Newly Qualified Canadian Nurses' Experiences With Digital Health in the Workplace: Comparative Qualitative Analysis.

BACKGROUND: Clinical practice settings have increasingly become dependent on the use of digital or eHealth technologies such as electronic health records. It is vitally important to support nurses in adapting to digitalized health care systems; however, little is known about nursing graduates' experiences as they transition to the workplace. OBJECTIVE: This study aims to (1) describe newly qualified nurses' experiences with digital health in the workplace, and (2) identify strategies that could help support new graduates' transition and practice with digital health. METHODS: An exploratory descriptive qualitative design was used. A total of 14 nurses from Eastern and Western Canada participated in semistructured interviews and data were analyzed using inductive content analysis. RESULTS: Three themes were identified: (1) experiences before becoming a registered nurse, (2) experiences upon joining the workplace, and (3) suggestions for bridging the gap in transition to digital health practice. Findings revealed more similarities than differences between participants with respect to gaps in digital health education, technology-related challenges, and their influence on nursing practice. CONCLUSIONS: Digital health is the foundation of contemporary health care; therefore, comprehensive education during nursing school and throughout professional nursing practice, as well as organizational support and policy, are critical pillars. Health systems investing in digital health technologies must create supportive work environments for nurses to thrive in technologically rich environments and increase their capacity to deliver the digital health future.

Resources to Support Canadian Nurses to Deliver Virtual Care: Environmental Scan.

BACKGROUND: Regulatory and professional nursing associations have an important role in ensuring that nurses provide safe, competent, and ethical care and are capable of adapting to emerging phenomena that influence society and population health needs. Telehealth and more recently virtual care are 2 digital health modalities that have gained momentum during the COVID-19 pandemic. Telehealth refers to telecommunications and digital communication technologies used to deliver health care, support health care provider and patient education, and facilitate self-care. Virtual care facilitates the delivery of health care services via any remote communication between patients and health care providers and among health care providers, either synchronously or asynchronously, through information and communication technologies. Despite nurses' adaptability to delivering virtual care, many have also reported challenges. OBJECTIVE: This study aims to describe resources about virtual care, digital health, and nursing informatics (ie, practice guidelines and fact sheets) available to Canadian nurses through their regulatory and professional associations. METHODS: An environmental scan was conducted between March and July 2023. The websites of nursing regulatory bodies across 13 Canadian provinces and territories and relevant nursing and a few nonnursing professional associations were searched. Data were extracted from the websites of these organizations to map out educational materials, training opportunities, and guidelines made available for nurses to learn and adapt to the ongoing digitalization of the health care system. Information from each source was summarized and analyzed using an inductive content analysis approach to identify categories and themes. The Virtual Health Competency Framework was applied to support the analysis process. RESULTS: Seven themes were identified: (1) types of resources available about virtual care, (2) terminologies used in virtual care resources, (3) currency of virtual care resources identified, (4) requirements for providing virtual care between provinces, (5) resources through professional nursing associations and other relevant organizations, (6) regulatory guidance versus competency in virtual care, and (7) resources about digital health and nursing informatics. Results also revealed that practice guidance for delivering telehealth existed before the COVID-19 pandemic, but it was further expanded during the pandemic. Differences were noted across available resources with respect to terms used (eg, telenursing, telehealth, or virtual care), types of documents (eg, guideline vs fact sheet), and the depth of information shared. Only 2 associations provided comprehensive telenursing practice guidelines. Resources relative to digital health and nursing informatics exist, but variations between provinces were also noted. CONCLUSIONS: The use of telehealth and virtual care services is becoming mainstream in Canadian health care. Despite variations across jurisdictions, the existing nursing practice guidance resources for delivering telehealth and virtual care are substantial and can serve as a beginning step for developing a standardized set of practice requirements or competencies to inform nursing practice and the education of future nurses.

Digital Health Education and Training for Undergraduate and Graduate Nursing Students: Scoping Review.

