Nursing informatics: computer applications and decision support systems

Computers Used by Nurses

The area of interest in nursing informatics are nursing information, nursing data and nursing knowledge. The present state of knowledge related to these phenomena proposes four implications for the development of systems to assist nursing. First, research suggests that experience and knowledge is linked to the quality of nursing assessment, diagnosis or clinical inference, and planning of nursing care, and also that knowledge is task-specific Information technology can provide access to a variety of information resources, such as knowledge bases and decision support systems, to enhance the level of knowledge of the nurse decision-maker. Second, organized patient assessment forms with linkages to knowledge bases of diagnoses have the capability to improve the quality of the patient check up and the accuracy of the diagnosis. Third, studies on planning care have demonstrated the complexity of the task when a number of options are potentially appropriate Model-based decision support applications such as decision analysis and multi-attribute utility theory can help the clinicians and patients to analyze and compare the treatment alternatives in a systematic manner. Fourth, there is little support for proving the relationship between the process and results of clinical decision-making. Large databases built upon nursing data are needed to further examine this relationship.

Computer as nurse

Using computer as "Physician" for "nurse" has produced significantly more results. In light of this, the search terms "nurses and computers" and "nurses attitudes and computers" were used successfully. Future research may require appropriate search terms to produce the desired results. The research studies that cover multiple aspects of interest: attitudes and anxieties towards computers and computer use, factors related to usage of innovations, email, and use of handheld technology. These studies were representative of the literature, had predictive value about nurses and/or use of technology, with obvious implications for future study. (PDA CORTEX, 2000)

Current usage of computers

Nurses have been using technology for decades. From IV therapy in the post war years to the use of ICU in the mid-20 the century and to the current use of compact digital point of care devices nurses have become accustomed to and experienced in using technology in different areas. The mixture of healthcare and technology has created an industry that now drives both the cost and the standard of healthcare. Nurses are now using arterial lines and PA waveforms, and mastering microchip driven IV pumps and other important aspects of their work, but the documentation and communication have remained, as a rule, limited to pen and paper, and face-to-face or phone-to-phone talking.

Nurses and Email

An email study, by Bunting, Russell, & Gregory, (1998), declared email as a basic communication method between members of a research team. The authors were working on different data sets and research texts. They explored that use of email provided a medium for immediately exchanging ideas, in a way as if they were actually face-to-face. Their electronic "meetings" also included fax, telephone and some face-to-face meetings between the principal author and each member separately. Through electronic media, they were able to establish consensus, and felt that email made precious contribution to the process of writing and synthesizing the work of three different researchers. In addition to the benefits of overcoming communication hurdles described above, another benefit was cost control, e.g., decreased use of phone calls and use of snail mail (postage). Barriers highlighted included access to email by either reliability of Internet connections, physical reach to a computer, and reasonably priced Internet service providers. They also establish that use of email required minimum skills. As a medium for exchanging manuscripts or editing documents, email requires that users have friendly software applications that recognize and assist features such as, strikeout, marking text for changes and highlighting. The authors establish that in their experience of long distance research using email as the basic communication medium, that email provided them with "an unexpected bonus" (p. 132); allowing for reflection, creation of new ideas, and wider perspectives all around. Future use of the medium could be extended to the international level.

Personal digital assistants

Investigators at Mount Sinai Hospital in Toronto, Canada conducted study-using Palm computing technology. The purpose of the study was to implement this new technology in an ICU setting and study its impact on efficiency and physician competence. Participants included 24 medical staff, medical trainees, pharmacists, respiratory therapists, researchers and nurse educators. Using regular group focus meetings and findings on advantages and disadvantages, their overall results were positive. The study investigators, Stephen Lapinsky, MD and Tom Stewart, MD, established that handheld technology could revolutionize patient data management as well as access to medical reference materials

3-Drug databases

Different types of databases have been created. One of the famous drug databases is of Australia that was created in 1987 in Australia. It provides references to books, videos, journal articles, conference papers, research reports and unpublished materials on health, social and economic aspects of alcohol and other drug use.

4-Evidence-based medicines

Evidence-based medicine (EBM) tries to apply the best available evidence obtained from the scientific method to clinical decision making. It also tries to judge the strength of the evidence of risks and benefits of treatments (including lack of treatment) and diagnostic tests. This helps clinicians understand whether a treatment will be beneficial or not. Evidence quality can be judged based on the source type (from Meta analyses and systematic reviews of triple-blind randomized placebo-clinical trials with concealment of allocation and no attrition at the top end

Down to conventional wisdom at the bottom), as well as other factors including statistical validity, clinical relevance, currency, and peer-review acceptance. EBM journals provide information in this regard.

5-Dosing and Medical calculators

It contains drug specific dosing calculators and medical calculators. FOR example fixed concentration medicated infusions calculator (version 1.3, December 24, 2009). Enters the patient weight and click on the desired concentration will give you the detail of tables that associate infusion rates to dosing rates.

6-IV compatibility

It describes the compatibility of drug and its solutions. For example Micromedex provides The IV Index; it gives answers within few seconds and help to make accurate, confident intravenous compatibitility decisions. It is a kind of decision support system.

7-Laboratory manuals

It presents a point of care for Lab tests. For example, WHO provides laboratory manual for the examination and processing of human semen.

Other programs used in Nursing

Grasp

The system is automatic, currently working in approximately 100 nursing areas including inpatient units, clinics and day units. Data is updated by clinic staff in each shift to show the care provided to patients. The workload information is maintained monthly and reports are generated to send to the Ministry as well as for analysis within the organization to assist unit/clinic budgeting and decision making.

Oncology patient information system

It is an electronic medication system for chemotherapy orders in the ambulatory oncology services of the Oncology and Blood Disorders at Princess Margaret Hospital for over 20 nurse-led chemotherapy treatment clinics and physician-led ambulatory assessment clinics. OPIS differs from conventional electronic medication systems as it offers medication order entry of chemotherapy orders with a specific sequence to guarantee patient safety during dispensing and administration.

Electronic patient record

It is UHN's standard Clinical Desktop which gives healthcare professionals with immediate access to integrated patient records available in real time. EPR can operate with more than one patient record at a time as well as access to other applications such as the Internet, Intranet, Virtual Library and GRASP.

The EPR is the hub of the patient record. It is used for order entry of medications (TGH and TWH), labs, and radiology and displays results. The online admission assessment can be launched or reviewed in the EPR.

Nursing internet

The Corporate Nursing Internet gives precious information about University Health Network (UHN) to the world. The Nursing Internet site provides UHN and chance to profile nursing practice, education and research to the whole world. The Web Enabled Nursing Innovation Team is responsible for the creation, design and maintenance of the UHN Nursing Internet site. (UHN Nursing)

Key characteristics required in nursing software

Capabilities, portability, ease of learning, use, reliability and cost.

Conclusion

There are multiple soft wares available in the market, which can assist nurses in their profession, however apart from use of quick and efficient softwares, it is also needed that nurses should be highly educated with proper training and their hesitation against use of softwares can be removed. Moreover, the shortage of nurses can also be overcome by the use of computer softwares.