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Yangöz ŞT, Turan Kavradim S, Özer Z. Global Trends and Hotspots in Nursing Research on Decision Support Systems: A Bibliometric Analysis in CiteSpace. Comput Inform Nurs 2024; 42:207-217. [PMID: 38241720 DOI: 10.1097/cin.0000000000001090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Decision support systems have been widely used in healthcare in recent years; however, there is lack of evidence on global trends and hotspots. This descriptive bibliometric study aimed to analyze bibliometric patterns of decision support systems in nursing. Data were extracted from the Web of Science Core Collection. Published research articles on decision support systems in nursing were identified. Co-occurrence and co-citation analysis was performed using CiteSpace version 6.1.R2. In total, 165 articles were analyzed. A total of 358 authors and 257 institutions from 20 countries contributed to this research field. The most productive authors were Andrew Johnson, Suzanne Bakken, Alessandro Febretti, Eileen S. O'Neill, and Kathryn H. Bowles. The most productive country and institution were the United States and Duke University, respectively. The top 10 keywords were "care," "clinical decision support," "clinical decision support system," "decision support system," "electronic health record," "system," "nursing informatics," "guideline," "decision support," and "outcomes." Common themes on keywords were planning intervention, national health information infrastructure, and methodological challenge. This study will help to find potential partners, countries, and institutions for future researchers, practitioners, and scholars. Additionally, it will contribute to health policy development, evidence-based practice, and further studies for researchers, practitioners, and scholars.
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Affiliation(s)
- Şefika Tuğba Yangöz
- Author Affiliations: Department of Internal Medicine Nursing, Faculty of Health Sciences, Pamukkale University (Dr Yangöz), Denizli; and Department of Internal Medicine Nursing, Faculty of Nursing, Akdeniz University (Drs Kavradim and Özer), Antalya, Turkey
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Hants L, Bail K, Paterson C. Clinical decision-making and the nursing process in digital health systems: An integrated systematic review. J Clin Nurs 2023; 32:7010-7035. [PMID: 37485751 DOI: 10.1111/jocn.16823] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/19/2023] [Accepted: 07/04/2023] [Indexed: 07/25/2023]
Abstract
AIMS To identify how the nursing process (assessment, planning, intervention and outcome evaluation) has been incorporated into digital health systems (electronic medical records, electronic care plans and clinical decision support systems) to gain an understanding of known benefits and challenges posed to nurses' decision-making processes. BACKGROUND Nursing terminologies, including the International Classification for Nursing Practice (ICNP), and Nursing Minimum Data Set's (NMDS), have been developed to improve standardised language integration of components of nursing care into digital systems. However, there is limited evidence regarding whether the complete nursing process is effectively being incorporated into digital health systems. METHODS An integrative systematic review following PRISMA guidelines. A search strategy was applied to extract articles from included databases: CINAHL, MEDLINE, SCOPUS and Web of Science Core Collection. Articles were limited to English language and published January 2007-March 2022 and assessed using a pre-determined eligibility criteria. Quality assessment and a narrative synthesis were conducted. RESULTS A total of 3321 articles were identified, and 27 studies included. There were (n = 10) qualitative, (n = 4) quantitative non-randomised controlled trials, (n = 3) quantitative descriptive studies and (n = 10) mixed methods. Nurse assessment and planning components were the most comprehensive phases incorporated into digital health systems, and interventions and outcome evaluation were scarcely reported. CONCLUSIONS Inadequate capture of nursing work is a problem unresolved by digital health systems. This omission may be hindering nurse clinical decision-making for patient care and limiting the visibility of the nursing role in health care interventions and the associated impact on patient outcomes. RELEVANCE TO CLINICAL PRACTICE Further research is needed on how digital systems can support nurses to apply the full nursing process and to further evaluate patient outcomes. Digital systems can support health-service level evaluation through capturing missed nursing care and the consequences on patients utilising nurse-sensitive-outcomes; however, this is not yet being realised.
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Affiliation(s)
- Laura Hants
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Kasia Bail
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia
- Canberra Health Services and ACT Health, SYNERGY Nursing and Midwifery Research Centre, ACT Health Directorate Level 3, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Catherine Paterson
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia
- Canberra Health Services and ACT Health, SYNERGY Nursing and Midwifery Research Centre, ACT Health Directorate Level 3, Canberra Hospital, Canberra, Australian Capital Territory, Australia
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Toffaha KM, Simsekler MCE, Omar MA. Leveraging artificial intelligence and decision support systems in hospital-acquired pressure injuries prediction: A comprehensive review. Artif Intell Med 2023; 141:102560. [PMID: 37295900 DOI: 10.1016/j.artmed.2023.102560] [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] [Received: 12/01/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Hospital-acquired pressure injuries (HAPIs) constitute a significant challenge harming thousands of people worldwide yearly. While various tools and methods are used to identify pressure injuries, artificial intelligence (AI) and decision support systems (DSS) can help to reduce HAPIs risks by proactively identifying patients at risk and preventing them before harming patients. OBJECTIVE This paper comprehensively reviews AI and DSS applications for HAPIs prediction using Electronic Health Records (EHR), including a systematic literature review and bibliometric analysis. METHODS A systematic literature review was conducted through PRISMA and bibliometric analysis. In February 2023, the search was performed using four electronic databases: SCOPIS, PubMed, EBSCO, and PMCID. Articles on using AI and DSS in the management of PIs were included. RESULTS The search approach yielded 319 articles, 39 of which have been included and classified into 27 AI-related and 12 DSS-related categories. The years of publication varied from 2006 to 2023, with 40% of the studies taking place in the US. Most studies focused on using AI algorithms or DSS for HAPIs prediction in inpatient units using various types of data such as electronic health records, PI assessment scales, and expert knowledge-based and environmental data to identify the risk factors associated with HAPIs development. CONCLUSIONS There is insufficient evidence in the existing literature concerning the real impact of AI or DSS on making decisions for HAPIs treatment or prevention. Most studies reviewed are solely hypothetical and retrospective prediction models, with no actual application in healthcare settings. The accuracy rates, prediction results, and intervention procedures suggested based on the prediction, on the other hand, should inspire researchers to combine both approaches with larger-scale data to bring a new venue for HAPIs prevention and to investigate and adopt the suggested solutions to the existing gaps in AI and DSS prediction methods.
