%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e20184 %T Improving Patient Prioritization During Hospital-Homecare Transition: Protocol for a Mixed Methods Study of a Clinical Decision Support Tool Implementation %A Zolnoori,Maryam %A McDonald,Margaret V %A Barrón,Yolanda %A Cato,Kenrick %A Sockolow,Paulina %A Sridharan,Sridevi %A Onorato,Nicole %A Bowles,Kathryn %A Topaz,Maxim %+ Center for Home Care Policy & Research, Visiting Nurse Service of New York, 5 Penn Plaza, 12th floor, New York, NY, 10001, United States, 1 (212) 609 1774, maxim.topaz@vnsny.org %K clinical decision support system %K homecare agencies %K rehospitalization %K RE-AIM framework %K PREVENT %K effective implementation %D 2021 %7 22.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Homecare settings across the United States provide care to more than 5 million patients every year. About one in five homecare patients are rehospitalized during the homecare episode, with up to two-thirds of these rehospitalizations occurring within the first 2 weeks of services. Timely allocation of homecare services might prevent a significant portion of these rehospitalizations. The first homecare nursing visit is one of the most critical steps of the homecare episode. This visit includes an assessment of the patient’s capacity for self-care, medication reconciliation, an examination of the home environment, and a discussion regarding whether a caregiver is present. Hence, appropriate timing of the first visit is crucial, especially for patients with urgent health care needs. However, nurses often have limited and inaccurate information about incoming patients, and patient priority decisions vary significantly between nurses. We developed an innovative decision support tool called Priority for the First Nursing Visit Tool (PREVENT) to assist nurses in prioritizing patients in need of immediate first homecare nursing visits. Objective: This study aims to evaluate the effectiveness of the PREVENT tool on process and patient outcomes and to examine the reach, adoption, and implementation of PREVENT. Methods: Employing a pre-post design, survival analysis, and logistic regression with propensity score matching analysis, we will test the following hypotheses: compared with not using the tool in the preintervention phase, when homecare clinicians use the PREVENT tool, high-risk patients in the intervention phase will (1) receive more timely first homecare visits and (2) have decreased incidence of rehospitalization and have decreased emergency department use within 60 days. Reach, adoption, and implementation will be assessed using mixed methods including homecare admission staff interviews, think-aloud observations, and analysis of staffing and other relevant data. Results: The study research protocol was approved by the institutional review board in October 2019. PREVENT is currently being integrated into the electronic health records at the participating study sites. Data collection is planned to start in early 2021. Conclusions: Mixed methods will enable us to gain an in-depth understanding of the complex socio-technological aspects of the hospital to homecare transition. The results have the potential to (1) influence the standardization and individualization of nurse decision making through the use of cutting-edge technology and (2) improve patient outcomes in the understudied homecare setting. Trial Registration: ClinicalTrials.gov NCT04136951; https://clinicaltrials.gov/ct2/show/NCT04136951 International Registered Report Identifier (IRRID): PRR1-10.2196/20184 %M 33480855 %R 10.2196/20184 %U https://www.researchprotocols.org/2021/1/e20184 %U https://doi.org/10.2196/20184 %U http://www.ncbi.nlm.nih.gov/pubmed/33480855 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e23939 %T Predicted Influences of Artificial Intelligence on the Domains of Nursing: Scoping Review %A Buchanan,Christine %A Howitt,M Lyndsay %A Wilson,Rita %A Booth,Richard G %A Risling,Tracie %A Bamford,Megan %+ Registered Nurses' Association of Ontario, 500-4211 Yonge Street, Toronto, ON, M2P 2A9, Canada, 1 800 268 7199 ext 281, cbuchanan@rnao.ca %K nursing %K artificial intelligence %K machine learning %K robotics %K patient-centered care %K review %D 2020 %7 17.12.2020 %9 Review %J JMIR Nursing %G English %X Background: Artificial intelligence (AI) is set to transform the health system, yet little research to date has explored its influence on nurses—the largest group of health professionals. Furthermore, there has been little discussion on how AI will influence the experience of person-centered compassionate care for patients, families, and caregivers. Objective: This review aims to summarize the extant literature on the emerging trends in health technologies powered by AI and their implications on the following domains of nursing: administration, clinical practice, policy, and research. This review summarizes the