Enhancing knowledge management in nursing through documentation

Knowledge management (KM) is the process of catching, improving, sharing and successfully using organizational knowledge obtained using electronic and paper data tools to inform clinical decisions (Girard & Girard, 2015). As colleagues in healthcare can attest, the amount of both patient and administrative data increases exponentially daily, requiring nursing managers, bedside nurses, nurse educators and nurse researchers to be well versed in KM. This requirement is particularly evident in multi-professional healthcare settings. However, when information is not easily accessible, its absence can be detrimental to patients and stressful for nurses. In this editorial, we highlight the essential conditions needed to enhance KM, the importance of the manager and bedside nurse's role in collecting usable and relevant data in healthcare systems using KM principles and practices, and some challenges to implementing KM practices. Issues currently being addressed in Finland provide an example. KM is facilitated by an organizational culture and leadership that promotes the sharing of information, as well as emphasizing individual and collective learning. Consequently, system and leader KM competencies are prerequisites for successful KM. According to a systematic review, nurse managers' KM expertise and leadership abilities are critical to integrate data effectively into everyday practice (Lunden et al., 2017). Moreover, nurse managers and nurses need to be flexible as new technologies such as artificial intelligence (AI) become more common. In their study Laukka et al. (2022) demonstrated that Finnish nurse managers and developers of digital services saw AI transforming work, care and services in Finland. Participants believed that AI's significance will increase as it supports proactive data management (Laukka et al., 2022). Appreciating and implementing the principles and practice of KM means reliable and high-quality data are included in documentation systems such that comparability between different organizations and productivity is improved. Viewed from a reasonable operations perspective, it is important to examine care practices in healthcare organizations, identify and reduce low value care activities that do not benefit patients, can even harm them, and use up healthcare resources (Jackson, 2023). Data produced by technology can reduce task-oriented activities such as storage of visit statistics, which can be facilitated and automated through effective KM and free up time for other nursing care activities. Another benefit of KM is that nurse managers and nurses have access to information more quickly and can make ‘just-in-time’ modifications to staffing and to patient care. In addition, KM principles and practices contribute to developing effective nursing interventions to promotion quality, safety and efficiency of patient care. Recent studies show that KM has been used as an aid to develop predictive models to support decision-making, for example for identifying the suicidal ideation risk among older adults (Kim et al., 2023). Implementing sound KM practices can enable strategies such as the use of benchmarks by which patient care outcomes of one unit may be compared with outcomes of other similar units in order to determine best practices. It is critical that nurses understand why, what and how they should document both for clinical (for patient care) and non-clinical purposes (for statistics and research for example). The advent of Electronic Health Record (EHR) has enhanced the critical role KM principles and practices play enhancing the care patients receive. However, Forde-Johnston et al. (2023), in their integrative review, found use of EHR influences the quality of nurse–patient interactions and communication. It hinders face-to-face communication, promotes task-oriented communication and affects communication patterns. One challenge is educating nurses on the use of technology such as EHR. Uniform recording aims to ensure that patient information is high quality and comprehensive. Information is easier to search for and utilize. Such enhancements require nurses to not only be informed but also direct what information should be collected. Another challenge is that there are numerous EHR programs that are unique, limiting transferability of information (Moy et al., 2023). Structured nursing documentation is not either universal and uniform, also limiting transferability. Structured nursing documentation means the use of classifications of data elements formats such as NANDA-International, earlier known as the North American Nursing Diagnosis Association (NANDA) or the Finnish Care Classification (FinCC). With the help of statistical information obtained from classifications, it is possible to verify what kind of care needs the unit's patients have had and what kind of nursing interventions have been used. Classifications can generate information about the outcomes of nursing practice (Strudwick & Hardiker, 2016). They are prerequisite for AI use to enable more efficient data management (Laukka et al., 2022). However, these practices are limited at best, thus contributing to a significant gap in information sharing to address patient safety and quality issues. Thus, addressing this gap is where technologies such as AI and structured recording play a key role. Finland is one of the leading countries in the use of electronic documentation in the world with both the primary and secondary use of information being legally defined. Government and the public believe social and health information should be made useful and refined into knowledge that helps both the healthcare service system and the individual citizen. Moreover, internationally recognized nursing-sensitive quality indicators such as pressure ulcers, falls that cause harm, and nursing-specific patient feedback connected with the Magnet hospital model from the United States are used and followed nationwide in Finland. Those measures provide data for national and in the future hopefully international benchmarking. Data-based information collection takes place at the national level. However, measuring, monitoring and evaluating nursing-sensitive patient outcomes are not consistent in country. There are differences in the data that are not so much due to the information systems (EHR), but to the way data are recorded in general, and to the fact that there have not always been common metrics. There are many different EHRs and from every EHR data can be not obtained automatically for non-clinical purposes (Moy et al., 2023). Moreover, there are numerous measures to assess the same patient concerns such as pressure injury risk, quality of life or hospital infections. For example, data regarding hospital infections is coded differently in different EHRs and in different healthcare organizations resulting in different classifications that are not compatible, rendering transfer of information impossible, contributing to diminishing communication between healthcare organizations, thus limiting implementation of effective and safe care. In addition, in some healthcare organizations data collection still occurs manually using paper questionnaires. The challenges associated with data reporting procedures hinder the use of information for such undertakings as quality management and development patient-centred care. Different recording practices arise especially when trying to compare one's own organization's data with data from other organizations. Possible reasons for these differences include different documentation practices, missing data and inadequate support of recording and reporting systems. Nurse managers should be aware of the KM principles. They should be involved in multidisciplinary KM teams, have an active and continue dialogue with information system suppliers and demand improvements to information systems and EHRs. Not only do nurse managers have a significant role in how to organize and invest in data collecting and auditing in their units, but they also need to encourage staff nurses to be active participants in documentation, give feedback and allow access to education. Nurse managers can motivate staff by providing them with up-to-date feedback on records and statistics gathered as possible. Nurse managers can use KM to motivate staff nurses to continuously improve their operations. Nurses also have a critical role as knowledge workers in recording patient information and in using KM principles. They have a professional obligation to document as well as maintain and develop their documentation skills. It is an essential aspect of nursing that supports patient safety. Nurse managers in turn need up-to-date information about the demanding level of patient care and adverse events that occur in their units so that they can manage and allocate nurse resources in accordance with the needs of patient care. Nurses' roles can be enhanced by actively providing input in how best to collect data. Inviting nurses to address such question as ‘Should only the adverse events that have occurred be recorded?’ or ‘Should no adverse events also be recorded?’ could enhance practices for data collection. Staff nurses can in turn encourage, educate and support patients and family members giving feedback for example with surveys either on paper or with the help of an electronic application. Using the principles and practices associated with KM, nursing managers and nurses can make invisible nursing work visible. Every day, millions of nurses around the world in various roles record hours of documentation that could be automated to reduce workload and free up time to spend with patients and families. We call on nurses everywhen to be leaders in KM. The authors attest that all work are their own. The opportunity was provided by the ECR of JAN. Many thanks to Dr. D. Jackson for her critical review. The authors do not have relevant political or other affiliations to declare.