Meeting the Educational Needs of the Busy Bedside Nurse: Curbside Education an Innovative Program

Seek out educational needs of staff based on current changes, trends and new hires Provide on the spot reinforcement of skills, policies, education and policy changes for all staff Implement skill stations, including off shifts , to increase staff cohesiveness and preparedness in emergent and nonemergent scenarioshttps://digitalcommons.centracare.com/nursing_posters/1111/thumbnail.jp

Nursing Home Implementation of Health Information Technology: Review of the Literature Finds Inadequate Investment in Preparation, Infrastructure, and Training.

Health information technology (HIT) is increasingly adopted by nursing homes to improve safety, quality of care, and staff productivity. We examined processes of HIT implementation in nursing homes, impact on the nursing home workforce, and related evidence on quality of care. We conducted a literature review that yielded 46 research articles on nursing homes' implementation of HIT. To provide additional contemporary context to our findings from the literature review, we also conducted semistructured interviews and small focus groups of nursing home staff (n = 15) in the United States. We found that nursing homes often do not employ a systematic process for HIT implementation, lack necessary technology support and infrastructure such as wireless connectivity, and underinvest in staff training, both for current and new hires. We found mixed evidence on whether HIT affects staff productivity and no evidence that HIT increases staff turnover. We found modest evidence that HIT may foster teamwork and communication. We found no evidence that the impact of HIT on staff or workflows improves quality of care or resident health outcomes. Without initial investment in implementation and training of their workforce, nursing homes are unlikely to realize potential HIT-related gains in productivity and quality of care. Policy makers should consider creating greater incentives for preparation, infrastructure, and training, with greater engagement of nursing home staff in design and implementation

Behavior change techniques to promote healthcare professionals' eHealth competency : A systematic review of interventions

Introduction: The use of eHealth is rapidly ->increasing; however, many healthcare professionals have insufficient eHealth competency. Consequently, interventions addressing eHealth competency might be useful in fostering the effective use of eHealth. Objective: Our systematic review aimed to identify and evaluate the behavior change techniques applied in interventions to promote healthcare professionals' eHealth competency. Methods: We conducted a systematic literature review following the Joanna Briggs Institute's Manual for Evidence Synthesis. Published quantitative studies were identified through screening PubMed, Embase, and CINAHL. Two reviewers independently performed full-text and quality assessment. Eligible interventions were targeted to any healthcare professional and aimed at promoting eHealth capability or motivation. We synthesized the interventions narratively using the Behavior Change Technique Taxonomy v1 and the COM-B model. Results: This review included 32 studies reporting 34 heterogeneous interventions that incorporated 29 different behavior change techniques. The interventions were most likely to improve the capability to use eHealth and less likely to enhance motivation toward using eHealth. The promising techniques to promote both capability and motivation were action planning and participatory approach. Information about colleagues' approval, emotional social support, monitoring emotions, restructuring or adding objects to the environment, and credible source are techniques worth further investigation. Conclusions: We found that interventions tended to focus on promoting capability, although motivation would be as crucial for competent eHealth performance. Our findings indicated that empathy, encouragement, and usercentered changes in the work environment could improve eHealth competency as a whole. Evidence-based techniques should be favored in the development of interventions, and further intervention research should focus on nurses and multifaceted competency required for using different eHealth systems and devices.Peer reviewe

Strategies Rural Hospital Leaders Use to Implement Electronic Health Record

The Centers for Medicare and Medicaid Services issued over 144,000 payments totaling $7.1 billion to medical facilities that have adopted and successfully demonstrated meaningful use of certified electronic health record (EHR). Hospital organizations can increase cost savings by using the electronic components of EHRs to improve medical coding and reduce medical errors and transcription costs. Despite the incentives, some rural health care facilities are failing to progress. The purpose of this multiple case study was to explore the strategies rural hospital leaders used to implement an EHR. The target population consisted of rural hospital leaders who were involved in the successful implementation of an EHR in South Texas. The conceptual framework chosen for this study was the sociotechnical systems theory. Data were collected through telephone interviews using open-ended semistructured interviews with 5 participants from 4 rural hospitals who were involved in the EHR implementation. Data analysis occurred using Yin\u27s 5-step process which includes compiling, disassembling, reassembling, interpreting, and concluding. Data analysis included collecting information from government websites, company documents, and open-ended information to develop recurring themes. Several themes emerged including ongoing training, provider buy-in, constant communication, use of super users, and workflow maintenance. The findings could influence social change by making the delivery of health care more efficient and improving quality, safety, and access to health care services for patients

