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Nurses' Perception of the Impact of Electronic Documentation on the Nurse-Patient Relationship

Misto, Kara, PhD, RN; Padula, Cynthia, PhD, RN; Bryand, Elizabeth, BSN, RN-BC; Nadeau, Kate, MPH, RN

doi: 10.1097/NCQ.0000000000000339

Background: While there are many benefits of electronic medical record documentation, the presence of a computer may adversely affect provider-patient interaction.

Purpose: 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.

Methods: A survey was administered to 276 staff nurses, and open-ended interviews were conducted with 11 novice and 20 expert nurses.

Results: 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.

Conclusions: Both novice and expert nurses identified strategies that they used to ensure they were “maintaining the connection” to patients during electronic medical record documentation.

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.

Correspondence: Cynthia Padula, PhD, RN, The Miriam Hospital, 164 Summit Ave, Providence, RI 02906 (

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted for publication: April 3, 2018

Published ahead of print: July 2, 2018

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