Nurses’ Perception of Challenges in the Use of an Electronic Nursing Documentation System

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.

Benefits, barriers, and facilitators of using speech recognition technology in nursing documentation and reporting: A cross-sectional study

Background and Aim

Nursing reports are necessary for clinical communication and provide an accurate reflection of nursing assessments, care provided, changes in clinical status, and patient-related information to support the multidisciplinary team to provide individualized care. Nurses always face challenges in recording and documenting nursing reports. Speech recognition systems (SRS), as one of the documentation technologies, can play a potential role in recording medical reports. Therefore, this study seeks to identify the barriers, benefits, and facilitators of utilizing speech recognition technology in nursing reports.

Materials and Methods

This cross-sectional was conducted through a researcher-made questionnaire in 2022. Invitations were sent to 200 ICU nurses working in the three educational hospitals of Imam Reza (AS), Qaem and Imam Zaman in Mashhad city (Iran), 125 of whom accepted our invitation. Finally, 73 nurses included the study based on inclusion and exclusion criteria. Data analysis was performed using SPSS 22.0.

Results

According to the nurses, "paperwork reduction" (3.96, ±1.96), "performance improvement" (3.96, ±0.93), and "cost reduction" (3.95, ±1.07) were the most common benefits of using the SRS. "Lack of specialized, technical, and experienced staff to teach nurses how to work with speech recognition systems" (3.59, ±1.18), "insufficient training of nurses" (3.59, ±1.11), and "need to edit and control quality and correct documents" (3.59, ±1.03) were the most common barriers to using SRS. As well as "ability to fully review documentation processes" (3.62, ±1.13), "creation of integrated data in record documentation" (3.58, ±1.15), "possibility of error correction for nurses" (3.51, ±1.16) were the most common facilitators. There was no significant relationship between nurses' demographic information and the benefits, barriers, and facilitators.

Conclusions

By providing information on the benefits, barriers, and facilitators of using this technology, hospital managers, nursing managers, and information technology managers of healthcare centers can make more informed decisions in selecting and implementing SRS for nursing report documentation. This will help to avoid potential challenges that may reduce the efficiency, effectiveness, and productivity of the systems.

Development and evaluation of an electronic nursing documentation system

Background

Nursing documentation is a critical aspect of the nursing care workflow. There is a varying degree in how detailed nursing reports are described in scientific literature and care practice, and no uniform structured documentation is provided. This study aimed to describe the process of designing and evaluating the content of an electronic clinical nursing documentation system (ECNDS) to provide consistent and unified reporting in this context.

Methods

A four-step sequential methodological approach was utilized. The Minimum Data Set (MDS) development process consisted of two phases, as follows: First, a literature review was performed to attain an exhaustive overview of the relevant elements of nursing and map the available evidence underpinning the development of the MDS. Then, the data included from the literature review were analyzed using a two-round Delphi study with content validation by an expert panel. Afterward, the ECNDS was developed according to the finalized MDS, and eventually, its performance was evaluated by involving the end-users.

Results

The proposed MDS was divided into administrative and clinical sections; including nursing assessment and the nursing diagnosis process. Then, a web-based system with modular and layered architecture was developed based on the derived MDS. Finally, to evaluate the developed system, a survey of 150 registered nurses (RNs) was conducted to identify the positive and negative impacts of the system.

Conclusions

The developed system is suitable for the documentation of patient care in nursing care plans within a legal, ethical, and professional framework. However, nurses need further training in documenting patient care according to the nursing process, and in using the standard reporting templates to increase patient safety and improve documentation.

Nurses’ Views on the Use, Quality, and Satisfaction with Electronic Medical Record in the Outpatient Department at a Tertiary Hospital

Background:

Many nurses perceive that the Electronic Medical Record (EMR) reduces the workload, improves the quality of documentation, and improves safety and patient care. However, other nurses reported that the system and environment of healthcare might impede EMR documentation at the bedside.

Objective:

The study aimed to describe the nurses' views of the use, quality, and satisfaction with EMR in daily practice in outpatient settings. Furthermore, the relationships among the use, quality, and user’s satisfaction of EMR were assessed in the study.

Methods:

The proposed study employed a cross-sectional, descriptive correlational design. Inclusion criteria were nurses willing to participate in the study, fluent in the English language, and have been working in the Outpatient Department for more than three months until the time of study implementation. A self-reported questionnaire with strong validity and reliability was used to assess nurses’ views of use, quality and satisfaction of EMR.

Results:

The response rate was 77.2% (170 out of 220), 91.2% of the participants were females. Results about the use of EMR have shown positive views ranging from 51.2% to 84.7%, with the lowest scores reported when to write nurse care worksheets (Kardex). For the quality of EMR, the results have shown positive views ranging from 70% to 87.6% with the lowest scores reported related to the EMR system problems and crashes, and for the user’s satisfaction, the results have shown positive views ranging from 76.5% to 87.1%. There were significant positive correlations between the three elements use, quality, and user’s satisfaction of EMR.

Conclusion:

Participants reported positive views in the domain of use, quality, and satisfaction with EMR. Furthermore, positive correlations were reported between the use, quality, and satisfaction domains of EMR.

