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Mobile health (mHealth) holds considerable promise as a way to give people greater control of their health information, privacy, and sharing in the context of HIV research and clinical services. The purpose of this study was to determine the feasibility of an mHealth research application from the perspective of three stakeholder groups involved in an HIV clinical trial in Jakarta, Indonesia: (a) incarcerated people living with HIV (PLWH), (b) research assistants (RAs), and (c) research investigators. Incarcerated PLWH (n = 150) recruited from two large all-male prisons completed questionnaires, including questions about mHealth acceptability, on an mHealth survey application using a proprietary data collection software development platform. RAs who administered questionnaires (n = 8) rated the usability of the software application using the system usability scale (SUS) and open-ended questions. Research investigators (n = 2) completed in-depth interviews, that were coded and analyzed using the technology acceptance model (TAM) as a conceptual framework. Over 90% of incarcerated PLWH felt the mHealth application offered adequate comfort, privacy, and accuracy in recording their responses. RAs' SUS scores ranged from 60% to 90% (M = 76.25) and they found the mHealth survey application challenging to learn, but highly satisfying. Compared with paper-based data collection, researchers felt that electronic data collection led to improved accuracy and efficiency of data collection and the ability to monitor data collection remotely and in real time. The researchers perceived the learnability of the application as acceptable but required self-instruction.

To maintain their quality of life and avoid hospitalization and early mortality, patients with heart failure must recognize and respond to symptoms of exacerbation. A promising method for engaging patients in their self-care is through mobile health applications (mHealth apps). However, for mHealth to have its greatest chance for improving patient outcomes, the app content must be readable, provide useful functions and be based in evidence. The study aimed to determine: (1) readability, (2) types of functions, and (3) linkage to authoritative sources of evidence for self-care focused mHealth apps targeting heart failure patients that are available in the Apple and Google Play Stores. We systematically searched for mHealth apps targeting patients with heart failure in the Apple and Google Play Stores and applied selection criteria. Readability of randomly selected informational paragraphs were determined using Flesch-Kincaid grade level test tool in Microsoft Word. Ten mHealth apps met our criteria. Only one had a reading grade level at or below the recommended 6th grade reading level (average 9.35). The most common functions were tracking, clinical data feedback, and non-data-based reminders and alerts. Only three had statements that clearly linked the mHealth app content to trustworthy, evidence-based sources. Only two had interoperability with the electronic health record and only one had a communication feature with clinicians. Future mHealth designs that are tailored to patients' literacy level and have advanced functions may hold greater potential for improving patient outcomes.

ObjectiveThe study sought to synthesize published literature on direct care nurses’ use of workarounds related to the electronic health record.Materials and MethodsWe conducted an integrative review of qualitative and quantitative peer-reviewed research through a structured search of Academic Search Complete, EBSCO Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, Engineering Village, Ovid Medline, Scopus, and Web of Science. We systematically applied exclusion rules at the title, abstract, and full article stages and extracted and synthesized their research methods, workaround classifications, and probable causes from articles meeting inclusion criteria.ResultsOur search yielded 5221 results. After removing duplicates and applying rules, 33 results met inclusion criteria. A total of 22 articles used qualitative approaches, 10 used mixed methods, and 1 used quantitative methods. While researchers may classify workarounds differently, they generally fit 1 of 3 broad categories: omission of process steps, steps performed out of sequence, and unauthorized process steps. Each study identified probable causes, which included technology, task, organizational, patient, environmental, and usability factors.ConclusionsExtensive study of nurse workarounds in acute settings highlights the gap in ambulatory care research. Despite decades of electronic health record development, poor usability remains a key concern for nurses and other members of care team. The widespread use of workarounds by the largest group of healthcare providers subverts quality health care at every level of the healthcare system. Research is needed to explore the gaps in our understanding of and identify strategies to reduce workaround behaviors.

