15 results
Search Results
2. Cocreated internet-based stepped care for individuals with cancer and concurrent symptoms of anxiety and depression : Results from the U-CARE AdultCan randomized controlled trial
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Helena Igelström, Birgitta Johansson, Louise von Essen, Anna Hauffman, Susanne Mattsson, Marina Forslund, Peter Nygren, Sven Alfonsson, Anna Bill-Axelson, and Leif Bergkvist
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Male ,medicine.medical_treatment ,Anxiety ,Hospital Anxiety and Depression Scale ,law.invention ,Stress Disorders, Post-Traumatic ,0302 clinical medicine ,Randomized controlled trial ,Quality of life ,law ,Neoplasms ,Medicine ,030212 general & internal medicine ,technology-based interventions ,Depression (differential diagnoses) ,Depression ,Middle Aged ,anxiety ,Telemedicine ,Cognitive behavioral therapy ,Psychiatry and Mental health ,Treatment Outcome ,030220 oncology & carcinogenesis ,Papers ,depression ,oncology ,Female ,medicine.symptom ,Paper ,Adult ,medicine.medical_specialty ,Randomization ,Experimental and Cognitive Psychology ,Nursing ,psychosocial intervention ,technology‐based interventions ,03 medical and health sciences ,Psychoeducation ,Humans ,cancer ,Internet ,Cancer och onkologi ,Cognitive Behavioral Therapy ,business.industry ,Omvårdnad ,psycho‐oncology ,Cancer and Oncology ,randomized controlled trial ,Physical therapy ,Quality of Life ,psycho-oncology ,eHealth ,Self Report ,internet ,business - Abstract
Objective The aim was to evaluate the effects of cocreated internet-based stepped care (iCAN-DO) on anxiety, depression, posttraumatic stress, and health-related quality of life (HRQoL) in individuals with cancer and self-reported anxiety and/or depression symptoms, compared with standard care. Methods Clinically recruited individuals with breast, colorectal, or prostate cancer underwent online screening with the Hospital Anxiety and Depression Scale (HADS). Those with anxiety and/or depression symptoms (>7 on any of the HADS subscales) were randomized to iCAN-DO or standard care. iCAN-DO comprised psychoeducation and self-care strategies (step 1) and internet-based cognitive behavioral therapy (iCBT, step 2). Data were collected before randomization and at 1, 4, 7, and 10 months and analyzed with intention-to-treat regression analysis and randomization tests. Results Online screening identified 245 (27%) of 909 individuals who reported anxiety and/or depression symptoms. They were randomized to iCAN-DO (n = 124) or standard care (n = 121). Of them 49% completed the 10-month assessment, and in the iCAN-DO group 85% accessed step 1 and 13% underwent iCBT. iCAN-DO decreased the levels of symptoms of depression (−0.54, 95% confidence interval: −1.08 to −0.01, P < .05) and the proportion of individuals with symptoms of depression (P < .01) at 10 months, compared with standard care, according to HADS. There were no significant effects on anxiety, posttraumatic stress, or HRQoL. Conclusion Internet-based stepped care improves symptoms of depression in individuals with cancer. Further studies are needed to gain knowledge on how to optimize and implement internet-based support in oncology care.
