The high quality of nursing documentation is a prerequisite for the secondary use of data. Poor-quality data can lead to incorrect decision-making. This study aimed to describe the assessment of nursing documentation quality and the utilization of this assessment data in the knowledge-based management and development of daily nursing practices. Using a cross-sectional study design, an online survey of information systems for registered nurses in Finland was conducted in spring 2023. A total of 2970 nurses responded. Descriptive methods were used to characterize the frequency of the secondary use of nursing data. Across units, nursing documentation quality was not assessed in 51% of cases, results were not reviewed in 66% of units, and nursing data were not used for knowledge-based management in 58% of units. In private health care and social services, nursing documentation reviews occurred in 21% of units, and 24% reported using nursing data for knowledge-based management. In contrast, public hospitals demonstrated lower engagement, with only 17% of units reviewing nursing documentation and 13% utilizing nursing data for management purposes. The private sector led in the secondary use of nursing data compared with other sectors. Nursing managers consistently provided more positive responses than nurses across all aspects of secondary use of data. This difference may stem from the fact that nursing managers use secondary data for daily management.

Digital health services are largely provided, but little is known about the safety and security issues endangering patient safety and data security. In this study, the Bowtie method was used to analyze incidents reported to have jeopardized patient safety and data security when a patient and a healthcare professional used an online chat or video service (DigiClinic) in the Wellbeing Service County of Pirkanmaa, Finland. In 2025, there were ca. 230,000 conversations in DigiClinic. User reports related to DigiClinic were collected from 2024 and 2025 (N=135), of which all resulted in harm: minor (n=117), moderate (n=16), or severe (n=2). Only 2 incidents were due to patients' inability to use the digital service, and 22 were due to technical problems. In conclusion, DigiClinic is a widely used digital healthcare service with a low number of user reports. The primary cause leading to patient harm is deviations in information management across levels. The digital service itself does not compromise patient safety or data security.

The patient portal ‘Kanta Services’ was implemented in the healthcare to offer secure exchange of patient data among all healthcare service providers in Finland. This study examines how nurses experience using it and whether there are differences by nurse status and work context. A cross-sectional study included registered nurses and licensed practical nurses. The inclusion criteria were based on the respondents’ answers regarding their professional role and use of a primary data system, either an electronic health record or a clinical information system. Responses were received from 2970 registered nurses and from 2341 licensed practical nurses. The associations of nurse status and work context with positive experiences of Kanta Service use were analyzed using a binary logistic regression model. Registered nurses’ experiences of Kanta Services were more positive than those of licensed practical nurses. Those who worked in public healthcare experienced Kanta Services more positively than those who worked in public social services. Respondents’ good competence in using the primary system was associated with agreement with all five positive statements related to Kanta Services’ use. Kanta Services play a key role in Finland’s digital healthcare infrastructure and are becoming increasingly important in social services, but the experiences of nurses’ use of these services need attention. Specifically, accessing and retrieving information from Kanta Services through the primary data system requires improvements to meet the expectations of both nursing groups and to support their daily work more effectively.

The high quality of nursing documentation is a prerequisite for the secondary use of data. Poor-quality data can lead to incorrect decision-making. This study aimed to describe the assessment of nursing documentation quality and the utilization of this assessment data in the knowledge-based management and development of daily nursing practices. Using a cross-sectional study design, an online survey of information systems for registered nurses in Finland was conducted in spring 2023. A total of 2970 nurses responded. Descriptive methods were used to characterize the frequency of the secondary use of nursing data. Across units, nursing documentation quality was not assessed in 51% of cases, results were not reviewed in 66% of units, and nursing data were not used for knowledge-based management in 58% of units. In private health care and social services, nursing documentation reviews occurred in 21% of units, and 24% reported using nursing data for knowledge-based management. In contrast, public hospitals demonstrated lower engagement, with only 17% of units reviewing nursing documentation and 13% utilizing nursing data for management purposes. The private sector led in the secondary use of nursing data compared with other sectors. Nursing managers consistently provided more positive responses than nurses across all aspects of secondary use of data. This difference may stem from the fact that nursing managers use secondary data for daily management.

