Nephrology Nurse Perceptions Toward Advance Care Planning: Validation of a Measure.

Advance care planning is critical for persons with chronic kidney disease because they face a shortened lifespan. There is a paucity of reliable and valid measures exploring nephrology nurse perceptions toward advance care planning. This article reports the results of testing the factor structure, reliability, and validity of a newly developed measure of nephrology nurse perceptions toward advance care planning as well as information on nephrology nurses'perceptions on advance care planning. Measuring nephrology nurse perceptions toward advance care planning may facilitate planning of interventions to assist nurses to become more active in the process.

Exploring Advance Care Planning from the Nephrology Nurse Perspective: A Literature Review.

Advance care planning is a process that engages healthcare providers and patients to articulate wishes of patients as their illness progresses. Persons with chronic kidney disease require earlier and more frequent advance care planning conversations because they are faced with increased co-morbidities and a shortened lifespan. This literature review explores the phenomenon of advance care planning and the potential factors affecting nephrology nurse engagement in these discussions.

Development and Initial Validation of the NephRN Perceptions Toward Advance Care Planning Instrument.

The purpose of this study was to develop and pilot test an instrument to measure the perceptions of nephrology nurses toward advance care planning, the NephRN Perceptions Toward Advance Care Planning instrument. Four components of advance care planning were identified: knowledge, attitudes, comfort, and support. The four-component solution explained 63.88% of variance. Cronbach's alpha was 0.92, and subscale reliability ranged between 0.86 and 0.94. This instrument shows promise as a reliable and valid measure of nephrology nurse perceptions toward advance care planning for persons with chronic kidney disease.

Electronic health record tools' support of nurses' clinical judgment and team communication.

Nurses need to quickly process information to form clinical judgments, communicate with the healthcare team, and guide optimal patient care. Electronic health records not only offer potential for enhanced care but also introduce unintended consequences through changes in workflow, clinical judgment, and communication. We investigated nurses' use of improvised (self-made) and electronic health record-generated cognitive artifacts on clinical judgment and team communication. Tanner's Clinical Judgment Model provided a framework and basis for questions in an online survey and focus group interviews. Findings indicated that (1) nurses rated self-made work lists and medication administration records highest for both clinical judgment and communication, (2) tools aided different dimensions of clinical judgment, and (3) interdisciplinary tools enhance team communication. Implications are that electronic health record tool redesign could better support nursing work.

Nurses' perceptions of the impact of electronic health records on work and patient outcomes.

This study addresses community hospital nurses' use of electronic health records and views of the impact of such records on job performance and patient outcomes. Questionnaire, interview, and observation data from 46 nurses in medical-surgical and intensive care units at two community hospitals were analyzed. Nurses preferred electronic health records to paper charts and were comfortable with technology. They reported use of electronic health records enhanced nursing work through increased information access, improved organization and efficiency, and helpful alert screens. They thought use of the records hindered nursing work through impaired critical thinking, decreased interdisciplinary communication, and a high demand on work time (73% reported spending at least half their shift using the records). They thought use of electronic health records enabled them to provide safer care but decreased the quality of care. Administrative implications include involving bedside nurses in system choice, streamlining processes, developing guidelines for consistent documentation quality and location, increasing system speed, choosing hardware that encourages bedside use, and improving system information technology support.

Perceptions of impact of electronic health records on nurses' work.

This study addresses how community hospital nurses use Electronic Health Records (EHRs) during patient care and their views of its impact on their job performance. Questionnaire, interview and observation data from 46 nurses in medical-surgical and intensive care units at two community hospitals within a regional healthcare system (second year of EHR implementation) were analyzed for themes and compared across hospital and unit dimensions. Nurses preferred EHRs to paper charts and were comfortable with technology. They felt EHR use enhanced nursing work through increased information access, improved organization and efficiency, and alert screens. They felt it hindered nursing work through increased documentation time (slow system response, multiple screens), decreased interdisciplinary communication and impaired critical thinking through overuse of checkboxes and "copy and paste" documentation. 73% spent at least half their work time using EHRs, and felt use enabled them to provide safer care but decreased quality of care. Administrative implications include streamlining EHR work processes, developing guidelines to improve consistency in documentation quality and location, increasing system speed, and choosing hardware that encourages bedside use.