Sheila M Gephart

Interests

Research

Instrument development: GutCheckNEC for timely recognition of necrotizing enterocolitis and the Carrington-Gephart Unintended Consequences of Electronic Health Records Questionnaire (CG-UCE-Q).Dissemination strategies for informatics innovations (especially scalable clinical decision support).Prevention and timely recognition for necrotizing enterocolitis in fragile infants (NEC-Zero project) using the NEC-Zero toolkit and the NEC-Zero clinical decision support dashboard.

Teaching

Nursing education, nursing faculty loan program. Synthesis strategies and theory development for PhD and DNP in nursing programs. Clinical decision support systems and informatics.

Courses

Scholarly Contributions

Chapters

• Msowoya, A., & Gephart, S. M. (2018). Patient Centered Evidence Based Practices.. In Evidence-Based Practice for Nursing and Healthcare Quality Improvement(pp 219-230). St. Louis, MO: Elsevier.

Journals/Publications

• Gallo, T., Heise, C., Woosely, R., Tisdale, J., Antonescu, C., Gephart, S. M., & Malone, D. C. (2021). Clinician satisfaction with advanced clinical decision support to reduce the risk of torsades de pointes. Applied Clinical Informatics.
• Platt, C., & Gephart, S. M. (2020). Placement Disruption of Children with Disabilities in Foster Care. Journal of Nursing Scholarship.
• Dolan, H., Amidon, B. J., & Gephart, S. M. (2022). Evidentiary and theoretical foundations for virtual simulation in nursing education. Journal of professional nursing : official journal of the American Association of Colleges of Nursing, 37(5), 810-815.
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  Virtual simulation has been used extensively in nursing education since the beginning of the COVID-19 pandemic due to the unavailability of clinical sites. Extant research supports substitution of up to 50% of nursing clinical hours with simulation. However, in many nursing programs virtual simulation is currently substituting more than half of traditional clinical hours, and the knowledge gaps and limitations surrounding virtual simulation exist. The purpose of this paper is to describe the evidentiary and theoretical foundations for virtual simulation. Through examination of adult learning theories, learning styles and Bloom's Revised Taxonomy, recommendations for maximizing the use of virtual simulation in the current clinical learning environment are outlined. Debriefing is a vital component of virtual simulation. Synchronous debriefing with nursing students, faculty, preceptors, and peers provides the opportunity for scaffolding to support students' learning needs and foster reflection and evaluation to mitigate shortcomings of virtual simulation in the current clinical learning environment.
• Moore, E. F., & Gephart, S. M. (2022). State of the science of care coordination, rurality, and well-being for infants with single ventricle heart disease in the Interstage period, an integrative review. Heart & lung : the journal of critical care, 50(5), 720-729.
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  Ensuring the quality of interstage management of infants with single ventricle heart disease (SVHD) residing in rural communities is difficult. Tailored care coordination through parental discharge education, formal and informal care team and family communication, adequate access to healthcare, and informed provider handoffs are crucial to the infant's well-being and survival.
• Ringo, N., & Gephart, S. M. (2022). Exploring Greater Rates of Breastfeeding Among Civilian Military Wives. Nursing for women's health.
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  To explore factors contributing to the greater rates of breastfeeding initiation and duration among civilian military wives (e.g., legally married to an active-duty spouse) and to determine what might be learned from these factors for intervention design for the broader population of women in the postpartum period.
• Tolentino, D. A., Subbian, V., & Gephart, S. M. (2022). Applying Computational Ethnography to Examine Nurses' Workflow Within Electronic Health Records. Nursing research, 70(2), 132-141.
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  The aim of this study was to describe computational ethnography as a contemporary and supplemental methodology in EHR workflow analysis and the relevance of this method to nursing research.
• Chou, E., Boyce, R. D., Balkan, B., Subbian, V., Romero, A., Hansten, P. D., Horn, J. R., Gephart, S., & Malone, D. C. (2021). Designing and evaluating contextualized drug-drug interaction algorithms. JAMIA open, 4(1), ooab023.
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  Alert fatigue is a common issue with off-the-shelf clinical decision support. Most warnings for drug-drug interactions (DDIs) are overridden or ignored, likely because they lack relevance to the patient's clinical situation. Existing alerting systems for DDIs are often simplistic in nature or do not take the specific patient context into consideration, leading to overly sensitive alerts. The objective of this study is to develop, validate, and test DDI alert algorithms that take advantage of patient context available in electronic health records (EHRs) data.
• Galatzan, B. D., Carrington, J. M., & Gephart, S. M. (2021). Testing the Within Methods Triangulation Data Analysis with Nurse Hand-Off Text Data. Computers, Informatics, Nursing.
• Galatzan, B. J., Carrington, J. M., & Gephart, S. (2021). Testing the Use of Natural Language Processing Software and Content Analysis to Analyze Nursing Hand-off Text Data. Computers, informatics, nursing : CIN, 39(8), 411-417.
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  Natural language processing software programs are used primarily to mine both structured and unstructured data from the electronic health record and other healthcare databases. The mined data are used, for example, to identify vulnerable at-risk populations and predicting hospital associated infections and complications. Natural language processing programs are seldomly used in healthcare research to analyze the how providers are communicating essential patient information from one provider to another or how the language that is used impacts patient outcomes. In addition to analyzing how the message is being communicated, few studies have analyzed what is communicated during the exchange in terms of data, information, and knowledge. The analysis of the "how" and "what" of healthcare provider communication both written and verbal has the potential to decrease errors and improve patient outcomes. Here, we will discuss the feasibility of using an innovative within-methods triangulation data analysis to uncover the contextual and linguistic meaning of the nurse-to-nurse change-of-shift hand-off communication. The innovative within-methods triangulation data analysis uses a natural language processing software program and content analysis to analyze the nursing hand-off communication.
• Gephart, S. M., & Quinn, M. (2021). A Call to Action to Fight for Equity and End Necrotizing Enterocolitis Disparities. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 21(5), 333-335.
• Gephart, S. M., Dolan, H., & Amidon, B. (2021). Evidentiary and Theoretical Foundations for Virtual Simulation in Nursing Education. Journal of Professional Nursing.
• Gephart, S. M., Newnam, K., Weiss, A., Wyles, C., & Shea, K. (2021). Feasibility and Acceptability of a Neonatal Project ECHO (NeoECHO) as a Dissemination and Implementation Strategy to Prevent Necrotizing Enterocolitis. Worldviews on evidence-based nursing, 18(6), 361-370.
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  Caregivers in the neonatal intensive care unit (NICU) often determine care practices in silos, although access to learning communities can improve quality. Project ECHO, a telehealth-delivered mentoring intervention, provides specialists' expertise but not in the NICU until now. Necrotizing enterocolitis (NEC) prevention and timely recognition is one area where specialist support and engaging with a learning community could improve outcomes. NEC-Zero is one care bundle that aims to improve care quality by providing tools to implement NEC prevention in family-engaged ways.
• Gephart, S. M., Newnam, K., Weiss, A., Wyles, C., & Shea, K. D. (2020). Feasibility and Acceptability of a Neonatal Project ECHO as a Dissemination and Implementation Strategy to Prevent Necrotizing Enterocolitis. Worldviews in Evidence based Nursing.
• Moore, E. F., Thomas, K., & Gephart, S. M. (2021). Fresh Perspectives on an Old Method: Secondary Analysis in a Big Data Era. Computers, informatics, nursing : CIN, 39(8), 393-399.
• Moore, E., & Gephart, S. M. (2020). State of the Science of Care Coordination, Rurality, and Well-being for Infants with Single Ventricle Heart Disease in the Interstage Period. Heart and Lung.
• Subbian, V., Tolentino, D. A., Subbian, V., & Gephart, S. M. (2021). Applying Computational Ethnography to Examine Nurses' Workflow Within Electronic Health Records.. Nursing Research, 70(2), 132-141. doi:10.1097/nnr.0000000000000486
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  OBJECTIVE: The aim of this study was to describe computational ethnography as a contemporary and supplemental methodology in EHR workflow analysis and the relevance of this method to nursing research. METHODS: We explore the use of audit logs as a computational ethnographic data source and the utility of data mining techniques, including sequential pattern mining (SPM) and Markov chain analysis (MCA), to analyze nurses' workflow within the EHRs. SPM extracts frequent patterns in a given transactional database (e.g., audit logs from the record). MCA is a stochastic process that models a sequence of states and allows for calculating the probability of moving from one state to the next. These methods can help uncover nurses' global navigational patterns (i.e., how nurses navigate within the record) and enable robust workflow analyses. RESULTS: We demonstrate hypothetical examples from SPM and MCA, such as (a) the most frequent sequential pattern of nurses' workflow when navigating the EHR using SPM and (b) transition probability from one record screen to the next using MCA. These examples demonstrate new methods to address the inflexibility of current approaches used to examine nursing EHR workflow. DISCUSSION: Within a clinical context, the use of computational ethnographic data and data mining techniques can inform the optimization of the EHR. Results from these analyses can be used to supplement the data needed in redesigning the EHR, such as organizing and combining features within a screen or predicting future navigation to improve the record that nurses use.
• Tolentino, D. A., Gephart, S. M., & Subbian, V. (2020). Applying computational ethnography to examine nurses' workflow within the Electronic Health Record. Nursing Research.
