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Bignell CA, Petrovskaya O. Understanding the role and impact of electronic health records in labor and delivery nursing practice: A scoping review protocol. Digit Health 2024; 10:20552076241249271. [PMID: 38665885 PMCID: PMC11044773 DOI: 10.1177/20552076241249271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Background Electronic health records have a significant impact on nursing practice, particularly in specializations such as labor and delivery, or acute care maternity nursing practice. Although primary studies on the use of electronic health records in labor and delivery have been done, no reviews on this topic exist. Moreover, the topic of labor and delivery nurses' organizing work in the electronic health record-enabled context has not been addressed. Objective To (a) synthesize research on electronic health record use in labor and delivery nursing and (b) map how labor and delivery nursing organizing work is transformed by the electronic health record (as described in the reviewed studies). Methods The scoping review will be guided by a modified methodology based on selected recommendations from the Joanna Briggs Institute and the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews. A comprehensive search will be conducted in the following databases: CINAHL Complete, MEDLINE, Academic Search Complete, Web of Science, Scopus and Dissertations and Theses Abstracts and Indexes. Included sources will be primary research, dissertations, or theses that address the use of electronic health records in labor and delivery nursing practice in countries with high levels of electronic health record adoption. Data extracted from included sources will be analyzed thematically. Further analysis will theorize labor and delivery nurses' organizing work in the context of electronic health record use by utilizing concepts from Davina Allen's Translational Mobilization Theory. Findings will be presented in tabular and descriptive formats. Conclusion The findings of this review will help understand transformations of nursing practice in the electronic health record-enabled labor and delivery context and identify areas of future research. We will propose an extension of the Translational Mobilization Theory and theorize nurses' organizing work involving the use of the electronic health record.
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Tsarfati B, Cojocaru D. Introducing Computerized Technology to Nurses: A Model Based on Cognitive Instrumental and Social Influence Processes. Healthcare (Basel) 2023; 11:1788. [PMID: 37372906 DOI: 10.3390/healthcare11121788] [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: 05/02/2023] [Revised: 06/07/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
The use of computerized technologies as an integral part of nursing has become a reality in the health care system. Studies present different approaches that range from accepting technology as a health promoter to an approach that opposes computerization. This study, which examined social and instrumental processes that influence nurses' attitudes toward computer technology, will present a model for the optimal assimilation of computer technology in the nurses' work environment. The study, which included 224 participants, was designed as a mixed method and included questionnaires and semi-structured interviews of participants. The data were analyzed to understand the factors that influenced nurses' attitudes toward the use of computer technology. The research findings show that the more clearly nurses understand the positive impact of using technology on the quality of care, the more positive their response to changes in registration and reporting methods. It is not surprising that the research findings found that cognitive instrumental processes and social influence processes have a positive effect on the perceived usefulness of using computer technologies. The unusual finding was the fact that cognitive instrumental processes were the main factor influencing the assimilation of computer technology even though nursing is a social profession.
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Affiliation(s)
- Becky Tsarfati
- Department of Sociology and Social Work, "Alexandru Ioan Cuza" University of Iasi, 700506 Iasi, Romania
| | - Daniela Cojocaru
- Department of Sociology and Social Work, "Alexandru Ioan Cuza" University of Iasi, 700506 Iasi, Romania
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Forde-Johnston C, Butcher D, Aveyard H. An integrative review exploring the impact of Electronic Health Records (EHR) on the quality of nurse-patient interactions and communication. J Adv Nurs 2023; 79:48-67. [PMID: 36345050 PMCID: PMC10100205 DOI: 10.1111/jan.15484] [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: 06/06/2022] [Revised: 10/07/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
Abstract
AIM To explore how nurses' use of electronic health records impacts on the quality of nurse-patient interactions and communication. DESIGN An integrative review. DATA SOURCES MEDLINE®, CINAHL®, PscyINFO, PubMed, BNI and Cochrane Library databases were searched for papers published between January 2005 and April 2022. REVIEW METHODS Following a comprehensive search, the studies were appraised using a tool appropriate to the study design. Data were extracted from the studies that met the inclusion criteria relating to sample characteristics, methods and the strength of evidence. Included empirical studies had to examine interactions or communication between a nurse and patient while electronic health records were being used in any healthcare setting. Findings were synthesized using a thematic approach. RESULTS One thousand nine hundred and twenty articles were initially identified but only eight met the inclusion criteria of this review. Thematic analysis revealed four key themes, indicating that EHR: impedes on face-to-face communication, promotes task-orientated and formulaic communication and impacts on types of communication patterns. CONCLUSION Research examining nurse-patient interactions and communication when nurses' use electronic health records is limited but evidence suggests that closed nurse-patient communications, reflecting a task-driven approach, were predominantly used when nurses used electronic health records, although some nurses were able to overcome logistical barriers and communicate more openly. Nurses' use of electronic health records impacts on the flow, nature and quality of communication between a nurse and patient. IMPACT The move to electronic health records has taken place largely without consideration of the impact that this might have on nurse-patient interaction and communication. There is evidence of impact but also evidence of how this might be mitigated. Nurses must focus future research on examining the impact that these systems have, and to develop strategies and practice that continue to promote the importance of nurse-patient interactions and communication. PATIENT OR PUBLIC CONTRIBUTION Studies examined within this review included patient participants that informed the analysis and interpretation of data.
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Affiliation(s)
- Carol Forde-Johnston
- School of Health and Life Sciences, Oxford Brookes University, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Dan Butcher
- School of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Helen Aveyard
- School of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Catalina QM, Fuster-Casanovas A, Vidal-Alaball J, Escalé-Besa A, Marin-Gomez FX, Femenia J, Solé-Casals J. Knowledge and perception of primary care healthcare professionals on the use of artificial intelligence as a healthcare tool. Digit Health 2023; 9:20552076231180511. [PMID: 37361442 PMCID: PMC10286543 DOI: 10.1177/20552076231180511] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/19/2023] [Indexed: 06/28/2023] Open
Abstract
Objective The rapid digitisation of healthcare data and the sheer volume being generated means that artificial intelligence (AI) is becoming a new reality in the practice of medicine. For this reason, describing the perception of primary care (PC) healthcare professionals on the use of AI as a healthcare tool and its impact in radiology is crucial to ensure its successful implementation. Methods Observational cross-sectional study, using the validated Shinners Artificial Intelligence Perception survey, aimed at all PC medical and nursing professionals in the health region of Central Catalonia. Results The survey was sent to 1068 health professionals, of whom 301 responded. And 85.7% indicated that they understood the concept of AI but there were discrepancies in the use of this tool; 65.8% indicated that they had not received any AI training and 91.4% that they would like to receive training. The mean score for the professional impact of AI was 3.62 points out of 5 (standard deviation (SD) = 0.72), with a higher score among practitioners who had some prior knowledge of and interest in AI. The mean score for preparedness for AI was 2.76 points out of 5 (SD = 0.70), with higher scores for nursing and those who use or do not know if they use AI. Conclusions The results of this study show that the majority of professionals understood the concept of AI, perceived its impact positively, and felt prepared for its implementation. In addition, despite being limited to a diagnostic aid, the implementation of AI in radiology was a high priority for these professionals.
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Affiliation(s)
- Queralt Miró Catalina
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Aïna Fuster-Casanovas
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Josep Vidal-Alaball
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Spain
| | - Anna Escalé-Besa
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Francesc X Marin-Gomez
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Joaquim Femenia
- Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Spain
| | - Jordi Solé-Casals
- Data and Signal Processing group, Faculty of Science, Technology and Engineering, University of Vic-Central University of Catalonia, Vic, Spain
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Hopkins DF, Visser RC, Armes J. Going paper-lite: housebound patient perspectives on the introduction of mobile working. Br J Community Nurs 2022; 27:508-514. [PMID: 36194397 DOI: 10.12968/bjcn.2022.27.10.508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Healthcare policies promote technology use as a means to modernise healthcare and support seamless, person-centred care. However, despite information technology (IT) use being common practice in clinical settings, its use in patients' homes is still developing. This study explored patients' perspectives on the use of IT and electronic health records (EHR) in their home environment. Semi structured interviews were conducted with housebound patients who received regular care from the district nursing team, and thematic data analysis was undertaken. Participants reported variable knowledge and experiences with mobile working and EHR. Most were positive and identified clear benefits for clinicians. However, few participants reported benefits to themselves. Contrary to popular belief, IT use is expected by older patients and, while barriers were identified, the overall opinion was positive. A digital divide was apparent, with some at risk of being disadvantaged by the increasing use of technology.
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Affiliation(s)
| | | | - Jo Armes
- Professor of Cancer Care, University of Surrey, Guildford, UK
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Shala DR, Jones A, Fairbrother G, Davis J, MacGregor A, Baysari M. Adopting an American framework to optimize nursing admission documentation in an Australian health organization. JAMIA Open 2022; 5:ooac054. [PMID: 35821796 PMCID: PMC9272497 DOI: 10.1093/jamiaopen/ooac054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 05/18/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Apply and modify the American Essential Clinical Dataset (ECD) approach to optimize the data elements of an electronic nursing admission assessment form in a metropolitan Australian local health district. Materials and Methods We used the American ECD approach but made modifications. Our approach included (1) a review of data, (2) a review of current admission practice via consultations with nurses, (3) a review of evidence and policies, (4) workshops with nursing and informatics teams in partnership with the electronic medical record (eMR) vendor, and (5) team debrief sessions to consolidate findings and decide what data elements should be kept, moved, or removed from the admission form. Results Of 165 data elements in the form, 32% (n = 53) had 0% usage, while 25% (n = 43) had 100% usage. Nurses’ perceptions of the form’s purpose varied. Eight policy documents specifically prescribed data to be noted at admission. Workshops revealed risks of moving or removing data elements, but also uncovered ways of streamlining the form. Consolidation of findings from all phases resulted in a recommendation to reduce 91% of data elements. Discussion Application of a modified ECD approach allowed the team to identify opportunities for significantly reducing and reorganizing data elements in the eMR to enhance the utility, quality, visibility, and value of nursing admission data. Conclusion We found the modified ECD approach effective for identifying data elements and work processes that were unnecessary and duplicated. Our findings and methodology can inform improvements in nursing clinical practice, information management, and governance in a digital health age.
