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BACKGROUND: Health economic evaluation of digital nursing technologies (DNT) is important to provide information that helps avoid undesirable developments and implementations as well as increase the chances of success of developed applications. At the same time, studies and evidence on cost-effectiveness are still very rare in this field. Review studies in related technology areas such as telemedicine frequently criticise the quality and comparability of health economic evaluations conducted in this field. Based on a content analysis of methodological literature on the economic evaluation of innovative (digital) technologies in health and nursing, this article aims to identify specific challenges in this research area and offers recommendations on how to address these challenges to promote more sound health economic evaluations in the future. METHODS: A rapid review was conducted, consisting of a systematic search in the Pubmed database as well as Google Scholar. In addition, the literature lists of the analysed texts were scoured for additional texts to be included. Methodological literature, single studies, and reviews were included. A total of 536 studies were screened, of which 29 were included in the full text analysis. RESULTS: Based on the systematic content analysis of the studies under consideration, 10 specific methodological challenges are identified, and the methodological recommendations were examined for consideration. A particular focus was given to whether specific methodological approaches might be needed in the context of evaluating the efficiency of DNT. CONCLUSION: Many of the challenges identified for the health economic evaluations of digital nursing technologies are comparable to those of other complex health care interventions. The recommendations discussed can help to alleviate those challenges. Future research should focus on alternative approaches to assessing causality in different phases of technology development while maintaining high evidence standards. High-evidence economic assessment of technologies in nursing care should be carried out in routine use, especially if they are intended to be reimbursed by the social insurance.
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BACKGROUND: The evaluation of digital nursing technologies (DNT) plays a major role in gaining knowledge about certain aspects of a technology such as acceptance, effectiveness, or efficiency. Evaluation frameworks can help to classify the success or failure of a DNT or to further develop the technology. In general, there are many different evaluation frameworks in the literature that provide overviews of a wide variety of aspects, which makes this a highly diverse field and raises the question how to select a suitable framework. The aim of this article is to provide orientation in the field of comprehensive evaluation frameworks that can be applied to the field of DNT and to conduct a detailed analysis and assessment of these frameworks to guide field researchers. METHODS: This overview was conducted using a three-component search process to identify relevant frameworks. These components were (1) a systematized literature search in PubMed; (2) a narrative review and (3) expert consultations. Data relating to the frameworks' evaluation areas, purpose, perspectives, and success definitions were extracted. Quality criteria were developed in an expert workshop and a strength and weakness assessment was carried out. RESULTS: Eighteen relevant comprehensive evaluation frameworks for DNT were identified. Nine overarching evaluation areas, seven categories of purposes, five evaluation perspectives and three categories of success definitions could be identified. Eleven quality criteria for the strengths and weaknesses of DNT-related evaluation frameworks were developed and the included frameworks were assessed against them. CONCLUSION: Evaluators can use the concise information and quality criteria of this article as a starting point to select and apply appropriate DNT evaluation frameworks for their research projects or to assess the quality of an evaluation framework for DNT, as well as a basis for exploring the questions raised in this article. Future research could address gaps and weaknesses in existing evaluation frameworks, which could improve the quality of future DNT evaluations.
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BACKGROUND: The field of digital technologies being developed or applied to support nursing care is extensive. The aim of this scoping review is to provide an overview on technologies for which results on positive or negative effects on persons in need of care, caregivers or care institutions are available and to appraise the reliability of these results. METHODS: A scoping review design has been used to identify studies focussing on the effectiveness of digital technologies in nursing care for persons in need of care, caregivers or care institutions. The screening process included 19,510 scientific publications from 9 databases. RESULTS: A total of 123 single studies and 31 reviews were subjected to the analysis. The included technologies comprise nursing and health information technologies, such as assistive devices, information and communication technologies, sensors and robotics. The results show that there are many studies that demonstrate positive effects, but the level of evidence is mostly low and study sizes are often small. Hardly any technology has been researched intensively enough to produce conclusive results. Studies on a high level of evidence (RCTs) lack for most technological areas. Heterogeneous results in some areas indicate that effects may depend strongly on the mode and specific context into which the technologies are introduced. CONCLUSION: Due to the limited evidence on effectiveness of digital technologies in nursing care, it is not surprising that care institutions are reluctant to put innovative technologies into practice. The scoping review indicates technology areas that should be subject to future research with higher quality studies. Research on outpatient, informal and cross-sectoral care should be intensified to further exploit the potential of digital technologies with a view to improving independence of care-recipients and unburdening formal and informal carers.
