ORIGINAL RESEARCH: EMPIRICAL RESEARCH – MIXED METHODS
The use of electronic devices for communication with colleagues and other healthcare professionals – nursing professionals’ perspectives Marita Koivunen, Anne Niemi & Maija Hupli Accepted for publication 23 August 2014
Correspondence to Marita Koivunen: e-mail: [email protected] Marita Koivunen PhD Docent, Nursing Director Satakunta Hospital District / University of Turku, Department of Nursing Science, Pori, Finland Anne Niemi MNSc RN Nurse Eura Healthcare Centre / University of Turku, Department of Nursing Science, Eura, Finland Maija Hupli PhD Senior Lecturer Department of Nursing Science, University of Turku, Finland
K O I V U N E N M . , N I E M I A . & H U P L I M . ( 2 0 1 4 ) The use of electronic devices for communication with colleagues and other healthcare professionals – nursing professionals’ perspectives. Journal of Advanced Nursing 00(0), 000–000. doi: 10.1111/jan.12529
Abstract Aim. The aim of the study is to describe nursing professionals’ experiences of the use of electronic devices for communication with colleagues and other healthcare professionals. Background. Information and communication technology applications in health care are rapidly expanding, thanks to the fast-growing penetration of the Internet and mobile technology. Communication between professionals in health care is essential for patient safety and quality of care. Implementing new methods for communication among healthcare professionals is important. Design. A cross-sectional survey was used in the study. Methods. The data were collected in spring 2012 using an electronic questionnaire with structured and open-ended questions. The target group comprised the nursing professionals (N = 567, n = 123) in one healthcare district who worked in outpatient clinics in publically funded health care in Finland. Findings. Nursing professionals use different electronic devices for communication with each other. The most often used method was email, while the least used methods were question–answer programmes and synchronous communication channels on the Internet. Communication using electronic devices was used for practical nursing, improving personnel competences, organizing daily operations and administrative tasks. Electronic devices may speed up the management of patient data, improve staff cooperation and competence and make more effective use of working time. The obstacles were concern about information security, lack of technical skills, unworkable technology and decreasing social interaction. Conclusion. According to our findings, despite the obstacles related to use of information technology, the use of electronic devices to support communication among healthcare professionals appears to be useful. Keywords: communication, electronic device, information and communication technology, nursing personnel
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Why is this research needed? ● Communication between professionals in health care is essential for patient safety and quality of care, which is why it is important to implement new methods to support communication. ● Nursing
professionals
are
increasingly
using
mobile
phones, laptop computers, hand-held tablets and other electronic devices for communication with each other. ● There is not much knowledge about how nursing professionals can use electronic devices for communication.
What are the key findings? ● Emails and text messaging by mobile phones were the two most commonly used methods in communication between nursing professionals. ● Communication using electronic devices was used for
increasingly using mobile phones, laptop computers, handheld tablets and other electronic devices for communication with healthcare team members (Locke et al. 2009), colleagues (Brooks et al. 2004) and clients (Wade et al. 2010, Weaver et al. 2012). Patients’ care involves many different professionals needing to share patient information and discuss their management (Lindberg et al. 2013). Today, many changes are taking place in the workplace and in health care. The costs of public health services are constantly increasing (National Institute for Health & Welfare 2013). The economic situation of healthcare services calls for a constant search for cost-cutting strategies. Communication between professionals is essential for patient safety and quality of care (Nadzam 2009), which is why it is important to look for and implement cost-effective methods for communication among healthcare professionals (Weaver et al. 2012).
practical nursing, improving personnel competences, organizing operations and for transmitting administrative information. ● The nurses’ perceptions are that electronic communication speeds up the management of patient data, increases staff cooperation and competence and makes more effective use of working time. ● The obstacles for the use of electronic communication were concern about information security, lack of technical skills, unworkable technology and decreasing social interaction.
How should the findings be used to influence policy/ practice/research/education? ● The findings can be used when new communication methods are implemented for nursing practices. ● Some obstacles related to the use of electronic devices in communication should be taken into account in the implementation processes. ● Nursing directors can maximize the benefits of the use of electronic devices by educating themselves and their employees to better understand the possibilities and obstacles of new communication methods and to consider ways to help overcome the obstacles.
Introduction Information and communication technology (ICT) applications in health care are rapidly expanding, thanks to the fastgrowing penetration of the Internet (OECD 2012) and mobile telephone technology (Official Statistics of Finland (OSF) 2007, Wu et al. 2011). Nursing professionals are 2
Background Effective communication between professionals is critical to information transfer and patient safety (Mann et al. 2006, Nadzam 2009). Use of ICT can increase professionals’ contacts (Jenkins & White 2001) and enhance sharing of patient information (Locke et al. 2009). It has been found that online communities of practice could be valuable to nurses who work alone with limited peer support (Valaitis et al. 2011). The review of Lindberg et al. (2013) showed that healthcare professionals gave positive feedback on using different electronic devices and ICT applications in communication with each other. The maintenance and development of nursing competence also require connections and discussion between professionals (Foster & Whitworth 2005). Nursing professionals have experienced many benefits of electronic communication with their colleagues. For example, professionals’ discussion forums on the Internet were found to be useful tools for sharing knowledge and new ideas (Brooks et al. 2004, Weaver et al. 2012). In addition, it was found that the use of electronic forums could increase nurses’ active participation in developing nursing practice by networking with colleagues in other organizations (Barry & Hardiker 2012). Electronic applications also make quick consultations possible (Clemensen et al. 2007) and patients would be able to stay at home rather than be moved to hospital (Lawton & Timmons 2005). Locke et al. (2009) have described the use of Web-based communication tools for professionals that make it possible to send urgent and non-urgent messages between nurses and physicians. It was stated that the application would improve workflow for both groups. (Locke et al. 2009). © 2014 John Wiley & Sons Ltd
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At present, nursing professionals have good possibilities to access the Internet and other electronic health information channels in their workplaces, particularly in Western countries (Gilmour et al. 2012). Hence, the use of electronic devices for communication is often possible. However, apart from traditional landline phones, the use of these devices for communication and consultation among colleagues is not very common (Viitanen et al. 2011). Successful adoption of new communication methods and services requires high user acceptance (Vuonovirta et al. 2009) and functional software and hardware (Wilkowska & Ziefle 2012). Furthermore, privacy protection, data security (Barton 2012, Wilkowska & Ziefle 2012) and confirmation of patient safety are important in the healthcare environment (Nadzam 2009, Broussard & Broussard 2013). More knowledge is needed about how nursing professionals can use electronic devices for mutual communication.
The study Aim The study is part of a wider project whose objective is to clarify nursing professionals’ experiences of the use of electronic communication in publicly funded healthcare services in Finland. The aim of this part of the project is to describe nursing professionals’ experiences of the use of electronic devices for communication with colleagues and other healthcare professionals. In addition, the project gathered information about the use of electronic devices in communication with patients. The findings of this part of the project will be reported elsewhere. The research questions of the part reported in this paper are as follows:
• • •
What kind of electronic devices have nursing professionals used for communication with colleagues and other healthcare professionals? For what kinds of tasks have nursing professionals used electronic devices when communicating with colleagues and other healthcare professionals? What advantages and obstacles have nursing professionals found in the use of electronic devices for communication with colleagues and other healthcare professionals?
Design A cross-sectional survey was used in the study. The study included both qualitative and quantitative components. © 2014 John Wiley & Sons Ltd
The use of electronic devices for communication
Sample The target group (N = 567) of the study comprised the nursing professionals of one healthcare district who worked in outpatient clinics in either specialized or primary health care in Finland. The inclusion criteria were as follows: permanent or temporary employment for nursing staff (Registered Nurse, practical nurse, community nurse, public health nurse, charge nurse, physiotherapist, occupational therapist) during the time of data collection, working in outpatient clinic and Finnish speaking.
