Enabling nurses' engagement in the design of healthcare technology - Core competencies and requirements: A qualitative study.

Background: Due to the globally increasing demand for care, innovation is important to maintain quality, safety, effectiveness, patient sensitivity, and outcome orientation. Health care technologies could be a solution to innovate, maintain, or improve the quality of care and simultaneously decrease nurses' workload. Currently, nurses are rarely involved in the design of health care technologies, mostly due to time constraints with clinical nursing responsibilities and limited exposure to technology and design disciplines. To ensure that health care technologies fit into nurses' core and routine practice, nurses should be actively involved in the design process. Objective: The aim of the present study was to explore the main requirements for nurses' active participation in the design of health care technologies. Design: An exploratory descriptive qualitative design was used which helps to both understand and describe a phenomenon. Participants: Twelve nurses from three academic hospitals in the Netherlands participated in this study. Method: Data were collected from semistructured interviews with hospital nurses experienced in design programs and thematically analysed. Results: Four themes were identified concerning the main requirements for nurses to participate in the design of health care technologies: (1) nurses' motivations to participate, (2) the process of technology development, (3) required competence to participate (such as assertiveness, creative thinking, problem solving skills), and (4) facilitating and organizing nurses' participation. Conclusion: Nurses experience their involvement in the design process as essential, distinctive, and meaningful but experience few possibilities to combine this work with their current workload, flows, routines, and requirements. To participate in the design of health care technologies nurses need motivation and specific competencies. Organizations should facilitate time for nurses to acquire the required competencies and to be intentionally involved in technology design and development activities.

Health Care Workers' Expectations of the Mercury Advance SMARTcare Solution to Prevent Pressure Injuries: Individual and Focus Group Interview Study.

BACKGROUND: The transformation in global demography and the shortage of health care workers require innovation and efficiency in the field of health care. Digital technology can help improve the efficiency of health care. The Mercury Advance SMARTcare solution is an example of digital technology. The system is connected to a hybrid mattress and is able to detect patient movement, based on which the air pump either starts automatically or sends a notification to the app. Barriers to the adoption of the system are unknown, and it is unclear if the solution will be able to support health care workers in their work. OBJECTIVE: This study aims to gain insight into health care workers' expectations of factors that could either hamper or support the adoption of the Mercury Advance SMARTcare unit connected to a Mercury Advance mattress to help prevent patients from developing pressure injuries in hospitals and long-term care facilities. METHODS: We conducted a generic qualitative study from February to December 2022. Interviews were conducted, and a focus group was established using an interview guide of health care workers from both the United Kingdom and the Netherlands. Thematic analysis was performed by 2 independent researchers. RESULTS: A total of 14 participants took part in the study: 6 (43%) participants joined the focus group, and 8 (57%) participants took part in the individual interviews. We identified 13 factors based on four themes: (1) factors specifically related to SMARTresponse, (2) vision on innovation, (3) match with health care activities, and (4) materials and resources involved. Signaling function, SMARTresponse as prevention, patient category, representatives, and implementation strategy were identified as facilitators. Perception of patient repositioning, accessibility to pressure injury aids, and connectivity were identified as barriers. CONCLUSIONS: Several conditions must be met to enhance the adoption of the Mercury Advance SMARTcare solution, including the engagement of representatives during training and a reliable wireless network. The identified factors can be used to facilitate the implementation process.

Games to support teaching clinical reasoning in health professions education: a scoping review.

