Sample Answer for NURS 6501 THE APPLICATION OF DATA TO PROBLEM-SOLVING Included After Question

In the modern era, there are few professions that do not to some extent rely on data. Stockbrokers rely on market data to advise clients on financial matters. Meteorologists rely on weather data to forecast weather conditions, while realtors rely on data to advise on the purchase and sale of property. In these and other cases, data not only helps solve problems, but adds to the practitioner’s and the discipline’s body of knowledge. 

Of course, the nursing profession also relies heavily on data. The field of nursing informatics aims to make sure nurses have access to the appropriate date to solve healthcare problems, make decisions in the interest of patients, and add to knowledge. 

In this Discussion, you will consider a scenario that would benefit from access to data and how such access could facilitate both problem-solving and knowledge formation. 



Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.  


To Prepare: 

  • Reflect on the concepts of informatics and knowledge work as presented in the Resources. 
  • Consider a hypothetical scenario based on your own healthcare practice or organization that would require or benefit from the access/collection and application of data. Your scenario may involve a patient, staff, or management problem or gap. 


Post a description of the focus of your scenario. Describe the data that could be used and how the data might be collected and accessed. What knowledge might be derived from that data? How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience? 


Respond to at least two of your colleagues* on two different days, asking questions to help clarify the scenario and application of data, or offering additional/alternative ideas for the application of nursing informatics principles. 

*Note: Throughout this program, your fellow students are referred to as colleagues.



With the efficient use of information systems, using informatics in healthcare systems can raise the quality of care. Patient care management is the scenario that would require informatics within the healthcare system. The scenario concerns a third-trimester patient who visits a hospital with symptoms of Severe pain lasting more than five hours, intense itching, nausea, and vomiting.

This scenario demonstrates the use of EHR which contains pertinent data when requested presents from other hospitals or encounters. For Epic, as a robust EHR, Care Everywhere is a function of the EHR and it contains information about the outcomes of the most recent screening tests, for additional review and guidance of the current screening procedure. In this scenario, this information reveals the patient’s history of severe cholelithiasis, which prompts a scheduled Cesarean section and eventually a cholecystectomy.

Before implementing any treatment plans, a nursing leader will rigorously gather and process information about the patient’s condition, relying on clinical reasoning and judgment. At the administrative level, it is necessary to understand and modify data and information for the information system’s decision-making processes (Sweeney, 2017). In any case, virtual health services are a growing trend worldwide (Nagle et al., 2017). By making this effort, the patient in this situation will be certain to receive the right diagnosis and treatment, resulting in the greatest possible health results based on best practices.


Julianne Sweeney, B. S. N. (2021, May 11). Healthcare Informatics. HIMSS. Retrieved February 28, 2023, from

Nagle, L. M., Sermeus, W., & Junger, A. (2017). Evolving Role of the Nursing Informatics Specialist. Studies in health technology and informatics232, 212–221.

A Sample Answer 2 For the Assignment: NURS 6501 THE APPLICATION OF DATA TO PROBLEM-SOLVING


Telephone triage 

 The phone rings on a busy Saturday afternoon and the pleasant voice of a registered nurse answers professionally, greeting the caller seeking advice and care. This could be a day for a typical for an ambulatory telephone triage nurse. The concept of telephone triage and consultation can be one of a registered nurse using evidence-based algorithms from electronic databases. The nurses, like most nurses, working in a progressive health care industry are using technology to counsel patients. According to McGonigue & Mastrian, (2022), “For information to be valuable, it must be accessible, accurate, timely, complete, cost-effective, flexible, reliable, relevant, simple, verifiable, and secure.” p.9. 

This information could be valuable to many leaders in the healthcare team. Accessibility would be easiest in form of electronic records and telephone recordings. McGonigue & Mastrian (2022), argue, “Computer science offers extremely valuable tools that when used skillfully, can facilitate the acquisition and manipulation of data and information by nurses, who then can synthesize the data into an evolving knowledge and wisdom base ”p. 35). Accurate and timely information could be an interest in nursing quality and control. One argument on how telephone triage could be cost-effective is that paying nurses to man the phone lines is cheaper than using inappropriate resources such as the emergency room to care that can be directed elsewhere. Flexibility, reliability, simple, verifiable and secure would require a more in-depth look into the nature of telephone triage and program development within a system, but the concept of triage nursing seems to be malleable to the interest of how the data would be used. 

