Shared responsibility for electronic records: governance in perinatal data entry

This paper presents research undertaken as part of a larger research project to examine the factors that influence midwives when entering perinatal data. A grounded theory methodology was used to undertake qualitative interviews with 15 participants from 12 different hospitals across Queensland, Australia using three different systems for perinatal data collection. The findings surrounding accountability are presented revealing that a shift in governance relating to responsibility and accountability is not occurring in midwifery units across Queensland. Without assignation of responsibility for entries and accountability for mistakes or omissions, perinatal data records can be left incomplete or inaccurate. Increasing use of electronic health records and creation of digital hospitals indicates these issues are highly relevant in planning for these services

Evidence-based guidelines for intrapartum maternal hydration assessment and management: A scoping review

Problem: Inconsistent practice relating to intrapartum hydration assessment and management is reported, and potential harm exists for laboring women and birthing persons. Background: Labor and birth are physically demanding, and adequate nutrition and hydration are essential for labor progress. A lack of clear consensus on intrapartum hydration assessment and management during labor and birth currently exists. In addition, there is an inconsistent approach to managing hydration, often including a mixture of intravenous and oral fluids that are poorly monitored. Aim: The aim of this scoping review was to identify and collate evidence-based guidelines for intrapartum hydration assessment and management of maternal hydration during labor and birth. Methods: PubMed, Embase, and CINAHL databases were searched, in addition to professional college association websites. Inclusion criteria were intrapartum clinical guidelines in English, published in the last 10 years. Findings: Despite searching all appropriate databases in maternity care, we were unable to identify evidence-based guidelines specific to hydration assessment and management, therefore resulting in an “empty review.” A subsequent review of general intrapartum care guidelines was undertaken. Our adapted review identified 12 guidelines, seven of which referenced the assessment and management of maternal hydration during labor and birth. Three guidelines recommend that “low-risk” women in spontaneous labor at term should hold determination over what they ingest in labor. No recommendations with respect to assessment and management of hydration for women undergoing induction of labor were found. Discussion: Despite the increasing use of intravenous fluid as an adjunct to oral intake to maintain maternal intrapartum hydration, there is limited evidence and, subsequently, guidelines to determine best practice in this area. How hydration is assessed was also largely absent from general intrapartum care guidelines, further perpetuating potential clinical variation in this area. Conclusion: There is an absence of guidelines specific to the assessment and management of maternal hydration during labor and birth, despite its importance in ensuring labor progress and safe care

International nurse education leaders' experiences of responding to the COVID-19 pandemic:A qualitative study

AIMS: To explore the experiences of strategic leads for nurse education as they sought to respond to the COVID‐19 pandemic. DESIGN: We utilised a qualitative interpretative approach to explore education leaders’ experiences of leading during the early months of the pandemic. METHODS: Nineteen leaders with significant strategic responsibility for nurse education in Australia, Canada, New Zealand, Singapore and the United Kingdom were identified via purposive sampling and agreed to participate. Interviews were held between May and July 2020. RESULTS: Four overarching themes arose from the analysis: (1) Crisis driven adaptability & flexibility; (2) Responsive, complex and changing communication; (3) Making decisions for student and staff safety; (4) Looking to the future; stronger partnerships. CONCLUSION: Internationally, while nursing education leaders faced different problems, they shared a common goal amidst the crisis to remain student‐centred. They demonstrated they were able to face major challenges, respond to large scale logistical problems and make decisions under significant and ongoing pressure. IMPACT: In responding to the pandemic, nurse leaders shared knowledge and offered mutual support. This bodes well for future collaboration. The move to online learning accelerated an existing trend and it seems likely that this will continue. Given the pressures they experienced over an extended period, the sector may wish to consider how it prepares and supports existing and future leaders

Nurses’ education, knowledge and perceptions of peripheral intravenous catheter management: A web-based, cross-sectional survey

