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- Stevenson-Ågren, Jean, et al.
(författare)
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Factors influencing the quality of vital signs data in electronic health records : a qualitative study
- 2018
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Ingår i: Journal of Clinical Nursing. - New Jersey : John Wiley & Sons. - 0962-1067 .- 1365-2702. ; 27:5-6, s. 1276-1286
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectivesTo investigate reasons for inadequate documentation of vital signs in an electronic health record.BackgroundMonitoring vital signs is crucial to detecting and responding to patient deterioration. The ways in which vital signs are documented in electronic health records have received limited attention in the research literature. A previous study revealed that vital signs in an electronic health record were incomplete and inconsistent.DesignQualitative study.MethodsQualitative study. Data were collected by observing (68 hr) and interviewing nurses (n = 11) and doctors (n = 3), and analysed by thematic analysis to examine processes for measuring, documenting and retrieving vital signs in four clinical settings in a 353-bed hospital.ResultsWe identified two central reasons for inadequate vital sign documentation. First, there was an absence of firm guidelines for observing patients’ vital signs, resulting in inconsistencies in the ways vital signs were recorded. Second, there was a lack of adequate facilities in the electronic health record for recording vital signs. This led to poor presentation of vital signs in the electronic health record and to staff creating paper “workarounds.”ConclusionsThis study demonstrated inadequate routines and poor facilities for vital sign documentation in an electronic health record, and makes an important contribution to knowledge by identifying problems and barriers that may occur. Further, it has demonstrated the need for improved facilities for electronic documentation of vital signs.Relevance to clinical practicePatient safety may have been compromised because of poor presentation of vital signs. Thus, our results emphasised the need for standardised routines for monitoring patients. In addition, designers should consult the clinical end-users to optimise facilities for electronic documentation of vital signs. This could have a positive impact on clinical practice and thus improve patient safety.
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| 2. |
- Stevenson-Ågren, Jean, et al.
(författare)
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Recording signs of deterioration in acute patients : The documentation of vital signs within electronic health records in patients who suffered in-hospital cardiac arrest
- 2016
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Ingår i: Health Informatics Journal. - : Sage Publications. - 1460-4582 .- 1741-2811. ; 22:1, s. 21-33
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Tidskriftsartikel (refereegranskat)abstract
- Vital sign documentation is crucial to detecting patient deterioration. Little is known about the documentation of vital signs in electronic health records. This study aimed to examine documentation of vital signs in electronic health records. We examined the vital signs documented in the electronic health records of patients who had suffered an in-hospital cardiac arrest and on whom cardiopulmonary resuscitation was attempted between 2007 and 2011 (n = 228), in a 372-bed district general hospital. We assessed the completeness of vital sign data compared to VitalPACTM Early Warning Score and the location of vital signs within the electronic health records. There was a noticeable lack of completeness of vital signs. Vital signs were fragmented through various sections of the electronic health records. The study identified serious shortfalls in the representation of vital signs in the electronic health records, with consequential threats to patient safety.
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| 4. |
- Israelsson, Johan, 1970-, et al.
(författare)
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Post cardiac arrest care and follow-up in Sweden – a national survey
- 2016
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Ingår i: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955 .- 1472-6955. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundRecent decades have shown major improvements in survival rates after cardiac arrest. However, few interventions have been tested in order to improve the care for survivors and their family members. In many countries, including Sweden, national guidelines for post cardiac arrest care and follow-up programs are not available and current practice has not previously been investigated. The aim of this survey was therefore to describe current post cardiac arrest care and follow-up in Sweden.MethodsAn internet based questionnaire was sent to the resuscitation coordinators at all Swedish emergency hospitals (n = 74) and 59 answers were received. Quantitative data were analysed with descriptive statistics and free text responses were analysed using manifest content analysis.ResultsAlmost half of the hospitals in Sweden (n = 27, 46 %) have local guidelines for post cardiac arrest care and follow-up. However, 39 % of them reported that these guidelines were not always applied. The most common routine is a follow-up visit at a cardiac reception unit. If the need for neurological or psychological support are discovered the routines are not explicit. In addition, family members are not always included in the follow-up.ConclusionsAlthough efforts are already made to improve post cardiac arrest care and follow-up, many hospitals need to focus more on this part of cardiac arrest treatment. In addition, evidence-based national guidelines will have to be developed and implemented in order to achieve a more uniform care and follow-up for survivors and their family members. This national survey highlights this need, and might be helpful in the implementation of such guidelines.
