Patricia Alexander - University of Southern Queensland · Patricia Alexander For the award of Masters of Health 2007 . The Impact of Computer Technology in the Clinical Setting: a

University of Southern Queensland

Faculty of Sciences

THE IMPACT OF COMPUTER TECHNOLOGY IN THE CLINICAL SETTING: A NURSING PERSPECTIVE

A Dissertation Submitted By

Patricia Alexander

For the award of

Masters of Health

2007

The Impact of Computer Technology in the Clinical Setting: a nursing perspective

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CERTIFICATION OF DISSERTATION

I certify that the ideas, work, results, analyses, interpretations and

conclusions reported in this dissertation are entirely my own effort, except

where otherwise acknowledged. I also certify that the work is original and

has not been previously submitted for any other award, except where

otherwise acknowledged.

Signature of Candidate Date

ENDORSEMENT

Signature of Supervisors Date



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ACKNOWLEDGEMENTS

While research and writing can be an arduous task, the completion of this

work would not have been possible without the help, assistance, support

and encouragement given to me by so many people. I wish to respectfully

extend my sincere gratitude.

To my Principle Supervisor – Doctor Cheryl Perrin: Thank you for always

being supportive and reading and commenting on the many drafts of this

work. Your direction has sustained me and your encouragement has

been essential in completing this work. This is much more than could

ever have been expected.

To my Initial Supervisor – Professor Desley Hegney: From the start of this

work, you have challenged me and guided me through with a sense of

perspective and balance.

To my Associate Supervisor – Jill Scanlon: Thank you for assisting me to

clarify ideas.

To the Participants – Daffodil, Daisy, Geranium, Hyacinth, Iris, Lilly,

Poppy, Rosemary and Violet who made this dissertation a reality. For the

time they gave, the trust they had and the thoughts they shared, I will

always be grateful. I am both honoured and humbled by their contribution.



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To Chris Cunningham – your insightful comments on the final draft gave

me the confidence to finish.

To my husband David and son Rodney – I sincerely acknowledge your

constant patience, tolerance and infinite support and undying love.

To Kerry Cuskelly – Librarian Extraordinaire; Thank you for your

assistance, your valuable advice and everlasting patience.

To my friends – Marianne, Sandra and Kris who have shown me the

meaning of true friendship.

During the time this study was undertaken the nursing profession lost two

nurses, both of whom I am proud to have known and worked with;

therefore it is with deep gratitude that this work is dedicated to the

memory of Mary Hicks and Marcia Wilson.



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TABLE OF CONTENTS

CERTIFICATION OF DISSERTATION............................................................2

ACKNOWLEDGEMENTS ...............................................................................3

TABLE OF CONTENTS ..................................................................................5

APPENDIX D.................................................................................................12

CHAPTER 1 ABSTRACT.............................................................................13

1.1 INTRODUCTION .....................................................................................14 1.1.1 Change Concerns 15

1.2 NURSING BACKGROUND......................................................................16

1.3 COMPUTER TECHNOLOGY BACKGROUND........................................20

1.4 DEFINITIONS AND TERMINOLOGY ......................................................23

1.4.0 Introduction ...........................................................................................23 1.4.1 Nursing Technology 24 1.4.2 Nursing Informatics 25 1.4.3 Computer Technology 26 1.4.4 The Internet 29

1.5 STUDY OVERVIEW ................................................................................29 1.5.1 Chapter Two 30 1.5.2 Chapter Three 31 1.5.3 Chapter Four 32 1.5.4 Chapter Five 33 1.5.5 Chapter Six 34 1.5.6 Chapter Seven 34 1.5.7 Chapter Eight 34 1.5.8 Chapter Nine 34 1.5.9 Chapter Ten 35

1.6. CONCLUSION........................................................................................35

CHAPTER 2 LITERATURE REVIEW...........................................................36

2.0 INTRODUCTION .....................................................................................36

2.1 POLITICAL CONCERNS .......................................................................37

2.2 ORGANISATIONAL CONCERNS............................................................42



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2.3 NURSING CONCERNS...........................................................................44 2.3.1 Nursing Language 47 2.3.2 Nursing Education 50

2.4 TELEHEALTH..........................................................................................54

2.5 INTERNATIONAL CONCERNS...............................................................57

3.0 INTRODUCTION .....................................................................................60

3.1 THE ORIGIN OF INTEREST ...................................................................61

3.2 THE RESEARCH QUESTION .................................................................63

3.3 AIM OF THE STUDY ...............................................................................63

3.4 THE STUDY OBJECTIVES .....................................................................64 3.4.1 Objective No 1 64 3.4.2 Objective No 2 65 3.4.3 Objective No 3 65 3.4.4 Objective No 4 65

3.5 SIGNIFICANCE TO NURSES..................................................................65 3.5.1 Space 66 3.5.2 Body 68 3.5.3 Time 69 3.5.4 Relationships 70

3.6 DIMINISHING ASSUMPTIONS, BIAS, EXPERIENCES, INTUITION AND PERCEPTIONS.....................................................................................72

3.7 THE STUDY SETTING ............................................................................73 3.7.1 Rurality 73

3.8 THE INTERVIEW SETTING ....................................................................75

3.9 THE SAMPLE ..........................................................................................76 3.9.1 The Sampling Size 80

3.10 THE PARTICIPANTS.............................................................................81

3.11 RECRUITMENT.....................................................................................82

3.12 DATA COLLECTION .............................................................................84 3.12.1 Interviews 84 3.12.2 Transcripts 87 3.12.3 Journaling 90

3.13 MAINTAINING A STRONG RELATIONSHIP TO RESEARCH THEORY........................................................................................................90

3.13.1 To be orientated 91


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3.13.5 Summary 92

3.

