The role of ICT in nursing practice: an integrative literature review of the Swedish context

Pre-Registration Nursing Students' Perceptions of Digital Health Technology on the Future of Nursing: A Qualitative Exploratory Study

BACKGROUND

Health informatics competencies, digital health education, and nursing students' perceptions of technology are critical to ensure a future digitally capable health care workforce.

PURPOSE

To explore preregistration students' perceptions of digital health technology impact on their role as nurses.

METHODS

Using a qualitative exploratory approach, students from 2 Australian universities were purposively sampled. Data were collected through photo-elicitation from 3 focus groups and thematically analyzed. Photo-elicitation provided reference points to encourage more in-depth exploration.

RESULTS

Themes included fear of the unknown and who am I? Nursing in a digital world . Human interaction was fundamental to their nursing role and digital health technology could depersonalize care, creating tension around their reason for choosing a nursing career.

CONCLUSIONS

Educators should prepare students to redefine their nursing identity by exploring how digital health technology augments their practice and critical thinking skills, while addressing fear of a perceived threat to the future of nursing.

ICT in Nursing and Patient Healthcare Management: Scoping Review and Case Studies

Over the past few decades, Information and Communication Technologies (ICT) have revolutionized the fields of nursing and patient healthcare management. This scoping review and the accompanying case studies shed light on the extensive scope and impact of ICT in these critical healthcare domains. The scoping review explores the wide array of ICT tools employed in nursing care and patient healthcare management. These tools encompass electronic health records systems, mobile applications, telemedicine solutions, remote monitoring systems, and more. This article underscores how these technologies have enhanced the efficiency, accuracy, and accessibility of clinical information, contributing to improved patient care. ICT revolution has revitalized nursing care and patient management, improving the quality of care and patient satisfaction. This review and the accompanying case studies emphasize the ongoing potential of ICT in the healthcare sector and call for further research to maximize its benefits.

Satisfaction and use of the didactic simulator for learning the nursing process: an observational study

INTRODUCTION

The implementation of Information and Communication Technology (ICT) in daily healthcare practice has become standardized. In relation to education within the nursing degree, ICTs make it possible to carry out practical immersion training from the" classroom or from any other place with an Internet connection, as evidenced by circumstances that have occurred in recent years, such as the pandemic caused by COVID-19.

OBJECTIVE

Design and assess a didactic simulation program for the training of the nursing process that promotes learning in the nursing care METHODOLOGY: The methodological approach is quantitative and it is a descriptive cross-sectional study. The sampling method used was non-probabilistic by convenience.

RESULTS

When observing the comparison of the averages of student satisfaction with respect to the didactic simulator, it is worth mentioning that all the items are above 2.80 on a score in which "0" is the minimum value and "5" the maximum value. The results of the use of the computer tool by the students, we highlight as significant data that all the items present an average equal to or lower than 3.04 out of 7, where "1" corresponds to a lot of use and "7" to little use.

CONCLUSION

The implication of ICT in the teaching-learning process among Nursing Degree students, it is considered optimal. when analyzing the answers obtained in the items that refer to a higher ease in the execution of development of Care plans, a fundamental work in Nursing performance.

First and final year physiotherapy students' expectations of their future profession

BACKGROUND AND AIM

Students' expectations of their future profession may have an impact on their professional development. This study aimed to describe first and final year physiotherapy students' expectations of their future profession.

METHODS

A total of 96 respondents participated; 45 students in their first semester 2006, and 51 students in their final semester 2014. Individual written reflections were analyzed separately for each semester, using qualitative manifest inductive content analysis.

RESULTS

The analysis resulted in six categories from each semester. The categories from the first semester were: 1) Professional and person-centered; 2) Promote health in a holistic way; 3) Competence makes the patient and therapist feel confident; 4) Focus on education and behavioral change; 5) Confirmed as a role model; and 6) The impact of previous experiences and an unknown situation. The categories from the final semester were: 1) Interaction and learning; 2) Confidence by competence; 3) Value the work environment and knowledge exchange; 4) Personal goals and strategies; 5) Specialist or generalist work; and 6) Work with public health in a global world.

CONCLUSIONS

In the first semester, students described different work approaches, while students in the last semester described how approaches were to be used. Furthermore, students in their first semester referred more to previous experiences, while students in their final semester developed strategies to achieve their professional goals. These findings might contribute to guide students' in their continuous professional development based on their experiences and expectations.

Technological machines and artificial intelligence in nursing practice

This article is a theoretical discourse about technological machines and artificial intelligence, highlighting their effective interactive outcomes in nursing. One significant influence is technological efficiency which positively affects nursing care time, enabling nurses to focus more on their patients as the core of nursing. The article examines the impact of technology and artificial intelligence on nursing practice in this era of rapid technological advancements and technological dependence. Strategic opportunities in nursing are advanced, exemplified by robotics technology and artificial intelligence. A survey of recent literature focused on what is known about the influence of technology, healthcare robotics, and artificial intelligence on nursing in the contexts of industrialization, societal milieu, and human living environments. Efficient, precision-driven machines with artificial intelligence support a technology-centered society in which hospitals and healthcare systems become increasingly technology-dependent, impacting healthcare quality and patient care satisfaction. As a result, higher levels of knowledge, intelligence, and recognition of technologies and artificial intelligence are required for nurses to render quality nursing care. Designers of health facilities should be particularly aware of nursing's increasing dependence on technological advancements in their practice.

