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: An evaluation of the initial implementation, integration and impact of a Digital Nursing Care Record into clinical acute settings in Wales - a case study

Abstract

Background
The thesis details an evaluation of the initial implementation, integration and impact of a digital nursing care record (Welsh Nursing Care Record (WNCR)) in clinical acute settings in Wales. The Welsh Nursing Care Record (WNCR) is a digital system that can be used by health professionals to record, store and access patient information electronically. WNCR has been implemented by an all-Wales project focused on standardising and digitising clinical documents used by nursing staff across Wales.
Methods
A multiple (embedded) case study approach (Yin, 2014) using a mixed methods approach (Creswell & Plano Clark, 2017) has been utilised as this will allow a representation from various stakeholders, professionals and service users from differing and contrasting perspectives logistically and geographically. The intention is to develop an explanatory account derived from the case study approach which will seek to build on the existing evidence base. Secondary data has also been evaluated.
Findings
The evaluation resulted in the emergence of 12 themes which highlighted the complex nature of WNCR in terms of implementation, integration and impact across Wales. The themes identified focused on a wide range of interrelated factors that emerged from the initial ‘roll out’ of the WNCR programme. The themes highlighted process and attitudinal factors that characterised a dynamic adoption of WNCR within the case study areas, representing areas of strengths and weaknesses. The themes included the following: Time, IT Issues, Ease of Use, Standardisation, Preferences/Benefits, Change, Quality, Integration, Negatives/Challenges, Training, Equipment and Patient Feedback. Overall, the findings suggested there were factors that represented a series of mechanisms that were focused on ‘coalescence’ and ‘conflict’ in terms of how structural, processual and attitudinal factors supported or challenged both integration and impact. In this way, the findings highlighted the need to support factors that supported coalescence around WNCR and tackle areas of conflict.
Conclusion
The literature suggests that some challenges are expected during the implementation of a clinical digital application in healthcare settings. However, the thesis highlights the merit of considering these challenges in the context of ‘coalescing’ and ‘conflicting’ mechanisms which may help manage the implementation of such a complex digital programme in practice.

Date of Award	5 Aug 2025
Original language	English
Awarding Institution	Bangor University
Supervisor	Sion Williams (Supervisor)