3.14.4 The existential approach 94

3.

3.15.4 Privacy 97

3.16 VIGOUR OF THE STUDY......................................................................98

3.17 CONCLUSION .......................................................................................99

CHAPTER 4 RESEARCH METHODOLOGY .............................................101

4.0 INTRODUCTION ...................................................................................101

4.1 IDENTIFICATION OF A QUALITATIVE APPROACH............................101

4.2 PHENOMENOLOGY .............................................................................103

4.3 HERMENEUTICS ..................................................................................106

4.4 THE SIGNIFICANCE OF THE RESEARCH ..........................................107

TO THE WORLD .........................................................................................109

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4.6.2 Uncovering Thematic Aspects 112

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4.7.5 Writing & Rewriting 118

4.8 ORIENTATING THE ANALYSIS & RESULTS.......................................118

3.13.2 To be strong 91 3.13.3 To be rich 92 3.13.4 To be deep 92

14 BALANCING THE RESEARCH CONTEXT ...........................................93 3.14.1 The analytical approach 93 3.14.2 The exemplificative approach 94 3.14.3 The thematic approach 94

15 RIGOR & QUALITY ...............................................................................95 3.15.0 Introduction 95 3.15.1 Ethical Issues 96 3.15.3 Consent 97

4.5 TURNING TO A PHENOMENON OF INTEREST THAT COMMITS US

4.6 REFLECTING ON THE ESSENTIAL THEMES WHICH HARACTERISE THE PHENOMENON......................................................110 4.6.1 Thematic Analysis 110

4.7 DESCRIBING THE PHENOMENON THROUGH THE ART OF RITING & REWRITING ............................................................................114 4.7.1 Sensitive Understanding 115 4.7.2 Measure Thoughtfulness 116 4.7.3 Ability to See 117 4.7.4 Showing Something 117



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4.

4.8.4 To be rich 119

4.

4.9.3 The Lived Time (Temporality) 122

5.

5.2.4 The Rural Hospital 128

5.

5.3.8 Rosemary 150

6.

6.2.2 A Sense of Space Gives Strength to Identity 156

6.

8.1 Introduction .........................................................................................118 4.8.2 To be orientated 118 4.8.3 To be strong 119

4.8.5 To be deep 120

9 METHODOLOGICAL CONNECTION ....................................................121 4.9.1 The Lived Body (Corporeality) 121 4.9.2 The Lived Space (Spatiality) 122

4.9.4 The Lived Relationship (Relationality) 123

4.10 THEME FORMS ..................................................................................123

4.11 CONCLUSION .....................................................................................124

CHAPTER 5 INTRODUCING THE PARTICIPANTS...................................125

5.1 INTRODUCTION ...................................................................................125

2 GEOGRAPHY AND DEMOGRAPHY OF THE STUDY SETTING.........126 5.2.1 The Rural District 127

5.2.5 The Rural Referral Facility 130

3 THE PARTICIPANTS.............................................................................131 5.3.1 Hyacinth 137 5.3.2 Lilly 140 5.3.3 Daisy 142 5.3.4 Daffodil 143 5.3.5 Iris 145 5.3.6 Geranium 146 5.3.7 Violet 148

5.3.9 Poppy 151

5.4 CONCLUSION.......................................................................................152

6.1 INTRODUCTION ...................................................................................154

2 BACKGROUND ...................................................................................155 6.2.1 A Sense of Structure Gives Shape to Space 156

6.2.3 A Sense of Identity Gives Shape to Space. 157

3 DEFINITIONS ........................................................................................157 6.3.1 Lived Space: 157 6.3.2 Mathematical Space: 157 6.3.3 Body Space: 157 6.3.4 Public Space: 158



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6.3.6 Personal Space: 158

6.4 A SENSE OF STRUCTURE GIVES SHAPE TO SPACE ......................159

6.6.5.1 Introduction 170

6.7 CONCLUSION.......................................................................................182

7.

7.7.2.1 “First Hand Nursing Time” 189

7.

7.3.4 Nurse Public Time 190

7.4 FIRST HAND NURSING TIME ..............................................................191

7.5 SECOND HAND NURSING TIME .........................................................198

7.6 THIRD HAND NURSING TIME..............................................................210

7.6.2 Summary 216

8.

