Feasibility of Licensed Vocational Nurses Using a CDS App to Communicate Signs and Symptoms of a UTI

Student summary

Why This Research Matters

This article explores how licensed vocational nurses (LVNs) can use a clinical decision support (CDS) app to assess urinary tract infections (UTIs) in nursing home residents. UTIs are common and often difficult to diagnose accurately, especially for LVNs who may have less experience or training compared to registered nurses.

The study was conducted as a simulation at a university in the Southern United States. Ten practicing LVNs participated by using an algorithm developed specifically for this purpose. This algorithm was designed based on existing UTI assessment guidelines and practical considerations relevant to nursing home care.

To evaluate how well the LVNs used the CDS app, researchers looked at several things: 1. **Ease of Use:** The LVNs were asked about their experience with the app itself – whether it was easy or difficult to navigate and use during the simulation. 2. **Engagement:** Researchers observed the LVNs' behavior while they interacted with the algorithm, noting how actively they used it throughout the simulated assessment process. 3. **Value Perception:** After completing the simulation, the LVNs were interviewed about their thoughts on using such an app for UTI assessments in real nursing home settings. They shared what they found helpful or valuable about this approach.

The study's findings suggest that LVNs generally had a positive experience with the CDS algorithm: * **Ease of Use:** The majority of LVNs reported finding the algorithm easy or very easy to use within the simulation environment. * **Engagement Levels:** Their behaviors during the simulation indicated high levels of engagement as they worked through the assessment process using the app. * **Positive Value Placed on Algorithmic Approach:** Interviews confirmed that LVNs saw value in using a structured, algorithm-based approach for assessing UTIs. They appreciated how it guided their data collection and decision-making related to resident care.

For nursing students like you, this study highlights several important aspects: * **Technology in Nursing Practice:** It shows how technology (in the form of CDS apps) can be a tool to support nurses, especially those with less experience or training. You might consider how such tools could assist you in your future clinical practice. * **Standardization and Guidance:** The algorithm provided a standardized way for LVNs to approach UTI assessment. This is important because it helps ensure consistency and reduces the chance of missing key information that leads to accurate diagnosis. * **Role of Simulation:** Simulations are valuable learning tools. They allow nurses (and students) to practice new skills or technologies in a safe, controlled environment before applying them with real patients.

When appraising this study, consider: * The sample size was small (ten LVNs), which limits the generalizability of the findings to all LVNs across different settings. More research would be needed to confirm these results on a larger scale or in various nursing home environments. * This was a simulation-based study; while useful for assessing feasibility and initial reactions, it doesn't directly tell us about real-world effectiveness or impact on actual patient outcomes yet.

Regarding source and rights: The paper is open access via DOAJ (Directory of Open Access Journals), which means you can typically read the full text without a subscription. Always check the journal's website for specific usage permissions if you plan to share or cite extensively, though standard academic citation should be fine. The record indicates a high source authority level and confidence score.

As future nurses, reasoning from this evidence might involve: * Considering how CDS tools could improve diagnostic accuracy in your practice area. * Reflecting on the potential benefits of structured algorithms for guiding assessments, particularly for common conditions like UTIs where symptoms can be non-specific or easily misinterpreted. * Thinking about how simulation experiences prepare you to use new technologies effectively and confidently when they become available in clinical settings. It's a step towards evidence-based practice by providing a tool that is grounded in existing assessment criteria.

Faculty notes

Educational Relevance

This study investigates the feasibility of licensed vocational nurses (LVNs) utilizing a Clinical Decision Support (CDS) algorithm for assessing urinary tract infections (UTIs) in nursing home residents, conducted as a simulation at a university. The research addresses a significant clinical issue: UTIs are poorly assessed and challenging to treat in this vulnerable population.

The study employed a structured observational design with ten practicing LVNs from the Southern United States. These nurses used an algorithm developed by the authors based on published UTI assessment criteria and practice-driven considerations, applied within a simulated NH resident scenario. Data collection was multifaceted: (a) a UTI-guided assessment tool captured their performance; (b) researchers analyzed LVN behavior and verbal interactions with the CDS app during the simulation; and (c) postsimulation interviews explored their perceptions of the algorithm's utility.

The key findings indicate positive initial reception for this technological intervention: 1. **Ease of Use:** The majority of participating LVNs found the CDS algorithm easy or very easy to use within the simulated environment. 2. **High Engagement:** Observational data revealed high levels of engagement as LVNs interacted with and utilized the algorithm throughout their assessment process in the simulation. 3. **Positive Value Perception:** Post-simulation interviews consistently supported the positive value that LVNs placed on using an algorithmic approach for UTI assessment, suggesting they saw it as a beneficial tool. 4. **Gap Filling Potential:** The authors assert that this developed algorithm fills a gap in current approaches to diagnosing UTIs in NHs by specifically focusing on the role of the LVN in data collection and its direct application to resident assessment. 5. **Simulation Efficacy for Feasibility Testing:** The study demonstrates that simulation settings are effective for evaluating the feasibility, usability, and initial acceptance of such technological tools among practicing nurses.

For faculty, this paper offers several points for discussion: * It exemplifies a practical application of technology in nursing education and practice, specifically targeting LVNs who may have varying levels of experience with complex diagnostic processes like UTI assessment. The simulation method is particularly relevant as it allows for controlled testing of new tools. * The study highlights the potential for CDS to standardize care pathways and improve diagnostic accuracy by guiding nurses through evidence-based criteria. This aligns well with goals of promoting evidence-based practice (EBP) in nursing curricula. * It underscores the importance of considering the role of LVNs in specialized assessments within long-term care settings, a topic often underrepresented compared to registered nurse roles.

When discussing this paper, faculty might guide students to consider: * The limitations inherent in simulation studies (e.g., artificiality of the environment vs. real-world pressures) and how these findings translate beyond the controlled setting. * The specific design of the CDS algorithm – its basis on published criteria versus novel elements – and whether this enhances or complicates usability for LVNs. * The broader implications for nursing education, such as integrating simulation-based training with emerging technologies like CDS apps to prepare students for future practice environments. * The need for further research: While feasibility is promising, studies on actual clinical outcomes (e.g., diagnostic accuracy improvements, impact on treatment delays) and long-term adoption rates are essential next steps.