Received: 7 January 2023 | Revised: 4 July 2023 | Accepted: 20 July 2023

DOI: 10.1111/jan.15810

DISCURSIVE PAPER

Digitizing nursing: A theoretical and holistic exploration to

understand the adoption and use of digital technologies by
nurses

Matthew Wynn1 | Lisa Garwood-­Cross1 | Cristina Vasilica1 | Marie Griffiths1 |

Vanessa Heaslip1 | Natasha Phillips2

1
University of Salford, Salford, UK
2
NHS England, Leeds, UK
Abstract
Background: With healthcare undergoing rapid digitalization, the effective integra-
Correspondence
Matthew Wynn, University of Salford,
tion of new technologies is crucial for nursing professionals, who form the largest
Salford, UK. group in the healthcare workforce. However, barriers within the nursing profession
Email: [email protected]
may impede digitalization efforts, leading to under utilization of available technolo-
gies and missed opportunities for enhancing healthcare quality and population health.
Aims: This article aims to investigate the adoption and use of digital technologies
by nurses, considering how key demographics, such as gender, age, and voluntari-
ness of technology use, interact to influence their acceptance and utilization of these
technologies.
Methods: Employing the Unified Theory of Acceptance and Use of Technology
(UTAUT) as a framework, we conducted a discursive exploration, supplemented by a
literature review from diverse academic sources. Keywords related to UTAUT, digitali-
zation, nursing practice and technology adoption were searched on PubMed, CINAHL
and Google Scholar. Additionally, UK government and professional regulator reports
were examined to understand current recommendations concerning digital technolo-
gies in nursing practice and the profession's demography. Searches focused on mod-
erating factor domains, and the last search was conducted on 26 April 2023.
Results: The study revealed that the successful implementation of digital technologies
in nursing practice requires a nuanced understanding of the nursing workforce's char-
acteristics and preferences. Gender, age and voluntariness of technology use were
found to intersect and influence nurses' acceptance and utilization of digital tools.
Discussion: By applying UTAUT in the context of nursing, this study highlights the im-
portance of tailored implementation strategies for digital technologies. A technologi-
cally deterministic perspective is insufficient; instead, consideration of social factors
specific to nursing is essential for successful adoption.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.

J Adv Nurs. 2023;79:3737–3747.  wileyonlinelibrary.com/journal/jan | 3737

 |

13652648, 2023, 10, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jan.15810 by Morocco Hinari NPL, Wiley Online Library on [18/12/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
3738 WYNN et al.

Conclusion: To maximize the benefits of digitalization in healthcare, it is imperative to ad-

dress the barriers faced by nursing professionals. A comprehensive understanding of how
key demographics impact technology adoption will inform targeted strategies, enhancing
the engagement of nurses with digital tools and fostering innovation in healthcare prac-
tices. Further research and primary data are needed, but this study lays the foundation
for future advancements in digital healthcare integration for nursing professionals.
Relevance to Clinical Practice: The issues highlighted in this article are relevant to
nurse leaders and those responsible for implementing technologies within nursing
contexts. They are also relevant to technology developers who may benefit from
considering the evidence associated with the moderating demographic factors high-
lighted in this article. Without a holistic approach to the implementation of technol-
ogy, challenges associated with the use of digital technology by nurses are likely to
persist. By considering the moderating demographic factors highlighted within the
UTAUT (age, gender, voluntariness of use and experience) nurse leaders and technol-
ogy developers may have greater success obtaining greater clinical outcomes from
digital technology. This work was completed in 2022.
No Patient or Public Contribution: Due to the focus of this article being one on pro-
fessional challenges within the nursing profession, no involvement from patients or
the public was sought.

KEYWORDS
acceptance, age, digital, diversity, gender, innovation, technology, UTAUT

1 | I NTRO D U C TI O N The use of big data to support developments in healthcare is argu-

ably reliant on digital technology usage on a broad scale. Without
The advent of the fourth industrial revolution has seen digital technolo- widescale usage, staff investment in accurate data input and oper-
gies, such as smartphones, social media, digital resources and software ation and well-­integrated digital systems, the data yielded from our
applications introduced into all aspects of life and the increasing digi- digital technologies is of little value. Healthcare professionals must
tization of working practices worldwide (Susskind & Susskind, 2016). be able to recognize the potential value of technology and data and
The COVID-­19 pandemic has also hastened the adoption of new digital ideally be involved in the development of new digital infrastructure
technologies in many industries. In the context of healthcare, it is argu- to ensure that digital technologies work for our healthcare systems,
able that digital transformation is directly linked with health profession- our patients and answer the questions which traditional research
als' acceptance and use of technologies, alongside having the necessary methods are unable to answer. Existing research on the utilization of
digital skills . This has become a requisite for safe and effective service such technologies has found improved health behaviour and treat-
delivery in an increasingly digital environment. ment compliance (Ibrahim et al., 2022), the satisfaction of patient
The value of using technology in healthcare has inspired some information needs (Allen et al., 2016; Garwood-­Cross et al., 2021;
contemporary healthcare theorists to suggest that technological Vasilica, Garwood-­Cross, et al., 2021; Vasilica, Oates, et al., 2021)
competency is itself an expression of caring (Krel et al., 2022; Locsin and improved service metrics (Wynn & Scholes, 2022). Digital tech-
et al., 2021). The authors of this theory emphasize that technological nologies can be utilized in a number of ways such as utilizing digi-
developments are mechanisms to inform care and that the competent tal data to improve health research, joining up provision between
use of technology can enable that (Locsin et al., 2021). The creation services and improving patients' self-­management of conditions to
of new technologies by health professionals has also been suggested influence health outcomes.
as an equally important expression of care (Bahari et al., 2021).
Indeed, the exploitation of digital technologies to improve clinical
outcomes and better understand the needs of patients has been the 2 | BAC KG RO U N D
focus of much discussion recently (Tortorella et al., 2021). This has
notably been highlighted by the high dependence on rapid access In nursing practice, despite the advantages of utilizing digital tech-
to centralized healthcare data collected digitally throughout the nologies, there are challenges associated with implementing and
COVID-­19 pandemic which was crucial to support decision making sustaining their use. For example, in a recent survey of wound care
by senior healthcare leaders (Budd et al., 2020). clinicians, predominantly nurses, in the United Kingdom (UK) almost
 |