BACKGROUND: As technology will continue to play a pivotal role in modern-day health care and given the potential impact on the nursing profession, it is vitally important to examine the types and features of digital health education in nursing so that graduates are better equipped with the necessary knowledge and skills needed to provide safe and quality nursing care and to keep abreast of the rapidly evolving technological revolution. OBJECTIVE: In this scoping review, we aimed to examine and report on available evidence about digital health education and training interventions for nursing students at the undergraduate and graduate levels. METHODS: This scoping review was conducted using the Joanna Briggs Institute methodological framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A comprehensive search strategy was developed and applied to identified bibliographic databases including MEDLINE (Ovid; 1946 to present), Embase (Ovid; 1974 to present), CINAHL (EBSCOhost; 1936 to present), ERIC (EBSCOhost; 1966 to present), Education Research Complete (EBSCOhost; inception to present), and Scopus (1976 to present). The initial search was conducted on March 3, 2022, and updated searches were completed on January 11, 2023, and October 31, 2023. For gray literature sources, the websites of select professional organizations were searched to identify relevant digital health educational programs or courses available to support the health workforce development. Two reviewers screened and undertook the data extraction process. The review included studies focused on the digital health education of students at the undergraduate or graduate levels or both in a nursing program. Studies that discussed instructional strategies, delivery processes, pedagogical theory and frameworks, and evaluation strategies for digital health education; applied quantitative, qualitative, and mixed methods; and were descriptive or discussion papers, with the exception of review studies, were included. Opinion pieces, editorials, and conference proceedings were excluded. RESULTS: A total of 100 records were included in this review. Of these, 94 records were identified from database searches, and 6 sources were identified from the gray literature. Despite improvements, there are significant gaps and limitations in the scope of digital health education at the undergraduate and graduate levels, consequently posing challenges for nursing students to develop competencies needed in modern-day nursing practice. CONCLUSIONS: There is an urgent need to expand the understanding of digital health in the context of nursing education and practice and to better articulate its scope in nursing curricula and enforce its application across professional nursing practice roles at all levels and career trajectories. Further research is also needed to examine the impact of digital health education on improving patient outcomes, the quality of nursing care, and professional nursing role advancement. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.11124/JBIES-22-00266.

Digital health education and training for undergraduate and graduate nursing students: a scoping review protocol.

OBJECTIVE: The objective of this review is to collate and analyze literature reporting on digital health education and training courses, or other pedagogical interventions, for nursing students at the undergraduate and graduate level to identify gaps and inform the development of future educational interventions. INTRODUCTION: In this era of technology-driven health care, upskilling and/or reskilling the nursing workforce is urgently needed for nurses to lead the digital health future and improve patient care. While informatics competency frameworks serve to inform nursing education and practice, they do not address the entire digital health spectrum. INCLUSION CRITERIA: This review will include research studies, theoretical/discussion papers, and reports, as well as gray literature from relevant sources published in the last 10 years. Opinion pieces, editorials, conference proceedings, and papers published in languages other than English will be excluded. METHODS: The JBI methodology for scoping reviews will be followed. Searches will be conducted in Embase, CINAHL, ERIC, MEDLINE, Scopus, and Education Research Complete to retrieve potentially relevant studies. Hand searches of reference lists of included studies will be conducted. Two reviewers will independently screen records against predefined eligibility criteria and consult a third reviewer if conflicts arise. Decisions will be documented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Quantitative data will be analyzed using descriptive statistics. Content analysis will be applied to qualitative data to identify categories and themes. Findings will be synthesized and reported in tables and narrative format. REVIEW REGISTRATION NUMBER: Open Science Framework osf.io/42eug.

Validation and prioritisation of health informatics competencies for Australian nursing and midwifery leaders: A modified Delphi study.

