Lost in translation - Silent reporting and electronic patient records in nursing handovers: An ethnographic study

Ihlebæk, Hanna Marie

doi:10.1016/j.ijnurstu.2020.103636

Cited by 12 publications

(11 citation statements)

References 40 publications

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“…The related causes of a lack of trust are a lack of perceived usefulness of the (new) system and insufficient confidence in (completeness) of the data available in the EHR [ 33 - 39 ]. The description of the rationale awareness has been refined to also cover awareness of the information needs of patients and not just of colleagues [ 40 ]. Likewise, the description of the rationale social norms has been refined to make cultural [ 30 , 41 ] and collaborative [ 27 , 42 ] aspects more explicit.…”

Section: Resultsmentioning

confidence: 99%

Workarounds in Electronic Health Record Systems and the Revised Sociotechnical Electronic Health Record Workaround Analysis Framework: Scoping Review

Blijleven¹,

Hoxha²,

Jaspers³

2022

J Med Internet Res

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Background Electronic health record (EHR) system users devise workarounds to cope with mismatches between workflows designed in the EHR and preferred workflows in practice. Although workarounds appear beneficial at first sight, they frequently jeopardize patient safety, the quality of care, and the efficiency of care. Objective This review aims to aid in identifying, analyzing, and resolving EHR workarounds; the Sociotechnical EHR Workaround Analysis (SEWA) framework was published in 2019. Although the framework was based on a large case study, the framework still required theoretical validation, refinement, and enrichment. Methods A scoping literature review was performed on studies related to EHR workarounds published between 2010 and 2021 in the MEDLINE, Embase, CINAHL, Cochrane, or IEEE databases. A total of 737 studies were retrieved, of which 62 (8.4%) were included in the final analysis. Using an analytic framework, the included studies were investigated to uncover the rationales that EHR users have for workarounds, attributes characterizing workarounds, possible scopes, and types of perceived impacts of workarounds. Results The SEWA framework was theoretically validated and extended based on the scoping review. Extensive support for the pre-existing rationales, attributes, possible scopes, and types of impact was found in the included studies. Moreover, 7 new rationales, 4 new attributes, and 3 new types of impact were incorporated. Similarly, the descriptions of multiple pre-existing rationales for workarounds were refined to describe each rationale more accurately. Conclusions SEWA is now grounded in the existing body of peer-reviewed empirical evidence on EHR workarounds and, as such, provides a theoretically validated and more complete synthesis of EHR workaround rationales, attributes, possible scopes, and types of impact. The revised SEWA framework can aid researchers and practitioners in a wider range of health care settings to identify, analyze, and resolve workarounds. This will improve user-centered EHR design and redesign, ultimately leading to improved patient safety, quality of care, and efficiency of care.

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Section: Resultsmentioning

confidence: 99%

Workarounds in Electronic Health Record Systems and the Revised Sociotechnical Electronic Health Record Workaround Analysis Framework: Scoping Review

Blijleven¹,

Hoxha²,

Jaspers³

2022

J Med Internet Res

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“…Ihlebaek 53 claims that relying solely on written information in handover situations falls short, because written information appears to be insufficient. It therefore needs to be supplemented with oral information in 'silent' handover situations intended to help RNs share sensitive information concerning patients' psychological health, and when attempting to resolve issues connected to patients' care.…”

Section: Discussionmentioning

confidence: 99%

Compliance between registered nurses’ clinical judgment and documentation in homecare for older patients with COPD: A multiple case study

Øfsti

Devik

Enmarker

et al. 2023

Nordic Journal of Nursing Research

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Registered nurses (RNs) play a crucial role in the clinical judgment (CJ) and documentation of the health conditions and the healthcare of patients diagnosed with chronic obstructive pulmonary disease (COPD). Using a multiple case study approach, the aim of the present study was to explore and describe RNs’ CJ in homecare visits for older patients with COPD as they appeared in the electronic patient records (EPRs) and how well the content corresponded to what the RNs explained verbally was important to report. Data were collected through observations of 16 homecare visits, interviews with RNs, and retrospective reviews of EPRs. The study is reported in accordance with COREQ. Quantitative and qualitative content analysis revealed that the RNs’ CJs in homecare visits were represented only to a small extent in the documentation in the EPRs. The documentation was mainly about procedures and tasks performed and did not correspond to what the RNs explained verbally was important to report. This knowledge contributes to improvements to ensure patient safety in this research field.

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“…The problem that concealing matters from patients risks the same thing happening to colleagues was a recurring theme in the interviews. Ihlebæk (2020) found similar difficulties in her study of nurses' handovers where verbal information is mixed with record information, the latter accessible by patients, and where nurses balanced avoiding writing unnecessarily unfavourably about patients and the need for record information to be precise and specific. One of our informants thus explained that having to keep information off the record but in their head could even threaten patient safety.…”

Section: Three Versions Of Invisibility Workmentioning

confidence: 98%

“…Omitting this information could also be interpreted as a way to uphold doctors' professional status vis‐à‐vis patients by restricting notes to medically relevant and ‘objective’ information, avoiding entries that may be interpreted as morally judgemental (cf. Ihlebæk, 2020).…”

Section: Three Versions Of Invisibility Workmentioning

confidence: 99%

Off the record: The invisibility work of doctors in a patient‐accessible electronic health record information service

Petersson

Backman

2021

Sociology Health & Illness

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In this article, we draw on Michael Lipsky's work on street‐level bureaucrats and discretion to analyse a real case setting comprising an interview study of 30 Swedish doctors regarding their experiences of changes in clinical work following patients being given access to medical records information online. We introduce the notion of invisibility work to capture how doctors exercise discretion to preserve the invisibility of their work, in contrast to the well‐established notion of invisible work, which denotes work made invisible by parties other than those performing it. We discuss three main forms of invisibility work in relation to records: omitting information, cryptic writing and parallel note writing. We argue that invisibility work is a way for doctors to resolve professional tensions arising from the political decision to provide patients with online access to record information. Although invisibility work is understood by doctors as a solution to government‐initiated visibility, we highlight how it can create difficulties for doctors concerning accountability towards patients, peers and authorities.

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Lost in translation - Silent reporting and electronic patient records in nursing handovers: An ethnographic study

Cited by 12 publications

References 40 publications

Workarounds in Electronic Health Record Systems and the Revised Sociotechnical Electronic Health Record Workaround Analysis Framework: Scoping Review

Workarounds in Electronic Health Record Systems and the Revised Sociotechnical Electronic Health Record Workaround Analysis Framework: Scoping Review

Compliance between registered nurses’ clinical judgment and documentation in homecare for older patients with COPD: A multiple case study

Off the record: The invisibility work of doctors in a patient‐accessible electronic health record information service

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