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| 5. |
- Stevenson-Ågren, Jean, Senior lecturer, et al.
(författare)
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A bilingual evidence-based app to improve communication in maternity care
- 2019
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Ingår i: Nursing World Congress on Nursing Education and Practice.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background. Sweden, with a population of 10 million, received approximately 300,000 refugees 2015-2016 (The Statistics Portal 2018), the majority from Arabic-speaking countries, many of whom were women of child-bearing age. Midwives in pre-natal care experienced communication problems despite telephone interpreters. Studies have shown that immigrant women have poorer outcomes in pregnancy (Bollini et al. 2009). This has been linked to communication and cultural difficulties. Although there are many health-related applications (apps), many are not evidence-based (Lewis & Wyatt 2014). AimThe aim of this project was to develop an evidence-based app to promote effective communication between midwives and Arabic-speaking women. MethodsA multi-disciplinary team was formed to develop a bilingual app in cooperation with midwives who worked in pre-natal care. End-user perspectives were prioritised. Data were collected by 1) focus group interviews to determine the objectives of maternity care, 2) observations to gain understanding of work processes and 3) workshops to discuss material with midwives and refine content according to user-needs. All material was further validated by professional midwifery sources.ResultsAn evidence-based, multi-modal, bilingual app with text, images and voiced recordings was developed to use as a complement to interpreters in pre-natal care. Both midwives and the pregnant women feel empowered; midwives do not have to risk inadequate translation by interpreters; women receive accurate information. Women receive information directly from the midwife through the app, rather than depending on an interpreter. ConclusionsThis app contributes to ensuring equity of care within midwifery services. It provides improved communication within pre-natal care to help promote safe pregnancy and delivery of a healthy baby. ReferencesBollini, P., Pampallona, S., Wanner, P., & Kupelnick, B. (2009). Pregnancy outcomes of migrant women and integration policy: a systematic review of the international literature. Soc Sci Med, 68, 452-461. Lewis T and Wyatt J. mHealth and Mobile Medical Apps: A Framework to Assess Risk and Promote Safer Use. Journal of Medical Internet Research. 2014; 16: e210.The Statistics Portal. (2018). Number of immigrants in Sweden from 2007 to 2017. Retrieved from https://www.statista.com/statistics/523293/immigration-to-sweden/
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| 6. |
- Stevenson-Ågren, Jean
(författare)
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A project to promote equality in ante-natal care for women who do not speak Swedish
- 2017
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundHealth care in Sweden aims to be equal. In antenatal care, women who do not speak Swedish have a higher rate of maternal and infant mortality (Essen et al. 2001, Wahlberg et al. 2013). Cultural and communicative problems have been identified as one reason for this disparity. Due to recent immigration, Arabic-speaking women (ASW) have been identified as a vulnerable group. Technology has the potential to solve language and cultural barriers (Haith-Cooper 2014). A pilot study in which midwives were interviewed suggested that an ‘app’ for a tablet with multimodal components could be an aid to cultural and linguistic understanding (Axelsson et al. 2016). AimThe aim of the project is to identify women’s and midwives’ information needs and cultural issues, and subsequently, to develop an app with norm-critical design for interactive communication in antenatal care (ANC). The app will serve as a complement to interpreters and provide essential information about ANC.MethodTwo data collection methods will be used. The first is to observe meetings between midwives and pregnant women. The second is to interview midwives in focus groups so that they can freely express their wishes. Following this, a trial version of the app will be constructed, which will then be tested and evaluated iteratively in midwifery practice. The material will be analysed in workshops using linguistic and norm critique methods.ResultsThe app is expected to improve and ensure the quality of ANC for ASW and improve their understanding of pregnancy, fetal development and parenting. It will hlep midwives to be sure that women have been given the correct information and improve patient safety. We will improve our own understanding of the risks in communication that can arise when two parties do not understand each other, and of how communication can be promoted through an app. ReferencesEssen, B. et al. (2001) Increased perinatal mortality among sub-Saharan immigrants in a city-population in Sweden. [Dissertation]. Malmö and Lund: Lund University; 2001.Haith-Cooper, M. (2014) Mobile translators for non-English-speaking women accessing maternity services. British Journal of Midwifery. 2014; 22: 795-803. http://www.magonlinelibrary.com/doi/abs/10.12968/bjom.2014.22.11.795Axelsson, C. et al. (2016). ”Det kan bli så mycket fel”: Förstudie om barnmorskors upplevelser av kommunikation med gravida kvinnor utan funktionell behärskning av svenska. Kalmar/Växjö: Linnéuniversitetet.Wahlberg, A. et al. (2013) Increased risk of severe maternal morbidity (near-miss) among immigrant women in Sweden: a population register-based study Epidemiology. 2013 Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala, Sweden
