Abstract：
BACKGROUND: The time that nurses spent on documentation can be substantial and burdensome. To date it was unknown if documentation activities are related to the workload that nurses perceive. A distinction between clinical documentation and organizational documentation seems relevant. This study aims to gain insight into community nurses\' views on a potential relationship between their clinical and organizational documentation activities and their perceived nursing workload.
METHODS: A convergent mixed-methods design was used. A quantitative survey was completed by 195 Dutch community nurses and a further 28 community nurses participated in qualitative focus groups. For the survey an online questionnaire was used. Descriptive statistics, Wilcoxon signed-ranked tests, Spearman\'s rank correlations and Wilcoxon rank-sum tests were used to analyse the survey data. Next, four qualitative focus groups were conducted in an iterative process of data collection - data analysis - more data collection, until data saturation was reached. In the qualitative analysis, the six steps of thematic analysis were followed.
RESULTS: The majority of the community nurses perceived a high workload due to documentation activities. Although survey data showed that nurses estimated that they spent twice as much time on clinical documentation as on organizational documentation, the workload they perceived from these two types of documentation was comparable. Focus-group participants found organizational documentation particularly redundant. Furthermore, the survey indicated that a perceived high workload was not related to actual time spent on clinical documentation, while actual time spent on organizational documentation was related to the perceived workload. In addition, the survey showed no associations between community nurses\' perceived workload and the user-friendliness of electronic health records. Yet focus-group participants did point towards the impact of limited user-friendliness on their perceived workload. Lastly, there was no association between the perceived workload and whether the nursing process was central in the electronic health records.
CONCLUSIONS: Community nurses often perceive a high workload due to clinical and organizational documentation activities. Decreasing the time nurses have to spend specifically on organizational documentation and improving the user-friendliness and intercommunicability of electronic health records appear to be important ways of reducing the workload that community nurses perceive.
METHODS: A convergent mixed-methods design was used. A quantitative survey was completed by 195 Dutch community nurses and a further 28 community nurses participated in qualitative focus groups. For the survey an online questionnaire was used. Descriptive statistics, Wilcoxon signed-ranked tests, Spearman\'s rank correlations and Wilcoxon rank-sum tests were used to analyse the survey data. Next, four qualitative focus groups were conducted in an iterative process of data collection - data analysis - more data collection, until data saturation was reached. In the qualitative analysis, the six steps of thematic analysis were followed.
RESULTS: The majority of the community nurses perceived a high workload due to documentation activities. Although survey data showed that nurses estimated that they spent twice as much time on clinical documentation as on organizational documentation, the workload they perceived from these two types of documentation was comparable. Focus-group participants found organizational documentation particularly redundant. Furthermore, the survey indicated that a perceived high workload was not related to actual time spent on clinical documentation, while actual time spent on organizational documentation was related to the perceived workload. In addition, the survey showed no associations between community nurses\' perceived workload and the user-friendliness of electronic health records. Yet focus-group participants did point towards the impact of limited user-friendliness on their perceived workload. Lastly, there was no association between the perceived workload and whether the nursing process was central in the electronic health records.
CONCLUSIONS: Community nurses often perceive a high workload due to clinical and organizational documentation activities. Decreasing the time nurses have to spend specifically on organizational documentation and improving the user-friendliness and intercommunicability of electronic health records appear to be important ways of reducing the workload that community nurses perceive.
摘要：
背景：护士在文档上花费的时间可能是大量和繁重的。迄今为止，尚不清楚文档活动是否与护士认为的工作量有关。临床文档和组织文档之间的区别似乎是相关的。本研究旨在深入了解社区护士对其临床和组织文档活动与其感知的护理工作量之间潜在关系的看法。
方法：采用收敛混合方法设计。由195名荷兰社区护士完成了定量调查，另外28名社区护士参加了定性焦点小组。在调查中使用了在线问卷。描述性统计，威尔科克森签名排名测试，采用Spearman秩相关和Wilcoxon秩和检验对调查数据进行分析。接下来,四个定性焦点小组在数据收集-数据分析-更多数据收集的迭代过程中进行，直到数据达到饱和。在定性分析中,遵循主题分析的六个步骤。
结果：大多数社区护士由于文档活动而感到工作量很大。尽管调查数据显示，护士估计他们在临床文档上花费的时间是组织文档的两倍，他们从这两种类型的文档中感知到的工作量是相当的。焦点小组的参与者发现组织文件特别多余。此外，调查表明，感知到的高工作量与花费在临床文档上的实际时间无关，而在组织文档上花费的实际时间与感知的工作量有关。此外,调查显示,社区护士感知的工作量与电子健康记录的用户友好性之间没有关联.然而，焦点小组的参与者确实指出了有限的用户友好性对他们感知的工作量的影响。最后,感知的工作量与护理过程是否在电子健康记录中处于中心地位之间没有关联.
结论：社区护士通常由于临床和组织文件活动而感到工作量很大。减少护士必须专门花费在组织文档上的时间，提高电子健康记录的用户友好性和可通信性似乎是减少社区护士认为的工作量的重要途径。
方法：采用收敛混合方法设计。由195名荷兰社区护士完成了定量调查，另外28名社区护士参加了定性焦点小组。在调查中使用了在线问卷。描述性统计，威尔科克森签名排名测试，采用Spearman秩相关和Wilcoxon秩和检验对调查数据进行分析。接下来,四个定性焦点小组在数据收集-数据分析-更多数据收集的迭代过程中进行，直到数据达到饱和。在定性分析中,遵循主题分析的六个步骤。
结果：大多数社区护士由于文档活动而感到工作量很大。尽管调查数据显示，护士估计他们在临床文档上花费的时间是组织文档的两倍，他们从这两种类型的文档中感知到的工作量是相当的。焦点小组的参与者发现组织文件特别多余。此外，调查表明，感知到的高工作量与花费在临床文档上的实际时间无关，而在组织文档上花费的实际时间与感知的工作量有关。此外,调查显示,社区护士感知的工作量与电子健康记录的用户友好性之间没有关联.然而，焦点小组的参与者确实指出了有限的用户友好性对他们感知的工作量的影响。最后,感知的工作量与护理过程是否在电子健康记录中处于中心地位之间没有关联.
结论：社区护士通常由于临床和组织文件活动而感到工作量很大。减少护士必须专门花费在组织文档上的时间，提高电子健康记录的用户友好性和可通信性似乎是减少社区护士认为的工作量的重要途径。
