Persistent Link:
http://hdl.handle.net/10150/194728
Title:
Sociotechnical Influences on Outcomes in Telehomecare
Author:
Shea, Kimberly Denise
Issue Date:
2007
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
Telehomecare utilizes electronic communication technologies to support care when distance separates home health nurses from their patients. Telehomecare nurses, or Care Coordinators, use text-based technology to monitor chronically ill patients. Successful home health care outcomes depend on social and technical interactions within diverse patient, caregiver and nurse triad groups. No theory or analysis method for evaluating telehomecare service delivery as a multi-level system exists. Therefore, it is not known which characteristics of interpersonal relationships influence outcomes. This research examined trust, interdependence, communication and technology integration influence on outcomes of satisfaction and self-care. The Sociotechnical Systems Theory and Social Relations Model served as guides to explore individual, relational and group effects on patient quality outcomes. The purpose of this research is to examine the relationships among patients', caregivers' and nurses' social and technical characteristics and quality outcomes in telehomecare.Three VHA sites in the western U.S. participated in this descriptive, multi-level, correlational study. Forty-three groups comprised of patient, nurse and caregiver provided survey data on social and technical characteristics. Additionally, patients provided data on outcomes. All scales performed well, except trust. Results show statistically significant bivariate correlations demonstrate associations between characteristics and outcomes at multi-levels: interdependence with satisfaction at individual and dyad levels; communication with satisfaction at all levels of analysis and simple self care at individual levels; technology integration with satisfaction at group levels as wells as simple and complex self care at individual levels. The principle of joint optimization states that service delivery systems function optimally only if the social and technical characteristics of the subsystem groups fit the demands of each other and the environment. A measure of joint optimization is computed for outcome predictability using multiple regressions. Joint optimization for three social and one technical characteristic was shown to have significant influences on the patient's perception of being well cared for.Many implications of this research for nursing practice in telehomecare are discussed. Telehomecare nurses can use the results of this study to guide optimal practice methods to provide quality outcomes for their patients. This study provides a basis for further best practice research in telehomecare.
Type:
text; Electronic Dissertation
Keywords:
Nursing Informatics
Degree Name:
PhD
Degree Level:
doctoral
Degree Program:
Nursing; Graduate College
Degree Grantor:
University of Arizona
Advisor:
Verran, Joyce A
Committee Chair:
Verran, Joyce A

Full metadata record

DC FieldValue Language
dc.language.isoENen_US
dc.titleSociotechnical Influences on Outcomes in Telehomecareen_US
dc.creatorShea, Kimberly Deniseen_US
dc.contributor.authorShea, Kimberly Deniseen_US
dc.date.issued2007en_US
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractTelehomecare utilizes electronic communication technologies to support care when distance separates home health nurses from their patients. Telehomecare nurses, or Care Coordinators, use text-based technology to monitor chronically ill patients. Successful home health care outcomes depend on social and technical interactions within diverse patient, caregiver and nurse triad groups. No theory or analysis method for evaluating telehomecare service delivery as a multi-level system exists. Therefore, it is not known which characteristics of interpersonal relationships influence outcomes. This research examined trust, interdependence, communication and technology integration influence on outcomes of satisfaction and self-care. The Sociotechnical Systems Theory and Social Relations Model served as guides to explore individual, relational and group effects on patient quality outcomes. The purpose of this research is to examine the relationships among patients', caregivers' and nurses' social and technical characteristics and quality outcomes in telehomecare.Three VHA sites in the western U.S. participated in this descriptive, multi-level, correlational study. Forty-three groups comprised of patient, nurse and caregiver provided survey data on social and technical characteristics. Additionally, patients provided data on outcomes. All scales performed well, except trust. Results show statistically significant bivariate correlations demonstrate associations between characteristics and outcomes at multi-levels: interdependence with satisfaction at individual and dyad levels; communication with satisfaction at all levels of analysis and simple self care at individual levels; technology integration with satisfaction at group levels as wells as simple and complex self care at individual levels. The principle of joint optimization states that service delivery systems function optimally only if the social and technical characteristics of the subsystem groups fit the demands of each other and the environment. A measure of joint optimization is computed for outcome predictability using multiple regressions. Joint optimization for three social and one technical characteristic was shown to have significant influences on the patient's perception of being well cared for.Many implications of this research for nursing practice in telehomecare are discussed. Telehomecare nurses can use the results of this study to guide optimal practice methods to provide quality outcomes for their patients. This study provides a basis for further best practice research in telehomecare.en_US
dc.typetexten_US
dc.typeElectronic Dissertationen_US
dc.subjectNursing Informaticsen_US
thesis.degree.namePhDen_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplineNursingen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.advisorVerran, Joyce Aen_US
dc.contributor.chairVerran, Joyce Aen_US
dc.contributor.committeememberEffken, Judith A.en_US
dc.contributor.committeememberMcEwen, Marylyn Morrisen_US
dc.identifier.proquest2341en_US
dc.identifier.oclc659748217en_US
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