The unseen and unacceptable face of digital libraries

The social and organisational aspects of digital libraries (DLs) are often overlooked, but this paper reviews how they can affect users' awareness and acceptance of DLs. An analysis of research conducted within two contrasting domains (clinical and academic) is presented which highlights issues of user interactions, work practices and organisational social structures. The combined study comprises an analysis of 98 in-depth interviews and focus groups with lecturers, librarians and hospital clinicians. The importance of current and past roles of the library, and how users interacted with it, are revealed. Web-based DLs, while alleviating most library resource and interaction problems, require a change in librarians' and DL designers' roles and interaction patterns if they are to be implemented acceptably and effectively. Without this role change, users will at best be unaware of these digital resources and at worst feel threatened by them. The findings of this paper highlight the importance of DL design and implementation of the social context and supporting user communication (i.e., collaboration and consultation) in information searching and usage activities. © Springer-Verlag 2004

Digital libraries in a clinical setting: Friend or foe?

Clinical requirements for quick accessibility to reputable, up-to-date information have increased the importance of web accessible digital libraries for this user community. To understand the social and organisational impacts of ward-accessible digital libraries (DLs) for clinicians, we conducted a study of clinicians. perceptions of electronic information resources within a large London based hospital. The results highlight that although these resources appear to be a relatively innocuous means of information provision (i.e. no sensitive data) social and organisational issues can impede effective technology deployment. Clinical social structures, which produce information. and technology. hoarding behaviours can result from poor training, support and DL usability

Acute care nurses' perceptions of barriers to using research information in clinical decision-making

Aim. To examine the barriers that nurses feel prevent them from using research in the decisions they make. Background. A sizeable research literature focusing on research utilization in nursing has developed over the past 20 years. However, this literature is characterized by a number of weaknesses: self-reported utilization behaviour; poor response rates and small, nonrandom sampling strategies. Design. Cross-case analysis involving anonymised qualitative interviews, observation, documentary audit and Q methodological modelling of shared subjectivities amongst nurses. The case sites were three large acute hospitals in the north of England. One hundred and eight nurses were interviewed, 61 of whom were also observed for a total of 180 h, and 122 nurses were involved in the Q modelling exercise (response rate of 64%). Results. Four perspectives were isolated that encompassed the characteristics associated with barriers to research use. These related to the individual, organization, nature of research information itself and environment. Nurses clustered around four main perspectives on the barriers to research use: (1) Problems in interpreting and using research products, which were seen as too complex, 'academic' and overly statistical; (2) Nurses who felt confident with research-based information perceived a lack of organizational support as a significant block; (3) Many nurses felt that researchers and research products lack clinical credibility and that they fail to offer the desired level of clinical direction; (4) Some nurses lacked the skills and, to a lesser degree, the motivation to use research themselves. These individuals liked research messages passed on to them by a third party and sought to foster others' involvement in research-based practice, rather than becoming directly involved themselves. Conclusions. Rejection of research knowledge is not a barrier to its application. Rather, the presentation and management of research knowledge in the workplace represent significant challenges for clinicians, policy-makers and the research community

The Ethical Implications of Personal Health Monitoring

Personal Health Monitoring (PHM) uses electronic devices which monitor and record health-related data outside a hospital, usually within the home. This paper examines the ethical issues raised by PHM. Eight themes describing the ethical implications of PHM are identified through a review of 68 academic articles concerning PHM. The identified themes include privacy, autonomy, obtrusiveness and visibility, stigma and identity, medicalisation, social isolation, delivery of care, and safety and technological need. The issues around each of these are discussed. The system / lifeworld perspective of Habermas is applied to develop an understanding of the role of PHMs as mediators of communication between the institutional and the domestic environment. Furthermore, links are established between the ethical issues to demonstrate that the ethics of PHM involves a complex network of ethical interactions. The paper extends the discussion of the critical effect PHMs have on the patient’s identity and concludes that a holistic understanding of the ethical issues surrounding PHMs will help both researchers and practitioners in developing effective PHM implementations

