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Zoller R, Weiß C, Kießling PJ, Wittmann M. [Influence of digital documentation on working hours and workflow in the intensive care unit: An observational pre-post-study]. Pflege 2024; 37:159-167. [PMID: 37170597 DOI: 10.1024/1012-5302/a000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Influence of digital documentation on working hours and workflow in the intensive care unit: An observational pre-post-study Abstract: Background: The introduction of digital patient documentation systems in hospitals and intensive care units is increasing in Germany. The effects of these systems on the workflow of nurses have hardly been studied. Aim: It is analysed how high the workload is with a digital documentation system compared to paper-based documentation, how the workflow changes and how the digital documentation is evaluated in comparison to paper-based in terms of usability, time required and documentation quality. Methods: Before (to) and after the introduction of the digital patient documentation system (t1), the time for documentation and the documentation frequency was measured in a prospective pre-post observation study using an app configured specifically for this purpose, and both survey periods were statistically compared (Mann-Whitney-U-test). Furthermore, a survey of nursing staff on digital patient documentation was carried out. Results: The working time for the documentation remains the same after digitization. However, 80% of respondents state that the documentation time would have been reduced. Furthermore, the number of documentation processes decreases significantly (p = 0.03). In addition, a majority (55%) indicated an increase in documentation quality. Conclusions: Digital patient documentation does not necessarily save working time, but it defragments the process of documentation work and has the potential to positively influence the documentation workflow.
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Affiliation(s)
- Richard Zoller
- Stabsstelle Medizinisch-Wissenschaftliche Technologieentwicklung und -koordination (MWTek), Universitätsklinikum Bonn, Deutschland
| | - Claudia Weiß
- Chirurgische Intensivstation, Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Deutschland
| | - Patrick Joachim Kießling
- Klinik für Nephrologie, Rheumatologie, Diabetologie und Allgemeine Innere Medizin, Universitätsklinikum Köln, Deutschland
| | - Maria Wittmann
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Deutschland
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Peivandi S, Ahmadian L, Farokhzadian J, Jahani Y. Evaluation and comparison of errors on nursing notes created by online and offline speech recognition technology and handwritten: an interventional study. BMC Med Inform Decis Mak 2022; 22:96. [PMID: 35395798 PMCID: PMC8994328 DOI: 10.1186/s12911-022-01835-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/31/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite the rapid expansion of electronic health records, the use of computer mouse and keyboard, challenges the data entry into these systems. Speech recognition software is one of the substitutes for the mouse and keyboard. The objective of this study was to evaluate the use of online and offline speech recognition software on spelling errors in nursing reports and to compare them with errors in handwritten reports. METHODS For this study, online and offline speech recognition software were selected and customized based on unrecognized terms by these softwares. Two groups of 35 nurses provided the admission notes of hospitalized patients upon their arrival using three data entry methods (using the handwritten method or two types of speech recognition software). After at least a month, they created the same reports using the other methods. The number of spelling errors in each method was determined. These errors were compared between the paper method and the two electronic methods before and after the correction of errors. RESULTS The lowest accuracy was related to online software with 96.4% and accuracy. On the average per report, the online method 6.76, and the offline method 4.56 generated more errors than the paper method. After correcting the errors by the participants, the number of errors in the online reports decreased by 94.75% and the number of errors in the offline reports decreased by 97.20%. The highest number of reports with errors was related to reports created by online software. CONCLUSION Although two software had relatively high accuracy, they created more errors than the paper method that can be lowered by optimizing and upgrading these softwares. The results showed that error correction by users significantly reduced the documentation errors caused by the software.
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Affiliation(s)
- Sahar Peivandi
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Leila Ahmadian
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran.
| | | | - Yunes Jahani
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Larjow E, Lingner T. Resource use of geriatric nurses due to documentation practices: A cross-sectional study of applied recording techniques in nursing homes. Nurs Open 2021; 9:1126-1135. [PMID: 34921751 PMCID: PMC8859046 DOI: 10.1002/nop2.1152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/27/2021] [Accepted: 11/16/2021] [Indexed: 11/06/2022] Open
Abstract
AIM To compare recent compliance cost estimates by nurses of German nursing homes who employ the new documentation approach structural model with those who use traditional documentation frameworks. DESIGN A cross-sectional survey. METHODS For each documentation approach, five sub-processes were surveyed employing standard activities. The postal and online surveys were based on the same self-administered questionnaire. The measures addressed time investments and further costs to carry out the components of nursing documentation. Data were collected from a convenience sample of nurses (n = 264) from German nursing homes between October 2018 and June 2019. RESULTS The analysed sub-processes consume between 26 min and 8 hr per fulfilment. For users of the structural model, collecting information on a new admission is the costliest part of the documentation, at €90 per case. For users of other documentation approaches, care planning requires the most expensive effort, at €130 per case.
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Affiliation(s)
- Eugenia Larjow
- Department of Health Care Management, Institute of Public Health and Nursing Research, Health Sciences, University of Bremen, Bremen, Germany
| | - Tobias Lingner
- Federal Agency for Public Safety Digital Radio, Berlin, Germany
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Moldskred PS, Snibsøer AK, Espehaug B. Improving the quality of nursing documentation at a residential care home: a clinical audit. BMC Nurs 2021; 20:103. [PMID: 34154606 PMCID: PMC8215798 DOI: 10.1186/s12912-021-00629-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 06/09/2021] [Indexed: 11/21/2022] Open
Abstract
Background Quality in nursing documentation holds promise to increase patient safety and quality of care. While high-quality nursing documentation implies a comprehensive documentation of the nursing process, nursing records do not always adhere to these documentation criteria. The aim of this quality improvement project was to assess the quality of electronic nursing records in a residential care home using a standardized audit tool and, if necessary, implement a tailored strategy to improve documentation practice. Methods A criteria-based clinical audit was performed in a residential care home in Norway. Quantitative criteria in the N-Catch II audit instrument was used to give an assessment of electronic nursing records on the following: nursing assessment on admission, nursing diagnoses, aims for nursing care, nursing interventions, and evaluation/progress reports. Each criterium was scored on a 0–3 point scale, with standard (complete documentation) coinciding with the highest score. A retrospective audit was conducted on 38 patient records from January to March 2018, followed by the development and execution of an implementation strategy tailored to local barriers. A re-audit was performed on 38 patient records from March to June 2019. Results None of the investigated patient records at audit fulfilled standards for recommended nursing documentation practice. Mean scores at audit varied from 0.4 (95 % confidence interval 0.3–0.6) for “aims for nursing care” to 1.1 (0.9–1.3) for “nursing diagnoses”. After implementation of a tailored multifaceted intervention strategy, an improvement (p < 0.001) was noted for all criteria except for “evaluation/progress reports” (p = 0.6). The improvement did not lead to standards being met at re-audit, where mean scores varied from 0.9 (0.8–1.1) for “evaluation/progress reports” to 1.9 (1.5–2.2) for “nursing assessment on admission”. Conclusions A criteria-based clinical audit with multifaceted tailored interventions that addresses determinants of practice may improve the quality of nursing documentation, but further cycles of the clinical audit process are needed before standards are met and focus can be shifted to sustainment of knowledge use.
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Affiliation(s)
- Preben Søvik Moldskred
- Luranetunet Care Centre, Solstrandvegen 39, 5200, Os, Norway. .,Centre for Evidence-Based Practice, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Postbox 7030, 5020, Bergen, Norway.
| | - Anne Kristin Snibsøer
- Centre for Evidence-Based Practice, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Postbox 7030, 5020, Bergen, Norway.,Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Postbox 7030, 5020, Bergen, Norway
| | - Birgitte Espehaug
- Centre for Evidence-Based Practice, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Postbox 7030, 5020, Bergen, Norway
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Fennelly O, Grogan L, Reed A, Hardiker NR. Use of standardized terminologies in clinical practice: A scoping review. Int J Med Inform 2021; 149:104431. [PMID: 33713915 DOI: 10.1016/j.ijmedinf.2021.104431] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/20/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022]
Abstract
AIM To explore the use and impact of standardized terminologies (STs) within nursing and midwifery practice. INTRODUCTION The standardization of clinical documentation creates a potential to optimize patient care and safety. Nurses and midwives, who represent the largest proportion of the healthcare workforce worldwide, have been using nursing-specific and multidisciplinary STs within electronic health records (EHRs) for decades. However, little is known regarding ST use and impact within clinical practice. METHODS A scoping review of the literature was conducted (2019) across PubMed, CINAHL, Embase and CENTRAL in collaboration with the Five Country Nursing and Midwifery Digital Leadership Group (DLG). Identified studies (n = 3547) were reviewed against a number of agreed criterion, and data were extracted from included studies. Studies were categorized and findings were reviewed by the DLG. RESULTS One hundred and eighty three studies met the inclusion criteria. These were conducted across 25 different countries and in various healthcare settings, utilising mainly nursing-specific (most commonly NANDA-I, NIC, NOC and the Omaha System) and less frequently local, multidisciplinary or medical STs (e.g., ICD). Within the studies, STs were evaluated in terms of Measurement properties, Usability, Documentation quality, Patient care, Knowledge generation, and Education (pre and post registration). As well as the ST content, the impact of the ST on practice depended on the healthcare setting, patient cohort, nursing experience, provision of education and support in using the ST, and usability of EHRs. CONCLUSION Employment of STs in clinical practice has the capability to improve communication, quality of care and interoperability, as well as facilitate value-based healthcare and knowledge generation. However, employment of several different STs and study heterogeneity renders it difficult to aggregate and generalize findings.
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Affiliation(s)
- Orna Fennelly
- Insight Centre for Data Analytics, University College Dublin, Ireland; School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.
| | - Loretto Grogan
- Office of the Nursing and Midwifery Services Director, Health Service Executive (HSE), Ireland.
| | - Angela Reed
- Northern Ireland Practice & Education Council for Nursing and Midwifery, Northern Ireland.
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Mujlli G, Aldisi D, Aljuraiban GS, Abulmeaty MMA. Impact of Nutrition Care Process Documentation in Obese Children and Adolescents with Metabolic Syndrome and/or Non-Alcoholic Fatty Liver Disease. Healthcare (Basel) 2021; 9:healthcare9020188. [PMID: 33572340 PMCID: PMC7916099 DOI: 10.3390/healthcare9020188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 11/16/2022] Open
Abstract
This study evaluated the Nutrition Care Process documentation used by dietitians for obese pediatric patients diagnosed with metabolic syndrome (MetS) and/or non-alcoholic fatty liver disease (NAFLD) and its impact on the achievement of nutritional goals. This retrospective cohort study utilized data retrieved from three tertiary care hospitals in Riyadh. A total of 142 obese pediatric patients aged 8–18 years diagnosed with NAFLD and/or MetS were evaluated. Data on weight, height, blood pressure (BP), lipid profile, and liver enzymes were collected. A validated audit was used to assess the documentation quality. Twenty-seven (46.6%) dietitian notes received a high score, 21 (36.2%) received a medium score, and 10 (17.2%) received a low score. There was no significant effect of dietitian audit scores on nutritional outcomes, however, the change in body mass index from 6 to 12 months follow-up period was inversely correlated with the audit score (r = −0.761, p = 0.007), and alkaline phosphatase was inversely correlated with the audit score (r = −0.819, p = 0.013). In conclusion, there was a clear variation in the quality of dietitians’ documentation and the impact of documentation scores on nutritional outcomes.
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Affiliation(s)
- Gadah Mujlli
- Clinical Nutrition Program, Community Health Department, King Saud University, Riyadh 11362, Saudi Arabia; (G.M.); (D.A.); (G.S.A.)
