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Wynn M, Garwood-Cross L. Reassembling nursing in the digital age: An actor-network theory perspective. Nurs Inq 2024:e12655. [PMID: 38941564 DOI: 10.1111/nin.12655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/30/2024]
Abstract
This article explores the application of actor-network theory (ANT) to the nursing profession, proposing a novel perspective in understanding nursing in the context of modern digital healthcare. Traditional grand nursing theories, while foundational, often fail to encapsulate the dynamic and complex nature of nursing, particularly in an era of rapid technological advancements and shifting societal dynamics. ANT, with its emphasis on the relationships between human and nonhuman actors, offers a framework to understand nursing beyond traditional paradigms. This article makes two key arguments: first, that nursing can be viewed as a highly organised social assemblage, where both human (nurses, patients and policymakers) and nonhuman actors (technologies, medical equipment, institutional policies) play a crucial role, and second, that ANT can be used to enhance existing nursing theory to better understand the role of technology in nursing practice. The article considers how ANT can provide a more holistic and adaptable model for describing the nursing profession, particularly in an era where technology plays an integral role in healthcare delivery. It discusses the implications of viewing nursing through ANT, highlighting the need for nursing education and practice to adapt to the interconnected and technologically advanced nature of modern healthcare. The article also acknowledges the limitations of ANT, particularly its potential oversimplification of the complex ethical dimensions inherent in nursing and its focus on observable phenomena.
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Affiliation(s)
- Matthew Wynn
- School of Health and Society, University of Salford, Salford, UK
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Krel C, Vrbnjak D, Štiglic G, Bevc S. Psychometric Testing of the Slovene Version of the Perceived Inventory of Technological Competency as Caring in Nursing. Healthcare (Basel) 2024; 12:561. [PMID: 38470672 PMCID: PMC10930641 DOI: 10.3390/healthcare12050561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/10/2024] [Accepted: 02/24/2024] [Indexed: 03/14/2024] Open
Abstract
The Perceived Inventory of Technological Competency as Caring in Nursing (PITCCN) questionnaire has been designed to measure technological competency as caring in nursing practice. It incorporates the use of technology with the fundamental principles of caring that are central to nursing. As there were no psychometrically sound instruments to quantify the concept of technological competency as caring in the Slovene language, we adapted the English version of the questionnaire to the local environment. The goal was to assess the level of psychometric properties of the PITCCN investigated in Slovene hospitals. METHODS Content validity was conducted with eight experts and quantified by the content validity index (CVI) and the modified Cohen's kappa index. Face validity was assessed through discussions with participants from the target culture in the pilot study. To assess construct validity and internal consistency, a cross-sectional research methodology was used on a convenience sample of 121 nursing personnel from four hospitals. Principal component analysis (PCA) was used to examine construct validity, while Cronbach's alpha and adjusted item-total correlations were used to measure internal consistency. RESULTS The content and face validity of PITCCN were adequate. The scale validity index (S-CVI) was 0.97. Cronbach's α was 0.92, and subscale reliabilities ranged from 0.810 to 0.925. PCA showed four components, which explained more than 73.49% of the variance. CONCLUSIONS The Slovenian version of PITCCN (PITCCN_SI) has good psychometric properties.
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Affiliation(s)
- Cvetka Krel
- Department of Nephrology, University Clinical Centre Maribor, 2000 Maribor, Slovenia;
- Faculty of Health Sciences, University of Maribor, 2000 Maribor, Slovenia; (D.V.); (G.Š.)
| | - Dominika Vrbnjak
- Faculty of Health Sciences, University of Maribor, 2000 Maribor, Slovenia; (D.V.); (G.Š.)
| | - Gregor Štiglic
- Faculty of Health Sciences, University of Maribor, 2000 Maribor, Slovenia; (D.V.); (G.Š.)