Data collection The data were collected by an electronic questionnaire developed for the study in spring 2012. The questionnaire contained both structured and open-ended questions. The demographics of the respondents included age, gender, job position and workplace. There was a question with eight alternatives concerning what kind of electronic devices the nurses use for communication with colleagues and other healthcare professionals. In addition, the questionnaire contained three open-ended questions concerning the purposes of the use of electronic devices and the advantages and obstacles the nurses had found with the use of electronic devices in communication. The participants were asked to answer from their own work point of view. The questionnaire was sent via email to the nursing professionals in the target group. The questionnaire was accompanied by an introductory email including information about the purpose of the study and assurance of anonymity and confidentiality. The staff in one organization did not have email addresses, thus they responded by completing paper forms. The response time given was 3 weeks. Two reminder messages were sent for those who had an email address during the response time. A total of 123 people took part in the study. The response rate was 217%.
Ethical considerations The basic principles of research ethics in health care were followed at every stage of the study (World Medical Association Declaration of Helsinki 2004, Finnish Advisory Board of Research Integrity 2012). Permits for sampling were obtained from the directors of the organizations. Nursing staff participation was voluntary and anonymous. The data were treated in confidence (Polit & Beck 2004). According to Finnish ethical protocol, no statement of ethical commission was needed because the study did not focus on patients (Medical Research Act 1999). 3
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Data analysis Descriptive statistics (frequencies, mean values, percentages) were used to analyse the quantitative data. The data were processed using the statistical software package IBM SPSS for Windows (version 20, SPSS Inc., Chigaco, IL, USA). Answers for open questions were analysed using qualitative content analyses. The material was transferred from the Webropol application to word processing software. The preliminary analyses were performed by the responsible researcher (MK) and the results were peer-reviewed by a member of the research group (AN). First, the text was read through so that a general idea of its contents was obtained. Second, the aim was to find the key parts of longer answers and these were written down in the margins of the transcripts. Third, the primary expressions related to the research questions were coded, after which similar expressions were brought together and reduced expressions were formed. Similar expressions were combined and made into subcategories and main categories. An example of the analysis is described in Figure 1.
Findings Demographics of the respondents Of 122 respondents, 23% (n = 28) worked in specialized health care and 77% (n = 94) in primary health care. There was only one male among the participants. Respondents’ age varied from 26 to 62 years and the mean was 47 years. Of the respondents, 34% (n = 41) were Registered Nurses, 46% (n = 56) were public health nurses, 7% (n = 9) were charge Main category
Sub category
Reduced expression
nurses, 7% (n = 9) practical nurses and others, while 5% (n = 6) were physiotherapists and occupational therapists.
The use of electronic devices for communication with colleagues and other healthcare professionals Nursing professionals used different electronic methods for communication with colleagues and other healthcare professionals. Email was the most commonly used method. Only four (3%) participants reported that they did not use emails when communicating with colleagues. The second most common method was text messaging by mobile phone. Nearly two-thirds (61%) of the nursing professionals reported that they used the text messages. A quarter (26%) of the respondents reported that they used electronic forms, which can be filled out and sent over the Internet. These are used among professionals, for example, for obtaining patients’ preliminary information. Sixteen (13%) professionals described that they used other methods for communication with colleagues. Most of them mentioned internal messages in the patient record system or internal email program used in the organization. The least frequently used methods were question– answer programmes (6%), which enable interactive asynchronous communication and synchronous communication channels on the Internet (5%) (Table 1).
The purposes of the use of the electronic devices in communication with colleagues and other healthcare professionals The purposes of the use of electronic devices in communication with colleagues and other healthcare professionals were Examples of the primary expressions
Consultation
Immediate nursing care
Practical nursing
Supportive activities
‘I use it for consultation and informing.’ ‘I ask for the opinion and advice.’ ‘The Spark program is workable when I want to get a quick comment from the colleague or doctor.’ ‘Collegial consultation.’ Communication related patient transfer ‘I inform colleagues about the patient’s transfer to another ward or organization.’ ‘Sharing of the information related to patient’s transfer.’ Appointment actions ‘I inform the patients of appointments.’ ‘With the help of Spark I make appointments or communicate with typist.’ ‘I use the application in appointment actions with other professionals.’ Sharing digital imagines ‘I send a digital image of the wound to the special wound nurse. After that, we can make a care plan together.’ ‘Sending the photograph to the doctor for consultation.’
Figure 1 An example of the analysis. 4
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Table 1 Nursing professionals’ (n = 123) use of electronic devices for communication with colleagues and other healthcare professionals. Electronic method/device
User n (%)
Non user n (%)
Email Mobile phone text messages Electronic form Other Video conferencing Internet message Question–answer programme Internet, synchronous communication
119 75 26 16 12 8 6 5
4 48 97 107 111 115 117 118
(97) (61) (21) (13) (10) (7) (5) (4)
(3) (39) (79) (87) (90) (93) (95) (96)
The use of electronic devices for communication
they described that they used the technology when requesting patient documents from another organization. Using electronic devices for instrument and material orders is also possible as well as convenient. The participants also reported that electronic devices were useful when drawing up patient guidelines, for example. Thanks to the devices, they are able to exchange information that is needed in the guideline preparation process: With the help of Spark I make appointments or communicate with the typist. I send a digital image of the wound to the special wound nurse. . .
investigated by an open-ended question. Of the eligible participants, 107 gave information on this issue. Five main categories were formed to describe healthcare professionals’ purposes of the use of electronic devices in communication with colleagues and other healthcare professionals. The categories were: (1) practical nursing; (2) supporting and developing competencies; (3) organizing daily operations; (4) organizing administrative tasks; and (5) other purposes (Figure 2). Practical nursing The category ‘practical nursing’ included responses where nursing professionals described factors related to immediate nursing care and care-supporting activities. The respondents reported that they consulted other professionals by using electronic devices when they needed help getting information about the current status and/or treatment of patients. They shared patient information and care instructions by using emails and video calls, for example. Electronic devices were also used when nursing professionals made follow-up treatment plans and discharge plans. They could communicate with colleagues in another institution before moving the patient and also transfer patient data via electronic devices: I use it for consultation and informing. I inform colleagues about the patient’s transfer to another ward or organization.
Care-supporting activities included responses where professionals described factors related to patients’ care that they were not direct care activities. This group included appointments with other professionals made by nurses. The respondents reported that they could use emails or text messages to relay appointment information. The ICT systems also enable transferring digital images. In addition, © 2014 John Wiley & Sons Ltd
Supporting and developing competencies The category ‘supporting and developing competencies’ included the subcategories informing and collaboration. Nursing professionals described using electronic devices to share different types of information related to their competence and special knowledge between each other. They shared educational material, publications and current information. They also reported that sharing material helped them with educational planning for themselves or for the whole work team: The participants described that they were able to collaborate actively using electronic devices. They maintained and developed multi-professional collaboration and emphasized that by using modern methods they could more easily seek support from different peer groups: I use it to share information and material and to consult colleagues. Multiprofessional collaboration. . .such as information about the client’s current status with a psychiatric nurse. For communication with colleagues in Finland, such as how a certain problem has been solved elsewhere.
