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Validity and Reliability of a New Measure of Nursing Experience With Unintended Consequences of Electronic Health Records

Gephart, Sheila M. PhD, RN; Bristol, Alycia A. MS, RN, AGCNS-BC; Dye, Judy L. MS, RN, ANP; Finley, Brooke A. BS, RN; Carrington, Jane M. PhD, RN

CIN: Computers, Informatics, Nursing: October 2016 - Volume 34 - Issue 10 - p 436–447
doi: 10.1097/CIN.0000000000000285

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 patient safety 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 data entry. 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).

Author Affiliation: College of Nursing, The University of Arizona, Tucson.

This project was funded by the Lawrence B. Emmons Foundation from the University of Arizona.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality or the Robert Wood Johnson Foundation.

The authors have disclosed that they have no significant relationship, or financial interest in, any commercial companies pertaining to this article.

Corresponding author: Sheila M. Gephart, PhD, RN, College of Nursing, The University of Arizona, PO Box 210203, Tucson, AZ 85721 (

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