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The primary objectives of this research on paper-based cognitive artifacts are to 1) identify the aspects that are perceived as useful, and 2) identify similarities and differences with respect to written content. Two paper-based cognitive artifacts used by nurses are studied, the Kardex® and the `brains’. The conceptual underpinnings of this research are from human factors engineering, including the assumption that cognitive artifacts display information in an external manner to support cognitive processing and recall. The research objectives are met using a triangulation approach across semi-structured interviews, targeted `in situ’ observations, and content analysis of digital photographs. The triangulated findings from the multiple methods indicate that both artifacts were useful in 1) serving as a `snapshot’ of the historical and current status of the patient, and 2) supporting personal activity management (`to-do’ list). The `brains’ artifact was useful in supporting remembering key information to incorporate into formal chart documentation at a later time. Regarding content, 1) brains were more frequently updated than the Kardex®, likely because it is a personal tool as opposed to a shared tool in a unit across nurses, charge nurses, nurse aides, and unit clerks, 2) `brains’ incorporated medication information whereas the Kardex® maintained the medication information on a separate card, 3) both artifacts heavily employed `margin jots’ for information that was not in pre-defined categories, 4) there was variation by nurse and patient in terms of what categories were included and frequently updated. These findings have potential implications for hospitals to request revised interfaces that better support situation awareness for electronic health records and to help develop and maintain policies and procedures with respect to the use of `brains’. In addition, design recommendations are made for mobile phone application developers or existing or `next generation’ electronic health record companies to employ in an integrated ’NurseBrain’ concept.