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Shelley D, Davis D, Bail K, Heland R, Paterson C. Oncology Nurses' Experiences of Using Health Information Systems in the Delivery of Cancer Care in a Range of Care Settings: A Systematic Integrative Review. Semin Oncol Nurs 2024; 40:151579. [PMID: 38402020 DOI: 10.1016/j.soncn.2023.151579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/19/2023] [Accepted: 12/30/2023] [Indexed: 02/26/2024]
Abstract
OBJECTIVES This systematic review aimed to identify oncology nurses' experiences of using health information systems (HIS) in the delivery of cancer care. DATA SOURCES The electronic databases searched included CINAHL, MEDLINE (EBSCO host), SCOPUS, Web of Science Core Collection, Google Scholar, OVID, and ProQuest Central (using advanced search strategy) and hand searching of reference lists of the included articles and relevant systematic reviews. Studies published in English language were examined. CONCLUSION Twenty-six studies were included. Three themes emerged: (1) the transparency and application of the nursing process within HIS, (2) HIS enhancing and facilitating communication between nurses and patients, and (3) the impact of HIS on the elements of person-centered care. Nurses' experiences with HIS were overall positive. However, digital systems do not fully capture all elements of the nursing processes; this was confirmed in this review, through the nurses' lens. Most studies used HIS for symptom reporting and monitoring within non-inpatient settings and largely biomedical and lack insight into the person-centeredness and overall holistic care. IMPLICATIONS FOR NURSING PRACTICE There are evidently varied views of HIS adoption across the globe. HIS can improve health-related quality of life and symptom burden, including self-reporting of symptoms among patients. However, there is a need for ongoing high-quality research, and clearer reporting than is evident in the current 26 studies, to fully understand the impact of HIS within the nursing processes and patient outcomes across all specialty cancer fields.
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Affiliation(s)
- Delilah Shelley
- PhD Candidate-Nursing, Faculty of Health, University of Canberra, Canberra, Australia.
| | - Deborah Davis
- Professor of Midwifery, Faculty of Health, University of Canberra, Canberra, Australia
| | - Kasia Bail
- Associate Professor of Nursing and Midwifery, Faculty of Health, University of Canberra, Canberra, Australia
| | - Rebecca Heland
- Chief Nursing & Midwifery Information Officer, ACT Health Directorate, ACT Health, Canberra, Australia
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Ekstedt M, Nordheim ES, Hellström A, Strandberg S, Hagerman H. Patient safety and sense of security when telemonitoring chronic conditions at home: the views of patients and healthcare professionals - a qualitative study. BMC Health Serv Res 2023; 23:581. [PMID: 37340472 DOI: 10.1186/s12913-023-09428-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/20/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Chronic diseases are increasing worldwide, and the complexity of disease management is putting new demands on safe healthcare. Telemonitoring technology has the potential to improve self-care management with the support of healthcare professionals for people with chronic diseases living at home. Patient safety threats related to telemonitoring and how they may affect patients' and healthcare professionals' sense of security need attention. This study aimed to explore patients' and healthcare professionals' experiences of safety and sense of security when using telemonitoring of chronic conditions at home. METHODS Semi-structured interviews were conducted with twenty patients and nine healthcare professionals (nurses and physicians), recruited from four primary healthcare centers and one medical department in a region in southern Sweden using telemonitoring service for chronic conditions in home healthcare. RESULTS The main theme was that experiences of safety and a sense of security were intertwined and relied on patients´ and healthcare professionals´ mutual engagement in telemonitoring and managing symptoms together. Telemonitoring was perceived to increase symptom awareness and promote early detection of deterioration promoting patient safety. A sense of security emerged through having someone keeping track of symptoms and comprised aspects of availability, shared responsibility, technical confidence, and empowering patients in self-management. The meeting with technology changed healthcare professionals' work processes, and patients' daily routines, creating patient safety risks if combined with low health- and digital literacy and a naïve reliance on technology. Empowering patients' self-management ability and improving shared understanding of the patient's health status and symptom management were prerequisites for safe care and the patient´s sense of security. CONCLUSIONS Telemonitoring chronic conditions in the homecare context can promote a sense of security when care is co-created in a mutual understanding and responsibility. Attentiveness to the patient's health literacy, symptom management, and health-related safety behavior when using eHealth technology may enlighten and mitigate latent patient safety risks. A systems approach indicates that patient safety risks related to telemonitoring are not only associated with the patient's and healthcare professionals functioning and behavior or the human-technology interaction. Mitigating patient safety risks are likely also dependent on the complex management of home health and social care service.
