The role of ICT in nursing practice: an integrative literature review of the Swedish context

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In today's healthcare environment, demands with respect to quality, security and efficiency are continually increasing 1. These demands, together with a growing and rapidly ageing population, challenge healthcare systems (e.g. through an imbalance between individual needs and demands and the financial resources and manpower available to the Swedish healthcare system).
In response, the Swedish Ministry of Health and Social Affairs has encouraged the use of information and communication technology (ICT) in nursing practice and in Swedish healthcare organisations 2, as such tools are considered to be valuable 3, necessary and unavoidable in providing accessible and safe health care. Since its introduction into the healthcare arena, ICT has both fascinated and troubled nurses. Today, ICT is used widely and is integrated with nursing practice 4. This persists even when nurses themselves do not always feel that it is convenient to use ICT in their nursing practice due to a lack of the skills needed to utilise such technologies in a satisfactory, safe and effective way 5. It is interesting to note that similar problems were identified in the mid‐1990s 6, but 13 years later, such barriers appear to remain 7. Though these phenomena are thus not new and scientific results on these issues exist, experiences of the influences of ICT on nursing practice need to be compiled to deepen knowledge of the roles played by ICT in healthcare settings.
ICT is a term frequently used to label technological systems and applications that are designed to manage and communicate information in healthcare settings 8. ICT can be understood as tools and services 8. Examples of ICT in nursing practice described in the literature include services that support patients, decision‐making processes 9, management systems and education and research in clinical practice 10. The motive and aim of ICT development often arise from the will to assist users in different ways (both patients and personnel) 11 and to help address future care needs 3. Existing ICT takes on a variety of forms (e.g. web pages, health‐related e‐services, Internet‐based management and treatment services, electronic medical records and web‐based education and simulation systems). Such services have been found to be more effective when used in combination with traditional management systems (rather than traditional systems alone) 11. ICT could be useful in health care insofar as it could replace human labour for simple tasks 12 while improving performance levels, minimising errors 12 and increasing accessibility 14. Integrating ICT into nursing practice could result in greater patient participation and therefore closer relationships with nursing personnel 15. Alongside these positive effects, however, ICT may also negatively impact relationships between staff and patients. For instance, negative effects include barriers to and a lack of relational closeness in nurse–patient encounters and a focus on technologies rather than on the patient (cf. 15). Experiences of the conditions under which ICT is and is not able to replace or complement interactions in nursing practice are likely to be extremely varied. Thus, in cases where ICT is included in the healthcare environment, evidence of both shortcomings and advantages for human relationships can be expected.
As managing and structuring information has always been a part of nursing practice 4, nurses are expected to possess sufficient knowledge to interpret and valuate information 16. Although ICT is viewed a fundamental tools needed for nurses to obtain information necessary to provide holistic care effectively and safely 17, the pace of the ICT development in nursing practice has been slow 18.
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