- Education, Simulation and Skills Development Center, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
| | - Dara Aldisi
- Clinical Nutrition Program, Community Health Department, King Saud University, Riyadh 11362, Saudi Arabia; (G.M.); (D.A.); (G.S.A.)
| | - Ghadeer S. Aljuraiban
- Clinical Nutrition Program, Community Health Department, King Saud University, Riyadh 11362, Saudi Arabia; (G.M.); (D.A.); (G.S.A.)
| | - Mahmoud M. A. Abulmeaty
- Clinical Nutrition Program, Community Health Department, King Saud University, Riyadh 11362, Saudi Arabia; (G.M.); (D.A.); (G.S.A.)
- Obesity Management and Research Unit, Medical Physiology Department, Zagazig University, Zagazig 44519, Egypt
- Correspondence: ; Tel.: +96-65-4815-5983
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Muinga N, Abejirinde IO, Paton C, English M, Zweekhorst M. Designing paper-based records to improve the quality of nursing documentation in hospitals: A scoping review. J Clin Nurs 2021; 30:56-71. [PMID: 33113237 PMCID: PMC7894495 DOI: 10.1111/jocn.15545] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/13/2020] [Accepted: 10/18/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Inpatient nursing documentation facilitates multi-disciplinary team care and tracking of patient progress. In both high- and low- and middle-income settings, it is largely paper-based and may be used as a template for electronic medical records. However, there is limited evidence on how they have been developed. OBJECTIVE To synthesise evidence on how paper-based nursing records have been developed and implemented in inpatient settings to support documentation of nursing care. DESIGN A scoping review guided by the Arksey and O'Malley framework and reported using PRISMA-ScR guidelines. ELIGIBILITY CRITERIA We included studies that described the process of designing paper-based inpatient records and excluded those focussing on electronic records. Included studies were published in English up to October 2019. SOURCES OF EVIDENCE PubMed, CINAHL, Web of Science and Cochrane supplemented by free-text searches on Google Scholar and snowballing the reference sections of included papers. RESULTS 12 studies met the eligibility criteria. We extracted data on study characteristics, the development process and outcomes related to documentation of inpatient care. Studies reviewed followed a process of problem identification, literature review, chart (re)design, piloting, implementation and evaluation but varied in their execution of each step. All studies except one reported a positive change in inpatient documentation or the adoption of charts amid various challenges. CONCLUSIONS The approaches used seemed to work for each of the studies but could be strengthened by following a systematic process. Human-centred Design provides a clear process that prioritises the healthcare professional's needs and their context to deliver a usable product. Problems with the chart could be addressed during the design phase rather than during implementation, thereby promoting chart ownership and uptake since users are involved throughout the design. This will translate to better documentation of inpatient care thus facilitating better patient tracking, improved team communication and better patient outcomes. RELEVANCE TO CLINICAL PRACTICE Paper-based charts should be designed in a systematic and clear process that considers patient's and healthcare professional's needs contributing to improved uptake of charts and therefore better documentation.
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Affiliation(s)
- Naomi Muinga
- Athena InstituteVU University AmsterdamAmsterdamThe Netherlands
- KEMRI/Wellcome Trust Research ProgrammeNairobiKenya
- Department of Public HealthInstitute of Tropical MedicineMaternal and Reproductive Health UnitAntwerpBelgium
| | - Ibukun‐Oluwa Omolade Abejirinde
- International Program Evaluation UnitSickKids Centre for Global Child HealthTorontoONCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
| | - Chris Paton
- Nuffield Department of MedicineCentre for Tropical Medicine and Global HealthUniversity of OxfordOxfordUK
| | - Mike English
- KEMRI/Wellcome Trust Research ProgrammeNairobiKenya
- Nuffield Department of MedicineCentre for Tropical Medicine and Global HealthUniversity of OxfordOxfordUK
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Implementation and factors affecting the nursing process among nurses working in selected government hospitals in Southwest Ethiopia. BMC Nurs 2020; 19:105. [PMID: 33292177 PMCID: PMC7654185 DOI: 10.1186/s12912-020-00498-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The nursing process was initially adopted from the general system theory, and was developed and implemented in the field of education. There is a demand to implement the nursing process in practical care in every health institution, but the perception remains that it is time-consuming and impractical. If the nursing process is not valued and not used, nurses may continue to intervene on the basis of a medical diagnosis rather than on the basis of a rational nursing Process steps. In any of the steps, oversight or omission can result in less than optimal nursing care. The purpose of this study was to assess implementation and factors affecting the nursing process among nurses working in selected government hospitals in Southwest Ethiopia. METHODS An institution-based cross-sectional descriptive study was conducted from March 10 to April 1, 2015 in three hospitals in southwest Ethiopia using self-administered questionnaires. This study included a total of 138 nurses using simple random sampling. Data were classified, coded and entered into epidemiological information version 3.5.3, and exported to the statistical package for social science version 20 for analysis, descriptive statistics were used to describe the variables, bivariable and multivariable logistic regression were used to see the effect of each variable on the dependent variable. RESULT The nursing process was found to be 73.9% implemented. Compared to a Bachelor of Science nurses', the likelihood of implementing the nursing process was less likely among diploma nurses. Nurses working in administratively supported hospitals implemented the nursing process more compared to those without administrative support. The nursing process had been implemented higher by trained nurses compared to untrained nurses. CONCLUSION The implementation of nursing process was good where; nearly seven in every ten nurses implemented the nursing process. Low educational qualification, lack of training, and non-supportive hospital administration were predictors of the nursing process implementation. The health service management, in collaboration with Ethiopian nursing/professional associations and international governmental and non-governmental organizations should give continuous on the job professional development education, and develop nursing practice guidelines.
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Ayorinde AA, Williams I, Mannion R, Song F, Skrybant M, Lilford RJ, Chen YF. Publication and related bias in quantitative health services and delivery research: a multimethod study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Bias in the publication and reporting of research findings (referred to as publication and related bias here) poses a major threat in evidence synthesis and evidence-based decision-making. Although this bias has been well documented in clinical research, little is known about its occurrence and magnitude in health services and delivery research.
Objectives
To obtain empirical evidence on publication and related bias in quantitative health services and delivery research; to examine current practice in detecting/mitigating this bias in health services and delivery research systematic reviews; and to explore stakeholders’ perception and experiences concerning such bias.
Methods
The project included five distinct but interrelated work packages. Work package 1 was a systematic review of empirical and methodological studies. Work package 2 involved a survey (meta-epidemiological study) of randomly selected systematic reviews of health services and delivery research topics (n = 200) to evaluate current practice in the assessment of publication and outcome reporting bias during evidence synthesis. Work package 3 included four case studies to explore the applicability of statistical methods for detecting such bias in health services and delivery research. In work package 4 we followed up four cohorts of health services and delivery research studies (total n = 300) to ascertain their publication status, and examined whether publication status was associated with statistical significance or perceived ‘positivity’ of study findings. Work package 5 involved key informant interviews with diverse health services and delivery research stakeholders (n = 24), and a focus group discussion with patient and service user representatives (n = 8).
Results
We identified only four studies that set out to investigate publication and related bias in health services and delivery research in work package 1. Three of these studies focused on health informatics research and one concerned health economics. All four studies reported evidence of the existence of this bias, but had methodological weaknesses. We also identified three health services and delivery research systematic reviews in which findings were compared between published and grey/unpublished literature. These reviews found that the quality and volume of evidence and effect estimates sometimes differed significantly between published and unpublished literature. Work package 2 showed low prevalence of considering/assessing publication (43%) and outcome reporting (17%) bias in health services and delivery research systematic reviews. The prevalence was lower among reviews of associations than among reviews of interventions. The case studies in work package 3 highlighted limitations in current methods for detecting these biases due to heterogeneity and potential confounders. Follow-up of health services and delivery research cohorts in work package 4 showed positive association between publication status and having statistically significant or positive findings. Diverse views concerning publication and related bias and insights into how features of health services and delivery research might influence its occurrence were uncovered through the interviews with health services and delivery research stakeholders and focus group discussion conducted in work package 5.
Conclusions
This study provided prima facie evidence on publication and related bias in quantitative health services and delivery research. This bias does appear to exist, but its prevalence and impact may vary depending on study characteristics, such as study design, and motivation for conducting the evaluation. Emphasis on methodological novelty and focus beyond summative assessments may mitigate/lessen the risk of such bias in health services and delivery research. Methodological and epistemological diversity in health services and delivery research and changing landscape in research publication need to be considered when interpreting the evidence. Collection of further empirical evidence and exploration of optimal health services and delivery research practice are required.
Study registration
This study is registered as PROSPERO CRD42016052333 and CRD42016052366.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 33. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Abimbola A Ayorinde
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Iestyn Williams
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Russell Mannion
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Fujian Song
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Magdalena Skrybant
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Richard J Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Yen-Fu Chen
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Joseph J, Moore ZEH, Patton D, O'Connor T, Nugent LE. The impact of implementing speech recognition technology on the accuracy and efficiency (time to complete) clinical documentation by nurses: A systematic review. J Clin Nurs 2020; 29:2125-2137. [DOI: 10.1111/jocn.15261] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/10/2020] [Accepted: 03/12/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Joseph Joseph
- Naas General hospital Naas Ireland
- School of Nursing and Midwifery Royal College of Surgeons in Ireland Dublin 2 Ireland
| | - Zena E. H. Moore
- School of Nursing and Midwifery Royal College of Surgeons in Ireland Dublin 2 Ireland
| | - Declan Patton
- School of Nursing and Midwifery Royal College of Surgeons in Ireland Dublin 2 Ireland
| | - Tom O'Connor
- School of Nursing and Midwifery Royal College of Surgeons in Ireland Dublin 2 Ireland
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Quality of Care: Ecological Study for the Evaluation of Completeness and Accuracy in Nursing Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093259. [PMID: 32392838 PMCID: PMC7246491 DOI: 10.3390/ijerph17093259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/25/2020] [Accepted: 05/02/2020] [Indexed: 01/04/2023]
Abstract
Nursing documentation is an important proxy of the quality of care, and quality indicators in nursing assessment can be used to assess and improve the quality of care in health care institutions. The study aims to evaluate the completeness and the accuracy of nursing assessment, analyzing the compilation of pain assessment and nutritional status (body mass index (BMI)) in computerized nursing records, and how it is influenced by four variables: nurse to patient ratio, diagnosis related group weight (DRG), seniority of charge nurse, and type of ward (medical, surgical or other). The observational ecological pilot study was conducted between September and October 2018 in an Italian Tertiary-Level Teaching Hospital. The nursing documentation analyzed for the ‘Assessment’ phase included 12,513 records, 50.4% concerning pain assessment, and 45% BMI. The nurse–patient ratio showed a significant direct association with the assessment of nutritional status (p = 0.032). The average weight DRG has a negative influence on pain and BMI assessment; the surgical units positively correlate with the compilation of nursing assessment (BMI and pain). The nursing process is an essential component for the continuous improvement in the quality of care. Nurses need to be accountable to improve their knowledge and skills in nursing documentation.
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12
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Martin K, Ricciardelli R, Dror I. How forensic mental health nurses' perspectives of their patients can bias healthcare: A qualitative review of nursing documentation. J Clin Nurs 2020; 29:2482-2494. [PMID: 32242997 DOI: 10.1111/jocn.15264] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/12/2020] [Accepted: 03/12/2020] [Indexed: 01/05/2023]
Abstract
AIMS AND OBJECTIVES Our aim was to examine the notes produced by nurses, paying specific attention to the style in which these notes are written and observing whether there are concerns of distortions and biases. BACKGROUND Clinicians are responsible to document and record accurately. However, nurses' attitudes towards their patients can influence the quality of care they provide their patients and this inevitably impacts their perceptions and judgments, with implications to patients' care, treatment, and recovery. Negative attitudes or bias can cascade to other care providers and professionals. DESIGN This study used a retrospective chart review design and qualitative exploration of documentation using an emergent theme analysis. METHODS We examined the notes taken by 55 mental health nurses working with inpatients in the forensic services department at a psychiatric hospital. The study complies with the SRQR Checklist (Appendix S1) published in 2014. RESULTS The results highlight some evidence of nurses' empathic responses to patients, but suggest that most nurses have a style of writing that much of the time includes themes that are negative in nature to discount, pathologise, or paternalise their patients. CONCLUSIONS When reviewing the documentation of nurses in this study, it is easy to see how they can influence and bias the perspective of other staff. Such bias cascade and bias snowball have been shown in many domains, and in the context of nursing it can bias the type of care provided, the assessments made and the decisions formed by other professionals. RELEVANCE TO CLINICAL PRACTICE Given the critical role documentation plays in healthcare, our results indicate that efforts to improve documentation made by mental health nurses are needed and specifically, attention needs to be given to the writing styles of the notation.
