Nurses as Stakeholders in the Adoption of Mobile Technology in Australian Health Care Environments: Interview Study

Glycemic Outcomes and Nurse Perceptions of Continuous Glucose Monitoring for Hospitalized Patients

BACKGROUND

Continuous glucose monitoring (CGM) can decrease hypoglycemic events and health care costs; however, barriers and facilitators that influence CGM use are unknown.

PURPOSE

The purpose of this study was to evaluate hypoglycemic events and cost outcomes after CGM implementation and describe associated barriers and facilitators.

METHODS

A mixed-methods study design was used to evaluate CGM implementation on 2 pulmonary units within an academic health center. Hypoglycemic events were evaluated before and after CGM implementation, and nurses were interviewed about facilitators and barriers that influence CGM use.

RESULTS

Hypoglycemic events decreased from a rate of 0.0906 per 1000 patient days to 0.0503 postimplementation, P < .0001. A $105 766 cost avoidance was recognized. Barriers and facilitators to CGM use are described.

CONCLUSIONS

Findings support CGM implementation, while uniquely contributing financial impact and device use barriers and facilitators. Hospitals may consider CGM use to improve timely identification and treatment of hypoglycemia.

Healthcare workers' informal uses of mobile phones and other mobile devices to support their work: a qualitative evidence synthesis

BACKGROUND

Healthcare workers sometimes develop their own informal solutions to deliver services. One such solution is to use their personal mobile phones or other mobile devices in ways that are unregulated by their workplace. This can help them carry out their work when their workplace lacks functional formal communication and information systems, but it can also lead to new challenges.

OBJECTIVES

To explore the views, experiences, and practices of healthcare workers, managers and other professionals working in healthcare services regarding their informal, innovative uses of mobile devices to support their work.

SEARCH METHODS

We searched MEDLINE, Embase, CINAHL and Scopus on 11 August 2022 for studies published since 2008 in any language. We carried out citation searches and contacted study authors to clarify published information and seek unpublished data.

SELECTION CRITERIA

We included qualitative studies and mixed-methods studies with a qualitative component. We included studies that explored healthcare workers' views, experiences, and practices regarding mobile phones and other mobile devices, and that included data about healthcare workers' informal use of these devices for work purposes.

DATA COLLECTION AND ANALYSIS

We extracted data using an extraction form designed for this synthesis, assessed methodological limitations using predefined criteria, and used a thematic synthesis approach to synthesise the data. We used the 'street-level bureaucrat' concept to apply a conceptual lens to our findings and prepare a line of argument that links these findings. We used the GRADE-CERQual approach to assess our confidence in the review findings and the line-of-argument statements. We collaborated with relevant stakeholders when defining the review scope, interpreting the findings, and developing implications for practice.

