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The aim of the study was to develop a comprehensive competency framework for advanced practice nurses in Belgium.
A co-design development process was conducted.
This study consisted of two consecutive stages (November 2020–December 2021): (1) developing a competency framework for advanced practice nurses in Belgium by the research team, based on literature and (2) group discussions or interviews with and written feedback from key stakeholders. 11 group discussions and seven individual interviews were conducted with various stakeholder groups with a total of 117 participants.
A comprehensive competency framework containing 31 key competencies and 120 enabling competencies was developed based on the Canadian Medical Education Directions for Specialists Competency Framework. These competencies were grouped into seven roles: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator and health promoter.
The developed competency framework has resemblance to other international frameworks. This framework emphasized the independent role of the advanced practice nurse and provided guidance in a clear task division and delegation to other professionals. It can provide a solid foundation for delivering high-quality, patient-centred care by advanced practice nurses in the years to come.
This competency framework can guide further development of advanced practice nursing education in Belgium and represents a starting point for future evaluation of its feasibility and usability in education and clinical practice. Advanced practice nurses and healthcare managers can also use the framework as an instrument for personal and professional development, performance appraisal, and further alignment of these function profiles in clinical practice. Finally, this framework can inform and guide policymakers towards legal recognition of advanced practice nursing in Belgium and inspire the development of advanced practice nursing profiles in countries where these profiles are still emerging.
What problem did the study address? The absence of a detailed competency framework for advanced practice nurses complicates legal recognition, role clarification and implementation in practice in Belgium. A rigorously developed competency framework could clarify which competencies to integrate in future advanced practice nursing education, mentorship programs and practice.
What were the main findings? The competency framework outlined seven roles for advanced practice nurses: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator, and health promoter. Differentiation from other expert nursing profiles and clinical autonomy of advanced practice nurses were pivotal.
Where and on whom will the research have impact? The comprehensive competency framework for advanced practice nurses and the collaborative methodology used can inspire other countries where these profiles are still emerging. The competency framework can be used as an instrument for role clarification, performance appraisals, continuous professional development, and professional (e-)portfolios. The competency framework can guide policymakers when establishing Belgian’s legal framework for advanced practice nurses.
The authors have adhered to CONFERD-HP: recommendations for reporting COmpeteNcy FramEwoRk Development in health professions.
No patient or public contribution in the design of the study. A patient advisory panel commented on the developed competency framework.
Effective communication can help optimise healthcare interactions and patient outcomes. However, few interventions have been tested clinically, subjected to cost-effectiveness analysis or are sufficiently brief and well-described for implementation in primary care. This paper presents the protocol for determining the effectiveness and cost-effectiveness of a rigorously developed brief eLearning tool, EMPathicO, among patients with and without musculoskeletal pain.
A cluster randomised controlled trial in general practitioner (GP) surgeries in England and Wales serving patients from diverse geographic, socioeconomic and ethnic backgrounds. GP surgeries are randomised (1:1) to receive EMPathicO e-learning immediately, or at trial end. Eligible practitioners (eg, GPs, physiotherapists and nurse practitioners) are involved in managing primary care patients with musculoskeletal pain. Patient recruitment is managed by practice staff and researchers. Target recruitment is 840 adults with and 840 without musculoskeletal pain consulting face-to-face, by telephone or video. Patients complete web-based questionnaires at preconsultation baseline, 1 week and 1, 3 and 6 months later. There are two patient-reported primary outcomes: pain intensity and patient enablement. Cost-effectiveness is considered from the National Health Service and societal perspectives. Secondary and process measures include practitioner patterns of use of EMPathicO, practitioner-reported self-efficacy and intentions, patient-reported symptom severity, quality of life, satisfaction, perceptions of practitioner empathy and optimism, treatment expectancies, anxiety, depression and continuity of care. Purposive subsamples of patients, practitioners and practice staff take part in up to two qualitative, semistructured interviews.
Approved by the South Central Hampshire B Research Ethics Committee on 1 July 2022 and the Health Research Authority and Health and Care Research Wales on 6 July 2022 (REC reference 22/SC/0145; IRAS project ID 312208). Results will be disseminated via peer-reviewed academic publications, conference presentations and patient and practitioner outlets. If successful, EMPathicO could quickly be made available at a low cost to primary care practices across the country.
