Acceptability and Initial Adoption of the Heart Observation App for Infants With Congenital Heart Disease: Qualitative Study.

BACKGROUND: Approximately 1% of all infants are born with a congenital heart disease (CHD). Internationally CHD remains a major cause of infant death, some of which occur unexpectedly after a gradual deterioration at home. Many parents find it difficult to recognize worsening of symptoms. OBJECTIVE: This study aims to report the acceptability and initial adoption of a mobile app, the Heart Observation app (HOBS), aiming to support parents' understanding and management of their child's condition and to increase quality in follow-up from health care professionals in complex health care services in Norway. METHODS: A total of 9 families were interviewed on discharge from the neonatal intensive care unit and after 1 month at home. The infant's primary nurse, community nurse, and cardiologist were also interviewed regarding their experiences about collaboration with the family. The interviews were analyzed inductively with thematic content analysis. RESULTS: The analysis generated 4 main themes related to acceptability and adoption: (1) Individualize Initial Support, (2) Developing Confidence and Coping, (3) Normalize When Appropriate, and (4) Implementation in a Complex Service Pathway. The receptivity of parents to learn and attend in the intervention differs according to their present situation. Health care professionals emphasized the importance of adapting the introduction and guidance to parents' receptivity to ensure comprehension, self-efficacy, and thereby acceptance before discharge (Individualize Initial Support). Parents perceived that HOBS served them well and nurtured confidence by teaching them what to be aware of. Health care professionals reported most parents as confident and informed. This potential effect increased the possibility of adoption (Developing Confidence and Coping). Parents expressed that HOBS was not an "everyday app" and wanted to normalize everyday life when appropriate. Health care professionals suggested differentiating use according to severity and reducing assessments after recovery to adapt the burden of assessments when appropriate (Normalize When Appropriate). Health care professionals' attitude to implement HOBS in their services was positive. They perceived HOBS as useful to systemize guidance, to enhance communication regarding an infant's condition, and to increase understanding of heart defects in health care professionals with sparse experience (Implementation in a Complex Service Pathway). CONCLUSIONS: This feasibility study shows that both parents and health care professionals found HOBS as a positive addition to the health care system and follow-up. HOBS was accepted and potentially useful, but health care professionals should guide parents initially to ensure comprehension and adapt timing to parents' receptivity. By doing so, parents may be confident to know what to look for regarding their child's health and cope at home. Differentiating between various diagnoses and severity is important to support normalization when appropriate. Further controlled studies are needed to assess adoption, usefulness, and benefits in the health care system.

A quantitative, multicentre, longitudinal study of patient experiences after gynaecological day surgery.

AIM: The aim of this study was to explore patients' experiences after gynaecological day surgery one and 30 days postoperatively, as well as potential factors influencing these experiences. DESIGN: The study had a multicentre, quantitative, longitudinal design. METHODS: The study was conducted in three different hospitals' day surgical unit and included patients undergoing gynaecological surgery in general anaesthesia. We used a questionnaire including the European Quality of Life tool (EQ5D3L), the Quality-of-Recovery-15 questionnaire (QoR-15) and items relating to patient experiences, the first day (T1, n = 444) and 30 days (T2, n = 193) after surgery. Data were collected in the period March 2019 to March 2020. RESULTS: Results show that patients mainly had positive experiences and ranged quality of recovery high, even though some areas needed improvement. Patient scores on the QoR-15 relating to their experiences 24 h postoperative were rated higher at T1 than at T2. Twenty per cent of the respondents experienced complications such as infection, haemorrhage and pain. About 1/5 of these contacted healthcare services, and three per cent was hospitalized. EQ5D score was the only factor that made an statistically significant impact on patients' experiences with quality of recovery (R2 .169, F = 82.87). However, this effect was weak.

Heart OBServation app: development of a decision support tool for parents of infants with severe cardiac disease.

BACKGROUND AND OBJECTIVES: Many parents of infants with CHD find it difficult to recognise symptoms of deterioration in their children. Therefore, a personalised decision support application for parents has been developed. This application aims to increase parents' awareness of their infant's normal condition, help them assess signs of deterioration, decide who and when to contact health services, and what to report. The aim of this paper is to describe the concept and report results from a usability study. METHODS: An interprofessional group developed a mobile application called the Heart OBServation app in close collaboration with parents using an iterative process. We performed a usability study consisting of semi-structured interviews of 10 families at discharge and after one month and arranged two focus group interviews with nurses caring for these families. A thematic framework analysis of the interviews explored the usability of features in the application. Usability was assessed twice using the System Usability Scale, and a user log was registered throughout the study. RESULTS: The overall system usability score, 82.3 after discharge and 81.7 after one month, indicates good system usability. The features of Heart OBServation were perceived as useful to provide tailored information, increase awareness of the child's normal condition, and to guide parents in what to look for. To empower parents, an interactive discharge checklist was added. CONCLUSIONS: The Heart OBServation demonstrated good usability and was well received by parents and nurses. Feasibility and benefits of this application in clinical practice will be investigated in further studies.

E-learning or lectures to increase knowledge about congenital heart disease in infants: A comparative interventional study.

AIM: This project aimed to create, implement and evaluate an e-learning course on nursing infants with congenital heart disease (CHD) and to measure its efficacy compared with classroom learning. DESIGN: This is a comparative interventional study with two groups. METHODS: The study involved 15 postgraduate students and 13 newly employed nurses. The learning outcome was computed as the difference between pre-test and post-test knowledge scores and analysed using t tests and multiple regression. RESULTS: Both learning groups scored significantly higher 1 week after training. The improvement did not differ significantly between the groups when controlling for the years of experience in CHD nursing and the baseline knowledge score. Participants with higher baseline knowledge scores improved their scores less. Neither learning method was proven more effective than the other. Participants reported experiencing traditional classroom teaching as more positive, but e-learning was more time effective.