📖 ABSTRACT/OVERVIEW
Background: Electronic health record adoption is reshaping clinical nursing practice globally. The implementation experience and practice transformation dynamics in Nigerian teaching hospitals remain theoretically underexplored and require systematic investigation. Aim: This study examined nursing practice transformation following electronic health record introduction at three teaching hospitals in South West, North Central, and South South Nigeria. Methods: A multiple case study design used document analysis, semi-structured interviews with 42 nurses and eight clinical informaticists, and non-participant observation over 12 months per site. Cross-case synthesis guided pattern identification, with technology-practice theory employed as an interpretive lens. Results: Three transformation trajectories were identified: reproductive transformation, where nurses replicated paper-based practices digitally; additive transformation, where records enhanced care coordination; and disruptive transformation, where nurses fundamentally restructured care assessment processes. Trajectory was shaped by electronic health record design quality, training investment, and nursing leadership engagement. Conclusion: Electronic health record-driven nursing transformation is not automatic. Contextually responsive EHR design, sustained nursing informatics training, and nursing leadership in implementation are prerequisites for meaningful practice improvement in Nigerian tertiary hospitals. Keywords: electronic health records, nursing practice, digital transformation, case study, Nigeria.
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