A realistic evaluation of the impact of a computerised information system on clinical practice : the nurses' perspective.

The aim of this study is to explore nurses' perceptions of the impact in clinical practice of the use of a computerised hospital information system. Design: A realistic evaluation design based on Pawson and Tilley's work has been used across all the phases of the study. It is a theory driven approach and focuses evaluation on the study of what works, for whom and in what circumstances. These relationships are constructed as context-mechanisms-outcomes configurations (CMO). Methods: A self-developed questionnaire containing both closed and open-ended questions was piloted and distributed to all nurses working in in-patient units of the Clinica Universitaria of Navarra (n= 227). Quantitative data were analysed using SPSS 13.0. Descriptive statistics were used for an overall overview of nurses' perception. Inferential analysis, including both bivariate and multivariate methods (path analysis), were used for cross-tabulation of variables searching for CMO relationships. Content analysis of open-ended questions was used to identify major themes in nurses' responses. Results: 179 nurses participated in the study (78.8% response rate). Overall satisfaction with the IT system is positive and only 7.5% of the nurses wanted to go back to paper records. Mechanisms and outcomes are highly correlated. Comparisons with context variables show how users' characteristics, except attitude towards the introduction of technology, did not have a significant influence on perceptions while the nursing unit context had greater influence. Path analysis illustrated that the influence of unit context variables are on outcomes and not on mechanisms. Six main themes emerged from open-ended questions: information, communication, patient care, documentation processes, work dynamics and running of the program. Some differences in relation to the unit context were observed

Atributos del rol avanzado en enfermería: práctica clínica directa

La práctica avanzada surge en una confluencia de necesidades del paciente (mayor complejidad, envejecimiento y comorbilidad) y del sistema de salud (avances tecnológicos, cambios organización, escasez médicos) junto a un desarrollo de las oportunidades de educación (Ramirez et al, 2002). En otros países la formación de master ha llevado al desarrollo de lo que se conoce como práctica avanzada de enfermería, un concepto complejo por las circunstancias en las que ha surgido y la variabilidad que existe. Los cambios en el entorno sanitario han ido ampliando y perfilando el perfil. Las enfermeras de práctica avanzada han sido claves en estos procesos integrándose activamente en ellos.El desarrollo del master y doctorado en enfermería en nuestro contexto abre puertas no solo a un mayor desarrollo del conocimiento e investigación en enfermería sino también a nuevos perfiles profesionales que logren un desarrollo y avance de la práctica diaria de enfermería. Bryant-Lukosious et al (2004) afirman: “La práctica avanzada es la frontera futura para la práctica de enfermería y el desarrollo profesional. Es una forma de ver el mundo que permite cuestionar la práctica actual, la creación de nuevo conocimiento de enfermería y la mejora de los cuidados y servicios de salud” (pp 520). Este capítulo pretende abordar una de las competencias de la enfermera de práctica avanzada: la práctica clínica directa. La práctica avanzada es la confluencia de distintas competencias pero la práctica clínica se considera la competencia central e informa las demás; aunque realizan otras actividades el cuidado directo es la base necesaria para articular el resto de competencias

A quantitative analysis of the impact of a computerised information system on nurses' clinical practice using a realistic evaluation framework

Objective: To explore nurses' perceptions of the impact on clinical practice of the use of a computerised hospital information system. Design: A realistic evaluation design based on Pawson and Tilley's work has been used across all the phases of the study. This is a theory-driven approach and focuses evaluation on the study of what works, for whom and in what circumstances. These relationships are constructed as context-mechanisms-outcomes (CMO) configurations. Measurements: A questionnaire was distributed to all nurses working in in-patient units of a university hospital in Spain (n = 227). Quantitative data were analysed using SPSS 13.0. Descriptive statistics were used for an overall overview of nurses' perception. Inferential analysis, including both bivariate and multivariate methods (path analysis), was used for cross-tabulation of variables searching for CMO relationships. Results: Nurses (n = 179) participated in the study (78.8% response rate). Overall satisfaction with the IT system was positive. Comparisons with context variables show how nursing units' context had greater influence on perceptions than users' characteristics. Path analysis illustrated that the influence of unit context variables are on outcomes and not on mechanisms. Conclusion: Results from the study looking at subtle variations in users and units provide insight into how important professional culture and working practices could be in IT (information technology) implementation. The socio-technical approach on IT systems evaluation suggested in the recent literature appears to be an adequate theoretical underpinning for IT evaluation research. Realistic evaluation has proven to be an adequate method for IT evaluation. (C) 2009 Elsevier Ireland Ltd. All rights reserved

