Volume 34 Issue 1 Article 3

2-24-2021

Smartphones in the operating room: Can perioperative nurses be trusted?

Tarryn Armour Deakin University, Victoria, [email protected]

Elyse Coffey Deakin University, Australia, [email protected]

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Recommended Citation Armour, Tarryn and Coffey, Elyse (2021) "Smartphones in the operating room: Can perioperative nurses be trusted?," Journal of : Vol. 34 : Iss. 1 , Article 3. Available at: https://doi.org/10.26550/2209-1092.1114 https://www.journal.acorn.org.au/jpn/vol34/iss1/3

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Author Tarryn Armour Smartphones in the operating MClinEd, GradDipAdNrsgPrac (periop), GCertHELT, BN, BaHthProm, RN, FACORN room: Can perioperative nurses Elyse Coffey MNurs (Perian), GCertHELT, BN(Honours), be trusted? RN Introduction Digital Health Capability Framework3 supports the safe and effective The use of hand-held technology implementation of digital health has become ubiquitous in modern in Australia. The framework also life1. For many Australians, hand- recognises that, increasingly, all held technology is a necessity with nurses and midwives work in a digital nearly nine out of ten owning a environment and that it is essential smartphone2. Smartphones are now for every nurse and midwife to have so powerful they can supersede digital literacy skills to maximise the need to use any other digital health and societal outcomes, device. In the clinical environment, improve services and extend their smartphones offer a pocket- evidence-based practice3. This sized, convenient and immediate requirement is clearly evident in the means of accessing a wide range technologically dense perioperative of information and resources on environment where nurses are relevant topics such as medications, expected to intersect with digital surgical procedures and equipment technology as part of everyday as well as access to organisational provision of patient care. Advocating email communications and health for digital literacy among nurses and care–related apps. While computers the requirement to use technology are available in many clinical areas, for many patient care activities has access is often constrained and their been part of nursing practice for use remains dedicated to patient over a decade5; yet, within operating management systems, diagnostics, rooms, staff access to personal pathology, sterile tracking systems hand-held technology continues to and, more recently, electronic be discouraged by management6. A medical records. As with previous lack of policy and difference between technological advancements, the generations’ perceptions regarding use of smartphones presents the use of personal hand-held unique social and professional devices has resulted in a persistent opportunities and challenges. How cultural overtone of distrust of their we choose to use – or not use – our use in the clinical environment. smartphone is critical. The increasing Perhaps it is time to consider the availability and capability of hand- use of hand-held technology by held technology in perioperative nurses in the operating requires a specialised workforce with room as a valuable resource to an understanding of appropriate enhance patient safety and improve use of digital technology3. While the delivery of patient care. there has been a rapid evolution in smartphone technology with In order to explore this field, a review widespread application in health of the literature was conducted care, the development of guidelines to identify the drawbacks to and and policies to govern their use has benefits of access to hand-held been slow to follow4. technology in the clinical setting and to make recommendations for The recent publication of the healthy technological behaviours in National Nursing and Midwifery the perioperative environment.

Journal of Perioperative Nursing Volume 34 Number 1 Autumn 2021 acorn.org.au e-27 Drawbacks to the use of worker concerns related to patient professional nursing organisations privacy and infection control risks as are also reluctant to exert agency hand-held technology well as an overall discomfort with the and challenge traditional work Distraction has been identified in hand-held devices being used in the patterns to advance protocols to the literature as a major drawback to clinical environment11. Two studies govern digital professionalism. While using hand-held technology in the examined the concept of smartphone a number of drawbacks to using clinical environment7–10. Distraction addiction and how this can affect hand-held technology in the clinical in the clinical environment can be therapeutic relationships in the environment were apparent in the defined as a direct interruption clinical environment12,13. A common literature, the potential also exists for of a clinician’s immediate task by theme of these studies was that smartphones to be used to improve using their smartphone7. Distraction negative perceptions of smartphone patient care and enhance quality and from using a smartphone in the use were commonly based on safety outcomes11,14. clinical area can lead to perceived older generations’ beliefs that performance deficits in clinical staff; smartphones were purely used for Considerations for however, no evidence of any actual or cyberloafing, rather than for seeking the use of hand-held potential patient harm was observed information related to patient care. in two studies. McBride8 compared Both studies recognised the need technology self-reported data to performance to develop strategies for preventing A major benefit of using smartphone errors of registered nurses (n=825) smartphone dependency and to technology in the clinical setting, that working in American health care promote healthy and safe use of was identified in the literature, is organisations while Cambier9 smartphones to ensure appropriate, mobile learning – a modality that has examined the impact on workplace point-of-care access to clinical been strongly adopted in Australian 12,13 cognitive failure of registered nurses’ information and resources . tertiary education and within mobile phones (n=849) from three A qualitative study by Mather et Bachelor of Nursing degrees. Mobile in Belgium. al.1 reports on interviews with learning enables nursing students Using a smartphone for reasons not representatives from professional to seek and retrieve information in related to work, such as engaging nursing organisations aiming to real-time and this can aid decision with social media or ‘cyberloafing’, explore the factors influencing the making, potentially improving patient 15 is a potential cause of distraction10. governance of hand-held technology outcomes . However, uptake of McBride and colleagues suggest used at the point of care for informal mobile learning by stakeholders in that this misuse of smartphone learning and continuing professional health care environments, especially technology may be attributed to an development (CPD). Themes such nurses, to augment traditional inadequate understanding of digital as access, negative perceptions teaching and learning has been slow professionalism by registered nurses. of use and distraction highlight and digital knowledge transfer is 16 Digital professionalism is required the complexity of using hand-held under-utilised . Access to and use to judge when it is appropriate to technology for informal learning and of hand-held devices for learning at access smartphone technology8 and continuing professional development the point of care within Australian is a professional attribute that must in the clinical setting. Giles-Smith health care environments is poorly be developed and modelled. It is et al.14 also explored nurses’ use governed and is not an explicitly 16 argued that the increasing diversity of hand-held technologies and sanctioned nursing activity . Despite of resources and information showed that access to and use of much of the literature acknowledging accessible via a smartphone results smartphones is already occurring the benefits of undergraduate in uncertainty about whether in the clinical setting with a lack nurses using hand-held technology 4,13,17 this technology is being used for of leadership, role modelling or for mobile learning , along with cyberloafing or for legitimate work- professional guidance about how to many universities having graduate related activities. This uncertainty support and foster positive use of learning outcomes related to digital often results in any smartphone this technology to enhance patient literacy and self-management, there use being misconstrued as a care14. This finding is supported by exists the paradox of undergraduate distraction. In addition to the use Mather et al.1 who determined that nurses being discouraged from of smartphones being perceived as not only is leadership in digital or not permitted to use hand- a distraction from clinical activities, professionalism within held technology in the clinical other research reports health care management lacking but that environment.

