Nursing staff's assessments of medication management process in the psychiatric and operative domains: A cross-sectional study after introduction of an electronic medication chart.

AIMS AND OBJECTIVES: To describe nursing staff's assessments of medication management process in the psychiatric and operative domains after introduction of an electronic medication chart. BACKGROUND: The medication management process includes all structures and practices within the organisation that guide and support medication administration and related procedures. DESIGN: A cross-sectional survey. METHODS: A Finnish version of the Medication Administration System - Nurses Assessment of Satisfaction (modified MAS-NAS) paper-based questionnaire was sent to all nursing staff (N = 855) working in operative (n = 498) and psychiatric (n = 357) domains in one central hospital. Data were analysed using statistical methods. RESULTS: In total, 324 nursing staff members participated. More than half agreed that medication management is efficient (64%), safe for patients (76%), and that the current medication administration system provides the necessary medical treatment information (e.g. prescriptions by physicians, medication data) (64%). Respondents' overall satisfaction with medication management process was slightly above average on a scale from 1 to 10 (mean = 6.2; SD = 1.8; median = 7, range 2-9). Respondents who used electronic medication chart reported higher overall satisfaction with medication management process (median = 7, mean = 6.1, SD = 1.8 and range 2-9) than those not using it (median = 6.5, mean = 6.3, SD = 1.6 and range 2-9). No statistically significant difference was found (U = 8552.000, p = 0.33). CONCLUSIONS: This study revealed several problems in the medication management process. The results can be used in developing the medication management process. RELEVANCE TO CLINICAL PRACTICE: Electronic medication chart should be used and developed further in terms of efficacy, safety and access. One year after the electronic medication chart was introduced, only half of the respondents had used it. That is why implementation of electronic systems or technological applications should be carefully considered as a whole.

Daily functioning support - a qualitative exploration of rehabilitative approach in acute hospitalised care.

OBJECTIVES: Hospitalised patients are at risk of temporary or permanent loss of functioning which impacts their future independence. Implementation of a rehabilitative approach in everyday nursing in the acute care setting may produce good therapeutic results and promote independent daily living of patients. Thus, the aim of the study was to explore and understand the patterns of a rehabilitative approach in acute hospital wards from the perspective of interdisciplinary team members. Specifically, our aim was to identify the factors promoting and preventing a rehabilitative approach. METHOD: We conducted four focus group interviews with 21 participants, including multidisciplinary team members from acute hospital wards. Data were analysed with conventional inductive content analysis. RESULTS: The findings highlighted that the rehabilitative approach, as a personal way of working and personal working attitude, was a part of comprehensive nursing. The main goals of the rehabilitative approach were to support the physical functioning of the patients and their independent initiative and individuality during clinical care in hospital ward. The promoting and preventing factors that influenced the development of the rehabilitative approach consisted of personal factors, organisational factors and the physical settings of the hospital wards. CONCLUSION: The findings of this study indicate that the rehabilitative approach in nursing focused on supporting the physical functioning, independence and self-confidence of the patient. The staff highlighted that interdisciplinary teamwork was one feature of the rehabilitative approach. The rehabilitative approach in nursing should be established as a part of everyday activity in clinical practice.

Risks and prevalence of pressure ulcers among patients in an acute hospital in Finland.

OBJECTIVE: To quantify pressure ulcer (PU) prevalence and to describe and identify the PU risk factors in acute hospital wards. METHOD: A descriptive quantitative study was performed in 13 wards in a central hospital in Finland. The study included PU risk evaluation using the Braden risk assessment method, and full skin and medical assessment of consenting adult patients. Patients in paediatric, maternity and psychiatric wards, and in the intensive care unit were excluded. Patient's PUs were examined on the ward, and evaluated and classified using the international European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel (EPUAP/NPUAP) Pressure Ulcer Classification System. Demographic data, the Braden risk assessment scale, skin assessment, and the location and severity of PUs were also recorded. RESULTS: A sample of 229 inpatients was examined for signs of PUs on one day in 2013. The overall PU prevalence was 8.7% (20 patients). Of those assessed as 'at risk of developing PUs', four patients (1.7%) were considered at 'very high risk', 39 patients (17.0%) at 'high risk', and 60 patients (26.2%) with a 'moderate risk'. The patient's age and length of treatment period were associated with PU risk, while only length of treatment period was associated with PU prevalence. Older patients had a higher risk of PUs than younger ones. The longer the hospital stay, the higher the PU risk was. In addition, patients with a long hospital stay more often had a PU. CONCLUSION: According to the study, PUs occur with significant frequency in acute hospital wards. It is important to carry out PU prevention actions among all patient groups, but risk increases among older patients and those who, for any reason, stay in hospital for a longer period of time.

