Jeungok Choi

Perceived Nursing Work Environment of Critical Care Nurses

Background:Different concepts and measures have been used to evaluate the work environment of nurses in hospital settings. There is increasing need for updated measurement tools that reflect the evolving nature of the work environment. Objectives:To report the psychometric properties of the Perceived Nursing Work Environment (PNWE) instrument, and to compare these results with those of other scales derived from the same background instrument: the Nursing Work Index—Revised. Methods:The Nursing Work Index—Revised was used in a national survey of critical care nurses. Exploratory principal component analysis with orthogonal rotation was conducted. Psychometric properties were examined. Construct validity was evaluated by comparing the scores for a subsample of nurses in magnet and nonmagnet hospitals. Results:Surveys obtained from 68 hospitals across the nation had a mean response rate of 41%, resulting in a sample of 2,324 participants. The PNWE, with its seven subscales and 42 items, explained 53% of the total variance of the Nursing Work Index—Revised. The subscales exhibited moderate to high reliabilities ranging from .70 to .91, except for one subscale (.56), and generally low intercorrelation. A similar version of the nurse–physician collaboration subscale was found in three of the other four scales compared. The positive scheduling climate subscale was a unique finding. Nurses employed at magnet hospitals had more positive perceived work environments than those employed at nonmagnet hospitals, and showed higher mean scores in four of the seven subscales (p < .05). Conclusions:The PNWE, a measure of the work environment as perceived by nurses, represents the latest version of the Nursing Work Index—Revised based on current practice. In this study, it exhibited sound psychometric properties. Further application and testing of the PNWE in various patient care settings is recommended.

Literature Review: Using Pictographs in Discharge Instructions for Older Adults with Low-Literacy Skills

AIMS To evaluate current visual aids used in health education; to explore evidence regarding the use of pictographs (simple line drawings showing explicit health care actions); and to provide suggestions for uses of pictographs in discharge instructions for older adults with low-literacy skills. BACKGROUND Discharge instructions consist of recommended homecare actions. However, these healthcare actions are provided in text-based discharge instructions, which are often difficult for patients with low-literacy skills to follow precisely at home. Various forms of visual aids are currently used to improve health education; however, the appropriateness of these visual aids for educating discharge instructions for older adults with low-literacy skills is unknown. DESIGN A narrative literature review. METHODS Eligible articles were identified via electronic searches of databases. In total, 44 articles were reviewed and analysed. RESULTS Among various visual aids, pictographs using simple line drawings combined with simplified text are the most efficient and effective tool to improve discharge education. Indeed, pictographs are well suited to show a step-by-step procedure of complex and lengthy discharge instructions consisting of multiple actions, thus making an entire action sequence easier to learn. CONCLUSION By using pictographs with simplified text, healthcare educators can improve discharge instructions for low-literate older adults. Further research is needed to develop pictographs representing explicit healthcare actions themselves rather than concepts associated with healthcare actions; and to examine the effects of pictographs on adherence and health outcomes. RELEVANCE TO CLINICAL PRACTICE Healthcare education materials using pictographs provide effective strategies in improving discharge education for low-literate older adults in acute healthcare settings where nurses have primary responsibility as a first line of healthcare providers. It can also serve as an efficient tool to improve health education for immigrants speaking English as a second language.

Toward Semantic Interoperability in Home Health Care: Formally Representing OASIS Items for Integration into a Concept-oriented Terminology

OBJECTIVE The authors aimed to (1) formally represent OASIS-B1 concepts using the Logical Observation Identifiers, Names, and Codes (LOINC) semantic structure; (2) demonstrate integration of OASIS-B1 concepts into a concept-oriented terminology, the Medical Entities Dictionary (MED); (3) examine potential hierarchical structures within LOINC among OASIS-B1 and other nursing terms; and (4) illustrate a Web-based implementation for OASIS-B1 data entry using Dialogix, a software tool with a set of functions that supports complex data entry. DESIGN AND MEASUREMENTS Two hundred nine OASIS-B1 items were dissected into the six elements of the LOINC semantic structure and then integrated into the MED hierarchy. Each OASIS-B1 term was matched to LOINC-coded nursing terms, Home Health Care Classification, the Omaha System, and the Sign and Symptom Check-List for Persons with HIV, and the extent of the match was judged based on a scale of 0 (no match) to 4 (exact match). OASIS-B1 terms were implemented as a Web-based survey using Dialogix. RESULTS Of 209 terms, 204 were successfully dissected into the elements of the LOINC semantics structure and integrated into the MED with minor revisions of MED semantics. One hundred fifty-one OASIS-B1 terms were mapped to one or more of the LOINC-coded nursing terms. CONCLUSION The LOINC semantic structure offers a standard way to add home health care data to a comprehensive patient record to facilitate data sharing for monitoring outcomes across sites and to further terminology management, decision support, and accurate information retrieval for evidence-based practice. The cross-mapping results support the possibility of a hierarchical structure of the OASIS-B1 concepts within nursing terminologies in the LOINC database.

