Greek School Nurses' Confidence With Diabetes Devices

Aim School nurses often use diabetes mellitus devices as part of the care provided to students with Type 1 Diabetes Mellitus. The aim of this study was to explore the psychometric properties of the Greek version of the Diabetes Devices Confidence Scale (DDCS). Methods In this cross-sectional, descriptive study, 143 school nurses completed the DDCS. This is a self-administered questionnaire exploring the nurses' confidence in the use of diabetes devices. The scale was translated and culturally adapted according to the WHO guidelines. The Intraclass Correlation Coefficient and Cronbach's Alpha Index were used to explore the reliability and internal consistency, respectively. The construct validity was tested via exploratory and confirmatory factor analysis (EFA, CFA). Data were analyzed via Statistical Package for the Social Sciences (SPSS), version 22.0 (IBM Corp., Armonk, NY, USA). Results Significant correlations were observed between the two administrations (p<0.001) indicating the good reliability of the scale (ICC = 0525, p<0.001) while Cronbach's Alpha was 0.966 suggesting excellent internal consistency. The EFA resulted in a unidimensional solution explaining 53.7% of the total variance. The CFA showed that the model presents good fit to the data. Conclusions The DDCS is a reliable and valid tool to test the nurses' confidence in diabetes devices.

The Impact of Digital Hospitals on Patient and Clinician Experience: Systematic Review and Qualitative Evidence Synthesis

BACKGROUND

The digital transformation of health care is advancing rapidly. A well-accepted framework for health care improvement is the Quadruple Aim: improved clinician experience, improved patient experience, improved population health, and reduced health care costs. Hospitals are attempting to improve care by using digital technologies, but the effectiveness of these technologies is often only measured against cost and quality indicators, and less is known about the clinician and patient experience.

OBJECTIVE

This study aims to conduct a systematic review and qualitative evidence synthesis to assess the clinician and patient experience of digital hospitals.

METHODS

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) guidelines were followed. The PubMed, Embase, Scopus, CINAHL, and PsycINFO databases were searched from January 2010 to June 2022. Studies that explored multidisciplinary clinician or adult inpatient experiences of digital hospitals (with a full electronic medical record) were included. Study quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis was performed narratively for quantitative studies. Qualitative evidence synthesis was performed via (1) automated machine learning text analytics using Leximancer (Leximancer Pty Ltd) and (2) researcher-led inductive synthesis to generate themes.

RESULTS

A total of 61 studies (n=39, 64% quantitative; n=15, 25% qualitative; and n=7, 11% mixed methods) were included. Most studies (55/61, 90%) investigated clinician experiences, whereas few (10/61, 16%) investigated patient experiences. The study populations ranged from 8 to 3610 clinicians, 11 to 34,425 patients, and 5 to 2836 hospitals. Quantitative outcomes indicated that clinicians had a positive overall satisfaction (17/24, 71% of the studies) with digital hospitals, and most studies (11/19, 58%) reported a positive sentiment toward usability. Data accessibility was reported positively, whereas adaptation, clinician-patient interaction, and workload burnout were reported negatively. The effects of digital hospitals on patient safety and clinicians' ability to deliver patient care were mixed. The qualitative evidence synthesis of clinician experience studies (18/61, 30%) generated 7 themes: inefficient digital documentation, inconsistent data quality, disruptions to conventional health care relationships, acceptance, safety versus risk, reliance on hybrid (digital and paper) workflows, and patient data privacy. There was weak evidence of a positive association between digital hospitals and patient satisfaction scores.

CONCLUSIONS

Clinicians' experience of digital hospitals appears positive according to high-level indicators (eg, overall satisfaction and data accessibility), but the qualitative evidence synthesis revealed substantive tensions. There is insufficient evidence to draw a definitive conclusion on the patient experience within digital hospitals, but indications appear positive or agnostic. Future research must prioritize equitable investigation and definition of the digital clinician and patient experience to achieve the Quadruple Aim of health care.

Documentation Completeness and Nurses' Perceptions of a Novel Electronic App for Medical Resuscitation in the Emergency Room: Mixed Methods Approach

BACKGROUND

Complete documentation of critical care events in the accident and emergency department (AED) is essential. Due to the fast-paced and complex nature of resuscitation cases, missing data is a common issue during emergency situations.

OBJECTIVE

This study aimed to evaluate the impact of a tablet-based resuscitation record on documentation completeness during medical resuscitations and nurses' perceptions of the use of the tablet app.

METHODS

A mixed methods approach was adopted. To collect quantitative data, randomized retrospective reviews of paper-based resuscitation records before implementation of the tablet (Pre-App Paper; n=176), paper-based resuscitation records after implementation of the tablet (Post-App Paper; n=176), and electronic tablet-based resuscitation records (Post-App Electronic; n=176) using a documentation completeness checklist were conducted. The checklist was validated by 4 experts in the emergency medicine field. The content validity index (CVI) was calculated using the scale CVI (S-CVI). The universal agreement S-CVI was 0.822, and the average S-CVI was 0.939. The checklist consisted of the following 5 domains: basic information, vital signs, procedures, investigations, and medications. To collect qualitative data, nurses' perceptions of the app for electronic resuscitation documentation were obtained using individual interviews. Reporting of the qualitative data was guided by Consolidated Criteria for Reporting Qualitative Studies (COREQ) to enhance rigor.

RESULTS

A significantly higher documentation rate in all 5 domains (ie, basic information, vital signs, procedures, investigations, and medications) was present with Post-App Electronic than with Post-App Paper, but there were no significant differences in the 5 domains between Pre-App Paper and Post-App Paper. The qualitative analysis resulted in main categories of "advantages of tablet-based documentation of resuscitation records," "challenges with tablet-based documentation of resuscitation records," and "areas for improvement of tablet-based resuscitation records."

