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Irwin P, Hanson M, McDonald S, Noble D, Mollart L. Nursing students' perspectives on being work-ready with electronic medical records: Intersections of rurality and health workforce capacity. Nurse Educ Pract 2024; 77:103948. [PMID: 38678867 DOI: 10.1016/j.nepr.2024.103948] [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: 11/27/2023] [Revised: 02/22/2024] [Accepted: 03/24/2024] [Indexed: 05/01/2024]
Abstract
AIM To explore nursing students' views on being prepared for using electronic medical records during clinical placement. BACKGROUND The need for an undergraduate nursing curriculum to include electronic medical record training has been internationally recognised, however successful implementation has been inconsistent worldwide and limited in Australia. Many nursing students are unprepared to effectively provide care during clinical placement using electronic medical records and are therefore not work-ready as registered nurses. DESIGN Online survey. METHODS Third-year nursing students from two multi-campus universities were invited to complete the survey. RESULTS Most students believed that learning electronic medical records during simulations would be extremely or very useful. Student confidence levels correlate with the amount and type of exposure to electronic medical records prior to clinical placement. Four themes emerged from qualitative analysis: Don't throw out the baby with the bathwater; Prepare us for practice; Mistakes - hardly any; and Universities need to catch up and put out. CONCLUSION Students receiving hospital-based education on eMR and eObs can improve student confidence in preparation for clinical practice. First-year optional eMR university education had a limited impact on students' perception of preparedness for clinical practice. Shared responsibility between both the universities and health services on eMR education would provide improved student confidence and preparedness for clinical practice. This study supports the international research that eMR education needs to be scaffolded over the three years of study with increasing complexity of real-life scenarios.
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Affiliation(s)
- Pauletta Irwin
- School of Nursing, Paramedicine and Health Sciences, Charles Sturt University, Australia.
| | - Melissa Hanson
- School of Nursing, Paramedicine and Health Sciences, Charles Sturt University, Australia
| | - Simon McDonald
- Spatial Data Analysis Network (SPAN) - Office of Research Services and Graduate Studies, Charles Sturt University, Australia
| | - Danielle Noble
- School of Nursing and Midwifery, University of Newcastle, Australia
| | - Lyndall Mollart
- School of Nursing and Midwifery, University of Newcastle, Australia
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Aungsuroch Y, Gunawan J, Juanamasta IG, Montayre J. Updating Factors Influencing Nurse Work Engagement in the Hospital Settings: A Systematic Review. J Healthc Leadersh 2024; 16:157-176. [PMID: 38523801 PMCID: PMC10961065 DOI: 10.2147/jhl.s451056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/29/2024] [Indexed: 03/26/2024] Open
Abstract
Background Understanding the factors influencing work engagement among nurses is crucial for ensuring high-quality care and positive patient outcomes. Despite numerous factors associated with nurse work engagement, many were explored before the pandemic, potentially overlooking aspects relevant to the current context. Aim To explore and update factors related to nurse work engagement in the new normal era. Design Systematic review. Data Sources The search was restricted to articles published from 2019 to 2024 in CINAHL, PubMed, Scopus, ScienceDirect, Web of Science, and ProQuest, with full English text. The search was conducted from September 13th to 15th, 2023. Quantitative research articles that examined factors related to work engagement were included. Review Methods Data extraction, quality appraisal, and data analysis were performed in all included studies. Manual content analysis method was used to classify and group the factors. Results Sixty-one research articles were included in the final review. Five key groups of factors were generated from content analysis, including 1) individual-related factors, 2) organizational-related factors, 3) job and role-related factors, 4) work-life balance, and 5) work environment. Conclusion Understanding and addressing these multifaceted factors holistically is essential to develop strategies to sustain optimal engagement levels among nursing staff and improve overall patient care outcomes. Further studies are needed to confirm the findings.