• Tolentino, D. A., Patmon, F., & Gephart, S. M. (2020). A descriptive study of nurses' experiences with unintended consequences of the electronic health record in two urban hospitals. Journal of Informatics Nursing.
• Villa-Zapata, L., Carhart, B. S., Horn, J. R., Hansten, P. D., Subbian, V., Gephart, S., Tan, M., Romero, A., & Malone, D. C. (2021). Serum potassium changes due to concomitant ACEI/ARB and spironolactone therapy: A systematic review and meta-analysis. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 78(24), 2245-2255.
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  To provide evidence of serum potassium changes in individuals taking angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers (ARBs) concomitantly with spironolactone compared to ACEI/ARB therapy alone.
• Weiss, A. B., Newnam, K. M., Wyles, C., Shea, K., & Gephart, S. M. (2021). Exploring Internal Facilitators' Experience With NeoECHO to Foster NEC Prevention and Timely Recognition Through the iPARIHS Lens. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 21(6), 462-472.
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  Necrotizing enterocolitis (NEC) remains a major complication in the neonatal population. Standard practices regarding the care of premature infants and attitudes toward NEC prevention strategies vary across neonatal intensive care units (NICUs). Evidence-based best practice dissemination was presented through the NEC-Zero bundle. To close gaps between evidence and practice, a telehealth-delivered intervention (ie, NeoECHO) was provided to NICUs.
• Dunn Lopez, K., Gephart, S. M., & Hershberger, P. E. (2020). Using Online Survey Software to Enhance Rigor and Efficiency of Knowledge Synthesis Reviews. Western journal of nursing research, 42(10), 838-845.
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  With the explosion of scientific literature, information technologies, and the rise of evidence-based health care, methodologies for literature reviews continue to advance. Yet there remains a lack of clarity about techniques to rigorously and efficiently extract and synthesize data from primary sources. We developed a new method for data extraction and synthesis for completing rigorous, knowledge synthesis using freely available online survey software that results in a review-specific, online data extraction, and synthesis tool. The purpose of this paper is to delineate this method using our published integrative review as an exemplar. Although the purpose of online survey software is to obtain and analyze survey responses, these software programs allows for the efficient extraction and synthesize of disparate study features from primary sources. Importantly, use of the method has the potential to increase the rigor and efficiency of published reviews bringing the promise of advancing multiple areas of health science.
• Gephart, S. M., Newnam, K., Wyles, C., Bethel, C., Porter, C., Quinn, M. C., Canvasser, J., Umberger, E., & Titler, M. (2020). Development of the NEC-Zero Toolkit: Supporting Reliable Implementation of Necrotizing Enterocolitis Prevention and Recognition. Neonatal network : NN, 39(1), 6-15.
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  The goal of the NEC-Zero project is to reduce the burden of necrotizing enterocolitis (NEC) by increasing access to evidence-based tools to help clinicians and parents integrate evidence into daily care. It involves (a) human milk feeding with prioritized mother's own milk; (b) use of a unit-adopted standardized feeding protocol; (c) a unit-adopted strategy for timely recognition that integrates risk awareness and a structured communication tool when symptoms develop; and (d) stewardship of empiric antibiotics and avoidance of antacids. A toolkit for caregivers and parents was developed to make implementation consistent. For clinicians the toolkit includes: the GutCheck risk score, a structured communication tool, the "Avoiding NEC" checklist, and the NEC-Zero website. For parents, NEC-Zero tools include the website, three educational brochures in English and Spanish, and a collaborative care video produced with the NEC Society. This article describes the toolkit and how it has been accessed and used.
• Gephart, S. M., Underwood, M. A., Rosito, S., Kim, J. H., & Caplan, M. S. (2020). Grading the evidence to identify strategies to modify risk for necrotizing enterocolitis. Pediatric research, 88(Suppl 1), 41-47.
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  Although risk for necrotizing enterocolitis (NEC) is often presented from the perspective of a premature infant's vulnerability to nonmodifiable risk factors, in this paper we describe the evidence and present recommendations to manage modifiable risks that are amenable to clinical actions. Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, we present recommendations in the context of their supporting evidence in a way that balances risks (e.g. potential harm, cost) and benefits. Across the prenatal, intrapartum, early and late clinical course, strategies to limit NEC risk in premature infants are presented. Our goal is to summarize modifiable NEC risk factors, grade the evidence to offer quality improvement (QI) targets for healthcare teams and offer a patient-family advocate's perspective on how to engage parents to recognize and reduce NEC risk.
• Knapp, S., Kehring, A., Stepp, J., Calton, C. M., Gephart, S. M., Bandlamuri, S., Boyle, K. E., Dietz, G. I., Johnson, H., Romo, R. E., Spencer, M., Bedrick, A. D., & Halpern, M. D. (2020). Elevated Coefficient of Variation in Total Fecal Bile Acids Precedes Diagnosis of Necrotizing Enterocolitis. Scientific reports, 10(1), 249.
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  Accumulation of bile acids (BAs) may mediate development of necrotizing enterocolitis (NEC). Serial fecal samples were collected from premature infants with birth weight (BW) ≤ 1800 g, estimated gestational age (EGA) ≤ 32 weeks, and
• Shea, K. D., Wyles, C., Weiss, A., Newnam, K., & Gephart, S. M. (2020). Feasibility and Acceptability of a Neonatal Project ECHO as a Dissemination and Implementation Strategy to Prevent Necrotizing Enterocolitis. Worldviews in Evidence based Nursing.
• Subbian, V., Malone, D. C., Zapata, L. V., Subbian, V., Romero, A., Panic, J., Malone, D. C., Horn, J. R., Hansten, P. D., Gephart, S. M., & Boyce, R. D. (2020). PGI27 GASTROINTESTINAL BLEEDING WITH CONCOMITANT EXPOSURE TO WARFARIN AND NON-STEROIDAL ANTI-INFLAMMATORY DRUGS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Value in Health, 23, S147. doi:10.1016/j.jval.2020.04.382
• Tolentino, D. A., & Gephart, S. M. (2020). State of the Science of Dimensions of Nurses' User Experience When Using an Electronic Health Record. Computers, informatics, nursing : CIN.
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  This integrative review synthesized relevant studies in the last decade associated to nurses' experience with the electronic health record using Robert and Lesage's dimensions of User Experience: functional, physical, perceptual, cognitive, psychological, and social. A comprehensive search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance across four electronic databases. We included articles if they were specific to nurses' electronic health record experience and workflow, published between January 2008 and June 2018, and available in English. The search resulted in 793 records with 26 articles included in the final analysis. Articles ranged from quantitative, qualitative, mixed-methods, and quality improvement studies. Across studies, the suboptimal design of the electronic health record affected the functional experience of nurses, often resulting in interruptions. The navigational design contributed to nurses' perceptual experience leading to many workarounds and workflow mismatches. Most of the studies reported overall satisfaction with the electronic health record that represented the psychological dimension of nurses' experience. Communication barriers due to the use of the electronic health record prevented nurses from having meaningful interaction with other clinicians and patients. Although nurses reported substandard user experience, many stated that reverting to a linear paper-based system was not an option.
• Villa Zapata, L., Hansten, P. D., Horn, J. R., Boyce, R. D., Gephart, S., Subbian, V., Romero, A., & Malone, D. C. (2020). Evidence of Clinically Meaningful Drug-Drug Interaction With Concomitant Use of Colchicine and Clarithromycin. Drug safety, 43(7), 661-668.
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  Colchicine is currently approved for the treatment of gout and familial Mediterranean fever, among other conditions. Clarithromycin, a strong inhibitor of CYP3A4 and P-glycoprotein, dramatically increases colchicine's half-life, augmenting the risk of a life-threatening adverse reaction when used inadvertently with colchicine.
• Villa Zapata, L., Hansten, P. D., Panic, J., Horn, J. R., Boyce, R. D., Gephart, S., Subbian, V., Romero, A., & Malone, D. C. (2020). Risk of Bleeding with Exposure to Warfarin and Nonsteroidal Anti-Inflammatory Drugs: A Systematic Review and Meta-Analysis. Thrombosis and haemostasis, 120(7), 1066-1074.
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   Warfarin use can trigger the occurrence of bleeding independently or as a result of a drug-drug interaction when used in combination with nonsteroidal anti-inflammatory drugs (NSAIDs).
• Caplan, M. S., Underwood, M. A., Modi, N., Patel, R., Gordon, P. V., Sylvester, K. G., McElroy, S., Manzoni, P., Gephart, S., Chwals, W. J., Turner, M. A., Davis, J. M., & , N. E. (2019). Necrotizing Enterocolitis: Using Regulatory Science and Drug Development to Improve Outcomes. The Journal of pediatrics, 212, 208-215.e1.
• Caplan, M., Underwood, M., Modi, N., Patel, R., Sylvester, K., McElroy, S., Manzoni, P., Gephart, S. M., Chwals, W., Turner, M., Davis, J., & The NEC Workgroup of the International Neonatal Consortium, . (2018). Necrotizing Enterocolitis: Improving Diagnosis, Prevention, and Treatment.. Journal of Pediatric Research.
• Davis, M., Rosenfeld, A. G., Shea, K. D., Rosenfeld, A. G., Gephart, S. M., Davis, M., Carrington, J. M., & Brewer, B. B. (2019). A model to evaluate data science in nursing doctoral curricula.. Nursing outlook, 67(1), 39-48. doi:10.1016/j.outlook.2018.10.007
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  Building on the efforts of the American Association of Colleges of Nursing, we developed a model to infuse data science constructs into doctor of philosophy (PhD) curriculum. Using this model, developing nurse scientists can learn data science and be at the forefront of data driven healthcare..Here we present the Data Science Curriculum Organizing Model (DSCOM) to guide comprehensive doctoral education about data science..Our team transformed the terminology and applicability of multidisciplinary data science models into the DSCOM..The DSCOM represents concepts and constructs, and their relationships, which are essential to a comprehensive understanding of data science. Application of the DSCOM identified areas for threading as well as gaps that require content in core coursework..The DSCOM is an effective tool to guide curriculum development and evaluation towards the preparation of nurse scientists with knowledge of data science.