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| 7. |
- Stevenson-Ågren, Jean
(författare)
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Documentation of Vital Signs in Electronic Health Records : A Patient Safety Issue
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and aim: Hospitals in the developed world are increasingly adopting digital systems such as electronic health records (EHRs) for all kinds of documentation. This move means that traditional paper case notes and nursing records are often documented in EHRs. Documentation of vital signs is important for monitoring a patient's physiological condition and how vital signs are presented in a clinical record can have a profound impact on the ability of clinicians to recognise changes, such as deterioration in a patient's condition. Vital signs have received minimal attention with regard to how they are documented in EHRs which suggests that there is an urgent need for this to be examined. Design, methodology and approach: A mixed methods study was conducted in a 372-bed county hospital in two phases. Phase one was a quantitative study, and was followed by a qualitative study in phase two. The aim of the quantitative study was to examine the vital signs documented in the electronic health records of patients who had previously suffered a cardiac arrest. The aim of the qualitative study was to investigate how medical and nursing staff measured, reported and retrieved information on vital signs. Observations were made and interviews were conducted in four clinical areas. Findings: The quantitative study found that documentation of vital signs was incomplete in relation to current universal standards for monitoring vital signs, and that vital signs were dispersed inconsistently throughout the EHR. The qualitative study provided a detailed understanding of the routines and practices for monitoring vital signs and demonstrated variation in routines and in methods of documentation in the four clinical areas. Documenting and retrieving vital signs in the EHR was problematic because of usability issues and led to workflow problems. Workflow problems were solved at ward level by the creation of paper workarounds. Contribution to knowledge: This thesis has shown that poor facilities for the documentation of vital signs in EHRs could have a negative impact on patient safety because it reduces the possibility of good record keeping. This leads to limited availability of easily accessible, up-to-date information, essential for identifying clinical deterioration and, thus, is a challenge to patient safety. Related to this, the thesis has identified possible solutions to usability problems in the EHR. Inconsistent routines and practices were also identified and suggestions were made for how this problem might be approached.
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| 8. |
- Stevenson-Ågren, Jean, et al.
(författare)
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Documentation of vital signs in electronic records : the development of workarounds
- 2015
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Ingår i: Health informatics for enhancing health and well-being.
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Konferensbidrag (refereegranskat)abstract
- Workarounds are commonplace in health care settings. An increase in the use of electronic health records (EHR) has led to an escalation of workarounds as health care professionals cope with systems which are inadequate for their needs. Closely related to this, the documentation of vital signs in EHR has been problematic. The accuracy and completeness of vital sign documentation has a direct impact on the recognition of deterioration in a patient’s condition. We examined work flow processes to identify workarounds related to vital signs in a 372-bed hospital in Sweden. In three clinical areas, a qualitative study was performed with data collected during observations and interviews and analysed through thematic content analysis. We identified paper workarounds in the form of hand-written notes and a total of eight pre-printed paper observation charts. Our results suggested that nurses created workarounds to allow a smooth workflow and to ensure patients safety.
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| 9. |
- Stevenson-Ågren, Jean, Senior lecturer
(författare)
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How we created an evidence-based communication app for maternity care
- 2019
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Ingår i: Vitalis conference 2019, Svenskmassan, Göteborg. May 21-23..
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Konferensbidrag (refereegranskat)abstract
- This presentation describes how an app was developed in a multi-disciplinary research team in close collaboration with midwives to improve communication between midwives and their non-Swedish speaking clients. The project aims to promote equal and effective communication between midwives and Arabic speaking women in maternity care. A prototype version of the app was tested in spring 2018 in Kalmar County Council. After revision the final version of the app was produced in December 2018. It is currently being used by midwives in pre-natal care.
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| 10. |
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