NURSES AND FAMILIES. A Guide to Family Assessment and Intervention

Background: Engaging patients in the delivery of health care has the potential to improve health outcomes and patient satisfaction. Patient portals may enhance patient engagement by enabling patients to access their electronic medical records (EMRs) and facilitating secure patient-provider communication. Objective: The aim of this study was to review literature describing patient portals tethered to an EMR in inpatient settings, their role in patient engagement, and their impact on health care delivery in order to identify factors and best practices for successful implementation of this technology and areas that require further research. Methods: A systematic search for articles in the PubMed, CINAHL, and Embase databases was conducted using keywords associated with patient engagement, electronic health records, and patient portals and their respective subject headings in each database. Articles for inclusion were evaluated for quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR) for systematic review articles and the Quality Assessment Tool for Studies with Diverse Designs for empirical studies. Included studies were categorized by their focus on input factors (eg, portal design), process factors (eg, portal use), and output factors (eg, benefits) and by the valence of their findings regarding patient portals (ie, positive, negative, or mixed). Results: The systematic search identified 58 articles for inclusion. The inputs category was addressed by 40 articles, while the processes and outputs categories were addressed by 36 and 46 articles, respectively: 47 articles addressed multiple themes across the three categories, and 11 addressed only a single theme. Nineteen articles had high- to very high-quality, 21 had medium quality, and 18 had low- to very low-quality. Findings in the inputs category showed wide-ranging portal designs; patients’ privacy concerns and lack of encouragement from providers were among portal adoption barriers while information access and patient-provider communication were among facilitators. Several methods were used to train portal users with varying success. In the processes category, sociodemographic characteristics and medical conditions of patients were predictors of portal use; some patients wanted unlimited access to their EMRs, personalized health education, and nonclinical information; and patients were keen to use portals for communicating with their health care teams. In the outputs category, some but not all studies found patient portals improved patient engagement; patients perceived some portal functions as inadequate but others as useful; patients and staff thought portals may improve patient care but could cause anxiety in some patients; and portals improved patient safety, adherence to medications, and patient-provider communication but had no impact on objective health outcomes. Conclusions: While the evidence is currently immature, patient portals have demonstrated benefit by enabling the discovery of medical errors, improving adherence to medications, and providing patient-provider communication, etc. High-quality studies are needed to fully understand, improve, and evaluate their impact.

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Patient Portals Facilitating Engagement With Inpatient Electronic Medical Records: A Systematic Review.

Background: Sickle cell disease is an inherited blood disorder that affects over 100,000 Americans. Sickle cell disease–related complications lead to significant morbidity and early death. Evidence supporting the feasibility, acceptability, and efficacy of self-management electronic health (eHealth) interventions in chronic diseases is growing; however, the evidence is unclear in sickle cell disease. Objective: We systematically evaluated the most recent evidence in the literature to (1) review the different types of technological tools used for self-management of sickle cell disease, (2) discover and describe what self-management activities these tools were used for, and (3) assess the efficacy of these technologies in self-management. Methods: We reviewed literature published between 1995 and 2016 with no language limits. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and other sources. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent reviewers screened titles and abstracts, assessed full-text articles, and extracted data from articles that met inclusion criteria. Eligible studies were original research articles that included texting, mobile phone–based apps, or other eHealth interventions designed to improve self-management in pediatric and adult patients with sickle cell disease. Results: Of 1680 citations, 16 articles met all predefined criteria with a total of 747 study participants. Interventions were text messaging (4/16, 25%), native mobile apps (3/16, 19%), Web-based apps (5/16, 31%), mobile directly observed therapy (2/16, 13%), internet-delivered cognitive behavioral therapy (2/16, 13%), electronic pill bottle (1/16, 6%), or interactive gamification (2/16, 13%). Interventions targeted monitoring or improvement of medication adherence (5/16, 31%); self-management, pain reporting, and symptom reporting (7/16, 44%); stress, coping, sleep, and daily activities reporting (4/16, 25%); cognitive training for memory (1/16, 6%); sickle cell disease and reproductive health knowledge (5/16, 31%); cognitive behavioral therapy (2/16, 13%); and guided relaxation interventions (1/16, 6%). Most studies (11/16, 69%) included older children or adolescents (mean or median age 10-17 years; 11/16, 69%) and 5 included young adults (≥18 years old) (5/16, 31%). Sample size ranged from 11 to 236, with a median of 21 per study: 50 participants in 4 studies (25%). Most reported improvement in self-management–related outcomes (15/16, 94%), as well as high satisfaction and acceptability of different study interventions (10/16, 63%). Conclusions: Our systematic review identified eHealth interventions measuring a variety of outcomes, which showed improvement in multiple components of self-management of sickle cell disease. Despite the promising feasibility and acceptability of eHealth interventions in improving self-management of sickle cell disease, the evidence overall is modest. Future eHealth intervention studies are needed to evaluate their efficacy, effectiveness, and cost effectiveness in promoting self-management in patients with sickle cell disease using rigorous methods and theoretical frameworks with clearly defined clinical outcomes.

