort Hare in South Africa (n=376). Results: The study received ethical approval from the University College Cork Ethics Committee (2022-027A1). The approval obtained from University College Cork sufficed as ethics coverage for the University of Galway in Ireland. Ethics approval was also received from the Mzuzu University Research Ethics Committee (ID MZUNIREC/DOR/23/28) and the Inter-Faculty Research Ethics Committee of the University of Fort Hare (ID CIL002-21). Data collection is currently underway and will continue until the end of February 2024. The quantitative and qualitative data are expected to be analyzed in March 2024. Conclusions: Results from this study will allow for an investigation into the impact of podcasts in different settings: a high-income country (Ireland), an upper-middle–income country (South Africa), and a low-to-middle–income country (Malawi). The data gathered from this feasibility study will provide more clarity on the potential utility of podcasts as an intervention tool. We will gather data regarding listener demographics (eg, country of residence, age, gender, and year of study). International Registered Report Identifier (IRRID): DERR1-10.2196/50735 %M 38319702 %R 10.2196/50735 %U https://www.researchprotocols.org/2024/1/e50735 %U https://doi.org/10.2196/50735 %U http://www.ncbi.nlm.nih.gov/pubmed/38319702 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54213 %T Model for Doctor of Nursing Practice Projects Based on Cross-Fertilization Between Improvement and Implementation Sciences: Protocol for Quality Improvement and Program Evaluation Studies %A Sowan,Azizeh %A Chinman,Matthew %+ School of Nursing, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 7975, United States, 1 210 567 5799, sowan@uthscsa.edu %K quality improvement %K implementation %K Doctor of Nursing Practice %K model %K methodology %K Nursing %K Doctor of Nursing %K hybrid approach %K implementation sciences %K scholarship %K scholars %K Nursing Practice Program %K nursing program %D 2024 %7 31.1.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Hundreds of nursing professionals graduate each year from Doctor of Nursing Practice (DNP) programs, entrusted with roles as practice scholars and leaders. Graduates are tasked to lead multidisciplinary knowledge implementation projects to improve safety, quality, and key performance metrics. Nevertheless, there is a continued lack of agreement and faculty dissatisfaction with the format, focus, and results of the DNP graduation projects. The use of a wide range of models and methodologies from different sciences for knowledge implementation introduces challenges to DNP students; affects the scientific rigor of the projects; and results in the overuse, superficial use, or misuse of the models. Quality improvement (QI) and program evaluation studies are substantial investments that may lead to waste and even harm if not well conducted. Traditional QI methodologies, commonly used in DNP projects, were found to be uncertain in improving health care outcomes. The complexity of health care systems calls for cross-fertilization between improvement and implementation sciences to improve health care outcomes. Objective: This study describes the development, implementation, and evaluation of a hybrid model for QI and program evaluation studies to guide scholarship in the DNP program. Methods: The hybrid model was based on cross-fertilization between improvement and implementation sciences. The model adapted the Getting to Outcome (GTO) and Knowledge to Action (KTA) models as the overarching process models for knowledge implementation. Within each phase of the GTO and KTA models, expected barriers and facilitators for the implementation and adoption of innovation were identified based on the CFIR (Consolidated Framework for Implementation Research). Accordingly, strategies to facilitate the implementation and adoption of innovations were identified based on a refined list of implementation strategies and QI tools. The choice of these models was based on the top 5 criteria for selecting implementation science theories and frameworks. Seven DNP students used the hybrid model to conduct QI projects. Students evaluated their experiences by responding to a Qualtrics survey. Results: The hybrid model encouraged a comprehensive systematic way of thinking, provided tools essential to implementation success, emphasized the need for adaptability in implementation, maintained rigor in QI, and guided the sustainability of change initiatives. Some of the challenges faced by students included finding reliable and valid measures, attaining and maintaining staff buy-in, and competing organizational priorities. Conclusions: Cross-fertilization between improvement and implementation sciences provided a roadmap and systematic thinking for successful QI projects in the DNP program. The integration of the CFIR with the GTO or KTA process models, enforced by the use of evidence-based implementation strategies and QI tools, reflected the complexity of health care systems and emphasized the need for adaptability in implementation. International Registered Report Identifier (IRRID): RR1-10.2196/54213 %M 38294860 %R 10.2196/54213 %U https://www.researchprotocols.org/2024/1/e54213 %U https://doi.org/10.2196/54213 %U http://www.ncbi.nlm.nih.gov/pubmed/38294860 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 8 %N %P e50703 %T Exploring Nursing Research Culture in Clinical Practice: Qualitative Ethnographic Study %A Hwang,Hyeyoung %A De Gagne,Jennie C %A Yoo,Leeho %A Lee,Miji %A Jo,Hye Kyung %A Kim,Ju-eun %+ College of Nursing, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea, 82 10 7259 9699, jueun.kimmm@gmail.com %K clinical nursing research %K ethnography %K evidence-based nursing %K nursing research %K qualitative research %D 2024 %7 9.1.2024 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: Cultivating a positive research culture is considered the key to facilitating the utilization of research findings. In the realm of clinical nursing research, nurses conducting research may find the utilization of findings challenging due to the lack of a positive research culture. Objective: This study aims to identify and describe the sociocultural context of nursing research in a clinical setting at a Korean tertiary hospital. Methods: We included participant observation and ethnographic interviews with 6 registered nurses working in a medical-surgical unit in a Korean tertiary hospital who had experience conducting nursing research in clinical settings in this qualitative ethnographic study. The study was conducted from April 2022 to May 2022. Data analysis was conducted using Spradley’s ethnographic approach, which includes domain analysis, taxonomic analysis, componential analysis, and theme analysis, and occurred concurrently with data collection. Results: The overarching theme identified for nursing research culture in clinical practice was the development of a driving force for growth within the clinical environment. This theme encompasses (1) balancing positive and negative influences in the research process, (2) fostering transformational change for both nurses and patients, and (3) promoting complementary communication among nurses. Conclusions: Clinical research plays a vital role in nursing practice that requires a balance of supportive elements, such as patient-driven research questions and hospital research support, with practical challenges such as shift work and high work intensity. This study found that a positive clinical nursing research culture can serve as a unifying bridge, connecting researchers, patients, who serve as both the origin and ultimate beneficiaries of research, and hospitals that facilitate research endeavors. Future research should explore whether the themes derived from this study fully reflect a clinical nursing research culture comprising patients, nurses, and the hospital environment and determine what requirements are needed to establish such a nursing research culture. %M 38194262 %R 10.2196/50703 %U https://apinj.jmir.org/2024/1/e50703 %U https://doi.org/10.2196/50703 %U http://www.ncbi.nlm.nih.gov/pubmed/38194262 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50626 %T Robotics in Nursing: Protocol for a Scoping Review %A Darko,Elizabeth Mirekuwaa %A Kleib,Manal %A Lemermeyer,Gillian %A Tavakoli,Mahdi %+ Faculty of Nursing, College of Health Sciences, University of Alberta, 4-171 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada, 1 7807826810, darko@ualberta.ca %K automation %K robots %K nursing %K nursing robots %K nursing robotic technologies %D 2023 %7 13.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, health care systems are challenged with the shortage of health care professionals, particularly nurses. The decline in the nursing workforce is primarily attributed to an aging population, increased demand for health care services, and a shortage of qualified nurses. Stressful working conditions have also increased the physical and emotional demands and perceptions of burnout, leading to attrition among nurses. Robotics has the potential to alleviate some of the workforce challenges by augmenting and supporting nurses in their roles; however, the impact of robotics on nurses is an understudied topic, and limited literature exists. Objective: We aim to understand the extent and type of evidence in relation to robotics integration in nursing practice. Methods: The Joanna Briggs Institute methodology and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist will guide the scoping review. The MEDLINE (Ovid), Embase (Ovid), CINAHL Plus with Full Text (EBSCOhost), Scopus, Cochrane Library, and IEEE Xplore electronic bibliographic databases will be searched to retrieve papers. In addition, gray literature sources, including Google Scholar, dissertations, theses, registries, blogs, and relevant organizational websites will be searched. Furthermore, the reference lists of included studies retrieved from the databases and the gray literature will be hand-searched to ensure relevant papers are not missed. In total, 2 reviewers will independently screen retrieve papers at each stage of the screening process and independently extract data from the included studies. A third reviewer will be consulted to help decision-making if conflicts arise. Data analysis will be completed using both descriptive statistics and content analysis. The results will be presented using tabular and narrative formats. Results: The review is expected to describe the current evidence on the integration and impact of robots and robotics into nursing clinical practice, provide insights into the current state and knowledge gaps, identify a direction for future research, and inform policy and practice. The authors expect to begin the data searches in late January 2024. Conclusions: The robotics industry is evolving rapidly, providing different solutions that promise to revamp health care delivery with possible improvements to nursing practice. This review protocol outlines the steps proposed to systematically investigate this topic and provides an opportunity for more insights from scholars and researchers working in the field. International Registered Report Identifier (IRRID): PRR1-10.2196/50626 %M 37955956 %R 10.2196/50626 %U https://www.researchprotocols.org/2023/1/e50626 %U https://doi.org/10.2196/50626 %U http://www.ncbi.nlm.nih.gov/pubmed/37955956 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48432 %T Clinical Utility Assessment of a Nursing Checklist Identifying Complex Care Needs Due to Inequities Among Ambulatory Patients With Cancer: Protocol for a Mixed Methods Study %A Chung,Holly %A Hyatt,Amelia %A Crone,Elizabeth %A Milne,Donna %A Aranda,Sanchia %A Gough,Karla %A Krishnasamy,Meinir %+ Academic Nursing Unit, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia, 61 0385597043, meinir.krishnasamy@petermac.org %K cancer %K oncology %K cancer nursing %K clinical utility %K nursing checklist %K social determinants of health %K equity %K cancer care %K disparity %K barrier %K checklist %K nursing %K nurse %K caregiver %K specialist nurse %K patient outcome %D 2023 %7 9.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Disparities in cancer incidence, complex care needs, and poor health outcomes are largely driven by structural inequities stemming from social determinants of health. To date, no evidence-based clinical tool has been developed to identify newly diagnosed patients at risk of poorer outcomes. Specialist cancer nurses are well-positioned to ameliorate inequity of opportunity for optimal care, treatment, and outcomes through timely screening, assessment, and intervention. We designed a nursing complexity checklist (the “Checklist”) to support these activities, with the ultimate goal of improving equitable experiences and outcomes of care. This study aims to generate evidence regarding the clinical utility of the Checklist. Objective: The primary objectives of this study are to provide qualitative evidence regarding key aspects of the Checklist’s clinical utility (appropriateness, acceptability, and practicability), informed by Smart’s multidimensional model of clinical utility. Secondary objectives explore the predictive value of the Checklist and concordance between specific checklist items and patient-reported outcome measures. Methods: This prospective mixed methods case series study will recruit up to 60 newly diagnosed patients with cancer and 10 specialist nurses from a specialist cancer center. Nurses will complete the Checklist with patient participants. Within 2 weeks of Checklist completion, patients will complete 5 patient-reported outcome measures with established psychometric properties that correspond to specific checklist items and an individual semistructured interview to explore Checklist clinical utility. Interviews with nurses will occur 12 and 24 weeks after they first complete a checklist, exploring perceptions of the Checklist’s clinical utility including barriers and facilitators to implementation. Data describing planned and unplanned patient service use will be collected from patient follow-up interviews at 12 weeks and the electronic medical record at 24 weeks after Checklist completion. Descriptive statistics will summarize operational, checklist, and electronic medical record data. The predictive value of the Checklist and the relationship between specific checklist items and relevant patient-reported outcome measures will be examined using descriptive statistics, contingency tables, measures of association, and plots as appropriate. Qualitative data will be analyzed using a content analysis approach. Results: This study was approved by the institution’s ethics committee. The enrollment period commenced in May 2022 and ended in November 2022. In total, 37 patients with cancer and 7 specialist cancer nurses were recruited at this time. Data collection is scheduled for completion at the end of May 2023. Conclusions: This study will evaluate key clinical utility dimensions of a nursing complexity checklist. It will also provide preliminary evidence on its predictive value and information to support its seamless implementation into everyday practice including, but not limited to, possible revisions to the Checklist, instructions, and training for relevant personnel. Future implementation of this Checklist may improve equity of opportunity of access to care for patients with cancer. International Registered Report Identifier (IRRID): DERR1-10.2196/48432 %M 37943601 %R 10.2196/48432 %U https://www.researchprotocols.org/2023/1/e48432 %U https://doi.org/10.2196/48432 %U http://www.ncbi.nlm.nih.gov/pubmed/37943601 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45830 %T Factors Associated With Work Engagement of Nurses During the Fifth Wave of the COVID-19 Pandemic in Japan: Web-Based Cross-Sectional Study %A Muroi,Kei %A Ishitsuka,Mami %A Hachisuka,Tomoko %A Shibata,Itsuka %A Ikeda,Tomohiko %A Hori,Daisuke %A Doki,Shotaro %A Takahashi,Tsukasa %A Sasahara,Shin-ichiro %A Matsuzaki,Ichiyo %+ Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan, 81 (0)29 853 6025, s-sshara@md.tsukuba.ac.jp %K age %K COVID-19 %K cross-sectional study %K engagement %K experience %K gender %K intensive care %K Japan %K JD-R model %K job demands-resources %K mental health %K nurses %K psychiatric %K psychological %K survey %K work engagement %D 2023 %7 3.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has brought to light the prevalence of mental health issues among nurses. Work engagement (WE) is a concept that describes work-related positive psychological states and is of importance within mental health measures. There is, however, a lack of research on factors associated with the WE of nurses during the COVID-19 pandemic. Objective: We aimed to determine which factors are associated with WE among nurses during the COVID-19 pandemic using the job demands-resources (JD-R) model as a framework. Methods: A web-based cross-sectional survey was conducted among nurses working in acute care and psychiatric institutions in the prefectures of Chiba and Tokyo in Japan. The survey period occurred between August 8 and September 30, 2021, during a time when the number of patients with a positive COVID-19 infection increased. The 3-item version of the Utrecht Work Engagement Scale (UWES-3) was used to measure WE. Factors such as age, gender, years of experience, affiliated ward, COVID-19–related stress, financial rewards from the government and hospital, encouragement from the government and patients, and workplace social capital were assessed. A total of 187 participants were included in the final analysis. Multiple regression analysis was performed to examine the factors related to WE. Partial regression coefficients (B), 95% CI, and P values were calculated. Results: The mean overall score for the UWES-3 was 3.19 (SD 1.21). Factors negatively associated with UWES-3 were COVID-19–related stress on work motivation and escape behavior (Β –0.16, 95% CI –0.24 to –0.090; P<.001), and factors positively associated with UWES-3 were affiliation of intensive care units (Β 0.76, 95% CI 0.020-1.50; P=.045) and financial rewards from the government and hospital (Β 0.40, 95% CI 0.040-0.76; P=.03). Conclusions: This study examined factors related to WE among nurses during the COVID-19 pandemic using the JD-R model. When compared with findings from previous studies, our results suggest that nurses’ WE was lower than before the COVID-19 pandemic. Negative motivation and escape behaviors related to COVID-19 were negatively associated with WE, while there were positive associations with financial rewards from the government and hospital and affiliation with an intensive care unit. Further research into larger populations is needed to confirm these findings. %M 37921864 %R 10.2196/45830 %U https://formative.jmir.org/2023/1/e45830 %U https://doi.org/10.2196/45830 %U http://www.ncbi.nlm.nih.gov/pubmed/37921864 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36324 %T Use of the Smart Excretion Care System Linked to Electronic Medical Records to Alleviate Nursing Burden and Enhance Patient Convenience: Mixed Methods Study %A Moon,Hui-Woun %A Park,Da Som Me %A Jung,Se Young %+ Office of eHealth Research and Business, Seoul National University Bundang Hospital, 172 Dolma-ro, Bundang-gu, Seongnam-si, 13620, Republic of Korea, 82 31 787 0114, imsyjung@gmail.com %K care %K caregiving %K instrument development %K elderly %K quality of life %K ergonomics %K focus groups %K musculoskeletal %K usability %K feasibility %K digital health intervention %K digital health %K health intervention %K nursing %K electronic medical record %D 2023 %7 30.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The surge in older demographics has inevitably resulted in a heightened demand for health care, and a shortage of nursing staff is impending. Consequently, there is a growing demand for the development of nursing robots to assist patients with urinary and bowel elimination. However, no study has examined nurses’ opinions of smart devices that provide integrated nursing for patients’ urinary and bowel elimination needs. Objective: This study aimed to evaluate the feasibility of the Smart Excretion Care System tethered to electronic medical records in a tertiary hospital and community care setting and discuss the anticipated reductions in the burden of nursing care. Methods: Focus group interviews were conducted using the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. The interviews were conducted in March 2021 and involved 67 nurses who had worked at Seoul National University Bundang Hospital for more than 1 year and had experience in assisting patients with excretion care. Data were collected using purposive and snowball sampling methods. Results: A total of four themes relevant to the Smart Excretion Care System were found: (1) expected reductions in the burden of nursing care, (2) applicable indications (by departments and diseases), (3) preferred features/functions, and (4) expected benefits of using the Smart Excretion Care System in clinical facilities. Nurses from comprehensive nursing care wards had the highest burden when it came to excretion care. It was a common opinion that the Smart Excretion Care System would be very useful in intensive care units and should be applied first to patients with stroke or dementia. Conclusions: Excretion care is one of the most burdensome tasks for nurses, increasing their workload. The development of the Smart Excretion Care System as a digital health intervention could help improve nurses’ work efficiency, reduce their burden, and extend to caregivers and guardians. %M 37902820 %R 10.2196/36324 %U https://formative.jmir.org/2023/1/e36324 %U https://doi.org/10.2196/36324 %U http://www.ncbi.nlm.nih.gov/pubmed/37902820 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 6 %N %P e51303 %T Impact of an Electronic Medical Record–Connected Questionnaire on Efficient Nursing Documentation: Usability and Efficacy Study %A Kodama,Kana %A Konishi,Shozo %A Manabe,Shirou %A Okada,Katsuki %A Yamaguchi,Junji %A Wada,Shoya %A Sugimoto,Kento %A Itoh,Sakiko %A Takahashi,Daiyo %A Kawasaki,Ryo %A Matsumura,Yasushi %A Takeda,Toshihiro %+ Department of Medical Informatics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan, 81 6 6879 5900, konishi.shozo.med@osaka-u.ac.jp %K nursing system %K electronic questionnaire %K electronic medical record %K medical informatics %K EMR %K medical records %K EHR %K health record %K health records %K nursing %K documentation %K documenting %K usability %K self-reported %K patient data %K questionnaires %K data conversion %K nursing record %K nursing records %K data capture %K information system %K information systems %D 2023 %7 25.9.2023 %9 Original Paper %J JMIR Nursing %G English %X Background: Documentation tasks comprise a large percentage of nurses’ workloads. Nursing records were partially based on a report from the patient. However, it is not a verbatim transcription of the patient's complaints but a type of medical record. Therefore, to reduce the time spent on nursing documentation, it is necessary to assist in the appropriate conversion or citation of patient reports to professional records. However, few studies have been conducted on systems for capturing patient reports in electronic medical records. In addition, there have been no reports on whether such a system reduces the time spent on nursing documentation. Objective: This study aims to develop a patient self-reporting system that appropriately converts data to nursing records and evaluate its effect on reducing the documenting burden for nurses. Methods: An electronic medical record–connected questionnaire and a preadmission nursing questionnaire were administered. The questionnaire responses entered by the patients were quoted in the patient profile for inpatient assessment in the nursing system. To clarify its efficacy, this study examined whether the use of the electronic questionnaire system saved the nurses’ time entering the patient profile admitted between August and December 2022. It also surveyed the usability of the electronic questionnaire between April and December 2022. Results: A total of 3111 (78%) patients reported that they answered the electronic medical questionnaire by themselves. Of them, 2715 (88%) felt it was easy to use and 2604 (85%) were willing to use it again. The electronic questionnaire was used in 1326 of 2425 admission cases (use group). The input time for the patient profile was significantly shorter in the use group than in the no-use group (P<.001). Stratified analyses showed that in the internal medicine wards and in patients with dependent activities of daily living, nurses took 13%-18% (1.3 to 2 minutes) less time to enter patient profiles within the use group (both P<.001), even though there was no difference in the amount of information. By contrast, in the surgical wards and in the patients with independent activities of daily living, there was no difference in the time to entry (P=.50 and P=.20, respectively), but there was a greater amount of information in the use group. Conclusions: The study developed and implemented a system in which self-reported patient data were captured in the hospital information network and quoted in the nursing system. This system contributes to improving the efficiency of nurses’ task recordings. %M 37634203 %R 10.2196/51303 %U https://nursing.jmir.org/2023/1/e51303 %U https://doi.org/10.2196/51303 %U http://www.ncbi.nlm.nih.gov/pubmed/37634203 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49020 %T Wellness in Nursing Education to Promote Resilience and Reduce Burnout: Protocol for a Holistic Multidimensional Wellness Intervention and Longitudinal Research Study Design in Nursing Education %A Strout,Kelley %A Schwartz-Mette,Rebecca %A McNamara,Jade %A Parsons,Kayla %A Walsh,Dyan %A Bonnet,Jen %A O'Brien,Liam M %A Robinson,Kathryn %A Sibley,Sean %A Smith,Annie %A Sapp,Maile %A Sprague,Lydia %A Sabegh,Nima Sajedi %A Robinson,Kaitlin %A Henderson,Amanda %+ School of Nursing, University of Maine, Dunn Hall, Orono, ME, 04469, United States, 1 2075812601, kelley.strout@maine.edu %K nursing workforce %K academic performance %K burnout %K resilience %K wellness %K nursing %K education %K nursing education %K protocol %K nursing students %K students %K holistic %K implementation %K workforce %D 2023 %7 8.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The United States faces a nursing shortage driven by a burnout epidemic among nurses and nursing students. Nursing students are an integral population to fuel the nursing workforce at high risk of burnout and increased rates of perceived stress. Objective: The aim of this paper is to describe WellNurse, a holistic, interdisciplinary, multidimensional longitudinal research study that examines evidence-based interventions intended to reduce burnout and increase resilience among graduate and undergraduate nursing students. Methods: Graduate and undergraduate nursing students matriculated at a large public university in the northeastern United States are eligible to enroll in this ongoing, longitudinal cohort study beginning in March 2021. Participants complete a battery of health measurements twice each semester during the fourth week and the week before final examinations. The measures include the Perceived Stress Scale, the Satisfaction with Life Scale, the Oldenburg Burnout Inventory, the Brief Resilience Scale, and the Pittsburgh Sleep Quality Index. Participants are eligible to enroll in a variety of interventions, including mindfulness-based stress reduction, mindful eating, fitness training, and massage therapy. Those who enroll in specific, targeted interventions complete additional measures designed to target the aim of the intervention. All participants receive a free Fitbit device. Additional environmental changes are being implemented to further promote a culture that supports academic well-being, including recruiting a diverse student population through evidence-based holistic admissions, inclusive teaching design, targeted resilience and stress reduction workshops, and cultural shifts within classrooms and curricula. The study design protocol is registered at Open Science Framework DOI 10.17605/OSF.IO/NCBPE. Results: The project was funded on January 1, 2022. Data collection started in March 2022. A total of 267 participants have been recruited. Results will be published after each semester starting in December 2023. WellNurse evaluation follows the Rapid Cycle Quality Improvement framework to continuously monitor ongoing project processes, activity outcomes, and progress toward reducing burnout and increasing resilience. Rapid Cycle Quality Improvement promotes the ability to alter WellNurse interventions, examine multiple interventions, and test their effectiveness among the nursing education population to identify the most effective interventions. Conclusions: Academic nursing organizations must address student burnout risk and increase resilience to produce a future workforce that provides high-quality patient care to a diverse population. Findings from WellNurse will support evidence-based implementations for public baccalaureate and master’s nursing programs in the United States. International Registered Report Identifier (IRRID): DERR1-10.2196/49020 %R 10.2196/49020 %U https://www.researchprotocols.org/2023/1/e49020/ %U https://doi.org/10.2196/49020 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 6 %N %P e44435 %T Differing Effects of Implementation Leadership Characteristics on Nurses’ Use of mHealth Technologies in Clinical Practice: Cross-Sectional Survey Study %A Ronquillo,Charlene Esteban %A Dahinten,V Susan %A Bungay,Vicky %A Currie,Leanne M %+ School of Nursing, The University of British Columbia Okanagan, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada, 1 250 807 8332, charlene.ronquillo@ubc.ca %K mobile health %K mHealth applications %K nursing %K leadership %K implementation science %K nursing informatics %D 2023 %7 25.8.2023 %9 Original Paper %J JMIR Nursing %G English %X Background: Leadership has been consistently identified as an important factor in shaping the uptake and use of mobile health (mHealth) technologies in nursing; however, the nature and scope of leadership remain poorly delineated. This lack of detail about what leadership entails limits the practical actions that can be taken by leaders to optimize the implementation and use of mHealth technologies among nurses working clinically. Objective: This study aimed to examine the effects of first-level leaders’ implementation leadership characteristics on nurses’ intention to use and actual use of mHealth technologies in practice while controlling for nurses’ individual characteristics and the voluntariness of use, perceived usefulness, and perceived ease of use of mHealth technologies. Methods: A cross-sectional exploratory correlational survey study of registered nurses in Canada (n=288) was conducted between January 1, 2018, and June 30, 2018. Nurses were eligible to participate if they provided direct care in any setting and used employer-provided mHealth technologies in clinical practice. Hierarchical multiple regression analyses were conducted for the 2 outcome variables: intention to use and actual use. Results: The implementation leadership characteristics of first-level leaders influenced nurses’ intention to use and actual use of mHealth technologies, with 2 moderating effects found. The final model for intention to use included the interaction term for implementation leadership characteristics and education, explaining 47% of the variance in nurses’ intention to use mHealth in clinical practice (F10,228=20.14; P<.001). An examination of interaction plots found that implementation leadership characteristics had a greater influence on the intention to use mHealth technologies among nurses with a registered nurse diploma or a bachelor of nursing degree than among nurses with a graduate degree or other advanced education. For actual use, implementation leadership characteristics had a significant influence on the actual use of mHealth over and above the control variables (nurses’ demographic characteristics, previous experience with mHealth, and voluntariness) and other known predictors (perceived usefulness and perceived ease of use) in the model without the implementation leadership × age interaction term (β=.22; P=.001) and in the final model that included the implementation leadership × age interaction term (β=−.53; P=.03). The final model explained 40% of the variance in nurses’ actual use of mHealth in their work (F10,228=15.18; P<.001). An examination of interaction plots found that, for older nurses, implementation leadership characteristics had less of an influence on their actual use of mHealth technologies. Conclusions: Leaders responsible for the implementation of mHealth technologies need to assess and consider their implementation leadership behaviors because these play a role in influencing nurses’ use of mHealth technologies. The education level and age of nurses may be important factors to consider because different groups may require different approaches to optimize their use of mHealth technologies in clinical practice. %M 37624628 %R 10.2196/44435 %U https://nursing.jmir.org/2023/1/e44435 %U https://doi.org/10.2196/44435 %U http://www.ncbi.nlm.nih.gov/pubmed/37624628 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43692 %T Assessing the Well-Being at Work of Nurses and Doctors in Hospitals: Protocol for a Scoping Review of Monitoring Instruments %A Boskma,Amber %A van der Braak,Kim %A Ansari,Neda %A Hooft,Lotty %A Wietasch,Götz %A Franx,Arie %A van der Laan,Maarten %+ Department of Surgery, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713, Netherlands, 31 653561255, boskma@nfu.nl %K well-being at work %K well-being %K well being %K health care professionals %K doctors %K nurses %K monitoring %K assessment %K measure %K scale %K instruments %K scoping literature review %K occupational health %D 2023 %7 25.