Modes of dying in the electronic patient record

Nobody Dies Alone in the Electronic Patient Record—A Qualitative Analysis of the Textual Practices of Documenting Dying and Death

“…From this, two main ethical implications follow: first, the risk of communicating a story that the involved parties (i.e., family) perceive as false or skewed and, second, the fact that an unnuanced description of dying contributes to silencing potential reflections on what might have been otherwise. Compared with our findings on the transition from curative to palliative care (Hov et al, 2020a), the language of the transition to death is more conclusive and less open than that of the negotiation of a turning point, making the text less nuanced. We argue that a genre more tolerant of nuances could contribute to greater openness about patients' experiences and the quality of care.…”

“…The present article is part of a larger study on the EPRs of patients who died in Norwegian hospitals. In the first article (Hov et al, 2020a), we investigated how physicians negotiate the turning point from curative to palliative care in the days leading up to death. In the second article (Hov et al, 2020b), we investigated how numbering, timing and categorising impact the documentation of the patient's last 24 hours of life.…”

“…This story points out that EPRs do not provide an objective textual representation of what "really happened"; instead, they are a significant social actor that produces its own reality and thus aids in achieving expected effects (Hov et al, 2020a;Aarseth et al, 2017). Inspired by Engebretsen (2005) and Andersen's (2002) application of Bakhtin's notion of dialogic language, we see the utterances made in an EPR as consisting of a dialogical interplay between living voices (healthcare professionals, patients, and family), rather than anonymous utterances unattributed to a source.…”