Cin-Computers Informatics Nursing最新文献

The purpose of this article is to conduct a scoping review, which examines research evidence on therapeutic alliance development in adolescents while using telehealth during mental health encounters (telemental health). Thirty-seven percent of all high school students in the United States reported poor mental health during the pandemic, and 44% reported sadness and/or hopelessness in the past year. Therapeutic alliance is a collaborative relationship between patient and provider with a strong affective bond and agreement on treatment tasks and goals. Telehealth may facilitate access, but preliminary research demonstrates provider challenges for building therapeutic alliance during telehealth visits in adolescents. CINAHL, Embase, PsycINFO, PubMed, Google Scholar, and ProQuest were searched through June 2023. Inclusion studies examined therapeutic alliance in mental health patients with a mean age of 14 to 18 years and synchronous telehealth use. Articles published in English; publication dates and geographic location were not excluded. A total of 1091 articles were obtained after duplications were discarded. Three reviewers, working in pairs, independently reviewed each citation against predetermined criteria. Joanna Briggs Scoping Review Methodology, the Preferred Reporting Items for Systematic reviews and Meta-Analyses-Scoping Review process organized the findings. The 9 articles that met the criteria were case reports, descriptive, qualitative, mixed methods, and a partially randomized patient preference pilot study. There were 416 adolescent participants (mean age = 15.74 years). Five themes synthesized the findings: "established relationship prior to telemental health," "diagnoses best suited for telemental health," "role of technology," "therapeutic space and privacy," and "appointment attendance." A recommendation emerged in offering a hybrid approach. However, many barriers still exist in the complex, high-risk, and geographically challenged patient. Telemental health can bridge the divide between those who traditionally cannot access treatment, but providers must learn how to develop relationships virtually. Another recommendation is to allow adolescents alone time and privacy with the provider. Further research is needed to assess therapeutic alliance using telehealth between adolescents and clinicians in the postpandemic era, particularly from the adolescents' perspective. Limitations included that three studies occurred before March 2020, when the SARS-CoV-2 (COVID-19) pandemic started, and the remaining articles occurred during the pandemic when social distancing measures were in place. Therefore, this limited study methods to single-group designs, and many of the participants already established a relationship with their provider before shifting to telehealth, so there was less focus on the initiation of therapeutic alliance via telehealth.

The human-centered design approach has gained prominence in the development of mobile health solutions. However, its application to support foot self-care for persons with diabetes has not been extensively explored. This study aims to develop a mobile application prototype using a human-centered design approach to support foot self-care for persons with type 2 diabetes. The project used mixed methods, including a scoping review, patient interviews, a Delphi panel, and an acceptability and usability study of an educational booklet. This three-phase approach encompassed defining the context of use, specifying user requirements, and developing design solutions. This article specifically details the third phase of the project: the development of the low-fidelity prototype. Functionalities such as daily reminders for foot care, notifications for medical appointments, communication features with healthcare professionals and peers, and repositories of videos and educational content were integrated into the design. These features were tailored to address user needs, emphasizing knowledge enhancement in self-care practices. The human-centered design approach enabled the creation of a comprehensive prototype with essential functionalities and robust educational content, filling gaps in the digital health market and empowering persons to better manage their foot health.

The shortage of nurses, which harms both patients and nurses, is a global issue. Healthcare providers are actively introducing information and communication technology and artificial intelligence to improve the efficiency of their nursing work. Electronic devices in healthcare often face challenges such as poor accessibility, complex documentation processes, and interference with patient care. Therefore, this study focuses on smart glasses as alternative devices and develops a hospital-work support application to test its usability. The usability test involved nurses who perform hospital-admission tasks in a simulated hospital-room environment at a general hospital in Japan as part of a performance measurement, followed by interviews and questionnaires (System Usability Scale) with nurses. The smart glasses used in this study were AR100 and DE100 from Dynabook. The tests yielded results from five nurses, including System Usability Scale scores ranging from 37.5 to 70, reduced documentation time, and a nearly 100% task-completion rate. However, we found usability issues related to the input method and distraction risks owing to the presence of the display, and the required application functionalities may vary depending on the nurses' capabilities. Although smart glasses can potentially improve the efficiency of nurses' hospital duties, further enhancements in usability are necessary.

