Abstract
Aim: The aim of this research was to study the phenomenon of the use of hand-held devices (HHDs) at the point of care by nurses; specifically, the research was striving to comprehend how nurses experienced the phenomenon in the context of their daily workflow and delivery of care in the acute hospital environment.
Background: Improving patient safety and the further development of the electronic health record have been drivers for change in health in New Zealand. A few New Zealand District Health Boards have implemented projects that have introduced small tablet computers to replace traditional clinical tools such as the medication chart and the vital signs chart. This move is a significant change in the culture and environment for nursing, and the people who care for. There is a paucity of research on how this cultural change will affect the nursing workflow and ultimately the person at the centre of the care, the patient.
Method: A qualitative descriptive inductive approach was used to discover the experiences of the nurse through the thematic analysis of focus group discussion transcribed as text. Eight nurses working on different acute hospital wards made up two focus groups were led through discussions by semi-formal questioning.
Findings: Thematic analysis uncovered six distinct themes that were recognised as important as experienced by the participants: Rage against the machine; With me, not to me, understanding our clinical reality; The humans in the system; The information age; Being prepared, and It's getting better. Each theme is described separately, though in clinical practice many of the findings were intertwined adding to the complexity of the already complex depiction of the environment.
Discussion: The study showed that problems experienced by nurses using HHDs are multifaceted and reliant upon many interrelated systems and technical
infrastructure that are beyond the influence of the ward nurse. Benefits were experienced as the nurse did not need to find or spend time looking for information but negative aspects were experienced as new work was required when the systems did not work as expected. The study found that the HHDs have the ability to both improve and hinder the care that nurses deliver depending on how well the HHD, and the tools that they contain, perform.