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IT-adoption and the interaction of task, technology and individuals: a fit framework and a case study.

BACKGROUND: Factors of IT adoption have largely been discussed in the literature. However, existing frameworks (such as TAM or TTF) are failing to include one important aspect, the interaction between user and task. METHOD: Based on a literature study and a case study, we developed the FITT framework to help analyse the socio-organisational-technical factors that influence IT adoption in a health care setting. RESULTS: Our FITT framework ("Fit between Individuals, Task and Technology") is based on the idea that IT adoption in a clinical environment depends on the fit between the attributes of the individual users (e.g. computer anxiety, motivation), attributes of the technology (e.g. usability, functionality, performance), and attributes of the clinical tasks and processes (e.g. organisation, task complexity). We used this framework in the retrospective analysis of a three-year case study, describing the adoption of a nursing documentation system in various departments in a German University Hospital. We will show how the FITT framework helped analyzing the process of IT adoption during an IT implementation: we were able to describe every found IT adoption problem with regard to the three fit dimensions, and any intervention on the fit can be described with regard to the three objects of the FITT framework (individual, task, technology). We also derive facilitators and barriers to IT adoption of clinical information systems. CONCLUSION: This work should support a better understanding of the reasons for IT adoption failures and therefore enable better prepared and more successful IT introduction projects. We will discuss, however, that from a more epistemological point of view, it may be difficult or even impossible to analyse the complex and interacting factors that predict success or failure of IT projects in a socio-technical environment.

Anxiety↗

[The computer as a support tool in nursing care and administration].

The introduction of informatic tools directed to the Assistence and Administration's support will be able to bring important benefits to Brazilian Nursing. Based on American literature the authors expose some specific applications of the computer in the assistence and administration's actives of nursing, demonstrating the various ways to these actives, in order otimize the assistence rended to the patient.

Hospital Information Systems↗

Putting post-registration nursing students on-line: important lessons learned.

A web site and discussion forum to support a part time degree course for nurses was introduced not only to support student learning but also to encourage students to use and develop their IT skills. Previous cohorts had identified that health informatics skills needed to be addressed more explicitly throughout the programme. The aims of the project were to: (i) evaluate the use of the web site and discussion forum; (ii) determine the barriers to using the web site and discussion forum; (iii) identify ways of overcoming any barriers. The first aim was addressed by analysing web page hits and contributions to the discussion forum. Students' experiences of using the web site and the discussion forum were collected using a questionnaire and followed up by a focus group made up of high and low users of the discussion forum. Students who had accessed the web site most often felt they had been able to communicate with their peers (Spearman's rho, p < 0.01) and had gained peer support by accessing the web site (Spearman's rho, p > 0.05). None of the participants in this study had used a discussion forum before and whilst some students had the skills and confidence to contribute to the on-line discussions, others 'lurked' and some did not access the discussion facility at all. Strategies for improving the engagement and quality of on-line learning are proposed from the lessons learned during this study.

Attitude of Health Personnel↗

Documenting nursing practice by using ICNP on the Web.

This paper presents the design and implementation of an internet based nursing care planning system which helps nursing professionals and students to study ICNP beta 2 version and to create nursing diagnoses, interventions and outcomes by selecting relevant terms from ICNP. This advanced web-based ICNP browser enables the authentication of the user, and the creation of a type of nursing care plan through the use of ICNP. It provides different ways for creating nursing diagnoses, interventions and outcomes, by selecting relevant ICNP terms through the tree-structure view, index and search components of the tool. The created diagnoses, interventions and outcomes are stored to a secured database. The system provides to the user the facility to build and manage nursing care plans by using both the English and the translated Greek ICNP versions. The first results of the implementation of this internet based nursing care planning system are presented.

Database Management Systems↗

Contexts for the study of the economic influence of nursing diagnoses on patient outcomes.

