The factors influencing community nurses' usage of electronic health records: findings from focus groups
Electronic health records (EHRs) are integral to community nursing, and mobile access aids seamless, responsive care, prevents repetition and reduces hospital admissions. This saves time and money, enabling smoother workflows and increased productivity. Common practice among community nurses is to return to workbases to access EHRs. This research was conducted to explore what leads to inconsistency in EHR use. Focus groups were held with community nurses, and reflexive thematic analysis of the data was undertaken. Nurses who used EHRs during consultations described the practice as integrative and informed, promoting collaborative care. Those who did not described EHRs as time-consuming, template-laden and a barrier to nurse-patient communication. One barrier to mobile working is the threat to collegiate teamworking and the social and clinical supports it provides. This study suggests specific strategies could increase mobile EHR engagement: role-specific training for effective EHR use; clear organisational directives; innovative team communication; and peer-to-peer coaching.
The ‘Understanding quality in district nursing services’ report (King's Fund, 2016) highlighted significant issues in service provision facing community services and argued that mobile electronic health record (EHR) access, shared records and linked IT systems are crucial in joining up services and addressing the problems of fragmented and poorly coordinated community care (Gov.UK, 2013; King's Fund, 2018).
EHRs have been found to enable and support evidence-based clinical decision-making (Mangalampalli et al, 2006). Trust in the effectiveness of available technology, delivered performance and efficiency improvements were primary factors in clinician engagement (Kim et al, 2016) with EHRs. The importance of EHRs to the future of community healthcare is not in doubt.
Internationally, there has been movement toward the increased use of EHRs, and a growing evidence base of their benefits. However, little of the current body of research relates to community nursing and to the lived experiences of nurses using these systems. Themes that emerge from the literature are of nurses seeing the potential benefits of increased engagement with technology being stymied by slow IT systems, poor design and badly supported implementation (Huryk, 2010; Ward et al, 2011; Kuek and Hakkennes, 2020). Where there is good engagement, it is characterised by nurses seeing benefits to patients, sharing positive peer-to-peer experience and receiving support from their organisation (Kaye, 2017; King's Fund, 2020).
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