Analysis 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.

Literature Review

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.

Qualitative Research

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


Survey Design

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 barrier.


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.

Further Research.

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.


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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 from

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.

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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


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