”– – kun saisi vain keskittyä tähän hommaan ajan kanssa.” Tarkastelussa Visma InSchool -ohjelmistokokonaisuuden pääkäyttäjät ja heidän käyttäjäkokemuksensa

Tutkimuksen tavoitteena oli selvittää, millainen käyttäjäryhmä on oppilaitoksissa hyödynnettävän tietojärjestelmän pääkäyttäjät. Tämän tutkimuksen kohteena oli oppilaitoksissa hyödynnettävän Visma InSchool -ohjelmistokokonaisuuden toimivuudesta, kehittämisestä ja päivittämisestä vastaavat pääkäyttäjät ja heidän käyttäjäkokemuksensa. Tarkentavia tutkimuskysymyksiä olivat, millaisena pääkäyttäjät kokevat käyttämänsä järjestelmän ja millaisena pääkäyttäjät kokevat roolinsa. Tutkimuksen viitekehys muodostui käyttäjäkokemuksen teorioista ja aikaisemmista tutkimuksista, joiden pohjalta laadittiin kysely ja haastattelu sekä toteutettiin havainnointi. Kyselyyn vastasi 21 pääkäyttäjää, joista viisi osallistui haastatteluihin ja havainnointiin. Saatua aineistoa analysoitiin viitekehyksen pohjalta muodostetuilla teemoilla, joihin sisältyivät muun muassa tunteet, motivaatio, järjestelmä ja toimintaympäristö. Tutkimuksessa selvisi, että oppilaitoksissa laajalti käytössä olevan ohjelmistokokonaisuuden pääkäyttäjät muodostavat kirjavan käyttäjäryhmän. Tämä näkyy muun muassa siinä, että heidän koulutustaustansa ja työnimikkeensä vaihtelevat. Jotkut toimivat pääkäyttäjinä yhdessä oppilaitoksessa ja jotkut saattavat työskennellä kunnan kaikkien koulujen pääkäyttäjinä. Osa toimii pääkäyttäjinä päätoimisesti, mutta suurin osa muun työn ohella. Ohjelmistokokonaisuuden ominaisuuksissa ei koettu olevan suuria puutteita, vaan pääkäyttäjien työhön saattoivat negatiivisesti vaikuttaa käyttäjän itsensä ja järjestelmän ulkopuolelta tulevat tekijät, kuten rajallinen aika tai tuen puute. Tutkimukseen osallistuneiden pääkäyttäjien voidaan sanoa olleen kehitysmyönteisiä, koska he muutamaa lukuunottamatta kokivat työnsä vähintään kiinnostavaksi. Pääkäyttäjät ovat avainasemassa organisaatiossa, koska heidän tekemänsä työ helpottaa muiden työtä. Asiantuntijuutta vaativaa pääkäyttäjien työtä voitaisiin kehittää esimerkiksi muuttamalla työ kokoaikaiseksi ja järjestämällä pääkäyttäjien keskinäisiä tapaamisia.fi=Opinnäytetyö kokotekstinä PDF-muodossa.|en=Thesis fulltext in PDF format.|sv=Lärdomsprov tillgängligt som fulltext i PDF-format

Registered Nurses\u27 Intention To Use Electronic Documentation Systems: A Mixed Methods Study

