Nurses' use of online clinical evidence

Understanding the Adoption Process of National Security Technology: An Integration of Diffusion of Innovations and Volitional Behavior Theories

After the 9/11 terrorist attacks, the U.S. government initiated several national security technology adoption programs. The American public, however, has been skeptical about these initiatives and adoption of national security technologies has been mandated, rather than voluntary. We propose and test a voluntary behavioral intention formation model for the adoption of one type of new security technology: portable radiation detectors. Portable radiation detectors are an efficient way of detecting radiological and nuclear threats and could potentially prevent loss of life and damage to individuals' health. However, their functioning requires that a critical mass of individuals use them on a daily basis. We combine the explanatory advantages of diffusion of innovation with the predictive power of two volitional behavior frameworks: the theory of reasoned action and the health belief model. A large sample survey (N = 1,482) investigated the influence of factors identified in previous diffusion of innovation research on portable radiation detector adoption intention. Results indicated that nonfinancial incentives, as opposed to financial incentives, should be emphasized in persuasive communications aimed at fostering adoption. The research provides a new integration of diffusion of innovation elements with determinants of volitional behavior from persuasion literature, and offers recommendations on effective communication about new security technologies to motivate public adoption and enhance national safety.

Maternity patients' access to their electronic medical records: use and perspectives of a patient portal

Patients have been able to access clinical information from their paper-based health records for a number of years. With the advent of Electronic Medical Records (EMRs) access to this information can now be achieved online using a secure electronic patient portal. The purpose of this study was to investigate maternity patients' use and perceptions of a patient portal developed at the Mater Mothers' Hospital in Brisbane, Australia. A web-based patient portal, one of the first developed and deployed in Australia, was introduced on 26 June 2012. The portal was designed for maternity patients booked at Mater Mothers' Hospital, as an alternative to the paper-based Pregnancy Health Record. Through the portal, maternity patients are able to complete their hospital registration form online and obtain current health information about their pregnancy (via their EMR), as well as access a variety of support tools to use during their pregnancy such as tailored public health advice. A retrospective cross-sectional study design was employed. Usage statistics were extracted from the system for a one year period (1 July 2012 to 30 June 2013). Patients' perceptions of the portal were obtained using an online survey, accessible by maternity patients for two weeks in February 2013 (n=80). Descriptive statistics were employed to analyse the data. Between July 2012 and June 2013, 10,892 maternity patients were offered a patient portal account and access to their EMR. Of those 6,518 created one (60%; 6,518/10,892) and 3,104 went on to request access to their EMR (48%; 3,104/6,518). Of these, 1,751 had their access application granted by 30 June 2013. The majority of maternity patients submitted registration forms online via the patient portal (56.7%). Patients could view their EMR multiple times: there were 671 views of the EMR, 2,781 views of appointment schedules and 135 birth preferences submitted via the EMR. Eighty survey responses were received from EMR account holders, (response rate of 8.1%; 80/985). The majority of respondents indicated they would use the portal and access their EMR for future pregnancies (86.2%; 69/80). Approximately half looked at their EMR after a visit with their care provider (51.3%); 41/80) and 37.5% (30/80) viewed their EMR before, to prepare for their visit. The majority (65.8%) thought that the EMR improved their ability to understand and recall appointments and almost half (48.1%) thought that with the EMR they were less likely to repeat pregnancy information to caregivers. This study provides the first Australian evidence of a patient portal system, tied to an EMR, working effectively in a maternity care context. It provides new evidence that portals can deliver benefits to maternity patients in terms of providing quick and easy access to current personal and general health information and support patients in their ability to recall and prepare for appointments.

Using Mobile Technologies to Access Evidence-Based Resources: A Rural Health Clinic Experience

This study describes the feasibility and usability of a mobile device and selected electronic evidence-based information programs used to support clinical decision making in a rural health clinic. The study focused on nurses' perceptions on when they needed more information, where they sought information, what made them feel comfortable about the information they found, and rules and guidelines they used to determine if the information should be used in patient care. ATLAS.ti, the qualitative analysis software, was used to assist with qualitative data analysis and management.

Nurses’ and midwives’ information behaviour: a review of literature from 1998 to 2014

Purpose

– This paper aims to provide an overview of recent literature on nurses’ and midwives’ information behaviour, with a particular focus on sources used and barriers encountered.

Design/methodology/approach

– Comprehensive searching was undertaken and an analysis of the appropriate literature carried out.

Findings

– Practitioners within the nursing profession have a marked preference for interactive and human sources of information. They habitually associate information seeking with professional development rather than with clinical practice. Lack of time is the most frequently reported problem; also, they frequently lack confidence in searching and appraising the professional literature and in applying research in practice. Cultural factors may inhibit information seeking in the workplace, and access to appropriate information technology may be limited.

Practical implications

– As a group, nurses and midwives present significant challenges to health library and information professionals seeking to design services to meet their needs. A perceived lack of access to information resources may be associated with pervasive information literacy skill deficits, with the inability to undertake critical appraisal of material that is retrieved, or with the lack of a workplace culture that is supportive of information seeking. To reach nurses and midwives, more than diligent marketing is required; library and information professionals need to work closely with the holders of nursing and midwifery research, practice development and educational roles within their institutions on “embedded”, specific information initiatives.