MAIN RESULTS

We included 30 studies in the review, published between 2013 and 2022. The studies were from high-, middle- and low-income countries and covered a range of healthcare settings and healthcare worker cadres. Most described mobile phone use as opposed to other mobile devices, such as tablets. We have moderate to high confidence in the statements in the following line of argument. The healthcare workers in this review, like other 'street-level bureaucrats', face a gap between what is expected of them and the resources available to them. To plug this gap, healthcare workers develop their own strategies, including using their own mobile phones, data and airtime. They also use other personal resources, including their personal time when taking and making calls outside working hours, and their personal networks when contacting others for help and advice. In some settings, healthcare workers' personal phone use, although unregulated, has become a normal part of many work processes. Some healthcare workers therefore experience pressure or expectations from colleagues and managers to use their personal phones. Some also feel driven to use their phones at work and at home because of feelings of obligation towards their patients and colleagues. At best, healthcare workers' use of their personal phones, time and networks helps humanise healthcare. It allows healthcare workers to be more flexible, efficient and responsive to the needs of the patient. It can give patients access to individual healthcare workers rather than generic systems and can help patients keep their sensitive information out of the formal system. It also allows healthcare workers to communicate with each other in more personalised, socially appropriate ways than formal systems allow. All of this can strengthen healthcare workers' relationships with community members and colleagues. However, these informal approaches can also replicate existing social hierarchies and deepen existing inequities among healthcare workers. Personal phone use costs healthcare workers money. This is a particular problem for lower-level healthcare workers and healthcare workers in low-income settings as they are likely to be paid less and may have less access to work phones or compensation. Out-of-hours use may also be more of a burden for lower-level healthcare workers, as they may find it harder to ignore calls when they are at home. Healthcare workers with poor access to electricity and the internet are less able to use informal mobile phone solutions, while healthcare workers who lack skills and training in how to appraise unendorsed online information are likely to struggle to identify trustworthy information. Informal digital channels can help healthcare workers expand their networks. But healthcare workers who rely on personal networks to seek help and advice are at a disadvantage if these networks are weak. Healthcare workers' use of their personal resources can also lead to problems for patients and can benefit some patients more than others. For instance, when healthcare workers store and share patient information on their personal phones, the confidentiality of this information may be broken. In addition, healthcare workers may decide to use their personal resources on some types of patients, but not others. Healthcare workers sometimes describe using their personal phones and their personal time and networks to help patients and clients whom they assess as being particularly in need. These decisions are likely to reflect their own values and ideas, for instance about social equity and patient 'worthiness'. But these may not necessarily reflect the goals, ideals and regulations of the formal healthcare system. Finally, informal mobile phone use plugs gaps in the system but can also weaken the system. The storing and sharing of information on personal phones and through informal channels can represent a 'shadow IT' (information technology) system where information about patient flow, logistics, etc., is not recorded in the formal system. Healthcare workers may also be more distracted at work, for instance, by calls from colleagues and family members or by social media use. Such challenges may be particularly difficult for weak healthcare systems.

AUTHORS' CONCLUSIONS

By finding their own informal solutions to workplace challenges, healthcare workers can be more efficient and more responsive to the needs of patients, colleagues and themselves. But these solutions also have several drawbacks. Efforts to strengthen formal health systems should consider how to retain the benefits of informal solutions and reduce their negative effects.

Analysis of the effect of digital hospital efforts on paper savings in inpatient procedures and on the duration of nursing care services

Background

This study has two primary objectives. Firstly, it aims to measure the time savings achieved through the digitization of paper forms filled out by nurses in the inpatient care process. Secondly, it seeks to reveal the financial savings resulting from reduced paper consumption due to the digitalization. The Health Information Management System Society (HIMSS)-Electronic Medical Record Adaption Model (EMRAM), which makes stage-based (0-7) evaluations, serves as a tool to measure the rate of technology utilization in public hospitals in Turkey. The study is based on the HIMSS EMRAM criteria for 2018. Bahçelievler State Hospital, a public hospital in Turkey, was chosen as the research facility. In 2017, it was accredited as Stage 6 with HIMSS EMRAM. However, not all its wards have been digitalized. Initially, pilot selected wards were digitized. Therefore, digital and non-digital wards serve together. In this context, 4 wards were randomly selected and time, paper and toner savings before and after digitalization were measured.

Method

A table was created in Microsoft Excel,listing the forms used by nurses in inpatient care and the time required to fill them out.The time spent for filling paper-based forms and digital-based forms was measured in randomly selected wards.

Result

The analysis showed that digital forms saved more time, paper and toner. For example, filling out the patient history form took 45 min when using paper, compared to 12 min in digital environment. Approximately 27% time savings are achieved only for the patient history form. The total time savings delivered by digitalization for 1,153 inpatients during the year were found as 117 care days, and the savings on total paper consumption was 41.289 pages. For 1,153 inpatients throughout the year, the total time savings from digitalization was 117 care days and the total paper consumption savings was 41,289 pages. In addition, in 4 wards with a total bed capacity of 25, annual paper savings of $1,705.86 and toner savings of $283,736 were achieved.

Discussion

This study reveals the benefits of digitalisation in hospitals for nurses. It saves the time that nurses allocate for filling out paper forms with digitalised forms. Thus, it is a good practice example in terms of using the time allocated for form filling for patient care.When we extend this study to Turkey in general, it can be considered that the time savings achieved by nurses by digitizing inpatient forms varies between 10.8% and 13%. The number of nurses working in public hospitals in Turkey is approximately 160,000. Assuming that 60% of the nurses work in the inpatient ward, it is understood that the annual savings achieved by digitizing the forms corresponds to a range of 398-559 nursing hours.

