This single-blind, randomized controlled design study aims to examine the effect of a mobile-based Lymphedema Self-care Support Program on self-care, the quality of life, and lymphedema symptoms in women with breast cancer-related lymphedema. A control group was offered online standard lymphedema education, and an intervention group was provided with the mobile-based Lymphedema Self-care Support Program in addition to the standard education. Outcome measures were self-care, quality of life, lymphedema symptoms, and arm circumference measurements. The intervention and control groups were similar in sociodemographic and clinical features at baseline. Although there was a significant difference in the mean self-care scores between the groups, there was no significant difference in the mean scores on the quality of life and lymphedema symptoms. The mean scores on self-care and the quality of life increased and arm circumferences decreased significantly across time in the intervention group. The mobile-based Lymphedema Self-care Support Program is a beneficial method to enhance self-care and the quality of life and reduce symptoms in women with breast cancer-related lymphedema. Breast cancer survivors can increase their self-care practices, prevent an increase in their symptoms and arm circumferences, and improve the quality of their lives by using the mobile-based Lymphedema Self-care Support Program.
This statewide study was conducted to determine the impact of the COVID-19 pandemic on nurses’ experience with use of the Electronic Health Record (EHR). This work was part of a larger study conducted in partnership with the Texas Nurses Association, ANA-Michigan, the Texas Organization of Nurse Leaders, and the Michigan Organization of Nurse Leaders to examine nurses’ EHR satisfaction in 2 states. Although EHRs benefit patients and clinicians, unnecessary documentation burden and usability issues have negatively impacted clinician well-being, and the pandemic contributed additional burden. A mixed methods exploratory descriptive analysis with a cross-sectional survey from a random sample of Michigan nurses was conducted in 2021 within Michigan (n=551). Nurse participants were asked open-ended questions specific to their EHR experience including any changes introduced to address the COVID crisis. Findings indicate challenges with nurses’ EHR experience, with EHR maturity and Magnet status significantly impacting satisfaction. Results and qualitative themes are presented along with recommendations for reducing burden during crises, including improving organizational culture and leadership through the use of compassionomics. As this study presents findings of stress and frustration that could indicate moral distress from dissatisfaction with EHRs and lack of system-level support, policy considerations are warranted.
The high quality of nursing documentation is a prerequisite for the secondary use of data. Poor-quality data can lead to incorrect decision-making. This study aimed to describe the assessment of nursing documentation quality and the utilization of this assessment data in the knowledge-based management and development of daily nursing practices. Using a cross-sectional study design, an online survey of information systems for registered nurses in Finland was conducted in spring 2023. A total of 2970 nurses responded. Descriptive methods were used to characterize the frequency of the secondary use of nursing data. Across units, nursing documentation quality was not assessed in 51% of cases, results were not reviewed in 66% of units, and nursing data were not used for knowledge-based management in 58% of units. In private health care and social services, nursing documentation reviews occurred in 21% of units, and 24% reported using nursing data for knowledge-based management. In contrast, public hospitals demonstrated lower engagement, with only 17% of units reviewing nursing documentation and 13% utilizing nursing data for management purposes. The private sector led in the secondary use of nursing data compared with other sectors. Nursing managers consistently provided more positive responses than nurses across all aspects of secondary use of data. This difference may stem from the fact that nursing managers use secondary data for daily management.
This study aims to investigate the relationships between self-leadership, digital literacy, attitudes towards the professional development, and readiness for artificial intelligence among midwifery students. This correlational study was conducted between March 1st and April 30th, 2023, and included 405 midwifery students in T & uuml;rkiye. The study aimed to assess the readiness of midwifery students in T & uuml;rkiye for the integration of artificial intelligence in healthcare. Data were collected using the Medical Artificial Intelligence Readiness Scale for Medical Students, Self-Leadership Questionnaire, Attitude Scale for Professional Development, and Digital Literacy Scale. The study found that self-leadership, attitudes towards professional development, and digital literacy were significant factors in explaining midwifery students' readiness for artificial intelligence. Furthermore, the results indicated that self-leadership has a positive impact on readiness for artificial intelligence by promoting attitudes towards professional development and digital literacy. The readiness of midwifery students for artificial intelligence is determined by their self-leadership, attitude towards professional development, and digital literacy. These findings can guide the organization of teaching programs in midwifery, the development of intervention programs, and the adaptation of midwifery students to technology to enhance their practices.
