Experience of using a personal digital assistant in nursing practice - a single case study

johansson p., petersson g. & nilsson g. (2011) Journal of Nursing Management 19, 855–862 Experience of using a personal digital assistant in nursing practice – a single case study Aim The aim of this study was to describe one nurse’s experience of using a personal digital assistant (PDA) in nursing practice. Background Nurses handle large amounts of information and a PDA may contain valuable information that nurses need in their daily work. Methods In this qualitative single case study, data were collected through an open-ended interview with one registered nurse and were analysed by content analysis. Results The findings show that the PDA provides immediate access to information anywhere and at anytime, with advantages for both the nurse and for her patients. The PDA increased her confidence and efficiency in practice; it was easier to keep up-to-date and spend more time with the patient. Furthermore, the PDA was perceived as improving patient safety and patient participation. Conclusions The PDA requires improved content and more functions. Ease of use should also be improved. This study indicates that PDAs could be valuable and may inspire further research. Implications for nursing management The incorporation of a multifunctional PDA is an important issue for nursing management, as it could both change and provide new possibilities for nursing practice. The use of PDAs could also aid decision-making, improve patient safety and benefit patient outcomes.     

基于掌上电脑的护理质量评价系统的开发与应用

目的建立更加科学、有效的护理质量评价方法。方法在原有的护理质量评价体系的基础上，将电子信息技术应用于护理质量评价过程，通过移动设备（掌上电脑）与计算机终端的有机结合，形成了更加科学、有效的护理质量评价系统。结果护理质量评价系统的应用提高了护理质量管理的科学性和有效性，降低了管理成本，提高了工作效率。结论护理质量评价系统的开发与应用为信息化时代护理管理提供了新的思路和方向。     

Consumers' and professionals' perceptions of a breast cancer review clinic

AIM: This paper is a report of a study to explore the healthcare needs of women attending consultant-led breast cancer review clinics from their own perspectives, how these healthcare needs were being met, and healthcare professionals' perceptions of ways in which the service could be delivered more efficiently and effectively. BACKGROUND: The value of routine medical follow-up both in terms of detection of recurrence and patient satisfaction has been questioned. However traditional, where routine follow-up continues, there are rising numbers of women with breast cancer attending review clinics. METHODS: A qualitative approach was adopted, using non-participant observation during seven outpatient oncology/surgical breast review sessions. Interviews were carried out in 2005 with a convenience sample of 21 women clinic attenders, two outpatient nurses, three breast care nurses, four oncologists, three surgeons and an outpatient sister. FINDINGS: Although women saw themselves as having returned to a precancer state, they still had fears of recurrence and a need for reassurance. This need was generally met through the review clinic but many psychosocial needs were unaddressed. However, nurses seemed to be under-used as a potential source of support. Medical and nursing staff perceived that women needed to be reviewed but acknowledged that appropriately prepared nurses could deliver a more holistic and efficient service. CONCLUSION: The number of women with breast cancer requiring ongoing review is likely to increase, but the current review service is not meeting all their needs. A nurse-led follow-up service could be an attractive alternative to routine medical follow-up.     

Value of wireless personal digital assistants for practice: perceptions of advanced practice nurses