The lack of a proper system for ongoing open interprofessional communication among care providers increases miscommunications and medical errors. Seamless access to patient information is important for care providers to prevent miscommunication and improve patient safety. A shared understanding of the information needs of different care providers in an interprofessional team is lacking. Our purpose is to identify care providers' information needs from the perspective of different professions for communication, shared understanding about the patient, and decision-making. We conducted semi-structured interviews with 10 subject matter experts representing eight professions, including dentistry, dietetics, medicine, nursing, occupational therapy, pharmacy, physical therapy, and social work in a 465-bed academic hospital at a large urban Midwestern city. We used an in-house rounding tool presenting physicians' information needs and a hypothetical patient scenario to collect participants' feedback. Interview notes were coded using direct content analysis. We identified 22 additional essential data elements for an interprofessional rounding tool. We categorized those into six domains: discharge-related, social determinants of health, hospital safety, nutrition, interprofessional situation awareness, and patient history. A well-designed validated rounding tool that includes an interprofessional team of care providers' information needs could improve communication, care planning, and decision-making among them.

Purpose To provide guidance to nurses caring for individuals with COVID-19, we developed linkages using interoperable standardized nursing terminologies: NANDA International (NANDA-I) nursing diagnoses, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC). We also identified potential new NANDA-I nursing diagnoses, NOC outcomes, and NIC interventions for future development related to nurses' role during a pandemic. Methods Using a consensus process, seven nurse experts created the linkages for individuals during the COVID 19 pandemic using the following steps: (a) creating an initial list of potential nursing diagnoses, (b) selecting and categorizing outcomes that aligned with all components of each nursing diagnosis selected, and (c) identifying relevant nursing interventions. Findings A total of 16 NANDA-I nursing diagnoses were identified as the foundation for the linkage work, organized in two dimensions, physiological and psychosocial. A total of 171 different NOC outcomes were identified to guide care based on the nursing diagnoses and 96 NIC interventions were identified as suggested interventions. A total of 13 proposed concepts were identified for potential future development across the three classifications. Conclusions The linkages of nursing diagnoses, outcomes, and interventions developed in this article provide a guide to enhance nursing practice and determine the effectiveness of nurses' contribution to patient outcomes for individuals at risk for or infected by COVID-19. Implications for nursing practice NANDA-I, NOC, and NIC linkages identified in this paper are an important example of the value of using standardized nursing terminologies to guide and document nursing care. When included in electronic health record databases and used widely, the data generated from the care plans can be used to create new knowledge about how to better improve outcomes for patients with COVID-19.

PURPOSE We developed linkages using interoperable standardized nursing terminologies, NANDA International (NANDA‐I) nursing diagnoses, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC), to present initial guidance for the development of care plans focused on COVID‐19 for nurses practicing in community or public health roles. METHODS Seven nurse experts identified the linkages of NANDA‐I, NOC and NIC for our work related to the COVID‐19 pandemic. A model was developed to guide the project. The first step in creating linkages focused on the identification of nursing diagnoses. Then, for each nursing diagnosis, outcomes aligned with all components of the diagnosis were categorized and a list of nursing interventions was selected. The experts used their clinical judgment to make final decisions on the linkages selected in this study. FINDINGS Two community level nursing diagnoses were identified as key problems appropriate for a pandemic related to COVID‐19: Deficient Community Health and Ineffective Community Coping. For the nursing diagnosis Deficient Community Health, eight nursing outcomes and 12 nursing interventions were selected. In comparison for the nursing diagnosis, Ineffective Community Coping, nine nursing outcomes and 18 nursing interventions were identified. A total of40 concepts were identified for future development across the three classifications. CONCLUSIONS The nursing diagnoses, outcomes and interventions selected during this linkage process provide knowledge to support the community challenged with responding to the COVID‐19 pandemic, provide the opportunity to quantify the impact of nursing care, and enhance nursing practice by promoting the use of three standardized terminologies. IMPLICATIONS FOR NURSING PRACTICE NANDA‐I, NOC and NIC linkages identified in this manuscript provide resources to support clinical decisions and care plan development for nurses practicing in the community.

