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Golay, D. (2019). An invisible burden: An experience-based approach to nurses' daily work life with healthcare information technology. (Licentiate dissertation). Uppsala University
Open this publication in new window or tab >>An invisible burden: An experience-based approach to nurses' daily work life with healthcare information technology
2019 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Information and Communication Technology (ICT) has been an increasingly pervasive component of most workplaces throughout the past half century. In healthcare, the turn to the digital has resulted into the broad implementation of Healthcare Information Technology (HIT). The impacts of ICT on work life have been investigated predominantly through surveys, although some researchers have advocated for the use of a qualitative, experience-based approach. Meanwhile, the existing body of research on the impacts of HIT on clinicians has painted a mixed picture of digitalization. Despite some clear benefits, HIT has indeed been found to have unexpected, unintended adverse consequences for hospital staff. Typical issues include loss in efficiency, extra effort to carry out routine tasks, and the creation of new, HIT-induced work activities. Simultaneously, research outside of the healthcare domain has shown that ICT could require extra effort from some users in order for the sociotechnical system to function properly – extra work often invisible to developers.

Based on observation, interview and focus group data collected at a large Swedish hospital, this thesis set out to investigate the impact of HIT on hospital nurses from an experience-based perspective, resulting in four main contributions. First, a method supporting experience-based data analysis, the HolisticUX method, is introduced. Second, 13 forms of HIT-induced additional tasks in nurses' workload are identified, five of which are not acknowledged in previous research. Third, task avoidance is identified as a consequence of nurses' increased workload, negatively affecting patient safety, care quality and nurses' professional satisfaction. Finally, four factors are argued to contribute to a suggested invisibility of the HIT-induced time burden in nurses' work life to management and developers: 1) lack of a holistic perspective, 2) the hidden cost of a single click, 3) the invisibility of nursing work, and 4) visible data, invisible work.

Place, publisher, year, edition, pages
Uppsala University, 2019
Series
Information technology licentiate theses: Licentiate theses from the Department of Information Technology, ISSN 1404-5117 ; 2019-001
National Category
Human Computer Interaction
Research subject
Computer Science with specialization in Human-Computer Interaction
Identifiers
urn:nbn:se:uu:diva-381433 (URN)
Supervisors
Available from: 2019-02-22 Created: 2019-04-09 Last updated: 2019-04-09Bibliographically approved
Golay, D. (2019). More work, same hours: Invisible HIT-induced tasks in nurses' everyday work.
Open this publication in new window or tab >>More work, same hours: Invisible HIT-induced tasks in nurses' everyday work
2019 (English)In: Article in journal (Other academic) Submitted
National Category
Human Computer Interaction
Identifiers
urn:nbn:se:uu:diva-381431 (URN)
Available from: 2019-04-09 Created: 2019-04-09 Last updated: 2019-04-09Bibliographically approved
Golay, D., Löscher, I. & Lind, T. (2019). The impact of information and communication technology on work, workers, and the psychosocial work context: Research trends from 2000–2017.
Open this publication in new window or tab >>The impact of information and communication technology on work, workers, and the psychosocial work context: Research trends from 2000–2017
2019 (English)In: Article in journal (Other academic) Submitted
National Category
Human Computer Interaction
Identifiers
urn:nbn:se:uu:diva-381428 (URN)
Available from: 2019-04-09 Created: 2019-04-09 Last updated: 2019-04-09Bibliographically approved
Salminen-Karlsson, M. & Golay, D. (2019). Why not use the phone: Digitalisation and nurses’ communication in a large hospital. In: Abstract Book. Work 2019: Real Work in the Virtual World. Paper presented at WORK2019. Real Work in the Virtual World.
Open this publication in new window or tab >>Why not use the phone: Digitalisation and nurses’ communication in a large hospital
2019 (English)In: Abstract Book. Work 2019: Real Work in the Virtual World, 2019Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

