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Stevenson-Ågren, JeanORCID iD iconorcid.org/0000-0002-4626-3979
Publications (10 of 15) Show all publications
Stevenson-Ågren, J., Israelsson, J., Petersson, G. & Bath, P. (2018). Factors influencing the quality of vital signs data in electronic health records: a qualitative study. Journal of Clinical Nursing, 27(5-6), 1276-1286
Open this publication in new window or tab >>Factors influencing the quality of vital signs data in electronic health records: a qualitative study
2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 5-6, p. 1276-1286Article in journal (Refereed) Published
Abstract [en]

Aims and objectives

To investigate reasons for inadequate documentation of vital signs in an electronic health record.

Background

Monitoring 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.

Design

Qualitative study.

Methods

Qualitative 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.

Results

We 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.”

Conclusions

This 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 practice

Patient 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.

Place, publisher, year, edition, pages
New Jersey: John Wiley & Sons, 2018
Keywords
Vital signs, patient safety, electronic health records
National Category
Other Medical Sciences not elsewhere specified
Research subject
Health and Caring Sciences, Health Informatics
Identifiers
urn:nbn:se:lnu:diva-70319 (URN)10.1111/jocn.14174 (DOI)000428419400087 ()29149483 (PubMedID)2-s2.0-85044258923 (Scopus ID)
Available from: 2018-01-31 Created: 2018-01-31 Last updated: 2019-08-29Bibliographically approved
Stevenson-Ågren, J., Israelsson, J., Nilsson, G., Petersson, G. & Bath, P. A. (2018). Vital sign documentation in electronic records: the development of workarounds. Health Informatics Journal, 24(2), 206-215
Open this publication in new window or tab >>Vital sign documentation in electronic records: the development of workarounds
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2018 (English)In: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811, Vol. 24, no 2, p. 206-215Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
electronic health records, healthcare professionals, patient safety, vital signs, workarounds
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Information Systems
Research subject
Health and Caring Sciences, Health Informatics
Identifiers
urn:nbn:se:lnu:diva-55697 (URN)10.1177/1460458216663024 (DOI)000432068300008 ()27542887 (PubMedID)
Available from: 2016-08-22 Created: 2016-08-22 Last updated: 2019-03-05Bibliographically approved
Stevenson-Ågren, J. (2017). A project to promote equality in ante-natal care for women who do not speak Swedish. In: : . Paper presented at Forum för Textforskning 12, Växjö, 13-14 June, 2017.
Open this publication in new window or tab >>A project to promote equality in ante-natal care for women who do not speak Swedish
2017 (English)Conference paper, Oral presentation only (Other academic)
Abstract [en]

Background

Health 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).

 

Aim

The 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.

Method

Two 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.

Results

The 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.

 

