PALIENF DEVELOPMENT AND ASSESSMENT: APPLICATION FOR RECORDING ONCOPEDIATRIC PALLIATIVE CAREABSTRACT
Objective: to present the development stages and assess the usability of an application to assist nurses in recording the nursing process for the pediatric oncology population in palliative care.
Method: this is methodological research based on User-Centered Design carried out in Niterói, Rio de Janeiro, Brazil, in three stages: content definition; application development; and usability assessment. The application was developed between 2020 and 2023, and usability assessment was carried out between March and May 2023 by 39 participants, nurses specializing in palliative care and information technology professionals. The tools used to assess usability were MATCH-MED and System Usability Scale. They were presented descriptively.
Results: the study generated four products, one brand, two slogans and the application itself on the Android system, with data security, architecture and application in Javascript. Regarding usability assessment, it was considered high or very high by 100 % of the information technology professionals who assessed the heuristics in the second round and excellent by the mean of 84.4 points in nurses’ assessment considering practice, evidencing the tool acceptance.
Conclusion: the study developed and assessed the PaliEnf application, which aims to contribute to nurses’ practice in assisting in the execution and recording of daily care for children diagnosed with cancer in palliative care. Clinical studies that seek to assess the effectiveness and impact on quality of care and nursing records are underway.
DESCRIPTORS:
Mobile applications; Nursing process; Nursing records; Palliative care; Oncology nursing; Pediatrics
RESUMO
Objetivo: apresentar as etapas de desenvolvimento e avaliar a usabilidade de um aplicativo para auxiliar os enfermeiros no registro do processo de enfermagem para a população oncológica pediátrica em cuidados paliativos.
Método: pesquisa metodológica baseada em Design Centrado no Usuário realizada em Niterói, Rio de Janeiro, Brasil, em três etapas: definição do conteúdo, desenvolvimento do aplicativo e avaliação da usabilidade. O desenvolvimento do aplicativo ocorreu entre 2020 e 2023 e a avaliação da usabilidade entre março e May de 2023 por 39 participantes enfermeiros especialistas em cuidados paliativos e profissionais de tecnologia da informação. As ferramentas utilizadas para avaliação da usabilidade foram: MATCH-MED e System Usability Scale. Foram apresentados de forma descritiva.
Resultados: O estudo gerou quatro produtos, uma marca, dois slogans e o próprio aplicativo em sistema Android. A segurança dos dados, arquitetura e aplicação em Javascript. Quanto a avaliação da usabilidade, foi considerada alta ou muito alta por 100 % dos profissionais de tecnologia da informação que avaliaram as heurísticas na segunda rodada e excelente pela média de 84,4 pontos na avaliação dos enfermeiros considerando a prática, evidenciando a aceitação da ferramenta.
Conclusão: O estudo desenvolveu e avaliou o aplicativo PaliEnf que objetiva contribuir para a prática dos enfermeiros no auxílio a execução e registro dos cuidados diários as crianças com diagnóstico de câncer em cuidados paliativos. Estudos clínicos que buscam avaliar a eficácia e o impacto na qualidade da assistência e no registro de enfermagem estão em andamento.
DESCRITORES:
Aplicativos móveis; Processo de enfermagem; Registros de enfermagem; Cuidados paliativos; Enfermagem oncológica; Pediatria
RESUMEN
Objetivo: presentar las etapas de desarrollo y evaluar la usabilidad de una aplicación para ayudar a las enfermeras a registrar el proceso de enfermería para la población oncológica pediátrica en cuidados paliativos.
Método: investigación metodológica basada en el Diseño Centrado en el Usuario realizada en Niterói, Rio de Janeiro, Brazil, en tres etapas: definición de contenido, desarrollo de la aplicación y evaluación de usabilidad. La aplicación fue desarrollada entre 2020 y 2023 y su usabilidad fue evaluada entre marzo y mayo de 2023 por 39 participantes, enfermeras especializadas en cuidados paliativos y profesionales de tecnologías de la información. Las herramientas utilizadas para evaluar la usabilidad fueron MATCH-MED y System Usability Scale. Fueron presentados de manera descriptiva.
