What Nurses Need to Know about Personal Digital Assistants (PDAs)
Colleen B. Davenport, RN, MSN
Davenport, C. B. (October, 2004). What Nurses Need to Know about Personal Digital Assistants (PDAs), (OJNI). Vol. 8, No. 3 [Online]. Available at http://ojni.org/8_3/davenport.htm
Personal Digital Assistants (PDAs) provide nurses with portable access to extensive reference materials as well as other organizational and time saving benefits. Although many nurses have adopted PDA technology, many nurses have not. One barrier to nurses’ use of PDAs is lack of knowledge about PDAs. This paper presents basic information to help nurses make decisions about purchasing PDAs and PDA applications; gives basic directions for getting started; and discusses future PDA uses.
Keywords: Nursing Informatics, Personal Digital Assistants, Computers, Education
Although many nurses are using personal digital assistants (PDAs) PDA users are still a minority. Forrester's Consumers Technographics 2003 North American Bench Mark Study found that only 559,800 nurses were using PDAs (cited by Stolworthy, 2003). Apparently many nurses still need more information in order to adopt PDAs as nursing tools. This paper seeks to meet major PDA knowledge needs of nurses by presenting information on nursing culture, why nurses should be using PDAs, information technology literacy for nurses, what PDAs can do, which PDA to buy, basic and intermediate PDA use, evaluation criteria for PDA nursing applications, and prospective uses for PDAs in nursing. Basic information on each of these topics is provided in the text of the article. Many sections are accompanied by “Selected Resources,” Web sites that provide alternative and expanded learning opportunities for that section. These Web sites were selected on the basis of their authorship, purpose, accuracy, currency, easy navigation, and appeal to nurses.
According to Hebert, nursing culture does not encourage nurses to use information technology (IT) to manage information (The National Advisory Council on Nurse Education and Practice, 1997, as cited by Hebert, n.d.). In addition, computer anxiety may cause nurses to avoid using IT (Orr, n.d.). Nurses are frustrated if IT requires more time for documentation. Naturally, nursing culture does not encourage nurses toward PDA use either.
However, nurses are skilled in information management, routinely collecting and organizing data (Hebert, n.d.). PDAs will give them better information management but will also require them to adopt a new technology. To begin the adoption process, nurses need to be aware of PDAs, see themselves as PDA users, and understand what PDAs can do. Because PDAs are light and mobile, nurses will find answers in their hands, not at the nurses’ station. The information will be kept current through routine updates. Eventually, nurses will shape PDA application development by demanding that the technology meets nursing needs. PDA benefits will include increased productivity, reduced errors, better patient care, and increased worker satisfaction.
A Health Care Library at the Bedside This power point presentation, written by a nurse, was designed to show nurses how PDAs help nurses.
The Computer Anxiety Scale This scale, attributed to Cohen and Waugh (1989), is a measurement of computer anxiety. If nurses have high computer anxiety, they may need more time to learn to use a PDA.
Why Nurses Should Be Using PDAs
PDAs are tiny, functional computers that will allow nurses to be more effective and more organized. Nurses can quickly access current drug and clinical references and medical calculators. They can record patient data as they work, chart quickly and efficiently, and share data. They can also organize and track patient data, and document treatments and assessments as they are done.
PDAs provide contact lists, email, date books, and to do lists for personal organization as well as the ability to make word documents and power point presentations. Other PDA options include games, books, music, and photos.
Many universities recommend or require nursing students to use PDAs, implying that PDAs are a valuable nursing tool. The number of these schools is increasing, and includes Duke University School of Nursing and Arizona Health Sciences, for example.. Robert Morris University School of Nursing (2004) provides all of their nursing students with PDAs and is incorporating a PDA teaching platform this Fall.
Duke University School of Nursing Designed for nursing students, this Web site provides a good start for learning about PDAs in nursing. Be sure to click on “Basics” to get PDA terminology, how-to, and tips and tricks.
University of Saint Francis The library designed this beginning PDA Web site for nursing students. Check the April 29 th Nursing Summit PDA Session reports for detailed and recent (2004) information on purchasing or upgrading PDAs, drug information sources, and nursing applications.