INTRODUCTION: Given the complexity of teaching clinical reasoning to (future) healthcare professionals, the utilization of serious games has become popular for supporting clinical reasoning education. This scoping review outlines games designed to support teaching clinical reasoning in health professions education, with a specific emphasis on their alignment with the 8-step clinical reasoning cycle and the reflective practice framework, fundamental for effective learning. METHODS: A scoping review using systematic searches across seven databases (PubMed, CINAHL, ERIC, PsycINFO, Scopus, Web of Science, and Embase) was conducted. Game characteristics, technical requirements, and incorporation of clinical reasoning cycle steps were analyzed. Additional game information was obtained from the authors. RESULTS: Nineteen unique games emerged, primarily simulation and escape room genres. Most games incorporated the following clinical reasoning steps: patient consideration (step 1), cue collection (step 2), intervention (step 6), and outcome evaluation (step 7). Processing information (step 3) and understanding the patient's problem (step 4) were less prevalent, while goal setting (step 5) and reflection (step 8) were least integrated. CONCLUSION: All serious games reviewed show potential for improving clinical reasoning skills, but thoughtful alignment with learning objectives and contextual factors is vital. While this study aids health professions educators in understanding how games may support teaching of clinical reasoning, further research is needed to optimize their effective use in education. Notably, most games lack explicit incorporation of all clinical reasoning cycle steps, especially reflection, limiting its role in reflective practice. Hence, we recommend prioritizing a systematic clinical reasoning model with explicit reflective steps when using serious games for teaching clinical reasoning.

A systematic approach to quantify the influence of indoor environmental parameters on students' perceptions, responses, and short-term academic performance.

Several studies found that classrooms' indoor environmental quality (IEQ) can positively influence in-class activities. Understanding and quantifying the combined effect of four indoor environmental parameters, namely indoor air quality and thermal, acoustic, and lighting conditions on people is essential to create an optimal IEQ. Accordingly, a systematic approach was developed to study the effect of multiple IEQ parameters simultaneously. Methods for measuring the IEQ and students' perceived IEQ, internal responses, and academic performance were derived from literature. Next, this systematic approach was tested in a pilot study during a regular academic course. The perceptions, internal responses, and short-term academic performance of participating students (n = 163) were measured. During the pilot study, the IEQ of the classrooms varied slightly. Significant associations (p < 0.05) were observed between these natural variations and students' perceptions of the thermal environment and indoor air quality. These perceptions were significantly associated with their physiological and cognitive responses (p < 0.05). Furthermore, students' perceived cognitive responses were associated with their short-term academic performance (p < 0.01). The observed associations confirm the construct validity of the systematic approach. However, its validity for investigating the influence of lighting remains to be determined.

Educational intervention to increase nurses' knowledge, self-efficacy and usage of telehealth: A multi-setting pretest-posttest study.

The widespread use of telehealth, providing healthcare remotely, is hampered by various barriers. Dutch nurses currently working in practice never received education in this new way of healthcare delivery. Education is frequently suggested as a strategy to overcome barriers in telehealth use. However, the nature and effectiveness of such education has not yet been specified and tested in practice. In a previous study, we identified 14 nursing telehealth activities and accompanying competencies. In the current study, we established the effectiveness of training in these competencies on nurses' subjective knowledge, self-efficacy and usage of telehealth. A two-day tailored training program in nursing telehealth activities was evaluated in a Dutch context among 37 participants across three settings: (a) twelve primary care (PC), (b) fourteen homecare (HC) and (c) eleven hospital (H) nurses. In each team, telehealth knowledge significantly increased during the training sessions. In each team, nurses' telehealth self-efficacy also significantly increased 6-10 weeks after the training. After the training, the number of remote consultations increased from 2 to 12 in primary care, 12 to 35 in homecare and decreased from 28 to 17 in the hospital setting. We conclude that training nurses in telehealth activities contributes to their knowledge and self-efficacy.

Classrooms' indoor environmental conditions affecting the academic achievement of students and teachers in higher education: A systematic literature review.

This study reports the outcomes of a systematic literature review, which aims to determine the influence of four indoor environmental parameters - indoor air, thermal, acoustic, and lighting conditions -on the quality of teaching and learning and on students' academic achievement in schools for higher education, defined as education at a college or university. By applying the Cochrane Collaboration Method, relevant scientific evidence was identified by systematically searching in multiple databases. After the screening process, 21 publications of high relevance and quality were included. The collected evidence showed that the indoor environmental quality (IEQ) can contribute positively to the quality of learning and short-term academic performance of students. However, the influence of all parameters on the quality of teaching and the long-term academic performance could not be determined yet. Students perform at their best in different IEQ conditions, and these conditions are task-dependent, suggesting that classrooms which provide multiple IEQ classroom conditions facilitate different learning tasks optimally. In addition, the presented evidence illuminates how to examine the influence of the IEQ on users. Finally, this information supports decision-makers in facility management and building systems engineering to improve the IEQ, and by doing so, allow teachers and students to perform optimally.