An additional source of centralized evidence-based algorithm software program could also be used and from my research is being used in assisting the nurses to effectively triage the caller and ensure best practice standards. Documentation done by triage nurses would have data from the callers that are subjective and objective, the nursing assessment, and recommendations based on the call. 

From this data collection, multiple departments within healthcare could use this or would have an interest in this data collection. Intradisciplinary teams have an opportunity to look at how to retrieve data from electronic retrieval of health records or from recorded lines if those are being used.  An ambulatory nurse manager might be interested in using the data as a system educator of staff development and improvement strategy to support the training needs within their triage staff. A quality nurse might want to use this data to help in creating of protocol development and safety improvements for effective triage and outcomes. Ambulatory providers could use data to see the patient population’s interests and barriers to care and from there use it to modify their practices.  Health information technology departments within health care organizations could be supportive of this nursing department in implementing programs in making documentation more time efficient and detailed. Nursing leadership could use this as a cost-effective strategy. 

                All departments could build off one another and become temporary team members to gain knowledge and benefit in patient care and satisfaction. Emerging roles could be created as, “Teams are working across boundaries of organizations and will be organized around a particular patient.” (Nagale et al, 2017, p. 215).   Within most healthcare systems the mission and visions of these organizations are built on patient outcomes and patient centered care. An informatics nurse specialist could support patients, nurses, providers, and leaders with the interpretation of data analytics and therefore participate in applying new knowledge from data to wisdom. (Nauright et al., 1999) 

This hypothetical scenario of a nurse working at a telephone triage call center would benefit immensely from data access, problem-solving and the process of knowledge formation. In a real-time, scenario, I could see how this could impact patient care and outcomes on a global level and be a perfect role for a nurse informatics specialist to pilot. 


Nauright,L.P.,Moneyham,L.& Williamson,J.1999. Telephone triage and consultation: An emerging role 

for nurses,Nursing Outlook, 47(5) , 219-226. 

 Nagle, L., Sermeus, W., & Junger, A. (2017).  Evolving Role of the Nursing Informatics Specialist Links to an external site. Links to an external site.. In J. Murphy, W. Goosen, &  P. Weber  (Eds.), Forecasting Competencies for Nurses in the Future of Connected Health (212-221). 

McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning. 

A Sample Answer 3 For the Assignment: NURS 6501 THE APPLICATION OF DATA TO PROBLEM-SOLVING


It was great going through your post. Telehealth is a crucial part of our healthcare system, especially with technological advancement in the recent past. I agree with the benefits of telehealth, as your post indicated.It allows access to healthcare information in a swift manner. Technology helped telemedicine reduce congestion in hospitals as patients can easily access information via teleconference. It has also expanded the opportunities for the nurses who interact closely with the patients.
Telemedicine is a sustainable type of healthcare and can open several doors for treatment for patients and practitioners. It saves time, and treatment is convenient and affordable for people who dread visiting the doctor and avoid going to the hospital. In addition, telehealth is helpful in diagnosis, administrative work, and professional and patient education.
A study assessing the effectiveness of telehealth consultations discovered they could improve patient outcomes in certain areas. Telehealth may not help and completely replace traditional office visits — after all, many services and procedures can only be done in person — but it can reduce the need for them. Telehealth effectively reduces the spread of infectious diseases, especially in this Coronavirus (COVID-19) warfare. When other patients have an infectious disease, they can stay home and call their healthcare provider to get treatment. By staying at home, patients do not expose their illnesses to healthcare professionals and other patients. Patients also reduce the chances of contracting an infectious disease from another person or transmitting and spreading their own  while using telehealth services.




Aggarwal, A. (2017). Telepyschiatry: Current outcomes and future directions. International Journal of Clinical Psychiatry and Mental Health, 5. to an external site. 

Menage, J. (2020). Why telemedicine diminishes the doctor-patient relationship. BMJ, m4348. to an external site. 

Stokel-Walker, C. (2020). Why telemedicine is here to stay. BMJ, m3603. to an external site. 

