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Journal Description

JMIR Nursing (JN, Editor-in-Chief: Elizabeth Borycki RN PhD, FIAHIS, FACMI, FCAHS) is a new peer-reviewed journal for nursing in the 21st century. The focus of this journal is original research related to the paradigm change in nursing due to information technology and the shift towards preventative, predictive, personal medicine: 

"In the 21st century the whole foundations of health care are being shaken. Technology is taking service to new heights of portability: less invasive, short-term, and with greater impact on both the length and quality of life. (...)

Time-based nursing care with the activities of bathing, treating, changing, feeding, intervening, drugging, and discharging are quickly becoming historic references to an age of practice that no longer exists. Now the challenge for nursing practice skills relates more to taking on the activities of accessing, informing, guiding, teaching, counseling, typing, and linking. "

(Tim Porter-O'Brady, Nurs Outlook 2001;49:182-6)

JN is a "platinum open access" journal, with currrently no charges for readers or authors.

All papers are rigorously peer-reviewed, copyedited, and XML-typeset, ready for submission in PubMed Central/PubMed.


Recent Articles:

  • Source: iStock by Getty Images; Copyright: monkeybusinessimages; URL:; License: Licensed by the authors.

    Understanding Nursing Workflow for Inpatient Education Delivery: Time and Motion Study


    Background: Diabetes self-management education and support (DSMES) improves diabetes-related outcomes, but many persons living with diabetes do not receive DSMES. Adults with diabetes have high hospitalization rates, so hospital stays may present an opportunity for diabetes education. Nurses, supported by patient care technicians (PCTs), are typically responsible for delivering patient education but often do not have time. Using technology to support education delivery in the hospital is one potentially important solution. Objective: The aim of this study was to evaluate nurse and PCT workflow to identify opportunities for providing education. The results informed implementation of a diabetes education program on a tablet computer in the hospital setting within existing nursing workflow with existing staff. Methods: We conducted a time and motion study of nurses and PCTs on three medical-surgical units of a large urban tertiary care hospital. Five trained observers conducted observations in 2-hour blocks. During each observation, a single observer observed a single nurse or PCT and recorded the tasks, locations, and their durations using a Web-based time and motion data collection tool. Percentage of time spent on a task and in a location and mean duration of task and location sessions were calculated. In addition, the number of tasks and locations per hour, number of patient rooms visited per hour, and mean time between visits to a given patient room were determined. Results: Nurses spent approximately one-third of their time in direct patient care and much of their time (60%) on the unit but not in a patient room. Compared with nurses, PCTs spent a significantly greater percentage of time in direct patient care (42%; P=.001). Nurses averaged 16.2 tasks per hour, while PCTs averaged 18.2. The mean length of a direct patient care session was 3:42 minutes for nurses and 3:02 minutes for PCTs. For nurses, 56% of task durations were 2 minutes or less, and 38% were one minute or less. For PCTs, 62% were 2 minutes or less, and 44% were 1 minute or less. Nurses visited 5.3 and PCTs 9.4 patient rooms per hour. The mean time between visits to a given room was 37:15 minutes for nurses and 33:28 minutes for PCTs. Conclusions: The workflow of nurses and PCTs, constantly in and out of patient rooms, suggests an opportunity for delivering a tablet to the patient bedside. The average time between visits to a given room is consistent with bringing the tablet to a patient in one visit and retrieving it at the next. However, the relatively short duration of direct patient care sessions could potentially limit the ability of nurses and PCTs to spend much time with each patient on instruction in the technology platform or the content.

  • Source: Image created by the Authors; Copyright: The Authors; URL:; License: Licensed by JMIR.

    Four Dissemination Pathways for a Social Media–Based Breastfeeding Campaign: Evaluation of the Impact on Key Performance Indicators


    Background: Social media utilization is on the rise globally, and the potential of social media for health behavior campaigns is widely recognized. However, as the landscape of social media evolves, so do techniques used to optimize campaign dissemination. Objective: The primary aim of this study was to evaluate the impact of 4 material dissemination paths for a breastfeeding social media marketing campaign in Ghana on exposure and engagement with campaign material. Methods: Campaign materials (n=60) were posted to a Facebook and Twitter campaign page over 12 weeks (ie, baseline). The top 40 performing materials were randomized to 1 of 4 redissemination arms (control simply posted on each platform, key influencers, random influencers, and paid advertisements). Key performance indicator data (ie, exposure and engagement) were extracted from both Facebook and Twitter 2 days after the material was posted. A difference-in-difference model was used to examine the impact of the dissemination paths on performance. Results: At baseline, campaign materials received an average (SD) exposure of 1178 (670) on Facebook and 1071 (905) on Twitter (n=60). On Facebook, materials posted with paid advertisements had significantly higher exposure and engagement compared with the control arm (P<.001), and performance of materials shared by either type of influencer did not differ significantly from the control arm. No differences in Twitter performance were detected across arms. Conclusions: Paid advertisements are an effective mechanism to increase exposure and engagement of campaign posts on Facebook, which was achieved at a low cost.

