This document summarizes a literature review of research papers in clinical informatics and digital health in nursing from 2015-2016. It describes the search strategy and criteria for including papers, which resulted in 73 papers being shortlisted. Of these, 5 top papers were chosen that either identified gaps in the literature or demonstrated improved patient care through digital health innovations. The document discusses each of these 5 papers and their relevance. It concludes with recommendations and limitations of the literature review.

1. Clinical informatics and
digital health: my top
five papers in Nursing.
2015-2016
Arthur: Odette Richards, RN, rural Australia.
Australia aims to improved health care through effective and innovative use of
digital health. To be apart of this digital environment nurses need to understand
and participate in the field of health informatics. To contribute to knowledge in
this field, a literature review was conducted. Research papers were chosen based
on their potential to advance the field of health informatics. To advance the field
of informatics the papers needed to have: (1) identified “gaps” in the literature
or (2) demonstrated improved patient care using digital health innovation.

2. Search strategy
 The first phase of the literature review was conducted by searching key words
“informatics” AND “nursing” in the following bibliographical databases:
Medline on OVID and OVID Emcare.
 Inclusion criteria included, research papers published in 2015-2016, full text,
and English language. Medline on OVID had the greatest yield with 95 papers.
The OVID Emcare database search resulted with 68 papers.
 In phase two, papers were excluded if not available online or if pay per view
was required. Twenty-eight papers were excluded using this process.(Medline,
Twenty & OVID Emcare, eight).
 In phase three, papers were excluded if they did not have an RN as the first
author; this was determined by an Internet search if not included in the
authorship of the article.
 The data bases results were again reviewed and duplicated papers removed.
In total 73 papers were shortlisted for further review.

3. Top 5 papers of 2015-2016 : Rational
 This paper explores informatics and digital health in the field of nursing .
 Despite this broad topic, the narrow scope of 20015-2016 and exclusion
criteria proved difficult.
 The articles identified had a lack of overarching models or theories to guide
the review process.
 Consequently, a generalist approach to the critique process was adopted.
 Article were chosen based on their potential to advance the field of health
informatics.
 To advance the field of informatics the papers needed to have:
(1) identified “gaps” in the literature or (2) have demonstrated improved
patient care using digital health innovation.

4. Bouyer-Ferullo, S., Androwich, I.M., Dykes, P.C., (2015). Clinical Decision Support and Perioperative
Peripheral Nerve Injury: A Quality Improvement Project. CIN: Computers, Informatics, Nursing.
33(6):238-48.
UI: 25851559
 This paper was selected because it demonstrated how a decision support
systems can improve patient care by reducing injury risk.
 Bouyer-Ferullo, et. Al. (2015), described a project involving the
implementation of a decision support screen that identified patients at risk of
peripheral nerve injury (PNI). The decision support screen (DSS) assisted
nurses with patient assessment, PNI risk identification & offered evidence
based interventions to improve patient care. The system also prompted
nurses to document their interventions to reduce PNI. Project results
demonstrated a significant increase in documentation of PNI interventions.
Documentation improved from 63% to 92% and missing documentation rates
decreased from 26% to 19%.
 Another strengths of this project was its staff engagement strategies. Overall
the nurses demonstrated a positive attitude towards their exposure to basic
decision support (P=.046). Positive experiences with digital health will
ultimately advance the field of nursing informatics.
 The key findings from this research demonstrate how technology can support
a nurse’s assessment, documentation and improve patient care.

5. Choi, M., Park, J.H., Lee, H.S., (2016). Assessment of the Need to Integrate Academic Electronic Medical
Records Into the Undergraduate Clinical Practicum: A Focus Group Interview. CIN: Computers, Informatics,
Nursing. 34(6):259-65.
 This paper was chosen because it identified a gap in the literature relating to
nursing curricula development. No study has reported on the use of an
academic electronic medical record (AEMR) to assist students for clinical
placement in South Korea.
 Choi, Park, and Lee (2016), explored how students, new nurses, clinical
nurses, clinical instructors and faculty perceive this integration.
 Choi et. al. reported (2016), electronic medical record (EMR) adoption rates
in South Korea were 50% to 77% in 2009 & 2010. Without the integration of an
AEMR in undergraduate studies, students reported being “passive observers
rather than active doers” on clinical placement p.264. The researches
explored three major themes (1) EMR as a learning tool (2) essential functions
of an AEMR & (3) expected outcomes of an AEMR.
 The findings from this study can inform the process of developing an AEMR for
clinical practicum, which will then increase students informatics
competencies. This will improve their clinical care and advance the field of
health informatics.

