digital health and implications for nursing

WEEK 8
In this module we will explore some of the contemporary practice perspectives on digital
health and implications for nursing, drawing on recent literature and innovations in the field
1. Discuss the past, present and future of digital health;
2. Articulate what digital literacy is and the surrounding challenges;
3. Describe the connection between social determinants of health and digital literacy;
4. Discuss digital health applications across the lifespan from child to older person;
5. Summarise the digital health services and requirements, including need, in their
local community;
6. Discuss a variety of strategies being implemented across Australia and their local
area to support the provision of timely healthcare in acute care environments;
7. Reflect and share with peer’s information about digital health programs that support
the provision of healthcare in their local settings;
8. Discuss the future of Australia’s digital health and to measure the progress achieved
to date.
Introduction
2. Digital health, communication and digital health literacy
Digital health allows innovation to be combined with nursing knowledge and science, and
nursing practice including inter professional collaboration to improve patient outcomes.
Social Determinants and Digital Health
Social determinants of health are defined as the conditions in which people are born, grow,
live, work and age. Social determinants of health are shaped by the distribution of power,
money and resources throughout local communities, nations and the world. Differences in
these conditions lead to health inequities and avoidable differences in health status between
Australians and the rest of the world (Centers for Disease Control and Prevention, 2020).
Study the following diagram.
(Australian Institute of Health and Welfare (2020). Framework for determinants of health.
Australia’s health data insights, p. 81)
As you examine this diagram, consider where advances in digital health may reduce inequity
between population groups who are disadvantaged through social determinants. For

example, remoteness, health literacy, social inclusion. You may find clues here for a topic for
your group presentation.
Alam et al., (2019) discusses determinants of access to eHealth services in Regional
Australia. What is identified in this paper is that when low education levels and low
socioeconomic status are coupled with remote / regional location, engagement in digital
health systems decreases. Therefore, digital health needs to be targeted to meet the needs of
these individuals to remove the disparity in healthcare.
Alam, Khorshed, Mahumud, Rashidul Alam, Alam, Fariha, Keramat, Syed Afroz, ErdiawKwasie, Michael O, & Sarker, Abdur Razzaque. (2019). Determinants of access to eHealth
services in regional Australia. International Journal of Medical Informatics (Shannon,
Ireland), 131, 103960–103960. https://doi.org/10.1016/j.ijmedinf.2019.103960
Person-centred care
The use of health informatics to record, monitor and track patient progress and outcomes
should be about allowing individuals to control what information is shared with other health
care professionals to minimise delays in treatment and fragmented health experiences.
Healthcare professionals utilise resources that surround them in order to provide care that
is person-centred. Health informatics, such as digital records and the data it generates, are
important to build effective care and evidence. The data that can be gained from digital
records allows evidence of treatment to be monitored and guidance of best practice, through
research, to be communicated to healthcare professionals and to be inclusive of the person’s
perspectives.
Snyder et. al., (2011) share with the reader how health informatics and technology have the
potential to facilitate and support care for cancer patients. Consider how this can be applied
to all chronic and acute healthcare conditions and create more efficient care for Australians.
Snyder, C. F., Wu, A. W., Miller, R. S., Jensen, R. E., Bantug, E. T., & Wolff, A. C. (2011). The role
of informatics in promoting patient-centered care. Cancer Journal (Sudbury, Mass.), 17(4),
211https://10.1097/PPO.0b013e318225ff89
Digital Healthcare in Acute Care
Digital health care communication with innovations such as telehealth extends beyond
providing care to individuals at home. Telehealth is being used around the world in the acute
care sector with healthcare providers providing support to other organisations through the
use of video technology.

Emory University (2018, May 18) emory e ICU [Video] You Tube

Management of stroke patients during the early stages is important for their outcomes. The
Victorian Government has funded a Victorian Stroke Telemedicine (VST) program to provide
neurologists to assess individuals remotely.Stroke Foundation (2019, October 3). What is
stroke telemedicine? [Video} You Tube
Some hospitals have embraced digital hospitals with 100% digital implementation. Metro
South Health in Queensland shares an insight into what a 100% digital hospital looks like.
Metro South Health (2018, December 20) Metro South Health Australia’s first digital health
service. [Video] You Tube.
https://www.youtube.com/watch?v=UCvg_M00wkM
Digital Tools for Reporting Incidents
Health care services have a plethora of digital tools that are used to report and monitor
workplace incidents. This is important as incident reporting and management is closely
aligned with work health and safety, and patient safety legislation. Digital incident reporting
tools and systems allow issues to be identified and to allow patterns of errors to be
identified and actioned prior to the occurrence of a sentinel event. In Australia 1 in 10
emergency admissions to a hospital will have an error of some form. Thanks to our
standards of care, Australia is doing much better than other western medicine countries
such as the US. The US error rate equates to at least one jumbo jet crashing every day, a
shocking reality put in that context.

