New BSN Nurse Informatics Competencies: Perceptions of Academic Preparedness for Practice

One rapidly expanding nursing program at a public research university in the mid-south region of the United States served as the site for this study. Recent nurse graduates were selected in a purposeful sampling from alumni who had conferred degrees from May 2007 through May 2013. Sixty-three graduates completed the online survey in Phase I and five recent graduates participated in semi-structured interviews during Phase II of the study. Data were collected utilizing a mixed methods design. Descriptive statistics explained survey and interview results. Of the knowledge, skills, and attitudes (KSAs), attitude competencies reported the highest means and were very effective at providing informatics attitude competencies to graduates. The program was also reported being somewhat effective at providing skills competencies and included navigating and documenting in the electronic medical record. The most desired skills reported by participants to include as more curriculum focus were electronic medical record (EMR) navigation, hands-on experience with different technology systems, and documentation, charting, and nurses\u27 notes with legal implications. The top comparable competencies introduced at the new nurse orientation were facility specific navigation of the EMR and computer documentation. Findings in this study served to provide additional knowledge to existing literature about competency preparedness and transition into practice. Results of this inquiry also served to provide direction for future curriculum planning involving QSEN informatics competencies at the nursing program

Understanding the knowledge gaps in whistleblowing and speaking up in health care: narrative reviews of the research literature and formal inquiries, a legal analysis and stakeholder interviews

BackgroundThere is compelling evidence to suggest that some (or even many) NHS staff feel unable to speak up, and that even when they do, their organisation may respond inappropriately.MethodsThe study comprised four distinct but interlocking strands: (1) a series of narrative literature reviews, (2) an analysis of the legal issues related to whistleblowing, (3) a review of formal Inquiries related to previous failings of NHS care and (4) interviews with key informants.ResultsPolicy prescriptions often conceive the issue of raising concerns as a simple choice between deciding to ‘blow the whistle’ and remaining silent. Yet research suggests that health-care professionals may raise concerns internally within the organisation in more informal ways before utilising whistleblowing processes. Potential areas for development here include the oversight of whistleblowing from an independent agency; early-stage protection for whistleblowers; an examination of the role of incentives in encouraging whistleblowing; and improvements to criminal law to protect whistleblowers. Perhaps surprisingly, there is little discussion of, or recommendations concerning, whistleblowing across the previous NHS Inquiry reports.LimitationsAlthough every effort was made to capture all relevant papers and documents in the various reviews using comprehensive search strategies, some may have been missed as indexing in this area is challenging. We interviewed only a small number of people in the key informant interviews, and our findings may have been different if we had included a larger sample or informants with different roles and responsibilities.ConclusionsCurrent policy prescriptions that seek to develop better whistleblowing policies and nurture open reporting cultures are in need of more evidence. Although we set out a wide range of issues, it is beyond our remit to convert these concerns into specific recommendations: that is a process that needs to be led from elsewhere, and in partnership with the service. There is also still much to learn regarding this important area of health policy, and we have highlighted a number of important gaps in knowledge that are in need of more sustained research.Future workA key area for future research is to explore whistleblowing as an unfolding, situated and interactional process and not just a one-off act by an identifiable whistleblower. In particular, we need more evidence and insights into the tendency for senior managers not to hear, accept or act on concerns about care raised by employe

From Faculty Development to the Classroom: A Qualitative Study of How Nurse Educators Turn Faculty Development into Action

The purpose of this qualitative study was to better understand the transfer of learning by uncovering how various factors supported the integration of knowledge and skills gleaned from the Faculty Development: Integrated Technology into Nursing Education and Practice Initiative (ITNEP) programs into nursing education curricula. Through interviews with 20 participants from four ITNEP programs, this study confirmed the importance of learner characteristics, program design elements, and factors in the work environment for supporting successful transfer of learning and supports a variety of other transfer of learning research findings. New or seldom discussed supportive individual characteristics were found, including: leadership abilities, lifelong learning, ability to recognize limitations, persistence, creativity, and risk-taking. Study findings suggest that proactive personality may support transfer of learning. Participants maintained motivation from pre-training through post-training at a high enough level to successfully transfer learning. The importance of networking opportunities, a diversity of perspectives, post conference support, and teams in programs designs were found to positively influence transfer and were discussed in relation to social influence. The variety of supportive factors in the participants' work environments, including strategic alignment, strengthens the assertions that transfer may be individually context dependent. Barriers to transfer efforts in the work environment were also addressed. Additionally, while patterns of specific characteristics emerged, interacting findings were found threaded throughout

Understanding User Resistance to Information Technology: Toward A Comprehensive Model in Health Information Technology

