Factors Related to Health Informatics Competencies for Nurses—Results of a National Electronic Health Record Survey

Patients' perspectives of the digital counselling competence of healthcare professionals-A qualitative descriptive study

AIM

To describe the perspectives of patients using digital services on the digital counselling competence of healthcare professionals.

DESIGN

A descriptive qualitative interview study.

METHODS

The analysed data were collected in Finland during the spring of 2023 via 11 individual, semi-structured interviews from participants who had received video-mediated counselling. The interviews were carried out online through Microsoft Teams and adhered to an interview guide using main and ancillary questions. The data were analysed using inductive content analysis.

RESULTS

The patients' perspectives of healthcare professionals' digital counselling competence were related to five categories: (1) competence in preparing for video-mediated counselling, (2) digital competence in implementing the video-mediated counselling, (3) competence in interacting with the patient during the video-mediated counselling, (4) competence in supporting the patient's self-management in video-mediated counselling and (5) competence in self-development as a digital counsellor.

CONCLUSION

The results of this study indicate that healthcare professionals need to possess a wide range of digital counselling competencies when providing video-mediated counselling. This study thus lays the groundwork for future studies of patients' perspectives of healthcare professionals' digital counselling competence.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The results of this study can be used to develop healthcare professionals' digital counselling competence and patient-centered care. The presented insights can also be used to map further research topics.

REPORTING METHOD

The Consolidated criteria for reporting qualitative research (COREQ) checklist was used when reporting the results.

PATIENT OR PUBLIC CONTRIBUTION

Patients who had experience in using digital services participated in the data collection of this study.

IMPACT

What problem did the study address? Healthcare professionals may well need to develop new competencies as counselling is increasingly moving to digital environments. What were the main findings? The main areas of digital counselling competence that emerged from the patients' perspectives were competence in preparing for video-mediated counselling, digital competence, competence in interacting with the patient, competence in supporting self-management and competence in self-development as a digital counsellor. Where and on whom will the research have an impact? The research can be used to build and develop healthcare professionals' digital counselling competence, as well as improve the delivery of patient-centered care.

Impact of Health Informatics Analyst Education on Job Role, Career Transition, and Skill Development: Survey Study

Background

Professionals with expertise in health informatics play a crucial role in the digital health sector. Despite efforts to train experts in this field, the specific impact of such training, especially for individuals from diverse academic backgrounds, remains undetermined.

Objective

This study therefore aims to evaluate the effectiveness of an intensive health informatics training program on graduates with respect to their job roles, transitions, and competencies and to provide insights for curriculum design and future research.

Methods

A survey was conducted among 206 students who completed the Advanced Health Informatics Analyst program between 2018 and 2022. The questionnaire comprised four categories: (1) general information about the respondent, (2) changes before and after program completion, (3) the impact of the program on professional practice, and (4) continuing education requirements.

Results

The study received 161 (78.2%) responses from the 206 students. Graduates of the program had diverse academic backgrounds and consequently undertook various informatics tasks after their training. Most graduates (117/161, 72.7%) are now involved in tasks such as data preprocessing, visualizing results for better understanding, and report writing for data processing and analysis. Program participation significantly improved job performance (P=.03), especially for those with a master's degree or higher (odds ratio 2.74, 95% CI 1.08-6.95) and those from regions other than Seoul or Gyeonggi-do (odds ratio 10.95, 95% CI 1.08-6.95). A substantial number of respondents indicated that the training had a substantial influence on their career transitions, primarily by providing a better understanding of job roles and generating intrinsic interest in the field.

Conclusions

The integrated practical education program was effective in addressing the diverse needs of trainees from various fields, enhancing their capabilities, and preparing them for the evolving industry demands. This study emphasizes the value of providing specialized training in health informatics for graduates regardless of their discipline.

Healthcare professionals' digital health competence profiles and associated factors: A cross-sectional study

AIMS

To identify healthcare professionals' digital health competence profiles and explore associated factors to digital health competence in healthcare settings.

DESIGN

A cross-sectional study.

METHODS

Data were collected from 817 healthcare professionals from nine organizations with an electronic questionnaire by using Digital Health Competence instrument (42 items) and Aspects Associated with Digital Health instrument (15 items) between 1st March and 31st July 2022. K-means clustering was used to describe digital health competence profiles. Binary logistic regression analysis was used to explore associated factors.

RESULTS

Analysis revealed three digital health competence profiles: A - high competence (n = 336), B - intermediate competence (n = 352) and C - low competence (n = 129). Between the profiles, digital health competence showed significant differences (p < .001). Recent graduation year, working in outpatient environments and leader or specialist position were associated with higher digital health competence. Organizational practices and the influence from colleagues improved competence in human-centred remote counselling, digital solutions as part of work, competence in utilizing and evaluating digital solutions and ethical competence. Support from management improved digital solutions as part of work and ethical competence.

