Digital competences of nursing staff for patient care information transmission: a semiological work analysis

RESEARCH Cognition, Technology & Work https://doi.org/10.1007/s10111-025-00831-8 transformation of communication practices is accompanied by new digital competence requirements for healthcare professionals to improve care quality and prevent harmful consequences (Wynn et al. 2023), and it is particularly visible in patient care information (PCI) transmission and documentation within healthcare institutions (Rouleau et al. 2017). In this study, we use “PCI transmission” rather than the term handover usually used in nursing practice, as the latter 1 Introduction In the context of the ever-increasing digitalisation of nursing activity (Schlicht et al. 2024; Tischendorf et al 2024; Wynn et al. 2023; Chen et al. 2020), the introduction of information and communication technology (ICT)–supported documentation and communication systems is particularly significant to nursing care (Daum 2017). This Andrea Carla Volpe [email protected] Deli Salini [email protected] Maria-Luisa Schmitz [email protected] Kezia Loeffel [email protected] Ines Trede [email protected] Thomas Buerkle [email protected] Patrizia Salzmann [email protected] 1 Swiss Federal University for Vocational Education and Training, SFUVET, Kirchlindachstrasse 79, 3052 Zollikofen, Switzerland 2 Institute of Education, University of Zurich, Kantonsschulstrasse 3, 8001 Zurich, Switzerland 3 H+ Swiss Hospitals, Lorrainestrasse 4 A, 3013 Bern, Switzerland 4 School of Engineering and Computer Science, Bern University of Applied Sciences, BFH, Lehre Höheweg 80, 2502 Biel, Switzerland Abstract The lack of nursing digital competences for patient care information transmission can negatively affect the continuity of care. Identifying digital competences grounded in real-work practice is essential for developing effective professional nursing profiles. This study adopts a situated approach to competence, employing a semiological work analysis based on the course-of-action theoretical framework. The aim was to identify digital competences in real nursing situations related to the transmission of patient care information. Twenty-four nurses were observed and recorded during full shifts (approximately 24 h each) across six hospital wards, capturing authentic practices. The study identified 27 situated digital competences associated with patient care information transmission. These competences are grouped into four main categories of activity and are aligned with core digital competency domains defined in an international digital competence framework for nursing. The findings help bridge the gap between local practices and global standards and provide valuable insights for developing nursing curricula and training programs. Keywords Digital competences · Nurses · Patient care information transmission · Semiological work analysis · Situated approach Received: 23 June 2025 / Accepted: 22 August 2025 © The Author(s) 2025 Digital competences of nursing staff for patient care information transmission: a semiological work analysis Andrea CarlaVolpe1· DeliSalini1· Maria-LuisaSchmitz1,2 · KeziaLoeffel1· InesTrede3· ThomasBuerkle4· PatriziaSalzmann1 1 3 Cognition, Technology & Work captures only selected aspects of the broader range of activities involved in sharing information relevant to patient care (Kim and Seomun 2020; Wong et al. 2008). PCI transmission encompasses all activities concerned with collecting and sharing information, whether conveyed orally, in writing, or digitally, and it occurs both with patients and among caregivers. Ensuring its quality is fundamental to continuity of care and the prevention of medical errors (WHO 2024). A lack of competence in using digital technologies can inhibit the benefits of digital transformation, either by creating obstacles to nurses’ work or by compromising the safety and continuity of patient care (Kleib et al. 2025). Hence the World Health Organization recommends integrating digital competences into all healthcare curricula (WHO 2021). The concept of competence has multiple definitions including in the nursing context. It is widely recognised as the activation, in a specific context, of a combination of knowledge, skills and attitudes needed to perform professional tasks successfully. This concept is both situated, as it assumes that competence emerges in contextualised situations, and tripartite, as it identifies three main types of resources that an individual activates in each context. To act competently in a specific situation, an individual mobilises, selects and coordinates those resources. More specifically, knowledge is defined as declarative or procedural. The former is acquired and reportable information, while the latter manifests in action and is less easily communicable. Skills denotes a set of actions and procedures, while attitudes refers to the feelings and social behaviours adopted to manage a situation (Baartman and de Bruijn 2011; Golz et al. 2023). No competence exists a priori: it becomes effective only when activated in situated action. For this reason, conducting fieldwork is essential to observe and analyse how digital devices are implemented and adapted in nursing practice, ensuring that digital competences in the nursing profession are developed according to the specific needs of the