Despite the great advances in the field of electronic health records (EHRs) over the past 25 years, implementation and adoption challenges persist, and the benefits realized remain below expectations. This scoping review aimed to present current knowledge about the effects of EHR implementation and the barriers to EHR adoption and use. A literature search was conducted in PubMed, Web of Science, IEEE Xplore Digital Library and ACM Digital Library for studies published between January 2005 and May 2020. In total, 7641 studies were identified of which 142 met the criteria and attained the consensus of all researchers on inclusion. Most studies (n = 91) were published between 2017 and 2019 and 81 studies had the United States as the country of origin. Both positive and negative effects of EHR implementation were identified, relating to clinical work, data and information, patient care and economic impact. Resource constraints, poor/insufficient training and technical/educational support for users, as well as poor literacy and skills in technology were the identified barriers to adoption and use that occurred frequently. Although this review did not conduct a quality analysis of the included papers, the lack of uniformity in the use of EHR definitions and detailed contextual information concerning the study settings could be observed.

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Effects of Electronic Health Record Implementation and Barriers to Adoption and Use: A Scoping Review and Qualitative Analysis of the Content

A provincial electronic health record is being developed in the Province of Quebec (and in all other provinces in Canada), and authorities hope that it will enable a safer and more efficient healthcare system for citizens. However, the expected benefits can occur only if healthcare professionals, including nurses, adopt this technology. Although attention to the use of the electronic health record by nurses is growing, better understanding of nurses' intention to use an electronic health record is needed and could help managers to better plan its implementation. This study examined the factors that influence primary care nurses' intention to adopt the provincial electronic health record, since intention influences electronic health record use and implementation success. Using a modified version of Ajzen's Theory of Planned Theory of Planned Behavior, a questionnaire was developed and pretested. Questionnaires were distributed to 199 primary care nurses. Multiple hierarchical regression indicated that the Theory of Planned Behavior variables explained 58% of the variance in nurses' intention to adopt an electronic health record. The strong intention to adopt the electronic health record is mainly determined by perceived behavioral control, normative beliefs, and attitudes. The implications of the study are that healthcare managers could facilitate adoption of an electronic health record by strengthening nurses' intention to adopt the electronic health record, which in turn can be influenced through interventions oriented toward the belief that using an electronic health record will improve the quality of patient care.

Determinants of primary care nurses' intention to adopt an electronic health record in their clinical practice.

Advanced Practice Nurses' Meaningful use of electronic health records.

Telecare is a healthcare resource based on new technologies that, through the services offered, attempt to help elderly people to continue living in their homes. In this sense, first-generation telecare services have quickly developed in Europe. The aim of this work was to define the profile, pattern of medication consumption and disease frequencies of elderly users of a telecare service. The cross-sectional study involved 742 Spanish community-dwelling elders (85.3% of the total users aged 65 years and over who used a telecare service before the end of the data collection period). Data were collected between March and September 2012. Subjects’ mean age was 83.3 (SD 6.6) years, and the majority lived alone (78.3%) and were female (85.8%). The mean Charlson comorbidity index score was 1.13 (SD 1.1), and the mean number of prescribed medications per day was 5.6 (SD 3.0). The most frequent diseases were hypertension (51.1%) and rheumatic disorders (44%); and the most consumed medications were those for the cardiovascular (75%) and nervous (65.2%) systems. For the total sample, the three main determinants of polymedication (five or more medications) were hypertension, anxiety-depressive symptoms and coronary heart disease. Regardless of the social elements contributing to the implementation of telecare services, specific health characteristics of potential users, such as morbidity and polypharmacy, should be carefully considered when implementing telecare services in the coming years.

Morbidity and medication consumption among users of home telecare services.