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Affiliation(s)
- Danielle Ritz Shala
- Nursing and Midwifery Services, Sydney Local Health District , Camperdown, NSW, Australia
- Health Informatics Unit, Sydney Local Health District , Camperdown, NSW, Australia
| | - Aaron Jones
- Nursing and Midwifery Services, Sydney Local Health District , Camperdown, NSW, Australia
- Health Informatics Unit, Sydney Local Health District , Camperdown, NSW, Australia
- University of Sydney, Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health , Camperdown, NSW, Australia
| | - Greg Fairbrother
- The University of Sydney Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health , Camperdown, NSW, Australia
- Sydney Research , Camperdown, NSW, Australia
| | | | | | - Melissa Baysari
- University of Sydney, Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health , Camperdown, NSW, Australia
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Schmid T, Hoffmann F, Dörks M, Jobski K. Nurse-Filled Versus Pharmacy-Filled Medication Organization Devices—Survey on Current Practices and Views of Home Care Nursing Services. Healthcare (Basel) 2022; 10:healthcare10040620. [PMID: 35455796 PMCID: PMC9028845 DOI: 10.3390/healthcare10040620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/22/2022] Open
Abstract
Medication organization devices (MODs) are widely used among home care nursing services. However, current practices such as the responsibility for filling MODs, different MOD types used and requirements of home care nursing services are largely unknown. The study aimed at analyzing home care nursing services’ current practices regarding MOD use, investigating their requirements and determining whether different practices met these requirements. A survey was administered online to German home care nursing services in February 2021. The importance of requirements and the extent of satisfaction were measured using a five-point scale. Attitudes towards disposable, pharmacy-filled MODs were recorded as free text. In total, 690 nursing services responded (67.5% privately owned and 34.5% based in large cities), 92.2% filled MODs themselves and used predominantly reusable, rigid MODs. Pharmacies filling MODs used primarily disposable MODs. Satisfaction with current practices was generally high. Respondents filling MODs themselves were more satisfied with nurses’ medication knowledge, but less satisfied with cost effectiveness than those who had pharmacies fill MODs. Of all respondents filling MODs themselves who expressed an opinion on disposable, pharmacy-filled MODs, 50.9% were skeptical, primarily due to fear of losing flexibility. However, no difference in satisfaction with flexibility was found between respondents filling MODs themselves and those using pharmacy-filled MODs. In conclusion, employment of MODs in the professional care setting is a complex task with nursing services as key constituents. There is potential for improvement in the inter-professional collaboration between pharmacies and home care nursing services on the use of MODs. Measures for improvement have to address home care nursing services’ requirements with respect to flexibility and medication knowledge.
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Affiliation(s)
- Thomas Schmid
- Faculty of Social and Health Studies, University of Applied Sciences Kempten, 87435 Kempten, Germany;
| | - Falk Hoffmann
- Department of Health Services Research, Faculty VI Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (F.H.); (M.D.)
| | - Michael Dörks
- Department of Health Services Research, Faculty VI Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (F.H.); (M.D.)
| | - Kathrin Jobski
- Department of Health Services Research, Faculty VI Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (F.H.); (M.D.)
- Correspondence: ; Tel.: +49-441-798-2330
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Shinners L, Grace S, Smith S, Stephens A, Aggar C. Exploring healthcare professionals' perceptions of artificial intelligence: Piloting the Shinners Artificial Intelligence Perception tool. Digit Health 2022; 8:20552076221078110. [PMID: 35154807 PMCID: PMC8832586 DOI: 10.1177/20552076221078110] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/18/2022] [Indexed: 12/31/2022] Open
Abstract
Objective There is an urgent need to prepare the healthcare workforce for the
implementation of artificial intelligence (AI) into the healthcare setting.
Insights into workforce perception of AI could identify potential challenges
that an organisation may face when implementing this new technology. The aim
of this study was to psychometrically evaluate and pilot the Shinners
Artificial Intelligence Perception (SHAIP) questionnaire that is designed to
explore healthcare professionals’ perceptions of AI. Instrument validation
was achieved through a cross-sectional study of healthcare professionals
(n = 252) from a regional health district in
Australia. Methods and Results Exploratory factor analysis was conducted and analysis yielded a two-factor
solution consisting of 10 items and explained 51.7% of the total variance.
Factor one represented perceptions of ‘Professional impact of
AI’ (α = .832) and Factor two represented ‘Preparedness
for AI’ (α = .632). An analysis of variance indicated that ‘use
of AI’ had a significant effect on healthcare professionals’ perceptions of
both factors. ‘Discipline’ had a significant effect on Allied Health
professionals’ perception of Factor one and low mean scale score across all
disciplines suggests that all disciplines perceive that they are not
prepared for AI. Conclusions The results of this study provide preliminary support for the SHAIP tool and
a two-factor solution that measures healthcare professionals’ perceptions of
AI. Further testing is needed to establish the reliability or re-modelling
of Factor 2 and the overall performance of the SHAIP tool as a global
instrument.
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Affiliation(s)
- Lucy Shinners
- (Faculty of Health), Southern Cross University, Australia
| | - Sandra Grace
- (Faculty of Health), Southern Cross University, Australia
| | - Stuart Smith
- (Faculty of Health), Southern Cross University, Australia
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Kaihlanen AM, Gluschkoff K, Saranto K, Kinnunen UM. The associations of information system's support and nurses' documentation competence with the detection of documentation-related errors: Results from a nationwide survey. Health Informatics J 2021; 27:14604582211054026. [PMID: 34814758 DOI: 10.1177/14604582211054026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The use of information systems and electronic documentation has become a central part of a nurse's work, and it is expected to increase the quality of documentation and patient safety. However, errors related to documentation have been identified as a significant risk for the quality and safety of care. This study examined whether information system's support for documentation and nurses' documentation competence are associated with how frequently nurses detect documentation-related errors that have caused an adverse event. A nationwide survey was conducted in 2020, and a total of 3610 nurses participated. Results from linear regression analyses showed that high documentation support from the information system and high documentation competence were associated with fewer detected documentation-related errors. Nurses with low documentation support from the system and low documentation competence detected the most errors. The results highlight the need to develop electronic health record functions in a way that they better support accurate documentation. Furthermore, organisations should invest in ensuring the documentation skills of nurses and providing appropriate training.
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Affiliation(s)
| | - Kia Gluschkoff
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - 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
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Shala DR, Jones A, Fairbrother G, Thuy Tran D. Completion of electronic nursing documentation of inpatient admission assessment: Insights from Australian metropolitan hospitals. Int J Med Inform 2021; 156:104603. [PMID: 34628256 DOI: 10.1016/j.ijmedinf.2021.104603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/30/2021] [Accepted: 09/26/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Electronic nursing documentation is an essential aspect of inpatient care and multidisciplinary communication. Analysing data in electronic medical record (eMR) systems can assist in understanding clinical workflows, improving care quality, and promoting efficiency in the healthcare system. This study aims to assess timeliness of completion of an electronic nursing admission assessment form and identify patient and facility factors associated with form completion in three metropolitan hospitals. MATERIALS AND METHODS Records of 37,512 adult inpatient admissions (November 2018-November 2019) were extracted from the hospitals' eMR system. A dichotomous variable descriptive of completion of the nursing assessment form (Yes/No) was created. Timeliness of form completion was calculated as the interval between date and time of admission and form completion. Univariate and multivariate multilevel logistic regression were used to identify factors associated with form completion. RESULTS An admission assessment form was completed for 78.4% (n = 29,421) of inpatient admissions. Of those, 78% (n = 22,953) were completed within the first 24 h of admission, 13.3% (n = 3,910) between 24 and 72 h from admission, and 8.7% (n = 2,558) beyond 72 h from admission. Patient length of hospital stay, admission time, and admitting unit's nursing hours per patient day were associated with form completion. Patient gender, age, and admitting unit type were not associated with form completion. DISCUSSION Form completion rate was high, though more emphasis needs to be placed on the importance of timely completion to allow for adequate patient care planning. Staff education, qualitative understanding of delayed form completion, and streamlined guidelines on nursing admission and eMR use are recommended.
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Affiliation(s)
- Danielle Ritz Shala
- Nursing and Midwifery Services, Sydney Local Health District, Camperdown, NSW, Australia; Health Informatics Unit, Sydney Local Health District, Camperdown, NSW, Australia; Centre for Big Data Research in Health, University of New South Wales, Kensington, NSW, Australia.
| | - Aaron Jones
- Nursing and Midwifery Services, Sydney Local Health District, Camperdown, NSW, Australia; Health Informatics Unit, Sydney Local Health District, Camperdown, NSW, Australia; University of Sydney, Faculty of Medicine and Health, NSW, Australia
| | | | - Duong Thuy Tran
- Centre for Big Data Research in Health, University of New South Wales, Kensington, NSW, Australia
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11
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Wynter K, Holton S, Nguyen L, Sinnott H, Wickramasinghe N, Crowe S, Rasmussen B. Nurses. AUST HEALTH REV 2021; 46:188-196. [PMID: 34454640 DOI: 10.1071/ah21118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/28/2021] [Indexed: 11/23/2022]
Abstract
ObjectiveThe aim of this study was to describe nurses' and midwives' experiences following the first phase of the implementation of an electronic medical record (EMR) system at a large public health service in metropolitan Melbourne, Australia.MethodsFour focus groups were held 8-10 months after implementation of the EMR. Transcripts were analysed using thematic analysis.ResultsOf 39 participants, 25 were nurses (64%), 12 were midwives (31%) and two did not provide this information. The mean (±s.d.) duration of clinical experience was 15.6±12.2 years (range 2-40 years). Three main themes were identified: (1) effects on workflow: although some participants reported that EMR facilitated easier access to real-time patient data, others indicated that workflow was disrupted by the EMR being slow and difficult to navigate, system outages and lack of interoperability between the EMR and other systems; (2) effects on patient care and communication: some participants reported that the EMR improved their communication with patients and reduced medication errors, whereas others reported a negative effect on patient care and communication; and (3) negative effects of the EMR on nurses' and midwives' personal well-being, including frustration, stress and exhaustion. These experiences were often reported in the context of cognitive workload due to having to use multiple systems simultaneously or extra work associated with EMR outages.ConclusionNurses' and midwives' experiences of the EMR were complex and mixed. Nurses and midwives require significant training and ongoing technical support in the first 12 months after implementation of an EMR system. Including nurses and midwives in the design and refinement of the EMR will ensure that the EMR aligns with their workflow.What is known about the topic?Studies reporting nurses' and midwives' experiences of using EMR are scarce and mostly based in countries where whole-of-service implementations are carried out, funded by governments.What does this paper add?Nurses and midwives perceive benefits of using an EMR relatively soon after implementation in terms of their workflow and patient care. However, in the first year after EMR implementation, nurses and midwives experience some negative effects on workflow, patient care and their own well-being. The effects on clinical workflow are further compounded by EMR downtime (scheduled and unscheduled) and hybrid systems that require users to access other technology systems alongside the EMR.What are the implications for practitioners?In countries like Australia, whole-of-service, simultaneous implementation of EMR systems using best-available server technology may not be possible due to funding constraints. In these circumstances, nurses and midwives may initially experience increased workload and frustration. Ongoing training and technical support should be provided to nurses and midwives for several months following implementation. Including nurses and midwives in the design of the EMR will result in better alignment with their specific workflow, thus maximising benefits of EMR implementation.