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Affiliation(s)
- Mirjam Ekstedt
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1, Kalmar/Växjö, 392 31, Sweden.
- Department of Learning Informatics Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
| | - Espen S Nordheim
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1, Kalmar/Växjö, 392 31, Sweden
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Amanda Hellström
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1, Kalmar/Växjö, 392 31, Sweden
| | - Susanna Strandberg
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1, Kalmar/Växjö, 392 31, Sweden
| | - Heidi Hagerman
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1, Kalmar/Växjö, 392 31, Sweden
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Tobiano G, Roberts S, Muir R, Jerofke-Owen T, Ting C, Thorning S, Heyland DK, Marshall AP. Patient-mediated interventions in hospital: A systematic review. J Adv Nurs 2023; 79:418-441. [PMID: 36408930 DOI: 10.1111/jan.15500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/13/2022] [Accepted: 11/06/2022] [Indexed: 11/22/2022]
Abstract
AIMS To describe the characteristics of hospital-based, patient-mediated interventions and their impact on patient, clinician and organization outcomes. DESIGN Systematic review. DATA SOURCES Health literature databases (MEDLINE, CINAHL and EMBASE) were searched in August 2021. Backward and forward citation searching was conducted. REVIEW METHODS Studies investigating patient-mediated interventions, targeted at adult hospitalized patients were eligible. Data were extracted related to study and intervention characteristics. Narrative synthesis was used to understand intervention impact on patient, clinician and organization outcomes (as per a framework). Methodological quality was assessed using the Mixed Methods Assessment Tool. RESULTS Thirty-three studies, reporting 18 interventions, were included. Twelve interventions prompted patients to report health information about their own health/needs/concerns and six interventions encouraged patients to provide feedback about clinical practice. Across all interventions, there was evidence that patients used patient-mediated interventions and that they may improve patient communication. Healthcare professional outcomes were mixed for actual/intended use, acceptability and usefulness of interventions; yet there was some evidence of healthcare professional behaviour change. Interventions that encouraged patients to report health information about their own health/needs/concerns appeared more successful than other types of interventions. CONCLUSIONS There is some evidence that hospital-based patient-mediated interventions may influence patient communication and healthcare professional behaviour. Patient-mediated interventions that encourage patients to report patient data before a clinical encounter may be more impactful than interventions that encourage patient feedback during or post-encounter. IMPACT To date, most patient-mediated intervention research has been conducted in primary care settings; we uncovered the types of patient-mediated interventions that have been trialled in hospitals. We found that patient communication and healthcare professional behaviour may be influenced by these patient-mediated interventions. Future researchers could explore the suitability and effectiveness of a wider range of hospital-based patient-mediated interventions. NO PATIENT OR PUBLIC CONTRIBUTION There was no funding to remunerate a patient/member of the public for this review.
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Affiliation(s)
- Georgia Tobiano
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,NHMRC CRE in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Shelley Roberts
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Rachel Muir
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | | | - Christine Ting
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Sarah Thorning
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Daren K Heyland
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.,Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
| | - Andrea P Marshall
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
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McVay MA, Cooper KB, Donahue ML, Carrera Seoane M, Shah NR, Webb F, Perri M, Jake‐Schoffman DE. Engaging primary care patients with existing online tools for weight loss: A pilot trial. Obes Sci Pract 2022; 8:569-584. [PMID: 36238223 PMCID: PMC9535672 DOI: 10.1002/osp4.592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/29/2021] [Accepted: 01/18/2022] [Indexed: 11/11/2022] Open
Abstract
Objective Free online tools show potential for promoting weight loss at a low cost, but there is limited evidence about how to effectively engage patients with them. To address this, a low‐dose, flexible intervention was developed that aims to enhance weight‐related discussions with primary care providers (PCPs) and engage patients with an organic (i.e., not researcher‐created) weight loss‐focused social media community and online self‐monitoring tool. Feasibility and acceptability of the intervention was evaluated in a single‐arm, 12‐week pilot. Methods PCPs were recruited at two clinics, then PCP's patients with upcoming appointments were identified and recruited. Patients received an interactive online kickoff before their scheduled primary care appointment, then 8 follow‐up messages over 12 weeks via email or their electronic health record patient portal. Patients completed assessments at baseline, post‐appointment, and week 12. Primary care providers and patients completed semi‐structured interviews. Results All PCPs approached enrolled (n = 6); patient recruitment was on track to meet the study goal prior to COVID‐19 restrictions, and n = 27 patients enrolled. Patient satisfaction with the pre‐appointment kickoff was high. Twenty‐four patients reported discussing weight‐related topics at their primary care appointment and all were satisfied with the discussion. Twenty‐two patients completed 12‐week assessments. Of these, 15 reported engaging with the self‐monitoring tool and 9 with the social media community. Patient interviews revealed reasons for low social media community engagement, including perceived lack of fit. On average, patients with available data (n = 21) lost 2.4 ± 4.1% of baseline weight, and 28.6% of these patients lost ≥3% of baseline weight. Primary care providers reported high intervention satisfaction. Conclusions The intervention and trial design show potential, although additional strategies are needed to promote tool engagement.
