An integrative review exploring the impact of Electronic Health Records (EHR) on the quality of nurse-patient interactions and communication

J Adv Nurs. 2023 Jan;79(1):48-67. doi: 10.1111/jan.15484. Epub 2022 Nov 7.

Abstract

Aim: To explore how nurses' use of electronic health records impacts on the quality of nurse-patient interactions and communication.

Design: An integrative review.

Data sources: MEDLINE®, CINAHL®, PscyINFO, PubMed, BNI and Cochrane Library databases were searched for papers published between January 2005 and April 2022.

Review methods: Following a comprehensive search, the studies were appraised using a tool appropriate to the study design. Data were extracted from the studies that met the inclusion criteria relating to sample characteristics, methods and the strength of evidence. Included empirical studies had to examine interactions or communication between a nurse and patient while electronic health records were being used in any healthcare setting. Findings were synthesized using a thematic approach.

Results: One thousand nine hundred and twenty articles were initially identified but only eight met the inclusion criteria of this review. Thematic analysis revealed four key themes, indicating that EHR: impedes on face-to-face communication, promotes task-orientated and formulaic communication and impacts on types of communication patterns.

Conclusion: Research examining nurse-patient interactions and communication when nurses' use electronic health records is limited but evidence suggests that closed nurse-patient communications, reflecting a task-driven approach, were predominantly used when nurses used electronic health records, although some nurses were able to overcome logistical barriers and communicate more openly. Nurses' use of electronic health records impacts on the flow, nature and quality of communication between a nurse and patient.

Impact: The move to electronic health records has taken place largely without consideration of the impact that this might have on nurse-patient interaction and communication. There is evidence of impact but also evidence of how this might be mitigated. Nurses must focus future research on examining the impact that these systems have, and to develop strategies and practice that continue to promote the importance of nurse-patient interactions and communication.

Patient or public contribution: Studies examined within this review included patient participants that informed the analysis and interpretation of data.

Keywords: electronic health record; health information technology; integrative review; nurse-patient interactions; patient communication; person-centred care.

Publication types

  • Review

MeSH terms

  • Communication
  • Electronic Health Records*
  • Humans
  • Nurse-Patient Relations*