The Effect of Web-Based Preoperative and Postoperative Patient Care Education on Nursing Students: A Randomized Controlled Study This study examined the effect of Web-based preoperative and postoperative patient care education among undergraduate nursing students. This was an experimental, randomized controlled study. The study included 305 nursing students (experimental group: n = 155, control group: n = 150), who were assessed with the following instruments: the Preoperative and Postoperative Care Knowledge Test, Preoperative and Postoperative Care Skill Control List, Clinical Decision Making in Nursing Scale, and Nursing Student Clinical Performance Evaluation Scale. t Tests and χ2 tests were used to evaluate the data. There was no statistically significant difference between the students' posttest knowledge levels, clinical performance assessment, or clinical decision-making scores. The experimental group was found to perform the skills of “check patient's documents and prophylactic antibiotics when going to surgery” (χ2 = 4.88; P = .02), “controls the surgical safety checklist (before surgery) before going to surgery” (χ2 = 10.41; P = .00), and “observes surgical site/dressing (χ2 = 7.77; P = .00)” at a statistically significantly higher level. The education provided in the Web-based education was equivalent to that provided in traditional education. Thus, Web-based education appears to be a useful tool to educate student nurses in preoperative and postoperative patient care. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Hale Turhan Damar, PhD, RN, Nursing Faculty, Dokuz Eylul University, Inciralti, Balçova, Turkey 35340 (hale.turhan1986@gmail.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Recruitment and Retention of Asian Americans in Web-Based Physical Activity Promotion Programs: A Discussion Paper Web-based interventions that promote physical activity have been tested in various populations and proven effective. However, information on recruiting and retaining ethnic minorities in these interventions is limited. This study discusses practical issues in recruitment and retention of Asian Americans using three strategies: (1) only Web-based intervention (Group 1), (2) one with Fitbit Charge HR (Group 2), and (3) one with Fitbit Charge HR and office visits (Group 3). Recruitment and retention rates, minutes of weekly research team meetings, and the researchers' memos were collected. Retention rates were analyzed using descriptive statistics, and the minutes and memos were content analyzed following Weber's methods. Retention rates varied by the end of the first (12% in Group 3, 36.9% in Group 2) and third month (0% in Group 3, 36.9% in Group 2). The practical issues were (1) difficulties in recruitment across strategies, (2) the necessity of using community consultants/leaders across strategies, (3) subethnic differences across strategies, (4) timing issues across strategies, (5) Fitbit as a facilitator with several hindrances, and (6) office visits as an inhibitor. Fitbits with user guidelines and community consultants'/leaders' involvement are proposed for future Web-based interventions to promote physical activity in Asian Americans. 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. The study was funded by the University Research Foundation grant and the Dr Dorothy Mereness Endowed Research Fund at the University of Pennsylvania and the Chang Gung Medical Research Foundation (grant NMRPF3G0141/0051 and ZZRPF3C0011) and Ministry of Science and Technology (MOST 105-2511-S-255-001,106-2511-S-255-001, 106-2511-S-255-003-MY3). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Hsiu-Min Tsai, PhD, RN, FAAN, Chang Gung University of Science and Technology, No. 261, Wenhua 1st Rd, Guishan Dist, Taoyuan, Taiwan 333 (hsiumin2011@gmail.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Comparative Cost of Virtual Reality Training and Live Exercises for Training Hospital Workers for Evacuation Adoption of virtual reality technology may be delayed due to high up-front costs with unknown returns on that investment. In this article, we present a cost analysis of using virtual reality as a training tool. Virtual reality was used to train neonatal intensive care workers in hospital evacuation. A live disaster exercise with mannequins was also conducted that approximated the virtual experience. Comparative costs are presented for the planning, development, and implementation of both interventions. Initially, virtual reality is more expensive, with a cost of $229.79 per participant (total cost $18 617.54 per exercise) for the live drill versus $327.78 (total cost $106 951.14) for virtual reality. When development costs are extrapolated to repeated training over 3 years, however, the virtual exercise becomes less expensive with a cost of $115.43 per participant, while the cost of live exercises remains fixed. The larger initial investment in virtual reality can be spread across a large number of trainees and a longer time period with little additional cost, while each live drill requires additional costs that scale with the number of participants. This study was supported by the Agency for Health Research and Quality through grant R18 HS23149. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Sharon L. Farra, PhD, RN, CNE, CHSE, Wright State University College of Nursing and Health, 3640 Colonel Glenn Hwy, Dayton OH 45435 (sharon.farra@wright.edu). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Technology-Supported Interventions for Pregnant Women: A Systematic Review Technology is deeply embedded in daily life; thus, more pregnant women seek information through the Internet and incorporate the use of technological devices during their pregnancies. This systematic review aimed to examine to what extent and how technology-supported interventions were developed and delivered to pregnant women, as well as intervention effects on the targeted outcomes. Electronic data were collected from MEDLINE, CINAHL, and Scopus. Among the 11 selected studies, most were pilot studies to test the feasibility, acceptability, or preliminary effects of technology-supported interventions. The studies included both women with healthy pregnancies and pregnancies complicated by factors including preterm labor, smoking, and alcohol abuse. Most were conducted in the US, and most participants were white or African American. Interventions were primarily developed by research teams and focused on mental health issues including depression, anxiety, and stress. Interventions incorporated the use of technology including computers, mobile phones, and audiovisual aids. The overall interventions were reported to be feasible, acceptable, and beneficial in all the selected studies. Based on the review of literature, suggestions were provided for future research including the need for careful selection of intervention topics and objectives to target women who can benefit more from technology-supported interventions. Corresponding author: Yaelim Lee, PhD, RN, 84 Heukseok-ro, Dongjak-gu, Seoul, Korea 06974 (ylcaregiver@gmail.com). This research was supported by the National Research Foundation of Korea in 2018 (2017R1C1B5075221). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Alignment of American Association of Colleges of Nursing Graduate-Level Nursing Informatics Competencies With American Medical Informatics Association Health Informatics Core Competencies This study yielded a map of the alignment of American Association of Colleges of Nursing Graduate-Level Nursing Informatics Competencies with American Medical Informatics Association Health Informatics Core Competencies in an effort to understand graduate-level accreditation and certification opportunities in nursing informatics. Nursing Informatics Program Directors from the American Medical Informatics Association and a health informatics expert independently mapped the American Association of Colleges of Nursing competencies to the American Medical Informatics Association Health Informatics knowledge, skills, and attitudes. The Nursing Informatics Program Directors' map connected an average of 4.0 American Medical Informatics Association Core Competencies per American Association of Colleges of Nursing competency, whereas the health informatics expert's map connected an average of 5.0 American Medical Informatics Association Core Competencies per American Association of Colleges of Nursing competency. Agreement across the two maps ranged from 14% to 60% per American Association of Colleges of Nursing competency, revealing alignment between the two groups' competencies according to knowledge, skills, and attitudes. These findings suggest that graduates of master's degree programs in nursing, especially those specializing in nursing informatics, will likely be prepared to sit for the proposed Advanced Health Informatics Certification in addition to the American Nurses Credentialing Center bachelor's-level Informatics Nursing Certification. This preliminary map sets the stage for further in-depth mapping of nursing informatics curricula with American Medical Informatics Association Core Competencies and will enable interprofessional conversations around nursing informatics specialty program accreditation, nursing workforce preparation, and nursing informatics advanced certification. Nursing informaticists should examine their need for credentials as key contributors who will address critical health informatics needs. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Karen A. Monsen, PhD, RN, FAMIA, FAAN, University of Minnesota School of Nursing, 5–140 Weaver-Densford Hall, 308 Harvard St SE, Minneapolis, MN 55455 (mons0122@umn.edu). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Evaluation of Nursing Practice in Patients With HIV/AIDS With the Omaha System Electronic-Based Information Program: A Retrospective Study The Omaha System is a standardized health care terminology that has been used in many different settings for nursing care worldwide for more than 20 years. In Turkey, it has been used mainly in nursing education and research. In this context, the purpose of this study was to examine paper-based nursing care plans of inpatients with HIV/AIDS according to the Omaha System and to assess the clinical suitability of the Omaha System. The study has a descriptive-retrospective design and was carried out at the Department of Infectious Diseases and Clinical Microbiology in a hospital. The sample consisted of 30 patients with HIV/AIDS who were chosen randomly from patients hospitalized between January 2007 and April 2017. Nursing care plans were reevaluated and encoded according to the Omaha System. The five most frequently diagnosed problems were oral health (27.2%), neuromusculoskeletal function (20.2%), communicable/infectious condition (19.4%), skin condition (13.2%), and circulation (5.7%). A total of 4409 nursing interventions were applied to solve the problems, and almost 74% of the interventions were categorized in the surveillance. Among the targets, physical signs/symptoms were indicated for more than 68% (3.026). The results confirmed the clinical suitability of the Omaha System. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Ozlem Koseoglu Ornek, PhD, RN, Department of Nursing, Faculty of Health Sciences, Istanbul Bilgi University, Dolapdere Kampus, Haciahmet Mahallesi, Pir Hüsamettin Sokak, No. 20, 34440 Beyoğlu, Istanbul, Turkey (ozlem.koseoglu@bilgi.edu.tr; ozlem.koseoglu62@gmail.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Usability of a Disease Management Mobile Application as Perceived by Patients With Diabetes The use of mobile applications in chronic disease management has grown significantly over the past decade. When properly designed, these apps provide a convenient, safe, high-quality service to patients. In this study, a health management app was developed, and its usability among patients with diabetes mellitus was examined. A convenience sample of 136 patients, referred to two academic centers from December 2016 to July 2017, was enrolled. Upon completion of informed consent, the participants were asked to install the app on their smartphone. Two weeks later, they were required to complete a postapplication usability questionnaire, comprising 21 questions classified into six domains. The response rate was 89%. The highest scores were given for “ease of use and learnability”; the lowest-scored domains were “interaction quality” and “reliability.” Urban residents, participants with lower educational qualifications, and retirees were significantly more satisfied with the app. Overall, patients with diabetes mellitus perceived the app as useful for disease management. However, the overall usability of health apps is expected to improve when a multidisciplinary team (health professionals, computer engineers, art designers) is involved in the development process. This work was a master's degree project approved at and founded by Guilan University of Medical Sciences, Iran (registration no. 951010). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Rasoul Tabari-Khomeiran, PhD, RN, Social Determinants of Health Research Center, Guilan University of Medical Sciences, Nursing & Midwifery Faculty, Danshjoo Rd, Rasht, Postal 41469-39841, Iran (rtabari@gums.ac.ir; rasooltabari@gmail.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Sequential Two-Stage Network and Thematic Analysis for Exploring an Interdisciplinary Care Approach in Nursing Homes Since various groups of older adults with different conditions and levels of function coexist in nursing homes, it is necessary to develop integrated care strategies through collaboration among experts across related fields. The purposes of this study are to identify the regularity of information sharing in managing daily function for older adults, with a special focus on interdisciplinary cooperation, and to explore a practical care strategy for nursing home residents. The collaborative methods of network and thematic analysis were done by conducting in-depth interviews with 33 interdisciplinary experts working at seven nursing homes. This study proposed three relationships and three themes as interrelated key factors for providing interdisciplinary care to the elderly at various levels of function based on the experiences accumulated by the practitioners. First, independent sharing is required to make professional judgments about how daily function in older adults changes from reported baselines. Second, practitioners accurately judge clinical situations and supplement experts' judgments through partial sharing. Finally, all interdisciplinary consensus through complete sharing achieves the ultimate goal of maintaining remaining function in older adults. These findings can be the first step in developing practical care guidelines for interdisciplinary use, and the results can be used to develop integrated assessment and intervention strategies. Corresponding author: Sung Ok Chang, PhD, RN, College of Nursing, Korea University, 145 Anam-ro, Seongbuk-Gu, Seoul, Republic of Korea 02841 (sungok@korea.ac.kr). This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2015R1D1A1A01057258). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

An Electronic Medical Record Training Conversion for Onboarding Inpatient Nurses In recent times, policies stemming from the American Recovery and Reinvestment Act of 2009 have served as a stimulus for healthcare organizations to adopt an electronic medical record. As a result, nurses are now more knowledgeable of and experienced with an electronic medical record. In August 2016, our facility converted from instructor-led training to electronic learning for inpatient nurse electronic medical record training, hoping to capitalize on previous experience with the clinical information system. However, a complete program evaluation of this transition had yet to be conducted. The purpose of this study was to evaluate electronic learning usability and the return on investment of an electronic medical record training conversion. Evaluations of electronic medical record electronic learning training were collected from 75 newly hired, inpatient nurses from November and December 2017, and compared to our instructor-led program. Results showed that users found it effective and were satisfied with this training method. The electronic learning had superior efficiency, reducing training time by ~50% compared to instructor-led training, while proving to yield effectiveness and satisfaction. The return on investment was $18 540, with a gain of 593.25 hours in nursing time during the study period of two months. These results support the organizational decision to convert to electronic learning, further supporting the conversion for other clinical roles. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Paula S. Smailes, DNP, RN, Information Technology, The Ohio State University Wexner Medical Center, 670 Ackerman Rd, Suite 370, Columbus, OH 43202 (paula.smailes@osumc.edu). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Development and Evaluation of the Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection Catheter-associated urinary tract infection is one of the most common healthcare-acquired infections. It is important to institute preventive measures such as surveillance of the appropriate use of indwelling urinary catheters and timely removal by identifying patients at high risk for catheter-associated urinary tract infection. The purpose of this study was to develop an Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection and evaluate its predictive validity. This study involved secondary data analysis based on a case-control study and used the data extracted from electronic health records. The Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection was developed using a risk-scoring algorithm that was based on a logistic regression model and integrated into the electronic health records. The following eight risk factors for urinary tract infection were included in the logistic regression model: length of stay, admission to the Intensive Care Unit, dependent physical activity, highest neutrophil level (%), lowest blood sodium level of less than 136 mEq/L, lowest blood albumin level of less than 3.5 g/dL, highest blood urea nitrogen level of greater than 20 mg/dL, and indwelling urinary catheter application period (days). The risk groups classified by the Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection were automatically displayed on the patient summary screen of the electronic health record. The predictive validity of the Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection gradually increased up to the fifth and sixth assessment data after patients' admission; then, it leveled. It is possible to allocate nurses' time and effort for catheter-associated urinary tract infection risk assessment to surveillance of the use, removal, and management of indwelling urinary catheters and education and training by using the Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection in clinical settings. This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (NRF-2010-0027077, NRF-2014R1A2A2A01003313). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. All the authors contributed to the design of the study, collection of data, analysis and interpretation of data, and writing and approval of the manuscript. Corresponding author: Sun-Mi Lee, PhD, MSN, The Catholic University of Korea, College of Nursing, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea 06591 (leesunmi@catholic.ac.kr). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.