Validity and reliability of a new measure of nursing experience with unintended consequences of electronic health records

Sheila M Gephart, Alycia A. Bristol, Judy L. Dye, Brooke A. Finley, Jane M Carrington

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Unintended consequences of electronic health records represent undesired effects on individuals or systems, which may contradict initial goals and impact patient care. The purpose of this study was to determine the extent to which a new quantitative measure called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire (CG-UCE-Q) was valid and reliable. Then, it was used to describe acute care nurses' experience with unintended consequences of electronic health records and relate them to the professional practice environment. Acceptable content validity was achieved for two rounds of surveys with nursing informatics experts (n = 5). Then, acute care nurses (n = 144) were recruited locally and nationally to complete the survey and describe the frequency with which they encounter unintended consequences in daily work. Principal component analysis with oblique rotation was applied to evaluate construct validity. Correlational analysis with measures of the professional practice environment and workarounds was used to evaluate convergent validity. Test-retest reliability was measured in the local sample (N = 68). Explanation for 63% of the variance across six subscales (patient safety, system design, workload issues, workarounds, technology barriers, and sociotechnical impact) supported construct validity. Relationships were significant between subscales for electronic health record-related threats to patientsafety and low autonomy/leadership (P < .01), poor communication about patients (P < .01), and low control over practice (P < .01). The most frequent sources of unintended consequences were increased workload, interruptions that shifted tasks from the computer, altered workflow, and the need to duplicate dataentry.Convergent validity of the CG-UCE-Q was moderately supported with both the context and processes of workarounds with strong relationships identified for when nurses perceived a block and altered process to work around it to subscales in the CG-UCE-Q for electronic health record system design (P < .01) and technological barriers (P < .01).

Original languageEnglish (US)
Pages (from-to)436-447
Number of pages12
JournalCIN - Computers Informatics Nursing
Volume34
Issue number10
DOIs
StatePublished - Oct 1 2016

Fingerprint

Electronic Health Records
Reproducibility of Results
Nursing
Professional Practice
Nurses
Workload
Nursing Informatics
Workflow
Patient Safety
Principal Component Analysis
Patient Care
Communication
Surveys and Questionnaires
Technology

Keywords

  • Barrier
  • Electronic health record
  • Electronic medical record
  • Measurement
  • Nursing
  • Nursing informatics
  • Patient safety
  • Professional practice environment
  • Psychometric analysis
  • Unintended consequences
  • Workaround

ASJC Scopus subject areas

  • Health Informatics
  • Nursing (miscellaneous)

Cite this

Validity and reliability of a new measure of nursing experience with unintended consequences of electronic health records. / Gephart, Sheila M; Bristol, Alycia A.; Dye, Judy L.; Finley, Brooke A.; Carrington, Jane M.

In: CIN - Computers Informatics Nursing, Vol. 34, No. 10, 01.10.2016, p. 436-447.

Research output: Contribution to journalArticle

@article{41d9138edb3743ef9294df106ed0a536,
title = "Validity and reliability of a new measure of nursing experience with unintended consequences of electronic health records",
abstract = "Unintended consequences of electronic health records represent undesired effects on individuals or systems, which may contradict initial goals and impact patient care. The purpose of this study was to determine the extent to which a new quantitative measure called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire (CG-UCE-Q) was valid and reliable. Then, it was used to describe acute care nurses' experience with unintended consequences of electronic health records and relate them to the professional practice environment. Acceptable content validity was achieved for two rounds of surveys with nursing informatics experts (n = 5). Then, acute care nurses (n = 144) were recruited locally and nationally to complete the survey and describe the frequency with which they encounter unintended consequences in daily work. Principal component analysis with oblique rotation was applied to evaluate construct validity. Correlational analysis with measures of the professional practice environment and workarounds was used to evaluate convergent validity. Test-retest reliability was measured in the local sample (N = 68). Explanation for 63{\%} of the variance across six subscales (patient safety, system design, workload issues, workarounds, technology barriers, and sociotechnical impact) supported construct validity. Relationships were significant between subscales for electronic health record-related threats to patientsafety and low autonomy/leadership (P < .01), poor communication about patients (P < .01), and low control over practice (P < .01). The most frequent sources of unintended consequences were increased workload, interruptions that shifted tasks from the computer, altered workflow, and the need to duplicate dataentry.Convergent validity of the CG-UCE-Q was moderately supported with both the context and processes of workarounds with strong relationships identified for when nurses perceived a block and altered process to work around it to subscales in the CG-UCE-Q for electronic health record system design (P < .01) and technological barriers (P < .01).",
keywords = "Barrier, Electronic health record, Electronic medical record, Measurement, Nursing, Nursing informatics, Patient safety, Professional practice environment, Psychometric analysis, Unintended consequences, Workaround",
author = "Gephart, {Sheila M} and Bristol, {Alycia A.} and Dye, {Judy L.} and Finley, {Brooke A.} and Carrington, {Jane M}",
year = "2016",
month = "10",
day = "1",
doi = "10.1097/CIN.0000000000000285",
language = "English (US)",
volume = "34",
pages = "436--447",
journal = "CIN - Computers Informatics Nursing",
issn = "1538-2931",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - Validity and reliability of a new measure of nursing experience with unintended consequences of electronic health records