Nursing informatics competencies: assessment of undergraduate and graduate nursing students

AIMS AND OBJECTIVES To report the informatics competencies of students in selected undergraduate and graduate nursing programmes, to examine whether informatics competencies differed between the different programmes and to suggest competency-based applications that will strengthen informatics courses and informatics-related content throughout the curricula. BACKGROUND Nursing students in undergraduate and graduate nursing programmes have different educational backgrounds and different practice experience. Thus, their informatics preparation is apt to be varied, and nursing curricula must reflect this variation while advancing students towards informatics proficiency. However, studies on informatics competency assessment in these nursing students are scarce. DESIGN A descriptive survey design. METHODS Data were collected from 289 nursing students using a 30-item Self-Assessment of Nursing Informatics Competencies Scale via an email sent to students using a LISTSERV mailing list. The email embedded link to the Internet survey package, SurveyMonkey, which included the Self-Assessment of Nursing Informatics Competencies Scale and demographic questions along with an online consent form. RESULTS Students in both programmes were competent in three subscale areas: basic computer knowledge and skills, clinical informatics attitude, and wireless device skills. Graduate students reported slightly higher mean competency scores than did undergraduate students in three subscales: clinical informatics role, clinical informatics attitude and wireless device skills. CONCLUSIONS Findings indicate specific topics for nurse educators to consider when designing informatics curricula. The comparison of undergraduate and graduate students indicates similarities in informatics competencies in terms of areas where students were competent and small mean score differences. Further studies are suggested to examine whether there are differences in informatics competencies between undergraduate and graduate students. RELEVANCE TO CLINICAL PRACTICE These results assist nurse educators in determining specific areas of informatics content that need greater focus and inclusion in the design of better nursing educational programmes. Examples of integrating competencies into existing curriculum or informatics courses are suggested.

Development and pilot test of pictograph‐enhanced breast health‐care instructions for community‐residing immigrant women

Current written text-based health-care instructions are not suitable for presenting lengthy, complex breast health-care instructions and are difficult for immigrant women with limited literacy skills. The aims of this study were to develop breast health-care instructions enhanced by pictographs (simple line drawings representing health-care actions) and pilot test the instructions in a sample of six immigrant women with limited literacy skills. Based on the Mayers Cognitive Theory of Multimedia Learning, pictographs were developed in addition to low-literacy text. The text and the pictographs were then pilot tested with six immigrant women in community health centres for clarity, comprehension and acceptability through face-to-face interviews. Participants perceived that the drawings were engaging and enhanced clarity of the intended health-care messages. The black and white simple line drawings were well received by participants of varying race and ethnicity. The pictograph-based approach might be an effective tool in developing health-care instructions for immigrant women with limited literacy skills. Future research is needed to compare the effect of pictograph-enhanced instructions with written text-based instructions on adherence to instructions and health outcomes.

Pictograph-based discharge instructions for low-literate older adults after hip replacement surgery: development and validation.

Current forms of written text-based discharge instructions are not suitable for presenting lengthy, complex discharge home care actions, and are difficult for low-literate patients to follow precisely at home. The aims of this study were to develop and validate pictograph-based discharge instructions for older adults after hip replacement surgery. Once low-literacy text and pictographs were created, their appropriateness, accuracy, and relevance were reviewed and validated by five experts. The findings show that pictographs (i.e., simple line drawings showing explicit discharge care actions) using stick figures are well suited for presenting action-based discharge instructions. The experts perceived the pictographs as engaging and easy to understand. The pictograph-based approach can be an effective tool in developing health care instructions not only for patients with low-literate skills in acute health care settings, but also for immigrants and refugees who speak English as a second language and present significant communication challenges for health care providers.

Self-Assessment of Nursing Informatics Competencies for Doctor of Nursing Practice Students

This study examined the informatics competencies of doctor of nursing practice (DNP) students and whether these competencies differed between DNP students in the post-baccalaureate (BS) and post-masters (MS) tracks. Self-reported informatics competencies were collected from 132 DNP students (68 post-BS and 64 post-MS students) in their first year in the program (2007 to 2010). Students were assessed in 18 areas of 3 competency categories: computer skills, informatics knowledge, and informatics skills. Post-BS students were competent in 4 areas (computer skills in communication, systems, documentation, and informatics knowledge about impact of information management), whereas post-MS students were competent in only 1 area (computer skills in communication). Students in both tracks reported computer skills in decision support as their least competent area. Overall, post-BS students reported slightly higher than or similar competency scores as post-MS students, but scores were statistically significant in only 3 of 18 areas. The assessment indicated that knowledge and skills on informatics competencies need to be improved, especially in computer skills for data access and use of decision support systems. Strategies are suggested to integrate competencies into existing informatics course and DNP curricula. Further studies are recommended using an objective measure of informatics competencies.

