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Blanchard J, Vigen C, Mallinson T, Carlson M, Garber SL, Bates-Jensen B. Pressure Injury Data Reconciliation in a Randomized Controlled Trial. Arch Phys Med Rehabil 2023; 104:1833-1839. [PMID: 37121533 PMCID: PMC10611896 DOI: 10.1016/j.apmr.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/01/2023] [Accepted: 04/07/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To advance pressure injury (PrI) research in individuals with spinal cord injury (SCI) by describing lessons learned and recommendations for future research, ultimately promoting PrI prevention and more effective wound care. This paper describes the detailed procedures undertaken to collect and reconcile PrI data and summarizes the types of discrepancies identified. DESIGN Secondary analyses of PrI data collected between 2009 and 2014 in a randomized controlled trial (parent study). SETTING Participants in the parent study were recruited from a large rehabilitation center in the Los Angeles area that serves primarily individuals with limited resources. PARTICIPANTS 232 participants with SCI and a history of 1 or more medically serious PrI (MSPrI) in the previous 5 years. INTERVENTIONS Participants in the parent study were randomized to a 12-month PrI prevention intervention led by an occupational therapist, or to usual care. MAIN OUTCOME MEASURES Relations among PrI characteristics, data sources (phone interviews, skin checks, paper and electronic medical records [MRs]), and treatment condition, and sensitivity of 6 different data sources in detecting MSPrIs. RESULTS The majority (62%) of MSPrIs were in the pelvic region. MRs detected 82% of the MSPrIs overall, making it the most sensitive data source, and scheduled skin checks were the second-most sensitive data source, finding 37% of the MSPrIs. CONCLUSIONS MR review is the preferred method for ascertaining MSPrIs in clinical trials of interventions designed to reduce the incidence of these injuries. When multiple sources of information are used, careful reconciliation of reports is necessary to ensure accuracy.
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Affiliation(s)
- Jeanine Blanchard
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA.
| | - Cheryl Vigen
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Trudy Mallinson
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Mike Carlson
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Susan L Garber
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX
| | - Barbara Bates-Jensen
- School of Nursing and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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Furtado K, Voorham J, Infante P, Afonso A, Morais C, Lucas P, Lopes M. The Relationship between Nursing Practice Environment and Pressure Ulcer Care Quality in Portugal's Long-Term Care Units. Healthcare (Basel) 2023; 11:1751. [PMID: 37372869 DOI: 10.3390/healthcare11121751] [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: 03/30/2023] [Revised: 06/01/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The morbidity associated with ageing has contributed to an increase in the prevalence of Pressure Ulcers (PUs) in all care settings. The impact of these on people's quality of life and the extent of the associated economic and social burden constitutes today, by their importance, a serious public health problem. This study aims to describe the nursing work environment in Portuguese long-term care (LTC) units and to assess how this environment relates to the quality of PU care. METHODS A longitudinal study among inpatients with PUs was conducted in LTC units. The Nursing Work Index-Revised Scale (NWI-R) was sent to all nurses in these units. Cox proportional hazard models were used to relate the satisfaction degree with the service (measured by the NWI-R-PT items) to the healing time of the PUs, adjusting for confounders. RESULTS A total of 165 of 451 invited nurses completed the NWI-R-PT. Most were women (74.6%) and had 1 to 5 years of professional experience. Less than half (38.4%) had education in wound care. Of the 88 patients identified with PUs, only 63 had their PU documented, highlighting the difficulties in updating electronic records. The results showed that the level of concordance with Q28 "Floating so that staffing is equalised among units" is strongly associated with a shorter PU healing time. CONCLUSION A good distribution of nursing staff over the units will likely improve the quality of wound care. We found no evidence for possible associations with the questions on participation in policy decisions, salary level, or staffing educational development and their relationship with PUs healing times.
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Affiliation(s)
- Katia Furtado
- Out Patient Department, Hospital of Portalegre, Unidade Local de Saúde do Norte Alentejano, 7300-312 Portalegre, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Escola Superior de Enfermagem de Lisboa, Av. Prof. Egas Moniz, 1600-096 Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-671 Évora, Portugal
| | - Jaco Voorham
- DTIRS-Data to Insights Research Solutions, 1750-307 Lisboa, Portugal
| | - Paulo Infante
- Research Center in Mathematics and Applications (CIMA), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, 7000-671 Évora, Portugal
- Departamento de Matemática, Escola de Ciências e Tecnologia (ECT), Universidade de Évora, 7000-671 Évora, Portugal
| | - Anabela Afonso
- Research Center in Mathematics and Applications (CIMA), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, 7000-671 Évora, Portugal
- Departamento de Matemática, Escola de Ciências e Tecnologia (ECT), Universidade de Évora, 7000-671 Évora, Portugal
| | - Clara Morais
- Administração Regional de Saúde do Alentejo, Largo do Jardim do Paraíso, nº 1, 7000-864 Évora, Portugal
| | - Pedro Lucas
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Escola Superior de Enfermagem de Lisboa, Av. Prof. Egas Moniz, 1600-096 Lisbon, Portugal
| | - Manuel Lopes
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-671 Évora, Portugal
- São João de Deus School of Nursing, Universidade de Évora, 7000-671 Évora, Portugal
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Li D, Mathews C, Zamarripa C, Zhang F, Xiao Q. Wound tissue segmentation by computerised image analysis of clinical pressure injury photographs: a pilot study. J Wound Care 2022; 31:710-719. [PMID: 36001699 DOI: 10.12968/jowc.2022.31.8.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Wound tissues can provide ample information about the wound development and healing process. However, the manual identification and measurement of wound tissue types is time-consuming and challenging due to the complexities of pressure injuries (PI). This study aims to develop an image analysis algorithm to automatically identify and differentiate wound tissue types from PI wound beds. METHOD This was a cross-sectional algorithm development study. PI photographs were obtained from a western Pennsylvania hospital. We used our previously developed wound bed segmentation tool to identify PI wound beds. We then used the k-means clustering method to classify the subzones on the wound beds. Finally, the support vector machine classifier was used to identify the classified subzones to certain types of wound tissue. RESULTS An image analysis algorithm was developed, using 64 selected PI photographs, to automatically identify different wound tissues for PIs. CONCLUSION Validation of the wound tissue identification of the PIs by image analysis algorithm demonstrated that our image analysis algorithm is a reliable and objective approach to monitoring wound healing progress through clinical PI photographs, and offers new insight into PI evaluation and documentation. DECLARATION OF INTEREST The authors have no conflicts of interest to declare.
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Affiliation(s)
- Dan Li
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, US
| | - Carol Mathews
- University of Pittsburgh Medical Center Presbyterian Shadyside, US
| | | | - Fei Zhang
- Department of Nurse Anesthesia, University of Pittsburgh School of Nursing, US
| | - Qian Xiao
- School of Nursing, Capital Medical University, Beijing, China
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Content and comprehensiveness in the nursing documentation for residents in long-term dementia care: a retrospective chart review. BMC Nurs 2022; 21:84. [PMID: 35410289 PMCID: PMC9004102 DOI: 10.1186/s12912-022-00863-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background Insight into and understanding of content and comprehensiveness in nursing documentation is important to secure continuity and high-quality care planning in long-term dementia care. The accuracy of nursing documentation is vital in areas where residents have difficulties in communicating needs and preferences. This study described the content and comprehensiveness of nursing documentation for residents living with dementia in nursing homes. Methods We used a retrospective chart review to describe content and comprehensiveness in the nursing documentation. Person-centered content related to identity, comfort, inclusion, attachment, and occupation was identified, using an extraction tool derived from person-centered care literature. The five-point Comprehensiveness in the Nursing Documentation scale was used to describe the comprehensiveness of the nursing documentation in relation to the nursing process. Results The residents’ life stories were identified in 16% of the reviewed records. There were variations in the identified nursing diagnoses related to person-centered information, across all the five categories. There were variations in comprehensiveness within all five categories, and inclusion and occupation had the least comprehensive information. Conclusion Findings from this study highlights challenges in documenting person-centered information in a comprehensive way. To improve nursing documentation of residents living with dementia in nursing homes, nurses need to include residents’ perspectives and experiences in their planning and evaluation of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-00863-9.
