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Mannevaara P, Kinnunen UM, Egbert N, Hübner U, Vieira-Marques P, Sousa P, Saranto K. Discovering the importance of health informatics education competencies in healthcare practice. A focus group interview. Int J Med Inform 2024; 187:105463. [PMID: 38643700 DOI: 10.1016/j.ijmedinf.2024.105463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/18/2024] [Accepted: 04/17/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND As healthcare and especially health technology evolve rapidly, new challenges require healthcare professionals to take on new roles. Consequently, the demand for health informatics competencies is increasing, and achieving these competencies using frameworks, such as Technology Informatics Guiding Reform (TIGER), is crucial for future healthcare. AIM The study examines essential health informatics and educational competencies and health informatics challenges based on TIGER Core Competency Areas. Rather than examine each country independently, the focus is on uncovering commonalities and shared experiences across diverse contexts. METHODS Six focus group interviews were conducted with twenty-one respondents from three different countries (Germany (n = 7), Portugal (n = 6), and Finland (n = 8)). These interviews took place online in respondents' native languages. All interviews were transcribed and then summarized by each country. Braun and Clarke's thematic analysis framework was applied, which included familiarization with the data, generating initial subcategories, identifying, and refining themes, and conducting a final analysis to uncover patterns within the data. RESULTS Agreed upon by all three countries, competencies in project management, communication, application in direct patient care, digital literacy, ethics in health IT, education, and information and knowledge management were identified as challenges in healthcare. Competencies such as communication, information and communication technology, project management, and education were identified as crucial for inclusion in educational programs, emphasizing their critical role in healthcare education. CONCLUSIONS Despite working with digital tools daily, there is an urgent need to include health informatics competencies in the education of healthcare professionals. Competencies related to application in direct patient care, IT-background knowledge, IT-supported and IT-related management are critical in educational and professional settings are seen as challenging but critical in healthcare.
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Affiliation(s)
- Pauleen Mannevaara
- Faculty of Social Sciences and Business Studies, University of Eastern Finland, Kuopio, Finland.
| | - Ulla-Mari Kinnunen
- Faculty of Social Sciences and Business Studies, University of Eastern Finland, Kuopio, Finland
| | - Nicole Egbert
- Health Informatics Research Group, Osnabrück University of Applied Sciences, Osnabrück, Germany
| | - Ursula Hübner
- Health Informatics Research Group, Osnabrück University of Applied Sciences, Osnabrück, Germany
| | - Pedro Vieira-Marques
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paulino Sousa
- Center for Health Technology and Services Research (CINTESIS), Escola Superior Enfermagen do Porto, Porto, Portugal
| | - Kaija Saranto
- Faculty of Social Sciences and Business Studies, University of Eastern Finland, Kuopio, Finland
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Jedwab RM, Manias E, Redley B, Dobroff N, Hutchinson AM. Impacts of technology implementation on nurses' work motivation, engagement, satisfaction and well-being: A realist review. J Clin Nurs 2023; 32:6037-6060. [PMID: 37082879 DOI: 10.1111/jocn.16730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
AIM To examine current literature for causal explanations on how, why and under what circumstances, implementation of a new hospital electronic medical record system or similar technology impacts nurses' work motivation, engagement, satisfaction or well-being. BACKGROUND Implementation of new technology, such as electronic medical record systems, affects nurses and their work, workflows and inter-personal interactions in healthcare settings. Multiple individual and organisational-level factors can affect technology adoption by nurses and may have negative consequences for nurses and patient safety. DESIGN Five-step realist review method and Realist And Meta-narrative Evidence Syntheses: Evolving Standards checklist was used to guide this review. Eight initial theories (programme theories) were used as the basis to explore, examine and refine literature from a range of sources. DATA SOURCES Literature from five databases (APA PsycInfo, CINAHL, Embase, IEEE Xplore and MEDLINE Complete) and grey literature (from 1 January 2000 to 31 October 2021) were systematically searched and retrieved on 4 November 2021. RESULTS In all, 8980 records were screened at the title and abstract level, of which 1027 full texts were screened and 10 were included in the review. Seven studies assessed concepts in both pre- and post-technology implementation. Most common contexts related to knowledge, rationale and skills to use new technology. Mechanisms that impacted nurses or nursing care delivery included: nurses' involvement in technology implementation processes; nurses' perceptions, understanding and limitations of technology impact(s) on patient care delivery; social supports; skills; implementation attitude and hardware. Work satisfaction was the most frequently examined outcome. An analysis led to nine final programme theories (including two original, six revised and one new programme theory). CONCLUSION Nurses must be informed about the rationale for new technology and have the knowledge and skills for its use. Understanding nurses' work motivation and attitudes related to technology adoption in the workplace can support work engagement, satisfaction and well-being. IMPLICATIONS FOR THE PROFESSION Complex contexts and mechanisms play a role in nurses' work motivation, engagement, satisfaction and well-being with the implementation of new technology into healthcare settings. RELEVANCE TO CLINICAL PRACTICE Nurses, their work and workflows are all influenced by the implementation of new technologies (such as electronic medical records), which in turn has consequences for patient safety and quality of care. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. PROSPERO REGISTRATION NUMBER CRD42020131875 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131875).
