Knowing the patient in an age of electronic records

In our current featured article, authors Tiffany Kelley, PhD, MBA, RN; Sharron Docherty, PhD, PNP-BC, FAAN and Debra Brandon, PhD, RN, CCNS, FAAN report on their qualitative study designed to explore the meaning of the concept of “knowing the patient.”  This work provides important evidence on which to develop and design systems in patient care settings for recording and tracking information that serve the nurses’ needs for knowing their patients on a level that supports the best possible individualized nursing care.  Dr. Kelley describes how this work came about:

This article, “Information Needed to Support Knowing the Patient” was the first research study I conducted as part of my Ph.D. program at Duke University School of Nursing. I came to the program with the experience of working with an academic medical center during their transition from a paper-based record to an electronic health record system. I recall supporting many nurses providing direct inpatient care during and after the transition. After weeks on the system, I remember hearing nurses tell me a variation of “I feel like I don’t know my patient.” I wondered, “What does this phrase mean?” and “What had changed in the transition from a paper to electronic health record to stimulate this response?”

The questions travelled with me as I transitioned to a doctoral student at Duke. I recall being in my Philosophy of Science class during my first semester and describing this experience. My professors, Dr. Debra Brandon and Dr. Sharron Docherty (co-authors of this paper) were also intrigued. They listened attentively during class and encouraged me to explore this phenomenon further in the empirical literature. In doing so, I came across several papers where ‘knowing the patient’ was a key finding in qualitative studies of caring, the nurse-patient relationship, and decision-making. However, few scholars had directly asked nurses what it means to know their patients. Additionally, the literature was limited in describing the relationship of the information found in the patient’s medical record to support nurses’ knowledge of the patient. In the era of electronic health records, the role of the patient’s record must be understood so that we can ensure the design supports nurses to know their patient for optimal health outcomes.

This paper, “Information Needed to Support Knowing the Patient” is a qualitative descriptive study that aimed to understand the meaning of ‘knowing the patient’ from the perspective of nurses caring for hospitalized pediatric patients in an intensive care setting. We selected this population and setting as they represent a vulnerable patient population who are often unable to communicate their care needs due to their developmental status (e.g., infant or toddler) and/or medical condition (e.g., intubated or sedated). Additionally, we aimed to understand how nurses use available information sources to know their patients. The findings from this study have strong implications for how we begin to approach integrating EHRs and other clinical information systems into hospitals in order to support nurses in knowing the patient. Many opportunities exist to create new electronic solutions that address nurses’ existing information needs and gaps from the existing solutions. Future studies must aim to conduct process-oriented research studies to understand how and why nurses use specific information to know their patient and subsequently where the information is stored within the EHR.

I hope that you enjoy reading this paper.

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