AU - Gephart, Sheila M

AU - Bristol, Alycia A.

AU - Dye, Judy L.

AU - Finley, Brooke A.

AU - Carrington, Jane M

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Unintended consequences of electronic health records represent undesired effects on individuals or systems, which may contradict initial goals and impact patient care. The purpose of this study was to determine the extent to which a new quantitative measure called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire (CG-UCE-Q) was valid and reliable. Then, it was used to describe acute care nurses' experience with unintended consequences of electronic health records and relate them to the professional practice environment. Acceptable content validity was achieved for two rounds of surveys with nursing informatics experts (n = 5). Then, acute care nurses (n = 144) were recruited locally and nationally to complete the survey and describe the frequency with which they encounter unintended consequences in daily work. Principal component analysis with oblique rotation was applied to evaluate construct validity. Correlational analysis with measures of the professional practice environment and workarounds was used to evaluate convergent validity. Test-retest reliability was measured in the local sample (N = 68). Explanation for 63% of the variance across six subscales (patient safety, system design, workload issues, workarounds, technology barriers, and sociotechnical impact) supported construct validity. Relationships were significant between subscales for electronic health record-related threats to patientsafety and low autonomy/leadership (P < .01), poor communication about patients (P < .01), and low control over practice (P < .01). The most frequent sources of unintended consequences were increased workload, interruptions that shifted tasks from the computer, altered workflow, and the need to duplicate dataentry.Convergent validity of the CG-UCE-Q was moderately supported with both the context and processes of workarounds with strong relationships identified for when nurses perceived a block and altered process to work around it to subscales in the CG-UCE-Q for electronic health record system design (P < .01) and technological barriers (P < .01).

AB - Unintended consequences of electronic health records represent undesired effects on individuals or systems, which may contradict initial goals and impact patient care. The purpose of this study was to determine the extent to which a new quantitative measure called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire (CG-UCE-Q) was valid and reliable. Then, it was used to describe acute care nurses' experience with unintended consequences of electronic health records and relate them to the professional practice environment. Acceptable content validity was achieved for two rounds of surveys with nursing informatics experts (n = 5). Then, acute care nurses (n = 144) were recruited locally and nationally to complete the survey and describe the frequency with which they encounter unintended consequences in daily work. Principal component analysis with oblique rotation was applied to evaluate construct validity. Correlational analysis with measures of the professional practice environment and workarounds was used to evaluate convergent validity. Test-retest reliability was measured in the local sample (N = 68). Explanation for 63% of the variance across six subscales (patient safety, system design, workload issues, workarounds, technology barriers, and sociotechnical impact) supported construct validity. Relationships were significant between subscales for electronic health record-related threats to patientsafety and low autonomy/leadership (P < .01), poor communication about patients (P < .01), and low control over practice (P < .01). The most frequent sources of unintended consequences were increased workload, interruptions that shifted tasks from the computer, altered workflow, and the need to duplicate dataentry.Convergent validity of the CG-UCE-Q was moderately supported with both the context and processes of workarounds with strong relationships identified for when nurses perceived a block and altered process to work around it to subscales in the CG-UCE-Q for electronic health record system design (P < .01) and technological barriers (P < .01).

KW - Barrier

KW - Electronic health record

KW - Electronic medical record

KW - Measurement

KW - Nursing

KW - Nursing informatics

KW - Patient safety

KW - Professional practice environment

KW - Psychometric analysis

KW - Unintended consequences

KW - Workaround

UR - http://www.scopus.com/inward/record.url?scp=84983349240&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84983349240&partnerID=8YFLogxK

U2 - 10.1097/CIN.0000000000000285

DO - 10.1097/CIN.0000000000000285

M3 - Article

C2 - 27551947

AN - SCOPUS:84983349240

VL - 34

SP - 436

EP - 447

JO - CIN - Computers Informatics Nursing

JF - CIN - Computers Informatics Nursing

SN - 1538-2931

IS - 10

ER -