Information Technology (IT) Literacy for Nurses
Skills related to information technology (IT) skills will help nurses to adopt PDA technology. Nurses should be competent in the IT skills of e-mail and the Internet. Nurses should also understand word processing, keyboarding, and some peripherals such as printers, CDs and DVDs. Therefore, nurses need to assess and build IT skills. Kaminski (2003) provided a comprehensive list of online IT self-assessment tests and related online IT tutorials. Even though PDAs are simple and do not require a depth of computer knowledge a bit of IT literacy is helpful.
Nursing Informatics Competencies Self Assessment - Nursing Informatics.com:
This Web site (by a nurse for nurses) lists computer related competencies that nurses should have or attain. There are also numerous links to help nurses attain computer competency.
Webopedia: Online Dictionary for Computer and Internet Terms
Like medicine, informatics has its own language. This Web site offers easy definitions for terminology and acronyms.
What a PDA Can Do
There are hundreds of applications for PDAs. Many are free or moderately priced. Most can be downloaded from the Internet to a personal computer and easily transferred to a PDA. Be aware that some applications require a subscription to a wireless service while others are updated on the basis of the purchase price. Also, the ability to directly send information such as blood sugars to a hospital information system requires collaboration with hospital information systems and not all facilities have the infrastructure to allow uploads and downloads between PDAs and clinical information systems.
Here are a few examples of PDA applications:
ePocrates Drug Database Take a virtual tour of this free PDA drug database.
Blood Pressure Manager This Web site presents an application to track an individual’s blood pressure. The screen shots slow graphic trends.
Medical Calculator This medical calculator contains the most commonly used medical equations
Shots 2004 This reference guide to the 2004 Childhood Immunization Schedule was recommended by the Advisory Committee on Immunization Practices (ACIP).
Nursing Commercial Applications
HHM Nursing Care Plans 1.0 These comprehensive guidelines for nursing care plans are listed as one of the most popular products by PDAcortex, a leading vendor of PDA medical applications and products.
DrugGuide (Davis's DrugGuide for Nurses) powered by Skyscape
This drug guide is already used by many nurses in book form.
AACN Cardiac Medications Pocket Reference 2.0
This application is the PDA version of the AACN laminated card presenting cardiac medications, dosing, etc.
BugMe! This application allows note taking and reminders.
Diet and Exercise Assistant Track daily nutrition, exercise, and health with this application. The food database lists calories, carbohydrates, protein, fiber, and fat for many foods and also allows input of new items.
PrintBoy Premium This application allows you to print from you PDA using an infrared, Bluetooth, Wi-Fi, serial or TCP/IP connection. Unfortunately, most printers don’t have wireless capabilities. However Bachman has developed an InfraReady Adapter ($99) to convert any printer with a parallel port to accept infrared beaming.
CollectiveMed.com This Web site is a division of MDBook, LLC, is a reputable PDA vendor. Their marketing goal is to provide the “best” offering of products instead of “all” of the products. They offer to transform “your document or book to an electronic format” and help to market it.
PDA cortex: The Journal of Mobile Informatics This Web site is nursing oriented and offers PDAs, software, articles, and a PDA nursing listserve (ongoing PDA discussions).
New PDA models are being released all the time and any PDA purchased now will soon be surpassed. To ensure longer usability, nurses should take care to make the best choice. Basically, there are two systems: the Palm Operating System (OS) and the Pocket PC System. However, the Palm OS is currently preferred by most physicians. Perhaps this is because Palm products are readily available and there many available medical applications for this system. PDAs made by Palm and Sony use the Palm OS.
As nurses browse PDA reviews before making their choice they should be aware of the following PDA features presented by Thompson (2003b): speed, memory, expansion, screen size and color, connection options, extra options such as a camera, and cost. Nurses should choose the most speed and memory they can afford. A color screen will also improve usability. Pricing for PDAs continues to fall. For example, in July 2004 a “nursing bundle” at PDA cortex included a very good PDA (the Palm Tungsten E) and the Davis 's Drug Guide was available for $199. Ken McGowen, of PDA cortex stated that they “will continue to offer bundles like this but the products will vary over time.” (The author’s first PDA, purchased in January 2003 was $400).
PDA Buyer's Guide Reviews This Web site provides current product reviews.The review links are on the left side of the Web page.
Brighthand This Web site offers another set of PDA comparisons that are conversational and easy to understand. Look in the middle of the Web page to the right for the review links.
Jim’s Palm Pages This Web site is maintained by a Canadian ER doctor. He offers his viewpoint on PDA selection in his “Which Palm Model” link on the left side of the Web page.