Views of patient, healthcare professionals and administrative staff on flow of information and collaboration in a regional health information exchange: a qualitative study.

BACKGROUND: Nowadays, patients can be more involved in developing healthcare services with their healthcare professionals. Patient-centred information is a key part of improving regional health information exchange (HIE), giving patients an active role in care management. AIM: The aim was to get a deeper understanding of the flow of information and collaboration in one hospital district area from the viewpoint of patients, healthcare professionals and administrative staff. METHODS: The data were collected by themed interviews and analysed using both deductive and inductive content analyses. The interview themes were the flow of information and collaboration after 5 years of HIE usage in one hospital district area in Finland. FINDINGS: Health information exchange usage had changed the regional flow of information after the 5-year period. The patients were satisfied that their primary care physician was able to access their special care information. The experiences of healthcare professionals and administrative staff also showed that information availability and information exchange had improved regionally. HIE usage was also found to have improved regional collaboration between different organisations in patient health care. CONCLUSIONS: It was recognised that patients had taken on more responsibility for transferring their follow-up treatment information. Healthcare information exchange between professionals not only improves patient care or patient involvement in their own care, but it also requires that patient self-care or self-care management is integrated into HIE systems to share information not only among professionals, but also between patients and professionals. This information will be used in the development of healthcare systems to meet more the developing of the continuity of care the patient's point of view.

Do nurses feel stressed? A perspective from primary health care.

This study describes nurses' experiences of stress in primary healthcare settings, and examines correlations between stress and personal factors. There were 187 nurses from 18 public primary care centers participating, drawn from one county of Lithuania. The Expanded Nursing Stress Scale was used to evaluate the study data. The study indicates that in primary healthcare centers, nurses working with adult patients experienced less stress than those working with younger patients. The most frequently reported stressors were those related to death and dying, and conflicts with physicians and patients and their families. In particular, older nurses more frequently experienced stress related to death and dying. The intensity of nurses' stress in conflict situations with physicians was related to age, however, the depth of work experience in the healthcare setting was more influential. Findings indicate that more detailed research is needed regarding stress experiences in primary health care, and especially the related impact of the social contexts involved in the setting.

The utilization rate of the regional health information exchange: how it impacts on health care delivery outcomes.

UNLABELLED: Interest in improving quality and effectiveness is the primary driver for health information exchange efforts across a health care system to improve the provision of public health care services. OBJECTIVE: The aim here was to describe and identify the impact of a regional health information exchange (HIE) using quantitative statistics for 2004-2008 in one hospital district in Finland. DESIGN: We conducted a comparative, longitudinal 5-year follow-up study to evaluate the utilization rates of HIE, and the impact on health care delivery outcomes. The selected outcomes were total laboratory tests, radiology examinations, appointments, emergency visits, and referrals. RESULTS: The HIE utilization rates increased annually in all 10 federations of municipalities, and the viewing of reference information increased steadily in each professional group over the 5-year study period. In these federations, a significant connection was found to the number of laboratory tests and radiology examinations, with a statistically significant increase in the number of viewed references and use of HIE. The higher the numbers of emergency visits and appointments, the higher the numbers of emergency referrals to specialized care, viewed references, and HIE usage among the groups of different health care professionals. CONCLUSIONS: There is increasing interest in HIE usage through regional health information system among health professionals to improve health care delivery regionally and bring information on the patient directly to care delivery. It will be important to study which changes in working methods in the service system are explained by RHIS. Also, the experiences of the change that has taken place should be studied among the different stakeholders, administrative representatives, and patients.

