1
|
Harmon CS, Adams SA, Davis JE, Gephart SM, Donevant SB. Unintended consequences of the electronic health record and cognitive load in emergency department nurses. Appl Nurs Res 2023; 73:151724. [PMID: 37722792 DOI: 10.1016/j.apnr.2023.151724] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 09/20/2023]
Abstract
AIM The study aimed to explore the relationship between the unintended consequences of the electronic health record and cognitive load in emergency department nurses. METHODS The study utilized a correlational quantitative design with a survey method approach. This study had a 30.4 % response rate for a total of 304 ED nurse participants who were members of a national ED nursing organization. Data analysis included descriptive and correlational measurements of two instruments. RESULTS In this study, there was a statistically significant, weak negative relationship between CL and UC-EHR in ED nurses, rs (264) = -0.154, p 0.002. Although a significant weak relationship was identified in this study, the study variables, subscales, and demographic data groupings presented moderate-to-strong positive, statistically significant correlations. Descriptive frequency data unveiled EHR stimulated patient safety threats occurring once a week to monthly. CONCLUSIONS The novelty of this research study provided profound implications for the future of nursing practice, policy, and nursing science. EHR optimization to minimize patient safety risks is recommended with the inclusion of end-users from this study's identified subgroups. The researchers propose a reduction of EHR burden in nursing practice.
Collapse
Affiliation(s)
- Carolyn S Harmon
- Tennessee Center for Nursing Advancement at East Tennessee State University, American Nursing Informatics Association, USA.
| | - Swann Arp Adams
- College of Nursing and Arnold School of Public Health at the University of South Carolina in Columbia, SC, USA
| | - Jean E Davis
- College of Nursing at the University of South Carolina in Columbia, SC, USA
| | - Sheila M Gephart
- Biobehavioral Health Sciences Division at the University of Arizona in Tucson, AZ, USA
| | - Sara B Donevant
- College of Nursing at the University of South Carolina in Columbia, SC, USA
| |
Collapse
|
2
|
Galatzan BJ, Carrington JM. Communicating Data, Information, and Knowledge in the Nursing Handoff. Comput Inform Nurs 2022; 40:21-27. [PMID: 34347647 DOI: 10.1097/cin.0000000000000806] [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: 11/26/2022]
Abstract
Miscommunication occurring during the nursing handoff continues to be a primary cause of sentinel events and adverse patient outcomes. The primary purpose of the nursing handoff is to communicate essential patient data, information, and knowledge to ensure the safe continued continuity of care. The aim of this study was to examine the content of the nurse-to-nurse change-of-shift handoff communication in terms of data, information, and knowledge for both bedside and nonbedside handoffs of a patient who has experienced a clinical event. The setting was an urban medical center on a medical-surgical floor. The sample consisted of one nurse giving and one nurse receiving the handoff (n = 19 registered nurses). Five bedside and five nonbedside handoffs were audio recorded and analyzed using content analysis. The handoff overall contained 34.7% data, 51.7% information, and 13.6% knowledge. The nonbedside handoff compared with the bedside handoff contained a substantially higher percentage of data and less information. The percentage of knowledge being communicated in both the nonbedside and bedside handoff was low at 13.6% and 13.7%, respectively. The percentage of data compared with the percentage of knowledge in the handoff places the nurses at greater risk of experiencing cognitive lapses due to cognitive overload.
Collapse
Affiliation(s)
- Benjamin J Galatzan
- Author Affiliations: University of Alabama at Birmingham School of Nursing (Dr Galatzan); and College of Nursing Health Professions, University of Florida, Gainesville (Dr Carrington)
| | | |
Collapse
|
3
|
Hong JY, Ivory CH, VanHouten CB, Simpson CL, Novak LL. Disappearing expertise in clinical automation: Barcode medication administration and nurse autonomy. J Am Med Inform Assoc 2021; 28:232-238. [PMID: 32909610 DOI: 10.1093/jamia/ocaa135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/01/2020] [Accepted: 06/09/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Using the case of barcode medication administration (BCMA), our objective is to describe the challenges nurses face when informatics tools are not designed to accommodate the full complexity of their work. MATERIALS AND METHODS Autonomy is associated with nurse satisfaction and quality of care. BCMA organizes patient information and verifies medication administration. However, it presents challenges to nurse autonomy. Qualitative fieldwork, including observations of everyday work and interviews, was conducted during the implementation of BCMA in a large academic medical center. Fieldnotes and interview transcripts were coded and analyzed to describe nurses' perspectives on medication safety. RESULTS Nurses adopt orienting frames to structure work routines and require autonomy to ensure safe task completion. Nurses exerted agency by trusting their own judgment over system information when the system did not consider workload complexity. Our results indicate that the system's rigidity clashed with adaptive needs embodied by nurses' orienting frames. DISCUSSION Despite the fact that the concept of nurse as knowledge worker is foundational to informatics, nurses may be perceived as doers, rather than knowledge workers. In practice, nurses not only make decisions, but also engage in highly complex task-related work that is not well supported by process-oriented information technology tools. CONCLUSIONS Information technology developers and healthcare organization managers should engage and better understand nursing work in order to develop technological and social systems to support it.