Can Special Light Glasses Reduce Sleepiness and Improve Sleep of Nightshift Workers? A Placebo-Controlled Explorative Field Study.

Nightshift workers go against the natural sleep-wake rhythm. Light can shift the circadian clock but can also induce acute alertness. This placebo-controlled exploratory field study examined the effectiveness of light glasses to improve alertness while reducing the sleep complaints of hospital nurses working nightshifts. In a crossover within-subjects design, 23 nurses participated, using treatment glasses and placebo glasses. Sleepiness and sleep parameters were measured. A linear mixed model analysis on sleepiness revealed no significant main effect of the light intervention. An interaction effect was found indicating that under the placebo condition, sleepiness was significantly higher on the first nightshift than on the last night, while under the treatment condition, sleepiness remained stable across nightshift sessions. Sleepiness during the commute home also showed a significant interaction effect, demonstrating that after the first nightshift, driver sleepiness was higher for placebo than for treatment. Subjective sleep quality showed a negative main effect of treatment vs. placebo, particularly after the first nightshift. In retrospect, both types of light glasses were self-rated as effective. The use of light glasses during the nightshift may help to reduce driver sleepiness during the commute home, which is relevant, as all participants drove home by car or (motor) bike.

Ageing and ageing cities: healthy and functional / Envelhecimento e cidades envelhecidas: saudável e funcional

By 2050, 70% of the population will live in cities. The majority of the persons living in cities will be 60 plus years old. Ageing cities demands for cities environments to adapt to an ageing population. Modern cities though, don't anticipate fast enough and in an adequate manner to face the challenges due to population-related transitions. Modifying and adapting the built environment with a focus on the aged population could help to support older people facing functional and cognitive decline.(AU)

Em 2050, 70% da população viverá nas cidades. A maioria das pessoas que vivem nas cidades terá 60 anos ou mais. O envelhecimento das cidades exige que os ambientes das cidades se adaptem ao envelhecimento da população. No entanto, as cidades modernas não se antecipam de forma rápida e adequada para enfrentar os desafios decorrentes das transições relacionadas à população. Modificar e adaptar o ambiente construído com foco na população idosa pode ajudar a apoiar os idosos que enfrentam declínio funcional e cognitivo.(AU)

Methods for Involving People Living with Dementia and Their Informal Carers as Co-Developers of Technological Solutions.

This paper reports on the research methods used in five different projects aimed at supporting people living with dementia in their everyday lives and activities of daily living. In all five projects, people living with dementia and their informal carers were involved. Applied methods ranged from passive involvement in the form of observations to very active involvement consisting of consultation rounds and think-aloud sessions. The projects highlighted that people living with dementia can still contribute to the development of solutions that support them in the self-management of their symptoms and challenges, as well as technological solutions that support them in daily living.

Hospital Nurses' Self-Reported Confidence in Their Telehealth Competencies.

BACKGROUND: The diffusion of telehealth into hospital care is still low, partially because of a lack of telehealth competence among nurses. In an earlier study, we reported on the knowledge, skills, and attitudes (KSAs) nurses require for the use of telehealth. The current study describes hospital nurses' confidence in possessing these telehealth KSAs. METHOD: In a cross-sectional study, we invited 3,543 nurses from three hospitals in the Netherlands to rate their self-confidence in 31 telehealth KSAs on a 5-point Likert scale, using an online questionnaire. RESULTS: A total of 1,017 nurses responded to the survey. Nine KSAs were scored with a median value of 4.0, 19 KSAs with a median value of 3.0, and three KSAs with a median value of 2.0. CONCLUSION: Given that hospital nurses have self-confidence in only nine of the 31 essential telehealth KSAs, continuing education in additional KSAs is recommended to support nurses in gaining confidence in using telehealth. [J Contin Educ Nurs. 2019;50(1):26-34.].