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Affiliation(s)
- Krystle Martin
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada.,Ontario Tech University, Oshawa, Ontario, Canada
| | - Rosemary Ricciardelli
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada.,Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Itiel Dror
- University College London (UCL), London, UK
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Yu P, Jiang T, Hailey D, Ma J, Qian S. The contribution of electronic health records to risk management through accreditation of residential aged care homes in Australia. BMC Med Inform Decis Mak 2020; 20:58. [PMID: 32192492 PMCID: PMC7082951 DOI: 10.1186/s12911-020-1070-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/10/2020] [Indexed: 11/22/2022] Open
Abstract
Background The Australian government has implemented a compulsory aged care accreditation system to guide and monitor the risk management approach in registered residential aged care (RAC) homes. This research assessed the contribution of electronic health records (EHR) to risk management in RAC homes in relation to the extent that aged care accreditation fulfils its role. Methods A convenience sample of 5560 aged care accreditation reports published from 2011 to 2018 was manually downloaded from the Accreditation Agency web site. A mixed-method approach of text data mining and manual content analysis was used to identify any significant differences in failure to meet accreditation outcomes among the RAC homes. This took account of whether EHR or paper records were used, year of accreditation, and size and location of the homes. Results It appears that aged care accreditation was focused on structure and process, with limited attention to outcome. There was a big variation between homes in their use of measurement indicators to assess accreditation outcomes. No difference was found in outcomes between RAC homes using EHR and those using paper records. Only 3% of the RAC homes were found to have failed some accreditation outcomes. Failure in monitoring mechanism was the key factor for failing many accreditation outcomes. The top five failed outcomes were Human Resource Management, Clinical Care, Information Systems, Medication Management and Behavioural Management. Conclusions Sub-optimal outcomes have limited the effectiveness of accreditation in driving and monitoring risk management for care recipient safety in RAC homes. Although EHR is an important structure and process component for RAC services, it made a limited contribution to risk management for accreditation in Australian RAC homes. Either EHR was not effective, or the accreditation process was not robust enough to recognize its influence. Aged care accreditation in Australia needs to develop further outcome-based measures that are supported by robust data infrastructure and clear guidance.
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Affiliation(s)
- Ping Yu
- Centre for IT-enabled Transformation, School of Computing and Information Technology, University of Wollongong, Wollongong, NSW, 2522, Australia. .,Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia. .,SMART Infrastructure Facility, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Tao Jiang
- School of Nursing and Health Management, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - David Hailey
- Centre for IT-enabled Transformation, School of Computing and Information Technology, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Jun Ma
- Centre for IT-enabled Transformation, School of Computing and Information Technology, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Siyu Qian
- Centre for IT-enabled Transformation, School of Computing and Information Technology, University of Wollongong, Wollongong, NSW, 2522, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia
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14
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Myklebust KK, Bjørkly S. The quality and quantity of staff-patient interactions as recorded by staff. A registry study of nursing documentation in two inpatient mental health wards. BMC Psychiatry 2019; 19:251. [PMID: 31412803 PMCID: PMC6694476 DOI: 10.1186/s12888-019-2236-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/08/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Therapeutic staff-patient interaction is fundamental in psychiatric care. It is recognized as a key to healing in and of itself, or a premise to enhance psychiatric treatment adherence. Still, little is known about how these interactions are recorded in nursing documentation. The purpose of the study was to assess the quality and quantity of staff-patient interactions as recorded in progress notes in nursing documentation. METHODS The study has an observational registry study design. A random sample of 3858 excerpts was selected from progress notes in 90 patient journals on an acute psychiatric unit and an open inpatient district psychiatric centre (DPC) in Norway. The Scale for the Evaluation of Staff-Patient Interactions in progress notes (SESPI) was used to assess the progress note excerpts. It is developed to assess the quality and quantity in excerpt descriptions of staff-patient interactions in terms of empathic attunement. Descriptive statistics were calculated for the total sample and for each ward separately. Ordinal and multinomial logistic regression were used to estimate control for shift type, staff education level, and type of hospital ward. RESULTS Only 7.6% of the total number of excerpts (N = 3858) described staff-patient interactions sufficiently to analyze them in terms of attunement. Compared to the DPC, the acute ward reported more staff-patient interactions. The evening excerpts reported more successful types of attunement than those from the night shifts. Education level did not contribute significantly to our models. CONCLUSION These findings present a unique insight into the quality and quantity of mental health nursing documentation regarding staff-patient interactions. Therapeutic interactions where staff tried to attune to the patients were rarely described. However, this is the first study measuring nursing documentation with the SESPI, and more studies are required to validate the scale and our findings. One potential clinical implication of this research is the development of a scale that personnel in psychiatric wards can have for evaluation of the quality of their reporting practice with emphasis on staff-patient interactions. By regular use this may help keeping up emphasis on emphatic attunement in milieu treatment contexts.
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Affiliation(s)
- Kjellaug K. Myklebust
- 0000 0004 0434 9525grid.411834.bFaculty of Health Sciences and Social Care, Molde University College, Box 2110, 6402 Molde, Norway
| | - Stål Bjørkly
- 0000 0004 0434 9525grid.411834.bFaculty of Health Sciences and Social Care, Molde University College, Box 2110, 6402 Molde, Norway ,0000 0004 0389 8485grid.55325.34Centre for Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
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Salas Muñoz RM, Fernández Jiménez AJ. Valoración de las necesidades de atención psicológica en pacientes en hemodiálisis mediante indicadores de ansiedad y depresión. ENFERMERÍA NEFROLÓGICA 2019. [DOI: 10.4321/s2254-28842019000200009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: Numerosos trabajos sugieren relaciones entre la enfermedad renal crónica severa y trastornos del estado de ánimo.
Objetivo: Valorar las necesidades de atención psicológica de la población en hemodiálisis a partir de indicadores objetivos de ansiedad y depresión.
Material y Método: Estudio descriptivo transversal entre octubre de 2016 y marzo de 2018, con una muestra de 103 pacientes a los que se entrevistó y se les aplicó el inventario de depresión de Beck y el inventario de Ansiedad Estado-Rasgo. Se registró el sexo, edad y el tiempo que cada persona llevaba en diálisis.
Resultados: Un 8,7% de la muestra presentó niveles de depresión grave, frente a un 60,2% con depresión mínima. El 23,3% obtuvo niveles leves de depresión y un 7,8% depresión moderada.
Un 25,24% de la muestra presentaban ansiedad elevada, un 37,86% ansiedad moderada y un 36,89% baja ansiedad.
Según cuestionarios realizados, 92 de los 103 participantes, describieron la existencia de un evento traumático en sus vidas, junto con estrategias de afrontamiento pasivo/evitativas.
Conclusiones: A partir de los resultados observados en los que es patente la presencia de ansiedad y depresión en los pacientes en hemodiálisis, podemos apreciar la importancia de disponer para ellos de un tratamiento psicológico.
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Sáenz Martínez S, Pérez López F, Martí-García C. Conocimiento sobre la enfermedad renal crónica en la población universitaria de Málaga. ENFERMERÍA NEFROLÓGICA 2019. [DOI: 10.4321/s2254-28842019000200010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: El debut de la Enfermedad Renal Crónica (ERC) se ha relacionado en parte con los escasos conocimientos de los pacientes acerca de la fisiopatología renal y los factores de riesgo relacionados, lo que a su vez predice un peor diagnóstico y pronóstico. En este sentido, una correcta alfabetización en salud desde edades tempranas puede prevenir el desarrollo de hábitos de vida perniciosos. Objetivo principal: Evaluar los conocimientos de la población universitaria de Málaga sobre los conceptos básicos asociados a la ERC. Material y Método: Se llevó a cabo un estudio transversal-descriptivo con estudiantes de Grado en la Universidad de Málaga durante el curso 2016-2017, a través de un cuestionario autoadministrado elaborado Ad Hoc para determinar sus conocimientos sobre fisiopatología renal y su prevención. El cuestionario constó de 28 preguntas, divididas en 5 categorías temáticas y fue revisado previa administración, por 10 expertos en nefrología (médicos y enfermeras) y pilotado con 38 personas. Resultados: El nivel de conocimientos resultó ser bajo en general, con 14,3±4,7 respuestas correctas de 28. Se encontraron diferencias estadísticamente significativas según rama de conocimiento, donde los estudiantes de Ciencias de la Salud obtuvieron los mejores resultados con 18,25 (IC 17,18-19,32) respuestas correctas (p<0,001). Además, los estudiantes de la rama de Ciencias obtuvieron resultados equiparables a los de Ciencias de la Salud en preguntas sobre la anatomofisiología del riñón. Discusión y Conclusiones: La población universitaria de Málaga posee un bajo nivel de conocimientos acerca de la ERC. Se necesitan futuros estudios con población sana en este campo.
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Cuevas Budhart MÁ, González Martínez BR, Álvarez Bolaños E, Barrera García MJ, Almeida Souza AD, Gómez del Pulgar García M, González Jurado MA. Diseño y validación de un nuevo registro clínico de enfermería, para la continuidad de los cuidados y seguridad del paciente en hemodiálisis. ENFERMERÍA NEFROLÓGICA 2019. [DOI: 10.4321/s2254-28842019000200008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: Diseñar y Validar una herramienta para la mejora del proceso de atención en enfermería en una unidad de hemodiálisis de un hospital de segundo nivel. Material y Método: Se desarrolló un estudio de mejora de la calidad de la atención, en el Hospital General Regional nº 1 “Vicente Guerrero” en Guerrero, (México), entre mayo-agosto de 2017. Se modificó la hoja de registros clínicos de enfermería de la unidad de hemodiálisis en dos etapas. Para la etapa de diseño se realizó un grupo focal con expertos y para la validación de contenido se aplicó el método Delphi. Los datos recolectados se procesaron y analizaron en el programa estadístico SPSS V.22. Resultados: El 70% de los expertos consideró el instrumento como bueno en cuanto a la calidad del registro. Hubo una discrepancia en el diseño encontrándose como parcialmente eficiente (70%) ya que cada experto evaluó de acuerdo al área que dominaba. Se incorporaron todas las observaciones realizadas en el diseño final. Conclusión: El instrumento se considera válido, proporcionando información adecuada del paciente previo al tratamiento hemodialítico, lo cual satisface los requerimientos legales respecto a la continuidad de los cuidados.