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Affiliation(s)
| | - Joko Gunawan
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
| | - I Gede Juanamasta
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
- Nursing Program, STIKES Wira Medika Bali, Bali, Indonesia
| | - Jed Montayre
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, People’s Republic of China
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Canfell OJ, Woods L, Meshkat Y, Krivit J, Gunashanhar B, Slade C, Burton-Jones A, Sullivan C. The Impact of Digital Hospitals on Patient and Clinician Experience: Systematic Review and Qualitative Evidence Synthesis. J Med Internet Res 2024; 26:e47715. [PMID: 38466978 PMCID: PMC10964148 DOI: 10.2196/47715] [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: 03/29/2023] [Revised: 11/08/2023] [Accepted: 01/31/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND The digital transformation of health care is advancing rapidly. A well-accepted framework for health care improvement is the Quadruple Aim: improved clinician experience, improved patient experience, improved population health, and reduced health care costs. Hospitals are attempting to improve care by using digital technologies, but the effectiveness of these technologies is often only measured against cost and quality indicators, and less is known about the clinician and patient experience. OBJECTIVE This study aims to conduct a systematic review and qualitative evidence synthesis to assess the clinician and patient experience of digital hospitals. METHODS The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) guidelines were followed. The PubMed, Embase, Scopus, CINAHL, and PsycINFO databases were searched from January 2010 to June 2022. Studies that explored multidisciplinary clinician or adult inpatient experiences of digital hospitals (with a full electronic medical record) were included. Study quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis was performed narratively for quantitative studies. Qualitative evidence synthesis was performed via (1) automated machine learning text analytics using Leximancer (Leximancer Pty Ltd) and (2) researcher-led inductive synthesis to generate themes. RESULTS A total of 61 studies (n=39, 64% quantitative; n=15, 25% qualitative; and n=7, 11% mixed methods) were included. Most studies (55/61, 90%) investigated clinician experiences, whereas few (10/61, 16%) investigated patient experiences. The study populations ranged from 8 to 3610 clinicians, 11 to 34,425 patients, and 5 to 2836 hospitals. Quantitative outcomes indicated that clinicians had a positive overall satisfaction (17/24, 71% of the studies) with digital hospitals, and most studies (11/19, 58%) reported a positive sentiment toward usability. Data accessibility was reported positively, whereas adaptation, clinician-patient interaction, and workload burnout were reported negatively. The effects of digital hospitals on patient safety and clinicians' ability to deliver patient care were mixed. The qualitative evidence synthesis of clinician experience studies (18/61, 30%) generated 7 themes: inefficient digital documentation, inconsistent data quality, disruptions to conventional health care relationships, acceptance, safety versus risk, reliance on hybrid (digital and paper) workflows, and patient data privacy. There was weak evidence of a positive association between digital hospitals and patient satisfaction scores. CONCLUSIONS Clinicians' experience of digital hospitals appears positive according to high-level indicators (eg, overall satisfaction and data accessibility), but the qualitative evidence synthesis revealed substantive tensions. There is insufficient evidence to draw a definitive conclusion on the patient experience within digital hospitals, but indications appear positive or agnostic. Future research must prioritize equitable investigation and definition of the digital clinician and patient experience to achieve the Quadruple Aim of health care.
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Affiliation(s)
- Oliver J Canfell
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Digital Health Cooperative Research Centre, Australian Government, Sydney, Australia
- UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, Brisbane, Australia
| | - Leanna Woods
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Yasaman Meshkat
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jenna Krivit
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Brinda Gunashanhar
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Christine Slade
- Institute for Teaching and Learning Innovation, The University of Queensland, Brisbane, Australia
| | - Andrew Burton-Jones
- UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, Brisbane, Australia
| | - Clair Sullivan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Metro North Hospital and Health Service, Department of Health, Queensland Government, Brisbane, Australia
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Park S, Marquard J, Austin RR, Pieczkiewicz D, Jantraporn R, Delaney CW. A Systematic Review of Nurses' Perceptions of Electronic Health Record Usability Based on the Human Factor Goals of Satisfaction, Performance, and Safety. Comput Inform Nurs 2024; 42:168-175. [PMID: 38191474 DOI: 10.1097/cin.0000000000001084] [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: 01/10/2024]
Abstract
The poor usability of electronic health records contributes to increased nurses' workload, workarounds, and potential threats to patient safety. Understanding nurses' perceptions of electronic health record usability and incorporating human factors engineering principles are essential for improving electronic health records and aligning them with nursing workflows. This review aimed to synthesize studies focused on nurses' perceived electronic health record usability and categorize the findings in alignment with three human factor goals: satisfaction, performance, and safety. This systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Five hundred forty-nine studies were identified from January 2009 to June 2023. Twenty-one studies were included in this review. The majority of the studies utilized reliable and validated questionnaires (n = 15) to capture the viewpoints of hospital-based nurses (n = 20). When categorizing usability-related findings according to the goals of good human factor design, namely, improving satisfaction, performance, and safety, studies used performance-related measures most. Only four studies measured safety-related aspects of electronic health record usability. Electronic health record redesign is necessary to improve nurses' perceptions of electronic health record usability, but future efforts should systematically address all three goals of good human factor design.