A Sample Answer 4 For the Assignment: NURS 6501 THE APPLICATION OF DATA TO PROBLEM-SOLVING



A nursing home trach to vent patient comes in to the ER. Their vital signs are a Temperature of 101 F, heart rate of 110, respiratory rate of 24, BP of 85/60. He complains of pain in his back and upon assessment we see a large amount of discharge from his stage 4 sacral wound. Blood work is drawn and white blood cells are greater than 16,000/mm3, with a lactic level of 3. The vital signs are inputted into my charting system, Epic, by the nurse. With Epic, we get an automatic pop-up that due to this patients vital signs, this patient meets sepsis criteria and should be worked up appropriately. When the lab results come back, they are automatically added to epic, which also triggers the sepsis warning. The nurse and provider document their physical assessment, including the stage 4 wound, which along with the sepsis warning pop-up, help us think this may be the source of their infection. 


Data collection, Knowledge Derived, Clinical Reasoning: 

As you can see from the description of the scenario, data like vital signs, blood work, and a physical assessment are collected and assessed. Knowledge can be derived from that data from our medical knowledge, but as a reminder, the charting system can remind us that a patient meets sepsis criteria. Based on the physical assessment, the nurse can use clinical reasoning and judgement to find the cause of the abnormal vital signs and blood work. The likely diagnosis is sepsis due to a sacral wound. These criteria in the EHR are developed based on evidence-based studies, such as the International Guidelines for Management of Severe Sepsis and Septic Shock (Dellinger et al., 2012). I see this scenario very often when I worked as a medical step-down nurse, where many chronically ill, bed-bound, chronically vented nursing home patients came in. 


Supporting Data: 

As described by Walden University, very soon artificial intelligence is going to be a great support to medical professionals, where when a patient comes in with a certain complaint, asking a certain set of questions will help diagnose or rule out the most common possible conditions (Walden University, 2018). This does not replace the nurse or physician but certainly supports us in our decision-making, just like how the Epic Sepsis warning helps remind us to keep this diagnosis in mind if the patient meets the initial criteria. 

Public Health Informatics professionals are the ones who make it so that an EHR like Epic works between different hospitals, outpatient offices, and more (Public Health Informatics Institute, 2017). For example, I would be able to see that the above patient in my scenario had a recent primary care office visit for a fever 1 week prior, and was discharged on antibiotics. When the provider enters the billing code for sepsis, it is thanks to the work of Informatics professionals that that code can be translated from ICD-10 to another medical billing language, so that everyone including insurance companies are receiving the correct information (Public Health Informatics Institute, 2017). 



Walden University, LLC. (Producer). (2018). Health Informatics and Population Health:            Trends in Population Health [Video file]. Baltimore, MD: Author. 

Public Health Informatics Institute. (2017). Public Health Informatics: “translating”            knowledge for health Links to an external site. [Video file]. Retrieved from 

Dellinger, Levy, Rhodes, Annane, Gerlach, & Opal. (2012). Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012. Guideline Central. Retrieved 2022, from 

A Sample Answer 5 For the Assignment: NURS 6501 THE APPLICATION OF DATA TO PROBLEM-SOLVING


Thank you for your example of how nursing informatics can be beneficial to provide treatment plans and medical coding. This sounds like an essential feature that technology is providing for both information and safety in the realm of patient care. I like what Ohno-Machado, 2018, states “Although media attention occasionally concentrates on what can go wrong when information systems are employed in practice, there is also much to say on what might go wrong if information systems were not employed” p.773. This pop-up feature you mention seems to be in alignment with technology use as a benefit. In your experience, how do you see this in time management? Do you agree or disagree with the argument this enables the nurses to focus on analyzing the data rather than obtaining it? Did an informatics specialist train you on the usage of this application?  

In my experience, when new technology was added to my practice, I lacked the education on new programs and found new integrations to take time. I feel that could be minimized by having supportive education in assuming new roles and use of new products. There were only a few trainers available during the rollout period of new styles and most of us were “figuring it out” solo. This was frustrating and gave the staff residence to the technology intended to be helpful.  