BACKGROUND: Home care in Ontario has become the fastest growing sector and cornerstone of the healthcare system. As a result of the increased shift to the home care sector in Ontario, there have been several health information technology (HIT) initiatives to improve the quality and delivery of health care services to patients. This is exemplified with the province-wide development and implementation of electronic documentation systems (EDS). Electronic documentation systems have the potential to ensure timely, up-to-date and comprehensive patient health and care-related information is available and accessible to healthcare providers such as registered nurses regardless of their physical location. Access to patient health and care-related information supports high-quality nursing care, decision-making, and care delivery processes. Despite the benefits of EDS (i.e., improved workflow, reduced diagnostic and laboratory tests and adverse drug events), low intention by registered nurses to use these systems is well documented. Existing evidence suggests that an expressed intention to use HIT such as EDS is a direct predictor and antecedent of behavioural usage. Despite the growing efforts to understand registered nurses’ perceptions and overall intention to use EDS in practice, there is limited knowledge about registered nurses’ intention to use EDS in the context of home care practice. AIMS: The purpose of this study was to understand and examine factors that influence nurses’ intention and overall perception of using EDS in their home care practice. The conceptual model framing this study was adapted from the Unified Theory of Acceptance and Use of Technology (UTAUT) to delineate the relationships among factors that influence registered nurses’ intention to use EDS in home care practice. METHOD: A sequential, explanatory mixed methods design, using a sample of nurses from Ontario who are currently practicing within the home care sector were recruited to address the study’s objectives. Data were collected using both quantitative (online survey) and qualitative (semi-structured individual telephone interviews) methods. Quantitative data were analyzed with descriptive statistics and hierarchical multiple regression analysis and qualitative data were analyzed with content and inductive thematic analysis. RESULTS: Individual, technological and organizational / environmental characteristics were found to influence nurses’ intention, level of comfort and experience with EDS usage in home care practice. Additional factors found to influence home care nurses’ experience with EDS usage included: the development and employment of workarounds, the influence of nurse-patient interaction amidst system usage, and the ability to provide input towards the system design. CONCLUSION: Nurses play a significant role in the delivery of home health care services to Ontarians. The findings highlight the importance for: a) further exploration of the most appropriate model and / or adaptation of a model identifying a range of factors influencing nurses’ intention to use EDS in different healthcare contexts; b) continued integration of nursing informatics competencies within nursing curricula; c) an organizational culture that supports the use of EDS in nurses’ home practice (i.e., enlisting user champions and providing adequate training and IT support); and d) having representation of nurses in the EDS design and / or implementation processes through a user-centered design approach

Strategies for Applying Electronic Health Records to Achieve Cost Saving Benefits

The American Recovery and Reinvestment Act (ARRA) of 2009 authorized the distribution of about $30 billion incentive funds to accelerate electronic health record (EHR) applications to improve the quality of care, safety, privacy, care coordination, and patients\u27 involvement in healthcare. EHR use has the potential of saving$731 in costs for hospitals per patient admission; however, most hospitals are not applying EHR to reach the level at which cost savings are possible. The purpose of this single case study was to explore strategies that IT leaders in hospitals can use to apply EHR to achieve the cost saving benefits. The participants were IT leaders and EHR super users at a large hospital in Texas with successful experience in applying EHR. Information systems success model formed the conceptual framework for the study. I conducted face-to-face interviews and analyzed organizational documents. I used qualitative textual data analysis method to identify themes. Five themes emerged from this study, which are ensuring information quality, ensuring system quality, assuring service quality, promoting usability, and maximizing net benefits of the EHR system. The findings of this study included four strategies to apply EHR; these strategies include engaging training staff, documenting accurately and in a timely manner, protecting patient data, and enforcing organizational best practice policies to maximize reimbursement and cost savings. The findings of this study could contribute to positive social change for the communities because EHR successful application includes lower cost for hospitals that may lead to the provision of affordable care to more low-income patients

Guidelines for nurse managers to promote the competence levels of professional nurses in utilising the electronic system for staffing of agency nurses, in public hospitals in the Western Cape

Magister Curationis - MCurIn 2011, a structured electronic system for the staffing of agency nurses was implemented in the Western Cape as part of the Nursing Information Management System (NIMS). This electronic system was developed to ensure a fair tendering process for the procurement of agency staff, providing information on agency expenditure, maximum wage rates and adherence to principles and rules of supply chain management. Although technology is used more and more in healthcare services within the Western Cape, some professional nurses could lack the skills needed to implement the electronic system appropriately. A descriptive and quantitative design was followed to determine the competence levels of professional nurses in utilising the electronic staffing system for agency nurses in public hospitals in the Metropole, Western Cape. The aim of the study was to develop guidelines for nurse managers according to which they can train professional nurses in hospitals to utilise the electronic system for staffing of agency nurses. Assumptions were adapted from the theoretical framework of Benner (1984) on different levels of competencies and used as theoretical departure of the study. The accessible population for this study was all the professional nurses in hospitals within the Metropole of the Western Cape Government Health registered as users on the database, called the Nursing Information Management System (NIMS) (N=278). This population served as the total inclusive sample for the study. The method of data collection was a self-administered structured questionnaire. The data was analysed by using the SPSS Version 24 software program and descriptive and inferential statistics were conducted