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Well-being at work can be defined as “creating an environment to promote a state of contentment which allows an employee to flourish and achieve their full potential for the benefit of themselves and their organisation.” In the health care context, well-being at work of nurses and doctors is important for good patient care. Moreover, it is strongly associated with individual- and organization-level consequences. Relevant literature presents models and concepts of physical, mental, and social well-being. This study uses the 6 elements of the job demands-resources (JD-R) model to interpret well-being at work (job demands, job resources, personal resources, leadership, well-being, and outcomes) as part of a Netherlands Federation of University Medical Hospitals program to find ways to improve and monitor health care professionals’ well-being in Dutch hospitals. Many instruments exist to measure well-being at work in terms of population, setting, and other aspects. An overview of available and eligible instruments assessing and monitoring the well-being of nurses and doctors is currently missing. Objective: We will perform a scoping review aiming to provide an overview of validated instruments assessing and monitoring the well-being of nurses and doctors at work. Methods: We will perform a search of published literature in the following databases: Medline, Embase, and CINAHL. Studies will be eligible if they (1) assess well-being at work of nurses and doctors employed in hospitals; (2) describe an evaluation of an instrument or review an instrument; (3) measure well-being at work or aspects of well-being at work according to the elements of the JD-R model, and (4) were published in English from 2011 onwards. Title/abstract screening according to the eligibility criteria will be followed by full-text screening. Data extraction of included studies will be conducted by 3 reviewers independently. Reviewers will use standardized data extraction forms that include study characteristics, sample characteristics, measurement instrument details, and psychometric properties. The analysis will be descriptive. When synthesizing the data, a distinction will be made between comprehensive instruments and common instruments. Results: This scoping review identifies instruments that have been developed and validated for monitoring the well-being of nurses and doctors at work. Studies were searched between September and December 2021 and screened between December 2021 and May 2022. A total of 739 studies were included. Conclusions: Timely screening of well-being at work may be beneficial for individual health care workers, the organization, and patients. There is often a substantial gap and mismatch between employer perceptions of well-being and well-being interventions. It is important to develop and implement suitable interventions adapted to the needs of nurses and doctors and their health or other problems. Well-being screening should be timely to gain insight into these needs and problems. Moreover, to determine the effectiveness of well-being interventions, measurement is mandatory. The results will be critical for organizations to select a monitoring instrument that best fits the needs of employees and organizations. International Registered Report Identifier (IRRID): DERR1-10.2196/43692 %M 37624632 %R 10.2196/43692 %U https://www.researchprotocols.org/2023/1/e43692 %U https://doi.org/10.2196/43692 %U http://www.ncbi.nlm.nih.gov/pubmed/37624632 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43258 %T A Nurse-Led Care Delivery App and Telehealth System for Patients Requiring Wound Care: Mixed Methods Implementation and Evaluation Study %A Brown-Johnson,Cati G %A Lessios,Anna Sophia %A Thomas,Samuel %A Kim,Mirini %A Fukaya,Eri %A Wu,Siqi %A Kling,Samantha M R %A Brown,Gretchen %A Winget,Marcy %+ Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, 3180 Porter Dr, Palo Alto, CA, 94304, United States, 1 650 736 3394, catibj@stanford.edu %K nursing %K telehealth %K telemedicine %K follow-up %K wound care %K capacity building %K mobile phone %D 2023 %7 23.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Innovative solutions to nursing care are needed to address nurse, health system, patient, and caregiver concerns related to nursing wellness, work flexibility and control, workforce retention and pipeline, and access to patient care. One innovative approach includes a novel health care delivery model enabling nurse-led, off-hours wound care (PocketRN) to triage emergent concerns and provide additional patient health education via telehealth. Objective: This pilot study aimed to evaluate the implementation of PocketRN from the perspective of nurses and patients. Methods: Patients and part-time or per-diem, wound care–certified and generalist nurses were recruited through the Stanford Medicine Advanced Wound Care Center in 2021 and 2022. Qualitative data included semistructured interviews with nurses and patients and clinical documentation review. Quantitative data included app use and brief end-of-interaction in-app satisfaction surveys. Results: This pilot study suggests that an app-based nursing care delivery model is acceptable, clinically appropriate, and feasible. Low technology literacy had a modest effect on initial patient adoption; this barrier was addressed with built-in outreach and by simplifying the patient experience (eg, via phone instead of video calls). This approach was acceptable for users, despite total patient enrollment and use numbers being lower than anticipated (N=49; 17/49, 35% of patients used the app at least once beyond the orientation call). We interviewed 10 patients: 7 who had used the app were satisfied with it and reported that real-time advice after hours reduced anxiety, and 3 who had not used the app after enrollment reported having other resources for health care advice and noted their perception that this tool was meant for urgent issues, which did not occur for them. Interviewed nurses (n=10) appreciated working from home, and they reported comfort with the scope of practice and added quality of care facilitated by video capabilities; there was interest in additional wound care–specific training for nonspecialized nurses. Nurses were able to provide direct patient care over the web, including the few participating nurses who were unable to perform in-person care (n=2). Conclusions: This evaluation provides insights into the integration of technology into standard health care services, such as in-clinic wound care. Using in-system nurses with access to electronic medical records and specialized knowledge facilitated app integration and continuity of care. This care delivery model satisfied nurse desires for flexible and remote work and reduced patient anxiety, potentially reducing postoperative wound care complications. Feasibility was negatively impacted by patients’ technology literacy and few language options; additional patient training, education, and language support are needed to support equitable access. Adoption was impacted by a lack of perceived need for additional care; lower-touch or higher-acuity settings with a longer wait between visits could be a better fit for this type of nurse-led care. %M 37610798 %R 10.2196/43258 %U https://formative.jmir.org/2023/1/e43258 %U https://doi.org/10.2196/43258 %U http://www.ncbi.nlm.nih.gov/pubmed/37610798 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e35790 %T Clinical and Economic Assessment of MyDiaCare, Digital Tools Combined With Diabetes Nurse Educator Support, for Managing Diabetes in South Africa: Observational Multicenter, Retrospective Study Associated With a Budget Impact Model %A Makan,Hemant %A Makan,Lindie %A Lubbe,Jacqueline %A Alami,Sarah %A Lancman,Guila %A Schaller,Manuella %A Delval,Cécile %A Kok,Adri %+ Centre for Diabetes, 80 Gemsbok Avenue, Lenasia, Johannesburg, 1827, South Africa, 27 011 852 4397, h.makan@megaweb.co.za %K diabetes mellitus %K diabetes nurse educator %K digital tool %K MyDiaCare program %K type 2 %D 2023 %7 7.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In South Africa, diabetes prevalence is expected to reach 5.4 million by 2030. In South Africa, diabetes-related complications severely impact not only patient health and quality of life but also the economy. Objective: The Diabetes Nurse Educator (DNE) study assessed the benefit of adding the MyDiaCare program to standard of care for managing patients with type 1 and type 2 diabetes in South Africa. An economic study was also performed to estimate the budget impact of adding MyDiaCare to standard of care for patients with type 2 diabetes older than 19 years treated in the South African private health care sector. Methods: The real-world DNE study was designed as an observational, retrospective, multicenter, single-group study. Eligible patients were older than 18 years and had at least 6 months of participation in the MyDiaCare program. The MyDiaCare program combines a patient mobile app and a health care professional platform with face-to-face visits with a DNE. The benefit of MyDiaCare was assessed by the changes in glycated hemoglobin (HbA1c) levels, the proportion of patients achieving clinical and biological targets, adherence to care plans, and satisfaction after 6 months of participating in the MyDiaCare program. A budget impact model was performed using data from the DNE study and another South African cohort of the DISCOVERY study to estimate the economic impact of MyDiaCare. Results: Between November 25, 2019, and June 30, 2020, a total of 117 patients (8 with type 1 diabetes and 109 with type 2 diabetes) were enrolled in 2 centers. After 6 months of MyDiaCare, a clinically relevant decrease in mean HbA1c levels of 0.6% from 7.8% to 7.2% was observed. Furthermore, 54% (43/79) of patients reached or maintained their HbA1c targets at 6 months. Most patients achieved their targets for blood pressure (53/79, 67% for systolic and 70/79, 89% for diastolic blood pressure) and lipid parameters (49/71, 69% for low-density-lipoprotein [LDL] cholesterol, 41/71, 58% for high-density-lipoprotein [HDL] cholesterol, and 59/71, 83% for total cholesterol), but fewer patients achieved their targets for triglycerides (32/70, 46%), waist circumference (12/68, 18%), and body weight (13/76, 17%). The mean overall adherence to the MyDiaCare care plan was 93%. Most patients (87/117, 74%) were satisfied with the MyDiaCare program. The net budget impact per patient with type 2 diabetes, older than 19 years, treated in the private sector using MyDiaCare was estimated to be approximately South African Rands (ZAR) 71,023 (US $4089) during the first year of introducing MyDiaCare. Conclusions: The results of using MyDiaCare program, which combines digital tools for patients and health care professionals with DNE support, suggest that it may be a clinically effective and cost-saving solution for diabetes management in the South African private health care sector. %M 37548994 %R 10.2196/35790 %U https://formative.jmir.org/2023/1/e35790 %U https://doi.org/10.2196/35790 %U http://www.ncbi.nlm.nih.gov/pubmed/37548994 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46715 %T Barriers to Video Call–Based Telehealth in Allied Health Professions and Nursing: Scoping Review and Mapping Process %A Rettinger,Lena %A Kuhn,Sebastian %+ Health Assisting Engineering, FH Campus Wien, University of Applied Sciences, Favoritenstrasse 226, Vienna, 1100, Austria, 43 1 606 68 77 ext 4382, lena.rettinger@fh-campuswien.ac.at %K telehealth %K telemedicine %K eHealth %K barriers %K allied health professions %K nursing %K video call %K videoconferencing %K web-based consultation %K remote consultation %K mobile phone %D 2023 %7 1.8.2023 %9 Review %J J Med Internet Res %G English %X Background: Telehealth interventions have become increasingly important in health care provision, particularly during the COVID-19 pandemic. Video calls have emerged as a popular and effective method for delivering telehealth services; however, barriers limit the adoption among allied health professionals and nurses. Objective: This review aimed to identify and map the perceived barriers to the use of video call–based telehealth interventions among allied health professionals and nurses. Methods: A comprehensive literature search was conducted in the PubMed and CINAHL databases on June 22, 2022, and updated on January 3, 2023, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Only original studies published in English or German since June 2017 that reported barriers to the use of video call–based telehealth interventions were eligible for inclusion. The studies had to involve interviews, focus groups, or questionnaires with physical therapists, occupational therapists, speech and language therapists, audiologists, orthoptists, dieticians, midwives, or nurses. Each publication was coded for basic characteristics, including country, health profession, and target group. Inductive coding was used to identify the patterns, themes, and categories in the data. Individual codings were analyzed and summarized narratively, with similarities and differences in barriers identified across health professions and target groups. Results: A total of 56 publications were included in the review, with barriers identified and categorized into 8 main categories and 23 subcategories. The studies were conducted in various countries, predominantly the United States, Australia, the United Kingdom, Canada, Israel, and India. Questionnaires were the most commonly used evaluation method, with 10,245 health professionals involved. Interviews or focus groups were conducted with 288 health professionals. Most of the included publications focused on specific health care professions, with the highest number addressing barriers for physical therapists, speech and language therapists, and audiologists. The barriers were related to technology issues, practice issues, patient issues, environmental issues, attributions, interpersonal issues, policies and regulations, and administration issues. The most reported barriers included the lack of hands-on experience, unreliable network connection, the lack of technology access, diminished fidelity of observations and poor conditions for visual instructions, the lack of technology skills, and diminished client-practitioner interaction and communication. Conclusions: This review identified key barriers to video call–based telehealth use by allied health professionals and nurses, which can foster the development of stable infrastructure, education, training, guidelines, policies, and support systems to improve telehealth services. Further research is necessary to identify potential solutions to the identified barriers. %M 37526957 %R 10.2196/46715 %U https://www.jmir.org/2023/1/e46715 %U https://doi.org/10.2196/46715 %U http://www.ncbi.nlm.nih.gov/pubmed/37526957 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48178 %T Wearable Devices and Nurses’ Health: Protocol for an Integrative Review %A Buchholz,Susan W %A Mowbray,Fabrice I %A Allman,Gabrielle %A Verboncoeur,John P %A Beam,Lauren %A Small,Leigh %+ College of Nursing, Michigan State University, 1355 Bogue Street, #C284, East Lansing, MI, 48824, United States, 1 2197765227, buchho44@msu.edu %K nurse %K wearable %K wearable device %K mHealth %K mobile health %K health technology adoption and use %K health outcome %K adoption %K usage %K health technology %K digital health %K integrative review %K literature review %D 2023 %7 21.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Nurses comprise over half of the global health care workforce, and the nursing care they provide is critical for the global population's health. High patient volumes and increased medical complexity have increased the workload and stress of nurses. As a result, the health of nurses is often negatively impacted. Wearables are used within the health care setting to assess patient outcomes; however, efforts to synthesize the use of wearable devices focusing on nurses’ health are limited. Objective: The primary objective of our integrative review is to synthesize available data concerning the utility of wearable devices for evaluating or improving (or both) the health of nurses. Methods: We are conducting an integrative review synthesizing data specific to wearable devices and nurses’ health. The research question for this review aims to answer how wearable devices are used to evaluate health outcomes among nurses. We searched the following electronic databases from inception until July 2022: PubMed, Embase, CINAHL, Web of Science, IEEE Explore, and AS&T. Titles and abstracts were imported into Covidence software, where citations were screened and duplicates removed. Title and abstract screening has been completed; however, full-text screening has not been started. Further screening is being conducted independently and in duplicate by 2 teams of 2 reviewers each. These reviewers will extract data independently. Results: Search strategies have been developed, and data were extracted from 6 databases. After the removal of duplicates, we collected 8603 studies for title and abstract screening. Two independent reviewers conducted the title and abstract review, and after resolving conflicts, 277 full-text articles are available for review to determine whether they meet the inclusion criteria. Conclusions: This integrative review will provide synthesized data to inform nurses and other stakeholders about the extent of wearable device–related work done with nurses and provide direction for future research. International Registered Report Identifier (IRRID): DERR1-10.2196/48178 %M 37477950 %R 10.2196/48178 %U https://www.researchprotocols.org/2023/1/e48178 %U https://doi.org/10.2196/48178 %U http://www.ncbi.nlm.nih.gov/pubmed/37477950 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45342 %T New Web-Based System for Recording Public Health Nursing Practices and Determining Best Practices: Protocol of an Exploratory Sequential Design %A Yoshioka-Maeda,Kyoko %A Matsumoto,Hiroshige %A Honda,Chikako %A Shiomi,Misa %A Taira,Kazuya %A Hosoya,Noriko %A Sato,Miki %A Sumikawa,Yuka %A Fujii,Hitoshi %A Miura,Takahiro %+ Department of Community Health Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, 113-0033, Japan, 81 358413597, kyokoy-tky@g.ecc.u-tokyo.ac.jp %K community-based activity %K evidence-based practice %K individual care %K information and communication technology %K program development %K public health nursing %K quality assurance %K digitalization %K eHealth %K electronic record %D 2023 %7 12.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digitalization and information and communication technology (ICT) promote effective, efficient individual and community care. Clinical terminology or taxonomy and its framework visualize individual patients’ and nursing interventions’ classifications to improve their outcomes and care quality. Public health nurses (PHNs) provide lifelong individual care and community-based activities while developing projects to promote community health. The linkage between these practices and clinical assessment remains tacit. Owing to Japan’s lagging digitalization, supervisory PHNs face difficulties in monitoring each department’s activities and staff members’ performances and competencies. Randomly selected prefectural or municipal PHNs collect data on daily activities and required hours every 3 years. No study has adopted these data for public health nursing care management. PHNs need ICTs to manage their work and improve care quality; it may help identify health needs and suggest best public health nursing practices. Objective: We aim to develop and validate an electronic recording and management system for evaluating different public health nursing practice needs, including individual care, community-based activities, and project development, and for determining their best practices. Methods: We used a 2-phase exploratory sequential design (in Japan) comprising 2 phases. In phase 1, we developed the system’s architectural framework and a hypothetical algorithm to determine the need for practice review through a literature review and a panel discussion. We designed a cloud-based practice recording system, including a daily record system and a termly review system. The panels included 3 supervisors who were prior PHNs at the prefectural or municipal government, and 1 was the executive director of the Japanese Nursing Association. The panels agreed that the draft architectural framework and hypothetical algorithm were reasonable. The system was not linked to electronic nursing records to protect patient privacy. Phase 2 validated each item through interviews with supervisory PHNs using a web-based meeting system. A nationwide survey was distributed to supervisory and midcareer PHNs across local governments. Results: This study was funded in March 2022 and approved by all ethics review boards from July to September and November 2022. Data collection was completed in January 2023. Five PHNs participated in the interviews. In the nationwide survey, responses were obtained from 177 local governments of supervisory PHNs and 196 midcareer ones. Conclusions: This study will reveal PHNs’ tacit knowledge about their practices, assess needs for different approaches, and determine best practices. Additionally, this study will promote ICT-based practices in public health nursing. The system will enable PHNs to record their daily activities and share them with their supervisors to reflect on and improve their performance, and the quality of care to promote health equity in community settings. The system will support supervisory PHNs in creating performance benchmarks for their staff and departments to promote evidence-based human resource development and management. Trial Registration: UMIN-ICDR UMIN000049411; https://tinyurl.com/yfvxscfm International Registered Report Identifier (IRRID): DERR1-10.2196/45342 %M 37307040 %R 10.2196/45342 %U https://www.researchprotocols.org/2023/1/e45342 %U https://doi.org/10.2196/45342 %U http://www.ncbi.nlm.nih.gov/pubmed/37307040 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44692 %T Domesticating Social Alarm Systems in Nursing Homes: Qualitative Study of Differences in the Perspectives of Assistant Nurses %A Chang,Fangyuan %A Östlund,Britt %A Kuoppamäki,Sanna %+ Department of Design, Shanghai Jiao Tong University, Dongchuan Road 800, Shanghai, 200240, China, 86 18205195569, fangyuanchang@sjtu.edu.cn %K technology implementation %K nursing care %K social alarm system %K domestication %K nursing home %K technology integration %K long-term care %K social alarm %K nursing %K elder %K older adult %K aging %K gerontology %K geriatric %K interview %K qualitative %D 2023 %7 5.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: New social alarm solutions are viewed as a promising approach to alleviate the global challenge of an aging population and a shortage of care staff. However, the uptake of social alarm systems in nursing homes has proven both complex and difficult. Current studies have recognized the benefits of involving actors such as assistant nurses in advancing these implementations, but the dynamics by which implementations are created and shaped in their daily practices and relations have received less attention. Objective: Based on domestication theory, this paper aims to identify the differences in the perspectives of assistant nurses when integrating a social alarm system into daily practices. Methods: We interviewed assistant nurses (n=23) working in nursing homes to understand their perceptions and practices during the uptake of social alarm systems. Results: During the four domestication phases, assistant nurses were facing different challenges including (1) system conceptualization; (2) spatial employment of social alarm devices; (3) treatment of unexpected issues; and (4) evaluation of inconsistent competence in technology use. Our findings elaborate on how assistant nurses have distinct goals, focus on different facets, and developed diverse coping strategies to facilitate the system domestication in different phases. Conclusions: Our findings reveal a divide among assistant nurses in terms of domesticating social alarm systems and stress the potential of learning from each other to facilitate the whole process. Further studies could focus on the role of collective practices during different domestication phases to enhance the understanding of technology implementation in the contexts of complex interactions within a group. %M 37145835 %R 10.2196/44692 %U https://www.jmir.org/2023/1/e44692 %U https://doi.org/10.2196/44692 %U http://www.ncbi.nlm.nih.gov/pubmed/37145835 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43300 %T A Technology-Supported Guidance Model to Support the Development of Critical Thinking Among Undergraduate Nursing Students in Clinical Practice: Concurrent, Exploratory, Flexible, and Multimethod Feasibility Study %A Zlamal,Jaroslav %A Roth Gjevjon,Edith %A Fossum,Mariann %A Steindal,Simen A %A Nes,Andréa Aparecida Gonçalves %+ Department of Bachelor Education in Nursing, Lovisenberg Diaconal University College, Lovisenberggata 15B, Oslo, 0456, Norway, 47 95963522, Jaroslav.Zlamal@ldh.no %K technology %K guidance model %K critical thinking %K feasibility %K nursing %K nursing education %K medical education %K nursing student %K digital intervention %K mobile app %K clinical practice %D 2023 %7 26.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There is widespread recognition and acceptance of the need for critical thinking in nursing education, as it is necessary to provide high-quality nursing. The Technology-Supported Guidance Model (TSGM) intervention was conducted during clinical practice among undergraduate nursing students and aimed to support the development of critical thinking. A major element of this newly developed intervention is an app, Technology-Optimized Practice Process in Nursing (TOPP‑N), combined with the daily guidance of nursing students from nurse preceptors and summative assessments based on the Assessment of Clinical Education. Objective: The main objective of this study was to assess the feasibility of a newly developed intervention, TSGM, among undergraduate nursing students, nurse preceptors, and nurse educators. Further objectives were to assess the primary and secondary outcome measures, recruitment strategy, and data collection strategy and to identify the potential causes of dropout and barriers to participant recruitment, retention, intervention fidelity, and adherence to the intervention. Methods: This study was designed as a concurrent, exploratory, flexible, and multimethod feasibility study of the TSGM intervention that included quantitative and qualitative data from nursing students, nurse preceptors, and nurse educators. The primary outcome measures were the feasibility and acceptability of the intervention. The secondary outcomes included the suitability and acceptance of the outcome measures (critical thinking, self-efficacy, clinical learning environment, metacognition and self-regulation, technology acceptance, and competence of mentors); data collection strategy; recruitment strategy; challenges related to dropouts; and hindrances to recruitment, retention, and intervention fidelity and adherence. Results: Nursing students, nurse preceptors, and nurse educators had varied experiences with the TSGM intervention. We identified factors that make the intervention feasible and challenging and may influence the feasibility, acceptability, dropout rate, adherence, and fidelity of the intervention. We also identified areas for future improvement of the intervention. Conclusions: The use of a newly developed intervention, TSGM, is feasible and accepted by undergraduate nursing students, nurse preceptors, and nurse educators; however, refinement and improvement of the intervention and the TOPP‑N app, improvement in intervention management, and mitigation of negative factors are necessary before a randomized controlled trial can be performed. International Registered Report Identifier (IRRID): RR2-10.2196/31646 %M 37099377 %R 10.2196/43300 %U https://formative.jmir.org/2023/1/e43300 %U https://doi.org/10.2196/43300 %U http://www.ncbi.nlm.nih.gov/pubmed/37099377 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45067 %T Utilization of Research in Clinical Nursing and Midwifery Practice in Ghana: Protocol for a Mixed Methods Study %A Owusu,Lydia Boampong %A Scheepers,Nicholin %A Tenza,Immaculate Sabelile %+ Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, No. 12 Akroso Road, KNUST, Kumasi, 00233, Ghana, 233 243721605, lydiaowusu7@yahoo.com %K clinical practice %K educators %K evidence-based practice %K health facilities %K managers %K midwife %K midwives %K nurses %K nursing practice %K nursing %K research utilization %D 2023 %7 7.