Electronic Medication Administration System Supports Safe Medication Administration.

The purpose of this study is to describe nurses' views of what supports safe medication administration in the current electronic medication administration system. Data was collected at the turn of 2014-2015 and open-ended answers were inductively analyzed using content analysis. The system's usefulness, good usability, and the feature that there is extra information available on medications and the patient-specific information needed in medication administration are elements that support safe medication administration. The study identifies wide support for the electronic medication administration system in safe medication administration.

Experiences with the electronic nursing discharge summary.

The aim of this paper is to describe nursing staff's experiences with the Electronic Nursing Discharge Summary (ENDS) [Hoitotyön yhteenveto, HOIY]. This study is a part of the Salpa project of the Satakunta Hospital District (SHD). The goal of the project was to implement the Regional Information System (Fiale System) for social and health care in Satakunta, Finland. During the project (2004-2007), 3600 social and health care professionals were trained to use the Fiale System. The ENDS is used in the patient transfer phase. It complies with the national definition work of core information and can be opened through the Fiale System. The ENDS includes basic information on the care period in question for purposes of further care. 22 nurses, both those processing and those receiving the ENDS were interviewed by phone in 2006 about their experiences and satisfaction with the ENDS. The data was analyzed using content analysis. Experiences with this system are mainly positive. When done carefully, the ENDS enables real time communication, fast enough and safely, though the new structure needs consideration and documentation takes time. On the basis of this and other studies it can be concluded that acceptance of the nursing documentation process is more important than IT skills [1]. The ENDS has a guiding role as a tool for supporting nurses in their day-to-day documentation.

Implementation of a regional health information system - overview of selected outcomes in one hospital district.

The aim of this paper is to give an overview of some selected outcomes after the implementation of a Regional Health Information System (RHIS) in one hospital district in Finland. The implementation project of the Regional Health Information Systems (SALPA) administered by Satakunta Hospital District in 2004 - 2007 is comprised of integrated services between primary, secondary and tertiary care. The general aim was to provide the member municipalities' access to specialised health care information and sustain seamless care, and to enhance organisational information exchange regardless of time and place. The data were collected by using computer-based statistics and reports in 2004 - 2007 of the selected outcomes: laboratory and radiology tests and appointments in the member municipalities of the hospital district area. Preliminary results of the selected outcomes indicate that the laboratory tests seem mainly to have increased. However, the radiographic tests and the clinicians' appointments seem mainly to have reduced. A deeper investigation should be done in order to determine the outcomes in the field under investigation.

Health care information systems - the outcomes of the integrated use of health information.

The objective of this study is to formulate a clearer picture of how a regional healthcare information system affects the completeness of patient health care and health care delivery. The purpose is to study how the implementation of regional health information systems has influenced outcomes in health care delivery in one hospital area in Finland. The essential concepts in this study are health care information systems and outcomes. The research consists of four different phases. Research material will be processed through qualitative and quantitative research methods and statistical tests.

Contents of Informational and Management Continuity of Care.

Continuity of patient care (COC) is considered an essential feature of good quality care, but the ambiguity of the concept has given rise to methodological challenges in scientific studies. This study has a strong link to the functional definitions of electronic health records (EHR). In order to evaluate how COC is achieved, through a discharge summary, for example, the contents of COC should be defined. Conceptual consensus on COC as a multidimensional concept has increased. This study was conducted to provide an overview of the dimensions and descriptions of informational and management continuity of care. A scoping review was conducted. We found that informational continuity of care refers to data tool, data content, data structures or information quality related processes. Management continuity of care refers to information flow, co-operation, co-ordination, multiprofessionality or management processes. We identified the need to define next the contents of relational and cross-border continuities.

Usefulness of a Regional Health Care Information System in primary care: a case study.