A digital health tool that allows the recording, tracking and monitoring of heath care related
errors is important. These tools seek to avoid blame, but rather have a learning focus that
aim to support the provision of better care and improved processes. Digital risk tools allow
the reporting of:
·
A near miss ( A near miss is a potential for harm or system error which is intercepted
prior to the completion of the incident/event. This might include a medication order written
incorrectly, a medication that the patient is allergic to ordered or a failure of a process that is
identified. )
·
A notification (A notification is the reporting of events that the organisation requires to
ensure safe practice and that may require follow-up to ensure further injury is not sustained.
These can include errors in documentation and failure to provide care.)
·
An adverse event (An adverse event is an unintended injury or complication resulting in
disability or prolongation of a hospital stay and is caused by healthcare management rather
than patient disease or condition. This can include a pressure area, a medication error or an
incident in which the individual is harmed.)
·
A sentinel event. (A sentinel event is a relatively infrequent, clear-cut event occurring
independently of a patient’s condition. Such an event commonly reflects hospital system and
process deficiencies and can result in unnecessary outcomes for a patient. These are often
incidents in which the individual is harmed irreparably or who dies as a result of failures in
healthcare.)
Research and explore what other digital health services are offered in your state and area
that support positive outcomes for patients. Think about those that you engage with during
placement or during the management of your own / families health. As you engage in this
activity think of how this supports you community. What are the digital literacy barriers and
what can be done to overcome these?
Digital health is also for carers
Carers of person’s with chronic disease require a level of support in the healthcare system
that is often difficult to access. A carer is at risk of emotional and physical fatigue and
requires supports in place to ensure they are equipped to provide the care that is so
important for their loved one. Sin et al., (2018) conducted a systematic review of the findings
of eHealth interventions for carers. The research highlighted that carers across a broad
range of languages, populations, demographics and geographical areas all welcomed eHealth
interventions to support them and their loved ones. The flexibility and at times self-paced
nature and individualised programs were uniquely advantageous. Carers supported the
ability to create a support network through online spaces and forums in which healthcare
professionals took part. Greater enrolment and acceptance were found in programs offered
digitally, using communication technology, than those offered in face-to-face formats.

Sin et al., (2018) presents a detailed systematic review that may be challenging to read in its
entirety. If you prefer you can simply read the introduction, discussion section, future
directions and the conclusion.
Sin, Jacqueline, Henderson, Claire, Spain, Debbie, Cornelius, Victoria, Chen, Tao, & Gillard,
Steve. (2018). eHealth interventions for family carers of people with long term illness: A
promising approach? Clinical Psychology Review, 60, 109–125.
https://doi.org/10.1016/j.cpr.2018.01.008
Student Experiences with
Digital Technology (
REFLECTION)
Please reflect upon the below reading and consider how you as a registered nurse will
navigate the changing setting of healthcare. You will have had some exposure to clinical
environments at this point in your degree, and reflection on these experiences supports
valuable learning.
Brown Wilson, Christine, Slade, Christine, Wong, Wai Yee Amy, & Peacock, Ann. (2020).
Health care students experience of using digital technology in patient care: A scoping review
of the literature. Nurse Education Today, 95, 104580–104580.
https://doi.org/10.1016/j.nedt.2020.104580
Think of how the registered nurse needs to adapt and what digital health tools and systems
have you engaged with.
· Were they 100% digital?
· Was it a combination?
· What were the challenges in paper?

