Electronic Health Record Documentation of Nursing Care: A Hermeneutic Investigation

Electronic Health Record Documentation of Nursing Care: A Hermeneutic Investigation

Author: 
Candace Marrast
Program of study: 
Ph.D./NUR
Abstract: 
There have been many changes in nursing practice and nursing documentation. One recent change is the transition to the electronic health record (EHR). Over the past 10 years, health care facilities began implementing the EHR and now electronic recording has widely replaced the traditional paper-based format. Driven primarily by concerns around patient safety, the EHR is in the process of becoming mandatory in all health care organizations across the United States. The purpose of this study was to investigate the lived experiences of nurses working on a medical unit using the EHR to document nursing care. The study used a hermeneutic phenomenological research approach and responded to research questions in the context of Max Van Manen's approach to phenomenology and the Theory of Acceptance Model. Consideration of the salient issues intrinsic in these theories directed the formulation of semi-structured prompts, which constituted the primary data collection method. The sample consisted of 14 nurses working on the medical units of one of the major hospitals in New York City. Hermeneutic phenomenological data analysis using Modell's 1992 three-step method along with the Colaizzi's 1978 phenomenological method, and the QSR Nvivo 10 software revealed six essential themescomprehensive picture of the patient, user friendliness, decreased medication errors, effective documentation, optimized /prioritization of plan of care, and increased staff interactions. The study findings could assist in the development and refining of the EHR as a documentation mechanism for enhancing nursing practice, patient outcomes, and the promotion of excellence in the delivery of health care
Dedication: 
First, to my Heavenly Father God the Almighty and His Son – my Savior and Messiah, who both gave me the wisdom, knowledge, and understanding to begin this journey. Through the many moments when I felt the wind was taken out of my sails and I wanted to give up, I remembered to look to the Lord from whence comes my help – Psalm 121:1-2. They gave me the spiritual, emotional, and physical strength to stay committed to the vision. I was also very confident in the saying, “He who begun a good work in me would perform it until the completion – Philippians 1:6.” I constantly reminded myself “I can do all things through my Lord and Savior who strengthens me – Philippians 4:13.” My Father and my Lord and Savior illuminated every step I took in the process and gave me the academic ability to persevere, finish the quest, and accomplish this legendary milestone. Secondly, I dedicate this dissertation to my deceased mother (Catherine Harper James). I embarked on the journey with her planting the seed for me to further my education because she believed in my ability to achieve this goal. Since I was a child, she always instilled in me the value of education. On the evening before she died, she said to me, “I want you to go for your doctorate. You have the brains for it; please promise me that you would do it.” The next day she died suddenly. I knew that I had to return to school and stay dedicated to the end. Throughout the process, her words resonated with me. I could hear her voice saying, “You can do it, you can do it.” Therefore, I kept my eye on the prize and forged ahead despite the challenges I faced. Lastly, I dedicate this dissertation as a legacy to my three beloved children–Cindy-Ann Bautista, Trevon Marrast, and Kiana Marrast, my son-in-law Miguel Bautista, and my two grandchildren Catherine Bautista and Miguel Bautista. I want each of you to keep embracing education, continue working diligently, reach for the stars, and you will achieve academic success – completing a PhD degree is possible
Acknowledgements: 
I would like to thank everyone who assisted me in completing this journey, first to my dissertation chair and committee members. To my dissertation chair, Dr. Margaret Kroposki, thank you for stepping in and agreeing to be my mentor in the few weeks before submission to QRM. You willingly shared your expertise and wealth of knowledge with me on a weekly basis. Your extensive feedback, our weekly discussions, and the additional resources you sent me provided the clarification and insights needed to enhance my writing experience and helped me complete the dissertation. At times when I felt overwhelmed and discouraged, you continually offered words of support, inspiration, empowerment, and encouragement. You always knew the right words to turn my negative fears into positive outlooks. To my committee members, Dr. Francine Nelson and Dr. Ela Joy Lehrman, thank you for your comments and willingness to tell me the truth. These comments redirected me and kept me focused on the information I needed to include in my study. Without the assistance and support of the three of you for my academic pursuits, I could not have otherwise brought this dissertation to fruition. I would also like to acknowledge my family and friends with special thanks. It is with utmost respect and gratitude that I say many-many thanks to my husband Trevor Marrast, my sisters Ruby James Myers and Brenda James, and my brother Trevor James; my friends John Revill, Norva Jacob-Bonner, Carol Martin Brown, Gresmor Blackman, Reynold Andrews, and Joy Allen; and my cousins Cathy Morgan and Sherrol Brebnor-Levy. Your unwavering support and encouragement undoubtedly motivated me to keep on writing and complete the process. I am also grateful for the support of my church family, especially Dale Bissessar, Lomax and Marcia Morris, Michael Motley, Franklyn Laroc, and two of my church pastors Mr. Chuck Smith and Howard Davis – thanks for your prayers and continual support. In addition, I would also like to extend thanks to my enrollment counsellor Debbie Guggisberg who became a sister friend to me. I appreciate your loyalty in being a constant sense of support. Thanks for continually checking up on me and sending me those daily motivators. Many of them certainly helped me to keep the fire burning under my feet. Special thanks as well to my academic counselor Carola Garfias. I truly appreciate your phones calls prior to and after each class and your constant reminders that you were proud of me. You willing re-scheduled my classes to accommodate both my academic and personal needs – thanks for your confidence in me demonstrating your support. Additionally, I would like to thank especially two of my class facilitators Dr. Linda Amankwaa and Dr. Carman Kelsey-Jenkins. I remembered at one point in the journey I wanted to give up and quit school. Dr. Linda you were the only person who spoke with me very sternly yet with love and compassion and told me unequivocally that I could finish the degree and you would accept nothing less. I was shocked back into reality by your words and never doubted myself again. To Dr. Kelsey, thank you for facilitating my year 4 residency and for sharing your experience and wealth of knowledge. Your soft, welcoming, and empowering approach undoubtedly enhanced my confidence and motivated me to maintain my energy and focus to write chapters 4 and 5 so I can give myself the gift of completing the process. Finally, I am greatly indebted to several employees of the Research Facility. To Clelia Belfort, MSN, RN who introduced me to key personnel at the research department, to Dr. Stanley John the IRB manager, to the IRB committee members for providing me with the approval to conduct my study. To members of the Nursing Department–Miriam Cohen MSN, RN; Dr. Cynthia Caroselli, PhD, RN; and to the 14 nurses who willing and freely shared their lived experiences with me. Without the help of each of you, I could not have completed this study. I am very appreciative of all your assistance and support–very special thanks