CONCLUSION

Nursing and allied health professionals working in other than outpatient environments should be specifically acknowledged when digital health competence development initiatives are designed and targeted. The positive influence from colleagues could be harnessed by enhancing their involvement in digital health competence development methods such as orientation, mentoring or coaching. Additionally, managers should take a stronger role in supporting different areas of digital health competence.

IMPACT

This was the first study that explored healthcare professionals' digital health competence profiles and associated factors. The detection of healthcare professionals' digital health competence profiles guides the development of digital health education according to different needs in healthcare environments.

REPORTING METHOD

The study has adhered to STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Recommended target audience, course content and learning arrangements for teaching health informatics competencies: A scoping review

Background: As healthcare depends on health information technology, there is a growing need for Health Informatics competencies in daily practice. This review aimed to explore how the teaching of education in HI has been arranged. 28 publications, published in English between 2016 and 2020 and obtained from selected bibliographic databases, were reviewed. The data was analyzed using deductive content analysis with the following pre-formulated topics: target audience, course content and learning arrangements. The results highlight three key competencies: documentation and communication, management, and understanding of health information technology. It underlines a blended teaching method to improve the competencies of healthcare professionals, graduates, undergraduates, and suggests adding active interactions, multi-professional interactions, and hands-on skills. This study highlights the importance of adapting to changes in healthcare, improving HI competencies in healthcare, and fostering positive digital experiences. It underlined the need for practical training, in theory and hands-on sessions, including key competencies in documentation and communication, management and health information systems.

Experiences of Electronic Health Records' and Client Information Systems' Use on a Mobile Device and Factors Associated With Work Time Savings Among Practical Nurses: Cross-Sectional Study

BACKGROUND

The transmission of clinical information in nursing predominantly occurs through digital solutions, such as computers and mobile devices, in today's era. Various technological systems, including electronic health records (EHRs) and client information systems (CISs), can be seamlessly integrated with mobile devices. The use of mobile devices is anticipated to rise, particularly as long-term care is increasingly delivered in environments such as clients' homes, where computers are not readily accessible. However, there is a growing need for more user-centered data to ensure that mobile devices effectively support practical nurses in their daily activities.

OBJECTIVE

This study aims to analyze practical nurses' experiences of using EHRs or CISs on a mobile device in their daily practice. In addition, it aims to examine the factors associated with work time savings when using EHRs/CISs on a mobile device.

METHODS

A cross-sectional study using an electronic survey was conducted in spring 2022. A total of 3866 practical nurses participated in the survey based on self-assessment. The sample was limited to practical nurses who used EHRs or CISs on a mobile device and worked in home care or service housing within the social welfare or health care sector (n=1014). Logistic regression analysis was used to explore the factors associated with work time savings.

RESULTS

The likelihood of perceiving work time savings was higher among more experienced EHR/CIS users compared with those with less experience (odds ratio [OR] 1.59, 95% CI 1.30-1.94). Participants with 0-5 years of work experience were more likely to experience work time savings compared with those who had worked 21 years or more (OR 2.41, 95% CI 1.43-4.07). Practical nurses in home care were also more likely to experience work time savings compared with those working in service housing (OR 1.95, 95% CI 1.23-3.07). A lower grade given for EHRs/CISs was associated with a reduced likelihood of experiencing work time savings (OR 0.76, 95% CI 0.66-0.89). Participants who documented client data in a public area were more likely to experience work time savings compared with those who did so in the nurses' office (OR 2.33, 95% CI 1.27-4.25). Practical nurses who found documentation of client data on a mobile device easy (OR 3.05, 95% CI 2.14-4.34) were more likely to experience work time savings compared with those who did not. Similarly, participants who believed that documentation of client data on a mobile device reduced the need to memorize things (OR 4.10, 95% CI 2.80-6.00) were more likely to experience work time savings compared with those who did not.

CONCLUSIONS

To enhance the proportion of practical nurses experiencing work time savings, we recommend that organizations offer comprehensive orientation and regular education sessions tailored for mobile device users who have less experience using EHRs or CISs and find mobile devices less intuitive to use.

Measuring the Digital Competence of Health Professionals: Scoping Review

BACKGROUND

Digital competence is listed as one of the key competences for lifelong learning and is increasing in importance not only in private life but also in professional life. There is consensus within the health care sector that digital competence (or digital literacy) is needed in various professional fields. However, it is still unclear what exactly the digital competence of health professionals should include and how it can be measured.

