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Kayla C Everhart,1 Sara B Donevant,1 Victor N Iskersky,2 Michael D Wirth,1 Robin B Dail1 1College of Nursing, University of South Carolina, Columbia, SC, USA; 2Department of Neonatology, Prisma Health Richland/Pediatrix, Columbia, SC, USACorrespondence: Kayla C Everhart, College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA, Email everhakc@email.sc.eduPurpose: Researchers report associations between packed red blood cell (PRBC) transfusions and morbid outcomes in preterm infants. Published standards are lacking for giving PRBC transfusions to preterm infants in the neonatal intensive care unit (NICU). This study examined standard practices reported by nurses across the United States (US) for administering PRBC transfusions to preterms to identify variation in practice which may contribute to the relationship of PRBC transfusions and morbidity.Design and Methods: A 23-item questionnaire developed using REDCap based on literature and nursing experience of experts on the procedure of administering PRBC transfusions to preterm infants was distributed via social media and email to NICU nurses across the US.Results: A total of 757 responses received and 518 completed responses were analyzed from level IV (48%) and level III (49%) NICU nurses in 47/50 US states. Most (94%) report PRBCs are ordered for anemia. Most (74%) report NICU policies do not specify warming PRBC transfusions prior to infusing; 10% (n = 53) specifically indicate they warm PRBC transfusions. Only 2% report using a blood warmer device. NICU nurses in the US (66%) reported feedings are altered during the PRBC transfusion. A 97% of nurses reported their NICU employs a specific physiologic assessment policy during PRBC transfusions. The two most common infusion sites used are (99%) peripheral IV as preferred and an umbilical venous catheter (74.5%) as next best option.Conclusion: This study reveals inconsistencies in PRBC transfusion practices in US NICUs. Vast inconsistencies were shown in warming transfusions and in feeding practices surrounding PRBC transfusions. Future research should examine these variations in PRBC transfusion practices for any contributions to the relationship of PRBC transfusions and morbidity in preterm infants. A standard guideline should be developed based on the research evidence to guide nurses in administering preterm PRBC transfusions.Keywords: neonate, hypothermia, blood transfusions, survey

Background: Nursing Doctor of Philosophy program enrollment has declined. Undergraduate nursing student (UGS) research engagement is associated with future graduate education, an essential element for building the nursing faculty pipeline., Purpose: (a) To describe the infrastructure and culture-enhancing resources and strategies associated with building UGS research engagement and (b) to evaluate UGS research engagement., Methods: Guided by a socioecological systems model university and college documents, databases, and college of nursing survey results were used to identify approaches to, and outcomes of, engaging UGS in research. Descriptive statistics were calculated to illustrate 5-year UGS research engagement trends., Findings: Resources and strategies included grant funding, research assistant funding, student research showcases, and faculty mentorship. UGS research 5-year engagement trends included (a) a 75% increase in the number of students mentored, (b) a 30% rise in funded research proposals, and (c) a 54% increase in paid research assistantships., Discussion: Purposefully using existing resources, growing the college of nursing infrastructure, and cultivating a culture recognizing faculty contributions were approaches associated with increased UGS research engagement., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Aim: The study aimed to explore the relationship between the unintended consequences of the electronic health record and cognitive load in emergency department nurses., Methods: The study utilized a correlational quantitative design with a survey method approach. This study had a 30.4 % response rate for a total of 304 ED nurse participants who were members of a national ED nursing organization. Data analysis included descriptive and correlational measurements of two instruments., Results: In this study, there was a statistically significant, weak negative relationship between CL and UC-EHR in ED nurses, r s (264) = -0.154, p 0.002. Although a significant weak relationship was identified in this study, the study variables, subscales, and demographic data groupings presented moderate-to-strong positive, statistically significant correlations. Descriptive frequency data unveiled EHR stimulated patient safety threats occurring once a week to monthly., Conclusions: The novelty of this research study provided profound implications for the future of nursing practice, policy, and nursing science. EHR optimization to minimize patient safety risks is recommended with the inclusion of end-users from this study's identified subgroups. The researchers propose a reduction of EHR burden in nursing practice., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Carolyn S. Harmon reports financial