Understanding nurses’ perceptions of barriers and enablers to use of a new electronic medical record system in Australia: A qualitative study

Electronic medical record system implementations impact nurses, their work and workflows. The aim of this study was to understand nurses’ perceptions of barriers and enablers to using a new electronic medical record in an acute hospital environment. Data were collected just prior to an organisation-wide new electronic medical record implementation at a large tertiary healthcare organization in Victoria, Australia. Sixty-three nurses from five hospital sites participated in 12 focus group interviews. Transcripts were transcribed and deductive content analysis used the 14-domain Theoretical Domains Framework to identify barriers and enablers. Coded data mapped to 13 of the 14 domains. Nurse motivation emerged as a dominant theme among both barriers and enablers. Nurses’ most common perceived barriers related to emotions (24.1%) and environmental context and resources (21.3%). Conversely, the most common enablers related to social influences (21%) and reinforcement (20.8%). In addition to effecting changes in their work and workflows, the dominance of nurses’ emotional responses reveals the potential for implementation of a new electronic medical record to negatively affect nurses’ psychological well-being. Using data aligned to the Theoretical Domains Framework assisted identification of behavior change strategies to target the barriers and enablers perceived by nurses. Strategies aligned with nine behavioral intervention categories are recommended for successful implementation and optimization of an electronic medical record by nurses. Multifaceted strategies targeting multiple behaviors are required to support adoption of the electronic medical record by nurses, and reduce the risk for nurse attrition in the workforce.