OBJECTIVE

This scoping review aims to provide an overview of the common definitions of digital literacy in scientific literature in the field of health care and the existing measurement instruments.

METHODS

Peer-reviewed scientific papers from the last 10 years (2013-2023) in English or German that deal with the digital competence of health care workers in both outpatient and inpatient care were included. The databases ScienceDirect, Scopus, PubMed, EBSCOhost, MEDLINE, OpenAIRE, ERIC, OAIster, Cochrane Library, CAMbase, APA PsycNet, and Psyndex were searched for literature. The review follows the JBI methodology for scoping reviews, and the description of the results is based on the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist.

RESULTS

The initial search identified 1682 papers, of which 46 (2.73%) were included in the synthesis. The review results show that there is a strong focus on technical skills and knowledge with regard to both the definitions of digital competence and the measurement tools. A wide range of competences were identified within the analyzed works and integrated into a validated competence model in the areas of technical, methodological, social, and personal competences. The measurement instruments mainly used self-assessment of skills and knowledge as an indicator of competence and differed greatly in their statistical quality.

CONCLUSIONS

The identified multitude of subcompetences illustrates the complexity of digital competence in health care, and existing measuring instruments are not yet able to reflect this complexity.

Nurses' Informatics Competency Assessment of Health Information System Usage: A Cross-sectional Survey

Nurses' informatics competencies are nurses' professional requirements to guarantee the quality of patient care and affect nurses' use of health information systems. The purpose of this survey was to describe nurses' perceptions of their informatics competencies regarding health information system usage. A previously tested web-based questionnaire with multiple-choice questions was sent to nurses whose e-mail address was available through three Finnish Nursing Associations (N = 58 276). A total of 3610 nurses working in Finland responded. Both descriptive and explanatory statistics were used to analyze the data. The three dependent variables "nursing documentation," "digital environment," and "ethics and data protection" were formulated from the data. Nurses' overall informatics competency was good. The "ethics and data protection" competency score was higher than that of "nursing documentation" or "digital environment." Recently graduated nurses and nurses working in outpatient care, virtual hospital, examination, or operation had highest "digital environment" competency score. Health information system experience was associated with "nursing documentation." Nurses are highly qualified health information systems users. However, the competency requirements generated by rapidly expanding digitalization have challenged nurses. It is important to increase educational programs for nurses of how to use digital devices, and how to support patients to use digital services.

An Integrative Review of Response Rates in Nursing Research Utilizing Online Surveys

BACKGROUND

Online surveys in nursing research have both advantages and disadvantages. Reaching a sample and attaining an appropriate response rate is an ongoing challenge and necessitates careful consideration when designing a nursing research study using an online survey approach.

OBJECTIVE

In this study, we aimed to explore response rates and survey characteristics of studies by nurse researchers that used online methodologies to survey nurses, nursing students, and nursing faculty.

METHODS

We conducted an integrative review of research studies that used online surveys for data collection published from 2011 to 2021. We examined response rates and survey characteristics such as recruitment method, use of incentives, question type, length of survey, time to complete the survey, and use of reminders.

RESULTS

Our review included 51 studies published by nurses with target samples of nurses, nursing students, or nursing faculty. Study sample sizes ranged from 48 to 29,283, the number of respondents ranged from 29 to 3,607, and the response rates ranged from 3.4% to 98%, with an average of 42.46%. Few patterns emerged regarding recruitment or other factors to enhance response rates; only five studies used incentives.

CONCLUSION

Response rates to online surveys are unlikely to reach the rates seen in older mailed surveys. Researchers need to design online survey studies to be easily accessible, concise, and appealing to participants.

Nursing informatics competence profiles and perceptions of health information system usefulness among registered nurses: A latent profile analysis

AIMS

To identify different nursing informatics competence (NIC) profiles in nurses, examine the factors associated with profile memberships and examine the associations of the derived profiles with the nurses' perception of the usefulness of a health information system (HIS).

DESIGN

A cross-sectional study.

METHODS

A sample of 3610 registered nurses responded to a nationwide survey in March 2020. A latent profile analysis was performed to identify NIC profiles based on three competence areas: nursing documentation, working in digital environment, and ethics and data protection. A multinomial logistic regression was carried out to examine the associations of demographic and background variables with the profile membership. Linear regression analyses were carried out to examine the association between the profile membership and perceived HIS usefulness.

RESULTS

Three NIC profiles were identified and labelled as low, moderate and high competence groups. A younger age, recent graduation year, sufficient orientation and high-rated proficiency as an HIS user were associated with nurses belonging to a high or moderate competence group relative to a low competence group. Competence group membership was associated with perceived HIS usefulness. The high competence group consistently expressed the highest usefulness of the HIS and the low competence group the lowest.