Organizing daily operations The category ‘organizing daily operations’ included subcategories related to daily routines and developing operations. Nursing professionals discussed their daily work with each other or with other professionals using electronic devices. They also ordered supportive services, such as maintenance for devices used in patient treatment. Meal services were also ordered with the help of the computer. In addition, participants reported that they drew up schedules and arranged appointments using short messages or emails. 5
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Main categories
Sub categories
Immediate nursing care Practical nursing
Supportive activities
Supporting and developing competencies
Informing
Collaboration
Appointment actions Patient document orders Sharing digital imagines Formulating patient guidelines Instrument orders Sharing referrals Completing and sharing forms
Sharing education handouts Education planning Sharing publications and materials Sharing current information Maintaining multi-professional collaboration Maintaining peer group
Daily routines
Discussing daily routines Ordering supportive services Setting timetables
Developing of the operation
Informing operation related changes Making operation related contracts Sharing development related information Informing workplace’s rules and guidelines
Organizing daily operations
Administrative routines Organizing administrative tasks Information sharing
Other purposes
Consultation Communication related patient transfer Sharing patient information Sharing care instructions Preparing follow-up treatment plans Discharge planning
Leisure activities
Informing current actions Appointing meetings Making procurements Video conferencing Reference requests Sharing personnel administrative information Sharing strategy related information Sharing minutes of the meetings
Sharing information of leisure time activities Sharing joke messages
Figure 2 The purposes of the use of the electronic devices in communication with colleagues and other healthcare professionals. Nursing professionals described that they used electronic devices for organizing operations by informing each other about work- and operations-related changes. They also made contracts and shared information relating to development actions. In addition, email or other electronic channels were used particularly by nursing managers to inform staff about workplace rules and to share various guidelines: Daily routines with people working in different units.
Organizing administrative tasks Electronic devices were often used to support administrative routines and to share administrative information. Nursing professionals described that they informed staff about current activities in the organization. They called meetings and made procurements using electronic devices. In some organizations, videoconferencing was used for meetings. Administrative and strategy-related information was shared by electronic devices, as were minutes from the meetings:
Ordering patient documents. Video conferencing is used for technical aids acquisitions. 6
Informing about training events and meetings. © 2014 John Wiley & Sons Ltd
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Table 2 The advantages of the use of the electronic devices for communication with colleagues and other healthcare professionals. Categories
Contents
The use of electronic devices for communication
advantages perceived by healthcare professionals in the use of electronic devices. The categories illustrate the advantages to (1) patients, (2) professionals’ work, (3) professionals’ competence and (4) organization (Table 2).
Advantages to Patients
Speed up patient data transfer Save patients’ time Save patients’ costs Increase patients’ satisfaction
Professionals’ work
Make working time more effective Speed up working processes Speed up management of patients’ affairs Increase accessibility Possibility for time- and placeindependent communication Increase flexibility Relayed messages were documented Decrease travelling
Professionals’ competence
Facilitate information sharing Facilitate consultations Increase access to education programmes
Organization
Decrease healthcare costs Save time Save labour costs Save educational costs
Agreeing on meetings. . . Mutual affairs. . . informing about workplace activities.
Other purposes Some of the participants reported that they had used electronic devices to share information about leisure activities, such as cultural or sporting events, with their colleagues. Nurses also reported that they sometimes shared joke messages with colleagues:
Advantages to patients. The respondents described factors relating to patients. They wrote that the use of electronic devices speeded up transfer of patient information between healthcare personnel who participated in patients’ care. They described that the use of electronic devices produced both time and cost savings for the patients. Patients did not need to come to the practice as often as before when information about their situation was transferred among personnel using electronic devices. According to the nurses’ experiences, patients could be more satisfied with their treatment and service: Speeds things up, patients are often admitted to care more rapidly. Clients may save time and money if they don’t have to be referred to specialized care, for instance to show a wound. As a result, client satisfaction may also increase.
Advantages to professionals’ work. According to nursing professionals, the use of electronic devices for communication with colleagues made their working time more effective. Electronic devices speeded up the management of patients’ affairs. Communication was quicker, resulting in less waiting for critical information to be certain and thereby more efficient work processes for nurses. The participants brought out that by using emails, many people could be accessed with one message and the relayed messages could be documented. The nurses also felt that the use of electronic devices increased flexibility because it enabled time- and place-independent communication allowing the employees to organize their work more independently:
Quite a lot of communication via email, such as about leisure activities. . .
Speeds up communication and allows you to access the experts you want.
Occasionally joke messages! Fast access and the other party can respond at a schedule that suits
The perceived advantages and obstacles in the use of electronic devices for communication with colleagues and other healthcare professionals Advantages The respondents were asked to explore the perceived advantages in the use of electronic devices for communication with colleagues and other healthcare professionals. Of the eligible participants, 104 expressed their opinions on the topic. Four categories were formed to describe the © 2014 John Wiley & Sons Ltd
them. Leaves a trace, you can ask for more information and store the document.
Advantages to professionals’ competence. The participants were of the opinion that the use of electronic devices enabled effective information sharing among nursing personnel. With the help of quick consultations with colleagues, nurses could increase their knowledge and develop 7
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their competence. In addition, it increased access to education programmes and nursing personnel were able to find trainings relevant to their needs: It’s useful to discuss matters related to patient care with colleagues. Sharing professional information. You get more information about training opportunities.
Advantages to organization. The participants described that the use of electronic devices could help reduce healthcare costs by decreasing the number of face-to-face visits. The use of electronic devices for continuing training could produce savings in educational costs for the organization. The organization could achieve both time and labour cost savings, for example, as a result of reduced travelling on the part of staff: You save time as you don’t have to go anywhere. Taking care of things takes less time now. Time use at work is more efficient thanks to videoconferencing and online training events. . .
Obstacles The perceived obstacles in the use of the electronic devices for communication with other healthcare professionals and colleagues were investigated by an open-ended question. Of
Table 3 The obstacles to the use of electronic devices for communication with colleagues and other healthcare professionals. Categories
Obstacles related to data transfer. Nursing professionals described that some misunderstandings can happen when quick messages are used. In addition, sometimes the messages can disappear and the sender cannot know it in adequate time. The nurses worried that the messages could potentially be read by outsiders, which would break confidentiality. They always could not be sure who can be the receiver of the message. Although the participants described that use of electronic devices for communication with colleagues brought some benefits to the arrangements of their work, however, they pointed out that there are some obstacles related to the use of working time. They wrote that sometimes they must wait too long the answers of the collegues when emails are used. In addition, emails are sent so much that the important mails could disappear in the mass of messages. Otherwise, at times, the working time is not enough for reading and managing all messages: Sometimes the use of emails is slow because everybody does not answer the messages fast. Emails will come so much that the important mails could disappear in the mass.
Contents
Obstacles related to Data transfer
Risks related to the reliability of the data Possibilities of misunderstandings Disappearance of messages Doubt about the receiver of the messages Long delays in answering Too many emails Lack of time
Technology and devices
Risks related to privacy protection Lack of devices Unworkable devices and solutions Unworkable connections Blackouts
Users’ attributes
Lack of technical skills Negative attitudes towards technology
Social interaction
Diminished personal contacts Diminished face-to-face cooperation
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the eligible participants, 88 expressed their opinions on the topic. Four categories were formed to describe the obstacles perceived by healthcare professionals in the use of electronic devices for communication. The obstacles related to (1) data transfer, (2) technology and devices, (3) users’ attributes and (4) social interaction (Table 3).
Obstacles related to technology and devices. The respondents were worried about information security when using electronic devices for communication. They wrote that privacy protection could be endangered when sharing patient information among personnel via electronic devices. Nursing professionals could not use patients’ personal details when, for example, using email for communication. In addition, the participants described that there could be lack of computers and other electronic devices for personal use in the organization. In some cases, the devices did not work very well and the Internet connections and video links could be unworkable, for example. These problems pose risks for optimal data transfer. In addition, blackouts might appear, causing written messages to get lost: Unclear which connections are protected and how client information may be delivered via Internet. © 2014 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH: EMPIRICAL RESEARCH – MIXED METHODS Personal patient information may not be sent by email, i.e. data protection issues. Technical problems and lack of user rights to various functions.
Obstacles related to users’ attributes. According to participants, nursing personnel might lack technical skills that are important for the optimal use of electronic devices for communication. The respondents wrote there are still those among the nursing staff who have negative attitudes towards the use of technology in their work: Lack of ability to use electronic devices as well and willingly. Some people have a negative attitude towards electronic devices, because they consider them to take up so much time.
