Doctor of Philosophy
School of Information Systems and Technology
Munyisia, Esther Naliaka, The impact of the introduction of an electronic nursing documentation system on caregivers' activities in residential aged care, Doctor of Philosophy thesis, School of Information Systems and Technology, University of Wollongong, 2012. http://ro.uow.edu.au/theses/3740
Health information technology (health IT) holds great promise for improving the quality and efficiency of aged care services in residential aged care facilities (RACFs). Health IT, and, in particular, electronic documentation systems, have potential to improve the management of residents’ records, to facilitate the delivery of high quality care to the residents by reducing caregivers’ time on documentation and increasing their time with the residents. Despite the expected benefits, adoption of health IT in RACFs remains poor. A number of aged care providers are reluctant to introduce health IT into residential aged care services. Among the reasons for this is uncertainty about how the use of health IT may affect the work of caregivers. To address this concern, this study examines the impact of the introduction of an electronic nursing documentation system on caregivers’ distribution of time on activities.
This study utilized a work sampling method with an observational component. Data collection was carried out between 2007 and 2011, before and after the implementation of the electronic documentation system. An observer (ENM) used a work classification tool with 48 activities grouped into 8 categories to identify and record activities being undertaken by registered nurses (RNs), endorsed enrolled nurses (EENs), personal carers (PCs), and recreational activity officers (RAOs) at particular times in high and low care houses of an RACF. Additional information was collected through surveys.
In general, 30,179 activities were recorded, with 17,732 recorded in the high care house and 12,447 in the low care house. Compared with the proportions of time spent on activities in the pre-implementation period, caregivers’ proportion of time on documentation increased or remained stable at most measurement periods after the implementation of the electronic system in both high and low care houses. A comparison of the proportions of time spent on documentation and communication activities after the implementation of the system in the high care house showed that the proportion of time of RNs on these two activities remained stable during the first 12 months after the implementation of the electronic system. At 23 months, their proportion of time on communication reduced and the proportion on documentation increased. The proportions of time of PCs and EENs spent on documentation increased and their proportions of time on communication were reduced during most measurement periods in 12 months after the implementation of the electronic system. At 23 months, the proportion of EEN time on communication increased and the proportion on documentation was reduced. The PCs’ proportions of time on these activities returned to the original levels recorded for the paper-based system. Similar trends in the proportion of time on these two activities were recorded in the low care house after the implementation of the electronic system. Caregivers’ proportion of time on direct care duties remained unchanged at most measurement periods after the introduction of the electronic system at the RACF. The caregivers’ proportion of time on other activities either remained stable after implementation or the changes in proportion of time were not directly associated with the introduction of the electronic system.
In conclusion, this study has provided insight into the effects of the introduction of an electronic documentation system on caregivers’ activities in residential aged care. The results suggest that the introduction of an electronic documentation system in an RACF may not interfere with the caring duties of caregivers, although the caregivers’ efficiency of documentation may not necessarily improve. The second insight is that after implementation caregivers tend to use the electronic system which is widely perceived as more efficient in communicating their care than using oral communication. This practice, however, may not be sustained over time. This implies that although adoption and use of an electronic documentation system may stimulate positive changes in caregivers’ documentation practice, maintaining the positive change appears to be a challenge. This calls for continuous training and support of the caregivers in the use of the electronic system for sustainable benefits in practice. The results also suggest that it may take over one year for nursing staff members to completely integrate and use an electronic documentation system in their daily work. So, to optimise the benefits of electronic documentation in RACFs, organisations implementing such systems need to identify strategies that support and accelerate the speed with which the new documentation practice is integrated into residential aged care services.