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The article presents a study describing nursing workload, patient acuity, and length of stay (LOS) and their relationship through a case study of Spaulding Rehabilitation Hospital (SRH) in Boston, Massachusetts. Changes in patient profile were investigated during two periods, between July 2002 and September 2006, and between October 2006 and September 2008. During the study, a 10% or more increase was observed in the categories of close observation, cardiovascular/neurologic management, information/instructional needs, educational needs/lifestyle change, and coping support. It also shows that patients admitted to SRH need intense nursing care.

Health-related mobile apps have the potential to allow patients and providers to proactively and responsibly manage pain together. However, there is a gap between the science of pain and current mobile apps. To develop a prototype science-based pain assessment mobile app (PainSmart) for Android smartphones, pain assessment tasks were extracted from a clinical guideline. These tasks were then converted to activity diagrams and became the logic of PainSmart. Five participants diagnosed with breast cancer evaluated usability of PainSmart with the System Usability Scale. Patient experience was recorded using Camtasia Studio Version 9 software. The five participants were able to explore the pain app after only 20 minutes of training. Using the System Usability Scale with comments, participant mean usability score was 77.5; above 68 is considered an above average system. A prototype of a pain assessment mobile app for cancer patients demonstrated high usability and will be refined based on participant feedback.

Many hospital information systems have been developed and implemented to collect clinical data from the bedside and have used the information to improve patient care. Because of a growing awareness that the use of clinical information improves quality of care and patient outcomes, measuring tools (electronic and paper based) have been developed, but most of them require multiple steps of data collection and analysis. This necessitated the development of a Web-based Nursing Practice and Research Information Management System that processes clinical nursing data to measure nurses' delivery of care and its impact on patient outcomes and provides useful information to clinicians, administrators, researchers, and policy makers at the point of care. This pilot study developed a computer algorithm based on a falls prevention protocol and programmed the prototype Web-based Nursing Practice and Research Information Management System. It successfully measured performance of nursing care delivered and its impact on patient outcomes successfully using clinical nursing data from the study site. Although Nursing Practice and Research Information Management System was tested with small data sets, results of study revealed that it has the potential to measure nurses' delivery of care and its impact on patient outcomes, while pinpointing components of nursing process in need of improvement.

Health information systems are often designed and developed without integrating users' specific needs and preferences. This decreases the users' productivity, satisfaction, and acceptance of the system and increases the necessity for a local adaptation process to reduce the unwanted outcomes after implementation. A workflow-oriented framework developed in a previous study indicates that users' needs and preferences could be incorporated into the system when implementation follows the steps of the framework, eventually increasing satisfaction with and usefulness of the system. The overall goal of this study was to demonstrate application of the workflow-oriented framework to the implementation of a nursing documentation system at Spaulding Rehabilitation Hospital. In this case study, we present specific steps of implementing and adapting a health information system at a local site and raise critical questions that need to be answered in each step based on the workflow-oriented framework.

Medical logic modules are a procedural representation for sharing task-specific knowledge for decision support systems. Based on the premise that clinicians may perceive object-oriented expressions as easier to read than procedural rules in Arden Syntax-based medical logic modules, we developed a method for improving the readability of medical logic modules. Two approaches were applied: exploiting the concept-oriented features of the Medical Entities Dictionary and building an executable Java program to replace Arden Syntax procedural expressions. The usability evaluation showed that 66% of participants successfully mapped all Arden Syntax rules to Java methods. These findings suggest that these approaches can play an essential role in the creation of human readable medical logic modules and can potentially increase the number of clinical experts who are able to participate in the creation of medical logic modules. Although our approaches are broadly applicable, we specifically discuss the relevance to concept-oriented nursing terminologies and automated processing of task-specific nursing knowledge.