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The International Council of Nurses’ 2021 code of ethics mandates nurses to provide evidence-informed care to patients. Globally, using research evidence has led to improvement in nursing and midwifery practice, according to the World Health Organization. A study in Ghana found that 25.3% (n=40) of nurses and midwives use research in clinical care. Research utilization (RU) increases therapeutic effectiveness, improves health outcomes, and enhances the personal and professional development of clinicians. However, it is uncertain the extent to which nurses and midwives are prepared, skilled, and supported to utilize research in clinical care in Ghana. Objective: This study aims to develop a conceptual framework that can facilitate RU among clinical nurses and midwives in Ghanaian health facilities. Methods: This will be a cross-sectional study with a concurrent mixed methods approach. It will be conducted in 6 hospitals and 4 nursing educational institutions in Kumasi, Ghana. The study has 4 objectives which will be executed in 3 phases. Phase 1 follows a quantitative approach to describe the knowledge, attitudes, and practices of clinical nurses and midwives on the use of research in their practice. Using a web-based survey, 400 nurses and midwives working in 6 health facilities will be recruited. Data analysis will be conducted using SPSS, with statistical significance set at .05. Qualitative methodology, using focus group discussions with clinical nurses and midwives, will be conducted to identify the factors influencing their RU. In phase 2, focus group discussions will be used to examine and describe how nurse educators in 4 nursing and midwifery educational institutions prepare nurses and midwives for RU during their education. Views of nurse managers on the RU in Ghanaian health care facilities will be explored in the second section of this phase through one-on-one interviews. Inductive thematic analysis will be used to analyze the qualitative data, and Lincoln and Guba’s principles of trustworthiness will be applied. In phase 3, the stages of model development proposed by Chinn and Kramer; and Walker and Avant will be used to triangulate findings from all objectives and formulate a conceptual framework. Results: Data collection started in December 2022. Publication of the results will begin in April 2023. Conclusions: RU in clinical practice has become an acceptable practice in nursing and midwifery. It is critical that nursing and midwifery professionals in sub-Saharan Africa shift their practice to embrace the global movement. This proposed conceptual framework will empower nurses and midwives to improve their practice of RU. International Registered Report Identifier (IRRID): DERR1-10.2196/45067 %M 37027196 %R 10.2196/45067 %U https://www.researchprotocols.org/2023/1/e45067 %U https://doi.org/10.2196/45067 %U http://www.ncbi.nlm.nih.gov/pubmed/37027196 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e42512 %T Virtual Reflection Group Meetings as a Structured Active Learning Method to Enhance Perceived Competence in Critical Care: Focus Group Interviews With Advanced Practice Nursing Students %A Solberg,Marianne Trygg %A Sørensen,Anne Lene %A Clarke,Sara %A Nes,Andrea Aparecida Goncalves %+ Lovisenberg Diaconal University College, Lovisenberggata 15 b, Oslo, 0456, Norway, 47 47097070, marianne.trygg.solberg@ldh.no %K advanced practice nurse %K nursing education %K virtual reflection group %K teaching design %K critical care %K active learning approach %D 2023 %7 23.3.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: Advanced practice nurses (APNs) are in high demand in critical care units. In Norway, APNs are educated at the master’s degree level and acquire the competence to ensure the independent, safe, and effective treatment of patients in constantly and rapidly changing health situations. APNs’ competence embraces expert knowledge and skills to perform complex decision-making in the clinical context; therefore, it is essential that educational institutions in nursing facilitate learning activities that ensure and improve students’ achievement of the required competence. In clinical practice studies of APN education, face-to-face reflection group (FFRG) meetings, held on campus with the participation of a nurse educator and advanced practice nursing students (APNSs), are a common learning activity to improve the competence of APNSs. Although FFRG meetings stimulate APNSs’ development of required competencies, they may also result in unproductive academic discussions, reduce the time that APNSs spend in clinical practice, and make it impossible for nurse preceptors (NPs) to attend the meetings, which are all challenges that need to be addressed. Objective: This study aimed to address the challenges experienced in FFRG meetings by implementing virtual reflection group (VRG) meetings and to explore the experiences of APNSs, NPs, and nurse educators in VRG meetings as an active learning method supported by technology to stimulate students’ development of the required competence to become APNs in critical care. Methods: This study adopted a qualitative explorative design with 2 focus group interviews and used inductive content analysis to explore the collected data. Results: The main finding is that reflection group meetings supported by technology resulted in a better-structured active learning method. The VRG meeting design allowed APNSs to spend more time in clinical practice placements. The APNSs and NPs experienced that they participated actively and effectively in the meetings, which led to a perceived increase in competence. The APNSs also perceived an improved learning experience compared with their prior expectations. Conclusions: Users perceived that the implemented novel teaching design supported by technology, the VRG meeting, was a more effective method than FFRG meetings on campus to develop APNSs’ required competence in critical care. The VRG was also perceived as an improved method to solve the challenges encountered in FFRG meetings. Specifically, the APNSs felt that they were prepared to undertake complex decision-making with a higher level of analytic cognition in a clinical context and to lead professional discussions in the ward. This developed teaching design can easily be adapted to diverse educational programs at various levels of professional education. %M 36951919 %R 10.2196/42512 %U https://mededu.jmir.org/2023/1/e42512 %U https://doi.org/10.2196/42512 %U http://www.ncbi.nlm.nih.gov/pubmed/36951919 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e40677 %T Developing the Next Generation of Nursing Disciplinary Leaders in Higher Education: Protocol for a Sequential Mixed Methods Study %A Slattery,Melissa %A Grech,Carol %A Vernon,Rachael %+ Department of Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, 5001, Australia, 61 433672741, slamj010@mymail.unisa.edu.au %K academic %K attributes %K behaviors %K characteristics %K higher education %K leadership %K nursing %K qualities %D 2023 %7 16.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Leading nurse education and research in the higher education (HE) sector has become increasingly challenging over the last decade with many universities in Australia and New Zealand having undergone academic restructuring. The future of HE faces many challenges including recruitment of suitably qualified staff to lead teaching and research and advance professional disciplines. Increasing cultural diversity of the Nursing workforce and the communities’ nurses serve, and the identification of cultural attributes in the context of racial inequities exposed by the pandemic and the climate emergency suggest different forms of leadership may be required in the future by those leading nurse education in the HE sector. Currently, there is a dearth of research evidence that identifies the qualities, behaviors, and characteristics (collectively identified as core attributes) required by nurse academic leaders. Objective: This research aims to identify an evidenced based set of core attributes that are required to lead the discipline of Nursing in the Australian and New Zealand HE sectors. Methods: This research is using a 2-phase sequential mixed methods design incorporating a scoping review; and Delphi technique. In phase 1, a scoping review will be undertaken to identify the qualities, behaviors, and characteristics that can influence the evolution of the next generation of academic nurse leaders. A set of draft statements and questions will be prepared based on analysis of findings from the review. Phase 2 uses Delphi technique consisting of e-survey rounds with experts in leading nursing faculties in Australia and New Zealand. An Expert Advisory Group will consider the initial set of draft statements and questions from phase 1. Consistent with Delphi technique, a series of “rounds” will then occur using an e-survey method. Established leaders (Professors and Associate Professors who are members of the Council of Deans Australia and New Zealand) will rate their level of agreement to statements on the qualities, behaviors, and characteristics required to lead the discipline of nursing in the HE sector in Australia and New Zealand. Results: The findings of the scoping review will identify what is currently known about the qualities, behaviors, and characteristics of academic nurse leaders. Quantitative and qualitative results from the Delphi study will initially be reported in separate manuscripts for publication. It is projected that a final paper will be prepared from aggregated research data and outline how the findings can inform the preparation of future academic nurse leaders. Conclusions: The generation of an evidenced-based set of core attributes will serve to inform the next generation of academic nurse leaders including informing recruitment processes and postgraduate nurse leadership programs. It is anticipated that the data sets and findings will be transferrable to other disciplines within HE to aid in future-proofing discipline-based expertise and leadership in the context of academic restructure. International Registered Report Identifier (IRRID): PRR1-10.2196/40677 %M 36758578 %R 10.2196/40677 %U https://www.researchprotocols.org/2023/1/e40677 %U https://doi.org/10.2196/40677 %U http://www.ncbi.nlm.nih.gov/pubmed/36758578 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e40390 %T Impact of the COVID-19 Pandemic on Health, Well-being, and Quality of Work-Life Outcomes Among Direct Care Nursing Staff Working in Nursing Home Settings: Protocol for a Systematic Review %A Thorne,Trina %A Duan,Yinfei %A Slubik,Sydney %A Estabrooks,Carole A %+ Faculty of Nursing, University of Alberta, 5-183 Edmonton Clinic Health Academy, Edmonton, AB, T6G1C9, Canada, 1 780 492 8270, tethorne@ualberta.ca %K care aide %K COVID-19 pandemic %K direct care %K frontline staff %K mental health %K nurse %K nursing home %K physical health %K residential long-term care %K work-life %D 2023 %7 28.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Increased workload, lack of resources, fear of infection, and the suffering and loss of residents have placed a significant emotional burden on regulated and unregulated direct care nursing staff (eg, registered nurses, licensed practical nurses, and care aides) in nursing homes (residential long-term care homes). Psychological distress and burnout related to COVID-19 have been cited among direct care staff within nursing homes. Studies have also emphasized the resilience of direct care staff, who, despite the significant challenges created by the pandemic, remained committed to providing quality care. To date, only one nursing home–specific review has synthesized evidence from 15 studies conducted early in the pandemic, which reported anxiety, posttraumatic stress disorder, and depression among direct care staff. Objective: The objectives of this systematic review are to (1) synthesize all empirical evidence on the impact of the COVID-19 pandemic on direct care staffs’ mental health, physical health, and work-life outcomes; (2) identify specific risks and protective factors; and (3) examine the effect of strategies or interventions that have been developed to improve these outcomes. Methods: We will include all study designs reporting objective or subjective measurements of direct care staffs’ mental health, physical health, and quality of work-life in nursing home settings during the COVID-19 pandemic (January 2020 onward). We will search multiple databases (MEDLINE, CINAHL, Embase, Scopus, and PsycINFO) and gray literature sources with no language restrictions. Two authors will independently screen, assess data quality, and extract data for synthesis. Given the heterogeneity in research designs, we will use multiple data synthesis methods that are suitable for quantitative and qualitative studies. Results: As of December 2022, full text screening has been completed and data extraction is underway. The expected completion date is June 30, 2023. Conclusions: This systematic review will uncover gaps in current knowledge, increase our understanding of the disparate findings to date, identify risks and factors that protect against the sustained effects of the pandemic, and elucidate the feasibility and effects of interventions to support the mental health, physical health, and quality of work-life of frontline nursing staff. This study will inform future research exploring how the health care system can be more proactive in improving quality of work-life and supporting the health and psychological needs of frontline staff amid extreme stressors such as the pandemic and within the wider context of prepandemic conditions. Trial Registration: PROSPERO CRD42021248420; https://tinyurl.com/4djk7rpm International Registered Report Identifier (IRRID): DERR1-10.2196/40390 %M 36853752 %R 10.2196/40390 %U https://www.researchprotocols.org/2023/1/e40390 %U https://doi.org/10.2196/40390 %U http://www.ncbi.nlm.nih.gov/pubmed/36853752 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43771 %T Implementation of a Web-Based Resilience Enhancement Training for Nurses: Pilot Randomized Controlled Trial %A Henshall,Catherine %A Davey,Zoe %A Srikesavan,Cynthia %A Hart,Liam %A Butcher,Dan %A Cipriani,Andrea %+ Oxford Institute for Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Headington Campus, Marston Road Site, Oxford, OX3 0FL, United Kingdom, 44 7778 428994, chenshall@brookes.ac.uk %K burnout %K COVID-19 %K health care setting %K health care staff %K health care provider %K mental health %K mental well-being %K nurses %K nursing %K pilot trial %K psychological health %K resilience training %K resilience %K web-based health %K web-based training %D 2023 %7 14.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Global workforce challenges faced by health care providers are linked to low levels of job satisfaction, recruitment, retention, and well-being, with detrimental impacts on patient care outcomes. Resilience-building programs can provide support for staff who endure highly stressful environments, enhance resilience, and support recruitment and retention, with web-based formats being key to increasing accessibility. Objective: We aimed to examine participants’ engagement with a newly developed Resilience Enhancement Online Training for Nurses (REsOluTioN), explore its acceptability, and compare levels of resilience and psychological well-being in nurses who completed REsOluTioN with those who did not. Methods: We carried out a pilot randomized trial (1:1), conducted at a single site (mental health and community trust in South England) between August 2021 and May 2022. Local research ethics approvals were obtained. Nurses were invited to participate and were randomly assigned to a waitlist group or REsOluTioN group. Training lasted for 4 weeks, consisting of prereading, web-based facilitated sessions, and mentorship support. We evaluated trial engagement, acceptability of training, and pre-post changes in resilience, measured by the Brief Resilience Scale, and psychological well-being, measured by the Warwick Edinburgh Mental Wellbeing Scale. Qualitative participant feedback was collected. Consolidated Standards of Reporting Trials 2010 extension guidelines for reporting pilot and feasibility trials were used. Results: Of 108 participants recruited, 93 completed the study. Participants’ mean age was 44 (SD 10.85) years. Most participants were female (n=95, 88.8%), White (n=95, 88.8%), and worked in community settings (n=91, 85.0%). Sixteen facilitated and 150 mentoring sessions took place. Most REsOluTioN program participants reported the sessions helped improve their resilience (n=24, 72.8%), self-confidence (n=24, 72.7%), ability to provide good patient care (n=25, 75.8%), relationships with colleagues (n=24, 72.7%), and communication skills (n=25, 75.8%). No statistically significant differences between training and control groups and time on well-being (F1,91=1.44, P=.23, partial η2=0.02) and resilience scores (F1,91=0.33, P=.57, partial η2=0.004) were revealed; however, there were positive trends toward improvement in both. Nurse participants engaged with the REsOluTioN program and found it acceptable. Most found web-based training and mentoring useful and enjoyed learning, reflection, networking, and participatory sessions. Conclusions: The REsOluTioN program was acceptable, engaging, perceived as useful, and nurses were keen for it to be implemented to optimize resilience, psychological health, communication, and workplace environments. The study has evidenced that it is acceptable to implement web-based resilience programs with similar design features within busy health care settings, indicating a need for similar programs to be carefully evaluated. Mentorship support may also be a key in optimizing resilience. Trial limitations include small sample size and reduced statistical power; a multicenter randomized controlled trial could test effectiveness of the training on a larger scale. Trial Registration: ClinicalTrials.gov NCT05074563; https://clinicaltrials.gov/ct2/show/NCT05074563 International Registered Report Identifier (IRRID): RR2-10.2196/37015 %M 36787181 %R 10.2196/43771 %U https://www.jmir.org/2023/1/e43771 %U https://doi.org/10.2196/43771 %U http://www.ncbi.nlm.nih.gov/pubmed/36787181 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e43130 %T The Nursing Home Severity Index and Application to Pressure Injury Risk: Measure Development and Validation Study %A Yap,Tracey L %A Horn,Susan D %A Sharkey,Phoebe D %A Brooks,Katie R %A Kennerly,Susan %+ School of Nursing, Duke University, 311 Trent Drive, DUMC 3322, Durham, NC, 27710, United States, 1 (919) 613 6170, tracey.yap@duke.edu %K geriatrics %K nursing homes %K pressure ulcer %K propensity scores %K severity of illness index %K development %K validation %K clinical %K treatment %K pressure injury %K injury %K risk %K prevention %D 2023 %7 9.2.2023 %9 Original Paper %J JMIR Aging %G English %X Background: An assessment tool is needed to measure the clinical severity of nursing home residents to improve the prediction of outcomes and provide guidance in treatment planning. Objective: This study aims to describe the development of the Nursing Home Severity Index, a clinical severity measure targeted for nursing home residents with the potential to be individually tailored to different outcomes, such as pressure injury. Methods: A retrospective nonexperimental design was used to develop and validate the Nursing Home Severity Index using secondary data from 9 nursing homes participating in the 12-month preintervention period of the Turn Everyone and Move for Ulcer Prevention (TEAM-UP) pragmatic clinical trial. Expert opinion and clinical literature were used to identify indicators, which were grouped into severity dimensions. Index performance and validation to predict risk of pressure injury were accomplished using secondary data from nursing home electronic health records, Minimum Data Sets, and Risk Management Systems. Logistic regression models including a resident’s Worst-Braden score with/without severity dimensions generated propensity scores. Goodness of fit for overall models was assessed using C statistic; the significance of improvement of fit after adding severity components to the model was determined using the likelihood ratio chi-square test. The significance of each component was assessed with odds ratios. Validation based on randomly selected 65% training and 35% validation data sets was used to confirm the reliability of the severity measure. Finally, the discriminating ability of models was evaluated using propensity stratification to evaluate which model best discriminated between residents with/without pressure injury. Results: Data from 1015 residents without pressure injuries on admission were used for the Nursing Home Severity Index–Pressure Injury and included laboratory, weights/vitals/pain, underweight, and locomotion severity dimensions. Logistic regression C statistic measuring predictive accuracy increased by 19.3% (from 0.627 to 0.748; P<.001) when adding four severity dimensions to Worst-Braden scores. Significantly higher odds of developing pressure injuries were associated with increasing dimension scores. The use of the three highest propensity deciles predicting the greatest risk of pressure injury improved predictive accuracy by detecting 21 more residents who developed pressure injury (n=58, 65.2% vs n=37, 42.0%) when both severity dimensions and Worst-Braden score were included in prediction modeling. Conclusions: The clinical Nursing Home Severity Index–Pressure Injury was successfully developed and tested using the outcome of pressure injury. Overall predictive capacity was enhanced when using severity dimensions in combination with Worst-Braden scores. This index has the potential to significantly impact the quality of care decisions aimed at improving individual pressure injury prevention plans. Trial Registration: ClinicalTrials.gov NCT02996331; http://clinicaltrials.gov/ct2/show/NCT02996331 %M 36757779 %R 10.2196/43130 %U https://aging.jmir.org/2023/1/e43130 %U https://doi.org/10.2196/43130 %U http://www.ncbi.nlm.nih.gov/pubmed/36757779 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41729 %T The Nurse-Physician Relationship During the COVID-19 Pandemic in Shanghai, China: Cross-sectional Study %A Shi,Yueping %A Gu,Pinhua %A Wang,Qiufeng %A Zhang,Xuelian %+ Department of Cardiology, Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine (Preparatory Stage), Zhongshan Zhong Road No 746, Songjiang, Shanghai, 201600, China, 86 18918285320, zxuelian2003@sina.com %K nurse %K physician %K collaboration %K online survey %K nursing %K COVID-19 %K structural equation modeling %K equation modeling %K nurse-physician %K ordinal logistic regression %D 2023 %7 6.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The nurse-physician relationship is important for the stability of collaboration. The COVID-19 pandemic has put unprecedented pressure on the health care system and has placed greater demands on nurse-physician collaboration. Nurses and physicians often struggle to share mutual responsibility and communicate effectively. Objective: This study aimed to evaluate the relationship between nurses and physicians during the COVID-19 pandemic and construct a new model combining the attitude and behaviors of the 2 groups to assess various factors’ impacts on job satisfaction and confrontational behavior. Methods: We conducted this quantitative cross-sectional study to assess the relationship between nurses and physicians based on the attitudes and behaviors toward nurse-physician collaboration. We first investigated the satisfaction of nurses and physicians with their relationship and how they thought the COVID-19 pandemic had affected that relationship. We used an adapted and modified Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration questionnaire that consisted of 17 items under 5 dimensions. Structural equation modeling was used to assess the relationships between domains. Ordinal logistic regression was used to evaluate the relationship between different domains of the questionnaire and the satisfaction of the current nurse-physician relationship. Results: We included a total of 176 nurses and 124 physicians in this study. Compared to 7.2% (9/124) of physicians, 22.7% (40/176) of nurses were dissatisfied with the current nurse-physician relationship. Most physicians (101/124, 81.5%) and nurses (131/176, 74.5%) agreed that the nurse-physician relationship had become better because of the COVID-19 pandemic and that the public had greater respect for them. However, significantly fewer nurses (59/176, 33.5% vs 79/124, 63.7%; P<.001) thought that physicians and nurses were treated with the same respect. Nurses scored significantly higher scores in caring versus curing (mean 16.27, SD 2.88 vs mean 17.43, SD 2.50; P<.001) and physician’s authority (mean 8.72, SD 3.21 vs mean 7.24, SD 3.32; P<.001) subscales compared with physicians. The shared education and collaboration subscale had a significantly positive relationship with the nurse’s autonomy subscale (standardized coefficient=0.98; P<.001). Logistic regression showed that 4 subscales (shared education and collaboration: P<.001; caring versus curing: P<.001; nurse’s autonomy: P<.001; and confrontation: P=.01) were significantly associated with the level of satisfaction of the current nurse-physician relationship. Conclusions: This study showed that nurses were more dissatisfied with the current nurse-physician relationship than physicians in Shanghai. Policy makers and managers in the medical and educational system should emphasize an interprofessional collaboration between nurses and physicians. Positive attitudes toward shared collaboration and responsibility may help to improve the relationship between the 2 parties. %M 36745499 %R 10.2196/41729 %U https://formative.jmir.org/2023/1/e41729 %U https://doi.org/10.2196/41729 %U http://www.ncbi.nlm.nih.gov/pubmed/36745499 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e44101 %T A Technology-Supported Guidance Model to Increase the Flexibility, Quality, and Efficiency of Nursing Education in Clinical Practice in Norway: Development Study of the TOPP-N Application Prototype %A Nes,Andréa Aparecida Gonçalves %A Zlamal,Jaroslav %A Linnerud,Silje Christin Wang %A Steindal,Simen A %A Solberg,Marianne Trygg %+ Lovisenberg Diaconal University College, Lovisenberggt 15B, Oslo, 0456, Norway, 47 90703168, andrea.nes@ldh.no %K clinical practice %K guidance application model %K nursing students %K constructive alignment %K metacognition %K technological tool %K nursing %K nursing profession %K application %K mobile health, eHealth %K educator %K communication %D 2023 %7 3.2.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The challenges of nursing shortage in the nursing profession and of limited nursing educational capacity in nursing education in clinical practice need to be addressed to ensure supply according to the demand of these professionals. In addition, communication problems among nursing students, nurse educators, and nurse preceptors; variations in the guidance competence of nurse preceptors; and limited overview from nurse educators on nursing students’ clinical practice are common challenges reported in several research studies. These challenges affect the quality of nursing education in clinical practice, and even though these problems have been highlighted for several years, a recent study showed that these problems are increasing. Thus, an approach is required to ensure the quality of nursing education in clinical practice. Objective: We aimed to develop a guidance and assessment application to meet the challenges reported in clinical practice. The application intended to increase the flexibility, quality, and efficiency of nursing education in clinical practice. Furthermore, it intended to increase interactive communication that supports guidance and ensure structured evaluation of nursing students in clinical practice. Methods: This study employed a multidisciplinary user-participatory design. Overall, 23 stakeholders from the project team (ie, 5 researchers, 2 software developers, 1 pedagogical advisor, and 15 user representatives [4 educators, 6 preceptors, and 5 students]) participated in a user-centered development process that included workshops, intervention content development, and prototype testing. Results: This study resulted in the creation of the Technology-Optimized Practice Process in Nursing (TOPP-N) guidance and assessment application for use as a supportive tool for nursing students, nurse preceptors, and nurse educators in clinical practice. The development process included the application’s name and logo, technical architecture, guidance and assessment module, and security and privacy. Conclusions: This study offers insights into the development of an evidence-based technological tool to support nursing students, nurse preceptors, and nurse educators in clinical practice. Furthermore, the developed application has the potential to meet several challenges reported in nursing education in clinical practice. After a rigorous development process, we believe that the TOPP-N guidance and assessment application prototype is now ready to be tested in further intervention studies. %M 36735289 %R 10.2196/44101 %U https://humanfactors.jmir.org/2023/1/e44101 %U https://doi.org/10.2196/44101 %U http://www.ncbi.nlm.nih.gov/pubmed/36735289 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 6 %N %P e41331 %T The Use and Structure of Emergency Nurses’ Triage Narrative Data: Scoping Review %A Picard,Christopher %A Kleib,Manal %A Norris,Colleen %A O'Rourke,Hannah M %A Montgomery,Carmel %A Douma,Matthew %+ Faculty of Nursing, University of Alberta, Graduate Office, 4-171 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada, 1 (780) 492 4567, picard.ct@gmail.com %K nursing %K artificial intelligence %K machine learning %K triage %K review %K narrative %D 2023 %7 13.1.2023 %9 Review %J JMIR Nursing %G English %X Background: Emergency departments use triage to ensure that patients with the highest level of acuity receive care quickly and safely. Triage is typically a nursing process that is documented as structured and unstructured (free text) data. Free-text triage narratives have been studied for specific conditions but never reviewed in a comprehensive manner. Objective: The objective of this paper was to identify and map the academic literature that examines triage narratives. The paper described the types of research conducted, identified gaps in the research, and determined where additional review may be warranted. Methods: We conducted a scoping review of unstructured triage narratives. We mapped the literature, described the use of triage narrative data, examined the information available on the form and structure of narratives, highlighted similarities among publications, and identified opportunities for future research. Results: We screened 18,074 studies published between 1990 and 2022 in CINAHL, MEDLINE, Embase, Cochrane, and ProQuest Central. We identified 0.53% (96/18,074) of studies that directly examined the use of triage nurses’ narratives. More than 12 million visits were made to 2438 emergency departments included in the review. In total, 82% (79/96) of these studies were conducted in the United States (43/96, 45%), Australia (31/96, 32%), or Canada (5/96, 5%). Triage narratives were used for research and case identification, as input variables for predictive modeling, and for quality improvement. Overall, 31% (30/96) of the studies offered a description of the triage narrative, including a list of the keywords used (27/96, 28%) or more fulsome descriptions (such as word counts, character counts, abbreviation, etc; 7/96, 7%). We found limited use of reporting guidelines (8/96, 8%). Conclusions: The breadth of the identified studies suggests that there is widespread routine collection and research use of triage narrative data. Despite the use of triage narratives as a source of data in studies, the narratives and nurses who generate them are poorly described in the literature, and data reporting is inconsistent. Additional research is needed to describe the structure of triage narratives, determine the best use of triage narratives, and improve the consistent use of triage-specific data reporting guidelines. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-055132 %M 36637881 %R 10.2196/41331 %U https://nursing.jmir.org/2023/1/e41331 %U https://doi.org/10.2196/41331 %U http://www.ncbi.nlm.nih.gov/pubmed/36637881 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42516 %T Nurses’ Perceptions of Climate Change: Protocol for a Scoping Review %A Diallo,Thierno %A Bérubé,Anouk %A Roberge,Martin %A Audate,Pierre-Paul %A Larente-Marcotte,Stéphanie %A Jobin,Édith %A Moubarak,Nisrine %A Guillaumie,Laurence %A Dupéré,Sophie %A Guichard,Anne %A Goupil-Sormany,Isabelle %+ Faculty of Nursing Sciences, Laval University, Pavillon Ferdinand-Vandry, 1050, rue de la Médecine, Quebec, QC, G1V 0H6, Canada, 1 4186562131 ext 413488, bebs.diallo13@gmail.com %K perception %K climate change %K nurse %K scoping review %K review method %K environment %K nursing %K perspective %K search strategy %K global warming %K health care professional %D 2023 %7 11.