Resultados: el estudio generó cuatro productos, una marca, dos eslóganes y la propia aplicación Android. Seguridad de datos, arquitectura y aplicación en Javascript. En cuanto a la evaluación de usabilidad, fue considerada alta o muy alta por el 100 % de los profesionales de tecnología de la información que evaluaron las heurísticas en la segunda ronda y excelente por el promedio de 84,4 puntos en la evaluación de los enfermeros considerando la práctica, evidenciando la aceptación de la herramienta.
Conclusión: el estudio desarrolló y evaluó la aplicación PaliEnf, que tiene como objetivo contribuir a la práctica de los enfermeros en la asistencia en la ejecución y registro del cuidado diario a niños diagnosticados con cáncer en cuidados paliativos. Se están realizando estudios clínicos que buscan evaluar la efectividad y el impacto en la calidad de la atención y los registros de enfermería.
DESCRIPTORES:
Aplicaciones móviles; Proceso de enfermería; Registros de enfermería; Cuidados paliativos; Enfermería oncológica; Pediatría
INTRODUCTION
The quality of nursing records is considered one of the most important indicators for assessing the quality of care provided to patients1. However, some research points to serious inconsistencies in nursing records, such as the absence of patient and professional identification data, incomplete prescription and intervention data, lack of information on complaints and therapeutic plans, use of non-standardized acronyms, illegible notes, among others1-3.
A study conducted in the state of Espírito Santo assessed nurses’ perceptions of the relevance of nursing records in patient care in emergency situations. The results showed that nurses have superficial knowledge of the nursing process (NP), which is rarely used in records, citing reduced time and insufficient human resources4.
Supporting this data, studies that assessed the quality of nursing records demonstrate that nurses understand the importance and obligation of records, but do not consider them a priority in relation to the care provided to patients5-7. This aspect presents itself as a serious gap in the development of the profession. Therefore, investment in continuing education is recommended, implementation of actions aimed at carrying out nursing records with excellence, use of tools that promote change and the implementation of technology with a view to assisting nurses in the recording process6-8.
Therefore, researchers have used technology through the development of applications to promote nursing record qualification. Among these applications are SNAKE WOUND, developed to direct the care of patients who have been victims of accidents caused by the Bothropic species, using NP9, TecDEnf, aimed at the teaching and learning process for the electronic recording of nursing diagnoses10, and PREHSystem, aimed at nursing care records in pre-hospital care11.
These studies demonstrate that the use of applications can assist nurses in NP implementation and recording. However, no studies were found in the context of palliative care in pediatric oncology. An area of practice in which nurses aim to control children’s suffering in the biopsychosocial and spiritual spheres through symptom prevention and control12. To achieve this goal, it is essential to correctly apply and record all stages of NP, as comprehensive data collection supports the identification of accurate diagnoses, specific interventions to achieve planned results, in addition to monitoring and continuity of the care provided, which is possible through interprofessional communication resulting from well-described records in children’s medical records6.
Thus, in order to contribute to promoting NP application and recording in this area of nursing activity, the study aimed to present the development stages and assess the usability of an application to assist nurses in recording NP for the pediatric oncology population in palliative care.
METHOD
This is methodological research13 that developed and assessed the usability of an application for executing and recording NP with the NANDA International Nursing Diagnosis Classification (NANDA-I), Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC) Standardized Language Systems (SLS) for the pediatric population diagnosed with cancer in palliative care in three stages: content development; application development; and usability assessment. It was carried out in the city of Niterói, Rio de Janeiro, between 2020 and 2023.
For the application development stage, the User-Centered Design method was used, which has a broad approach. According to this method, all methodological stages of development must be thought of according to the context of use of the technological tool and the requirements provided by users14. Thus, the application was designed and developed to assist nurses intuitively through the interconnections of interfaces along the NP lines in planning palliative care for children diagnosed with cancer.