findings from 3 research questions, examining how these emerging trends might influence the roles and functions of nurses and compassionate nursing care over the next 10 years and beyond. Methods: Using an established scoping review methodology, MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central, Education Resources Information Center, Scopus, Web of Science, and ProQuest databases were searched. In addition to the electronic database searches, a targeted website search was performed to access relevant gray literature. Abstracts and full-text studies were independently screened by 2 reviewers using prespecified inclusion and exclusion criteria. Included articles focused on nursing and digital health technologies that incorporate AI. Data were charted using structured forms and narratively summarized. Results: A total of 131 articles were retrieved from the scoping review for the 3 research questions that were the focus of this manuscript (118 from database sources and 13 from targeted websites). Emerging AI technologies discussed in the review included predictive analytics, smart homes, virtual health care assistants, and robots. The results indicated that AI has already begun to influence nursing roles, workflows, and the nurse-patient relationship. In general, robots are not viewed as replacements for nurses. There is a consensus that health technologies powered by AI may have the potential to enhance nursing practice. Consequently, nurses must proactively define how person-centered compassionate care will be preserved in the age of AI. Conclusions: Nurses have a shared responsibility to influence decisions related to the integration of AI into the health system and to ensure that this change is introduced in a way that is ethical and aligns with core nursing values such as compassionate care. Furthermore, nurses must advocate for patient and nursing involvement in all aspects of the design, implementation, and evaluation of these technologies. International Registered Report Identifier (IRRID): RR2-10.2196/17490 %R 10.2196/23939 %U https://nursing.jmir.org/2020/1/e23939/ %U https://doi.org/10.2196/23939 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e24521 %T Academic Nurse-Managed Community Clinics Transitioning to Telehealth: Case Report on the Rapid Response to COVID-19 %A Sutter,Rebecca %A Cuellar,Alison E %A Harvey,Megan %A Hong,Y Alicia %+ Department of Health Administration and Policy, College of Health and Human Services, George Mason University, 4400 University Dr, MS 1J3, Fairfax, VA, 22030, United States, 1 7039931929, yhong22@gmu.edu %K telehealth %K telemedicine %K COVID-19, nurse practitioners %K safety net clinics %K community clinics %K nurse %K clinic %K transition %D 2020 %7 1.12.2020 %9 Original Paper %J JMIR Nursing %G English %X Background: In response to the COVID-19 pandemic, many health care organizations have adopted telehealth. The current literature on transitioning to telehealth has mostly been from large health care or specialty care organizations, with limited data from safety net or community clinics. Objective: This is a case report on the rapid implementation of a telehealth hub at an academic nurse-managed community clinic in response to the national COVID-19 emergency. We also identify factors of success and challenges associated with the transition to telehealth. Methods: This study was conducted at the George Mason University Mason and Partners clinic, which serves the dual mission of caring for community clinic patients and providing health professional education. We interviewed the leadership team of Mason and Partners clinics and summarized our findings. Results: Mason and Partners clinics reacted quickly to the COVID-19 crisis and transitioned to telehealth within 2 weeks of the statewide lockdown. Protocols were developed for a coordination hub, a main patient triage and appointment telephone line, a step-by-step flowchart of clinical procedure, and a team structure with clearly defined work roles and backups. The clinics were able to maintain most of its clinical service and health education functions while adapting to new clinic duties that arose during the pandemic. Conclusions: The experiences learned from the Mason and Partners clinics are transferable to other safety net clinics and academic nurse-led community clinics. The changes arising from the pandemic have resulted in sustainable procedures, and these changes will have a long-term impact on health care delivery and training. %M 33496682 %R 10.2196/24521 %U https://nursing.jmir.org/2020/1/e24521/ %U https://doi.org/10.2196/24521 %U http://www.ncbi.nlm.nih.gov/pubmed/33496682 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e17509 %T Acceptability of Using a Robotic Nursing Assistant in Health Care Environments: Experimental Pilot Study %A Saadatzi,Mohammad Nasser %A Logsdon,M Cynthia %A Abubakar,Shamsudeen %A Das,Sumit %A Jankoski,Penelope %A Mitchell,Heather %A Chlebowy,Diane %A Popa,Dan O %+ Electrical and Computer Engineering Department, University of Louisville, 2210 S Brook St, Louisville, KY, 40208, United States, 1 502 852 5555, nasser_saadatzi@yahoo.com %K robot-assisted healthcare %K robotic nurse assistant %K technology acceptance model %K user acceptability %K patient walking %D 2020 %7 12.