Perceived facilitators and inhibitors for the use of personal digital assistants (PDAs) by nurses: a systematic review

Clint Moloney, Lisa Becarria
JBI Library of Systematic Reviews 2009, 7 (33): 1431-1488

BACKGROUND: It is clear from the literature that more investigation into the infusion of this technology within nursing is required with a particular emphasis on the advantages of documenting best practices in nursing education. Current literature highlights the importance of incorporating wireless devices in nursing organisations without discussing how effectively nurses can collect data. Good information is found on the factors of adoption and barriers associated with such devices in nursing however the evidence supplied in such findings is yet to be well substantiated. Therefore, this study conducted an investigation into the factors of adoption of wireless applications for data collection. By doing so, this review has attempted to fill-in the gap in the literature and provides insights into those factors that need to be given priority when implementing handheld technologies in nursing. The overarching aim of this systematic review was therefore to explore and confirm the facilitators and inhibitors to the adoption of handheld technology in nursing.

OBJECTIVE: The objective of this review was to summarise the available evidence on the facilitators and inhibitors of adopting and utilising handheld wireless technology into the nursing profession. In particular this review set out to understand the supportive interventions that assist nurses to adjust to the use of such technology.

INCLUSION CRITERIA: Types of participants - This review was only interested in the nursing profession and was not limited to any one culture or setting. Therefore the review included nurses both Australian and overseas who were working in acute settings, community settings, and student nurses still in an academic setting.Types of intervention(s)/phenomena of interest - The review only considered studies that were endeavouring to understand the behavioural intention and user acceptance of handheld wireless technology (PDA's) in a nursing setting.Types of studies - This review considered studies that focus on qualitative data including, but not limited to, designs such as phenomenology, ground theory, ethnography, action research and feminist research.Types of outcomes - Outcomes of interest were a strong reflection on the perception of nurses towards the technology and an identification of the major inhibitors and facilitators in adoption and utilisation of the technology.

SEARCH STRATEGY: A three-step search strategy was utilised in each component of this review. An initial limited search of MEDLINE and CINAHL was undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe article. A second search using all identified keywords and index terms was then undertaken across all included databases. Thirdly, the reference list of all identified reports and articles was searched for additional studies.

METHODOLOGICAL QUALITY: Each paper was assessed by two reviewers for methodological quality prior to inclusion in the review using a critical appraisal instrument from Joanna Briggs Institute-Qualitative Assessment and Review Instrument (JBI-QARI) software developed by the Joanna Briggs Institute (JBI), ().

DATA COLLECTION: Qualitative data was extracted from papers included in the review using the standardised data extraction tool from the JBI-QARI ().

DATA SYNTHESIS: The JBI Qualitative Assessment and Review Instrument (JBI-QARI) was utilised to merge similar findings into categories and then similar categories were again narrowed down to a common generic concept.

RESULTS: A total of 18 papers were retrieved. Of these, 11 were included in the review with all 11 being qualitative research papers. Reasons for the 7 papers being excluded from the review, were because experiences of nurses were not addressed (7 papers); the definition of nurse did not fit the inclusion criteria (2 papers); the concept "Nurses utilising PDAs" was not completely clear (1 paper). In addition all 7 of these papers were also excluded because of poor or incomplete descriptions of the methodology following critical appraisal using the JBI-QARI critical appraisal tool. The findings of the remaining 11 papers were extracted and combined in the meta-synthesis. Key findings in this review included: The saving of nursing time; both advantages and disadvantage in assisting with information flow; the assistance of the technology with nurse decision making; varied opinions on the usability of the technology; positive links to nursing support; innovation diffusion considerations; and positive results on the use of the technology as an effective learning tool.

CONCLUSIONS: Findings of this systematic review provide sound evidence that information flow and real-time nurse decision making are enhanced with the use of PDAs in a clinical setting. What is clear is the technology can play a particularly important role in the pre-registered population of nurses still undergoing their training. Nursing support for this cohort would appear fundamental and hence the additional support given by using such technology would appear to enhance critical thinking skills and an ability to analyse evidence based practice information.Wireless connectively to the World Wide Web can expand the breadth of information made available to nursing staff and promote a safer and more therapeutic environment. The role PDAs may have in providing a safer medication administration environment for nurses needs to be investigated in greater depth. Issues of innovation diffusion require significant attention and manufacturers of these devices need to work with the nursing profession to find the most suitable design for a busy clinical setting. E-learning through the use of such technology would appear to have great potential and increase a nurse's exposure to education resources. This would seem of great benefit to student nurses in the academic sector.

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