Accepted Manuscript

What is the Problem with Nursing Documentation? Perspective of Indonesian

Nurses

Hajjul Kamil, R. Rachmah, Elly Wardani

PII: S2214-1391(17)30120-8
DOI: https://doi.org/10.1016/j.ijans.2018.09.002
Reference: IJANS 112

To appear in: International Journal of Africa Nursing Sciences

Received Date: 8 December 2017

Revised Date: 26 September 2018
Accepted Date: 27 September 2018

Please cite this article as: H. Kamil, R. Rachmah, E. Wardani, What is the Problem with Nursing Documentation?
Perspective of Indonesian Nurses, International Journal of Africa Nursing Sciences (2018), doi: https://doi.org/
10.1016/j.ijans.2018.09.002

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers
we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and
review of the resulting proof before it is published in its final form. Please note that during the production process
errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
 TITLE PAGE

Research Title:

What is the Problem with Nursing Documentation? Perspective of Indonesian Nurses

Authors:

Dr. Hajjul Kamil*

Associate Professor

Rachmah, R., MN*

Senior Lecturer

Elly Wardani, MS., PhD*

Senior Lecturer

Postal Address:

*Nursing Leadership and Management Department

Faculty of Nursing, Syiah Kuala University
Jalan Tengku Tanoh Abee Darussalam, 23111
Banda Aceh-Indonesia

Corresponding author e-mail:

ellywardani@unsyiah.ac.id

Acknowledgements:

The research is part from Penelitian Unggulan Universitas (University Excellent Research) funding
scheme, grant number: 73/UN11.2/PP/PNBP/SP3/2017, Syiah Kuala University. Our thanks to all
the nurses involved for their time and knowledge on this study.
Original Article

What is the Problem with Nursing Documentation? Perspective of Indonesian Nurses

Abstract

Background

Nursing documentation reflects the quality in patient care. It promotes effective communication

between caregivers. However, although its significance has been discussed in numerous articles,

nursing documentation remains problematic in Indonesia.

Objective

This research was the first of its kind in Indonesia which aim to identify issues with nursing

documentation.

Method

A qualitative approach through focus group discussions (FGD) with head nurses and staff was

conducted to identify problems that hinder nurses’ abilities to follow proper documentation

procedure in an urban hospital in Indonesia. The nurses who have more than one year work

experience were recruited through simple random technique. There were 35 participants involved.

The open-ended questions regarding the nursing documentation process were administered. The

group discussions were held two times on each teams and conducted separately between the head

nurses and their staff. The data for this descriptive qualitative study were recognized through

content analysis methods.

Results

The results of the study were captured in three themes: (1) Inadequate supervision for nurses on

nursing documentation; (2) Competency issues in documentation; (3) Lack of confidence and

motivation on documentation.

Conclusion

Education is amongst the top listed contributing factors for quality nursing documentation. This is

confirmed with this research. The findings of the study suggest the need for continuous support and

educational intervention to ensure adherence to the nursing documentation procedure.

Key words: Indonesia; Nursing documentation; Nurses competency; Patient report; Quality
 Introduction

As prominent care provider, nurses have continual direct contact with patients. Such conditions

place nurses in the critical position of maintaining detailed documentation to ensure all health-care

team members are well-informed to any changes in a patient’s health status (Mbabazi & Cassimjee,

2006). An array of literature has underlined the importance of nursing documentation. For instance,

accurate documentation promotes communication and collaboration, aids in the legal aspect of the

process and outcomes of care, facilitates patient care decisions and safety, and fulfills professional

and practice standards (Blake‐Mowatt, Lindo, & Bennett, 2013; Jefferies, Johnson, & Griffiths,

2010). The inclusion of documentation as a pertinent role of nurses’ professional practice started

with Florence Nightingale (Iyer & Camp, 2004). Up to now, it is still recognized as one of the

important core competencies (Asamani, Amenorpe, Babanawo, & Ansah Ofei, 2014;

Cheevakasemsook, Chapman, Francis, & Davies, 2006; Lindo et al., 2016). This is because

information provided in nursing documentation reflects the complete series of nursing processes

ranging from nursing assessments and diagnosis, nursing interventions, nursing care

implementation and evaluation, and, ultimately, patient response and outcomes (Austin, 2011;

Higginbotham & McCarthy, 2001).

