Evaluation of the national nursing model and four nursing documentation systems in Finland - Lessons learned and directions for the future

International Journal of Medical Informatics

Volumn 81, Issue 8, 2012, Pages 507-520

  Nykänen, Pirkko ^a   Kaipio, Johanna ^b   Kuusisto, Anne ^c  

^a TAMPERE UNIVERSITY OF TECHNOLOGY   (Finland)

^b AALTO UNIVERSITY   (Finland)

^c Satakunta Hospital District   (Finland)

Author keywords

Evaluation; Feasibility; Multiprofessional collaboration; Multiprofessional communication; Nursing classification; Nursing documentation; Nursing documentation system; Nursing model; Qualitative; Usability

Indexed keywords

EVALUATION; FEASIBILITY; MULTIPROFESSIONAL COLLABORATION; NURSING DOCUMENTATION; QUALITATIVE; USABILITY;

ELECTRONIC DOCUMENT EXCHANGE; INFORMATION DISSEMINATION; PATIENT TREATMENT; USABILITY ENGINEERING;

NURSING;

ARTICLE; CONTEXTUAL INQUIRY; FINLAND; HUMAN; INFORMATION PROCESSING; INSPECTION BASED EXPERT REVIEW; INTERDISCIPLINARY COMMUNICATION; MEDICAL DOCUMENTATION; NURSING ASSESSMENT; NURSING CARE; NURSING CARE PLAN; NURSING CLASSIFICATION; NURSING DIAGNOSIS; NURSING DOCUMENTATION SYSTEM; NURSING INTERVENTION; NURSING MINIMUM DATA SET; NURSING PRACTICE; NURSING PROCESS; NURSING THEORY; PATIENT INFORMATION; PRIORITY JOURNAL; QUALITATIVE RESEARCH; SCENARIO WALKTHROUGH; THEMATIC INTERVIEW; WORKLOAD;

DOCUMENTATION; FINLAND; HUMANS; LEARNING; MEDICAL RECORDS SYSTEMS, COMPUTERIZED; MODELS, NURSING; NURSING INFORMATICS; NURSING RECORDS; QUALITATIVE RESEARCH;

EID: 84863779792     PISSN: 13865056     EISSN: 18728243     Source Type: Journal    
DOI: 10.1016/j.ijmedinf.2012.02.003     Document Type: Article

References (69)

