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Mobile applications for nurses in the care of the elderly after stroke: scoping review protocol
INTRODUCTION
Human aging involves economic, social, and public policy issues. In this sense, it is necessary for governmental spheres to pay special attention to health services in order to make decisions that prioritize meeting and resolving the demands of the elderly, for example in developing and low-income countries, where there are greater weaknesses and gaps in health care services.1 Therefore, investment in strategies and technologies, with a focus on prevention, promotion, and health care actions for the elderly are fundamental to promoting healthy and active aging, as well as minimizing the risks of complications from chronic diseases.
Among the Chronic Non-Communicable Diseases (CNCDs) responsible for compromising the health of the elderly, Cerebral Vascular Accident (CVA) stands out as one of the main causes of death in the population worldwide. 2 CVA is characterized as a sudden cerebral dysfunction, which culminates in alterations in the neurological blood vessels,3 and is divided into hemorrhagic and ischemic strokes.4 Stroke causes systemic changes that can severely and disablingly compromise the health of the elderly, often irreversibly affecting their quality of life.5
The rehabilitation of the elderly after a stroke can be slow and exhausting, requiring specialized and continuous care from health services. Recovery after a stroke encompasses multifactorial aspects, given that the elderly are affected by multiple dysfunctions, as well as physical, cognitive, and social disorders.6 Thus, the elderly after a stroke need to be fully accompanied, and health professionals must plan care with the aim of minimizing the sequelae caused by the disease.7
Nurses are indispensable professionals in the health care of elderly stroke survivors, as they help to care for individuals at all levels of health care and carry out activities that include care, prevention, and health education. The nurse's role is related to the elderly person's rehabilitation process, whether at home and/or in-hospital, with a view to improving the overall functionality of the person being cared for.8
In this sense, the inclusion of nurses in the care of the elderly after a stroke implies positive repercussions for their rapid recovery.9 The focus of nurses in the care of the elderly is configured in the evaluation, investigation of risk factors and the main sequelae resulting from CNCDs, and subsequent planning of nursing diagnoses according to the clinical conditions of the elderly person. In addition, the care provided by nurses may be able to avoid possible complications and prevent further stroke episodes and an unfavorable clinical outcome.
It is therefore up to nursing care and prevention to propose innovative and resolutive care models that are capable of helping the elderly affected by stroke. In view of the above, health technologies have emerged as appropriate tools to help nurses during their care. According to the Global Health Observatory, mobile technologies are medical or public health practices that use wireless technology to prevent, monitor, and diagnose diseases. 10 In the context of mobile technologies, mobile applications are defined as software that performs a particular function on devices such as smartphones and tablets. In this scenario, the use of mobile applications by nurses has become a skillful strategy for meeting the needs of individuals in person or at a distance, contributing to the provision of more effective and systematic care.11-12
In view of the above, during a preliminary search of the Medical Literature Analysis and Retrieval System Online (MEDLINE/via PubMed), the Cochrane Database of Systematic Reviews, PROSPERO, JBI Evidence Synthesis, Open Science Framework (OSF), and Figshare, no systematic reviews or scoping reviews on the subject were identified.
OBJECTIVE
To present a scoping review protocol to map the available evidence on the use of mobile applications to assist nurses in caring for the elderly after a stroke.
METHOD
The scoping review presented in this protocol will be guided by the methodology proposed by the JBI Collaboration (JBI)13 for scoping reviews, and the recommendations suggested by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: Extension for Scoping Reviews (PRISMA-ScR) will be followed for writing up the results of the review.14
The protocol was developed and prospectively registered in the Open Science Framework (OSF) under the identifier doi 10.17605/OSF.IO/Q8RUF.
Review question
What is the scientific evidence on the use of mobile applications to assist nurses in caring for the elderly after a stroke?
Eligibility criteria
The studies will be selected according to the PCC strategy (Population, Concept, and Context). Regarding the study participants, evidence will be considered that includes elderly people of both sexes after a hemorrhagic and/or ischemic stroke, regardless of the length of time after the stroke. Regarding the concept, studies will be selected that report and involve the use of mobile applications by nurses, as a technology for intervention, guidance, rehabilitation, and care for the elderly with stroke. These applications are capable of optimizing and improving the work process of nurses since they are tools that can streamline health care and reduce costs.
As for the context, it will not be limited to any geographical and physical location, field of concept, health care, or levels of health care. Therefore, scientific studies will be included that address the topic presented.
Studies published and peer-reviewed, such as qualitative studies; quantitative studies, experimental studies (randomized clinical trials, pragmatic clinical trials, controlled trials) and quasi-experimental studies (non-randomized clinical trials, before and after studies), analytical observational studies, (prospective and retrospective cohort studies, case-control studies, analytical cross-sectional studies), descriptive observational studies (case series, individual case reports, and descriptive cross-sectional studies), mixed methods studies, systematic reviews, scoping, integrative and narrative reviews. In addition, unpublished studies from the gray literature, such as theses, dissertations, guidelines, and reports of pre-print and post-print manuscripts and book chapters will be included.