Nonetheless, documentation is one of the most disputed and dubious nursing roles (Heartfield,

1996) because it is interpreted differently across settings or even summarily dismissed as a

misrepresentation of nursing care. This could be true considering that attention on nursing

documentation is somewhat unpopular and often perceived not as being important as hands on

nursing care (Hoban, 2003). Hand-written nursing report, in particular, historically seen as nurses
ritual and mostly provide inadequate information (Hager & Munden, 2008) since it tends to be

messy and hard to read. Despite the availability of technology for accuracy in patient care

documentation in some settings, it does not necessarily uplifted problems that nurses’ encounter on

patient report (Whittaker, Aufdenkamp, & Tinley, 2009). Nurses’ major barriers on proper report

that extensively reported include time constraints, disproportion between staffing resources and

workload, insufficient guidelines for completing documentation, institutional policies (Kärkkäinen

& Eriksson, 2005; Laitinen, Kaunonen, & Åstedt‐ Kurki, 2010), and discontinuity on education as

underlying problem related to documentation was also found (Blair & Smith, 2012); thus education

is amongst the top listed contributing factors to ensure quality nursing reports which is

aimed at improving and maintaining the standard of documentation (Noorkasiani, Gustina, &

Maryam, 2015).

Evidence on hurdles around patient care documentation is globally identified. These, however, were

mostly reported findings in developed countries. Limited studies are available on nursing

documentation in developing countries compared to other issues such as inadequacy of nurses or

workplace facilities (Nakate, Dahl, Petrucka, Drake, & Dunlap, 2015). Indonesia, as one of

developing country in Asia is yet struggling with this issue. Nursing as professional relatively new

in the country. In terms of nursing availability, Shields et al. found that there were about 50 nurses

per 100,000 people in Indonesia (Shields & Hartati, 2003). Most of these nurses were educated at

diploma level, known as Akademi Keperawatan, in both private and public institutions. More

recently, the nursing profession in Indonesia has been striving to develop competency assessments

and accreditation procedures. Each level of nursing education has been standardized and accredited

for decades by referring to Presidential Act No. 8, 2012, regarding the Indonesian National

Qualification Framework (Indonesian National Nurses Association . The aforementioned Act is a

general rule for all Indonesian professionals. After a significantly long process, the Nursing Law

(Undang-Undang Keperawatan) was passed by the country’s legislature under Bill No. 38/2014

(Indonesian National Nurses Association (INNA), 2014). The law addresses several critical areas

such as legal protection for nursing professionals, the organisation, and professional education for

nurses. In addition to this, nurses in Indonesia are expected to adhere to a code of conduct

standardised by INNA. These professional standards involve nurses’ responsibility for clients,

nurses and their best practice, community, colleagues, and their own profession (PPNI, 2012).

Nursing documentation is therefore on the priority list in conducting quality nursing care. Nurses in

Indonesia have been taught to prepare appropriate nursing records during their education. This was

reemphasized again during their clinical training. On the other hand, despite the availability of

evidence on the impact of insufficient documentation of patient care, nursing documentation

problems in this context exist. Recent national publications have been clearly stated that nursing

documentation in a number of hospitals in Indonesia is far from ideal. Studies report that most

nurses only fulfill 50% or less of the total target of 80% required documentation as mandated by the

ministry of health; this, unfortunately, indicates the low quality of nursing care (Noorkasiani,

Gustina, & Maryam, 2015). Reflecting on this problem and the paucity of research with regard to

nursing documentation in the country, this study sought to further identify problems faced by these

nurses that lead to inadequate documentation in nursing.

Methods

Ethics approval for the research was obtained from the Faculty of Nursing, University of Syiah

Kuala Ethics Committee with certificate number: 113001180517, as well as permission from the

Research and Development Center of the hospital where the study took place. This study adopted a

qualitative approach by undertaking focus group discussion (FGD) with head nurses and staff
nurses. After obtaining a list of staff and head nurses in the hospital supplied by the Hospital’s

Human Resource Department, participants for the study were randomly recruited. The inclusion

criteria were nurses who have more than one year experience. The selected participants were

contacted to seek for their consent to participate to this study. All the contacted head nurses and

staff were able and willing to have FGDs with the researchers. To protect the participants,

permission obtained include consent for participation in the study as well as for recording the

FGDs. The FGDs were conducted during the nurses’ lunch break. One of the researchers who is

experienced in the methodology, led the FGD discussions. Open-ended questions were used as

FGDs guide to ensure the discussion is on its track. Each participant was allocated a random

number to ensure their anonymity. There were 35 participants involved including 14 head nurses

