In this final chapter I present a discussion of this dissertation as a larger body of work, and conclude with various implications, recommendations, and study limitations for consideration. The two research questions addressed in this study included: (a) how do nurses conceptualize health technology used in practice? and, (b) how do nurses learn about health technology used in practice? For the purposes of this dissertation,
technology was described as a non-human entity underpinned by a computerized processor. Technology used in or for health-related purposes was denoted as health technology. Various data collection methods from a number of human and non-human actors helped identify different perspectives about how nurses conceptualized and learned health technology. In the following sections, a discussion of the study findings is
provided, along with implications and recommendations, study limitations, and concluding thoughts.
Key Findings and Discussion Technology Conceptualization by Nurses
The findings of this study provide insight into nurses’ conceptions of technology as used in practice. Three thematic projections emerged from this study. First, nurses typically positioned themselves as the user of technology and were able to describe and identify meaningful technical actors in their larger networks. Second, nurses used a variety of conceptual and philosophical approaches to describe what technology was, and how these non-human actors operated in their environments. Third, nurses consistently projected the theme of action or praxis onto their interaction or use of technology.
The positioning of human actors (e.g., nurses) in relation to technical actors was an interesting finding. Nurses were cognizant of the way they outlined their relationship with technology by highlighting features in relation to their work environment or the way other experiences in their daily life influenced their understanding of technology. This blending and blurring of environments and apparent transference of knowledge and skills from practice environments to personal life (and vice versa) was uncovered in the
participants’ categorization of described technology. The listings of various technologies provided by participants provided an insight into what present day nurses deemed to be
health technology, and also elucidated a number of nuances of naming and identification strategies currently in operation. From the findings of this study, it is clear that nurses did not describe or identify technology as a monolithic entity; rather, nurses commonly defined technology by describing their positionality when using a form of technology, and by conceptualizing technology’s role from within practice.
The ability of nurses to describe finer elements of technology used in practice was also highlighted in a number of the participants’ use of conceptual and philosophical perspectives to describe their relationship with technical actors. Unlike the technological conceptualization themes published by authors like Barnard (1996; 1997) and
Sandelowski (1997a; 1999) in the late 1990s, the current conceptions of technology by nurses in this study appear to be more balanced and cognizant of sociomaterial
considerations. None of the human participants interviewed or accessed in this study provided conceptions that were strongly analogous to technical romanticist or optimist ideals. If anything, nurses’ conceptualizations of technology used for practice appear to be influenced by factors originating from outside the profession. For instance, in the
majority of interviews conducted with nurses, descriptions and discussions of social technologies or technology used for personal purposes emerged and became central to the dialogue. In a few extreme cases, nurses stated that they saw little difference between technologies used for personal purposes and health purposes. In these cases, health technology was a technical actor that could be used for a health purpose, and did not necessitate being physically located in a traditional healthcare related environment (e.g., hospital).
Finally, the action or praxis elements of technology described by nurses were similar to other examinations of technology used in practice (Munck, Fridlund, & Mårtensson, 2011; Wikström, Cederborg, & Johanson, 2007). The conceptions and definitions of technology have long possessed an affinity toward describing various action and movement oriented phenomena (Barnard, 1996). Nurses interviewed in this study also endorsed the appreciation that technology was an actor that allowed an individual to change or modify some element of the immediate environment. A number of participants described how technology enabled them to complete an action (or set of actions) within a health context. Conversely, action that is sometimes facilitated (or enabled) by technology was not always deemed to be positive or warranted. Nurses did not always view technology as a positive actor in the generation of action; instead, it was an actor that needed to be negotiated within the network of other sociomaterial actors. In this respect, technology was not always conceptualized as a positive entity for healthcare purposes. Technology was constantly and consistently subject to a dynamic array of forces that were initiated by other actors in the immediate (and proximal) networks, and the resulting changes modified the technical actor’s value to the presenting context.
