of PDAs in Nursing: Benefits and Barriers
By Colleen Davenport, RN, BSN, MSN
Colleen Davenport provides health care in rural Wrangell,
Alaska. In 1972, she received a Bachelor's Degree in
education from the University
of Utah (1972). Since she always wanted to be a nurse,
she returned to school in 1994. Salt
Lake Community College was the setting for her first
nursing degrees: Practical Nursing (1996), Associate in
Health Science (1997), and Registered Nursing (1997). While
nursing at Intermountain Health Care and University of Utah
Medical Center, she worked on her BSN at University of Utah
(1999). After relocating to a small southeast Alaska island
(Wrangell), she completed her Master's degree from University
of Phoenix Online (2004). Information technology allows
her to enjoy the beauties of rural life while maintaining
professional currency and connections.
Analysis of PDAs in Nursing: Benefits and Barriers
This paper was part of Colleen's Master's project
at University of Phoenix Online
Personal Digital Assistants (PDAs) are small handheld
computers that can provide nurses with the ability to access salient
and current information, thereby improving patient care. Many nurses
have not adopted this technology, although Stolworthy (2003) indicated
that 559,800 nurses were using PDAs. Healthcare organizations and
nursing leaders in a position to help nurses to incorporate PDA
technology; and will subsequently reap the benefits of improved
patient care and overall organizational quality.
How nurses perceive the benefits and barriers of PDA
use should influence decisions about organizational adoption of
PDAs for nurses. There is scant research on nurses' PDA use to date.
This paper presents the survey and consequent analysis of nurses'
perceptions of benefits and barriers on nurses' PDA use. It presents
an overview of the literature on benefits and barriers to PDA use
in healthcare, describes development of the PDA barriers and benefits
survey, its survey distribution, the sample, and the survey results.
The survey limitations and recommendations for further research
are included along with the implications for nurses and administrators.
Quantitative, Peer-Reviewed Research
Rothschild, Lee, Bae, and Bates (2002) polled ePocrates
drug database users, even though these early adopters were not likely
representative of a normal physician population. Descriptive analysis
of 946 respondents revealed that the PDA drug database saved time
during information retrieval, was easily incorporated into workflow,
and improved decision-making.
Lu, Lee, Xiao, Sears, Jack and Charters (2003) interviewed
twenty physicians who owned PDAs but were not using them. They identified
organizational problems, usability, inadequate technical support,
and lack of motivation as barriers to PDAs.
McLeod, Ebbert, and Lymp (2003) surveyed four hundred
and seventy-three Mayo Clinic physicians. Chi-square, and McNeman
methods revealed that the sample had significant preference for
Palm Operating System (OS) and that work roles influenced PDA use.
Miller (2003) summarized a survey conducted by Skyscrape,
a provider of PDA references. Ninety percent of the 900 physicians
reported better patient care, 85% had less medical errors, and 40%
said they treated more patients each day.
Jao, Hier, and Su (2003) evaluated a Digital Resident Diagnosis
Log and noted that physicians often use the expenditures of their
time to decide whether or not to adopt a new device.
Tschopp and Geissbuhler (2001) described a pilot project
to supply one hundred physicians with PDAs and applications. Although
outcome data was not presented, the authors' opinions that there
is not knowledge of possible technical, logistic, and cultural challenges
is valid. These authors felt PDAs were superior to books because
of small size, more information, more currency, and easier access.
Fischer, Stewart, Mehta, Wax, and Lapinsky (2003)
reviewed 119 articles on PDAs, and stated there were not enough
evidenced-based studies on PDA use. They identified confidentiality
issues, organizational costs, lack of standards, and lack of consumer
interest as barriers.
Dee, Teolis, and Todd (n.d.) surveyed 131 healthcare
PDA users and found that users were limited by lack of software,
PDA memory limits, cost, not understanding the software, and not
understanding how to download the software. They identified the
benefits of improved decision making because of access to drug,
treatment, diagnosis, and test information.
Grasso's (n.d.) annotated bibliography revealed the
benefits of small size, relatively low price, no boot-up time, rapid
application switching, one-time data entry. Additional benefits
are patient information management, procedure logs, general office
tools, transmission of messages and tests, critical value notification,
bedside data collection with timestamps, decision protocols, audible
alarms, research data collection, and connectivity to computers,
cell phones, printers, etc. PDA problems included small display
screens, risks of damage or loss, data transmission problems, data
input problems, and privacy requirements.
Breton (2003) complained that PDA input was laborious
because they do not have keyboards. He also felt they were easy
to lose and that hackers could tap into wireless hospital PDA networks.
In spite of this, he summarized a PDA as an "unprecedented
knowledge base that will travel anywhere."
