This study assessed patterns of smartphone use among nurses and evaluated its impact on clinical performance and patient safety in healthcare settings in Egypt, using a convergent mixed-methods design. A cross-sectional survey was conducted between October 2025 and February 2026 across diverse clinical settings at Alexandria University Hospitals, including critical and emergency care, medical-surgical wards, operating theaters, outpatient clinics, home care services, and psychiatric support units. Of 900 nurses invited, 368 completed the online questionnaire via Google Forms (response rate: 40.9%). Quantitative data assessed nurses' patterns of smartphone use and its impact on patient care using an adapted validated scale. Qualitative data were collected through two open-ended narrative questions exploring smartphone-related clinical incidents and recommendations for safe use. A total of 105 clinical incidents attributed to smartphone distraction were identified and categorized into four themes, while 176 respondents provided actionable recommendations categorized into five strategic pillars for safe clinical integration.

This study employs a prospective observational design to investigate the integration of smartphone technology in nursing workflows and its direct implications for patient safety. As healthcare environments become increasingly fast-paced, the reliance on instant messaging (e.g., WhatsApp, specialized hospital apps) for clinical communication has grown.

The research focuses on several key dimensions:

Communication Efficiency: Assessing how instant messages facilitate rapid clinical decision-making and "instant action" compared to traditional communication methods.

• An online self-administered questionnaire will be used for the quantitative part; it will be shared with participants through their personal WhatsApp number after meeting them and getting their approval to participate in the study.
• Semi-structured interviews will be used to collect data for the qualitative part; interviews will be conducted in the Arabic language, either face-to-face or online through the MS Teams platform (synchronous/asynchronous) mode for easy contact with participants

Patient Safety Outcomes: Monitoring the reporting of critical lab values, medication clarifications, and urgent patient status changes through digital messages.

Workflow Integration: Identifying how nurses prioritize urgent clinical messages amidst their daily responsibilities.

Data collection involves a mixed-methods approach, including the analysis of communication patterns and clinical outcome indicators. The study aims to provide evidence-based insights into how smartphone use can be standardized to minimize risks and maximize the speed of life-saving interventions in hospital settings.

Inclusion Criteria:

Device Usage: Must actively use a personal communication device (smartphone or tablet) during working hours for either personal or professional purposes.

Work Setting: Must be assigned to in-patient care units where direct patient monitoring and interaction occur.

Exclusion Criteria:

• Nurses on leave or those who declined to participate

The study population consists of nurses who are actively providing direct in-patient care in clinical settings. This includes nurses from various departments such as medical-surgical units, intensive care units, and specialized wards. These professionals are primarily those who utilize personal communication devices (PCDs) during their shifts and are capable of reporting their usage patterns and clinical incidents related to patient safety.

Individual participant data will not be shared to protect the privacy and confidentiality of the participating nurses