13652648, 2023, 10, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jan.15810 by Morocco Hinari NPL, Wiley Online Library on [18/12/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
WYNN et al. 3739

none used contemporary smartphone technology in their practice to be filled by future study. Previous reviews of research using the
despite 99% of study participants having access to smartphones and UTAUT have identified that these moderating factors are rarely
58% having access to more than one device (Wynn & Clark, 2022a, included in analyses (Dwivedi et al., 2011) and it is rarely used in
2022b). Similar findings have been noted in relation to the adoption healthcare contexts compared with the other industries (Williams
of electronic health records (Arikan et al., 2021) despite being a key et al., 2015). We suggest that by using the UTAUT, gaps in literature
focus of contemporary digitalization efforts which have repeatedly and understanding can be identified, and thus targeted for future
failed to materialize for over 20 years (Burke, 2002; Rumball-­Smith primary research to fill the gaps required for a holistic understand-
et al., 2020). This may be due, in part, to resistance to an ever-­shifting ing of technology implementation in healthcare practitioner popula-
technological landscape. In 2018, the UK Health Secretary ordered tions, in this case, nursing.
that fax machines be phased out from the National Health Service
(NHS) after it was discovered that more than 8000 were still in use
in the NHS trusts, and placed a ban on their use from 2020 to has- 3 | TH E U N I FI E D TH EO RY O F TH E
ten a move towards more modern technologies such as secure email ACC E P TA N C E A N D U S E O F TEC H N O LO G Y
for communication (Department of Health and Social Care, 2018). (U TAU T )
However, in 2022 it was reported that over 800 fax machines are
still in use in NHS trusts (Gross, 2022) showing a potential resistance The success of technological innovations is not determined solely
to modernize in line with changes in technology. by the value of technologies themselves. It has long been argued in
Nurses' resistance to digital technology implementation is not the field of Science and Technology Studies that there is a mutual
a new phenomenon (Kirkley & Stein, 2004; Salzmann-­Erikson & shaping between technologies and humans, particularly by actor
Eriksson, 2016; Sweis et al., 2014; Timmons, 2003; Wilson, 2002). network theory (ANT) scholars (Callon, 1989; Latour, 1987, 2005;
A study by Timmons (2003) highlighted nurses resisted the imple- Law, 1992, 2016). Applying this lens of the mutual shaping of tech-
mentation and use of computer systems in a variety of ways includ- nology to digitized nursing, and considering particularly the litera-
ing avoidance, extensive criticism and in rare cases refusal of use. ture about nurses' resistance to technologies (Kirkley & Stein, 2004;
In some cases, this is linked with nurses' concerns about reliability, Salzmann-­Erikson & Eriksson, 2016; Sweis et al., 2014; Timmons,
over-­reliance on technology, the degradation of skills or needing 2003; Wilson, 2002), we can see why more thought must be given to
to complete digital plans away from patients, which mirrored find- the ways nurses and technologies interact. Taking an example from
ings from Wilson (2002). Whilst these studies are now approach- Timmons (2003) study, a new electronic care planning system was
ing 20 years old, they highlight that resistance to a fast-­changing introduced, nurses are concerned about how the technology shapes
technological landscape has been observed in nurse populations them—­they fear it will make them over-­reliant on technologies, will
for some time. Moreover, Timmons (2003) highlights that resistance degrade their skills, and that system issues will impact the care of
to technology should not just be seen through the lens of irrational their patients, therefore, they resist the technology by avoiding its
technophobia but should be considered an indication of systems fail- use, updating notes on article and in extreme cases outright refusal
ures. We take this argument a step further to suggest that it may also to engage with the technology. In a situation like this not only are
be indicative of failures to provide implementation strategies that nurses concerned about how the technology will impact them, but
acknowledge the population the technology is being implemented their resistance impacts the implementation of the technology itself.
within. Contemporary studies and reviews typically focus on tech- If a technology is not utilized effectively then it may be considered
nologies in terms of their functionalities, usability, acceptability, inefficient or have diminished impact, potentially affecting decisions
uptake, efficacy, and impact on health outcomes, with little prior to continue broader implementation. Acceptance of technology is
emphasis placed on the needs, expectations and requirements or believed to influence productivity, efficiency and effectiveness
technological habits of the target demographics of the digital tech- (Bhattacherjee & Sanford, 2006). Therefore, it is important to un-
nology users themselves. derstand nurses' technology acceptance to successfully implement
In this article, we demonstrate how the moderating factors identi- new innovative technologies with this professional group.
fied within the Unified Theory of Acceptance and Use of Technology Technology acceptance and consumer behaviour research dates
(UTAUT) (Venkatesh et al., 2003) can be used as a lens to under- to 1978 (Du Plessis et al., 1990). There are a variety of different the-
take a holistic analysis of the nursing profession for digital technol- ories that can be applied when considering technology acceptance
ogy adoption. As nursing roles and populations vary from country to and these fall into three main categories; social psychology, infor-
country, we use the UK as a case study to demonstrate this however, mation system management and behavioural psychology (Venkatesh
the UTAUT framework can be applied to other countries and health et al., 2003). These theories include the Technology Acceptance
professions, and we encourage other scholars to do so. Model, Theory of Planned Behaviour, Social Cognitive Theory,
In doing so, we aim to identify what understanding this profes- Innovation Diffusion Theory and the Motivational Model. However,
sional population can tell us about how best to implement and de- Venkatesh et al. (2003) suggest these theories can be limited in
velop digital technologies for use with and by nurses for technology unpacking more complex technologies and in response, developed
acceptance in the profession and identify the gaps in knowledge the UTAUT via a synthesis of several of these earlier theories of
 |

13652648, 2023, 10, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jan.15810 by Morocco Hinari NPL, Wiley Online Library on [18/12/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
3740 WYNN et al.

technology acceptance. UTAUT was therefore selected for this arti- in leadership, culture and infrastructure. The moderating factors
cle as it combines the features of alternative theories and provides a shown at the bottom of the diagram in Figure 1, specifically gender,
more holistic view of technology use and acceptance. age and voluntariness of use are arguably relatively predictable or
The theory identifies four predictors of users' behavioural inten- stable within the nursing profession and can therefore be examined
tion with technology including performance expectancy (the degree in greater depth to provide insights which may assist digital innova-
to which users think a system will help them gain job performance), tors hoping to implement technologies within nursing practice in a
effort expectancy (the ease of use of the system), social influence more general sense. Therefore, this article will focus on gender, age,
(the degree to which individuals perceive that others think they voluntariness of use and experience, to identify existing knowledge
should use a system) and facilitating conditions (the perception of of these areas of the nursing profession or where future primary
an individual that their organizations technical infrastructure is able data are required. The authors are also conducting a study to col-
to support the use of the system). In addition, UTAUT identifies four lect data from UK nurses on all the UTAUT domains, therefore, this
social/demographic factors; gender, age, experience and voluntari- article represents a first step in interrogating the key demographics
ness of use. These social demographic factors intersect to influence and how they may impact the implementation of technology with
a user's perception of performance expectancy, effort expectancy, nurses.
social influence and facilitating conditions, thus impacting their
behavioural intention and use behaviour of technology as seen in
Figure 1. 4 | DATA S O U RC E S
As technology usage is somewhat linked to demographic charac-
teristics (ONS, 2020), UTAUT is the only theory providing a clear link Although this article is discursive and not a systematic review of lit-
between immutable demographic features such as gender and age, erature, the authors aimed to ensure that peer-­reviewed literature
and factors which may be relatively consistent within a well-­defined was obtained from a range of academic sources. Keywords such as
professional group (i.e. experience with technology and voluntari- ‘Unified Theory of Acceptance and Use of Technology’, ‘UTAUT’,
ness of use) (Marikyan & Papagiannidis, 2021) as is possible within ‘digitalization’, ‘nursing practice’ and ‘technology adoption’ were
registered nurses working within a nationalized health system. Given searched on PubMed, CINAHL and Google Scholar to identify lit-
nursing is uniquely non-­diverse in relation to gender in particular, it erature broadly related to the use of the UTAUT theory. UK gov-
is possible that this may exert a disproportionate moderating influ- ernment and professional regulator reports related to technology
ence on interactions between technology and their acceptance by usage and nursing demographics were reviewed to gain insights into
nurses. This may be compounded by the standardized training cur- current recommendations related to digital technologies in nursing
riculums set by the Nursing and Midwifery Council leading to poten- practice and the demography of the profession. In addition, searches
tially homogenous experiences and expectations of the use of digital focussed on the moderating factor domains were run on PubMed
technologies in clinical practice along with the culture experienced using the search statements below. The last search was run on 26
within a nationalized health system. A recent systematic review in- April 2023.
dicated that the UTAUT is still valid and effective for predicting the The details of the search statements used can be seen in
use of technologies by healthcare professionals (Rouidi et al., 2022). Appendix 1. The searches were conducted and screened for rele-
While the predictors on the left-­hand side of Figure 1 are chal- vance by two of the authors MW and LGC. UK sources were prior-
lenging to predict without specific primary data and are likely to itized, however, where insufficient literature from a UK or nursing
vary considerably within different clinical contexts due to variations context was found, the authors noted the need for future primary