Potentially complex structures underlie the barriers to digital health transformation. This study aimed to identify the elements of barriers to digital health transformation and clarify the relationships among them using Interpretive Structural Modeling and Cross Impact Matrix-Multiplication Applied to Classification. We identified 11 barriers through a brainstorming session conducted by 3 nursing researchers in Japan. These elements were analyzed via mathematical processing, and a hierarchical structural diagram was constructed. The characteristics of each element were classified using the Cross Impact Matrix-Multiplication Applied to Classification analysis. The results demonstrated consistency with those of previous studies, thus indicating content validity. Furthermore, this study succeeded in systematically organizing the multilayered barriers and visualizing a comprehensive model that even individuals unfamiliar with the cultural context of health care could easily understand. These findings suggest that the organizational culture of nursing plays a fundamental role in the promotion of digital health transformation and emphasize the importance of collaboration among stakeholders at the clinical, developmental, and policy levels. Future strategies for digital health transformation should incorporate more flexible approaches using SWOT analysis and the Decision-Making Trial and Evaluation Laboratory technique.
This descriptive cross-sectional study investigated the content, quality, and reliability of migraine-related videos on TikTok. The top 200 migraine-related TikTok videos (176 eligible) were analyzed to assess content quality and reliability using Goobie's 6 questions and the DISCERN questionnaire. Although 98.8% (174/176) of the videos were physician-uploaded, 58.5% lacked disease definitions, and 34.7% omitted outcomes. While physician-uploaded videos had higher DISCERN scores, 36.93% still received a "poor" rating, and no correlation was found between video quality and engagement metrics (likes, shares) or duration. Despite TikTok's potential for health education, migraine-related content remains inconsistent and biased, highlighting the need for improved, evidence-based public health messaging on social media platforms. This study investigates the quality and reliability of migraine-related TikTok videos and identifies the issues, aiming to promote the improvement of migraine science video quality in the future.
This study aimed to identify key risk factors associated with high-somatization risk among frontline nurses responding to infectious diseases, utilizing a robust machine learning approach. Data were collected from 222 nurses in South Korea, including sociodemographic factors, work-related conditions, job stress, and somatic symptoms. Of the participants, 13.1% had high levels of somatization. Machine learning models, including Logistic regression, XGBoost, and the Random Forest algorithm, were developed to predict high-somatization risk. The models were evaluated based on their mean performance across ten CV folds. While XGBoost demonstrated the highest mean AUC (0.734), the Logistic Regression model was prioritized for interpretation due to its superior performance in identifying the high-risk group. Cross-model feature importance analysis revealed that Infection Anxiety and Delayed Staffing Assignment were the 2 most consistent and influential predictors across both models, followed by factors like satisfaction with salary/bonus and daily PPE hours. These findings suggest that integrating machine learning into occupational health assessments can facilitate the early identification of frontline nurses at high risk of somatization, enabling targeted workplace interventions. This study highlights the potential for proactive support strategies to enhance nurse well-being and maintain health care system resilience during future infectious disease responses.
Heart failure with reduced ejection fraction treatment with quadruple therapy reduces hospitalizations and improves patient survival. Despite evidence-based recommendations to initiate and up-titrate guideline-directed medical therapy to target doses, a gap remains in the achievement of target doses of guideline-directed medical therapies. Evidence-based tools have shown improvement in obtaining target doses of guideline-directed medical therapies using shared decision-making concepts, patient activation videos, and checklists. We conducted a cohort-controlled quality improvement study that aimed to evaluate a digital care platform for the implementation of shared decision-making using a digital patient activation tool, video, and checklist to achieve guideline-directed medical therapies among patients with heart failure with reduced ejection fraction discharged from a large academic medical center. In the implementation phase, 64 patients sent the patient activation video and checklist, which had successful transmission and good engagement, as compared to poor transmission and engagement in the pre-implementation cohort. Though adaptations in digital delivery processes took place throughout the implementation phase, only 26.2% of patients viewed the patient activation video at 2 weeks post-discharge. The trend in improved guideline-directed medical therapy between the pre-implementation and post-implementation cohorts was not statistically significant. Lessons learned for digital dissemination are discussed.
