We Don't Need No Stinkin' Theory! The Practical Uses of a Theory-Driven Literature Review of Smartphone Technology Used by Interprofessional Teams

Background: Smartphone technologies are increasingly used in the acute care setting to enhance interprofessional team-based care. However, evidence in the literature is scant and of low quality. There has been nothing to date using a realist lens. Realist reviews of literature are based on the theory-driven methodology of realist evaluation (Pawson & Tilley, 1997) that provide the heuristic context-mechanism-outcome (CMO) configuration to explain socially mediated complex interventions. Realist reviews use a variety of sources to aid in theory-building including peer-reviewed and gray literature. The results of realist reviews produce contingency CMOs of how, why, when, and for whom an intervention works.

Purpose: The aim of this realist review was two-fold. First, we sought to systematically deconstruct the existing evidence of smartphone technologies used by interprofessional teams to explain how they impact people, processes, and outcomes. Specifically, we sought to uncover, a) the changes in thinking, behavior, and attitude of team members who are exposed to smartphone technology (mechanisms), b) the anticipated and unanticipated outcomes resulting from those mechanisms, and c) the contextual factors that trigger or block those mechanisms. Second, our aim was to provide practical guidance for decision-makers, implementers, evaluators, and researchers.

Methods: We searched CINAHL, Medline, and PubMed from 2009 to March 2019. For gray literature, we used Google as the search engine. We appraised evidence for relevance and rigor according to realist standards. Inclusion criteria included articles of smartphone technologies used by interprofessional healthcare teams to communicate, collaborate, or coordinate patient care within hospital settings. Analysis was completed using retroductive logic. We operationalized our findings to make them relevant to nurse leaders and nurse informaticists.

Results: 21 reports from 2009 to 2019 were fully reviewed and categorized as qualitative (7), quantitative (7), multi-methods (4), and expert opinion (3). The evidence supported 7 CMO statements. The use of smartphone technologies results in positive outcomes (patient- and team-related) when the following mechanisms are triggered: feeling efficient, feeling a sense of urgency to act, learning and a sense of security. Smartphone technologies, in certain contexts, can also result in negative outcomes when users feel frustrated, misinterpret messages, feel inefficient, and feel disrupted or slighted by other team members. Contextual factors that influence whether a mechanism will be triggered or blocked include: a) having protocols in place for smartphone use,(b) the complexity of patient care, c) team members in disparate locations, d) voluntary smartphone usage or having multiple choices of communication modes, e) time-sensitive disease processes that have protocol-driven care, f) team members who are not involved in the entire case, and g) team members who are supervisors or coordinators of team-based care.

Conclusion: Smartphone technology results in different outcomes based on the responses and reasonings of team members and the contextual characteristics of team members, teams, and environment. The findings of this realist review are relevant to nurse informaticists and nurse leaders who are making decisions regarding smartphone technology purchases, implementations, and evaluations. The resulting CMOs offer a myriad of opportunities for scholarly research.