Performance
Expectancy

Effort
Expectancy
Behavioral Use
Intention Behavior
Social
Influence

Facilitating
Conditions

F I G U R E 1 Unified theory of
Voluntariness
Gender Age Experience acceptance and use of technology
of Use
(Venkatesh et al., 2003).
 |

13652648, 2023, 10, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jan.15810 by Morocco Hinari NPL, Wiley Online Library on [18/12/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
WYNN et al. 3741

data and have drawn on data from other countries or broader stud- 5.2 | Gender
ies to provide awareness of possible future findings.
Nursing remains a predominantly female profession, with 24 million
of the 28.5 million nurses globally being women (World Health
5 | FI N D I N G S Organization, 2019), and the UK nursing population being 89%
female (NMC, 2022). The UTAUT highlights gender as a factor in
5.1 | Who are nurses? the acceptance and use of technology, therefore, it is valuable
to question what impact this might have in a majority-­female
According to the most recent data available on the nursing profes- profession, and how technology implementation for this population
sion in the UK, there were 704,520 nurses on the register in March might be rethought accordingly. Our search identified no existing
2022 (NMC, 2022). Of these registrants, 89% are female, typically studies related to the impact of gender on the UK nurses' technology
between 31 and 50 years of age and are mainly of white British acceptance or usage, therefore, further research is required to draw
ethnicity (71.9%) and 24.7% from Asian and Black minority ethnic clear understandings of how gender impacts acceptance in this
groups. Only a small proportion of nurses have recordable qualifica- population. Whilst no demographic group can ever be assumed to be
tions indicating further study (n = 126,843, 18%) although this may homogenous in their thoughts, feelings or skills, by considering some
be an underestimation of nurses who have undertaken additional of the existing literature around gender and technology adoption
training/education as not all courses lead to recordable qualifica- we may be able to reveal under-­considered ways of supporting the
tions. Since 2013, all the nurses have been required to complete an technology adoption of nurses.
undergraduate degree prior to registration as a nurse as such there A review by Goswami and Dutta (2016) investigating differences
is potentially a substantial proportion of nurses who do not have a in the usage of technology associated with gender highlighted sev-
university education and a demographic shift in relation to education eral common factors across a range of technologies including the
is currently underway in the UK nursing context. Some changes in use of social media, e-­commerce, online banking and e-­learning plat-
demographics are notable within the NMC (2022) data including a forms. Critically, the study reviewed studies from across the globe
reduction in nurses from the European Union following the UKs exit including from the UK, Malaysia, Nigeria, Singapore, Taiwan, Brazil
from the EU in 2016 decreasing 4.8% from 35,115 to 28,863 over and others indicating that consistencies in findings are unlikely an
the 5-­year period from 2017 to 2022. This has accompanied a 60.3% artefact of any country's unique cultural features with regards to
increase in nurses from outside the EU which have increased from gender. The authors found that females tended to use technology
68,434 to 113,579 over the same period with most of these nurses which requires less effort to use than men indicating that effort ex-
coming from the Philippines and India. The data broadly indicate that pectancy is a greater predictor of technology acceptance in females
the current nursing workforce is eclectic comprising both the UK and than males. Social influence was also found to be greater among
internationally trained nurses, some of which trained before 2013 females than males indicating that gender also moderates this pre-
when nursing became a graduate profession in the UK and as such dictor to a greater extent in female populations. Notably, this was
their digital preparedness is likely broad. also observed in the usage of technologies with females generally
However, from the NMC data, the key demographics of the UK making more use of social media platforms and demonstrating
nurse can be summarized as typically, female, aged between 31 and more sensitivity to customer reviews when using e-­commerce ser-
50, educated to at least a diploma level and of white British eth- vices than males. Critically, females were reportedly more likely to
nicity. It could, therefore, also be assumed that most UK nurses adopt technologies due to social influence than males who are more
have experienced contemporary British digital culture and access likely to adopt technologies due to personal choice. Other patterns
to technologies as per current norms within the UK. According to identified included increased concerns about privacy by females
the Office for National Statistics, in 2020, 96% of UK households than males and variations in perceptions of self-­efficacy. Females
had internet access, 76% of adults used internet banking and 87% reportedly demonstrated higher levels of anxiety and reduced per-
shopped online. Of adults aged 25–­34 years, 49% reportedly used ceptions of self-­efficacy in relation to using technologies than men.
virtual assistants, smart speakers or apps. This dropped considerably However, this study examined the use of technologies by individuals
in those aged over 65 to just 17%. This data helps generate an image for personal reasons and not in a work context. Despite this, the
of the contemporary experience of the nurse and their potential re- clear differences between how males and females use technology
lationship with technology. They are likely to use digital technology are arguably likely to be consistent in its moderating impact even
to manage their finances, utilize smartphone applications and pos- in a professional context and should be considered. The results of a
sibly virtual assistants. This is suggestive of both a level of compe- recent study evaluating the adoption of digital technologies in nurs-
tency to use digital technology, good access to the internet and trust ing practice in Germany reflect these findings, reporting that usabil-
that these technologies are secure enough to manage their money ity was the dominant reason for the non-­adoption of technologies
with. Considering the above factors, it is necessary to review in more alongside perceptions of benefits (Seibert et al., 2020).
granular detail how these demographic factors may influence the The findings of the Goswami and Dutta (2016) study were re-
acceptance and the use of technologies by nurses in the workplace. peated in a later systematic review and meta-­analysis examining
 |

13652648, 2023, 10, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jan.15810 by Morocco Hinari NPL, Wiley Online Library on [18/12/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
3742 WYNN et al.

