Artificial intelligence in nursing and midwifery: A systematic review.

BACKGROUND: Artificial Intelligence (AI) techniques are being applied in nursing and midwifery to improve decision-making, patient care and service delivery. However, an understanding of the real-world applications of AI across all domains of both professions is limited. OBJECTIVES: To synthesise literature on AI in nursing and midwifery. METHODS: CINAHL, Embase, PubMed and Scopus were searched using relevant terms. Titles, abstracts and full texts were screened against eligibility criteria. Data were extracted, analysed, and findings were presented in a descriptive summary. The PRISMA checklist guided the review conduct and reporting. RESULTS: One hundred and forty articles were included. Nurses' and midwives' involvement in AI varied, with some taking an active role in testing, using or evaluating AI-based technologies; however, many studies did not include either profession. AI was mainly applied in clinical practice to direct patient care (n = 115, 82.14%), with fewer studies focusing on administration and management (n = 21, 15.00%), or education (n = 4, 2.85%). Benefits reported were primarily potential as most studies trained and tested AI algorithms. Only a handful (n = 8, 7.14%) reported actual benefits when AI techniques were applied in real-world settings. Risks and limitations included poor quality datasets that could introduce bias, the need for clinical interpretation of AI-based results, privacy and trust issues, and inadequate AI expertise among the professions. CONCLUSION: Digital health datasets should be put in place to support the testing, use, and evaluation of AI in nursing and midwifery. Curricula need to be developed to educate the professions about AI, so they can lead and participate in these digital initiatives in healthcare. RELEVANCE FOR CLINICAL PRACTICE: Adult, paediatric, mental health and learning disability nurses, along with midwives should have a more active role in rigorous, interdisciplinary research evaluating AI-based technologies in professional practice to determine their clinical efficacy as well as their ethical, legal and social implications in healthcare.

Can We Do Better than Gesturing? Requirements for a Digital Communication Aid to Support Non-Verbal Communication in Paediatric Emergency Care.

Providing urgent and emergency care to migrant children is often hampered or delayed. Reasons for this are language barriers when children, and their care givers, don't speak any of the languages commonly spoken in Switzerland, which include German, French, Italian, and English. By a participatory design process, we want to develop a novel image-based digital communication aid tailored to the needs of migrant patients and nurses within Swiss paediatric clinics.

Participatory Development of an Image-Based Communication Aid for Migrant Patients and Emergency Nurses.

Language barriers hamper or delay delivery of urgent and emergency care to migrant children when they or their parents don't speak any of the languages commonly spoken in Switzerland. In such situations, nurses often fall back to use ad hoc communication aids, including translation apps and visual dictionaries, to collect information about a patient's medical history. In this paper, we report on the participatory design process for a novel image-based communication aid. It is specifically tailored to the needs of migrant patients and nurses within Swiss pediatric clinics. We collected requirements in surveys and in-depth interviews with pediatric nurses. A prototype app was developed and tested with users in a scenario-based usability test. The results clearly show that the images developed, especially for symptoms, accidents or nutrition and excretion, are well comprehensible for triage and anamnesis. In contrast, a temporal classification or chronological occurrence of health incidents is difficulty to express with images.

[Involvement of employees, residents, and relatives in digital transformation at long-term care institutions for older adults - A cross-sectional survey]. / Einbezug von Mitarbeitenden, Bewohnenden und Angehörigen in die digitale Transformation im stationären Altersbereich.

Involvement of employees, residents, and relatives in digital transformation at long-term care institutions for older adults - A cross-sectional survey Abstract. Background: Long-term care institutions for older adults are currently undergoing a digital transformation process. But who are the decision-makers in this transformation process? AIM: The aim of the study was to determine the role of employees, residents, and their relatives in the provision of the technical solutions used in long-term care institutions. METHODS: The standardized online survey was conducted at 466 long-term care institutions throughout Switzerland. The respective managers were surveyed. RESULTS: The majority of the managers surveyed saw more advantages than disadvantages in the use of technical solutions. Nevertheless, the results also show that while 52 % involve their staff in decisions about the acquisition of technology, only 11 % involve their residents, and 8 % involve the residents' relatives. This involvement depends on how much technology has been used so far and what leeway the managers themselves have in making such decisions. CONCLUSIONS: It is apparent that residents and their relatives are involved very little in decision-making processes. This can mean that the organization's digital transformation ultimately depends on just one person, the manager, and that the wishes of the people who are directly affected by these technical innovations are not considered in such decisions.

Facilitating the use of personal safety alerting device with older adults: The views, experiences and roles of relatives and health care professionals.

To explore relatives', community nurses' and general practitioners' perspectives and experiences in promoting Personal Safety Alerting Device (PSAD) use among community-dwelling older adults, we applied a qualitative study design. Altogether 15 focus groups and 11 semi-structured interviews were conducted. Data-analysis followed the Qualitative Analysis Guide of Leuven. PSAD use was considered to be complex. Relatives and health care professionals are involved in a negotiation process comprising three phases: A) waiting for a critical event in the older adult's everyday life; B) introducing the idea of a PSAD; C) deciding on and supporting PSAD use. In conclusion, the actors involved in PSAD use should be aware of the negotiation process, which is complex, dynamic, iterative and needs time. While nurses play a crucial role, they lack sufficient knowledge for comprehensive PSAD counselling. The negotiation process could serve as an example for other technologies in the context of aging in place.

