Clinical reasoning in telenursing: A data-driven analysis of real-world electronic nursing records
Tomoko Kamei, Aki Kawada, Yuko Yamamoto, Yuki NakayamaObjective
Telenursing supports remote chronic disease management, yet clinical reasoning documented in routine practice remains insufficiently understood. This study characterized clinical reasoning documented in real-world telenursing records structured according to the subjective, objective, assessment, and plan (SOAP) format and examined differences between deterioration-related and non-deterioration records and among chronic disease groups.
Methods
We conducted a secondary analysis of 11,131 person-day electronic telenursing records collected from 78 participants with chronic diseases between June 2009 and March 2025. Each original study and the present secondary analysis received ethical approval. Quantitative text analysis using KH Coder 3 comprised word-frequency, hierarchical cluster, co-occurrence, and correspondence analyses and was integrated with qualitative thematic analysis. Findings were treated as documented representations of clinical reasoning rather than direct observations of cognitive processes.
Results
SOAP records showed linked patterns of client-reported information, objective monitoring, nursing assessment, and care planning. Fifty deterioration-related records were analyzed, including 20 hospitalization-day records and 30 records documented 1–2 days before hospitalization. Compared with non-deterioration records, deterioration-related records contained terms denoting change, worsening, communication, and escalation, whereas non-deterioration records reflected confirmation-oriented monitoring. Disease-related differences in assessment documentation were also identified. These findings should be interpreted cautiously because deterioration-related records were few and disease-group sizes were unequal.
Conclusion
SOAP-structured electronic telenursing records provide structured representations of clinical reasoning documented in routine practice. The findings offer exploratory, real-world insights into documentation patterns associated with deterioration rather than validated predictors.