[Next-Generation Intelligent Care Opportunities].

Nursing information systems are becoming increasingly prevalent in our medical institutions. However, changes in the social environment and imbalances between the demands of caregivers and care recipients mean that current nursing information systems are inadequate in terms of quality and operational needs. This article was written to provide insights into opportunities to leverage technology to further promote care quality by applying a "data, information, knowledge, and wisdom" system development structure to develop intelligent technology products that equitably meet the needs of patients, caregivers, and nursing processes. Applied in clinical settings, these products should help satisfy patient needs and facilitate nursing work.

Correction: Development of a Therapeutic Video Game With the MDA Framework to Decrease Anxiety in Preschool-Aged Children With Acute Lymphoblastic Leukemia: Mixed Methods Approach.

[This corrects the article DOI: 10.2196/37079.].

Development of a Therapeutic Video Game With the MDA Framework to Decrease Anxiety in Preschool-Aged Children With Acute Lymphoblastic Leukemia: Mixed Methods Approach.

BACKGROUND: Preschool-aged children with acute lymphoblastic leukemia (ALL) receive long-term treatment according to the Taiwan Pediatric Oncology Group (TPOG)-ALL 2013 protocol. Severe anxiety and noncompliance ahead of frequent invasive therapies leads to an increase in health care costs. Previous studies have shown that therapeutic video games (TVGs) can decrease the anxiety experienced by children who are ill. To our knowledge, no existing TVG has been designed specifically for preschool-aged children with ALL in Taiwan. OBJECTIVE: The purpose of this study was to develop a TVG using the popular Mechanics, Dynamics, and Aesthetics (MDA) framework for game design and to investigate the effect of this TVG on the reduction of therapy-related anxiety among preschool-aged children with ALL. METHODS: This study used a mixed methods approach over three phases: (1) develop a TVG using the MDA framework, (2) test the reliability of the TVG among three certified children's art therapists, and (3) evaluate the reduction of therapy-related anxiety among participants after using the TVG for 6 weeks, using a two-group, stratified randomized controlled trial at a medical center in northern Taiwan. Eligible preschool-aged children with ALL were randomly assigned 1:1 into an experimental group or a control group. The two groups of subjects received the same usual care, and only the experimental group had access to and used the TVG. The children's anxiety responses were reported by their family caregivers using the face rating scale (FRS). Descriptive analyses, the Fisher exact test, the Pearson chi-square test, and the Mann-Whitney U test were used to statistically analyze the variables. RESULTS: Six mechanics rules supported the dynamics of the TVG using four main features-character, nursery, tasks, and market-in order to complete all of the therapy-related anxiety reduction scenarios and to achieve eight aesthetics goals. The results of reliability test showed that participants found the TVG to be useful and trustworthy for preschool-aged children with ALL (Cronbach α=.98). A total of 15 participants were enrolled and randomly allocated to the experimental group (n=7) or the control group (n=8). The average number of TVG log-ins was 37.9 (SD 15.30, range 14-62) in the experimental group. The demographic data showed homogeneity across the two groups regarding age (3 to 5 years), sex (male), risk classification (standard risk), and treatment status (continuation therapy). The mean FRS score was 6.16 (SD 3.31) for the experimental group as compared to 7.45 (SD 2.71) for the control group (P=.04), which represented a significant difference between the groups at the 6-week follow-up. CONCLUSIONS: This research provides evidence that using a TVG can decrease anxiety in preschool-aged children with ALL in Taiwan. The TVG could be used to support clinical professionals before they perform invasive therapies. However, it is recommended to increase the statistical power for inference. TRIAL REGISTRATION: ClinicalTrials.gov NCT04199637; https://www.clinicaltrials.gov/ct2/show/NCT04199637.

Developing a Heart Transplantation Self-Management Support Mobile Health App in Taiwan: Qualitative Study.

