JMIR nursing最新文献

Background: Diabetes has become a significant global health issue, particularly imposing a deep economic burden on low-income countries. Innovative and integrated digital solutions can reduce the impact of diabetes and enhance the quality of care. However, digital solutions have not been utilized before in Myanmar.

Objective: This study aimed to demonstrate the novel integrated effect of diabetes knowledge and registry tools on the performance of front-line health workers in primary health care settings.

Methods: A quasi-experimental study with an intervention and a control group was conducted in two townships from October 2022 to April 2023. For the first time, researchers trained the intervention group to use digital tools for diabetes control and performed monthly follow-ups. The study employed multiple linear regression models to explore the novel impact of digital tools on knowledge and performance scores, their correlations, and their association with covariates. Additionally, it assessed the cost-effectiveness of the intervention by using self-administered questionnaires as measurement tools formulated based on the National Diabetes Guidelines.

Results: A total of 96 participants were enrolled in the study, divided evenly into the two groups. The intervention group exhibited a significant increase in the mean knowledge scores from 85.81 to 99.25 (P<.001) and performance scores from 71.22 to 107.16 (P<.001). The intervention accounted for 43.2% of the variance in knowledge scores and 62.5% in performance scores (P<.001). A positive correlation was found between knowledge and performance scores (r=0.45, P<.001). The intervention was also cost-effective, with a cost-effectiveness analysis value of 0.711 and an incremental cost-effectiveness ratio of 10127.04 Kyats (US$ 4.83).

Conclusions: As the new integrated intervention yields significant economic gains and positive effects, researchers suggest policy makers replicate this intervention as a nationwide program and recommend scaling up the use of digital tools to improve knowledge and performance for diabetes control in frontline health workers.

Background: Unplanned extubation (UEX) is a critical indicator of nursing care quality. Existing research primarily focuses on pediatric intensive care units (PICUs), with limited data available from general pediatric surgery. Currently, most studies on this topic are mainly focused on PICUs, and there is a lack of research data regarding general pediatric surgery. Therefore, further research should be conducted based on this consideration.

Objective: This study aimed to analyze the high-risk factors for UEX in children and implement appropriate nursing strategies to reduce its incidence, ensuring clinical safety of pediatric patients.

Methods: A retrospective study (January 2018 - December 2023) included pediatric patients with indwelling catheters in general surgery. Exclusion criteria included mental disorders or abnormal Glasgow Coma Scale scores. Data on catheter days, UEX incidents, and risk factors were analyzed.

Results: A total of 1977 catheter days were recorded during the perioperative period, comprising 1079 days with urinary catheters, 768 days with postoperative wound drainage tubes, 68 days with gastric tubes, 46 days with peripheral central venous catheters, and 8 days with central venous catheters. During this period, 13 incidents of UEX occurred, yielding an overall UEX rate of 6.58 per 1000 catheter days. Urinary catheters accounted for the highest proportion of UEX incidents (8/13, 61.5%), followed by gastric tubes (3/13, 21.3%) and postoperative wound drainage tubes (2/13, 15.4%). The reintubation rate following UEX was 15.38% (2/13). Further analysis identified significant risk factors associated with UEX: (1) patient characteristics: age ≤3 years (8/13, 61.5%) and male sex (10/13, 76.9%); (2) clinical management: absence of physical restraints (10/13, 76.9%); and (3) temporal factors: incidents occurring during holidays (9/13, 69.2%). Multivariate analysis revealed that UEX risk was influenced by inter-related factors, including pediatric physiological characteristics (eg, limited self-regulation capacity), suboptimal catheter fixation methods, positional discomfort during patient movement, and variations in nursing interventions (eg, frequency of rounds and caregiver education).

