The effects of information technology on the delivery of nursing care : a comparative study

Abstract

Background In response to the advances made in information technology (IT), many healthcare institutions worldwide have integrated IT into their healthcare systems. Some hospitals in South Africa have changed to a computer- based system for the delivery of nursing care and nursing documentation, whereas others still use a paper-based system. The main aim of introducing IT in nursing is to improve the quality of nursing care. Research has shown, however, that IT can negatively impact on the quality of nursing care rather than improve it. This study compared the delivery of nursing care in two public hospitals in the eThekwini district in KwaZulu-Natal: one hospital which uses a computer-based documentation system for patient care and one hospital which uses a paper-based documentation system. Aim of the study The aim of the study is to determine the effects of IT on the delivery of nursing care as experienced by registered and enrolled nurses working in the hospital setting. Methodology A quantitative comparative descriptive design was used in this study. The delivery of nursing care in a hospital which uses a computer-based documentation system for patient care was compared with a hospital which uses a paper-based documentation system. The participants in this study were registered and enrolled nurses working in the wards and units of the two selected hospitals. Data was collected through the administration of a questionnaire (Appendix G) directed at the registered and enrolled nurses in the two hospitals involved in the study. One hundred percent of registered and enrolled nurses in the two selected hospitals at the time of data collection were approached and invited to participate in the study. One hundred and four participants for the hospital which uses a computer-based documentation system and 104 participants for the hospital which uses a paper-based documentation system were willing to participate in the study. Data was summarised and described using descriptive statistics such as frequencies, measures of central tendency such as means and modes, as well as means of variability such as range, variance and standard deviation. Graphs and tables were used to graphically represent the data. Data analysis was done using the Statistical Package for the Social Sciences (SPSS), version 22. Findings The effects of IT on the delivery of nursing care was measured by the quality of nursing documentation, the amount of time nurses have available for hands-on patient care and the reduction of medication errors. This study revealed that IT positively affected the experiences of nurses with the delivery of nursing care, with only a few exceptions. Information technology did not decrease the use of unauthorised abbreviations. It also did not improve the time nursing care was rendered being reflected in nursing documentation. Errors being made when entering patient data from, for example, cardiac monitors, intravenous pumps or results to investigations into the patient’s record were not decreased by IT. Furthermore, IT failed to improve nurses being alerted to drug interactions and to contra-indications of prescribed medications. There were a few instances where IT had a negative effect on the delivery of nursing care. Information technology increased the need to copy the same data when creating and updating a nursing care plan as well as documenting nursing care. Although the need for taking telephonic orders was reduced through the use of IT, it was found that when nurses in the hospital with a computer-based documentation system took telephonic orders, errors were made more often than when nurses in the hospital with a paper-based documentation system took telephonic orders.