6. Gartrell, K., Trinkoff, A.M., Storr, C.L., Wilson, M.L., (2015). Electronic Personal Health Record Use
Among Nurses in the Nursing Informatics Community. CIN: Computers, Informatics, Nursing. 33(7):306-
14.
UI: 26061563
 The researcher successfully identified a gap in the literature. To data no
studies have examined the adoption of electronic personal health record’s
(ePHR) amongst nurses in the informatics community.
 Overall, 72% used ePHR for their own healthcare.
 The study had several strengths. The target sample group was appropriate -
nurse members of the American Medical Informatics Association (AMIA) &/or
Healthcare information and Management Systems Society (HIMSS). The survey
was equally distributed across the US to all practicing nurse members.
Therefore, the findings could be interpreted as representative of this group.
 This study, is important because it is encourages the nurse informatics
community (NIC) to use the products they promote. As “consumers”
informatics nurses are well positioned to identify design faults and offer
meaningful design improvements. It also helps informatics nurses to engage
with patients and other health care professionals. Thus, advancing the field of
health informatics and improving patient care.

7. Gee, P.M., Paterniti, D.A., Ward. D., Soederberg Miller, L.M., (2015) e-Patients Perceptions of Using
Personal Health Records for Self-management Support of Chronic Illness. CIN: Computers,
Informatics, Nursing. 33(6):229-37.
UI: 25899440
 Although there is a body of literature regarding the use of personal health
records (PHR). This qualitative research was unique in exploring the
subjective experiences of the needs of patients with chronic illness.
 Gee P. et al. (2015), identified four themes that capture the perceptions of
the chronically ill using PHR’s: “(1) patient engagement & health self-
management, (2) access to & control over personal health data, (3) promotion
of productive communication, & (4) opportunities for training &
education”p229.
 Contrary to many PHR studies, the participants in this study were not
concerned about privacy of their health data.
 Whilst this research has limitations for improving Australia’s PHR (myHealth
record). Nurses working in the field of informatics need to access research
with a consumers narrative. They need to hear their voices, to ensure digital
health meets the needs of the consumer. This will ultimately lead to
improved satisfaction & improved patient care.

8. Sousa, V.E., Lopez, K.D., Febretti, A., Stifter, J., Yao, Y., Johnson, A., Wilkie, D.J., Keenan, G.M.,
(2015). Use of Simulation to Study Nurses' Acceptance and Nonacceptance of Clinical
Decision Support Suggestions. CIN: Computers, Informatics, Nursing. 33(10):465-72.
UI: 26361268
 This paper was selected as it identified a major gap in the literature in
relation to clinical decision support systems (CDS).
 Most CDS studies are conducted post implementation and they report on the
general characteristic of CDS or nuanced details of CDS.
 This study addressed this gap by adopting a pre-implementation method to
assess CDS systems. To achieve this goal this randomized controlled trial was
implemented in a life-size simulated nursing station. The researchers
examined reasons nurses accepted or rejected specific prototype CDS’s during
a simulated documentation exercise.
 The importance of this study lies in its contribution to understanding the
nurses rationale for their decisions about CDS acceptance that can be
repeatedly applied to building high quality and robust CDS for nurses to
improve patient outcomes in the future.
 More importantly this is part of a larger study to develop a quantitative tool
that can be applied to evaluate any nursing CDS systems in the future.
Consequently, this research has significant potential to advance the field of
nursing informatics and improve patient care.

9. Recommendations
 Nursing informatics research has grown and has demonstrated its value as a
science generating knowledge about nursing and technology.
 In keeping with the theme of “gaps” in the literature. Of the 73 papers
shortlisted for further review none had been conducted by nurses in Australia.
 Consequently, more informatics research conducted by nurses in Australia is
recommended .
 The review also found a lack of informatics research with a rural and remote
narrative. One paper, referenced rural and remote health. However this
paper was excluded, as it did not have an RN as the first author. Given
Australia’s vastness, Australian nurses are well situated to contribute to
research in this area.

10. Limitations
 The selected search terms and inclusion criteria may have eliminated other
papers advancing the field of nursing informatics research. The work
described in this article is not comprehensive of all published work by nursing
informatics scientists. Three project design elements resulted in an
incomplete list of “gap identifying” or “improving care” nursing informatics
research from 2015-2016 .
 First, it is possible that not all authors use the explicit terms as keywords in
their articles. Since authors may use terms more specific to the domains of
the study and not include the general terms we used in our search, many
articles were not included in our analysis. The goal of the project is to review
the broad science of nursing informatics, without attempting to capture all
the specific domains.
 Second, exclusion if not available online or pay per view was required. It was
the researchers stance, that papers need to be “free” and available online to
benefit all of the nursing profession. Living remotely means nurses are often
dependant on online literature.
 Third, use of the nurse as the first author in the search may have eliminated
team science articles in which the nurse, in a more senior role, was listed as
the last author. The rationale for use of the nurse as the first author, is to
promote nurses to become leaders in the field of informatics research.