Tecnoestrés y sobrecarga cognitiva asociados al uso de historias clínicas electrónicas en profesionales de enfermería: revisión bibliográfica estructurada

Candida Vanesa Lanche-Troya; Yésica Patricia Sarmiento-Quezada

Autores/as

Lanche-Troya Candida Vanesa Enfermera ocupacional. Loja, Ecuador. https://orcid.org/0009-0002-4059-2939
Sarmiento-Quezada Yésica Patricia Licenciada en Enfermería. Loja, Ecuador. https://orcid.org/0009-0001-7866-3731

Palabras clave:

Estrés laboral; Registros electrónicos de salud; Enfermería; Carga cognitiva; Documentación clínica; Usabilidad

Resumen

DOI: https://doi.org/10.46296/gt.v9i18.0409

Resumen

Introducción: Las historias clínicas electrónicas (HCE) facilitan el acceso y la trazabilidad de información, pero pueden incrementar demandas mentales, interrupciones y obligaciones documentales. Objetivo: sintetizar la evidencia sobre tecnoestrés, sobrecarga cognitiva y carga documental vinculados a las HCE en profesionales de enfermería e identificar factores modificables. Métodos: revisión bibliográfica estructurada con tres ecuaciones reproducibles en PubMed (2018–20 de octubre de 2026), cribado asistido de títulos/resúmenes y síntesis temática de investigaciones primarias. Se conservaron identificadores únicos y motivos preliminares en una matriz auditable. Resultados: se obtuvieron 226 registros de búsqueda, 190 PMID únicos después de 36 repeticiones, 28 informes preseleccionados y 23 estudios incorporados provisionalmente a la síntesis; cinco se descartaron tras evaluación temática. Los resultados más consistentes relacionan mala usabilidad, documentación redundante, cambios de sistema y dificultades de navegación con mayor estrés o esfuerzo mental. Se detectaron hallazgos no uniformes: algunos estudios atribuyen beneficios al registro electrónico y otros identifican vínculos débiles con burnout. Conclusión: las HCE no constituyen por sí solas una causa demostrada de tecnoestrés; el riesgo está condicionado por diseño, capacitación y organización del trabajo. Son necesarios estudios longitudinales e intervenciones sociotécnicas, con medidas validadas y seguridad del paciente.

Palabras claves: Estrés laboral; Registros electrónicos de salud; Enfermería; Carga cognitiva; Documentación clínica; Usabilidad.

Abstract

Background: Electronic health records (EHRs) improve access to clinical information but may introduce cognitive demands, interruptions, and documentation burden. Objective: To synthesize evidence on technostress, cognitive workload, and documentation burden associated with EHR use among nurses, and to identify modifiable factors. Methods: A structured literature review used three reproducible PubMed strategies covering 2018 through October 20, 2026, assisted title/abstract screening, an auditable record-level matrix, and thematic narrative synthesis of primary research. Results: The searches generated 226 entries and 190 unique PubMed identifiers after 36 repeated hits. Twenty-eight reports underwent preliminary thematic eligibility assessment and 23 primary studies were provisionally synthesized; five were excluded at this step. Poor usability, redundant charting, difficult navigation, and system transitions were frequently linked to distress or higher mental workload, whereas associations with burnout were not uniform. Conclusions: EHR-associated occupational and cognitive strain is influenced by system design and organizational context. Nurse-centered redesign, training, and rigorous prospective evaluations are warranted. This documented search and screening workflow does not constitute a fully independently verified systematic review.

Keywords: Occupational Stress; Electronic Health Records; Nursing; Mental Workload; Documentation Burden; Usability.

Información del manuscrito:
Fecha de recepción: 14 de julio de 2026.
Fecha de aceptación: 21 de septiembre de 2026.
Fecha de publicación: 29 de octubre de 2026.

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Citas

Harris DA, Haskell J, Cooper E, Crouse N, Gardner R. Estimating the association between burnout and electronic health record-related stress among advanced practice registered nurses. Appl Nurs Res. 2018;43:36-41. doi:10.1016/j.apnr.2018.06.014.

AlQahtani M, AlShaibani W, AlAmri E, Edward D, Khandekar R. Electronic health record-related stress among nurses: determinants and solutions. Telemed J E Health. 2021;27(5):544-550. doi:10.1089/tmj.2020.0059.

Kaihlanen AM, Gluschkoff K, Hyppönen H, et al. The associations of electronic health record usability and user age with stress and cognitive failures among Finnish registered nurses. JMIR Med Inform. 2020;8(11):e23623. doi:10.2196/23623.

Dunn Lopez K, Chin CL, Azevedo RFL, et al. Electronic health record usability and workload changes over time for provider and nursing staff following transition to new EHR. Appl Ergon. 2021;93:103359. doi:10.1016/j.apergo.2021.103359.

Melnick ER, West CP, Nath B, et al. The association between perceived electronic health record usability and professional burnout among US nurses. J Am Med Inform Assoc. 2021;28(8):1632-1641. doi:10.1093/jamia/ocab059.