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INTRODUCTION: Even though the importance of nurses' participation in the process of technology development is frequently stressed by stakeholders, participation has been described as negligible and limited by nurses' abilities to identify and communicate their needs and ideas for application scenarios or the improvement of digital nursing technologies (DNT) in everyday care practice. Prior research often uses hypothetical scenarios or laboratory settings with little real-world relevance, and the number of studies investigating needs for technology development, application scenarios or requested technologies from the perspective of nurses with experience in technology use is exceedingly small. Against this background, this study aims to investigate needs, application scenarios and perspectives of nurses with practical experience in real-world DNT application in a range of different care settings. METHODS: An explanatory sequential mixed methods design including an online survey (QUANT) and focus group (FG) discussions (qual) was used to explore nurses' perspectives and experiences. A convenience sample of participants was accessed via 19,000 e-mail contacts of directors of nursing (DONs) in care facilities and hospitals throughout Germany. Preliminary results of the online survey were discussed and elaborated in depth in three FGs. Quantitative results of the online survey were included in the development of the interview guideline for and data collection from the FGs. Descriptive, setting-specific analysis was conducted for quantitative data, and qualitative data was analysed by identifying key aspects. RESULTS: A total of 1,335 participants took part in the online survey, most of whom worked in ambulatory care institutions and held management positions such as DON or team leader. There were 14 FG participants. Ninety-five per cent of the participants of the online survey reported having experience in the use of DNT, predominantly with information and communication technologies (ICT). Overall, DNT were deemed to make work easier, and participants concurred on other positive effects such as increased efficiency or saved time and improved quality of care. Negative effects or concerns were reported less frequently. Reasons for non-adoption included technology-related (e.g. usability, functionality) and non-technology-related (e.g. competencies and context factors) issues, and facilitators for adoption were discussed in the FGs. Key aspects of application scenarios were enhanced technological support of direct nursing care tasks to reduce physical burden and mental stressors. Specifically, participants of the FGs expressed their wish for participative development and a general openness for nurses to be included in the development and testing of digital technologies. DISCUSSION AND CONCLUSION: Although efforts in development, research and theory-building have been increasing over recent years, DNT that go beyond more traditional or common applications within the ICT category (such as electronic nursing records or process planning) are rare. There are already technologies available for many of the expressed needs for which, however, adoption fails or does not happen. The reported barriers and facilitators indicate issues that should be taken into account when developing DNT for application in nursing practice. The study reveals a distinct need for information, counselling, facilitation and organizational development, and brings to light broad opportunities for the collaborative development of guided DNT implementation and evaluation processes. Future development and research activities should preferably be conducted by interdisciplinary research groups.