workplace (Becka et al. 2020). Several studies have attempted to identify digital competences in the healthcare sector. General digital competence frameworks already exist (e.g. van Laar et al. 2020), as well as those specifically for nursing. In particular, a scoping review has identified 30 digital competence frameworks related to the nursing sector (Nazeha et al. 2020). These frameworks—based on literature reviews, qualitative interview and quantitative data or Delphi methodology—are essential to describing the landscape of digital competences in healthcare and in a nursing context; although there is no consensus in literature on a complete list of such competences, as these vary from framework to framework. Among the healthcare frameworks cited by Nazeha et al. (2020), one stands out for its high relevance: the Technology informatics guiding education reform (TIGER), developed by an international task force of 72 members from 24 countries worldwide (Hübner et al. 2018). This framework is grounded in a survey conducted among nursing experts, a workshop held during an international conference to validate and categorize key competence areas and case studies comparing the results with six national nursing education curricula. This framework is pertinent to the present study for two main reasons. First, it is grounded in a broad and ongoing debate involving multiple stakeholders in the nursing field and aims to define key areas of digital nursing competences through discussions and case studies. Second, it establishes a clear relationship between the broad domains of digital competence it identifies, and the more specific digital competences required in nursing practice. In this regard, we adopt this framework as a general reference for categorizing digital competence areas within the nursing sector. On the other hand, although it integrates various data collection methodologies, the TIGER framework does not adopt a situated perspective on competences. It struggles to capture the tripartite construct of competences —knowledge, attitudes, and skills activated in specific situations — and does not provide a detailed account of competences required within nursing processes, such as those involved in the transmission of PCI. A truly comprehensive examination of digital competences requires in fact a rigorous real work analysis approach (Filliettaz and Billett 2015). A general competence lists do not show how knowledge, skills and attitudes are mobilised in professional situations. It is therefore essential to connect the competence domains, as those identified in the TIGER framework, to concrete, contextualised competence situations within specific nursing processes. This connection allows the definition of situated competence requirements, operationally integrates an international framework of nursing digital competences and translates those requirements into clear learning objectives for training curricula. Building on these premises, the study combines field observations, videorecording of nursing activity and selfconfrontation sessions, in which nurses expresses their experience during the video-recorded activities. The empirical focus is the digital nursing activity of PCI transmission; the situated data are subsequently related to the TIGER framework’s core competency areas. Methodologically, we adopt semiological work analysis anchored in the course-of-action framework (Poizat and Martin 2020; Theureau 2006), which accounts for the complexity of professional contexts, the individuality of actors and the need to ground training in real work needs. Integrating this perspective with the tripartite view of competence makes it possible to identify the resources that nurses mobilise. 1 3 Cognition, Technology & Work Accordingly, the study pursues four objectives: (1) Identify the components of the meaning-making process in nurses’ lived experiences through semiological analysis. (2) Explicitly relate the semiological analysis, through a methodological process, to the situated and tripartite competence perspective. (3) Identify the situated competences (knowledge, skills, and attitudes) activated in the context of digital PCI transmission. (4) Map these competences to the TIGER framework’s core competency areas, achieving an integration between this international framework and actual work practice. 2 Method 2.1 Theoretical framework The course-of-action approach originates in Francophone ergonomics, and it emphasises the agents’ lived experiences in real work situations (Poizat and Martin 2020; Theureau 2006). From this perspective, human activity is considered embodied, socially and culturally situated and constantly evolving. The course-of-action approach postulates that research on human activity and the development of training courses must rely on field data collection and consider both observational data obtained onsite and reflexive data derived from exploring the lived experiences of those who performed the activity (Durand and Poizat 2015). This approach is based on a) the perspective of enaction (Varela et al. 1991), b) the essential hypothesis of a prereflexive consciousness (Sartre 1957), and c) the experience conception as semiosis, in reference to Peirce’s semiotics (1994). From this perspective, the human experience is characterised by continuous interpretive activity, which involves a permanent