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Affiliation(s)
- Khaled M Toffaha
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Mecit Can Emre Simsekler
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates.
| | - Mohammed Atif Omar
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
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Using health information technology in residential aged care homes: An integrative review to identify service and quality outcomes. Int J Med Inform 2022; 165:104824. [DOI: 10.1016/j.ijmedinf.2022.104824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/07/2022] [Accepted: 06/22/2022] [Indexed: 11/24/2022]
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Kim MS, Ryu JM, Choi BK. Development and Effectiveness of a Clinical Decision Support System for Pressure Ulcer Prevention Care Using Machine Learning: A Quasi-experimental Study. Comput Inform Nurs 2022; 41:00024665-900000000-99171. [PMID: 35266901 DOI: 10.1097/cin.0000000000000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study was conducted to develop and evaluate the effectiveness of a clinical decision support system for pressure ulcer prevention on clinical (performance, visual discrimination ability, and decision-making ability) and cognitive (knowledge and attitude) workflow. After developing a clinical decision support system using machine learning, a quasi-experimental study was used. Data were collected between January and April 2020. Forty-nine RNs who met the inclusion criteria and worked at seven tertiary and five secondary hospitals participated. A clinical decision support system was provided to the intervention group during the same period. Differences in outcome variables between the two groups were analyzed using t tests. The level of pressure ulcer prevention nursing performance and visual differentiation ability of skin pressure and oral mucosa pressure ulcer showed significantly greater improvement in the experimental group compared with the control group, whereas clinical decision making did not differ significantly. A clinical decision support system using machine learning was partially successful in performance of skin pressure ulcer prevention, attitude, and visual differentiation ability for skin and oral mucosa pressure ulcer prevention. These findings indicated that a clinical decision support system using machine learning needs to be implemented for pressure ulcer prevention.
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Affiliation(s)
- Myoung Soo Kim
- Author Affiliations: Department of Nursing, Pukyong National University (Dr Kim); Department of Nursing, Busan Institute of Science and Technology (Dr Ryu); and Department of Neurosurgery, College of Medicine, Pusan National University (Dr Choi), Busan, South Korea
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Akbar S, Lyell D, Magrabi F. Automation in nursing decision support systems: A systematic review of effects on decision making, care delivery, and patient outcomes. J Am Med Inform Assoc 2021; 28:2502-2513. [PMID: 34498063 PMCID: PMC8510331 DOI: 10.1093/jamia/ocab123] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/24/2021] [Accepted: 06/03/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The study sought to summarize research literature on nursing decision support systems (DSSs ); understand which steps of the nursing care process (NCP) are supported by DSSs, and analyze effects of automated information processing on decision making, care delivery, and patient outcomes. MATERIALS AND METHODS We conducted a systematic review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed, CINAHL, Cochrane, Embase, Scopus, and Web of Science were searched from January 2014 to April 2020 for studies focusing on DSSs used exclusively by nurses and their effects. Information about the stages of automation (information acquisition, information analysis, decision and action selection, and action implementation), NCP, and effects was assessed. RESULTS Of 1019 articles retrieved, 28 met the inclusion criteria, each studying a unique DSS. Most DSSs were concerned with two NCP steps: assessment (82%) and intervention (86%). In terms of automation, all included DSSs automated information analysis and decision selection. Five DSSs automated information acquisition and only one automated action implementation. Effects on decision making, care delivery, and patient outcome were mixed. DSSs improved compliance with recommendations and reduced decision time, but impacts were not always sustainable. There were improvements in evidence-based practice, but impact on patient outcomes was mixed. CONCLUSIONS Current nursing DSSs do not adequately support the NCP and have limited automation. There remain many opportunities to enhance automation, especially at the stage of information acquisition. Further research is needed to understand how automation within the NCP can improve nurses' decision making, care delivery, and patient outcomes.
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Affiliation(s)
- Saba Akbar
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - David Lyell
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Farah Magrabi
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Ting JJ, Garnett A. E-Health Decision Support Technologies in the Prevention and Management of Pressure Ulcers: A Systematic Review. Comput Inform Nurs 2021; 39:955-973. [PMID: 34132227 DOI: 10.1097/cin.0000000000000780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pressure ulcers are problematic across clinical settings, negatively impacting patient morbidity and mortality while resulting in substantial costs to the healthcare system. E-health clinical decision support technologies can play a key role in improving pressure ulcer-related outcomes. This systematic review aimed to assess the impact of electronic health decision support interventions on pressure ulcer management and prevention. A systematic search was conducted in PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, and Cochrane. Nineteen articles, published from 2010 to 2020, were included for review. The findings of this review showed promising results regarding the usability and accuracy of electronic health decision support tools to aid in pressure ulcer prevention and management. Evidence indicated improved clinician adherence to pressure ulcer prevention practices and decreased healthcare costs postimplementation of an electronic health decision support intervention. However, the studies included in this review did not consistently show reductions in pressure ulcer prevalence, incidence, or risk. Most of the articles included in the review were limited by small sample sizes drawn from single hospitals or long-term care homes. More high-quality studies are needed to determine the types of electronic health decision support tools that can drive sustainable improvements to patient outcomes.
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Affiliation(s)
- Justine Jeanelle Ting
- Author Affiliation: Arthur Labatt School of Nursing, Western University, London, Ontario, Canada
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Abdellatif A, Bouaud J, Lafuente-Lafuente C, Belmin J, Séroussi B. Computerized Decision Support Systems for Nursing Homes: A Scoping Review. J Am Med Dir Assoc 2021; 22:984-994. [PMID: 33639117 DOI: 10.1016/j.jamda.2021.01.080] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/15/2021] [Accepted: 01/24/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To summarize the research literature describing the outcomes of computerized decision support systems (CDSSs) implemented in nursing homes (NHs). DESIGN Scoping review. METHODS Search of relevant articles published in the English language between January 1, 2000, and February 29, 2020, in the Medline database. The quality of the selected studies was assessed according to PRISMA guidelines and the Mixed Method Appraisal Tool. RESULTS From 1828 articles retrieved, 24 studies were selected for review, among which only 6 were randomized controlled trials. Although clinical outcomes are seldom studied, some studies show that CDSSs have the potential to decrease pressure ulcer incidence and malnutrition prevalence. Improvement of process outcomes such as increased compliance with practice guidelines, better documentation of nursing assessment, improved teamwork and communication, and cost saving, also are reported. CONCLUSIONS AND IMPLICATIONS Overall, the use of CDSSs in NHs may be effective to improve patient clinical outcomes and health care delivery; however, most of the retrieved studies were observational studies, which significantly weakens the evidence. High-quality studies are needed to investigate CDSS effects and limitations in NHs.