Experiences of frontline nurse managers during the COVID-19: a qualitative study

Aim The aim of this study is to explore the experiences of Jordanian first-line nurse managers during COVID-19. Background Nurses are exposed to life-threatening occupational risks during COVID-19. Exploring the first-line nurse managers' experiences will help in designing health policies to better deal with such emerging crises. Methods A descriptive phenomenological study was conducted. A purposive sample was used to recruit 16 first-line nurse managers from Jordanian hospitals. Semistructured interviews were conducted. Phenomenological data analysis method was used to analyse the data. Results Four major themes emerged: (a) unprecedented pressure (first-line nurse managers revealed their suffering with the unprecedented demanding situations during COVID-19 pandemic); (b) strengthening system and resilience (nurse managers employed several strategies to strengthen the health system and enhance resilience); (c) building a supportive team (the presence of a robust supportive system is vital to deal with the pandemic); and (d) maturity during the crisis (exposure to a new experience developed nurse managers management skills and self-awareness). Conclusions The unprecedented pressure associated with COVID-19 drained first-line nurse managers physically and psychosocially. Providing adequately trained staff and medical equipment is important to better deal with crises. Implications for Nursing Management Strengthening emergency training and improving emergency response plans of hospitals are essential

Transforming care in nursing: a concept analysis

Although the concept of ‘Transforming care’ is promising for improving healthcare, there is no consensus in the field as to its definition. The aim of this concept analysis is to develop a deeper understanding of the term ‘Transforming care’ within the nursing discipline, in order to facilitate its comprehension, implementation and evaluation. We performed a comprehensive literature review on electronic databases such as Medline (PubMed), Cinahl (Ebsco), Cochrane Library, PsycINFO (Ovid), Web of Science, Wiley- Blackwell, ScienceDirect and SpringerLink, and used Walker and Avant’s approach to analyse the concept. From the 20 studies selected for this analysis, three main attributes of ‘Transforming care’ were identified: patient-centredness, evidence-based change, and transformational leadership-driven. We suggest an operational definition to facilitate the implementation of the concept in practice. Furthermore, we propose that implementation is guided by the following key ideas: 1) fostering a culture of continuous improvement; 2) encouraging bottom-up initiatives; 3) promoting patient-centred care; and 4) using transformational leadership. Lastly, the evaluation of ‘Transforming care’ initiatives should assess care processes, and professionals’ and patients’ outcomes

Nurses' protocol-based care decision-making: a multiple case study

Aim: To describe and explain nurses' protocol-based care decision-making. Background: Protocol-based care is a strategy to reduce variability in clinical practice. There are no studies looking at protocol-based care decision-making. Understand this process is key to successful implementation. Method: A multiple embedded case study was carried out. Nurses' protocol-based care decision-making was studied in three inpatient wards (medical, surgical and medical-surgical) of a university hospital in northern Spain. Data collection was performed between 2015 and 2016 including documentary analysis, non-participant observations, participant observations and interviews. Analysis of quantitative data involved descriptive statistics and qualitative data was submitted to Burnard's method of content analysis (1996). The data integration comprised the integration of the data set of each case separately and the integration of the findings resulting from the comparison of the cases. The following the thread method of data integration was used for this purpose. The SRQR guideline was used for reporting. Results: The multiple embedded case study revealed protocol-based care decision-making as a linear and variable process that depends on the context and consists of multiple interrelated elements, among which the risk perception is foremost. Conclusion: This study has allowed progress in protocol-based care decision-making characterisation. This knowledge is crucial to support the design of educational and management strategies aimed at implementing protocol-based care. Relevance to clinical practice: Strategies to promote protocol-based care should address the contexts of practice and the ability of professionals' to accurately assess the degree of risk of clinical activity. Hence, it will promote quality of care, patient safety and efficiency in healthcare cost

