Journal of Clinical Nursing - 2020 - Brown - Issues affecting nurses capability to use digital technology at work An

🗂️ AI & Agents · View mindmap

preface_schema: ‘1.0’ title: ‘work: An integrative review’ source_type: ‘Academic’ publisher: ‘Wiley’ publishing_date: ‘2020’ authors: [‘Janie Brown PhD’, ‘Nicole Pope MPhil’, ‘Course Coordinator’, ‘Janie Brown’, ‘Kent St’] available_at: ‘https://doi.org/10.1177/1937586719861553’ keywords: [’. appropriate combining search terms were explored. truncation and wildcards relevant to each database were deployed’, ‘and phrase k e y w o r d s capability’, ‘digital’, ‘informatics’, ‘integrative review’, ‘literacy’, ‘technology what does this paper contribute to the wider global clinical community? • this paper provides summarised information that indi- cates that nurses recognise technology can enhance the quality of care they deliver as well as improving their efficiency. • the literature describes the ways in which digital capa- bility enhances the utilisation and adoption of technol- ogy in nursing practice. • further’, ‘it is apparent that digital capability can be de- veloped through continuing professional development’] abstract: ‘Background: Digital capability, that is the ability to live, work, participate and thrive in a digital world, is imperative for nurses because increasingly nurses” work and pa- tient outcomes are influenced by technology. Aim: To evaluate and synthesise the evidence regarding the development of digital capability in nurses and the strategies that support effective integration of digital skills into the workplace. Design: Whittemore and Knafl”s methodology, following the preferred reporting items for systematic reviews (PRISMA) guidelines. Data sources: CINAHL, Embase, PsychINFO, Medline (Ovid) and PubMed databases were searched for articles published in English from 2008–2019. Search terms in- cluded; digital capabil*, digital literacy, informatics, nursing informatics, health infor- matics, nurs*, knowledge, knowledge integration, competency, continuing education, nursing skills, workplace and work environment. Review me

l literacy, informatics, nursing informatics, health infor- matics, nurs*, knowledge, knowledge integration, competency, continuing education, nursing skills, workplace and work environment. Review methods: A total of 35 studies were retrieved for quality assessment by two reviewers using standardised critical appraisal instruments from the Joanna Briggs Institute (JBI-MAStARI and JBI-QARI). Minimum essential criteria and scores were agreed prior to appraisal. Results: The 17 studies included comprised quantitative (n = 7), qualitative (n = 8) and mixed methods (n = 2). Integration of digital capability in nurses” workplaces is dependent on user proficiency and competence (theme 1). Nurses use technology to access data at the point of care, specifically accessing evidence to guide care (theme 2a) as well as accessing the medical records (theme 2b). Nurses have several concerns related to the use of technology at point of care (theme 3), some of which can be resolved through investment for implementation (theme 4). Conclusions: There are key attributes of digitally proficient nurses. Nurses with these attributes are more inclined to use digital technology in their work. Involvement of the nurses as end users in the development of digital systems to ensure they are fit for purpose, alongside investment in professional development opportunities for nurses to develop digital capability, should be prioritised. > [Image 1]: The photograph is a completely blank white image with no visible content or details. There is no main subject or specific setting identifiable within the frame. The only color present is white, covering the entire image uniformly. > [Image 2]: The photograph shows a rectangular button labeled “Check for updates” with a circular logo containing red, blue, and yellow segments. The button appears to be part of a software interface, likely for checking system updates. The main subject is the update check button, set against a light gray background

, blue, and yellow segments. The button appears to be part of a software interface, likely for checking system updates. The main subject is the update check button, set against a light gray background with dark gray text, while the logo uses vibrant red, blue, and yellow colors. ---‘

Page 1

J Clin Nurs. 2020;29:2801–2819. wileyonlinelibrary.com/journal/jocn | 2801 © 2020 John Wiley & Sons Ltd Received: 17 October 2019 | Revised: 16 April 2020 | Accepted: 3 May 2020 DOI: 10.1111/jocn.15321 R E V I E W Issues affecting nurses’ capability to use digital technology at work: An integrative review Janie Brown PhD, Senior Lecturer and Course Coordinator Master of Nursing Practice1 | Nicole Pope MPhil, Lecturer1,2,3 | Anna Maria Bosco PhD, Lecturer and Course Coordinator Graduate Diploma of Midwifery1 | Jaci Mason MSc, Lecturer and Course Coordinator Bachelor of Science (Paramedicine)1 | Alani Morgan Research Assistant1 1School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia 2West Australian Centre of Evidence Informed Healthcare Practice: a Collaborating Centre of Joanna Briggs Institute, Curtin University, Perth, WA, Australia 3Monash University, School of Nursing and Midwifery, Melbourne, Vic, Australia Correspondence Janie Brown, PhD, School of Nursing, Midwifery and Paramedicine, Curtin University, Kent St, Bentley, WA, Australia. Email: janie.brown@curtin.edu.au Funding information This research was made possible thanks to the 2018 Curtin University Learning and Teaching Grant Scheme. Abstract Background: Digital capability, that is the ability to live, work, participate and thrive in a digital world, is imperative for nurses because increasingly nurses’ work and pa- tient outcomes are influenced by technology. Aim: To evaluate and synthesise the evidence regarding the development of digital capability in nurses and the strategies that support effective integration of digital skills into the workplace. Design: Whittemore and

and synthesise the evidence regarding the development of digital capability in nurses and the strategies that support effective integration of digital skills into the workplace. Design: Whittemore and Knafl’s methodology, following the preferred reporting items for systematic reviews (PRISMA) guidelines. Data sources: CINAHL, Embase, PsychINFO, Medline (Ovid) and PubMed databases were searched for articles published in English from 2008–2019. Search terms in- cluded; digital capabil*, digital literacy, informatics, nursing informatics, health infor- matics, nurs*, knowledge, knowledge integration, competency, continuing education, nursing skills, workplace and work environment. Review methods: A total of 35 studies were retrieved for quality assessment by two reviewers using standardised critical appraisal instruments from the Joanna Briggs Institute (JBI-MAStARI and JBI-QARI). Minimum essential criteria and scores were agreed prior to appraisal. Results: The 17 studies included comprised quantitative (n = 7), qualitative (n = 8) and mixed methods (n = 2). Integration of digital capability in nurses’ workplaces is dependent on user proficiency and competence (theme 1). Nurses use technology to access data at the point of care, specifically accessing evidence to guide care (theme 2a) as well as accessing the medical records (theme 2b). Nurses have several concerns related to the use of technology at point of care (theme 3), some of which can be resolved through investment for implementation (theme 4). Conclusions: There are key attributes of digitally proficient nurses. Nurses with these attributes are more inclined to use digital technology in their work. Involvement of the nurses as end users in the development of digital systems to ensure they are fit for purpose, alongside investment in professional development opportunities for nurses to develop digital capability, should be prioritised.

n the development of digital systems to ensure they are fit for purpose, alongside investment in professional development opportunities for nurses to develop digital capability, should be prioritised.

[Image 1]: The photograph is a completely blank white image with no visible content or details. There is no main subject or specific setting identifiable within the frame. The only color present is white, covering the entire image uniformly.

[Image 2]: The photograph shows a rectangular button labeled “Check for updates” with a circular logo containing red, blue, and yellow segments. The button appears to be part of a software interface, likely for checking system updates. The main subject is the update check button, set against a light gray background with dark gray text, while the logo uses vibrant red, blue, and yellow colors.

Page 2

2802 | 1 | INTRODUCTION In their working lives, nurses will increasingly utilise technology to access data, manage e-records and provide care via e-medicine and telehealth platforms (Skiba, 2017). Whilst this presents op- portunities to improve, enhance and positively transform care and clinical treatment, it is imperative that nurses and graduates have the knowledge, skills and resources they need to utilise tech- nology at the bedside and in the community, especially as many initiatives related to technological adoption fail due to a lack of user uptake (Sassen, 2009). The ability to use technologies at the point of care requires a level of digital capability. Digital ca- pability has been defined as “those capabilities that fit someone for living, working, participating and thriving in a digital society” (Health Education England, 2016). Many nursing curricula around the world have attempted to integrate content to support the de- velopment of digital capability of students; however, the adoption of recommended curriculum changes has been slow (Cummings, Shin, Mather, & Hovenga, 2016; Risling, 2017). Furth

nt to support the de- velopment of digital capability of students; however, the adoption of recommended curriculum changes has been slow (Cummings, Shin, Mather, & Hovenga, 2016; Risling, 2017). Further, curriculum modifications do not necessarily reflect the needs of industry or the experience of students (Kennedy & Yaldren, 2017). The Digital Health Education Collaboration has undertaken a number of re- views of the evidence on digital education in health professions (Car et al., 2019). Further, a recent review by Foster and Sethares (2017) reported the strategies used to implement informatics into nursing curricula and described the facilitators and barriers to implementation of informatics into nursing curricula. However, there is a lack of understanding of the required digital capability of health professionals, including nurses and how digital capability is incorporated into nurses’ workplace/s. This integrative review explores nurses’ digital capability and the ways nurses and organi- sations are developing, incorporating and using technology when providing patient care. 2 | THE REVIEW 2.1 | Aims The purpose of this integrative review was to synthesise and evaluate the evidence regarding the development of digital ca- pability in nurses’ and the strategies that support effective in- tegration of digital skills into the workplace. This evidence may be useful to better understand the educational needs of nurses, graduates and students and may be used to inform preregis- tration curricula and continuing professional education (CPE) opportunities. 2.2 | Design This review used the Whittemore and Knafl (2005) Integrative Review methodology and followed the preferred reporting items for systematic reviews (PRISMA) guidelines (see Appendix S1). This ap- proach allowed the analysis and synthesis of both empirical (quali- tative and quantitative) and theoretical literature related to digital capability. In addition, as the concepts (digital capability, nurses and util

