Information Technology in Nursing Practice: A Scoping Review of Assessment Tools for Evaluating Nurses’ Competencies

Introduction

The health care delivery system supports key tenets of person-centered care, encompassing dimensions of safety, effectiveness, efficiency, and easy accessibility. This is attributed to a combination of rapid technological advancements, rising expectations and demands for sustainability, along with staff shortages, turnover, migration, and potential geopolitical instability.^1–3 The World Health Organization views nurses as the backbone of healthcare systems across all societies; consequently, a lack of competence among nurses can significantly impact patient outcomes.⁴ Nurses’ competence in relation to safety and quality of care has been extensively discussed.^5–9 Indeed, Aiken et al⁵ studies have demonstrated that the educational level of nurses is critical; specifically, higher competence among nurses in hospital wards leads to a lower incidence of mortality, morbidity, and adverse events.¹⁰

As the central theme of nursing is “caring” and if the integration of technology as a mean of collecting data and improving patient safety is reaching maturity, this moment is of particular importance in care practices. If nursing technology aims to improve the quality results of patient care, caring for the patient is certainly part of this equation, if not the central theme.¹¹ Consequently, the implementation of Nursing Information Systems¹² generated in nurses the need to acquire new skills in providing care.^13.Many countries have enhanced competency requirements with minimum standards of knowledge, skills, and attitudes for healthcare practice.² Technical competencies are the capabilities and skills of healthcare workers to practice and perform effectively and safely without leader supervision while applying appropriate skills, knowledge, and judgment.¹⁴

The most recent literature refers us to the use of different technological tools, for example, early warning systems aim to detect patients’ deteriorating condition, improving the quality of nursing care and reducing the number of emergencies.¹⁵ Barcode Medication Administration technology improves quality and safety by reducing the risk of human error and simultaneously guarantees product traceability. However, either depends on nurses’ knowledge to mediate between the embedded logics of their design and the unpredictable needs of patients,¹⁶ to reap these benefits, digital transformation in the health sector will require not only technical advancements but also adaptation of attitudes, skills, and culture within the health workforce.¹⁷ This includes the specific knowledge and skills required for successful job performance in specialty fields. Behavioral competencies refer to the ability to engage and collaborate with others in specific practice contexts.¹⁸ Leadership competencies include behaviors and skills that contribute to organizational performance.² Healthcare organizations will be more prepared to integrate information technology into care processes if teams have the appropriate knowledge and skills.

Aim of the Review

The objectives of this study were twofold, namely identify and map the information technologies and measurement instruments used to assess nurses’ competencies.

Material and Methods

This scoping review was conducted by guidelines of Joanna Briggs Institute (JBI) updated methodology for scoping review¹⁹ and was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist (PRISMA-ScR checklist).²⁰ A protocol for this scoping review has been registered and published on the Open Science Framework (https://osf.io/ey8qr/)

The research was conducted in three distinct phases, utilizing the Medline, CINAHL, Cochrane databases through the EBSCO platform, as well as ScienceDirect, Wiley Online Library, SciELO, and PubMed. Data extraction and analysis were performed using the JBI Template for Source of Evidence Details, Characteristics, and Results Extraction Instrument, which was adapted to address the specific questions of this review: What information technologies do nurses use, and what measuring instruments are used to assess their competencies in technological environments in hospitals?

Criteria for Eligibility

The inclusion criteria were based on the mnemonic PCC – Population, Concept and Context, which refers to the type of study, language, and the date of publication of the documents added.¹⁹

Population: Nurse/Nurse Manager

Nurse competence is connected to professional performance, showcasing the effective use of skills and knowledge that facilitate clinical judgment and decision-making in research, teaching, training, management, and consultancy, ultimately contributing to the enhancement and progression of nursing care delivery.²¹

Concept: Information Technology

Health technology refers to the application of skills and knowledge organized into devices, procedures, and systems designed to address health issues and enhance quality of life.³ Nursing information technologies are mainly utilized to facilitate the nursing process,²² based on technical and semantic interoperability standards.²³

Context

Technological environments in hospitals.

Study Selection

Therefore, this study involves nurses and nurse managers in hospital settings who incorporate information technology into their caregiving practices.

Inclusion Criteria

All types of studies containing instruments that assess how nurses use information technologies in their care practice and what competencies they develop.

Types of Evidence Sources

All types of peer-reviewed studies published since January 2012 to December 2023, with abstracts in Portuguese, English and Spanish (Castilian) were considered eligible. From the perspective of the methodology of a scoping review,²⁴ included studies were both qualitative and quantitative, whether prospective or retrospective, encompassing randomized clinical trials, cross-sectional studies, experimental studies, literature reviews with or without meta-analysis, qualitative context analyses, expert opinions, reflections, and descriptive studies. Editorials and posters were excluded.

