Handheld computer devices to support clinical decision-making in acute nursing practice: a systematic scoping review (Preprint)

Abstract

BACKGROUND Nursing care is increasingly supported by computerised 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 To understand the professional and clinical impacts of nurse use of mobile health applications to assist clinical decision-making in acute care settings. To explore the scope of published research and identify key nomenclature with respect to research into this emerging field within nursing practice. METHODS This scoping review involved a tripartite search of electronic databases (CINAHL, EMBASE, MEDLINE, Google Scholar) using (1) preliminary, (2) broad, and (3) comprehensive search terms. Included studies were hand-searched for additional citations. Two researchers independently screened studies for inclusion and appraised quality using structured critical appraisal tools. RESULTS Of the 2,309 unique studies screened, 28 were included in final analyses: randomized controlled trials (n = 3); and quasi-experimental (n = 9), observational (n =10), mixed-methods (n = 2), qualitative-descriptive (n = 2), and diagnostic accuracy (n = 2) studies. Studies investigated the impact of HCDs on nurse decisions (n = 12, 42.9%), the effectiveness, safety, and quality of care (n = 9, 32.1%), 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 three discrete technology platforms (‘PDA technology, ‘Smartphone / tablet technology’, ‘Healthcare-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; computerised 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 into 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 their true potential in optimising acute nursing care. CLINICALTRIAL not applicable