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Climate change is a major threat to human health. Nurses are in contact with patients suffering from the effects of climate change in their daily work. Therefore, they need to be involved in combating it at both the individual and collective levels. However, there is still very little known about nurses’ perception of climate change and their role toward it. A few recent studies have embarked on the process of examining the perceptions of these health professionals relative to climate change, but no exploratory review of the literature has been conducted on nurses’ perception of this phenomenon. Objective: The purpose of this protocol is to develop a research strategy for an exploratory review of the literature focused on identifying nurses’ perceptions of climate change. Methods: Firstly, with the help of a specialized librarian, we defined keywords and their combinations, using an iterative process, to develop a documentary search strategy. This strategy was tested in the following four bibliographic databases: MEDLINE (PubMed), CINAHL, Embase, and Web of Science. A search of the grey literature will also be conducted to supplement the results of the bibliographic database search. The next step will be for 2 members of the research team to carry out a 2-stage selection process using the web-based systematic review software Covidence. They will carry out this selection process independently, with the aim of identifying relevant studies that meet the inclusion criteria for our exploratory review. Finally, data on year of publication, authors, geographic area, article type, study objectives, methodology, and key findings will be extracted from selected articles for analysis. The data will be analyzed by the research team based on an in-depth examination of the findings and will be directed toward answering the research question and fulfilling the study’s objective. Results: The results will help in defining nurses’ perceptions of climate change more clearly as well as the role they can play and what they need to be able to bring forward solutions to this phenomenon. The findings should also serve to guide the health sector and nursing faculty’s interventions aimed at preparing health professionals to act on the potential threats associated with climate change. Conclusions: The preliminary search suggests a possible gap between the importance of the nursing role in addressing the health impacts of climate change and the nurses’ lack of knowledge and awareness on this matter. The results will allow for raising nurses’ awareness of their role in the fight against climate change and the ways to address its health effects. This study will also open up new research perspectives on how to equip nurses to better integrate response to climate change issues into their professional practice. International Registered Report Identifier (IRRID): DERR1-10.2196/42516 %M 36630170 %R 10.2196/42516 %U https://www.researchprotocols.org/2023/1/e42516 %U https://doi.org/10.2196/42516 %U http://www.ncbi.nlm.nih.gov/pubmed/36630170 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e37731 %T Enhancing Nurse–Robot Engagement: Two-Wave Survey Study %A Liao,Gen-Yih %A Huang,Tzu-Ling %A Wong,May-Kuen %A Shyu,Yea-Ing Lotus %A Ho,Lun-Hui %A Wang,Chi %A Cheng,T C E %A Teng,Ching-I %+ Department of Nursing, Chang Gung Memorial Hospital, Linkou, 5, Fuxing St, Taoyuan, 333, Taiwan, 886 3 3281200, gigy@cgmh.org.tw %K healthcare %K health care %K eHealth %K digital heath %K health technology %K personal innovativeness %K robot %K structural equation modeling %K survey %K intelligent technology %K smart technology %K robotics %K nurse %K nursing %K attitude %K engagement %K healthcare professional %K benefit %K Taiwan %K Asia %D 2023 %7 9.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Robots are introduced into health care contexts to assist health care professionals. However, we do not know how the benefits and maintenance of robots influence nurse–robot engagement. Objective: This study aimed to examine how the benefits and maintenance of robots and nurses’ personal innovativeness impact nurses’ attitudes to robots and nurse–robot engagement. Methods: Our study adopted a 2-wave follow-up design. We surveyed 358 registered nurses in operating rooms in a large-scale medical center in Taiwan. The first-wave data were collected from October to November 2019. The second-wave data were collected from December 2019 to February 2020. In total, 344 nurses participated in the first wave. We used telephone to follow up with them and successfully followed-up with 331 nurses in the second wave. Results: Robot benefits are positively related to nurse–robot engagement (β=.13, P<.05), while robot maintenance requirements are negatively related to nurse–robot engagement (β=–.15, P<.05). Our structural model fit the data acceptably (comparative fit index=0.96, incremental fit index=0.96, nonnormed fit index=0.95, root mean square error of approximation=0.075). Conclusions: Our study is the first to examine how the benefits and maintenance requirements of assistive robots influence nurses’ engagement with them. We found that the impact of robot benefits on nurse–robot engagement outweighs that of robot maintenance requirements. Hence, robot makers should consider emphasizing design and communication of robot benefits in the health care context. %M 36622738 %R 10.2196/37731 %U https://www.jmir.org/2023/1/e37731 %U https://doi.org/10.2196/37731 %U http://www.ncbi.nlm.nih.gov/pubmed/36622738 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 9 %P e37965 %T A Care Concept of Community Health Nursing Interventions for Adults With Chronic Health Conditions in an Urban Area: Protocol for a Randomized Controlled Field Trial (CoSta Study) %A Nock,Annike Morgane %A Iversen,Linda %A Waidhas,Lukas %A Zapf,Antonia %A Seifert,Caroline %A Petersen-Ewert,Corinna %+ Department of Nursing and Management, Hamburg University of Applied Sciences, Campus Alexanderstraße, Alexanderstraße 1, Hamburg, 20099, Germany, 49 40 428 757128, Annike.Nock@haw-hamburg.de %K community health nursing %K chronic health conditions %K randomized controlled trial %K community-based program %K health-related quality of life %K nurse-led consultation %K nursing %K nurse %K intervention %K urban %K protocol %K Germany %K adults %D 2022 %7 28.9.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Implementing community health nursing programs is a new field of application in the primary health sector of Germany. Hence, there is limited evidence of effective community-based and nurse-led interventions with regard to the German health care system. International research findings are mostly not transferable. The Community Health Nursing in der Stadt (CoSta; ie, “Community Health Nursing in the City”) project is the first study that examines a community health nurse–led intervention for adults with chronic health conditions. Objective: This study protocol describes the design and methods of a randomized controlled field trial that will investigate if a community health nurse–based intervention has an impact on health-related quality of life in adults with chronic conditions. Methods: The study was designed as a randomized controlled trial that will be conducted under real-life conditions in the field. In a 4-month period, patients with at least 1 chronic International Classification of Diseases, Tenth Revision, diagnosis will be enrolled. Participants will be randomly allocated to an intervention group or a control group. The sample size was assumed based on an effect size of 0.50 with a significance level of .05, using a 2-sided (2-tailed), 2-sample unequal variance t test. The control group will be treated as usual. The intervention group will receive—in addition to the usual treatment—preventive home visits; consultations; and educative training, which will be offered by 2 community health nurses for up to 12 months. Both groups will be followed up at baseline, after 6 months, and after 12 months. The primary outcome measure is the mental component summary score from the 36-Item Short Form Health Survey after 12-months. Secondary patient outcomes will be included. The study received ethics approval from the Competence Health Center’s institutional review board at the University of Applied Sciences Hamburg (procedure number: 2020-14). Results: The CoSta project was funded by the Federal Ministry of Education and Research Germany (contract number: 13FH019SX8). In total, 187 participants were recruited at the beginning of August 2021. Further, 92 were excluded and 94 were randomized. Data collection will be conducted until the end of 2022. Conclusions: Our study will provide data with regard to the effectiveness of community nurse–led interventions that focus on the treatment of vulnerable adults with chronic health conditions in a community health center. In secondary analyses, the associations among influencing social factors (education, income, and employment) will be examined. We expect results that will help reduce the research-to-practice gap. Trial Registration: German Clinical Trials Register DRKS00026164; https://tinyurl.com/yckxc5ut International Registered Report Identifier (IRRID): DERR1-10.2196/37965 %M 36170005 %R 10.2196/37965 %U https://www.researchprotocols.org/2022/9/e37965 %U https://doi.org/10.2196/37965 %U http://www.ncbi.nlm.nih.gov/pubmed/36170005 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 3 %P e37297 %T Using Mobile Virtual Reality Simulation to Prepare for In-Person Helping Babies Breathe Training: Secondary Analysis of a Randomized Controlled Trial (the eHBB/mHBS Trial) %A Ezenwa,Beatrice Nkolika %A Umoren,Rachel %A Fajolu,Iretiola Bamikeolu %A Hippe,Daniel S %A Bucher,Sherri %A Purkayastha,Saptarshi %A Okwako,Felicitas %A Esamai,Fabian %A Feltner,John B %A Olawuyi,Olubukola %A Mmboga,Annet %A Nafula,Mary Concepta %A Paton,Chris %A Ezeaka,Veronica Chinyere %+ Department of Paediatrics, College of Medicine, University of Lagos, Ishaga Road, Idi-Araba, Lagos, 100254, Nigeria, 234 8051403189, beatriceezenwa@yahoo.com %K virtual reality %K mobile learning %K Helping Babies Breathe %K neonatal resuscitation %K mobile Helping Babies Survive powered by District Health Information Software 2 %K neonatal mortality %K digital education %K health care education %K health care worker %K medical education %K digital intervention %D 2022 %7 12.9.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: Neonatal mortality accounts for approximately 46% of global under-5 child mortality. The widespread access to mobile devices in low- and middle-income countries has enabled innovations, such as mobile virtual reality (VR), to be leveraged in simulation education for health care workers. Objective: This study explores the feasibility and educational efficacy of using mobile VR for the precourse preparation of health care professionals in neonatal resuscitation training. Methods: Health care professionals in obstetrics and newborn care units at 20 secondary and tertiary health care facilities in Lagos, Nigeria, and Busia, Western Kenya, who had not received training in Helping Babies Breathe (HBB) within the past 1 year were randomized to access the electronic HBB VR simulation and digitized HBB Provider’s Guide (VR group) or the digitized HBB Provider’s Guide only (control group). A sample size of 91 participants per group was calculated based on the main study protocol that was previously published. Participants were directed to use the electronic HBB VR simulation and digitized HBB Provider’s Guide or the digitized HBB Provider’s Guide alone for a minimum of 20 minutes. HBB knowledge and skills assessments were then conducted, which were immediately followed by a standard, in-person HBB training course that was led by study staff and used standard HBB evaluation tools and the Neonatalie Live manikin (Laerdal Medical). Results: A total of 179 nurses and midwives participated (VR group: n=91; control group: n=88). The overall performance scores on the knowledge check (P=.29), bag and mask ventilation skills check (P=.34), and Objective Structured Clinical Examination A checklist (P=.43) were similar between groups, with low overall pass rates (6/178, 3.4% of participants). During the Objective Structured Clinical Examination A test, participants in the VR group performed better on the critical step of positioning the head and clearing the airway (VR group: 77/90, 86%; control group: 57/88, 65%; P=.002). The median percentage of ventilations that were performed via head tilt, as recorded by the Neonatalie Live manikin, was also numerically higher in the VR group (75%, IQR 9%-98%) than in the control group (62%, IQR 13%-97%), though not statistically significantly different (P=.35). Participants in the control group performed better on the identifying a helper and reviewing the emergency plan step (VR group: 7/90, 8%; control group: 16/88, 18%; P=.045) and the washing hands step (VR group: 20/90, 22%; control group: 32/88, 36%; P=.048). Conclusions: The use of digital interventions, such as mobile VR simulations, may be a viable approach to precourse preparation in neonatal resuscitation training for health care professionals in low- and middle-income countries. %M 36094807 %R 10.2196/37297 %U https://mededu.jmir.org/2022/3/e37297 %U https://doi.org/10.2196/37297 %U http://www.ncbi.nlm.nih.gov/pubmed/36094807 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e35319 %T Remote Moderator and Observer Experiences and Decision-making During Usability Testing of a Web-Based Empathy Training Portal: Content Analysis %A Lobchuk,Michelle %A Bathi,Prachotan Reddy %A Ademeyo,Adedotun %A Livingston,Aislinn %+ College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Room 315 - 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada, 1 204 474 7135, Michelle.Lobchuk@umanitoba.ca %K web browser %K user-centered design %K qualitative research %K internet %K empathy %D 2022 %7 3.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 restrictions severely curtailed empirical endeavors that involved in-person interaction, such as usability testing sessions for technology development. Researchers and developers found themselves using web-based moderation for usability testing. Skilled remote moderators and observers are fundamental in this approach. However, to date, more empirical work is needed that captures the perceptions and support needs of moderators and observers in testing situations. Objective: The aim of this paper was to identify remote moderator and observer participant experiences and their use of certain tools to capture feedback of users as they interact with the web browser application. Methods: This research is part of a broader study on an educational web browser application for nursing students to learn perspective taking and enhance their perceptual understanding of a dialogue partner’s thoughts and feelings. The broader study used a quantitative and think-aloud qualitative problem-discovery usability study design. This case study explored written accounts of the remote moderator and observer participants regarding their roles, experiences, and reactions to the testing protocol and their suggestions for improved techniques and strategies for conducting remote usability testing. Content analysis was used to analyze participants’ experiences in the usability testing sessions. Results: We collected data from 1 remote moderator and 2 remote observers. Five themes were identified: dealing with personal stressors, dealing with user anxiety, maintaining social presence, ethical response to the study protocol, and communication during sessions. The participants offered recommendations for the design of future remote testing activities as well as evidence-informed training materials for usability project personnel. Conclusions: This study’s findings contribute to a growing body of endeavors to understand human-computer interaction and its impact on remote moderator and observer roles. As technology rapidly advances, more remote usability testing will occur where the knowledge gleaned in this study can have an impact. Recommendations based on moderator and observer participant perspectives identify the need for more evidence-informed training materials for their roles that focus on web-based interpersonal communication skills, execution of user testing protocols, troubleshooting technology and test user issues, proficiency in web conferencing platforms, behavior analysis and feedback technologies, and time management. %M 35921138 %R 10.2196/35319 %U https://formative.jmir.org/2022/8/e35319 %U https://doi.org/10.2196/35319 %U http://www.ncbi.nlm.nih.gov/pubmed/35921138 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e37015 %T Resilience Enhancement Online Training for Nurses (REsOluTioN): Protocol for a Pilot Randomized Controlled Trial %A Srikesavan,Cynthia %A Davey,Zoe %A Cipriani,Andrea %A Henshall,Catherine %+ Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, Gipsy Lane, Headington, Oxford, OX3 0BP, United Kingdom, 44 07768 918298, chenshall@brookes.ac.uk %K online training %K nurses %K resilience %K mental well-being %K pilot trial %K COVID-19 %K nursing %K mental health %K health care staff %K psychological health %K online health %K resilience training %K health care setting %D 2022 %7 3.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, nurses are facing increased pressure to provide high-quality complex patient care within environments with scarce resources in terms of staffing, infrastructure, or financial reward. The strain and demand on the psychological health and well-being of nurses during COVID-19 has been substantial, with many experiencing burnout; as such, interventions to enhance resilience within the workplace are required. A face-to-face resilience enhancement training program for nurses that was effective in improving resilience levels was translated into a 4-week online training program, Resilience Enhancement Online Training for Nurses (REsOluTioN), to enable greater accessibility for nurses. Objective: This study aims to compare levels of resilience, psychological health, and well-being in nurses before and after the online resilience training compared to a wait list control group. It will also explore participants’ engagement with the trial and their acceptability of the online training. Methods: This is a two-arm, parallel, randomized controlled trial with a 6-week follow-up period. Up to 100 registered nonagency nurses working at a National Health Service hospital trust in South England will be recruited. Four cohorts will run, and participants will be randomized into a wait list control group or to REsOluTioN. Pre- and postonline surveys will collect study outcome measure data. In the REsOluTioN arm, data will be collected on the perceived usefulness of the online training via an online survey. Institutional and health research authority approvals have been obtained. Results: REsOluTioN will aim to empower nurses to maintain and enhance their resilience while working under challenging clinical conditions. The online training will be interactive with input from mentors, health care leaders, and peers to promote engagement and enhanced communication, and will create a forum where nurses can express their views and concerns, without hierarchical infrastructures inhibiting them. This can increase self-knowledge and learning around workplace resilience coping strategies and provide a safe space to validate feelings through mentorship and peer support. Findings will be reported in accordance with the CONSORT (Consolidated Standards of Reporting Trials) guidelines. The trial is now finished and was conducted between August 2021 and May 2022. Conclusions: The REsOluTioN trial will enable preliminary data to be gathered to indicate the online training’s effectiveness in enhancing nurses’ resilience in the workplace, with the potential for larger scale follow-up studies to identify its value to nurses working across a range of health care settings. Trial Registration: ClinicalTrials.gov NCT05074563; https://clinicaltrials.gov/ct2/show/NCT05074563 International Registered Report Identifier (IRRID): DERR1-10.2196/37015 %M 35862692 %R 10.2196/37015 %U https://www.researchprotocols.org/2022/8/e37015 %U https://doi.org/10.2196/37015 %U http://www.ncbi.nlm.nih.gov/pubmed/35862692 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e37195 %T Effects of a Mindfulness Intervention Comprising an App, Web-Based Workshops, and a Workbook on Perceived Stress Among Nurses and Nursing Trainees: Protocol for a Randomized Controlled Trial %A Schönfeld,Simone %A Rathmer,Ines %A Michaelsen,Maren M %A Hoetger,Cosima %A Onescheit,Miriam %A Lange,Silke %A Werdecker,Lena %A Esch,Tobias %+ Institute for Integrative Health Care and Health Promotion (IGVF), Faculty of Health/School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, Witten, 58448, Germany, 49 2302926 ext 838, IGVF@uni-wh.de %K nurses %K nursing trainee %K nursing student %K acute care %K inpatient %K health promotion %K mindfulness %K mobile %K web-based %K stress %K mobile phone %D 2022 %7 2.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Previous research has found digitally supported mindfulness interventions to be effective when used for stress management among workers in high-stress occupations. Findings on digitally supported mindfulness interventions among nurses working in acute inpatient care settings are heterogeneous, lack long-term follow-up, and do not assess adherence and acceptability. Objective: This study aimed to investigate the effectiveness and efficacy of a digitally supported mindfulness intervention designed to improve health- and work-related outcomes among nurses and nursing trainees working in acute inpatient care settings. Methods: We will conduct a multicenter randomized controlled trial using a wait-list control group design. Randomization will be stratified by hospital and job status (nurse or nursing trainee). Recruitment will take place on the web and offline during the working hours of nurses and nursing trainees. The intervention group will receive a digitally supported mindfulness intervention, which will comprise an app, 2 web-based workshops, and a workbook, whereas the wait-list control group will be scheduled to receive the same intervention 14 weeks later. The 2 web-based workshops will be led by a certified mindfulness-based stress reduction trainer. Nurses will use the app and the workbook independently. Self-report web-based surveys will be conducted on the web at baseline, at 10 weeks after allocation, at 24 weeks after allocation, and at 38 weeks after allocation. Outcomes of interest will include perceived stress (primary outcome), health- and work-related variables, and variables related to adherence and acceptability of the digitally supported mindfulness intervention. We will perform intention-to-treat and per-protocol analyses. Results: Data collection will be completed by the beginning of August 2022. Data analyses will be completed by December 2022. Conclusions: Our study design, including long-term follow-up and the investigation of variables related to adherence and acceptability, will ensure rigorous evaluation of effectiveness and efficacy. Relative to costly in-person intervention efforts, this program may present a cost-effective and potentially highly scalable alternative. Findings regarding effectiveness, efficacy, adherence, and acceptability will inform stakeholders’ decisions regarding the implementation of similar interventions to promote the well-being of nurses and nursing trainees, which may, in turn, alleviate detrimental stress-related outcomes (eg, burnout) because of work-related demands. Trial Registration: German Clinical Trials Register DRKS00025997; https://tinyurl.com/433cas7u International Registered Report Identifier (IRRID): DERR1-10.2196/37195 %M 35916708 %R 10.2196/37195 %U https://www.researchprotocols.org/2022/8/e37195 %U https://doi.org/10.2196/37195 %U http://www.ncbi.nlm.nih.gov/pubmed/35916708 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e37380 %T Technology-Supported Guidance Models Stimulating the Development of Critical Thinking in Clinical Practice: Mixed Methods Systematic Review %A Zlamal,Jaroslav %A Roth Gjevjon,Edith %A Fossum,Mariann %A Trygg Solberg,Marianne %A Steindal,Simen A %A Strandell-Laine,Camilla %A Hamilton Larsen,Marie %A Nes,Andréa Aparecida Gonçalves %+ Department of Bachelor Education in Nursing, Lovisenberg Diaconal University College, Lovisenberggt. 15b, Oslo, 0456, Norway, 47 95963522, Jaroslav.Zlamal@ldh.no %K critical thinking %K guidance models %K technology %K nursing education %K clinical practice %D 2022 %7 7.6.2022 %9 Review %J JMIR Nursing %G English %X Background: Nursing education has increasingly focused on critical thinking among nursing students, as critical thinking is a desired outcome of nursing education. Particular attention is given to the potential of technological tools in guiding nursing students to stimulate the development of critical thinking; however, the general landscape, facilitators, and challenges of these guidance models remain unexplored, and no previous mixed methods systematic review on the subject has been identified. Objective: This study aims to synthesize existing evidence on technology-supported guidance models used in nursing education to stimulate the development of critical thinking in nursing students in clinical practice. Methods: This mixed methods systematic review adopted a convergent, integrated design to facilitate thematic synthesis. This study followed the guidelines of the Joanna Briggs Institute Manual for Evidence Synthesis. Results: We identified 3 analytical themes: learning processes implemented to stimulate critical thinking, organization of the learning process to stimulate critical thinking, and factors influencing the perception of the learning process. We also identified 4 guidance models, all based on facilitator or preceptorship models using tailored instructional or learning strategies and one or several technological tools that were either generic or custom-made for specific outcomes. The main facilitators of these technology-supported guidance models were nurse educators or nurse preceptors, and the main challenges in using technology-supported guidance models were the stress associated with technical difficulties or increased cognitive load. Conclusions: Although we were able to identify 4 technology-supported guidance models, our results indicate a research gap regarding the use of these models in nursing education, with the specific aim of stimulating the development of critical thinking. Both nurse preceptors and nurse educators play a crucial role in the development of critical thinking among nursing students, and technology is essential for such development. However, technology-supported guidance models should be supervised to mitigate the associated stress. International Registered Report Identifier (IRRID): RR2-10.2196/25126 %M 35671078 %R 10.2196/37380 %U https://nursing.jmir.org/2022/1/e37380 %U https://doi.org/10.2196/37380 %U http://www.ncbi.nlm.nih.gov/pubmed/35671078 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e36959 %T A Nurse-Led Multimedia Intervention to Increase Patient Participation in Recovery After Knee Arthroplasty: Hybrid Type II Implementation Study %A McDonall,Jo %A Redley,Bernice %A Livingston,Patricia %A Hutchinson,Ana %A de Steiger,Richard %A Botti,Mari %+ School of Nursing and Midwifery, Faculty of Health, Deakin University, 1 Gheringhap St., Geelong, 3220, Australia, 61 92446630, jo.mcdonall@deakin.edu.au %K patient participation %K multimedia %K nurse-facilitated %K knee arthroplasty %K orthopedic surgery %K acute care %K nurse %K participatory medicine %K digital technology %D 2022 %7 19.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Advances in digital technology and the use of multimedia platforms to deliver information provide clinicians with a unique opportunity to develop innovative ways to consistently provide high-quality, accessible, and evidence-based information to support patient participation. Introducing new technologies into everyday acute care clinical practice can be difficult. Objective: The aim of this paper was to provide a description of an implementation strategy and the subsequent evaluation undertaken to examine the contextual factors important to the successful adoption of new technology by nurses in the context of acute postoperative care. Methods: Implementation of the intervention and process evaluation was undertaken in 3 phases: phase 1, preimplementation stakeholder engagement and identification of barriers and enablers to implementation; phase 2, supported implementation of the intervention; and phase 3, evaluation of uptake, usability, and acceptability of the intervention in clinical practice. Results: The outcomes of the implementation of the multimedia intervention in the context of acute postoperative care were positive. Of the 104 patients in the intervention group, 103 (99%) received the intervention. All 103 patients completed the 8-item intervention questionnaire and 93.3% (97/103) were interviewed on day 3 to evaluate usability, uptake, and acceptability. Of these 97 patients, almost all (n=94, 91%) found the program easy to use and most (n=64, 62%) could view the MyStay Total Knee Replacement program as often as they wanted. The findings also suggest that the time to implement the program was minimal (5-10 minutes). Collaboration with nurses and patients before and during implementation to identify potential barriers to successful implementation of the intervention was essential to develop timely strategies to overcome these barriers. To ensure end-user engagement, careful consideration was given to nurses’ views on who was responsible for facilitating this intervention. Conclusions: The findings provide evidence that the structured implementation of the multimedia intervention was robust and successful in terms of patient participant recruitment and application; however, it was difficult to assess the level of engagement by nurse clinicians with the program. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614000340639; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000340639 %M 35588363 %R 10.2196/36959 %U https://humanfactors.jmir.org/2022/2/e36959 %U https://doi.org/10.2196/36959 %U http://www.ncbi.nlm.nih.gov/pubmed/35588363 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e33960 %T Factors Influencing Clinician Trust in Predictive Clinical Decision Support Systems for In-Hospital Deterioration: Qualitative Descriptive Study %A Schwartz,Jessica M %A George,Maureen %A Rossetti,Sarah Collins %A Dykes,Patricia C %A Minshall,Simon R %A Lucas,Eugene %A Cato,Kenrick D %+ Department of Biomedical Informatics, Columbia University, 622 West 168th Street, PH20 3720, New York, NY, 10032, United States, 1 212 305 5334, jms2468@cumc.columbia.edu %K clinical decision support systems %K machine learning %K inpatient %K nurses %K physicians %K qualitative research %D 2022 %7 12.