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Affiliation(s)
- Rebecca M Jedwab
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University School of Nursing and Midwifery, Melbourne, Victoria, Australia
- Monash Health Nursing and Midwifery Informatics, Melbourne, Victoria, Australia
| | - Elizabeth Manias
- Institute for Health Transformation, Deakin University School of Nursing and Midwifery, Melbourne, Victoria, Australia
| | - Bernice Redley
- Deakin University School of Nursing and Midwifery, Melbourne, Victoria, Australia
| | - Naomi Dobroff
- Monash Health Nursing and Midwifery Informatics, Melbourne, Victoria, Australia
- Deakin University School of Nursing and Midwifery, Melbourne, Victoria, Australia
| | - Alison M Hutchinson
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University School of Nursing and Midwifery, Melbourne, Victoria, Australia
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Alrasheeday AM, Alshammari B, Alkubati SA, Pasay-an E, Albloushi M, Alshammari AM. Nurses' Attitudes and Factors Affecting Use of Electronic Health Record in Saudi Arabia. Healthcare (Basel) 2023; 11:2393. [PMID: 37685427 PMCID: PMC10486676 DOI: 10.3390/healthcare11172393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/13/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
(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.
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Affiliation(s)
- Awatif M. Alrasheeday
- Nursing Administration Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia;
| | - Bushra Alshammari
- Medical Surgical Nursing Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia;
| | - Sameer A. Alkubati
- Medical Surgical Nursing Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia;
- Department of Nursing, Faculty of Medicine and Health Sciences, Hodeida University, Hodeida P.O. Box 3114, Yemen
| | - Eddieson Pasay-an
- Maternal and Child Nursing Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia;
| | - Monirah Albloushi
- Medical Surgical Department, College of Nursing, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Awayed M. Alshammari
- Nursing Administration, King Khalid General Hospital, Ministry of Health, Hafar Al Batin 39921, Saudi Arabia;
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Dan X, Huang Y, Ren JH, Tian YL, He YL. Professional Nursing Practice Environment and Work Engagement: The Mediating Roles of Self-Efficacy and Achievement Motivation. J Nurs Res 2023; Publish Ahead of Print:00134372-990000000-00068. [PMID: 37257016 DOI: 10.1097/jnr.0000000000000563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND The shortage of nurses is a global problem. Increasing the level of work engagement is known to effectively reduce turnover rate among nursing staff. Strategies to improve work engagement based on the job demands-resources model may effectively improve nurses' job satisfaction and reduce staff turnover. PURPOSE A job demands-resources model was used in this study to test the hypothesis that work engagement is affected by both external resources (professional nursing practice environment) and internal resources (self-efficacy and achievement motivation). In addition, the mediating role of self-efficacy and achievement motivation in the relationship between professional nursing practice environment and work engagement was also verified. METHODS A cross-sectional survey employing a convenience sampling design was implemented. Five hundred fifteen registered nurses were recruited from four tertiary hospitals in Chengdu, China, from January to June 2020. The Practice Environment Scale of the Nursing Work Index, General Self-Efficacy Scale, Achievement Motive Scale, and Utrecht Work Engagement Scale were used to measure the four variables. RESULTS The results of the structural equation model showed that the degree of fit for each index model was good, indicating that all of the three variables, including professional nursing practice environment, self-efficacy, and achievement motivation, directly affected work engagement. In addition, the variable professional nursing practice environment was found to indirectly influence work engagement through the partial mediation of self-efficacy and achievement motivation. CONCLUSIONS The results may be used to guide health policymakers and nurse managers attempting to enhance the work engagement of nurses by providing a supportive working environment, improving the welfare mechanism, formulating a talent training plan, and fostering appropriate empowerment to improve the working environment, self-efficacy, and motivation in nurses.
