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1.
Artigo em Inglês | MEDLINE | ID: mdl-32326300

RESUMO

Despite major investment, health information technology (HIT) implementation often tends to fail. One of the reasons for HIT implementation failure is poor leadership in healthcare organisations, and thus, more research is needed on leaders' roles in HIT implementation. The aim of the review was to identify the role of healthcare leaders in HIT implementation. A scoping review with content analysis was conducted using a five-step framework defined by Arksey and O'Malley. Database searches were performed using CINAHL, Business Source Complete, ProQuest, Scopus and Web of Science. The included studies were written either in English or Finnish, published between 2000 and 2019, focused on HIT implementation and contained leadership insight given by various informants. In total, 16 studies were included. The roles of healthcare leaders were identified as supporter, change manager, advocate, project manager, manager, facilitator and champion. Identifying healthcare leaders' roles in HIT implementation may allow us to take a step closer to successful HIT implementation. Yet, it seems that healthcare leaders cannot fully realise these identified roles and their understanding of HIT needs enforcement. Also, healthcare leaders seem to need more support when actively participating in HIT implementation.

2.
J Adv Nurs ; 2020 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-32202314

RESUMO

AIM: To examine: (a) whether nativity status was associated with workplace discrimination, and (b) whether this association was mediated through psychosocial work characteristics (job strain, job demands, and job control) among registered female nurses. DESIGN: Cross-sectional survey with a self-report questionnaire was conducted. METHODS: A random sample of 610 native Registered Nurses and a total sample of 188 foreign-born Registered Nurses working in Finland were used. Data were collected between September-November of 2017 and analysed using a counterfactual approach in the causal mediation framework. RESULTS: After adjusting for several potential confounders, foreign-born nurses scored higher on workplace discrimination than native nurses. Approximately 20% of the association between nativity status and workplace discrimination was mediated through job control. Job demands and job strain were unlikely to mediate this association. CONCLUSION: The study provides further evidence that migrant status is associated with a higher risk of workplace discrimination among nurses. Lower levels of control over one's own job may partly contribute to the higher risk of workplace discrimination in foreign-born women nurses. IMPACT: Our study addresses the relationship between nativity status and workplace discrimination among female nurses and its mediating factors. The findings suggest that healthcare organization leaders need to be aware of the increased risk of workplace discrimination among migrant nurses. Moreover, healthcare organizations need to consider psychosocial work characteristics, including job control, in the efforts aimed to prevent and reduce discrimination against their foreign-born employees.

3.
J Nurs Scholarsh ; 52(3): 281-291, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32212311

RESUMO

OBJECTIVE: Workplace violence against nurses is a widespread phenomenon that has been associated with many unfavorable individual and organizational outcomes. The aim of this study was to analyze the relationship between violence and work functioning in a sample of Italian nurses. DESIGN: Cross-sectional, with retrospective analysis of exposure. METHODS: All nurses from a local hospital were invited to complete a questionnaire assessing violent experiences that occurred in the previous 12 months. The questionnaire also measured job strain (with the Demand-Control-Support questionnaire), organizational justice (with Colquitt's Questionnaire), and work impairment (with the Nurses Work Functioning Questionnaire). The associations were examined with logistic regression analyses. FINDINGS: Of the 302 nurses who were invited, 275 (91.1%) agreed to participate. The total work impairment score was significantly higher among the nurses exposed to violence compared with the nonexposed nurses (42.2 ± 27.8 vs. 31.9 ± 31.6, respectively; p < .001). Exposed nurses also reported significantly higher levels of job strain (0.96 ± 0.25 vs. 0.8 ± 0.21; p = .003) and lower levels of perceived organizational justice (56.6 ± 12.6 vs. 62.5 ± 14.8; p = .001) than nonexposed nurses. Nurses who had experienced violence had a significantly higher risk for impairment of work functioning than their colleagues (crude odds ratio [OR] = 2.33; 95% confidence interval [CI 95%] = 1.42-3.83). The association between violence and impairment remained significant after adjusting for demographic variables, occupational stress, and perceived organizational justice (OR = 1.83; 95% CI 95% = 1.06-3.17). CONCLUSIONS: Workplace violence is associated with impaired work function in nurses. Job strain and perceived organizational injustice are associated with impairment. CLINICAL RELEVANCE: Violence prevention programs in healthcare activities should include training for violent behavior identification and de-escalation techniques, structural and administrative measures for violence control (such as alarms, surveillance, staff increase), and measures to reduce occupational stress, which can include wellness courses, spirituality, organizational improvements, and staffing methodologies.