  • Source: The Authors / Placeit; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    Design of a Consumer Mobile Health App for Heart Failure: Findings From the Nurse-Led Co-Design of Care4myHeart


    Background: Consumer health care technology shows potential to improve outcomes for community-dwelling persons with chronic conditions, yet health app quality varies considerably. In partnership with patients and family caregivers, hospital clinicians developed Care4myHeart, a mobile health (mHealth) app for heart failure (HF) self-management. Objective: The aim of this paper was to report the outcomes of the nurse-led design process in the form of the features and functions of the developed app, Care4myHeart. Methods: Seven patients, 4 family caregivers, and 7 multidisciplinary hospital clinicians collaborated in a design thinking process of innovation. The co-design process, involving interviews, design workshops, and prototype feedback sessions, incorporated the lived experience of stakeholders and evidence-based literature in a design that would be relevant and developed with rigor. Results: The home screen displays the priority HF self-management components with a reminder summary, general information on the condition, and a settings tab. The health management section allows patients to list health care team member’s contact details, schedule medical appointments, and store documents. The My Plan section contains 9 important self-management components with a combination of information and advice pages, graphical representation of patient data, feedback, and more. The greatest strength of the co-design process to achieve the design outcomes was the involvement of local patients, family caregivers, and clinicians. Moreover, incorporating the literature, guidelines, and current practices into the design strengthened the relevance of the app to the health care context. However, the strength of context specificity is also a limitation to portability, and the final design is limited to the stakeholders involved in its development. Conclusions: We recommend health app development teams strategically incorporate relevant stakeholders and literature to design mHealth solutions that are rigorously designed from a solid evidence base and are relevant to those who will use or recommend their use.

  • Nurses as stakeholders in mobile technology adoption. Source: Image created by the Authors; Copyright: Carey Mather; URL:; License: Creative Commons Attribution (CC-BY).

    Nurses as Stakeholders in the Adoption of Mobile Technology in Australian Health Care Environments: Interview Study


    Background: The 2017 Australian Digital Health Agency (ADHA) Strategy is based on the underlying assumption that digital technology in health care environments is ubiquitous. The ADHA Strategy views health professionals, especially nurses, as grappling with the complexity of installing and using digital technologies to facilitate personalized and sustainable person-centered care. Yet, ironically, the 2018 debate over how to enroll Australians into the national electronic health record system and its alteration from an opt-in to an opt-out model heightened public and professional concern over what constituted a “safe, seamless and secure” health information system. What can be termed a digital technology paradox has emerged where, although it is widely acknowledged that there are benefits from deploying and using digital technology in the workplace, the perception of risk renders it unavailable or inaccessible at point of care. The inability of nurses to legitimately access and use mobile technology is impeding the diffusion of digital technology in Australian health care environments and undermining the 2017 ADHA Strategy. Objective: This study explored the nature and scope of usability of mobile technology at point of care, in order to understand how current governance structures impacted on access and use of digital technology from an organizational perspective. Methods: Individual semistructured interviews were conducted with 6 representatives from professional nursing organizations. A total of 10 interview questions focused on factors that impacted the use of mobile technology for learning at point of care. Seven national organizations and 52 members from the Coalition of National Nursing and Midwifery Organisations were invited to participate. Interviews were recorded and transcribed verbatim. Data analysis was systematic and organized, consisting of trial coding; member checking was undertaken to ensure rigor. A codebook was developed to provide a framework for analysis to identify the themes latent in the transcribed data. Nurses as stakeholders emerged as a key theme. Results: Out of 6 participants, 4 female (67%) and 2 male (33%) senior members of the nursing profession were interviewed. Each interview lasted between 17 and 54 minutes, which reflected the knowledge of participants regarding the topic of interest and their availability. Two subthemes, coded as ways of thinking and ways of acting, emerged from the open codes. Participants provided examples of the factors that impacted the capacity of nurses to adopt digital technology from an emic perspective. There were contributing factors that related to actions, including work-arounds, attentiveness, and experiences. Nurses also indicated that there were attitudes and influences that impacted thinking regarding access and use of mobile technology at point of care. Conclusions: Nurses are inadequately prepared for the digital future that has now arrived in health care environments. Nurses do not perceive that they are leaders in decision making regarding digital technology adoption, nor are they able to facilitate digital literacy or model digital professionalism.