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Affiliation(s)
- Abir Abdellatif
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, LIMICS, UMR S_1142, Paris, France; APHP, Hôpital Charles-Foix, Ivry-sur-Seine, France; Teranga Software, Paris, France
| | - Jacques Bouaud
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, LIMICS, UMR S_1142, Paris, France; AP-HP, Direction de la Recherche Clinique et de l'Innovation, Paris, France
| | - Carmelo Lafuente-Lafuente
- APHP, Hôpital Charles-Foix, Ivry-sur-Seine, France; Faculté de Médecine, Sorbonne Université, Paris, France
| | - Joël Belmin
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, LIMICS, UMR S_1142, Paris, France; APHP, Hôpital Charles-Foix, Ivry-sur-Seine, France; Faculté de Médecine, Sorbonne Université, Paris, France.
| | - Brigitte Séroussi
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, LIMICS, UMR S_1142, Paris, France; APHP, Hôpital Tenon, Paris, France
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Araujo SM, Sousa P, Dutra I. Clinical Decision Support Systems for Pressure Ulcer Management: Systematic Review. JMIR Med Inform 2020; 8:e21621. [PMID: 33064099 PMCID: PMC7600011 DOI: 10.2196/21621] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/27/2020] [Accepted: 09/06/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The clinical decision-making process in pressure ulcer management is complex, and its quality depends on both the nurse's experience and the availability of scientific knowledge. This process should follow evidence-based practices incorporating health information technologies to assist health care professionals, such as the use of clinical decision support systems. These systems, in addition to increasing the quality of care provided, can reduce errors and costs in health care. However, the widespread use of clinical decision support systems still has limited evidence, indicating the need to identify and evaluate its effects on nursing clinical practice. OBJECTIVE The goal of the review was to identify the effects of nurses using clinical decision support systems on clinical decision making for pressure ulcer management. METHODS The systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. The search was conducted in April 2019 on 5 electronic databases: MEDLINE, SCOPUS, Web of Science, Cochrane, and CINAHL, without publication date or study design restrictions. Articles that addressed the use of computerized clinical decision support systems in pressure ulcer care applied in clinical practice were included. The reference lists of eligible articles were searched manually. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. RESULTS The search strategy resulted in 998 articles, 16 of which were included. The year of publication ranged from 1995 to 2017, with 45% of studies conducted in the United States. Most addressed the use of clinical decision support systems by nurses in pressure ulcers prevention in inpatient units. All studies described knowledge-based systems that assessed the effects on clinical decision making, clinical effects secondary to clinical decision support system use, or factors that influenced the use or intention to use clinical decision support systems by health professionals and the success of their implementation in nursing practice. CONCLUSIONS The evidence in the available literature about the effects of clinical decision support systems (used by nurses) on decision making for pressure ulcer prevention and treatment is still insufficient. No significant effects were found on nurses' knowledge following the integration of clinical decision support systems into the workflow, with assessments made for a brief period of up to 6 months. Clinical effects, such as outcomes in the incidence and prevalence of pressure ulcers, remain limited in the studies, and most found clinically but nonstatistically significant results in decreasing pressure ulcers. It is necessary to carry out studies that prioritize better adoption and interaction of nurses with clinical decision support systems, as well as studies with a representative sample of health care professionals, randomized study designs, and application of assessment instruments appropriate to the professional and institutional profile. In addition, long-term follow-up is necessary to assess the effects of clinical decision support systems that can demonstrate a more real, measurable, and significant effect on clinical decision making. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42019127663; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=127663.
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Affiliation(s)
- Sabrina Magalhaes Araujo
- Medical Informatics, Faculty of Medicine and Faculty of Sciences, University of Porto, Porto, Portugal
| | - Paulino Sousa
- Nursing School of Porto, Porto, Portugal
- Health Information Systems & Electronic Health Records, Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Inês Dutra
- Department of Computer Science, Faculty of Sciences, University of Porto, Porto, Portugal
- Artificial Intelligence for Health Care, Center for Health Technology and Services Research, University of Porto, Porto, Portugal
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Østensen E, Hardiker NR, Bragstad LK, Hellesø R. Introducing standardised care plans as a new recording tool in municipal health care. J Clin Nurs 2020; 29:3286-3297. [PMID: 32472572 DOI: 10.1111/jocn.15355] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/07/2020] [Accepted: 05/09/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore how nurses use standardised care plans as a new recording tool in municipal health care, and to identify their thoughts and opinions. BACKGROUND In spite of being an important information source for nurses, care plans have repeatedly been found unsatisfactory. Structuring and coding information through standardised care plans is expected to raise the quality of recorded information, improve overviews, support evidence-based practice and facilitate data aggregation. Previous research on this topic has mostly focused on the hospital setting. There is a lack of knowledge on how standardised care plans are used as a recording tool in the municipal healthcare setting. DESIGN An exploratory design with a qualitative approach using three qualitative methods of data collection. The study complied with the Consolidated Criteria for Reporting Qualitative Research. METHODS Empirical data were collected in three Norwegian municipalities through participant observation and individual interviews with 17 registered nurses. In addition, we collected nursing records from 20 electronic patient records. RESULTS Use of standardised care plans was influenced by the nurses' consideration of their benefits. Partial implementation created an opportunity for nonuse. There was no consensus regarding how much information to include, and the standardised care plans could become both short and generic, and long and comprehensive. The themes "balancing between the old and the new care planning system," "considering the usefulness of standardised care plans as a source of information" and "balancing between overview and detail" reflect these findings. CONCLUSIONS Nurses' use of standardised care plans was influenced by the plans' partial implementation, their views on usefulness and their personal views on the detail required in a care plan. RELEVANCE TO CLINICAL PRACTICE The structuring of nursing records is a fast-growing trend in health care. This study gives valuable information for those attempting to implement such structures in municipal health care.
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Affiliation(s)
- Elisabeth Østensen
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nicholas R Hardiker
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Line Kildal Bragstad
- Institute of Health and Society and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, Oslo, Norway
| | - Ragnhild Hellesø
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Huang HY, Lee TT, Hsu TC, Mills ME, Tzeng IS. Evaluation of the Pressure Injury Prevention Information System. Comput Inform Nurs 2020; 38:625-632. [PMID: 32467444 DOI: 10.1097/cin.0000000000000627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Clinical decision support systems provide empirical guidance to improve the quality of nursing care. This study aimed to evaluate the outcomes of implementation of decision support functions into the preventive care system as regards nurses' acceptance of technology, documentation completeness, and incidence of hospital-acquired pressure injury. The researchers performed data collection in a regional hospital in northern Taiwan. The study used the Davis Science and Technology Acceptance Model scale to investigate nurses' technology acceptance before and after the introduction of a clinical decision support system and compared documentation compliance of preventive records with the incidence of hospital-acquired pressure injuries. Results showed that nurses' acceptance of the technology was significantly improved, and the completion rate of the pressure injury preventive care record significantly increased from 88.9% to 99.9%. Meanwhile, the incidence of hospital-acquired pressure injury decreased significantly from 0.057% to 0.021%. Therefore, it was concluded that the clinical decision support system provides evidenced-based support to nurses and is effective in identifying patient-specific prevention nursing plans of care.
