Nursing Research: Clinical Research Question and Evidence

This nursing research assignment explores the impact of electronic health records (EHRs) on patient satisfaction. The student develops a PICO question to guide the research: 'Does the use of electronic health records in clinical settings increase patient satisfaction compared to paper prescriptions?' The assignment includes a detailed search strategy using key terms and MESH terms related to nurses, caregivers, EHRs, paper prescriptions, and patient outcomes. Part B of the assignment presents a table summarizing five relevant studies, detailing their methodologies, findings, and author conclusions. The assignment also includes a citation and appraisal of one study using the CASP tool, evaluating its validity, results, and generalizability. References to supporting literature are provided.

Running head: NURSING RESEARCH
NURSING RESEARCH
Name of the Student
Name of the university
Author’s note

1NURSING RESEARCH
1. Search strategy for literature to support the proposal
(P) Key terms and MESH terms
1. Nurses
2. Health Attendant
3. Caregivers
4. Carer
5. Nurses OR health workers OR Caregivers OR Carer
(I) Key terms and MESH terms
1. Electronic health records
2. Electronic prescription
3. Electronic medical records
4. e- documentation
5. Electronic health records OR HER OR Electronic medical records OR e-
documentation
(C) Key terms and MESH terms
1. Paper prescriptions
2. Paper documents
3. Medicine instruction
4. Paper prescriptions OR Paper documents OR Medicine instruction
(O) Key terms and MESH terms
1. Patient outcome
2. Patient expectation
3. satisfaction
4. Empowerment
5. Positive outcome OR Patient expectation OR satisfaction OR empowerment

2NURSING RESEARCH
Part A: Background research
1. PICO (Quantitative analytic studies )
Key terms Alternatives
How would you describe your patients or the patient group?
Patient or
population
Nurses Caregivers, carers
What intervention are you interested in?
Electronic health
record
Electronic medical
record
What alternative or different options do you want to compare your intervention to?
Comparison Paper prescription Paper health records
What measurable outcomes are you interested in?
Outcome Patient satisfaction Patient experience
2. PICO question
Does use of electronic health records (I) in clinical settings increases patient satisfaction (O) in
comparison to the paper prescriptions (C)?

3NURSING RESEARCH
Part B: Characteristics of Study Table
No. Article
reference
Countr
y
Participants Study type
and the
Methods
Main
results
/findings
Author’s
conclusion
1. Gildon, B.
L.,
Condren,
M., &
Hughes, C.
C. (2019,
June).
Impact of
Electronic
Health
Record
Systems on
Prescribing
Errors in
Pediatric
Clinics. In
Healthcare
(Vol. 7,
No. 2, p.
57).
Multidiscip
linary
Digital
Publishing
Institute.
USA 3 paediatric
clinics
representing
three
different
EHR systems
and practice
settings.
139
prescriptions
were
considered
A cross
sectional
descriptive
study
design,
quantitative
study
The
prescribing
error in
clinic 1 is
higher than
the two
clinics as it
did not
comply to
the AAP
(American
academy of
paediatrics )
requirements
The HER
system
present in the
clinics does
not meet the
requirements,
thus the
medication
error rates are
high
2. Maillet, É.,
Mathieu,
L., &
Sicotte, C.
(2015).
Modeling
factors
explaining
the
Canada Medical
surgical
wards of four
hospitals
ranked at
Quantitative
study, A
multicentre
cross
sectional
The
variables
explained
33.6% of the
variance of
The research
highlighted
the
importance of
effort