With the explosion of scientific literature, information technologies, and the rise of evidence-based health care, methodologies for literature reviews continue to advance. Yet there remains a lack of clarity about techniques to rigorously and efficiently extract and synthesize data from primary sources. We developed a new method for data extraction and synthesis for completing rigorous, knowledge synthesis using freely available online survey software that results in a review-specific, online data extraction, and synthesis tool. The purpose of this paper is to delineate this method using our published integrative review as an exemplar. Although the purpose of online survey software is to obtain and analyze survey responses, these software programs allows for the efficient extraction and synthesize of disparate study features from primary sources. Importantly, use of the method has the potential to increase the rigor and efficiency of published reviews bringing the promise of advancing multiple areas of health science.

Background Being able to make accurate clinical decisions about actual or potential health problems is crucial to provide a safe and effective care. However, nursing students generally have difficulties identifying nursing diagnoses accurately. Objective To compare the diagnostic accuracy within and across the NANDA-I diagnoses domains of junior, senior, and graduate-entry students. Design Descriptive study Participants and Setting The sample comprised one hundred thirty nursing students from a Midwestern American university. Methods The participants were divided in three groups (juniors, seniors and graduate-entry) and invited to engage in a series of diagnostic exercises presented in a software. Students were presented with 13 scenarios and asked to identify the applicable defining characteristics, related factors, and nursing diagnoses from the NANDA-I taxonomy. The number of correct answers per scenario was used to compute diagnostic accuracy. Age, gender, previous exposure to the NANDA-I taxonomy, and student level were covariates in the analysis. Results The average percent correct answers across all groups was 64.4% and no statistical differences between the groups were found. The scenarios belonging to the Health Promotion, Self-Perception, and Growth/Development Domains were those in which students had a higher number of incorrect answers. Students also had more difficulty recognizing the correct nursing diagnoses compared with related factors and defining characteristics. Conclusions This study found no associations between demographic variables, exposure to the NANDA-I taxonomy, or academic program level and diagnostic accuracy. Some areas in which students had a poor performance indicate need for improvement in diagnostic reasoning skills.

Background Patient access to health information using electronic patient portals is increasingly common. Portal use has the potential to improve patients’ engagement with their health and is particularly important for patients with chronic illness; however, patients’ abilities, attitudes, and use of portals are poorly understood. Methods A single-center, cross-sectional survey was conducted of 240 consecutive pre- and post-kidney transplant patients of all levels of technological proficiency who presented to an urban transplant center in the United States. The investigator-developed Patient Information and Technology Assessment-Patient Portal was used to assess patients’ attitudes towards the use of patient portals. Results Most patients surveyed did not use the patient portal (n = 176, 73%). Patients were more likely to use the patient portal if they were White, highly educated, in the post-transplant period, more comfortable with technology, and reported being a frequent internet user (P Conclusions We identified several modifiable barriers to patient portal use. Some barriers can be addressed by patient education and training on portal use, and federal initiatives are underway to improve interoperability; however, a preference for traditional communications represents the most prominent barrier. Additional strategies are needed to improve portal adoption by encouraging acceptance of technologies as a way of clinical communication.

Purpose This study aimed to investigate effects of individual nurse and hospital characteristics on patient adverse events and quality of care using a multilevel approach. Design This is a secondary analysis of a combination of nurse survey data (N = 1,053 nurses) and facility data (N = 63 hospitals) in Canada. Methods Multilevel ordinal logistic regression was employed to examine effects of individual nurse and hospital characteristics on patient adverse events. Multilevel linear regressions were used to investigate effects of individual nurse and hospital characteristics on quality of care. Findings Organizational safety culture was associated with patient adverse events and quality of care. Controlling for effects of nurse and hospital characteristics, nurses in hospitals with a stronger safety culture were 64% less likely to report administration of wrong medication, time, or dose; 58% less likely to report patient falls with injury; and 60% less likely to report urinary tract infections; and were more likely to report higher levels of quality of care. Additionally, the effects of individual-level baccalaureate education and years of experience on quality of care differed across hospitals, and hospital-level nurse education interacted with individual-level baccalaureate education. Conclusions This study makes significant contributions to existing knowledge regarding the positive effect of organizational safety culture on patient adverse events and quality of care. Clinical relevance Healthcare organizations should strive to improve their safety culture by creating environments where healthcare providers trust each other, work collaboratively, and share accountability for patient safety and care quality.