(i.e., HN team) and 21 staff nurses (i.e., SN team). We divided the selected head nurses and staff

into two groups which make four groups in total for the FGDs. Each of the HN teams consisted of

seven head nurses. For the staff nurses, the first group consisted of 10 nurses and the second one

was 11 nurses. Separate FGDs were conducted for head nurses and their staff. The intention to

interview them separately, was to provide comfort for nurses in expressing their opinions and

thoughts. It was also anticipated that participants may feel pressurised if the leaders and staff are

mixed together. The duration for the FGDs was 40 to 50 minutes and took place at a large urban

hospital in a province in Indonesia. This hospital was purposefully selected because it is the main

health referral and education center in the province. Content analysis was conducted after coding

and categorizing data into thematic areas. Three themes of nurse perspectives on obstacles

hindering them from proper nursing documentation were derived. We checked the transcribed data

verbatim for reliability of data. To escalate the findings trustworthiness, we conducted peer
debriefing. An experienced colleague was asked to check over the study for credibility and

determine if the results align with the data obtained from participants.

Results

Demographic Description

All participants involved in the research were the staff nurses and head nurses in the hospital. They

were all female nurses and their age were between 29 and 52 years old. Educational backgrounds

vary amongst them, and range from the diploma level (n = 23 nurses), bachelor in nursing (n = 10

nurses) to master degree (n = 2 nurses).

Problems with Nursing Documentation

Primary problems encountered by nurses in documentation from the perspective of head nurses and

their staff can be viewed within these themes: (1) Inadequate supervision for nurses on nursing

documentation; (2) Competency issues in documentation; (3) Lack of confidence and motivation on

documentation.

(1) Inadequate supervision for nurses on nursing documentation

The greatest problem encountered by the nurses is primarily caused by inadequate supervision in

the documentation process. The nurses were asked to complete the documentation procedure but

rarely assessed on how they completed its process. One head nurse complained:

“We do know that documenting nursing process is important for a patient during his time

with us in the hospital, but, what I have seen is that the staff do not know how to fill that in.

They need more supervision on that” (Head nurse 5, Group 1)

A staff member also argued:

“The management only care about documentation when we get closer to hospital

accreditation” (Staff nurse 4, Group 2)

These findings revealed the importance of regular support to develop staff competency in

documenting nursing care. The nurses confirmed that supervision was conducted at irregular

intervals. The auditing gets much more intense when the hospital was due for accreditation.

However, once the hospital accreditation was achieved, the documentation quality decreased.

Lack of supervision and auditing in nursing documentation puts the nurses in a difficult position.

On one side, they are expected to complete documentation as a measurable tool for nursing care

quality. On the other side, they received minimal attention and support on how to conduct effective

yet efficient documentation.

(2) Competency issues in nursing documentation

The head nurses agreed that their staff have various levels of competency. The staff’s mixed nursing

education and training is a likely reason for their variable ability to handle documentation.

A head nurse said:

 “I don’t think that the staff nurses understand documentation. Some nurses have bachelor

degrees but some others have diplomas in nursing. This makes it kind of hard to put them at

the same level” (Head nurse 8, Group 2)

The head nurses felt that the staff members’ backgrounds influence the way they see

documentation. They realized that it is challenging to have the same expectations for everyone since

every nurse is unique and has a different capabilities in learning. As one nurse explained:

“We have different phase on learning, so, it’s kind of hard” (Staff nurse 10, Group 1)

(3) Lack of confidence and motivation on nursing documentation

The head nurses claimed that confidence is almost always a problem with nurses, including in the

documentation process. As the following head nurse said:

“The documentation that my staff did mostly copied what others had done before. It doesn’t

really matter what they have written in there” (Head nurse 5, Group 1)

Another head nurse claimed:

“There is no adviser for the documentation they have done. I think the nurses in ward just do

documentation as a regular task. They don’t take that seriously” (Head nurse 10 , Group 1)

Such low motivation was also described by the following staff nurse:

“We have so many things to do at once. We have to fulfill responsibilities with patients and

the paperwork. I don’t think we can commit to having a good patient record in that

condition” (Staff nurse 16, Group 2)

The aforementioned opinions confirm the inadequacy of confidence and motivation in

understanding the documentation process. There seems to be a prominent feeling of insecurity about

nursing documentation. Additionally, nurses lack the motivation to perform the documentation

process considering the burden of the other responsibilities they have to carry out during their duty

hours. There is opportunity, with these limitations in mind, for nurses’ to consider nursing

documentation as a less crucial component in the delivery of care.