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Bunting J, de Klerk M. Strategies to Improve Compliance with Clinical Nursing Documentation Guidelines in the Acute Hospital Setting: A Systematic Review and Analysis. SAGE Open Nurs 2022; 8:23779608221075165. [PMID: 35620302 PMCID: PMC9127672 DOI: 10.1177/23779608221075165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction This systematic review attempts to answer the following question - which strategies to improve clinical nursing documentation have been most effective in the acute hospital setting? Methods A keyword search for relevant studies was conducted in CINAHL and Medline in May 2019 and October 2020.Studies were appraised using the Joanna Briggs Institute (JBI) critical appraisal for quasi-experimental studies. The studies were graded for level of evidence according to GRADE principles.The data collected in each study were added to a Summary of Data (SOD) spreadsheet. Pre intervention and a post intervention percentage compliance scores were calculated for each study where possible i.e. (mean score/possible total score) × (100/1). A percentage change in compliance for each study was calculated by subtracting the pre intervention score from the post intervention score. The change in compliance score and the post intervention compliance score were both added to the SOD and used as a basis for comparison between the studies. Each study was analyzed thematically in terms of the intervention strategies used. Compliance rates and the interventions used were compared to determine if any strategies were effective in achieving a meaningful improvement in compliance. Results Seventy six full text articles were reviewed for this systematic review. Fifty seven of the studies were before and after studies and 66 were conducted in western countries. Publishing dates for the studies ranged from 1991 to 2020.Eleven studies included documentation audits with personal feedback as one of the strategies used to improve nursing documentation. Ten of these studies achieved a post intervention compliance rate ≥ 70%. Conclusion Notwithstanding the limitations of this study, it may be that documentation audit with personal feedback, when combined with other context specific strategies, is a reliable method for gaining meaningful improvements in clinical nursing documentation. The level of evidence is very low and further research is required.
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Affiliation(s)
- Jeanette Bunting
- Joondalup Health Campus Librarian, Joondalup, Western Australia,
Australia
| | - Melissa de Klerk
- Joondalup Health Campus Library
Technician, Joondalup, Western Australia, Australia
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Powell LE, Winn E, Andersen ES, Pozez AL. Utilizing a Comprehensive Wound Care Team to Lower Hospital-Acquired Pressure Injuries in an Academic Public Hospital: A Retrospective Cohort Study. J Wound Ostomy Continence Nurs 2022; 49:34-50. [PMID: 35040814 DOI: 10.1097/won.0000000000000821] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Hospital-acquired pressure injuries (HAPIs) have significant impacts on patient morbidity and mortality, with approximately 2.5 million patients treated for pressure-related injuries annually.1 This study aimed to describe the influence of a comprehensive wound care team on HAPIs over an 8-year period. DESIGN Retrospective cohort study. SUBJECTS AND SETTING All inpatients at an academic public hospital system with HAPIs during the study period from May 2012 to February 2020. METHODS Data on wound stage, location, infection, medical device location if applicable, and risk factors were recorded from medical records. A 1-way analysis of variance was performed to assess for significance of mean number of cases, National Pressure Injury Advisory Panel (NPIAP) stage on initial presentation, and mean number of medical device-related wounds by year. RESULTS A total of 957 cases were included. The median stage of pressure injury on assessment was 2, with the mean NPIAP stage declining from 2012 to 2020 (P = .003). Thirty-three percent of pressure injuries were attributed to medical devices, most commonly endotracheal tubing. The most common site of pressure injury was the sacrum (33.6%). CONCLUSION Creation of a comprehensive wound care team within our academic public hospital system demonstrated a significant decline in device-related and pressure injury cases over the past 8 years. The wound care team focused on frequent assessment, education, and evidence-based treatment to lower these HAPI events.
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Affiliation(s)
- Lauren E Powell
- Lauren E. Powell, MD, Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis
- Elisa Winn, MSN, RN, RN-BC, CWON, Virginia Commonwealth University Health System, Richmond
- Emily S. Andersen, MD, Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University Health System, Richmond
- Andrea L. Pozez, MD, Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University Health System, Richmond
| | - Elisa Winn
- Lauren E. Powell, MD, Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis
- Elisa Winn, MSN, RN, RN-BC, CWON, Virginia Commonwealth University Health System, Richmond
- Emily S. Andersen, MD, Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University Health System, Richmond
- Andrea L. Pozez, MD, Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University Health System, Richmond
| | - Emily S Andersen
- Lauren E. Powell, MD, Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis
- Elisa Winn, MSN, RN, RN-BC, CWON, Virginia Commonwealth University Health System, Richmond
- Emily S. Andersen, MD, Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University Health System, Richmond
- Andrea L. Pozez, MD, Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University Health System, Richmond
| | - Andrea L Pozez
- Lauren E. Powell, MD, Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis
- Elisa Winn, MSN, RN, RN-BC, CWON, Virginia Commonwealth University Health System, Richmond
- Emily S. Andersen, MD, Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University Health System, Richmond
- Andrea L. Pozez, MD, Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University Health System, Richmond
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Li Z, Marshall AP, Lin F, Ding Y, Chaboyer W. Pressure injury prevention practices among medical surgical nurses in a tertiary hospital: An observational and chart audit study. Int Wound J 2021; 19:1165-1179. [PMID: 34729917 PMCID: PMC9284631 DOI: 10.1111/iwj.13712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/13/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022] Open
Abstract
Pressure injuries are frequently occurring adverse events in hospitals, negatively impacting patient safety and quality of care. Most pressure injuries are avoidable if effective prevention strategies are used. However, the extent to which various settings influence their use of prevention strategies is unknown. The aim of this study was to describe and compare pressure injury prevention strategies used by medical and surgical nurses in the Chinese context. In this observational study, we used semi-structured observations with chart audits to collect data in two medical and two surgical wards in a tertiary hospital from June to December 2020. Observations were patient-focused; any prevention practices the patient received were recorded, and a chart audit was used to identify documented prevention strategies. The frequency of each prevention strategy was reported, and differences between medical and surgical wards were analysed using independent t-test or χ2 test. A total of 577 patients (n = 294, 50.9% medical; n = 283, 49.1% surgical) were observed and their charts audited. Risk assessment was completed on admission for all patients. Repositioning was the most frequently used strategy, with about 84% (n = 486) patients being repositioned regularly. However, skin care, nutritional risk screening and the use of support surfaces were suboptimal. Patient education was not commonly observed but was documented in 75% (n = 433) of audited charts. More medical patients' skin was kept clean and hydrated, but more surgical patients received barrier creams, had a support surface and received more nutrition support and if a prone position was used, they were more likely to be turned after 2 hr and to be repositioned after sitting in a chair for an hour. Prevention strategies were more likely to be documented in surgical patients' charts. Despite pressure injury prevention guideline recommendations provided various prevention strategies for nurses to apply, the observed use of some strategies such as nutrition, skin care and support surfaces was not ideal. Nurses relied heavily on repositioning for pressure injury prevention. Most pressure injury prevention practices need improvement although surgical patients generally received better preventative care. These findings can facilitate clinicians and nurse managers when tailoring future pressure injury prevention work.
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Affiliation(s)
- Zhaoyu Li
- School of Nursing and Midwifery, Griffith University, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Nursing and Midwifery Education and Research Unit, Gold Coast Health, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Frances Lin
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Yanming Ding
- Nursing Department, Peking University First Hospital, Beijing, China
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Jedwab RM, Chalmers C, Dobroff N, Redley B. Measuring nursing benefits of an electronic medical record system: A scoping review. Collegian 2019. [DOI: 10.1016/j.colegn.2019.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Stewart K, Doody O, Bailey M, Moran S. Improving the quality of nursing documentation in a palliative care setting: a quality improvement initiative. Int J Palliat Nurs 2019; 23:577-585. [PMID: 29272195 DOI: 10.12968/ijpn.2017.23.12.577] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM This paper reports on a quality-improvement project to develop nursing documentation that reflects holistic care within a specialist palliative centre. BACKGROUND The World Health Organization definition of palliative care includes impeccable assessment and management of pain and other symptoms. However, existing nursing documentation focuses mainly on the management of physical symptoms, with other aspects of nursing less frequently documented. METHODS Supported by a project team and expert panel, cycles of review, action and reflection were used to develop a new palliative nursing documentation. The project was divided into three phases: audits of existing nursing documentation, development of a new palliative nursing care document and audit tool, and pilot implementation and audit of the new nursing documentation. RESULTS The new palliative nursing care document demonstrated a higher level of compliance in relation to nursing assessments and a more concise, accurate and comprehensive approach to documenting holistic nursing care and recording of patients' perspective. CONCLUSIONS This project has enabled the consistent documentation of holistic nursing care and patients' perspectives; however, continuous education is necessary in order to sustain positive results and ensure that documentation does not become a 'tick box' exercise. Organisational support is required in order to improve documentation systems.
