Unintended consequences of the electronic health record and cognitive load in emergency department nurses

Available online 5 August 2023, 151724

Author links open overlay panel, , , , AbstractAim

The study aimed to explore the relationship between the unintended consequences of the electronic health record and cognitive load in emergency department nurses.

Methods

The study utilized a correlational quantitative design with a survey method approach. This study had a 30.4 % response rate for a total of 304 ED nurse participants who were members of a national ED nursing organization. Data analysis included descriptive and correlational measurements of two instruments.

Results

In this study, there was a statistically significant, weak negative relationship between CL and UC-EHR in ED nurses, rs (264) = −0.154, p 0.002. Although a significant weak relationship was identified in this study, the study variables, subscales, and demographic data groupings presented moderate-to-strong positive, statistically significant correlations. Descriptive frequency data unveiled EHR stimulated patient safety threats occurring once a week to monthly.

Conclusions

The novelty of this research study provided profound implications for the future of nursing practice, policy, and nursing science. EHR optimization to minimize patient safety risks is recommended with the inclusion of end-users from this study's identified subgroups. The researchers propose a reduction of EHR burden in nursing practice.

Section snippetsBackground

The research literature related to UC-EHR or CL on nurses is limited. Carrington et al. (2015) stated that most research on the UC-EHR was conducted on the physician experience, with the nursing experience severely underdeveloped and deficient in research. The significance of the UC-EHR phenomena to the nursing discipline is the adverse effects on patient care outcomes, patient safety, nursing workflow, and nursing workload. Drs. Carrington and Gephart have published most of the research

Conceptual framework

After identifying the UC-EHR and CL research gaps within the literature, the researchers conducted a principle-based concept analysis on the concept of UC-EHR (Harmon, Corbett, et al., 2022). Subsequently, the investigators used a theory-driven research approach to guide the research question. Thus, Walker and Avant (2018)'s theory derivation procedure was used to select the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 framework (Holden et al., 2013) to guide this study.

Methods

A descriptive, correlational quantitative study determined the relationship between the UC-EHR and self-reported CL in ED nurses. This design was chosen because of the limited knowledge of the relationship between the UC-EHR and reported CL in nurses who work in the ED. Data were collected from November 29, 2021, to January 30, 2022. This study was approved exempt after institutional review board review (protocol number: Pro00115766).

Participants

This study had a total number of 304 participants, exceeding our target of 90 participants. The response rate was 30.4 %. See Table 1 for a comprehensive detail of the participant's characteristics. The majority of respondents consisted of females (75.6 %) aged 30–39 years (46.7 %) who were white (73.7 %) with a Registered Nurse (RN) license (75.7 %) and with a bachelor's degree (57.3 %) employed full-time (75.7 %) and as a staff nurse (49 %).

The NASA TLX descriptive data results revealed the

Discussion

Guided by the study aim, a weak, negative relationship exists between the UC-EHR and CL in ED nurses. Participants' scores for unintended consequences increased slightly as cognitive load decreased. According to Harrington (2021), cognitive burden increases with poor EHR usability, creating threats to patient safety. Therefore, stronger positive correlations were expected between CL and UC-EHR. However, the researchers did not have comparative studies that reported correlations within

Implications for emergency clinical care

One of the most crucial study results entailed the weekly-to-monthly occurrence of patient safety concerns stimulated by the EHR in the ED. The researchers recommend an EHR system redesign and optimization to improve patient safety and reduce the UC-EHR clinician burden. Therefore, the results of this study lead to recommendations for clinical practice related to EHR optimization to minimize negative safety experiences.

Additional findings included moderate-to-strong relationships between ED

Conclusion

This innovative research study contributed to discovering new knowledge about the relationship between UC-EHR and CL with the goal of informing and improving ED nursing practice. Exploring the relationship between the UC-EHR and CL in ED nurses is an essential precursor for a better understanding of ED nursing practice. Limited knowledge exists related to the UC-EHR and CL in ED nurses due to minimal research on these topics within this nursing population.

The study findings discovered an

Funding

This study was funded by the Emergency Nursing Association (ENA) and Sigma Foundations [USCeRA 10011084, 2021-2022].

CRediT authorship contribution statement

Carolyn S. Harmon: Conceptualization, Project administration, Funding acquisition, Writing – original draft, Methodology, Formal analysis, Investigation, Software, Data curation, Visualization. Swann Arp Adams: Supervision, Conceptualization, Writing – review & editing, Formal analysis, Visualization. Jean E. Davis: Supervision, Conceptualization, Writing – review & editing, Funding acquisition, Methodology. Sheila M. Gephart: Supervision, Conceptualization, Writing – review & editing,

Uncited references

American Recovery and Reinvestment Act of 2009 (ARRA), n.d

Gephart, Carrington and Finley, 2015

Gephart, Davis and Shea, 2017

Higbee, 2018

Declaration of competing interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Carolyn S. Harmon reports financial support was provided by Emergency Nursing Association Foundation. Carolyn S. Harmon reports financial support was provided by Sigma.

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