New Web-Based System for Recording Public Health Nursing Practices and Determining Best Practices: Protocol of an Exploratory Sequential Design

BACKGROUND

Digitalization and information and communication technology (ICT) promote effective, efficient individual and community care. Clinical terminology or taxonomy and its framework visualize individual patients' and nursing interventions' classifications to improve their outcomes and care quality. Public health nurses (PHNs) provide lifelong individual care and community-based activities while developing projects to promote community health. The linkage between these practices and clinical assessment remains tacit. Owing to Japan's lagging digitalization, supervisory PHNs face difficulties in monitoring each department's activities and staff members' performances and competencies. Randomly selected prefectural or municipal PHNs collect data on daily activities and required hours every 3 years. No study has adopted these data for public health nursing care management. PHNs need ICTs to manage their work and improve care quality; it may help identify health needs and suggest best public health nursing practices.

OBJECTIVE

We aim to develop and validate an electronic recording and management system for evaluating different public health nursing practice needs, including individual care, community-based activities, and project development, and for determining their best practices.

METHODS

We used a 2-phase exploratory sequential design (in Japan) comprising 2 phases. In phase 1, we developed the system's architectural framework and a hypothetical algorithm to determine the need for practice review through a literature review and a panel discussion. We designed a cloud-based practice recording system, including a daily record system and a termly review system. The panels included 3 supervisors who were prior PHNs at the prefectural or municipal government, and 1 was the executive director of the Japanese Nursing Association. The panels agreed that the draft architectural framework and hypothetical algorithm were reasonable. The system was not linked to electronic nursing records to protect patient privacy. Phase 2 validated each item through interviews with supervisory PHNs using a web-based meeting system. A nationwide survey was distributed to supervisory and midcareer PHNs across local governments.

RESULTS

This study was funded in March 2022 and approved by all ethics review boards from July to September and November 2022. Data collection was completed in January 2023. Five PHNs participated in the interviews. In the nationwide survey, responses were obtained from 177 local governments of supervisory PHNs and 196 midcareer ones.

CONCLUSIONS

This study will reveal PHNs' tacit knowledge about their practices, assess needs for different approaches, and determine best practices. Additionally, this study will promote ICT-based practices in public health nursing. The system will enable PHNs to record their daily activities and share them with their supervisors to reflect on and improve their performance, and the quality of care to promote health equity in community settings. The system will support supervisory PHNs in creating performance benchmarks for their staff and departments to promote evidence-based human resource development and management.

TRIAL REGISTRATION

UMIN-ICDR UMIN000049411; https://tinyurl.com/yfvxscfm.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/45342.

'It increases my ability to influence my ways of working': A qualitative study on digitally mediated patient management in primary healthcare

BACKGROUND

Digitally mediated primary healthcare is increasingly influencing working conditions, raising questions about how digitally mediated patient management is experienced.

AIM

The aim of this study was to generate insights, through the lens of postphenomenology, into how digitally mediated primary healthcare affects the work and working environment, by gathering perspectives from primary healthcare professionals who regularly manage patient errands through a digital platform.

METHODS

Two rounds of interviews were conducted with a diversified sample of primary healthcare professionals at a primary healthcare centre. The first round of interviews was conducted during the initial phase of the deployment of a digital platform for patient management, with the second round conducted a year later (n = 24). The interview transcripts were analysed using reflexive thematic analysis.

RESULTS

Four themes relating to digitally mediated care work were identified: 'positive feelings towards digitally mediated primary healthcare', 'seeing a positive work atmosphere as a prerequisite for change', 'experiencing increased control over the pace of workflow' and 'reconfiguration of previous problems'.

CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE

Building on postphenomenology, our study adds to the understanding of how material and symbolic aspects mutually affect the mediating role of a digital platform for patient management. Thus, the results indicate that the experience of using digitally mediated care processes is conditioned by the discourse towards digitalisation at the workplace and the management's approach to and inclusion of employees in the digital transition of primary healthcare, as well as the usefulness and usability of the digital platform. The findings can inform both practice and policy.

Nursing informatics skills relevance and competence for final year nursing students

BACKGROUND

 The increasing use of technology in nursing practice requires nursing students to be competent in nursing informatics with an attitude of acceptance of technology in the healthcare environment.

OBJECTIVES

 The objectives of the study were to determine final year nursing students' perceptions and skills in nursing informatics and their attitudes towards computerisation in nursing practice.

METHOD

 The study population were 198 final year nursing students from a selected university in the Western Cape, South Africa. All-inclusive sampling was used. A descriptive survey was conducted using a self-administered questionnaire which included two validated scales, namely the validated Nursing Informatics Competency Assessment Tool (NICAT) and the Nurses' Attitudes towards Computerisation scale. Means and 95% confidence intervals (CI) of the ratings of the perceived relevance of nursing informatics skills in nursing practice, perceived levels of competence in nursing informatics skills and attitudes towards computers were calculated.

RESULTS

 A total of 91 undergraduate respondents completed the survey. Computer literacy skills were rated overall as most relevant (4.23, 95% confidence interval [95% CI]: 4.06-4.40) and the skills perceived most competent (4.16, 95% CI: 3.81-4.22). The respondents had an overall positive score for attitudes towards computerisation in healthcare (67.34, s.d. = 10.40, 95% CI: 65.18-69.51).

CONCLUSION

 The study concluded that computer literacy skills, informatics literacy skills and information management skills were relevant to nursing practice, despite varying levels of competence in these skills among nurses.Contribution: What key insights into the research results and its future function are revealed? How do these insights link to the focus and scope of the journal? It should be a concise statement of the primary contribution of the manuscript; and how it fits within the scope of the journal.