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Affiliation(s)
- Megan A. McVay
- Department of Health Education & Behavior University of Florida Gainesville FL
| | - Kellie B Cooper
- Department of Health Education & Behavior University of Florida Gainesville FL
| | | | | | - Nipa R. Shah
- Department of Community Health and Family Medicine University of Florida College of Medicine Jacksonville FL
| | - Fern Webb
- Department of Surgery University of Florida Jacksonville FL
| | - Michael Perri
- College of Public Health and Health Professions University of Florida Gainesville
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Seljelid B, Varsi C, Solberg Nes L, Øystese KA, Børøsund E. A Digital Patient-Provider Communication Intervention (InvolveMe): Qualitative Study on the Implementation Preparation Based on Identified Facilitators and Barriers. J Med Internet Res 2021; 23:e22399. [PMID: 33830063 PMCID: PMC8294341 DOI: 10.2196/22399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/09/2020] [Accepted: 03/18/2021] [Indexed: 01/15/2023] Open
Abstract
Background Chronic health conditions are affecting an increasing number of individuals, who experience various symptoms that decrease their quality of life. Digital communication interventions that enable patients to report their symptoms have been shown to positively impact chronic disease management by improving access to care, patient-provider communication, clinical outcomes, and health-related quality of life. These interventions have the potential to prepare patients and health care providers (HCPs) before visits and improve patient-provider communication. Despite the recent rapid development and increasing number of digital communication interventions that have shown positive research results, barriers to realizing the benefits offered through these types of interventions still exist. Objective The aim of this study is to prepare for the implementation of a digital patient-provider communication intervention in the daily workflow at 2 outpatient clinics by identifying potential determinants of implementation using the Consolidated Framework for Implementation Research (CFIR) to tailor the use of digital communication intervention to the intended context and identify key aspects for an implementation plan. Methods A combination of focus groups, workshops, and project steering committee meetings was conducted with HCPs (n=14) and patients (n=2) from 2 outpatient clinics at a university hospital. The CFIR was used to guide data collection and analysis. Transcripts, written minutes, and notes were analyzed and coded into 5 CFIR domains using thematic analysis. Results Data were examined and analyzed into 18 CFIR constructs relevant to the study purpose. On the basis of the identified determinants, important intervention tailoring includes adjustments to the digital features and adjustments to fit the clinical workflow and a decision to conduct a future pilot study. Furthermore, it was decided to provide the intervention to patients as early as possible in their disease trajectory, with tailored information about its use. Key aspects for the implementation plan encompassed maintaining the identified engagement and positive attitude, involving key stakeholders in the implementation process, and providing the needed support and training. Conclusions This study offers insight into the involvement of stakeholders in the tailoring and implementation planning of a digital communication intervention in clinical practice. Stakeholder involvement in the identification of implementation facilitators and barriers can contribute to the tailoring of digital communication interventions and how they are used and can also inform systematic and targeted implementation planning.
