School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.
Centre for Quality and Patient Safety Research - Monash Health Partnership, Monash Health, Clayton, Victoria, Australia.
J Clin Nurs. 2019 Aug;28(15-16):2868-2879. doi: 10.1111/jocn.14874. Epub 2019 Apr 21.
(a) Describe the co-development of a point-of-care App to promote uptake of best practice recommendations and consolidate nurses' knowledge for managing symptoms of neurocognitive disorders. (b) Report acceptability, usability and feasibility of the App to nurses for patient care in hospital.
Strategies used in hospitals to reduce symptoms, risk of harm, or complications of behavioural and psychological symptoms associated with neurocognitive disorders are frequently inconsistent with best practice recommendations.
Three-stage, mixed-methods, process and outcome evaluation.
The App was co-developed with experts, nurse end-users and a consumer. Evaluation data were collected from a convenience sample of nurses observed during delivery of 80.5 hr of care to 38 patients; the App (n = 32 patients); and individual and focus group interviews with nurses (n = 25). Reporting adhered to an adapted STROBE checklist.
The App included three components: cognition and risk assessment; tailored evidence-based strategies; and monitoring and evaluation of effectiveness. Observation data captured nurses using the App with 44.7% (n = 17) of eligible inpatients. Cognitive screening was completed at least once for each patient, with 146 risk assessments recorded. Interview data indicated the App's acceptability was enhanced by familiarity and perceived benefits, but hindered by perceived increases in workload, inconsistent use, pressure to use the App and resistance to change. Feasibility and usability were enhanced by easy navigation, and clear and useful content, but hindered by unclear expectations, unfamiliarity and device-related factors.
The App provided an evidence-based tool that was, overall, considered feasible and acceptable to support best practice. Findings provide guidance to enhance usability for future implementation.
Co-development using best evidence and key stakeholders enabled creation of a novel, feasible and acceptable technology. Real-time access to assessment tools and tailored knowledge supported nurses' clinical decision-making; workload and unfamiliarity were barriers to use.
(a) 描述一种即时护理应用程序的共同开发，以促进最佳实践建议的采纳，并巩固护士管理神经认知障碍症状的知识。(b) 报告该应用程序对医院护士进行患者护理的可接受性、可用性和可行性。
用于减少与神经认知障碍相关的行为和心理症状的行为、风险或并发症的医院策略经常与最佳实践建议不一致。
三阶段、混合方法、过程和结果评估。
该应用程序是与专家、护士最终用户和消费者共同开发的。评估数据是从对 38 名患者护理的 80.5 小时中观察到的护士的便利样本中收集的（n=32 名患者）；该应用程序（n=32 名患者）；以及对护士的个人和焦点小组访谈（n=25）。报告符合经过改编的 STROBE 清单。
该应用程序包括三个部分：认知和风险评估；定制的基于证据的策略；以及监测和评估效果。观察数据捕捉到 44.7%（n=17）的合格住院患者使用该应用程序。对每位患者至少进行了一次认知筛查，共记录了 146 次风险评估。访谈数据表明，应用程序的可接受性因熟悉度和感知收益而提高，但因工作量增加、使用不一致、使用应用程序的压力和对变革的抵制而受到阻碍。易于导航、内容清晰有用，提高了可行性和可用性，但由于期望不明确、不熟悉和设备相关因素，可用性受到阻碍。
该应用程序提供了一个基于证据的工具，总体上被认为是可行和可接受的，支持最佳实践。研究结果为提高未来实施的可用性提供了指导。
使用最佳证据和主要利益相关者进行共同开发，使创建一种新的、可行的和可接受的技术成为可能。实时访问评估工具和定制知识支持护士的临床决策；工作量和不熟悉度是使用的障碍。