This study aimed to develop a mobile application self-management program for patients with implantable cardioverter-defibrillators and evaluate its effectiveness. A nonequivalent experimental group pre-post quasi-experimental study was conducted. The experimental group (n = 32) received the mobile application and education for 8 weeks. The control group (n = 32) received a booklet and education. Uncertainty, self-care competence, physical quality of life, mental quality of life, and physiological indicators (ejection fraction, systolic blood pressure, diastolic blood pressure, pulse rate) were assessed. Outcomes were analyzed using the independent t test, Mann-Whitney U test, analysis of covariance, and ranked analysis of covariance. Physical and mental quality of life significantly increased in the experimental group compared with the control group. Physiological indicators were unchanged. The mobile application self-management program may be utilized as a nursing intervention to improve quality of life for patients with implantable cardioverter-defibrillators.

Prior to implementing an electronic health record-integrated patient-reported outcomes system, eSyM, the perceived facilitators and barriers to implementation from multiple stakeholder perspectives were sought. The purpose is to report the findings of the perceived facilitators and barriers to implementation of eSyM from multiple clinician stakeholder perspectives. Stakeholders included administrators, clerical staff, information technology professionals, support staff, physicians, providers, and nurses from six Symptom Management Implementation of Patient-Reported Outcomes in Oncology health systems, a diverse mix of academic/community, rural/metropolitan, and Northeastern and Southern community-based cancer centers. Site information, participant information, perceived effectiveness, and perceived patient barriers to use were collected from 173 stakeholders. RNs were the most represented participants, followed by physicians, physician assistants, and nurse practitioners. Stakeholders felt that eSyM would be effective in improving patient symptom management, keeping patients out of the hospital and emergency department, and improving clinic efficiency. Clinician stakeholders perceived eSyM as necessary and effective for improving symptom management. Most stakeholders felt that their colleagues would be supportive of using eSyM. Stakeholders perceived minor patient barriers were access to technology, distrust of technology, and English language proficiency. Computer literacy was perceived as a major barrier. Future longitudinal mixed-methods design that combines quantitative findings with qualitative observations is needed. Understanding the contextual factors that influence the facilitation or barriers of implementing eSyM is needed to scale and spread the intervention to other institutions. As a nursing intervention, the assessment of the perceptions of improvement of eSyM workflow would be especially useful.

Providing effective training for surgical nurses is important to prevent venous thromboembolism (VTE). This study was conducted to evaluate the effect of a mobile-supported venous thromboembolism training program on the knowledge and practices of surgical nurses. A total of 147 surgical nurses were given mobile-supported venous thromboembolism training. The data were collected using an Information and Practices Form. It was determined that the nurses' knowledge and practice scores increased significantly over time, from baseline (T0) to immediately after training (T1) and 1 month after training (T2) ( P  < .0005). All nurses were satisfied with the mobile-based VTE training. A moderate and positive correlation was found between the satisfaction scores of the nurses and their knowledge and practice scores immediately after training ( P  < .05). A weak and positive correlation was found between knowledge and practice scores immediately after training and 1 month later ( P  < .05). One month before VTE training, two patients were readmitted to the hospital with postoperative VTE. No patients who were given care by the same nurses were readmitted with postoperative VTE 1 month after training. In conclusion, mobile-supported training provided improvement and ensured the sustainability of nurses' knowledge and practices regarding VTE, was a satisfactory and acceptable training strategy, positively affected patient outcomes, and prevented repeated hospitalizations.