Health care, especially ICUs, rely on multiple types of technology to promote the best patient outcomes. Unfortunately, too often these technologies are poorly designed, causing errors, additional workload, and unnecessary frustration. The purpose of this article is to (1) empower nurses with the needed usability and usability testing vocabulary to identify and articulate clinical technology usability problems and (2) provide ideas on ways nurses can advocate to have an impact on positive change related to technology usability within a health care organization.

Sepsis, life-threatening organ dysfunction in response to infection, is an alarmingly common and aggressive illness in US hospitals, especially for intensive care patients. Preventing sepsis deaths rests on the clinicians' ability to promptly recognize and treat sepsis. To aid early recognition, many organizations have employed clinician-facing electronic sepsis alert systems. However, the effectiveness of the alert relies on heavily on the visual interface, textual information, and overall usability. This article reports a usability inspection of a sepsis alert system. The authors found violations in 12 of the 14 usability principles and promote use of this method in practice to systematically identify usability problems.

Background Physician and nurses have worked together for generations; however, their language and training are vastly different; comparing and contrasting their work and their joint impact on patient outcomes is difficult in light of this difference. At the same time, the EHR only includes the physician perspective via the physician-authored discharge summary, but not nurse documentation. Prior research in this area has focused on collaboration and the usage of similar terminology. Objective The objective of the study is to gain insight into interprofessional care by developing a computational metric to identify similarities, related concepts and differences in physician and nurse work. Methods 58 physician discharge summaries and the corresponding nurse plans of care were transformed into Unified Medical Language System (UMLS) Concept Unique Identifiers (CUIs). MedLEE, a Natural Language Processing (NLP) program, extracted “physician terms” from free-text physician summaries. The nursing plans of care were constructed using the HANDS© nursing documentation software. HANDS© utilizes structured terminologies: nursing diagnosis (NANDA-I), outcomes (NOC), and interventions (NIC) to create “nursing terms”. The physician's and nurse's terms were compared using the UMLS network for relatedness, overlaying the physician and nurse terms for comparison. Our overarching goal is to provide insight into the care, by innovatively applying graph algorithms to the UMLS network. We reveal the relationships between the care provided by each professional that is specific to the patient level. Results We found that only 26% of patients had synonyms (identical UMLS CUIs) between the two professions’ documentation. On average, physicians’ discharge summaries contain 27 terms and nurses’ documentation, 18. Traversing the UMLS network, we found an average of 4 terms related (distance less than 2) between the professions, leaving most concepts as unrelated between nurse and physician care. Conclusion Our hypothesis that physician's and nurse's practice domains are markedly different is supported by the preliminary, quantitative evidence we found. Leveraging the UMLS network and graph traversal algorithms, allows us to compare and contrast nursing and physician care on a single patient, enabling a more complete picture of patient care. We can differentiate professional contributions to patient outcomes and related and divergent concepts by each profession.

This integrative literature review was conducted to examine the relationships between safety culture and patient safety and quality of care outcomes in hospital settings and to identify directions for future research. Using a search of six electronic databases, 17 studies that met the study criteria were selected for review. This review revealed semantic inconsistencies, infrequent use of a theory or theoretical framework, limited discussions of validity of instruments used, and significant methodological variations. Most notably, this review identified a large array of nonsignificant and inconsistent relationships between safety culture and patient safety and quality of care outcomes. To improve understanding of the relationships, investigators should consider using a theoretical framework and valid measures of the key concepts. Researchers should also give more attention to selecting appropriate sampling and data collection methods, units of analysis, levels of data measurement and aggregation, and statistical analyses.