According to Nagle et al, 2017, nursing informatics specialists will be supporting and assuming new roles within data analytics and applying this knowledge. As the scope of practice of nurses changes, nursing informaticians have such an opportunity to support the profession. As healthcare is already vastly integrating new uses of technology there is a growing demand for this specialty to support it. 

In hindsight to my experience, I would have advocated more for training to be supportive rather than resistant. Thank you for your scenario to highlight some of my own inner biases based on a negative experience.  

McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning 

Nagle, L., Sermeus, W., & Junger, A. (2017).  Evolving Role of the Nursing Informatics Specialist Links to an external site. Links to an external site. Links to an external site.. In J. Murphy, W. Goosen, &  P. Weber  (Eds.), Forecasting Competencies for Nurses in the Future of Connected Health (212-221). 

Ohno-Machado, L. (2018). The role of informatics in promoting patient safety. Journal of the American Medical Informatics Association, 25(7), 773–773. 

A Sample Answer 6 For the Assignment: NURS 6501 THE APPLICATION OF DATA TO PROBLEM-SOLVING


I have come to respect that computer and electronic mediums are here to stay with regard to taking care of patients in the clinical settings as well as remote areas as we all witnessed with the Covid-19 pandemic. Nursing informatics helps with integrating nursing sciences, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice (Sheridan, et al., 2016). This definition of informatics is needed in this age and time. The informatics side of technology is what I believe I will need more as I transition into the clinical nurse specialist role. I want to be comfortable with the use of computers, data gathering, and the means to disseminate materials as they help to safeguard patients by preventing errors and harm to patients.   


Sheridan, P., Watzlaf, V., Fox, L., (2016). Health Information Management Leaders and the Practice of Leadership through the Lens of Bowen Theory. Retrieved June 9, 2022, from: 

A Sample Answer 7 For the Assignment: NURS 6501 THE APPLICATION OF DATA TO PROBLEM-SOLVING


I enjoyed reading your post, and I agree that health informatics plays a huge role in gathering medical information and making sure it gets communicated to all areas of the integrated public health arena such as other hospitals, outpatient offices, and even urgent care clinics. This however can be our downfall if we rely too heavily on computer systems. We still as healthcare professionals need to know how to utilize communication when technology fails. Some of the negative aspects of EPIC include the cost of EPIC (Pow, 2021). Not all healthcare providers can afford that type of EMR. There was not a current article on the outage that occurred this last month, but EPIC was down for two weeks in some areas, in my area all EPIC access was down for 3 days which included all our local hospitals and clinics, it slowed our usual pace down. According to McCann, something similar happened back in 2014 in Florida and patient safety becomes a top priority in these scenarios ( 2014).  Overall, healthcare professionals must be prepared and not rely solely on health informatics. 


McCann, E. (2014, January 28). Network glitch brings Down Epic EMR. Healthcare IT News. Retrieved December 1, 2022, from 

Pow, A. (2021, April 23). Epic EMR cost – in 2022. The Pricer. Retrieved December 1, 2022, from 

A Sample Answer 8 For the Assignment: NURS 6501 THE APPLICATION OF DATA TO PROBLEM-SOLVING


Your scenario was excellent!  Technology systems such as EPIC, serve more than 250 healthcare organizations nationwide and store approximately 45 percent of the US population’s health records (Jo Ann Day, 2016)  Although the utilization of EHR such as EPIC has greatly impacted overall patient outcomes, there is the human error factor that poses a constraint. In this case, documentation of vital signs and other pertinent assessments was extremely important for the sepsis alerts. For this reason, appropriate treatment was implemented based on set guidelines such as those of the International Guidelines for Management of Severe Sepsis and Septic Shock. According to Ruppel & Liu (2019), ”Sepsis is a global health priority of staggering impact, resulting in at least 6 million deaths worldwide each year and contributing to as many one-half of all hospital deaths in the US”.  A drawback to the appropriate utilization of information technology such as the sepsis alert trigger is that sometimes, healthcare professionals do not input data in real-time, and end up delaying timely notifications. In my experience years ago as a medical surgical nurse, Nursing Assistants who were responsible for recording vital signs were sometimes unable to record vitals on time and end up documenting vitals at the end of the shift. Although they would verbally notify nurses of abnormal blood glucose and blood pressure, other pertinent information such as respiratory rate and temperature is sometimes overlooked. Uploading an abnormal respiratory rate and low body temperature to a  system that already has records of an elevated white blood cell count, will trigger a sepsis alert. If the information was inputted earlier in the day, the appropriate treatment would be initiated in a timely manner.  To effectively utilize EHR, I believe that healthcare leaders need to allocate resources to units with higher patient-to-nurse or nurse-assistant ratios. An example will be investing in vital sign machines that automatically upload EHR to the patient chart to avoid delay.  


