“Lost in translation”: The challenges of seamless integration in nursing practices

PurposeTo explore and characterize how the implementation and use of an electronic nursing module supports the care process, the interrelation of interdisciplinary documentation and the role of redundant information in the interplay between technology and clinical practice.MethodA qualitative case study was carried out at a surgical ward and a post-anesthesia care unit (PACU). A mixed method of data collection was used, including semi-structured interviews, observation and document analysis.ResultsThe study revealed that the electronic care plan was used in daily practice, and international nursing classifications were extensively used. However, the study also illustrates a gap between nurse-specific documentation (care plans) and other sources of information used in the documentation of the care process, such as the medication sheet, medical chart, and a custom-designed medical chart used by the post-anesthesia care unit (PACU). Moreover, the study also highlights how redundant information can serve as a “glue” in the socio-technical network to facilitate information sharing and coordination across domain-specific boundaries.ConclusionDifferentiating between negative and positive redundancy provides increased understanding of how the correlation of supplementary information has a role in the integration between work processes and computer systems. Coordination and pragmatic redundancies are emphasized to inform the further design and implementation of process-based electronic patient records (EPR).

► A case study of the implementation and use of standardized terminologies in nursing.
► High percentage of terminologies in use as an embedded part of guiding care plans.
► A collective achievement in which standards were co-constructed and facilitated communication and coordination among nurses in local practice.
► Use of correlated and supplementary information to maintain integration across domain-specific boundaries.