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Affiliation(s)
- Kate Stewart
- Clinical Effectiveness Administrator, Royal College of Pathologists, London, UK
| | - Owen Doody
- Lecturer, Department of Nursing and Midwifery, University of Limerick, Ireland
| | - Maria Bailey
- Lecturer, Department of Nursing and Midwifery, University of Limerick, Ireland
| | - Sue Moran
- Clinical Nurse Manager, Milford Care Centre, Limerick, Ireland
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Quantity of Documentation by Nursing Students Using Paper and Educational Electronic Medical Record System. Nurse Educ 2019; 44:293-294. [DOI: 10.1097/nne.0000000000000651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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González-Samartino M, Delgado-Hito P, Adamuz-Tomás J, Cano MFV, Creus MC, Juvé-Udina ME. Accuracy and completeness of records of adverse events through interface terminology. Rev Esc Enferm USP 2018; 52:e03306. [PMID: 29668785 DOI: 10.1590/s1980-220x2017011203306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 11/13/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine what adverse events, including pressure ulcers, infection of the surgical site and aspiration pneumonia, nurses record in clinical histories, in terms of diagnostic accuracy and completeness, through ATIC. METHOD Observational, descriptive, cross-sectional, multicenter study of 64 medical-surgical and semi-critical units of two university hospitals in Catalonia, Spain, during 2015. The diagnostic accuracy was assessed by means of the correspondence between the event declared in the Minimum Basic Data Set and the problem documented by the nurse. The record was considered complete when it contained the risk of the event, prescriptions of care and a record of the evolution. RESULTS The sample evaluated included 459 records. The accuracy results of pressure ulcers are highly correlated between the nursing diagnosis recorded and that declared in the Minimum Basic Data Set. The accuracy in surgical site infection is moderate, and aspiration resulting in pneumonia is very low. The completeness of results is remarkable, except for the risk of bronchoaspiration. CONCLUSION The adverse event recorded by nurses with greatest accuracy is pressure ulcers.
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Priestman W, Sridharan S, Vigne H, Collins R, Seamer L, Sebire NJ. What to expect from electronic patient record system implementation: lessons learned from published evidence. BMJ Health Care Inform 2018; 25:92-104. [DOI: 10.14236/jhi.v25i2.1007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/17/2018] [Indexed: 01/09/2023] Open
Abstract
BackgroundNumerous studies have examined factors related to success, failure and implications of electronic patient record (EPR) system implementations, but usually limited to specific aspects.ObjectiveTo review the published peer-reviewed literature and present findings regarding factors important in relation to successful EPR implementations and likely impact on subsequent clinical activity.MethodLiterature review.ResultsThree hundred and twelve potential articles were identified on initial search, of which 117 were relevant and included in the review. Several factors were related to implementation success, such as good leadership and management, infrastructure support, staff training and focus on workflows and usability. In general, EPR implementation is associated with improvements in documentation and screening performance and reduced prescribing errors, whereas there are minimal available data in other areas such as effects on clinical patient outcomes. The peer-reviewed literature appears to under-represent a range of technical factors important for EPR implementations, such as data migration from existing systems and impact of organisational readiness.ConclusionThe findings presented here represent the synthesis of data from peer-reviewed literature in the field and should be of value to provide the evidence-base for organisations considering how best to implement an EPR system.
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Shin EH, Cummings E, Ford K. A qualitative study of new graduates' readiness to use nursing informatics in acute care settings: clinical nurse educators' perspectives. Contemp Nurse 2017; 54:64-76. [PMID: 29037119 DOI: 10.1080/10376178.2017.1393317] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is an increase in demand for newly graduated nurses who are ready to use nursing informatics (NI) efficiently in technology-rich healthcare environments. However, the progress of embedding NI into curricula has been slow worldwide, and literature reports graduates are not ready to use NI tools effectively in the workplace, posing potential threats to patient safety. In the absence of National Standards for NI competencies, graduates' NI needs on entering the workplace need to be explored. AIM To identify graduates' NI needs on entering the workplace in acute care settings from the perspectives of clinical nurse educators. METHODS A qualitative study using interpretive description with one focus group of six clinical nurse educators was conducted. Clinical nurse educators who are significantly involved in supporting graduates from their first day in the workplace were purposively recruited. The focus group was audiotaped, transcribed verbatim and analysed using thematic analysis. RESULTS Graduates were found to be inadequately prepared to use NI tools on entering the workplace. Inefficient hospital systems and a ward culture that was discouraging graduates' NI practice were identified as major barriers to the implementation of NI practice. Lack of exposure to specific hospital systems as undergraduates was also identified as a significant barrier to NI practice among graduates. CONCLUSIONS As well as supporting the pre-existing studies on NI skills in graduates and barriers to graduates' NI practice, this current study identified the need for nursing schools to further integrate NI into formal curricula and increased opportunity for exposure to hospital systems as undergraduates. Further studies in multiple settings across Australia are recommended to ensure the transferability of the findings of this study.
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Affiliation(s)
- Eun Hee Shin
- a School of Health Sciences , University of Tasmania , Hobart , Australia
| | - Elizabeth Cummings
- a School of Health Sciences , University of Tasmania , Hobart , Australia
| | - Karen Ford
- a School of Health Sciences , University of Tasmania , Hobart , Australia.,b Centre for Education and Research , Royal Hobart Hospital , Hobart , Australia
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Gunningberg L, Bååth C, Sving E. Staff's perceptions of a pressure mapping system to prevent pressure injuries in a hospital ward: A qualitative study. J Nurs Manag 2017; 26:140-147. [DOI: 10.1111/jonm.12526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Lena Gunningberg
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala University Hospital; Uppsala Sweden
| | - Carina Bååth
- Faculty of Health, Sciences and Technology; Department of Health Sciences; Karlstad University; County Council of Värmland; Värmland Sweden
| | - Eva Sving
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala University Hospital; Uppsala Sweden
- Region Gävleborg; Gävle Sweden
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Bjarnadottir RI, Herzig CT, Travers JL, Castle NG, Stone PW. Implementation of Electronic Health Records in US Nursing Homes. Comput Inform Nurs 2017; 35:417-424. [PMID: 28800581 PMCID: PMC5555048 DOI: 10.1097/cin.0000000000000344] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
While electronic health records have emerged as promising tools to help improve quality of care, nursing homes have lagged behind in implementation. This study assessed electronic health records implementation, associated facility characteristics, and potential impact on quality indicators in nursing homes. Using national Centers for Medicare & Medicaid Services and survey data for nursing homes, a cross-sectional analysis was conducted to identify variations between nursing homes that had and had not implemented electronic health records. A difference-in-differences analysis was used to estimate the longitudinal effect of electronic health records on commonly used quality indicators. Data from 927 nursing homes were examined, 49.1% of which had implemented electronic health records. Nursing homes with electronic health records were more likely to be nonprofit/government owned (P = .04) and had a lower percentage of Medicaid residents (P = .02) and higher certified nursing assistant and registered nurse staffing levels (P = .002 and .02, respectively). Difference-in-differences analysis showed greater quality improvements after implementation for five long-stay and two short-stay quality measures (P = .001 and .01, respectively) compared with those who did not implement electronic health records. Implementation rates in nursing homes are low compared with other settings, and better-resourced facilities are more likely to have implemented electronic health records. Consistent with other settings, electronic health records implementation improves quality in nursing homes, but further research is needed to better understand the mechanism for improvement and how it can best be supported.
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Affiliation(s)
- Ragnhildur I. Bjarnadottir
- Center for Health Policy, Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA
| | - Carolyn T.A. Herzig
- Center for Health Policy, Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168 Street, New York, NY, 10032, USA
| | - Jasmine L. Travers
- Center for Health Policy, Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA
| | - Nicholas G. Castle
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Patricia W. Stone
- Center for Health Policy, Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA
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López M, Jiménez JM, Peña I, Cao MJ, Simarro M, Castro MJ. Ongoing nursing training influence on the completion of electronic pressure ulcer records. NURSE EDUCATION TODAY 2017; 52:22-27. [PMID: 28229916 DOI: 10.1016/j.nedt.2017.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 01/26/2017] [Accepted: 02/08/2017] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Pressure ulcer (PU) care in nursing at the Hospital Clínico Universitario de Valladolid (HCUV) in Spain includes basic care and its registration through the electronic GACELA Care tool. To assess and evaluate the nursing intervention in PU evolution, a training programme was carried out to unify criteria on PU assessment, treatment, evaluation and monitoring. OBJECTIVE To assess the influence of training on the completion of PU records in the GACELA Care application, and identify the level of satisfaction of the nurses after its use. MATERIALS AND METHODS A quasi-experimental prospective study consisting of a specific training programme assessed pre- and post-training was carried out on the records of PU documentation at the HCUV. The PU records included in the study were collected using the electronic nursing healthcare management computer tool GACELA Care and belonged to patients admitted for >48h, excluding venous, arterial and stage I PUs. The pre-training sample consisted of 65 records collected between 1 April and 30 June 2014, and there were 57 post-training records, completed from 1 January to 31 March 2015. The training programme consisted of thirty-minute theoretical and practice training sessions. The study variables were ulcer type, location, stage, length and diameter, perilesional skin, cure type, products used and cure frequency, in addition to the number of actions taken in the records in correlation to the days of hospitalisation. To identify the nurses' opinions, a satisfaction survey about the management platform of ongoing Castilla y León training was administered. RESULTS The variations from the pre- to the post-training PU-sample completion rates were the following: from 23% to 40% for PU diameter, from 11% to 38% for PU length and from 57% to 79% for perilesional skin condition records. There was also a significant increase in the number of form updates after the training activity. The nurses' level of satisfaction with the training activity showed a positive outcome, with an average score of 8.84 over 10. CONCLUSION The training activity improved PU record completion significantly and was deemed positive by the nurses, mainly for its applicability in clinical practice.