Strategy for Search

In December 2023, we conducted a three-step search strategy as recommended by JBI.^25,26

1. A preliminary search of two databases
2. Analysis of keywords, titles, and abstracts
3. Manual search of pertinent materials

First, indexing terms were determined in the CINAHL and MEDLINE databases to select the most relevant words and phrases for creating the Boolean search query. The second phase involved a systematic search of electronic databases using predefined terms. The databases accessed were Medline, CINAHL, Cochrane Central Register of Controlled Trials via the EBSCO platform, ScienceDirect, Wiley Online Library, SciELO, and PubMed. The search strategy involved different combinations of descriptors, utilizing the Boolean operators ‘AND’ and ‘OR’, along with the truncation symbol ‘*’, to capture multiple suffixes, having been established as a limiting filter, publication date of January 2012 to December 2023. To obtain documents not included in the previously mentioned databases, a search was also conducted in the gray literature, aiming to incorporate information and studies that fulfilled the predefined inclusion criteria but were absent from scientific publications - Table 1. In the third stage, the reference lists of selected articles were reviewed, examining studies deemed relevant and supplementary to enhance the research’s sensitivity and encompass the broadest possible range of existing literature.

Table 1 Data Sources and Research

Data Extraction

Study selection, data extraction and coding were carried out by two independent reviewers, a third reviewer was available to resolve possible discrepancies. To manage the research results, the Covidence^® software was used, facilitating the process of selecting studies. Duplicate studies were automatically eliminated. Initially, the titles and abstracts of the selected studies were analyzed based on the inclusion criteria. Following this initial selection, the articles were reviewed in their entirety. Some studies were identified where both reviewers did not agree, so that each one justified their choice, and a consensus was reached, without the need for the intervention of the third reviewer. Finally, after the reading of the eligible studies in full by both reviewers, relevant data were extracted and analyzed using the JBI Template Source of Evidence Details, Feature and Results Extraction Instrument, adapted to the question of this review, validated, and accepted by both reviewers. The results of the search and selection of studies are presented in full schematized using the PRISMA-ScR – Figure 1.

Figure 1 Flowchart of the study selection.

A total of 101 results were identified across all sources. There were three (n = 3) duplicates identified, leaving 98 (n = 98) titles and abstracts for review. There were 86 (n = 86) articles excluded through this process due to the irrelevance of the papers to the aims of the review. Screening yielded 12 studies with potential for eligibility. Exclusion of several articles deemed to be out of scope resulted in 4 studies being included in this review.

To respond to the objective of this review, the analysis of the articles went through 3 stages, identifying the dimensions analyzed in each of the stages, represented in Tables 2–4.

The first step was to understand the design and objective of the studies under analysis, identify the information technology used by nurses in the care environment and skills developed, and the identification of instruments that allow evaluating these skills. The second stage was dedicated to checking the instruments, understanding what the instruments assess, the type of measurement scales used and identifying the methodology used when analyzing the psychometric quality of these instruments. The analysis and report of a psychological measure’s internal consistency is a well-established requirement in the scientific community carried out for each instrument. Among the several available methods to estimate internal consistency, Cronbach’s α ranks high in most researchers’ preferences.²⁷ Thus, in the third stage, it was considered important to explore the methodology and results of the psychometric analysis regarding demographic data, construction validity and reliability, to safely understand the applicability of the instruments.

Table 2 Details of Included Studies

Table 3 Characterization of Instruments

Table 4 Psychometric Analysis of the Instruments

Results

Studies spanned over our predefined timeframe from the earliest in 2017²⁸ to the most recent paper, published in 2022.²⁹ The studies were carried out in various geographic locations: United States (n = 2); Philippines and Saudi Arabia (n = 1); West Bank and Palestine (n = 1); Türkiye (n = 1).

This research highlights methodological studies with cross-sectional quantitative approaches, through exploratory factor analyzes (n = 3).^28–31 Methodological studies aim to develop, validate, and evaluate solid and reliable measurement instruments.³² One of the studies presents a cross-sectional, descriptive-correlational design with a quantitative and qualitative approach²⁸ - Table 2. Of the 4 studies included in this review, 4 of the 5 instruments under analysis conclude that the identified instruments have acceptable reliability and validity values. Aiming at a greater understanding of the identified instruments, Table 3 shows their characterization, specifically, what the instruments evaluate, items and the measurement scale, and route to evaluate the psychometric qualities of the instrument’s measurement scales.

It was also considered that it was important to understand how the instruments had been tested and validated, regarding translation, validation, and consistency to understand whether the instruments were suitable and accurate for the intended application. Table 4 presents the methodology of the studies, results of the psychometric analysis of the instruments and conclusions of the studies.

Discussion

Monitoring the development of nursing technologies is a consequence of the growing dependence on technologies that critically influence human life and impact the experience of care recipients. Thus, it is important to develop a look at technological competence as nursing care, guided by a model of practice formalized as technological competence and care in nursing theory.³³

After analysis, the four articles included in this review highlight the importance of instruments for assessing nurses’ skills, given the growing integration of information technology in health organizations, with great representation in the contexts of care practice at different levels. One of the instruments is a specific instrument for nurse leaders, focusing on specific areas such as, concepts and management, strategic planning, executive leadership, financial management and ethical/legal concepts - The Nursing Informatics Competency Assessment for the Nurse Leader (NICA – LN),²⁸ will enable nurse leaders to acknowledge the competencies required in their role, help create solutions to address potential gaps and improve patient care delivery.