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Affiliation(s)
- Berit Seljelid
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cooperation, Patient Education and Equivalent Health Services, CEO's Staff, Oslo University Hospital, Oslo, Norway
| | - Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry & Psychology, College of Medicine & Science, Mayo Clinic, Rochester, MN, United States
| | - Kristin Astrid Øystese
- Section of Specialized Endocrinology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Department of Medical Biochemistry, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
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Zhou Y, Li Z, Li Y. Interdisciplinary collaboration between nursing and engineering in health care: A scoping review. Int J Nurs Stud 2021; 117:103900. [PMID: 33677250 DOI: 10.1016/j.ijnurstu.2021.103900] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Due to the rapid advancements in precision medicine and artificial intelligence, interdisciplinary collaborations between nursing and engineering have emerged. Although engineering is vital in solving complex nursing problems and advancing healthcare, the collaboration between the two fields has not been fully elucidated. OBJECTIVES To identify the study areas of interdisciplinary collaboration between nursing and engineering in health care, particularly focusing on the role of nurses in the collaboration. METHODS In this study, a scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews was performed. A comprehensive search for published literature was conducted using the PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Embase, Web of Science, ScienceDirect, Institute of Electrical and Electronics Engineers Digital Library, and Association for Computing Machinery Digital Library from inception to November 22, 2020. Data screening and extraction were performed independently by two reviewers. Any discrepancies in results were resolved through discussions or in consultation with a third reviewer. Data were analyzed by descriptive statistics and content analysis. Results were visualized in an interdisciplinary collaboration model. RESULTS We identified 6,752 studies through the literature search, and 60 studies met the inclusion criteria. The study areas of interdisciplinary collaboration concentrated on patient safety (n = 18), symptom monitoring and health management (n = 18), information system and nursing human resource management (n = 16), health education (n = 5), and nurse-patient communication (n = 3). The roles of nurses in the interdisciplinary collaboration were divided into four themes: requirement analyst (n = 21), designer (n = 22), tester(n = 37) and evaluator (n = 49). Based on these results, an interdisciplinary collaboration model was constructed. CONCLUSIONS Interdisciplinary collaborations between nursing and engineering promote nursing innovation and practice. However, these collaborations are still emerging and in the early stages. In the future, nurses should be more involved in the early stages of solving healthcare problems, particularly in the requirement analysis and designing phases. Furthermore, there is an urgent need to develop interprofessional education, strengthen nursing connections with the healthcare engineering industry, and provide more platforms and resources to bring nursing and engineering disciplines together.
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Affiliation(s)
- Ying Zhou
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, No 33 Ba Da Chu Road, Shijingshan District, Beijing 100144, China.
| | - Zheng Li
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, No 33 Ba Da Chu Road, Shijingshan District, Beijing 100144, China.
| | - Yingxin Li
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, No 236 Bai Di Lu Road, Nankai District, Tianjin 300192, China.
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Mohsen K, Kildea J, Lambert SD, Laizner AM. Exploring Cancer Patients' Perceptions of Accessing and Experience with Using the Educational Material in the Opal Patient Portal. Support Care Cancer 2021; 29:4365-4374. [PMID: 33415366 DOI: 10.1007/s00520-020-05900-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Opal is a new patient-centered mobile application that gives cancer patients access to their real time medical data in conjunction with disease- and treatment-specific patient education material. Few studies have focused on patients' experiences with such mobile applications. This study's objectives were to (1) explore cancer patients' perceptions of accessing the educational materials through Opal and (2) explore their experiences using these educational materials. METHODS A qualitative descriptive design was used. Patients were invited to participate in the study via Opal itself. Semi-structured individual interviews were done in person or over the phone, transcribed verbatim and analyzed using qualitative content analysis. RESULTS Nine women were interviewed. Three themes were identified as participants spoke about their perceptions of and experiences with Opal. First, Opal makes me feel like I have more control, conveying how learning more about their diagnosis and treatments allowed patients to advocate for themselves and plan their care. Second, Opal tends to reassure me, illustrating that having access to information was reassuring. Lastly, Opal is just starting to have information which could help meet my needs, reflecting patients' belief Opal is on the right track but could provide more of their medical record, treating team contact information and education material. CONCLUSION Patients can feel more empowered when using patient-centered mobile applications, and mobile applications have potential for improving collaboration with healthcare professionals and care coordination. Healthcare professionals, including oncologists and nurses, should support patients' use of mobile applications and integrate them in their patient interactions.
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Affiliation(s)
- Katherine Mohsen
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
| | - John Kildea
- Medical Physics Unit - Gerald Bronfman, Department of Oncology, McGill University, Montréal, Québec, Canada
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Sylvie D Lambert
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
- St. Mary's Research Centre, Montréal, Québec, Canada
| | - Andréa M Laizner
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada.
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada.
- Nursing Directorate, McGill University Health Centre, Montréal, Québec, Canada.
