Proposal
Technological advances enable healthcare professionals to provide high-quality services that improve patients’ quality of life. Electronic health records (EHR) can be regarded as one of the latest innovations that are still evolving to address the needs of the involved stakeholders (Needleman, 2013). This system implies effective knowledge sharing that enables healthcare professionals to access data, share information, and even make evidence-based decisions. The system is used by many stakeholders, which is one of its primary strengths since different healthcare professionals can access the necessary data promptly.
EHR has been utilized in the acute care unit (ACU) setting and managed to improve hospitals’ performance considerably (Appari, Johnson, & Anthony, 2013). One of the major positive outcomes is the reduction of medical errors associated with the use of this software (Needleman, 2013). Collins et al. (2013) found that EHR could predict patients’ mortality as nurses tended to add more comments and details when they had some concerns about their patients’ health status. At the same time, the complexity of the system negatively correlated with the facilities’ performance and the quality of the provided services (Appari et al., 2013). Nurses are active users of EHR, which makes it critical to evaluate the effectiveness of the system and these professionals’ expertise, as well as opinions on the matter.
Many factors affect the use of EHR including but not confined to nurses’ workload, skills, education and training, motivation, and the overall viewpoint concerning the system and its efficiency. According to Penoyer et al. (2014), nurses spend up to 4 hours daily to complete forms and reports, and between 1 and 2 hours a day to review the information available from EHR. The researchers also add that a substantial number of the details nurses provide within the system are rarely viewed by other healthcare professionals. This trend should be properly researched, and the corresponding changes should be introduced into the existing EHR-based systems. It is also essential to identify other flaws associated with the use of HER, and the views of nursing professionals can provide the necessary insights into the problem. These practitioners’ comments can help in developing an effective system that will be utilized effectively. The purpose of this study is to develop an intervention for ACU nurses aimed at enabling these professionals to use EHR-based systems in the most effective way to achieve desired health outcomes for patients.
The significance of this project lies in its potential impact on nursing practitioners’ performance and patients’ health status. Nurses will receive educational services that will improve their skills associated with the use of EHR systems. The project is likely to positively affect nursing professionals’ motivation and job satisfaction. Needleman (2013) notes that effective EHR has a positive influence on nursing practitioners’ motivation as these systems are instrumental in making evidence-based decisions and completing certain tasks within shorter periods. Furthermore, according to Appari et al. (2013), nurses are rather willing to document relevant data, but this eagerness fades away due to some software or organizational flaws. The fact that many documents are rarely viewed discourages nurses from proper documenting. The proposed project involves the implementation of a study that will explore nursing professionals’ attitudes towards the use of EHR and identify their strengths and weaknesses. The intervention will be developed based on this data. This evidence-based project has considerable significance for practitioners as well as researchers who will be able to use its methodology to come up with new interventions and programs.
Theoretical Framework
To achieve the goals of the proposed study, it is essential to choose an appropriate theoretical framework. Theories provide the necessary frames that can help researchers and practitioners to set clear goals and remain focused. This project is associated with the use of EHR and the potential improvement of this process. Therefore, theories concerning organizational issues and change will be helpful. For this project, it is possible to focus on such theoretical paradigms as Complex Adaptive Systems Theory and Lewin’s Theory of Planned Change. It is noteworthy that each of these theories is based on three concepts that are rather similar and consistent with the process of change.
Since the primary objective of the intervention is the implementation of change, it is necessary to consider the use of Lewin’s framework. Lewin identified three major stages of change that include unfreezing, changing, and refreezing (Shirey, 2013). The first phase involves the effort aimed at unveiling the flaws to be eliminated and encouraging people to engage in the process of change. In simple terms, the study implementation and dissemination of its results will be unfreezing. Nurses will acknowledge the existing gaps and will be encouraged to discuss possible solutions. The second stage is the change itself. The intervention is the core of this process. Nursing professionals will be trained to use EHR effectively. Refreezing will start with the evaluation of the results of the intervention and the development of policies and standards that will ensure the proper utilization of EHR. This stage also implies the use of various motivational strategies and methods to develop a strong culture.
Another framework to guide this project is the Complex Adaptive Systems (CAS) Theory. Three central principles of CAS include “relationships, self-organization, and nonlinear predictability” (Chapman, 2014, p. 110). The first principle is based on the assumption that different systems interact. Self-organization is associated with the emergence of various trends and patterns. Finally, it is believed that the evolution of systems and relationships occurs in a chaotic, non-linear, and unpredictable manner. Slight changes in certain practices and routines may lead to fundamental transformations of systems or the entire organization.
This theoretical paradigm can be applied to this project. First, it is necessary to state that such systems as nursing staff, EHR, and patients will be central to the proposed change. These systems have certain relationships since nursing practitioners have been using EHR-based for years. These relationships will be explored during the preparation for the intervention and will guide the development of training sessions. The role of patients in these relationships should also be considered as these stakeholders and their health conditions affected the way EHR were documented and reviewed by nurses. Self-organization is the primary target of this project as the utilization of EHR was associated with the emergence of certain patterns such as ways nurses used them. Finally, the concept of non-linear adaptability is closely linked to the nature of the changes that will occur. The intervention is likely to lead to the development of certain guidelines. In terms of CAS theory, it is clear that detailed and simple rules are associated with the most positive outcomes as nurses will follow them and improve their performance as well as patient outcomes.
References
Appari, A., Johnson, M. E., & Anthony, D. L. (2013). Meaningful use of electronic health record systems and process quality of care: Evidence from a panel data analysis of U.S. acute-care hospitals. Health Services Research, 48(2pt1), 354-375.
Chapman, K. (2014). Using complex adaptive systems theory to guide change. In J. S. Fulton et al. (Eds.), Foundations of clinical nurse specialist practice (2nd ed.) (pp. 109-122). New York, NY: Springer Publishing Company.
Collins, S. A., Cato, K., Albers, D., Scott, K., Stetson, P. D., Bakken, S., & Vawdrey, D. K. (2013). Relationship between nursing documentation and patients’ mortality. American Journal of Critical Care, 22(4), 306-313.
Needleman, J. (2013). Increasing acuity, increasing technology, and the changing demands on nurses. Nursing Economics, 31(4), 200-202.
Penoyer, D. A., Cortelyou-Ward, K. H., Noblin, A. M., Bullard, T., Talbert, S., Wilson, J., … Briscoe, J. G. (2014). Use of electronic health record documentation by healthcare workers in an acute care hospital system. Journal of Healthcare Management, 59(2), 130-144.
Shirey, M. R. (2013). Lewin’s theory of planned change as a strategic resource. JONA: The Journal of Nursing Administration, 43(2), 69-72.