Internet-Generation Nursing Students' View of Technology-Based Health Care.

BACKGROUND: Today's nursing school applicants are considered "digital natives." This study investigated students' views of new health care technologies. METHOD: In a cross-sectional survey among first-year nursing students, 23 common nursing activities and five telehealth nursing activities were presented along with three statements: "I consider this a core task of nursing," "I look forward to becoming trained in this task," and "I think I will do very well in performing this task." RESULTS: Internet-generation nursing students (n = 1,113) reported a significantly (p ⩽ .001) less positive view of telehealth activities than of common nursing activities. Median differences were 0.7 (effect size [ES], -0.54), 0.4 (ES, -0.48), and 0.3 (ES, -0.39), measured on a 7-point scale. CONCLUSION: Internet-generation nursing students do not naturally have a positive view of technology-based health care provision. The results emphasize that adequate technology and telehealth education is still needed for nursing students. [J Nurs Educ. 2017;56(12):717-724.].

Technology use by older adults in the Netherlands and its associations with demographics and health outcomes.

Information and communications technology (ICT) has the potential to contribute to the quality of life of older adults. The aim of this study was to analyze the use of a broad array of ICT devices and services among Dutch older adults and to determine whether demographics and health outcomes are associated with this use. A questionnaire was dispensed among a group of Dutch older adults (≥65 years). A univariate analysis of covariance was used to analyse results. Two hundred ninety-one subjects filled out the questionnaire. Reported use of newer technologies was lower compared with older technologies. Increased age (p = 0.048, Confidence Interval [CI]: -0.73: -0.004), lower degree of education (p = 0.008, CI: -59.64: -5.59), birthplace outside of Europe (p = 0.024, CI: -21.99: -0.73), lower income (p = 0.005, CI: -46.44:25.38), less arthrosis of the hands (p = 0.042, CI: -1.38:21.11), and a lower physical functioning (p = 0.008, CI: 1.43:9.41) resulted in a lower ICT use score with an adjusted R2 of 0.311. Older adults are slower to adapt to newer technologies. It appears it is not the degree of physical restrictions, but rather the degree of adaptability to these restrictions that influence the use of ICT.

Efficacy of an mHealth intervention to stimulate physical activity in COPD patients after pulmonary rehabilitation.

Physical inactivity in patients with chronic obstructive pulmonary disease (COPD) is associated with poor health status and increased disease burden. The present study aims to test the efficacy of a previously developed mobile (m)Health intervention to improve or maintain physical activity in patients with COPD after pulmonary rehabilitation.A randomised controlled trial was performed in 32 physiotherapy practices in the Netherlands. COPD patients were randomised into intervention or usual care groups. The intervention consisted of a smartphone application for the patients and a monitoring website for the physiotherapists. Measurements were performed at 0, 3, 6 and 12 months. Physical activity, functional exercise capacity, lung function, health-related quality of life and body mass index were assessed.157 patients started the study and 121 completed it. There were no significant positive effects of the intervention on physical activity (at 0 months: intervention 5824±3418 steps per weekday, usual care 5717±2870 steps per weekday; at 12 months: intervention 4819±2526 steps per weekday, usual care 4950±2634 steps per weekday; p=0.811) or on the secondary end-points. There was a significant decrease over time in physical activity (p<0.001), lung function (p<0.001) and mastery (p=0.017), but not in functional exercise capacity (p=0.585).Although functional exercise capacity did not deteriorate, our mHealth intervention did not improve or maintain physical activity in patients with COPD after a period of pulmonary rehabilitation.

Competencies required for nursing telehealth activities: A Delphi-study.

