Digitizing nursing: A theoretical and holistic exploration to understand the adoption and use of digital technologies by nurses

Perceived acceptance, intention to use and actual use behavior of digital information technologies among nursing professionals in Shanghai: a cross-sectional study

BACKGROUND

Digital information technologies (DITs) can contribute to optimizing the quality and efficiency of healthcare delivery. However, profiles of awareness and use behavior of DITs among Chinese nursing professionals remained limited. This study aimed to investigate the profiles of perceived acceptance, intention to use and use behavior of DITs and identify influencing factors among nursing professionals in hospitals in Shanghai.

METHODS

A total of 1421 nursing professionals from 20 hospitals across Shanghai were selected as participants between August and October 2021. After excluding missing values, 1395 participants were included in the analyses. Using the technology acceptance model, perceived acceptance of general DITs was measured as perceived ease of use (PEU) and perceived usefulness (PU). Intention to use and use behavior were measured using two single 5-point Likert scales. Linear and logistic regression models and mediation analyses were developed to examine influencing factors.

RESULTS

All of the PU and PEU items received affirmative responses (agree or strongly agree) among over 50% of participants. Of all participants, 1101 (78.9%) expressed intention to use DITs; 626 (44.9%) were frequent users. Age, bachelor's degree, in-house training on DITs, school-based training, and out-of-hospital training were associated with perceived acceptance. Licensed practical nurse, deputy chief nurse, working years, in-house training, and school-based training were significant predictors of intention to use. Vocational college diploma, bachelor's degree, in-house training, school-based training, out-of-hospital training, tertiary level 1 and tertiary level 2 hospitals, and specialized hospitals were associated with frequent use. Intention to use mediated 42.6% (95%CI: 10.3% ~ 60.4%) of the total effects of perceived acceptance on frequent use of DITs.

CONCLUSIONS

This study suggests that although nursing professionals in Shanghai have positive perceived acceptance and strong intention to use DITs, they rarely use DITs in their practice. Therefore, policies and interventions should be developed to enhance the integration of DITs into nursing professionals' daily practice.

Multi Perspective Considerations for Health Smart Home: Early Phase Exploratory Study

AIMS

This study engaged key stakeholders-older adults, family caregivers, home care support workers, nurses, and home healthcare leaders-to explore perspectives on essential components and integration into home care models, and to explore the role of their technology readiness for health smart homes adoption.

DESIGN

A qualitative methodology with a quantitative component, early-phase exploratory design.

METHODS

Semi-structured interviews underwent qualitative thematic analysis, with cross-case analysis comparing stakeholder perspectives to identify convergences and divergences. Descriptive statistics were used to analyse Technology Readiness Index (TRI 2.0) survey data to provide background and context to the qualitative findings.

RESULTS

Among 18 participants-older adults (n = 6), family caregivers (n = 2), nurses (n = 7), and support workers/healthcare leaders (n = 3)-findings reflected optimism for health smart home adoption and its potential to support ageing in place. Nurses and care workers saw health smart home as a tool for improving care coordination and quality of life. Key adoption considerations included education, data visualisation, privacy, and security. Technology readiness scores were moderate, with nurses scoring highest (3.52), followed by caregivers (3.41), support workers (3.13), and older adults (3.10).

CONCLUSION

While stakeholders were open to integrating health smart home into home care, concerns around usability, security, and training must be addressed to facilitate adoption.

IMPLICATIONS FOR THE PROFESSION

Findings suggest that while health smart home technology holds promise for enhancing ageing in place, varying levels of technology readiness across stakeholders highlight the need for tailored education and support strategies to ensure successful implementation.

PROBLEM ADDRESSED

Despite a strong preference for ageing in place among older adults, integrating health smart home technologies into home care remains challenging. Key issues include ensuring intuitive functionality, protecting privacy, and clarifying the roles of caregivers and healthcare professionals in a technology-enhanced care model. This study addresses the critical gap in understanding how health smart home solutions can be effectively tailored to support the diverse needs of older adults, family caregivers, and home care nurses and support workers.

