Evaluation of vocal-electronic nursing documentation: A comparison study in Iran

Firouzeh, Mona Mohammadi; Jafarjalal, Ezzat; Ghasemi, Hormat Sadat Emamzadeh; Bahrani, N; Sardashti, Sara

doi:10.1080/17538157.2016.1178119

Cited by 8 publications

(8 citation statements)

References 40 publications

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“…Beberapa tahun belakangan ini pengembangan teknologi dalam pelayanan keperawatan banyak bermunculan, salah satunya adalah dalam pengembangan dokumentasi keperawatan berbasis elektronik. Kualitas dokumentasi keperawatan dalam sistem elektronik secara signifikan lebih baik daripada sistem dokumentasi berbasis kertas (Mohammadi Firouzeh, Jafarjalal, Emamzadeh Ghasemi, Bahrani, & Sardashti, 2017).…”

Section: Pendahuluanunclassified

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Perbandingan kualitas dokumentasi keperawatan berbasis elektronik dan berbasis kertas: Study literature

Suganda

Hariyati

2020

J.HolHealth

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Paper‐based versus electronic‐based of health records in quality of nursing documentation: A literature review study.Background: Many technological developments in nursing services have emerged, one of them is electronic-based nursing documentation. The electronic nursing documentation has a good impact which increases the quality of service. But the readiness is still questionable.Purpose: Describing the quality comparison of electronic-based nursing documentation and paper-based nursing documentation.Method: This study uses a PRISMA literature review. Through the remote-lib.ui.ac.id database that is connected to various scientific publication pages such as, Scopus, Ebsco, PROQUEST Scholar-Articles with several key words such as electronic nursing documentation, nursing paper documentation, management information systems.Results: Electronic-based documentation has a higher level of quality documentation than paper-based documentation in terms of efficiency, effectiveness, patient focus and timeliness.Conclusion: Electronic-based documentation offers the optimization of nursing care, effective and efficient documentation, integrated nursing care and cost-effective through (paperless). Strong support from hospital institutions, organizations and government at the beginning of the nurse adaptation system and process is a challenge so that the application of electronic nursing documentation is realized properly.Keywords: Paper‐based; Electronic‐based; Health records; Quality; Nursing documentation.Pendahuluan: Pengembangan teknologi dalam pelayanan keperawatan banyak bermunculan, salah satunya dokumentasi keperawatan berbasis elektronik. Dokumentasi keperawatan elektronik memberikan dampak baik yang luarannya meningkatkan kualitas pelayanan. Namun kesiapan masih dipertanyakan.Tujuan: Menggambarkan perbandingan kualitas dokumentasi keperawatan berbasis elektronik dan dokumentasi keperawatan berbasis kertas.Metode: Penelitian ini menggunakan tinjauan pustaka PRISMA. Melalui Database remote-lib.ui.ac.id yang terhubung dengan berbagai macam laman publikasi ilmiah seperti, Scopus, Ebsco, PROQUEST, Scholar-Artikel dengan beberapa kata kunci seperti dokumentasi keperawatan elektronik, dokumentasi keperawatan kertas, sistem informasi manajemen.Hasil: Dokumentasi berbasis elektronik memiliki tingkat kualitas dokumentasi lebih dibandingkan dokumentasi berbasis kertas secara efesiensi, efektifitas, fokus pada pasien maupun ketepatan waktu.Simpulan: Dokumentasi berbasis elektronik menawarkan keoptimalan melakukan asuhan keperawatan, dokumentasi efektif dan efesien, asuhan keperawatan terintegrasi serta cost-effective melalui (paperless). Dukungan kuat dari institusi rumah sakit, organisasi maupun pemerintah dalam permulaan sistem dan proses adaptasi perawat menjadi tantangan, agar penerapan dokumentasi keperawatan elektronik terealisasi dengan baik.