Healthcare decision-making (DM) has shifted from a paternalistic model to shared DM, where professionals contribute with clinical expertise and patients share their values and preferences. Simultaneously, access to online health information influences how patients engage in decisions concerning care. This study examined perceived DM experiences during doctor's appointments and online health information-seeking among older adults and individuals with long-term conditions. A total of 736 Finnish respondents (mean age 68 years) completed an online survey. The Shared Decision-Making Questionnaire (SDM-Q-9-FIN) assessed involvement in clinical decisions. Most participants reported feeling involved, with a mean SDM-Q-9 score of 25.96/36. Longer appointment duration (β = .50, P < .001), higher education attainment, and better health status were positively associated with perceived involvement. Adherence to treatment also enhanced DM experiences. Nearly half (48.6%) did not seek online health information before appointments. Respondents from patient associations reported more frequent information-seeking. The findings suggest that adequate consultation time and tailored communication can enhance DM. Support should be prioritized for patients with lower health status or limited health literacy.

Background:In 2018, the "TIGER International Recommendation Framework of Core Competencies in Health Informatics for Nurses" was published and used worldwide as a global guidance for educators and students to navigate educational requirements in an increasing digital working environment. Objective:Recent developments in digital health point to the need to revise these recommendations. Methods:This update followed the three-step logic of the 2018 framework development process, comprising (1) a global survey capturing the relevance of 43 core competency areas based on the ratings of 117 experts from all continents, (2) four regional expert workshops, and (3) 21 educational case studies. To ensure comparability with the 2018 framework, the same role-based structure was retained, covering Clinical Nursing, Nursing Management, Quality Management in Nursing, Coordination of Interprofessional Care, and Information Technology IT-Management in Nursing. Results:These recommendations underpin the high relevance level of health informatics for all nursing roles, characterizing each role by an informatics pattern: in Clinical Nursing patient issues, personal skills of working properly in a digital environment and a thorough understanding of the legal and ethical background of one's own work dominate the pattern. In Nursing Management, a similar composition prevails extended by management knowledge. The skill mix for Quality Management emerged as a blend of Clinical Nursing and Nursing Management, whereas Coordination of Interprofessional Care strongly emphasized coordination and teamwork capacities. IT Management in Nursing required basic and specialized computer skills incorporating problem solving, communication, and teamwork. These recommendations strongly suggest artificial intelligence (AI) topics should be addressed in all domains and for all roles of nurses. Conclusion:This updated recommendation framework provides guidance for focusing on areas that gained further priority such as patient safety, electronic health records, making use of its data and AI while retaining a core of invariant components of health informatics education for nurses.

The interpretative framework was used to explore how healthcare professionals (HCPs), artificial intelligence (AI), and researchers construct and negotiate meaning, trust, and authority in critical, highly ethical medical contexts. This case study aimed to explore and test the integration of the Microsoft Copilot® large language model (LLM) chatbot into ethically sensitive clinical decision-making (DM) to identify the problems HCPs face in do-not-attempt-resuscitation (DNAR) order-making and key areas for development. A sample of 100 HCPs' views was analyzed using qualitative content analysis. AI identified 15 thematic categories emerging from responses that described issues related to DNAR protocols and DM. The frequency of opinions in categories ranged from 4 to 16 (Copilot®) and from 2 to 16 (researchers). Based on a three-level frequency scale, AI's interpretations were especially evident in categories describing the roles of patients and families as well as practical issues related to DNAR orders. In contrast, the researchers focused on the importance of communication and documentation.

A Do Not Attempt Resuscitation (DNAR) order is one of the most important medical decisions in providing adequate end-of-life care. Physicians in general perceive challenges in decision-making and in interpreting DNAR orders. Our objectives were to explore hospital specialists' and residents’ opinions and perceptions of the DNAR order-making process and training related to DNAR order-making. A link to the web-based multiple-choice questionnaire was sent by e-mail to all physicians working in the special responsibility area of the Tampere University Hospital. The questionnaire covered several issues related to DNAR orders, including their meaning and documentation. Participants responded anonymously. Residents' responses were compared with those of specialists. 219 physicians covering all specialties responded. A total of 155 (71%) were specialists and 64 (29%) were residents. Challenges in DNAR order-making, documentation, and interpretation were more common among residents (60%) than among specialists (34%) (p < 0.001). Training in DNAR order-making was considered adequate by 40% (n=25) of the residents, compared with 61% (n=94) of the specialists (p=0.007). Structured education on DNAR protocols and end-of-life decision-making should be incorporated into all clinical specialty training programs. Integration of artificial intelligence (AI)-based decision-support tools into electronic health record (EHR) systems may further enhance consistency and accuracy in the DNAR process.

