• Robyn Daskein Robyn Daskein

Little is known about the relationship between registered nurses’ (RNs’) knowledge of nursing documentation, their attitudes towards this documentation, and how they perceive the importance of the forms used in the documentation process within residential aged care. The current study has several aims. This investigation sought to gain a measure of RNs’ knowledge of, and attitudes towards documentation, and assess their perception of the importance of forms used to document care. There were two phases of study. Study 1 utilised a cross-sectional, retrospective design with a large sample of RNs (n = 360) who completed Edelstein’s (1990) modified questionnaire to identify factors that influence nurses’ documentation in residential aged care in Queensland. A factor analysis was undertaken to extract influencing factors. The second study developed and tested a conceptual model of nursing practice and quality of care to determine relationships between the factors under investigation. This phase used a smaller sample of RNs (n = 46). Participating RNs were asked to provide personal characteristics (e.g. age, gender, first nursing qualification and studies in aged care) and to complete Edelstein’s (1990) modified questionnaire. A chart audit was conducted on residents’ records where the resident required interventions for challenging behaviour. Relatives of residents whose charts were audited also completed a survey to measure their perceived satisfaction with care of their family member. Finally, a model of the relationships between documentation and outcome measures was developed on the basis of prior literature and previous empirical studies. This model was labelled “The Nursing Practice and Quality of Care Model”. This model was then tested with a smaller sample of RNs, seeking to find out if it appropriately represented the relationships that exist between RN documentation and outcomes. Edelstein’s (1990) modified questionnaire was demonstrated to have acceptable reliability and validity. Results of Study 1 revealed that RNs working in aged care in Queensland have high levels of knowledge about documentation, and consider the forms they use to document care to be very important, but have mixed attitudes towards documentation. Several issues influenced the results for the knowledge and attitude scales. These included knowledge factors such as care-reporting guidelines, nurse time issues, legal issues and quality of reporting. Attitudes were influenced by charting, practice and policy issues. These findings provide important information on what variables affect RNs’ documentation. The RN participants in Study 2 were comparable to the national and state figures for RN aged care demographics (Hsu, Moyle, Creedy, & Venturato, 2005; Richardson & Martin, 2004). Overall, the findings of Edelstein’s (1990) modified questionnaire in Study 2 were consistent with Study 1, although different relationships were found between the knowledge and attitude factors. The chart audit revealed that although RNs did complete most items on the forms, no form was fully complete, and suggests that RNs are not generally fully compliant with nursing documentation requirements in residential aged care. Relatives of aged care residents were generally happy with the level of care for their family member, but felt that individual issues such as leisure and activity programs, meals, and dining services could be improved. Analysis of “The Nursing Practice and Quality of Care Model” involved structural equation modeling (SEM) to determine the relationship between experiences, knowledge and attitudes toward nursing documentation, compliance with writing nursing documentation and relatives’ satisfaction. Testing revealed that the model was generally a good fit; however, only some variables predicted to be included in the model were significant. Of greatest interest was the strong predictive relationship between care reporting guidelines and caring behaviour, which suggested that the more RNs knew about documentation, the better they were able to care for residents with challenging behaviour. Positive attitudes to policy issues by RNs, and high completion of charting review items also predicted better outcomes for residents. RNs who had studies in aged care showed a relationship with quality issues suggested that the more education RNs completed the more they knew about quality issues. However, there were some significant negative predictive relationships between variables such as quality issues and caring behaviour that were not anticipated. Overall results suggest that some RN documentation factors did significantly predict residents’ quality of care. This is an important step forward in finding ways to improve the care of residents in aged care facilities.