Living With Intelligent Sensors: Older Adult and Family Member Perceptions This qualitative study is part of a larger randomized prospective intervention study that examined the clinical and cost effectiveness of using sensor data from an environmentally embedded sensor system for early illness recognition. It explored the perceptions of older adults and family members on the sensor system's usefulness, impact on daily routine, privacy, and sharing of health information. This study was conducted in 13 assisted-living facilities in Missouri, and 55 older adults were interviewed. Data were collected over five points in time with a total of 188 interviews. From these five participant interview iterations, the following themes emerged: (1) understanding and purpose, (2) daily life and benefits, (3) impact on privacy, and (4) sharing of information. Three themes emerged from one round of family interviews: (1) benefits of bed sensors, (2) family involvement/staff interaction, and (3) privacy protection versus sensor benefits. The sensor suite was regarded as helpful in maintaining independence, health, and physical functioning. Responses suggest that the willingness to adopt the sensor suite was motivated by both a decline in functional status and a desire to remain independent. Participants were willing to share their health data with providers and select family members. Recommendations for future practice are provided. This research was made possible through funding from the National Institute of Nursing Research, National Institutes of Health (grant 1R01NR014255), Intelligent Sensor System for Early Illness Alerts in Senior Housing. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Colleen Galambos, PhD, ACSW, LCSW-C, FGSA, Helen Bader School of Social Welfare, Enderis Hall, Room 1157, PO Box 786, Milwaukee, WI 53201 (galamboc@uwm.edu). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Effects of Simulation-Based Advanced Life Support Education for Nursing Students Advanced life support education for nursing students is very important because nurses are first responders in emergency situations. The purpose of this study was to identify the effects of simulation-based advanced life support education on nursing students' knowledge, performance, self-efficacy, and teamwork. A nonequivalent control group posttest-only design was used. Fourth-year nursing students were randomly assigned to either simulation-based Korean Advanced Life Support (n = 30) or lecture-based education (n = 30) groups. Data were analyzed using descriptive statistics and the Mann-Whitney U test. The experimental group showed statistically significant higher scores in knowledge (P < .001), performance (P < .001), and self-efficacy (P = .049) when compared with the control group. However, there was no significant difference in teamwork scores between the two groups (P = .529). The 4.5-hour simulation-based Korean Advanced Life Support education was more effective than the 4.5-hour lecture-based education for nursing students in terms of knowledge, performance, and self-efficacy. Nurse educators should adopt simulation-based advanced life support education into the curriculum for the optimal competence of nursing students. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Young Sook Roh, PhD, RN, Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-gu, Seoul, Republic of Korea 06974 (aqua@cau.ac.kr). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Improving Prediction of Fall Risk Using Electronic Health Record Data With Various Types and Sources at Multiple Times Inpatient falls are among the most common adverse events threatening patient safety. Although many studies have developed predictive models for fall risk, there are some drawbacks. First, most previous studies have relied on an incident-reporting system alone to identify fall events. Thus, it has been found that falls are more likely to be underreported. Second, there has been a controversy on how to select accurate representative values for patient status data across multiple times and various data sources in electronic health records. Given this background, this study used nurses' progress notes as a complementary data source to detect fall events. In addition, we developed criteria including coverage, currency, and granularity in order to integrate electronic health records data documented at multiple times in various data types and sources. Based on this methodology, we developed three models, logistic regression, Cox proportional hazard regression, and decision tree, to predict risk of patient falls and evaluate the predictive performance of these models by comparing the results to results from the Hendrich II Fall Risk Model. The findings of this study will be used in a clinical decision support system to predict risk of falling and provide evidence-based tailored recommendations in the future. This work was supported by the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (NRF-2018R1A2A2A05022021). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Hyeoun-Ae Park, PhD, RN, FAAN, FACMI, College of Nursing, Seoul National University, Daehak-ro 103, Jongno-gu, Seoul 03080, South Korea (hapark@snu.ac.kr). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

