Investigating the mediating role of nursing information systems using activity theory.

Abstract

INTRODUCTION/ BACKGROUND: Nursing documentation is essential for keeping accurate records of delivered care and patient data, as well as supporting clinical communication, decision-making, interventions and outcome evaluation. Nursing information systems (NIS) are increasingly introduced as a support tool to enable nurses to document and access real-time and accurate patient care data. This study summarises findings from our examination of the enabling role of two nursing information systems respectively in one public and one private hospital in Victoria. METHOD: Multiple case studies were adopted. Activity Theory (AT) was used as the theoretical lens to examine the mediating roles. AT suggests that the relationship between a human actor and his/her objective/goal is mediated by tools and the collective elements including Community, Rules, and Division of Labour. Multi-methods were adopted for data collection and analysis. RESULTS: Case study 1: the nurse-documentation relationship was mediated by the new tool (NIS) including change to documentation location which impacted patient clinician dynamics. Mapping with AT, we note that the dynamics of the interactions between nurses (as actors), NIS (as new tool), and nursing documentation (as objective) are appropriated to reproduce the new technology-enabled documentation practice. Fidelity of NIS can be examined through the mediating role of the system in terms of how it reflects rules, division of labour, its potential to support communication and collective care between nurses and other healthcare professionals; i.e. the community. Initial findings from the second case study suggest a higher level of complexity as it involves multiple actors using the second system for multiple activities. CONCLUSION: Both case studies examined the mediating role for NIS during implementation in naturalistic acute care hospital contexts and reveal how the new nursing documentation culture and practice emerges; socially constructed and technically mediated. Both studies suggest the importance of engaging nurses in technology implementation, training and change management.