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ABSTRACT: Computerized decision support systems (CDSSs) have the potential to significantly improve the quality of nursing care of older people by enhancing the decision making of nursing personnel. Despite this potential, health care organizations have been slow to incorporate CDSSs into nursing home practices.
This study describes facilitators and barriers that impact the ability of nursing personnel to effectively use a clinical CDSS for planning and treating pressure ulcers (PUs) and malnutrition and for following the suggested risk assessment guidelines for the care of nursing home residents.
We employed a qualitative descriptive design using varied methods, including structured group interviews, cognitive walkthrough observations and a graphical user interface (GUI) usability evaluation. Group interviews were conducted with 25 nursing personnel from four nursing homes in southern Norway. Five nursing personnel participated in cognitive walkthrough observations and the GUI usability evaluation. Text transcripts were analyzed using qualitative content analysis.
Group interview participants reported that ease of use, usefulness and a supportive work environment were key facilitators of CDSS use. The barriers identified were lack of training, resistance to using computers and limited integration of the CDSS with the facility's electronic health record (EHR) system. Key findings from the usability evaluation also identified the difficulty of using the CDSS within the EHR and the poorly designed GUI integration as barriers.
Overall, we found disconnect between two types of nursing personnel. Those who were comfortable with computer technology reported positive feedback about the CDSS, while others expressed resistance to using the CDSS for various reasons. This study revealed that organizations must invest more resources in educating nursing personnel on the seriousness of PUs and poor nutrition in the elderly, providing specialized CDSS training and ensuring that nursing personnel have time in the workday to use the CDSS.
Applied clinical informatics. 01/2011; 2(4):420-36.
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ABSTRACT: Existing classifications in Sweden of health care interventions used for quality assurance issues and for decisions on resource allocation does not capture all types of health care interventions. The work of professional groups like nurses, physiotherapists, and occupational therapists is partly invisible. There is a need to develop a classification of health care interventions that comprise all activity within the health care sector.
To describe a multi-professional collaborative work on classification development and to provide suggestions for an organizing structure that can capture interventions in the health care services incorporating different professional perspectives.
The professional groups reached a common understanding about the use of the classification of The International Classification of Functioning, Disability and Health (ICF) as a unifying framework in the classification of health care interventions. Proposal was made for a revised structure of a current classification of interventions using ICD as unifying framework.
The use of ICF as a unifying framework is seen as a fruitful way of overcoming professional differences, and by that supporting the process of reaching a common understanding and use of a common language when describing interventions in health care.
International Journal of Medical Informatics 01/2006; 74(11-12):973-9. · 2.41 Impact Factor
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8th International Congress in Nursing Informatics, NI2003; 01/2003
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ABSTRACT: The objective of this paper is twofold: (a) to explore different approaches in reviewing records based on a literature review of studies of audits of patient records and (b) to apply these approaches on a sample of records to illuminate consequences of their application. The method used was a literature review of papers on recording of nursing care (n = 56). Based on our findings, an audit of a stratified sample of records (n = 298) from Swedish community health care and nursing homes was performed, applying the different approaches for auditing previously described in the literature. The review showed that audits of patient records were performed using four different approaches with varying aims. The focus of the four approaches can be described as formal structure, process comprehensiveness, knowledge-based and concordance with actual care. The results of this study suggest that audits of patient records should not be solely limited to encompass the formal structure of recording. To avoid a superficial picture or a false sense of high quality and to obtain a more complete and reliable portrait of the quality of recording, we suggest the process comprehensiveness approach in combination with a critical review of the knowledge base for the assessment, diagnosis and interventions of patient records.
Scandinavian Journal of Caring Sciences 02/2001; 15(2):133-41. · 0.89 Impact Factor
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ABSTRACT: The accuracy of patient records in Swedish nursing homes: congruence of record content and nurses' and patients' descriptions. Data from patient records will increasingly be used for care planning, quality assessment, research, health planning and allocation of resources. Knowledge about the accuracy of such secondary data, however, is limited and only a few studies have been conducted on the accuracy of nursing recording. The aim of this study was to analyse the concordance between the nursing documentation in nursing homes and descriptions of some specific problems of nurses and patients. Comparisons were made between wards where nurses had received training in structured recording based on the nursing process (study group) and wards where no intervention had taken place (reference group). Data were collected from the patient records of randomly selected nursing home residents (n=85). The methods used were audits of patient records and structured interviews with residents and nurses. The study revealed considerable deficiencies in the accuracy of the patient records when the records were compared with the reports from nurses and residents. The overall agreement between the interview data from nurses and from the patient records was low. Concordance was better in the study group as compared with the reference group in which the recorded data were structured only following chronological order. The study unequivocally demonstrates that there are major limitations in using records as a data source for the evaluation, planning and development of care.
