Karnehed Sara, Erlandsson Lena-Karin, Norell Pejner Margaretha
School of Health and Welfare, Halmstad University, Halmstad, Sweden.
JMIR Nurs. 2022 Apr 22;5(1):e35363. doi: 10.2196/35363.
eHealth is considered by policy makers as a prerequisite for meeting the demands of health care from the growing proportion of older people worldwide. The expectation about what the efficiency of eHealth can bring is particularly high in the municipal home health care sector, which is facing pressure regarding resources because of, for example, earlier discharges from hospitals and a growing number of patients receiving medications and treatments at home. Common eHealth services in home health care are electronic medication administration records (eMARs) that aim to communicate delegated tasks between professionals. However, there is an extensive gap in the research on how technology affects and is experienced by home health care professionals.
The objective of this paper is to shed light on how home care nurses experience eMARs in a Swedish municipality.
This qualitative interview study was conducted among home health care nurses using eMARs to facilitate communication and signing of delegated nursing tasks. The analysis of the interviews was performed using constructivist grounded theory, according to Charmaz.
Of the 19 day-employed nurses in the municipality where an eMAR was used, 16 (84%) nurses participated in the study. The following two categories were identified from the focus group interviews: nurses become monitors and slip away from the point of care. The nurses experienced that they became monitors of health care through the increased transparency provided by the eMAR and the measurands they also applied, focusing on the quantitative aspects of the delegated nursing tasks rather than the qualitative aspects. The nurses experienced that their monitoring changed the power relations between the professions, reinforcing the nurses' superior position. The experience of the eMAR was regarded as transitioning the nurses' professional role-away from the point of care and toward more administration-and further strengthened the way of managing work through delegation to health care assistants.
Previous analyses of eHealth services in health care showed that implementation is a complex process that changes health care organizations and the work of health care professionals in both intended and unintended ways. This study adds to the literature by examining how users of a specific eHealth service experience its impacts on their daily work. The results indicate that the inscribed functions in an eHealth service may affect the values and priorities where the service is in use. This presents an opportunity for future research and for health care organizations to assess the impacts of specific eHealth services on health care professionals' work and to further examine the effects of inscribed functions in relation to how they may affect actions and priorities at individual and organizational levels.
政策制定者认为电子健康是满足全球老年人口比例不断增长所带来的医疗保健需求的先决条件。在市政家庭医疗保健部门，对电子健康能带来何种效率的期望尤其高，该部门正因例如医院提前出院以及越来越多患者在家接受药物治疗和护理等原因而面临资源压力。家庭医疗保健中常见的电子健康服务是电子用药管理记录（eMARs），其旨在在专业人员之间传达委托任务。然而，关于技术如何影响家庭医疗保健专业人员以及他们对技术的体验，这方面的研究存在很大差距。
本文的目的是阐明瑞典一个市政辖区内的家庭护理护士如何体验电子用药管理记录。
本定性访谈研究在使用电子用药管理记录以促进委托护理任务沟通和签署的家庭医疗保健护士中进行。根据查马兹的方法，使用建构主义扎根理论对访谈进行分析。
在使用电子用药管理记录的市政辖区内的19名日间工作护士中，16名（84%）护士参与了研究。从焦点小组访谈中识别出以下两类情况：护士成为监督者并脱离护理点。护士们体验到，通过电子用药管理记录提供的更高透明度以及他们所应用的测量指标，他们成为了医疗保健的监督者，专注于委托护理任务的定量方面而非定性方面。护士们体验到他们的监督改变了不同职业之间的权力关系，强化了护士的优越地位。电子用药管理记录的体验被视为使护士的职业角色从护理点转变为更多的管理工作，并进一步强化了通过将工作委托给医疗保健助理来管理工作的方式。
先前对医疗保健中电子健康服务的分析表明，实施是一个复杂的过程，会以有意和无意的方式改变医疗保健组织以及医疗保健专业人员的工作。本研究通过考察特定电子健康服务的用户如何体验其对日常工作的影响，为文献增添了内容。结果表明，电子健康服务中预设的功能可能会影响该服务使用场所的价值观和优先事项。这为未来研究以及医疗保健组织提供了一个机会，以评估特定电子健康服务对医疗保健专业人员工作的影响，并进一步研究预设功能与它们可能如何影响个人和组织层面的行动及优先事项之间的关系。
