EVALUATION OF MOBILE APPLICATIONS RELATED TO THE NURSING PROCESSABSTRACT
Objective: to evaluate the quality of applications related to the Nursing Process available on Google Play using the Mobile App Rating Scale (MARS).
Methods: a descriptive study, designed as an evaluation of mobile applications, in order to identify and evaluate applications related to the nursing process, available on the Android platform. The search was conducted on the Google Play store from September to October 2021. The Mobile App Rating Scale (MARS) was used to assess the quality of apps in the domains of engagement, functionality, aesthetics and information quality, and their respective items, on a five-point scale. The quality assessment was carried out by the authors of the study.
Results: a total of 53 applications related to the Nursing Process were identified, which were free and predominantly available in English (64%). The apps obtained an overall mean quality rating in the domains of engagement (3.1), functionality (4.8), aesthetics (4.6) and information quality (4.26).
Conclusion: the apps evaluated were of good quality overall. Engagement was identified as an aspect to be improved in the Nursing Process apps.
DESCRIPTORS:
Nursing process; Nursing informatics; Mobile apps; Educational technology
RESUMO
Objetivo: avaliar a qualidade de aplicativos relacionados ao Processo de Enfermagem disponíveis na base Google Play por meio da escala Mobile App Rating Scale (MARS).
Métodos: estudo descritivo, delineado como avaliação de aplicativos móveis, a fim de identificar e avaliar aplicativos relacionados ao Processo de enfermagem, disponíveis na plataforma Android. A busca foi conduzida na loja virtual da Google Play, no período de setembro a outubro de 2021. Foi utilizada a Mobile App Rating Scale (MARS) para avaliar a qualidade dos aplicativos nos domínios engajamento, funcionalidade, estética e qualidade da informação, e seus respectivos itens, numa escala de cinco pontos. A avaliação de qualidade foi realizada pelos autores do estudo.
Resultados: foram identificados 53 aplicativos relacionados ao Processo de Enfermagem, gratuitos e disponíveis predominantemente na língua inglesa (64%). Os aplicativos obtiveram na avaliação de qualidade média geral nos domínios engajamento (3,1), funcionalidade (4,8), estética (4,6) e qualidade da informação (4,26).
Conclusão: os aplicativos avaliados alcançaram boa qualidade de forma geral. O engajamento foi identificado como um aspecto a ser aperfeiçoado nos aplicativos sobre Processo de Enfermagem.
DESCRITORES:
Processo de enfermagem; Informática em enfermagem; Aplicativos móveis; Tecnologia educacional
RESUMEN
Objetivo: evaluar la calidad de las aplicaciones relacionadas al Proceso de Enfermería disponibles en la base de datos de Google Play utilizando la Escala de Calificación de Aplicaciones Móviles (MARS).
Métodos: estudio descriptivo, diseñado como evaluación de aplicaciones móviles, con el objetivo de identificar y evaluar aplicaciones relacionadas al Proceso de Enfermería, disponibles en la plataforma Android. La búsqueda se realizó en la tienda virtual Google Play, de septiembre a octubre de 2021. Se utilizó la Mobile App Rating Scale (MARS) para evaluar la calidad de las aplicaciones en los dominios de participación, funcionalidad, estética e calidad de la información, y sus respectivos ítems. en una escala de cinco puntos. La evaluación de calidad se llevó a cabo por los autores del estudio.
Resultados: se identificaron 53 aplicaciones relacionadas al Proceso de Enfermería, gratuitas y predominantemente disponibles en inglés (64%). Las aplicaciones obtuvieron una evaluación de calidad media general en los ámbitos de compromiso (3,1), funcionalidad (4,8), estética (4,6) e calidad de la información (4,26).
Conclusión: las solicitudes evaluadas alcanzaron buena calidad en general. El grado de participación fue identificado como aspecto a mejorar en las aplicaciones del Proceso de Enfermería.
DESCRIPTORES:
Proceso de enfermería; Informática de enfermería; Aplicaciones móviles; Tecnología educativa
INTRODUCTION
The adoption of mobile technologies, such as apps, is growing every day in various areas, whether for everyday activities such as eating and physical activity, or even to access and disseminate health information1-4.
Apps are mobile digital technologies for devices such as smartphones, and when related to health they are called Mobile Health (mHealth) or mobile health. These tools help professionals and users in various services, such as clinical assessment and monitoring, as well as facilitating the dissemination of scientific knowledge in an easy, practical and up-to-date way5-7.
