Electronic Health Record Stress and Burnout Among Clinicians in Hospital Settings: A Systematic Review

Physician and Medical Student Burnout, a Narrative Literature Review: Challenges, Strategies, and a Call to Action

Background: Burnout is a state of emotional, physical, and mental exhaustion produced by excessive and prolonged professional stress. Its prevalence is unclear, and figures from 2 to 81% have been reported, although studies focused on this issue are scarce and inconsistent definitions and the absence of validated measurement tools make comparisons difficult. Methods: Our narrative review's purpose was to explore physician and medical student burnout across medical specialties and in specific subgroups, including young doctors, researchers, and female physicians. We also assess burnout effects in medical students and patients and the possible strategies to prevent and reverse it. Results: Burnout affects doctors, medical students, and patients. It impacts significantly on physicians mental health and can be the trigger for depression, substance abuse, and suicide attempts. Moreover, this psychological and physical exhaustion can also increase the risk of systemic conditions such as cardiovascular disease. Physician burnout increases the risk of medical errors, reduces professional efficacy, and might compromise patients' safety. Strategies focusing on mental, physical, social, and occupational well-being can help to prevent and treat burnout. These include resilience training, self-care, exercise, work-life balance, and institutional changes, such as reducing administrative burdens and improving electronic health record systems. Medical students' burnout might be triggered by specific problems related to their young age, economic situation, exam stress and workload, high academic expectations, lack of support, and others. Conclusions: Burnout is common in physicians and medical students, negatively affecting mental health, professional/academic efficacy, and patient outcomes. Addressing burnout requires a multifaceted approach, including individual strategies and systemic changes within institutions.

Technostress and its associated factors: Burnout and fatigue among Malaysian healthcare workers (HCWs) in state hospitals

BACKGROUND

Technostress is defined as a psychological state associated with the increased usage of advanced computer technologies on a daily basis. It is also defined as an anxiety feeling or mental strain due to excessive exposure or involvement with technologies.

AIM

This study aimed to determine the level of technostress associated with burnout and fatigue among healthcare workers (HCWs) in the state hospitals of Malaysia.

METHODS

A cross-sectional study was conducted from September 2022 to November 2023 among HCWs working in the 15-state hospitals in Malaysia. A standardized questionnaire was distributed among the HCWs in the state hospitals in Malaysia. The questionnaire contains information on socio-demography and topic-specific scales on technostress, burnout and fatigue.

RESULTS

A total of 1620 HCWs were included in the analysis, of which 244 (15%) have high level of technostress, 1089 (67%) have moderate technostress, and 287 (18%) have low technostress. Burnout, and fatigue were significantly associated with technostress. HCWs with moderate burnout were less likely to have high technostress compared to those with high burnout (B =  -0.993, 95% CI; 0.231 - 0.594; p <  0.001). Those with moderate fatigue were less likely to have high technostress (B =  -3.844, 95% CI; 0.003 - 0.162; p <  0.001) compared to those with high fatigue.

CONCLUSIONS

This study found that majority of the HCWs have moderate level of technostress. Technostress has become more common after the COVID-19 pandemic in 2020 drastically altered working conditions and made remote work using information and communication technologies (ICT) a necessity rather than a luxury. Mitigation measures and programs that include psychological support for individuals who are struggling with the technostress and burnout are needed to overcome this issue.

Qualitative Analysis of Therapist Documentation of Assessments of Orally Feeding Infants Who Require Noninvasive Respiratory Support

PURPOSE

This is a qualitative analysis of speech-language pathology and occupational therapy documentation of bedside assessments of infants orally feeding on noninvasive respiratory support (NRS).

METHOD

Data were extracted from speech-language pathology and occupational therapy electronic health record documentation of bedside feeding/swallowing assessment and treatment of infants on NRS. These data included the rate of documentation of objective metrics, as well as themes in feeding safety, quality, and therapeutic interventions.

RESULTS

Notes from 37 speech-language pathologist and occupational therapist bedside visits were included. Data on the amount of NRS during oral feeding were inconsistently documented, but reported flow rate ranged from 0.2 to 5.0 l per minute. Approximately 57% of notes indicated some type of overt feeding problem. Objective data were inconsistently documented, but common metrics included signs of possible aspiration (cough in 16.2% and congestion in 13.5% of notes), liquid viscosity (43.2% of notes), feeding modality (94.6% of notes), volume offered (56.8% of notes) and consumed (81.1% of notes), and feeding time (56.8% of notes). Documentation themes include assessment of both safety and quality, implied stability and success rather than explicit documentation of such, infrequent instrumental assessment referral, differences between assessment versus follow-up treatment notes, differences in structured/templated notes versus unstructured narratives, and missing data.

