An examination of nine hospitals that recently implemented a comprehensive electronic health record (EHR) system finds that clinical and administrative leaders built EHR adoption into their strategic plans to integrate inpatient and outpatient care and provide a continuum of coordinated services. Successful implementation depended on: strong leadership, full involvement of clinical staff in design and implementation, mandatory staff training, and strict adherence to timeline and budget. The EHR systems facilitate patient safety and quality improvement through: use of checklists, alerts, and predictive tools; embedded clinical guidelines that promote standardized, evidence-based practices; electronic prescribing and test-ordering that reduces errors and redundancy; and discrete data fields that foster use of performance dashboards and compliance reports. Faster, more accurate communication and streamlined processes have led to improved patient flow, fewer duplicative tests, faster responses to patient inquiries, redeployment of transcription and claims staff, more complete capture of charges, and federal incentive payments.

Background Health inequities remain a public health concern. Chronic adversity such as discrimination or racism as trauma may perpetuate health inequities in marginalized populations. There is a growing body of the literature on trauma informed and culturally competent care as essential elements of promoting health equity, yet no prior review has systematically addressed trauma informed interventions. The purpose of this study was to appraise the types, setting, scope, and delivery of trauma informed interventions and associated outcomes. Methods We performed database searches— PubMed, Embase, CINAHL, SCOPUS and PsycINFO—to identify quantitative studies published in English before June 2019. Thirty-two unique studies with one companion article met the eligibility criteria. Results More than half of the 32 studies were randomized controlled trials (n = 19). Thirteen studies were conducted in the United States. Child abuse, domestic violence, or sexual assault were the most common types of trauma addressed (n = 16). While the interventions were largely focused on reducing symptoms of post-traumatic stress disorder (PTSD) (n = 23), depression (n = 16), or anxiety (n = 10), trauma informed interventions were mostly delivered in an outpatient setting (n = 20) by medical professionals (n = 21). Two most frequently used interventions were eye movement desensitization and reprocessing (n = 6) and cognitive behavioral therapy (n = 5). Intervention fidelity was addressed in 16 studies. Trauma informed interventions significantly reduced PTSD symptoms in 11 of 23 studies. Fifteen studies found improvements in three main psychological outcomes including PTSD symptoms (11 of 23), depression (9 of 16), and anxiety (5 of 10). Cognitive behavioral therapy consistently improved a wide range of outcomes including depression, anxiety, emotional dysregulation, interpersonal problems, and risky behaviors (n = 5). Conclusions There is inconsistent evidence to support trauma informed interventions as an effective approach for psychological outcomes. Future trauma informed intervention should be expanded in scope to address a wide range of trauma types such as racism and discrimination. Additionally, a wider range of trauma outcomes should be studied.

Background: With the rapid growth in online education programs in nursing, quality of education through this modality is becoming of greater importance. Purpose: This paper aims to explore current recommendations and standards for quality in online nursing education offered by nursing regulatory, accrediting, and licensing organizations. Method: Individual interviews were conducted with the leaders from four accrediting, licensing and certifying organizations in nursing about their perspectives on quality standards for online education. Findings: The following themes emerged from the qualitative interviews: Theme 1-Standards are not specific to online education; Theme 2-This is not up to us-Professional organizations can offer recommendations but not responsible for regulations; and Theme 3-Each institution has responsibility to provide support and evaluate the quality of online education. Discussion: Schools of nursing should continue to incorporate current standards for quality in online education as the methods of delivery continue to evolve in this highly technologically-oriented world.

Introduction In the 1980s, nurses became more recognized as interprofessional healthcare partners who actively participated in the advancement of patient care and the nursing profession. There is a significant gap in the nursing literature about the significant contributions of executive military nurse leaders. The purpose of the interview with Brigadier General (Brig Gen) Hale O’Connor was to explore the personal stories, experiences, leadership strategies, lessons learned, and impact of her leadership on the future development of nursing as a profession. Methods The oral history method provided a framework for the interview and the analysis. In compliance with the Oral History Association guidelines, the primary investigator obtained Institutional Review Board permission, participant informed consent, and an audiotaped interview. A graduate research assistant transcribed the 3-hour audiotaped interview verbatim. The participant reviewed the transcription, provided clarification, and validated accuracy. Three independent coders extracted prevalent themes and subthemes during analysis. Researchers compared findings and reached a consensus when resolving minor discrepancies. Results Two broad thematic qualities, commitment to duty and fairness, emerged from the data with their respective subthemes. Subthemes of trust, patriotism, loyalty, and assiduousness supported the main theme of commitment to duty. Pillars of alignment, equality, and advocacy supported the broad theme of fairness. Conclusion Although the team did not use the Reina Trust Model as a framework, the trust-building behaviors emerged from the transcribed interview during the analysis. Surprisingly, many of the leadership strategies utilized by Brig Gen Hale O’Connor fit well into the Reina Trust Model, published 25 years following O’Connor’s tenure as Chief, Air Force Nurse Corps. In addition, several of Brig Gen Hale O’Connor’s leadership accomplishments are still relevant today, solidifying the observation that the foresight of Brig Gen Hale O’Connor was fundamental to the advancement of nursing during her tenure and for those who followed.

BACKGROUND With the advent of electronic health record (EHR) systems, there is increasing attention on the EHR system with regard to its use in facilitating patients to play active roles in their care via secure patient portals. However, there is no systematic review to comprehensively address patient portal interventions and patient outcomes. OBJECTIVE This study aimed to synthesize evidence with regard to the characteristics and psychobehavioral and clinical outcomes of patient portal interventions. METHODS In November 2018, we conducted searches in 3 electronic databases, including PubMed, EMBASE, and Cumulative Index to Nursing and Allied Health Literature, and a total of 24 articles met the eligibility criteria. RESULTS All but 3 studies were conducted in the United States. The types of study designs varied, and samples predominantly involved non-Hispanic white and highly educated patients with sizes ranging from 50 to 22,703. Most of the portal interventions used tailored alerts or educational resources tailored to the patient’s condition. Patient portal interventions lead to improvements in a wide range of psychobehavioral outcomes, such as health knowledge, self-efficacy, decision making, medication adherence, and preventive service use. Effects of patient portal interventions on clinical outcomes including blood pressure, glucose, cholesterol, and weight loss were mixed. CONCLUSIONS Patient portal interventions were overall effective in improving a few psychological outcomes, medication adherence, and preventive service use. There was insufficient evidence to support the use of patient portals to improve clinical outcomes. Understanding the role of patient portals as an effective intervention strategy is an essential step to encourage patients to be actively engaged in their health care.