Applying Computational Ethnography to Examine Nurses' Workflow Within Electronic Health Records

Adaptation of the Workflow Integration Survey to Turkey: A Validity and Reliability Study

Background and Purpose: Electronic health record systems (EHRSs) are widely used to record patients' data and should be compatible with nurses' workflow. The purpose of this study was to adapt the Workflow Integration Survey (WIS) to the Turkish language and examine the reliability and validity measures of the Turkish version of the scale. Methods: In this methodological study, data were collected between December 2019 and February 2020 from 120 nurses. This study included the following phases: translation and evaluation of the content validity; explanatory factor analysis and confirmatory factor analysis (CFA) and reliability analysis. The intraclass correlation coefficient (ICC) was used for the test-retest reliability with 30 nurses. Results: The results of CFA revealed a two factors' structure, and these two factors explained 50.57% of the total variance. This was confirmed (χ2/df = 1.673, goodness-of-fit index = 0.948, incremental fit index = 0.923, comparative fit index = 0.918, root mean square error of approximation = 0.075, and standardized root mean square residual = 0.0604) using structural equation modeling. The total Cronbach's alpha value was found to be .702, .636, and .649 for the subscales. The ICC was calculated for test-retest reliability and was found to be 0.871. Conclusions: The validity and reliability of the WIS have been found to be sufficient. It is recommended that the validity and reliability studies on the WIS be conducted in different hospitals with a larger number of participants. Furthermore, the use of the scale in cross-cultural studies to evaluate the compatibility of EHRSs with nurses' workflow in different cultures is also suggested.

Computerization of risk prediction scale: strategy for safety and quality of care

OBJECTIVE

To describe the development of computerization of risk prediction scales used by nursing in the AGHUse® system.

METHOD

An experience report of technological production at a university hospital, which followed the phases of conception, detailing, construction and prototyping.

RESULTS

Different scales were computerized, with emphasis on the Braden and Braden Q, which assess the risk of pressure injuries, and the Severo-Almeida-Kuchenbecker, which assesses the risk of falls. The process of computerization and implementation took place through registration of the scales in the software, application of them in care practice, integration and visualization of their scores with the other functionalities of the electronic medical record.

FINAL CONSIDERATIONS

The functionalities developed in the computerization of risk prediction scales favored its operation, reflecting positively on nursing practice and patient safety.

Neonatal Intensive Care Workflow Analysis Informing NEC-Zero Clinical Decision Support Design

Decision support in neonatal ICUs is needed, especially for prevention and risk awareness of the devastating complication of necrotizing enterocolitis, a major cause of emergency surgery among fragile infants. The purpose of this study was to describe the current clinical workflow and sociotechnical processes among clinicians for necrotizing enterocolitis risk awareness, timely recognition of symptoms, and treatment to inform decision support design. A qualitative descriptive study was conducted. Focus groups were held in two neonatal ICUs (five groups in Unit A and six in Unit B). Transcripts were analyzed using content analysis and compared with field notes. Clinicians (N = 27) included nurses (37%), physicians (30%), neonatal nurse practitioners (19%), and other staff (16%). Workflow processes differed for nurses (who see necrotizing enterocolitis signs and notify providers to order diagnostic tests and treatments) and providers (who receive notification of necrotizing enterocolitis concern and then decide how to act). Clinicians desired (1) a necrotizing enterocolitis-relevant dashboard to support nutrition tracking and necrotizing enterocolitis recognition; (2) features to support decision-making (eg, necrotizing enterocolitis risk and adherence scoring); (3) breast milk tracking and feeding clinical decision support; (4) tools for necrotizing enterocolitis surveillance and quality reporting; and (5) general EHR optimizations to improve user experience.

Information and Data Visualization Needs among Direct Care Nurses in the Intensive Care Unit

OBJECTIVES

Intensive care unit (ICU) direct care nurses spend 22% of their shift completing tasks within the electronic health record (EHR). Miscommunications and inefficiencies occur, particularly during patient hand-off, placing patient safety at risk. Redesigning how direct care nurses visualize and interact with patient information during hand-off is one opportunity to improve EHR use. A web-based survey was deployed to better understand the information and visualization needs at patient hand-off to inform redesign.

METHODS

A multicenter anonymous web-based survey of direct care ICU nurses was conducted (9-12/2021). Semi-structured interviews with stakeholders informed survey development. The primary outcome was identifying primary EHR data needs at patient hand-off for inclusion in future EHR visualization and interface development. Secondary outcomes included current use of the EHR at patient hand-off, EHR satisfaction, and visualization preferences. Frequencies, means, and medians were calculated for each data item then ranked in descending order to generate proportional quarters using SAS v9.4.

RESULTS

In total, 107 direct care ICU nurses completed the survey. The majority (46%, n = 49/107) use the EHR at patient hand-off to verify exchanged verbal information. Sixty-four percent (n = 68/107) indicated that current EHR visualization was insufficient. At the start of an ICU shift, primary EHR data needs included hemodynamics (mean 4.89 ± 0.37, 98%, n = 105), continuous IV medications (4.55 ± 0.73, 93%, n = 99), laboratory results (4.60 ± 0.56, 96%, n = 103), mechanical circulatory support devices (4.62 ± 0.72, 90%, n = 97), code status (4.40 ± 0.85, 59%, n = 108), and ventilation status (4.35 + 0.79, 51%, n = 108). Secondary outcomes included mean EHR satisfaction of 65 (0-100 scale, standard deviation = ± 21) and preferred future EHR user-interfaces to be organized by organ system (53%, n = 57/107) and visualized by tasks/schedule (61%, n = 65/107).

CONCLUSION

We identified information and visualization needs of direct care ICU nurses. The study findings could serve as a baseline toward redesigning an EHR interface.