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- 2020
3. A National Quality Improvement Collaborative for the clinical use of outcome measurement in specialised mental healthcare
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Christina M. van der Feltz-Cornelis, Margot J. Metz, Gerdien Franx, Edwin de Beurs, Aartjan T.F. Beekman, Marjolein A. Veerbeek, Geestelijke Gezondheidszorg, Tranzo, Scientific center for care and wellbeing, APH - Mental Health, and Psychiatry
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Paper ,Quality management ,business.industry ,Declaration ,Outcome (game theory) ,030227 psychiatry ,law.invention ,Mental healthcare ,03 medical and health sciences ,Psychiatry and Mental health ,0302 clinical medicine ,Nursing ,Randomized controlled trial ,law ,Intervention (counseling) ,Medicine ,030212 general & internal medicine ,Cluster randomised controlled trial ,business ,License - Abstract
BackgroundAlthough the importance and advantages of measurement-based care in mental healthcare are well established, implementation in daily practice is complex and far from optimal.AimsTo accelerate the implementation of outcome measurement in routine clinical practice, a government-sponsored National Quality Improvement Collaborative was initiated in Dutch-specialised mental healthcare.MethodTo investigate the effects of this initiative, we combined a matched-pair parallel group design (21 teams) with a cluster randomised controlled trial (RCT) (6 teams). At the beginning and end, the primary outcome ‘actual use and perceived clinical utility of outcome measurement’ was assessed.ResultsIn both designs, intervention teams demonstrated a significant higher level of implementation of outcome measurement than control teams. Overall effects were large (parallel group d=0.99; RCT d=1.25).ConclusionsThe National Collaborative successfully improved the use of outcome measurement in routine clinical practice.
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- 2017
4. Psychosis seminars: an open forum for service users, carers and professionals
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Stefan Priebe, Simon Tulloch, Domenico Giacco, Aysegul Dirik, and Justina Kaselionyte
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Paper ,Psychosis ,medicine.medical_specialty ,030504 nursing ,education ,Attendance ,Declaration ,medicine.disease ,Mental illness ,Mental health ,03 medical and health sciences ,Psychiatry and Mental health ,0302 clinical medicine ,Nursing ,Content analysis ,medicine ,030212 general & internal medicine ,0305 other medical science ,Psychiatry ,Attribution ,Psychology ,License - Abstract
BackgroundPsychosis seminars enable service users, their carers and mental health professionals to meet outside of a formal care setting, increase understanding of mental illness and help establish a dialogue.AimsTo explore feasibility of psychosis seminars in the UK and the experiences of participants.MethodSeven meetings attended by 25 people were held over a 3-month period. An open-ended questionnaire was returned by ten participants. Responses were subjected to content analysis.ResultsBenefits experienced were having an open forum for talking freely about mental health issues in a neutral space, learning from others about psychosis and hearing different views. Suggested adjustments were clarifying expectations of participants at the beginning, strengthening facilitation and increasing attendance.ConclusionsPsychosis seminars may help to establish a dialogue among users, carers and professionals and seem feasible in the UK, although adjustment to delivery can help their implementation.
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- 2016
5. Use of Electronic and Paper-based Standardized Nursing Care Plans to Improve Nurses' Documentation Quality in a Nigerian Teaching Hospital
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Chinma Stella Adereti and Adenike Ayobola Olaogun
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Adult ,Male ,Paper ,media_common.quotation_subject ,Developing country ,Nigeria ,Documentation ,Nursing Staff, Hospital ,Patient Care Planning ,Teaching hospital ,03 medical and health sciences ,Nursing care ,Young Adult ,0302 clinical medicine ,Nursing ,Electronic Health Records ,Humans ,Nursing documentation ,Quality (business) ,030212 general & internal medicine ,Hospitals, Teaching ,media_common ,Nursing practice ,030504 nursing ,Research and Theory ,Paper based ,Middle Aged ,Fundamentals and skills ,Female ,0305 other medical science ,Psychology - Abstract
Purpose To evaluate the effect of electronic and paper-based standardized nursing care plans (SNCPs) use on quality of nurses' documentation. Methods Using quasi-experimental design, two wards were grouped into electronic and paper-based wards. Nurses were trained to use electronic- and paper-based SNCPs for care-planning and documentation. Data was collected before, 3, and 6 months postintervention and analyzed with SPSS version 20. Findings There was improvement in documentation quality in the two wards after introducing SNCPs with higher quality scores in the electronic ward postintervention. Conclusion Providing SNCPs in electronic and paper formats is critical to improving nursing documentation. Implication for nursing practice Adequate training and support for nurses are needed for successful implementation of SNCPs in electronic health records (EHRs) in developing nations.