Obstacles related to social interaction. Some of the participants pointed out that the use of electronic devices could diminish personal contacts and social interaction with colleagues. They described face-to-face discussions with other professionals as very important for their professional growth and knowledge sharing. They emphasized that personal meetings could not be wholly replaced by electronic communication: Lack of social interaction may cause misunderstandings. You see your colleagues more seldom. In my opinion, actual face-to-face communication is the best alternative.
Discussion Nursing professionals used different electronic methods for communication with colleagues and other healthcare professionals. Email and text messages were the two most commonly used methods. This is natural because today organizations almost invariably offer mobile phones and email applications for the use of their personnel. Nursing professionals use mobile phones and laptop computers in their daily practice and email is an easy way to communicate with colleagues (Brooks et al. 2004, Locke et al. 2009). Electronic patient records and Internet connections were in use in the organizations participating in our study. There was no email application for nursing professionals in use in one organization, while 61% of the professionals had the possibility to use mobile phones at work. © 2014 John Wiley & Sons Ltd
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However, the use of emails and text messages is associated with some challenges in health care. The information transferred is often sensitive. It contains patients’ personal health information, but professionals could not share patients’ personal data without strong privacy protection. Nursing professionals should therefore be aware of what information they can share via electronic devices. According to our findings, nurses are quite well aware of the information security risks. However, there should be detailed instructions on how to use electronic devices in communication in healthcare organizations. Nursing professionals use electronic devices in communication with each other for a variety of purposes. They brought out that ICT supports their daily practices and makes work smooth. The development of healthcare practices is rapid and knowledge sharing requires networking with other professionals (e.g. Weaver et al. 2012). Our finding is that nursing professionals consider quick consultations important for their decision-making and the use of electronic devices makes this possible. Our finding is supported by results of earlier studies (Clemensen et al. 2007, Barry & Hardiker 2012). The participants in our study described the advantages of the use of electronic devices in communication from the point of view of their work, but also from patients’ point of view. They explained that effective and rapid information sharing between professionals could save patients’ time and costs. The finding is supported by the earlier study of Lawton and Timmons. They found that active information sharing among healthcare professionals decreased patients’ hospital visits, thereby reducing costs (Lawton & Timmons 2005). As the expenses of public health service increase, it will be important to find effective methods to curb costs. Despite the fact that nursing professionals pointed out that the use of ICT in communication makes the working processes more effective, they thought that there were some obstacles related to the use of working time, particularly in relation to the added workload from email use. The volume of email messages might be so large that the most valuable information could get lost. Nurses’ work might thus contain unnecessary practices, which take time away from the basic tasks. It is important to ensure that nursing professionals have the skills to use electronic devices when new methods are implemented in communication practices. Nursing directors have a significant role in these processes. They can maximize the benefits of the use of electronic devices by educating themselves and their employees to better understand the possibilities and explore ways to overcome the obstacles of new communication methods. In addition, the devices and 9
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connections should be workable and easy to use. Guidelines and instructions for optimal and safe use are needed. Healthcare organizations are responsible for security practices in information sharing and for the competence of their personnel.
Limitations The study has some weaknesses particularly in relation to the number of participants. It was known that the use of electronic devices for communication among healthcare personnel was not very common in the area of the participating hospital district. As a result, some people in the target group did not have any experience of the issue. We can assume this to be the reason why they did not complete the survey. However, because the information was partly collected using open-ended questions, the number of respondents is quite high. In addition, the qualitative data were rich and participants have described the use of electronic communication with colleagues from several aspects. The majority of the participants were public health nurses (46%) and Registered Nurses (34%). It is known that in the outpatient clinics in the participating organizations, particularly in primary health care, public health nurses are the largest professional group, as was the case in our study group. We can thus claim that in this respect the study group is similar to the target group. The findings are suggestive and more knowledge is needed of the use of electronic devices for communication among healthcare personnel. We assume that the findings of the study are useful in the development and implementation processes of electronic devices for communication in health care.
devices. They were worried about information security and experienced a lack of technical skills. Nursing professionals brought out that devices and technology were not always very functional or easy to use. In addition, they were worried about decreasing face-to-face contacts, which they felt to be very important for their professional growth and knowledge sharing. According to the findings, the use of electronic devices for communication among healthcare professionals is a promising method when some obstacles are taken into account. The findings can be used when new communication methods are implemented for nursing practices. In future, it is important to study this subject also from the point of view of the healthcare service users.
Funding The study was partly funded by Satakunta Hospital District (EVO 81051) and the Finnish Cultural Foundation, Satakunta Regional Fund.
Conflict of interest No conflict of interest has been declared by the authors.
Author contributions All authors have agreed on the final version and meet at least one of the following criteria [recommended by the ICMJE (http://www.icmje.org/ethical_1author.html)]:
• •
Conclusion According to the study, nursing professionals use different electronic methods for communication with other healthcare professionals and colleagues. The most commonly used method was email while the least frequently used methods were question–answer programmes and synchronous communication channels on the Internet. Communication using electronic devices was used for practical nursing, improving personnel competences, developing operation and transmitting administrative information. Nursing personnel found several advantages with communicating with each other using electronic devices. Electronic communication speeds up the management of patient data, it increases professionals’ cooperation and competence and makes the use of working time more effective. However, nursing personnel also experienced some obstacles in the use of electronic 10
substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content.
References Barry J. & Hardiker N. (2012) Advancing nursing practice through social Media: a global perspective. The Online Journal of Issues in Nursing 17, Manuscript 5. doi:10.3912/OJIN.Vol17 No03Man05. Barton A. (2012) Health information technology safety. Implications for the clinical nurse specialist. Clinical Nurse Specialist 26, 198–199. Brooks F., Rospopa C. & Scott P. (2004) Midwifery on the net: new communication technology. British Journal of Midwifery 12, 107–110. Broussard B. & Broussard A. (2013) Using electronic communication safely in health care settings. Nursing for Women’s Health 17, 59–62. Clemensen J., Larsen S.B., Kirkevold M. & Ejskjaer N. (2007) Telemedical network between home and hospital: a synergetic © 2014 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH: EMPIRICAL RESEARCH – MIXED METHODS triangle emerges. Studies in Health Technology and Informatics 130, 81–90. Finnish Advisory Board of Research Integrity (2012) Responsible conduct of research and procedures for handling allegations and misconduct in Finland. Retrieved from http://www.tenk.fi/sites/ tenk.fi/files/HTK_ohje_2012.pdf on 08 March 2014. Foster P. & Whitworth J. (2005) The role of nurses in telemedicine and child abuse. Computers, Informatics, Nursing 23, 127–131. Gilmour J.A., Huntington A., Broadbent R., Strong A. & Hawkins M. (2012) Nurses’ use of online health information in medical wards. Journal of Advanced Nursing 68, 1349–1358. Jenkins R. & White P. (2001) Telehealth advancing nursing practice. Nursing Outlook 49, 100–105. Lawton S. & Timmons S. (2005) Stakeholders’ experience of teledermatology in a nurse-led community clinic: a case study. Health Informatics Journal 11, 111–122. Lindberg B., Nilsson C., Zotterman D., S€ oderberg S. & Sk€ar L. (2013) Using information and communication technology in home care for communication between patients, family members and healthcare professionals: a systematic review. International Journal of Telemedicine and Applications 2013, 461829. doi:10.1155/2013/461829. Locke K., Duffey-Rosenstein B., De Lio G., Morra D. & Hariton N. (2009) Beyond paging: building a web-based communication tool for nurses and physicians. Journal of General Internal Medicine 24, 105–110. Mann M.Y., Lloyd-Puryear M.A. & Linzer D. (2006) Enhancing communication in the 21st century. Pediatrics 117, 315–319. Medical Research Act (1999) Retrieved from http://www.finlex.fi/ en/laki/kaannokset/1999/en19990488.pdf on 10 March 2014. Nadzam D. (2009) Nurses’ role in communication and patient safety. Journal of Nursing Care Quality 24, 184–188. National Institute for Health and Welfare (2013) Health Expenditure and Financing 2011. Official Statistics of Finland, Statistics Report 6/2013. Retrieved from http://urn.fi/URN:NBN: fi-fe201309115693 on 09 February 2014. OECD (2012) OECD Internet economy outlook 2012. The Organization for Economic Co-operation and Development. Retrieved from http://www.keepeek.com/oecd/media/science-andtechnology/oecd-internet-economy-outlook2012_9789264086463-en#page1 on 09 February 2014.
