A qualitative study of computer-mediated nursing care plans from the perspective of the staff nurse

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)




R. J. Chesser


Nursing, Nursing care, Computer science, Qualitative research

Subject Categories

Organizational Behavior and Theory


For the past twenty years, nurses have been expected to write nursing care plans for individual patients; such plans are expected to promote individualization of care, setting of priorities, and continuity of care. Now, in many health care organizations, this planning process is computer-mediated (selecting items from screens), and other forms of complex computer-mediated work are entering the nurse's workspace.

The research question that guided this study is: what meanings are ascribed by staff nurses to the development and use of computer-mediated nursing care plans, and what behaviors are associated with these meanings? The theoretical orientation of the study is symbolic interaction; the staff nurse actively constructs, over time, meanings related to the computer, the care plan, and the computer-mediated care plan, and acts on the basis of these meanings.

A qualitative research methodology was used, relying mainly on interviews with nurses in one hospital where computers are used in developing these plans. Data analysis followed Glazer and Strauss's (1967) grounded theory.

When the stories told by fifteen staff nurses were analyzed, meaning emerged as metaphor, as the basic human needs of food, clothing, and shelter. The food metaphors, for example, are fast food, empty calories, and oil and vinegar. A picture of felt discomfort emerges; this is understandable when basic needs have not been fully satisfied. The type of strain described by the nurses is similar to role strain. Associated, or contributory, variables also appear.

The behaviors that emerge as linked to meaning are conceptualized as the Contented Leaner, Neutral Complier, Matter-of-Fact Tool User, Frustrated Compromiser, and Motivated Coopter. Most nurses used a mix of all or most of these behaviors, although, for a few, one behavior was dominant.

The ideas revealed here have relevance for the way nursing practice is structured within the institution, as well as for research in role theory, and in all workplaces where computers are used not only for information management but to assist with or substitute for intellectual activities such as patient care planning. Also, the need for organizational assessment of the assumptions upon which work activities are based is highlighted.


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