NimbleMiner: An Open-Source Nursing-Sensitive Natural Language Processing System Based on Word Embedding This study develops and evaluates an open-source software (called NimbleMiner) that allows clinicians to interact with word embedding models with a goal of creating lexicons of similar terms. As a case study, the system was used to identify similar terms for patient fall history from homecare visit notes (N = 1 149 586) extracted from a large US homecare agency. Several experiments with parameters of word embedding models were conducted to identify the most time-effective and high-quality model. Models with larger word window width sizes (n = 10) that present users with about 50 top potentially similar terms for each (true) term validated by the user were most effective. NimbleMiner can assist in building a thorough vocabulary of fall history terms in about 2 hours. For domains like nursing, this approach could offer a valuable tool for rapid lexicon enrichment and discovery. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Maxim Topaz, PhD, RN, 560 W 168th St, New York, NY 10032 (mtopaz80@gmail.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Evaluation of Electronic Health Records on the Nursing Process and Patient Outcomes Regarding Fall and Pressure Injuries Digitalizing the nursing process has become a trend in medical care. The purpose of this study was to evaluate implementation of the Standardized Computerized Nursing Process Documentation System and patient outcomes. We analyzed hospitalized patients' electronic health record database with a total of 19 659 patients in 2015. The analysis focused on nurses' selection of nursing care plans for patients with a high risk of falls or pressure injuries through admission assessments. The effectiveness of implemented nursing care plans following falls or pressure injuries was explored. The results reveal that 55% of the hospitalized patients had a risk of falling, and 27.85% of patients were at risk of pressure injuries. Patients receiving nursing care plan who experienced falls or pressure injuries were significantly higher than those without a nursing care plan (P < .001). This study could not provide direct evidence for the effect of nursing care plans on reducing the incidence of falls and pressure injuries, which may be attributable to patient characteristics. Furthermore, an analysis on data from 2007 to 2017 using a run chart revealed that the mean incidence rate for pressure injuries decreased, whereas that for falls remained stable. The results indicate that the system did not increase the occurrence of such incidences. This study was supported by a grant (105-CCH-IRP-151) to M.-W.W. from ChangHua Christian Hospital, Taiwan. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Tsai-Hsiu Chang, PhD, RN, Department of Nursing, HungKuang University, No. 1018, Sec. 6, Taiwan Boulevard, Shalu District, Taichung City 43302, Taiwan (R.O.C.) (tchang24yttmy@gmail.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Developing and Pilot Testing an Integrated Technology–Moderated Institutional Health Promotion Model Using Operational Research Approach The study aimed to develop and pilot test an Integrated Technology–Moderated Institutional Health Promotion Model for university staff in Nigeria. An operational research approach using mixed concurrent design was adopted to develop the model, and pretest-posttest method was used to evaluate the utilization and effectiveness of the developed model. The participants in the study were university staff. Health-promoting lifestyle behavior and health status were measured via the adapted Health-Promoting Lifestyle Profile II instrument. The emerging model (an Integrated Technology–Moderated Institutional Health Promotion Model, which is an Android phone app named Tertiary Staff Health Promotion App) was deployed. Data were collected before and 12 weeks after the app deployment. The quantitative and qualitative data findings were combined to develop an integrated technology–moderated institutional health promotion model as a means to enhance health-promoting lifestyle behavior and health status of staff. The result of the pilot testing of the model showed that the model enhances health-promoting lifestyle behaviors and improves the health status of staff. Nurses, especially in community/public health nursing practice, can provide innovative interventions to drive and enhance health-promoting lifestyle behavior and improve health status of workers and other population groups through effective use of information and communication technology. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Elizabeth M. Joseph-Shehu, MSc, RN, Department of Nursing Science, National Open University of Nigeria, Plot 91, Cadastral Zone, University Village, Jabi, Abuja (ejoseph-shehu@noun.edu.ng; lizjoe26@gmail.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Employing a User-Centered Design to Engage Mothers in the Development of a mHealth Breastfeeding Application Breastfeeding has numerous health benefits; however, many mothers do not continue breastfeeding to the recommended 6 months of age. Breastfeeding support after discharge from the hospital is often lacking in the communities with the greatest need. Therefore, the Mother's Milk Connection mHealth application was designed to improve breastfeeding duration and access to support. This article describes a user-centered design process to engage mothers in the development of the Mother's Milk Connection application. Two phases of stakeholder and user studies were conducted. Phase 1 involved concept generation, prototype development, and usability testing. Phase 2 focused on prototype redesign and usability testing. We used a descriptive mixed-method approach with data collected using a demographic questionnaire, System Usability Scale, exit survey, and focus groups. Final features of the Mother's Milk Connection application included resources and education, peer support, automated activity tracking, and professional support via video conference. Stakeholder and user engagement indicated the integration of four distinct features is acceptable for use as a comprehensive mHealth intervention to improve access to breastfeeding support. mHealth has the potential to be a useful strategy for providing breastfeeding support, and a clinical trial regarding the efficacy of the Mother's Milk Connection application is needed. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Phase 1 of this project was supported by grant R24HS022140 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. Phase 2 was supported by funding from University of Missouri Institute for Clinical and Translational Science. Corresponding author: Urmeka T. Jefferson, PhD, RN, S416 Sinclair School of Nursing, University of Missouri, Columbia, MO 65211 (jeffersonu@missouri.edu). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Development and Evaluation of a Quick Response Code–Based Nursing Education Program for Operating and Recovery Room Nurses The purpose of this study was to develop and evaluate the effectiveness of a quick response code–based nursing education program to improve the competence of operation and recovery room nurses. An experimental methodological design was used to develop a quick response code–based nursing educational program and analyze its effects and nurses' satisfaction with its use. The quick response code–based nursing education program was developed in five steps based on the ADDIE model: analysis, design, development, implementation, and evaluation. The program was built on smartphones, and a Web site was linked to it. After testing the program for 40 days, nurses' attitudes toward various medical devices were significantly less negative. Nurses were able to use a large number of medical devices and were highly satisfied and willing to engage with the quick response code–based nursing educational program. In the context of nursing education, introducing educational content using quick response codes helps to improve nurses' knowledge and competence in providing high-quality nursing care and medical services. Corresponding author: Eun Kyoung Yun, PhD, RN, College of Nursing Science, Kyung Hee University, 26, Kyungheedae-Ro, Dongdaemun-Gu, Seoul, Republic of Korea (ekyun@khu.ac.kr). The authors have disclosed they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Author Contributions: Study design: E.K.Y., E.W.P.; data collection and analysis: E.K.Y., E.W.P.; manuscript writing: E.K.Y., E.W.P., H.L. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Improved Patient Flow and Provider Efficiency After the Implementation of an Electronic Health Record Electronic health records are used widely across the nation in many different types of healthcare facilities. Electronic health record systems can provide more accurate and complete information about a patient's health, improve patient safety, and improve patient care. The purpose of this project is to evaluate a provider efficiency and workflow program at a hospital-owned, freestanding urgent care system after implementation of an electronic health record. A retrospective, longitudinal approach was used to evaluate the implementation of an electronic health record system among six freestanding urgent care clinics. The logic model was used as a guiding framework to determine whether provider efficiency and patient flow were improved. Data were collected from participants via an online survey, electronic health record data review, paper chart review, and direct observation of providers. An evaluation of a provider efficiency program using door-to-triage, door-to-provider, door-to-discharge, and average length of stay at each urgent care clinic was collected. The results indicate improvement in all areas after implementation of the electronic health record in all six urgent care settings. The average length of stay decreased from 109 minutes in 2014 to 73 minutes in 2016. The authors have disclosed they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Lesley Pyron, DNP, APRN, FNP-BC, Capstone College of Nursing, The University of Alabama, 650 University Boulevard East, Box 870358, Tuscaloosa, AL 35487 (lesrn2np@gmail.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Perceptions and Experiences of Hospital Nurses During Transition to an Electronic Handover Informatics System An effective patient transfer, or handover, among healthcare professionals can help prevent communication-related medical errors, and a reliable electronic handover informatics system can standardize the handoff process. Adapting to a new handover system may cause stress for nurses. This descriptive qualitative study aimed to explore the perceptions and transition experiences of hospital nurses in adopting and adapting to a new handover informatics system. Thirty-eight nurses at a medical center in Taiwan participated in the study from December 2016 to January 2017. The researcher conducted five focus group interviews and analyzed all responses using content analysis. Results showed three major themes: “Perceptions of challenges and barriers related to the transition to a new handover informatics system,” “Perceptions of benefits and strategies to the transition to a new handover informatics system,” and “Suggestions for successful implementation of a new handover informatics system.” Five subthemes emerged from the first theme, and six subthemes emerged from the second theme. The results of this study could enhance our understanding of nurses' perceptions and experiences with transition to a new handover informatics system and could provide a reference for hospitals to develop individualized strategies to facilitate the implementation of a handover informatics system. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. This research work was supported by research grants from Kaohsiung Medical University Hospital (KMUH104-M401), Taiwan. Corresponding author: Shu-Yuan Lin, PhD, RN, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Rd, Siamin District, Kaohsiung City 807, Taiwan (m845008@kmu.edu.tw). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.