PubMed4Hh: A Point-of-Care Mobile App for Evidence-Based Clinical Decision Support for Nurse Residents in Maryland.

Evidence-based clinical decision-making is considered a core competency for professional nurses. However, barriers such as lack of time in clinical practice; information overload; restricted access to resources; lack of evidence appraisal skills, awareness, and knowledge; and unreliable resources prevent them from adopting evidence-based practice. This study examined the usefulness of the PubMed4Hh (PubMed for Handhelds) mobile application for clinical decision-making at the point of care among Maryland newly licensed RNs. Using iOS and Android smartphones, 178 newly licensed RNs participated in a 6-month trial from November 2019 to April 2020. Nurses manually entered free-text queries or used voice inputs on the "Patient, Intervention, Comparison, Outcome" or "askMEDLINE" search engines. The results retrieved were presented as journal article abstracts or short summaries called "the bottom line," designed for quick reading at the point of care. Both Patient, Intervention, Comparison, Outcome and askMEDLINE were rated highly for their usefulness, and participants said they would continue using PubMed4Hh and recommend it to others. Newly licensed RNs had a significantly higher perception of the usefulness of PubMed4Hh when the results of "the bottom line" or abstracts confirmed, led, or modified their nursing skills, knowledge, or the patient's care plan.

Feasibility of Using Blood Pressure Self-Monitoring and the Epic MyChart Blood Pressure Flowsheet to Monitor Blood Pressure After Preeclampsia.

Preeclampsia is associated with significant morbidity and mortality. Women who experienced preeclampsia require close blood pressure surveillance postpartum. Remote monitoring of blood pressure using a mobile health application may be a viable method of surveillance in this population. The purpose of this project was to assess the feasibility of using the MyWellSpan mobile application to engage postpartum women who experienced preeclampsia in blood pressure self-monitoring. Women who chose to participate were provided an automatic blood pressure cuff and educational materials and were enrolled in MyWellSpan. A survey created by the authors asked participants to rate by Likert scale their satisfaction with the program and ease of use of the blood pressure cuff and self-monitoring. The electronic health record was reviewed retrospectively to assess utilization of the MyWellSpan mobile application to document blood pressure. The majority of women who participated reported that operating the blood pressure cuff was very easy and felt that it would be very easy to monitor their blood pressure twice daily. Sixty-nine percent of those women in the program electronically submitted at least 1 blood pressure measurement, thus confirming the feasibility of self-monitoring and reporting using a mobile application.

Preadmission predictors for first semester course success in a baccalaureate nursing program.

BACKGROUND: Identifying students' who are able to complete a rigorous course of study, graduate on time, and pass the NCLEX-RN© is a principle role of nursing program admissions teams. PURPOSE: To examine which preadmission factors predict students' success in the first semester of a baccalaureate nursing program. METHODS: Undergraduate students' data from the academic years 2013 to 2017 were analyzed (N = 927). Bivariate and multiple regression analyses were used to examine potential predictors of first semester course success, and scores on standardized NCLEX preparation exams. RESULTS: Preadmission cumulative GPA (OR = 3.82, 95% CI = 1.43-10.16) and prerequisite science GPA (OR = 2.57, 95% CI = 1.14-5.78) predicted success in the pathopharmacology course. Preadmission cumulative GPA (OR = 6.53, 95% CI = 1.59-26.85) and TEAS composite score (OR = 1.15, 95% CI = 1.09-1.22) predicted success in the health assessment course. Preadmission cumulative GPA (OR = 3.42, 95% CI = 1.18-9.92) and TEAS composite score (OR = 1.05, 95% CI = 1.01-1.10) predicted success in the foundations course. Higher preadmission cumulative GPA (B = 14.19, p < 0.01), prerequisite science GPA (B = 12.62, p < 0.01), and TEAS composite score (B = 0.48, p < 0.01) predicted a higher pathopharmacology-KAPLAN, Inc. test scores. Higher preadmission cumulative GPA (B = 62.52, p < 0.01), prerequisite science GPA (B = 61.18, p < 0.01), and TEAS composite score (B = 4.76, p < 0.01) predicted a higher fundamentals-HESI test scores. CONCLUSIONS: Preadmission cumulative GPA, prerequisite science GPA, and TEAS composite score were significant predictors of success in first semester courses and performance on standardized tests.

Three-factor structure of the eHealth Literacy Scale and its relationship with nurses' health-promoting behaviours and performance quality.

