title: The role of ICT in supporting disruptive innovation: a multi-site qualitative study of nurse practitioners in emergency departments.
abstract: BACKGROUND
  The disruptive potential of the Nurse Practitioner (NP) is evident in their ability to offer services traditionally provided by primary care practitioners and their provision of a health promotion model of care in response to changing health trends. No study has qualitatively investigated the role of the Emergency NP in Australia, nor the impact of Information and Communication Technology (ICT) on this disruptive workforce innovation. This study aimed to investigate ways in which Nurse Practitioners (NP) have incorporated the use of ICT as a mechanism to support their new clinical role within Emergency Departments.
  
  
  METHODS
  A cross-sectional qualitative study was undertaken in the Emergency Departments (EDs) of two large Australian metropolitan public teaching hospitals. Semi-structured, in-depth interviews were conducted with five nurse practitioners, four senior physicians and five senior nurses. Transcribed interviews were analysed using a grounded theory approach to develop themes in relation to the conceptualisation of the ED nurse practitioner role and the influences of ICT upon the role. Member checking of results was achieved by revisiting the sites to clarify findings with participants and further explore emergent themes.
  
  
  RESULTS
  The role of the ENP was distinguished from those of Emergency nurses and physicians by two elements: advanced practice and holistic care, respectively. ICT supported the advanced practice dimension of the NP role in two ways: availability and completeness of electronic patient information enhanced timeliness and quality of diagnostic and therapeutic decision-making, expediting patient access to appropriate care. The ubiquity of patient data sourced from a central database supported and improved quality of communication between health professionals within and across sites, with wider diffusion of the Electronic Medical Record holding the potential to further facilitate team-based, holistic care.
  
  
  CONCLUSIONS
  ICT is a facilitator through which the disruptive impact of NPs can be extended. However, integration of ICT into work practices without detracting from provider-patient interaction is crucial to ensure utilisation of such interventions and realisation of potential benefits.
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, NSW 2052, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Li
authors.forename: Johanna
authors.initials: J
authors.lastname: Westbrook
authors.forename: Joanne
authors.initials: J
authors.lastname: Callen
authors.forename: Andrew
authors.initials: A
authors.lastname: Georgiou
mesh_terms: D001291:Attitude of Health Personnel; D001315:Australia; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated; D004059:Diffusion of Innovation; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D006302:Health Services Research; D006694:Holistic Health; D006801:Humans; D007407:Interviews as Topic; D008490:Medical Informatics; D009718:Nurse Administrators / Q000523:psychology / Q000706:statistics & numerical data; D009722:Nurse Practitioners / Q000523:psychology* / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care / Q000592:standards; D008486:Physician Executives / Q000523:psychology / Q000706:statistics & numerical data; D036301:Qualitative Research; D058996:Quality Improvement; D017751:Safety Management / Q000592:standards; D011795:Surveys and Questionnaires; D000078329:Workforce