Sociotechnical Challenges of Digital Health in Nursing Practice During the COVID-19 Pandemic: National Study

BACKGROUND

The COVID-19 pandemic has accelerated the use of digital health innovations, which has greatly impacted nursing practice. However, little is known about the use of digital health services by nurses and how this has changed during the pandemic.

OBJECTIVE

This study explored the sociotechnical challenges that nurses encountered in using digital health services implemented during the pandemic and, accordingly, what digital health capabilities they expect from the emerging workforce.

METHODS

Five groups of nurses, including chief nursing information officers, nurses, clinical educators, nurse representatives at digital health vendor companies, and nurse representatives in government bodies across Australia were interviewed. They were asked about their experience of digital health during the pandemic, their sociotechnical challenges, and their expectations of the digital health capabilities of emerging nurses to overcome these challenges. Interviews were deductively analyzed based on 8 sociotechnical themes, including technical challenges, nurse-technology interaction, clinical content management, training and human resources, communication and workflow, internal policies and guidelines, external factors, and effectiveness assessment of digital health for postpandemic use.

RESULTS

Sixteen participants were interviewed. Human factors and clinical workflow challenges were highly mentioned. Nurses' lack of knowledge and involvement in digital health implementation and evaluation led to inefficient use of these technologies during the pandemic. They expected the emerging workforce to be digitally literate and actively engaged in digital health interventions beyond documentation, such as data analytics and decision-making.

CONCLUSIONS

Nurses should be involved in digital health interventions to efficiently use these technologies and provide safe and quality care. Collaborative efforts among policy makers, vendors, and clinical and academic industries can leverage digital health capabilities in the nursing workforce.

Researching nurses' use of digital technology during the COVID-19 pandemic

The adoption of digital technology by nurses accelerated during the coronavirus disease 2019 (COVID-19) pandemic. However, not all nurses were familiar with the various digital systems used in their organisations and there were reports of digital technology not being fit for purpose. This article describes a service evaluation that used an online survey to obtain nurses' feedback on the digital systems used to support patient care during the pandemic. Fifty-five respondents provided details about 85 separate digital systems. The usability of these systems varied significantly across technology types, while barriers to their use included nurses' lack of digital literacy and inadequate access to IT infrastructure. However, most of the nurse respondents felt that digital technology had supported effective patient care during the COVID-19 pandemic.

eHealth Literacy of Australian Undergraduate Health Profession Students: A Descriptive Study

Rapid growth in digital health technologies has increased demand for eHealth literacy of all stakeholders within health and social care environments. The digital future of health care services requires the next generation of health professionals to be well-prepared to confidently provide high-quality and safe health care. The aim of this study was to explore the eHealth literacy of undergraduate health profession students to inform undergraduate curriculum development to promote work-readiness. A cross-sectional survey was undertaken at an Australian university using the seven-domain eHealth Literacy Questionnaire (eHLQ), with 610 students participating. A one-way Multivariate Analysis of Variance (MANOVA) with follow-up univariate analysis (ANOVA) was used to determine if there were differences in eHLQ scores across 11 sociodemographic variables. Students generally had good knowledge of health (Scale 2); however, they had concerns over the security of online health data (Scale 4). There were also significant differences in age and ownership of digital devices. Students who were younger reported higher scores across all seven eHLQ scales than older students. This research provided an understanding of eHealth literacy of health profession students and revealed sub-groups that have lower eHealth literacy, suggesting that digital health skills should be integrated into university curriculums, especially related to practice-based digital applications with special focus to address privacy and security concerns. Preparation of health profession students so they can efficiently address their own needs, and the needs of others, is recommended to minimise the digital divide within health and social care environments.