AIMS: To examine the factorial validity of the eHealth Literacy Scale among hospital nurses and to investigate the associations of its components with health-promoting behaviours and nursing performance quality. DESIGN: This cross-sectional study used survey data of 484 Korean hospital nurses, which were collected between March-May 2016. METHODS: The three-factor structure was tested using confirmatory factor analyses. Multiple linear regression was conducted to test associations of the three components' scores with health-promoting behaviours and self-rated nursing performance quality. RESULTS: The eHealth Literacy Scale supported a three-factor structure: awareness of internet health resources (awareness), having skills needed to access resources (skills), and the ability to evaluate the quality of internet health resources (evaluation). All the three components were significantly associated with higher quality of nursing performance and better interpersonal relations. Stress management, spiritual growth, and health responsibility were linked with evaluation or skills but physical activity and nutrition were not. CONCLUSION: Strategies to enhance eHealth literacy among nurses could improve nurses' health and further patient care. Training to build nurses' self-efficacy to evaluate internet health information could improve eHealth literacy and should be developed and examined. IMPACT: To improve nurses' health and patient care, training programs to build nurses' self-efficacy to access and evaluate internet health information should be developed.

Patient Acuity Related to Clinical Research: Concept Clarification and Literature Review.

In research settings, clinical and research requirements contribute to nursing workload, staffing decisions, and resource allocation. The aim of this article is to define patient acuity in the context of clinical research, or research intensity, and report available instruments to measure it. The design was based on Centre for Reviews and Dissemination recommendations, including defining search terms, developing inclusion and exclusion criteria, followed by abstract review by three members of the team, thorough reading of each article by two team members, and data extraction procedures, including a quality appraisal of each article. Few instruments were available to measure research intensity. Findings provide foundational work for conceptual clarity and tool development, both of which are necessary before workforce allocation based on research intensity can occur.

Clinicians' perceptions of usefulness of the PubMed4Hh mobile device application for clinical decision making at the point of care: a pilot study.

BACKGROUND: Although evidence-based practice in healthcare has been facilitated by Internet access through wireless mobile devices, research on the effectiveness of clinical decision support for clinicians at the point of care is lacking. This study examined how evidence as abstracts and the bottom-line summaries, accessed with PubMed4Hh mobile devices, affected clinicians' decision making at the point of care. METHODS: Three iterative steps were taken to evaluate the usefulness of PubMed4Hh tools at the NIH Clinical Center. First, feasibility testing was conducted using data collected from a librarian. Next, usability testing was carried out by a postdoctoral research fellow shadowing clinicians during rounds for one month in the inpatient setting. Then, a pilot study was conducted from February, 2016 to January, 2017, with clinicians using a mobile version of PubMed4Hh. Invitations were sent via e-mail lists to clinicians (physicians, physician assistants and nurse practitioners) along with periodic reminders. Participants rated the usefulness of retrieved bottom-line summaries and abstracts and indicated their usefulness on a 7-point Likert scale. They also indicated location of use (office, rounds, etc.). RESULTS: Of the 166 responses collected in the feasibility phase, more than half of questions (57%, n = 94) were answerable by both the librarian using various resources and by the postdoctoral research fellow using PubMed4Hh. Sixty-six questions were collected during usability testing. More than half of questions (60.6%) were related to information about medication or treatment, while 21% were questions regarding diagnosis, and 12% were specific to disease entities. During the pilot study, participants reviewed 34 abstracts and 40 bottom-line summaries. The abstracts' usefulness mean scores were higher (95% CI [6.12, 6.64) than the scores of the bottom-line summaries (95% CI [5.25, 6.10]). The most frequent reason given was that it confirmed current or tentative diagnostic or treatment plan. The bottom-line summaries were used more in the office (79.3%), and abstracts were used more at point of care (51.9%). CONCLUSIONS: Clinicians reported that retrieving relevant health information from biomedical literature using the PubMed4Hh was useful at the point of care and in the office.

A systematic approach for studying the signs and symptoms of fever in adult patients: the fever assessment tool (FAST).

