Literature Review: Digital Health Tech & Nursing Documentation Effects

This literature review investigates the effects of digital health technology and nursing documentation within perioperative or day surgery settings. It begins by formulating a searchable question and developing a search strategy, including key search terms, relevant databases like CINAHL, ScienceDirect, and PubMed, Boolean operators, and inclusion/exclusion criteria. The review then discusses the importance of levels of evidence and provides an overview of three articles, critically appraising them using the CASP tool. The first article examines the effectiveness of digital technologies in supporting nursing care, the second explores how digital mobile technology facilitates communication and streamlines patient care, and the third investigates the effects of intraoperative care documentation forms on error reporting. Finally, the review synthesizes the findings to answer the clinical question regarding the impact of digital health technology and nursing documentation on perioperative care, highlighting both the benefits and challenges of implementing these technologies in healthcare settings.

Literature review of affects of digital
health technology and nursing
documentation in perioperative or day
surgery setting

Table of Contents
1. DEVELOPING SEARCHABLE QUESTION............................................................................3
2. DEVELOPING SEARCH STRATEGY.....................................................................................3
Key Search Terms........................................................................................................................3
Databases.....................................................................................................................................4
Boolean Operators.......................................................................................................................5
Inclusion and Exclusion Criteria.................................................................................................5
3. LEVEL OF EVIDENCE..............................................................................................................5
Importance of Level of evidence.................................................................................................6
4. OVERVIEW OF ARTICLES......................................................................................................6
Article 1 - Effectiveness of Digital Technologies to Support Nursing Care: Results of a
Scoping Review...........................................................................................................................6
Article 2 - Digital mobile technology facilitates HIPAA-sensitive perioperative messaging,
improves physician-patient communication, and streamlines patient care.................................7
Article 3 - The effects of using intraoperative care documentation forms on the number of
reported errors..............................................................................................................................8
5. ANSWER TO CLINICAL QUESTION.....................................................................................9
REFERENCES................................................................................................................................1
Appendices......................................................................................................................................2

1. DEVELOPING SEARCHABLE QUESTION
Digital Health Technology refers to the application of organized skills and knowledge
which in the form of Devices, vaccines, etc. It also includes the developed system which help to
cure health problem (Sharma, and et.al., (2018)). Nursing documentation is defined as a record
related to nursing care which is delivered and planned to clients with the help of nurses who are
qualified (Tajabadi, and et.al., (2020)). This also includes information regarding the steps takes
under nursing process. Perioperative Patients defines to those patients who are currently under a
surgery. This period considers the time before the patients gets discharged from the hospital
(Desai, Schofield, & Richards, (2018)).
PICO is a process which is used as mnemonic in the evidence-based practice which helps
to frame and provide answer which is related to the question of clinical health or health care
(Krs, and et.al., (2020)). It is also beneficial while a person is developing strategies related to
literature search.
In this study PICO Framework includes:
P — Perioperative Patients
I — Digital Health Technology
C — Nursing Documentation
O — Nil
PICO Question — What are the effects of Digital Health Technology and nursing documentation
in perioperative or day care settings?
2. DEVELOPING SEARCH STRATEGY
Appropriate search strategy is identified for conducting this study. This includes various
aspects such as search terms, databases appropriate for searching articles, and various other
criteria that are discussed further.
Key Search Terms
Key search terms are the words which are used for searching the articles in the
databases (Goossen, and et.al., (2018)). Key terms used for this study are —
Terms Synonyms
Perioperative Postoperative

Digital Technology Computerized machinery, programmed technology
Health Well-being
Nursing Documentation Clinical Record, Healthcare Evidence
Effects Consequence, Outcome, Impact
Databases
Databases are collection which consists of structured information and stores the
data which is used in future and is accessible in electronic form. Database has been used in
the study to identify the needed information related to the effect of digital health
technology and nursing documentation in preoperative or day care settings (Sakai, (2021)).
These databases consist of various journal articles as well as other articles. Databases help
to save the time of researcher as they provide articles valid for the topic. The databases
which is used in the study are discussed below:
Databases Description
CINAHL CINAHL is known as Cumulative Index to Nursing And
Allied Health Literature. These databases help the researcher to
find the articles related to nursing journal. It also provides
various care sheets with evidence, trials related to clinic, and
various others (CINAHL Database. 2021).
Science Direct It is a website that gives access to huge database which are
bibliographic related to science and medical publication
(ScienceDirect. 2021).
PubMed It is a search engine which provide access to MEDLINE
database for references as well as abstracts related to life
sciences as well as biomedical topics (PubMed Overview.
2021).