The successful implementation of health information systems is expected to increase legibility, reduce medical errors, boost the quality of healthcare and shrink costs. Yet, evidence points to the fact that healthcare professionals resist the full use of these systems. Physicians and nurses have been reported to resist the system. Even though resistance to technology has always been identified as key issue in the successful implementation of information technology, the subject remains largely under-theorized and deficient of empirical testing. Only two proposed model have been tested so far. Hence, though user resistance is clearly identified and defined in literature, not very much is known about its antecedents; and about how and why it comes about. This study seeks therefore, to fill this gap. If organizational change managers must go past the hurdle of under-utilized systems, low productivity and the high implementation costs associated with them, a clear understanding of the very nature of resistance is important. The following questions are investigated: (1) why do healthcare personnel resist health information technology? (2) What are the antecedents of perceived threats to health information technology? And, (3) does user resistance vary across healthcare professions? The study utilizes the theory of psychological reactance, the cognitive dissonance theory, the extended technology acceptance model and other relevant theories to build on the Lapointe and Rivard (2005) resistance framework. The resulting theoretical model is further tested empirically using primary data. Partial Least Squares technique will be used to analyze data and findings would be discussed. This work is expected to contribute to both our understanding of the resistance theory—through the extension of current theory—as well as provide useful tools for change practitioners to mitigate the phenomenon and improve electronic health records implementation outcomes

How do medical doctors with specific learning difficulties (SpLD) cope in a clinical setting?

There have been a small number of studies conducted with qualified nurses and nursing/medical students with Specific Learning Difficulties (SpLD), showing that SpLD may affect those in the medical profession in relation to clinical tasks, career choices and success. There has been an increase in the number of medical students with SpLD (Gibson and Leinster, 2011) entering the medical profession, yet there is very limited research available regarding doctors who have SpLD. This research aimed to explore how doctors with SpLD are coping in the workplace, the coping strategies used, any perceived possible areas of strength or weakness, and any practices for ensuring patient safety. It also explored the perceptions held by doctors with SpLD about the impact this has on their working life, and factors that could influence their career choice and success. These areas were also explored in relation to medical students. A mixed methods approach was used for this project, consisting of 3 studies incorporating quantitative questionnaires with 129 doctors (Study 1) and 74 medical students (Study 3) with and without SpLD and qualitative telephone interviews with 11 doctors with SpLD (Study 2). The results showed that the main difficulties participants with SpLD experienced were in relation to written work and associated tasks, such as spelling. These were often overcome through the use of coping strategies. The doctors rated their clinical skills highly and described strengths such as communication skills and empathy. The doctors were selective when deciding who to disclose their SpLD to. In conclusion this project showed that SpLD do have a number of effects on doctors in the workplace. Through the implementation of coping strategies and support doctors were able to successfully overcome any difficulties experienced, indicating that having SpLD did not prevent individuals from becoming successful doctors

Growing an information infrastructure for healthcare based on the development of large-scale Electronic Patient Records

The papers of this thesis are not available in Munin. Paper 1. Silsand, L., Ellingsen, G. (2014). Generification by Translation: Designing Generic Systems in Context of the Local. Available in: Journal of Association for Information Systems, vol. 15(4): 3. Paper 2. Christensen, B., Silsand, L., Wynn, R. and Ellingsen, G. (2014). The biography of participation. In Proceedings of the 13th Participatory Design Conference, 6-10 Oct. Windhoek, Namibia. ACM Digital Library. Paper 3. Silsand, L. and Ellingsen, G. (2016). Complex Decision-Making in Clinical Practice. In: Proceedings of the 19th ACM Conference on Computer-Supported Cooperative Work & Social Computing (CSCW '16). ACM Digital Library. ISBN: 978-1-4503-3592-8. Paper 4: Silsand, L., Ellingsen, G. (2017). Governance of openEHR-based information Infrastructures. (Manuscript). Paper 5. Silsand, L. (2017). The ‘Holy Grail’ of Interoperability of Health Information Systems: Challenges and Implications. Available in: Stigberg S., Karlsen J., Holone H., Linnes C. (eds) Nordic Contributions in IS Research. SCIS 2017. Lecture Notes in Business Information Processing, vol 294. Springer, Cham. This thesis provides empirical insights about socio-technical interdependencies affecting the making and scaling of an Information Infrastructure (II) for healthcare based on the development of large-scale Electronic Patient Records. The Ph.D. study is an interpretive case study, where the empirical data has been collected from 2012 to 2017. In most developed countries, the pressures from politicians and public in general for better IT solutions have grown enormously, not least within Electronic Patient Record (EPR) systems. Considerable attention has been given to the proposition that the exchange of health information is a critical component to reach the triple aim of (1) better patient experiences through quality and satisfaction; (2) better health outcomes of populations; and (3) reduction of per capita cost of health care. A promising strategy for dealing with the challenges of accessibility, efficiency, and effective sharing of clinical information to support the triple aim is an open health-computing platform approach, exemplified by the openEHR approach in the empirical case. An open platform approach for computing EPR systems addresses some vital differences from the traditional proprietary systems. Accordingly, the study has payed attention to the vital difference, and analyze the technology and open platform approach to understand the challenges and implications faced by the empirical process. There are two main messages coming out of this Ph.D. study. First, when choosing an open platform approach to establish a regional or national information infrastructure for healthcare, it is important to define it as a process, not a project. Because limiting the realization of a large-scale open platform based infrastructure to the strict timeline of a project may hamper infrastructure growth. Second, realizing an open platform based information infrastructure requires large structural and organizational changes, addressing the need for integrating policy design with infrastructure design