construction of meanings. The semiotic process enables the dynamics of learning and knowledge acquisition, which are essential components of situated experience (Durand and Poizat 2015; Strand and Legg 2019). The semiotic dynamic can be partially re-actualised, explained and commented on by participants investigating their lived experiences (Poizat and Martin 2020; Theureau 2006). This experience can be analysed through a methodological framework for the semiological analysis of human activity. This framework is based on three registers defined by Peirce (1994) and further detailed in a six-component diagram or hexadic sign specified by Theureau (2006), which is reported in the data analysis phase chapter. The first register, Potential, refers to actors’ possibilities and intentions that are actualised in the situation. The second register, the Actual, refers to what the actor does and experiences in the here and now. The third register, the Virtual, encompasses the process of generalisation and ongoing inquiry, highlighting the emerging new knowledge. The relevance of associating the semiological analysis framework with the situated competence approach lies in the fact that both are grounded in a situated approach and reflect a learning dynamic. Just as the semiotic dynamic is a continuous process of constructing, deconstructing and reconstructing knowledge (Peirce 1994; Strand and Legg 2019), the competence development dynamic is similarly embedded in a broader process of learning (e.g. Baartman and de Bruijn 2011). The elements identified through the semiological analysis framework can be matched to theframework of situated competence. 2.2 Study design The study was organised into two main phases (Table 1). The first phase (data collection and processing)1 involved a) a familiarisation step to get acquainted with the professional context and the participants, b) field data collection, in which video ethnography and job shadowing were combined to capture observable data, followed by processing the recorded videos to ensure their suitability for the next step and c) self-confrontation sessions, in which participants described their own observed practices. This was followed by the establishment of a data analysis protocol, aligning descriptions of the video-recorded situations with transcripts of the self-confrontation sessions. During the second phase, the protocols developed were used in a four-step data analysis process: a) a cross-sectional thematic analysis to categorise the typical situations of PCI digital transmission, b) a semiological analysis to identify the semiotic components of lived experiences, 1 In the broader research project, an initial phase was dedicated to gathering contextual data; however, this aspect is not addressed here as it is not directly pertinent to this study. Table1 The two phases of research Data collection and data processing • Familiarisation/observant participation • Job shadowing and video footage • Constituting videos for the self-confrontation step • Self-confrontation sessions • Data analysis protocol constitution Data analysis • Thematic analysis • Semiological analysis • Articulation between semiological analysis and situated competence framework • Alignment of identified situated competences with international TIGER framework 1 3 Cognition, Technology & Work directly involved in data collection while also providing a preliminary understanding of the professional context (Blandford et al 2015). The participants were introduced to the data collection process and methods to ensure that they fully understood the procedures and to obtain their informed consent. Data collection combined three structured methods: job shadowing, video ethnography, and self-confrontation sessions. Job shadowing (Czarniawska 2007) involved observing participants in practice without interference. In line with video ethnographic methodology (Collier et al. 2015), wearable devices recorded nurses’ activities. Each researcher video-recorded participants’ daily activities across three consecutive 8-h shifts, either morning or afternoon-evening. The recordings, amounting to approximately 24 h of footage per participant, were selected and edited to focus on three objectives: a) typical situations of PCI transmission, b) representative instances involving digital communication, and c) a variety of transmission methods (oral, written, mixed, and interactions with other professionals and patients). This process resulted in the selection of 8–10 situations, condensed into a one-hour video. The selection of situations and video duration were designed to standardize the material for self-confrontation sessions and prevent cognitive overload, ensuring a manageable time commitment. A meeting was scheduled with each nurse within a week of the job shadowing to aid memory recall and reenactment (Theureau 2006). Self-confrontation sessions involve showing participants video recordings of their past activities in the presence of a researcher (Theureau 2006; Terrien et al. 2024). The goal is to reveal the tacit aspects of their actions, which the participant expresses during the session. These sessions, also video-recorded, took place in a protected space with a PC and monitor to display the footage. The researcher guided the process, encouraging participants to relive and describe their experiences chronologically, using questions to help them articulate implicit aspects of their actions. The content from the self-confrontation sessions was transcribed, capturing both verbal and nonverbal aspects. 