1. Improving health outcomes with digital health
3. Digital health in nursing: The future
Communicating amongst Health Professionals
Health professionals need to be able to communicate effectively in order to share knowledge
of patient conditions and needs. Digital health offers avenues in which this can be achieved.
Australia’s National Digital Health Strategy priority number two (2) aims to achieve Health
information can be exchanged securely between health professionals.
Please read pages 24-27 of
Australia’s National Digital Health Strategy to learn more about
the advancing means of communication between healthcare professionals and to patients’
and their carers’.
High quality data is required by healthcare workers to provide efficient and effective care to
individuals. Standard 3 of the National Digital Health Strategy requires that the information
shared be high quality and presented in a manner with common meaning to allow use with
confidence.
Please read pages 28- 33 of
Australia’s National Digital Health Strategy to learn more about
digital communication with confidence and connectedness of systems.
(Australian Digital Health Agency (2017) Australia’s National Digital Health Strategy)
Health Literacy
Health literacy determines an individual’s ability to engage in healthcare. Each person has
their own challenges when it comes to digital literacy. As a registered nurse it is important to
assess an individual’s risk for poor health and digital literacy and provide support as
appropriate. Digital health literacy is influenced by the social determinants of health with a
strong connection between the two. Digital health has a significant focus upon the ability of
individuals to access and manage their health information. This need extends to all age
groups from children to older persons. Digital health creates avenues for nurses to
communicate with person’s seeking care and with other health professionals. This requires a
level of professional communication and knowledge.
Digital healthcare requires that healthcare professionals and the consumers of healthcare
(patients, clients and families) have a level of health literacy. Health literacy is a priority for
healthcare with significant government focus and initiatives being developed. Health literacy
develops during life and from formal education and capacity building and is influenced by
personal, situational and societal determinants (Sørensen, 2019). The Australian Institute of
Health and Welfare (2020) defines health literacy as the how people access, understand and
use health information to benefit their health. Individual’s with low health literacy are
considered to have worse health outcomes and poorer health behaviours. Health literacy has
two (2) main components:
· Individual health literacy: this refers to individual skills such as the ability to find,
understand and utilise health information, for example how to access forms (such as My
Health Record).
· The health literacy environment: these are the health system core requirements such as
policies, processes and materials and affect the way the individual engages with the health
system (also My Health Record).
(Australian Institute of Health and Welfare, 2020)

The following video clarifies the concept of digital literacy in healthcare.
Health Education England (2018, February 10) What is digital literacy and why is it
important to the health and social care workforce? [Video] You Tube
https://www.youtube.com/watch?v=jFS8D2YKQK8
Reflection Activity:
· Consider for a moment your level of computer literacy. How often do you use a
computer or a mobile phone device? What do you use it for?
· Is it the way that you conduct all banking, shopping, communication, etc.?
· Are there limits to what you know how to do?
· Now think about the generation above you. What is their interface / connection with
technology like?
· Do they navigate it easily? Do they find it difficult and frustrating?
· How do you find supporting them?
· Take some time to think about the next generation. How do they navigate technology?
What is their level of engagement? Can they find information they need to easily?
All the above impacts upon how an individual will engage and utilise healthcare in a digital
age. For some adapting to new programs, interfaces and technology is just what you do, for
others navigating the internet, university systems, healthcare etc., is complex and a slow
process. This all relates to levels of digital literacy, which in turn influences how you will
interface with digital health in the clinical environment. Once familiar with programs things
become much easier, but that first interaction is often difficult, and it takes a while to
become proficient.
Brown, Janie, Pope, Nicole, Bosco, Anna Maria, Mason, Jaci, & Morgan, Alani. (2020). Issues
affecting nurses’ capability to use digital technology at work: An integrative review. Journal
of Clinical Nursing, 29(15-16), 2801–2819. https://doi.org/10.1111/jocn.15321
Digital literacy is more than the ability to utilise technology and technical skills. Digital
literacy includes creativity, critical thinking and evaluation, cultural and social
understanding. It requires collaboration, the ability to decipher information and
communicate effectively and to have electronic safety (Almond, Cummings & Turner, 2019).
What does digital health look like in the future?
Digital health in the future is unknown, but what is known is that healthcare will change. The
future of nursing will therefore change in order to adopt to the dynamics of the healthcare
context.

