Understanding the role and impact of electronic health records in labor and delivery nursing practice: A scoping review protocol.

Background: Electronic health records have a significant impact on nursing practice, particularly in specializations such as labor and delivery, or acute care maternity nursing practice. Although primary studies on the use of electronic health records in labor and delivery have been done, no reviews on this topic exist. Moreover, the topic of labor and delivery nurses' organizing work in the electronic health record-enabled context has not been addressed. Objective: To (a) synthesize research on electronic health record use in labor and delivery nursing and (b) map how labor and delivery nursing organizing work is transformed by the electronic health record (as described in the reviewed studies). Methods: The scoping review will be guided by a modified methodology based on selected recommendations from the Joanna Briggs Institute and the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews. A comprehensive search will be conducted in the following databases: CINAHL Complete, MEDLINE, Academic Search Complete, Web of Science, Scopus and Dissertations and Theses Abstracts and Indexes. Included sources will be primary research, dissertations, or theses that address the use of electronic health records in labor and delivery nursing practice in countries with high levels of electronic health record adoption. Data extracted from included sources will be analyzed thematically. Further analysis will theorize labor and delivery nurses' organizing work in the context of electronic health record use by utilizing concepts from Davina Allen's Translational Mobilization Theory. Findings will be presented in tabular and descriptive formats. Conclusion: The findings of this review will help understand transformations of nursing practice in the electronic health record-enabled labor and delivery context and identify areas of future research. We will propose an extension of the Translational Mobilization Theory and theorize nurses' organizing work involving the use of the electronic health record.

Patient and Health Care Provider Perspectives on Patient Access to Test Results via Web Portals: Scoping Review.

BACKGROUND: A frequently used feature of electronic patient portals is the viewing of test results. Research on patient portals is abundant and offers evidence to help portal implementers make policy and practice decisions. In contrast, no comparable comprehensive summary of research addresses the direct release of and patient access to test results. OBJECTIVE: This scoping review aims to analyze and synthesize published research focused on patient and health care provider perspectives on the direct release of laboratory, imaging, and radiology results to patients via web portals. METHODS: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Searches were conducted in CINAHL, MEDLINE, and other databases. Citations were screened in Covidence using the inclusion and exclusion criteria. Primary studies that focused on patient and health care provider perspectives on patient access to laboratory and imaging results via web portals were included. An updated search was conducted up to August 2023. Our review included 27 articles-20 examining patient views, 3 examining provider views, and 4 examining both patient and provider views. Data extraction and inductive data analysis were informed by sensitizing concepts from sociomaterial perspectives, and 15 themes were generated. RESULTS: Patient perspectives (24 papers) were synthesized using nine themes: (1) patterns of use and patient characteristics; (2) emotional response when viewing the results and uncertainty about their implications; (3) understanding test results; (4) preferences for mode and timing of result release; (5). information seeking and patients' actions motivated by viewing results via a portal; (6) contemplating changes in behavior and managing own health; (7) benefits of accessing test results via a portal; (8) limitations of accessing test results via a portal; and (9) suggestions for portal improvement. Health care provider perspectives (7 papers) were synthetized into six themes: (1) providers' view of benefits of patient access to results via the portal; (2) effects on health care provider workload; (3) concerns about patient anxiety; (4) timing of result release into the patient portal; (5) the method of result release into the patient portal: manual versus automatic release; and (6) the effects of hospital health information technology system on patient quality outcomes. CONCLUSIONS: The timing of the release of test results emerged as a particularly important topic. In some countries, the policy context may motivate immediate release of most tests directly into patient portals. However, our findings aim to make policy makers, health administrators, and other stakeholders aware of factors to consider when making decisions about the timing of result release. This review is sensitive to the characteristics of patient populations and portal technology and can inform result release framework policies. The findings are timely, as patient portals have become more common internationally.

Farewell to humanism? Considerations for nursing philosophy and research in posthuman times.