Background: Peripheral intravenous catheters (PIVCs) are the most used invasive medical device. Unfortunately, PIVCs fail for a variety of reasons and failure often results in serious adverse events leading to patient discomfort, infection, delays in treatment, increased healthcare costs, and even death. In Australia, qualified nurses assess, manage, and remove a PIVC as part of their clinical role. To date, no study has described the current state of knowledge and confidence (self-efficacy) about PIVCs from the perspectives of qualified nurses working in Australian hospital settings. Aims: To describe the current state of knowledge and confidence (self-efficacy) about PIVC management from the perspectives of qualified nurses working in Australian hospital settings. To explore how these related to the education received by these nurses. Methods: An online cross-sectional survey. Findings: Qualified nurses in Australia thought that education about PIVCs was important and that it should be underpinned by evidence-based guidelines. Knowledge Test score for the sample was 12.4/17 (SD 2.1), this equates to a mean grade of 73.0%. Respondents reported very high levels of confidence about caring for a patient with a PIVC in situ. Conclusion: Despite the frequent and increasing use of PIVCs and importantly the documented adverse events associated with poor assessment, management and inappropriate removal, qualified nurses’ knowledge and confidence remain poorly reported. We demonstrated fundamental gaps in qualified nurses’ knowledge in relation to assessment, management, and removal of PIVCs

Partnering with carers in the management of delirium in general acute care settings:An integrative review

Objectives: Delirium is a common, preventable condition. However, delirium is poorly recognised and often missed because symptoms are misinterpreted, and risk factors overlooked by health-care professionals. Carers usually have intimate knowledge about the person they care for. Therefore, they are well placed within care teams to implement delirium prevention strategies, identify symptoms and support the early diagnosis of delirium. The aim of this integrative review was to synthesise findings from the published research reporting on partnering with carers in the management of delirium in general acute care settings. Methods: Five databases (Medline-EBSCO, PubMed, PsycINFO, ProQuest, CINAHL and SCOPUS) were searched to identify primary research regarding partnering with carers in the management of delirium in acute care settings, and results were synthesised. PRISMA guidelines were adhered to, and quality appraisal was conducted using the Mixed Methods Appraisal Tool. Results: All seven studies reported that partnering with carers was a viable strategy in the management of delirium to maximise outcomes for people at risk of or experiencing delirium and that increasing carers' knowledge of delirium was key. The synthesis of findings also identified two themes: Increasing knowledge and Effective partnerships. Conclusions: A collaborative approach to increasing carers' and nurses' knowledge about the management of delirium, coupled with education on how to develop therapeutic nurse–carer relationships, is important for ongoing effective partnerships in the management of delirium. Good communication supported effective partnerships, which enabled both nurses and carers the opportunity to express their needs and concerns and negotiate collaborative involvement in the management of delirium.</p

A Grounded Theory examination of the factors that influence midwives when entering perinatal data: the theory of beneficial engagement

Healthcare documentation, traditionally consisting of paper medical records, is being migrated to electronic records at increasing speed worldwide. The movement to paperless environments is believed to increase data accessibility and create savings in the tighter fiscal environments of modern healthcare. Population health data sets are collected to monitor mortality and morbidity, leading to identification of areas of most significant need and professional practice deficiency. Perinatal data collection is one such data set and is mandated for collection on all mothers and their babies born Australia-wide. Movement to computerised collection of perinatal data in Queensland, Australia, is proposed to have improved accuracy and decreased the turnaround time of the availability of this dataset. Midwives collect and enter perinatal data across Queensland, utilising eHealth technology. This research aimed to understand the factors that influence midwives interaction with the computer when collecting and entering perinatal data. A Grounded Theory methodology was utilised and in-depth interviews were conducted with fifteen participants resulting in the development of a substantive theory, The Theory of Beneficial Engagement. This theory is grounded in the data, with a core category of engagement informed by nine elements: accountability, valuing, adapting, perceived benefits, workload, software, shifting focus, knowledge and data entry along with their subsequent themes. The Theory of Beneficial Engagement proposes that midwives who enter perinatal data into a computer do so in the face of elements which act as barriers to successful use. However, data analysis identified elements particular to some participants that were not seemingly present in others. Some of these midwives appeared to effectively overcome barriers to entering perinatal data, hence forming a beneficial engagement with perinatal data. Such beneficial engagement emerged via participants personally identifying a reward for the effort of entering perinatal data into the computer. The Theory of Beneficial Engagement purports that the optimisation of any, some, or all of the elements of engagement in order to overcome barriers to perinatal data entry, may lead to achieving more timely, complete and accurate perinatal data entry. Translation of this theory proposes that any computer system can have an identified, individual set of elements that work to either enhance or act as barriers to engagement with particular software. Identification of these elements for any system and its group of users as well as their resulting modification to an optimal state, may lead to users becoming beneficially engaged with the software system. In this way, The Theory of Beneficial Engagement is translatable to any mandatory use software operated by users to achieve workplace goals. This theory adds to the body of knowledge by being the first study to explain midwives use of computerised perinatal data collection in Queensland. Recommendations are suggested for improvement to the design and functionality of software, as well as professional development for users on the value and benefit of perinatal data collection to the care of mothers and their babies. Complete and accurate perinatal data entry into the computer contributes to care assisting in it being of the highest standard