Aims and objectives. The aims were to explore advanced practice nurses’ perceptions on wireless Personal Digital Assistant technologies, to establish the type and range of tools that would be useful to support their practice and to identify any requirements and limitations that may impact the implementation of wireless Personal Digital Assistants in practice. Background. The wireless Personal Digital Assistant is becoming established as a hand‐held computing tool for healthcare professionals. The reflections of advanced practice nurses’ about the value of wireless Personal Digital Assistants and its potential to contribute to improved patient care has not been investigated. Design. A qualitative interpretivist design was used to explore advanced practice nurses’ perceptions on the value of wireless Personal Digital Assistant technologies to support their practice. Methods. The data were collected using survey questionnaires and individual and focus group interviews with nurse practitioners, clinical nurse specialists and information technology managers based in British Columbia, Canada. An open‐coding content analysis was performed using qualitative data analysis software. Results. Wireless Personal Digital Assistant’s use supports the principles of pervasivity and is a technology rapidly being adopted by advanced practice nurses. Some nurses indicated a reluctance to integrate wireless Personal Digital Assistant technologies into their practices because of the cost and the short technological life cycle of these devices. Many of the barriers which precluded the use of wireless networks within facilities are being removed. Nurses demonstrated a complex understanding of wireless Personal Digital Assistant technologies and gave good rationales for its integration in their practice. Conclusions. Nurses identified improved client care as the major benefit of this technology in practice and the type and range of tools they identified included clinical reference tools such as drug and diagnostic/laboratory reference applications and wireless communications. Relevance to clinical practice. Nurses in this study support integrating wireless mobile computing technologies into their practice to improve client care.     

Nursing care of older people: a personal construct theory perspective

This paper outlines the use of the repertory grid technique, with nurses caring for elderly residents, and residents of a nursing home. The method focuses on the individuality of each person's attempt at making sense of her/his caring world. Previous papers have focused on a discussion of the repertory grid technique as a research method and tool for psychiatric nurses, an overview of studies using this technique with nurses and social workers, and applications of personal construct theory (from which the technique is derived) to nursing research. A paper by Rawlinson described content analysis of the role constructs elicited from the nurses. In this study, content analysis of caring constructs elicited by nurses and residents was also undertaken, and the results are presented. Additionally, principal component analysis of the repertory grids was carried out, and three examples are presented. This combined analysis provides an in-depth insight into nurses' perceptions of caring for others; perceptions which guide their caring behaviours. This information can be used by individual nurses to review their caring practice.     

The use of theory in qualitative approaches to research: application in end‐of‐life studies

Title. The use of theory in qualitative approaches to research: application in end‐of‐life studies. Aim. This paper is a report of an analysis of the use of theory in qualitative approaches to research as exemplified in qualitative end‐of‐life studies. Background. Nurses researchers turn to theory to conceptualize research problems and guide investigations. However, researchers using qualitative approaches do not consistently articulate how theory has been applied, and no clear consensus exists regarding the appropriate application of theory in qualitative studies. A review of qualitative, end‐of‐life studies is used to illustrate application of theory to study design and findings. Data sources. A review of theoretical literature was carried out, focusing on definitions and use of theory in qualitative end‐of‐life studies published in English between 1990 and 2008. Discussion. The term ‘theory’ continues to be used in a variety of ways by theorists and researchers. Within the reviewed end‐of‐life studies, the use of theory included theory creation or provision of a comparative framework for data analysis and interpretation. Implications for nursing. Nurses who conduct qualitative studies should examine the philosophical and theoretical bases of their selected methodological approach, articulate a theoretical framework that fits the phenomenon being studied, and adopt a critical, flexible and creative attitude when applying theory to a study. Conclusion. Theory can be put to several uses in qualitative inquiry and should guide nurse researchers as they develop and implement their studies. Nurse educators who teach qualitative approaches to research should emphasize a variety of ways to incorporate theory in qualitative designs.     

