JMIR Publications

ABSTRACT

Background:

E-health is considered by policymakers as the prerequisite for meeting the demands of healthcare from the growing proportion of older people worldwide. The expectation of what the efficiency of e-health can bring is particularly high in the municipal home healthcare sector, which is facing pressure regarding resources, due to e.g., earlier discharges from hospitals as well as a growing number of patients receiving medications and treatments at home. Common e-health services in home healthcare are electronic medication administration records (eMAR) aiming to communicate delegated tasks between professionals. However, there is an extensive gap in research regarding how technology affects and is experienced by home healthcare professionals.

Objective:

The aim of the study was to explore how homecare nurses in a Swedish municipality experience an electronic medication administration record (eMAR).

Methods:

This qualitative interview study was conducted among home healthcare nurses utilizing an eMAR to facilitate communication and signing of delegated nursing tasks. Constructivist Grounded Theory (GT) according to Charmaz (1) (2) was used as a method.

Results:

16 out of 19 day-employed nurses in the municipality where an eMAR was used, participated in the study. Two categories were identified from the focus group interviews: (1) Nurses become monitors and (2) slip away from point-of-care. The nurses experienced that they became monitors of the healthcare through the increased transparency provided by the eMAR, which measurands they also applied, focusing on the quantitative parts of the delegated nursing tasks, rather than the qualitative aspects. The nurses experienced that their monitoring changed the power relations between the professions, reinforcing the nurses´ superior position. The experience of the eMAR was regarded as transitioning the nurses´ professional role, away from point-of-care, toward more administration and further strengthened the way of managing work through delegation to healthcare assistants (HCA).

Conclusions:

This study identified that the utilization of an eMAR had impacts on nurses' work and professional role. We suggest that these impacts should be taken into consideration when planning for and using this type of e-health service. Impacts of using e-health services can be alerted by examining its embedded functions to ensure alignment with the ongoing processes and values in the healthcare organization, or to estimate the organizational adjustments required, and by taking end-users perspectives into account.