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Affiliation(s)
- María López
- GACELA Care Management Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Faculty of Nursing, Universidad de Valladolid, Spain.
| | - José María Jiménez
- Hospital Universitario Rio Hortega, Valladolid, Spain; Faculty of Nursing, Universidad de Valladolid, Spain.
| | - Isabel Peña
- Research of Nursing Care Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - María Simarro
- Research Instituto Biología y Genética Molecular IBGM, Universidad de Valladolid, Valladolid, Spain; Faculty of Nursing, Universidad de Valladolid, Spain
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Li D, Mathews C. Automated measurement of pressure injury through image processing. J Clin Nurs 2017; 26:3564-3575. [PMID: 28071843 DOI: 10.1111/jocn.13726] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2017] [Indexed: 01/09/2023]
Abstract
AIMS AND OBJECTIVES To develop an image processing algorithm to automatically measure pressure injuries using electronic pressure injury images stored in nursing documentation. BACKGROUND Photographing pressure injuries and storing the images in the electronic health record is standard practice in many hospitals. However, the manual measurement of pressure injury is time-consuming, challenging and subject to intra/inter-reader variability with complexities of the pressure injury and the clinical environment. DESIGN A cross-sectional algorithm development study. METHODS A set of 32 pressure injury images were obtained from a western Pennsylvania hospital. First, we transformed the images from an RGB (i.e. red, green and blue) colour space to a YCb Cr colour space to eliminate inferences from varying light conditions and skin colours. Second, a probability map, generated by a skin colour Gaussian model, guided the pressure injury segmentation process using the Support Vector Machine classifier. Third, after segmentation, the reference ruler - included in each of the images - enabled perspective transformation and determination of pressure injury size. Finally, two nurses independently measured those 32 pressure injury images, and intraclass correlation coefficient was calculated. RESULTS An image processing algorithm was developed to automatically measure the size of pressure injuries. Both inter- and intra-rater analysis achieved good level reliability. CONCLUSIONS Validation of the size measurement of the pressure injury (1) demonstrates that our image processing algorithm is a reliable approach to monitoring pressure injury progress through clinical pressure injury images and (2) offers new insight to pressure injury evaluation and documentation. RELEVANCE TO CLINICAL PRACTICE Once our algorithm is further developed, clinicians can be provided with an objective, reliable and efficient computational tool for segmentation and measurement of pressure injuries. With this, clinicians will be able to more effectively monitor the healing process of pressure injuries.
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Affiliation(s)
- Dan Li
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carol Mathews
- Wound, Ostomy, Continence nurse clinician, Shadyside Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Mohammadi Firouzeh M, Jafarjalal E, Emamzadeh Ghasemi HS, Bahrani N, Sardashti S. Evaluation of vocal-electronic nursing documentation: A comparison study in Iran. Inform Health Soc Care 2016; 42:250-260. [PMID: 27322956 DOI: 10.1080/17538157.2016.1178119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM Documentation is a critical element in the function of the nursing team, and cannot be separated from high-quality, patient-centered care. The aim of this study was to compare the quality of nursing documentation in electronic and paper-based systems. METHOD A retrospective descriptive study was designed to compare the quality of nursing documentation in electronic health records (EHR) versus paper-based documentation systems before and after the application of the electronic system. RESULTS Analysis of data found a significant difference in the quality of nursing documentation in the two hospitals both before and after the implementation of an EHR system (p < 0.001).Quality of nursing documentation in the electronic system was significantly better than that of paper-based documentation systems. CONCLUSION Vocal-electronic systems help to improve quality of nursing documentation, suggesting this aspect may be essential to implementing a successful system in local settings.
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Affiliation(s)
- Mona Mohammadi Firouzeh
- a Iranian Research Center for HIV/AIDS , Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences , Tehran , Iran.,b Department of Nursing Education and Management, Faculty of Nursing and Midwifery , Tehran University of Medical Sciences , Tehran , Iran
| | - Ezzat Jafarjalal
- c Department of Nursing Education and Management, School of Nursing and Midwifery , Iran University of Medical Sciences , Tehran , Iran
| | | | - Naser Bahrani
- e Department of Mathematics-Statistics, Faculty of Sciences , Air University of Shahid Sattari , Tehran , Iran
| | - Sara Sardashti
- a Iranian Research Center for HIV/AIDS , Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences , Tehran , Iran
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Li D. The relationship among pressure ulcer risk factors, incidence and nursing documentation in hospital-acquired pressure ulcer patients in intensive care units. J Clin Nurs 2016; 25:2336-47. [PMID: 27302084 DOI: 10.1111/jocn.13363] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the quality/comprehensiveness of nursing documentation of pressure ulcers and to investigate the relationship between the nursing documentation and the incidence of pressure ulcers in four intensive care units. BACKGROUND Pressure ulcer prevention requires consistent assessments and documentation to decrease pressure ulcer incidence. Currently, most research is focused on devices to prevent pressure ulcers. Studies have rarely considered the relationship among pressure ulcer risk factors, incidence and nursing documentation. Thus, a study to investigate this relationship is needed to fill this information gap. DESIGN A retrospective, comparative, descriptive, correlational study. METHOD A convenience sample of 196 intensive care units patients at the selected medical centre comprised the study sample. All medical records of patients admitted to intensive care units between the time periods of September 1, 2011 through September 30, 2012 were audited. Data used in the analysis included 98 pressure ulcer patients and 98 non-pressure ulcer patients. The quality and comprehensiveness of pressure ulcer documentation were measured by the modified European Pressure Ulcer Advisory Panel Pressure Ulcers Assessment Instrument and the Comprehensiveness in Nursing Documentation instrument. RESULT The correlations between quality/comprehensiveness of pressure ulcer documentation and incidence of pressure ulcers were not statistically significant. Patients with pressure ulcers had longer length of stay than patients without pressure ulcers stay. There were no statistically significant differences in quality/comprehensiveness scores of pressure ulcer documentation between dayshift and nightshift. CONCLUSION This study revealed a lack of quality/comprehensiveness in nursing documentation of pressure ulcers. This study demonstrates that staff nurses often perform poorly on documenting pressure ulcer appearance, staging and treatment. Moreover, nursing documentation of pressure ulcers does not provide a complete picture of patients' care needs that require nursing interventions. RELEVANCE TO CLINICAL PRACTICE The implication of this study involves pressure ulcer prevention and litigable risk of nursing documentation.
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Affiliation(s)
- Dan Li
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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Jamieson T, Ailon J, Chien V, Mourad O. An electronic documentation system improves the quality of admission notes: a randomized trial. J Am Med Inform Assoc 2016; 24:123-129. [PMID: 27274016 DOI: 10.1093/jamia/ocw064] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE There are concerns that structured electronic documentation systems can limit expressivity and encourage long and unreadable notes. We assessed the impact of an electronic clinical documentation system on the quality of admission notes for patients admitted to a general medical unit. METHODS This was a prospective randomized crossover study comparing handwritten paper notes to electronic notes on different patients by the same author, generated using a semistructured electronic admission documentation system over a 2-month period in 2014. The setting was a 4-team, 80-bed general internal medicine clinical teaching unit at a large urban academic hospital. The quality of clinical documentation was assessed using the QNOTE instrument (best possible score = 100), and word counts were assessed for free-text sections of notes. RESULTS Twenty-one electronic-paper note pairs (42 notes) written by 21 authors were randomly drawn from a pool of 303 eligible notes. Overall note quality was significantly higher in electronic vs paper notes (mean 90 vs 69, P < .0001). The quality of free-text subsections (History of Present Illness and Impression and Plan) was significantly higher in the electronic vs paper notes (mean 93 vs 78, P < .0001; and 89 vs 77, P = .001, respectively). The History of Present Illness subsection was significantly longer in electronic vs paper notes (mean 172.4 vs 92.4 words, P = .0001). CONCLUSIONS An electronic admission documentation system improved both the quality of free-text content and the overall quality of admission notes. Authors wrote more in the free-text sections of electronic documents as compared to paper versions.