Background Clinical decision support (CDS) tools—with easily understood and actionable information, at the point of care—are needed to help registered nurses (RNs) make evidence-based decisions. Not clear are the optimal formats of CDS tools. Thorough, preclinical testing is desirable to avoid costly errors associated with premature implementation in electronic health records. Objective The aims of this study were to determine feasibility of the protocol designed to compare multiple CDS formats and evaluate effects of numeracy and graph literacy on RN adoption of best practices and care planning time in a simulated environment. Methods In this pilot study, 60 RNs were randomly assigned to one of four CDS conditions (control, text, text + graph, and text + table) and asked to adjust the plan of care for two patient scenarios over three shifts. Fourteen best practices were identified for the two patients and sent as suggestions with evidence to the three CDS groups. Best practice adoption rates, care planning time, and their relationship to the RN's numeracy and graph literacy scores were assessed. Results CDS groups had a higher adoption rate of best practices ( p < .001) across all shifts and decreased care planning time in shifts 2 ( p = .01) and 3 ( p = .02) compared with the control group. Higher numeracy and graph literacy were associated with shorter care planning times under text + table ( p = .05) and text + graph ( p = .01) conditions. No significant differences were found between the three CDS groups on adoption rate and care planning time. Discussion This pilot study shows the feasibility of our protocol. Findings show preliminary evidence that CDS improves the efficiency and effectiveness of care planning decisions and that the optimal format may depend on individual RN characteristics. We recommend a study with sufficient power to compare different CDS formats and assess the impact of potential covariates on adoption rates and care planning time.

Anticipatory grieving, grief associated with an impending loss, is common for patients facing end of life or for their families. There is little research on the outcomes of interventions for anticipatory grieving among hospitalized patients. A descriptive, comparative analysis of an existing valid a

The ubiquity of EHRs in healthcare means that small EHR inefficiencies can have a major impact on clinician workload. We conducted a sequential explanatory mixed methods study to: 1) identify EHR-associated workload and usability effects for clinicians following an EHR change over time, 2) determine workload and usability differences for providers (MD and Advance Practice Nurses) versus nurses (RNs and MAs), 3) determine if usability predicts workload, 4) identify potential sources of EHR design flaws. Workload (NASA-Task Load Index) and usability (System Usability Scale) measures were administered pre, 6-8 month and 30-32 months post-implementation. We found significant increase in perceived workload post-implementation that persisted for 2.5 years (p .001). The workload increase was associated with usability ratings, which in turn may relate to EHR interface design violations identified by a heuristic evaluation. Our findings suggest further innovation and attention to interface design flaws are needed to improve EHR usability and reduce clinician workload.

PURPOSE To critically evaluate 2014 American Academy of Nursing (AAN) call-to-action plan for generating interoperable nursing data. DATA SOURCES Healthcare literature. DATA SYNTHESIS AAN's plan will not generate the nursing data needed to participate in big data science initiatives in the short term because Logical Observation Identifiers Names and Codes and Systematized Nomenclature of Medicine – Clinical Terms are not yet ripe for generating interoperable data. Well-tested viable alternatives exist. CONCLUSIONS Authors present recommendations for revisions to AAN's plan and an evidence-based alternative to generating interoperable nursing data in the near term. These revisions can ultimately lead to the proposed terminology goals of the AAN's plan in the long term.

PURPOSE To develop methods for rapid and simultaneous design, testing, and management of multiple clinical decision support (CDS) features to aid nurse decision-making. METHODS We used quota sampling, think-aloud and cognitive interviews, and deductive and inductive coding of synchronized audio video data and archival libraries. FINDINGS Our methods and organizational tools allowed us to rapidly improve the usability, understandability, and usefulness of CDS in a generalizable sample of practicing nurses. CONCLUSIONS The method outlined allows the rapid integration of nursing terminology based electronic health record data into routine workflow and holds strong potential for improving patient outcomes. IMPLICATIONS FOR NURSING PRACTICE The methods and organizational tools for development of multiple CDS system features can be used to translate knowledge into practice.