In this paper, I argue that critical posthumanism is a crucial tool in nursing philosophy and scholarship. Posthumanism entails a reconsideration of what 'human' is and a rejection of the whole tradition founding Western life in the 2500 years of our civilization as narrated in founding texts and embodied in governments, economic formations and everyday life. Through an overview of historical periods, texts and philosophy movements, I problematize humanism, showing how it centres white, heterosexual, able-bodied Man at the top of a hierarchy of beings, and runs counter to many current aspirations in nursing and other disciplines: decolonization, antiracism, anti-sexism and Indigenous resurgence. In nursing, the term humanism is often used colloquially to mean kind and humane; yet philosophically, humanism denotes a Western philosophical tradition whose tenets underpin much of nursing scholarship. These underpinnings of Western humanism have increasingly become problematic, especially since the 1960s motivating nurse scholars to engage with antihumanist and, recently, posthumanist theory. However, even current antihumanist nursing arguments manifest deep embeddedness in humanistic methodologies. I show both the problematic underside of humanism and critical posthumanism's usefulness as a tool to fight injustice and examine the materiality of nursing practice. In doing so, I hope to persuade readers not to be afraid of understanding and employing this critical tool in nursing research and scholarship.

Compassionate nursing care and the use of digital health technologies: A scoping review.

BACKGROUND: Compassion is an essential component of quality patient-centered care and a core value in nursing practice. Although much work has been done to enhance nurses' informatics competency, there is limited understanding of how nurses can use, express, and preserve compassion when they use digital health technologies in the provision of patient care. PURPOSE: This study aimed to explore the nursing literature on how nurses provide compassionate care when they use digital health technologies. A secondary aim was to identify best practices that could be used to guide nursing education and practice toward enhancing compassionate care in digital environment. METHOD: A scoping review was conducted to address the following research question: What is known about compassionate care in relation to the use of digital health technologies within the nursing literature? A comprehensive search strategy was applied to CINAHL Plus with full text, Ovid Medline, Ovid HealthStar, Embase, APAPsychINFO, Scopus, and ProQuest Dissertations and Theses. In addition, a search of selected organizational websites and a hand search of reference lists of included studies were conducted. The eligibility of articles was determined by two reviewers independently. Descriptive and content analyses were applied. Findings were presented narratively and in a tabular format. RESULTS: Twenty-eight articles were included in this review. Most of this research was published between 2004 and 2020, using mostly qualitative methods. Narrative results were organized into three themes: 1) evolving understanding of compassionate nursing care in relation to use of digital health technology, 2) compassionate nursing care in relation to the type of digital health technology, and 3) strategies and interventions to improve education and competence relevant to digital health and compassionate nursing care. CONCLUSION: The use of technology influences how nurses do their work and interact with patients. As advances in digital health continue to evolve, future research should aim to expand understanding of compassion relevant to digital health by articulating its characteristics and associated competencies for nurses to further enhance their ability to provide compassionate care when digital health technologies and services are used to support care delivery. TWEETABLE ABSTRACT: A scoping review that identified how nurses can provide compassionate nursing care in technologically rich practice environments.

Oncology Patients' Experiences With Novel Electronic Patient Portals to Support Care and Treatment: Qualitative Study With Early Users and Nonusers of Portals in Alberta, Canada.

BACKGROUND: With the current proliferation of clinical information technologies internationally, patient portals are increasingly being adopted in health care. Research, conducted mostly in the United States, shows that oncology patients have a keen interest in portals to gain access to and track comprehensive personal health information. In Canada, patient portals are relatively new and research into their use and effects is currently emerging. There is a need to understand oncology patients' experiences of using eHealth tools and to ground these experiences in local sociopolitical contexts of technology implementation, while seeking to devise strategies to enhance portal benefits. OBJECTIVE: The purpose of this study was to explore the experiences of oncology patients and their family caregivers when using electronic patient portals to support their health care needs. We focused on how Alberta's unique, 2-portal context shapes experiences of early portal adopters and nonadopters, in anticipation of a province-wide rollout of a clinical information system in oncology facilities. METHODS: This qualitative descriptive study employed individual semistructured interviews and demographic surveys with 11 participants. Interviews were audio-recorded and transcribed verbatim. Data were analyzed thematically. The study was approved by the University of Alberta Human Research Ethics Board. RESULTS: Participants currently living with nonactive cancer discussed an online patient portal as one among many tools (including the internet, phone, videoconferencing, print-out reports) available to make sense of their diagnosis and treatment, maintain connections with health care providers, and engage with information. In the Fall of 2020, most participants had access to 1 of 2 of Alberta's patient portals and identified ways in which this portal was supportive (or not) of their ongoing health care needs. Four major themes, reflecting the participants' broader concerns within which the portal use was occurring, were generated from the data: (1) experiencing doubt and the desire for transparency; (2) seeking to become an informed and active member of the health care team; (3) encountering complexity; and (4) emphasizing the importance of the patient-provider relationship. CONCLUSIONS: Although people diagnosed with cancer and their family caregivers considered an online patient portal as beneficial, they identified several areas that limit how portals support their oncology care. Providers of health care portals are invited to recognize these limitations and work toward addressing them.