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- 2018
6. The Hidden Lives of Nurses’ Cognitive Artifacts
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Alexa K. Doig, Nancy Staggers, Jacquelyn W. Blaz, and Kristin G. Cloyes
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Paper ,Need for cognition ,020205 medical informatics ,media_common.quotation_subject ,Specialty ,Nurses ,Health Informatics ,Context (language use) ,02 engineering and technology ,Medical Oncology ,03 medical and health sciences ,Cognition ,Health Information Management ,Nursing ,0202 electrical engineering, electronic engineering, information engineering ,Electronic Health Records ,Medicine ,Function (engineering) ,media_common ,Medical education ,030504 nursing ,Inpatient care ,business.industry ,Nursing Handoff ,Patient Handoff ,Computer Science Applications ,Artifacts ,0305 other medical science ,business ,Research Article ,Qualitative research - Abstract
SummaryStandardizing nursing handoffs at shift change is recommended to improve communication, with electronic tools as the primary approach. However, nurses continue to rely on personally created paper-based cognitive artifacts - their “paper brains” - to support handoffs, indicating a deficiency in available electronic versions.The purpose of this qualitative study was to develop a deep understanding of nurses’ paper-based cognitive artifacts in the context of a cancer specialty hospital.After completing 73 hours of hospital unit field observations, 13 medical oncology nurses were purposively sampled, shadowed for a single shift and interviewed using a semi-structured technique. An interpretive descriptive study design guided analysis of the data corpus of field notes, transcribed interviews, images of nurses’ paper-based cognitive artifacts, and analytic memos.Findings suggest nurses’ paper brains are personal, dynamic, living objects that undergo a life cycle during each shift and evolve over the course of a nurse’s career. The life cycle has four phases: Creation, Application, Reproduction, and Destruction. Evolution in a nurse’s individually styled, paper brain is triggered by a change in the nurse’s environment that reshapes cognitive needs. If a paper brain no longer provides cognitive support in the new environment, it is modified into (adapted) or abandoned (made extinct) for a different format that will provide the necessary support.The “hidden lives” - the life cycle and evolution - of paper brains have implications for the design of successful electronic tools to support nursing practice, including handoff. Nurses’ paper brains provide cognitive support beyond the context of handoff. Information retrieval during handoff is undoubtedly an important function of nurses’ paper brains, but tools designed to standardize handoff communication without accounting for cognitive needs during all phases of the paper brain life cycle or the ability to evolve with changes to those cognitive needs will be underutilized.Citation: Blaz JW, Doig AK, Cloyes KG, Staggers N. The hidden lives of nurses’ cognitive artifacts.
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- 2016
7. An electronic documentation system improves the quality of admission notes: a randomized trial
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Jonathan Ailon, Ophyr Mourad, Trevor Jamieson, and Vince Chien
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Paper ,medicine.medical_specialty ,media_common.quotation_subject ,Documentation system ,Health Informatics ,Documentation ,Research and Applications ,Medical Records ,law.invention ,03 medical and health sciences ,Patient Admission ,0302 clinical medicine ,Randomized controlled trial ,Nursing ,law ,medicine ,Electronic Health Records ,Humans ,Quality (business) ,Prospective Studies ,030212 general & internal medicine ,Clinical teaching ,media_common ,Cross-Over Studies ,business.industry ,05 social sciences ,050301 education ,Crossover study ,Data Accuracy ,Present illness ,Physical therapy ,business ,0503 education ,Health care quality - Abstract
Objective: There are concerns that structured electronic documentation systems can limit expressivity and encourage long and unreadable notes. We assessed the impact of an electronic clinical documentation system on the quality of admission notes for patients admitted to a general medical unit.Methods: This was a prospective randomized crossover study comparing handwritten paper notes to electronic notes on different patients by the same author, generated using a semistructured electronic admission documentation system over a 2-month period in 2014. The setting was a 4-team, 80-bed general internal medicine clinical teaching unit at a large urban academic hospital. The quality of clinical documentation was assessed using the QNOTE instrument (best possible score = 100), and word counts were assessed for free-text sections of notes.Results: Twenty-one electronic-paper note pairs (42 notes) written by 21 authors were randomly drawn from a pool of 303 eligible notes. Overall note quality was significantly higher in electronic vs paper notes (mean 90 vs 69, P Conclusions: An electronic admission documentation system improved both the quality of free-text content and the overall quality of admission notes. Authors wrote more in the free-text sections of electronic documents as compared to paper versions.
