An exploration of nurse-patient interactions in acute hospital settings when electronic patient record (EPR) systems are used

Background: The introduction of Electronic Patient Record (EPR) systems is changing contemporary nursing practice at a rapid rate. EPR systems use an anticipatory approach to address patient needs via digital prompts, that promote patient safety and assure fundamental care needs are met. It is widely accepted that quality nurse-patient interactions involve a compassionate nurse presence, open and reciprocal communication and shared decision-making. EPR systems are underpinned by a systems-based medical model that may conflict with a person-centred approach to care. There are few studies that explore the impact of EPR on nurse-patient communication, with the majority focusing on communication in general practice. Research within nursing focuses on evaluating nurses’ EPR use. Studies examining how nurses’ EPR use impacts on the quality of nurse-patient interactions are lacking. Aim: This study aimed to explore how nurses' use of EPR systems in four acute hospital wards influenced the quality of nurse-patient interactions. Methods: This mixed methods study included observations using a published tool to evaluate the duration and quality of nurse-patient interactions, as well as nurse and patient interviews. Following convenience sampling, 16 observations and 16 nurse and 16 patient interviews were conducted. Descriptive statistics and thematic analysis informed overall study themes. Results: Four study Meta-themes emerged: 1. Nurse-patient communication lacked social, open, reciprocal and face-to-face communication; 2. Cumbersome computer systems monopolised nurses’ time and attention and impeded face-to-face communication; 3. Nurses’ use of EPR scripts fostered a task-orientated agenda; and 4. Patients’ perceptions of the quality of nurse-patient interactions were more positive than nurses. Conclusion and recommendations: The introduction of EPR has had a significant and unreported impact on the way nurses engage with patients. Rather than attending to the patient, many interactions see the nurse's attention focus on the computer screen and EPR prompts. Nurses’ use of EPR scripts promoted a didactic, formulaic style of communication that impacted the fundamental tenets of nursing. Nurses, employers and EPR system developers need to consider the unintended impact of nurses' EPR use on the quality of nurse-patient interactions. Nurse educators need to promote techniques that facilitate person-centred communication and quality nurse-patient interactions when nurses use EPR systems. Researchers need to evaluate practices that promote, and not hinder, quality nurse-patient interactions when nurses use EPR systems in acute care wards. There is a need for unobtrusive EPR technology that is designed and evaluated with the participation of nurses and patients. Digital transformation will continue to dominate nursing over the next decade. It is hoped that forthcoming publications, disseminating the outcomes from this study, will place future exploration in this area firmly on the map.

Grantor dc:publisher

Oxford Brookes University

Author dc:creator

• Forde-Johnston, Carol

Contributors dc:contributor

• Aveyard, Helen
• Butcher, Dan
• Mounce, Ginny

Statement dc:rights

• All rights reserved

Language dc:language

en

DOI dc:identifier

https://doi.org/10.24384/1nqk-5611

OAI identifier oai:identifier

tle:14b34b45-ebe4-441c-9290-63f8b2d53a83:d6bd9758-527a-46cd-bfe2-c433766e8fca:1