gender attitudes towards technology by Cai et al. (2017). This later how nurses as a professional group perceive their digital skills, and
review also used a sample drawn from across North America, Europe, further research is needed to develop this understanding. In 2017,
Asia and others and examined the data across a 20-­year period. They Health Education England (HEE) and the Royal College of Nursing
found that males showed more favourable attitudes towards tech- (RCN) produced a report on improving confidence the digital literacy
nology, while females demonstrated lower self-­efficacy and levels of the nursing profession. Within which definitions of digital liter-
of belief in the utility of technology. Notably, the authors reported acy, ‘e-­nurse’ and approaches to improving digital literacy are de-
that, across the 20-­year period, the data indicated little change in scribed. However, the research from which this report was based
lower levels of positive attitudes towards technology among females did not focus on the nursing profession but instead looked at data
despite changes in the capabilities and ubiquity of technology in so- related to trainees, learners and employees in healthcare and indus-
ciety. It has been proposed that these variations in attitude and per- try more widely and is therefore unlikely to account for the unique
ception may be a result of the widespread perception of technology demographic features of the nursing profession (de Normanville
as a male-­dominated field, although there has been little enquiry et al., 2016; de Normanville & Scott, 2016). Critically, the literature
into the causation of varying attitudes between genders. Given the review underpinning the HEE/RCN report found that there is little, if
specific nature of the disparities between genders it appears un- any evidence of evaluation of the impact that a digital literacy strat-
likely that focussing on the unique factors influencing acceptance egy has upon any specific workforce's performance (de Normanville
of technology by females will reduce their usage by the minority & Scott, 2016).
of male nurses. However, it is evident that failing to consider these Given that nursing is a female-­dominated profession, and the
factors may have a disproportionate impact on the majority of the research suggests women may have lower confidence in their dig-
nursing profession and could risk a reduction in the acceptance and ital skills, efforts to improve nurses' perception of their digital skills
sustainability of technologies within nursing practice. Notably, the and develop those skills further may aid in the adoption of technol-
Cai et al. (2017) study demonstrated that the differences in attitudes ogies within the profession. This could be in the form of dedicated
towards technology between males and females were both statis- digital skills training programmes utilizing pedagogical approaches
tically significant and stable over the period of 17 years for which which build confidence in technology and harness the impacts of
data were available. Whilst the reasons for this remain poorly under- social influence to moderate intentions to use technology in fu-
stood, it highlights considerations when implementing technologies ture practice. This would also be consistent with the World Health
as to how the benefits, designs and skills required are presented. Organization's (2021) strategic Directions for Nursing and Midwifery
These findings raise interesting considerations for how we in- which emphasizes the need for nurses and midwives to be educated
troduce digital innovation into healthcare systems. When introduc- with cross-­cutting competencies including culturally appropriate
ing new technologies into healthcare, the focus is often on the time care and the use of digital technologies.
and money-­saving benefits of these technologies as motivators for
adoption. In fact, in most cases, demonstration of economic benefit
is essential for end-­users to justify adoption of the technology (Guo 5.3 | Age
et al., 2020). Thereby creating a paradox whereby no successful
implementation means no evidence and therefore no adoption and In a UK context, the NMC publish descriptive statistics of registrants
vice versa. However, taking the UTAUT into consideration highlights ages, which gives us an insight into the age demographics in nursing
that to effectively implement technology in a female-­dominated and midwifery. This data (NMC, 2022) highlights that the profession
profession such as nursing efforts must be made to appeal particu- is an ageing profession with most nurses falling between ages 31
larly to the factors that motivate females to adopt technology, such and 50. Beyond the descriptive statistics published by the NMC on
as social influence. This might be done by highlighting the benefits the age of UK registrants, there is currently little data on the age
to patients' well-­being, sharing the value of building communities distribution of nurses working at different levels within the NHS. In
of practice through technology, or introducing professional role addition, due to the relatively unstructured nature of nursing careers
models to emphasize the benefits of technologies in the workplace. in the UK, it is difficult to predict at what age a nurse might be at
Likewise, recognizing that effort expectancy is important to women any given level within the professional hierarchy. Compounding this,
provides opportunities for those developing technologies for the there is currently no requirement to register senior positions such as
female-­dominated nursing profession to account for the importance managerial or most specialist clinical positions which may indicate
of ease of use, with intuitive and effective user design, rather than positions of formal authority and potentially greater social influence
adding unnecessary features which may over-­complicate the tech- over more junior nurses. This makes it challenging to predict how age
nological innovation and have a negative impact on user perceptions may influence nursing services as there is currently no data available
of effort expenditure needed to adopt the technology. indicating the age diversity of nurses in roles where key decisions
Considering the existing research on gender variations in tech- might influence the adoption of digital technologies.
nology acceptance and use, increased efforts may also be required Whilst there appear to be no studies exploring the role of age in
to improve perceptions of self-­efficacy when it comes to digital skills a UK nurse-­only context, a recent study looking at the adoption of
with nurses. At present, there is a scarcity of studies to understand mobile health technologies and recommendations of their use for
 |

13652648, 2023, 10, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jan.15810 by Morocco Hinari NPL, Wiley Online Library on [18/12/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
WYNN et al. 3743

patients by NHS health professionals, including nurses, found that This could be compounded by the lack of inclusion of nurses in the
age was a significant factor (Leigh et al., 2020). The authors noted design and development of new technologies. Nurses are rarely in-
that HCP over the age of 46 were considerably less likely to recom- volved in the development of new technologies (Seibert et al., 2020)
mend the use of mobile health technologies to patients. Although and have mixed feelings about the mandatory implementation of
it is important to note that nurses made up only a small proportion technology (Nguyen et al., 2016). These studies highlight the need
of the sample in this study (n = 27/185). This may reflect higher for nurses to be engaged in the creation and implementation of
self-­reported digital competence among younger HCP which was technologies to increase their voluntariness of use. The impacts of
indicated in a study of 27 UK primary care facilities (Hammerton mandatory use of technologies may also hinder innovation and de-
et al., 2022). A recent Italian study by Barchielli et al. (2021) inves- grade nurses' sense of agency to act within the new universal tech-
tigating nurses' acceptance of innovations in technology-­intensive nological domain. Rather, nurses should be encouraged to increase
contexts also supports the hypothesis of age as a key factor in the their agency as digital healthcare workers and see themselves as
nursing-­technology context. They found that age is a key moderator digital innovators able to actively shape technologies useful to their
for social influence and that older nurses appeared to be influenced practice, rather than having technologies introduced compulsorily.
less by social factors. The authors suggest this may be because Seibert et al. (2020) support this notion and argue that greater em-
younger nurses are more dependent on others whilst older nurses phasis on multidisciplinary development teams is required to sup-
may feel more confident and therefore less influenced by others. port innovation. Curtis and Brooks (2020) highlight in their UK study
This may indicate the compounding impact of older nurses who are that co-­creating nurse-­led initiatives for implementing digital health
more likely to be in positions of formal authority having a dispropor- technologies in nursing homes required a whole-­team approach that
tionate influence over younger nurses who are more likely to yield listens to nurse's concerns and prepares the nursing home work-
to their social influence as leaders because of both their younger force for digital implementation. According to Booth et al. (2021),
age and being (mainly) female. However, there is currently limited nurses must adapt to the digital age by re-­conceptualizing nursing
evidence on how age impacts on technology usage among nurses. practice to account for the new demands on nursing professionals
Age should be included as a variable in future studies evaluating with regards to skills, knowledge and leadership and the disruption
the usage of technology by nurses to provide more evidence on how to traditional nurse–­patient relationships caused by technology. The
this factor affects technology usage. These sentiments are reflected Philips Ives review is currently underway in the UK to generate evi-
in the recently published ‘What Good Looks Like Framework’ by dence and inform strategy to ensure that nursing professionals have
NHS England (2021), which highlights the need for a people-­centred the knowledge skills and education to operate effectively in an in-
approach to the digitalization of healthcare services. creasingly digital care environment.