Studies that are not specifically about mobile applications used by nurses in the care of the elderly, Internet texts, event proceedings, opinion articles, and advertisements will be excluded. There will be no language limitation and no time cut-off will be applied.
Sources of information
The published studies will be retrieved from the databases accessed on the CAPES Journals Portal: MEDLINE/PubMed (via the National Library of Medicine), Scopus (Elsevier), Web of Science - Main Collection (Clarivate Analytics), Science Direct (Elsevier), CINAHL and Embase. The Virtual Health Library (VHL) will be consulted for Latin American and Caribbean Health Sciences Literature (LILACS) the Nursing Database - Brazilian Bibliography (BDENF) and the Scientific Electronic Library (SciELO). The sources of unpublished studies/grey literature will include Theses Canada Portal, Open Access Theses and Dissertations (OATD), Catalog of Theses and Dissertations of the Coordination for the Improvement of Higher Education Personnel (CAPES), Brazilian Digital Library of Theses and Dissertations (BDTD) and Open Access Scientific Repositories of Portugal (OASRP).
Search strategy
The search strategy will use the Descritores em Ciências da Saúde (DeCS) from the Virtual Health Library (VHL), Medical Subject Headings (MeSH) from PubMed, Subject Headings (Emtree) from Embase, Subject Headings (CINAHL) and the Entry Terms vocabulary (Figure 1), in order to raise awareness and obtain more satisfactory results, depending on each source of information. The Boolean operators AND and OR will be used to cross-reference the descriptors and build the relationship between the search terms.
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Controlled descriptors |
Entry Terms |
||
|
DeCS/MeSH |
EMTREE terms |
CINAHL Subject Headings |
Elderly; Oldest Old; Older people; Cerebrovascular Accident; Brain Vascular Accident; Cerebral Stroke; Acute Stroke; Acute Cerebrovascular Accident; Brain Infarction; Mobile application; Mobile App; Mobile phone applications; Smartphone Application; Portable Software Application; Portable Electronic Application |
|
Aged |
Aged |
Aged |
|
Figure 1. DeCS/MeSH descriptors, Emtree terms, CINAHL titles, and Entry terms. Manaus (AM), Brazil, 2024.
The search strategy will be carried out in three stages and will be carried out by two reviewers independently, with a librarian also contributing to the review. The first stage, which has already been carried out, consisted of an initial search in MEDLINE/PubMed (via the National Library of Medicine) and Web of Science (Clarivate Analytics), in order to identify keywords and potentially relevant terms for the development of a final search string in all databases, with the following strategy (Figure 2).
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Scoping review search strategy (syntax) |
|
(Aged OR “Aged, 80 and over” OR Elderly OR “Oldest old” OR “Older people” AND (Stroke OR “Cerebrovascular accident” OR “Brain vascular accident” OR “Cerebral stroke” OR “Acute stroke” OR “Acute cerebrovascular accident” OR “Hemorrhagic stroke” OR “Ischemic stroke” OR “Brain infarction”) AND (“Mobile applications” OR “Mobile application” OR Mobile app” OR “Mobile phone application” OR “Smartphone application” OR “Portable software application” OR “Portable electronic application” AND (Nurses OR Nurse OR Nursing OR “Nursing care”) |
Figure 2. Search strategy for the scoping review. Manaus (AM), Brazil, 2024.
In stage two, a complete search will be carried out in all the sources of information included in the review using the syntax (strings) previously developed, using the combination of controlled descriptors and keywords, which will be adapted according to the specifics of each source accessed, as exemplified by MEDLINE/PubMed (via the National Library of Medicine) and Web of Science figures 3 and 4, respectively. The third stage will be an analysis of the list of references of all the studies found in order to identify additional articles according to the inclusion criteria. In addition, "forward citation searching" on Google Scholar will be used.
|
Search |
Query |
Results |
|
#5 |
Search: (((((((aged) OR (aged, 80 and over)) OR (elderly)) OR (oldest old)) OR (older people)) AND (((((((((stroke) OR (cerebrovascular accident)) OR (brain vascular accident)) OR (cerebral stroke)) OR (acute stroke)) OR (acute cerebrovascular accident)) OR (hemorrhagic stroke)) OR (ischemic stroke)) OR (brain infarction))) AND (((((((mobile applications) OR (mobile application)) OR (mobile app)) OR (mobile phone application)) OR (smartphone application)) OR (portable software application)) OR (portable electronic application))) AND ((((nurses) OR (nurse)) OR (nursing)) OR (nursing care)) |
31 |
|
#4 |
Search: (((nurses) OR (nurse)) OR (nursing)) OR (nursing care) |
|
|
#3 |
Search: ((((((mobile applications) OR (mobile application)) OR (mobile app)) OR (mobile phone application)) OR (smartphone application)) OR (portable software application)) OR (portable electronic application) |
|
|
#2 |
Search: ((((((((stroke) OR (cerebrovascular accident)) OR (brain vascular accident)) OR (cerebral stroke)) OR (acute stroke)) OR (acute cerebrovascular accident)) OR (hemorrhagic stroke)) OR (ischemic stroke)) OR (brain infarction) |
|
|
#1 |
Search: ((((aged) OR (aged, 80 and over)) OR (elderly)) OR (oldest old)) OR (older people) |
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Figure 3. MEDLINE database search strategy. Manaus (AM), Brazil, 2024.
