Identifying nursing sensitive indicators from electronic health records in acute cardiac care―Towards intelligent automated assessment of care quality

Aim: The aim of this study is to explore the potential of using electronic health records for assessment of nursing care quality through nursing-sensitive indicators in acute cardiac care. Background: Nursing care quality is a multifaceted phenomenon, making a holistic assessment of it difficult. Quality assessment systems in acute cardiac care units could benefit from big data-based solutions that automatically extract and help interpret data from electronic health records. Methods: This is a deductive descriptive study that followed the theory of value-added analysis. A random sample from electronic health records of 230 patients was analysed for selected indicators. The data included documentation in structured and free-text format. Results: One thousand six hundred seventy-six expressions were extracted and divided into (1) established and (2) unestablished expressions, providing positive, neutral and negative descriptions related to care quality. Conclusions: Electronic health records provide a potential source of information for information systems to support assessment of care quality. More research is warranted to develop, test and evaluate the effectiveness of such tools in practice. Implications for Nursing Management Knowledge-based health care management would benefit from the development and implementation of advanced information systems, which use continuously generated already available real-time big data for improved data access and interpretation to better support nursing management in quality assessment.</p

Nurses and Midwives in the Digital Age

Technological development has enabled Artificial Intelligence (AI) to better support health care delivery and nursing. The need for nurses to be involved and steer the development and implementation of AI in health care is recognized. A 60-minute scientific debate is organized to explore if AI will replace nursing

Assessing the carbon footprint of digital health interventions: a scoping review

Objective: Integration of environmentally sustainable digital health interventions requires robust evaluation of their carbon emission life-cycle before implementation in healthcare. This scoping review surveys the evidence on available environmental assessment frameworks, methods, and tools to evaluate the carbon footprint of digital health interventions for environmentally sustainable healthcare.Materials and methods: Medline (Ovid), Embase (Ovid). PsycINFO (Ovid), CINAHL, Web of Science, Scopus (which indexes IEEE Xplore, Springer Lecture Notes in Computer Science and ACM databases), Compendex, and Inspec databases were searched with no time or language constraints. The Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA_SCR), Joanna Briggs Scoping Review Framework, and template for intervention description and replication (TiDiER) checklist were used to structure and report the findings.Results: From 3299 studies screened, data was extracted from 13 full-text studies. No standardised methods or validated tools were identified to systematically determine the environmental sustainability of a digital health intervention over its full life-cycle from conception to realisation. Most studies (n = 8) adapted publicly available carbon calculators to estimate telehealth travel-related emissions. Others adapted these tools to examine the environmental impact of electronic health records (n = 2), e-prescriptions and e-referrals (n = 1), and robotic surgery (n = 1). One study explored optimising the information system electricity consumption of telemedicine. No validated systems-based approach to evaluation and validation of digital health interventions could be identified.Conclusion: There is a need to develop standardised, validated methods and tools for healthcare environments to assist stakeholders to make informed decisions about reduction of carbon emissions from digital health interventions.</p

"Mul on aika hyvät eväät tällä hetkellä hoitaa" : vanhempien kokemuksia astmalasten perheiden ohjaukseen kehitetyn intervention toteutuksesta