MAIN FINDINGS

Stakeholders were generally optimistic about health smart home technologies supporting ageing in place and improving quality of life. Nurses and support workers highlighted the need for tailored data visualisations, alert parameters, and clear role guidelines. A novel finding was that older adults and family caregivers viewed health smart home as a way to reduce intrusive monitoring, promote independence, and maintain a familiar living environment. Family caregivers valued the ability to stay involved remotely through activity data, offering reassurance and peace of mind. Across all groups, privacy safeguards were seen as essential, with strong concerns about data security, transparent usage policies, and user control over data sharing.

IMPACT

Findings have implications for community-dwelling older adults, family caregivers, home care professionals, researchers, and technology developers. Insights from this study can inform the design of user-friendly health smart home technologies, shape future research, and guide tailored implementation strategies in home care settings.

PATIENT OR PUBLIC CONTRIBUTION

An advisory group of community-dwelling older adults in Western Australia provided input on study design and methodology. Their recommendations led to the use of one-on-one interviews to ensure accessibility and relevance for older adults when exploring technology readiness and smart home integration. While the advisory group did not contribute to the data itself or its analysis, their feedback shaped the method of engagement to ensure its relevance and accessibility to potential participants.

Beyond Competency: Developing Critical Digital Capabilities in Nursing Students Through Freirean Pedagogy

The digitalisation of healthcare is transforming nursing practice, presenting unique opportunities and challenges that demand more than technical competence from nursing professionals. Despite the growing integration of digital tools, nursing remains in the 'foothills of digital transformation', with significant gaps in the critical and theoretical frameworks required to navigate this shift effectively. This article explores how Paulo Freire's critical pedagogy may address these gaps by fostering critical digital skills in nursing students. Drawing on Freire's concepts of problem-posing education, conscientization, dialogue and praxis, the article proposes a pedagogical model that encourages students to critically examine the socio-political and ethical implications of digital tools within their practice. By aligning Freirean principles with contemporary nursing challenges, the article argues for a shift away from solely competency-based frameworks toward educational approaches that promote reflective, dialogical, and ethically informed engagement with technology. The limitations of Freirean pedagogy, including its difficulty in evidencing direct outcomes, are discussed alongside its potential to cultivate a philosophically engaged nursing workforce capable of navigating the complexities of a digital healthcare environment and its associated impact on the profession. This approach underscores the importance of preserving nursing's core ethical and relational values while embracing the transformative potential of digital technologies.

Self-efficacy Through Digital Care Plan Participation

The concept of self-care is a foundational construct of individual health and wellness. Facilitated self-care is the next logical step in society's uptake of technology for previously high-touch clinical activities, such as patient education and frequent biometric data tracking. This retrospective study aimed to assess whether participation in a digital interactive care plan correlated with an increase in participants' perceived self-efficacy as measured by a change in the Shortened Perceived Medical Condition Self-management Scale score from baseline to end-of-care plan. We included adult patients who were enrolled in at least one of 15 different interactive care plans at our institution between October 21, 2021, and December 30, 2022. Among 3196 patients included, 48.7% of participants did not complete the Shortened Perceived Medical Condition Self-management Scale assessment at baseline, and 73.5% did not complete it at end-of-care plan. For those who completed both assessments (n = 848), 52.2% had no change in their reported self-efficacy on completion of care plan. Similar percentages of patients had increased and decreased scores (25.6% vs 21.9%). The low completion rates were not sufficient to answer the research questions and generalize results. They also underscore the importance of patient engagement for understanding health outcomes associated with implementation of digital health solutions.

Measuring the relationship between reciprocity behaviour and technology readiness of nursing staff working in residential care and community nursing: A cross-sectional study

AIM

The aim of this study is to measure how collaborative factors are associated with the technology readiness of nursing staff working in residential care and community nursing. The Reciprocity Instrument and Technology Readiness Index 2.0 were applied to measure this association.

DESIGN

A cross-sectional survey was conducted between October 2020 and January 2021.

METHODS

The Technology Readiness Index 2.0 was translated into Dutch, administered together with the Reciprocity Instrument and linguistically validated. And 1660 Registered Nurses and Nursing Assistants received an invitation to the online survey. Descriptive statistics and regression analyses were used to analyse the data.