Discussions

This research has elucidated issues related to nursing documentation amongst nurses in Indonesia.

While most available literature provides findings and recommendations on how to maximize the

documentation procedure, this research has introduced the problems that lead nurses to complete

inadequate documentation of nursing care in Indonesia.

Nursing documentation should reflect nurses’ critical thinking that leads to decisions or intervention

in care. Considering the first theme, it reflected the importance of documentation. The nurses in the

study confirmed the significance of documentation for patient care. They knew that there is a

special tie between patients and nurses. This should underline that these nurses may actually

understand that proper documentation contributes to the quality of care they provide to their

patients. It builds a relationship between both parties to ensure the continuity of care. This response

is concurrent with Cheevakaemaoo, et al. (2006) who describes the pertinence of documentation in

the nursing field.

The nurses are aware of the importance of documentation, however, since supervision or auditing

processes are irregular, they are not likely to perform proper documentation. Nurses claimed that

they lacked an auditing or supervision process. The drawback of documentation due to lack of

supervision has been identified in earlier studies (Björvell, Wredling, & Thorell‐Ekstrand, 2003;

Edelstein, 1990; Owen, 2005). It is clearly asserted that organizational support is indeed a crucial

link to improving the quality of nursing documentation.

Furthermore, problems of competency were strongly articulated amongst the nurses. Nurses

competency has been linked with educational attainment. For the case of Indonesia, the educational

entry level for nurses in Indonesia ranged from Diploma III to the Bachelor’s stage (Hennessy,

Hicks, Hilan, & Kawonal, 2006). The development of nursing education since 1999 has shown that

about 1% of nurses are educated at university level to the degree of Bachelor’s, Master’s and

Doctorates (Shields & Hartati, 2003). The applied concepts in nursing education are influenced by

the American nursing curriculum (Strength & Cagle, 1999). Textbooks or other nursing reading

materials are mostly American-based resources providing a challenge for users in understanding

them, since the majority of teachers and students have difficulty reading in English (Gillund,

Rystedt, Wilde-Larsson, Abubakar, & Kvigne, 2013). Moreover, Gillund et al. found that, due to

limited resources, most of the qualified nursing students receive an offer of a teaching position

following graduation from school, creating nursing instructors who have an inadequate amount of

clinical experience (Gillund et al., 2013; Lock, 2011; Shields & Hartati, 2003).

Referring to nursing education context in Indonesia, it clearly stated that the nurses acknowledged

that the diversity of nursing education and training may determine their abilities in documentation.

That suggestion was supported through the observation and review of nursing notes in patients’

records. Nurses’ competencies varied from the diploma level to a bachelor’s degree in nursing.
Thus, the range in education created a spectrum in how they documented care. Research has argued

for educational processes for all nurses for quality assurance improvement of nursing

documentation. Therefore, it is recommended to educate nurses at all levels on documentation

rather than expecting a few pioneer nurses to lead other nurses to reach the desired outcomes

(Darmer et al., 2004, 2006).

Last but not least, the final problem identified by nurses in determining low documentation quality

can be found under the lack of confidence and motivation theme. The nurses seemed to expect

minimal time spent on the documentation procedure in order to balance it with their other duties.

Similarly, workloads and its effect on documentation has been spotted in other studies (Björvell, et

al., 2003; Persenius, Hall-Lord, Bååth, & Larsson, 2008; Wang, Hailey, & Yu, 2011). The

imbalanced workload of patient care and the expectation of quality documentation is likely to

hinder innovations in nursing (Björvell, et al., 2003). Furthermore, it often affects the nurses’

motivation to complete proper nursing documentation. The theme potentially introduced the role of

nursing leadership and their commitment to documentation. Head nurses, along with their staff,

admitted that there were an absence of leadership among them. All tasks and duties were regarded

simply as regular activities, likely leading to a devaluation of nursing documentation. Although

nurses previously acknowledged the significance of documentation in nursing care, there must be

an urgent call for hospital management and leadership to strengthen nurses’ patient reporting and

the the quality of care (Müller‐Staub, Needham, Odenbreit, Ann Lavin, & Van Achterberg, 2007;

Thoroddsen & Ehnfors, 2007; Wardani, 2017).