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Affiliation(s)
- Xin Dan
- MS, RN, NP, Department of Radiation Therapy and Chemotherapy for Gynecological Center Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University; and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Yan Huang
- PhD, RN, Associate Senior Nurse, Department of Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University; and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Jian-Hua Ren
- PhD, RN, Head Nurse, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Sichuan University/West China School of Nursing, Sichuan University; and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Ya-Lin Tian
- MS, RN, Head Nurse, Department of Radiation Therapy and Chemotherapy for Gynecological Center Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University; and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, People's Republic of China
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Rohani N, Yusof MM. Unintended consequences of pharmacy information systems: A case study. Int J Med Inform 2023; 170:104958. [PMID: 36608630 DOI: 10.1016/j.ijmedinf.2022.104958] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/11/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pharmacy information systems (PhIS) can cause medication errors that pharmacists may overlook due to their increased workload and lack of understanding of maintaining information quality. This study seeks to identify factors influencing unintended consequences of PhIS and how they affect the information quality, which can pose a risk to patient safety. MATERIALS AND METHODS This qualitative, explanatory case study evaluated PhIS in ambulatory pharmacies in a hospital and a clinic. Data were collected through observations, interviews, and document analysis. We applied the socio-technical interactive analysis (ISTA) framework to investigate the socio-technical interactions of pharmacy information systems that lead to unintended consequences. We then adopted the human-organization-process-technology-fit (HOPT-fit) framework to identify their contributing and dominant factors, misfits, and mitigation measures. RESULTS We identified 28 unintended consequences of PhIS, their key contributing factors, and their interrelations with the systems. The primary causes of unintended consequences include system rigidity and complexity, unclear knowledge, understanding, skills, and purpose of using the system, use of hybrid paper and electronic documentation, unclear and confusing transitions, additions and duplication of tasks and roles in the workflow, and time pressure, causing cognitive overload and workarounds. Recommended mitigating mechanisms include human factor principles in system design, data quality improvement for PhIS in terms of effective use of workspace, training, PhIS master data management, and communication by standardizing workarounds. CONCLUSION Threats to information quality emerge in PhIS because of its poor design, a failure to coordinate its functions and clinical tasks, and pharmacists' lack of understanding of the system use. Therefore, safe system design, fostering awareness in maintaining the information quality of PhIS and cultivating its safe use in organizations is essential to ensure patient safety. The proposed evaluation approach facilitates the evaluator to identify complex socio-technical interactions and unintended consequences factors, impact, and mitigation mechanisms.
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Affiliation(s)
- Nurkhadija Rohani
- Pharmaceutical Policy & Strategic Planning Division, Pharmaceutical Information Technology & Informatics Branch, Pharmacy Service Program, 46200 Petaling Jaya, Selangor, Malaysia.
| | - Maryati Mohd Yusof
- Center for Software Technology & Management, Faculty of Information Science & Technology, Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor, Malaysia.
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Zhai Y, Yu Z, Zhang Q, Qin W, Yang C, Zhang Y. Transition to a new nursing information system embedded with clinical decision support: a mixed-method study using the HOT-fit framework. BMC Med Inform Decis Mak 2022; 22:310. [PMID: 36443738 PMCID: PMC9703774 DOI: 10.1186/s12911-022-02041-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/04/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Nursing information systems embedded with standardized nursing language and clinical decision support have been increasingly introduced in health care settings. User experience is key to the adoption of health information technologies. Despite extensive research into the user experience with nursing information systems, few studies have focused on the interaction between user, technology and organizational attributes during its implementation. Guided by the human, organization and technology-fit framework, this study aimed to investigate nurses' perceptions and experiences with transition to a new nursing information system (Care Direct) 2 years after its first introduction. METHODS This is a mixed-method study using an embedded design. An online survey was launched to collect nurses' self-reported use of the new system, perceived system effectiveness and experience of participation in system optimization. Twenty-two semi structured interviews were conducted with twenty nurses with clinical or administrative roles. The quantitative and qualitative data were merged using the Pillar Integration Process. RESULTS The average score of system use behavior was 3.76 ± 0.79. Regarding perceived system effectiveness, the score of each dimension ranged 3.07-3.34 out of 5. Despite large variations in approaches to participating in system optimization, nurses had generally positive experiences with management and technical support. Eight main categories emerged from the integrated findings, which were further condensed into three themes: perceptions on system content, structure, and functionality; perceptions on interdisciplinary and cross-level cooperation; and embracing and accepting the change. CONCLUSIONS Effective collaboration between clinicians, administrators and technical staff is required during system promotion to enhance system usability and user experience. Clear communication of organizational missions to staff and support from top management is needed to smooth the system implementation process and achieve broader system adoption.