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18
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Horvath H, Brindis CD, Reyes EM, Yamey G, Franck L. Preterm birth: the role of knowledge transfer and exchange. Health Res Policy Syst 2017; 15:78. [PMID: 28874160 PMCID: PMC5586007 DOI: 10.1186/s12961-017-0238-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 08/03/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Preterm birth (PTB) is the leading cause of death in children under age five. Healthcare policy and other decision-making relevant to PTB may rely on obsolete, incomplete or inapplicable research evidence, leading to worsened outcomes. Appropriate knowledge transfer and exchange (KTE) strategies are an important component of efforts to reduce the global PTB burden. We sought to develop a 'landscape' analysis of KTE strategies currently used in PTB and related contexts, and to make recommendations for optimising programmatic implementation and for future research. METHODS In the University of California, San Francisco's Preterm Birth Initiative, we convened a multidisciplinary working group and examined KTE frameworks. After selecting a widely-used, adaptable, theoretically-strong framework we reviewed the literature to identify evidence-based KTE strategies. We analysed KTE approaches focusing on key PTB stakeholders (individuals, families and communities, healthcare providers and policymakers). Guided by the framework, we articulated KTE approaches that would likely improve PTB outcomes. We further applied the KTE framework in developing recommendations. RESULTS We selected the Linking Research to Action framework. Searches identified 19 systematic reviews, including two 'reviews of reviews'. Twelve reviews provided evidence for KTE strategies in the context of maternal, neonatal and child health, though not PTB specifically; seven reviews provided 'cross-cutting' evidence that could likely be generalised to PTB contexts. For individuals, families and communities, potentially effective KTE strategies include community-based approaches, 'decision aids', regular discussions with providers and other strategies. For providers, KTE outcomes may be improved through local opinion leaders, electronic reminders, multifaceted strategies and other approaches. Policy decisions relevant to PTB may best be informed through the use of evidence briefs, deliberative dialogues, the SUPPORT tools for evidence-informed policymaking and other strategies. Our recommendations for research addressed knowledge gaps in regard to partner engagement, applicability and context, implementation strategy research, monitoring and evaluation, and infrastructure for sustainable KTE efforts. CONCLUSIONS Evidence-based KTE, using strategies appropriate to each stakeholder group, is essential to any effort to improve health at the population level. PTB stakeholders should be fully engaged in KTE and programme planning from its earliest stages, and ideally before planning begins.
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Affiliation(s)
- Hacsi Horvath
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 Sixteenth Street, third floor, San Francisco, CA 94158 United States of America
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA United States of America
- Global Health Sciences, University of California, San Francisco, San Francisco, CA United States of America
| | - Claire D. Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA United States of America
- Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, CA United States of America
| | - E. Michael Reyes
- Department of Family and Community Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA United States of America
| | - Gavin Yamey
- Global Health Sciences, University of California, San Francisco, San Francisco, CA United States of America
- Present affiliation: Duke Global Health Institute, Duke University, Durham, NC United States of America
| | - Linda Franck
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA United States of America
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19
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Archambault PM, van de Belt TH, Kuziemsky C, Plaisance A, Dupuis A, McGinn CA, Francois R, Gagnon M, Turgeon AF, Horsley T, Witteman W, Poitras J, Lapointe J, Brand K, Lachaine J, Légaré F. Collaborative writing applications in healthcare: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2017; 5:CD011388. [PMID: 28489282 PMCID: PMC6481880 DOI: 10.1002/14651858.cd011388.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Collaborative writing applications (CWAs), such as wikis and Google Documents, hold the potential to improve the use of evidence in both public health and healthcare. Although a growing body of literature indicates that CWAs could have positive effects on healthcare, such as improved collaboration, behavioural change, learning, knowledge management, and adaptation of knowledge to local context, this has never been assessed systematically. Moreover, several questions regarding safety, reliability, and legal aspects exist. OBJECTIVES The objectives of this review were to (1) assess the effects of the use of CWAs on process (including the behaviour of healthcare professionals) and patient outcomes, (2) critically appraise and summarise current evidence on the use of resources, costs, and cost-effectiveness associated with CWAs to improve professional practices and patient outcomes, and (3) explore the effects of different CWA features (e.g. open versus closed) and different implementation factors (e.g. the presence of a moderator) on process and patient outcomes. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and 11 other electronic databases. We searched the grey literature, two trial registries, CWA websites, individual journals, and conference proceedings. We also contacted authors and experts in the field. We did not apply date or language limits. We searched for published literature to August 2016, and grey literature to September 2015. SELECTION CRITERIA We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-and-after (CBA) studies, interrupted time series (ITS) studies, and repeated measures studies (RMS), in which CWAs were used as an intervention to improve the process of care, patient outcomes, or healthcare costs. DATA COLLECTION AND ANALYSIS Teams of two review authors independently assessed the eligibility of studies. Disagreements were resolved by discussion, and when consensus was not reached, a third review author was consulted. MAIN RESULTS We screened 11,993 studies identified from the electronic database searches and 346 studies from grey literature sources. We analysed the full text of 99 studies. None of the studies met the eligibility criteria; two potentially relevant studies are ongoing. AUTHORS' CONCLUSIONS While there is a high number of published studies about CWAs, indicating that this is an active field of research, additional studies using rigorous experimental designs are needed to assess their impact and cost-effectiveness on process and patient outcomes.
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Affiliation(s)
- Patrick M Archambault
- Université LavalDepartment of Family Medicine and Emergency MedicineQuébec CityQCCanada
- Centre hospitalier affilié universitaire Hôtel‐Dieu de LévisCentre intégré de santé et de services sociaux de Chaudière‐AppalachesLévisQCCanada
- Université LavalPopulation Health and Optimal Health Practice Research Unit, CHU de Québec ‐ Université Laval Research Center, CHU de Québec ‐ Université LavalQuébec CityQCCanada
- Université LavalDepartment of Anesthesiology and Critical Care Medicine, Division of Critical Care MedicineQuébec CityQCCanada
| | - Tom H van de Belt
- Radboud University Medical CenterRadboud REshape Innovation CenterPostbus 91016500 HB NijmegenNijmegenNetherlands
| | - Craig Kuziemsky
- University of OttawaTelfer School of Management55 Laurier Avenue EastOttawaONCanadaK1N 6N5
| | - Ariane Plaisance
- Centre hospitalier affilié universitaire Hôtel‐Dieu de LévisCentre intégré de santé et de services sociaux de Chaudière‐AppalachesLévisQCCanada
| | - Audrey Dupuis
- Centre hospitalier affilié universitaire Hôtel‐Dieu de LévisCentre intégré de santé et de services sociaux de Chaudière‐AppalachesLévisQCCanada
- Université LavalDepartment of Information and Communication1055, avenue du SéminaireQuébec CityQCCanadaG1V0A6
| | - Carrie A McGinn
- Centre hospitalier affilié universitaire Hôtel‐Dieu de LévisCentre intégré de santé et de services sociaux de Chaudière‐AppalachesLévisQCCanada
| | - Rebecca Francois
- Centre hospitalier affilié universitaire Hôtel‐Dieu de LévisCentre intégré de santé et de services sociaux de Chaudière‐AppalachesLévisQCCanada
| | - Marie‐Pierre Gagnon
- Université LavalPopulation Health and Optimal Health Practice Research Unit, CHU de Québec ‐ Université Laval Research Center, CHU de Québec ‐ Université LavalQuébec CityQCCanada
- Université LavalFaculty of NursingQuébec CityQCCanada
| | - Alexis F Turgeon
- Université LavalPopulation Health and Optimal Health Practice Research Unit, CHU de Québec ‐ Université Laval Research Center, CHU de Québec ‐ Université LavalQuébec CityQCCanada
- Université LavalDepartment of Anesthesiology and Critical Care Medicine, Division of Critical Care MedicineQuébec CityQCCanada
| | - Tanya Horsley
- Royal College of Physicians and Surgeons of CanadaResearch Unit774 Echo DriveOttawaONCanadaK1S 5N8
| | - William Witteman
- Université LavalClinical and Evaluative Research Unit, CHU de Québec Research Center45 Leclerc ‐ Room D6‐729Québec CityQCCanadaG1L 3L5
| | - Julien Poitras
- Université LavalDepartment of Family Medicine and Emergency MedicineQuébec CityQCCanada
- Centre hospitalier affilié universitaire Hôtel‐Dieu de LévisCentre intégré de santé et de services sociaux de Chaudière‐AppalachesLévisQCCanada
- Université LavalPopulation Health and Optimal Health Practice Research Unit, CHU de Québec ‐ Université Laval Research Center, CHU de Québec ‐ Université LavalQuébec CityQCCanada
| | - Jean Lapointe
- Université LavalDepartment of Family Medicine and Emergency MedicineQuébec CityQCCanada
- Centre hospitalier affilié universitaire Hôtel‐Dieu de LévisCentre intégré de santé et de services sociaux de Chaudière‐AppalachesLévisQCCanada
| | - Kevin Brand
- University of OttawaTelfer School of Management55 Laurier Avenue EastOttawaONCanadaK1N 6N5
| | - Jean Lachaine
- Université de MontréalFaculty of PharmacyC.P. 6128, Succursale Centre‐villeMontréalQCCanadaH3C 3J7
| | - France Légaré
- Université LavalDepartment of Family Medicine and Emergency MedicineQuébec CityQCCanada
- Université LavalPopulation Health and Optimal Health Practice Research Unit, CHU de Québec ‐ Université Laval Research Center, CHU de Québec ‐ Université LavalQuébec CityQCCanada
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Rouleau G, Gagnon MP, Côté J, Payne-Gagnon J, Hudson E, Dubois CA. Impact of Information and Communication Technologies on Nursing Care: Results of an Overview of Systematic Reviews. J Med Internet Res 2017; 19:e122. [PMID: 28442454 PMCID: PMC5424122 DOI: 10.2196/jmir.6686] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/27/2017] [Accepted: 03/05/2017] [Indexed: 12/17/2022] Open
Abstract
Background Information and communication technologies (ICTs) are becoming an impetus for quality health care delivery by nurses. The use of ICTs by nurses can impact their practice, modifying the ways in which they plan, provide, document, and review clinical care. Objective An overview of systematic reviews was conducted to develop a broad picture of the dimensions and indicators of nursing care that have the potential to be influenced by the use of ICTs. Methods Quantitative, mixed-method, and qualitative reviews that aimed to evaluate the influence of four eHealth domains (eg, management, computerized decision support systems [CDSSs], communication, and information systems) on nursing care were included. We used the nursing care performance framework (NCPF) as an extraction grid and analytical tool. This model illustrates how the interplay between nursing resources and the nursing services can produce changes in patient conditions. The primary outcomes included nurses’ practice environment, nursing processes, professional satisfaction, and nursing-sensitive outcomes. The secondary outcomes included satisfaction or dissatisfaction with ICTs according to nurses’ and patients’ perspectives. Reviews published in English, French, or Spanish from January 1, 1995 to January 15, 2015, were considered. Results A total of 5515 titles or abstracts were assessed for eligibility and full-text papers of 72 articles were retrieved for detailed evaluation. It was found that 22 reviews published between 2002 and 2015 met the eligibility criteria. Many nursing care themes (ie, indicators) were influenced by the use of ICTs, including time management; time spent on patient care; documentation time; information quality and access; quality of documentation; knowledge updating and utilization; nurse autonomy; intra and interprofessional collaboration; nurses’ competencies and skills; nurse-patient relationship; assessment, care planning, and evaluation; teaching of patients and families; communication and care coordination; perspectives of the quality of care provided; nurses and patients satisfaction or dissatisfaction with ICTs; patient comfort and quality of life related to care; empowerment; and functional status. Conclusions The findings led to the identification of 19 indicators related to nursing care that are impacted by the use of ICTs. To the best of our knowledge, this was the first attempt to apply NCPF in the ICTs’ context. This broad representation could be kept in mind when it will be the time to plan and to implement emerging ICTs in health care settings. Trial Registration PROSPERO International Prospective Register of Systematic Reviews: CRD42014014762; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014014762 (Archived by WebCite at http://www.webcitation.org/6pIhMLBZh)
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Affiliation(s)
- Geneviève Rouleau
- Faculty of Nursing Sciences, Université Laval, Quebec, QC, Canada.,Research Center of the Centre Hospitalier de l'Université de Montréal, Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
| | - Marie-Pierre Gagnon
- Faculty of Nursing Sciences, Université Laval, Quebec, QC, Canada.,Research Centre of the Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada
| | - José Côté
- Research Center of the Centre Hospitalier de l'Université de Montréal, Research Chair in Innovative Nursing Practices, Montreal, QC, Canada.,Faculty of Nursing Sciences, Université de Montréal, Montreal, QC, Canada
| | - Julie Payne-Gagnon
- Research Centre of the Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada
| | - Emilie Hudson
- School of Nursing, McGill University, Montreal, QC, Canada
| | - Carl-Ardy Dubois
- Faculty of Nursing Sciences, Université de Montréal, Montreal, QC, Canada
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Triantafillou P. Making electronic health records support quality management: A narrative review. Int J Med Inform 2017; 104:105-119. [PMID: 28599812 DOI: 10.1016/j.ijmedinf.2017.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/05/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Since the 1990s many hospitals in the OECD countries have introduced electronic health record (EHR) systems. A number of studies have examined the factors impinging on EHR implementation. Others have studied the clinical efficacy of EHR. However, only few studies have explored the (intermediary) factors that make EHR systems conducive to quality management (QM). OBJECTIVE Undertake a narrative review of existing studies in order to identify and discuss the factors conducive to making EHR support three dimensions of QM: clinical outcomes, managerial monitoring and cost-effectiveness. METHOD A narrative review of Web of Science, Cochrane, EBSCO, ProQuest, Scopus and three Nordic research databases. LIMITATION most studies do not specify the type of EHR examined. RESULTS 39 studies were identified for analysis. 10 factors were found to be conducive to make EHR support QM. However, the contribution of EHR to the three specific dimensions of QM varied substantially. Most studies (29) included clinical outcomes. However, only half of these reported EHR to have a positive impact. Almost all the studies (36) dealt with the ability of EHR to enhance managerial monitoring of clinical activities, the far majority of which showed a positive relationship. Finally, only five dealt with cost-effectiveness of which two found positive effects. DISCUSSION AND CONCLUSION The findings resonates well with previous reviews, though two factors making EHR support QM seem new, namely: political goals and strategies, and integration of guidelines for clinical conduct. Lacking EHR type specification and diversity in study method imply that there is a strong need for further research on the factors that may make EHR may support QM.