24 synchronization protocols were created, with one column summarizing the situations and the other providing full transcriptions aligned to each situation. This structure allowed for precise matching of situations with the nurses’ commentary, enabling a detailed analysis of their practices and perspectives. 2.5 Data analysis Data analysis began with a cross-sectional thematic analysis (Clarke and Braun 2017) of all situations (= 277) described in the 24 protocols. The situations were labelled to categorize PCI transmission. The protocols were then reviewed to c) the articulation between the findings of the semiological analysis and the tripartite competence resources for the formulation of the corresponding situated competences and d) the matching process of the identified situated competences, categorised within the domains of PCI transmission, with the core competency areas outlined in the international TIGER framework. 2.3 Study setting and participants Data were collected from six Swiss hospitals located across two linguistic regions (two in the Italian-speaking region and four in the German-speaking region). The data collection and analysis phases involved four researchers with specific expertise in the healthcare sector or proficiency in ethnographic methods for data collection and analysis. A criterion-based sampling approach was used to select both the research fields and the participants. The main criteria were as follows: a) voluntary participation from both the hospitals and the study participants, specifically the nurses, b) sufficient diversification of the hospitals and wards involved while preserving the characteristics of qualitative approach and c) definition of the main characteristics of nurses involved in each hospital. A participatory and collaborative approach was established to carry out the on-site data collection. The selection of hospitals ensured linguistic and regional differentiation, thereby providing a national perspective. The selection of hospital wards was guided by the objective of capturing a broad range of variations across medical disciplines (e.g. orthopaedics and rheumatology, neurology, acute rehabilitation), nursing care practices, clinical information systems and digital devices. Within these wards, emphasis was placed on selecting nurses with tertiary-level diplomas, responsible for care communication and documentation, directly involved in patient care and working at least 80% of the standard full-time weekly hours. Consultation with hospitals set the optimal participation at four nurses per ward, ensuring voluntary involvement without burdening staff. A total of 24 nurses participated (83% women), with diverse educational backgrounds: 58% from specialized nursing schools, 21% from university programs, and 21% trained abroad. Age distribution was 25% (14–28), 50% (29–43), 8% (45–59), and 17% (60–80). 2.4 Data collection and processing To enable data collection a familiarisation step was implemented. Adopting a participant observation approach (Hammersley and Atkinson 2019), each researcher spent around six days at the selected ward. This facilitated mutual acquaintance between the researchers and the nursing staff 1 3 Cognition, Technology & Work rash caused by an allergic reaction to the same treatment. Then, the nurse called the on-duty physician to correct the inconsistency in the EMR. This situation in 5.1 unit of experience highlights the nurse’s actions when identifying an inconsistency in a prescription, focusing on their immediate response and the knowledge and engagement used to address the issue effectively. In the step involving the correlation between the semiological analysis and the situated competence framework, a selection of units related to situations solely involving the digital transmission of PCI was made. Accordingly, the components of the hexadic sign have been related to the tripartite framework of competence resources. Thus, the Skills category has been aligned with the two components of the actual; Knowledge has been associated with elements pertaining to both the potential and the virtual dimensions (SK, A, and I); finally, the Attitudes category has been mapped onto the E component of the potential (Fig. 1). This selection aimed to formulate specific digital resources and competence requirements. Out of 277 situations collected, a total of 173 situations were selected, and for these, some correspondence was established between the six components of the hexadic sign (Theureau 2006) and the resources defined by the situated and tripartite competence framework (Baartman and de Bruijn 2011; Jonnaert 2009; Weinert 2001), encompassing knowledge, skills and attitudes. The following criteria enabled the establishment of the correspondence: ●The unit of experience is manifested through concrete actions, and by identifying the element that drives an individual to act (representamen), it is possible to discern the performance and abilities exercised by the individual and thus identify the relevant skills. ●By articulating the knowledge activated in the performed action, it was possible to identify the knowledge mobilised for that action—the knowledge that