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Kristjansdottir OB, Børøsund E, Westeng M, Ruland C, Stenberg U, Zangi HA, Stange K, Mirkovic J. Mobile App to Help People With Chronic Illness Reflect on Their Strengths: Formative Evaluation and Usability Testing. JMIR Form Res 2020; 4:e16831. [PMID: 32130126 PMCID: PMC7081135 DOI: 10.2196/16831] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/13/2020] [Accepted: 01/27/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Supporting patient engagement and empowerment is increasingly seen as essential in providing person-centered health care to people with chronic illness. Mobile apps helping patients reflect on their concerns as preparation for consultations with their health care providers can have beneficial effects on the consultation quality. However, apps focusing on empowerment and personal strengths are still scarce. OBJECTIVE This study aimed to (1) develop a mobile app to support patients with rheumatic diseases in reflecting on their strengths in preparation for consultations with health care providers and (2) explore patients' perceived usability of the app in a nonclinical test setting. METHODS A prototype app was developed based on input from patients and health care providers, as reported in previous studies. The app was designed for use in self-management support settings aiming to promote awareness of strengths and to focus attention on strengths in the patient-health care provider dialogue. The features included in the prototype were as follows: (1) introduction to the topic of strengths, (2) list of examples of strengths to promote reflection and registration of own strengths, (3) summary of registered strengths, (4) value-based goal setting, (5) linking of strengths to goals, (6) summary of all registrations, and (7) options to share summary digitally or as a print version. In this study, the app was refined through a formative evaluation with patients and health care providers recruited from a specialized rheumatology hospital unit. Patients' perceptions of the app's usability were explored in a test setting with self-report measurements and semistructured interviews. The interviews were audiotaped, transcribed, and analyzed with directed content analysis. Data from questionnaires were analyzed with descriptive statistics. RESULTS Developmental and formative evaluation included 18 patients and 7 health care providers. The evaluation resulted in minor adjustments to the prototype but no major changes in features. The usability testing included 12 patients. All participants found the usability acceptable; the median score on the System Usability Scale was 86.3 (range 70-100). All reported that it was meaningful and relevant to use the app. Out of 12 participants, 9 (75%) reported becoming more aware of their own strengths by using the app; 1 (8%) disagreed and 2 (17%) provided a neutral response. The results on the goal-related feature were mixed, with half of the patients finding it useful to link strengths to concrete goals. A statistically significant positive change from pre- to postintervention was identified on measures of self-efficacy and negative emotions. CONCLUSIONS In this formative evaluation of a mobile app to promote patients' reflections on their strengths, patients perceived the app as meaningful and supporting awareness. The results suggest the usefulness of building in functionality to support use of strengths and goal attainment. Further studies on efficacy and usability in a clinical setting, including health care providers, are needed.
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Affiliation(s)
- Olöf Birna Kristjansdottir
- Department for Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | - Elin Børøsund
- Department for Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Marianne Westeng
- Department for Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Cornelia Ruland
- Department for Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Una Stenberg
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | - Heidi A Zangi
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Kurt Stange
- The Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, United States
| | - Jelena Mirkovic
- Department for Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
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10
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Thórarinsdóttir K, Kristjánsson K, Gunnarsdóttir TJ, Björnsdóttir K. Facilitation of a Person-Centered Approach in Health Assessment of patients with chronic pain: An Ethnographic Study. QUALITATIVE HEALTH RESEARCH 2019; 29:471-483. [PMID: 29685099 DOI: 10.1177/1049732318770628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A phenomenologically derived assessment tool, Hermes, was developed in a rehabilitation setting for adopting the central ideals of person-centered care and patient participation into health-assessment practices in nursing. This focused ethnographic study aimed at exploring the feasibility of using Hermes for enabling the application of these ideals into assessment of patients with chronic pain upon admission to a rehabilitation center. Participants were patients with chronic pain, enrolled in rehabilitation, and their nurses. Data were collected by participant observation and interviews, and analyzed by thematic analysis. By the use of Hermes, the impact of illness was explored through supportive connection and dialogue with open, reflective, and interpretative features; understanding of the illness situation was enhanced; and possibilities provided in adjusting to health issues of concern. In sum, Hermes facilitated person-centered participation of patients with chronic pain in their health assessment and made a phenomenological philosophy usable in nursing-assessment practices.