Conclusions: Unplanned extubation in pediatric inpatients represents a critical clinical complication that may compromise treatment efficacy and prolong hospitalization. Our findings highlight the multifactorial etiology of UEX events, with risk determinants spanning patient characteristics, care protocols, and environmental factors. To mitigate these risks, we propose implementing evidence-based multidisciplinary preventive strategies, including standardized risk assessment protocols for high-risk subgroups (eg, male patients aged ≤3 years), enhanced staff training on age-appropriate restraint techniques and securement device utilization

Background: Patients with post-COVID-19 continue to experience lingering physical and psychological symptoms, requiring coordinated and continuous care. Addressing these needs is essential, especially in resource-limited settings.

Objective: The objectives of this paper are to study the issues and needs, as well as the nursing and continuous care systems for residents living with COVID-19, to design and develop a database system, develop continuous care guidelines, and evaluate the effectiveness of the database system for continuous monitoring and care for residents living with COVID-19 in Nakhon Pathom Province, Thailand.

Methods: Participatory action research was used to engage stakeholders and guide the development process.

Results: A total of 375 patients and family members affected by post-COVID-19 symptoms reported that symptoms persisted for approximately 6 months, with common symptoms including persistent cough and easy fatigue. These patients experienced reduced access to health care services, relying mainly on symptomatic treatment at local facilities and using telehealth nursing systems. They expressed a need for continuous care support from 50 professional nurses and village health volunteers. As a result, health care guidelines for post-COVID recovery were developed, comprising 5 core components: (1) self-care through digital information retrieval, (2) care via telehealth nursing systems, (3) physical health care services postrecovery, (4) mental health services postrecovery, and (5) continuous care for referral in case of postrecovery incidents. These guidelines were used to design a database system for continuous monitoring and care, which was evaluated as highly effective (mean 4.51, SD 0.59).

Conclusions: This research highlights the critical need for a proactive and comprehensive approach to managing post-COVID-19 care in Nakhon Pathom Province. By developing and implementing a database system for continuous monitoring and care, along with clear guidelines, the study effectively addresses the ongoing needs of individuals recovering from COVID-19. The integration of technology, along with continuous care provided by professional nurses and village health volunteers, has been shown to be highly effective in improving the quality of care. The findings suggest that adopting these strategies, along with implementing supportive policies on data management and communication systems focused on home visits, will significantly enhance health service management and better prepare the region for future public health challenges.

Background: The growing use of social media has created concerns about addiction, and thus, it is necessary to explore how personality traits and fear of missing out (FOMO) can be utilized to predict social media addiction (SMA).

Objectives: The purpose of this study was to investigate the connection between personality traits, FOMO, and SMA in university students in Saudi Arabia.

Methods: In this cross-sectional study, data were collected from nursing students using the shortened version of the big five inventory, fear of missing out scale, and SMA scale from May to September 2024.

Results: The study achieved a response rate of 66.7% (414/620), finally including a total of 411 participants. The majority of participants (247/411, 60.1%) had low FOMO scores, while SMA scores showed a different pattern, with a larger proportion (261/411, 63.5%) of participants scoring in the moderate range. In terms of gender differences, male participants exhibited higher levels of FOMO (t=3.86, P<.001) and SMA (t=2.51, P=.013) compared to female participants. Additionally, male participants scored higher in neuroticism (t=3.30, P=.001) and openness (t=1.98, P=.048). Regression analysis revealed that both conscientiousness (β=.357, P<.01) and FOMO (β=.213, P<.01) positively predicted SMA, while neuroticism (β=-.223, P<.01) and being female (β=-.098, P<.05) were associated with lower levels of addiction. The resulting model accounted for 35.8% of the variance.

Conclusions: The study provides evidence that conscientiousness and FOMO are positive predictors of SMA, while neuroticism is negatively correlated with it. Moreover, male participants exhibited higher levels of both FOMO and SMA in comparison to female participants. These findings emphasize the impact of personality traits and FOMO on SMA among university students.

Background: The current Information and Communication Technologies, digital literacy, and ease of access to communication and information devices by nurses provide them with new ways and intention to access information for technical-scientific updating, ensuring the quality and safety of health care. M-learning offers a flexible and accessible alternative for continuing professional education, overcoming barriers such as time constraints and financial burden.