Correction: The State of Evidence in Patient Portals: Umbrella Review.

[This corrects the article DOI: 10.2196/23851.].

The role of philosophy in the development and practice of nursing: Past, present and future.

This article summarizes a virtual live-streamed panel event that occurred in August 2020 and was cosponsored by the International Philosophy of Nursing Society (IPONS) and the University of California, Irvine's Center for Nursing Philosophy. The event consisted of a series of three self-contained panel discussions focusing on the past, present and future of IPONS and was moderated by the current Chair of IPONS, Catherine Green. The first panel discussion explored the history of IPONS and the journal Nursing Philosophy. The second panel involved a reflection on the challenges of doing nursing philosophy in a research-intensive context of a Canadian university and the history and current movements in nursing philosophy in the Nordic countries. The final panel involved presentations on the future potential for philosophy in/and for nursing, the critical connections between nursing philosophy and nursing theory, dismantling racism in nursing and the potential for process philosophy to help explore nursing's unique efficacy in creating possibilities for health. The panels were followed by a lively Q&A session with participants, of which there were 252 registrants from across the globe. The event underscored the wide and diverse interests of nurses in philosophical discussion and the need for more virtual events and other connective modalities bringing nurses together to discuss and analyze the value and potential of philosophy to better understand and advance nursing theory and practice.

Effectiveness of cognitive interventions on cognitive outcomes of adult intensive care unit survivors: A scoping review.

BACKGROUND: Cognitive impairments have been identified as significant under-recognised negative sequelae of postintensive care syndrome. No treatment guidelines exist for cognitive interventions addressing the devastating consequences of impairments and their potential impact on outcomes of intensive care unit (ICU) survivors. AIM: The aim of the study was to identify all available cognitive interventions and measurable outcomes for the cognitive rehabilitation of adult ICU survivors, as reported in published articles. Secondary aims included to critically synthesise existing evidence in improving adult ICU survivors' cognitive outcomes after ICU discharge and to extract implications for future research. METHODS: A scoping review was conducted based on a rigorous literature search (CINAHL, Embase, MEDLINE, PubMed, SCOPUS, Cochrane Library, and Google Scholar) using predefined keywords. The protocol was based on current guidelines. Eligibility criteria included published (i) experimental and quasi-experimental studies reporting the effects of cognitive interventions on cognitive outcomes of adult critical illness survivors after hospital discharge and (ii) protocols identifying cognitive interventions with predefined cognitive outcome measures. RESULTS: Seven studies were included: three experimental studies, two quasi-experimental studies, and two published protocols. Significant heterogeneity in the type of interventions, outcome measures, and assessment tools was noted. Interventions included variations of goal management training and an integrated multidisciplinary model. The setting, delivery, and duration of interventions varied. Cognitive outcomes included variations of global cognitive function and executive function. Overall, the evidence on the effects of cognitive interventions, as compared with routine care, in improving global cognitive function is inconclusive. More evidence support exists with respect to improving executive function. CONCLUSION: Although various cognitive intervention approaches have shown some positive effects on outcomes of ICU survivors after hospital discharge, the high risk of bias and high heterogeneity across studies preclude conclusions about the most appropriate post-ICU care to rehabilitate cognitive deficits in critical care survivors. This review highlighted a number of methodological limitations that require further investigation.

Efficacy of embedded metribuzin and tribenuron-methyl herbicides in field-grown vegetable crops infested by weeds.

