Facilitating the Implementation of Standardized Care Plans in Municipal Healthcare.

Standardized care plans have the potential to enhance the quality of nursing records in terms of content and completeness, thereby better supporting workflow, easing the documentation process, facilitating continuity of care, and permitting systematic data gathering to build evidence from practice. Despite these potential benefits, there may be challenges associated with the successful adoption and use of standardized care plans in municipal healthcare information practices. Using a participatory approach, two workshops were conducted with nurses and nursing leaders (n = 11) in two Norwegian municipalities, with the objective of identifying success criteria for the adoption and integration of standardized care plans into practice. Three themes were found to describe the identified success criteria: (1) "facilitating system level support for nurses' workflow"; (2) "engaged individuals creating a culture for using standardized care plans"; and (3) "developing system level safety nets." The findings suggest success criteria that could be useful to address to facilitate the integration of standardized care plans in municipal healthcare information practice and provide useful knowledge for those working with implementation and further development of standardized care plans.

Introducing standardised care plans as a new recording tool in municipal health care.

AIMS AND OBJECTIVES: To explore how nurses use standardised care plans as a new recording tool in municipal health care, and to identify their thoughts and opinions. BACKGROUND: In spite of being an important information source for nurses, care plans have repeatedly been found unsatisfactory. Structuring and coding information through standardised care plans is expected to raise the quality of recorded information, improve overviews, support evidence-based practice and facilitate data aggregation. Previous research on this topic has mostly focused on the hospital setting. There is a lack of knowledge on how standardised care plans are used as a recording tool in the municipal healthcare setting. DESIGN: An exploratory design with a qualitative approach using three qualitative methods of data collection. The study complied with the Consolidated Criteria for Reporting Qualitative Research. METHODS: Empirical data were collected in three Norwegian municipalities through participant observation and individual interviews with 17 registered nurses. In addition, we collected nursing records from 20 electronic patient records. RESULTS: Use of standardised care plans was influenced by the nurses' consideration of their benefits. Partial implementation created an opportunity for nonuse. There was no consensus regarding how much information to include, and the standardised care plans could become both short and generic, and long and comprehensive. The themes "balancing between the old and the new care planning system," "considering the usefulness of standardised care plans as a source of information" and "balancing between overview and detail" reflect these findings. CONCLUSIONS: Nurses' use of standardised care plans was influenced by the plans' partial implementation, their views on usefulness and their personal views on the detail required in a care plan. RELEVANCE TO CLINICAL PRACTICE: The structuring of nursing records is a fast-growing trend in health care. This study gives valuable information for those attempting to implement such structures in municipal health care.

Nurses' information practice in municipal health care-A web-like landscape.

AIM: To uncover the characteristics of nurses' information practice in municipal health care and to address how, when and why various pieces of information are produced, shared and managed. BACKGROUND: Nursing documentation in the electronic patient record has repeatedly been found unsatisfactory. Little is known about how the information practice of nurses in municipal health care actually is borne out. In order to understand why nursing documentation continues to fail at living up to the expected requirements, a better understanding of nurses' information practice is needed. DESIGN: A qualitative observational field study. The study complied with the Consolidated Criteria for Reporting Qualitative Research. METHODS: Empirical data were collected in three Norwegian municipalities through participant observations and individual interviews with 17 registered nurses on regular day shifts. The data were analysed through thematic content analysis. RESULTS: Nurses' information practice in municipal health care can be described as complex. The complexity is reflected in four themes that emerged from the data: (1) web of information sources, (2) knowing the patient and information redundancy, (3) asynchronous information practice and (4) compensatory workarounds. CONCLUSIONS: The complex and asynchronous nature of nurses' information practice affected both how and when information was produced, recorded and shared. When available systems lacked functions the nurses wanted, they created compensatory workarounds. Although electronic patient record was an important part of their information practice, nurses in long-term care often knew their patients well, which meant that a lot of information about the patients was in their heads, and that searching for information in the electronic patient record sometimes seemed redundant. RELEVANCE TO CLINICAL PRACTICE: This study provides contextual knowledge that might be valuable (a) in the further development of information systems tailored to meet nurses' information needs and (b) when studying patient safety in relation to nurses' information practice.

ICNP.

The International Classification for Nursing Practice (ICNP®) terminology was in 2016 implemented in three Norwegian municipalities through the introduction of five standardized care plans in the Electronic Patient Record (EPR) system. This poster provides results from an exploratory, qualitative study, investigating how nurses in these municipalities applied the care plans into their daily informational work.

