Nursing Identity and the Computer: The Impact of Care Realities on Information Systems Use

Driven by developments in technology and communication, and by social, political and economic issues, the introduction of different information systems in nursing has risen significantly in recent years. However, little is known about the understanding of these systems by the nurses who are intended to use them. Informed by a Symbolic Interactionist approach, this research explored the experience of nurses interacting with information systems. Using grounded theory methods, the main sources of data were interviews, textual analysis and observation with nurses in three Canadian cities. The key findings of this research are fourfold. First, the core category developed in this study is the care reality, a multi-faceted understanding of care that is central to the nursing identity, which adds a new level of understanding behaviour beyond the common attributes identified within nursing and information systems research. Second, this research identified the existence and importance of ready-to-hand and unready-to-hand information systems objects within nursing. Third, this research identified a care reality negotiation process, where each individual is continuously introduced to different care realities when they come into contact with co-workers or management who do not share the same care reality. The individual must then go through a negotiation process whereby each individual manages his or her care reality. The care reality negotiation process includes four phases: exposure, developing consciousness, sense-making and acclimatizing. Finally, the fourth result of this research was the identification of how an individual’s identity impacts on his or her understanding of information systems. This research produces a theoretical understanding of the experiences of nurses interacting with information systems. It identified a link between an individual’s care reality and his or her behaviour toward all technology, including information systems. The findings inform nursing research and practice, as well as contribute to the development, implementation and use of information systems in other areas of the modern healthcare system

Evaluation of a technology-enhanced integrated care model for frail older persons: protocol of the SPEC study, a stepped-wedge cluster randomized trial in nursing homes

Background Limited evidence exists on the effectiveness of the chronic care model for people with multimorbidity. This study aims to evaluate the effectiveness of an information and communication technology- (ICT-)enhanced integrated care model, called Systems for Person-centered Elder Care (SPEC), for frail older adults at nursing homes. Methods/Design SPEC is a prospective stepped-wedge cluster randomized trial conducted at 10 nursing homes in South Korea. Residents aged 65 or older meeting the inclusion/exclusion criteria in all the homes are eligible to participate. The multifaceted SPEC intervention, a geriatric care model guided by the chronic care model, consists of five components: comprehensive geriatric assessment for need/risk profiling, individual need-based care planning, interdisciplinary case conferences, person-centered care coordination, and a cloud-based information and communications technology (ICT) tool supporting the intervention process. The primary outcome is quality of care for older residents using a composite measure of quality indicators from the interRAI LTCF assessment system. Outcome assessors and data analysts will be blinded to group assignment. Secondary outcomes include quality of life, healthcare utilization, and cost. Process evaluation will be also conducted. Discussion This study is expected to provide important new evidence on the effectiveness, cost-effectiveness, and implementation process of an ICT-supported chronic care model for older persons with multiple chronic illnesses. The SPEC intervention is also unique as the first registered trial implementing an integrated care model using technology to promote person-centered care for frail older nursing home residents in South Korea, where formal LTC was recently introduced

Nursing Students\u27 Self-Efficacy and Attitude: Examining the Influence ofthe Omaha System In Nurse Managed Centers

Self-efficacy, or confidence, as an outcome behavior has been identified as influencing nursing job satisfaction and retention. Clinical learning environments and teaching strategies that build and support perceived self-efficacy are critical aspects of preparing new nurses for their entry and continuing role as professional nurses in today\u27s information-intensive data-management healthcare environment. The purpose of this pre-test post-test study is to measure, using the C-scale (Grundy, 1992), nursing students\u27 self-efficacy to perform patient assessment in Nurse Managed Centers (NMC) after one semester of using the Omaha System documentation framework. Nursing students\u27 attitudes of preparation for using Standardized Nursing Languages (SNL) in the future was also examined. Bandura\u27s (1977, 19986) theoretical model of self-efficacy provided the conceptual framework. Students\u27 overall self-efficacy scores increased significantly over the 12 week study. Use of the Omaha System \u27prepared a little\u27 to \u27very prepared\u27 90% of student nurses for future use of SNL. Continued use of the Omaha System documentation framework in Nurse Managed Center clinicals as a tool for understanding SNL is recommended.