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Affiliation(s)
- Trevor Jamieson
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada .,Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Ailon
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Vince Chien
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Ophyr Mourad
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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Tschannen D, Mckay M, Steven M. Improving Pressure Ulcer Staging Accuracy Through a Nursing Student Experiential Intervention. J Nurs Educ 2016; 55:266-70. [DOI: 10.3928/01484834-20160414-05] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 02/19/2016] [Indexed: 11/20/2022]
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The prevalence of pressure ulcers in the paediatric population. J Tissue Viability 2016; 25:127-34. [PMID: 26896309 DOI: 10.1016/j.jtv.2016.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 01/31/2016] [Accepted: 02/01/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND A paucity of research related to the problem of pressure ulcers in paediatrics is found, with a variety of reported prevalence rates. OBJECTIVE To record the prevalence, location and categories of PU in the inpatient paediatric wards, and to identify the characteristics of pressure ulcer patients. DESIGN A descriptive point prevalence study. SETTING All paediatric inpatient wards in two hospitals in Jordan. One of which is a university-affiliated hospital and the other a paediatric public hospital. Isolation, burn and emergency units, outpatients' clinics and psychiatric wards were excluded. SAMPLE One sixty six paediatric patients aged from one day up to 18 years from both hospitals. METHODS Patients who met the inclusion criteria were included and examined for the existence of pressure ulcers on one day in each hospital by the primary investigator. The European Pressure Ulcer Advisory Panel classification system was used to categorise each identified ulcer. The characteristics of ulcers were collected as well. RESULTS Sixteen ulcers were identified in 11 patients, giving a prevalence rate of 6.6%.When Category I ulcers were excluded, the prevalence rate dropped to 2.4%. All except one of the PU patients were being treated in critical care units (n = 10, 90.9%), and most of the ulcers were category one (n = 7, 63.6%) and caused by devices (n = 7, 63.6). The face was the most frequently reported location of PUs (n = 6, 54.5%), followed by the occiput (n = 2, 18.2%). Most PU patients were male (n = 6, 54.5%), and less than 12 months old (n = 8, 72.7%). PU patients had experienced longer hospital stays than patients free from PU (U = 499.0, p = 0.02). CONCLUSION Jordanian paediatric patients do have pressure ulcers, with a prevalence rate congruent with previously reported international rates. Most of the ulcers found were caused by devices used in critical care units. This should encourage nurses to pay extra attention to their paediatric patients when they are connected to medical devices.
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Stifter J, Yao Y, Lodhi MK, Lopez KD, Khokhar A, Wilkie DJ, Keenan GM. Nurse Continuity and Hospital-Acquired Pressure Ulcers: A Comparative Analysis Using an Electronic Health Record "Big Data" Set. Nurs Res 2015; 64:361-71. [PMID: 26325278 PMCID: PMC4692274 DOI: 10.1097/nnr.0000000000000112] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little research demonstrating the association between nurse continuity and patient outcomes exists despite an intuitive belief that continuity makes a difference in care outcomes. OBJECTIVE The aim of this study was to examine the association of nurse continuity with the prevention of hospital-acquired pressure ulcers (HAPU). METHODS A secondary use of data from the Hands on Automated Nursing Data System (HANDS) was performed for this comparative study. The HANDS is a nursing plan of care data set containing 42,403 episodes documented by 787 nurses, on nine units, in four hospitals and includes nurse staffing and patient characteristics. The HANDS data set resides in a "big data" relational database consisting of 89 tables and 747 columns of data. Via data mining, we created an analytic data set of 840 care episodes, 210 with and 630 without HAPUs, matched by nursing unit, patient age, and patient characteristics. Logistic regression analysis determined the association of nurse continuity and additional nurse-staffing variables on HAPU occurrence. RESULTS Poor nurse continuity (unit mean continuity index = .21-.42 [1.0 = optimal continuity]) was noted on all nine study units. Nutrition, mobility, perfusion, hydration, and skin problems on admission, as well as patient age, were associated with HAPUs (p < .001). Controlling for patient characteristics, nurse continuity, and the interactions between nurse continuity and other nurse-staffing variables were not significantly associated with HAPU development. DISCUSSION Patient characteristics including nutrition, mobility, and perfusion were associated with HAPUs, but nurse continuity was not. We demonstrated a high level of variation in the degree of continuity between patient episodes in the HANDS data, showing that it offers rich potential for future study of nurse continuity and its effect on patient outcomes.
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Affiliation(s)
- Janet Stifter
- Janet Stifter, PhD, RN, is Postdoctoral Scholar, College of Nursing, University of Illinois at Chicago. Yingwei Yao, PhD, is Research Associate Professor, College of Nursing, University of Illinois at Chicago, and College of Nursing, University of Florida, Gainesville. Muhammad Kamran Lodhi, BS, is PhD Candidate, University of Illinois at Chicago Electrical and Computer Engineering. Karen Dunn Lopez, PhD, MPH, RN, is Assistant Professor, College of Nursing, University of Illinois at Chicago. Ashfaq Khokhar, PhD, is Professor, Illinois Institute of Technology, Chicago. Diana J. Wilkie, PhD, RN, FAAN, is Earl and Margo Powers Endowed Professor, College of Nursing, University of Florida at Gainesville, and was the Harriet J. Werley Endowed Chair for Nursing Research, College of Nursing, University of Illinois at Chicago. Gail M. Keenan, PhD, RN, FAAN, is Professor and Annabel Jenks Davis Endowed Chair, College of Nursing, University of Florida at Gainesville, and was a Professor, College of Nursing, University of Illinois at Chicago
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Tubaishat A, Tawalbeh LI, AlAzzam M, AlBashtawy M, Batiha AM. Electronic versus paper records: documentation of pressure ulcer data. ACTA ACUST UNITED AC 2015; 24:S30, S32, S34-7. [PMID: 25816001 DOI: 10.12968/bjon.2015.24.sup6.s30] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The documentation of patient data on health records is a vital component of the care process. Accurate and complete recording of this data is a necessary practice. The adoption of electronic health records to improve the quality of nursing documentation is on the rise. OBJECTIVES This study compares the accuracy and completeness of pressure ulcer data documentation between electronic and paper records. DESIGN A descriptive, comparative design with a retrospective review of patient records. Settings and sample: Two hospitals were chosen purposefully, one using electronic recording of patient data and the other using paper records. METHODS In the first phase, all hospitalised patients aged 18 years and over were inspected for pressure ulcers. In the second phase, the files of patients with pressure ulcers were audited. RESULTS Of the 52 patients with ulcers found in the hospital that used an electronic system, 43 of their records documented the pressure ulcers (83%). Of the 55 patients with pressure ulcers in the hospital using paper records, 39 files had corresponding documentation of the presence of a pressure ulcer (71%). CONCLUSION In terms of accuracy and completeness, more comprehensive documentation practice was found on the electronic health records compared with paper records. However, both types of systems have shortcomings in the practice of pressure ulcer data documentation.
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Wang N, Yu P, Hailey D. The quality of paper-based versus electronic nursing care plan in Australian aged care homes: A documentation audit study. Int J Med Inform 2015; 84:561-9. [DOI: 10.1016/j.ijmedinf.2015.04.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 04/26/2015] [Accepted: 04/29/2015] [Indexed: 11/26/2022]
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Samadbeik M, Gorzin Z, Khoshkam M, Roudbari M. Managing the security of nursing data in the electronic health record. Acta Inform Med 2015; 23:39-43. [PMID: 25870490 PMCID: PMC4384867 DOI: 10.5455/aim.2015.23.39-43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 02/12/2015] [Indexed: 11/30/2022] Open
Abstract
Background: The Electronic Health Record (EHR) is a patient care information resource for clinicians and nursing documentation is an essential part of comprehensive patient care. Ensuring privacy and the security of health information is a key component to building the trust required to realize the potential benefits of electronic health information exchange. This study was aimed to manage nursing data security in the EHR and also discover the viewpoints of hospital information system vendors (computer companies) and hospital information technology specialists about nursing data security. Methods: This research is a cross sectional analytic-descriptive study. The study populations were IT experts at the academic hospitals and computer companies of Tehran city in Iran. Data was collected by a self-developed questionnaire whose validity and reliability were confirmed using the experts’ opinions and Cronbach’s alpha coefficient respectively. Data was analyzed through Spss Version 18 and by descriptive and analytic statistics. Results: The findings of the study revealed that user name and password were the most important methods to authenticate the nurses, with mean percent of 95% and 80%, respectively, and also the most significant level of information security protection were assigned to administrative and logical controls. There was no significant difference between opinions of both groups studied about the levels of information security protection and security requirements (p>0.05). Moreover the access to servers by authorized people, periodic security update, and the application of authentication and authorization were defined as the most basic security requirements from the viewpoint of more than 88 percent of recently-mentioned participants. Conclusions: Computer companies as system designers and hospitals information technology specialists as systems users and stakeholders present many important views about security requirements for EHR systems and nursing electronic documentation systems. Prioritizing of these requirements helps policy makers to decide what to do when planning for EHR implementation. Therefore, to make appropriate security decisions and to achieve the expected level of protection of the electronic nursing information, it is suggested to consider the priorities of both groups of experts about security principles and also discuss the issues seem to be different between two groups of participants in the research.