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Clinician trust in machine learning–based clinical decision support systems (CDSSs) for predicting in-hospital deterioration (a type of predictive CDSS) is essential for adoption. Evidence shows that clinician trust in predictive CDSSs is influenced by perceived understandability and perceived accuracy. Objective: The aim of this study was to explore the phenomenon of clinician trust in predictive CDSSs for in-hospital deterioration by confirming and characterizing factors known to influence trust (understandability and accuracy), uncovering and describing other influencing factors, and comparing nurses’ and prescribing providers’ trust in predictive CDSSs. Methods: We followed a qualitative descriptive methodology conducting directed deductive and inductive content analysis of interview data. Directed deductive analyses were guided by the human-computer trust conceptual framework. Semistructured interviews were conducted with nurses and prescribing providers (physicians, physician assistants, or nurse practitioners) working with a predictive CDSS at 2 hospitals in Mass General Brigham. Results: A total of 17 clinicians were interviewed. Concepts from the human-computer trust conceptual framework—perceived understandability and perceived technical competence (ie, perceived accuracy)—were found to influence clinician trust in predictive CDSSs for in-hospital deterioration. The concordance between clinicians’ impressions of patients’ clinical status and system predictions influenced clinicians’ perceptions of system accuracy. Understandability was influenced by system explanations, both global and local, as well as training. In total, 3 additional themes emerged from the inductive analysis. The first, perceived actionability, captured the variation in clinicians’ desires for predictive CDSSs to recommend a discrete action. The second, evidence, described the importance of both macro- (scientific) and micro- (anecdotal) evidence for fostering trust. The final theme, equitability, described fairness in system predictions. The findings were largely similar between nurses and prescribing providers. Conclusions: Although there is a perceived trade-off between machine learning–based CDSS accuracy and understandability, our findings confirm that both are important for fostering clinician trust in predictive CDSSs for in-hospital deterioration. We found that reliance on the predictive CDSS in the clinical workflow may influence clinicians’ requirements for trust. Future research should explore the impact of reliance, the optimal explanation design for enhancing understandability, and the role of perceived actionability in driving trust. %M 35550304 %R 10.2196/33960 %U https://humanfactors.jmir.org/2022/2/e33960 %U https://doi.org/10.2196/33960 %U http://www.ncbi.nlm.nih.gov/pubmed/35550304 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e36346 %T Normalizing Telemonitoring in Nurse-Led Care Models for Complex Chronic Patient Populations: Case Study %A Gordon,Kayleigh %A Dainty,Katie N %A Steele Gray,Carolyn %A DeLacy,Jane %A Shah,Amika %A Seto,Emily %+ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 416 978 4326, kayleigh.gordon@mail.utoronto.ca %K telemonitoring %K TM %K nurse practitioner %K NP-led care %K models of care %K integrated care %K disease care model %K disease %K nurse %K nurse-led implementation %K complex chronic conditions %K CCC %K clinical team %K mobile phone %D 2022 %7 28.4.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: The implementation of telemonitoring (TM) has been successful in terms of the overall feasibility and adoption in single disease care models. However, a lack of available research focused on nurse-led implementations of TM that targets patients with multiple and complex chronic conditions (CCC) hinders the scale and spread to these patient populations. In particular, little is known about the clinical perspective on the implementation of TM for patients with CCC in outpatient care. Objective: This study aims to better understand the perspective of the clinical team (both frontline clinicians and those in administrative positions) on the implementation and normalization of TM for complex patients in a nurse-led clinic model. Methods: A pragmatic, 6-month implementation study was conducted to embed multicondition TM, including heart failure, hypertension, and diabetes, into an integrated nurse-led model of care. Throughout the study, clinical team members were observed, and a chart review was conducted of the care provided during this time. At the end of the study, clinical team members participated in qualitative interviews and completed the adapted Normalization Measure Development questionnaires. The Normalization Process Theory guided the deductive data analysis. Results: Overall, 9 team members participated in the study as part of a larger feasibility study of the TM program, of which 26 patients were enrolled. Team members had a shared understanding of the purpose and value of TM as an intervention embedded within their practice to meet the diverse needs of their patients with CCC. TM aligned well with existing chronic care practices in several ways, yet it changed the process of care delivery (ie, interactional workability subconstruct). Effective TM normalization in nurse-led care requires rethinking of clinical workflows to incorporate TM, relationship development between the clinicians and their patients, communication with the interdisciplinary team, and frequent clinical care oversight. This was captured well through the subconstructs of skill set workability, relational integration, and contextual integration of the Normalization Process Theory. Conclusions: Clinicians successfully adopted TM into their everyday practice such that some providers felt their role would be significantly and negatively affected without TM. This study demonstrated that smartphone-based TM systems complemented the routine and challenging clinical work caring for patients with CCC in an integrated nurse-led care model. %M 35482375 %R 10.2196/36346 %U https://nursing.jmir.org/2022/1/e36346 %U https://doi.org/10.2196/36346 %U http://www.ncbi.nlm.nih.gov/pubmed/35482375 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e35363 %T Nurses’ Perspectives on an Electronic Medication Administration Record in Home Health Care: Qualitative Interview Study %A Karnehed,Sara %A Erlandsson,Lena-Karin %A Norell Pejner,Margaretha %+ School of Health and Welfare, Halmstad University, Kristian IV:s väg 3, Halmstad, 30118, Sweden, 46 733224077, sara.karnehed@hh.se %K e-health %K eHealth %K eMAR %K electronic medication administration record %K homecare nurses %K home health care %K nursing profession %K delegation %K task-shifting %K medication administration %D 2022 %7 22.4.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: eHealth is considered by policy makers as a prerequisite for meeting the demands of health care from the growing proportion of older people worldwide. The expectation about what the efficiency of eHealth can bring is particularly high in the municipal home health care sector, which is facing pressure regarding resources because of, for example, earlier discharges from hospitals and a growing number of patients receiving medications and treatments at home. Common eHealth services in home health care are electronic medication administration records (eMARs) that aim to communicate delegated tasks between professionals. However, there is an extensive gap in the research on how technology affects and is experienced by home health care professionals. Objective: The objective of this paper is to shed light on how home care nurses experience eMARs in a Swedish municipality. Methods: This qualitative interview study was conducted among home health care nurses using eMARs to facilitate communication and signing of delegated nursing tasks. The analysis of the interviews was performed using constructivist grounded theory, according to Charmaz. Results: Of the 19 day-employed nurses in the municipality where an eMAR was used, 16 (84%) nurses participated in the study. The following two categories were identified from the focus group interviews: nurses become monitors and slip away from the point of care. The nurses experienced that they became monitors of health care through the increased transparency provided by the eMAR and the measurands they also applied, focusing on the quantitative aspects of the delegated nursing tasks rather than the qualitative aspects. The nurses experienced that their monitoring changed the power relations between the professions, reinforcing the nurses’ superior position. The experience of the eMAR was regarded as transitioning the nurses’ professional role—away from the point of care and toward more administration—and further strengthened the way of managing work through delegation to health care assistants. Conclusions: Previous analyses of eHealth services in health care showed that implementation is a complex process that changes health care organizations and the work of health care professionals in both intended and unintended ways. This study adds to the literature by examining how users of a specific eHealth service experience its impacts on their daily work. The results indicate that the inscribed functions in an eHealth service may affect the values and priorities where the service is in use. This presents an opportunity for future research and for health care organizations to assess the impacts of specific eHealth services on health care professionals’ work and to further examine the effects of inscribed functions in relation to how they may affect actions and priorities at individual and organizational levels. %M 35452400 %R 10.2196/35363 %U https://nursing.jmir.org/2022/1/e35363 %U https://doi.org/10.2196/35363 %U http://www.ncbi.nlm.nih.gov/pubmed/35452400 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e36725 %T Simulation-Based Learning Supported by Technology to Enhance Critical Thinking in Nursing Students: Protocol for a Scoping Review %A Stenseth,Hege Vistven %A Steindal,Simen Alexander %A Solberg,Marianne Trygg %A Ølnes,Mia Alexandra %A Mohallem,Andrea %A Sørensen,Anne Lene %A Strandell-Laine,Camilla %A Olaussen,Camilla %A Aure,Caroline Farsjø %A Riegel,Fernando %A Pedersen,Ingunn %A Zlamal,Jaroslav %A Martini,Jussara Gue %A Bresolin,Paula %A Linnerud,Silje Christin Wang %A Nes,Andréa Aparecida Gonçalves %+ Lovisenberg Diaconal University College, Lovisenbergata 15B, Oslo, 0456, Norway, 47 93840197, hege.vistven@ldh.no %K simulation-based learning %K technological supported simulation-based learning %K critical thinking %K nursing students %K nursing education, educational approach %K education %K nursing %D 2022 %7 4.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Critical thinking is a crucial skill in the nursing profession, so teaching strategies and methodology must be carefully considered when training and preparing nursing students to think critically. Studies on simulation-based learning supported by technology are increasing in nursing education, but no scoping reviews have mapped the literature on simulation-based learning supported by technology to enhance critical thinking in nursing students. Objective: The proposed scoping review aims to systematically map research on the use of simulation-based learning supported by technology to enhance critical thinking in nursing students. Methods: The proposed scoping review will use the framework established by Arksey and O’Malley and will be reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. A systematic, comprehensive literature search was performed in the LILACS, ERIC, MEDLINE, EMBASE, PsycINFO, and Web of Science databases. Pairs of authors independently selected the articles by screening titles, abstracts, full-text papers, and extract data. The data will be analyzed and thematically categorized. Results: The development of a comprehensive and systematic search strategy was completed in June 2021. The database searches were performed in July 2021, and the screening of titles and abstracts was completed in September 2021. Charting the data began in February 2022. Analysis and synthesis will be performed sequentially, and the scoping review is expected to be complete by May 2023. Conclusions: The results of this proposed scoping review may identify gaps in the literature and provide an overview of research on the topic of simulation-based learning supported by technology to enhance critical thinking in nursing students. The research may identify nursing students’ reported barriers and enablers for learning critical thinking skills through simulation-based learning supported by technology, and the results may help educators enhance their educational approach through knowledge of students’ firsthand experiences and further development of successful teaching strategies in nursing education. International Registered Report Identifier (IRRID): DERR1-10.2196/36725 %M 35373777 %R 10.2196/36725 %U https://www.researchprotocols.org/2022/4/e36725 %U https://doi.org/10.2196/36725 %U http://www.ncbi.nlm.nih.gov/pubmed/35373777 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e33586 %T Uncovering Important Drivers of the Increase in the Use of Virtual Care Technologies in Nursing Care: Quantitative Analysis From the 2020 National Survey of Canadian Nurses %A Beauséjour,Waldo %A Hagens,Simon %+ Canada Health Infoway, 150 King St W, Toronto, ON, M5H 1J9, Canada, 1 416 595 3449 ext 3421, wbeausejour@infoway-inforoute.ca %K adoption of virtual care %K secure messaging %K nurses %K nursing %K telehealth %K telehomecare %K telemonitoring %K remote patient monitoring %K virtual videoconferencing %K uptake of virtual care %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: Canadian nurses are at the forefront of patient care delivery. Although the use of digital health technologies for care delivery is gaining momentum in Canada, nurses are encouraged to integrate virtual care into their practice. In early 2020, more Canadian nurses delivered care virtually compared with 3 years ago. Objective: This study seeks to uncover the professional characteristics of Canadian nurses accessing virtual care in 2020, understand how these characteristics differ across types of technologies, investigate whether the nurses accessing virtual care possess the skills and knowledge needed to use these technologies, and determine the important drivers of the uptake of virtual care observed in 2020. Methods: We used data from the 2017 and 2020 National Survey of Canadian Nurses. This survey collected data on the use of digital health technologies in nursing practice. It concerned regulated nursing professionals working in different health care settings and from different domains of nursing practice. We combined the chi-square independence test and logistic regression analysis to uncover the most relevant drivers of virtual care uptake by nurses in 2020. Results: In early 2020, before the declaration of the COVID-19 pandemic, nurses who delivered care virtually were predominantly nurse practitioners (135/159, 84.9%) and more likely to work in a primary or community care setting (202/367, 55%) and in an urban setting (194/313, 61.9%). Factors such as nursing designation (P<.001), perceived quality of care at the health facility where the nurses practiced (P<.001), and the type of patient record–keeping system they had access to (P=.04) had a statistically significant effect on the probability of nurses to deliver care virtually in early 2020. Furthermore, nurses’ perception of the quality of care they delivered through virtual technologies was statistically associated with their perception of the skills (χ24=308.7; P<.001) and knowledge (χ24=283.4; P<.001) to use these technologies. Conclusions: This study emphasizes the critical importance of nursing designation, geographic location, and type of patient record–keeping system in predicting virtual care integration in nursing practice. The findings related to geographic location can be used by decision-makers for better allocation of digital health resources among care settings in rural and urban areas. Similarly, the disparities observed across nursing designations have some implications for the digital training of nurses at all levels of practice. Finally, the association between electronic medical record use and uptake of virtual care could accelerate the implementation of more modernized record-keeping systems in care settings. Hence, this could advance interoperability and improve health care delivery. %M 35357326 %R 10.2196/33586 %U https://nursing.jmir.org/2022/1/e33586 %U https://doi.org/10.2196/33586 %U http://www.ncbi.nlm.nih.gov/pubmed/35357326 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e19641 %T Comparison of the Mental Burden on Nursing Care Providers With and Without Mat-Type Sleep State Sensors at a Nursing Home in Tokyo, Japan: Quasi-Experimental Study %A Itoh,Sakiko %A Tan,Hwee-Pink %A Kudo,Kenichi %A Ogata,Yasuko %+ Department of Genome Informatics, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan, 81 6 6210 8361, itoh@gi.med.osaka-u.ac.jp %K long-term care %K caregiver burden %K nursing homes %K aged %K information technology %K sensors %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Increasing need for nursing care has led to the increased burden on formal caregivers, with those in nursing homes having to deal with exhausting labor. Although research activities on the use of internet of things devices to support nursing care for older adults exist, there is limited evidence on the effectiveness of these interventions among formal caregivers in nursing homes. Objective: This study aims to investigate whether mat-type sleep state sensors for supporting nursing care can reduce the mental burden of formal caregivers in a nursing home. Methods: This was a quasi-experimental study at a nursing home in Tokyo, Japan. The study participants were formal caregivers who cared for residents in private rooms on the fourth and fifth floors of the nursing home. In the intervention group, formal caregivers took care of residents who used sleep state sensors on the fourth floor of the nursing home. The sleep state sensors were mat types and designed to detect body motion such as the frequency of toss and turning and to measure heartbeat and respiration. One sensor was placed on a bed in a private room. When body motion is detected, the information is instantly displayed on a monitor at a staff station. In addition, the mental condition of the formal caregivers was measured using a validated self-reported outcome measure—the Profile of Mood States (POMS), Short-Form, 2nd edition. Formal caregivers in both groups received the POMS at baseline, midpoint (week 4), and endpoint (week 8) to identify changes in these domains. The primary outcome was the difference in total mood disturbance (TMD) of the POMS at baseline and week 8. Results: Of the 22 eligible formal caregivers, 12 (intervention group) utilized sleep state sensors for 8 weeks. The remaining 10 formal caregivers (control group) provided nursing care as usual. As for the primary outcome of the difference between TMD at baseline and week 8, TMD in the intervention group improved by –3.67 versus 4.70 in the control group, resulting in a mean difference of –8.37 (95% CI –32.02 to 15.29; P=.48) in favor of the intervention. Conclusions: The present 8-week study showed that sleep state sensing for elderly residents might not be associated with reduced mental burdens on formal caregivers in nursing homes. %M 35319474 %R 10.2196/19641 %U https://aging.jmir.org/2022/1/e19641 %U https://doi.org/10.2196/19641 %U http://www.ncbi.nlm.nih.gov/pubmed/35319474 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e31912 %T Effects of a Nurse-Led Telehealth Self-care Promotion Program on the Quality of Life of Community-Dwelling Older Adults: Systematic Review and Meta-analysis %A Wong,Arkers Kwan Ching %A Bayuo,Jonathan %A Wong,Frances Kam Yuet %A Yuen,Wing Shan %A Lee,Athena Yin Lam %A Chang,Pui King %A Lai,Jojo Tsz Chui %+ School of Nursing, The Hong Kong Polytechnic University, Hung Hom Campus, FG 512, Kowloon, Hong Kong, 852 34003805, arkers.wong@polyu.edu.hk %K telehealth %K meta-analysis %K self-care %K community-dwelling older adult %K nurse %D 2022 %7 21.3.2022 %9 Review %J J Med Internet Res %G English %X Background: In recent years, telehealth has become a common channel for health care professionals to use to promote health and provide distance care. COVID-19 has further fostered the widespread use of this new technology, which can improve access to care while protecting the community from exposure to infection by direct personal contact, and reduce the time and cost of traveling for both health care users and providers. This is especially true for community-dwelling older adults who have multiple chronic diseases and require frequent hospital visits. Nurses are globally recognized as health care professionals who provide effective community-based care to older adults, facilitating their desire to age in place. However, to date, it is unclear whether the use of telehealth can facilitate their work of promoting self-care to community-dwelling older adults. Objective: This review aims to summarize findings from randomized controlled trials on the effect of nurse-led telehealth self-care promotion programs compared with the usual on-site or face-to-face services on the quality of life (QoL), self-efficacy, depression, and hospital admissions among community-dwelling older adults. Methods: A search of 6 major databases was undertaken of relevant studies published from May 2011 to April 2021. Standardized mean differences (SMDs) and their 95% CIs were calculated from postintervention outcomes for continuous data, while the odds ratio was obtained for dichotomous data using the Mantel–Haenszel test. Results: From 1173 possible publications, 13 trials involving a total of 4097 participants were included in this meta-analysis. Compared with the control groups, the intervention groups of community-dwelling older adults significantly improved in overall QoL (SMD 0.12; 95% CI 0.03 to 0.20; P=.006; I2=21%), self-efficacy (SMD 0.19; 95% CI 0.08 to 0.30; P<.001; I2=0%), and depression level (SMD –0.22; 95% CI –0.36 to –0.08; P=.003; I2=89%). Conclusions: This meta-analysis suggests that employing telehealth in nurse-led self-care promotion programs may have a positive impact on older adults, although more studies are needed to strengthen the evidence base, particularly regarding organization and delivery. Trial Registration: PROSPERO (Prospective International Register of Systematic Reviews) CRD42021257299; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=257299 %M 35311680 %R 10.2196/31912 %U https://www.jmir.org/2022/3/e31912 %U https://doi.org/10.2196/31912 %U http://www.ncbi.nlm.nih.gov/pubmed/35311680 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e34036 %T Virtual Reality in Clinical Practice and Research: Viewpoint on Novel Applications for Nursing %A Son,Hyojin %A Ross,Alyson %A Mendoza-Tirado,Elizabeth %A Lee,Lena Jumin %+ Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, 20892, United States, 1 667 701 5768, hyojin.son@nih.gov %K virtual reality %K health care %K application %K nursing %D 2022 %7 16.3.2022 %9 Viewpoint %J JMIR Nursing %G English %X Virtual reality is a novel technology that provides users with an immersive experience in 3D virtual environments. The use of virtual reality is expanding in the medical and nursing settings to support treatment and promote wellness. Nursing has primarily used virtual reality for nursing education, but nurses might incorporate this technology into clinical practice to enhance treatment experience of patients and caregivers. Thus, it is important for nurses to understand what virtual reality and its features are, how this technology has been used in the health care field, and what future efforts are needed in practice and research for this technology to benefit nursing. In this article, we provide a brief orientation to virtual reality, describe the current application of this technology in multiple clinical scenarios, and present implications for future clinical practice and research in nursing. %M 35293870 %R 10.2196/34036 %U https://nursing.jmir.org/2022/1/e34036 %U https://doi.org/10.2196/34036 %U http://www.ncbi.nlm.nih.gov/pubmed/35293870 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e34372 %T Self-compassion Education for Health Professionals (Nurses and Midwives): Protocol for a Sequential Explanatory Mixed Methods Study %A Steen,Mary %A Othman,Shwikar Mahmoud Etman %A Briley,Annette %A Vernon,Rachael %A Hutchinson,Steven %A Dyer,Susan %+ UniSA Clinical and Health Sciences, University of South Australia, Corner of North Terrace and, Frome Rd, Adelaide, 5001, Australia, 61 470626813, shwikar.othman@unisa.edu.au %K self-compassion %K mixed methods research %K study protocol %K health professionals %K nurses %K midwives %D 2022 %7 13.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: A few recent studies have reported that having the ability to provide self-compassion can reduce health professionals’ levels of anxiety and stress, the risk of compassion fatigue, and burnout, and it can generally improve their well-being. Therefore, there is evidence to support further research into the investigation and exploration of self-compassion education and training for health professionals. Objective: This study aims to increase the knowledge and understanding of self-compassion and how this may enhance the health and well-being of health professionals. Methods: The proposed research study will adopt a sequential explanatory mixed methods design. This study will be conducted in 3 phases. Phase 1 will use a pre-educational self-compassion questionnaire (web-based survey) to collect data from participants at 3 time points (before, immediately after, and after follow-up at 6-8 weeks) after they have attended a self-compassion education and training program. Phase 2 will use an interview schedule to explore the participants’ views and experiences through a follow-up focus group or individual interview. Finally, phase 3 will include data integration and dissemination of key findings and recommendations. Results: This study was approved by the Women’s and Children’s Health Network Human Research Ethics Committee and the Human Research Ethics Committee at the University of South Australia on June 26, 2021 (ID: 204,074). A scoping review was conducted to inform this research study (focusing on nurses and midwives). The preparatory phase was completed in April 2021. Phase 1 is expected to be completed by June 2022 and phase 2 will commence in July 2022. Conclusions: The key findings from the data integration for this research project will provide in-depth details and insights to broaden the discussion about self-compassion and its influence on health professionals’ health and well-being. Health professionals (nurses and midwives) may benefit from self-compassion education and training programs to improve their health and well-being. International Registered Report Identifier (IRRID): PRR1-10.2196/34372 %M 34848389 %R 10.2196/34372 %U https://www.researchprotocols.org/2022/1/e34372 %U https://doi.org/10.2196/34372 %U http://www.ncbi.nlm.nih.gov/pubmed/34848389 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e31878 %T Accuracy of Physical Assessment in Nursing for Cervical Spine Joint Pain and Stiffness: Pilot Study Protocol %A Soares,Bruno %A Fonseca,Raquel %A Fonseca,Patrícia %A Alves,Paulo %+ Instituto Ciências da Saúde, Universidade Católica Portuguesa, Rua de Diogo Botelho, 1327, Porto, 4169-005, Portugal, 351 933880937, brunomgsoares@gmail.com %K nursing process %K nursing assessment %K pain %K referred pain %K range of motion %K neck pain %K stomatognathic system %K viscerosomatic reflexes %K cervical spine dysfunction %D 2021 %7 17.12.2021 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Cervical spine dysfunction is a condition with high personal, social, and economic impact worldwide. Although its etiology is described as multifactorial, there is a need for further clarification. The literature has demonstrated the anatomical, physiological, and pathophysiological relationship among the cervical spine, temporomandibular joint, and visceral system. To guide and contribute to the accuracy of the physical assessment performed by nurses, we will study the influence of the stomatognathic system and viscerosomatic reflexes on pain and joint stiffness of the cervical spine. Objective: The aim of this study is to describe a pilot study protocol to investigate the influence of the stomatognathic system and viscerosomatic reflexes on cervical structures. Methods: A pilot study with a quasi-experimental design was conducted with 50 volunteers from the university population of the Universidade Católica Portuguesa-Porto. We studied the influence of changes in the usual intercuspation, the occlusal deprogramming, and the pressure stimulus of the reflex skin region of the ilium/colon in the cervical spine. This study was divided into 2 phases. In the first phase, we performed the kinematic and pain analysis during the passive mobilization of the upper cervical spine using the Motion Capture System at the Motion Capture Laboratory at UCP-Porto and the Visual Analog Scale. In the second phase, we evaluated the pain threshold on palpation of the erector neck muscles and the structures of the stomatognathic system using algometry. The influence of viscerosomatic reflexes on the structures of the stomatognathic system was also analyzed. Results: Selection and preparation of the data collection site, acquisition of materials, constitution of the sample group and data collection were completed. The analysis of the results is being carried out. Conclusions: The data from this study will allow for the detection of the possible influence of the stomatognathic system and viscerosomatic reflexes on pain and range of motion of the upper cervical spine, providing data for future randomized studies. We have also identified potential limitations of this study. International Registered Report Identifier (IRRID): RR1-10.2196/31878 %M 34927588 %R 10.2196/31878 %U https://www.researchprotocols.org/2021/12/e31878 %U https://doi.org/10.2196/31878 %U http://www.ncbi.nlm.nih.gov/pubmed/34927588 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e33695 %T Harnessing Innovative Technologies to Train Nurses in Suicide Safety Planning With Hospitalized Patients: Protocol for Formative and Pilot Feasibility Research %A Darnell,Doyanne %A Areán,Patricia A %A Dorsey,Shannon %A Atkins,David C %A Tanana,Michael J %A Hirsch,Tad %A Mooney,Sean D %A Boudreaux,Edwin D %A Comtois,Katherine Anne %+ Department of Psychiatry & Behavioral Sciences, University of Washington, 325 Ninth Avenue, Box 359911, Seattle, WA, 98104, United States, 1 206 744 9108, darnelld@uw.edu %K suicide prevention %K hospital %K training %K e-learning %K artificial intelligence %K implementation science %K user-centered design %K task-shifting %K quality assessment %K fidelity %D 2021 %7 15.