Lydia Chen was one of the center’s de Tornyay Center’s 2024-2025 Healthy Aging Scholars and a DNP student. Her project was on ‘Using Artificial Intelligence in Improving Nursing Documentation in Skilled Nursing Facilities’ and her faculty mentor was Jamie Young.
What made you choose nursing?
My career started as an occupational therapist. I was working as an occupational therapist for over 12 years, mostly with the geriatric population, in skilled nursing facilities. Over the years, I noticed there’s a lot of biases in social determinants of health and health equity toward older adults.
When I was in Northern California, we didn’t even have a primary care provider in the facility, and we had to hire health care providers from L.A. to visit the residents to provide care, sign orders, and complete paperwork.
I felt there was something else I could do to serve those older adults better. I was looking to see what career change paths I could do. I decided nurse practitioner sounded like the care model that matches what I want to do for the patients, so I decided to pursue a nurse practitioner degree.
What interests you about healthy aging and working with older adults?
A lot of it is personal preference. Healthy aging is important to me because my grandma had a stroke and my dad has Parkinson’s. I feel that society should pay more attention to older people and spend time with older people. It’s like traveling. You get to learn so much from them. You travel through their lifespan, and you learn from their life experiences, their knowledge, and their wisdom.
It’s our responsibility, right? We take care of babies. Culturally, I was always taught to take care of our older generation and to respect our elders. So that’s why I choose nursing, and that’s why I want to work with the geriatric population.
What made you want to do this project?
When I was picking my DNP project I made a point that I wanted to do something regarding aging or geriatrics and long-term care. I realized that a lot of research excludes older people and you cannot really find much research on skilled nursing facilities. So when I saw the topic using artificial intelligence in skilled nursing facilities, I’m like, oh, yeah, we have so much technology, why can’t we use that to help our older population? When I was talking to my agency mentor, they have been working with a software development team on AI to use on their EHR [Electronic Health Record] systems.
We decided to do a needs assessment to see the nurses’ perspective on the current EHR system and what they think the AI could help them with to save them time, so that they can go back to the bedside and spend time with the patients.
What does doing a needs assessment look like?
I am developing a survey to figure out nurses’ perspective on the current EHR system. When I was doing my literature search, I found there is a lot of EHR research on nursing documentation, accuracy, and consistency, but not focused on skilled nursing facilities. Most of the published research is in acute care, and [most] research in skilled nursing facilities is not done in the United States. So we don’t know how the nurses who work at skilled nursing facilities in America feel about their EHR systems: if it’s accurate, if it’s consistent, then how easy it is to navigate the EHR systems.
When I was working in long-term care as a nurse, I had trouble finding information that I needed to care for the patient, and I spent a lot of time just navigating their EHR system. Even when I found information, I didn’t really trust it, because sometimes it was outdated.
The purpose of the survey is to find their perspective, the barriers with the EHR systems, and what they want AI to be able to do for them.
Why is this project important?
Research shows that nurses spend probably at least a quarter to 50% of their time documenting instead of spending time with patients. I think, for older adults, one of the most important parts of care is companionship. Nurses already have sometimes 15, 20, 30 patients per shift at skilled nursing facilities, and the more time they spend on documenting, the less time they have for the physical presence with the patient. I think it’s really important for healthy aging just to be there for them. Companionship greatly enhances cognitive function and emotional well-being. Even just an extra two minutes talking to them, holding their hands, I think it made a great difference to older adults’ quality of life.
Is there anything interesting you found while doing your literature review?
It sounds like common sense, but nursing documentation really affects the patient outcomes, and the accuracy and consistency of the documentation can really change older adults’ quality of life and continuity of care.
Healthcare providers are often forced to prioritize immediate patient care over detailed charting, resulting in rushed, incomplete, or erroneous records. One research study recorded the patient-provider interactions and compared the clinical encounter notes with recorded patient-provider interactions, and they found nearly half of the notes included information that could not be verified from the recorded interactions. The finding suggests EHR system might have propagated errors or omitted crucial information in addition to the inaccurate data/information due to lack of staff and time.
Sometimes we put a lot of personal assumptions into the documentation. I hope this project will help the consistency and accuracy of the documentation, and help other people who care for the same patients provide better care.
Is there anything else you want to share?
I just want to bring more awareness to our older adult population. They have contributed to society, and now it is time for the next generation to care for them.