The positive aspects and impacts of the use of apps in health are well known in terms of health literacy, support and access to information, use for patients in various health contexts8-10, use by health professionals in various specialties11-13, conducting scientific research14 and attracting participants for research15-16, among other examples that could be cited.
Furthermore, apps have played an important role in data collection and in optimizing the work process of healthcare professionals, due to the autonomous recording of information, facilitating patient monitoring and data sharing. They also contribute to improving health and clinical practice by supporting the development of skills, clinical judgment and decision-making1,5-6.
Mobile applications that explore stages of the Nursing Process (NP) can support and assist nurses in assessment, diagnosis and clinical decision-making, favoring access to information and quality of care4.
Federal Nursing Council Resolution 736/2024 provides for the implementation of the NP in every socio-environmental context where nursing care takes place. It is organized into five interrelated, interdependent, recurring and cyclical stages: Nursing Assessment; Nursing Diagnosis; Nursing Planning; Nursing Implementation; and Nursing Evolution17. Standardized Nursing Language Systems such as NANDA International Inc. (NANDA-I), the International Classification for Nursing Practice (ICNP®), the Nursing Interventions Classification (NIC), and the Nursing Outcome Classification (NOC) are used in the NP2.
The inclusion of apps in professional practice does not in itself guarantee effective performance if the information and objectives are unreliable7,18, so it is necessary for these resources to be evaluated for their technical quality and scientific content, so that they can be recommended for use or not in the context of NP.
Studies have been carried out to evaluate the quality of health applications19-22, to guarantee the safety, reliability and efficiency of the technology, as well as the quality and security of the information, a relevant aspect when it comes to instruments involving human health7,23.
Therefore, considering the exponential use of apps in nursing work processes, as well as the relevance of NP in nurses' professional practice, this research proposed evaluating the quality of NP-related apps available on Google Play, using the Mobile App Rating Scale (MARS).
METHOD
A descriptive study, designed as an evaluation of mobile applications, in order to identify and evaluate applications related to NP, available on the Android operating system platform. The study is restricted to the Android platform and the Google Play store, as this is currently the largest base of apps available.
The following steps were taken: (1) writing the research question, (2) designing the protocol, (3) determining the eligibility criteria, (4) conducting the search and finding applications, (5) extracting the data, (6) assessing quality and functionality and (7) analyzing and summarizing the results24.
The research question is presented using the acronym TECH, a strategy for analyzing apps24. Target Use (T): nurses; Evaluation Focus (E): engagement, functionality, aesthetics and information quality; Connectedness (C): available on the Android platform; Health Domain (H): Nursing Process. Research question: what is the evaluation of the engagement, functionality, aesthetics and information quality of the Nursing Process apps available for the Android platform?
The search was conducted by the researchers in the Google Play store from 09/28/2021 to 10/04/2021. The search terms used were: Nursing process, Systematization of nursing care, ICNP, NANDA, Nursing classification, Nursing consultation, Nursing diagnosis, Nursing intervention and Nursing results.
Included in the study were apps that referred to the NP stages, were free and available in Portuguese, English or Spanish. Applications in the form of games were excluded, since the main interest of the study was directed at the nurses' work process in health care.
The applications were evaluated by the authors. The evaluation used the Mobile App Rating Scale (MARS)25 a tool developed by the Queensland University of Technology, which consists of four domains and 19 items, namely: engagement (entertainment, interest, personalization, interactivity and target group), functionality (performance, ease of use, navigation and design), aesthetics (layout, graphics, visual appeal) and information quality (accuracy of description, goals, quality of information, quantity of information, visual information, credibility and evidence base). The scale has a subjective category, but this was not used in the study as it consists of questions that involve perceptions of the user's individual context.
The engagement domain assessed whether the apps were fun, interesting, interactive, had customizable features and met the expectations of the target audience. In the functionality domain, the accuracy and speed of the apps, ease of use, design and navigation were observed. In terms of aesthetics, the layout, resolution, quality of graphics and appearance of the app were evaluated. In information, we evaluated whether the app matches what was described in the app store, whether the objectives are presented, the quality and quantity of the information, visual information, as well as credibility and whether it is evidence-based.