The Impact of Healthcare 4.0 on the Healthcare Service Quality: A Systematic Literature Review

Healthcare 4.0 is inspired by Industry 4.0 and its application has resulted in a paradigmatic shift in the field of healthcare. However, the impact of this digital revolution in the healthcare system on healthcare service quality is not known. The purpose of this study is to examine the impact of healthcare 4.0 on healthcare service quality. This study used the systematic literature review methodology suggested by Transfield et al. to critically examine 67 articles. The impact of healthcare 4.0 is analyzed in-depth in terms of the interpersonal, technical, environmental, and administrative aspect of healthcare service quality. This study will be useful to hospitals and other stakeholders to understand the impact of healthcare 4.0 on the service quality of health systems. Besides, this study critically analyses the existing literature and identifies research areas in this field and hence will be beneficial to researchers. Though there are few literature reviews in healthcare 4.0, this is the first study to examine the impact of Healthcare 4.0 on healthcare service quality.

Still engaged – healthcare staff’s engagement when introducing a new eHealth solution for wound management: a qualitative study

Background

eHealth solutions have often been considered favourable for improved effectiveness and quality in healthcare services for wound management. Staff engagement related to organisational changes is a key factor for successful development and implementation of a new eHealth solution, like a digital decision support systems (DDSS). It is essential to understand the engagement process in terms of sustainability, wellbeing in staff and efficiency in a long-term perspective. The aim of this study was to describe healthcare staff’s engagement during a 6-month test of an eHealth solution (DDSS) for wound management.

Methods

A qualitative design, including interviews conducted with healthcare staff working with wound management within primary, community and specialist care (n = 11) on two occasions: at the introduction of the solution and after 6 months, when the test period was over. Data were interpreted with qualitative content analysis.

Results

Healthcare staff’s descriptions from a 6-month test of an eHealth solution for wound management can be summarised as Engaging through meaning, but draining. The analysis revealed a result with three subcategories: Having a shared interest is stimulating, Good but not perfect and Exciting, but sometimes exhausting. The staff described their engagement as sustained through feelings of meaningfulness when using the eHealth solution, but limited by feelings of exhaustion due to heavy workload and lack of support and understanding from others.

Conclusions

The results indicate that the healthcare staff who tested the eHealth solution described themselves as individuals who easily become engaged when an idea and efforts felt meaningful. The staff needed resources to nourish engagement in their new role when implementing eHealth in the clinical everyday work of wound management. Allocating time and support are important to consider when planning for sustainable implementation of eHealth solutions in healthcare organisations.

The Impact of Information and Communication Technology on Doctors' and Registered Nurses' Working Conditions and Clinical Work - A Cross-Sectional Study in a Norwegian Hospital

Purpose

Previous studies indicate that the introduction of information and communication technology (ICT) in health care organizations impairs health care professional’s working conditions and diminishes job discretion. Most of these studies, however, were designed to explore the influence of ICT exclusively on a single group of health care professionals and thereby did not consider the influence of the same technology on other groups of health care professionals. The aim of this article is to explore the influence of a fully integrated ICT system on both doctors and registered nurses within the same working environment: a high-tech hospital.

Methods

This is a cross-sectional study conducted in a high-tech Norwegian hospital. Data were collected in 2016. In total, 264 registered nurses and 172 doctors responded to a questionnaire on their working conditions and experiences with ICT in clinical work. Descriptive statistics, compare means, cross-tables, Chi-square and bivariate correlation analysis were used to analyze the data. Statistical significance was set at p < 0.05.

Results

The findings revealed differences in doctors' and registered nurses' working conditions. Registered nurses reported a statistically significant higher workload and better job content than doctors. There was no difference in job discretion between doctors and registered nurses. Both occupational groups experienced that the ICT system impairs patient contact and the quality of health services. We found statistically significant correlations between registered nurses’ and doctors’ experiences with ICT in clinical work and working conditions, whereof the strongest correlation was related to job discretion in clinical work.

Conclusion

This study concludes that the impact of ICT on doctors’ and registered nurses’ working conditions in a hospital depends on the experiences of ICT in clinical work. In consequence, it is recommended to involve doctors and registered nurses in the implementation of ICT in hospitals.

Negative Emotions Induced by Work-Related Information Technology Use in Hospital Nursing

There is a lack of research into the implications of information technology-related issues for nurses' experiences and well-being at work. However, negative work experiences can generate negative emotions, which, in turn, can negatively affect well-being. Despite this, research has not systematically addressed negative emotions generated by work-related information technology use in hospital nursing. Drawing on data collected through focus groups and interviews with a total of 15 ward nurses, this paper identifies the discrete negative emotions that emerge from work-related information technology use in hospital nursing and maps the identified emotions onto the perceptions associated with and triggering them. The analysis was qualitative and included process, emotion, and causation coding alongside extensive memo writing. We identified six primary negative emotions: frustration, moral distress, alienation, psychological distress, anxiety, and perplexity. All of the identified emotions can be associated with four types of experiences of feeling hindered: mental effort, inability to carry out a task, doing extra or unnecessary work, and failing to complete a task successfully. The framework we present may support healthcare organizations in identifying potentially harmful information technology-related configurations in their infrastructure and implementing appropriate measures to foster nurses' well-being at work.

Can Leaders Prevent Technology From Backfiring? Empowering Leadership as a Double-Edged Sword for Technostress in Care

Purpose: Recent studies have called for more contextual studies of technostress and the role leaders can have in this experience. While technostress is an increasingly prevalent and severe phenomenon in care professions, limited studies have addressed its potential negative consequences for employee well-being and quality of care delivered in this sector or, more importantly, examined how the adverse consequences of technostress could be mitigated. Therefore, the present study addresses this gap by investigating how technostress in childcare affects quality of care delivered via emotional exhaustion and what influence empowering leadership plays in this relationship. Design/methodology approach: Incorporating the views of 339 Dutch childcare workers, this study tests a model in which technostress influences quality of care delivered, mediated by emotional exhaustion and moderated by empowering leadership. Findings: Results confirm that techno-invasion and techno-overload predict higher emotional exhaustion and lower quality of care delivered among childcare workers. Empowering leadership reduced the influence of techno-invasion on emotional exhaustion but strengthened the influence of techno-overload. Originality/value: Our results provide childcare organizations with relevant information on the increasing use of ICT that influences both childcare workers' well-being and quality of care they deliver. Important implications are suggested for leadership geared at stimulating employees' responsibility and accountability for different dimensions of technostress.