References

Essen, 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.2014.22.11.795

Axelsson, 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

Keywords
App development, antenatal care, communication
National Category
Other Health Sciences Information Systems
Research subject
Computer Science, Software Technology; Health and Caring Sciences, Health Informatics
Identifiers
urn:nbn:se:lnu:diva-70322 (URN)
Conference
Forum för Textforskning 12, Växjö, 13-14 June, 2017
Funder
VINNOVA
Available from: 2018-01-31 Created: 2018-01-31 Last updated: 2018-02-28Bibliographically approved
Stevenson-Ågren, J., Petersson, G., Israelsson, J. & Bath, P. (2017). Reasons for poor vital sign documentation in electronic health records: A qualitative study. In: European Society of Cardiology Congress, Barcelona, 26-30 August, 2017: . Paper presented at European Society of Cardiology (ESC) Congress, Barcelona, 2017.
Open this publication in new window or tab >>Reasons for poor vital sign documentation in electronic health records: A qualitative study
2017 (English)In: European Society of Cardiology Congress, Barcelona, 26-30 August, 2017, 2017Conference paper, Poster (with or without abstract) (Refereed)
Keywords
Patient safety, vital signs, electronic health records
National Category
Other Medical Sciences not elsewhere specified
Research subject
Health and Caring Sciences, Health Informatics
Identifiers
urn:nbn:se:lnu:diva-70321 (URN)
Conference
European Society of Cardiology (ESC) Congress, Barcelona, 2017
Available from: 2018-01-31 Created: 2018-01-31 Last updated: 2018-09-07Bibliographically approved
Axelsson, C., Byrman, G., Petersson, G., Skoglund, A. & Stevenson-Ågren, J. (2016). "Det kan bli så mycket fel": Förstudie om barnmorskors upplevelser av kommunikation med gravida kvinnor utan funktionell behärskning av svenska.. Kalmar/Växjö: Linnéuniversitetet
Open this publication in new window or tab >>"Det kan bli så mycket fel": Förstudie om barnmorskors upplevelser av kommunikation med gravida kvinnor utan funktionell behärskning av svenska.
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2016 (Swedish)Report (Other academic)
Place, publisher, year, edition, pages
Kalmar/Växjö: Linnéuniversitetet, 2016. p. 15
Keywords
mödrahälsovård, samtalsstöd, kommunikation, tolk
National Category
Languages and Literature Nursing
Research subject
Humanities, Swedish as a Second Language; Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-49900 (URN)
Available from: 2016-02-24 Created: 2016-02-24 Last updated: 2018-05-18Bibliographically approved
Stevenson-Ågren, J. (2016). Documentation of Vital Signs in Electronic Health Records: A Patient Safety Issue. (Doctoral dissertation). Sheffield: White Rose ethesis on line
Open this publication in new window or tab >>Documentation of Vital Signs in Electronic Health Records: A Patient Safety Issue
2016 (English)Doctoral thesis, monograph (Other academic)
Abstract [en]

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.

Place, publisher, year, edition, pages
Sheffield: White Rose ethesis on line, 2016. p. 322
Keywords
patient safety, vital signs, electronic health records
National Category
Nursing
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-53351 (URN)
Supervisors
Available from: 2016-07-26 Created: 2016-06-10 Last updated: 2018-05-18Bibliographically approved
Israelsson, J., Lilja, G., Bremer, A., Stevenson-Ågren, J. & Årestedt, K. (2016). Post cardiac arrest care and follow-up in Sweden: a national web-survey. BMC Nursing, 15(1)
Open this publication in new window or tab >>Post cardiac arrest care and follow-up in Sweden: a national web-survey
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2016 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 15, no 1Article in journal (Refereed) Published
Abstract [en]

Background: Recent 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.

Methods: An 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.

Results: Almost 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.

Conclusions: Although 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.

Place, publisher, year, edition, pages
BioMed Central, 2016
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-60826 (URN)10.1186/s12912-016-0123-0 (DOI)000377513900001 ()26752975 (PubMedID)2-s2.0-84953406318 (Scopus ID)
Funder
Medical Research Council of Southeast Sweden (FORSS)The Swedish Heart and Lung Association
Note

Forskningsfinansiär: Riksförbundet HjärtLung

Available from: 2017-02-27 Created: 2017-02-27 Last updated: 2019-08-28Bibliographically approved
Stevenson-Ågren, J., Israelsson, J., Nilsson, G., Petersson, G. & Bath, P. (2016). Recording signs of deterioration in acute patients: The documentation of vital signs within electronic health records in patients who suffered in-hospital cardiac arrest. Health Informatics Journal, 22(1), 21-33
Open this publication in new window or tab >>Recording signs of deterioration in acute patients: The documentation of vital signs within electronic health records in patients who suffered in-hospital cardiac arrest
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2016 (English)In: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811, Vol. 22, no 1, p. 21-33Article in journal (Refereed) Published
Abstract [en]

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. 