he analysis and synthesis of both empirical (quali- tative and quantitative) and theoretical literature related to digital capability. In addition, as the concepts (digital capability, nurses and utilisation) were known and essentially form the categories, extracted data could be summarised and descriptively presented (Dixon-Woods, Agarwal, Jones, Young, & Sutton, 2005). Following the chosen methodology, the first step in the re- view process involved clearly identifying the issue (i.e. the aim of the review) to allow a focused literature search to be undertaken (step 2). Data from relevant articles were then carefully evaluated (step 3) and analysed (step 4) using the Joanna Briggs Institute Methodological Appraisal tools (Aromataris & Munn, 2017). Finally, conclusions to inform practice, policy and education were developed (step 5) and presented in table format (Whittemore & Knafl, 2005). The Preferred Reporting Items For Systematic Reviews And Meta- Analysis (PRISMA) checklist was followed (Moher, Liberati, Tetzlaff, Altman, & The PRISMA Group, 2009). 2.3 | Search methods This review included articles related to the integration of digital ca- pability in nurses’ workplaces. With the assistance of the Faculty of Health, librarian and search strategy was developed. A concept grid was used to determine the likely subject headings and keywords. Appropriate combining search terms were explored. Truncation and wildcards relevant to each database were deployed, and phrase K E Y W O R D S capability, digital, informatics, integrative review, literacy, technology What does this paper contribute to the wider global clinical community? • This paper provides summarised information that indi- cates that nurses recognise technology can enhance the quality of care they deliver as well as improving their efficiency. • The literature describes the ways in which digital capa- bility enhances the utilisation and adoption of technol- ogy in nursing practice. • Further, it is a

well as improving their efficiency. • The literature describes the ways in which digital capa- bility enhances the utilisation and adoption of technol- ogy in nursing practice. • Further, it is apparent that digital capability can be de- veloped through continuing professional development, especially at the point of care.

Page 3

| 2803 FI G U R E 1 Search process for review. From Moher et al. (2009) Number of records identified through a systematic search (N = 640) Number of additional records identified through other sources (N = 0) Number of records after duplicates removed (N = 615) Number of records excluded (N = 580) Number of records screened (N= 615) Number of articles excluded on reading full- text (N = 15) Number of full-text articles assessed for eligibility (N = 35) Number of articles included (N = 17) Included Number of articles assessed for quality (N = 20) Identification Screening Eligibility Number of articles excluded on critical appraisal (N = 3) Quantitative (N = 7) Qualitative (N = 8) Mixed Methods (N = 2)

Page 4

essed for quality (N = 20) Identification Screening Eligibility Number of articles excluded on critical appraisal (N = 3) Quantitative (N = 7) Qualitative (N = 8) Mixed Methods (N = 2)

Page 4

2804 | searching was adopted as needed. The search terms include varia- tions of the following keywords and phrases; digital capabil*, digital literacy, informatics, nursing informatics, health informatics, nurs*, knowledge, knowledge integration, competency, continuing educa- tion, nursing skills, workplace, work environment. Articles that fo- cused solely on current integration strategies used in undergraduate nursing curricula were excluded due to the presence of a recent re- view on this topic (Foster & Sethares, 2017). The articles included in this review were identified by searching the following databases; CINAHL, Embase, PsychINFO, Medline (Ovid) and PubMed. A three- step search strategy was undertaken. An initial search of CINAHL was conducted and keywords contained within titles, abstracts and index terms of articles were noted. A second, more detailed search using the identified keywords and index terms was under- taken across each selected database. Third, reference lists of rele- vant articles were searched to identify additional studies. Given the relatively recent introduction of most of the technologies in nurses’ workplaces and the rapid rate of technology redundancy, articles published from 2008–2019. Additional inclusion criteria were peer reviewed articles reporting original quantitative, qualitative or mixed methods research of nurses experiences of technology, published in English. 2.4 | Search outcome The initial literature search was conducted in 2018 and repeated 2019 (last search date 2nd August 2019) and produced 640 articles using search strategies specific to each database. Following removal of duplicates (n = 25), 615 potentially relevant studies remained. The titles and abstracts were screened for relevance with respect to the objectiv

tegies specific to each database. Following removal of duplicates (n = 25), 615 potentially relevant studies remained. The titles and abstracts were screened for relevance with respect to the objectives of this review, and 580 studies were excluded. The full-text of the remaining 35 studies were retrieved for detailed assessment against the inclusion criteria, and a further 15 studies were excluded leaving a total of 20 articles which underwent critical appraisal against the JBI appraisal instruments. Three articles (two quantitative and one qualitative) were excluded based on meth- odological quality, leaving 17 studies to be included in the review. There were minimal differences among reviewers regarding the as- sessment of these articles. Of the remaining 17 articles, seven were quantitative, eight were qualitative and two were mixed methods studies. The references of these articles were reviewed for studies not previously identified, and no additional papers were selected for critical appraisal. Figure 1 provides the PRISMA diagram which de- picts search process for this review. 2.5 | Quality appraisal The titles and abstracts of articles identified using the search strat- egy were initially reviewed. The full-text articles of studies deemed relevant were obtained to determine whether they met the inclusion criteria. Quality appraisal of the final selected articles was under- taken by two reviewers independently using standardised instru- ments from the Joanna Briggs Institute (JBI). Quantitative studies were appraised (author initials to be inserted here after the review) using the JBI Meta-analysis of Statistical Assessment and Review Instrument (JBI-MAStARI), whilst qualitative studies were appraised TA B LE 1 Critical Assessment using MAStARI (descriptive case studies) rankings Study Is the study based on a random or pseudo- random sample? (desirable, but not an essential item) Q2 Are the criteria for inclusion in the sample clearly defined? (essential crite

tudies) rankings Study Is the study based on a random or pseudo- random sample? (desirable, but not an essential item) Q2 Are the criteria for inclusion in the sample clearly defined? (essential criterion) Q3 Are confounding factors identified and strategies to deal with them stated? (essential criterion) Q4 Are outcomes assessed using objective criteria? (essential criterion) De Veer et al. (2011) ✓ ✓ N/A ✓ Hwang & Park, (2011)a ? ✓ N/A ✓ Jensen et al. (2016) N/A ✓ ✓ ? Kleib et al. (2010) ✓ ✓ ✓ ✓ Kleib and Nagle (2018) x ✓ N/A ✓ Olajubu, Irinoye, Ogunfowokan, & Olowokere (2015)a ✓ ✓ N/A ✓ Wei-Lan et al. (2013) x ✓ N/A ✓ Holtz and Krein (2011)b x ✓ N/A ✓ Koivunen et al. (2015)b x ✓ N/A ✓ Baskaran & Baby (2015)c X ✓ N/A X Miller et al. (2014)c x ✓ X X cExcluded after review.

Page 5

| 2805 (author initials to be inserted here after the review) using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) (Aromataris & Munn, 2017). Mixed methods studies were assessed (author initials to be inserted here after the review) using both JBI-MAStARI and JBI-QARI (Aromataris & Munn, 2017). Any disagreements that arose between reviewers regarding assessment of the articles were resolved through discussion, and with a third reviewer. The JBI Meta-analysis of Statistical Assessment and Review Instrument (MAStARI) comprises nine questions which address sampling, control of confounders, justification of measurements and approaches to statistical analysis. The JBI-MAStARI tool re- quires reviewers to allocate findings of “yes,” “no,” “unclear” or “not applicable.” In this review, it was agreed prior to critical ap- praisal that six of the criteria were considered to be essential and that articles would be included if at least five of six essential ques- tions were answered “yes” and there was agreement between the reviewers. The JBI-QARI appraisal instrument comprises of ten qu

at articles would be included if at least five of six essential ques- tions were answered “yes” and there was agreement between the reviewers. The JBI-QARI appraisal instrument comprises of ten questions which address congruency between the philosophical basis of the study, study methodology, description of the context, the influ- ence of the researcher, how data are represented and how results interpreted. Like the JBI-MAStARI tool, the JBI-QARI appraisal tool requires reviewers to allocate findings of “yes,” “no,””unclear” or “not applicable.” In this review, it was agreed prior to critical appraisal that papers would be included if eight of the ten ap- praisal questions were answered “yes,” there was evidence of the study being ethically sound, and there was agreement between the reviewers. 2.6 | Data synthesis To ensure rigor in this stage of the review, two of the authors un- dertook independent analyses of the included studies. The process involved each author independently and carefully considering each source to determine its contribution to meeting the research aim, that is they described either the development of digital capability in nurses’ or the strategies that support effective integration of digital skills into the workplace. Patterns and themes (similar words, phrases or constructs that were reported in the studies result) and that were consistent across the sources were identified. Following this independent process, the two authors conferred and subsequently synthesised the data into a final understanding of the phenomenon as it is described in the set of disparate publi- cations. There were no discrepancies, although by agreement one theme was split into two sub-themes. 3 | RESULTS All included papers met the minimum criteria set by the reviewers to ensure scientific rigor. For all the included quantitative studies and the quantitative aspect of the mix methods studies, at least five of six applicable questions were answer

set by the reviewers to ensure scientific rigor. For all the included quantitative studies and the quantitative aspect of the mix methods studies, at least five of six applicable questions were answered in the affirmative on the critical appraisal checklist (Table 1). For the qualitative studies and qualitative aspect of the mixed methods studies, each met eight of the nine criteria on the critical appraisal checklist (Table 2). The 17 included studies (table 3) were published over an eight- year period (2010–2018) and sample sizes ranged from 8–35,579 Q5 If comparisons are being made, is there sufficient description of groups Q6 Is follow-up carried out over a sufficient period of time? (Not essential, but noted as a limitation to the study) Q7 Are the outcomes of people who withdraw described and included in the analysis? Q8 Are outcomes measured in a reliable way? (essential criterion) Q9 Is appropriate statistical analysis used? (essential criterion) Score ✓ N/A N/A ✓ ✓ 6/9 (6/6 applicable) ✓ N/A N/A ✓ ✓ 5/9 (5/6 applicable) ✓ N/A N/A ✓ ✓ 5/9 (5/6 applicable) ✓ N/A N/A ✓ ✓ 7/9 (6/6 applicable) ✓ N/A N/A ✓ ✓ 5/9 (5/6 applicable) ✓ N/A N/A ✓ ✓ 6/9 (6/6 applicable) ✓ N/A N/A ✓ ✓ 5/9 (5/6 applicable) ✓ N/A N/A ✓ ✓ 5/9 (5/6 applicable) ✓ N/A N/A ✓ ✓ 5/9 (5/6 applicable) X N/A N/A ✓ ✓ 3/9 (3/6 applicable) ✓ N/A N/A ✓ N/A 3/9 (3/6 applicable)