Pain and analgesics in patients with hard-to-heal ulcers: using telemedicine or standard consultations

OBJECTIVE

To compare consultations carried out via video with those performed in person for patients with painful, hard-to-heal ulcers, with a focus on ulcer pain and pain treatment. A further aim was to investigate predictors for pain and pain treatment.

METHOD

This was a register-based, quasi-experimental study based on data from the Swedish Registry of Ulcer Treatment (RUT). A total of 100 patients with hard-to-heal ulcers diagnosed via video consultation were compared with 1888 patients diagnosed in person with regard to pain assessment, intensity and treatment. Ulcer pain intensity was assessed by the visual analogue scale (VAS). Normally distributed variables (age, VAS) were compared between consultation groups using Student's t-test. Non-normally distributed variables (ulcer size, ulcer duration) were compared using the Mann-Whitney U-test, except for healing time, which was analysed with a log-rank test. Categorical variables (gender, ulcer aetiology and prescribed analgesics) were compared using Pearson's chi-square test (χ²). A p value of less than 0.05 was considered to indicate statistical significance. Predictors for pain and pain treatment were analysed in multiple regression analyses.

RESULTS

The results showed a high presence of pain; 71% of patients with pain reported severe ulcer pain. There was no significant difference in ability to assess pain by VAS in the group diagnosed via video consultation (90%) compared with the group diagnosed in person (86%) (χ², p=0.233). A significantly higher amount of prescribed analgesics was found for patients diagnosed via video (84%) compared with patients diagnosed by in-person assessment (68%) (χ², p=0.044). Predictors for high-intensity pain were female gender or ulcers due to inflammatory vessel disease, while the predictors for receiving analgesics were older age, longer healing time and being diagnosed via video consultation.

CONCLUSION

To identify, assess and treat ulcer pain is equally possible via video as by in-person consultation. The results of this study confirm that patients with hard-to-heal ulcers suffer from high-intensity ulcer pain, with a discrepancy between pain and pain relief. Further well-designed randomised controlled studies are necessary to understand how best to deploy telemedicine in ulcer pain treatment.

Oncology nurses' lived experiences of video communication in follow-up care of home-living patients: A phenomenological study in rural Norway

PURPOSE

To explore the lived experiences of oncology nurses (ONs) during three months of virtual care provided through video conferencing (VC) in the follow-up care for home-living patients with cancer in rural Norway.

METHOD

An exploratory study employing a descriptive phenomenological approach conducted with a purposive sample of four ONs working in primary health care in three municipalities. Individual interviews based on open-ended questions about the ONs' experiences of VC use in follow-up care were analyzed using methodology inspired by Clark Moustakas. The COREQ checklist was utilized in this study.

RESULTS

ONs provided VC as a quality-promoting supplement to traditional follow-up. Their lived experiences of the phenomenon were described by the following themes: 1) Choice of VC based on care need considerations, 2) Use of VC on portable tablets facilitated contact and frequent follow-up, and 3) Adaption of relevant virtual care in person-centered and goal-oriented practice.

CONCLUSION

The use of VC may contribute to accessible and frequent quality care and reduce the ONs' travel time for home visits. This study points to a need to individualize and assess the appropriateness of virtual care in challenging cancer situations. Furthermore, there is a need for larger-scale studies on how VC may influence quality care.

Effectiveness of Digital Technologies to Support Nursing Care: Results of a Scoping Review

Background

The field of digital technologies being developed or applied to support nursing care is extensive. The aim of this scoping review is to provide an overview on technologies for which results on positive or negative effects on persons in need of care, caregivers or care institutions are available and to appraise the reliability of these results.

Methods

A scoping review design has been used to identify studies focussing on the effectiveness of digital technologies in nursing care for persons in need of care, caregivers or care institutions. The screening process included 19,510 scientific publications from 9 databases.

Results

A total of 123 single studies and 31 reviews were subjected to the analysis. The included technologies comprise nursing and health information technologies, such as assistive devices, information and communication technologies, sensors and robotics. The results show that there are many studies that demonstrate positive effects, but the level of evidence is mostly low and study sizes are often small. Hardly any technology has been researched intensively enough to produce conclusive results. Studies on a high level of evidence (RCTs) lack for most technological areas. Heterogeneous results in some areas indicate that effects may depend strongly on the mode and specific context into which the technologies are introduced.

Conclusion

Due to the limited evidence on effectiveness of digital technologies in nursing care, it is not surprising that care institutions are reluctant to put innovative technologies into practice. The scoping review indicates technology areas that should be subject to future research with higher quality studies. Research on outpatient, informal and cross-sectoral care should be intensified to further exploit the potential of digital technologies with a view to improving independence of care-recipients and unburdening formal and informal carers.

Israeli nursing students' acceptance of information and communication technologies in clinical placements

BACKGROUND

Nursing students are required to be adequately prepared to use Information and Communication Technologies (ICT) in clinical practice. Yet, studies conducted worldwide indicate personal, organizational, and social barriers reported by students and a discrepancy between clinical resources and students' needs.

PURPOSE

To explore nursing students' usage of ICT during clinical placement and the associations between students' ICT acceptance, human and organizational resources, and ICT usage.

METHOD

Data were collected from 303 second and third year Israeli nursing students, through a self-administered structured questionnaire.

