PRELIMINARY

The emergency care system for patients is divided into two parts: outside
the hospital (prehospital) and inside the hospital (in hospital)[1]. Pre-hospital care
is a medical emergency service provided outside the hospital [2]. Pre-hospital
service is carried out when there is an emergency call outside the hospital [3].
Meanwhile, emergency service in hospital is an emergency action given by a
nurse in an emergency room [4].

Nurses have a heavy workload in emergency services, they work based on

response time, precise and accurate in order to maximize help to increase patient
life expectancy [5]. The workload felt by nurses is not only related to emotional
workloads but also related to documentation that spends time in their work [6].
Documentation of medical records in pre-hospital services is still rarely done and
this results in safety data and actions being not properly documented [7]

One of several ways to reduce workload and fatigue, and increase job
satisfaction for nurses and professional officers is to use an information
technology system, such as the electronic health record (EHR) [8]. The electronic
method-based health care system has many benefits in health services, including
saving costs and time, more integrated services with others, more accurate patient
data and improving the quality, efficiency of medical care and services to reduce
the risk of clinical errors [9].

In a research [10] explained that emergency services really need EHR

because it has an impact on workload, quality of care and quality of clinical
decisions. Based on the description above, the authors is interested in synthesizing
articles or reviewing articles related to the influence of information technology
systems on the nurses workload in emergency services.

METHODOLOGY

The method used in this literature review was a scoping review method.
The process of developing a review focus and article search strategy using the
PICO format, such as Population (P) is a nurse who works in emergency services,
Intervention (I) is using an information technology system in the form of
electronic medical records, Comparison (C) is not available, Outcome (O) the
nurse's workload increases. Based on these keywords, the authors formulate
research questions that will be used in this scoping review, such as "how is the
influence of information technology systems on the nurses workload in
emergency services?.

The authors then conducted an article search on three databases, such as ProQuest,
PubMed and Science Direct from 2012 to 2022 using several predetermined
keywords in English, such as “Influence of Information Technology Systems”,
AND “, “Nurses' Workload”, OR , "Emergency Services". Boolean Operators
phrases are used during the search process using keyword combinations. Articles
were selected according to predetermined inclusion criteria, and carried out
systematically based on PRISMA. Relevant articles from the included literature
reference list were also retrieved to obtain more thorough search results.

The articles obtained from the search process were then screened for eligibility
using several inclusion and exclusion criteria. The inclusion criteria were full text
articles, published in 2012-2022, in English, Relevant Abstracts, and emergency
services. The authors uses the Mandeley citation manager to collect and filter
search results. Authors independently screened articles by title and abstract after
deletion of duplicates. Full text articles were then screened for eligibility based on
inclusion and exclusion criteria. Data analysis was carried out by narrative
synthesis. Where the authors looks at the overall contents of each article reviewed,
then specifically the authors analyzes the results of the research and also the
discussion of articles about the nurses workload in pre-hospital services. After
that, the writer discusses this subject.
 Figure 1. Flowchart of Literature Searching

Identification through database searching Identify additional articles

(ProQuest, PubMed and Science Direct) from other sources

Identification n = 414 n=0

Total amount after article duplication was

removed
Screening n = 397

Records Screened (Title and Records Excluded

abstract) n = 367
n = 25
Eligibility
Articles that have been Articles that have been excluded
accepted n=8
n = 17
- 5 articles containing research
that was not carried out in
emergency services
Included - 3 articles containing research
Articles that have been that does not use information
accepted and analyzed technology systems
n = 17

RESULTS

There were 17 research articles used by authors and obtained from

database searching, such as 414 articles, of which 170 articles were obtained from
the ProQuest database, 139 articles from Science Direct and 105 articles from
PubMed. Furthermore, the authors conducted a screening by looking at the
suitability of the title and abstract of the articles with the topic in this research,
assessed whether there was duplication of articles. From the screening process, 17
duplicate articles were obtained and 397 articles were not appropriate, so the
authors found 25 articles. Then the authors re-screened to read the entire contents
of each selected article. In the end, the total articles used in this research were 17
articles.

