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Nurses' Perception of Nursing Services Documentation Barriers

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Nurses' Perception of Nursing Services Documentation Barriers Electron J Gen Med 2018;15(3):em28 ISSN:2516-3507 OPEN ACCESS Original Article https://doi.org/10.29333/ejgm/86184 Nurses’ perception of nursing services documentation barriers: a qualitative approach Seyed Majid Vafaei1, Zahra Sadat Manzari2, Abbas Heydari3, Razieh Froutan4, Leila Amiri Farahani5 ABSTRACT Background: Researches has shown that the quality of nursing documentation services in the world, including Iran, is far from existing standards. Understanding the barriers to improving the documentation of nursing services is essential for the first step. The aim of this study was to identify barriers to improving the nursing documentation services using the experience of nurses in the emergency department of one of the Iranian hospitals. Materials and Methods: This study is based on content analysis in accordance with the style of Graneheim in 2017 in the emergency department of one of the Iranian hospitals. This qualitative study was performed on 20 participant from different nursing grades including 17 nurses, 1 head nurse, and 2 members of the accreditation committee. The data were collected through semi-structured interviews and using interview guide and field note. Results: Research data have been explained in four main themes of qualification of documentation including sub-categories of the need for effective training, the need for training in the standards of documentation, and the necessity of skills in reporting; job burnout including sub-categories of job stress and work pressure; perceived control including sub-categories of planned control and effective monitoring and control; intra-organizational coordination including sub-categories of improving health information system and documentation management time, legal barrier for documentation including sub-categories of escaping from the law and legal liabilities. Conclusion: In this study, 599 primary codes were extracted and the main themes documentation competency, job burnout, perceived control, intra- organizational coordination, and legal barrier extracted. Keywords: qualitative approach, barriers, nursing services documentation INTRODUCTION Documentation is an important factor in improving the quality of nursing care, and quality promotion is an effective factor in the transparency of nursing practice (1). Researches shows that the quality of documentation of patients’ files is not satisfactory and is not in accordance with nursing standards (1-3). Several methods are used, such as workshop training, continuous and planned monitoring, the use of documentary evidence-based procedures, document service audits, and reduced work pressure to improve the documentation of nursing care (4-7). In Iran, this problem is more prominent than other developed countries in the world, which we are trying to improve the conditions and bring them closer to standards. In this regard, many descriptive studies have been done on the documentation of nursing services, but these studies have not significantly improved. In the research environment, a preliminary study showed that the current documentation has many problems, and the researcher’s observations, which have been present in this environment for many years, are in agreement with this issue. Introduction to intervention In this regard, understanding the experiences of nurses working in the research environment is a barrier to the documentation of nursing services so that effective interventions can be planned and, on the other hand, they also insure the participation of nurses. Accordingly, this study aims to identify 1 PhD candidate in Nursing, School of Nursing and Midwifery, Mashhad University of Correspondence: Zahra Sadat Manzari Medical Sciences, Mashhad. Iran. Email: [email protected] Assistant Professor, Medical-Surgical Nursing Department, Faculty of Nursing and 2 Assistant Professor, Medical-Surgical Nursing Department, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran. Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran. Tel: +98 5138591511 3 Department of Medical- Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran. E-mail: [email protected] 4 Assistant Professor, Medical-Surgical Nursing Department, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran. 5 Assistant professor Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran. Received: 4 Jan 2018, Accepted: 13 Feb 2018 © 2018 by the authors; licensee Modestum Ltd., UK. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/). Electronic Journal of General Medicine Vafaei et al. / Triage Methods in Children, A Systematic Review these barriers nurses’ perception of nursing services documentation in the emergency department of one of the hospitals in Iran. RESEARCH METHOD Content analysis strategy has been used in this research. Participants were selected based on purpose from among the emergency department staff at one of the Iranian hospitals. It is a state-owned hospital covered by a medical university with 240 active beds. Participants working in the Emergency Department Hospital with diverse backgrounds and undergraduate nursing graduates were male and female. Accordingly, the researcher conducted 20 semi- structured interviews with 13 contributors. Terms of participation Participants in the research had at least one year of work experience in the emergency department and were involved in the process of documentation of nursing services. Sampling was initially based on the purpose and then on the development of the theory and data collection based on Snowball sampling. The data of this study was collected through semi-structured interviews with 20 persons involved in nursing documentation, which had at least one year of work experience and 20 hours of observation. Data collection was started from clinical nurses and then extended to other groups according to the extracted data and codes. This qualitative study was performed on 20 participant from different nursing grades including 17 nurses, 1 head nurse, and 2 members of the accreditation committee nurses, 2 medical doctor and one matron. The interview guide included several open questions to allow participants to express their perceptions and experiences in detail. The length of the interview varied from 65 minutes to 30 minutes to 90 minutes depending on the participants’ circumstances. At the beginning of each interview, participants were asked to describe their work day. They were then asked to describe their perceptions and practices regarding how to document nursing care. After each interview, the recorded information was examined and then the interviews were transcribed word by word. The recorded information was typed and re- matched with the recordings; this action was taken to increase the accuracy of the information recorded and to allow researchers to gain more control over the information provided. Therefore, based on this, the following were removed, respectively, by the implementation of the word-for-word interview bar immediately after each interview, by reading the entire text several times to obtain a general understanding of the content, the division of the text into meaning, Extracting a summary of semantic and coding units, classifying primary codes into subcategories and hands based on comparing their similarities and differences, and finally extracting categories as the expression of latent content in the data that results from Each unstructured interview was the guide for the next interview, so sampling continued until saturation. The research question was: What are the barriers and problems associated with documentation with regard to the experiences of nursing staff in the emergency department? The validity and reliability of the present study are rooted in four dimensions of credibility, Dependability, conformability, and transferability (8). Credibility of this research was obtained through continuous engagement to the participants and the research data, and the correctional views of the experts in the process of interviews and the analysis of the extracted Credibility d data were used. In addition, the text of interviews, extracted codes, and subcategories were shared with some contributors. Integration was used in the data collection method and attempts have been made to select the a variety of samples so that staff from different groups depending on the type of responsibility, use of the opinion of experts outside the research team to evaluate the coordination of the findings, interpret and conclusions based on data could be provided. In the case of conformability, all the activities carried out, including the stages of the work and how the data were obtained, were carefully recorded. Finally, for transferability of the research findings, efforts were made to share the information obtained with an individual outside the research environment where the situations was similar to the participants in the research, and the results would be matched with his experiences. In this research, the purpose of the research is to explain the interview method. This study has been approved by the University’s Ethics Committee of Mashhad University Health Sciences under the code 940864. To respect ethics in the research, consent has been obtained from all the
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