The level of alignment between the use of implemented Health Information Technologies (HITs) and the clinical work activities of nurses in the public hospitals of Cape Town

Abstract

In the healthcare field, technological innovations have been introduced which are referred to as digital health technologies (DHTs). As digital technologies continue to impact the nursing profession on a global scale, nurses are increasingly required to use a variety of digital health technologies when providing direct care across the healthcare sphere. When considering the lived experiences of using DHTs in practice, the perspectives of nurses have received insufficient attention. Consequently, there is limited information on the experiences of nurses regarding the use of DHTs in healthcare in sub-Saharan Africa (including South Africa) to guide future use thereof, particularly in view of the current influx of ICT into the region. It is evident that there is a misalignment between the implemented DHTs and the work practices/clinical work practices of nurses as they experience DHTs in the practice (Lammintakanen et al., 2010; While & Dewsbury, 2011; Middleton et al., 2013; Karuri et al., 2013; Limbu, Kongsuwan & Yodchai, 2019; Zaslavsky, Chu & Renn, 2022). This misalignment indicates that there is a substantial gap in engagement between decision-makers and the nursing workforce to the extent that the perceived benefits of the implemented DHTs are not fully realized. The research questions for this study are: 1) How do nurses experience their work practices influenced by DHTs? This question is based on the lived experience of the nurse who uses DHT in the nursing care process when providing care to patients in a particular situation. 2) Why is there a misalignment between the intended use of DHTs and the lived experience of nurses using DHTs in practice? This question is based on the lived experience of nurses in terms of their involvement in the development and support processes versus the use of DHTs. The researcher adopted an interpretive stance, and a qualitative phenomenological approach was the most appropriate research method to explore the lived experiences of experienced nurses who are presently using DHTs in practice. In-depth interviews and observation were used to collect data. A thematic analysis was used to organize the data acquired from the participants and the Normalization Process Theory (NPT) served as a theoretical lens to interpret the findings of this study. Purposive sampling was used to identify participants, who included nurses, nurse managers, an operations manager and a member of the clinical engineering department. The findings of this study indicate the following: While the NPT provides a conceptual framework that explain the processes by which new health technologies and other complex interventions can be routinely embedded or operationalised into everyday work, and subsequently sustained in practice, the NPT constructs only focus on the implementation of new health technologies, and not on the design and development thereof. Further findings include the fact that DHTs have been fully incorporated/embedded into their daily work activities as patient care is optimised. This is evident from the positive perceptions of nurses to the extent that they cannot do their work without DHTs. This is substantiated by their desire to learn new technology, not only to optimise patient care but to augment their knowledge and skill. Further findings indicate that nurses’ input is not sought before the introduction of new technologies, they are merely informed via the nurse managers (whose input is also not sought) that the implementation of new technologies is underway. The findings clearly show that nurses’ work practices were not considered when DHTs were developed, and as such, training needs do not seem to be a priority, before and after implementation. Although nurses are not involved in the development of DHTs, they nevertheless use these DHTs and are happy with it and the support structures that are available to them. This study's knowledge contribution is using the theories, lived experience, interpretive phenomenology, and the NPT, as theoretical lenses to guide the data collection and analysis based on the in-situ lived experience of nurses in public hospitals. It contributes the knowledge of using the results of both the interpretive phenomenology analysis and normalized process analysis to gain deeper insights into the lived experiences of nurses using digital health technologies in practice from their introduction to the level of enabling routine work. Although there is existing knowledge about the design-reality gap of health technologies, the contribution is that it has not yet been studied from a lived experience perspective. This study contributed on a practical level to determine the best practices in the involvement of the nursing workforce in the implementation processes of ICTs in the healthcare field. On a methodological level, the researcher demonstrated the use of theoretical lenses to analyse the data representing the nurses' in-situ lived experiences as informed by the different fields of the study.