PURPOSE: To examine the historical, legal/ organizational, informatics, clinical, economic, and policy contexts underlying economic consequences of nursing diagnoses on patient outcomes. DATA SOURCES: Published literature, online material. DATA SYNTHESIS: Nursing diagnoses influence diagnostic-specific patient outcomes and other outcome variables such as length of hospital stay, morbidity, and mortality. CONCLUSIONS: Examination of the economic ramifications of nursing diagnosis on patient outcomes can be facilitated using standardized language and databases containing nursing-sensitive measures.

Bayes Theorem↗

Discipline-based approaches to evidence-based practice: a view from nursing.

BACKGROUND: Research carried out by nurses or by others on patient problems of concern to nurses is contributing to the development of evidence-based nursing practice. In the past few decades, there has been a dramatic increase in clinical research, in health services research, and in the content and process of informatics, all focused on nursing care. The translation of findings of this research into clinical practice and the organization of nursing is less dramatic. The opportunity to implement research-based practice is great, but requires attention, methods, and resources. Also required are a database and an information system which include terms essential to nursing practice. DIMENSIONS OF NURSES' INVOLVEMENT IN EVIDENCE-BASED PRACTICE: The importance of nurses' involvement in evidence-based practice (EBP) can be viewed from three perspectives: (1) nurses' participation in medical problems and medical interventions, (2) nursing problems and nursing interventions, and (3) development and use of a standardized language that describes the problems, interventions, and outcomes important to nursing. APPLYING EBP TO COMBINED MEDICAL AND NURSING PROBLEMS: The best outcomes for a specific patient population are achieved through a combination of the medical and nursing problems and evidence-based interventions. Examples of problems of importance to nursing practice and research include pain, dehydration, incontinence, lifestyle change, confusion, immobility, knowledge deficit, noncompliance, anxiety, skin breakdown, inappropriate use of restraints, and falls. Interventions for prevention and treatment of the individual problem or combination of problems comprise the focus of nursing research and EBP.

Databases as Topic↗

Nursing constraint models for electronic health records: a vision for domain knowledge governance.

Various forms of electronic health records (EHRs) are currently being introduced in several countries. Nurses are primary stakeholders and need to ensure that their information and knowledge needs are being met by such systems information sharing between health care providers to enable them to improve the quality and efficiency of health care service delivery for all subjects of care. The latest international EHR standards have adopted the openEHR approach of two-level modelling. The first level is a stable information model determining structure, while the second level consists of constraint models or 'archetypes' that reflect the specifications or clinician rules for how clinical information needs to be represented to enable unambiguous data sharing. The current state of play in terms of international health informatics standards development activities is providing the nursing profession with a unique opportunity and challenge. Much work has been undertaken internationally in the area of nursing terminologies and evidence-based practice. This paper argues that to make the most of these emerging technologies and EHRs we must now concentrate on developing a process to identify, document, implement, manage and govern our nursing domain knowledge as well as contribute to the development of relevant international standards. It is argued that one comprehensive nursing terminology, such as the ICNP or SNOMED CT is simply too complex and too difficult to maintain. As the openEHR archetype approach does not rely heavily on big standardised terminologies, it offers more flexibility during standardisation of clinical concepts and it ensures open, future-proof electronic health records. We conclude that it is highly desirable for the nursing profession to adopt this openEHR approach as a means of documenting and governing the nursing profession's domain knowledge. It is essential for the nursing profession to develop its domain knowledge constraint models (archetypes) collaboratively in an international context.

Artificial Intelligence↗

Nurses' requirements for information technology in the next millennium.

The main purpose of this study was to identify nurses' requirements for information technology in the next millennium. We distributed 350 questionnaires in a teaching hospital in Brazil and in the USA. We received 86 from Brazil and 78 from USA. Besides the capabilities of computers to be used in different sectors of human actions, nurses' requirements for information technology can not be considered sophisticated. Nurses in Brazil prefer a standalone system. In contrast, in USA they prefer systems that could be integrated to the whole healthcare system. Also, in the USA, nurses were more comfortable with use of computers than nurses in Brazil. In general terms, nurses in both countries feel that computer systems could make their practice easier and more efficient.

Attitude to Computers↗

Leadership in the digital age: a framework to balance high touch with high tech.

