54 research outputs found

    Aspectos éticos da informática médica: princípios de uso e usuário apropriado de sistemas computacionais na atenção clínica

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    Medical Informatics (MI) studies the intersection among computer technology, medicine and the influence of electronic clinical history and the intelligent systems for diagnosis support in clinical decision making. The inadequate use of technology may divert the purposes of MI towards an inadequate use by third parties involved in clinical health care, such as health care managers or insurance agents. The principles for “use and appropriate user for MI applications” as base are proposed to manage suitably computational technology in health care. The development of these principles must be based in the evaluation of their applications, emphasizing that the evaluation must be carried out with the same considerations as other types of medical or surgical interventions.La Informática Médica (IM) estudia la intersección entre la tecnología computacional, la medicina y la influencia del uso de la historia clínica electrónica y los sistemas inteligentes de apoyo diagnóstico en la toma de decisiones clínicas. El uso inadecuado de la tecnología puede desviar los propósitos de la IM hacia su aprovechamiento impropio por terceros involucrados en la atención clínica, tales como administradores de salud o agentes aseguradores. Se plantea que los principios de “uso y usuario apropiado de la aplicaciones en IM” sean los fundamentos con los cuales se maneje adecuadamente la tecnología computacional en salud. El desarrollo de estos principios debe basarse en la evaluación de las propias aplicaciones, recalcando que ésta debe realizarse con las mismas consideraciones de otros tipos de intervenciones médicas o quirúrgicas.A Informática Médica (IM) estuda a interseção entre a tecnologia computacional, a medicina e a influência do uso da história clínica eletrônica e os sistemas inteligentes de apoio diagnóstico na tomada de decisões clínicas. O uso inadequado da tecnologia pode desviar os propósitos da IM para seu aproveitamento inadequado por terceiros envolvidos na atenção clínica, tais como administradores de saúde ou agentes de seguros. Propõe-se que os princípios de “uso e usuário apropriado das aplicações em IM” sejam os fundamentos com os quais se manipule adequadamente a tecnologia computacional em saúde. O desenvolvimento destes princípios deve se basear na avaliação das próprias aplicações, recalcando que esta se deve realizar com as mesmas considerações de outros tipos de intervenções médicas ou cirúrgicas

    MMC WELLBEING & PEER SUPPORT PROGRAM

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    An Evidence-Based Evaluation of Medication Barcode Scanning Acceptance in a Community Hospital

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    Barcode scanning during medication administration is a powerful tool to prevent errors and support patient safety. In spite of the significant patient safety benefits, there is a lack of adoption and acceptance of barcode scanning. The purpose of this project was to implement an evidence-based assessment, utilizing a survey instrument based on the technology acceptance model, to understand adoption and acceptance of barcode scanning at a community hospital. Forty-four people, 38 nurses and 8 respiratory therapists, participated in the survey. Data analyses were performed using descriptive statistics, Kruskal-Wallis, Mann-Whitney U, and Spearman\u27s rho tests. The subscales for the intention to use barcode scanning and the influence of others were rated highest by the survey participants. The subscales for the training and technical support received the lowest ratings. There were significant differences among the departments on the subscale scores, with the acute inpatient area reporting the highest subscale ratings and the surgical services/procedural area reporting the lowest subscale ratings. There were no differences in the scores for the survey subscales in regards to participants\u27 age and years of computer use at work and at home. There were several themes identified related to barcode scanning issues and concerns. Recommendations to address the survey results and the barcode scanning issues were developed

    Patient Safety and Quality: An Evidence-Based Handbook for Nurses

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    Compiles peer-reviewed research and literature reviews on issues regarding patient safety and quality of care, ranging from evidence-based practice, patient-centered care, and nurses' working conditions to critical opportunities and tools for improvement

    Understanding organizational stakeholder commitment to ensure information systems/information technology benefits in portuguese hospitals: an analysis based on the theory of technological frames.

