A short simulated nature experience as an effective way to promote restoration from work-related stress.

Spending time in nature, and even watching images or videos of nature, has positive effects on one's mental state. However, cognitively stressful work is often performed indoors, in offices that lack easy access to nature during breaks. In this study, we investigated whether watching a 5-min audiovisual video that describes a first-person perspective walk on a forest path could help to restore one's mental state after cognitive stress. Participants were asked to perform cognitive stressor tasks, after which they were shown either a nature walk video or a control video. Subjective restoration was measured using self-reports before and after the videos, while electrodermal activity (EDA) and electroencephalography (EEG) were measured during the video-watching session. The results showed that experiencing the nature walk video enhanced subjective restoration more than watching the control video. Arousal of the autonomic nervous system, measured using EDA, decreased more during the nature walk video than during the control video. Additionally, activity in the EEG's upper theta band (6-8 Hz) and lower alpha band (8-10 Hz) increased during the nature walk video, suggesting that it induced a relaxed state of mind. Interestingly, the participants' connection with nature moderated the effects of the nature video. The subjective and physiological measures both suggest that watching a short, simulated nature walk may be beneficial in relaxing the mind and restoring one's mental state after cognitive stress.

Health-Related Telemonitoring Parameters/Signals of Older Adults: An Umbrella Review.

Aging is one of the greatest challenges in modern society. The development of wearable solutions for telemonitoring biological signals has been viewed as a strategy to enhance older adults' healthcare sustainability. This study aims to review the biological signals remotely monitored by technologies in older adults. PubMed, the Cochrane Database of Systematic Reviews, the Web of Science, and the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports were systematically searched in December 2021. Only systematic reviews and meta-analyses of remote health-related biological and environmental monitoring signals in older adults were considered, with publication dates between 2016 and 2022, written in English, Portuguese, or Spanish. Studies referring to conference proceedings or articles with abstract access only were excluded. The data were extracted independently by two reviewers, using a predefined table form, consulting a third reviewer in case of doubts or concerns. Eighteen studies were included, fourteen systematic reviews and four meta-analyses. Nine of the reviews included older adults from the community, whereas the others also included institutionalized participants. Heart and respiratory rate, physical activity, electrocardiography, body temperature, blood pressure, glucose, and heart rate were the most frequently measured biological variables, with physical activity and heart rate foremost. These were obtained through wearables, with the waist, wrist, and ankle being the most mentioned body regions for the device's placement. Six of the reviews presented the psychometric properties of the systems, most of which were valid and accurate. In relation to environmental signals, only two articles presented data on this topic. Luminosity, temperature, and movement were the most mentioned variables. The need for large-scale long-term health-related telemonitoring implementation of studies with larger sample sizes was pointed out by several reviews in order to define the feasibility levels of wearable devices.

Predicting patient acuity from electronic patient records.

BACKGROUND: The ability to predict acuity (patients' care needs), would provide a powerful tool for health care managers to allocate resources. Such estimations and predictions for the care process can be produced from the vast amounts of healthcare data using information technology and computational intelligence techniques. Tactical decision-making and resource allocation may also be supported with different mathematical optimization models. METHODS: This study was conducted with a data set comprising electronic nursing narratives and the associated Oulu Patient Classification (OPCq) acuity. A mathematical model for the automated assignment of patient acuity scores was utilized and evaluated with the pre-processed data from 23,528 electronic patient records. The methods to predict patient's acuity were based on linguistic pre-processing, vector-space text modeling, and regularized least-squares regression. RESULTS: The experimental results show that it is possible to obtain accurate predictions about patient acuity scores for the coming day based on the assigned scores and nursing notes from the previous day. Making same-day predictions leads to even better results, as access to the nursing notes for the same day boosts the predictive performance. Furthermore, textual nursing notes allow for more accurate predictions than previous acuity scores. The best results are achieved by combining both of these information sources. The developed model achieves a concordance index of 0.821 when predicting the patient acuity scores for the following day, given the scores and text recorded on the previous day. CONCLUSIONS: By applying language technology to electronic patient documents it is possible to accurately predict the value of the acuity scores of the coming day based on the previous daýs assigned scores and nursing notes.

Crucial information needs of ICU charge nurses in Finland and Greece.