BACKGROUND: Heart transplantation (HTx) is the most effective treatment for end-stage heart failure patients. After transplantation, patients face physiological, psychological, social, and other health care problems. Mobile health (mHealth) apps can change the delivery of conventional health care to ubiquitous care and improve health care quality. However, a dearth of mHealth apps exists for patients with HTx worldwide, including in Taiwan. OBJECTIVE: The aim of this study was to investigate the information needed and to develop a preliminary framework for an mHealth app for post-HTx patients. METHODS: A qualitative approach with individual in-depth interviews was conducted at a heart center in the regional hospital of northern Taiwan from June to November 2017. Patients that had undergone HTx and their health professionals were recruited for purposeful sampling. A semistructured interview guideline was used for individual interviews and transcribed. Thematic analysis was used for data analysis. RESULTS: A total of 21 subjects, including 17 patients and 4 health professionals, were recruited for the study. The following five major themes were identified: reminding, querying, experience sharing, diet, and expert consulting. Minor themes included a desire to use the app with artificial intelligence and integration with professional management. CONCLUSIONS: An intelligent mHealth app that addresses the five main themes and integrates the processes of using a mobile app could facilitate HTx self-management for Taiwanese patients.

The Development of a Mobile Health App for Breast Cancer Self-Management Support in Taiwan: Design Thinking Approach.

BACKGROUND: Evidence has shown that breast cancer self-management support from mobile health (mHealth) apps can improve the quality of life of survivors. Although many breast cancer self-management support apps exist, few papers have documented the procedure for the development of a user-friendly app from the patient's perspective. OBJECTIVE: This study aimed to investigate the information needs of Taiwanese women with breast cancer to inform the development of a self-management support mHealth app. METHODS: A 5-step design thinking approach, comprising empathy, define, ideate, prototype, and test steps, was used in the focus groups and individual interviews conducted to collect information on the requirements and expectations of Taiwanese women with breast cancer with respect to the app. A thematic analysis was used to identify information needs. RESULTS: A total of 8 major themes including treatment, physical activity, diet, emotional support, health records, social resources, experience sharing, and expert consultation were identified. Minor themes included the desire to use the app under professional supervision and a trustworthy app manager to ensure the credibility of information. CONCLUSIONS: The strengths of the design thinking approach were user-centered design and cultural sensitivity. The results retrieved from each step contributed to the development of the app and reduction of the gap between end users and developers. An mHealth app that addresses these 8 main themes can facilitate disease self-management for Taiwanese women with breast cancer.

Nurses' Attitudes Toward Electronic Clinical Quality Measures: A Descriptive Study.

BACKGROUND: Electronic clinical quality measures (eCQMs) are a method that automatically extract data from electronic health records (EHRs) and compute and generate the results to report and track the quality of care and patient outcomes. PURPOSE: The purpose of this study was to explore nurses' attitudes toward eCQMs and the factors influencing this attitude. METHODS: A descriptive cross-sectional study was conducted using a closed-ended questions survey of 92 nurses in a teaching hospital. RESULTS: The average score for nurses' attitudes toward eCQMs was 3.47 out of 4. Participants with a master's degree had more positive attitudes than those with a baccalaureate degree. Head nurses had more positive attitudes than staff nurses. CONCLUSIONS: The nurses in the study hospital have a positive attitude toward eCQMs. Health care organizations should strengthen the attitudes of nurses toward eCQMs.

Wound Care Knowledge, Attitudes, and Practices and Mobile Health Technology Use in the Home Environment: Cross-Sectional Survey of Social Network Users.

BACKGROUND: Injury causing wounds is a frequent event. Inadequate or inappropriate treatment of injuries can threaten individual health. However, little is known about wound care knowledge, attitudes, and practices and mobile health (mHealth) use in the home environment in Taiwan. OBJECTIVE: This study aimed to evaluate wound care knowledge, attitudes, and practices and mHealth technology use among social network users. METHODS: A cross-sectional survey on social media platforms was conducted on adults aged 20 years and older. Data were collected from social network users in the home environment. RESULTS: A total of 361 participants were enrolled. The mHealth technology use of participants was positively correlated with wound care knowledge (r=.132, P=.01), attitudes (r=.239, P<.001), and practices (r=.132, P=.01). Participants did not have adequate knowledge (correct rate 69.1%) and were unfamiliar with the guidelines of proper wound care (correct rate 74.5%). Most participants had positive attitudes toward wound care and mHealth technology use. A total of 95.6% (345/361) of participants perceived that the use of mHealth technology can improve wound care outcomes, and 93.9% (339/361) perceived that wound care products should be optimized to be used with a mobile device. However, 93.6% (338/361) of participants had no experience using mHealth technology for wound care. CONCLUSIONS: Our study shows the potential of mHealth technology to enhance wound care knowledge among social network users. Thus, government agencies and medical institutions in Taiwan should provide easy-to-use information products that enhance wound care knowledge, promote adequate behavior toward wound care, and prevent unpredictable or undesirable outcomes.

