User centred design and aged care : a case study investigation into aged care nurses' information systems user needs within five Tasmanian aged care facilities

This thesis investigates aged care nurses‚ÄövÑvº information systems user needs in their delivery of care to patients within five Tasmanian aged care facilities. The thesis generates insights aimed at improving the design, adoption and use of human-centred information systems in residential aged care. The ageing demographic of the Australian population is changing the nature of demand for health care services. This has led to a situation in many health service areas of demand outstripping supply at a time when the workforce is also shrinking in relative size (Hogan, P, Moxham & Dwyer 2007). In aged care, these problems are compounded by the sector itself having an ageing workforce and major challenges in recruitment and retention of staff (Hogan, P, Moxham & Dwyer 2007). E-health initiatives have been promoted by the Australian government and the aged care sector as one set of responses to the challenges being faced. Business cases focused on increased information access, cost efficiencies and improved auditing of service delivery have driven the design and implementation of most IT systems in aged care, with relatively few focused on the delivery of care at the bedside (Chau, Cummings & Turner 2004; Yu & Yu 2004). While some business benefits have been gained, it is evident that the deployment of these systems raises numerous socio-technical and clinical challenges for nursing staff that require more detailed investigation (Kushniruk & Borycki 2008). The limited involvement of aged care nurses in the design of these information systems is partly a product of conventional information systems methodologies that presume users have some experience or knowledge of the potential for IT systems ‚Äö- experience that many aged care nurses lack (Eley et al. 2008). Indeed, even where nurses have participated, often their lack of exposure to technology and perceived technophobia (Toofany, 2006, Timmons, 2003, Simpson, 2004) have inhibited the clear articulation of the importance of such nursing activities as reflective practice to providing quality care. In this context, this research deploys a case study methodology informed by Grounded Theory to investigate aged care nurses‚ÄövÑvº user needs through an exploration of their work practices and nursing techniques proven to enhance the quality of care. One such technique is reflective practice (Ashby, 2006a). Deploying a subjective ontology (Orlikowski & Baroudi 1991) and an interpretivist epistemology (Hirschheim 1992), the research strategy was completed in three phases. Phase one involved the use of detailed semi-structured interviews, a focus group with aged care nurses and limited participant observation, to determine their technological sophistication and the existing role of reflective practice for nurses within the field. The collected data was used to generate core categories in Phase two, describing interactions between themes in the analysed data. Phase three identified the user needs from the core categories as the central findings of the research and developed a model to demonstrate how the user needs interacted to focus upon the human requirements of aged care. Scenarios were developed based upon this model to communicate the model‚ÄövÑvºs application. The nurses‚ÄövÑvº technique of reflective practice offered a way of opening discussion with the nurses to discover their user needs. Reflective practice was a useful tool in this role due to the legal requirement for its practice (ANMC, 1992), and its positive role in providing quality care (Ashby, 2006a). Aged care facilities were carefully selected that were on the cusp of introducing e-health solutions to their facilities. This thesis reveals that for the nurses in the aged care environments studied, the presumption of technophobia is problematic. The nurses were limited in their experience and knowledge of information systems, yet their flexibility and acceptance of any technology that could improve nursing outcomes ensured that with the appropriate assistance, aged care nurses could fully and meaningfully participate in the systems development process. The documentation burden has rightly been a major focus for IT in aged care (Courtney-Pratt 2005; Little & Carland 1991; Yu 2005a; Yu & Yu 2004), but while it is a worthy focal point, engaging with empowered nurses aware of the possibilities of technology, aware of their own specialised human-centric care techniques, far more holistic, relevant and beneficial systems can be developed. This thesis represents a starting point for the development of such systems for the aged care sector. This thesis contributes to the Information Systems body of knowledge on three levels. At the substantive level this research has used an exploration of the reflective practices undertaken by aged care nurses in order for the researcher to reveal the nurses‚ÄövÑvº user needs. At the methodological level, this research has demonstrated the potential for using a range of techniques to gain a qualitative understanding of a field where the level of technological sophistication of the users is very low. At the theoretical level the research developed a model for encouraging patient centric design of systems in aged care, without ignoring the sector‚ÄövÑvºs business requirements.