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Dilemmas, Tetralemmas, Reimagining the Electronic Health Record

Petrovskaya, Olga BScN, RN; McIntyre, Marjorie PhD, RN; McDonald, Carol PhD, RN

doi: 10.1097/ANS.0b013e3181b1056e

With the transition from paper-based to computer-based records, nursing practice shifts to computerized documentation of care in the electronic health record (EHR). Viewed not only as an electronic document, but as an instrument of modern economic and technological ideology that serves organizational goals of cost-efficiency, the EHR can be perceived as creating a dilemma for a patient-centered nursing practice. Viewing the EHR as relying solely on the use of standardized languages begets a number of questions and furthers the dilemma for nurses. Through a discussion that draws on the Indian tradition of the tetralemma, authors transcend the EHR/nursing dilemma.

School of Nursing, University of Victoria, Victoria, British Columbia, Canada.

Corresponding Author: Olga Petrovskaya, BScN, RN, 3800 Finnerty Rd, HSD Bldg A 402, Victoria, BC V8P 5C2, Canada (

© 2009 Lippincott Williams & Wilkins, Inc.