Disturbance of Ecological Self and Impairment of Affordance Perception.

Affordance, a radical concept James Gibson introduced in the 1970s, remains controversial today. Defined as environmental properties taken with reference to an animal's anatomy and action capabilities, affordances are opportunities for action the environment offers. By perceiving affordances, organisms hold meaningful relationships with their surroundings.

Impaired Affordance Perception as the Basis of Tool Use Deficiency in Alzheimer's Disease.

The present study investigated whether defective affordance perception capacity underpins tool use deficits in patients with Alzheimer's disease (AD). An affordance, a concept James Gibson introduced, scales environmental objects to an animal's action capabilities, thus offering opportunities for action. Each man-made artifact carries both a primary affordance (its designed function) and secondary affordances.

Exploring the Stability of Communication Network Metrics in a Dynamic Nursing Context.

Network stability is of increasing interest to researchers as they try to understand the dynamic processes by which social networks form and evolve. Because hospital patient care units (PCUs) need flexibility to adapt to environmental changes (Vardaman, Cornell, & Clancy, 2012), their networks are unlikely to be uniformly stable and will evolve over time. This study aimed to identify a metric (or set of metrics) sufficiently stable to apply to PCU staff information sharing and advice seeking communication networks over time.

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.

Relationship of Staff Information Sharing and Advice Networks to Patient Safety Outcomes.

Objective: The aim of this study was to compare information sharing and advice networks' relationships with patient safety outcomes.

Background: Communication contributes to medical errors, but rarely is it clear what elements of communication are key.

Methods: We investigated relationships of information-sharing and advice networks to patient safety outcomes in 24 patient care units from 3 hospitals over 7 months.

Nursing Unit Design, Nursing Staff Communication Networks, and Patient Falls: Are They Related?

Purpose:: The purpose of this research is to (1) investigate the impact of nursing unit design on nursing staff communication patterns and, ultimately, on patient falls in acute care nursing units; and (2) evaluate whether differences in fall rates, if found, were associated with the nursing unit physical structure (shape) or size.

Background:: Nursing staff communication and nursing unit design are frequently linked to patient safety outcomes, yet little is known about the impact of specific nursing unit designs on nursing communication patterns that might affect patient falls.

Method:: An exploratory longitudinal correlational design was used to measure nursing unit communication structures using social network analysis techniques.

Expert consensus building using e-Delphi for necrotizing enterocolitis risk assessment.

Objective: To confirm content validity of GutCheck(NEC) , a risk index for necrotizing enterocolitis (NEC) and to determine the level of agreement among experts about NEC risk factors in premature infants.

Design: Electronic Delphi method (e-Delphi).

Setting: Online electronic surveys and e-mail communication supported by an interactive study website.

Development and initial evaluation of the Clinical Information Systems Success Model (CISSM).

Purpose: Most clinical information systems (CIS) today are technically sound, but the number of successful implementations of these systems is low. The purpose of this study was to develop and test a theoretically based integrated CIS Success Model (CISSM) from the nurse perspective.

Methods: Model predictors of CIS success were taken from existing research on information systems acceptance, user satisfaction, use intention, user behavior and perceptions, as well as clinical research.

Using *ORA, a network analysis tool, to assess the relationship of handoffs to quality and safety outcomes.

Communication during patient handoffs has been widely implicated in patient safety issues. However, few studies have actually been able to quantify the relationship between handoffs and patient outcomes. We used *ORA, a dynamic network analysis tool, to examine handoffs between day and night shifts on seven units in three hospitals in the Southwest.

Simulating nursing unit performance with OrgAhead: strengths and challenges.

In this article, we briefly describe our use of a computational modeling tool, OrgAhead, details of which have been reported previously, then discuss several of the challenges computational modeling presented and our solutions. We used OrgAhead to simulate 39 nursing units in 13 Arizona hospitals and then predict changes to improve overall patient quality and safety outcomes. Creating the virtual units required (1) collecting data from managers, staff, patients, and quality and information services on each of the units; (2) mapping specific data elements (eg, control over nursing practice, nursingworkload, patient complexity, turbulence, orientation/tenure, education) to OrgAhead's parameters and variables; and then (3) validating that the newly created virtual units performed functionally like the actual units (eg, actual patient medication errors and fall rates correlated with the accuracy outcome variable in OrgAhead).

Validating the personal health records adoption model using a modified e-Delphi.

Aim: To report the results of a preliminary test of validity of a proposed theoretical framework of electronic personal health record adoption by older adults.

Background: Personal health records can assist older adults in managing or co-managing their chronic health conditions. Although there is interest by this population, their adoption of this technology has been slow.

Modeling factors that influence personal health records adoption.