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Soumerai SB, Ceccarelli R, Koppel R. False Dichotomies and Health Policy Research Designs: Randomized Trials Are Not Always the Answer. J Gen Intern Med 2017; 32:204-209. [PMID: 27757714 PMCID: PMC5264670 DOI: 10.1007/s11606-016-3841-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/13/2016] [Accepted: 07/29/2016] [Indexed: 11/28/2022]
Abstract
Some medical scientists argue that only data from randomized controlled trials (RCTs) are trustworthy. They claim data from natural experiments and administrative data sets are always spurious and cannot be used to evaluate health policies and other population-wide phenomena in the real world. While many acknowledge biases caused by poor study designs, in this article we argue that several valid designs using administrative data can produce strong findings, particularly the interrupted time series (ITS) design. Many policy studies neither permit nor require an RCT for cause-and-effect inference. Framing our arguments using Campbell and Stanley's classic research design monograph, we show that several "quasi-experimental" designs, especially interrupted time series (ITS), can estimate valid effects (or non-effects) of health interventions and policies as diverse as public insurance coverage, speed limits, hospital safety programs, drug abuse regulation and withdrawal of drugs from the market. We further note the recent rapid uptake of ITS and argue for expanded training in quasi-experimental designs in medical and graduate schools and in post-doctoral curricula.
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Affiliation(s)
- Stephen B Soumerai
- Harvard Medical School Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, MA, USA.
| | - Rachel Ceccarelli
- Harvard Medical School Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, MA, USA
| | - Ross Koppel
- Sociology Department & LDI Wharton & School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Keenan GM, Lopez KD, Sousa VEC, Stifter J, Macieira TGR, Boyd AD, Yao Y, Herdman TH, Moorhead S, McDaniel A, Wilkie DJ. A Shovel-Ready Solution to Fill the Nursing Data Gap in the Interdisciplinary Clinical Picture. Int J Nurs Knowl 2017; 29:49-58. [PMID: 28093877 DOI: 10.1111/2047-3095.12168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/05/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE To critically evaluate 2014 American Academy of Nursing (AAN) call-to-action plan for generating interoperable nursing data. DATA SOURCES Healthcare literature. DATA SYNTHESIS AAN's plan will not generate the nursing data needed to participate in big data science initiatives in the short term because Logical Observation Identifiers Names and Codes and Systematized Nomenclature of Medicine - Clinical Terms are not yet ripe for generating interoperable data. Well-tested viable alternatives exist. CONCLUSIONS Authors present recommendations for revisions to AAN's plan and an evidence-based alternative to generating interoperable nursing data in the near term. These revisions can ultimately lead to the proposed terminology goals of the AAN's plan in the long term.
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Affiliation(s)
- Gail M Keenan
- College of Nursing, University of Florida, Gainesville, Florida
| | - Karen Dunn Lopez
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Vanessa E C Sousa
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Janet Stifter
- American Organization of Nurse Executives, American Hospital Association, Chicago, Illinois
| | - Tamara G R Macieira
- College of Nursing, University of Florida, Gainesville, Gainesville, Florida
| | - Andrew D Boyd
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Yingwei Yao
- College of Nursing, University of Florida, Gainesville, Gainesville, Florida
| | - T Heather Herdman
- NANDA International and University of Wisconsin-Green Bay, Green Bay, Wisconsin
| | - Sue Moorhead
- Nursing Classification Center, College of Nursing, University of Iowa, Iowa City, Iowa
| | - Anna McDaniel
- College of Nursing, University of Florida, Gainesville, Gainesville, Florida
| | - Diana J Wilkie
- College of Nursing, University of Florida, Gainesville, Gainesville, Florida
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Chauhan BF, Jeyaraman MM, Mann AS, Lys J, Skidmore B, Sibley KM, Abou-Setta AM, Zarychanski R. Behavior change interventions and policies influencing primary healthcare professionals' practice-an overview of reviews. Implement Sci 2017; 12:3. [PMID: 28057024 PMCID: PMC5216570 DOI: 10.1186/s13012-016-0538-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/13/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is a plethora of interventions and policies aimed at changing practice habits of primary healthcare professionals, but it is unclear which are the most appropriate, sustainable, and effective. We aimed to evaluate the evidence on behavior change interventions and policies directed at healthcare professionals working in primary healthcare centers. METHODS Study design: overview of reviews. DATA SOURCE MEDLINE (Ovid), Embase (Ovid), The Cochrane Library (Wiley), CINAHL (EbscoHost), and grey literature (January 2005 to July 2015). STUDY SELECTION two reviewers independently, and in duplicate, identified systematic reviews, overviews of reviews, scoping reviews, rapid reviews, and relevant health technology reports published in full-text in the English language. DATA EXTRACTION AND SYNTHESIS two reviewers extracted data pertaining to the types of reviews, study designs, number of studies, demographics of the professionals enrolled, interventions, outcomes, and authors' conclusions for the included studies. We evaluated the methodological quality of the included studies using the AMSTAR scale. For the comparative evaluation, we classified interventions according to the behavior change wheel (Michie et al.). RESULTS Of 2771 citations retrieved, we included 138 reviews representing 3502 individual studies. The majority of systematic reviews (91%) investigated behavior and practice changes among family physicians. Interactive and multifaceted continuous medical education programs, training with audit and feedback, and clinical decision support systems were found to be beneficial in improving knowledge, optimizing screening rate and prescriptions, enhancing patient outcomes, and reducing adverse events. Collaborative team-based policies involving primarily family physicians, nurses, and pharmacists were found to be most effective. Available evidence on environmental restructuring and modeling was found to be effective in improving collaboration and adherence to treatment guidelines. Limited evidence on nurse-led care approaches were found to be as effective as general practitioners in patient satisfaction in settings like asthma, cardiovascular, and diabetes clinics, although this needs further evaluation. Evidence does not support the use of financial incentives to family physicians, especially for long-term behavior change. CONCLUSIONS Behavior change interventions including education, training, and enablement in the context of collaborative team-based approaches are effective to change practice of primary healthcare professionals. Environmental restructuring approaches including nurse-led care and modeling need further evaluation. Financial incentives to family physicians do not influence long-term practice change.
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Affiliation(s)
- Bhupendrasinh F Chauhan
- College of Pharmacy, University of Manitoba, Winnipeg, Canada.
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.
| | - Maya M Jeyaraman
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | | | - Justin Lys
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | | | - Kathryn M Sibley
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ahmed M Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ryan Zarychanski
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Haematology and Medical Oncology, CancerCare Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
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Jung D, Kim JH. Effects of a sexual health care nursing record on the attitudes and practice of oncology nurses. SEXUAL & REPRODUCTIVE HEALTHCARE 2016; 9:21-6. [DOI: 10.1016/j.srhc.2016.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 06/11/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
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Lindo J, Stennett R, Stephenson-Wilson K, Barrett KA, Bunnaman D, Anderson-Johnson P, Waugh-Brown V, Wint Y. An Audit of Nursing Documentation at Three Public Hospitals in Jamaica. J Nurs Scholarsh 2016; 48:499-507. [PMID: 27459736 DOI: 10.1111/jnu.12234] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE Nursing documentation provides an important indicator of the quality of care provided for hospitalized patients. This study assessed the quality of nursing documentation on medical wards at three hospitals in Jamaica. METHODS This cross-sectional study audited a multilevel stratified sample of 245 patient records from three type B hospitals. An audit instrument which assessed nursing documentation of client history, biological data, client assessment, nursing standards, discharge planning, and teaching facilitated data collection. Descriptive statistics were conducted using IBM SPSS, Version 19 (IBM Inc., Armonk, NY, USA). FINDINGS Records from three hospitals (Hospital 1, n = 119, 48.6%; Hospital 2, n = 56, 22.9%; Hospital 3, n = 70, 28.6%) were audited. Documented evidence of the patient's chief complaint (81.6%), history of present illness (78.8%), past health (79.2%), and family health (11.0%) were noted; however, less than a third of the dockets audited recorded adequate assessment data (e.g., occupation or living accommodations of patients). The audit noted 90% of records had a physical assessment completed within 24 hr of admission and entries timed, dated, and signed by a nurse. Less than 5% of dockets had evidence of patient teaching, and 13.5% had documented evidence of discharge planning conducted within 72 hr of admission. CONCLUSIONS This study highlights the weakness in nursing documentation and the need for increased training and continued monitoring of nursing documentation at the hospitals studied. Additional research regarding the factors that affect nursing documentation practice could prove useful. CLINICAL RELEVANCE The study provides valuable information for the development of strategic risk management programs geared at improving the quality of care delivered to clients and presents an opportunity for nurse leaders to implement structured interventions geared at improving nursing documentation in Jamaica. In light of Jamaica's epidemiologic transition of chronic diseases, gaps in nurses' documentation of client assessment, patient teaching, and discharge planning should be addressed with urgency. Patient teaching and discharge planning enable the clients to participate more effectively in their health maintenance process.
