Home Healthcare, Hospice, and Information Technology Innovations Conference

Innovations in Home Healthcare, Hospice, and Information Technology

A forum towards achieving evidence-based diffusion and implementation of innovations

H3IT: Home Healthcare, Hospice, and Information Technology Conference Washington – D.C., 2014

Information Practices and Information Systems in

Home Health Care: A Field-Study

Ragnhild Hellesø

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, Merete Lyngstad

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n line with the general development in health care an increasing number of people receive health care in their

homes. Caring for patients in their homes requires that providers have systems that collaborate with other

providers, with access to relevant, accurate, up-dated and situation specific information. To enhance quality

of care and efficiency in collaboration of services, the use of appropriate health information technologies (HIT)

is frequently suggested as a solution.

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In addition different types of collaborative processes must be supported by different

technologies in order to provide proper support to the work. Most studies which have investigated health care informa-

tion practices have been conducted in hospitals.

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We have not identified studies exploring home care nurses’ information

practices in-depth. The aim of this presentation is to report from an ongoing study aimed to explore home care nurses’

information practices including their collaborators in the different situations and available information.

Methods: A field study using observations, individual and group interviews were conducted. The entire material contains

totally 97 observations and 23 interviews with nurses in two Norwegian municipalities. A conceptual framework building on

a practice typology guided the overall study design. The typology describes that nursing care could be separated within four

different practice situations; acute situations, problematic situations, non-problematic situations, and problem identifying

situations. Each of the practice situations has their own distinct characteristics, though they are not mutually exclusive

categories.

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An integrative analytical approach was used to analyze the collected data.

Results: The analysis revealed that practice situations in home health care are characterized along two different but inter-

dependent axes regarding the nurses’ information needs. Firstly, patient related axes representing a continuum from acute to

long term care situations. The second axes concerns organizational factors representing a continuum from where the nurses

collaborated with other providers in a particular situation in a limited time and space, to practice situations which required

long-time interdisciplinary and inter-organizational coordination and information. The home care nurses did not always have

access to relevant situation specific information in the different practice situations. This was partly due to lack in their HIT

system and partly due to gaps between providers in different levels of the health care system. The two different municipalities

had different HIT systems. Both systems had their advantages but also shortcomings for covering the nurses’ information

and collaboration situations.

Discussion: The findings illustrate that home care nurses need to manage different information situations. They are not

guaranteed accurate information at point of care in every situation. Their HIT systems are not developed at a level of meeting

the plurality and complexity of practice and information situations. However, the findings from the current study may be

helpful towards a more systematized development of feasible and appropriate HIT.

Conclusion: The study highlights the need for developing more appropriate and accurate HIT-systems for ensuring quality

and safe health care for patients at home.

References

1. Committee on Patient Safety and Health Information Technology, Services, BoHC, and Medicine, I of. Health IT and

Patient Safety: Building Safer Systems for Better Care. 2012. url: https://www.iom.edu:443/Reports/2011/Health-

IT-and-Patient-Safety-Building-Safer-Systems-for-Better-Care.aspx.

2. Hellesø, R, Sorensen, L, and Lorensen, M. Nurses’ information management at patients’ discharge from hospital to home

care. International Journal of Integrated Care 2005;5.

3. Webster, J, Davis, J, Holt, V, Stallan, G, New, K, and Yegdich, T. Australian nurses’ and midwives’ knowledge of

computers and their attitudes to using them in their practice. Journal of Advanced Nursing 2003;41:140–146.

4. Stevenson, JE and Nilsson, G. Nurses’ perceptions of an electronic patient record from a patient safety p erspective: a

qualitative study. Journal of Advanced Nursing 2012;68:667–676.

5. Ammenwerth, E, Mansmann, U, Iller, C, and Eichstädter, R. Factors affecting and affected by user acceptance of

computer-based nursing documentation: results of a two-year study. Journal of the American Medical Informatics

Association : JAMIA 2003;10:69–84.

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Institute of Health and Society, University of Oslo, Norway

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