Digital Literacy in Nursing

Nurses and Nursing Students’ Attitudes and Beliefs Regarding the Use of Technology in Patient Care: A Mixed-Method Systematic Review

Saab, Mohamad M. PhD, RGNLanders, Margaret PhD, RNT, RGN, RMEgan, Sophia MPHMurphy, David PGDip L&T, BMusHegarty, Josephine PhD, RNT, RGNAuthor Information

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Abstract

Advancements in information technology and computer science have resulted in the development of computerized healthcare information systems. Information technology can optimize patient care through providing immediate electronic education. The purpose of this mixed-methods systematic review was to synthesize evidence from studies exploring nurses and nursing students’ attitudes and beliefs regarding the use of technology in patient care. Electronic databases Academic Search Complete, CINAHL, MEDLINE, Education Full Text, PsycARTICLES, Psychology and Behavioral Sciences Collection, PsycINFO, and ERIC were searched. The methodological quality of the studies was assessed using the Mixed Methods Appraisal Tool. Convergent integrated synthesis was conducted. Eight studies were included. Technologies used in the reviewed studies include smartphones (n = 4) and Web-based information/educational resources (n = 4). Overall, nurses and nursing students’ attitudes and beliefs regarding the use of smartphone applications were positive. When compared with other healthcare professionals, nurses were more likely to have access to Web-based resources and to appraise the importance of such resources in patient education. Nurses and nursing students are in a prime position to use technology in patient care and education. It is important therefore that nurses’ positive attitudes toward technology be reinforced to increase the use and application of Web-based and smartphone technologies in clinical practice.

The application of technology-rich information systems is considered by service providers to be at the core of global health and a positive means of enhancing the quality of patient care.1–3 Recent advancements in information technology and computer science have resulted in the development of computerized information systems across a wide range of healthcare delivery systems.4 According to Kuwabara et al,5 technology has redefined the way patients and healthcare providers communicate and exchange information. Internet-based patient support systems are now widely assumed to play a significant role in patient education initiatives.6,7Nurses are often at the initial point of care and are aware of the importance of communicating with patients regarding their health status on a regular basis.3,8 Nurses also play a key role in empowering patients with chronic conditions to enhance their self-management skills.9 Currently, digital technologies provide great opportunities for nurses to develop patient health-related literacy skills to support the efficacious use of online health information.10–12 Specifically, Darvish et al3 are of the view that information technology can optimize the nursing management of patient care situations by providing immediate electronic education regardless of time or place. Therefore, accurate and easily accessible information is a prerequisite for the provision of safe patient-centered care.10Traditionally, healthcare providers have used paper-based formats such as articles, written messages, and pamphlets as means of providing health-focused information and education to patients.5,13 However, more recently, a wide array of multimedia such as emails, group texting,14 video, audio,5 and interactive patient care technologies15 are being integrated into a number of clinical practice settings. Healthcare professionals are beginning to see evidence of the potential use of such technologies in enhancing patient education.14,16 Indeed, a survey by Moore and Jayewardene16 found that nurses and doctors recognized the benefits of devices such as smartphones and healthcare applications in helping improve patient access to information, decision-making, and efficiency of care. Of the nurse respondents, 58% used their smartphones in practice; this figure was 81% for doctors.16Nurses and nursing students are important contributors to the healthcare workforce and thus important users of information technology in the clinical setting.12 In a cross-sectional study, Tubaishat12 measured fourth-year nursing students’ attitudes toward the use of technology in healthcare. This study highlighted the need to provide further education on technology to final-year nursing students to help prepare for their future role as RNs.12 Tubaishat’s12 findings demonstrate that nursing students hold a generally positive attitude toward technology.According to Kuwabara et al,5 technological devices will continue to develop in their capacity to efficiently monitor, educate, and support individual patients to practice health-related behaviors. Thus, Holden et al17 contend that it is important to explore the perceptions of nurses toward novel technologies in order to use such technologies in clinical practice. Nurses’ attitudes can be a pivotal point upon which successful health-related technology implementation hinges. To this end, the aim of this mixed-methods systematic review was to synthesize evidence from studies that explored nurses and nursing students’ attitudes and beliefs regarding the use of technology in patient care. In particular, this systematic review aimed to answer the following questions:

  • What are the different technologies used in patient care within the included studies?
  • What are nurses and nursing students’ attitudes and beliefs regarding these technologies?
  • What are patients and family members’ attitudes and beliefs regarding these technologies?

METHODS

Design

Mixed-methods systematic reviews allow for the inclusion of qualitative, quantitative, and mixed-methods studies, therefore combining the strengths of quantitative and qualitative research and accounting for design limitations.18 This review was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis19 and reported using the 27-item PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) checklist.20

Eligibility Criteria

Study eligibility criteria were predetermined according to the review aim and questions using the SPIDER (sample, phenomenon of interest, design, evaluation, and research type) framework.21 Studies were considered for inclusion if they included nurses, nursing educators, nurse managers, and nursing students; used any empirical design; and primarily explored participants’ attitudes, beliefs, feelings, and perceptions regarding the use of any technology in patient care in general and education in particular (primary outcome). Studies exploring the way nurses and nursing students use the technology and studies reporting on patient outcomes as a result of using technology (secondary outcomes) were also considered for inclusion.Studies with healthcare professionals other than nurses and studies where findings from nurses could not be isolated were excluded. Studies that have solely evaluated participants’ knowledge, awareness, and behaviors regarding the use of technology in patient care were also excluded. Literature reviews, editorials, opinion pieces, abstracts, dissertations, and theses were not considered for inclusion.