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- 2016
8. Characteristics of multi-institutional health sciences education research: a systematic review
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Terry Kind, Sherilyn Smith, Gary L. Beck Dallaghan, Jocelyn Schiller, Heather McLauchlan, and Joseph Gigante
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Paper ,020205 medical informatics ,MEDLINE ,Graduate medical education ,lcsh:Medicine ,Health Informatics ,02 engineering and technology ,CINAHL ,Library and Information Sciences ,Health informatics ,03 medical and health sciences ,Health Information Systems ,0302 clinical medicine ,Professional Competence ,Nursing ,Education, Professional ,0202 electrical engineering, electronic engineering, information engineering ,Medicine ,Humans ,030212 general & internal medicine ,Multi-Institutional Research ,Cooperative Behavior ,Curriculum ,Funding ,Medical education ,Descriptive statistics ,business.industry ,lcsh:R ,lcsh:Z ,lcsh:Bibliography. Library science. Information resources ,Systematic Review ,Descriptive research ,business ,Inclusion (education) - Abstract
Objectives: Multi-institutional research increases the generalizability of research findings. However, little is known about characteristics of collaborations across institutions in health sciences education research. Using a systematic review process, the authors describe characteristics of published, peer-reviewed multi-institutional health sciences education research to inform educators who are considering such projects.Methods: Two medical librarians searched MEDLINE, the Education Resources Information Center (ERIC), EMBASE, and CINAHL databases for English-language studies published between 2004 and 2013 using keyword terms related to multi-institutional systems and health sciences education. Teams of two authors reviewed each study and resolved coding discrepancies through consensus. Collected data points included funding, research network involvement, author characteristics, learner characteristics, and research methods. Data were analyzed using descriptive statistics.Results: One hundred eighteen of 310 articles met inclusion criteria. Sixty-three (53%) studies received external and/or internal financial support (87% listed external funding, 37% listed internal funding). Forty-five funded studies involved graduate medical education programs. Twenty (17%) studies involved a research or education network. Eighty-five (89%) publications listed an author with a master’s degree or doctoral degree. Ninety-two (78%) studies were descriptive, whereas 26 studies (22%) were experimental. The reported study outcomes were changes in student attitude (38%; n=44), knowledge (26%; n=31), or skill assessment (23%; n=27), as well as patient outcomes (9%; n=11).Conclusions: Multi-institutional descriptive studies reporting knowledge or attitude outcomes are highly published. Our findings indicate that funding resources are not essential to successfully undertake multi-institutional projects. Funded studies were more likely to originate from graduate medical or nursing programs.
