Language
English (en)
Date of Award
5-15-2025
Degree Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Chair and Committee
Po-Yin Yen
Committee Members
Heidi Holtz, Lisa Kidin, Sarah Rossetti, Marilyn Schallom
Abstract
Objective: This study aimed to understand how inpatient nurses determine and prioritize patient care documentation within the context of the Electronic Health Records (EHRs) burden.
Methodology: We employed a Nested Concurrent Mixed Methods (NCMM) design, predominantly using qualitative interviews supplemented by quantitative web-based surveys. Both approaches were conducted simultaneously but analyzed independently. The findings were merged using a narrative weave approach during the data triangulation. A phenomenological approach explored the lived experiences of inpatient nurses' EHR documentation prioritization. The qualitative component used an interpretive phenomenology design, while the quantitative component utilized a cross-sectional survey design to measure nurses' perceptions of the EHR documentation burden. Registered nurses (RNs) from acute and critical care settings were recruited via purposive and snowball sampling. Qualitative data were collected through semi-structured interviews and analyzed using Colaizzi’s 7-step thematic analysis and Smith’s Interpretive Phenomenology Analysis (IPA). The quantitative data collection used Qualtrics to distribute a 27-item questionnaire, analyzed with descriptive statistics and content analysis for open-ended questions.
Results: Fourteen RNs participated in the qualitative study, revealing five key themes: (1) Professional judgment in documentation, (2) Real-time versus delayed documentation, (3) EHR-driven documentation impacting nurse autonomy, (4) Unnecessary and redundant documentation, and (5) Emotional strain from defensive charting. Nurses prioritized patient care over EHR documentation, frequently encountering tasks that did not contribute to patient care. Of the 133 RNs surveyed, 80% (n=103) reported that EHR documentation requirements fail to reflect the true quality of care and identified some documentation as unnecessary. Flowsheets, notes, and patient education were the most burdensome tasks. Nurses supported by leadership valued their documentation more (r=0.44). Open-ended responses indicated concerns about repetitive documentation, care plans, daily cares and safety, time spent, and navigating flowsheets. Recommendations included automating data entry, eliminating redundancy, and simplifying care plans.
Discussion: Healthcare organizations must empower nurses by reducing non-value-added documentation and allowing them to exercise clinical judgment. Streamlined documentation processes can reduce emotional stress and promote patient-centered care. Survey findings underscored the need to reduce unnecessary tasks and leverage EHR functionality for meaningful documentation.
Conclusion: Understanding how nurses prioritize documentation provides valuable insights into reducing EHR burden and enhancing patient care quality and organizational efficiency.
DOI
https://doi.org/10.48765/tct2-wk22
Recommended Citation
Mugoya, Rosemary, "Exploring Nurses’ Documentation Prioritization in the Context of Documentation Burden: A Mixed Methods Approach." (2025). WUSM Theses and Dissertations – All Programs. 51.
https://digitalcommons.wustl.edu/all_etd/51