RESULTS

The use of Medical Health Records during clinical placements was rated highest (M = 4.62, SD = 0.74, range 1-5), whereas the use of e-Books was rated lowest (M = 2.26, SD = 1.37, range 1-5). Positive correlations were found between ICT use and human resources, social influence, organizational resources, and performance expectancy. Significant differences were found according to study years and proficiency in computer skills between students. Perceived human resources, cultural group, Hebrew proficiency, and social influence explained 28% of students' variance in ICT usage.

CONCLUSIONS

Nurse administrators and educators should promote the preparation of clinical settings in accordance with students' needs and proficiencies. Moreover, the development of curricula and clinical practicums must also take into account the role of organizational, social, and computer proficiency in students' ICT adoption.

Health Care Staff's Experiences of Engagement When Introducing a Digital Decision Support System for Wound Management: Qualitative Study

Background

eHealth solutions such as digital decision support systems (DDSSs) have the potential to assist collaboration between health care staff to improve matters for specific patient groups. Patients with hard-to-heal ulcers have long healing times because of a lack of guidelines for structured diagnosis, treatment, and follow-up. Multidisciplinary collaboration in wound management teams is essential. A DDSS could offer a way of aiding improvement within wound management. The introduction of eHealth solutions into health care is complicated, and the engagement of the staff seems crucial. Factors influencing and affecting engagement need to be understood and considered for the introduction of a DDSS to succeed.

Objective

This study aims to describe health care staff’s experiences of engagement and barriers to and influencers of engagement when introducing a DDSS for wound management.

Methods

This study uses a qualitative approach. Interviews were conducted with 11 health care staff within primary (n=4), community (n=6), and specialist (n=1) care during the start-up of the introduction of a DDSS for wound management. The interviews focused on the staff’s experiences of engagement. Content analysis by Burnard was used in the data analysis process.

Results

A total of 4 categories emerged describing the participants’ experiences of engagement: a personal liaison, a professional commitment, an extended togetherness, and an awareness and understanding of the circumstances.

Conclusions

This study identifies barriers to and influencers of engagement, reinforcing that staff experience engagement through feeling a personal liaison and a professional commitment to make things better for their patients. In addition, engagement is nourished by sharing with coworkers and by active support and understanding from leadership.

Pain and analgaesics in patients with hard-to-heal ulcers: using telemedicine or standard consultations

OBJECTIVE

To compare consultations carried out via video with those performed in person for patients with painful, hard-to-heal ulcers, with a focus on ulcer pain and pain treatment. A further aim was to investigate predictors for pain and pain treatment.

METHOD

This was a register-based, quasi-experimental study based on data from the Swedish Registry of Ulcer Treatment (RUT). A total of 100 patients with hard-to-heal ulcers diagnosed via video consultation were compared with 1888 patients diagnosed in person with regard to pain assessment, intensity and treatment. Ulcer pain intensity was assessed by the visual analogue scale (VAS). Normally distributed variables (age, VAS) were compared between consultation groups using Student's t-test. Non-normally distributed variables (ulcer size, ulcer duration) were compared using the Mann-Whitney U-test, except for healing time, which was analysed with a log-rank test. Categorical variables (gender, ulcer aetiology and prescribed analgesics) were compared using Pearson's chi-square test (χ²). A p value of less than 0.05 was considered to indicate statistical significance. Predictors for pain and pain treatment were analysed in multiple regression analyses.

RESULTS

The results showed a high presence of pain; 71% of patients with pain reported severe ulcer pain. There was no significant difference in ability to assess pain by VAS in the group diagnosed via video consultation (90%) compared with the group diagnosed in person (86%) (χ², p=0.233). A significantly higher amount of prescribed analgesics was found for patients diagnosed via video (84%) compared with patients diagnosed by in-person assessment (68%) (χ², p=0.044). Predictors for high-intensity pain were female gender or ulcers due to inflammatory vessel disease, while the predictors for receiving analgesics were older age, longer healing time and being diagnosed via video consultation.

CONCLUSION

To identify, assess and treat ulcer pain is equally possible via video as by in-person consultation. The results of this study confirm that patients with hard-to-heal ulcers suffer from high-intensity ulcer pain, with a discrepancy between pain and pain relief. Further well-designed randomised controlled studies are necessary to understand how best to deploy telemedicine in ulcer pain treatment.

Older adults' technology use and its association with health and depressive symptoms: Findings from the 2011 National Health and Aging Trends Study

Background

Information and communication technology (ICT) provides older adults with access to information and resources that benefit their health.

Purpose

To explore ICT use among older adults and examine the influence of information technology (IT), communication technology (CT), or ICT use on older adults' self-rated health status and depressive symptoms.

Method

A sample of community-dwelling Medicare beneficiaries aged 65 and older in the United States (N = 4,976) from the 2011 National Health and Aging Trends Study.

Findings

Older adults who embraced ICT and used this technology for a variety of purposes were more likely to report better health status, and were less likely to experience major depressive symptoms than nonusers.

Discussion

In accordance with the Health Information Technology for Economic and Clinical Health Act, nursing professional can play an important role by responding to older adults' diverse technology preferences and effectively incorporating them into nursing practice.

Use and Perceptions of Information and Communication Technologies Among Ecuadorian Nurses: A Cross-sectional Study

Background:

Nurses represent a key group for the implementation of Information and Communication Technologies (ICTs), however, few studies have explored the current use of these technologies among healthcare professionals in developing countries. Our study aims to achieve a better understanding of how Ecuadorian nurses perceive the theoretical advantages and limitations of ICTs, as well as to explore the current use of these technologies in the setting of the professional nursing practice.

