Year

2015

Degree Name

Doctor of Philosophy

Department

School of Information Systems & Technology - Faculty of Engineering & Information Sciences

Abstract

The use of nursing information systems (NIS) has the potential to improve the delivery of nursing care. In particular, these systems facilitate accurate, efficient and high quality documentation.

Further, the other benefits of using NIS are to reduce staff time on documentation, facilitate organisational management and improve communication. Although NIS have been introduced throughout the healthcare sector in recent years, the use of these systems is still limited in residential aged care homes (RACHs). To date, there is limited or no research in Australia that has examined the factors that can facilitate or hinder exploitation of the potential of NIS by RACHs.

The main purpose of this study is to identify the technology-related, organisational, and individual factors that may influence the use of NIS among nursing staff in RACHs. The study consisted of two phases using a combination of qualitative and quantitative methods. In the first phase of the investigation, a qualitative content analysis technique was used to examine factors influencing the use of NIS from interview data collected preimplementation, six months post-implementation, and two years post-implementation in two RACHs from 30 nursing staff members.

The second phase was carried out between 2012 and 2013 using questionnaire surveys, and video-based observation to collect nursing staff characteristics and human-computerinteraction data. Data from video recording software and self-report ratings were used to gain insight into the performance and cognitive differences of nursing staff in terms of expertise with NIS (inexperienced vs. experienced) and task complexity (simple vs. complex). Each group had 12 staff members consisting of managers, registered nurses, enrolled nurses and personal care workers from two RACHs.

This study identified three technology-related factors that influenced NIS use by nursing staff in RACHs: ease of use, usefulness of the NIS and design and technical constraints. Four organisational factors were identified: training, work-related time constraints and staffing levels, access to computers, and peer and information technology (IT) support. Demographics of nursing staff, attitudes toward NIS and cognitive load (cognitive factor) were identified as individual factors.

The top five frequently mentioned factors that emerged from the interview data were positive attitudes, usefulness of the NIS, training, negative attitudes, design, and technical constraints. The other factors identified from the questionnaire survey and human-computer interaction study were expertise, task complexity, and cognitive load, and were analysed to determine how they affect nursing staff computer interaction.

In conclusion, this study provided insight into technology-related, organisational, and individual factors, which may facilitate or hinder the use of NIS in RACHs. Firstly, the results indicated that perceived ease of use, usefulness of the system, adequate training, sufficient access to computers and readily available support (including peer and IT support) might facilitate nursing staff use of the system.

Secondly, the results indicated that interface design, lack of key functions, technical or network problems, insufficient staffing levels, and inadequate numbers of computers may hinder the use of the NIS in RACHs. Thirdly, results indicated that the lack of a systematic approach to training may affect the amount of time it will take staff members to fully use and adopt NIS. Five years post-implementation of the NIS, nursing staff were still struggling to use the system. The level of expertise significantly affected the cognitive load experienced in interaction with the system. The performance measures indicated that expertise played a significant role in the effective and efficient use of the system. The results suggest that it is important to design an effective training program to facilitate effective use of NIS by nursing staff. Therefore, to optimise the benefits of NIS, organisations introducing these systems should invest in strategies to support staff members and overcome the challenges of unproductive use of such technology in the work place.

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Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.