Boolean Operators
Boolean operators are the words which are conjunctions whose work is to combine or
excludes the Keywords during the search process. It is useful in the research as they are focused
on the search & result are productive. The basic Boolean operators are AND, OR and NOT. In
this study AND and OR are used as boolean operators (Li, and et.al., (2019)). AND boolean
operator instructs the search engine to search and provide the information which includes all the
keywords. Such as, effect of digital health technology AND nursing documentation. This will
provide the result which contains the journal article with both the keywords. Whereas OR give
instruction to the search engine to search for those results which include one of the keywords
used in searching the journal articles. Such as, effect of digital health technology OR nursing
documentation. This will provide results which have one of these keywords.
Inclusion and Exclusion Criteria
Inclusion and Exclusion criteria are opposite to each other as inclusion criteria helps to
accept articles while exclusion criteria helps to reject the articles (Patino, & Ferreira, (2018)).
The below mentioned criteria are applied in the study.
Inclusion Criteria Exclusion Criteria
Articles published in English Language. Articles published in other than English
Language.
Articles published after 2012. Articles published before 2012.
Articles on Effect of Digital health technology
and nursing documentation in preoperative or
day care settings is considered.
Articles on Effect of Digital health technology
and nursing documentation on other factors are
not considered.
3. LEVEL OF EVIDENCE
The level of evidence chosen for this study is as discussed below:
Level of evidence Type of evidence
1B Individual RCT's which have narrow confidence interval

2B Individual Cohort studies which have low quality RCT's
4 Case series (Grades and Levels of Evidence., 2022)
Importance of Level of evidence
Level of evidence helps the researcher to target the search with the type of evidence
which s most likely to give a valid answer to the research question. It is designed to help the
researcher which is used as short-cut for those who are busy in their life to find the best evidence
for their research. This is important because it tells the validity of the research evidence. It helps
the researcher to know whether to use the source of information provided by the journal articles.
It ensures that every type of evidence mentioned in the article have some level of evidence which
will helps the company to identify whether the evidence is to be considered or not. It is important
because it sets the hierarchy for the research design which the project will be based on which
shows the validity of the project. It is important to analyse the level of evidence to ensure that the
confidence can be given to the certain report. Also, it shows that the researcher can provide valid
recommendation to its reader or target market. It is important because every levels included in
evidence have different purpose as well as research design. This will help to find out the
differences in the work of various researchers. This will help the researcher to analyse the
validity of its own study as he is taking those papers as a support system to help make the
research valid (Greaves, and et.al., (2018)).
4. OVERVIEW OF ARTICLES
For critically appraising the articles CASP tool has been applied. CASP tool is refereed to
as most used tool for appraising qualitative evidence related to health. CASP tool is known as
Critical Appraisal Skills Programme.
Article 1 - Effectiveness of Digital Technologies to Support Nursing Care: Results of a Scoping
Review
The review addressed a clearly focused question of effectiveness of digital technologies.
They screened 19,510 publication from various databases. The authors were considering the
outcomes of effects of the digital technologies in nursing care. Some research paper were not
related to question of the review. While some paper were related to the Key terms which can be

