Background: The existence, usage and benefits of digital technologies in nursing care are relevant topics in the light of the current discussion on technologies as possible solutions to problems such as the shortage of skilled workers and the increasing demand for long-term care. A lack of good empirical overviews of existing technologies in the present literature prompted us to conduct this review. Its purpose was to map the field of digital technologies for informal and formal care that have already been explored in terms of acceptance, effectiveness and efficiency (AEE), and to show the scope of the used methods, target settings, target groups and fields of support. Methods: A systematic literature search was conducted using Medline, Scopus, CINAHL, Cochrane Library, ACM Digital Library, IEEE Xplore, the Collection of Computer Science Bibliographies, GeroLit and CareLit. In addition, project websites were manually screened for relevant publications. Results: Seven hundred fifteen papers were included in the review. Effectiveness studies have been most frequently performed for ICT, robots and sensors. Acceptance studies often focussed on ICT, robots and EHR/EMR. Efficiency studies were generally rare. Many studies were found to have a low level of evidence. Experimental designs with small numbers and without control groups were the most common methods used to evaluate acceptance and effectiveness. Study designs with high evidence levels were most commonly found for ICT, robots and e-learning. Technologies evaluated for informal caregivers and children or indicated for formal care at home or in cross-sectoral care were rare. Conclusion: We recommend producing high-quality evaluations on existing digital technologies for AEE in real-life settings rather than systematic reviews with low-quality studies. More focus should be placed on research into efficiency. Future research should be devoted to a closer examination of the applied AEE evaluation methods. Policymakers should provide funding to enable large-scale, long-term evaluations of technologies in the practice of care, filling the research gaps for technologies, target settings and target groups identified in this review.

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There is a need for development and implementation of economically driven studies, with methods adjusted to particular character of HP and/or PP strategies for older population.

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Introduction: Even though the importance of nurses' participation in the process of technology development is frequently stressed by stakeholders, participation has been described as negligible and limited by nurses' abilities to identify and communicate their needs and ideas for application scenarios or the improvement of digital nursing technologies (DNT) in everyday care practice. Prior research often uses hypothetical scenarios or laboratory settings with little real-world relevance, and the number of studies investigating needs for technology development, application scenarios or requested technologies from the perspective of nurses with experience in technology use is exceedingly small. Against this background, this study aims to investigate needs, application scenarios and perspectives of nurses with practical experience in real-world DNT application in a range of different care settings. Methods: An explanatory sequential mixed methods design including an online survey (QUANT) and focus group (FG) discussions (qual) was used to explore nurses' perspectives and experiences. A convenience sample of participants was accessed via 19,000 e-mail contacts of directors of nursing (DONs) in care facilities and hospitals throughout Germany. Preliminary results of the online survey were discussed and elaborated in depth in three FGs. Quantitative results of the online survey were included in the development of the interview guideline for and data collection from the FGs. Descriptive, settingspecific analysis was conducted for quantitative data, and qualitative data was analysed by identifying key aspects. Results: A total of 1,335 participants took part in the online survey, most of whom worked in ambulatory care institutions and held management positions such as DON or team leader. There were 14 FG participants. Ninety-five per cent of the participants of the online survey reported having experience in the use of DNT, predominantly with information and communication technologies (ICT). Overall, DNT were deemed to make work easier, and participants concurred on other positive effects such as increased efficiency or saved time and improved quality of care. Negative effects or concerns were reported less frequently. Reasons for non-adoption included technology-related (e.g. usability, functionality) and non-technologyrelated (e.g. competencies and context factors) issues, and facilitators for adoption were discussed in the FGs. Key aspects of application scenarios were enhanced technological support of direct nursing care tasks to reduce physical burden and mental stressors. Specifically, participants of the FGs expressed their wish for participative development and a general openness for nurses to be included in the development and testing of digital technologies. Discussion and conclusion: Although efforts in development, research and theory-building have been increasing over recent years, DNT that go beyond more traditional or common applications within the ICT category (such as electronic nursing records or proces...