support was provided by Emergency Nursing Association Foundation. Carolyn S. Harmon reports financial support was provided by Sigma., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: As of May 2023, the novel SARS-CoV-2 has claimed nearly 7 million lives globally and >1.1 million lives in the United States. Low-income populations are often disproportionately affected by risk factors such as lifestyle, employment, and limited health literacy. These populations may lack the knowledge of appropriate infection precautions or have reduced access to care during illness, particularly in countries without universal health care., Objective: We aimed to explore the perceptions and experiences of COVID-19, including symptoms and risk factors among uninsured individuals seeking care at a free medical clinic, and to obtain respondents' perceptions of and suggestions for adapting a mobile health (mHealth) app to an uninsured population known to have low health literacy., Methods: We conducted a prospective multimethod survey study with a convenience sample of uninsured adults seeking care at 3 free clinics in the United States. Respondents were questioned about their risk for and awareness of COVID-19 symptoms, COVID-19 testing, current technology use, and the use of technology to facilitate their health regarding COVID-19. Data were analyzed using descriptive statistics (eg, frequencies and mean differences). In addition, a small subset of respondents from one of the clinics (n=10) participated in interviews to provide feedback about the design of a COVID-19 web-based smartphone (mHealth) app., Results: The survey respondents (N=240) were 53.8% (n=129) female, were primarily White (n=113, 47.1%), and had a mean age of 50.0 (SD 11.67; range 19-72) years. Most respondents (162/222, 73%) did not think that they were at risk for COVID-19. Although respondents reported only moderate confidence in their knowledge of the short- and long-term symptoms of COVID-19, their knowledge of the symptoms aligned well with reports published by the Centers for Disease Control and Prevention of the most common acute (590/610, 96.7%) and long-term (217/271, 80.1%) symptoms. Most respondents (159/224, 71%) reported an interest in using the mHealth app to gain additional information regarding COVID-19 and available community resources. Respondents who were interviewed provided suggestions to improve the mHealth app but had overall positive perceptions about the potential usefulness and usability of the app., Conclusions: It was encouraging that the knowledge of COVID-19 symptoms aligned well with the reports published by the Centers for Disease Control and Prevention and that respondents were enthusiastic about using an mHealth app to monitor symptoms. However, it was concerning that most respondents did not think they were at a risk of contracting COVID-19., (©Khushi S Patel, Cynthia F Corbett, Elizabeth M Combs, Sara B Donevant, Margaret J Selph, Lynette M Gibson, Robin M Dawson, Amit P Sheth, Ronda G Hughes. Originally published in JMIR Formative Research (https://formative.jmir.org), 28.07.2023.)

Background: Very preterm infants (less than 32 weeks gestational age) experience acute morbidity during their stay in a neonatal intensive care unit. Because of their prematurity and frequent laboratory testing, they experience anemia, requiring correction with packed red blood cell (PRBC) transfusion(s). PRBC transfusions have been linked to neonatal morbidity, such as necrotizing enterocolitis, but never signs and symptoms of physiological stability., Objective: The secondary data analysis aimed to examine very preterm infants' physiological stability before, during, and after PRBC transfusions., Methods: A within-case, mixed-methods design was used in a secondary data analysis for 16 transfusion cases from 13 very preterm infants., Results: The findings showed very preterm infants with physiological variables falling within defined limits based on gestational age during the transfusion. Two contrasting case exemplars will be presented., Discussion: PRBC transfusions are necessary and prevent morbidity in very preterm infants. Observing instability during transfusions and prospectively studying hypothermia, cardiac instability, and thermal gradients is essential to design interventions to decrease morbidity associated with PRBC transfusions., Competing Interests: The authors have no conflicts of interest to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Preterm infants have increased morbidity and mortality due to immature physiology and neonatal complications. Necrotizing enterocolitis (NEC) is a devastating gastrointestinal complication that affects morbidity and mortality in preterm infants. The authors present an adaptation of Neuman's systems model called the NEC systems model to explore intrinsic and extrinsic factors leading to NEC in preterm infants. The literature was searched for theoretical models to guide exploration of neonatal disease influenced by the environment. Neuman's Systems Model provides a holistic approach to care of the system, offering a foundation to develop frameworks to examine preterm infants in their environment with associated stressors.