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: According to the US Bureau of Labor Statistics, nurses will be the largest labor pool in the United States by 2022, and more than 1.1 million nursing positions have to be filled by then in order to avoid a nursing shortage. In addition, the incidence rate of musculoskeletal disorders in nurses is above average in comparison with other occupations. Robot-assisted health care has the potential to alleviate the nursing shortage by automating mundane and routine nursing tasks. Furthermore, robots in health care environments may assist with safe patient mobility and handling and may thereby reduce the likelihood of musculoskeletal disorders. Objective: This pilot study investigates the perceived ease of use and perceived usefulness (acceptability) of a customized service robot as determined by nursing students (as proxies for nursing staff in health care environments). This service robot, referred to as the Adaptive Robotic Nurse Assistant (ARNA), was developed to enhance the productivity of nurses through cooperation during physical tasks (eg, patient walking, item fetching, object delivery) as well as nonphysical tasks (eg, patient observation and feedback). This pilot study evaluated the acceptability of ARNA to provide ambulatory assistance to patients. Methods: We conducted a trial with 24 participants to collect data and address the following research question: Is the use of ARNA as an ambulatory assistive device for patients acceptable to nurses? The experiments were conducted in a simulated hospital environment. Nursing students (as proxies for nursing staff) were grouped in dyads, with one participant serving as a nurse and the other acting as a patient. Two questionnaires were developed and administrated to the participants based on the Technology Acceptance Model with respect to the two subscales of perceived usefulness and perceived ease of use metrics. In order to evaluate the internal consistency/reliability of the questionnaires, we calculated Cronbach alpha coefficients. Furthermore, statistical analyses were conducted to evaluate the relation of each variable in the questionnaires with the overall perceived usefulness and perceived ease of use metrics. Results: Both Cronbach alpha values were acceptably high (.93 and .82 for perceived usefulness and perceived ease of use questionnaires, respectively), indicating high internal consistency of the questionnaires. The correlation between the variables and the overall perceived usefulness and perceived ease of use metrics was moderate. The average perceived usefulness and perceived ease of use metrics among the participants were 4.13 and 5.42, respectively, out of possible score of 7, indicating a higher-than-average acceptability of this service robot. Conclusions: The results served to identify factors that could affect nurses’ acceptance of ARNA and aspects needing improvement (eg, flexibility, ease of operation, and autonomy level). %M 33180024 %R 10.2196/17509 %U http://www.jmir.org/2020/11/e17509/ %U https://doi.org/10.2196/17509 %U http://www.ncbi.nlm.nih.gov/pubmed/33180024 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e20282 %T How the Integration of Telehealth and Coordinated Care Approaches Impact Health Care Service Organization Structure and Ethos: Mixed Methods Study %A Davidson,Rosemary %A Barrett,David Ian %A Rixon,Lorna %A Newman,Stanton %A , %+ Institute for Health Research, University of Bedfordshire, University Square, Luton, LU1 3JU, United Kingdom, 44 1234 400 400, rosemary.davidson@beds.ac.uk %K coordinated care %K telehealth %K health care organization %K staff engagement %K staff training %D 2020 %7 9.10.2020 %9 Original Paper %J JMIR Nursing %G English %X Background: Coordinated care and telehealth services have the potential to deliver quality care to chronically ill patients. They can both reduce the economic burden of chronic care and maximize the delivery of clinical services. Such services require new behaviors, routines, and ways of working to improve health outcomes, administrative efficiency, cost-effectiveness, and user (patient and health professional) experience. Objective: The aim of this study was to assess how health care organization setup influences the perceptions and experience of service managers and frontline staff during the development and deployment of integrated care with and without telehealth. Methods: As part of a multinational project exploring the use of coordinated care and telehealth, questionnaires