Basic PDA Use
Getting started with a PDA is like learning any other new skill. A good attitude and willingness to make mistakes will help getting over initial unfamiliarity. Start by keeping the PDA in your pocket while at work to be able to use spare moments for learning and fun. Realize that you are not alone in your learning. Most all of us have some difficulty with technology transitions. Since there are many ways to learn, explore different options including a PDA user group, a class, web learning, and books. Talk to other nurses about PDAs. Try something fun such as a PDA game, fiction, or taking PDA pictures. For example, the author recorded a friend’s voice with a humorous saying to play back when a humor is needed.
Thomson of Jim’s Palm Pages (2003a) suggested some basic steps for getting started with a PDA:
Don’t rush into later steps. Start with exploring pre-installed software. Browse for optional accessories such as a case, extra style, and recharging cables on the Internet or a local store.
Ectopic Brain - The Basics This Web site, designed by a MD, is a PDA starting point.
Jim's Palm Pages This Web site was mentioned before and has great PDA start up help.
palmOne – Support This Web site is run by Palm and offers customer support, accessories, tips, and software for each model.
Beyond the PDA Basics
After getting started, nurses will need to know how to download and install PDA applications, how to delete applications, security, and resetting the PDA.
When nurses decide to download a PDA application, they should be at the same computer that HotSyncs with their PDA. They just need to click the download button on the application website. This button will be available for freeware and become available after purchase of a commercial application. A pop-up box will appear showing that the download has started. Follow the instructions that appear on the computer screen to complete this process. Every software vendor may have some additional steps, but those steps will be explained during the download process.
A screen called “Save As” will appear to allow the user to save the new application to a specific file. Make one folder for all downloaded application files so they will be easy to find. Write down the name of the file that appears in the bottom of this screen for later use. Then click the “Save” button. Then check the last letters of the file name. If the last letters are “.prc,” “.pdb,” or “.exe” the decompression step can be omitted.
Many application files are “compressed” so they will download faster and they must be decompressed before use. The computer uses a program such as WinZip to decompress the file. If the computer does not already have a decompression program, one can be downloaded from the WinZip® Home Page. Find the new application file in the downloaded applications folder and double click on it to start file decompression. Then click on the “Extract” button.
Application Installation to PDA
Follow these steps:
Original manufacture applications cannot be deleted, but other applications can be deleted to conserve space. This process takes place on the PDA itself. Choose the application to be deleted by looking at the “Home” screen. Tap the menu button to display “App” choices in the upper left hand corner. Tap on “Delete.” All the applications will be listed. Highlight the program to be deleted by tapping on it. Now tap “Delete” from this screen. Confirm the deletion by tapping “Yes” from the next screen. The application is now deleted from the PDA.
If the PDA does not respond to its buttons or screen, it must be reset to get it back to normal. A soft reset starts the PDA and keeps all the records and entries that are stored on the PDA. Use the reset tool or a tip of an unfolded paper clip or the stylus point on some models. Press the reset button inside the hole on the back panel of the PDA.
A hard reset erases all records and entries on the PDA and factory default settings are restored. All data that was previously synchronized can be restored during the next HotSync. Third party applications will be restored by systems that are Palm OS 3.3 or higher. Don’t perform a hard reset unless the soft reset doesn’t work. Check the user’s manual for the hard reset process.
Palm OS has built-in security functions to password protect individual entries and to block general access to the PDA. Individual records can be locked in the Memo Pad, Address Book, and Date Book by marking the records as “Private” and setting the device not to display those records without entering the correct password. To do this, tap on the preferences icon and then tap the on “security.” Tap “Hide” on the next screen, and confirm this on the screen after that. Be aware that this level of security is easily breached by hackers.
Locking the PDA allows more security and causes a security screen to appear the next time the PDA is turned on. A password will then be needed to access the PDA. To lock the PDA, tap the preferences icon and tap “security.” Tap on “Turn off and lock device.” Once the PDA is locked it can only be turned on with the password. If the password is lost, a hard reset will reactivate the PDA.
Nurses who keep sensitive information on their PDAs should consider what level of security is needed for the type of information stored on their PDA. Check with the HIPAA security officer to be certain that private health care information is adequately protected and that individual PDA security is compliant with institutional policies. If further security is necessary, there are other PDA applications designed to enhance security.
