A Mobile,Electronic Health Record-Connected Application for Managing Team Workflows in Inpatient Care

Background  Clinical workflows require the ability to synthesize and act on existing and emerging patient information. While offering multiple benefits, in many circumstances electronic health records (EHRs) do not adequately support these needs. Objectives  We sought to design, build, and implement an EHR-connected rounding and handoff tool with real-time data that supports care plan organization and team-based care. This article first describes our process, from ideation and development through implementation; and second, the research findings of objective use, efficacy, and efficiency, along with qualitative assessments of user experience. Methods  Guided by user-centered design and Agile development methodologies, our interdisciplinary team designed and built Carelign as a responsive web application, accessible from any mobile or desktop device, that gathers and integrates data from a health care institution''s information systems. Implementation and iterative improvements spanned January to July 2016. We assessed acceptance via usage metrics, user observations, time–motion studies, and user surveys. Results  By July 2016, Carelign was implemented on 152 of 169 total inpatient services across three hospitals staffing 1,616 hospital beds. Acceptance was near-immediate: in July 2016, 3,275 average unique weekly users generated 26,981 average weekly access sessions; these metrics remained steady over the following 4 years. In 2016 and 2018 surveys, users positively rated Carelign''s workflow integration, support of clinical activities, and overall impact on work life. Conclusion  User-focused design, multidisciplinary development teams, and rapid iteration enabled creation, adoption, and sustained use of a patient-centered digital workflow tool that supports diverse users'' and teams'' evolving care plan organization needs.     

How to Choose or Change an Electronic Health Record System

Nurse practitioners across the United States use or are about to use electronic health record (EHR) systems while having minimal input into EHR purchase decisions. The EHR system can affect provider and patient satisfaction, reimbursement, and other aspects of practice. Most EHR planning tools focus on hardware and software needs, rather than the process used to identify the right product; however, the EHR may fail if an inappropriate process is used. Ten elements essential to purchase and implement an EHR system and the steps to take if the current EHR does not meet practice needs are reviewed.     

The San Francisco Collaborative: An Evaluation of a Partnership Between Three Schools of Nursing and a Public Health Department

ABSTRACT Many factors are contributing to a decline in the number of nurses who opt to choose public health nursing as a career option. One factor is the lack of preceptors in public health, which has led to the placement of nursing students in nontraditional clinical settings. Thus, many nursing students are not exposed to public health nursing while still in school. Graduating students may not have a clear idea of what a public health nurse is or does. The purpose of the study was to describe a collaborative project between three schools of nursing aimed at increasing interest in public health nursing among undergraduate nursing students. The study method involved analysis of student, faculty, and staff feedback received after an orientation to public health nursing. Nursing students found the experience valuable. Participation in the collaborative project has increased clinical experiences for nursing students in public health, increased exposure of nursing students to public health nursing, and has led to opportunities for both students and faculty within an urban public health department.     

Standardized Nursing Diagnoses in an Electronic Health Record: Nursing Survey Results

PURPOSE. A survey was conducted to obtain feedback from registered nurses as end‐users of standardized nursing terminology for care planning in an electronic health record. Revisions to the care plan terminology were completed as part of an evidence‐based project by nurses at one facility. METHODS. The survey was conducted pre‐, post‐, and 2‐year post‐implementation to obtain feedback from the acute care registered nurses (RNs). FINDINGS. Nurses reported a more positive agreement with the changes at 6 months compared with baseline, which generally was found to be sustained in the 2‐year survey. Overall, the standardized terminology provided the nurses greater ease in their selection of nursing diagnoses and interventions in planning patient care, yet their reported satisfaction did not change. The survey identified several problematic areas related to nurses and care planning. Nurses reported less agreement with the statement about the care plans offering them the ability to determine the status of their patient's nursing care needs. They noted less agreement with statements of the care plan offering information on assessment of patient outcomes of nursing care. CONCLUSIONS. The patient plan of care in the electronic record is expected to offer nurses the ability to communicate the needs of the patient and assess outcomes of care. The survey findings indicate weaknesses warranting further exploration to identify changes needed to improve care planning documentation.     

Understanding Patient Perceptions of the Electronic Personal Health Record

Nurse practitioners are being asked to implement meaningful use initiatives including electronic personal health records (PHRs), yet little research has been done on the usability of the systems from a patient perspective. This qualitative study identified patient perceptions and barriers to the use of the PHR. Four themes were identified: access issues, perceived value of the PHR, potential usability, and security issues. Specific patient issues were those around the use of technology and health literacy issues. Nurse practitioners have an opportunity to work with patients and health information technology staff to address these issues and improve patient engagement through the use of PHRs.     

A Work in Progress: Electronic Health Record Utilization in Residential Treatment

The use of Electronic Health Records (EHRs) has increased dramatically in the past few years, in part as a result of the 2009 Health Information Technology for Economic and Clinical Health Act (HITECH), and has significant potential benefit for youth residential treatment providers. Although use is widespread in the medical profession, youth residential treatment providers have only recently begun to use EHRs, and there is little information available to guide them in selection. Members of the Association of Children’s Residential Centers (ACRC) were invited via the association newsletter, and targeted email and phone call reminders, to participate in a 13-item on-line survey focused on use, satisfaction and concerns with EHRs. Eighty-seven percent of ACRC member organizations responded to the survey. Two thirds (66%) of the organizations reported using a wide variety of EHRs, and cited a range of strengths and challenges of the various systems; no single EHR product dominated the residential agency market. The authors discuss the need for further comparative EHR information and stress the importance of EHRs for data exchange and outcomes evaluation.     

