This study comprised a purposive sample of 19 female DNs. The inclusion criteria were that the participants must be registered nurses with a DN graduate diploma, and must be working as a DN. The participants’ age ranged from 30 to 64 years (md = 47), and their work experience as DNs ranged from 1 to 23 years (md = 5). They worked at five primary healthcare centres in two municipalities in northern Sweden. Eleven participants worked in daytime shifts, while eight worked in the evenings.

The DNs were selected with the assistance from the heads of five primary healthcare centres. Information was given about the nature of the study, and participation was voluntary with the possibility of withdrawing at any time. Information letters were distributed to the heads, who informed the DNs, and the heads distributed the letters to the DNs. The DNs were assured of confidentiality and anonymous presentation of the results. The Regional Ethical Review Board in Umeå, Sweden (05-059M) approved the study.

Data were collected from May 2005 to March 2006 through focus group discussions to describe DNs’ attitudes regarding the implementation of ICT in home nursing for people with serious chronic illness living at home. According to Morgan [20] focus group discussions is a method that can explore new research areas and is well suited for obtaining research information from the participants’ perspective. Through the interaction of the group, data will arise according to the specific topic being discussed [21].In this study, four focus groups with four DNs and one group with three DNs were included.

During data collection, the first and third authors were represented as moderators. The first author’s role was to lead the discussion and create a non-threatening supportive environment that encourages all the participants to share their views, i.e., facilitating interactions among the participants and interjecting probing comments and transitional questions [20]. Before commencing the focus group discussions, the participants were instructed not to talk about the contents of the discussion to others outside the group. The first author started the focus group discussion with an introduction to the aim of the study and the different topics that should be discussed: the current and future use of ICT in home nursing; expectations, advantages, disadvantages and hindrances in the use of ICT in home nursing; and the use of ICT from an ethical perspective.

To stimulate the discussions among the participants, two examples of ICT applications were presented and explained.

The first example described a field case used in home visits that included different equipment, such as laptop with access to the computerised case-record system, digital camera, web camera, mobile phone, bladder scan, and electrocardiograph with the possibility to send test results to physicians. The second example defined an ICT application with text messages used for communications between people with serious chronic illness living at home and their DNs [22]. The discussions started with the question, “Tell me about your views on using different types of technology in your work as DN”. Two of the focus group discussions were carried out in the participants’ workplace, and three in a university department. Each focus group discussion lasted for about 90 min, and was audio taped and later transcribed verbatim.

The transcribed focus group discussions were analysed using a qualitative content analysis. The goal of this analysis method was to provide knowledge and understanding of the phenomena under study [23]. The interview texts were read several times to gain a sense of the content [24]. Bearing in mind the aim of the study, textual units were identified, condensed, and coded. The textual units with similar content were sorted into areas, and consequently, the areas were sorted into categories in several steps. During the whole process, the researchers occasionally went back to the original textual units and compared the results.

The DNs pointed out the significance of being a part of the development of new technology to influence the design. This was a prerequisite for using ICT in their work and they pointed out the importance of ICT being simple, user-friendly, and suitable. In their experience, some technical equipment were too advanced, unnecessary, or unsuitable for their use in nursing care. The DNs indicated that some technical equipment were designed by people who were unfamiliar with the DNs’ work, as was discussed in the following citation:

…it should be easy to use and less moment. (DN 17) Yes (DN 19) …I think that the one who work with it, should design it, now it has been the IT-personnel…it must be the personnel who work with it, who develop the technique... (DN 18).

The DNs described the importance of being a part of the introduction of ICT in nursing care. They asserted that instructions on how to use the technology and who would have access to the technology must be clear from the beginning, because they had earlier experienced how difficult it was not to have been a part of the introduction. They also pointed out that information and education were necessary, since from their experience they found that technologies often lacked instructions. They remembered when the case records were computerised a few years ago, and this experience gave them a negative perception of the new technology from the beginning. However, as they observed the benefits of the computerised case-record system, the DNs now had a better understanding of what these technologies demanded from them as users. One DN described:

…this must be solved first otherwise it’s no idea that we go there with an equipment …it’s no idea to take a test if I am not able to do something about it… (DN 9).