CONCLUSIONS

This study demonstrated that higher documentation completion rates are achieved with electronic tablet-based resuscitation records than with traditional paper records. During the transition period, the nurse documenters faced general problems with resuscitation documentation such as multitasking and unique challenges such as software updates and a need to familiarize themselves with the app's layout. Automation should be considered during future app development to improve documentation and redistribute more time for patient care. Nurses should continue to provide feedback on the app's usability and functionality during app refinement to ensure a successful transition and future development of electronic documentation records.

Nurses' Attitudes and Factors Affecting Use of Electronic Health Record in Saudi Arabia

(1) Background: Nurses' attitudes toward electronic health records (EHRs) is a very valuable issue that needs to be evaluated, understood, and considered one of the main factors that can lead to its improvement or handicap its implementation. This study aimed to assess nurses' attitudes toward EHRs and associated factors that affect the implementation of EHRs in different hospitals in Saudi Arabia. (2) Methods: A cross-sectional study was utilized to collect data from 297 nurses working in public hospitals and primary healthcare centers in Ha'il Province from January to May 2023. Data were collected using the Nurses' Attitudes Towards Computerization questionnaire and a sociodemographic and work-related characteristics sheet. (3) Results: Most of the participants' attitude scores (81.1%, n = 241) were more than or equal to 60, representing positive attitudes, whereas 18.9% (n = 56) of the nurses' scores were less than 60, which is interpreted as negative attitudes. There was a significant relationship between nurses' attitudes toward EHRs and a participants' sex, where males had a more positive attitude than females (p < 0.001). Particularly, young nurses and those who had previous computer experience had a more positive attitude than older nurses and those who had no computer experience (p = 0.044 and < 0.001, respectively). Saudi nurses holding a master's degree had significantly more positive attitudes toward EHRs than non-Saudi nurses holding a bachelor's or diploma degree (p = 0.007 and 0.048, respectively). Nurses with less experience (less than five years) in the nursing field had a significantly positive attitude. Multiple linear regression showed that sex (p = 0.038), level of education (p = 0.001), and previous computer experience (p < 0.001) were independent factors of nurses' knowledge of EHRs. (4) Conclusion: The majority of nurses had positive overall attitudes toward using EHRs. Nurses who are Saudi nationals, male, younger, have previous computer experience, and have less than five years of experience had a more positive attitude toward EHRs than nurses who are non-Saudi, female, older, have no computer experience, have bachelor's or diploma degree, and have less than five years of experience, respectively. Sex, education level, and previous computer experience were independent factors of nurses' knowledge of EHRs.

Readiness-Based Implementation of Electronic Health Records: A Survey of Jordanian Nurses

Electronic health record (EHR) implementation is expanding worldwide to achieve the benefits of that technology, but it is reported in the literature as a "disruptive" change to the work environment in which all health-care workers need to be ready for the change, to enhance adoption and harvest the benefits. Jordan has rolled out a national EHR system. This study explored EHR implementation readiness, levels of realizing the benefits of EHR, and adoption among Jordanian nurses, using a self-report questionnaire at nine governmental hospitals in Jordan. A total of 462 registered nurses participated in the study. Results showed that nurses have moderate levels of readiness for EHR implementation, but higher levels of EHR benefits realization and adoption. All health-care workers' readiness for EHR implementation must be assessed regularly before, during, and after EHR implementation. Readiness-based roll-out can be used as a strategy in implementing EHR systems. Introducing a large-scale change management program is recommended to assess readiness, guide roll-out plans, enhance EHR implementation readiness, improve benefits realization, and increase EHR adoption levels, to help move health-care systems into the digital era.

Nurses’ Views on the Use, Quality, and Satisfaction with Electronic Medical Record in the Outpatient Department at a Tertiary Hospital

Background:

Many nurses perceive that the Electronic Medical Record (EMR) reduces the workload, improves the quality of documentation, and improves safety and patient care. However, other nurses reported that the system and environment of healthcare might impede EMR documentation at the bedside.

Objective:

The study aimed to describe the nurses' views of the use, quality, and satisfaction with EMR in daily practice in outpatient settings. Furthermore, the relationships among the use, quality, and user’s satisfaction of EMR were assessed in the study.

Methods:

The proposed study employed a cross-sectional, descriptive correlational design. Inclusion criteria were nurses willing to participate in the study, fluent in the English language, and have been working in the Outpatient Department for more than three months until the time of study implementation. A self-reported questionnaire with strong validity and reliability was used to assess nurses’ views of use, quality and satisfaction of EMR.

Results:

The response rate was 77.2% (170 out of 220), 91.2% of the participants were females. Results about the use of EMR have shown positive views ranging from 51.2% to 84.7%, with the lowest scores reported when to write nurse care worksheets (Kardex). For the quality of EMR, the results have shown positive views ranging from 70% to 87.6% with the lowest scores reported related to the EMR system problems and crashes, and for the user’s satisfaction, the results have shown positive views ranging from 76.5% to 87.1%. There were significant positive correlations between the three elements use, quality, and user’s satisfaction of EMR.

Conclusion:

Participants reported positive views in the domain of use, quality, and satisfaction with EMR. Furthermore, positive correlations were reported between the use, quality, and satisfaction domains of EMR.

A Qualitative Content Analysis of Nurses' Comfort and Employment of Workarounds With Electronic Documentation Systems in Home Care Practice

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.