HomeAsia Pacific Journal of Allied Health Sciencesvol. 6 no. 2 (2023)

Lived Experiences of Nurses on Utilization of Electronic Health Records on Patients’ Safety and Quality Care

Kremlin Marie Eraham | Maria Jocelyn B. Natividad

Discipline: nursing (non-specific)

 

Abstract:

This study investigated the lived experiences of nurses on utilization of Electronic Health Record (EHR) on patient safety and quality care. Phenomenology type of qualitative research had been utilized to explore nurses lived experiences when using EHR for patients’ documentation. Nine staff nurses who are currently working in a tertiary hospital in western part of Saudi Arabia were chosen as the informants of the study. Interview with the informants was conducted to assess the lived experiences of nurses on utilization of EHRs. Ethical approval and consent were sought prior data collection. Giorgi’s method of thematic analysis was used to analyze the data. Dependability and conformability were tracked through transcripts and notes after each interview and during data analysis. The study elucidates on six emergent themes namely: cognizance on electronic health record, software that offers substantial benefits, efficient delivery of quality patient care, abreast with current patient documentation system, discourse over EHR and paper-based documentation system; and challenges in utilization of EHR. Significantly, EHR contributes to delivering quality patient team-based care through provision of access to all pertinent information in real time. Nurses using EHR demonstrate efficiency, patient-centered care, safety, and collaboration as they provide care to their patients. However, utilization of EHR also has drawbacks which includes interoperability, potential privacy, and cybersecurity issues that need to be addressed by the management. It is therefore recommended that further orientation and training on electronic health records may be conducted among nurses to deliver patients care effectively and safely.



References:

  1. Saraswasta, I. W. G., & Hariyati, R. T. S. (2018). The Implementation of Electronic-Based Nursing Care Documentation on Quality of Nursing Care: A Literature Review. International Journal of Nursing and Health Services (IJNHS), 1(2), 19-31.
  2. McBride, S., Tietze, M., Hanley, M. A., & Thomas, L. (2017). Statewide study to assess nurses’ experiences with meaningful use–based electronic health records. CIN: Computers, Informatics, Nursing, 35(1), 18-28.
  3. Tubaishat, A. (2018). Perceived usefulness and perceived ease of use of electronic health records among nurses: Application of Technology Acceptance Model. Informatics for Health and Social Care, 43(4), 379-389.
  4. Alsohime, F., Temsah, M. H., Al-Eyadhy, A., Bashiri, F. A., Househ, M., Jamal, A., ... & Amer, Y. S. (2019). Satisfaction and perceived usefulness with newly implemented Electronic Health Records System among pediatricians at a university hospital. Computer Methods and Programs in Biomedicine, 169, 51-57.
  5. Blijleven, V., Koelemeijer, K., Wetzels, M., & Jaspers, M. (2017). Workarounds emerging from electronic health record system usage: consequences for patient safety, effectiveness of care, and efficiency of care. JMIR human factors, 4(4), e7978.
  6. Gesner, E., Gazarian, P., & Dykes, P. (2019). The burden and burnout in documenting patient care: an integrative literature review. MEDINFO 2019: Health and Wellbeing e-Networks for All, 1194-1198.
  7. Robinson, K. E., & Kersey, J. A. (2018). Novel electronic health record (EHR) education intervention in large healthcare organization improves quality, efficiency, time, and impact on burnout. Medicine, 97(38).
  8. Creswell, J.W. and Poth, C.N. (2018) Qualitative Inquiry and Research Design Choosing among Five Approaches. 4th Edition, SAGE Publications, Inc., Thousand Oaks.
  9. Polit, D., & Beck, C. (2020). Essentials of nursing research: Appraising evidence for nursing practice. Lippincott Williams & Wilkins.
  10. Kinnunen, U. M., Heponiemi, T., Rajalahti, E., Ahonen, O., Korhonen, T., & Hyppönen, H. (2019). factors related to health informatics competencies for nurses—results of a national electronic health record survey. CIN: Computers, Informatics, Nursing, 37(8), 420-429.
  11. De Groot, K., De Veer, A. J., Paans, W., & Francke, A. L. (2020). Use of electronic health records and standardized terminologies: a nationwide survey of nursing staff experiences. International journal of nursing studies, 104, 103523.
  12. Ting, J., Garnett, A., & Donelle, L. (2021). Nursing education and training on electronic health record systems: An integrative review. Nurse Education in Practice, 55, 103168.
  13. Weinschreider, J., Sisk, H., & Jungquist, C. (2022). Electronic Health Record Knowledge, Skills, and Attitudes Among Newly Graduated Nurses: A Scoping Review. The Journal of Continuing Education in Nursing, 53(11), 505-512.
  14. Ommaya, A. K., Cipriano, P. F., Hoyt, D. B., Horvath, K. A., Tang, P., Paz, H. L., ... & Sinsky, C. A. (2018). Care-centered clinical documentation in the digital environment: solutions to alleviate burnout. NAM Perspectives.
  15. Burkoski, V., Yoon, J., Hutchinson, D., Solomon, S., & Collins, B. E. (2019). Experiences of Nurses Working in a Fully Digital Hospital: A Phenomenological Study. Nursing Leadership (1910-622X), 32.
  16. Janett, R. S., & Yeracaris, P. P. (2020). Electronic Medical Records in the American Health System: challenges and lessons learned. Ciencia & saude coletiva, 25, 1293-1304.
  17. Mishra, V., Liebovitz, D., Quinn, M., Kang, L., Yackel, T., & Hoyt, R. (2022). Factors That Influence Clinician Experience with Electronic Health Records. Perspectives in Health Information Management, 19(1).
  18. Moll, J., & Cajander, Å. (2020). Oncology health-care professionals’ perceived effects of patient accessible electronic health records 6 years after launch: A survey study at a major university hospital in Sweden. Health informatics journal, 26(2), 1392-1403.
  19. Aldosari, B., Al-Mansour, S., Aldosari, H., & Alanazi, A. (2018). Assessment of factors influencing nurses acceptance of electronic medical record in a Saudi Arabia hospital. Informatics in Medicine Unlocked, 10, 82-88.
  20. Gaughan, M. R., Kwon, M., Park, E., & Jungquist, C. (2022). Nurses’ Experience and Perception of Technology Use in Practice: A Qualitative Study Using an Extended Technology Acceptance Model. CIN: Computers, Informatics, Nursing, 40(7), 478-486.
  21. Rathert, C., Porter, T. H., Mittler, J. N., & Fleig-Palmer, M. (2019). Seven years after Meaningful Use: Physicians’ and nurses’ experiences with electronic health records. Health care management review, 44(1), 30-40.
  22. Keshta, I., & Odeh, A. (2021). Security and privacy of electronic health records: Concerns and challenges. Egyptian Informatics Journal, 22(2), 177-183.
