Background Electronic health records (EHRs) are an elementary part of the work of registered nurses (RNs) in healthcare. RNs are the largest group of healthcare workers, and their experiences with EHRs and their informatics competence play a crucial role in a fluent workflow. The present study examined EHR usability factors and nurses’ informatics competence factors related to self-reported time pressure and psychological distress. Methods A nationwide survey was conducted for working-age registered nurses in 2017. The study sample included 3607 nurses (5% men) in Finland. The association of age, sex, employment sector, EHR usability factors, and nurses’ informatics competence factors with time pressure and psychological distress were examined with analyses of covariance. Results The EHR usability factors that were associated with high time pressure were low EHR reliability and poor user-friendliness. Regarding the nurses’ informatics competence factors, only low e-Care competence was associated with time pressure. Of the EHR usability factors, low EHR reliability and low support for cooperation were associated with high psychological distress. Of the nurses’ informatics competence factors, low e-Care competence was associated with high psychological distress. Conclusions Unreliability and poor user-friendliness of EHRs seem to be prominent sources of time pressure and psychological distress among registered nurses. User-friendly EHR systems and digital tools in healthcare are needed. Nurses’ competence to use eHealth tools to tailor patient care should be strengthened through organizational and regional actions. For example, house rules about how to use eHealth tools and instructions on common practices in cooperation with other organizations could be useful.

In order to assess the effectiveness of lifestyle interventions in reducing cardiovascular disease risk factors, morbidity and mortality among working-age adults, we undertook a systematic review of randomized controlled trials of various lifestyle interventions (diet, exercise, smoking cessation, alcohol intake reduction) in adults followed for 1 year or longer. Twenty-one single-factor and 21 multifactorial interventions were analysed by outcome. Changes in cardiovascular morbidity and mortality and total mortality were considered as main outcomes. Changes in weight, total cholesterol, blood pressure, sodium excretion, smoking and alcohol consumption were also analysed, and numbers needed to treat were calculated for smoking, morbidity and mortality. In secondary prevention, both single and multifactorial lifestyle interventions were shown to reduce morbidity and mortality, and multifactorial approaches reduced cholesterol levels. Primary prevention was found to reduce risk factors efficiently, especially when the intervention is multifactorial. Effect sizes were heterogeneous with wide confidence intervals. Standardized ways of describing interventions, measuring their effects and reporting outcomes systematically would facilitate effect-size evaluations. Interventions should optimally be multifactorial and targeted at high-risk patients with multiple risk factors for cardiovascular disease.

TiivistelmäPotilastietojärjestelmien toimivuus on terveydenhuollon ammattilaisten työn sujuvuuden kannalta tärkeää. Tutkimme fokusryhmähaastattelujen avulla ammattilaisten työprosesseja, tietojärjestelmien käyttökokemuksia ja stressaavuutta, sekä niiden vaikutuksia työhyvinvointiin. Haastattelujen analyysi toteutettiin käyttäen sisällön analyysiä.Tekniset ongelmat kuten käyttökatkokset ja hitaus, moniin järjestelmiin vaadittava kirjautuminen ja monien järjes-telmien yhtäaikaiskäyttö aiheuttivat terveydenhuollon ammattilaisille stressiä. Organisaatioiden välistä yhteistyötä hidasti sähköisen potilastiedon puuttuminen. Puutteelliset lääkitysmerkinnät aiheuttivat stressiä työntekijöille sekä huolen potilasturvallisuudesta. Potilastiedon kirjaamiseen ei aina tuntunut riittävän aikaa, jolloin yritettiin kirjata lyhyesti tai työvuoron päätteeksi. Työn keskeytysten ja eri näkymien välillä hyppelyn koettiin häiritsevän kirjaamista. Ohjelmien välisiä toiminnallisuuksia toivottiin lisää, jotta kirjaamiseen käytetty aika vähenisi ja kertakirjaaminen riittäisi.Kokonaisuudessaan tietojärjestelmiä ja niihin kirjaamista ei kuitenkaan pidetty työn suurimpana stressitekijänä, vaan potilastyöstä tai ajoittaisesta työryppäästä aiheutuva rasitus oli monen työntekijän kohdalla ensisijaista. Erääksi työhyvinvoinnin parantamismahdollisuudeksi nimettiin koulutus, joka antaisi valmiuksia muuttuvaan digityöhön. Terveydenhuollon ammattilaiset kokivat, että palautteen antamisen mahdollisuudet tietojärjestelmistä olivat vähäiset.Työn sujuvuuden (tehokkuuden ja laadun) ja alan houkuttelevuuden kannalta olisi keskeistä, että terveydenhuollon työntekijöiden työhyvinvoinnista huolehdittaisiin poistamalla tunnistettuja stressitekijöitä: parantamalla tietojärjestelmien vakautta, kehittämällä kertakirjautumista sekä tiedonhaun ja kirjaamisen käytettävyyttä, tarjoamalla kirjaamiseen rauhallinen työympäristö ja parantamalla luotettavan, kattavan ja ajantasaisen tiedon saatavuutta muista organisaatioista. Ammattilaisten antaman palautteen tulisi näkyä järjestelmien kehittämisessä, ja järjestel-mien käyttötaitoa ja digityötapoja pitäisi kehittää organisaatioissa systemaattisesti. Jatkotutkimuksissa on tarpeen seurata terveydenhuollon ammattilaisten kokemuksia organisaatioiden välisen tiedonkulun kehittymisestä.

Background Constantly changing and difficult-to-use information systems have arisen as a significant source of stress in physicians’ work. Physicians have reported several usability problems, system failures, and a lack of integration between the systems and have experienced that systems poorly support the documentation and retrieval of patient data. This stress has kept rising in the 21st century, and it seems that it may also affect physicians’ well-being. Objective This study aimed to examine the associations of (1) usability variables (perceived benefits, technical problems, support for feedback, and user-friendliness), (2) the number of systems in daily use, (3) experience of using information systems, and (4) participation in information systems development work with physicians’ distress and levels of stress related to information systems (SRIS) levels. Methods A cross-sectional survey was conducted among 4018 Finnish physicians (64.82%, 2572 out of 3968 women) aged between 24 and 64 years (mean 46.8 years) in 2017. The analyses of covariance were used to examine the association of independent variables with SRIS and distress (using the General Health Questionnaire) adjusted for age, gender, employment sector, specialization status, and the electronic health record system in use. Results High levels of technical problems and a high number of systems in daily use were associated with high levels of SRIS, whereas high levels of user-friendliness, perceived benefits, and support for feedback were associated with low levels of SRIS. Moreover, high levels of technical problems were associated with high levels of psychological distress, whereas high levels of user-friendliness were associated with low distress levels. Those who considered themselves experienced users of information systems had low levels of both SRIS and distress. Conclusions It seems that by investing in user-friendly systems with better technical quality and good support for feedback that professionals perceive as being beneficial would improve the work-related well-being and overall well-being of physicians. Moreover, improving physicians’ skills related to information systems by giving them training could help to lessen the stress that results from poorly functioning information systems and improve physicians’ well-being.

The CATI-method is a useful tool in screening of high-CVD-risk patients and in guiding them to local CVD primary prevention programmes.