Digital Nursing Technology to Achieve Job Satisfaction: A Systematic Review

BACKGROUND: Technological advances are needed to provide nursing care for patients, however, there are still different perceptions of nurses in accepting its application in health care. This is because the use of these technologies can affect job satisfaction of nurses. AIM: This study aims to identify the digital technology in nursing and its effect on nurses’ job satisfaction. METHODS: This study used a systematic review method, where the articles are obtained on scientific databases such as PubMed, PubMed Central, Science Direct, Scopus, and Web of Sciences, that were published from 2019 to 2021. Meanwhile, the preferred reporting items were analyzed using Systematic Reviews and Meta-Analyses. RESULTS: Out of the 312 articles that were screened and checked, only 17 fulfill the eligibility criteria. The result showed that six articles were perceived as positive on the use of technology by nurses, six articles were positive and negative, and five articles were all negative. Furthermore, there were ten articles on technology information and communication, five on sensor technology, one article on the use of sensors and technology information, and another one article on technology. CONCLUSION: Nurses have a positive response because technology makes the completion of work easier, maintains patient safety where job satisfaction is affected, however, negative perceptions are the basis for solving the problems. Therefore, support from their leaders is required to motivate and create nurses’ awareness of technology to achieve patient safety goals and centered care.

When online learning becomes compulsory: Student nurses' adoption of information communication technology in a private nursing education institution

BACKGROUND

Integrating the use of information communication technology (ICT) in nursing curricula when preparing student nurses for the digital health future such as the sudden online learning as a result of the coronavirus disease 2019 (COVID-19) pandemic is vital. However, when student nurses in a South African private nursing education institution, struggled to complete obligatory online learning courses, nurse educators had to search for solutions.

OBJECTIVES

To explore the barriers and enablers for ICT adoption by a diverse group of student nurses in a private nursing education institution in the Free State Province.

METHOD

Following a qualitative, explorative, interpretive-descriptive design, student nurses were invited to participate. Based on all-inclusive, purposive sampling with inclusion criteria enabled selecting, a total of 17 participants who took part in three focus groups and written narratives. Transcribed interviews underwent thematic analysis with co-coder consensus. The study adhered to strategies to enhance trustworthiness.

RESULTS

Students shared their views related to ICT and online learning within their theory and practice training. Student nurses held positive, negative and contrasting views of ICT adoption and online learning. Actions to master ICT adoption and online learning are highlighted. Information communication technology brings a challenging interdependence between nurses and technology.

CONCLUSION

Integration of ICT into nursing programmes is important. The enablers and barriers to ICT are described. Expose students to different technologies, especially using smart phones to search for (academic/non-academic) information. The adoption of ICT should enhance the learning process and facilitate deep learning. Students preferred online learning for self-assessment and described how they tried to master ICT and online learning. Information communication technologies in the clinical setting highlight the challenged interdependence between nurses and technology. Context-specific recommendations are proposed.

When online learning becomes compulsory: Student nurses' adoption of information communication technology in a private nursing education institution

Background

Integrating the use of information communication technology (ICT) in nursing curricula when preparing student nurses for the digital health future such as the sudden online learning as a result of the coronavirus disease 2019 (COVID-19) pandemic is vital. However, when student nurses in a South African private nursing education institution, struggled to complete obligatory online learning courses, nurse educators had to search for solutions.

Objectives

To explore the barriers and enablers for ICT adoption by a diverse group of student nurses in a private nursing education institution in the Free State Province.

Method

Following a qualitative, explorative, interpretive-descriptive design, student nurses were invited to participate. Based on all-inclusive, purposive sampling with inclusion criteria enabled selecting, a total of 17 participants who took part in three focus groups and written narratives. Transcribed interviews underwent thematic analysis with co-coder consensus. The study adhered to strategies to enhance trustworthiness.

Results

Students shared their views related to ICT and online learning within their theory and practice training. Student nurses held positive, negative and contrasting views of ICT adoption and online learning. Actions to master ICT adoption and online learning are highlighted. Information communication technology brings a challenging interdependence between nurses and technology.

Conclusion

Integration of ICT into nursing programmes is important. The enablers and barriers to ICT are described. Expose students to different technologies, especially using smart phones to search for (academic/non-academic) information. The adoption of ICT should enhance the learning process and facilitate deep learning. Students preferred online learning for self-assessment and described how they tried to master ICT and online learning. Information communication technologies in the clinical setting highlight the challenged interdependence between nurses and technology. Context-specific recommendations are proposed.

