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The Health Insurance Portability and Accountability Act of 1996 (HIPAA) transformed the protection of patient information from an ethical dilemma to a legal issue. Combined with directives from the Centers for Medicare and Medicaid Services (CMS) and the expanding prevalence of technology, healthcare organizations have been forced to rapidly adopt strict and innovative methods of ensuring electronic security, privacy, and confidentiality.

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Security refers to the protection of electronics systems, devices, and networks from unauthorized access, manipulation, or damage. It involves various measures and technologies to ensure the confidentiality, integrity, and availability of digital information (U.S. Department of Commerce, n.d.).

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Securing network information is a crucial aspect of electronic security. It involves implementing strong network security measures to prevent unauthorized access to sensitive data.
This can be achieved through the use of firewalls, intrusion detection systems, and virtual private networks (VPNs). According to IBM (2021), “communicating by using the private network is inherently more secure. Security controls attempt to prevent cyber security threats from attacking the network, however, attackers sometimes are successful, these tools help to create a secure perimeter around the network and monitor for any suspicious activities or attempts to breach the system (IBM, n.d.).

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Privacy and confidentiality are also essential components of electronic security as human beings truly value their privacy. No one really wants to have their private information out
accessible by the public. Privacy and Confidentiality involve protecting personal or sensitive information from being accessed or disclosed without proper authorization. Encryption is a commonly used technique to ensure the privacy and confidentiality of data. By encrypting data,
it becomes unreadable to unauthorized individuals, and only those with the appropriate decryption key can access or decipher it (Stanford, 2014).

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Regular data backup is crucial for ensuring the confidentiality of information. Backing up data regularly helps in recovering it in case of any security breaches, system failures, or data loss
incidents. It is important to store the backups in secure locations, preferably off-site or in the cloud, to prevent unauthorized access or physical damage (Berkeley, 2023).

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other security measures such as access controls, user
authentication, and data backup are employed to safeguard privacy and confidentiality. Access controls restrict access to information based on user roles and privileges, ensuring that only authorized individuals can view or modify the data (Microsoft, n.d.). User authentication methods like passwords, biometrics, or two-factor authentication add an extra layer of security by confirming the identity of users.

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Antivirus, antimalware, or anti-ransomware cybersecurity tools can monitor activities within a device. By comparing the signatures of all processes running within the device's memory, they are able to detect and block any known malicious process.

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IBM Security® MaaS360® is a unified endpoint management (UEM) solution that can help healthcare organizations comply with regulations, reduce IT workload, and lower mobile device management costs. It is user-friendly and designed to manage and protect healthcare mobile devices, users, and apps. The device management has AI analytics capabilities that can help detect and respond to malicious attacks that may put employee and patient data at risk, while also offering healthcare mobile device security.

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IBM Security® MaaS360® provides automated and continuous monitoring of mobile devices, built-in threat management, data loss prevention, and identity management to proactively achieve mobile device security in healthcare.

This security system also provides near-real-time, in-depth security analysis and scores. It acts as a protected digital data platform with built-in AI to create an interactive, graphical summary of your mobile device management operations and compliance.

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Hospitals and other healthcare providers must use healthcare data security tools to reduce risks and prevent attacks and data breaches. Such security leaks can cause dire financial and legal damage for organizations. To successfully address the new threats that healthcare groups regularly face, companies must consider upgrading their cybersecurity tools to better protect themselves against newer and more sophisticated attacks against healthcare data security that involve phishing, spoofing, ransomware, and identity theft.

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Chouffani, R. (2019, April 17). The 8 key ways to Assess Healthcare Data Security tools: TechTarget. Health IT. https://www.techtarget.com/searchhealthit/feature/The-8-key-ways-to-assess-healthcare-data-security-tools#:~:text=There%20are%20a%20handful%20of,Platform%20and%20Cisco%20Security%20Manager.

Mobile Device Management (MDM) for healthcare - IBM security maas360. IBM. (n.d.). https://www.ibm.com/products/maas360/healthcare?utm_content=SRCWW&p1=Search&p4=43700075497813952&p5=p&gclid=EAIaIQobChMIgLC65ZeRgAMVf6VaBR2bAg5xEAAYASAAEgJ7HfD_BwE&gclsrc=aw.ds

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Top threats to Cyber security explained! 

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Top threats to Cyber security explained! 

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Best practices for nurses to help prevent cyberattacks

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Best practices for nurses to help prevent cyberattacks

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In the age of EHR, storing info on a cloud, and working on smart phones, it's also a prime time for hacking. Nurses need to protect the security and privacy of their patients' personal and health care-related info so it's important to educate yourself about cybersecurity best practices. So, how do you go about it?

We connected with Casey Crane, a cybersecurity journalist at SectigoStore.com, who has written for a variety of cybersecurity industry publications, including Hashed Out at The SSL Store, HackerNoon, Experfy and Infosec Insights. Crane answered our questions about cybersecurity and what you absolutely need to know.
What are the best ways for nurses to protect their patients' information?
One of the best ways that nurses can protect their patients' personal and health care-related information is to inform themselves about cybersecurity best practices. If your organization doesn't offer cyber awareness training, request that they do so. This type of training can help you understand cyber threats like malicious websites, phishing emails, and other tactics that cybercriminals use to carry out attacks.

Here are a few other good cybersecurity best practices that you can use right away:

Always use unique passwords for your accounts.

One of the biggest mistakes that people across all industries make is using the same password for multiple accounts. A poll from Google and Harris shows that 52% of users reuse passwords across multiple accounts, and another 13% indicate that they use the same passwords across all accounts.

This means that all of your accounts should have unique passwords. This prevents hackers from using the same password to access multiple accounts in the event that one of your accounts becomes compromised.
Never plug personal devices (or unauthorized devices) into workstations or work devices.
If a device has previously been plugged into another device infected with malicious software, then you could inadvertently infect your workstation with the same malware. This gives hackers direct access to your network.
Don't click on attachments or links in emails without first inspecting the messages.
Check to see if the sender's name and email match, and if any links are legitimate. If the name and email don't match, or if the link is from some unknown web address, that should send up a red flag. For example:

If you normally get emails from your boss ([email protected]) but suddenly receive an email from an email address like mynameisjo[email protected] or [email protected], that would be suspicious.

If there's a link embedded in the email, hover your mouse over the link (without clicking on it!) and it should display the true web address where the link would take you.

If you receive an email from a suspicious address that contains a PDF, Excel file, or Word doc, don't click on it. It's possible that the file may contain malware.