Content definition
For the application content, a previous study was used, in which the “Instrumento de Cuidados Paliativos de Enfermagem para Terapia Intensiva Oncológica Pediátrica” was developed and validated15-16. However, although the aforementioned instrument was the basis for developing the application, there is the possibility of it being used in different settings with the pediatric oncology public, and its effectiveness may be proven through future clinical studies.
Application development
The team that participated in the application development between January 2020 and February 2023 was composed of seven professionals: three nurses, three developers and one nursing student. During the development period, the team met monthly to define the stages to be developed and assess each development process.
Regarding duties and responsibilities, the participating nurses and nursing students actively participated in all stages of development. Between February and November 2020, the application name was defined; the trademark registration application was filed with the Instituto Nacional da Propriedade Industrial (INPI); and the color palette was selected. With the contribution of two contracted designers, work was done on creating an image that captured the meaning of palliative care in pediatric oncology with the following suggestions: children without hair, referring to oncology, the golden ribbon that symbolizes awareness of early detection of childhood cancer, and the blue butterfly, symbol of palliative care.
In November 2020, three developers were invited to join the team and were responsible for developing the application. An intense exchange of knowledge among professionals was necessary so that the application would meet the technical, operational and practical objectives to assist nurses in the NP implementation and recording with SLS. The application was developed between November 2020 and January 2024.
During this period, it was decided that the application should contain the extensive content of the nursing care instrument, to be presented to users as an easy, dynamic and intuitive tool that could encourage nurses to perform all NP stages in their care quickly and that would generate a complete record for the children’s electronic medical record. The Android operating system was chosen, considering the applicability of the tool in a real-world context, where a tablet or smartphone would act in place of paper and pen. This made it possible to develop an easy-to-use interface without requiring major prior knowledge of how to handle the device by users.
The technology used to create the interface was React, the same technology used by Facebook in its products such as Instagram and Facebook itself. The structure responsible for data handling was built in Java with the Quarkus framework, which allows high scalability for systems deployed in the cloud, allowing the application to always be accessible regardless of the number of users. The c-type system was built with modern tools combining React and Quarkus technologies, allowing easy expansion to new functionalities.
Concerning data security, the architecture and application consist of a Javascript frontend using the React Native framework and a Java backend using the Quarkus framework. The frontend is an application that was not made available on the App Store but was manually installed on specific devices that will only be used in hospital areas with specific access permission for nurse users. For authentication, the encryption standard called Json Web Token or JWT was used, which uses a signature with a private secret or a public/private key, so backend endpoints are only accessible through keys.
The application interfaces were designed to be intuitive, i.e., one page would lead to another dynamically, helping nurses to automatically complete each page using clinical reasoning in the course of completing each page, thus planning nursing care in a shorter period of time based on NP stages. This was the process that required the most time, due to the excess of information to be entered; each page was re-assessed numerous times by the development team until the first version was reached.
Usability assessment
To assess the application usability, an assessment of heuristics was carried out, which aims to indicate possible interface errors, without the participation of end users17, and practical usability, which aims to obtain the end user’s assessment.
According to the NBR ISO/IEC 14598-6 standard, there must be at least eight evaluators for each category in the usability assessment; the standard does not specify a maximum number of evaluators18. Therefore, in this research, 21 participants assessed the usability heuristics, considering professionals and professors with expertise in the development of information technologies, applications and software as inclusion criteria. Practical usability was assessed by 18 nursing professionals with experience in pediatric oncology or pediatric palliative care, considering as inclusion criteria criteria guided by Jasper19: having a set of specialized knowledge or skills; having extensive experience in the practical field; having highly developed levels of pattern recognition; being recognized by others. There were no exclusions.
To select participants, nominations were requested from professionals in the Universidade Federal Fluminense “Study Group on Systematization of Nursing Care” (GESAE) and “Research and Study Center on Comprehensive Health for Children and Adolescents” (NUPESICA) registered in the Directory of Research Groups of the Brazilian National Council for Scientific and Technological Development (In Portuguese, Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq).