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Affiliation(s)
- Yue Zhai
- grid.8547.e0000 0001 0125 2443School of Nursing, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhenghong Yu
- grid.8547.e0000 0001 0125 2443Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Zhang
- grid.8547.e0000 0001 0125 2443Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Qin
- grid.8547.e0000 0001 0125 2443Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chun Yang
- grid.8547.e0000 0001 0125 2443Department of Information, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuxia Zhang
- grid.8547.e0000 0001 0125 2443School of Nursing, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
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Zhai Y, Yu Z, Zhang Q, Zhang Y. Barriers and facilitators to implementing a nursing clinical decision support system in a tertiary hospital setting: A qualitative study using the FITT framework. Int J Med Inform 2022; 166:104841. [PMID: 36027798 DOI: 10.1016/j.ijmedinf.2022.104841] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/23/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Clinical decision support systems (CDSSs) have been increasingly introduced to health care settings; however, their adoption is far from ideal. Guided by the FITT framework, this study aims to explore barriers and facilitators to the implementation of a CDSS from the perspective of nurses. METHODS A qualitative study with 200 h of participatory observation and 21 semi structured interviews was conducted from February to August 2021 in four medical-surgical wards in a 2000-bed tertiary hospital in Shanghai, China. The field notes were typed and the audio-recorded interviews were transcribed to texts verbatim and were coded with a four-step approach. We used the FITT framework to interpret our findings based on the technology, individual and task attributes and the fit between them. RESULTS A total of twelve categories were identified, which were integrated into two themes: barriers and facilitators to system implementation. All categories but one can be mapped to the three attributes of the FITT framework: technology, individual and task. We assumed that management has a vital role to play in the following areas: addressing user resistance, improving system usability, setting standards on practice and, finally, building connectivity between nurses and the technical staff to improve the fit between the technology, individual and task attribute and thus promote system implementation. CONCLUSION Barriers and facilitators to CDSS implementation include system-related, user-related and organizational factors which can largely be fit io the FITT framework. There is potential to extend the FITT framework to represent management intervention on inter-disciplinary collaboration. Future empirical studies on facilitating strategies from the management to improve user experience and willingness of CDSS adoption are needed.
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Affiliation(s)
- Yue Zhai
- School of Nursing, Fudan University, Shanghai 200032, China; Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zhenghong Yu
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qi Zhang
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - YuXia Zhang
- School of Nursing, Fudan University, Shanghai 200032, China; Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
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Jedwab RM, Manias E, Hutchinson AM, Dobroff N, Redley B. Nurses’ Experiences After Implementation of an Organization-Wide Electronic Medical Record: Qualitative Descriptive Study. JMIR Nurs 2022; 5:e39596. [PMID: 35881417 PMCID: PMC9328123 DOI: 10.2196/39596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 11/28/2022] Open
Abstract
Background Reports on the impact of electronic medical record (EMR) systems on clinicians are mixed. Currently, nurses’ experiences of adopting a large-scale, multisite EMR system have not been investigated. Nurses are the largest health care workforce; therefore, the impact of EMR implementation must be investigated and understood to ensure that patient care quality, changes to nurses’ work, and nurses themselves are not negatively impacted. Objective This study aims to explore Australian nurses’ postimplementation experiences of an organization-wide EMR system. Methods This qualitative descriptive study used focus group and individual interviews and an open-ended survey question to collect data between 12 and 18 months after the implementation of an EMR across 6 hospital sites of a large health care organization in Victoria, Australia. Data were collected between November 2020 and June 2021, coinciding with the COVID-19 pandemic. Analysis comprised complementary inductive and deductive approaches. Specifically, reflexive thematic analysis was followed by framework analysis by the coding of data as barriers or facilitators to nurses’ use of the EMR using the Theoretical Domains Framework. Results A total of 158 nurses participated in this study. The EMR implementation dramatically changed nurses’ work and how they viewed their profession, and nurses were still adapting to the EMR