EHRs: Losing the Nuances of Nursing Care, and the Value

Image by mcmurryjulie from Pixabay

Our December issue is out, but before we move on from the November issue I want to highlight the Viewpoint, “Advocating for HIT That Captures Nursing Process.” It’s about something that greatly affects nurses’ work, seems to be the bane of all clinicians, and, I think, often prevents individualized patient-centered care.

I’m referring to the electronic health record (EHR), a system built to capture data important for billing and tracking aggregate patient outcomes—but arguably not designed for what clinicians deem as most important for understanding and documenting patient care.

Dylan Stein and colleagues Jasmine Travers and Jacqueline Merrill write what most nurses know about EHRs:

“The nuances of our care get lost in task-oriented, quantitative drop-down menus and checkboxes, while the qualitative value of our interventions and impressions are not encoded in a useful way.”

Nursing notes devalued.

In the old days BC (before computers), clinicians used some checklists for charting but also relied heavily on narrative notes to describe the patient’s individual story. While there are areas one can add notes in an EHR, nurses tell me that it’s not very easy to do so and that no one really reads them because […]

2019-12-05T12:03:16-05:00December 5th, 2019|digital health, Technology|2 Comments
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The ECRI Top 10 Patient Safety Concerns of 2019

A list grounded in data and expert opinion.

Atlantic Training/Wikimedia Commons

Each year, ECRI Institute creates a list of top 10 patient safety concerns in order “to support organizations in their efforts to proactively identify and respond to threats to patient safety.”

The list isn’t generated out of thin air. The ECRI Institute relies both on data regarding events and concerns and on expert judgment. Since 2009, ECRI and partner patient safety organizations “have received more than 2.8 million event reports.”

2019 Top 10 Patient Safety Concerns

  1. Diagnostic Stewardship and Test Result Management Using EHRs
  2. Antimicrobial Stewardship in Physician Practices and Aging Services
  3. Burnout and Its Impact on Patient Safety
  4. Patient Safety Concerns Involving Mobile Health
  5. Reducing Discomfort with Behavioral Health
  6. Detecting Changes in a Patient’s Condition
  7. Developing and Maintaining Skills
  8. Early Recognition of Sepsis across the Continuum
  9. Infections from Peripherally Inserted IV Lines
  10. Standardizing Safety Efforts across Large Health System

[…]

2019-04-15T08:16:15-04:00April 15th, 2019|digital health, Nursing, patient safety, Patients|0 Comments
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The Continuing Invisibility of Nurses in the Media

Nurse Jackie aside, how visible are nurses in the media today?

Nurse Jackie was supposed to put nurses “on the map” in the sense of portraying the real world of nursing. After all, here was a modern, gutsy, “take no guff” nurse who stood her ground and stood up for patients. (Sure, she had a drug problem, traded sex for drugs, and her marriage came apart—but one can’t have everything.) At least, there was a nurse character on television who wasn’t relegated to only saying “Yes, doctor,” or standing silently behind an OR mask.

The show portrayed a dynamic, compellingly complex nurse character. But what did the show, or what could any such fictional drama, do to change how people think about nurses and their place and value in health care? It certainly didn’t change the media’s thinking—in 2018, reporters rarely consider getting nurses’ views on stories about health care.

The 1998 Woodhull Study on Nursing and the Media: ‘dismal’ results.

In 1998, Sigma Theta Tau International commissioned a study—the Woodhull Study on Nursing and the Media—to examine how the media portrayed nursing. (You can read AJN’s summary (free until May 28) of the study in the December 1998 issue.) The results were dismal—after examining over 20,000 articles in newspapers and magazines, the researchers found that nurses were mentioned in only four percent of articles about health care.

2018-05-14T13:18:47-04:00May 14th, 2018|healthcare social media, Nursing|3 Comments
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Wabi-Sabi: Nursing and the Art of Brokenness

Wabi-Sabi (Kintsugi), watercolor and acrylic on paper, 2018 by Julianna Paradisi

Nursing is the art of healing, which ironically also makes it an art of brokenness. We pack and bind wounds. We administer medications to cure disease. We offer interventions for the side effects caused by the medication administered to cure.

We work in a health care system which, despite our best intentions, is broken: not enough resources, not enough staff or providers, not enough health care to go around for everyone.

Nurses have broken areas within ourselves too, but our work environments expect us to perform as perfectly as possible, amidst the brokenness of our patients, the brokenness of health care.

Patients, physicians, other departments, and hospital administrators expect nurses will fix problems, whatever they are, despite the brokenness.

A timely example this flu season is the paradoxical message: “Don’t come to work sick,” coupled with the implication, “Your sick call leaves us understaffed.”

The answer to brokenness is wholeheartedness.

The effort to fix the brokenness or imperfection of nursing and health care may be particularly exhausting for nurses because we are directly responsible for the safety of our patients.

The words of author David Whyte as he recounts a wise friend’s advice elegantly […]

2018-02-14T10:05:33-05:00February 14th, 2018|healthcare social media, Nursing, nursing perspective|0 Comments
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How to Identify and Avoid Predatory Journals

Photo by Alice Rosen, via Flickr.

I remember receiving my first “accept” letter for a novel I was working on many years ago. In my excitement, I didn’t stop to think that it was strange that, before the editor began working with me, I would have to pay a large sum of money to get the manuscript into shape. When my euphoria died down and my skepticism shot up, I decided to submit a fake query to the same publisher, highlighting a novel that could never possibly get published. Imagine my dismay when I received the exact same acceptance letter.

So in a way, predatory publishing is not an entirely new concept. And in fact, many more or less legitimate self-publishing options for books, fiction or otherwise, still exist. But with the increasing dominance of the Web and the rise of the open access movement—established to help spread publicly funded research—a more invidious and widely pervasive form of predatory publishing has taken hold in scholarly publishing. And the stakes are far higher. While my novel probably wasn’t going to affect anyone’s life, articles published by unscrupulous publishers—especially medical and nursing literature—have a lot more power to cause damage.

Flawed, unreliable content.

Since predatory journals often forego rigorous […]

2018-01-19T10:56:23-05:00January 19th, 2018|digital health, nursing research, writing|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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