Handheld Computer Devices to Support Clinical Decision-making in Acute Nursing Practice: Systematic Scoping Review

Abstract

Background Nursing care is increasingly supported by computerized information systems and decision support aids. Since the advent of handheld computer devices (HCDs), there has been limited exploration of their use in nursing practice. Objective The study aimed to understand the professional and clinical impacts of the use of mobile health apps in nursing to assist clinical decision-making in acute care settings. The study also aimed to explore the scope of published research and identify key nomenclature with respect to research in this emerging field within nursing practice. Methods This scoping review involved a tripartite search of electronic databases (CINAHL, Embase, MEDLINE, and Google Scholar) using preliminary, broad, and comprehensive search terms. The included studies were hand searched for additional citations. Two researchers independently screened the studies for inclusion and appraised quality using structured critical appraisal tools. Results Of the 2309 unique studies screened, 28 (1.21%) were included in the final analyses: randomized controlled trials (n=3, 11%) and quasi-experimental (n=9, 32%), observational (n=10, 36%), mixed methods (n=2, 7%), qualitative descriptive (n=2, 7%), and diagnostic accuracy (n=2, 7%) studies. Studies investigated the impact of HCDs on nursing decisions (n=12, 43%); the effectiveness, safety, and quality of care (n=9, 32%); and HCD usability, uptake, and acceptance (n=14, 50%) and were judged to contain moderate-to-high risk of bias. The terminology used to describe HCDs was heterogenous across studies, comprising 24 unique descriptors and 17 individual concepts that reflected 3 discrete technology platforms (“PDA technology,” “Smartphone/tablet technology,” and “Health care–specific technology”). Study findings varied, as did the range of decision-making modalities targeted by HCD interventions. Interventions varied according to the level of clinician versus algorithmic judgment: unstructured clinical judgment, structured clinical judgment, and computerized algorithmic judgment. Conclusions The extant literature is varied but suggests that HCDs can be used effectively to support aspects of acute nursing care. However, there is a dearth of high-level evidence regarding this phenomenon and studies exploring the degree to which HCD implementation may affect acute nursing care delivery workflow. Additional targeted research using rigorous experimental designs is needed in this emerging field to determine the true potential of HCDs in optimizing acute nursing care.

Digitalization in the Emergency Department—An Interview Study of Nurses’ Experiences in Norway

“…To them, this represented increased patient safety. This positive effect of digitalization in the ED has been underlined in several previous studies [6][7][8]15]. However, few of these studies were based on the perspectives of ED nurses and beyond specific digital tools, such as wearable sensors or handheld computers.…”

“…Also, wearable tracking technology has shown promise for data-driven innovations in ED-clinician workflow [ 7 ]. A systematic scoping review of studies on handheld computer devices to support clinical decision-making in acute nursing indicated that these can be used effectively [ 8 ]. However, the authors underlined the need for more research.…”

“…Previous studies have provided an overview of available technologies in the ED [ 6 ], and explored the effects of wearable tracking devices [ 7 ] or handheld computer devices [ 8 ]. Studies exploring ED nurses’ perspectives are limited to focusing on iPhones [ 14 ] and EHRs [ 15 ].…”