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A quantitative analysis of the impact of a computerised information system on nurses' clinical practice using a realistic evaluation framework

Oroviogoicoechea, Cristina; Watson, Roger


Cristina Oroviogoicoechea


Objective: To explore nurses' perceptions of the impact on clinical practice of the use of a computerised hospital information system. Design: A realistic evaluation design based on Pawson and Tilley's work has been used across all the phases of the study. This is a theory-driven approach and focuses evaluation on the study of what works, for whom and in what circumstances. These relationships are constructed as context-mechanisms-outcomes (CMO) configurations. Measurements: A questionnaire was distributed to all nurses working in in-patient units of a university hospital in Spain (n = 227). Quantitative data were analysed using SPSS 13.0. Descriptive statistics were used for an overall overview of nurses' perception. Inferential analysis, including both bivariate and multivariate methods (path analysis), was used for cross-tabulation of variables searching for CMO relationships. Results: Nurses (n = 179) participated in the study (78.8% response rate). Overall satisfaction with the IT system was positive. Comparisons with context variables show how nursing units' context had greater influence on perceptions than users' characteristics. Path analysis illustrated that the influence of unit context variables are on outcomes and not on mechanisms. Conclusion: Results from the study looking at subtle variations in users and units provide insight into how important professional culture and working practices could be in IT (information technology) implementation. The socio-technical approach on IT systems evaluation suggested in the recent literature appears to be an adequate theoretical underpinning for IT evaluation research. Realistic evaluation has proven to be an adequate method for IT evaluation.


Oroviogoicoechea, C., & Watson, R. (2009). A quantitative analysis of the impact of a computerised information system on nurses' clinical practice using a realistic evaluation framework. International journal of medical informatics, 78(12), 839-849.

Journal Article Type Article
Acceptance Date Aug 31, 2009
Online Publication Date Sep 19, 2009
Publication Date 2009-12
Print ISSN 1386-5056
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 78
Issue 12
Pages 839-849
Keywords Computers; Information systems; Information technology; Patient records; Nurses; Nursing; Realistic evaluation; Socio-technical approach; Evaluation studies
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