Background: The global COVID-19 pandemic has brought numerous challenges for conducting the human subjects research needed to advance science and improve health., Objectives: The purpose of this article is to discuss how a college of nursing at a large public university in the southeast United States has responded to the challenges of conducting research during the novel COVID-19 pandemic., Methods: Seven faculty researchers at the University of South Carolina College of Nursing share their experiences in overcoming the unique challenges of conducting research because of the COVID-19 pandemic. Strategies to overcome the challenges posed by COVID-19 are presented within the context of the research process, career implications, communication, and maintaining morale., Results: Fears of COVID-19 and social distancing measures have hindered participant recruitment, enrollment, and involvement in ongoing studies. Increasing virtual technology use and enhancing safety precautions have assisted researchers to overcome barriers. Scholarly writing has increased for some faculty members whose studies have been stalled by the pandemic, yet others have seen a decline because of additional personal responsibilities. The careers of faculty members across all ranks have been uniquely affected by the pandemic. With most faculty working remotely, enhanced communication strategies at the university and college have supported the research enterprise. Morale has been adversely affected, but a variety of personal and collegial efforts have helped faculty cope and preserve a sense of normalcy during this devastating pandemic., Discussion: Faculty and their ability to conduct the research needed to inform clinical and public health practice have been adversely affected by the COVID-19 pandemic. Despite the challenges of conducting research during this unprecedented crisis, faculty and institutions are taking novel steps to ensure the continuity of scientific progress for improving the health and well-being of patients and populations., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

To maintain their quality of life and avoid hospitalization and early mortality, patients with heart failure must recognize and respond to symptoms of exacerbation. A promising method for engaging patients in their self-care is through mobile health applications (mHealth apps). However, for mHealth to have its greatest chance for improving patient outcomes, the app content must be readable, provide useful functions and be based in evidence. The study aimed to determine: (1) readability, (2) types of functions, and (3) linkage to authoritative sources of evidence for self-care focused mHealth apps targeting heart failure patients that are available in the Apple and Google Play Stores. We systematically searched for mHealth apps targeting patients with heart failure in the Apple and Google Play Stores and applied selection criteria. Readability of randomly selected informational paragraphs were determined using Flesch-Kincaid grade level test tool in Microsoft Word. Ten mHealth apps met our criteria. Only one had a reading grade level at or below the recommended 6th grade reading level (average 9.35). The most common functions were tracking, clinical data feedback, and non-data-based reminders and alerts. Only three had statements that clearly linked the mHealth app content to trustworthy, evidence-based sources. Only two had interoperability with the electronic health record and only one had a communication feature with clinicians. Future mHealth designs that are tailored to patients' literacy level and have advanced functions may hold greater potential for improving patient outcomes., (© 2020 Wiley Periodicals LLC.)