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Section: Pendahuluanunclassified

“…Kualitas dokumentasi keperawatan dalam sistem elektronik secara signifikan lebih baik daripada sistem dokumentasi berbasis kertas (Mohammadi Firouzeh et al, 2017).…”

Section: Pembahasanunclassified

Perbandingan kualitas dokumentasi keperawatan berbasis elektronik dan berbasis kertas: Study literature

Suganda

Hariyati

2020

J.HolHealth

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“…Hasil penelitian ini menemukan perbedaan yang signifikan dalam kualitas dokumentasi keperawatan di dua rumah sakit, baik sebelum dan sesudah penerapan sistem catatan kesehatan elektronik (p <0,001). Kualitas dokumentasi keperawatan elektronik secara signifikan lebih baik daripada sistem dokumentasi berbasis kertas (Mohammadi Firouzeh, Jafarjalal, Emamzadeh Ghasemi, Bahrani, & Sardashti, 2017).…”

Section: Hasilunclassified

Dampak Penerapan Sistem Pencatatan Keperawatan Elektronik: Literatur Review

Dewi

2019

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Catatan keperawatan adalah suatu laporan baik komunikasi secara lisan, tertulis maupun melalui komputer untuk menyampaikan informasi kepada orang lain. Perkembangan teknologi informasi digital yang sangat cepat dalam dunia kesehatan, membawa dampak pada kemajuan yang cukup berarti dalam bidang keperawatan. Catatan keperawatan dari yang sebelumnya manual, bergeser menjadi komputerisasi. Tujuan penulisan ini untuk melihat dampak penerapan sistem pencatatan keperawatan elektronik. Metode yang digunakan adalah literature review, pencarian menggunakan beberapa database elektronik, yakni Google Scholar, ProQuest, SpringerLink, CINAHL dan ScienceDirect dengan menggunakan kata kunci the impact of electronic nursing recording systems, information technology. Hasil telaah ditemukan bahwa penerapan sistem pencatatan keperawatan elektronik ini memberikan dampak terhadap peningkatan kualitas asuhan keperawatan, efisiensi dan keamanan data pasien. Kesimpulannya diperlukan dukungan manajer dan keterlibatan perawat dalam pengembangan desain sistem, agar perawat terus menggunakannya untuk meningkatkan mutu dan keselamatan pasien.

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“…Documentation of records is a critical component for the functioning of nursing teams and cannot be detached from excellence of patient care (Firouzeh et al 2016 ). Patient health records are significant for the provision of healthcare services (Mutshatshi et al 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Experiences of operational managers regarding record keeping by new professional nurses in public hospitals in the North West province, South Africa

Nkoane

2023

Health SA Gesondheid

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Background: Documentation can be written or computerised and is used to communicate healthcare and treatment among healthcare professionals. Documentation is the tool that records and measures the healthcare provided to patients, and it must be accurate, complete and timely.Aim: This study aims to explore and describe the experiences of the operational managers regarding record keeping by new nurses in selected public hospitals in South Africa.Setting: The study was conducted in selected public hospitals in the North West province.Method: This study used a qualitative, explorative and descriptive approach with a purposive sampling method. A total of 35 operational managers participated in the process of data collection.Results: The following themes emerged from this study: gaps in record keeping, the impact of inaccurate documentation and the need for improvement in record keeping.Conclusion: The study has shown the need to bring technological innovation to strengthen the effective improvement of digitalisation in nursing record keeping in the facilities furthermore, nurses should be supported through programmes on intentional and mindful record keeping curbing the incidences of inaccuracy and incompleteness.Contribution: This study’s findings confirmed that new nurses were not consistent with accurate documentation of patient records, and this needs further strengthening in public hospitals to have an impact on the health and safety of the patient.

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Evaluation of vocal-electronic nursing documentation: A comparison study in Iran

Abstract: Vocal-electronic systems help to improve quality of nursing documentation, suggesting this aspect may be essential to implementing a successful system in local settings.

Cited by 8 publications

References 40 publications

Perbandingan kualitas dokumentasi keperawatan berbasis elektronik dan berbasis kertas: Study literature

Perbandingan kualitas dokumentasi keperawatan berbasis elektronik dan berbasis kertas: Study literature

Dampak Penerapan Sistem Pencatatan Keperawatan Elektronik: Literatur Review

Experiences of operational managers regarding record keeping by new professional nurses in public hospitals in the North West province, South Africa

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