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the potential also exists for smartphones to be used to improve patient care and enhance quality and safety outcomes11,14. Considerations for the use of hand-held technology A major benefit of using smartphone technology in the clinical setting, that was identified in the literature, is mobile learning – a modality that has been strongly adopted in Australian tertiary education and within Bachelor of Nursing degrees. Mobile learning enables nursing students to seek and retrieve information in real-time and this can aid decision making, potentially improving patient outcomes15. However, uptake of mobile learning by stakeholders in health care environments, especially nurses, to augment traditional teaching and learning has been slow and digital knowledge transfer is under-utilised16. Access to and use of hand-held devices for learning at the point of care within Australian health care environments is poorly governed and is not an explicitly sanctioned nursing activity16. Despite much of the literature acknowledging the benefits of undergraduate nurses using hand-held technology for mobile learning4,13,17, along with many universities having graduate learning outcomes related to digital literacy and self-management, there exists the paradox of undergraduate nurses being discouraged from or not permitted to use handheld technology in the clinical environment. Journal of Perioperative Nursing Volume 34 Number 1 Autumn 2021 acorn.org.au e-29 To examine the behaviour of undergraduate nurses when accessing information using handheld technology during clinical placement or work integrated learning (WIL), Mather and colleagues18 surveyed (n = 84) Australian undergraduate nurses and found that undergraduate nurses limited activity not related to work during WIL; only using their smartphones to access information related to nursing, medical professional development and study. Undergraduate nurses also expected easy access to their smartphones when working to ensure they delivered safe and competent care, a finding that is reflected in a number of other studies worldwide4,12,14,17,19. This access to and appropriate clinical use of smartphone technology needs to be reflected in the clinical environment and role modelled by those training novice nurses. It is argued that health care managers and nursing staff need to start advocating for the healthy use of smartphone technology in order to guide and support student nurses as well as model digital professionalism in the clinical setting4,19. Recommendations Nurses comprise the largest health care workforce3 and are consistently nominated as the most ethical and honest profession20. A dichotomy currently exists between being the most trusted profession in Australia, depended on to provide complex nursing care and administer controlled substances, yet not trusted to responsibly use smartphones in the clinical setting. On review of the literature, it is recommended that health care organisations develop policies for hand-held technology and provide guidance for its use in the clinical environment in order to encourage healthy technological behaviours, and infection prevention guidelines that serve to enhance patient care and promote positive patient outcomes. In October 2020 the Australian government released the National Nursing and Midwifery Digital Health Capability Framework, which highlights the need for digital health training and education across Australia as well as encouraging positive attitudes to the increasing adoption of technology and innovation3 . Prior to this, an analysis of many sources including government health recommendations21, the National Safety and Quality Health Service Standards22, Registered Nurse Standards for Practice23, Standards for Perioperative Nursing in Australia24 and the Nursing and Midwifery Board of Australia Code of Conduct for Nurses25 revealed an absence of guidance to support digital responsibility in health care despite the World Health Organization endorsing the use of digital, mobile and wireless technologies to achieve heath objectives and improve patient care outcomes26. As smartphones are readily available to all staff in the operating
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