Staff experiences within the implementation of computer-based nursing records in residential aged care facilities: a systematic review and synthesis of qualitative research

Abstract

BackgroundSince the introduction of electronic nursing documentation systems, its implementation in recent years has increased rapidly in Germany. The objectives of such systems are to save time, to improve information handling and to improve quality. To integrate IT in the daily working processes, the employee is the pivotal element. Therefore it is important to understand nurses’ experience with IT implementation. At present the literature shows a lack of understanding exploring staff experiences within the implementation process.MethodsA systematic review and meta-ethnographic synthesis of primary studies using qualitative methods was conducted in PubMed, CINAHL, and Cochrane. It adheres to the principles of the PRISMA statement. The studies were original, peer-reviewed articles from 2000 to 2013, focusing on computer-based nursing documentation in Residential Aged Care Facilities.ResultsThe use of IT requires a different form of information processing. Some experience this new form of information processing as a benefit while others do not. The latter find it more difficult to enter data and this result in poor clinical documentation. Improvement in the quality of residents’ records leads to an overall improvement in the quality of care. However, if the quality of those records is poor, some residents do not receive the necessary care. Furthermore, the length of time necessary to complete the documentation is a prominent theme within that process. Those who are more efficient with the electronic documentation demonstrate improved time management. For those who are less efficient with electronic documentation the information processing is perceived as time consuming. Normally, it is possible to experience benefits when using IT, but this depends on either promoting or hindering factors, e.g. ease of use and ability to use it, equipment availability and technical functionality, as well as attitude.ConclusionsIn summary, the findings showed that members of staff experience IT as a benefit when it simplifies their daily working routines and as a burden when it complicates their working processes. Whether IT complicates or simplifies their routines depends on influencing factors. The line between benefit and burden is semipermeable. The experiences differ according to duties and responsibilities.

Impact of Information and Communication Technologies on Nursing Care: Results of an Overview of Systematic Reviews

“…Effects of these ICTs on documentation time were mixed within and across the reviews: six reviews demonstrated positive effects [15,16,47,53,56,60], six demonstrated negative effects [15,16,43,47,53,60], and three demonstrated no effect [43,47,60]. Negative results showed that nurses spent more time documenting when they used management systems and the positive results showed the contrary: documentation time diminished with ICTs.…”

“…Additionally, due to some features of CDSSs and management systems (eg, readability of data, remote accessibility of data, better quality of patients’ records, presence of reminders, or automatic alerts), these ICTs supported clinical judgment and decision-making [43,56]. Conversely, some features of the ICTs not previously available on paper, such as copy and paste, drop-down menus, and check boxes, affected the nurses’ capacity to employ critical thinking regarding their patients [60].…”

“…In four reviews [15,43,56,58], negative results were discussed: EHRs do not improve patient care as perceived by nurses [58]; and patients do not receive necessary care because the quality of residents’ records is lacking [56]. …”

Tietorakenteet potilaan hoitotietojen kirjaamisessa – Case hoitotyön yhteenveto

“…Hoitotietojen tulee olla virheettömiä ja täydellisiä, sillä tiedon laatu on edellytys potilaan hyvälle hoidolle [7,8]. Sähköinen potilaskertomus koostuu eritasoisista hierarkkisista tietokokonaisuuksista, joita jäsennetään näkymien, hoitoprosessien vaiheiden ja otsikoiden avulla sekä käytetään kirjaamiseen tarkoitettuja luokituksia ja koodistoja [3].…”

Electronic patient records as a tool to facilitate care provision in nursing homes: an integrative review

“…16,19,20 Furthermore, a previous systematic review of six studies exploring staff experiences with IT implementation in nursing homes found that the introduction of IT for documentation purposes may bring both benefits and burdens. 21 Consequently, there have been calls to expand research to further examine the impact that electronic documentation systems have on working practices in nursing homes. 9,15,22 Therefore, this literature review aims to add to existing knowledge in the field by exploring the impact of electronic documentation systems on the provision of care in nursing homes.…”