Mobile health technology has extended nurses’ reach, giving them the ability to improve care and communication while educating patients in managing their own health. Technologies such as smartphones, wearable activity trackers and web-based or downloadable apps allow nurses to monitor patients for specific or indefinite periods of time in the home setting. Some university faculty are putting their energies toward technological innovations that improve nursing curricula and patients’ lives.
Support to nursing faculty
Marilyn M. Lombardi, PhD, the director of CONCEPT: Center of Nursing Collaboration, Entrepreneurship and Technology, an associate professor at Duke University School of Nursing in Durham, N.C., says the center is intent on developing technological tools that are useful in the academic and patient care realms.
“The main goal of this faculty development program is to incentivize and engage faculty in finding solutions to real issues in education,” Lombardi said. “We want to strengthen our clinical instructors and build their careers as researchers and scholars.”
Faculty apply for the CATALYST Faculty Innovation grant, and if accepted, they work with Lombardi to make their project a reality, identifying the challenges and technology required to implement it. Lombardi introduces faculty to appropriate IT specialists, and together they brainstorm and design the project from scratch.
Margaret “Peggy” Bush, PhD, MBA, RPH, and Remi Hueckel, DNP, CPNP-AC, FAANP, assistant professors at Duke’s School of Nursing, chose to develop dedicated online interactive modules on medication safety for students in the prelicensure nursing program. With Lombardi’s support, they selected specific software that provided a storyline, with animation and interactional elements. With additional learning analytics, they also followed the students’ progress to see where there were misconceptions and where the students were engaged. Results from their work were published in Nurse Educator, July/August 2015.
An expert in research design analysis, Susan Silva, PhD, RN, research associate professor and statistician in the Office of Research Affairs who teaches in the MSN/APN and doctoral programs at Duke, identified that students had difficulty making critical connections between and among the key concepts in research design and analysis. Working with Lombardi, she reimagined the concepts into a kinship tree so students could visualize the family of ideas and how they were related to one another. The web-based program also linked students to a set of animated tutorials, with Silva’s voice narration.
“Each concept is a node, in which there is a pathway that students can drill down to get more and more specific information,” said Lombardi, who described the innovation as one that explored information visualization.
“At first we weren’t sure what technology tool would be best, and then we turned to a web-published platform and Duke’s WordPress. Dr. Silva was committed and engaged and developed her own skills to work in WordPress.”
In three other projects, faculty members are looking at the issue of clinical hours and whether it is possible to approximate the power of facility-based simulation laboratory experiences in the fully online realm. “In these projects, we want to produce an online instruction platform where distance-based students can practice their assessment and decision-making skills within a virtualized simulation environment,” Lombardi said.
Rebuilding for success
Experts in mHealth advise nurses to review the literature to help them determine the need for mHealth tools in their area of interest or for a specific age group.
Sophia K. Smith, PhD, MSW, associate professor, Duke University, School of Nursing, who leads the Duke’s Cancer Survivorship Center, identified a need for cancer survivors and built on an app the National Center for Posttraumatic Stress Disorder had created for patients with PTSD.
Recognizing the relationship of symptoms between those with PTSD and those diagnosed with cancer, Smith contacted the NCPTSD to discuss revising the VA-developed PTSD Coach for the oncology population. After applying cancer-specific revisions to the app, Smith conducted usability testing among 30 cancer survivors that resulted in suggested improvements and yielded, after another round of revisions, the new app, Cancer Distress Coach.
The result of her joint venture with the NCPTSD consists of four modules covering information, assessment, skill building and resources for support to help users self-manage PTSD symptoms. For example, the Cancer Distress Coach contains a 17-item instrument to assess for symptoms and has a robust tools section containing mind-body techniques, such as relaxation exercises and guided imageries.
They are receiving encouraging results, Smith said.
“Preliminary data are showing statistically significant reductions in PTSD symptoms with one month of use,” she said. “In addition, the reductions are more pronounced when the scores are adjusted for app usage, that is, greater reductions are associated with increased app usage. Results from the pilot study will be used as preliminary data to support a large NIH grant submission in March in which we propose to study it in a trial.”
In the pilot study, Smith and her team are focusing on patients with lymphoma and those with breast and prostate cancer, based on literature findings that support the relationship between PTSD and those specific cancers. Eventually they hope to enroll all patients with cancer in future studies.
Smith’s team includes an app programmer, a research assistant who obtains the consents and collects the data, a psychologist from the NCPTSD, an undergraduate psychology student who makes the reminder phone calls and inputs the data; and nurses who introduce the patients to the study.
“In technological innovations, you are never alone,” she said. “If you come up with an idea, there are others you must depend on to support you in the design of the technology and the implementation of the study. Interdisciplinary teamwork is essential to success.”
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To read Lynch’s article “On the move with mHealth,” visit Nurse.com/Article/Move-mHealth.