BackgroundThe support of health promotion activities for older people gains societal relevance in terms of enhancing the health and well-being of older people with a view to the efficient use of financial resources in the healthcare sector. Health economic evaluations have become an important instrument to support decision-making processes in many countries. Sound evidence on the cost-effectiveness of health promotion activities would encourage support for the implementation of health promotion activities for older people. This debate article discusses to what extent economic evaluation techniques are appropriate to support decision makers in the allocation of resources regarding health promotion activities for older people. We address the problem that the economic evaluation of these interventions is hampered by methodological obstacles that limit comparability, e.g. with economic evaluations of curative measures. Our central objective is to describe and discuss the specific problems and challenges entailed in the economic evaluation of health promotion activities especially for older people with regard to their usefulness for informing decision making processes.DiscussionBeyond general problems concerning the economic evaluation of health promotion, our discussion focusses on problems that pertain to the analysis of cost and outcomes of health promotion interventions for older people. With regard to costs these are general problems of economic evaluations, namely the actual implementation of a societal perspective, the appropriate measurement and valuation of informal caregiver time, the measurement and valuation of productivity costs and costs incurred in added years of life. The main problems concerning the identification and measurement of outcomes are related to the identification of outcome parameters that, firstly, adequately reflect the broad effects of health promotion interventions, especially social benefits that gain importance for older people, and secondly, ensure a comparability of effects across different age groups. In particular, the limitations of the widely used QALY for older people are discussed and recently developed alternatives are presented.ConclusionsThe key conclusion of the article is that a comparison of the effects of different health promotion initiatives between different age groups by means of economic evaluation is not recommendable. Taking into account the complex outcomes of health promotion interventions it has to be accepted that the outcomes of these interventions will often not be comparable with clinical interventions and have to be assessed differently.

Background: Digital nursing technologies (DNT) comprise an expanding, highly diverse field of research, explored using a wide variety of methods and tools. Study results are therefore difficult to compare, which raises the question how effectiveness of DNT can be adequately measured. Methods currently used might not be sufficient for certain specific nursing contexts. A comprehensive outcome framework that shows the multitude of possible outcome areas could be useful to generate more comparable results. The aim of the present study is to develop an outcome framework for DNT and to indicate which outcome areas have been most frequently evaluated in previous studies and how this has been done. Methods: We combined an inductive and deductive approach to develop the framework. The numerical analysis is based on a scoping review focussing on the effectiveness of DNT for persons in need of care, formal or informal caregivers or care institutions. Nine databases were included in the screening: Medline, Scopus, CINAHL, Cochrane Library, ACM Digital Library, IEEE Xplore, the Collection of Computer Science Bibliographies, GeroLit and CareLit. Additional literature searches and expert interviews were included. Results: The developed framework comprises four outcome target groups and 47 outcome areas. There are considerable differences in the researched outcome areas for the individual outcome target groups. Persons in need of care were by far the most frequently surveyed, particularly with respect to their psychological health. There are much fewer studies on formal and informal caregivers, and it is particularly noticeable that the quality of life of both groups has rarely been investigated. Care process quality was most frequently researched for organisations.

BackgroundIn the light of demographic developments health promotion interventions for older people are gaining importance. In addition to methodological challenges arising from the economic evaluation of health promotion interventions in general, there are specific methodological problems for the particular target group of older people. There are especially four main methodological challenges that are discussed in the literature. They concern measurement and valuation of informal caregiving, accounting for productivity costs, effects of unrelated cost in added life years and the inclusion of ‘beyond-health’ benefits. This paper focuses on the question whether and to what extent specific methodological requirements are actually met in applied health economic evaluations.MethodsFollowing a systematic review of pertinent health economic evaluations, the included studies are analysed on the basis of four assessment criteria that are derived from methodological debates on the economic evaluation of health promotion interventions in general and economic evaluations targeting older people in particular.ResultsOf the 37 studies included in the systematic review, only very few include cost and outcome categories discussed as being of specific relevance to the assessment of health promotion interventions for older people. The few studies that consider these aspects use very heterogeneous methods, thus there is no common methodological standard.ConclusionThere is a strong need for the development of guidelines to achieve better comparability and to include cost categories and outcomes that are relevant for older people. Disregarding these methodological obstacles could implicitly lead to discrimination against the elderly in terms of health promotion and disease prevention and, hence, an age-based rationing of public health care.Electronic supplementary materialThe online version of this article (10.1186/s12962-018-0100-4) contains supplementary material, which is available to authorized users.