Bakhoum N, Gerhart C, Schremp E, et al. A time and motion analysis of nursing workload and electronic health record use in the emergency department. J Emerg Nurs. 2021;47(5):733-741. PMID:33888334. doi:10.1016/j.jen.2021.03.007.

Heponiemi T, Kaihlanen AM, Gluschkoff K, et al. The association between using a mobile version of an electronic health record and the well-being of nurses. JMIR Med Inform. 2021;9(7):e28729. doi:10.2196/28729.

Khairat S, Xi L, Liu S, Shrestha S, Austin C. Understanding the association between electronic health record satisfaction and the well-being of nurses. JMIR Nurs. 2020;3(1):e13996. doi:10.2196/13996.

Wisner K, Chesla CA, Spetz J, Lyndon A. Managing the tension between caring and charting: labor and delivery nurses’ experiences of the electronic health record. Res Nurs Health. 2021;44(5):822-832. doi:10.1002/nur.22177.

Heponiemi T, Gluschkoff K, Vehko T, et al. Electronic health record implementations and insufficient training endanger nurses’ well-being. J Med Internet Res. 2021;23(12):e27096. doi:10.2196/27096.

Shan Y, Shang J, Yan Y, Ye X. Workflow interruption and nurses’ mental workload in electronic health record tasks: an observational study. BMC Nurs. 2023;22:63. doi:10.1186/s12912-023-01209-9.

Harmon CS, Adams SA, Davis JE, Gephart SM, Donevant SB. Unintended consequences of the electronic health record and cognitive load in emergency department nurses. Appl Nurs Res. 2023;73:151724. doi:10.1016/j.apnr.2023.151724.

Naamneh R, Bodas M. The effect of electronic medical records on medication errors, workload, and medical information availability among qualified nurses in Israel. BMC Nurs. 2024;23:270. doi:10.1186/s12912-024-01936-7.

Alobayli F. Impact of EHRs on nursing burnout in a hospital setting in Saudi Arabia: mixed-methods study. Stud Health Technol Inform. 2024;315:322-326. doi:10.3233/SHTI240161.

Jacques D, Will J, Dauterman D, et al. Evaluating nurses’ perceptions of documentation in the electronic health record: multimethod analysis. JMIR Nurs. 2025;8:e69651. doi:10.2196/69651.

Nguyen OT, Carey A, Steege LM, Cho H. Characteristics and contributors to workarounds in the electronic health record system among inpatient nurses. Int J Nurs Stud. 2026;173:105261. doi:10.1016/j.ijnurstu.2025.105261.

Kemp J, Shin HD, Pape C, et al. Variations in nursing documentation time in a mental health setting. Appl Clin Inform. 2025;16(5):1799-1814. doi:10.1055/a-2750-4422.

Al-Yasin AM, Alharbi HA. Time burden of electronic medical records on nurses and physicians in Saudi Arabia. Healthcare (Basel). 2026;14(4):441. doi:10.3390/healthcare14040441.

Mugoya R, Thate J, Hao F, Rossetti SC, Yen PY. Exploring nurses’ documentation prioritization strategies to alleviate EHR documentation burden. JAMIA Open. 2026;9(2):ooag056. doi:10.1093/jamiaopen/ooag056.

Mugoya R, Thate J, Fan H, Rossetti SC, Yen PY. Caring for the EHR rather than the patient: nurses’ perception of documentation burden. Comput Inform Nurs. 2026. doi:10.1097/CIN.0000000000001549.

Xia L, Lew D, Tessmer L, et al. Association between electronic health record-based nursing workload and turnover. JMIR Nurs. 2026;9:e89645. doi:10.2196/89645.

Hebert CA, Trinity C, Messer A. Nursing perspectives on documentation burden in a Veterans Affairs health care system. Comput Inform Nurs. 2026. doi:10.1097/CIN.0000000000001591.

Taylor-Vaughan L, Morrison WH, Silva Torres GE, et al. Spatially integrated electronic health record prototype improves usability and reduces cognitive load for intensive care nurses: a randomized crossover trial. Appl Clin Inform. 2026;17(3):604-614. doi:10.1055/a-2903-5822.

Wisner K, Lyndon A, Chesla CA. The electronic health record’s impact on nurses’ cognitive work: an integrative review. Int J Nurs Stud. 2019;94:74-84. doi:10.1016/j.ijnurstu.2019.03.003.

Park S, Marquard J, Austin RR, et al. A systematic review of nurses’ perceptions of electronic health record usability. Comput Inform Nurs. 2024;42(3):168-175. doi:10.1097/CIN.0000000000001084.

Rossetti SC, et al. Measurement of clinical documentation burden among physicians and nurses using electronic health records: a scoping review. J Am Med Inform Assoc. 2021;28(5):998-1008. doi:10.1093/jamia/ocaa325.

Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021;10:89. doi:10.1186/s13643-021-01626-4.