The EHR’s Impact on Nurse-Patient Communication
While I love technology for what it can do for clinician workflow and for patient care – it can get in our way. One of the biggest concerns is the use of the EHR while at the patient’s bedside. I once watched an emergency department (ED) nurse stand about 10 feet away from her elderly (and somewhat hard of hearing patient) and literally yell the assessment questions. Why? Because her computer cart didn’t have enough charge to allow her to unplug it and move next to the patient. She told me that because the ED was so busy they didn’t have time to leave the carts unused long enough for them to recharge.
Computer carts can also be problematic if there is not enough space to roll them into the patient’s room. An empty room may look like it has plenty of room for computing carts, but once multiple pieces of equipment such as IV pumps, dialysis machines, etc. plus family members, the space is used up rapidly.
But are bedside wall mounted computers the answer?
Well, yes and no. Depending on the room configuration, the placement may be less than desirable, leading to poor ergonomic positioning for the nurse. And if that is the only computer access in the room, what happens when two people need to use it? And will it even get used? I have seen multiple facilities with dust covered in room computers. The reality is that most healthcare professionals are not comfortable with documenting at the bedside for a variety of reasons that we won’t discuss today.
There are two major reasons why nurses should be facing their patients – one is obvious. Who can have a meaningful conversation with a patient or their family while looking at a computer screen? All the non-verbal communication is missed and it is next to impossible to establish a trusting relationship when you are looking elsewhere.
But another reason that many people don’t consider is the nurses’ personal safety. In my years of practice, I have been assaulted by angry and/or impaired individuals, and even by frail elders with dementia – don’t ever let anyone tell you it doesn’t hurt to get bitten by someone without teeth! There are many patients that we simply dare not turn our backs on – even for a moment.
These factors limit the amount of data entry that is done by nurses at the point-of-care. Delayed charting increases the chances of missing or incorrect data, which could have a negative outcome on patients.
But the advent of handheld devices that can be used easily for collecting flowsheet data while allowing the nurse to be right next to the patient – regardless of room configuration or amount of available space – can change the equation. When patients ask a question about their care such as ineffective pain management, how much easier is it for the nurse to pull a device out of their pocket, scan the patient’s wristband to open the correct patient record, then have a discussion about pain management. Add to that the ability to send a secure text to the physician right from the bedside so that the patient knows their concern has immediately addressed.
This is using technology to enhance patient communication – would you agree?