implementation 18 months after implementation. Reflexive thematic analysis led to the development of 2 themes: An unintentional divide captured nurses’ feelings of division related to how using the EMR affected nurses, patient care, and the broader nursing profession. This time, it’s personal detailed nurses’ beliefs about the EMR implementation leading to bigger changes to nurses as individuals and nursing as a profession than other changes that nurses have experienced within the health care organization. The most frequent barriers to EMR use by nurses were related to the Theoretical Domains Framework domain of environmental context and resources. Facilitators of EMR use were most often related to memory, attention, and decision processes. Most barriers and facilitators were related to motivation. Conclusions Nurses perceived EMR implementation to have a mixed impact on the provision of quality patient care and on their colleagues. Implementing technology in a health care setting was perceived as a complex endeavor that impacted nurses’ perceptions of their autonomy, ways of working, and professional roles. Potential negative consequences were related to nursing workforce retention and patient care delivery. Motivation was the main behavioral driver for nurses’ adoption of EMR systems and hence a key consideration for implementing interventions or organizational changes directed at nurses.
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Affiliation(s)
- Rebecca M Jedwab
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
- Nursing and Midwifery Informatics, Monash Health, Melbourne, Australia
| | - Elizabeth Manias
- Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Alison M Hutchinson
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
- Nursing and Midwifery, Monash Health, Melbourne, Australia
| | - Naomi Dobroff
- Nursing and Midwifery Informatics, Monash Health, Melbourne, Australia
- School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Bernice Redley
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
- Nursing and Midwifery, Monash Health, Melbourne, Australia
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Crehan C, Chiume M, Mgusha Y, Dinga P, Hull-Bailey T, Normand C, Sassoon Y, Nkhoma D, Greenwood K, Lorencatto F, Lakhanpaul M, Heys M. Usability-Focused Development and Usage of NeoTree-Beta, an App for Newborn Care in a Low-Resource Neonatal Unit, Malawi. Front Public Health 2022; 10:793314. [PMID: 35570891 PMCID: PMC9096438 DOI: 10.3389/fpubh.2022.793314] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/02/2022] [Indexed: 11/24/2022] Open
Abstract
Background Neonatal mortality is high in low-resource settings. NeoTree is a digital intervention for neonatal healthcare professionals (HCPs) aiming to achieve data-driven quality improvement and improved neonatal survival in low-resource hospitals. Optimising usability with end-users could help digital health interventions succeed beyond pilot stages in low-resource settings. Usability is the quality of a user's experience when interacting with an intervention, encompassing their effectiveness, efficiency, and overall satisfaction. Objective To evaluate the usability and usage of NeoTree beta-app and conduct Agile usability-focused intervention development. Method A real-world pilot of NeoTree beta-app was conducted over 6 months at Kamuzu Central Hospital neonatal unit, Malawi. Prior to deployment, think-aloud interviews were conducted to guide nurses through the app whilst voicing their thoughts aloud (n = 6). System Usability Scale (SUS) scores were collected before the implementation of NeoTree into usual clinical care and 6 months after implementation (n = 8 and 8). During the pilot, real-world user-feedback and user-data were gathered. Feedback notes were subjected to thematic analysis within an Agile “product backlog.” For usage, number of users, user-cadre, proportion of admissions/outcomes recorded digitally, and median app-completion times were calculated. Results Twelve overarching usability themes generated 57 app adjustments, 39 (68%) from think aloud analysis and 18 (32%) from the real-world testing. A total of 21 usability themes/issues with corresponding app features were produced and added to the app. Six themes relating to data collection included exhaustiveness of data schema, prevention of errors, ease of progression, efficiency of data entry using shortcuts, navigation of user interface (UI), and relevancy of content. Six themes relating to the clinical care included cohesion with ward process, embedded education, locally coherent language, adaptability of user-interface to available resources, and printout design to facilitate handover. SUS scores were above average (88.1 and 89.4 at 1 and 6 months, respectively). Ninety-three different HCPs of 5 cadres, recorded 1,323 admissions and 1,197 outcomes over 6 months. NeoTree achieved 100% digital coverage of sick neonates admitted. Median completion times were 16 and 8 min for admissions and outcomes, respectively. Conclusions This study demonstrates optimisation of a digital health app in a low-resource setting and could inform other similar usability studies apps in similar settings.
