Lene Baagøe Laukvik

• Laukvik, Lene Baagøe; Chomutare, Taridzo Fred; Hernandez, Miguel Angel Tejedor & Fossum, Mariann (2026). Time to Care-AI Supported Nursing Documentation. Studies in Health Technology and Informatics. ISSN 0926-9630. 336, p. 1551–1555. doi: 10.3233/SHTI260469. Full text in Research Archive Show summary

  This study conducted a needs assessment to evaluate contextual factors, adoption barriers, and overall readiness of municipal healthcare services to implement and utilize AI-supported documentation solutions. The study was carried out by a multidisciplinary team consisting of two municipalities in the South of Norway, data and artificial intelligence (AI) researchers, healthcare researchers, and a European health technology company. Three participatory workshops were conducted with healthcare professionals, ICT personnel, and legal experts, revealing overall optimism about the potential of AI to enhance documentation practices and facilitate more efficient information exchange. At the same time, the findings highlighted important challenges related to system integration, usability, and trust in AI-supported solutions within municipal healthcare services.

• Laukvik, Lene Baagøe; Lyngstad, Merete; Rotegård, Ann Kristin & Fossum, Mariann (2024). Utilizing nursing standards in electronic health records: A descriptive qualitative study. International Journal of Medical Informatics. ISSN 1386-5056. 184, p. 1–7. doi: 10.1016/j.ijmedinf.2024.105350. Full text in Research Archive Show summary

  Background The electronic health record (EHR), including standardized structures and languages, represents an important data source for nurses, to continually update their individual and shared perceptual understanding of clinical situations. Registered nurses’ utilization of nursing standards, such as standardized nursing care plans and language in EHRs, has received little attention in the literature. Further research is needed to understand nurses’ care planning and documentation practice. Aims This study aimed to describe the experiences and perceptions of nurses’ EHR documentation practices utilizing standardized nursing care plans including standardized nursing language, in the daily documentation of nursing care for patients living in special dementia-care units in nursing homes in Norway. Methods A descriptive qualitative study was conducted between April and November 2021 among registered nurses working in special dementia care units in Norwegian nursing homes. In-depth interviews were conducted, and data was analyzed utilizing reflexive thematic analysis with a deductive orientation.

• Laukvik, Lene Baagøe; Lyngstad, Merete; Rotegård, Ann Kristin; Slettebø, Åshild & Fossum, Mariann (2022). Content and comprehensiveness in the nursing documentation for residents in long-term dementia care: a retrospective chart review. BMC Nursing. 21. doi: 10.1186/s12912-022-00863-9. Full text in Research Archive Show summary

  Background: Insight into and understanding of content and comprehensiveness in nursing documentation is important to secure continuity and high-quality care planning in long-term dementia care. The accuracy of nursing documentation is vital in areas where residents have difculties in communicating needs and preferences. This study described the content and comprehensiveness of nursing documentation for residents living with dementia in nursing homes. Methods: We used a retrospective chart review to describe content and comprehensiveness in the nursing documentation. Person-centered content related to identity, comfort, inclusion, attachment, and occupation was identifed, using an extraction tool derived from person-centered care literature. The fve-point Comprehensiveness in the Nursing Documentation scale was used to describe the comprehensiveness of the nursing documentation in relation to the nursing process. Results: The residents’ life stories were identifed in 16% of the reviewed records. There were variations in the identifed nursing diagnoses related to person-centered information, across all the fve categories. There were variations in comprehensiveness within all fve categories, and inclusion and occupation had the least comprehensive information. Conclusion: Findings from this study highlights challenges in documenting person-centered information in a comprehensive way. To improve nursing documentation of residents living with dementia in nursing homes, nurses need to include residents’ perspectives and experiences in their planning and evaluation of care.