• Gephart, S. M., & Newnam, K. (2018). Closing the gap between recommended and actual human milk use for fragile infants- what will it take to overcome disparities?. Clinics in Perinatology.
• Gephart, S. M., & Newnam, K. M. (2019). Closing the Gap Between Recommended and Actual Human Milk Use for Fragile Infants: What Will It Take to Overcome Disparities?. Clinics in perinatology, 46(1), 39-50.
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  This article describes the components of human milk and their value to reduce risk for necrotizing enterocolitis, disparities in access to human milk, potential relationships to care practices within the neonatal intensive care unit, and ways to overcome the disparity.
• Gephart, S. M., & Quinn, M. (2018). Relationship of necrotizing enterocolitis (NEC) rates to adoption of prevention practices in U.S. neonatal intensive care units.. Advances in Neonatal Care.
• Gephart, S. M., & Quinn, M. C. (2019). Relationship of Necrotizing Enterocolitis Rates to Adoption of Prevention Practices in US Neonatal Intensive Care Units. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 19(4), 321-332.
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  Applying quality improvement methods has reduced necrotizing enterocolitis (NEC) in some neonatal intensive care units (NICUs) by 40% to 90%.
• Menon, U., Cohn, E., Downs, C. A., Gephart, S. M., & Redwine, L. (2019). Precision health research and implementation reviewed through the conNECT framework. Nursing outlook, 67(4), 302-310.
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  Precision health is a population-based approach that incorporates big-data strategies to understand the complex interactions between biological, environmental, lifestyle, and psychosocial factors that influence health.
• Quinn, J. M., Gephart, S. M., & Davis, M. P. (2019). External Facilitation as an Evidence-Based Practice Implementation Strategy During an Antibiotic Stewardship Collaborative in Neonatal Intensive Care Units. Worldviews on evidence-based nursing, 16(6), 454-461.
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  Despite research support, evidence-based practices (EBPs) are inconsistently implemented throughout the United States. Facilitation is one implementation strategy to speed adoption in clinical settings. Facilitation has not been previously described in the literature as an implementation strategy within neonatal care.
• Wang, J., Gephart, S. M., Mallow, J., & Bakken, S. (2018). Models of collaboration and dissemination for nursing informatics innovations in the 21st century.. Nursing Outlook.
• Wang, J., Gephart, S. M., Mallow, J., & Bakken, S. (2019). Models of collaboration and dissemination for nursing informatics innovations in the 21st century. Nursing outlook, 67(4), 419-432.
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  Nursing informatics innovations are constantly adapting to a rapidly changing health care environment.
• Bristol, A. A., Nibbelink, C. W., Gephart, S. M., & Carrington, J. M. (2018). Nurses' Use of Positive Deviance When Encountering Electronic Health Records-Related Unintended Consequences. Nursing administration quarterly, 42(1), E1-E11.
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  As organizations adopt electronic health records (EHRs), nurses frequently encounter system barriers and difficulty performing role expectations. This article describes nurses' experiences with unintended consequences emerging from the use of an EHR. In some situations, nurses were positively deviant when encountering unintended consequences relating to EHRs to accomplish patient care or protect patient safety. Nurses engaged in work-arounds to provide patient care when the EHR did not meet their needs, sometimes in positively deviant ways. Qualitative data were collected from 5 open-ended questions at the end of a quantitative survey. Analysis included coding of responses and organization of processes in line with the triangle model, a human factors framework, to identify overarching themes. Five themes emerged: (1) User support after implementation of EHR; (2) User satisfaction with EHR; (3) Communication for patient care, quality, and safety; (4) Effort to complete tasks; and (5) Areas for improvement. Nurses' ability to adopt positive deviance as they experience unintended consequences offers opportunities for organizations to engage nursing perspectives in improving the EHR and engineer it to be more resilient to nursing work.
• Gephart, S. M., Davis, M., & Shea, K. (2018). Perspectives on Policy and the Value of Nursing Science in a Big Data Era. Nursing science quarterly, 31(1), 78-81.
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  As data volume explodes, nurse scientists grapple with ways to adapt to the big data movement without jeopardizing its epistemic values and theoretical focus that celebrate while acknowledging the authority and unity of its body of knowledge. In this article, the authors describe big data and emphasize ways that nursing science brings value to its study. Collective nursing voices that call for more nursing engagement in the big data era are answered with ways to adapt and integrate theoretical and domain expertise from nursing into data science.
• Gephart, S. M., Dudding, K. M., & Carrington, J. M. (2018). Neonatal Nurses Experience Unintended Consequences and Risks to Patient Safety With Electronic Health Records.. Computers, informatics, nursing : CIN, 36(4), 167-176. doi:10.1097/cin.0000000000000406
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  In this article, we examine the unintended consequences of nurses' use of electronic health records. We define these as unforeseen events, change in workflow, or an unanticipated result of implementation and use of electronic health records. Unintended consequences experienced by nurses while using electronic health records have been well researched. However, few studies have focused on neonatal nurses, and it is unclear to what extent unintended consequences threaten patient safety. A new instrument called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire has been validated, and secondary analysis using the tool explored the phenomena among neonatal nurses (N = 40). The purposes of this study were to describe unintended consequences of use of electronic health records for neonatal nurses and to explore relationships between the phenomena and characteristics of the nurse and the electronic health record. The most frequent unintended consequences of electronic health record use were due to interruptions, followed by a heavier workload due to the electronic health record, changes to the workflow, and altered communication patterns. Neonatal nurses used workarounds most often with motivation to better assist patients. Teamwork was moderately related to higher unintended consequences including patient safety risks (r = 0.427, P = .007), system design (r = 0.419, P = .009), and technology barriers (r = 0.431, P = .007). Communication about patients was reduced when patient safety risks were high (r = -0.437, P = .003). By determining the frequency with which neonatal nurses experience unintended consequences of electronic health record use, future research can be targeted to improve electronic health record design through customization, integration, and refinement to support patient safety and better outcomes.
• Gephart, S. M., Gordon, P. V., Penn, A. H., Gregory, K. E., Swanson, J. R., Maheshwari, A., & Sylvester, K. (2018). Changing the paradigm of defining, detecting, and diagnosing NEC: Perspectives on Bell's stages and biomarkers for NEC. Seminars in pediatric surgery, 27(1), 3-10.
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  Better means to diagnose and define necrotizing enterocolitis are needed to guide clinical practice and research. Adequacy of Bell's staging system for clinical practice and clarity of cases used in NEC clinical datasets has been a topic of controversy for some time. This article provides reasons why a better global definition for NEC is needed and offers a simple alternative bedside definition for preterm NEC called the "Two out of Three" rule. Some argue that biomarkers may fill knowledge gaps and provide greater precision in defining relevant features of a clinical disease like NEC. NEC biomarkers include markers of inflammation, intestinal dysfunction, hematologic changes, and clinical features. Development and reporting of NEC biomarkers should be guided by the FDA's BEST Consensus resource, "Biomarkers, EndpointS, & other Tools" and consistently report metrics so that studies can be compared and results pooled. Current practice in the NICU would be enhanced by clinical tools that effectively inform the clinical team that a baby is at increasing risk of NEC. Ideally, these tools will incorporate both clinical information about the baby as well as molecular signals that are indicative of NEC. While meaningful biomarkers for NEC and clinical tools exist, translation into practice is mediocre.
• Gephart, S. M., Moore, E. F., & Fry, E. (2018). Standardized Feeding Protocols to Reduce Risk of Necrotizing Enterocolitis in Fragile Infants Born Premature or with Congenital Heart Disease: Implementation Science Needed. Critical care nursing clinics of North America, 30(4), 457-466.
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  Although a unit-adopted standardized feeding protocol (SFP) for neonates is standard of care, implementation strategies for SFPs vary across neonatal and pediatric intensive care. Besides improving growth and reducing feeding interruptions, SFPs reduce risk for necrotizing enterocolitis in infants with heart disease or born premature. The purpose of this article is to bridge the gap between recommended and actual care using SFPs.
• Gephart, S. M., Wyles, C., & Canvasser, J. (2018). Expert consensus to weight an adherence score for audit and feedback of practices that prevent necrotizing enterocolitis in very low birth weight infants. Applied nursing research : ANR, 39, 182-188.
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  Necrotizing enterocolitis (NEC) is a catastrophic abdominal complication threatening the life of premature infants, but adoption of prevention and early recognition practices differs as do NEC rates in Neonatal Intensive Care Units (NICUs). The purpose of this research was to validate and weight an evidence-based adherence score (aka NEC-Zero Adherence Score) to prevent and foster timely recognition of NEC.
• Shea, K. D., Brewer, B. B., Carrington, J. M., Davis, M., Gephart, S., & Rosenfeld, A. (2018). A model to evaluate data science in nursing doctoral curricula. Nursing outlook.
  More info