| | - Sebastjan Bevc
- Department of Nephrology, University Clinical Centre Maribor, 2000 Maribor, Slovenia;
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
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Abbasi H, Rahimi B, Jebraeily M, Nourani A. End-users' perspectives on factors affecting implementation and utilization of the Iranian electronic health record system: a qualitative study in a developing country. BMC Health Serv Res 2023; 23:1064. [PMID: 37798629 PMCID: PMC10557278 DOI: 10.1186/s12913-023-10033-5] [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: 02/15/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND As one of the most important information technologies for storing, managing, and exchanging health information, the electronic health record (EHR) plays a major role in the health system. However, these systems in developing countries have been associated with multidimensional issues. The purpose of the present study was the assessment of nonclinical end-users' points of view on the implementation and utilization of the Iranian electronic health record system. METHODS This was a large qualitative study conducted in 2021 for 7 months from February to August. In this study, data were collected through in-depth semi-structured interviews with 70 non-clinical end-users in 22 public and six private hospitals of West Azerbaijan province in Iran. To analyze the data, the thematic analysis method was used. RESULTS The study results indicated that technical, human, cultural, managerial, and financial readiness are the most important factors affecting the implementation of EHRs in Iran. Among the mentioned factors, technical and human readiness were emphasized more by the users. Also, technical, organizational, human, and managerial factors were identified as factors influencing EHRs utilization, and technical and organizational factors had a stronger role in the system utilization. CONCLUSIONS According to the results, several factors influence EHR implementation and adequate utilization in Iran. To achieve the predetermined goals of this system, implementation issues and problems of using the system should be considered and solved.
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Affiliation(s)
- Hajar Abbasi
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Bahlol Rahimi
- Health and Biomedical Informatics Research Center, Urmia University of Medical Sciences, Urmia, Iran.
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran.
| | - Mohamad Jebraeily
- Health and Biomedical Informatics Research Center, Urmia University of Medical Sciences, Urmia, Iran
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran
| | - Aynaz Nourani
- Health and Biomedical Informatics Research Center, Urmia University of Medical Sciences, Urmia, Iran
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran
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Green S, Hillersdal L, Holt J, Hoeyer K, Wadmann S. The practical ethics of repurposing health data: how to acknowledge invisible data work and the need for prioritization. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:119-132. [PMID: 36402853 PMCID: PMC9676846 DOI: 10.1007/s11019-022-10128-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
Throughout the Global North, policymakers invest in large-scale integration of health-data infrastructures to facilitate the reuse of clinical data for administration, research, and innovation. Debates about the ethical implications of data repurposing have focused extensively on issues of patient autonomy and privacy. We suggest that it is time to scrutinize also how the everyday work of healthcare staff is affected by political ambitions of data reuse for an increasing number of purposes, and how different purposes are prioritized. Our analysis builds on ethnographic studies within the Danish healthcare system, which is internationally known for its high degree of digitalization and well-connected data infrastructures. Although data repurposing ought to be relatively seamless in this context, we demonstrate how it involves costs and trade-offs for those who produce and use health data. Even when IT systems and automation strategies are introduced to enhance efficiency and reduce data work, they can end up generating new forms of data work and fragmentation of clinically relevant information. We identify five types of data work related to the production, completion, validation, sorting, and recontextualization of health data. Each of these requires medical expertise and clinical resources. We propose that the implications for these forms of data work should be considered early in the planning stages of initiatives for large-scale data sharing and reuse, such as the European Health Data Space. We believe that political awareness of clinical costs and trade-offs related to such data work can provide better and more informed decisions about data repurposing.
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Affiliation(s)
- Sara Green
- Section for History and Philosophy of Science, Department of Science Education, University of Copenhagen, Niels Bohr Building (NBB), Universitetsparken 5, 2100 Copenhagen Ø, Denmark
| | - Line Hillersdal
- Department of Anthropology, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen K, Denmark
| | - Jette Holt
- Infectious Disease Epidemiology & Prevention, The National Center for Infection Control (CEI), Artillerivej 5, 2300 Copenhagen S, Denmark
| | - Klaus Hoeyer
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Øster Farigmagsgade 5, 1014 Copenhagen K, Denmark
| | - Sarah Wadmann
- The Danish Center for Social Science Research, VIVE, Herluf Trolles Gade 11, 1052 Copenhagen, Denmark
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McBride S, Tietze M, Thomas L, Hanley MA. Electronic Health Record Maturity Matters! Texas Nurses Speak Out in Their Second Statewide Study. Comput Inform Nurs 2023; 41:110-122. [PMID: 35550410 DOI: 10.1097/cin.0000000000000915] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With the passage of the Health Information Technology for Economic and Clinical Health Act in 2009, Texas nurses were faced with the rapid uptake of technology driven by this legislation. Texas Nurses Association and Texas Organization for Nursing Leadership formed a partnership to collectively track the impact on practicing nurses. The Health IT Committee was commissioned to evaluate the changing health information technology environment and associated solutions. As such, a study in 2015, entitled "Statewide Study Assessing the Experiences of Nurses with their Electronic Health Records," was conducted. The follow-up study in 2020 was conducted to compare 2015 and 2020 findings to identify improvements made on nurses' satisfaction with EHRs and identify improvement opportunities. The study design was an exploratory descriptive comparative analysis with a cross-sectional survey from a random sample of Texas nurses for the two study periods of 2015 (n = 1177) and 2020 (n = 1117). The Clinical Information Systems Implementation Evaluation Scale and a demographic survey including the Meaningful Use Maturity-Sensitive Index were the measurement instruments. Results and key covariates are discussed along with recommendations for achieving more mature EHRs and more mature organizational culture and leadership.
