Aims and objectives: To evaluate acceptability, efficiency, and quality of a new digital care management system in a residential aged care home (RACH).Background: Improving care quality and efficiency in RACH, while simultaneously upgrading data management, is a priority for communities and governments.Design: Participatory action research with mixed methods data collection was employed to evaluate a digital care management system implemented at a 169-bed RACH. This paper reports qualitative findings of the 2-year evaluation.Methods: Qualitative data were collected using focus groups with residents, visitors, nurses, managers, care workers, and consultants; resident/visitor and staff hallway interviews and responses to open-ended questions in online staff surveys. Data were analysed thematically under the four predetermined study objectives. Reporting adhered to COREQ guidelines.Results: 325 data captures from 88 participants, over seven data sources were coded.Findings indicate that the system was acceptable to both residents and staff due to perceptions of time-saving and improved quality of care. Increased efficiency was perceived through timeliness as well as reduced time spent retrieving and documenting information. Quality of care was improved through care scheduling individualised to resident needs, with reminders to avoid missed care. Relatives were reassured and activities were scheduled to loved one's preferences. The co-design implementation | 175 BAIL et AL.

The aim of this study was to investigate the implementation of a novel electronic bedside nursing chart in an acute hospital setting. The case study used multiple data sources captured within a real-life clinical ward context. Quantitative findings included significant reductions in nurse-reported missed care (P<0.05) and increased mean time spent at the bedside (from 21 to 28min h−1; P<0.0001); reductions in patient-reported missed care and nurses’ walking distances were not significant. Qualitative themes included: (1) inconsistent expectations (perceptions about potential vs actual functionality and benefits of the technology); (2) decisional conflict between managers and end-user nurses (discordance between governance decisions and clinical operations; 30% of beds were closed and six of the eight trained nurse ‘super-users’ were moved from the pilot ward); and (3) workflow effects (ergonomic set-up of the digital interface). This study highlights the complex challenges of implementing and examining the effects of technology to support nursing care. Shared understanding of the technology goals and project scope in relation to nursing care and flexible and adaptive project and contingency planning are fundamental considerations. Complexity, unpredictability and uncertainty of ‘usual business’ are common confounders in acute hospital settings. What is known about the topic?Although much has been written about the implementation of electronic records into hospital systems, there is little research evaluating the effect of information technology systems that support the complex clinical decision making and documentation required to meet nurse and patient needs at the point of care. What does this paper add?This study highlights the potential to reduce missed care through better nursing workflow. Contributing factors to low nurse adoption of new technology have been identified, including inconsistent expectations and goals for the design of systems to support quality nursing care, incongruous decision making in design, adaptation and implementation processes and constrained physical workability in relation to nursing workflow. What are the implications for practitioners?The design of information systems to support nursing work requires a shared understanding of ‘good practice’ for high-quality nursing care that is consistent with theories of nursing practice, best evidence and professional practice standards. Recognition of effective and ineffective sociotechnical interactions that occur during complex nursing processes can help avoid ‘disruption without benefit’ and ‘amplification of errors already in the system’ during acute care technology implementation. Ongoing dynamic input from individuals and groups with different expertise and perspectives, as well as iterative, generative processes for moving towards a shared goal, are critical for effective and efficient implementation.

Aim: To describe the self-reported experiences of clinicians evaluating a novel Health Information System in an acute care environment. Design: The Health Information System was implemented over a one-month period in 2017 into a 26-bed acute medical ward within a 760-bed tertiary teaching hospital in Australia. Methods: Data were collected using interviews with 48 multidisciplinary clinicians and 20 patients, and 2 focus groups with 13 nurses, and analysed with a 'content, context, and process' evaluation framework. Results: Three themes reflecting unanticipated difficulties emerged from the qualitative data: (1) inconsistent expectations; (2) decisional conflict between managers and end-user nurses; and (3) workflow impacts. Conclusions: Designers and evaluators of information systems must listen to, prioritise and respond to the needs of the clinicians who provide care.

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Purpose Computing ethics represents a long established, yet rapidly evolving, discipline that grows in complexity and scope on a near-daily basis. Therefore, to help understand some of that scope it is essential to incorporate a range of perspectives, from a range of stakeholders, on current and emerging ethical challenges associated with computer technology. This study aims to achieve this by using, a three-pronged, stakeholder analysis of Computer Science academics, ICT industry professionals, and citizen groups was undertaken to explore what they consider to be crucial computing ethics concerns. The overlap between these stakeholder groups are explored, as well as whether their concerns are reflected in the existing literature. Design/methodology/approach Data collection was performed using focus groups, and the data was analysed using a thematic analysis. The data was also analysed to determine if there were overlaps between the literature and the stakeholders’ concerns and attitudes towards computing ethics. Findings The results of the focus group analysis show a mixture of overlapping concerns between the different groups, as well as some concerns that are unique to each of the specific groups. All groups stressed the importance of data as a key topic in computing ethics. This includes concerns around the accuracy, completeness and representativeness of data sets used to develop computing applications. Academics were concerned with the best ways to teach computing ethics to university students. Industry professionals believed that a lack of diversity in software teams resulted in important questions not being asked during design and development. Citizens discussed at length the negative and unexpected impacts of social media applications. These are all topics that have gained broad coverage in the literature. Social implications In recent years, the impact of ICT on society and the environment at large has grown tremendously. From this fast-paced growth, a myriad of ethical concerns have arisen. The analysis aims to shed light on what a diverse group of stakeholders consider the most important social impacts of technology and whether these concerns are reflected in the literature on computing ethics. The outcomes of this analysis will form the basis for new teaching content that will be developed in future to help illuminate and address these concerns. Originality/value The multi-stakeholder analysis provides individual and differing perspectives on the issues related to the rapidly evolving discipline of computing ethics.