Tecnologia móvel à beira do leito: processo de enfermagem informatizado em terapia intensiva a partir da cipe 1.0®  <span class="so-article-trans-title" dir="auto"> Translated title: Mobile bedside technology: computerized nursing processes in intensive care unit from icnp 1.0 </span> <span class="so-article-trans-title" dir="auto"> Translated title: Tecnología móvil en la cabecera del lecho: un proceso informatizado de enfermería en unidades de cuidados intensivos a partir de la cipe 1.0® </span>

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Abstract

Produção tecnológica e estudo metodológico baseado na evidência que avaliou com os enfermeiros de Terapia Intensiva os critérios de Ergonomia e Usabilidade do Processo de Enfermagem Informatizado desenvolvido em um dispositivo tecnológico móvel a partir da Classificação Internacional para as Práticas de Enfermagem versão 1.0. O estudo foi conduzido de maio a junho de 2008 com 13 avaliadores. Os dados foram analisados mediante o estabelecimento de médias e refletidos a partir da Classificação Internacional para as Práticas de Enfermagem versão 1.0 e das evidências dos estudos na área. O estudo mostra que o sistema possui critérios de Ergonomia e Usabilidade de acordo com a Organização Internacional de Padrões de Sistemas. Sobretudo, o sistema desenvolvido tem aplicação prática porque permite avaliar, intervir e gerenciar o cuidado de enfermagem proporcionando maior segurança, conhecimento e envolvimento dos enfermeiros com as necessidades do paciente à beira do leito.

Translated abstract

This technological production and methodological evidence-based study aimed to evaluate with Intensive Care Unit nurses the criteria of Ergonomics and Usability of the computerized Nursing Process in a mobile device from the International Classification for Nursing Practices version 1.0. The study was conducted from May to June of 2008, with 13 appraisers. The data was analyzed by establishing averages and reflected based on the International Classification for Nursing Practices and the evidence of studies in the area. This study shows that the system has Ergonomics and Usability criteria according to the International Systems Standards Organization. Above all, the system developed has practical applications because it enables decision makers to assess, intervene, and manage nursing care providing greater security, knowledge, and involvement of nurses with the bedside needs of the patient.

Translated abstract

Producción tecnológica e investigación metodológica basada en la evidencia que tuvo por objeto evaluar, con los enfermeros de las Unidades de Cuidados Intensivos, los criterios de Ergonomía y Usabilidad de los sistemas computadorizados del Proceso de Enfermería desarrollado en un dispositivo tecnológico móvil, a partir de la Clasificación Internacional para las Prácticas de Enfermería versión 1.0. El estudio se realizó de mayo a junio de 2008 con 13 evaluadores. Los datos se analizaron mediante el establecimiento de promedios y fueron considerados a partir de la Clasificación Internacional para las Prácticas de Enfermería y de las evidencias de los estudios en el área. La investigación muestra que el sistema tiene criterios de Ergonomía y Usabilidad que están de acuerdo con la Organización Internacional de Patrones de Sistemas. El sistema desarrollado tiene aplicación práctica ya que permite evaluar, intervenir y gestionar la prestación de cuidados de enfermería proporcionando una mayor seguridad, el conocimiento y la participación de los enfermeros con las necesidades del paciente en la cabecera del lecho.

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The impact of electronic health records on time efficiency of physicians and nurses: a systematic review.

Lise Poissant, Jennifer Pereira, Robyn Tamblyn … (2005)

A systematic review of the literature was performed to examine the impact of electronic health records (EHRs) on documentation time of physicians and nurses and to identify factors that may explain efficiency differences across studies. In total, 23 papers met our inclusion criteria; five were randomized controlled trials, six were posttest control studies, and 12 were one-group pretest-posttest designs. Most studies (58%) collected data using a time and motion methodology in comparison to work sampling (33%) and self-report/survey methods (8%). A weighted average approach was used to combine results from the studies. The use of bedside terminals and central station desktops saved nurses, respectively, 24.5% and 23.5% of their overall time spent documenting during a shift. Using bedside or point-of-care systems increased documentation time of physicians by 17.5%. In comparison, the use of central station desktops for computerized provider order entry (CPOE) was found to be inefficient, increasing the work time from 98.1% to 328.6% of physician's time per working shift (weighted average of CPOE-oriented studies, 238.4%). Studies that conducted their evaluation process relatively soon after implementation of the EHR tended to demonstrate a reduction in documentation time in comparison to the increases observed with those that had a longer time period between implementation and the evaluation process. This review highlighted that a goal of decreased documentation time in an EHR project is not likely to be realized. It also identified how the selection of bedside or central station desktop EHRs may influence documentation time for the two main user groups, physicians and nurses.

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Evaluating informatics applications--some alternative approaches: theory, social interactionism, and call for methodological pluralism.

Bonnie Kaplan (2001)

A review of evaluation literature concerning CDSSs indicates that randomized controlled clinical trials (RCTs) are the 'gold standard' for evaluation. While this approach is excellent for studying system or clinical performance, it is not well suited to answering questions concerning whether systems will be used or how they will be used. Because lack of use of CDSS has been of concern for some years, other evaluation research designs are needed to address those issues. This paper critiques RCT and experimental evaluation approaches and presents alternative approaches to evaluation that address questions outside the scope of the usual RCT and experimental designs. A wide range of literature is summarized to illustrate the value of evaluations that take into account social, organizational, professional, and other contextual considerations. Many of these studies go beyond the usual measures of systems performance or physicians' behavior by focusing on 'fit' of the system with other aspects of professional and organizational life. Because there is little explicit theory that informs many evaluations, the paper then reviews CDSS evaluations informed by social science theories. Lastly, it proposes a theoretical social science base of social interactionism. An example of such an approach is given. It involves a CDSS in psychiatry and is based on Kaplan's 4Cs, which focus on communication, control, care, and context. Although the example is a CDSS, the evaluation approach also is useful for clinical guideline implementation and other medical informatics applications. Similarly, although the discussion is about social interactionism, the more important point is the need to broaden evaluation through a variety of methods and approaches that investigate social, cultural, organizational, cognitive, and other contextual concerns. Methodological pluralism and a variety of research questions can increase understanding of many influences concerning informatics applications development and deployment.