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- 2017
9. The quality of paper-based versus electronic nursing care plan in Australian aged care homes: A documentation audit study
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David Hailey, Ping Yu, and Ning Wang
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Paper ,Quality Assurance, Health Care ,Nursing Records ,Information Storage and Retrieval ,Health Informatics ,Documentation ,InformationSystems_GENERAL ,Nursing care ,Nursing care plan ,Nursing ,Patient-Centered Care ,Electronic Health Records ,Homes for the Aged ,Humans ,Medicine ,Nurse education ,Nursing process ,Nursing Assessment ,Primary nursing ,Retrospective Studies ,business.industry ,Nursing research ,Nursing Audit ,Nursing Outcomes Classification ,Team nursing ,business - Abstract
The nursing care plan plays an essential role in supporting care provision in Australian aged care. The implementation of electronic systems in aged care homes was anticipated to improve documentation quality. Standardized nursing terminologies, developed to improve communication and advance the nursing profession, are not required in aged care practice. The language used by nurses in the nursing care plan and the effect of the electronic system on documentation quality in residential aged care need to be investigated.To describe documentation practice for the nursing care plan in Australian residential aged care homes and to compare the quantity and quality of documentation in paper-based and electronic nursing care plans.A nursing documentation audit was conducted in seven residential aged care homes in Australia. One hundred and eleven paper-based and 194 electronic nursing care plans, conveniently selected, were reviewed. The quantity of documentation in a care plan was determined by the number of phrases describing a resident problem and the number of goals and interventions. The quality of documentation was measured using 16 relevant questions in an instrument developed for the study.There was a tendency to omit 'nursing problem' or 'nursing diagnosis' in the nursing process by changing these terms (used in the paper-based care plan) to 'observation' in the electronic version. The electronic nursing care plan documented more signs and symptoms of resident problems and evaluation of care than the paper-based format (48.30 vs. 47.34 out of 60, P0.01), but had a lower total mean quality score. The electronic care plan contained fewer problem or diagnosis statements, contributing factors and resident outcomes than the paper-based system (P0.01). Both types of nursing care plan were weak in documenting measurable and concrete resident outcomes.The overall quality of documentation content for the nursing process was no better in the electronic system than in the paper-based system. Omission of the nursing problem or diagnosis from the nursing process may reflect a range of factors behind the practice that need to be understood. Further work is also needed on qualitative aspects of the nurse care plan, nurses' attitudes towards standardized terminologies and the effect of different documentation practice on care quality and resident outcomes.
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- 2015
10. Toward the Elimination of Paper Orders: Managing the Challenge of Low Frequency Physician Users of Computerized Patient Order Entry (CPOE)
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Ricardo Ramirez, George A Gellert, and S. L. Webster
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Paper ,020205 medical informatics ,As is ,health care facilities, manpower, and services ,education ,Health Informatics ,02 engineering and technology ,Commit ,State of the Art / Best Practice Paper ,Clinical decision support system ,Medical Order Entry Systems ,Order entry ,03 medical and health sciences ,Patient safety ,0302 clinical medicine ,Health Information Management ,Nursing ,health services administration ,Physicians ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Electronic Health Records ,Humans ,030212 general & internal medicine ,Cities ,Cost implications ,business.industry ,medicine.disease ,Hospitals ,Computer Science Applications ,Software modules ,Medical emergency ,business ,Mixed pattern - Abstract
SummaryWith the adoption of Computerized Patient Order Entry (CPOE), many physicians – particularly consultants and those who are affiliated with multiple hospital systems – are faced with the challenge of learning to navigate and commit to memory the details of multiple EHRs and CPOE software modules. These physicians may resist CPOE adoption, and their refusal to use CPOE presents a risk to patient safety when paper and electronic orders co-exist, as paper orders generated in an electronic ordering environment can be missed or acted upon after delay, are frequently illegible, and bypass the Clinical Decision Support (CDS) that is part of the evidence-based value of CPOE.We defined a category of CPOE Low Frequency Users (LFUs) – physicians issuing a total of less than 10 orders per month – and found that 50.4% of all physicians issuing orders in 3 urban/suburban hospitals were LFUs and actively issuing orders across all shifts and days of the week. Data are presented for 2013 on the number of LFUs by month, day of week, shift and facility, over 2.3 million orders issued.A menu of 6 options to assist LFUs in the use of CPOE, from which hospital leaders could select, was instituted so that paper orders could be increasingly eliminated. The options, along with their cost implications, are described, as is the initial option selected by hospital leaders. In practice, however, a mixed pattern involving several LFU support options emerged. We review data on how the option mix selected may have impacted CPOE adoption and physician use rates at the facilities. The challenge of engaging LFU physicians in CPOE adoption may be common in moderately sized hospitals, and these options can be deployed by other systems in advancing CPOE pervasiveness of use and the eventual elimination of paper orders.