Adoption of Electronic Health Record Systems Within Primary Care Practices

Primary care physicians (PCPPs) have been slow to implement electronic health records (EHRs), even though there is a U.S. federal requirement to implement EHRs. The purpose of this phenomenological study was to determine why PCPPs have been slow to adopt electronic health record (EHR) systems despite the potential to increase efficiency and quality of health care. The complex adaptive systems theory (CAS) served as the conceptual framework for this study. Twenty-six PCPPs were interviewed from primary care practices (PCPs) based in southwestern Ohio. The data were collected through a semistructured interview format and analyzed using a modified van Kaam method. Several themes emerged as barriers to EHR implementation, including staff training on the new EHR system, the decrease in productivity experienced by primary care practice (PCP) staff adapting to the new EHR system, and system usability and technical support after adoption. The findings may contribute to the body of knowledge regarding EHR system implementation and assist healthcare providers who are slow to adopt EHRs. Additionally, findings could contribute to social change by reducing healthcare costs, increasing patient access to care, and improving the efficacy of patient diagnosis and treatment

An investigation of healthcare professionals’ experiences of training and using electronic prescribing systems: four literature reviews and two qualitative studies undertaken in the UK hospital context

Electronic prescribing (ePrescribing) is the process of ordering medicines electronically for a patient and has been associated with reduced medication errors and improved patient safety. However, these systems have also been associated with unintended adverse consequences. There is a lack of published research about users’ experiences of these systems in UK hospitals. The aim of this research was therefore to firstly describe the literature pertaining to the recent developments and persisting issues with ePrescribing and clinical decision support systems (CDS) (chapter 2). Two further systematic literature reviews (chapters 3 and 4) were then conducted to understand the unintended consequences of ePrescribing and clinical decision support (CDS) systems across both adult and paediatric patients. These revealed a taxonomy of factors, which have contributed to errors during use of these systems e.g., the screen layout, default settings and inappropriate drug-dosage support. The researcher then conducted a qualitative study (chapters 7-10) to explore users’ experiences of using and being trained to use ePrescribing systems. This study involved conducting semi-structured interviews and observations, which revealed key challenges facing users, including issues with using the ‘Medication List’ and how information was presented. Users experienced benefits and challenges when customising the system, including the screen display; however, the process was sometimes overly complex. Users also described the benefits and challenges associated with different forms of interruptive and passive CDS. Order sets, for instance, encouraged more efficient prescribing, yet users often found them difficult to find within the system. A lack of training resulted in users failing to use all features of the ePrescribing system and left some healthcare staff feeling underprepared for using the system in their role. A further literature review (chapter 5) was then performed to complement emerging themes relating to how users were trained to use ePrescribing systems, which were generated as part of a qualitative study. This review revealed the range of approaches used to train users and the need for further research in this area. The literature review and qualitative study-based findings led to a follow-on study (chapter 10), whereby the researcher conducted semi-structured interviews to examine how users were trained to use ePrescribing systems across four NHS Hospital Trusts. A range of approaches were used to train users; tailored training, using clinically specific scenarios or matching the user’s profession to that of the trainer were preferred over lectures and e-learning may offer an efficient way of training large numbers of staff. However, further research is needed to investigate this and whether alternative approaches such as the use of students as trainers could be useful. This programme of work revealed the importance of human factors and user involvement in the design and ongoing development of ePrescribing systems. Training also played a role in users’ experiences of using the system and hospitals should carefully consider the training approaches used. This thesis provides recommendations gathered from the literature and primary data collection that can help inform organisations, system developers and further research in this area