Originality/value

– An overview of recent work is presented on the information behaviour of nurses and midwives within developed economies, focusing particularly on the UK. It may be of interest and value to health librarians and to nursing and midwifery educators in facilitating evidence-based practice.

Primary health-care nurses and Internet health information-seeking: Access, barriers and quality checks

Online information is a critical resource for evidence-based practice and patient education. This study aimed to establish New Zealand nurses' access and evaluation of online health information in the primary care context using a postal questionnaire survey; there were 630 respondents from a random sample of 931 nurses. The majority of respondents were satisfied with work access to online information (84.5%, n = 501) and searched for online information at least several times a week (57.5%, n = 343). The major barrier to online information seeking was insufficient time, but 68 respondents had no work online information access. The level of nursing qualification was significantly correlated with computer confidence and information quality checking. A range of information evaluation approaches was used. Most nurses in study accessed and evaluated Internet information in contrast to the findings of earlier studies, but there were barriers preventing universal integration into practice.

Patient-specific computer-based decision support in primary healthcare--a randomized trial

BACKGROUND

Computer-based decision support systems are a promising method for incorporating research evidence into clinical practice. However, evidence is still scant on how such information technology solutions work in primary healthcare when support is provided across many health problems. In Finland, we designed a trial where a set of evidence-based, patient-specific reminders was introduced into the local Electronic Patient Record (EPR) system. The aim was to measure the effects of such reminders on patient care. The hypothesis was that the total number of triggered reminders would decrease in the intervention group compared with the control group, indicating an improvement in patient care.

METHODS

From July 2009 to October 2010 all the patients of one health center were randomized to an intervention or a control group. The intervention consisted of patient-specific reminders concerning 59 different health conditions triggered when the healthcare professional (HCP) opened and used the EPR. In the intervention group, the triggered reminders were shown to the HCP; in the control group, the triggered reminders were not shown. The primary outcome measure was the change in the number of reminders triggered over 12 months. We developed a unique data gathering method, the Repeated Study Virtual Health Check (RSVHC), and used Generalized Estimation Equations (GEE) for analysing the incidence rate ratio, which is a measure of the relative difference in percentage change in the numbers of reminders triggered in the intervention group and the control group.

RESULTS

In total, 13,588 participants were randomized and included. Contrary to our expectation, the total number of reminders triggered increased in both the intervention and the control groups. The primary outcome measure did not show a significant difference between the groups. However, with the inclusion of patients followed up over only six months, the total number of reminders increased significantly less in the intervention group than in the control group when the confounding factors (age, gender, number of diagnoses and medications) were controlled for.

CONCLUSIONS

Computerized, tailored reminders in primary care did not decrease during the 12 months of follow-up time after the introduction of a patient-specific decision support system.

TRIAL REGISTRATION

ClinicalTrial.gov NCT00915304.

Nurses' information appraisal within the clinical setting

Limited discussion in nursing literature exists regarding how nurses appraise information. In the absence of information appraisal skills, nurses cannot safely and effectively apply evidence in practice. The research study used an interpretive description design to define and describe the process of information appraisal in the clinical setting. This study represented a sample of 44 RNs employed at a medical center in the Southeastern US. Based on the descriptions offered by participants, information appraisal contains three dimensions: gathering, analysis, and application. In addition, nurses perform information appraisal by way of an unspoken algorithm, incorporating two major decision points: first situational urgency, then familiarity with information sources. In most cases, the trusted resource served as a proxy for evaluating the information that was provided by the resource. Findings suggest that information appraisal is described in a number of ways by nurses, resulting in an unclear definition for the process. Understanding the perceptions of this sample has given insight into how nurses describe and perform information evaluation. Knowledge gained from this study may be used by nurse educators in the academic and clinical setting as they work to deliver relevant information that facilitates providing the highest-quality care.

Clinical decision support must be useful, functional is not enough: a qualitative study of computer-based clinical decision support in primary care

Background

Health information technology, particularly electronic decision support systems, can reduce the existing gap between evidence-based knowledge and health care practice but professionals have to accept and use this information. Evidence is scant on which features influence the use of computer-based clinical decision support (eCDS) in primary care and how different professional groups experience it. Our aim was to describe specific reasons for using or not using eCDS among primary care professionals.

Methods

The setting was a Finnish primary health care organization with 48 professionals receiving patient-specific guidance at the point of care. Multiple data (focus groups, questionnaire and spontaneous feedback) were analyzed using deductive content analysis and descriptive statistics.

Results

The content of the guidance is a significant feature of the primary care professional’s intention to use eCDS. The decisive reason for using or not using the eCDS is its perceived usefulness. Functional characteristics such as speed and ease of use are important but alone these are not enough. Specific information technology, professional, patient and environment features can help or hinder the use.

Conclusions

Primary care professionals have to perceive eCDS guidance useful for their work before they use it.