4.
Int J Med Inform ; 134: 104018, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31835158

RESUMO

BACKGROUND: Usability associates with patient safety and quality of care. This article reports results from nation-wide usability-focused survey studies for physicians and nurses in Finland. Earlier research has shown dissatisfaction and serious deficiencies, which hamper the efficient use of health information systems (HIS); however, evaluation studies covering the viewpoints of both user groups are practically lacking. Our study aimed at comparing end-users' experiences on the usability of electronic health record (EHR) systems by employment sector and EHR brand. METHODS: To measure usability, we used the validated National Usability-focused HIS Scale (NuHISS). For this study, we selected 11 usability statements that relate to technical quality (n = 3), ease of use (n = 6), benefits (n = 1) and collaboration (n = 1), and were identical in both surveys. We report the responses from 3013 physicians and 2560 nurses working in public sector hospitals or primary care health centers in 2017. RESULTS: Results in total and by healthcare sector showed notable differences between nurses' and physicians' experiences on usability of their EHR systems. Physicians were more satisfied than nurses on technical quality and learnability of the EHR-systems, while nurses experienced the ease of use better and were more satisfied with collaboration aspects than physicians. Two EHR brands used in hospitals appeared to have succeeded in supporting physician workflows, while two others used in health centers were more suitable for nurses' needs. CONCLUSIONS: Nurses' and physicians' experiences on EHR usability appear to vary more by EHR brand and employment sector rather than either professional group being generally more satisfied. Development of EHR systems should consider the perspectives of these two main user groups and their working contexts.

5.
JMIR Med Inform ; 7(4): e13466, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31687938

RESUMO

BACKGROUND: Constantly changing and difficult-to-use information systems have arisen as a significant source of stress in physicians' work. Physicians have reported several usability problems, system failures, and a lack of integration between the systems and have experienced that systems poorly support the documentation and retrieval of patient data. This stress has kept rising in the 21st century, and it seems that it may also affect physicians' well-being. OBJECTIVE: This study aimed to examine the associations of (1) usability variables (perceived benefits, technical problems, support for feedback, and user-friendliness), (2) the number of systems in daily use, (3) experience of using information systems, and (4) participation in information systems development work with physicians' distress and levels of stress related to information systems (SRIS) levels. METHODS: A cross-sectional survey was conducted among 4018 Finnish physicians (64.82%, 2572 out of 3968 women) aged between 24 and 64 years (mean 46.8 years) in 2017. The analyses of covariance were used to examine the association of independent variables with SRIS and distress (using the General Health Questionnaire) adjusted for age, gender, employment sector, specialization status, and the electronic health record system in use. RESULTS: High levels of technical problems and a high number of systems in daily use were associated with high levels of SRIS, whereas high levels of user-friendliness, perceived benefits, and support for feedback were associated with low levels of SRIS. Moreover, high levels of technical problems were associated with high levels of psychological distress, whereas high levels of user-friendliness were associated with low distress levels. Those who considered themselves experienced users of information systems had low levels of both SRIS and distress. CONCLUSIONS: It seems that by investing in user-friendly systems with better technical quality and good support for feedback that professionals perceive as being beneficial would improve the work-related well-being and overall well-being of physicians. Moreover, improving physicians' skills related to information systems by giving them training could help to lessen the stress that results from poorly functioning information systems and improve physicians' well-being.