CONCLUSION

Tailored training and support should be provided for nurses with different levels of informatics competence, thereby facilitating their ability to respond to increasingly digitalized work. This could contribute to higher usefulness of the HIS in terms of supporting the nurses' work tasks and promoting the quality of care.

IMPACT

This was the first study exploring latent profiles of informatics competence in nurses. Insights from this study are useful for nursing management to identify different competence profiles of their employees, provide support and training to meet their needs, and promote the successful use of an HIS.

Embracing digital and technological solutions in nursing: A scoping review and conceptual framework

INTRODUCTION

Digital and technological solutions (DTS) are emerging as promising avenues to improve the quality and efficiency of healthcare. This scoping review aimed to map the literature on embracing DTS in nursing, from primary to tertiary care settings.

METHODS

The Joanna Briggs Institute guidance for scoping reviews was used. The authors searched MEDLINE, Embase, CINAHL, Scopus, Web of Science, Cochrane Library, and PROSPERO databases for published articles and relevant peer-reviewed research protocols. Screening and data abstraction were conducted by two reviewers independently, with a third reviewer resolving discrepancies. Frequency and thematic analyses were conducted.

RESULTS

The study highlights the crucial role nurses play in introducing, implementing, and using DTS. The summarized literature emphasizes that cultivating positive attitudes, possessing sufficient knowledge, competencies, self-efficacy, and displaying appropriate behaviors toward such technologies are vital in ensuring their effective incorporation into nursing practice.

DISCUSSION AND CONCLUSIONS

The findings of this scoping review provide a foundation for future research on DTS adoption in nursing and support the development of evidence-based strategies to improve nursing practice through DTS implementation. Therefore, the article proposes the Digital and Technological Framework (Digitech-F) for healthcare professionals as a comprehensive conceptual framework that addresses skills, knowledge, attitude, and competence to ensure the effective adoption of DTS in nursing.

Healthcare professionals' digital health competence and its core factors; development and psychometric testing of two instruments

BACKGROUND

Healthcare professionals' digital health competence is an important phenomenon to study as healthcare practices are changing globally. Recent research aimed to define this complex phenomenon and identify the current state of healthcare professionals' competence in digitalisation but did not include an overarching outlook when measuring digital health competence of healthcare professionals.

OBJECTIVES

The purpose of this study was to develop and psychometrically validate two self-assessed instruments measuring digital health competence and factors associating with it.

METHODS

The study followed three phases of instrument development and validation: 1) conceptualisation and item pool generation; 2) content validity testing and pilot study; and 3) construct validity and reliability testing. The conceptual background of the instruments was based on individual interviews conducted with healthcare professionals (n = 20) and previous systematic reviews. A total of 17 experts assessed the instrument's content validity. Face validity was evaluated by a group of healthcare professionals (n = 20). Data collection from 817 professionals took place in spring-summer 2022 in nine organisations. Construct validity was confirmed with exploratory factor analysis. Cronbach's alpha was used to assess the internal consistency of the instruments.

RESULTS

The instrument development and validation process resulted in two instruments: DigiHealthCom and DigiComInf. DigiHealthCom included 42 items in 5 factors related to digital health competence, and DigiComInf included 15 items in 3 factors related to educational and organisational factors associated with digital health competence. The DigiHealthCom instrument explained 68.9 % of the total variance and the factors' Cronbach alpha values varied between 0.91 and 0.97. The DigiComInf instrument explained 59.6 % of the total variance and the factors' Cronbach alpha values varied between 0.76 and 0.88.

CONCLUSIONS

The two instruments gave valid and reliable results in psychometric testing. The instruments could be used to evaluate healthcare professionals' digital health competence and associated factors.

Nurse Managers' Opinions of Information System Support for Performance Management: A Correlational Study

BACKGROUND

 Current information systems do not effectively support nurse managers' duties, such as reporting, resource management, and assessing clinical performance. Few performance management information systems are available and features in many are scattered.

OBJECTIVES

 The purpose of the study was to determine nurse managers' opinions of information system support for performance management.

METHODS

 An online questionnaire was used to collect data from nurse managers (n = 419). Pearson's correlation coefficients and linear regression were used to examine the relationships between variables, which were nurse managers' ability to manage resources, to report and evaluate productivity, and to assess nursing performance and clinical procedures.

RESULTS

 More than half of the managers used performance management systems daily. Managers (60%) felt that they can use information systems to follow the use of physical resources, and in general (63%), they felt that it is easy to perform searches with the systems used for following up activity. Nurse managers' ability to manage resources, to report productivity, and to assess nursing care performance were correlated significantly with each other.