Each domain was assessed on a five-point scale: 1: inadequate, 2: insufficient, 3: acceptable, 4: good and 5: excellent. The final score was calculated based on the mean of the four domains of the scale25.
A total of 2,159 apps were found: 193 with the search term “Systematization of nursing care”; 221 with the term “ICNP”; 248 with the term “NANDA” AND “Nursing classification”; 249 with the term “Nursing consultation”; and 250 apps with the terms “Nursing process” AND “Nursing diagnosis” AND “Nursing intervention” AND “Nursing results”.
Fifty-three apps were included for evaluation using the MARS scale. The flowchart for identifying and screening the applications is shown in Figure 1.
The data was entered into Microsoft Excel software and is presented in tables and charts. The Moto G9Plus device was used to evaluate the apps, which was conducted by the study's principal investigator and checked by a second evaluator.
This study did not need to be examined by the Research Ethics Committee, as it used public data and did not involve human beings. The review was conducted using the Reporting systematic reviews and meta-analyses (PRISMA).
RESULTS
A total of 53 free NP-related apps were included. The characterization of the apps evaluated in the study is shown in Chart 1.
Applications related to the Nursing Process available in the Google Play Store. Botucatu, SP, Brazil, 2021.
As for the main language of the apps, 17 were in Portuguese, two in Spanish and 34 in English. There was a predominance of English (64%) in the apps included.
Some of the apps we evaluated were free to download, but had some paid features.
All the apps included in the study had a free rating, with recent updates, the oldest update being on 06/13/2019, in the “Diane - Diagnoses, Nursing Prescriptions” app. The “Integumentary Nursing Care Plans” and “Respiratory Nursing Care Plans” apps had no information on the date of update.
Chart 2 shows the app evaluation scores according to the MARS instrument.
Evaluation of applications related to the Nursing Process, based on the Mobile App Rating Scale. Botucatu, SP, Brazil, 2021.
The means obtained for each domain were: engagement (3.1), functionality (4.8), aesthetics (4.66) and information quality (4.26).
Most of the apps lacked entertainment features to promote user engagement. On the other hand, those with this feature contained interactivity strategies such as sharing mode or the option to favorite content.
In terms of functionality and aesthetics, most of them were easy to use, not slow to navigate and had an appropriate layout. The information contained in the apps was generally high quality, based on scientific literature and had a list of references.
The apps “Amamenta”, “Cirúrgico”, “Enfermagem & Violência”, “Nursebook: Técnico Enfermagem” and ‘Ped’, had similar scores on the MARS scale, with the highest means (4.77). The first three apps mentioned have the same layout and functionalities, differing only in the subject of the content covered. The apps that obtained the highest mean scores had engagement strategies, using case studies or quizzes, as well as information supported by scientific evidence.
Some of the apps analyzed only had care plans for certain health conditions, relating to one of the NP stages. Others made books available for reading and consultation, and allowed free access to chapters, as well as the possibility of buying the app to access the material in full.
The “CIAP-2” and “CIAP” applications are catalogs of the International Classification of Primary Care (ICPC), which provide codes related to the recording of symptoms, complaints and procedures carried out in primary health care. The CIAP was considered part of the NP at the stages of data collection and implementation of nursing care.
The apps “PEET”, “Nursing diagnoses”, “Nurse diagnoses”, “Diane - Diagnoses, Nursing prescriptions”, “Nurse Companion”, “Patrones de Vincilacion NANDA” use NANDA-I as a reference. The “CIPE-APS” and “Cipe Violência” apps used ICNP®. Some apps used both NANDA and ICNP®, such as the “Amamenta”, “Enfermagem e Violência” and “Ped” apps.
In short, most of the apps can be used in both hospital and primary care, but the “Surgical” and “Surgery and Perioperative Nursing Care Plans” apps are aimed at hospital care and the “SAE in Primary Care”, “CIAP-2”, “CIAP” and “CIPE-APS” apps are aimed at primary care.
The category with the lowest overall mean was engagement (3.1), since most of the apps evaluated did not have features that stimulated the user's attention, such as gamification, quizzes or case studies.
DISCUSSION
When analyzing the 53 apps for the different healthcare scenarios, it can be considered that they are easy to access, i.e. they do not require technical knowledge on the part of the user to learn how to use the available resources.
