Usability Assessment of an Electronic Handoff Tool to Facilitate and Improve Postoperative Communication Between Anesthesia and Intensive Care Unit Staff The handoff or handover is the exchange of pertinent medical information from one provider to another. Inadequate handoff communication between healthcare providers can negatively impact patient outcomes. In an effort to improve handoff communication, many studies have developed and evaluated the use of a handoff tool such as a handoff checklist or handoff form to facilitate handoff communication. Recently, the use of the IPASS handoff form, based on the mnemonic for the process, has been associated with a reduction in the rate of adverse events and improvement in information transfer and nurse satisfaction. This quality improvement project adapted the IPASS handoff form for postoperative use in an iterative approach over a series of four phases: (1) requirements/information gathering, (2) adaptation/development, (3) evaluation and modification, and (4) usability testing. Results of this project show that participants viewed the postoperative IPASS handoff form to be easy to use (87.5%), satisfactory (75.0%), and user-friendly (75.0%), which can facilitate its widespread adoption. The key feature identified in making the handoff form user-friendly was its customization feature, which allowed the handoff report to be shortened or expanded to meet the provider- or unit-specific 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: Virginia C. Muckler, DNP, CRNA, CHSE, School of Nursing, Duke University, 307 Trent Dr, Durham, NC 27710 (chris.muckler@duke.edu). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.cinjournal.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Contextualizing Instructional Technology to the Demands of Nursing Education This article reviews current technologies in nursing education and the impact of technology on learning. The integration of technology into nursing curricula is thought to improve efficiency and enhance student experiences through active learning and interactive learning designs. The following focused questions are explored: (1) What are the current technologies used by university students and faculty in nursing programs? (2) How does that technology influence student learning? The primary themes were student-centered technology, with five subthemes, and faculty-centered technology. Consumers of healthcare (patients) demand quality care and expect highly skilled, compassionate, ethical practitioners; to this end, training and education of future nurses by skilled, qualified nurse educators who are comfortable with technological demands of all aspects of healthcare are fundamental. While it is essential that nurses and nurse educators continue to publish as a mechanism for open discussion and transparency in our teaching and learning approaches, we need higher levels of evidence to strengthen the argument that technology improves the learning environment and student outcomes and has a positive impact on clinical settings and patient care. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Denise Smart, DrPH, MPH, BSN, RN, Master of Nursing Program, Washington State University, College of Nursing, 412 E Spokane Falls Blvd, Spokane, WA 99202 (dsmart@wsu.edu). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Comparing the Two Techniques for Nursing Staff Rescheduling to Streamline Nurse Managers' Daily Work in Finland The aim of this study was to identify nurse managers' daily tasks during the rescheduling of sudden nursing staff absences by comparing two techniques: a paper-based system as phone calls and emails or information technology–based staffing systems. In addition, it is intended to evaluate the usability of information technology–based staffing solutions and evaluate estimated cost savings by using hospital permanent staff to cover sudden absences. A quasi-experimental pretest and posttest one-group study design was used to evaluate nurse managers' (n = 61) daily tasks (n = 5800) during rescheduling nursing staff sudden absences (n = 2628); furthermore, we engaged in observations and provided estimates of cost savings generated by our proposed intervention. The number of nurse manager tasks during rescheduling decreased significantly (P < .001) as well as unstaffed shifts (P < .001) and unplanned shift changes (P < .001) after the information technology–based scheduling system was implemented. The usability score ranged from 76 to 100, showing that the information technology–based scheduling solution has good usability. The use of information technology–based staffing solution can streamline the rescheduling process, save nurse managers time for other activities, and offer organizations opportunities for cost savings. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Outi Tuominen, MNSc, RN, Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Kiinamyllynkatu 4-8, PO Box 52, 20521 Turku, Finland (ouantu@utu.fi). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Impact of a Prescription Drug Monitoring Program on Health Information Exchange Utilization, Prescribing Behaviors, and Care Coordination in an Emergency Department Timely access to patient data is critical in patient care. The utilization of health information exchange and prescription drug monitoring programs can make pertinent data readily accessible for emergency department providers to coordinate care. A quasi-experimental preintervention-postintervention design, with 62 providers and 53 554 emergency department visits linked to a health information exchange and prescription drug monitoring program, was used to evaluate rates for utilization, laboratory/imaging orders, narcotic prescribing and readmission. Health information exchange utilization increased significantly after the drug monitoring program was implemented (mean = 119.33 to mean = 231.33, t2 = −15.79, P < .001). There was no significant effect postprescription drug monitoring program for laboratory/imaging orders or narcotics at discharge, although narcotic orders during emergency visits increased (F1,23 = 7.953, P = .010), which may suggest the data confirmed the immediate need to control acute or chronic conditions. In addition, readmission rates decreased from 14.64% to 12.58%. Through streamlining processes, health information exchange and prescription drug monitoring program usage were increased, which can improve care. As organizations promote interoperability of health information, the nurse informaticist plays a significant role in managing access to systems that can assist all providers in coordinating care. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Anna E. Schoenbaum, DNP, RN-BC, Enterprise Clinical Systems, University of Maryland Medical System, 920 Elkridge Landing, Linthicum, MD 21090 (aschoenbaum@umm.edu). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Developing Structured Omaha System Goals for Use in an Electronic Health Record Use of standardized terminology has been essential for clear, concise, and accurate documentation of client assessments, care plans, and outcomes. The purpose of this study was to create standardized language goals for a case management system that used the Omaha System. A group of nursing informaticists analyzed, refined, and developed revised goals evaluated using medical vocabulary properties. A set of unique goals aligned with the Omaha System was developed with specifically designed characteristics and functionality that allowed individualization and evaluation of goal attainment. Goal statements and ratings were standardized and written to reflect goals a client could attain. The Omaha System goals served as a template for nurse case managers to use in telephonic support with clients and future development of new goals and allowed the organization the ability to generate quality metrics. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Marci D. Newcome, DNP, APRN, CNP, 200 First Street SW, Rochester, MN 55905 (newcome.marci@mayo.edu). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Web-Based Tailored Nursing Intervention to Support Medication Self-management: A Qualitative Study of the Experience of Kidney Transplant Recipients Optimal adherence to immunosuppressive medication is essential to kidney graft success. A Web-based tailored virtual nursing intervention was developed to promote medication adherence and support self-management among kidney transplant recipients. A qualitative study was undertaken in a hospital setting in Montreal (Canada) to document how users experience the intervention and to explore medication intake self-management behaviors. To participate, transplant recipients had to be at least 18 years old and had to have completed at least one computer session of the intervention. Semistructured interviews were conducted with 10 participants (two women, eight men) with a mean age of 47.8 years. They reported receiving their latest renal transplant on average 10.6 years prior. Content analysis of the interview transcripts yielded five major themes: (1) kidney transplant is a gift from life; (2) routinization of medication intake; (3) intervention is a new and positive experience; (4) using the intervention offers many benefits; and (5) individual relevance of the intervention. Patient experience shows the intervention is acceptable and can help better manage medication intake. Results also underscore the importance of offering the intervention early in the care trajectory of transplant recipients. Web-based tailored virtual nursing interventions could constitute an easily available adjunct to existing specialized services. Licensing options have been granted for the marketing of VIH-TAVIE. The study was funded by the Kidney Foundation of Canada (2013–2015), the Canadian Institutes of Health Research (2012–2013), and the Research Chair in Innovative Nursing Practices. J.C. has received a clinical research bursary (senior) from the Fonds de recherche du Québec - Santé (2013–2017) to support her research program on innovative virtual interventions intended for persons living with a chronic health problem. The TAVIE platform was developed with the financial support of the Réseau Sidami du FRSQ. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: José Côté, PhD, RN, 850 St-Denis, Montreal, Québec, Canada H2X 0A9 (jose.cote@umontreal.ca). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Knowledge Discovery With Machine Learning for Hospital-Acquired Catheter-Associated Urinary Tract Infections Massive generation of health-related data has been key in enabling the big data science initiative to gain new insights in healthcare. Nursing can benefit from this era of big data science, as there is a growing need for new discoveries from large quantities of nursing data to provide evidence-based care. However, there are few nursing studies using big data analytics. The purpose of this article is to explain a knowledge discovery and data mining approach that was employed to discover knowledge about hospital-acquired catheter-associated urinary tract infections from multiple data sources, including electronic health records and nurse staffing data. Three different machine learning techniques are described: decision trees, logistic regression, and support vector machines. The decision tree model created rules to interpret relationships among associated factors of hospital-acquired catheter-associated urinary tract infections. The logistic regression model showed what factors were related to a higher risk of hospital-acquired catheter-associated urinary tract infections. The support vector machines model was included to compare performance with the other two interpretable models. This article introduces the examples of cutting-edge machine learning approaches that will advance secondary use of electronic health records and integration of multiple data sources as well as provide evidence necessary to guide nursing professionals in practice. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Jung In Park, PhD, RN, 100D Berk Hall, University of California, Irvine, CA 92697 (junginp@uci.edu). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Defining Menstrual Literacy With the Aim of Evaluating Mobile Menstrual Tracking Applications For the estimated 75 million people in the United States who menstruate, understanding menstrual health as a critical “vital sign” is an important aspect of managing personal health. Unsurprisingly, in the past decade, menstrual tracking applications have become increasingly popular, with more than 300 applications available for download and an estimated 200 million downloads worldwide. This study had two purposes. The first was to formulate a definition for menstrual literacy—a baseline of knowledge and skills for understanding anatomical and biological facts of menstruation, caring for the menstruating body, and completing menstrual care tasks—by building on prior work about health literacy and by conducting content analysis of eight Web sites containing information about menstruation. The second was to evaluate a maximum variation sample of 17 menstrual tracking applications; here, features and functions related to the concepts about menstrual literacy identified in a content analysis were compared. These applications had insufficient support for facilitating menstrual literacy, especially for teen and perimenopausal users. The article discusses these disconnects and subsequent design opportunities for menstrual tracking applications to facilitate more robust support of menstrual literacy and overall health of people who menstruate. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding Author: Jordan Eschler, PhD, School of Communication Northwestern University, 710 N Lake Shore Dr, 15th Floor, Abbott Hall, Chicago, IL 60611 (jordan.eschler@northwestern.edu). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Purpose of Bedside Robots: Exploring the Needs of Inpatients and Healthcare Professionals Robotic systems are used to support inpatients and healthcare professionals and to improve the efficiency and quality of nursing. There is a lack of scientific literature on how applied robotic systems can be used to support inpatients. This study uses surveys and focus group interviews to identify the necessary aspects and functions of bedside robots for inpatients. A total of 90 healthcare professionals and 108 inpatients completed the questionnaire, and four physicians and five nurses participated in the focus group interviews. The most highly desired functionalities were related to patient care and monitoring, including alerting staff, measuring vital signs, and sensing falls. Nurses and physicians reported different needs for human-robot interaction. Nurses valued robotic functions such as nonverbal expression recognition, automatic movement, content suggestion, and emotional expressions. The results of the patients' open-ended questions and healthcare professionals' focus groups indicate that the purpose of the robots should primarily be treatment and nursing. Participants believe bedside robots would be helpful but have concerns regarding safety and utility. This study attempts to determine which aspects of robots may increase their acceptance. Our findings suggest that if robots are used in healthcare institutions, they may improve the effectiveness of care. This material is based upon work supported by the Ministry of Trade, Industry & Energy (MOTIE, Korea) under Industrial Technology Innovation Program (no. 10063098, “Telepresence Robot System Development for the Support of POC (Point of Care) Service Associated With ICT 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: Jeongeun Kim, PhD, RN, College of Nursing, Seoul National University Research Institute of Nursing Science, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea (kim0424@snu.ac.kr). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Representing Nursing Data With Fast Healthcare Interoperability Resources: Early Lessons Learned With a Use Case Scenario on Home-Based Pressure Ulcer Care Healthcare communities are rapidly embracing Health Level 7's Fast Healthcare Interoperability Resources standard as the next-generation messaging protocol to facilitate data interoperability. Implementation-friendly formats for data representation and compliance to widely adopted industry standards are among the strengths of Fast Healthcare Interoperability Resources that are accelerating its wide adoption. Research confirms the advantages of Fast Healthcare Interoperability Resources in increasing data interoperability in mortality reporting, genetic test sharing, and patient-generated data. However, few studies have investigated the application of Fast Healthcare Interoperability Resources in nursing-specific domains. In this study, a Fast Healthcare Interoperability Resources document was generated for a use case scenario in a home-based, pressure ulcer care setting. Study goals were to describe the step-by-step process of generating a Fast Healthcare Interoperability Resources artifact and to inform nursing communities about the advantages and challenges in representing nursing data with Fast Healthcare Interoperability Resources. Overall, Fast Healthcare Interoperability Resources effectively represented the majority of the data included in the use case scenario. A few challenges that could potentially cause information loss were noted such as the lack of standardized concept codes for value encoding and the difficulty directly connecting an observation to a related condition. Continuous evaluations in diverse nursing domains are needed in order to gain a more thorough insight on potential challenges that Fast Healthcare Interoperability Resources holds in representing nursing data. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Hyeoneui Kim, PhD, MPH, RN, FAAN, Duke University School of Nursing, 307 Trent Dr, Durham, NC 27710 (hyeoneui.kim@duke.edu). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.cinjournal.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.