Evaluation of a Web Application for Nursing Records of Multiple Trauma Patients in an Emergency Department : Journal of Emergencies, Trauma, and Shock

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Original Article

Evaluation of a Web Application for Nursing Records of Multiple Trauma Patients in an Emergency Department

Phaken, Chananta1,2; Pearkao, Chatkhane1,; Potisopha, Wiphawadee1; Angkasith, Phati3

Author Information
Journal of Emergencies, Trauma, and Shock 15(4):p 167-172, Oct–Dec 2022. | DOI: 10.4103/jets.jets_87_22
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Abstract

INTRODUCTION

Multiple trauma injuries refer to multiple significant injuries sustained as a result of an event such as a fall, an attack, or an accident. The injuries might result in significant causes of death due to complex pathology.[1] According to the World Health Organization, approximately 1.35 million people die from multiple traumatic injuries caused by road accidents annually. Thailand is ranked ninth in the world for road accidents reported by the World Health Organization.[2] It is specifically important to provide emergent care for multiple trauma patients at an emergency department (ED), especially in the 1st h of care, or what is called the “Golden Hour” by the Advanced Trauma Life Support (ATLS) 10th Edition.[3]

Nurses in the ED play an important role in providing urgent care, including assessment, nursing care, and treatment for patients with multiple traumatic injuries.[4] All activities need to be recorded in medical and nursing documents. Due to time constraints, it is challenging to complete providing emergency care and recording documents. Most hospitals in Thailand currently use paper-based documents for recording nursing care and writing nurses’ notes. Sometimes, handwritten documents become problematic, such as time-consuming, missing information, and difficult to read, which increases the workload for the nurses and affects the quality of care.[45]

The implementation of information technology is necessary to make nursing documentation more effective and convenient.[6] An electronic-based recording system could help to improve the quality of patient care data, reduce documentation time and cost, and eventually increase the quality of nursing care.[7] The management of large amounts of patient data is more efficient when using the electronic-based recording system.[6] A web application is a software that is kept on a distant server and distributed through the Internet using a browser interface. It can reduce the time for recording nursing care activities, classify and store data more efficiently, and facilitate the decision-making process of health-care providers.[589] The data collected will be useful for analyzing the situation and eventually enhancing the quality of care. In Thailand, an electronic medical record for general patients was implemented in some hospitals, and the medical staff tended to accept using it.[10] However, a web application for nursing records for trauma patients is currently lacking.

As a result, we developed a web-based application for nursing records of multiple trauma patients based on the guidelines of ATLS. This study aimed to explore the quality of nursing records through the web application and to evaluate users’ satisfaction with implementing this web application in the clinical setting.

METHODS

Design

A descriptive study was used to evaluate the developed web application platform to record nursing care for multiple trauma patients in the emergency phase. It was implemented in a resuscitation room in the ED of a university hospital in Khon Kaen, Thailand, from January to March 2022.

Sampling and recruitment

Forty-five nurses were working in the ED of the study hospital. Of these, 37 nurses (82%) were recruited because they were assigned to a resuscitation room and performed nursing care interventions for multiple trauma patients. Inclusion criteria were males or females, aged 18 years or older, who agreed to participate in this study.

Research instruments

The web application for nursing records of multiple trauma patients

The web application was developed by the principal investigator (PI) and colleagues based on the guidelines of ATLS. The review of the literature analysis will be utilized to build a web application form with the main components for evaluating the primary survey in accordance with the ABCDE principle: airway maintenance with restriction of cervical spine motion (A), breathing and ventilation (B), circulation and hemorrhage control (C), disability (D), and exposure/environment (E).[1311] In the primary survey, when the web application form was examined, irregularities were found. The web application form leads to a nursing diagnosis, nursing activities, and assessments. The secondary survey evaluated a comprehensive physical examination once the patient’s vital signs had stabilized [Figure 1]. This web application was validated by five experts, and the content validity index (CVI) was 0.92.

F1-4
Figure 1:
A web application platform to record nursing activities for multiple trauma patients

The quality of nursing records through the web application

We evaluated the quality of nursing records through the web application using the nursing record quality checker, which was examined for validity by three experts. The CVI was reported as 0.94. This checklist consisted of five domains (17 items) with a scale ranging from 0 (not recorded), 1 (partially completed record), and 2 (completed record). We tested the reliability of this instrument. We used ten nurses to examine the instrument’s reliability by evaluating the multiple trauma patient histories of five. The inter-rater consistency was used to evaluate the reliability of the instrument. The reliability was reported as 0.93.

