Resistance of multiple stakeholders to e-health innovations: Integration of fundamental insights and guiding research paths

Consumer/user resistance is considered a key factor responsible for the failure of digital innovations. Yet, existing scholarship has not given it due attention while examining user responses to e-health innovations. The present study addressed this need by consolidating the existing findings to provide a platform to motivate future research. We used a systematic literature review (SLR) approach to identify and analyze the relevant literature. To execute the SLR, we first specified a stringent search protocol with specific inclusion and exclusion criteria to identify relevant studies. Thereafter, we undertook an in-depth analysis of 72 congruent studies, thus presenting a comprehensive structure of findings, gaps, and opportunities for future research. Specifically, we mapped the relevant literature to elucidate the nature and causes of resistance offered by three key constituent groups of the healthcare ecosystem—patients, healthcare organizational actors, and other stakeholders. Finally, based on the understanding acquired through our critical synthesis, we formulated a conceptual framework, classifying user resistance into micro, meso, and macro barriers which provide context to the interventions and strategies required to counter resistance and motivate adoption, continued usage, and positive recommendation intent. Being the first SLR in the area to present a multi-stakeholder perspective, our study offers fine-grained insights for hospital management, policymakers, and community leaders to develop an effective plan of action to overcome barriers that impede the diffusion of e-health innovations.publishedVersionPaid open acces

An Empirical Evaluation Of User Satisfaction With A School Nursing Information System

The adoption of a school nursing information system is considered one of the most efficient ways in which to document health records as well as monitor health conditions electronically. However, despite the importance of computerized health records in school nursing practice, few studies have examined user satisfaction of a school nursing information system. The aim of this study is to investigate the critical factors effecting school nurses’ satisfaction with a school nursing information system Utilizing a survey approach, questionnaires are distributed to nurses working in a primary or high school which introduces a new school nursing information system. The findings show several factors, including perceived usefulness, perceived of ease of use, training and workload are significant with user satisfaction. These results suggest that school nursing information system designers should comprehensively understand users’ demands and perceptions about the system, which will further facilitate user satisfaction, decrease their workload, and ultimately enhance job performance

Registered Nurses\u27 Intention To Use Electronic Documentation Systems: A Mixed Methods Study

BACKGROUND: Home care in Ontario has become the fastest growing sector and cornerstone of the healthcare system. As a result of the increased shift to the home care sector in Ontario, there have been several health information technology (HIT) initiatives to improve the quality and delivery of health care services to patients. This is exemplified with the province-wide development and implementation of electronic documentation systems (EDS). Electronic documentation systems have the potential to ensure timely, up-to-date and comprehensive patient health and care-related information is available and accessible to healthcare providers such as registered nurses regardless of their physical location. Access to patient health and care-related information supports high-quality nursing care, decision-making, and care delivery processes. Despite the benefits of EDS (i.e., improved workflow, reduced diagnostic and laboratory tests and adverse drug events), low intention by registered nurses to use these systems is well documented. Existing evidence suggests that an expressed intention to use HIT such as EDS is a direct predictor and antecedent of behavioural usage. Despite the growing efforts to understand registered nurses’ perceptions and overall intention to use EDS in practice, there is limited knowledge about registered nurses’ intention to use EDS in the context of home care practice. AIMS: The purpose of this study was to understand and examine factors that influence nurses’ intention and overall perception of using EDS in their home care practice. The conceptual model framing this study was adapted from the Unified Theory of Acceptance and Use of Technology (UTAUT) to delineate the relationships among factors that influence registered nurses’ intention to use EDS in home care practice. METHOD: A sequential, explanatory mixed methods design, using a sample of nurses from Ontario who are currently practicing within the home care sector were recruited to address the study’s objectives. Data were collected using both quantitative (online survey) and qualitative (semi-structured individual telephone interviews) methods. Quantitative data were analyzed with descriptive statistics and hierarchical multiple regression analysis and qualitative data were analyzed with content and inductive thematic analysis. RESULTS: Individual, technological and organizational / environmental characteristics were found to influence nurses’ intention, level of comfort and experience with EDS usage in home care practice. Additional factors found to influence home care nurses’ experience with EDS usage included: the development and employment of workarounds, the influence of nurse-patient interaction amidst system usage, and the ability to provide input towards the system design. CONCLUSION: Nurses play a significant role in the delivery of home health care services to Ontarians. The findings highlight the importance for: a) further exploration of the most appropriate model and / or adaptation of a model identifying a range of factors influencing nurses’ intention to use EDS in different healthcare contexts; b) continued integration of nursing informatics competencies within nursing curricula; c) an organizational culture that supports the use of EDS in nurses’ home practice (i.e., enlisting user champions and providing adequate training and IT support); and d) having representation of nurses in the EDS design and / or implementation processes through a user-centered design approach

Factors affect the social engagement among community dwelling older person: community nurses perspective.