4NURSING RESEARCH
acceptance,
actual use
and
satisfaction
of nurses
using an
Electronic
Patient
Record in
acute care
settings:
An
extension
of the
UTAUT.
Internation
al journal
of medical
informatics
, 84(1), 36-
47.
different
EPR
adoption
stages.
Questionnair
e was used
for the
collection of
the data.
study. A
randomised
stratified
sampling
approach
was used.
actualize,
54.9% of
nurses’
satisfaction,
50.2% of
performance
expectancy
and 52.9%
of effort
expectancy.
expectancy
and the actual
use of patient
health records
explaining
nurse’s
satisfaction.
3. van Der
Vaart, R.,
Drossaert,
C. H., Taal,
E.,
Drossaers-
Bakker, K.
W.,
Vonkeman,
H. E., &
van de
Laar, M. A.
(2014).
Impact of
patient-
accessible
electronic
medical
records in
rheumatolo
gy: use,
satisfaction
and effects
USA 415 patients
diagnosed
with
Rheumatoid
arthritis was
chosen and a
paper and
pencil
questionnaire
was
provided. All
the patients
Quantitative
study,
survey was
done for
collecting
the data. A
pre-test-
post-test
design was
used in this
study.
54% of
respondents,
viewed their
EMR, 44%
had admitted
feeling more
engaged in
their
treatment
and 37% felt
they had
more
A personal
web portal
can be made
for the
patients, who
can access
their personal
EMR as they
feel more
empowered
and informed
about their

5NURSING RESEARCH
on
empowerm
ent among
patients.
BMC
musculoske
letal
disorders,
15(1), 102.
were invited
to log in to
the portal
with a
personal
account. Five
months later
a post –test
questionnaire
was provided
to these
patients
information
about their
treatment
treatment.
4. Street Jr, R.
L., Liu, L.,
Farber, N.
J., Chen,
Y., Calvitti,
A., Zuest,
D., ... &
Ashfaq, S.
(2014).
Provider
interaction
with the
electronic
health
record: the
effects on
patient-
centered
communica
tion in
medical
encounters.
USA 23 primary
care
providers
from the
USA
Veterans
Administrati
on (VA)
primary care
clinics were
selected in
Quantitative
study. The
proportion
of the time
spent
looking at
the computer
was
recorded and
conversation
al silence
It was found
that PCPs
who spent
more time in
the
consultation
process
gazing at the
computer
had more
conversation
EHR activity
during
consultation
has been
found to be
consuming
more time.
Hence, in
order to
ensure
effective

6NURSING RESEARCH
Patient
education
and
counseling,
96(3), 315-
319.
the study.
The time
spend by the
PCPs gazing
at the
computer
were
recorded in
real time by
video
recording
was coded
as the time
when the
therapist was
not talking
to the
patient.
al silence
and was
denoted as
less patient
centeredness
.
communicatio
n, the
clinicians
might be
benefitted
from using the
communicatio
n strategies
that
maintained
the flow of
communicatio
n between the
patient and
the nurses.
5. Jarvis, B.,
Johnson,
T., Butler,
P.,
O’Shaughn
essy, K.,
Fullam, F.,
Tran, L., &
Gupta, R.
(2013).
Assessing
the impact
of
electronic
health
records as
USA All the
hospitals in
the United
States that
were eligible
to participate
in the CMS
hospital VBP
A
quantitative
cohort ,
descriptive
statistics
used for the
study.
The study
included
2988
hospitals
having 248
EHR. After
controlling
the hospital
Advanced
EHR have
been found to
be having
greater payoff
in the EHR
infrastructure.

7NURSING RESEARCH
an enabler
of hospital
quality and
patient
satisfaction
. Academic
Medicine,
88(10),
1471-1477.
program. characteristi
c hospitals
having
advanced
EHR was
found to be
associated to
greater care
scores .