Subject(s)
Communication , Digital Technology , Focus Groups , Germany , HumansABSTRACT
BACKGROUND: Digital nursing technologies (DNT) comprise an expanding, highly diverse field of research, explored using a wide variety of methods and tools. Study results are therefore difficult to compare, which raises the question how effectiveness of DNT can be adequately measured. Methods currently used might not be sufficient for certain specific nursing contexts. A comprehensive outcome framework that shows the multitude of possible outcome areas could be useful to generate more comparable results. The aim of the present study is to develop an outcome framework for DNT and to indicate which outcome areas have been most frequently evaluated in previous studies and how this has been done. METHODS: We combined an inductive and deductive approach to develop the framework. The numerical analysis is based on a scoping review focussing on the effectiveness of DNT for persons in need of care, formal or informal caregivers or care institutions. Nine databases were included in the screening: Medline, Scopus, CINAHL, Cochrane Library, ACM Digital Library, IEEE Xplore, the Collection of Computer Science Bibliographies, GeroLit and CareLit. Additional literature searches and expert interviews were included. RESULTS: The developed framework comprises four outcome target groups and 47 outcome areas. There are considerable differences in the researched outcome areas for the individual outcome target groups. Persons in need of care were by far the most frequently surveyed, particularly with respect to their psychological health. There are much fewer studies on formal and informal caregivers, and it is particularly noticeable that the quality of life of both groups has rarely been investigated. Care process quality was most frequently researched for organisations. CONCLUSION: We were able to provide a comprehensive DNT outcome framework, thereby identifying the outcome tools used and the less researched outcome areas. We recommend a detailed investigation of all areas and tools in future research projects with a view to initiating a discussion on the differing importance of existing outcome areas and on a standardisation of outcome tools. We also recommend the development of outcome areas for the macro level of effectiveness assessment.
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Biomedical Technology , Nursing , Humans , Nursing Evaluation ResearchABSTRACT
Ensuring care is one of the biggest humanitarian challenges of the future since an acute shortage in nursing staff is expected. At the same time, this offers the opportunity for new technologies in nursing, as the use of robotic systems. One potential use case is outpatient care, which nowadays involves traveling long distances. Here, the use of telerobotics could provide a major relief for the nursing staff, as it could spare them many of those-partially far-journeys. Since autonomous robotic systems are not desired at least in Germany for ethical reasons, this paper evaluates the design of a telemanipulation system consisting of off-the-shelf components for outpatient care. Furthermore, we investigated the suitability of two different input devices for control, a kinesthetic device, and a keyboard plus mouse. We conducted the investigations in a laboratory study. This laboratory represents a realistic environment of an elderly home and a remote care service center. It was carried out with 25 nurses. Tasks common in outpatient care, such as handing out things (manipulation) and examining body parts (set camera view), were used in the study. After a short training period, all nurses were able to control a manipulator with the two input devices and perform the two tasks. It was shown that the Falcon leads to shorter execution times (on average 0:54.82 min, compared to 01:10.92 min with keyboard and mouse), whereby the participants were more successful with the keyboard plus mouse, in terms of task completion. There is no difference in usability and cognitive load. Moreover, we pointed out, that the access to this kind of technology is desirable, which is why we identified further usage scenarios.
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BACKGROUND: The existence, usage and benefits of digital technologies in nursing care are relevant topics in the light of the current discussion on technologies as possible solutions to problems such as the shortage of skilled workers and the increasing demand for long-term care. A lack of good empirical overviews of existing technologies in the present literature prompted us to conduct this review. Its purpose was to map the field of digital technologies for informal and formal care that have already been explored in terms of acceptance, effectiveness and efficiency (AEE), and to show the scope of the used methods, target settings, target groups and fields of support. METHODS: A systematic literature search was conducted using Medline, Scopus, CINAHL, Cochrane Library, ACM Digital Library, IEEE Xplore, the Collection of Computer Science Bibliographies, GeroLit and CareLit. In addition, project websites were manually screened for relevant publications. RESULTS: Seven hundred fifteen papers were included in the review. Effectiveness studies have been most frequently performed for ICT, robots and sensors. Acceptance studies often focussed on ICT, robots and EHR/EMR. Efficiency studies were generally rare. Many studies were found to have a low level of evidence. Experimental designs with small numbers and without control groups were the most common methods used to evaluate acceptance and effectiveness. Study designs with high evidence levels were most commonly found for ICT, robots and e-learning. Technologies evaluated for informal caregivers and children or indicated for formal care at home or in cross-sectoral care were rare. CONCLUSION: We recommend producing high-quality evaluations on existing digital technologies for AEE in real-life settings rather than systematic reviews with low-quality studies. More focus should be placed on research into efficiency. Future research should be devoted to a closer examination of the applied AEE evaluation methods. Policymakers should provide funding to enable large-scale, long-term evaluations of technologies in the practice of care, filling the research gaps for technologies, target settings and target groups identified in this review.