  • Nurse showing patient a website. Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Primary Health Care Nurses’ Experiences of Consultations With Internet-Informed Patients: Qualitative Study


    Background: Most people in modern societies now use the Internet to obtain health-related information. By giving patients knowledge, digital health information is considered to increase patient involvement and patient-centered interactions in health care. However, concerns are raised about the varying quality of health-related websites and low health literacy in the population. There is a gap in the current knowledge of nurses’ experiences with Internet-informed patients. Objective: The objective of this study was to explore primary health care nurses’ experiences of consultations with patients who present health-related information from the Internet. Methods: This is a qualitative study based on interviews with 9 primary health care nurses. Data were analyzed using qualitative content analysis. Results are reported according to the consolidated criteria for reporting qualitative research guidelines. Results: The phenomenon of Internet-informed patients was considered to change the usual rules in health care, affecting attributes and actions of patients, patterns of interactions in consultations, and roles of nurses and patients. Three categories were identified: (1) Facing the downsides of Googling, (2) Patients as main actors, and (3) Nurse role challenged. Although the benefits of health-related Internet information were described, its negative consequences were emphasized overall. The problems were mainly ascribed to inaccurate Internet information and patients’ inability to effectively manage the information. Conclusions: Our study suggests ambivalent attitudes among nurses toward health-related Internet information. In order to promote equitable care in the digital era, increased awareness in health care about useful strategies for overcoming the difficulties and embracing the benefits of conferring with Internet-informed patients seems to be a legitimate goal.

  • Source: freepik; Copyright: katemangostar; URL:; License: Licensed by JMIR.

    The Needs and Barriers of Medication-Taking Self-Efficacy Among Poststroke Patients: Qualitative Study


    Background: Stroke is one of the top 10 leading diseases worldwide, with high mortality and morbidity rates. There is an incomplete understanding of the various types of self-efficacy involved in the prevention of recurrent stroke, and one of them is medication-taking self-efficacy. Objective: This study aimed to explore the fundamental needs and barriers of medication-taking self-efficacy in poststroke patients in Malaysia. Methods: We performed in-depth individual interviews with poststroke patients (N=10) from the Outpatient Neurology Clinic, Hospital Kuala Lumpur. All interviews were transcribed verbatim, and an inductive thematic analysis was performed on the data collected from the interviews. Results: Two key themes were identified: (1) self-efficacy in taking the effort to understand stroke and its preventative treatment for recurrent stroke and (2) self-efficacy in taking prescribed medication to prevent stroke. Patients needed to be proactive in seeking reliable information about stroke and the perceived benefits of preventative treatment for stroke. The discussion was focused on eliciting the needs and barriers related to medication-taking self-efficacy. Patients needed to develop independence and self-reliance to overcome barriers such as dependency and low motivation. External factors such as limited information resources, low perceived severity, poor social environment, and poor communication add to the challenges of poststroke patients to improve their self-efficacy of managing their medications. Conclusions: The study identified potential key findings related to the needs of patients in a localized setting, which are also related to several health behavioral concepts and constructs, indicating the importance of overcoming barriers to improve the quality of life in poststroke patients. We anticipate that the results will be taken into consideration for future personalized patient education interventions.

  • Murray Mom. Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Advancing the Science of Recruitment for Family Caregivers: Focus Group and Delphi Methods


    Background: Successful recruitment of participants is imperative to a rigorous study, and recruitment challenges are not new to researchers. Many researchers have used social media successfully to recruit study participants. However, challenges remain for effective online social media recruitment for some populations. Objective: Using a multistep approach that included a focus group and Delphi method, researchers performed this study to gain expert advice regarding material development for social media recruitment and to test the recruitment material with the target population. Methods: In the first phase, we conducted a focus group with 5 social media experts to identify critical elements for effective social media recruitment material. Utilizing the Delphi method with 5 family caregivers, we conducted the second phase to reach consensus regarding effective recruitment videos. Results: Phase I utilized a focus group that resulted in identification of three barriers related to social media recruitment, including lack of staff and resources, issues with restrictive algorithms, and not standing out in the crowd. Phase II used the Delphi method. At the completion of Delphi Round 1, 5 Delphi participants received a summary of the analysis for feedback and agreement with our summary. Using data and recommendations from Round 1, researchers created two new recruitment videos with additions to improve trustworthiness and transparency, such as the university’s logo. In Round 2 of the Delphi method, consensus regarding the quality and trustworthiness of the recruitment videos reached 100%. Conclusions: One of the primary challenges for family caregiver research is recruitment. Despite the broad adoption of social media marketing approaches, the effectiveness of online recruitment strategies needs further investigation.