The purpose of the present study was to investigate the efficacy of the experimental formulations of the metribuzin (MET) and tribenuron-methyl (TBM) herbicides embedded in the matrix of degradable poly-3-hydroxybutyrate blended with wood flour in field-grown tomato and beet crops infested by weeds. There is a necessity to develop environmentally friendly and effective means to protect plants because of the shortcomings of the free herbicide forms such as the environmentally unsafe spray application of solutions and suspensions of the widespread metribuzin and tribenuron-methyl herbicides, removal from soil during watering events and rains, and transport to natural aquatic environments, where the herbicides accumulate in the trophic chains of biota. Free TBM is also rapidly inactivated in soil and metabolized to nontoxic products in plants. The efficacy of experimental formulations of metribuzin and tribenuron-methyl embedded in the matrix of degradable poly-3-hydroxybutyrate blended with wood flour was tested in field-grown tomato and beet crops infested with weeds. Application of metribuzin resulted in the highest productivity of tomatoes (2.3 kg/m2) and table beet (3.4 kg/m2), improved biometric parameters of tomato fruits and beet roots, and caused reduction in nitrate nitrogen concentrations in them. The mode of herbicide delivery did not affect sugar contents, but application of both metribuzin and tribenuron-methyl induced a 1.7-fold and 1.4-fold, respectively, increase in vitamin C concentrations in tomato fruits and beet roots relative to the vegetables grown on the subplots treated with free herbicides and the intact plants. Embedded herbicides can be used as preemergence herbicides in the field. Fig. a Graphical abstract.

The State of Evidence in Patient Portals: Umbrella Review.

BACKGROUND: Patient portals have emerged as a recognized digital health strategy. To date, research on patient portals has grown rapidly. However, there has been limited evaluation of the growing body of evidence on portal availability, use, clinical or health behavior and outcomes, and portal adoption over time. OBJECTIVE: This paper aims to comprehensively consolidate the current state of evidence on patient portals using the umbrella review methodology, introduce our approach for evaluating evidence for quantitative and qualitative findings presented in included systematic reviews, and present a knowledge translation tool that can be used to inform all stages of patient portal adoption. METHODS: For this study, a modified version of the Joanna Briggs Institute umbrella review method was used. Multiple databases were searched for systematic reviews focused on patient portals, and the final sample included 14 reviews. We conducted a meta-level synthesis of findings from quantitative, qualitative, and mixed methods primary studies reported in systematic reviews. We organized the umbrella review findings according to the Clinical Adoption Meta-Model (CAMM). Vote-counting, GRADE (Grading of Recommendations, Assessment, Development, and Evaluations), and CERQual (Confidence in the Evidence from Review of Qualitative Research) were used to assess the umbrella review evidence. RESULTS: Our knowledge translation tool summarizes the findings in the form of an evidence map. Organized by the CAMM categories, the map describes the following factors that influence portal adoption and effects over time: patient contexts, patient's interest and satisfaction, portal design, facilitators and barriers, providers' attitudes, service utilization, behavioral effects, clinical outcomes, and patient-reported outcomes. The map lists the theories and mechanisms recognized in the included portal research while identifying the need for business models and organizational theories that can inform all stages of portal adoption. Our GRADE and CERQual umbrella review evaluation resulted in the majority of evidence being rated as moderate to low, which reflects methodological issues in portal research, insufficient number of studies, or mixed results in specific focus areas. The 2 findings with a high rating of evidence were patients' interest in using portals for communication and the importance of a simple display of information in the portals. Over 40 portal features were identified in the umbrella review, with communication through secure messaging and appointment booking mentioned in all systematic reviews. CONCLUSIONS: Our umbrella review provides a meta-level synthesis to make sense of the evidence on patient portals from published systematic reviews. Unsystematic and variable reporting of portal features undermines the ability to evaluate and compare portal effects and overlooks the specific context of portal use. Research designs sensitive to the social, organizational, policy, and temporal dimensions are needed to better understand the underlying mechanisms and context that leverage the identified factors to improve portal use and effects.

Biological effects of the free and embedded metribuzin and tribenuron-methyl herbicides on various cultivated weed species.