5.4 | Voluntariness of use 5.5 | Experience

This moderating factor relates to the degree to which the use of While numerous studies have delved into nurses' experiences with
technology is perceived as being voluntary or of free will. Currently, specific technologies in practice, comprehensive research focus-
nursing teams have varied abilities to either adopt or reject new ing on nurse experiences of technology use and implementation
technologies dependent on factors such as budgets, leadership and in a broader sense remains scarce. For instance, we could find no
cultural factors. However, as mentioned at the beginning of this investigations into nurses' personal philosophies concerning digital
article, there have been instances of the use of technology being technologies based on their experiences, which may subsequently
forcibly altered within the NHS, such as the ban on fax machines by influence future or ongoing interactions with digital technologies.
the Department of Health and Social Care (2018). Whilst the authors However, comprehending nurses' experiences with technology
were unable to locate data on forced changes to UK nurses' use of and their capabilities related to digital skills is crucial as healthcare
technology, Chiu and Ku (2015) noted that when physiotherapists systems progressively adopt digitization. A study by Hammerton
in Hong Kong had electronic health records made mandatory, et al. (2022) identified that self-­reported competence was higher
dependent on ease of use, they were more resistant to these for electronic patient record (EPR) technology than patient apps
technologies than they had been when they were voluntary. Whilst and wearables and social media among primary care staff in the UK
this study was not conducted with nurses, it highlights the potential potentially reflecting the level of experience associated with these
resistance against the mandatory use of technologies in a healthcare technologies. However, this study was not focussed on nurses and
context. A broader study of HCP by Leigh et al. (2020) also found data were not disaggregated to allow a closer analysis of this specific
that an ‘NHS stamp of approval’ may increase the likelihood of HCP population.
recommending the use of mobile health applications to patients. Inadequate digital competence has given rise to new types
However, again this study did not focus explicitly on nurses and of potential healthcare-­associated harm. A prime example is e-­
may not account for the more specific social and cultural influences iatrogenesis, described by Weiner et al. (2007; p. 1) as ‘patient harm
guiding perceptions of voluntariness of use in the nursing context. caused at least in part by the application of health information
 |

13652648, 2023, 10, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jan.15810 by Morocco Hinari NPL, Wiley Online Library on [18/12/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
3744 WYNN et al.

technology’. Often, substandard medical data processing systems To remain relevant and effective, nurses must adapt to this new
contribute significantly to medical errors (Adane et al., 2019), such context, which requires a shift in the epistemology of professional
as medication errors (Gupta & Moran, 2019). The experiences nursing to account for the digital environment in which care is
of nurses in relation to digital technology must therefore be the delivered. The development, implementation and adoption of new
focus of further investigation to help guide efforts to upskill the digital technologies that enhance nursing capabilities should be
profession and focus on technologies that nurses may have less prioritized by nursing and healthcare leaders, with nurses as a key
experience with. focus in the process of digitalization. Understanding the demographic
makeup of the nursing profession, including gender, age and nurses'
voluntary use of technologies according to the UTAUT, is crucial for
6 | DISCUSSION gaining a clearer analysis of the nursing situation and supporting
ongoing efforts to engage nurses in digitalization.
This article has considered four elements impacting UTAUT (gender, Further research is needed to gain insight into how the factors
age, voluntariness of use and experience) which intersect with discussed in this article influence nurses' adoption of digital tech-
performance expectancy, effort expectancy, social influence and nologies. However, current data suggest that several factors may
facilitating conditions. By interrogating categories, this article lays increase technology adoption among nurses. These factors include
the foundation for further exploration of the UTAUT in nursing and placing greater emphasis on usability rather than functionality, in-
highlights the need for further primary data on UTAUT domains in volving influential nurses as social influencers during implementa-
the UK nursing population. To account for the moderating impacts tion, incorporating feedback systems into digital technologies to
on performance expectancy, effort expectancy, social influence and visualize their impact on patient care, promoting age diversity among
facilitating conditions, individuals aiming to implement or develop nurse leaders, and better understanding nurses' perceptions of their
new technologies for nurses must consider these factors. Crucially, voluntary use of technologies. It is evident that nurses must take
the evidence for how these demographic characteristics intersect to on greater roles in the development of new technologies, which will
influence the use and acceptance of technology must be investigated require the acquisition of new digital skills not traditionally included
further to support ongoing digitalization efforts within the nursing in nursing curricula, such as proposing new technology initiatives or
profession. improving existing ones.
Recognizing how these elements may have a mediating effect Recommendations include considering the UTAUT factors in the
on other aspects of technology acceptance and use also allows us implementation of new technologies within the nursing profession
to consider how those charged with implementing technology in and conducting similar work in other healthcare professions with
healthcare can alter their implementation strategies to appeal to slightly homogeneous demographics. Demographic patterns, in-
nurses' unique intersections. It is also valuable to consider how cluding age, gender and education level, can influence nurses' per-
this mapping of healthcare professionals’ unique demographics and ceptions of digital technologies and their willingness to adopt them.
perspectives using UTAUT may be valuable in other health profes- Additionally, social and organizational factors, such as perceived use-
sions, particularly those where the demographics of the profession fulness, ease of use and support from colleagues and management,
are more homogenous and may have strong moderating impacts on play a critical role in shaping nurses' attitudes towards digitalization.
overall technology acceptance and use.
In addition, performing this first stage of a holistic UTAUT anal- AU T H O R C O N T R I B U T I O N S
ysis of the nursing profession has highlighted that despite the imple- MW, LGC, CV, MG, VH, NP—­made substantial contributions to
mentation of technology within the UK NHS being a process that conception and design, or acquisition of data or analysis and inter-
has been going on for 20 years (Timmons, 2003; Wilson, 2002), the pretation of data; Involved in drafting the manuscript or revising it
literature and data required to perform a full holistic UTAUT anal- critically for important intellectual content; Given final approval of
ysis of the nursing profession in relation to technology acceptance the version to be published. Each author should have participated
and use is still not readily available. As such, the authors have used sufficiently in the work to take public responsibility for appropriate
the framework of both UTAUT and ANT discussed in this article to portions of the content; Agreed to be accountable for all aspects
shape the collection of data from the UK nurses about their digital of the work in ensuring that questions related to the accuracy or
capabilities, perspectives on digital technologies and training needs integrity of any part of the work are appropriately investigated and
for digitalization. resolved.