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Not a Straight Line—Patients’ Experiences of Prostate Cancer and Their Journey Through the Healthcare System. Cancer Nurs 2019; 42:E36-E43. [DOI: 10.1097/ncc.0000000000000559] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Lepore M, Scales K, Anderson RA, Porter K, Thach T, McConnell E, Corazzini K. Person-directed care planning in nursing homes: A scoping review. Int J Older People Nurs 2018; 13:e12212. [PMID: 30358099 PMCID: PMC6282715 DOI: 10.1111/opn.12212] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 08/07/2018] [Accepted: 09/21/2018] [Indexed: 11/28/2022]
Abstract
AIM Federal regulations require nursing homes in the United States to support residents in directing their own care rather than having their care plans developed for them without their engagement, but knowledge of person-directed approaches to care planning in nursing homes is limited. The purpose of this study was to advance understanding of person-directed care planning (PDCP). METHODS A multidisciplinary research team conducted a scoping review on individual and family involvement in care planning, including literature from a variety of care contexts. Search results were systematically screened to identify literature that addressed individual or family involvement in care planning as a primary concern, and then analysed using thematic content analysis. RESULTS Several themes were identified, including definitions of the concept of PDCP, essential elements of PDCP, barriers, facilitators and outcomes. The concept of PDCP is informed by multiple disciplines, including humanist philosophy, disability rights and end-of-life care. Essential elements of PDCP include knowing the person, integrating the person's goals in care planning and updating care plans as individuals' needs or preferences change. Limited time for care planning in nursing homes hinders PDCP. Facilitators include regulatory mandates and humanist social trends. Outcomes of PDCP were found to be positive (e.g., increased independence), but were inconsistently assessed across studies. CONCLUSION This study offers pragmatic information that can support PDCP within nursing homes and insights for policy reform that may more effectively support PDCP. IMPLICATIONS FOR PRACTICE These findings can be used to guide implementation of PDCP.
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Affiliation(s)
| | - Kezia Scales
- Duke University School of NursingDurhamNorth Carolina
- Present address:
PHIBronxNew York
| | - Ruth A. Anderson
- The Office of Research Support and Consultation (RSC)University of North Carolina‐Chapel Hill School of NursingChapel HillNorth Carolina
- Present address:
Department of Health Policy and ManagementUniversity of North CarolinaChapel HillNorth Carolina
| | | | - Trini Thach
- RTI InternationalResearch Triangle ParkNorth Carolina
- Present address:
Department of Health Policy and ManagementUniversity of North CarolinaChapel HillNorth Carolina
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Aldekhyyel RN, Melton GB, Lindgren B, Wang Y, Pitt MB. Linking Pediatrics Patients and Nurses With the Pharmacy and Electronic Health Record System Through the Inpatient Television: A Novel Interactive Pain-Management Tool. Hosp Pediatr 2018; 8:588-592. [PMID: 30115680 DOI: 10.1542/hpeds.2018-0096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Implement a novel pain-management interface that is used to bring real-time, patient-reported pain assessments to the inpatient television and evaluate the impact of implementation on the pain-management clinical workflow, patient engagement, and nursing pain reassessments. METHODS We developed a pain-management tool interfacing 4 stand-alone technologies: a television-based, interactive patient care system; electronic health record system; nursing call system; and pharmacy inventory-management system. The workflow is triggered when pain medications are dispensed by sending an automatic pain assessment rating question via the patient's television at a predefined time. To measure the effects of implementation, we calculated patient and/or parent use rates and pain reassessment timely documentation rates. Data were extracted from the electronic health record for a period of 22 months and covered pre- and postimplementation. RESULTS A total of 56 931 patient records were identified during the study period, representing 2447 unique patients. In total, 608 parents and/or patients reported their pain through the tool. Use rates were 6.5% for responding to the pain rating prompt and 13.3% for the follow-up prompt, in which additional nonpharmacologic strategies to eliminate pain were offered. A modest increase was found in the mean timely documentation rates on the basis of nursing documentation standards (26.1% vs 32.8%, a percentage increase of 25.7%; P < .001) along with decreased median time to pain reassessment documentation (29 minutes versus 25 minutes, a percentage decrease of 13.8%; P < .001). CONCLUSIONS With this novel tool, we offer a potentially scalable approach in supporting the pain-management clinical workflow, integration of technologies, and promoting of patient and/or parent engagement in the inpatient setting.