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Affiliation(s)
- Karen Wynter
- School of Nursing and Midwifery, Deakin University, Geelong, Vic. 3220, Australia
| | - Sara Holton
- School of Nursing and Midwifery, Deakin University, Geelong, Vic. 3220, Australia
| | - Lemai Nguyen
- Department of Information Systems and Business Analytics, Deakin Business School, Deakin University, Burwood, Vic. 3125, Australia
| | - Helen Sinnott
- Nursing and Midwifery Informatics, Western Health, Footscray, Vic. 3011, Australia
| | - Nilmini Wickramasinghe
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Vic. 3122, Australia
| | - Shane Crowe
- Nursing and Midwifery Executive, Western Health, St Albans, Vic. 3021, Australia
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Deakin University, Geelong, Vic. 3220, Australia
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Martín-Méndez ME, García-Díaz V, Zurrón-Madera P, Fernández-Feito A, Jimeno-Demuth F, Lana A. Evolution of Nursing Workload Indicators Since the Implementation of the Electronic Health Record at a Tertiary Hospital in Spain. Comput Inform Nurs 2021; 39:689-695. [PMID: 34747892 DOI: 10.1097/cin.0000000000000759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nurses can be overwhelmed by the growing need for documentation derived from the implantation of electronic health records. The objective was to describe the evolution of nursing workload since the implementation of the EHR. We performed a longitudinal study of global workload indicators over a 5-year period at a referral hospital in Spain since introduction of the EHR (2014). Clinical activity records of each nurse were monitored using audit logs of their accesses to EHRs. During the study period, the number of EHR sessions, the number of EHR sessions in which a nursing order was changed, and the time needed to complete each session significantly increased. The number of mouse clicks and keystrokes and the time required to complete each nursing order decreased. Documentation of the following nursing tasks increased: administration of medication, peripheral vascular catheters, urinary catheters, pressure ulcers, nursing assessment forms, and pre-surgical verification. In conclusion, since the implementation of the EHR, an increase in the workload of nursing professionals-estimated through indirect indicators-has been observed due to greater documentation.
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Affiliation(s)
- María E Martín-Méndez
- Author Affiliations: Department of Medicine, School of Medicine and Health Sciences, University of Oviedo (Ms Martín-Méndez and Drs Zurrón-Madera, Fernández-Feito, and Lana); Health Care Service of Asturias, Central University Hospital of Asturias (Drs García-Díaz and Jimeno-Demuth); Healthcare Research Area, Health Research Institute of Asturias (ISPA) (Drs García-Díaz, Zurrón-Madera, Fernández-Feito, Jimeno-Demuth, and Lana); and Health Care Service of Asturias (Spain), Mental Health Center of La Corredoria (Dr Zurrón-Madera), Oviedo, Spain
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13
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Shinners L, Aggar C, Grace S, Smith S. Exploring healthcare professionals' perceptions of artificial intelligence: Validating a questionnaire using the e-Delphi method. Digit Health 2021; 7:20552076211003433. [PMID: 33815816 PMCID: PMC7995296 DOI: 10.1177/20552076211003433] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/23/2021] [Indexed: 01/15/2023] Open
Abstract
Objective The aim of this study was to draw upon the collective knowledge of experts in the fields of health and technology to develop a questionnaire that measured healthcare professionals' perceptions of Artificial Intelligence (AI). Methods The panel for this study were carefully selected participants who demonstrated an interest and/or involvement in AI from the fields of health or information technology. Recruitment was accomplished via email which invited the panel member to participate and included study and consent information. Data were collected from three rounds in the form of an online survey, an online group meeting and email communication. A 75% median threshold was used to define consensus. Results Between January and March 2019, five healthcare professionals and three IT experts participated in three rounds of study to reach consensus on the structure and content of the questionnaire. In Round 1 panel members identified issues about general understanding of AI and achieved consensus on nine draft questionnaire items. In Round 2 the panel achieved consensus on demographic questions and comprehensive group discussion resulted in the development of two further questionnaire items for inclusion. In a final e-Delphi round, a draft of the final questionnaire was distributed via email to the panel members for comment. No further amendments were put forward and 100% consensus was achieved. Conclusion A modified e-Delphi method was used to validate and develop a questionnaire to explore healthcare professionals' perceptions of AI. The e-Delphi method was successful in achieving consensus from an interdisciplinary panel of experts from health and IT. Further research is recommended to test the reliability of this questionnaire.
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Affiliation(s)
- Lucy Shinners
- Faculty of Health, Southern Cross University, Gold Coast Airport, Bilinga, Australia
| | - Christina Aggar
- Faculty of Health, Southern Cross University, Gold Coast Airport, Bilinga, Australia
| | - Sandra Grace
- Faculty of Health, Southern Cross University, East Lismore, Australia
| | - Stuart Smith
- Faculty of Health, Southern Cross University, Coffs Harbour, Australia
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14
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Huang FT. Caring for Computers: The Hidden Work of Clinical Nurses during the Introduction of Health Information Systems in a Teaching Hospital in Taiwan. NURSING REPORTS 2021; 11:105-119. [PMID: 34968317 PMCID: PMC8608098 DOI: 10.3390/nursrep11010011] [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: 01/25/2021] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 12/02/2022] Open
Abstract
Implementing health information systems for enhancing patient care and management occurs worldwide. Discovering how nurses, as important system end-users, experience technology-reliant clinical practice involved focus groups (n = 25) and in-depth individual interviews with nurses (n = 4) and informatics staff (n = 3) in a major Taiwanese medical center. This qualitative study explores the unintended effects of these systems on nurses’ role and clinical practice. First, nurses’ additional role caring for computer devices supporting patient care involves highly-demanding invisible effort, especially when tackling system malfunctions affecting patients with urgent conditions. Second, nurses are resourceful in developing solutions to protect patients during unexpected technical malfunctions. Third, troubleshooting using telephone technical support as the first resort is problematic. It is argued that computerization requires nurses to care for co-clients: patients and computers. Managing technical malfunctions is an unintended consequence for nurses, reflecting the hidden work required by new technology.
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Affiliation(s)
- Feng-Tzu Huang
- Liberal Arts Center, Department of Nursing, Da-Yeh University, Changhua 51591, Taiwan
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15
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AlQahtani M, AlShaibani W, AlAmri E, Edward D, Khandekar R. Electronic Health Record-Related Stress Among Nurses: Determinants and Solutions. Telemed J E Health 2020; 27:544-550. [PMID: 32857018 DOI: 10.1089/tmj.2020.0059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Documentation and navigation through electronic health records (EHRs) is an essential, but stressful, task. We present the magnitude, determinants of such events, and solutions proposed by nurses to address EHR-related stress (EHR-S) at a tertiary eye hospital in Saudi Arabia. Methods: Nurses of an eye hospital were surveyed in 2019 about EHR-S. A Likert scale was used to assess the responses of 10 components of EHR-related work. The total score was graded as follows: minimum (<-10), mild (<0 to -10), moderate (1-10), and severe (>11). The score was correlated with determinants. Solutions suggested by nurses to reduce stress were reviewed. Results: This survey covered 212 nurses. Of them, 106 (50%; 95% confidence interval: 43.3-56.7) reported EHR-S. The median EHR-S score was -3.0 (interquartile range: -9.0; +8.0). Thirty-five (16%) nurses reported severe EHR-S. Senior nurses (M-W, p < 0.02) and those working in emergency and recovery units (M-W, p < 0.01) had statistically higher EHR-S. The main stressors were incomplete EHR work by other departments affecting nursing care (70.8%), difficulty in correction after entering the data (60.4%), and difficulty in data retrieval (60.4%). The main solutions to reduce EHR-S were to reduce the frequency of changes to configuration of the EHR (58%), more training (54.2%), and appreciation of good work (52.8%). Conclusions: EHR-S is experienced by half of the nurses working at an eye care hospital. Implementation of solutions such as better training and fewer changes to the EHR system could reduce stress levels of nurses.
