Computers, Informatics, Nursing

Structure and Characteristics of Diabetes Self-management Applications: A Systematic Review of the Literature Diabetes is one of the most common chronic conditions, and a good self-management regimen is needed in order to control the disease and prevent complications. In the last few years, the number of health information technologies has increased, and while there are many smartphone applications for diabetic patients, their effectiveness is still unclear. This systematic review aims to outline structure and characteristics that can make an application for diabetes management effective and safe and improve usability and the chances of success for a mobile health service. Applications found in the literature have been analyzed to evaluate the different features. Findings of the review suggest that patients seem to be more attracted by tools that are helpful in everyday management of diabetes, and that allow them to save time and increase safety. The personalization of the application is essential to obtain success in promoting use, and applications should be based upon patients' predisposition to use technological tools that will ensure better outcomes. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding authors: Sara Angelini, MSN, RN, Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy (sarangelini.s@icloud.com); Marco Di Muzio, PhD, RN, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Italy (marco.dimuzio.uniroma1.it). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Evaluation of Nursing Practice in Patients With HIV/AIDS With the Omaha System Electronic-Based Information Program: A Retrospective Study The Omaha System is a standardized health care terminology that has been used in many different settings for nursing care worldwide for more than 20 years. In Turkey, it has been used mainly in nursing education and research. In this context, the purpose of this study was to examine paper-based nursing care plans of inpatients with HIV/AIDS according to the Omaha System and to assess the clinical suitability of the Omaha System. The study has a descriptive-retrospective design and was carried out at the Department of Infectious Diseases and Clinical Microbiology in a hospital. The sample consisted of 30 patients with HIV/AIDS who were chosen randomly from patients hospitalized between January 2007 and April 2017. Nursing care plans were reevaluated and encoded according to the Omaha System. The five most frequently diagnosed problems were oral health (27.2%), neuromusculoskeletal function (20.2%), communicable/infectious condition (19.4%), skin condition (13.2%), and circulation (5.7%). A total of 4409 nursing interventions were applied to solve the problems, and almost 74% of the interventions were categorized in the surveillance. Among the targets, physical signs/symptoms were indicated for more than 68% (3.026). The results confirmed the clinical suitability of the Omaha System. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Ozlem Koseoglu Ornek, PhD, RN, Department of Nursing, Faculty of Health Sciences, Istanbul Bilgi University, Dolapdere Kampus, Haciahmet Mahallesi, Pir Hüsamettin Sokak, No. 20, 34440 Beyoğlu, Istanbul, Turkey (ozlem.koseoglu@bilgi.edu.tr; ozlem.koseoglu62@gmail.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

eHealth Services in the Near and Distant Future in Swedish Home Care Nursing Sweden and other developed countries are putting deliberate efforts into eHealth and digitalization of home care nursing. eHealth services have big potential in this area because they can provide mobile access to healthcare information. This study explores the eHealth services that home care nursing providers in Sweden currently use, plan to use, and have discarded. It also investigates their eHealth visions for the future. We sent a survey to the 264 Swedish municipalities responsible for home care nursing and received 144 responses (55%). The results show a large diversity of eHealth services in use. A few can be considered core services since they are broadly implemented or will be in the near future. Trials are also being carried out with more specialized services. The respondents envision more automation and remote monitoring services, while technical and usability issues are the main obstacles to implementation today. Much knowledge can be gained from proper evaluation of the ongoing work. More research is needed regarding (1) what eHealth can offer home care nursing, (2) the effects of using eHealth in home care nursing, and (3) if and how home care nursing organizations need to adapt to best make use of eHealth. The work presented in this study was funded by AFA Insurance. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Christofer Rydenfält, PhD, Department of Design Sciences, Faculty of Engineering, Lund University, PO Box 118, SE-221 00 Lund, Sweden. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Evaluating the Development Processes of Consumer mHealth Interventions for Chronic Condition Self-management: A Scoping Review Innovative, patient-centered mHealth interventions have the potential to help with the burden of chronic conditions. This review aims to describe the development of consumer mHealth interventions for chronic condition self-management. A scoping review methodology was used to search medical databases for eligible reports, published between January 1, 2010, and December 31, 2017, that provided information on consumer mHealth interventions for respiratory disease, cancer, diabetes, and cardiovascular disease. Twenty-one reports were included, representing the development of 14 mHealth interventions. Most were developed collaboratively, using user-centered and participatory design processes. Predesign work involved a thorough needs assessment, and redesign processes were described as