Jo Ann Day. (2016, September 23). Why Epic | Johns Hopkins Medicine. to an external site.

Ruppel H, Liu V. To catch a killer: electronic sepsis alert tools reaching a fever pitch? BMJ Qual Saf. 2019 Sep;28(9):693-696. doi: 10.1136/bmjqs-2019-009463. Epub 2019 Apr 23. PMID: 31015377; PMCID: PMC6702042.

A Sample Answer 9 For the Assignment: NURS 6501 THE APPLICATION OF DATA TO PROBLEM-SOLVING


Technology has added so greatly to the effectiveness of our care. The work that has gone into vital signs and other assessment findings to create alerts when out of range is impressive. In paper forms, essential data can sometimes be missed or even go unnoticed, but having a system that connects the dots help health providers to see the bigger picture. “Advances in technology have been made available to aid nurses perform their jobs and care for patients more efficiently and safely. Nursing today is not the same as it was 30 years ago”(Pepito & Locsin, 2019). 

As wonderful as technology is, it requires the working knowledge to derive or identify what is happening with the patients to offer the proper treatment. One cannot overlook the many lives technology has saved. Even the most prudent nurse can make a mistake. We have seen many things that improved in the area of medication administration. “On average, roughly 7,000 patients in the United States die each year from adverse drug events. To help curb these incidents, electronic medication administration has become commonplace”(Impact of Technology in Nursing | Nursing & Technology | Queens, 2020). Technology advancements are happening daily and will continue to revolutionize how we care for our patients. It is such a wonderful thing. 


Impact of Technology in Nursing | Nursing & Technology | Queens. (2020, December 10). Qnstux; Queen University. 

Pepito, J. A., & Locsin, R. (2019). Can nurses remain relevant in a technologically advanced future? International Journal of Nursing Sciences, 6(1), 106–110. 

A Sample Answer 10 For the Assignment: NURS 6501 THE APPLICATION OF DATA TO PROBLEM-SOLVING


Nursing informatics is a concept that integrates information science, computer science, and nursing science to facilitate efficient data management and utilization in the nursing and healthcare process (McGonigle & Mastrian, 2017). Nearly all professions currently rely on computer and information science to collect, analyze, and interpret organizational data, thus making it easy for organizations to anticipate issues and make decisions promptly (Backonja et al., 2022). Some technologies used in nursing informatics include electronic health records (EHRs), electronic medical records (EMRs), online portals, and others used by nurses and other healthcare professionals to manage and address patient health issues and data (Backonja et al., 2022). Components of nursing informatics are also used in psychiatric mental health to manage patient data, plan treatment regimens, and analyze patient symptoms. 

One time in a local psychiatric and mental health clinic, I observed that most patients overstayed in the facility, and they were not getting any better during their stay. I also observed that patients were admitted to various units depending on their chief complaints without assessments for comorbid mental health disorders and other diseases. I enquired why most patients treated for psychiatric and mental health disorders presented with other clinical conditions and why the management found it difficult to provide comprehensive care that addressed all the patient’s physical, psychological, and emotional needs. It was explained that mental health disorders are diverse and that most of the symptoms used to diagnose mental health disorders are similar, making the appropriate diagnosis a challenging endeavor. Further explanation was that diagnosing mental health disorders is undertaken using the DSM-V criteria manual, which may not be 100% accurate in diagnosing patients with comorbid mental health conditions. The number of hospital readmissions in the facility kept increasing due to relapses and the emergence of other symptoms. 

