EP02.05 - Use of Documentation Systems and Community Nurses' Problem Solving
e-Health ePoster Library. Al-Masslawi D. Jun 7, 2016; 131580; EP02.05
Dawood Al-Masslawi
Dawood Al-Masslawi
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Purpose/Objectives: To study the use of documentation systems by home and community nurses who provide care for patients with wounds. Furthermore to identify the most common patterns of problem solving used by the nurses in order to manage their patients and use Health Information Technology for patient documentation. Methodology/Approach: An ethnographic fieldwork was carried out for duration of six weeks at seven community healthcare units in Metro Vancouver, British Columbia. Approximately 120 hours of nursing shifts were observed and data was collected using field notes, event logs, and a survey. The field notes were coded topically and analyzed thematically. The topical codes were adapted from the literature. The event logs and the results of the collected surveys were analyzed with descriptive statistics. Finding/Results: The nurses had spent approximately 39.51 percent of their time on using technology which coincided with 106 instances where nurses had to solve technology related problems, that is 36.93 percent of all problems (N=287). The problems were grouped into 11 categories. The nurses had worked around these problems by changing the typical use of technology systems (N=144) and work processes (N=488). The patterns identified in system and process workarounds were further refined, which resulted in seven groups of workarounds. These categories included, prospective prompts (when a nurse prompts a colleague or herself prospectively), retrospective prompts, parallel paper system use, appropriative system use (when a nurse uses the system to complete a task that is not intended to be completed with the system), appropriative resource use, circumventive system use (when a nurse uses the system in unintended ways to complete a task and circumvent a block to that task), and circumventive resource use. The largest group of problems was recorded as related to technology, while the largest group of workarounds was recorded as process workarounds. Finally, 78.68 percent (N=384) of process workarounds and 79.86 percent (N=115) of system workarounds were caused by problems related to technology. The results of the collected survey exhibited evidence suggesting that the prevalence of workarounds created by the nurses is higher in home and community healthcare comparing to acute care. In addition, the nurses have perceived usefulness and ease of use as key to technology adoption. Conclusion/Implication/Recommendations: The large proportion of process workarounds that are caused by technology suggests that technology is not successfully adopted, since workarounds are seen as manifestations of rejection of technology. The analysis of the qualitative and the quantitative data shows that the key constructs that had affected technology adoption were usefulness and ease of use. These findings are consistent with the findings of others in acute care. The nomadic nature of the nursing practice in home and community healthcare requires implementations, specifically patient documentation systems, to be done mindful of usefulness and ease of use. Workarounds as creative problem solving solutions can be used to provide feedback for the design of tools that can be used by the home and community nurses to solve problems that they face while providing care for patients with wounds. 140 Character Summary: The study of the use of documentation systems by home and community nurses identified the most common patterns of problem solving used by the nurses.
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