Research use in the care of older people: a survey among healthcare staff

Background.  Sweden has one of the largest proportions of older people in the world. To manage the healthcare needs of an aging population, there has been an alteration from hospital care to community-based care. In these settings, the majority of staff is enrolled nurses (EN) and nurse aides (NA) without university education. Aim and design.  The overall aim of this cross-sectional survey was to explore staff perceptions of factors related to research utilization in the care of older people. Method.  Questionnaires covering research utilization and demographics were sent to all staff (n = 132) working in seven units in older people care. The response rate was 67% (n = 89). The respondents consisted of ENs/NAs (n = 63), Registered Nurses (RN) and rehabilitation professionals (RP) as physiotherapists and occupational therapists (RN/RP n = 26). Results.  Most of staff reported positive attitudes towards research. The RNs/RPs stated more often than the ENs/NAs that they wanted to base their practice on research (81% vs. 25%; P = 0.001). The RNs/RPs also reported a greater extent of research use in daily practice (54% vs. 17%; P = 0.001). Support from colleagues (77% vs. 22%; P < 0.001) and unit managers (73% vs. 10%; P < 0.001) for implementing research findings was also more frequently reported by the RNs/RPs compared with the ENs/NAs. The majority of the ENs/NAs stated Do not know on many items concerning attitudes towards research, support for research utilization and actual use of research. Conclusions.  Despite overall positive attitudes towards research, the majority of staff did not use research findings in daily practice. This was particularly valid for the EN/NA group. Relevance to clinical practice.  There is an urgent need for managers and others in the care of older people to develop strategies for implementing evidence-based practice that involves the EN/NA group.

Quality assurance of nursing web sites: development and implications of the ALEU method

This article presents a study that evaluated the physical accessibility, readability, and usability of Spanish nursing Web sites and discusses the quality assurance issues raised, which are relevant to the wider nursing community. The Internet is recognized as an important source of health information for both nurses and the general public. Although it makes health-related information universally available, the wide variation in the overall quality of health Web sites is problematic. This raises many questions for the nursing profession: about what constitutes a good-quality Web site, about the nature of the information that nurses are finding and using to support their professional education, research, and clinical practice, and about the impact that Internet information ultimately has on health interactions and nursing care. The process of completing this small study showed that it is possible to usefully assess dimensions of Web site quality and suggested that it may be feasible to develop tools to help nurses evaluate national and international nursing Web sites. More research is needed to understand how nurses use the Internet to support their everyday professional practices, but the development and application of international Web site quality assurance tools may be important for maintaining professional nursing standards in the Internet age.

Information-seeking behaviour of nurses: where is information sought and what processes are followed?

AIM

This paper is a report of a study on how nurses inform their decision-making in the workplace.

BACKGROUND

Despite the growing availability of research evidence, nurses have been slow to adopt it into their daily decision-making.

METHOD

The study was undertaken in Ireland between 2006 and 2007 using a sequential mixed methods approach. In phase 1, the views of a quota sample of 29 nurses were explored using semi-structured interviews incorporating vignettes. Phase 2 involved the design and dissemination of a survey to a disproportionate stratified random sample of 1356 nurses. The response rate was 29%.

FINDINGS

In decision-making, nurses accessed other people, especially nursing colleagues, the most frequently. Sources that provided prepackaged information such as guidelines were favoured over sources that provided access to original research. The process of information-seeking for routine and non-routine decisions was different. Nurses making routine decisions relied mostly on their experience and an assessment of the patient. In non-routine decision-making, participants experienced more uncertainty about their decisions. Accordingly, sources of information used were more varied and the information-seeking process more extensive. The study highlighted the complexities of establishing whether information used in decision-making is research based or not.

CONCLUSION

Routine practices should be reviewed and updated regularly through organizational mandates, as nurses do not generally question them. Research information to inform non-routine decision-making must be easily available to nurses in their workplace, as information searches generally prioritize finding enough, rather than the best, information to make a decision.

Evidence-Based Practice Among Nurses in Italy

A cross-sectional survey was conducted among a random sample of 449 nurses in Italy, using a self-administered questionnaire to assess knowledge, attitudes, and behaviors regarding evidence-based practice (EBP). A significantly higher level of knowledge was observed among nurses who (a) did not work in medical and surgical wards; (b) believed that the evaluation of the efficacy of the health interventions is needed in their activity; (c) believed that the clinical experience must be combined with the evidence; (d) attended a course about EBP in the last year; and (e) received information from courses and scientific journals. The perceived importance of the application of guidelines and protocols was significantly higher among nurses who (a) worked in medical wards; (b) agreed that the guidelines are useful in identifying and selecting interventions; (c) believed that the evaluation of the efficacy of the health interventions is needed in their activity; (d) believed that the clinical experience must be combined with the evidence; (e) attended a course about EBP in the last year; and (f) received information from courses and scientific journals. Nurses were more likely to have modified their practice in the last year if they attended a course about EBP in the last year and if they often/always read scientific journals and guidelines. While these data were cross-sectional and the response rate was only 49%, the results suggest that continuing education programs are needed for improving nurses’ knowledge and practice of EBP among nurses in Italy.

[Analysis of the web pages of the intensive care units of Spain]

In order to determine the Intensive Care Units (ICU) of Spanish hospitals that had a web site, to analyze the information they offered and to know what information they needed to offer according to a sample of ICU nurses, a cross-sectional observational, descriptive study was carried out between January and September 2008. For each ICU website, an analysis was made on the information available on the unit, its care, teaching and research activity on nursing. Simultaneously, based on a sample of intensive care nurses, the information that should be contained on an ICU website was determined. The results, expressed in absolute numbers and percentage, showed that 66 of the 292 hospitals with ICU (22.6%) had a web site; 50.7% of the sites showed the number of beds, 19.7% the activity report, 11.3% the published articles/studies and followed research lines and 9.9% the organized formation courses. 14 webs (19.7%) displayed images of nurses. However, only 1 (1.4%) offered guides on the actions followed. No web site offered a navigation section for nursing, the E-mail of the chief nursing, the nursing documentation used or if any nursing model of their own was used. It is concluded that only one-fourth of the Spanish hospitals with ICU have a web site; number of beds was the data offered by the most sites, whereas information on care, educational and investigating activities was very reduced and that on nursing was practically omitted on the web pages of intensive care units.

