Information Resource Network Analysis of Factors Influencing Breastfeeding Planning and Duration

Purpose@#This study aimed to identify the modifiable factors affecting breastfeeding planning and duration among healthy mothers and their use of breastfeeding information resources. @*Methods@#A cross-sectional survey was conducted in a community setting. Four hundreds participants were recruited at five pediatric clinics and three community health centers located in Paju-si and Goyang-si, Gyeonggi-do, between January and May 2019. Based on the breastfeeding decision-making model, driven by Martens and Young’s work, the survey items consisted of demographics, childbirth and breastfeeding characteristics, and breastfeeding information resources. In the analysis, 389 responses were used in the t-test, ANOVA, and logistic regression. Information resource networks were compared before and after childbirth including a subgroup analysis depending on the breastfeeding duration. @*Results@#The modifiable factors affecting breastfeeding planning and duration were antenatal and postpartum breastfeeding education and the provision of information in the hospital.The frequency of Internet use and websites visited were notable and potentially modifiable factors, which were also observed in the networks showing different relationship patterns according to participant subgroups and times. The childbirth event increased the centralization of the network in the planned group, while the network of the non-planned group was more diffused after childbirth. The network of the short-term breastfeeding group was characterized by a more centralized pattern and the resources of high betweenness centrality than the long-term group. @*Conclusion@#Breastfeeding education is a consistent factor that affects breastfeeding behavior. A well-designed internet-based approach would be an effective nursing intervention to meet the needs of women seeking breastfeeding information and changing their behaviors.

Information Resource Network Analysis of Factors Influencing Breastfeeding Planning and Duration

Purpose@#This study aimed to identify the modifiable factors affecting breastfeeding planning and duration among healthy mothers and their use of breastfeeding information resources. @*Methods@#A cross-sectional survey was conducted in a community setting. Four hundreds participants were recruited at five pediatric clinics and three community health centers located in Paju-si and Goyang-si, Gyeonggi-do, between January and May 2019. Based on the breastfeeding decision-making model, driven by Martens and Young’s work, the survey items consisted of demographics, childbirth and breastfeeding characteristics, and breastfeeding information resources. In the analysis, 389 responses were used in the t-test, ANOVA, and logistic regression. Information resource networks were compared before and after childbirth including a subgroup analysis depending on the breastfeeding duration. @*Results@#The modifiable factors affecting breastfeeding planning and duration were antenatal and postpartum breastfeeding education and the provision of information in the hospital.The frequency of Internet use and websites visited were notable and potentially modifiable factors, which were also observed in the networks showing different relationship patterns according to participant subgroups and times. The childbirth event increased the centralization of the network in the planned group, while the network of the non-planned group was more diffused after childbirth. The network of the short-term breastfeeding group was characterized by a more centralized pattern and the resources of high betweenness centrality than the long-term group. @*Conclusion@#Breastfeeding education is a consistent factor that affects breastfeeding behavior. A well-designed internet-based approach would be an effective nursing intervention to meet the needs of women seeking breastfeeding information and changing their behaviors.

Evidence-based Clinical Nursing Practice Guideline for Management of Inpatient Falls: Adopting the Guideline Adaptation Process / 기본간호학회지

Purpose@#Despite research efforts, current fall rates are still higher than expected. To approach this problem, we developed guidelines on preventing falls in hospitals. @*Methods@#Four guidelines were selected by the K-AGREE II process. Recommendations from each guideline were retrieved and evaluated based on the quality of evidence and the strength of the recommendations. Recommendations followed the grading system of the Korean Hospital Nurses Association’s Guideline Adaptation Manual. In the external review, 13 practice nurses from 5 hospitals and 13 panel experts including doctors, nursing managers, and pharmacists participated. @*Results@#The final guideline consisted of 5 sections and 341 recommendations. The first two sections were composed of recommendations for institutional readiness for change process and management, and Section 3 was divided into assessment of risk factors, preventive intervention and post-fall management. The summary of falls risk factors included seven components. Multifaceted interventions were modeled into six strategies. The final sections consisted of recommendations for implementing fall improvement programs and for sustaining effective prevention programs. @*Conclusion@#Given that falls result from various combinations of risk factors, the present guideline contains multifaceted assessments and interventions including risk-targeted strategy. This guideline will contribute to decreasing fall rates in hospitals by stimulating compliance with evidence-based practice.