RESULTS

A total of 475 nursing staff responded, a response rate of 28.6%. The following factors have a statistically significant association with technology readiness: age, education level, years of working experience, type of organization, reciprocity behaviour and conditions of reciprocity behaviour: digital communication usage to reach one another, multilayeredness and future perspective.

CONCLUSION

This study shows that reciprocity behaviour is positively associated with technology readiness. The influencing factor reciprocity remains intact after the correction of the other factors that were measured. This confirms the relevance of collaborative factors that influence the technology adoption process of nursing staff working in residential care and community nursing.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This study offers insights into how collaboration based on reciprocity behaviour positively impacts the technology readiness of nursing staff engaged in residential care and community nursing and could be used in the education of nursing staff and healthcare teams.

IMPACT

Being aware of the impact that collaborative factors have on the adoption process of ICT among nursing staff could be used to support the desired preparatory activities as part of ICT implementation for healthcare managers, innovators, and nursing work groups charged with implementing technology in the healthcare process.

REPORTING METHOD

The study has adhered to STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Digital and technological solutions in cardiovascular nursing and perspectives for a smooth digital shift: a discussion paper

Digital and technological solutions (DTS) in cardiovascular nursing are profoundly transforming the landscape of patient care by integrating advanced data-driven approaches. DTS help to enhance patient outcomes and streamline clinical workflows, supporting the shift of the traditional roles of healthcare providers and patients towards more engaged and collaborative care processes. This article presents a perspective in this regard. The adoption of DTS, including mobile health applications and wearable devices, enables continuous monitoring and management of patient health, fostering significant improvements in cardiovascular health management. However, the rapid incorporation of such technologies presents various challenges, such as robust data standardization, the development of digital literacy among healthcare professionals, and addressing privacy and security concerns. Effective integration of DTS into nursing practice demands structured clinical curricula that equip nurses with essential technological skills and a deep understanding of ethical considerations. Theoretical frameworks should guide the systematic implementation and integration of digital tools, ensuring comprehensive consideration of the complexities involved in digital transformations in healthcare.

Electronic Nursing Records: Importance for Nursing and Benefits of Implementation in Health Information Systems-A Scoping Review

Introduction: The advancement of nursing science and practice necessitates the documentation of information, which is increasingly being recorded in electronic mediums due to the progress of information technology. Various countries around the world have implemented electronic nursing records (ENRs) or are in the process of implementing them. This study aims to ascertain the significance of electronic nursing records and consolidate their primary benefits for nursing. Methods: The study utilized an established scoping review methodology (Arksey and O'Malley protocol; JBI method; PRISMA ScR (2018)). Results: Out of 6970 initial articles extracted from four databases, 36 were included in the study. Several essential elements for structuring, introducing, and emphasizing the importance of ENRs have been recognized, including the availability of standardized terminology, enhancement of nursing care quality, advancement of research activity, integration with electronic systems, optimization of healthcare, and conditions for ENR integration. Conclusions: Electronic nursing records are indispensable and beneficial for enhancing care quality, improving patient safety, and affirming the autonomy of the nursing profession.

Advanced practitioners working with older people in primary care and community settings: a survey of roles and use of technology

Background

Advanced practitioner (AP) roles are becoming increasingly common in primary care and community settings for supporting older people and those living with frailty.

Aims

The aim of this study was to explore health and social work AP roles in primary care and community settings in the UK, and understand how they support older people and factors that may impact on APs use of technology in practice.

Methods

A cross-sectional, web-based survey was adopted to explore the views and perspectives of APs.

Results

The survey received 111 responses. There were different views as to whether technology was suitable for older people. Although digital exclusion was a concern, it was perceived that this would change in the future as generations become more digitally literate. Respondents suggested that using technology brought about efficiencies and the ability to respond sooner to symptom changes, with some concerns mentioned regarding the accuracy of technology that may miss signs and symptoms.

Conclusion

This is the first national survey to explore advanced practice roles with older people in non-hospital settings. While APs have wide-ranging skills, few currently use technology in their practice. Findings will inform a future study on digitally enhanced comprehensive geriatric assessments.

