The impact of using electronic patient records on practices of reading and writing.

The aim of this study was to investigate the use of electronic patient records in daily practice. In four wards of a large hospital district in Finland, N = 43 patients' care and activities were observed and analysed in terms of the Grounded Theory method. The findings revealed that using electronic patient records created a particular process of writing and reading. Wireless technology enabled simultaneous patient involvement and point-of-care documentation, additionally supporting real-time reading. Remote and retrospective documentation was distant in terms of both space and time. The remoteness caused double documentation, reduced accuracy and less-efficient use of time. 'Non-reading' practices were witnessed in retrospective reading, causing delays in patient care and increase in workload. Similarly, if documentation was insufficient or non-existent, the consequences were found to be detrimental to the patients. The use of an electronic patient record system has a significant impact on patient care. Therefore, it is crucial to develop wireless technology and interdisciplinary collaboration in order to improve and support high-quality patient care.

Methodological tools for the collection and analysis of participant observation data using grounded theory.

AIM: To give clarity to the analysis of participant observation in nursing when implementing the grounded theory method. BACKGROUND: Participant observation (PO) is a method of collecting data that reveals the reality of daily life in a specific context. In grounded theory, interviews are the primary method of collecting data but PO gives a distinctive insight, revealing what people are really doing, instead of what they say they are doing. However, more focus is needed on the analysis of PO. DATA SOURCES: An observational study carried out to gain awareness of nursing care and its electronic documentation in four acute care wards in hospitals in Finland. REVIEW METHODS: Discussion of using the grounded theory method and PO as a data collection tool. DISCUSSION: The following methodological tools are discussed: an observational protocol, jotting of notes, microanalysis, the use of questioning, constant comparison, and writing and illustrating. Each tool has specific significance in collecting and analysing data, working in constant interaction. CONCLUSION: Grounded theory and participant observation supplied rich data and revealed the complexity of the daily reality of acute care. In this study, the methodological tools provided a base for the study at the research sites and outside. The process as a whole was challenging. It was time-consuming and it required rigorous and simultaneous data collection and analysis, including reflective writing. Using these methodological tools helped the researcher stay focused from data collection and analysis to building theory. IMPLICATIONS FOR RESEARCH/PRACTICE: Using PO as a data collection method in qualitative nursing research provides insights. It is not commonly discussed in nursing research and therefore this study can provide insight, which cannot be seen or revealed by using other data collection methods. Therefore, this paper can produce a useful tool for those who intend to use PO and grounded theory in their nursing research.

When time matters: the reality of patient care in acute care settings.

Laitinen H, Kaunonen M, Åstedt-Kurki P. International Journal of Nursing Practice 2011; 17: 388-395 When time matters: The reality of patient care in acute care settings The purpose of the study was to investigate the reality of patient care in acute care settings when the patients' stay in the hospital was relatively short. The study was conducted by using the grounded theory method with constant comparative analysis. The sample comprised patients (n = 43) participating, relatives and hospital staff. The data were collected by participant observation, including informal interviews in natural settings, and by reviewing participating patients' electronic patient records. The main findings are presented in three categories: patients' endurance, interface and broken interface (along with several subcategories). The study showed that even with time pressures, good health care was delivered. However, it also showed some challenging issues for improvement. The study concluded that it is crucial for caregivers to focus on interactive patient care.

Patient-focused nursing documentation expressed by nurses.

AIM: The aim of the study was to investigate what expressions nurses use when documenting patient-focused nursing care in electronic patient records. BACKGROUND: Much effort has been made in the development of nursing documentation. Many studies have found inadequate reporting, focused more on tasks and treatment than on the patient's voice. Electronic patient record-systems have been introduced, bringing new challenges because of unfamiliarity with computers. Electronic patient records have caused dissatisfaction and frustration, however, some studies show improvement in documentation given enough time and effort. Electronic patient record documentation is an integral part of patient-focused care and thus needs to be investigated. DESIGN: The study is based on the grounded theory approach, as developed by Strauss and Corbin. METHODS: Forty electronic patient records were analysed, considering whether nurses' written expressions reflected a patient-focused approach. An inductive qualitative method was used, involving constant comparative analysis, up to axial coding. RESULTS: Three categories emerged from the data: Patient's voice: the patient has expressed his/her thoughts, which are written by the nurse, Nurse's view: the nurse recounts the patient's own thoughts, state or situation and mutual view in patient-nurse relationship: the documentation describes the patient-nurse relationship. CONCLUSIONS: This study found that the nursing documentation was patient-focused, to some extent. This is significant because nursing documentation represents much more than simply a record of the continuity of care. Many topics for further studies were presented, e.g., the timing of documentation and the differences between the mode of nursing and the documentation. RELEVANCE TO CLINICAL PRACTICE: The presented findings may be helpful in the development of nursing documentation in electronic patient records and in nursing practice generally. Highlighting the patient's voice could become an effective tool in nursing and its documentation, saving time and getting clear information for improving the patient's care.