were sent to service managers and frontline practitioners. These questionnaires gathered quantitative and qualitative data related to organizational issues in the implementation of coordinated care and telehealth. Three analytical stages were followed: (1) preliminary analysis for a direct comparison of the responses of service managers and frontline staff to a range of organizational issues, (2) secondary analysis to establish statistically significant relationships between baseline and follow-up questionnaires, and (3) thematic analysis of free-text responses of service managers and frontline staff. Results: Both frontline practitioners and managers highlighted that training, tailored to the needs of different professional groups and staff grades, was a crucial element in the successful implementation of new services. Frontline staff were markedly less positive than managers in their views regarding the responsiveness of their organization and the pace of change. Conclusions: The data provide evidence that the setup of health care services is positively associated with outcomes in several areas, particularly tailored staff training, rewards for good service, staff satisfaction, and patient involvement. %R 10.2196/20282 %U https://nursing.jmir.org/2020/1/e20282/ %U https://doi.org/10.2196/20282 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e22118 %T Experiences of Complex Patients With Telemonitoring in a Nurse-Led Model of Care: Multimethod Feasibility Study %A Gordon,Kayleigh %A Dainty,Katie N %A Steele Gray,Carolyn %A DeLacy,Jane %A Shah,Amika %A Resnick,Myles %A Seto,Emily %+ Dalla Lana School of Public Health, University of Toronto, Institute for Health Policy, Management, & Evaluation, 155 College St. 4th Floor, Toronto, ON, Canada, 1 416 978 4326, kayleigh.gordon@mail.utoronto.ca %K telemonitoring %K adherence %K patient experience %K complex patients %K normalization process theory %K implementation %K mobile phone %D 2020 %7 29.9.2020 %9 Original Paper %J JMIR Nursing %G English %X Background: Telemonitoring (TM) interventions have been designed to support care delivery and engage patients in their care at home, but little research exists on TM of complex chronic conditions (CCCs). Given the growing prevalence of complex patients, an evaluation of multi-condition TM is needed to expand TM interventions and tailor opportunities to manage complex chronic care needs. Objective: This study aims to evaluate the feasibility and patients’ perceived usefulness of a multi-condition TM platform in a nurse-led model of care. Methods: A pragmatic, multimethod feasibility study was conducted with patients with heart failure (HF), hypertension (HTN), and/or diabetes. Patients were asked to take physiological readings at home via a smartphone-based TM app for 6 months. The recommended frequency of taking readings was dependent on the condition, and adherence data were obtained through the TM system database. Patient questionnaires were administered, and patient interviews were conducted at the end of the study. An inductive analysis was performed, and codes were then mapped to the normalization process theory and Implementation Outcomes constructs by Proctor. Results: In total, 26 participants were recruited, 17 of whom used the TM app for 6 months. Qualitative interviews were conducted with 14 patients, and 8 patients were interviewed with their informal caregiver present. Patient adherence was high, with patients with HF taking readings on average 76.6% (141/184) of the days they were asked to use the system and patients with diabetes taking readings on average 72% (19/26) of the days. The HTN adherence rate was 55% (29/52) of the days they were asked to use the system. The qualitative findings of the patient experience can be grouped into 4 main themes and 13 subthemes. The main themes were (1) making sense of the purpose of TM, (2) engaging and investing in TM, (3) implementing and adopting TM, and (4) perceived usefulness and the perceived benefits of TM in CCCs. Conclusions: Multi-condition TM in nurse-led care was found to be feasible and was perceived as useful. Patients accepted and adopted the technology by demonstrating a moderate to high level of adherence across conditions. These results demonstrate how TM can address the needs of patients with CCCs through virtual TM assessments in a nurse-led care model by supporting patient self-care and keeping patients connected to their clinical team. %R 10.2196/22118 %U https://nursing.jmir.org/2020/1/e22118/ %U https://doi.org/10.2196/22118 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e16318 %T Using the Self-Management Assessment Scale for Screening Support Needs in Type 2 Diabetes: Qualitative Study %A Öberg,Ulrika %A Orre,Carl Johan %A Hörnsten,Åsa %A Jutterström,Lena %A Isaksson,Ulf %+ Department of Nursing, Umeå University, Lasarettsbacken 7, Umeå, 907 46, Sweden, 46 (0)90 786 