Place, publisher, year, edition, pages
Sage Publications, 2016
Keywords
vital signs, electronic health records, documentation
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Caring Sciences, Health Informatics
Identifiers
urn:nbn:se:lnu:diva-46355 (URN)10.1177/1460458214530136 (DOI)000368726900002 ()24782478 (PubMedID)2-s2.0-84955322777 (Scopus ID)
Available from: 2015-09-16 Created: 2015-09-16 Last updated: 2019-02-18Bibliographically approved
Stevenson-Ågren, J., Israelsson, J., Nilsson, G., Petersson, G. & Bath, P. (2015). Documentation of vital signs in electronic records: the development of workarounds. In: P. Bath, H. Spring, &, B Sen, B (Ed.), Health informatics for enhancing health and well-being: Proceedings of the seventeenth International Symposium for Health Information Management Research, York, UK 24-26 June 2015. Paper presented at ISHIMR 2015: 17th International Symposium for Health Information Management Research, York, UK, June 25-26, 2015.
Open this publication in new window or tab >>Documentation of vital signs in electronic records: the development of workarounds
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2015 (English)In: Health informatics for enhancing health and well-being: Proceedings of the seventeenth International Symposium for Health Information Management Research, York, UK 24-26 June 2015 / [ed] P. Bath, H. Spring, &, B Sen, B, 2015Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

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.

Keywords
Electronic records, Vital signs, Workarounds, Patient safety
National Category
Other Medical Sciences not elsewhere specified
Research subject
Health and Caring Sciences, Health Informatics
Identifiers
urn:nbn:se:lnu:diva-71128 (URN)
Conference
ISHIMR 2015: 17th International Symposium for Health Information Management Research, York, UK, June 25-26, 2015
Available from: 2018-02-28 Created: 2018-02-28 Last updated: 2018-05-18Bibliographically approved
Stevenson-Ågren, J., Israelsson, J., Nilsson, G., Petersson, G. & Bath, P. (2014). Dokumentation av vitalparametrar i datorjournaler: En risk för patientsäkerheten?. In: VITALIS - Nordens ledande eHälsomöte: Vetenskapliga papers presenterade vid Vitalis konferens, Svenska Mässan, Göteborg, 8-10 april 2014. Paper presented at VITALIS - Nordens ledande eHälsomöte. Göteborg: Göteborgs universitet
Open this publication in new window or tab >>Dokumentation av vitalparametrar i datorjournaler: En risk för patientsäkerheten?
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2014 (English)In: VITALIS - Nordens ledande eHälsomöte: Vetenskapliga papers presenterade vid Vitalis konferens, Svenska Mässan, Göteborg, 8-10 april 2014, Göteborg: Göteborgs universitet, 2014Conference paper, Poster (with or without abstract) (Other academic)
Abstract [sv]

Tidig upptäckt och snabb hantering av riskpatienter har betraktats som det ’första steget i kedjan till överlevnad’ i hjärtlungräddning (HLR)[1]. Patienter uppvisar ofta tecken på försämring av kliniskt tillstånd under perioden före oväntad hjärtstopp [2]. För att förbättra identifieringen av försämring i kliniskt tillstånd hos patienter har många varianter på system för snabb respons införts med fokus på mätning, rapportering och hantering av patienter med avvikande vitalparametrar [3]. Datorjournaler journaler används allt mer inom vården för i stort sett all dokumentation. Däremot är kunskapen begränsad kring betydelsen av dokumentationen i datorjournalen för att upptäcka försämring av patienternas kliniska tillstånd. Syftet med denna studie var att undersöka dokumentationen av vitala parametrar i datorjournalen för sjukhusvårdade patienter, som efter inläggning drabbats av oväntat hjärtstopp.

Place, publisher, year, edition, pages
Göteborg: Göteborgs universitet, 2014
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Caring Sciences, Health Informatics
Identifiers
urn:nbn:se:lnu:diva-46648 (URN)
Conference
VITALIS - Nordens ledande eHälsomöte
Available from: 2015-10-06 Created: 2015-10-06 Last updated: 2018-05-18Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4626-3979

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