If you receive an unusual or urgent request, call to confirm.
A common tactic that cybercriminals use to get you to do something or to provide information is to create an urgent situation. If you get an email or phone call from someone asking (or demanding) that you send them sensitive information, tell them you're going to call them back to confirm. Use the contact information that's provided through your organization's official contact directory-never respond using an email address or phone number provided by the person who reached out to you!
Be aware of what's going on around you.
Not all data breaches occur because of cyber attacks-sometimes, they come in the form of physical security breaches. Is there someone hanging around the nurses' station that you don't recognize or who doesn't belong there? Ask them if they need help. This proactive approach can help to prevent cybercriminals from gaining physical access to records and other data by accessing computers at those stations or stealing portable devices from the area.

Much like how you sanitize your hands and wear protective gear to keep yourself and your patients healthy, having strong "cyber hygiene" is what keeps your organization (and your patients' data) safe and secure.
Why do nurses need to protect their own email accounts, social media accounts, or their phones? Why do hackers start there?
Your personal email and social media accounts are a goldmine of data for cybercriminals. They can use information that they learn about you through those channels to guess your work account passwords. It also serves as fodder for social engineering tactics.

Nowadays, people tend to use their mobile devices and apps for banking, sending emails, and for handling other sensitive data. If a cybercriminal gets a hold of your cell phone or another mobile device that you use to access those accounts, then they have control of those accounts.
What are the most common tricks that hackers use?
Cybercriminals use the tactics that demonstrate the best outcomes with the least amount of effort. Needless to say, it's a lot easier to trick someone into handing over their credentials than it is to hack through their organization's network security defenses.

That's why phishing is among the most common tactics used by cybercriminals. Phishing relies on the use of social engineering tactics, which often involves them pretending to be a colleague, manager, or another authority figure. Cybercriminals use strong social skills and charm to disarm you while also evoking a sense of urgency, fear, or curiosity that compels you to act. Their ultimate goal is to trick you into doing something you'd normally never do.

For example, you'd never just give a stranger your employee credentials or a patient's health records or personal information. But if you receive a fraudulent email from someone pretending to be your organization's IT team saying that your password has been compromised and that you need to reset it via a link they provide, you may be doing precisely that without even knowing it.

Cybercriminals use phishing emails to get users to download malicious software or to click on malicious links. Continuing with the previous example, if you enter your username and password in a password reset form on a fraudulent website that looks like your organization's site, then you're giving them the ability to log in to your accounts and access any systems your account touches.
What kind of information are hackers trying to get? What do they do with it?
Hackers love all types of data. They can choose to use it themselves to carry out crimes or sell it to other cybercriminals through a market known as the dark web for profit. Some of the types of data they look for include:

Personally identifiable information (PII) such as names, phone numbers, addresses, social security numbers, etc.

Financial information such as credit or debit card information, bank account numbers, etc.

Protected health information (PHI) such as health records and insurance-related information

Proprietary data and intellectual property

Usernames, passwords, and other account credentials

User credentials and passwords are particularly valuable to cybercriminals. If they have your username and password, then they have the virtual keys to the kingdom. Hackers can use this information to access your organization's network, databases, patient files, or any other systems that your account touches.
What would readers be most surprised about regarding cybersecurity?
Unless an organization chooses to eliminate everything digital within their environments, there's no way to prevent every cyber attack. Hackers are always going to find vulnerabilities and weaknesses to exploit. But what you can do is follow cybersecurity best practices to make yourself and your organization tougher targets.

Firewalls, antivirus software, and other technologies can protect your organization from some threats but not all. You and your fellow health care providers are what constitute the "human firewall" of your organization.
Is there anything else that is important for our readers to know?

Cybercriminals are capitalizing on the COVID-19 pandemic to carry out phishing scams and other cyber attacks.

Data from Black Book Market Research shows that "Over 93% of healthcare organizations have experienced a data breach since Q3 2016 and 57% have had more than five data breaches during the same timeframe."

Researchers at Vanderbilt University believe that there may be a link between ransomware attacks and data breaches and an increase in heart-related deaths among patients at hospitals hit by those attacks. According to Brian Krebs, a cybersecurity expert and author: "Hospitals that have been hit by a data breach or ransomware attack can expect to see an increase in the death rate among heart patients in the following months or years because of cybersecurity remediation efforts."

You can complete cyber awareness training on your own. The U.S. Department of Defense offers free cyber awareness training online in the form of its DoD Cyber Awareness Challenge.

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Cybersecurity: What Nurses Need to Know - Daily Nurse

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Nurses need to protect the security and privacy of their patients' info so it's important to educate yourself about cybersecurity best practices.

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Hackers target Hospitals with "Ransomware"

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Hackers target Hospitals with "Ransomware"

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Hackers have continued to target Hospitals with ransomware attacks. Ransomware attacks disrupt Hospitals ability to function until they pay the ransom which can amount to hundreds of millions. This in turn affects the patients because Hospitals cant access patient data, financial records, scheduling services, etc.

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Despite an apparent decline in activity against hospitals during 2022, ransomware attacks have continued to endanger medical care and patient health this year and show no signs of abating.

Ransomware gangs typically have not restrained their avarice for healthcare organizations. Despite the pledges of some gangs in 2020 to refrain from attacking medical facilities during the COVID-19 pandemic, ransomware attacks continued to plague the industry across the globe. While U.S. law enforcement agencies have focused more attention on threat groups that target critical infrastructure, that scrutiny -- and potential for causing patient deaths -- has not deterred some ransomware gangs from attacking hospitals.

Cybersecurity vendor Emsisoft recorded 25 ransomware attacks on healthcare organizations, including "hospitals and multi-hospital health systems" in 2022, affecting as many as 290 hospitals across the country. That number is a significant decline from 2021, when Emsisoft observed 68 attacks on healthcare providers.

But U.S. hospitals and medical centers are still popular targets for threat actors. According to Check Point Research, the sector was the most targeted industry for ransomware attacks during the third quarter of 2022.

Attacking the healthcare sector, which often means impairing medical services and jeopardizing patient health, is considered unethical even by some cybercriminals. However, this is no deterrent for some ransomware gangs, especially with the potential value in attacking healthcare. In addition to encrypting IT systems, ransomware actors often target lucrative data in healthcare computer systems.

As electronic healthcare record databases grow by the second, threat actors see the sector as a vast landscape for monetization. In addition, technological advances create endpoints for cyber actors to subsidize from sensitive data on the dark web or via ransom payment.

"The attack threat actors are making a huge amount of money from all cyber attacks. But the healthcare information is so valuable to them," said Deryck Mitchelson, field CISO for EMEA at Check Point Software Technologies. "They can commoditize up very easily on the dark web."

In Sopho's "State of Ransomware in Healthcare 2022" report, the threat detection vendor found that 66% of the 381 healthcare organizations involved in the study were victim to ransomware attacks that year -- an increase of about 50% from 2021. Healthcare computer systems are complicated environments to secure. To maintain swift medical procedures, the necessary safeguards are sometimes neglected, leaving data vulnerable for attackers.