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Suicide is the 10th leading cause of death in the United States, with >47,000 deaths in 2019. Most people who died by suicide had contact with the health care system in the year before their death. Health care provider training is a top research priority identified by the National Action Alliance for Suicide Prevention; however, evidence-based approaches that target skill-building are resource intensive and difficult to implement. Advances in artificial intelligence technology hold promise for improving the scalability and sustainability of training methods, as it is now possible for computers to assess the intervention delivery skills of trainees and provide feedback to guide skill improvements. Much remains to be known about how best to integrate these novel technologies into continuing education for health care providers. Objective: In Project WISE (Workplace Integrated Support and Education), we aim to develop e-learning training in suicide safety planning, enhanced with novel skill-building technologies that can be integrated into the routine workflow of nurses serving patients hospitalized for medical or surgical reasons or traumatic injury. The research aims include identifying strategies for the implementation and workflow integration of both the training and safety planning with patients, adapting 2 existing technologies to enhance general counseling skills for use in suicide safety planning (a conversational agent and an artificial intelligence–based feedback system), observing training acceptability and nurse engagement with the training components, and assessing the feasibility of recruitment, retention, and collection of longitudinal self-report and electronic health record data for patients identified as at risk of suicide. Methods: Our developmental research includes qualitative and observational methods to explore the implementation context and technology usability, formative evaluation of the training paradigm, and pilot research to assess the feasibility of conducting a future cluster randomized pragmatic trial. The trial will examine whether patients hospitalized for medical or surgical reasons or traumatic injury who are at risk of suicide have better suicide-related postdischarge outcomes when admitted to a unit with nurses trained using the skill-building technology than those admitted to a unit with untrained nurses. The research takes place at a level 1 trauma center, which is also a safety-net hospital and academic medical center. Results: Project WISE was funded in July 2019. As of September 2021, we have completed focus groups and usability testing with 27 acute care and 3 acute and intensive care nurses. We began data collection for research aims 3 and 4 in November 2021. All research has been approved by the University of Washington institutional review board. Conclusions: Project WISE aims to further the national agenda to improve suicide prevention in health care settings by training nurses in suicide prevention with medically hospitalized patients using novel e-learning technologies. International Registered Report Identifier (IRRID): DERR1-10.2196/33695 %M 34914618 %R 10.2196/33695 %U https://www.researchprotocols.org/2021/12/e33695 %U https://doi.org/10.2196/33695 %U http://www.ncbi.nlm.nih.gov/pubmed/34914618 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e34652 %T Developing an mHealth Application to Coordinate Nurse-Provided Respite Care Services for Families Coping With Palliative-Stage Cancer: Protocol for a User-Centered Design Study %A Castro,Aimee R %A Arnaert,Antonia %A Moffatt,Karyn %A Kildea,John %A Bitzas,Vasiliki %A Tsimicalis,Argerie %+ Ingram School of Nursing, McGill University, 680 Sherbrooke Ouest, #1800, Montreal, QC, H3A 2M7, Canada, 1 4383883548, aimee.castro2@mail.mcgill.ca %K respite care %K caregivers %K cancer %K neoplasms %K user-centered design %K mobile applications %K palliative care %K home care services %K information systems research framework %K hospice and palliative care nursing %D 2021 %7 13.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients living with palliative-stage cancer frequently require intensive care from their family caregivers. Without adequate community support services, patients are at risk of receiving inadequate care, and family caregivers are at risk for depression and poor health. For such families, in-home respite care can be invaluable, particularly when the services are flexible and staffed by trusted care providers, such as nurses. Other industries are using mobile apps to make services more flexible. However, few apps have been developed to coordinate nurse-provided respite care services, and to our knowledge, none have been designed in conjunction with families affected by cancer. Objective: The aim of this study is to develop a mobile health (mHealth) app prototype for coordinating flexible and trusted in-home respite care services provided by nurses to families coping with palliative-stage cancer in Québec, Canada. Methods: This user-centered design research comprises the core component of the iRespite Services iRépit research program. For this study, we are recruiting 20 nurses, 15 adults with palliative-stage cancer, and 20 of their family caregivers, from two palliative oncology hospital departments and one palliative home-care community partner. Overseen by an Expert Council, remote data collection will occur over three research phases guided by the iterative Information Systems Research Framework: Phase 1, brainstorming potential app solutions to challenging respite care scenarios, for better supporting the respite needs of both family caregivers and care recipients; Phase 2, evaluating low-fidelity proofs of concept for potential app designs; and Phase 3, usability testing of a high-fidelity interactive proof of concept that will then be programmed into an app prototype. Qualitative and quantitative data will be descriptively analyzed within each phase and triangulated to refine the app features. Results: We anticipate that preliminary results will be available by Spring 2022. Conclusions: An app prototype will be developed that has sufficient complimentary evidence to support future pilot testing in the community. Such an app could improve the delivery of community respite care services provided to families with palliative-stage cancer in Québec, supporting death at home, which is where most patients and their families wish to be. International Registered Report Identifier (IRRID): PRR1-10.2196/34652 %M 34898464 %R 10.2196/34652 %U https://www.researchprotocols.org/2021/12/e34652 %U https://doi.org/10.2196/34652 %U http://www.ncbi.nlm.nih.gov/pubmed/34898464 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e31358 %T Nursing Perspectives on the Impacts of COVID-19: Social Media Content Analysis %A Koren,Ainat %A Alam,Mohammad Arif Ul %A Koneru,Sravani %A DeVito,Alexa %A Abdallah,Lisa %A Liu,Benyuan %+ Solomont School of Nursing, University of Massachusetts Lowell, 113 Wilder Street, Suite 200, Health and Social Science Building, Lowell, MA, 01854-3058, United States, 1 9789344429, Ainat_Koren@uml.edu %K mental health %K information retrieval %K coronavirus %K COVID-19 %K nursing %K nurses %K health care workers %K pandemic %K impact %K social media analytics %D 2021 %7 10.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Nurses are at the forefront of the COVID-19 pandemic. During the pandemic, nurses have faced an elevated risk of exposure and have experienced the hazards related to a novel virus. While being heralded as lifesaving heroes on the front lines of the pandemic, nurses have experienced more physical, mental, and psychosocial problems as a consequence of the COVID-19 outbreak. Social media discussions by nursing professionals participating in publicly formed Facebook groups constitute a valuable resource that offers longitudinal insights. Objective: This study aimed to explore how COVID-19 impacted nurses through capturing public sentiments expressed by nurses on a social media discussion platform and how these sentiments changed over time. Methods: We collected over 110,993 Facebook discussion posts and comments in an open COVID-19 group for nurses from March 2020 until the end of November 2020. Scraping of deidentified offline HTML tags on social media posts and comments was performed. Using subject-matter expert opinions and social media analytics (ie, topic modeling, information retrieval, and sentiment analysis), we performed a human-in-a-loop analysis of nursing professionals’ key perspectives to identify trends of the COVID-19 impact among at-risk nursing communities. We further investigated the key insights of the trends of the nursing professionals’ perspectives by detecting temporal changes of comments related to emotional effects, feelings of frustration, impacts of isolation, shortage of safety equipment, and frequency of safety equipment uses. Anonymous quotes were highlighted to add context to the data. Results: We determined that COVID-19 impacted nurses’ physical, mental, and psychosocial health as expressed in the form of emotional distress, anger, anxiety, frustration, loneliness, and isolation. Major topics discussed by nurses were related to work during a pandemic, misinformation spread by the media, improper personal protective equipment (PPE), PPE side effects, the effects of testing positive for COVID-19, and lost days of work related to illness. Conclusions: Public Facebook nursing groups are venues for nurses to express their experiences, opinions, and concerns and can offer researchers an important insight into understanding the COVID-19 impact on health care workers. %M 34623957 %R 10.2196/31358 %U https://formative.jmir.org/2021/12/e31358 %U https://doi.org/10.2196/31358 %U http://www.ncbi.nlm.nih.gov/pubmed/34623957 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e30238 %T The Communicating Narrative Concerns Entered by Registered Nurses (CONCERN) Clinical Decision Support Early Warning System: Protocol for a Cluster Randomized Pragmatic Clinical Trial %A Rossetti,Sarah Collins %A Dykes,Patricia C %A Knaplund,Christopher %A Kang,Min-Jeoung %A Schnock,Kumiko %A Garcia Jr,Jose Pedro %A Fu,Li-Heng %A Chang,Frank %A Thai,Tien %A Fred,Matthew %A Korach,Tom Z %A Zhou,Li %A Klann,Jeffrey G %A Albers,David %A Schwartz,Jessica %A Lowenthal,Graham %A Jia,Haomiao %A Liu,Fang %A Cato,Kenrick %+ Department of Biomedical Informatics, Columbia University, 622 W 168th Street PH20, New York, NY, 10032, United States, 1 781 801 9211, sac2125@cumc.columbia.edu %K nursing documentation %K prediction %K early warning system %K deterioration %K clinical trial %K clinical decision support system %K natural language processing %D 2021 %7 10.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Every year, hundreds of thousands of inpatients die from cardiac arrest and sepsis, which could be avoided if those patients’ risk for deterioration were detected and timely interventions were initiated. Thus, a system is needed to convert real-time, raw patient data into consumable information that clinicians can utilize to identify patients at risk of deterioration and thus prevent mortality and improve patient health outcomes. The overarching goal of the COmmunicating Narrative Concerns Entered by Registered Nurses (CONCERN) study is to implement and evaluate an early warning score system that provides clinical decision support (CDS) in electronic health record systems. With a combination of machine learning and natural language processing, the CONCERN CDS utilizes nursing documentation patterns as indicators of nurses’ increased surveillance to predict when patients are at the risk of clinical deterioration. Objective: The objective of this cluster randomized pragmatic clinical trial is to evaluate the effectiveness and usability of the CONCERN CDS system at 2 different study sites. The specific aim is to decrease hospitalized patients’ negative health outcomes (in-hospital mortality, length of stay, cardiac arrest, unanticipated intensive care unit transfers, and 30-day hospital readmission rates). Methods: A multiple time-series intervention consisting of 3 phases will be performed through a 1-year period during the cluster randomized pragmatic clinical trial. Phase 1 evaluates the adoption of our algorithm through pilot and trial testing, phase 2 activates optimized versions of the CONCERN CDS based on experience from phase 1, and phase 3 will be a silent release mode where no CDS is viewable to the end user. The intervention deals with a series of processes from system release to evaluation. The system release includes CONCERN CDS implementation and user training. Then, a mixed methods approach will be used with end users to assess the system and clinician perspectives. Results: Data collection and analysis are expected to conclude by August 2022. Based on our previous work on CONCERN, we expect the system to have a positive impact on the mortality rate and length of stay. Conclusions: The CONCERN CDS will increase team-based situational awareness and shared understanding of patients predicted to be at risk for clinical deterioration in need of intervention to prevent mortality and associated harm. Trial Registration: ClinicalTrials.gov NCT03911687; https://clinicaltrials.gov/ct2/show/NCT03911687 International Registered Report Identifier (IRRID): DERR1-10.2196/30238 %M 34889766 %R 10.2196/30238 %U https://www.researchprotocols.org/2021/12/e30238 %U https://doi.org/10.2196/30238 %U http://www.ncbi.nlm.nih.gov/pubmed/34889766 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 4 %P e30831 %T Medical Brain Drain From Southeastern Europe: Using Digital Demography to Forecast Health Worker Emigration %A Jurić,Tado %+ Catholic University of Croatia, Ilica 242, Zagreb, 10000, Croatia, 385 955795181, tado.juric@unicath.hr %K digital demography %K Google Trends %K the emigration of doctors and nurses %K medical brain drain %K Croatia %K demography %K brain drain %K emigration %K doctors %K nurses %K Western Balkans %K health care workers %K health professionals %K health systems %K jobs %K Germany %K personnel %K migration %K workforce %K medical professionals %D 2021 %7 30.11.2021 %9 Original Paper %J JMIRx Med %G English %X Background: This paper shows that the tools of digital demography, such as Google Trends, can be used for determining, estimating, and predicting the migration of health care workers (HWs), in this case, from Croatia and the Western Balkans (WB) to Germany and Austria. Objective: This study aims to test the usefulness of Google Trends indexes to forecast HW migration from Croatia and the WB to Germany and Austria. The paper analyzes recent trends in HW mobility in Europe and focuses specifically on mobility patterns among medical doctors and nurses using digital demography. Without increased emigration in the last 10 years, Croatia and the WB would have 50% more HWs today, and this staff is now crucial in the fight against a pandemic. Furthermore, the COVID-19 pandemic contributed to the increase in emigration. Methods: A particular problem in analyzing the emigration of HCWs from Croatia and the WB is that there is no system for monitoring this process. Official data is up to 3 years late and exists only for persons deregistered from the state system. Furthermore, during the pandemic, the “normal” ways of data collection are simply too slow. The primary methodological concept of our approach is to monitor the digital trace of language searches with the Google Trends analytical tool. To standardize the data, we requested the data from January 2010 to December 2020 and divided the keyword frequency for each migration-related query. We compared this search frequency index with official statistics to prove the significance of the results and correlations, and test the model’s predictive potential. Results: All tested migration-related search queries, which indicate HCWs’ emigration planning, showed a positive linear association between Google index and data from official statistics (Organisation for Economic Co-operation and Development: Serbia R2=0.3381, Bosnia and Herzegovina [B&H] R2=0.2722, Croatia R2=0.4515). Migration-related search activities such as “job application + nurses” from Croatia correlate strongly with official German data for emigrated HWs from Croatia, Serbia, and B&H. Decreases in Google searches were correlated with the decrease in the emigration of HWs. Thus, this method allows reliable forecasts for the future. Conclusions: This paper highlights that the World Health Organization’s list of countries with HWs shortages should be updated to include Croatia and the countries from the WB. The issue of the European Union drawing HWs from the EU periphery (Croatia) and nearby countries (B&H, Serbia) clearly shows a clash between the EU freedom of movement and the right to health care and a need to ensure a health care workforce in all European regions. Understanding why HWs emigrate from Croatia and the WB, and the consequences of this process are crucial to enabling state agencies and governments to develop optimal intervention strategies to retain medical staff. The benefit of this method is reliable estimates that can enable a better response to a possible shortage of HWs and protect the functioning of the health system. The freedom of movement of workers in the EU must be supplemented with a common pension and health care system in the EU. %M 37725553 %R 10.2196/30831 %U https://med.jmirx.org/2021/4/e30831 %U https://doi.org/10.2196/30831 %U http://www.ncbi.nlm.nih.gov/pubmed/37725553 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e26456 %T Clinical Impact of an Analytic Tool for Predicting the Fall Risk in Inpatients: Controlled Interrupted Time Series %A Cho,Insook %A Jin,In sun %A Park,Hyunchul %A Dykes,Patricia C %+ Nursing Department, College of Medicine, Inha University, 100 Inha-ro, namu-gu, Incheon, 22212, Republic of Korea, 82 01042323943, insook.cho@inha.ac.kr %K clinical effectiveness %K data analytics %K event prediction %K inpatient falls %K process metrics %D 2021 %7 25.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Patient falls are a common cause of harm in acute-care hospitals worldwide. They are a difficult, complex, and common problem requiring a great deal of nurses’ time, attention, and effort in practice. The recent rapid expansion of health care predictive analytic applications and the growing availability of electronic health record (EHR) data have resulted in the development of machine learning models that predict adverse events. However, the clinical impact of these models in terms of patient outcomes and clinicians’ responses is undetermined. Objective: The purpose of this study was to determine the impact of an electronic analytic tool for predicting fall risk on patient outcomes and nurses’ responses. Methods: A controlled interrupted time series (ITS) experiment was conducted in 12 medical-surgical nursing units at a public hospital between May 2017 and April 2019. In six of the units, the patients’ fall risk was assessed using the St. Thomas’ Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) system (control units), while in the other six, a predictive model for inpatient fall risks was implemented using routinely obtained data from the hospital’s EHR system (intervention units). The primary outcome was the rate of patient falls; secondary outcomes included the rate of falls with injury and analysis of process metrics (nursing interventions that are designed to mitigate the risk of fall). Results: During the study period, there were 42,476 admissions, of which 707 were for falls and 134 for fall injuries. Allowing for differences in the patients’ characteristics and baseline process metrics, the number of patients with falls differed between the control (n=382) and intervention (n=325) units. The mean fall rate increased from 1.95 to 2.11 in control units and decreased from 1.92 to 1.79 in intervention units. A separate ITS analysis revealed that the immediate reduction was 29.73% in the intervention group (z=–2.06, P=.039) and 16.58% in the control group (z=–1.28, P=.20), but there was no ongoing effect. The injury rate did not differ significantly between the two groups (0.42 vs 0.31, z=1.50, P=.134). Among the process metrics, the risk-targeted interventions increased significantly over time in the intervention group. Conclusions: This early-stage clinical evaluation revealed that implementation of an analytic tool for predicting fall risk may to contribute to an awareness of fall risk, leading to positive changes in nurses’ interventions over time. Trial Registration: Clinical Research Information Service (CRIS), Republic of Korea KCT0005286; https://cris.nih.go.kr/cris/search/detailSearch.do/16984 %M 34626168 %R 10.2196/26456 %U https://medinform.jmir.org/2021/11/e26456 %U https://doi.org/10.2196/26456 %U http://www.ncbi.nlm.nih.gov/pubmed/34626168 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e33158 %T An Advanced Nursing Directive for Children With Suspected Appendicitis: Protocol for a Quality Improvement Feasibility Study %A Chaudhari,Hanu %A Schneeweiss,Michelle %A Rebinsky,Reid %A Rullo,Enrico %A Eltorki,Mohamed %+ Faculty of Health Sciences, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada, 1 416 985 4520, hanu.chaudhari@medportal.ca %K quality improvement %K pediatric %K nursing %K medical directive %K appendicitis %K emergency department flow %K nursing directive %D 2021 %7 20.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Pediatric appendicitis accounts for an estimated 7% to 10% of abdominal pain cases in the emergency department (ED). The diagnosis is time-consuming, and the investigative process depends on physician assessment, resulting in delays in diagnosis and therapeutic management. The utility of an advanced nursing directive (AND) to expedite this process is unclear and needs further exploration. Objective: This study aims to describe key components of ED flow in patients with suspected appendicitis seen at a pediatric ED and pilot a directive that allows ED nurses to perform an order set that includes blood work, urine tests, analgesics, fluids, and an abdominal-pelvis ultrasound prior to physician assessment. Methods: This study involves conducting a retrospective chart review alongside a quality improvement initiative to compare key ED flow metrics before and after AND implementation. Primary outcome measures include median time from ED triage assessment to ultrasound completion, analgesia administration, blood work results, and time to disposition (consult or discharge), alongside other key ED flow metrics for suspected appendicitis. Secondary outcomes will involve patient and caretaker satisfaction surveys. Descriptive statistics will be used to summarize the data. For differences in proportions, a chi-square test will be used. The Student t test will be used for continuous variables. A variable-controlled run chart will be performed to assess impact on ED flow metrics. Patient and family satisfaction surveys are administered immediately after the directive encounter and 7 days afterward. Results: There are currently 3900 patients who have been screened, 344 patients who have been enrolled, and 90 patients who have received the medical directive since implementation in June 2020. Interim results on reduction of time to diagnostic and therapeutic ED flow parameters and satisfaction surveys are expected to be published in February 2022. The final study endpoint will be in June 2022. Conclusions: This study proposes a novel protocol for improving the diagnosis and treatment of suspected pediatric appendicitis through implementation of an evidence-based AND. This model may provide a standardized, international pathway for management of common pediatric and adult emergencies. International Registered Report Identifier (IRRID): RR1-10.2196/33158 %M 34668867 %R 10.2196/33158 %U https://www.researchprotocols.org/2021/10/e33158 %U https://doi.org/10.2196/33158 %U http://www.ncbi.nlm.nih.gov/pubmed/34668867 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e32911 %T Female Genital Mutilation/Cutting Education for Midwives and Nurses as Informed by Women’s Experiences: Protocol for an Exploratory Sequential Mixed Methods Study %A Diaz,Monica Pilar %A Steen,Mary %A Brown,Angela %A Fleet,Julie-Anne %A Williams,Jan %+ UniSA Clinical and Health Sciences Unit, University of South Australia, City East Campus, GPO BOX 2471, Adelaide, 5001, Australia, 61 08 83021372, diamp001@mymail.unisa.edu.au %K education %K midwives %K nurses %K female genital mutilation/cutting %K maternity care %K women’s health care, knowledge %K attitude %K practice %D 2021 %7 15.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Female genital mutilation/cutting (FGM/C) is a complex and deeply rooted sociocultural custom that is innately entrenched in the lives of those who continue its practice despite the physical and psychological dangers it perpetrates. FGM/C is considered a significant independent risk factor for adverse maternal and fetal outcomes in pregnancy and childbirth. Several studies in high-income countries have explored the experiences and needs of women with FGM/C as well as the knowledge of the health professionals, particularly midwives and nurses, who care for them. However, to date, no studies have evaluated the implementation of education for health professionals in high-income countries to meet the specific needs of women with FGM/C. Objective: This study aims to explore the impact of an FGM/C education program for midwives and nurses as informed by the experiences of women with FGM/C accessing maternity, gynecological, and sexual health services in South Australia. Methods: This study will adopt a three-phase, exploratory sequential mixed methods design. Phase 1 will involve the exploration of women with FGM/C views and experiences accessing maternity and gynecological (including sexual health) services in South Australia. The findings from phase 1 will inform phase 2: the development of an educational program for midwives and nurses on the health and cultural needs of women with FGM/C. Phase 3 will involve the evaluation of the program by measuring midwives’ and nurses’ changes in knowledge, attitude, and practice immediately before and after the education as well as 4 months after completing the program. Phase 1 of this study has been approved by the Women’s and Children’s Health Network human research ethics committee (ID number 2021/HRE00156) and the University of South Australia human research ethics committee (ID number 204096). Results: Phase 1 will commence in August 2021, with the interpretation of findings being undertaken by November 2021. Phase 2 will be developed and facilitated by February 2022, and the final phase of this study will begin in March 2022. This study is expected to be completed by February 2023. Conclusions: The findings of this research will provide insight into the development and evaluation of education programs for midwives and nurses that includes collaboration with women from culturally and linguistically diverse backgrounds to address the specific cultural and health needs of communities. International Registered Report Identifier (IRRID): PRR1-10.2196/32911 %M 34652281 %R 10.2196/32911 %U https://www.researchprotocols.org/2021/10/e32911 %U https://doi.org/10.2196/32911 %U http://www.ncbi.nlm.nih.gov/pubmed/34652281 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e31646 %T Technology-Supported Guidance Model to Support the Development of Critical Thinking Among Undergraduate Nursing Students in Clinical Practice: Protocol of an Exploratory, Flexible Mixed Methods Feasibility Study %A Zlamal,Jaroslav %A Gjevjon,Edith Roth %A Fossum,Mariann %A Steindal,Simen Alexander %A Nes,Andréa Aparecida Gonçalves %+ Lovisenberg Diaconal University College, Lovisenberggata 15b, Oslo, 0456, Norway, 47 95963522, Jaroslav.Zlamal@ldh.no %K critical thinking %K guidance model %K feasibility %K technology %K medical education %K nursing education %K clinical practice %D 2021 %7 13.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Critical thinking is an essential set of skills in nursing education, and nursing education therefore needs a sharper focus on effective ways to support the development of these skills, especially through the implementation of technological tools in nursing education. Objective: The aim of this study protocol is to assess the feasibility of a technology-supported guidance model grounded in the metacognition theory for nursing students in clinical practice. Methods: Both quantitative (research questionnaires) and qualitative (focus group interviews) approaches will be used to collect data for a feasibility study with an exploratory, flexible mixed methods design to test a newly developed intervention in clinical practice. Results: The intervention development was completed in December 2020. The intervention will be tested in 3 independent nursing homes in Norway. Conclusions: By determining the feasibility of a technology-supported guidance model for nursing students in clinical practice, the results will provide information on the acceptability of the intervention and the suitability of the outcome measures and data collection strategy. They will also identify the causes of dropout and obstacles to retention and adherence. International Registered Report Identifier (IRRID): DERR1-10.2196/31646 %M 34643536 %R 10.2196/31646 %U https://www.researchprotocols.org/2021/10/e31646 %U https://doi.org/10.2196/31646 %U http://www.ncbi.nlm.nih.gov/pubmed/34643536 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 2 %P e29200 %T Predicting Prolonged Apnea During Nurse-Administered Procedural Sedation: Machine Learning Study %A Conway,Aaron %A Jungquist,Carla R %A Chang,Kristina %A Kamboj,Navpreet %A Sutherland,Joanna %A Mafeld,Sebastian %A Parotto,Matteo %+ Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Suite 130, 155 College Street, Toronto, ON, M5T 1P8, Canada, 1 (416) 340 4654, aaron.conway@utoronto.ca %K procedural sedation and analgesia %K conscious sedation %K nursing %K informatics %K patient safety %K machine learning %K capnography %K anesthesia %K anaesthesia %K medical informatics %K sleep apnea %K apnea %K apnoea %K sedation %D 2021 %7 5.10.