Nursing, a practice discipline, occurs in many environments: from home care, to acute care, to the care of the community. Nurses in a variety of settings have used PDAs, and the results of PDA use have been briefly reported in the literature. Goss and Carrico1 have reported the use of PDAs by the infusion therapy team of the infection control department for enhancing evidence-based decision making. Here they highlight to need to better understand user intent and in doing so better understand the motivating factors to usage. Several studies have reported a positive impact of PDAs on nursing practice however were truly unable to highlight the driving forces behind this positive adoption.2-4 A common theme among investigators was the positive impact of PDAs on providing care consistent with the best evidence and reduction of errors. This could be outlined as a motivating factor for nurses however requires further exploration.
Another report indicates the use of the PDA by nurses in the operating room, which improves care and saves them time by streamlining their work, these too could be interpreted as facilitators to the usage of the PDA by nurses however requires a deeper analysis.5 Also, PDAs have been used by nurses and the healthcare team for point-of care trauma documentation. Findings support the use for many reasons, but most notably the alleviation of repetitive documentation by the nurse and team members.6 Few articles appear in the literature on the use of PDAs by nurse educators for teaching and infusing technology into clinical practice. Clinical nursing instructors use PDAs for student record keeping and evaluation.7 One article focused on the use of handheld technology in nursing education and suggested infusion of the technology into nursing curricula by first adopting the use of the PDA in a pharmacology class.8 For this pharmacology class, the students were required to purchase a PDA. In this course project, the faculty found incorporation of the PDA as a teaching strategy challenge; however, the students reported positive responses to the inclusion of this technology. Currently minimal literature is available on the evaluation of the use of the PDA by baccalaureate and/or accelerated baccalaureate students. For documentation of best practices in nursing education, more investigation into this technology infusion in nursing curricula is needed. Current literature highlights the importance of incorporating wireless devices in organisations without discussing how effectively nurses can collect data. Good information is found on the factors of adoption9 and barriers associated with such devices in nursing however the evidence supplied in such findings is yet to be well substantiated. Therefore, this study will conduct an investigation into the factors of adoption of wireless applications for data collection. By doing so, this study will fill-in the gap in the literature and provide insights into those factors that need to be given priority while using handheld technologies in nursing. The overarching aim of this systematic review is therefore to explore and confirm the drivers and inhibitors to the adoption of handheld technology in nursing.
This systematic review seeks to identify known facilitators and barriers to the use of held technologies in nursing and examine the experiences of nurses when using this technology.
More specifically, the objectives are to identify:
The meaningfulness and appropriateness of hand held technologies for the nursing profession.
Criteria for considering studies for this review
Types of Studies
This review will consider any interpretive studies that draw on the experiences of nurses using PDAs or relevant hand held technologies including, but not limited to, designs such as phenomenology, grounded theory and ethnography. In the absence of research studies, other text such as opinion papers and reports will be considered.
Types of participants
This review will consider studies that include nurses and hand held technologies working within a structured health environment. This review will look at including PDA experiences from a wide range of clinical nursing environments such as acute care, critical care, intensive care unit (ICU), emergency care, and community nursing.
Phenomena of Interest
This component of the review will only consider studies that include the experiences of nurses using PDAs or hand held technologies.
This study will seek to include PDA experiences from a wide range of clinical environment such as acute care, critical care, intensive care unit (ICU), emergency care, and community nursing. Articles which explore behavioural issues, technology & infrastructure issues, workload issues, education & training issues, access to resources issues and nurses' experience will be included to get a bigger picture on the use of PDA.
Types of outcome measures
Outcomes of interest that relate to the experiences of nurses using PDAs and/or hand held technologies will be explored in both a positive and negative context. Themes or emerging themes derived through qualitative techniques such as interviews or focus group discussion will be included. Interactions of interest will be those that are apparent across the nursing profession and those within the nursing team itself.
Search Strategy for identification of studies
The search strategy of this review aims to find both published and unpublished studies and papers. The search will be limited to English language reports. A three-step search strategy will be utilised in each component of this review. An initial limited search of MEDLINE and CINAHL will be undertaken followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms will then be undertaken. Thirdly, the reference list of all identified reports and articles will be searched for additional studies.
The databases to be searched include:
- Cochrane library
- Database of Abstracts of Reviews of Effectiveness (DARE)
- Worldviews on Evidence based Nursing Journal
- Journal of Advanced Nursing (Blackwell Publishing Ltd - which publishes systematic reviews)
- ACM Digital library
- Academic Search Premier, Psychology and Behavioural Science Collection
- Science Direct
- QuEST [deals exclusively with qualitative evidence
- Multiple database search (which combines - ACM Digital library, EBSCOhost research databases, EBSCOhost-Academic search premier, Psychology and behavioural science collection, PsycINFO, Science Direct, Wiley Interscience)
The search for unpublished studies will include:
Grey literature in the form of dissertations, conference materials etc that meet the inclusion criteria will be included.
