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Table 1 Summary of analyzed articles

From: Staff experiences within the implementation of computer-based nursing records in residential aged care facilities: a systematic review and synthesis of qualitative research

Authors Aims and objectives Methods design Interview Focus group Observation Results
Data analysis
Date of publication
Alexander et al. (2007) U.S.A. Clinical information systems in nursing homes: an evaluation of initial implementation strategies [38] To explore implementation strategies, employee experiences, and factors influencing employee satisfaction Explorative 4 nursing homes, 6 months after implementation 23 22 --- Five themes emerged: (1) perception and cognition, (2) change, (3) workable system, (4) competence and (5) connectedness.
Focus groups (22 à 60 Min.)
Implementation strategies associated with lower satisfaction were availability of equipment, training resources, and the presence of professional information technology. The experiences differ [according] to the role.
Unstructured observations (< 5 min., made when using the technology, (n=?) semi-structured interviews (unknown type) (n=23) axial coding
Cherry et al. (2008) U.S.A. Factors affecting electronic health record adoption in long-term care facilities [39] To gain information about Long Term Care leaders’ general understanding about Electronic Health Records (EHR) and identify factors that hinder and facilitate EHR in Long Term Care Explorative --- 34 --- Primary barriers identified were costs, the need for training and the culture of change. Primary facilitators were training programs, well-defined implementation plans, evidence that the electronic systems will improve care outcomes.
Focus groups (34) via telephone conference call with directors of nursing, Administrators and corporate executives divided into users and non-users
Cherry et al. U.S.A. (2011) Experiences with electronic health records: early adopters in long-term care facilities [40] Providing a description of the early users’ experiences, challenges and benefits with Electronic Health Records in Long Term Care Explorative 70 --- 10 The RACF employees who work with EHR systems on a daily basis were positive about their experiences. In particular, operational improvements were achieved through increased access to resident information, cost avoidance, increased documentation accuracy and implementation of evidence-based practices.
Semi-structured interviews of unknown type, group-observation
10 "freestanding" Sites, one-site visit for 6-8 hours per visit with the following schedule for the face-to-face interviews: (a) 60 min for facility tour, (b) 45 min with the administrator, (c) 45 min with the DON, (d) 45 min with a group of assistant DONs and charge nurses, (e) 45 min with a group of direct care staff, (f) 45 min with residents and family members, (g) 60 min for observation on the unit during shift change
Munyisia et al. (2012) Australia The impact of an electronic nursing documentation system on efficiency of documentation by caregivers in a residential aged care facility [26] To examine the effect of the introduction of an Electronic Health Records system on the efficiency in a Long Term Care facility NOT INCLUDED IN THIS REVIEW: 8 --- --- Qualitative interviews to gain a better understanding
1. Personal Carers were happy in general because of quicker access and release from referring to written doctors notes
Longitudinal cohort study
2. Certain information items were double charted (Paper and EHR) due to organizational reasons
Explorative semi-structured Interviews (n=8) unknown type 6 and 12 months after introduction
3. It took longer to complete some documentation tasks using a computer (too many clicks to enter data)
Qualitative content analysis 4. Continuous training is needed for some caregivers to effectively use the EHR
Rantz et al. (2011) U.S.A. The use of a bedside electronic medical record to improve quality of care in nursing facilities: a qualitative analysis [41] To examine the effect of the introduction of a bedside electronic medical record on the improvement of care in nursing facilities (Part of the study of Alexander et al.) 120 22 ? Communication and information was improved which led to a general improvement of patient care
Explorative qualitative interviews (n=120), observations (?), focus groups (22) content analysisin all 4 homes 6,12, 18 months after implementation, additional interviews took place (n=?) 24 months after implementation in 2 homes
Experience of limited time due to EHR (Direct Carer) vs. saved time (Management)
Too much time for operating and managing the system
Yu et al. (2008) Australia Caregivers' acceptance of electronic documentation in nursing homes [35] The aim of the study was to investigate nursing home caregivers' acceptance of electronic documentation NOT INCLUDED IN THIS REVIEW 12 --- --- Some staff (4) with low experience wished for more time in the beginning and more instructions
Some staff (4) often used computers at home felt the software was easy to use
Questionnaire survey Other staff (4) felt they needed more practice than theoretical lessons
Semi-structured interviews unknown type after 11 weeks computer-based (n = 12)
Paper-based n =?
One Home that implemented an Electronic Health Records; one home remained paper-based.
Zhang (2012) Australia The benefit of introducing electronic health records in residential aged care facilities: A multiple case study [42] The aim of this study was to identify the benefits of Electronic Health Record in Long Term Care and to examine how the benefit have been achieved Explorative semi-structured Interviews (n=110) content analysis, theoretical sampling 110 --- --- BENEFITS TO THE STAFF
Convenience and efficiency in data entry, distribution, storage and retrieval
Ease of access more information to better understand the residents, the service and peer-learning
Empowering care staff
Improving Quality of Care
better information management
Improving the communication system
Improving access to funding facilitating care quality control better work environment educational benefits
Data Foundation (at least) // 23 Interviews and 22 focus groups removed due to doubling 320 56 10