  Building on the efforts of the American Association of Colleges of Nursing, we developed a model to infuse data science constructs into doctor of philosophy (PhD) curriculum. Using this model, developing nurse scientists can learn data science and be at the forefront of data driven healthcare.
• Dudding, K. M., Gephart, S. M., & Carrington, J. M. (2017). Neonatal Nurses Experience Unintended Consequences and Risks to Patient Safety With Electronic Health Records. Computers, informatics, nursing : CIN.
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  In this article, we examine the unintended consequences of nurses' use of electronic health records. We define these as unforeseen events, change in workflow, or an unanticipated result of implementation and use of electronic health records. Unintended consequences experienced by nurses while using electronic health records have been well researched. However, few studies have focused on neonatal nurses, and it is unclear to what extent unintended consequences threaten patient safety. A new instrument called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire has been validated, and secondary analysis using the tool explored the phenomena among neonatal nurses (N = 40). The purposes of this study were to describe unintended consequences of use of electronic health records for neonatal nurses and to explore relationships between the phenomena and characteristics of the nurse and the electronic health record. The most frequent unintended consequences of electronic health record use were due to interruptions, followed by a heavier workload due to the electronic health record, changes to the workflow, and altered communication patterns. Neonatal nurses used workarounds most often with motivation to better assist patients. Teamwork was moderately related to higher unintended consequences including patient safety risks (r = 0.427, P = .007), system design (r = 0.419, P = .009), and technology barriers (r = 0.431, P = .007). Communication about patients was reduced when patient safety risks were high (r = -0.437, P = .003). By determining the frequency with which neonatal nurses experience unintended consequences of electronic health record use, future research can be targeted to improve electronic health record design through customization, integration, and refinement to support patient safety and better outcomes.
• Gadepalli, S. K., Canvasser, J., Eskenazi, Y., Quinn, M., Kim, J. H., & Gephart, S. M. (2017). Roles and Experiences of Parents in Necrotizing Enterocolitis: An International Survey of Parental Perspectives of Communication in the NICU. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 17(6), 489-498.
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  Although partnering with parents is important to improving neonatal outcomes, no studies have investigated what parents are taught, remember, or experience when their child is afflicted with necrotizing enterocolitis (NEC).
• Gephart, S. M., & Eklund, W. M. (2017). THE INAUGURAL NEC SYMPOSIUM: A TRANSDISCIPLINARY APPROACH TO TACKLE NECROTIZING ENTEROCOLITIS IN US NEONATAL INTENSIVE CARE UNITS. Advances in neonatal care : official journal of the National Association of Neonatal Nurses.
• Gephart, S. M., Fleiner, M., & Kijewski, A. (2016). The conNECtion between clinical signs and necrotizing enterocolitis in infants 501-1500 grams. Advances in Neonatal Care.
• Gephart, S. M., Fleiner, M., & Kijewski, A. (2017). The ConNECtion Between Abdominal Signs and Necrotizing Enterocolitis in Infants 501 to 1500 g. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 17(1), 53-64.
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  Necrotizing enterocolitis (NEC) can become severe quickly, making early recognition a priority and understanding the occurrence of abdominal and clinical signs of impending NEC important.
• Gephart, S. M., Hanson, C., Wetzel, C. M., Fleiner, M., Umberger, E., Martin, L., Rao, S., Agrawal, A., Marin, T., Kirmani, K., Quinn, M., Quinn, J., Dudding, K. M., Clay, T., Sauberan, J., Eskenazi, Y., Porter, C., Msowoya, A. L., Wyles, C., , Avenado-Ruiz, M., et al. (2017). NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis. Maternal health, neonatology and perinatology, 3, 23.
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  Although decades have focused on unraveling its etiology, necrotizing enterocolitis (NEC) remains a chief threat to the health of premature infants. Both modifiable and non-modifiable risk factors contribute to varying rates of disease across neonatal intensive care units (NICUs).
• Gephart, S., & Lanning Lowther, L. C. (2017). Necrotizing enterocolitis: Battling an enigma. JAAPA : official journal of the American Academy of Physician Assistants, 30(8), 8-9.
• Quinn, J. M., Sparks, M., & Gephart, S. M. (2017). Discharge Criteria for the Late Preterm Infant: A Review of the Literature. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 17(5), 362-371.
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  Standardized late preterm infant (LPI) discharge criteria ensure best practice and help guide the neonatal provider to determine the appropriate level of care following birth. However, the location can vary from the well newborn setting to the neonatal intensive care unit (NICU).
• Sousa, V. E., Shehorn, L. E., Raszewski, R., Lopez, K. D., Gephart, S. M., & Abraham, J. (2017). Integrative review of clinical decision support for registered nurses in acute care settings.. Journal of the American Medical Informatics Association : JAMIA, 24(2), 441-450. doi:10.1093/jamia/ocw084
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  To report on the state of the science of clinical decision support (CDS) for hospital bedside nurses..We performed an integrative review of qualitative and quantitative peer-reviewed original research studies using a structured search of PubMed, Embase, Cumulative Index to Nursing and Applied Health Literature (CINAHL), Scopus, Web of Science, and IEEE Xplore (Institute of Electrical and Electronics Engineers Xplore Digital Library). We included articles that reported on CDS targeting bedside nurses and excluded in stages based on rules for titles, abstracts, and full articles. We extracted research design and methods, CDS purpose, electronic health record integration, usability, and process and patient outcomes..Our search yielded 3157 articles. After removing duplicates and applying exclusion rules, 28 articles met the inclusion criteria. The majority of studies were single-site, descriptive or qualitative (43%) or quasi-experimental (36%). There was only 1 randomized controlled trial. The purpose of most CDS was to support diagnostic decision-making (36%), guideline adherence (32%), medication management (29%), and situational awareness (25%). All the studies that included process outcomes (7) and usability outcomes (4) and also had analytic procedures to detect changes in outcomes demonstrated statistically significant improvements. Three of 4 studies that included patient outcomes and also had analytic procedures to detect change showed statistically significant improvements. No negative effects of CDS were found on process, usability, or patient outcomes..Clinical support systems targeting bedside nurses have positive effects on outcomes and hold promise for improving care quality; however, this research is lagging behind studies of CDS targeting medical decision-making in both volume and level of evidence.
• Burca, N. D., Gephart, S. M., & Miller, C. (2016). A Nurse's Guide to Promoting Breast Milk Nutrition in Infants With Cleft Lip and/or Palate. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 16(5), 345-346.
• Burca, N. D., Gephart, S. M., Miller, C., & Cote, C. (2016). Promoting Breast Milk Nutrition in Infants With Cleft Lip and/or Palate. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 16(5), 337-344.
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  The orofacial defect of cleft lip/palate (CL/P) involves an altered physiological anatomy that affects the infant's feeding ability. Infants have cleft lip (CL), cleft palate (CP), or both (CL/P). Dysfunction in the seal, as with cleft lip, or in the ability to coordinate muscle movement to generate negative pressure, as with cleft palate, leads to feeding issues that may compromise growth and affect bonding.
• Gephart, S. M., Bristol, A. A., Dye, J. L., Finley, B. A., & Carrington, J. M. (2016). Validity and Reliability of a New Measure of Nursing Experience With Unintended Consequences of Electronic Health Records. Computers, informatics, nursing : CIN, 34(10), 436-447.
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  Unintended consequences of electronic health records represent undesired effects on individuals or systems, which may contradict initial goals and impact patient care. The purpose of this study was to determine the extent to which a new quantitative measure called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire (CG-UCE-Q) was valid and reliable. Then, it was used to describe acute care nurses' experience with unintended consequences of electronic health records and relate them to the professional practice environment. Acceptable content validity was achieved for two rounds of surveys with nursing informatics experts (n = 5). Then, acute care nurses (n = 144) were recruited locally and nationally to complete the survey and describe the frequency with which they encounter unintended consequences in daily work. Principal component analysis with oblique rotation was applied to evaluate construct validity. Correlational analysis with measures of the professional practice environment and workarounds was used to evaluate convergent validity. Test-retest reliability was measured in the local sample (N = 68). Explanation for 63% of the variance across six subscales (patient safety, system design, workload issues, workarounds, technology barriers, and sociotechnical impact) supported construct validity. Relationships were significant between subscales for electronic health record-related threats to patient safety and low autonomy/leadership (P < .01), poor communication about patients (P < .01), and low control over practice (P < .01). The most frequent sources of unintended consequences were increased workload, interruptions that shifted tasks from the computer, altered workflow, and the need to duplicate data entry. Convergent validity of the CG-UCE-Q was moderately supported with both the context and processes of workarounds with strong relationships identified for when nurses perceived a block and altered process to work around it to subscales in the CG-UCE-Q for electronic health record system design (P < .01) and technological barriers (P < .01).
• Price, L. E., Shea, K., & Gephart, S. (2016). The Veterans Affairs's Corporate Data Warehouse: Uses and Implications for Nursing Research and Practice. Nursing administration quarterly, 39(4), 311-8.