Reassembling nursing in the digital age: An actor-network theory perspective

This article explores the application of actor-network theory (ANT) to the nursing profession, proposing a novel perspective in understanding nursing in the context of modern digital healthcare. Traditional grand nursing theories, while foundational, often fail to encapsulate the dynamic and complex nature of nursing, particularly in an era of rapid technological advancements and shifting societal dynamics. ANT, with its emphasis on the relationships between human and nonhuman actors, offers a framework to understand nursing beyond traditional paradigms. This article makes two key arguments: first, that nursing can be viewed as a highly organised social assemblage, where both human (nurses, patients and policymakers) and nonhuman actors (technologies, medical equipment, institutional policies) play a crucial role, and second, that ANT can be used to enhance existing nursing theory to better understand the role of technology in nursing practice. The article considers how ANT can provide a more holistic and adaptable model for describing the nursing profession, particularly in an era where technology plays an integral role in healthcare delivery. It discusses the implications of viewing nursing through ANT, highlighting the need for nursing education and practice to adapt to the interconnected and technologically advanced nature of modern healthcare. The article also acknowledges the limitations of ANT, particularly its potential oversimplification of the complex ethical dimensions inherent in nursing and its focus on observable phenomena.

Influence of information anxiety on core competency of registered nurses: mediating effect of digital health literacy

BACKGROUND

In the information age of health care, nurses often face information overload, leading to negative emotions, e.g., anxiety that may impede the adoption of evidence-based practice and clinical decision-making process. Nurses with higher digital health literacy can effectively process and manage information. Despite this, no research has explored the relationship between information anxiety, digital health literacy, and core competency among nurses. Therefore, this study aims to investigate the mediating effects of digital health literacy on information anxiety and core competency among nurses.

METHODS

From July to October 2023, the data for this cross-sectional study were collected. The study surveyed a total of 608 nurses from three tertiary hospitals in Fujian Province, and the survey instruments included a sociodemographic information questionnaire, Chinese revision version of the Digital Health Literacy Instrument (CR-DHLI), Information Anxiety Scale (IAS), and Competency Inventory for Registered Nurses (CIRN). Descriptive statistics and Pearson correlation analysis were conducted using SPSS 29.0, and the mediating effect of digital health literacy was examined using Mplus.

RESULTS

The mean score of nurses' information anxiety, digital health literacy, and core competency was 3.03 ± 0.91, 2.46 ± 0.56, 2.72 ± 0.88, respectively. And the mediation model of information anxiety on core competency for nurses showed a good model fit index (χ²/df = 2.207, CFI = 0.985, TLI = 0.982, RMSEA = 0.045, SRMR = 0.035). Digital health literacy was positively correlated with nurses' core competency but negatively correlated with information anxiety. The results of path analysis revealed that information anxiety had negative and significant direct effects on NCC (β = -0.119, P = 0.004) and DHL (β = -0.297, P < 0.001). DHL had a positive effect on NCC (β = 0.306, P < 0.001). Digital health literacy played a partial mediating role, accounting for 43.54% of the relationship between information anxiety and nurses' core competency.

CONCLUSIONS

Information anxiety among nurses was at relatively high levels, which had a negative impact on the core competency of nurses. This issue requires attention from nursing managers. The mediating role of digital health literacy in the relationship between information anxiety and core competency among nurses has been established. Nursing managers should strengthen the evaluation of nurses' DHL and devise effective support strategies to enhance DHL, thus improving the core competence of nurses in information age.

Mapping Digital Public Health Interventions Among Existing Digital Technologies and Internet-Based Interventions to Maintain and Improve Population Health in Practice: Scoping Review

BACKGROUND

The rapid progression and integration of digital technologies into public health have reshaped the global landscape of health care delivery and disease prevention. In pursuit of better population health and health care accessibility, many countries have integrated digital interventions into their health care systems, such as web-based consultations, electronic health records, and telemedicine. Despite the increasing prevalence and relevance of digital technologies in public health and their varying definitions, there has been a shortage of studies examining whether these technologies align with the established definition and core characteristics of digital public health (DiPH) interventions. Hence, the imperative need for a scoping review emerges to explore the breadth of literature dedicated to this subject.