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Affiliation(s)
- Raniah N Aldekhyyel
- Institute for Health Informatics, and.,MIELU, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Bruce Lindgren
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota; and
| | - Yan Wang
- Institute for Health Informatics, and
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Gharaveis A, Kazem-Zadeh M. The Role of Environmental Design in Cancer Prevention, Diagnosis, Treatment, and Survivorship: A Systematic Literature Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2018; 11:18-32. [PMID: 29417852 DOI: 10.1177/1937586717754186] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The purpose of this literature review is to provide a better understanding of the impact that environmental design can have on the process of cancer prevention, diagnosis, treatment, and survivorship. Cancer is considered a chronic disease in the United States, and more than 1.6 million new cases are diagnosed annually. New strategies of cancer care propose patient-centered services to achieve the best outcome, and researchers have found that environmental design can be an important part of improving this care. Searches were conducted in the PubMed and Google Scholar databases as well as in specific healthcare design journals such as Health Environments Research & Design, Environmental Psychology, and Environment and Behavior. The criteria for articles included in the review were (a) English-language articles related to facility design, which addressed (b) the topics of built environment in relation to cancer diagnosis, treatment, and survivorship, and were (c) published in peer-reviewed journals between 2000 and 2017. Finally, 10 articles were selected, and the contents were analyzed. The selected articles demonstrate that environmental design is one of the critical factors for success throughout the whole continuum of cancer care from diagnosis to end-of-treatment. Some of the specific conclusions from the review are that "neighborhood-oriented" design strategies can be beneficial (by providing accessibility to all facilities along the patient's path), that access to nature for patients, staff, and visitors alike is associated with better outcomes, and that provisions for natural lighting and noise reduction are associated with cancer patients' well-being.
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Affiliation(s)
- Arsalan Gharaveis
- 1 College of Health and Human Services, Southeast Missouri State University, One University Plaze, Cape Girardeau, MO, USA
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Coolbrandt A, Steffens E, Wildiers H, Bruyninckx E, Verslype C, Milisen K. Use of a symptom diary during chemotherapy: A mixed-methods evaluation of the patient perspective. Eur J Oncol Nurs 2017; 31:37-45. [DOI: 10.1016/j.ejon.2017.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 09/23/2017] [Accepted: 09/25/2017] [Indexed: 01/17/2023]
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Coolbrandt A, Bruyninckx E, Verslype C, Steffens E, Vanhove E, Wildiers H, Milisen K. Implementation and Use of a Patient Symptom Diary During Chemotherapy: A Mixed-Methods Evaluation of the Nurse Perspective. Oncol Nurs Forum 2017; 44:E213-E222. [PMID: 28820510 DOI: 10.1188/17.onf.e213-e222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To gain a deeper understanding of nurses' experience working with a patient diary for tracking and treating side effects during chemotherapy.
. DESIGN A mixed-methods design was used to learn about oncology nurses' use and perceptions of a symptom diary.
. SETTING Six oncology wards and two outpatient clinics at the University Hospitals Leuven, Belgium.
. SAMPLE 79 nurses completed a survey, and 14 nurses participated in focus group discussions.
. METHODS First, a survey sampled nurses' use and perceptions of the diary. Next, focus group discussions were held with the aim of arriving at a deeper understanding of the survey results.
. MAIN RESEARCH VARIABLES Use and perceptions of a symptom diary.
. FINDINGS Most nurses reported performing diary-related behavior to some extent. The survey and focus groups indicated that many nurses strongly believed in the value of the diary, but some were still hesitant or had concerns about patients' perceptions of the diary. The focus group results showed that nurses' use of the diary in daily practice was influenced by their personal beliefs about the value of the diary, the team's, and those of their patients.
. CONCLUSIONS Although a positive trend was noted, nurses' use of the symptom diary was suboptimal six months after its implementation.
. IMPLICATIONS FOR NURSING This study highlights important issues that need to be addressed to advance the successful implementation of the symptom diary.
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Demiris G, Kneale L. Informatics Systems and Tools to Facilitate Patient-centered Care Coordination. Yearb Med Inform 2017; 10:15-21. [PMID: 26293847 DOI: 10.15265/iy-2015-003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION There is a growing international focus on patient- centered care. A model designed to facilitate this type of care in the primary care setting is the patient-centered medical home. This model of care strives to be patient-focused, comprehensive, team-based, coordinated, accessible, and focused on quality and safety of care. OBJECTIVE The objective of this paper is to identify the current status and future trends of patient-centered care and the role of informatics systems and tools in facilitating this model of care. METHODS In this paper we review recent scientific literature of the past four years to identify trends and state of current evidence when it comes to patient-centered care overall, and more specifically medical homes. RESULTS There are several studies that indicate growth and development in seven informatics areas within patient-centered care, namely clinical decision support, registries, team care, care transitions, personal health records, telehealth, and measurement. In some cases we are still lacking large randomized clinical trials and the evidence base is not always solid, but findings strongly indicate the potential of informatics to support patient-centered care. CONCLUSION Current evidence indicates that advancements have been made in implementing and evaluating patient-centered care models. Technical, legal, and practical challenges still remain. Further examination of the impact of patient-centered informatics tools and systems on clinical outcomes is needed.
