Competencies for nursing in a digital world. Methodology, results, and use of the DACH-recommendations for nursing informatics core competency areas in Austria, Germany, and Switzerland

Finnish experts' perceptions of digital healthcare forms in 2035 and the anticipated healthcare workforce impacts: a Delphi study

PURPOSE

To explore Finnish experts' perceptions of the forms of digital healthcare that are anticipated to be the most utilised in healthcare in the medium-term future (year 2035) and anticipated healthcare workforce impacts those forms will have.

DESIGN/METHODOLOGY/APPROACH

A total of 17 experts representing relevant interest groups participated in a biphasic online Delphi study. The results for each round were analysed using descriptive statistical methods and inductive content analysis.

FINDINGS

The forms of digital healthcare that the experts perceived as most likely to be utilised were those enabling patient participation, efficient organisation of services and automated data collection and analysis. The main impacts on the healthcare workforce were seen as being the redirection of workforce needs within the healthcare sector and need for new skills and new professions. The decrease in the need for a healthcare workforce was seen as less likely. The impacts were perceived as being constructed through three means: impacts within healthcare organisations, impacts on healthcare professions and impacts via patients.

RESEARCH LIMITATIONS/IMPLICATIONS

The results are not necessarily transferable to other contexts because the experts anticipated local futures. Patients' views were also excluded from the study.

ORIGINALITY/VALUE

Healthcare organisations function in complex systems where drivers, such as regional demographics, legislation and financial constraints, dictate how digital healthcare is utilised. Anticipating the workforce effects of digital healthcare utilisation has received limited attention; the study adds to this discussion.

[Digital Healthcare: Requirements for a Successful Transformation]

Digital transformation of healthcare is the dominating discussion topic for all healthcare stakeholders. Digital transformation encompasses all areas of healthcare and is far more than digital healthcare applications (DiGA), digital care applications (DiPA), telemedicine applications, telematics infrastructure activities, and applications from the fields of eHealth, mHealth, or Telehealth. All existing care processes and structures in the healthcare system are undergoing an inventory in order to transfer analog components of care into a digital context. The digital transformation is not taking place exclusively in economic sectors such as healthcare, but is a process of change throughout society in the collection, use, provision, linking and evaluation of information (=data). For the healthcare sector, it is clear that different technical concepts are used, while digital healthcare takes place in different places and at different times, may include different user (groups) and retains, expands or changes the healthcare context. Established healthcare functions such as diagnostics, therapy, documentation and the management of healthcare services are retained and transferred to a digital context. In addition, new application areas will emerge, such as the overarching access to health data by different actors, real-time-driven monitoring systems of holistic health data, (clinical) decision systems, or the provision of data for health services. Even if the majority of the digital transformation has not yet taken place, it is assumed that these functions and application areas of healthcare will serve to sustainably improve the quality of care and benefit the well-being of all (future) patients. For the transfer of existing processes into a digital context and the establishment of new application areas, there are prerequisites for healthcare institutions and the healthcare system itself.

Content Validation of a Questionnaire to Measure Digital Competence of Nurses in Clinical Practice

Clinical practice nurses need adequate digital competence to use technologies appropriately at work. Questionnaires measuring clinical practice nurses' digital competence lack content validity because attitude is not included as a measure of digital competence. The aim of the current study was to identify items for an item pool of a questionnaire to measure clinical practice nurses' digital competence and to evaluate the content validity. A normative Delphi study was conducted, and the content validity index on item and scale levels was calculated. In each round, 21 to 24 panelists (medical informatics specialists, nurse informatics specialists, digital managers, and researchers) were asked to rate the items on a 4-point Likert scale ranging from "not relevant" to "very relevant." Within three rounds, the panelists reached high consensus and rated 26 items of the initial 37 items as relevant. The average content validity index of 0.95 (SD, 0.07) demonstrates that the item pool showed high content validity. The final item pool included items to measure knowledge, skills, and attitude. The items included represent the international recommendations of core competences for clinical nursing. Future research should conduct psychometric testing for construct validity and internal consistency of the generated item pool.

[Digital transformation of German healthcare organizations : Current status and existing challenges from the perspective of quality management]

INTRODUCTION

Digital transformation includes, among other things, the project planning and implementation of digital applications, technologies, and measures and currently represents the day-to-day business of all organizations and institutions in the healthcare sector. In this article, the current activities of digital transformation in healthcare facilities from the perspective of quality management are presented.