AIMS: To describe crucial information needs of ICU charge nurses, and to compare these needs in two countries in Europe. BACKGROUND: ICU charge nurses are on the front line for ensuring that the activities of their units are running smoothly. They are accountable for making sure that the right tasks are performed under the right circumstances, with the right people, at the right time. DESIGN AND PARTICIPANTS: An online survey based on a previous observation study regarding the ad hoc decision-making of ICU shift leaders. A total of 257 Finnish and 50 Greek ICU charge nurses participated in this study, from 17 Finnish and 16 Greece ICUs for adults. METHODS: Our survey incorporated 122 statements divided into six dimensions (patient admission, organization and management of work, allocation of staff, allocation of material, special treatments and patient discharge) with a rating scale from 0 to 10. Analysis involved descriptive statistics. Mann-Whitney U and Kruskal-Wallis tests were used to compare the answers of the two countries. Validity was verified with confirmatory factor analysis and the reliability was tested with Cronbach's α values. RESULTS: The most crucial information needs of ICU charge nurses concerned the overall organization and management of work. Both staff-related and individual patient-related information was needed. Information needs of Finnish and Greek charge nurses concerned similar kinds of situations in ICUs. However, there were some differences that might depend on the cultural differences between the countries. CONCLUSIONS: Accurate and real-time information is a prerequisite for ICU charge nurses' ad hoc decision-making during daily care management. Identification of the most crucial information is needed when tools for information management are developed. RELEVANCE TO CLINICAL PRACTICE: The results of this study indicated that a major portion of immediate information needs of ICU charge nurses are internationally common in similar settings.

National survey focusing on the crucial information needs of intensive care charge nurses and intensivists: same goal, different demands.

BACKGROUND: Although information technology adequately supports clinical care in many intensive care units (ICUs), it provides much poorer support for the managerial information needed to coordinate multi-professional care. To gain a general view of the most crucial multi-professional information needs of ICU shift leaders a national survey was conducted, focusing on the information needs of charge nurses and intensivists. METHODS: Based on our previous observation study an online survey was developed, containing 122 information need statements related to the decision-making of ICU shift leaders. Information need statements were divided into six dimensions: patient admission, organisation and management of work, allocation of staff and material resources, special treatments, and patient discharge. This survey involved all ICU shift leaders (n = 738) who worked in any of the 17 highest level ICUs for adults in university hospitals in Finland during the autumn of 2009. Both charge nurses' and intensivists' crucial information needs for care coordination were evaluated. RESULTS: Two hundred and fifty-seven (50%) charge nurses and 96 (43%) intensivists responded to the survey. The consistency of the survey was found to be good (Cronbach's α scores between .87-.97, with a total explanatory power of 64.53%). Altogether, 57 crucial information needs for care coordination were found; 22 of which were shared between shift leaders. The most crucial of these information needs were related to organisation and management, patient admission, and allocation of staff resources. The associations between working experience, or shift leader acting frequencies, and crucial information needs were not statistically significant. However, a statistically significant difference was found between the number of ICU beds and the ICU experience of charge nurses with information needs, under the dimension of organisation and management of work. The information needs of charge nurses and intensivists differed. Charge nurses' information needs related to care coordination, were more varied, and concerned issues at a unit level, whereas intensivists focused on direct patient care. CONCLUSIONS: The reliability and validity of our survey was found to be good. Our study findings show that care coordination at an ICU is a collaborative process among ICU shift leaders with multiprofessional information needs related to organisation and management, patient admission, and allocation of staff resources. Study findings can be used to identify the most crucial information needs of ICU shift leaders when new information technology is developed to support managerial decision-making during care coordination.

Information utilization in tactical decision making of middle management health managers.

Healthcare is an information-intensive field, as information is needed to make strategic, tactical, and operational decisions. The purpose of this study was to identify the tactical decisions that middle management healthcare managers make, the information that is available, and the necessary information that is missing using the cardiac care process as an example. Data were collected through focused interviews of nurses and physicians who work in middle management in a secondary healthcare field. The interviews were coded and analyzed using the thematic content analysis method. We identified two main categories of tactical decisions: those concerning the process of care and those concerning the resources for the care. We termed the categories "process decisions" and "resource decisions." The availability of information varied. Much of the necessary information was created and processed manually. Our results show that the collection, mining, and systematic use of information are difficult because of the existence of many types of information systems and their varying abilities to produce and report information. Finally, much of the important information is missing. In conclusion, the information management process in healthcare settings needs to be improved, and a new generation of information system is needed to support tactical decision making in middle management.

Managing daily intensive care activities: an observational study concerning ad hoc decision making of charge nurses and intensivists.