Scandinavian Journal of Caring Sciences 02/2001; 15(4):303-10. · 0.89 Impact Factor
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ABSTRACT: The meaning of elderly patients' experiences of living with chronic heart failure was studied. Narrative interviews were analysed using a phenomenological hermeneutic approach. 'Feeling imprisoned in illness' and 'feeling free despite illness' constituted the themes. These themes were interpreted as describing variations in awareness of the relationship between the self and the body. In theme 'feeling imprisoned in illness' the body's illness and disability hindered the subjects from being themselves. In the theme 'feeling free despite illness' the disabled body was not experienced as limiting, but rather as a part of the self. The patients' understanding of the illness must be interpreted by the caregiver, who also needs to be aware of different modes of communicating feeling about the illness.
Scandinavian Journal of Caring Sciences 02/2000; 14(2):130-6. · 0.89 Impact Factor
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European Heart Journal 04/1999; 20(5):393-4. · 10.48 Impact Factor
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ABSTRACT: The purpose of this study was to describe the effects on the contents and comprehensiveness of the nursing-care documentation in the patient records at nursing homes following an educational intervention. A review was made of records (n = 120) from nursing homes in six Swedish municipalities, allocated to a study group and a reference group. All the nursing home nurses in three municipalities received education concerning the nursing process and how to document according to the VIPS model. A retrospective audit of all nursing notes in the records from the nursing homes was made before and after the intervention. Improvements were found in the contents of the records in the study group. The number of notes on nursing history more than doubled. The occurrence of the recording of nursing diagnoses, goals and discharge notes increased. No corresponding changes were observed in the reference group. In the study group, an increase in the number of acceptable notes with contents on nursing history, status, nursing diagnosis, planned and implemented interventions, and nursing discharge notes was found. This increase was significant. The comprehensiveness in the documentation of single nursing problems was only slightly improved in the study group. No record met the requirements of the national regulations on nursing documentation or followed the nursing process thoroughly.
Scandinavian Journal of Caring Sciences 02/1999; 13(2):72-82. · 0.89 Impact Factor
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ABSTRACT: To evaluate the feasibility of a nurse-monitored, outpatient-care program for elderly patients previously hospitalized with chronic heart failure.
Patients with chronic heart failure hospitalized in the medical wards were screened to find those eligible for a randomized study to compare the effect of a nurse-monitored, outpatient-care programme aiming at symptom management, with conventional care. The inclusion criteria were patients classified in New York Heart Association classes III-IV, age 65 years, and eligibility for an outpatient follow-up programme. The total in-hospital population of patients discharged with a heart-failure diagnosis was surveyed. Eighty-nine per cent of all the hospitalized patients (n=1541) were 65 years old. Of these, 69% (n=1058) were treated in the medical wards which were screened. The study criteria were met by 158 patients (15%). No visits to the nurse occurred in 23 cases among the 79 patients randomized to the structured-care group (29%), mainly on account of death or fatigue. The numbers of hospitalizations and hospital days did not differ between the structured-care and the usual-care groups.
Given the selection criteria and the outline of the interventions, the outpatient, nurse-monitored, symptom-management programme was not feasible for the majority of these elderly patients with moderate-to-severe, chronic heart failure, mainly because of the small proportion of eligible patients and the high drop-out rate. Management of these patients would have to be more adjusted to their home situation.
European Heart Journal 09/1998; 19(8):1254-60. · 10.48 Impact Factor
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ABSTRACT: The development of common concepts and terms for nursing practice is crucial for the effective use of nursing-information systems. In Sweden, the VIPS model has been developed to support the systematic and common documentation of nursing care in patient records. The model has been widely used in different areas of nursing practice. This literature review was conducted as a part of a larger project to study the validity and reliability of the VIPS model, as well as its dissemination into the Swedish health-care system. The findings showed in general good reliability and content validity for the keywords in the VIPS model. The implications for the further development of the model are discussed.
Studies in health technology and informatics 02/1997; 46:408-10.