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Affiliation(s)
- Maha AlQahtani
- Department of Research and King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Wadha AlShaibani
- Department of Nursing, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Enaz AlAmri
- Department of Nursing, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Deepak Edward
- Department of Research and King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Rajiv Khandekar
- Department of Research and King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Joseph J, Moore ZEH, Patton D, O'Connor T, Nugent LE. The impact of implementing speech recognition technology on the accuracy and efficiency (time to complete) clinical documentation by nurses: A systematic review. J Clin Nurs 2020; 29:2125-2137. [DOI: 10.1111/jocn.15261] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/10/2020] [Accepted: 03/12/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Joseph Joseph
- Naas General hospital Naas Ireland
- School of Nursing and Midwifery Royal College of Surgeons in Ireland Dublin 2 Ireland
| | - Zena E. H. Moore
- School of Nursing and Midwifery Royal College of Surgeons in Ireland Dublin 2 Ireland
| | - Declan Patton
- School of Nursing and Midwifery Royal College of Surgeons in Ireland Dublin 2 Ireland
| | - Tom O'Connor
- School of Nursing and Midwifery Royal College of Surgeons in Ireland Dublin 2 Ireland
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17
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Wang Y, Zhao Y, Dang W, Zheng J, Dong H. The Evolution of Publication Hotspots in Electronic Health Records from 1957 to 2016 and Differences Among Six Countries. BIG DATA 2020; 8:89-106. [PMID: 32319801 DOI: 10.1089/big.2019.0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study aims to reveal the evolution of publication hotspots in the field of electronic health records (EHRs) and differences among countries. We applied keyword frequency analysis, keyword co-occurrence analysis, principal component analysis, multidimensional scaling analysis, and visualization technology to compare the high-frequency Medical Subject Heading (MeSH) terms in six countries during the periods 1957-2008 and 2009-2016. After 2009, the number of MeSH terms reflecting information exchange and information mining increased, and various types of evaluations based on EHRs and cohort studies significantly increased. The top 20 MeSH terms between 2009 and 2016 constitute five relatively larger knowledge groups. Thus, we conclude that publication hotspots in EHR field have shifted from issues related to the adoption of EHRs to the utilization of EHRs, and the knowledge structure has become systematic. The publication's focus was different in the six countries, which may relate to their national characteristics.
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Affiliation(s)
- Yanjun Wang
- Academic Department, Shanxi Health Education Center, Taiyuan, China
| | - Ye Zhao
- Department of Obstetrics and Gynecology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Weijia Dang
- Department of Health Information and Management, Changzhi Medical College, Changzhi, China
| | - Jianzhong Zheng
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Haiyuan Dong
- Academic Department, Shanxi Health Education Center, Taiyuan, China
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Redley B, Douglas T, Botti M. Methods used to examine technology in relation to the quality of nursing work in acute care: A systematic integrative review. J Clin Nurs 2020; 29:1477-1487. [PMID: 32045059 DOI: 10.1111/jocn.15213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/09/2020] [Accepted: 02/03/2020] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To systematically locate, assess and synthesise research to describe methods used to examine technology in relation to the quality of nursing work in acute care. Specific objectives were to (a) describe the types of nursing work examined; (b) describe methods used to examine technology in nursing work; (c) identify outcomes used to evaluate technology in relation to the quality of nursing work; and (d) make recommendations for future research. BACKGROUND New technologies can offer numerous benefits to nurses; however, it is challenging to evaluate health information technologies in relation to the quality of nurses' complex day-to-day work. DESIGN A systematic integrative review using a five-step process. METHODS Five databases were searched using search terms "nurs*," "workload," "task," "time." Data screening, extraction and interpretation were conducted independently by at least two authors and agreement verified by discussion. Data extraction followed PRISMA guidelines. RESULTS Of the 41 studies included, most (87.8%, n = 36) examined physical dimensions of nursing work; 31.7% (n = 13) organisational dimensions; 17.1% (n = 8) cognitive dimensions; and only 12.2% (n = 5) emotional dimensions. More than half (58.5%, n = 24) examined only one dimension; one captured all four dimensions. Most frequently examined technologies were electronic medical/health records (36.5%) and electronic medication management (19.5%). Direct observation (58.8%, n = 28) and multiple methods (19.5%, n = 8) were the most common methods; nurse tasks, frequency, duration and time distribution were variables most often measured. CONCLUSIONS Examinations of technology in nursing work often failed to capture the multiple dimensions of this work nor did they recognise the complexity of day-to-day nursing work in acute care. There is a paucity of literature to inform how and what technology should be measured in relation to the quality of nursing care. RELEVANCE TO CLINICAL PRACTICE The outcomes inform useful research methods to comprehensively examine technology to enhance the quality of complex nursing work.
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Affiliation(s)
- Bernice Redley
- Centre for Quality and Patient Safety Research - Monash Health Partnership, School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia
| | - Tracy Douglas
- School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia
| | - Mari Botti
- Centre for Quality and Patient Safety Research - Epworth Healthcare Partnership, School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia
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McCrorie C, Benn J, Johnson OA, Scantlebury A. Staff expectations for the implementation of an electronic health record system: a qualitative study using normalisation process theory. BMC Med Inform Decis Mak 2019; 19:222. [PMID: 31727063 PMCID: PMC6854727 DOI: 10.1186/s12911-019-0952-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/28/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Global evidence suggests a range of benefits for introducing electronic health record (EHR) systems to improve patient care. However, implementing EHR within healthcare organisations is complex and, in the United Kingdom (UK), uptake has been slow. More research is needed to explore factors influencing successful implementation. This study explored staff expectations for change and outcome following procurement of a commercial EHR system by a large academic acute NHS hospital in the UK. METHODS Qualitative interviews were conducted with 14 members of hospital staff who represented a variety of user groups across different specialities within the hospital. The four components of Normalisation Process Theory (Coherence, Cognitive participation, Collective action and Reflexive monitoring) provided a theoretical framework to interpret and report study findings. RESULTS Health professionals had a common understanding for the rationale for EHR implementation (Coherence). There was variation in willingness to engage with and invest time into EHR (Cognitive participation) at an individual, professional and organisational level. Collective action (whether staff feel able to use the EHR) was influenced by context and perceived user-involvement in EHR design and planning of the implementation strategy. When appraising EHR (Reflexive monitoring), staff anticipated short and long-term benefits. Staff perceived that quality and safety of patient care would be improved with EHR implementation, but that these benefits may not be immediate. Some staff perceived that use of the system may negatively impact patient care. The findings indicate that preparedness for EHR use could mitigate perceived threats to the quality and safety of care. CONCLUSIONS Health professionals looked forward to reaping the benefits from EHR use. Variations in level of engagement suggest early components of the implementation strategy were effective, and that more work was needed to involve users in preparing them for use. A clearer understanding as to how staff groups and services differentially interact with the EHR as they go about their daily work was required. The findings may inform other hospitals and healthcare systems on actions that can be taken prior to EHR implementation to reduce concerns for quality and safety of patient care and improve the chance of successful implementation.
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Affiliation(s)
- Carolyn McCrorie
- Patient Safety Translational Research Centre, Bradford Institute of Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK.
| | - Jonathan Benn
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | | | - Arabella Scantlebury
- York Trials Unit, Department of Health Sciences, ARRC Building, University of York, York, YO10 5DD, UK
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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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21
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Castellà-Creus M, Delgado-Hito P, Casanovas-Cuellar C, Tàpia-Pérez M, Juvé-Udina ME. Barriers and facilitators involved in standardised care plan individualisation process in acute hospitalisation wards: A grounded theory approach. J Clin Nurs 2019; 28:4606-4620. [PMID: 31512328 DOI: 10.1111/jocn.15059] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/07/2019] [Accepted: 08/18/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify and classify the barriers and facilitators of the individualisation process of the standardised care plan in hospitalisation wards. BACKGROUND The administration of individualised care is one of the features of the nursing process. Care plans are the structured record of the diagnosis, planning and evaluation stages of the nursing process. Although the creation of standardised care plan has made recording easier, it is still necessary to record the individualisation of the care. It is important to study the elements that influence the individualisation process from the nurses' perspective. DESIGN Qualitative study with the grounded theory approach developed by Strauss and Corbin. METHODS Thirty-nine nurses from three hospitals participated by way of theoretical sampling. In-depth interviews were conducted, as well as participant observation, document analysis and focus group discussion. The analysis consisted of open, axial and selective coding until data saturation was reached. EQUATOR guidelines for qualitative research (COREQ) were applied. RESULTS For both barriers and facilitators, three thematic categories emerged related to organisational, professional and individual aspects. The identified barriers included routines acquired in the wards, the tradition of narrative records, lack of knowledge and limited interest in individualisation. The identified facilitators included holding clinical care sessions, use of standardised care plan and an interface terminology, the nurse's expertise and willingness to individualise. CONCLUSION The individualisation process of the standardised care plan involves multiple barriers and facilitators, which influence its degree of accuracy. RELEVANCE TO CLINICAL PRACTICE Implementing strategies at an organisational level, professional level and individual level to improve the way the process is carried out would encourage individualising the standardised care plan in a manner that is consistent with the needs of the patient and family; it would improve the quality of care and patient satisfaction.
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Affiliation(s)
- Mònica Castellà-Creus
- Doctoral Program in Nursing and Health, University of Barcelona, Barcelona, Spain.,Institute of Bellvitge Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Pilar Delgado-Hito
- Institute of Bellvitge Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Spain.,Department of Fundamental Care and Medical-Surgical Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Cristina Casanovas-Cuellar
- Department of Research and Training, Catalan Institute of Health, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Marta Tàpia-Pérez
- Department of Health Information Systems, Catalan Institute of Health, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Maria-Eulàlia Juvé-Udina
- Institute of Bellvitge Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Spain.,Department of Fundamental Care and Medical-Surgical Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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22
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Ang RJ. Use of content management systems to address nursing workflow. Int J Nurs Sci 2019; 6:454-459. [PMID: 31728400 PMCID: PMC6839280 DOI: 10.1016/j.ijnss.2019.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 09/18/2019] [Accepted: 09/23/2019] [Indexed: 12/01/2022] Open
Abstract
Nurses are at the forefront of providing healthcare services to individuals of all age groups and with varying medical conditions. Aside from the critical knowledge and technical skills from nursing science, advancement in technology has assisted nurses in delivering quality nursing care by streamlining workflow processes and ensuring that data can easily be retrieved or modified. Electronic health records dramatically changed the landscape of the healthcare practice by providing an electronic means to store data and for healthcare professionals to retrieve and manipulate health information in a secured and collaborative environment. But with the nature of data being stored in the electronic health records, nurses still need to organize and process these data into relevant information, knowledge or wisdom so they can provide better holistic care to patients. This discussion paper details the role of content management systems in addressing nursing workflow by providing a mechanism for nurses to be developers themselves, and not just users or consumers of health innovative technologies. By using content management systems as platform for application development, nurses or other healthcare professionals, may be able to address problems with internal workflow without having to incur huge amounts in software development, or having to extensively learn programming languages.
