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Fossum, Mariann
Publications (10 of 10) Show all publications
Saetra, P., Fossum, M., Svensson, E. & Cohen, M. Z. (2016). Evaluation of two instruments of perceived symptom intensity in palliative care patients in an outpatient clinic. Journal of Clinical Nursing, 25(5-6), 799-810
Open this publication in new window or tab >>Evaluation of two instruments of perceived symptom intensity in palliative care patients in an outpatient clinic
2016 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 5-6, p. 799-810Article in journal (Refereed) Published
Abstract [en]

Aims and objectives: To evaluate the test-retest stability in assessments of perceived symptom intensity on the Edmonton Symptom Assessment System-revised and the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative. The possible interchangeability between the instruments and the patients' experiences of completing the instruments were also studied.

Background: The two instruments assess the same symptoms, but the symptom intensity is assessed on 11-point numerical scales on the Edmonton Symptom Assessment System-revised and on four-point verbal descriptive scales on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative. Both instruments are commonly used; however, uncertainty exists about which instrument should be recommended and about the interchangeability of the instruments.

Design: This study used a test-retest design with inter-scale comparisons.

Methods: Data from 54 patients with cancer who were receiving palliative care in an oncology outpatient clinic were self-reported by the patients in the clinic, at home and when patients returned to the clinic.

Results: The assessments on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative verbal rating scales showed a higher level of test-retest stability than the assessments on the Edmonton Symptom Assessment System-revised numerical scoring scales, indicating higher reliability. The correspondence between the verbal categories and the numerical scores of symptom intensity were low because different verbal categories were used by patients who assessed the same numerical score.

Comclusions: The test-retest stability in the assessments was higher on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative and the results show that assessments on the two instruments could not be used interchangeably. Therefore, the symptom instrument chosen must be specified and unchanged within a patient to improve efficacy in clinical practice.

Relevance to clinical practice: The Edmonton Symptom Assessment System-revised or the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative can be used for initial assessments of patients, but should not be compared or used interchangeably. It is vitally important to have individual follow-up for all patients who score an instrument.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
Keyword
Hospital, Norway, nursing, outpatient clinics, palliative care, rating scales, reliability, symptom assessment, test-retest stability
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-49210 (URN)10.1111/jocn.13100 (DOI)000370627000025 ()26813779 (PubMedID)2-s2.0-84958213466 (Scopus ID)
Available from: 2016-03-10 Created: 2016-03-10 Last updated: 2017-11-30Bibliographically approved
Fossum, M., Ehnfors, M., Svensson, E., Hansen, L. M. & Ehrenberg, A. (2013). Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: an intervention study. International Journal of Medical Informatics, 82(10), 911-921
Open this publication in new window or tab >>Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: an intervention study
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2013 (English)In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 82, no 10, p. 911-921Article in journal (Refereed) Published
Abstract [en]

Background: Nursing documentation is essential for facilitating the flow of information to guarantee continuity, quality and safety in care. High-quality nursing documentation is frequently lacking; the implementation of computerized decision support systems is expected to improve clinical practice and nursing documentation.

Aim: The present study aimed at investigate the effects of a computerized decision support system and an educational program as intervention strategies for improved nursing documentation practice on pressure ulcers and malnutrition in nursing homes.

Design, setting and participants: An intervention study with two intervention groups and one control group was used. Fifteen nursing homes in southern Norway were included. A convenience sample of electronic healthcare records from 46 units was included. Inclusion criteria were records with presence of pressure ulcers and/or malnutrition. The residents were assessed before and after an intervention of a computerized decision support system in the electronic healthcare records. Data were collected through a review of 150 records before (2007) and 141 records after the intervention (2009).

Methods: The nurses in intervention group 1 were offered educational sessions and were trained to use the computerized decision support system, which they used for eight months in 2008 and 2009. The nurses in intervention group 2 were offered the same educational program but did not use the computerized decision support system. The nurses in the control group were not subject to any intervention. The resident records were examined for the completeness and comprehensiveness of the documentation of pressure ulcers and malnutrition with three data collection forms and the data were analyzed with non-parametric statistics.