To deepen our understanding of why nurses decide to leave their occupation instead of changing jobs, we examined the antecedents that led to this decision through the theoretical lens of psychological contract breach.
A qualitative design with semi-structured interviews.
We collected 28 interviewees from our social networks and a social media platform. We included professional nurses who had decided to leave or had left the occupation. We analysed our data with reflexive thematic analysis, thereby giving space for the interviewee voices to rise.
We identified various experiences of dissonance between interviewee expectations and reality. The interviewees expressed unfulfilled expectations or psychological contract breaches in relation to their occupation on different levels and over extended time periods. The psychological contract breaches and decisions to leave the occupation were built up over time because of continuous disappointment and dissonance between expectations and reality. The frustration, dissonance and unfulfilled expectations were expressed towards the institution of nursing rather than a specific employer or organization.
Unfulfilled expectations over a longer period might cause psychological contract breach, leading to turnover intentions. Our research brings novel insights into the psychological contract, as our findings indicate that the psychological contract can be formed and breached, also between the employee and the occupation. This means that turnover intentions might result in nurses leaving the profession rather than seeking work in new organizations.
The study addresses the problem of nurse shortage by showing the root reasons for deciding to leave the occupation. Our findings show how psychological contract breaches over time erupt as turnover intentions regarding the occupation rather than a job. The results guide healthcare managers and decision-makers to recognize factors leading to a psychological contract breach, thereby enabling the retention of nurses.
No patient or public contribution.
To assess completeness and accuracy of the family folder in terms of capturing community-level health data.
A capture–recapture method was applied in six randomly selected districts of Tigray Region, Ethiopia.
Child health data, abstracted from randomly selected 24 073 family folders from 99 health posts, were compared with similar data recaptured through household survey and routine health information made by these health posts.
Completeness and accuracy of the family folder data; and coverage selected child health indicators, respectively.
Demographic data captured by the family folders and household survey were highly concordant, concordance correlation for total population, women 15–49 years age and under 5-year child were 0.97 (95% CI 0.94 to 0.99, p
The family folder system comprises a promising development. However, operational issues concerning the seamless capture and recording of events and merging community and facility data at the health centre level need improvement.
by Marcus Westerberg, Sandra Irenaeus, Hans Garmo, Pär Stattin, Rolf Gedeborg
Assessment of comorbidity is crucial for confounding adjustment and prediction of mortality in register-based studies, but the commonly used Charlson comorbidity index is not sufficiently predictive. We aimed to develop a multidimensional diagnosis-based comorbidity index (MDCI) that captures comorbidity better than the Charlson Comorbidity index. The index was developed based on 286,688 men free of prostate cancer randomly selected from the Swedish general population, and validated in 54,539 men without and 68,357 men with prostate cancer. All ICD-10 codes from inpatient and outpatient discharges during 10 years prior to the index date were used to define variables indicating frequency of code occurrence, recency, and total duration of related hospital admissions. Penalized Cox regression was used to predict 10-year all-cause mortality. The MDCI predicted risk of death better than the Charlson comorbidity index, with a c-index of 0.756 (95% confidence interval [CI] = 0.751, 0.762) vs 0.688 (95% CI = 0.683, 0.693) in the validation cohort of men without prostate cancer. Men in the lowest vs highest MDCI quartile had distinctively different survival in the validation cohort of men with prostate cancer, with an overall hazard ratio [HR] of 5.08 (95% CI = 4.90, 5.26). This was also consistent within strata of age and Charlson comorbidity index, e.g. HR = 5.90 (95% CI = 4.65, 7.50) in men younger than 60 years with CCI 0. These results indicate that comorbidity assessment in register-based studies can be improved by use of all ICD-10 codes and taking related frequency, recency, and duration of hospital admissions into account.by Chris Bradley, Kaihua Hou, Patrick Herbert, Mathias Unberath, Greg Hager, Michael V. Boland, Pradeep Ramulu, Jithin Yohannan
