Impact Of An Educational Program And Electronic Nursing Documentation On The Quality Of Nursing Care Process March 2022

Abstract

Purpose:

The purpose of this study was to assess the effectiveness of the educational program "Guided Clinical Reasoning" (GCR) and the implementation of an intelligent electronic nursing documentation system (e-doc) on the quality of the nursing process.

Methods:

The evaluation was conducted at three different measurement points using the "Quality of Nursing Diagnoses, Interventions, and Outcomes" (Q-DIO) instrument.

Findings:

Results indicated that GCR yielded the highest Q-DIO scores, suggesting its effectiveness in enhancing the quality of the nursing process. However, no long-term effect was observed after the cessation of GCR. Conversely, the e-doc system produced the lowest scores, although it provided adequate support for utilizing nursing diagnoses

Conclusions:

While e-docs have the potential to assist in conducting the nursing process, this study underscores the importance of clinical reasoning for meaningful utilization of electronic documentation systems.

Background

In 2004, a midsized Swiss general hospital implemented the nursing process based on the NNN taxonomy. To facilitate this implementatio[1]n, an educational program known as "Guided Clinical Reasoning" (GCR) was introduced (see Table 1). A pre-test/post-test evaluation study conducted in 2005 revealed significant improvements in the quality of documentation, including assessment, nursing diagnoses (ND), interventions, and outcomes (p < .0001) (Müller-Staub et al., 2007).

To further enhance the quality of the diagnostic process, an advanced version of GCR was conducted in 2006. This was followed by a randomized intervention study comparing a traditional case study group (control group) with an intervention group receiving GCR. In the control group, nurses were simply informed about the link between ND, interventions, and outcomes before engaging in discussion. In contrast, the intervention group underwent training in critical thinking and clinical reflection through GCR, which encouraged them to establish evidence-based connections between ND, effective interventions, and nursing-sensitive outcomes (Müller-Staub, Needham, Odenbreit, Lavin, & van Achterberg, 2008).

Despite investing the same amount of time in both groups, the intervention group receiving GCR demonstrated significantly higher accuracy in nursing diagnoses, effectiveness of interventions, and improved patient outcomes (p < .0001).