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Affiliation(s)
- Raymund John Ang
- Health Carousel, LLC., OH, USA.,Regional Hospital of Scranton, Scranton, PA, USA
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Myklebust KK, Bjørkly S. The quality and quantity of staff-patient interactions as recorded by staff. A registry study of nursing documentation in two inpatient mental health wards. BMC Psychiatry 2019; 19:251. [PMID: 31412803 PMCID: PMC6694476 DOI: 10.1186/s12888-019-2236-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/08/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Therapeutic staff-patient interaction is fundamental in psychiatric care. It is recognized as a key to healing in and of itself, or a premise to enhance psychiatric treatment adherence. Still, little is known about how these interactions are recorded in nursing documentation. The purpose of the study was to assess the quality and quantity of staff-patient interactions as recorded in progress notes in nursing documentation. METHODS The study has an observational registry study design. A random sample of 3858 excerpts was selected from progress notes in 90 patient journals on an acute psychiatric unit and an open inpatient district psychiatric centre (DPC) in Norway. The Scale for the Evaluation of Staff-Patient Interactions in progress notes (SESPI) was used to assess the progress note excerpts. It is developed to assess the quality and quantity in excerpt descriptions of staff-patient interactions in terms of empathic attunement. Descriptive statistics were calculated for the total sample and for each ward separately. Ordinal and multinomial logistic regression were used to estimate control for shift type, staff education level, and type of hospital ward. RESULTS Only 7.6% of the total number of excerpts (N = 3858) described staff-patient interactions sufficiently to analyze them in terms of attunement. Compared to the DPC, the acute ward reported more staff-patient interactions. The evening excerpts reported more successful types of attunement than those from the night shifts. Education level did not contribute significantly to our models. CONCLUSION These findings present a unique insight into the quality and quantity of mental health nursing documentation regarding staff-patient interactions. Therapeutic interactions where staff tried to attune to the patients were rarely described. However, this is the first study measuring nursing documentation with the SESPI, and more studies are required to validate the scale and our findings. One potential clinical implication of this research is the development of a scale that personnel in psychiatric wards can have for evaluation of the quality of their reporting practice with emphasis on staff-patient interactions. By regular use this may help keeping up emphasis on emphatic attunement in milieu treatment contexts.
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Affiliation(s)
- Kjellaug K. Myklebust
- 0000 0004 0434 9525grid.411834.bFaculty of Health Sciences and Social Care, Molde University College, Box 2110, 6402 Molde, Norway
| | - Stål Bjørkly
- 0000 0004 0434 9525grid.411834.bFaculty of Health Sciences and Social Care, Molde University College, Box 2110, 6402 Molde, Norway ,0000 0004 0389 8485grid.55325.34Centre for Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
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Vehko T, Hyppönen H, Puttonen S, Kujala S, Ketola E, Tuukkanen J, Aalto AM, Heponiemi T. Experienced time pressure and stress: electronic health records usability and information technology competence play a role. BMC Med Inform Decis Mak 2019; 19:160. [PMID: 31412859 PMCID: PMC6694657 DOI: 10.1186/s12911-019-0891-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Electronic health records (EHRs) are an elementary part of the work of registered nurses (RNs) in healthcare. RNs are the largest group of healthcare workers, and their experiences with EHRs and their informatics competence play a crucial role in a fluent workflow. The present study examined EHR usability factors and nurses' informatics competence factors related to self-reported time pressure and psychological distress. METHODS A nationwide survey was conducted for working-age registered nurses in 2017. The study sample included 3607 nurses (5% men) in Finland. The association of age, sex, employment sector, EHR usability factors, and nurses' informatics competence factors with time pressure and psychological distress were examined with analyses of covariance. RESULTS The EHR usability factors that were associated with high time pressure were low EHR reliability and poor user-friendliness. Regarding the nurses' informatics competence factors, only low e-Care competence was associated with time pressure. Of the EHR usability factors, low EHR reliability and low support for cooperation were associated with high psychological distress. Of the nurses' informatics competence factors, low e-Care competence was associated with high psychological distress. CONCLUSIONS Unreliability and poor user-friendliness of EHRs seem to be prominent sources of time pressure and psychological distress among registered nurses. User-friendly EHR systems and digital tools in healthcare are needed. Nurses' competence to use eHealth tools to tailor patient care should be strengthened through organizational and regional actions. For example, house rules about how to use eHealth tools and instructions on common practices in cooperation with other organizations could be useful.
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Affiliation(s)
- Tuulikki Vehko
- The Department of Information Services, National Institute for Health and Welfare (THL), P.O. Box 30, FI-00271, Helsinki, Finland.
| | - Hannele Hyppönen
- The Department of Information Services, National Institute for Health and Welfare (THL), P.O. Box 30, FI-00271, Helsinki, Finland
| | | | - Sari Kujala
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Eeva Ketola
- The Department of Information Services, National Institute for Health and Welfare (THL), P.O. Box 30, FI-00271, Helsinki, Finland
| | - Johanna Tuukkanen
- Emergency Unit, Central Finland Healthcare District, Jyväskylä, Finland
| | - Anna-Mari Aalto
- The Department of Information Services, National Institute for Health and Welfare (THL), P.O. Box 30, FI-00271, Helsinki, Finland
| | - Tarja Heponiemi
- The Department of Information Services, National Institute for Health and Welfare (THL), P.O. Box 30, FI-00271, Helsinki, Finland
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25
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Byrne MD. A Nurse's Guide to Enhancing Clinical Technologies. J Perianesth Nurs 2019; 34:1069-1073. [PMID: 31255439 DOI: 10.1016/j.jopan.2019.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/28/2019] [Indexed: 11/20/2022]
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Ibrahim S, Donelle L, Regan S, Sidani S. A Qualitative Content Analysis of Nurses' Comfort and Employment of Workarounds With Electronic Documentation Systems in Home Care Practice. Can J Nurs Res 2019; 52:31-44. [PMID: 31200603 DOI: 10.1177/0844562119855509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Electronic documentation systems have the potential to assist registered nurses with timely access to patient health- and care-related information. Registered nurses are the largest users of electronic documentation systems; however, limited evidence exists about their comfort with electronic documentation system usage and the types of workarounds developed within the context of home care. Aim To explore home care registered nurses’ comfort with electronic documentation system usage and identify the types and reasons for the development and implementation of workarounds. Methods A cross-sectional survey design was employed to collect quantitative and qualitative data. A total of 217 home care registered nurses participated in the survey. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using inductive content analysis. Findings: Individual (e.g., registered nurses’ technology-related experience), technological (e.g., electronic documentation system design) and organizational (e.g. training) characteristics influenced registered nurses’ comfort with electronic documentation system usage. Furthermore, workarounds stemmed from the technological characteristics of the electronic documentation system. Conclusion Findings highlight the need for assessing registered nurses’ level of comfort with electronic documentation system usage to inform training initiatives. Including registered nurses in the system design is advocated to ensure electronic documentation systems fit with the complexity of nursing practice, potentially enhancing registered nurses’ level of comfort and mitigating the development and employment of workarounds during system usage.
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Affiliation(s)
- Sarah Ibrahim
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Lorie Donelle
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Sandra Regan
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
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Ryu H, Kim J. Evaluation of User Experience of New Defense Medical Information System. Healthc Inform Res 2019; 25:73-81. [PMID: 31131141 PMCID: PMC6517624 DOI: 10.4258/hir.2019.25.2.73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/01/2019] [Accepted: 02/07/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives This study aimed to investigate the user experience (UX) of the New Defense Medical Information System (N-DEMIS), which was introduced in 2012 as part of an effort to improve the old system of armed forces hospitals and ultimately bring their standards up to those of civilian hospitals. Methods In this study, the dependent variable was the UX of N-DEMIS and was composed of usability, affect, and user value. The questionnaire comprised 41 questions: nine on general characteristics, 20 on usability, four on affect, and eight on user value. The data collection period was from April 15 to April 30, 2018. Overall, 85 responses were received; of these, three insincere responses were excluded, and the remaining 82 responses were used in the analysis. Results The overall value of Cronbach's alpha was 0.917, indicating an overall high-reliability. There was a significant difference between user value and usability, but there was no significant differences between the other pairs. We observed a significant effect on UX for length of time working in an armed forces hospital and employment type. Conclusions The results of our survey showed an even distribution of scores across the three elements of UX, showing that no particular aspect of N-DEMIS is superior to the others in terms of user satisfaction. However, the overall UX score of around 60% indicates the need for future improvements. Rather than focusing improvements on a specific area, improvements should be spread across usability, affect, and user value.
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Affiliation(s)
- Hyeongju Ryu
- College of Nursing, Seoul National University, Seoul, Korea
| | - Jeongeun Kim
- College of Nursing, Seoul National University, Seoul, Korea.,Research Institute of Nursing Science, Seoul National University, Seoul, Korea
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Hardiker NR, Dowding D, Dykes PC, Sermeus W. Reinterpreting the nursing record for an electronic context. Int J Med Inform 2019; 127:120-126. [PMID: 31128823 DOI: 10.1016/j.ijmedinf.2019.04.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/15/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND This article seeks to facilitate the re-imagining of nursing records purposefully within an electronic context. It questions existing approaches to nursing documentation, critically examines existing nursing record systems and identifies new requirements. METHODS A comprehensive literature review was conducted to identify themes, that might meaningfully contribute to a new approach to nursing record systems development, around four key interrelated areas - standards, decision making, abstraction and summarization, and documenting. Studies were analyzed using narrative synthesis to provide a critical analysis of the current 'state of the art', and recommendations for the future. RESULTS Included studies collectively described aspects of current best practice, both in terms of nursing record systems themselves, and how nurses and other health professionals contribute to and engage with those systems. A number of cross-cutting themes identified more novel approaches taken by nurses to systems development: going back to basics in determining purpose; firming up informatics foundations; nuancing or tailoring to suit different requirements; and engagement, involvement and participation. CONCLUSION There is a paucity of research that specifically focuses on the nature of the electronic nursing record and its impact on patient care processes and outcomes. In addition to further research in these areas, there is a need: to reinterpret nurses as knowledge workers rather than as 'data collectors'; to agree on the application in practice of appropriate standards and terminologies; and to work together with system developers to change the ways in which data are captured and care is documented.