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    Doutoramento em GestãoThe unique context of healthcare organizations provides opportunities to develop or refine theory relating to organizational change and information systems. This research looks at the role stakeholder commitment plays in the realisation of expected benefits for an information system project in a healthcare setting. Case studies, relating to an organization-wide information systems (IS) project, were conducted in two Portuguese hospitals, allowing a study of the perceptions and behaviours of stakeholders, their commitment to the Information System and Information Technology (IS/IT), organizational change and the achievement of business benefits. A qualitative, interpretative, case-based research strategy was implemented based on semi-structured interviews and document analysis. The Three Component Model of Organizational Commitment and Technological Frames of Reference (TFR) provided the theoretical grounding for analysing the collected data. A resulting theoretical framework is proposed to reduce the many issues associated with the implementation of Healthcare Information Systems (HIS) in healthcare organizations, enabling them to quickly achieve the expected benefits. A contribution to TFR theory is made by extending the development of frame structure to include the shaping of perceptions by stakeholders. As part of the conceptual model, a set of frames is identified that healthcare professionals hold regarding Information Technology.O contexto único das organizações de saúde oferece oportunidades para desenvolver ou aperfeiçoar teoria relacionada com a mudança organizacional e sistemas de informação. Esta pesquisa, propõe uma análise do papel que o compromisso dos stakeholders desempenha na realização dos benefícios esperados com a implementação de um Sistema de Informação no sector da saúde. Nesta pesquisa, foram estudadas as percepções e os comportamentos dos profissionais de saúde, a fim de compreender o seu compromisso com os Sistemas e Tecnologias de Informação (SI/TI), a mudança organizacional e a obtenção de benefícios com os investimentos em SI/TI. Foi adoptada uma estratégia de investigação qualitativa e interpretativa, baseada em estudos de caso. A recolha de dados baseou-se em entrevistas semiestruturadas e análise documental. The Three-Component Model of Organizational Commitment e Technological Frames of Reference (TFR) fornecem a base teórica para analisar os dados recolhidos. É proposto um quadro teórico para reduzir as muitas questões associadas à implementação de Sistemas de Informação na Saúde (SIS) nas organizações de saúde, permitindo-lhes uma obtenção mais rápida dos benefícios esperados. Uma contribuição para a teoria dos TFR resulta da extensão da estrutura de frames tecnológicos dos stakeholders. Como parte do modelo conceptual, é identificado um conjunto de percepções que os profissionais de saúde detêm sobre as TI.N/

    Doctor of Philosophy

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    dissertationThe cost of medication errors is burdensome to patients, institutions, and frontline providers. Nurses are accountable for and vulnerable to institutional safe medication practices and make this responsibility their highest priority; yet, contextual factors relevant to nurses' work encompassing medication administration are not well understood. The aim of this ethnographic study was to identify and describe nurses' work in the context of medication administration, errors, and organizational safety. Using nonparticipant observation (92 hours) and 37 unstructured interviews with nurses, administrators, and pharmacist in a mid-sized hospital in the United States, I found the nature of nurses' work characterized by: 1) chasing a standard of care, 2) prioritizing practice , and 3) renegotiating routines. These characteristics were inextricably linked to organizational structures, the medication management system, competing obligations, and shifting of priorities. Data were divided into two articles: 1) Nurses' Work in the Context of Medication Administration: Untenable Expectations provides a thick description of everyday experiences on the unit, medication administration, and the potential for errors. From these data, I present an emerging theoretical model. 2) The Paradox of Safety in Medication Management is a microanalysis of the medication use process with a specific focus on patterns of medication errors in the hospital, and the role of the pharmacists as a "stop-gap" between the physicians and patients in the recognition and interception of medication errors. These results enhance our understanding of why present efforts targeting the reduction of medication errors may be ineffective

    Ethical aspects of medical informatics : principles for use and appropriate user of computational systems in clinical health care

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    Resumen: 1.a Informática Medica (IM) estudia la intersección entre la tecnología computacional, la medicina y la influencia del uso de la historia clínica electrónica y los sistemas inteligentes de apoyo diagnóstico en la toma de decisiones clínicas. F.I uso inadecuado de la tecnología puede desviar los propósitos de la IM hacia su aprovechamiento impropio por terceros involucrados en la atención clínica, tales como administradores de salud o agentes aseguradores. Se plantea que los principios de ' “uso y usuario apropiado de la aplicaciones en IM” sean los fundamentos con los cuales se maneje adecuadamente la tecnología computacional en salud. El desarrollo de estos principios debe basarse en la evaluación de las propias aplicaciones, recalcando que esta debe realizarse con las mismas consideraciones de otros tipos de intervenciones medicas o quirúrgicas.Q4Q4Artículo original199-208Medical Informatics (MI) studies the intersection among computer technology, medicine and the influence of electronic clinical history and the intelligent systems for diagnosis support in clinical decision making. The inadequate use of technology may divert the purposes of MI towards an inadequate use by third parties involved in clinical health care, such as health care managers or insurance agents. The principles for “use and appropriate user for MI applications” as base are proposed to manage suitably computational technology in health care. The development of these principles must be based in the evaluation of their applications, emphasizing that the evaluation must be carried out with the same considerations as other types of medical or surgical interventions