6.
BMC Health Serv Res ; 19(1): 624, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481042

RESUMO

BACKGROUND: A physician shortage is a worldwide problem and foreign-born physicians fill in the shortage of physicians in many developed countries. One problem that is associated with the physician shortage is increased physician turnover. Also, regarding foreign-born physicians, migration can be costly. The present study aimed to examine the turnover intentions and intentions to leave the country of foreign-born physicians. We examined how demographics, discrimination, language problems, perceived employment barriers, satisfaction with living in Finland, team climate, job satisfaction and patient-related stress were associated with these factors. METHODS: The present study was a cross-sectional questionnaire study among 371 foreign-born physicians in Finland that were aged between 26 and 65 (65% women). Binary logistic regression analyses were conducted to examine the associations. RESULTS: Half of the respondents had turnover intentions and 14.5% had considered leaving the country. High satisfaction with living in Finland was associated with a lower likelihood of both turnover intentions and intentions to leave the country. High levels of discrimination and employment barriers were associated with a high likelihood of turnover intentions whereas good team climate was associated with a low likelihood of turnover intentions. High levels of language problems were associated with a high likelihood of intentions to leave the country. CONCLUSIONS: The present study showed the importance of satisfaction with living in the host country, the prevention of discrimination and employment barriers, language skills and a good team climate for the retention of foreign-born physicians in their current job and in the host country. Thus, to keep their foreign-born physicians, health care organisations should implement measures to tackle these challenges. Organisations could arrange, for example, diversity training, self-assessment, team reflections, leadership coaching and culturally-specific networks. Moreover, internships associated with the qualification process could be utilised better in order to give a thorough introduction to the host country's health care environment and the possibilities for learning the language.


Assuntos
Médicos Graduados Estrangeiros/estatística & dados numéricos , Reorganização de Recursos Humanos/estatística & dados numéricos , Adulto , Idoso , Atitude do Pessoal de Saúde , Estudos Transversais , Emigração e Imigração/estatística & dados numéricos , Emprego/psicologia , Emprego/estatística & dados numéricos , Feminino , Finlândia , Médicos Graduados Estrangeiros/psicologia , Humanos , Intenção , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Estresse Ocupacional/etiologia , Satisfação Pessoal , Médicos/psicologia , Médicos/estatística & dados numéricos , Preconceito/psicologia , Preconceito/estatística & dados numéricos , Inquéritos e Questionários
7.
BMC Med Inform Decis Mak ; 19(1): 160, 2019 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412859

RESUMO

BACKGROUND: Electronic health records (EHRs) are an elementary part of the work of registered nurses (RNs) in healthcare. RNs are the largest group of healthcare workers, and their experiences with EHRs and their informatics competence play a crucial role in a fluent workflow. The present study examined EHR usability factors and nurses' informatics competence factors related to self-reported time pressure and psychological distress. METHODS: A nationwide survey was conducted for working-age registered nurses in 2017. The study sample included 3607 nurses (5% men) in Finland. The association of age, sex, employment sector, EHR usability factors, and nurses' informatics competence factors with time pressure and psychological distress were examined with analyses of covariance. RESULTS: The EHR usability factors that were associated with high time pressure were low EHR reliability and poor user-friendliness. Regarding the nurses' informatics competence factors, only low e-Care competence was associated with time pressure. Of the EHR usability factors, low EHR reliability and low support for cooperation were associated with high psychological distress. Of the nurses' informatics competence factors, low e-Care competence was associated with high psychological distress. CONCLUSIONS: Unreliability and poor user-friendliness of EHRs seem to be prominent sources of time pressure and psychological distress among registered nurses. User-friendly EHR systems and digital tools in healthcare are needed. Nurses' competence to use eHealth tools to tailor patient care should be strengthened through organizational and regional actions. For example, house rules about how to use eHealth tools and instructions on common practices in cooperation with other organizations could be useful.


Assuntos
Registros Eletrônicos de Saúde , Tecnologia da Informação , Enfermeiras e Enfermeiros/psicologia , Competência Profissional , Adulto , Feminino , Finlândia , Humanos , Masculino , Estresse Ocupacional , Reprodutibilidade dos Testes , Inquéritos e Questionários , Fatores de Tempo , Fluxo de Trabalho
8.
Stud Health Technol Inform ; 264: 1253-1257, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438126

RESUMO

The training and competence of healthcare professionals are key factors in adopting new eHealth services. The scope of eHealth is broadening from information systems to eHealth services such as patient portals supporting self-management, which create a need for new competencies. In this study, we evaluated clinical leaders' eHealth competencies and training needs in two public healthcare organizations in Finland. The target organizations' goal was to increase the number of patients' eHealth services and clinical leaders were seen as critical in this change. Data were collected through an online survey of 98 clinical leaders working in two healthcare organizations. The results imply that managing change and planning implementation are challenging to clinical leaders. They need more information about eHealth services, their possibilities, and benefits in order to support their subordinates and patients. The clinical leaders seem to be in a critical role in supporting healthcare professionals and avoiding resistance to change.