Quality of Life of Women After a First Diagnosis of Breast Cancer Using a Self-Management Support mHealth App in Taiwan: Randomized Controlled Trial.

BACKGROUND: There are over 2 million newly diagnosed patients with breast cancer worldwide with more than 10,000 cases in Taiwan each year. During 2017-2018, the National Yang-Ming University, the Taiwan University of Science and Technology, and the Taiwan Breast Cancer Prevention Foundation collaborated to develop a breast cancer self-management support (BCSMS) mHealth app for Taiwanese women with breast cancer. OBJECTIVE: The aim of this study was to investigate the quality of life (QoL) of women with breast cancer in Taiwan after using the BCSMS app. METHODS: After receiving a first diagnosis of breast cancer, women with stage 0 to III breast cancer, who were recruited from social networking sites or referred by their oncologists or oncology case managers, were randomized 1:1 into intervention and control groups. Intervention group subjects used the BCSMS app and the control group subjects received usual care. Two questionnaires-the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire Core 30 (QLQ-C30) and the EORTC Breast Cancer-Specific Quality-of-Life Questionnaire (QLQ-BR23)-were distributed to subjects in both arms. Paper-based questionnaires were used at baseline; paper-based or Web-based questionnaires were used at 1.5-month and 3-month follow-up evaluations. All evaluations were self-assessed and anonymous, and participants were blinded to their allocation groups. Descriptive analysis, the Pearson chi-square test, analysis of variance, and the generalized estimating equation were used to analyze the data. Missing values, with and without multi-imputation techniques, were used for sensitivity analysis. RESULTS: A total of 112 women were enrolled and randomly allocated to either the experimental group (n=53) or control group (n=59). The follow-up completion rate was 89.3% (100/112). The demographic data showed homogeneity between the two groups in age (range 50-64 years), breast cancer stage (stage II), marital status (married), working status (employed), and treatment status (receiving treatments). The mean total QoL summary scores from the QLQ-C30 (83.45 vs 82.23, P=.03) and the QLQ-BR23 (65.53 vs 63.13, P=.04) were significantly higher among the experimental group versus the control group, respectively, at 3 months. CONCLUSIONS: This research provides support for using a mobile health care app to promote the QoL among women in Taiwan after a first diagnosis of breast cancer. The BCSMS app could be used to support disease self-management, and further evaluation of whether QoL is sustained is warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT004174248; https://clinicaltrials.gov/ct2/show/NCT04174248.

Distraction using virtual reality for children during intravenous injections in an emergency department: A randomised trial.

AIM AND OBJECTIVES: To determine whether the virtual reality as a distracting intervention could reduce pain and fear in school-age children receiving intravenous injections at an emergency department. BACKGROUND: An intravenous injection is the most common invasive procedure that paediatric patients encounter in emergency department. School-age children seldom show their fear or discomfort during the procedure which may be ignored. DESIGN: A randomised controlled trial was conducted from December 2017-May 2018 and performed according to the CONSORT guidelines. METHODS: One hundred and thirty-six children aged 7-12 years were randomly allocated to receive either a routine intravenous injection procedure or one with an immersive virtual reality experience. Children were asked to rate their pain and fear along with their caregivers and nurses on the Wong-Baker FACES Pain Rating Scale and Children's Fear Scale, respectively. The time required for successful intravenous insertion was also assessed in the emergency department. Clinical trial registration was done (ClinicalTrials.gov.: NCT04081935). RESULTS: Pain and fear scores were significantly lower in the virtual reality group, as were the children's ratings as perceived by their caregivers and nurses. The children's ratings of pain and fear were positively correlated with the caregivers' ratings and the nurses' ratings as well. The time required for successful intravenous insertion was significantly lower in the virtual reality group. CONCLUSION: Visual reality intervention can effectively reduce the pain and fear during intravenous procedure in school-age children in emergency department. RELEVANCE TO CLINICAL PRACTICE: The results of this study indicate the feasible clinical value of virtual reality interventions during the administration of intravenous injections in school-age children in emergency departments.