Those nominated were contacted by email or WhatsApp. Those who responded, met the inclusion criteria and agreed to participate in the research were asked to indicate other potential participants, successively. Thus, for usability heuristics assessment, 22 participants were invited in the first round, of which six did not respond, three did not meet the inclusion criteria and 13 participated in the research.
In the second round, 18 participants were invited, 10 did not respond and eight participated in the survey. Concerning practical usability, 20 nurses were invited, two did not meet the inclusion criteria and 18 participated in the survey.
Initially, usability heuristics were assessed using the MATCH-MED: Heurísticas de usabilidade instrument17, which consists of a checklist to operationalize usability assessment in mHealth applications. This checklist consists of 43 items divided into 11 heuristics: application status visibility; correspondence between the application and the real world; user control and freedom; consistency and standards; error prevention; recognition instead of recall; efficiency and flexibility; aesthetics and minimalist design; physical and ergonomic interaction; readability; quick visualization and workflow.
Data were collected in 60-minute online meetings via Google Meet with participants in April 2023. During the meetings, the computer screen was shared with participants, and the application, all interfaces and functionalities were presented. After the application was presented, participants used the link provided to access and respond to the MATcH-MED online usability assessment checklist and assessed the application usability. Participants were also asked to provide criticisms and suggestions for improvements. Two rounds of assessment were necessary at this stage.
In the practical usability assessment, in-person meetings were scheduled with each nurse in May 2023. During these meetings, nurses were able to use the application or tablet provided by the researcher and perform all of its functionalities, simulating real care. The tests lasted a mean of 40 minutes. At the end, nurses assessed usability using the System Usability Scale (SUS), in a version translated and validated for Portuguese20.
Data analysis
For heuritic analysis, the MATCH-MED: Heurísticas de usabilidade developers make it available free of charge on the website http://match.inf.ufsc.br:90/matchmed/index.html to be filled out, with four options for each heuristic: yes, partially, does not meet, does not apply. After answering and sending, the result is transmitted with a final score that indicates the application usability degree. The result can be very low usability, low usability, reasonable usability, high usability and very high usability.
It was considered satisfactory when 80 % or more of participants obtained high or very high usability in their assessments. As this did not occur in the first round, the application was revised and underwent a second round of assessment.
Regarding practical usability, nurses answered 10 questions from the SUS with 5 response options on a Likert-type scale ranging from “strongly disagree” to “strongly agree.” The items answered included: “I would like to use the product frequently; complexity of the product; ease of use; requires help to use it; the functionalities were well integrated; there were many inconsistencies; they quickly learn how to use the product; it is complicated to use; confidence in using the product; need for prior learning before being able to use the product.”
The analysis was performed as follows: for odd-numbered answers (1, 3, 5), 1 was subtracted from the score given by users; for even-numbered answers (2 and 4), the answer was subtracted from 5. In other words, if a user answered 2, 3 was counted, and if a user answered 4, 1 was counted. Subsequently, all the values of the ten questions were added together and multiplied by 2.5. This is the final score, which can range from 0 to 100. The mean score for the SUS is 68. Therefore, the application can be considered to have good practical usability when 80 % or more of nurses’ results are greater than 70 points, and excellent usability when 80 % or more of nurses’ results are greater than 90 points. If the 70 points are not achieved by at least 80 % of participants, adjustments to the application and reassessment are necessary. A second round of assessment was not necessary at this stage.
Ethical aspects
The study complied with the General Personal Data Protection Law 13,709/2018 21 and Resolution 466/12 22 of the Brazilian National Health Council. It was approved by the Universidade Federal Fluminense Research Ethics Committee. All study participants signed the Informed Consent Form.
RESULTS
The application content was defined based on the Instrumento Assistencial de Enfermagem para Cuidados Paliativos Pediátricos Oncológicos, consisting of objective and subjective data collection, nursing diagnoses, goal planning, nursing interventions and assessment of nursing outcomes based on the NANDA-I-NIC-NOC SLS aimed at the pediatric population diagnosed with cancer in palliative care.
During the application development, the name for the application was defined by assuming that it should be short to fit in the icon, represent the assistance provided, palliative care, the nurses performing the care and children diagnosed with cancer, since the assistance provided with the help of the application was intended for a specific population. Therefore, it was decided to have a name associated with an image, a specific brand that represented the application.