|
Search |
Query |
Results |
|
#5 |
#1 AND #2 AND #3 AND #4 |
22 |
|
#4 |
ALL= (Nurses OR Nurse OR Nursing OR Nursing care) |
|
|
#3 |
ALL= (Mobile applications OR Mobile application OR Mobile app OR Mobile phone application OR Smartphone application OR Portable software application OR Portable electronic application) |
|
|
#2 |
ALL= (Stroke OR Cerebrovascular accident OR Brain vascular accident OR Cerebral stroke OR Acute stroke OR Acute cerebrovascular accident OR Hemorrhagic stroke OR Ischemic stroke OR Brain infarction) |
|
|
#1 |
ALL= (Aged OR aged, 80 and over OR elderly OR oldest old OR older people) |
|
Figure 4. Search strategy in the Web of Science database. Manaus (AM), Brazil, 2024.
Study selection
After searching the information sources, all the studies identified will be organized in the EndNote web reference manager (Clarivate Analytics, PA, USA), where duplicates will be excluded. After this, the studies will be grouped and imported into the Rayyan software, developed by the Qatar Computing Research Institute,15 to screen the records by reading the titles and abstracts. The selection will be carried out according to the inclusion criteria by two independent reviewers.
The reports of the selected registries will then be retrieved in full for a thorough reading. The full text of the selected records will be assessed in detail against the inclusion criteria, again by two independent reviewers. The reasons for excluding studies that do not fit and do not meet the inclusion criteria will be reported in the final scoping review.
If there are disagreements between the reviewers during the review stages, the disagreement will be resolved with the opinion of a third reviewer. The results of the search and the study inclusion process will be reported in full in the final scoping review and presented in a flow chart for scoping reviews, in accordance with PRISMA-ScR.14
Data extraction
The data will be extracted by two independent reviewers using a data extraction tool developed by the reviewers. The extracted data will be organized in a Microsoft Excel spreadsheet, which will be filled in according to the information contained in Figure 5. It is worth mentioning that the data collection instrument will be modified and revised as necessary during the course of the review, as recommended by the JBI. The modifications will be detailed in the final report version of this review.
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Variables |
Extraction details |
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Article identification |
|
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Study title |
Full title of the evidence |
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Author |
Name and surname of all study authors |
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Place of study |
City or country where the study was carried out |
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Year |
Year the study was published |
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Study objective |
Main objective of the study |
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Source of publication |
Name of journal |
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Type of publication |
Article, thesis, dissertation, or other |
|
Population |
|
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Population/number of participants |
Sample size |
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Sex of participants |
Female or male |
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Age of participants |
Average age |
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Concept |
|
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Characteristics of the mobile application |
Full description of the mobile application and the type of intervention proposed |
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Purpose of the mobile application |
Describe the main theme/purpose of the application/theme to help nurses |
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Duration of intervention with mobile app |
Time of application of the technology (days, months, years) |
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Application name |
Describe the name of the application or what it is called in the study |
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Phases of technology applicability |
Application intervention stages |
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Method |
Study design |
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Main results for participants |
Benefits of using the mobile application |
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Focus and characteristics of care |
What care is proposed in the app |
|
Limitations of the study |
|
|
Context |
|
|
The application's area of applicability |
|
Figure 5. Data extraction tool. Manaus (AM), Brazil, 2024.
Data analysis and presentation
Data analysis will be carried out in a thematic and descriptive manner and the results will be categorized and then discussed in relation to the review's objective and research question. The data extracted will be presented graphically using tables, charts, flowcharts, or flow diagrams, as recommended by the recommendations for presenting and interpreting data from scoping reviews.16
RESULTS
It is expected that the results of this scoping review will provide relevant information to assist in the process of building a prototype mobile application aimed at nurses caring for the elderly after a stroke, as well as providing evidence of what has been published nationally and internationally on this subject.
CONCLUSION
The scoping review in question will play a relevant role in deepening knowledge on the subject of mobile health technologies that help nurses in their care for elderly people who have suffered a stroke. The evidence found in this review will also expose existing gaps in this area of research, as well as guide future researchers in the field.
CONTRIBUTIONS
Costa AMS: Conception, study planning, data analysis and interpretation, writing, and critical review.
Reis DA: Conception, study planning, data analysis, and interpretation, writing, and critical review.
Gomes VO: Writing and critical review.
Silva TS: Writing and critical review. All the authors of this study approved the final version of the manuscript.
CONFLICT OF INTEREST
Nothing to declare.
FUNDING
Amazonas State Research Foundation - FAPEAM.
ACKNOWLEDGMENTSA
To the Postgraduate Program in Nursing-PPGENF (UEPA/UFAM).
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Correspondence
Ana Maria Souza da Costa
Email: anamariasouza1996@gmail.com
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