Using a Text Mining Approach to Explore the Recording Quality of a Nursing Record System.

BACKGROUND: Most nursing records in Taiwan have been computerized, resulting in a large amount of unstructured text data. The quality of these records has rarely been discussed. PURPOSE: This study used a text mining method to analyze the quality of a nursing record system to establish an auditing model and associated tools for nursing records, with the ultimate objective of improving the quality of electronic nursing records. METHODS: This study utilized a retrospective method to collect the electronic nursing records of 6,277 patients who had been discharged from the internal medicine departments of a medical center in northern Taiwan from January to June 2014. SAS Enterprise Guide Version 6.1 and SAS Text Miner Version 13.2 software were used to perform text mining. Nursing experts were invited to examine the electronic nursing records. The text mining results were compared against a benchmark that was developed by the experts, and the efficiency of SAS Text Miner was examined using the criteria of specificity, sensitivity, and accuracy. RESULTS: In this study, 27,356 nurse-formulated events were used in the analysis. The results of the nurse-formulated events showed an 8.08% similar error with system-formulated events, 29.72% were identified as necessary and appropriate names, 17.53% were retained, 10.15% involved error event names, and 34.52% were not classified. In this study, the sensitivity of SAS text mining in the training (testing) data set was 96% (95%), and the specificity and accuracy were both 99% (99%). CONCLUSIONS: The results of this study show that text mining is an effective approach to auditing the quality of electronic nursing records. SAS Text Miner software was shown to identify inappropriate nursing record content quickly and efficiently. Furthermore, the results of this study may be included in in-service education teaching materials to promote the writing of better nursing records to improve the quality of electronic nursing records.

Evaluation of Clinical Nursing Information System in Taiwan Regional Hospital.

The purpose of this study was to evaluate the Clinical Nursing Information System (CNIS) in Taiwan regional hospital. In 2016, a total of 333 nurses responded to the Technology Acceptance Model-based questionnaire after 15 months of CNIS implementation. The results showed positive acceptance toward CNI, especially among those nurses who were younger, those who worked as administrative managers or in non-critical care units, and had advanced computer skills.

Using Modified-ISS Model to Evaluate Medication Administration Safety During Bar Code Medication Administration Implementation in Taiwan Regional Teaching Hospital.

Bar code medication administration (BCMA) could reduce medical errors and promote patient safety. This research uses modified information systems success model (M-ISS model) to evaluate nurses' acceptance to BCMA. The result showed moderate correlation between medication administration safety (MAS) to system quality, information quality, service quality, user satisfaction, and limited satisfaction.

Evaluation of a tablet-based instruction of breathing technique in patients with COPD.

PURPOSE: Tablet computers are a convenient audio-visual aid for patient education. Teaching patients with chronic obstructive pulmonary disorder (COPD) appropriate therapeutic breathing techniques and encouraging them to practice regularly has been recognized as an effective care strategy. The purpose of this study was to evaluate the effectiveness of using a tablet computer with the Breathing Easier Support Toolkit (BEST), a supplemental software application we developed that instructs and assists COPD patients during the process of respiratory retraining. PATIENTS AND METHODS: From May 2013 to September 2014, participants were randomly assigned to an experimental group (n=36) or a control group (n=35). Correct breathing technique, practice frequency, application of breathing technique, self-efficacy, quality of life, and patient feedback on the tablet-computer education were evaluated with blinded assessments at baseline and immediate, 1-month, and 3-month follow-up assessments after training completion. Data analysis consisted of basic characteristics and outcome indicators presented in terms of descriptive statistics; inferential statistics were estimated by generalized estimating equations. RESULTS: The participants were mostly male (83.1%) with an average age of 71.5 (SD=11.4). Both the experimental and control groups showed statistically significant improvement in correct breathing technique and application of breathing technique from baseline for each follow-up (p<0.001). A significantly increase in self-efficacy for the experimental group was found immediately after completing the breathing retraining program compared to the control group (p=0.045). CONCLUSION: Our tablet computer-assisted educational aid did not provide an improvement over the traditional method for teaching breathing techniques to elderly patients with COPD. The results only showed an immediate effect on the self-efficacy of the breathing technique. The elderly did not use the tablet computer actively and the research was conducted without intervention after discharge, which may be a reason why the effect did not last. Further research to evaluate the effectiveness of such a strategy for the elderly is needed in the future.