Nurses, computers and pre-registration education

Nursing informatics, the use of information and technology, to support the work of the nurse, is an essential part of the modern nurses' job. In the UK this is supported by a range of National Health Service policy documents over the past decade, starting with Information for Health in 1998. Research carried out over this period has however found that nurses lack the necessary skills and knowledge to use computers effectively, and that pre-registration education does not fully prepare student nurses for this aspect of the role of the nurse. This paper presents the results of a longitudinal study carried out with a cohort of nursing students, which found that although the students lacked computer skills and knowledge at the start of their programme they were willing to engage with this agenda. Two factors were found to be necessary for students to use the available IT on placement. One was a belief that they had the skills to use the computers; the other was a supportive environment that encouraged their use. Unfortunately only a minority of students reported that they had experienced a supportive environment.

Midwives' use of the Internet: an Australian study

OBJECTIVE

to report findings on midwives' use of the Internet drawn from a larger study that explored midwives' attitudes and experiences to online and computer-based learning.

DESIGN AND SETTING

a descriptive, quantitative design using anonymous questionnaires was employed to obtain information from a sample of midwives in Victoria, Australia.

PARTICIPANTS

questionnaires were forwarded by mail to a sample of 300 members of the Victorian branch of the Australian College of Midwives. A total of 169 questionnaires were returned by reply paid mail, representing a response rate of 56%.

FINDINGS

around 92.3% of respondents reported that they used the Internet. However, 31.5% did not find navigating it to be easy, 34.7% reported that finding information was not easy, and 27.2% were not confident using the Internet.

KEY CONCLUSIONS

many midwives have insufficient Internet competence to be able to access necessary evidence to support practice and to assist women with decision making.

IMPLICATIONS FOR PRACTICE

ongoing education and training is needed to ensure that midwives have the skills to source evidence to support practice, and are able to effectively critique Internet information.

Towards a team-based, collaborative approach to embedding e-learning within undergraduate nursing programmes

E-learning approaches are incorporated in many undergraduate nursing programmes but there is evidence to suggest that these are often piecemeal and have little impact on the wider, nurse education curriculum. This is consistent with a broader view of e-learning within the higher education (HE) sector, which suggests that higher education institutions (HEIs) are struggling to make e-learning a part of their mainstream delivery [HEFCE, 2005. HEFCE Strategy for E-Learning 2005/12. Bristol, UK, Higher Education Funding Council for England (HEFCE). [online] Available at: <http://www.hefce.ac.uk/pubs/hefce/2005/05_12/> Accessed: 30 May 07]. This article discusses some of the challenges that face contemporary nurse education and seeks to account for reasons as to why e-learning may not be fully embedded within the undergraduate curriculum. These issues are considered within a wider debate about the need to align e-learning approaches with a shift towards a more student focused learning and teaching paradigm. The article goes on to consider broader issues in the literature on the adoption, embedding and diffusion of innovations, particularly in relation to the value of collaboration. A collaborative, team-based approach to e-learning development is considered as a way of facilitating sustainable, responsive and multidisciplinary developments within a field which is constantly changing and evolving.

From pull to push: understanding nurses' information needs

Electronic access to research information for health professionals is a key component in developing evidence-based healthcare. As nurses take on extended roles and work more autonomously, it is assumed that they will take increasing advantage of these technologies. However, little is known about the decisions that nurses make and the information needs that arise within the context of those decisions. This article presents an analysis of 410 nurse—patient consultations and interviews with 76 primary care nurses, and explores nurses' information needs and their use of electronic information tools. The findings suggest that, if we wish to encourage nurses to use research information in clinical practice, we need to move from `pull' to `push' technology.

Continence specialists use of quality of life information in routine practice: a national survey of practitioners

OBJECTIVES

To survey continence specialists (CSs) about their assessment practice including their use of quality of life (QoL) information, perceived barriers, benefits and training needs.

METHODS

Cross-sectional national postal survey of 624 practicing CSs in the UK. The questionnaire included open and closed questions relating to assessment practice.

RESULTS

Completed questionnaires were returned by 299 (49%) CSs. Although 80% routinely assessed QoL, fewer than 54% demonstrated awareness of published questionnaires. The majority used structured questions (41%) many of which were non-standardised single items (26%) or locally developed questionnaires (19%). Only 22% used standardised patient-completed questionnaires such as the King's Health Questionnaire and the Incontinence Quality of Life questionnaire. Perceived assessment barriers included the availability of appropriate questionnaires, patient disability, limited guidance, resources and time. Of those routinely assessing QoL, 77% wanted more support; the most useful media cited being the internet, followed by professional guidance and training courses.

CONCLUSION

Although QoL measurement is highly valued, there was wide variation in assessment practice with few adopting standardised approaches. Most CSs require greater guidance and support that takes account of their diverse needs. Familiar assessment barriers exist which the use of web-based information, in association with professional guidance might help overcome. Clear mechanisms are required to direct standardised and appropriate assessment practice.

