Utilizing nursing standards in electronic health records: A descriptive qualitative study.

BACKGROUND: The electronic health record (EHR), including standardized structures and languages, represents an important data source for nurses, to continually update their individual and shared perceptual understanding of clinical situations. Registered nurses' utilization of nursing standards, such as standardized nursing care plans and language in EHRs, has received little attention in the literature. Further research is needed to understand nurses' care planning and documentation practice. AIMS: This study aimed to describe the experiences and perceptions of nurses' EHR documentation practices utilizing standardized nursing care plans including standardized nursing language, in the daily documentation of nursing care for patients living in special dementia-care units in nursing homes in Norway. METHODS: A descriptive qualitative study was conducted between April and November 2021 among registered nurses working in special dementia care units in Norwegian nursing homes. In-depth interviews were conducted, and data was analyzed utilizing reflexive thematic analysis with a deductive orientation. Findings Four themes were generated from the analysis. First, the knowledge, skills, and attitude of system users were perceived to influence daily documentation practice. Second, management and organization of documentation work, internally and externally, influenced motivation and engagement in daily documentation processes. Third, usability issues of the EHR were perceived to limit the daily workflow and the nurses' information-needs. Last, nursing standards in the EHR were perceived to contribute to the development of documentation practices, supporting and stimulating ethical awareness, cognitive processes, and knowledge development. CONCLUSION: Nurses and nursing leaders need to be continuously involved and engaged in EHR documentation to safeguard development and implementation of relevant nursing standards.

Consequences of the Early Phase of the COVID-19 Pandemic for Home-Healthcare Recipients in Norway: A Nursing Perspective.

Municipal home-healthcare services are becoming increasingly important as growing numbers of people are receiving healthcare services in their home. The COVID-19 pandemic represented a challenge for this group, both in terms of care providers being restricted in performing their duties and care receivers declining services for fear of being infected. Furthermore, preparedness plans were not always in place. The purpose of this study is to investigate the consequences for recipients of home healthcare in Norway of the actual level of COVID-19 infection spread in the local population, as observed by licensed nurses working in home-healthcare services. Approximately 2100 nurses answered the survey. The most common adverse consequences for home-healthcare recipients were increased isolation and loneliness, increased health concerns, and the loss of respite care services. An increased burden for relatives/next of kin and fewer physical meetings with service providers were frequently observed and reported as well. This study shows that there were more adverse consequences for service users in municipalities with higher levels of contagion than in those with lower levels of contagion. This indicates that the municipalities adapted measures to the local rate of contagion, in line with local municipal preparedness strategies.

Registered nurses' reasoning process during care planning and documentation in the electronic health records: A concurrent think-aloud study.

AIMS AND OBJECTIVES: To explore the clinical reasoning process of experienced registered nurses during care planning and documentation of nursing in the electronic health records of residents in long-term dementia care. BACKGROUND: Clinical reasoning is an essential element in nursing practice. Registered nurses' clinical reasoning process during the documentation of nursing care in electronic health records has received little attention in nursing literature. Further research is needed to understand registered nurses' clinical reasoning, especially for care planning and documentation of dementia care due to its complexity and a large amount of information collected. DESIGN: A qualitative explorative design was used with a concurrent think-aloud technique. METHODS: The transcribed verbalisations were analysed using protocol analysis with referring phrase, assertional and script analyses. Data were collected over ten months in 2019-2020 from 12 registered nurses in three nursing homes offering special dementia care. The COREQ checklist for qualitative studies was used. RESULTS: The nurses primarily focused on assessments and interventions during documentation. Most registered nurses used their experience and heuristics when reasoning about the residents' current health and well-being. They also used logical thinking or followed local practice rules when reasoning about planned or implemented interventions. CONCLUSION: The registered nurses moved back and forth among all the elements in the nursing process. They used a variety of clinical reasoning attributes during care planning and nursing documentation. The most used clinical reasoning attributes were information processing, cognition and inference. The most focused information was planned and implemented interventions. RELEVANCE TO CLINICAL PRACTICE: Knowledge of the clinical reasoning process of registered nurses during care planning and documentation should be used in developing electronic health record systems that support the workflow of registered nurses and enhance their ability to disseminate relevant information.

Content and comprehensiveness in the nursing documentation for residents in long-term dementia care: a retrospective chart review.

BACKGROUND: Insight into and understanding of content and comprehensiveness in nursing documentation is important to secure continuity and high-quality care planning in long-term dementia care. The accuracy of nursing documentation is vital in areas where residents have difficulties in communicating needs and preferences. This study described the content and comprehensiveness of nursing documentation for residents living with dementia in nursing homes. METHODS: We used a retrospective chart review to describe content and comprehensiveness in the nursing documentation. Person-centered content related to identity, comfort, inclusion, attachment, and occupation was identified, using an extraction tool derived from person-centered care literature. The five-point Comprehensiveness in the Nursing Documentation scale was used to describe the comprehensiveness of the nursing documentation in relation to the nursing process. RESULTS: The residents' life stories were identified in 16% of the reviewed records. There were variations in the identified nursing diagnoses related to person-centered information, across all the five categories. There were variations in comprehensiveness within all five categories, and inclusion and occupation had the least comprehensive information. CONCLUSION: Findings from this study highlights challenges in documenting person-centered information in a comprehensive way. To improve nursing documentation of residents living with dementia in nursing homes, nurses need to include residents' perspectives and experiences in their planning and evaluation of care.

