| 1. |
- Bergström, Anna, 1983-, et al.
(författare)
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The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature
- 2020
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Ingår i: Implementation science : IS. - : Springer Science and Business Media LLC. - 1748-5908. ; 15:1
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. METHODS: This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. RESULTS: The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. CONCLUSIONS: In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.
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| 2. |
- Fossum, Mariann, 1970-
(författare)
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Computerized decision support system in nursing homes
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to study the thinking strategies and clinical reasoning processes of registered nurses (RNs) and to implement and test a computerized decision support system (CDSS) integrated into the electronic health care record (EHR) to improve patient outcomes, i.e. to prevent pressure ulcers (PUs) and malnutrition among residents in nursing homes. A think-aloud (TA) study with a purposeful sample of RNs (n=30) was conducted to explore their thinking strategies and clinical reasoning (Paper I). A quasi-experimental study with a convenience sample of residents (at baseline, n=491 and at follow-up, n=480) from nursing homes (n=15) allocated into two intervention groups and one control group was carried out in 2007 and 2009 (Paper II). In Paper III residents’ records were reviewed with three instruments. Nursing personnel (n=25) from four nursing homes that had used the CDSS for eight months were interviewed and the CDSS was tested by nursing personnel (n=5) in two usability evaluations (Paper IV).The results showed that the RNs used a variety of thinking strategies and a lack of systematic risk assessment was identified (Paper I). The proportion of malnourished residents decreased significantly in one of the intervention groups after implementing the CDSS, however there were no differences between the groups (Paper II). The CDSS resulted in more complete and comprehensive documentation of PUs and malnutrition (Paper III). The nursing personnel considered ease of use, usefulness and a supportive work environment as the main facilitators of CDSS use in nursing homes. Barriers were lack of training, resistance to using computers and limited integration of the CDSS within the EHR system (Paper IV). In conclusion, the findings support integrating CDSSs into the EHR in nursing homes to support the nursing personnel.
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| 4. |
- Berg, Lena M, et al.
(författare)
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Associations between crowding and ten-day mortality among patients allocated lower triage acuity levels without need of acute hospital care on departure from the emergency department
- 2019
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Ingår i: Annals of Emergency Medicine. - : Elsevier BV. - 0196-0644 .- 1097-6760. ; 74:3, s. 345-356
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Tidskriftsartikel (refereegranskat)abstract
- STUDY OBJECTIVE: We describe the association between emergency department (ED) crowding and 10-day mortality for patients triaged to lower acuity levels at ED arrival and without need of acute hospital care on ED departure.METHODS: This was a registry study based on ED visits with all patients aged 18 years or older, with triage acuity levels 3 to 5, and without need of acute hospital care on ED departure during 2009 to 2016 (n=705,699). The sample was divided into patients surviving (n=705,076) or dying (n=623) within 10 days. Variables concerning patient characteristics and measures of ED crowding (mean length of stay and ED occupancy ratio) were extracted from the hospital's electronic health records. ED length of stay per ED visit was estimated by the average length of stay for all patients who presented to the ED during the same day and shift and with the same acuity level. The 10-day mortality after ED discharge was used as the outcome measure. Multivariable logistic regression analyses were conducted.RESULTS: The 10-day mortality rate was 0.09% (n=623). The event group had larger proportions of patients aged 80 years or older (51.4% versus 7.7%) and triaged with acuity level 3 (63.3% versus 35.6%), and greater comorbidity (age-combined Charlson comorbidity index median interquartile range 6 versus 0). We observed an increased 10-day mortality for patients with a mean ED length of stay greater than or equal to 8 hours versus less than 2 hours (adjusted odds ratio 5.86; 95% confidence interval [CI] 2.15 to 15.94) and for elevated ED occupancy ratio. Adjusted odds ratios for ED occupancy ratio quartiles 2, 3, and 4 versus quartile 1 were 1.48 (95% CI 1.14 to 1.92), 1.63 (95% CI 1.24 to 2.14), and 1.53 (95% CI 1.15 to 2.03), respectively.CONCLUSION: Patients assigned to lower triage acuity levels when arriving to the ED and without need of acute hospital care on departure from the ED had higher 10-day mortality when the mean ED length of stay exceeded 8 hours and when ED occupancy ratio increased.
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| 5. |
- Fossum, Mariann, et al.