When comes to digitalization of nurses’ work, electronic patient records and medical technology have been in focus. This paper looks at something that has been seen as more peripheral but that, nevertheless, has a profound impact on nurses’ daily work, in particular in large hospitals: internal communication that is mediated by computer systems.28The paper is based on fieldwork and group interviews in one large hospital in Sweden. The focus of the research project of which this paper is a part is the impact of digitalization on nurses’ work environment. Both certified nurses and assistant nurses took part in the fieldwork and observations.Computer mediated communication has increased rapidly in healthcare. Electronic patient records are one form of such communication: different professions treating the same patient use ito store information and retrieve information about the treatment process. This communication tool is mainly used by the healthcare professions. However, to communicate with different service functions in the hospital, the nurses were obliged to use a number of different systems.By the participants in the study, the obligation to use these messaging systems was taken up as a major stressor and their efficiency was repudiated. These complaints were illustrated by absurd or dramatic examples. Also during the fieldwork, problems with using the messaging systems became evident. While both design and functionality problems with the systems were exemplified, the complaints were frequently concluded with a question why these systems should be used at all. A common opinion, concerning communication with service functions, was that the systems were used to make the work of the service units easier, but that they disrupted the core task of the hospital, the medical carework, in a way that should not be permissible. The nurses thought that using the phone to order internal services was a much more efficient communication channel for them. In particular, they were indignant when service functions seemed to show no understanding for a patient’s situation.Computer-mediated internal communication in a hospital can be seen as positive in that it structures information flows and task allocations, it secures quality by producing traces that can be used for verification in case mistakes are made, and it produces information that can be used in administrative processes, for example when calculating resource allocations. However, introducing these communication systems does not take into account the practicalities of carework. Effective use of such systems count on a different temporality than what is prevalent in the everyday work of nurses.The temporality in nurses’ work implies that work pace is high, work is often disrupted and can only partially be planned, several work processes exist in parallel and prioritisations often have to be made on short notice. Even a well-functioning structured messaging system (in contrast to the problematic ones that these nurses had encountered) requires a form to be filled in with certain information, which sometimes is necessary and sometimes may be superficial, and, thus, generally requires writing time. There is normally a time interval between sending the message and getting a confirmation (if a confirmation is received at all), which implies further mental overload and difficulty to prioritise. Some information, for example related to the urgency of the message may not have a proper place in the form, or may not go through with sufficient emphasis. In such conditions a telephone is more suitable. Often the nurses used both a messaging system and a telephone in parallel, when this was possible, i.e. they sent the required message but made a telephone call to get a confirmation and to possibly give information that was not easily put in the form.The introduction of computer systems for internal communication in a hospital is yet one step of trying to transform care to production, in terms of new public management. Computer mediated communication systems contribute to the efforts to transform the interactive, unpredictable and individual conditions of care, to predictable, impersonal and scheduled conditions of production. Nurses, who are responsible for the care (rather than doctors, who are responsible for the more limited concept of treatments) are the ones whose everyday work is most affected by this. Their apprehension that in the mandated communication patterns the concerns of administration were prioritised above the concerns of care was reasonable. The concerns of administration fit much more nicely in the structured way of producing care that is the political vision of today’s healthcare. However, the while following the mandated routines would make the communication in the healthcare organization more streamlined, without nurses’ concerns and their pushing the boundaries, it would make hospital care less effective and cause patients more suffering.

Keywords
nurses, computer-mediated communication, temporality
National Category
Communication Systems Work Sciences
Research subject
Computer Science with specialization in Human-Computer Interaction
Identifiers
urn:nbn:se:uu:diva-400778 (URN)
Conference
WORK2019. Real Work in the Virtual World
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2020-01-02 Created: 2020-01-02 Last updated: 2020-01-02
Golay, D. (2018). Analyzing work-related technology use from a UX perspective: the holisticUX method. In: Proc. 10th Nordic Conference on Human-Computer Interaction: . Paper presented at NordiCHI 2018, September 29 – October 3, Oslo, Norway (pp. 711-715). New York: ACM Press
Open this publication in new window or tab >>Analyzing work-related technology use from a UX perspective: the holisticUX method
2018 (English)In: Proc. 10th Nordic Conference on Human-Computer Interaction, New York: ACM Press, 2018, p. 711-715Conference paper, Published paper (Refereed)
Place, publisher, year, edition, pages
New York: ACM Press, 2018
National Category
Human Computer Interaction
Identifiers
urn:nbn:se:uu:diva-363980 (URN)10.1145/3240167.3240244 (DOI)000455775700067 ()978-1-4503-6437-9 (ISBN)
Conference
NordiCHI 2018, September 29 – October 3, Oslo, Norway
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-07153
Available from: 2018-09-29 Created: 2018-10-22 Last updated: 2019-04-09Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-8240-0942

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