• Laukvik, Lene Baagøe; Rotegård, Ann Kristin; Lyngstad, Merete; Slettebø, Åshild & Fossum, Mariann (2022). Registered nurses’ reasoning process during care planning and documentation in the electronic health records: A concurrent think-aloud study. Journal of Clinical Nursing (JCN). ISSN 0962-1067. 32. doi: 10.1111/jocn.16210. Full text in Research Archive Show summary

  noAbstractAims and objectives: To explore the clinical reasoning process of experienced reg-istered nurses during care planning and documentation of nursing in the electronic health records of residents in long-term dementia care.Background: Clinical reasoning is an essential element in nursing practice. Registered nurses’ clinical reasoning process during the documentation of nursing care in elec-tronic health records has received little attention in nursing literature. Further re-search is needed to understand registered nurses’ clinical reasoning, especially for care planning and documentation of dementia care due to its complexity and a large amount of information collected.Design: A qualitative explorative design was used with a concurrent think-aloud technique.Methods: The transcribed verbalisations were analysed using protocol analysis with referring phrase, assertional and script analyses. Data were collected over ten months in 2019–2020 from 12 registered nurses in three nursing homes offering special de-mentia care. The COREQ checklist for qualitative studies was used.Results: The nurses primarily focused on assessments and interventions during documentation. Most registered nurses used their experience and heuristics when reasoning about the residents’ current health and well- being. They also used logi-cal thinking or followed local practice rules when reasoning about planned or imple-mented interventions.Conclusion: The registered nurses moved back and forth among all the elements in the nursing process. They used a variety of clinical reasoning attributes during care planning and nursing documentation. The most used clinical reasoning attributes were information processing, cognition and inference. The most focused information was planned and implemented interventions.Relevance to clinical practice: Knowledge of the clinical reasoning process of regis-tered nurses during care planning and documentation should be used in developing electronic health record systems that support the workflow of registered nurses and enhance their ability to disseminate relevant information.

• Laukvik, Lene Baagøe; Mølstad, Kathryn & Fossum, Mariann (2016). The Construction of a Subset of ICNP® for Patients with Dementia. Studies in Health Technology and Informatics. ISSN 0926-9630. 225, p. 1068–1069. doi: 10.3233/978-1-61499-658-3-1068. Full text in Research Archive
• Laukvik, Lene Baagøe; Mølstad, Kathy & Fossum, Mariann (2015). The construction of a subset of ICNP® for patients with dementia: a Delphi consensus and a group interview study. BMC Nursing. 14:49. doi: 10.1186/s12912-015-0100-z. Full text in Research Archive

