Point-of-care documentation has been identified as a patient safety measure for improving accuracy and timeliness of data. To evaluate the barriers that nurses and nurse aide/clinical technicians encounter for electronic point-of-care documentation, we conducted surveys on a telemetry unit at a southwestern Pennsylvania community hospital. Our first survey revealed that the location of the in-room computers, perceived lack of in-room computer reliability, Health Insurance Portability and Accountability Act/privacy concerns, and perceptions of the patients' response to charting on computers in patient rooms were all barriers to point-of-care documentation. Our second survey revealed that workflow priority issues were also a barrier to point-of-care documentation, as staff members did not rate documentation as a high priority in terms of delivering timely medical care. Changes in both nursing practices and hospital infrastructure may be needed if these barriers to point-of-care documentation are to be overcome.
We report on the development of an instrument to measure clinicians' perceptions of their personal power in the workplace in relation to resistance to computerized physician order entry (CPOE). The instrument is based on French and Raven's six bases of social power and uses a semantic differential methodology. A measurement study was conducted to determine the reliability and validity of the survey. The survey was administered online and distributed via a URL by email to 19 physicians, nurses, and health unit coordinators from a university hospital. Acceptable reliability was achieved by removing or moving some semantic differential word pairs used to represent the six power bases (alpha range from 0.76 to 0.89). The Semantic Differential Power Perception (SDPP) survey validity was tested against an already validated instrument and found to be acceptable (correlation range from 0.51 to 0.81). The SDPP survey instrument was determined to be both reliable and valid.
Implementation of electronic health records (EHR), particularly computerized physician/provider order entry systems (CPOE), is often met with resistance. Influence presented at the right time, in the right manner, may minimize resistance or at least limit the risk of complete system failure. Combining established theories on power, influence tactics, and resistance, we developed the Ranked Levels of Influence model. Applying it to documented examples of EHR/CPOE failures at Cedars-Sinai and Kaiser Permanente in Hawaii, we evaluated the influence applied, the resistance encountered, and the resulting risk to the system implementation. Using the Ranked Levels of Influence model as a guideline, we demonstrate that these system failures were associated with the use of hard influence tactics that resulted in higher levels of resistance. We suggest that when influence tactics remain at the soft tactics level, the level of resistance stabilizes or de-escalates and the system can be saved.
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