Change in nurses’ psychosocial characteristics pre- and post-electronic medical record system implementation coinciding with the SARS-CoV-2 pandemic: pre- and post-cross-sectional surveys

Jedwab, Rebecca M; Hutchinson, Alison; Manias, Elizabeth; Calvo, Rafael A.; Dobroff, Naomi; Redley, Bernice

doi:10.1016/j.ijmedinf.2022.104783

Cited by 10 publications

(23 citation statements)

References 31 publications

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“…This qualitative descriptive study used data collected from focus group and individual interviews and free-text responses to an open-ended question at the end of a survey: “Please use the box below for any additional comments on your experiences of EMR.” Qualitative data were collected in the context of a large mixed methods pre- and postimplementation study. Preimplementation qualitative data and pre-post survey findings have been reported elsewhere [ 14 - 16 ].…”

Section: Methodsmentioning

confidence: 99%

Nurses’ Experiences After Implementation of an Organization-Wide Electronic Medical Record: Qualitative Descriptive Study

Jedwab¹,

Manias²,

Hutchinson³

et al. 2022

JMIR Nursing

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Background Reports on the impact of electronic medical record (EMR) systems on clinicians are mixed. Currently, nurses’ experiences of adopting a large-scale, multisite EMR system have not been investigated. Nurses are the largest health care workforce; therefore, the impact of EMR implementation must be investigated and understood to ensure that patient care quality, changes to nurses’ work, and nurses themselves are not negatively impacted. Objective This study aims to explore Australian nurses’ postimplementation experiences of an organization-wide EMR system. Methods This qualitative descriptive study used focus group and individual interviews and an open-ended survey question to collect data between 12 and 18 months after the implementation of an EMR across 6 hospital sites of a large health care organization in Victoria, Australia. Data were collected between November 2020 and June 2021, coinciding with the COVID-19 pandemic. Analysis comprised complementary inductive and deductive approaches. Specifically, reflexive thematic analysis was followed by framework analysis by the coding of data as barriers or facilitators to nurses’ use of the EMR using the Theoretical Domains Framework. Results A total of 158 nurses participated in this study. The EMR implementation dramatically changed nurses’ work and how they viewed their profession, and nurses were still adapting to the EMR implementation 18 months after implementation. Reflexive thematic analysis led to the development of 2 themes: An unintentional divide captured nurses’ feelings of division related to how using the EMR affected nurses, patient care, and the broader nursing profession. This time, it’s personal detailed nurses’ beliefs about the EMR implementation leading to bigger changes to nurses as individuals and nursing as a profession than other changes that nurses have experienced within the health care organization. The most frequent barriers to EMR use by nurses were related to the Theoretical Domains Framework domain of environmental context and resources. Facilitators of EMR use were most often related to memory, attention, and decision processes. Most barriers and facilitators were related to motivation. Conclusions Nurses perceived EMR implementation to have a mixed impact on the provision of quality patient care and on their colleagues. Implementing technology in a health care setting was perceived as a complex endeavor that impacted nurses’ perceptions of their autonomy, ways of working, and professional roles. Potential negative consequences were related to nursing workforce retention and patient care delivery. Motivation was the main behavioral driver for nurses’ adoption of EMR systems and hence a key consideration for implementing interventions or organizational changes directed at nurses.

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Section: Methodsmentioning

confidence: 99%

Nurses’ Experiences After Implementation of an Organization-Wide Electronic Medical Record: Qualitative Descriptive Study

Jedwab¹,

Manias²,

Hutchinson³

et al. 2022

JMIR Nursing

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“…34 Nurses were also dis satisfied with the complexity and lack of intuitiveness of the system, as well as the need to remember how to navigate it and access information. 24…”

Section: Nurses' Perceived Ehr Satisfactionmentioning

confidence: 99%

“…20 Nurses reported that they were able to view all clinical information in one location, improving legibility and reducing duplication of documentation. 24 Nurses reported that EHRs improved efficiency by reducing time spent on transcribing nursing reports, allowing nurses to allocate more time to patient care. 22 Nurses perceive that EHRs enabled easier and more immediate communication of patient information, thus supporting them in staying up to date with changes in patient care and facilitating clinicaldecision-making.…”

Section: Nurses' Perceived Ehr Performancementioning

confidence: 99%

A Systematic Review of Nurses' Perceptions of Electronic Health Record Usability Based on the Human Factor Goals of Satisfaction, Performance, and Safety

Park,

Marquard,

Austin

et al. 2024

CIN: Computers, Informatics, Nursing

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The poor usability of electronic health records contributes to increased nurses' workload, workarounds, and potential threats to patient safety. Understanding nurses' perceptions of electronic health record usability and incorporating human factors engineering principles are essential for improving electronic health records and aligning them with nursing workflows. This review aimed to synthesize studies focused on nurses' perceived electronic health record usability and categorize the findings in alignment with three human factor goals: satisfaction, performance, and safety. This systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Five hundred forty-nine studies were identified from January 2009 to June 2023. Twenty-one studies were included in this review. The majority of the studies utilized reliable and validated questionnaires (n = 15) to capture the viewpoints of hospital-based nurses (n = 20). When categorizing usability-related findings according to the goals of good human factor design, namely, improving satisfaction, performance, and safety, studies used performance-related measures most. Only four studies measured safety-related aspects of electronic health record usability. Electronic health record redesign is necessary to improve nurses' perceptions of electronic health record usability, but future efforts should systematically address all three goals of good human factor design.