OBJECTIVE

This scoping review aims to outline DiPH interventions from different implementation stages for health promotion, primary to tertiary prevention, including health care and disease surveillance and monitoring. In addition, we aim to map the reported intervention characteristics, including their technical features and nontechnical elements.

METHODS

Original studies or reports of DiPH intervention focused on population health were eligible for this review. PubMed, Web of Science, CENTRAL, IEEE Xplore, and the ACM Full-Text Collection were searched for relevant literature (last updated on October 5, 2022). Intervention characteristics of each identified DiPH intervention, such as target groups, level of prevention or health care, digital health functions, intervention types, and public health functions, were extracted and used to map DiPH interventions. MAXQDA 2022.7 (VERBI GmbH) was used for qualitative data analysis of such interventions' technical functions and nontechnical characteristics.

RESULTS

In total, we identified and screened 15,701 records, of which 1562 (9.94%) full texts were considered relevant and were assessed for eligibility. Finally, we included 185 (11.84%) publications, which reported 179 different DiPH interventions. Our analysis revealed a diverse landscape of interventions, with telemedical services, health apps, and electronic health records as dominant types. These interventions targeted a wide range of populations and settings, demonstrating their adaptability. The analysis highlighted the multifaceted nature of digital interventions, necessitating precise definitions and standardized terminologies for effective collaboration and evaluation.

CONCLUSIONS

Although this scoping review was able to map characteristics and technical functions among 13 intervention types in DiPH, emerging technologies such as artificial intelligence might have been underrepresented in our study. This review underscores the diversity of DiPH interventions among and within intervention groups. Moreover, it highlights the importance of precise terminology for effective planning and evaluation. This review promotes cross-disciplinary collaboration by emphasizing the need for clear definitions, distinct technological functions, and well-defined use cases. It lays the foundation for international benchmarks and comparability within DiPH systems. Further research is needed to map intervention characteristics in this still-evolving field continuously.

TRIAL REGISTRATION

PROSPERO CRD42021265562; https://tinyurl.com/43jksb3k.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/33404.

The digital dilemma in nursing: a critique of care in the digital age

There is an inherent tension between the nursing profession's empathetic, human-centric ethos and the impersonal nature of digital technology. However, digital solutions such as robot carers could offer convenience, dignity and reduced feelings of burden, so there is potentially a significant misalignment between nursing concepts of care and contemporary patient needs. The notion of 'care' should be reconceptualised to include digital advancements, aligning practice with changing patient expectations and technological progress. A strategy to do this could involve a philosophical overhaul of nursing care models, integration of advanced patient-centric technologies, comprehensive education and training, collaborative development of nursing technologies, showcasing successful digital integration and policy advocacy for digital care models. This transformation is essential if nursing is to stay relevant and effective in the digital era, bridging the traditional care and modern healthcare needs while maintaining its core ethic of care.

[How much digital public health is in public health degree programs? A systematic analysis of module handbooks in German full-time study programs at public colleges and universities]

BACKGROUND

Professionals, especially in the field of digital public health (DiPH), are crucial for a successful digital transformation in social and health care. However, it is still unclear to what extent academic professionals are taught DiPH-related content in their public health (PH) studies.

METHODS

This study used a systematic module handbook analysis to analyze accredited full-time PH-oriented degree programs at public colleges and universities in Germany for DiPH-related module content. Through the "Hochschulkompass" platform and the member programs of the German Public Health Association (DGPH), 422 programs were identified. Included module handbooks were evaluated by content analysis using MAXQDA.

RESULTS

Only 10 bachelor and 6 master programs contain DiPH. They are heterogeneous in their focus and belong to different subfields of public health ("methods, definition, history, and social medicine" = 5; "health management" = 5; "digital health" = 3; "health services research" = 2; "health communication" = 1). Differences were found between the common understanding of DiPH in academia and the content in the module handbooks. The content identified in the analysis focuses mainly on technical areas. Social and health science content is only marginally present.

DISCUSSION

The heterogeneous study programs with a connection to DiPH allow academic PH specialists to develop specific profiles. To achieve comprehensive competencies in DiPH, there is a need for further development of modules with relevance to the respective degree program. The results could be used for the (further) development of relevant modules and a core curriculum in DiPH.