Objective: To report on the state of the science of clinical decision support (CDS) for hospital bedside nurses. Materials and Methods: We performed an integrative review of qualitative and quantitative peer-reviewed original research studies using a structured search of PubMed, Embase, Cumulative Index to Nursing and Applied Health Literature (CINAHL), Scopus, Web of Science, and IEEE Xplore (Institute of Electrical and Electronics Engineers Xplore Digital Library). We included articles that reported on CDS targeting bedside nurses and excluded in stages based on rules for titles, abstracts, and full articles. We extracted research design and methods, CDS purpose, electronic health record integration, usability, and process and patient outcomes. Results: Our search yielded 3157 articles. After removing duplicates and applying exclusion rules, 28 articles met the inclusion criteria. The majority of studies were single-site, descriptive or qualitative (43%) or quasi-experimental (36%). There was only 1 randomized controlled trial. The purpose of most CDS was to support diagnostic decision-making (36%), guideline adherence (32%), medication management (29%), and situational awareness (25%). All the studies that included process outcomes (7) and usability outcomes (4) and also had analytic procedures to detect changes in outcomes demonstrated statistically significant improvements. Three of 4 studies that included patient outcomes and also had analytic procedures to detect change showed statistically significant improvements. No negative effects of CDS were found on process, usability, or patient outcomes. Discussion and Conclusions: Clinical support systems targeting bedside nurses have positive effects on outcomes and hold promise for improving care quality; however, this research is lagging behind studies of CDS targeting medical decision-making in both volume and level of evidence.

PURPOSE To design and test educational software to improve nursing students’ diagnostic reasoning through NANDA-I-based clinical scenarios. METHODS A mixed method approach was used and included content validation by a panel of 13 experts and prototype testing by a sample of 56 students. FINDINGS Experts’ suggestions included writing adjustments, new response options, and replacement of clinical information on the scenarios. Percentages of students’ correct answers were 65.7%, 62.2%, and 60.5% for related factors, defining characteristics, and nursing diagnoses, respectively. CONCLUSION Full development of this software shows strong potential for enhancing students’ diagnostic reasoning. IMPLICATIONS FOR NURSING PRACTICE New graduates may be able to apply diagnostic reasoning more rapidly by exercising their diagnostic skills within this software. OBJETIVO Desenvolver e testar um prototipo de software educativo para melhorar o raciocinio diagnostico de estudantes de enfermagem. METODOS Uma abordagem mista foi utilizada e incluiu validacao de conteudo por 13 experts e testagem do prototipo por 56 estudantes. RESULTADOS Sugestoes dos experts incluiram ajustes na escrita, inclusao de novas opcoes de resposta e substituicao de dados clinicos nos cenarios. Os percentuais de respostas corretas dos estudantes foram 65,7%, 62,2% e 60,5% para fatores relacionados, caracteristicas definidoras e diagnosticos de enfermagem respectivamente. CONCLUSAO O desenvolvimento deste software tem um forte potencial para melhorar o raciocinio diagnostico de estudantes. IMPLICACOES PARA A PRATICA EM ENFERMAGEM Atraves deste software, enfermeiros poderao ser capazes de exercitar o raciocinio diagnostico e aplica-lo mais rapidamente.

We present findings of a comparative study of numeracy and graph literacy in a representative group of 60 practicing nurses. This article focuses on a fundamental concern related to the effectiveness of numeric information displayed in various features in the electronic health record during clinical workflow. Our findings suggest the need to consider numeracy and graph literacy when presenting numerical information as well as the potential for tailoring numeric display types to an individual's cognitive strengths.

