Touted as solution to globally access patient safety, healthcare records and support and enhancement of quality measures for evidence based care provision, electronic medical record advent began with less reviews from all healthcare practitioners sectors. Nurses, who have been protecting their paper documents, have shown resistance to the change of abandoning papers for computers. We have many reasons for the difficulty of this transition, providing educators and administrators with both opportunities and challenges to expand comfort levels and knowledge base of nurses. Therefore, methods for enhancing computerization skills together with clinical software systems development and implementation involvement of staff to serve as resistance problem solution deserve merit(Ball, Hannah, Jelger, & Peterson, 2013).
Many reasons for computerization resistance exist. These include feelings of fear and apprehension, anxiety and workflow interference with having time away of healthcare staff from their patient care work being among the most noticed(Ball, et al., 2013). However, some people argue that nurses don't resist technology but the addition of an extra item in their work. Nurses may fear online charting as it would take more of their time compared to paper charting.
Fear, apprehension, and anxiety feelings may be attributed to computer system instability and unreliability, electronic documentation process difficulty, workflow process changes, or user skill level lack of confidence. Majority of nursing workforce today, didn't grow up through a technological age, since statistics show that only 8% of the current Registered Nurses are under 30 years of age, with 41% being over 50 years of age(McGonigle, & Mastrian, 2011).
Nursing staff involvement from patient care front lines in the process from beginning with program and software design to continuing through the evaluation is highly advised. There is an emphasis for computer training necessity both during initial implementation and ongoing basis via continuing education. As a result, staff members will serve as software super-users in their future roles and will be useful to their fellow colleagues at nursing unit resources or EMR train-the-trainer sessions(McGonigle, & Mastrian, 2011). Therefore, these nurses will provide insight into nursing workflow, processes, and practice during the phase of software development.
During training sessions, technology use should be matched to the skill level of learner. Basic computer tutorials, typing and Microsoft Office Suite components such as Outlook, Excel, and Word, should be introduced for learning concepts enhancement related to the EMR software. Data shows strong impact on adequate training of numerous user acceptance aspects. Users who had received training assessed themselves as skilled to using the system than those who were not trained(Ball, et al., 2013).
Providing computer training which is comprehensive and appropriate for the learner's level has been noted in literature as a suitable resistance problem solution. Having EMR outcome goals, such as provision of quality. cost-effective, evidence based care, and patient safety, it is clear that nurses will require to acquire a computer proficiency basic level(McGonigle, & Mastrian, 2011). Therefore, data driven informatics models which are developed to be able to provide knowledge and information, will not be effective if nurses don't realize information need, demonstrate the skills and knowledge to evaluate and retrieve information, and have wisdom to be able to integrate findings from research to support in their practices the positive changes.
An example of change and resistance to technology in healthcare happened in the year 2003, January, which was reported by CIO magazine. This was a case of high profile which spooked the medical field and which gives a classical user resistance example. Cedars-Sanai Medical Center's doctors in Los Angeles were very unhappy with some new computerized physician order entry (CPOE) system. Tired for the more time taken by this system to enter their orders on a computer, they planned demonstrations against this new CPOE system. As a result, the hospital management shelved this CPOE system portion of 32 million dollars implementation project only after using it for three months(Ball, et al., 2013).
Lewin's theory may help to understand how change affects an organization, identify successful implementation barriers and can be used to identify opposing forces which during change do act on the behavior, hence leading to acceptance and overcoming resistance by nurses of new technologies. Numerous health care institutions have been able to use Kurt Lewin's theory in understanding human behavior while relating to change and the patterns of change resistance(Ball, et al., 2013). It is also known as Lewin's Force Field Analysis and it includes three phases called unfreezing, moving, and refreezing or freezing.
The change focus identification is the initial step of Lewin's analysis of unfreezing stage. Communication with all parties including administration, mangers and frontline nurses is this step's key components. Communication lines should remain honest and open to create trust and sense of security to all involved with this proposed change. The second stage which is moving stage does represent actual change period including the project stages of planning and implementation. The nursing staff should actively be involved to create a sense of project's success ownership. The last stage in Lewin's theory is refreezing or freezing of the changed practice which leads to stability and evaluation time. Ongoing frontline nurses' support and all stakeholders' technology support should continue till change is complete and everyone is comfortable with this technology(McGonigle, & Mastrian, 2011).
References:
Ball, M., Hannah, K., Jelger, U., & Peterson, H. (2013). Nursing Informatics: Where Caring and Technology Meet. New York, N.Y: Springer Science & Business Media.
McGonigle, D., & Mastrian, K. (2011). Nursing Informatics and the Foundation of Knowledge. Burlington: Jones & Bartlett Publishers.