BACKGROUND: Although body temperature is one of four key vital signs routinely monitored and treated in clinical practice, relatively little is known about the symptoms associated with febrile states. The purpose of this study was to assess the validity, reliability and feasibility of the Fever Assessment Tool (FAST) in an acute care research setting. METHODS: Qualitative: To assess content validity and finalize the FAST instrument, 12 adults from an inpatient medical-surgical unit at the National Institutes of Health (NIH) Clinical Center participated in cognitive interviews within approximately 12 h of a febrile state (tympanic temperature ≥ 38° Celsius). Quantitative: To test reliability, validity and feasibility, 56 new adult inpatients completed the 21-item FAST. RESULTS: The cognitive interviews clarified and validated the content of the final 21-item FAST. Fifty-six patients completed the FAST from two to 133 times during routine vital sign assessment, yielding 1,699 temperature time points. Thirty-four percent of the patients (N = 19) experienced fever at one or more time points, with a total of 125 febrile time points. Kuder-Richardson 20 (KR-20) reliability of the FAST was 0.70. Four nonspecific symptom categories, Tired or Run-Down (12), Sleepy (13), Weak or Lacking Energy (11), and Thirsty (9) were among the most frequently reported symptoms in all participants. Using Generalized Estimating Equations (GEE), the odds of reporting eight symptoms, Warm (4), Sweating (5), Thirsty (9), General Body Aches (10), Weak or Lacking Energy (11), Tired or Run Down (12) and Difficulty Breathing (17), were increased when patients had a fever (Fever Now), compared to the two other subgroups-patients who had a fever, but not at that particular time point, (Fever Not Now) and patients who never had a fever (Fever Never). Many, but not all, of the comparisons were significant in both groups. CONCLUSION: Results suggest the FAST is reliable, valid and easy to administer. In addition to symptoms usually associated with fever (e.g. feeling warm), symptoms such as Difficulty Breathing (17) were identified with fever. Further study in a larger, more diverse patient population is warranted. TRIAL REGISTRATION: Clinical Trials Number: NCT01287143 (January 2011).

Electronic Personal Health Record Use Among Nurses in the Nursing Informatics Community.

An electronic personal health record is a patient-centric tool that enables patients to securely access, manage, and share their health information with healthcare providers. It is presumed the nursing informatics community would be early adopters of electronic personal health record, yet no studies have been identified that examine the personal adoption of electronic personal health record's for their own healthcare. For this study, we sampled nurse members of the American Medical Informatics Association and the Healthcare Information and Management Systems Society with 183 responding. Multiple logistic regression analysis was used to identify those factors associated with electronic personal health record use. Overall, 72% were electronic personal health record users. Users tended to be older (aged >50 years), be more highly educated (72% master's or doctoral degrees), and hold positions as clinical informatics specialists or chief nursing informatics officers. Those whose healthcare providers used electronic health records were significantly more likely to use electronic personal health records (odds ratio, 5.99; 95% confidence interval, 1.40-25.61). Electronic personal health record users were significantly less concerned about privacy of health information online than nonusers (odds ratio, 0.32; 95% confidence interval, 0.14-0.70) adjusted for ethnicity, race, and practice region. Informatics nurses, with their patient-centered view of technology, are in prime position to influence development of electronic personal health records. Our findings can inform policy efforts to encourage informatics and other professional nursing groups to become leaders and users of electronic personal health record; such use could help them endorse and engage patients to use electronic personal health records. Having champions with expertise in and enthusiasm for the new technology can promote the adoptionof electronic personal health records among healthcare providers as well as their patients.

Electronic personal health record use among registered nurses.

INTRODUCTION: Nurses promote self-care and active participation of individuals in managing their health care, yet little is known about their own use of electronic personal health records (ePHRs). The purpose of this study was to examine factors associated with ePHR use by nurses for their own health management. METHODS: A total of 664 registered nurses working in 12 hospitals in the Maryland and Washington DC area participated in an online survey from December 2013 to January 2014. Multiple logistic regression models identified factors associated with ePHR use. RESULTS: More than a third (41%; 95% confidence interval [CI], 0.37-0.44) of the respondents were ePHR users. There was no variation between ePHR users and nonusers by demographic or job-related information. However, ePHR users were more likely to be active health care consumers (i.e., have a chronic medical condition and take prescribed medications; odds ratio [OR] = 1.64; 95% CI, 1.06-2.53) and have health care providers who used electronic health records for care (OR = 3.62; 95% CI, 2.45-5.36). CONCLUSIONS: Nurses were proactive in managing their chronic medical conditions and prescribed medication use with ePHRs. ePHR use by nurses can be facilitated by increasing use of electronic health records.

Leadership education, certification and resident outcomes in US nursing homes: cross-sectional secondary data analysis.