was deployed, was connected or emerged (situated knowledge, anticipation and interpretant). ●Finally, by identifying the statements related to concerns (engagement), interests and affective states, it was possible to connect this analytical category to the attitudes to act. In line with the cited literature, standardisation criteria were established for the language used to describe resources. For skills, action verbs in the infinitive form were employed. For knowledge, each statement began with ‘knowing what’, referring to the object of knowledge considered. For attitudes, nouns were used to describe the values that guided the actions. select the most representative ones regarding information transmission and the use of digital devices. Guided by the principle of data saturation—that is, when data collection no longer provides meaningful insights but merely reiterates what has already been identified (Saunders et al. 2018)— two-thirds of the protocols (16 in total) were chosen for the semiological analysis (Salini et al. 2024). In the semiological analysis step, the process began by outlining the Actual category, expressed by the Representamen (what makes a sign for the individual) and Unit of Experience, to identify distinct analytical units in each situation. Each unit was then examined in detail to identify the Potential category expressed by Engagements, Anticipation and Situated Knowledge. The Virtual category expressed by the Interpretant includes generalisations, rules for action, doubts, questions and hypotheses that potentially arise from the actor’s activity and become a reference for future actions (Table 2). It should also be noted that not all elements of the Possible and Virtual categories were identifiable within every analytical unit, in consideration of the variability and context-specific nature of the data. The analysis was conducted by each researcher active in the field and subsequently verified, corrected and/or validated by at least one or two other researchers. To illustrate this analysis, a fragment of the synchronisation protocol for Nurse N23,2 focusing on unit of experience 5.1 (Table 3) would be presented. In this situation characterised by an Inconsistency in the prescription of a painkiller, N23 is in the nursing office gathering care information about their own patients on a stationary computer. While reviewing the electronic medical record (EMR) of a patient, the prescription for an opioid treatment caught the nurse’s attention because that patient had previously a skin 2 Each nurse involved was coded with a number (N1, N2, N3, etc., up to N24), which cannot be traced to the hospital at which the field investigations were carried out. Table2 Six components of the hexadic sign and their encoding Potential Engagement: intentions, concerns, moods and open inquiries [E] Anticipations: expectations or predictions regarding forthcoming events [A] Situated knowledge: knowledge, action rules, habits and previously experienced situations [SK] Actual Representamen: what is meaningful (i.e. perturbation) to the individual at a given moment and captures attention [R] Unit of experience: concrete actions, communication and emotions that manifest at a specific moment in the situation [UE] Virtual Interpretant: (new) generalisations or action rules formed during the activity experienced (new learnings) or the elements of activated new enquiry cycles (doubts, questions, hypotheses, etc.) and general comments about nursing activity [I] 1 3 Cognition, Technology & Work The nurse critically evaluates PCI stored in the electronic medical record to the best of their knowledge to ensure its accuracy, correctness and consistency for the patient’s proper treatment and to correct or flagging inconsistencies between information recorded, if needed. All defined situated digital competences were mapped to the relevant TIGER core competency areas, considering that the framework covers a broad range beyond PCI. The core competences of the TIGER framework are divided Through a recursive process that combined a cross-sectional analysis of all data, inductive reasoning, comparisons to the literature concerning competence frameworks and discussions among researchers, for each situation, resources mobilised to manage situations have been identified and a list of situated competences adequately representative of similar situations was formulated. On this basis and considering similar cases, the situation handled by N23 allowed the following situated competence to be described: Table3 Fragment of protocol of analysis: nurse 23, situation 5, unit of experience 5.1 (colour figure online) N23 Protocol for Collected Data Semiological Analysis Situation description Transcription of the self-confrontation session Actual (UE,R) Potential (E,A,SK) Virtual (I) The nurse, N23, is standing in front of the stationary computer in the ward office and notices that the patient has been prescribed an opioid (morphine) again, to which the patient previously had an allergic reaction in the emergency department. N23 therefore calls the on-duty doctor again and asks to change the prescription. Since N23 is speaking to the second duty doctor this time, N23 must inform the second duty doctor about the patient’s situation. N23: Here we are...at the medication cabinet. (laughs) To my horror, I realize the physician prescribed the same thingagain. (laughs) No. I’m not completely satisfied with this prescriptionbecause I just saw that she has a skin rash. Researcher: Yes, yes. N23: That’swhy I’m calling again.