We are living in a time when a large part of the population owns a smartphone, which means that access to information is simple, with just one touch and the possibility of being connected 24 hours a day. Added to this, the industry is producing cell phones with more and more functions, and the advance in the development of technologies, encompassing health26. This shows the importance of incorporating these resources into public health policies.
As in many areas, the use of information technology tools, such as text or voice messages, videos, calls and the use of mobile applications designed to increase access to care, is exponential in the health sector. Telehealth is one of the activities that incorporate these resources, a modality used by many countries, and with a significant increase in the period of the COVID-19 pandemic, due to the need for distance1.
Apps can facilitate the work process of nurses and improve the quality of care, as they have the potential to offer interactive, agile tools, and to aid quick and safe decision-making, based on evidence to support professionals in the NP4.
Even though NP is an activity regulated by COFEN, and its relevance is well known, there can still be barriers to its implementation in practice, for various reasons, such as work overload, lack of professional qualification and lack of an organizational culture, making it difficult to understand its relevance and make decisions in clinical care21. Furthermore, the complexity of the NP and nurses' lack of familiarity with the methodology can make its implementation challenging for some professionals. There is also resistance to change in some healthcare institutions, where the organizational culture may not be conducive to implementing this practice and new technologies such as apps27.
Positive aspects of using apps have been identified, such as: Updated databases with diagnoses, interventions and nursing outcomes, allowing nurses to quickly access relevant information during the NP; Standardization of protocols and guidelines, helping to ensure that nurses follow a systematic approach, regardless of their level of experience; Monitoring and recording of data, which reduces recording errors, facilitates follow-up and enables subsequent analysis to improve the quality of care; Alerts and reminders, by receiving notifications and reminders about specific tasks related to the NP, helping to ensure that nothing is forgotten during patient care; and continuing education on the subject21.
Thus, the successful implementation of mobile apps for NP requires proper planning, involvement of nurses from the beginning of the process, adequate training and ongoing support. In addition, it is essential to guarantee the security and privacy of patient information when using these applications. Above all, since the incorporation of mobile applications aimed at NP can be a valuable solution to address the challenges of current nursing practice; they can also support nurses in the implementation of NP, to favor quality care and to contribute to the improvement of patients' clinical outcomes28.
Nursing provides care that directly affects the health of the user, so it is important that mobile applications developed for this purpose are based on current scientific evidence, but there is a need for research that evaluates the quality of apps29, to contribute to their quality9.
However, many applications limit themselves to presenting the NP in a superficial way or address only one stage of the NP. In addition, they do not explain in their theoretical body the basis of nursing theories, predominantly the use of Basic Human Needs with the reference of Wanda Horta22.
Even though apps are useful, accessible and practical tools, they still don't achieve the necessary engagement or the desired accessibility. It is therefore hoped that the development of these technologies for health professionals can be based on the target audience, ensuring that they are designed for real use by potential users6,30.
It should be emphasized that the contribution of this study to the field of nursing is associated with bringing greater visibility to apps as a tool designed to support the nurses' work process in implementing the NP. A limitation of the study is that only one of the researchers evaluated the applications.
For future studies, it is recommended that apps can be peer-reviewed using robust instruments, in order to contribute to the quality of these technologies, since few studies have been identified from this perspective. In this way, the results of this research may motivate broader studies evaluating the quality of apps in health and nursing.
CONCLUSION
This study made it possible to analyze mobile applications related to NP, available on the Android operating system, in terms of engagement, functionality, aesthetics and information, and it is inferred that there is national and international production on the subject and they present important information that can support nursing training and care practice.
The apps evaluated obtained a good overall mean score on the MARS scale, showing good quality. Engagement was identified as an aspect to be improved in the apps.
Furthermore, the importance of new app quality assessment studies and the development of free apps related to NP, available in Portuguese, has been identified. Above all, it is recommended that developers take into account in the development process the characteristics used to evaluate the quality of apps, as presented by MARS.
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NOTES
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ORIGIN OF THE ARTICLE
Residency Conclusion Paper - Evaluation of Mobile Applications Related to the Nursing Process, presented to the Multiprofessional Residency Program in Family Health, Faculty of Medicine, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Botucatu Campus, in 2022.
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FUNDING INFORMATION
Fundação de Amparo à Pesquisa e ao Desenvolvimento Científico e Tecnológico do Maranhão (FAPEMA), number BD-10348/22, through notice No. 13/2022.
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TRANSLATED BY
Agência LatinTrad - Leonardo Parachú