CONCLUSION

 Currently, managers have to collect data from various systems for management purposes, as system integration does not support performance data collection. The availability of continuous in-service training had a positive effect on information system use.

Using standardized nursing data for knowledge generation - Ward level analysis of point of care nursing documentation

BACKGROUND

Standardized nursing terminology is a prerequisite for describing nursing care processes and generating knowledge for decision-making and management. The structure of the Finnish Care Classification (FinCC) facilitates documentation of nationally agreed core nursing data: nursing diagnoses, interventions, and outcomes.

PURPOSE

To analyze the use of FinCC to assess patient care needs (nursing diagnoses), care implementations (interventions) and evaluation of the outcomes of nursing care in electronic health records.

METHODS AND MATERIALS

The descriptive study applied purposeful sampling of nursing data from nursing data repositories in three surgical wards in tertiary and secondary care hospitals. The aggregated, anonymous ward level data from a six-month period was analyzed to show distributions within frequencies and means of component, main and subcategory level use of FinCC in the three hospitals.

RESULTS

Each of the three levels of the FinCC (component, main and subcategory) were used for recording nursing care. In all hospitals, the three most used diagnosis components covered about one third of the use of all the 17 components. The five most used intervention components cover about one third of the components. The most often used components for diagnoses and interventions were Coordination of care and follow-up care, Pain Management, Activities of daily living and independence and Medication. The prevalence of different components and the main and subcategory level usage for both diagnoses and interventions varied between the hospitals.

CONCLUSION

Standardized point-of-care nursing data makes patients' daily nursing care transparent. Structured, standardized, and point-of-care nursing data can be utilized to generate new knowledge of nursing care processes and nursing care practice at ward level.

Assessing EHR Data for Use in Clinical Improvement and Research

ABSTRACT

Data from electronic health records (EHRs) are becoming accessible for use in clinical improvement projects and nursing research. But the data quality may not meet clinicians' and researchers' needs. EHR data, which are primarily collected to document clinical care, invariably contain errors and omissions. This article introduces nurses to the secondary analysis of EHR data, first outlining the steps in data acquisition and then describing a theory-based process for evaluating data quality and cleaning the data. This process involves methodically examining the data using six data quality dimensions-completeness, correctness, concordance, plausibility, currency, and relevance-and helps the clinician or researcher to determine whether data for each variable are fit for use. Two case studies offer examples of problems that can arise and their solutions.

Evaluation of an Electronic Medical Record Module for Nursing Documentation in Paediatric Palliative Care: Involvement of Nurses with a Think-Aloud Approach

BACKGROUND

Paediatric palliative care (PPC) is a noncurative approach to the care of children and adolescents with life-limiting and life-threatening illnesses. Electronic medical records (EMRs) play an important role in documenting such complex processes. Despite their benefits, they can introduce unintended consequences if future users are not involved in their development.

AIM

The aim of this study was to evaluate the acceptance of a novel module for nursing documentation by nurses working in the context of PPC.

METHODS

An observational study employing concurrent think-aloud and semi-structured qualitative interviews were conducted with 11 nurses working in PPC. Based on the main determinants of the unified theory of acceptance and use of technology (UTAUT), data were analysed using qualitative content analysis.

RESULTS

The main determinants of UTAUT were found to potentially influence acceptance of the novel module. Participants perceived the module to be self-explanatory and intuitive. Some adaptations, such as the reduction of fragmentation in the display, the optimization of confusing mouseover fields, and the use of familiar nursing terminology, are reasonable ways of increasing software adoption.

CONCLUSIONS

After adaptation of the modules based on the results, further evaluation with the participation of future users is required.

Jordanian nurses' attitudes toward using electronic health records during COVID-19 pandemic

Electronic health records (EHRs) have proven their effectiveness during the coronavirus disease (COVID-19) pandemic. However, successful implementation of EHRs requires assessing nurses' attitudes as they are considered the first line in providing direct care for patients. This study assessed Jordanian nurses' attitudes and examined factors that affect nurses' attitudes toward using EHRs. A cross-sectional, correlational design was used. A convenient sample of 130 nurses was recruited from three major public hospitals in Jordan. All Participants completed the Nurses' attitudes Towards Computerization (NATC) Questionnaire. The overall nurses' attitude was positive; the mean was 61.85 (SD = 10.97). Findings revealed no significant relationship between nurses' attitudes toward using EHRs and nurses’ age, gender, education level, previous computer skills experience, years of work experience, and years of dealing with EHRs. However, the work unit was found to have a significant correlation with nurses' attitudes toward using EHRs. Therefore, nurse administrators should arrange for the conduct of educational workshops and continuous training programs considering the needs of the nurses.

