Abstract
BackgroundThe electronic patient record (EPR) has been introduced into nursing homes in order to facilitate documentation practices such as assessment and care planning, which play an integral role in the provision of dementia care. However, little is known about how the EPR facilitates or hinders these practices from the end-user’s perspective. Therefore, the objective of this qualitative study was to explore the usability issues associated with the EPR for assessment and care planning for people with dementia in nursing homes from a staff perspective.MethodsAn exploratory, qualitative research design with a multiple case study approach was used. Contextual Inquiry was carried out with a variety of staff members (n = 21) who used the EPR in three nursing homes situated in Belgium, Czech Republic and Spain. Thematic analysis was used to code interview data, with codes then sorted into a priori components of the Health Information Technology Evaluation Framework: device, software functionality, organisational support. Two additional themes, structure and content, were also added.ResultsStaff provided numerous examples of the ways in which EPR systems are facilitating and hindering assessment and care planning under each component, particularly for people with dementia, who may have more complex needs in comparison to other residents. The way in which EPR systems were not customisable was a common theme across all three homes. A comparison of organisational policies and practices revealed the importance of training, system support, and access, which may be linked with the successful adoption of the EPR system in nursing homes.ConclusionsEPR systems introduced into the nursing home environment should be customisable and reflect best practice guidelines for dementia care, which may lead to improved outcomes and quality of life for people with dementia living in nursing homes. All levels of nursing home staff should be consulted during the development, implementation and evaluation of EPR systems as part of an iterative, user-centred design process.
Highlights
The electronic patient record (EPR) has been introduced into nursing homes in order to facilitate documentation practices such as assessment and care planning, which play an integral role in the provision of dementia care
Device Type of device A tablet device was preferred by many participants as it could be transported in the nurses’ trolley for easy access to care plans: When you are with a resident who needs care, I do not have to go downstairs to see the treatment. (Nurse)
This study has primarily focused on the ways in which technical components of the EPR were impacting usability for dementia care, a comparison of organisational policies and practices across the three homes revealed the importance of certain factors implicit in the successful adoption of an EPR system [33]
Summary
The electronic patient record (EPR) has been introduced into nursing homes in order to facilitate documentation practices such as assessment and care planning, which play an integral role in the provision of dementia care. Nursing homes currently face a multitude of pressures, such as difficulties in recruiting staff, high employee turnover and low staff morale [1] Added to these pressures is a growing demand for documentation, which has come about from ‘increasing regulatory scrutiny’ [2]. Assessment provides a core set of information from which to identify personalised interventions that maximise an individual’s functionality, so that quality of life can be maintained [4]. These interventions form part of an individual’s care plan [5]
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