Digitalisation and transmission of clinical information in nursing: implications and perspectives (digi-care)
Based on observations in hospitals, researchers analysed the impact that digitalisation has had on the transmission of clinical patient information in nursing. Which digital competencies need to be acquired? Can IT solutions and their usability be improved? A multimedia prototype and various learning situations were then developed for the initial and continuous training of nurses, and suggestions for optimised digital workflows were made.
This project is part of the National Research Programme 'Digital Transformation' (NRP 77)run by the Swiss National Science Foundation (SNSF). It was conducted by the Swiss Federal University for Vocational Education and Training (SFUVET) and the Institute for Medical Informatics (I4MI) at the Bern University of Applied Sciences (BFH). Hospitals and educational institutions from the German-speaking part of Switzerland and the Canton of Ticino participated in the project.
Increasing digitalisation in healthcare is changing the way care teams communicate and share knowledge. This project was designed to shed light on how digital devices and clinical information systems affect the way patient care information is shared among care teams. This is a top priority when it comes to ensuring continuity of patient care and avoiding errors in treatment. Implications for nurses’ competency requirements were highlighted and IT-related events that may be considered dissatisfying from a technological point of view were documented.
To date, only a few studies have examined collaborative and interactive work processes in nursing and used the experiences of nurses as a basis for possible pedagogical and technological innovations. This study does not evaluate the quality of nursing activities at hospital wards or of the quality of the digital devices and clinical information systems in use. Instead, researchers asked nurses to share their perspectives on the digital devices that they use, and as a result, options of improvement were developed in a collaborative project.
The starting point was an ethnographic study in hospitals where nurses were accompanied and filmed during their work (job shadowing). The nurses were then invited to comment on video footage (showed to them) to get ahold of the nurses’ own perception of their performed activities. Based on their descriptions and the collected video material, researchers identified typical situations in which digital devices were used for patient care information transmission. Subsequently, these situations were validated with nurses involved in the study, nursing and IT managers of the hospitals and training managers. On this basis, researchers developed a multimedia prototype consisting of an interactive 360° video on the subject of shift handover. We also produced learning situations that can be used for the initial and continuous training of nurses. In addition, the research team documented IT-related events that affected the transfer of patient care information and then developed mock-ups of possible technical solutions to enhance IT usability and digital processes. The prototypes and learning situations were validated in workshops with individuals from nursing, education and informatics.
Here you can access the multimedia prototype on the subject of shift handover and the learning situations, which are based on real work situations. You will also find interactive IT mock-ups: a digitalised individualised nursing worklist on mobile device as well as a digitalised preoperative checklist on patient-assigned tablet. Two additional IT-related events are presented in use cases to show how certain workflows can be optimised.
The Digi-care project consisted of several phases:
In the first phase, we conducted an ethnographic study at six hospital wards, two in the Italian-speaking part and four in the German-speaking part of Switzerland. This involved job shadowing and self-confrontation interviews with the aim of identifying situations where patient care information is transmitted using digital devices, and which are perceived as significant by the participants. To understand the subjective meaning of the situations for the nurses, we performed semiological analyses of their activities. During our observations, we also documented IT-related events, which were then analysed to determine whether they could be avoided by improving the usability of the IT systems.
In the second phase, a multi-stage selection process was used to select relevant situations involving patient care information transmission as well as IT-related events that had a generic potential for improvement. Our findings were then validated in several workshops with the involved nurses and nursing and IT managers. The larger regional workshops included training managers at the participating hospitals and representatives and students from educational institutions.
In the third phase, we developed a multimedia prototype consisting of an interactive 360° video based on the selected situations. In addition, we produced learning situations that can be used by hospitals and educational institutions for the initial and continuous training of nurses. These learning situations were developed in consultation with a group of representatives from the participating hospitals and educational institutions.
For selected IT-related events, we developed either interactive IT mock-ups or descriptions of improved IT workflows which demonstrate how such incidents could be avoided in the future through usability and workflow enhancements. The mock-ups were validated by nurses and IT managers at participating hospitals.