used in the review. The authors have considered scoping review design to analyse results related
to the question. Studies included in the review are of English language which makes the study
relevant for the researchers.
The quality of research is very much important during the research which the author
considered. As they have taken wide range of interventions of digital technology in the field of
nursing care. The researcher have not combined results with their own study. It was reasonable
to do so because they concluded the research on their own study of various papers. Also, there
were not proper evidence regarding the effectiveness of the technologies which differs the
conclusion of the study. The result of the research was that the hospitals were hesitant to
introduce the innovative technologies as there are various negative and positive impact of these
technologies. Also, there are lesser number of evidence for various technologies. There are
various studies which are aiming towards improving the quality care of the hospitals. The results
were also showing that the studies should improve their qualities in providing evidence regarding
the effectiveness of digital technologies.
This result can be applied to the local population as the studies conducted are related to
technologies which is used in various hospitals. The local setting of UK is not very much
different from the studies conducted in the research. This research considered all the outcomes of
the digital technology positive as well as negative. There were no other information which was to
be seen in the research as they addressed various effects of the digital technology on the care of
the patients. It cannot be said that the benefits are worth the harm and costs. It is because if some
negative effect is projected on the customers then the hospital will be held responsible for the
harm. This is not good for the image of the hospitals. It will positively impact the hospital only
when the technology use is successful and benefit the customer in the recovery (Huter. K. and
et.al., (2020)).
Article 2 - Digital mobile technology facilitates HIPAA-sensitive perioperative messaging,
improves physician-patient communication, and streamlines patient care
The issue focused by the study is clear as they want to focus on the communication with
digital technology to improve perioperative care. They took survey of around 423 patients who
were to undergo surgery procedures.The Cohurt was recruited in proper manner as the
population which have to included was included in the survey. The special aspect was that they

took patients who were supposed to undergo surgeries of their choice. The exposure was
accurately measured as they took the exposure of providing a method of communication between
the doctors and patients. They took objective measurements as they took survey of the patients.
The outcome was accurately measured as they got around 1195 communication messages
between the patients and doctors. For this they were able to successfully implement their plan.
The authors have taken all the necessary factors such as patient enrolment and electronic
communication. For which they took the survey with the patients. The restriction can be that they
were not in direct contact with the patients as they were taking survey based on minimum
question. Follow up was complete as it resulted into the positive response from the survey. They
were able to establish a communication method among them. It was not long for the patients as
they were able to successfully respond to the researcher. The result of the study was that the
communication technology implemented among the patients and doctors was deemed to be
successful. It is because the patients were satisfied with the services which was provided to them.
The patients' family member were also satisfied with the outcome of the technology. There is no
confidence intervals were provided by the authors. The result is believable as the doctors are able
to provide high quality services to the patients with the help of technology. The technology is
designed such that the patient and their family member were able to use it easily.
The result can be applied to the population as the method used was online survey with
valid questions. Population of study is not too different from the local population. Results fit
with the other evidence available as technology have various positive and negative effect and this
research outcome was positive. The study can be put into practice as the quality of perioperative
care will increase for the consumer (Gordon, C. R. and et.al., (2015)).
Article 3 - The effects of using intraoperative care documentation forms on the number of
reported errors
The study has chosen to population of all operating room technicians as well as nurses.
Intervention was considered in the study as the authors visited the patients in the hospital. The
Comparison was done of pretest and post-test number of reported. The current study didn't take
any randomized interventions of the participants. As the randomization was not done so the
follow-up and exclusions of randomized population was not accounted.

The participants were not blinded during the intervention they were provided. Also, the
investigators were also not blind during the taking of interventions. People were assessing the
outcomes presently as they were asked to fill the form during the sessions. There were no
differences among the groups which the study undertook. As they were the patients of the same
hospital. All the patients were receiving same care for their problems. It was asked during the
session which was conducted to communicate with the patients.
The outcomes of the intervention was reported comprehensively as the calculation was
undertaken. The outcomes were measured in the form of test which is included in the report in
form of a picture. There was no incomplete data in the study. The study chosen mean as well as
Wilcoxon test for analysing the data. The data test was separated properly according to the
subject data. There was no confidence interval considered in the study. Intervention was taken of
65 operating rooms which shows the review of the customers. There were no harm was
mentioned in the study analysis which shows the effectiveness of the doctors. With the help of
which it can be said that the intervention does not outweigh the harms.
The result can be applied in the local population of the country as the hospital system is
same of the population. If the population will differ the outcome will be same as it was to
analyse the effectiveness of the documents in care of the patients. The main limitation of the
study was the intervention course was short and can have biasses among the participants of the
study. Also, the control of group was lacking in the study. The skills for developing this
intervention is communication as the participants should understand and be able to communicate
with the researcher. The researcher took the help of social media to stay connected (Maraki. F.
and et.al., (2019)).
5. ANSWER TO CLINICAL QUESTION
Digital health technology and nursing documentation have various effects on
perioperative or day care settings whether positive or negative. The digital health technology
includes various treatments for the patients. But the technology can give negative effect on the
health of the employees as well as positive impact on the patients. The negative effect will
happen when the staff of hospital is not able to familiarize themselves with the technology which
will impact on the recovery of the patients. The positive impact of technology is that the patients
can stay in touch with the doctor which ensures that the customers are able to recover in proper