Työ oli osa Metropolia Ammattikorkeakoulun terveys- ja hoitoalan sekä HYKS:n naisten ja lastentautien tulosyksikön yhteistä Lapsen, nuoren ja lapsiperheen ohjaus -projektia. Projektissa on kehitetty ohjausinterventio lasten ohjaukseen. Työn tarkoitus oli haastatella astmalasten vanhempia heidän lääkehoidon ohjauskokemuksistaan. Tavoitteenamme oli tuottaa tietoa ohjauksesta perheen näkökulmasta. Teemahaastattelulla selvitimme astmaa ja astman kaltaisia oireita sairastavien alle 4-vuotiaiden lasten vanhempien ohjauskokemuksia kehitetystä lääkehoidon ohjausinterventiosta. Keräsimme aineiston haastattelemalla perheitä. Analysoimme 9 perheen kokemuksia käyttämällä induktiivista sisällönanalyysiä. Vanhempia haastattelemalla esiin nousi perhekeskeisyyden ja voimaantumisen merkitys ohjausprosessissa. Perhekeskeisyys toteutui ohjauksessa, jos perheen yksilöllisyys huomioitiin ohjauksen suunnittelussa sekä ohjaustilanteessa. Jos perhettä tai perheen tarpeita ei huomioitu ohjaustilanteessa, ei ohjaus ollut perhekeskeistä. Vanhemmilla oli erilaisia kokemuksia voimaantumisesta. Voimaantumisen kokemusta lisäsi perheen tiedolliseen tarpeeseen vastaaminen, perheen kokemus lääkehoidosta selviytymisestä kotona, perheelle sopiva ohjauksen toteutus, perheen aktiivinen rooli ohjaustilanteessa sekä perheen tyytyväisyys ohjaustilanteeseen. Voimaantumista ei tapahtunut, jos sisältö oli puutteellinen tai ohjaustilanne oli valmisteltu puutteellisesti. Kaikki vanhemmat kokivat ohjaustilanteen positiivisena ja pitivät kokonaisuutta hyvänä. Osa vanhemmista olisi kuitenkin kaivannut koko perheen huomiointia ohjaustilanteessa, ohjaustilanteen parempaa suunnittelua ja sisällön räätälöimistä vastaamaan paremmin perheen tarpeita. Vanhempien toiveisiin voitaisiin vastata keskustelemalla vanhempien kanssa ennen ohjausta. Näin perhekeskeisyys ja voimaantumisen kokemus lisääntyisivät ohjauksessa.Our study was a part of joint project between Helsinki Metropolia University of Applied Sciences, Helsinki, Finland, and HUCH Department of Gynecology and Pediatric, Helsinki, Finland. The purpose of this study was to interview parents of children with asthma about their counselling experiences in medical care. Our aim was to create information on patient education from the family's point of view. During the joint project an intervention on patient education was ccomplished. Using theme interviews, we studied the experiences the parents of children under the age of four with asthma and asthmatic symptoms had of the handbook in practice. We collected the data by interviewing families. We included the experiences of nine families in to our analysis. We used the inductive contents analysis to analyse the gathered data. Based on the interviews, family-centreness and empowerment in the patient guidance process were important to the parents. By taking the individuality of families into consideration in planning and during the patient education session, family-centricity was achieved. If the family and it’s needs were disregarded during the session, patient education was not family-centered. The feeling of empowerment was increased when the family was given information and when the family experienced that they coped with medical care at home. In addition, the feeling of empowerment was increased when the patient education met the family's needs and when they had an active role in the session. Likewise, if the families were satisfied with counselling, it was also considered empowering. Inadequate content of or planning of the session did not lead to empowerment. All the parents felt that the counselling was positive and successful. However, part of them would have wished that the whole family had been taken into consideration during the session, the session had been planned better and the content had been tailored to meet the family's needs. By discussing with the parents about the counselling beforehand, their expectations could be answered. This way family-centredness and experience of empowerment would increase in patient education.Liite 1 (teemahaastattelurunko) ei ole sähköisessä muodossa, koska se kuuluu projektille, eikä sitä ole vielä virallisesti julkaistu

Sydäntauteja sairastavan potilaan hoitotyön laadun arviointi erikoissairaanhoidon potilaskertomuksista : Kohti tekoälyllä tuettua tiedolla johtamista

