数字化健康新时代护士的现状与未来

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In a recent review published in JMIR Nursing, researchers reviewed nursing practices and additional skills required to be mastered by nurses in the digital health revolution, with the use of digital technologies exponentially increasing during the coronavirus disease 2019 (COVID-19) pandemic.

Background

Nursing roles have expanded digitally and evolved to improve clinical practice quality and provide remote health assistance to individuals residing in places where healthcare facilities may not be accessible. In recent times, nurses have been required to complete a three-year university degree course in most nations to be authorized to provide care and assistance to patients and healthcare professionals, respectively.

About the review

In the present review, researchers explored the roles of nurses and the skills they require to adapt to digital health practices and improve the quality of healthcare services in light of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.

English publications assessing the impact of telemedicine on nursing practices, published between 2011 and 2021, were retrieved from the Web of Science, Google Scholar, and PubMed databases. Initially, 250 papers were identified, of which eight duplicate papers were discarded, and 156 papers with inaccessible free full text or which did not meet the research purpose were excluded. Further, 26 papers with redundant topics and insufficient detail were excluded, and as a result, 60 relevant studies were analyzed, and the review was completed by July 2021.

The findings broadly denoted five major areas of improvement to upscale digital health (eHealth) nursing practices: leadership skills, soft skills, nurse training, COVID-19 management remotely, and managing interpersonal relations with professionals and patients by digital means. Good leadership skills are essential for high-quality clinical practice since nurses are mainly involved in coordination and collaboration between healthcare professionals, caregivers, and patients.

Soft skills are required for effective communication, problem-solving, and adaptiveness to digital approaches and equipment. Communicative, technological, and transversal skills need to be added to nurse education curriculums to improve eHealth literacy levels and make nurses more prepared, competent, and autonomous for the successful transformation of healthcare from the manual to the digital world.

Nurses need to hone their remote chronic illness management skills to provide Ehealth support and assistance to patients living in remote locations and enable service decentralization from hospital settings to remote areas. Nurses need to enhance their interpersonal skills to provide patient-centered telemedicine support with a sensitive and open for effective healthcare delivery in situations wherein face-to-face (FTF) sessions are not possible and, therefore, nonverbal indicators may go unnoticed.

Nurses are responsible for patient enrollment, explaining services to patients and their caregivers, and managing data from digital health-monitoring devices (such as pulse oximeters and blood pressure monitors) used. Nurses must receive adequate technical training to use data management software and troubleshoot telemedicine-related issues.

International organizations such as the International Medical Informatics Association and Commission on Accreditation for Health Informatics and Information Management Education have proposed mobile health (mHealth) training frameworks to improve the health professional preparedness for facilitating digital care.

The mHealth frameworks aim to improve digital communication skills, digital education, digital device, and software use skills, regulatory issues, compliance issues, deploying telemedicine services and products, and improving inter-professional health communications. The skills need to be mastered by nurses to conduct remote medical consultations, health monitoring, and diagnosis and management of patients.

Incorporating telemedicine in nursing practice would improve information and technology (IT) use in health domains for improving guidance, support, and assistance to patients in remote locations by improving communication and interpersonal relationships between nurses and patients and transforming nurses into efficient leaders to administer innovative and high-quality care to patients.

Conclusions

In the review based on literature published over 10 years, the team outlined the skills and attitudes nurses need to master in the digital health era, the emerging responsibilities of nurses in adopting telemedicine-based approaches, and the impact of the digital health revolution concerning nursing requirements.

The review findings showed that improving nurses’ readiness for adopting telehealth approaches needs an integrated method, combining technical equipment and device knowledge, remote management abilities, effective communication skills, soft skills, and interpersonal skills. Nurses need to undergo digital training; however, effective and precise nurse training methods are yet to be developed.

Existing nurse educational curriculums are based on conventional lectures and instructions that may be inadequate for proper digital health training, creating obstacles to incorporating digital technologies into routine clinical practice. In addition, quiet and disturbance-free environments are required to impart telemedicine education to nurses.

