Dilemmas, Tetralemmas, Reimagining the Electronic Health Record

Abstract

With the transition from paper-based to computer-based records, nursing practice shifts to computerized documentation of care in the electronic health record (EHR). Viewed not only as an electronic document, but as an instrument of modern economic and technological ideology that serves organizational goals of cost-efficiency, the EHR can be perceived as creating a dilemma for a patient-centered nursing practice. Viewing the EHR as relying solely on the use of standardized languages begets a number of questions and furthers the dilemma for nurses. Through a discussion that draws on the Indian tradition of the tetralemma, authors transcend the EHR/nursing dilemma.

Nursing documentation in inpatient psychiatry: The relevance of nurse–patient interactions in progress notes—A focus group study with mental health staff

“…Our findings about the one‐sided focus on mental and behavioural problems from a neutral and distant position correspond to qualitative studies of nursing documentation (Berring, Pedersen, & Buus, ; Martin & Street, ). The problem‐oriented nursing process and nursing diagnoses might be obstacles to reporting interactions between nursing staff and patients (Gjevjon & Hellesø, ; Petrovskaya et al., ). Although nursing diagnoses theoretically cover both problems and resources, previous studies found that only the problem‐oriented aspect of nursing diagnoses was used in practice (Darmer et al., ).…”

“…The records primarily comprised nurses’ observations of patients’ behaviour and provided only limited information about nurse–patient interactions. Some argue that nursing diagnoses may strengthen nurses’ positions as experts who overrule patients’ perspectives and thus become an obstacle to the development of mutual nurse–patient relationships (Petrovskaya, McIntyre, & McDonald, ). Others have asserted that the nursing process is problem‐oriented in nature, that it may be an obstacle to focusing on the patient as a whole person and may conflict with person‐centred care (Merritt & Procter, ).…”

The practical ethics of repurposing health data: how to acknowledge invisible data work and the need for prioritization

“…New IT solutions, including the Epic system examined in this paper, often place constraints on free text spaces, because non-standardized terminology is not straightforwardly machine-readable and therefore conflicts with the aim of data repurposing (Pine and Bossen 2020 ). We must therefore acknowledge the trade-offs documented above and in other studies reporting how the use of predefined default options can negatively affect qualitative aspects of patient care, such as the inclusion of relevant information concerning the specific circumstances of the individual patient (Fogelberg et al 2009 ; Petrovskaye et al 2009 ; Robichaux 2019 ; Siegler and Adelman 2009 ).…”

Comparison of Manual versus Automated Data Collection Method for an Evidence-Based Nursing Practice Study

“…Although research is vitally important and definitively falls under the professional practice umbrella of nursing, the ability of modern EHRs and software tools should be leveraged to replace manual data collection which takes a small but nonetheless meaningful toll on nurses' time. This is particularly relevant in an era where EHRs are a source of frustration for nurses who often express that clinical documentation and time spent at the computer is taking time away from direct patient care [18,19]. Future research could build upon the results of this study by quantifying and comparing the actual costs of developing an automated algorithm against the benefits in terms of actual cost savings in clinical provider time.…”