Laadukas hoitotyö on tehokasta, turvallista sekä ihmiskeskeistä toimintaa. Hoitotyön laadun arviointi on tärkeä osa hoitotyön esihenkilöiden työtä, ja laadun arvioinnin varmistamiseksi on kehitetty lukuisia erilaisia laadunarviointimenetelmiä. Nämä menetelmät ovat aikaa vieviä sekä raskaita toteuttaa. Terveydenhuolto tuottaa runsaasti tietoa kuten potilaskertomuksia, joista olisi mahdollista poimia hoitotyön laatuun liittyviä ilmauksia laatuun liittyvien indikaattoreiden avulla. Tämän tutkimuksen tarkoituksena oli analysoida laatuun liittyviä ilmauksia erikoissairaanhoidon potilaskertomuksista. Tavoitteena oli muodostaa sydäntauteja sairastavan potilaan hoitotyön laatuun liittyvistä ilmauksista viitekehys, jota on mahdollista hyödyntää tekoälypohjaisessa työkalussa, joka tuottaa hoitotyön laadusta kertovaa tietoa automaattisesti ja reaaliaikaisesti hoitotyön esihenkilöiden käyttöön tiedolla johtamisen tueksi. Tutkimus oli kaksivaiheinen. Ensimmäinen vaihe oli kuvaileva kirjallisuuskatsaus hoitotyön laatuun liittyvien indikaattorien käytöstä sydäntauteja sairastavien potilaiden hoidon laadun arvioinnissa potilasasiakirjoista. Aineisto muodosti kuudesta artikkelista. Tulokseksi saatiin 16 hoidon laatua kuvaavaa indikaattoria, joista neljä soveltui tutkimuksen toista vaihetta varten muodostettuun sydäntauteja sairastavan potilaan hoitotyön laadun arvioinnin viitekehykseen. Viitekehystä täydennettiin yhdistämällä sydäntauteja sairastavien potilaiden erikoissairaanhoidon potilaskertomusten analysointiin soveltuvia hoitotyön laatua kuvaavia indikaattoreita. Tutkimuksen toinen vaihe oli retrospektiivinen asiakirja-analyysi. Tutkimus suoritettiin analysoimalla yhden sairaanhoitopiirin sydänkeskuksessa tammikuussa 2020 hoidettujen potilaiden kaikkien hoitojaksojen potilaskertomuksia. 230 potilaasta satunnaisesti kerättyyn otokseen sisältyi 540 hoitojaksoa sekä 6867 erilaista sairaanhoitajan, lääkärin ja laboratorion sähköistä kirjausta. Aineisto analysoitiin käyttämällä deduktiivista sisällönanalyysia, teema-analyysia sekä kuvailevaa tilastonanalyysia. Aineistosta poimittiin yhteensä 1714 hoitotyön laatuun liittyvää ilmausta, joista 1296 kuvasi potilaaseen liittyviä havaintoja ja 418 potilaan hoitoon liittyviä haittatapahtumia. Ilmauksista 1270 poimittiin narratiivisesta vapaasta tekstistä ja 444 rakenteisen kirjaamisen merkinnöistä. Ilmauksista 555 tulkittiin kuvaavan potilaan tilaa negatiivisesti, 196 neutraalisti ja 963 positiivisesti. Aineistossa oli mukana myös 42 rakenteisen kirjaamisen merkintää ilman arvosisältöä, sekä 1284 rakenteista FinCC-otsikkoa narratiiviselle tekstille. Suurin osa ilmauksista kuvasi kipua (n=662), sairaalainfektiota (n=359) tai potilaan koettua terveyttä (n=327). Alustavat tulokset antavat viitteitä siitä, että laatua kuvaavien indikaattoreiden avulla potilaskertomuksista on mahdollista poimia hoitotyön laatuun liittyvää tietoa. Potilaan hoidon laatu ja potilaan vointi ovat toisistaan erillisiä ilmiöitä, eivätkä tulosindikaattorit eivät itsessään kerro sitä, reflektoivatko ne laadukasta hoitoa vai potilaan perustilaa. Pelkkien tulosten huomiointi hoitotyön laadun arvioinnissa voi johtaa kokonaiskuvan menettämiseen. Hoitotyön laadun arvioinnissa tulisikin huomio kiinnittää hoidon kokonaisuuteen, sen toteuttamiseen sekä sen kontekstiin ja huomioida hoidon ihmisläheisyys. Jatkotutkimuksissa olisi hyödyllistä kartoittaa myös indikaattoreiden ajallista ilmaantuvuutta, indikaattoreiden pysyvyyttä sekä prosessi-indikaattoreiden mukaan ottamista tulosindikaattoreiden rinnalle.Nursing care quality can be assessed according to its efficiency, safety and people-centeredness. Assessing the nursing care quality is essential for nursing managers, and a variety of quality evaluation methods have been developed to ensure good quality. These methods are perceived as time consuming and adding up to the workload. The healthcare system generates vast amounts of data, such as patient health records, that could be used to extract expressions describing the nursing care quality using quality indicators. The expressions could be utilized in an artificial intelligence-based tool generating automated quality information in real time to be used by nursing managers to support knowledge-based management. The aim of this study was to extract these expressions from patient health records and construct a framework describing expressions related to the nursing care quality. The study was conducted in two phases, the first being a descriptive review on using quality indicators in assessing nursing care quality of heart patients from health records. The review resulted in six articles with 16 quality indicators. Four indicators were suitable to be used in a framework for assessing nursing care quality, that was developed for the second phase of this study. The framework was supplemented with quality of care outcome indicators suitable to be used in assessing nursing care quality from acute care patient health records. The second phase of the study was a retrospective document analysis, conducted by analyzing care episodes of patients treated in the cardiac center of one hospital district during one month in the early 2020. The randomly selected sample of 230 patients included 540 care episodes and 6867 electronic entries made by nurses, physicians and laboratory technicians. Methods used for this study included deductive content analysis, thematic analysis and descriptive statistics. A total of 1714 expressions related to quality of care were extracted from patient records. 1296 expressions described patient-related observations and 418 adverse events related to patient care. 1270 of the expressions were extracted from narrative free entries and 444 from structured entries. 555 of the expressions were interpreted as describing negative, 196 neutral and 963 positive patient status related to quality of care. In addition, 42 structured data entries without value content were extracted, as well as 1284 structured FinCC-headings for narrative free text. Majority of the expressions described pain (n=662), hospital acquired infections (n=359) or perceived health of the patient (n=327). The preliminary findings indicate that outcome indicators could be used to extract a rich variety of expressions indicating quality of care from patient health records. Patient care quality and patient status are separate phenomena. The outcome indicators themselves don’t reveal whether they reflect good care quality or the patient’s baseline condition and focusing only on the outcome indicators could result in losing sight of the overall picture. The nursing care quality assessment should therefore address the entirety of care, as well as the execution and the context of care, taking into account the person-centeredness in care. Further studies would benefit from investigating the timeline and stability of indicators, in addition to supplementing process indicators and assessing the entity of nursing care quality