INTRODUCTION: Management of daily activities in ICUs is challenging. ICU shift leaders, charge nurses and intensivists have to make several immediate ad hoc decisions to enable the fluent flow of ICU activities. Even though the management of ICU activities is quite well delineated by international consensus guidelines, we know only a little about the content of the real clinical decision making of ICU shift leaders. METHODS: We conducted an observational study with the think-aloud technique to describe the ad hoc decision making of ICU shift leaders. The study was performed in two university-affiliated hospital ICUs. Twelve charge nurses and eight intensivists were recruited. Observations were recorded and transcribed for qualitative content analysis using the protocol analysis method. The software program NVivo 7 was used to manage the data. The interrater agreement was assessed with percentages and by Cohen's κ. RESULTS: We identified 463 ad hoc decisions made by the charge nurses and 444 made by the intensivists. During our data collection time, this breaks down to over 230 immediately made decisions per day (24 hours). We divided the ad hoc decision making of ICU shift leaders into two types: process-focused and situation-focused. Process-focused decision making included more permanent information, such as human resources, know-how and material resources, whereas situation-focused decision making included decisions about single events, such as patient admission. We named eight different categories for ICU ad hoc decision making: (1) adverse events, (2) diagnostics, (3) human resources and know-how, (4) material resources, (5) patient admission, (6) patient discharge, (7) patient information and vital signs and (8) special treatments. CONCLUSIONS: ICU shift leaders make a great number of complex ad hoc decisions throughout the day. Often this decision making involves both intensivists and charge nurses. It forms a bundle that requires versatile, immediate information for a successful outcome. In the future, we need to investigate which information is crucial for ad hoc decision making. These challenges should also be emphasised when information technology programs for ICU care management are developed.

Critical incidents and important information in the care processes of patients with cardiac symptoms.

AIM: To describe important information in the care processes of patients with cardiac symptoms. BACKGROUND: Process-based work-flow models are increasingly being used in healthcare. At the same time, developments in information systems offer the possibility of supporting improvements in process and information management in healthcare. To better utilize these possibilities we need to understand more about important information content and flow during treatment processes. METHOD: A qualitative approach involving the critical incident technique was used. Critical incidents were collected using a semi-structured questionnaire (50 respondents) and interviews (n=10). RESULTS: Three incident categories of important information were identified: (1) process-related incidents, (2) managerial incidents and (3) clinical incidents. Process-related incidents focused on agreed-care practices and the importance of the care environment. Managerial incidents focused on human and material resources. Clinical incidents focused on medical and nursing care and the importance of patient education. CONCLUSIONS: Information content, information flow and the timing of such information should be modelled further in order to improve the management of care processes. IMPLICATIONS FOR NURSING MANAGEMENT: Increasing knowledge about essential points of information as part of nursing management is important.

Key elements of successful care process of patients with heart symptoms in an emergency care - could an ERP system help?

The aim of the study was to identify key elements of successful care process of patients with heart symptoms from the nursing management viewpoint in an emergency care. Through these descriptions, we aimed at identifying possibilities for using enterprise resource planning (ERP) systems to support decision making in emergency care. Hospitals are increasingly moving to process-based workings and at the same time new information system in healthcare are developed and therefore it is essential to understand the strengths and weaknesses of current processes better. A qualitative descriptive design using critical incident technique was employed. Critical Incidents were collected with an open-ended questionnaire. The sample (n=50), 13 head nurses and 37 registered nurses, was purposeful selected from three acute hospitals in southern Finland. The process of patients with heart symptoms in emergency care was described. We identified three competence categories where special focus should be placed to achieve successful process of patients with heart symptoms: process-oriented competencies, personal/management competencies and logistics oriented competencies. Improvement of decision making requires that the care processes are defined and modeled. The research showed that there are several happenings in emergency care where an ERP system could help and support decision making. These happenings can be categorized in two groups: 1) administrative related happenings and 2) patient processes related happenings.

Intensive care admission and discharge - critical decision-making points.

Delivery of intensive care has many critical points impacting the outcomes of critically ill patients. Two important key events in intensive care are patients' admission and discharge procedures. The decision making of intensive care experts should be supported in these two points, in order to attain good quality and safe care. We hypothesize that in the future this decision-making process can be effectively supported with information technology. To reveal the complex decision-making, we studied the decision-making processes and information needs of intensive care charge nurses during patients' admission and discharge procedures. We identified several interconnected decision-making steps during these procedures.