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Contents lists available atScienceDirectApplied Nursing Research journal homepage:www.elsevier.com/locate/apnr Nurses distracted by smartphone use during clinical practice: Italianvalidation of the“Nurses’ use of Personal Communication Devices (PCD)questionnaire ”Marco Di Muzio a,⁎ , Christian Napoli b, Massimo Fiorinelli c, Giovanni Battista Orsi d aDepartment of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa 1035 – 00189 Rome, ItalybDepartment of Surgical and Medical Sciences and Translational MedicinecCatholic University of the Sacred Heart of Rome, ItalydDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, Italy1. BackgroundIn healthcare as at home, digital technology is always a part of oureveryday life. Regardless of social conditions or age, everyone has anelectronic device (i.e. smartphone, tablet, personal computer), as itallows fast communication and internet connection. Technologicalevolution has altered modern society radically, particularly healthcare,where digital systems provide medical consultation ( McBride, 2015),and improve patient education ( Shepherd, Badger-Brown, & Legassic,2012 ). Mobile health (MHealth) is a very important element foreHealth, supporting healthcare practice through mobile devices such assmartphones, tablets, patient monitoring devices, personalized digitaldiaries (PDAs) and other wireless devices. MHealth is emerging as arapidly developing sector, promoting healthcare transformation, im-proving quality and e fficiency. A study showed that 63% of nurses,during their clinical practice, use smartphones for personal purposes( Whitlow, Drake, Tullmann, Hoke, & Barth, 2014). There are manyadvantages to technology in a care setting, such as drug dosage calcu-lation ( Di Simone et al., 2018a ), or communication improvement be-tween multidisciplinary teams as reported in the study by Wu et al. ( Wuet al., 2010). Nevertheless, smartphone use during the care processcould cause distraction and medication errors ( Di Simone et al., 2016),with negative consequences for the patients ( Di Muzio, Tartaglini, DeVito, & La Torre, 2016a ).As the goal of all heath care systems is to increase patient safety,distraction of the healthcare providers by electronic devices could serveas a potential risk towards that goal. Such concern is highlighted andshared by the World Health Organization (WHO), which as of 2001,asks for urgent action by the health organizations themselves. In amulticenter Italian study approximately 80% of intensive care unit(ICU) nurses answered that distractions, while preparing or adminis-trating IV drugs, might lead to medication errors ( Di Muzio, De Vito,Tartaglini, & Villari, 2017 ). A survey conducted in the UK ( Robinsonet al., 2013) among medical students, demonstrated that 70% of them associate smartphone usage with sending and/or reading e-mails andinternet browsing. A study conducted by Katz-Sidlow highlighted thatmost interviewed doctors had been distracted by smartphone useduring working hours (Katz-Sidlow, Ludwig, Miller, & Sidlow, 2012 ).While a separate study indicates that fatigue, physical or mental, cana ff ect the use of the Internet during patient care ( Lin, Tsai, Chen, & Koo,2013 ). Several studies exhibit that interruptions during patient care arecommon in hospitals, ( Schmucker, Heid, & Haag, 2014) contributing toerrors in healthcare ( Márquez-Hernández et al., 2019 ). Overall, this“ distracted nursing ”might a ffect patient care in a hospital setting andprovide signi ficant risk to their safety ( McBride, Levasseur, & Li, 2013).A research showed how using a smartphone for personal purposes ne-gatively in fluenced the interdisciplinary communication betweenHealth Professions and could decrease the nurse’s working performance( Fujino & Kawamoto, 2013 ). McBride and colleagues ( McBride et al.,2013 ) have developed an instrument devoted to examining the impactof personal communication device usage (such as basic cell phones,enhanced cell phones or smartphones, and tablet computers) on patientcare. The questionnaire is composed of 30 multi-part questions, withfour-domains (utilization, impact, opinions, and performance), re-sulting in a total of 50 items. It consists of questions used to obtaininformation about (a) demographics, (b) use of personal communica- tion devices, (c) opinions about the electronic device’s e ffects on thework of registered nurses, and (d) hospital policies concerning personalcommunication devices. According to the authors ( McBride et al., 2013), Nurses’ Use ofPersonal Communication Devices Questionnaire (PCDs Questionnaire)may be used to explore registered nurses’ perceptions of the impact thatpersonal electronic devices have on hospital units in Italy. In the con-text of the Italian nursing education and health system, with patientsafety as its theoretical and practical core-curriculum, it is necessary tosupport the management process of personal devices appropriately. Validating an instrument such as the Nurses’ Use of Personal https://doi.org/10.1016/j.apnr.2019.07.008Received 17 January 2019; Received in revised form 23 April 2019; Accepted 27 July 2019⁎Corresponding author.E-mail address: [email protected] (M. Di Muzio). Applied Nursing Research 49 (2019) 23–280897-1897/ © 2019 Elsevier Inc. All rights reserved. T