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Affiliation(s)
- Hsiu-Yen Huang
- Author Affiliations: Department of Nursing, Taiwan Adventist Hospital (Ms Huang); School of Nursing, National Yang-Ming University (Dr Lee); and Taiwan Adventist Hospital (Dr Hsu), Taipei, Taiwan; School of Nursing, University of Maryland (Dr Mills), Baltimore; and Department of Research, Taipei Tzu Chi Hospital (Dr Tzeng), Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
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Paulsen MM, Paur I, Gjestland J, Henriksen C, Varsi C, Tangvik RJ, Andersen LF. Effects of using the MyFood decision support system on hospitalized patients' nutritional status and treatment: A randomized controlled trial. Clin Nutr 2020; 39:3607-3617. [PMID: 32241711 DOI: 10.1016/j.clnu.2020.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Compliance to guidelines for disease-related malnutrition is documented as poor. The practice of using paper-based dietary recording forms with manual calculation of the patient's nutritional intake is considered cumbersome, time-consuming and unfeasible among the nurses and does often not lead to appropriate nutritional treatment. We developed the digital decision support system MyFood to deliver a solution to these challenges. MyFood is comprised of an app for patients and a website for nurses and includes functions for dietary recording, evaluation of intake compared to requirements, and a report to nurses including tailored recommendations for nutritional treatment and a nutritional care plan for documentation. The study aimed to investigate the effects of using the MyFood decision support system during hospital stay on adult patients' nutritional status, treatment and hospital length of stay. The main outcome measure was weight change. METHODS The study was a parallel-arm randomized controlled trial. Patients who were allocated to the intervention group used the MyFood app during their hospital stay and the nurses were encouraged to use the MyFood system. Patients who were allocated to the control group received routine care. RESULTS We randomly assigned 100 patients (51.9 ± 14 y) to the intervention group (n = 49) and the control group (n = 51) between August 2018 and February 2019. Losses to follow-up were n = 5 in the intervention group and n = 1 in the control group. No difference was found between the two groups with regard to weight change. Malnutrition risk at discharge was present in 77% of the patients in the intervention group and 94% in the control group (p = 0.019). Nutritional treatment was documented for 81% of the patients in the intervention group and 57% in the control group (p = 0.011). A nutritional care plan was created for 70% of the intervention patients compared to 16% of the control patients (p < 0.001). CONCLUSIONS The intervention had no effect on weight change during hospital stay. A higher proportion of the patients in the control group was malnourished or at risk of malnutrition at hospital discharge compared to the patients in the intervention group. The documentation of nutritional intake, treatment and nutritional care plans was higher for the patients using the MyFood system compared to the control group. This trial was registered at clinicaltrials.gov (NCT03412695).
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Affiliation(s)
- Mari Mohn Paulsen
- Norwegian National Advisory Unit on Disease Related Undernutrition, Division of Cancer Medicine, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway; Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Box 1110 Blindern, 0317 Oslo, Norway.
| | - Ingvild Paur
- Norwegian National Advisory Unit on Disease Related Undernutrition, Division of Cancer Medicine, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway
| | - Johanna Gjestland
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Box 1110 Blindern, 0317 Oslo, Norway; Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Christine Henriksen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Box 1110 Blindern, 0317 Oslo, Norway
| | - Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Aker Hospital, Box 4959 Nydalen, 0424 Oslo, Norway
| | - Randi Julie Tangvik
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Box 7804, 5020 Bergen, Norway
| | - Lene Frost Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Box 1110 Blindern, 0317 Oslo, Norway
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Alexander GL, Georgiou A, Doughty K, Hornblow A, Livingstone A, Dougherty M, Jacobs S, Fisk MJ. Advancing health information technology roadmaps in long term care. Int J Med Inform 2020; 136:104088. [PMID: 32120318 DOI: 10.1016/j.ijmedinf.2020.104088] [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: 08/19/2019] [Revised: 12/11/2019] [Accepted: 01/23/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Our purpose is to provide evidence that health information technology should be a mainstay of all future health and social support services for older people globally, both within and across community and residential care services. METHODS This work was conducted in two phases. In phase I, the authors conducted a focused exploration by selecting a convenience sample of four long term care health information technology roadmaps, developed by members of four different long term care health information technology collaboratives in United States, Australia, United Kingdom, and New Zealand. During Phase II the research team carried out an extensive systematic review of existing literature sources (2000-2018) to support roadmap assumptions. RESULTS Using converging domains and content, we offer recommendations among five aged care roadmap domains: Strategy/Vision, Continuing Care Community, Services and Support Provided, External Clinical Support, and Administrative. Within these domains we provide recommendations in five content areas: Innovation, Policy, Evaluation, Delivery Systems and Human Resources. We recommend future strategies for LTC HIT roadmaps that include 61 emphasis areas in aged care in these content areas and domains. CONCLUSIONS The roadmap provides a navigation tool for LTC leaders to take a strategic and comprehensive approach as they harness the potential of health information technologies to address the challenges and opportunities of LTC in the future.
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Affiliation(s)
- Gregory L Alexander
- University of Missouri, Sinclair School of Nursing S415, Columbia, MO 65211.
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW Australia 2109.
| | - Kevin Doughty
- Director at i-Centre for Usable Home Technology, Caernarfon, Gwynedd United Kingdom.
| | | | - Anne Livingstone
- Research and Development Lead, Global Community Resourcing, 1/747 Lytton Road, Murarrie, QLD 4172.
| | - Michelle Dougherty
- Sr. Health Informatics Research Scientist, RTI International, Digital Health Policy & Standards.
| | - Stephen Jacobs
- Senior Lecturer, The School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92-019, Auckland Mail Centre, Auckland NZ 1142.
| | - Malcolm J Fisk
- Senior Research Fellow, Centre for Computing and Social Responsibility, De Montfort University, Leicester., Director, Telehealth Quality Group EEIG.
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14
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Bourbonnais A, Rousseau J, Lalonde MH, Meunier J, Lapierre N, Gagnon MP. Perceptions and needs regarding technologies in nursing homes: An exploratory study. Health Informatics J 2019; 26:1714-1727. [PMID: 31797712 DOI: 10.1177/1460458219889499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Two of the most salient problems in nursing homes are the responsive behaviours and falls of older people living with Alzheimer's disease and related disorders. Intelligent videomonitoring and mobile applications are potential technologies that may help prevent and manage these problems. However, evidence for the needs for technologies in nursing homes is scarce. This study aimed to explore the perceptions and needs of care managers, and of formal and family caregivers in nursing homes regarding these potential technologies. With an exploratory qualitative design based on Rogers' diffusion of innovation theory, individual interviews and a content analysis were conducted. Results show that the potential users of these technologies consider them relevant in nursing homes. The characteristics that would make these technologies useful in nursing homes are described. These results could be used to develop useful technologies to improve the quality of clinical practice in nursing homes.
