Nurses' Expectations of an Inpatient Portal for Hospitalized Patients and Caregivers

Abstract

Background Patient portals are intended to engage patients and enhance patient-centered care. Recent studies suggest that the information within portals could provide benefits to patients and their caregivers during hospitalization; however, few studies have examined nurse and staff expectations of portals when used in the hospital setting. Objective This article examines inpatient nurse and support staff expectations of a commercially available inpatient portal prior to its hospital-wide implementation. Methods In this cross-sectional study, nurses and support staff were surveyed 1 month prior to the implementation of an inpatient portal for patients. Items included respondent characteristics, satisfaction with online inpatient portal training, expectations of the effects of portal use on patients, caregivers, and staff, overall acceptance, and barriers to its implementation. Results Of 881 respondents, 73.0% were staff nurses, 18.4% nurse assistants, 4.3% unit coordinators, and 1.2% nurse managers. Respondents were generally satisfied with the portal information they received from online training. A majority liked the portal to some extent prior to its use (66.7%); however, they noted multiple implementation barriers, including: tablets would get lost/damaged (66.2% of respondents), patients and/or caregivers would have too many questions (48.5%), and staff would have problems integrating it into their workflow (44.7%). Respondents working on medical units had higher expectations (p < 0.001) and acceptance (p < 0.01) of the portal than those on surgical and intensive care units. Nurse managers were more positive than respondents with other job roles were (all p < 0.001). Conclusion Overall, nurse and support staff had high expectations of the effects of inpatient portal use prior to its hospital-wide implementation. They thought it would benefit patients and/or their caregivers; however, they also perceived several barriers to its implementation. These results will be used in conjunction with patient and caregiver perspectives to inform future efforts to evaluate and improve upon inpatient portal implementation and dissemination across health systems.

Improving Provisioning of an Inpatient Portal: Perspectives from Nursing Staff

“…1,2,21 Yet getting portals into the hands of hospitalized patients in a reliable manner remains a challenge for many hospitals. 8,11,12 Our findings suggested that the three strategies of establishing provisioning processes, having persistent unit-level champions, and actively promoting the distribution and use of MCB tablets can make a difference in unit provisioning performance. Notably, our study results suggest the need to further add to the list of work-related tasks falling to nursing staff who should prioritize, champion, and promote tablet provisioning.…”

“…1 2 21 Yet getting portals into the hands of hospitalized patients in a reliable manner remains a challenge for many hospitals. 8 11 12 Our findings suggested that the three strategies of establishing provisioning processes, having persistent unit-level champions, and actively promoting the distribution and use of MCB tablets can make a difference in unit provisioning performance.…”

“…5 6 7 Despite these benefits, use of inpatient portals in hospital settings can be difficult, with problems such as lost tablets, the need to address patient and family questions, and trouble integrating patient portals into clinical workflow reported as barriers. 8 9 To address these challenges, practices such as allowing patients to access portals on their own devices, offering portal training, and keeping portals updated with easy-to-understand content have been suggested as ways to facilitate inpatient portal use. 10 11 12 13 Yet, in the face of multiple competing priorities for care team members, integrating portal provisioning into nursing care team members' workflows continues to be a challenge.…”

“…10 11 12 13 Yet, in the face of multiple competing priorities for care team members, integrating portal provisioning into nursing care team members' workflows continues to be a challenge. 8 9 11 12 Current published reports offer minimal specific guidance for hospitals seeking to develop or improve their provisioning process—referring to the assignment of a hospital-provided tablet to patients by hospital nursing staff and enrollment of patients in the inpatient portal for use during the hospital stay. Thus, although inpatient portals provide benefits for both patients and health care teams, hospitals continue to face difficulties with tablet provisioning by their staff.…”

Facilitating Organizational Change to Accommodate an Inpatient Portal

“…6,7 While these outcomes are promising, other researchers have focused attention on upstream factors that contribute to the success of inpatient portals, such as their use 6,[8][9][10] and usability, [11][12][13][14] the patient's experience of the portal, [15][16][17][18] and the care team's expectations of and experience with the portal. [19][20][21][22] This evidence provides insight into the nuanced ways in which different stakeholders interact with the technology. Importantly, the growing evidence regarding inpatient portals highlights the collaborative aspects of the technology between the patient and the care team with both optimistic potential and cautious pragmatism.…”