CONCLUSIONS

Missing data limited our ability to draw conclusions regarding safety and quality of oral feeding during NRS use. We make recommendations for documentation, including prioritizing objective data, clarifying clinical interpretations, patient responses to interventions trialed, and use of structured narratives and flowcharting.

The mediating role of emotional intelligence in the relationship between technostress and burnout prevention among critical care nurses a structural equation modelling approach

BACKGROUND

Critical care nurses frequently experience high levels of technostress due to the increasing demands of healthcare technology, which contributes to burnout. Emotional intelligence has been shown to buffer stress in demanding environments, potentially mitigating burnout. However, its mediating role in the relationship between technostress and burnout among critical care nurses remains underexplored.

AIM

This study aims to examine the mediating role of emotional intelligence in the relationship between technostress and burnout among critical care nurses.

METHODS

A cross-sectional study was conducted among 180 critical care nurses from two hospitals in Damnhour City, Egypt. Data were collected using the Technostress Questionnaire, Copenhagen Burnout Inventory (CBI), and Emotional Intelligence Scale. Structural Equation Modeling (SEM) was used to test the hypothesized relationships between technostress, emotional intelligence, and burnout, with bootstrapping employed to assess mediation.

RESULTS

Technostress was positively correlated with burnout (r = 0.56, p < 0.01), while emotional intelligence was negatively correlated with both technostress (r = -0.45, p < 0.01) and burnout (r = -0.49, p < 0.01). SEM analysis revealed that emotional intelligence significantly mediated the relationship between technostress and burnout (indirect effect = 0.23, p = 0.002), reducing burnout levels.

CONCLUSION

Emotional intelligence plays a crucial role in mitigating the effects of technostress on burnout among critical care nurses. Targeted interventions to enhance emotional intelligence may help reduce burnout in technology-driven healthcare environments.

Effect of a Practice-Oriented Electronic Medical Record Education Program for New Nurses

Background/Objectives: New nurses often face challenges in adapting to clinical environments, particularly in mastering electronic medical record (EMR) systems, which are critical for effective patient care and communication. This study aimed to evaluate the effectiveness of a practice-oriented EMR education program designed to improve new nurses' EMR competencies. Methods: A quasi-experimental pretest-post-test design with a non-equivalent control group was employed. Fifty-four new nurses employed for less than a year participated, with 25 in the intervention group and 29 in the comparison group. The intervention group underwent five weekly sessions focused on core EMR tasks, including admission nursing, operation/procedure documentation, patient transfer/discharge, night duties, and SBAR handovers. The program, led by clinical nurse educators, incorporated lectures, practical exercises, and Q&A sessions. EMR competencies were assessed using a validated 5-point Likert scale. Results: The intervention group showed significant improvements across all assessed domains, with post-program scores significantly higher than those of the comparison group. The most notable improvements were in operation/procedure documentation and patient transfer/discharge tasks. The comparison group's gains were limited, likely reflecting natural skill acquisition through clinical experience. Conclusions: The practice-oriented EMR education program effectively enhanced new nurses' EMR competencies. The program's structured approach, which combined theoretical instruction with extensive hands-on practice and department-specific adaptations, proved particularly effective in improving complex documentation tasks. The integration of comprehensive EMR training into nursing curricula and the expansion of such programs to other institutions are recommended for broader implementation.

The imperative of teamwork in antimicrobial stewardship (AMS) interventions: insights from an ethnographic study with practitioners in Spain

Teamwork-the activity of working together in a group towards a similar goal-is a defining feature of the practice of clinical medicine carried out in hospitals and other healthcare facilities. This Viewpoint suggests that teamwork is a defining feature of antimicrobial stewardship (AMS) programmes, and identifies six elements that characterise AMS team dynamics. These insights arise from an original ethnographic study of AMS carried out in Spain, where these programmes are known as Programas para la Optimización de Antimicrobianos. The study used qualitative research methods including ethnographic observations in public hospitals and scientific and educational fora, in-depth interviews and archival research. It calls for a reflection on the part of the global community of AMS practitioners on the role of team dynamics in building sustainable AMS interventions and the inclusion of teamwork skills in training curricula aimed at future practitioners.

