JMIR Publications

ABSTRACT

Background:

Digitalisation in hospital settings is increasingly promoted as a means of reducing nursing workload. However, empirical evidence suggests a more ambivalent picture: digital systems may alleviate certain burdens while simultaneously generating new ones. A systematic, multi-dimensional investigation of burden and relief from the perspective of registered nurses remains largely absent from the literature.

Objective:

This study aimed to systematically analyse registered nurses' experiences of digitalisation-related burden and relief potentials in a German university hospital using a multi-dimensional analytical framework grounded in the Job Demands–Resources Model.

Methods:

A qualitative exploratory design was employed. Between July and August 2025, eight individual semi-structured interviews were conducted with registered nurses from two distinct ward settings within the same university hospital: an innovation ward functioning as a digital pilot unit and two comparator wards in the trauma surgery department. Participants were recruited using purposive sampling. Interviews were audio-recorded and fully transcribed. Data were analysed using structuring qualitative content analysis (Kuckartz, 2018). Coding was performed independently by two researchers; categories were subsequently discussed and refined within the research team through consensual validation. The study was reported in accordance with the COREQ checklist (see Multimedia Appendix 1).

Results:

Fifteen categories comprising 246 coded segments were developed and assigned to five analytically distinct burden dimensions, illustrated below by two representative subcategories per dimension: temporal (dual documentation, media discontinuities), cognitive (system complexity, fragmented integration), physical (walking distances, lifting demands), emotional (loss of patient time, erosion of professional identity), and organisational (inadequate training, insufficient participation). Each dimension was accompanied by corresponding relief potentials. Across all participants, the evaluation of digital technologies was consistently anchored in one criterion: whether digitalisation creates or depletes time for direct patient care.

Conclusions:

Digitalisation in nursing cannot be understood as a unidimensional process of relief but represents a complex reorganisation of work demands and resources. The developed multi-dimensional burden model provides a theoretically grounded framework for implementation research and practice. Future studies should quantitatively validate the model across diverse care settings.