Using an integrated information system to reduce interruptions and the number of non-relevant contacts in the inpatient pharmacy at tertiary hospital

Patient care is provided by a multidisciplinary team of healthcare professionals intended for high-quality and safe patient care. Accordingly, the team must work synergistically and communicate efficiently. In many hospitals, nursing and pharmacy communication relies mainly on telephone calls. In fact, numerous studies have reported telephone calls as a source of interruption for both pharmacy and nursing operations; therefore, the workload increases and the chance of errors raises. This report describes the implementation of an integrated information system that possibly can reduce telephone calls through providing real-time tracking capabilities and sorting prescriptions urgency, thus significantly improving traceability of all prescriptions inside pharmacy. The research design is based on a quasi-experiment using pre-post testing using the continuous improvement approach. The improvement project is performed using a six-step method. A survey was conducted in Prince Sultan Military Medical City (PSMMC) to measure the volume and types of telephone calls before and after implementation to evaluate the impact of the new system. Beforehand of the system implementation, during the two-week measurement period, all pharmacies received 4466 calls and the majority were follow-up calls. Subsequently of the integrated system rollout, there was a significant reduction (p > 0.001) in the volume of telephone calls to 2630 calls; besides, the calls nature turned out to be more professional inquiries (p > 0.001). As a result, avoidable interruptions and workload were decreased

Technology-Enhanced Practice for Patients with Chronic Cardiac Disease: Home Implementation and Evaluation

Objective: This 3-year field experiment engaged 60 nurses and 282 patients in the design and evaluation of an innovative home-care nursing model, referred to as technology-enhanced practice (TEP). Methods: Nurses using TEP augmented the usual care with a web-based resource (HeartCareII) that provided patients with self-management information, self-monitoring tools, and messaging services. Results: Patients exposed to TEP demonstrated better quality of life and self-management of chronic heart disease during the first 4 weeks, and were no more likely than patients in usual care to make unplanned visits to a clinician or hospital. Both groups demonstrated the same long-term symptom management and achievements in health status. Conclusion: This project provides new evidence that the purposeful creation of patient-tailored web resources within a hospital portal is possible; that nurses have difficulty with modifying their practice routines, even with a highly-tailored web resource; and that the benefits of this intervention are more discernable in the early postdischarge stages of care

A quantitative analysis of the impact of a computerised information system on nurses' clinical practice using a realistic evaluation framework

Objective: To explore nurses' perceptions of the impact on clinical practice of the use of a computerised hospital information system. Design: A realistic evaluation design based on Pawson and Tilley's work has been used across all the phases of the study. This is a theory-driven approach and focuses evaluation on the study of what works, for whom and in what circumstances. These relationships are constructed as context-mechanisms-outcomes (CMO) configurations. Measurements: A questionnaire was distributed to all nurses working in in-patient units of a university hospital in Spain (n = 227). Quantitative data were analysed using SPSS 13.0. Descriptive statistics were used for an overall overview of nurses' perception. Inferential analysis, including both bivariate and multivariate methods (path analysis), was used for cross-tabulation of variables searching for CMO relationships. Results: Nurses (n = 179) participated in the study (78.8% response rate). Overall satisfaction with the IT system was positive. Comparisons with context variables show how nursing units' context had greater influence on perceptions than users' characteristics. Path analysis illustrated that the influence of unit context variables are on outcomes and not on mechanisms. Conclusion: Results from the study looking at subtle variations in users and units provide insight into how important professional culture and working practices could be in IT (information technology) implementation. The socio-technical approach on IT systems evaluation suggested in the recent literature appears to be an adequate theoretical underpinning for IT evaluation research. Realistic evaluation has proven to be an adequate method for IT evaluation. (C) 2009 Elsevier Ireland Ltd. All rights reserved