Workarounds and Spaces: a nurse’s view on the perceived constraints of Electronic Patient Records (EPR)

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2020-08-19
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en
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This thesis focussed on how nurses work with and around technology, specifically Electronic Patient Records. The goal of this thesis was to contribute to the current knowledge on the underexplored theoretical links between perceived constraints, workarounds, and spaces. Imbrication theory, routine dynamics and a theory of workarounds were discussed to explore these links. A qualitative method, inspired by informed grounded theory was employed to interview seven nurses and a day activity coach working in a Dutch hospital. The findings showed that besides affordances, nurses perceived four types of constraints concerning usability, data, functionality, and conflicts of logic. To deal with these constraints, nurses employed five types of workarounds, namely double checking and correcting, a backup paper-based system, using other resources, pretending to comply, and suspending actions. Nurses facilitated these workarounds by creating informal spaces without challenging the imbricated infrastructure. When nurses wanted to change this infrastructure, more formal spaces were created and expanded to include relevant stakeholders like managers and IT-specialists. These findings suggest that informal spaces provide the theoretical link between workarounds and routine dynamics. Further research should dive deeper into these informal spaces and how perceived constraints can lead to change over time.
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Faculteit der Managementwetenschappen