Nurses’ satisfaction

We surveyed the nurses’ satisfaction levels with the web application. The survey consists of ten questionnaire items with a five-Likert rating scale ranging from 1 (least satisfied) to 5 (most satisfied). Each item was interpreted using the mean score and divided into five levels of satisfaction: least satisfied (1.00–1.50), slightly satisfied (1.51–2.50), moderately satisfied (2.51–3.50), very satisfied (3.51–4.50), and extremely satisfied (4.51–5.00).[12]

Nurses’ and patients’ characteristics

We obtained the nurses’ characteristics, including gender, age, education level, work experience, and training experience, in trauma patient care. The patients’ characteristics consisted of gender, age, causes of injuries, and organ injury. We also recorded the Emergency Severity Index (ESI), which was used to classify the patient’s emergencies into five categories, from ESI level I (a life-threatening condition) to ESI level V (a general illness).[13]

Data collection

The ethical approval was issued by the Ethics Committee on Human Research at Khon Kaen University. After obtaining approval, the PI (C. P.) introduced our web application to the nurses working in the resuscitation room. The nurses were trained to use the web application by the PI for 2 h and tried out the web application using the case scenarios. We tested their understanding and provided all the information they needed until they reached their satisfaction. They were informed that participating in this research was voluntary and that they could withdraw at any time without notifying the researcher.

The nurses who were willing to participate in this study completed informed consent. Then, they performed nursing care for patients with multiple traumatic injuries from initial admission to discharge from the resuscitation room and recorded information through this web application. Nurses spent an average time on the web application of 70 min (range: 30–130 min). The implementation phase took place in 3 months (January to March 2022). The PI reviewed the quality of the nursing record through the web application. Afterward, the questionnaire on user satisfaction was distributed to the nurses.

Data analysis

The data were analyzed using IBM SPSS Statistics 26.0. Descriptive statistics (i.e., frequency and percentage) were used to analyze participant characteristics and the quality of nursing records through the web application. The user’s satisfaction was analyzed using mean and standard deviation (SD).

RESULTS

Nurses’ characteristics

The majority of the nurses included in this study were female (83.8%) and aged between 20 and 40 years (97.2%). Their mean age was 30.78 years (SD: 4.47). Most of them had a bachelor’s degree in nursing (89.1%), and 64.9% completed special training for trauma patients [Table 1].

T1-4
Table 1:
Nurses’ characteristics (n=37)

Patients’ characteristics

The majority of the multiple trauma patients recorded through the web application were male (72.5%) and aged 20–40 years (52.5%). Seventy percent were classified as ESI Level II, while the remaining patients (30%) were classified as ESI Level I. Of the total participants, 77.5% were involved in traffic accidents. The mean time of using this web application from ED admission to discharge from the hospital was 70.93 min (SD: 33.36).

Quality of nursing records through the web application

Overall, 80.3% of the records were completed [Table 2]. There were some items with a 100% completed record, including the patient’s physical examination following the principle of primary survey (ABCDE) and the method of distribution and referral to an appropriate health-care facility. On the other hand, 35% of the items related to recording vital sign monitoring were not recorded. Among 17 items, 11 (64.7%) were completed at 80% or higher.

T2-4
Table 2:
Quality of nursing records (n=40)

Nurse’s satisfaction

Nurses were satisfied with the use of the web application platform at a high level, averaging 3.99 (SD: 0.68) [Table 3]. The item that they were most satisfied was this web application contains sufficient contents, especially nursing care for multiple trauma patients. They also added comments to support their satisfaction. For instance, “this application is interesting and suitable for working in today’s era,” “if actually used in the agency, it can help reduce the time,” and “the web application design is clearly detailed and comprehensive for assessing the care of multiple trauma injury patients.”

T3-4
Table 3:
Nurses’ satisfaction level with the implementation of a web application for nursing records of multiple trauma patients in an emergency department (n=37)

DISCUSSION

Using a web application platform to record nursing care of multiple trauma patients satisfied registered nurses who work in the ED. The nursing records through this web application were mostly complete, clear, concise, and correct. This web application for nursing records of multiple trauma patients enables the nurse as a user to assess patients, identify problems, execute nursing tasks, and assess the outcomes following the nursing process, sequentially.