全文翻译（仅供参考）

在最近发表于JMIR护理的文章中，研究人员回顾了护理实践和护士在数字健康革命中需要掌握的额外技能，在2019年冠状病毒病（COVID-19）大流行期间，数字技术的使用呈指数级增长。

项目背景  

护理角色已经以数字化方式扩展和发展，以提高临床实践质量，并为居住在医疗保健设施可能无法访问的地方的个人提供远程医疗援助。最近，大多数国家要求护士完成三年大学学位课程，才能被授权分别为患者和医疗保健专业人员提供护理和援助。

在本综述中，研究人员探讨了护士的角色和他们需要的技能，以适应数字卫生实践，并提高医疗服务质量，鉴于严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行。

从Web of Science、Google Scholar和PubMed数据库中检索2011年至2021年间发表的评估远程医疗对护理实践影响的英语出版物，初步识别出250篇论文，其中8篇重复论文被丢弃，156篇免费全文无法访问或不符合研究目的的论文被排除。剔除了26篇主题冗余、细节不足的论文，因此共分析了60篇相关研究，综述工作于2021年7月完成。

调查结果大致表明了提升数字健康（eHealth）护理实践的五个主要改进领域：领导技能、软技能、护士培训、COVID-19远程管理以及通过数字化手段管理与专业人员和患者的人际关系。良好的领导技能对于高质量的临床实践至关重要，因为护士主要参与医疗保健专业人员、护理人员和患者之间的协调和合作。

软技能是有效沟通、解决问题和适应数字化方法和设备所必需的。需要将沟通、技术和横向技能添加到护士教育课程中，以提高电子健康素养水平，使护士为医疗保健从手工世界向数字世界的成功转型做好更充分的准备、更有能力和更自主。

护士需要磨练其远程慢性疾病管理技能，为生活在偏远地区的患者提供电子健康支持和帮助，并使服务从医院分散到偏远地区。护士需要提高其人际交往技能，以提供以患者为中心的远程医疗支持，在面对面的情况下提供敏感和开放的有效医疗保健服务。（FTF）会话是不可能的，因此，非语言指示符可能会被忽视。

护士负责患者登记，向患者及其护理人员解释服务，管理所用数字健康监测设备（如脉搏血氧仪和血压监测仪）的数据。护士必须接受足够的技术培训，才能使用数据管理软件和解决远程医疗相关问题。

国际医学信息学协会和卫生信息学和信息管理教育认证委员会等国际组织已经提出了移动健康（mHealth）培训框架，以提高卫生专业人员为促进数字化护理所做的准备。

mHealth框架旨在提高数字通信技能、数字教育、数字设备和软件使用技能、监管问题、合规问题、部署远程医疗服务和产品以及改善跨专业健康通信。护士需要掌握这些技能来进行远程医疗咨询、健康监测以及患者诊断和管理。

将远程医疗纳入护理实践将改善信息和技术（IT）在卫生领域的使用，通过改善护士和患者之间的沟通和人际关系，并将护士转变为高效的领导者，为患者提供创新和高质量的护理，从而改善对偏远地区患者的指导、支持和援助。

五.结论

在基于10年来发表的文献的综述中，该团队概述了护士在数字健康时代需要掌握的技能和态度，以及护士在采用基于远程医疗方法，以及数字健康革命对护理需求的影响。

研究结果显示，提升护士接受远端医疗服务的准备程度，需要整合技术设备与装置知识、远端管理能力、有效沟通技巧、软技巧、人际技巧等，护士需要接受数位训练;然而，有效和精确的护士培训方法仍有待开发。

现有的护士教育课程以传统的讲座和指导为基础，可能不足以进行适当的数字化健康培训，这对将数字化技术纳入常规临床实践造成了障碍。此外，需要安静和无干扰的环境来向护士传授远程医疗教育。

Journal reference:

Isidori, V. et al. (2022) "Digital Technologies and the Role of Health Care Professionals: Scoping Review Exploring Nurses’ Skills in the Digital Era and in the Light of the COVID-19 Pandemic", JMIR Nursing, 5(1), p. e37631. doi: 10.2196/37631. https://nursing.jmir.org/2022/1/e37631/

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