Informing nursing policy: An exploration of digital health research by nurses in England

AIMS

Digital health technologies are designed, implemented, and evaluated to support clinical practice, enable patients to self-manage illness, and further public and global health. Nursing and health policies often emphasise the importance of evidence-based digital health services to deliver better care. However, the contribution nurses make to digital health research in many countries is unknown. Hence, this study aims to examine digital health research conducted by nurses in England.

DESIGN

A bibliometric analysis.

METHODS

The CINAHL, MEDLINE, and Scopus databases were searched between 2000 and 2022, and supplemented with a hand search of nurses' research profiles. Results were screened by title, abstract, and full text against eligibility criteria. Data were extracted and bibliometric analysis used to summarise the findings.

RESULTS

Mental health nurses produced the most digital health research in England, followed by nurses working in community care, with several disciplines underrepresented or missing. Web/online health services or information was the most researched technology, followed by mobile health and telehealth. Nurses based in the south-east and north-west of England produced the most digital health research, with other regions less well represented.

CONCLUSION

Nurse leaders should support nurses to conduct more digital health research by providing dedicated time, funding, and professional development opportunities, particularly in under researched clinical areas, technologies, and geographic regions to further evidence-based practice and patient care. More digital nursing data is needed to support nurse led research in areas like artificial intelligence and data science. The findings supported the national Philips Ives Review by identifying areas of digital nursing research that need more investment in England.

What engagement strategies are useful in facilitating the implementation of electronic health records in health care settings? A rapid review of qualitative evidence synthesis using the normalization process theory

Objective

The study aimed to identify and describe the engagement strategies used in implementing electronic health records in health care settings and to ascertain why they were successful or not, using normalization process theory.

Methods

In this rapid review, we searched PubMed and CINAHL for qualitative and mixed methods primary studies published from 2010 to 2023 (June). We identified 41 studies that explored the implementation of EHRs, involving clinicians as participants. For quality appraisal, we employed the standards for reporting qualitative research (SRQR) tool. For analysis, a qualitative comparative analysis, using the normalization process theory was conducted. This was followed by a narrative synthesis to compile and analyze key findings.

Results

About 56% (n = 23) of the studies were conducted in hospitals, while the remaining were done in mental health, maternity, and ambulatory care settings. Participants included a range of clinicians such as nurses, physicians, doctors, dentists, pediatricians and other specialists. Evidence shows that prior to implementation, effective communication of the vision of EHRs and early user involvement in decision-making are useful engagement strategies in preparing users for implementation. Tailored training and on-demand technical support for users sustain system usage during the roll out. Lastly, ongoing engagement with users is essential for continuous user support and system improvements.

Conclusion

User engagement improves the chances of successful implementation, particularly if engagement strategies are effective for the specific stages of implementation. The success of these strategies is more evident when they ensure normalization process theory tenets, which include user coherence, cognitive participation, collective action and reflective monitoring.

Measuring the impact of digitisation on NHS nurses' time and morale: A time and motion study

Objective

Despite the benefits of digital transformation, many healthcare organisations still rely on manual, traditional processes to transfer clinical images and videos to electronic patient records (EPRs), consuming valuable nurse-patient-facing time. Our study aimed to outline tasks performed by nurses to traditionally transfer clinical images and videos to EPRs, assess the impact on nurses' time and efficiency cost, and report on nurse experiences when transitioning to a digitised process.

Methods

Observations spanned two one-week periods in the ENT outpatient department of Royal Devon University Healthcare NHS Foundation Trust, using direct observational time and predetermined motion time system analysis to map nurses' tasks pre-and post-implementation of a Medical Video Recorder and Centralised Medical Content Management. Two staff experience surveys were conducted, and data was aggregated to evaluate the impact of digitisation.

Results

Nurses traditionally followed two processes to transfer clinical images and video to EPRs. Digitisation saved 43 seconds per endoscopy (a 10% efficiency gain) compared to Process 1, in which nurses print, attach, scan, and digitise images off-site to EPRs, and 3 minutes and 8 seconds (a 33% efficiency gain) compared to Process 2, where urgent content is recorded on an iPad and transferred to EPRs. Digitising could save nurses 26 working days annually by reducing non-patient-facing tasks in the ENT department, leading to an annual time efficiency cost-saving of £6780. Furthermore, 75% of nurses reported significantly improved morale, 63% strongly agreed that digitisation improved confidence in the accuracy of patient details, and all paper processes were eliminated.

Conclusion

Our findings highlight the inefficiency of traditional methods in transferring images and videos to EPRs. Digital transformation could enhance nursing efficiency and morale, improving care quality. Future studies should evaluate the effectiveness of Medical Video Recorders and Centralised Medical Content Management in other departments.