Please watch the below video’s and think about how care will be provided in the future.
Advances in healthcare technology are forms of health informatic and digital health. With
the advances in digital healthcare is the need to embrace humanity and personalisation that
can only be achieved, at this point in time through personal contact.
Ted X Talks. (2017 July,7) Lets talk about health care in 2030. Dr Marcus Ranney TedX
Surat.[Video] You Tube https://youtu.be/9zlUNw3y5rg
Manipal Hospitals (2016, July 22). Introducing IBM Watson for oncology- cancer treatment in
India/ Manipal Hospitals. [Video] You Tube
https://www.youtube.com/watch?v=qG6jfHI4ucw
Digital health leading to health innovation.
Healthcare is complex and providing care to the broader Australian community is
challenging due to geographical barriers, cultural and language differences and the complex
social determinants of health. However, healthcare in Australia is embracing digital
technology from Arnhem land to capital cities.
Take some time to explore the work being undertaken in East Arnhem, Northern Territory.
This work highlights the capabilities of digital health to provide care to individuals in their
local area and that is culturally appropriate.
Australian Digital Health Agency for Healthcare Providers (2022) Delivering connected health
care for East Arnhem NT.
https://www.digitalhealth.gov.au/healthcare-providers/initiativesand-programs/communities-of-excellence/east-arnhem-northern
Mental health is one of the largest healthcare needs in Australia. Provision of healthcare to
support the mental health needs of individuals faces many challenges. The Mental Health
Tool kit has been developed with resources to demonstrate how the mental health
consumer can be included journey and clinical workflows.
Australian Digital Health Agency (2022) Mental Health
Toolkit.
https://www.myhealthrecord.gov.au/for-healthcare-professionals/mental-healthtoolkit
Digital healthcare in COVID-19 pandemic supported the work undertaken by nurses. Faced
with an unprecedented health situation in western medicine nurses and other healthcare
professionals needed to react quickly. The COVID-19 pandemic resulted in many Australians
failing to seek care. The use of digital health and telehealth became an integral component
of key healthcare to ensure safe and effective care for persons.
Australian Digital Health Agency (2020, October, 27) The impact of digital health: In the word
of Australia’s healthcare providers. [Video] You Tube

Changes in the context of health care, and challenges such as the pandemic have given
impetus to the development of innovations in health care and digital health innovations.
These innovations themselves provide the source of ongoing research, future advancement
and better adaptation to the challenges that emerge in the future.
In this module you have explored some of the specific nursing practice implications of digital
health. Examples presented will alert you to the possibilities that digital health innovations
have for future health care across the scope of health care conditions and services in which
nurses practice. An important part of your professional development is to maintain
knowledge of these developments and their implications for your practice.
REFERENCES
Alam, Khorshed, Mahumud, Rashidul Alam, Alam, Fariha, Keramat, Syed Afroz, ErdiawKwasie, Michael O, & Sarker, Abdur Razzaque. (2019). Determinants of access to eHealth
services in regional Australia. International Journal of Medical Informatics (Shannon,
Ireland), 131, 103960–103960. https://doi.org/10.1016/j.ijmedinf.2019.103960
Australian Institute of Health and Welfare (2020). Framework for determinants of health.
Australia’s health data insights.
Brown Wilson, Christine, Slade, Christine, Wong, Wai Yee Amy, & Peacock, Ann. (2020).
Health care students experience of using digital technology in patient care: A scoping review
of the literature. Nurse Education Today, 95, 104580–104580.
https://doi.org/10.1016/j.nedt.2020.104580
Brown, Janie, Pope, Nicole, Bosco, Anna Maria, Mason, Jaci, & Morgan, Alani. (2020). Issues
affecting nurses’ capability to use digital technology at work: An integrative review. Journal
of Clinical Nursing, 29(15-16), 2801–2819. https://doi.org/10.1111/jocn.15321
Sin, Jacqueline, Henderson, Claire, Spain, Debbie, Cornelius, Victoria, Chen, Tao, & Gillard,
Steve. (2018). eHealth interventions for family carers of people with long term illness: A
promising approach? Clinical Psychology Review, 60, 109–125.
https://doi.org/10.1016/j.cpr.2018.01.008
Snyder, C. F., Wu, A. W., Miller, R. S., Jensen, R. E., Bantug, E. T., & Wolff, A. C. (2011). The role
of informatics in promoting patient-centered care. Cancer Journal (Sudbury, Mass.), 17(4),
211https://10.1097/PPO.0b013e318225ff89