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Affiliation(s)
- Caroline Crehan
- Population Policy and Practice Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Msandeni Chiume
- Paediatric Department, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Yamikani Mgusha
- Paediatric Department, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Precious Dinga
- Paediatric Department, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Tim Hull-Bailey
- Population Policy and Practice Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | | | | | - Deliwe Nkhoma
- Parent and Child Health Initiative, Lilongwe, Malawi
| | | | - Fabiana Lorencatto
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Monica Lakhanpaul
- Population Policy and Practice Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Michelle Heys
- Population Policy and Practice Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Kernebeck S, Busse TS, Jux C, Dreier LA, Meyer D, Zenz D, Zernikow B, Ehlers JP. Evaluation of an Electronic Medical Record Module for Nursing Documentation in Paediatric Palliative Care: Involvement of Nurses with a Think-Aloud Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063637. [PMID: 35329323 PMCID: PMC8954648 DOI: 10.3390/ijerph19063637] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/04/2022] [Accepted: 03/14/2022] [Indexed: 02/01/2023]
Abstract
Background: Paediatric palliative care (PPC) is a noncurative approach to the care of children and adolescents with life-limiting and life-threatening illnesses. Electronic medical records (EMRs) play an important role in documenting such complex processes. Despite their benefits, they can introduce unintended consequences if future users are not involved in their development. Aim: The aim of this study was to evaluate the acceptance of a novel module for nursing documentation by nurses working in the context of PPC. Methods: An observational study employing concurrent think-aloud and semi-structured qualitative interviews were conducted with 11 nurses working in PPC. Based on the main determinants of the unified theory of acceptance and use of technology (UTAUT), data were analysed using qualitative content analysis. Results: The main determinants of UTAUT were found to potentially influence acceptance of the novel module. Participants perceived the module to be self-explanatory and intuitive. Some adaptations, such as the reduction of fragmentation in the display, the optimization of confusing mouseover fields, and the use of familiar nursing terminology, are reasonable ways of increasing software adoption. Conclusions: After adaptation of the modules based on the results, further evaluation with the participation of future users is required.
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Affiliation(s)
- Sven Kernebeck
- Department of Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (T.S.B.); (C.J.); (J.P.E.)
- Correspondence: ; Tel.: +49-(0)2302-926-786-13
| | - Theresa Sophie Busse
- Department of Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (T.S.B.); (C.J.); (J.P.E.)
- PedScience Research Institute, 45711 Datteln, Germany; (L.A.D.); (D.M.); (B.Z.)
| | - Chantal Jux
- Department of Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (T.S.B.); (C.J.); (J.P.E.)
| | - Larissa Alice Dreier
- PedScience Research Institute, 45711 Datteln, Germany; (L.A.D.); (D.M.); (B.Z.)
- Department of Children’s Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
| | - Dorothee Meyer
- PedScience Research Institute, 45711 Datteln, Germany; (L.A.D.); (D.M.); (B.Z.)
- Department of Children’s Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
| | - Daniel Zenz
- Smart-Q Softwaresystems GmbH, Lise-Meitner-Allee 4, 44801 Bochum, Germany;
| | - Boris Zernikow
- PedScience Research Institute, 45711 Datteln, Germany; (L.A.D.); (D.M.); (B.Z.)
- Department of Children’s Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
- Pediatric Palliative Care Centre, Children’s and Adolescents’ Hospital, 45711 Datteln, Germany
| | - Jan Peter Ehlers
- Department of Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (T.S.B.); (C.J.); (J.P.E.)