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Affiliation(s)
| | - Jacqueline Rousseau
- Université de Montréal, Canada; Research Centre of the Institut universitaire de gériatrie de Montréal, Canada
| | | | | | - Nolwenn Lapierre
- Research Centre of the Institut universitaire de gériatrie de Montréal, Canada
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15
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Næss G, Wyller TB, Kirkevold M. Structured follow-up of frail home-dwelling older people in primary health care: is there a special need, and could a checklist be of any benefit? A qualitative study of experiences from registered nurses and their leaders. J Multidiscip Healthc 2019; 12:675-690. [PMID: 31686832 PMCID: PMC6709575 DOI: 10.2147/jmdh.s212283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/02/2019] [Indexed: 11/23/2022] Open
Abstract
Aim To identify experiences and opinions about the need for a structured follow-up and to identify potential benefits and barriers to the use of a checklist (Sub Acute Functional decline in the Older people [SAFE]) when caring for frail home-dwelling older people. Background The complexity of older peoples’ health situation requires more coordinated health care across health care levels and a better structured follow-up than is currently being offered, especially in the transitional phase between hospital discharge and primary care, but also in more stable phases at home. Design This was a qualitative study using focus group interviews. Methods Data were collected during six focus group interviews in three districts in a municipality. Nineteen registered nurses (RNs) and seventeen leaders responsible for the follow-up of frail home-dwelling older people participated. Participants were representatives of the RNs in homecare and their leaders. Results Our results highlight that although most RNs and their leaders saw a number of significant benefits to conducting a structured assessment and follow-up of frail older people home care recipients, a number of barriers made this difficult to realize on a daily basis. Conclusion There is no common perception that a structured follow-up of frail home-dwelling older people in primary health care is an important and contributing factor to better quality of health care. Despite this, most RNs and leaders found that the use of a structured checklist such as SAFE was a benefit to achieving a structured follow-up of the frail older people. We identified several factors of importance to whether a structured follow-up with a checklist is conducted in home care.
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Affiliation(s)
- Gro Næss
- Charm Research Centre for Habilitation and Rehabilitation Models & Services, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Nursing and Health Sciences, Faculty of Health and Sciences, University of South- Eastern Norway, Kongsberg, Norway.,Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Torgeir Bruun Wyller
- Charm Research Centre for Habilitation and Rehabilitation Models & Services, Institute of Health and Society, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Marit Kirkevold
- Charm Research Centre for Habilitation and Rehabilitation Models & Services, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
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16
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Citty SW, Cowan LJ, Wingfield Z, Stechmiller J. Optimizing Nutrition Care for Pressure Injuries in Hospitalized Patients. Adv Wound Care (New Rochelle) 2019; 8:309-322. [PMID: 31832278 DOI: 10.1089/wound.2018.0925] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/14/2019] [Indexed: 12/13/2022] Open
Abstract
Significance: It is estimated that up to 50% of hospitalized patients are malnourished. Malnutrition can lead to longer hospital stays, altered immune function, and impaired skin integrity and wound healing. Malnutrition has been found to be a significant factor influencing pressure injury (PI) risk and wound healing. While PI prevention requires multidimensional complex care using a variety of evidence-based strategies, hospitalized patients benefit from interventions that focus on improving oral nutrition to reduce PI risk and enhance wound healing. Unfortunately, malnutrition is often under-recognized and inadequately managed in hospitalized patients and this can lead to higher rates of complications such as PI. Recent Advances: Recent studies suggest that nutritional care has a major impact in PI prevention and management. Strategies, including early identification and management of malnutrition and provision of specially-formulated oral nutritional interventions to at-risk patients, optimization of electronic health record systems to allow for enhanced administration, monitoring, and evaluation of nutritional therapies, and implementation of protocol-based computerized decision support systems, have been reported to improve outcomes. Critical Issues: Unfortunately, there are gaps in the implementation of nutritional care in hospitals. Timely identification and management of malnutrition is needed to advance quality care for hospitalized patients and reduce malnutrition and associated PI. Future Directions: Further research on effective, evidence-based strategies for implementation of all stages of the nutrition care process is needed to reduce pressure injuries and malnutrition in hospitalized patients.
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Affiliation(s)
- Sandra W. Citty
- Department of Family, Community and Health System Science, University of Florida College of Nursing, Gainesville, Florida
| | - Linda J. Cowan
- Nursing Service and Research, Tampa VA Center of Innovation for Disability and Rehabilitation Research (CINDRR), Tampa, Florida
| | - Zandra Wingfield
- Department of Family, Community and Health System Science, University of Florida College of Nursing, Gainesville, Florida
| | - Joyce Stechmiller
- Department of Behavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida
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17
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Ko M, Wagner L, Spetz J. Nursing Home Implementation of Health Information Technology: Review of the Literature Finds Inadequate Investment in Preparation, Infrastructure, and Training. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2018; 55:46958018778902. [PMID: 29888677 PMCID: PMC6050994 DOI: 10.1177/0046958018778902] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Health information technology (HIT) is increasingly adopted by nursing homes to improve safety, quality of care, and staff productivity. We examined processes of HIT implementation in nursing homes, impact on the nursing home workforce, and related evidence on quality of care. We conducted a literature review that yielded 46 research articles on nursing homes' implementation of HIT. To provide additional contemporary context to our findings from the literature review, we also conducted semistructured interviews and small focus groups of nursing home staff (n = 15) in the United States. We found that nursing homes often do not employ a systematic process for HIT implementation, lack necessary technology support and infrastructure such as wireless connectivity, and underinvest in staff training, both for current and new hires. We found mixed evidence on whether HIT affects staff productivity and no evidence that HIT increases staff turnover. We found modest evidence that HIT may foster teamwork and communication. We found no evidence that the impact of HIT on staff or workflows improves quality of care or resident health outcomes. Without initial investment in implementation and training of their workforce, nursing homes are unlikely to realize potential HIT-related gains in productivity and quality of care. Policy makers should consider creating greater incentives for preparation, infrastructure, and training, with greater engagement of nursing home staff in design and implementation.