Midwives\u27 concerns about a shift of focus to computers in maternity settings: technology invading birth

Information and communication technology (ICT) is moving rapidly into all areas of health care in what is claimed to be an effort to combat tightening fiscal budgets, rising costs, the ageing population and a diminishing workforce (Yu & Comensoli 2004, Smedley 2005, Healy et al 2006, Deloitte 2008, Eley et al 2008, Vimarlund & Koch 2012, National eHealth Transition Authority (NEHTA) 2013). Maternity practice and care delivery are no exception, and increasingly electronic health records (EHR) and the computerisation of documentation traditionally carried out on paper, are being introduced. One such newly computerised practice in Queensland, Australia is the entry of data in to the population data set: the perinatal data collection. Perinatal data are collected across Australia by maternity unit clinical staff to fulfil related mandatory data requirements (National Perinatal Epidemiology and Statistics Unit 2013). Data collected via the perinatal data ‘form’ serves to monitor patterns of obstetric and neonatal practice and provide information on obstetric and perinatal outcomes such as mortality rates and congenital abnormalities (Data Collections Unit, Queensland Health 2012). Since 2009, collection of perinatal data has been transitioning from paper to an electronic format. Over 80% of perinatal data in Queensland are now collected this way (Craswell et al 2013)

Midwives and the Computerization of Perinatal Data Entry: The Theory of Beneficial Engagement

Theory building in nursing and midwifery both to explain and inform practice is important to advance these professions via provision of a theoretical foundation. This research explored the process of perinatal data entry undertaken by midwives to explore the impact of the movement from paper to computer collection of data. Use of grounded theory methodology enabled theory building, leading to a theoretical understanding of the phenomenon and development of the Theory of Beneficial Engagement grounded in the data. Methods involved in-depth semistructured interviews with 15 users of perinatal data systems. Participants were recruited from 12 different healthcare locations and were utilizing three different electronic systems for data entry. The research question that guided the study focused on examining the influences of using the computer for perinatal data entry. Findings indicated that qualities particular to some midwives denoted engagement with perinatal data entry, suggesting a strong desire to enter complete, timely, and accurate data. The Theory of Beneficial Engagement provides a model of user engagement with systems for perinatal data entry consistent with other theories of engagement. The theory developed describes this phenomenon in a simple, elegant manner that can be applied to other areas where mandatory data entry is undertaken

Does use of computer technology for perinatal data collection influence data quality?

Population health data, collected worldwide in an effort to monitor mortality and morbidity of mothers and babies, namely, perinatal data, are mandated at a federal level within Australia. The data are used to monitor patterns in midwifery, obstetric and neonatal practice, health outcomes, used for research purposes, funding allocation and education. Accuracy in perinatal data is most often reported via quantitative validation studies of perinatal data collections both internationally and in Australia. These studies report varying levels of accuracy and suggest researchers need to be more aware of the quality of data they use. This article presents findings regarding issues of concern identified by midwives relating to their perceptions of how technology affects the accuracy of perinatal data records. Perinatal data records are perceived to be more complete when completed electronically. However, issues regarding system functionality, the inconsistent use of terminology, lack of data standards and the absence of clear, written records contribute to midwives\u27 perceptions of the negative influence of technology on the quality of perinatal data