Page 6

� 5/9 (5/6 applicable) ✓ N/A N/A ✓ ✓ 5/9 (5/6 applicable) ✓ N/A N/A ✓ ✓ 5/9 (5/6 applicable) X N/A N/A ✓ ✓ 3/9 (3/6 applicable) ✓ N/A N/A ✓ N/A 3/9 (3/6 applicable)

Page 6

2806 | (qualitative studies 6–93, quantitative studies 32–35,579). The most common method of qualitative data collection was semi-structured interview with individual nurses followed by focus groups and obser- vation. Quantitative studies tended to use questionnaires developed specifically for the specific study (n-6), although validated data col- lection tools such as the Canadian Nurse Informatics Competency Assessment Scale (C-NICAS), the Information Technology Attitude Scales for Health (ITASH) and the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire were all used. Qualitative studies were more likely to explore the impact of the adoption, im- plementation, integration and acceptance of digital technology. This impact was related to nurses as users, and patients and their families as recipients of care. Quantitative studies were more likely to ex- plore nurses knowledge of and attitudes towards digital technology at the point of care, as well as their self-perceived competence. The ten countries represented in the studies were as follows: the United States of America (n = 5), Canada (n = 2), Australia (n = 2), China (n = 1), Taiwan (n = 2), Korea (n = 1), the Netherlands (n = 1), Finland (n = 1), Nigeria (n = 1) and Brazil (n = 1). Various types of technology were considered. Most of the included studies focused on Electronic Health Records (EHRs)/Electronic Medical Records (EMR), mobile electronic devices and bedside fixed data entry and retrieval devices. Data were unable to be pooled due to the differences in tools used (quantitative studies) and the qualitative approaches adopted (including data collection and analysis techniques used). As indicated in the table, there was wide variation in sample types (from new nurses to managers

dies) and the qualitative approaches adopted (including data collection and analysis techniques used). As indicated in the table, there was wide variation in sample types (from new nurses to managers and informaticists) as well as in the sites from which they were recruited which included acute and chronic care, adult and paediatric environment, inpatient and outpatient settings and metropolitan and rural contexts. The final themes were derived based on the consistent quantita- tive outcomes or major qualitative themes that each paper reported, namely: (1) User proficiency and competence, (2) Point of care ac- cess to data, (3) Nurses concerns and (4) Investment for implemen- tation. Theme 2 was further divided into the following: (a) Point of care access to the evidence and (b) Point of care access to the elec- tronic health record (EHR). With reference to the primary sources, the consistently important elements were combined to summarise the integration of digital capability in nurses workplaces as demon- strated in Table 4. 3.1 | User proficiency and competence This theme captured the factors related to the proficiency of nurses with respect to informatics in clinical practice and the factors associated with the development of competence. Many of the studies utilised descriptive methods to report the charac- teristics of nurses that are associated with competence. Nurses self-report their informatics competence as below “average” (Hwang & Park, 2011) or only slightly above “competent” (Kleib & Nagle, 2018). However, the younger the nurse, the more profi- cient they believe they are, with both Hwang and Park (2011) and Kleib and Nagle (2018) reporting a negative correlation between TA B LE 2 Critical Assessment using QARI (qualitative assessment tool) Study Congruity between the stated philosophical perspective and the research methodology. (It was agreed that if the study demonstrated a sound qualitative approach, it would be included) Congruity between t

ngruity between the stated philosophical perspective and the research methodology. (It was agreed that if the study demonstrated a sound qualitative approach, it would be included) Congruity between the research methodology and the research question or objectives (It was agreed that study design congruent with the interpretative paradigm would suffice) Congruity between the research methodology and the methods used to collect data (It was agreed that methods congruent with the interpretative paradigm would suffice) Congruity between the research methodology and the representation and analysis of data (It was agreed that representation and analysis of the data congruent with the interpretative paradigm would suffice) Asan et al. (2017) ✓ ✓ ✓ ? Chang et al. (2016) ✓ ✓ ✓ ✓ Dowding et al. (2015) ✓ ✓ ✓ ✓ Heidarizadeh et al. (2017)a N/A ✓ ✓ ✓ Kent et al. (2015) ✓ ✓ ✓ ✓ Liu et al. (2015) N/A ✓ ✓ ✓ Shin et al. (2018) ✓ ✓ ✓ ✓ Staggers et al. (2011) ✓ ✓ ✓ ✓ Staggers et al. (2018) ✓ ✓ ✓ ✓ Holtz and Krein (2011)b ✓ ✓ ✓ ✓ Koivunen et al. (2015)b ✓ ✓ ✓ ✓

Page 7

al. (2018) ✓ ✓ ✓ ✓ Staggers et al. (2011) ✓ ✓ ✓ ✓ Staggers et al. (2018) ✓ ✓ ✓ ✓ Holtz and Krein (2011)b ✓ ✓ ✓ ✓ Koivunen et al. (2015)b ✓ ✓ ✓ ✓

Page 7

| 2807 increasing age and informatics competency. This finding was also echoed in qualitative findings by Holtz and Krein (2011) and Shin, Cummings, and Ford (2018), where younger nurses reported is- sues similar to those expressed as follows “We have a lot of older nurses that are not that strong in computers and stuff, and those seem to be the ones that have the most questions” and older nurses concurred in ways similar to this “You know, the younger people have grown up with computers—I do not even have a com- puter at home” (Holtz & Krein, 2011, p. 256). To some extent, it was identified that this can be overcome by education where nurses with a higher qualification (such as a Master’s degree or Doctoral qualification) or an additional, non-nursing qualifica- tion (Kleib & Nagle, 2018) self-reported higher informatics com- petence than nurses with a Bachelor only qualification (Kleib, Sales, Lima, Andrea-Baylon, & Beaith, 2010; Wei-Lan, Li-Qun, & Hong-Yu, 2013). Nurses with an additional qualification in in- formation technology are also more proficient and competent in the use of technology within their role (Kleib & Nagle, 2018). In addition to age and qualification, results revealed that nursing experience also influences informatics competence. Increased clinical experience was associated with an increased likelihood to utilise technology at point of care (Hwang & Park, 2011; Kleib et al., 2010; Wei-Lan et al., 2013). To improve nurse digital capability, informatics education is increasingly becoming available during undergraduate education and through continuing professional education (CPE). This is cre- ating opportunity for the development of competence in nurses who are already well qualified or experienced; however, consistent with other finding

ontinuing professional education (CPE). This is cre- ating opportunity for the development of competence in nurses who are already well qualified or experienced; however, consistent with other findings related to age, older nurses are less likely to pursue CPE opportunities (Kleib et al., 2010). Where formal edu- cation is undertaken, it results in increased competence (Hwang & Park, 2011; Kleib et al., 2010); however, those nurses whose work is predominately at the bedside are less likely to undertake CPE (Kleib et al., 2010). 3.2 | Point of care access to data The access to data needed at the point of care was prevalent in the literature, with both access to the evidence and the electronic medi- cal record frequently discussed as reasons why nurses require digital capability. 3.2.1 | Access to evidence Having access to data and evidence in electronic form facilitates clinical decision making by virtue of the ease and efficiency of access to information at the point of care. This is true for nurse mangers seeking data to make decisions at an organisational level (Jensen, Guedes, & Leite, 2016) as well as nurses using local poli- cies and procedures or published evidence (Kent et al., 2015) to guide their clinical practice. Coupled with proficiency in using basic electronic forms of communication, this evidence can There is congruence between the research methodology and the interpretation of results (It was agreed that the of results must be congruent with the interpretative paradigm) Locating the researcher culturally or theoretically (It was agreed that the context of the study would suffice to meet this criteria) Influence of the researcher on the research, and vice- versa, is addressed Representation of participants and their voices Ethical approval by an appropriate body Relationship of conclusions to analysis, or interpretation of data. Score ✓ ✓ X ✓ ✓ ✓ 8/10 ✓ ✓ x x ✓ ✓ 8/10 ✓ ✓ x ✓ ✓ ✓ 9/10 ✓ ✓ X ? ✓ ✓ 7/10 ✓ ✓ X ✓

te body Relationship of conclusions to analysis, or interpretation of data. Score ✓ ✓ X ✓ ✓ ✓ 8/10 ✓ ✓ x x ✓ ✓ 8/10 ✓ ✓ x ✓ ✓ ✓ 9/10 ✓ ✓ X ? ✓ ✓ 7/10 ✓ ✓ X ✓ ✓ ✓ 9/10 ✓ ✓ X ✓ ✓ ✓ 8/10 ✓ X X ✓ ✓ ✓ 8/10 ✓ ✓ X ? ✓ ✓ 8/10 ✓ ✓ X ✓ ✓ ✓ 9/10 ✓ ✓ X X ✓ ✓ 8/10 ✓ ✓ X ✓ ✓ ✓ 9/10