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Affiliation(s)
- Jascinth Lindo
- Lecturer, The University of the West Indies School of Nursing, Mona Kingston, Jamacia and Barry University, Miami, FL, USA. ,
| | - Rosain Stennett
- Research Assistant, The University of the West Indies School of Nursing, Mona, Kingston, Jamaica
| | | | | | - Donna Bunnaman
- Campus Director, Browns Town Community College, Saint Ann, Jamaica
| | | | - Veronica Waugh-Brown
- Assistant Lecturer, The University of the West Indies School of Nursing, Mona, Saint James, Jamaica
| | - Yvonne Wint
- Lecturer, The University of the West Indies School of Nursing, Mona, Saint James, Jamaica
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Mapping communication spaces: The development and use of a tool for analyzing the impact of EHRs on interprofessional collaborative practice. Int J Med Inform 2016; 93:2-13. [PMID: 27435942 DOI: 10.1016/j.ijmedinf.2016.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Members of the healthcare team must access and share patient information to coordinate interprofessional collaborative practice (ICP). Although some evidence suggests that electronic health records (EHRs) contribute to in-team communication breakdowns, EHRs are still widely hailed as tools that support ICP. If EHRs are expected to promote ICP, researchers must be able to longitudinally study the impact of EHRs on ICP across communication types, users, and physical locations. OBJECTIVE This paper presents a data collection and analysis tool, named the Map of the Clinical Interprofessional Communication Spaces (MCICS), which supports examining how EHRs impact ICP over time, and across communication types, users, and physical locations. METHODS The tool's development evolved during a large prospective longitudinal study conducted at a Canadian pediatric academic tertiary-care hospital. This two-phased study [i.e., pre-implementation (phase 1) and post implementation (phase 2)] of an EHR employed a constructivist grounded theory approach and triangulated data collection strategies (i.e., non-participant observations, interviews, think-alouds, and document analysis). The MCICS was created through a five-step process: (i) preliminary structural development based on the use of the paper-based chart (phase 1); (ii) confirmatory review and modification process (phase 1); (iii) ongoing data collection and analysis facilitated by the map (phase 1); (iv) data collection and modification of map based on impact of EHR (phase 2); and (v) confirmatory review and modification process (phase 2). RESULTS Creating and using the MCICS enabled our research team to locate, observe, and analyze the impact of the EHR on ICP, (a) across oral, electronic, and paper communications, (b) through a patient's passage across different units in the hospital, (c) across the duration of the patient's stay in hospital, and (d) across multiple healthcare providers. By using the MCICS, we captured a comprehensive, detailed picture of the clinical milieu in which the EHR was implemented, and of the intended and unintended consequences of the EHR's deployment. The map supported our observations and analysis of ICP communication spaces, and of the role of the patient chart in these spaces. CONCLUSIONS If EHRs are expected to help resolve ICP challenges, it is important that researchers be able to longitudinally assess the impact of EHRs on ICP across multiple modes of communication, users, and physical locations. Mapping the clinical communication spaces can help EHR designers, clinicians, educators and researchers understand these spaces, appreciate their complexity, and navigate their way towards effective use of EHRs as means for supporting ICP. We propose that the MCICS can be used "as is" in other academic tertiary-care pediatric hospitals, and can be tailored for use in other healthcare institutions.
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Munroe B, Curtis K, Murphy M, Strachan L, Considine J, Hardy J, Wilson M, Ruperto K, Fethney J, Buckley T. A structured framework improves clinical patient assessment and nontechnical skills of early career emergency nurses: a pre-post study using full immersion simulation. J Clin Nurs 2016; 25:2262-74. [PMID: 27135203 DOI: 10.1111/jocn.13284] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2016] [Indexed: 12/18/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to evaluate the effect of the new evidence-informed nursing assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) on the quality of patient assessment and fundamental nontechnical skills including communication, decision making, task management and situational awareness. BACKGROUND Assessment is a core component of nursing practice and underpins clinical decisions and the safe delivery of patient care. Yet there is no universal or validated system used to teach emergency nurses how to comprehensively assess and care for patients. DESIGN A pre-post design was used. METHODS The performance of thirty eight emergency nurses from five Australian hospitals was evaluated before and after undertaking education in the application of the HIRAID assessment framework. Video recordings of participant performance in immersive simulations of common presentations to the emergency department were evaluated, as well as participant documentation during the simulations. Paired parametric and nonparametric tests were used to compare changes from pre to postintervention. RESULTS From pre to postintervention, participant performance increases were observed in the percentage of patient history elements collected, critical indicators of urgency collected and reported to medical officers, and patient reassessments performed. Participants also demonstrated improvement in each of the four nontechnical skills categories: communication, decision making, task management and situational awareness. CONCLUSION The HIRAID assessment framework improves clinical patient assessments performed by emergency nurses and has the potential to enhance patient care. RELEVANCE TO CLINICAL PRACTICE HIRAID should be considered for integration into clinical practice to provide nurses with a systematic approach to patient assessment and potentially improve the delivery of safe patient care.
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Affiliation(s)
- Belinda Munroe
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia.,Emergency Department, The Wollongong Hospital, Wollongong, NSW, Australia
| | - Kate Curtis
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia.,Emergency Department, The Wollongong Hospital, Wollongong, NSW, Australia.,Trauma Service, St George Hospital, Sydney, NSW, Australia
| | - Margaret Murphy
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia.,Emergency Department, Westmead Hospital, Westmead, NSW, Australia
| | - Luke Strachan
- Emergency Department, Blacktown Hospital, Blacktown, NSW, Australia
| | - Julie Considine
- School of Nursing and Midwifery/Eastern Health, Deakin University, Geelong, Vic., Australia
| | - Jennifer Hardy
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
| | - Mark Wilson
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Kate Ruperto
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Judith Fethney
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
| | - Thomas Buckley
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
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Törnvall E, Jansson I. Preliminary Evidence for the Usefulness of Standardized Nursing Terminologies in Different Fields of Application: A Literature Review. Int J Nurs Knowl 2015; 28:109-119. [DOI: 10.1111/2047-3095.12123] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Eva Törnvall
- Research and Development Unit for Local Health Care; Linköping Sweden
- Faculty of Health Sciences; Linköping University; Linköping Sweden
| | - Inger Jansson
- Institute of Health and Care Sciences; University of Gothenburg; Gothenburg Sweden
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Soumerai SB, Starr D, Majumdar SR. How Do You Know Which Health Care Effectiveness Research You Can Trust? A Guide to Study Design for the Perplexed. Prev Chronic Dis 2015; 12:E101. [PMID: 26111157 PMCID: PMC4492215 DOI: 10.5888/pcd12.150187] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Stephen B Soumerai
- Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Ave, 6th Floor, Boston, MA 02215. . Dr Soumerai is also co-chair of the Evaluative Sciences and Statistics Concentration of Harvard University's PhD Program in Health Policy
| | - Douglas Starr
- College of Communication, Science Journalism Program, Boston University, Boston, Massachusetts
| | - Sumit R Majumdar
- Medicine and Dentistry and Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta
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Impacts of information and communication technologies on nursing care: an overview of systematic reviews (protocol). Syst Rev 2015; 4:75. [PMID: 26002726 PMCID: PMC4449960 DOI: 10.1186/s13643-015-0062-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 05/15/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Information and communication technologies (ICTs) used in the health sector have well-known advantages. They can promote patient-centered healthcare, improve quality of care, and educate health professionals and patients. However, implementation of ICTs remains difficult and involves changes at different levels: patients, healthcare providers, and healthcare organizations. Nurses constitute the largest health provider group of the healthcare workforce. The use of ICTs by nurses can have impacts in their practice. The main objective of this review of systematic reviews is to systematically summarize the best evidence regarding the effects of ICTs on nursing care. METHODS/DESIGN We will include all types of reviews that aim to evaluate the influence of ICTs used by nurses on nursing care. We will consider four types of ICTs used by nurses as a way to provide healthcare: management systems, communication systems, information systems, and computerized decision support systems. We will exclude nursing management systems, educational systems, and telephone systems. The following types of comparisons will be carried out: ICT in comparison with usual care/practice, ICT compared to any other ICT, and ICT versus other types of interventions. The primary outcomes will include nurses' practice environment, nursing processes/scope of nursing practice, nurses' professional satisfaction as well as nursing sensitive outcomes, such as patient safety, comfort, and quality of life related to care, empowerment, functional status, satisfaction, and patient experience. Secondary outcomes will include satisfaction with ICT from the nurses and patients' perspective. Reviews published in English, French, or Spanish from 1 January 1995 will be considered. Two reviewers will independently screen the title and abstract of the papers in order to assess their eligibility and extract the following information: characteristics of the population and setting, type of interventions (e.g., type of ICTs and service provided), comparisons, outcomes, and review limitations. Any disagreements will be resolved by discussion and consensus involving the two reviewers or will involve a third review author, if needed. DISCUSSION This overview is an interesting starting point from which to compare and contrast findings of separate reviews regarding the positive and negative effects of ICTs on nursing care. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014014762.
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Implementation of Free Text Format Nursing Diagnoses at a University Hospital's Medical Department. Exploring Nurses' and Nursing Students' Experiences on Use and Usefulness. A Qualitative Study. Nurs Res Pract 2015; 2015:179275. [PMID: 26075091 PMCID: PMC4444573 DOI: 10.1155/2015/179275] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/23/2015] [Indexed: 11/30/2022] Open
Abstract
Background. Nursing documentation has long traditions and represents core element of nursing, but the documentation is often criticized of being incomplete. Nursing diagnoses are an important research topic in nursing in terms of quality of nursing assessment, interventions, and outcome in addition to facilitating communication and continuity. Aim. The aim of this study was to explore the nurses' and nursing students' experiences after implementing free text format nursing diagnoses in a medical department. Method. The study design included educational intervention of free text nursing diagnoses. Data was collected through five focus group interviews with 18 nurses and 6 students as informants. The data was analyzed using qualitative content analysis. Results. The informants describe positive experiences concerning free text format nursing diagnoses' use and usefulness; it promotes reflection and discussion and is described as a useful tool in the diagnostic process, though it was challenging to find the diagnosis' appropriate formulation. Conclusion. Our findings indicate a valid usability of free text format nursing diagnoses as it promotes the diagnostic process. The use seems to enhance critical thinking and may serve as valuable preparation towards an implementation of standardized nursing diagnoses. Use and support of key personnel seem valuable in an implementation process.
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Pokorná A, Leaper D. Assessment and documentation of non-healing, chronic wounds in inpatient health care facilities in the Czech Republic: an evaluation study. Int Wound J 2015; 12:224-31. [PMID: 25224308 PMCID: PMC7950913 DOI: 10.1111/iwj.12372] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/05/2014] [Accepted: 08/25/2014] [Indexed: 01/22/2023] Open
Abstract
The foundation of health care management of patients with non-healing, chronic wounds needs accurate evaluation followed by the selection of an appropriate therapeutic strategy. Assessment of non-healing, chronic wounds in clinical practice in the Czech Republic is not standardised. The aim of this study was to analyse the methods being used to assess non-healing, chronic wounds in inpatient facilities in the Czech Republic. The research was carried out at 77 inpatient medical facilities (8 university/faculty hospitals, 63 hospitals and 6 long- term hospitals) across all regions of the Czech Republic. A mixed model was used for the research (participatory observation including creation of field notes and content analysis of documents for documentation and analysis of qualitative and quantitative data). The results of this research have corroborated the suspicion of inconsistencies in procedures used by general nurses for assessment of non-healing, chronic wounds. However, the situation was found to be more positive with regard to evaluation of basic/fundamental parameters of a wound (e.g. size, depth and location of a wound) compared with the evaluation of more specific parameters (e.g. exudate or signs of infection). This included not only the number of observed variables, but also the action taken. Both were significantly improved when a consultant for wound healing was present (P = 0·047). The same applied to facilities possessing a certificate of quality issued by the Czech Wound Management Association (P = 0·010). In conclusion, an effective strategy for wound management depends on the method and scope of the assessment of non-healing, chronic wounds in place in clinical practice in observed facilities; improvement may be expected following the general introduction of a 'non-healing, chronic wound assessment' algorithm.