Predictors for assessing electronic messaging between nurses and general practitioners as a useful tool for communication in home health care services: a cross-sectional study.

BACKGROUND: Nurses providing home health care services are dependent on access to patient information and communicating with general practitioners (GPs) to deliver safe and effective health care to patients. Information and communication technology (ICT) systems are viewed as powerful tools for this purpose. In Norway, a standardized electronic messaging (e-messaging) system is currently being established in health care. OBJECTIVE: The aim of this study was to explore home health care nurses' assessments of the utility of the e-messaging system for communicating with GPs and identify elements that influence the assessment of e-messaging as a useful communication tool. METHODS: The data were collected using a self-developed questionnaire based on variables identified by focus group interviews with home health care nurses (n=425) who used e-messaging and existing research. Data were analyzed using logistic regression analyses. RESULTS: Over two-thirds (425/632, 67.2%) of the home health care nurses returned the questionnaire. A high proportion (388/399, 97.2%) of the home health care nurses who returned the questionnaire found the e-messaging system to be a useful tool for communication with GPs. The odds of reporting that e-messaging was a useful tool were over five times higher (OR 5.1, CI 2.489-10.631, P<.001) if the nurses agreed or strongly agreed that e-messaging was easy to use. The odds of finding e-messaging easy to use were nearly seven times higher (OR 6.9, CI 1.713-27.899, P=.007) if the nurses did not consider the system functionality poor. If the nurses had received training in the use of e-messaging, the odds were over six times higher (OR 6.6, CI 2.515-17.437, P<.001) that they would consider e-messaging easy to use. The odds that a home health care nurse would experience e-messaging as easy to use increased as the full-time equivalent percentage of the nurses increased (OR 1.032, CI 1.001-1.064, P=.045). CONCLUSIONS: This study has shown that technical (ease of use and system functionality), organizational (training), and individual (full-time equivalent percentage) elements had an impact on home health care nurses' assessments of using e-messaging to communicate with GPs. By identifying these elements, it is easier to determine which interventions are the most important for the development and implementation of ICT systems in home health care services.

Electronic communication experiences of home health care nurses and general practitioners: a cross-sectional study.

Future health care will require suitable means of communication between home health care nurses and general practitioners (GPs) to ensure safe care for homebound patients. The overall aim of this study was to investigate the experiences of home health care nurses and general practitioners using e-messaging in their communication. We conducted a cross-sectional study with a mailed questionnaire. A total of 584 home health care nurses and GPs who used e-messaging and 495 home health care nurses and GPs who did not use e-messaging completed the questionnaire. The results showed that there was high agreement, in all the groups, that e-messaging led to better communication quality, better access to patient information, and an improved ability to prevent and reduce errors and omissions. Nurses reported the most agreement, which led to the conclusion that it was the characteristics of the profession rather than the use of e-messaging that influenced high agreement.

Home care nurses' experiences with using electronic messaging in their communication with general practitioners.

AIMS AND OBJECTIVES: To investigate the experiences of home care nurses with electronic messaging (e-messaging) and to determine how it influenced their communication with general practitioners. BACKGROUND: Nurses in home care services must collaborate with general practitioners to care for homebound patients. Studies have shown that communication and collaboration are often constrained because they are organised separately and are dispersed. The use of information and communication technology is expected to support communication and to be a tool for increased patient safety and higher-quality care. DESIGN: Cross-sectional study with group comparisons METHODS: The data were collected with a mailed questionnaire that was answered by home care nurses (n = 425) who had implemented e-messaging and by home care nurses in a comparison group who had not implemented e-messaging (n = 364). The data were analysed using descriptive analyses, chi-square test, Mann-Whitney U-test and multilevel analysis. RESULTS: The home care nurses who used e-messages reported to a greater extent that they had communication procedures with general practitioners compared to what the home care nurses in the comparison group reported. The implementation of e-messaging did not result in timelier communication or differences between the two groups in the use of nonelectronic communication, except for a lower use of faxes in the e-messaging group. However, the home care nurses who used e-messaging reported more frequent contacts with general practitioners. CONCLUSION: The results demonstrate that even if e-messaging was implemented, the home care nurses and the general practitioners continued to use nonelectronic communication methods. RELEVANCE TO CLINICAL PRACTICE: E-messaging did not replace but rather complemented the communication methods and thereby transformed clinical communication and collaboration. This should be considered when planning and implementing new information technology in primary care.

Standardised electronic information exchange between nurses in home care and GPs - the medication information processes.

Improving the transfer of medication information between home care nurses and patient's general practitioners (GP) is assessed as essential for ensuring safe care. In this paper, we report on a Norwegian study in which we investigated how home care nurses experienced using standardised electronic messages in their communication with the GPs. Standardised electronic solutions were developed and implemented to resolve gaps in the medication information processes when patients received nursing care in their homes. Data was collected combining focus group interviews and individual interviews with nurses from home care in two municipalities in Norway. The data was analysed using systematic text condensation. We found that the nurses reported mostly advantages, but also some disadvantages regarding accuracy, consistency, availability and efficiency in the medication information process when they used standardised electronic messages. Efforts to refine the electronic messages to achieve better work processes and patient safety should be addressed.