Assuntos
Portais do Paciente , Autogestão , Telemedicina , Finlândia , Pessoal de Saúde , Humanos
9.
BMC Nurs ; 18: 38, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31440116

RESUMO

Background: Nowadays, healthcare professionals worldwide deliver care for increasing numbers of culturally and linguistically diverse patients. The importance of cultural competence is evident in terms of the quality of healthcare, and more knowledge is needed about different educational models and approaches that aim to increase cultural competence. This study examines the perceptions of nurses about the content and utility of cultural competence training that focuses on increasing awareness of one's own cultural features. Methods: The training was conducted at one primary care hospital in southern Finland. Participants were registered nurses (n = 14) and practical nurses (n = 6) from different hospital units. Four 4-h training sessions-including lectures, discussions and short web-based learning tasks-were arranged during a four-week period. Semi-structured, small group interviews were conducted with 10 participants to examine their perceptions about the content and utility of the training. Qualitative content analysis with a conventional approach was used to analyse the data. Results: Perceptions about the training were divided into three main categories: general utility of the training, personal utility of the training, and utility of the training for patients. General utility pertains to the general approach that the training provided on cross-cultural care, the possibility to initiate an open discussion, and the opportunity to improve current practices. Personal utility pertains to the opportunity to become aware of one's own cultural features, to change one's way of thinking, to obtain a new perspective on one's own communication practices and to receive justification for carrying out particular workable practices. Utility for patients pertains to fostering better awareness and acknowledgement of patients' differing cultural features and an increased respect in healthcare delivery. Additionally, the quality of the training was highlighted, and suggestions for improvement were offered. Conclusion: Training that increases healthcare professionals' awareness of their own cultural features was perceived as useful and thought-provoking. Increased awareness might facilitate the communication between healthcare professionals and patients, which is a crucial component of quality healthcare. It seems that in the future, training opportunities that allow larger groups to participate are needed, regardless of the time and place, and utilising the potential of e-learning should be considered.

10.
Res Nurs Health ; 42(5): 349-357, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31310012

RESUMO

Cross-cultural competence is an essential component of the nursing profession, but little is known about the specific psychosocial work characteristics that potentially promote or hinder such competence. In the present study, psychosocial work characteristics were based on Karasek's Job Demand-Control Model. The researchers examined whether Karasek's psychosocial work characteristics, such as high-strain jobs, high-strain isolated jobs, active jobs, and active collective jobs, are associated with cross-cultural competence (empathy, skills, positive attitudes, and motivation), and whether there are differences between native and foreign-born registered nurses (RN) in these potential associations. A random sample of 744 native RNs (91.0% women) and a total sample (n = 212) of foreign-born RNs (94.3% women) working in Finland were used. Data were collected using a questionnaire and analyzed with a series of multiple linear regression analyses. High-strain and high-strain isolated jobs were negatively associated with all four dimensions of cross-cultural competence. Active collective jobs, but not active jobs, were positively associated with cross-cultural skills. There were no differences between native and migrant nurses in these associations. The psychosocial work environment is associated with cross-cultural competence in both native and migrant nurses. Improvements in psychosocial working conditions, especially minimizing negative factors in the work environment, such as high-strain and high-strain isolated jobs, may need to be considered as a part of the efforts aimed to enhance cross-cultural competence among nursing personnel.


Assuntos
Competência Clínica , Competência Cultural , Pessoal Profissional Estrangeiro/psicologia , Recursos Humanos de Enfermagem/psicologia , Recursos Humanos de Enfermagem/normas , Local de Trabalho/psicologia , Adulto , Atitude do Pessoal de Saúde , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Psicológico , Inquéritos e Questionários
11.
Artigo em Inglês | MEDLINE | ID: mdl-31336707

RESUMO

This study aimed to find out which countries around the world require psychosocial hazards and workplace violence to be assessed by employers through a mandatory occupational risk assessment process and to compare the type of legislation between countries. We systematically searched the International Labour Office (ILO) "LEGOSH" database for documents published during the period between December 2017 and February 2018. The search included 132 countries, of which 23 were considered as developed and 109 as developing according to the United Nations. Our review showed that most countries (85, i.e., 64%) have not included mandatory psychosocial risk assessment and prevention in their national occupational safety and health legislation. Moreover, we found differences between developed and developing countries, showing that developed countries more frequently have legislative measures. Within developed countries, we also found differences between countries following the Scandinavian model of workplace health and safety culture and other countries. Moreover, in many countries, workplace violence was prohibited only if it involves an offence to moral or religious customs. In conclusion, the marked difference in psychosocial hazards and workplace violence regulations among countries leads to unequal levels of workers' protection, with adverse effects on global health.