e-28 Journal of Perioperative Nursing Volume 34 Number 1 Autumn 2021 acorn.org.au To examine the behaviour of behaviours, and infection prevention levels, is required. The goal should be undergraduate nurses when guidelines that serve to enhance to develop organisational policy that accessing information using hand- patient care and promote positive establishes a better balance between held technology during clinical patient outcomes. the costs and benefits of access to placement or work integrated hand-held technology in real-time In October 2020 the Australian learning (WIL), Mather and by perioperative nurses1,19. A digitally government released the National colleagues18 surveyed (n = 84) capable workforce will be able to Nursing and Midwifery Digital Australian undergraduate nurses guide the new generation of nurses Health Capability Framework, which and found that undergraduate to become digitally professional and highlights the need for digital nurses limited activity not related minimise the potential risks, such health training and education to work during WIL; only using their as distraction, associated with using across Australia as well as smartphones to access information hand-held technology. encouraging positive attitudes related to nursing, medical to the increasing adoption of professional development and study. technology and innovation3. Prior to Conclusion Undergraduate nurses also expected this, an analysis of many sources Hand-held technology, such as easy access to their smartphones including government health smartphones, provide a pocket-sized when working to ensure they recommendations21, the National and instant means of accessing delivered safe and competent care, a Safety and Quality Health Service information and resources related to finding that is reflected in a number Standards22, patient care. The drawbacks that limit of other studies worldwide4,12,14,17,19. This Standards for Practice23, Standards for the use of hand-held technology access to and appropriate clinical Perioperative Nursing in Australia24 include potential distraction from use of smartphone technology and the Nursing and Midwifery clinical activities, smartphone needs to be reflected in the clinical Board of Australia Code of Conduct addiction, negative perceptions environment and role modelled by for Nurses25 revealed an absence that smartphones will be used for those training novice nurses. It is of guidance to support digital activities not related to work such argued that health care managers responsibility in health care despite as cyberloafing, interference to and nursing staff need to start the World Health Organization patient privacy and infection control advocating for the healthy use of endorsing the use of digital, mobile risks. Conversely, the benefits of smartphone technology in order to and wireless technologies to achieve using hand-held technology include guide and support student nurses as heath objectives and improve patient enhanced mobile learning at the well as model digital professionalism care outcomes26. point of care, easy and instant in the clinical setting4,19. access to information and efficacious As smartphones are readily available communications across hospital to all staff in the operating room Recommendations departments and professions. It and commonly used, nursing Nurses comprise the largest health is recommended that hand-held management should recognise care workforce3 and are consistently technology as part of perioperative the benefits of this technology in nominated as the most ethical and nurses’ digital literacy, learning and the perioperative environment honest profession20. A dichotomy work enhancement be accepted and guide perioperative nurses currently exists between being and policies be developed to guide to learn digital professionalism. the most trusted profession in responsible use within the operating Importantly, this should encompass Australia, depended on to provide room. Perioperative teams looking to the need to understand, develop complex nursing care and administer allow smartphone use should consult and demonstrate appropriate controlled substances, yet not trusted evidence-based practice standards behaviour when using smartphones3. to responsibly use smartphones in for their safe use in perioperative For mobile learning and access to the clinical setting. On review of the care settings. Additionally, further clinical information related to patient literature, it is recommended that research into the current use of care using smartphones in the health care organisations develop digital technology in specific clinical perioperative setting to be perceived policies for hand-held technology settings such as the operating room, as a legitimate nursing function, a and provide guidance for its use in including usage modes, frequency holistic approach to risk management the clinical environment in order and timing of use, and the impact on that includes all stakeholders, at all to encourage healthy technological patient care, is recommended.

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e-30 Journal of Perioperative Nursing Volume 34 Number 1 Autumn 2021 acorn.org.au