The purpose of this article was to describe the Personal Health Records Adoption Model and how it was developed. Older adults who often find themselves managing their own care or the care of their families have expressed interest in using electronic personal health records as a management tool, but few are using them. The literature does not provide a comprehensive model of personal health record adoption among older adults with chronic illness; therefore, essential barriers and facilitators were synthesized from existing literature to create the model.

Necrotizing enterocolitis risk: state of the science.

Necrotizing enterocolitis (NEC) is the most common cause of gastrointestinal-related morbidity and mortality in the neonatal intensive care unit (NICU). Its onset is sudden and the smallest, most premature infants are the most vulnerable. Necrotizing enterocolitis is a costly disease, accounting for nearly 20% of NICU costs annually.

An exploratory study of the personal health records adoption model in the older adult with chronic illness.

Background: Despite international efforts moving toward integrated care using health information technologies and the potential of electronic PHRs to help us better coordinate patient-centered care, PHR adoption in the United States remains low among patients who have been offered free access to them from private-sector companies. If older adult stand to benefit from the use of PHRs for its usefulness in self-managing chronic illness, why have they not been more readily adopted? Since the chronically ill older adult has unique circumstances that impact their decision to participate in self-directed care, a theoretical framework to help understand factors that influence the adoption of PHRs is important. Here we describe the results of an exploratory study that provided an initial test of such a framework.

Using Cognitive Work Analysis to fit decision support tools to nurse managers' work flow.

Purpose: To better understand the environmental constraints on nurse managers that impact their need for and use of decision support tools, we conducted a Cognitive Work Analysis (CWA). A complete CWA includes system analyses at five levels: work domain, decision-making procedures, decision-making strategies, social organization/collaboration, and worker skill level. Here we describe the results of the Work Domain Analysis (WDA) portion in detail then integrate the WDA with other portions of the CWA, reported previously, to generate a more complete picture of the nurse manager's work domain.

Failure to rescue in neonatal care.

Failure to rescue (FTR) has been described as the end result of a series of events relating to the environment of care and nursing quality. Only recently has FTR as a process measure been applied to perinatal care settings. Nurses' continuous presence at the bedside puts them in a privileged position to recognize signs of clinical deterioration and to take action.

Using ORA to explore the relationship of nursing unit communication to patient safety and quality outcomes.

Purpose: We used ORA, a dynamic network analysis tool, to identify patient care unit communication patterns associated with patient safety and quality outcomes. Although ORA had previously had limited use in healthcare, we felt it could effectively model communication on patient care units.

Methods: Using a survey methodology, we collected communication network data from nursing staff on seven patient care units on two different days.

Correlations of nursing communication network metrics with patient outcomes.

Communication problems have been implicated in many safety and quality issues, but tools to examine communication networks and their impact on patient outcomes are only beginning to become available. We used *ORA, an organizational risk analyzer that allows the dynamic analysis of organizational networks to explore the communication networks among staff on seven nursing units in three Arizona hospitals. The results showed correlations between a number of *ORA metrics and patient safety and quality outcomes.

Strengths and limitations of the electronic health record for documenting clinical events.

The purpose of this research was to compare nurses' perceptions of the strengths and limitations of the electronic health record with and without nursing languages for documenting and retrieving patient information regarding a clinical event. The effectiveness of the electronic health record to facilitate nurse-to-nurse communication is not well understood. Furthermore, little is known how nurse-to-nurse communication influences patient safety and failure-to-rescue events.

Designing a tailored Web-based educational mammography program.

Breast cancer has become increasingly prevalent in Taiwanese women, especially in younger women. Unfortunately, early breast cancer detection may be hampered by Taiwanese women's beliefs about breast cancer, risk factors, and mammography. The Internet has become a powerful way to disseminate health information, but health education Web sites are frequently neither patient-centered nor theoretically based.

The relationship between cesarean section and labor induction.

Background: Numerous study results vary when analyzing the relationship between labor induction and the likelihood of cesarean delivery; and few have accounted for the multiple influences of maternal sociodemographic characteristics combined with the provider and hospital in subsequent birth outcomes such as cesarean section.

Objective: This study evaluated the likelihood of cesarean birth following labor induction while accounting for maternal, hospital, and provider characteristics.

Methods: A cross-sectional retrospective descriptive design using secondary data was employed to determine what variation in cesarean births was due to differences of hospitals, providers, and patients using the Quality Health Outcomes Model (QHOM).

Creating and testing a deaf-friendly, stop-smoking web site intervention.

Deaf adults' access to smoking cessation programs is limited due to cultural, linguistic, and geographic barriers. Web-based stop-smoking interventions have demonstrated cessation rates comparable to other interventions. The Internet is widely used by Deaf adults, but difficulties with online English text remain.