"If you can't issue their medicine in a timely manner in an emergency room or you can't access a record to determine what somebody's allergies might be like, these things are literally life and death choices," said Chester Wisniewski, field CTO of applied research at Sophos. "Often, systems get left a lot more open for the convenience of providing care."

Moreover, infosec experts have long argued that the environment under which medical professionals work leads them to quickly open emails, making them susceptible to phishing attacks.

"They do tend to respond quickly, click on things quickly," said Mitchelson. "They're often walking in between doing things, so they're doing things on the move. That's why phishing emails are something that you see that's one of the highest vectors."

The burden on hospitals

Ransomware attacks come with heavy expenses, as victims frequently experience company downtime where IT and/or power restoration may be required. It can be especially painful for healthcare organizations. Sophos' study showed recovery on average lasted one week and cost healthcare providers an average of $1.85 million in 2022.

Ransom payments are an additional expense for companies. Sophos' study found the healthcare sector paid a ransom in about 61% of incidents, up from 34% in 2020 and the highest rate of any vertical industry in its 2022 study.

Mitchelson said the payment rate is typically high because U.S. healthcare organizations primarily operate within the private sector, and executive teams can make their own decision to pay a demanded ransom. But in Europe, he said, many healthcare organizations are publicly funded and government operated and, therefore, are much less likely to pay. The situation is like the education sector in the U.S. For example, K-12 schools rarely pay a ransom because they function under the supervision of local governments and require approval to use taxpayer money for such expenditures.

Sophos' 'The State of Ransomware in Healthcare 2022' report found that 61% of healthcare organizations paid the ransom following an attack, which was the highest percentage among vertical industries analyzed.

Paying threat actors not only perpetuates a cycle of ransomware targeting on healthcare but also funds their operations, which can improve the cybercrime tools and attacking strategy.

"It tells them that the sector pays, so the chance of them attacking the sector increases," Mitchelson said. "They're able to use the money to invest in developing better ransomware kits that they can deploy or [developing] better ransomware as a service to deliver the payloads or just [hiring] more attackers."

Therefore, it's not ideal for healthcare organizations to pay, especially with the additional and inevitable remediation and recovery costs. However, without the proper safeguards and best practices, such as regularly patching systems, employing effective backups and establishing an incident response procedure, organizations can find themselves in a quandary. The pressure of quickly recovering from an attack and resuming patient care often means paying a ransom.

Compounding the problem for U.S. hospitals is that most do not have large cybersecurity budgets. T.J. Ramsey, director of threat operations at Fortified Health Security, said investing in quality medical equipment and assistance typically offsets any urgency for healthcare organizations to update systems and create backups. Healthcare systems do not have the funding to heavily invest in these cybersecurity defenses.

"Healthcare in general -- even major hospitals -- often operate on a budget of 2 to 5% in total of their net patient revenue," Ramsey said. "Patient care, preservation of human life and the delivery of medical services is going to be the number one concern for anybody."

Patient information and health at risk

Deficiencies in cybersecurity not only rack up costs for health centers, but they also lead to compromises of patient data and personal health information (PHI). This has become increasingly common over recent years.

Fortified Health Security found 51.4 million records were breached in 2022, an increase from 49.4 million in 2021.

Jama Health Forum conducted a study on 374 ransomware attacks on healthcare delivery organizations from 2016 to 2021. It found that threat actors exposed the PHI of more patients as time progressed. To make matters worse, the study showed the likelihood in restoring encrypted or stolen data from backups decreased over that period. On average, only one out of five organizations could restore their data from backups.

Some of these attacks impacted hundreds of thousands of patients. In April, Yuma Regional Medical Center in Arizona suffered a ransomware attack in which threat actors obtained the PHI of 737,448 patients; files were encrypted and exfiltrated from systems.

CommonSpirit Health, an umbrella organization with 150 hospitals and 2,000 healthcare sites, also took a big hit last fall when a ransomware attack compromised PHI of 623,774 past and current patients. The ransomware attack on CommonSpirit caused procedural disruptions like inaccessibility to patient portals, cancellation of appointments and redirection of ambulances to other hospitals.

More than that, some health systems argue that attacks are directly causing a loss of human life. According to the Ponemon Institute, 22% of healthcare organizations claim that ransomware attacks led to an increase in patient mortality rates in 2022. While some patient deaths have resulted in legal action and law enforcement investigations, there are no confirmed cases as of yet that directly attribute fatalities to an attack.

Are ransomware actors apologetic?

The dire impacts of ransomware sometimes cause threat groups to retreat in the name of reputability. Last December, ransomware group LockBit hacked into SickKids, a children's hospital in Canada, which delayed disclosure of lab and imaging results for patients and families resulted.

Two days later, LockBit apologized to the hospital, blaming the attack on a rogue affiliate. The group returned the decryption key at no cost.

Like many other security professionals, Ramsey found the apology insincere. "You have to remember we're dealing with a criminal element here," said Ramsey. "They might feign apologies or [play] to their emotional side there. We're a caring species; we, by default, want to be helpful to one another. But at the same time, you're dealing with the bad guys here."

Other ransomware gangs have apologized for their invasions in the past. In 2021, ransomware gang Conti attacked Ireland's public health system, compromising 54 hospitals and 4,000 other healthcare locations. Amid intense law enforcement pressure, the group provided the decryption key for free.

Despite that gesture, the now-defunct Conti group was known to attack healthcare systems. Jeremy Kennelly, Mandiant senior manager of financial crimes analysis at Google Cloud, said that one third of publicized attacks by UNC2727, a cybercrime group associated with Conti ransomware, were against the healthcare sector. Even with the occasional apologies and amends, there are currently no indications that ransomware groups will cease attacks on healthcare organizations.

Will Hive's defeat have an impact?

In January, the FBI announced that it had infiltrated the Hive ransomware gang's network and obtain decryption keys for hundreds of victims, saving them $130 million in ransom payments. Authorities also seized the gang's infrastructure and took down its dark web site.

Hive ransomware, notorious for their attacks on healthcare, was first observed in June 2021. Since then, Hive has affected over 1,500 victims globally and accumulated $100 million in ransom exchanges. In December, Hive claimed responsibility for a ransomware attack on Lake Charles Memorial Health System, which compromised nearly 270,000 patient records.

While it represents a major victory in the fight against ransomware, the Hive takedown may not have much of an impact on the overall threat landscape. Threat researchers believe the upward trend of attacks will only continue to grow this year. In 2023, there have already been several ransomware attacks on healthcare organizations, including a recent attack on Atlantic General Hospital in Maryland.

In addition, the ransomware as a service (RaaS) market has demonstrated resilience over the years, with many operators shutting down their sites and later forming new RaaS gangs with different names but similar code and tactics. Affiliate hackers working for Hive may simply shift to Vice Society, Lock Bin or another competing RaaS.

