1 Running Head: ADAPTATION OF ELECTRONIC MEDICAL RECORDS 4 ADAPTATION OF ELECTRONIC MEDICAL RECORDS Adaptation of Electronic Medical Records The development of nursing theory, and evidenced based research are essential to the advancement of nursing practice and the profession. Chinn and Kramer (1995) defines theory as: "A creative and rigorous structuring of ideas that project a tentative, purposeful, and systematic view of phenomenon" (p.72). Nursing theories are considered holistic when they conceptualize nursing to include the four concepts of the person, environment, health and the nurse who provides the care. Nursing theory development is directly influenced by a distinct focus on the discipline of nursing, otherwise known as nursing's unique perspective. Theories such as grand, middle-range and borrowed theories can be applied to nursing practice to resolve issues relevant to any specialty within the nursing profession. Nursing theory is often utilized by nursing professionals to describe, explain, predict or prescribe a particular situation of interest; used in turn as a guide to solve issues relevant to nursing practice (Kenney, 2013). Nursing theory identifies and utilizes concepts of care and helping, define relationships, structure ideas, facilitate disciplined inquiry, communicate, and also predict outcomes of practice to guide the discipline of nursing. The application of nursing theory in combination with knowledge and clinical experience facilitates critical thinking that allows the nurse to formulate appropriate interventions and make informed moral and ethical decisions based on proven concepts. Nursing theory, research and practice are essential to the growth of the nursing profession and are applicable in solving issues within the healthcare system.  The choice of grand, middle-range or borrowed theories are dependent on the issue that needs to be resolved. Nursing theories aim to improve nursing practice and the health of the population in general. Roy Adaptation Model is a logical theory with a strong focus on observing how individuals, families, groups and organizations interact with their changing environment. Roy's theory embraces four modes of adaptation, which include: physiologic needs, self- concept, role function and inter-dependence. The model confirms that the process of adaptation is successful when individuals show positive response to changes in the environment, through conscious awareness, self-reflection and individual choice to integrate the human with the environment (Phillips & Harris, 2010).   Roy's Adaptation model will be used as a framework in solving issues related to the use of, electronic medical record systems by healthcare professionals in nursing practice. The model will be conceptualized to formulate clear objectives and interventions to solve the issue. This will conclude with a summary of applicable new knowledge of nursing theory to practice. Issue   The evol ...

1. 1
Running Head: ADAPTATION OF ELECTRONIC MEDICAL
RECORDS
4
ADAPTATION OF ELECTRONIC MEDICAL RECORDS
Adaptation of Electronic Medical Records
The development of nursing theory, and evidenced based
research are essential to the advancement of nursing practice
and the profession. Chinn and Kramer (1995) defines theory as:
"A creative and rigorous structuring of ideas that project a
tentative, purposeful, and systematic view of phenomenon"
(p.72). Nursing theories are considered holistic when they
conceptualize nursing to include the four concepts of the
person, environment, health and the nurse who provides the
care. Nursing theory development is directly influenced by a
distinct focus on the discipline of nursing, otherwise known as

2. nursing's unique perspective. Theories such as grand, middle-
range and borrowed theories can be applied to nursing practice
to resolve issues relevant to any specialty within the nursing
profession.
Nursing theory is often utilized by nursing professionals to
describe, explain, predict or prescribe a particular situation of
interest; used in turn as a guide to solve issues relevant to
nursing practice (Kenney, 2013). Nursing theory identifies and
utilizes concepts of care and helping, define relationships,
structure ideas, facilitate disciplined inquiry, communicate, and
also predict outcomes of practice to guide the discipline of
nursing. The application of nursing theory in combination with
knowledge and clinical experience facilitates critical thinking
that allows the nurse to formulate appropriate interventions and
make informed moral and ethical decisions based on proven
concepts.
Nursing theory, research and practice are essential to the growth
of the nursing profession and are applicable in solving issues
within the healthcare system. The choice of grand, middle-
range or borrowed theories are dependent on the issue that
needs to be resolved. Nursing theories aim to improve nursing
practice and the health of the population in general.
Roy Adaptation Model is a logical theory with a strong focus on
observing how individuals, families, groups and organizations
interact with their changing environment. Roy's theory
embraces four modes of adaptation, which include: physiologic
needs, self- concept, role function and inter-dependence. The
model confirms that the process of adaptation is successful
when individuals show positive response to changes in the
environment, through conscious awareness, self-reflection and
individual choice to integrate the human with the environment
(Phillips & Harris, 2010).
Roy's Adaptation model will be used as a framework in
solving issues related to the use of, electronic medical record
systems by healthcare professionals in nursing practice. The
model will be conceptualized to formulate clear objectives and

