Digital technology: why nurses need to be at the centre of new developments

Nurse researchers should contribute to the meaningful design and implementation of digital innovations, says professor of nursing Rhonda Wilson

Embracing technology
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Technology is increasingly pervasive in our lives, and the sentiment it evokes will depend on the nature of the activity that it enables or restricts. Throughout the isolation brought about by the COVID-19 pandemic, technology capacity and capability has mobilised a way of life that could not be achieved, or imagined, without technological solutions. As well as purchasing supplies online for contactless home delivery, videoconferencing has kept us connected personally and professionally, working and studying from home has been achieved online, tracking apps are enabling early identification of risk exposure, public hygiene health promotion messages have been sent to mass populations, telehealth has provided an alternative to face-to-face primary care, and social media communications have enabled social proximity, while ensuring physical distancing.

Such technological activities are conveniently accessible for the 2.5 billion smartphone users of the world, facilitating a ‘stay at home’ lifestyle during the pandemic, thereby reducing the intensity of its impact. Surely, this demonstrates that the smartphone is one of the most revolutionary bring-your-own technological tools of our lifetimes.

A new experience of the familiar with the smartphone

Smartphone technology has supported people to maintain the practical routine habits of their usual daily lives, both virtually, and in real-life. Facebook – as Welch (2019) highlights in her article on effective recruitment – and other social media channels are commonly used, and seamlessly integrate, into our daily lives and research data collection strategies.

'Design and implementation scientists will need to work in closer collaboration with nursing clinicians and nursing scientists if they are to fully understand the end-user experiences'

Practical familiarity for daily functioning is a critical and developmental life skill attainment. When achieved, it enables people to move with ease across the habitual activities that are routine elements of daily life (Bissell 2013).

Disruptions to a familiar routine cause us to reorient and require our cognitive attentions, leaving less availability for complex higher order thinking that usually frames our productivity (Geake 2009, Wilson and Usher 2015). COVID-19 has been disruptive, altering our experience of the familiar and routine. The smartphone has enhanced the transition to a new experience of the familiar.

Nursing science must adapt to digital literacy

As smartphone users, most of us will organise our settings, apps and hardware appliances, with data plans that support our productivity. Habits are formed, and this familiarity with technology contributes to a baseline of digital literacy that enhances and transforms successful communication exchanges, and practical or administrative transactions. COVID-19 has pushed us all further into the technological landscape, forcing us to expand our digital scope.

Digital escalation will require that nursing science adapts and accommodates to this shift, so nursing remains meaningful as health needs and environments change (Grace and Zumstein‐Shaha 2020), and is fundamentally person-centred in approach (McCormack and McCance 2017). Our research methods and practice must adapt if we are to explore relevant questions that investigate contemporary health needs, framed in digital and real-life experiences, and propose solutions and recommendations. Our recruitment techniques and data collection strategies must ensure that we achieve samples of qualified and informative participants in our research studies. To do this, it is increasingly relevant that we refine our communication channels for invitations to participate in our research, and tailor our questions to populations using digital technologies such as social media and technological communication tools and repositories (Wilson and Usher 2017). A failure to do so would compromise the reliability of our outputs.

Nursing voice on end-user experiences of technology

Harding et al (2020) raise the matter of purposeful design of technological solutions such as electronic health records. As we increase the use of integrated systems in health care we must pay attention to user experiences of technology. Human computer interaction principles and design features are important factors in aligning aims, processes and outcomes (Morrison et al 2012, Søgaard Nielsen and Wilson 2018). There are many challenges for health sector software designers, who are largely building new systems and retrofitting these to ageing technological architectures. The renovations do not always go smoothly. ‘Bugs’ emerge in implementation, and, as Harding et al (2020) point out, frequently the preset options, and drop-down menus available to users fail to accommodate the ambiguity that is innate in the administration of nursing practice. Co-morbid conditions and frailty pose a challenge to implementation of informatics and machine learning processing. In response to these challenging limitations, nurses sometimes adopt dynamic work-around solutions to mitigate the limitations of our electronic health record systems, to provide holistic and comprehensive nursing care which is better suited to the creative cognition of practice-informed clinicians (Møller Jensen 2019).

'Nurses must be willing to adapt their clinical and research practice to embrace digital technology, critique implementation, and ready themselves to participate actively in the technological health sector landscape in response to rapidly evolving needs'

Design and implementation scientists will need to work in closer collaboration with nursing clinicians and nursing scientists if they are to fully understand the end-user experiences. They will need to pay due diligence to feasibility and usability study feedback to inform future development of technological responses to clinical problems. Too often, nurses are left out of decision-making at critical points of innovation, conceptual development, governance, design selection, policy development and implementation management, without adequate representation early, and added as an afterthought mid process (Carryer 2019). Without the timely voice of nursing end-user experience and expertise, it is not surprising that digital design of electronic health records systems have a narrow spectrum of use, and are not fit for secondary purposes such as research investigations (Harding et al 2020).

What can we learn from our experiences of rapid lifestyle and technological use changes as we reflect on our roles as nursing researchers in the International Year of the Nurse and Midwife? It is evident that the pace of global change in response to COVID-19 has challenged us to investigate more diligently, and to pivot our expertise to search for innovative technological solutions targeting health problems that can be implemented rapidly, and safely. Our familiar ways of conducting personal and professional activities of daily living have increasingly embraced digital technologies, with the smartphone an example of a common ‘bring your own technology’ widely available to vast populations. The scope for using digital technologies and communication channels to benefit populations is rapidly expanding.

To maximise the potential for scalable beneficial outcomes, nursing researchers need to contribute to the meaningful design and implementation of innovations. The end use for many of the digital interventions and solutions rests with nurses, and their use of these innovations at point-of-care. Nurses must be willing to adapt their clinical and research practice to embrace digital technology, critique implementation, and ready themselves to participate actively in the technological health sector landscape in response to rapidly evolving needs. We must lead, and be included in, genuine and authentic collaborative research partnerships if solutions are intended for end-use success.

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About the author

Rhonda WilsonRhonda Wilson is professor of nursing at the School of Nursing and Midwifery, University of Newcastle, Central Coast, New South Wales, Australia, and professor of nursing at the School of Nursing, Massey University, Albany, New Zealand