Participatory Design of an Electronic Cross-Facility Health Record (ECHR) System for Pediatric Palliative Care: A Think-Aloud Study

Background: Pediatric palliative care (PPC) patients experience years of multisectoral and professional care. An electronic cross-facility health record (ECHR) system can support the immediate exchange of information among PPC professionals. Based on a needs assessment, a prototype ECHR system was developed. Methods: To evaluate potential users’ perspective regarding the system, a qualitative observational study was conducted consisting of a concurrent think-aloud session and a semi-structured qualitative interview. Results: Twenty PPC professionals (nurses, physicians) from specialized outpatient PPC teams, a PPC unit, and medical offices rated the ECHR system as a helpful tool to improve the exchange and collection of information, communication between PPC professionals, and treatment planning. From the user’s point of view, the basic logic of the ECHR system should be further adapted to improve the interaction of data remirrored from patient records of outpatient and inpatient care with those entered via the system. The users wished for further functions (text search) and content (information on therapies). Some content, such as the treatment process, needs to be further adapted. Conclusion: The developed ECHR system needs to be more specific in some features by offering all available information; while for other features, be less specific to offer a quick overview. The ability to share information promptly and automatically was seen as a tremendous improvement to the quality of care for PPC patients.

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Addressing multidrug resistant pathogens in pediatric palliative care patients—the nurses point of view: A qualitative study

Palliative Medicine ◽

10.1177/0269216319883981 ◽

2019 ◽

Vol 34 (3) ◽

pp. 349-357 ◽

Cited By ~ 3

Author(s):

Pia Schmidt ◽

Almut Hartenstein-Pinter ◽

Julia Wager ◽

Carola Hasan ◽

Boris Zernikow

Keyword(s):

Palliative Care ◽

Social Participation ◽

Large Scale ◽

Multidrug Resistant ◽

Point Of View ◽

Pediatric Palliative Care ◽

Increased Risk ◽

Control Versus ◽

Multidrug Resistant Pathogens ◽

Pathogen Colonization

Background: Multidrug resistant pathogens are a large-scale healthcare issue. In particular, children with life-limiting conditions have a significantly increased risk of multidrug resistant pathogen colonization. Official hygiene requirements recommend children, who are colonized with multidrug resistant pathogens, to be isolated. In the context of pediatric palliative care, such isolation adversely affects the aim of social participation. To overcome this challenge of conflicting interests on a pediatric palliative care inpatient unit, a hygiene concept for patients colonized with multidrug resistant pathogens, called PALLINI, was implemented. Aim: The aim of this study was to identify the nurses’ attitudes and opinions toward PALLINI. Methods: Nurses ( N = 14) from the pediatric palliative care unit were queried in guideline-oriented interviews. Interviews were analyzed qualitatively by means of content analysis. Results: The following four categories were identified: (1) safety, (2) effort, (3) quality of care, and (4) participation. All categories demonstrated ambivalence by nursing staff regarding PALLINI. Ambivalence arose from guaranteeing infection control versus noncompliance by the families, additional workload for patients with multidrug resistant pathogens versus lack of resources, impaired relationship with the parents versus enabling better care for the child, as well as enabling some limited contact versus the larger goal of genuine social participation. Despite this, nurses reported the importance of arranging everyday-life for the patients so that they experience as much social participation as possible. Conclusion: The implementation of a new hygiene concept is challenging. Despite positive reception of PALLINI from the nurses, ambivalence remained. Addressing these ambivalences may be critical to best implement the new hygiene concept.

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Planning for Implementation Success of an Electronic Cross-Facility Health Record for Pediatric Palliative Care Using the Consolidated Framework for Implementation Research (CFIR)

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19010453 ◽

2022 ◽

Vol 19 (1) ◽

pp. 453

Author(s):

Theresa Sophie Busse ◽

Sven Kernebeck ◽

Larissa Alice Dreier ◽

Dorothee Meyer ◽

Daniel Zenz ◽

...

Keyword(s):

Palliative Care ◽

Implementation Research ◽

Positive Impact ◽

Pediatric Palliative Care ◽

Successful Implementation ◽

Health Record ◽

Implementation Barriers ◽

Related Information ◽

Facilitators And Barriers

Pediatric palliative care (PPC) patients require years of care across professions and sectors. Sharing treatment-related information and communicating among different PPC professionals is critical to ensure good quality of care. In Germany, this communication is mostly paper-based and prone to errors. Therefore, an electronic cross-facility health record (ECHR) was participatorily designed with users, wherein information can be shared and PPC professionals can communicate with each other. As this form of electronic health record differs from existing models in Germany, there is a need for successful implementation to ensure a positive impact. Therefore, the facilitators and barriers to the implementation of ECHR in PPC were examined. Using the consolidated framework for implementation research (CFIR), transcripts of 32 interviews, 3 focus groups, and 20 think-aloud studies with PPC professionals were analyzed. CFIR indicated that the ECHR-design was viewed positively by users and can be a facilitator for implementation. Barriers exist, mainly due to the fact that the implementation is not planned, the use of the ECHR involves effort, costs are not covered, and all users must be motivated to use the ECHR for functionality. CFIR helps uncover the crux of the issues that need to be considered when planning ECHR implementation to improve care in PPC.