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  The Department of Veterans Affairs Veterans Healthcare Administration (VHA) is supported by one of the largest integrated health care information systems in the United States. The VHA's Corporate Data Warehouse (CDW) was developed in 2006 to accommodate the massive amounts of data being generated from more than 20 years of use and to streamline the process of knowledge discovery to application. This article describes the developments in research associated with the VHA's transition into the world of Big Data analytics through CDW utilization. The majority of studies utilizing the CDW also use at least one other data source. The most commonly occurring topics are pharmacy/medications, systems issues, and weight management/obesity. Despite the potential benefit of data mining techniques to improve patient care and services, the CDW and alternative analytical approaches are underutilized by researchers and clinicians.
• Quinn, M., & Gephart, S. (2016). Evidence for Implementation Strategies to Provide Palliative Care in the Neonatal Intensive Care Unit. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 16(6), 430-438.
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  Palliative care is a holistic framework that is designed to improve quality of life by identifying and treating distressing symptoms of life-threatening or complex conditions. Neonatal palliative care (NPC) has potential benefits for parents, staff, and patients, yet evidence suggests that implementation and utilization of organized NPC services are low.
• Carrington, J. M., Gephart, S. M., Verran, J. A., & Finley, B. A. (2015). Development of an Instrument to Measure the Unintended Consequences of EHRs. Western journal of nursing research, 37(7), 842-58.
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  This article augments the existing body of literature through examining the creation and design of an instrument measuring unintended consequences (UCs) of electronic health records (EHRs). Data from a previous qualitative study that explored nurses' perceptions of EHR effectiveness as a communication system were analyzed using a theoretical model focused on decision making. The qualitative data, informed by the model, were then organized into an instrument seeking to quantitatively measure nurses' experiences with UCs of EHRs. The model assisted in revealing patterns in nurses' perceptions of the effectiveness of the EHR as a communication system that ultimately strengthened the development of the instrument. Instrumentation from qualitative data has long been considered an acceptable and positive approach to scale development. The process for accomplishing this goal has often been omitted from the literature. We contend that other researchers will find this methods article informative for similar undertakings.
• Gephart, S. M. (2015). Fostering Best Practice: Strategies for Writing Evidence-Based Practice Briefs. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 15(5), 299-306.
• Gephart, S. M., Martin, L. B., Kijewski, A., & Johnson, S. R. (2015). Joseph's Story: A Case Study of Late-Onset Necrotizing Enterocolitis From Early Birth to Recovery. The Journal of perinatal & neonatal nursing, 29(4), 345-55.
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  Although necrotizing enterocolitis (NEC) is often catastrophic among premature infants, most cases occur in the first month after birth. This case study presents Joseph's story about a 24-week surviving twin who developed severe NEC at 5 months of age just days before he was to go home. The purpose of this case study report is to place Joseph and his parents' experience in the context of what is known about NEC risk factors, clinical presentation, and treatment, and then to offer recommendations to healthcare professionals to support families from NEC diagnosis to recovery. Now 5 years old, Joseph continues to manage consequences of NEC including deafness, developmental delay, multiple food allergies, and recurrent gastrointestinal challenges from short gut syndrome. Although NEC struck late and kept Joseph in the neonatal intensive care unit for 228 days, its consequences remain with this resilient child and his family.
• Gephart, S., Carrington, J. M., & Finley, B. (2015). A Systematic Review of Nurses' Experiences With Unintended Consequences When Using the Electronic Health Record. Nursing administration quarterly, 39(4), 345-56.
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  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.
• Hartley, K. A., Miller, C. S., & Gephart, S. M. (2015). Facilitated tucking to reduce pain in neonates: evidence for best practice. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 15(3), 201-8.
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  Increasing survival rates of preterm infants and a greater understanding of the long-term consequences of early exposure to pain have generated a greater need for nonpharmacologic pain management strategies in the neonatal intensive care unit (NICU) setting. Facilitated tucking supports the preterm infant and is a valuable strategy to manage neonatal pain. Alternative nonpharmacologic approaches to pain management in neonates include nonnutritive sucking and kangaroo care.
• Payne, T. H., Hines, L. E., Chan, R. C., Hartman, S., Kapusnik-Uner, J., Russ, A. L., Chaffee, B. W., Hartman, C., Tamis, V., Galbreth, B., Glassman, P. A., Phansalkar, S., van der Sijs, H., Gephart, S. M., Mann, G., Strasberg, H. R., Grizzle, A. J., Brown, M., Kuperman, G. J., , Steiner, C., et al. (2015). Recommendations to improve the usability of drug-drug interaction clinical decision support alerts. Journal of the American Medical Informatics Association : JAMIA, 22(6), 1243-50.
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  To establish preferred strategies for presenting drug-drug interaction (DDI) clinical decision support alerts.
• Vincent, D., Hastings-Tolsma, M., Gephart, S., & Alfonzo, P. M. (2015). Nurse practitioner clinical decision-making and evidence-based practice. The Nurse practitioner, 40(5), 47-54.
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  Evidence-based practice is key to improving patient outcomes but can be challenging for busy nurse practitioners to implement. This article describes the process of critically appraising evidence for use in clinical practice and offers strategies for implementing evidence-based innovations and disseminating the findings.
• Gephart, S. M., & Weller, M. (2014). Colostrum as oral immune therapy to promote neonatal health. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 14(1), 44-51.
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  It is well known that the immune response is blunted and underdeveloped in the premature infant, but human milk supports the infant's growth, function, and effectiveness. Thus, own mother's colostrum (OMC) administered oropharyngeally has potential to deliver oral immune therapy (C-OIT) even before enteral feedings have begun. Colostrum interacts with lymphoid tissue in the oropharynx and gut. Colostrum as oral immune therapy is delivered by swabbing the cheeks in the first days of life. Little formal study has evaluated its effectiveness. However, small studies demonstrate that it is a practice that is safe, feasible, and well tolerated even by the smallest premature infants. Encouraging preliminary evidence supports the effect of C-OIT to reduce the time to full enteral feedings. Effects on other outcomes is unclear, in part because existing studies are underpowered to detect significant differences on outcomes like necrotizing enterocolitis, sepsis, and death. Another limitation in the evidence base is that adherence to the intervention and the number of doses of colostrum infants received in the studies is not consistently made clear. More well-designed studies are needed to demonstrate the impact on neonatal complications and how C-OIT supports the infant's immune development. Quality improvement and time series reports of differences pre- and postimplementation of OMC given orally should minimally include statistics for adherence to the intervention and/or the number of doses an infant received as a covariate. Even so, OMC is an immune therapy that poses little risk yet offers likely cost-effective benefit for vulnerable infants.
• Gephart, S. M., Gephart, S. M., Spitzer, A. R., Spitzer, A. R., Effken, J. A., Effken, J. A., Dodd, E., Dodd, E., Halpern, M., Halpern, M., McGrath, J. M., & McGrath, J. M. (2014). Discrimination of GutCheck^NEC: a clinical risk index for necrotizing enterocolitis. Journal of Perinatology.
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  Abstract: Objective:Better measures are needed to identify infants at risk for developing necrotizing enterocolitis (NEC) and facilitate communication about risk across transitions. Although NEC is multi-factorial, quantification of composite risk for NEC in an individual infant is not clearly defined. The objective of this study was to describe the derivation, validation and calibration testing of a novel clinical NEC risk index, GutCheckNEC. Individual risk factors were weighted to assess composite odds of developing NEC. GutCheckNEC is designed to improve communication about NEC risk and coordination of care among clinicians across an infant's clinical course.Study design:On the basis of a synthesis of research evidence about NEC risk and an e-Delphi study including 35 neonatal experts, we identified NEC risk factors believed by the experts to be most relevant for a NEC risk index, then applied a logistic model building process to derive and validate GutCheckNEC. De-identified data from the Pediatrix BabySteps Clinical Data Warehouse (discharge date 2007 to 2011) were split into three samples for derivation, validation and calibration. By comparing infants with medical NEC, surgical NEC and those who died to infants without NEC, we derived the logistic model using the un-matched derivation set. Discrimination was then tested in a case-control matched validation set and an un-matched calibration set using receiver operating characteristic curves. Result:Sampled from a cohort of 58 820 infants, the randomly selected derivation set (n=35 013) revealed nine independent risk factors (gestational age, history of packed red blood cell transfusion, unit NEC rate, late-onset sepsis, multiple infections, hypotension treated with inotropic medications, Black or Hispanic race, outborn status and metabolic acidosis) and two risk reducers (human milk feeding on both days 7 and 14 of life, and probiotics). Unit NEC rate carried the most weight in the summed score. Validation using a 2:1 matched case-control sample (n=360) demonstrated fair to good discrimination. In the calibration set (n=23 447), GutCheckNEC scores (range 0 to 58) discriminated those infants who developed surgical NEC (area under the curve (AUC)=0.84, 95% confidence interval (CI) 0.82 to 0.84) and NEC leading to death (AUC=0.83, 95% CI 0.81 to 0.85), more accurately than medical NEC (AUC= 0.72, 95% CI 0.70 to 0.74). Conclusion:GutCheckNEC represents weighted composite risk for NEC and discriminated infants who developed NEC from those who did not with very good accuracy. We speculate that targeting modifiable NEC risk factors could reduce national NEC prevalence.Journal of Perinatology advance online publication, 20 March 2014; doi:10.1038/jp.2014.37.
