Clinical implementation of the electronic Holistic Needs Assessment: a qualitative exploration of organisational factors and nursing culture

Abstract

Background:

Variations of electronic Holistic Needs Assessments (eHNAs) are well-established in cancer care worldwide, traditionally delivered by nurses. Although nursing teams are ideally placed to provide eHNAs, organisational dynamics and culture can affect their value to patients.

Aims:

This paper focuses on understanding healthcare professionals’ perceptions of eHNAs in breast cancer care, including barriers and enablers to implementation.

Methods:

Qualitative case studies were undertaken in two healthcare organisations in England, involving 24 healthcare professionals. Data collected included semi-structured interviews, observations, and documentary analysis of care plans. Data were analysed using principles of Framework Analysis.

Results:

Two main categories affected implementation of eHNAs: Leadership and Motivations (sub-categories: First Impressions, Prioritising Targets, Infrastructure and Accountability) and Service-Level Integration and Culture (sub-categories: Developing Processes, Resistance to Change and Business-as-usual). Findings highlighted challenges in adopting eHNAs and a lack of infrastructure to facilitate implementation.

Conclusion:

Methods of integrating eHNAs should focus on effective service integration, staff engagement and resource allocation. If eHNAs are implemented without resource and infrastructure, or misalignment to the service, this may negatively impact nursing team dynamics or the assessments’ value to patients. Processes to successfully embed this may require more creative methods that provide a greater prioritisation of eHNAs as an essential part of nursing care.