Similarly, technology used for health purposes is not static; rather, health technology actors are dynamic and evolve depending on context and the needs of other actors in their proximity. Given the increased blurring of personal and professional lives through the use of Internet and mobile technologies, nurses do not seem to need to fix their conceptualizations of health technology to either a specific actor or environment. Evidence of this broadening view of health technology was observed in nurses’ active use and endorsement of non-traditional technology (e.g., iPhone and social media) for clinical purposes. Unfortunately, much of the messaging related to health technology (e.g.,
Infoway,2006; 2011) has continued to focus on conceptualizing end-users (e.g., nurses) as adversarial actors who require mobilization to adopt and use technology. The findings of this study demonstrated that nurses are actively adopting, modifying, translating, and using technology for health purposes. Regardless, it is appreciated that the processes and methods that some nurses use to learn and adopt technology (e.g., anti-programs) may not be compatible with usage inscriptions presented by organizations like Infoway. If
anything, the findings of this study offer insight for organizations like Infoway who are interested in generating increased and deeper levels of clinician adoption and use of technology. Firstly, the positionality of nurses in relation to technological actors needs to be taken into account when exploring and mandating why nurses should adopt and use technology. To date, much of the scholarly literature that examines nurses’ use of technology has ignored this extremely important sociomaterial attribute. Secondly, it may be worthwhile for health organizations to recast their perspectives of end-user adoption in light of nurses’ current conceptualizations of health technology in 2013. Health technology no longer presents as a monolithic entity to nurses; rather, it is viewed
and conceptualized as a dynamic tool that is modifiable by nurses and other actors in the environment.
Further evidence of the importance of sociomaterial considerations in relation to nurse adoption of technology has been recently noted by Cross and MacDonald (2013). In Cross and MacDonald’s (2013) grounded theory study, they examined the range of emotions and reactions by nurses’ toward the integration of computer and electronic health record technology into clinical practice. Their study findings outlined a range of important factors that facilitate the adoption of computer technology in clinical
environments. Included in their findings was a dynamic array of socio-cultural-technical considerations (e.g., organizational and professional discourse, past experiences,
biomedical technology, etc.) active in the nurses’ environments that facilitated the
potential for technology adoption. Over this process of developing a relationship with the technology, nurses individually made the decision to “adopt, adapt to, or ignore” (p. 129) the computerized technology.
Learning: Process and Product
A specific finding that emerged from this study was the dynamic interplay between the process and product elements of learning technology. The process of learning technology was a dynamic action operationalized by nurses in two ways: informal and formal learning (Marsick & Watkin, 2001). Informal learning was a preferred method of continued learning once a baseline knowledge or competency with the technology had been acquired. Formalized approaches to learning technology were generally not viewed as valuable methods to learn nuanced or deeper level competencies
of a specific system. Examples presented of formal learning related to technology use were typically found to be ill-suited for learner engagement and customization, especially in relation to new systems used in academia or practice. A few nurses commented that the formalized training sessions for specific technology were not valuable and they would rather utilize various self-sponsored informal approaches for future learning. Nurses in this study also appeared to use informal approaches to learning technology when they required specific knowledge related to using a system in practice. Given the previous finding related to the action-praxis conceptualization of technology, it is not surprising that the findings in this study highlighted nurses’ affinity for a just-in-time learning approach. Since technology engenders an action-praxis response by nurses (e.g., nurses are using technology to do something), it is likely that clinicians preferred to seek a source of learning that was more spontaneous, and dependent on emergent needs arising from the practice setting.
The preference for an informal learning typology has also been found in other texts that come from management sciences literature. For instance, Pisano, Bohmer, and Edmonson (2001) found that “learning-by-doing” (p. 766) through cumulative
experiences played an important role in the adoption of minimally invasive surgical technology used by surgical staff at 16 different organizations with more than 660
surgeries. This learning-by-doing process was heavily influenced by social factors in the immediate environment, including the stability of the surgical team, and how knowledge of the procedure was captured and translated over time. Further evidence of the benefits of unstructured learning was uncovered by Schilling, Vidal, and Ployhart (2003) who studied teams of people solving complex problems. Schilling et al. (2003) found that