Prescription for nursing informatics in pre-registration nurse education

Nurses need to be able to use information and communications technology not only to support their own practice, but also to help their patients make best use of it. This article argues that nurses are not currently adequately prepared to work with information and technology through their pre-registration education. Reflecting the lack of nursing informatics expertise, it is recommended that all pre-registration nursing programmes should have access to a nursing informatics specialist. A prescription to meet the informatics needs of the newly qualified nurse is proposed. This places the areas that need to be included in pre-registration education into broad groups that both articulate the competencies that nurses need to develop, and indicate why they are needed, rather than providing context-free checklists of skills. This is presented as a binary scatter chart with two axes, skill to knowledge and technology to information.

Exploring nurses' attitudes to, and use of, an online palliative care resource

AIM

The internet provides access to information and evidence that can support palliative care practice. This study aims to evaluate the use and utility of a palliative care website with particular regard to its use and issues for nurses. STUDY DETAILS: A survey of online visitors and a postal survey of staff working in palliative care services were conducted; 134 visitors completed the survey and 371 staff in palliative services responded.

FINDINGS

Users of the site found the content credible and over 95% would recommend the site to others. Over 90% of specialist palliative care nurses use online resources and half use the CareSearch website. Awareness of the resource was much lower for registered nurses than specialist nurses working in palliative care.

CONCLUSION

Understanding attitudes to, and use of, online palliative care resources by nurses working in palliative care services could help to develop these resources to more effectively meet their needs and circumstances.

Primary Care Physicians' Experience with Electronic Medical Records: Barriers to Implementation in a Fee-for-Service Environment

Our aging population has exacerbated strong and divergent trends between health human resource supply and demand. One way to mitigate future inequities is through the adoption of health information technology (HIT). Our previous research showed a number of risks and mitigating factors which affected HIT implementation success. We confirmed these findings through semistructured interviews with nine Alberta clinics. Sociotechnical factors significantly affected physicians' implementation success. Physicians reported that the time constraints limited their willingness to investigate, procure, and implement an EMR. The combination of antiquated exam room design, complex HIT user interfaces, insufficient physician computer skills, and the urgency in patient encounters precipitated by a fee-for-service remuneration model and long waitlists compromised the quantity, if not the quality, of the information exchange. Alternative remuneration and access to services plans might be considered to drive prudent behavior during physician office system implementation.

Nursing students and Internet health information

This study investigates use of the internet by nursing students to access health information and their evaluation practices in relation to this information. The research method was a retrospective descriptive postal survey. A questionnaire was sent to all undergraduate students enrolled in a Bachelor of Nursing programme at a New Zealand university in 2005. The response rate was 50% or 174 responses. Findings from the study included marked variations in respondents ability to successfully search for and evaluate relevant internet health and nursing information. Few respondents assessed patients use of the internet to gather health information or assisted patients with evaluation. As searching, evaluating and sharing online information is a core element of nursing practice, formal education to develop competency in the ability of all nursing students to retrieve and assess internet health information is essential. The integration of these skills into nursing practice is a vital step in developing new approaches to working with knowledgeable consumers of internet health information.

What factors are associated with the integration of evidence retrieval technology into routine general practice settings?

BACKGROUND

Information retrieval systems have the potential to improve patient care but little is known about the variables which influence clinicians' uptake and use of systems in routine work.

AIM

To determine which factors influenced use of an online evidence retrieval system.

DESIGN OF STUDY

Computer logs and pre- and post-system survey analysis of a 4-week clinical trial of the Quick Clinical online evidence system involving 227 general practitioners across Australia.

RESULTS

Online evidence use was not linked to general practice training or clinical experience but female clinicians conducted more searches than their male counterparts (mean use=14.38 searches, S.D.=11.68 versus mean use=8.50 searches, S.D.=9.99; t=2.67, d.f.=157, P=0.008). Practice characteristics such as hours worked, type and geographic location of clinic were not associated with search activity. Information seeking was also not related to participants' perceived information needs, computer skills, training nor Internet connection speed. Clinicians who reported direct improvements in patient care as a result of system use had significantly higher rates of system use than other users (mean use=12.55 searches, S.D.=13.18 versus mean use=8.15 searches, S.D.=9.18; t=2.322, d.f.=154 P=0.022). Comparison of participants' views pre- and post- the trial, showed that post-trial clinicians expressed more positive views about searching for information during a consultation (chi(2)=27.40, d.f.=4, P< or =0.001) and a significantly greater number reported seeking information between consultations as a result of having access to an online evidence system in their consulting rooms (chi(2)=9.818, d.f.=2, P=0.010).

CONCLUSION

Clinicians' use of an online evidence system was directly related to their reported experiences of improvements in patient care. Post-trial clinicians positively changed their views about having time to search for information and pursued more questions during clinic hours.

Predicting research use in nursing organizations: a multilevel analysis

BACKGROUND

No empirical literature was found that explained how organizational context (operationalized as a composite of leadership, culture, and evaluation) influences research utilization. Similarly, no work was found on the interaction of individuals and contextual factors, or the relative importance or contribution of forces at different organizational levels to either such proposed interactions or, ultimately, to research utilization.

OBJECTIVE

To determine independent factors that predict research utilization among nurses, taking into account influences at individual nurse, specialty, and hospital levels.

DESIGN

Cross-sectional survey data for 4,421 registered nurses in Alberta, Canada were used in a series of multilevel (three levels) modeling analyses to predict research utilization.