The goal of this paper is to describe some benefits and possible cost consequences of computer based access to specialised health care information. A before-after activity analysis regarding 20 diabetic patients' clinical appointments was performed in a Health Centre in Satakunta region in Finland. Cost data, an interview, time-and-motion studies, and flow charts based on modelling were applied. Access to up-to-date diagnostic information reduced redundant clinical re-appointments, repeated tests, and mail orders for missing data. Timely access to diagnostic information brought about several benefits regarding workflow, patient care, and disease management. These benefits resulted in theoretical net cost savings. The study results indicated that Regional Information Systems may be useful tools to support performance and improve efficiency. However, further studies are required in order to verify how the monetary savings would impact the performance of Health Care Units.

Development of Elderly Service System on the Basis of Big Data.

This presentation includes action proposals with impact to growing older populations and shows how a plan for developing elderly service system was created as one part of a bigger welfare plan at one hospital district in Finland. The central part of preparing a plan was the public administration anonymous Big Data concerning ageing and functional capacity. The aim was to establish a customer-oriented plan based on the need for population service.

Perception of work-related empowerment of nurse managers.

PURPOSE/AIM: The paper aims to analyse the perception of being empowered according to the self-evaluation of nurse managers, presenting it as structural and psychological empowerment. METHODS: A questionnaire-based study was conducted. The sample consisted of 193 nurse managers working in a total of seven university and general level hospitals in Lithuania. The Conditions of Work Effectiveness Questionnaire-II measuring structural empowerment and the Work Empowerment Questionnaire measuring psychological empowerment were used. RESULTS: The paper reveals that nurse managers experienced structural empowerment at a moderate level and were highly psychologically empowered. CONCLUSIONS: These findings are in line with previous research. The results showed that particular background factors were related to aspects of empowerment. The findings of this research can be used to examine the structural and psychological aspects that function as barriers to feeling empowered. The results are also useful for chief nurses who are involved in the recruitment and retention of nurse managers. Further research is needed to look into the question of improving formal power issues, e.g. the rewards for innovation at work, and also outcome empowerment aspects that may affect changes in the way that nurse managers carry out their work.

Development Needs of Electronic Nursing Discharge Summaries in Finland.

In this study the development needs of Electronic Nursing Discharge summaries (ENDS) mentioned by nursing professionals are classified and addressed using the FITT model ("Fit between Individuals, Task and Technology") framework.

The effects of electronic health record on the flow of information - a pilot study.

Papery or electrical data processing tools are used for documenting, transmitting, evaluating, recording and archiving patient data. An implementation of an electronic health record (EHR) is a complex and multi-dimensional entity. There is a need to ensure that the impact of EHR is fully evaluated. For systematic evaluation of the Hospital Information System is developed and tested a HIS-monitor (Ammenwerth et al 2007, 2011). HIS-monitor testing is one part of the evaluation study of the implementation of EHR at the Satakunta Hospital District (SHD) in Finland. With 2500 health care professionals SHD produces specialized medical care services for 226 000 residents. The aim of this study is to evaluate the effects of EHR on the flow of information. The study design is before and after of EHR system implementation. At the pilot phase the survey material was collected and the HIS-monitor questionnaire was tested. Results show that current data processing tools do not support enough the flow of information. Results were used in further development of HIS-monitor.

The outcomes of regional healthcare information systems in health care: a review of the research literature.

The resulting regional healthcare information systems were expected to have effects and impacts on health care procedures, work practices and treatment outcomes. The aim is to find out how health information systems have been investigated, what has been investigated and what are the outcomes. A systematic review was carried out of the research on the regional health information systems or organizations. The literature search was conducted on four electronic Cinahl Medline, Medline/PubMed and Cochrane. The common type of study design was the survey research and case study, and the data collection was carried out via different methodologies. They found out different types of regional health information systems (RHIS). The systems were heterogeneous and were in different phases of these developments. The RHIS outcomes focused on the five main areas: flow of information, collaboration, process redesign, system usability and organization culture. The RHIS improved the clinical data access, timely information, and clinical data exchange and improvement in communication and coordination within a region between professionals but also there was inadequate access to patient relevant clinical data. There were differences in organization culture, vision and expectations of leadership and consistency of strategic plan. Nevertheless, there were widespread participation by both healthcare providers and patients.