Evidence Summary
Nurses Need Training and Policies to Address Barriers to Use of Mobile
Devices and Apps for Direct Patient Care in Hospital Settings
A Review of:
Giles-Smith,
L., Spencer, A., Shaw, C., Porter, C., & Lobchuk,
M. (2017). A study of the impact of an
educational intervention on nurse attitudes and behaviours toward mobile device
and application use in hospital settings. Journal of the Canadian Health Libraries
Association/Journal de l'Association des bibliothèques de la santé du Canada, 38(1), 12-29.
doi: 10.5596/c17-003
Reviewed by:
Kelley Wadson
Library Information Specialist
Bow Valley College
Calgary, Alberta, Canada
Email: kwadson@bowvalleycollege.ca
Received: 4
Dec. 2017 Accepted: 21 Feb. 2018
2018 Wadson.
This is an Open Access article distributed under the terms of the Creative
Commons‐Attribution‐Noncommercial‐Share Alike License 4.0
International (http://creativecommons.org/licenses/by-nc-sa/4.0/),
which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly attributed, not used for commercial
purposes, and, if transformed, the resulting work is redistributed under the
same or similar license to this one.
Abstract
Objective - To describe nurses’ usage of and attitudes
toward mobile devices and apps and assess the impact of an educational
intervention by hospital librarians and educators
Design - Descriptive, cross-sectional survey,
one-group pre- and post-test, and post-intervention focus group
Setting - One 251-bed community hospital and one
554-bed tertiary care hospital in Winnipeg, Canada
Subjects - 348 inpatient medical and surgical nurses
Methods – The study had two phases. In Phase I,
respondents completed a survey of 21 fixed and open-ended questions offered
online or in print to a convenience sample from the community hospital and a
random sample of medical and surgical units from the tertiary hospital. The
survey collected demographic data and included questions about mobile devices
and apps covering current awareness of hospital policy, ownership, internet
access, usage patterns, concerns, and attitudes toward their use for direct
patient care. It also included information to recruit volunteers for Phase II.
In Phase II, participants attended four 30-minute educational sessions
facilitated by the researchers. The first session addressed the regional health
authority’s policies, Personal Health Information Act, and infection control
practices. Subsequent sessions covered relevance, features, and training
exercises for one or more selected apps. Participants installed five free or
low-cost apps, which were chosen by the librarians and nurse educators, on
their mobile devices: Medscape, Lab Tests Online, Lexicomp,
Twitter, and Evernote. Participants were then given a two-month period to use
the apps for patient care. Afterward, they completed the same survey from Phase
I and their pre- and post-intervention responses were matched for comparative
analysis. Phase II concluded with a one-hour audio-recorded focus group using
ten open-ended questions to gather feedback on the impact of the educational
sessions.
Main Results – 94 nurses completed the Phase I survey
for a response rate of 27%. Although 89 respondents reported owning a mobile
device, less than half used them for patient care. Just under half
the respondents were unsure if they were allowed to use mobile devices at work
and a similar number answered that devices were not allowed. Two-thirds of
respondents were unsure whether any institutional policies existed regarding
mobile device use. Of the 16
participants that volunteered for Phase II, 14 completed the post-intervention
survey and 6 attended the focus group. In comparison to the Phase I survey,
post-intervention survey responses showed more awareness of institutional
policies and increased concern about mobile devices causing distraction. In the
Phase I survey, just over half of the nurses expressed a desire to use mobile
devices in patient care.
Four themes emerged from the survey’s
qualitative responses in Phase I:
(1)
policy: nurses were unsure of institutional policy or
experienced either disapproval or bans on mobile device use from management;
(2)
barriers to use, namely cost, potential damage to or
loss of devices, infection control, and lack of familiarity with technology;
(3)
patient perceptions, including generational
differences with younger patients seen as more accepting than older patients;
and
(4)
nurse perceptions: most valued access to information
but expressed concerns about distraction, undermining of professionalism, and
use of technology.