INTRODUCTION: Remaining involved in activities that are meaningful and purposeful and maintaining chose relationship. METHOD: Descriptive qualitative research approach. CONCLUSION: Promoting a considerate cultures in all levels of society is fundamental to create friendly and conducive environment for all people

A Study Identifying Information Technology Development Strategies for Nursing Professional Development Specialists Practicing in Healthcare Settings

The increased use of information systems (IS) in healthcare institutions, federal health information technology (IT) policy mandating the use of information systems in patient care, and the nursing informatics agenda force healthcare organizations to address the informatics competency of its workforce (Murphy, 2010). This study validates IT competencies for Nursing Professional Development (NPD) Specialists and determines self-directed, informal learning strategies for developing information technology competency. The NPD Specialist is responsible for the professional development of nursing caregivers in healthcare settings. This study validated 53 IT competencies for the NPD Specialist role in healthcare settings. The validated competencies include current healthcare technology, federal health IT policy, evidence-based practice, and other necessary topics within healthcare. This study regarded 41 competencies (of the 53 validated IT competencies) as high importance, or essential, to the NPD Specialists role in healthcare settings today. Strategies were also identified for developing the essential IT competencies. The NPD Specialists and leaders within healthcare organizations can use the validated essential IT competencies and development strategies from this study to build IT competency amongst its workforce (ANA, 2010)

Utilizing TIGER Competencies to Improve Informatics Practice

Nursing Informatics (NI) is quickly becoming an essential part of nursing. From the classroom, to the bedside, and to the boardroom, nurses across the nursing continuum are expected to use NI in their practice with the hopes of delivering better quality care to their patients. However, the training and education of NI provided to all levels of nurses is unable to keep up with the pace of technology. This project seeks to improve the NI competency of the nursing workforce at a pediatric hospital through an educational course using NI competencies identified by the Technology Informatics Guiding Educational Reform (TIGER) Initiative (2009). The value of this project is that it addresses the gap in NI education and competencies at a 265-bed pediatric hospital and creates a NI curriculum that is relevant, timely, and teaches nurses the essential skills to use NI to provide quality care and become a driver of patient quality outcomes

Breastfeeding knowledge and attitudes of baccalaureate nursing students in Taiwan : (The BONUS Project)

Background: Optimal nutrition during the first year of life is critical to an infant’s healthy growth and development. Hence, it is vital that undergraduate health professional curricula provide opportunities for quality theoretical and clinical learning related to breastfeeding to enable students to acquire the necessary knowledge and skills to support breastfeeding mothers. There is evidence that theoretical and clinical education can improve such knowledge bases and attitudes among nursing students prior to clinical placement. Aims: The aim of this research project was to examine, in relation to breastfeeding, the effects of the theoretical and clinical learning experiences of Taiwanese nursing students’ knowledge and attitudes. This research project also explored the role and experiences of nursing students in supporting breastfeeding from the perspectives of the students themselves, new mothers, nursing staff and teachers. Methodology: A mixed-methods design was used and involved both quantitative and qualitative data collection and analysis. First, a systematic review reporting on outcomes for nursing students was conducted. Accordingly, the Australian Breastfeeding Knowledge and Attitude Questionnaire (Short-Form) (ABKAQ-SF) was selected as an appropriate tool to examine the current knowledge and attitudes of Taiwanese nursing students. This questionnaire was further validated in Chinese, the approach to which is presented in Paper 2. Second, quantitative data were collected using a pre- and post-test survey design with two cohorts of nursing students. Knowledge and attitude were assessed before and after students’ theoretical learning and clinical placement. Third, qualitative data were collected by conducting focus groups and small group interviews with four participant groups. Ethics approval was obtained prior to data collection. Findings: The findings of this research project are presented in four published papers. The systematic review of the literature indicated that health professional students demonstrated mid-range scores on breastfeeding attitudes, and their knowledge of breastfeeding was limited. The review also highlights the need to determine how breastfeeding knowledge and skills are best facilitated in undergraduate curricula to help students relate theoretical breastfeeding knowledge to practice (Paper 1). The results of the study determined the effect of breastfeeding education in a Baccalaureate of Nursing (BN) program on students’ knowledge and attitude towards breastfeeding. Students demonstrated significant improvements in both areas following theoretical and clinical intervention (Paper 3). The final paper explored the experiences of nursing students in supporting breastfeeding mothers in a postpartum unit. Students highlighted the importance of establishing trust to effectively support mothers and a need to feel confident to provide breastfeeding information, in turn. The study also identified nursing students’ need for further support, to develop effective communication skills and to build confidence prior to clinical placement. Conclusion: Results revealed that the current breastfeeding education program in Taiwan, both its theoretical and clinical components, increased nursing students’ knowledge and improved positive attitudes towards breastfeeding. Any sociodemographic differences in knowledge and attitude about breastfeeding were ameliorated following theoretical and clinical learning. The findings also demonstrated the need for further support in developing effective communication skills and building confidence prior to clinical placement