The present study addresses the herbicidal activity and biological effects of the metribuzin (MET) and tribenuron-methyl (TBM) herbicides used to control various weed species (Amaranthus retroflexus, Sinapis arvensis, and Leucanthemum maximum). The effects of the free herbicides and the herbicides embedded in granules of degradable polymer poly-3-hydroxybutyrate [P(3HB)] blended with birch wood flour were compared. Metribuzin, regardless of the form, caused 100% mortality of the three weeds by day 21. The herbicidal activity of tribenuron-methyl was lower than that of metribuzin, but the embedded TBM was superior to the free herbicide in the length and strength of its action on the weeds. Both metribuzin forms dramatically decreased the main parameters of fluorescence: maximum quantum yield of photosystem-II [Y(II)max], maximum quantum yield of non-photochemical quenching [Y(NPQ)max], and maximum rate of non-cyclic electron transport [ETRmax] and concentrations of chlorophyll a and b. The effect of the embedded TBM on the photosynthetic activity of the weeds was lower in the first two weeks of the growth of herbicide-treated plants but lasted longer than the effect of the free TBM and increased over time. Embedding of metribuzin in the matrix of degradable blend did not decrease its herbicidal activity.

Is research on patient portals attuned to health equity? A scoping review.

OBJECTIVE: Our scoping review examined how research on patient portals addresses health equity. Questions guiding our review were: 1) What health equity concepts are addressed in patient portal research-both explicitly and implicitly? 2) What are the gaps? 3) Is the potential for ehealth-related health inequities explicitly acknowledged in studies on patient portals? 4) What novel approaches and interventions to reduce health inequities are tested in patient portal research? MATERIALS AND METHODS: We searched 4 databases. Search terms included "patient portal" in combination with a comprehensive list of health equity terms relevant in ehealth context. Authors independently reviewed the papers during initial screening and full-text review. We applied the eHealth Equity Framework to develop search terms and analyze the included studies. RESULTS: Based on eHealth Equity Framework categories, the main findings generated from 65 reviewed papers were governance structures, ehealth policies, and cultural and societal values may further inequities; social position of providers and patients introduces differential preferences in portal use; equitable portal implementation can be supported through diverse user-centered design; and intermediary strategies are typically recommended to encourage portal use across populations. DISCUSSION: The predominant focus on barriers in portal use may be inadvertently placing individual responsibility in addressing these barriers on patients already experiencing the greatest health disparities. This approach may mask the impact of the socio-technical-economic-political context on outcomes for different populations. CONCLUSION: To support equitable health outcomes related to patient portals we need to look beyond intermediary initiatives and develop equitable strategies across policy, practice, research, and implementation.

Synthesising evidence on patient portals: a protocol for an umbrella review.

INTRODUCTION: Over the last two decades, patient portals have emerged as a noticeable eHealth strategy. To date, research on patient portals has been rapidly increasing. Our umbrella review aims to provide a meta-level synthesis to make sense of the evidence on patient portals from published systematic reviews (SRs). METHODS: We will employ a modified version of the Joanna Briggs Institute umbrella review method. The search strategy encompasses multiple databases. The inclusion criterion is specific to SRs focused on patient portal. Patients or public were not involved in this work. ANALYSIS: Two researchers will independently screen titles/abstracts and then full-text articles against the inclusion/exclusion criteria. Methodological quality of included reviews will be assessed and data will be extracted from the final selection of reviews. These reviews will be categorised into quantitative, qualitative and/or mixed-synthesis groups based on information about the design of primary studies provided in the reviews. Correspondingly, we will create quantitative, qualitative and/or mixed-synthesis Excel data-extraction tables. Within each table, data will be extracted with the reference to primary studies as reported in the reviews, and will be synthesised into themes and then a smaller number of findings/outcomes. Modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Confidence in the Evidence from Reviews of Qualitative research (CERQual) tools will be applied to assess the strength of evidence at the level of each finding/outcome. The output of our umbrella review will consist of summary of findings tables and evidence profile tables. A narrative meta-level synthesis will be provided. We will use the clinical adoption meta-model as an organising framework. ETHICS AND DISSEMINATION: As an outcome of this review, we will create a guidance and roadmap to be used in a future Delphi study to gather feedback from Canadian eHealth stakeholders. We will also present at conferences and publish the final report. The umbrella review does not require ethical approval. PROSPERO REGISTRATION NUMBER: CRD42018096657.

Towards Developing an eHealth Equity Conceptual Framework.

