CIN: Computers, Informatics, Nursing

Characteristics of and Factors Influencing College Nursing Students' Willingness to Utilize mHealth for Health Promotion More than half of practicing nurses have suboptimal physical or mental health. Impaired health is associated with a 76% higher likelihood that nurses will make medical errors. Improving the health habits of nursing students is essential to shaping and sustaining health prior to joining the workforce. Technology such as mobile health applications holds great promise in facilitating behavioral change and encouraging healthy habits in nursing students. Identifying the predictors of willingness to use mobile health is essential to creating mobile health applications that will engage nursing students and promote sustainable usage. Evaluation of psychological, attitudinal, and health-related correlates of mobile health can highlight predictors of willingness to use mobile health, which can influence nursing students' utilization and long-term engagement with mobile health applications. Analysis of these correlates shows that psychological attributes, such as hope, play a role in the willingness to use and may facilitate engagement in the utilization of a mobile health application. Development of a mobile health application that increases hope and helps establish healthy habits may enable nursing students to remain healthy throughout their lives, creating a new generation of happier, healthier nurses and, ultimately, improving safety for patients under their care. The abstract of this article was presented at the Association for Information Systems' Americas Conference on Information Systems 2019 as part of the Technology Research, Education, and Opinion (TREO) Talk Sessions. Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001417. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Scott Sittig, PhD, MHI, RHIA, 150 Jaguar Dr, Mobile, AL 36688 (sittig@southalabama.edu). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Nurses' Compliance With Bar-code Medication Administration Technology: Results of Direct Observation of Jordanian Nurses' Practice Medication administration using bar-code medication administration technology enhances the verification of medication administration rights. Nurses' compliance with bar-code medication administration procedure is essential to maximize the benefits. This study evaluated the current rate of nurses' compliance with bar-code medication administration use through direct observation. A descriptive design was used and 134 RNs were recruited from two public hospitals located in the middle region of Jordan. Compliance with bar-code medication administration was evaluated using an evidence-based checklist of 17 items. Participants' compliance with the bar-code medication administration was 55%, which had a significant positive correlation with their level of comfort using bar-code medication administration, usefulness, and ease of use, perceived job productivity, and overall rating of bar-code medication administration. Stakeholders can benefit from assessing end-user acceptance and perceptions regarding the bar-code medication administration technology to promote acceptance and compliance. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. The authors would like to acknowledge the deanship of The University of Jordan for funding this project. Corresponding author: Elham H. Othman, MSN, RN, King Hussein Cancer Center, School of Nursing, The University of Jordan, Queen Rania Street, Amman, 11942, Jordan (elham.othman@ymail.com). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Perceived eHealth Literacy and Learning Experiences Among Japanese Undergraduate Nursing Students: A Cross-sectional Study This study aimed to describe undergraduate nursing students' perceived eHealth literacy and learning experiences of eHealth literacy in Japan and to clarify the relationship between these factors. We conducted a self-administered online questionnaire survey using a convenience sample of 353 Japanese undergraduate nursing students selected from three universities. Participants completed the eHealth Literacy Scale and questionnaires on learning experiences of eHealth literacy and some demographic factors. Participants had moderate perceived eHealth (mean [SD], 24.52 [5.20]). More than half the participants responded that they had no learning experiences of health or science literacy. We observed a positive correlation between the total mean eHealth literacy and learning experiences scores. Undergraduate nursing students in Japan had slightly lower perceived eHealth literacy than nursing students in other countries, hospital nurses, and even patients. Of the 353 participants in this study, 69.4% did not know “where to find helpful health resources on the Internet,” 80.2% of those lacked the skills “to evaluate health resources,” and 68.9% could not “differentiate the quality of health resources on the Internet”; few of the participants perceived themselves as having any experience in learning the six domains of eHealth literacy. Very few reported learning about health (43.3%) and scientific (21.8%) literacy. The low perceived eHealth literacy among participants might reflect lack of knowledge and confidence in eHealth literacy as well as their own low level of health-promoting behaviors; this might influence the quality of health education of clients and their families. Nursing educators should address the lack of eHealth literacy among undergraduate 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: Junichi Tanaka, PhD, MPH, RN, Department of Clinical Nursing Sciences, Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8520, Japan (jtanaka@nagasaki-u.ac.jp). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Transforming Nursing Education Through Interprofessional Collaborative Innovation: A Project Story This project story is about transforming nursing education through interprofessional collaborative innovation to develop and use a complement of technology-based portable simulation devices collectively known as the Healthcare Education Simulation Station. This collection of inexpensive, simulated point-of-care instruments controlled wirelessly by an instructor or simulation operator were developed and field tested by an interdisciplinary team to enhance learning experiences in several configurations, including those using standardized patients and those using static and low-, mid-, and high-fidelity manikins. The core feature of this project story is the collaboration of students and faculty from two unrelated disciplines, nursing and engineering. The story includes a description of the development, field testing, and initial deployment of a simulated pulse oximeter, capnograph, automated sphygmomanometer, cardiac monitor, thermometer, and fetal monitor. Underpinning this project story is Rogers' Diffusion of Innovation theory and how the characteristics of the innovation, the personnel, and the environment worked together to enable this project and the innovation's subsequent diffusion into nursing education. The aspiration to improve learning experiences for students in multiple disciplines was paramount. The desire to acquire high-quality, dynamic educational tools for nursing educators, coupled with an environment that encourages collaboration, led to an innovation that can transform nursing preparation and ultimately improve patient care, while minimizing cost. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: John D. Chovan, PhD, DNP, APRN, PMHNP-BC, ACHPN, Department of Nursing, Otterbein University, One South Grove St, Westerville, OH 43081 (jchovan@otterbein.edu). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

A Task-Analytic Framework Comparing Preoperative Electronic Health Record–Mediated Nursing Workflow in Different Settings Preoperative care is a critical, yet complex, time-sensitive process. Optimization of workflow is challenging for many reasons, including a lack of standard workflow analysis methods. We sought to comprehensively characterize electronic health record–mediated preoperative nursing workflow. We employed a structured methodological framework to investigate and explain variations in the workflow. Video recording software captured 10 preoperative cases at Arizona and Florida regional referral centers. We compared the distribution of work for electronic health record tasks and off-screen tasks through quantitative analysis. Suboptimal patterns and reasons for variation were explored through qualitative analysis. Although both settings used the same electronic health record system, electronic health record tasks and off-screen tasks time distribution and patterns were notably different across two sites. Arizona nurses spent a longer time completing preoperative assessment. Electronic health record tasks occupied a higher proportion of time in Arizona, while off-screen tasks occupied a higher proportion in Florida. The contextual analysis helped to identify the variation associated with the documentation workload, preparation of the patient, and regional differences. These findings should seed hypotheses for future optimization efforts and research supporting standardization and harmonization of workflow across settings, post–electronic health record conversion. D.R.K. is senior author. The Mayo Clinic provided all funding support for the project. R.A.H., K.A.P., and T.A.M. are employees of the Mayo Clinic. The other authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Lu Zheng, MS, RN, MHI, Mayo Clinic, Samuel C. Johnson Research Blvd, Scottsdale, AZ 85259 (lzheng29@asu.edu). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Decision-making Factors Associated With Telehealth Adoption by Patients With Heart Failure at Home: A Qualitative Study Telehealth has been reported to be effective in helping patients with heart failure manage their symptoms at home. Despite this, the adoption rate for telehealth among home care patients with heart failure is low, and there is limited research on reasons for this. This study was undertaken to explore factors associated with patients' decisions to adopt telehealth at home. A qualitative descriptive study underpinned by the Unified Theory of Acceptance Use of Technology model was conducted using semi-structured telephone interviews with patients with heart failure (N = 20) referred for telehealth. Interviews were analyzed using a mixture of deductive and inductive coding. Among the theoretical model elements, the perceived usefulness of the technology (performance expectancy), the availability of clinical/technical support (facilitating conditions), and the opinion of other individuals important to the patient (social influence) were associated with telehealth initiation. However, the ease of use (effort expectancy) was not an associated factor. Other factors such as experience, knowledge, confidence, satisfaction, and attitudes were also associated with the decision. Identification of factors related to higher telehealth initiation rates can be used to inform individualized care planning by nurses. Knowledge of such associations can inform referral process to improve the efficiency and utilization of telehealth. This research was supported by the Reducing Health Disparities Through Informatics (T32 NR007969) and Comparative and Cost-Effectiveness Research (T32 NR014205) training grants through the National Institute of Nursing Research (NINR). The views expressed here are those of the authors and not those of the NINR. At the time of the study, Dr Dowding was a professor of nursing at Columbia University School of Nursing and Center for Home Care Policy and Research, Visiting Nurse Service of New York (VNSNY). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Kyungmi Woo, PhD, RN, CCM, Columbia University School of Nursing, 560 W 168th St, New York, NY 10032 (kw2142@columbia.edu). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Improving Shared Decision-making and Treatment Planning Through Predictive Modeling: Clinical Insights on Ventral Hernia Repair Abdominal wall hernia repair, including ventral hernia repair, is one of the most common general surgical procedures. Nationally, at least 350 000 ventral hernia repairs are performed annually, and of those, 150 000 cases were identified as incisional hernias. Outcomes are reported to be poor, resulting in additional surgical repair rates of 12.3% at 5 years and as high as 23% at 10 years. Healthcare costs associated with ventral hernia repair are estimated to exceed $3 billion each year. Additionally, ventral hernia repair is often complex and unpredictable when there is a current infection or a history of infection and significant comorbidities. Accordingly, a predictive model was developed using a retrospectively collected dataset to associate the pre- and intra-operative characteristics of patients to their outcomes, with the primary goal of identifying patients at risk of developing complications a priori in the future. The benefits and implications of such a predictive model, however, extend beyond this primary goal. This predictive model can serve as an important tool for clinicians who may use it to support their clinical intuition and clarify patient need for lifestyle modification prior to abdominal wall reconstruction. This predictive model can also support shared decision-making so that a personalized plan of care may be developed. The outcomes associated with use of the predictive model may include surgical repair but may suggest lifestyle modification coupled with less invasive interventions. Dr Bruce Ramshaw has consulted and presented for WL Gore, Medtronic, Johnson & Johnson, Pacira Pharmaceuticals, Cumberland Pharmaceuticals, ConMed, and Atrium. There are no other disclosures. Corresponding author: Rebecca S. Koszalinski, PhD, RN, CRRN, CMSRN, College of Nursing, University of Tennessee, Knoxville, 1200 Volunteer Blvd, Room 231, Knoxville, TN 37996 (rkoszali@utk.edu). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Assessing How Well Electronic Nursing Records Reflect Changes in the Nursing Profession's Scope of Practice in Korea Electronic health records, a source of key administrative data for patient care, have been used in Korea for the past 13 years. In recent years, there have been significant changes in the Korean hospital nursing care delivery system. “Comprehensive nursing service,” in which nurses provide direct care to patients, including activities of daily living without a family member, is one of the changes in the nursing profession's scope of practice. Accordingly, this study attempts to determine how well the electronic nursing record reveals nursing services that are being used differently. This study analyzed 19 372 nursing records of a total of 200 patients using the random sampling method in two comprehensive nursing service wards and two noncomprehensive nursing service wards. The number of nursing activity records for all items in the comprehensive nursing service ward was higher; only three items showed significant differences. Five nursing diagnoses including “anxiety” and “pain” were more significantly used in the records of the comprehensive nursing service ward. This study found that there were significant differences in nursing records based on the nursing services provided and that the current electronic nursing recording system adequately reflects changes in nursing practice. This work was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (no. NRF-2016R1D1A2B03933036). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Soyoung Yu, PhD, RN, College of Nursing, CHA University, 120 Haeryong-ro, Pocheon-shi, Gyeongghi-do, Republic of Korea (yusso2012@daum.net). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Usability Evaluation of Four Top-Rated Commercially Available Diabetes Apps for Adults With Type 2 Diabetes Despite the many diabetes applications available, the rate of use is low, which may be associated with design issues. This study examined app usability compliance with heuristic design principles, guided by the Self-determination Theory on motivation. Four top-rated commercially available apps (Glucose Buddy, MyNetDiary, mySugr, and OnTrack) were tested for data recording, blood glucose analysis, and data sharing important for diabetes competence, autonomy, and connection with a healthcare provider. Four clinicians rated each app's compliance with Nielsen's 10 principles and its usability using the System Usability Scale. All four apps lacked one task function related to diabetes care competence or autonomy. Experts ranked app usability rated with the System Usability Scale: OnTrack (61) and Glucose Buddy (60) as a “D” and MyNetDairy (41) and mySugr (15) as an “F.” A total of 314 heuristic violations were identified. The heuristic principle violated most frequently was “Help and Documentation” (n = 50), followed by “Error Prevention” (n = 45) and “Aesthetic and Minimalist Design” (n = 43). Four top-rated diabetes apps have “marginally acceptable” to “completely unacceptable.” Future diabetes app design should target patient motivation and incorporate key heuristic design principles by providing tutorials with a help function, eliminating error-prone operations, and providing enhanced graphical or screen views. This study was supported by the Robert Wood Johnson Foundation Future of Nursing. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Helen N. C. Fu, PhD, School of Nursing, University of Minnesota, 308 Harvard St SE, Minneapolis MN 55455 (helen007@umn.edu). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Visualizations Integrated Into Consumer Health Technologies Support Self-management of Chronic Diseases: A Systematic Review While chronic diseases remain a global problem, visualizations of data and information are a potential solution to assist patients with chronic disease in communication, self-management, and decision making. The purpose of this systematic review is to synthesize evidence regarding data and information visualizations integrated into consumer health informatics solutions for chronic disease management in the community. A search was conducted in CINAHL, EMBASE, Engineering Village, PsycINFO, PubMed, and Web of Science between January 1, 2007, and May 1, 2019. Studies were evaluated using the Mixed Methods Appraisal Tool. Of the 2549 published studies, six studies met inclusion criteria. Of these six studies, two used information visualizations, two used data visualizations, and two used both information and data visualizations. Graphs were the main type of visualization used. Visualizations were mainly delivered in mobile applications and were interactive. The goals of the visualizations varied across studies including to (1) improve understanding of health data, (2) improve patient-provider communication, (3) monitor chronic disease, and/or (4) improve chronic disease management. Five studies reported subjective outcomes of the visualizations (eg, perceived usability, acceptability). One study reported both subjective and objective outcomes (eg, recall) of the visualizations. Findings highlight the need for more research on data and information visualizations integrated into consumer health technologies that support chronic disease management in daily life. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Maichou Lor, PhD, RN, Columbia University, School of Nursing, 560 W 168th St, New York, NY 10032 (mlor2@wisc.edu). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.