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Jedwab RM, Manias E, Hutchinson AM, Dobroff N, Redley B. Understanding nurses' perceptions of barriers and enablers to use of a new electronic medical record system in Australia: A qualitative study. Int J Med Inform 2021; 158:104654. [PMID: 34883386 DOI: 10.1016/j.ijmedinf.2021.104654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/13/2021] [Accepted: 11/22/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Electronic medical record system implementations impact nurses, their work and workflows. The aim of this study was to understand nurses' perceptions of barriers and enablers to using a new electronic medical record in an acute hospital environment. METHODS Data were collected just prior to an organisation-wide new electronic medical record implementation at a large tertiary healthcare organization in Victoria, Australia. Sixty-three nurses from five hospital sites participated in 12 focus group interviews. Transcripts were transcribed and deductive content analysis used the 14-domain Theoretical Domains Framework to identify barriers and enablers. RESULTS Coded data mapped to 13 of the 14 domains. Nurse motivation emerged as a dominant theme among both barriers and enablers. Nurses' most common perceived barriers related to emotions (24.1%) and environmental context and resources (21.3%). Conversely, the most common enablers related to social influences (21%) and reinforcement (20.8%). DISCUSSION In addition to effecting changes in their work and workflows, the dominance of nurses' emotional responses reveals the potential for implementation of a new electronic medical record to negatively affect nurses' psychological well-being. Using data aligned to the Theoretical Domains Framework assisted identification of behavior change strategies to target the barriers and enablers perceived by nurses. Strategies aligned with nine behavioral intervention categories are recommended for successful implementation and optimization of an electronic medical record by nurses. CONCLUSIONS Multifaceted strategies targeting multiple behaviors are required to support adoption of the electronic medical record by nurses, and reduce the risk for nurse attrition in the workforce.
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Affiliation(s)
- Rebecca M Jedwab
- Deakin University School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation 221 Burwood Highway, Burwood, Melbourne, Victoria 3125, Australia; Monash Health Nursing and Midwifery Informatics 246 Clayton Road, Clayton, Melbourne, Victoria 3168, Australia.
| | - Elizabeth Manias
- Deakin University School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation 221 Burwood Highway, Burwood, Melbourne, Victoria 3125, Australia.
| | - Alison M Hutchinson
- Deakin University School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation 221 Burwood Highway, Burwood, Melbourne, Victoria 3125, Australia; Monash Health Nursing and Midwifery 246 Clayton Road, Clayton, Melbourne, Victoria 3168, Australia.
| | - Naomi Dobroff
- Monash Health Nursing and Midwifery Informatics 246 Clayton Road, Clayton, Melbourne, Victoria 3168, Australia; Deakin University School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Melbourne, Victoria 3125 Australia.
| | - Bernice Redley
- Deakin University School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation 221 Burwood Highway, Burwood, Melbourne, Victoria 3125, Australia; Monash Health Nursing and Midwifery 246 Clayton Road, Clayton, Melbourne, Victoria 3168, Australia.
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Jedwab RM, Redley B, Manias E, Dobroff N, Hutchinson AM. How does implementation of an electronic medical record system impact nurses' work motivation, engagement, satisfaction and well-being? A realist review protocol. BMJ Open 2021; 11:e055847. [PMID: 34620677 PMCID: PMC8499349 DOI: 10.1136/bmjopen-2021-055847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Electronic medical record (EMR) systems are used worldwide as repositories for patients' clinical information, providing clinical decision support and increasing visibility of and access to clinical information. While EMR systems facilitate improved healthcare delivery, emerging reports suggest potential detrimental effects on clinician well-being. EMR system implementation influences on nurses' work motivation, engagement, satisfaction and well-being (including burnout) are not well understood, nor have they been examined in relation to contextual factors and mechanisms of action. This paper presents a realist review protocol to examine causal explanations to address the question: How, why and under what circumstances does the implementation of a new hospital EMR system or similar technology impact nurses' work motivation, engagement, satisfaction or well-being? METHODS AND ANALYSIS The five-step method for realist review will be used to identify causal relationships, how the relationships work, for whom and under what circumstances: (1) defining the review scope; (2) developing initial program theories; (3) searching the evidence; (4) selecting and appraising the evidence; (5) extracting and synthesising the data. Initial program theories were developed using scoping review findings and qualitative data collected from nurses pre-EMR and post-EMR. Five databases will be systematically searched from 1 January 2000 to 31 October 2021 (APA PsycInfo, CINAHL, Embase, IEEE Xplore and MEDLINE Complete), and forward and backward citation searching, grey literature searching and literature recommended by the research team. Search results will be screened by two research team members. Data extracted will assist in refining program theories to develop a conceptual model that synthesises how work motivation, engagement, satisfaction and well-being may influence, or be influenced by, an EMR implementation. ETHICS AND DISSEMINATION The larger project has previously obtained low-risk ethics approval. The review will be published in a peer-reviewed journal and reported as per RAMESES guidelines. PROSPERO REGISTRATION NUMBER CRD42020131875.