Results: The implementation of the computerized decision support system and the educational program resulted in a more complete and comprehensive documentation of pressure ulcer- and malnutrition-related nursing assessments and nursing interventions.

Conclusion: This study provides evidence that the computerized decision support system and an educational program as implementation strategies had a positive influence on nursing documentation practice.

Keyword
Decision support system, Documentation, Intervention studies, Malnutrition, Nursing audit, Pressure ulcer
National Category
Medical and Health Sciences Probability Theory and Statistics
Research subject
Caring sciences; Statistics
Identifiers
urn:nbn:se:oru:diva-31983 (URN)10.1016/j.ijmedinf.2013.05.009 (DOI)000324312000002 ()
Available from: 2013-10-14 Created: 2013-10-14 Last updated: 2017-12-06Bibliographically approved
Vatnoy, T. K., Fossum, M., Smith, N. & Slettebo, A. (2013). Triage assessment of registered nurses in the emergency department. International Emergency Nursing, 21(2), 89-96
Open this publication in new window or tab >>Triage assessment of registered nurses in the emergency department
2013 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 21, no 2, p. 89-96Article in journal (Refereed) Published
Abstract [en]

Standardised triage systems have been implemented in emergency departments (EDs) to improve the efficacy of assessment strategies as performed by registered nurses (RNs). However, the exact effect the standardised triage systems have on the decision-making process remains unclear.

Aim: To evaluate decision making in the triage setting before and after implementation of the Medical Emergency Triage and Treatment System Adult in one hospital's ED.

Methods: A descriptive intervention design with a quantitative approach. A total of 655 patients before and 413 patients after the intervention were included. A questionnaire was used to evaluate how the RNs assessed the patients before intervention while the emergency patient records were used for data collection after intervention.

Results: Before the intervention, a majority of the assessments were founded on signs and symptoms and medical diagnoses, whereas vital parameters were rarely used. After the intervention, nearly two thirds of the patients were assessed according to a triage system with vital parameters and standardised algorithm for symptoms and signs included in the assessment procedure.

Conclusion: Implementing a standardised triage system, including vital parameters and standardised algorithms for signs and symptoms, increased the use of vital parameters and signs and symptoms for decision making and acuity assignment.

Keyword
Emergency department, Nursing assessment, Triage, Vital signs
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-29766 (URN)10.1016/j.ienj.2012.06.004 (DOI)000319032400003 ()
Available from: 2013-06-27 Created: 2013-06-25 Last updated: 2017-12-06Bibliographically approved
Fossum, M. (2012). Computerized decision support system in nursing homes. (Doctoral dissertation). Örebro: Örebro universitet
Open this publication in new window or tab >>Computerized decision support system in nursing homes
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to study the thinking strategies and clinical reasoning processes of registered nurses (RNs) and to implement and test a computerized decision support system (CDSS) integrated into the electronic health care record (EHR) to improve patient outcomes, i.e. to prevent pressure ulcers (PUs) and malnutrition among residents in nursing homes. 

A think-aloud (TA) study with a purposeful sample of RNs (n=30) was conducted to explore their thinking strategies and clinical reasoning (Paper I). A quasi-experimental study with a convenience sample of residents (at baseline, n=491 and at follow-up, n=480) from nursing homes (n=15) allocated into two intervention groups and one control group was carried out in 2007 and 2009 (Paper II). In Paper III residents’ records were reviewed with three instruments. Nursing personnel (n=25) from four nursing homes that had used the CDSS for eight months were interviewed and the CDSS was tested by nursing personnel (n=5) in two usability evaluations (Paper IV).