- Published
- 2016
11. Comparison of accuracy of physical examination findings in initial progress notes between paper charts and a newly implemented electronic health record
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Michael Maddens, Sudarshan Paudel, Siddhartha Yadav, Noora Kazanji, Michael A Barnes, Narayan K. C, John Falatko, and Sandor Shoichet
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Male ,Paper ,020205 medical informatics ,Word count ,Health Informatics ,Physical examination ,02 engineering and technology ,Documentation ,Research and Applications ,Medical Records ,03 medical and health sciences ,0302 clinical medicine ,Chart ,Nursing ,Electronic health record ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Electronic Health Records ,Humans ,030212 general & internal medicine ,Medical diagnosis ,Physical Examination ,Progress note ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Data Accuracy ,Initial phase ,Female ,Medical emergency ,business - Abstract
Introduction: There have been several concerns about the quality of documentation in electronic health records (EHRs) when compared to paper charts. This study compares the accuracy of physical examination findings documentation between the two in initial progress notes. Methodology: Initial progress notes from patients with 5 specific diagnoses with invariable physical findings admitted to Beaumont Hospital, Royal Oak, between August 2011 and July 2013 were randomly selected for this study. A total of 500 progress notes were retrospectively reviewed. The paper chart arm consisted of progress notes completed prior to the transition to an EHR on July 1, 2012. The remaining charts were placed in the EHR arm. The primary endpoints were accuracy, inaccuracy, and omission of information. Secondary endpoints were time of initiation of progress note, word count, number of systems documented, and accuracy based on level of training. Results: The rate of inaccurate documentation was significantly higher in the EHRs compared to the paper charts (24.4% vs 4.4%). However, expected physical examination findings were more likely to be omitted in the paper notes compared to EHRs (41.2% vs 17.6%). Resident physicians had a smaller number of inaccuracies (5.3% vs 17.3%) and omissions (16.8% vs 33.9%) compared to attending physicians. Conclusions: During the initial phase of implementation of an EHR, inaccuracies were more common in progress notes in the EHR compared to the paper charts. Residents had a lower rate of inaccuracies and omissions compared to attending physicians. Further research is needed to identify training methods and incentives that can reduce inaccuracies in EHRs during initial implementation.
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- 2015
12. Problems with the electronic health record
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Jan E. Angus, Joan Liaschenko, and Hans-Peter de Ruiter
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Paper ,Evidence-based practice ,Quality management ,Documentation ,03 medical and health sciences ,0302 clinical medicine ,Hospitals, Urban ,Nursing ,Medicine ,Electronic Health Records ,Humans ,030212 general & internal medicine ,Risk management ,Reimbursement ,Accreditation ,030504 nursing ,Research and Theory ,business.industry ,Health Priorities ,General Medicine ,Public relations ,United States ,Issues, ethics and legal aspects ,Philosophy ,Work (electrical) ,Ethics of care ,sense organs ,0305 other medical science ,business ,Delivery of Health Care - Abstract
One of the most significant changes in modern healthcare delivery has been the evolution of the paper record to the electronic health record (EHR). In this paper we argue that the primary change has been a shift in the focus of documentation from monitoring individual patient progress to recording data pertinent to Institutional Priorities (IPs). The specific IPs to which we refer include: finance/reimbursement; risk management/legal considerations; quality improvement/safety initiatives; meeting regulatory and accreditation standards; and patient care delivery/evidence based practice. Following a brief history of the transition from the paper record to the EHR, the authors discuss unintended or contested consequences resulting from this change. These changes primarily reflect changes in the organization and amount of clinician work and clinician-patient relationships. The paper is not a research report but was informed by an institutional ethnography the aim of which was to understand how the EHR impacted clinicians and administrators in a large, urban hospital in the United States. The paper was also informed by other sources, including the philosophies of Jacques Ellul, Don Idhe, and Langdon Winner.
- Published
- 2015
13. Electronic forms trump paper for surgical scheduling
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Debra Thieret, Elizabeth Clark, and Dee Lantz Carbaugh
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Advanced and Specialized Nursing ,Paper ,Quality management ,Perioperative nursing ,business.industry ,Communication ,Documentation ,Assessment and Diagnosis ,Emergency Nursing ,Surgery scheduling ,LPN and LVN ,Critical Care Nursing ,Efficiency, Organizational ,Quality Improvement ,Appointments and Schedules ,Nursing ,Nursing Evaluation Research ,Perioperative Nursing ,Surgical Procedures, Operative ,Medicine ,Electronic Health Records ,Humans ,business ,Surgery Department, Hospital - Published
- 2015
14. Integrated care among healthcare providers in shared maternity care: what is the role of paper and electronic health records?
