Digital Pulse - Ch 2 - Sec 1 - Understanding Community Health Care: Implications for Technology Design

Summary

This paper is the result of a small, but intensive, qualitative research exercise into the experiences and needs of community health care nurses working in the field in rural and urban Queensland, Australia. The intent was to evaluate the potential for integration of ICTs into the nurses' daily practices and to contribute insights to the design of technology solutions. With home-based health care on the rise, there is growing demand for technology supports for both patients and health care providers. These demands must be guided by both the advantages technology has to offer and the pre-existing and informal works systems that constitute working in the field.

Key Points

The article begins with an extensive review of the settings and methodologies that were used for this study. Nurse were “shadowed” for a day as they made their various rounds in the community and worked out of their offices at the health centre that is the hub of each regional health district. The authors argue that this type of intimate observation is critical to the development of sound strategies for technology implementation. Also of importance was the lessons gleaned from interviews regarding an earlier ICT project that the health centre had participated in years previous. The data was analysed using a grounded theory approach integrating both theory and observation.

An overview of the work of a community health care nurse follows, explaining the daily routine, describing some of the challenges faced and observing the important social interactions that are central to community health practice. The nurse's work took place in three distinct places: the car, which served as mobile office and supplies store as well as mode of transportation; the client's home, where the nurse interacts with the patient and gains intimate knowledge about their current state of health that can only be had by ‘being there'; and the office at the health centre where the nurse processes the days paperwork and partakes in various important peer interactions.

The study resulted in several implications for technology design that might help to improve the overall functioning of the nurses and enhance the services delivered:

External communication with other health care providers such as doctors and Occupational Therapists (OT) was observed to be difficult and inconsistent. Doctors were difficult to reach through synchronous methods such as the telephone, requiring several attempts. This led to wasted time and delays in the provision of other medical interventions. The proposed solution was the utilization of asynchronous communication technologies such as email to overcome conflicting schedules. The inclusion of enhanced features such as digital photos for remote diagnosis was also seen to have potential and would reduce disturbances to the patient.

The client chart was also evaluated for its potential to be transformed by technological inputs. The client chart was the main source of paperwork for the nurses and represented an area that required considerable time and energy. Several issues emerged when considering the potential for an electronic client chart including the fact that 60% of charts were left in the clients home to facilitate scheduling flexibility in the field - so that any practitioner could attend to the client if need be. These charts also had an important, informal collaborative function as nurses left notes for each other and other service providers. This required that any technical solution was above all else going to have to be universally accessible by any member of the health team. Nevertheless, the potential for such an application exists, one that would likely include a host of enhanced features such as instant access to information that might be useful during the visit with the client. The collaborative function also required recognition of the informal behaviours that revolved around the chart, such as the use of post-it notes for reminders and alerts. These types of behaviours have been observed in other pieces of literature on technology design and require what is known as a ‘pliant' approach to computing. Thus, while the potential exists, these important work practices need to be taken into account.

The issue of mobile devices was also examined, taking into account the nurse's past experiences with PDAs that they attempted to use for scheduling purposes. The issues that arose from this past exercise included physical issues such as screen size and the durability of the technology as well as concerns regarding timely information synchronization with central computer units. This raised issues about the type of connections needed to support the mobile work of the nurses. Information and communication devices are merging and widespread wireless infrastructure networks are on the rise. Furthermore, mobile devices are becoming mature as technologies are becoming increasingly user friendly and incorporating multiple modes of input such as voice recognition. One important issue that also stemmed from this evaluation was how the use of such mobile devices in the care setting impacted the social interactions between the nurse and their client.

In concluding, the authors recommended further study in the field but also suggest that there are definite advantages to be gained from utilizing the new ICTs but that they must also adapt the pre-existing beneficial work practices in place. There are many idiosyncratic subtleties to this type of work that require ICTs to be ‘pliant' and flexible. And while there presently does not seem to be a mobile information device on the market that would fit this role, the lessons learned from this study can still contribute both to the design of technologies in this field but also to other fields through an appreciation of research methods used to derive the above observations.

Source: Austin D, et al. "Understanding community health care: Implications for technology design." Realising Quality Health Care, HIC 2001.