8.8.2.1 Body Work; Subtle Influence 220

6.3.5 Social Space: 158

6.3.7 Intimate Space: 159 6.3.8 Summary 159

6.4.1 Introduction 159 6.4.2 Summary 169

5 A SENSE OF SPACE GIVES STRENGTH TO IDENTITY.....................170

6.5.2 Summary 176 6.6.2 Summary 182

1 INTRODUCTION ...................................................................................185

2 BACKGROUND .....................................................................................189

7.2.2 “Second Hand Nursing Time” 189 7.2.3 “Third Hand Nursing Time” 189

3 DEFINITIONS ........................................................................................190 7.3.1 Temporal Dissonance 190 7.3.2 Nurse Professional Time 190 7.3.3 Nurse Private Time 190

7.3.5 Clock Time 190 7.3.6 Linear Monochronic Model. 190



7.6.1 Introduction 210

7.7 CONCLUSION.......................................................................................216

CHAPTER 8 - THE VISION OF THE NURSING BODY ..............................218

1 INTRODUCTION ...................................................................................218

2 BACKGROUND .....................................................................................220



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8.

8.3.3 Lived Body: 221

8.4 BODY WORK A SUBTLE INFLUENCE .................................................222

8.5 BODY SCULPTURE ENHANCING THE UNIQUE.................................228

8.4 BODY BUILDING: STRENGTHENING THE SHAPE.............................239

8.6.2 Summary 243

CHAPTER 9 - THE SOUND OF NURSING SOCIETY ................................246

9.

9.9.2.1 Fashioning the Nursing Partnership 248

9.2.3 Approaching an Organisational Connection 248

9.

9.4 FASHIONING THE NURSING PARTNERSHIP.....................................249

9.5 RENAISSANCE OF THE NURSING PARTNERSHIP ...........................258

9.6 APPROACHING AN ORGANISATIONAL CONNECTION.....................264

9.6.2 Summary 272

8.2.2 Body Sculpture; Enhancing the Unique 220 8.2.3 Body Building Strengthening the Shape 221

3 DEFINITIONS ........................................................................................221 8.3.1 Nursing Informatics: 221 8.3.2 Fleshy body: 221

8.3.4 Virtual body: 222 8.3.5 Presence: 222




8.7 CONCLUSION.......................................................................................244

1 INTRODUCTION ...................................................................................246

2 BACKGROUND .....................................................................................247

9.2.2 Renaissance of the Nursing Partnership 248

3 DEFINITIONS ........................................................................................248




9.7 CONCLUSION.......................................................................................273



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RECOMMENDATIONS ...............................................................................275

10

10

10.2.1 Introduction .......................................................................................276

10.2.5 Summary 280

10

10.4 DISCUSSION: THE LIVED

10

10.5.5 Summary 292

10.6 FINDINGS............................................................................................293

APPENDIX C...............................................................................................302

REFERENCES - BIBLIOGRAPHY.............................................................303

CHAPTER 10 DISCUSSION, CONCLUSION FINDINGS AND

.1 INTRODUCTION .................................................................................275

.2 DISCUSSION: THE LIVED SPACE (SPATIALITY) .............................276

10.2.2 Common Space 277 10.2.3 Personal Space 278 10.2.4 Private Space 279

.3 DISCUSSION: THE LIVED BODY (CORPOREALITY)........................281 10.3.1 Introduction 281 10.3.2 Summary 284

TIME (TEMPORALITY) ............................284 10.4.1 Introduction 284 10.4.2 Professional Time 285 10.4.3 Personal Time 286 10.4.4 Public Time 287

.5 DISCUSSION: THE LIVED RELATIONSHIP (RELATIONALITY)........288 10.5.1 Introduction 28810.5.2 Access 289 10.5.3 Education 290 10.5.4 Support 291

10.6.1 Introduction 293 10.6.2 Summary Findings 293

10.7 RECOMENDATIONS...........................................................................296

APPENDIX A...............................................................................................299

APPENDIX B...............................................................................................301



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APPENDIX D

Definition List (NIA 2004 p.51) ACHI Australian College of Health Informatics

AHIC Australian Health Information Council

ANF Australian Nursing Federation

CIAP Clinical Information Access Program

Conceptual framework

A set of basic beliefs, values, attitudes, and assumptions that shape and reflect how one views oneself and others. Warren (1996) p20.

DoH NSW Health

DoHA Department of Health & Ageing Commonwealth

EHR Electronic Health Record

N³ET National Nursing & Nursing Education Taskforce

NaMO Nursing and Midwifery Office NSW

HI Health Informatics. An evolving socio-technical and scientific

discipline that deals with the collection, storage, retrieval,

communication and optimal use of health-related data,

information and knowledge.

HISA (HISA 1998) Health Informatics Society of Australia

ICNP International Council of Nursing Practice

ICT Information & Communication Technologies

IMIA International Medical Informatics Association

IM&T Information Management & Technology.

IT Information Technology

NeHTA National Electronic Health Transition Authority

NIA Nursing Informatics Australia. The national nursing special

interest group of HISA.

NISA Nursing Informatics Society of Australia

RCNA Royal College Nursing Australia