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To conceptualise information distortion in Electronic Health Records (EHRs), with the goal of providing a theoretical foundation for improving documentation practices.
A concept analysis.
Walker and Avant's strategy for concept analysis was used. The defining attributes, antecedents and consequences were identified.
A comprehensive search was conducted across PubMed, Web of Science, Embase, CINAHL and Scopus from their inception to December 2024. Studies published in English that addressed information distortion in EHRs were included.
A total of 37 studies were included. The three defining attributes were: real-world health truth, representation of reality and mismatch relationship. Antecedents were divided into five categories: people-related factors, equipment factors, regulatory factors, working environment factors and management factors. The consequences of information distortion in EHRs included threats to patient safety, poor operational performance, eroded trust, compromised research quality and health inequity.
This concept analysis enhances the understanding of information distortion in EHRs and provides a foundation for further empirical validation. The findings may contribute to the development of measurement instruments and strategies to mitigate information distortion in healthcare settings.
By undertaking a concept analysis of information distortion in EHRs, healthcare professionals will be better equipped to recognise and assess this ethical phenomenon, thereby supporting the development of targeted interventions to mitigate potential harms to healthcare practices. In addition, the clarity of this concept could provide a new angle from which to analyse the origins of flawed EHR documentation and its ripple effects across healthcare systems.
No patient or public involvement.
To systematically analyse international empirical literature and establish a comprehensive understanding of the push and pull factors influencing retention and turnover among mid-career nurses.
An integrative review.
PubMed, Web of Science, Scopus, EMBASE (Ovid), and CINAHL (EBSCO) were searched for studies published between January 2001 and November 2024.
An integrative literature review was conducted following the five-step process outlined by Whittemore and Knafl. Articles were screened by title, abstract, and full text based on predefined inclusion and exclusion criteria. The quality of eligible studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Data were extracted and synthesised narratively, and the findings were presented according to the socio-ecological framework.
A total of 1930 studies were identified, with 14 included for analysis: 10 qualitative, 3 quantitative, and 1 mixed-methods study. Guided by the socio-ecological framework, four themes and 10 subthemes emerged: (1) Intrapersonal (professional knowledge/skills, health issues, work-family balance); (2) Interpersonal (professional collaborative relationships, supervisor support); (3) Organisational (organisational characteristics, work characteristics, career development); and (4) Societal (salary/benefits, Social/governmental recognition).
This review reveals the heterogeneity of research on this topic and confirms previous findings. It identifies certain push-and-pull factors common to nurses across all stages of their careers. However, mid-career nurses face unique challenges, including more complex healthcare demands, declining health status, growing family caregiving responsibilities, unclear organisational roles, underutilisation of professional skills, career stagnation, and limitations on salary growth. These findings highlight the need for tailored retention strategies for mid-career nurses.
A “one-size-fits-all” retention strategy does not meet the needs of all nurses. To improve nurse retention rates, it is essential to address the shifting demands and priorities that arise as nurses reassess and transition through different career stages. For mid-career nurses, acknowledging and valuing their expertise and capabilities, providing sufficient resources, and fostering a supportive work environment that promotes career development may be effective strategies for retaining these experienced professionals.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
No Patient or Public Contribution.
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