The results showed that the RNs used a variety of thinking strategies and a lack of systematic risk assessment was identified (Paper I). The proportion of malnourished residents decreased significantly in one of the intervention groups after implementing the CDSS, however there were no differences between the groups (Paper II). The CDSS resulted in more complete and comprehensive documentation of PUs and malnutrition (Paper III). The nursing personnel considered ease of use, usefulness and a supportive work environment as the main facilitators of CDSS use in nursing homes. Barriers were lack of training, resistance to using computers and limited integration of the CDSS within the EHR system (Paper IV). In conclusion, the findings support integrating CDSSs into the EHR in nursing homes to support the nursing personnel.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 95
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 36
Keyword
Computerized decision support, intervention study, malnutrition, nursing documentation, pressure ulcer, qualitative content analysis, think-aloud interviews, usability evaluation
National Category
Medical and Health Sciences Nursing Information Systems
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-21673 (URN)978-91-7668-857-1 (ISBN)
Public defence
2012-04-20, Hörsal P2, Prismahuset, Örebro universitet, Fakultetsgatan 1, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2012-02-16 Created: 2012-02-16 Last updated: 2018-01-12Bibliographically approved
Fossum, M., Ehnfors, M., Fruhling, A. & Ehrenberg, A. (2012). The experiences of using a computerized decision support system. In: : . Paper presented at The 11th International Congress on Nursing Informatics, Montreal, Canada. June 2012. American Medical Informatics Association (pp. 113-115). , 2012
Open this publication in new window or tab >>The experiences of using a computerized decision support system
2012 (English)Conference paper, Published paper (Other academic)
Abstract [en]

The aim was to describe the facilitators and barriers influencing the ability of nursing personnel to effectively use a CDSS for planning and treating pressure ulcers and malnutrition in nursing homes. Usability evaluations and group interviews were conducted. Facilitators were ease of use, usefulness and a supportive work environment. Lack of training, resistance to using computers and limited integration of the CDSS with the electronic health record system were reported.

National Category
Nursing Information Systems
Identifiers
urn:nbn:se:oru:diva-41316 (URN)24199144 (PubMedID)
Conference
The 11th International Congress on Nursing Informatics, Montreal, Canada. June 2012. American Medical Informatics Association
Available from: 2015-01-14 Created: 2015-01-14 Last updated: 2018-05-14Bibliographically approved
Fossum, M., Ehnfors, M., Fruhling, A. & Ehrenberg, A. (2011). An evaluation of the usability of a computerized decision support system for nursing homes. Applied Clinical Informatics, 2(4), 420-436
Open this publication in new window or tab >>An evaluation of the usability of a computerized decision support system for nursing homes
2011 (English)In: Applied Clinical Informatics, ISSN 1869-0327, Vol. 2, no 4, p. 420-436Article in journal (Refereed) Published
Abstract [en]

Background: Computerized decision support systems (CDSSs) have the potential to significantly improve the quality of nursing care of older people by enhancing the decision making of nursing personnel. Despite this potential, health care organizations have been slow to incorporate CDSSs into nursing home practices.

Objective: This study describes facilitators and barriers that impact the ability of nursing personnel to effectively use a clinical CDSS for planning and treating pressure ulcers (PUs) and malnutrition and for following the suggested risk assessment guidelines for the care of nursing home residents.

Methods: We employed a qualitative descriptive design using varied methods, including structured group interviews, cognitive walkthrough observations and a graphical user interface (GUI) usability evaluation. Group interviews were conducted with 25 nursing personnel from four nursing homes in southern Norway. Five nursing personnel participated in cognitive walkthrough observations and the GUI usability evaluation. Text transcripts were analyzed using qualitative content analysis.

Results: Group interview participants reported that ease of use, usefulness and a supportive work environment were key facilitators of CDSS use. The barriers identified were lack of training, resistance to using computers and limited integration of the CDSS with the facility’s electronic health record (EHR) system. Key findings from the usability evaluation also identified the difficulty of using the CDSS within the EHR and the poorly designed GUI integration as barriers.

Conclusion: Overall, we found disconnect between two types of nursing personnel. Those who were comfortable with computer technology reported positive feedback about the CDSS, while others expressed resistance to using the CDSS for various reasons. This study revealed that organizations must invest more resources in educating nursing personnel on the seriousness of PUs and poor nutrition in the elderly, providing specialized CDSS training and ensuring that nursing personnel have time in the workday to use the CDSS.