  • Source: iStock by Getty Images; Copyright: Cecilie_Arcurs; URL:; License: Licensed by the authors.

    Nursing Unit Communication During a US Public Health Emergency: Natural Experiment


    Background: In the second half of 2014, the first case of Ebola virus disease (EVD) was diagnosed in the United States. During this time period, we were collecting data for the Measuring Network Stability and Fit (NetFIT) longitudinal study, which used social network analysis (SNA) to study relationships between nursing staff communication patterns and patient outcomes. One of the data collection sites was a few blocks away from where the initial EVD diagnosis was made. The EVD public health emergency during the NetFIT data collection time period resulted in the occurrence of a natural experiment. Objective: The objectives of the NetFIT study were to examine the structure of nursing unit decision-making and information-sharing networks, identify a parsimonious set of network metrics that can be used to measure the longitudinal stability of these networks, examine the relationship between the contextual features of a unit and network metrics, and identify relationships between key network measures and nursing-sensitive patient-safety and quality outcomes. This paper reports on unit communication and outcome changes that occurred during the EVD natural disaster time period on the 10 hospital units that had data collected before, during, and after the crisis period. Methods: For the NetFIT study, data were collected from nursing staff working on 25 patient care units, in three hospitals, and at four data collection points over a 7-month period: Baseline, Month 1, Month 4, and Month 7. Data collection was staggered by hospital and unit. To evaluate the influence of this public health emergency on nursing unit outcomes and communication characteristics, this paper focuses on a subsample of 10 units from two hospitals where data were collected before, during, and after the EVD crisis period. No data were collected from Hospital B during the crisis period. Network data from individual staff were aggregated to the nursing unit level to create 24-hour networks and three unit-level safety outcome measures—fall rate, medication errors, and hospital-acquired pressure ulcers—were collected. Results: This analysis includes 40 data collection points and 608 staff members who completed questionnaires. Participants (N=608) included registered nurses (431, 70.9%), licensed vocational nurses (3, 0.5%), patient care technicians (133, 21.9%), unit clerks (28, 4.6%), and monitor watchers (13, 2.1%). Changes in SNA metrics associated with communication (ie, average distance, diffusion, and density) were noted in units that had changes in patient safety outcome measures. Conclusions: Units in the hospital site in the same city as the EVD case exhibited multiple changes in patient outcomes, network communication metrics, and response rates. Future research using SNA to examine the influence of public health emergencies on hospital communication networks and relationships to patient outcomes is warranted.

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  • Understanding Complex Factors That Influence the Adoption and Use of Electronic Nursing Documentation: A Scoping Review

    Date Submitted: Nov 1, 2019

    Open Peer Review Period: Nov 1, 2019 - Dec 27, 2019

    Background: While the basic intent of all nursing documentation is to be representative of what the nurse does with and for the patient, each nursing professional association has identified and legisl...

    Background: While the basic intent of all nursing documentation is to be representative of what the nurse does with and for the patient, each nursing professional association has identified and legislated documentation standards. Despite these standards, several challenges exist leading to documentation burden and ultimately the introduction of electronic nursing documentation to support evidence-based care. Objective: The objective of this scoping review was to evaluate the complex factors including enablers, mediating/moderating factors and barriers that influence adoption and use, and its outputs related to electronic clinical documentation by nurses. The analysis of the data will advance an understanding of the factors influence adoption of electronic nursing documentation and the resulting output. Methods: A scoping review of literature was conducted on electronic nursing documentation. The reviewers utilized the Arksey and O’Malley methodological framework for all five stages of the scoping review. Results: Following the data-charting phase, 13 key themes were identified in articles that discussed factors that influence the adoption of electronic nursing documentation. The dominant and recurring themes were grouped according to the category they aligned with (i.e. structure, process, or outcomes) within the Donabedian Framework. Conclusions: Factors that influence the adoption of electronic nursing documentation are multifactorial, interrelated and require careful consideration for implementation and support. A thorough evaluation of structures, processes, and individual user characteristics are required to understand the root causes of adoption levels and potential mitigating factors. Further research is required to understand the impacts that adoption has on clinical outcomes.