Sairaanhoitajien valmiudet tiedonhallintaan sekä kokemukset potilas- ja asiakastietojärjestelmien tuesta työtehtäviin

Experiences of Electronic Health Records' and Client Information Systems' Use on a Mobile Device and Factors Associated With Work Time Savings Among Practical Nurses: Cross-Sectional Study

BACKGROUND

The transmission of clinical information in nursing predominantly occurs through digital solutions, such as computers and mobile devices, in today's era. Various technological systems, including electronic health records (EHRs) and client information systems (CISs), can be seamlessly integrated with mobile devices. The use of mobile devices is anticipated to rise, particularly as long-term care is increasingly delivered in environments such as clients' homes, where computers are not readily accessible. However, there is a growing need for more user-centered data to ensure that mobile devices effectively support practical nurses in their daily activities.

OBJECTIVE

This study aims to analyze practical nurses' experiences of using EHRs or CISs on a mobile device in their daily practice. In addition, it aims to examine the factors associated with work time savings when using EHRs/CISs on a mobile device.

METHODS

A cross-sectional study using an electronic survey was conducted in spring 2022. A total of 3866 practical nurses participated in the survey based on self-assessment. The sample was limited to practical nurses who used EHRs or CISs on a mobile device and worked in home care or service housing within the social welfare or health care sector (n=1014). Logistic regression analysis was used to explore the factors associated with work time savings.

RESULTS

The likelihood of perceiving work time savings was higher among more experienced EHR/CIS users compared with those with less experience (odds ratio [OR] 1.59, 95% CI 1.30-1.94). Participants with 0-5 years of work experience were more likely to experience work time savings compared with those who had worked 21 years or more (OR 2.41, 95% CI 1.43-4.07). Practical nurses in home care were also more likely to experience work time savings compared with those working in service housing (OR 1.95, 95% CI 1.23-3.07). A lower grade given for EHRs/CISs was associated with a reduced likelihood of experiencing work time savings (OR 0.76, 95% CI 0.66-0.89). Participants who documented client data in a public area were more likely to experience work time savings compared with those who did so in the nurses' office (OR 2.33, 95% CI 1.27-4.25). Practical nurses who found documentation of client data on a mobile device easy (OR 3.05, 95% CI 2.14-4.34) were more likely to experience work time savings compared with those who did not. Similarly, participants who believed that documentation of client data on a mobile device reduced the need to memorize things (OR 4.10, 95% CI 2.80-6.00) were more likely to experience work time savings compared with those who did not.

CONCLUSIONS

To enhance the proportion of practical nurses experiencing work time savings, we recommend that organizations offer comprehensive orientation and regular education sessions tailored for mobile device users who have less experience using EHRs or CISs and find mobile devices less intuitive to use.

Interorganizational health information exchange-related patient safety incidents: A descriptive register-based qualitative study

PURPOSE

The current literature related to patient safety of interorganizational health information is fragmented. This study aims to identify interorganizational health information exchange-related patient safety incidents occurring in the emergency department, emergency medical services, and home care. The research also aimed to describe the causes and consequences of these incidents.

METHODS

A total of sixty (n = 60) interorganizational health information exchange-related patient safety incident free text reports were analyzed. The reports were reported in the emergency department, emergency medical services, or home care between January 2016 and December 2019 in one hospital district in Finland.

RESULTS

The identified interorganizational health information exchange-related incidents were grouped under two main categories: "Inadequate documentation"; and "Inadequate use of information". The causes of these incidents were grouped under the two main categories "Factors related to the healthcare professional " and "Organizational factors", while the consequences of these incidents fell under the two main categories "Adverse events" and "Additional actions to prevent, avoid, and correct adverse events".

CONCLUSION

This study shows that the inadequate documentation and use of information is mainly caused by factors related to the healthcare professional and organization, including technical problems. These incidents cause adverse events and additional actions to prevent, avoid, and correct the events. The sociotechnical perspective, including factors related to health care professionals, organization, and technology, should be emphasized in patient safety development of inter-organizational health information exchange and it will be the focus of our future research. Continuous research and development work is needed because the processes and information systems used in health care are constantly evolving.

Registered Nurses' and Medical Doctors' Experiences of Patient Safety in Health Information Exchange During Interorganizational Care Transitions: A Qualitative Review

OBJECTIVE

This systematic review aimed to identify, critically appraise, and synthesize the best available literature on registered nurses' and medical doctors' experiences of patient safety in health information exchange (HIE) during interorganizational care transitions.

METHODS

The review was conducted according to the JBI methodology for systematic reviews of qualitative evidence. A total of 5 multidisciplinary databases were searched from January 2010 to September 2020 to identify qualitative or mixed methods studies. The qualitative findings were pooled using JBI SUMARI with the meta-aggregation approach.

RESULTS

The final review included 6 original studies. The 53 distinct findings were aggregated into 9 categories, which were further merged into 3 synthesized findings: (1) HIE efficiency and accuracy support patient safety during interorganizational care transitions; (2) inaccuracies in content and structure, along with poor HIE usability, jeopardize patient safety during interorganizational care transitions; and (3) health care professionals' (HCP) actions in HIE are associated with patient safety during interorganizational care transitions.

CONCLUSIONS

The results of this review identified several advantages of HIE, namely, improvements in patient safety based on reduced human error. Nevertheless, a lack of usability and functionality can amplify the effects of human error and increase the risk of adverse events. In addition, HCPs' individual actions in HIE were found to influence patient safety. Hence, the cognitive and sociotechnical perspectives of work related to HIE should be studied. In addition, HCPs' experiences of each stage of HIE deployment should be clarified to ensure a high standard of patient safety. Registration: PROSPERO CRD42020220631, registered on November 13, 2020.

