“Transition in and between Discourse Communities: One Nurse’s Struggle”
by Terri Cole | Xchanges 9.2
Writing in Nursing
Nurses have endless amounts of information to learn and tasks to perform. They provide patient care, which in itself consists of administering medication, educating patients and families, bathing, changing, helping patients to the bathroom, restraining patients, calming down family members, and the list continues. Nurses also document patient care. As Lena reveals: “We all [nurses] rely on writing the moment we walk in the door.” In order for nurses and any medical staff to provide constructive care, tasks and procedures must be documented. Nurses record patient care and patient outcomes in order to inform the subsequent nurse or doctor about patient history and treatment plans. Writing, therefore, is crucial in nursing—for patient safety, but also for the hospital accountable for their staff conducting the appropriate measures.
Nurse documentation includes many forms or genres: Care Plans, Admission History, Continuity of Care Forms, Care Documentation Form, Progress Notes, Change-of-Shift Report, Pre-Procedure Check Lists, and other genres that are specific to the nursing unit. Furthermore, nurses are continually shifting between their nursing and documentation roles, and documentation roles are also shifting from the computerized to handwritten.
The Obama administration recently instituted a mandate for all hospitals to use electronic medical records in order to implement what they call “Meaningful Use Data” and “Pay for Performance” strategies and to invoke reform in hospitals. The Sherwood Hospital, where Lena works, has begun this implementation by use of portable computers which nurses use to document patient care. The software is designed in an orderly and standardized structure so that the nurse must complete one priority task in order to proceed to the next. The electronic medical records are used in almost every literacy practice nurses engage in, with the exception of Patient Care Plans, Shift Reports, and Continuity and Care Plans, each of which combines electronic, written, and even verbal modes of communication.
Technology affects not just the way documentation is carried out in nursing but also the ways in which nurses negotiate social status within the community. Cook-Gumperz and Hanna (1997) found “the social status of nurses in the hospital hierarchy increased when they started using bedside computer terminals to chart patients’ conditions and accessing database tools for patient assessment” (p. 318). However, Beaufort (2000) notes that “nurses’ use of bedside computers to chart patients’ conditions and access databases for diagnostic purposes both depersonalized the writing for the nurses and raised the visibility of the nurses’ observations to the rest of the medical staff” (p. 225). In sum, technological tools in nursing can result in a lack of authority in documentation practices, creating an additional level of struggle for neophytes like Lena.