Description of Data that could be used 

            To mend this gap and ensure that all patients receive optimal care that meets all their needs, providers can collect and use the patient’s demographic data (age, sex, race, residence, education, occupation, and others) to understand what mental health problems affect specific demographic groups in the community (Backonja et al., 2022). Informatics can also be used to collect and analyze patients’ clinical data, including medical history, hospitalizations, current medications, and other EHRs data before planning and administering treatments to patients (Backonja et al., 2021). It would also be important to collect the patient’s social data to identify various health risks associated with social determinants of health (SDOH), access to health information, and available social support networks. Data on patients’ behaviors and lifestyles can also be collected and analyzed to establish the relationship between their behaviors/lifestyles and strategize patient education and health promotion (Backonja et al., 2021). These data pieces can be collected through family health assessments, community surveys, patient feedback after discharge, and general health assessments. 

Knowledge derived from the Data 

The data can provide insightful knowledge on the prevalence and incidence rates of mental health diseases across population groups. It can also be used in the identification of available mental health resources, access rate to the resources, and SDOH affecting access to appropriate mental health services (Backonja et al., 2021). Moreover, data on social life can help psychiatric mental health workers to identify behavioral and lifestyle practices within communities and populations that influence their mental and physical health status (McGonigle & Mastrian, 2017). Providers can also use the data in planning public health promotion programs and initiating behavioral health education and awareness programs. 

How a Nurse Leader Would Use Clinical Reasoning and Judgment 

A nurse leader would use clinical judgment to gain knowledge by using the aforementioned data to promote population health, advocate for different demographic groups and populations, and formulate new policies (Backonja et al., 2021). For example, a nurse leader would use clinical data to identify persistent disparities in mental health services access and engage the relevant agencies and provider groups in charting effective strategies for eradicating the disparities (Backonja et al., 2021). Nurse leaders can also use the data to write policy briefs, review current evidence-based practices for addressing mental health issues, and create awareness about various mental health concerns across population groups (McGonigle & Mastrian, 2017). Lastly, a nurse leader can use the data collected to promote public health through health education, awareness creation, and advocacy campaigns. 


Backonja, U., Langford, L. H., & Mook, P. J. (2022). How to support the nursing informatics leadership pipeline: Recommendations for nurse leaders and professional organizations. CIN: Computers, Informatics, Nursing, 40(1), 8-20. 

Backonja, U., Mook, P., & Heermann Langford, L. (2021). Calling nursing informatics leaders: Opportunities for personal and professional growth. OJIN: The Online Journal of Issues in Nursing, 26(3), 1-8. 

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning. 

A Sample Answer 11 For the Assignment: NURS 6501 THE APPLICATION OF DATA TO PROBLEM-SOLVING


Hello Oluremilekun! I appreciated your post because you mentioned medication scanning. I work in a facility that uses this kind of system, and for the most part, it does a good job of preventing medication errors. The patient must be scanned first, then their medication list comes up. Then each medication must be scanned individually. Alerts populate for many reasons, like if it hasn’t been enough time since the last dose given, the medication has been discontinued, or only a portion of what was scanned is to be given. These alerts make it so nothing else can be scanned until the alert is addressed, so the nurse is sure to see the message and be aware of what they are doing during their medication pass. The system does its job, but the people using it also must be sure they are paying attention to the system and following orders correctly. “If BCMA (barcode medication administration) is not integrated well into nursing workflow, workarounds may occur that deviate from the expected use (Strudwick et al., 2018).” Our facility requires that nurses must scan at least 95% of patients and 95% of medications to comply or nurses will receive corrective action.  The computer system for medication administration is smart, but so are we! McGonigle and Mastrian (2022) explained that “in the healthcare environment, the hardware, software, networking, algorithms, and human organic information systems work together to create meaningful information and generate knowledge.” We need to be able to use the technology we have as well as our own clinical knowledge to create the best patient outcomes. 


McGonigle, D., & Mastrian, K. (2022). Nursing Informatics and the Foundation of Knowledge (5th edition). Jones & Bartlett Learning. 

Strudwick, G., Reisdorfer, E., Warnock, C., Kalia, K., Sulkers, H., Clark, C., & Booth, R. (2018). Factors Associated with Barcode Medication Administration Technology That Contribute to Patient Safety: An Integrative Review. Journal of Nursing Care Quality, Volume 33(1), 79-85. DOI: 10.1097/NCQ.0000000000000270