BACKGROUND: Telehealth is viewed as a major strategy to address the increasing demand for care and a shrinking care professional population. However, most nurses are not trained or are insufficiently trained to use these technologies effectively. Therefore, the potential of telehealth fails to reach full utilization. A better understanding of nursing telehealth entrustable professional activities (NT-EPAs) and the required competencies can contribute to the development of nursing telehealth education. METHOD: In a four-round Delphi-study, a panel of experts discussed which NT-EPAs are relevant for nurses and which competencies nurses need to possess to execute these activities effectively. The 51 experts, including nurses, nursing faculty, clients and technicians all familiar with telehealth, were asked to select items from a list of 52 competencies based on the literature and on a previous study. Additionally, the panelists could add competencies based on their experience in practice. The threshold used for consensus was set at 80%. RESULTS: Consensus was achieved on the importance of fourteen NT-EPAs, requiring one or more of the following core competencies; coaching skills, the ability to combine clinical experience with telehealth, communication skills, clinical knowledge, ethical awareness, and a supportive attitude. Each NT-EPA requires a specific set of competencies (at least ten). In total, 52 competencies were identified as essential in telehealth. DISCUSSION/CONCLUSION: Many competencies for telehealth, including clinical knowledge and communication skills, are not novel competencies. They are fundamental to nursing care as a whole and therefore are also indispensable for telehealth. Additionally, the fourteen NT-EPAs appeared to require additional subject specific competencies, such as the ability to put patients at ease when they feel insecure about using technology. The NT-EPAs and related competencies presented in this study can be used by nursing schools that are considering including or expanding telehealth education in their curriculum.

Visual functioning of aging care professionals and the influence of light, a brief literature study.

Ageing is an important factor that affects visual functioning. In the Netherlands the average age in healthcare facilities is on increase. The current study is a preliminary literature review regarding the influence of light on the visual functioning of the aging workforce and their related tasks.

Creating healthy nursing home environment via lighting interventions: a theoretical approach.

In the Netherlands long-term care facilities made investments in order to improve the well-being of their residents and to support healthcare professionals in their daily task. Light is one of the technical solutions that might be contribute to support the well-being of older residents in long-term care facilities. This study investigates which possibilities are available to enrich the current situation to support the well-being, activities of daily living, and quality of life of older residents from lighting perspective. The light measurements show that the conditions are low and the value of 750 lux mainly reached on measurements points close to the window area. In this field study the light conditions are improved through a static lighting system. Further research is needed in order to investigate how the new light plan affect the quality of life and to define light guidelines for long-term care facilities.

Dutch nurses' willingness to use home telehealth: implications for practice and education.

Home telehealth (HT) refers to the use of videoconferencing to provide care to patients remotely and can help older adults age in place. However, these technologies are unlikely to impact care unless health care providers are motivated to use them. Education may play a key role in increasing motivation to use and competence regarding HT. To help guide the development of nursing education to facilitate adoption and use, the current study examined predictors of Dutch nurses' willingness to use HT, based on a survey of 67 Dutch nurses with and 126 without HT experience. Nurses' willingness to use this technology was predicted by HT's (a) perceived usefulness to the client, (b) effort expectancy, (c) social influence, and (d) cost expectations. These observed relationships are anticipated to help with the development of effective educational programs to increase HT use and, therefore, improve older adults' quality of life. [Journal of Gerontological Nursing, 41(4), 47-56.].

eHealth Technology Competencies for Health Professionals Working in Home Care to Support Older Adults to Age in Place: Outcomes of a Two-Day Collaborative Workshop.

BACKGROUND: The demand for care is increasing, whereas in the near future the number of people working in professional care will not match with the demand for care. eHealth technology can help to meet the growing demand for care. Despite the apparent positive effects of eHealth technology, there are still barriers to technology adoption related to the absence of a composite set of knowledge and skills among health care professionals regarding the use of eHealth technology. OBJECTIVE: The objective of this paper is to discuss the competencies required by health care professionals working in home care, with eHealth technologies such as remote telecare and ambient assisted living (AAL), mobile health, and fall detection systems. METHODS: A two-day collaborative workshop was undertaken with academics across multiple disciplines with experience in working on funded research regarding the application and development of technologies to support older people. RESULTS: The findings revealed that health care professionals working in home care require a subset of composite skills as well as technology-specific competencies to develop the necessary aptitude in eHealth care. This paper argues that eHealth care technology skills must be instilled in health care professionals to ensure that technologies become integral components of future care delivery, especially to support older adults to age in place. Educating health care professionals with the necessary skill training in eHealth care will improve service delivery and optimise the eHealth care potential to reduce costs by improving efficiency. Moreover, embedding eHealth care competencies within training and education for health care professionals ensures that the benefits of new technologies are realized by casting them in the context of the larger system of care. These care improvements will potentially support the independent living of older persons at home. CONCLUSIONS: This paper describes the health care professionals' competencies and requirements needed for the use of eHealth technologies to support elderly adults to age in place. In addition, this paper underscores the need for further discussion of the changing role of health care professionals working in home care within the context of emerging eHealth care technologies. The findings are of value to local and central government, health care professionals, service delivery organizations, and commissioners of care to use this paper as a framework to conduct and develop competencies for health care professionals working with eHealth technologies.