Qualitative responses in the Phase II
survey and focus group also revealed four themes:
(1)
barriers: participants did not cite loss of device or
infection control as concerns as in Phase I;
(2)
patient acceptance and non-acceptance: education and
familiarity with mobile devices were noted as positive influential factors;
(3)
information need, accessibility, and convenience:
nurses reported needing easy-to-use apps, particularly Lexicomp,
and appreciated improved access to information; and
(4)
nurse behaviour and attitude: participants reported
more time would be needed for changes to occur in these areas.
Conclusion – The study found that although most
nurses own mobile devices and express strong interest in using them for patient
care, there are significant barriers including lack of clarity about
institutional policies and concerns about infection control, risk of damage to
personal devices, costs, lack of experience with the
technology, distraction, and negative patient perceptions. To address these
concerns, the authors recommend that hospital librarians and educators work
together to offer training and advocate for improved communication and policies
regarding use of mobile devices in hospital settings. Moreover, the study
affirmed the benefits of using mobile devices and apps to support
evidence-based practice, for example by providing access to reliable drug
information. The authors conclude that additional research is needed to inform
policy and develop strategies that hospital librarians and nurse educators can
use to promote the most effective application of mobile technologies for
patient care.
Commentary
As noted
by the authors, the study contributes to the growing literature addressing the
use of mobile technologies in the nursing workplace. Another recent and larger
study of registered nurses in hospitals in the United States drew similar
results, including concerns about distraction, safety, and policy as well as
generational differences in the perception and use of mobile devices (McBride
& LeVasseur, 2017). The study thus affirms many
of the findings of previous and more recent studies on the topic (McBride &
LeVasseur, 2017; Grabowsky,
2015; Planitz, Sanderson, Kipps, & Driver, 2013).
The study was evaluated using Koufogiannakis, Booth, and Brettle’s
(2006) ReLIANT instrument. Several flaws were found
in the areas of study design and educational context.
In terms of study design, the study’s
objectives, methods, and instruments are well explained but as the authors
recognize in the Discussion section, there are significant limitations due to
the sample size and method that compromise its validity and introduce the risk
of bias. The use of convenience sampling at the community hospital, low
response rate in Phase I, and small sample size in Phase II mean the results
lack external validity and cannot be generalized to the broader population or
beyond. This is reinforced by the composition of the Phase I respondents;
almost half (48%) identified as having less than five years of experience and a
significant portion (35%) were aged 24 to 34, which suggests the sample was not
representative of the target population. Moreover, a calculation of the margin
of error was not provided. Lastly, while inclusion of the research instruments
in the appendices is helpful, the authors do not indicate if these were piloted
or validated.
Additional flaws are found in the study’s
educational context. Although the content of the educational sessions is
clearly outlined, the study lacks description of the teaching method and
learning objectives against which the intervention could have been evaluated.
While the objective of the study suggests the intervention aimed to invoke
affective and behavioural changes, there is no explanation of how or if it
purposively intended to do so through instructional design. The study
consequently missed an opportunity to extend its applicability into the realm
of nursing education curriculum and nursing competencies maintained by
professional associations, which would be relevant for librarians working in
higher education.
The study’s conclusions are most useful
for librarians and nurse educators and managers working in hospital settings.
Specifically, its description of the professional concerns, behaviours, and
barriers to mobile device use encountered by nurses can be used to direct and
inform policy and training interventions in similar contexts. However, given
the deficiencies found in the study design, the study’s findings should be
corroborated by other sources of published evidence to affirm their external
validity and relevance for practice.
References
Grabowsky A. (2015). Smartphone use to answer
clinical questions: A descriptive study of APNs. Medical Reference Services Quarterly, 34(2), 135-148. http://dx.doi.org/10.1080/02763869.2015.1019320
Koufogiannakis, D., Booth, A., & Brettle,
A. (2006). ReLIANT: Reader’s guide to the literature on interventions
addressing the need for education and training. Library & Information
Research, 30(94), 44-51. Retrieved from http://www.lirgjournal.org.uk