NURS 630 Week 5 Evidence-Based Project Part 3: Translation, Integration, and Evaluation Example

Evidence-Based Project Part 3, Translation, Integration, and Evaluation: A New Inpatient Portal Access and Coaching Protocol for Medical-Surgical Units

Is a Policy, Procedure or Protocol Needed?

Before proposing a change, I reviewed Lakeside Regional Medical Center's existing documents related to the patient portal. The health information management policy on portal accounts covers identity verification, activation codes and proxy access for parents and legal representatives. The admission procedure asks registration staff to offer an activation code. The nursing discharge procedure lists the after-visit summary but does not mention the portal. No document assigns anyone to help hospitalized patients use the portal during their stay, to address language or device barriers, or to record whether patients chose to use it.

The evidence from Part 2 shows why this gap matters. Use of inpatient portals is consistently lower among older, Black, Hispanic, non-English-speaking and publicly insured patients (Redelman-Sidi et al., 2026), while research on what patients and parents experience points to gains in understanding, involvement and even safety when access comes with support (Alla et al., 2026; Kieren et al., 2026). Because current documents assign no one to provide that support, revising an existing policy would not be enough. A new nursing protocol, the Inpatient Portal Access and Coaching Protocol, is needed. A registration policy can make sure every patient is offered a code; only a nursing protocol can make sure every patient is offered help.

The Protocol

The protocol has five elements. First, at admission, the nurse asks every adult patient, or a designated caregiver, whether they use the portal, and records the answer in a new admission database field with options for active user, wants help, has no device and declines. Second, for patients who want help or have no device, the nurse or a trained unit portal champion offers a ten-minute coaching session within 24 hours, on the patient's own phone or a hospital-owned tablet, with an interpreter when the preferred language is not English. Third, coaching shows the patient where to find results, notes, the medication list and the care team's messaging, using a one-page guide in English and Spanish. Fourth, before discharge, the nurse shows the patient the after-visit summary in the portal and confirms that proxy access is set up for any caregiver the patient chooses. Fifth, declines are respected and documented, so that later measures can separate choice from missed opportunity.

How the Change Will Occur

The change will follow a Plan-Do-Study-Act model, which allows a small test, measurement and adjustment before spread. An interdisciplinary team led by the nursing informatics specialist will include two staff nurses from each pilot unit, a nurse manager, a health information management analyst, an interpreter services coordinator and a member of the patient and family advisory council. In the planning phase, the team will build the admission field, write the coaching guide and train eight portal champions. The first cycle will run for six weeks on one medical unit, the second on a surgical unit, and the third on both units together, with each cycle adjusted based on the data and staff feedback from the last.

Lessons from other technology changes shape the plan. Nurses who lived through transitions between electronic records recommended building institution-specific guidance rather than relying on vendor training, staging education to match users' readiness and setting up shared governance for ongoing decisions (Brunner et al., 2026). The project will follow those recommendations by having champions train peers on their own units and by placing the protocol under the nursing informatics council for review.

Integration Into Practice

Integration depends on making the protocol part of work nurses already do. The portal question will sit inside the admission database rather than in a separate form, and a best practice advisory will remind the nurse only when a patient has been marked as wanting help and no coaching has been documented after 24 hours. Coaching documentation will be a single checkbox with a time field. The discharge checklist will include a line for showing the after-visit summary in the portal. Each pilot unit will have two tablets kept in the clean utility room, enrolled in the hospital's device management system and wiped between patients.

Clinician concerns must also be addressed. Clinicians have expressed worry that patients reading their records will change how notes are written, a concern that a scoping review of 42 studies examined across inpatient and outpatient settings (Meier-Diedrich et al., 2025). Nurses on the pilot units will receive a short session on writing notes and care plans that patients will read, including plain-language summaries of the plan for the day. The experience of a Singapore hospital that added functions to bedside tablets in stages, with patient involvement rising as features were added, supports introducing the coaching content gradually rather than all at once (Cheong et al., 2026).

Evaluation

The equity ratio is the project's primary measure, because overall use could rise while gaps widen if coaching reached mainly patients who were already likely to use the portal. Results will be reported monthly to the pilot units and quarterly to the nursing informatics council.

Privacy and Ethical Considerations

Coaching patients to read their records raises privacy questions that the protocol must answer. Patients sometimes share rooms, and a tablet left on a bedside table could display another person's results to a visitor, so tablets will lock after two minutes and coaching will happen only when the patient chooses. Proxy access requires the patient's consent, and nurses will not set it up for a family member at the family's request alone. Some notes contain sensitive information, such as behavioral health or substance use history, that patients may not want relatives to see; coaching will show patients how proxy access works so they can decide what to share. Finally, nurses will be taught to answer questions about results within their scope and to refer questions about diagnoses or prognosis to the provider, so that early access does not leave patients alone with frightening information.

Anticipated Barriers

The main barriers are time, devices and language. The ten-minute session competes with other admission tasks, so champions will provide most sessions on busy days. Tablets may be lost or damaged, which device management and sign-out logs are meant to limit. Some nurses may also see coaching as one more task added to admission without anything taken away, so the team will ask the pilot units which duplicate admission questions could be removed to make room, and report the result in the first cycle's review. Spanish-language materials will cover most non-English speakers at Lakeside, but interpreter support will be needed for others.

Conclusion

The research shows a consistent gap in inpatient portal use and suggests real benefits when patients are supported to use it, while Lakeside's documents assign no one to provide that support. A new nursing protocol, introduced through Plan-Do-Study-Act cycles, built into existing workflows and evaluated with equity as its primary measure, translates that evidence into practice. The final part of the project will present it on a digital poster.

References

Alla, S., Kukreja, R., Harrison, G., Royal, S., & Markus-Rodden, M. (2026). Effect of patient portal utilization on patient experience among hospitalized adult patients on an orthopedic surgical unit. CIN: Computers, Informatics, Nursing, 44(1). https://doi.org/10.1097/CIN.0000000000001311

Brunner, J. A., Amano, A., Gauntlett, L., Sullivan, S. C., Krein, S. L., & Davila, J. A. (2026). Recommendations for improving EHR transitions: Nursing perspectives from three healthcare systems. Medical Care, 64(1 Suppl. 1), S91-S99. https://doi.org/10.1097/MLR.0000000000002233

Cheong, S. H. R., Fan, P. E. M., Aloweni, F., Ang, S. Y., Ng, G. N., & Ayre, T. C. (2026). The effectiveness of a digital solution on improving patient experience. Clinical Nursing Research, 35(2-3), 84-92. https://doi.org/10.1177/10547738251414275

Kieren, M. Q., Lee-Miller, C., Smith, C. A., Brown, R., Limjoco, J. J., McArdle, K., Uhing, A., Veit, A., & Kelly, M. M. (2026). Parent experiences accessing inpatient clinical notes on a pediatric oncology service. Hospital Pediatrics, 16(6), 536-543. https://doi.org/10.1542/hpeds.2025-008530

Meier-Diedrich, E., Lyckblad, C., Davidge, G., Hägglund, M., Kharko, A., McMillan, B., Blease, C., & Schwarz, J. (2025). Impact of patient online record access on documentation: Scoping review. Journal of Medical Internet Research, 27, Article e64762. https://doi.org/10.2196/64762

Redelman-Sidi, Y., White, C., Seier, K., Lipitz-Snyderman, A., Dawson, J. P., Kuperman, G., Polubriaginof, F. C. G., & Chimonas, S. (2026). Disparities in cancer patients' portal usage during hospitalizations. Applied Clinical Informatics, 17(4), 844-853. https://doi.org/10.1055/a-2961-1034