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Affiliation(s)
- Andrea Pokorná
- Department of Nursing, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Wu MW, Lee TT, Tsai TC, Huang CY, Fu-Sheng Wu F, Mills ME. Evaluation of a Mobile Station Electronic Health Record on Documentation Compliance and Nurses’ Attitudes. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojn.2015.57071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ridgway L, Mitchell C, Sheean F. Information and communication technology (ICT) use in child and family nursing: What do we know and where to now? Contemp Nurse 2014; 40:118-29. [DOI: 10.5172/conu.2011.40.1.118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Archambault PM, van de Belt TH, Faber MJ, Plaisance A, Kuziemsky C, Gagnon MP, Turgeon A, Aubin K, Poitras J, Horsley T, Lapointe J, Brand K, Witteman W, Lachaine J, Légaré F. Collaborative writing applications in healthcare: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2014. [DOI: 10.1002/14651858.cd011388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Instefjord MH, Aasekjær K, Espehaug B, Graverholt B. Assessment of quality in psychiatric nursing documentation - a clinical audit. BMC Nurs 2014; 13:32. [PMID: 25349532 PMCID: PMC4207848 DOI: 10.1186/1472-6955-13-32] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 10/03/2014] [Indexed: 11/24/2022] Open
Abstract
Background Quality in nursing documentation facilitates continuity of care and patient safety. Lack of communication between healthcare providers is associated with errors and adverse events. Shortcomings are identified in nursing documentation in several clinical specialties, but very little is known about the quality of how nurses document in the field of psychiatry. Therefore, the aim of this study was to assess the quality of the written nursing documentation in a psychiatric hospital. Method A cross-sectional, retrospective patient record review was conducted using the N-Catch audit instrument. In 2011 the nursing documentation from 21 persons admitted to a psychiatric department from September to December 2010 was assessed. The N-Catch instrument was used to audit the record structure, admission notes, nursing care plans, progress and outcome reports, discharge notes and information about the patients’ personal details. The items of N-Catch were scored for quantity and/or quality (0–3 points). Results The item ‘quantity of progress and evaluation notes’ had the lowest score: in 86% of the records progress and outcome were evaluated only sporadically. The items ‘the patients’ personal details’ and ‘quantity of record structure’ had the highest scores: respectively 100% and 71% of the records achieved the highest score of these items. Conclusions Deficiencies in nursing documentation identified in other clinical specialties also apply to the clinical field of psychiatry. The quality of electronic written nursing documentation in psychiatric nursing needs improvements to ensure continuity and patient safety. This study shows the importance of the existence of a validated tool, readily available to assess local levels of nursing documentation quality.
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Affiliation(s)
| | - Katrine Aasekjær
- Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway
| | - Birgitte Espehaug
- Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway
| | - Birgitte Graverholt
- Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway
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Ritmala-Castren M, Axelin A, Kiljunen K, Sainio C, Leino-Kilpi H. Sleep in the intensive care unit - nurses' documentation and patients' perspectives. Nurs Crit Care 2014; 22:238-246. [DOI: 10.1111/nicc.12102] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 02/12/2014] [Accepted: 04/08/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Marita Ritmala-Castren
- Department of Nursing Science, University of Turku, and Clinical nurse consultant, Department of Surgery/Critical Care Clinic; Helsinki University Hospital; Helsinki Finland
| | - Anna Axelin
- Department of Nursing Science; University of Turku; Turun Yliopisto Finland
| | | | - Carita Sainio
- Department of surgery; Helsinki University Hospital; Helsinki Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science; University of Turku, Finland and Nurse Manager, Turku University Hospital; Turku Finland
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Meißner A, Schnepp W. Staff experiences within the implementation of computer-based nursing records in residential aged care facilities: a systematic review and synthesis of qualitative research. BMC Med Inform Decis Mak 2014; 14:54. [PMID: 24947420 PMCID: PMC4114165 DOI: 10.1186/1472-6947-14-54] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 06/06/2014] [Indexed: 11/29/2022] Open
Abstract
Background Since the introduction of electronic nursing documentation systems, its implementation in recent years has increased rapidly in Germany. The objectives of such systems are to save time, to improve information handling and to improve quality. To integrate IT in the daily working processes, the employee is the pivotal element. Therefore it is important to understand nurses’ experience with IT implementation. At present the literature shows a lack of understanding exploring staff experiences within the implementation process. Methods A systematic review and meta-ethnographic synthesis of primary studies using qualitative methods was conducted in PubMed, CINAHL, and Cochrane. It adheres to the principles of the PRISMA statement. The studies were original, peer-reviewed articles from 2000 to 2013, focusing on computer-based nursing documentation in Residential Aged Care Facilities. Results The use of IT requires a different form of information processing. Some experience this new form of information processing as a benefit while others do not. The latter find it more difficult to enter data and this result in poor clinical documentation. Improvement in the quality of residents’ records leads to an overall improvement in the quality of care. However, if the quality of those records is poor, some residents do not receive the necessary care. Furthermore, the length of time necessary to complete the documentation is a prominent theme within that process. Those who are more efficient with the electronic documentation demonstrate improved time management. For those who are less efficient with electronic documentation the information processing is perceived as time consuming. Normally, it is possible to experience benefits when using IT, but this depends on either promoting or hindering factors, e.g. ease of use and ability to use it, equipment availability and technical functionality, as well as attitude. Conclusions In summary, the findings showed that members of staff experience IT as a benefit when it simplifies their daily working routines and as a burden when it complicates their working processes. Whether IT complicates or simplifies their routines depends on influencing factors. The line between benefit and burden is semipermeable. The experiences differ according to duties and responsibilities.
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Affiliation(s)
- Anne Meißner
- Department of Nursing Science, University Witten/Herdecke, Witten, Germany.
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Nair M, Yoshida S, Lambrechts T, Boschi-Pinto C, Bose K, Mason EM, Mathai M. Facilitators and barriers to quality of care in maternal, newborn and child health: a global situational analysis through metareview. BMJ Open 2014; 4:e004749. [PMID: 24852300 PMCID: PMC4039842 DOI: 10.1136/bmjopen-2013-004749] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 04/10/2014] [Accepted: 05/02/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Conduct a global situational analysis to identify the current facilitators and barriers to improving quality of care (QoC) for pregnant women, newborns and children. STUDY DESIGN Metareview of published and unpublished systematic reviews and meta-analyses conducted between January 2000 and March 2013 in any language. Assessment of Multiple Systematic Reviews (AMSTAR) is used to assess the methodological quality of systematic reviews. SETTINGS Health systems of all countries. Study outcome: QoC measured using surrogate indicators--effective, efficient, accessible, acceptable/patient centred, equitable and safe. ANALYSIS Conducted in two phases (1) qualitative synthesis of extracted data to identify and group the facilitators and barriers to improving QoC, for each of the three population groups, into the six domains of WHO's framework and explore new domains and (2) an analysis grid to map the common facilitators and barriers. RESULTS We included 98 systematic reviews with 110 interventions to improve QoC from countries globally. The facilitators and barriers identified fitted the six domains of WHO's framework--information, patient-population engagement, leadership, regulations and standards, organisational capacity and models of care. Two new domains, 'communication' and 'satisfaction', were generated. Facilitators included active and regular interpersonal communication between users and providers; respect, confidentiality, comfort and support during care provision; engaging users in decision-making; continuity of care and effective audit and feedback mechanisms. Key barriers identified were language barriers in information and communication; power difference between users and providers; health systems not accounting for user satisfaction; variable standards of implementation of standard guidelines; shortage of resources in health facilities and lack of studies assessing the role of leadership in improving QoC. These were common across the three population groups. CONCLUSIONS The barriers to good-quality healthcare are common for pregnant women, newborns and children; thus, interventions targeted to address them will have uniform beneficial effects. Adopting the identified facilitators would help countries strengthen their health systems and ensure high-quality care for all.
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Affiliation(s)
- Manisha Nair
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Sachiyo Yoshida
- Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Thierry Lambrechts
- Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Cynthia Boschi-Pinto
- Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Krishna Bose
- Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Elizabeth Mary Mason
- Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Matthews Mathai
- Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland
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Min YH, Park HA, Chung E, Lee H. Implementation of a next-generation electronic nursing records system based on detailed clinical models and integration of clinical practice guidelines. Healthc Inform Res 2014; 19:301-6. [PMID: 24523995 PMCID: PMC3920043 DOI: 10.4258/hir.2013.19.4.301] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/06/2013] [Accepted: 12/18/2013] [Indexed: 11/23/2022] Open
Abstract
Objectives The purpose of this paper is to describe the components of a next-generation electronic nursing records system ensuring full semantic interoperability and integrating evidence into the nursing records system. Methods A next-generation electronic nursing records system based on detailed clinical models and clinical practice guidelines was developed at Seoul National University Bundang Hospital in 2013. This system has two components, a terminology server and a nursing documentation system. Results The terminology server manages nursing narratives generated from entity-attribute-value triplets of detailed clinical models using a natural language generation system. The nursing documentation system provides nurses with a set of nursing narratives arranged around the recommendations extracted from clinical practice guidelines. Conclusions An electronic nursing records system based on detailed clinical models and clinical practice guidelines was successfully implemented in a hospital in Korea. The next-generation electronic nursing records system can support nursing practice and nursing documentation, which in turn will improve data quality.
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Affiliation(s)
- Yul Ha Min
- College of Nursing, Seoul National University, Seoul, Korea. ; Research Institute of Nursing Science, Seoul National University, Seoul, Korea
| | - Hyeoun-Ae Park
- College of Nursing, Seoul National University, Seoul, Korea. ; Systems Biomedical Informatics Research Center, Seoul National University, Seoul, Korea
| | - Eunja Chung
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyunsook Lee
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Korea
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Hyppönen H, Saranto K, Vuokko R, Mäkelä-Bengs P, Doupi P, Lindqvist M, Mäkelä M. Impacts of structuring the electronic health record: a systematic review protocol and results of previous reviews. Int J Med Inform 2013; 83:159-69. [PMID: 24374018 DOI: 10.1016/j.ijmedinf.2013.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 11/27/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE This paper (1) presents the protocol of an on-going systematic literature review on the methods of structuring electronic health record (EHR) data and studying the impacts of implemented structures, thus laying basis for the analysis of the empirical articles (2) describes previous reviews published on the subject and retrieved during the search of bibliographic databases, and (3) presents a summary of the results of previous reviews. METHODS Cochrane instructions were exploited to outline the review protocol - phases and search elements. Test searches were conducted to refine the search. The abstracts and/or full texts of review papers captured by the search were read by two of the team members independently, with disagreements first negotiated between them and if necessary eventually resolved in the team meetings. Additional review articles were picked from the reference lists of the reviews included in our search results. The elements defined in the search strategy and analytic framework were converted to a data extraction tool, which was tested by extracting data from the reviews captured by the search. Descriptive analysis of the extracted data was conducted. RESULTS The 12-stage review protocol that we developed includes definition of the problem, the search strategy and search terms, testing the strategy, conducting the search, updating search from references found, removing duplicates, defining the inclusion and exclusion criteria, exclusion and inclusion of papers, definition of the analytic framework to extract data, extracting data and reporting results. Our searches in fifteen electronic bibliographic databases retrieved 27 reviews, of which 14 were included for full text analysis. Of these, 11 focused on medical and three on nursing record structures. The data structures included forms, ontologies, classifications and terminologies. Some evidence was found on data structure impact on information quality, process quality and efficiency, but not on patients or professionals. CONCLUSIONS The 12 step review protocol resulted in a variety of reviews of different ways to structure EHR data. None of them compared outcomes of different structuring methods; all had a narrower definition of the Intervention (a specific EHR structure) and Outcome (a specific impact category). Several reviews missed a clear connection between the data structures (interventions) and outcomes, indicating that the methods and applications for structuring patient data have rarely been viewed as independent variables. The review protocol should be defined in a manner that allows replication of the review. There are different ways of structuring patient data with varying impacts, which should be distinguished in further empirical studies, as well as reviews.