"It's just causing a small amount of disruption until they all continue and go again," Mitchelson said. "There are clear trends that there are more and more criminals within these gangs. The numbers are actually going up, and the groups are thriving despite us taking them down."

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No relief in sight for ransomware attacks on hospitals | TechTarget

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Ransomware gangs will continue to target the hospitals and healthcare providers in 2023, despite efforts to curb the threat.

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In the fast-paced world of healthcare, there is an ever-increasing demand for quick and reliable access to more and more information. Smartphones provide a means of access that is available to nearly all healthcare workers with direct patient contact. In the linked literature review, the authors examined the use of personal smartphones in the workplace among nurses. They found that 64% of nurses had used their smartphones to access medication, pathophysiology, and education information, 50% had used their phones to contact other members of the healthcare team, and more than 75% of nurses would prefer to use their phones for information (de Jong et al, 2020).

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Monitoring Editor: Gunther Eysenbach and Lorraine Buis

Reviewed by Gillian Strudwick and Julie Ayre

Andrea de Jong, BSCN, MSCN,#¹ Lorie Donelle, BSCN, PhD, #¹ and Michael Kerr, PhD#¹

Abstract

Background

There has been an increase in the technological infrastructures of many health care organizations to support the practice of health care providers. However, many nurses are using their personal digital devices, such as smartphones, while at work for personal and professional purposes. Despite the proliferation of smartphone use in the health care setting, there is limited research on the clinical use of these devices by nurses. It is unclear as to what extent and for what reasons nurses are using their personal smartphones to support their practice.

Objective

This review aimed to understand the current breadth of research on nurses' personal smartphone use in the workplace and to identify implications for research, practice, and education.

Methods

A scoping review using Arksey and O'Malley's methodological framework was conducted, and the following databases were used in the literature search: CINAHL, PubMed, ProQuest Dissertations and Theses, Embase, MEDLINE, Nursing and Allied Health Database, Scopus, Web of Science, and Cochrane Reviews. Search terms used were Nurs* AND (personal digital technology OR smartphone OR cellphone OR mobile phone OR cellular phone). Inclusion criteria included research focused on nurses' use of their own digital technologies, reported in English, and published between January 2010 and January 2020. Exclusion criteria were if the device or app was implemented for research purposes, if it was provided by the organization, if it focused on infection control, and if it was focused on nursing students or nursing education.

Results

A total of 22 out of 2606 articles met the inclusion criteria. Two main themes from the thematic analyses included personal smartphone use for patient care and implications of personal smartphone use. Nurses used their smartphones to locate information about medications, procedures, diagnoses, and laboratory tests. Downloaded apps were used by nurses to locate patient care-related information. Nurses reported improved communication among health team members and used their personal devices to communicate patient information via text messaging, calling, and picture and video functions. Nurses expressed insight into personal smartphone use and challenges related to distraction, information privacy, organizational policies, and patient perception.

Conclusions

Nurses view personal smartphones as an efficient method to gather patient care information and to communicate with the health care team. This review highlights knowledge gaps regarding nurses' personal device use and information safety, patient care outcomes, and communication practices. This scoping review facilitates critical reflection on patient care practices within the digital context. We infer that nurses' use of their personal devices to communicate among the health care team may demonstrate a technological "work-around" meant to reconcile health system demands for cost-efficiency with efforts to provide quality patient care. The current breadth of research is focused on acute care, with little research focus in other practices settings. Research initiatives are needed to explore personal device use across the continuum of health care settings.

Keywords: nurses, digital health, smartphone, evidence-informed practice

Introduction

Smartphone use is increasing globally, with an estimated 3.3 billion users in 2019 and an anticipated 3.8 billion users by 2021 [ 1]. Countries with the greatest number of smartphone users include China, India, and the United States [ 1]. A smartphone is a device that has both computing abilities and mobile communication technology [ 2]. Mobile communication technology has undergone rapid development [ 3], and smartphone production is one of the fastest growing technological industries [ 4]. Coupled with the proliferation of smartphones is the high demand for downloadable apps that a smartphone user can add to their device. In 2018, over 4 million Android and Apple apps were available either free or for a cost [ 5]. These apps provide the user with additional services and features on their smartphone device.

Within the health care context, there has been an increase in the use of smartphones by health care providers in the last several years [ 2], including an increase in the use of health professional apps [ 6]. Fölster [ 7] reported over 200,000 health-related apps available for purchase or free of charge. The increased use of smartphones and selected apps by health care professionals mirrors the increased use of information technology within health care. There has been a significant increase in the implementation and use of electronic documentation systems, with billions of dollars being utilized to support the provision and coordination of health care to patients using information technology [ 8]. However, despite the increased use of apps in health care, health care professionals have expressed concerns relating to the trustworthiness of apps and a knowledge gap on the effectiveness of apps [ 9].

Electronic documentation systems have been integrated within health care systems to provide a centralized repository and accessible source of clinical information for health care providers [ 10]. These same systems are intended to support clinical care practices among all health care providers while providing access to information, decision-support tools, and improved workflow [ 10, 11]. Given their extended contact with patients and families, nurses tend to have the greatest interaction with electronic documentation systems relative to other health care providers [ 12].

Despite the increase in technological infrastructures of many health care organizations to support the practice of health care providers, many nurses are using their personal digital devices (eg, smartphones) while at work for both professional and personal purposes [ 13, 14]. Yet, there is limited research available on the clinical use of personal smartphone devices by nurses. In addition, there is limited research available that focuses on nurses' use of commercially available health-related apps in the workplace [ 15]. These gaps in research are especially important to understand given the most recent global pandemic caused by COVID-19 [ 16]. The COVID-19 pandemic lead to rapidly evolving public health measures with frequent changes in practice guidelines in all health care settings. Health care organizations had to respond and adapt quickly. With smartphones being a convenient and accessible way to locate information, the use of these devices in practice by nurses needs to be an area of focus, especially when facing a global pandemic.

It is unclear as to what extent and for what reasons nurses are using their personal smartphones to support their practice. Similarly, there is a lack of clarity regarding the quality and credibility of the resources accessed by nurses via their personal devices. However, the expectation of evidence-informed patient care practices highlights the importance of access to health-related resources for nurses and other health care providers [ 17]. In essence, evidence-informed practice necessitates nurses to critically evaluate information collected regarding patients' needs and to integrate it with the available clinical and research evidence to enable evidence-informed patient care [ 18]. A valued feature of mobile smartphones is the pro re nata, or PRN, access to vast amounts of online health-related information. In this scoping review, we are interested in how nurses are leveraging their personal smartphones for personal and patient care-related purposes across a variety of health care settings.

This research aims to explore and synthesize the current literature regarding nurses' use of their personal digital devices in the workplace. The purpose of this review is to understand the current breadth of research to identify knowledge gaps, practice and policy implications, and future research opportunities. More specifically, this review seeks to gain an understanding of nurses' use of their personal digital technology within the workplace.