F U N D I N G I N FO R M AT I O N
7 | CO N C LU S I O N No funding was provided for this work.

Healthcare services are undergoing transformative changes due to C O N FL I C T O F I N T E R E S T

rapid advancements in technology, particularly digital technologies. The author declares no conflicts of interest.
 |

13652648, 2023, 10, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jan.15810 by Morocco Hinari NPL, Wiley Online Library on [18/12/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
WYNN et al. 3745

PEER REVIEW in the workplace. TrueBlueSky Social Enterprise Ltd for Health
The peer review history for this article is available at https:// Education England (HEE).
de Normanville, C., Scott, G., & Speake, A. (2016). Examining the extent
www.webof​s cien​ce.com/api/gatew​ay/wos/peer-­revie​w/10.1111/
to which employers and organisations are meeting the challenge of
jan.15810. improving the digital literacy of their workforce. TrueBlueSky Social
Enterprise Ltd for Health Education England.
DATA AVA I L A B I L I T Y S TAT E M E N T Department of Health and Social Care. (2018). Health and Social Care
Secretary bans fax machines in NHS. https://www.gov.uk/gover​
Data sharing not applicable to this article as no datasets were
nment/​n ews/healt​h -­a nd-­s ocia​l -­c are-­s ecre​t ary-­b ans-­f ax-­m achi​
generated or analysed during the current study. nes-­in-­nhs
Du plessis, P. J., Rousseau, G. G., & Blem, N. H. (1990). Consumer be-
ORCID haviour: A South African perspective. Southern Book Publishers.
Dwivedi, Y. K., Rana, N. P., Chen, H., & Williams, M. D. (2011). A meta-­
Matthew Wynn https://orcid.org/0000-0001-9021-4747
analysis of the unified theory of acceptance and use of technology
(UTAUT). In M. Nüttgens, A. Gadatsch, K. Kautz, I. Schirmer, & N.
REFERENCES Blinn (Eds.), Governance and sustainability in information systems.
Adane, K., Gizachew, M., & Kendie, S. (2019). The role of medical data Managing the transfer and diffusion of IT. TDIT 2011. IFIP advances
in efficient patient care delivery: A review. Risk Management and in information and communication technology (Vol. 366). Springer.
Healthcare Policy, 12, 67–73. https://doi.org/10.1007/978-­3-­6 42-­24148​-­2_10
Allen, C., Vassilev, I., Kennedy, A., & Rogers, A. (2016). Long-term condi- Garwood-­Cross, L., Vasilica, C., Ormandy, P., & Finnigan, R. (2021).
tion self-management support in online communities: A meta-syn- Examining social media to understand the support needs of kidney
thesis of qualitative papers. Journal of Medical Internet Research, patients. University of Salford. Report for Kidney Care UK. ISBN:
18(3), e61. 978-­1-­912337-­47-­7.
Arikan, F., Kara, H., Erdogan, E., & Ulker, F. (2021). Barriers to adoption Goswami, A., & Dutta, S. (2016). Gender differences in technology us-
of electronic health record systems from the perspective of nurses: age—­A literature review. Open Journal of Business and Management,
A cross-­sectional study. Computers, Informatics, Nursing, 40(4), 4, 51–­59. https://doi.org/10.4236/ojbm.2016.41006
236–­243. https://doi.org/10.1097/CIN.00000​0 0000​0 00848 Gross, A. (2022). UK regulator Ofcom sounds death knell of the fax ma-
Bahari, K., Talosig, A. T., Pizarro, J. B., & Kissa, B. (2021). Nursing tech- chine. Financial Times Online. https://www.ft.com/conte​nt/2daf6​
nologies creativity as an expression of caring: A grounded theory 89b-7df4-434f-ab86-aa602​85dcc9a
study. Global Qualitative Nursing Research, 8, 1–­10. https://doi. Guo, C., Ashrafian, H., Ghafur, S., Fontana, G., Gardner, C., & Prime, M.
org/10.1177/23333​93621​997397 (2020). Challenges for the evaluation of digital health solutions—­A
Barchielli, C., Marullo, C., Bonciani, M., & Vainieri, M. (2021). Nurses and call for innovative evidence generation approaches. NPJ Digital
the acceptance of innovations in technology-­intensive contexts: Medicine, 3(1), 110. https://doi.org/10.1038/s4174​6-­020-­0 0314​-­2
The need for tailored management strategies. BMC Health Services Gupta, A., & Moran, B. (2019). E-iatrogenesis: unnecessary ordering of
Research, 21(1), 639. https://doi.org/10.1186/s1291​3-­021-­06628​-­5 urine creatine. American Journal of Medical Quality, 34(1), 99.
Bhattacherjee, A., & Sanford, C. (2006). Influence processes for infor- Hammerton, M., Benson, T., & Sibley, A. (2022). Readiness for five digital
mation technology acceptance: An elaboration likelihood model. technologies in general practice: Perceptions of staff in one part
MIS Quarterly, 30(4), 805–825. https://doi.org/10.2307/25148755 of southern England. BMJ Open Quality, 11, e001865. https://doi.
Booth, R. G., Strudwick, G., McBride, S., O'Connor, S., & Solano López, org/10.1136/bmjoq​-­2022-­0 01865
A. L. (2021). How the nursing profession should adapt for a digital Health Education England and the Royal College of Nursing. (2017).
future. BMJ (Online), 373, n1190. https://doi.org/10.1136/bmj.n119 Improving digital literacy. Online. https://www.hee.nhs.uk/sites/​
Budd, J., Miller, B. S., Manning, E. M., Lampos, V., Zhuang, M., Edelstein, defau​l t/files/​d ocum​e nts/Impro​v ing%20Dig​i tal%20Lit​e racy​
M., Rees, G., Emery, V. C., Stevens, M. M., Keegan, N., Short, %20-­%20HEE​%20and​%20RCN​%20rep​ort.pdf
M. J., Pillay, D., Manley, E., Cox, I. J., Heymann, D., Johnson, A. M., Ibrahim, M. S., Mohamed Yusoff, H., Abu Bakar, Y. I., Thwe Aung, M. M.,
& McKendry, R. A. (2020). Digital technologies in the public-­health Abas, M. I., & Ramli, R. A. (2022). Digital health for quality health-
response to COVID-­19. Nature Medicine, 26(8), 1183–­1192. https:// care: A systematic mapping of review studies. Digital Health, 8,
doi.org/10.1038/s4159​1-­020-­1011-­4 20552076221085810. https://doi.org/10.1177/20552​07622​1085810
Burke, K. (2002). NHS misses target for introducing electronic records. Kirkley, D., & Stein, M. (2004). Nurses and clinical technology: Sources of re-
BMJ-­British Medical Journal (International Ed.), 324(7342), 870. sistance and strategies for acceptance. Nursing Economics, 22(4), 216.
Cai, Z., Fan, X., & Du, J. (2017). Gender and attitudes toward technology Krel, C., Vrbnjak, D., Bevc, S., Štiglic, G., & Pajnkihar, M. (2022).
use: A meta-­analysis. Computers and Education, 105, 1–­13. https:// Technological competency as caring in nursing: A description, anal-
doi.org/10.1016/j.compe​du.2016.11.003 ysis and evaluation of the theory. Zdravstveno varstvo, 61(2), 115–
Callon, M. (1989). Society in the making: The study of technology as a 123. https://doi.org/10.2478/sjph-2022-0016
tool for sociological analysis. In W. E. Bijker, T. P. Hughes, & T. Pinch Latour, B. (1987). Science in action: How to follow scientists and engineers
(Eds.), The social construction of technological systems: New directions through society. Harvard University Press.
in the sociology and history of technology (pp. 83–­103). MIT Press. Latour, B. (2005). Reassembling the social: An introduction to actor network
Chiu, T. M. L., & Ku, B. P. S. (2015). Moderating effects of voluntariness on theory. Oxford University Press.
the actual use of electronic health records for allied health profes- Law, J. (1992). Notes on the theory of the actor-­network: Ordering, strat-
sionals. JMIR Medical Informatics, 3(1), e7. https://doi.org/10.2196/ egy, and heterogeneity. Systems Practice, 5(4), 379–­393.
medin​form.2548 Law, J. (2016). Actor network theory and material semiotics. The New
Curtis, K., & Brooks, S. (2020). Digital health technology: Factors affect- Blackwell Companion to Social Theory, 3, 141–­158.
ing implementation in nursing homes. Nursing Older People, 32(2), Leigh, S., Ashall-­Payne, L., & Andrews, T. (2020). Barriers and facilita-
14–­21. https://doi.org/10.7748/nop.2020.e1236 tors to the adoption of mobile health among health care profes-
de Normanville, C., & Scott, G. (2016). Examining the extent to which dig- sionals from the United Kingdom: Discrete choice experiment. JMIR
ital literacy is seen as a challenge for trainers, learners and employees mHealth and uHealth, 8(7), e17704. https://doi.org/10.2196/17704
 |