3. interventions to solve the issue. This will conclude with a
summary of applicable new knowledge of nursing theory to
practice.
Issue
The evolution of advanced computerized technology has
brought about a worldwide change, converting paper-recording
systems to electronic records. The fast constant explosion of
technology has challenged organizations and individuals to
change their old ways of paper charting/recording and adapt to
an environment that brings promise to improved health-care
systems and organizations. Electronic medical records are
records of a patient in digital form containing all pertinent
information regarding a patient's medical history, status, labs,
diagnostic tests, diagnoses and treatment plan. Electronic
medical records have several advantages over paper recording
systems. Medical records in electronic form, increase office
space as it lessen the requirement of paper charts, improve
efficiency as it decreases time spent locating paper charts,
provide health maintenance reminders and significantly
minimize errors. Paper recording systems are at a disadvantage
as they are subject to a larger number of errors due to
misspelling, illegibility and different terminologies, requires a
lot of storage space, can be untidy, misplaced or lost, is often
time consuming (Benefits of EMRs, 2014). Despite the many
advantages of electronic medical records, change from paper
recording systems and adaptation to that change has faced an
enormous amount of resistance within the medical field.
Resistance to the adaptation of new technology within an
organization is often linked to the organizations culture rather
than the computer system itself. Organizational cultures that
promote resistance to change, foster environments that resent
adaptation and refer to the way things were done prior to any
change. Healthcare professions within these organizations, often
relate the issue of change and adaptation to be that of the
system being introduced rather than themselves. Kumar, Bhati,
and Chiang (2013) acknowledged that nurses and other health

4. care providers are known for resisting change, therefore
appropriate communication and careful change management
plans must be instituted in favor of the adaptation process. (p.
472).
Adaptation may be significantly impacted by negative
perceptions to change, for example, healthcare professionals
may find it difficult to make the transition from paper
documentation to electronic medical records because they
perceive that the process would be time consuming, or that the
nurse-patient relationship and patient-physician relationships
would be affected. Risk and benefits to the patient is also an
important aspect considered and hinders adaptation. Such risk
may involve, transfer of incorrect data, which can be fatal for
future treatments provided to patients. More experienced
healthcare professionals view themselves as competent and
proficient with the use of paper recording systems. They share
the belief that the notion of adapting to an unfamiliar system,
such as, electronic medical records may somehow impact their
level of competence. Some healthcare professionals such as
nurses attribute their resistance to change and adaptation to
their moral and ethical obligations to patients. That is, the
needs of the patient takes priority, therefore the idea of placing
machines before patient care is dehumanizing and not
concurrent with the goals of nursing practice.
Healthcare professionals may view electronic medical
recording systems as a threat, with the notion that it impedes
critical-thinking and hands on approach to patient care. It may
be viewed as non-user friendly because it dictates how to
document and perform patient care.
Environmental or situational changes within an organization
often ignite resistance to adaptation. In an effort to facilitate
adaptation as it relates to the use of electronic medical records,
identified concepts of Roy’s adaptation theory can be utilized.
Roy theorizes that adaptation takes place when individuals are
able to positively integrate changes within themselves and the
environment (Phillips & Harris, 2010). Organizations must