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18
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Adereti CS, Olaogun AA. Use of Electronic and Paper-based Standardized Nursing Care Plans to Improve Nurses' Documentation Quality in a Nigerian Teaching Hospital. Int J Nurs Knowl 2018; 30:219-227. [PMID: 30525306 DOI: 10.1111/2047-3095.12232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the effect of electronic and paper-based standardized nursing care plans (SNCPs) use on quality of nurses' documentation. METHODS Using quasi-experimental design, two wards were grouped into electronic and paper-based wards. Nurses were trained to use electronic- and paper-based SNCPs for care-planning and documentation. Data was collected before, 3, and 6 months postintervention and analyzed with SPSS version 20. FINDINGS There was improvement in documentation quality in the two wards after introducing SNCPs with higher quality scores in the electronic ward postintervention. CONCLUSION Providing SNCPs in electronic and paper formats is critical to improving nursing documentation. IMPLICATION FOR NURSING PRACTICE Adequate training and support for nurses are needed for successful implementation of SNCPs in electronic health records (EHRs) in developing nations.
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19
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Shiells K, Holmerova I, Steffl M, Stepankova O. Electronic patient records as a tool to facilitate care provision in nursing homes: an integrative review. Inform Health Soc Care 2018; 44:262-277. [PMID: 30125140 DOI: 10.1080/17538157.2018.1496091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: The electronic patient record (EPR) has been introduced into nursing homes with the aim of reducing time spent on documentation, improving documentation quality and increasing transferability of information, all of which should facilitate care provision. However, previous research has shown that EPR may be creating new burdens for staff. The purpose of this literature review is to explore how EPR is facilitating or hindering care provision in nursing homes. Methods: An integrative literature review was carried out using four electronic databases to search for relevant articles. After screening, 22 articles were included for thematic synthesis. Results: Thematic synthesis resulted in six analytical themes linked to care provision: time for direct care; accountability; assessment and care planning; exchange of information; risk awareness; and person-centered care. Conclusion: For EPR to facilitate care provision in nursing homes, consideration should be given to the type of device used for documentation, as well as the types of applications, the functionality, content, and structure of EPR. Further research exploring the experiences of end users is required to identify the optimal characteristics of an EPR system specifically for use in nursing homes.
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Affiliation(s)
- Kate Shiells
- a Centre of Expertise in Longevity and Long-Term Care, Faculty of Humanities, Charles University , Prague , Czech Republic
| | - Iva Holmerova
- a Centre of Expertise in Longevity and Long-Term Care, Faculty of Humanities, Charles University , Prague , Czech Republic
| | - Michal Steffl
- b Department of Physiology and Biochemistry, Faculty of Physical Education and Sport, Charles University , Prague , Czech Republic
| | - Olga Stepankova
- c Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague , Prague , Czech Republic
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20
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Mariani E, Chattat R, Ottoboni G, Koopmans R, Vernooij-Dassen M, Engels Y. The Impact of a Shared Decision-Making Training Program on Dementia Care Planning in Long-Term Care. J Alzheimers Dis 2018; 64:1123-1135. [PMID: 30010130 DOI: 10.3233/jad-180279] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Shared decision-making (SDM) can be a way for staff to adopt international recommendations advocating the involvement of nursing home residents and their family members in care planning and the development of personalized care plans. OBJECTIVE The main aim was to analyze the effects of training nursing home staff in the implementation of SDM on agreement of residents' 'life-and-care plans' with the recommendations (primary outcome) and on family caregivers' quality of life and sense of competence, and staff's job satisfaction (secondary outcomes). METHODS In the intervention condition, staff attended a training program on the use of SDM with residents and family caregivers in the care planning process. In the control condition, care planning as usual took place. For the primary outcome, in-depth qualitative and quantitative analyses of the care plans were performed. Multivariate Permutation Tests were applied to assess the impact on secondary outcomes. RESULTS Forty-nine residents and family caregivers and 34 professionals were involved. Overall, many of the care plans developed during the intervention showed a high level of agreement with the care planning recommendations. Both Italian and Dutch care plans showed improvement in the number of clear problem statements (p < 0.001). In Italy, significant improvements (p < 0.05) were also found regarding specific care objectives, documentation of objectives met, and of residents and families' involvement. No impact was found on secondary outcomes. CONCLUSION The involvement of residents and family caregivers in care planning contributed to an improvement of the residents' care plans, but it did not have an effect on family caregivers and staff outcomes.
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Affiliation(s)
- Elena Mariani
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Psychology, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Rabih Chattat
- Department of Psychology, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giovanni Ottoboni
- Department of Psychology, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Raymond Koopmans
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.,Joachimen Anna, Center for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Myrra Vernooij-Dassen
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands.,Radboudumc Alzheimer Center, Nijmegen, The Netherlands.,Kalorama Foundation, Beek-Ubbergen, The Netherlands
| | - Yvonne Engels
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
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21
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López M, Jiménez JM, Peña I, Cao MJ, Simarro M, Castro MJ. Ongoing nursing training influence on the completion of electronic pressure ulcer records. NURSE EDUCATION TODAY 2017; 52:22-27. [PMID: 28229916 DOI: 10.1016/j.nedt.2017.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 01/26/2017] [Accepted: 02/08/2017] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Pressure ulcer (PU) care in nursing at the Hospital Clínico Universitario de Valladolid (HCUV) in Spain includes basic care and its registration through the electronic GACELA Care tool. To assess and evaluate the nursing intervention in PU evolution, a training programme was carried out to unify criteria on PU assessment, treatment, evaluation and monitoring. OBJECTIVE To assess the influence of training on the completion of PU records in the GACELA Care application, and identify the level of satisfaction of the nurses after its use. MATERIALS AND METHODS A quasi-experimental prospective study consisting of a specific training programme assessed pre- and post-training was carried out on the records of PU documentation at the HCUV. The PU records included in the study were collected using the electronic nursing healthcare management computer tool GACELA Care and belonged to patients admitted for >48h, excluding venous, arterial and stage I PUs. The pre-training sample consisted of 65 records collected between 1 April and 30 June 2014, and there were 57 post-training records, completed from 1 January to 31 March 2015. The training programme consisted of thirty-minute theoretical and practice training sessions. The study variables were ulcer type, location, stage, length and diameter, perilesional skin, cure type, products used and cure frequency, in addition to the number of actions taken in the records in correlation to the days of hospitalisation. To identify the nurses' opinions, a satisfaction survey about the management platform of ongoing Castilla y León training was administered. RESULTS The variations from the pre- to the post-training PU-sample completion rates were the following: from 23% to 40% for PU diameter, from 11% to 38% for PU length and from 57% to 79% for perilesional skin condition records. There was also a significant increase in the number of form updates after the training activity. The nurses' level of satisfaction with the training activity showed a positive outcome, with an average score of 8.84 over 10. CONCLUSION The training activity improved PU record completion significantly and was deemed positive by the nurses, mainly for its applicability in clinical practice.