13652648, 2023, 10, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jan.15810 by Morocco Hinari NPL, Wiley Online Library on [18/12/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
3746 WYNN et al.

Locsin, R. C., Soriano, G. P., Juntasopeepun, P., Kunaviktikul, W., & Weiner, J. P., Kfuri, T., Chan, K., & Fowles, J. B. (2007). "e-­Iatrogenesis":
Evangelista, L. S. (2021). Social transformation and social isolation The most critical unintended consequence of CPOE and other HIT.
of older adults: Digital technologies, nursing, healthcare. Collegian, Journal of the American Medical Informatics Association, 14(3), 387–­
28(5), 551–­558. https://doi.org/10.1016/j.colegn.2021.01.005 389. https://doi.org/10.1197/jamia.M2338
Marikyan, D., & Papagiannidis, S. (2021). Unified theory of accep- Williams, M. D., Rana, N. P., & Dwivedi, Y. K. (2015). The unified theory
tance and use of technology: A review. In S. Papagiannidis (Ed.), of acceptance and use of technology (UTAUT): A literature review.
TheoryHub book. http://open.ncl.ac.uk Journal of Enterprise Information Management, 28(3), 443–­488.
Nguyen, L., Haddad, P., Moghimi, H., Muhammad, I., Coleman, K., https://doi.org/10.1108/JEIM-­09-­2014-­0 088
Redley, B., Botti, M., & Wickramasinghe, N. (2016). The acceptance Wilson, M. (2002). Making nursing visible? Gender, technology and the
of nursing information systems: An analysis using UTAUT. In N. care plan as script. Information Technology & People., 15, 139–­158.
Wickramasinghe, I. Troshani, & J. Tan (Eds.), Contemporary consumer World Health Organisation. (2019). Female health workers drive global
health informatics (pp. 347–­365). Springer International Publishing. health. Online. https://www.who.int/news-­room/comme​ntari​es/
https://doi.org/10.1007/978-­3-­319-­25973​- ­4_19 detai​l/femal​e-­healt​h-­worke​rs-­drive​-­globa​l-­health
NHS England. (2021). What good looks like framework. Online. https:// World Health Organisation. (2021). The WHO global strategic directions
trans​form.engla​nd.nhs.uk/digit​ise-­conne​c t-­trans​form/what-­good-­ for nursing and midwifery (2021–­2025). Online. https://www.who.
looks​-­like/what-­good-­looks​-­like-­publi​c atio​n/ int/publi​c atio​ns/i/item/97892​4 0033863
Nursing and Midwifery Council. (2022). The NMC register 1 April 2021–­ Wynn, M., & Clark, M. (2022a). Attitudes of UK based wound specialists
31 March 2022. Online. https://www.nmc.org.uk/globa​lasse​t s/sited​ towards the use of mobile applications in wound care delivery: A
ocume​nts/data-­repor​t s/march​-­2022/nmc-­regis​ter-­march​-­2022.pdf cross-­sectional survey. Part 1 quantitative findings. Wounds UK,
Office for National Statistics. (2020). Internet access—­Households and 18(2), 20–­28.
individuals, Great Britain: 2020. Online. https://www.ons.gov.uk/ Wynn, M., & Clark, M. (2022b). Attitudes of UK based wound special-
peopl​epopu​latio​nandc​ommun​ity/house​holdc​harac​teris​tics/homei​ ists towards the use of mobile applications in wound care delivery:
ntern​etand​socia​lmedi​ausag​e/bulle​tins/inter​netac​cessh​ouseh​oldsa​ A cross-­sectional survey. Part 2 qualitative findings. Wounds UK,
ndind​ividu​als/2020\ 18(3), 10–­16.
Rouidi, M., Elouadi, A., Hamdoune, A., Choujtani, K., & Chati, A. (2022). TAM-­ Wynn, M., & Scholes, L. (2022). Trial of the Minuteful mobile application
UTAUT and the acceptance of remote healthcare technologies by for wound care in an inpatient setting. Wounds UK, 18(4), 37–­4 0.
healthcare professionals: A systematic review. Informatics in Medicine
Unlocked, 32, 101008. https://doi.org/10.1016/j.imu.2022.101008
Rumball-­Smith, J., Ross, K., & Bates, D. W. (2020). Late adopters of the
electronic health record should move now. BMJ Quality & Safety,
How to cite this article: Wynn, M., Garwood-­Cross, L.,
29(3), 238–­240. https://doi.org/10.1136/bmjqs​-­2019-­010002
Salzmann-­Erikson, M., & Eriksson, H. (2016). Tech-­resistance: The complexity Vasilica, C., Griffiths, M., Heaslip, V., & Phillips, N. (2023).
of implementing nursing robots in healthcare workplaces. Contemporary Digitizing nursing: A theoretical and holistic exploration to
Nurse: A Journal for the Australian Nursing Profession, 52(5), 567–­568. understand the adoption and use of digital technologies by
Seibert, K., Domhoff, D., Huter, K., Krick, T., Rothgang, H., & Wolf-­
nurses. Journal of Advanced Nursing, 79, 3737–3747. https://
Ostermann, K. (2020). Application of digital technologies in nurs-
ing practice: Results of a mixed methods study on nurses' experi- doi.org/10.1111/jan.15810
ences, needs and perspectives. Zeitschrift für Evidenz, Fortbildung
und Qualität im Gesundheitswesen, 158-­159, 94–­106. https://doi.
org/10.1016/j.zefq.2020.10.010
Susskind, R., & Susskind, D. (2016). The future of the professions: APPENDIX 1
How technology will transform the work of human experts. In
Gender:
The future of the professions. Oxford University Press. https://doi.
org/10.1093/01910​22403.001.0001 ((Nurs*[Title/Abstract]) AND (technology[Title/Abstract] OR
Sweis, R., Isa, A., Azzeh, H., Shtyh, B., Musa, E., & AlBtoush, R. (2014). digital[Title/Abstract] OR electronic health record[Title/Abstract]
Nurses' resistance to the adoption of information technology in OR EHR[Title/Abstract] OR app[Title/Abstract] OR devices[Title/
Jordanian hospitals. Life Science Journal, 11(4s), 8–­18.
Abstract])) AND (gender[Title/Abstract] OR female[Title/Abstract]
Timmons, S. (2003). Nurses resisting information technology. Nursing
Inquiry, 10(4), 257–269. OR male[Title/Abstract] OR women[Title/Abstract] OR men[Title/
Tortorella, G. L., Saurin, T. A., Fogliatto, F. S., Rosa, V. M., Tonetto, L. M., & Abstract]) AND (acceptance [Title/Abstract] OR adoption [Title/
Magrabi, F. (2021). Impacts of Healthcare 4.0 digital technologies on Abstract] OR usage[Title/Abstract] OR utilization [Title/Abstract]
the resilience of hospitals. Technological Forecasting and Social Change,
OR implementation [Title/Abstract]) AND (UK[Title/Abstract] OR
166, 120666. https://doi.org/10.1016/j.techf​ore.2021.120666
Vasilica, C., Oates, T., Clausner, C., Ormandy, P., Barratt, J., & Graham-­ United Kingdom [Title/Abstract] OR England [Title/Abstract] OR
Brown, M. (2021). Identifying information needs of patients with Northern Ireland [Title/Abstract] OR Scotland [Title/Abstract] OR
IgA nephropathy using an innovative social media–­stepped analyti- Wales [Title/Abstract])
cal approach. Kidney International Reports, 6(5), 1317–­1325. https://
Age:
doi.org/10.1016/j.ekir.2021.02.030
((Nurs*[Title/Abstract]) AND (technology[Title/Abstract] OR
Vasilica, C. M., Garwood-­Cross, L., Finnigan, R., Bashford, T., O'Kane, P.,
& Ormandy, P. (2021). Participating in CaMKIN: Impact on patients. digital​[ Title/Abstract] OR electronic health record[Title/Abstract]
University of Salford, School of Health & Society & Liverpool OR EHR[Title/Abstract] OR app[Title/Abstract] OR devices[Title/
University Hospitals Report. ISBN: 978-­1-­912337-­50-­7. Abstract])) AND (age[Title/Abstract] OR older[Title/Abstract] OR
Venkatesh, V., Morris, M. G., Davis, F. D., & Davis, G. B. (2003). User
younger[Title/Abstract] OR young[Title/Abstract]) AND (accept-
acceptance of information technology: Toward a unified view. MIS
Quarterly, 27, 425–­478. ance​[ Title/Abstract] OR adoption[Title/Abstract] OR usage[Title/
 |

