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Using Multivariate Statistics

Principles and Practice of Structural Equation Modeling (2nd ed.)

While the technology acceptance model (TAM), introduced in 1986, continues to be the most widely applied theoretical model in the IS field, few previous efforts examined its accomplishments and limitations. This study traces TAM’s history, investigates its findings, and cautiously predicts its future trajectory. One hundred and one articles published by leading IS journals and conferences in the past eighteen years are examined and summarized. An openended survey of thirty-two leading IS researchers assisted in critically examining TAM and specifying future directions.

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The Technology Acceptance Model: Past, Present, and Future

Methodological Review: The Technology Acceptance Model: Its past and its future in health care

Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors

SEVERAL STUDIES quantifying the impact of poor communication on clinical work suggest that communication is a likely cause of systematic error in the health system. In Australia, inadequate communication has been associated with 17% of system problems, and, of these, 84% were deemed potentially preventable. 1 About 50% of all adverse events detected by general practitioners were associated with communication difficulties. 2 Within intensive care units, 2% of the activity consists of verbal communication between nurses and doctors, but accounts for 37% of error reports. 3 Thus, the evidence strongly suggests that poor communication wastes time, threatens patient care and may be one of the chief culprits behind preventable adverse events in clinical practice. 4 The research reported here extends work begun in the United Kingdom in the mid-1990s, 5,6 in which it was found that physician teams in hospital were subject to high levels of interruption. Clinical staff also appeared to bear a higher communication load than necessary, considering the many tasks that could be accomplished by accessing information sources rather than asking questions of people. It has since been hypothesised that such interruptions impose cognitive loads on clinical staff and have a negative impact on memory, leading to clinical error. 7 As a continuation of this research, we measured communication load more precisely and studied communication patterns in a high-workload clinical setting. METHODS 1.Methods

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Communication loads on clinical staff in the emergency department.

Aims
To determine the incidence of hepatitis C virus (HCV) infection and identify risk factors for seroconversion.
Design
Prospective cohort study. Participants were recruited through direct approaches, street-based outreach,
methadone and sexual health clinics and needle and syringe programmes.
Setting
Urban, regional and rural settings
in New South Wales, Australia.
Participants
Injecting drug users (IDUs) (
n
=
584) were screened and tested for
exposure to HCV. Between 1999 and 2002 antibody HCV negative IDUs (
n
=
368) were enrolled and followed-up every
3–6 months until seroconversion or study completion.
Measurements
Interviewer-administered baseline and follow-
up questionnaires consisted of 131 items and included demographics, drug use and risk behaviour. Approximately
10 cc of whole blood was drawn at each visit. Specimens were stored at
−
70C and serology performed using one or
two third-generation enzyme-linked immunosorbent assays and polymerase chain reaction testing.
Findings
Sixtyeight
seroconversions were observed and incidence was 30.8 per 100 person-years, with incidence in IDUs injecting
<
1 year, 133 per 100 person-years. Independent predictors of seroconversion were female gender, duration of injecting,
injecting cocaine, shared use of filters and recruitment strategy.
Conclusions
Women, new initiates and IDUs
recruited via outreach appear to be at increased risk of infection. Results confirm the significance of cocaine injection
as a risk factor and provide the first evidence outside North America of the link between shared use of drug preparation
equipment and incident HCV infection. Prevention efforts should attempt to raise awareness of the risks associated
with drug sharing and, in particular, the role of potentially contaminated syringes in HCV infection.

Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia

Aim This study attempts to address the content of nursing handover when compared with formal documentation sources. Background The nursing handover has attracted criticism in the literature in relation to its continuing role in modern nursing. Criticisms include those related to time expenditure, content, accuracy and the derogatory terms in which patients are sometimes being discussed. Methods Twenty-three handovers, covering all shifts, from one general medical ward were audio-taped. Their content was analysed and classified according to where, within a ward's documentation systems, the information conveyed could be located. Findings Results showed that almost 84.6% of information discussed could be located within existing ward documentation structures and 9.5% of information discussed was not relevant to ongoing patient care. Only 5.9% of handover content involved discussions related to ongoing care or ward management issues that could not be recorded in an existing documentation source. Limitations The results of this study are representative of only one ward in one Australian Hospital. Specific documentation sources were also not checked to determine their content. Conclusion Streamlining the nursing handover may improve the quality of the information presented and reduce the amount of time spent in handover.

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Nursing handovers: do we really need them?

Within certain industries there is an increasing prevalence toward computerizing work practices and mandating specific tasks performed using an Information System (IS). This trend is unlikely to diminish the need for stakeholders, involved in the implementation of an IS, to identify the determinants of successful use. Yet, to date, there is a paucity of research that has considered the issues specific to predicting and explaining user behavior in these situations. In this paper, we identify the relevant issues necessary for applying the technology acceptance model and the theory of planned behavior to the prediction and explanation of mandated IS usage, and we assess the value of these models to the task. The results of a longitudinal study conducted in a hospital setting are presented and we suggest the direction that future research might take.

Issues in predicting and explaining usage behaviors with the technology acceptance model and the theory of planned behavior when usage is mandatory

Ongoing care for chronic conditions such as diabetes is best provided by a range of health professionals working together. There are challenges in achieving this where collaboration crosses organisational and sector boundaries. The aim of this article is to explore the influence of power dynamics and trust on collaboration between health professionals involved in the management of diabetes and their impact on patient experiences. A qualitative case study conducted in a rural city in Australia. Forty five health service providers from nineteen organisations (including fee-for-service practices and block funded public sector services) and eight patients from two services were purposively recruited. Data was collected through semi-structured interviews that were audio-taped and transcribed. A thematic analysis approach was used using a two-level coding scheme and cross-case comparisons. Three themes emerged in relation to power dynamics between health professionals: their use of power to protect their autonomy, power dynamics between private and public sector providers, and reducing their dependency on other health professionals to maintain their power. Despite the intention of government policies to support more shared decision-making, there is little evidence that this is happening. The major trust themes related to role perceptions, demonstrated competence, and the importance of good communication for the development of trust over time. The interaction between trust and role perceptions went beyond understanding each other's roles and professional identity. The level of trust related to the acceptance of each other's roles. The delivery of primary and community-based health services that crosses organisational boundaries adds a layer of complexity to interprofessional relationships. The roles of and role boundaries between and within professional groups and services are changing. The uncertainty and vulnerability associated with these changes has affected the level of trust and mistrust. Collaboration across organisational boundaries remains challenging. Power dynamics and trust affect the strategic choices made by each health professional about whether to collaborate, with whom, and to what level. These decisions directly influenced patient experiences. Unlike the difficulties in shifting the balance of power in interprofessional relationships, trust and respect can be fostered through a mix of interventions aimed at building personal relationships and establishing agreed rules that govern collaborative care and that are perceived as fair.

/pdf/the-influence-of-power-dynamics-and-trust-on-4y3fquqthz.pdf

Rohan Jayasuriya

Papers

Communication loads on clinical staff in the emergency department.

Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia

Nursing handovers: do we really need them?

Issues in predicting and explaining usage behaviors with the technology acceptance model and the theory of planned behavior when usage is mandatory

The influence of power dynamics and trust on multidisciplinary collaboration: a qualitative case study of type 2 diabetes mellitus