Methods

Overview

A scoping review was the chosen method to review the literature as it is well suited for burgeoning areas of research. In addition, scoping reviews aim to identify gaps in research while mapping key concepts and types of evidence [ 19]. Arksey and O'Malley's [ 20] methodological framework outlines five stages for conducting a scoping review, including identifying the research question; identifying relevant studies; study selection; charting the data; and collating, summarizing, and reporting the results. A critical step in this final stage involves identifying the research and evidence gaps that need to be addressed [ 20]. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist was used to ensure that the scoping review is robust and includes all essential reporting items [ 21].

Step 1: Identify the Research Question

The research question we identified for this review is "How are nurses using their personal smartphones within the clinical workplace?"

Step 2: Identifying Relevant Studies

The following databases were used in the literature search process: CINAHL, PubMed, ProQuest Dissertations and Theses, Embase, MEDLINE, Nursing and Allied Health Database, Scopus, Web of Science, and Cochrane Reviews. Search terms used were: Nurs* AND (personal digital technology OR smartphone OR cellphone OR mobile phone OR cellular phone). Different search terms were trialed during the initial literature search process. The search terms selected were broad and were determined to capture all relevant studies that relate to the research question. See Multimedia Appendix 1 for the full syntax of search terms.

Articles included in the review had to meet the following inclusion criteria: a research focus on nurses' use of their own digital technology, research reported in English, and research published between January 2010 and January 2020 in order to capture data that aligned with the proliferation of mobile phone ownership. Studies focusing on a specific device or online app use were included only if the motivation for use was nurse driven. Studies were excluded from this review if the workplace organization provided the technology or if the technology was implemented for research purposes. Studies that focused on infection control of personal digital technology were excluded. Studies were also excluded if they focused on personal digital technology use and nursing students or nursing education, as this review was aimed at understanding practicing nurses' use of digital health technologies within clinical settings.

Step 3: Study Selection

A total of 2606 studies were identified using the search criteria above. Through consensus agreement between two reviewers, 22 studies met the inclusion and exclusion criteria and were included for the scoping review. See Figure 1 for a flow diagram of the article selection process.

Step 4: Charting the Data

Two databases were set up in Step 4. One database, Mendeley, was used for sharing of articles between authors, including sharing to achieve consensus review. The other database was a matrix where all the data were collected. A spreadsheet was created to organize relevant information from the included articles. Data collected from each article included author names, year of publication, study design, data collection method, target population, study location, and research question.

Step 5: Collating, Summarizing, and Reporting the Results

During the final stage of collating, summarizing, and reporting the results, the framework approach described by Ritchie and Spencer [ 22] and used by Arksey and O'Malley [ 20] was used in this review. This technique involves synthesizing and interpreting the data by sifting, sorting, and charting the information based on the key themes and issues presented in the literature [ 22]. The data were charted and thematically analyzed. Data analysis was conducted by two researchers and analytical discrepancies were resolved through discussion until consensus was achieved.

Results

Overview

The 22 studies included in this research (see Tables 1 - ​-3 3 [ 23- 44]) were conducted across a diverse range of countries and published between 2013 and 2019, with most (17/22, 77%) published in 2016 or later. Out of the 22 included studies, 16 (73%) used quantitative (ie, cross-sectional survey) research designs [ 23- 38], 4 (18%) were qualitative [ 39- 42], and 2 (9%) used a mixed methods design [ 43, 44].

Table 1

Study design and author (year)

Data collection method

Target population

Study location

Research questions

Negative implications of personal digital technology

Purpose for digital technology use

Alameddine et al (2019) [ 23]

Survey, cross-sectional

97 emergency department (ED) providers, including ED faculty members, attending physicians, medical students, residents, and nurses (33% nurses)

Academic health center with the highest volume of patient visits in Lebanon

1. What are the frequency and patterns of smart device use among health care providers in the ED of a large academic health center in Lebanon?

Bautista (2019) [ 24]

Pen and paper survey

517 staff nurses

19 tertiary-level general hospitals in Metro Manila, Philippines

1. Using a ranking system, how do Filipino nurses use their smartphones for work purposes?
2. What are the differences in nurses' smartphone use for work purposes based on demographic and organizational factors?

N/A a

De Benedictis et al (2019) [ 25]

Survey

125 nurses and 66 physicians

An Italian university hospital in Rome, Italy

1. In what way is WhatsApp used in hospital settings by physicians and nurses with patients and between colleagues?
2. Which are the main perceived benefits and threats concerning the use of WhatsApp in a hospital
setting by physicians and nurses?
3. Which are the determinants (individual and/or organizational) of the use of WhatsApp in a hospital setting?
4. Is there an interplay between individual and organizational determinants?

Di Muzio et al (2019) [ 26]

Survey

193 nurses

Sapienza University Hospital, Rome, Italy

1. What is the validity and reliability of the Nurses' Use of PCDs b Questionnaire in the Italian hospitals?

Flynn et al (2018) [ 27]

Survey

735 acute care nurses, point of care and not point of care

Six acute care medical-surgical facilities in an urban health care system in the Southern United States

1. What are the current rates of personal smartphone use by nurses in acute care settings?
2a. What are nurses' preferences regarding the use of smartphone functionality in acute care settings?
2b. Are there differences in use by age category or role?
3a. What are nurses' perceptions of the benefits and drawbacks of using smartphones in the acute care setting?
3b. Are there differences in perceptions by age category or role?

Garner et al (2017) [ 28]

Survey

97 acute care nurses and physicians (82.5% were nurses)

340+-bed tertiary facility in Bengaluru, India

1. What are the smartphone access and use, including future opportunities for mHealth c and potential ethical implications, among health care professionals practicing at a health care facility in Bengaluru, India?

Misuse of health information

Grabowsky (2015) [ 29]

Survey

59 advanced practice nurses (APNs)

Alabama, United States; physician's office, outpatient clinics, hospitals, academic health centers, employee health clinic, hospice, nurse practitioner-owned practice, Veterans Administration nursing home, urgent care, health department, and dialysis unit

1. What types of clinical questions are answered using smartphones?
2. Are there barriers to information seeking with smartphones?
3. What phone apps and online resources do APNs find most useful in clinical situations?
4. How do APNs view their current online searching skills?
5. What is the level of interest in receiving training in online searching and what type of training is preferred?
6. Is the use of smartphones to answer clinical questions related to gender, level of education, population of practice area, practice type, or years approved to practice as an APN?

Hranchook et al (2018) [ 30]

Survey

258 certified registered nurse anesthetists (CRNAs)

Michigan Association of Nurse Anesthetists, United States

1. What are the clinical and nonclinical uses of mobile computing devices among Michigan CRNAs?
2. What are the experiences of Michigan CRNAs with regard to the impact of using these devices on patient care?