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Participatory Design of an Electronic Medical Record for Paediatric Palliative Care: A Think-Aloud Study with Nurses and Physicians

Children ◽

10.3390/children8080695 ◽

2021 ◽

Vol 8 (8) ◽

pp. 695

Author(s):

Sven Kernebeck ◽

Theresa Sophie Busse ◽

Chantal Jux ◽

Dorothee Meyer ◽

Larissa Alice Dreier ◽

...

Keyword(s):

Palliative Care ◽

Participatory Design ◽

Positive Influence ◽

Unintended Consequences ◽

Think Aloud ◽

Structured Interviews ◽

Paediatric Palliative Care ◽

Complex Information ◽

Use Of Technology ◽

Facilitating Conditions

Background: Electronic medical records (EMRs) offer a promising approach to mapping and documenting the complex information gathered in paediatric palliative care (PPC). However, if they are not well developed, poorly implemented EMRs have unintended consequences that may cause harm to patients. One approach to preventing such harm is the involvement of users in the participatory design to ensure user acceptance and patient safety. Therefore, the aim of this study is to evaluate the acceptance of a novel patient chart module (PCM) as part of an EMR from the perspective of potential users in PPC and to involve these professionals in the design process. Methods: A qualitative observational study with N = 16 PPC professionals (n = 10 nurses, n = 6 physicians) was conducted, including concurrent think aloud (CTA) and semi-structured interviews. A structured content analysis based on the Unified Theory of Acceptance and Use of Technology was applied. Results: The results can be summarized in terms of general observations, performance expectancy, effort expectancy and facilitating conditions, all of which are likely to have a positive influence on acceptance of the PCM from the user perspective in the context of PPC. Conclusions: The involvement of users in the development of EMRs is important for meeting the requirements in PPC. Further software adaptations are necessary to implement these requirements.

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Participatory Design of a Medication Module in an Electronic Medical Record for Paediatric Palliative Care: A Think-Aloud Approach with Nurses and Physicians

Children ◽

10.3390/children9010082 ◽

2022 ◽

Vol 9 (1) ◽

pp. 82

Author(s):

Sven Kernebeck ◽

Chantal Jux ◽

Theresa Sophie Busse ◽

Dorothee Meyer ◽

Larissa Alice Dreier ◽

...

Keyword(s):

Palliative Care ◽

Participatory Design ◽

Development Process ◽

Qualitative Content Analysis ◽

Qualitative Interviews ◽

Think Aloud ◽

Paediatric Palliative Care ◽

Use Of Technology ◽

Actual Use ◽

High Level

Background: Electronic medical records (EMRs) play a key role in improving documentation and quality of care in paediatric palliative care (PPC). Inadequate EMR design can cause incorrect prescription and administration of medications. Due to the fact of complex diseases and the resulting high level of medical complexity, patients in PPC are vulnerable to medication errors. Consequently, involving users in the development process is important. Therefore, the aim of this study was to evaluate the acceptance of a medication module from the perspective of potential users in PPC and to involve them in the development process. Methods: A qualitative observational study was conducted with 10 nurses and four physicians using a concurrent think-aloud protocol and semi-structured qualitative interviews. A qualitative content analysis was applied based on a unified theory of acceptance and use of technology. Results: Requirements from the user’s perspective could be identified as possible influences on acceptance and actual use. Requirements were grouped into the categories “performance expectancies” and “effort expectancies”. Conclusions: The results serve as a basis for further development. Attention should be given to the reduction of display fragmentation, as it decreases cognitive load. Further approaches to evaluation should be taken.

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High-resolution electron microscopy of Cu2O surfaces

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100143584 ◽

1986 ◽

Vol 44 ◽

pp. 396-397

Author(s):

V. Castano ◽

W. Krakow

Keyword(s):

High Resolution ◽

Natural Extension ◽

High Resolution Electron Microscopy ◽

Point Of View ◽

Initial Oxidation ◽

System A ◽

Resolution Electron ◽

Surface Reconstructions ◽

Atomic Surface ◽

Au Thin Films

In non-UHV microscope environments atomic surface structure has been observed for flat-on for various orientations of Au thin films and edge-on for columns of atoms in small particles. The problem of oxidation of surfaces has only recently been reported from the point of view of high resolution microscopy revealing surface reconstructions for the Ag2O system. A natural extension of these initial oxidation studies is to explore other materials areas which are technologically more significant such as that of Cu2O, which will now be described.

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