A revision of a job evaluation system

AIMS: This paper reports a revision of the United Kingdom's National Health Service Job Evaluation System and tests the revised system in eight clinical nursing management jobs in four Turkish hospitals. BACKGROUND: A job evaluation system was developed in the United Kingdom in 2003-2004. Most studies have focused on how the whole system will be implemented in a health organization. No study investigating proficiency of the system in terms of factors and their level definitions was found. METHODS: The factors Knowledge, Training and experience and Working conditions were divided into five factors: Knowledge, Experience, Education, Environmental conditions and Hazards. To test the revised system, all the nursing management jobs in four hospitals were evaluated using a factor-based questionnaire including nurses' demographic information and 19 variables. The questionnaire was distributed to 57 supervisor nurses in 31 clinics at four hospitals in one Turkish city in 2005. All the questionnaires were analysed to evaluate the jobs. RESULTS: The job scores change depending on clinical conditions. Although the score range in the National Health Service Job Evaluation system has been determined as 405-465 points (band VI) for Nurse team leader and 469-536 points (band VII) for Nurse team manager jobs, the job scores in the present study were 363 (band V) - 557 points (band VIIIa) and 379 (band V) - 586 points (band VIIIa) respectively. CONCLUSION: Although this exploratory study was limited to four hospitals in one city in Turkey, the results indicated that two new jobs would be identified in the National Health Service system to match the jobs in the intensive care and emergency units.     

Application of a computerized nursing care plan system in one hospital: experiences of ICU nurses in Taiwan

AIM OF THE STUDY: The purpose of this paper is to present ICU nurses' experiences with a computerized nursing care plan system at a medical centre in Taiwan. BACKGROUND: Computerized nursing care plans have been implemented in recent years, but users' perceptions of this technology have not been comprehensively explored. It is believed that by taking into consideration users' experiences with computer use, strategies and programs can be developed to help users adapt to new systems. METHODS: A qualitative study, involving one-to-one interviews, was conducted with 12 Registered Nurses. Data were analysed according to Miles and Huberman's data reduction, data display and conclusion verification process. FINDINGS: Themes related to the clinical impact of system use were: 'saves paper/time', 'time-consuming for print-outs', 'de-individualization of care plan', 'routine/paperwork requirement', 'no consensus for nursing diagnoses', and 'guidelines for the novice'. CONCLUSIONS: Nurses prefer tools that can help them save time with paperwork and focus on targeting patient problems. With careful assessment and evaluation of nurses' experiences in the use of clinical computer systems, the success of computer implementation can be enhanced.     

The system of nursing in Chile: Insights from a systems theory perspective

Nursing is possible owing to a series of intricate systemic relations. Building on an established tradition of sociological research, we critically analysed the nursing profession in Chile, with an emphasis on its education system, in the light of social systems theory. The paper's aim was to explore basic characteristics of nursing education as a system, so as to outline its current evolution. Drawing on recent developments in nursing, we applied an empirical framework to identify and discuss functionally differentiated systems that are relevant to nursing and observe communications between them. We found that the dynamics of nursing as a whole develop from communications with closely related systems, including the nursing profession and the education system more broadly. While the discipline (as a system of representations) strives to control the profession (as an applied occupational field), the necessities of practicing nurses imply other forces mediating the making of the profession, a process framed by market dynamics in education and health.     

Rules and resources: a structuration approach to understanding the coordination of children's inpatient health care

AIM: This paper presents findings from a multi-method study exploring the process of care coordination in children's inpatient health care. BACKGROUND: Existing work on care coordination is typified by "black-box" type studies that measure inputs to and outcomes of care coordination roles and practices, without addressing the process of coordination. METHOD: Using questionnaires, interviews and observation to collect data in multiple sites in the United Kingdom and Denmark between 1999 and 2005, the study gathered the perceptions of staff and compared these with observed practice. Giddens' structuration theory was used to provide an analytical and explanatory framework. FINDINGS: Current care coordination practice is diverse and inconsistent. It involves a wide range of clinical and non-clinical staff, many of whom perceive a lack of clarity about who should perform specific coordination activities. Staff draw upon a wide range of different material and non-material resources in coordinating care, the use of which is governed by largely tacit and informal rules. CONCLUSIONS: Care coordination can be usefully conceptualized as a "structurated" process--one that is continually produced and reproduced by staff using rules and resources to "instantiate" or bring about care coordination through action. Potentially negative implications of this are manifested in diversity and inconsistency in care coordination practice. However, positive aspects such as the opportunity this provides to tailor care to the needs of the individual patient can be realized.