Date of Award

Summer 2022

Document Type

Open Access Dissertation


College of Nursing

First Advisor

Swann Arp Adams


Background: The electronic health record (EHR) was rapidly implemented to improve patient safety. However, this rapid and widespread EHR implementation negatively connects to patient safety. Clinician cognitive overload is also thought to be negatively connected to patient safety, especially in the chaotic emergency department (ED) setting. Limited research has been conducted on unintended consequences of the EHR (UC-EHR) and cognitive load (CL) in ED nurses. Understanding the UC-EHR and CL in ED nurses facilitate informed interventions to improve nursing practice and patient safety.

Aims: Guided by the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 framework, the aims of this study were twofold. The first aim was to explore the relationship between UC-EHR and CL in ED Nurses. The second and third study aims were to examine the stability reliability of the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire (CG-UCE-Q) and the National Aeronautics and Space Administration Task Load Index (NASA TLX) measurement instruments in ED nurses.

Methods: This study utilized a longitudinal and correlational quantitative design with a survey method approach. The 304 participants (n = 453 total surveys completed, n = 304 initial, n = 149 repeat) included ED nurses who are members of a national ED nursing organization. Data analysis included descriptive, correlations, and psychometric measurements of two instruments.

Findings: In this study, there was a statistically significant, weak negative relationship between CL and UC-EHR in ED nurses, rs (264) = -.154, p .002. The test-retest reliability for the NASA TLX tool calculated a Cronbach α coefficient 0.513 and the CG-UCE-Q instrument measured a Cronbach α coefficient 0.753.

Conclusions: Although a significant weak relationship was identified in this study, the study variables and demographic data groupings presented moderate-to-strong positive, statistically significant correlations. Descriptive frequency data unveiled EHR stimulated patient safety threats occurring once a week to monthly. The NASA TLX survey signified moderate test-retest reliability and the CG-UCE-Q instrument indicated good test-retest reliability in ED nurses. The novelty of this research study provided profound implications for future research study directions.

Funding: This study was funded by the Emergency Nursing Association (ENA) and Sigma Foundations.


© 2022, Carolyn S. Harmon

Available for download on Saturday, October 05, 2024

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