1. Ensio A., Saranto K. The Finnish classification of nursing interventions (FiCNI) - development and use in nursing documentation. Naming Nursing. Proceedings of the First ACENDIO Conference 2003, 191-195. Verlag Hans Huber, Bern. J. Clarke (Ed.).
2. Tanttu K. National Nursing Documentation Project in Finland 5/2005-5/2008: Nationally Standardized Electronic Nursing Documentation, Presentation 2008, Available from: http://www.vsshp.fi/fi/dokumentit/15158/National-Nursing-Project-2005-2007.pdf (accessed 01.03.11).
3. Thoroddsen A., Saranto K., Ehrenberg A., Sermeus W. Models, standards and structures of nursing documentation in European countries. Connecting Health and Humans: Proceedings of 10th International Congress on Nursing Informatics. Studies in Health Technology and Informatics, vol. 146 2009, 327-331. IOS Press, Amsterdam. K. Saranto, P. Brennan Flatley, H.A. Park, M. Tallberg, A. Ensio (Eds.).
4. Green S.D., Thomas J.D. Interdisciplinary collaboration and the electronic medical record. Paediatr. Nurs. 2008, 34(3):225-227.
5. Ala-Hiiro T., Lemmetty K., Pitkänen S., Häyrinen E. Adopting the national structure of nursing documentation is consequential in the development of care. MEDINFO2010 Proceedings. Studies in Health Technology and Informatics, vol. 160 2010, 421-423. IOS Press, Amsterdam. C. Safran (Ed.).
6. Ensio A., Saranto K., Ikonen H. The National Evaluation of the Standardized Terminology. Studies in Health Technology and Informatics 2006, vol. 122. IOS Press, Amsterdam, pp. 749-752.
7. Voutilainen P., Isola A., Muurinen S. Nursing documentation in nursing homes-state-of-art and implications for quality improvement. Scand. J. Caring Sci. 2004, 18:72-81.
8. Saranummi N., Ensio A., Laine M., Nykänen P., Itkonen P. National Health IT services in Finland. Meth. Inform. Med. 2007, 46(4):463-469.
9. Häyrinen K., Saranto K., Nykänen P. Definition, structure, content, use and impacts of electronic health records: a review of the research literature. Int. J. Med. Inform. 2008, 77(5):291-304.
10. Harno K., Ruotsalainen P., Nykänen P., Kopra K. Health care information exchange and care integration. Int. J. Adv. Life Sci. 2009, 1(1):46-57. IEEE Computer Society.
11. Häyrinen K., Lammintakanen J., Saranto K. Evaluation of electronic nursing documentation-nursing process model and standardised terminologies as keys to visible and transparent nursing. Int. J. Med. Inform. 2010, 79:554-564.
12. Tanttu K., Ikonen H. Nationally standardised electronic nursing documentation in Finland by the year 2007. Studies in Health Technology and Informatics 122 2006, 540-541. IOS Press, Amsterdam.
13. Jokinen T., Ensio A., Saranto K. Using Standardized Terminology for Nursing Documentation. Studies in Health Technology and Informatics 2006, vol. 122. IOS Press, Amsterdam, p. 995.
14. Saranto K., Moss J., Jylhä V. Medication counseling: analysis of electronic documentation using the clinical care classification system. MEDINFO2010 Proceedings. Studies in Health Technology and Informatics 160 2010, 284-288. IOS Press, Amsterdam. X. Safran (Ed.).
15. Fagesrtröm L., Rainio A.K., Rauhala A., Nojonen K. Validation of a new method for patient classification: the Oulu patient classification. J. Adv. Nurs. 2000, 31:481-490.
16. V.K. Saba, Clinical Care Classification System, Available at: (accessed 28.05.10). http://www.sabacare.com/.
17. Saba V.K. Nursing classifications: home health care classification system (HHCC): an overview. Online J. Issues Nurs. 2002, 7(3):9.
18. Hellesø R., Ruland C.M. Developing a module for nursing documentation integrated in the electronic patient record. J. Clin. Nurs. 2001, 10(6):799-805.
19. Urquhart C., Currell R., Grant M.J., Hardiker N.R. Nursing documentation systems: effects on nursing practice and healthcare outcomes. Cochrane Database Syst. Rev. 2009, 1. Available at: doi:10.1002/14651858, art no CD002099.pub2 (accessed 28.02.11).
20. Saranto K., Ensio A., Jokinen T. Patient Medication-How is it Documented? Studies in Health Technology and Informatics 2006, vol. 122. IOS Press, Amsterdam, pp. 738-741.
21. Nahm R., Poston I. Measurement of the effects of an integrated, point-of-care computer system on quality of nursing documentation and patient satisfaction. Comput. Nurs. 2000, 18(5):220-229.
22. Langowski C. The times they are changing effects of online nursing documentation systems. Qual. Manage. Health Care 2005, 14(2):121-125.
23. Hellesø R. Information handling in the nursing discharge note. J. Clin. Nurs. 2006, 15:11-21.
24. Oroviogoicoechea C., Elliot B., Watson R. Review: evaluating information systems in nursing. J. Clin. Nurs. 2008, 17(5):567-575.
