Linsey M. Steege

Information needs and information-seeking behaviour analysis of primary care physicians and nurses: a literature review

BACKGROUND The increase in the adoption of electronic health records (EHR) has contributed to physicians and nurses experiencing information overload. To address the problem of information overload, an assessment of the information needs of physicians and nurses will assist in understanding what they view as useful information to make patient care more efficient. OBJECTIVE To analyse studies that assessed the information needs and information-seeking behaviour of physicians and nurses in a primary care setting to develop a better understanding of what information to present to physicians when they making clinical decisions. METHOD A literature review of studies was conducted with a comprehensive search in PubMed, cinahl, scopus, as well as examination of references from relevant papers and hand-searched articles to identify articles applicable to this review. RESULTS Of the papers reviewed the most common information needs found among physicians and nurses were related to diagnoses, drug(s) and treatment/therapy. Colleagues remain a preferred information source among physicians and nurses; however, a rise in Internet usage is apparent. CONCLUSION Physicians and nurses need access to the Internet and job-specific resources to find practitioner-oriented information. In addition, effective usage of resources is important for improving patient care.

Health information needs, sources, and barriers of primary care patients to achieve patient-centered care: A literature review

To synthesize findings from previous studies assessing information needs of primary care patients on the Internet and other information sources in a primary care setting. A systematic review of studies was conducted with a comprehensive search in multiple databases including OVID MEDLINE, CINAHL, and Scopus. The most common information needs among patients were information about an illness or medical condition and treatment methods, while the most common information sources were the Internet and patients’ physicians. Overall, patients tend to prefer the Internet for the ease of access to information, while they trust their physicians more for their clinical expertise and experience. Barriers to information access via the Internet include the following: socio-demographic variables such as age, ethnicity, income, education, and occupation; information search skills; and reliability of health information. Conclusion: Further research is warranted to assess how to create accurate and reliable health information sources for both Internet and non-Internet users.

Evaluation of physically and mentally fatiguing tasks and sources of fatigue as reported by registered nurses

AIMS To identify fatiguing tasks and develop a model of sources of fatigue in nursing work. BACKGROUND Research has identified multiple factors contributing to occupational fatigue; however, comprehensive consideration of diverse factors identified by nurses as contributing to fatigue in nursing work systems is lacking. METHODS Content and frequency analyses were performed on previously unpublished data from an online survey of registered nurses. Responses from 100 registered nurses to questions related to the most fatiguing tasks in their work and factors that cause those tasks to be most fatiguing were analysed. RESULTS Physically demanding patient care tasks, and organisation, management and logistics tasks, respectively, were listed as the most frequent physically and mentally fatiguing. Time and multitasking demands were listed frequently as sources of both fatigue dimensions. CONCLUSIONS Registered nurses reported working in environments that include physically and mentally fatiguing tasks. They identified factors related to work content demands, including physical and mental task demands as well as time and multitasking demands, as most frequently contributing to fatigue. IMPLICATIONS FOR NURSING MANAGEMENT This work and our conceptual model of sources of fatigue provide a framework to support nurses, nursing managers and administrators to develop strategies to reduce fatigue among RNs.

Physician Information Needs and Electronic Health Records (EHRs): Time to Reengineer the Clinic Note

Background: Primary care physicians face cognitive overload daily, perhaps exacerbated by the form of electronic health record documentation. We examined physician information needs to prepare for clinic visits, focusing on past clinic progress notes. Methods: This study used cognitive task analysis with 16 primary care physicians in the scenario of preparing for office visits. Physicians reviewed simulated acute and chronic care visit notes. We collected field notes and document highlighting and review, and we audio-recorded cognitive interview while on task, with subsequent thematic qualitative analysis. Member checks included the presentation of findings to the interviewed physicians and their faculty peers. Results: The Assessment and Plan section was most important and usually reviewed first. The History of the Present Illness section could provide supporting information, especially if in narrative form. Physicians expressed frustration with the Review of Systems section, lamenting that the forces driving note construction did not match their information needs. Repetition of information contained in other parts of the chart (eg, medication lists) was identified as a source of note clutter. A workflow that included a patient summary dashboard made some elements of past notes redundant and therefore a source of clutter. Conclusions: Current ambulatory progress notes present more information to the physician than necessary and in an antiquated format. It is time to reengineer the clinic progress note to match the workflow and information needs of its primary consumer.

