Hello everyone. I'm Ankit Shrestha, a PhD student at
Utah State University. Here is a quick glimpse of the beautiful USU
campus situated in Logan. Moving forward today, I will be
presenting our research on understanding the behavior,
challenges, and privacy risks in digital technology use by
nursing professionals. This is going to be the overall flow of
the presentation today. We will start with motivations and prior
literature. One of our motivation was the increasing
digitization and electronic storage of patients healthcare
data in the recent years. But we may wonder why nurses? Nurses
are the primary medical staff who are responsible for charting
patient information and recording patient's health
condition. They are the ones who deal with the sensitive data of the
patients. On this note, there have been multiple works, which
have shown that information technology has helped the
medical staffs provide faster services in health care
institutions. However, such works have also shown that the
digitization has impacted the collaboration between the
different medical staffs. To resolve such issues, Zhou et al. have
suggested to reach agreement on data collection and sharing in
digital platforms by in-person collaboration among medical
staffs before each of their shifts. However, very few prior
works have focused on understanding the issues that
nursing professionals face with using digital systems at their
workplace. We address this gap in our first research question.
What challenges do nurses encounter in using digital
systems at workplace and how to that affect their professional
duties? Next motivation for us to do this study was the privacy
in healthcare. Data breach can result in mental anguish,
economic threats and social stigma for the patients, whereas
the medical organizations can face lawsuits and financial
losses. In this context, prior work has shown that HIPAA
regulations which provide standards for handling patient
data are not clearly understood by many healthcare
practitioners. Similarly, Aylott et al. pointed out the
risk of leaking a person's identity when the medical staff
are not mindful in using online social media and mobile devices
in their workplace. However, there is still a gap from prior
literature in understanding the privacy risks arising from the
practices and behavior of nurses when interacting with digital
systems. This motivates our second research question: How
could nursing professionals practices and behavior in using
digital systems lead to the risk of privacy leakage in a healthcare
organization? Moving on to our methodology, we recruited 16
participants via email online social media and snowball
sampling. 13 of our participants were female, two
were male, and one did not prefer to reveal their gender.
Participants had to be at least 18 years old and working as a
full time professional nurse to take part in our study. We
conducted a semi-structured interview with our participants
over Zoom that lasted between 30 to 60 minutes. The participants
were compensated with a $25 Amazon gift card. We conducted
inductive thematic analysis in the collected data. So what are
the limitations of our methodology? Our findings should
not be generalize to all the nursing professionals in the
USA. To do that, we need to do a large scale quantitative study.
We had non uniform distribution in terms of the participant's gender.
However, US Census Bureau reports 91% of the nurses are
female. Our distribution is not uniform, but it's reasonable.
And finally, our study is limited to the US participants
only. Moving on to the results section, we'll be using some
keywords as shown here to refer to the corresponding participant
range. Our first theme is digital systems in nursing.
Almost all of our participants mentioned about the help
received from digital technologies broadly in three
areas: easier and structured charting, faster and remote
communications, and integrated services of medicine. Some of
the participants talked about how the abundance of features in
medical charting with little or no direct connection to nurses
needs can lead to confusion and user errors. In this quote,
participant PN14 talks about how they had to put three nurses
in a single room- one for taking care of the patient, and
two for charting because of how overwhelming the charting
software was. Many nurses talked about the lack of functionality
in the current system. In this quote, the participant talks
about facing difficulties getting medicine for emergency
patients, because the system only allows medicine to be
ordered using the patient band, which was not always assigned
due to the urgency of the treatment.
Let's move on to the second theme, which is infrastructure
and technological barriers. Participants reported that the
IT support in the organization were insufficient due to the
lack of manpower and inability of support and the inconsistency
and slowness in their response. In the quote, the participant
complains about the slow IT support and how it caused
delays in their work. Some participants mentioned that they
keep the nursing stations and their rooms open so that the
patients could easily get access to them. However, there were
cases where the patient's entered the room without
knocking or prior notice. In such situations, patients might
get access to sensitive health information, as there may be
some paper with important information lying around or the
screen of the nurses may be active. Some nurses also allow
patients to access internet from their workstation as a courtesy
service in good faith, where they reported concern that
allowing such access as inherent privacy risks due to the
sensitive healthcare data accessible through their computer. A
few of our participants mentioned the open space
architecture of the workplace where the risk of HIPAA
violation is high, because the patients being attended at one
workstation can hear the communication of nurses at nearby
stations. There were other concerning privacy risks
reported by our participants, we encourage you to read the paper
for details. Many nurses mentioned about inadequate
training, which was generic and non interactive. Here,
participant PN5 talks about having only a single day
of training, which was generic and didn't help much because
each unit uses different features and technologies. This
inadequacy in training could be attributed to the gap between
the academic preparation and professional practice, which was
mentioned by majority of the participants. To understand this
gap in detail, we did a follow up study with nursing faculties.
In this study, we recruited five participants four female and one
male via email invitation to nursing department of several
universities. Participant had to be faculty members in nursing
department who taught courses on digital systems. The interview
and analysis were done using the similar techniques as the study
with the nursing professionals. From this follow up study, were
able to identify two major contributors. The first one is
the lack of collaboration between the nursing schools and
the medical organizations. Here we can see one of the nursing
faculty reporting how the hospitals are becoming
increasingly hesitant to allow nursing students to perform in
the clinical context due to liability concerns. The other
cause is the lack of hands on experiences. In the quote, we can
see one of the nursing faculty talking about the realism
component and how their students that have graduated have wished
to be better in using electronic health record that the prototype
in the nursing schools just can't keep up with. As we
reported our findings, let's talk about some of these
implications. In this section, we have used three colors in our
figures to separate the findings from the nursing professional
study., findings from the nursing faculty study, and their
implications. Our first implication is the recalibration
of technology and procedure. Our findings talk about the
insufficient IT support, which needs to be improved by
installing feedback mechanisms to gather suggestions and needs of
the medical staff. We also reported on the privacy risks
due to patient walk-ins and overhearing of nurses
communication by patients. To address this, nursing stations
need to be rearranged to minimize the privacy risks.
Further, our findings showed the complexity introduced in getting
medicine for emergency patients, which can be simplified by
adding override features for nursing heads in case of
emergency. Finally, to address the lack of training reported by
our participants, the medical organizations can focus on
creating contextualized hands on training that is focused on
specific needs of the nursing units, which can also be stored
in an online repository for future reference. Our findings
lead to several other interesting recommendations. You
will find the details in the paper.
Thank you