(laughs) Researcher: Ah, I see. N23: Exactly, because she prescribed morphine again. Now, another doctor answered. Researcher: Ah, okay. N23: I know the patient better,so I suggested <opioid medication name>. I: Ah, okay. Are you going to check the patient graphic page again? (Video continues) N23: Yes, now the doctor wants to know when the rash appeared, how severe it is, whether it itches or not. (video continues) I sound very complicated. (both laugh) Researcher: You only notice it when you see it. N23: She said she’sdiscussing it because of another pain medication...and the physician will prescribe something new and exact. That’s because of <name of the medication>, which is also a medication, so I quickly told the physician about that too. Usually, it’s okay like this. […] N23: I think that in the end, I recorded it in the wound documentation. UEa: Nurse is reading the medical prescriptions and observes that the patient was incorrectly prescribed an opioid. R: The inconsistency in the electronic medical record (EMR) between the declared patient’s opioid allergy and the opioid prescription. E: Ensuring that the patient receives the correct treatment. E: Informing other professionals about the wrong prescription. E: Ensuringthe accuracy of the EMR information documented. SK: Knows different IT module functions. SK: Knows the nursing care domain when entering prescriptions. I: How can one address the fact that despite recommendatio ns, the on-call physician once again prescribed morphine, to which the patient also had a reaction? aThe coding system marked the semiological analysis categories using colour codes: Representamen (R), Engagement (E) in light blue, Situated Knowledge (SK) in green, and Interpretant (I) in light red. The digital devices and software modules used by the nurse for the transmission and documentation of clinical patient information are written in italics. 1 3 Cognition, Technology & Work and confirmed on 30 January 2020). Additionally, a data management plan, as an integral part of the grant proposal, was approved by the Swiss National Science Foundation (5 November 2020). 3 Findings The initial step of the data analysis, performed on 277 real nursing work situations, allowed to categorise different ways in which PCI is transmitted. Specifically, the situations were split into two main types of transmission: synchronous and asynchronous. Synchronous PCI transmission and documentation refers to activities involving reading, inserting or editing PCI in the EMR concurrently with interactions with other people, including a) communication with patients, b) intraprofessional communication (among nursing staff) and c) interprofessional communication (with other healthcare professionals). Conversely, asynchronous nursing documentation refers to moments when the digital documentation activity is performed by the nurse without simultaneous interactions with other people (Salzmann et al. 2025, manuscript in preparation). The semiological analysis revealed several meaningful aspects of nursing activities related to PCI transmission and documentation. Within the Actual register, the analysis highlighted specific situations involving digitalization processes and the application of theoretical and methodological knowledge in the daily use of digital tools. Various elements to which nurses pay particular attention were identified, including recognizing informational cues from patients or colleagues, detecting technical malfunctions, identifying inconsistencies between documented and received information, anticipating routine tasks, and reflecting on coordination and collaboration with other team members. into six domains of competency, which are further divided into core competency areas (= 24), offering more detailed descriptions than the domains. These domains relate to the wide range of activities that nurses carry out with the support of digital tools, across the various roles that a nurse may assume (Hübner et al. 2018). The TIGER framework identifies six professional nursing roles and assigns ITrelated core competencies to each of these roles, including the one observed in nursing practice during data collection: the ‘Clinical Nursing Role’ (direct patient care). 2.6 Ethical considerations The onsite data collection required ensuring ethical conditions and confidentiality for all participants—nurses and patients alike—to comply with the rigorous ethical standards and data protection requirements set by the Swiss National Science Foundation and the Swiss Association of Research Ethics Committees (Swiss Ethics). These requirements entailed the following: a) respecting the individuals involved in the research and their voluntary participation, providing the flexibility to withdraw their involvement at any point of the study, b) the researchers’ nondisruptive presence during ongoing care activities, c) respecting the anonymity of the individuals involved, particularly in the presentation and dissemination of results and d) each hospital signed a collaboration agreement, and each participating nurse and patient signed an informed consent form. Additionally, data collection was avoided during intimate care activities or in the presence of family members, while all ward patients, healthcare professionals, and family members were informed about the ongoing research. Swiss Ethics has approved that the research does not fall under the Swiss Act on Research Involving Human Beings (approval number: Req 2018-00354, dated 30 April 2018, Fig.1 Correspondence between the components of the hexadic sign and the competence resources framework (The abbreviations refer to the analysis codes explained in Table 2.) 