Mayer et al (2019) [ 31]

Survey

1293 nurses across a range of settings, including hospital care, primary care, social health care, prehospital care, management, teaching and research, and private practice

Nursing Association of Barcelona

1. Are nurses using health apps professionally and what types of apps are they using?
2. Among nurses, is there a need for training in the use of health apps?
3. What are nurses' perceptions of health professional apps?
4. Is there a need for a certification process for health apps and what type of institution or organization should review and validate these apps for professional use?

McBride et al (2015) [ 32]

Survey

825 acute care hospital registered nurses (RNs)

Members of Academy of Medical Surgical Nurses, United States

1. What is the frequency of nonwork-related use of personal mobile phones and other personal communication devices among hospital RNs?

N/A

McBride and LeVasseur (2017) [ 33]

Survey

1268 nurses (staff, charge, advanced practice, managers, faculty, and executive)

Members of the Academy of Medical Surgical Nurses and the Society of Pediatric Nurses, United States

1. How do RNs working on inpatient units use their PCDs at work (excluding lunch and breaks) and what are their opinions about how PCD use impacted their work and the work of their colleagues?

Mobasheri et al (2015) [ 34]

Survey

564 acute care nurses and 287 doctors

Five individual hospital sites in London, United Kingdom

1. What are the ways that frontline staff are using smartphones, tablet devices, and mHealth apps in the clinical environment?

Moore and Jayewaedene (2014) [ 35]

Survey

82 acute care nurses and 334 doctors

40+ acute trusts in England

1. How do nurses and doctors use their smartphones at work, what do they use them for, and do they assess the risks associated with the apps they use?

Piscotty et al (2016) [ 36]

Survey

140 nurses in Registered Nurse to Bachelor of Science in Nursing program (RNs already had worked as nurses)

Public school of nursing in Southeast Michigan, United States

1. What is the prevalence of social media use by nurses during work hours?

N/A

Pucciarelli et al (2019) [ 37]

Survey

256 acute care nurses who worked in hospitals, outpatient facilities, or day surgeries

Seven hospitals in Central and Southern Italy

1. What are the work- and nonwork-related activities performed by nurses using smartphones in the workplace?
2. What are the differences between smartphone use and nurses' age, gender, and working environment?
3.What are the positive or negative influences that smartphones have on nurses' performance during their health care activities?

Stergiannis et al (2017) [ 38]

Survey

974 acute care medical and nursing staff (18.5% nursing assistants and 42.6% nurses, with the rest being doctors and junior doctors)

Six general hospitals in Athens, Greece

1. What is the clinical use of smartphones among medical and nursing staff in Greece?

Unaware of apps that can be used to assist them in their daily clinical task

Did not think smartphones were useful

Unsure about appropriate sites and apps

Distrustful of information

Lack of education on how to use phone

N/A

Table 3

Study design and author (year)

Data collection method

Target population

Study location

Research questions

Negative implications of personal digital technology

Purpose for digital technology use

Giles-Smith et al (2017) a
[ 43]

Survey, focus groups

94 acute care inpatient medical and surgical nurses

Community hospital and tertiary hospital in Winnipeg, Canada

1. What is the current usage of mobile devices and apps by nurses for direct patient care within the study sites?
2. What are the attitudes of nurses at these study sites toward the use of mobile devices and apps for direct patient care?

Lack of wireless internet

Unsure if allowed to use at work

Potential damage or loss of phone

Concern of patient perception of phone

Planitz et al (2013) [ 44]

Survey, observation

299 acute care nurses

Various units and wards in a tertiary hospital located in Brisbane, Australia

1. What is the level of actual personal smartphone use by nurses that is occurring within the hospital?
2. What are the attitudes of nurses toward smartphone use at the hospital?
3. Do the benefits of smartphones outweigh the consequences of distractions and occasional misuse?
4. What are the factors influencing whether nurses used smartphones at work?
5. How are nurses using their smartphones at work?

Table 2

Study design and author (year)

Data collection method

Target population

Study location

Research questions

Negative implications of personal digital technology

Purpose for digital technology use

Bautista and Lin (2016) [ 40]

Semistructured interview

30 acute care staff, charge, and nurse managers

13 tertiary hospitals in the Philippines

1. How do the interactions of sociotechnical components (users, technology, and policy) affect staff nurses' use of personal mobile phones at work?

Personal cost, as hospital does not provide phone

Privacy gaps and punishments

Bautista and Lin (2017) [ 39]

Semistructured interview

20 acute care staff nurses

Nine hospitals in the Philippines

1. How and why are mobile instant messaging apps used by Filipino nurses as part of their work?
2. What are the gratifications derived by nurses when using mobile instant messaging apps?

N/A a

Chiang and Wang (2016) [ 41]

Semistructured interview

17 community nurses working for home care facilities

Two regional hospital-affiliated home care facilities and four community home care facilities in Southern Taiwan

1. What are nurses' experiences regarding the benefits and obstacles of using a smart mobile device app in home care?

Park and Lee (2019) [ 42]

Semistructured focus group interviews

4 orthopedic scrub nurses

Operating room of a veterans' hospital, Korea

1. How are scrub nurses using a commercially available smartphone app to solve information needs in orthopedic surgery?

N/A

Health Care Settings

In reviewing the included studies, most researchers focused on investigating personal smartphone use among hospital-based nurses (18/22, 82%) [ 23- 28, 30, 32- 35, 37- 40, 42- 44]. As well, 6 studies out of 22 (27%) included a multidisciplinary group that also included inquiry into physicians' use of personal smartphones in the clinical setting [ 23, 25, 28, 34, 35, 38]. There was a single study that investigated registered nurses' personal technology use during work hours, whose sample population were enrolled in a Registered Nurse to Bachelor of Science in Nursing program, with 93% of the nurse participants currently working in acute care [ 36].

Out of 22 studies, 2 (9%) targeted nurses working in community-based health care settings [ 29, 41]. Grabowsky [ 29] focused on advanced practice nurses who worked in an array of settings, including a variety of outpatient clinics. Chiang and Wang [ 41] investigated personal digital technology use among community nurses who worked for home care organizations. Out of 22 studies, 1 (5%) included nurses from a range of settings, both acute and nonacute, including hospital, primary care, social health care, prehospital care, management, education, and private practice settings [ 31].

Two main themes with associated subthemes were generated from the analyses. The first theme was personal smartphone use for patient care. This theme was divided into three subthemes: information seeking, communication, and mobile device functions. The second theme was implications of personal smartphone use, which was refined into five subthemes: smartphone use for personal reasons, distraction, patient perception, privacy and confidentiality, and organizational support and policy confusion. The details of the themes and subthemes are described narratively in the following sections.