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Affiliation(s)
- María López
- GACELA Care Management Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Faculty of Nursing, Universidad de Valladolid, Spain.
| | - José María Jiménez
- Hospital Universitario Rio Hortega, Valladolid, Spain; Faculty of Nursing, Universidad de Valladolid, Spain.
| | - Isabel Peña
- Research of Nursing Care Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - María Simarro
- Research Instituto Biología y Genética Molecular IBGM, Universidad de Valladolid, Valladolid, Spain; Faculty of Nursing, Universidad de Valladolid, Spain
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22
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Alexander GL, Madsen RW, Miller EL, Schaumberg MK, Holm AE, Alexander RL, Wise KK, Dougherty ML, Gugerty B. A national report of nursing home information technology: year 1 results. J Am Med Inform Assoc 2017; 24:67-73. [PMID: 27107444 PMCID: PMC7654080 DOI: 10.1093/jamia/ocw051] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/25/2016] [Accepted: 03/12/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To provide a report on year 1 results of a national study investigating nursing home information technology (IT) adoption, called IT sophistication. METHODS A reliable and valid survey was used to measure IT sophistication. The target goal was 10% from each state in the United States, 1570 nursing homes. A random sample of homes from each state was recruited from Nursing Home Compare. RESULTS The team reached 2627 nursing home administrators, among whom 1799 administrators agreed to participate and were sent a survey. A total of 815 surveys were completed (45.3% response rate), which was below the goal. Facilities in the participating sample have similar demographic characteristics (ownership, total population in a location, and bed size) to the remaining homes not participating. There are greater IT capabilities in resident care and administrative activities, less in clinical support. The extent of use of these capabilities appears to be highest in administrative activities and lowest in clinical support. IT in resident care appears to be the most integrated with internal and external stakeholders. IT capabilities appear to be greater than IT extent of use in all health domains, with the greatest difference in resident care. DISCUSSION National evaluations of nursing home IT are rare. Measuring trends in IT adoption in a nationally representative sample provides meaningful analytics that could be more useful for policy makers and nursing home leaders in the future. CONCLUSION Discovering national baseline assessments is a first step toward recognizing nursing home trends in IT adoption.
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Affiliation(s)
- Gregory L Alexander
- University of Missouri, S415 Sinclair School of Nursing, Columbia, MO 65211, USA
| | - Richard W Madsen
- Medical Research Office, University of Missouri, Columbia, MO, USA
| | - Erin L Miller
- Department of Anthropology, University of Missouri, Columbia, MO, USA
| | | | - Allison E Holm
- Department of Health Management and Informatics, University of Missouri, Columbia, MO, USA
| | | | - Keely K Wise
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | | | - Brian Gugerty
- Clinical Informatics Division, GiC Informatics, LLC, Annapolis, MD, USA
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23
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Mariani E, Chattat R, Vernooij-Dassen M, Koopmans R, Engels Y. Care Plan Improvement in Nursing Homes: An Integrative Review. J Alzheimers Dis 2016; 55:1621-1638. [DOI: 10.3233/jad-160559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Elena Mariani
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Psychology, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Rabih Chattat
- Department of Psychology, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Myrra Vernooij-Dassen
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
- Kalorama Foundation, Beek-Ubbergen, The Netherlands
- Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - Raymond Koopmans
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- Joachim & Anna, Center for Specialized Geriatric Care, Nijmegen, The Netherlands
- Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
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24
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Abstract
This research studied 12,507 residents in 1174 nursing homes from the 2004 National Nursing Home Survey. A multinomial logistic regression model was used to predict risk-adjusted probabilities of pressure ulcers with 4 stages. A medical director or a director of nursing on board reduced the odds of ulcers. Facilities offering clusters of beds for rehabilitation and special care programs for hospice care or behavior problems reduced the odds of stage IV ulcers.
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Hansen RL, Fossum M. Nursing documentation of pressure ulcers in nursing homes: comparison of record content and patient examinations. Nurs Open 2016; 3:159-167. [PMID: 27708826 PMCID: PMC5047344 DOI: 10.1002/nop2.47] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 02/09/2016] [Indexed: 11/29/2022] Open
Abstract
Aim The aim of this study was to describe the accuracy and quality of nursing documentation of the prevalence, risk factors and prevention of pressure ulcers, and compare retrospective audits of nursing documentation with patient examinations conducted in nursing homes. Design This study used a cross‐sectional descriptive design. Method A retrospective audit of 155 patients' records and patient examinations using the European Pressure Ulcer Advisory Panel form and the Braden scale, conducted in January and February 2013. Results The prevalence of pressure ulcers was 38 (26%) in the audit of the patient records and 33 (22%) in patient examinations. A total of 17 (45%) of the documented pressure ulcers were not graded. When comparing the patient examinations with the patient record contents, the patient records lacked information about pressure ulcers and preventive interventions.
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Affiliation(s)
- Ruth-Linda Hansen
- Department of Health and Nursing Science Faculty of Health and Sport Sciences University of Agder/Centre for Caring Research Grimstad/Southern Norway Norway
| | - Mariann Fossum
- Department of Health and Nursing Science Faculty of Health and Sport Sciences University of Agder/Centre for Caring Research Grimstad/Southern NorwayNorway; Deakin University School of Nursing and Midwifery Deakin Alfred Health Nursing Research Center Alfred Health Melbourne Victoria Australia
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26
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Neloska L, Damevska K, Nikolchev A, Pavleska L, Petreska-Zovic B, Kostov M. The Association between Malnutrition and Pressure Ulcers in Elderly in Long-Term Care Facility. Open Access Maced J Med Sci 2016; 4:423-427. [PMID: 27703567 PMCID: PMC5042627 DOI: 10.3889/oamjms.2016.094] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND: Malnutrition is common in elderly and is a risk factor for pressure ulcers. AIM: The aim of the present study was to determine the prevalence of malnutrition in geriatric and palliative patients hospitalised in long-term care facility, and to examine the influence of nutritional status on the prevalence of pressure ulcers (PU). MATERIAL AND METHODS: Descriptive, observational and cross-sectional study including 2099 patients admitted to the Hospital during a 24 month period (January 2013 to December 2014). We recorded: demographic data, body mass index (BMI), Braden score, laboratory parameters of interest (albumin, total protein, RBC count, haemoglobin and iron levels) and presence or absence of malnutrition and pressure ulcers. RESULTS: The pressure ulcer prevalence was 12.9% (256 out of 2099). Based on the BMI classification, 61.7% of patients had a good nutritional status, 27.4% were undernourished, and 2.1% were considered malnourished. Nutritional status was statistically significantly different between patients with and without PU (p < 0.0001). This study also showed that hypoproteinemia, hypoalbuminemia, low RBC was positively associated with PU prevalence. CONCLUSION: The results highlight the impact of nutritional status on the prevalence of pressure ulcers in hospitalised geriatric and palliative population. It is of paramount importance to correctly evaluate the presence of malnutrition in patients at risk of pressure ulcers.