Background: South Asian region has been experiencing the increasing burden of antimicrobial resistance (AMR) primarily due to over and irrational prescribing of antibiotics. Acute respiratory infections (ARIs) are the leading cause of out-patients' visits in the region. Despite commonly known viral aetiology, ARI is the single largest reason for antibiotic prescriptions contributing the exponential growth of AMR in the region. Collated data on antibiotic consumption for ARI at outpatients and resistance pattern of respiratory pathogen are lacking in the region., Methods: MEDLINE, Cochrane, CINAHL Plus (EBSCO), and Web of Science will be searched for eligible papers. Titles and abstracts, and full texts of the relevant studies will be screened by 2 independent reviewers against the inclusion criteria. Data extraction and quality of the studies will be assessed by 2 reviewers independently using the JBI Critical Appraisal Tools. A third reviewer will resolve any disagreement at any point between 2 reviewers., Results: The review will assess proportions of ARI patients receiving antibiotic therapy and types of antibiotics prescribed among outpatients of all ages in South Asia. This review will also assess the pattern of antimicrobial resistance among respiratory pathogens causing ARI in the region., Conclusions: This systematic review will evaluate published literature, summarize the existing data on the antibiotic prescribing patterns for outpatients with ARI in South Asia. The holistic finding of the proportion of patients receiving antibiotic therapy for ARI, proportion of different types of antibiotic received, and resistance against respiratory pathogen might guide future research. This underscores a need for formulating regional and national policy for AMR mitigation strategy, and revising clinical practice guidelines for the clinician to ensure rational use of antibiotics for ARI., Prospero: registration no: CRD42018116658., Competing Interests: There is no conflict of interest in this systematic review protocol., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Mobile health (mHealth) apps are dramatically changing how patients and providers manage and monitor chronic health conditions, especially in the area of self-monitoring. African Americans have higher mortality rates from heart failure than other racial groups in the United States. Therefore, self-management of heart failure may improve health outcomes for African American patients., Objective: The aim of the present study was to determine the feasibility of using an mHealth app, and explore the outcomes of quality of life, including self-care maintenance, management, and confidence, among African American patients managing their condition after discharge with a diagnosis of heart failure., Methods: Prior to development of the app, we conducted qualitative interviews with 7 African American patients diagnosed with heart failure, 3 African American patients diagnosed with cardiovascular disease, and 6 health care providers (cardiologists, nurse practitioners, and a geriatrician) who worked with heart failure patients. In addition, we asked 6 hospital chaplains to provide positive spiritual messages for the patients, since spirituality is an important coping method for many African Americans. These formative data were then used for creating a prototype of the app, named Healthy Heart. Specifically, the Healthy Heart app incorporated the following evidence-based features to promote self-management: one-way messages, journaling (ie, weight and symptoms), graphical display of data, and customized feedback (ie, clinical decision support) based on daily or weekly weight. The educational messages about heart failure self-management were derived from the teaching materials provided to the patients diagnosed with heart failure, and included information on diet, sleep, stress, and medication adherence. The information was condensed and simplified to be appropriate for text messages and to meet health literacy standards. Other messages were derived from interviews conducted during the formative stage of app development, including interviews with African American chaplains. Usability testing was conducted over a series of meetings between nurses, social workers, and computer engineers. A pilot one-group pretest-posttest design was employed with participants using the mHealth app for 4 weeks. Descriptive statistics were computed for each of the demographic variables, overall and subscales for Health Related Quality of Life Scale 14 (HQOL14) and subscales for the Self-Care of Heart Failure Index (SCHFI) Version 6 using frequencies for categorical measures and means with standard deviations for continuous measures. Baseline and postintervention comparisons were computed using the Fisher exact test for overall health and paired t tests for HQOL14 and SCHFI questionnaire subscales., Results: A total of 12 African American participants (7 men, 5 women; aged 51-69 years) diagnosed with heart failure were recruited for the study. There was no significant increase in quality of life (P=.15), but clinically relevant changes in self-care maintenance, management, and confidence were observed., Conclusions: An mHealth app to assist with the self-management of heart failure is feasible in patients with low literacy, low health literacy, and limited smartphone experience. Based on the clinically relevant changes observed in this feasibility study of the Healthy Heart app, further research should explore effectiveness in this vulnerable population., (©Sue P Heiney, Sara B Donevant, Swann Arp Adams, Pearman D Parker, Hongtu Chen, Sue Levkoff. Originally published in JMIR Aging (http://aging.jmir.org), 03.04.2020.)