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Affiliation(s)
- Rebecca M Jedwab
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
- Nursing and Midwifery Informatics, Monash Health, Melbourne, Victoria, Australia
| | - Bernice Redley
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
- Nursing and Midwifery, Monash Health, Melbourne, Victoria, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
| | - Naomi Dobroff
- Nursing and Midwifery Informatics, Monash Health, Melbourne, Victoria, Australia
- School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
- Nursing and Midwifery, Monash Health, Melbourne, Victoria, Australia
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Numair T, Harrell DT, Huy NT, Nishimoto F, Muthiani Y, Nzou SM, Lasaphonh A, Palama K, Pongvongsa T, Moji K, Hirayama K, Kaneko S. Barriers to the Digitization of Health Information: A Qualitative and Quantitative Study in Kenya and Lao PDR Using a Cloud-Based Maternal and Child Registration System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126196. [PMID: 34201107 PMCID: PMC8228682 DOI: 10.3390/ijerph18126196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/29/2021] [Accepted: 06/04/2021] [Indexed: 12/23/2022]
Abstract
Digitalization of health information can assist patient information management and improve health services even in low middle-income countries. We have implemented a mother and child health registration system in the study areas of Kenya and Lao PDR to evaluate barriers to digitalization. We conducted in-depth interviews with 20 healthcare workers (HCWs) who used the system and analyzed it qualitatively with thematic framework analysis. Quantitatively, we analyzed the quality of recorded data according to missing information by the logistic regression analysis. The qualitative analysis identified six themes related to digitalization: satisfaction with the system, mothers’ resistance, need for training, double work, working environment, and other resources. The quantitative analysis showed that data entry errors improved around 10% to 80% based on odds ratios in subsequent quarters compared to first quarter periods. The number of registration numbers was not significantly related to the data quality, but the motivation, including financial incentives among HCWs, was related to the registration behavior. Considering both analysis results, workload and motivation to maintain high performance were significant obstacles to implementing a digital health system. We recommend enhancing the scope and focus on human needs and satisfaction as a significant factor for digital system durability and sustainability.
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Affiliation(s)
- Tarek Numair
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8523, Japan;
- Department of Ecoepidemiology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan;
| | - Daniel Toshio Harrell
- Department of Ecoepidemiology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan;
- Dell Medical School, The University of Texas in Austin, Austin, TX 78712, USA
| | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki 852-8523, Japan; (N.T.H.); (F.N.); (K.M.)
| | - Futoshi Nishimoto
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki 852-8523, Japan; (N.T.H.); (F.N.); (K.M.)
| | - Yvonne Muthiani
- Nairobi Research Station, Nagasaki University-Institute of Tropical Medicine—Kenya Medical Research Institute (NUITM-KEMRI) Project, Nairobi 19993-00202, Kenya; (Y.M.); (S.M.N.)
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland
| | - Samson Muuo Nzou
- Nairobi Research Station, Nagasaki University-Institute of Tropical Medicine—Kenya Medical Research Institute (NUITM-KEMRI) Project, Nairobi 19993-00202, Kenya; (Y.M.); (S.M.N.)
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi 54840-00200, Kenya
| | - Angkhana Lasaphonh
- Savannakhet Provincial Health Department, Savannakhet 13000, Laos; (A.L.); (K.P.); (T.P.)
| | - Khomsonerasinh Palama
- Savannakhet Provincial Health Department, Savannakhet 13000, Laos; (A.L.); (K.P.); (T.P.)
| | - Tiengkham Pongvongsa
- Savannakhet Provincial Health Department, Savannakhet 13000, Laos; (A.L.); (K.P.); (T.P.)
| | - Kazuhiko Moji
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki 852-8523, Japan; (N.T.H.); (F.N.); (K.M.)
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan;
| | - Satoshi Kaneko
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8523, Japan;
- Department of Ecoepidemiology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan;
- Nairobi Research Station, Nagasaki University-Institute of Tropical Medicine—Kenya Medical Research Institute (NUITM-KEMRI) Project, Nairobi 19993-00202, Kenya; (Y.M.); (S.M.N.)
- Correspondence: ; Tel.: +81-95-819-7866
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