Provider perceptions of mHealth engagement for low-resourced, safety-net communities

OBJECTIVE

Evaluate nurses' and other health care professionals' (HCPs) perceptions about implementing mobile health technology (mHealth) in clinical practice to support health care delivery for low-resourced, safety-net communities.

DESIGN

Qualitative exploratory study using data collected from focus group sessions. Respondents addressed four topics: (1) technology's role in health care delivery; (2) barriers to incorporating mHealth data in clinical practice; (3) need for mHealth Clinical Practice Guide (CPG); and (4) mHealth's potential to improve health care access for marginalized communities.

SAMPLE

Thirty HCPs providing services to community health center patients in Washington State and Washington, DC.

MEASUREMENTS

Thematic analysis of qualitative data.

RESULTS

Themes included:(1) mHealth's ability to provide customized reminders and data accuracy; (2) patients' mistrust of technology; (3) the possibility of linking community resources to address the social determinants of health;(4) mHealth's potential to improve patient-provider communication.

CONCLUSION

Health care professionals support incorporating mHealth inpatient care but suggest that an mHealth CPG would improve its potential for facilitating health care delivery in low-resourced communities.

Identification of Factors Influencing the Adoption of Health Information Technology by Nurses Who Are Digitally Lagging: In-Depth Interview Study

BACKGROUND

The introduction of health information technology (HIT) has drastically changed health care organizations and the way health care professionals work. Some health care professionals have trouble coping efficiently with the demands of HIT and the personal and professional changes it requires. Lagging in digital knowledge and skills hampers health care professionals from adhering to professional standards regarding the use of HIT and may cause professional performance problems, especially in the older professional population. It is important to gain more insight into the reasons and motivations behind the technology issues experienced by these professionals, as well as to explore what could be done to solve them.

OBJECTIVE

Our primary research objective was to identify factors that influence the adoption of HIT in a sample of nurses who describe themselves as digitally lagging behind the majority of their colleagues in their workplaces. Furthermore, we aimed to formulate recommendations for practice and leadership on how to help and guide these nurses through ongoing digital transformations in their health care work settings.

METHODS

In a Dutch university medical center, 10 face-to-face semi-structured interviews were performed with registered nurses (RN). Ammenwerth's FITT-framework (fit between the Individual, Task, and Technology) was used to guide the interview topic list and to formulate themes to explore. Thematic analysis was used to analyze the interview data. The FITT-framework was also used to further interpret and clarify the interview findings.

RESULTS

Analyses of the interview data uncovered 5 main categories and 12 subthemes. The main categories were: (1) experience with digital working, (2) perception and meaning, (3) barriers, (4) facilitators, and (5) future perspectives. All participants used electronic devices and digital systems, including the electronic health record. The latter was experienced by some as user-unfriendly, time-consuming, and not supportive in daily professional practice. Most of the interviewees described digital working as "no fun at all," "working in a fake world," "stressful," and "annoying." There was a lack of general digital knowledge and little or no formal basic digital training or education. A negative attitude toward computer use and a lack of digital skills contributed to feelings of increased incompetency and postponement or avoidance of the use of HIT, both privately and professionally. Learning conditions of digital training and education did not meet personal learning needs and learning styles. A positive impact was seen in the work environment when colleagues and nurse managers were aware and sensitive to the difficulties participants experienced in developing digital skills, and when there was continuous training on the job and peer support from digitally savvy colleagues. The availability of a digital play environment combined with learning on the job and support of knowledgeable peers was experienced as helpful and motivating by participants.

CONCLUSIONS

Nurses who are digitally lagging often have had insufficient and ineffective digital education. This leads to stress, frustration, feelings of incompetency, and postponement or avoidance of HIT use. A digital training approach tailored to the learning needs and styles of these nurses is needed, as well as an on-the-job training structure and adequate peer support. Hospital management and nurse leadership should be informed about the importance of the fit between technology, task, and the individual for adequate adoption of HIT.