Display Omitted We describe SCA (Sequential Conversational Analysis), a mixed-method approach.SCA combines conversational analysis with temporal pattern analysis.Useful for highlighting temporal relationships within verbal content.SCA is used to describe relationships in nurse handoff communication. Effective communication during nurse handoffs is instrumental in ensuring safe and quality patient care. Much of the prior research on nurse handoffs has utilized retrospective methods such as interviews, surveys and questionnaires. While extremely useful, an in-depth understanding of the structure and content of conversations, and the inherent relationships within the content is paramount to designing effective nurse handoff interventions. In this paper, we present a methodological framework-Sequential Conversational Analysis (SCA)-a mixed-method approach that integrates qualitative conversational analysis with quantitative sequential pattern analysis. We describe the SCA approach and provide a detailed example as a proof of concept of its use for the analysis of nurse handoff communication in a medical intensive care unit. This novel approach allows us to characterize the conversational structure, clinical content, disruptions in the conversation, and the inherently phasic nature of nurse handoff communication. The characterization of communication patterns highlights the relationships underlying the verbal content of nurse handoffs with specific emphasis on: the interactive nature of conversation, relevance of role-based (incoming, outgoing) communication requirements, clinical content focus on critical patient-related events, and discussion of pending patient management tasks. We also discuss the applicability of the SCA approach as a method for providing in-depth understanding of the dynamics of communication in other settings and domains.

Aim The aim of this study was to identify the core components of nurse-nurse handoffs. Background Patient handoffs involve a process of passing information, responsibility and control from one caregiver to the next during care transitions. Around the globe, ineffective handoffs have serious consequences resulting in wrong treatments, delays in diagnosis, longer stays, medication errors, patient falls and patient deaths. To date, the core components of nurse-nurse handoff have not been identified. This lack of identification is a significant gap in moving towards a standardized approach for nurse-nurse handoff. Design Mixed methods design using the Delphi technique. Methods From May 2016 - October 2016, using a series of iterative steps, a panel of handoff experts gave feedback on the nurse-nurse handoff core components and the content in each component to be passed from one nurse to the next during a typical unit-based shift handoff. Consensus was defined as 80% agreement or higher. Results/findings After three rounds of participant review, 17 handoff experts with backgrounds in clinical nursing practice, academia and handoff research came to consensus on the core components of handoff: patient summary, action plan and nurse-nurse synthesis. Conclusion This is the first study to identify the core components of nurse-nurse handoff. Subsequent testing of the core components will involve evaluating the handoff approach in a simulated and then actual patient care environment. Our long-term goal is to improve patient safety outcomes by validating an evidence-based handoff framework and handoff curriculum for pre-licensure nursing programmes that strengthen the quality of their handoff communication as they enter clinical practice.

Background. As health-related communications become digitized, strategies to increase adoption of these Web-based platforms are needed. The purpose of this study was to assess facilitators and barriers to in-home Internet use among prekidney and postkidney transplant patients. Methods. A single center, cross-sectional survey of 240 consecutive patients of all levels of technological proficiency who presented to an urban transplant center in the United States. The Patient Information and Technology Assessment consists of 6 demographic questions, 3 disease-related questions, and 8 technology-related questions. Results. Much of the sample was African American, male with a mean age of 51 years, and median income of $53 800/year. Logistic regression analysis was undertaken, and after adjusting for covariates, we found Smartphone ownership (odds ratio [OR], 4.94; 95% confidence interval [CI], 2.32-10.52), a higher number of Internet users in the home (OR, 2.00; 95% CI, 1.11-3.62), and having college education and beyond (OR, 4.88; 95% CI, 2.03-11.74) increased the likelihood of being a frequent Internet user. African American or Hispanic/Latino patients were less likely to be frequent Internet users compared with white patients (OR, 0.26 and 0.24, respectively, compared with whites, all P < 0.05). As the total number of people in the household increased, frequent Internet use decreased (OR, 0.52; 95% CI, 0.29-0.92). As age increased, reports of frequent Internet use decreased. Conclusions. Lower rates of Internet use among African Americans and Hispanic/Latinos in urban areas in the United States remains a problem despite a significant increase in access to the Internet and Smartphone ownership. The finding that Internet use increases as the number of Internet users in the household increases indicates that leveraging the patient’s social support network and/or the development of patient information champion programs may aid with patient’s adoption of health technology and patient engagement in self-care.

