"Når den elektroniske børnejournal åbnes for forældre-hvilke udfordringer giver det sundhedsplejerskerne?"

Abstract

Indenfor de sidste år er der kommet mere fokus på, at borgere og patienter skal kunne tilgå deres elektroniske patientjournal via offentlige portaler. Også i sundhedsplejen er dette tilbud ved at blive realiseret, nemlig at forældre kan få adgang til deres barns elektroniske børnejournal. Lige nu er det ikke via en offentlig portal, men via et firma der udbyder elektroniske børnejournaler til sundhedsplejen. Det er ikke et tilbud for alle forældre i alle kommuner, men for de kommuner der benytter dette journalsystem, og hvor sundhedsplejerskerne har tilvalgt denne service. I dette projekt sættes der fokus på, hvilke udfordringer sundhedsplejerskerne får omkring arbejdsgangen journalskrivning, når forældre samtidig får tilgang til deres barns elektroniske børnejournal. H. J. Leavitts systemiske organisationsmodel er brugt til at uddybe relevante områder indenfor de fem komponenter, omverden, aktører, opgaver, teknologi og struktur, der har relation til ovenstående arbejdsgang. Ved hjælp af en sammenhængsanalyse mellem komponenterne fremkommer der flere umiddelbare udfordringer for sundhedsplejerskerne. For at få en yderligere viden om de udfordringer sundhedsplejerskerne oplever i deres praksis udføres fire kvalitative interviews af sundhedsplejersker fra forskellige kommuner. De kvalitative interviews udføres ved hjælp af Kvale og hans metode, hvor der tages udgangspunkt i en fænomenologisk, hermeneutisk, dialektisk og postmodernistisk tilgang. Der udføres en tolkning af interviewene på de tre niveauer, selvforståelses niveauet og kritisk common sense niveau og det teoretiske niveau. Teorien der benyttes på det teoretiske niveau er E. Scheins kulturteori, som bidrager med kulturens betydning i forhold til sundhedsplejerskernes praksis. Desuden benyttes G. Batesons kommunikationsteori der har fokus på kommunikationens formelle aspekter og dennes betydning for sundhedsplejerskernes praksis i relation til journalføring. Umiddelbart oplever sundhedsplejerskerne ikke de store udfordringer, når forældre kan tilgå deres barns elektroniske journal, men ved at gå bag om sundhedsplejerskernes grundlæggende antagelser om journalføring, så opstår der flere udfordringer. Der er en formidlingsudfordring, idet formålet med de notater forældre kan tilgå er uklart. Sundhedsplejerskerne blander to metabudskaber sammen nemlig sundhedsplejerskens dokumentation og et skriftlig notat til forældrene (Barnets Bog notat), hvilket har betydning for notatets nytteværdi og den sproglige fremstilling. Der er en juridisk udfordring i forhold til, hvor forskellige oplysninger skal journaliseres, da journalsystemet ikke er opbygget i henhold til lovgivningen, som kræver en journal pr. person. Hvis ”Barnets Bog” bliver digitaliseret nationalt, vil der komme en udfordring i forhold til at bruge notaterne som et dokumentationsredskab i det tværfaglige samarbejde med andre sundhedspersoner. Lige nu oplever sundhedsplejerskerne ikke, at notater til Barnets Bog bruges som et tværfagligt redskab. Til sidst er der tekniske udfordringer i forbindelse med forældrenes log in til deres barns elektroniske børnejournal, som har krævet sundhedsplejerskernes tid. Alt i alt bliver fremtidens udfordring for sundhedsplejerskerne, at skrive journaler så man ikke går på kompromis med egen faglighed samtidig med, at forældrene forstår journalnotatets indhold i den tiltænkte kontekst.

Over the recent years, there has been increasing focus on providing access for citizens and patients to their electronic patient file through public internet portals. This also applies to children’s health care, where parents can access the electronic record of their child. At the moment it is not through a public internet portal but through a company based portal, provided by the company which has developed the software used for keeping electronic records for the children’s health care system. Therefore, access is not offered to all parents but only to parents who live in municipalities which use this software and whose health visitors have chosen to open the records for parents. The scope of this project is to identify the challenges that meet the children’s health visitors when they write the electronic child’s record, when this is fully accessible for the parents. The organizational model of Leavitt is applied in the description of relevant aspects of keeping electronic children’s records within the following 5 components: outside world/surroundings, actors, tasks, technology and structure. By using this model several apparent challenges for the health visitors are identified. To further gain insight into the challenges that health visitors experience in relation to the fully accessible electronic child’s record, 4 qualitative interviews are conducted with health care visitors from 4 different municipalities. The interviews are performed according to the methodology of Kvale, with emphasis on phenomenological, hermeneutical, dialectic and post modernistic aspects. The interviews are interpreted on three levels; the level of self comprehension, critical common sense and theoretical level. E. Scheins cultural theory is used at the theoretical level, which contribute with respect to the importance of culture in relation to the custom and practice of the health visitors. Furthermore, the Bateson’s communication theory is used. His theory focuses on the formal aspects of communication and is used in the evaluation of the importance of communication in relation to medical record keeping by health visitors. Initially, the health visitors do not see any major challenges emerge as parents can access their child´s electronic record, but more challenges arise as the interviews progress and the health visitor’s basic assumptions regarding the medical record-keeping are questioned. There is a communication challenge merely because the purpose of the child´s electronic record is obscure. The health visitors mix up two meta-messages namely the documentation in the child’s electronic record and a written note for the parents as a part of “Barnets Bog”. This has implications for the linguistic style and for the usefulness of the written record. There is a legal challenge, since the current child’s electronic record does not fulfill the legislation, which demands separate records for each person in a family. If “Barnets Bog” is to be digitalized nationwide, this will impose a challenge concerning the use of the records as a tool of documentation and information between different health care professionals. Currently, the health visitors do not experience that notes for “Barnets Bog” are used in the interdisciplinary collaboration. Finally, as technical difficulties such as log in problems are experienced by parents, the health visitors are involved in the solution of these problems. This is time consuming for the health visitors. All in all, the future challenge of health visitors will be to write the child’s electronic record without compromising the professional competency but at the same time to ensure that parents understand the content of the record in the intended context.

A master programme thesis from Aalborg University

"Når den elektroniske børnejournal åbnes for forældre-hvilke udfordringer giver det sundhedsplejerskerne?"

["When the electronic child record becomes fully accessible for parents - what challenges will meet the health visitors?"]