Personal Smartphone Use for Patient Care

Implications of Personal Smartphone Use

Patient Perception

Similarly, nurses expressed their lack of knowledge about patients' perceptions of their smartphone use and the potential for patient complaints [ 27, 28, 35, 40, 43]. Nurses were concerned about patients' possible negative feelings and thoughts about mobile devices being used at the beside [ 23, 43].

Privacy and Confidentiality

Nurses identified privacy and confidentiality of patient health information as a concern associated with the use of their personal devices within the workplace [ 25, 28, 34, 40, 41]. Mobasheri et al [ 34] found that 3.6% of nurses believed there was patient-related clinical information retained on their personal smartphones. Similarly, home care nurses discussed their concerns regarding their use of the Line app, reporting that "others could easily see patients' recent whereabouts or sensitive personal information on the software platform" [ 41].

Lack of Organizational Support and Policy Confusion

Lack of organizational support and policy confusion was expressed by nurses [ 30, 40, 41, 43]. Despite organizational policy that prohibited personal smartphone use within their clinical setting, most nurses considered their smartphones as helpful technology in their workplace. Some nurses were aware of policies restricting personal smartphone use, while others stated they did not know what the existing policies for personal smartphone use entailed. Hranchook et al [ 30] reported that 47.2% of the nurse participants in their study knew that their organization had a personal device use policy, 22.6% said their institution did not, while 30.2% were unsure. When asked if medical administrators should develop a code of conduct for smartphone use to minimize unnecessary distraction, 44% of participants agreed, while 51% disagreed [ 23]. Nurses also reported barriers to Wi-Fi and internet access issues within their organizations that impeded their access to online resources [ 28, 29, 38, 43].

Discussion

Principal Findings

A scoping review of 22 studies was conducted to examine the current breadth and range of research on nurses' use of personal smartphones in the workplace; to our knowledge, this is the first review of its kind. Based on the studies included in this review, nurses have reportedly been using their personal smartphones within their workplace for personal and patient care purposes since 2013.

From the existing evidence, we know that nurses used their personal smartphone devices to gather patient care information and to communicate within the health care team. In support of evidence-informed patient care, nurses used online apps and programs to locate information relating to patient-prescribed medications, clinical procedures, diagnoses, laboratory tests, and more. The information-seeking and consultation behaviors align with evidence-informed nursing practice [ 18, 45]. Nurses require access to specialized knowledge and comprehensive clinical information to inform their clinical decision making. However, the significant demands on nurses' time impedes their ability to engage with research and health care resources required for evidence-informed practice [ 46]. The use of their personal smartphone devices provided nurses with rapid and easy access to online health information. It is possible that nurses are using their personal smartphones as a way to efficiently access needed resources and support their patient care information needs.

Despite the high level of smartphone and app use, there was minimal reporting on nurses' attention to the quality and accuracy of the information garnered from the apps used. The commercial profitability of health-related apps tend to take priority over ensuring that apps are critically appraised for information accuracy [ 47]. However, when asked, nurses expressed that they want health apps to be certified by a health or professional institution, exemplifying their concern about information quality [ 31]. Nurses who conducted a risk assessment on the apps that they used assessed the trustworthiness of the source, sought guidance from professional bodies on technology and app use, and were vigilant about patient information privacy [ 35].

Similarly, nurses may be resorting to their own personal digital devices to compensate for the lack of support provided by their organizations [ 42]. As reported elsewhere, nurses who have access to resources from a medical library, have internet access at work, and have the opportunity to work with computer technologies are more likely to engage in evidence-informed nursing practice [ 48]. Organizations that strive to provide the highest-quality patient care are also accountable to providing the resources that make this achievable. The presupposition of health information technology within the clinical setting highlights the need for organizations to provide continuing education to all health care providers regarding risk assessments of health information technologies (eg, devices and apps) for responsible use and to support evidence-informed practices.

Effective communication among the health care team is essential for quality patient care and effective teamwork [ 49]. In fact, the most common reason for errors resulting in patient harm result from communication failures [ 50]. In our review, nurses used text messaging, telephone, and picture and video functions on their smartphones to communicate with other members of the health care team. Furthermore, nurses preferred the use of their own smartphones for efficient and immediate communication among health care team members. Medical students have also reported using personal smartphones as an efficient means of communication and for coordination of the clinical team [ 51]. It may be that organizationally based communication systems do not provide satisfactory options to meet the precipitous communication needs of health care teams working within a digital health context [ 52]. Similarly, nurses' use of their personal devices to communicate among members of the health care team may demonstrate a technological "work-around" meant to reconcile health system demands for cost-efficiency with efforts to provide quality patient care [ 53].

Despite nurses' desires to use their personal smartphones in the workplace, they were also mindful of concerns that included personal and/or colleague distraction, and they acknowledged challenges to information privacy and information security related to possible retention of patient data on their smartphones. Nurses' use of their personal devices to share practice-related information among health care teams may characterize their "work-around" of organizational health information systems that have not effectively considered nurses' workflows, their need for accessible and up-to-date health care information, nor communication practices among multidisciplinary health care teams [ 52, 54]. Nurses are not the only health professionals experiencing these tensions. Physicians report that barriers to using their smartphones in practice include organizational policies against smartphone use and concerns about using them during patient consultations [ 9]. The tension between quality health practices and pressure to find system efficiencies may have also contributed to nurses' use of their personal smartphones within the workplace [ 54]. The reported lack of awareness of organizational policies related to personal smartphone use and nurses' lack of knowledge regarding patient perception of their smartphone use for patient care constitute two important areas for future research and health professional education [ 55].

Implications

Implications for Research

This scoping review highlights significant gaps in research regarding nurses' use of personal smartphones in the workplace. To date, research has focused on acute care nurses, with little investigation of nurses' device use within other practice settings. Research is needed to understand personal smartphone use across a more diverse range of health care settings, such as home care, long-term care, and public health. A greater understanding of other health care settings, such as long-term care, will provide invaluable information, especially due to the aging population in Canada and the growing demand on care providers for the elderly. COVID-19 exposed profound gaps in long-term care in Canada, including access to practice standards and education. The importance of public health care workers was also emphasized during the COVID-19 pandemic. Research can help to inform how smartphones can be leveraged to support nurses, especially during resource and staffing shortages. This will also help to generate a greater understanding of the online resources (eg, online information sites and apps) that support nurses' practices. Research is also needed to inform smartphone practice strategies and policies that support efficient team communication and that are accountable to information, privacy, and security concerns.

Implications for Practice

Nurses are using their personal devices to access clinical information and to contribute to clinical decision making. If apps are being used and patient information is entered, it is important to know where the information is being stored, who has access to it, and who owns the data. Nurses' use of their personal digital devices for sharing patient-related information within the health care team carries a potential risk for inappropriate disclosure of personal health information. While unapologetic about using their personal devices, nurses instead advocated for information-secure messaging apps that would ensure the safety and security of people's personal health information [ 34].