Deciding about the use of a Personal Safety Alerting Device-The need for a legitimation process: A qualitative study.

AIMS: To explore reasons, thoughts, motives, and influencing factors regarding the use or non-use of Personal Safety Alerting Devices (PSADs) in the daily lives of community-dwelling older persons. DESIGN: A qualitative descriptive study design was used. METHODS: Six focus groups were conducted with a total of 32 older persons between February-August 2016. Data analysis followed the Qualitative Analysis Guide of Leuven. RESULTS: The participants described the use or non-use of PSADs as a decision resulting from a "legitimation process". This process implies that a person needs to perceive the necessity for a PSAD and then determine the right moment at which to start using it. During this process, each person weighs her or his "ageing self" and "perception of technology" then decides whether to start using a device or to delay its use. "Critical events" initiate this process, compelling the person to consider their own safety and their possible need for assistance. CONCLUSION: The legitimation process suggests that the initiation of PSAD use represents a turning point in life. Using a PSAD is not simply a matter of obtaining one. It is a complex decision-making process establishing legitimation for its use, which is interwoven with one's individual ageing, self-perception, and the meaning attributed to the device. IMPACT: Older persons need to be supported; in particular, they require time to go through the legitimation process for PSAD use. Nurses can empower them in this process, such that they perceive using a PSAD as a means to restore their frailty balance and feel enabled to (re)gain control over their own life and thus to preserve their independence.

[Digital transformation in residential old age institutions]. / Digitale Transformation im stationären Altersbereich.

BACKGROUND: Residential old age institutions are currently undergoing a digital transformation process, which is characterized by an orientation towards increasing digitalization of work processes as well as the institutional infrastructure. But what does the variety of technical solutions used in these old-age institutions look like and how is the digital transformation process assessed by the managers of these institutions? MATERIAL AND METHODS: The survey was carried out as a standardized online survey of residential old age homes throughout Switzerland. The respective managers were interviewed. The sample was made up of 466 institutions. RESULTS: Established technologies, such as television, contact and fall mats as well as software solutions in the administrative area are used almost everywhere, while robots for activating the clientele, gaming consoles or telemedical technologies are rarely used. Among those interviewed there were more people who saw advantages rather than disadvantages in the use of technical tools. The greatest obstacles that were perceived when introducing a new technology were the associated costs, a lack of employee skills and a nonexistent infrastructure. Multivariate analysis showed that the degree of digitalization in a facility depends not only on its size but above all on the technological affinity and rating of the senior staff. CONCLUSION: The degree of technology in old age institutions varies but overall it is rather sobering regarding the use of completely new technologies, such as robotics or telemedicine. Barriers to the increasing digital transformation were worked out from the survey and are discussed.

Team efficacy and leadership in managing aggressive situations in the general hospital setting: A qualitative descriptive analysis of focus groups with ward managers.

AIMS AND OBJECTIVES: To explore the perception and issues regarding the ability of nursing teams to manage patient and visitor aggression in clinical practice, from ward managers' perspectives. BACKGROUND: Patient and visitor aggression causes substantial human suffering and financial damage in healthcare organisations. Nurse managers are key persons for developing their teams' efficacy in dealing with patient and visitor aggression. However, their perception of patient and visitor aggression in clinical practice has rarely been explored, and issues relating to team management in this context are underinvestigated. DESIGN: A secondary, qualitative thematic analysis of focus group interviews. METHODS: Five focus groups consisting of a total of 30 ward and deputy ward managers from five Swiss hospitals were interviewed with audio recording between December 2015-January 2016. Since the recordings were rich in additional content exceeding the primary research question, a secondary analysis was conducted to answer the questions: (1) Which factors influence team efficacy in regard to patient and visitor aggression? (2) What are the implications for nurse leadership? The Consolidated Criteria for Reporting Qualitative Research was followed in the conduct and reporting of this study. RESULTS: Three themes emerged from our analysis: (a) contextual factors (organisational safety culture and collaboration), (b) influences from within the team (team culture, nursing aggression and general management principles) and (c) implications for nurse leadership. CONCLUSIONS: Managing patient and visitor aggression is a challenge for nurse managers. A team's ability to prevent, de-escalate and debrief after PVA incidents is an important leadership task in which ward managers are neither supported in nor trained for within their organisations. RELEVANCE TO CLINICAL PRACTICE: Nurse managers in general hospitals require more support to enable their teams to cope effectively with patient and visitor aggression. Policy and guideline implementation need to be prioritised.

Usability of a wearable fall detection prototype from the perspective of older people-A real field testing approach.

