Narrative nursing notes in the electronic health record: A key communication tool

Abstract

Documentation of patient conditions and progress toward care plan goals is a long-standing and important aspect of the nursing role. With an increase in electronic health record (EHR) use, there is a growing emphasis on data-driven documentation, and less on traditional narrative nursing notes. Although narrative notes are still used to convey information that may not fit in a structured field within an EHR, there is evidence that indicates clinicians may not be reading them despite their established value. This paper explores the literature regarding clinicians' experiences reviewing clinical information in an EHR, as well as the importance of the information documented in narrative nursing notes. The implications for nursing leaders, nursing educators and nursing informaticians are discussed, as well as recommendations for future research. Documentation of patient care is a fundamental skill used by nurses to communicate the current health status of a patient's individual needs and responses to care (Bjorvell, Wredling, & Thorell-Ekstrand, 2003). Electronic health records (EHR) provide several methods for documenting, including both structured data fields and free-text narrative formats; however, narrative data is not easily analyzed or linked to the structured portion of the patient record. It is also more time-consuming to enter narrative data, and it is not as easily accessed for viewing (Moss, Andison, & Sobko, 2007). Certain nursing specialties, such as psychiatric nursing, rely heavily on narrative notes as they allow the nurses to pull together events and information in a meaningful way within an environment that is subjectively experienced, as well as to document time-oriented events (Hall & Powell, 2011). Studies such as those done by Rosenbloom et al. (2011) and Collins et al. (2013) have shown that nurses also use narrative notes to convey important information and communicate concern for the patient. However, several other studies, such as those done by Kossman and Scheidenhelm (2008); Brown, Borowitz and Novicoff (2004); and Hripcsak, Vawdrey, Fred, and Bostwick (2011) have found that clinicians are not reading narrative nursing notes entered into the EHR. Therefore, it is important to understand the implication of this, as these notes are important communication tools utilized by nurses and are information-rich parts of any patient's EHR.