Implications for Policy

Evidence that over 75% of nurses and physicians within acute care settings use their personal smartphones to support their patient care practices is indicative of a clear gap between policy and practice [ 27, 38]. If nurses, as well as other health care professionals, use their smartphones as an efficient way to retrieve and share information, it would be incumbent on organizations to reassess their policies regarding personal phone use and to work with technology developers and care providers to nurture their innovative thinking and insight into effective, responsive, and responsible technology-enabled solutions.

Limitations

There were several limitations when completing this scoping review. As 16 of the 22 studies were quantitative and used cross-sectional surveys to gather data, there were limited descriptions and examples available to provide an in-depth understanding of smartphone and mobile phone use. In addition, due to the lack of diversity in the target population, there is limited evidence across the nursing continuum. Lastly, studies included were only in English; studies in other languages were not included in these findings.

Conclusions

This scoping review provides insight into nurses' use of their personal smartphones within the workplace setting. The review highlights knowledge gaps regarding nurses' personal device use and the safety and privacy of personal health information, patient care outcomes, communication practices among health care teams, and insight into app and information accuracy and reliability, thus creating significant opportunities for future research regarding nurses' use of personal digital technology in the workplace. Organizational policies that limit or prohibit smartphone use may be shortsighted; insightful leadership would leverage the knowledge of nurses with other health care providers to collaboratively develop strategies that enable efficient, respectful, and ethical use of communication technology for effective patient care practices [ 56].

Abbreviations

PRISMA-ScR

Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews

PRN

pro re nata

Appendix

Multimedia Appendix 1

Full syntax of search terms for the literature search process.

Footnotes

Conflicts of Interest: None declared.

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Articles from JMIR mHealth and uHealth are provided here courtesy of JMIR Publications Inc.

# data[].attributes.attachment_link.title
Nurses' Use of Personal Smartphone Technology in the Workplace: Scoping Review

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There has been an increase in the technological infrastructures of many health care organizations to support the practice of health care providers. However, many nurses are using their personal digital devices, such as smartphones, while at work for personal ...

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Healthcare organizations carry an ethical and legal obligation to protect the privacy of their clients' protected health information. Several tools to aid this effort exist, including anti-virus and anti-malware software, firewalls, and two-factor authorization for licensed users. Healthcare workers, especially nurses, are encouraged to increase their awareness of cybersecurity threats and the role their actions play in protecting patient information. As healthcare facilities increasingly rely on technology to improve efficiency, the workforce must remain vigilant in safeguarding patient privacy and information.

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Web and application intrusion : Unauthorized and malicious access to a website or app.

Credential threat: Stolen usernames and passwords.

Malware: Software designed to disrupt, damage, or gain unauthorized access to a computer system.

DDoS: A malicious attempt to disrupt access to a website by flooding it with illegitimate request, ex: more request to a website than it can handle.

Insider threat: Someone with authorized access intentionally causing harm to a facility.

# data[].attributes.body
The Health Insurance Privacy and Portability Act of 1996 (HIPPA) provides guidelines for what constitutes private healthcare information and imposes severe financial penalties against organizations that violate their obligations to protect that information. Personal mobile devices used for work in a professional healthcare environment pose a substantial security risk for employers. Potential risks include being connected to the hospital's unsecured public Wi-Fi, the possible presence of undetected malware on a phone, and persons other than the healthcare worker having access to the phone. Despite most hospitals having policies that prohibit personal cellphone use at work, "...most nurses considered their smartphones as helpful technology in their workplace" (de Jong et al., 2020).

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In today's Information Age, mobile devices provide access to degrees of on-demand knowledge and instant communication that have become engrained within our society. These tools have the potential to positively impact healthcare on a global scale, but not without risk. Privacy concerns and security risks are major barriers to the use of mobile devices in a healthcare setting.

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Overall, electronic security plays a vital role in securing network information, protecting privacy, and maintaining the confidentiality of sensitive data. Organizations and individuals need to implement robust security measures and stay updated with the latest technologies and best practices to mitigate the risks associated with electronic threats.

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Mobile Device Use in Healthcare Facilities

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Mobile Device Use in Healthcare Facilities

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Please view this short video for a discussion on how healthcare facilities can safely utilize mobile devices in the workplace.

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Mobile Device Use in Hospitals - NUR 353

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Two factor authentication is an accepted approach to securing user data and providing additional defense against brute-force attacks, dictionary attacks, snooping, or main-in-the-middle tactics bay adding a factor of position, which acts as an extra step in the authentication process (Suleski et al., 2023). While two factor authentication via ones phone or email address is the standard, the next step is biometric verification. Biometrics is not new, in fact the department of homeland security has been using face recognition since 1969. It is already being applied in healthcare. The perfect example is accessing the Pyxis by requiring a password and finger scanning.

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Implications on Nursing Practice and Patient Care

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Implications on Nursing Practice and Patient Care

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Healthcare facilities stand to benefit from taking advantage of the capabilities of modern mobile devices. These devices have the potential to empower nurses with fast, quality information and education resources, enhance communication, and improve nurse workflow. These benefits can lead to a corresponding improvement in the nurse-patient relationship and patient outcomes. Further research may be required to quantify the perceived and actual benefit of mobile devices in a healthcare practice.

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Electronic Health Records: Privacy and Security

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Electronic Health Records: Privacy and Security

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Electronic Health Records: Privacy and Security

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1) What are some examples of measures nurses can take to protect the electronic security of their patients' information?

2) What are some of the barriers healthcare organizations face when adopting new measures to enhance electronic security?

3) How does the CMS's 2019 Final Rule on Interoperability impact electronic security?

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Implications of authentication of users in nursing research, practice, and patient care.

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Implications of authentication of users in nursing research, practice, and patient care.

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User authentication methodologies are continuously evolving with advanced hardware solution and enhanced multi factor authentication. This is improving access to e Health resources for patients while adding an additional layer of security.

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1. de Jong, A., Donelle, L., & Kerr, M. (2020). Nurses' Use of Personal Smartphone Technology in the Workplace: Scoping Review. JMIR mHealth and uHealth, 8(11), e18774. https://doi.org/10.2196/18774

2. Wood, M. (2020, July 13). Mobile Device Use in Hospitals - NUR 353 [Video]. YouTube.  https://www.youtube.com/watch?v=4dCVkaoh0cM

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Suleski, T., Ahmed, M., Yang, W., & Wang, E. (2023). A review of multi-factor authentication in the Internet of Healthcare Things. Digital health, 9, 20552076231177144. https://doi.org/10.1177/20552076231177144

Utilizing two factor authorization. U.S. Department of Health and Human Services. (n.d.). https://www.hhs.gov/sites/default/files/two-factor-authorization.pdf