Connecting Professional Practice and Technology at the Bedside

Abstract

The purpose of this research is to determine the effects of implementing an electronic health record on medical-surgical registered nurses' time spent in direct professional patient-centered nursing activities, attitudes and beliefs related to implementation, and changes in level of nursing engagement after deployment of the electronic health record. Patient-centered activities were categorized using Watson's Caritas Processes and the Relationship-Based Care Delivery System. Methods included use of an Attitudes and Beliefs Assessment Questionnaire, Nursing Engagement Questionnaire, and Rapid Modeling Corporation's personal digital assistants for time and motion data collection. There was a significant difference in normative belief between nurses with less than 15 years' experience and nurses with more than 15 years' experience (t21 = 2.7, P = .01). While nurses spent less time at the nurses' station, less time charting, significantly more time in patients' rooms and in purposeful interactions, time spent in relationship-based caring behavior categories actually decreased in most categories. Nurses' engagement scores did not significantly increase. These results serve to inform healthcare organizations about potential factors related to electronic health record deployment which create shifts in nursing time spent across care categories and can be used to explore further patient centered care practices.

An integrative review exploring the impact of Electronic Health Records (EHR) on the quality of nurse–patient interactions and communication

“…The eight studies included within this review represent data from 187 Nurses, 139 Patients, 11 Doctors and 13 Allied Health Professional from the United States (US) (Dowding et al, 2015 ; Fore et al, 2019 ; Gaudet, 2016 ; Gomes et al, 2016 ), United Kingdom (UK) (Rhodes et al, 2006 , 2008 ) and Australia (Burridge et al, 2018 ; Walker et al, 2019 ). Most studies took place on in‐patient acute surgical or medical hospital ward settings in the US and Australia, apart from Rhodes et al ( 2006 and 2008 ), which took place in primary care settings in the UK.…”

“…A range of research study designs were used including micro‐ethnography (Gaudet ( 2016 ); exploratory (Burridge et al, 2018 ; Rhodes et al, 2006 , 2008 ); multi‐site case study (Dowding et al, 2015 ); and time and motion; Fore et al, 2019 ; Gomes et al, 2016 ; Walker et al, 2019 ). Seven out of eight studies included observational data collection methods when examining the impact of nurses' use of EHR on nurse–patient interactions, ensuring that interactions were observed rather than reflected on.…”

“…Seven out of eight studies included observational data collection methods when examining the impact of nurses' use of EHR on nurse–patient interactions, ensuring that interactions were observed rather than reflected on. In contrast, Gomes et al ( 2016 ) examined nurses' time and motion using Rapid Modelling Corporation's personal digital assistants (PDA) to determine nurses' time spent on person‐centred activities.…”

“…A range of EHR device types were used across studies, such as: static computers in GP clinic rooms (Rhodes et al, 2006 , 2008 ); workstations on wheels moved into the vicinity of patients (Burridge et al, 2018 ; Dowding et al, 2015 ; Gomes et al, 2016 ; Walker et al, 2019 ); and wall mounted computers away from patient rooms (Burridge et al, 2018 ; Dowding et al, 2015 ). Some studies stated specifically where computers were located and being used by nurses, such as: adjacent to the head of each patient's bed (Gaudet, 2016 ); a laptop computer mounted on a wall (Gomes et al, 2016 ); or on a terminal in the medication room (Dowding et al, 2015 ).…”

“…Five studies identified that EHR impacts on the types of communication patterns, for example, changes in the time nurses spent on documentation and direct patient care activities/interactions (Fore et al, 2019 ; Gomes et al, 2016 ; Walker et al, 2019 ); and two studies identified communication patterns (Gaudet, 2016 ; Rhodes et al, 2008 ). Gomes et al ( 2016 ), for example, found that most nurses in US medical‐surgical units spent less time at the nurses' station, less time charting and significantly more time in patients' rooms in purposeful interactions 6 months post‐EHR implementation. However, time spent in relationship‐based caring behaviour categories decreased, except for the categories of listening to the patient, being with the patient and providing spiritual support (Gomes et al, 2016 ).…”