NURS 630 Week 3 Evidence-Based Project Part 2: Evidence Summary Example

Evidence-Based Project Part 2, Evidence Summary: What Research Shows About Inpatient Portal Use, Its Benefits and the Gaps Nurses Can Close

Introduction

Part 1 of this project identified unequal use of the patient portal during hospitalization as a problem at a composite 300-bed community hospital and proposed a nurse-led bedside coaching program. This synthesis asks what the recent literature shows about three questions: which hospitalized patients use portals, what they and their families gain, and what open access means for clinicians. I searched CINAHL and PubMed for peer-reviewed studies published from 2021 onward, after the information blocking rule took effect, using terms for inpatient or hospitalized patients combined with patient portals, open notes and bedside tablets. Nine studies were selected because they examined hospitalized patients or inpatient record access directly, and studies limited to outpatient portals were set aside even when they were large, since the experience of reading a record from a hospital bed differs from reading it at home. They include four large retrospective cohorts, three studies of patient or family experience, one prospective observational study and one scoping review.

Theme 1: Inpatient Portal Use Is Common but Unequal

Four large observational studies agree on two points: a substantial share of hospitalized patients use the portal, and use is consistently lower among the same groups. In a cohort of 43,588 adults at one academic center, fewer than a third had an active account during their stay, and about half of those logged in while admitted (Cool et al., 2025). Among 58,801 surgical admissions at another center, patients logged in during roughly half of admissions, although only one admission in ten included viewing a note (Bain et al., 2025). Use was higher in a cancer hospital, where 65% of 28,386 patients logged in at least once (Redelman-Sidi et al., 2026), and activation was nearly universal, 93%, among families of 40,371 hospitalized children in two pediatric systems (Luke et al., 2026).

The disparities are remarkably consistent across these settings. Older age, Black race, non-English language and public insurance were associated with lower activation or use in all four studies, and Hispanic ethnicity, being single and living in a lower-opportunity neighborhood appeared in some (Bain et al., 2025; Cool et al., 2025; Luke et al., 2026; Redelman-Sidi et al., 2026). Bain et al. (2025) add that immediate release of results and notes increased logins and viewing, which suggests that what the portal offers changes how often patients use it. The evidence for this theme is strong in size and consistency, though all four studies are retrospective and drawn from academic or specialty centers, so a community hospital may see different rates. Across four health systems and more than 170,000 patients, the same groups were left out, which suggests the gap comes from how access is offered rather than from any one hospital's population.

Theme 2: Patients and Families Gain Understanding, Involvement and Safety

Smaller studies describe what patients and families gain from using a portal during a stay. After brief training on an adult inpatient floor, most of 33 surveyed patients said talking with the people caring for them had become easier, and they reported a clearer understanding of their medications, and most found the portal easy to use (Alla et al., 2026). In Singapore, a hospital that introduced bedside tablets with access to health information tracked patient experience across five years of implementation and found that nurse communication clarity and patient involvement in care improved, with involvement peaking when self-charting and record synchronization were added, although scores for addressing patient concerns stayed low and family information declined (Cheong et al., 2026). Interviews with patients on a hematology ward in Melbourne showed how access to results, notes, vital signs and medication information on a hospital tablet supported awareness, agency and participation, and often started conversations with clinicians (Schmidt et al., 2024).

Access may also improve safety. When parents of 25 children on a pediatric oncology service received real-time access to notes through a bedside tablet, nearly half of all notes written were opened, most parents found notes understandable and useful, and one parent in five identified possible inaccuracies, most of which were confirmed safety concerns such as a medication error (Kieren et al., 2026). Luke et al. (2026) reported that children whose families had used the portal before admission were less often moved to intensive care and went home sooner, though not with fewer readmissions. Together, these studies suggest benefits to understanding, engagement and possibly safety, but the evidence is weaker than in Theme 1: samples are small, several studies lack comparison groups, and the outcome associations may reflect differences between families who use portals and those who do not.

Theme 3: Open Access and Clinicians' Documentation

A frequent concern among clinicians is that patients reading their notes will change what clinicians write. Meier-Diedrich et al. (2025) addressed that concern in a scoping review of 42 studies, drawn from 3,143 screened papers, on documentation changes after patients gained online record access. Most included studies were qualitative and from the United States, and they spanned inpatient and outpatient settings. The review describes subjective and objective changes clinicians reported or that were measured in notes, which is relevant to nurses because nursing notes and care plans are also released. For this project, the main implication is that clinicians, including nurses, need guidance on writing notes that patients will read, and that the coaching program should include staff, not only patients.