Leveraging the Electronic Health Record to Address the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic continues its global spread. Coordinated effort on a vast scale is required to halt its progression and to save lives. Electronic health record (EHR) data are a valuable resource to mitigate the COVID-19 pandemic. We review how the EHR could be used for disease surveillance and contact tracing. When linked to “omics” data, the EHR could facilitate identification of genetic susceptibility variants, leading to insights into risk factors, disease complications, and drug repurposing. Real-time monitoring of patients could enable early detection of potential complications, informing appropriate interventions and therapy. We reviewed relevant articles from PubMed, MEDLINE, and Google Scholar searches as well as preprint servers, given the rapidly evolving understanding of the COVID-19 pandemic.     

Partnership: an analysis of the concept within the nurse-client relationship

BACKGROUND/RATIONALE: Current nursing literature that describes the nurse-client relationship as a partnership provides little clarity about the elements and processes of this partnership. This is hardly surprising as conceptual definitions of partnership differ in scope and vary according to the context of the partnership and types of partners. AIMS OF THE PAPER: This paper examines the concept of partnership using Rodgers's (2000) evolutionary approach to concept analysis. The paper describes the antecedents, attributes and consequences of partnership as well as changing socio-political and economic contexts that illuminate how and why nurse-client partnership emerged. Temporal changes in the concept of partnership are also examined. FINDINGS: The nurse-client relationship as partnership evolved from a growth in democratic thinking and progress in clarifying how to honour basic human rights in health care relationships. The attributes of partnership include structural and process phenomena. The structure of partnership includes the phases of the relationship, focus and aims of each phase, and roles and responsibilities of the partners. The process of partnership embodies power sharing and negotiation. The main consequence of partnership is client empowerment, which is understood to be the improved ability of the client to act on his/her own behalf. CONCLUSIONS: The paper concludes with suggestions for further development of the concept of partnership through empirical research.     

Capturing interprofessional collaboration between physicians and nurses in an acute care setting. A validation study of the revised German version of the Collaborative Practice Scales

ABSTRACT

The relevance of interprofessional collaboration (IPC) is widely acknowledged. Given the lack of a fully validated instrument in the German language for measuring the level of IPC, we built upon the current, albeit psychometrically weak, German-language version of the instrument to devise a new version with improved wording and for subsequent psychometric testing. In a tertiary hospital in German-speaking Switzerland, 160 physicians and 374 nurses completed the revised Collaborative Practice Scales in German (CPS-G) and additional scales regarding positive and negative activation at work and regarding job demands and job resources. A confirmatory factor analysis of the CPS-G was performed, and internal consistency estimates were computed. Partial correlations between the CPS-G and the additional scales were examined for criterion validity. The model fit of the CPS-G was good for physicians (χ²/df = 2.38, p?<?.001; CFI = .923; RMSEA = .051, 90%-CI (0.037–0.065)) and moderate for nurses (χ²/df = 5, p?<?.001; CFI = .919; RMSEA = .087, 90%-CI (0.072–0.102)) supporting the two-factor structure of the original English version. Reliability was acceptable in all sub-scales for physicians (inclusion, α = 0.79; consensus, α = 0.80) and nurses (assertiveness, α = 0.77; understanding α = 0.82). As expected, the CPS-G physicians’ subscales correlated positively with positive activation and job resources and negatively with negative activation and job demands, albeit not always statistically significantly. Similar correlations were found with the CPS-G nurses’ subscales other than in one instance. The CPS-G showed good construct and criterion validity and acceptable internal consistency. It consequently represents a valid instrument ready for application to measure the level of interprofessional collaboration between nurses and physicians in acute care settings.     

A Time and Motion Analysis of Nursing Workload and Electronic Health Record Use in the Emergency Department

IntroductionThe use of an electronic health record may create unanticipated consequences for emergency care delivery. We sought to describe emergency department nursing task distribution and the use of the electronic health record.MethodsThis was a prospective observational study of nurses in the emergency department using a time-and-motion methodology. Three trained research assistants conducted 1:1 observations between March and September 2019. Nurse tasks were classified into 6 established categories: electronic health record, direct/indirect patient care, communication, personal time, and other. Nurses’ perceived workload was assessed using the National Aeronautics and Space Administration (NASA) Task Load Index.ResultsTwenty-three observations were conducted over 46 hours. Overall, nurses spent 27% of their time on electronic health record tasks, 25% on direct patient care, 17% on personal time, 15% on indirect patient care, and 6% on communication. During morning (7 am-12 pm) and afternoon shifts (12 pm-3 pm), the use of the health record was the most commonly performed task, whereas indirect patient care was the task most performed during evening shifts (3 pm-12 pm). Using the National Aeronautics and Space Administration (NASA) Task Load Index, nurses reported an increase in mental demand and effort during afternoon shifts compared with morning shifts.DiscussionWe observed that emergency nurses spent more time using the electronic health record as compared to other tasks. Increased usability of the electronic health record, particularly during high occupancy periods, may be a target for improvement.     

Creating and sustaining an academic‐practice Partnership Engagement Model

Public health clinical educators and practicing public health nurses (PHNs) are experiencing challenges in creating meaningful clinical learning experiences for nursing students due to an increase in nursing programs and greater workload responsibilities for both nursing faculty and PHNs. The Henry Street Consortium (HSC), a collaborative group of PHNs and nursing faculty, conducted a project to identify best practices for public health nursing student clinical learning experiences. Project leaders surveyed HSC members about preferences for teaching‐learning strategies, facilitated development of resources and tools to guide learning, organized faculty/PHN pilot teams to test resources and tools with students, and evaluated the pilot team experiences through two focus groups. The analysis of the outcomes of the partnership engagement project led to the development of the Partnership Engagement Model (PEM), which may be used by nursing faculty and their public health practice partners to guide building relationships and sustainable partnerships for educating nursing students.