METHODS

A Germany-wide survey among 141 members of the Society for Quality Management in Healthcare (physicians in private practice, hospitals, health insurers, and other healthcare institutions) was conducted on all fields of digital technologies, existing projects, and digital technologies that are currently being implemented. Based on six thematic modules, the participants evaluated the chronological sequence and the relevance of the content for their organization.

RESULTS

Of the survey participants, 82% stated that digital transformation influences or changes their everyday workplace. The most frequent projects include topics from process and interface management (53%) and improving patient safety (52%). The most frequent concrete projects are electronic patient files and topics that were commissioned as part of the Krankenhauszukunftsgesetz.

DISCUSSION

According to the respondents, digital transformation is changing the structures and processes of healthcare facilities and requires additional competencies so that digital technologies can be implemented in a targeted and sustainable manner. A structured coordination of the competencies of all professions in a healthcare facility is required to anchor digital technologies in the everyday life of healthcare facilities.

[Establishing health-promoting structures in professional long-term care through digitization: call for a perspective change]

Digitization is becoming increasingly important in health promotion and disease prevention. At the same time, the Prevention Act has contributed to the strengthening of health promotion and disease prevention interventions in various settings. In a lifeworld- or setting-oriented approach, disease prevention and health promotion target both the behavior and the situation around individuals. Although the use of digital occupational health management has increased in working environments in recent years, the potential of digitization is still insufficiently exploited. This is particularly true for health promotion and disease prevention among nursing professionals.Therefore, this discussion paper focuses on health promotion and disease prevention in inpatient long-term care facilities. Since the structured implementation of digital applications in care facilities represents an innovation within the organization, this momentum could be used to simultaneously design structures and processes in a way that promotes health. In this context, health promotion through digitization is understood as an organizational task with a needs-sensitive and diversity-oriented focus. Digitization can thus be a vehicle for substantially advancing the establishment of health-promoting facilities in long-term care.

Bibliometric analysis of core competencies associated nursing management publications

AIMS

This study aimed to identify high-impact papers on global nursing to determine and analyze the publication of articles on core competencies in nursing-related journals and the research trends in the era of globalization.

BACKGROUND

Bibliometrics has been shown to be an effective method for analyzing publications. Through bibliometrics, nursing managers and researchers can understand the trends of high-impact international nursing core competencies research, identify mainstream research directions, and obtain relevant knowledge and information, thereby facilitating the translation of research outcomes into nursing management practice.

EVALUATION

The study adopted bibliometric analysis and the VOSviewer software to explore dynamic publication trends and analyze the current situation of nursing research from a comprehensive development perspective, which was realized by searching for nursing core competencies papers in the Web of Science (WoS) database, calculating citations, and determining the trends of the most influential papers.

RESULTS

Nursing core competencies research grew rapidly between 1997 and 2022. Countries with the most core competencies publications were the United States, England, Australia, and Canada. The Journal of Nursing Management has attracted substantial attention from researchers worldwide. Education, Management, and Nurses were the most frequently used keywords in the study. A total of 534 papers were retrieved from the WoS database with the main research fields, including nursing, business economics, public environmental occupational health, and health care science services.

CONCLUSION

Equipping nursing graduates with core competencies has always been an important goal of global medical and nursing education. This study analyzed papers across 35 years, most of which were published in the Journal of Nursing Management. In addition, the study identified some of the main research topics of nursing management, such as the integration of education with nursing management and the cultivation of nurses' core competencies. The study also provides a fresh review of highly cited articles. The results of the study show that high-quality articles play the role of improving both the quality and the quantity of related research. By analyzing the trends of the research on core competencies, this study lays a bibliometric foundation for researchers regarding international journals, hot topics, and relevant fields. In addition, the highly cited articles reveal new perspectives for the nursing field, providing inspiration for nursing management and education researchers.

IMPLICATIONS FOR NURSING MANAGEMENT

This study provides scholars and managers with an overview of the current situation of nursing management research and the development of benchmark journals. The study provides researchers not only with a better understanding of various international journals, allowing them to transition out of traditional thinking in the era of science and technology, but also with innovative thinking by combining research with nursing management. The results of this study invite nursing managers to study relevant topics of core competencies and integrate information technology to education, management, and nurses, thereby contributing to nursing management and educational research.

