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The process of nurses’ adoption of the electronic health record Cox, Richard Anthony


The electronic health record (EHR) is being introduced on some nursing units. The process of nurses' adoption of the EHR into practice is not well understood. The purpose of this grounded theory study was to gain further understanding of this adoption process, to identify the factors that influenced the adoption process, and the factors that influenced the learning experience. Semi-structured audio taped interviews were conducted with six nurses representing some variation in their level of technology adoption and the level of technology of the unit where they worked. Using the constant comparative method of data analysis, data was collected and analyzed simultaneously. Memos were used to assist in the development of the stages and phases identified in the analysis process. Findings revealed a three-staged process that involved "getting started", "getting comfortable with the computer system", and "establishing a pattern". "Getting started" included the nurses' receiving EHR training. "Getting comfortable with the computer system" involved learning how to access and use the EHR. "Establishing a pattern" involved choosing how they would access patient information. Individual, technical, and organizational factors seemed to influence the adoption process. Individual factors included the nurses' age and role, their educational preparedness, and their motivation to use the EHR; technical factors included the nurse's computer skill level, their use of the pre-existing computer system, and the availability of the EHR program; and organization factors included the nursing units' general response to change, the availability of time to practice, the availability and nature of support, and the organization's method of communication and implementation of the EHR appeared to influence the adoption process. Training geared to the learner's level, their computer skill level, their level of fear and anxiety, their sense of information overload, and the make-up of the training class related to computer skill mix influenced the learning experience. Although there are limitations in the study because more depth and variation in sampling is needed, the findings can add to our understanding of the adoption process of the EHR and factors that influenced that process. These findings suggest implications for education, practice, administration and research.

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