Objective: To evaluate the effectiveness of m-learning in nurses' knowledge retention of Chronic Obstructive Pulmonary Disease self-management, using a Massive Open Online Course with integrated virtual clinical simulation.

Methods: A quasi-experimental pre- and post-test study was conducted, with no control group, with 168 nurses from a Portuguese hospital. The intervention included an asynchronous online course with 13 modules. Knowledge retention was assessed by comparing the mean scores before and after the course.

Results: The results indicated a significant increase in knowledge retention. The participants' average score increased from 59.97% in the initial assessment to 84.05% in the final assessment (p<.001). Nurses with a master's degree exhibited a higher level of basic knowledge than those with a bachelor's degree. The course completion rate was 93.45%, reflecting significant engagement attributed to gamification and clinically relevant content.

Conclusions: M-learning is useful in nurses' lifelong learning, offering flexibility and more effective support for clinical practice. Integrating virtual simulation and gamification boosted motivation and reduced drop-out rates, highlighting the potential of m-learning in lifelong learning in healthcare. This study confirms the effectiveness of m-learning in improving knowledge retention in nursing. This strategy is a valuable approach to lifelong learning, promoting quality and safety in delivering healthcare.

Clinicaltrial:

Unlabelled: Each year, nursing informatics researchers contribute to nursing and health informatics knowledge. The year 2024 emerged as yet another year of significant advances. In this editorial, I describe and highlight some of the key trends in nursing informatics research as published in JMIR Nursing in 2024. Artificial intelligence (AI), data science, mobile health (mHealth), and the integration of technology into nursing education and practice remain key research themes in the literature. Nursing informatics publications continue to grow in number. A greater number of AI and data science articles are being published, while at the same time, mHealth and technology research continues to be conducted in nursing education and practice contexts.

Background: Older adults manage multiple impacts on health, including chronic conditions and adverse external events. Smart homes are positioned to have a positive impact on older adults' health by (1) allowing new understandings of behavior change so risks associated with external events can be assessed, (2) quantifying the impact of social determinants on health, and (3) designing interventions that respond appropriately to detected behavior changes. Information derived from smart home sensors can provide objective data about behavior changes to support a learning health care system. In this paper, we introduce a smart home capable of detecting behavior changes that occur during adverse external events like pandemics and wildfires.

Objective: Examine digital markers collected before and during 2 events (the COVID-19 pandemic and wildfires) to determine whether clinically relevant behavior changes can be observed and targeted upstream interventions suggested.

Methods: Secondary analysis of historic ambient sensor data collected on 39 adults managing one or more chronic conditions was performed. Interrupted time series analysis was used to extract behavior markers related to external events. Comparisons were made to examine differences between exposures using machine learning classifiers.

Results: Behavior changes were detected for 2 adverse external events (the COVID-19 pandemic and wildfire smoke) initially and over time. However, the direction and magnitude of change differed between participants and events. Significant pandemic-related behavior changes ranked by impact included a decrease in time (3.8 hours/day) spent out of home, an increase in restless sleep (946.74%), and a decrease in indoor activity (38.89%). Although participants exhibited less restless sleep during exposure to wildfire smoke (120%), they also decreased their indoor activity (114.29%). Sleep duration trended downward during the pandemic shutdown. Time out of home and sleep duration gradually decreased while exposed to wildfire smoke. Behavior trends differed across exposures. In total, two key discoveries were made: (1) using retrospective analysis, the smart home was capable of detecting behavior changes related to 2 external events; and (2) older adults' sleep efficiency, time out of home, and overall activity levels changed while experiencing external events. These behavior markers can inform future sensor-based monitoring research and clinical application.

