Uncovering the Value of a Historical Paper-Based Collaborative Artifact: The Nursing Unit's Kardex System

Abstract

We identify useful functions and usability characteristics of a historical cognitive artifact used by nurses working in a hospital unit, the Kardex. By identifying aspects of a widely used artifact, we uncover opportunities to improve the usefulness of current systems for hospital nurses. We conducted semi-structured interviews with registered nurses about their prior experience with the Kardex. Questions included what elements of the Kardex are missing from their current electronic support. Memos were generated iteratively from interview transcript data and grouped into themes. Eighteen nurses from multiple clinical areas participated and had a median of 25-29 years of nursing experience. The themes were: (1) a status at a glance summary for each patient, (2) a prospective memory aid, (3) efficiency and ease of use, (4) updating information required to maintain value, (5) activity management, (6) verbal handover during shift-to-shift report, (7) narrative charting and personalized care, and (8) non-clinical care communication. Implications for digital support are to provide immediate, portable access to a standardized patient summary, support for nurses to manage their planned activities during a series of shifts, provide unstructured text fields for narrative charting, and to support adding informal notes for personalized care.

A critical review of the role of technology and context in digital health research

“…They described IT failures as complex, contributed to by the interactional effects of the technology, people and the broader context. Another example is the work of Mount-Campbell et al 36 on the value of a widely used paper-based artefact, the Kardex, for collaboration among nurses. Comparing the aspects of this ‘historical’ artefact to how existing digital solutions support nursing practices, they draw implications for digital designs.…”

Quality of nursing records in a sector of the Public Hospital of the City of Oberá

“…(15) El Sistema Kardex ayuda a registrar de manera más práctica, ya que posibilita generar plantillas para las evoluciones y el registro del tratamiento de manera más clara, sin errores, como ocurre con la legibilidad de las indicaciones hechas en las historias clínicas en papel. (16) El registro de enfermería que tradicionalmente se observa contiene muchas falencias, por lo general son incompletos ya que no es registrado todos los procedimientos realizados en el sujeto, en muchos casos se observa que lo único registrado son los signos vitales del individuo, entonces si no se registra la valoración global del sujeto repercute en la calidad y continuidad de los cuidados al mismo.…”

Design and Development of Kardex and Nursing Reports in the Rehabilitation Hospital

“…When shifts change, nurses use Kardex to provide patient information and follow-up to the next shift nurse. Although Kardex contains the most essential patient information, it has not covered the patient's clinical condition yet ( Chanyagorn et al, 2016 ; Mount-Campbell et al, 2020 ), while its comprehensiveness is one of the essential elements in assured quality care ( Ang, 2019 ).…”

“…Therefore, by emphasizing to their remained capabilities, their independence should be strengthened as much as possible to achieve self-sufficiency in self-care. Given these goals, designing a special Kardex for clients who have undergone rehabilitation programs seems to be necessary for promoting the level of independence ( Mount-Campbell et al, 2020 ).…”