Nurses’ Perspectives on an Electronic Medication Administration Record in Home Health Care: Qualitative Interview Study

Abstract

Background eHealth is considered by policy makers as a prerequisite for meeting the demands of health care from the growing proportion of older people worldwide. The expectation about what the efficiency of eHealth can bring is particularly high in the municipal home health care sector, which is facing pressure regarding resources because of, for example, earlier discharges from hospitals and a growing number of patients receiving medications and treatments at home. Common eHealth services in home health care are electronic medication administration records (eMARs) that aim to communicate delegated tasks between professionals. However, there is an extensive gap in the research on how technology affects and is experienced by home health care professionals. Objective The objective of this paper is to shed light on how home care nurses experience eMARs in a Swedish municipality. Methods This qualitative interview study was conducted among home health care nurses using eMARs to facilitate communication and signing of delegated nursing tasks. The analysis of the interviews was performed using constructivist grounded theory, according to Charmaz. Results Of the 19 day-employed nurses in the municipality where an eMAR was used, 16 (84%) nurses participated in the study. The following two categories were identified from the focus group interviews: nurses become monitors and slip away from the point of care. The nurses experienced that they became monitors of health care through the increased transparency provided by the eMAR and the measurands they also applied, focusing on the quantitative aspects 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 the point of care and toward more administration—and further strengthened the way of managing work through delegation to health care assistants. Conclusions Previous analyses of eHealth services in health care showed that implementation is a complex process that changes health care organizations and the work of health care professionals in both intended and unintended ways. This study adds to the literature by examining how users of a specific eHealth service experience its impacts on their daily work. The results indicate that the inscribed functions in an eHealth service may affect the values and priorities where the service is in use. This presents an opportunity for future research and for health care organizations to assess the impacts of specific eHealth services on health care professionals’ work and to further examine the effects of inscribed functions in relation to how they may affect actions and priorities at individual and organizational levels.

Contributing factors involved in the safety of elderly people with chronic illness in home healthcare: a qualitative study

“…In fact, it can be argued that these centres engage all parties in care like the links of a chain; on the other hand, an inefficient management can break the links of the chain. According to the evidence, management,37 coordination,38 follow-up,39 supervision,40 training,41 recruiting and assembling an efficient team42 and formulating the rules and procedures43 to maintain and improve patient safety are among the main principles of home healthcare centres. Considering the above, these centres should try to drive their organisational culture towards patient safety 44…”

Electronic medication administration record (eMAR) in Swedish home healthcare—Implications for Nurses' and nurse Assistants' Work environment: A qualitative study

“…While eHealth services can facilitate information transmission [26,27], they also have secondary effects that are worth acknowledging. For example, the use of eHealth can contribute to burnout and negatively influence job satisfaction for healthcare professionals [28,29] and working methods and professional roles can be changed in unexpected ways [30][31][32]. Previous research on eMAR has shown that nurses perceive that it can improve medication administration safety and efficiency [25], reduce medication errors [33] and improve documentation compliance [34].…”