Softer perspectives on enhancing the patient experience using IS/IT

Purpose – This paper aims to argue that the implementation of the Choose and Book system has failed due to the inability of project sponsors to appreciate the complex and far-reaching softer implications of the implementation, especially in a complex organisation such as the NHS, which has multifarious stakeholders. Design/methodology/approach – The authors use practice-oriented research to try and isolate key parameters. These parameters are compared with existing conventional thinking in a number of focused areas. Findings – Like many previous NHS initiatives, the focus of this system is in its obvious link to patients. However we find that although this project has cultural, social and organisational implications, programme managers and champions of the Connecting for Health programme emphasised the technical domains to IS/IT adoption. Research limitations/implications – This paper has been written in advance of a fully implemented Choose and Book system. Practical implications – The paper requests that more attention be paid to the softer side of IS/IT delivery, implementation, introduction and adoption. Originality/value – The paper shows that patient experience within the UK healthcare sector is still well below what is desired

Interpretive flexibility along the innovation decision process of the UK NHS Care Records Service (NCRS): Insights from a local implementation case study

Interpretive flexibility is a term used to describe the diverse perspectives on what a technology is and can or can not do during the process of technological development. In this article, we look at how interpretive flexibility manifests through the diverse perceptions of stakeholders involved in the diffusion and adoption of the NHS Care Records Service (NCRS). Our analysis shows that while the policy makers acting upon the application of details related to the implementation of the system, the potential users are far behind the innovation decision process, namely at the knowledge or persuasion stages. We use data from a local heath authority from a county close to London. The research explores, compares, and evaluates contrasting views on the systems implementation at the local as well as national level. We believe that our analysis is useful for NCRS implementation strategies, in particular, and technology diffusion in large organisations, in general

A Study to Understand and Compare Evidence Based Practice Among Health Professionals Involved in Pain Management

Pain management is a common concern of multiple health professionals. Evidence-based practice (EBP) in pain management is a recognized approach used to improve health outcomes. EBP tools can facilitate its implementation. PAIN+ is a tool that provides access to pre-appraised current best research evidence on pain to support clinical decisions. It is important to understand the knowledge, attitudes and behavior of professionals towards EBP and more specifically how they access research about pain management. The overarching purpose of this thesis is to better understand how clinicians from different professions involved in pain management view EBP and implement specific strategies to find pain related research evidence. We conducted a series of studies incorporating various methods to address these questions. Data was collected supplementary to a large randomized control trial to compare “Push” vs. “Pull” strategies for uptake of pain research. In the first study, we compared the knowledge, attitudes, outcomes expectations and behaviors of physicians, nurses, physiotherapists, occupational therapists and psychologists towards EBP in pain management using a validated knowledge attitude and behavior (KABQ) questionnaire. In the second study, we used a mixed methods approach to understand the competencies of clinicians accessing electronic databases to search for evidence on pain management. In the third study, we performed a structured classification of the abstracts that were viewed by clinicians to understand their access behaviors. In the last part of the thesis, we compared the usefulness of PAIN+ with PubMed using a randomized crossover trial approach. The results of this thesis indicate that the professionals involved in pain management have good knowledge of and attitudes towards EBP, but behavior i.e. implementation of EBP in practice and perception of outcomes of implementing EBP were low. In the second study, we found that professionals had acceptable levels of basic literature searching skills but had low levels of use of more advanced skills, and were not aware of using clinical queries in their search. In the third study, we found that all professionals accessed research evidence when provided alerts about pain research and some variations in the types of studies accessed were observed. Differences in access behaviors might reflect differences in professional approach to pain management. In our fourth study the crossover randomized controlled trial; we found PAIN+ and PubMed were both rated useful in retrieving pain evidence for clinicians. Professionals showed an interest in evidence-based pain management, but their skills for finding evidence were limited, they appeared to need training in locating and appraising pain related research evidence, and may benefit from tools that reduce this burden