Conclusions: Sensor-based findings could support individualized interventions aimed at sustaining the health of older adults during events like pandemics and wildfires. Creating care plans that directly respond to sensor-derived health information, like adding guided indoor exercise, web-based socialization sessions, and mental health-promoting activities, would have practical impacts on wellness. The sm

Background: Nurses are one of the largest user groups of the electronic health record (EHR) system, relying on its tools to support patient care and nursing workflows. Recent studies suggested that the redesign of nursing documentation may reduce the time spent in the EHR system and improve nurse satisfaction.

Objective: We aimed to assess nurses' perceptions of the redesigned EHR, evaluate the impact of documentation interventions, and identify future improvement needs.

Methods: Guided by the American Nursing Informatics Association's Six Domains of Burden conceptual framework, this multimethod project combined both qualitative and quantitative approaches. Registered nurses across the academic health system were recruited via email invitations to participate in focus group discussions. The focus groups were conducted via a web conference and ranged from 60 to 90 minutes in duration. The focus group discussions were transcribed and analyzed through thematic analysis. The EHR vendor's time data were used to analyze nurses' time spent in documentation.

Results: In total, 20 registered nurses participated in the focus group discussions, and 17 nurses completed the demographic survey; 88% (15/17) of participants had ≥3 years of EHR experience at the academic health system, and 53% (9/17) self-reported being competent in the EHR system. The following six themes emerged: positive feedback, usability and workflow opportunities, nuisance, training and education, communication, and time spent in the system. EHR vendor time data revealed that the time spent in flowsheets averaged 31.11% per 12-hour shift.

Conclusions: Overall, participants reported a positive experience and that the EHR supported patient care. There are opportunities to further reduce redundancies in documentation and implement programs that support continuous learning about EHR and health technology tools. Specific suggestions include optimizing the oral health assessment tool. Analyzing frontline nursing perspectives in the redesign of EHR workflows is imperative for identifying interventions that support nurses' satisfaction with the EHR.

Background: The COVID-19 pandemic placed unprecedented pressure on health care systems worldwide, significantly impacting frontline health care workers, especially nurses. These professionals faced considerable psychological stress from caring for patients with COVID-19 and the fear of spreading the virus to their families. Studies report that more than 60% (132/220) of nurses experience anxiety, depression, and emotional exhaustion, which adversely affect their mental health and the quality of care they provide.

Objective: This study aimed to investigate the relationship between work-related stress and emotional exhaustion among nurses and to assess whether listening to podcasts moderates this association.

Methods: A cross-sectional online survey was conducted between March 1, 2023, and March 31, 2023. A total of 271 clinical nurses, aged 20 years to 65 years, were recruited for the study. Participants were divided into 2 groups: experimental group consisting of regular podcast listeners (n=173) and control group comprising nonlisteners (n=98). Ethical approval for this study was obtained from the local ethics committee (IRB number YGHIRB20230421B). Validated scales were used to measure work stress, emotional dissonance, and emotional exhaustion. Data analysis included descriptive statistics, independent t tests, and structural equation modeling to examine the relationships between variables.

Results: No statistically significant differences were found between the experimental and control groups in terms of overall work stress (mean difference=-0.09, 95% CI -0.31 to 0.13; P=.42) or emotional exhaustion (mean difference=0.07, 95% CI -0.15 to 0.29; P=.53). Emotional dissonance emerged as a significant predictor of emotional exhaustion in both the experimental (β=0.476, P<.001) and control (β=0.321, P=.01) groups. Nurses reporting higher workloads had significantly higher emotional exhaustion levels (experimental group: β=0.302, P<.001; control group: β=0.327, P=.002). Podcast listening demonstrated only a slight, nonsignificant moderating effect.

Conclusions: Although podcasts alone may not significantly reduce work stress or emotional exhaustion among nurses, there was a potential, albeit limited, moderating effect of podcasts on emotional well-being. They could serve as a supplementary tool for emotional support. However, broader and more comprehensive interventions are required to address the underlying causes of stress and emotional exhaustion in this population. More in-depth exploration and recommendations are possible by analyzing the content and patterns of listening. Further research is needed to examine the long-term benefits of integrating podcasts with other digital tools for holistic stress management in health care settings.