Assuntos
Saúde Global , Saúde do Trabalhador , Gestão da Segurança , Local de Trabalho/psicologia , Países em Desenvolvimento , Humanos , Medição de Risco , Nações Unidas
12.
J Med Internet Res ; 21(5): e12875, 2019 05 16.
Artigo em Inglês | MEDLINE | ID: mdl-31099336

RESUMO

BACKGROUND: Problems in the usability of health information systems (HISs) are well acknowledged, but research still lacks a validated questionnaire for measuring and monitoring different dimensions of usability of HISs. Such questionnaires are needed not only for research but also for developing usability of HISs from the viewpoint of end-user experiences. OBJECTIVE: This study aimed to develop and test the validity of the questionnaire measuring the National Usability-Focused HIS-Scale (NuHISS) among a nationally representative sample of Finnish physicians. METHODS: We utilized 2 cross-sectional data collected from a random sample of Finnish physicians in 2014 (N=3781; of which 2340 [61.9%] were women) and 2017 (N=4018; of which 2604 [64.8%] were women). Exploratory and confirmatory factor analyses (structural equation modeling [SEM]) were applied to test the structural validity of the NuHISS. As the concurrent validity measure, we used the self-reported overall quality of the electronic health record system (school grade) provided by the participants using marginal structural models. RESULTS: The exploratory factor analyses with Varimax rotation suggested that the 7-factor solution did offer a good fit to the data in both samples (C2=2136.14 in 2014 and C2=2109.83 in 2017, both P<.001). Moreover, structural equation modelling analyses, using comparative fit index (CFI), Tucker-Lewis Index (TLI), Normed Fit Index (NFI), root mean squared error of approximation (RMSEA), and Standardized Root Mean square Residual (SRMR), showed that the 7-factor solution provided an acceptable fit in both samples (CFI=0.92/0.91, TLI=0.92/0.91, NFI=0.92/0.91, RMSEA=0.048/0.049, and SRMR=0.040/0.039). In addition, concurrent validity of this solution was shown to be acceptable. Ease of use, but also all other dimensions, was especially associated with overall quality reports independent of measured confounders. The 7-factor solution included dimensions of technical quality, information quality, feedback, ease of use, benefits, internal collaboration, and cross-organizational collaboration. CONCLUSIONS: NuHISS provides a useful tool for measuring usability of HISs among physicians and offers a valid measure for monitoring the long-term development of HISs on a large scale. The relative importance of items needs to be assessed against national electronic health policy goals and complemented with items that have remained outside the NuHISS from the questionnaire when appropriate.


Assuntos
Sistemas de Informação em Saúde/normas , Médicos/normas , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estudos de Validação como Assunto
13.
BMC Health Serv Res ; 19(1): 294, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31068175

RESUMO

BACKGROUND: To test the validity of the Finnish version of the Bernhard et al.'s Cross-Cultural Competence instrument of Healthcare Professionals (CCCHP). METHODS: The study sample comprised registered nurses (N = 810) from the Finnish "Competent workforce for the future" -project (COPE). Exploratory factor analyses and structural equation modelling were applied to test structural validity of the CCCHP. Internal consistency of the sub-scales was evaluated using the Cronbach's alphas. Criterion validity was explored in terms of received education for multicultural work, perceived difficulty of patients, and job satisfaction variables. RESULTS: The revised version of the instrument including four (motivation/curiosity, attitudes, skills and emotions/empathy) of the five original dimensions provided satisfactory psychometric properties (internal consistency, a good model fit of the data). Of the four remaining competence sub-scales, motivation/curiosity, attitudes and emotions/empathy were associated with the amount of received education for multicultural work, and all with perceived difficulty of patients, and all but attitudes with job satisfaction. CONCLUSION: This revised Finnish version of the CCCHP provides a useful tool for studies focusing on the healthcare personnel's cross-cultural competence in delivering effective and culturally sensitive healthcare services for patients from different cultures.