Early implementation of electronic health records and patient portals had great promise of addressing the widening disparities in health. However, recent research has found that not only are these disparities persisting, but the differences in health outcomes between populations are increasing. Addressing this gap specific to ehealth calls for attention to health equity. Health equity approaches reveal the systematic and societal structures that contribute to preventable and unjust outcomes for different populations. To conceptualize and apply a health equity approach within ehealth, we propose the eHealth Equity Framework (eHEF). Derived from the World Health Organization's conceptual framework for actions on the social determinants of health, eHEF can be useful for public health practitioners, researchers, policymakers and information technology designers to keep health equity agenda at the forefront of all stages of health information technology lifecycle.

Bearing witness in nursing practice: More than a moral obligation?

In this paper, we explore the concept of bearing witness in nursing practice. We examine the description of bearing witness in the nursing literature, particularly that offered by William Cody who suggests that bearing witness results in the limited moral obligation of "true presence." We then turn to Lorraine Code's work on testimony, drawing parallels between the concepts of testimony and bearing witness. Code suggests that receiving testimony results in a responsibility to respond, and that this is an ethico-political obligation. We discuss these ideas in relation to a Canadian exemplar of witnessing the Truth and Reconciliation Commission of Canada's work to understand and address the historical injustices done to Indigenous peoples in Canada. Here, we focus on the Commission's definition of witnessing and highlight the experience of Shelagh Rogers who served as an honorary witness. As an outcome of our analysis, we suggest that bearing witness in nursing practice is most usefully conceptualized as both a moral and a political obligation. Implications for nursing practice are suggested, including first, the need to critically examine our own understandings of power and privilege in order to authentically bear witness and avoid being complicit in injustice, and second, the concomitant responsibility to take action to challenge injustice once we have borne witness to it.

A study of structural properties of gene network graphs for mathematical modeling of integrated mosaic gene networks.

Gene network modeling is one of the widely used approaches in systems biology. It allows for the study of complex genetic systems function, including so-called mosaic gene networks, which consist of functionally interacting subnetworks. We conducted a study of a mosaic gene networks modeling method based on integration of models of gene subnetworks by linear control functionals. An automatic modeling of 10,000 synthetic mosaic gene regulatory networks was carried out using computer experiments on gene knockdowns/knockouts. Structural analysis of graphs of generated mosaic gene regulatory networks has revealed that the most important factor for building accurate integrated mathematical models, among those analyzed in the study, is data on expression of genes corresponding to the vertices with high properties of centrality.

Is there nursing phenomenology after Paley? Essay on rigorous reading.

At the bedside, nurses are expected to be precise when they read indications on screens and on the bodies of patients and decide on the meaning of words framed by the context of acute care. In academia, although there is no incident report to fill when we misread or misrepresent complex philosophical ideas, the consequences of inaccurate reading include misplaced epistemological claims and poor scholarship. A long and broad convention of nursing phenomenological research, in its various forms, claims a philosophical grounding in the ideas of Husserl, Heidegger, and other thinkers. But for nearly two decades, nurse phenomenologists' knowledge claims have been challenged by well-informed criticisms, most notably by John Paley. At the heart of criticism lies an observation that Continental phenomenological thought is misrepresented in many nursing sources and that nursing phenomenology, both descriptive and interpretive, cannot appeal to the authority of either Husserl or Heidegger. Taking these criticisms seriously, I am asking, Is phenomenology after Paley possible? If misreading seems to be an issue, how can - or should - we read rigorously? My thinking through these questions is influenced by the ideas of Jacques Derrida. Under a condition of a play of language, of Derridian différance, when meaning is never self-identical and never fully arrives, I suggest that one has to negotiate meanings through reading for differences. I develop this idea in relation to the methodological conventions of phenomenological nursing research and argue for a careful rereading of the whole field of phenomenological nursing research. Such rereading presupposes and necessitates interdisciplinary engagement between nursing and the humanities and interpretive social sciences. Greater familiarity with research practices of those disciplines that stress theoretical and writing rigour might make visible the limits of nursing research approaches and their quality criteria. An understanding of philosophical and theoretical works - a condition of quality scholarship - depends on our reading of both originary texts and contemporary literature from the humanities and the social sciences. This understanding, far from obliging researchers to always trace (often erroneously) their work to its philosophical roots, opens other, often more sound, methodological possibilities.