Methods to understand patterns of adoption of an electronic nursing documentation system in residential aged care facilities

Methods to understand patterns of adoption of an electronic nursing documentation system in residential aged care facilities Kieren Diment1, Ping Yu1, Karin Garrety2, 1Health Informatics Research Lab, Faculty of Informatics, University of Wollongong, NSW 2 School of Management, University of Wollongong, NSW PhD Scholarship funded by ARC Linkage Grant held by Dr Ping Yu: Introducing computer-based nursing documentation into residential aged care: A multi-method evaluation of success

Preliminary research Progress at 6 months Assessment of organisation change after the introduction of electronic nursing documentation in residential aged care

Study Sites • One management group (so far ...) • High Care • Low Care • Mixed Care

• 58 Interviews • Managers / Deputies (N=10) • Registered Nurses (N=9) • Enrolled Nurses (N=6) • Personal Care Workers (N=25) • Others (N=8) • Recreation Ofﬁcers (N=5) • Physiotherapy Assistants (N=2) • Carer “promoted” to administration (1)

Methodology • Interview followed by analysis with continuous comparative technique: ...

Qualitative Interview Research • Rich content • Many ﬁndings • Many potential conclusions. • How to deal with them?

Continuous comparative technique • Generate and revise conclusions based on evidence from research materials • coding and conceptualisation • continuous re-examination and review • Iterative process

Continuous comparative technique 1. Grounded theory - default, frequently cited due to being “the most popular approach”. • Varying degrees of tabula rasa assumption • minimise role of researcher assumptions • Data driven • Difﬁcult to identify implicit data

Continuous comparative technique 2. Situational analysis1: post-modern grounded theory • Suited to detailed individual case studies, micro-sociology. • Addresses many concerns with grounded theory • e.g. role of silence in discource • Emphasises visualisation as a research technique 1. Clarke, A. (2005) Situational Analysis. Grounded theory after the postmodern turn SAGE

A situational map of nursing practice: Visualisation of sociological situations From Clarke, A. (2005) Situational Analysis. Grounded theory after the postmodern turn. SAGE Publications.

Continuous comparative technique 3.Institutional Ethnography1: • Using interview research to understand how “ruling relations” shape local experiences. 1. DeVault, M., & McCoy, L. (2006). Institutional ethnography: Using interviews to investigate ruling relations. In J. Gubrium & J. Holstein (Eds.), Handbook of Interview Research: Context & Method (pp. 751-776).

Continuous comparative technique 3.Institutional Ethnography1: • Top down / bottom up • Emphasises experience • Emphasises invisible work • Origins in feminist sociology 1. Campbell, M. (2004) Mapping Social Relations: A Primer in Doing Institutional Ethnography AltaMira Press

Management Group Nursing Nursing Nursing Home Home Home Manager Deputy Manager Recreation Registered Activity Physio Nurses or Assistant Low Care TL Ofﬁcer Enrolled Nurses Personal Personal Personal Care Care Care Workers Workers Workers

A way of combining situational maps with other visualisations would be nice

1. Novak, J. D. (1998) Learning, Creating, and Using Knowledge: Concept Maps™ As Facilitative Tools in Schools and Corporations Lawrence Erlbaum.

Equivalent Concept Map for Subset of Clarke

? Detect and resolve ambiguities

Automatically convert to text Hospital Administration/ Managers Capitation Plans Restructuring Plans Nurse's Emotion Work/Caregiving Health Maintenance Organizations Patient/ Customer Satisfaction Discourses Nurse's Emotion Work/Caregiving Outpatient Services Patient/ Cutsomer Satisfaction Discources Invisible Knowledge & Skills Over the counter Drugs & Devices Old,Current & New Medical Equipment & Technologies Nurses Invisible Knowledge & Skills Pharmaceutical Companies Old,Current & New Medical Equipment & Technologies Old,Current & New Medical Equipment & Technologies Physicians' Associations Invisible Knowledge & Skills Invisible Knowledge & Skills Private Insurance Companies Old,Current & New Medical Equipment & Technologies U.S. Government Insurance for Elderly & Poor: Hospital Administration/ Managers Medicare/Medicaid Restructuring Plans Easy to provide comprehensive report

Alternate views U.S. Government Insurance for Elderly & Poor: Medicare/Medicaid Hospital Administration/ Managers Capitation Plans Over the counter Drugs & Devices Pharamceutical Companies Physicians' Associations Invisible Knowledge & Skills Private Insurance Companies Private Insurance Companies Health Maintenance Organizations Nurse's Emotion Work/Caregiving Nurses Outpatient Services Physicians' Associations Pharamceutical Companies Old,Current & New Medical Equipment & Technologies Over the counter Drugs & Devices Private Insurance Companies Outpatient Services Patient/ Customer Satisfaction Discourses Health Maintenance Organizations U.S. Government Insurance for Elderly & Poor: Medicare/Medicaid Restructuring Plans Capitation Plans

Software • CMapTools: http://cmap.ihmc.us/ • Available at no cost

Organisational hierarchy • Management Professional nursing has Group roots in the military Nursing Home Nursing Home Nursing Home “I started as an AIN for many Manager many years and in those days we had to stand up when the matron Deputy Manager came into the room that's how much better [the hierarchy has] Recreation Registered Physio got.” Activity Nurses or Ofﬁcer Assistant Low Care TL Deputy Residential Services Manager Enrolled Nurses Personal Personal Personal Care Care Care Workers Workers Workers

Organisational hierarchy • Also replicable as concept map Management Group Nursing Nursing Nursing Home Home Home Manager Deputy Manager Recreation Registered Physio Nurses or Activity Assistant Low Care TL Ofﬁcer Enrolled Nurses Personal Personal Personal Care Care Care Workers Workers Workers

Conclusion ★Importance of strategy ★Main inﬂuences on strategic approach

Concept mapping provides: An easy way to relate data together at different levels

Contact/Further info kd21@uow.edu.au http://www.uow.edu.au/~kd21/ace

Methods to understand patterns of adoption of an electronic nursing documentation system in residential aged care facilities

by singingfish

Accessibility

Categories

Upload Details

Usage Rights

2 Embeds 32

Statistics

Methods to understand patterns of adoption of an electronic nursing documentation system in residential aged care facilities Presentation Transcript

http://www.uow.edu.au	27
http://www.slideshare.net	5