Methods:

We conducted an anonymous survey-based cross-sectional study where 191 nurses rated their frequency of use and level of agreement to specific statements on perceptions related to ICTs. For the statistical analyses, adjusted binomial logistic regressions and the chi-squared test for association were applied.

Results:

In general, 96.3% of nurses reported the use of ICTs to communicate with colleagues, and 80.1% reported the use of ICTs to communicate with patients. More than 70% of participants agreed that ICTs can be useful to promote professional services, help in the search for new job opportunities and/or professional development, foster health promotion, and improve the workflow with colleagues. Meanwhile, 78.6% of nurses had privacy or security concerns about personal and/or patient information, and 60.6% reported not having enough time neither to learn how to use ICTs nor to use them.

Conclusion:

High use of ICTs was found among Ecuadorian nurses for communicating with both colleagues and patients. Most of the participants had a positive perception of the use of ICTs in the healthcare practice, particularly among younger nurses. Finally, the major reservations perceived were related to privacy and patient confidentiality, and lack of time to learn how to use, or use ICTs.

Use and Perceptions of Information and Communication Technologies Among Ecuadorian Nurses: A Cross-sectional Study

Background:

Nurses represent a key group for the implementation of Information and Communication Technologies (ICTs), however, few studies have explored the current use of these technologies among healthcare professionals in developing countries. Our study aims to achieve a better understanding of how Ecuadorian nurses perceive the theoretical advantages and limitations of ICTs, as well as to explore the current use of these technologies in the setting of the professional nursing practice.

Methods:

We conducted an anonymous survey-based cross-sectional study where 191 nurses rated their frequency of use and level of agreement to specific statements on perceptions related to ICTs. For the statistical analyses, adjusted binomial logistic regressions and the chi-squared test for association were applied.

Results:

In general, 96.3% of nurses reported the use of ICTs to communicate with colleagues, and 80.1% reported the use of ICTs to communicate with patients. More than 70% of participants agreed that ICTs can be useful to promote professional services, help in the search for new job opportunities and/or professional development, foster health promotion, and improve the workflow with colleagues. Meanwhile, 78.6% of nurses had privacy or security concerns about personal and/or patient information, and 60.6% reported not having enough time neither to learn how to use ICTs nor to use them.

Conclusion:

High use of ICTs was found among Ecuadorian nurses for communicating with both colleagues and patients. Most of the participants had a positive perception of the use of ICTs in the healthcare practice, particularly among younger nurses. Finally, the major reservations perceived were related to privacy and patient confidentiality, and lack of time to learn how to use, or use ICTs.

Nurses' Use and Ways of Understanding Web-Based National Guidelines for Child Healthcare

The national Rikshandboken for child healthcare is both a Web-based guideline containing knowledge and methodological guidance and a national child healthcare program in the process of being implemented in Sweden. The aim of this study was to examine child healthcare nurses' use and ways of understanding the national Web-based Rikshandboken. A mixed-methods study with sequential explanatory design in two phases was used; a Web survey with descriptive statistics was followed with telephone interviews with phenomenographic analysis. The study showed variations in use and contributed deeper knowledge of child healthcare nurses' ways of understanding the unit Rikshandboken whose varied parts interact with each other. To be reliable, useful, and relevant for nurses in their specific contexts, Rikshandboken must be kept updated and involve the end users in the development process. With access to technical devices and optimal use of the possibilities of information and communication technology, Rikshandboken can be a resource for continuing learning, a tool in everyday work, and a possible determinant to equality in child healthcare. The study contributes valuable knowledge for the design of Web-based national guidelines for healthcare, making them useful and relevant for the end users.

Self-care ability and sense of security among older persons when using an app as a tool for support

THE STUDY'S RATIONALE

The need for home care among older persons is increasing, and mHealth is evolving to help meet the challenge. When developing an app to help maintain their health, it is essential to incorporate older persons' preferences.

AIMS AND OBJECTIVES

To describe and evaluate the experiences of self-care support and sense of security among older persons using an interactive app to report health concerns.

METHODOLOGICAL DESIGN AND JUSTIFICATION

The study had a descriptive and evaluative design. Qualitative and quantitative methods were applied to achieve a broader understanding.

ETHICAL ISSUES AND APPROVAL

Ethical approval was obtained from the Regional Ethical Review Board. The older persons received verbal and oral information about the study and gave written informed consent.

RESEARCH METHODS

Questionnaires (n = 17 older persons) answered at baseline, end of the intervention and at a 6-month follow-up were analysed with statistical analysis. Interviews (n = 17 older persons) conducted at the end of the intervention were analysed using a qualitative directed approach.

MEASUREMENTS AND INTERVENTION

The questionnaire included the Appraisal of Self-care Agency Scale and a question concerning sense of security. For 3 months, the older persons used an app for regular reporting of health concerns. The app included self-care advice, graphs and a risk assessment model that generated alerts directly to the nurses.

RESULTS

The older persons described how self-care and sense of security increased at the end of intervention, but statistically, it was shown to decrease afterwards.

STUDY LIMITATIONS

The small sample size for statistical analysis.

CONCLUSIONS

This study shows that an app can be a complementary tool to conventional home care that can increase older persons' sense of security and self-care ability. The results mirror the older persons' awareness that the support they received with the app was only temporary. Larger studies are needed for generalisation.