BACKGROUND: Leadership is a key consideration in improving nursing home care quality. Previous research found nursing homes with more credentialed leaders had lower rates of care deficiencies than nursing homes with less credentialed leaders. Evidence that nursing home administrator (NHA) and director of nursing (DON) education and certification is related to resident outcomes is limited. OBJECTIVES: To examine associations of education and certification among NHAs and DONs with resident outcomes. DESIGN: Cross-sectional secondary data analysis. SETTINGS: This study used National Nursing Home Survey data on leadership education and certification and Nursing Home Compare quality outcomes (e.g. pain, catheter use). PARTICIPANTS: 1142 nursing homes in the survey which represented 16628 nursing homes in the US. METHODS: Leadership education and certification were assessed separately for NHAs and DONs. Nursing home resident outcomes were measured using facility-level nursing home quality indicator rates selected from the Minimum Data Set. Facility-level quality indicators were regressed onto leadership variables in models that also held constant facility size and ownership status. RESULTS: Nursing homes led by NHAs with both Master's degrees or higher and certification had significantly better outcomes for pain. Nursing homes led by DONs with Bachelor's degrees or higher plus certification also had significantly lower pain and catheter use. Whereas pressure ulcer rates were higher in facilities led by DONs with more education. CONCLUSIONS: Selected outcomes for nursing home residents might be improved by increasing the education and certification requirements for NHAs and DONs. Additional research is needed to clarify these relationships.

Associations between state regulations, training length, perceived quality and job satisfaction among certified nursing assistants: cross-sectional secondary data analysis.

BACKGROUND: In the U.S., there are federal requirements on how much training and annual continuing education a certified nursing assistant must complete in order to be certified. The requirements are designed to enable them to provide competent and quality care to nursing home residents. Many states also require additional training and continuing education hours as improved nursing home quality indicators have been found to be related to increased training. OBJECTIVES: This study investigated the associations among state level regulations, initial training quality and focus, and job satisfaction in certified nursing assistants. DESIGN: Cross-sectional secondary data analysis. SETTINGS: This study used the National Nursing Home Survey and National Nursing Assistant Survey as well as data on state regulations of certified nursing assistant training. PARTICIPANTS: 2897 certified nursing assistants in 580 nursing homes who were currently working at a nursing home facility, who represented 680,846 certified nursing assistants in US. METHODS: State regulations were related to initial training and job satisfaction among certified nursing assistants using chi square tests and binomial logistic regression models. Analyses were conducted using SAS-callable SUDAAN to correct for complex sampling design effects in the National Nursing Home Survey and National Nursing Assistant Survey. Models were adjusted for personal and facility characteristics. RESULTS: Certified nursing assistants reporting high quality training were more likely to work in states requiring additional initial training hours (p=0.02) and were more satisfied with their jobs (OR=1.51, 95% CI=1.09-2.09) than those with low quality training. In addition, those with more training focused on work life skills were 91% more satisfied (OR=1.91, 95% CI=1.41-2.58) whereas no relationship was found between training focused on basic care skills and job satisfaction (OR=1.36, 95% CI=0.99-1.84). CONCLUSIONS: Certified nursing assistants with additional initial training were more likely to report that their training was of high quality, and this was related to job satisfaction. Job satisfaction was also associated with receiving more training that focused on work life skills. Federal training regulations should reconsider additional hours for certified nursing assistant initial training, and include work life skills as a focus. As job satisfaction has been linked to nursing home turnover, attention to training may improve satisfaction, ultimately reducing staff turnover.

Turnover, staffing, skill mix, and resident outcomes in a national sample of US nursing homes.

OBJECTIVES: The authors examined the relationship of staff turnover to selected nursing home quality outcomes, in the context of staffing and skill mix. BACKGROUND: Staff turnover is a serious concern in nursing homes as it has been found to adversely affect care. When employee turnover is minimized, better care quality is more likely in nursing homes. METHODS: Data from the National Nursing Home Survey, a nationally representative sample of US nursing homes, were linked to Nursing Home Compare quality outcomes and analyzed using logistic regression. RESULTS: Nursing homes with high certified nursing assistant turnover had significantly higher odds of pressure ulcers, pain, and urinary tract infections even after controlling for staffing, skill mix, bed size, and ownership. Nurse turnover was associated with twice the odds of pressure ulcers, although this was attenuated when staffing was controlled. CONCLUSIONS: This study suggests turnover may be more important in explaining nursing home (NH) outcomes than staffing and skill mix and should therefore be given greater emphasis.