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“…Although there is evidence negatively linking EMR systems and physician well‐being, until recently there was limited literature on how an EMR system may affect nurses' well‐being (Downing et al, 2018; Gardner et al, 2019; Jedwab, Hutchinson, et al, 2021, 2022; Nguyen et al, 2021; Rotenstein et al, 2018). Unintended negative impacts on nurses' work motivation, engagement and satisfaction have consequences for patient safety, nurses' well‐being and workforce retention (Jedwab, Hutchinson, et al, 2022; Melnick et al, 2021). This research addresses the current gap in understanding the complex contextual factors, mechanisms and outcomes that influence nurses with electronic medical record implementation (Nguyen et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…EMRs have been reported to contribute to nurses' difficulties in synthesising and contextualising patient clinical information, resulting in difficulty in planning patient care (Wisner et al, 2019). Nurses' adoption of EMR systems is influenced by their attitude or perception, which, in turn, can be examined using the concepts of motivation, engagement, satisfaction and well‐being (Jedwab, Hutchinson, et al, 2022; Melnick et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Impacts of technology implementation on nurses' work motivation, engagement, satisfaction and well‐being: A realist review

Jedwab

Manias

Redley

et al. 2023

Journal of Clinical Nursing

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AimTo examine current literature for causal explanations on how, why and under what circumstances, implementation of a new hospital electronic medical record system or similar technology impacts nurses' work motivation, engagement, satisfaction or well‐being.BackgroundImplementation of new technology, such as electronic medical record systems, affects nurses and their work, workflows and inter‐personal interactions in healthcare settings. Multiple individual and organisational‐level factors can affect technology adoption by nurses and may have negative consequences for nurses and patient safety.DesignFive‐step realist review method and Realist And Meta‐narrative Evidence Syntheses: Evolving Standards checklist was used to guide this review. Eight initial theories (programme theories) were used as the basis to explore, examine and refine literature from a range of sources.Data SourcesLiterature from five databases (APA PsycInfo, CINAHL, Embase, IEEE Xplore and MEDLINE Complete) and grey literature (from 1 January 2000 to 31 October 2021) were systematically searched and retrieved on 4 November 2021.ResultsIn all, 8980 records were screened at the title and abstract level, of which 1027 full texts were screened and 10 were included in the review. Seven studies assessed concepts in both pre‐ and post‐technology implementation. Most common contexts related to knowledge, rationale and skills to use new technology. Mechanisms that impacted nurses or nursing care delivery included: nurses' involvement in technology implementation processes; nurses' perceptions, understanding and limitations of technology impact(s) on patient care delivery; social supports; skills; implementation attitude and hardware. Work satisfaction was the most frequently examined outcome. An analysis led to nine final programme theories (including two original, six revised and one new programme theory).ConclusionNurses must be informed about the rationale for new technology and have the knowledge and skills for its use. Understanding nurses' work motivation and attitudes related to technology adoption in the workplace can support work engagement, satisfaction and well‐being.Implications for the ProfessionComplex contexts and mechanisms play a role in nurses' work motivation, engagement, satisfaction and well‐being with the implementation of new technology into healthcare settings.Relevance to Clinical PracticeNurses, their work and workflows are all influenced by the implementation of new technologies (such as electronic medical records), which in turn has consequences for patient safety and quality of care.Patient or Public ContributionNo patient or public contribution.Prospero Registration NumberCRD42020131875 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131875).

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Change in nurses’ psychosocial characteristics pre- and post-electronic medical record system implementation coinciding with the SARS-CoV-2 pandemic: pre- and post-cross-sectional surveys

Cited by 10 publications

References 31 publications

Nurses’ Experiences After Implementation of an Organization-Wide Electronic Medical Record: Qualitative Descriptive Study

Nurses’ Experiences After Implementation of an Organization-Wide Electronic Medical Record: Qualitative Descriptive Study

A Systematic Review of Nurses' Perceptions of Electronic Health Record Usability Based on the Human Factor Goals of Satisfaction, Performance, and Safety

Impacts of technology implementation on nurses' work motivation, engagement, satisfaction and well‐being: A realist review

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