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Capnography is commonly used for nurse-administered procedural sedation. Distinguishing between capnography waveform abnormalities that signal the need for clinical intervention for an event and those that do not indicate the need for intervention is essential for the successful implementation of this technology into practice. It is possible that capnography alarm management may be improved by using machine learning to create a “smart alarm” that can alert clinicians to apneic events that are predicted to be prolonged. Objective: To determine the accuracy of machine learning models for predicting at the 15-second time point if apnea will be prolonged (ie, apnea that persists for >30 seconds). Methods: A secondary analysis of an observational study was conducted. We selected several candidate models to evaluate, including a random forest model, generalized linear model (logistic regression), least absolute shrinkage and selection operator regression, ridge regression, and the XGBoost model. Out-of-sample accuracy of the models was calculated using 10-fold cross-validation. The net benefit decision analytic measure was used to assist with deciding whether using the models in practice would lead to better outcomes on average than using the current default capnography alarm management strategies. The default strategies are the aggressive approach, in which an alarm is triggered after brief periods of apnea (typically 15 seconds) and the conservative approach, in which an alarm is triggered for only prolonged periods of apnea (typically >30 seconds). Results: A total of 384 apneic events longer than 15 seconds were observed in 61 of the 102 patients (59.8%) who participated in the observational study. Nearly half of the apneic events (180/384, 46.9%) were prolonged. The random forest model performed the best in terms of discrimination (area under the receiver operating characteristic curve 0.66) and calibration. The net benefit associated with the random forest model exceeded that associated with the aggressive strategy but was lower than that associated with the conservative strategy. Conclusions: Decision curve analysis indicated that using a random forest model would lead to a better outcome for capnography alarm management than using an aggressive strategy in which alarms are triggered after 15 seconds of apnea. The model would not be superior to the conservative strategy in which alarms are only triggered after 30 seconds. %M 34609322 %R 10.2196/29200 %U https://periop.jmir.org/2021/2/e29200 %U https://doi.org/10.2196/29200 %U http://www.ncbi.nlm.nih.gov/pubmed/34609322 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 3 %P e27854 %T Nursing Student Perceptions and Attitudes Toward Patients With Cancer After Education and Mentoring: Integrative Review %A Hedenstrom,Margot Lisa %A Sneha,Sweta %A Nalla,Anusha %A Wilson,Barbara %+ Wellstar School of Nursing, Wellstar College of Health Sciences, Kennesaw State University, 520 Parliament Garden Way, Rm 3114 MD 4102, Kennesaw, GA, 30144, United States, 1 470 578 7969, mhedenst@kennesaw.edu %K nursing students %K nurse %K cancer %K attitudes %K health care professionals %K nursing %K cancer patients %K oncology %K patient support %K continuing education %K mentoring %D 2021 %7 24.9.2021 %9 Review %J JMIR Cancer %G English %X Background: Knowledge about nursing student attitudes toward patients with cancer after an educational intervention and mentoring support is limited. This review examined the literature on this topic. Objective: This integrative review aims to explore the literature on the experiences of students who participate in an oncology elective or educational course on cancer and their attitudes toward cancer. Methods: A comprehensive search was conducted using PubMed, CINAHL, and MEDLINE databases. Each study was systematically assessed. An evidence table was completed to identify the key aspects of each study that was reviewed. Results: There is insufficient information on the impact of nursing student education on the attitudes and skills of nursing students caring for patients with cancer. An integrative review was completed on the impact of education and mentoring for nursing students on cancer care, which yielded 10 studies that were reviewed. These studies indicate that educational intervention and mentoring improve the confidence and ability of nursing students to care for patients with cancer. Conclusions: Student nurses need to be armed with knowledge, skills, and positive attitudes while caring for patients with cancer. Nursing students perform best when they have accurate information, positive role models, and mentoring by experienced oncology professionals, to support proficiency in caring for patients with cancer. The lack of knowledge of nursing students in the areas of cancer care, treatment, and patient support requires additional education and research to promote expertise and positive attitudes toward cancer and treating patients with cancer. This will support nursing students’ ability to care for patients with cancer as well as develop future educational interventions to shape nursing student attitude and knowledge. This integrative review also identifies the positive impact on the attitudes of other health care professionals who have received training or education on cancer. %M 34559056 %R 10.2196/27854 %U https://cancer.jmir.org/2021/3/e27854 %U https://doi.org/10.2196/27854 %U http://www.ncbi.nlm.nih.gov/pubmed/34559056 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e24542 %T Implementation of an Automated Dispensing Cabinet System and Its Impact on Drug Administration: Longitudinal Study %A Wang,Yi-Chen %A Tsan,Chin-Yuan %A Chen,Meng-Chun %+ Department of Nursing, National Taiwan University Hospital, Yunlin Branch, No 95, Xuefu Rd, Huwei Township, Yunlin County, 632007, Taiwan, 886 5 5354740, yuanf222@gmail.com %K automated dispensing cabinets %K medication administration system %K medication errors %K dispensing %K medication %K nursing %K Taiwan %D 2021 %7 17.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: A technology that has been widely implemented in hospitals in the United States is the automated dispensing cabinet (ADC), which has been shown to reduce nurse drug administration errors and the time nurses spend administering drugs. Objective: This study aimed to determine the impact of an ADC system on medication administration by nurses as well as safety before and after ADC implementation. Methods: We conducted a 24-month-long longitudinal study at the National Taiwan University Hospital in Taipei, Taiwan. Clinical observations and questionnaires were used to evaluate the time differences in drug preparation, delivery, and returns in the inpatient ward by nurses before and after using the ADC. Drug errors recorded in the Medical Incident Events system were assessed the year before and after ADC implementation. Results: The drug preparation time of the wards increased significantly (all P<.005). On average, 2 minutes of preparation time is needed for each patient. Only 1 unit showed an increase in the drug return time, but this was not significant. There were 9 (45%) adverse events during the drug administration phase, and 11 (55%) events occurred during the drug-dispensing phase. Although a decrease in the mean number of events reported was observed during the ADC implementation period, this difference was not significant. As for the questionnaire that were administered to the nurses, the overall mean score was 3.90; the highest score was for the item “I now spend less time waiting for medications that come from the pharmacy than before the ADC was implemented” (score=4.24). The item with the lowest score was “I have to wait in line to get my patient medications” (score=3.32). Conclusions: The nurses were generally satisfied with ADC use over the 9 months following complete implementation and integration of the system. It was acknowledged that the ADC offers benefits in terms of pharmaceutical stock management; however, this comes at the cost of increased nursing time. In general, the nurses remained supportive of the benefits for their patients, despite consequences to their workflows. Their acceptance of the ADC system in this study demonstrates this. %M 34533467 %R 10.2196/24542 %U https://formative.jmir.org/2021/9/e24542 %U https://doi.org/10.2196/24542 %U http://www.ncbi.nlm.nih.gov/pubmed/34533467 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e26700 %T Matching Registered Nurse Services With Changing Care Demands in Psychiatric Hospitals: Protocol for a Multicenter Observational Study (MatchRN Psychiatry Study) %A Gehri,Beatrice %A Bachnick,Stefanie %A Schwendimann,René %A Simon,Michael %+ Institute of Nursing Science, University of Basel, Bernoullistrasse 28, Basel, 4056, Switzerland, 41 41 61 207 0912, m.simon@unibas.ch %K quality of care %K psychiatric hospitals %K nurses %K patient routine data %K work environment %K Switzerland %D 2021 %7 17.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The quality of care is often poorly assessed in mental health settings, and accurate evaluation requires the monitoring and comparison of not only the outcomes but also the structures and processes. The resulting data allow hospital administrators to compare their patient outcome data against those reported nationally. As Swiss psychiatric hospitals are planned and coordinated at the cantonal level, they vary considerably. In addition, nursing care structures and processes, such as nurse staffing, are only reported and aggregated at the national level, whereas nurse outcomes, such as job satisfaction or intention to leave, have yet to be assessed in Swiss psychiatric hospitals. Because they lack these key figures, psychiatric hospitals’ quality of care cannot be reasonably described. Objective: This study’s purpose is to describe health care quality by exploring hospital structures such as nurse staffing and the work environment; processes such as the rationing of care; nurse outcomes, including job satisfaction and work-life balance; and patients’ symptom burden. Methods: MatchRN Psychiatry is a multicenter observational study of Swiss psychiatric hospitals. The sample for this study included approximately 1300 nurses from 113 units of 13 psychiatric hospitals in Switzerland’s German-speaking region. In addition, routine patient assessment data from each participating hospital were included. The nurse survey consisted of 164 items covering three dimensions—work environment, patient safety climate, and the rationing of care. The unit-level questionnaire included 57 items, including the number of beds, number of nurses, and nurses’ education levels. Routine patient data included items such as main diagnosis, the number and duration of freedom-restrictive measures, and symptom burden at admission and discharge. Data were collected between September 2019 and June 2021. The data will be analyzed descriptively by using multilevel regression linear mixed models and generalized linear mixed models to explore associations between variables of interest. Results: The response rate from the nurse survey was 71.49% (1209/1691). All data are currently being checked for consistency and plausibility. The MatchRN Psychiatry study is funded by the participating psychiatric hospitals and the Swiss Psychiatric Nursing Leaders Association (Vereinigung Pflegekader Psychiatrie Schweiz). Conclusions: For the first time, the MatchRN Psychiatry study will systematically evaluate the quality of care in psychiatric hospitals in Switzerland in terms of organizational structures, processes, and patient and nurse outcomes. The participating psychiatric hospitals will benefit from findings that are relevant to the future planning of nurse staffing. The findings of this study will contribute to improvement strategies for nurses’ work environments and patient experiences in Swiss psychiatric hospitals. International Registered Report Identifier (IRRID): DERR1-10.2196/26700 %M 34402796 %R 10.2196/26700 %U https://www.researchprotocols.org/2021/8/e26700 %U https://doi.org/10.2196/26700 %U http://www.ncbi.nlm.nih.gov/pubmed/34402796 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e23516 %T Health Care Providers and the Public Reporting of Nursing Home Quality in the United States Department of Veterans Affairs: Protocol for a Mixed Methods Pilot Study %A Pimentel,Camilla B %A Clark,Valerie %A Baughman,Amy W %A Berlowitz,Dan R %A Davila,Heather %A Mills,Whitney L %A Mohr,David C %A Sullivan,Jennifer L %A Hartmann,Christine W %+ Center for Healthcare Organization and Implementation Research, United States Department of Veterans Affairs Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, United States, 1 781 687 4653, Camilla.Pimentel@va.gov %K nursing homes %K public reporting %K quality %D 2021 %7 21.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In June 2018, the United States Department of Veterans Affairs (VA) began the public reporting of its 134 Community Living Centers’ (CLCs) overall quality by using a 5-star rating system based on data from the national quality measures captured in CLC Compare. Given the private sector’s positive experience with report cards, this is a seminal moment for stimulating measurable quality improvements in CLCs. However, the public reporting of CLC Compare data raises substantial and immediate implications for CLCs. The report cards, for example, facilitate comparisons between CLCs and community nursing homes in which CLCs generally fare worse. This may lead to staff anxiety and potentially unintended consequences. Additionally, CLC Compare is designed to spur improvement, yet the motivating aspects of the report cards are unknown. Understanding staff attitudes and early responses is a critical first step in building the capacity for public reporting to spur quality. Objective: We will adapt an existing community nursing home public reporting survey to reveal important leverage points and support CLCs’ quality improvement efforts. Our work will be grounded in a conceptual framework of strategic orientation. We have 2 aims. First, we will qualitatively examine CLC staff reactions to CLC Compare. Second, we will adapt and expand upon an extant community nursing home survey to capture a broad range of responses and then pilot the adapted survey in CLCs. Methods: We will conduct interviews with staff at 3 CLCs (1 1-star CLC, 1 3-star CLC, and 1 5-star CLC) to identify staff actions taken in response to their CLCs’ public data; staff’s commitment to or difficulties with using CLC Compare; and factors that motivate staff to improve CLC quality. We will integrate these findings with our conceptual framework to adapt and expand a community nursing home survey to the current CLC environment. We will conduct cognitive interviews with staff in 1 CLC to refine survey items. We will then pilot the survey in 6 CLCs (2 1-star CLCs, 2 3-star CLCs, and 2 5-star CLCs) to assess the survey’s feasibility, acceptability, and preliminary psychometric properties. Results: We will develop a brief survey for use in a future national administration to identify system-wide responses to CLC Compare; evaluate the impact of CLC Compare on veterans’ clinical outcomes and satisfaction; and develop, test, and disseminate interventions to support the meaningful use of CLC Compare for quality improvement. Conclusions: The knowledge gained from this pilot study and from future work will help VA refine how CLC Compare is used, ensure that CLC staff understand and are motivated to use its quality data, and implement concrete actions to improve clinical quality. The products from this pilot study will also facilitate studies on the effects of public reporting in other critical VA clinical areas. International Registered Report Identifier (IRRID): DERR1-10.2196/23516 %M 34287218 %R 10.2196/23516 %U https://www.researchprotocols.org/2021/7/e23516 %U https://doi.org/10.2196/23516 %U http://www.ncbi.nlm.nih.gov/pubmed/34287218 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e24974 %T Examining the Relationship Between Environmental Factors and Inpatient Hospital Falls: Protocol for a Mixed Methods Study %A Shorr,Ronald I %A Ahrentzen,Sherry %A Luther,Stephen L %A Radwan,Chad %A Hahm,Bridget %A Kazemzadeh,Mahshad %A Alliance,Slande %A Powell-Cope,Gail %A Fischer,Gary M %+ Shimberg Center for Housing Studies, College of Design, Construction and Planning, University of Florida, 1480 Inner Road, Gainesville, FL, United States, 1 352 317 8172, m.kazemzadeh@ufl.edu %K falls %K accidental falls %K hospital design and construction %K health facility environment %K hospital units %K evidence-based facility design %K nursing %K environmental factors %K well-being %K accident %D 2021 %7 13.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patient falls are the most common adverse events reported in hospitals. Although it is well understood that the physical hospital environment contributes to nearly 40% of severe or fatal hospital falls, there are significant gaps in the knowledge about the relationship between inpatient unit design and fall rates. The few studies that have examined unit design have been conducted in a single hospital (non-Veterans Health Administration [VHA]) or a small number of inpatient units, limiting generalizability. The goal of this study is to identify unit design factors contributing to inpatient falls in the VHA. Objective: The first aim of the study is to investigate frontline and management perceptions of and experiences with veteran falls as they pertain to inpatient environmental factors. An iterative rapid assessment process will be used to analyze the data. Interview findings will directly inform the development of an environmental assessment survey to be conducted as part of aim 2 and to contribute to interpretation of aim 2. The second aim of this study is to quantify unit design factors and compare spatial and environmental factors of units with higher- versus lower-than-expected fall rates. Methods: We will first conduct walk-through interviews with facility personnel in 10 medical/surgical units at 3 VHA medical centers to identify environmental fall risk factors. Data will be used to finalize an environmental assessment survey for nurse managers and facilities managers. We will then use fall data from the VA Inpatient Evaluation Center and patient data from additional sources to identify 50 medical/surgical nursing units with higher- and lower-than-expected fall rates. We will measure spatial factors by analyzing computer-aided design files of unit floorplans and environmental factors from the environmental assessment survey. Statistical tests will be performed to identify design factors that distinguish high and low outliers. Results: The VA Health Services Research and Development Service approved funding for the study. The research protocol was approved by institutional review boards and VA research committees at both sites. Data collection started in February 2018. Results of the data analysis are expected by February 2022. Data collection and analysis was completed for aim 1 with a manuscript of results in progress. For aim 2, the medical/surgical units were categorized into higher- and lower-than-expected fall categories, the environmental assessment surveys were distributed to facility managers and nurse managers. Data to measure spatial characteristics are being compiled. Conclusions: To our knowledge, this study is the first to objectively identify spatial risks for falls in hospitals within in a large multihospital system. Findings can contribute to evidence-based design guidelines for hospitals such as those of the Facility Guidelines Institute and the Department of Veterans Affairs. The metrics for characterizing spatial features are quantitative indices that could be incorporated in larger scale contextual studies examining contributors to falls, which to date often exclude physical environmental factors at the unit level. Space syntax measures could be used as physical environmental factors in future research examining a range of contextual factors—social, personal, organizational, and environmental—that contribute to patient falls. International Registered Report Identifier (IRRID): DERR1-10.2196/24974 %M 34255724 %R 10.2196/24974 %U https://www.researchprotocols.org/2021/7/e24974 %U https://doi.org/10.2196/24974 %U http://www.ncbi.nlm.nih.gov/pubmed/34255724 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e27963 %T Presenteeism Among Nurses in Switzerland and Portugal and Its Impact on Patient Safety and Quality of Care: Protocol for a Qualitative Study %A Pereira,Filipa %A Querido,Ana Isabel %A Bieri,Marion %A Verloo,Henk %A Laranjeira,Carlos António %+ School of Health Sciences, HES-SO Valais/Wallis, Chemin de l'Agasse 5, Sion, 1950, Switzerland, 41 786661700, filipa.pereira@hevs.ch %K healthcare %K nurses %K predictors %K presenteeism %K quality of care %K frontline %K managers %K Portugal %K Switzerland %K patient safety %K patients %K safety %K stress %K emotion %K knowledge transfer %K acute care %K long-term care %D 2021 %7 13.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Nurses dispense direct care in a wide variety of settings and are considered the backbone of the health care system. They often work long hours, face emotional stress, and are at a high risk of psychosocial and somatic illnesses. Nurses sometimes fall sick but work regardless, leading to presenteeism and subsequent risks to quality of care and patient safety due to the increased likelihood of patients falling, medication errors, and staff-to-patient disease transmission. Objective: This study aims to understand presenteeism among frontline nurses and nurse managers in acute, primary, and long-term health care settings and to contribute to the development of future interventional studies and recommendations. Methods: A qualitative study based on online focus group discussions will explore the perceptions of, attitudes to, and experiences with presenteeism among frontline nurses and nurse managers. Using a pilot-tested interview guide, 8 focus group discussions will involve nurses working in acute care hospitals, primary care settings, and long-term residential care facilities in Switzerland’s French-speaking region and Portugal’s Center region. The data collected will be examined using a content analysis approach via NVivo 12 QSR International software. Results: The University of Applied Sciences and Arts Western Switzerland’s School of Health Sciences and the Polytechnic of Leiria’s School of Health Sciences in Portugal have both approved funding for the study. The research protocol has been approved by ethics committees in both countries. Study recruitment commenced in February 2021. The results of the data analysis are expected by September 2021. Conclusions: This present study aims to gain more insight into the dilemmas facing nurses as a result of all causes of presenteeism among frontline nurses and nurse managers in different health care settings. The researchers will prepare manuscripts on the study’s findings, publish them in relevant peer-reviewed journals, exhibit them in poster presentations, and give oral presentations at appropriate academic and nonscientific conferences. Regarding further knowledge transfer, researchers will engage with stakeholders to craft messages focused on the needs of nurses and nurse managers and on disseminating our research findings to deal with the issue of nursing presenteeism. International Registered Report Identifier (IRRID): PRR1-10.2196/27963 %M 33983134 %R 10.2196/27963 %U https://www.researchprotocols.org/2021/5/e27963 %U https://doi.org/10.2196/27963 %U http://www.ncbi.nlm.nih.gov/pubmed/33983134 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 4 %N 2 %P e26944 %T Academic Electronic Health Records in Undergraduate Nursing Education: Mixed Methods Pilot Study %A Kleib,Manal %A Jackman,Deirdre %A Duarte Wisnesky,Uirá %A Ali,Shamsa %+ Faculty of Nursing, University of Alberta, 5-112 Edmonton Clinic Health Academy, Edmonton, AB, T6G1C9, Canada, 1 7802481422, manal.kleib@ualberta.ca %K academic electronic health record %K Lippincott DocuCare %K simulation %K nursing informatics education %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Nursing %G English %X Background: Teaching students about electronic health records presents challenges for most nursing programs, primarily because of the limited training opportunities within clinical practice settings. A simulated electronic health record is an experiential, learner-centered strategy that enables students to acquire and apply the informatics knowledge needed for working with electronic records in a safe learning environment before the students have encounters with real patients. Objective: The aim of this study is to provide a preliminary evaluation of the Lippincott DocuCare simulated electronic health record and determine the feasibility issues associated with its implementation. Methods: We used one-group pretest-posttest, surveys, and focus group interviews with students and instructors to pilot the DocuCare simulated electronic health record within an undergraduate nursing program in Western Canada. Volunteering students worked through 4 case scenarios during a 1-month pilot. Self-reported informatics knowledge and attitudes toward the electronic health record, accuracy of computerized documentation, satisfaction, and students’ and educators’ experiences were examined. Demographic and general information regarding informatics learning was also collected. Results: Although 23 students participated in this study, only 13 completed surveys were included in the analysis. Almost two-thirds of the students indicated their overall understanding of nursing informatics as being fair or inadequate. The two-tailed paired samples t test used to evaluate the impact of DocuCare on students’ self-reported informatics knowledge and attitudes toward the electronic health record revealed a statistically significant difference in the mean score of knowledge before and after using DocuCare (before: mean 2.95, SD 0.58; after: mean 3.83, SD 0.39; t12=5.80, two-tailed; P<.001). There was no statistically significant difference in the mean scores of attitudes toward the electronic health record before and after using DocuCare (before: mean 3.75, SD 0.40; after: mean 3.70, SD 0.34; t12=0.39, two-tailed; P=.70). Students’ documentation scores varied from somewhat accurate to completely accurate; however, performance improved for the majority of students as they progressed from case scenarios 1 to 4. Both the faculty and students were highly satisfied with DocuCare and highly recommended its integration. Focus groups with 7 students and 3 educators revealed multiple themes. The participants shared suggestions regarding the DocuCare product customization and strategies for potential integration in undergraduate nursing programs. Conclusions: This study demonstrated the feasibility and suitability of the DocuCare program as a tool to enhance students’ learning about informatics and computerized documentation in electronic health records. Recommendations will be made to academic leadership in undergraduate programs on the basis of this study. Furthermore, a controlled evaluation study will be conducted in the future. %M 34345797 %R 10.2196/26944 %U https://nursing.jmir.org/2021/2/e26944 %U https://doi.org/10.2196/26944 %U http://www.ncbi.nlm.nih.gov/pubmed/34345797 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24313 %T Adaptation of Extended Reality Smart Glasses for Core Nursing Skill Training Among Undergraduate Nursing Students: Usability and Feasibility Study %A Kim,Sun Kyung %A Lee,Youngho %A Yoon,Hyoseok %A Choi,Jongmyung %+ Department of Biomedicine, Health & Life Convergence Sciences, BK21 Four, Mokpo National University, 1666, Yeongsan-ro, Cheonggye-myeon, Muan-gun, Jeollanam-do, Muan, Republic of Korea, 82 614506292, skkim@mokpo.ac.kr %K nursing education %K skill training %K self-practice %K smart glass %K usability %K feasibility %D 2021 %7 2.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Skill training in nursing education has been highly dependent on self-training because of Korea’s high student-faculty ratio. Students tend to have a passive attitude in self-practice, and it is hard to expect effective learning outcomes with traditional checklist-dependent self-practice. Smart glasses have a high potential to assist nursing students with timely information, and a hands-free device does not interrupt performance. Objective: This study aimed to develop a smart glass–based nursing skill training program and evaluate its usability and feasibility for the implementation of self-practice. Methods: We conducted a usability and feasibility study with 30 undergraduate nursing students during a 2-hour open lab for self-practice of core nursing skills, wearing smart glasses for visualized guidance. The usability test was conducted using a 16-item self-reporting questionnaire and 7 open-ended questions. Learning satisfaction was assessed using a 7-item questionnaire. The number of practice sessions was recorded, and perceived competency in core nursing skills was measured before and after the intervention. At the final evaluation, performance accuracy and time consumed for completion were recorded. Results: Smart glass–assisted self-practice of nursing skills was perceived as helpful, convenient, and interesting. Participants reported improved recollection of sequences of skills, and perceived competency was significantly improved. Several issues were raised by participants regarding smart glasses, including small screen size, touch sensors, fogged lenses with masks, heaviness, and heat after a period of time. Conclusions: Smart glasses have the potential to assist self-practice, providing timely information at students’ own paces. Having both hands free from holding a device, participants reported the convenience of learning as they could practice and view the information simultaneously. Further revision correcting reported issues would improve the applicability of smart glasses in other areas of nursing education. %M 33650975 %R 10.2196/24313 %U https://www.jmir.org/2021/3/e24313 %U https://doi.org/10.2196/24313 %U http://www.ncbi.nlm.nih.gov/pubmed/33650975 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e25126 %T Technology-Supported Guidance Models Stimulating the Development of Critical Thinking in Clinical Practice: Protocol for a Mixed Methods Systematic Review %A Zlamal,Jaroslav %A Gjevjon,Edith Roth %A Fossum,Mariann %A Solberg,Marianne Trygg %A Steindal,Simen Alexander %A Strandell-Laine,Camilla %A Larsen,Marie Hamilton %A Pettersen,Fredrik Solvang %A Nes,Andréa Aparecida Gonçalves %+ Lovisenberg Diaconal University College, Lovisenberggata 15b, Oslo, 0456, Norway, 47 95963522, Jaroslav.Zlamal@ldh.no %K critical thinking %K technology %K guidance models %K nursing education %K clinical practice %D 2021 %7 19.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Critical thinking is an essential skill that nursing students need to develop. Technological tools have opened new avenues for technology-supported guidance models, but the challenges and facilitators of such guidance models, as well as how they stimulate the development of critical thinking, remain unclear. Objective: We developed a protocol for a mixed methods systematic review to investigate the use of technology-supported guidance models that stimulate the development of critical thinking in nursing education clinical practice. Methods: A convergent integrated design following the Joanna Briggs Institute Manual for Evidence Synthesis will be employed. A pair of authors will select the articles by screening titles and abstracts, and the methodological quality of the articles included in the review will be assessed by a pair of authors according to checklists for specific study designs. The data will be extracted using the standardized Joanna Briggs Institute mixed methods data extraction form and following a convergent integrated approach. The thematic synthesis for data transformation will be used. Results: Development of a comprehensive systematic search strategy was completed in October 2020. The database searches were performed on October 21, 2020. As of January 2021, analysis and synthesis is ongoing. Completion of this review is expected by January 2021. Conclusions: By combining evidence from studies with varied methodological approaches, the results should provide broad insight into the use of technology-supported guidance models for clinical practice in nursing education with a focus on the development of nursing students’ critical thinking. The results of this mixed methods systematic review can also be used to develop or improve current technology-supported guidance models for clinical practice in nursing education. International Registered Report Identifier (IRRID): PRR1-10.2196/25126 %M 33464214 %R 10.2196/25126 %U http://www.researchprotocols.org/2021/1/e25126/ %U https://doi.org/10.2196/25126 %U http://www.ncbi.nlm.nih.gov/pubmed/33464214 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e21832 %T Health Professional Student Placements and Workforce Location Outcomes: Protocol of an Observational Cohort Study %A Campbell,Narelle %A Farthing,Annie %A Witt,Susan %A Anderson,Jessie %A Lenthall,Sue %A Moore,Leigh %A Rissel,Chris %+ Flinders University, Northern Territory, Royal Darwin Hospital, Darwin, 0810, Australia, 61 0889200297, chris.rissel@flinders.edu.au %K remote health %K students %K training %K workforce retention %K workforce location %K workforce %K allied health %K allied health professionals %K Northern Territory of Australia %K rural %K nursing %K rural employment %D 2021 %7 14.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The successful recruitment and retention of health professionals to rural and remote areas of Australia is a health policy priority. Nursing or allied health professional students’ learning placements in the Northern Territory (NT) of Australia, most of which is considered remote, may influence rural or remote work location decisions. Objective: The aim of this study is to determine where allied health professionals and nurses who have had a student placement in the NT of Australia end up practicing. Methods: This research is an observational cohort study, with data collection occurring at baseline and then repeated annually over 10 years (ie, 2017-2018 to 2029). The baseline data collection includes a demographic profile of allied health and nursing students and their evaluations of their NT placements using a nationally consistent questionnaire (ie, the Student Satisfaction Survey). The Work Location Survey, which will be administered annually, will track work location and the influences on work location decisions. Results: This study will generate unique data on the remote and rural work locations of nursing and allied health professional students who had a placement in the NT of Australia. It will be able to determine what are the most important characteristics of those who take up remote and rural employment, even if outside of the NT, and to identify barriers to remote employment. Conclusions: This study will add knowledge to the literature regarding rates of allied health and nursing professionals working in remote or rural settings following remote or rural learning placements. The results will be of interest to government and remote health workforce planners. