The changes in caregivers’ perceptions about the quality of information and benefits of nursing documentation associated with the introduction of an electronic documentation system in a nursing home

doi:10.1016/j.ijmedinf.2010.10.011

International Journal of Medical Informatics

Volume 80, Issue 2, February 2011, Pages 116-126

https://doi.org/10.1016/j.ijmedinf.2010.10.011 Get rights and content

Abstract

Purpose

To date few studies have compared nursing home caregivers’ perceptions about the quality of information and benefits of nursing documentation in paper and electronic formats. With the increased interest in the use of information technology in nursing homes, it is important to obtain information on the benefits of newer approaches to nursing documentation so as to inform investment, organisational and care service decisions in the aged care sector. This study aims to investigate caregivers’ perceptions about the quality of information and benefits of nursing documentation before and after the introduction of an electronic documentation system in a nursing home.

Methods

A self-administered questionnaire survey was conducted three months before, and then six, 18 and 31 months after the introduction of an electronic documentation system. Further evidence was obtained through informal discussions with caregivers.

Results

Scores for questionnaire responses showed that the benefits of the electronic documentation system were perceived by the caregivers as provision of more accurate, legible and complete information, and reduction of repetition in data entry, with consequential managerial benefits. However, caregivers’ perceptions of relevance and reliability of information, and of their communication and decision-making abilities were perceived to be similar either using an electronic or a paper-based documentation system. Improvement in some perceptions about the quality of information and benefits of nursing documentation was evident in the measurement conducted six months after the introduction of the electronic system, but were not maintained 18 or 31 months later.

Conclusions

The electronic documentation system was perceived to perform better than the paper-based system in some aspects, with subsequent benefits to management of aged care services. In other areas, perceptions of additional benefits from the electronic documentation system were not maintained. In a number of attributes, there were similar perceptions on the two types of systems.

Introduction

Nursing documentation is an integral component of nursing and a pre-requisite for quality nursing care. It is an important communication tool amongst caregivers in nursing homes and between aged care providers and other healthcare professionals [1], [2], [3]. Documented evidence enables nursing managers to assess whether care provided by individual caregivers was professional, safe and competent [2], [4]. It also increases the visibility of nursing care activities [5], [6]. Reimbursement for the provision of care services also benefits substantially from having thorough and accurate nursing records [3]. Moreover, nursing records can serve as legal evidence in the event of a lawsuit [3]. They also facilitate research activities and standards setting in nursing education and clinical practice [3]. For these reasons, nursing documentation has to be systematically implemented and continuously maintained.

Paper-based nursing documentation practice is time-consuming. Records are often illegible, missing or incorrect, which may lead to medical errors [5], [7]. Also, the manual documentation process is often repetitive and data may not be easy to retrieve or update [1], [5], [7]. The paper record is thus incomplete and inadequate for supporting caregivers in the provision of quality nursing care [5], [6].

Since the introduction of information technology (IT) into nursing practice, various applications have been developed and used by nurses with the hope of reducing paperwork [8], [9], improving the quality of nursing data [10], [11] and saving caregivers’ time [12], [13]. However, most studies evaluating nursing information systems have concentrated on the process of introducing technology into nursing care [9], [14], [15], [16], [17]. A few studies that have explored the changes that might occur after the introduction of an electronic documentation system were mainly focused on efficiency gains [10], [18], [19], [20].

Most evaluation efforts have been confined to hospital settings and results have varied due to the differences in study designs, context and applications under study. To our knowledge, few studies have investigated caregivers’ perceptions about the quality of information and the benefits of electronic documentation in a nursing home setting. A gap therefore exists in knowledge about whether IT investment in a nursing home will bring in the benefits of improved information management. This knowledge is essential in informing decisions by aged-care managers on investment of scarce resources in health IT solutions. Therefore, the aim of this study was to investigate whether there were any changes in caregivers’ perceptions about the quality of information and benefits of nursing documentation before and after the introduction of an electronic nursing documentation system.