Development and Evaluation of Empowering Education Program for Maternal Fetal Intensive Care Unit (MFICU) Nurses / 여성건강간호학회지

PURPOSE: This study was conducted to develop an empowering education program for Maternal-Fetal Intensive Care Unit (MFICU) nurses who provide intensive care to high-risk mother and fetus at hospitals, to test effects of the education program on nursing care confidence and nursing knowledge, and to examine program satisfaction. METHODS: This study comprised of 2 phases: program development and evaluation. First, we have followed a process of program development to develop and refine an empowering education program for MFICU nurses through collaborative works among clinical obstetrics and gynecology doctors and nurses and academic nursing professors. Second, the empowering education program was provided to 49 nurses and evaluated from July 5 to 6, 2019. Levels of MFICU nursing care confidence and knowledge were measured. RESULTS: The empowering education program included 18 hours of lectures, discussion, and Q & A, which continued for 2 days. This program significantly improved high-risk maternal-fetal nursing care confidence and knowledge of nurses. The program was well met with nurses' education need and goals, and found to be highly satisfactory. CONCLUSION: The empowering education program was observed to be effective in terms of improve nursing care confidence and knowledge of nurses in MFICU. It is proposed that this program should be open regularly for nurses to obtain and improve their clinical knowledge, confidence, and competency. Further study is needed to develop and run 2-levels of education such as basic and advanced levels based on nurses' clinical background and competency.

Safety and Usability Guidelines of Clinical Information Systems Integrating Clinical Workflow: A Systematic Review / 대한의료정보학회지

OBJECTIVES: The usability of clinical information systems (CISs) is known to be an essential consideration in ensuring patient safety as well as integrating clinical flow. This study aimed to determine how usability and safety guidelines of CIS consider clinical workflow through a systematic review in terms of the target systems, methodology, and guideline components of relevant articles. METHODS: A literature search was conducted for articles published from 2000 to 2015 in PubMed, Cochrane, EMBASE, Web of Science, and CINAHL. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement method was employed. Articles containing recommendations, principles, and evaluation items for CIS usability and safety were included. The selected articles were classified according to article type, methodology, and target systems. Taking clinical workflow into consideration, the components of guidelines were extracted and classified. RESULTS: A total of 7,401 articles were identified by keyword search. From the 76 articles remaining after abstract screening, 15 were selected through full-text review. Literature review (n = 7) was the most common methodology, followed by expert opinions (n = 6). Computerized physician order entry (n = 6) was the most frequent system. Four articles considered the entire process of clinical tasks, and two articles considered the principles of the entire process of user interface affecting clinical workflow. Only two articles performed heuristic evaluations of CISs. CONCLUSIONS: The usability and safety guidelines of CISs need improvement in guideline development methodology and with consideration of clinical workflow.

Multiple-Case Studies of Hand-on Breast Massage Techniques used by Breastfeeding Experts

PURPOSE: The aim of this study was to understand the hand-on breast massage techniques used by well-known experts in breastfeeding clinics. METHODS: A qualitative multiple-case design was applied that involved a feasibility test. Four experts sampling qualitative data collected by observing participants and in individual interviews were analyzed by content analysis, linking data to the propositions, and cross-case pattern matching. This study explored differences within and between cases, and the possibilities of replicating findings across cases. Thirty-nine postpartum women participated voluntarily in the feasibility test, which investigated the usability of four massage techniques. RESULTS: The four techniques showed considerable similarities in terms of the application of stimulation to the breast base and increased flexibility of the wired flexible body, which was the core mechanism underlying the techniques. The breast management strategies were consistent with existing practice guidelines with the exception of using cold cabbage to control engorgement pain. There was insufficient scientific evidence for supporting the massage techniques used by the experts. All of the techniques showed 100% education completeness, but application rates were higher for self-control-oriented techniques. CONCLUSION: The massage techniques applied by experts in breastfeeding were based on hypotheses and self-control techniques are feasible to apply in practice.