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Affiliation(s)
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, UK.
| | - Patricia C Dykes
- Department of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, USA.
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven, Belgium.
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Rentmeester C. Heeding humanity in an age of electronic health records: Heidegger, Levinas, and Healthcare. Nurs Philos 2018; 19:e12214. [PMID: 29785721 DOI: 10.1111/nup.12214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 04/25/2018] [Indexed: 11/28/2022]
Abstract
The American Recovery and Reinvestment Act of 2009 (ARRA) required healthcare providers in the United States to adopt and demonstrate meaningful use of electronic health records (EHRs) by January 1, 2014. In many ways, EHRs mark a notable improvement over paper medical records as they are more easily accessible and allow for electronic searching and sharing of medical history. However, as EHRs have become mandated by ARRA, many nurses now rely upon computers far more heavily during nurse-patient interactions, thereby decreasing the level of direct interpersonal communication between the two. There is evidence that eye contact between nurses and patients positively affects patient satisfaction. Above and beyond the issue of patient satisfaction is the more basic ethical issue of respecting the patient as a person. The author argues that the templates used in electronic health systems have the possibility of eroding the respect for humanity that is the hallmark of nurse-patient relationships, as signalled by the American Nurses Association's first principle in their Code of Ethics. Using concepts from philosophers Martin Heidegger and Emmanuel Levinas, the author provides guidance as to what an ethical interaction between nurse and patient should look like in an age of EHRs.
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Howsmon DP, Baysal N, Buckingham BA, Forlenza GP, Ly TT, Maahs DM, Marcal T, Towers L, Mauritzen E, Deshpande S, Huyett LM, Pinsker JE, Gondhalekar R, Doyle FJ, Dassau E, Hahn J, Bequette BW. Real-Time Detection of Infusion Site Failures in a Closed-Loop Artificial Pancreas. J Diabetes Sci Technol 2018; 12:599-607. [PMID: 29390915 PMCID: PMC6154252 DOI: 10.1177/1932296818755173] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As evidence emerges that artificial pancreas systems improve clinical outcomes for patients with type 1 diabetes, the burden of this disease will hopefully begin to be alleviated for many patients and caregivers. However, reliance on automated insulin delivery potentially means patients will be slower to act when devices stop functioning appropriately. One such scenario involves an insulin infusion site failure, where the insulin that is recorded as delivered fails to affect the patient's glucose as expected. Alerting patients to these events in real time would potentially reduce hyperglycemia and ketosis associated with infusion site failures. METHODS An infusion site failure detection algorithm was deployed in a randomized crossover study with artificial pancreas and sensor-augmented pump arms in an outpatient setting. Each arm lasted two weeks. Nineteen participants wore infusion sets for up to 7 days. Clinicians contacted patients to confirm infusion site failures detected by the algorithm and instructed on set replacement if failure was confirmed. RESULTS In real time and under zone model predictive control, the infusion site failure detection algorithm achieved a sensitivity of 88.0% (n = 25) while issuing only 0.22 false positives per day, compared with a sensitivity of 73.3% (n = 15) and 0.27 false positives per day in the SAP arm (as indicated by retrospective analysis). No association between intervention strategy and duration of infusion sets was observed ( P = .58). CONCLUSIONS As patient burden is reduced by each generation of advanced diabetes technology, fault detection algorithms will help ensure that patients are alerted when they need to manually intervene. Clinical Trial Identifier: www.clinicaltrials.gov,NCT02773875.
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Affiliation(s)
- Daniel P. Howsmon
- Department of Chemical & Biological
Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Nihat Baysal
- Department of Chemical & Biological
Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Bruce A. Buckingham
- Department of Pediatrics, Division of
Pediatric Endocrinology, Stanford University, Palo Alto, CA, USA
| | | | - Trang T. Ly
- Department of Pediatrics, Division of
Pediatric Endocrinology, Stanford University, Palo Alto, CA, USA
| | - David M. Maahs
- Department of Pediatrics, Division of
Pediatric Endocrinology, Stanford University, Palo Alto, CA, USA
| | - Tatiana Marcal
- Department of Pediatrics, Division of
Pediatric Endocrinology, Stanford University, Palo Alto, CA, USA
| | - Lindsey Towers
- Barbara Davis Center, University of
Colorado Denver, Denver, CO, USA
| | - Eric Mauritzen
- Department of Computer Science and
Engineering, University of California, San Diego, San Diego, CA, USA
| | - Sunil Deshpande
- Harvard John A. Paulson School of
Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Sansum Diabetes Research Institute,
Santa Barbara, CA, USA
| | - Lauren M. Huyett
- Sansum Diabetes Research Institute,
Santa Barbara, CA, USA
- Department of Chemical Engineering,
University of California, Santa Barbara, Santa Barbara, CA, USA
| | | | - Ravi Gondhalekar
- Harvard John A. Paulson School of
Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Sansum Diabetes Research Institute,
Santa Barbara, CA, USA
| | - Francis J. Doyle
- Harvard John A. Paulson School of
Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Sansum Diabetes Research Institute,
Santa Barbara, CA, USA
| | - Eyal Dassau
- Harvard John A. Paulson School of
Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Sansum Diabetes Research Institute,
Santa Barbara, CA, USA
| | - Juergen Hahn
- Department of Chemical & Biological
Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
- Department of Biomedical Engineering,
Rensselaer Polytechnic Institute, Troy, NY, USA
| | - B. Wayne Bequette
- Department of Chemical & Biological
Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
- B. Wayne Bequette, PhD, Chemical &
Biological Engineering, Rensselaer Polytechnic Institute, 110 8th St, Ricketts
Building, Troy, NY 12180, USA.
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Barrett AK. Electronic Health Record (EHR) Organizational Change: Explaining Resistance Through Profession, Organizational Experience, and EHR Communication Quality. HEALTH COMMUNICATION 2018; 33:496-506. [PMID: 28157382 DOI: 10.1080/10410236.2016.1278506] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The American Recovery and Reinvestment Act passed by the U.S. government in 2009 mandates that all healthcare organizations adopt a certified electronic health record (EHR) system by 2015. Failure to comply will result in Medicare reimbursement penalties, which steadily increase with each year of delinquency. There are several repercussions of this seemingly top-down, rule-bound organizational change-one of which is employee resistance. Given the penalties for violating EHR meaningful use standards are ongoing, resistance to this mandate presents a serious issue for healthcare organizations. This study surveyed 345 employees in one healthcare organization that recently implemented an EHR. Analysis of variance results offer theoretical and pragmatic contributions by demonstrating physicians, nurses, and employees with more experience in their organization are the most resistant to EHR change. The job characteristics model is used to explain these findings. Hierarchical regression analyses also demonstrate the quality of communication surrounding EHR implementation-from both formal and informal sources-is negatively associated with EHR resistance and positively associated with perceived EHR implementation success and EHR's perceived relative advantage.
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Electronic Fetal Monitoring Documentation: Connecting Points for Quality Care and Communication. J Perinat Neonatal Nurs 2018; 32:24-33. [PMID: 29240649 DOI: 10.1097/jpn.0000000000000299] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Contemporaneous, complete, and objective documentation is the foundation for continuity of patient care and facilitates communication between all levels of healthcare clinicians. The impact of electronic fetal monitoring on obstetric safety has become a high priority, with documentation being essential to evaluating care quality. Over several decades, electronic fetal monitoring documentation has reached a higher level of precision because paper is being replaced with health information technology that incorporates system's features such as checklists, drop-down boxes, and decision analysis. The intent of this article is to provide a synopsis of important concepts regarding electronic fetal monitoring documentation and liability-reduction strategies for perinatal nurses.
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33
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Myklebust KK, Bjørkly S, Råheim M. Nursing documentation in inpatient psychiatry: The relevance of nurse-patient interactions in progress notes-A focus group study with mental health staff. J Clin Nurs 2017; 27:e611-e622. [PMID: 29048775 DOI: 10.1111/jocn.14108] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To gain insight into mental health staff's perception of writing progress notes in an acute and subacute psychiatric ward context. BACKGROUND The nursing process structures nursing documentation. Progress notes are intended to be an evaluation of a patient's nursing diagnoses, interventions and outcomes. Within this template, a patient's status and the care provided are to be recorded. The therapeutic nurse-patient relationship is recognised as a key component of psychiatric care today. At the same time, the biomedical model remains strong. Research literature exploring nursing staff's experiences with writing progress notes in psychiatric contexts, and especially the space given to staff-patient relations, is sparse. DESIGN Qualitative design. METHODS Focus group interviews with mental health staff working in one acute and one subacute psychiatric ward were conducted. Systematic text condensation, a method for transverse thematic analysis, was used. RESULTS Two main categories emerged from the analysis: the position of the professional as an expert and distant observer in the progress notes, and the weak position of professional-patient interactions in progress notes. CONCLUSIONS The participants did not perceive that the current recording model, which is based on the nursing process, supported a focus on patients' resources or reporting professional-patient interactions. This model appeared to put ward staff in an expert position in relation to patients, which made it challenging to involve patients in the recording process. Essential aspects of nursing care related to recovery and person-centred care were not prioritised for documentation. RELEVANCE TO CLINICAL PRACTICE This study contributes to the critical examination of the documentation praxis, as well as to the critical examination of the documentation tool as to what is considered important to document.