5. employ strategies that will encourage healthcare professionals
to become involved in the process of technological advancement
and adapt to new situations.
Strategy
Many organizations within the healthcare industry have
recognized the benefits of converting from paper records to
electronic medical records, which are more accurate, reliable
and efficient. However as, organizations continue to introduce
and implement the use of electronic medical records, they must
address the embedded challenges within the organization culture
that foster resistance to change and hinder adaptation. One such
challenge is the lack of understanding on part of the employees
to use the system, which may lead to uncertainty and errors.
According to Roy's Adaptation Model individuals are
viewed, as a bio-psycho-social being that is always interacting
with environmental changes, and for adaptation to take place,
the individual must be able to positively respond to such
changes (Phillips & Harris, 2010). Therefore in order to
promote adaptation and facilitate a smooth transition from paper
documentation to electronic medical records, organizations must
provide adequate training and resources to employees.
To facilitate change and support the adaptation theory, the
mentioned eight models of change management proposed by
John P. Kotter can be implemented. 1) managers can create a
sense of readiness and urgency in regard to change, 2)
effectively communicate and promote the change process
through team building, 3) Present a clear vision for the change
and how it will occur, 4) involve healthcare professionals in the
planning phase, 5) empower action by encouraging feedback and
rewards, 6) establish short term goals to address the change
process one step at a time, 7) train and coach participants, 8)
prevent resistance to change by incorporating the needs of the
healthcare professional (Parker, 2014).
Healthcare professionals and administrators are essential to
the successful implementation of electronic medical records.
The steps outlined by Kotter in conjunction with Roy’s

6. adaptation model can promote adaptation of electronic medical
record in the health care field. Adequate information regarding
the process of change prior to initiation and throughout the
process should be effectively communicated. Healthcare
professionals should be actively involved in the change process
with valued input on how the implementation of electronic
medical records will affect the day-to-day activities of patient
care and their moral and ethical obligations.
One legitimate concern of healthcare professionals is the
capability of electronic medical records to safeguard patient
privacy and confidentiality, to prevent Health Insurance
Portability and Accountability Act (HIPPA) violations (Privacy
& Security, 2013). Healthcare facilitators of change should
effectively communicate strategies to eliminate the possible
breach of patient privacy to help ensure the security of the
patient's information. It is imperative that leaders within the
healthcare system effectively communicate and acknowledge the
physical and psychological needs of individuals prior to
initiating the change process, to reduce resistance and promote
seamless adaptation.
Conclusion
It is paramount that healthcare leaders set objectives to
facilitate the change process and promote adaptation. The
successful implementation and adaptation of electronic medical
records rely heavily on the principles of Roy’s adaptation
theory. Effective communication, training and education will
reduce resistance, and foster an inviting environment that will
streamline the adaptation of electronic medical recording
systems for healthcare professionals.
The token value learnt from this paper is that the challenge
to adapt to change does not reside with the system to be
implemented, but with the users of that system to adapt to
change. Communication is essential to effect change while,
incorporating the physiological and psychological needs of the
users to preserve their confidence, reduce resistance and allow
for a smooth adaptation process. Healthcare professionals are at

7. the forefront of patient care, therefore their involvement and
valued input within the change process will promote adaptation
and allow for continued competent care and improved outcomes.
References
Benefits of EHRs. (2014). What Is an Electronic Medical
Record (EMR). Retrieved from www.healthit.gov/providers-
professionals/electronic-medical-records-emr
Kenney, J. W. (2013). Theory-based advanced nursing practice.
In W. K Cody (Ed.), Philosophical and theoretical perspectives
for advanced nursing practice (5th ed; pp. 333–35). Sudbury,
MA: Jones & Bartlett.
Kumar, A; Bhati, S; & Chiang, J. (2013). Deployment of an in-
house designed training process in a quaternary care
hospital.Technol Health Care, 21(5), 469-478. doi:
10.3233/THC-130750.
Nursing Theories. (n.d.). (2009). Mosby's Medical Dictionary, 8
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Parker, B. (2014). Kotter's Eight Step Model. Retrieved from
https://tipqc.org/qi/jit/leaders-guide/kotters-eight-step-change-
model/
Phillips, K. D., & Harris, R. (2010). Roy’s adaptation model in
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8. security/practice-integration