Older adults' perceptions of pictograph-based discharge instructions after hip replacement surgery.

Current text-based discharge instructions are unsuitable for low-literate older adults who have difficulty following written action-based instructions. To address this issue, we developed discharge instructions for low-literate older adults after hip replacement surgery using pictographs (i.e., simple line drawings with stick figures showing explicit care actions). The aim of this focus group study was to examine the acceptability and comprehension of these instructions to 15 low-literate older adults. Participants perceived that the pictograph-based discharge instructions helped them understand the intended health care messages, especially for step-by-step procedures of discharge actions. The black-and-white line drawings were well received by all participants of various race/ethnicity. A pictograph-based approach is an effective strategy for developing discharge instructions not only for patients with low literacy skills in acute health care settings, but also for immigrants with significant communication challenges. Future research is suggested to compare the effects of pictograph-based and text-based instructions on adherence to instructions and health outcomes.

Evaluating the psychometric properties of the Jacelon Attributed Dignity Scale

AIM To develop and psychometrically test the Jacelon Attributed Dignity Scale (JADS). BACKGROUND The JADS was designed to measure self-perceived attributed dignity in community-dwelling older adults. Attributed dignity was conceived of as a state characteristic of the self. The JADS is a short, positively scored, norm-referenced, evaluation index designed to measure self-perceived attributed dignity during the last week. DESIGN Instrument development and testing including psychometric properties, internal consistency, factor structure, temporal stability and construct validity. METHOD Using a quota sample, 289 older adults (65-99 years old) were recruited from senior centres in western New England to complete the JADS, demographic information, the Self-Esteem Scale and the Social Desirability Scale during 2010-2011. Descriptive statistics, exploratory factor analysis, construct validity and temporal stability were evaluated. RESULTS The resulting positively scored 18-item scale has four factors with high internal consistency for each factor and the entire scale. Construct validity was established by examining correlations with instruments that measured self-esteem and social desirability. Attributed dignity is a unique concept that is stable over time. CONCLUSION The JADS is an 18-item Likert-scaled instrument designed to measure attributed dignity. Attributed dignity is a concept with four factors and is defined as a cognitive component of the self-connoting self-value, perceived value from others, self in relation to others and behaving with respect. The importance of attributed dignity for older adults in relation to health, function, independence, quality of life and successful ageing can now be evaluated.

An e‐health intervention for increasing diabetes knowledge in African Americans

An evidence-based e-health program, eCare We Care, was developed to disseminate information on diabetes management through web-based interactive tutorials. This study examined the effect of the eCare We Care program on diabetes knowledge development in African American adults with low diabetes literacy. Forty-six African American adults with type 1 or type 2 diabetes and low diabetes literacy were recruited from two health-care centres in eastern Winston Salem, North Carolina. The eCare We Care program included four weekly sessions: introduction to diabetes; eye complications; foot care; and meal planning. Significant differences in scores on the diabetes knowledge survey were demonstrated between the eCare We Care program participants and the comparison group. Study findings indicate the eCare We Care program is more effective in improving diabetes knowledge of African American adults with low diabetes literacy than paper-based, text-only tutorials. The eCare We Care program can be an effective educational strategy for improving diabetes knowledge and decreasing diabetes disparities among African American adults.An evidence-based e-health program, eCare We Care, was developed to disseminate information on diabetes management through web-based interactive tutorials. This study examined the effect of the eCare We Care program on diabetes knowledge development in African American adults with low diabetes literacy. Forty-six African American adults with type 1 or type 2 diabetes and low diabetes literacy were recruited from two health-care centres in eastern Winston Salem, North Carolina. The eCare We Care program included four weekly sessions: introduction to diabetes; eye complications; foot care; and meal planning. Significant differences in scores on the diabetes knowledge survey were demonstrated between the eCare We Care program participants and the comparison group. Study findings indicate the eCare We Care program is more effective in improving diabetes knowledge of African American adults with low diabetes literacy than paper-based, text-only tutorials. The eCare We Care program can be an effective educational strategy for improving diabetes knowledge and decreasing diabetes disparities among African American adults.