25. Ammenwerth E., Rauchegger F., Ehlers F., Hirsch B., Schaubmayr C. Effect of nursing information system on the quality of information processing in nursing: an evaluation study using the HIS-monitor instrument. Int. J. Med. Inform. 2011, 80(1):25-38.
26. Ammenwerth E., Mansmann U., Iller C., Eichstädter R. Factors affecting and affected by user acceptance of computer-based nursing documentation: results of a two-year study. JAMIA 2003, 10:69-84.
27. Poissant L., Pereira J., Tamblyn R., Kawasumi Y. The impact of electronic health records on time efficiency on physicians and nurses: a systematic review. JAMIA 2005, 12(5):505-516.
28. Gugerty B., Maranda M.J., Beachley M., Navarro V.B., Newbold S., Hawk W., Karp J., Koszalka M., Morrison S., Poe S.S., Wilhelm D. Challenges and opportunities in documentation of the nursing care of patients. A Report of the Maryland Nursing Workforce Commission, Documentation Work Group 2007, Available at: http://www.mbon.org/commission2/documentation_challenges.pdf (accessed 21.03.11).
29. Verwey R., Claassen R.A., Rutgers M.J., de Witte L.P. The implementation of an electronic nursing record in a general hospital in the Netherlands: lessons learned. Stud. Health Technol. Inform. 2008, 141:130-138.
30. Törnvall E., Wilhelmsson S., Wahren L.K. Electronic nursing documentation in primary health care. Scand. J. Caring Sci. 2004, 18:310-317.
31. Fogelberg-Dahm M., Wadensten B. Nurses' experiences of and opinions about using standardized care plans in electronic health records-a questionnaire study. J. Clin. Nurs. 2008, 17:2137-2145.
32. Kuusisto A., Asikainen P., Lukka H., Tanttu K. Experiences with the electronic nursing discharge summary. Connecting Health and Humans. Proceedings of 10th International Congress on Nursing Informatics. Studies in Health Technology and Informatics 146 2009, 226-230. IOS Press, Amsterdam. K. Saranto, P. Brennan Flatley, H.A. Park, M. Tallberg, A. Ensio (Eds.).
33. Moody L.E., Slocumb E., Berg B., Jackson D. Electronic health records documentation in nursing: nurses' perceptions, attitudes, and preferences. Comput. Inform. Nurs. 2004, 22(6):337-344.
34. Stevenson J.E., Nilsson G.C., Petersson G.I., Johansson P.E. Nurses' experiences of using electronic patient records in everyday practice in acute/inpatient ward setting: a literature review. Health Inform. J. 2010, 16(1):63-72.
35. ISO 9241-11 International Standard: Ergonomic Requirements for Office Work With Visual Display Terminals, Part 11: Guidance on Usability 1998, International Organization for Standardization, Geneva.
36. Nielsen J. Usability Engineering 1993, Academic Press, New York.
37. Hertzum M. Images of usability. Int. J. Hum. Comput. Interact. 2010, 26(6):567-600.
38. Patterson E.S., Boebbeling B.N., Fung C.H., Militello L., Anders S., Asch S.M. Identifying barriers to the effective use of clinical reminders: bootstrapping multiple methods. J. Biomed. Inform. 2005, 38:189-199.
39. Kjeldskov J., Skov M., Stage J. A longitudinal study of usability in health care: does time heal?. Int. J. Med. Inform. 2008, 79(6):e135-e143.
40. Peute L.W.P., Spithoven R., Bakker P.J.M., Jaspers M.W.M. Usability studies on interactive health information systems: where do we stand?. eHealth Beyond the Horizon - Get It There 2008, IOS Press, Amsterdam. S.K. Andersen (Ed.).
41. Pizziferri L., Kittler A.F., Volk L.A., Honour M.M., Gupta S., Wang S. Primary care physician time utilization before and after implementation of an electronic health record: a time-motion study. J. Biomed. Inform. 2005, 38:176-188.
42. Chaudhry B., Wang J., Wu S., Maglione M., Mojica W., Roth E., Morton S.C., Shekelle P.G. Systematic review: impact of health information technology on quality, efficiency and costs of medical care. Ann. Intern. Med. 2006, 144(10):742-752.
43. Spies T.H., Mokkink H.G.A., de Vries-Robbe P.F., Grol R.P.T. Which data sources in clinical performance assessment. A pilot study comparing self-recording with patient records and observation. Int. J. Qual. Health Care 2004, 16(1):65-72.
44. Reuss E., Naef R., Keller R., Norrie M. Physicians' and nurses' documenting practices and implications for electronic patient record design. USAB 2007, LNCS 4799 2007, 113-118. Springer-Verlag, Berlin Heidelberg. A. Holzinger (Ed.).
45. Shah S.G.S., Robinson I. User involvement in healthcare technology development and assessment: structured literature review. Int. J. Healthcare Qual. Assur. 2006, 19(6):500-515.
46. Kushniruk A.W., Patel V.L. Cognitive and usability engineering methods for the evaluation of clinical information systems. J. Biomed. Inform. 2004, 37:56-76.