Page 8

2808 | TA B LE 3 Included studies Aim/Purpose Setting or context Design and sample Asan et al. (2017) USA To evaluate the use of a novel Health Information technology (HIT) in a pediatric ICU. Specifically, explored nurses’ perceptions of the HIT and perceived effect on family engagement Children’s hospital PICU Qual, PICU RNs (n = 55) Baskaran & Baby (2015) India To assess the knowledge and attitude of staff nurses to nursing informatics and determine the association between knowledge regarding nursing informatics with selected demographic variables. Hospital Quant, RNs (n = 60) Chang et al. (2016) Taiwan To examine the perspectives of nurses from paper to Electronic Health Records (EHRs) and to explore the adoption process in different implementation processes General medical and surgical wards of teaching hospital Qual, female RNs, Total n = 55 (stage 1 n = 26, stage 2 n = 29) De Veer et al. (2011) The Netherlands To gain a better understanding of determinants influencing the success of the introduction of new technologies as perceived by nursing staff Dutch hospitals, psychiatric organisations, care organisations for mentally disabled people, home care organisations, nursing homes or homes for the elderly Mixed methods, nursing staff panel members; a permanent group of Nursing Assistants (NAs) and Registered Nurses (RNs) n = 685 Dowding et al. (2015) United States of America (USA) To explore how nurses’ use an integrated Electronic Health Record (EHR) in practice. Two hospitals in northern California Qual, multi-site case study, male & female RNs n = 29 Heidarizadeh et al. (2017) Ira

lore how nurses’ use an integrated Electronic Health Record (EHR) in practice. Two hospitals in northern California Qual, multi-site case study, male & female RNs n = 29 Heidarizadeh et al. (2017) Iran To explore nurses’ perceptions of the challenges involved in the use of the electronic nursing documentation system based on the Technology Acceptance Model (V2) Teaching hospital in Western Iran Qual, Nurses with associate degree, bachelors degree and masters degree n = 18 Holtz and Krein (2011)a USA To understand how hospital nurses perceived the implementation of a new electronic medical record (EMR) system Midwestern regional hospital (rural area of Michigan) Mixed methods. Registered Nurses (RNs) or Licensed Practical Nurses (LPNs) 113 participants. Only ICU/CCU nurses were interviewed

Page 9

| 2809 Results Seven semi-structured focus group interviews Content analysis Six major themes

familiarity and use routines,
positive perceptions with the LCIM,
negative perceptions with the LCIM,
privacy,
training and
suggestions for improvement. Information Technology Attitude Scales for Health (ITASH) Descriptive statistics, chi- square tests 85% of respondents had no previous knowledge of nursing informatics. 53% and 45% of respondents had a negative or neutral attitude towards informatics (respectively). There was a significant association between knowledge and education, years of experience. Four semi-structured focus group interviews Content analysis Six major themes
liability, work stress and anticipation for electronic health record
slow network speed, user-unfriendly design for learning process
insufficient information technology/organisation support; on the second stage
getting used to electronic health record and further system requirements
benefits of electronic health record in time saving and documentation
unrealistic information technology competence expectation and future use. Open- and close-ended questionnaire d

requirements 5. benefits of electronic health record in time saving and documentation 6. unrealistic information technology competence expectation and future use. Open- and close-ended questionnaire developed for the study Descriptive statistics, chi- square tests “Coding” 25% of respondents rated the introduction technology as positive. The factors impeding actual use were related to the technology itself, for example malfunctioning, ease of use, relevance for patients and risks to patients. Respondents stress importance of an adequate innovation strategy. Nonparticipant observation & semi-structured interviews Thematic Analysis Key themes: Introducing the EHR improved:

communication,
ease of access to information
safety of medication administration processes. In-depth, semi-structured interviews Directed content analysis Main categories:
Perceived usefulness a. Subjective norms b. Experienced benefits
Perceived difficulty a. Rationalisation b. Challenges in accepting change Quant: UTAUT questionnaire (Venkatesh, Morris, Davis, & Davis, 2003) Qual: Semi-structured interviews to capture concepts from the UTAUT, as well as general organisational and communication themes Descriptive statistics, Multiple regression analysis and a correlation matrix, T-tests Thematic analysis Quant: Social influence and performance expectancy were significant factors in system adoption. Effort expectancy did not have a significant influence on the intention to use the EMR Main themes (qual):
Social influence via superusers
Physicians not strong influencers
EMR is a useful tool (except ICU/CCU participants)
Nurses age influence perception of EMR use.

Page 10

es (qual):

Social influence via superusers
Physicians not strong influencers
EMR is a useful tool (except ICU/CCU participants)
Nurses age influence perception of EMR use.

Page 10

2810 | Aim/Purpose Setting or context Design and sample Hwang & Park, (2011) Korea To examine the factors affecting informatics competency to help develop strategies to improve nurses’ informatics practice Two tertiary teaching hospitals in Seoul, Korea Quant: cross-sectional survey Nurses n = 350 Jensen et al. (2016) Brazil To identify informatics abilities essential to decision-making in nursing management All regions of Brazil Quant: Survey study with specialist Brazilian Nurses in fields of health informatics and nursing management, n = 32 Kent et al. (2015) Australia To understanding the issue of acceptance of technology by nurses, allowing for a full exploration of participants’ reactions to the new technology being proposed Two hospitals in Australia (One public & One Private) Qual, male & female RNs and ENs n = 52 Kleib et al. (2010) USA To identify the proportion and characteristics of U.S. registered nurses reporting continuing education in informatics in 2000 All RNs in the USA or district of Columbia Secondary data analysis of data obtained from the 2000 NSSRN cross-sectional survey. RNs from USA or district of Columbia n = 35,579. Kleib and Nagle (2018) Canada To determine self-perceived information competencies and factors associated with competency among practising nurses in Alberta Clinical practice sites in Alberta Exploratory descriptive cross- sectional survey. n = 2,844 RNs (98.5%) and Registered psychiatric nurses Koivunen et al. (2015)a Finland Describe nursing professionals’ experiences of the use of electronic devices for communication with colleagues and other healthcare professional Outpatient clinics in one healthcare district in Finland A cross-sectional survey (electronic questionnaire with structured and open-ended questions.) n = 122, Re

ues and other healthcare professional Outpatient clinics in one healthcare district in Finland A cross-sectional survey (electronic questionnaire with structured and open-ended questions.) n = 122, Response rate was 21% (n = 41 Registered Nurses, n = 56), public health nurses, n = 9 charge nurses, n = 9 practical nurses, n = 6 OT or Physiotherapist)

Page 11

| 2811 Results Questionnaire designed for the study to collect data on nurses’ informatics competency, basic computer skills and attitudes towards computerisation Descriptive statistics, Student t tests and ANOVA tests, Pearson correlation coefficient, multiple regression analysis 69% of respondents considered their overall informatics competency below average. Scored highest on security and confidentiality, and lowest on telehealth. 59% rated their computer skills to be below average. Respondents had favourable attitudes towards computerisation. Significant factors associated with informatics competency were basic computer skills and formal informatics education. Questionnaire developed based on the competencies Information Literacy (five categories; 40 abilities) and Information Management (nine categories; 69 abilities) of the TIGER – Technology Informatics Guiding Education Reform – initiative Rasch analysis In the information literacy competency, 18 abilities were considered essential and in Information Management, 38. Four semi-structured focus group interviews Analysed using the 12 theoretical domains framework (TDF) and component constructs developed by Michie et al. (2005) as a guide. Perceived threat to participants clinical skill, and capability to capture clinical workflow. Potential to integrate care between departments; help management and support of nursing processes; and coordinate patient care. Responses differed across sites, influenced by experiences. The NSSRN is a cross-sectional survey conducted every 4 years by the U.S. Department of Health and Human Services, Bureau of Health

nt care. Responses differed across sites, influenced by experiences. The NSSRN is a cross-sectional survey conducted every 4 years by the U.S. Department of Health and Human Services, Bureau of Health Professions. Bivariate and logistic regression analyses 21% of respondents reported CPE in informatics in the year before the survey. The probability of continuing education in informatics increased with Internet access and decreased for nurses working outside hospitals or providing direct patient care. Canadian Nurse Informatics Competency Assessment Scale (C-NICAS) Descriptive statistics, one-way ANOVA with post hoc comparisons and general linear model univariate analysis Perceptions of competency were highest on foundational computer literacy skills and lowest on information and knowledge management competencies. Mean scores varied significantly in relation to age, qualification, experience and work setting. The quality of informatics training and support offered by employers contributed most to variance. Previous informatics education, CPE and training, access to the internet and resources, use of health technology and informatics role also contributed to mean scores variance. Questionnaire developed for the study Descriptive statistics and content analyses. Respondents mostly use email for communication. Question–answer programmes and synchronous communication channels on the Internet were least used. Electronic devices were used for the following:

communicating practical nursing,
improving personnel competences,
organising daily operations
and administrative tasks. Respondents believe devices may:
speed up the management of
patient data,
improve staff cooperation and competence and
make more effective use of working time. Identified obstacles were as follows:
concern about information security,
lack of technical skills,
unworkable technology and
decreasing social interaction.

Page 12

working time. Identified obstacles were as follows:

concern about information security,
lack of technical skills,
unworkable technology and
decreasing social interaction.