DISCUSSION

Nurse workload is defined as all achievements made by nurses and may

influence the quality of their work [26]. Nurse workload is also defined as the
number of nursing activities that must be carried out during work shifts, these
activities are direct and indirect nursing activities [26]. The nurses workload in
pre-hospital and emergency services is very large, experiencing high stress due to
facing a new environment according to the patient's condition, direct contact with
people who have the potential to take aggressive action [27]. Often pre-hospital
and emergency room nurses experience physical and verbal abuse from patients
and their families [28].

There are two types of workload, such as physical workload (all activities
that involve a lot of physical strength) and psychological workload (level of
expertise and work performance as well as jobs that have a great mental
responsibility) [29]. A balanced workload can maximize a person's performance
[30]. According to [30] there are two components that can affect a person's
workload, such as external factors (workload originating from outside the
worker's body, such as tasks, work organization and work environment) and
Internal factors (workload factors originating from within a person's body due to
reactions from External workloads that can be potential stressors include somatic
factors and psychological factors [6] explaining that nurses often feel a high
workload because of the large amount of documentation that must be done in the
service.

Information and communication technology systems are effective in the

daily activities of the Health profession and improve learning in the service
process in hospitals and in higher education [31]. Information technology (IT) is
guided by a combination of hardware (hardware), software (software), and
services used to manage, communicate, and share information [32]. The nursing
information system is part of the health care information system that deals with
aspects of nursing, specifically on the maintenance of nursing records [33]. In the
health sector, technology has been developed to facilitate the performance of
nurses and help solve problems that exist in the world of nursing [34]. Nursing
information systems are closely related to the application of health technology and
information technology in the nursing field in the form of data, information,
knowledge and nursing care services [35]. There are several advantages or
benefits of using information technology systems in the nursing field, as follows:

1. Improve the quality and efficiency of medical services and care (reducing
clinical risks and errors, can improve the safety of staff or workers, can
improve decision-making efficiency, improve workflow and treatment
planning [9].
2. Facilitate communication management (can facilitate communication in
services, can improve communication between organizations, and expand
intra-organizational communication [36]
3. Improve management in documentation and monitoring of information
(can improve accessibility of data and documents, can create archives of
documents and information that is accurate and safe [36]
4. Improve resource management (reducing the nurses workload, reducing
the use of paper resources in patient medical records, saving time and
costs, reducing the work of other staff, making work directed and optimal
[37]

There are several benefits of using electronic medical records in

emergency services such as officers being able to re-check things that were
forgotten to be entered when taking actions at the scene, with the EHR providing
convenience in filling out data quickly, EHR can create better collaboration
between officers, the REM system integrated with the emergency department
[11], EHR helps to avoid the risk of data errors, supports a variety of remote
diagnostic information in real time, facilitates the referral system, provides
information storage and automatic management, and reduces the burden of paper
usage and storage space. 38].
 There are also several researches that explain about the obstacles in the use
of electronic medical records in emergency services, such as most of senior nurses
have difficulty in operating electronic nursing system, EHR design is not in
accordance with the workflow and causing obstacles [36], there is no equal
distribution of training on the use of information technology systems, not all areas
are equipped with computers and good communication networks [33].

CLOSURE

The research findings indicate that the use of information technology

systems, especially in electronic medical records in emergency services, is needed
and has a positive influence on the nurses workload, thereby creating better
service quality. There are many benefits felt by nurses related to electronic
medical records, such as workload reduction, speed up the process of collecting
data of the patients, avoid missing data to be inputted, reduce costs in medical
records procuring. There are also obstacles the use of electronic medical records
due to the lack of experience of senior nurses in using technological devices and
constrained by several EHR designs. It is hoped that more training will be held
regarding the use of information technology systems in the form of electronic
medical records in every emergency service and the need to develop innovative
and easy-to-use electronic medical record designs.