47. Edwards P.J., Moloney K.P., Jacko J.A., Sainfort F. Evaluating usability of a commercial electronic health record: a case study. Int. J. Hum. Comput. Stud. 2008, 66:718-728.
48. Pohl M., Rester M., Wiltner S. Usability and transferability of a visualization methodology for medical data. USAB 2007, LNCS 4799 2007, 171-184. Springer-Verlag, Berlin Heidelberg. A. Holzinger (Ed.).
49. Kyhlbäck H., Sutter B. What does it take to replace an old functioning information system with a new one?. Int. J. Med. Inform. 2007, 76S:149-158.
50. Jaspers M.W.M. A comparison of usability methods for testing interactive health technologies: methodological aspects and empirical evidence. Int. J. Med. Inform. 2009, 78(5):340-353.
51. Horsky J., McColgan K., Pang J.E., Melnikas A.J., Linder J.A., Schnipper J.I., Middleton B. Complementary methods of system usability evaluation: surveys and observations during software design and development cycles. J. Biomed. Inform. 2010, 43:782-790.
52. J. Kaipio, Usability in Healthcare: Overcoming the Mismatch Between Information Systems and Clinical Work, Aalto University Publication Series, Doctoral Dissertations 105, Unigrafia Oy, Helsinki, 2011, Available at: (accessed 22.11.11). http://lib.tkk.fi/Diss/2011/isbn9789526043340/isbn9789526043340.pdf.
53. Hackos J.T., Redish J.C. User and Task Analysis for Interactive Design 1998, John Wiley and Sons, New York, NY.
54. Beyer H., Holzblatt K. Contextual Design: Designing Customer-centered Systems 1998, Academic Press, San Diego, CA.
55. Kirakowski J. Questionnaires in Usability Engineering. A List of Frequently Asked Questions 1977, Jurek Human Factors Research Group, Cork, Ireland, Available at: http://www.ucc.ie/hfrg/resources/qfaq1.html (accessed 15.05.10). 3rd ed.
56. Brooke J. SUS: a "quick and dirty" usability scale. Usability Evaluation in Industry 1996, Taylor and Francis, London. P. Jordan, B. Thomas, T. Weerdmeester, A. McClelland (Eds.).
57. Kushniruk A. Evaluation in the design of health information systems: application of approaches emerging from usability engineering. Comput. Biol. Med. 2009, 32:141-149.
58. J. Viitanen, A User-centred Approach to Healthcare ICT Development, Licentiate's Thesis, Department of Computer Science and Engineering, Helsinki University of Technology, 2009, Available at: (accessed 20.03.11). http://www.soberit.hut.fi/~jpviitan/Publications/lic_thesis_Viitanen_Johanna.pdf.
59. P. Nykänen, J. Viitanen, A. Kuusisto, Hoitotyön kansallisen kirjaamismallin ja hoitokertomusten käytettävyys, University of Tampere, Report D-2010-7, 2010, Available at: (accessed 08.03.2011) (in Finnish). http://www.cs.uta.fi/reports/dsarja/D-2010-7.pdf.
60. Viitanen J., Kuusisto A., Nykänen P. Usability of electronic nursing record systems: definition and results from an evaluation study in Finland. International Perspectives in Health Informatics. Studies in Health Technology and Informatics 164 2011, 333-338. IOS Press, Amsterdam. E.M. Borycki, J.A. Bartle-Clar, M.S. Househ, C.E. Kuziemsky, E.G. Schraa (Eds.).
61. Nykänen P., Brender J., Talmon J., deKeizer N., Rigby M., Beuscart-Zephir M.-C., Ammenwerth E. Guideline for good evaluation practice in health informatics (GEP-HI). Int. J. Med. Inform. 2011, 80(12):815-827.
62. Lee T.T., Mills M.E., Bausell B., Lu M.H. Two-stage evaluation of the impact of a nursing information system in Taiwan. Int. J. Med. Inform. 2008, 77:698-707.
63. Beutscart-Zéphir M.C., Pelayo S., Anceaux F., Meaux J.-J., Degroisse M., Degoulet P. Impact of CPOE on doctor-nurse cooperation for the medication ordering and administration process. Int. J. Med. Inform. 2005, 74:629-641.
64. Horsky J., Kuperman G.J., Patel V.L. Comprehensive analysis of a medication dosing error related to CPOE. JAMIA 2005, 12:377-382.
65. Reddy M., Dourish P. A finger on the pulse: temporal rhythms and information seeking in medical work. Proc. CSCW'02 2002, 344-353. ACM, New Orleans, LA.
66. Pratt W., Reddy M.C., McDonald D.W., Tarczy-Hornoch P., Gennari J.H. Incorporating ideas from computer-supported cooperative work. J. Biomed. Inform. 2004, 37:128-137.
67. Xiao Y. Artifacts and collaborative work in healthcare: methodological, theoretical, and technological implications of the tangible. J. Biomed. Inform. 2005, 38:26-33.
68. Pirnejad H., Niazkhani Z., van der Sijs H., Berg M., Bal R. Impact of a computerized physician order entry system on nurse-physician collaboration in the medication process. Int. J. Med. Inform. 2008, 77:735-744.
69. Viitanen J., Hyppönen H., Lääveri T., Vänskä J., Reponen J., Winblad I. National questionnaire study on clinical ICT systems proofs: physicians suffer from poor usability. Int. J. Med. Inform. 2011, 80(10):708-725.