Page 12

2812 | Aim/Purpose Setting or context Design and sample Liu et al. (2015) Taiwan To explore informatic nurses’ experiences and alternatives to assist the growth and development of nursing informatics in practice. National - eight hospitals Qual, RNs n = 8 Miller et al. (2014) USA To identify what, if any, gaps exist between the informatics knowledge and skills self- reported by new/novice nurses and the informatics knowledge and skills that new/novice nurses demonstrate in acute-care settings, as reported by nurse managers. Acute-care settings, defined as any healthcare setting, excluding primary and long-term care, that used EHRs Quant, new/novice nurses n = 222 and nurse managers n = 326 Olajubu et al. (2015) Nigeria To examine nurses’ knowledge and attitude to the use of nursing informatics and determine the extent to which nursing informatics is being utilised in practice Primary, secondary and tertiary healthcare facilities (n = −37) across six major towns in Osun State, Nigeria Cross-sectional survey design Nurses n = 350 Shin et al. (2018) Australia Tertiary, acute, public hospital Qual. N = 6 clinical nurse educators significantly involved in supporting graduates Staggers et al. (2011) USA To explore nurses’ information management and use of electronic tools before and during nursing handoffs One tertiary care facility & one cancer specialty hospital in Western USA Qual, Handoffs n = 93 Staggers et al. (2018) USA To understand usability pain points faced by nurses regarding the use of health IT, identify their impact and importance, discuss responsibilities and develop possible solutions to improve the health IT-user experience for nurses. Experts in the areas of health IT design and national leaders who were nursing experts or those who interacted frequentl

develop possible solutions to improve the health IT-user experience for nurses. Experts in the areas of health IT design and national leaders who were nursing experts or those who interacted frequently with nurses were sought Qual, n = 27 (n = 9 nursing/NI, UX professional leaders n = 4, nursing researchers n = 7, and site leaders from a variety of settings across federal and nonfederal healthcare sectors n = 7) Wei-Lan et al. (2013) China To determine nursing informatics implementation in Qiqihar, China Specifically, to evaluate the relationship between NI and clinical competence, including NI’s role in clinical decision making, nursing research, nursing outcomes, professional development and the patient– nurse relationship Three hospitals in Qiqihar, China;

General hospital,
Gynaecological/obstetric & infant hospital
Affiliated Hospital Descriptive survey, n = 150 RNs (n = 50 from each hospital) aMixed methods studies.

Page 13

| 2813 Results In-depth, 1:1, face-to-face interviews Content analysis The main themes included

diversified roles and functions,
vague job description,
no decision-making authority,
indispensable management support,
searching resources for work fulfilment. Questionnaire developed for the study. New/novice nurses answered questions about their knowledge and skill levels in 28 areas and nurse managers answered questions about the extent to which new/ novice nurses in their facility demonstrate each of 28 knowledge and skills. The knowledge and skills were identified by reviewing existing literature discussing critical knowledge and skills in using an EHR. Both participant populations were asked to answer questions about EHR access as a nursing student, factors affecting EHR knowledge and skills, length of time to be comfortable using EHR, workload issues related to EHR and type and hours of training received on EHR use. Descriptive statistics There was agreement between new/novice RNs and managers that seven

o be comfortable using EHR, workload issues related to EHR and type and hours of training received on EHR use. Descriptive statistics There was agreement between new/novice RNs and managers that seven of the 28 skill areas were “strengths” (word processing, email, online classrooms/education, presentation development, Internet usage and search engines, keyboarding and nursing note documentation). There was agreement between new/novice nurses and nurse managers that eight skills areas were development areas (database use, webpage design, electronic publishing, computer languages, coding for billing purposes, electronic billing/payment, graphic development and order entry). Self-administered questionnaire, which assessed attitude to nursing informatics and accessibility to resources, knowledge and utilisation of nursing informatics. Questions on attitude were adapted from Pretest for Attitudes towards Computers in Healthcare (PATCH) Assessment Scale version 32 Descriptive statistics 61% of respondents demonstrated poor knowledge of nursing informatics. 62% of respondents in secondary & 66% in tertiary facilities had a positive attitude towards utilisation of nursing informatics. 1 of the 37 facilities had functioning computers and 54% of respondents never had access to computers at work. 50% of respondents in primary 75% in secondary & 66% in tertiary facilities do not utilise nursing informatics in providing services One focus group Thematic analysis. Main barriers:

Graduates inadequately prepared to use NI tools
Inefficient hospital systems
Discouraging ward culture
Lack of exposure to systems as a student Audiotaping handoffs, semi-structured interviews, observations and field notes Descriptive coding 5 themes (from 33 categories):
“good nurse” expectations for handoffs,
paper forms are best,
information at a glance,
only pertinent information please and
information tools that work Semi-structured interviews Content analysis Four

xpectations for handoffs, 2. paper forms are best, 3. information at a glance, 4. only pertinent information please and 5. information tools that work Semi-structured interviews Content analysis Four themes emerged:

user experience pain points
importance of the issues
the responsibility gap
acting on usability issues Four-part questionnaire developed for the study; Part 1: respondent characteristics. Part 2: NI mission, implementation, applications, patient care management and HIS. Part 3 advantages of NI for clinical practice. Part 4 disadvantages associated with NI implementation. Descriptive statistics, logistic regression and chi-square analyses. Nursing informatics was adequately implemented, and nurses were knowledgeable about information systems. Respondents identified advantages particularly usefulness in patient care. Respondents identified hospital information system instability as an obstacle to implementation.

Page 14

2814 | rapidly be shared within nursing teams, benefiting the patient, the nurse and the organisation (Koivunen, Niemi, & Hupli, 2015). However, there is concern that nurses, particularly new gradu- ates, may not know how to identify “good” information and evi- dence and interpret it for use in the clinical environment (Shin et al., 2018). 3.2.2 | Access to the EHR Healthcare organisations are increasingly moving to a paperless or paper-light record management associated with a patient’s epi- sode of care. The EHR (also known as the electronic medical record or hospital information system) is perceived by nurses to improve TA B LE 4 Data synthesis Themes Source/s

User proficiency and competence a. Age is factor (younger tend to be more able and accepting/ adaptable to new technology) (Holtz & Krein, 2011; Hwang & Park, 2011; Kleib & Nagle, 2018; Kleib et al., 2010; Shin et al., 2018; Wei-Lan et al., 2013) b. Experience is a factor (Holtz & Krein, 2011; Hwang & Park, 2011; Kleib et al., 2010; Wei-Lan et al., 2013

rk, 2011; Kleib & Nagle, 2018; Kleib et al., 2010; Shin et al., 2018; Wei-Lan et al., 2013) b. Experience is a factor (Holtz & Krein, 2011; Hwang & Park, 2011; Kleib et al., 2010; Wei-Lan et al., 2013) c. Qualification is a factor and relies on adequate, early and ongoing informatics education (Hwang & Park, 2011; Kleib & Nagle, 2018; Kleib et al., 2010; Olajubu et al., 2015; Shin et al., 2018; Wei-Lan et al., 2013) d. Previous ICT education is a factor (Kleib & Nagle, 2018) 2. Point of care access to a. Evidence (need help critiquing) (Shin et al., 2018) (i) Clinical care, for example Wound care (Kent et al., 2015) (ii) Decision-making, for example policies and procedures (Jensen et al., 2016) (iii) Can quickly share evidence (Koivunen et al., 2015) b. EMR/ EHR/ HIS (i) Improves quality of pt care and facilitates family involvement in care (Asan et al., 2017; Dowding et al., 2015; Kent et al., 2015; Wei-Lan et al., 2013) (ii) Improves communication between health professionals (Dowding et al., 2015; Koivunen et al., 2015; Staggers et al., 2011; Wei-Lan et al., 2013) (iii) Improves pt and family education (Asan et al., 2017) (iv) Reduces errors (Wei-Lan et al., 2013) (v) Decreases workload and improves time Mx (Koivunen et al., 2015; Wei-Lan et al., 2013) 3. Nurses concerns a. Time away from the patient which increases workload (Dowding et al., 2015; Holtz & Krein, 2011; Kent et al., 2015; Staggers et al., 2018) b. Stress and frustration related to time, technical issues, duplication (Chang et al., 2016; Liu et al., 2015; Staggers et al., 2011, 2018) c. Confidentiality and privacy of patient data (Asan et al., 2017; Koivunen et al., 2015) d. Copyright and plagiarism (Jensen et al., 2016) e. Can also cause pt and family concerns (Asan et al., 2017) 4. Investment for implementation a. Nurse champions/ leaders should be involved in development so that the system solves their problems and in evaluation. This involvement assists with adaption and acceptance. (Chang et al

ementation a. Nurse champions/ leaders should be involved in development so that the system solves their problems and in evaluation. This involvement assists with adaption and acceptance. (Chang et al., 2016; Kent et al., 2015; Liu et al., 2015; Staggers et al., 2011, 2018; de Veer et al., 2011) b. Nurses need orientation, training and ongoing support (Asan et al., 2017; Chang et al., 2016; Koivunen et al., 2015; Liu et al., 2015; Shin et al., 2018; Staggers et al., 2018; de Veer et al., 2011; Wei-Lan et al., 2013) c. Nurses need time to adopt and adapt (Chang et al., 2016; Kent et al., 2015; de Veer et al., 2011) d. System should be stable/ fast/ accessible to prevent (Shin et al., 2018) (i) Disruption (Asan et al., 2017; Koivunen et al., 2015; Staggers et al., 2011, 2018; Wei-Lan et al., 2013), (ii) Workarounds, problem-solving, avoidance (Chang et al., 2016; Liu et al., 2015) (iii) Reverting to (preferring) paper (Dowding et al., 2015; Staggers et al., 2011)