Exploring the Use of Technology for Active Aging and Thriving.

The study explores how older adults with limited digital experience become users of tablet computers (iPad) with Internet access, and how the tablet computers become part of their daily life facilitating active aging and thriving. Volunteer adolescents were mobilised to teach and follow up the participants regularly.

Introducing Technology for Thriving in Residential Long-Term Care.

PURPOSE: To present an emerging innovative care model that supports participation and thriving by older adults in residential care, by introduction to new technology and mobilizing volunteer services. DESIGN: Qualitative, exploratory study, introducing tablet computers to 15 older adults in two municipalities. METHODS: The intervention encompassed weekly workshops over the course of 1 year with volunteer adolescents as personal tutors. Observations of workshops, interviews with nurses, and repeated semistructured interviews with older adult participants eliciting their perspective on use, experiences, perceived usefulness, and overall evaluation of the intervention. FINDINGS: A model of four components is suggested to support participation and thriving by older adults in residential care: (a) simplified tools: iPad-technology relatively easy to use; (b) person-centered process: one-to-one tutoring following each individual's own pace; (c) young volunteers to teach technology, establishing an intergenerational arena; and (d) being mindful of driving forces that encourage use and learning. We found that all kinds of use and all levels of mastery generated a sense of pride that supported thriving and enjoyment. CONCLUSIONS: These findings support the use of new technology and use of volunteer services for sustaining thriving in older adults. The person-centered approach stimulates use of the tablet, and participants showed enjoyment, more social participation, and reported subjective experiences of thriving. CLINICAL RELEVANCE: Innovative models of care that prevent (or postpone) functional decline and support thriving in older adults are highly sought after in health care. A model that systematically involves volunteer services comes with potentials to alleviate nurses' workload, and then the intervention is seen as a manageable and low-cost initiative in residential care.

Success Criteria for Implementing Standardized Care Plans in Community Health Care.

Standardized Care Plans (SCPs) based on ICNP® are currently being piloted in the community health care setting in four Norwegian municipalities. The goal is that SCPs will improve the quality of nursing documentation, and that they will contribute to improved continuity of care and thereby increased patient safety. We are studying the implementation process of the SCPs, and will report on success criteria for them to become an integral part of everyday nursing documentation in community health care.

Persons with Dementia and Their Caregivers Using GPS.

The aim of the study is to generate knowledge on the use of Global Positioning Systems (GPS) to support autonomy and independence for persons with dementia. By studying a larger cohort of persons with dementia (n=208) and their caregivers, this study provides essential knowledge for planning and implementing GPS technology as a part of public health care services. Commercially available GPS technology was provided to the cohort of 208 persons with dementia from nineteen different Norwegian municipalities. The participants used GPS when performing outdoor activities as part of their daily life during a period of time between 2012 and 2014. Their family caregivers were instructed on how to use the GPS technology for locating the participants. The study documents that using GPS for locating persons with dementia provide increased safety for the person with dementia, their family caregivers and their professional caregivers. Furthermore the results confirm that by using GPS, persons with dementia may maintain their autonomy, enjoy their freedom and continue their outdoor activities despite the progression of the disease. Preconditions for successful implementation are that health professionals are trained to assess the participant's needs, that ethical dilemmas are considered, that caregivers have adequate knowledge about using the technology and that procedures and routines for administrating the GPS and locating persons with dementia are established. Early intervention and close collaboration between persons with dementia, family caregivers and professional caregivers are important for successful implementation of GPS in public health care.

Evaluation of ambient assisted living interventions--which tool to choose?

This paper discusses suggested evaluation frameworks' appropriateness for a study introducing Ambient Assisted Living (AAL) interventions. Specifically, we look at how well proposals cover these dimensions: impact on society, impact on professionals, and impact on patients. We discuss three widely used approaches for such assessments: RE-AIM, MAST, and UTAUT. Our assessment showed careful selection of elements from all three models seems needed to sufficiently cover the dimensions. RE-AIM provides a broad framework; MAST adds aspects of transferability and ethics, and UTAUT adds perception of technology and future use. All these approaches lack pivotal aspects concerning inclusion of patients' or citizens' point of view in a study's planning phase. To ensure rigor and include meaningful use from citizens' perspective, we added these aspects to our study.