As both a nurse and an information scientist, I was intrigued by the recent article “Information Needed to Support Knowing the Patient,” authored by Kelley et al1 in the October-December 2013 issue of Advances in Nursing Science on many levels. I applaud the authors and Advances in Nursing Science for writing and publishing, respectively, an article on the concept of “knowing-the-patient.” All too often, today we hear colloquiums (eg, treat ‘em and street ‘em) and see technology used (eg, texting used to end a relationship) in ways that do nothing but depersonalize human beings and human relations. From a theoretical standpoint, however, I was surprised by the noted omission of Hildegard Peplau and her work on Interpersonal Relations in Nursing.2–4 Her pioneering theory2–4 encompasses many of the elements of knowing the patient discussed by the authors,1 including understanding individual human response patterns and the development of the nurse-patient relationship.2–4
A second point related to Peplau is that she emphasized the importance of bedside nurses contributing to nursing theory,2–4 and this could be addressed through better management of the daily paper-based information sheets discussed by the authors.1 I am perplexed by the authors' general characterization of this information practice as negative.1 On the contrary, the authors found that the daily paper information sheets contributed to knowing the patient, thereby adding to safe, quality, patient-centered care.1 These sheets are individual-level decision aids that could help us explicate nursing actions and judgments, informing theory to define what it is nurses provide their patients. Yes, it is true, as the authors point out, that the information may vary from nurse to nurse1 but it is not uncommon for individuals to have their own information systems.5,6
Furthermore, the authors stated that the nurses in the study were already required to type the contents of this sheet into a Word document,1 thus they are already halfway through the process of storing the information for analysis. It is unfortunate that institutions do not implement policies that enhance this practice and capture it within their electronic medical record. This article has shown these sheets to be a valuable, useful, rich data source for nurses1 and therefore potentially for nursing science as a whole. Capturing this type of data, information, and knowledge in electronic systems is what will lead us to new wisdom in nursing—knowledge in action.7 Perhaps, these sheets could be scanned into the electronic medical record and the contents later analyzed by using optical character recognition technology and data mining. If the hospital asserts that these sheets are part of quality improvement projects, they would be deemed undiscoverable: a potential benefit and treasure trove of data with little to no threat for risk management.
Peplau demonstrated the importance of the iterative cycle of theory and practice, promoting deep self-reflection on interactions with patients and then using these data to further inform theory.2–4 Peplau clearly stated that through our interactions with patients, nurses gain “invaluable data for advancement of the nursing profession.”4(p164) Fragments of these data may be captured in those daily notes and need further analysis. Ellis8 and Reed9 have more recently noted that too few nurses are contributing to nursing theory. As Ellis stated, “...if we really have a commitment to the future beyond the personal accumulation of wisdom from patient to patient, ....we must try to analyze our actions and formulate theories from them.”8(p1438) Conducting this type of information research with bedside nursing data could help us overcome this problem.
There are several other recent articles that focus on the important topic of knowing-the-patient.10–12 In one such article, a nurse-scientist11 reviewed a business researcher's work that predicts skills in human-to-human contact will become increasingly valued.12 It is hoped that this collection of recent publications signals a trend in the right direction, elevating the crucial importance of the nurse-patient relationship. We must, however, acknowledge the source of this vital concept and its associated theory as Hildegard Peplau.2–4
Finally, I thank the authors for bringing to light the intersection of nursing and information science. “Nurses are resource persons who have the information ... patients ... need. Such information reduces the uncertainty and stress for the patient.”4(p165) This statement from Peplau's theory is complementary to theory-based principles in information science, regarding relationships between information, anxiety, and uncertainty.13,14 The 2 domains need much more explication and integration since nurses are indeed today's knowledge workers7—with the human touch.
—Elizabeth Eisenhauer, BSN, RN, MLS
School of Nursing
University of Michigan
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