Linear regression of optical coherence tomography measurements of peripapillary retinal nerve fiber layer thickness is often used to detect glaucoma progression and forecast future disease course. However, current measurement frequencies suggest that clinicians often apply linear regression to a relatively small number of measurements (e.g., less than a handful). In this study, we estimate the accuracy of linear regression in predicting the next reliable measurement of average retinal nerve fiber layer thickness using Zeiss Cirrus optical coherence tomography measurements of average retinal nerve fiber layer thickness from a sample of 6,471 eyes with glaucoma or glaucoma-suspect status. Linear regression is compared to two null models: no glaucoma worsening, and worsening due to aging. Linear regression on the first M ≥ 2 measurements was significantly worse at predicting a reliable M+1st measurement for 2 ≤ M ≤ 6. This range was reduced to 2 ≤ M ≤ 5 when retinal nerve fiber layer thickness measurements were first “corrected” for scan quality. Simulations based on measurement frequencies in our sample—on average 393 ± 190 days between consecutive measurements—show that linear regression outperforms both null models when M ≥ 5 and the goal is to forecast moderate (75th percentile) worsening, and when M ≥ 3 for rapid (90th percentile) worsening. If linear regression is used to assess disease trajectory with a small number of measurements over short time periods (e.g., 1–2 years), as is often the case in clinical practice, the number of optical coherence tomography examinations needs to be increased.by Mohamad Awada, Burcin Becerik Gerber, Gale M. Lucas, Shawn C. Roll
Previous studies have primarily focused on predicting stress arousal, encompassing physiological, behavioral, and psychological responses to stressors, while neglecting the examination of stress appraisal. Stress appraisal involves the cognitive evaluation of a situation as stressful or non-stressful, and as a threat/pressure or a challenge/opportunity. In this study, we investigated several research questions related to the association between states of stress appraisal (i.e., boredom, eustress, coexisting eustress-distress, distress) and various factors such as stress levels, mood, productivity, physiological and behavioral responses, as well as the most effective ML algorithms and data signals for predicting stress appraisal. The results support the Yerkes-Dodson law, showing that a moderate stress level is associated with increased productivity and positive mood, while low and high levels of stress are related to decreased productivity and negative mood, with distress overpowering eustress when they coexist. Changes in stress appraisal relative to physiological and behavioral features were examined through the lenses of stress arousal, activity engagement, and performance. An XGBOOST model achieved the best prediction accuracies of stress appraisal, reaching 82.78% when combining physiological and behavioral features and 79.55% using only the physiological dataset. The small accuracy difference of 3% indicates that physiological data alone may be adequate to accurately predict stress appraisal, and the feature importance results identified electrodermal activity, skin temperature, and blood volume pulse as the most useful physiologic features. Implementing these models within work environments can serve as a foundation for designing workplace policies, practices, and stress management strategies that prioritize the promotion of eustress while reducing distress and boredom. Such efforts can foster a supportive work environment to enhance employee well-being and productivity.The prevalence of type 2 diabetes (T2D) is increasing in the Latinx community. Despite telehealth and technology becoming more available, these resources are not reaching the Latinx population. Diabetes education is a cornerstone of treatment; however, access to culturally tailored content is a barrier to the Latinx population. Real-time continuous glucose monitoring (RT-CGM) is a patient-empowering tool that can improve glycaemic control, but it is not readily available for Latinx patients with T2D. We aim to evaluate a culturally tailored diabetes self-management education and support (DSMES) curriculum, using a team-based approach to improve glycaemic control, promote healthy behaviours and enhance patient access with the use of telehealth in Latinx individuals. The primary aim of the study is to evaluate the additive effectiveness of RT-CGM on glycaemia and behavioural changes among Latinx patients undergoing a culturally tailored DSMES. A sub aim of the study is to evaluate family members’ change in behaviours.
We propose a randomised controlled trial of blinded versus RT-CGM with 100 Latinx participants with T2D who will receive DSMES via telemedicine over 12 weeks (n=50 per group). The study will be conducted at a single large federally qualified health centre system. The control group will receive culturally tailored DSMES and blinded CGM. The intervention group will receive DSMES and RT-CGM. The DSMES is conducted by community health educators weekly over 12 weeks in Spanish or English, based on participant’s language preference. Patients in the RT-CGM group will have cyclical use with a goal of 50 days wear time. The primary outcomes are changes in haemoglobin A1c and CGM-derived metrics at 3 and 6 months. The secondary outcomes include participants’ self-management knowledge and behaviour and household members’ change in lifestyle.
The study proposal was approved by the University of Washington ethics/institutional review board (IRB) Committee as minimal risk (IRB ID: STUDY00014396) and the Sea Mar IRB committee.