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Glenda Hawley, Claire Jackson, Julie Hepworth, and Shelley A. Wilkinson
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Male ,Paper ,Attitude of Health Personnel ,Health Personnel ,Interprofessional Relations ,Population health ,Midwifery ,Tertiary Care Centers ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,General Practitioners ,Pregnancy ,Health care ,Electronic Health Records ,Humans ,Medicine ,Maternal Health Services ,030212 general & internal medicine ,030219 obstetrics & reproductive medicine ,Delivery of Health Care, Integrated ,Information Dissemination ,business.industry ,Health Policy ,Medical record ,Australia ,Public Health, Environmental and Occupational Health ,Focus Groups ,Hospital Records ,Focus group ,Integrated care ,Community health ,Female ,business ,Healthcare providers ,Qualitative research - Abstract
This study examines a paper hand-held record and a shared electronic health record in an Australian tertiary hospital healthcare maternity setting and the role that both types of records play in facilitating integrated care among healthcare providers. A qualitative research design was used where five focus groups were conducted in two phases with 69 hospital healthcare providers. In total, 32 interviews were also carried out with general practitioners. Transcripts were analysed using qualitative content analysis. Three key themes were identified: (1) selective use of records; (2) records as communication of care; and (3) negativity about the use of records. This study demonstrates that healthcare providers do not effectively share information using either a paper hand-held record or a shared electronic health record. Considering a national commitment to e-health innovation, a multi-professional input, organisational support and continuing education are identified as crucial to realising the potential of a maternity shared electronic health record to facilitate integrated care.
- Published
- 2017
15. Cognitive workload changes for nurses transitioning from a legacy system with paper documentation to a commercial electronic health record
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Henry W W Potts, Lacey Colligan, Robert A. Sinkin, and Chelsea T. Finn
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Adult ,Male ,Paper ,NASA-TLX ,Attitude of Health Personnel ,Health Informatics ,Documentation ,Workload ,Nursing Staff, Hospital ,Health informatics ,Workflow ,Patient safety ,Technical support ,Young Adult ,Cognition ,Nursing ,Health care ,Adaptation, Psychological ,Information system ,Medicine ,Electronic Health Records ,Humans ,health care economics and organizations ,business.industry ,Attitude to Computers ,Middle Aged ,Workforce ,Female ,business - Abstract
Objective Healthcare institutions worldwide are moving to electronic health records (EHRs). These transitions are particularly numerous in the US where healthcare systems are purchasing and implementing commercial EHRs to fulfill federal requirements. Despite the central role of EHRs to workflow, the cognitive impact of these transitions on the workforce has not been widely studied. This study assesses the changes in cognitive workload among pediatric nurses during data entry and retrieval tasks during transition from a hybrid electronic and paper information system to a commercial EHR. Materials and methods Baseline demographics and computer attitude and skills scores were obtained from 74 pediatric nurses in two wards. They also completed an established and validated instrument, the NASA-TLX, that is designed to measure cognitive workload; this instrument was used to evaluate cognitive workload of data entry and retrieval. The NASA-TLX was administered at baseline (pre-implementation), 1, 5 and 10 shifts and 4 months post-implementation of the new EHR. Results Most nurse participants experienced significant increases of cognitive workload at 1 and 5 shifts after “go-live”. These increases abated at differing rates predicted by participants’ computer attitudes scores (p = 0.01). Conclusions There is substantially increased cognitive workload for nurses during the early phases (1–5 shifts) of EHR transitions. Health systems should anticipate variability across workers adapting to “meaningful use” EHRs. “One-size-fits-all” training strategies may not be suitable and longer periods of technical support may be necessary for some workers.
- Published
- 2014
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