Table 2:
Survey comments distribution by level and theme with example quotes.
| Level | Theme | Number of comments (% out of total comments)* | Example quotes |
|---|---|---|---|
| USER-TASK ISSUES | Systems fail to meet nursing clinical needs | 81 (28.6) | “The development of nursing information system is not based on nursing needs [China]”; “Hard to tell the patient story [U.S.]”; “Continuing invisibility of nursing’s contribution to outcomes [U.S.]”; “Currently doesn’t feel like it enhances live patient care [Australia].” |
| Systems are not nursing specific | 46 (16.3) | “Nursing documentation is driven by accreditation & regulatory needs rather than by what actually makes a difference to the patients/families/populations [U.S.]”; “[Systems] Need more focus on nursing care (processes, measurable tasks, outcomes associated with nursing Interventions) - needs to be more intuitive to nursing knowledge [U.S.]”; “Systems do not adequately reflect nursing practice, especially the critical thinking and the processing of data and information to knowledge [U.S.].” | |
| SYSTEM ISSUES | Poor system usability | 88 (31.1) | “Poor interface design [Taiwan]”; “Very time consuming and duplicative[Finland]”; “Documentation can be hard to find. Especially in non discrete data driven areas of the hospital- like behavioral health, social services, physical and speech therapies [U.S.]”; “Too many keystrokes, and nuisance alerts [U.S.].” |
| Non- integrated systems and poor interoperability | 67 (23.7) | “[Systems are] Scattered, hard to integrate [China]”; “For care coordination and achievement of the Triple Aim, Need more Health Information Exchanges between community - acute - primary care [U.S.]”; “Lack of interoperability with other systems [U.S.].” | |
| Lack of standards & standardization | 39 (13.8) | “There is very little to no standardization on documentation to facilitate information management and retrieval [Philippines]”; “Little, if any, implementation or use of standardized terms outside of physician practice (CPT or ICD-9/ICD-10) [U.S.]”; “Little comparison of the effect of clinical practice on patient outcomes - no clear way to compare since there is no standardization of terms[Philippines]”; “A great deal of information is not standardized without standard terminologies [U.S.].” | |
| Limited functionality/missing components | 58 (20.5) | “Missing process support and a long list of small details, missing functionality for check lists [Sweden]”; “Care Management options are limited [U.S.]”; “Pediatric content is limited in both Home Health and Hospital systems and must be created [U.S.].” | |
| ENVIROMENT ISSUES | Low prevalence of EHR systems | 30 (10.6) | “Unfortunately 95% nursing records are manual records [Venezuela]”; “Few electronic records are being used [South Africa]”; “Still using paper based systems for nursing documentation with minimal electronic records [Australia].” |
| Lack of user’s training | 21 (7.4) | “Users don’t know how to use the system [U.S.]”; “Need more awareness and inservice training for Indian Nurses [India]”; “Only very few professionals are qualified or trained to practice computerized documentation [Philippines].” | |
| Other | 32 (11.3) | “Lack of participation from clinical staffs in system development [Taiwan]”; “I know nothing about how nursing EHR is created because it is controlled by our vendor [U.S.]”; “No support from the authorities [Argentina]”; “Poor understanding of the implementation of computerized documentation in nursing, both by managers as the professionals themselves [Brazil].” | |
| Total comments | 283 |
*
Number of comments refers to the proportion of comments reported by individual respondents, e.g., 81 comments about systems that fail to meet nursing clinical needs/ 283 comments total= 28.3%.