Nursing Studies show Weakness in Failing to Consult

The impact of ignoring end-users when designing IT systems - generating resistance which can remove much of a system's value - has been underlined in a study of two nursing applications reported by the British Computer Society Nursing Specialist Group.

Stephen Timmons, a lecturer at Nottingham University's School of Nursing, and Sally Miller, community nursing services team leader at Mansfield Primary Care Trust undertook the study: 'The various manifestations of not using the system, and the delays, could be considered as examples of working round the system,' they said.

Low involvement by end-users in system design led to staff complying where they had to and resisting where they could, the study concluded, reported first in the Nursing Specialist Group magazine, ITIN.

One part of the study focused on three hospitals using a care planning system. Nurses are supposed to write and do at least daily updates of care plans for every patient.

'Outright refusal to use the systems was uncommon,' the researchers say. 'Much more common was a variety of ways the use of the system was adapted or delayed.'

Care plans were not created and updated fully. Regular updates were neglected. Many staff hand-wrote reports and did not have time to enter the information to the system. Updates were delayed, often being left to the night shift because of health care priorities during the day.

'On the whole nurses had little choice but to use the systems. What was less susceptible to management control, however, was how and when they did so. This had the effect of changing what the systems became through the processes of implementation and use.'

The second system studied is used by community nurses on their rounds. They use handheld devices to record details of visits. They are supposed to update the system after every visit but tend to do so at the end of the day or even the end of the week.

'The community nurses tended to record the bare minimum of data, and this, with the delays, led to a very high error rate,' the researchers say.

Nurses were concerned about managers using the system to monitor their visits and change their working practices.

The researchers point out that the response of staff will be common across other fields. 'The community nurses' main justification for not fully engaging with the system was that they got nothing back from it,' they say. 'It was perceived as being entirely an administrative system.

'This was due in part to problems with the system: it was slow, and support staff were often not available.

'Other technical and managerial issues were that it was largely imposed, with little user involvement in design and implementation, and there were some problems with the initial levels of IT literacy of the users.'

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