1 3 Cognition, Technology & Work intraprofessional communication (B1, B2, B3), two for interprofessional communication (C1, C2) and 24 for asynchronous nursing documentation (D1–D13). Furthermore, since some competences manifested across all four categories of situations during this alignment, a cross sectional category was defined as a Transversal category under which seven competences (E1–E7) were placed. Regarding the alignment with the core competences of TIGER model, half of the core competency areas were correlated with the 27 situated competences identified in the study. The most prevalent areas were Information and Knowledge Management in Patient Care (17 competences), followed by Nursing Documentation (13 competences), Process Management (8 competences), Principles of Nursing Informatics (6 competences) and Resource Planning and Logistics (3 competences). The remaining competences were each linked to a single area within the TIGER core competences: Biomedical Imaging and Signal Processing, Data Protection and Security, Decision Support by IT, Human Resource Management, Information Management in Research, Information Management in Teaching, Training and Education, and Quality Management. All findings were validated step by step through internal discussions within the research team, which included experts in qualitative methodologies, semiological analysis, healthcare research and nursing education. The findings were reviewed and refined based on the input from the participating nurses and representatives from the involved hospitals, ensuring that the findings were relevant and accurate within the specific context of nursing practice and in hospital settings. 4 Discussion This study aimed to identify situated digital competences required for nursing teams to transmit PCI using digital devices, connecting them to an international framework and detailing the process used to correlate the nurses’ lived experiences with specific resources and competences. Previous studies, such as those by Anastasiou and Smith (2023) and Nazeha et al. (2020), also highlight the essential and critical role of digital competences in managing and sharing information, consistent with the conclusions drawn in this study. Closing the digital competence gap among nurses is key to ensuring the effective use of ICT systems for documentation and communication, thereby ensuring the quality and continuity of patient care. The safe and accurate transmission of PCI is a critical process that can be undermined by poor digital competences. To mitigate these risks, integrating digital competence training into nursing education and professional development programmes is a must. There In the Possible register, four main areas of intentionality emerged that shape nursing actions: ensuring the proper execution of care processes; committing to the collection, documentation, and transmission of PCI; the effective management of clinical data, with a focus on archiving, clarity, overall coherence, and operational speed; and finally, the proactive organization of upcoming tasks, using lowintensity moments to carry out parallel activities or prepare for subsequent work. A general proactive attitude was also observed, with nurses often anticipating actions or events expected to occur within the same shift or in the following days, preparing materials and resources in advance to enhance workflow efficiency. The analysis of situated knowledge revealed a substantial presence of knowledge activated directly in practice, which can be categorized into two main types: a) general professional nursing knowledge, which will not be elaborated on here, and b) knowledge specifically related to the interaction with digital technologies, such as understanding how data is categorized within a specific EMR system; familiarity with medication verification procedures via EMR applications on mobile devices; awareness of color-coded prescriptions in EMR platforms and their clinical and operational implications; comprehension of the institutional system for measuring and recording nursing interventions; and knowledge of the electronic protocol for reordering unavailable medications. Finally, the exploration of the Virtual register revealed both the acquisition of new knowledge—regarding patients, treatments, or methodological aspects—and the widespread presence of clinical reasoning processes that characterize nursing practice. In these reasoning activities, aimed at interpreting and managing complex care or operational situations, digital tools were shown to play an essential role— not only by supporting access to information but also by enabling its analysis and interrelation, thereby actively contributing to decision-making processes. The integration of semiological analytical categories with the competence resources framework helped identify the resources mobilized to manage