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Affiliation(s)
- Lenche Neloska
- Gerontology Institute "13 November Skopje", Skopje, Republic of Macedonia
| | - Katerina Damevska
- University Clinic of Dermatology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Andjelka Nikolchev
- Gerontology Institute "13 November Skopje", Skopje, Republic of Macedonia
| | - Lidija Pavleska
- Gerontology Institute "13 November Skopje", Skopje, Republic of Macedonia
| | | | - Milenko Kostov
- University Clinic of Neurosurgery, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Förberg U, Unbeck M, Wallin L, Johansson E, Petzold M, Ygge BM, Ehrenberg A. Effects of computer reminders on complications of peripheral venous catheters and nurses' adherence to a guideline in paediatric care--a cluster randomised study. Implement Sci 2016; 11:10. [PMID: 26818599 PMCID: PMC4728777 DOI: 10.1186/s13012-016-0375-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 01/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reminder systems in electronic patient records (EPR) have proven to affect both health care professionals' behaviour and patient outcomes. The aim of this cluster randomised trial was to investigate the effects of implementing a clinical practice guideline (CPG) for peripheral venous catheters (PVCs) in paediatric care in the format of reminders integrated in the EPRs, on PVC-related complications, and on registered nurses' (RNs') self-reported adherence to the guideline. An additional aim was to study the relationship between contextual factors and the outcomes of the intervention. METHODS The study involved 12 inpatient units at a paediatric university hospital. The reminders included choice of PVC, hygiene, maintenance, and daily inspection of PVC site. Primary outcome was documented signs and symptoms of PVC-related complications at removal, retrieved from the EPR. Secondary outcome was RNs' adherence to a PVC guideline, collected through a questionnaire that also included RNs' perceived work context, as measured by the Alberta Context Tool. Units were allocated into two strata, based on occurrence of PVCs. A blinded simple draw of lots from each stratum randomised six units to the control and intervention groups, respectively. Units were not blinded. The intervention group included 626 PVCs at baseline and 618 post-intervention and the control group 724 PVCs at baseline and 674 post-intervention. RNs included at baseline were 212 (65.4 %) and 208 (71.5 %) post-intervention. RESULTS No significant effect was found for the computer reminders on PVC-related complications nor on RNs' adherence to the guideline recommendations. The complication rate at baseline and post-intervention was 40.6 % (95 % confidence interval (CI) 36.7-44.5) and 41.9 % (95 % CI 38.0-45.8), for the intervention group and 40.3 % (95 % CI 36.8-44.0) and 46.9 % (95 % CI 43.1-50.7) for the control. In general, RNs' self-rated work context varied from moderately low to moderately high, indicating that conditions for a successful implementation to occur were less optimal. CONCLUSIONS The reminders might have benefitted from being accompanied by a tailored intervention that targeted specific barriers, such as the low frequency of recorded reasons for removal, the low adherence to daily inspection of PVC sites, and the lack of regular feedback to the RNs. TRIAL REGISTRATION Current Controlled Trials ISRCTN44819426.
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Affiliation(s)
- Ulrika Förberg
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden. .,Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Elevhemmet H2:00, 171 76, Stockholm, Sweden.
| | - Maria Unbeck
- Division of Orthopaedics, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Max Petzold
- Centre for Applied Biostatistics, Department of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Karolinska Institutet, ICHAR, Stockholm, Sweden
| | - Britt-Marie Ygge
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Elevhemmet H2:00, 171 76, Stockholm, Sweden
| | - Anna Ehrenberg
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Evaluating clinical decision support tools for medication administration safety in a simulated environment. Int J Med Inform 2015; 84:308-18. [DOI: 10.1016/j.ijmedinf.2015.01.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 12/31/2014] [Accepted: 01/22/2015] [Indexed: 11/21/2022]
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Shepherd MM, Wipke-Tevis DD, Alexander GL. Analysis of qualitative interviews about the impact of information technology on pressure ulcer prevention programs: implications for the wound, ostomy and continence nurse. J Wound Ostomy Continence Nurs 2015; 42:235-41. [PMID: 25945822 PMCID: PMC4448947 DOI: 10.1097/won.0000000000000136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to compare pressure ulcer prevention programs in 2 long-term care (LTC) facilities with diverse Information Technology Sophistication (ITS), one with high sophistication and one with low sophistication, and to identify implications for the WOC nurse. DESIGN Secondary analysis of narrative data obtained from a mixed-methods study. SUBJECTS AND SETTING The study setting was 2 LTC facilities in the Midwestern United States. The sample comprised 39 staff from 2 facilities, including 26 from a high-ITS facility and 13 from the low-ITS facility. Respondents included certified nurse assistants, certified medical technicians, restorative medical technicians, social workers, RNs, licensed practical nurses, information technology staff, administrators, and directors. METHODS This study is a secondary analysis of interviews regarding communication and education strategies in 2 LTC agencies. This analysis focused on focus group interviews, which included both direct and nondirect care providers. RESULTS Eight themes (codes) were identified in the analysis. Three themes are presented individually with exemplars of communication and education strategies. The analysis revealed specific differences between the high-ITS and low-ITS facilities in regard to education and communication involving pressure ulcer prevention. These differences have direct implications for WOC nurses consulting in the LTC setting. CONCLUSIONS Findings from this study suggest that effective strategies for staff education and communication regarding PU prevention differ based on the level of ITS within a given facility. Specific strategies for education and communication are suggested for agencies with high ITS and agencies with low ITS.
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Affiliation(s)
- Marilyn Murphy Shepherd
- Marilyn Murphy Shepherd, MSN, RN, Sinclair School of Nursing, University of Missouri-Columbia, Columbia, Missouri. Deidre D. Wipke-Tevis, PhD, RN, Sinclair School of Nursing, University of Missouri-Columbia, Columbia, Missouri. Gregory L. Alexander, PhD, MHA, RN, FAAN, Sinclair School of Nursing, University of Missouri-Columbia, Columbia, Missouri
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Hospitals' Adoption of Targeted Cognitive and Functional Status Quality Indicators for Vulnerable Elders. J Nurs Care Qual 2014; 29:354-62. [DOI: 10.1097/ncq.0000000000000061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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