National Rules for Drug–Drug Interactions: Are They Appropriate for Tertiary Hospitals?

The application of appropriate rules for drug–drug interactions (DDIs) could substantially reduce the number of adverse drug events. However, current implementations of such rules in tertiary hospitals are problematic as physicians are receiving too many alerts, causing high override rates and alert fatigue. We investigated the potential impact of Korean national DDI rules in a drug utilization review program in terms of their severity coverage and the clinical efficiency of how physicians respond to them. Using lists of high-priority DDIs developed with the support of the U.S. government, we evaluated 706 contraindicated DDI pairs released in May 2015. We evaluated clinical log data from one tertiary hospital and prescription data from two other tertiary hospitals. The measured parameters were national DDI rule coverage for high-priority DDIs, alert override rate, and number of prescription pairs. The coverage rates of national DDI rules were 80% and 3.0% at the class and drug levels, respectively. The analysis of the system log data showed an overall override rate of 79.6%. Only 0.3% of all of the alerts (n = 66) were high-priority DDI rules. These showed a lower override rate of 51.5%, which was much lower than for the overall DDI rules. We also found 342 and 80 unmatched high-priority DDI pairs which were absent in national rules in inpatient orders from the other two hospitals. The national DDI rules are not complete in terms of their coverage of severe DDIs. They also lack clinical efficiency in tertiary settings, suggesting improved systematic approaches are needed.

Clinical Alarms in Intensive Care Units: Perceived Obstacles of Alarm Management and Alarm Fatigue in Nurses / 대한의료정보학회지

OBJECTIVES: The purpose of this descriptive study was to investigate the current situation of clinical alarms in intensive care unit (ICU), nurses' recognition of and fatigue in relation to clinical alarms, and obstacles in alarm management. METHODS: Subjects were ICU nurses and devices from 48 critically ill patient cases. Data were collected through direct observation of alarm occurrence and questionnaires that were completed by the ICU nurses. The observation time unit was one hour block. One bed out of 56 ICU beds was randomly assigned to each observation time unit. RESULTS: Overall 2,184 clinical alarms were counted for 48 hours of observation, and 45.5 clinical alarms occurred per hour per subject. Of these, 1,394 alarms (63.8%) were categorized as false alarms. The alarm fatigue score was 24.3 +/- 4.0 out of 35. The highest scoring item was "always get bothered due to clinical alarms". The highest scoring item in obstacles was "frequent false alarms, which lead to reduced attention or response to alarms". CONCLUSIONS: Nurses reported that they felt some fatigue due to clinical alarms, and false alarms were also obstacles to proper management. An appropriate hospital policy should be developed to reduce false alarms and nurses' alarm fatigue.

Identifying Usability Level and Factors Affecting Electronic Nursing Record Systems: A Multi-institutional Time-motion Approach

PURPOSE: The usability, user satisfaction, and impact of electronic nursing record (ENR) systems were investigated. METHODS: This mixed-method research was performed as a time-motion (TM) study and a survey which were carried out at six hospitals between August and November 2013. The TM study involved 108 nurses from medical, surgical, and intensive care units at each hospital, plus an additional 48 nurses who served as nonparticipating observers. In the survey, 1879 volunteer nurses completed the Impact of ENR Systems Scale, the System Usability Scale, and a global satisfaction scale. Qualitative and quantitative analyses were performed. RESULTS: The mean scores for the ENR impact, system usability, and satisfaction were 4.28 (out of 6), 58.62 (out of 100), and 74.31 (out of 100), respectively, and they differed significantly between hospitals (F=43.43, p<.001, F=53.08 and p<.001, and F=29.13 and p<.001, respectively). A workflow fragmentation assessment revealed different patterns of ENR system use among the included hospitals. Three user characteristics-educational background, practice period, and experience of using paper records-significantly affected the system usability and satisfaction scores. CONCLUSION: The system quality varied widely among the ENR systems. The generally low-to-moderate levels of system usability and user satisfaction suggest many opportunities for improvement.