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Official Statistics of Finland (OSF) (2007) From hand-cranked connections to hands-free mobile calls – history of telecommunications in Finland seen through statistics. Statistics Finland. Retrieved from http://www.stat.fi/tup/suomi90/ syyskuu_en.html on 09 February 2014. Polit D.F. & Beck C.T. (2004) Nursing Research: Principles and Methods, 7th edn. Lippincott Williams & Wilkins, Philadelphia, PA. Valaitis R.K., Akhtar-Danesh N., Brooks F., Binks S. & Semogas D. (2011) Online communities of practice as a communication resource for community health nurses working with homeless persons. Journal of Advanced Nursing 67, 1273–1284. Viitanen J., Nieminen M., Hypp€ onen H. & L€a€averi T. (2011) Finnish physicians’ experiences with computer-supported patient information exchange and communication in clinical work. International Journal of Electronic Healthcare 6, 153–173. Vuonovirta T., Kanste O., Timonen M., Kein€anen-Kiukaanniemi S., Timonen O., Ylitalo K. & Taanila A. (2009) Telehealth adoption to support the operation of health centers – Factors relating to telehealth adoption in primary health care. Journal of Social Medicine 46, 272–284. Wade V., Karnon J., Elshaug A. & Hiller J. (2010) A systematic review of economics analyses of telehealth services using real time video communication. BMC Health Service Research 10, 233. doi:10.1186/1472-6963-10-233. Weaver B., Lindsay B. & Gitelman B. (2012) Communication technology and social media: opportunities and implications for healthcare systems. The Online Journal of Issues in Nursing 17, 3. doi:10.3912/OJIN.Vol17No03Man03. Wilkowska W. & Ziefle M. (2012) Privacy and data security in E-health: requirements from the user’s perspective. Health Informatics Journal 18, 191–201. World Medical Association Declaration of Helsinki (2004) Ethical principles for medical research involving human subjects. Retrieved from http://www.wma.net/en/30publications/10policies/ b3/17c.pdf on 10 March 2014. Wu R., Rossos P., Quan S., Reeves S., Lo V., Wong P. & Morra D. (2011) An evaluation of the use of smartphones to communicate between clinicians: a mixed-method study. Journal of Medical Internet Research 13, 723–732. doi:10.2196/jmir.1655.
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The use of electronic devices for communication with colleagues and other healthcare professionals – nursing professionals’ perspectives Marita Koivunen, Anne Niemi & Maija Hupli Accepted for publication 23 August 2014
Correspondence to Marita Koivunen: e-mail: [email protected] Marita Koivunen PhD Docent, Nursing Director Satakunta Hospital District / University of Turku, Department of Nursing Science, Pori, Finland Anne Niemi MNSc RN Nurse Eura Healthcare Centre / University of Turku, Department of Nursing Science, Eura, Finland Maija Hupli PhD Senior Lecturer Department of Nursing Science, University of Turku, Finland
K O I V U N E N M . , N I E M I A . & H U P L I M . ( 2 0 1 4 ) The use of electronic devices for communication with colleagues and other healthcare professionals – nursing professionals’ perspectives. Journal of Advanced Nursing 00(0), 000–000. doi: 10.1111/jan.12529
Abstract Aim. The aim of the study is to describe nursing professionals’ experiences of the use of electronic devices for communication with colleagues and other healthcare professionals. Background. Information and communication technology applications in health care are rapidly expanding, thanks to the fast-growing penetration of the Internet and mobile technology. Communication between professionals in health care is essential for patient safety and quality of care. Implementing new methods for communication among healthcare professionals is important. Design. A cross-sectional survey was used in the study. Methods. The data were collected in spring 2012 using an electronic questionnaire with structured and open-ended questions. The target group comprised the nursing professionals (N = 567, n = 123) in one healthcare district who worked in outpatient clinics in publically funded health care in Finland. Findings. Nursing professionals use different electronic devices for communication with each other. The most often used method was email, while the least used methods were question–answer programmes and synchronous communication channels on the Internet. Communication using electronic devices was used for practical nursing, improving personnel competences, organizing daily operations and administrative tasks. Electronic devices may speed up the management of patient data, improve staff cooperation and competence and make more effective use of working time. The obstacles were concern about information security, lack of technical skills, unworkable technology and decreasing social interaction. Conclusion. According to our findings, despite the obstacles related to use of information technology, the use of electronic devices to support communication among healthcare professionals appears to be useful. Keywords: communication, electronic device, information and communication technology, nursing personnel
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Why is this research needed? ● Communication between professionals in health care is essential for patient safety and quality of care, which is why it is important to implement new methods to support communication. ● Nursing
professionals
are
increasingly
using
mobile
phones, laptop computers, hand-held tablets and other electronic devices for communication with each other. ● There is not much knowledge about how nursing professionals can use electronic devices for communication.
What are the key findings? ● Emails and text messaging by mobile phones were the two most commonly used methods in communication between nursing professionals. ● Communication using electronic devices was used for
increasingly using mobile phones, laptop computers, handheld tablets and other electronic devices for communication with healthcare team members (Locke et al. 2009), colleagues (Brooks et al. 2004) and clients (Wade et al. 2010, Weaver et al. 2012). Patients’ care involves many different professionals needing to share patient information and discuss their management (Lindberg et al. 2013). Today, many changes are taking place in the workplace and in health care. The costs of public health services are constantly increasing (National Institute for Health & Welfare 2013). The economic situation of healthcare services calls for a constant search for cost-cutting strategies. Communication between professionals is essential for patient safety and quality of care (Nadzam 2009), which is why it is important to look for and implement cost-effective methods for communication among healthcare professionals (Weaver et al. 2012).
practical nursing, improving personnel competences, organizing operations and for transmitting administrative information. ● The nurses’ perceptions are that electronic communication speeds up the management of patient data, increases staff cooperation and competence and makes more effective use of working time. ● The obstacles for the use of electronic communication were concern about information security, lack of technical skills, unworkable technology and decreasing social interaction.
How should the findings be used to influence policy/ practice/research/education? ● The findings can be used when new communication methods are implemented for nursing practices. ● Some obstacles related to the use of electronic devices in communication should be taken into account in the implementation processes. ● Nursing directors can maximize the benefits of the use of electronic devices by educating themselves and their employees to better understand the possibilities and obstacles of new communication methods and to consider ways to help overcome the obstacles.