As health technology has advanced, roles such as nurse informaticist, nurse informatician, and nurse informatics specialist have emerged to support its integration into clinical care. Despite growing demand for these nurses, there is limited understanding of how nurses are engaging in informatics across the Canadian health care system. Using a qualitative descriptive design and thematic analysis, this study aimed to explore the various nursing informatics roles that Canadian nurses assume in clinical practice settings, their experiences, and their contributions. Twenty-two nurses employed in nursing informatics roles within clinical settings in a Western Canadian province participated in semistructured interviews between September 2024 and February 2025. Findings revealed 3 themes: (1) qualifying for and advancing in nursing informatics roles, (2) rewarding aspects of nursing informatics roles, and (3) challenges associated with nursing informatics roles. Despite limited formal informatics education, this study shows that nurses are keen to assume nurse informatics roles given their clinical knowledge, but would benefit from more role clarity and support to advance their practice. Supporting nurses in developing their informatics practice roles not only advances the profession but also ensures the delivery of safe patient care in technologically enabled environments.
This study evaluated the effectiveness of virtual reality simulation in enhancing nursing students' competency in the nursing process. A multicenter randomized controlled trial was conducted at 3 nursing schools with 62 students randomly assigned to either an experimental group or a control group. The experimental group used the Oculus Quest 2 to engage in a 360-degree video-based simulation of a patient with pulmonary thromboembolism, while the control group reviewed the same scenario using text-based materials. Both groups collected objective and subjective patient data and completed nursing process documentation. Confidence in the nursing process and preparedness for practice were assessed through pretests and posttests. Learning satisfaction and engagement were measured postintervention. The quality of nursing process documentation was evaluated by an independent rater blinded to group assignment. The experimental group showed significantly higher scores in documentation quality and reported greater learning satisfaction than the control group. However, no significant differences were observed in engagement, confidence, or preparedness between the groups. These findings suggest that 360-degree video-based virtual reality simulations can effectively support nursing students' learning of the nursing process. To maximize learning outcomes, future research should incorporate more active learner participation, including verbal and physical task performance, along with structured debriefing and feedback.
This study assessed the effectiveness of care plan automation through Web and mobile applications among nursing students. Many undergraduate nursing programs lack access to electronic medical records for educational purposes. Our work aimed to transform nursing care plans into easily accessible, auditable, and storable electronic forms using a developed automation system. Conducted at a nursing school, the descriptive study involved 169 nursing students practicing pediatric health and nursing courses. Data were collected using a questionnaire with 15 statements to measure the effectiveness of care plan automation. The mean age of participants was 21.69 +/- 2.29, with a mean grade point average of 3.18 +/- 0.58, and 77.5% were female. The highest-rated statement was that automation allowed students to keep and review care plans (mean, 4.34 +/- 1.13), whereas the lowest was that it increased interest in care plans (mean, 3.91 +/- 1.37). Students also found automation more satisfying (mean, 4.14 +/- 1.23). Overall, the study found that nursing students rated care plan automation positively, indicating increased motivation and benefits and decreased challenges. Implementing this system in clinical practice may enhance students' education, efficiency, and motivation in care planning.
This study aimed to determine nursing students' perceived opinion leadership toward social media influencers and their attitudes toward the nursing profession, examine the relationship between these variables, and assess the effect of perceived opinion leadership on professional attitude. Using a descriptive, cross-sectional design, data were collected through the Demographic Characteristics Form, the Opinion Leadership Scale of Social Media Influencers Among Followers, and the Attitude Scale Toward the Nursing Profession. The study was conducted between October 2024 and May 2025 with 674 nursing students from a university in western Turkey. Reporting followed the STROBE checklist. The mean score for opinion leadership was 52.25±16.43, while the mean score for professional attitude was 155.94±20.43. Structural equation modeling showed that the Proximity dimension had a significant positive effect, and the Imitation dimension had a significant negative effect on all subdimensions of professional attitude ( P <.01). The Entertainment dimension positively influenced only the General Status subdimension ( P =.035). Students perceived social media influencers as low-level opinion leaders but held positive attitudes toward nursing. Although overall opinion leadership showed no direct effect on attitudes, its subdimensions had significant associations. These findings highlight the impact of social media dynamics and the need for media literacy strategies in nursing education.
