Misto Kara, Padula Cynthia, Bryand Elizabeth, Nadeau Kate
Rhode Island College, Providence (Drs Misto and Padula); The Miriam Hospital, Providence, Rhode Island (Dr Padula); Newport Hospital, Newport, Rhode Island (Ms Bryand); and Lifespan Oncology Clinical Research, The Miriam Hospital, Providence, Rhode Island (Ms Nadeau). Ms Bryand was formerly with The Miriam Hospital, Providence, Rhode Island.
J Nurs Care Qual. 2019 Apr/Jun;34(2):163-168. doi: 10.1097/NCQ.0000000000000339.
While there are many benefits of electronic medical record documentation, the presence of a computer may adversely affect provider-patient interaction.
The purpose of this project was to examine staff nurses' perception of the impact of electronic documentation in the presence of the patient on the nurse-patient relationship.
A survey was administered to 276 staff nurses, and open-ended interviews were conducted with 11 novice and 20 expert nurses.
Nurses identified benefits and challenges to electronic medical record documentation as well as strategies used to maintain therapeutic relationships and communication. Numerous nurses commented that documenting with their back to the patient had a negative impact on the nurse-patient relationship and communication.
Both novice and expert nurses identified strategies that they used to ensure they were "maintaining the connection" to patients during electronic medical record documentation.
虽然电子病历文档有诸多益处，但计算机的存在可能会对医护人员与患者的互动产生不利影响。
本项目的目的是研究注册护士对于在患者面前进行电子文档记录对护患关系影响的看法。
对276名注册护士进行了一项调查，并对11名新手护士和20名专家护士进行了开放式访谈。
护士们指出了电子病历文档记录的益处和挑战，以及用于维持治疗关系和沟通的策略。许多护士表示，背对着患者进行记录会对护患关系和沟通产生负面影响。
新手护士和专家护士都确定了他们在进行电子病历文档记录时用于确保与患者“保持联系”的策略。
