This study involves clinical, academic and policy-development partners, supported by the World Health Organisation (WHO) Regional Office for Europe and builds on our previous partnership working to enable nursing/midwifery leaders to develop a connected, interoperable digital health ecosystem across Europe.
The promise of digital health is redefining nursing/midwifery practice. However, research suggests that nursing/midwifery leaders are often absent from the strategic planning, design, and implementation of digitally enabled healthcare service models and the associated technological systems that directly impact practice.
This study aimed to explore how current digital health policy, specifically the ICN Position Statement on Digital Transformation (2023) and the WHO Digital Health Action Plan for the European Region (2022) are being implemented in practice to inform digital health policy for nursing and midwifery across Europe and beyond. The findings contribute new empirical insight into the policy, leadership, and infrastructural conditions shaping digital health advancement.
As digital health accelerates globally, nursing and midwifery leadership is vital to ensuring technology enhances, rather than erodes, person-centred care through professional nursing and midwifery practice.
While international frameworks, including the WHO Global Strategy and the ICN Position Statement on digital health, call for strengthened professional leadership, limited evidence exists on how national nursing and midwifery leaders engage with, implement, and evaluate these policies.
This sequential, multi-method study examined and evaluated the implementation of digital health policy across the WHO European Region member states. Phase one comprised an online survey of senior nursing and midwifery leaders with responsibility for digital health policy implementation. The survey focused on respondents’ awareness and application of key ICN and WHO digital health policies and resulted in 24 responses.
The survey findings informed phase two: three online focus groups with six participants to explore respondents’ digital health policy leadership experiences in greater depth. Quantitative data were analysed descriptively; qualitative data were analysed thematically using Braun and Clarke’s reflexive approach.
One overarching theme – person-centred care in a digital environment – and four subthemes – integration and awareness of digital health policy, nursing and midwifery leadership in digital health, workforce capability and capacity, and infrastructure and systems readiness, were identified.
Participants reported fragmented systems, limited recognition of digital nursing roles, low nursing and midwifery visibility in policy leadership, and the risk of digital exclusion, particularly for vulnerable populations.
Strengthening digital nursing and midwifery leadership is vital to achieving global digital health policy goals. These study findings emphasise the need for clear governance structures, inclusive procurement, workforce development, and better system interoperability, which is rooted in person-centred values and supported by national leadership.
Ethical approval: Ethical approval for this study was granted on 10 December 2024 [ID ETH2425-0725].
Janes, G., Chesterton, L., Heaslip, V., Reid, J., Shannon, M., Ludemann, B., Oxholm, R.-A., Gentil, J., Hamilton, C. and Phillips, N. (2025) 'Digital nursing and midwifery leadership: Protocol for a multi-method exploration of policy implementation and impact on practice in the WHO European Region', PLoS One, 20(9), e0332882.
This study builds on our previous published works, including, for example:
Janes, G., Chesterton, L., Heaslip, V., Reid, J., Ludemann, B., Gentil, J., Oxholm, R. A., Hamilton, C., Phillips, C. and Shannon, M. (2024) 'Current nursing and midwifery contribution to leading digital health policy and practice: An integrative review', Journal of Advanced Nursing. Available at: https://doi.org/10.1111/jan.16265
Phillips, N., Heaslip, V., Janes, G., Reid, J., Ludemann, B., Oxholm, R., Gentil, J., Shannon, M., Langins, M., Hamilton, C. and Bjoro, K (2022) 'ICN Statement in support of the regional digital health action plan for the WHO European Region 2023–2030, WHO Europe Regional Committee RC72, Tel Aviv: