Nurse involvement in health information technology design for digital nursing practice: a scoping review

There is growing demand for user involvement in health information technology (IT) design to ensure that emerging technologies meet the needs and expectations of end users. This scoping review explored the state of nurses involvement in health IT design, focusing on the: (1) methods, frequency, capacity, and levels of involvement in the design process; (2) types of health IT systems nurses are included in designing; and (3) outcomes of nurses inclusion in the design process. This review followed the Joanna Briggs Institute methodology for scoping reviews. A systematic search was conducted in seven databases: MEDLINE (Ovid), Cumulative Index to Nursing and Applied Health Literature (CINAHL) (EBCOhost), Embase (Ovid), Scopus, Web of Science, Compendex Engineering Village and Institute of Electrical and Electronics Engineers (IEEE) Xplore Digital Library database platforms. A total of 3,364 studies were screened at the title/abstract phase. After initial exclusions, 632 articles were screened for full texts, 495 were excluded, resulting in a final set of 137 eligible articles. Included studies most frequently involved nurses as users or testers of the technologies - usually at the end stages of the design process. Most studies interchangeably used the concepts of human-centred design and user-centred design to guide the design process. Interviews, surveys, observations and think-aloud techniques were the most frequently used design methods to elicit nurses perspectives about health IT systems. However, it was unclear which methods or approaches were most effective in engaging nurses in the design process. No standardized or validated nurse engagement frameworks were reported. These findings highlight the need to explore the nature of nurses involvement in design, their preferences in engagement and specific contributions and roles in order to develop an evidence-based approach to guide nurses participation in the design process. Author summaryNurses are rarely involved in health IT design, particularly in the early design stages. Failure to involve nurses in early stages can lead to IT systems lacking specific nursing contents, functionalities, and technical features, which may affect the use of the systems for nursing work. In this study, we found evidence of nurses being included at the end stages of the design process. Despite majority of the studies focusing on health IT design and development, nurses were mainly involved as users or testers of the technologies. In other words, nurses were mainly engaged in usability testing activities, which typically occur at the end of the design process rather than upstream design phases. We found that the concepts of human-centred design and user-centred design used interchangeably. At the end of the design processes, nurses perceived the IT systems as acceptable and usable, and either integrated or willing to integrate into clinical practice. Nurses perceived satisfaction with the design process resulting from effective technologies highlight the importance of engaging them in every stage of the design process. Our findings suggest that nurses have potential to leverage their clinical expertise and practical understanding of nursing workflows to guide health care technology design processes.