A Mixed Methods Study Exploring Nurse-Patient Interactions in Acute Hospital Settings When Electronic Health Record Systems Are Used.

AIM: To describe the quality of nurse-patient interactions when nurses use Electronic Health Record systems in four acute hospital wards. DESIGN: An explanatory sequential mixed methods study. METHODS: Sixteen researcher observations were conducted using a published Quality of Interactions Schedule tool to evaluate the duration and quality of nurse-patient interactions. Observations were followed by 16 nurse and 16 patient interviews. Data were analysed by descriptive statistics and thematic analysis and integrated to inform overall study meta-themes. RESULTS: Three study meta-themes emerged: (1) Limited social, open, reciprocal and face-to-face nurse-patient communication; (2) Cumbersome computer systems monopolised nurses' time and attention and impeded face-to-face communication; and (3) Nurses' use of Electronic Health Record scripts fostered a task-orientated agenda. CONCLUSION: Nurses, healthcare employers and system developers need to consider the unintended impact of nurses' use of Electronic Health Records on the quality of nurse-patient interactions. Nurses need to evaluate practices that promote, and not hinder, quality nurse-patient interactions when nurses use Electronic Health Record systems in acute care settings. Researchers developing Electronic Health Record systems need to involve nurses and patients. IMPLICATIONS: Balancing the complex tripartite relationship between the nurse, patient and digital interface has implications for nursing practice, education and research. The challenges encountered when nurses use Electronic Health Records need to be addressed to promote quality nurse-patient interactions. Less obtrusive Electronic Health Record technology is required that is developed with nurses who are the principal users. Nurse educators need to promote techniques that facilitate person-centred communication when nurses use Electronic Health Record systems and researchers need to evaluate practices that promote quality nurse-patient interactions. Digital transformation will continue to dominate nursing in the future and the significant findings from this study will help inform further exploration and developments in this area. NO PATIENT OR PUBLIC CONTRIBUTION: Patients consented to the collection of data and for the data to be used in future potential publications. Patient participants were all discharged from the acute care hospital soon after data collection.