METHODS

A multilevel model was developed in MLwiN version 2.0 and used to: (a) estimate simultaneous effects of several predictors and (b) quantify the amount of explained variance in research utilization that could be apportioned to individual, specialty, and hospital levels.

FINDINGS

There was significant variation in research utilization (p <.05). Factors (remaining in the final model at statistically significant levels) found to predict more research utilization at the three levels of analysis were as follows. At the individual nurse level (Level 1): time spent on the Internet and lower levels of emotional exhaustion. At the specialty level (Level 2): facilitation, nurse-to-nurse collaboration, a higher context (i.e., of nursing culture, leadership, and evaluation), and perceived ability to control policy. At the hospital level (Level 3): only hospital size was significant in the final model. The total variance in research utilization was 1.04, and the intraclass correlations (the percent contribution by contextual factors) were 4% (variance = 0.04, p <.01) at the hospital level and 8% (variance = 0.09, p <.05) at the specialty level. The contribution attributable to individual factors alone was 87% (variance = 0.91, p <.01).

CONCLUSIONS

Variation in research utilization was explained mainly by differences in individual characteristics, with specialty- and organizational-level factors contributing relatively little by comparison. Among hospital-level factors, hospital size was the only significant determinant of research utilization. Although organizational determinants explained less variance in the model, they were still statistically significant when analyzed alone. These findings suggest that investigations into mechanisms that influence research utilization must address influences at multiple levels of the organization. Such investigations will require careful attention to both methodological and interpretative challenges present when dealing with multiple units of analysis.

Evidence in the palm of your hand: development of an outcomes-focused knowledge translation intervention

AIM

The aim of the project was to develop an electronic information gathering and dissemination system to support both nursing-sensitive outcomes data collection and evidence-based decision-making at the point-of-patient care.

BACKGROUND

With the current explosion of health-related knowledge, it is a challenge for nurses to regularly access information that is most current. The Internet provides timely access to health information, however, nurses do not readily use the Internet to access practice information because of being task-driven and coping with heavy workloads. Mobile computing technology addresses this reality by providing the opportunity for nurses to access relevant information at the time of nurse-patient contact.

METHOD

A cross-sectional, mixed-method design was used to describe nurses' requirements for point-of-care information collection and utilization. The sample consisted of 51 nurses from hospital and home care settings. Data collection involved work sampling and focus group interviews.

FINDINGS

In the hospital sector, 40% of written information was recorded onto "personal papers" at point-of-care and later transcribed into the clinical record. Nurses often sought information away from the point-of-care; for example, centrally located health records, or policy and procedure manuals. In home care, documentation took place in clients' homes. The most frequent source of information was "nurse colleagues." Nurses' top priorities for information were vital signs data, information on intravenous (IV) drug compatibility, drug references, and manuals of policies and procedures.

IMPLICATIONS

A prototype software system was designed that enables nurses to use handheld computers to simultaneously document patients' responses to treatment, obtain real-time feedback about patient outcomes, and access electronic resources to support clinical decision-making.

CONCLUSION

The prototype software system has the potential to increase nurses' access to patient outcomes information and evidence for point-of-care decision-making.

A preliminary usability evaluation of Web-based portal application for patients with schizophrenia

This study evaluated the usability of a Web-based portal application developed for the use of nursing staff with patients suffering from schizophrenia and related psychosis. The study was designed solely to gain direct inputs from the nursing staff (N = 76, n = 38) in acute inpatient wards in two Finnish psychiatric hospitals. The data were collected by questionnaire covering the functionality, content and benefits of the portal. The evaluation showed that the portal is user-friendly enabling a user to move inside the service and to find the relevant information. The content of the portal was interesting, understandable and easy to read. Some nurses were concerned about the effects of the portal on the patients' care, well-being or personal contacts between nursing staff and patients. Some nurses have difficulties in evaluating the portal because they did not actively use it in clinical practice during the testing period. Emphasis should be put on nurses' motivation and concerns regarding possible negative effects of the portal, which may influence the future implementation of eHealth applications in clinical practice.

Collaborative practice: usability of text-based, electronic patient care guidelines

The Intermountain Healthcare system has developed a text-based, electronic reference system for nonphysician staff to provide patient care guidelines intended to reduce variability in bedside care processes and improve patient outcomes. Implementation issues with two interface tools used to deploy the electronic documents at the bedside have caused difficulty with document accessibility. A third interface tool (Viewer) was designed to solve the accessibility problems. This study was designed to compare the time spent searching for information and success of information retrieval from all three interfaces before clinical deployment of the Viewer interface. Study results were used by nursing leadership in a decision to continue supporting the electronic dissemination of text-based practice guidelines for nonphysician staff within our health system's acute care settings.

Supporting pre-registration students in practice: A review of current ICT use

It is unclear how current healthcare students based in the United Kingdom (UK) use information and communication technology (ICT) to support their learning and care delivery in practice environments. This position reflects the dearth of current empirical evidence that needs development in this rapidly changing field. Using focus group interviews involving 16 students from nursing and the allied health professions, to reflect the interprofessional nature of healthcare education, this research explored how students employ technology in placement settings. The students drew on networked resources for personal learning and gave examples of use to meet patient and user needs. Technology also provided a vehicle for communication with the University, though use was complicated by a number of issues. Access to computers and the Internet whilst in placement environments proved problematic for some, with the culture not seeming to support ICT use. Lack of time, attitudes towards computers and ICT skills also affected student engagement. These findings provide information to guide the development of ICT use in placement settings.