BACKGROUND: Health informatics competency standards for nurses are required to ensure the use and management of health information technologies contributes to the delivery and management of safe, quality care delivery. Historically, these competencies have been identified for nurses as a general group and specifically for undergraduate nursing students but not to the same extent for nurse leaders. AIM: The aim of this study was to validate and prioritise health informatics competencies for Australian nurse leaders. METHOD: This study utilised a modified Delphi technique to validate and prioritise 26 health informatics competencies for the Australian setting. The competencies were previously developed for Canadian nurses through literature review and consulation with experts. This modified Delphi study included invitations to 20 Australian Chief Nursing Information Officers who were then asked to extend the invitation to nurse leaders in their corresponding organisations. RESULTS: Eleven Chief Nursing Information Officers and seven Nurse Leaders completed the study including 3 rounds of informatics competencies consensus surveys. As a result, 22 revised competency statements were agreed to by the study participants. The top priority competency (Nursing and Midwifery leaders support clinicians to adopt and use information and communication technologies that support safe, quality care delivery) was also the highest ranked in the Canadian team's initial work. This reflects a common objective of nurses' need to ensure technology is fit for purpose, not only for nurses and midwives, but for patient safety and quality of care. CONCLUSION: Knowledge is required in the digital health landscape in order for nursing leaders to increase their capability in decision-making in the current and future digital healthcare environments. Differences in the competencies validated and prioritised by Australian nurse leaders and previous work by Canadian nurse leaders support the need to examine context-specific factors for nurse leaders to utilise these competencies.

The Psychometric Properties of Version 2 of the Canadian Nurse Informatics Competency Assessment Scale.

In 2020, we conducted a mixed methods study comprised of a cross-sectional survey in which we applied a modified version of the 21-item Canadian Nurse Informatics Competency Assessment Scale and one-on-one interviews to explore self-perceived nursing informatics competency and readiness for future digital health practice. A total of 221 senior-level students in BScN programs in western Canada participated. This article reports on results related to the factor structure and internal consistency reliability of the 26-item (version 2) of the Canadian Nurse Informatics Competency Assessment Scale. Exploratory principal component analysis with the varimax rotation revealed a four-component structure, explaining 55.10% of the variance. All items on the Canadian Nurse Informatics Competency Assessment Scale 2 had good loadings, except item 7, which did not load to any domain but was retained based on an evaluation of the α value and item relevance to nursing practice. A few items shifted to different domains. The overall reliability of the Canadian Nurse Informatics Competency Assessment Scale 2 was ( α = .916) and its subscales: information and knowledge management ( α = .814), professional and regulatory accountability ( α = .741), and use of information and communication technology ( α = .895). This study provided preliminary evidence for the factor structure and reliability of the Canadian Nurse Informatics Competency Assessment Scale 2 among nursing students. Further testing is recommended.

Are Future Nurses Ready for Digital Health?: Informatics Competency Baseline Assessment.

BACKGROUND: Research continues to show significant gaps in nursing graduates' preparedness in digital health. PURPOSE: The aim of this study was to explore nursing students' self-perceived nursing informatics competency and preparedness in digital health, describe learning opportunities available, and identify perceived learning barriers and facilitators to developing informatics competency. METHODS: A sequential mixed-methods design, using a cross-sectional survey and interviews, was used. Senior undergraduate students (n = 221) in BScN programs in a Western Canadian Province participated. RESULTS: Participants self-reported being somewhat competent in nursing informatics. Three themes were identified: struggling to make sense of informatics nursing practice; learning experiences; and preparedness for future practice. CONCLUSION: Addressing inconsistencies in informatics education is an urgent priority so that nursing graduates are competent upon joining the workforce. Implications for nursing education, practice, and policy are discussed.

Opportunities and challenges to enhance the value and uptake of Chief Nursing Informatics Officer (CNIO) Roles in Canada: A Qualitative Study.

Clinician informatics leadership has been identified as an essential component of addressing the 'implementation to benefits realization gap' that exists for many digital health technologies. Chief Medical Informatics Officers (CMIOs), and Chief Nursing Informatics Officers (CNIOs) are well-positioned to ensure the success of these initiatives. However, while the CMIO role is fairly well-established in Canada, there is limited uptake of CNIO roles in the country. The main objective of this work is to build on the current progress of the CMIO role and explore how the CNIO role can be best positioned for uptake and value across healthcare organizations in Canada. A qualitative study was conducted. Ten clinician leaders in CMIO, CNIO, and related roles in Canada were interviewed about the value of these roles and strategies for supporting the uptake of the role. This study provides the foundation for future initiatives for supporting and showcasing the value of the CNIO in a digitally enabled healthcare organization.

Supporting the Development of Informatics Competencies Among Senior Nurse Leaders in Canada.

This poster will provide an overview of the various initiatives completed to support the development of informatics competencies among senior nurse leaders in Canada. These initiatives have included a literature review to uncover competencies of relevance to the Canadian context, and a Delphi study to achieve consensus on the competencies for Canada. Current and future plans will be discussed to translate these competencies into practice among senior nurse leaders.

We Need Not Wait to See What Others Do.

In the last issue of the Canadian Journal of Nursing Leadership, authors provided numerous examples of nurse leaders making efforts to address the mental health of nurses in the midst of the pandemic. I personally thank guest editor Joan Almost for leading the collation of the issue and the authors who took the time to share their strategies and learnings. Unfortunately, we are not out of the woods yet, and I hope this collection of papers will continue to provide guidance to our readers for many months to come.

Digital and informatics competencies: Requirements for nursing leaders in Canada.

The use of health information technologies continues to grow, especially with the increase in virtual care in response to COVID-19. As the largest health professional group in Canada, nurses are key stakeholders and their active engagement is essential for the meaningful adoption and use of digital health technologies to support patient care. Nurse leaders in particular are uniquely positioned to inform key technology decisions; therefore, enhancing their informatics capacity is paramount to the success of digital health initiatives and investments. The purpose of this commentary is to reflect on current projects relevant to the development of informatics competencies for nurse leaders in the Canadian context and offer our perspectives on ways to enhance current and future nurse leaders' readiness for participation in digital health initiatives. Addressing the digital health knowledge and abilities of nurse leaders will improve their capacity to champion and lead transformative health system changes through digital innovation.

Time to Adjust the Sails.

After a year of living a masked, isolated, virtual existence, there is much reflection among healthcare decision makers and providers around the world. What have we done well? What could we have done better? And more importantly, how will we ensure that our learnings inform decisions and actions the next time? In this latest installment of crisis leadership papers, authors address the toll exacted upon our profession thus far. Although profound, the psychological sequelae of the COVID-19 pandemic are directly related to a number of pre-existing conditions that have been festering below the surface for several years. In particular, blame for the state of health inequities, ageism, staff shortages and workplace violence cannot be ascribed to the pandemic. Rather, each has been exacerbated because of it.

Approaches for defining and assessing nursing informatics competencies: a scoping review.