AIMS AND OBJECTIVES: Community-dwelling older people were involved in the testing of a fall detection device to improve its utilisation and acceptance in everyday life. BACKGROUND: The usability of alerting devices remains unsatisfactory, as they are scarcely utilised by older people, despite wide recognition of the importance of rapid assistance after a fall. Moreover, the time a person remains on the floor negatively impacts the severity of fall consequences. However, it is unclear how to increase alerting device utilisation in everyday life. Therefore, older people were involved in this research to consider their perspective during prototype development. DESIGN: A qualitative focus group study was conducted, following a real field testing approach, underpinned by the theoretical framework "Medical Device Technology Development Process." METHODS: Fifteen community-dwelling older people tested the prototype in daily living over a period of nine days. Different means of involvement were exploited such as "user seminars" or "discussion with users." On day 9, data were collected using focus groups and analysed with qualitative content analysis. RESULTS: The participants' perspectives yielded positive aspects of the prototype along with aspects requiring improvement. They indicated that technical requirements are essential. They also revealed that a minimal change in daily routines, support for physical activity and independent living and the inclusion of trusted contact persons could lead to wider use of the alerting device. CONCLUSIONS: Involving users is crucial in gaining a deeper understanding of aspects influencing utilisation of an alerting device. The study revealed that usability is influenced both by technical requirements as well as habits and personal preferences. This finding is vital, as habits and personal preferences can only be identified through the involvement of target users. RELEVANCE TO CLINICAL PRACTICE: The study provides key insights for health practitioners interested in promoting the use of an alerting device in community-dwelling older people.

Using and choosing digital health technologies: a communications science perspective.

Purpose The purpose of this paper is to explore a non-technical overview for leaders and researchers about how to use a communications perspective to better assess, design and use digital health technologies (DHTs) to improve healthcare performance and to encourage more research into implementation and use of these technologies. Design/methodology/approach Narrative overview, showing through examples the issues and benefits of introducing DHTs for healthcare performance and the insights that communications science brings to their design and use. Findings Communications research has revealed the many ways in which people communicate in non-verbal ways, and how this can be lost or degraded in digitally mediated forms. These losses are often not recognized, can increase risks to patients and reduce staff satisfaction. Yet digital technologies also contribute to improving healthcare performance and staff morale if skillfully designed and implemented. Research limitations/implications Researchers are provided with an introduction to the limitations of the research and to how communications science can contribute to a multidisciplinary research approach to evaluating and assisting the implementation of these technologies to improve healthcare performance. Practical implications Using this overview, managers are more able to ask questions about how the new DHTs will affect healthcare and take a stronger role in implementing these technologies to improve performance. Originality/value New insights into the use and understanding of DHTs from applying the new multidiscipline of communications science. A situated communications perspective helps to assess how a new technology can complement rather than degrade professional relationships and how safer implementation and use of these technologies can be devised.

Involvement of the end user: exploration of older people's needs and preferences for a wearable fall detection device - a qualitative descriptive study.

PURPOSE: To explore the needs and preferences of community-dwelling older people, by involving them in the device design and mock-up development stage of a fall detection device, consisting of a body-worn sensor linked to a smartphone application. PATIENTS AND METHODS: A total of 22 community-dwelling persons 75 years of age and older were involved in the development of a fall detection device. Three semistructured focus group interviews were conducted. The interview data were analyzed using qualitative descriptive analysis with deductive coding. RESULTS: The mock-up of a waterproof, body-worn, automatic and manual alerting device, which served both as a day-time wearable sensor and a night-time wearable sensor, was welcomed. Changes should be considered regarding shape, color and size along with alternate ways of integrating the sensor with items already in use in daily life, such as jewelry and personal watches. The reliability of the sensor is key for the participants. Issues important to the alerting process were discussed, for instance, who should be contacted and why. Several participants were concerned with the mandatory use of the smartphone and assumed that it would be difficult to use. They criticized the limited distance between the sensor and the smartphone for reliable fall detection, as it might restrict activity and negatively influence their degree of independence in daily life. CONCLUSION: This study supports that involving end users in the design and mock-up development stage is welcomed by older people and allows their needs and preferences concerning the fall detection device to be explored. Based on these findings, the development of a "need-driven" prototype is possible. As participants are doubtful regarding smartphone usage, careful training and support of community-dwelling older people during real field testing will be crucial.

Involvement of older people in the development of fall detection systems: a scoping review.

BACKGROUND: The involvement of users is recommended in the development of health related technologies, in order to address their needs and preferences and to improve the daily usage of these technologies. The objective of this literature review was to identify the nature and extent of research involving older people in the development of fall detection systems. METHODS: A scoping review according to the framework of Arksey and O'Malley was carried out. A key term search was employed in eight relevant databases. Included articles were summarized using a predetermined charting form and subsequently thematically analysed. RESULTS: A total of 53 articles was included. In 49 of the 53 articles, older people were involved in the design and/or testing stages, and in 4 of 53 articles, they were involved in the conceptual or market deployment stages. In 38 of the 53 articles, the main focus of the involvement of older people was technical aspects. In 15 of the 53 articles, the perspectives of the elderly related to the fall detection system under development were determined using focus groups, single interviews or questionnaires. CONCLUSIONS: Until presently, involvement of older people in the development of fall detection systems has focused mainly on technical aspects. Little attention has been given to the specific needs and views of older people in the context of fall detection system development and usage.