manner. It is because they can always ask for suggestion from the doctor whenever they need the
assistance with their health. Health technology improves the efficiency of the doctors in
analysing the disease of a particular patient. This ensures that the disease is identified at the
initial stage which will ensure that the risk on lives of patients can be minimized. It will harm the
patients when the technology has some sort of defect which have to detected to ensure the health
of the patient's. The documentation ensures that the doctors and nurses have knowledge of every
patient and can treat them in better manner. Nursing document is beneficial for the hospitals as
they can monitor the growth of the patients and ensure that the patients receive appropriate
treatment for their disease. The documents help the hospital to reach to the patients to know
about the recovery process.

REFERENCES
Books and journals
Krs, V. and et.al., (2020). PICO: procedural iterative constrained optimizer for geometric
modeling. IEEE Transactions on Visualization and Computer Graphics. 27(10). 3968-
3981.
Sharma, A. and et.al., (2018). Using digital health technology to better generate evidence and
deliver evidence-based care. Journal of the American College of Cardiology. 71(23).
2680-2690.
Tajabadi, A. and et.al., (2020). Unsafe nursing documentation: A qualitative content analysis.
Nursing ethics. 27(5). 1213-1224.
Desai, N., Schofield, N., & Richards, T. (2018). Perioperative patient blood management to
improve outcomes. Anesthesia & Analgesia. 127(5). 1211-1220.
Goossen, K. and et.al., (2018). Optimal literature search for systematic reviews in surgery.
Langenbeck's archives of surgery. 403(1). 119-129.
Sakai, T. (2021). Role and applicability of spontaneous reporting databases in medical big data.
Yakugaku Zasshi: Journal of the Pharmaceutical Society of Japan. 141(2). 165-168.
Li, L. and et.al., (2019). Search strategies to identify observational studies in MEDLINE and
Embase. Cochrane Database of Systematic Reviews, (3).
Patino, C. M., & Ferreira, J. C. (2018). Inclusion and exclusion criteria in research studies:
definitions and why they matter. Jornal Brasileiro de Pneumologia, 44, 84-84.
Greaves, F. and et.al., (2018). What is an appropriate level of evidence for a digital health
intervention?. The Lancet, 392(10165), 2665-2667.
Gordon, C. R. and et.al., (2015). Digital mobile technology facilitates HIPAA-sensitive
perioperative messaging, improves physician-patient communication, and streamlines
patient care. Patient Safety in Surgery. 9(21).
Huter. K. and et.al., (2020). Effectiveness of Digital Technologies to Support Nursing Care:
Results of a Scoping Review. J Multidiscip Healthc. 13.
Maraki. F. and et.al., (2019). The effects of using intraoperative care documentation forms on the
number of reported error. Nursing and midwifery studies. 8(3). pp. 137-142.
Online References
CINAHL Database. 2021. [Online]. Available Through:
<https://www.ebsco.com/products/research-databases/cinahl-database>.
PubMed Overview. 2021. [Online]. Available Through:
<https://pubmed.ncbi.nlm.nih.gov/about/>.
ScienceDirect. 2021. [Online]. Available Through:
<https://www.elsevier.com/solutions/sciencedirect>.
Grades and Levels of Evidence., 2022. [Online]. Available Through: <https://www.physio-
pedia.com/Grades_and_Levels_of_Evidence>.
1

Appendices
Evidence 1: Cohurt
Gordon, C. R. and et.al., (2015). Digital mobile technology facilitates HIPAA-sensitive
perioperative messaging, improves physician-patient communication, and streamlines patient
care. Patient Safety in Surgery. 9(21).
2