Collapse
Affiliation(s)
- Jennifer Y Hong
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Catherine H Ivory
- Center for Evidenced-Based Practice and Nursing Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Courtney B VanHouten
- IBM Corporation, Watson Health, Center for AI, Research and Evaluation, Armonk, New York
| | - Christopher L Simpson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laurie Lovett Novak
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
4
|
Rikos N, Linardakis M, Economou C, Rovithis M, Philalithis A. The nurses' own views about the inter-shift handover process. Contemp Nurse 2019; 55:83-94. [PMID: 30975066 DOI: 10.1080/10376178.2019.1606723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Nursing handovers provide critical information on the patient, requiring special communication skills and techniques between the nurses' shift-change. Aim: Current study investigates the experiences/views of nurses regarding the handover process. Methods: An observation method was applied assesing 22 interviews using a semi-structured questionnaire and an audio recording system throughout mixed content analysis. Results: Nursing handover mainly involves medical instructions, detailed records of each patient's general condition or drug administration guidelines. Nurses determined which pieces of information were significant to transfer to the next shift were the medical instructions, the patient's hemodynamic condition and the care plans implemented by the previous nurse. The information was mainly drawn from events occurring in the previous 24 h, from the medical instructions, or the doctors and the nursing outcomes, and to a lesser extent from the events of the previous shifts and the nursing folders. None of the participants had received, as they stated, any training in the handover process. Conclusions: It is highlighting the importance of organized, standardized and up-to-date handovers, and the fundamental part they play in the health care system.
Collapse
Affiliation(s)
- Nikos Rikos
- a Department of Nursing, School of Health and Welfare Services , Technological Educational Institute (TEI) of Crete , Heraklion , Greece.,b Department of Social Medicine, Faculty of Medicine , University of Crete , Heraklion , Greece
| | - Manolis Linardakis
- b Department of Social Medicine, Faculty of Medicine , University of Crete , Heraklion , Greece
| | - Charalampos Economou
- c Department of Sociology, School of Social Sciences , Panteion University of Social and Political Sciences , Athens , Greece
| | - Michael Rovithis
- a Department of Nursing, School of Health and Welfare Services , Technological Educational Institute (TEI) of Crete , Heraklion , Greece
| | - Anastas Philalithis
- b Department of Social Medicine, Faculty of Medicine , University of Crete , Heraklion , Greece
| |
Collapse
|
5
|
|
6
|
|
7
|
Abstract
INTRODUCTION Nursing is a knowledge-intensive profession. Therefore, to cope with the demands of the nursing role, nursing students need to become competent in managing information to build nursing knowledge. However, nursing students' knowledge building process is poorly understood. This research aimed to explore (1) nursing students' dynamics of how they process nursing information for knowledge building and (2) nursing students' learning context in South Korea for their knowledge building. METHODS A constructivist grounded theory approach was used for this research. Data collection was achieved through four rounds of intensive individual and group interviews with 16 fourth year nursing students in South Korea. The collected data were coded by initial, focused and theoretical coding methods. Constant comparison analysis between data, codes, memos and categories was applied. RESULTS This research identified knowledge building dynamics consisting of three cognitive processes: connecting with information, deciding to accept information and building knowledge. Five motivational factors, including learners' interest, necessity of information, volition to learn, utility of information and the frequency of information that influence the processes were discovered. Moreover, four knowledge stages of memorising, understanding, synthesising and applying and creating emerged. CONCLUSIONS This is the first empirical study on knowledge building dynamics in educational environments for healthcare professionals. The findings of this research provide nursing educators with a practical model that can be used to improve nursing curricula in facilitating students' knowledge building processes. Moreover, a deeper understanding of sociocultural influences on nursing education can assist educators to adapt and generalise the findings to their pedagogical contexts, providing a culturally sensitive and relevant approach to nursing education.