This study aimed to develop, evaluate, and assess knowledge regarding the prevention of transmission and medication adherence in patients with TB through the Application to Interventions and Learn Tuberculosis (AILs TB). The Delphi study was conducted in 3 phases. The first phase involved content development using the Delphi method, which was carried out in 3 rounds with 13 experts to reach a consensus on the prevention of transmission and medication adherence. The second phase involved the application development process carried out by IT experts, which was evaluated by 4 experts using a content validity index (CVI). The third phase consisted of a pilot study involving 15 patients with TB in both the intervention and control groups, selected based on the inclusion and exclusion criteria to assess changes in knowledge about prevention, transmission, and medication adherence. The Delphi study results identified 9 themes for consensus on the prevention of transmission and 12 for consensus on treatment adherence, with a CVI value >80%. In addition, the pilot study indicated an increase in patients' knowledge after receiving education through the AILs TB application ( P =.001). The AILs TB application, developed based on consensus results, enhances knowledge about the prevention of transmission and treatment adherence among patients with TB.
This methodological study describes the cultural adaptation and validation of the e-Nurse mobile application for use in the United States. Originally developed in Portuguese to support the teaching of clinical reasoning and the Nursing Process to Brazilian undergraduate nursing students, the application was translated and culturally adapted into American English. The process followed established steps: translation, synthesis, back-translation, expert committee review, app adaptation, pretest, and development of the final version. An expert committee evaluated a total of 225 items, all of which were validated with agreement indices ranging between 0.81 and 0.87. In the pretest phase, 20 US nursing students used the adapted version of the app to work through clinical scenarios and identify appropriate nursing diagnoses. The correct response rates ranged from 73% to 100%, with 55% of the students achieving >90% correct responses. App quality was assessed via User Version of the Mobile Application Rating Scale (uMARS), with an overall mean score of 4.03 (±0.40). Usability was evaluated using the System Usability Scale (SUS), with a mean score of 74.3 (±15.93), which is classified as "excellent." The findings indicate that the English version of e-Nurse is a promising educational tool to support nursing education and clinical reasoning in the American cultural and linguistic setting.
The ubiquitous, evolving presence of informatics and health care technologies in nursing practice requires that nurse educator students be equipped to teach this content. Several professional guidelines articulate general informatics and health care technologies competencies, but limited guidance exists regarding how they should be applied to the nurse educator specialty. This article describes how one university identified informatics and health care technologies knowledge and skills essential for nurse educator students and strengthened this content in the program's curriculum. Following a search of 3 databases for relevant peer-reviewed literature, a 11-article sample was analyzed for themes. In addition, competencies from 3 professional guidelines were cross-mapped. Five themes congruent with professional guideline competencies were identified from the reviewed literature: facilitate learner proficiency with electronic health records and standardized terminologies; use existing and emerging health care technologies in practice; use data and technology to inform nursing practice; incorporate informatics and health care technologies standards in curriculum; and promote digital literacy and nurses' influence on informatics and health care technologies. Themes were used to revise objectives in several master's-level nurse educator courses. Findings may help other nurse educator programs strengthen informatics and health care technologies curriculum. They could also be used to inform professional development activities for current nurse educators.
Cardiovascular diseases represent a significant public health challenge, especially among older adults. Educational strategies that provide clear and accessible information can positively influence outcomes for older patients undergoing invasive procedures such as cardiac catheterization. This methodological study aimed to evaluate the evidence of content and appearance (face) validity of an educational video for older adults undergoing cardiac catheterization. The research was conducted in 3 stages: development of the video based on the 12 principles of the Cognitive Theory of Multimedia Learning; content validation by 11 multidisciplinary experts using the Suitability Assessment of Materials (SAM) instrument; and face validation with 10 older adults assisted in the hemodynamics unit of a university hospital, using the Health Educational Technology Appearance Validation Instrument. The final video consisted of 49 scenes, lasted 5 minutes and 55 seconds, and achieved a global SAM score of 97.1 and an Appearance Validity Index of 0.97. It was considered an appropriate and accessible educational resource by participants. The video constitutes an innovative tool to support health education for older adults and contributes to professional practice in interventional cardiology. Future research should evaluate its effectiveness and verify its impact on hemodynamic parameters, anxiety levels, and adherence to therapeutic guidelines.