Place, publisher, year, edition, pages
Schattauer Gmbh, 2011
Keyword
Decision Support System, computerized, graphical user interface evaluation, nursing homes, qualitative content analysis
National Category
Information Systems Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-21753 (URN)10.4338/ACI-2011-07-RA-0043 (DOI)000208686800003 ()23616886 (PubMedID)2-s2.0-84884484684 (Scopus ID)
Note

Mariann Fossum is also affiliated to Centre for Caring Research – Southern Norway, Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway

Available from: 2012-02-22 Created: 2012-02-22 Last updated: 2018-05-03Bibliographically approved
Fossum, M., Alexander, G. L., Ehnfors, M. & Ehrenberg, A. (2011). Effects of a computerized decision support system on pressure ulcers and malnutrition in nursing homes for the elderly. International Journal of Medical Informatics, 80(9), 607-617
Open this publication in new window or tab >>Effects of a computerized decision support system on pressure ulcers and malnutrition in nursing homes for the elderly
2011 (English)In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 80, no 9, p. 607-617Article in journal (Refereed) Published
Abstract [en]

Background: Computerized decision support systems (CDSSs) have been shown to help health care professionals to avoid errors and improve clinical practice and efficiency in health care. Little is known about its influence on nursing practice and outcomes for residents in nursing homes.

Aim: The aim of this study was to evaluate the effects on the risk for and prevalence of pressure ulcers (PUs) and malnutrition of implementing a CDSS to improve prevention and care of PUs and also to improve nutrition in the elderly in nursing homes.

Design setting and participants: The study used a quasi-experimental design with two intervention groups and one control group. A convenience sample of residents from 46 units in 15 nursing homes in rural areas in Norway was included. A total of 491 residents participated at baseline in 2007 and 480 residents at follow-up in 2009. Methods: The intervention included educational sessions in prevention of PUs and malnutrition for registered nurses (RNs) and nursing aides (NAs) in the two intervention groups. In addition, one intervention group (intervention group 1) had a CDSS integrated into the electronic healthcare record (EHR) based on two research-based risk assessment instruments: the Risk Assessment Pressure Scale (RAPS) for PU risk screening and the Mini Nutritional Assessment (MNA (R)) scale for screening nutritional status. In each participating nursing home trained RNs and NAs examined all residents who consented to participate on the RAPS and the MNA (R) scale. This examination included a skin assessment and details about PUs were collected.

Results: The proportion of malnourished residents decreased significantly in intervention group 1 between the two data collection periods (2007 and 2009). No other significant effects of the CDSS on resident outcomes based on the RAPS and MNA (R) scores were found.

Conclusion: CDSSs used by RNs and NAs in nursing homes are still largely unexplored. A CDSS can be incorporated into the EHR to increase the meaningful use of these computerized systems in nursing home care. The effects of CDSS on healthcare provider workflow, clinical decision making and communication about preventive measures in nursing home practice still need further exploration. Based on results from our study, recommendations would be to increase both sample size and the number of RNs and NAs who participate in CDSS education programs.

Place, publisher, year, edition, pages
Elsevier, 2011
Keyword
Computerized, Decision support system, Electronic health record, Intervention, Malnutrition, Nursing home, Pressure ulcer, Risk assessment
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-17019 (URN)10.1016/j.ijmedinf.2011.06.009 (DOI)000293729900001 ()21783409 (PubMedID)2-s2.0-79961210693 (Scopus ID)
Available from: 2011-09-07 Created: 2011-09-02 Last updated: 2017-12-08Bibliographically approved
Fossum, M., Alexander, G. L., Göransson, K. E., Ehnfors, M. & Ehrenberg, A. (2011). Registered nurses' thinking strategies on malnutrition and pressure ulcers in nursing homes: a scenario-based think-aloud study. Journal of Clinical Nursing, 20(17-18), 2425-2435
Open this publication in new window or tab >>Registered nurses' thinking strategies on malnutrition and pressure ulcers in nursing homes: a scenario-based think-aloud study
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2011 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 17-18, p. 2425-2435Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to explore the thinking strategies and clinical reasoning processes registered nurses use during simulated care planning for malnutrition and pressure ulcers in nursing home care.