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Affiliation(s)
- Suhyun Park
- Author Affiliations: School of Nursing (Mss Park and Jantraporn and Drs Marquard, Austin, and Delaney) and Institute for Health Informatics (Drs Marquard, Pieczkiewicz, and Delaney), University of Minnesota, Minneapolis
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Morris ME, Brusco NK, McAleer R, Billett S, Brophy L, Bryant R, Carey L, Wright AC, East C, Eckert M, Edvardsson K, Fetherstonhaugh D, Fowler-Davis S, Frederico M, Gray R, McCaskie D, McKinstry C, Mitchell R, Oldenburg B, Shields N, Smith K, Spelten E, Taylor N, Thwaites C, Young S, Blackberry I. Professional care workforce: a rapid review of evidence supporting methods of recruitment, retention, safety, and education. HUMAN RESOURCES FOR HEALTH 2023; 21:95. [PMID: 38093376 PMCID: PMC10720209 DOI: 10.1186/s12960-023-00879-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Across the care economy there are major shortages in the health and care workforce, as well as high rates of attrition and ill-defined career pathways. The aim of this study was to evaluate current evidence regarding methods to improve care worker recruitment, retention, safety, and education, for the professional care workforce. METHODS A rapid review of comparative interventions designed to recruit, retain, educate and care for the professional workforce in the following sectors: disability, aged care, health, mental health, family and youth services, and early childhood education and care was conducted. Embase and MEDLINE databases were searched, and studies published between January 2015 and November 2022 were included. We used the Quality Assessment tool for Quantitative Studies and the PEDro tools to evaluate study quality. RESULTS 5594 articles were initially screened and after applying the inclusion and exclusion criteria, 30 studies were included in the rapid review. Studies most frequently reported on the professional nursing, medical and allied health workforces. Some studies focused on the single domain of care worker education (n = 11) while most focused on multiple domains that combined education with recruitment strategies, retention strategies or a focus on worker safety. Study quality was comparatively low with a median PEDro score of 5/10, and 77% received a weak rating on the Quality Assessment tool for Quantitative Studies. Four new workforce strategies emerged; early career rural recruitment supports rural retention; workload management is essential for workforce well-being; learning must be contextually relevant; and there is a need to differentiate recruitment, retention, and education strategies for different professional health and care workforce categories as needs vary. CONCLUSIONS Given the critical importance of recruiting and retaining a strong health and care workforce, there is an immediate need to develop a cohesive strategy to address workforce shortfalls. This paper presents initial evidence on different interventions to address this need, and to inform care workforce recruitment and retention. Rapid Review registration PROSPERO 2022 CRD42022371721 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022371721.
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Affiliation(s)
- Meg E Morris
- The Victorian Rehabilitation Centre, Academic and Research Collaborative in Health (ARCH), and CERI, La Trobe University, Bundoora, VIC, 3083, Australia
| | - Natasha K Brusco
- La Trobe University, Bundoora, VIC, 3086, Australia.