iterative, engaging with usability testing and design improvements. Tensions from competing priorities between patients and healthcare professionals were uncovered, with the intention to develop a useful product for the patient while ensuring clinical relevance. This review provides clear evidence that consumer mHealth interventions are developed inconsistently even when engaging with participatory or user-centered design principles, sometimes without direct involvement of patients themselves. Further, the incomplete description of the development processes presents challenges to furthering the knowledge base as healthcare professionals need timely access to quality information on mHealth products in order to recommend safe, effective consumer mHealth interventions. Corresponding author: Leanna Woods, BN (Hons), Patient Care Level 6, St Vincent's Private Hospital Sydney, 406 Victoria St, Darlinghurst, New South Wales, Australia 2010 (Leanna.Woods@svha.org.au). L.W. is supported by a St Vincent's Clinic Foundation Grant and the University of Tasmania's Elite Research Scholarship funded by The District Nurses. The remaining authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Bedside Usability Surveys: Adding Authentic User Detail to the Assessment Errors in healthcare are a leading cause of death in the United States. Equipment usability and user interfaces remain an area not fully elucidated. Infusion pumps play a vital role in care delivery, often essential for critical therapies. While pump function is comparatively simple, their programming, configuration, and form provide opportunity for error. Our purpose was to assess qualities nurses identified as important to pump operation by electronic survey. A self-developed usability survey was distributed to a random sample of 500 nurses, stratified by unit type and employed at the large academic quaternary care hospital. The overall response rate was 48% (n = 240). Descriptive and inferential statistics describe the responses and represent more than 5500 weekly infusions. Nurses described confident use of the system with some differences by unit type. Ninety percent of respondents indicated they have omitted use of the dose error reduction system, which should raise safety concerns. Users reported issues with the user interface and error prevention systems. Qualitative items elicited suggestions for improving aspects of the pump. Employing a usability survey in a clinical area proved to be a simple, inexpensive way to gather more information on the use and potential improvements of infusion pumps. Corresponding author: Krisanne Graves, PhD, RN, CPHQ, Texas Children's Hospital, 6621 Fannin St, Suite A270, Houston TX 77030 (kxgraves@texaschildrens.org). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.cinjournal.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Current Trends in Robotics in Nursing Patents—A Glimpse Into Emerging Innovations The purpose of this study was to describe the current evidence found through a patent search about robotics used to assist nurses in providing care. The authors used a modified seven-step strategy of searching patents according to the US Patent and Trademark Office guidelines. The nursing robotic search was performed in four databases including the US Patent and Trademark Office issued patent database, the US Patent and Trademark Office published patent application database, the European Patent Office database, and Relecura. Keywords reflecting the scope of the term "robot" were defined for the purposes of this specific search. This broad search yielded large numbers of patents germane to nursing care. These results were narrowed using keywords and the Cooperative Patent Classification schemes to determine relevance, ensure rigor, and capture the most relevant results. This review of patents suggests robots for nursing care are proliferating. The opportunity for robotics in nursing is emerging in industry. Although nursing will likely benefit from robotics, we must determine the appropriate place to include robots in nursing care delivery. Partial support of the project was provided by The University of Alabama's Office for Research and Economic Development through NSF (IIP-1450293). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Rachel M. Frazier, PhD, Graphenics, LLC, Williamsburg, VA (rachel@graphenics.net). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Usability of a Disease Management Mobile Application as Perceived by Patients With Diabetes The use of mobile applications in chronic disease management has grown significantly over the past decade. When properly designed, these apps provide a convenient, safe, high-quality service to patients. In this study, a health management app was developed, and its usability among patients with diabetes mellitus was examined. A convenience sample of 136 patients, referred to two academic centers from December 2016 to July 2017, was enrolled. Upon completion of informed consent, the participants were asked to install the app on their smartphone. Two weeks later, they were required to complete a postapplication usability questionnaire, comprising 21 questions classified into six domains. The response rate was 89%. The highest scores were given for "ease of use and learnability"; the lowest-scored domains were "interaction quality" and "reliability." Urban residents, participants with lower educational qualifications, and retirees were significantly more satisfied with the app. Overall, patients with diabetes mellitus perceived the app as useful for disease management. However, the overall usability of health apps is expected to improve when a multidisciplinary team (health professionals, computer engineers, art designers) is involved in the development process. This work was a master's degree project approved at and founded by Guilan University of Medical Sciences, Iran (registration no. 951010). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Rasoul Tabari-Khomeiran, PhD, RN, Social Determinants of Health Research Center, Guilan University of Medical Sciences, Nursing & Midwifery Faculty, Danshjoo Rd, Rasht, Postal 41469-39841, Iran (rtabari@gums.ac.ir; rasooltabari@gmail.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Sequential Two-Stage Network and Thematic Analysis for Exploring an Interdisciplinary Care Approach in Nursing Homes Since various groups of older adults with different conditions and levels of function coexist in nursing homes, it is necessary to develop integrated care strategies through collaboration among experts across related fields. The purposes of this study are to identify the regularity of information sharing in managing daily function for older adults, with a special focus on interdisciplinary cooperation, and to explore a practical care strategy for nursing home residents. The collaborative methods of network and thematic analysis were done by conducting in-depth interviews with 33 interdisciplinary experts working at seven nursing homes. This study proposed three relationships and three themes as interrelated key factors for providing interdisciplinary care to the elderly at various levels of function based on the experiences accumulated by the practitioners. First, independent sharing is required to make professional judgments about how daily function in older adults changes from reported baselines. Second, practitioners accurately judge clinical situations and supplement experts' judgments through partial sharing. Finally, all interdisciplinary consensus through complete sharing achieves the ultimate goal of maintaining remaining function in older adults. These findings can be the first step in developing practical care guidelines for interdisciplinary use, and the results can be used to develop integrated assessment and intervention strategies. Corresponding author: Sung Ok Chang, PhD, RN, College of Nursing, Korea University, 145 Anam-ro, Seongbuk-Gu, Seoul, Republic of Korea 02841 (sungok@korea.ac.kr). This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2015R1D1A1A01057258). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Quality Improvement in Online Course Development: Igniting the Online Teaching Team Online courses and programs in higher education, including nursing education, continue to multiply exponentially in the United States. In order to meet accreditation standards and build internal standards of quality in online course delivery, nursing administrators and faculty must keep abreast of evidence and best practice in online course design. Awareness and adoption of online standards of excellence may be a departure from standard operating procedure with faculty adept at creating face-to-face courses and mavericks self-taught in online course development. The Plan-Do-Study-Act process for improvement is a viable and scalable method to achieve national certification of online course quality, improving ability to compete in a dynamic online education environment. Considerations of infrastructure and multiple stakeholder groups are critical to successful implementation. The case of one nursing program that used faculty development, team building, and continuous quality improvement to successfully reach national online quality benchmarks is presented. The authors are certified as peer reviewers for Quality Matters, a scholarly activity for which they have received no personal remuneration. They have both presented at Quality Matters conferences. They have received no funding for this work. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Tara Spalla King, PhD, The Ohio State University College of Nursing, 1585 Neil Ave, Columbus, OH 43210 (king.2541@osu.edu). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Do Brief Educational Sessions Increase Electronic Health Literacy of Low-Income Persons Living With HIV/AIDS? This research explored whether participating in a brief educational intervention using the National Library of Medicine video, Evaluating Health Information: A Tutorial From the National Library of Medicine, would increase electronic health literacy. A quasi-experimental longitudinal design was used in two randomly selected settings of a treatment program for low-income persons living with HIV/acquired immune deficiency syndrome (N = 100). Individuals in both intervention groups watched the video and completed an at-home assignment brought to the second session 1 week later; one group received an additional 15 minutes with an HIV nurse clinician who reinforced video content. Generalized linear models were used in order to account for the longitudinal nature of the data; a full model was fitted first that included age, gender, race, ethnicity, education, acquired immune deficiency syndrome diagnosis, time, group, and the interaction of time by intervention group with electronic health literacy as the dependent variable. Group means were not significantly different, and the overall group pattern were the same; the only significant variable was older age, which is consistent with the findings of other literature. Electronic health literacy can be increased by viewing a free video; making this video available in a variety of settings and encouraging clients to use the Internet as a source of health information may improve self-management strategies of persons living with chronic illnesses. Corresponding author: Kathleen M. Nokes, PhD, RN, FAAN, Graduate Center, CUNY, 868 Buck Rd, Stone Ridge, NY 12484 (kathynokes@aol.com). Sources of funding: Jonas Center for Nursing and Veterans Healthcare and Alpha Phi Chapter of Sigma Theta Tau Research grant. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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