Nurses' information practice in municipal health care—A web‐like landscape

Abstract

Aim To uncover the characteristics of nurses' information practice in municipal health care and to address how, when and why various pieces of information are produced, shared and managed. Background Nursing documentation in the electronic patient record has repeatedly been found unsatisfactory. Little is known about how the information practice of nurses in municipal health care actually is borne out. In order to understand why nursing documentation continues to fail at living up to the expected requirements, a better understanding of nurses' information practice is needed. Design A qualitative observational field study. The study complied with the Consolidated Criteria for Reporting Qualitative Research. Methods Empirical data were collected in three Norwegian municipalities through participant observations and individual interviews with 17 registered nurses on regular day shifts. The data were analysed through thematic content analysis. Results Nurses' information practice in municipal health care can be described as complex. The complexity is reflected in four themes that emerged from the data: (1) web of information sources, (2) knowing the patient and information redundancy, (3) asynchronous information practice and (4) compensatory workarounds. Conclusions The complex and asynchronous nature of nurses' information practice affected both how and when information was produced, recorded and shared. When available systems lacked functions the nurses wanted, they created compensatory workarounds. Although electronic patient record was an important part of their information practice, nurses in long‐term care often knew their patients well, which meant that a lot of information about the patients was in their heads, and that searching for information in the electronic patient record sometimes seemed redundant. Relevance to clinical practice This study provides contextual knowledge that might be valuable (a) in the further development of information systems tailored to meet nurses' information needs and (b) when studying patient safety in relation to nurses' information practice.

Introducing standardised care plans as a new recording tool in municipal health care

“…The individual information needs of healthcare workers differ with experience, formal health education and familiarity with a given patient (Bing-Jonsson et al, 2016;Østensen et al, 2019). It is therefore difficult to decide what level of detail to put into a care plan.…”

“…Previous studies have found that recording in EPRs is viewed as a less urgent task, that healthcare workers experience competing interests and that the EPR system does not support their workflow (Vabo, Slettebø, & Fossum, 2016). The EPR system is just one of multiple information sources used in long-term care and does not always support nursing practice due to availability at point of care (Østensen, Bragstad, Hardiker, & Hellesø, 2019). These are all factors that can influence the quality of nursing records and their ability to facilitate the continuity of care.…”

A nation-wide cross-sectional study of variations in homecare nurses’ assessments of informational continuity – the importance of horizontal collaboration and municipal context

“…Working longer at the current workplace is likely to reflect a certain degree of continuity of care in itself. Homecare nurses with more years of experience may perceive information as more available as they know their patients well and have memorized much information, so that searching for information in the electronic documentation system may seem redundant [14]. It may also indicate the skill of more experienced homecare nurses to locate patient information in the municipality's documentation system.…”

“…Extensive qualitative research has explored information practices within different municipal health care settings and has revealed a general lack of comprehensive nursing documentation [14][15][16][17][18]. This suggests that health care personnel has to make decisions based on incomplete information [18], which can lead to an incorrect allocation of services or even malpractice, with potentially serious consequences for care recipients.…”

“Looking for Deviations”: Nurses’ Observations of Older Patients With COPD in Home Nursing Care

“…Despite sound arguments for applying a more flexible approach to home nursing care, relying solely on nurses’ experiences and knowledge about the patient can also have adverse consequences. Østensen et al (2019) found that nurses who worked full time in long-term care facilities often knew their patients well and, therefore, considered reading electronic patient records to be redundant. By extension, knowing the patient can become an implicit and obvious knowledge that may be overlooked, in terms of documentation in the patient record, which can result in some observations being regarded as “private” information, and patient care may risk becoming person-dependent.…”