Identification of Factors Influencing the Adoption of Health Information Technology by Nurses Who Are Digitally Lagging: In-Depth Interview Study
Authors: De Leeuw Jacqueline A , Woltjer Hetty , Kool Rudolf B 
Published: July 2020

Background

The introduction of health information technology (HIT) has drastically changed health care organizations and the way health care professionals work. Some health care professionals have trouble coping efficiently with the demands of HIT and the personal and professional changes it requires. Lagging in digital knowledge and skills hampers health care professionals from adhering to professional standards regarding the use of HIT and may cause professional performance problems, especially in the older professional population. It is important to gain more insight into the reasons and motivations behind the technology issues experienced by these professionals, as well as to explore what could be done to solve them.

Objective

Our primary research objective was to identify factors that influence the adoption of HIT in a sample of nurses who describe themselves as digitally lagging behind the majority of their colleagues in their workplaces. Furthermore, we aimed to formulate recommendations for practice and leadership on how to help and guide these nurses through ongoing digital transformations in their health care work settings.

Methods

In a Dutch university medical center, 10 face-to-face semi-structured interviews were performed with registered nurses (RN). Ammenwerth’s FITT-framework (fit between the Individual, Task, and Technology) was used to guide the interview topic list and to formulate themes to explore. Thematic analysis was used to analyze the interview data. The FITT-framework was also used to further interpret and clarify the interview findings.

Results

Analyses of the interview data uncovered 5 main categories and 12 subthemes. The main categories were: (1) experience with digital working, (2) perception and meaning, (3) barriers, (4) facilitators, and (5) future perspectives. All participants used electronic devices and digital systems, including the electronic health record. The latter was experienced by some as user-unfriendly, time-consuming, and not supportive in daily professional practice. Most of the interviewees described digital working as “no fun at all,” “working in a fake world,” “stressful,” and “annoying.” There was a lack of general digital knowledge and little or no formal basic digital training or education. A negative attitude toward computer use and a lack of digital skills contributed to feelings of increased incompetency and postponement or avoidance of the use of HIT, both privately and professionally. Learning conditions of digital training and education did not meet personal learning needs and learning styles. A positive impact was seen in the work environment when colleagues and nurse managers were aware and sensitive to the difficulties participants experienced in developing digital skills, and when there was continuous training on the job and peer support from digitally savvy colleagues. The availability of a digital play environment combined with learning on the job and support of knowledgeable peers was experienced as helpful and motivating by participants.

Conclusions

Nurses who are digitally lagging often have had insufficient and ineffective digital education. This leads to stress, frustration, feelings of incompetency, and postponement or avoidance of HIT use. A digital training approach tailored to the learning needs and styles of these nurses is needed, as well as an on-the-job training structure and adequate peer support. Hospital management and nurse leadership should be informed about the importance of the fit between technology, task, and the individual for adequate adoption of HIT.