SummaryBackground: The use of e-health can lead to several positive outcomes. However, the potential for e-health to improve healthcare is partially dependent on its ease of use. In order to determine the usability for any technology, rigorously developed and appropriate measures must be chosen.Objectives: To identify psychometrically tested questionnaires that measure usability of e-health tools, and to appraise their generalizability, attributes coverage, and quality.Methods: We conducted a systematic review of studies that measured usability of e-health tools using four databases (Scopus, PubMed, CINAHL, and HAPI). Non-primary research, studies that did not report measures, studies with children or people with cognitive limitations, and studies about assistive devices or medical equipment were systematically excluded. Two authors independently extracted information including: questionnaire name, number of questions, scoring method, item generation, and psychometrics using a data extraction tool with pre-established categories and a quality appraisal scoring table.Results: Using a broad search strategy, 5,558 potentially relevant papers were identified. After removing duplicates and applying exclusion criteria, 35 articles remained that used 15 unique questionnaires. From the 15 questionnaires, only 5 were general enough to be used across studies. Usability attributes covered by the questionnaires were: learnability (15), efficiency (12), and satisfaction (11). Memorability (1) was the least covered attribute. Quality appraisal showed that face/content (14) and construct (7) validity were the most frequent types of validity assessed. All questionnaires reported reliability measurement. Some questionnaires scored low in the quality appraisal for the following reasons: limited validity testing (7), small sample size (3), no reporting of user centeredness (9) or feasibility estimates of time, effort, and expense (7).Conclusions: Existing questionnaires provide a foundation for research on e-health usability. However, future research is needed to broaden the coverage of the usability attributes and psychometric properties of the available questionnaires.Citation: Sousa VEC, Lopez KD. Towards usable e-health: A systematic review of usability questionnaires. Appl Clin Inform 2017; 8: 470–490 https://doi.org/10.4338/ACI-2016-10-R-0170

PURPOSE To determine the acceptability, usefulness, and ease of use for four nursing clinical decision support interface prototypes. METHODS In a simulated hospital environment, 60 registered nurses (48 female; mean age = 33.7 ± 10.8; mean years of experience = 8.1 ± 9.7) participated in a randomized study with four study groups. Measures included acceptability, usefulness, and ease of use scales. FINDINGS Mean scores were high for acceptability, usefulness, and the ease of use for all four groups. Inexperienced participants (

Questionnaire development involves rigorous testing to ensure reliability and validity. Due to time and cost constraints of developing new questionnaires, researchers often adapt existing questionnaires to better fit the purpose of their study. However, the effect of such adaptations is unclear. We conducted cognitive interviews as a method to evaluate the understanding of original and adapted questionnaire items to be applied in a future study. The findings revealed that all subjects (a) comprehended the original and adapted items differently, (b) changed their scores after comparing the original to the adapted items, and (c) were unanimous in stating that the adapted items were easier to understand. Cognitive interviewing allowed us to assess the interpretation of adapted items in a useful and efficient manner before use in data collection.

Patients with chronic conditions like heart failure are the most likely to be re-hospitalized. One step towards avoiding re-hospitalization is to devise strategies for motivating patients to take care of their own health. In this paper, we perform a quantitative analysis of patients’ narratives of their experience with heart failure and explore the different topics that patients talk about. We compare two different groups of patients- those unable to take charge of their illness, and those who make efforts to improve their health. We will use the findings from our analysis to refine and personalize the summaries of hospitalizations that our system automatically generates.