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000797976; https://www.anzctr.org.au/ACTRN12620000797976.aspx International Registered Report Identifier (IRRID): PRR1-10.2196/21832 %M 33443482 %R 10.2196/21832 %U http://www.researchprotocols.org/2021/1/e21832/ %U https://doi.org/10.2196/21832 %U http://www.ncbi.nlm.nih.gov/pubmed/33443482 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e18643 %T Creating Respectful Workplaces for Nurses in Regional Acute Care Settings: Protocol for a Sequential Explanatory Mixed Methods Study %A Hawkins,Natasha %A Jeong,Sarah %A Smith,Tony %+ The School of Nursing & Midwifery, The University of Newcastle Australia, 69a High Street, Taree, 2430, Australia, 61 0412341415, tash.hawkins@newcastle.edu.au %K bullying %K culture %K negative behavior %K nurses %K methods %K workforce %D 2021 %7 11.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Negative workplace behaviour among nurses is an internationally recognised problem, despite the plethora of literature spanning several decades. The various forms of mistreatments and uncaring attitudes experienced by nurses include workplace aggression, incivility, bullying, harassment and horizontal violence. Negative behaviour has detrimental effects on the individual nurse, the organisation, the nursing profession and patients. Multi-level organisational interventions are warranted to influence the “civility norms” of the nursing profession. Objective: The aim of this study is to investigate the self-reported exposure to and experiences of negative workplace behaviours of nursing staff and their ways of coping in regional acute care hospitals in one Local Health District (LHD) in NSW before and after Respectful Workplace Workshops have been implemented within the organisation. Methods: This study employs a mixed methods sequential explanatory design with an embedded experimental component, underpinned by Social World’s Theory. This study will be carried out in four acute care regional hospitals from a Local Health District (LHD) in New South Wales (NSW), Australia. The nurse unit managers, registered nurses and new graduate nurses from the medical and surgical wards of all four hospitals will be invited to complete a pre-survey examining their experiences, perceptions and responses to negative workplace behaviour, and their ways of coping when exposed. Face-to-face educational workshops will then be implemented by the organisation at two of the four hospitals. The workshops are designed to increase awareness of negative workplace behaviour, the pathways to seek assistance and aims to create respectful workplaces. Commencing 3 months after completion of the workshop implementation, follow up surveys and interviews will then be undertaken at all four hospitals. Results: The findings from this research will enhance understanding of negative workplace behaviour occurring within the nursing social world and assess the effectiveness of the LHD’s Respectful Workplace Workshops upon the levels of negative workplace behaviour occurring. By integrating qualitative and quantitative findings it will allow for a dual perspective of the social world of nurses where negative and/or respectful workplace behaviours occur, and provide data grounded in individuals lived experiences, positioned in a macro context Conclusions: It is expected that evidence from this study will inform nursing practice, and future policy development aimed at creating respectful workplaces. Trial Registration: Australian New Zealand Clinical Trials Registry (Registration No. ACTRN12618002007213; 14 December 2018). International Registered Report Identifier (IRRID): PRR1-10.2196/18643 %M 33427678 %R 10.2196/18643 %U http://www.researchprotocols.org/2021/1/e18643/ %U https://doi.org/10.2196/18643 %U http://www.ncbi.nlm.nih.gov/pubmed/33427678 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e18078 %T Cultural Impact on the Intention to Use Nursing Information Systems of Nurses in Taiwan and China: Survey and Analysis %A Chang,I-Chiu %A Lin,Po-Jin %A Chen,Ting-Hung %A Chang,Chia-Hui %+ Department of Nursing, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect 4, Taichung, 407204, Taiwan, 886 4 2359 2525, cjhsnd@gmail.com %K Nursing information system %K intention to use %K cultural differences %K information literacy %D 2020 %7 12.8.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32784174 %R 10.2196/18078 %U https://www.jmir.org/2020/8/e18078 %U https://doi.org/10.2196/18078 %U http://www.ncbi.nlm.nih.gov/pubmed/32784174 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16540 %T Exploring the Characteristics and Behaviors of Nurses Who Have Attained Microcelebrity Status on Instagram: Content Analysis %A Kerr,Hanna %A Booth,Richard %A Jackson,Kimberley %+ Western University, Room 3306, FIMS & Nursing Building, Western University, 1151 Richmond St, London, ON, N6A 5B9, Canada, 1 2262390224, hkerr4@uwo.ca %K nursing %K social media %K professionalism %K microcelebrity %K Instagram %K policy %K influencer %D 2020 %7 26.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Instagram is a social media platform that enables users to share images and videos worldwide. Some nurses have used Instagram to document their experiences as a nurse and have subsequently gained microcelebrity status—that is, a user who purposefully seeks to amass a substantive Web-based following and has become recognized as a niche area of interest. Objective: This study aimed to identify the characteristics and behaviors of microcelebrity nurses who act as influencers on Instagram and use their nursing profile to gain attention and presence on the Web. Methods: A qualitative, exploratory, nonparticipatory content analysis of media and text generated by a purposeful sample of 10 registered nurses who use Instagram and sustain a definable microcelebrity status was conducted. In this study, manifest and latent data were examined to gain an understanding of the characteristics and behaviors of nurses who have attained microcelebrity status on Instagram. Results: Data analysis revealed 5 themes of Instagram posts: (1) engaging Instagram users, (2) educational opportunities and insights, (3) nursing-related humor, (4) emotions experienced by nurses, and (5) media and narratives including patient details or work context. Messages were primarily positive in nature; however, multiple potential privacy, ethical, and professional issues were noted throughout the posted content. Conclusions: The findings of this study help to expand the current knowledge related to the use of social media platforms such as Instagram, especially in regard to the emergence of nurses who use this form of technology to achieve or maintain a microcelebrity status. This study calls for additional research on nurses’ attainment of microcelebrity status on social media as well as further policy development to adequately prepare nurses to navigate social media. %M 32452809 %R 10.2196/16540 %U http://www.jmir.org/2020/5/e16540/ %U https://doi.org/10.2196/16540 %U http://www.ncbi.nlm.nih.gov/pubmed/32452809 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 5 %P e17710 %T Reducing Antibiotic Prescriptions for Urinary Tract Infection in Nursing Homes Using a Complex Tailored Intervention Targeting Nursing Home Staff: Protocol for a Cluster Randomized Controlled Trial %A Arnold,Sif Helene %A Jensen,Jette Nygaard %A Kousgaard,Marius Brostrøm %A Siersma,Volkert %A Bjerrum,Lars %A Holm,Anne %+ The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, 1014, Denmark, 45 31603734, siar@sund.ku.dk %K urinary tract infection %K nursing home %K antibiotics %K antibiotic resistance %K drug prescription %K communication %K communication barriers %K interprofessional relationship %K elderly %D 2020 %7 8.5.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Urinary tract infection (UTI) is the most common reason for antibiotic prescription in nursing homes. Overprescription causes antibiotic-related harms in those who are treated and others residing within the nursing home. The diagnostic process in nursing homes is complicated with both challenging issues related to the elderly population and the nursing home setting. A physician rarely visits a nursing home for suspected UTI. Consequently, the knowledge of UTI and communication skills of staff influence the diagnosis. Objective: The objective of this study is to describe a cluster randomized controlled trial with a tailored complex intervention for improving the knowledge of UTI and communication skills of nursing home staff in order to decrease the number of antibiotic prescriptions for UTI in nursing home residents, without changing hospitalization and mortality. Methods: The study describes an open-label cluster randomized controlled trial with two parallel groups and a 1:1 allocation ratio. Twenty-two eligible nursing homes are sampled from the Capital Region of Denmark, corresponding to 1274 nursing home residents. The intervention group receives a dialogue tool, and all nursing home staff attend a workshop on UTI. The main outcomes of the study are the antibiotic prescription rate for UTI, all-cause hospitalization, all-cause mortality, and suspected UTI during the trial period. Results: The trial ended in April 2019. Data have been collected and are being analyzed. We expect the results of the trial to be published in a peer-reviewed journal in the fall of 2020. Conclusions: The greatest strengths of this study are the randomized design, tailored development of the intervention, and access to medical records. The potential limitations are the hierarchy in the prescription process, Hawthorne effect, and biased access to data on signs and symptoms through a UTI diary. The results of this trial could offer a strategy to overcome some of the challenges of increased antibiotic resistance and could have implications in terms of how to handle cases of suspected UTI. Trial Registration: ClinicalTrials.gov NCT03715062; https://clinicaltrials.gov/ct2/show/NCT03715062 International Registered Report Identifier (IRRID): DERR1-10.2196/17710 %M 32383679 %R 10.2196/17710 %U https://www.researchprotocols.org/2020/5/e17710 %U https://doi.org/10.2196/17710 %U http://www.ncbi.nlm.nih.gov/pubmed/32383679 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e18604 %T A Clinical Teaching Blended Learning Program to Enhance Registered Nurse Preceptors’ Teaching Competencies: Pretest and Posttest Study %A Wu,Xi Vivien %A Chi,Yuchen %A Panneer Selvam,Umadevi %A Devi,M Kamala %A Wang,Wenru %A Chan,Yah Shih %A Wee,Fong Chi %A Zhao,Shengdong %A Sehgal,Vibhor %A Ang,Neo Kim Emily %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66012756, nurwux@nus.edu.sg %K blended learning %K case-based learning %K clinical pedagogy %K clinical teaching competency %K web-based program %K nurse preceptor %D 2020 %7 24.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinical nursing education provides opportunities for students to learn in multiple patient care settings, receive appropriate guidance, and foster the development of clinical competence and professionalism. Nurse preceptors guide students to integrate theory into practice, teach clinical skills, assess clinical competencies, and enhance problem-solving and critical thinking skills. Previous research has indicated that the teaching competencies of nurse preceptors can be transferred to students’ clinical learning to enhance their clinical competencies. Objective: This study aimed to develop a clinical teaching blended learning (CTBL) program with the aid of web-based clinical pedagogy (WCP) and case-based learning for nurse preceptors and to examine the effectiveness of the CTBL program on nurse preceptors’ clinical teaching competencies, self-efficacies, attitudes toward web-based learning, and blended learning outcomes. Methods: A quasi-experimental single-group pretest and posttest design was adopted. A total of 150 nurse preceptors participated in the CTBL program, which was conducted from September 2019 to December 2019. A set of questionnaires, including the clinical teaching competence inventory, preceptor self-efficacy questionnaire, attitudes toward web-based continuing learning survey, and e-learning experience questionnaire, was used to assess the outcomes before and after the CTBL program. Results: Compared with the baseline, the participants had significantly higher total mean scores and subdomain scores for clinical teaching competence (mean 129.95, SD 16.38; P<.001), self-efficacy (mean 70.40, SD 9.35; P<.001), attitudes toward web-based continuing learning (mean 84.68, SD 14.76; P<.001), and blended learning outcomes (mean 122.13, SD 14.86; P<.001) after the CTBL program. Conclusions: The CTBL program provides a comprehensive coverage of clinical teaching pedagogy and assessment strategies. The combination of the WCP and case-based approach provides a variety of learning modes to fit into the diverse learning needs of the preceptors. The CTBL program allows the preceptors to receive direct feedback from the facilitators during face-to-face sessions. Preceptors also gave feedback that the web-based workload is manageable. This study provides evidence that the CTBL program increases the clinical teaching competencies and self-efficacies of the preceptors and promotes positive attitudes toward web-based learning and better blended learning outcomes. The health care organization can consider the integration of flexible learning and intellect platforms for preceptorship education. %M 32329743 %R 10.2196/18604 %U http://www.jmir.org/2020/4/e18604/ %U https://doi.org/10.2196/18604 %U http://www.ncbi.nlm.nih.gov/pubmed/32329743 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 4 %P e17490 %T Nursing in the Age of Artificial Intelligence: Protocol for a Scoping Review %A Buchanan,Christine %A Howitt,M Lyndsay %A Wilson,Rita %A Booth,Richard G %A Risling,Tracie %A Bamford,Megan %+ Registered Nurses' Association of Ontario, 158 Pearl Street, Toronto, ON, M5H 1L3, Canada, 1 800 268 7199 ext 281, cbuchanan@rnao.ca %K nursing %K artificial intelligence %K machine learning %K robotics %K compassionate care %K scoping review %D 2020 %7 16.4.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: It is predicted that digital health technologies that incorporate artificial intelligence will transform health care delivery in the next decade. Little research has explored how emerging trends in artificial intelligence–driven digital health technologies may influence the relationship between nurses and patients. Objective: The purpose of this scoping review is to summarize the findings from 4 research questions regarding emerging trends in artificial intelligence–driven digital health technologies and their influence on nursing practice across the 5 domains outlined by the Canadian Nurses Association framework: administration, clinical care, education, policy, and research. Specifically, this scoping review will examine how emerging trends will transform the roles and functions of nurses over the next 10 years and beyond. Methods: Using an established scoping review methodology, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central, Education Resources Information Centre, Scopus, Web of Science, and Proquest databases were searched. In addition to the electronic database searches, a targeted website search will be performed to access relevant grey literature. Abstracts and full-text studies will be independently screened by 2 reviewers using prespecified inclusion and exclusion criteria. Included literature will focus on nursing and digital health technologies that incorporate artificial intelligence. Data will be charted using a structured form and narratively summarized. Results: Electronic database searches have retrieved 10,318 results. The scoping review and subsequent briefing paper will be completed by the fall of 2020. Conclusions: A symposium will be held to share insights gained from this scoping review with key thought leaders and a cross section of stakeholders from administration, clinical care, education, policy, and research as well as patient advocates. The symposium will provide a forum to explore opportunities for action to advance the future of nursing in a technological world and, more specifically, nurses’ delivery of compassionate care in the age of artificial intelligence. Results from the symposium will be summarized in the form of a briefing paper and widely disseminated to relevant stakeholders. International Registered Report Identifier (IRRID): DERR1-10.2196/17490 %M 32297873 %R 10.2196/17490 %U http://www.researchprotocols.org/2020/4/e17490/ %U https://doi.org/10.2196/17490 %U http://www.ncbi.nlm.nih.gov/pubmed/32297873 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 2 %P e11619 %T Body Mass Index Screening and Follow-Up: A Cross-Sectional Questionnaire Study of Pennsylvania School Nurses %A Francis,Erica %A Hoke,Alicia Marie %A Kraschnewski,Jennifer Lynn %+ Department of Pediatrics, Penn State University, 90 Hope Drive, Suite 1103, Mail Code A145, Hershey, PA, 17033, United States, 1 717 531 1440 ext 8, efrancis@psu.edu %K body mass index %K childhood overweight %K childhood obesity %K pediatric obesity %K Pennsylvania %K school nursing %K Web-based survey %D 2018 %7 21.12.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: Childhood overweight and obesity health concerns can affect a student’s academic performance, so it is important to identify resources for school nurses that would help to improve self-efficacy, knowledge, and confidence when approaching parents with sensitive weight-related information and influence overall obesity prevention efforts in the school setting. Objective: The purpose of this study was to conduct a Pennsylvania (PA) state-wide 29-item survey addressing school nursing barriers and practices, supplementing information already known in this area. Although the survey covered a range of topics, the focus was body mass index (BMI) screening and its related practice within the schools. Methods: We conducted a state-wide Web-based survey of school nurses in PA to understand current areas of care, find ways to address child health through school BMI screenings and follow up, and identify current educational gaps to assist school nurses with providing whole child care within the realm of weight management. Chi-square test of independence was conducted to determine the relationship between BMI screening follow up and interest in a BMI toolkit. Results: Nurse participants (N=210), with a 42% (210/500) response rate, represented 208 school districts across PA. Participants were asked about their current process for notifying parents of BMI screening results. The majority (116/210, 55.2%) send a letter home in the mail, while others (62/210, 29.5%) send a letter home with students. A small number (8/210, 3.8%) said they did not notify parents altogether, and some (39/210, 18.6%) notify parents electronically. More than one-third (75/210, 35.7%) of nurses reported receiving BMI screening inquiries from parents; however, under half (35/75, 46.7%) of those respondents indicated they follow up with parents whose child screens overweight or obese. Overall, the vast majority (182/210, 86.7%) do not follow up with parents whose child screens overweight or obese. The majority (150/210, 71.4%) of the nurses responded they would benefit from a toolkit with resources to assist with communication with parents and children about BMI screenings. A significant association between respondent follow up and interest in a BMI toolkit was observed (P=.01). Conclusions: Schools must start recognizing the role school nurses play to monitor and promote children’s health. This goal might include involving them in school-based preventive programs, empowering them to lead initiatives that support whole child health and ensuring opportunities for professional development of interest to them. Nonetheless, the first step in facilitating obesity prevention methods within schools is to provide school nurses with meaningful tools that help facilitate conversations with parents, guardians, and caregivers regarding their child’s weight status and health through a BMI screening toolkit. %M 30578174 %R 10.2196/11619 %U http://www.i-jmr.org/2018/2/e11619/ %U https://doi.org/10.2196/11619 %U http://www.ncbi.nlm.nih.gov/pubmed/30578174 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 4 %P e11704 %T Alarm-Related Workload in Default and Modified Alarm Settings and the Relationship Between Alarm Workload, Alarm Response Rate, and Care Provider Experience: Quantification and Comparison Study %A Shanmugham,Manikantan %A Strawderman,Lesley %A Babski-Reeves,Kari %A Bian,Linkan %+ Department of Industrial and Systems Engineering, Mississippi State University, 260 McCain Hall, 479-2 Hardy Road, Box 9542, Mississippi State, MS, 39762, United States, 1 8016739973, ms195@msstate.edu %K clinical alarms %K fatigue %K physiologic monitoring %K nursing %K workload %D 2018 %7 23.10.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Delayed or no response to impending patient safety–related calls, poor care provider experience, low job satisfaction, and adverse events are all unwanted outcomes of alarm fatigue. Nurses often cite increases in alarm-related workload as a reason for alarm fatigue, which is a major contributor to the aforementioned unwanted outcomes. Increased workload affects both the care provider and the patient. No studies to date have evaluated the workload while caring for patients and managing alarms simultaneously and related it to the primary measures of alarm fatigue—alarm response rate and care provider experience. Many studies have assessed the effect of modifying the default alarm setting; however, studies on the perceived workload under different alarm settings are limited. Objective: This study aimed to assess nurses’ or assistants’ perceived workload index of providing care under different clinical alarm settings and establish the relationship between perceived workload, alarm response rate, and care provider experience. Methods: In a clinical simulator, 30 participants responded to alarms that occurred on a physiological monitor under 2 conditions (default and modified) for a given clinical condition. Participants completed a National Aeronautics and Space Administration-Task Load Index questionnaire and rated the demand experienced on a 20-point visual analog scale with low and high ratings. A correlational analysis was performed to assess the relationships between the perceived workload score, alarm response rate, and care provider experience. Results: Participants experienced lower workloads when the clinical alarm threshold limits were modified according to patients’ clinical conditions. The workload index was higher for the default alarm setting (57.60 [SD 2.59]) than for the modified alarm setting (52.39 [SD 2.29]), with a statistically significant difference of 5.21 (95% CI 3.38-7.04), t28=5.838, P<.05. Significant correlations were found between the workload index and alarm response rate. There was a strong negative correlation between alarm response rate and perceived workload, ρ28=−.54, P<.001 with workload explaining 29% of the variation in alarm response rate. There was a moderate negative correlation between the experience reported during patient care and the perceived workload, ρ28=−.49, P<.05. Conclusions: The perceived workload index was comparatively lower with alarm settings modified for individual patient care than in an unmodified default clinical alarm setting. These findings demonstrate that the modification of clinical alarm limits positively affects the number of alarms accurately addressed, care providers’ experience, and overall satisfaction. The findings support the removal of nonessential alarms based on patient conditions, which can help care providers address the remaining alarms accurately and provide better patient care. %M 30355550 %R 10.2196/11704 %U http://humanfactors.jmir.org/2018/4/e11704/ %U https://doi.org/10.2196/11704 %U http://www.ncbi.nlm.nih.gov/pubmed/30355550 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e122 %T Impact of Information and Communication Technologies on Nursing Care: Results of an Overview of Systematic Reviews %A Rouleau,Geneviève %A Gagnon,Marie-Pierre %A Côté,José %A Payne-Gagnon,Julie %A Hudson,Emilie %A Dubois,Carl-Ardy %+ Faculty of Nursing Sciences, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Quebec, QC, G1V 0A6, Canada, 1 418 525 4444 ext 53169, marie-pierre.gagnon@fsi.ulaval.ca %K information and communication technology %K eHealth %K telehealth %K nursing care %K review, overview of systematic review %D 2017 %7 25.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Information and communication technologies (ICTs) are becoming an impetus for quality health care delivery by nurses. The use of ICTs by nurses can impact their practice, modifying the ways in which they plan, provide, document, and review clinical care. Objective: An overview of systematic reviews was conducted to develop a broad picture of the dimensions and indicators of nursing care that have the potential to be influenced by the use of ICTs. Methods: Quantitative, mixed-method, and qualitative reviews that aimed to evaluate the influence of four eHealth domains (eg, management, computerized decision support systems [CDSSs], communication, and information systems) on nursing care were included. We used the nursing care performance framework (NCPF) as an extraction grid and analytical tool. This model illustrates how the interplay between nursing resources and the nursing services can produce changes in patient conditions. The primary outcomes included nurses’ practice environment, nursing processes, professional satisfaction, and nursing-sensitive outcomes. The secondary outcomes included satisfaction or dissatisfaction with ICTs according to nurses’ and patients’ perspectives. Reviews published in English, French, or Spanish from January 1, 1995 to January 15, 2015, were considered. Results: A total of 5515 titles or abstracts were assessed for eligibility and full-text papers of 72 articles were retrieved for detailed evaluation. It was found that 22 reviews published between 2002 and 2015 met the eligibility criteria. Many nursing care themes (ie, indicators) were influenced by the use of ICTs, including time management; time spent on patient care; documentation time; information quality and access; quality of documentation; knowledge updating and utilization; nurse autonomy; intra and interprofessional collaboration; nurses’ competencies and skills; nurse-patient relationship; assessment, care planning, and evaluation; teaching of patients and families; communication and care coordination; perspectives of the quality of care provided; nurses and patients satisfaction or dissatisfaction with ICTs; patient comfort and quality of life related to care; empowerment; and functional status. Conclusions: The findings led to the identification of 19 indicators related to nursing care that are impacted by the use of ICTs. To the best of our knowledge, this was the first attempt to apply NCPF in the ICTs’ context. This broad representation could be kept in mind when it will be the time to plan and to implement emerging ICTs in health care settings. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews: CRD42014014762; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014014762 (Archived by WebCite at http://www.webcitation.org/6pIhMLBZh) %M 28442454 %R 10.2196/jmir.6686 %U http://www.jmir.org/2017/4/e122/ %U https://doi.org/10.2196/jmir.6686 %U http://www.ncbi.nlm.nih.gov/pubmed/28442454 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 5 %N 2 %P e20 %T Relationship Between Difficulties in Daily Activities and Falling: Loco-Check as a Self-Assessment of Fall Risk %A Akahane,Manabu %A Maeyashiki,Akie %A Yoshihara,Shingo %A Tanaka,Yasuhito %A Imamura,Tomoaki %+ Faculty of Medicine, Department of Public Health, Health Management and Policy, Nara Medical University, Shijo 840, Kashihara, Nara 6348521, Japan, 81 744 22 3051 ext 2224, makahane@naramed-u.ac.jp %K accidental falls %K disability evaluation %K self-assessment %K activity of daily living %D 2016 %7 20.06.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: People aged 65 years or older accounted for 25.1% of the Japanese population in 2013, and this characterizes the country as a “super-aging society.” With increased aging, fall-related injuries are becoming important in Japan, because such injuries underlie the necessity for nursing care services. If people could evaluate their risk of falling using a simple self-check test, they would be able to take preventive measures such as exercise, muscle training, walking with a cane, or renovation of their surroundings to remove impediments. Loco-check is a checklist measure of early locomotive syndrome (circumstances in which elderly people need nursing care service or are at high risk of requiring the service within a short time), prepared by the Japanese Orthopaedic Association (JOA) in 2007, but it is unclear if there is any association between this measure and falls. Objective: To investigate the association between falls during the previous year and the 7 “loco-check” daily activity items and the total number of items endorsed, and sleep duration. Methods: We conducted an Internet panel survey. Subjects were 624 persons aged between 30 and 90 years. The general health condition of the participants, including their experience of falling, daily activities, and sleep duration, was investigated. A multivariate analysis was carried out using logistic regression to investigate the relationship between falls in the previous year and difficulties with specific daily activities and total number of difficulties (loco-check) endorsed, and sleep duration, adjusting for sex and age. Results: One-fourth of participants (157 persons) experienced at least one fall during the previous year. Fall rate of females (94/312: 30.1%) was significantly higher than that of males (63/312: 20.2%). Fall rate of persons aged more than 65 years (80/242: 33.1%) was significantly higher than that of younger persons (77/382: 20.2%). Logistic regression analysis revealed that daily activities such as “impossibility of getting across the road at a crossing before the traffic light changes” are significantly related to falling. Logistic regression analysis also demonstrated a relationship between the number of items endorsed on loco-check and incidence of falling, wherein persons who endorsed 4 or more items appear to be at higher risk for falls. However, logistic regression found no significant relationship between sleep duration and falling. Conclusions: Our study demonstrated a relationship between the number of loco-check items endorsed and the incidence of falling in the previous year. Endorsement of 4 or more items appeared to signal a high risk for falls. The short self-administered checklist can be a valuable tool for assessing the risk of falling and for initiating preventive measures. %M 27323871 %R 10.2196/ijmr.5590 %U http://www.i-jmr.org/2016/2/e20/ %U https://doi.org/10.2196/ijmr.5590 %U http://www.ncbi.nlm.nih.gov/pubmed/27323871