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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
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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
7.4.1 Introduction 191 7.4.2 Summary 197
7.5.1 Introduction 198 7.5.2 Summary 209
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
8.4.1 Introduction 222 8.4.2 Summary 228
8.5.1 Introduction 228 8.5.2 Summary 239
8.4.1 Introduction 239
8.7 CONCLUSION.......................................................................................244
1 INTRODUCTION ...................................................................................246
2 BACKGROUND .....................................................................................247
9.2.2 Renaissance of the Nursing Partnership 248
3 DEFINITIONS ........................................................................................248
9.4.1 Introduction 249 9.4.2 Summary 257
9.5.1 Introduction 258 9.4.2 Summary 263
9.6.1 Introduction 264
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
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