In clinical settings where nurses work around the world, health information technologies are being rapidly installed in order to improve the efficiency, safety and quality of care provided (Kutney-Lee & Kelly, 2011). Numerous studies have demonstrated that there are challenges for nurses in using these technologies (Asan et al., 2017; Dudding, Gephart & Carrington, 2017). Recently, several studies have demonstrated that there can also be unintended consequences for nurses in using these technologies, often when adequate supports are not available (Coiera, Ash & Berg, 2016; Sittig et al., 2016). In particular, a recent literature review conducted on the use of health information technologies by nurses in mental health settings demonstrated that there may be unique challenges in this setting given the: 1) ambulatory nature of patients; 2) documentation that does lend itself to discrete forms of data collection; and 3) other reasons related to usability, relevance and workflow (Strudwick & Eyasu, 2015).
In parallel to this challenge, there has been an increasing focus on nursing leaders in being able to adequately support direct care nurses in using health information technologies, as well as advocating for appropriate systems to be installed, as well as creating an environment where direct care nurses can leverage health information technologies to support patient care (Kennedy & Moen, 2017). Most research conducted on this topic has focused on identifying the appropriate informatics competencies that would best equip nursing leaders in being effective in their roles. To date, both the role of the nurse leader and the strategies that the nurse leader can use to support direct care nurses’ effective use of health information technologies have not been explored.
Given this gap in the literature, and the challenges often present in mental health settings in using health information technologies, a qualitative research study was conducted. The research questions were: 1) what role do nurse managers play in supporting point-of-care nurses’ adoption of health information technologies? And 2) what strategies have nurse managers used to support point-of-care nurses use of health information technologies, and how do point-of-care nurses perceive these strategies?
Methods:
This qualitative study used the Staggers and Parks Nurse-Computer Interaction Framework to inform the study design and analysis (Staggers & Parks, 1993). Specifically the framework was used to develop an interview guide, and to identify codes to use during data analysis. In the framework, nurses’ use of health information technologies is situated within a broader nursing context, such as the clinical environment in which nurses work. The interaction between the nurse and the health information technology is influenced by computer/technology characteristics, nursing characteristics and the organizational characteristics.
This study used a qualitative descriptive design (Sandelowski, 2000), which consisted of semi-structured interviews using an interview guide with nursing leaders and direct care nurses. The setting for this study was Canada’s largest mental health organization which is located in an urban setting. Recruitment consisted of an email sent to eligible nursing managers and direct care nursing staff. Interested participants then coordinated via email a date and time for the interview to take place. Informed consent was obtained from all participants, and ethical approval was received from the organization in which this study took place. Data analysis consisted of directed content analysis using pre-determined codes (Hsieh & Shannon, 2005), informed by the Stagger and Parks Nurse-Computer Interaction Framework (Staggers & Parks, 1993). Two coders independently analyzed the data, and compared their codes. Discrepancies in coding were addressed via discussion.
Results:
Interviews took place from May until December of 2017. There were a total of 18 participants in this study (9 nursing managers and 9 direct care nurses). Participants in this study ranged in their years of experience in their role, and mental health clinical area in which they worked.
The study participants described the role of the nurse manager in supporting direct care nurses’ use of health information technologies in the following three ways: 1) the “connector”; 2) the “advocate”; and 3) the “teacher”. The first way that the nurse manager role was described was that of a “connector”. This role involved ensuring that direct care nurses were connected to the appropriate supports they required in order to be able to effectively use health information technologies. Examples of nurse managers acting in connector roles were related to ensuring that nurses were connected to the information technology supports when there were hardware challenges, as well as asking a nurse educator to provide additional training for direct care nurses who required more support in learning to use the technology. The second way that the nurse manager role was described was that of an “advocate”. This role involved the manager speaking up at meetings to voice the concerns, feedback and experience of the direct care nurses in making critical decisions related to the further adoption, or evolution of the health information technology at the organization. The last way that the role of the nurse manager was described was that of a “teacher”. Some nurse managers were very proficient at using the health information technologies present at the study organization, and therefore acted as a teacher to direct care nurses in using the technology.
Conclusion:
This study complements the existing literature by providing nursing leaders with a better sense of how they can enact nursing informatics competencies to support direct care nurses use of health information technologies in mental health settings. In order to be able to do so effectively, nursing leaders may wish to identify where their nursing informatics competencies gaps exist. Fortunately, within the last year there has been the development of a self-assessment tool for nursing leaders to do just this (Collins et al., 2017; Yen et al., 2017).
There are numerous implications of this study that have global relevance. These will be discussed during the presentation. Namely, one of the implications includes identifying how those in nurse manager positions in various countries can acquire an appropriate level of nursing informatics competencies to be successful in enacting the roles described in this study.
Like any study, this study has its limitations. One of the limitations is that the study was conducted at a single site that has had various health information technologies present for several years. In the future, it could be helpful to conduct a similar study at various organizations with health information technologies at various levels of maturity.
In summary, nurse managers play an important role in supporting direct care nurses’ use of health information technologies around the world, especially in mental health settings. In this study nurse manager’s role in supporting nurses use of health information technologies was described as being connectors, advocates and teachers. In addition, nurse managers can use various strategies to support use, such as those related to the context, computer/technology and nurse themselves.