    The impact of electronic health records on nursing burnout in a hospital setting in Saudi Arabia: mixed-methods study

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    BACKGROUND: There is growing evidence suggesting that electronic health records (EHRs) can be associated with clinicians’ burnout, which may hamper the effective use of EHRs and introduce risks to patient safety and quality of care. Nursing research in this area is minimal in comparison with studies conducted on burnout among physicians. In addition, although the majority of research on the impact of EHR use on nursing burnout was conducted in Western contexts, this study fills the gap by exploring this prevalent issue within the context of Saudi Arabia. AIM: The research aim was to examine the association between nursing burnout and EHR use and to explore the contributing factors to nursing burnout related to EHR use in a hospital setting in Saudi Arabia. METHODS: The study used a mixed-methods approach with an explanatory sequential design: a quantitative study followed by a qualitative study. The study was conducted in a hospital that was adopting an advanced EHR system, in Riyadh, Saudi Arabia. Using a purposive sampling method, registered nurses working in inpatient units using an EHR system on a daily basis were included in the study. Two validated instruments were used in the online survey, the Mini-Z and EHR perceptions, to examine the association between nursing burnout and EHR-related factors. Qualitative interviews, undertaken both online and in-person, were used to gain an in-depth understanding of factors associated with nursing burnout and hospital EHR use. Survey data were analysed using regression analysis. Thematic analysis was utilised for the interview data. The study was informed by a sociotechnical approach to understanding the relationship between the social system (nurses) and the technical system (EHR use) in a given context (a hospital in Saudi Arabia). RESULTS: A total of 282 completed survey responses were included in the study, and a total of 21 nurses participated in the interviews. Participants were predominantly female and worked in acute and critical care units. Most survey respondents were from the Philippines (53%), Malaysia (21%), and Saudi Arabia (11.7%), with South African and European nurses accounting for about 5% each. Interviewees were primarily from the Philippines and Saudi Arabia (33% each), and 24% from Malaysia. The findings indicated that despite the overall acceptance of the EHR among the nurse participants being relatively high, negative perceptions of the EHR and stress related to EHR use were found. There was a slight inconsistency between the quantitative and qualitative results regarding the perceived burnout outcome. The survey statistics showed that the minority of nurses who reported negative perceptions about the EHR were likely to be burnt out while the interviews showed that all participants who reported stress related to the EHR did not think that EHR-related stress would lead to burnout. This inconsistency suggests there is a weak link between EHR use and burnout may exist, possibly indicating the mitigating role of resilience identified in the qualitative study. In this qualitative study, I identified specific perceived organisational stressors associated with EHR use, such as high EHR documentation workload creating a conflict between organisational requirements and direct patient care. Technological stressors were also identified, including usability issues causing disruption to nurses’ workflow, and concerns about data privacy through unauthorised access by healthcare workers at the hospital. Despite these stressors, resilience was demonstrated at both individual and organisational levels, which emerged as a protective factor from EHR-related burnout. Factors like computer literacy, perceived usefulness of the EHR, and nurses’ adaptability to change were key contributors to individual resilience that aided nurses in navigating EHR stressors and adjusting to the EHR system. At the organisational level, health information infrastructure facilitated smoother interaction with the EHR system, reducing potential stressors while supportive organisational culture fostered teamwork, work–life balance, continuous learning, and iterative improvement, thereby bolstering resilience among nurses. CONCLUSION: EHR did not significantly contribute to nursing burnout in a specific Saudi Arabian hospital context. The resilience mechanisms in place at both individual and organisational levels mitigated the potential impact of EHR-related stress on nurses’ burnout. The unique contribution of this research is the introduction of a novel conceptual model elucidating the impact of EHR on nursing burnout. This renewed perspective emphasises the role of resilience at both individual and organisational levels and their collective influence on mitigating EHR-related burnout among nurses. This model has the potential for further development and application both locally and globally. This study signals a need for healthcare organisations to foster resilience-building strategies in their EHR implementation processes and usability that should be tailored to the specific needs and circumstances of each organisation, to effectively manage EHR-related stress and prevent potential burnout. These include encouraging self-care practices among nurses, promoting work–life balance, fostering supportive workplace culture, improving health information infrastructure, providing training and continuous learning, and improving EHR usability through regular feedback sessions from EHR users. Additional research is needed to corroborate this finding with different types of clinicians in the same hospital, and in other hospital settings within Saudi Arabia
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