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Impact of Adoption of a Comprehensive Electronic Health Record on Nursing Work and Caring Efficacy

Schenk, Elizabeth PhD, MHI, RN-BC; Schleyer, Ruth MSN, RN-BC; Jones, Cami R. PhD; Fincham, Sarah DNP, ARNP, NP-C; Daratha, Kenn B. PhD; Monsen, Karen A. PhD, RN, FAAN

CIN: Computers, Informatics, Nursing: July 2018 - Volume 36 - Issue 7 - p 331–339
doi: 10.1097/CIN.0000000000000441

Nurses in acute care settings are affected by the technologies they use, including electronic health records. This study investigated the impacts of adoption of a comprehensive electronic health record by measuring nursing locations and interventions in three units before and 12 months after adoption. Time-motion methodology with a handheld recording platform based on Omaha System standardized terminology was used to collect location and intervention data. In addition, investigators administered the Caring Efficacy Scale to better understand the effects of the electronic health record on nursing care efficacy. Several differences were noted after the electronic health record was adopted. Nurses spent significantly more time in patient rooms and less in other measured locations. They spent more time overall performing nursing interventions, with increased time in documentation and medication administration, but less time reporting and providing patient-family teaching. Both before and after electronic health record adoption, nurses spent most of their time in case management interventions (coordinating, planning, and communicating). Nurses showed a slight decrease in perceived caring efficacy after adoption. While initial findings demonstrated a trend toward increased time efficiency, questions remain regarding nurse satisfaction, patient satisfaction, quality and safety outcomes, and cost.

Author Affiliations: College of Nursing, Washington State University (Drs Schenk, Jones, Fincham, and Daratha), Pullman; Informatics Education, Providence St. Joseph Health (Ms Schleyer), Renton, Washington; and Center for Nursing Informatics, School of Nursing, University of Minnesota (Dr Monsen), Minneapolis.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Corresponding author: Elizabeth Schenk, PhD, MHI, RN-BC, College of Nursing, Washington State University, 2407 Wylie Ave, Missoula, MT 59802 (

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