Research using mHealth apps has the potential to positively impact health care management and outcomes. However, choosing an appropriate mHealth app may be challenging for the health researcher. The author team used existing evaluation tools, checklists, and guidelines to assess selected mHealth apps to identify strengths, challenges, and potential gaps within existing evaluation tools. They identified specific evaluation tool components, questions, and items most effective in examining app content, usability, and features, including literacy demand and cultural appropriateness; technical information; practical aspects of app functionality; and evolving capabilities of mobile medical apps. Challenges included the subjective nature of the results, time required to complete the evaluation, lack of emphasis on evidence-based content, and inadequate tool flexibility. Health researchers considering the integration of mobile apps into research will benefit from evaluation tools that assess both evidence-based content and the ability of the mobile app to securely integrate with other digital technologies involved in patient care. Next steps will include the involvement of health care providers and professionals, including nurses a wide range of expertise, to develop an mHealth evaluation tool that focuses on identifying quality, evidence-based mobile apps into patient outcomes research., (© 2019 John Wiley & Sons Ltd.)

Objective: The testing of informatics tools designed for use during mass casualty incidents presents a unique problem as there is no readily available population of victims or identical exposure setting. The purpose of this article is to describe the process of designing, planning, and executing a functional exercise to accomplish the research objective of validating an informatics tool specifically designed to identify and triage victims of irritant gas syndrome agents., Materials and Methods: During a 3-year time frame, the research team and partners developed the Emergency Department Informatics Computational Tool and planned a functional exercise to test it using medical records data from 298 patients seen in 1 emergency department following a chlorine gas exposure in 2005., Results: The research team learned valuable lessons throughout the planning process that will assist future researchers with developing a functional exercise to test informatics tools. Key considerations for a functional exercise include contributors, venue, and information technology needs (ie, hardware, software, and data collection methods)., Discussion: Due to the nature of mass casualty incidents, testing informatics tools and technology for these incidents is challenging. Previous studies have shown a functional exercise as a viable option to test informatics tools developed for use during mass casualty incidents., Conclusion: Utilizing a functional exercise to test new mass casualty management technology and informatics tools involves a painstaking and complex planning process; however, it does allow researchers to address issues inherent in studying informatics tools for mas casualty incidents., (© The Author(s) 2019. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: Limited data are available on the correlation of mHealth features and statistically significant outcomes. We sought to identify and analyze: types and categories of features; frequency and number of features; and relationship of statistically significant outcomes by type, frequency, and number of features., Materials and Methods: This search included primary articles focused on app-based interventions in managing chronic respiratory diseases, diabetes, and hypertension. The initial search yielded 3622 studies with 70 studies meeting the inclusion criteria. We used thematic analysis to identify 9 features within the studies., Results: Employing existing terminology, we classified the 9 features as passive or interactive. Passive features included: 1) one-way communication; 2) mobile diary; 3) Bluetooth technology; and 4) reminders. Interactive features included: 1) interactive prompts; 2) upload of biometric measurements; 3) action treatment plan/personalized health goals; 4) 2-way communication; and 5) clinical decision support system., Discussion: Each feature was included in only one-third of the studies with a mean of 2.6 mHealth features per study. Studies with statistically significant outcomes used a higher combination of passive and interactive features (69%). In contrast, studies without statistically significant outcomes exclusively used a higher frequency of passive features (46%). Inclusion of behavior change features (ie, plan/goals and mobile diary) were correlated with a higher incident of statistically significant outcomes (100%, 77%)., Conclusion: This exploration is the first step in identifying how types and categories of features impact outcomes. While the findings are inconclusive due to lack of homogeneity, this provides a foundation for future feature analysis.

Mobile health (mHealth) applications may improve chronic disease management through enhanced patient-provider communication and collaboration. The aim of this review was to compare and critique the application of three theoretical frameworks to guide mHealth research and practice in patient-provider interactions.