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ABSTRACT: The VIPS model for the documentation of nursing care in patient records was scientifically developed and published in 1991, with the aim of supporting the systematic documentation of nursing care and promoting individualized care. As the model seemed to be accepted and used in many parts of Sweden, a study was conducted in order to gather further information on the validity of the model, to describe the clinical and educational experience of its use and to refine it. Experience of the use of the model was gathered from a review of the scientific papers and other reports on it, from questionnaires addressed to nurses (n = 514), from comments by key informants, and from interviews with faculty members at all the nursing schools in the country. The findings showed that an intense process of change and development was occurring regarding nursing documentation. However, there were limitations in the use of the entire nursing process, especially in the specification of patient problems and the formulation of nursing diagnoses and nursing interventions. The keywords (Swedish spelling) of the VIPS model had good content validity in different areas of nursing care. The findings also indicated the need for further elaboration and revision of some of the keywords. A revised version of the VIPS model based on these findings is presented.
Journal of Advanced Nursing 11/1996; 24(4):853-67. · 1.48 Impact Factor
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ABSTRACT: Patient questionnaires are commonly used to assess patient satisfaction. This study reports on methodological experiences based on practical use of a Swedish questionnaire. The material consists of questionnaires from five different studies at some 60 wards in three hospitals. Four of the studies were performed by "routine procedure", while one was performed specially to study sampling, non-response and other losses. The results showed that a large number of patients were not given a questionnaire despite the fact that they should have been included according to the sampling criteria. In the special study barely half of those discharged answered a questionnaire corresponding to only about one in four in some studies performed routinely. Many of the patients excluded were probably in a difficult situation and their needs ought to be particularly noticed. This was true of patients who were old or confused, had language difficulties, were seriously ill, or who died during the care episode.
Quality assurance in health care: the official journal of the International Society for Quality Assurance in Health Care / ISQA 04/1993; 5(1):19-32.
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M Ehnfors
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ABSTRACT: According to Swedish laws and regulations, registered nurses are required to document nursing care in the patient's record. In this exploratory study, nurses were asked to describe how they made their nursing records. The nursing process model was used as a framework. The findings show that a system for admission assessment was fairly common, regarding objectives and a nursing care plan together with a nursing discharge note; more than half of the wards studied recorded these aspects at least occasionally. Nursing diagnoses were seldom recorded in practice. The results reveal serious limitations and deficiencies in the practice of nursing documentation and the implementation of current laws and regulations. This underlines the importance of emphasizing nursing knowledge and nursing documentation in nursing training and practice.
Scandinavian Journal of Caring Sciences 02/1993; 7(4):201-7. · 0.89 Impact Factor
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ABSTRACT: A review of 106 nursing records from 12 wards was conducted to categorize and quantify the content of the documentation and to consider the comprehensiveness of the recording for individual nursing problems. Audit instruments, based on a model for nursing documentation were developed and applied. The results show that admission assessment was missing in slightly less than half of all records, two-thirds had no nursing care plan and about one-third had no documentation on nursing outcome. About 90% of the records had no nursing diagnosis, no objective or no nursing discharge note. Notes on nursing status and nursing interventions were most common. Only one-third of the nursing problems identified had recording that gave information about the progress of the patient's problem. The analyses performed give information on the quality of nursing records which may be used to evaluate the quality of nursing care.
Scandinavian Journal of Caring Sciences 02/1993; 7(4):209-20. · 0.89 Impact Factor
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ABSTRACT: To describe the main problems, needs, risks, and nursing diagnoses and to examine the descriptions of some common and serious patient problems in nursing home records.
A retrospective audit of a stratified, random sample (N = 12O) of patient records from eight nursing homes in six Swedish municipalities.
Results showed major deficiencies in nursing documentation in the patient records. Only one record contained a comprehensive description of one patient problem that corresponded to the requirements of Swedish laws and regulations. No record was found that contained a systematic and comprehensive assessment of any of the selected problems based on established criteria or the use of an assessment instrument.
Nursing documentation in patient records does not reflect the use of systematic assessment and research-based instruments for determining patient care needs. Nurses need skills in assessment in the care of the elderly to be able to set priorities in care and deliver adequate care.
Nursing diagnosis: ND: the official journal of the North American Nursing Diagnosis Association 10(2):65-76.
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ABSTRACT: Four key concepts for good nursing care and a list of key words for nursing documentation in patient records were established and to some extent tried in clinical practice in Sweden. The method consisted of the following steps: extensive literature review, review of nursing records, development of a list of key words on two levels, a first level corresponding to the nursing process, and a second level consisting of subdivisions for possible use in practice, use and assessment in clinical practice by nurses and students, expert panel judgement and refinement of the key words including an examination of semantic accuracy of the Swedish key words by an expert in Nordic languages. The proposed key words are presented both in English and Swedish and explanations, comments and references are given. The version of key words presented here is subject to further testing for possible modifications.
Vård i Norden 11(3-4):12-31.
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