13652648, 2023, 10, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jan.15810 by Morocco Hinari NPL, Wiley Online Library on [18/12/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
WYNN et al. 3747

Abstract] OR utilization[Title/Abstract] OR implementation[Title/ United Kingdom[Title/Abstract] OR England[Title/Abstract] OR

Abstract]) AND (UK[Title/Abstract] OR United Kingdom[Title/ Northern Ireland[Title/Abstract] OR Scotland[Title/Abstract] OR
Abstract] OR England[Title/Abstract] OR Northern Ireland[Title/ Wales[Title/Abstract])
Abstract] OR Scotland[Title/Abstract] OR Wales[Title/Abstract]) Experience:
Voluntariness of use: ((Nurs*[Title/Abstract]) AND (technology[Title/Abstract] OR
((Nurs*[Title/Abstract]) AND (technology[Title/Abstract] OR digital[Title/Abstract] OR electronic health record[Title/Abstract]
digital[Title/Abstract] OR electronic health record[Title/Abstract] OR EHR[Title/Abstract] OR app[Title/Abstract] OR devices[Title/
OR EHR[Title/Abstract] OR app[Title/Abstract] OR devices[Title/ Abstract])) AND (experience[Title/Abstract] OR usability[Title/
Abstract])) AND (voluntariness [Title/Abstract] OR autonomy[Title/ Abstract] OR satisfaction[Title/Abstract] OR perception[Title/
Abstract] OR choice[Title/Abstract] OR decision-­making[Title/ Abstract] OR opinion[Title/Abstract]) AND (UK[Title/Abstract] OR
Abstract]) AND (acceptance[Title/Abstract] OR adoption[Title/ United Kingdom[Title/Abstract] OR England[Title/Abstract] OR
Abstract] OR usage[Title/Abstract] OR utilization[Title/Abstract] Northern Ireland[Title/Abstract] OR Scotland[Title/Abstract] OR
OR implementation[Title/Abstract]) AND (UK[Title/Abstract] OR Wales[Title/Abstract])

The Journal of Advanced Nursing (JAN) is an international, peer-reviewed, scientific journal. JAN contributes to the advancement of evidence-based
nursing, midwifery and health care by disseminating high quality research and scholarship of contemporary relevance and with potential to ­advance
knowledge for practice, education, management or policy. JAN publishes research reviews, original research reports and methodological and
­theoretical papers.

For further information, please visit JAN on the Wiley Online Library website: www.wileyonlinelibrary.com/journal/jan

Reasons to publish your work in JAN:

• High-impact forum: the world’s most cited nursing journal, with an Impact Factor of 2.561 – ranked 6/123 in the 2019 ISI Journal Citation
Reports © (Nursing; Social Science).
• Most read nursing journal in the world: over 3 million articles downloaded online per year and accessible in over 10,000 libraries worldwide
(including over 6,000 in developing countries with free or low cost access).
• Fast and easy online submission: online submission at http://mc.manuscriptcentral.com/jan.
• Positive publishing experience: rapid double-blind peer review with constructive feedback.
• Rapid online publication in five weeks: average time from final manuscript arriving in production to online publication.
• Online Open: the option to pay to make your article freely and openly accessible to non-subscribers upon publication on Wiley Online Library,
as well as the option to deposit the article in your own or your funding agency’s preferred archive (e.g. PubMed).