Evaluation of ICU Nurses' Use of the Clinical Information System in Taiwan

Caring for Computers: The Hidden Work of Clinical Nurses during the Introduction of Health Information Systems in a Teaching Hospital in Taiwan

Implementing health information systems for enhancing patient care and management occurs worldwide. Discovering how nurses, as important system end-users, experience technology-reliant clinical practice involved focus groups (n = 25) and in-depth individual interviews with nurses (n = 4) and informatics staff (n = 3) in a major Taiwanese medical center. This qualitative study explores the unintended effects of these systems on nurses’ role and clinical practice. First, nurses’ additional role caring for computer devices supporting patient care involves highly-demanding invisible effort, especially when tackling system malfunctions affecting patients with urgent conditions. Second, nurses are resourceful in developing solutions to protect patients during unexpected technical malfunctions. Third, troubleshooting using telephone technical support as the first resort is problematic. It is argued that computerization requires nurses to care for co-clients: patients and computers. Managing technical malfunctions is an unintended consequence for nurses, reflecting the hidden work required by new technology.

Understanding the Essence of Caring from the Lived Experiences of Filipino Informatics Nurses

Caring is considered a unique concept in nursing because it subsumes all intrinsic attributes of nursing as a human helping discipline. Scholars have argued that caring is usually seen as an encounter between nurses and patients, but how about nurses with minimal or absent nurse-patient encounters, like informatics nurses? In this study, we explored the meaning of the phenomenon of caring to present lived experiences of caring, namely caring as actions of coming in between; caring as expressed within embodied relations; and caring and the path traversed by informatics nurses. The informatics nurse-cyborg-patient triad speaks of Filipino informatics nurses’ insightful understanding of the phenomenon of caring.

Barriers and facilitators to the implementation of an evidence-based electronic minimum dataset for nursing team leader handover: A descriptive survey

INTRODUCTION

There is widespread use of clinical information systems in intensive care units however, the evidence to support electronic handover is limited.

OBJECTIVES

The study aim was to assess the barriers and facilitators to use of an electronic minimum dataset for nursing team leader shift-to-shift handover in the intensive care unit prior to its implementation.

METHODS

The study was conducted in a 21-bed medical/surgical intensive care unit, specialising in cardiothoracic surgery at a tertiary referral hospital, in Queensland, Australia. An established tool was modified to the intensive care nursing handover context and a survey of all 63 nursing team leaders was undertaken. Survey statements were rated using a 6-point Likert scale with selections from 'strongly disagree' to 'strongly agree', and open-ended questions. Descriptive statistics were used to summarise results.

RESULTS AND DISCUSSION

A total of 39 team leaders responded to the survey (62%). Team leaders used general intensive care work unit guidelines to inform practice however they were less familiar with the intensive care handover work unit guideline. Barriers to minimum dataset uptake included: a tool that was not user friendly, time consuming and contained too much information. Facilitators to minimum dataset adoption included: a tool that was user friendly, saved time and contained relevant information. Identifying the complexities of a healthcare setting prior to the implementation of an intervention assists researchers and clinicians to integrate new knowledge into healthcare settings.

CONCLUSION

Barriers and facilitators to knowledge use focused on usability, content and efficiency of the electronic minimum dataset and can be used to inform tailored strategies to optimise team leaders' adoption of a minimum dataset for handover.

Towards Usable E-Health. A Systematic Review of Usability Questionnaires

BACKGROUND

The use of e-health can lead to several positive outcomes. However, the potential for e-health to improve healthcare is partially dependent on its ease of use. In order to determine the usability for any technology, rigorously developed and appropriate measures must be chosen.

OBJECTIVES

To identify psychometrically tested questionnaires that measure usability of e-health tools, and to appraise their generalizability, attributes coverage, and quality.

METHODS

We conducted a systematic review of studies that measured usability of e-health tools using four databases (Scopus, PubMed, CINAHL, and HAPI). Non-primary research, studies that did not report measures, studies with children or people with cognitive limitations, and studies about assistive devices or medical equipment were systematically excluded. Two authors independently extracted information including: questionnaire name, number of questions, scoring method, item generation, and psychometrics using a data extraction tool with pre-established categories and a quality appraisal scoring table.

RESULTS

Using a broad search strategy, 5,558 potentially relevant papers were identified. After removing duplicates and applying exclusion criteria, 35 articles remained that used 15 unique questionnaires. From the 15 questionnaires, only 5 were general enough to be used across studies. Usability attributes covered by the questionnaires were: learnability (15), efficiency (12), and satisfaction (11). Memorability (1) was the least covered attribute. Quality appraisal showed that face/content (14) and construct (7) validity were the most frequent types of validity assessed. All questionnaires reported reliability measurement. Some questionnaires scored low in the quality appraisal for the following reasons: limited validity testing (7), small sample size (3), no reporting of user centeredness (9) or feasibility estimates of time, effort, and expense (7).

CONCLUSIONS

Existing questionnaires provide a foundation for research on e-health usability. However, future research is needed to broaden the coverage of the usability attributes and psychometric properties of the available questionnaires.

The evaluation of diabetic patients' use of a telehealth program

Diabetes is a metabolic disorder that, if not treated promptly and appropriately, can cause complex health complications and mortality. Care models that apply technology, such as telehealth, may be useful in working with diabetes patients. The development and application of wireless communication telehealth have significantly affected healthcare in recent years. Thus, the purpose of this study was to evaluate diabetic patients' use of a telehealth program by using questionnaire survey and laboratory data results. A quantitative study, 1-group pretest-posttest design, was conducted. This study recruited 20 diabetic patients who received telehealth service to measure their glucose, heart rate, and blood pressure, with data uploaded back to the hospital daily. A questionnaire survey was conducted in May 2012 and between August and January 2013 with 20 participants. The test values (blood pressure, heart rate, and blood glucose) of subjects were obtained from the hospital telecare platform and the outpatient monthly reporting system. Study findings showed an overall satisfaction rating of 91% by telehealth participants. Nonparametric statistical analysis demonstrated a significant difference (P < .01) in participants' glycosylated hemoglobin and resultant effective control. These findings indicated that participants accepted this care model, and telehealth could improve participants' glucose control.

Usability Evaluation of An Electronic Medication Administration Record (eMAR) Application

BACKGROUND

Electronic medication administration records (eMARs) have been widely used in recent years. However, formal usability evaluations are not yet available for these vendor applications, especially from the perspective of nurses, the largest group of eMAR users.

OBJECTIVE

To conduct a formal usability evaluation of an implemented eMAR.

METHODS

Four evaluators examined a commercial vendor eMAR using heuristic evaluation techniques. The evaluators defined seven tasks typical of eMAR use and independently evaluated the application. Consensus techniques were used to obtain 100% agreement of identified usability problems and severity ratings. Findings were reviewed with 5 clinical staff nurses and the Director of Clinical Informatics who verified findings with a small group of clinical nurses.

RESULTS

Evaluators found 60 usability problems categorized into 233 heuristic violations. Match, Error, and Visibility heuristics were the most frequently violated. Administer Medication and Order and Modify Medications tasks had the highest number of heuristic violations and usability problems rated as major or catastrophic.

CONCLUSION

The high number of usability problems could impact the effectiveness, efficiency and satisfaction of nurses' medication administration activities and may include concerns about patient safety. Usability is a joint responsibility between sites and vendors. We offer a call to action for usability evaluations at all sites and eMAR application redesign as necessary to improve the user experience and promote patient safety.