6374, ulrika.oberg@umu.se %K eHealth %K internet %K type 2 diabetes %K self-management %K primary health care %K qualitative research %K nursing %D 2020 %7 15.9.2020 %9 Original Paper %J JMIR Nursing %G English %X Background: Globally, most countries face a common challenge by moving toward a population-based structure with an increasing number of older people living with chronic conditions such as type 2 diabetes. This creates a considerable burden on health care services. The use of digital tools to tackle health care challenges established views on traditional nursing, based on face-to-face meetings. Self-management is considered a key component of chronic care and can be defined as management of the day-to-day impact of a condition, something that is often a lifelong task. The use of a screening instrument, such as the Self-Management Assessment Scale (SMASc), offers the potential to guide primary health care nurses into person-centered self-management support, which in turn can help people strengthen their empowerment and self-management capabilities. However, research on self-management screening instruments is sparse, and no research on nurses’ experiences using a digitalized scale for measuring patients’ needs for self-management support in primary health care settings has been found. Objective: This paper describes diabetes specialist nurses’ (DSNs) experiences of a pilot implementation of the SMASc instrument as the basis for person-centered digital self-management support. Methods: This qualitative study is based on observations and interviews analyzed using qualitative content analysis. Results: From the perspectives of DSNs, the SMASc instrument offers insights that contribute to strengthened self-management support for people with type 2 diabetes by providing a new way of thinking and acting on the patient’s term. Furthermore, the SMASc was seen as a screening instrument with good potential that embraces more than medical issues; it contributed to strengthening person-centered self-management support, and the instrument was considered to lead both parts, that is, DSNs and patients, to develop together through collaboration. Conclusions: Person-centered care is advocated as a model for good clinical practice; however, this is not always complied with. Screening instruments, such as the SMASc, may empower both nurses and patients with type 2 diabetes with more personalized care. Using a screening instrument in a patient meeting may also contribute to a role change in the work and practice of DSNs. %R 10.2196/16318 %U https://nursing.jmir.org/2020/1/e16318/ %U https://doi.org/10.2196/16318 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 3 %N 1 %P e16714 %T Delivering Clinical Skin Examination Education to Nurse Practitioners Using an Internet-Based, Microlearning Approach: Development and Feasibility of a Video Intervention %A Stratton,Delaney B %A Shea,Kimberly D %A Knight,Elizabeth P %A Loescher,Lois J %+ College of Nursing, The University of Arizona, 1305 N Martin Ave, Tucson, AZ, 85721, United States, 1 4802136556, dstratton@email.arizona.edu %K microlearning %K clinical skin examination %K primary care %K nurse practitioners %K melanoma %K skin cancer %D 2020 %7 27.7.2020 %9 Original Paper %J JMIR Dermatol %G English %X Background: Skin cancer is the most common cancer; survival of the most serious skin cancers and malignant melanomas depends on early detection. Early detection relies on accessibility to clinical skin examination (CSE). Primary care nurse practitioners (PCNPs) are well-positioned to conduct CSEs; however, they require further education on CSE and have time constraints for continuing education. A digitally delivered intervention grounded in microlearning is a promising approach to deliver new information over a brief period. Objective: Our objective was to develop and explore the feasibility of implementing a 1-week digital video intervention with content on CSE skills, defined as melanoma risk assessment, head-to-toe skin examination, and pigmented lesion assessment, for PCNPs. Specific aims were as follows: (1) Aim 1: to develop three microlearning-based melanoma videos with content on CSE that are suitable for digital delivery to PCNPs in various formats and (2) Aim 2: to assess the feasibility of the video intervention, including enrollment and retention rates, adherence, and acceptability and usability of the video intervention. Methods: For Aim 1, the research team created storyboards for videos that addressed each CSE skill. An expert panel of three dermatologists reviewed the storyboards and videos for relevance, comprehension, and clarity using the content validity index (CVI). The panel evaluated the usability of the video intervention delivery by Research Electronic Data Capture (REDCap) and Vimeo using the System Usability Scale (SUS) and technical video production using Beaudin and Quick’s Quality