The Pilot Evaluation of Using the International Classification for Nursing Practice.

International Classification for Nursing Practice (ICNP®) was developed as the standardized terminology by the International Council of Nursing (ICN) since 1999. It is important to evaluate the applicability of using ICNP® as the electronic nursing data exchange standardization when adopting in Taiwan. A total of 87% clinical nursing problems could be cross-mapped to DC axis of ICNP® version 2 in traditional Chinese language (Kappa = .96). Only five nursing problems (following care problem; blood transfusion; potential risk for unstable blood sugar level; hyperbilirubinemia; and caregiver anxiety) couldn't be matched. ICNP® could mostly support the electronic nursing data exchange standardization. Developing Taiwan-ICNP® as the local terminology was seemed to be the strategy to create a more adoptive standardization across the country for Taiwan health care data exchange in the future.

Design of an Electronic Reminder System for Supporting the Integerity of Nursing Records.

The integrity of electronic nursing records (ENRs) stands for the quality of medical records. But patients' conditions are varied (e.g. not every patient had wound or need fall prevention), to achieve the integrity of ENRs depends much on clinical nurses' attention. Our study site, an one 2,300-bed hospital in northern Taiwan, there are a total of 20 ENRs including nursing assessments, nursing care plan, discharge planning etc. implemented in the whole hospital before 2014. It become important to help clinical nurses to decrease their human recall burden to complete these records. Thus, the purpose of this study was to design an ENRs reminder system (NRS) to facilitate nursing recording process. The research team consisted of an ENR engineer, a clinical head nurse and a nursing informatics specialist began to investigate NRS through three phases (e.g. information requirements; design and implementation). In early 2014, a qualitative research method was used to identify NRS information requirements through both groups (e.g. clinical nurses and their head nurses) focus interviews. According to the their requirements, one prototype was created by the nursing informatics specialist. Then the engineer used Microsoft Visual Studio 2012, C#, and Oracle to designed a web-based NRS (Figure 1). Then the integrity reminder system which including a total of twelve electronic nursing records was designed and the preliminary accuracy validation of the system was 100%. NRS could be used to support nursing recording process and prepared for implementing in the following phase.

[Nurses' Innovation Acceptance of Barcode Technology].

BACKGROUND: Healthcare organizations have increasingly adopted barcode technology to improve care quality and work efficiency. Barcode technology is simple to use, so it is frequently used in patient identification, medication administration, and specimen collection processes. PURPOSE: This study used a technology acceptance model and innovation diffusion theory to explore the innovation acceptance of barcode technology by nurses. METHODS: The data were collected using a structured questionnaire with open-ended questions that was based on the technology acceptance model and innovation diffusion theory. The questionnaire was distributed to and collected from 200 nurses from March to May 2014. Data on laboratory reporting times and specimen rejection rates were collected as well. RESULTS: Variables that were found to have a significant relationship (p<.001) with innovation acceptance included (in order of importance): perceived usefulness (r=.722), perceived ease of use (r=.720), observability (r=.579), compatibility (r=.364), and trialability (r=.344). N-level nurses demonstrated higher acceptance than their N1 and N2 level peers (F=3.95, p<.05). Further, the mean laboratory reporting time decreased 109 minutes (t=10.03, p<.05) and the mean specimen rejection rate decreased from 2.18% to 0.28%. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results revealed that barcode technology has been accepted by nurses and that this technology effectively decreases both laboratory reporting times and specimen rejection rates. However, network speed and workflow should be further improved in order to benefit clinical practice.