PalmDocs | Tutorials Information on downloading applications and converting regular documents to palm documents
pdaMD.com Learning Center This Web site has tutorials on downloading and installing software, securing data, and beaming data with the infra-red port. There is also more advanced information.
palmOne – Support This website provides extensive support for Palm PDAs. Look for the Knowledge Library, Tips and Tricks, Accessories, etc.
PDA Nursing Application Evaluation Criteria
Nurses should evaluate PDA nursing applications since that information will guide critical decisions. A set of PDA nursing application criteria has not yet been standardized. However, several groups have formulated criteria to guide evaluation of Internet healthcare information. Lantz (2004) listed six criteria: declaration of purpose and intended audience, authority, accuracy, objectivity, currency, and ease of use. The Health Summit Working Group (1999) chose seven similar criteria: credibility, content, disclosure, links, design, interactivity, and caveats (advisories). More specifically, Cader, Campbell, and Watson (2003) delineated seven criteria that nurses use to evaluate Internet nursing information: publication source, author background, research evidence, practice related, user-friendliness, and nature of information (p. 101).
These evaluation criteria seem to suggest four general PDA nursing application evaluation criteria:
Prospective: How PDAs Could be Used by Nurses
Although many nurses are using PDAs in their practice, general PDA adoption by nursing still seems futuristic to many. For example, many facilities do not have the infrastructure to coordinate PDA and hospital information systems and nurses will not be able to upload or download patient data. Nurses should expect larger organizations to take a longer time to respond to new technology and be prepared to assist their organizations with technological changes. However, individual PDA use is very valuable and nurses should be aware of PDA capabilities for improving nursing practice.
PDA applications to monitor blood glucose levels, blood pressure, diet, and activity are already available. Nurses should know of these applications and assist clients to obtain and use them. For example, Kerkenbush and Lasome (2003) reported that a PDA diary was helpful to diabetic patients to track blood glucose levels, dietary intake, activity level, and insulin doses.
PDAs can allow bedside data collection and charting, therefore reducing steps to and from the nurses station. Wilcox and La Tella (2001) pointed out that because PDAs offer easier information transmission to workers they offer greater continuity of care. Another workplace advantage was highlighted by Grasso, Genest, Yung, and Arnold (2002). These researchers reported decreased incidence of errors in discharge medication lists that were generated by PDAs instead of being hand transcribed.
PDAs can streamline classroom tasks. For example, assignments, reading selections, and other information can be beamed to all classroom students. Of course, drug references and other nursing references are critically valuable for nursing students. Fontelo, Ackerman, Kim and Locatis (2003) noted that PDAs have capabilities to connect to the Internet and can allow students to access MEDLINE and other knowledge sources in a wireless setting. For example, PDA cortex recently announced a centralized nursing education and information management platform called SoN cortex This platform may enhance current nursing education and should be evaluated by nursing educators.
PDAs are mobile data collection points. In fact, the device could be handed to a client for survey collection. The PDA can transmit the information back to the computer, eliminating the need for an extra paper link along with an opportunity for error. Giammattei (2003) reported using PDAs to collect quality-of-life surveys and clinical evaluations in the implementation of a total joint registry.
All nurses need to network with other nurses to share information, to assist research, to provide and receive mentoring, emotional support, and friendship. The PDA organizational functions will help nurses to build nursing networks.
Shaping PDA Nursing Application Development
Hebert (n.d.) opined that nurses will shape IT to their benefit. This is also true for PDAs. In addition standardized nursing language offers an appropriate PDA interface between nursing practice and documentation. The American Nursing Association (ANA) 1999 House of Delegates (1999) stated that “Nursing Information Systems have the potential for improving nursing performance, increasing nursing knowledge, and providing data and information necessary for nursing to participate in the formulation of health care policy PDAs should be included in nursing information systems and will contribute to ANA goals.
Clinical Trials Software This software allows investigators and co-ordinators to electronically create and extend their own forms for the electronic acquisition, exchange, submission and archiving of clinical trials data and metadata onto any handheld computing device or PC via wireless or any other connectivity option.
SoN cortex This software allows educators to create their own assessments & evaluation testing, homework assignments, class assignments and projects onto any handheld computing device or PC via wireless or any other connectivity option anywhere on campus.
PDAs are important nursing tools to help nurses manage information. As nurses learn about PDAs they will be more able to incorporate PDA technology into their personal and professional life. Nurses need to know why they should be using PDAs, which PDAs to buy, and how to operate their PDA. Nurses need to know about current PDA nursing applications and should critically evaluate PDA nursing applications. In addition, nurses should be aware of ways that PDAs can improve patient wellness, nursing education, and nursing research.