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Affiliation(s)
- Hannele Hyppönen
- Institute for Health and Welfare (THL), Department of Information, PB 30, 00271 Helsinki, Finland.
| | | | - Riikka Vuokko
- Institute for Health and Welfare (THL), Department of Information, PB 30, 00271 Helsinki, Finland
| | - Päivi Mäkelä-Bengs
- Institute for Health and Welfare (THL), Department of Information, PB 30, 00271 Helsinki, Finland
| | - Persephone Doupi
- Institute for Health and Welfare (THL), Department of Information, PB 30, 00271 Helsinki, Finland
| | - Minna Lindqvist
- Institute for Health and Welfare (THL), Department of Information, PB 30, 00271 Helsinki, Finland
| | - Marjukka Mäkelä
- Institute for Health and Welfare (THL), Service System Department, Finland
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Bruylands M, Paans W, Hediger H, Müller-Staub M. Effects on the Quality of the Nursing Care Process Through an Educational Program and the Use of Electronic Nursing Documentation. Int J Nurs Knowl 2013; 24:163-70. [DOI: 10.1111/j.2047-3095.2013.01248.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Wolter Paans
- University of Applied Sciences, Hanzehogeschool; Groningen
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Breimaier HE, Halfens RJG, Wilborn D, Meesterberends E, Haase Nielsen G, Lohrmann C. Implementation Interventions Used in Nursing Homes and Hospitals: A Descriptive, Comparative Study between Austria, Germany, and The Netherlands. ISRN NURSING 2013; 2013:706054. [PMID: 23956875 PMCID: PMC3727135 DOI: 10.1155/2013/706054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 06/23/2013] [Indexed: 11/17/2022]
Abstract
Translating guidelines into nursing practice remains a considerable challenge. Until now, little attention has been paid to which interventions are used in practice to implement guidelines on changing clinical nursing practice. This cross-sectional study determined the current ranges and rates of implementation-related interventions in Austria, Germany, and The Netherlands and explored possible differences between these countries. An online questionnaire based on the conceptual framework of implementation interventions (professional, organizational, financial, and regulatory) from the Cochrane Effective Practice and Organization of Care (EPOC) data collection checklist was used to gather data from nursing homes and hospitals. Provision of written materials is the most frequently used professional implementation intervention (85%), whereas changes in the patient record system rank foremost among organisational interventions (78%). Financial incentives for nurses are rarely used. More interventions were used in Austria and Germany than in The Netherlands (20.3/20.2/17.3). Professional interventions are used more frequently in Germany and financial interventions more frequently in The Netherlands. Implementation efforts focus mainly on professional and organisational interventions. Nurse managers and other responsible personnel should direct their focus to a broader array of implementation interventions using the four different categories of EPOC's conceptual framework.
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Affiliation(s)
- Helga E. Breimaier
- Institute of Nursing Science, Medical University of Graz, Billrothgaße 6, 8010 Graz, Austria
| | - Ruud J. G. Halfens
- Department of Health Services Research Focusing on Chronic Care and Ageing, Section of Nursing Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Doris Wilborn
- Department of Nursing and Management, Faculty of Business & Social Sciences, Hamburg University of Applied Sciences, Alexanderstraße 1, 20099 Hamburg, Germany
| | - Esther Meesterberends
- Department of Health Services Research Focusing on Chronic Care and Ageing, Section of Nursing Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Gunnar Haase Nielsen
- Department of Nursing and Health Sciences, Protestant University of Applied Sciences, Zweifalltorweg 12, 64293 Darmstadt, Germany
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Billrothgaße 6, 8010 Graz, Austria
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Munroe B, Curtis K, Considine J, Buckley T. The impact structured patient assessment frameworks have on patient care: an integrative review. J Clin Nurs 2013; 22:2991-3005. [PMID: 23656285 DOI: 10.1111/jocn.12226] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2012] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To evaluate structured patient assessment frameworks' impact on patient care. BACKGROUND Accurate patient assessment is imperative to determine the status and needs of the patient and the delivery of appropriate patient care. Nurses must be highly skilled in conducting timely and accurate patient assessments to overcome environmental obstacles and deliver quality and safe patient care. A structured approach to patient assessment is widely accepted in everyday clinical practice, yet little is known about the impact structured patient assessment frameworks have on patient care. DESIGN Integrative review. METHODS An electronic database search was conducted using Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System, PubMed and ProQuest Dissertations and Theses. The reference sections of textbooks and journal articles on patient assessment were manually searched for further studies. A comprehensive peer review screening process was undertaken. Research studies were selected that evaluated the impact structured patient assessment frameworks have on patient care. Studies were included if frameworks were designed for use by paramedics, nurses or medical practitioners working in prehospital or acute in-hospital settings. RESULTS Twelve studies met the inclusion criteria. There were no studies that evaluate the impact of a generic nursing assessment framework on patient care. The use of a structured patient assessment framework improved clinician performance of patient assessment. Limited evidence was found to support other aspects of patient care including documentation, communication, care implementation, patient and clinician satisfaction, and patient outcomes. CONCLUSION Structured patient assessment frameworks enhance clinician performance of patient assessment and hold the potential to improve patient care and outcomes; however, further research is required to address these evidence gaps, particularly in nursing. RELEVANCE TO CLINICAL PRACTICE Acute care clinicians should consider using structured patient assessment frameworks in clinical practice to enhance their performance of patient assessment.
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Affiliation(s)
- Belinda Munroe
- St George Hospital Trauma Department, Kogarah, NSW, Australia; The Wollongong Hospital Emergency Department, Wollongong, NSW, Australia; Sydney Nursing School, University of Sydney, Sydney, NSW , Australia
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Garcia-Smith D, Effken JA. Development and initial evaluation of the Clinical Information Systems Success Model (CISSM). Int J Med Inform 2013; 82:539-52. [PMID: 23497819 DOI: 10.1016/j.ijmedinf.2013.01.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 01/03/2013] [Accepted: 01/24/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Most clinical information systems (CIS) today are technically sound, but the number of successful implementations of these systems is low. The purpose of this study was to develop and test a theoretically based integrated CIS Success Model (CISSM) from the nurse perspective. METHODS Model predictors of CIS success were taken from existing research on information systems acceptance, user satisfaction, use intention, user behavior and perceptions, as well as clinical research. Data collected online from 234 registered nurses in four hospitals were used to test the model. Each nurse had used the Cerner Power Chart Admission Health Profile for at least 3 months. RESULTS Psychometric testing and factor analysis of the 23-item CISSM instrument established its construct validity and reliability. Initial analysis showed nurses' satisfaction with and dependency on CIS use predicted their perceived CIS use Net Benefit. Further analysis identified Social Influence and Facilitating Conditions as other predictors of CIS user Net Benefit. The level of hospital CIS integration may account for the role of CIS Use Dependency in the success of CIS. CONCLUSIONS Based on our experience, CISSM provides a formative as well as summative tool for evaluating CIS success from the nurse's perspective.
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Affiliation(s)
- Dianna Garcia-Smith
- College of Nursing, The University of Texas at Brownsville, Brownsville, TX, United States.
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Keenan GM, Yakel E, Yao Y, Xu D, Szalacha L, Tschannen D, Ford Y, Chen YC, Johnson A, Lopez KD, Wilkie DJ. Maintaining a consistent big picture: meaningful use of a Web-based POC EHR system. Int J Nurs Knowl 2012; 23:119-33. [PMID: 23043651 PMCID: PMC3674817 DOI: 10.1111/j.2047-3095.2012.01215.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To test the hypothesis that Hands-on Automated Nursing Data System (HANDS) "big picture summary" can be implemented uniformly across diverse settings, and result in positive registered nurse (RN) and plan of care (POC) data outcomes across time. DESIGN In a longitudinal, multisite, full test study, a representative convenience sample of eight medical-surgical units from four hospitals (one university, two large community, and one small community) in one Midwestern state implemented the HANDS intervention for 24 (four units) or 12 (four units) months. MEASUREMENTS (a) RN outcomes-percentage completing training, satisfaction with standardized terminologies, perception of HANDS usefulness, POC submission compliance rate. (b) POC data outcomes-validity (rate of optional changes/episode); reliability of terms and ratings; and volume of standardized data generated. RESULTS One hundred percent of the RNs who worked on the eight study units successfully completed the required standardized training; all units selected participated for the entire 12- or 24-month designated period; compliance rates for POC entry at every patient hand-off were 78-92%; reliability coefficients for use of the standardized terms and ratings were moderately strong; the pattern of optional POC changes per episode declined but remained reasonable across time; and the nurses generated a database of 40,747 episodes of care. LIMITATIONS Only RNs and medical-surgical units participated. CONCLUSION It is possible to effectively standardize the capture and visualization of useful "big picture" healthcare information across diverse settings. Findings offer a viable alternative to the current practice of introducing new health information layers that ultimately increase the complexity and inconsistency of information for frontline users.
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Affiliation(s)
- Gail M Keenan
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.
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Effectiveness of standardized Nursing Care Plans in health outcomes in patients with type 2 Diabetes Mellitus: a two-year prospective follow-up study. PLoS One 2012; 7:e43870. [PMID: 22952794 PMCID: PMC3428286 DOI: 10.1371/journal.pone.0043870] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 07/27/2012] [Indexed: 11/23/2022] Open
Abstract
Background Implementation of a standardized language in Nursing Care Plans (SNCP) allows for increased efficiency in nursing data management. However, the potential relationship with patientś health outcomes remains uncertain. The aim of this study was to evaluate the effectiveness of SNCP implementation, based on North American Nursing Diagnosis Association (NANDA) and Nursing Interventions Classification (NIC), in the improvement of metabolic, weight, and blood pressure control of Type 2 Diabetes Mellitus (T2DM) patients. Methods A two-year prospective follow-up study, in routine clinical practice conditions. 31 primary health care centers (Spain) participated with 24,124 T2DM outpatients. Data was collected from Computerized Clinical Records; SNCP were identified using NANDA and NIC taxonomies. Descriptive and ANCOVA analyses were conducted. Results 18,320 patients were identified in the Usual Nursing Care (UNC) group and 5,168 in the SNCP group. At the two-year follow-up, the SNCP group improved all parameters except LDL cholesterol and diastolic blood pressure. We analyzed data adjustming by the baseline value for these variables and variables with statistically significant differences between groups at baseline visit. Results indicated a lowering of all parameters except HbA1c, but a statistically significant reduction was only observed with diastolic blood pressure results. However, the adjusted reduction of diastolic blood pressure is of little clinical relevance. Greater differences of control values for diastolic blood pressure, HbA1c, LDL-cholesterol and Body Mass Index were found in the SNCP group, but only reached statistical significance for HbA1c. A greater proportion of patients with baseline HbA1c ≥7 decreased to <7% at the two-year follow-up in the SNCP group than in the UNC group (16.9% vs. 15%; respectively; p = 0.01). Conclusions Utilization of SNCP was helpful in achieving glycemic control targets in poorly controlled patients with T2DM (HbA1c ≥7%). Diastolic blood pressure results were slightly improved in the SNCP group compared to the UNC group. Trial Registration ClinicalTrials.gov NCT01482481
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Nykänen P, Kaipio J, Kuusisto A. Evaluation of the national nursing model and four nursing documentation systems in Finland – Lessons learned and directions for the future. Int J Med Inform 2012; 81:507-20. [DOI: 10.1016/j.ijmedinf.2012.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 01/30/2012] [Accepted: 02/04/2012] [Indexed: 10/28/2022]
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Estrada NA, Dunn CR. Standardized Nursing Diagnoses in an Electronic Health Record: Nursing Survey Results. Int J Nurs Knowl 2012; 23:86-95. [DOI: 10.1111/j.2047-3095.2011.01201.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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