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Affiliation(s)
- Kjellaug K Myklebust
- Institute of Health and Social Sciences, Molde University College, Molde, Norway
| | - Stål Bjørkly
- Institute of Health and Social Sciences, Molde University College, Molde, Norway.,Centre for Forensic Psychiatry, Oslo University Hospital, Molde, Norway
| | - Målfrid Råheim
- Institute of Health and Social Sciences, Molde University College, Molde, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Nygårdh A, Sherwood G, Sandberg T, Rehn J, Knutsson S. The visibility of QSEN competencies in clinical assessment tools in Swedish nurse education. NURSE EDUCATION TODAY 2017; 59:110-117. [PMID: 28985548 DOI: 10.1016/j.nedt.2017.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 07/03/2017] [Accepted: 09/07/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Prospective nurses need specific and sufficient knowledge to be able to provide quality care. The Swedish Society of Nursing has emphasized the importance of the six quality and safety competencies (QSEN), originated in the US, in Swedish nursing education. PURPOSE To investigate the visibility of the QSEN competencies in the assessment tools used in clinical practice METHOD: A quantitative descriptive method was used to analyze assessment tools from 23 universities. RESULTS AND CONCLUSION Teamwork and collaboration was the most visible competency. Patient-centered care was visible to a large degree but was not referred to by name. Informatics was the least visible, a notable concern since all nurses should be competent in informatics to provide quality and safety in care. These results provide guidance as academic and clinical programs around the world implement assessment of how well nurses have developed these essential quality and safety competencies.
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Affiliation(s)
- Annette Nygårdh
- Department of Nursing, School of Health and Welfare, Box 1026, SE-551 11, Jönköping University, Sweden; Improvement, Innovation, and Leadership in Health and Welfare, Jönköping University, Sweden.
| | - Gwen Sherwood
- University of North Carolina at Chapel Hill, School of Nursing, USA
| | | | | | - Susanne Knutsson
- Department of Nursing, School of Health and Welfare, Jönköping University, Sweden; CHILD research Group, Jönköping University, Sweden
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Nguyen L, Wickramasinghe N, Redley B, Haddad P, Muhammad I, Botti M. Exploring nurses’ reactions to electronic nursing documentation at the point of care. INFORMATION TECHNOLOGY & PEOPLE 2017. [DOI: 10.1108/itp-10-2015-0269] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to investigate nurses’ attitudes, perceptions, and reactions to a new point-of-care information system for documenting nursing care.
Design/methodology/approach
A design science research methodology (DSRM) was used to examine the feasibility and usability of a novel nursing informatics solution in the context of acute hospital care. Data were collected using focus groups and non-participant observations. Analyses were guided by the theoretical lens of actor-network theory (ANT).
Findings
The findings unpack an understanding of the potential value of a new technology, rather than a binary understanding of positive or negative value. Using the ANT lens, the study reveals the dynamics of the nurse-technology relationships and consequent disruptions throughout the translation process. The findings highlight the central role of negotiation in the socio-technical construction of the hybrid actor-network during the implementation of new technology in acute hospital contexts.
Research limitations/implications
Further studies are needed to investigate the dynamics and complexity of the translation process that occurs during technology adoption, reactions of the involved actors to the emerging network and impacts on their role and work process.
Practical implications
Engaging nurses early during development and testing; aligning the new system’s functionality and interface with nurses’ interests and work practices; and supporting changes to clinical work process to enable an effective heterogeneous actor-network to emerge and become stable.
Originality/value
This study presents a novel use of ANT in a DSRM to understand an enterprise-wide system involving nurses and real clinical settings. The emerged actor-network provides insights into the translation process when nurses adapt to using new technology in their work.
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36
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Hospital Nurses' Work Activity in a Technology-Rich Environment: A Triangulated Quality Improvement Assessment. J Nurs Care Qual 2017; 32:208-217. [PMID: 28541263 DOI: 10.1097/ncq.0000000000000237] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this project was to describe hospital nurses' work activity through observations, nurses' perceptions of time spent on tasks, and electronic health record time stamps. Nurses' attitudes toward technology and patients' perceptions and satisfaction with nurses' time at the bedside were also examined. Activities most frequently observed included documenting in and reviewing the electronic health record. Nurses' perceptions of time differed significantly from observations, and most patients rated their satisfaction with nursing time as excellent or good.
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37
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Rouleau G, Gagnon MP, Côté J, Payne-Gagnon J, Hudson E, Dubois CA. Impact of Information and Communication Technologies on Nursing Care: Results of an Overview of Systematic Reviews. J Med Internet Res 2017; 19:e122. [PMID: 28442454 PMCID: PMC5424122 DOI: 10.2196/jmir.6686] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/27/2017] [Accepted: 03/05/2017] [Indexed: 12/17/2022] Open
Abstract
Background Information and communication technologies (ICTs) are becoming an impetus for quality health care delivery by nurses. The use of ICTs by nurses can impact their practice, modifying the ways in which they plan, provide, document, and review clinical care. Objective An overview of systematic reviews was conducted to develop a broad picture of the dimensions and indicators of nursing care that have the potential to be influenced by the use of ICTs. Methods Quantitative, mixed-method, and qualitative reviews that aimed to evaluate the influence of four eHealth domains (eg, management, computerized decision support systems [CDSSs], communication, and information systems) on nursing care were included. We used the nursing care performance framework (NCPF) as an extraction grid and analytical tool. This model illustrates how the interplay between nursing resources and the nursing services can produce changes in patient conditions. The primary outcomes included nurses’ practice environment, nursing processes, professional satisfaction, and nursing-sensitive outcomes. The secondary outcomes included satisfaction or dissatisfaction with ICTs according to nurses’ and patients’ perspectives. Reviews published in English, French, or Spanish from January 1, 1995 to January 15, 2015, were considered. Results A total of 5515 titles or abstracts were assessed for eligibility and full-text papers of 72 articles were retrieved for detailed evaluation. It was found that 22 reviews published between 2002 and 2015 met the eligibility criteria. Many nursing care themes (ie, indicators) were influenced by the use of ICTs, including time management; time spent on patient care; documentation time; information quality and access; quality of documentation; knowledge updating and utilization; nurse autonomy; intra and interprofessional collaboration; nurses’ competencies and skills; nurse-patient relationship; assessment, care planning, and evaluation; teaching of patients and families; communication and care coordination; perspectives of the quality of care provided; nurses and patients satisfaction or dissatisfaction with ICTs; patient comfort and quality of life related to care; empowerment; and functional status. Conclusions The findings led to the identification of 19 indicators related to nursing care that are impacted by the use of ICTs. To the best of our knowledge, this was the first attempt to apply NCPF in the ICTs’ context. This broad representation could be kept in mind when it will be the time to plan and to implement emerging ICTs in health care settings. Trial Registration PROSPERO International Prospective Register of Systematic Reviews: CRD42014014762; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014014762 (Archived by WebCite at http://www.webcitation.org/6pIhMLBZh)
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Affiliation(s)
- Geneviève Rouleau
- Faculty of Nursing Sciences, Université Laval, Quebec, QC, Canada.,Research Center of the Centre Hospitalier de l'Université de Montréal, Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
| | - Marie-Pierre Gagnon
- Faculty of Nursing Sciences, Université Laval, Quebec, QC, Canada.,Research Centre of the Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada
| | - José Côté
- Research Center of the Centre Hospitalier de l'Université de Montréal, Research Chair in Innovative Nursing Practices, Montreal, QC, Canada.,Faculty of Nursing Sciences, Université de Montréal, Montreal, QC, Canada
| | - Julie Payne-Gagnon
- Research Centre of the Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada
| | - Emilie Hudson
- School of Nursing, McGill University, Montreal, QC, Canada
| | - Carl-Ardy Dubois
- Faculty of Nursing Sciences, Université de Montréal, Montreal, QC, Canada
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38
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Improving Effectiveness and Satisfaction of an Electronic Charting System in Taiwan. CLIN NURSE SPEC 2016; 30:E1-E6. [DOI: 10.1097/nur.0000000000000250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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40
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Cho I, Kim E, Choi WH, Staggers N. Comparing usability testing outcomes and functions of six electronic nursing record systems. Int J Med Inform 2016; 88:78-85. [DOI: 10.1016/j.ijmedinf.2016.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 12/27/2015] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
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41
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Cohen JF, Coleman E, Kangethe MJ. An importance-performance analysis of hospital information system attributes: A nurses' perspective. Int J Med Inform 2015; 86:82-90. [PMID: 26564330 DOI: 10.1016/j.ijmedinf.2015.10.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/25/2015] [Accepted: 10/31/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Health workers have numerous concerns about hospital IS (HIS) usage. Addressing these concerns requires understanding the system attributes most important to their satisfaction and productivity. Following a recent HIS implementation, our objective was to identify priorities for managerial intervention based on user evaluations of the performance of the HIS attributes as well as the relative importance of these attributes to user satisfaction and productivity outcomes. PROCEDURES We collected data along a set of attributes representing system quality, data quality, information quality, and service quality from 154 nurse users. Their quantitative responses were analysed using the partial least squares approach followed by an importance-performance analysis. Qualitative responses were analysed using thematic analysis to triangulate and supplement the quantitative findings. MAIN FINDINGS Two system quality attributes (responsiveness and ease of learning), one information quality attribute (detail), one service quality attribute (sufficient support), and three data quality attributes (records complete, accurate and never missing) were identified as high priorities for intervention. CONCLUSIONS Our application of importance-performance analysis is unique in HIS evaluation and we have illustrated its utility for identifying those system attributes for which underperformance is not acceptable to users and therefore should be high priorities for intervention.
