Implementation of a multi-professional standardized care plan in electronic health records for the care of stroke patients.

AIMS: To compare staff opinions about standardized care plans and self-reported habits with regard to documentation, and their perceived knowledge about the evidence-based guidelines in stroke care before and after implementation of an evidence-based-standardized care plan (EB-SCP) and quality standard for stroke care. The aim was also to describe staff opinions about, and their use of, the implemented EB-SCP. BACKGROUND: To facilitate evidence-based practice (EBP), a multi-professional EB-SCP and quality standard for stroke care was implemented in the electronic health record (EHR). METHOD: Quantitative, descriptive and comparative, based on questionnaires completed before and after implementation. RESULTS: Perceived knowledge about evidence-based guidelines in stroke care increased after implementation of the EB-SCP. The majority agreed that the EB-SCP is useful and facilitates their work. There was no change between before and after implementation with regard to opinions about standardized care plans, self-reported documentation habits or time spent on documentation. CONCLUSIONS: An evidence-based SCP seems to be useful in patient care and improves perceived knowledge about evidence-based guidelines in stroke care. IMPLICATIONS FOR NURSING MANAGEMENT: For nursing managers, introduction of evidence-based SCP in the EHR may improve the prerequisites for promoting high-quality EBP in multi-professional care.

Evidence-based practice: the importance of education and leadership.

AIM: To describe evidence-based practice among head nurses and to explore whether number of years of duty is associated with such activities. Further to evaluate the effects of education on evidence-based practice and perceived support from immediate superiors. BACKGROUND: Registered nurses in Sweden are required by law to perform care based on research findings and best experiences. In order to achieve this, evidence-based practice (EBP) is of key importance. METHOD: All 168 head nurses at two hospitals were asked to participate. Ninety-nine (59%) completed the survey. Data were collected using a study-specific web-based questionnaire. RESULTS: The majority reported a positive attitude towards EBP, but also a lack of time for EBP activities. A greater number of years as a head nurse was positively correlated with research utilization. Education in research methods and perceived support from immediate superiors were statistically and significantly associated with increased EBP activities. CONCLUSIONS: The present study highlights the value of education in research methods and the importance of supportive leadership. IMPLICATIONS FOR NURSING MANAGEMENT: Education is an important factor in the employment of head nurses. We recommend interventions to create increased support for EBP among management, the goal being to deliver high-quality care and increase patient satisfaction.

Nurses' experiences of and opinions about using standardized care plans in electronic health records.

The nurses in the study had generally positive attitudes towards use of standardized care plans, use of standardized care plans in EHR and quality standards for clinical practice. They considered that these procedures facilitate their work and improve the quality of care.

Nursing informatics in Sweden - the agenda for the future.

With the purpose of getting an overview of the current research and development in information systems and terminology for nursing practice and outline strategies for the future, an initiative for a workshop was taken at the national level in Sweden by the Section for Nursing Informatics, the Society of Nursing and the Association of Health Professionals in 2007. For the workshop around 30 nurses were invited, representing clinical practice, education, and research. The workshop resulted in recommendations for future strategies to support the development of nursing informatics in Sweden.

Improved quality and comprehensiveness in nursing documentation of pressure ulcers after implementing an electronic health record in hospital care.

AIMS: One aim was to compare the quality and comprehensiveness in nursing documentation of pressure ulcers before and after implementation of an electronic health record in a hospital setting. Another aim was to investigate the use of preformulated templates for pressure ulcer recording in the electronic health record. BACKGROUND: With the possibilities of the electronic health record to provide information and give accurate and reliable feedback to the healthcare organisation, it is of high priority to develop standardised documentation practices for various areas of care (e.g. such as pressure ulcer care). DESIGN: A cross-sectional retrospective review of health records. METHODS: Three departments in a Swedish university hospital participated. In 2002, there were 413 patients, including 59 paper-based records identified with notes on pressure ulcers and in 2006, 343 patients, including 71 electronic health records with pressure ulcer recording. Recorded data on pressure ulcers were retrospectively reviewed. Results. Significantly more patient records showed notes of pressure ulcer grade (p < 0.001), size (p = 0.004), risk assessment (p = 0.002), nursing history (p = 0.040), nursing diagnoses (p < 0.001), nursing goals (p < 0.001) and nursing outcomes (p = 0.016) in 2006 than in 2002. One third of the recordings used preformulated templates. CONCLUSIONS: Although there were significant improvements in pressure ulcer recording after the change to the electronic health record, several deficiencies remained. Due to the short time of our follow-up after implementation of the electronic health record, we suspect that the quality of recording will improve when nurses become more familiar with the new system. RELEVANCE TO CLINICAL PRACTICE: Education related to the use of the electronic health record and evidence-based pressure ulcer prevention should be provided to the nurses. To facilitate documentation, the templates need to be refined to be more user-friendly.

Nurses' perceptions of feed-back from the electronic patient record for the quality on pressure ulcer care.

When implementing an electronic patient record, templates with pre-formulated assessment variables related to pressure ulcers were developed from research-based instruments. The aim of this study was to describe the nurses' perceptions of feed-back from the electronic patient record on pressure ulcer care. Focus groups interviews with the nurses were used.