Two of the instruments focusing on IT skills related to the knowledge and use of the equipment itself, namely, areas of basic computer knowledge, information literacy - Technology Informatics Guiding Educational Reform–Based Assessment of Nursing Informatics Competencies Tool - TANIC-T,³¹ and wireless device skills, clinical informatics role, and applied informatics skills: clinical informatics, by using the Self-Assessment of Nursing Informatics Competencies Scale (SANICS).²⁹ In this study Batran,²⁹ sought to relate technological skills, with clinical decision-making, also presenting an instrument on Clinical Decision-Making in Nursing - Clinical Decision-Making in Nursing Scale (CDMNS),³⁴ which essentially focuses on the assessment of clinical decision-making, describing the nurse’s perception of clinical decision-making based on self-expression, therefore, none of these instruments correspond to what was intended.

The instrument, TCCNI_RePract,³⁰ evaluate the use of technology as a nursing care tool: comprehending patients’ needs, enhancing their self-esteem, encouraging improved health, and fostering stronger relationships with others. The understanding of technological competence as nursing care is anchored in Rozzano Locsin’s theory – Technological Competency as Caring in Nursing, which essentially focuses on knowing the person, through technological competence and understanding this competence as an instrument of care.^35,36 This instrument allows not only to evaluate how nurses perceive technological competence as nursing care but also how they use these skills in their daily practice, particularly in highly technological practice environments. According to the authors, The TCCNI-RePract is a tool that reliably assesses nurses’ perceptions and practices in relation to the TCCN.³⁰ This scale effectively and consistently measures nurses’ perceptions and practices across four dimensions: 1) Knowing People, 2) Technological Competence as Caring, 3) Technology and Caring, and 4) Nursing Expression as Caring. Therefore, it is deemed suitable for guiding the training of hospital nursing teams³⁰ Nursing informatics skills are essential for safe and effective clinical practice. Throughout the studies, it was noticed that knowledge and skills regarding information systems are a focus of attention for health organizations that invest in technology and have a major impact on the quality of care provided. Ongoing education and training are considered vital for enhancing the quality of care provided by nurses.³⁷ Although it is recognized that to increase nursing informatics competencies it is critical to assess nursing informatics competence levels and given that informatic technologies skills are necessary and should be an ongoing requirement, one of the recommendations is to use tools with nursing students to identify their computer knowledge, skill gaps and to better prepare them for practice in contemporary care environments. However, skills and knowledge are crucial for nurses in fostering relationships with their patients, as these relationships rely on trust in each nurse’s technical abilities. As nurses gain proficiency with technology, they significantly enhance their efficiency in utilizing it.³⁵ Nurses and healthcare professionals in general must be specifically recognized and involved in the escalation of digital development in healthcare, preparing themselves for the required skills development, increasing their involvement in digital competence in healthcare development methods, such as guidance, mentoring or coaching, and contributing to the design of models that support high-quality care practice. Additionally, as already mentioned by other authors, managers must take a stronger role in supporting different areas of digital health competence.³⁸ The International Council of Nurses also encourages national nurses’ associations, in collaboration with their governments, to contribute to the development of digital health competency frameworks to inform nursing education and ensure their integration into continuing nursing education at national and international level.¹⁷

Conclusion

With the growing use of technology and the consequent dependency experienced by care recipients, it is important to provide the acquisition and development of technological competences as nursing care, guided by a model of practice such as technological competence and caring in nursing theory. This importance is reinforced by the reality in which nurses find themselves with highly technological and increasingly developed nursing practice environments. These include knowledge and use of their own IT equipment, areas of basic IT knowledge, information literacy, wireless device skills, the role of clinical IT, and applied IT skills. These applied informatics skills should consider clinical informatics, using various support tools such as the Nursing Clinical Decision-Making tool, which essentially focuses on the evaluation of clinical decision-making, describing the nurse’s perception of clinical decision-making based on self-expression.

Evaluating the use of technology as a nursing care tool is crucial for understanding patients’ needs, enhancing their self-esteem, promoting better health, and fostering stronger relationships with others. But computer skills in nursing are also essential for safe and effective clinical practice.

Information systems knowledge and skills are a focus of attention for healthcare organizations that invest in technology and significantly influence the quality of care delivered. Continuing education and training are recognized as essential to improving the care provided by nurses. Although nurses are aware of the importance of using technology as a support to profoundly understand patients and promote their recovery, building a better relationship with patients, they sometimes fail to do so for various reasons.

Therefore, more studies are needed to better understand the obstacles and challenges that hinder nurses from delivering effective nursing care in technological environments, as well as how the organization and management of nursing care should be viewed so that care is supported by technology, but without losing the essence of care. Caring for the person as a unique and individual being, with their own values, experiencing a health experience that is also unique in a moment, aware that the current moment is not the next one. Hospitals and organizations that promote a human caring environment should support nurses’ ongoing professional development, such as acquiring new competencies based on the latest evidence that support the practice of nursing care, for better health outcomes and a better patient experience. We noted the scarcity of studies in the review area. This emphasizes the great relevance and importance of this review for scientific evidence.