Nurses' attitudes and perceived barriers to the reporting of medication administration errors.

AIMS: (1) To explore the attitudes and perceived barriers to reporting medication administration errors and (2) to understand the characteristics of - and nurses' feelings - about error reports. BACKGROUND: Under-reporting of medication administration errors is a global concern related to the safety of patient care. Understanding nurses' attitudes and perceived barriers to error reporting is the initial step to increasing the reporting rate. METHODS: A cross-sectional, descriptive survey with a self-administered questionnaire was completed by the nurses of a medical centre hospital in Taiwan. RESULTS: A total of 306 nurses participated in the study. Nurses' attitudes towards medication administration error reporting were inclined towards positive. The major perceived barrier was fear of the consequences after reporting. The results demonstrated that 88.9% of medication administration errors were reported orally, whereas 19.0% were reported through the hospital internet system. Self-recrimination was the common feeling of nurses after the commission of an medication administration error. CONCLUSIONS: Even if hospital management encourages errors to be reported without recrimination, nurses' attitudes toward medication administration error reporting are not very positive and fear is the most prominent barrier contributing to underreporting. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should establish anonymous reporting systems and counselling classes to create a secure atmosphere to reduce nurses' fear and provide incentives to encourage reporting.

Use of a mobile device by nursing home residents for long-term care comprehensive geriatric self-assessment: a feasibility study.

Long-term-care comprehensive geriatric assessments, such as the Minimum Data Set 3.0, are used to evaluate the clinical, psychological, and personal status of residents in long-term-care nursing facilities. Nursing staff conducts assessment interviews, thereby increasing the workload of nurses and the cost of patient care. This study explored the ability of nursing home residents to use two different mobile devices for a geriatric self-assessment. Study participants were residents of long-term-care nursing homes. A modified Minimum Data Set 3.0 was converted to a format for use with a 6-inch mobile pad and a 3.7-inch mobile smartphone. The survey completion rate and the response time were measured. A Technology Assessment Model questionnaire analyzed the participants' experience. All participants were able to use a 6-inch pad, with an average completion rate of 92.9% and an average time for completion of 21 minutes. Only 20% of the participants could complete the assessment with the 3.7-inch smartphone. The participants found the 6-inch pad easier to use than the 3.7-inch smartphone. This exploratory study suggests that nursing home residents are able to use a mobile device to perform a geriatric self-assessment and delineates the importance of the ergonomics of the device.

The evaluation of integrating physical restraint report and care record system.

Physical restraint is the nursing intervention to protect patient safety in the hospital. Nurses should monitor and charting during the physical restraint period. Physical restraint is also the measurement of Taiwan clinical performance indicator. The traditional physical restraint quality measurement depends on the nurses' report. Lacking of integrating of report and nurses' care record induces the low report rate. In 2007, we developed the integrating physical restraint report and care record system to facilitate the report process in 2300-bed medical center in northern Taiwan. We evaluated the system with two methods after system implemented for one year. The results show it significantly increased the reporting rate from before (0.77%) to after (1.5%) and had no significance difference with the average reporting rate in Taiwan (P>0.05). Most nurses felt nature to satisfy on the system usefulness (81%) and preferred to use system then use paper form record (83.1%). Almost every nurse had correct cognitions on report physical restrain event when it occurred to patients. The system seemed to be successful implemented and helpful for the quality measurement management.

A hair growth-promoting effect of Chinese black tea extract in mice.

Chinese black tea extract (CBTE) fermented with Aspergillus sp. significantly promoted hair growth after 2 weeks of topical application in shaved 6 week-old male C3H/He mice. The hair growth-promoting effect of CBTE was potentiated synergistically by capsaicin, which has no effect on hair growth by itself. CBTE displayed an affinity for estrogen receptor (ER)α, with an IC50 value of 74.8 µg/mL. This effect of CBTE might be mediated by the ERs, since a similar effect induced by orally administered soy isoflavone, a mixture of ERs ligands, has been reported to be synergistically potentiated by capsaicin.