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Affiliation(s)
- Jason F Cohen
- University of the Witwatersrand, Johannesburg, South Africa.
| | - Emma Coleman
- University of the Witwatersrand, Johannesburg, South Africa
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42
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Cho I, Choi WJ, Choi W, Hyun M, Park Y, Lee Y, Cho E, Hwang O. [Identifying Usability Level and Factors Affecting Electronic Nursing Record Systems: A Multi-institutional Time-motion Approach]. J Korean Acad Nurs 2015; 45:523-32. [PMID: 26364527 DOI: 10.4040/jkan.2015.45.4.523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 10/19/2014] [Accepted: 04/22/2015] [Indexed: 11/09/2022]
Abstract
PURPOSE The usability, user satisfaction, and impact of electronic nursing record (ENR) systems were investigated. METHODS This mixed-method research was performed as a time-motion (TM) study and a survey which were carried out at six hospitals between August and November 2013. The TM study involved 108 nurses from medical, surgical, and intensive care units at each hospital, plus an additional 48 nurses who served as nonparticipating observers. In the survey, 1879 volunteer nurses completed the Impact of ENR Systems Scale, the System Usability Scale, and a global satisfaction scale. Qualitative and quantitative analyses were performed. RESULTS The mean scores for the ENR impact, system usability, and satisfaction were 4.28 (out of 6), 58.62 (out of 100), and 74.31 (out of 100), respectively, and they differed significantly between hospitals (F=43.43, p<.001, F=53.08 and p<.001, and F=29.13 and p<.001, respectively). A workflow fragmentation assessment revealed different patterns of ENR system use among the included hospitals. Three user characteristics-educational background, practice period, and experience of using paper records-significantly affected the system usability and satisfaction scores. CONCLUSION The system quality varied widely among the ENR systems. The generally low-to-moderate levels of system usability and user satisfaction suggest many opportunities for improvement.
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Affiliation(s)
- Insook Cho
- Department of Nursing, Inha University, Incheon, Korea.
| | - Won Ja Choi
- Department of Nursing, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Woanheui Choi
- Department of Nursing, Seoul National University Hospital, Seoul, Korea
| | - Misuk Hyun
- Department of Nursing, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Yeonok Park
- Department of Nursing, Ajou University Hospital, Suwon, Korea
| | - Yoona Lee
- Department of Nursing, Korea University Guro Hospital, Seoul, Korea
| | - Euiyoung Cho
- Department of Nursing, Pai Chai University, Daejeon, Korea
| | - Okhee Hwang
- Department of Nursing, National Cancer Center, Goyang, Korea
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Cohen JF, Kangethe JM. The Relationship between User Satisfaction, System Attributes and the Motivating Potential of System Use. J ORGAN END USER COM 2015. [DOI: 10.4018/joeuc.2015070103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
User satisfaction (US) is an important information systems success measure. This paper contributes to our understanding of US in workplace settings by conceptualizing US as resulting from user evaluations of both the attribute level performance of the system and its impacts on the motivating potential of their work. Data was collected from a sample of 154 nurses in a regional public hospital in South Africa who are users of an integrated hospital information system. The authors considered that use of the system has implications for the motivating potential of work through its impacts on skill variety, task identity, significance, autonomy, and work performance. Their results show that a system's impact on motivating potential is significant for US. Moreover, system quality, information quality, and user support attributes of the IS have significant direct effects on US as well as indirect effects through motivating potential. A high performing system is thus important for US as it provides a platform to increase the motivating potential of work.
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Affiliation(s)
- Jason F. Cohen
- University of the Witwatersrand, Johannesburg, South Africa
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Laitinen H, Kaunonen M, Åstedt-Kurki P. The impact of using electronic patient records on practices of reading and writing. Health Informatics J 2015; 20:235-49. [PMID: 25411220 DOI: 10.1177/1460458213492445] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate the use of electronic patient records in daily practice. In four wards of a large hospital district in Finland, N = 43 patients' care and activities were observed and analysed in terms of the Grounded Theory method. The findings revealed that using electronic patient records created a particular process of writing and reading. Wireless technology enabled simultaneous patient involvement and point-of-care documentation, additionally supporting real-time reading. Remote and retrospective documentation was distant in terms of both space and time. The remoteness caused double documentation, reduced accuracy and less-efficient use of time. 'Non-reading' practices were witnessed in retrospective reading, causing delays in patient care and increase in workload. Similarly, if documentation was insufficient or non-existent, the consequences were found to be detrimental to the patients. The use of an electronic patient record system has a significant impact on patient care. Therefore, it is crucial to develop wireless technology and interdisciplinary collaboration in order to improve and support high-quality patient care.
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Affiliation(s)
- Heleena Laitinen
- School of Health Sciences, Nursing Science, University of Tampere, FinlandDepartment of Musculoskeletal Diseases, Tampere University Hospital, Finland Science Centre, Pirkanmaa Hospital District, FinlandTampere University of Applied Sciences, Finland
| | - Marja Kaunonen
- School of Health Sciences, Nursing Science, University of Tampere, Finland Science Centre, Pirkanmaa Hospital District, Finland
| | - Paivi Åstedt-Kurki
- School of Health Sciences, Nursing Science, University of Tampere, Finland Science Centre, Pirkanmaa Hospital District, Finland
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45
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Impacts of information and communication technologies on nursing care: an overview of systematic reviews (protocol). Syst Rev 2015; 4:75. [PMID: 26002726 PMCID: PMC4449960 DOI: 10.1186/s13643-015-0062-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 05/15/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Information and communication technologies (ICTs) used in the health sector have well-known advantages. They can promote patient-centered healthcare, improve quality of care, and educate health professionals and patients. However, implementation of ICTs remains difficult and involves changes at different levels: patients, healthcare providers, and healthcare organizations. Nurses constitute the largest health provider group of the healthcare workforce. The use of ICTs by nurses can have impacts in their practice. The main objective of this review of systematic reviews is to systematically summarize the best evidence regarding the effects of ICTs on nursing care. METHODS/DESIGN We will include all types of reviews that aim to evaluate the influence of ICTs used by nurses on nursing care. We will consider four types of ICTs used by nurses as a way to provide healthcare: management systems, communication systems, information systems, and computerized decision support systems. We will exclude nursing management systems, educational systems, and telephone systems. The following types of comparisons will be carried out: ICT in comparison with usual care/practice, ICT compared to any other ICT, and ICT versus other types of interventions. The primary outcomes will include nurses' practice environment, nursing processes/scope of nursing practice, nurses' professional satisfaction as well as nursing sensitive outcomes, such as patient safety, comfort, and quality of life related to care, empowerment, functional status, satisfaction, and patient experience. Secondary outcomes will include satisfaction with ICT from the nurses and patients' perspective. Reviews published in English, French, or Spanish from 1 January 1995 will be considered. Two reviewers will independently screen the title and abstract of the papers in order to assess their eligibility and extract the following information: characteristics of the population and setting, type of interventions (e.g., type of ICTs and service provided), comparisons, outcomes, and review limitations. Any disagreements will be resolved by discussion and consensus involving the two reviewers or will involve a third review author, if needed. DISCUSSION This overview is an interesting starting point from which to compare and contrast findings of separate reviews regarding the positive and negative effects of ICTs on nursing care. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014014762.
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de Oliveira NB, Peres HHC. Evaluation of the functional performance and technical quality of an Electronic Documentation System of the Nursing Process. Rev Lat Am Enfermagem 2015; 23:242-9. [PMID: 26039294 PMCID: PMC4458997 DOI: 10.1590/0104-1169.3562.2548] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 12/04/2014] [Indexed: 11/22/2022] Open
Abstract
Objective: To evaluate the functional performance and the technical quality of the
Electronic Documentation System of the Nursing Process of the Teaching Hospital of
the University of São Paulo. Method: exploratory-descriptive study. The Quality Model of regulatory standard 25010 and
the Evaluation Process defined under regulatory standard 25040, both of the
International Organization for Standardization/International Electrotechnical
Commission. The quality characteristics evaluated were: functional suitability,
reliability, usability, performance efficiency, compatibility, security,
maintainability and portability. The sample was made up of 37 evaluators. Results: in the evaluation of the specialists in information technology, only the
characteristic of usability obtained a rate of positive responses of less than
70%. For the nurse lecturers, all the quality characteristics obtained a rate of
positive responses of over 70%. The staff nurses of the medical and surgical
clinics with experience in using the system) and staff nurses from other units of
the hospital and from other health institutions (without experience in using the
system) obtained rates of positive responses of more than 70% referent to the
functional suitability, usability, and security. However, performance efficiency,
reliability and compatibility all obtained rates below the parameter established.
Conclusion: the software achieved rates of positive responses of over 70% for the majority of
the quality characteristics evaluated.
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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: 199] [Impact Index Per Article: 19.9] [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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Meißner A, Schnepp W. Staff experiences within the implementation of computer-based nursing records in residential aged care facilities: a systematic review and synthesis of qualitative research. BMC Med Inform Decis Mak 2014; 14:54. [PMID: 24947420 PMCID: PMC4114165 DOI: 10.1186/1472-6947-14-54] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 06/06/2014] [Indexed: 11/29/2022] Open
Abstract
Background Since the introduction of electronic nursing documentation systems, its implementation in recent years has increased rapidly in Germany. The objectives of such systems are to save time, to improve information handling and to improve quality. To integrate IT in the daily working processes, the employee is the pivotal element. Therefore it is important to understand nurses’ experience with IT implementation. At present the literature shows a lack of understanding exploring staff experiences within the implementation process. Methods A systematic review and meta-ethnographic synthesis of primary studies using qualitative methods was conducted in PubMed, CINAHL, and Cochrane. It adheres to the principles of the PRISMA statement. The studies were original, peer-reviewed articles from 2000 to 2013, focusing on computer-based nursing documentation in Residential Aged Care Facilities. Results The use of IT requires a different form of information processing. Some experience this new form of information processing as a benefit while others do not. The latter find it more difficult to enter data and this result in poor clinical documentation. Improvement in the quality of residents’ records leads to an overall improvement in the quality of care. However, if the quality of those records is poor, some residents do not receive the necessary care. Furthermore, the length of time necessary to complete the documentation is a prominent theme within that process. Those who are more efficient with the electronic documentation demonstrate improved time management. For those who are less efficient with electronic documentation the information processing is perceived as time consuming. Normally, it is possible to experience benefits when using IT, but this depends on either promoting or hindering factors, e.g. ease of use and ability to use it, equipment availability and technical functionality, as well as attitude. Conclusions In summary, the findings showed that members of staff experience IT as a benefit when it simplifies their daily working routines and as a burden when it complicates their working processes. Whether IT complicates or simplifies their routines depends on influencing factors. The line between benefit and burden is semipermeable. The experiences differ according to duties and responsibilities.
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Affiliation(s)
- Anne Meißner
- Department of Nursing Science, University Witten/Herdecke, Witten, Germany.
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