Competencies and needs of nurse educators and clinical mentors for teaching in the digital age – a multi-institutional, cross-sectional study

Background

The impact of technology and digitalization on health care systems will transform the nursing profession worldwide. Nurses need digital competencies to integrate new technology in their professional activities. Nurse educators play a crucial role in promoting the acquisition of digital competences and therefore need to be digitally competent themselves. Research on digital competencies of nursing educators is scarce but suggests lack of digital knowledge and skills and support needs. Although digitalization is to be seen as a global process, regional contexts need to be taken into account, such as pre-existing competencies, local conditions, and individual needs. Thus, it remains unclear which competencies nurse educators possess and which support needs they have.

Aim of this study was to assess nurse educators’ and clinical mentors’ digital competencies and explore their needs and requirements concerning the digital aspects of their pedagogy and teaching activities in Germany.

Methods

A descriptive exploratory study with a cross-sectional design was conducted. Participants were identified using a convenience sampling approach. Data were collected during July and September 2020 using a standardized self-reported questionnaire that was developed specifically for this study. The questionnaire was provided in a paper and online format and participants could decide which format to use. It contained open- and closed-ended questions. Data were analyzed using descriptive and content analysis. Additionally, explorative subgroup analyses based on job designation, age, and gender were performed. Reporting of this study adhered to the STROBE checklist.

Results

A total of 169 educating nurses participated in the survey. The respondents considered themselves as digitally competent and showed a positive attitude towards the integration of digital technology in their teaching activities. Their perceived preparedness to integrate digital technology into teaching and training varied. Almost all respondents (98%) declared a need for further training and seemed motivated to participate in corresponding educational events. There were some indications for differences in competencies or needs between subgroups.

Conclusions

Educating nurses appear to possess basic digital competencies but there is a need to support their professional development in terms of new technologies. Findings can be used as a basis for developing supportive interventions. Further qualitative investigations could inform the design and content of such interventions.

Impact of Nursing Professionalism on Perception of Patient Privacy Protection in Nursing Students: Mediating Effect of Nursing Informatics Competency

In recent times, as the healthcare system becomes more informational, the importance of patient privacy protection increases, making it necessary to identify factors that affect the perception of patient privacy protection. This study aimed to evaluate the relationship between nursing professionalism and the perception of patient privacy protection and the mediating role of nursing informatics competency. The study recruited 242 nursing students who had experienced dealing with patient information during clinical practice. The mediating model using the Hayes’ PROCESS macro (Model 4) was employed to test the study hypothesis. Nursing professionalism was found to be positively and significantly associated with the perception of patient privacy protection (β = 0.09, p = 0.021) with the mediation of nursing informatics (β = 0.18, p < 0.001). Our findings showed that nursing professionalism and nursing informatics competency determined the perception of patient privacy protection. The mediating role of nursing informatics competency implies that curricula designed to enhance nursing informatics competency of nursing students may increase their perception of patient privacy protection.

Technostress Among Health Professionals - A Multilevel Model and Group Comparisons between Settings and Professions

OBJECTIVE

Health organizations increasingly digitize. However, studies reveal contradictory findings regarding the impact of healthcare information technology on health professionals. Therefore, the aim of this study is to describe the prevalence of technostress among health professionals and elaborate on the influencing factors.

PARTICIPANTS

A secondary analysis was conducted utilizing cross-sectional data from the study, "Work-related stress among health professionals in Switzerland", which included 8,112 health professionals from 163 health organizations in Switzerland.

METHODS

ANOVA for group comparisons followed by post-hoc analyses, along with a Multilevel Model to identify influencing factors for technostress ranging from "0" (never/almost never) to "100" (always), were conducted.

RESULTS

Health professionals experienced moderate technostress (mean 39.06, SD 32.54). Technostress differed between settings (p <.001) and health professions (p < .001). The model explains 18.1% of the variance with fixed effects, or 24.7% of the variance with fixed and random effects. Being a physician (β = 12.96), a nurse (β = 6.49), or the presence of an effort-reward-imbalance, increased technostress most (β = 6.11). A professional with no professional qualification (β = -7.94) showed the most reduction.

CONCLUSION

Health professionals experience moderate technostress. However, decision-makers should consider the cognitive and social aspects surrounding digitalization, to reach a beneficial and sustainable level of usage.