Evaluation of Video (QEV). Aim 2 evaluated enrollment and retention rates of PCNPs, based on metrics from previous studies of CSE in the literature, and video intervention adherence. SUS and the Attitudes toward Web-based Continuing Learning Survey (AWCL) assessed usability and acceptability. Results: CVI scores indicated relevance and clarity for each video: mean scores ranged from 3.79 to 4, where 4 indicated the video was highly relevant and very clear. The integration of REDCap and Vimeo was usable: the SUS score was 96, where 0 was the worst and 100 was the best. The digital delivery of the videos was rated as exceptional on all five technical items: the mean score was 5, where scores ranged from 1 (poor) to 5 (exceptional). Of the 32 PCNPs who were sent emails, 12 enrolled (38%) and, out of these 12, 10 (83%) completed the intervention and the surveys. Video intervention adherence was ≤50%. Participants rated the usability as better (mean 85.8, SD 10.6; better=70-90) and favorably ranked the acceptability of the AWCL’s constructs of perceived usefulness (mean 5.26, SD 0.08), perceived ease of use (mean 5.40, SD 0.41), behavior (mean 5.53, SD 0.12), and affection (mean 5.77, SD 0.04), where scores ranged from 1 (strongly disagree) to 7 (strongly agree). Conclusions: The video intervention was feasible to deliver to PCNPs using a digital, microlearning approach. The findings provide support for using the videos as an intervention in a future pilot randomized trial targeting behavioral CSE outcomes among PCNPs and other primary care providers. %R 10.2196/16714 %U http://derma.jmir.org/2020/1/e16714/ %U https://doi.org/10.2196/16714 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e17113 %T Experiences With Developing and Using Vital Sign Telemonitoring to Support Mobile Nursing in Rural Regions: Feasibility and Usability Study %A Schweitzer,Marco %A Huber,Lukas %A Gorfer,Thilo %A Hörbst,Alexander %+ Institute for Biomedical Computer Sciences and Mechatronics, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, Hall in Tyrol, 6060, Austria, 43 50 8648 300, marco.schweitzer@umit.at %K mobile health %K telemedicine %K vital signs %K health monitoring %K mobile nursing %D 2020 %7 23.4.2020 %9 Original Paper %J JMIR Nursing %G English %X Background: Modern information and communication technology has the potential to support mobile care in rural regions such as the Alpine region, which is characterized by long distances or even physically unreachable areas. Objective: This study investigated the potential of supporting mobile nursing organizations in rural regions with the use of mobile telemonitoring systems in a case study setting. Methods: As a subproject of the European Union–funded project INTESI, the VITAl parameter MOnitoring (VITAMO) project gathered stakeholders’ requirements for telemonitoring support of mobile care in rural regions and then developed and implemented a prototype system that was used for a 3-month test period with a local nursing organization in Austria. Log analysis, surveys, and interviews were used to evaluate the system according to the Technology Acceptance Model. The focus was technology assessment and user satisfaction of both patients and nurses. Results: Participants were provided Bluetooth devices to measure blood pressure, body weight, and blood glucose and to track activity. They also received a tablet with a mobile internet connection to see the results. The nurses were able to access the results remotely. Regularly executed speed tests and log analysis demonstrated the availability of high-speed mobile internet in the rural test region. Log analysis, surveys, and interviews revealed the suitability of the technology environment and showed that the system was easy to use and potentially useful. The perceived usefulness for supporting mobile care was rated meaningfully low, and the frequency of nurses using the tool declined continuously over the field test period. Further group discussions investigated this issue. Conclusions: While the technology environment with mobile internet, Bluetooth devices, and smart vital sign monitoring devices was adequate and suitable to support mobile nursing in rural regions, the potential benefit for the nursing organization could not be confirmed. Further analysis revealed that operational care processes did not follow a well-defined care strategy. Technology has the potential to leverage the available environment for developing meaningful solutions. These experiences could contribute to further investigations that need to identify and analyze existing mobile care processes at an organizational level. %R 10.2196/17113 %U https://nursing.jmir.org/2020/1/e17113/ %U https://doi.org/10.2196/17113 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 5 %N 2 %P e17309 %T Assessment of Training Outcomes of Nurse Readers for Diabetic Retinopathy Telescreening: Validation Study %A