Background: Clinical reasoning is an essential component of nursing practice. Registered nurses’ thinking strategies and clinical reasoning have received limited attention in nursing science. Further research is needed to understand registered nurses’ clinical reasoning, especially for prevention of malnutrition and pressure ulcers as they are important quality indicators of resident care in nursing homes.

Design: A qualitative explorative design was used with a think-aloud interview technique.

Methods: The transcribed verbalisations were analysed with qualitative deductive content analysis. Data were collected during six months in 2007-2008 from 30 registered nurses at nine nursing homes in Norway.

Results: The registered nurses used a variety of thinking strategies, but there were differences in the frequency of use of the different strategies. The three most commonly used thinking strategies were ‘making choices’, ‘forming relationships’ and ‘drawing conclusions’. None of the nurses performed a structured risk assessment of malnutrition or pressure ulcers. Registered nurses started with assessing data from the scenarios, but after a short and elementary assessment they moved directly to planning.

Conclusion: Many different thinking strategies were used in registered nurses’ clinical reasoning for prevention of malnutrition and pressure ulcers. The thinking strategy ‘making choices’ was most commonly used and registered nurses’ main focus in their reasoning was on planning nursing interventions. Relevance to clinical practice. This study showed that most of the registered nurses go directly to planning when reasoning clinically about residents in nursing homes. A lack of systematic risk assessments was identified. The insight gained from this study can be used to recommend improvements in tools designed for nursing homes to support the registered nurses.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2011
Keyword
clinical reasoning, content analysis, pressure ulcers, registered nurses, think-aloud method, thinking strategies
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-17022 (URN)10.1111/j.1365-2702.2010.03578.x (DOI)000293748900005 ()21689181 (PubMedID)2-s2.0-80051573153 (Scopus ID)
Available from: 2011-09-07 Created: 2011-09-02 Last updated: 2017-12-08Bibliographically approved
Fossum, M., Terjesen, S., Odegaard, M., Sneltvedt, U., Andreassen, L., Ehnfors, M. & Ehrenberg, A. (2009). Clinical decision support systems to prevent and treat pressure ulcers and under-nutrition in nursing homes. In: Saranto K , Brennan PF , Park HA , Tallberg M , Ensio A (Ed.), Studies in Health Technology and Informatics: . Paper presented at 10th International Nursing Informatics Congress (NI2009) Helsingfors, Finland (pp. 877-878). Amsterdam: I O S PRESS, 146
Open this publication in new window or tab >>Clinical decision support systems to prevent and treat pressure ulcers and under-nutrition in nursing homes
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2009 (English)In: Studies in Health Technology and Informatics / [ed] Saranto K , Brennan PF , Park HA , Tallberg M , Ensio A, Amsterdam: I O S PRESS , 2009, Vol. 146, p. 877-878Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Clinical decision support systems (CDSSs) are believed to have the potential to improve care and change the behavior of health personnel. The project has focused on developing a CDSS to support prevention of pressure ulcer and undernutrition that is completely integrated in the electronic health record in nursing homes. Nursing staff have been involved in all phases in the development of the CDSS, which at present is ready to be implemented and systematically evaluated.

Place, publisher, year, edition, pages
Amsterdam: I O S PRESS, 2009
Series
Studies in Health Technology and Informatics, ISSN 0926-9630
National Category
Information Systems Nursing
Identifiers
urn:nbn:se:oru:diva-41333 (URN)10.3233/978-1-60750-024-7-877 (DOI)000273498700228 ()19593030 (PubMedID)2-s2.0-70349568702 (Scopus ID)978-1-60750-024-7 (ISBN)
Conference
10th International Nursing Informatics Congress (NI2009) Helsingfors, Finland
Note

Sponsor: Finnish Nurses Association

Available from: 2015-01-14 Created: 2015-01-14 Last updated: 2018-01-11Bibliographically approved
Fossum, M., Ehnfors, M., Svensson, E., Hansen, L. M. & Ehrenberg, A.Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes.
Open this publication in new window or tab >>Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes
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(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-22539 (URN)
Available from: 2012-04-13 Created: 2012-04-13 Last updated: 2017-10-17Bibliographically approved
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