Introduction Information and communication technology (ICT) applications in health care are rapidly expanding, thanks to the fastgrowing penetration of the Internet (OECD 2012) and mobile telephone technology (Official Statistics of Finland (OSF) 2007, Wu et al. 2011). Nursing professionals are 2
Background Effective communication between professionals is critical to information transfer and patient safety (Mann et al. 2006, Nadzam 2009). Use of ICT can increase professionals’ contacts (Jenkins & White 2001) and enhance sharing of patient information (Locke et al. 2009). It has been found that online communities of practice could be valuable to nurses who work alone with limited peer support (Valaitis et al. 2011). The review of Lindberg et al. (2013) showed that healthcare professionals gave positive feedback on using different electronic devices and ICT applications in communication with each other. The maintenance and development of nursing competence also require connections and discussion between professionals (Foster & Whitworth 2005). Nursing professionals have experienced many benefits of electronic communication with their colleagues. For example, professionals’ discussion forums on the Internet were found to be useful tools for sharing knowledge and new ideas (Brooks et al. 2004, Weaver et al. 2012). In addition, it was found that the use of electronic forums could increase nurses’ active participation in developing nursing practice by networking with colleagues in other organizations (Barry & Hardiker 2012). Electronic applications also make quick consultations possible (Clemensen et al. 2007) and patients would be able to stay at home rather than be moved to hospital (Lawton & Timmons 2005). Locke et al. (2009) have described the use of Web-based communication tools for professionals that make it possible to send urgent and non-urgent messages between nurses and physicians. It was stated that the application would improve workflow for both groups. (Locke et al. 2009). © 2014 John Wiley & Sons Ltd
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At present, nursing professionals have good possibilities to access the Internet and other electronic health information channels in their workplaces, particularly in Western countries (Gilmour et al. 2012). Hence, the use of electronic devices for communication is often possible. However, apart from traditional landline phones, the use of these devices for communication and consultation among colleagues is not very common (Viitanen et al. 2011). Successful adoption of new communication methods and services requires high user acceptance (Vuonovirta et al. 2009) and functional software and hardware (Wilkowska & Ziefle 2012). Furthermore, privacy protection, data security (Barton 2012, Wilkowska & Ziefle 2012) and confirmation of patient safety are important in the healthcare environment (Nadzam 2009, Broussard & Broussard 2013). More knowledge is needed about how nursing professionals can use electronic devices for mutual communication.
The study Aim The study is part of a wider project whose objective is to clarify nursing professionals’ experiences of the use of electronic communication in publicly funded healthcare services in Finland. The aim of this part of the project is to describe nursing professionals’ experiences of the use of electronic devices for communication with colleagues and other healthcare professionals. In addition, the project gathered information about the use of electronic devices in communication with patients. The findings of this part of the project will be reported elsewhere. The research questions of the part reported in this paper are as follows:
• • •
What kind of electronic devices have nursing professionals used for communication with colleagues and other healthcare professionals? For what kinds of tasks have nursing professionals used electronic devices when communicating with colleagues and other healthcare professionals? What advantages and obstacles have nursing professionals found in the use of electronic devices for communication with colleagues and other healthcare professionals?
Design A cross-sectional survey was used in the study. The study included both qualitative and quantitative components. © 2014 John Wiley & Sons Ltd
The use of electronic devices for communication
Sample The target group (N = 567) of the study comprised the nursing professionals of one healthcare district who worked in outpatient clinics in either specialized or primary health care in Finland. The inclusion criteria were as follows: permanent or temporary employment for nursing staff (Registered Nurse, practical nurse, community nurse, public health nurse, charge nurse, physiotherapist, occupational therapist) during the time of data collection, working in outpatient clinic and Finnish speaking.
Data collection The data were collected by an electronic questionnaire developed for the study in spring 2012. The questionnaire contained both structured and open-ended questions. The demographics of the respondents included age, gender, job position and workplace. There was a question with eight alternatives concerning what kind of electronic devices the nurses use for communication with colleagues and other healthcare professionals. In addition, the questionnaire contained three open-ended questions concerning the purposes of the use of electronic devices and the advantages and obstacles the nurses had found with the use of electronic devices in communication. The participants were asked to answer from their own work point of view. The questionnaire was sent via email to the nursing professionals in the target group. The questionnaire was accompanied by an introductory email including information about the purpose of the study and assurance of anonymity and confidentiality. The staff in one organization did not have email addresses, thus they responded by completing paper forms. The response time given was 3 weeks. Two reminder messages were sent for those who had an email address during the response time. A total of 123 people took part in the study. The response rate was 217%.
Ethical considerations The basic principles of research ethics in health care were followed at every stage of the study (World Medical Association Declaration of Helsinki 2004, Finnish Advisory Board of Research Integrity 2012). Permits for sampling were obtained from the directors of the organizations. Nursing staff participation was voluntary and anonymous. The data were treated in confidence (Polit & Beck 2004). According to Finnish ethical protocol, no statement of ethical commission was needed because the study did not focus on patients (Medical Research Act 1999). 3
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Data analysis Descriptive statistics (frequencies, mean values, percentages) were used to analyse the quantitative data. The data were processed using the statistical software package IBM SPSS for Windows (version 20, SPSS Inc., Chigaco, IL, USA). Answers for open questions were analysed using qualitative content analyses. The material was transferred from the Webropol application to word processing software. The preliminary analyses were performed by the responsible researcher (MK) and the results were peer-reviewed by a member of the research group (AN). First, the text was read through so that a general idea of its contents was obtained. Second, the aim was to find the key parts of longer answers and these were written down in the margins of the transcripts. Third, the primary expressions related to the research questions were coded, after which similar expressions were brought together and reduced expressions were formed. Similar expressions were combined and made into subcategories and main categories. An example of the analysis is described in Figure 1.
Findings Demographics of the respondents Of 122 respondents, 23% (n = 28) worked in specialized health care and 77% (n = 94) in primary health care. There was only one male among the participants. Respondents’ age varied from 26 to 62 years and the mean was 47 years. Of the respondents, 34% (n = 41) were Registered Nurses, 46% (n = 56) were public health nurses, 7% (n = 9) were charge Main category
Sub category
Reduced expression
nurses, 7% (n = 9) practical nurses and others, while 5% (n = 6) were physiotherapists and occupational therapists.
The use of electronic devices for communication with colleagues and other healthcare professionals Nursing professionals used different electronic methods for communication with colleagues and other healthcare professionals. Email was the most commonly used method. Only four (3%) participants reported that they did not use emails when communicating with colleagues. The second most common method was text messaging by mobile phone. Nearly two-thirds (61%) of the nursing professionals reported that they used the text messages. A quarter (26%) of the respondents reported that they used electronic forms, which can be filled out and sent over the Internet. These are used among professionals, for example, for obtaining patients’ preliminary information. Sixteen (13%) professionals described that they used other methods for communication with colleagues. Most of them mentioned internal messages in the patient record system or internal email program used in the organization. The least frequently used methods were question– answer programmes (6%), which enable interactive asynchronous communication and synchronous communication channels on the Internet (5%) (Table 1).
The purposes of the use of the electronic devices in communication with colleagues and other healthcare professionals The purposes of the use of electronic devices in communication with colleagues and other healthcare professionals were Examples of the primary expressions
Consultation
Immediate nursing care
Practical nursing
Supportive activities
‘I use it for consultation and informing.’ ‘I ask for the opinion and advice.’ ‘The Spark program is workable when I want to get a quick comment from the colleague or doctor.’ ‘Collegial consultation.’ Communication related patient transfer ‘I inform colleagues about the patient’s transfer to another ward or organization.’ ‘Sharing of the information related to patient’s transfer.’ Appointment actions ‘I inform the patients of appointments.’ ‘With the help of Spark I make appointments or communicate with typist.’ ‘I use the application in appointment actions with other professionals.’ Sharing digital imagines ‘I send a digital image of the wound to the special wound nurse. After that, we can make a care plan together.’ ‘Sending the photograph to the doctor for consultation.’
