Nurses

A Systematic Review of Nurses' Perceptions of Electronic Health Record Usability Based on the Human Factor Goals of Satisfaction, Performance, and Safety

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.

Investigating allied health professionals' attitudes, perceptions and acceptance of an electronic medical record using the Unified Theory of Acceptance and Use of Technology

Objective This study aimed to investigate allied health professionals' (AHPs') perspectives pre- and post-implementation of an electronic medical record (EMR) in a tertiary health service in Australia and examine factors influencing user acceptance. Methods Data were collected pre- and post-EMR implementation via cross-sectional online surveys based on the Unified Theory of Acceptance and Usage of Technology (UTAUT). All AHPs at a large tertiary hospital were invited to complete the surveys. Data analysis included descriptive analysis, Mann-Whitney U tests for pre-post item- and construct-level comparison and content analysis of free-text responses. The theoretical model was empirically tested using partial least squares structural equation modelling. Results AHPs had positive attitudes toward EMR use both pre- and post-implementation. Compared to pre-implementation, AHPs felt more positive post-implementation about system ease of use and demonstrated decreased anxiety and apprehension regarding EMR use. AHPs felt they had adequate resources and knowledge to use EMR and reported real-time data accessibility as a main advantage. Disadvantages of EMR included an unfriendly user interface, system outages and decreased efficiency. Conclusions As AHPs increase EMR system familiarity, their positivity towards its use increases. An understanding of what influences AHPs when implementing new compulsory technology can inform change management strategies to improve adoption.

[Evaluation of the impact of the implementation of the new primary health care information system on records of patient care and home visits in Brazil]

The replacement of the Primary Care Information System (SIAB, 1998-2015), as of January 2016, by the new Health Information System for Primary Care (SISAB) determined new forms of collecting, processing, and using information, with a possible impact on the records of activities carried out in primary health care in Brazil. This study aimed to evaluate the implementation impact of the new information system on records of physicians' and nurses' patient care and home visits of community health workers (CHW) in Brazil from 2007 to 2019. To this end, a Bayesian structural time-series model approach was used, based on a diffuse state-space regression. From 2016 to 2019, 463.47 million physician care, 210.61 million nursing care, and 1.28 billion CHW visits were recorded. Following the trend recorded before the implementation, 598.86 million, 430.46 million, and 1.5 billion physician and nursing appointments and CHW visits would be expected, respectively. In relative terms, there was a decrease of 25% in physician care, 51% in nursing care, and 15% in CHW visits when compared to the value expected by the Bayesian method. The negative impact on the records of patient care and home visits identified in this study, whether due to difficulties in adapting to the new system or a reduction in improper records, must be investigated so that the challenge of improving the primary care information system can be understood and overcome in a planned way.

Impacts of technology implementation on nurses' work motivation, engagement, satisfaction and well-being: A realist review

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).

Woman-centred care and integrated electronic medical records within Australian maternity settings: Point prevalence audit and observational study

OBJECTIVE

Transition to paperless records brings new challenges to midwifery practice across the continuum of woman-centred care. There is limited and conflicting evidence on the relative benefits of electronic medical records in maternity settings. This article aims to inform the use of integrative electronic medical records within the maternity services' environment with attention to the midwife-woman relationship.

DESIGN

This descriptive two-part study includes 1) an audit of electronic records in the early period following implementation (2-time points); and 2) an observational study to observe midwives' practice relating to electronic record use.

SETTING

Two regional tertiary public hospitals PARTICIPANTS: Midwives providing care for childbearing women across antenatal, intrapartum and postnatal areas.

FINDINGS

400 integrated electronic medical records were audited for completeness. Most fields had high levels of complete data in the correct location. However, between time 1 (T1) and time 2 (T2), persistent missing data (foetal heart rate documented 30 minutely T1 36%; T2 42%), and incomplete or incorrectly located data (pathology results T1:63%; T2 54%; perineal repair T1 60%; T2 46%) were identified. Observationally, midwives were actively engaged with the integrative electronic medical record between 23% to 68% (median 46%; IQR 16) of the time.

CONCLUSION

Midwives spent a significant amount of time completing documentation during clinical episodes of care. Largely, this documentation was found to be accurate, yet exceptions to data completeness, precision and location remained, indicating some concerns with software usability.

IMPLICATIONS FOR PRACTICE

Time-intensive monitoring and documentation may hinder woman-centred midwifery care.

Nurses’ Experiences After Implementation of an Organization-Wide Electronic Medical Record: Qualitative Descriptive Study

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.