Managing and analyzing trauma registry data is critical for optimizing trauma care and maintaining verification by organizations such as the American College of Surgeons. However, the volume and complexity of these data can be challenging to hone in on what is important. This study describes the design, implementation, and evaluation of an interactive trauma registry dashboard developed for enhancing compliance with trauma center verification standards. Developed using R programming, the dashboard consolidates trauma metrics into a layered, web-based interface featuring interactive visualizations and modular components tailored to performance improvement and compliance tracking. The primary data source is the trauma registry, with optional integration of external files. Implementation of the dashboard streamlined reporting processes by eliminating the need for multiple static reports, reducing analysis time, and enhancing communication among trauma team members. Monthly reviews of performance indicators supported real-time monitoring of compliance with American College of Surgeons standards. By transforming raw data into actionable insights, the dashboard improved operational efficiency and facilitated data-driven decision-making. This project demonstrates how applied informatics tools can enhance trauma program performance and verification readiness while supporting broader quality improvement efforts in clinical practice.
Diabetes is characterized as the "pandemic of the age" due to its increasing prevalence. Since it is a disease that affects all areas of life, it causes negative effects on the quality of life and self-care activities. This study aimed to determine the effect of Web-based diabetes education according to Orem's Self-Care Deficit Theory on the health outcomes of patients with type 2 diabetes. This study type is randomized controlled experimental study. The study was conducted between September 2023 and June 2024. Eighty people were included in the study. After the implementation of intervention, statistically significant difference was found in the mean scores of Diabetes Quality-of-Life Measure between the experimental and control groups ( P = .005), although there was no statistically significant difference between the experimental and control groups in the Summary of Diabetes Self-Care Activities results ( P = .575). As a result of the evaluation of the developed Web-based training program with the Web site Analysis and Measurement Inventory, it was found to be useful with the lowest subdimension score of 80.785 ± 13.875. Finally, when the glycosylated hemoglobin values of the participants were measured, it was calculated that there was a significant difference between the groups after the Web-based training ( P = .010).
Although there is no framework for prediction models for postembolization fever, potential influencing factors include demographic, clinical, laboratory, and radiologic data. We aim to develop and validate machine learning-based prediction models for postembolization fever after transarterial chemoembolization. Data from 1495 patients who underwent transarterial chemoembolization at a tertiary hospital were reviewed retrospectively. Seven machine learning-based algorithms were used to develop prediction models of postembolization fever occurrence after transarterial chemoembolization using SPSS WIN 27.0 and Python. The proposed ensemble method was the best algorithm for predicting postembolization fever. Variables positively correlated with postembolization fever occurrence were posttransarterial chemoembolization aspartate aminotransferase, C-reactive protein, alanine aminotransferase, and bilirubin levels, and international normalized ratio and platelet counts; pretransarterial chemoembolization aspartate aminotransferase and alpha-fetoprotein levels and platelet count; lipiodol and doxorubicin amounts; and a >5 cm tumor. Conversely, variables negatively correlated with postembolization fever were posttransarterial chemoembolization lymphocyte and monocyte counts and albumin levels; pretransarterial chemoembolization albumin levels and lymphocyte count; and probably hepatocellular carcinoma. Oncology clinicians should monitor demographic, clinical, laboratory, and radiologic data before and after transarterial chemoembolization to assess postembolization fever. In addition, health care professionals should be aware of the potential side effects of transarterial chemoembolization and management strategies, such as medications.
In home health care (HHC), video recordings can complement electronic health record (EHR) data by capturing essential details typically missed, such as environmental risk factors. This study developed a video annotation methodology for HHC by systematically annotating video data and mapping the resulting annotation codes to standardized clinical terminologies. Four simulated nurse home-visit videos were annotated and mapped to SNOMED CT and other vocabularies within the UMLS Metathesaurus. A total of 97 annotation codes were identified: 66 (68%) at the data level, mostly representing environmental observations (N=52, 78.8%). From these, 17 information-level (17.5%) and 14 knowledge-level (14.5%) codes were derived. Of these 97 annotation codes, 88.7% mapped exactly to SNOMED CT, 6.2% mapped partially to SNOMED CT but aligned better with other UMLS terminologies, 3.1% mapped only to non-SNOMED terminologies, and 2.1% could not be mapped. Among the 92 codes mapped to SNOMED CT, 88.0% were exact matches, 10.9% broader matches, and 1.1% close matches. This pilot study validates the feasibility and practicality of the proposed video annotation methodology in HHC. Future research could expand this methodology to diverse HHC settings and assess the added value of video-based information when integrating with EHR data in predicting patient outcomes.