Page 15

| 2815 patient care (Wei-Lan et al., 2013). Specific examples cited in the literature include facilitating a patient centred, coordinated ap- proach to care (Asan, Flynn, Azam, & Scanlon, 2017), nursing di- agnosis and care planning (Kent et al., 2015; Wei-Lan et al., 2013) including during emergencies (Asan et al., 2017), medication safety (Dowding, Turley, & Garrido, 2015; Kent et al., 2015). A quote pub- lished by Dowding succinctly captures this element of EHR utility: To me it is pretty accurate because it tells you if you are not giving the right medication to the right patient … It identifies the patient. It identifies the drugs … I think it has made it a lot safer especially with the scanning of the meds (p. 355). Further, the EHR facilitates nurses providing education to patients and their families (Asan et al., 2017; Dowding et al., 2015). Similarly, allowing patients and families to have access to the electronic record improves their involvement in care, although sufficient ed

d their families (Asan et al., 2017; Dowding et al., 2015). Similarly, allowing patients and families to have access to the electronic record improves their involvement in care, although sufficient education is re- quired to ensure that they have an understanding of the information and data (Asan et al., 2017). Access to and use of EHRs was identified as assisting in the re- duction of errors (Wei-Lan et al., 2013), decreasing workload and im- proving time management for nurses (Wei-Lan et al., 2013), especially where internal messaging is an element of the patient record system (Koivunen et al., 2015). The use of the EHR improved communication within the nursing team and between health professionals during the shift (Dowding et al., 2015; Koivunen et al., 2015; Wei-Lan et al., 2013) and between shifts (Staggers, Clark, Blaz, & Kapsandoy, 2011). 3.3 | Nurses concerns The impact of technology on patient outcomes is a driver for up- take. Where nurses believe systems will enhance patient care they are more willing to adopt the technology into their care (de Veer, Fleuren, Bekkema, & Francke, 2011). However, nurses have concerns that the use of technology can be time-consuming and can therefore leave them time poor when it comes to providing direct patient care. This is particularly the case when ensuring timely documentation whilst using the EHR (Dowding et al., 2015; Staggers, Elias, Makar, & Alexander, 2018) and in higher acuity areas (Holtz & Krein, 2011). Nurses are also concerned about ensuring confidentiality and pri- vacy of patient information (Koivunen et al., 2015) as demonstrated by this quote: The other thing is … you have visitors coming in the room and … who’s to say they want Aunt Sue to know all that information when she’s visiting. You know we have to get permission to give any information out so, yes it’s kind of right there for anybody. (Asan et al., 2017, p. 261) Another concern is related to the potential for plagiarism and copy- right breache

get permission to give any information out so, yes it’s kind of right there for anybody. (Asan et al., 2017, p. 261) Another concern is related to the potential for plagiarism and copy- right breaches when using information (Jensen et al., 2016). In addition to concerns related to utilisation of technology in patient care, nurses described frustration and stress associated with functionality of the technology. Where the technology was not fit for purpose, but its use was mandated, such as a hando- ver sheet, nurses reported reverting to printing hard copy docu- ments to manually include additional information. This helped to overcome the inflexibility and rigidity of the computerised tool (Staggers et al., 2011). Usability and reliability issues also reverse any gains that can be achieved at point of care and further threaten patient safety (Staggers et al., 2018). Technical issues, access to devices, duplication of information and poor implementation of systems all contribute to nurse stress and frustration (Chang, Lee, Liu, & Mills, 2016; Liu, Lee, & Mills, 2015; Shin et al., 2018; Staggers et al., 2011, 2018). TA B LE 5 Implications for practice, policy and education Practice Policy Education Allocation of time for nurses to explore and practice using digital platforms at the point of care delivery Inclusion of nurse leaders, nurse informaticians and nurse clinicians in the development of digital platforms and systems Incorporation of curriculum content that builds on student nurses pre-existing digital capability Digital services (help and support) for nurses to troubleshoot and problem solve usability, technical and reliability issues Development of guidelines regarding the confidentiality and privacy of patient and other sensitive information Continuing professional development to maintain and build digital capability in nurses Provision of point of care access to the evidence with education and support to identify appropriate clinical information Thorough im

nal development to maintain and build digital capability in nurses Provision of point of care access to the evidence with education and support to identify appropriate clinical information Thorough implementation strategy with engagement and appropriate timeline for the implementation of new technologies Quarantined education time in orientation and in-service education Widespread use of electronic medical records as a means to improve care quality and safety Buddies, preceptors and mentors identified and allocated to support the development of digital capability in nurses Patient and family education regarding use and types of digital technologies used in their care delivery

Page 16

2816 | 3.4 | Investment for implementation Several of the reviewed studies provided guidance and direction that could overcome some of the issues that nurses identified with the use of technology in patient care. The first of these is the im- portance of stable systems to prevent disruptions to services (Asan et al., 2017; Koivunen et al., 2015; Staggers et al., 2011, 2018; Wei- Lan et al., 2013) that drive nurses to seek workarounds or spend time problem solving (Chang et al., 2016; Liu et al., 2015) or preferring and reverting to lower tech solutions (Asan et al., 2017; Staggers et al., 2011). This quote presented by Chang et al. (2016) is illustra- tive of the issues nurses face and the solutions they use to address them: Our work is extremely busy, and the systems op- eration and data retrieval are too slow! Waiting for the screen to load takes too long. Sometimes, typ- ing/recording data does not require that much time! However, we are forced to wait for the screen to load before we are able to enter data. In the end, we had to adjust our work procedures; that is, we would do other things whilst we were waiting for a screen change. Previously, with the paper-based health re- cords, we could just pick up the paper chart and begin writing (p. 184). Nurse leaders and champio

other things whilst we were waiting for a screen change. Previously, with the paper-based health re- cords, we could just pick up the paper chart and begin writing (p. 184). Nurse leaders and champions should be involved in the devel- opment and evaluation of point of care digital tools and systems, to ensure that their design responds to the problems nurses face and that there is widespread acceptance of and adaptation to implemen- tation (Chang et al., 2016; Kent et al., 2015; Liu et al., 2015; Staggers et al., 2011, 2018). To build digital capability in nurses organisations should allow time for exploration of the technology’s utility (Kent et al., 2015), its adoption (de Veer et al., 2011) and then adaptation to the change in practice (Chang et al., 2016). However, it is overwhelmingly ap- parent that developing nurses’ digital capability requires initial and ongoing training opportunities (Asan et al., 2017; Chang et al., 2016; Koivunen et al., 2015; Liu et al., 2015; Shin et al., 2018; Staggers et al., 2018; de Veer et al., 2011; Wei-Lan et al., 2013) to build on the pre-existing capability that nurses bring with them to the workplace. Education and training opportunities should be provided at orien- tation (Shin et al., 2018), factored into the nurses duties (Wei-Lan et al., 2013) and should include general computer knowledge, as well as specifics relating to hardware and software (Wei-Lan et al., 2013). 4 | DISCUSSION “Every nurse, an e-nurse, able to use data, information, knowledge and technology to maximum effect for patients, carers and service users” was first proposed by the Royal College of Nursing in 2016 (Clever Together: National Information Board’s Building a Digital Ready Workforce (BDRW) Programme, 2018, p. 3) and is a reason- able expectation given the explosion of technology in our everyday world and in healthcare (Skiba, 2017). In order to be an e-nurse, a degree of digital capability is required. The purpose of this integra- tive review

given the explosion of technology in our everyday world and in healthcare (Skiba, 2017). In order to be an e-nurse, a degree of digital capability is required. The purpose of this integra- tive review was to synthesise and evaluate the evidence regarding the development of digital capability in nurses’ and the strategies that support effective integration of digital skills into the workplace. This review explored the development and integration of digital ca- pability into nurses’ work. Despite the rapid uptake and the swift evolution of innovation, there is a relative dearth of research on how nurses can develop digital capability and integrate this capabil- ity into their work. It is apparent from our review of the literature that whilst there are a number of factors that facilitate the use of technology in patient care, there are also a number of gaps in the literature about ongoing issues with technology integration, which we address in the following discussion. The delivery of initial and ongoing education to nurses helps to support nurses to integrate and maintain digital capability skills in their practice. This finding is echoed throughout literature (Hwang & Park, 2011; Kleib et al., 2010; Staggers et al., 2018) and empha- sises that high quality, accessible and timely education for nurses should be a priority for nurse educators and nursing management. Education focused on digital literacy seems to be particularly import- ant for experienced and mature nurses, where emerging research demonstrates age to be a factor in digital capability among nurses. Our findings revealed that older, more experienced nurses seem to be less digitally capable compared with their younger counterparts (Holtz & Krein, 2011; Hwang & Park, 2011; Kleib & Nagle, 2018; Shin et al., 2018). Bridging this generational gap with respect to digital liter- acy may be possible by encouraging older, more experienced nursing staff to undertake postregistration degrees, where they have more of

). Bridging this generational gap with respect to digital liter- acy may be possible by encouraging older, more experienced nursing staff to undertake postregistration degrees, where they have more of an opportunity to be expose to and develop digital literacy skills (Brown, Morgan, Mason, Pope, & Bosco, 2020; Kleib & Nagle, 2018). Alternatively, whilst also appreciating older more experienced nurses may not attend, the provision of mandatory continuing professional development as informal learning could bridge this gap (Hwang & Park, 2011; Kleib et al., 2010; Mather & Cummings, 2017). In addition to education, our findings showed that accessible, reliable, stable systems are essential for the successful integra- tion of technology into nurses’ work (Asan et al., 2017; Koivunen et al., 2015; Staggers et al., 2011, 2018; Wei-Lan et al., 2013). Technical issues are common when new technology is implemented into healthcare settings and access to timely technical support is important (de Veer et al., 2011), regardless of how robust and well developed the technology may be. Our findings highlight how tech- nical issues contribute to nurses’ feelings of frustration and perpetu- ate negative attitudes and resistance among nurses in the uptake of technology (Chang et al., 2016; Staggers et al., 2018). Further to this, both design and technical issues continue to impact on care deliver (Staggers et al., 2018) and could lead to patient dissatisfaction with care and delayed medical treatment. A robust IT support system is a major investment (Ward, Vartak, Schwichtenberg, & Wakefield, 2011), particularly through the

Page 17

t dissatisfaction with care and delayed medical treatment. A robust IT support system is a major investment (Ward, Vartak, Schwichtenberg, & Wakefield, 2011), particularly through the