Effectiveness of Simulation Integrated with Problem Based Learning on Clinical Competency and Self-efficacy in Nursing Students

PURPOSE: This study was conducted to examine the effects of simulation education integrated with problem based learning (SIM-PBL) on clinical competency and self-efficacy in post operation nursing care for children. METHODS: This study was a quasi-experimental design. Thirty six students in the third year of a 4-year baccalaureate nursing program were recruited conveniently and assigned to the control or intervention groups using time difference. Students were all in a pediatric nursing clinical practicum. The control group received the regular clinical practicum in a hospital setting. For the intervention group, a SIM-PBL education replaced 150 minutes of their clinical practicum. RESULTS: The intervention group showed greater improvement in two areas of clinical competency compared with the control group; physical assessment (t=3.019, p=.005) and post operation advice (t=2.428, p=.021). However, no statistically significant differences in improvement in any areas of self-efficacy were found between two groups. CONCLUSION: The results indicate that the SIM-PBL education is effective in improving some areas of clinical competence, but not self-efficacy in post operation nursing care for children. Further study is needed to develop SIM-PBL programs for various clinical topics and evaluate the effectiveness on the learning outcomes.

Depression of Married and Employed Women Based on Social-Role Theory

PURPOSE: This study was based on social-role theory, and purposes were to investigate (1) how depression and health determinants vary with married and employed women, and (2) what factors contribute to depression according to family cycle. METHODS: A stratified convenience sample of 765 married and employed women was recruited during May to August 2010. Study variables of depression, socio-demographic threatening factors, psycho-stimulating factors, and social-role related factors were measured via a structured questionnaire. RESULTS: Prevalence rate for depression was 18.6%, with highest rate (25.4%) from elementary laborers. Greater levels of depression were related to women's occupation, higher life stress, and poorer health; lower social support and vulnerable personality; higher levels of social-role related stress. From multivariate analysis, women with preadolescents were the most vulnerable to depression affected by occupation, life stress, personality, and parenting stress. These factors (except for occupational class) combined with economic status, social support, and housework unfairness were significant for depression in women with adolescents. CONCLUSION: Depression among married and employed women differs by psycho-stimulating and social role relevant factors in addition to occupational class and family life cycle. Female elementary laborers and women with children need to have the highest prioritization for community mental health programs.

Evaluation of a Fall Risk Assessment Tool to Establish Continuous Quality Improvement Process for Inpatients' Falls / 간호행정학회지

PURPOSE: The aims of study were; (1) to evaluate the validity and sensitivity of a fall-risk assessment tool, and (2) to establish continuous quality improvement (CQI) methods to monitor the effective use of the risk assessment tool. METHODS: A retrospective case-control cohort design was used. Analysis was conducted for 90 admissions as cases and 3,716 as controls during the 2006 and 2007 calendar years was conducted. Fallers were identified from the hospital's Accident Reporting System, and non-fallers were selected by randomized selection. Accuracy estimates, sensitivity analysis and logistic regression were used. RESULTS: At the lower cutoff score of one, sensitivity, specificity, and positive and negative predictive values were 82.2%, 19.3%, 0.03%, and 96.9%, respectively. The area under the ROC was 0.60 implying poor prediction. Logistic regression analysis showed that five out of nine constitutional items; age, history of falls, gait problems, and confusion were significantly associated with falls. Based on these results, we suggested a tailored falls CQI process with specific indexes. CONCLUSION: The fall-risk assessment tool was found to need considerable reviews for its validity and usage problems in practice. It is also necessary to develop protocols for use and identify strategies that reflect changes in patient conditions during hospital stay.

Assessing the Quality of Structured Data Entry for the Secondary Use of Electronic Medical Records / 대한의료정보학회지

OBJECTIVE: The raw material of quality improvement is information, whose building block is data. Data in an electronic medical record system have many secondary uses beyond their primary role in patient care, including research and organizational management. This study investigates the data quality of clinical observations recorded using a structured data entry format and assesses the impact of erroneous data. METHODS: A total of 4,580,846 input events from 3,348 inpatients, gathered over a three year period in a teaching hospital, were analyzed by using a 2-by-2 conceptual matrix framework for the appropriateness of data types and semantics. The data were classified into three categories: fully usable, partially usable, and not usable. RESULTS: The fully usable data constituted 88.6% of the correctly entered data the remaining 11.4% were erroneous. Among the erroneous data, 0.8% were partially usable (n=3,929), and the remaining 99.2% (n= 510,437) were identified as needing further assessment to improve their quality. CONCLUSION: Clinical information systems have increasingly used structured data entry or record templates, but the low quality of collected data has severely limited their secondary use potential.