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, 3150, Australia.
| | - Rachael McAleer
- La Trobe Rural Health School, La Trobe University, Bendigo, 3550, Australia
| | | | - Lisa Brophy
- La Trobe University, Bundoora, VIC, 3086, Australia
| | - Rosemary Bryant
- AO Research Centre, University of South Australia, Adelaide, 5001, Australia
| | - Leeanne Carey
- La Trobe University, Bundoora, VIC, 3086, Australia
- Florey Institute of Neuroscience and Mental Health, Heidelberg, 3084, Australia
| | | | - Christine East
- La Trobe University, Bundoora, VIC, 3086, Australia
- Mercy Health, Richmond, 3121, Australia
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, 5001, Australia
| | | | | | - Sally Fowler-Davis
- Centre for Health and Care Research, Collegiate Crescent, Sheffield Hallam University, Sheffield, S1 1WB, UK
| | | | - Richard Gray
- La Trobe University, Bundoora, VIC, 3086, Australia
| | - Doug McCaskie
- Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Carol McKinstry
- La Trobe Rural Health School, La Trobe University, Bendigo, 3550, Australia
| | | | - Brian Oldenburg
- La Trobe University, Bundoora, VIC, 3086, Australia
- Baker Heart and Diabetes Institute, Melbourne, 3004, Australia
| | - Nora Shields
- La Trobe University, Bundoora, VIC, 3086, Australia
| | - Karen Smith
- Silver Chain, Bourke Street, Melbourne, VIC, 3000, Australia
| | - Evelien Spelten
- La Trobe Rural Health School, La Trobe University, Bendigo, 3550, Australia
| | - Nicholas Taylor
- Eastern Health Academic and Research Collaborative in Health (ARCH), La Trobe University, Bundoora, 3086, Australia
| | - Claire Thwaites
- The Victorian Rehabilitation Centre and Academic and Research Collaborative in Health (ARCH) La Trobe University, Bundoora, VIC, 3083, Australia
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Jedwab RM, Manias E, Redley B, Dobroff N, Hutchinson AM. Impacts of technology implementation on nurses' work motivation, engagement, satisfaction and well-being: A realist review. J Clin Nurs 2023; 32:6037-6060. [PMID: 37082879 DOI: 10.1111/jocn.16730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
AIM To examine current literature for causal explanations on how, why and under what circumstances, implementation of a new hospital electronic medical record system or similar technology impacts nurses' work motivation, engagement, satisfaction or well-being. BACKGROUND Implementation of new technology, such as electronic medical record systems, affects nurses and their work, workflows and inter-personal interactions in healthcare settings. Multiple individual and organisational-level factors can affect technology adoption by nurses and may have negative consequences for nurses and patient safety. DESIGN Five-step realist review method and Realist And Meta-narrative Evidence Syntheses: Evolving Standards checklist was used to guide this review. Eight initial theories (programme theories) were used as the basis to explore, examine and refine literature from a range of sources. DATA SOURCES Literature from five databases (APA PsycInfo, CINAHL, Embase, IEEE Xplore and MEDLINE Complete) and grey literature (from 1 January 2000 to 31 October 2021) were systematically searched and retrieved on 4 November 2021. RESULTS In all, 8980 records were screened at the title and abstract level, of which 1027 full texts were screened and 10 were included in the review. Seven studies assessed concepts in both pre- and post-technology implementation. Most common contexts related to knowledge, rationale and skills to use new technology. Mechanisms that impacted nurses or nursing care delivery included: nurses' involvement in technology implementation processes; nurses' perceptions, understanding and limitations of technology impact(s) on patient care delivery; social supports; skills; implementation attitude and hardware. Work satisfaction was the most frequently examined outcome. An analysis led to nine final programme theories (including two original, six revised and one new programme theory). CONCLUSION Nurses must be informed about the rationale for new technology and have the knowledge and skills for its use. Understanding nurses' work motivation and attitudes related to technology adoption in the workplace can support work engagement, satisfaction and well-being. IMPLICATIONS FOR THE PROFESSION Complex contexts and mechanisms play a role in nurses' work motivation, engagement, satisfaction and well-being with the implementation of new technology into healthcare settings. RELEVANCE TO CLINICAL PRACTICE Nurses, their work and workflows are all influenced by the implementation of new technologies (such as electronic medical records), which in turn has consequences for patient safety and quality of care. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. PROSPERO REGISTRATION NUMBER CRD42020131875 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131875).
