Ausserhofer Dietmar, Favez Lauriane, Simon Michael, Zúñiga Franziska
College of Health Care-Professions Claudiana, Bolzano-Bozen, Italy.
Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.
JMIR Med Inform. 2021 Mar 2;9(3):e22974. doi: 10.2196/22974.
Nursing homes (NHs) are increasingly implementing electronic health records (EHRs); however, little information is available on EHR use in NH settings. It remains unclear how care workers perceive its safety, quality, and efficiency, and whether EHR use might ease the burden of documentation, thereby reducing its implicit rationing.
This study aims to describe nurses' perceptions regarding the usefulness of the EHR system and whether sufficient numbers of computers are available in Swiss NHs, and to explore the system's association with implicit rationing of nursing care documentation.
This was a multicenter cross-sectional study using survey data from the Swiss Nursing Homes Human Resources Project 2018. It includes a convenience sample of 107 NHs, 302 care units, and 1975 care workers (ie, registered nurses and licensed practical nurses) from Switzerland's German- and French-speaking regions. Care workers completed questionnaires assessing the level of implicit rationing of nursing care documentation, their perceptions of the EHR system's usefulness and of how sufficient the number of available computers was, staffing and resource adequacy, leadership ability, and teamwork and safety climate. For analysis, we applied generalized linear mixed models, including individual-level nurse survey data and data on unit and facility characteristics.
Overall, the care workers perceived the EHR systems as useful; ratings ranged from 69.42% (1362/1962; guarantees safe care and treatment) to 78.32% (1535/1960; allows quick access to relevant information on the residents). However, less than half (914/1961, 46.61%) of the care workers reported sufficient computers on their unit to allow timely documentation. Half of the care workers responded that they sometimes or often had to ration the documentation of care. After adjusting for work environment factors and safety and teamwork climate, both higher care worker ratings of the EHR system's usefulness (β=-.12; 95% CI -0.17 to -0.06) and sufficient numbers of computers (β=-.09; 95% CI -0.12 to -0.06) were consistently associated with lower implicit rationing of nursing care documentation.
Both the usefulness of the EHR system and the number of computers available were important explanatory factors for care workers leaving care activities (eg, developing or updating nursing care plans) unfinished. NH managers should carefully select and implement their information technology infrastructure with greater involvement and attention to the needs of their care workers and residents. Further research is needed to develop and implement user-friendly information technology infrastructure in NHs and to evaluate their impact on care processes as well as resident and care worker outcomes.
疗养院（NHs）越来越多地采用电子健康记录（EHRs）；然而，关于疗养院环境中电子健康记录使用情况的信息却很少。护理人员如何看待其安全性、质量和效率，以及电子健康记录的使用是否可能减轻文档记录负担，从而减少其隐性配给，仍不明确。
本研究旨在描述护士对电子健康记录系统有用性的看法，以及瑞士疗养院是否有足够数量的计算机，并探讨该系统与护理记录隐性配给之间的关联。
这是一项多中心横断面研究，使用了来自2018年瑞士疗养院人力资源项目的调查数据。它包括来自瑞士德语区和法语区的107家疗养院、302个护理单元和1975名护理人员（即注册护士和执业护士）的便利样本。护理人员完成了问卷调查，评估护理记录隐性配给水平、他们对电子健康记录系统有用性的看法以及可用计算机数量是否充足、人员配备和资源充足情况、领导能力以及团队合作和安全氛围。为了进行分析，我们应用了广义线性混合模型，包括个体层面的护士调查数据以及单元和机构特征数据。
总体而言，护理人员认为电子健康记录系统有用；评分范围从69.42%（1362/1962；保证安全护理和治疗）到78.32%（1535/1960；允许快速获取居民相关信息）。然而，不到一半（914/1961，46.61%）的护理人员报告其所在单元有足够的计算机以允许及时记录。一半的护理人员表示他们有时或经常不得不对护理记录进行配给。在对工作环境因素以及安全和团队合作氛围进行调整后，护理人员对电子健康记录系统有用性的较高评分（β = -0.12；95%置信区间 -0.17至 -0.06）和足够数量的计算机（β = -0.09；95%置信区间 -0.12至 -0.06）均始终与较低的护理记录隐性配给相关。
电子健康记录系统的有用性和可用计算机数量都是护理人员未完成护理活动（如制定或更新护理计划）的重要解释因素。疗养院管理人员应更加关注护理人员和居民的需求，更深入地参与并仔细选择和实施其信息技术基础设施。需要进一步研究以在疗养院开发和实施用户友好的信息技术基础设施，并评估其对护理流程以及居民和护理人员结果的影响。