  23. Mahdizadeh, J. (2022). Challenges and Opportunities of Using the National Electronic Health Record from the Perspective of Iranian Nursing Staff. On-Line Journal of Nursing Informatics, 26(1).
  24. Vos, J. F., Boonstra, A., Kooistra, A., Seelen, M., & van Offenbeek, M. (2020). The influence of electronic health record use on collaboration among medical specialties. BMC health services research, 20(1), 1-11.
  25. Kutney-Lee, A., Sloane, D. M., Bowles, K. H., Burns, L. R., & Aiken, L. H. (2019). Electronic health record adoption and nurse reports of usability and quality of care: the role of work environment. Applied clinical informatics, 10(01), 129-139.
  26. Golay, D., Karlsson, M. S., & Cajander, Å. (2022). Effortlessness and Security: Nurses’ Positive Experiences With Work-Related Information Technology Use. CIN: Computers, Informatics, Nursing, 40(9), 589-597.
  27. Oberlander, T., Scholle, S. H., Marsteller, J., Barr, M. S., & Dy, S. M. (2021). Implementation of Patient Safety Structures and Processes in the Patient-Centered Medical Home. Journal for healthcare quality : official publication of the National Association for Healthcare Quality, 43(6), 324–339. https://doi.org/10.1097/JHQ.0000000000000312
  28. de la Vega, P. B., Losi, S., Martinez, L. S., Bovell-Ammon, A., Garg, A., James, T., ... & Kressin, N. R. (2019). Implementing an EHR-based screening and referral system to address social determinants of health in primary care. Medical care, 57, S133-S139.
  29. Pendergrass, S. A., & Crawford, D. C. (2019). Using electronic health records to generate phenotypes for research. Current protocols in human genetics, 100(1), e80.
  30. Atasoy, H., Greenwood, B. N., & McCullough, J. S. (2019). The digitization of patient care: a review of the effects of electronic health records on health care quality and utilization. Annual review of public health, 40, 487-500.
  31. Juhn, Y., & Liu, H. (2020). Artificial intelligence approaches using natural language processing to advance EHR-based clinical research. Journal of Allergy and Clinical Immunology, 145(2), 463-469.
  32. Akhu-Zaheya, L., Al-Maaitah, R., & Bany Hani, S. (2018). Quality of nursing documentation: Paper-based health records versus electronic-based health records. Journal of clinical nursing, 27(3-4), e578–e589. https://doi.org/10.1111/jocn.14097  
  33. Joukes, E., de Keizer, N. F., de Bruijne, M. C., Abu-Hanna, A., & Cornet, R. (2019). Impact of electronic versus paper-based recording before EHR implementation on health care professionals’ perceptions of EHR use, data quality, and data reuse. Applied clinical informatics, 10(02), 199-209.
  34. Emmerich, E. (2023). Benchmark Study: Impact of Electronic Health Records vs. Paper-based Records.
  35. Abed, W. H., Shosha, G. M. A., Oweidat, I. A., Saleh, R. I., & Nashwan, A. J. (2022). Jordanian nurses’ attitudes toward using electronic health records during COVID-19 pandemic. Informatics in medicine unlocked, 34, 101102.
  36. Dave, K., Boorman, R. J., & Walker, R. M. (2020). Management of a critical downtime event involving integrated electronic health record. Collegian, 27(5), 542-552.
  37. Walsh, J. M., Borycki, E. M., & Kushniruk, A. W. (2020). Effects of electronic medical record downtime on patient safety, downtime mitigation, and downtime plans. International Journal of Extreme Automation and Connectivity in Healthcare (IJEACH), 2(1), 161-186.
  38. Harris, D. A., Haskell, J., Cooper, E., Crouse, N., & Gardner, R. (2018). Estimating the association between burnout and electronic health record-related stress among advanced practice registered nurses. Applied Nursing Research, 43, 36-41.
  39. Strudwick, G., McGillis Hall, L., Nagle, L., & Trbovich, P. (2018). Acute care nurses’ perceptions of electronic health record use: A mixed method study. Nursing open, 5(4), 491-500.
  40. Dudding, K. M., Gephart, S. M., & Carrington, J. M. (2018). Neonatal nurses experience unintended consequences and risks to patient safety with electronic health records. CIN: Computers, Informatics, Nursing, 36(4), 167-176.
  41. Kuek, A., & Hakkennes, S. (2020). Healthcare staff digital literacy levels and their attitudes towards information systems. Health informatics journal, 26(1), 592-612.
  42. Tsai, C. H., Eghdam, A., Davoody, N., Wright, G., Flowerday, S., & Koch, S. (2020). Effects of electronic health record implementation and barriers to adoption and use: a scoping review and qualitative analysis of the content. Life, 10(12), 327.
  43. Cho, Y., Kim, M., & Choi, M. (2021). Factors associated with nurses’ user resistance to change of electronic health record systems. BMC medical informatics and decision making, 21(1), 1-12.
  44. Wisner, K., Lyndon, A., & Chesla, C. A. (2019). The electronic health record’s impact on nurses’ cognitive work: An integrative review. International Journal of Nursing Studies, 94, 74-84.