• Gephart, S. M., Spitzer, A. R., Effken, J. A., Dodd, E., Halpern, M., & McGrath, J. M. (2014). Discrimination of GutCheck(NEC): a clinical risk index for necrotizing enterocolitis. Journal of perinatology : official journal of the California Perinatal Association, 34(6), 468-75.
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  Better measures are needed to identify infants at risk for developing necrotizing enterocolitis (NEC) and facilitate communication about risk across transitions. Although NEC is multi-factorial, quantification of composite risk for NEC in an individual infant is not clearly defined. The objective of this study was to describe the derivation, validation and calibration testing of a novel clinical NEC risk index, GutCheck(NEC). Individual risk factors were weighted to assess composite odds of developing NEC. GutCheck(NEC) is designed to improve communication about NEC risk and coordination of care among clinicians across an infant's clinical course.
• Gephart, S. M., Wetzel, C., & Krisman, B. (2014). Prevention and early recognition of necrotizing enterocolitis: a tale of 2 tools--eNEC and GutCheckNEC. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 14(3), 201-10; quiz 211-2.
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  Risk for neonatal necrotizing enterocolitis (NEC) is complex, reflecting its multifactorial pathogenesis.
• Poole, S. N., & Gephart, S. M. (2014). State of the Science for Practice to Promote Breastfeeding Success Among Young Mothers. Newborn and Infant Nursing Reviews, 14(3), 112-118. doi:10.1053/j.nainr.2014.06.009
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  Abstract A literature review and synthesis of qualitative and quantitative studies was conducted to evaluate the role of breastfeeding attitudes, beliefs, and support as they relate to young mothers. A search of CINAHL and PubMed was conducted for articles published from 2008–2013 using the terms breastfeeding and adolescents and duration; breastfeeding and adolescents and success; and breastfeeding and adolescents and support. Of several hundred papers identified, those articles selected for in depth review examined breastfeeding attitudes, beliefs, support, and practices. Factors contributing to breastfeeding success or failure were identified. Among them, participant descriptions reflected paradoxical factors such as: ‘breast is best’, ‘breastfeeding as not the norm’, convenience, privacy, sexuality, body image, healthcare provider support, family and peer support, and other barriers to breastfeeding. These factors were described to have both positive and negative effects on breastfeeding, at times in the same study.
• Poole, S. N., Gephart, S. M., & Crain, D. R. (2014). Qualitative Description of Neonatal Expert Perspectives About Necrotizing Enterocolitis Risk. Newborn and Infant Nursing Reviews, 14(3), 124-130. doi:10.1053/j.nainr.2014.06.004
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  Abstract The purpose of this qualitative descriptive study was to provide rich description of experts' perspectives about necrotizing enterocolitis risk. Comments from 35 NEC experts were coded by two reviewers, grouped into categories and organized into themes. From 93 category codes, 9 meta-categories, and two broad themes were derived. NEC risk was considered to arise from both individual factors of vulnerability and variation in neonatal care practices. Controversy arose about the role of patent ductus arteriosus (PDA) and its treatment, transfusions, risk differences based on gestational age, efficacy and safety of probiotics in prevention, and the role of antibiotic exposure and multiple infections. Experts indicated the need for a stronger evidence base about NEC risk yet experts cited a lack of a strong evidence base on occasion when good to high quality evidence was available.
• Beall, V., Hall, B., Mulholland, J. T., & Gephart, S. M. (2013). Neonatal Extravasation: An Overview and Algorithm for Evidence-based Treatment. Newborn and Infant Nursing Reviews, 13(4), 189-195.
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  Abstract: The peripheral intravenous (PIV) catheter is the most used vascular access device for the administration of medications in hospitalized neonates, however 95% of PIV catheters are removed due to complications. Infiltration and extravasation are one of the most destructive complications to the neonate's fragile skin. This article reviews multiple aspects of infiltration and extravasation injury. First, starting at the cellular level the role of vesicants in vascular injury and its role triggering inflammation will be discussed, followed by a comprehensive review of vesicants and their mechanism of injury, by pH, osmolality or chemical composition, then an overview of the NICU nurses knowledge and actions to prevent infiltration and ending with the use of an evidence-based algorithm that was developed at one children's hospital to minimize injury caused by extravasations through targeted, prompt treatment. © 2013 Elsevier Inc.
• Effken, J. A., Gephart, S. M., Brewer, B. B., & Carley, K. M. (2013). Using *ORA, a network analysis tool, to assess the relationship of handoffs to quality and safety outcomes. Computers, informatics, nursing : CIN, 31(1), 36-44.
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  Communication during patient handoffs has been widely implicated in patient safety issues. However, few studies have actually been able to quantify the relationship between handoffs and patient outcomes. We used *ORA, a dynamic network analysis tool, to examine handoffs between day and night shifts on seven units in three hospitals in the Southwest. Using *ORA's visualization and analysis capabilities, we examined the relationships between the handoff communication network metrics and a variety of patient safety quality and satisfaction outcomes. Unique network patterns were observed for different types of outcome variable (eg, safety, symptom management, self-care, and patient satisfaction). This exploratory project demonstrates the power of *ORA to identify communication patterns for large groups, such as patient care units. *ORA's network metrics can then be related to specific patient outcomes.
• Effken, J. A., Reed, P. G., Mcgrath, J. M., Gephart, S. M., & Effken, J. A. (2013). Expert consensus building using e-Delphi for necrotizing enterocolitis risk assessment.. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 42(3), 332-47. doi:10.1111/1552-6909.12032
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  To confirm content validity of GutCheck(NEC) , a risk index for necrotizing enterocolitis (NEC) and to determine the level of agreement among experts about NEC risk factors in premature infants..Electronic Delphi method (e-Delphi)..Online electronic surveys and e-mail communication supported by an interactive study website..Nurses and physicians (N = 35) from four countries and across the United States who rated themselves as at least moderately expert about NEC risk..e-Delphi involved three rounds of surveys and qualitative thematic analysis of experts' comments. Surveys continued until criteria for consensus and/or stability were met..Of 64 initial items, 43 were retained representing 33 risk factors (final GutCheck(NEC) Content Validity Index [CVI] = .77). Two broad themes about NEC risk emerged from 242 comments: the impact of individual physiologic vulnerability and variation in neonatal intensive care unit (NICU) clinicians' practices. Controversy arose over the impact of treatments on NEC, including probiotics, packed red blood cell (PRBC) transfusions, and patent ductus arteriosus (PDA) management using indomethacin..GutCheck(NEC) achieved borderline content validity for a new scale. The e-Delphi process yielded a broad perspective on areas in which experts share and lack consensus on NEC risk. Future testing is underway to reduce the number of risk items to the most parsimonious set for a clinically useful risk tool and test reliability.
• Garcia, C., & Gephart, S. M. (2013). The effectiveness of early intervention programs for NICU graduates. Advances in Neonatal Care, 13(4), 272-278.
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  PMID: 23912020;
• Gephart, S. M., & Effken, J. A. (2013). Using health information technology to engage patients in their care. Online Journal of Nursing Informatics, 17(3).
• Gephart, S. M., & Hanson, C. K. (2013). Preventing necrotizing enterocolitis with standardized feeding protocols: Not only possible, but imperative. Advances in Neonatal Care, 13(1), 48-54.
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  PMID: 23360859;
• Gephart, S. M., & Hanson, C. K. (2013). Preventing necrotizing enterocolitis with standardized feeding protocols: not only possible, but imperative. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 13(1), 48-54.
• Gephart, S. M., & Newnam, K. (2013). Inflammation and immune issues in the neonate. Newborn and Infant Nursing Reviews, 13(4), 146-147.
• Gephart, S., Garcia, C., & Gephart, S. M. (2013). The effectiveness of early intervention programs for NICU graduates. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 13(4).
• Newnam, K., Gephart, S. M., & Wright, L. (2013). Common complications of dysregulated inflammation in the neonate. Newborn and Infant Nursing Reviews, 13(4), 154-160.
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  Abstract: Preterm infants are faced with a multitude of challenges related to immature systems at delivery placing them at risk for both acute and chronic health conditions. A major component of the human immune system is the inflammatory process and the primary controllers of inflammation are cytokines. Cytokine expression is tightly regulated in the normal host immune response, but in neonates, particularly those born prematurely, the dysregulation is more the norm than the exception. A state in which the inflammatory systems are persistently activated can lead to chronic inflammation affecting the neonate systemically rather than targeting a specific location of illness, injury, or both. Serious neonatal morbidities including white matter injury, chronic lung disease, retinopathy of prematurity and necrotizing enterocolitis have been linked to this chronic inflammatory state. Through the use of a systems approach this article will serve as a focused review of these common neonatal complications. First, an overview explaining the human immune system and the complex process of inflammation will be presented with a focus on systemic neonatal response following acute and/or chronic inflammation. This review is important to promote an understanding of one of the multifactorial influences, inflammation, contributing to long term neonatal health challenges. Empirically supported nursing implications and recommended care strategies are highlighted. © 2013 Elsevier Inc.
• Gephart, S. M. (2012). The art of effective handoffs what is the evidence?. Advances in Neonatal Care, 12(1), 37-39.
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  PMID: 22301542;PMCID: PMC3272252;