Virtual nurses, experienced nurses who use technology to remotely direct patient care, are rapidly being introduced into acute care settings as part of the strategy to mitigate nursing shortages and burnout. We used an implementation science approach to evaluate the implementation outcomes of a pilot virtual nursing model in a 40-bed medical/surgical unit. Using Proctor's implementation outcomes of acceptability, adoption, appropriateness, fidelity, and feasibility, this mixed-methods study included observations, focus groups with virtual nurses, surveys on direct care staff, and additional quantitative analysis. Virtual nurses, who became integral members of the care team, engaged in admissions, discharges, patient education, remote monitoring, and staff mentoring. Virtual nurses reported high satisfaction due to greater patient interaction and supporting colleagues. Bedside care staff reported that the virtual nurse support not only was useful, but also increased time to provide direct patient care. The study highlights the learnings related to implementation outcomes of integrating a team-based virtual care model. The model, which introduced teamwork between bedside and virtual nurses, improved workflow, created a meaningful role for experienced nurses, and supported nursing practice for bedside nurses. Implications for standardizing training and the challenge in creating meaningful teamwork and efficient workflows are discussed.

This project aimed to evaluate the effect of patient portal utilization on patient experience and communication with care teams among hospitalized inpatients. Patients (n = 33) from an adult, 16-bed inpatient floor at an academic, level I trauma center completed a Web-based survey regarding their experience with a patient portal following training by medical students. Survey responses indicated a favorable perception of the portal. Most patients reported improved communication with healthcare providers and enhanced understanding of medications. The majority found the portal easy to navigate and expressed user satisfaction. The patient portal facilitated improved communication with care teams and a better understanding of medical management among patients. The study highlighted the importance of raising awareness about patient portal usage for inpatients. Health providers can foster improved communication, engagement, and medication education among hospitalized patients by promoting health information technology adoption.

Virtual reality technology offers an extended and repeatable environment for delivering digital learning and training. This study investigated the acceptance of a smartphone virtual reality training program among nursing students for chemotherapy administration using a modified Technology Acceptance Model. The teaching materials for the chemotherapy administration process were designed using smartphone virtual reality to provide prelicensure students with an opportunity to learn procedural steps in a controlled, risk-free environment. A total of 56 nursing students, both undergraduate and postbaccalaureate, participated in the virtual reality training and completed questionnaires assessing their perceptions of usefulness, ease of use, and intention to use the technology. Three factors of the modified Technology Acceptance Model had positive correlations with the overall complexity of chemotherapy (skill complexity): perceived usefulness ( r  = 0.27, P  = .04), perceived ease of use ( r  = 0.27, P  = .04), and intention to use ( r  = 0.38, P  = .004). No significant correlation was observed between attitude toward use and skill complexity. In subsequent path analysis, the model explained 63.4% of the variance in the intention to use virtual reality. Positive correlations were found for five hypotheses: perceived usefulness (γ = 0.586) and age (γ = 0.244) with attitude toward use, perceived ease of use with perceived usefulness (γ = 0.749), and perceived usefulness (γ = 0.595) and skill complexity (γ = 0.176) with intention to use. Nursing students showed a high willingness to learn and practice through virtual reality, particularly when techniques and skills were inherently difficult or dangerous. This suggests that virtual reality can be an effective teaching medium for complex and high-risk procedures in nursing education.

Chronic diseases globally contribute to heightened rates of morbidity and mortality. Telehealth is a viable approach to managing chronic illness. In response to the coronavirus pandemic, a research facility implemented telehealth in April 2020 to continue research activities. A telehealth program evaluation was needed to explore the facility's strengths and improvement opportunities. The Centers for Disease Control and Prevention's Framework for Program Evaluation guided the evaluation to determine whether telehealth implementation improved care access, efficiency, and provider experiences. Missed and canceled visits, visit duration, and wait times between April 2020 and June 2023 were analyzed for those 19 years and older with chronic illnesses identified by International Classification of Diseases, 10th Revision codes. Provider experiences were measured with the Telehealth Usability Questionnaire. The facility transitioned from Microsoft Teams® to a telehealth platform in March 2023, offering more robust data. Analyses revealed improved completed visits, decreased patient abandoned visits, and varied canceled and duration percentages. Providers missed visits less frequently than patients. Run charts for telehealth total visits versus chronic visits did not reveal special cause variations. Provider experiences were favorable except for telehealth reliability and interface quality. Recommendations include continued user training, evaluating patients' experiences, exploring telehealth's impact on research participant recruitment, and standardizing evaluation processes through policy development.