Conclusion
Though the performance remains rudimentary, the nurses acknowledged that nursing

documentation is a crucial element that builds positive linkage between nurses and their ability to

provide high-quality care to their patients. Lack of supervision, competency issues, and problems of

confidence and motivation affect the way they conduct documentation. Increasing support and

improvement of nursing skills across nursing education at all levels are essential for the successful

adherence to proper nursing documentation. The study was an initial attempt to identify the

problems with documentation among nurses in Indonesia. The mixed perspective of staff nurses and

their proximal leaders generated a larger view rather than single approach participant (e.g., staff

nurses only). The use of randomized selected participants has helped to avoid bias during

discussions. The results of this research, however, remains somewhat limited. The data was

generated from hospital based nurses, therefore it is less likely generalizable across Indonesia at

large. Single approach of focus group discussion, time constraints, and nurses as participants only

did not allow the researchers to fully engage in the organizational culture and may have limited the

study’s interpretations. Future research is therefore warranted by incorporating hospitals’

supervisory board and leaders perspective to investigate further on institutional oversight which

may enhance the quality of future studies on nursing documentation in the country of Indonesia.

Conflict of Interest

No conflict of interest stated for this research.

 REFERENCES

Asamani, J. A., Amenorpe, F. D., Babanawo, F., & Ansah Ofei, A. M. (2014). Nursing

documentation of inpatient care in eastern Ghana. British Journal of Nursing, 23(1).

Austin, S. (2011). Stay out of court with proper documentation. Nursing2016, 41(4), 24-29.

Björvell, C., Wredling, R., & Thorell‐Ekstrand, I. (2003). Improving documentation using a nursing

model. Journal of Advanced Nursing, 43(4), 402-410.

Blair, W., & Smith, B. (2012). Nursing documentation: frameworks and barriers. Contemporary

Nurse, 41(2), 160–168.

Blake‐Mowatt, C., Lindo, J., & Bennett, J. (2013). Evaluation of registered nurses' knowledge and

practice of documentation at a Jamaican hospital. International Nursing Review, 60(3),

328-334.

Cheevakasemsook, A., Chapman, Y., Francis, K., & Davies, C. (2006). The study of nursing

documentation complexities. International journal of nursing practice, 12(6), 366-374.

Darmer, M. R., Ankersen, L., Nielsen, B. G., Landberger, G., Lippert, E., & Egerod, I. (2004). The

effect of a VIPS implementation programme on nurses’ knowledge and attitudes towards

documentation. Scandinavian journal of caring sciences, 18(3), 325-332.

Darmer, M. R., Ankersen, L., Nielsen, B. G., Landberger, G., Lippert, E., & Egerod, I. (2006).

Nursing documentation audit–the effect of a VIPS implementation programme in

Denmark. Journal of clinical nursing, 15(5), 525-534.

Edelstein, J. (1990). A study of nursing documentation. Nursing management, 21(11), 40-46.

Gillund, M. V., Rystedt, I., Wilde-Larsson, B., Abubakar, S., & Kvigne, K. (2013). Building

competence through cross-cultural collaboration in the aftermath of a tsunami: Experiences

of Indonesian teachers. Nurse Education Today, 33(3), 192–198.

Hager, L., & Munden, J. (2008). Complete guide to documentation . Ambler. PA: Lippincott

Williams and Wilkins.

Heartfield, M. (1996). Nursing documentation and nursing practice: a discourse analysis. Journal of

Advanced Nursing, 24(1), 98-103.

Hennessy, D., Hicks, C., Hilan, A., & Kawonal, Y. (2006). The training and development needs of

nurses in Indonesia: paper 3 of 3. Human Resources for Health, 4(1), 10.

Higginbotham, E., & McCarthy, R. (2001). Elements of nursing negligence. Nursing practice and

the law: avoiding malpractice and other legal risks. Philadelphia: FA Davis Co, 118-131.

Hoban, V. (2003). How to... improve your record keeping. Nursing Times, 99(42), 78–79.

Iyer, P. W., & Camp, N. H. (2004). Nursing Documentation: A Nursing Process Approach: Med

League Support Services, Incorporated.

Jefferies, D., Johnson, M., & Griffiths, R. (2010). A meta‐study of the essentials of quality nursing

documentation. International journal of nursing practice, 16(2), 112-124.

Kärkkäinen, O., & Eriksson, K. (2005). Recording the content of the caring process. Journal of

Nursing Management, 13(3), 202–208.