ClinicalTrials.gov identifier: NCT05394844
To investigate work and living conditions as determinants of COVID-19 infection risks in foreign-born workers in non-healthcare occupations.
Data were collected according to a qualitative design, using semistructured interviews. Verbatim transcripts of these interviews were analysed according to systematic text condensation.
We recruited foreign-born workers (n=15) and union representatives (n=6) among taxi drivers, bus and tram drivers, pizza bakers, cleaners and property caretakers, all indicated as risk occupations during COVID-19 in Sweden.
Four overarching themes were found: ‘virus exposure at work’, ‘aspects of low status and undervalued work’, ‘lack of access to information’ and ‘foreign-born persons’ position’. Virus exposure was frequent due to many social interactions over a workday, out of which several were physically close, sometimes to the point of touching. The respondents fulfilled important societal functions, but their work was undervalued due to low job status, and they had little influence on improving safety at work. Lack of health literacy limited foreign-born workers to access information about COVID-19 infection risks and protection, since most information from health organisations and employers was only available in Swedish and not adapted to their living conditions or disseminated through unknown channels. Instead, many turned to personal contacts or social media, through which a lot of misinformation was spread. Foreign-born persons were also subjected to exploitation since a Swedish residency permit could depend on maintaining employment, making it almost impossible to make demands for improved safety at work.
Structural factors and a lack of adapted information manifested themselves as fewer possibilities for protection against COVID-19. In a globalised world, new widespread diseases are likely to occur, and more knowledge is needed to protect all workers equally. Our results are transferable to similar contexts and bring forth aspects that can be tried in quantitative studies or public health interventions.Cite Now
This study aimed to determine best practices for involving family caregivers in interventions aimed at preventing and reducing responsive behaviour stemming from unmet needs, including pain.
Scoping review, reported according to the Preferred Reporting Items for Systematic Reviews, Meta-Analyses extension for Scoping Reviews reporting guideline.
PubMed, Embase, Emcare, Web of Science, COCHRANE Library, PsycINFO, Academic Search Premier and Cinahl searched up to 23 July 2023.
Studies reporting on family involvement in interventions for nursing home residents with dementia were included.
Two researchers independently extracted the data, followed by a content analysis.
Of the 1486 records screened, 20 studies were included. Family caregivers were involved in interventions aimed at planning care, life review (eg, documentation of life experiences of their relative), and selecting activities for their relative. Family caregivers preferred an active role in developing optimal care for their relative. Drivers of success and barriers to family involvement centred around three themes: (1) communication between all involved; (2) prerequisites (organisational and other conditions) and (3) personal circumstances (family’s coping and skills).
Best practices for involving family caregivers in interventions aimed at addressing responsive behaviour in residents with dementia concerned those interventions in which family caregivers were given an important role in managing responsive behaviour. This means that, in order to achieve an active role of family caregivers in the whole care process, their needs must be taken into account.
The protocol of the review was regisered at OSF; https://osf.io/twcfq
To identify postoperative interventions and quality improvement initiatives used to prevent wound complications in patients undergoing colorectal surgeries, the types of activities nurses undertake in these interventions/initiatives and how these activities align with nurses' scope of practice.
A scoping review.
Three health databases were searched, and backward and forward citation searching occurred in April 2022. Research and quality improvement initiatives included focussed on adult patients undergoing colorectal surgery, from 2010 onwards. Data were extracted about study characteristics, nursing activities and outcomes. The ‘Dimensions of the scope of nursing practice’ framework was used to classify nursing activities and then the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework was used to synthesise the review findings.
Thirty-seven studies were included. These studies often reported negative wound pressure therapy and surgical site infection bundle interventions/initiatives. Nurses' scope of practice was most frequently ‘Technical procedure and delegated medical care’ meaning nurses frequently acted under doctors' orders, with the most common delegated activity being dressing removal.
The full extent of possible interventions nurses could undertake independently in the postoperative period requires further exploration to improve wound outcomes and capitalise on nurses' professional role.
Nurses' role in preventing postoperative wound complications is unclear, which may inhibit their ability to influence postoperative outcomes. In the postoperative period, nurses undertake technical activities, under doctors' orders to prevent wound infections. For practice, nurses need to upkeep and audit their technical skills. New avenues for researchers include exploration of independent activities for postoperative nurses and the outcomes of these activities.