A Comparison of the Nursing Records of Hysterectomy Patients: Pre and Post Implementation of an ICNP Based Electronic Nursing Record System / 대한의료정보학회지

OBJECTIVE: This study compared the abilities of electronic nursing records, which are based on standard nursing terminology, and paper-based nursing records to support the nursing process. METHODS: The nursing records of 38 pairs of inpatients admitted to a gynecology nursing unit were selected. The data from the paper records were obtained manually by a chart review as single statement units. The electronic records were extracted from a computerized system. The statements were categorized using the NANDA diagnosis and the modified Clinical Care Classification. Based on a semantic analysis of the components of the nursing process, the completeness of the nursing records was classified into complete and incomplete patterns according to the presence and relevancy of the assessment, the diagnosis, the intervention and the outcome. RESULTS: The numbers of nursing diagnoses used and the unique nursing diagnoses were both higher in the electronic records than those in the paper records. The number of statements of nursing assessments/outcomes, and nursing interventions was 1.4-fold higher in the electronic records than that in the paper records respectively. The proportion of complete patterns of the nursing process was 3.4% in the paper records and 25.7% in the electronic records. CONCLUSION: These results suggest that electronic records are better than paper records to support the nursing process in terms of the quantitative and qualitative aspects of nursing documentation.

Factors Influencing Care Burdens of Caregivers of Elders with Dementia who Request Dementia Domiciliary Welfare Services / 기본간호학회지

PURPOSE: The purpose of the study was to identify the factors, which predict care burden perceived by caregivers of elders with dementia. METHODS: The participants in this descriptive survey were 92 caregivers who used one of six daycare centers located in Incheon. The data were collected by questionnaires composed of items on general characteristics of the elders and caregivers, care burden, caregiver fatigue, and functional status of the elders. RESULTS: General characteristics of the elders associated with care burden were age, gender, religion, and the presence of a spouse. Features of caregivers related to care burden were education, relationship with elderly, amount of rest, intention to care, monthly family income, and perceived family economic status. There were significant correlations among care burden, fatigue of caregiver and functional status of the elders. In stepwised multiple regression analysis, significant influencing factors were identified as caregiver fatigue, functional status of the elders, intention to care, relationship with the elders, amount of rest and elder's gender. Those variables explained 46% of variance of care burden. CONCLUSION: Functional status of elders and amount of rest were significant predictors and are supported by other previous studies. Future interventions for caregivers need to be focused on the slowing down of functional status of elders and increasing of number and length of caregiver's rest periods.

Concept representation of decision logic for hypertension management using SNOMED CT / 대한의료정보학회지

OBJECTIVE: To obtain sharable and reusable knowledge among various hospital information systems, it is essential to represent each term with standard terminology. To support knowledge representation for interoperable clinical decision support system for hypertension management, the feasibility of SNOMED CT was evaluated. METHODS: Concept matching was conducted using the method of direct matching, post-coordinated matching and general matching. For semantic matching, the SNOMED CT hierarchy was considered, and for raising the mapping rate, preferred terms and synonyms were used. RESULTS: Excluding the recommendation concepts that were not used in clinical data, finally 182 concepts were evaluated in terms of concept matching. Seventy two percent of the concepts was directly matched to pre-coordinated concepts in SNOMED CT. For the post-coordinated matching and the general matching to broader meaning, 9.3% and 18.7% were covered respectively. CONCLUSION: The direct coverage of SNOMED CT was moderate to high level for representing guideline knowledge concepts without loss of semantics. To supplement the coverage, it is inevitable to consider defining local concepts for implementing hypertension management systems.