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• Laukvik, Lene Baagøe; Brandal, Annika & Fossum, Mariann (2025). Strukturerte og standardiserte data gir bedre sykepleiedokumentasjon. Sykepleien Forskning. ISSN 1890-2936. 113. doi: 10.4220/sykepleiens.2025.101775. Full text in Research Archive
• Laukvik, Lene Baagøe (2024). Standardized nursing terminology and care plans in the Norwegian setting. Full text in Research Archive
• Laukvik, Lene Baagøe (2024). Sykepleieres planleggings og dokumentasjonsprosesser i EPJ til pasienter som lever med demens. Full text in Research Archive
• Laukvik, Lene Baagøe (2024). KI - Trenger vi fortsatt standardisert terminologi? Full text in Research Archive
• Laukvik, Lene Baagøe; Lyngstad, Merete; Rotegård, Ann-Kristin & Fossum, Mariann (2024). Nursing standards in electronic health records. Full text in Research Archive
• Laukvik, Lene Baagøe; Rotegård, Ann-Kristin; Lyngstad, Merete & Fossum, Mariann (2023). Registered nurses’ reasoning process during care planning and documentation in the electronic health records: A concurrent think-aloud study. Full text in Research Archive
• Fossum, Mariann & Laukvik, Lene Baagøe (2022). Dokumentasjon av sykepleie - grunnlag, struktur, innhold og terminologi. In Bjørnnes, Ann Kristin; Gjevjon, Edith Roth; Grov, Ellen Karine & Holter, Inger Margrethe (Ed.), Sykepleieboken 1, Sykepleiens fundament. Cappelen Damm Akademisk. ISSN 9788202673543. p. 175–196. Full text in Research Archive
• Laukvik, Lene Baagøe (2022). Mening, sammenheng og struktur i dokumentasjon. Full text in Research Archive
• Laukvik, Lene Baagøe; Slettebø, Åshild; Lyngstad, Merete; Rotegård, Ann Kristin & Fossum, Mariann (2021). Person Centered Care in The Nursing Documentation for Residents in Long-term Dementia care: A retrospective chart review. Full text in Research Archive
• Laukvik, Lene Baagøe (2020). Dokumentasjon av helsehjelp. Full text in Research Archive
• Laukvik, Lene Baagøe (2018). Klassifikasjon og terminologi i faglighet og utdannelse. Full text in Research Archive
• Laukvik, Lene Baagøe; Mølstad, Kathy & Fossum, Mariann (2018). The construction of a subset of ICNP® for patients with dementia: a Delphi consensus and a group interview study (2015). Full text in Research Archive
• Laukvik, Lene Baagøe (2017). Felles språk i sykepleierutdanningen. Fordeler for pasienten, studenten og helsetjenesten. Full text in Research Archive
• Laukvik, Lene Baagøe; Mølstad, Kathryn & Fossum, Mariann (2017). Felles fagspråk i sykepleiedokumentasjon. Tidsskriftet sykepleien. ISSN 0806-7511. doi: 10.4220/Sykepleiens.2017.61855. Full text in Research Archive
• Laukvik, Lene Baagøe (2017). Standardisert terminologi i dokumentasjon av sykepleie - utvikling av en ICNP-katalog i demensomsorg. Full text in Research Archive
• Laukvik, Lene Baagøe; Mølstad, Kathryn & Fossum, Mariann (2016). The Construction of a subset of ICNP® for patients With dementia. Full text in Research Archive
• Laukvik, Lene Baagøe (2024). Nurses’ care planning and documentation processes in electronic health records of patients living with dementia. Universitetet i Agder. ISSN 9788284271842. Full text in Research Archive Show summary

  Background: Communication and coordination of patient information are central to achieving continuity and safety for patients in health services. Electronic health records (EHRs) are utilized in large parts of the world, including Norway, in daily clinical practice to plan and document healthcare. As the workload and transition of patients increase in health services, including in nursing homes, nurses and other healthcare professionals increasingly rely on patient information from the EHR to support their daily planning and management of high-quality nursing care for patients. In dementia care, the need to plan and document patient information in a safe and secure way is important for patient safety and a person-centered approach and follow-up of the patient. Little is known about the care planning and documentation process of nurses in long-term dementia care settings. Aim: The overall aim was to gain knowledge and understanding of the care planning and documentation processes of nurses in EHRs in the dementia nursing home setting. Methods: A qualitative descriptive design was utilized in this PhD project. Multiple approaches to elicit the perspectives and experiences of nurses were chosen to understand their everyday world of planning and documenting nursing care in the dementia care setting. The project comprises three substudies. In Substudy 1, a retrospective chart review was conducted utilizing content analysis with a deductive approach to describe the content and comprehensiveness of the nursing documentation of patients living with dementia in Norwegian nursing homes. The content was described in relation to person-centered care (PCC) and the nursing process (NP). Comprehensiveness was measured with the Comprehensiveness In Nursing Documentation (CIND) scale. In Substudy 2, a think-aloud (TA) study was conducted utilizing a stepwise verbal protocol analysis to explore and describe nurse’s clinical reasoning during care planning and documentation of nursing in the EHR of patients living in special dementia care units in Norwegian nursing homes. In Substudy 3, a one-on-one interview study was conducted utilizing a semi-structured interview guide. Following a deductive orientation, reflexive thematic analysis was utilized to generate patterns of shared views and meanings among the participants.

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