activities within each unit of experience. By mapping these connections, it was possible to identify the specific competences activated to manage each situation. This process led to the development of a list of 27 situated competences, which were organised according to the four categories of PCI transmission identified earlier and matched with the core competence areas proposed by the TIGER framework (Table 4). The competences presented are not intended as prescriptive standards, but rather as descriptive references grounded in specific, observed work situations. The list of situated competences was mapped to the four categories of PCI transmission as follows: two for the communication with patients (A1, A2), three for 1 3 Cognition, Technology & Work Situated nursing digital competences for PCI transmission TIGER framework A. Communication with patients A.1 Selecta the relevant PCI from the EMR during patient interaction to be kept in mind based on nursing knowledge and prior knowledge of the patient Information and knowledge management in patient care Principles of nursing informatics Nursing documentation A.2 Select the methods to protect the safety, dignity and fundamental rights of patients while editing and manipulating PCI using digital devices based on the legal provisions relating to the protection of sensitive data Nursing documentation Data protection and security B. Intraprofessional communication B.1 Analyse PCI stored in EMR to later manage the workload and to improve intraprofessional collaboration Human resource management B.2 Explain nursing interventions and PCI based on the criteria proposed by the EMR to colleagues and nursing students, differentiating between tailored interventions and standardised care protocols according to prescriptions or patient diagnoses Decision support by IT Information management in teaching, training and education B.3 Verify that PCI recorded in the EMR is accurate by evaluating or discussing it with colleagues Information and knowledge management in patient care C. Interprofessional communication C.1 Collect and analyse PCI discussed with the medical staff and ensure all of it is properly collected and organised within the EMR Information and knowledge management in patient care Process management C.2 Discuss the care process described in the EMR during the interaction with medical staff to ensure that the most relevant information is shared; identify the appropriate digital module where PCI is stored or needs to be stored based on its pertinence and ensure the accurate recording of PCI to facilitate communication flow Information and knowledge management in patient care Process management D. Asynchronous nursing documentation D.1 Evaluate and record nursing interventions performed in the EMR and define those still to be performed based on prescriptions or patient diagnosis Information and knowledge management in patient care Principles of nursing informatics Nursing documentation D.2 Evaluate the accuracy and completeness of PCI in the EMR and update or integrate them to facilitate the communication flow Information and knowledge management in patient care D.3 Manage various multimedia resources (images, scanned documents, etc.) to record PCI in the EMR Information and knowledge management in patient care Biomedical imaging and signal processing D.4 Update, explore and analyse PCI in sundry digital devices (platforms, applications, digital modules or multimedia devices) where they are stored to ensure that all PCI is present and consistent Information and knowledge management in patient care D.5 Record nursing interventions in the EMR by inserting the correct timing used for each nursing performance Information and knowledge management in patient care Principles of nursing informatics D.6 Select applicable semantic categories of PCI from those automatically proposed by the EMR based on the patient’s prescriptions or diagnosis to improve communication flow and efficiency Nursing documentation Information and knowledge management in patient care Process management D.7 Select and integrate the EMR content and draw up PCI correctly and concisely by choosing the most relevant information to facilitate the communication flow and ensure accurate intraprofessional and interprofessional collaboration Nursing documentation Information and knowledge management in patient care Process management D.8 Select and prioritise more relevant PCI stored in the EMR to be kept in mind based on nursing knowledge and prior knowledge of the patient to remember during the shift or to transmit orally to colleagues in the next shift Nursing documentation Information and knowledge management in patient care Process management D.9 Filter, select and retrieve significant and relevant PCI from the EMR to ensure comprehensive information exchange with the medical staff at the right time Nursing documentation Process management D.10 Select PCI needed to print to ensure transportable and immediate access to information Nursing documentation D.11 Verify the physical availability of the medications in the ward based on the information and prescriptions documented in the EMR to arrange the administration of therapies Nursing documentation Resource planning and logistics Table4 Situated nursing digital competences of patient care information transmission aligned with TIGER core competency areas 1 3