Lost in translation - Silent reporting and electronic patient records in nursing handovers: An ethnographic study

Abstract

Background: Electronic patient records are increasingly being implemented in hospitals around the world to promote a process of sharing information that is reliable, more efficient and will promote patient safety. Evidence suggests that in practice, adaptations are being made to how such technologies are being used in practice. Few studies have explicitly aimed to explore how electronic patient records influence on nurses’ communication of patient information in clinical practice. Objective: To enhance understanding of the impact of electronic patient records on nurses’ cognitive work, by exploring how nurses engage with the electronic patient record during handover and the representation of patient information. Methods: Ethnographic fieldwork was conducted in a Norwegian hospital cancer ward where computer-mediated handover referred to as ’silent reporting’ had been implemented. The fieldwork included five months of participant observation and nine semi-structured interviews with registered nurses. Participating nurses were selected to ensure representation by clinical experience. The analysis of field notes and transcripts was partly performed in NVivo 11, following thematic analysis (Braun and Clarke 2006). Findings: Four themes emerged: 1) nurses’ complex and dynamic workflow necessitated talk in handovers, 2) oral communication allowed nurses to share sensitive information on psychosocial issues, and 3) to solve uncertainties considered unsuited for the record, and 4) talk facilitated professional and moral support in clinical decisions-making, as collective achievements. Talk was thereby found to be essential to nurses’ cognitive work and professional knowledge, allowing for the translation and interplay between the embodied, informal knowledge of the individual nurse, and formal knowledge inscribed in record notes. Conclusions: Silent reporting has implications for nurses’ cognitive work and professional knowledge. With the sole reliance on the electronic patient record as handover tools, it is not only information essential to nurses’ evolving, dynamic, and contextualised understanding of the patient’s situation that is lost in translation, but also the visibility and legitimacy of nursing knowledge. Nurses’ continued practices of talk in handovers can be seen as efforts to counteract these effects in ways that also increased the relevance and usefulness of the electronic patient record as a mediator of knowledge.