Electronic Health Records as Information Source in Assessment of the Effectiveness of Delivered Care - A Pilot Study

Effectiveness is a key element of high quality health services. The aim of this pilot study was to explore the potential of electronic health records (EHR) as an information source for assessing the effectiveness of nursing care by investigating the appearance of nursing processes in the documentation of care. Deductive and inductive content analysis were used in a manual annotation of ten patients' EHRs. The analysis resulted in the identification of 229 documented nursing processes. The results indicate that EHRs can be used in decision support systems for assessing effectiveness of nursing care, however, future work is needed to verify these findings in a larger data set and extend to other dimensions related to care quality.Peer reviewe

Identifying nursing sensitive indicators from electronic health records in acute cardiac care―Towards intelligent automated assessment of care quality

Publisher Copyright: © 2022 The Authors. Journal of Nursing Management published by John Wiley & Sons Ltd.Aim: The aim of this study is to explore the potential of using electronic health records for assessment of nursing care quality through nursing-sensitive indicators in acute cardiac care. Background: Nursing care quality is a multifaceted phenomenon, making a holistic assessment of it difficult. Quality assessment systems in acute cardiac care units could benefit from big data-based solutions that automatically extract and help interpret data from electronic health records. Methods: This is a deductive descriptive study that followed the theory of value-added analysis. A random sample from electronic health records of 230 patients was analysed for selected indicators. The data included documentation in structured and free-text format. Results: One thousand six hundred seventy-six expressions were extracted and divided into (1) established and (2) unestablished expressions, providing positive, neutral and negative descriptions related to care quality. Conclusions: Electronic health records provide a potentialsource of information for information systems to support assessment of care quality. More research is warranted to develop, test and evaluate the effectiveness of such tools in practice. Implications for Nursing Management: Knowledge-based health care management would benefit from the development and implementation of advanced information systems, which use continuously generated already available real-time big data for improved data access and interpretation to better support nursing management in quality assessment.Peer reviewe

Development and validation of instrument for assessment of situational awareness in operational management of nursing leaders in hospital settings

Vertaisarvioitu. English abstract.Peer reviewe