Validez y fiabilidad de la versión española de la guía de valoración oral (OAG) en pacientes con cáncer

Fundamento. El instrumento Oral Assessment Guide (OAG) es una herramienta diseñada y ampliamente utilizada para evaluar problemas de la mucosa oral en pacientes con cáncer, sin embargo no está validada en español. El objetivo de este trabajo es traducir y validar al español la escala de la valoración de la cavidad oral (OAG) diseñada por Eilers. Método. El proceso de traducción se realizó utilizando el método de traducción retrotraducción por bilingües. El estudio se llevó a cabo en pacientes con cáncer ambulatorios y hospitalizados del Departamento Onco-hematológico y con enfermeras que trabajaban con pacientes de cáncer. Se evaluaron las siguientes propiedades psicométricas de la OAG: consistencia interna, validez concurrente con la escala de la mucositis de la OMS, la armonía interjueces entre dos enfermeras diferentes. También se recogió la percepción de los pacientes y enfermeras sobre la utilización de la OAG. Resultados. Se obtuvo una adecuada versión española de la OAG. Todos los participantes (n=40) completaron el estudio. La consistencia interna con el alpha de Cronbach fue de 0,71 y la armonía interjueces obtuvo un índice de Kappa moderado y bueno en la mayoría de los ítems (k=0,4-0,81) excepto en “lengua y encía” (k=0,33-0,37). La validez concurrente con la escala de la mucositis de la OMS fue aceptable (r=0,458). Todas las enfermeras (n=6) consideraron que la escala era fácil de entender y útil en la práctica clínica. Los pacientes dijeron que no les pareció incómoda la valoración de la boca con la escala. Conclusiones. La versión española de la OAG es un instrumento válido y fiable en pacientes con cáncer. Es una escala fácil de usar en la práctica clínica y bien aceptada por los pacientes.Background. The Oral Assessment Guide (OAG) is a widely used tool designed for evaluating problems of oral mucous in cancer patients, but it has not been validated in Spanish. The aim of this work is to translate and validate into Spanish the scale of the OAG designed by Eilers. Method. The translation process was carried out using the method of back-translation by bilingual translators. The study was carried out with cancer patients, both outpatient and inpatients, of the Hematology/Oncology Department and with oncology nurses. The following psychometric properties of the OAG were evaluated: internal consistency, concurrent validity with WHO’s mucositis scale, interjudge agreement between two different nurses. The perception of patients and nurses on the use of the OAG was also assessed. Results. An adequate Spanish version of the OAG was obtained. All the participants (n=40) completed the study. Internal consistency measured by Cronbach’s alpha was 0.71 and interjudge agreement obtained a moderate to good Kappa index in the majority of items (k=0.4-0.81), except in “tongue and gums” (k=0.33-0.37). Concurrent validity with WHO mucositis scale was acceptable (r=0.458). All the nurses (n=6) considered that the scale was easy to understand and useful in clinical practice. The patients said that oral evaluation with the scale did not cause them discomfort. Conclusions. The Spanish version of the OAG is a valid and reliable instrument in cancer patients. It is a scale that is easy to use in clinical practice and is well accepted by patients

Implantación de perfiles de práctica avanzada: retos y oportunidades en nuestro contexto

Curriculum:Doctora en Enfermería por la Universidad de Sheffield. Máster en Enfermería por la Universidad de Edimburgo. Diplomada en Enfermería por la Universidad de Navarra. Directora del Área de Investigación, Formación y Desarrollo en Enfermería en la Clínica Universidad de Navarra. Profesora de la Facultad de Enfermería de la Universidad de Navarra