Multi-disciplinary communication networks for skin risk assessment in nursing homes with high IT sophistication

BACKGROUND The role of nursing home (NH) information technology (IT) in quality improvement has not been clearly established, and its impacts on communication between care givers and patient outcomes in these settings deserve further attention. OBJECTIVES In this research, we describe a mixed method approach to explore communication strategies used by healthcare providers for resident skin risk in NH with high IT sophistication (ITS). METHODS Sample included NH participating in the statewide survey of ITS. We incorporated rigorous observation of 8- and 12-h shifts, and focus groups to identify how NH IT and a range of synchronous and asynchronous tools are used. Social network analysis tools and qualitative analysis were used to analyze data and identify relationships between ITS dimensions and communication interactions between care providers. RESULTS Two of the nine ITS dimensions (resident care-technological and administrative activities-technological) and total ITS were significantly negatively correlated with number of unique interactions. As more processes in resident care and administrative activities are supported by technology, the lower the number of observed unique interactions. Additionally, four thematic areas emerged from staff focus groups that demonstrate how important IT is to resident care in these facilities including providing resident-centered care, teamwork and collaboration, maintaining safety and quality, and using standardized information resources. CONCLUSION Our findings in this study confirm prior research that as technology support (resident care and administrative activities) and overall ITS increases, observed interactions between staff members decrease. Conversations during staff interviews focused on how technology facilitated resident centered care through enhanced information sharing, greater virtual collaboration between team members, and improved care delivery. These results provide evidence for improving the design and implementation of IT in long term care systems to support communication and associated resident outcomes.

Dimensions of Fatigue as Predictors of Performance: A Structural Equation Modeling Approach Among Registered Nurses

OCCUPATIONAL APPLICATIONS This study developed and evaluated a quantitative model relating dimensions of occupational fatigue and performance among registered nurses. Fatigue is a likely contributing factor to medical errors, with implications for both patient and provider safety. Thus, there is an ongoing need to further understand, define, and quantify the effects of fatigue on performance in healthcare workers, particularly nurses. The final model developed here supports existing evidence that mental and physical fatigue are distinct dimensions that contribute to a separate construct—total fatigue. Further, mental and physical fatigue dimensions had both direct and indirect effects on perceptions of mental and physical performance in this population. This model can be used by practitioners to evaluate fatigue interventions and estimate potential changes in perceived performance based on subjective measures of performance. TECHNICAL ABSTRACT Background: While fatigue has been linked to performance decrements in nurses, relationships between dimensions of fatigue and the effects of fatigue on performance have not been fully defined. Purpose: A quantitative model was developed here to relate mental and physical dimensions of fatigue to total fatigue and to evaluate direct and indirect effects of dimensions of fatigue on dimensions of performance. Methods: Data from a previous survey of registered nurses were used to estimate the model using structural equation modeling. Initial hypothesized and alternate models were evaluated for fit, and a final model was cross-validated with a subset of the sample. Results: All models had adequate fit to the data. Pathways in the initial and validation models indicated that total fatigue does exist as a construct and is directly affected by mental and physical fatigue. Direct effects were found between mental fatigue and mental performance and between physical fatigue and physical performance. Total fatigue, however, did not play a mediating role in the relationship between dimensions of fatigue and performance. Conclusions: The final model provides quantitative estimates of the strength of relationships between perceived dimensions of occupational fatigue and performance in registered nurses, and it can be used to guide the development and evaluation of fatigue interventions.

Hospital nurse force theory: a perspective of nurse fatigue and patient harm.

This article is focused on the primary finding of the 2010 Institute of Medicine report asserting that nurses practice to the full extent of their education and training. An evolving theoretical perspective for hospital nursing practice is proposed as a basis for reaching this goal. This article describes the background and current factors influencing professional hospital nursing practice, presents a theoretical model for future research designed to optimize the power of hospital nursing practice, using a newly evolved concept of “nurse force,” and discusses the implications of nurse force theory on perspectives of hospital nurse fatigue and patient harm.

Optimal nurse scheduling based on quantitative models of work-related fatigue

Previous nurse scheduling models have mainly focused on managerial constraints to minimize costs. Although some models incorporate nurse preferences and safety guidelines, human factors considerations related to performance of nurses (fatigue) have not been studied extensively. Fatigue has been linked to nursing injuries and medical errors, and shown to be impacted by schedule-related parameters (shift length). Thus, the objective of this article was to develop a nurse scheduling model incorporating quantitative models of fatigue. This model can help a nurse manager to make schedule-related decisions by highlighting trade-offs among many (conflicting) objectives including nurse shift preferences and nurse fatigue levels obtained from two different fatigue models, namely survey-based and circadian function-based fatigue models. The data used in the numerical experiments were obtained from real patient census data and various surveys of nurses working in different hospitals across the United States. Numerical results show that it is possible to obtain Pareto-optimal schedules where the nurse fatigue levels are significantly reduced for a slight decrement in nurse preferences.

Addressing human computer interaction issues of electronic health record in clinical encounters

Electronic Health Records (EHRs) are known to reduce medical errors and store comprehensive patient information, and they also impact the physician-patient interaction during clinical encounters. This study reviewed the literature to (1) identify the most common challenges to patient-physician relations while using an EHR during a clinical visit, (2) discuss limitations of the research methodologies employed, and (3) suggest future research directions related to addressing human computer interaction issues when physicians use an EHR in clinical encounters.

Getting Patients Walking: a Pilot Study of Mobilizing Older Adult Patients via a Nurse-Driven Intervention

To develop a system‐based intervention including five components that target barriers to nurse‐initiated patient ambulation.