Collapse
Affiliation(s)
- Jung Jae Lee
- School of Nursing, University of Hong Kong, Hong Kong, Hong Kong
| | - Charlotte L Clarke
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Maggie N Carson
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Sook Ching Yang
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
8
|
The Role of the Electronic Medical Record in the Intensive Care Unit Nurse's Detection of Patient Deterioration: A Qualitative Study. Comput Inform Nurs 2018; 36:284-292. [PMID: 29601339 DOI: 10.1097/cin.0000000000000431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Failure to detect patient deterioration signals leads to longer stays in the hospital, worse functional outcomes, and higher hospital mortality rates. Surveillance, including ongoing acquisition, interpretation, and synthesis of patient data by the nurse, is essential for early risk detection. Electronic medical records promote accessibility and retrievability of patient data and can support patient surveillance. A secondary analysis was performed on interview data from 24 intensive care unit nurses, collected in a study that examined factors influencing nurse responses to alarms. Six themes describing nurses' use of electronic medical record information to understand the patients' norm and seven themes describing electronic medical record design issues were identified. Further work is needed on electronic medical record design to integrate documentation and information presentation with the nursing workflow. Organizations should involve bedside nurses in the design of handoff formats that provide key information common to all intensive care unit patient populations, as well as population-specific information.
Collapse
|
9
|
|
10
|
Steichen O, Gregg W. Health Information Technology Coordination to Support Patient-centered Care Coordination. Yearb Med Inform 2017; 10:34-7. [PMID: 26293848 DOI: 10.15265/iy-2015-027] [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: 11/24/2022] Open
Abstract
OBJECTIVE To select papers published in 2014, illustrating how information technology can contribute to and improve patient-centered care coordination. METHOD The two section editors performed a literature review from Medline and Web of Science to select a list of candidate best papers on the use of information technology for patient-centered care coordination. These papers were peer-reviewed by external reviewers and three of them were selected as "best papers". RESULTS The first selected paper reports a qualitative study exploring the gap between current practices of care coordination in various settings and idealized longitudinal care plans. The second selected paper illustrates several unintended consequences of HIT designed to improve care coordination. The third selected paper shows that advanced analytic techniques in medical informatics can be instrumental in studying patient-centered care coordination. CONCLUSIONS The realization of true patient-centered care coordination is dependent upon a number of factors. Standardization of clinical documentation and HIT interoperability across organization and settings is a critical prerequisite for HIT to support patient-centered care coordination. Enabling patient involvement is an efficient means for goal setting and health information sharing. Additionally, unintended consequences of HIT tools (both positive and negative) must be measured and taken into account for quality improvement.
Collapse
Affiliation(s)
- O Steichen
- Olivier Steichen, Service de médecine interne, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France, Tel: +33 (0) 1 56 01 78 31, Fax: +33 (0) 1 56 01 71 13, E-mail:
| | | |
Collapse
|
11
|
Matney SA, Staggers N, Clark L. Nurses' Wisdom in Action in the Emergency Department. Glob Qual Nurs Res 2016; 3:2333393616650081. [PMID: 28462339 PMCID: PMC5342640 DOI: 10.1177/2333393616650081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 04/14/2016] [Accepted: 04/19/2016] [Indexed: 11/23/2022] Open
Abstract
Nurses seek to understand better what practicing with wisdom means and how to apply wisdom to practice; however, the experience of wisdom in nursing has not been well defined or researched. This study was designed to understand how emergency department (ED) nurses construct the meaning of wisdom within the culture of clinical nursing practice. Using Charmaz's constructivist grounded theory methodology, we developed a preliminary theory capturing the experience of wisdom in practice. The core theoretical model focuses on two juxtaposed processes, technical and affective, and is grounded in expertise. Significant findings were the recognition of affective categories, such as emotional intelligence, required to practice using wisdom. Results reinforce and extend the current wisdom literature and provide a new perspective on wisdom in practice in a nursing context.
Collapse
Affiliation(s)
| | | | - Lauren Clark
- The University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
12
|
Birmingham P, Buffum MD, Blegen MA, Lyndon A. Handoffs and Patient Safety: Grasping the Story and Painting a Full Picture. West J Nurs Res 2015; 37:1458-78. [PMID: 24951369 PMCID: PMC4272331 DOI: 10.1177/0193945914539052] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Effective handoff communication is critical for patient safety. Research is needed to understand how information processes occurring intra-shift impact handoff effectiveness. The purpose of this qualitative study was to examine medical-surgical nurses' (n = 21) perspectives about processes that promote and hinder patient safety intra-shift and during handoff. Results indicated that offgoing nurses' ability to grasp the story intra-shift was essential to convey the full picture during handoff. When oncoming nurses understood the picture being conveyed at the handoff, nurses jointly painted a full picture. Arriving and leaving the handoff with this level of information promoted patient safety. However, intra-shift disruptions often impeded nurses in their processes to grasp the story thus posing risks to patient safety. Improvement efforts need to target the different processes involved in grasping the story and painting a full picture. Future research needs to examine handoff practices and outcomes on units with good and poor practice environments.
Collapse
Affiliation(s)
| | - Martha D Buffum
- San Francisco Veterans Affairs Medical Center, USA University of California, San Francisco, USA
| | | | | |
Collapse
|