Laitinen, H., Kaunonen, M., & Åstedt‐ Kurki, P. (2010). Patient‐ focused nursing documentation

expressed by nurses. Journal of Clinical Nursing, 19(3‐ 4), 489–497.

Lindo, J., Stennett, R., Stephenson‐Wilson, K., Barrett, K. A., Bunnaman, D., Anderson‐Johnson,

P., . . . Wint, Y. (2016). An Audit of Nursing Documentation at Three Public Hospitals in

Jamaica. Journal of Nursing Scholarship, 48(5), 499-507.

Lock, L. R. (2011). Selecting examinable nursing core competencies: a Delphi project.

International Nursing Review, 58(3), 347–353.

Mbabazi, P., & Cassimjee, R. (2006). The quality of nursing documentation in a hospital in

Rwanda. Africa Journal of Nursing and Midwifery, 8(1), 31-42.

Müller‐Staub, M., Needham, I., Odenbreit, M., Ann Lavin, M., & Van Achterberg, T. (2007).

Improved quality of nursing documentation: results of a nursing diagnoses, interventions,

and outcomes implementation study. International Journal of Nursing Knowledge, 18(1),

5-17.

Nakate, G. M., Dahl, D., Petrucka, P., Drake, K. B., & Dunlap, R. (2015). The nursing

documentation dilemma in Uganda: Neglected but necessary. A case study at Mulago

National Referral Hospital. Open Journal of Nursing, 5(12), 1063.

Noorkasiani, N., Gustina, R., & Maryam, S. (2015). Faktor-Faktor yang Berhubungan dengan

Kelengkapan Dokumentasi Keperawatan. Jurnal Keperawatan Indonesia, 18(1), 1-8.

Owen, K. (2005). Documentation in nursing practice. Nursing standard, 19(32), 48-49.

Persenius, M. W., Hall-Lord, M.-L., Bååth, C., & Larsson, B. W. (2008). Assessment and

documentation of patients’ nutritional status: perceptions of registered nurses and their

chief nurses. Journal of clinical nursing, 17(16), 2125-2136. doi: 10.1111/j.1365-

2702.2007.02202.x

Shields, L., & Hartati, L. E. (2003). Nursing and health care in Indonesia. Journal of Advanced

Nursing, 44(2), 209–216.

Strength, D., & Cagle, C. S. (1999). Indonesia: An assessment of the health state, health care

delivery system, and nursing education. Journal of Cultural Diversity, 6(2), 41.
Thoroddsen, A., & Ehnfors, M. (2007). Putting policy into practice: pre‐and posttests of

implementing standardized languages for nursing documentation. Journal of clinical

nursing, 16(10), 1826-1838.

Wang, N., Hailey, D., & Yu, P. (2011). Quality of nursing documentation and approaches to its

evaluation: a mixed-method systematic review. Journal of Advanced Nursing, 67(9), 1858-

1875. doi: 10.1111/j.1365-2648.2011.05634.x

Wardani, E. (2017). Nursing Leadership: A Case of Indonesia. PhD thesis, University of Sheffield.

Whittaker, A. A., Aufdenkamp, M., & Tinley, S. (2009). Barriers and facilitators to electronic

documentation in a rural hospital. Journal of Nursing Scholarship, 41(3), 293–300.

 Suggested Reviewers:

1. Dr Tony Ryan

Reader in Older People, Care and the Family

Director of Research

School of Nursing and Midwifery

The University of Sheffield

Barber House Annexe

3a Clarkehouse Road

Sheffield S10 2LA

 Email: t.ryan@sheffield.ac.uk

2. Dr Joan Spicer

Chief Nursing Officer/Deputy Director,

San Mateo Medical Center/San Mateo County Health System

CA, United States

Samuel Merritt University

Faculty, Doctor of Nursing Practice

370 Hawthorne Ave, Oakland, CA 94609, United States

Email: jgspicer@pacbell.net

3. Catherine Waters, RN, PhD, FAAN

Professor and Associate Dean

UCSF-School of Nursing

2 Koret Way, Rm 505N

UCSF Box 0608

San Francisco, CA 94143

United States

Email: Catherine.Waters@ucsf.edu
Table 1

Questions
1. What do you understand by nursing documentation?
2. What effort that has been done to ensure proper documentation?
3. What do you think about the quality of documentation you have now?
4. Is there any challenges you encounter for this?
5. What should we do to overcome such challenges?
FGD Guide