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Affiliation(s)
- Mahnaz Samadbeik
- Department of Health Information Technology, School of Allied Health professions, Lorestan University of Medical Sciences, Khoramabad, Iran
| | - Zahra Gorzin
- Department of Health Information Technology, School of Health Management and Information Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Masomeh Khoshkam
- Department of Statistics and Mathematics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Roudbari
- Anti-Microbial Resistance Research Centre, Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Dowding DW, Turley M, Garrido T. Nurses' use of an integrated electronic health record: results of a case site analysis. Inform Health Soc Care 2014; 40:345-361. [PMID: 25122056 DOI: 10.3109/17538157.2014.948169] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To explore how nurses use an integrated Electronic Health Record (EHR) in practice. METHODS A multi-site case study across two hospitals in Kaiser Permanente Northern California. Non-participant observation was used to explore nurses' use of the EHR, while semi-structured interviews with nurses and managers explored their perceptions of the EHR and how it affected their practice. Data were analyzed thematically using codes derived deductively from the literature and inductively from the data. RESULTS Key themes arising from the analysis suggest that the EHR changed various elements of the way nurses practiced. Introducing the EHR was thought to have improved communication, ease of access to information and the safety of medication administration processes. At an organizational level, there was variability in how the EHR was used to support care documentation and initiatives to improve the quality of care provided by nurses. CONCLUSION The EHR was perceived to improve efficiency, safety and communication by the majority of nurses who were interviewed. However, it is likely that a number of other factors such as individual nurse's characteristics and organizational culture influence how an EHR can be used effectively to improve outcomes for patients.
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Affiliation(s)
- Dawn W Dowding
- a Columbia University School of Nursing , New York , NY , USA.,b Center for Home Care Policy and Research, Visiting Nurse Service of New York , New York , NY , USA
| | - Marianne Turley
- c Department of Health Information Technology Transformation & Analytics , Kaiser Permanente Program Office , Portland , OR , USA and
| | - Terhilda Garrido
- d Department of Health Information Technology Transformation & Analytics , Kaiser Permanente , Oakland , CA , USA
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Nguyen L, Bellucci E, Nguyen LT. Electronic health records implementation: an evaluation of information system impact and contingency factors. Int J Med Inform 2014; 83:779-96. [PMID: 25085286 DOI: 10.1016/j.ijmedinf.2014.06.011] [Citation(s) in RCA: 203] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 06/24/2014] [Accepted: 06/26/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This paper provides a review of EHR (electronic health record) implementations around the world and reports on findings including benefits and issues associated with EHR implementation. MATERIALS AND METHODS A systematic literature review was conducted from peer-reviewed scholarly journal publications from the last 10 years (2001-2011). The search was conducted using various publication collections including: Scopus, Embase, Informit, Medline, Proquest Health and Medical Complete. This paper reports on our analysis of previous empirical studies of EHR implementations. We analysed data based on an extension of DeLone and McLean's information system (IS) evaluation framework. The extended framework integrates DeLone and McLean's dimensions, including information quality, system quality, service quality, intention of use and usage, user satisfaction and net benefits, together with contingent dimensions, including systems development, implementation attributes and organisational aspects, as identified by Van der Meijden and colleagues. RESULTS A mix of evidence-based positive and negative impacts of EHR was found across different evaluation dimensions. In addition, a number of contingent factors were found to contribute to successful implementation of EHR. LIMITATIONS This review does not include white papers or industry surveys, non-English papers, or those published outside the review time period. CONCLUSION This review confirms the potential of this technology to aid patient care and clinical documentation; for example, in improved documentation quality, increased administration efficiency, as well as better quality, safety and coordination of care. Common negative impacts include changes to workflow and work disruption. Mixed observations were found on EHR quality, adoption and satisfaction. The review warns future implementers of EHR to carefully undertake the technology implementation exercise. The review also informs healthcare providers of contingent factors that potentially affect EHR development and implementation in an organisational setting. Our findings suggest a lack of socio-technical connectives between the clinician, the patient and the technology in developing and implementing EHR and future developments in patient-accessible EHR. In addition, a synthesis of DeLone and McLean's framework and Van der Meijden and colleagues' contingent factors has been found useful in comprehensively understanding and evaluating EHR implementations.
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Affiliation(s)
- Lemai Nguyen
- School of Information and Business Analytics, Deakin University, Melbourne, Australia.
| | - Emilia Bellucci
- School of Information and Business Analytics, Deakin University, Melbourne, Australia
| | - Linh Thuy Nguyen
- School of Information and Business Analytics, Deakin University, Melbourne, Australia
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Saranto K, Kinnunen U, Kivekäs E, Lappalainen A, Liljamo P, Rajalahti E, Hyppönen H. Impacts of structuring nursing records: a systematic review. Scand J Caring Sci 2013; 28:629-47. [DOI: 10.1111/scs.12094] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 09/27/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Kaija Saranto
- Department of Health and Social Management University of Eastern Finland Kuopio Finland
| | - Ulla‐Mari Kinnunen
- Department of Health and Social Management University of Eastern Finland Kuopio Finland
| | - Eija Kivekäs
- Department of Health and Social Management University of Eastern Finland Kuopio Finland
| | - Anna‐Mari Lappalainen
- Department of Health and Social Management University of Eastern Finland Kuopio Finland
| | - Pia Liljamo
- Department of Health and Social Management University of Eastern Finland Kuopio Finland
| | - Elina Rajalahti
- Department of Health and Social Management University of Eastern Finland Kuopio Finland
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Tubaishat A, Aljezawi M. The prevalence of pressure ulceration among Jordanian hospitalised patients. J Wound Care 2013; 22:305-6, 308-10. [PMID: 24049813 DOI: 10.12968/jowc.2013.22.6.305] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To measure the prevalence rate of pressure ulcers (PUs) among hospitalised patients and to assess the adequacy of preventative care provided to patients at-risk for PUs. METHOD A cross-sectional survey was conducted by inspecting the skin of each patient included; if a PU was noted, it was classified according to the European Pressure Ulcer Advisory Panel grading system. Risk was assessed using the Braden scale and the use of preventative interventions was also documented. RESULTS The sample included was 295 patients; mean age of the patients was 49.1 +/- 18.6 years (range 18-87 years) and 55% (n = 162) were male. The prevalence rate was 16% (8.8% excluding category I). Category I was the most common grade of PU (n = 22; 46%). The heels were the most commonly affected sites (n = 23; 49%). Only 19% of patients in need of prevention actually received proper adequate prevention. CONCLUSION PU prevalence rate was lower than published rates in studies that employed the same method. The young age and general health of our sample could be the best explanation. A very small percentage of at-risk patients receive adequate prevention. This should open the door to scrutinising the provision of PU prevention in Jordan.
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Affiliation(s)
- A Tubaishat
- Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan.
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Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: An intervention study. Int J Med Inform 2013; 82:911-21. [DOI: 10.1016/j.ijmedinf.2013.05.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 05/28/2013] [Accepted: 05/30/2013] [Indexed: 01/19/2023]
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Features of Computerized Clinical Decision Support Systems Supportive of Nursing Practice. Comput Inform Nurs 2013; 31:477-95; quiz 496-7. [DOI: 10.1097/01.ncn.0000432127.99644.25] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moore Z, Johansen E, van Etten M. A review of PU risk assessment and prevention in Scandinavia, Iceland and Ireland (part II). J Wound Care 2013; 22:423-4, 426-8, 430-1. [PMID: 23924842 DOI: 10.12968/jowc.2013.22.8.423] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To provide a critical appraisal of nurses risk assessment and pressure ulcer (PU) preventive practices across Scandinavia, Iceland and Ireland. METHOD An integrative research review following Cooper's five stages. Studies published in peer-reviewed journals, involving any study design, but specifically exploring PU risk assessment or preventative practices, in any care setting, were included. RESULTS Risk assessment practice was primarily investigated in the acute care setting and was found to be irregular, based on both numeric scales and clinical judgments. This irregular practice means that some vulnerable patients are not screened for pressure ulcer risk, conversely, when risk assessed, a care plan is not necessarily provided.A significant gap in nurse documentation, together with a lack of supporting evidence for repositioning and use of appropriate redistribution devices was also identified,indicating a lack of a standardised approach to pressure ulcer prevention. CONCLUSION Despite an abundance of literature exploring this subject, it is clear that current practice in pressure ulcer prevention is not embedded within best practice recommendations. Therefore, to address the potential patient safety implications, clinical practice could benefit from exploration and identification of practical methods for improving actual pressure ulcer preventive practice.