Figure 1 An example of the analysis. 4
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Table 1 Nursing professionals’ (n = 123) use of electronic devices for communication with colleagues and other healthcare professionals. Electronic method/device
User n (%)
Non user n (%)
Email Mobile phone text messages Electronic form Other Video conferencing Internet message Question–answer programme Internet, synchronous communication
119 75 26 16 12 8 6 5
4 48 97 107 111 115 117 118
(97) (61) (21) (13) (10) (7) (5) (4)
(3) (39) (79) (87) (90) (93) (95) (96)
The use of electronic devices for communication
they described that they used the technology when requesting patient documents from another organization. Using electronic devices for instrument and material orders is also possible as well as convenient. The participants also reported that electronic devices were useful when drawing up patient guidelines, for example. Thanks to the devices, they are able to exchange information that is needed in the guideline preparation process: With the help of Spark I make appointments or communicate with the typist. I send a digital image of the wound to the special wound nurse. . .
investigated by an open-ended question. Of the eligible participants, 107 gave information on this issue. Five main categories were formed to describe healthcare professionals’ purposes of the use of electronic devices in communication with colleagues and other healthcare professionals. The categories were: (1) practical nursing; (2) supporting and developing competencies; (3) organizing daily operations; (4) organizing administrative tasks; and (5) other purposes (Figure 2). Practical nursing The category ‘practical nursing’ included responses where nursing professionals described factors related to immediate nursing care and care-supporting activities. The respondents reported that they consulted other professionals by using electronic devices when they needed help getting information about the current status and/or treatment of patients. They shared patient information and care instructions by using emails and video calls, for example. Electronic devices were also used when nursing professionals made follow-up treatment plans and discharge plans. They could communicate with colleagues in another institution before moving the patient and also transfer patient data via electronic devices: I use it for consultation and informing. I inform colleagues about the patient’s transfer to another ward or organization.
Care-supporting activities included responses where professionals described factors related to patients’ care that they were not direct care activities. This group included appointments with other professionals made by nurses. The respondents reported that they could use emails or text messages to relay appointment information. The ICT systems also enable transferring digital images. In addition, © 2014 John Wiley & Sons Ltd
Supporting and developing competencies The category ‘supporting and developing competencies’ included the subcategories informing and collaboration. Nursing professionals described using electronic devices to share different types of information related to their competence and special knowledge between each other. They shared educational material, publications and current information. They also reported that sharing material helped them with educational planning for themselves or for the whole work team: The participants described that they were able to collaborate actively using electronic devices. They maintained and developed multi-professional collaboration and emphasized that by using modern methods they could more easily seek support from different peer groups: I use it to share information and material and to consult colleagues. Multiprofessional collaboration. . .such as information about the client’s current status with a psychiatric nurse. For communication with colleagues in Finland, such as how a certain problem has been solved elsewhere.
Organizing daily operations The category ‘organizing daily operations’ included subcategories related to daily routines and developing operations. Nursing professionals discussed their daily work with each other or with other professionals using electronic devices. They also ordered supportive services, such as maintenance for devices used in patient treatment. Meal services were also ordered with the help of the computer. In addition, participants reported that they drew up schedules and arranged appointments using short messages or emails. 5
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Main categories
Sub categories
Immediate nursing care Practical nursing
Supportive activities
Supporting and developing competencies
Informing
Collaboration
Appointment actions Patient document orders Sharing digital imagines Formulating patient guidelines Instrument orders Sharing referrals Completing and sharing forms
Sharing education handouts Education planning Sharing publications and materials Sharing current information Maintaining multi-professional collaboration Maintaining peer group
Daily routines
Discussing daily routines Ordering supportive services Setting timetables
Developing of the operation
Informing operation related changes Making operation related contracts Sharing development related information Informing workplace’s rules and guidelines
Organizing daily operations
Administrative routines Organizing administrative tasks Information sharing
Other purposes
Consultation Communication related patient transfer Sharing patient information Sharing care instructions Preparing follow-up treatment plans Discharge planning
Leisure activities
Informing current actions Appointing meetings Making procurements Video conferencing Reference requests Sharing personnel administrative information Sharing strategy related information Sharing minutes of the meetings
Sharing information of leisure time activities Sharing joke messages
Figure 2 The purposes of the use of the electronic devices in communication with colleagues and other healthcare professionals. Nursing professionals described that they used electronic devices for organizing operations by informing each other about work- and operations-related changes. They also made contracts and shared information relating to development actions. In addition, email or other electronic channels were used particularly by nursing managers to inform staff about workplace rules and to share various guidelines: Daily routines with people working in different units.
Organizing administrative tasks Electronic devices were often used to support administrative routines and to share administrative information. Nursing professionals described that they informed staff about current activities in the organization. They called meetings and made procurements using electronic devices. In some organizations, videoconferencing was used for meetings. Administrative and strategy-related information was shared by electronic devices, as were minutes from the meetings:
Ordering patient documents. Video conferencing is used for technical aids acquisitions. 6
Informing about training events and meetings. © 2014 John Wiley & Sons Ltd
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Table 2 The advantages of the use of the electronic devices for communication with colleagues and other healthcare professionals. Categories
Contents
The use of electronic devices for communication
advantages perceived by healthcare professionals in the use of electronic devices. The categories illustrate the advantages to (1) patients, (2) professionals’ work, (3) professionals’ competence and (4) organization (Table 2).
Advantages to Patients
Speed up patient data transfer Save patients’ time Save patients’ costs Increase patients’ satisfaction
Professionals’ work
Make working time more effective Speed up working processes Speed up management of patients’ affairs Increase accessibility Possibility for time- and placeindependent communication Increase flexibility Relayed messages were documented Decrease travelling
Professionals’ competence
Facilitate information sharing Facilitate consultations Increase access to education programmes
Organization
Decrease healthcare costs Save time Save labour costs Save educational costs
Agreeing on meetings. . . Mutual affairs. . . informing about workplace activities.
Other purposes Some of the participants reported that they had used electronic devices to share information about leisure activities, such as cultural or sporting events, with their colleagues. Nurses also reported that they sometimes shared joke messages with colleagues:
Advantages to patients. The respondents described factors relating to patients. They wrote that the use of electronic devices speeded up transfer of patient information between healthcare personnel who participated in patients’ care. They described that the use of electronic devices produced both time and cost savings for the patients. Patients did not need to come to the practice as often as before when information about their situation was transferred among personnel using electronic devices. According to the nurses’ experiences, patients could be more satisfied with their treatment and service: Speeds things up, patients are often admitted to care more rapidly. Clients may save time and money if they don’t have to be referred to specialized care, for instance to show a wound. As a result, client satisfaction may also increase.
Advantages to professionals’ work. According to nursing professionals, the use of electronic devices for communication with colleagues made their working time more effective. Electronic devices speeded up the management of patients’ affairs. Communication was quicker, resulting in less waiting for critical information to be certain and thereby more efficient work processes for nurses. The participants brought out that by using emails, many people could be accessed with one message and the relayed messages could be documented. The nurses also felt that the use of electronic devices increased flexibility because it enabled time- and place-independent communication allowing the employees to organize their work more independently:
Quite a lot of communication via email, such as about leisure activities. . .
Speeds up communication and allows you to access the experts you want.
Occasionally joke messages! Fast access and the other party can respond at a schedule that suits
The perceived advantages and obstacles in the use of electronic devices for communication with colleagues and other healthcare professionals Advantages The respondents were asked to explore the perceived advantages in the use of electronic devices for communication with colleagues and other healthcare professionals. Of the eligible participants, 104 expressed their opinions on the topic. Four categories were formed to describe the © 2014 John Wiley & Sons Ltd
them. Leaves a trace, you can ask for more information and store the document.
Advantages to professionals’ competence. The participants were of the opinion that the use of electronic devices enabled effective information sharing among nursing personnel. With the help of quick consultations with colleagues, nurses could increase their knowledge and develop 7
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their competence. In addition, it increased access to education programmes and nursing personnel were able to find trainings relevant to their needs: It’s useful to discuss matters related to patient care with colleagues. Sharing professional information. You get more information about training opportunities.
Advantages to organization. The participants described that the use of electronic devices could help reduce healthcare costs by decreasing the number of face-to-face visits. The use of electronic devices for continuing training could produce savings in educational costs for the organization. The organization could achieve both time and labour cost savings, for example, as a result of reduced travelling on the part of staff: You save time as you don’t have to go anywhere. Taking care of things takes less time now. Time use at work is more efficient thanks to videoconferencing and online training events. . .