Approaches for defining and assessing nursing informatics competencies: a scoping review

OBJECTIVE

The objective of this scoping review was to examine and map the literature on defining and assessing nursing informatics competencies for nurses and nursing students.

INTRODUCTION

Over the past three decades, nursing informatics competency research has evolved markedly within countries and nursing roles. It is important to examine the available literature on defining and assessing nursing informatics competencies to inform education, clinical practice, policy, and future research.

INCLUSION CRITERIA

We considered literature that defined or assessed the concept of nursing informatics competency as a combination of knowledge, skills, and attitudes. This included nursing informatics competencies of nurses and nursing students in a variety of health care or academic settings.

METHODS

An extensive search was conducted in Ovid MEDLINE, CINAHL Plus with Full Text via EBSCO, Ovid Embase, Ovid PsycINFO, ProQuest ERIC, Health and Psychosocial Instruments, ProQuest Australian Education Index, ProQuest Education Databases, ProQuest Dissertations and Theses Global, OCLC PapersFirst, Scopus, Web of Science Core Collection, Wiley Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and the JBI Database of Systematic Reviews and Implementation Reports. The initial search was conducted in May 2017 and updated several times. Nursing informatics websites were searched for gray literature, including unpublished research and organizational documents. Additional papers were identified based on a search of reference lists of all the included papers. Neither language nor date restrictions were applied. Two reviewers assessed each of the included papers independently. Data extraction was undertaken using an extraction tool developed specifically for the scoping review objectives.

RESULTS

Fifty-two papers were included. Thirty-four papers identified nursing informatics competencies, grouped into four categories: i) nursing informatics competencies for students, entry-level nurses, or generalist nurses; ii) nursing informatics competencies for a specific nursing role; iii) recommendations for consensus on defining core nursing informatics competencies at the international level; and iv) forecasting future nursing informatics competencies as per evolving nursing roles. Eighteen papers reported on nursing informatics competency assessment tools. Results were discussed in a narrative format supported by tables.

CONCLUSIONS

This review provided insights to the state of the science on defining and assessing nursing informatics competencies for nurses and nursing students. Several nursing informatics competency lists are available, and despite some variations in domains of nursing informatics competency and indicator statements, they mostly share common themes. This literature demonstrates a heightened awareness of the importance of nursing informatics competency; however, the availability of many lists may be challenging for frontline nursing staff, nursing educators, administrators, researchers, and students to assimilate. Further research is needed to reach a consensus on core domains of nursing informatics competency and associated indicators, preferably per nursing roles, with international involvement and consensus. Additionally, while many nursing informatics competency assessment tools exist, further research is needed to examine psychometric properties of some of these tools.

A Digitally Competent Health Workforce: Scoping Review of Educational Frameworks

Background

Digital health technologies can be key to improving health outcomes, provided health care workers are adequately trained to use these technologies. There have been efforts to identify digital competencies for different health care worker groups; however, an overview of these efforts has yet to be consolidated and analyzed.

Objective

The review aims to identify and study existing digital health competency frameworks for health care workers and provide recommendations for future digital health training initiatives and framework development.

Methods

A literature search was performed to collate digital health competency frameworks published from 2000. A total of 6 databases including gray literature sources such as OpenGrey, ResearchGate, Google Scholar, Google, and websites of relevant associations were searched in November 2019. Screening and data extraction were performed in parallel by the reviewers. The included evidence is narratively described in terms of characteristics, evolution, and structural composition of frameworks. A thematic analysis was also performed to identify common themes across the included frameworks.

Results

In total, 30 frameworks were included in this review, a majority of which aimed at nurses, originated from high-income countries, were published since 2016, and were developed via literature reviews, followed by expert consultations. The thematic analysis uncovered 28 digital health competency domains across the included frameworks. The most prevalent domains pertained to basic information technology literacy, health information management, digital communication, ethical, legal, or regulatory requirements, and data privacy and security. The Health Information Technology Competencies framework was found to be the most comprehensive framework, as it presented 21 out of the 28 identified domains, had the highest number of competencies, and targeted a wide variety of health care workers.

Conclusions

Digital health training initiatives should focus on competencies relevant to a particular health care worker group, role, level of seniority, and setting. The findings from this review can inform and guide digital health training initiatives. The most prevalent competency domains identified represent essential interprofessional competencies to be incorporated into health care workers’ training. Digital health frameworks should be regularly updated with novel digital health technologies, be applicable to low- and middle-income countries, and include overlooked health care worker groups such as allied health professionals.