A model on factors affecting nurses adoption of health information technology

Healthcare organisations are using Health Information Technology (HIT) to improve efficiency, reduce cost and reduce medical errors. This study focused on the factors that influence the acceptance of HIT among nurses in Saudi hospitals. This research used a 6 stage mixed-methods research approach. Literature was used to search for established models and frameworks of technology acceptance, and the many factors that could play a role. In the field study, the nature of practical HIT issues at the Prince Sultan Military Medical City (PSMMC) and the Heraa Hospital were studied, and combined with literature to create a HIT Implementation Issues Framework. The framework consolidates elements from the Technological, Organisational, Environmental and Human dimensions. The researcher participated in further PSMMC projects in the design and implementation of the new Cardio Pulmonary Resuscitation System and the Nurses and Pharmacists’ Communication System. From the implementation experience, pertinent factors were added to the Technology Acceptance Model and the “Nurses Acceptance Model” was proposed. The proposed model has eleven independent parameters, two dependent parameters, as well as seven moderators of key relationships. A questionnaire with 71 entries was distributed to over 2800 nurses in 52 wards in PSMMC. SPSS was used for data screening and descriptive statistics. The SmartPLS software was used for analysis and testing of the proposed hypotheses. The findings refined the “Nurses Acceptance Model” and highlight the significance of User Involvement and Training. The “Nurses Acceptance Model” enhances the scientific understanding of variables that affect technology acceptance among nurses in Saudi hospitals. The HIT Implementation Issues Framework helps hospital decision makers to plan HIT projects to improve the likelihood of successful adoption

The Moderating Effects of Age and Computer Knowledge on Nurses’ Acceptance of Information Systems: A Canadian Study

The objective of this study was to educate on the moderating effects of age and computer knowledge on nurses’ acceptance of information systems (IS). The background theoretical framework used was the technology acceptance model (TAM), which has been widely favored by healthcare researchers. A relevant research model including TAM’s core constructs, i.e., perceived usefulness (PUSS) and ease of use (PEOU), age, and computer knowledge was used. Usable data was collected from 197 registered nurses (RNs) in Nova Scotia, Canada, in a cross-sectional survey. The partial least squares (PLS) technique of structural equation modeling was used for data analysis. The results of the hypothesized relationships show that computer knowledge has a positive moderating effect on the influences of PEOU and PUSS on nurses’ attitudes toward IS (ATTI); the demographic factor of age did not. PEOU and PUSS have direct positive influence on nurses’ ATTI, which in turn impacts their behavioral intentions to use IS (BEHI). Lastly, nurses’ self-reported IS use is positively influenced by BEHI. The study’s results drew the attention of practitioners and academics to the impacts of age and computer knowledge in the discourse of nurses’ IS acceptance in work environments

Towards a B2B E-Commerce Evaluation Management Model to Assess Organizational Drivers in Hospitals

Effective utilization of business-to-business (B2B) electronic commerce (e-commerce) in hospitals may lead to many benefits such as increased accessibility to healthcare providers, improved process efficiency, enhanced quality of healthcare services, increased responses to changes, decreased scheduling conflicts, and reduction in administrative costs. However, many hospitals have found that they have not yet fully reaped the expected benefits from their B2B e-commerce investments. Despite this, there has not been much discussion in the literature with respect to the relationship between the organizational drivers on B2B e-commerce benefits for hospitals. Hence, a mixed-method of case study and survey was conducted to examine the relationships between B2B e-commerce benefits, IT evaluation resources allocation, IT investment evaluation methodologies, IT maturity, and user information requirements determination process. A B2B e-commerce evaluation management model was developed to test these relationships. The results provided empirical evidence in support of our proposed model and revealed that hospitals’ IT evaluation resources allocation practices mediated the relationship of IT investment evaluation methodologies, IT maturity, and user information requirements determination process with B2B e-commerce benefits. The results also showed that the level of IT maturity had a significant impact on the adoption of IT investment evaluation methodologies