• Gephart, S. M. (2012). Transfusio n-associated necrotizing enterocolitis: Evidence and uncertainty. Advances in Neonatal Care, 12(4), 232-236.
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  PMID: 22864004;PMCID: PMC3414263;Abstract: Transfusion-associated necrotizing enterocolitis (TANEC) has been described as necrotizing enterocolitis (NEC) that arises within 48 hours of a blood transfusion. It has been shown to be associated with 25% to 35% of NEC cases in recent studies. Evidence related to TANEC is limited to observational, retrospective studies. Infants who develop TANEC tend to be smaller, born preterm, more severely ill, and develop NEC after 30 days of age. Evidence in 2 studies support holding feedings during transfusion to protect the preterm gut from the cascade of events that lead to NEC, but higher quality research, including prospective randomized controlled trials, is needed to evaluate the effect of feeding on TANEC. Copyright © 2012 National Association of Neonatal Nurses.
• Gephart, S. M., & Cholette, M. (2012). P.U.R.E. Communication: A Strategy to Improve Care-Coordination for High Risk Birth. Newborn and infant nursing reviews : NAINR, 12(2), 109-114.
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  High-risk birth can be an emotionally-charged and sometimes emergent event that requires a cohesive multidisciplinary team. Communication breakdowns in perinatal emergencies are known to contribute to errors and adverse patient outcomes. One approach to breaching these barriers is the Purposeful, Unambiguous, Respectful, and Effective, P.U.R.E. process. P.U.R.E. is a method of communication that emphasizes coordination and recognizes the contributions of each member of the team. The purpose of this article is to describe how the P.U.R.E. process works and how teamwork strategies, group skills training, and structured communication techniques complement it.
• Gephart, S. M., & Cholette, M. (2012). PURE Communication: A Strategy to Improve Care Coordination for High-Risk Birth. Newborn and Infant Nursing Reviews, 12(2), 109-114.
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  Abstract: High-risk birth can be an emotionally charged and, sometimes, emergent event that requires a cohesive multidisciplinary team. Communication breakdowns in perinatal emergencies are known to contribute to errors and adverse patient outcomes. One approach to breaching these barriers is the Purposeful, Unambiguous, Respectful, and Effective (PURE) process. The PURE process is a method of communication that emphasizes coordination and recognizes the contributions of each member of the team. The purpose of this article is to describe how the PURE process works and how teamwork strategies, group skills training, and structured communication techniques complement it. © 2012 Elsevier Inc.
• Gephart, S. M., & McGrath, J. M. (2012). Family-Centered Care of the Surgical Neonate. Newborn and Infant Nursing Reviews, 12(1), 5-7.
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  Abstract: When infants require surgery, the family experiences a crisis. Surgical care of the infant and their family requires constant information sharing between health care providers (HCPs) and families. Parents' information needs and their readiness to learn vary along the infant's trajectory of healing. Information is acquired by parents from many sources and over time parents become an important source of information during the infant's stay in the neonatal intensive care unit (NICU). Family-centered approaches in all phases of surgical care (preoperative, postoperative and preparation for discharge) empowers and supports parents and ultimately leads to optimal outcomes. © 2012 Elsevier Inc.
• Gephart, S. M., & McGrath, J. M. (2012). Family-Centered Care of the Surgical Neonate. Newborn and infant nursing reviews : NAINR, 12(1), 5-7.
• Gephart, S. M., McGrath, J. M., Effken, J. A., & Halpern, M. D. (2012). Necrotizing enterocolitis risk state of the science. Advances in Neonatal Care, 12(2), 77-87.
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  PMID: 22469959;PMCID: PMC3357630;Abstract: Necrotizing enterocolitis (NEC) is the most common cause of gastrointestinal-related morbidity and mortality in the neonatal intensive care unit (NICU). Its onset is sudden and the smallest, most premature infants are the most vulnerable. Necrotizing enterocolitis is a costly disease, accounting for nearly 20% of NICU costs annually. Necrotizing enterocolitis survivors requiring surgery often stay in the NICU more than 90 days and are among those most likely to stay more than 6 months. Significant variations exist in the incidence across regions and units. Although the only consistent independent predictors for NEC remain prematurity and formula feeding, others exist that could increase risk when combined. Awareness of NEC risk factors and adopting practices to reduce NEC risk, including human milk feeding, the use of feeding guidelines, and probiotics, have been shown to reduce the incidence of NEC. The purpose of this review is to examine the state of the science on NEC risk factors and make recommendations for practice and research. Copyright © 2012 by The National Association of Neonatal Nurses.
• Gephart, S. M., McGrath, J. M., Effken, J. A., & Halpern, M. D. (2012). Necrotizing enterocolitis risk: state of the science. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 12(2), 77-87; quiz 88-9.
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  Necrotizing enterocolitis (NEC) is the most common cause of gastrointestinal-related morbidity and mortality in the neonatal intensive care unit (NICU). Its onset is sudden and the smallest, most premature infants are the most vulnerable. Necrotizing enterocolitis is a costly disease, accounting for nearly 20% of NICU costs annually. Necrotizing enterocolitis survivors requiring surgery often stay in the NICU more than 90 days and are among those most likely to stay more than 6 months. Significant variations exist in the incidence across regions and units. Although the only consistent independent predictors for NEC remain prematurity and formula feeding, others exist that could increase risk when combined. Awareness of NEC risk factors and adopting practices to reduce NEC risk, including human milk feeding, the use of feeding guidelines, and probiotics, have been shown to reduce the incidence of NEC. The purpose of this review is to examine the state of the science on NEC risk factors and make recommendations for practice and research.
• Gephart, S., & Gephart, S. M. (2012). The art of effective handoffs: what is the evidence?. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 12(1).
• Gephart, S., & Gephart, S. M. (2012). Transfusion-associated necrotizing enterocolitis: evidence and uncertainty. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 12(4).
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  Transfusion-associated necrotizing enterocolitis (TANEC) has been described as necrotizing enterocolitis (NEC) that arises within 48 hours of a blood transfusion. It has been shown to be associated with 25% to 35% of NEC cases in recent studies. Evidence related to TANEC is limited to observational, retrospective studies. Infants who develop TANEC tend to be smaller, born preterm, more severely ill, and develop NEC after 30 days of age. Evidence in 2 studies support holding feedings during transfusion to protect the preterm gut from the cascade of events that lead to NEC, but higher quality research, including prospective randomized controlled trials, is needed to evaluate the effect of feeding on TANEC.
• Effken, J. A., Brewer, B. B., Logue, M. D., Gephart, S. M., & Verran, J. A. (2011). Using Cognitive Work Analysis to fit decision support tools to nurse managers' work flow. International journal of medical informatics, 80(10), 698-707.
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  To better understand the environmental constraints on nurse managers that impact their need for and use of decision support tools, we conducted a Cognitive Work Analysis (CWA). A complete CWA includes system analyses at five levels: work domain, decision-making procedures, decision-making strategies, social organization/collaboration, and worker skill level. Here we describe the results of the Work Domain Analysis (WDA) portion in detail then integrate the WDA with other portions of the CWA, reported previously, to generate a more complete picture of the nurse manager's work domain.
• Effken, J. A., Carley, K. M., Gephart, S., Verran, J. A., Bianchi, D., Reminga, J., & Brewer, B. B. (2011). Using ORA to explore the relationship of nursing unit communication to patient safety and quality outcomes. International journal of medical informatics, 80(7), 507-17.
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  We used ORA, a dynamic network analysis tool, to identify patient care unit communication patterns associated with patient safety and quality outcomes. Although ORA had previously had limited use in healthcare, we felt it could effectively model communication on patient care units.
• Gephart, S. M., McGrath, J. M., & Effken, J. A. (2011). Failure to rescue in neonatal care. Journal of Perinatal and Neonatal Nursing, 25(3), 275-282.
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  PMID: 21825918;Abstract: Failure to rescue (FTR) has been described as the end result of a series of events relating to the environment of care and nursing quality. Only recently has FTR as a process measure been applied to perinatal care settings. Nurses continuous presence at the bedside puts them in a privileged position to recognize signs of clinical deterioration and to take action. Many factors contribute to nurses ability to save lives when infants develop complications. Although such factors are often system-related, nurses may be held responsible if they do not act according to an acceptable standard of care. In the neonatal intensive care unit, FTR has not been applied or adopted as a measure of nursing quality. This article describes how FTR is relevant in the neonatal intensive care unit and outlines nursing and system actions that can be taken to rescue some of the hospital's most vulnerable patients. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.
• Effken, J., Gephart, S., Bianchi, D., & Verran, J. (2010). Correlations of nursing communication network metrics with patient outcomes. AMIA ... Annual Symposium proceedings. AMIA Symposium, 2010, 197-201.
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  Communication problems have been implicated in many safety and quality issues, but tools to examine communication networks and their impact on patient outcomes are only beginning to become available. We used *ORA, an organizational risk analyzer that allows the dynamic analysis of organizational networks to explore the communication networks among staff on seven nursing units in three Arizona hospitals. The results showed correlations between a number of *ORA metrics and patient safety and quality outcomes. *ORA provides researchers another way to study the influence of communication among staff on patient outcomes.