Visual functioning in nursing home residents: information in client records.

AIM AND OBJECTIVES: To improve (eye)care in nursing homes by reporting and assessing visual functioning to enhance professional caregivers' awareness of visual problems. BACKGROUND: Older adults experience visual problems owing to biological ageing or eye disease. In the Netherlands, the prevalence of visual impairments is the highest in the subgroup of nursing home residents (41.3%). These impairments influence quality of life in terms of limiting daily activities and participation in social activities. Furthermore, 63% of visual problems are defined as 'avoidable blindness'. For this reason, screening of visual functioning in the nursing home is of major importance. Moreover, visual functioning should also be taken into account to prevent the incidence of falls. DESIGN: A field study on recorded information of visual functioning and visual assessment in nursing homes. METHODS: Assessment of visual functioning of 259 residents in nursing homes. Subsequently, recorded information in client files is related to the assessment outcome. RESULTS: Only in 101 (39%) of the 259 client records was some information on visual functioning found in client files. Whether a prescription for new glasses was dispensed made no difference in reporting on visual functioning in the client record. In more than half of the cases assessed as 'low vision or blindness', no information about visual functioning was found. Furthermore, no information was found in 31% (80/259) cases of suspected visual problems (referrals). A significant proportion of client records (p < 0.05) showed no recorded information in cases of referral for further check-up. CONCLUSIONS: In this study, one-third of nursing homes residents have visual problems, needing examination by an ophthalmologist. Problems with visual functioning should be assessed and captured in client records. Awareness of residents' visual functioning is a prerequisite for adapting basic daily care to the residents' needs.

Level of daily physical activity in individuals with COPD compared with healthy controls.

BACKGROUND: Persons with chronic obstructive pulmonary disease (COPD), performing some level of regular physical activity, have a lower risk of both COPD-related hospital admissions and mortality. COPD patients of all stages seem to benefit from exercise training programs, thereby improving with respect to both exercise tolerance and symptoms of dyspnea and fatigue. Physical inactivity, which becomes more severe with increasing age, is a point of concern in healthy older adults. COPD might worsen this scenario, but it is unclear to what degree. This literature review aims to present the extent of the impact of COPD on objectively-measured daily physical activity (DPA). The focus is on the extent of the impact that COPD has on duration, intensity, and counts of DPA, as well as whether the severity of the disease has an additional influence on DPA. RESULTS: A literature review was performed in the databases PubMed [MEDLINE], Picarta, PEDRO, ISI Web of Knowledge and Google scholar. After screening, 11 studies were identified as being relevant for comparison between COPD patients and healthy controls with respect to duration, intensity, and counts of DPA. Four more studies were found to be relevant to address the subject of the influence the severity of the disease may have on DPA. The average percentage of DPA of COPD patients vs. healthy control subjects for duration was 57%, for intensity 75%, and for activity counts 56%. Correlations of DPA and severity of the disease were low and/or not significant. CONCLUSIONS: From the results of this review, it appears that patients with COPD have a significantly reduced duration, intensity, and counts of DPA when compared to healthy control subjects. The intensity of DPA seems to be less affected by COPD than duration and counts. Judging from the results, it seems that severity of COPD is not strongly correlated with level of DPA. Future research should focus in more detail on the relation between COPD and duration, intensity, and counts of DPA, as well as the effect of disease severity on DPA, so that these relations become more understandable.