Boucher,Marie Carole %A Nguyen,Michael Trong Duc %A Qian,Jenny %+ Maisonneuve-Rosemont Ophthalmology University Center, Department of Ophthalmology, Université de Montréal, 5415, de l’Assomption, Montreal, QC, H1T 2M4, Canada, 1 514 252 3400 ext 4959, mariecarole@gmail.com %K training %K teleophthalmology %K telemedicine %K diabetic retinopathy %K screening %K referral %K nurse %D 2020 %7 7.4.2020 %9 Original Paper %J JMIR Diabetes %G English %X Background: With the high prevalence of diabetic retinopathy and its significant visual consequences if untreated, timely identification and management of diabetic retinopathy is essential. Teleophthalmology programs have assisted in screening a large number of individuals at risk for vision loss from diabetic retinopathy. Training nonophthalmological readers to assess remote fundus images for diabetic retinopathy may further improve the efficiency of such programs. Objective: This study aimed to evaluate the performance, safety implications, and progress of 2 ophthalmology nurses trained to read and assess diabetic retinopathy fundus images within a hospital diabetic retinopathy telescreening program. Methods: In this retrospective interobserver study, 2 ophthalmology nurses followed a specific training program within a hospital diabetic retinopathy telescreening program and were trained to assess diabetic retinopathy images at 2 levels of intervention: detection of diabetic retinopathy (level 1) and identification of referable disease (level 2). The reliability of the assessment by level 1−trained readers in 266 patients and of the identification of patients at risk of vision loss from diabetic retinopathy by level 2−trained readers in 559 more patients were measured. The learning curve, sensitivity, and specificity of the readings were evaluated using a group consensus gold standard. Results: An almost perfect agreement was measured in identifying the presence of diabetic retinopathy in both level 1 readers (κ=0.86 and 0.80) and in identifying referable diabetic retinopathy by level 2 readers (κ=0.80 and 0.83). At least substantial agreement was measured in the level 2 readers for macular edema (κ=0.79 and 0.88) for all eyes. Good screening threshold sensitivities and specificities were obtained for all level readers, with sensitivities of 90.6% and 96.9% and specificities of 95.1% and 85.1% for level 1 readers (readers A and B) and with sensitivities of 86.8% and 91.2% and specificities of 91.7% and 97.0% for level 2 readers (readers A and B). This performance was achieved immediately after training and remained stable throughout the study. Conclusions: Notwithstanding the small number of trained readers, this study validates the screening performance of level 1 and level 2 diabetic retinopathy readers within this training program, emphasizing practical experience, and allows the establishment of an ongoing assessment clinic. This highlights the importance of supervised, hands-on experience and may help set parameters to further calibrate the training of diabetic retinopathy readers for safe screening programs. %M 32255431 %R 10.2196/17309 %U https://diabetes.jmir.org/2020/2/e17309 %U https://doi.org/10.2196/17309 %U http://www.ncbi.nlm.nih.gov/pubmed/32255431 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 3 %P e15709 %T Impact of Motivational Interviewing on Self-Management in Patients With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial %A Wong,Man Kin %A Cheng,Sai Yip Ronald %A Chu,Tsun Kit %A Lam,Fung Yee %A Lai,Shiu Kee %A Wong,Kai Chung %A Liang,Jun %+ Department of Family Medicine and Primary Health Care, Tuen Mun Hospital, New Territories West Cluster, 23 Tsing Chung Koon Road, Tuen Mun,, New Territories, Hong Kong, 852 24685111, man_kin1130@yahoo.com.hk %K motivational interviewing %K diabetes %K nurse %K usual care %K self-management %K self-care %D 2020 %7 31.3.2020 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The nonpharmacological approach to diabetic control in patients with diabetes focuses on a healthy diet, physical activity, and self-management. Therefore, to help patients change their habits, it is essential to identify the most effective approach. Many efforts have been devoted to explain changes in or adherence to specific health behaviors. Such efforts have resulted in the development of theories that have been applied in prevention campaigns and include brief advice and counseling services. Within this context, motivational interviewing (MI) has proven to be effective in changing health behaviors for specific cases. However, stronger evidence is needed on the effectiveness of MI in treating chronic pathologies such as diabetes. Objective: This study will obtain preliminary data on the impact of a nurse-led MI intervention in improving glycemic control, as well as clinical, psychosocial, and self-care outcomes for individuals with type 2 diabetes mellitus when compared