There may be opportunities to broaden nurses' scope of practice to act more autonomously to prevent wound complication.
Scoping Reviews (PRISMA-ScR) checklist.
A health consumer interpreted the data and prepared the manuscript.
Stroke is a major cause of death and disability worldwide, frequently resulting in persistent cognitive deficits among survivors. These deficits negatively impact recovery and therapy engagement, and their treatment is consistently rated as high priority by stakeholders and clinicians. Although clinical guidelines endorse cognitive screening for poststroke management, there is currently no gold-standard approach for identifying cognitive deficits after stroke, and clinical stroke services lack the capacity for long-term cognitive monitoring and care. Currently, available assessment tools are either not stroke-specific, not in-depth or lack scalability, leading to heterogeneity in patient assessments.
To address these challenges, a cost-effective, scalable and comprehensive screening tool is needed to provide a stroke-specific assessment of cognition. The current study presents such a novel digital tool, the Imperial Comprehensive Cognitive Assessment in Cerebrovascular Disease (IC3), designed to detect both domain-general and domain-specific cognitive deficits in patients after stroke with minimal input from a health professional. To ensure its reliability, we will use multiple validation approaches, and aim to recruit a large normative sample of age-matched, gender-matched and education-matched UK-based controls. Moreover, the IC3 assessment will be integrated within a larger prospective observational longitudinal clinical trial, where poststroke cognition will be examined in tandem with brain imaging and blood biomarkers to identify novel multimodal biomarkers of recovery after stroke. This study will enable deeper cognitive phenotyping of patients at a large scale, while identifying those with highest risk of progressive cognitive decline, as well as those with greatest potential for recovery.
This study has been approved by South West—Frenchay Research Ethics Committee (IRAS 299333) and authorised by the UK’s Health Research Authority. Results from the study will be disseminated at conferences and within peer-reviewed journals.
NCT05885295. Stage: Pre-results.
To examine time trends in patient characteristics, care processes and case fatality of first emergency admission for alcohol-related liver disease (ARLD) in England.
National population-based, retrospective observational cohort study.
Clinical Practice Research Datalink population of England, 2008/2009 to 2017/2018. First emergency admissions were identified using the Liverpool ARLD algorithm. We applied survival analyses and binary logistic regression to study prognostic trends.
Patient characteristics; ‘recent’ General Practitioner (GP) consultations and hospital admissions (preceding year); higher level care; deaths in-hospital (including certified cause) and within 365 days. Covariates were age, sex, deprivation status, coding pattern, ARLD stage, non-liver comorbidity, coding for ascites and varices.
17 575 first admissions (mean age: 53 years; 33% women; 32% from most deprived quintile). Almost half had codes suggesting advanced liver disease. In year before admission, only 47% of GP consulters had alcohol-related problems recorded; alcohol-specific diagnostic codes were absent in 24% of recent admission records. Overall, case fatality rate was 15% in-hospital and 34% at 1 year. Case-mix-adjusted odds of in-hospital death reduced by 6% per year (adjusted OR (aOR): 0.94; 95% CI: 0.93 to 0.96) and 4% per year at 365 days (aOR: 0.96; 95% CI: 0.95 to 0.97). Exploratory analyses suggested the possibility of regional inequalities in outcome.
Despite improving prognosis of first admissions, we found missed opportunities for earlier recognition and intervention in primary and secondary care. In 2017/2018, one in seven were still dying during index admission, rising to one-third within a year. Nationwide efforts are needed to promote earlier detection and intervention, and to minimise avoidable mortality after first emergency presentation. Regional variation requires further investigation.