Presentations

• Grant, C., & Gephart, S. M. (2021, April). Nurse Collaborations across Fetal Diagnosis, NICU and HOME Health Networks. Western Institute of Nursing Communicating Research. Virtual: Western Institute of Nursing.
• Prettyman, A., & Gephart, S. M. (2022, January). Building Bridges: Engineering a Successful DNP/PhD Program. AACN Doctoral Education Conference. Virtual: AACN.
• Gephart, S. M. (2021, June). NEC risk, Timely recognition and communication. NEC society Nurses and NEC webinar. online: NEC Society.
• Gephart, S. M. (2021, September). NICU Nurse, I Believe You! GutCheckNEC to Improve NEC Risk Awareness and Communication. Annual conference. Chicago, Illinois: Academy of Neonatal Nursing.
• Gephart, S. M. (2021, September). Twists, Turns and Telehealth on the Road to End NEC. Annual Conference. Chicago, Illinois: Academy of Neonatal Nursing.
• Gephart, S. M., & Wyles, C. (2021, November). NeoECHO as an Implementation Process to Engage NICUs in NEC Prevention. Nurse Leadership Forum. Tucson, Arizona: Synova.
• Gephart, S. M., Gephart, S. M., Shea, K. D., Shea, K. D., Newnam, K., & Newnam, K. (2021, April). NEC-Zero Initiatives As a Foundation for Neoecho. Western Institute of Nursing. virtual: Western Institute of Nursing.
• Platt, C. R., & Gephart, S. M. (2021, April). Foster family adaptive theory (FFAT): A mid-range approach to complex family systems. Western Institute of Nursing Communicating Research Conference. Virtual: Western Institute of Nursing.
• Gephart, S. M. (2020, October). Educating under-resourced units to reduce NEC with NeoECHO. National Association of Neonatal Nursing. Virtual: NANN.
• Newnam, K., Shea, K. D., & Gephart, S. M. (2020, April). NEC-Zero Initiatives As a Foundation for Neoecho. Western Institute of Nursing. Portland, OR: Western Institute of Nursing.
• Weiss, A., Newnam, K., & Gephart, S. M. (2020, October). Exploring Internal Facilitators’ Experience with NeoECHO to Foster NEC Prevention and Timely Recognition through the iPARHIS Lens. NANN Research Summit. virtual: National Association of Neonatal Nursing.
• Wyles, C., & Gephart, S. M. (2020, October). Appraisal of NEC-Zero Español Toolkit Designed for Families of Fragile Infants. National Association of Neonatal Nurses Educational Conference. Virtual: NANN.
• Carrington, J. M., Carrington, J. M., Gephart, S. M., Gephart, S. M., Rosenfeld, A. G., Rosenfeld, A. G., Davis, M. P., Davis, M. P., Brewer, B. B., Brewer, B. B., Shea, K. D., & Shea, K. D. (2017, spring). Leading Change: Threading Data Science through the Nursing PhD Curriculum. Nursing Annual Regional Conference. Denver, CO: Western Institute of Nursing.
• Gephart, S. M. (2019, April). Implementation strategies to support Necrotizing enterocolitis (NEC) risk recognition and prevention in fragile infants: the Nec-Zero project. National Nursing Practice Network Monthly Webinar Series. Online: University of Michigan.
• Gephart, S. M. (2019, March). Implementation-Ready NEC-Zero Practices for Your NICU Today!. New England Association of Neonatal Nursing Annual Conference. Mystic, CT: New England Association of Neonatal Nursing.
• Gephart, S. M. (2019, March). Inertia breaking methods to change practice. NANN Research Summit. Scottsdale, AZ: National Association of Neonatal Nursing.
• Gephart, S. M. (2019, March). Twists and turns on the path to discovery: from GutCheckNEC to NEC-Zero. NANN Research Summit. Scottsdale, AZ: NANN.
• Gephart, S. M., & Gephart, S. M. (2019, March). Sound the Alarm: Risk, Readiness, and Rescue in the Neonatal Intensive Care Unit. New England Association of Neonatal Nursing Annual Conference. Mystic, CT.
• Gephart, S. M., & Sylvester, K. (2019, June). NEC Risk: Early Identification and Risk Stratification. NEC Symposium. Ann Arbor, Michigan: NEC Society.
• Gephart, S. M., Eklund, W., Grogan, C., Vernon, L., & Green, L. (2019, June). Workgroup facilitation: Tools to Support Families with NEC Survivors. NEC Symposium 2019. Ann Arbor, Michigan: NEC Society.
• Slebodnik, M. B., Wyles, C., & Gephart, S. M. (2019, April). Targeted NEC-Zero dissemination to reach caregivers of premature infants. Western Institute of Nursing Communicating Research Conference.
• Carrington, J. M., Gephart, S. M., Rosenfeld, A. G., Davis, M. P., Brewer, B. B., & Shea, K. D. (2017, spring). Leading Change: Threading Data Science through the Nursing PhD Curriculum. Nursing Annual Regional Conference. Denver, CO: Western Institute of Nursing.
• Gephart, S. M. (2018, February). NEC-Zero Resources to Reach Caregivers of Premature Infants at Risk for NEC. NNP of Arizona Conference. Chandler, AZ.
• Gephart, S. M. (2018, May). Innovating within the Electronic Health Record for Quality Care to Reduce Complications of Prematurity. National Pediatric Nurse Scientist Collaborative 2018 Research Fly-In. Milwaukee, Wisconsin.
• Gephart, S. M. (2018, October). Getting to zero NEC together: the NEC-Zero project. Florida Association of Neonatal Nurse Practitioners 29th Annual NNP Symposium. Clearwater Beach, FL.
• Gephart, S. M. (2018, October). Playing your part in patient safety to prevent failed rescue. Florida Association of Neonatal Nurse Practitioners 29th Annual NNP Symposium. Clearwater Beach, FL.
• Gephart, S. M. (2018, September). Precision health research and implementation reviewed through five synergistic principles: Clinical decision support needed to achieve precision health. Council for the Advancement of Nursing Science. Washington, D.C..
• Wyles, C., & Gephart, S. M. (2018, January). Engaging a community during a scoping review. Medical Library Group of Southern California & Arizona and the Northern California & Nevada Library Group 2018 Joint Meeting. Scottsdale, AZ.
• Wyles, C., & Gephart, S. M. (2018, January). Two examples of new ways of bridging the information gap by disseminating information: NEC-Zero Project & Project ECHO. Medical Library Group of Southern California & Arizona and the Northern California & Nevada Library Group 2018 Joint Meeting. Scottsdale, AZ.
• Gephart, S. M. (2017, August). Reliability, resilience and rescue. Arizona Research Festival. Phoenix, Arizona.
• Gephart, S. M. (2017, June). Integrating evidence, engagement and technology in implementation science at the frontline. Children's Hospital of Wisconsin. Milwaukee, WI.
• Gephart, S. M., Brewer, B. B., Carrington, J. M., Doyle, M., Shea, K. D., & Rosenfeld, A. G. (2017, January). Weaving data science into the fabric of core curriculum for the nursing research doctorate. Doctoral Education Conference. San Diego, CA: AACN.
• Gephart, S. M., Shea, K. D., Rosenfeld, A. G., Davis, M. P., Brewer, B. B., & Carrington, J. M. (2017, April). Use of NLP to Analyze Core Course Content and Weave in Data Science. InSpire 2017: Developing the Health Informatics Workforce of the Future Conference. La Jolla, California: American Medical Informatics Association.
• Quinn, M., & Gephart, S. M. (2017, April). The Current State of NEC Prevention Practices in the NICU. NEC Symposium. Davis, CA: NEC Society and PCORI.
• Shea, K. D., Brewer, B. B., Davis, M. P., Rosenfeld, A. G., Gephart, S. M., & Carrington, J. M. (2017, January). Weaving data science into the fabric of core curriculum for the nursing research doctorate. AACN Doctoral Education Conference. Coronado, CA: American Academy for Colleges of Nursing.
• Shea, K. D., Carrington, J. M., Brewer, B. B., Gephart, S. M., Davis, M. P., Rosenfeld, A. G., Rosenfeld, A. G., Davis, M. P., Gephart, S. M., Brewer, B. B., Carrington, J. M., & Shea, K. D. (2017, spring). Leading Change: Threading Data Science through the Nursing PhD Curriculum. Nursing Annual Regional Conference. Denver, CO: Western Institute of Nursing.
• Dudding, K. M., Gephart, S. M., & Carrington, J. M. (2016, April). Neonatal Nurses Experience Frequent Interruptions, Work- arounds, and Risks to Patient Safety with Electronic Health Records.. Research Summit. Scottsdale, AZ: National Association of Neonatal Nurses.
• Gephart, S. M. (2016, April). Preparing your presentation for publication. 11th Annual National Association of Neonatal Nurses (NANN) Research Summit. Scottsdale, AZ: NANN.
• Gephart, S. M. (2016, August). Steps to avoid failed rescue in neonatal ICU. Tucson Neonatal and Perinatal Nurses Conference. Tucson, AZ.
• Gephart, S. M. (2017, June). Solving the wicked problem of necrotizing enterocolitis. Denver Advanced Practice Neonatal Nursing Conference. Denver, Colorado: Children’s Hospital Colorado and Frontier Association of Neonatal Nurses.
• Gephart, S. M., & Rosenfeld, A. G. (2016, December). Adherence scoring to relate adoption of evidence to necrotizing enterocolitis in U.S. NICUs.. Robert Wood Johnson Foundation Nurse Faculty Scholars National Meeting. Baltimore, MD.
• Gephart, S. M., & Wyles, C. (2016, December). Engaging parents and clinicians to design a multi-faceted intervention to prevent neonatal complications. 9th Annual Conference on the Science of Dissemination and Implementation. Washington, D.C.: Academy Health.
• Gephart, S. M., & Wyles, C. (2016, September). Quantification and validation of an adherence score for practices that prevent necrotizing enterocolitis in very low birthweight infants. Council for the Advancement of Nursing Science. Washington, D. C..
• Gephart, S. M., & Wyles, C. (2016, September). SMART on FHIR sharing of clinical decision support for scalable nursing research and interoperable informatics practice. Council for the Advancement of Nursing Science. Washington, D. C.
• Gephart, S. M., Dunn-Lopez, K., & Abraham, J. (2016, November). Current state of nursing clinical decision support and future directions: an integrative literature review.. In symposium “Designing Next Generation of Clinical Decision Support for Nursing from Hospital to Homecare: AMIA Nursing Informatics Group Pre-Symposium Tutorial.. Chicago, Ill: AMIA.
• Quinn, M., Gephart, S. M., & Wyles, C. (2016, September). Identifying sociotechnical influences in early recognition of necrotizing enterocolitis to inform clinical decision support design for neonatal care.. Council for the Advancement of Nursing Science. Washington, D. C..
• Rosenfeld, A. G., Taylor-Piliae, R. E., Carrington, J. M., Gephart, S. M., Insel, K. C., Loescher, L. J., & Reed, P. G. (2016, January). Defying the skeptics! Strategies and successes of an online PhD program.. AACN Doctoral Education Conference. Florida: AACN.

Poster Presentations

• Calver, S., & Gephart, S. M. (2021, April). Design and Piloting an EHR Taskbar to Engineer System Resilience for Clinical Practice.. Western Institute of Nursing. Virtual: Western Institute of Nursing.
• Weiss, A., & Gephart, S. M. (2021, September). Patterns of Knowing Leveraged by Neonatal Nurses and Neonatal Nurse Practitioners During Clinical Deterioration. Annual conference. Chicago, Illinois: Academy of Neonatal Nursing.
• Zhang, T., Gephart, S. M., & Subbian, V. (2021, December). Barriers and Facilitators to Adoption of Drug-Drug Interaction Clinical Decision Support in US Healthcare Organizations. Dissemination and Implementation Annual Conference. virtual: Academy Health.
• Tolentino, D. A., Insel, K. C., & Gephart, S. M. (2020, November). The relationship between task-technology fit and nurses’ performance in the EHR. AMIA. Virtual: AMIA.
• Newnam, K., Shea, K. D., Gephart, S. M., Gephart, S. M., Newnam, K., & Shea, K. D. (2019, April). Project ECHO as an implementation strategy and opportunities to test mechanisms of effectiveness informed by the iPARHIS framework. Western Institute of Nursing Communicating Research Conferene. San Diego, CA.
• Tolentino, D. A., & Gephart, S. M. (2019, November). From User Experience to Digital Health Adoption (UXA): A Synthesized Framework to Guide Nursing Science. AMIA Annual Conference. Washington, D.C.: AMIA.
• Gephart, S. M., Tolentino, A., Quinn, M., Wyles, C., Surcouf, J., & Fry, E. (2018, May). NICU Workflow and Technical Needs to Prevent and Support Timely Recognition of Necrotizing Enterocolitis with NEC-Zero CDS. AMIA Clinical Informatics. Scottsdale, AZ: AMIA.
• Luckart, J., Gephart, S. M., Gregg, S. R., & Pacheco, C. L. (2018, April). Exploration of Preconception Education Using Social Media. Annual Interprofessional Rural Health Professions Conference. Tucson, AZ: AHEC.
• Gephart, S. M. (2017, April). Towards a NEC prevention checklist. NEC Symposium. Davis, CA: NEC Society.
• Gephart, S. M., Porter, C., & Wyles, C. (2017, December). Validation of adherence scoring, prevention checklist and parent education materials to reduce necrotizing enterocolitis to zero occurrence (NEC-Zero) in the neonatal intensive care unit.. Academy Health Dissemination and Implementation Science Conference. Washington, D.C.: Academy Health.
• Owen-Williams, E., Igwe, D., Gephart, S. M., & Pacheco, C. L. (2017, April). PRACTITIONERS PERCEPTION OF IMPLEMENTING THE PEDIATRIC EARLY WARNING SYSTEM (PEWS) IN RURAL PRIMARY CARE. Annual Interprofessional Rural Health Conference. Tucson, AZ: AzAHEC.
• Rothers, J. L., Fleiner, M., & Gephart, S. M. (2017, April). GutCheckNEC as predictor of NEC and relations with pediatric early warning scores. NEC Symposium. University of California, Davis: NEC Society.
• Rothers, J., Gephart, S. M., & Fleiner, M. (2017, April). GutCheckNEC as Predictor of NEC and Relations with Pediatric Early Warning Scores. NEC Symposium. Davis, CA: PCORI & NEC Society.
• Tolentino, D. A., & Gephart, S. M. (2017, April). Sequential pattern analysis of nurses’ EHR navigation and documentation. Communicating Nursing Research. Denver, CO: Western Institute of Nursing.

Reviews

• Dunn Lopez, K., Gephart, S. M., Raszewski, R., Sousa, V., Shehorn, L. E., & Abraham, J. (2016. Integrative review of clinical decision support for registered nurses in acute care settings.
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  To report on the state of the science of clinical decision support (CDS) for hospital bedside nurses.