Patient-Centered eHealth Interventions for Children, Adolescents, and Adults With Sickle Cell Disease: Systematic Review

Educating the nurses of 2025: Technology trends of the next decade

https://repo.lib.tokushima-u.ac.jp/files/public/11/115157/20200827170357858079/ijnss_6_1_106.pdf

Can nurses remain relevant in a technologically advanced future

Background: The prioritization of sustainable patient-centered care in contemporary health care has resulted in an increased focus on patient empowerment, which in turn is considered to facilitate patient independence, self-management, and self-efficacy. However, a definitional consensus of empowerment remains elusive, impeding efforts to translate the conceptual ideals of empowerment into a measurable entity associated with changes in health care behavior or outcomes. The rapid integration of technology in health care serves to add another layer of complexity in the measurability and operationalization of empowerment and helps to create a specific context in which this conceptual entity should be further examined. Objective: The primary objective of this scoping review was to explore the concept of patient empowerment within the electronic health (eHealth) context. A further focus on the association or measurement of this concept in conjunction with tethered patient portal use was also employed. Methods: In this scoping review, a six-step framework was used to guide the search and paper selection process. The review was initiated with two broad research questions, which are as follows: (1) What is the relationship between empowerment and the use of eHealth technologies from a patient perspective? (2) How is patient empowerment (and/or engagement or activation) influenced by accessing personal health information through a tethered patient portal? Multiple databases were employed in a comprehensive search strategy, and papers were primarily evaluated and selected for inclusion by 2 review authors, and a third author was consulted to resolve any issues in reaching consensus. Results: From an initial count of 1387 publications, this review returned nine systematic or literature review papers and 19 empirical studies that pertained to patient empowerment (and/or engagement and activation) in relation to the use of tethered patient portals providing access to electronic health records (EHRs). Of the 19 empirical publications, only four were found to have used specific patient empowerment measures with significant variety in their identified conceptual elements. Conclusions: There is a persistent lack of conceptual clarity in patient empowerment research, and this has extended to study within the eHealth context. The interchangeable use or conflation of terms such as patient empowerment, engagement, and activation, has further complicated the advancement of distinct conceptual measures. To more strongly align changes in patient empowerment with supportive eHealth solutions, the challenges of achieving a consensus on how best to operationalize and measure patient empowerment must be met. [J Med Internet Res 2017;19(9):e329]

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Evaluating Patient Empowerment in Association With eHealth Technology: Scoping Review

Background: Artificial intelligence (AI) is set to transform the health system, yet little research to date has explored its influence on nurses—the largest group of health professionals. Furthermore, there has been little discussion on how AI will influence the experience of person-centered compassionate care for patients, families, and caregivers.
Objective: This review aims to summarize the extant literature on the emerging trends in health technologies powered by AI and their implications on the following domains of nursing: administration, clinical practice, policy, and research. This review summarizes the findings from 3 research questions, examining how these emerging trends might influence the roles and functions of nurses and compassionate nursing care over the next 10 years and beyond.
Methods: Using an established scoping review methodology, MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central, Education Resources Information Center, Scopus, Web of Science, and ProQuest databases were searched. In addition to the electronic database searches, a targeted website search was performed to access relevant gray literature. Abstracts and full-text studies were independently screened by 2 reviewers using prespecified inclusion and exclusion criteria. Included articles focused on nursing and digital health technologies that incorporate AI. Data were charted using structured forms and narratively summarized.
Results: A total of 131 articles were retrieved from the scoping review for the 3 research questions that were the focus of this manuscript (118 from database sources and 13 from targeted websites). Emerging AI technologies discussed in the review included predictive analytics, smart homes, virtual health care assistants, and robots. The results indicated that AI has already begun to influence nursing roles, workflows, and the nurse-patient relationship. In general, robots are not viewed as replacements for nurses. There is a consensus that health technologies powered by AI may have the potential to enhance nursing practice. Consequently, nurses must proactively define how person-centered compassionate care will be preserved in the age of AI.
Conclusions: Nurses have a shared responsibility to influence decisions related to the integration of AI into the health system and to ensure that this change is introduced in a way that is ethical and aligns with core nursing values such as compassionate care. Furthermore, nurses must advocate for patient and nursing involvement in all aspects of the design, implementation, and evaluation of these technologies.