Thus, the name chosen was PaliEnf, in which Pali represents “cuidados paliativos” (palliative care) and Enf represents “enfermeiros” (nurses). Two images were chosen to compose PaliEnf, the first was used in the application icon and the second on the loading page. The main color palette was defined as petroleum blue, which represents palliative care, gold, which represents pediatric oncology, and light gray, as shown respectively in Figure 1.
Both logos have the AVCTORIS certificate with the name PaliEnf and PaliEnf Borboleta Azul. The PaliEnf brand has the Trademark Registration Certificate from INPI under 926938878, with nominative presentation, product/service brand nature, NCL11: 44 and nursing specification (class 44).
The final version of PaliEnf presents a certain complexity in the technological aspect, as it managed to capture all the nursing care instrument content that contains 30 pages, containing the collection of biopsychosocial data from children and adolescents in palliative care, 71 NANDA-I nursing diagnoses validated for this patient profile and the links between NIC nursing interventions and NOC outcomes, personal information, history of current and previous illness, with interconnections of the interfaces.
Thus, despite the amount of internal data, the developers managed to make using PaliEnf fun due to the internal dynamics of the interfaces, favoring the complete filling of information and generating a report at the end of assessment to be included in patients’ medical record, as demonstrated in Figure 2, and in Figure 3, it is possible to visualize some PaliEnf interfaces.
PaliEnf does not replace patients’ medical record; it is a tool that assists nurses in performing NP with SLS, facilitating clinical reasoning. It was developed with compatibility only for Android devices, but is not available on Play Store, as access is only possible by sharing the link, and the data entered in it is not deposited on the network, in order to provide greater security. It has the Computer Program Registration Certificate, with INPI, Process BR512023002490-2.
Usability assessment
After the first version of PaliEnf was finalized, it was subjected to a usability heuristics assessment, with the aim of identifying possible technical problems and correcting them. In this process, 13 professionals performed a usability assessment in the first round.
Regarding the level of education, 30.7 % (n=4) of participants were undergraduate students in information technology; 38.4 % (n=5) were graduate students; 15.3 % (n=2) had graduate degrees; and 15.3 % (n=2) had master’s degrees. All participants had experience in application development; 30.8 % (n=4) were developing or participating in the development of applications during their undergraduate course in information technology; 30.8 % (n=4) worked professionally developing and assessing applications and software, creating websites, modeling anatomical parts and 3D printing; 7.6 % (n=1) were professors, where they share knowledge about the development of applications, websites and software in general; 30.8 % (n=4) followed the development, functionality and usability assessment of their own applications, therefore having knowledge of the entire process.
According to the MATCH-MED checklist results, 38.4 % (n=5) of participants considered the usability of PaliEnf to be reasonable; 46.1 % (n=6) considered usability to be high; and 15.3 % (n=2) considered usability to be very high. Therefore, 61.5 % (n=8) of participants considered usability to be high or very high.
As the usability of PaliEnf according to the MATCH-MED checklist was below expectations, an analysis was made of the criticisms and suggestions made by participants, which could have reduced usability in order to be corrected.
Among the problems were: the absence of the password reveal icon on the access page; the ID card field on the registration page recognized any number even if it was not compatible with an ID card; on the home page, there was a help icon that did not actually have this function, but rather to report a problem, suggesting that the icon’s name be changed so that it fulfilled the function described; on the pages intended for physical examination, eliminations and spiritual psychosocial assessment, in addition to the click options, there was space for typed descriptions in situations where there were no options that portrayed children’s clinical situation, suggesting that the description option be added to all fields; and some icons were small in relation to the names they contained, suggesting that they be adapted. These suggestions were fully met.