OBJECTIVE: The objective of this scoping review was to examine and map the literature on defining and assessing nursing informatics competencies for nurses and nursing students. INTRODUCTION: Over the past three decades, nursing informatics competency research has evolved markedly within countries and nursing roles. It is important to examine the available literature on defining and assessing nursing informatics competencies to inform education, clinical practice, policy, and future research. INCLUSION CRITERIA: We considered literature that defined or assessed the concept of nursing informatics competency as a combination of knowledge, skills, and attitudes. This included nursing informatics competencies of nurses and nursing students in a variety of health care or academic settings. METHODS: An extensive search was conducted in Ovid MEDLINE, CINAHL Plus with Full Text via EBSCO, Ovid Embase, Ovid PsycINFO, ProQuest ERIC, Health and Psychosocial Instruments, ProQuest Australian Education Index, ProQuest Education Databases, ProQuest Dissertations and Theses Global, OCLC PapersFirst, Scopus, Web of Science Core Collection, Wiley Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and the JBI Database of Systematic Reviews and Implementation Reports. The initial search was conducted in May 2017 and updated several times. Nursing informatics websites were searched for gray literature, including unpublished research and organizational documents. Additional papers were identified based on a search of reference lists of all the included papers. Neither language nor date restrictions were applied. Two reviewers assessed each of the included papers independently. Data extraction was undertaken using an extraction tool developed specifically for the scoping review objectives. RESULTS: Fifty-two papers were included. Thirty-four papers identified nursing informatics competencies, grouped into four categories: i) nursing informatics competencies for students, entry-level nurses, or generalist nurses; ii) nursing informatics competencies for a specific nursing role; iii) recommendations for consensus on defining core nursing informatics competencies at the international level; and iv) forecasting future nursing informatics competencies as per evolving nursing roles. Eighteen papers reported on nursing informatics competency assessment tools. Results were discussed in a narrative format supported by tables. CONCLUSIONS: This review provided insights to the state of the science on defining and assessing nursing informatics competencies for nurses and nursing students. Several nursing informatics competency lists are available, and despite some variations in domains of nursing informatics competency and indicator statements, they mostly share common themes. This literature demonstrates a heightened awareness of the importance of nursing informatics competency; however, the availability of many lists may be challenging for frontline nursing staff, nursing educators, administrators, researchers, and students to assimilate. Further research is needed to reach a consensus on core domains of nursing informatics competency and associated indicators, preferably per nursing roles, with international involvement and consensus. Additionally, while many nursing informatics competency assessment tools exist, further research is needed to examine psychometric properties of some of these tools.

The Dawning of a New Era of Leadership.

This is the final issue of the Canadian Journal of Nursing Leadership (CJNL) for 2021, and the final issue for this editor-in-chief. It is with some reluctance that I step away from this role, but I am a firm believer in knowing when your expiry date is pending. When I took over CJNL from Dorothy Pringle in 2010, the task seemed daunting - what big shoes I had to fill - and almost immediately, imposter syndrome took hold of my psyche. But clearly, I forged ahead, and more than 10 years later, I have reflected on my editorial tenure, but more about that later.

A Cockeyed Optimist.

In the 1958 musical South Pacific, the character Nelly Forbush trills a song of optimism and hope amid the darkness of World War II (South Pacific Enterprises and Logan 1958). The chipper message of this fictional navy nurse might well be welcome amid the negative timbre of the pervasive political, cultural and societal upheaval that we are experiencing today - not to mention the burden of a global pandemic. The tune delivers the message of a so-called "cockeyed optimist," staying positive while many are not and being buoyed by the anticipation of brighter, sunny days ahead (South Pacific Enterprises and Logan 1958). COVID-19 has unloaded countless blows to virtually every aspect of the life we once knew; surely, this is enough to leave any cockeyed optimist reeling. Where do we find the strength of character to prevail during times like this? Somehow, good leaders do; finding creativity, courage and conviction to make the most of a bad situation, they rise above it. They show optimism in the face of fear, the unknown and circumstances beyond their control. Instilling abiding trust in their followers, they lead out of the abyss, shining light on new possibilities and opportunities.

What Do We Need to Do Now?

Over the past few months, in a world closed to face-to-face service delivery and social interaction, we have adapted and, for the most part, realized the importance of being apart to keep us all safe. In the face of the pandemic, we saw emergency department (ED) visits and hospitalizations for all but the most urgent injuries and illnesses drop dramatically. The number of people who failed to seek timely treatment because of fear of exposure to the contagion will never be known. But this also raises the question of how the thousands of non-emergent cases seeking care in Canada's EDs in pre-pandemic times have managed over these past months. Has anyone realized that once and for all, policy needs to mandate changes to ensure appropriate ED utilization?

Creating a Silver Linings Playbook.

The intensity of the COVID-19 pandemic has tested the mettle of political, healthcare and public health leaders over the past year. Amid the unfolding events, healthcare leaders, including many nurses, have been pivoting, innovating, collaborating, safeguarding, inspiring and navigating - all the while informing the creation of an effective playbook to wage a counterassault for all of us. Despite all efforts, this previously unseen opponent has been unrelenting. Having been in the eye of the storm during the severe acute respiratory syndrome (SARS) outbreak, my memories of the events remain vivid. It was a time rife with uncertainty and fear, forcing the creation of a playbook on the basis of the best evidence and common sense but without the benefit of a precedent. Over the course of several months, our leadership was challenged by efforts to contain the virus and mitigate the very real possibility of a globally emerging pandemic. However, SARS was but a microcosm of the present situation. The COVID-19 pandemic is not like any other crisis we have experienced in our collective lifetime. We can only imagine the toll of this pandemic when it is finally over. It will be measured in terms of post-pandemic posttraumatic stress disorder, deaths from COVID-19 and delayed care, and deaths by suicide among healthcare workers and citizens; in the end, it will not be trivial. Those contributing to the COVID-19 playbook have given their all, and we should be eternally grateful to every single one of them.

Live Until You Die.

Amid the profile of Medical Assistance in Dying (MAID) and a prevailing interest to support living until death, discussions of appropriate care and care settings for dying abound. The when and how of easing the passage from this corporeal being to a state of other being, whatever you believe that to be, has been focal in healthcare discussions in recent years. I remember a time when the notion of "palliative care" was somewhat novel, in later years when a family member was the recipient of excellent end-of-life care, but still many recent instances in which we, "the system" fail to ensure that that final life journey is aligned (as much as possible) with a person's final wishes. Alas, a 2013 survey by the Canadian Institute for Health Information (CIHI) showed that a majority of Canadians preferred to die at home, but few (15%) died outside of a hospital (CIHI 2018).

Let's Get Digital.

The editor-in-chief provides an overview of this issue's focus on nursing leadership and digital health. She encourages nurse leaders to be knowledgeable and engaged in digital health initiatives.

Adapting and validating informatics competencies for senior nurse leaders in the Canadian context: Results of a Delphi study.

BACKGROUND: Nurse leaders in senior leadership positions in various parts of the world can play an important role in the acquisition, implementation and use of health information technologies. To date, international research related to nurse leader informatics competencies has been carried out in specific healthcare delivery contexts with very specific health information technology environments. In this body of literature, the definition of a 'nurse leader' has not been clearly defined. As a result, it is challenging for senior nurse leaders in leadership and management positions in other countries to apply this research to their unique contexts. PURPOSE: The objective of this study was to obtain consensus on the informatics competencies of priority to senior Canadian nurse leaders. The goal of completing this work was to adapt and validate a set of nurse leader informatics competencies to be endorsed and supported nationally. METHODS: This study used a modified Delphi technique with a panel of nurse leaders with significant informatics knowledge from across Canada. Three rounds of information gathering were completed electronically. In Round 1, participants were provided a series of 26 potential competency statements obtained from a review of the literature; they were asked to comment on the clarity and wording of each statement. Two statements were eliminated after Round 1 due to redundancy. In Rounds 2 and 3, participants rated the remaining competency statements on a 7-point Likert scale for relative priority to nurse leaders. RESULTS: A total of 25, 24 and 23 participants completed the survey in Rounds 1, 2 and 3 respectively. Consensus was achieved at the end of Round 3 with the inclusion of 24 competency statements. All of the statements had a mean of 5 or greater on a 7-point Likert scale (1=low priority and 7=high priority). CONCLUSIONS: The study participants agreed upon 24 informatics competency statements of priority to Canadian nurse leaders. These competencies will be presented to senior national nursing leaders and nursing informatics organizations for endorsement. Inspired by work completed in the United States, the authors plan to develop a self-assessment instrument for use by Canadian nurse leaders using the identified competency statements. Future anticipated work includes identifying and creating resources for nurse leaders to develop these important informatics competencies.