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Predicted Influences of Artificial Intelligence on the Domains of Nursing: Scoping Review

Due to COVID-19, face-to-face mental health service delivery has been interrupted by social distancing and stay-at-home orders. To abridge physical distance between patients and healthcare providers, while limiting exposure to COVID-19, telepsychiatry has been widely adopted to provide services to patients with pre-existing mental health disorders. Though telepsychiatry has become more mainstream in delivering mental health services during COVID-19, evaluation studies of the rapid conversion of care delivery from face-to-face to telepsychiatry have been limited. The aim of this study was to review the literature on the transition of mental health service delivery to telepsychiatry during COVID-19. The findings of the current review showed that a majority of patients and healthcare providers were satisfied with telepsychiatry services, and suggest that telepsychiatry is feasible and appropriate for supporting patients and healthcare providers during COVID-19.

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Transition of Mental Health Service Delivery to Telepsychiatry in Response to COVID-19: A Literature Review.

Background: It is predicted that artificial intelligence (AI) will transform nursing across all domains of nursing practice, including administration, clinical care, education, policy, and research. Increasingly, researchers are exploring the potential influences of AI health technologies (AIHTs) on nursing in general and on nursing education more specifically. However, little emphasis has been placed on synthesizing this body of literature.
Objective: A scoping review was conducted to summarize the current and predicted influences of AIHTs on nursing education over the next 10 years and beyond.
Methods: This scoping review followed a previously published protocol from April 2020. Using an established scoping review methodology, the databases of MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central, Education Resources Information Centre, Scopus, Web of Science, and Proquest were searched. In addition to the use of these electronic databases, a targeted website search was performed to access relevant grey literature. Abstracts and full-text studies were independently screened by two reviewers using prespecified inclusion and exclusion criteria. Included literature focused on nursing education and digital health technologies that incorporate AI. Data were charted using a structured form and narratively summarized into categories.
Results: A total of 27 articles were identified (20 expository papers, six studies with quantitative or prototyping methods, and one qualitative study). The population included nurses, nurse educators, and nursing students at the entry-to-practice, undergraduate, graduate, and doctoral levels. A variety of AIHTs were discussed, including virtual avatar apps, smart homes, predictive analytics, virtual or augmented reality, and robots. The two key categories derived from the literature were (1) influences of AI on nursing education in academic institutions and (2) influences of AI on nursing education in clinical practice.
Conclusions: Curricular reform is urgently needed within nursing education programs in academic institutions and clinical practice settings to prepare nurses and nursing students to practice safely and efficiently in the age of AI. Additionally, nurse educators need to adopt new and evolving pedagogies that incorporate AI to better support students at all levels of education. Finally, nursing students and practicing nurses must be equipped with the requisite knowledge and skills to effectively assess AIHTs and safely integrate those deemed appropriate to support person-centered compassionate nursing care in practice settings.

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Tracie Risling

Papers

Evaluating Patient Empowerment in Association With eHealth Technology: Scoping Review

Educating the nurses of 2025: Technology trends of the next decade

Predicted Influences of Artificial Intelligence on the Domains of Nursing: Scoping Review

Transition of Mental Health Service Delivery to Telepsychiatry in Response to COVID-19: A Literature Review.

Predicted Influences of Artificial Intelligence on Nursing Education: Scoping Review.