Analyzing Nursing Students' Relation to Electronic Health and Technology as Individuals and Students and in Their Future Career (the eNursEd Study): Protocol for a Longitudinal Study

Background

The nursing profession has undergone several changes in the past decades, and new challenges are to come in the future; patients are now cared for in their home, hospitals are more specialized, and primary care will have a key role. Health informatics is essential in all core competencies in nursing. From an educational perspective, it is of great importance that students are prepared for the new demands and needs of the patients. From a societal point of view, the society, health care included, is facing several challenges related to technological developments and digitization. Preparation for the next decade of nursing education and practice must be done, without the advantage of certainty. A training for not-yet-existing technologies where educators should not be limited by present practice paradigms is desirable. This study presents the design, method, and protocol for a study that investigates undergraduate nursing students’ internet use, knowledge about electronic health (eHealth), and attitudes to technology and how experiences of eHealth are handled during the education in a multicenter study.

Objective

The primary aim of this research project is to describe the design of a longitudinal study and a qualitative substudy consisting of the following aspects that explore students’ knowledge about and relation to technology and eHealth: (1) what pre-existing knowledge and interest of this area the nursing students have and (2) how (and if) is it present in their education, (3) how do the students perceive this knowledge in their future career role, and (4) to what extent is the education capable of managing this knowledge?

Methods

The study consists of two parts: a longitudinal study and a qualitative substudy. Students from the BSc in Nursing program from the Blekinge Institute of Technology, Karlskrona, Sweden, and from the Swedish Red Cross University College, Stockholm/Huddinge, Sweden, were included in this study.

Results

The study is ongoing. Data analysis is currently underway, and the first results are expected to be published in 2019.

Conclusions

This study presents the design of a longitudinal study and a qualitative substudy. The eHealth in Nursing Education eNursEd study will answer several important questions about nursing students’ attitudes toward and use of information and communications technology in their private life, their education, and their emerging profession. Knowledge from this study will be used to compare different nursing programs and students’ knowledge about and relation to technology and eHealth. Results will also be communicated back to nursing educators to improve the teaching of eHealth, health informatics, and technology.

International Registered Report Identifier (IRRID)

DERR1-10.2196/14643

Investigating the determinants of human development index in Pakistan: an empirical analysis

In this modern era, the importance of information and communication technology (ICT) cannot be ignored for sustainable human development. However, Pakistan has experienced a considerable gap between ICT economic growth and human development. In this regard, this study has modeled the relationship between ICT, economic growth, and the human development index (HDI) considering urbanization, foreign direct investment (FDI), and trade for the period from 1990 to 2014. An autoregressive distributed lag (ARDL) and vector error correction model (VECM) approaches are used to analyze the data. The empirical results reveal that ICT promote human development index. Along with, economic growth has a positive and significant impact on human development. Besides, urbanization, trade, and FDI discourage human development in Pakistan. Finally, bidirectional causality is detected between the aforementioned variables. Recommendations to policymakers regarding the productive role of FDI and trade are provided.

Contradictions in information technology mediated work in long-term care: An activity theoretic ethnographic study

BACKGROUND

The growing demand for aged care services coupled with a global shortage of skilled nursing staff has hindered long-term care facilities' ability to provide necessary services to their residents. Healthcare information technology is expected to mitigate this challenge by streamlining nursing work, while also improving quality of care and productivity.

OBJECTIVES

This study set out to examine how nurses and care workers work, the role of information technology (IT) in their work and what contradictions they face in their IT mediated work.

DESIGN

Ethnographic study informed by six components of activity theory: subject, object, tool, rule, community and division of labor.

SETTING

Eight care units in two long-term care facilities in Australia.

PARTICIPANTS

Eleven staff from two long-term care facilities including registered nurses (n = 2), endorsed enrolled nurses (n = 5) and personal care workers (n = 4) participated in this study.

METHODS

Participants were shadowed during morning shifts (6:30 am to 3:00 pm). A total of 24 morning shifts were observed over four months. Field notes were created based on observational data and informal interviews, in addition to document review.

RESULTS

Through the lens of activity theory, the work activity system of nurses and care workers in the long-term care facilities consisted of the subject (nurses and care workers), their object (resident care), tools used for work including IT, rules of work, community, and division of labor. These components interacted through work processes; therefore, a "process" component was added in the activity system. Special attention was given to the role of IT as the conduit of information in the work processes. Although IT helped track medication rounds, automated documentation and communication among the staff, it introduced contradictions. Seven contradictions involving IT were identified, including contradictions within the IT tool, between the IT tool and the object of work, between the subjects and documentation rules, between the work activity system using paper records and the system using IT, and between the activity system within the long-term care facility and the pharmacists' work activity system outside the facility.

CONCLUSIONS

Activity theory provided a theoretic framework to model the work activity system of nurses and care workers. Information technology played an important role in supporting information flow in this system, however it also caused contradictions.

Nursing students' learning dynamics with clinical information and communication technology: A constructive grounded theory approach

BACKGROUND

The learning of nursing students can be facilitated through direct and/or indirect experiences of using clinical information and communication technology during clinical placements. However, nursing students experience difficulties in using technology for learning. Despite the difficulties, nursing students' learning dynamics with technology in real clinical contexts is poorly understood.

OBJECTIVES

To develop a theoretical model by identifying nursing students' learning dynamics with clinical information and communication technology and the factors influencing the dynamics.

DESIGN

A constructivist grounded theory approach was employed in order to develop the theoretical model.

SETTINGS

This research was conducted by recruiting nursing students from four universities in Seoul, South Korea.

PARTICIPANTS

Sixteen fourth year nursing students were recruited by purposive sampling.

METHODS

This research collected qualitative interview data in up to four rounds of interviews using open-ended and semi-structured interview questions. A total of 23 interviews were conducted. The data were transcribed verbatim. All interview data were analysed using three coding methods; initial, focused, and theoretical coding. NVivo 11 was used for data management.

RESULTS

This research developed a theoretical model of nursing students' learning dynamics with clinical information and communication technology. The model explains three dynamics that influence nursing students' use of clinical information and communication technology (interpersonal, organisational and emotional dynamics) and the students' responses regarding the dynamics for learning in clinical contexts.

