In response to unprecedented financial government incentives, electronic health record (EHR) adoption has tripled since 2009. While EHR benefits are emphasized, research demonstrates that adoption may result in unintended consequences that nurse administrators can anticipate and mitigate. Unintended consequences are defined as unplanned effects, whether positive or negative. Little is known about nursing perceptions and experience of unintended consequences arising from EHR implementation, and nursing studies are minimal in comparison with research on experience among their interprofessional colleagues. The purpose of this article is to present the state of the science on nurses' experiences with unintended consequences of EHRs derived from a systematic review that includes 4 original studies. Findings demonstrate that nurses experience changes to workflow, must continually adapt to meet patient's needs in the context of imperfect EHR systems, and have difficulty accessing the information they need to make patient care decisions. Even so, most state they would not revert to paper records if given the choice. Implications for nurse administrators include the need for continual engagement with nurses along the continuum of EHR design, as well as the need to encourage nurses to speak up and acknowledge workflow changes that threaten patient safety or do not support work efficiency.

Themes indicate that early-career oncology nurses enjoy connecting with patients and families, but over-relating, long patient stays, and high patient mortality rates trigger CF. Symptoms include internalizing patients' and families' pains and fears, being haunted by specific patient deaths, feeling emotionally depleted, assuming that all patients will die, and experiencing burnout, physical exhaustion, and hypervigilance protecting loved ones.

Background: Regular exercise is beneficial for adults with cardiovascular disease to improve psychological well-being. Tai Chi is a mind–body exercise thought to promote psychological well-being. Aim: Examine the efficacy of Tai Chi in improving psychological well-being among persons with cardiovascular disease. Methods: An electronic literature search of 10 databases (AMED, CINAHL, Embase, OpenGrey, PsycARTICLES, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science) was conducted. Clinical trials that examined one or more aspect of psychological well-being, incorporated a Tai Chi intervention among cardiovascular disease participants, and were published in English or German languages were included. Comprehensive Meta-Analysis version 2.0 software (Biostat, Inc.) was used to calculate the effect sizes (i.e. Hedges’ g) and the 95% confidence intervals using random effects models. Results: A total of 15 studies met the inclusion criteria, enrolling 1853 participants (mean age = 66 years old, 44% women). Outcomes included: quality of life (QOL), stress, anxiety, depression, and psychological distress. When Tai Chi was compared with controls, significantly better general QOL (Hedges’ g 0.96; p=0.02, I2=94.99%), mental health QOL (Hedges’ g=0.20; p=0.01, I2=15.93) and physical health QOL (Hedges’ g=0.40; p=0.00, I2=0%); with less depression (Hedges’ g=0.69; p=0.00, I2=86.64%) and psychological distress (Hedges’ g=0.58; p=0.00, I2=0%) were found. Conclusions: Few Tai Chi studies have been conducted during the past decade examining psychological well-being among older adults with cardiovascular disease. Further research is needed with more rigorous study designs, adequate Tai Chi exercise doses, and carefully chosen outcome measures that assess the mechanisms as well as the effects of Tai Chi.

BACKGROUND: Despite wide-spread use, telepsychiatry use among psychiatric mental health advanced practice nurse practitioners (PMH APRNs) has not been systematically explored in the literature. OBJECTIVE: Systematically review the PMH APRN usage of live-time, synchronous telepsychiatry including audiovisual teleconferencing technology. METHOD: A comprehensive, systematic search was performed with no publication date restriction across CINAHL, the Cochrane Library, Embase, Google Scholar, PsycINFO, PubMed, Scopus, and Web of Science on July 30, 2019, by a medical librarian. Each citation was blinded and independently reviewed by three reviewers, and consensus was reached for inclusion. Eligible articles were peer-reviewed research or quality improvement articles available in full-text, written in English, including real-time, synchronous, audiovisual telepsychiatry services with PMH APRN providers. Discussion articles and literature reviews were excluded. Article quality and bias were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment tool. RESULTS: The search yielded a total of 342 articles, and only nine articles met full inclusion criteria. Overall, risk of bias was high in all studies, and the GRADE rating consisted of three “very low,” five “low,” and one “medium” quality article. However, considering the collectively positive outcomes from PMH APRN telepsychiatry use, the overall GRADE recommendation was to “probably do it” for seven studies and “do it” for two studies. DISCUSSION: Though existent literature is low quality and sparse, evidence supports that PMH APRNs can feasibly and successfully provide telepsychiatry services across a wide range of demographic patients and locations. CONCLUSION: PMH APRNs should contribute more original evidence to guide telepsychiatry implementation and adoption as the service expands.