by Gerben A. van Kleef, Florian Wanders, Annelies E. M. van Vianen, Rohan L. Dunham, Xinkai Du, Astrid C. Homan
Norms play an important role in upholding orderly and well-functioning societies. Indeed, violations of norms can undermine social coordination and stability. Much is known about the antecedents of norm violations, but their social consequences are poorly understood. In particular, it remains unclear when and how norm violators gain or lose influence in groups. Some studies found that norm violators elicit negative responses that curtail their influence in groups, whereas other studies documented positive consequences that enhance violators’ influence. We propose that the complex relationship between norm violation and influence can be understood by considering that norm violations differentially shape perceptions of dominance and prestige, which tend to have opposite effects on voluntary influence granting, depending on the type of norm that is violated. We first provide correlational (Study 1) and causal (Study 2) evidence that norm violations are associated with dominance, and norm abidance with prestige. We then examine how dominance, prestige, and resultant influence granting are shaped by whether local group norms and/or global community norms are violated. In Study 3, protagonists who violated global (university) norms but followed local (sorority/fraternity) norms were more strongly endorsed as leaders than protagonists who followed global norms but violated local norms, because the former were perceived not only as high on dominance but also on prestige. In Study 4, popular high-school students were remembered as violating global (school) norms while abiding by local (peer) norms. In Study 5, individuals who violated global (organizational) norms while abiding by local (team) norms were assigned more leadership tasks when global and local norms conflicted (making violators “rebels with a cause”) than when norms did not conflict, because the former situation inspired greater prestige. We discuss implications for the social dynamics of norms, hierarchy development, and leader emergence.Objetivo: Identificar os efeitos da pandemia da COVID 19 nos profissionais atuantes no atendimento pré-hospitalar. Método: revisão integrativa, conduzida de acordo com o protocolo prisma, por meio das bases de dados: Medline/PubMed, Lilacs, SciElo, BDENF, CUIDEN, CINAHAL. Adotaram-se os Descritores em Ciências da Saúde (DeCS): “Saúde do trabalhador” “Pandemia” “COVID 19” “Atendimento pré-hospitalar” “Segurança” “Profissionais de saúde” “Trabalho”. Após a aplicação dos critérios de inclusão, foram selecionados treze artigos que compuseram a amostra do estudo. Resultados: dezoito artigos foram analisados e duas categorias foram construídas: risco de contaminação e exposição ocupacional dos profissionais da saúde que cuidam de pacientes acometidos pela COVID-19 e risco de adoecimento psicoemocional dos profissionais da saúde que cuidam pacientes acometidos pela COVID-19. Conclusão: A revisão mostrou os potenciais efeitos sobre a saúde dos profissionais durante o atendimento de pacientes acometidos pela COVID-19. E a importância da implementação de estratégias de intervenção focadas nos riscos ocupacionais.
Objetive: analizar las percepciones, motivaciones y dificultades de los técnicos de enfermería titulados en enfermería. Metodología: Me-todología: Se trata de una investigación cualitativa, exploratoria descriptiva, la recolección de datos se realizó en un Hospital Municipal del Noroeste de Paraná, durante el primer semestre de 2020, mediante la aplicación de un guión semiestructurado con preguntas orien-tadoras y un cuestionario sociodemográfico. Resultados: El conocimiento adquirido en la graduación de enfermería fue uno de los facto-res facilitadores que contribuyó a una mejor ejecución de la atención brindada, y la mayor dificultad está relacionada con la aceptación de los colegas y supervisores, en relación a las opiniones y sugerencias sobre los procedimientos u organización de la Servicio. Las razones que llevaron a los técnicos de enfermería a cursar una carrera en el área en la que trabajan se deben a la necesidad de cono-cimientos y la búsqueda de un mejor futuro financiero. Conclusión: cuando el profesional tiene un título, se desarrolla con mayor destreza y eficacia en la asistencia proporcionada.
Objetivo principal: Comparar la eficacia del uso del Expediente Clínico Electrónico (ECE) Vs Expediente Clínico Físico (ECF) en la mejora la calidad en atención de pacientes hospitalizados. Metodología: Se consideraron estudios relacionados con uso del ECE, utilizando los descriptores DeCS y MeSH, operadores booleanos AND, NOT y OR. Criterios inclusión: artículos de revisión con cinco años de publicación; criterios exclusión: pacientes ambulatorios o de consulta externa. Resultados principales: La evidencia establece ventajas del uso ECE como la facilidad de uso, accesibilidad, lectura, calidad en la documentación, control de información sobre los cuidados de los pacientes, cumplimiento normativo y toma de decisiones, lo cual reduce el riesgo de errores médicos; sin embargo, algunas desventajas es el empleo de hardware, software, redes; requiere soporte técnico las 24 horas al día. Conclusión principal: el empleo del ECE establece eficacia en la atención al paciente hospitalizado mediante la minimización de tiempos en registros y el aumento en la seguridad de la información.
FreshRSS 