Objective: This study aimed to investigate how nurses' backgrounds, documentation skills, and experiences with documentation practices and information systems usage influence documentation hazards and to determine whether these hazards are linked to technology-induced errors (TIEs). Methods: An online survey was conducted to collect data from 3065 registered nurses working in Finnish hospitals and in acute, primary, and home care services regarding their experiences with electronic health records (EHRs) or client information systems (CIS). The data were analysed using linear and logistic multilevel models to identify patterns and correlations. Results: User interaction with EHR/CIS systems significantly influenced documentation hazards across different work environments. Perceived system-provided documentation support and documentation hazards were identified as contributors to TIEs. Conclusions: Improving system design and documentation support is a desirable goal, but it is not sufficient to mitigate documentation hazards and promote efficient practices. To achieve the best possible results, skilled users are needed to operate these systems.

ObjectivesIncreased mobile phone use in Low- and Middle-Income countries (LMIC) has led to suggestions that health interventions using mobile phones can help solve some health problems. Vaccination has been shown to be an effective means of improving health outcomes. However, vaccination coverage in many LMIC has been generally low. The aim of this study was to synthesize evidence concerning the context, mechanisms, and outcome elements of mobile health interventions in improving vaccination coverage among children under 5 years of age in LMIC.MethodsA search conducted using PubMed, Web of Science, ScienceDirect, CINAHL, Embase, and the Cochrane library led to 27 studies included in the final analysis out of 357 identified articles.ResultsTwenty-one studies were from Africa, four from Asia and two studies were from Latin America and the Caribbean. Short Message Service (SMS) intervention was used exclusively in 21 studies while six studies used a combination of SMS and phone calls, and one intervention was based only on phone calls.ConclusionThe results from most studies suggest an improved uptake of vaccination with mobile health interventions. However, there is a need for further research to quantify the impact of these interventions and determine the most effective strategies.

The rapid development in health informatics has improved health outcomes but also poses challenges. Healthcare professionals need health information technology competencies for effective decision-making. This study aims to identify key health informatics competencies and proposes an educational structure to develop these competencies. A convergent design was used as a method for the interpretation of data from a scoping review and a focus group interview. The findings highlight challenges in health informatics pivots in management, interoperability, and patient care. A blended learning method including hands-on skills is suggested to develop health informatics competencies.

Aim and ObjectiveThis study described patients' experiences with advance care planning and decision-making in Finnish hospital palliative care wards.DesignA descriptive qualitative study with semi-structured individual interviews.MethodsThe study group consisted of purposely selected patients in palliative care wards from two university hospital districts. A pretested interview guide was used. The interviews focused on three main themes with auxiliary questions. Data were gathered until data saturation was reached. The data were analysed using inductive content analysis.ResultsA total of 20 patients with cancer were interviewed. Patients' experiences with advance care planning in palliative care were grouped into three parent categories with subcategories: (1) Making plans for the end of life (need for psychosocial support in cancer disease and wish for goals of care discussion), (2) Symptom management planning (wish for pharmacological interventions for symptom management and wish for non-pharmacological interventions for symptom management) and (3) Palliative care coordination (need for discharge planning and wish for compatibility between team members). Patients' experiences with care decision-making in palliative care were grouped into two parent categories with subcategories: (1) healthcare professional as a care decision-maker (medical care decision-making, nursing care decision-making and inter-professional care decision-making) and (2) shared decision-making (need for patient involvement in shared decision-making and need for family member involvement in shared decision-making).ConclusionThis study highlights the need for advance care planning and involvement in shared decision-making in palliative care from patient perspectives.Relevance for Clinical PracticeThe results from this study show that nurses must be critically concerned about the early and intentional initiation of palliative care.Reporting MethodThe consolidated criteria for reporting qualitative studies checklist (COREQ) was used.Patient or Public ContributionThe data consists of answers given by patients in interviews.

Technology-induced errors (TIE) first appeared in research reports in the early 2000s. This review analyzes the literature on technology-induced errors to classify problems into clinical and procedure errors, human factors, and technical difficulties. Based on the literature review, all 15 publications were classified into the human factors category, while the technical problems category was the minority of the publications. The studies' methods varied, with literature reviews being the most often used. Since the concept of TIE appeared in research, it took almost ten years before more publications became available.