Electronic Health Record Implementations and Insufficient Training Endanger Nurses' Well-being: Cross-sectional Survey Study

Background

High expectations have been set for the implementations of health information systems (HIS) in health care. However, nurses have been dissatisfied after implementations of HIS. In particular, poorly functioning electronic health records (EHRs) have been found to induce stress and cognitive workload. Moreover, the need to learn new systems may require considerable effort from nurses. Thus, EHR implementations may have an effect on the well-being of nurses.

Objective

This study aimed to examine the associations of EHR-to-EHR implementations and the sufficiency of related training with perceived stress related to information systems (SRIS), time pressure, and cognitive failures among registered nurses. Moreover, we examined the moderating effect of the employment sector (hospital, primary care, social services, and others) on these associations.

Methods

This study was a cross-sectional survey study of 3610 registered Finnish nurses in 2020. EHR implementation was measured by assessing whether the work unit of each respondent had implemented or will implement a new EHR (1) within the last 6 months, (2) within the last 12 months, (3) in the next 12 months, and (4) at no point within the last 12 months or in the forthcoming 12 months. The associations were examined using analyses of covariance adjusted for age, gender, and employment sector.

Results

The highest levels of SRIS (adjusted mean 4.07, SE 0.05) and time pressure (adjusted mean 4.55, SE 0.06) were observed among those who had experienced an EHR implementation within the last 6 months. The lowest levels of SRIS (adjusted mean 3.26, SE 0.04), time pressure (adjusted mean 4.41, SE 0.05), and cognitive failures (adjusted mean 1.84, SE 0.02) were observed among those who did not experience any completed or forthcoming implementations within 12 months. Nurses who perceived that they had received sufficient implementation-related training experienced less SRIS (F₁=153.40, P<.001), time pressure (F₁=80.95, P<.001), and cognitive failures (F₁=34.96, P<.001) than those who had received insufficient training. Recent implementations and insufficient training were especially strongly associated with high levels of SRIS in hospitals.

Conclusions

EHR implementations and insufficient training related to these implementations may endanger the well-being of nurses and even lead to errors. Thus, it is extremely important for organizations to offer comprehensive training before, during, and after implementations. Moreover, easy-to-use systems that allow transition periods, a re-engineering approach, and user involvement may be beneficial to nurses in the implementation process. Training and other improvements would be especially important in hospitals.

The associations of information system's support and nurses' documentation competence with the detection of documentation-related errors: Results from a nationwide survey

The use of information systems and electronic documentation has become a central part of a nurse's work, and it is expected to increase the quality of documentation and patient safety. However, errors related to documentation have been identified as a significant risk for the quality and safety of care. This study examined whether information system's support for documentation and nurses' documentation competence are associated with how frequently nurses detect documentation-related errors that have caused an adverse event. A nationwide survey was conducted in 2020, and a total of 3610 nurses participated. Results from linear regression analyses showed that high documentation support from the information system and high documentation competence were associated with fewer detected documentation-related errors. Nurses with low documentation support from the system and low documentation competence detected the most errors. The results highlight the need to develop electronic health record functions in a way that they better support accurate documentation. Furthermore, organisations should invest in ensuring the documentation skills of nurses and providing appropriate training.

The Association Between Using a Mobile Version of an Electronic Health Record and the Well-Being of Nurses: Cross-sectional Survey Study

BACKGROUND

Mobile devices such as tablets and smartphones are increasingly being used in health care in many developed countries. Nurses form the largest group in health care that uses electronic health records (EHRs) and their mobile versions. Mobile devices are suggested to promote nurses' workflow, constant updating of patient information, and improve the communication within the health care team. However, little is known about their effect on nurses' well-being.

OBJECTIVE

This study aimed to examine the association between using a mobile version of the EHR and nurses' perceived time pressure, stress related to information systems, and self-rated stress. Moreover, we examined whether mobile device use modifies the associations of EHR usability (ease of use and technical quality), experience in using EHRs, and number of systems in daily use with these well-being indicators.

METHODS

This was a cross-sectional population-based survey study among 3610 Finnish registered nurses gathered in 2020. The aforesaid associations were examined using analyses of covariance and logistic regression adjusted for age, gender, and employment sector (hospital, primary care, social service, and other).

RESULTS

Nurses who used the mobile version of their EHR had higher levels of time pressure (F_1,3537=14.96, P<.001) and stress related to information systems (F_1,3537=6.11, P=.01), compared with those who did not use mobile versions. Moreover, the interactions of mobile device use with experience in using EHRs (F_1,3581=14.93, P<.001), ease of use (F_1,3577=10.16, P=.001), and technical quality (F_1,3577=6.45, P=.01) were significant for stress related to information systems. Inexperience in using EHRs, low levels of ease of use, and technical quality were associated with higher stress related to information systems and this association was more pronounced among those who used mobile devices. That is, the highest levels of stress related to information systems were perceived among those who used mobile devices as well as among inexperienced EHR users or those who perceived usability problems in their EHRs.

CONCLUSIONS

According to our results, it seems that at present mobile device use is not beneficial for the nurses' well-being. In addition, mobile device use seems to intensify the negative effects of usability issues related to EHRs. In particular, inexperienced users of EHRs seem to be at a disadvantage when using mobile devices. Thus, we suggest that EHRs and their mobile versions should be improved such that they would be easier to use and would better support the nurses' workflow (eg, improvements to problems related to small display, user interface, and data entry). Moreover, additional training on EHRs, their mobile versions, and workflow related to these should be provided to nurses.