Section snippets

Setting

The study was conducted at Warrigal Care Warilla, a 101-bed nursing home in Shellharbour, New South Wales, Australia. There are two houses in the facility, a 56-bed dementia care special house and a 45-bed normal nursing home house. Warrigal Care is a not-for-profit aged care organisation that runs five nursing homes, besides community aged care services.

An electronic documentation system was implemented in Warrigal Care Warilla in June 2007. The functions of this system included progress

Results

In the period prior to electronic documentation, 32 of 50 caregivers (64%) participated in the questionnaire survey. In each of the measurements conducted six months or 18 months into electronic documentation, 25 of 50 caregivers (50%) responded. In the survey conducted 31 months after electronic documentation, 15 of 30 caregivers (50%) responded.

Six Registered Nurses (RNs), nine Endorsed Enrolled Nurses (EENs) and 17 Personal Care Workers (PCWs) participated in the study before the

Discussion

To our knowledge, this is the first study to compare caregivers’ perceptions about quality of information and benefits of nursing documentation using a questionnaire survey before and after the introduction of an electronic documentation system in a nursing home. All of the caregivers participated in our study entered data into computers themselves. It is important that all health care workers who provide information record it themselves [25]; therefore, this is a significant achievement for

Conclusions

The care staff members felt significantly more comfortable with electronic nursing documentation than writing on paper after using the electronic system for six months. The benefits of the electronic documentation system were perceived by the caregivers as providing more legible, accurate and complete information. There were also perceptions of reduced repetition in data entry and more managerial benefits. However, caregivers’ perceptions of their communication and decision-making ability

Ethical considerations

All procedures used in this study were approved by the Human Research Ethics Committee, University of Wollongong, Australia, and complied with the National Health and Medical Research Council National Statement on Ethical Conduct in Research Involving Humans, 1999.

Author contributions

EM: Survey instrument validation, data collection, interpretation and manuscript preparation. PY: study conceptualization and design, survey instrument development, statistical data analysis, data interpretation and manuscript preparation. DH: manuscript preparation, data interpretation.

Conflict of interest statement

The authors have no financial interest to this work.

Acknowledgements

The authors are grateful for the caregivers’ participation in the questionnaire surveys at Warrigal Care Warrilla. The CEO of Warrigal Care Mr Mark Sewell, Care Systems Officer Mr Dylan Hepworth and Residential Service Manager Ms Karen Herbert are acknowledged for their support in coordinating the data collection activity. This paper has been presented in part in a National Conference on Health Informatics (2009) in Australia. The research was sponsored by the Australia Research Council

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The changes in caregivers’ perceptions about the quality of information and benefits of nursing documentation associated with the introduction of an electronic documentation system in a nursing home

Abstract

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Setting

Results

Discussion

Conclusions

Ethical considerations

Author contributions

Conflict of interest statement

Acknowledgements

J. Am. Med. Inform. Assoc.

Int. J. Med. Inform.

Int. J. Med. Inform.

J. Am. Med. Inform. Assoc.

Int. J. Med. Inform.

Int. J. Med. Inform.

The complexities of documenting clinical information in long-term care settings in Australia

J. Gerontol. Nurs.

Accuracy of nursing home medical record information about care-process delivery: implications for staff management and improvement

J. Am. Geriatr. Soc.

Documentation and the Nursing Process Delmar Learning

The study of nursing documentation complexities

Int. J. Nurs. Pract.

Caregivers’ acceptance of electronic documentation in nursing homes

J. Telemed. Telecare.

Informatics and Nursing – Opportunities and Challenges

Application of a computerised nursing care plan system in one hospital: experiences of ICU nurses in Taiwan

J. Adv. Nurs.

Factors affecting and affected by user acceptance of computer based nursing documentation: results of a two year study

J. Am. Med. Inform. Assoc.

An electronic medical record intervention increased nursing home advance directive orders and documentation

J. Am. Geriatr. Soc.