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Affiliation(s)
- Susan McBride
- Author Affiliations: Texas Tech University Health Sciences Center (Drs McBride and Thomas), Lubbock; The University of Texas at Arlington (Dr Tietze); and Sul Ross University (Dr Hanley), Alpine, TX
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Electronic Health Records That Support Health Professional Reflective Practice: a Missed Opportunity in Digital Health. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2023; 6:375-384. [PMID: 36744083 PMCID: PMC9892400 DOI: 10.1007/s41666-022-00123-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 01/22/2023]
Abstract
A foundational component of digital health involves collecting and leveraging electronic health data to improve health and wellbeing. One of the central technologies for collecting these data are electronic health records (EHRs). In this commentary, the authors explore intersection between digital health and data-driven reflective practice that is described, including an overview of the role of EHRs underpinning technology innovation in healthcare. Subsequently, they argue that EHRs are a rich but under-utilised source of information on the performance of health professionals and healthcare teams that could be harnessed to support reflective practice and behaviour change. EHRs currently act as systems of data collection, not systems of data engagement and reflection by end users such as health professionals and healthcare organisations. Further consideration should be given to supporting reflective practice by health professionals in the design of EHRs and other clinical information systems.
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How the nursing profession should adapt for a digital future. BRITISH MEDICAL JOURNAL 2021. [PMCID: PMC8201520 DOI: 10.1136/bmj.n1190] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Relationship Between Burnout and Professional Behaviors and Beliefs Among US Nurses. J Occup Environ Med 2020; 62:959-964. [PMID: 32868601 DOI: 10.1097/jom.0000000000002014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the relationship between burnout and professional behaviors and beliefs among US nurses. METHODS We used data from 2256 nurses who completed a survey that included the Maslach Burnout Inventory and items exploring their professional conduct (documented something they had not done so they could "close out" an encounter in the EHR or part of the assessment not completed, requested continuing education credit for an activity not attended) and beliefs about reporting impaired colleagues. RESULTS On multivariable analysis, burnout was independently associated with higher odds of reporting 1 or more unprofessional behaviors in the last year and not believing nurses have a duty to report impairment among colleagues due to substance use or mental health problems. CONCLUSIONS Occupational burnout is associated with self-reported unprofessional behaviors and less favorable beliefs about reporting impaired colleagues among nurses.
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Abstract
OBJECTIVE The more people there are who use clinical information systems (CIS) beyond their traditional intramural confines, the more promising the benefits are, and the more daunting the risks will be. This review thus explores the areas of ethical debates prompted by CIS conceptualized as smart systems reaching out to patients and citizens. Furthermore, it investigates the ethical competencies and education needed to use these systems appropriately. METHODS A literature review covering ethics topics in combination with clinical and health information systems, clinical decision support, health information exchange, and various mobile devices and media was performed searching the MEDLINE database for articles from 2016 to 2019 with a focus on 2018 and 2019. A second search combined these keywords with education. RESULTS By far, most of the discourses were dominated by privacy, confidentiality, and informed consent issues. Intertwined with confidentiality and clear boundaries, the provider-patient relationship has gained much attention. The opacity of algorithms and the lack of explicability of the results pose a further challenge. The necessity of sociotechnical ethics education was underpinned in many studies including advocating education for providers and patients alike. However, only a few publications expanded on ethical competencies. In the publications found, empirical research designs were employed to capture the stakeholders' attitudes, but not to evaluate specific implementations. CONCLUSION Despite the broad discourses, ethical values have not yet found their firm place in empirically rigorous health technology evaluation studies. Similarly, sociotechnical ethics competencies obviously need detailed specifications. These two gaps set the stage for further research at the junction of clinical information systems and ethics.
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Affiliation(s)
- Ursula H Hübner
- Health Informatics Research Group, Dept. Business Management and Social Sciences Hochschule Osnabrück, Germany
- Health Informatics Research Group, Dept. Business Management and Social Sciences Hochschule Osnabrück, Germany
| | - Nicole Egbert
- Health Informatics Research Group, Dept. Business Management and Social Sciences Hochschule Osnabrück, Germany
| | - Georg Schulte
- Health Informatics Research Group, Dept. Business Management and Social Sciences Hochschule Osnabrück, Germany
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