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Affiliation(s)
- Z Moore
- School of Nursing, Royal College of Surgeons of Ireland, Dublin, Ireland.
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Validation of the Data Elements for the Health System Domain of the PNDS. AORN J 2013; 98:39-48. [DOI: 10.1016/j.aorn.2013.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 05/24/2012] [Accepted: 05/16/2013] [Indexed: 11/20/2022]
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Messmer PR, Williams PD, Williams AR. A Case–Control Study of Pediatric Falls Using Electronic Medical Records. Rehabil Nurs 2013; 38:73-9. [DOI: 10.1002/rnj.73] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2012] [Indexed: 11/10/2022]
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Papastavrou E, Andreou P, Tsangari H, Schubert M, De Geest S. Rationing of Nursing Care Within Professional Environmental Constraints. Clin Nurs Res 2013; 23:314-35. [DOI: 10.1177/1054773812469543] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to examine rationing of nursing care and the possible relationship between nurses’ perceptions of their professional practice environment and care rationing. A total of 393 nurses from medical and surgical units participated in the study. Data were collected using the Basel Extent of Rationing of Nursing Care (BERNCA) instrument and the Revised Professional Practice Environment (RPPE) Scale. The highest level of rationing was reported for “reviewing of patient documentation” ( M = 1.15, SD = 0.94; 31.2% sometimes or often) followed by “oral and dental hygiene” ( M = 1.06, SD = 0.94; 31.5% sometimes or often) and “coping with the delayed response of physicians” ( M = 1.04, SD = 0.96; 30% sometimes or often). Regression analyses showed that teamwork, leadership and autonomy, and communication about patients accounted in total 18.4% of the variance in rationing. In regard to application, the association between the practice environment and rationing suggests improvements in certain aspects that could minimize rationing.
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Factors associated with physician and nurse practitioner pressure ulcer staging practices in rehabilitative and long term care. J Am Med Dir Assoc 2012; 13:748-51. [PMID: 22868253 DOI: 10.1016/j.jamda.2012.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 05/16/2012] [Accepted: 06/22/2012] [Indexed: 11/20/2022]
Abstract
Pressure ulcer (PrU) documentation is a common clinical challenge in long term care and rehabilitative settings. This pilot observational study examined PrU staging documentation practices by physicians and nurse providers in two long term care facilities with short-term rehabilitative units. The study enrolled 57 subjects with PrUs, and only 30 (52.6%) of them had PrU staging documentation by the physician or nurse practitioner. Use of powered mattresses (adjusted relative risk (RR) 2.43 with 95% CI 1.19, 4.97) and physical therapy documentation (RR 1.72 with 95% CI 1.04, 2.81) were factors significantly associated with providers documenting the PrU stage. Inadequate statistical power, due to the small study sample size, may have prevented detecting of other significant associations between patient factors and documentation practices. Future research that is adequately powered is needed to replicate these results and detect other potential factors associated with documentation.
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Paans W, Sermeus W, Nieweg RMB, Krijnen WP, van der Schans CP. Do knowledge, knowledge sources and reasoning skills affect the accuracy of nursing diagnoses? a randomised study. BMC Nurs 2012; 11:11. [PMID: 22852577 PMCID: PMC3447681 DOI: 10.1186/1472-6955-11-11] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 08/01/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper reports a study about the effect of knowledge sources, such as handbooks, an assessment format and a predefined record structure for diagnostic documentation, as well as the influence of knowledge, disposition toward critical thinking and reasoning skills, on the accuracy of nursing diagnoses.Knowledge sources can support nurses in deriving diagnoses. A nurse's disposition toward critical thinking and reasoning skills is also thought to influence the accuracy of his or her nursing diagnoses. METHOD A randomised factorial design was used in 2008-2009 to determine the effect of knowledge sources. We used the following instruments to assess the influence of ready knowledge, disposition, and reasoning skills on the accuracy of diagnoses: (1) a knowledge inventory, (2) the California Critical Thinking Disposition Inventory, and (3) the Health Science Reasoning Test. Nurses (n = 249) were randomly assigned to one of four factorial groups, and were instructed to derive diagnoses based on an assessment interview with a simulated patient/actor. RESULTS The use of a predefined record structure resulted in a significantly higher accuracy of nursing diagnoses. A regression analysis reveals that almost half of the variance in the accuracy of diagnoses is explained by the use of a predefined record structure, a nurse's age and the reasoning skills of `deduction' and `analysis'. CONCLUSIONS Improving nurses' dispositions toward critical thinking and reasoning skills, and the use of a predefined record structure, improves accuracy of nursing diagnoses.
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Affiliation(s)
- Wolter Paans
- Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences, post-box 3109, 9701 DC, Groningen, the Netherlands
- School of Public Health, Faculty of Medicine, Centre for Health Services and Nursing Research, Catholic University Leuven, Leuven, Belgium
| | - Walter Sermeus
- School of Public Health, Faculty of Medicine, Centre for Health Services and Nursing Research, Catholic University Leuven, Leuven, Belgium
| | - Roos MB Nieweg
- Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences, post-box 3109, 9701 DC, Groningen, the Netherlands
| | - Wim P Krijnen
- Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences, post-box 3109, 9701 DC, Groningen, the Netherlands
| | - Cees P van der Schans
- Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences, post-box 3109, 9701 DC, Groningen, the Netherlands
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Thoroddsen A, Sigurjónsdóttir G, Ehnfors M, Ehrenberg A. Accuracy, completeness and comprehensiveness of information on pressure ulcers recorded in the patient record. Scand J Caring Sci 2012; 27:84-91. [PMID: 22630335 DOI: 10.1111/j.1471-6712.2012.01004.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To describe the accuracy, completeness and comprehensiveness of information on pressure ulcers documented in patient records. DESIGN AND SETTING A cross-sectional descriptive study performed in 29 wards at a university hospital in Iceland. The study included skin assessment of patients and retrospective audits of records of patients identified with pressure ulcers. PARTICIPANTS A sample of 219 patients was inspected for signs of pressure ulcers on 1 day in 2008. Records of patients identified with pressure ulcers were audited (n = 45) retrospectively. RESULTS The prevalence of pressure ulcers was 21%. Information in patient records lacked accuracy, completeness and comprehensiveness. Only 60% of the identified pressure ulcers were documented in the patient records. The lack of accuracy was most prevalent for stage I pressure ulcers. CONCLUSIONS The purpose of documentation to record, communicate and support the flow of information in the patient record was not met. The patient records lacked accuracy, completeness and comprehensiveness, which can jeopardise patient safety, continuity and quality of care. The information on pressure ulcers in patient records was found not to be a reliable source for the evaluation of quality in health care. To improve accuracy, completeness and comprehensiveness of data in the patient record, a systematic risk assessment for pressure ulcers and assessment and treatment of existing pressure ulcers based on evidence-based guidelines need to be implemented and recorded in clinical practice. Health information technology, including the electronic health record with decision support, has shown promising results to facilitate and improve documentation of pressure ulcers.
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Affiliation(s)
- Asta Thoroddsen
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
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Samuriwo R. Pressure ulcer prevention: the role of the multidisciplinary team. ACTA ACUST UNITED AC 2012; 21:S4, S6, S8 passim. [DOI: 10.12968/bjon.2012.21.sup5.s4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ray Samuriwo
- Faculty of Health Sport and Science, University of Glamorgan
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Health information technology in the workplace: findings from a 2010 national survey of registered nurses. J Nurs Adm 2011; 41:357-64. [PMID: 21881441 DOI: 10.1097/nna.0b013e31822a7165] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this study was to examine RNs' experiences with health information technology (HIT) and their perceptions of the effect of this technology on quality of care and daily work. The adoption and use of HIT are expected to increase substantially over the next 5 years because of policy efforts at the federal and state levels. Given the size of the RN workforce and their critical role in healthcare delivery, their experiences with HIT could help adoption efforts. The method used was a nationally representative survey of 1500 nurses with a 56% response rate. Findings suggest wide variation in the availability of HIT functionality, with functions more likely available to hospital RNs. Overall, RNs perceived the effect of these technologies on quality of care and their daily work as positive. Ensuring that HIT systems are relevant to and usable for RNs will be a critical component in achieving the meaningful use of these systems.
