Impact of a Prescription Drug Monitoring Program on Health Information Exchange Utilization, Prescribing Behaviors, and Care Coordination in an Emergency Department Timely access to patient data is critical in patient care. The utilization of health information exchange and prescription drug monitoring programs can make pertinent data readily accessible for emergency department providers to coordinate care. A quasi-experimental preintervention-postintervention design, with 62 providers and 53 554 emergency department visits linked to a health information exchange and prescription drug monitoring program, was used to evaluate rates for utilization, laboratory/imaging orders, narcotic prescribing and readmission. Health information exchange utilization increased significantly after the drug monitoring program was implemented (mean = 119.33 to mean = 231.33, t2 = −15.79, P < .001). There was no significant effect postprescription drug monitoring program for laboratory/imaging orders or narcotics at discharge, although narcotic orders during emergency visits increased (F1,23 = 7.953, P = .010), which may suggest the data confirmed the immediate need to control acute or chronic conditions. In addition, readmission rates decreased from 14.64% to 12.58%. Through streamlining processes, health information exchange and prescription drug monitoring program usage were increased, which can improve care. As organizations promote interoperability of health information, the nurse informaticist plays a significant role in managing access to systems that can assist all providers in coordinating care. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Anna E. Schoenbaum, DNP, RN-BC, Enterprise Clinical Systems, University of Maryland Medical System, 920 Elkridge Landing, Linthicum, MD 21090 (aschoenbaum@umm.edu). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Developing Structured Omaha System Goals for Use in an Electronic Health Record Use of standardized terminology has been essential for clear, concise, and accurate documentation of client assessments, care plans, and outcomes. The purpose of this study was to create standardized language goals for a case management system that used the Omaha System. A group of nursing informaticists analyzed, refined, and developed revised goals evaluated using medical vocabulary properties. A set of unique goals aligned with the Omaha System was developed with specifically designed characteristics and functionality that allowed individualization and evaluation of goal attainment. Goal statements and ratings were standardized and written to reflect goals a client could attain. The Omaha System goals served as a template for nurse case managers to use in telephonic support with clients and future development of new goals and allowed the organization the ability to generate quality metrics. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Marci D. Newcome, DNP, APRN, CNP, 200 First Street SW, Rochester, MN 55905 (newcome.marci@mayo.edu). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Web-Based Tailored Nursing Intervention to Support Medication Self-management: A Qualitative Study of the Experience of Kidney Transplant Recipients Optimal adherence to immunosuppressive medication is essential to kidney graft success. A Web-based tailored virtual nursing intervention was developed to promote medication adherence and support self-management among kidney transplant recipients. A qualitative study was undertaken in a hospital setting in Montreal (Canada) to document how users experience the intervention and to explore medication intake self-management behaviors. To participate, transplant recipients had to be at least 18 years old and had to have completed at least one computer session of the intervention. Semistructured interviews were conducted with 10 participants (two women, eight men) with a mean age of 47.8 years. They reported receiving their latest renal transplant on average 10.6 years prior. Content analysis of the interview transcripts yielded five major themes: (1) kidney transplant is a gift from life; (2) routinization of medication intake; (3) intervention is a new and positive experience; (4) using the intervention offers many benefits; and (5) individual relevance of the intervention. Patient experience shows the intervention is acceptable and can help better manage medication intake. Results also underscore the importance of offering the intervention early in the care trajectory of transplant recipients. Web-based tailored virtual nursing interventions could constitute an easily available adjunct to existing specialized services. Licensing options have been granted for the marketing of VIH-TAVIE. The study was funded by the Kidney Foundation of Canada (2013–2015), the Canadian Institutes of Health Research (2012–2013), and the Research Chair in Innovative Nursing Practices. J.C. has received a clinical research bursary (senior) from the Fonds de recherche du Québec - Santé (2013–2017) to support her research program on innovative virtual interventions intended for persons living with a chronic health problem. The TAVIE platform was developed with the financial support of the Réseau Sidami du FRSQ. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: José Côté, PhD, RN, 850 St-Denis, Montreal, Québec, Canada H2X 0A9 (jose.cote@umontreal.ca). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Knowledge Discovery With Machine Learning for Hospital-Acquired Catheter-Associated Urinary Tract Infections Massive generation of health-related data has been key in enabling the big data science initiative to gain new insights in healthcare. Nursing can benefit from this era of big data science, as there is a growing need for new discoveries from large quantities of nursing data to provide evidence-based care. However, there are few nursing studies using big data analytics. The purpose of this article is to explain a knowledge discovery and data mining approach that was employed to discover knowledge about hospital-acquired catheter-associated urinary tract infections from multiple data sources, including electronic health records and nurse staffing data. Three different machine learning techniques are described: decision trees, logistic regression, and support vector machines. The decision tree model created rules to interpret relationships among associated factors of hospital-acquired catheter-associated urinary tract infections. The logistic regression model showed what factors were related to a higher risk of hospital-acquired catheter-associated urinary tract infections. The support vector machines model was included to compare performance with the other two interpretable models. This article introduces the examples of cutting-edge machine learning approaches that will advance secondary use of electronic health records and integration of multiple data sources as well as provide evidence necessary to guide nursing professionals in practice. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Jung In Park, PhD, RN, 100D Berk Hall, University of California, Irvine, CA 92697 (junginp@uci.edu). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Defining Menstrual Literacy With the Aim of Evaluating Mobile Menstrual Tracking Applications For the estimated 75 million people in the United States who menstruate, understanding menstrual health as a critical “vital sign” is an important aspect of managing personal health. Unsurprisingly, in the past decade, menstrual tracking applications have become increasingly popular, with more than 300 applications available for download and an estimated 200 million downloads worldwide. This study had two purposes. The first was to formulate a definition for menstrual literacy—a baseline of knowledge and skills for understanding anatomical and biological facts of menstruation, caring for the menstruating body, and completing menstrual care tasks—by building on prior work about health literacy and by conducting content analysis of eight Web sites containing information about menstruation. The second was to evaluate a maximum variation sample of 17 menstrual tracking applications; here, features and functions related to the concepts about menstrual literacy identified in a content analysis were compared. These applications had insufficient support for facilitating menstrual literacy, especially for teen and perimenopausal users. The article discusses these disconnects and subsequent design opportunities for menstrual tracking applications to facilitate more robust support of menstrual literacy and overall health of people who menstruate. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding Author: Jordan Eschler, PhD, School of Communication Northwestern University, 710 N Lake Shore Dr, 15th Floor, Abbott Hall, Chicago, IL 60611 (jordan.eschler@northwestern.edu). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Purpose of Bedside Robots: Exploring the Needs of Inpatients and Healthcare Professionals Robotic systems are used to support inpatients and healthcare professionals and to improve the efficiency and quality of nursing. There is a lack of scientific literature on how applied robotic systems can be used to support inpatients. This study uses surveys and focus group interviews to identify the necessary aspects and functions of bedside robots for inpatients. A total of 90 healthcare professionals and 108 inpatients completed the questionnaire, and four physicians and five nurses participated in the focus group interviews. The most highly desired functionalities were related to patient care and monitoring, including alerting staff, measuring vital signs, and sensing falls. Nurses and physicians reported different needs for human-robot interaction. Nurses valued robotic functions such as nonverbal expression recognition, automatic movement, content suggestion, and emotional expressions. The results of the patients' open-ended questions and healthcare professionals' focus groups indicate that the purpose of the robots should primarily be treatment and nursing. Participants believe bedside robots would be helpful but have concerns regarding safety and utility. This study attempts to determine which aspects of robots may increase their acceptance. Our findings suggest that if robots are used in healthcare institutions, they may improve the effectiveness of care. This material is based upon work supported by the Ministry of Trade, Industry & Energy (MOTIE, Korea) under Industrial Technology Innovation Program (no. 10063098, “Telepresence Robot System Development for the Support of POC (Point of Care) Service Associated With ICT Technology”). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Jeongeun Kim, PhD, RN, College of Nursing, Seoul National University Research Institute of Nursing Science, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea (kim0424@snu.ac.kr). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Representing Nursing Data With Fast Healthcare Interoperability Resources: Early Lessons Learned With a Use Case Scenario on Home-Based Pressure Ulcer Care Healthcare communities are rapidly embracing Health Level 7's Fast Healthcare Interoperability Resources standard as the next-generation messaging protocol to facilitate data interoperability. Implementation-friendly formats for data representation and compliance to widely adopted industry standards are among the strengths of Fast Healthcare Interoperability Resources that are accelerating its wide adoption. Research confirms the advantages of Fast Healthcare Interoperability Resources in increasing data interoperability in mortality reporting, genetic test sharing, and patient-generated data. However, few studies have investigated the application of Fast Healthcare Interoperability Resources in nursing-specific domains. In this study, a Fast Healthcare Interoperability Resources document was generated for a use case scenario in a home-based, pressure ulcer care setting. Study goals were to describe the step-by-step process of generating a Fast Healthcare Interoperability Resources artifact and to inform nursing communities about the advantages and challenges in representing nursing data with Fast Healthcare Interoperability Resources. Overall, Fast Healthcare Interoperability Resources effectively represented the majority of the data included in the use case scenario. A few challenges that could potentially cause information loss were noted such as the lack of standardized concept codes for value encoding and the difficulty directly connecting an observation to a related condition. Continuous evaluations in diverse nursing domains are needed in order to gain a more thorough insight on potential challenges that Fast Healthcare Interoperability Resources holds in representing nursing data. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Hyeoneui Kim, PhD, MPH, RN, FAAN, Duke University School of Nursing, 307 Trent Dr, Durham, NC 27710 (hyeoneui.kim@duke.edu). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.cinjournal.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Home Monitoring to Track Activity and Sleep Patterns Among Older Adults: A Feasibility Study Measuring changes in activity and sleep over time is important for research and practice. While commercially available home monitoring systems passively track these parameters, the feasibility, acceptability, and usefulness of new products need to be evaluated. We tested a commercially available system for providing long-term data on activity and sleep with 10 single women (mean age, 86.5 years) who were monitored in their homes. Motion detectors, a bed sensor, door sensor, and chair sensor were installed for 3 months to collect data. Other measures, objective actigraphy data from 1 week and self-report, provided data for comparison. Sleep and activity data were similar across measures; the most active participant had the highest scores on all activity measures including sensor data. Participants were generally positive about the monitoring system, but participants varied in their awareness levels of the presence of the equipment. Use of the sensor system was feasible in this pilot study and acceptable to participants. The study also illustrates challenges researchers can encounter when working with a commercial company. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Helen W. Lach, PhD, RN, CNL, FGSA, FAAN, 3525 Caroline Mall, St Louis, MO 63104 (helen.lach@slu.edu). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Living With Intelligent Sensors: Older Adult and Family Member Perceptions This qualitative study is part of a larger randomized prospective intervention study that examined the clinical and cost effectiveness of using sensor data from an environmentally embedded sensor system for early illness recognition. It explored the perceptions of older adults and family members on the sensor system's usefulness, impact on daily routine, privacy, and sharing of health information. This study was conducted in 13 assisted-living facilities in Missouri, and 55 older adults were interviewed. Data were collected over five points in time with a total of 188 interviews. From these five participant interview iterations, the following themes emerged: (1) understanding and purpose, (2) daily life and benefits, (3) impact on privacy, and (4) sharing of information. Three themes emerged from one round of family interviews: (1) benefits of bed sensors, (2) family involvement/staff interaction, and (3) privacy protection versus sensor benefits. The sensor suite was regarded as helpful in maintaining independence, health, and physical functioning. Responses suggest that the willingness to adopt the sensor suite was motivated by both a decline in functional status and a desire to remain independent. Participants were willing to share their health data with providers and select family members. Recommendations for future practice are provided. This research was made possible through funding from the National Institute of Nursing Research, National Institutes of Health (grant 1R01NR014255), Intelligent Sensor System for Early Illness Alerts in Senior Housing. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Colleen Galambos, PhD, ACSW, LCSW-C, FGSA, Helen Bader School of Social Welfare, Enderis Hall, Room 1157, PO Box 786, Milwaukee, WI 53201 (galamboc@uwm.edu). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Effects of Simulation-Based Advanced Life Support Education for Nursing Students Advanced life support education for nursing students is very important because nurses are first responders in emergency situations. The purpose of this study was to identify the effects of simulation-based advanced life support education on nursing students' knowledge, performance, self-efficacy, and teamwork. A nonequivalent control group posttest-only design was used. Fourth-year nursing students were randomly assigned to either simulation-based Korean Advanced Life Support (n = 30) or lecture-based education (n = 30) groups. Data were analyzed using descriptive statistics and the Mann-Whitney U test. The experimental group showed statistically significant higher scores in knowledge (P < .001), performance (P < .001), and self-efficacy (P = .049) when compared with the control group. However, there was no significant difference in teamwork scores between the two groups (P = .529). The 4.5-hour simulation-based Korean Advanced Life Support education was more effective than the 4.5-hour lecture-based education for nursing students in terms of knowledge, performance, and self-efficacy. Nurse educators should adopt simulation-based advanced life support education into the curriculum for the optimal competence of nursing students. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Young Sook Roh, PhD, RN, Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-gu, Seoul, Republic of Korea 06974 (aqua@cau.ac.kr). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.