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Affiliation(s)
- Rebecca M Jedwab
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University School of Nursing and Midwifery, Melbourne, Victoria, Australia
- Monash Health Nursing and Midwifery Informatics, Melbourne, Victoria, Australia
| | - Elizabeth Manias
- Institute for Health Transformation, Deakin University School of Nursing and Midwifery, Melbourne, Victoria, Australia
| | - Bernice Redley
- Deakin University School of Nursing and Midwifery, Melbourne, Victoria, Australia
| | - Naomi Dobroff
- Monash Health Nursing and Midwifery Informatics, Melbourne, Victoria, Australia
- Deakin University School of Nursing and Midwifery, Melbourne, Victoria, Australia
| | - Alison M Hutchinson
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University School of Nursing and Midwifery, Melbourne, Victoria, Australia
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Jedwab RM, Manias E, Hutchinson AM, Dobroff N, Redley B. Nurses’ Experiences After Implementation of an Organization-Wide Electronic Medical Record: Qualitative Descriptive Study. JMIR Nurs 2022; 5:e39596. [PMID: 35881417 PMCID: PMC9328123 DOI: 10.2196/39596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 11/28/2022] Open
Abstract
Background Reports on the impact of electronic medical record (EMR) systems on clinicians are mixed. Currently, nurses’ experiences of adopting a large-scale, multisite EMR system have not been investigated. Nurses are the largest health care workforce; therefore, the impact of EMR implementation must be investigated and understood to ensure that patient care quality, changes to nurses’ work, and nurses themselves are not negatively impacted. Objective This study aims to explore Australian nurses’ postimplementation experiences of an organization-wide EMR system. Methods This qualitative descriptive study used focus group and individual interviews and an open-ended survey question to collect data between 12 and 18 months after the implementation of an EMR across 6 hospital sites of a large health care organization in Victoria, Australia. Data were collected between November 2020 and June 2021, coinciding with the COVID-19 pandemic. Analysis comprised complementary inductive and deductive approaches. Specifically, reflexive thematic analysis was followed by framework analysis by the coding of data as barriers or facilitators to nurses’ use of the EMR using the Theoretical Domains Framework. Results A total of 158 nurses participated in this study. The EMR implementation dramatically changed nurses’ work and how they viewed their profession, and nurses were still adapting to the EMR implementation 18 months after implementation. Reflexive thematic analysis led to the development of 2 themes: An unintentional divide captured nurses’ feelings of division related to how using the EMR affected nurses, patient care, and the broader nursing profession. This time, it’s personal detailed nurses’ beliefs about the EMR implementation leading to bigger changes to nurses as individuals and nursing as a profession than other changes that nurses have experienced within the health care organization. The most frequent barriers to EMR use by nurses were related to the Theoretical Domains Framework domain of environmental context and resources. Facilitators of EMR use were most often related to memory, attention, and decision processes. Most barriers and facilitators were related to motivation. Conclusions Nurses perceived EMR implementation to have a mixed impact on the provision of quality patient care and on their colleagues. Implementing technology in a health care setting was perceived as a complex endeavor that impacted nurses’ perceptions of their autonomy, ways of working, and professional roles. Potential negative consequences were related to nursing workforce retention and patient care delivery. Motivation was the main behavioral driver for nurses’ adoption of EMR systems and hence a key consideration for implementing interventions or organizational changes directed at nurses.
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Affiliation(s)
- Rebecca M Jedwab
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
- Nursing and Midwifery Informatics, Monash Health, Melbourne, Australia
| | - Elizabeth Manias
- Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Alison M Hutchinson
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
- Nursing and Midwifery, Monash Health, Melbourne, Australia
| | - Naomi Dobroff
- Nursing and Midwifery Informatics, Monash Health, Melbourne, Australia
- School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Bernice Redley
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
- Nursing and Midwifery, Monash Health, Melbourne, Australia
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