Assuntos
Competência Clínica/estatística & dados numéricos , Competência Cultural , Enfermeiras Internacionais/estatística & dados numéricos , Enfermagem Transcultural , Adulto , Competência Cultural/educação , Diversidade Cultural , Feminino , Finlândia , Pesquisa sobre Serviços de Saúde , Humanos , Satisfação no Emprego , Masculino , Enfermeiras Internacionais/psicologia , Psicometria/instrumentação , Reprodutibilidade dos Testes , Inquéritos e Questionários
14.
J Med Internet Res ; 21(3): e11413, 2019 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-30901003

RESUMO

BACKGROUND: Effective leadership and change management are thought to contribute to the successful implementation of health information technology innovations. However, limited attention has been paid to the role of frontline leaders in building health professional support for new technical innovations. OBJECTIVE: First, we examined whether frontline leaders' positive expectations of a patient portal and perceptions of its implementation were associated with their support for the portal. Second, we explored whether leaders' positive perceptions influenced the same unit's health professional support for the portal. METHODS: Data were collected through an online survey of 2067 health professionals and 401 frontline leaders working in 44 units from 14 health organizations in Finland. The participating organizations run a joint self-care and digital value services project developing a new patient portal for self-management. The survey was conducted before the piloting and implementation of the patient portal. RESULTS: The frontline leaders' perception of vision clarity had the strongest association with their own support for the portal (ß=.40, P<.001). Results also showed an association between leaders' view of organizational readiness and their support (ß=.15, P=.04). The leaders' positive perceptions of the quality of informing about the patient portal was associated with both leaders' own (ß=.16, P=.02) and subordinate health professionals' support for the portal (ß=.08, P<.001). Furthermore, professional participation in the planning of the portal was positively associated with their support (ß=.57, P<.001). CONCLUSIONS: Findings suggest that assuring good informing, communicating a clear vision to frontline leaders, and acknowledging organizational readiness for change can increase health professional support for electronic health (eHealth) services in the pre-implementation phase. Results highlight the role of frontline leaders in engaging professionals in the planning and implementation of eHealth services and in building health professionals' positive attitudes toward the implementation of eHealth services.


Assuntos
Pessoal de Saúde/normas , Liderança , Portais do Paciente/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
15.
Comput Inform Nurs ; 37(8): 420-429, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30741730

RESUMO

In 2015, the Finnish Ministry of Social Affairs and Health published an eHealth and eSocial strategy with key objectives that by 2020 health information systems will be smart and providers will be able to maximize their use. Measures include improving system usability and decision support, involving professionals in system and service development, and increasing professionals' training in information management, electronic documentation, data protection, and data security. The aim of this study was to explore the level of nurses' informatics competencies and sufficiency of in-house training regarding technology-induced changes in work practices. An electronic questionnaire produced by the National Institute of Health and Welfare was sent in February to April 2017 to 29 283 Finnish working-age nurses, community nurses, and midwives; 3607 replies were received. Respondents rated their overall informatics competency relatively high, with the lowest competency scores on terminology-based documentation (Finnish Care Classification) and patient-related digital work. Education, electronic health record system used, experience using electronic health record systems, sufficiency of training, higher levels of technical functionality, ease of use, and usefulness were all associated with competency and remained significant after all adjustments. One-third of the respondents felt that they had not received sufficient training. Age and participation in system development were associated with experiences of sufficiency of training.


