The impact of inpatient medication administration technologies on nursing autonomy and practice: a meta-ethnographic synthesis of the qualitative literature.

Objective: To conduct a meta-ethnographic synthesis summarizing the overarching themes of the qualitative literature on nurse interaction with medication administration technologies (MAT) comprising electronic medication administration record (eMAR) and bar-coded medication administration (BCMA).

Methods: We searched scientific databases from their inception until September 23, 2024, resulting in 2270 unique articles, and extracted data from 27 articles. Scientific rigor was assessed by the Standards for Reporting Qualitative Research (SRQR) checklist. Noblit and Hare's methodology was used to conduct a meta-ethnography to identify and interpret emergent themes.

Results: SRQR revealed low-to-medium methodological quality and theoretical framing of the literature. We found 6 overarching themes connecting MAT with nursing work: (1) View of the MAT system as mechanistic and invariant vs living and co-evolving with its users drives the research approach; (2) MAT limits nurse autonomy; (3) MAT unnaturally splits the medication administration workflow; (4) Nurses must manage MAT challenges at the sharp end; (5) MAT does not align with social dependencies of nursing work; and (6) MAT increases perceived safety but can also result in new types of errors.

Conclusions: MAT does not support key cognitive work that nurses must perform to maintain safety. Additionally, MAT can impede problem solving during medication management and limit nursing autonomy that is essential for safe medication administration. Conclusions: Recommendations based in human factors engineering recognizing how MAT design impacts nursing work and workload are essential in improving the fit of MAT to nurse cognitive workflows.