Obstacles The perceived obstacles in the use of the electronic devices for communication with other healthcare professionals and colleagues were investigated by an open-ended question. Of
Table 3 The obstacles to the use of electronic devices for communication with colleagues and other healthcare professionals. Categories
Obstacles related to data transfer. Nursing professionals described that some misunderstandings can happen when quick messages are used. In addition, sometimes the messages can disappear and the sender cannot know it in adequate time. The nurses worried that the messages could potentially be read by outsiders, which would break confidentiality. They always could not be sure who can be the receiver of the message. Although the participants described that use of electronic devices for communication with colleagues brought some benefits to the arrangements of their work, however, they pointed out that there are some obstacles related to the use of working time. They wrote that sometimes they must wait too long the answers of the collegues when emails are used. In addition, emails are sent so much that the important mails could disappear in the mass of messages. Otherwise, at times, the working time is not enough for reading and managing all messages: Sometimes the use of emails is slow because everybody does not answer the messages fast. Emails will come so much that the important mails could disappear in the mass.
Contents
Obstacles related to Data transfer
Risks related to the reliability of the data Possibilities of misunderstandings Disappearance of messages Doubt about the receiver of the messages Long delays in answering Too many emails Lack of time
Technology and devices
Risks related to privacy protection Lack of devices Unworkable devices and solutions Unworkable connections Blackouts
Users’ attributes
Lack of technical skills Negative attitudes towards technology
Social interaction
Diminished personal contacts Diminished face-to-face cooperation
8
the eligible participants, 88 expressed their opinions on the topic. Four categories were formed to describe the obstacles perceived by healthcare professionals in the use of electronic devices for communication. The obstacles related to (1) data transfer, (2) technology and devices, (3) users’ attributes and (4) social interaction (Table 3).
Obstacles related to technology and devices. The respondents were worried about information security when using electronic devices for communication. They wrote that privacy protection could be endangered when sharing patient information among personnel via electronic devices. Nursing professionals could not use patients’ personal details when, for example, using email for communication. In addition, the participants described that there could be lack of computers and other electronic devices for personal use in the organization. In some cases, the devices did not work very well and the Internet connections and video links could be unworkable, for example. These problems pose risks for optimal data transfer. In addition, blackouts might appear, causing written messages to get lost: Unclear which connections are protected and how client information may be delivered via Internet. © 2014 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH: EMPIRICAL RESEARCH – MIXED METHODS Personal patient information may not be sent by email, i.e. data protection issues. Technical problems and lack of user rights to various functions.
Obstacles related to users’ attributes. According to participants, nursing personnel might lack technical skills that are important for the optimal use of electronic devices for communication. The respondents wrote there are still those among the nursing staff who have negative attitudes towards the use of technology in their work: Lack of ability to use electronic devices as well and willingly. Some people have a negative attitude towards electronic devices, because they consider them to take up so much time.
Obstacles related to social interaction. Some of the participants pointed out that the use of electronic devices could diminish personal contacts and social interaction with colleagues. They described face-to-face discussions with other professionals as very important for their professional growth and knowledge sharing. They emphasized that personal meetings could not be wholly replaced by electronic communication: Lack of social interaction may cause misunderstandings. You see your colleagues more seldom. In my opinion, actual face-to-face communication is the best alternative.
Discussion Nursing professionals used different electronic methods for communication with colleagues and other healthcare professionals. Email and text messages were the two most commonly used methods. This is natural because today organizations almost invariably offer mobile phones and email applications for the use of their personnel. Nursing professionals use mobile phones and laptop computers in their daily practice and email is an easy way to communicate with colleagues (Brooks et al. 2004, Locke et al. 2009). Electronic patient records and Internet connections were in use in the organizations participating in our study. There was no email application for nursing professionals in use in one organization, while 61% of the professionals had the possibility to use mobile phones at work. © 2014 John Wiley & Sons Ltd
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However, the use of emails and text messages is associated with some challenges in health care. The information transferred is often sensitive. It contains patients’ personal health information, but professionals could not share patients’ personal data without strong privacy protection. Nursing professionals should therefore be aware of what information they can share via electronic devices. According to our findings, nurses are quite well aware of the information security risks. However, there should be detailed instructions on how to use electronic devices in communication in healthcare organizations. Nursing professionals use electronic devices in communication with each other for a variety of purposes. They brought out that ICT supports their daily practices and makes work smooth. The development of healthcare practices is rapid and knowledge sharing requires networking with other professionals (e.g. Weaver et al. 2012). Our finding is that nursing professionals consider quick consultations important for their decision-making and the use of electronic devices makes this possible. Our finding is supported by results of earlier studies (Clemensen et al. 2007, Barry & Hardiker 2012). The participants in our study described the advantages of the use of electronic devices in communication from the point of view of their work, but also from patients’ point of view. They explained that effective and rapid information sharing between professionals could save patients’ time and costs. The finding is supported by the earlier study of Lawton and Timmons. They found that active information sharing among healthcare professionals decreased patients’ hospital visits, thereby reducing costs (Lawton & Timmons 2005). As the expenses of public health service increase, it will be important to find effective methods to curb costs. Despite the fact that nursing professionals pointed out that the use of ICT in communication makes the working processes more effective, they thought that there were some obstacles related to the use of working time, particularly in relation to the added workload from email use. The volume of email messages might be so large that the most valuable information could get lost. Nurses’ work might thus contain unnecessary practices, which take time away from the basic tasks. It is important to ensure that nursing professionals have the skills to use electronic devices when new methods are implemented in communication practices. Nursing directors have a significant role in these processes. They can maximize the benefits of the use of electronic devices by educating themselves and their employees to better understand the possibilities and explore ways to overcome the obstacles of new communication methods. In addition, the devices and 9
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connections should be workable and easy to use. Guidelines and instructions for optimal and safe use are needed. Healthcare organizations are responsible for security practices in information sharing and for the competence of their personnel.
Limitations The study has some weaknesses particularly in relation to the number of participants. It was known that the use of electronic devices for communication among healthcare personnel was not very common in the area of the participating hospital district. As a result, some people in the target group did not have any experience of the issue. We can assume this to be the reason why they did not complete the survey. However, because the information was partly collected using open-ended questions, the number of respondents is quite high. In addition, the qualitative data were rich and participants have described the use of electronic communication with colleagues from several aspects. The majority of the participants were public health nurses (46%) and Registered Nurses (34%). It is known that in the outpatient clinics in the participating organizations, particularly in primary health care, public health nurses are the largest professional group, as was the case in our study group. We can thus claim that in this respect the study group is similar to the target group. The findings are suggestive and more knowledge is needed of the use of electronic devices for communication among healthcare personnel. We assume that the findings of the study are useful in the development and implementation processes of electronic devices for communication in health care.
devices. They were worried about information security and experienced a lack of technical skills. Nursing professionals brought out that devices and technology were not always very functional or easy to use. In addition, they were worried about decreasing face-to-face contacts, which they felt to be very important for their professional growth and knowledge sharing. According to the findings, the use of electronic devices for communication among healthcare professionals is a promising method when some obstacles are taken into account. The findings can be used when new communication methods are implemented for nursing practices. In future, it is important to study this subject also from the point of view of the healthcare service users.
Funding The study was partly funded by Satakunta Hospital District (EVO 81051) and the Finnish Cultural Foundation, Satakunta Regional Fund.
Conflict of interest No conflict of interest has been declared by the authors.
Author contributions All authors have agreed on the final version and meet at least one of the following criteria [recommended by the ICMJE (http://www.icmje.org/ethical_1author.html)]:
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Conclusion According to the study, nursing professionals use different electronic methods for communication with other healthcare professionals and colleagues. The most commonly used method was email while the least frequently used methods were question–answer programmes and synchronous communication channels on the Internet. Communication using electronic devices was used for practical nursing, improving personnel competences, developing operation and transmitting administrative information. Nursing personnel found several advantages with communicating with each other using electronic devices. Electronic communication speeds up the management of patient data, it increases professionals’ cooperation and competence and makes the use of working time more effective. However, nursing personnel also experienced some obstacles in the use of electronic 10
substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content.
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