Digital health competencies for primary healthcare professionals: A scoping review

BACKGROUND

Despite digital health providing opportunities to enhance the quality, efficiency and safety of primary healthcare, the adoption of digital tools and technologies has been slow, partly because of poor digital health literacy. For primary healthcare systems to take full advantage of these technologies, a capable, digitally literate workforce is necessary. Still, the essential digital health competencies (DHCs) for primary healthcare have not been explored. This review aims to examine the broad literature on DHCs as it applies to Primary Care (PC) settings.

METHODS

We performed a scoping review on all types of research linking DHCs to PC. We searched all major databases including Medline, Embase, CINAHL, and Cochrane Library in November 2019. Concurrently, a thorough grey literature search was performed through OpenGrey, ResearchGate, Google Scholar, and key government and relevant professional associations' websites. Screening and selection of studies was performed in pairs, and data was analysed and presented using a narrative, descriptive approach. Thematic analysis was performed to identify key DHC domains.

RESULTS

A total of 28 articles were included, most of them (54 %) published before 2005. These articles were primarily aimed at PC physicians or general practitioners, and focused on improving knowledge about information technologies and medical informatics, basic computer and information literacy, and optimal use of electronic medical records. We identified 17 DHC domains, and important knowledge gaps related to digital health education and curriculum integration, the need for evidence of the impact of services, and the importance of wider support for digital health.

CONCLUSIONS

Literature explicitly linking DHCs to PC was mostly published over a decade ago. There is a need for an updated and current set of DHCs for PC professionals to more consistently reap the benefits of digital technologies. This review identified key DHC domains and statements that may be used to guide on the development of a set of DHC for PC, and critical knowledge gaps and needs to be considered. Such a DHC set may be used for curricula development and for ensuring that the essential DHC for PC are met at a clinical or organizational level, and eventually improve health outcomes.

Clinical Information Systems - Seen through the Ethics Lens

OBJECTIVE

The more people there are who use clinical information systems (CIS) beyond their traditional intramural confines, the more promising the benefits are, and the more daunting the risks will be. This review thus explores the areas of ethical debates prompted by CIS conceptualized as smart systems reaching out to patients and citizens. Furthermore, it investigates the ethical competencies and education needed to use these systems appropriately.

METHODS

A literature review covering ethics topics in combination with clinical and health information systems, clinical decision support, health information exchange, and various mobile devices and media was performed searching the MEDLINE database for articles from 2016 to 2019 with a focus on 2018 and 2019. A second search combined these keywords with education.

RESULTS

By far, most of the discourses were dominated by privacy, confidentiality, and informed consent issues. Intertwined with confidentiality and clear boundaries, the provider-patient relationship has gained much attention. The opacity of algorithms and the lack of explicability of the results pose a further challenge. The necessity of sociotechnical ethics education was underpinned in many studies including advocating education for providers and patients alike. However, only a few publications expanded on ethical competencies. In the publications found, empirical research designs were employed to capture the stakeholders' attitudes, but not to evaluate specific implementations.

CONCLUSION

Despite the broad discourses, ethical values have not yet found their firm place in empirically rigorous health technology evaluation studies. Similarly, sociotechnical ethics competencies obviously need detailed specifications. These two gaps set the stage for further research at the junction of clinical information systems and ethics.

Education Into Policy: Embedding Health Informatics to Prepare Future Nurses-New Zealand Case Study

Background

Preparing emerging health professionals for practicing in an ever-changing health care environment along with continually evolving technology is an international concern. This is particularly pertinent for nursing because nurses make up the largest part of the health workforce.

Objective

This study aimed to explore how health informatics can be included in undergraduate health professional education.

Methods

A case study approach was used to consider health informatics within undergraduate nursing education in New Zealand. This has led to the development of nursing informatics guidelines for nurses entering practice.

Results

The process used to develop nursing informatics guidelines for entry to practice in New Zealand is described. The final guidelines are based on the literature and are refined using an advisory group and an iterative process.

Conclusions

Although this study describes the development of nursing informatics guidelines for nurses entering practice, the challenge is to move these guidelines from educational rhetoric to policy. It is only by ensuring that health informatics is embedded in the undergraduate education of all health professionals can we be assured that future health professionals are prepared to work effectively, efficiently, and safely with information and communication technologies as part of their practice.