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Similar to Methods to understand patterns of adoption of an electronic nursing documentation system in residential aged care facilities
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Methods to understand patterns of adoption of an electronic nursing documentation system in residential aged care facilities
- 1. 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
- 2. Preliminary research Progress at 6 months Assessment of organisation change after the introduction of electronic nursing documentation in residential aged care
- 3. Study Sites • One management group (so far ...) • High Care • Low Care • Mixed Care
- 4. • 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)
- 5. Methodology • Interview followed by analysis with continuous comparative technique: ...
- 6. Qualitative Interview Research • Rich content • Many findings • Many potential conclusions. • How to deal with them?
- 7. Continuous comparative technique • Generate and revise conclusions based on evidence from research materials • coding and conceptualisation • continuous re-examination and review • Iterative process
- 8. 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
- 9. 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
- 10. A situational map of nursing practice: Visualisation of sociological situations From Clarke, A. (2005) Situational Analysis. Grounded theory after the postmodern turn. SAGE Publications.
- 11. 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).
- 12. 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
- 13. 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
- 14. A way of combining situational maps with other visualisations would be nice
- 15. 1. Novak, J. D. (1998) Learning, Creating, and Using Knowledge: Concept Maps™ As Facilitative Tools in Schools and Corporations Lawrence Erlbaum.
- 16. Equivalent Concept Map for Subset of Clarke
- 18. ? Detect and resolve ambiguities
- 19. 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
- 20. 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
- 21. Software • CMapTools: http://cmap.ihmc.us/ • Available at no cost
- 22. 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
- 23. 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
- 25. Conclusion ★Importance of strategy ★Main influences on strategic approach
- 26. Concept mapping provides: An easy way to relate data together at different levels
- 27. Contact/Further info kd21@uow.edu.au http://www.uow.edu.au/~kd21/ace
Editor's Notes
- Be careful to define tabula rasa here - blank slate origins in aincient greek philosophy - in this case it means that the data that you collect is the central andthe researcher should enter the research act without assumptions. This is tricky. For example in the context of this research project I have experiences in mental health nursing and as a computer programmer that will affect my relationship to the data.
- Micro-sociology - individuals’ relationships to their social situation. Becomes tricky when trying to differentiate silence section is interesting. What’s the meaning of a pause in an interview transcript. The grounded theory approach can’t answer this, but it’s potentially important. Note that it emphasises visualisation as a researcher technique not a presentation technique.
- You can see why it’s a practitioner rather than a presentation technique here. The diagram is rather difficult to read.
- “ruling relations” - power. organisation within hierarchies are examples of this
- E.g of invisible work in Aged care - RN talking to family - which is at least invisible to the funding agency, but an important part of the job (source: care worker from standalone low care hostel)
- By the meso-level we mean that we’re interested in within the nursing home, between nursing homes and between management groups. Top down understanding (NH/Mgmt group). Bottom up understanding (individual staff). This slide is a visualisation of some aspects of the ruling relations within nursing homes
- We can see where the diagram is most connected and where connections are sparse more easily. I
- It’s also easier to spot ambiguities with the concept map due to the strict rules required.
- The concept map’s rigid structure allows us to have alternative views
- Machine readable due to strict structure.
- So now we will spend the last few slides looking at how to work this into my project.
- So here we have merged the hierarchy concept map with a concept map representing data that have come from interviews about different staffs’ potential to display resentment, resistance and refusal with respect to the electronic documentation system.
- We can see links to distant parts of the map The strategic approach can most affect the items furthest away (i.e. most connected to PCWs). These are: professional culture, take steps to reduce refusal (show the low skill PCWs the minimum they need), make best use of human resources (educated computer literate carers - 1 per site), allow the training pattern to take that apparently democratic approach.
- Propoganda. Managers and carers don’t really communicate with each other much outside of low care hostels, but the manager can reduce resistance by looking at the drivers of resentment which are mostly attributes most relevant to personal carers. I’m going to talk about the data in my talk at NIA tomorrow.