Barriers to Adoption of Electronic Health Record Systems from the Perspective of Nurses: A Cross-sectional Study

This study report aimed to investigate the barriers to implementation of electronic health record systems from the perspective of nurses. The research data comprised responses from nurses working in a university hospital. Our data collection instruments were the Participant Information Form and EHR Nurse Opinion Questionnaire, which were developed by the researchers. Data analysis was presented as summary statistics, including mean values of variables, standard deviation, frequency, and percentages. A total of 160 nurses participated in the study. The mean age of participants was 30.94 ± 0.59 years, and 77.5% were university graduates. Barriers to adoption of the electronic health record system included high number of patients (82.8%), limited time (79%), lack of knowledge and skills for effective use of the system (22.9%), lack of user-friendly interface and inability to create a common language within the team (17.8%), and attachment to the traditional method (17.2%). Although most nurses thought that the electronic health record system offered some advantages, they reported that factors such as large numbers of patients, limited time, and lack of user-friendly interface hindered its adoption. Innovative strategies should be explored to develop user-friendly designs for electronic health records and to produce solutions for nursing shortages to increase the time allocated for patient care.

Attitudes of Jordanian Oncology Nurses Toward Computerization

The implementation of electronic health records is viewed as an effective method to increase safety, efficiency, and effectiveness of nursing care. Nurses are crucial to the successful adoption of electronic health records. The purpose of this study is to assess oncology nurses' attitude toward electronic health records in Jordan. A quantitative cross-sectional survey design was used, in which 271 nurses completed the Nurses' Attitudes Towards Computerization questionnaire. The majority of participants were female (62.4%), with average age of 27.6 (SD = 5.2) years. The mean attitude score was 63.4 (SD = 13.3). Nurses' managers and nurses who received training on the adopted electronic healthcare systems were found to have a more positive attitude toward computer use in clinical practice than other nurses. The findings of this study demonstrated that oncology nurses had a positive attitude toward computerization. Training programs and facilities within an institution should be available to improve nurses' attitudes and enable them to adopt electronic healthcare systems.

A Task-Analytic Framework Comparing Preoperative Electronic Health Record-Mediated Nursing Workflow in Different Settings

Preoperative care is a critical, yet complex, time-sensitive process. Optimization of workflow is challenging for many reasons, including a lack of standard workflow analysis methods. We sought to comprehensively characterize electronic health record-mediated preoperative nursing workflow. We employed a structured methodological framework to investigate and explain variations in the workflow. Video recording software captured 10 preoperative cases at Arizona and Florida regional referral centers. We compared the distribution of work for electronic health record tasks and off-screen tasks through quantitative analysis. Suboptimal patterns and reasons for variation were explored through qualitative analysis. Although both settings used the same electronic health record system, electronic health record tasks and off-screen tasks time distribution and patterns were notably different across two sites. Arizona nurses spent a longer time completing preoperative assessment. Electronic health record tasks occupied a higher proportion of time in Arizona, while off-screen tasks occupied a higher proportion in Florida. The contextual analysis helped to identify the variation associated with the documentation workload, preparation of the patient, and regional differences. These findings should seed hypotheses for future optimization efforts and research supporting standardization and harmonization of workflow across settings, post-electronic health record conversion.

Issues affecting nurses' capability to use digital technology at work: An integrative review

BACKGROUND

Digital capability, that is the ability to live, work, participate and thrive in a digital world, is imperative for nurses because increasingly nurses' work and patient outcomes are influenced by technology.

AIM

To evaluate and synthesise the evidence regarding the development of digital capability in nurses and the strategies that support effective integration of digital skills into the workplace.

DESIGN

Whittemore and Knafl's methodology, following the preferred reporting items for systematic reviews (PRISMA) guidelines.

DATA SOURCES

CINAHL, Embase, PsychINFO, Medline (Ovid) and PubMed databases were searched for articles published in English from 2008-2019. Search terms included; digital capabil*, digital literacy, informatics, nursing informatics, health informatics, nurs*, knowledge, knowledge integration, competency, continuing education, nursing skills, workplace and work environment.

REVIEW METHODS

A total of 35 studies were retrieved for quality assessment by two reviewers using standardised critical appraisal instruments from the Joanna Briggs Institute (JBI-MAStARI and JBI-QARI). Minimum essential criteria and scores were agreed prior to appraisal.

RESULTS

The 17 studies included comprised quantitative (n = 7), qualitative (n = 8) and mixed methods (n = 2). Integration of digital capability in nurses' workplaces is dependent on user proficiency and competence (theme 1). Nurses use technology to access data at the point of care, specifically accessing evidence to guide care (theme 2a) as well as accessing the medical records (theme 2b). Nurses have several concerns related to the use of technology at point of care (theme 3), some of which can be resolved through investment for implementation (theme 4).

CONCLUSIONS

There are key attributes of digitally proficient nurses. Nurses with these attributes are more inclined to use digital technology in their work. Involvement of the nurses as end users in the development of digital systems to ensure they are fit for purpose, alongside investment in professional development opportunities for nurses to develop digital capability, should be prioritised.

Barriers to and Facilitators of Nurses' Adherence to Clinical Practice Guidelines: A Qualitative Study

BACKGROUND

Guidelines for clinical practice are needed in order for nurses to provide consistent, standardized care and avoid preventable harm.

AIMS

The present study aims to explore the barriers to and facilitators of nurses' adherence to clinical practice guidelines.

METHODS

Detailed semistructured interviews were conducted with 14 nurses from two educational hospitals in Kurdistan University of Medical Sciences, Sanandaj, Iran, about their involvement with clinical practice guidelines. The text of the interviews was analyzed by qualitative content analysis.

FINDINGS

Identified barriers to full adherence to clinical practice guidelines were work pressure, lack of facilities, paperwork, lack of motivational environment, and nonapplicability of guidelines. Facilitators identified were encouragement, improving working conditions, conscientiousness, training, and supervision.

CONCLUSION

Interventions to remove barriers to and provide facilitators of adherence to clinical practice guidelines should be designed and implemented. Removing organizational barriers is the responsibility of nursing managers.