Assuntos
Registros Eletrônicos de Saúde/normas , Informática Médica , Recursos Humanos de Enfermagem/normas , Interface Usuário-Computador , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem/educação , Recursos Humanos de Enfermagem/psicologia , Inquéritos e Questionários
16.
Int J Med Inform ; 122: 1-6, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30623778

RESUMO

INTRODUCTION: Timely, complete and accurate patient data is needed in care decisions along the continuum of care. To access patient data from other organizations, there are three types of regional health information exchange systems (RHIS) in use In Finland. Some regions use multiple RHISs while others do not have a RHIS available. The recently introduced National Patient Data Repository (Kanta) is increasingly used for health information exchange (HIE). OBJECTIVES: The purpose of this study was to assess usage of paper, RHISs and Kanta by context in 2017; evolution of paper use over the years; and predictors of paper use in 2017 among Finnish physicians for HIE system development. METHODS: Data from national electronic health record (EHR) usage and user experience surveys were taken from 2010 (prior to ePrescription system implementation), 2014 (prior to implementation of Kanta) and 2017 (Kanta was in full use in the public sector and in large private organizations). The web-based surveys were targeted to all physicians engaged in clinical work in Finland. RESULTS: Kanta was the most frequently used means of HIE in 2017. Paper use had reduced significantly from 2010 to 2014. The trend continued in 2017. Still, up to half of the physicians reported using paper daily or weekly in 2017. There were great variations in paper use by healthcare sector, available RHIS type and EHR system used. In multivariable analysis (with all other variables constant), predictors of more frequent use of paper than electronic means for HIE were: private sector or hospital, access to Master Patient Index RHIS (type 1), multiple RHIS (type 4) or no RHIS (type 5), two particular EHR systems, older age, less experience, operative, psychiatric or diagnostic specialties, and male gender. CONCLUSIONS: Usability of HIE systems including EHRs as access points to HIE need to be improved to facilitate usage of electronic HIE. Usage ensures more timely and complete patient data for safe, coordinated care. Specialty-specific needs and requirements call for more user participation in HIE design. Especially older professionals need training to better exploit HIS for HIE.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Troca de Informação em Saúde/estatística & dados numéricos , Sistemas de Informação em Saúde/estatística & dados numéricos , Papel/normas , Médicos/psicologia , Adulto , Idoso , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
17.
PLoS One ; 13(12): e0208761, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30532137

RESUMO

BACKGROUND: A growing body of research indicates that cross-cultural competence in nurses can improve migrant patients' health-related outcomes, but little is known about the potential benefits of cross-cultural competence on the nurses' own well-being. OBJECTIVE: To examine whether cross-cultural competence (empathy, skills, positive attitudes, and motivation) is associated with perceived time pressure at work, psychological distress, and sleep problems among registered nurses in Finland, and whether there are differences in these potential associations between native and foreign-born nurses. METHODS: The present cross-sectional study was based on a sample of 212 foreign-born nurses licensed to practice in Finland and a random sample of 744 native Finnish nurses. Data were collected with a questionnaire and analyzed using multiple linear regression and structural equation modeling (SEM). RESULTS: Of all four dimensions of cross-cultural competence, only empathy was associated with perceived time pressure (ß = -0.13, p = .018), distress (ß = -0.23, p < .001), and sleep problems (ß = -0.14, p = .004) after the adjustment for gender, age, employment sector, and frequency of interacting with patients and colleagues from different cultures. There were no differences between native and foreign-born nurses in these observed associations (all ps > .05). CONCLUSIONS: Cross-cultural empathy may protect against perceived time pressure, distress, and sleep problems in both native and foreign-born nurses. Thus, the promotion of this component of cross-cultural competence among nursing personnel should be encouraged.


Assuntos
Competência Clínica , Competência Cultural , Assistência à Saúde Culturalmente Competente , Enfermeiras Internacionais/psicologia , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Empatia , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Recursos Humanos de Enfermagem/psicologia , Transtornos do Sono-Vigília , Estresse Psicológico , Enfermagem Transcultural , Adulto Jovem
18.
Int J Med Inform ; 117: 82-87, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30032968