Brief Reports for Disseminating Systematic Reviews to Nurses

Much has been written about the importance of using research findings to guide nursing practice. How to best disseminate those findings to nurses remains a challenge. In many clinical settings, nurses interested in research utilization and evidence-based practice retrieve, review, and integrate knowledge from research reports to guide decisions about best practices. Major barriers to this approach, however, are staff nurses' lack of time, expertise, and resources for this process. One approach to overcoming these barriers is to disseminate the results of systematic research reviews directly to nurses in the form of brief reports, written in an easy-to-understand style, and sent via e-mail. This article describes the development of brief reports as a strategy for disseminating the results of systematic reviews to staff nurses. To demonstrate the use of brief reports for this purpose, we chose a systematic review published in the Cochrane Database of Systematic Reviews.

Ambulance officers' use of online clinical evidence

Background

Hospital-based clinicians have been shown to use and attain benefits from online evidence systems. To our knowledge there have been no studies investigating whether and how ambulance officers use online evidence systems if provided. We surveyed ambulance officers to examine their knowledge and use of the Clinical Information Access Program (CIAP), an online evidence system providing 24-hour access to information to support evidence-based practice.

Methods

A questionnaire was completed by 278 ambulance officers in New South Wales, Australia. Comparisons were made between those who used CIAP and officers who had heard of, but not used CIAP.

Results

Half the sample (48.6%) knew of, and 28.8% had used CIAP. Users were more likely to have heard of CIAP from a CIAP representative/presentation, non-users from written information. Compared to ambulance officers who had heard of but had not used CIAP, users were more likely to report better computer skills and that their supervisors regarded use of CIAP as a legitimate part of ambulance officers' clinical role. The main reasons for non-use were lack of access(49.0%) and training(31.4%). Of users, 51.3% rated their skills at finding information as good/very good, 67.5% found the information sought all/most of the time, 87.3% believed CIAP had the potential to improve patient care and 28.2% had directly experienced this. Most access to CIAP occurred at home. The databases frequently accessed were MIMS (A medicines information database) (73.8%) and MEDLINE(67.5%). The major journals accessed were Journal of Emergency Nursing(37.5%), American Journal of Medicine(30.0%) and JAMA(27.5%).

Conclusion

Over half of ambulance officers had not heard of CIAP. The proportion who knew about and used CIAP was also low. Reasons for this appear to be a work culture not convinced of CIAP's relevance to pre-hospital patient care and lack of access to CIAP at work. Ambulance officers who used CIAP accessed it primarily from home and valued it highly. Lack of access to CIAP at central work locations deprives ambulance officers of many of the benefits of an online evidence system.

Drug information resources used by nurse practitioners and collaborating physicians at the point of care in Nova Scotia, Canada: a survey and review of the literature

Background

Keeping current with drug therapy information is challenging for health care practitioners. Technologies are often implemented to facilitate access to current and credible drug information sources. In the Canadian province of Nova Scotia, legislation was passed in 2002 to allow nurse practitioners (NPs) to practice collaboratively with physician partners. The purpose of this study was to determine the current utilization patterns of information technologies by these groups of practitioners.

Methods

Nurse practitioners and their collaborating physician partners in Nova Scotia were sent a survey in February 2005 to determine the frequency of use, usefulness, accessibility, credibility, and current/timeliness of personal digital assistant (PDA), computer, and print drug information resources. Two surveys were developed (one for PDA users and one for computer users) and revised based on a literature search, stakeholder consultation, and pilot-testing results. A second distribution to nonresponders occurred two weeks following the first. Data were entered and analysed with SPSS.

Results

Twenty-seven (14 NPs and 13 physicians) of 36 (75%) recipients responded. 22% (6) returned personal digital assistant (PDA) surveys. Respondents reported print, health professionals, and online/electronic resources as the most to least preferred means to access drug information, respectively. 37% and 35% of respondents reported using "both print and electronic but print more than electronic" and "print only", respectively, to search monograph-related drug information queries whereas 4% reported using "PDA only". Analysis of respondent ratings for all resources in the categories print, health professionals and other, and online/electronic resources, indicated that the Compendium of Pharmaceuticals and Specialties and pharmacists ranked highly for frequency of use, usefulness, accessibility, credibility, and current/timeliness by both groups of practitioners. Respondents' preferences and resource ratings were consistent with self-reported methods for conducting drug information queries. Few differences existed between NP and physician rankings of resources.

Conclusion

The use of computers and PDAs remains limited, which is also consistent with preferred and frequent use of print resources. Education for these practitioners regarding available electronic drug information resources may facilitate future computer and PDA use. Further research is needed to determine methods to increase computer and PDA use and whether these technologies affect prescribing and patient outcomes.

Critical incidents and journey mapping as techniques to evaluate the impact of online evidence retrieval systems on health care delivery and patient outcomes

BACKGROUND

Online evidence retrieval systems are a potential tool in supporting evidence-based practice. Effective and tested techniques for assessing the impact of these systems on care delivery and patient outcomes are limited.