Sosiaali- ja terveydenhuollon palvelujen järjestämisvastuu on siirtynyt hyvinvointialueille ja muutoksessa hyvinvointialueilta odotetaan rohkeaa uudistamista. Digitalisaation hyödyntäminen ikäihmisten palveluissa on luonut mahdollisuuden toiminnan tehostumiseen ja digitaalisilla palveluilla on parannettu iäkkäiden kotona asumisen mahdollisuuksia. Digivalmiuksien ja toimintatapojen kehittäminen vanhuspalveluissa -hankkeessa (VaDigi) lähdettiin kehittämään mallia, jolla lisätään digiosaamista ikääntyneiden palveluiden työyhteisöissä. Tämän artikkelin tarkoituksena on arvioida hankkeessa kehitetyn mallin mahdollisuuksia kuvata työntekijöiden digiosaamisen vahvistamisessa. Käänteinen mentorointi -menetelmällä vahvistettiin henkilökunnan osallisuutta muutoksen toteutukseen. Tutkimuksen kohteena oli yhden hyvinvointialueen ikääntyvien palveluja tuottavat työyhteisöt. Arviointi perustuu kyselyllä koottuun aineistoon sekä fokusryhmähaastatteluiden ja työpajatyöskentelyn aineistoihin. Kyselytutkimus tavoitti 184 työntekijää 14 kunnasta. Digimentorointi tavoitti yli sata työntekijää seitsemässä työyksikössä. Opiskelijoiden (n = 14) ryhmähaastattelut ja työyksiköiden (n = 5) työpajatyöskentelyn aineisto analysointiin laadullisesti. Tutkimus tuotti tietoa käänteisen mentorointimallin kokemuksista ja menetelmän mahdollisuuksista konkretisoida sosiaali- ja terveydenhuollon ammattilaisten vahvaksi arvioimaa tietojärjestelmien käyttöosaamista muutoksiksi työyhteisöissä. Kyselyyn vastanneet arvioivat tietojärjestelmien osaamisensa paremmaksi kuin teknologiaosaamisensa. Hanke vahvisti opiskelijoiden valmiuksia tietojen oikeaan käsittelyyn sosiaali- ja terveydenhuollon palveluissa. Mentorointi tuotti konkreettisia muutoksia tietosuojan ja tietoturvan toteutukseen ikääntyneiden palveluyksiköissä. Tutkimusta käänteisestä mentoroinnista osallistavana menetelmänä tulee jatkaa.

BACKGROUND:As healthcare and especially health technology evolve rapidly, new challenges require healthcare professionals to take on new roles. Consequently, the demand for health informatics competencies is increasing, and achieving these competencies using frameworks, such as Technology Informatics Guiding Reform (TIGER), is crucial for future healthcare. AIM:The study examines essential health informatics and educational competencies and health informatics challenges based on TIGER Core Competency Areas. Rather than examine each country independently, the focus is on uncovering commonalities and shared experiences across diverse contexts. METHODS:Six focus group interviews were conducted with twenty-one respondents from three different countries (Germany (n = 7), Portugal (n = 6), and Finland (n = 8)). These interviews took place online in respondents' native languages. All interviews were transcribed and then summarized by each country. Braun and Clarke's thematic analysis framework was applied, which included familiarization with the data, generating initial subcategories, identifying, and refining themes, and conducting a final analysis to uncover patterns within the data. RESULTS:Agreed upon by all three countries, competencies in project management, communication, application in direct patient care, digital literacy, ethics in health IT, education, and information and knowledge management were identified as challenges in healthcare. Competencies such as communication, information and communication technology, project management, and education were identified as crucial for inclusion in educational programs, emphasizing their critical role in healthcare education. CONCLUSIONS:Despite working with digital tools daily, there is an urgent need to include health informatics competencies in the education of healthcare professionals. Competencies related to application in direct patient care, IT-background knowledge, IT-supported and IT-related management are critical in educational and professional settings are seen as challenging but critical in healthcare.