The negative impact of interface design, customizability, inefficiency, malfunctions, and information retrieval on user experience: A national usability survey of ICU clinical information systems in Finland

INTRODUCTION

Clinical information systems (CISs) used in intensive care units (ICU) integrate large amounts of patient data every minute, and from multiple systems and devices. Intensive care requires efficient use of information technology to acquire, synchronize, integrate, and analyze data in order to make quick decisions and implement interventions in a timely manner.

OBJECTIVES

To identify factors affecting poor user experience (UX) of CISs used in ICUs in Finland.

METHODS

Data from national Electronic Health Record (EHR) and user experience survey was undertaken in 2017. Those, who used the ICU CIS on a daily or weekly basis were asked supplementary questions and, therefore, comprise a subset of the responses reported in this article.

RESULTS

On a 4-10 scale (i.e., "Fail" to "Excellent"), the mean 'grade' for the principally used ICU CIS was 6.9 (SD 1.3) points. Of the respondents, 119 (57%) were categorized as having good UX. The factors identified as affecting poor UX of the ICU CISs related to poor interface design (OR 7.8; 95% CIs 12.5-24.1; p = 0.001), insufficient customizability (OR 7.2; 95% CIs 1.7-30.6; p = 0.008), the inefficiency of performing routine tasks (OR 4.3; 95% CIs 1.0-18.2; p = 0.044), malfunctions (OR 3.5; 95% CIs 1.2-9.6; p = 0.019), and difficulties in information retrieval (OR 3.0; 95% CIs 1.0-8.8; p = 0.044). The most commonly reported usability problems with the main EHR system and ICU CISs were also identified.

CONCLUSIONS

Overall satisfaction with the principally used ICU CIS was moderate. However, the overall grades varied significantly. Poor interface design, insufficient customizability, inefficiency, malfunctions, and difficulties in information retrieval all affect poor UX.

Electronic Health Record Implementations and Insufficient Training Endanger Nurses' Well-being: Cross-sectional Survey Study

Background

High expectations have been set for the implementations of health information systems (HIS) in health care. However, nurses have been dissatisfied after implementations of HIS. In particular, poorly functioning electronic health records (EHRs) have been found to induce stress and cognitive workload. Moreover, the need to learn new systems may require considerable effort from nurses. Thus, EHR implementations may have an effect on the well-being of nurses.

Objective

This study aimed to examine the associations of EHR-to-EHR implementations and the sufficiency of related training with perceived stress related to information systems (SRIS), time pressure, and cognitive failures among registered nurses. Moreover, we examined the moderating effect of the employment sector (hospital, primary care, social services, and others) on these associations.

Methods

This study was a cross-sectional survey study of 3610 registered Finnish nurses in 2020. EHR implementation was measured by assessing whether the work unit of each respondent had implemented or will implement a new EHR (1) within the last 6 months, (2) within the last 12 months, (3) in the next 12 months, and (4) at no point within the last 12 months or in the forthcoming 12 months. The associations were examined using analyses of covariance adjusted for age, gender, and employment sector.

Results

The highest levels of SRIS (adjusted mean 4.07, SE 0.05) and time pressure (adjusted mean 4.55, SE 0.06) were observed among those who had experienced an EHR implementation within the last 6 months. The lowest levels of SRIS (adjusted mean 3.26, SE 0.04), time pressure (adjusted mean 4.41, SE 0.05), and cognitive failures (adjusted mean 1.84, SE 0.02) were observed among those who did not experience any completed or forthcoming implementations within 12 months. Nurses who perceived that they had received sufficient implementation-related training experienced less SRIS (F₁=153.40, P<.001), time pressure (F₁=80.95, P<.001), and cognitive failures (F₁=34.96, P<.001) than those who had received insufficient training. Recent implementations and insufficient training were especially strongly associated with high levels of SRIS in hospitals.

Conclusions

EHR implementations and insufficient training related to these implementations may endanger the well-being of nurses and even lead to errors. Thus, it is extremely important for organizations to offer comprehensive training before, during, and after implementations. Moreover, easy-to-use systems that allow transition periods, a re-engineering approach, and user involvement may be beneficial to nurses in the implementation process. Training and other improvements would be especially important in hospitals.

The associations of information system's support and nurses' documentation competence with the detection of documentation-related errors: Results from a nationwide survey

The use of information systems and electronic documentation has become a central part of a nurse's work, and it is expected to increase the quality of documentation and patient safety. However, errors related to documentation have been identified as a significant risk for the quality and safety of care. This study examined whether information system's support for documentation and nurses' documentation competence are associated with how frequently nurses detect documentation-related errors that have caused an adverse event. A nationwide survey was conducted in 2020, and a total of 3610 nurses participated. Results from linear regression analyses showed that high documentation support from the information system and high documentation competence were associated with fewer detected documentation-related errors. Nurses with low documentation support from the system and low documentation competence detected the most errors. The results highlight the need to develop electronic health record functions in a way that they better support accurate documentation. Furthermore, organisations should invest in ensuring the documentation skills of nurses and providing appropriate training.