PURPOSE AND METHODS

In this study we applied the critical incident (CI) and journey mapping (JM) techniques to assess the integration of an online evidence system into everyday clinical practice and its impact on decision making and patient care. To elicit incidents semi-structured interviews were conducted with 29 clinicians (13 hospital physician specialists, 16 clinical nurse consultants (CNCs)) who were experienced users of the online evidence system. Clinicians were also asked questions about how they had first used the system and how their use and experiences had changed over time. These narrative accounts were then mapped and scored using the journey mapping technique.

RESULTS

Clinicians generated 85 critical incidents. Three categories of impact were identified: impact on clinical practice, impact on individual clinicians and impact on colleagues through the dissemination of information gained from the online evidence system. One quarter of these included specific examples of system use leading to improvements in patient care. Clinicians obtained an average journey mapping score of 22 out of a possible score of 36, demonstrating a good level of system integration. Average scores of doctors and CNCs were similar. However individuals with the same scores often had very different journeys in system integration.

CONCLUSIONS

The CI technique provided clear examples of the way in which system use had influenced practice and care delivery. The JM technique was found to be a useful method for providing a quantification of the different ways and extent to which, clinicians had integrated system use into practice, and insights into how system use can influence organisational culture. The development of the journey mapping stages provides a structure by which the program logic of a clinical information system and its desired outcomes can be made explicit and be based upon users' experiences in everyday practice. Further work is required using this technique to assess its value as an evaluation method.

Promoting practical clinical management learning: the current situation about Information and Communications Technology capability development in student nurses

AIM

This paper is about work-based learning in information management for student nurses. It seeks, through a literature review, to make a case for and promote Information and Communications Technology capability development in student nurses within their clinical environment.

BACKGROUND

The profession of nursing, like many other jobs, is facing the increasing usage of information technology in day-to-day operations. Admission and discharges of patients have been held on computer databases since at least the 1980s. With the new Labour Government in 1997, increasing focus was placed on the effectiveness of the National Health Service and using computers as one way to assist in achieving greater effectiveness. Nurse education therefore needed to reflect this need and support trainee nurses to acquire skills in Information and Communications Technology. This paper is part of an ongoing professional doctorate inquiry into Information and Communications Technology capability development in student nurses.

EVALUATION

A literature search was conducted on teaching information and technology skills via Cumulative Index to Nursing and Allied Health Literature. Most of the available studies were neither based on the UK nor were they about student nurses. As there is a dearth of published work in this specific area, relevant, related and tangential literature was reviewed.

KEY ISSUES

It is argued that current practice and published work on Information and Communications Technology capability development by student nurses hardly exists. The literature confirmed that success in this area requires sound change management, an understanding of National Health Service culture, and effective people leadership skills. Nurse educators and managers need to pay more attention to understand how organizations work, particularly organizations where student nurses carry out their work.

CONCLUSIONS

As the search revealed a significant gap in the literature in this area, a practical conceptual framework to fully analyse, develop and implement sustained Information and Communications Technology capability in student nurses is proposed.

Nursing and the informatics revolution

The Institute of Medicine's quality initiatives have collectively emphasized the importance of information technology to the transformation of health care. Not coincidentally, federal initiatives in 2004 have signaled the start of "the decade of health information technology." Building on those reports, this article describes the informatics revolution in process, and nursing's readiness to move in that direction. The promise of informatics in reshaping practice is sketched out in terms of seven aims for improvement, followed by a listing of some of the issues that must be addressed for nursing to realize those possibilities. In similar fashion, changes in academia are discussed both in terms of the promise of informatics applications and the barriers to achieving that preferred future. The article ends with some policy recommendations and reflections on opportunities at hand, particularly the growing emphasis on patient self-management support.

Do online information retrieval systems help experienced clinicians answer clinical questions?

OBJECTIVE

To assess the impact of clinicians' use of an online information retrieval system on their performance in answering clinical questions.

DESIGN

Pre-/post-intervention experimental design.

MEASUREMENTS

In a computer laboratory, 75 clinicians (26 hospital-based doctors, 18 family practitioners, and 31 clinical nurse consultants) provided 600 answers to eight clinical scenarios before and after the use of an online information retrieval system. We examined the proportion of correct answers pre- and post-intervention, direction of change in answers, and differences between professional groups.

RESULTS

System use resulted in a 21% improvement in clinicians' answers, from 29% (95% confidence interval [CI] 25.4-32.6) correct pre- to 50% (95% CI 46.0-54.0) post-system use. In 33% (95% CI 29.1-36.9) answers were changed from incorrect to correct. In 21% (95% CI 17.1-23.9) correct pre-test answers were supported by evidence found using the system, and in 7% (95% CI 4.9-9.1) correct pre-test answers were changed incorrectly. For 40% (35.4-43.6) of scenarios, incorrect pre-test answers were not rectified following system use. Despite significant differences in professional groups' pre-test scores [family practitioners: 41% (95% CI 33.0-49.0), hospital doctors: 35% (95% CI 28.5-41.2), and clinical nurse consultants: 17% (95% CI 12.3-21.7; chi(2) = 29.0, df = 2, p < 0.01)], there was no difference in post-test scores. (chi(2) = 2.6, df = 2, p = 0.73).

CONCLUSIONS

The use of an online information retrieval system was associated with a significant improvement in the quality of answers provided by clinicians to typical clinical problems. In a small proportion of cases, use of the system produced errors. While there was variation in the performance of clinical groups when answering questions unaided, performance did not differ significantly following system use. Online information retrieval systems can be an effective tool in improving the accuracy of clinicians' answers to clinical questions.