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Affiliation(s)
- G Demiris
- George Demiris PhD, FACMI, University of Washington, BNHS Box 357266, Seattle, WA, 98195, USA, Tel: +1 206 221 3866, Fax: +1 206 543 4771, E-mail:
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Development of Hermes, a New Person-Centered Assessment Tool in Nursing Rehabilitation, Through Action Research. ANS Adv Nurs Sci 2017; 40:207-221. [PMID: 27525956 DOI: 10.1097/ans.0000000000000132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In this article, an action-research project has been outlined, aimed at exploring ways for developing an assessment tool, underpinned by phenomenology, which would enhance a person-centered approach to the participation of patients in nursing assessment and care planning in rehabilitation. Participants were nurses in physical rehabilitation and a consultant. Data were collected by interviews and observation of the documentation on the tool. The tool, Hermes, was adopted in practice. Through its use, important person-centered assessment practices were enhanced and several aspects of its phenomenological grounding were supported. Hermes has potential for facilitating the transfusion of phenomenology into nursing practice.
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Martínez-González NA, Tandjung R, Djalali S, Rosemann T. The impact of physician-nurse task shifting in primary care on the course of disease: a systematic review. HUMAN RESOURCES FOR HEALTH 2015; 13:55. [PMID: 26149447 PMCID: PMC4493821 DOI: 10.1186/s12960-015-0049-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/24/2015] [Indexed: 05/23/2023]
Abstract
BACKGROUND Physician-nurse task shifting in primary care appeals greatly to health policymakers. It promises to address workforce shortages and demands of high-quality, affordable care in the healthcare systems of many countries. This systematic review was conducted to assess the evidence about physician-nurse task shifting in primary care in relation to the course of disease and nurses' roles. METHODS We searched MEDLINE, Embase, The Cochrane Library and CINAHL, up to August 2012, and the reference list of included studies and relevant reviews. All searches were updated in February 2014. We selected and critically appraised published randomized controlled trials (RCTs). RESULTS Twelve RCTs comprising 22,617 randomized patients conducted mainly in Europe met the inclusion criteria. Nurse-led care was delivered mainly by nurse practitioners following structured protocols and validated instruments in most studies. Twenty-five unique disease-specific measures of the course of disease were reported in the 12 RCTs. While most (84 %) study estimates showed no significant differences between nurse-led care and physician-led care, nurses achieved better outcomes in the secondary prevention of heart disease and a greater positive effect in managing dyspepsia and at lowering cardiovascular risk in diabetic patients. The studies were generally small, of varying follow-up episodes and were at risk of biases. Descriptive details about roles, qualifications or interventions were also incomplete or not reported. CONCLUSION Trained nurses may have the ability to achieve outcome results that are at least similar to physicians' for managing the course of disease, when following structured protocols and validated instruments. The evidence, however, is limited by a small number of studies reporting a broad range of disease-specific outcomes; low reporting standards of interventions, roles and clinicians' characteristics, skills and qualifications; and the quality of studies. More rigorous studies using validated tools could clarify these findings.
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Affiliation(s)
- Nahara A Martínez-González
- Institute of Primary Care, University of Zurich, University Hospital of Zurich, Pestalozzistrasse 24, CH-8091, Zurich, Switzerland.
| | - Ryan Tandjung
- Institute of Primary Care, University of Zurich, University Hospital of Zurich, Pestalozzistrasse 24, CH-8091, Zurich, Switzerland.
| | - Sima Djalali
- Institute of Primary Care, University of Zurich, University Hospital of Zurich, Pestalozzistrasse 24, CH-8091, Zurich, Switzerland.
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, University Hospital of Zurich, Pestalozzistrasse 24, CH-8091, Zurich, Switzerland.
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Gustafsson E, Litström E, Berterö C, Drott J. Reliability testing of oxaliplatin-associated neurotoxicity questionnaire (OANQ), a pilot study. Support Care Cancer 2015; 24:747-754. [PMID: 26137985 DOI: 10.1007/s00520-015-2838-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/22/2015] [Indexed: 11/30/2022]
Affiliation(s)
- E Gustafsson
- Department of Surgery and Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden
| | - E Litström
- Department of Surgery and Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden
| | - C Berterö
- Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden
| | - J Drott
- Department of Surgery and Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden.
- Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden.
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