The web application platform was built based on the ATLS guidelines, which are broadly applied in trauma nursing care.[3] The ATLS principles included nursing diagnosis, care procedures, and evaluation of trauma patients. With integration into the digital platform, such as a web application in this study, users are enabled to click and select the primary survey options (ABCDE) and follow the steps of nursing care guidance easily. The results of this study are consistent with a quasi-experimental research study using electronic software for nursing documentation in nursing students.[14] The experimental group was capable of following the nursing process correctly. As a result, the practice of nursing care for patients was standardized, not forgetting the steps that make patient care effective.

The necessary information was completely recorded through the web application in a shorter time, helping to reduce information duplication. The mean duration of the ED admission time to the time of discharge from the ED recorded through the web application was around 70 min. The comparison of the time to record nursing care through the web application and through the original form is necessary to assess the effectiveness of the web application. However, it was not evaluated in this study. Several studies have revealed that an electronic record makes the process of nursing records shorter.[141516] For instance, a study conducted by Zikos etal. compared the trauma patients’ length of stay in an emergency unit between using the electronic-based system and using the paper-based system. The authors found that the length of stay in the group using the electronic documentation system (92 min) was significantly shorter than those groups using the paper-based system (149 min).[4]

A previous study applied a mobile application to support bedside nurse documentation and care, and the findings showed a higher quality of nursing records.[17] The mobile application was simple to use for keeping track of patient data such as vital signs, medical reports, and nursing notes, which was easier for nurses to work covering the process. This tool aided in the work and improves the quality of nursing records.[518] The recording time was also reduced, and then, the nurses had more time to devote to patient care.[519] In our study, the quality of nursing recorded was completely 100% in the items related to the primary survey (ABCDE) and disposition from the ED. Some items, however, did not achieve the 80% completeness criteria of the quality nursing record, such as vital signs monitoring (42.5%). Patients with multiple traumatic injuries are usually in critical conditions and their vital signs and symptoms are required to be monitored every 15 min. The nurses were not able to record every time vital signs were monitored. The linkage between the vital signs monitors and the web application of nursing records should be considered to improve this issue in the future.

The nurses in our study were young staff and familiar with technology, and they would perceive that a web application was simple to use. This could be the reason behind their high satisfaction in using the web application on their smartphones, tablets, or computers for their work. The nurses were most satisfied with the comprehensive nursing content, user-friendliness, well-organized patterns, and up-to-date information, which can be useful for caring for multiple trauma patients in the real clinical setting. Consistently, Ranjbar, Sabetsarvestani, Oghlaee, Sarvestani, Dehghan, and Shirazi (2021) revealed that nursing students using electronic software for nursing documentation had significantly higher satisfaction compared to those who used the traditional platform. The electronic document system allowed them to easily record data according to the nursing process, making them very comfortable and confident in completing records according to the nursing process. In this technological era, especially for young nurses, electronic data recording has enabled systematic data categorization, effective communication, and simple information transmission.[619] However, the limitations of the Internet connection and privacy should be of concern. Due to a single-site study, the results may limit the ability to generalize.

CONCLUSIONS

The web application of nursing records for patients with traumatic injuries is feasible to use in the ED. Using this, the platform ensures the completeness of nursing records, and users have high satisfaction when implementing the web application in their realistic setting. This web application needs to improve in the mode of vital sign monitoring to enhance the quality of nursing records and care. The examination of the web application nursing record in reducing documentation time and improving patient outcomes is needed in the future.

Research quality and ethics statement

This study was approved by the study and was endorsed by the Khon Kaen University Ethic Committee (Protocol Number HE641550). The authors followed applicable EQUATOR Network (http://www.equator-network.org/) guidelines during the conduct of this research project.

Financial support and sponsorship

This study was supported by Research and Graduate Studies, Khon Kaen University, Thailand. It was under the research program entitled “Development of a Nursing System for Trauma Patients in the Digital Era in 2021.”

Conflicts of interest

There are no conflicts of interest.

Acknowledgment

The researcher team would like to express our gratitude to all the participants in this study.

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Keywords:

Nursing record; trauma patients; web application

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