After adjustments, PaliEnf went through the second round of assessment, in which eight professionals carried out the assessment. As for the level of education, 12.5 % (n=1) were undergraduate students; 25 % (n=2) were graduate students; and 62.5 % (n=5) held a master’s degree. All participants had experience in application development; 12.5 % (n=1) were professors where they work, sharing knowledge about application, website and software development in general; 25 % (n=2) worked professionally developing and assessing applications and software and creating websites; 62.5 % (n=5) followed the development, functionality and usability assessment of their own applications, therefore having knowledge of the entire process.
At this stage, 62.5 % (n=5) of participants considered the usability of PaliEnf to be high; and 37.5 % (n=3) considered usability to be very high. Therefore, 100 % (n=8) of participants considered usability to be high or very high, as shown in Table 1. PaliEnf was released for practical assessment.
The population that assessed practical usability was 18 nurses, 11 of whom were specialists in pediatric oncology with more than five years of experience, three with master’s degrees and four with doctoral degrees with dissertations/theses on themes related to pediatric oncology or pediatric palliative care. All of them worked in an oncology hospital in pediatric sectors during the data collection period. Their ages ranged from 28 to 50 years, with a mean of 40.6 years. In terms of gender, 22.2 % (n=4) were male and 77.8 % (n=14) were female.
In the assessment process, nurses answered the SUS after using PaliEnf (the mean time nurses used PaliEnf was twenty minutes). As shown in Table 2, 5.5 % (n=1) of nurses generated less than 70 points; 55.5 % (n=10) of nurses generated between 70 and 90 points; and 38.8 % (n=7) nurses generated more than 90 points, configuring a mean of 84.4 points, which characterizes excellent usability.
DISCUSSION
Through this study, the PaliEnf application was developed, which has very high usability according to heuristic assessments, configuring good aesthetics, design, few system bugs, good connection between interfaces, guidance messages for users such as “successfully saved”, among others, and excellent practical usability, i.e., nurses were able to perform all the stages of NP and generate the record for children’s medical records.
NP comprises the scientific knowledge that guides care, organizes nursing practice and records that reflect the quality of care provided. Although legislation is clear in holding nurses accountable for the duty to adequately record in its entirety the information arising from the care processes, studies support that nurses demonstrate a lack of in-depth knowledge about NP, resulting in poor execution and incomplete and incorrect records4,23.
This occurs mainly due to the influence of the work culture that exposes nursing to an exhausting workload, inadequate staffing, poor working conditions and little visibility for NP, which does not favor a paradigm shift in the way nurses understand and perform their work4. Therefore, the development of applications with PaliEnf is relevant and contributes to resolving this gap in nursing professionals’ practice.
Supporting PaliEnf, in order to assist nurses in the execution and recording of NP, researchers have developed technologies with good results. At the Universidade Federal de Pernambuco, researchers built a prototype that aims to assist nurses in the execution of NP for renal patients. Although it is a prototype, it highlights the real possibility of developing it, and may encourage other researchers to follow this path24. In another study, the Nursing APHMóveis application was developed by researchers from the Universidade Federal do Paraná to assist nurses from the Mobile Emergency Care Service (In Portuguese, Serviço de Atendimento Móvel de Urgência - SAMU) in carrying out the NP25.
The choice of the mobile application is in line with the daily lives of people in the 21st century, who are adapted to using applications to meet different needs and conditions, because they offer quick solutions to everyday demands, and can be used to inform, instruct, record, display, guide, alert and communicate with both professionals and patients26.
Considering this, when developing PaliEnf, we opted for an application rather than a computer software, because nurses can take the application with them to the children’s bedside and record the information as they examine and collect it. This makes it easier for nurses to not forget any information, speed up the process, since most of the information is entered without the need for typing, helps them to qualify the assistance by individualizing care, since proximity allows the participation of children and their companions in the selection of outcome indicators and interventions, reducing time, since nurses will not need to set aside another time for recording.
Supporting these statements, a multicenter study exploring the benefits of integrating and adopting technologies in healthcare from nurses’ perspective in four university hospitals in Kerman, Iran, concluded that care provided with the help of technology is more accurate, improves records, quality of care, medication management and inter-institutional communication27.