The information system stress, informatics competence and well-being of newly graduated and experienced nurses: a cross-sectional study

BACKGROUND

The use of information systems takes up a significant amount of nurses' daily working time. Increased use of the systems requires nurses to have adequate competence in nursing informatics and is known to be a potential source of stress. However, little is known about the role of nursing informatics competence and stress related to information systems (SRIS) in the well-being of nurses. Moreover, the potential impact of nurses' career stage on this matter is unknown. This study examined whether SRIS and nursing informatics competence are associated with stress and psychological distress in newly graduated nurses (NGNs) and experienced nurses.

METHODS

A cross-sectional study was conducted in Finland between October and December 2018. The participants were NGNs (n = 712) with less than two years of work experience and experienced nurses (n = 1226) with more than two years of work experience. The associations of nursing informatics and SRIS with nurses' stress and psychological distress were analyzed with linear regression analysis. Analyses were conducted separately for NGNs and experienced nurses. Models were adjusted for age, gender, and work environment.

RESULTS

SRIS was associated with stress / psychological distress for both NGNs (β = 0.26 p < 0.001 / β = 0.22 p < 0.001) and experienced nurses (β = 0.21 p < 0.001/ β = 0.12 p < 0.001). Higher nursing informatics competence was associated with lower stress (β = 0.20 p < 0.001) and psychological distress (β = 0.16 p < 0.001) in NGNs, but not among experienced nurses.

CONCLUSIONS

SRIS appears to be an equal source of stress and distress for nurses who are starting their careers and for more experienced nurses, who are also likely to be more experienced users of information systems. However, informatics competence played a more important role among NGNs and a lack of adequate competence seems to add to the strain that is already known to be high in the early stages of a career. It would be important for educational institutions to invest in nursing informatics so that new nurses entering the workforce have sufficient skills to work in increasingly digital health care.

Approaches for defining and assessing nursing informatics competencies: a scoping review

OBJECTIVE

The objective of this scoping review was to examine and map the literature on defining and assessing nursing informatics competencies for nurses and nursing students.

INTRODUCTION

Over the past three decades, nursing informatics competency research has evolved markedly within countries and nursing roles. It is important to examine the available literature on defining and assessing nursing informatics competencies to inform education, clinical practice, policy, and future research.

INCLUSION CRITERIA

We considered literature that defined or assessed the concept of nursing informatics competency as a combination of knowledge, skills, and attitudes. This included nursing informatics competencies of nurses and nursing students in a variety of health care or academic settings.

METHODS

An extensive search was conducted in Ovid MEDLINE, CINAHL Plus with Full Text via EBSCO, Ovid Embase, Ovid PsycINFO, ProQuest ERIC, Health and Psychosocial Instruments, ProQuest Australian Education Index, ProQuest Education Databases, ProQuest Dissertations and Theses Global, OCLC PapersFirst, Scopus, Web of Science Core Collection, Wiley Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and the JBI Database of Systematic Reviews and Implementation Reports. The initial search was conducted in May 2017 and updated several times. Nursing informatics websites were searched for gray literature, including unpublished research and organizational documents. Additional papers were identified based on a search of reference lists of all the included papers. Neither language nor date restrictions were applied. Two reviewers assessed each of the included papers independently. Data extraction was undertaken using an extraction tool developed specifically for the scoping review objectives.

RESULTS

Fifty-two papers were included. Thirty-four papers identified nursing informatics competencies, grouped into four categories: i) nursing informatics competencies for students, entry-level nurses, or generalist nurses; ii) nursing informatics competencies for a specific nursing role; iii) recommendations for consensus on defining core nursing informatics competencies at the international level; and iv) forecasting future nursing informatics competencies as per evolving nursing roles. Eighteen papers reported on nursing informatics competency assessment tools. Results were discussed in a narrative format supported by tables.

CONCLUSIONS

This review provided insights to the state of the science on defining and assessing nursing informatics competencies for nurses and nursing students. Several nursing informatics competency lists are available, and despite some variations in domains of nursing informatics competency and indicator statements, they mostly share common themes. This literature demonstrates a heightened awareness of the importance of nursing informatics competency; however, the availability of many lists may be challenging for frontline nursing staff, nursing educators, administrators, researchers, and students to assimilate. Further research is needed to reach a consensus on core domains of nursing informatics competency and associated indicators, preferably per nursing roles, with international involvement and consensus. Additionally, while many nursing informatics competency assessment tools exist, further research is needed to examine psychometric properties of some of these tools.