Strength of the Evidence and Gaps

Overall, the evidence that inpatient portal use is unequal is strong and consistent, coming from large cohorts in different types of hospitals. The evidence that portal use benefits hospitalized patients is promising but weaker, based mostly on small, single-site experience studies and observational associations. Three gaps are important for this project, and each shapes how the intervention will be designed and evaluated. No study tested an intervention designed specifically to close the equity gap in inpatient use. Few studies were set in community hospitals. And none examined nurse-led coaching, although the brief training study suggests that teaching patients at the bedside is feasible and well received (Alla et al., 2026). These gaps mean the project cannot borrow a proven protocol; it will have to design one from the evidence available, pilot it on a small scale and measure both use and equity from the start, so that its own results can add to the literature rather than simply repeat it.

Conclusion

The literature supports the problem identified in Discovery and points toward the project's direction. Hospitalized patients who are older, Black, Hispanic, non-English speaking or publicly insured use portals less in every setting studied, and the studies of patient and family experience suggest that access during a stay can improve understanding, involvement and safety. Because no tested intervention yet targets the equity gap, a nurse-led coaching program is a reasonable practice change to pilot and evaluate. Part 3 will decide whether a new protocol is needed and describe how it would be introduced and measured.

References

Alla, S., Kukreja, R., Harrison, G., Royal, S., & Markus-Rodden, M. (2026). Effect of patient portal utilization on patient experience among hospitalized adult patients on an orthopedic surgical unit. CIN: Computers, Informatics, Nursing, 44(1). https://doi.org/10.1097/CIN.0000000000001311

Bain, A. P., Heslin, R., Matthews, L., Ji, H., Moore, C. B., Higashi, R. T., Louissaint, J., McDonald, S. A., Navar, A. M., Willett, D., Steitz, B. D., & Turer, R. W. (2025). Patient portal use among admitted surgical patients following the 21st Century Cures Act. JAMA Surgery, 160(10), 1082-1090. https://doi.org/10.1001/jamasurg.2025.2799

Cheong, S. H. R., Fan, P. E. M., Aloweni, F., Ang, S. Y., Ng, G. N., & Ayre, T. C. (2026). The effectiveness of a digital solution on improving patient experience. Clinical Nursing Research, 35(2-3), 84-92. https://doi.org/10.1177/10547738251414275

Cool, J. A., Zhang, C., Yang, J., Herzig, S. J., & Roches, C. D. (2025). Hospitalized patient portal access in the post-information blocking rule era. Journal of Hospital Medicine, 20(12), 1290-1296. https://doi.org/10.1002/jhm.70093

Kieren, M. Q., Lee-Miller, C., Smith, C. A., Brown, R., Limjoco, J. J., McArdle, K., Uhing, A., Veit, A., & Kelly, M. M. (2026). Parent experiences accessing inpatient clinical notes on a pediatric oncology service. Hospital Pediatrics, 16(6), 536-543. https://doi.org/10.1542/hpeds.2025-008530

Luke, M. J., Zhu, Y., Wolk, C. B., Menko, S. G., Capriola, D., Fuller, K., Scribano, P. V., Bonafide, C. P., & Vasan, A. (2026). Patient portal use and care utilization among hospitalized children. Hospital Pediatrics. Advance online publication. https://doi.org/10.1542/hpeds.2026-009398

Meier-Diedrich, E., Lyckblad, C., Davidge, G., Hägglund, M., Kharko, A., McMillan, B., Blease, C., & Schwarz, J. (2025). Impact of patient online record access on documentation: Scoping review. Journal of Medical Internet Research, 27, Article e64762. https://doi.org/10.2196/64762

Redelman-Sidi, Y., White, C., Seier, K., Lipitz-Snyderman, A., Dawson, J. P., Kuperman, G., Polubriaginof, F. C. G., & Chimonas, S. (2026). Disparities in cancer patients' portal usage during hospitalizations. Applied Clinical Informatics, 17(4), 844-853. https://doi.org/10.1055/a-2961-1034

Schmidt, S., Boulton, A., Butler, B., & Fazio, T. (2024). Enabling awareness, agency and participation: Haematology patient experiences of an (in)patient portal's information affordances. Digital Health, 10, Article 20552076241288371. https://doi.org/10.1177/20552076241288371