8NURSING RESEARCH
Part 3
Citation: Jarvis, B., Johnson, T., Butler, P., O’Shaughnessy, K., Fullam, F., Tran, L., & Gupta, R.
(2013). Assessing the impact of electronic health records as an enabler of hospital quality and
patient satisfaction. Academic Medicine, 88(10), 1471-1477.
Appraisal using CASP tool
1. Yes the title of the paper was appropriate as interventions, outcome and the population
has been identified correctly. The outcome is hospital quality and patient condition. The
intervention applied is the use of advanced electronic health records. The target
population has also been identified- hospital settings.
2. No randomisation was done, instead only those hospitals that were eligible to participate
in the CMS Hospital VBP Program for FFY 2013were selected for the study. The
sampling strategy was purposeful. Randomisation in a study helps to reduce bias
(Barnham, 2015).
3. The exposure was accurately measured. The Healthcare Information Management
Systems Society (HIMSS) Analytics introduced an Electronic Medical Record Adoption
Model (EMRAM) for tracking the adoption of electronic medical record applications in
the hospital care settings. Finally the clinical process of the care domains were calculated
by summing up the improvement score for each of the process.
4. The outcome of the study was measured properly, the experience of the patients were
measured by the by summing the higher of the achievement or improvement score for
each of the eight HCAHPS scores. Hence, the consistency scores is mainly on the basis
of the distance that the lowest score (HCAHPS) is from the achievement threshold for the
HCAHPS dimension. HIMSS analytics EMRAM levels was used for defining the
advanced EHR

9NURSING RESEARCH
5. No, the confounding factors were not taken in to account.
6. a) Yes the follow up was long enough. Improper follow up might lead to selection bias
(Brannen, 2017).
7. Out of 2988 hospitals, 248 hospitals were considered to be the advanced HER users.
Hospitals with larger EHRs were found to be larger with more number of beds and more
admissions.
8. A statistical significant result was obtained, as the P value is less than 0.01.
9. The validity and the credibility of the paper cannot be overlooked due to the statistically
significant data and evidence based references.
10. Yes, the result is generalizable and can be added to the local population. It has been
found that the advanced care hospitals contained advanced EHR indicating towards
improved patient satisfaction and reduced medication errors.
11. The result fits with the other evidences, by the way, that it has been compared with other
studies under the same keywords and the result is in compliance with the other results.
12. The implication of the study is that the findings provide early evidence of the
effectiveness of the investments in the EHR . EHR has been found to be associated with

10NURSING RESEARCH
higher clinical process of the care scores, without degrading the experience of the
patients.

11NURSING RESEARCH
References
Barnham, C. (2015). Quantitative and qualitative research: Perceptual foundations. International
Journal of Market Research, 57(6), 837-854.
Brannen, J. (2017). Mixing methods: Qualitative and quantitative research. Routledge.
Gildon, B. L., Condren, M., & Hughes, C. C. (2019, June). Impact of Electronic Health Record
Systems on Prescribing Errors in Pediatric Clinics. In Healthcare (Vol. 7, No. 2, p. 57).
Multidisciplinary Digital Publishing Institute.
Jarvis, B., Johnson, T., Butler, P., O’Shaughnessy, K., Fullam, F., Tran, L., & Gupta, R. (2013).
Assessing the impact of electronic health records as an enabler of hospital quality and
patient satisfaction. Academic Medicine, 88(10), 1471-1477.
Maillet, É., Mathieu, L., & Sicotte, C. (2015). Modeling factors explaining the acceptance, actual
use and satisfaction of nurses using an Electronic Patient Record in acute care settings:
An extension of the UTAUT. International journal of medical informatics, 84(1), 36-47.
Street Jr, R. L., Liu, L., Farber, N. J., Chen, Y., Calvitti, A., Zuest, D., ... & Ashfaq, S. (2014).
Provider interaction with the electronic health record: the effects on patient-centered
communication in medical encounters. Patient education and counseling, 96(3), 315-319.
van Der Vaart, R., Drossaert, C. H., Taal, E., Drossaers-Bakker, K. W., Vonkeman, H. E., & van
de Laar, M. A. (2014). Impact of patient-accessible electronic medical records in

12NURSING RESEARCH
rheumatology: use, satisfaction and effects on empowerment among patients. BMC
musculoskeletal disorders, 15(1), 102.