The search will be limited to the following years (1995 to 2008). The search is unlikely to identify studies using PDAs prior to 1995 and between 1995 - 2000 as the internet became popular only around 1994 -1995 and nurses access to information and to newer technologies such as PDA is still a new concept in many countries. However, this systematic review will not exclude studies that have been conducted prior to 2000 and found useful to this study.
Initial Keywords to be used for qualitative components of this review will be:
- PDA or personal digital assistant
- Handheld Computer + (s)
- Hand Held Computer + (s)
- Nurses + PDA
- Nurse + technology
- Nurse + decision making
- PDA + Clinical decision making
- PDA + decision making
- Evidence + technology
- Point of Care
- Data Collection
- Data Error + PDA
- Improve patient care
- Technology + patient
Reference lists and bibliographies of articles collected from those identified in the above process will also be searched for eligible studies.
A search of eligible studies (matching the including criteria) will also be conducted using other sources, such as:
- Searching of relevant conference proceedings (available through CDROM, Internet, and databases)
- Reference lists of all eligible papers and reviews, identified from selected cited papers
- Authors of relevant papers will be contacted for further published or unpublished information
- Organisations that may be carrying out relevant case studies or project that may be similar or may be of relevance
Methods of review
Papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardised critical appraisal instruments from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information package (SUMARI, Appendix II and III). Any disagreements that arise between the reviewers will be resolved through discussion with a third reviewer.
Data will be extracted from papers included in the review using the standardised data extraction tool (QARI) from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information package (Appendix V and VI).
Where meta-synthesis is possible, qualitative research findings will be pooled using the Qualitative Assessment and Review Instrument (QARI). This will involve the aggregation or synthesis of findings to generate a set of statements that represent that aggregation, through assembling the findings (Level 1 findings) rated according to their quality, and categorising these findings on the basis of similarity in meaning (Level 2 findings). These categories are then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesised findings (Level 3 findings) that can be used as a basis for evidence-based practice. Where textual pooling is not possible the findings will be presented in narrative form.
Textual papers will, where possible, be pooled using the Narrative, Opinion and Text Assessment and Review Instrument (JBI-BITARI). This will involve the aggregation or synthesis of conclusions to generate a set of statements that represent that aggregation, through assembling and categorising these conclusions on the bases of similarity in meaning. These categories are then subjected to a meta-aggregation in order to produce a single comprehensive set of synthesised findings that can be used as a basis for evidence-based practice. Where textual pooling is not possible the conclusions will be presented in narrative format.
Potential conflicts of interest
Sources of Support
- Australian Centre for Rural and Remote Evidence Based Practice (ACRREBP), a division of Queensland Health
- University of Southern Queensland
1. Goss L, Carrico R. Get a grip on patient safety: outcomes in the palm of your hand. J Infusion Nurs.
2. Craig AE. Personal digital assistant use: practical advice for the advanced practice nurse. Top Adv Pract Nurs.
3. Moore L, Richardson BR, Williams RW. The USU medical PDA initiative: the PDA as an educational tool. In: Kohane IS, ed. Bio *Medical Informatics: One Discipline/The Annual Symposium of the American Medical Informatics Association, Proceedings, November 9-13, 2002.
Philadelphia, Pa: Hanley & Belfus; 2002:528-532.
4. Scordo KA, Yeager S, Young L. Use of personal digital assistants with acute care nurse practitioner students. AACN Clin Issues.
5. McCord L. Using a personal digital assistant to streamline the OR workload. AORN J.
6. Eastes L. Use of the personal digital assistant for point-of-care trauma documentation. J Emerg Nurs.
7. Lehman K. Clinical nursing instructor's use of handheld computers for student recordkeeping and evaluation. J Nurs Educ.
8. Huffstuler S, Wyatt T, Wright C. The use of handheld technology in nursing education. Nurse Educ.
9. Gururajan, Raj and Moloney, Clint and Soar, Jeffrey (2005) Challenges for implementing wireless hand-held technology in health care: views from selected Queensland nurses.
Journal of Telemedicine and Telecare, 11 (Supplement 2). pp. 37-38.
Appendix I JBI QARI Critical Appraisal Checklist for Interpretive & Critical Research
Appendix II JBI Critical Appraisal Checklist for Narrative, Expert opinion & text
Appendix III JBI QARI Data Extraction Form for Interpretive & Critical Research
Appendix IV JBI Data Extraction for Narrative, Expert opinion & text