Page 17

| 2817 implementation phase of integrating new technology to practice and associated training requirements. A reduction in these costs is anticipated as the technology becomes more readily available (Sharma et al., 2018). Our findings showed that managing techni- cal issues also increases nurses’ workload and takes nurses away from direct patient care. In addition to this, developing necessary digital skills, navigating and becoming familiar with new technol- ogy was perceived by nurses as time-consuming and increasing their workload. This finding is consistent with other studies, which showed that implementing new technology in healthcare demands more time of staff (Arguilera, Dickey, & Guzman, 2020; Knippa & Senecal, 2017) and nurses have also reported that the use of tech- nology can be time-consuming making them time-poor (Chang et al., 2016; Dowding et al., 2015; Holtz & Krein, 2011; Staggers et al., 2018). These increase demands faced by nurses during the im- plementation phase of integrating technology needs to be met with additional resources (i.e. more staff working on the floor) (Chang et al., 2016) and postimplementation comprehensive cost-benefit analyses should be undertaken before further changes to existing technologies are made. Whilst the implementation phase of integrating new technology in nurses’ workplaces presents challenges, studies have shown that patient care and satisfaction with care are improved through tech- nology (Asan et al., 2017; Dowding et al., 2015; Kent et al., 2015; Wei-Lan et al., 2013). In an era of person-centred care, this is an important consideration. Findings from our review showed that technology such as EHR can help to support active partnerships between nurses and patients and encourage patients to be more involved in th

mportant consideration. Findings from our review showed that technology such as EHR can help to support active partnerships between nurses and patients and encourage patients to be more involved in their care. The EHR can be used to facilitate conver- sations between nurses and patients, and as a means to provide education to patients and their families (Asan et al., 2017; Dowding et al., 2015). Patients and families also have the ability to eas- ily access their medical records, but this needs to be met with an increase in education offered by nurses and health care profes- sionals to ensure they understand the information that is offered (Asan et al., 2017). The use of the EHR can also improve commu- nication within the nursing team and between health professionals (Dowding et al., 2015; Koivunen et al., 2015; Staggers et al., 2011; Wei-Lan et al., 2013). What remains unclear from the literature we reviewed is the extent to which the EHRs are simply replacing paper versus whether the technology behind the EHR also incorporates elements of artificial intelligence (the use of algorithms) to support nurses care provision. The exponential growth in the use of technology for patient care will continue, and nurses should be ready and able to embrace a digital healthcare environment. In order for this to be a realistic ex- pectation, nurses must be involved in the development of systems, platforms and devices that are used at point of care and provided with the time and resources to implement them. An interesting feature of our review was the focus on competence with computer systems (including hardware and software) and communication tech- nology, at the expense of emerging technologies such as wearables and self-monitoring devices. More research is needed to understand nurse knowledge of and attitudes towards new generation technol- ogy in the workplace. Building digital capability in nurses will require a wide range of strategies to be put in place and investment from

se knowledge of and attitudes towards new generation technol- ogy in the workplace. Building digital capability in nurses will require a wide range of strategies to be put in place and investment from a number of stake- holders, including the nurses themselves, employers, policy makers and governing bodies. On the basis of the synthesis of literature regarding the integration of digital capability in nurses’ workplaces Table 5 makes suggestions for practice, policy and education that may enhance nurses ability to use existing and emerging clinical care technology. However, these results should be interpreted with caution as there was a lack of homogeneity in the approaches to research exploring digital literacy and there were a number of meth- odological weaknesses of the descriptive studies. These include nonrandomisation of participants and the fact that the outcomes of the people who withdrew were not described. Similarly, there were consistent methodological weaknesses in the qualitative studies with the lack of a statement locating the researcher culturally or theoretically evident in all studies. Further, the search terms used in this review do not encompass all terms used historically in the nursing informatics literature. We acknowledge there is a body of literature that exists prior to the introduction of the term “digital” to describe the concept of using software and/ or hardware by nurses within healthcare environments. Additionally, the searched terms were generic and may have not been sufficiently sensitive to detect literature making specific reference to some technology actively used in the patient care such as personal monitoring devices and health applications. 5 | CONCLUSION It is clear from the integrative review of the literature that there are a number of perceived key attributes of digitally proficient nurses. When these attributes are prevalent, nurses are more inclined to use the digital platforms to access medical records and point of c

a number of perceived key attributes of digitally proficient nurses. When these attributes are prevalent, nurses are more inclined to use the digital platforms to access medical records and point of care information. However, not all platforms and systems are designed with the nurse end user in mind, creating problems at the point of access. Therefore, the involvement of nurses in the development of digital systems should be prioritised and it is strongly recommended that there is investment in providing professional development op- portunities for nurses to ensure they have and continue to build their digital capability. ORCID Janie Brown https://orcid.org/0000-0001-8502-4252 REFERENCES Arguilera, L. S., Dickey, E. K., & Guzman, K. (2020). Using interdisciplinary dress rehearsal events to ensure staff readiness when opening a new healthcare facility. Health Environments Research & Design Journal, 13(1), 221–233. https://doi.org/10.1177/1937586719861553 Aromataris, E., & Munn, Z. (Eds.) (2017). Joanna Briggs Institute Reviewer’s Manual. The Joanna Briggs Institute. Available from https://revie wersmanual.joannabriggs.org/

Page 18

Aromataris, E., & Munn, Z. (Eds.) (2017). Joanna Briggs Institute Reviewer’s Manual. The Joanna Briggs Institute. Available from https://revie wersmanual.joannabriggs.org/

Page 18

2818 | Asan, O., Flynn, K. E., Azam, L., & Scanlon, M. C. (2017). Nurses’ per- ceptions of a novel health information technology: A qualitative study in the pediatric intensive care unit. International Journal of Human–Computer Interaction, 33(4), 258–264. https://doi. org/10.1080/10447318.2017.1279828 Baskaran, P. M. A., & Baby, P. (2015). A Descriptive Study to Assess the Knowledge and Attitude of the Staff Nurses Regarding Nursing Informatics in Selected Hospital. Bangalore. International Journal of Nursing Education, 7(2), 250–255. https://doi. org/10.5958/0974-9357.2015.00114.2 Brown, J., Morgan, A., Mason, J., Pope, N., & Bosco, A. M. (2020). Student nurses’ digital literacy levels: Lessons for curricula. CIN: Computers, Informatics, Nursing. https://doi.org/10.1097/CIN.0000000000000615 Car, J., Carlstedt-Duke, J., Tudor Car, L., Posadzki, P., Whiting, P., Zary, N., … Digital Health Education, C. (2019). Digital education in health professions: The need for overarching evidence synthe- sis. Journal of Medical Internet Research, 21(2), e12913. https://doi. org/10.2196/12913 Chang, C. P., Lee, T. T., Liu, C. H., & Mills, M. E. (2016). Nurses’ experi- ences of an initial and reimplemented electronic health record use. CIN: Computers, Informatics, Nursing, 34(4), 183–190. https://doi. org/10.1097/CIN.0000000000000222 Clever Together: National Information Board’s Building a Digital Ready Workforce (BDRW) Programme. (2018). Every nurse an e-nurse. Insights from a consultation on the digital future of nursing. London, UK: Royal College of Nursing. Cummings, E., Shin, E., Mather, C., & Hovenga, E. (2016). Embedding nursing informatics education into an Australian undergraduate nursing degree. Studies in Health Technology and Informatics, 225, 32

Cummings, E., Shin, E., Mather, C., & Hovenga, E. (2016). Embedding nursing informatics education into an Australian undergraduate nursing degree. Studies in Health Technology and Informatics, 225, 329–333. https://doi.org/10.3233/978-1-61499-658-3-329. de Veer, A. J. E., Fleuren, M. A. H., Bekkema, N., & Francke, A. L. (2011). Successful implementation of new technologies in nursing care: A questionnaire survey of nurse-users. BMC Medical Informatics and Decision Making, 11(1), 67. https://doi. org/10.1186/1472-6947-11-67 Dixon-Woods, M., Agarwal, S., Jones, D., Young, B., & Sutton, A. (2005). Synthesising qualitative and quantitative evidence: A review of pos- sible methods. Journal of Health Services Research & Policy, 10(1), 45– 53. https://doi.org/10.1177/135581960501000110 Dowding, D. W., Turley, M., & Garrido, T. (2015). Nurses’ use of an in- tegrated electronic health record: Results of a case site analysis. Informatics for Health and Social Care, 40(4), 345–361. https://doi. org/10.3109/17538157.2014.948169 Foster, M., & Sethares, K. (2017). Current strategies to implement in- formatics into the nursing curriculum: An integrative review. Online Journal of Nursing Informatics, 21(3). Health Education England (2016). Digital literacy: Towards a definition. Retrieved from https://www.hee.nhs.uk/sites/default/files/docum ents/1.%20Digital%20literacy%20Towards%20a%20definition.pdf Heidarizadeh, K., Rassouli, M., Manoochehri, H., Zagheri Tafreshi, M., & Kashef Ghorbanpour, R. (2017). Nurses’ Perception of Challenges in the Use of an Electronic Nursing Documentation System. CIN: Computers, Informatics, Nursing, 35(11), 599–605. https://doi. org/10.1097/CIN.0000000000000358 Holtz, B., & Krein, S. (2011). Understanding nurse perceptions of a newly implemented electronic medical record system. Journal of Technology in Human Services, 29(4), 247–262. https://doi.org/10.1080/15228 835.2011.639931 Hwang, J.-I.