American Nurses Association 1999 House of Delegates (1999). Standardized nursing language implementation [Electronic version]. Retrieved on April 13, 2004 from http://www.nursingworld.org/about/summary/sum99/nrglang.htm
Bauer, K. 2003). A health care library at the bedside [Electronic version, powerpoint]. Yale School of Nursing, Wellesley College. Retrieved on December 29, 2003 from http://info.med.yale.edu/library/nursing/pda/pdamass.ppt
Cader, R., Campbell, S., & Watson, D. (2003) Criteria used by nurses to evaluate practice-related information on the World Wide Web. CIN: Computers, Informatics, Nursing, 21 (2) 97-102.
Cohen, B.A., & Waugh, G. W. (1989). Assessing computer anxiety. Psychological Reports, 65, 735-738. The computer anxiety scale [Electronic version] Retrieved on January 26, 2004 from http://www.uncc.edu/pagoolka/ComputerAnxiety-intro.html
Fontelo, P. Ackerman, M., Kim, G., & Locatis, C (2003). The PDA as a portal to knowledge sources in a wireless setting [Abstract, electronic version].Telemedicine Journal and e-Health, 9, (2) 141-7.
Giammattei, F. P. (2003) Implementing a total joint registry using personal digital assistants: A proof of concept [Abstract, electronic version]. Orthopedic Nursing,22,(4) 284-8.
Grasso, B. C., Genest, R., Yung, K., & Arnold C. (2003). Reducing errors in discharge medication lists by using personal digital assistants [Abstract, electronic version]. Psychiatric Services,53,(10) 1356-6.
Health Summit Working Group (1999). Quality of Health Information Policy Paper [Electronic version]. Retrieved on April 12, 2004 from http://hitiweb.mitretek.org/docs/policy.html
Hebert, M. (n.d.) National nursing informatics project discussion paper [Electronic version]. Retrieved on December 8, 2003 from http://www.cna-nurses.ca/pages/resources/nni/nni_discussion_paper.doc
Kaminski, J. (2003) Nursing informatics competencies: Self – assessment [Electronic version]. Retrieved on February 6. 2004 from http://www.nursing-informatics.com/niassess/index.html
Kerkenbush, N. L. & Lasome, C. E., (2003). The emerging role of electronic diaries in the management of diabetes mellitus [abstract, electronic version]. AACN Clinical Issues,14,(3) 371-8.
Lantz, K., ed. (2004). Criteria we use [Electronic version, webpage]. Retrieved April 12, 2004 from Rheumatology Guide at http://www.ihealthcaregroup.com/rheumatologyguide/criteria.htm
Orr, L. V. (n.d.) Computer anxiety [Electronic version]. University of Southern Main, Communication 499. Retrieved on January 26, 2004 from http://www.usm.maine.edu/~com/lindap~1.htm
Stolworthy, Y. (2003). RNs are mobilizing [Electronic version]. Retrieved on December 29, 2003 from http://www.rnpalm.com/RNs_are_Mobilizing.htm
Robert Morris University School of Nursing (2004). Nursing at RMU [Web page]. Retrieved on July 10, 2004 from Robert Morris University Web site at http://www.rmu.edu/OnTheMove/findoutmore.open_page?ipage=60858
Thomson, J. (2003a). Getting started [Electronic version]. Retrieved on February 16, 2004 from http://www.jimthompson.net/palmpda/
Thomson, J. (2003b). Which Palm OS handheld model should I buy [Electronic version]. Retrieved February 12, 2004 from http://www.jimthompson.net/palmpda/
Wilcox, R. A., La Tella, R. R. (2001). The personal digital assistant, a new medical instrument for the exchange of clinical information at the point of care [Abstract, electronic version]. Medical Journal Australia,175, (11-12) 659-62.
Colleen B. Davenport, RN, MSN
Colleen Davenport provides health care in rural Wrangell, Alaska (hyperlink: http://www.wrangell.com/). She received her ADN from Salt Lake Community College, (hyperlink: http://www.slcc.edu/) , her BSN from University of Utah (hyperlink: http://www.utah.edu/) and MSN from University of Phoenix Online (hyperlink: http://online.phoenix.edu/CampusProgramDescript.asp?program=MSN).