INTRODUCCION: La progresiva generalizacion del uso de las tecnologias de la comunicacion y la creciente demanda de informacion y conocimiento para la prestacion de cuidados y su gestion han hecho emerger la necesidad de vocabularios controlados orientados a los sistemas de informacion asistenciales, cuya validez y fiabilidad debe ser establecida. OBJETIVO: Evaluar la validez de la terminologia enfermera de interfase ATIC. METODOLOGIA: Estudio de evaluacion con metodo mixto: (1) evaluacion de la validez inductiva de la estructura de la terminologia mediante la conceptualizacion interpretativa de los constructos metaparadigmaticos y del proceso enfermero y (2) evaluacion de su metrica con disenos descriptivos para la determinacion de la validez logica (en opinion de expertos), de contenido (segun la presencia de los conceptos de la terminologia en la literatura cientifica), de criterio (evaluando la equivalencia del eje diagnostico de ATIC versus la taxonomia NANDA Internacional) y la fiabilidad (usabilidad en la practica). RESULTADOS: La estructura de este vocabulario se apoya en una fundamentacion filosofica y teorica eclectica, que otorga un significado especifico a los constructos interpretados. En opinion de expertos, su validez aparente se cuantifica en 8,1/10. La produccion cientifica generada avala un 98,7 % de los conceptos terminologicos que conforman su validez de contenido. Mas del 60% de los conceptos del eje diagnostico de la terminologia tienen equivalencia con los de la taxonomia NANDA_I. Un 92,3% de los conceptos diagnosticos de ATIC son empleados por las enfermeras en la practica clinica. CONCLUSIONES: A la luz de los resultados, la terminologia enfermera de interfase ATIC es un instrumento disciplinar valido y fiable.

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Evaluación de la validez de una terminología enfermera de interfase

This study was aimed to analyze and assess the use and perception of electronic health records (EHRs) by nurses The study sample included 113 nurses from different shifts of primary health facilities in Catalonia, Spain, devoted to adult as well as pediatric outpatients using EHRs throughout the year 2010 A majority of the sample (875%) were women and 125% were men The average age was 4427 years and the average time working in primary healthcare was 4715 months A majority (804%) received specific training on the use of the EHR and 196% did not The use of the application required side technical support (mean: 342) and it is considered necessary to learn more about the performance of the application (mean: 350) The relationship between the average ratings that nurses have about the EHR and age shows that there is no statistically significant linear relationship (r=−0002, p-value=0984) As to how long they have used the EHRs, there are significant differences (r=−0304, p-value=000)

http://diposit.ub.edu/dspace/bitstream/2445/44831/1/600260.pdf

New technologies and nursing: use and perception of primary healthcare nurses about electronic health record in Catalonia, Spain.

Compassion fatigue and anxiety derived from continued exposure to trauma and death greatly impact nurses’ quality of care and quality of life, increasing their desire to leave work. The aim of the study is to assess compassion fatigue and anxiety prevalence and their association with secondary variables. A multicenter, cross-sectional study in nurses from four high-risk units, Emergency, Intensive Care, Oncology, and Pediatrics, was carried out in 14 hospitals in Catalonia (Spain) between 2015 and 2016. The primary endpoints were compassion satisfaction and compassion fatigue (burnout and secondary traumatic stress), which were assessed by Professional Quality of Life (ProQOL), and anxiety, assessed with the State-Trait Anxiety Inventory (STAI). Multivariable logistic regression analyzed the association of sociodemographic, training, working, and psychological factors. Of a total of 1302 nurses, 18.6% presented low compassion satisfaction; 19.7%, high burnout; and 36.4%, high secondary traumatic stress. Trait anxiety scored high in 7.2%. Although compassion satisfaction was present, it did not protect sufficiently against the high level of compassion fatigue or anxiety present in nurses in all centers. The working conditions in the units and variables showed a strong association with nurses’ desire to leave. This corroborates the global challenge of healthcare professionals’ shortage. Participants expressed the need for better training in emotional management.

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Nuria Fabrellas-Padrés

Papers

New technologies and nursing: use and perception of primary healthcare nurses about electronic health record in Catalonia, Spain.

Dealing with Emotional Vulnerability and Anxiety in Nurses from High-Risk Units—A Multicenter Study