The next great age will be influenced heavily by the physical sciences, biological sciences, and nanotechnologies. This article presents case scenarios highlighting the technologic possibilities for the next age. It also presents a potential leadership model for the digital age and beyond. Finally, it provides insight as to how nurse managers can reconcile one of the major dilemmas in nursing--balancing "high touch" with "high tech."

Conflict, Psychological↗

Collaborative efforts for representing nursing concepts in computer-based systems: international perspectives.

Current nursing terminology efforts have converged toward meeting the demand for a reference terminology for nursing concepts by building on the foundation of existing interface and administrative terminologies and by collaborating with terminology efforts across the spectrum of health care. In this article, the authors illustrate how collaboration is promoting convergence toward a reference terminology for nursing by briefly summarizing a wide range of exemplary activities. These include: 1) the International Classification of Nursing Practice (ICNP) activities of the International Council of Nurses (ICN), 2) work in Brazil and Korea that has contributed to, and been stimulated by, ICNP developments, 3) efforts in the United States to improve understanding of the different types of terminologies needed in nursing and to promote harmonization and linking among them, and 4) current nursing participation in major multi-disciplinary standards initiatives. Although early nursing terminology work occurred primarily in isolation and resulted in some duplicative efforts, the activities summarized in this article demonstrate a tremendous level of collaboration and convergence not only in the discipline of nursing but in multi-disciplinary standards initiatives. These efforts are an important prerequisite for ensuring that nursing concepts are represented in computer-based systems in a manner that facilitates multi-purpose use at local, national, regional, and international levels.

Medical Informatics Applications↗

Classification systems in nursing: formalizing nursing knowledge and implications for nursing information systems.

The development of nursing information systems (NIS) is often hampered by the fact that nursing lacks a unified nursing terminology and classification system. Currently there exist various initiatives in this area. We address the question as to how current initiatives in the development of nursing terminology and classification systems can contribute towards the development of NIS. First, the rationale behind the formalization of nursing knowledge is discussed. Next, using a framework for nursing information processing, the most important developments in the field of nursing on formalization, terminology and classification are critically reviewed. The initiatives discussed include nursing terminology projects in several countries, and the International Classification of Nursing Practice. Suggestions for further developments in the area are discussed. Finally, implications for NIS are presented, as well as the relationships of these components to other sections of an integrated computerized patient record.

Database Management Systems↗

New systems: the restructuring of cancer care delivery and economics.

PURPOSE/OBJECTIVE: To review and discuss the economic and care delivery implications of the healthcare reform currently being debated. DATA SOURCES: Projections are based on synthesis of multiple scholarly, professional, and governmental sources of information. DATA SYNTHESIS: Future projections regarding the hallmarks of healthcare reform (e.g., universal access, fewer payors, rationing of care), changes in practice settings, and novel communications technologies are discussed. CONCLUSIONS: Opportunities for nurses resulting from these changes include roles as resource allocators, cost-benefit analysis, cancer system liaisons, satellite-program builders, and quality-assessment experts. IMPLICATIONS FOR NURSING PRACTICE: Changes will challenge nurses to assume multiple responsibilities as clinicians, administrators, educators, and researchers who will need to integrate input from numerous sources to make decisions that take into account competing and contradictory factors.

Community Health Services↗

Assessing the progress of the M.Sc. course in health informatics under the ERASMUS programme.

Health informatics is an emerging and important multi-disciplinary field that involves, informatics but also medicine, nursing, engineering, biology and other-related subjects. A co-ordination of this field at a postgraduate level becomes important now in Europe where other European Community programs such as the 'Telematics for Health Care' will require at the Fourth Framework Programme (94-99) adequate human resources of higher potential and knowledge. This European M.Sc. course meets all the above objectives. The Curriculum was developed according to the results of the ERASMUS Workshop, which was held in Athens on 13-15 September 1990 under the ERASMUS Contract number ICP-90-G-0009/12. The implementation now runs under the contract ICP-95-G-1038/12. The 6-year evaluation of the course based both on staff and student evaluation proved that the M.Sc. course in health informatics has been successful.

Curriculum↗