When an application is developed, especially for the health sector, usability assessment is essential. Heuristic data assesses system suitability from users’ point of view and the quality from the engineering and construction perspective24. In the analysis of heuristics, evaluators can suggest solutions to problems of effectiveness and user experience, identify strengths and weaknesses that can be considered for the final version28.
Thus, heuristics assessment was fundamental, through them it was possible to identify flaws and add important points to make PaliEnf with good practical usability for end users, of which 100 % of nurses who assessed agreed that they would like to use PaliEnf frequently, that it is easy to use and that the various functions were well integrated according to the analysis of questions one, three and five of the SUS.
These usability assessment methods were ratified by other studies that also developed health applications, such as Quimio em Casa, a useful application in the daily lives of children and adolescents with cancer who are treated with oral antineoplastics at home and their families to clarify doubts about treatment and its side effects29, and OrtogApp, an educational application that offers patients undergoing orthognathic surgery comfort during the postoperative period by having important information for their recovery at their fingertips26. Both applications received good usability ratings.
However, although well assessed in usability tests, the studies still do not present clinical results of effectiveness, efficiency, and real benefits for patients and nursing. Such studies are necessary to assess possible barriers in the implementation of technologies, such as resistance from professionals or challenges in integration with existing hospital systems.
Regarding security, PaliEnf was developed in compliance with the General Data Protection Law. The backend architecture is hosted on Amazon Web Service with a cloud architecture orientation, where the machines are located on private subnets and are not accessible via the internet on public subnets. The application is not available on the Play store, and nurses must be registered by the service administrator to access the application.
In relation to the study limitations, it is worth noting that the PaliEnf application is not available in the IOS system, and its operation depends on the provision of internet, electronic medical records or a printer that allows the record to be attached to the physical medical record. This makes its use expensive and unfeasible for some centers. Another limiting aspect is the choice of a NANDA-I-NIC-NOC SLS, as it requires knowledge by nurses and restricts implementation in centers that choose to use other SLSs. The development of the application was not based on a technical standard.
Concerning PaliEnf effectiveness and applicability assessment in healthcare practice, a clinical study in a real environment is underway and the results will be published upon completion.
CONCLUSION
Through this study, it was possible to develop and assess the usability of the PaliEnf application, a technological innovation in health that was considered to have very high usability according to heuristics and excellent practical usability.
Thus, the use of the PaliEnf application contributes to nurses’ practice by assisting them in the execution of daily care for children diagnosed with cancer in palliative care by directing them in data collection and diagnostic and therapeutic clinical reasoning through the NANDA-I-NIC-NOC link and promotes the complete recording of NP, which is essential for continuity of care and reassessment of nursing outcomes.
Therefore, the PaliEnf application is a tool that can contribute to the quality of nursing care provided to children diagnosed with cancer in palliative care and to the quality of nursing records, in addition to the possibility of integration with electronic medical records when available. However, the effectiveness of PaliEnf in a real-world practice environment has not yet been proven, and studies with this objective are ongoing.
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NOTES
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ORIGIN OF THE ARTICLE
Excerpt from the thesis - Elaboração, avaliação de usabilidade e efeito da Tecnologia PaliEnf na qualidade dos registros dos enfermeiros em uma Unidade de Terapia Intensiva Pediátrica Oncológica - estudo quase-experimental, presented to the Academic Program of Health Care Sciences, Universidade Federal Fluminense, in 2024.
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APPROVAL OF ETHICS COMMITTEE IN RESEARCH
Approved by the Ethics Committee in Research of the Universidade Federal Fluminense, under Opinion 6.101.871/2023 and Certificate of Presentation for Ethical Assessment 67104323.3.0000.5243.
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TRANSLATED BY
Letícia Belasco.
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DATA AVAILABILITY
The entire data set that supported the results of this study and that do not compromise the privacy of the participants are available upon request to the corresponding author Amanda Danielle Resende Silva e Sousa at: amandadani@icloud.com.
Edited by
The entire data set that supported the results of this study and that do not compromise the privacy of the participants are available upon request to the corresponding author Amanda Danielle Resende Silva e Sousa at: amandadani@icloud.com.
