Human Factors Evaluation of PDAs and Smartphones in Nursing Practice

Objective
To determine which design features of popular mobile devices are supportive of various nursing tasks.  Device usability was determined through metrics such as performance and user perceptions of the following five mobile devices:   

• Nokia N810
• Blackberry Bold
• Apple iPhone 3G
  
• Palm Treo 680
• HP iPAQ 210

 Results

Human Factors Analysis

Test results indicate that perceived ease of use, failure rates and task completion time on their own do not determine acceptance of mobile devices in the clinical environment.  Nurses will forgo ease of use in favour of a more compact, lighter weight device.

Nokia N810.  The results tables clearly indicate that user performance on the Nokia N810 was significantly better than all other devices.  In particular, the accuracy and ease of navigating with the stylus, in addition to clear menu structure and information display as well as a physical keyboard were some of the major contributing factors to its success.  However, the Nokia N810 had significant drawbacks for nursing.  It was viewed as too bulky and heavy.  Additionally, the inability to outfit the sliding keyboard with a protective cover suitable for infection control is a risk in the clinical environment.

Blackberry Bold.  In overall device preference,  the Blackberry Bold was highly rated among the nurses tested.  Performance metrics indicate users had relative success completing most tasks quickly.  Fast browsing speeds, advanced page rendering and a physical keyboard likely contributed to its success.  However, users had some trouble navigating the menu structure for the first time, in particular when trying to compose a new email or locating the web address bar when browsing.

iPhone 3G.  Apple’s iPhone 3G was also highly rated during the testing.  Web browsing tasks demonstrated that the touchscreen navigation and rapid browsing speeds had a significant effect on performance and task completion times.  The device's large flat surface and lack of a physical keyboard lends itself to a clinical perspective from an infection control point-of-view.  From a text entry point-of-view, the absence of a physical keyboard made it difficult for first time users to compose an email or enter search terms in text entry fields.  Task completion times and completion performance were also affected by the ambiguity of certain icons.  In particular, users didn’t recognize the “Safari” icon as being representative of a web browser or the ‘create new email’ icon as being representative of its purpose.

Treo 680.  Despite being perceived as relatively easy to use and displaying acceptable performance metrics, the Palm Treo 680 has a number of shortcomings that make it unsuitable for clinical use.  Nurses liked the physical keyboard and completed text entry tasks quickly with it, but the device’s poor page rendering abilities, lack of Wi-Fi compatibility and small screen resulted in lower performance scores.

iPAQ 210.  Nurses had the most difficulty using the HP iPAQ 210 to complete typical clinical scenarios.  Nurses found the system speed to be slow, and although the device is Wi-Fi compatible, the connection often dropped causing frustration.  Despite having a large screen, the device rendered pages poorly which contributed to increased task completion times and decreased task completion performance.  The device was also deemed too heavy and bulky for the purpose of carrying it around throughout an entire shift.

Important Considerations

• Nurses expect lightweight devices with physical keyboards, advanced rendering capabilities, intuitive menu structure and data access speeds that are comparable to desktop applications
• Devices need to be portable and compact; ideally weigh less than 180g
• Larger screen sizes are preferred, so long as page rendering is advanced
• System speed perception was also an important indicator of device acceptance; in addition, Wi-Fi compatible devices are recommended
• Be mindful of the types of applications and tasks the nurses will be using most; if text entry is required for the majority of tasks, a device with a physical keyboard is recommended
• From an infection prevention and control standpoint, devices that can easily be used with a protective cover that can be easily wiped with a disinfectant are recommended.  Those devices with the fewest buttons, connectors, and crevices that could trap microbes are considered best.  From the devices that we reviewed, the iPhone 3G and iPAQ 210 would be most suitable in this regard.
   

Recommendations

The Blackberry Bold and iPhone 3G were found to be acceptable devices.  The Nokia N810 also met or exceeded the performance of these devices, but was generally considered too bulky and heavy for nurses to use on a routine basis.  The Palm Treo 680 and HP iPAQ 210 are not recommended.