Sosiaali- ja terveydenhuollon asiakas- ja potilastietojärjestelmät ovat olleet muutospaineiden alla, mikä jatkuu hyvinvointialueiden otettua vastuun sosiaali- ja terveyspalveluiden järjestämisestä. Loppukäyttäjien näkökulmasta päätös muuttaa käytössä olevaa pääasiallista asiakas- tai potilastietojärjestelmää on suuri, joten uusien järjestelmien käyttöönotot on syytä organisaatioissa toteuttaa huolellisesti. Tässä tutkimuksessa keskityttiin sairaanhoitajien arvioon asiakas- ja potilastietojärjestelmästä uuden järjestelmän käyttöönoton näkökulmasta. Tutkimuksen tarkoituksena oli logistisen regressioanalyysin keinoin selvittää, mitkä tausta-, osaamis- ja koulutustekijät ovat yhteydessä sairaanhoitajien hyvään arvioon asiakas- ja potilastietojärjestelmästä ja vaikuttaako käyttöönoton ajankohta mahdollisiin havaittuihin yhteyksiin. Aineistona käytettiin Tietojärjestelmäkysely sairaanhoitajille -tutkimukseen keväällä 2023 saatuja vastauksia 18–65-vuotiailta sairaanhoitajilta. Taustatekijöistä työskentely sosiaali- ja terveyskeskuksen vuodeosastolla, kotisairaanhoidossa tai kotisairaalassa ja asumispalveluissa olivat yhteydessä hyvään arvosanaan asiakas- ja potilastietojärjestelmälle. Osaamis- ja koulutustekijöiden osalta sairaanhoitajat, jotka arvioivat kokeneisuutensa asiakas- ja potilastietojärjestelmän käyttäjänä olevan vielä puutteellinen tai joilla oli puutteita kirjaamisosaamisessa, antoivat harvemmin hyvän arvosanan. Harvemmin hyvän arvosanan antoivat myös sairaanhoitajat, jotka kokivat, ettei kollegoiden tuki edistä järjestelmien käytön osaamista. Asiakas- ja potilastietojärjestelmän käyttöönoton ajankohta vaikutti sairaanhoitajien arvioon heidän pääasiallisesti käyttämästään asiakas- ja potilastietojärjestelmästä. Kun käyttöönotto oli tapahtunut 12 kuukauden sisällä verrattuna siihen, että käyttöönotosta oli vähintään vuosi, korostuivat työskentely-ympäristön, kokeneisuuden järjestelmien käyttäjänä ja jatkuvan koulutuksen merkitys. Jatkuvan koulutuksen järjestämistä voidaan siis pitää suositeltavana, jotta asiakas- ja potilastietojärjestelmät voidaan valjastaa tukemaan sairaanhoitajien työtä ja sitä myöten asiakkaiden hyvää hoitoa. Käyttöönoton jälkeen on myös syytä seurata sairaanhoitajien itsearvioitua osaamista asiakas- ja potilastietojärjestelmiin kirjaamisessa ja yleisesti niiden käyttäjänä.

Background: As healthcare depends on health information technology, there is a growing need for Health Informatics competencies in daily practice. This review aimed to explore how the teaching of education in HI has been arranged. 28 publications, published in English between 2016 and 2020 and obtained from selected bibliographic databases, were reviewed. The data was analyzed using deductive content analysis with the following pre-formulated topics: target audience, course content and learning arrangements. The results highlight three key competencies: documentation and communication, management, and understanding of health information technology. It underlines a blended teaching method to improve the competencies of healthcare professionals, graduates, undergraduates, and suggests adding active interactions, multi-professional interactions, and hands-on skills. This study highlights the importance of adapting to changes in healthcare, improving HI competencies in healthcare, and fostering positive digital experiences. It underlined the need for practical training, in theory and hands-on sessions, including key competencies in documentation and communication, management and health information systems.

AIMS:The aim of this study was to assess the cultural validity and reliability of a Finnish version of the nine-item Shared Decision-Making Questionnaire (SDM-Q-9) in a sample of patients with different sociodemographic characteristics. METHOD:The original SDM-Q-9 was translated into Finnish with the agreement of the developers of the original scale. The standardised translation procedure was followed by a pilot test of the questionnaire. The data were collected from an online questionnaire. Reliability was estimated by Cronbach's alpha. Structural validity of the questionnaire was assessed by confirmatory factor analysis. RESULTS:The pilot study assessing the cultural validity of the scale was a success, as it did not find any expressions needing to be revised. The Finnish version of the SDM-Q-9 - the SDM-Q-9-FIN - was tested in the study where a total of 736 patients responded to the questionnaire. The questionnaire yielded high reliability with a Cronbach's alpha of 0.92. Confirmatory factor analysis confirmed the unidimensional factor structure with Item 1 excluded. CONCLUSIONS:The SDM-Q-9-FIN was shown to be a reliable instrument for evaluating shared decision-making among Finnish patients. Further testing and research are recommended among a greater diversity of patient groups.

Nurses use electronic information systems daily, and digital devices have been developed to enable patient to live at home as long as possible. This study aimed to test reverse mentoring for professionals working with digital tools in home care. An electronic survey was sent twice to nurses to collect their opinions about the tools they use. Based on the results from the first survey (N=184), the mentoring content focused on the use of information systems and digital tools. Respondents’ experiences as information system users were more abundant than their experiences as digital tool users. Tools supporting independent living were seldom used, but safety devices and alarm monitoring were used daily. The mentoring meetings induced changes and encouraged participants to acquire skills related to the use of digital tools and to evaluate their work critically.