Measuring Nurses' Transition to Electronic Handover: Validation of the Perception and Adaptation Readiness of Electronic Handover Systems Scales

The transition from traditional handover methods to electronic handover is extremely stressful to nurses. This psychometric evaluation study tested the validity and reliability of the perception and adaptation readiness of electronic handover system scales for hospital nurses. A total of 253 Taiwanese nurses from a medical center participated in this study from January to March 2018. The perception and adaptation readiness of electronic handover system scales were self-developed, and content validity was tested via content validity index of the scale. Exploratory factor analysis and confirmatory factor analysis were utilized to test construct validity, while reliability was tested by Cronbach's α coefficient. Four factors explained 50.77% of the total variance in the perception of electronic handover system scale. Three factors accounted for 53.43% of the total variance in the adaptation readiness of electronic handover system scale. The confirmatory factor analysis results indicated a three-factor construct for both scales. Cronbach's α coefficients were 0.83 and 0.91 for the perception and adaptation readiness of the electronic handover system scale, respectively. The scales could be used to assess nurses' perceptions and adaptation readiness of electronic handover, while the assessing result serves as a reference for implementing educational and supportive interventions to facilitate adaptation in nurses.

Behavior change techniques to promote healthcare professionals' eHealth competency: A systematic review of interventions

INTRODUCTION

The use of eHealth is rapidly -->increasing; however, many healthcare professionals have insufficient eHealth competency. Consequently, interventions addressing eHealth competency might be useful in fostering the effective use of eHealth.

OBJECTIVE

Our systematic review aimed to identify and evaluate the behavior change techniques applied in interventions to promote healthcare professionals' eHealth competency.

METHODS

We conducted a systematic literature review following the Joanna Briggs Institute's Manual for Evidence Synthesis. Published quantitative studies were identified through screening PubMed, Embase, and CINAHL. Two reviewers independently performed full-text and quality assessment. Eligible interventions were targeted to any healthcare professional and aimed at promoting eHealth capability or motivation. We synthesized the interventions narratively using the Behavior Change Technique Taxonomy v1 and the COM-B model.

RESULTS

This review included 32 studies reporting 34 heterogeneous interventions that incorporated 29 different behavior change techniques. The interventions were most likely to improve the capability to use eHealth and less likely to enhance motivation toward using eHealth. The promising techniques to promote both capability and motivation were action planning and participatory approach. Information about colleagues' approval, emotional social support, monitoring emotions, restructuring or adding objects to the environment, and credible source are techniques worth further investigation.

CONCLUSIONS

We found that interventions tended to focus on promoting capability, although motivation would be as crucial for competent eHealth performance. Our findings indicated that empathy, encouragement, and user-centered changes in the work environment could improve eHealth competency as a whole. Evidence-based techniques should be favored in the development of interventions, and further intervention research should focus on nurses and multifaceted competency required for using different eHealth systems and devices.

The Associations of Electronic Health Record Usability and User Age With Stress and Cognitive Failures Among Finnish Registered Nurses: Cross-Sectional Study

BACKGROUND

Electronic health records (EHRs) are expected to provide many clinical and organizational benefits. Simultaneously, the end users may face unintended consequences, such as stress and increased cognitive workload, due to poor EHR usability. However, whether the effects of usability depend on end user characteristics, such as career stage or age, remains poorly understood.

OBJECTIVE

The objective of this study was to examine the associations of EHR usability and user age with stress related to information systems and cognitive failures among registered nurses.

METHODS

A cross-sectional survey design was employed in Finland in 2017. A total of 3383 registered nurses responded to the nationwide electronic survey. Multiple linear regression was used to examine the associations of EHR usability (eg, how easily information can be found and a patient's care can be documented) and user age with stress related to information systems and cognitive failures. Interaction effects of EHR usability and age were also tested. Models were adjusted for gender and employment sector.

RESULTS

Poor EHR usability was associated with higher levels of stress related to information systems (β=.38; P<.001). The strength of the association did not depend on user age. Poor EHR usability was also associated with higher levels of cognitive failures (β=.28; P<.001). There was a significant interaction effect between age and EHR usability for cognitive failures (β=.04; P<.001). Young nurses who found the EHR difficult to use reported the most cognitive failures.

CONCLUSIONS

Information system stress due to poor EHR usability afflicts younger and older nurses alike. However, younger nurses starting their careers may be more cognitively burdened if they find EHR systems difficult to use compared to older nurses. Adequate support in using the EHRs may be particularly important to young registered nurses, who have a lot to learn and adopt in their early years of practice.