(författare)
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An evaluation of the usability of a computerized decision support system for nursing homes
- 2011
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Ingår i: Applied Clinical Informatics. - Stuttgart : Schattauer Gmbh. - 1869-0327. ; 2:4, s. 420-436
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Tidskriftsartikel (refereegranskat)abstract
- Background: Computerized decision support systems (CDSSs) have the potential to significantly improve the quality of nursing care of older people by enhancing the decision making of nursing personnel. Despite this potential, health care organizations have been slow to incorporate CDSSs into nursing home practices.Objective: This study describes facilitators and barriers that impact the ability of nursing personnel to effectively use a clinical CDSS for planning and treating pressure ulcers (PUs) and malnutrition and for following the suggested risk assessment guidelines for the care of nursing home residents.Methods: We employed a qualitative descriptive design using varied methods, including structured group interviews, cognitive walkthrough observations and a graphical user interface (GUI) usability evaluation. Group interviews were conducted with 25 nursing personnel from four nursing homes in southern Norway. Five nursing personnel participated in cognitive walkthrough observations and the GUI usability evaluation. Text transcripts were analyzed using qualitative content analysis.Results: Group interview participants reported that ease of use, usefulness and a supportive work environment were key facilitators of CDSS use. The barriers identified were lack of training, resistance to using computers and limited integration of the CDSS with the facility’s electronic health record (EHR) system. Key findings from the usability evaluation also identified the difficulty of using the CDSS within the EHR and the poorly designed GUI integration as barriers.Conclusion: Overall, we found disconnect between two types of nursing personnel. Those who were comfortable with computer technology reported positive feedback about the CDSS, while others expressed resistance to using the CDSS for various reasons. This study revealed that organizations must invest more resources in educating nursing personnel on the seriousness of PUs and poor nutrition in the elderly, providing specialized CDSS training and ensuring that nursing personnel have time in the workday to use the CDSS.
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| 6. |
- Fossum, Mariann, 1970-, et al.
(författare)
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Clinical decision support systems to prevent and treat pressure ulcers and under-nutrition in nursing homes
- 2009
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Ingår i: Studies in Health Technology and Informatics. - Amsterdam : I O S PRESS. - 9781607500247 ; , s. 877-878
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Konferensbidrag (refereegranskat)abstract
- Clinical decision support systems (CDSSs) are believed to have the potential to improve care and change the behavior of health personnel. The project has focused on developing a CDSS to support prevention of pressure ulcer and undernutrition that is completely integrated in the electronic health record in nursing homes. Nursing staff have been involved in all phases in the development of the CDSS, which at present is ready to be implemented and systematically evaluated. © 2009 The authors and IOS Press. All rights reserved.
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| 7. |
- Fossum, Mariann, et al.
(författare)
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Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes : an intervention study
- 2013
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Ingår i: International Journal of Medical Informatics. - : Elsevier BV. - 1386-5056 .- 1872-8243. ; 82:10, s. 911-921
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Tidskriftsartikel (refereegranskat)abstract
- Background: Nursing documentation is essential for facilitating the flow of information to guarantee continuity, quality and safety in care. High-quality nursing documentation is frequently lacking; the implementation of computerized decision support systems is expected to improve clinical practice and nursing documentation.Aim: The present study aimed at investigate the effects of a computerized decision support system and an educational program as intervention strategies for improved nursing documentation practice on pressure ulcers and malnutrition in nursing homes.Design, setting and participants: An intervention study with two intervention groups and one control group was used. Fifteen nursing homes in southern Norway were included. A convenience sample of electronic healthcare records from 46 units was included. Inclusion criteria were records with presence of pressure ulcers and/or malnutrition. The residents were assessed before and after an intervention of a computerized decision support system in the electronic healthcare records. Data were collected through a review of 150 records before (2007) and 141 records after the intervention (2009).Methods: The nurses in intervention group 1 were offered educational sessions and were trained to use the computerized decision support system, which they used for eight months in 2008 and 2009. The nurses in intervention group 2 were offered the same educational program but did not use the computerized decision support system. The nurses in the control group were not subject to any intervention. The resident records were examined for the completeness and comprehensiveness of the documentation of pressure ulcers and malnutrition with three data collection forms and the data were analyzed with non-parametric statistics.Results: The implementation of the computerized decision support system and the educational program resulted in a more complete and comprehensive documentation of pressure ulcer- and malnutrition-related nursing assessments and nursing interventions.Conclusion: This study provides evidence that the computerized decision support system and an educational program as implementation strategies had a positive influence on nursing documentation practice.
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| 8. |
- Fossum, Mariann, 1970-, et al.
(författare)
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The experiences of using a computerized decision support system
- 2012
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The aim was to describe the facilitators and barriers influencing the ability of nursing personnel to effectively use a CDSS for planning and treating pressure ulcers and malnutrition in nursing homes. Usability evaluations and group interviews were conducted. Facilitators were ease of use, usefulness and a supportive work environment. Lack of training, resistance to using computers and limited integration of the CDSS with the electronic health record system were reported.
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| 9. |
- Göransson, Katarina, 1974-, et al.
(författare)
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The use of qualitative data analysis software (QDAS) to manage and support the analysis of think aloud (TA) data
- 2006
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Ingår i: Consumer-Centered Computer-Suppported Care for Healthy People. - Amsterdam, Netherlands : IOS Press. - 9781586036225 ; , s. 143-6, s. 143-6:122, s. 143-6
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Konferensbidrag (refereegranskat)abstract
- This methodological paper describes how qualitative data analysis software (QDAS) is being used to manage and support a three-step protocol analysis (PA) of think aloud (TA) data in a study examining emergency nurses' reasoning during triage. The authors believe that QDAS program QRS NVivo will greatly facilitate the PA and will allow them to identify and describe the information that triage nurses concentrate on during triage, and how they structure this information to make a triage decision. These findings could assist in designing and creating decision support systems to guide nurses' triaging. Additionally, details about how to use QRS NVivo for PA of TA data may assist and guide future informatics research using similar methodology are presented here. This innovative use of QDAS holds great promise for future nursing informatics research.
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