iPads in nursing education and practice: brief literature review

Here at UWEC faculty in the Technology and Facilities Committee of the College of Nursing and Health Sciences met on Friday, March 1st, 2013 to discuss the possibility of replacing aging laptops (for student checkout) in the Skills and Simulation labs with tablet computers such as iPads. They are also looking into ways of incorporating tablet computers like the iPad into the Nursing curriculum. On Tuesday, I took ten iPads from our mobile teaching lab over for Nursing faculty to try using their simulation software on them, but they did not work. So I was asked to find out what I knew about use of tablet computers in nursing education and clinical practice. Because the iPad did not come out until 2010, only a few articles have been published, and they paint an interesting picture of current practice in this area.

Mobile in nursing education and clinical practice

A preliminary literature review conducted at the turn of the decade found most evaluations of personal digital assistants (PDA) were limited to descriptive analyses and anecdotal evidence (Zurmehly, 2010). Since then, mobile devices have been utilized in the classroom to support nurses’ competency in both information literacy and digital literacy. Skiba (2011) recommended that strategies for use of these devices in the nursing classroom incorporate evaluation of the accuracy, authority, credibilty, bias or objectivity, currency and timeliness, and coverage of information accessed, which is music to this librarian’s ears. Inclusion of mobile technology in the classroom also supports three elements of what is now called digital literacy. They are:

  1. Understanding information access: mobile devices provide ready access to experts and information at the point of learning.
  2. Understanding the new sense of space: apps can layer information about our surroundings through GIS and other software. Instructors can design “situated, contextual, just-in-time, participatory and personalized learning” (p. 1) situations.
  3. Understanding hyperconnectivity: social media tools can be used to create collaborative learning environments.

Yet use of these devices in nursing education was not without problems. In hopes of improving learning, 35 students in a medical-surgical nursing course were given iPod touch units loaded with pre-recorded lectures. While there was no statistically significant difference between the grades of students who had iPods and those who did not, individuals who utilized the iPod more heavily just prior to the final exam received lower grades (Johnston, Hepworth, Goldsmith, & Lacasse, 2010).

Published research on use of iPads and other mobile devices in nursing practice, both clinical and public health, was also limited based on searches in CINAHL. Duffy (2012) suggested a number of general uses for tablet computers in this area because they are mobile, convenient, and easier to read than smartphones. Here are those suggestions, with examples derived from the experiences of myself and my colleagues:

  • Electronic living: email and social media both offer quick and asynchronous communication within and between organizations, and mobile technology can provide additional support in this area.
  • Keeping up with literature, and supporting professional development: using RSS feeds and email alerts, nursing professionals can keep abreast of the latest research in their fields on mobile devices. Also, a number of publishers offer CME credits through apps and subscription databases.
  • Patient and peer education: when a parent asked how her child could have an obstructed bowel, but still have diarreah, a medical student used a drawing program on her iPad to quickly diagram just how this happened, providing just-in-time education. With presentation and medical apps, iPads can be used to share learning with colleagues as well.
  • Electronic medical records (EMR): filling in information in an EMR system can be quickly and easily completed using a tablet computer, which is far less unwieldy that computers on wheels, also known as COWs.

And electronic charting does not appear to increase a nurse’s time spent in charting and other documentation (Yee et al, 2012).

Two major pitfalls of both tablet computers and smartphones are already being dealt with in the medical profession as a whole. First, additional care has to be taken to maintain patient privacy, as portable computers are easier to steal than COWs. Second, because many use social media as place for personal expression, a healthcare provider’s professionalism can be easily compromised with just a single post or picture uploaded to Facebook, Twitter, and others (Duffy 2012).

Applicable ideas from mobile in medical school

Looking at research published on use of these devices in medical education may provide new and interesting uses in nursing as well. In one study, med students watched mobile-optimized, just-in-time videos prior to patient encounters. The students then presented their findings to their supervising faculty. Those who saw the videos were more confident in their presentations to the instructor than those in the control group that did not view them (Twes, 2011). Along with just-in-time learning, mobile devices allow students immediate access to, and management of, clinically relevant information in practice. It is believed that this helps improve the student’s ability to provide “sound, effective, quality care” (Murray, 2013, p. 27).

In another study, this time in the UK, 387 medical school students were each equipped with a Hewlett Packard iPAQ PDA loaded with quick reference information. This enabled improved learing in four ways:

  1. Timely, in-context access to key facts.
  2. Consolidation of knowledge through repetition
  3. Devices served as an information supplement, not a replacement
  4. Allowed students to make use of down time between patients, etc.

Barriers to learning were created when devices freeze or malfunction. Students felt that use of these devices interrupted the ongoing educational experience. They also reported unpleasant experiences with patients and other staff: they were suspected of playing around instead of working (Davies, 2012).

(This post is a first draft of part of a paper that will hopefully be published in the coming months. Feedback is welcome, and all rights under copyright law are reserved.)

To nursing and medical faculty: how are you using mobile technology, and in particular tablet computers such as iPads, in both classes and clinical practice? Tell us at the fireside!

Reference

Davies, B. S., Rafique, J., Vincent, T. R., Fairclough, J., Packer, M. H., Vincent, R., & Haq, I. (2012). Mobile Medical Education (MoMEd) – how mobile information resources contribute to learning for undergraduate clinical students – a mixed methods study BMC Med Educ (Vol. 12, pp. 1). England.

Tews, M., Brennan, K., Begaz, T., & Treat, R. (2011). Medical student case presentation performance and perception when using mobile learning technology in the emergency department Med Educ Online (Vol. 16). United States.

Duffy, M. (2012). Tablet Technology for Nurses. American Journal of Nursing, 112(9), 59–64.

Johnston, R., Hepworth, J., Goldsmith, M., & Lacasse, C. (2010). Use of iPod[TM] technology in medical-surgical nursing courses: effect on grades. International Journal of Nursing Education Scholarship, 7(1), 1p. doi:10.2202/1548-923X.2092

Murray, T. (2013). Innovations in Nursing Education: The State of the Art. Journal of Nursing Regulation, 3(4), 25–31.

Skiba, D. (2011). On the Horizon Mobile Devices: Are They a Distraction or Another Learning Tool? Nursing Education Perspectives, 32(3), 195–197. doi:10.5480/1536-5026-32.3.195

Smith, C. (2012). Harnessing Mobile Devices in the Classroom. Journal of Continuing Education in Nursing, 43(12), 539–540. doi:10.3928/00220124-20121120-95

Yee, T., Needleman, J., Pearson, M., Parkerton, P., Parkerton, M., & Wolstein, J. (2012). The influence of integrated electronic medical records and computerized nursing notes on nurses’ time spent in documentation. CIN: Computers, Informatics, Nursing, 30(6), 287–292.

Zurmehly, J. (2010). Personal Digital Assistants (PDAs): Review and Evaluation. Nursing Education Perspectives, 31(3), 179–182.

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