RESUMO

OBJECTIVE: Patient portals have the potential to support patient empowerment, self-care, and management, but their adoption and use have reported to be limited. Patients' more active role creates tension, as health professionals need to change their traditional expert role and share control with patients. Professionals may also have other expectations and concerns that influence the acceptance of patient portals supporting patient empowerment. This study explores the health professionals' expectations influencing their support for a new patient portal for self-management prior to implementation. DESIGN: The study empirically evaluates the impact of several variables on health professionals' support for a new patient portal for self-management. The study variables include 1) expected influences on professionals' work, 2) expected influences on patients, 3) usability, 4) professional autonomy, 5) informing, 6) implementation practices, and 7) user participation. METHODS: Data was collected through an online survey of 2943 health professionals working in 14 health organizations in Finland. The participating organizations run a joint Self-Care and Digital Value Services (ODA) project, developing a national patient portal for self-management. Three main services of the patient portal are well-being coaching, diagnostic tool, and a health care plan. RESULTS AND CONCLUSIONS: The results show that health professionals' positive expectations about the new patient portal, adequate informing of professionals ahead of time, and the organization's good implementation practices had a positive impact on their support for the patient portal. Perceived threat to professional autonomy had a negative impact on professionals' support for the portal. Age, gender, and user participation did not influence support. Professionals' concerns were related especially to patients' willingness and capability to use the patient portal. The findings can guide health care providers to facilitate professionals' support and remove obstacles to introduce patient portals already in the pre-implementation phase.


Assuntos
Pessoal de Saúde , Participação do Paciente , Portais do Paciente , Autogestão , Adulto , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Inquéritos e Questionários , Adulto Jovem
19.
BMC Health Serv Res ; 18(1): 418, 2018 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-29879955

RESUMO

BACKGROUND: Foreign-born physicians fill in the shortage of physicians in many developed countries. Labour market theory and previous studies suggest that foreign-born physicians may be a disadvantaged group with a higher likelihood of discrimination and less prestigious jobs. The present study examines foreign-born physicians' experiences of discrimination (coming from management, colleagues and patients separately) and patient-related stress and integration-related stress, and it examines how gender, age, employment sector, country of birth, years from getting a practicing license in Finland, language problems, cross-cultural training, cross-cultural empathy, team climate and skill discretion were associated with these factors. METHODS: The present study was a cross-sectional questionnaire study among 371 foreign-born physicians in Finland, aged between 26 and 65 (65% women). Analyses of covariance and logistic regression analyses were conducted to examine the associations. RESULTS: A good team climate and high cross-cultural empathy were associated with lower likelihoods of discrimination from all sources, patient-related stress and integration-related stress. Skill discretion was associated with lower levels of integration-related stress and discrimination from management and colleagues. Language problems were associated with higher levels of integration-related stress. The biggest sources of discrimination were patients and their relatives. CONCLUSIONS: The present study showed the importance of a good team climate, cross-cultural empathy and patience, skill discretion and language skills in regard to the proper integration of foreign-born health care employees into the workplace. Good job resources, such as a good team climate and the possibility to use one's skills, may help foreign-born employees, for instance by giving them support when needed and offering flexibility. Health care organizations should invest in continuous language training for foreign-born employees and also offer support when there are language problems. Moreover, it seems that training increasing cross-cultural empathy and patience might be beneficial.


Assuntos
Médicos Graduados Estrangeiros , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Médicos , Racismo , Local de Trabalho/psicologia , Adulto , Barreiras de Comunicação , Estudos Transversais , Feminino , Finlândia/epidemiologia , Médicos Graduados Estrangeiros/psicologia , Médicos Graduados Estrangeiros/estatística & dados numéricos , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Estresse Ocupacional , Percepção , Médicos/psicologia , Médicos/estatística & dados numéricos , Racismo/psicologia , Racismo/estatística & dados numéricos , Estresse Psicológico , Inquéritos e Questionários
20.
Stud Health Technol Inform ; 247: 181-185, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29677947

RESUMO

An increasing number of new eHealth services that support patients' self-management has changed health professionals' work and has created a need for a new eHealth competence. In this study, we evaluated the health professionals' eHealth competences and training needs in a public health organization in Finland. The target organization's goal was to increase the number of eHealth services provided to patients, and health professionals and their competences were seen as critical for the adoption of services. Data was collected through an online survey of 701 health professionals working in the target organization. Professionals perceived their basic computer skills as good and they were mostly willing to use eHealth services in patient work. However, health professionals need guidance, especially in their patient work in the new eHealth-enabled environment. They were less confident about their competence to motivate and advise patients to use eHealth services and how to communicate with patients using eHealth solutions. The results also imply that eHealth competence is not merely about an individual's skills but that organizations need to develop new working processes, work practices and distribution of work. We suggest that the training and support needs identified be considered in curricula and lifelong learning.


Assuntos
Autogestão , Telemedicina , Finlândia , Pessoal de Saúde , Humanos , Inquéritos e Questionários
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