with usual care, with the aim of improving diabetic control in patients with diabetes. Methods: An open, two-arm, parallel, randomized controlled, pilot exploratory trial will be performed. Two government outpatient clinics in the New Territories West Cluster in Hong Kong will be involved. In total, 20 to 25 participants will be invited in each arm. Intervention participants will receive face-to-face MI interventions in addition to their usual care from the clinic. Control participants will only receive usual care. Outcomes are assessed at baseline, 6 months, and 12 months. The primary outcome measure is glycated hemoglobin levels. Secondary outcomes include blood pressure, BMI, hip and waist circumference, fasting blood, and psychosocial and self-care measures. Results: This study is currently underway with funding support from the Hong Kong College of Family Physician Research Seed Fund 2017. Conclusions: MI skills constitute the main strategies primary care nurses use on their patients. Having economical, simple, effective, and applicable techniques is essential for primary care professionals to help their patients change their lifestyle and improve their health. This study will provide scientific evidence on the effectiveness of MI. It will be performed with strict control over the data collection, ensuring the maintenance of therapeutic integrity. Trial Registration: Centre for Clinical Research and Biostatistics CUHK_CCRB00614; https://tinyurl.com/v9awzk6 International Registered Report Identifier (IRRID): DERR1-10.2196/15709 %M 32229475 %R 10.2196/15709 %U http://www.researchprotocols.org/2020/3/e15709/ %U https://doi.org/10.2196/15709 %U http://www.ncbi.nlm.nih.gov/pubmed/32229475 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e15691 %T Exploring an Innovative Care Model and Telemonitoring for the Management of Patients With Complex Chronic Needs: Qualitative Description Study %A Gordon,Kayleigh %A Steele Gray,Carolyn %A Dainty,Katie N %A DeLacy,Jane %A Ware,Patrick %A Seto,Emily %+ University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 (416) 978 4326, kayleigh.gordon@mail.utoronto.ca %K models of care %K complex patients %K multimorbidity %K telemonitoring %D 2020 %7 6.3.2020 %9 Original Paper %J JMIR Nursing %G English %X Background: The growing number of patients with complex chronic conditions presents an urgent challenge across the Canadian health care system. Current care delivery models are overburdened, struggling to monitor and stabilize the complex needs of this growing patient population. Objective: This qualitative study aimed to explore the needs and perspectives of patients and members of the care team to inform the development of an innovative integrated model of care and the needs of telemonitoring (TM) for patients with complex chronic conditions. Furthermore, we explored how these needs could be successfully embedded to support this novel model of complex chronic care. Methods: A qualitative description design was utilized to conduct and analyze 29 semistructured interviews with patients (n=16) and care team members (CTM) (n=13) involved in developing the model of care in an ambulatory care facility in Southern Ontario. Participants were identified through purposive sampling. Two researchers performed an iterative thematic analysis using NVivo 12 (QSR International; Melbourne, Australia) to gain insights from examining multiple perspectives of different participants on complex chronic care needs. Results: The analysis revealed 3 themes and 13 subthemes, including the following: (1) adequate health care delivery remains challenging for patients with complex care needs, (2) insights into how to structure an integrated care model, and (3) opportunities for TM in an integrated model of care. Participants not only identified continued challenges in accessing and navigating care in a fragmented and disconnected delivery system but also identified the need for more self-management support. Patients and CTM described the structure of an integrated model of care, including the need for a clear referral and triage processes and composing a tight-knit circle of collaborating interdisciplinary providers led by a nurse practitioner (NP). Finally, opportunities for TM in an integrated model of care were identified, including increasing access and communication, the ability to monitor specific signs and symptoms, and building a clinical workflow around TM-enabled care. Conclusions: Despite entrenched health care service delivery models, a new model of care is acutely needed to care for patients with complex chronic needs (CCN). NPs are in a unique position to lead TM-enabled integrated models of care. TM can facilitate frequent and necessary monitoring of patients with CCN with more than one condition in integrated models of care. %R 10.2196/15691 %U https://nursing.jmir.org/2020/1/e15691/ %U https://doi.org/10.2196/15691