Lusky (2002) felt that nurses' stumbling blocks for PDA utilization
are that nurses aren't very technologically savvy and information
technology (IT) resistant; that PDAs are hard to read and are too
expensive, and that there are security and confidentiality issues.
Lusky highlighted benefits of improved team and physician communication,
drug references, and patient wellness software.
Rullo (2000) had the opinion that healthcare was slow
to adopt wireless and Internet technologies because of organizational
cost, HIPAA concerns, failure to associate IT with better patient
care, and low IT among healthcare workers. He cited benefits of
immediate and current patient information and medical error reduction.
PDAcortex (2003) stated that nurses had trouble adopting
IT because they are an aging population with little or no IT training,
nursing schools do not have enough IT training, and nurses feel
that IT is dehumanizing. Other barriers included small PDA screens,
difficult data entry, limited memory, and high cost. Benefits included
serious drug events avoidance, quicker information access, improved
drug knowledge, and better and more satisfied patients.
PDA Benefits and Barriers for Nurses Survey
Thirty-eight barriers and sixty-eight benefits to
PDA use were extracted from the literature. Since they seemed to
center around themes, mind mapping techniques were used to allow
them to coalescence into six benefits and six barriers. In the survey,
nurses were asked to rate each benefit and barrier as to whether
it was significant, large, moderate, modest, or not a benefit or
The survey was distributed to nurses at the author's
worksite. Friends of workers, the Alaska Nurses Association, and
a former classmate also helped with survey distribution. As a result,
many surveys were distributed through email and completed by computer
users. Seventy-six were returned. Although four of these were incomplete,
their data was still included.
Ordinal data was assigned integer values, and data
was coded and entered into an Excel Spreadsheet. Data entry was
double checked. Descriptive statistic analysis was done with the
Excel Data Analysis Descriptive Statistic function for sample age
range, computer ownership time, and computer comfort levels as well
as each of the benefits and barriers.
The sample mean, median, and mode age was 40-49 years,
with a standard deviation of 1.026. This group included 71 females,
and 4 males.
Table 1 Sample Age Distribution
Respondents were from 12 different states, although most were from
Alaska (42). New York contributed fourteen surveys and Maryland
contributed nine. All the respondents except one were nurses. The
exception was an information specialist. Twenty-nine of the respondents
had either administrative or advanced practice roles, the rest characterized
themselves as registered nurses.
All of the respondents except two owned a computer
and years of computer ownership ranged from one to thirty. The mean
length of computer ownership time was 10.82 years with a standard
deviation of 6.03 years. Of this group, 84% said they were very
comfortable when using a computer, 11% were slightly nervous, 4%
were very anxious, and 1% said they couldn't stand using a computer.
Table 2 Years of Computer Ownership Distribution
Nurses rated having quick access to a current drug
database and nursing reference books as being the most significant
benefit (M = 4.47, SD = 0.895). The next three benefits were ranked
were very closely, implying that nurses value these benefits similarly.
These were the ability to manage patient and procedure information
(M = 3.81, SD = 1.246), bedside data entry (M = 3.66, SD = 1.356),
and data collection for research and teaching (M = 3.53, SD = 1.385).
Patient health management and improved team communication were rated
as moderate benefits (M = 3.33, SD = 1.233; M = 2.99, SD = 1.307).
Nurses confirmed their fears about patient confidentiality
as they rated the risk of storing confidential patient information
on PDAs as a moderate barrier (M = 3.03, SD = 1.276). Another moderate
barrier was that PDAs cost too much and are easy to lose or damage
(M=2.9, SD = 1.177). The next barrier, rated between modest and
moderate, was that there is there is not enough research on PDA
use in nursing (M = 2.61, SD, = 1.241). Nurses rated the barriers
that were related to technical issues and literacy as modest. Specifically,
PDAs are difficult to read and data entry is slow and PDAs are difficult
to understand (M = 2.47, SD = 2.47; M = 2.25, SD = 1.207). The barrier
that computer technology was not interesting was rated lowest (M
=1.85, SD = 0.981).
Strengths and Limitations
Survey. One of the strengths of this survey was that
the list of barriers and benefits was derived from current literature.
However, one of the problems with measuring anything related to
IT that it is changing rapidly. Therefore what is true today will
not necessary be true tomorrow. Concepts are often fluid or formative,
leading to decreased reliability and validity. In addition, by limiting
this survey to twelve specific items, the ability to measure unknown
phenomena was lost.
The survey is particularly valuable because it specifically
polled nurses. The age range distribution was relatively normal
and it included regular registered nurses, advanced practice nurses,
and administrative nurses. However, the online "snowball"
distribution method did not reach nurses who are extremely anxious
using IT and certainly did not reach many nurses who do not own
computers. Since it was a convenience sample, it did not include
people who were not interested in responding.