Based on the DNs’ experiences, learning, and using the technology was an individual task. They also pointed out that the use of technology in nursing care for the ill person must be voluntary. The DNs said that those who are ill should be a part of the introduction and that they, together with the DNs, should have time to practise using the technology. The following citation illustrates the dialogue between the DNs:

...important is that you really get the time you need [for practice], otherwise it could be wrong and you don’t have the strength to do the job you have to do. (DN 18) Yes, so be part of it. (DN 19).

From the DNs’ experience, new technology such as the computerised case records improved the nursing care. They mentioned that the computerised case records in the laptop enabled them to give and receive information independently, irrespective of where they are. They believed that it was a safer system. The DNs thought that ICT could improve their work. They referred to the ill person’s case record from a laptop in the person’s own home that made it possible to give information, prescriptions, or getting information when the ill person visited the primary healthcare centre.

By using ICT in communicating with the ill person at home, the DNs stated that the use of ICT could decrease stress because of decreased travelling time and home visits. The DNs also observed that the technology was time saving. They affirmed that ICT could improve accessibility and security for ill people staying at home, especially for those living in thinly populated areas or for those who refuse to visit hospitals or primary healthcare centres. Two DNs stated the following:

With that [the technology] you can give answers at once if they, for example, will know how the test I took a week ago. I can answer at once and don’t have to return to the primary health care centre and call back. (DN 9) ...this reduce the stress factor of going back and look into the case records and read the record and search for results...instead I can read the case record here in the patient’s home… (DN 10).

The DNs in another focus group also discussed the same topic:

I think it can be received safely if a patient, in an easy way, can be in contact with the DN at any time. (DN 4) …to use ICT is an alternative to drive far away to a patient and you will avoid risky drives in the dark and slipperiness… (DN 1).

On the other hand, the DNs pointed out that the use of ICT at home could bring difficulties and uncertainties. Some of these difficulties could be in retaining a holistic perspective on nursing care, and in obtaining important information from the ill person. The DNs also expressed an uncertainty about handling the equipment, which could be stressful. They also described the possibility that the use of ICT could be frightening, especially for older people. They mentioned that promoting the use of ICT in nursing care could take time, because of problems in the installation and management of the technology in the ill persons’ own home.

The DNs expressed anxiety about not being needed in the future, because information would be available online. They viewed the use of ICT rather as a complement to facilitate nursing care. Before using ICT for communicating, the DNs stressed that it is important to get to know the ill person first. They pointed out how important physical encounters are in building up a trusting relationship with the ill people staying at home. If the appropriate information given and the relationship with the ill person were satisfactory, the DNs considered that there would be no disadvantage in using ICT in their work. They indicated that the use of ICT would not be suitable for everybody, and home visits are valuable in terms of revealing so much more information about the ill person.

The DNs further expressed that the technical equipment could encroach in the ill person’s own home as well as on other family members. They discussed on how the autonomy of the ill person and the family would be threatened if anyone in the family did not want the equipment. The DNs pointed out the importance of being observant about how the technology was used, and in making sure that it did not hurt anybody. They discussed that in the future, the use of ICT in nursing care would increase, which would require changes in their work situation:

ICT can never replace the personal contact...someone can experience that nobody notice them. (DN 15). You cannot replace the human contact with the person, because it’s also another language that you have when you meet a person in real because sometimes you feel in the atmosphere that even if not the words say anything you can understand that here it’s not right. You must take it [ICT] as a complement I think that it cannot replace the human being. (DN 18)

The strength of this study was the use offocus group discussions to optimise the understanding of the complexities of the research questions. The discussions encouraged the DNs to express their points of view related to their experiences on the use of ICT. The moderator tried to avoid steering the discussion, and instead, allowed the DNs to discuss as freely as possible. To retain the focus of the discussion, an interview guide was used. The results showed that the focus group discussions ended up with agreement in almost all the questions discussed. To reach trustworthiness in the study, the findings were discussed with other researchers and colleagues.

The limitation of the study was mainly with the sampling issue. The number of available participants was limited and the number of focus groups was therefore few. The groups consisted only of DNs working in the same county council, which means that the sample is not representative of all DNs. However, the findings of this study cannot be generalised, as this is not the goal of qualitative research. Instead, the findings can be transferred to similar situations by modifying them to comply with the context [19].