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Papastavrou E, Efstathiou G, Acaroglu R, DA Luz MDA, Berg A, Idvall E, Kalafati M, Kanan N, Katajisto J, Leino-Kilpi H, Lemonidou C, Sendir M, Sousa VD, Suhonen R. A seven country comparison of nurses' perceptions of their professional practice environment. J Nurs Manag 2011; 20:236-248. [PMID: 22050114 DOI: 10.1111/j.1365-2834.2011.01289.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Papastavrou E., Efstathiou G., Acaroglu R., da Luz M.D.A., Berg A., Idvall E., Kalafati M., Kanan N., Katajisto J., Leino-Kilpi H., Lemonidou C., Sendir M., Sousa V.D. & Suhonen R. (2011) Journal of Nursing Management A seven country comparison of nurses' perceptions of their professional practice environment Aims To describe and compare nurses' perceptions of their professional practice environment in seven countries. Background There is evidence of variation in the nursing professional practice environments internationally. These different work environments affect nurses' ability to perform and are linked to differing nurse and patient outcomes. Methods A descriptive, comparative survey was used to collect data from orthopaedic and trauma nurses (n = 1156) in Finland, Cyprus, Greece, Portugal, Sweden, Turkey and Kansas, USA using the 39-item Revised Professional Practice Environment instrument. Results Differences were found between participants from the northern countries of Europe, Kansas, USA, and the Mediterranean countries regarding perceptions about control over practice. No between-country differences were reported in the internal work motivation among the nurses from any of the participating countries. Conclusions Although between-country differences in nurses' professional practice environment were found, difficulties related to demographic, cultural and health system differences and the way in which nursing is defined in each country need to be considered in the interpretation of the results. Implications for Nursing Management The results support investment to improve nurse's work environment, which is important for improving the quality of patient care, optimizing patient outcomes and developing the nursing workforce.
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Affiliation(s)
- Evridiki Papastavrou
- Lecturer, Department of Nursing, School of Health Studies, Cyprus University of Technology, Limassol, Cyprus PhD Student, Department of Nursing, School of Health Studies, Cyprus University of Technology, Limassol, Cyprus Associate Professor, Florence Nightingale School of Nursing, Istanbul University, Istanbul, Turkey Associate Professor, Unidade de Investigacão e Desenvolvimento em Enfermagem (ui&de), Escola Superior de Enfermagem de Lisboa (Nursing research and development Unity ui&de), Lisbon, Portugal Associate Professor, Kristianstad University, Kristianstad, Sweden Professor, Faculty of Health and Society, Malmö University, Malmö, Sweden Researcher, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece Professor, Florence Nightingale School of Nursing, Istanbul University, Istanbul, Turkey Senior Lecturer, Department of Statistics, University of Turku, Turku Professor and Chair/Nurse Manager, Department of Nursing Science/Hospital District of Southwest Finland, University of Turku, Turku, Finland Professor, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece Associate Professor, Florence Nightingale School of Nursing, Istanbul University, Istanbul, Turkey Associate Professor, School of Nursing, The University of Kansas, Kansas City, KS, USA Professor, Principal Investigator, Department of Nursing Science, University of Turku, Turku, Finland
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Higuchi KS, Davies BL, Edwards N, Ploeg J, Virani T. Implementation of clinical guidelines for adults with asthma and diabetes: a three-year follow-up evaluation of nursing care. J Clin Nurs 2011; 20:1329-38. [PMID: 21492279 DOI: 10.1111/j.1365-2702.2010.03590.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To report on a three-year follow-up evaluation in Canada of nursing care indicators following the implementation of the Adult Asthma Care Best Practice Guideline and the Reducing Foot Complications for People with Diabetes Best Practice Guideline and to describe the contextual changes in the clinical settings. BACKGROUND The Registered Nurses' Association of Ontario in Canada has developed and published more than 42 guidelines related to clinical nursing practice and healthy work environments. To date, evaluation has involved one-year studies of the impact of guideline implementation on the delivery of care in hospital and community settings, but little is known about whether changes in practice that were made during the initial implementation period have been sustained. DESIGN Longitudinal follow-up study. METHODS Site observations and interviews were conducted with key informants at two hospitals. Indicators of nursing care changes identified six months post-implementation were compared with indicators found during a retrospective chart audit at the same sites three years later. Fisher exact tests were used to compare outcomes for the two time periods. RESULTS Three out of 12 indicators related to asthma care remained consistently high (≥ 84% of audited charts) and four indicators declined significantly (p < 0.01). There were significant (p ≤ 0.05) improvements in nine out of 12 indicators related to diabetes foot care. Important contextual changes were made to better address the guideline recommendations for foot care in the out-patient program and the electronic documentation system. CONCLUSIONS Sustainability of guideline implementation recommendations was enhanced with the use of an electronic documentation system. RELEVANCE TO CLINICAL PRACTICE Long-term follow-up of both clinical indicators and contextual factors are important to monitor to promote sustained implementation of guidelines.
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Moore Z, Cowman S. Pressure ulcer prevalence and prevention practices in care of the older person in the Republic of Ireland. J Clin Nurs 2011; 21:362-71. [DOI: 10.1111/j.1365-2702.2011.03749.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Paans W, Nieweg RM, van der Schans CP, Sermeus W. What factors influence the prevalence and accuracy of nursing diagnoses documentation in clinical practice? A systematic literature review. J Clin Nurs 2011; 20:2386-403. [PMID: 21676043 DOI: 10.1111/j.1365-2702.2010.03573.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To identify what determinants influence the prevalence and accuracy of nursing diagnosis documentation in clinical practice. BACKGROUND Nursing diagnoses guide and direct nursing care. They are the foundation for goal setting and provide the basis for interventions. The literature mentions several factors that influences nurses' documentation of diagnoses, such as a nurse's level of education, patient's condition and the ward environment. DESIGN Systematic review. METHOD MEDLINE and CINAHL databases were searched using the following headings and keywords: nursing diagnosis, nursing documentation, hospitals, influence, utilisation, quality, implementation and accuracy. The search was limited to articles published between 1995-October 2009. Studies were only selected if they were written in English and were primary studies addressing factors that influence nursing diagnosis documentation. RESULTS In total, 24 studies were included. Four domains of factors that influence the prevalence and accuracy of diagnoses documentation were found: (1) the nurse as a diagnostician, (2) diagnostic education and resources, (3) complexity of a patient's situation and (4) hospital policy and environment. CONCLUSION General factors, which influence decision-making, and nursing documentation and specific factors, which influence the prevalence and accuracy of nursing diagnoses documentation, need to be distinguished. To support nurses in documenting their diagnoses accurately, we recommend taking a comprehensive perspective on factors that influence diagnoses documentation. A conceptual model of determinants that influence nursing diagnoses documentation, as presented in this study, may be helpful as a reference for nurse managers and nurse educators. RELEVANCE TO CLINICAL PRACTICE This review gives hospital management an overview of determinants for possible quality improvements in nursing diagnoses documentation that needs to be undertaken in clinical practice.
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Affiliation(s)
- Wolter Paans
- Hanze University of Applied Sciences, Groningen, The Netherlands.
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Wang N, Hailey D, Yu P. Quality of nursing documentation and approaches to its evaluation: a mixed-method systematic review. J Adv Nurs 2011; 67:1858-75. [PMID: 21466578 DOI: 10.1111/j.1365-2648.2011.05634.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS This paper reports a review that identified and synthesized nursing documentation audit studies, with a focus on exploring audit approaches, identifying audit instruments and describing the quality status of nursing documentation. INTRODUCTION Quality nursing documentation promotes effective communication between caregivers, which facilitates continuity and individuality of care. The quality of nursing documentation has been measured by using various audit instruments, which reflected variations in the perception of documentation quality among researchers across countries and settings. DATA SOURCES Searches were made of seven electronic databases. The keywords 'nursing documentation', 'audit', 'evaluation', 'quality', both singly and in combination, were used to identify articles published in English between 2000 and 2010. REVIEW METHODS A mixed-method systematic review of quantitative and qualitative studies concerning nursing documentation audit and reports of audit instrument development was undertaken. Relevant data were extracted and a narrative synthesis was conducted. RESULTS Seventy-seven publications were included. Audit approaches focused on three natural dimensions of nursing documentation: structure or format, process and content. Numerous audit instruments were identified and their psychometric properties were described. Flaws of nursing documentation were identified and the effects of study interventions on its quality. CONCLUSION Research should pay more attention to the accuracy of nursing documentation, factors leading to variation in practice and flaws in documentation quality and the effects of these on nursing practice and patient outcomes, and the evaluation of quality measurement.
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Affiliation(s)
- Ning Wang
- Health Informatics Research Lab, School of Information and Technology, Faculty of Informatics, University of Wollongong, New South Wales, Australia
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Diagnosis-Related Groups and Electronic Nursing Documentation. Comput Inform Nurs 2011; 29:73-4. [DOI: 10.1097/ncn.0b013e3181fcf814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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