To uncover the biggest barriers, research should be
extended to nurse populations who do not own personal computers
or personal digital assistants. Open-ended questions will elicit
more substantive information on what is preventing this group from
adopting PDA technology. In addition, rather than assuming that
a certain PDA application will afford nurses a certain benefit,
its actual benefits should be measured and reported.
Healthcare organizations and nurses should first acquire
PDA drug databases since this was rated as the most significant
benefit. The next rated tier of PDA benefits requires organizational
planning for in order to set PDAs up within an organization to manage
patient and procedure information, enable bedside data entry, or
data collection for research and teaching. Graduate nursing informatics
specialists should guide organizations to these capabilities. And
since nurses were concerned about confidentiality with PDA patient
records, these concerns should be addressed as systems are developed
within organizations. Graduate nursing informatics specialists should
also lead the way in staff development training for PDAs.
Healthcare organizations have the responsibility to
provide the safest possible patient care and that includes the use
of the most current, most easily accessed information. To start,
healthcare organizations should provide nurses with basic PDAs and
basic drug databases along with PDA training and encouragement to
help nurses overcome technical barriers. Nurses should encourage
organizational commitment to PDA technology.
Breton, J. (2003). Move your brain to your hand with
a PDA [Electronic version]. Retrieved on August 10, 2003 from Advance
for Nurses Database at www.advanceweb.com
Dee, C. R., Teolis, M., & Todd, A. (n.d.). Multi-state study
of health professionals' use of the personal digital assistant (PDA)
[Electronic version, PowerPoint]. Retrieved on February 14, 2004
Fishcher, S., Stewart, T.E., Mehta, S., Wax, R., & Lapinsky,
S. E. (2003). Handheld computing in medicine [Electronic version].
Journal of the American Medical Informatics Association, 10 (2)
139. Retrieved February 14, 2004 from ProQuest database.
Grasso, M. A. (n.d.). Clinical applications of palmtop computing
[Electronic version, annotated bibliography]. Retrieved on February
19, 2004 from http://www.cs.umbc.edu/~mikeg/palm.html
Jao, C., Hier, D. B., & Su, J. (2003). Evalutating a digital
resident diagnosis log: reasons for limited acceptance of a PDA
solution [Electronic version, abstract]. Proceedings of American
Medical Informatics Associatgion 2003, 876.
Lu, Y. C., Lee, J. K., Xiano, Y., Sears, A., Jacko, J. A., &
Charters, K. (2003). Why don't physicians use their personal digital
assistants [Electronic version]. American Medical Informatics Association
2003 Symposium Proceedings, 405.
Lusky, K. (2000). Is a personal digital assistant in your future?
[Electronic version]. Retrieved on February 15, 2004 from Nurses.com
McLeod, T.G., Ebbert, J. O., & Lymp, J. F. (2003). Survey assessment
of personal digital assistant use among trainees and attending physicians
[Electronic version]. Journal of the American Medical Informatics
Association, 10 (6) 605. Retrieved February 14, 2004 from ProQuest
Miller, J. (2003). Doctors say PDAs improves [sic] medical care.
Retrieved on February 18, 2004 from Rim Road: News at http://www.rimroad.com
Pancoast, P. E., Patrick. T. B., & Mitchell, J. A. (2003). Physician
PDA use and the HIPAA privacy rule [Electronic version]. Journal
of the American Medical Informatics Association, 10 (6) 611. Retrieved
February 14, 2003 from the ProQuest database.
PDAcortex.com (2001.). Adopting mobile technology to enhance patient
care [Electronic version]. Retrieved on December 8, 2003 from http://www.pdacortex.com/issues_and_attitudes.htm
Rothschild, J. M., Lee, T. H., Bae, T., & Bates, D. W. (2002).
Clinician use of a palmtop drug reference guide [Electronic version].
Journal of the American Medical Informatics Association, 9, (3)
233. Retrieved on February 14, 2004 from the ProQuest database.
Rullo, D. (2000). Why work wireless? [Electronic version]. Retrieved
on February 15, 2003 from http://www.healthmgttech.com
Stolworthy, Y. (2003). RNs are mobilizing [Electronic version].
Retrieved on December 29, 2003 from http://www.pdacortex.com/RNs_are_Mobilizing.htm
Tschopp, M., & Geissbuhler, A. (2001). Use of handheld computers
as bedside information providers [Electronic version]. From V. Patel
et al. (Eds.) 2001. Medineo 2001. Amsterdam: IOS Press.
Colleen can be reached by email