ding nurse perceptions of a newly implemented electronic medical record system. Journal of Technology in Human Services, 29(4), 247–262. https://doi.org/10.1080/15228 835.2011.639931 Hwang, J.-I., & Park, H.-A. (2011). Factors associated with nurses’ infor- matics competency. CIN: Computers, Informatics, Nursing, 29(4), 256– 262. https://doi.org/10.1097/NCN.0b013e3181fc3d24 Jensen, R., Guedes, E. S., & Leite, M. M. J. (2016). Informatics com- petencies essential to decision making in nursing management. Revista Da Escola De Enfermagem Da USP, 50(1), 109–117. https://doi. org/10.1590/S0080-623420160000100015 Kennedy, S., & Yaldren, J. (2017). A look at digital literacy in health and social care. British Journal of Cardiac Nursing, 12(9), 428–432. https:// doi.org/10.12968/bjca.2017.12.9.428. Kent, B., Redley, B., Wickramasinghe, N., Nguyen, L., Taylor, N. J., Moghimi, H., & Botti, M. (2015). Exploring nurses’ reactions to a novel technology to support acute health care delivery. Journal of Clinical Nursing, 24(15/16), 2340–2351. https://doi.org/10.1111/ jocn.12881. Kleib, M., & Nagle, L. (2018). Factors associated with canadian nurses’ informatics competency. CIN: Computers, Informatics, Nursing, 36(8), 406–415. https://doi.org/10.1097/CIN.0000000000000434 Kleib, M., Sales, A. E., Lima, I., Andrea-Baylon, M., & Beaith, A. (2010). Continuing education in informatics among registered nurses in the United States in 2000. Journal of Continuing Education in Nursing, 41(7), 329–336. https://doi.org/10.3928/00220124-20100503-08 Knippa, S., & Senecal, P. (2017). Using simulation to prepare nursing staff for the move to a new building. Journal for Nurses in Professional Development, 33(2), E1–E5. https://doi.org/10.1097/NND.00000 00000000329 Koivunen, M., Niemi, A., & Hupli, M. (2015). The use of electronic devices for communication with colleagues and other healthcare profession- als: Nursing professionals’ perspectives.

� 00000000329 Koivunen, M., Niemi, A., & Hupli, M. (2015). The use of electronic devices for communication with colleagues and other healthcare profession- als: Nursing professionals’ perspectives. Journal of Advanced Nursing, 71(3), 620–631. https://doi.org/10.1111/jan.12529 Liu, C.-H., Lee, T.-T., & Mills, M. E. (2015). The experience of informat- ics nurses in Taiwan. Journal of Professional Nursing, 31(2), 158–164. https://doi.org/10.1016/j.profnurs.2014.09.005 Mather, C., & Cummings, E. (2017). Modelling digital knowledge transfer: Nurse supervisors transforming learning at point of care to advance nursing practice. Informatics, 4(2), 12. https://doi.org/10.3390/infor matics4020012. Michie, S., Johnston, M., Abraham, C., Lawton, R., Parker, D., & Walker, A. (2005). Making psychological theory useful for implementing ev- idence based practice: A consensus approach. Quality and Safety in Health Care, 14, 26–33. Miller, L. A., Stimely, M. E., Matheny, P. M., Pope, M. F., McAtee, R. E., & Miller, K. A. (2014). Novice Nurse Preparedness to Effectively Use Electronic Health Records in Acute Care Settings: Critical Informatics Knowledge and Skill Gaps. Online Journal of Nursing Informatics, 18(2), 1–1. http://search.ebscohost.com/login.aspx?direct=true&db=r- zh&AN=103925127&site=ehost-live. Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group (2009). Preferred reporting items for systematic reviews and me- ta-analyses: The PRISMA Statement. PLoS Medicine, 6(6), e1000097. https://doi.org/10.1371/journal.pmed1000097 Olajubu, A. O., Irinoye, O. O., Ogunfowokan, A. A., & Olowokere, A. E. (2015). Utilization of nursing informatics by nurses in three tiers of health care facilities in Nigeria. West African Journal of Nursing, 26(1), 1–13. http://search.ebscohost.com/login.aspx?direct=true&db=r- zh&AN=108501531&site=ehost-live Risling, T. (2017). Educating the nurses of 2025: Technology trends of the nex

sing, 26(1), 1–13. http://search.ebscohost.com/login.aspx?direct=true&db=r- zh&AN=108501531&site=ehost-live Risling, T. (2017). Educating the nurses of 2025: Technology trends of the next decade. Nurse Education in Practice, 22, 89–92. https://doi. org/10.1016/j.nepr.2016.12.007 Sassen, J. E. (2009). Love, hate, or indifference: How nurses really feel about the electronic health record system. CIN: Computers, Informatics, Nursing, 27(5), 281–287. https://doi.org/10.1097/ NCN.0b013e3181b2162a Sharma, A., Harrington, R. A., McClellan, M. B., Turakhia, M. P., Eapen, Z. J., Steinhubl, S., … Peterson, E. D. (2018). Using digital health tech- nology to better generate evidence and deliver evidence-based care. Journal of the American College of Cardiology, 71(23), 2680–2690. https://doi.org/10.1016/j.jacc.2018.03.523 Shin, E. H., Cummings, E., & Ford, K. (2018). A qualitative study of new graduates’ readiness to use nursing informatics in acute care set- tings: Clinical nurse educators’ perspectives. Contemporary Nurse, 54(1), 64–76. https://doi.org/10.1080/10376178.2017.1393317

Page 19

iness to use nursing informatics in acute care set- tings: Clinical nurse educators’ perspectives. Contemporary Nurse, 54(1), 64–76. https://doi.org/10.1080/10376178.2017.1393317

Page 19

| 2819 Skiba, D. J. (2017). Nursing informatics education: From automation to connected care. In J. Murphy, W. Goossen, & P. Weber (Eds.), Forecasting informatics competencies for nurses in the future of con- nected health (Vol. 232, pp. 9–19). Amsterdam, the Netherlands: IOS Press BV. Staggers, N., Clark, L., Blaz, J. W., & Kapsandoy, S. (2011). Nurses’ in- formation management and use of electronic tools during acute care handoffs. Western Journal of Nursing Research, 34(2), 153–173. https://doi.org/10.1177/0193945911407089 Staggers, N., Elias, B. L., Makar, E., & Alexander, G. L. (2018). The imper- ative of solving nurses’ usability problems with health information technology. Journal of Nursing Administration, 48(4), 191–196. https:// doi.org/10.1097/NNA.0000000000000598 Venkatesh, V., Morris, M., Davis, G., & Davis, F. (2003). User acceptance of information technology: Toward a unified view. Management Information Systems Quarterly, 27, 425–478. Ward, M. M., Vartak, S., Schwichtenberg, T., & Wakefield, D. S. (2011). Nurses’ perceptions of how clinical information system implementa- tion affects workflow and patient care. CIN: Computers, Informatics, Nursing, 29(9), 502–511. https://doi.org/10.1097/NCN.0b013e3182 2b8798 Wei-Lan, X. M., Li-Qun, Y. M., & Hong-Yu, Z. (2013). Nursing infor- matics in clinical practice in china. CIN: Computers, Informatics, Nursing, 31(5), 214–218. https://doi.org/10.1097/NXN.0b013 e31828a0db0 Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52(5), 546–553. https:// doi.org/10.1111/j.1365-2648.2005.03621.x SUPPORTING INFORMATION Additional supporting information may be found online in the Supporting Information section. How to cite this a

(5), 546–553. https:// doi.org/10.1111/j.1365-2648.2005.03621.x SUPPORTING INFORMATION Additional supporting information may be found online in the Supporting Information section. How to cite this article: Brown J, Pope N, Bosco AM, Mason J, Morgan A. Issues affecting nurses’ capability to use digital technology at work: An integrative review. J Clin Nurs. 2020;29:2801–2819. https://doi.org/10.1111/jocn.15321

digital technology literacy — Wikipedia
integrative review — Wikipedia
capabilities enhancement — Wikipedia
clinical informatics — Wikipedia
digital capability — Wikipedia
digital literacy — Wikipedia
nursing informatics — Wikipedia
health informatics — Wikipedia
PRISMA guidelines — Wikipedia
Whittemore and Knafl methodology — Wikipedia
continuing professional development — Wikipedia
knowledge integration — Wikipedia
competency — Wikipedia
workplace integration — Wikipedia
point-of-care data access — Wikipedia
electronic medical records — Wikipedia
user proficiency — Wikipedia
system implementation — Wikipedia

Janie Brown — Wikipedia
Nicole Pope — Wikipedia
Kent St — Wikipedia
Journal of Clinical Nursing — Wikipedia
Wiley — Wikipedia
Kent State — Wikipedia
CINAHL — Wikipedia
Embase — Wikipedia
PsychINFO — Wikipedia
Medline — Wikipedia
PubMed — Wikipedia
Joanna Briggs Institute — Wikipedia
JBI-MAStARI — Wikipedia

NemoClaw Knowledge Wiki

Explorer

Journal of Clinical Nursing - 2020 - Brown - Issues affecting nurses capability to use digital technology at work An

, blue, and yellow segments. The button appears to be part of a software interface, likely for checking system updates. The main subject is the update check button, set against a light gray background with dark gray text, while the logo uses vibrant red, blue, and yellow colors. ---‘

Page 1

Page 2

Page 3

Page 4

Page 4

Page 5

Page 6

Page 6

Page 7

Page 7

Page 8

Page 9

Page 10

Page 10

Page 11

Page 12

Page 12

Page 13

Page 14

Page 15

Page 16

Page 17

Page 17

Page 18

Page 18

Page 19

Page 19

Graph View

Table of Contents

Backlinks

NemoClaw Knowledge Wiki

Explorer

Journal of Clinical Nursing - 2020 - Brown - Issues affecting nurses capability to use digital technology at work An

, blue, and yellow segments. The button appears to be part of a software interface, likely for checking system updates. The main subject is the update check button, set against a light gray background with dark gray text, while the logo uses vibrant red, blue, and yellow colors. ---‘

Page 1

Page 2

Page 3

Page 4

Page 4

Page 5

Page 6

Page 6

Page 7

Page 7

Page 8

Page 9

Page 10

Page 10

Page 11

Page 12

Page 12

Page 13

Page 14

Page 15

Page 16

Page 17

Page 17

Page 18

Page 18

Page 19

Page 19

Related Concepts

Related Entities

Graph View

Table of Contents

Backlinks