CONCLUSIONS

Nursing educators can use the theoretical model to understand how best to support nursing students in navigating their clinical environments to build competency in using clinical information and communication technology.

Discovering aspects of health-experiences of a web-based health diary among adults with primary immunodeficiency

AIM

Advances in technology generate new opportunities to develop e-health tools to help individuals in self-management by assessing symptoms of illness and its relation to treatments. Self-management is central when living with primary immunodeficiency diseases. The aim was to explore the experiences of people living with primary immunodeficiency, who used a pilot version of the web-based health diary.

DESIGN

Explorative design.

METHODS

In total, 16 participants (median age 59) attended one of three focus groups. Inductive content analysis was used.

RESULTS

The participants could be encouraged to discover aspects of their health by contributing to documentation which could support the health concept. A greater understanding about their own health and communicating with healthcare professionals during encounters was expressed. The web-based health diary is a helpful tool to discover aspects of health that affects the individuals' life situation and assists the self-management of a long-term condition such as immunodeficiency.

Decision-makers and mediators in a home healthcare digitisation process: nurses' experiences of implementation and use of a decision support system

BACKGROUND

This study focuses on a decision support system (DSS) for home healthcare and the implementation of it.

AIM

To describe home healthcare nurses' experiences of the implementation and use of a new DSS, with a focus on how it influences decision making in everyday work practice.

DESIGN

A qualitative research design.

METHODS

Data was collected through three focus group interviews with six home healthcare nurses.The data analysis was drawn from Burnard's method for content analysis.

RESULTS

The DSS was experienced as bringing support to decisions, but sometimes incompatible with home healthcare nurses' work practice. Professional understanding and the DSS were sometimes experienced as parallel support systems not assisting work across healthcare organisations.

CONCLUSION

When a DSS is used to transform work of healthcare organisations several aspects should be highlighted. If the organisation does not consider these aspects, nurses may adopt a role as mediator in the implementation process.

Implementation of a web-based national child health-care programme in a local context: A complex facilitator role

Aim: The aim of this study was to investigate child health-care coordinators’ experiences of being a facilitator for the implementation of a new national child health-care programme in the form of a web-based national guide. Methods: The study was based on eight remote, online focus groups, using Skype for Business. A qualitative content analysis was performed. Results: The analysis generated three categories: adapt to a local context, transition challenges and led by strong incentives. There were eight subcategories. In the latent analysis, the theme ‘Being a facilitator: a complex role’ was formed to express the child health-care coordinators’ experiences. Conclusions: Facilitating a national guideline or decision support in a local context is a complex task that requires an advocating and mediating role. For successful implementation, guidelines and decision support, such as a web-based guide and the new child health-care programme, must match professional consensus and needs and be seen as relevant by all. Participation in the development and a strong bottom-up approach was important, making the web-based guide and the programme relevant to whom it is intended to serve, and for successful implementation. The study contributes valuable knowledge when planning to implement a national web-based decision support and policy programme in a local health-care context.

Perceptions of Persons With Type 2 Diabetes Treated in Swedish Primary Health Care: Qualitative Study on Using eHealth Services for Self-Management Support

Background

Digital health services are increasing rapidly worldwide. Strategies to involve patients in self-monitoring of type 2 diabetes (T2D) on a daily basis is of crucial importance, and there is a need to optimize the delivery of care such as self-management support. Digitalized solutions have the potential to modify and personalize the way in which people use primary health services, both by increasing access to information and providing other forms of support at a distance. It is a challenge to integrate core values of person-centered care into digitalized health care services.

Objective

The objective of this study was to describe perceptions of using electronic health (eHealth) services and related technologies for self-management support among people with T2D treated in Swedish primary health care.

Methods

This is a qualitative study based on interviews analyzed using qualitative content analysis conducted among people diagnosed with T2D.

Results

Findings suggest that the participants had mixed feelings regarding the use of digital health services for self-management support. They experienced potentials such as increased involvement, empowerment, and security, as well as concerns such as ambivalence and uncertainty.

Conclusions

Digital health services for self-management are easily accessible and have the potential to reach a wide population. However, targeted training to increase digital skills is required, and personalized devices must be adapted and become more person-centered to improve patients’ involvement in their own care.

Testing an app for reporting health concerns-Experiences from older people and home care nurses

AIMS AND OBJECTIVES

To explore the experiences of using an app among older people with home-based health care and their nurses.

BACKGROUND

Few information and communication technology innovations have been developed and tested for older people with chronic conditions living at home with home-based health care support. Innovative ways to support older people's health and self-care are needed.

DESIGN

Explorative qualitative design.

METHODS

For 3 months to report health concerns, older people receiving home-based health care used an interactive app, which included direct access to self-care advice, graphs and a risk assessment model that sends alerts to nurses for rapid management. Interviews with older people (n = 17) and focus group discussions with home care nurses (n = 12) were conducted and analysed using thematic analysis.

RESULTS

The findings reveal that a process occurs. Using the app, the older people participated in their care, and the app enabled learning and a new way of communication. The interaction gave a sense of security and increased self-confidence among older people. The home care nurses viewed the alerts as appropriate for the management of health concerns. However, all participants experienced challenges in using new technology and had suggestions for improvement.

CONCLUSIONS

The use of an app appears to increase the older people's participation in their health care and offers them an opportunity to be an active partner in their care. The app as a new way to interact with home care nurses increased the feeling of security. The older people were motivated to learn to use the app and described potential use for it in the future.

IMPLICATIONS FOR PRACTICE

The use of an app should be considered as a useful information and communication technology innovation that can improve communication and accessibility for older people with home-based health care.