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An evaluation of the usability of a computerized decision support system for nursing homes
Örebro University, School of Health and Medical Sciences.
Örebro University, School of Health and Medical Sciences.
School of Interdisciplinary Informatics, College of Information Science and Technology, University of Nebraska, Omaha, USA;.
School of Health and Social Studies, Dalarna University, Falun, Sweden.ORCID iD: 0000-0002-3964-196X
2011 (English)In: Applied Clinical Informatics, ISSN 1869-0327, Vol. 2, no 4, p. 420-436Article in journal (Refereed) Published
Abstract [en]

Background: Computerized decision support systems (CDSSs) have the potential to significantly improve the quality of nursing care of older people by enhancing the decision making of nursing personnel. Despite this potential, health care organizations have been slow to incorporate CDSSs into nursing home practices.

Objective: This study describes facilitators and barriers that impact the ability of nursing personnel to effectively use a clinical CDSS for planning and treating pressure ulcers (PUs) and malnutrition and for following the suggested risk assessment guidelines for the care of nursing home residents.

Methods: We employed a qualitative descriptive design using varied methods, including structured group interviews, cognitive walkthrough observations and a graphical user interface (GUI) usability evaluation. Group interviews were conducted with 25 nursing personnel from four nursing homes in southern Norway. Five nursing personnel participated in cognitive walkthrough observations and the GUI usability evaluation. Text transcripts were analyzed using qualitative content analysis.

Results: Group interview participants reported that ease of use, usefulness and a supportive work environment were key facilitators of CDSS use. The barriers identified were lack of training, resistance to using computers and limited integration of the CDSS with the facility’s electronic health record (EHR) system. Key findings from the usability evaluation also identified the difficulty of using the CDSS within the EHR and the poorly designed GUI integration as barriers.

Conclusion: Overall, we found disconnect between two types of nursing personnel. Those who were comfortable with computer technology reported positive feedback about the CDSS, while others expressed resistance to using the CDSS for various reasons. This study revealed that organizations must invest more resources in educating nursing personnel on the seriousness of PUs and poor nutrition in the elderly, providing specialized CDSS training and ensuring that nursing personnel have time in the workday to use the CDSS.

Place, publisher, year, edition, pages
Schattauer Gmbh, 2011. Vol. 2, no 4, p. 420-436
Keywords [en]
Decision Support System, computerized, graphical user interface evaluation, nursing homes, qualitative content analysis
National Category
Information Systems Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-21753DOI: 10.4338/ACI-2011-07-RA-0043ISI: 000208686800003PubMedID: 23616886Scopus ID: 2-s2.0-84884484684OAI: oai:DiVA.org:oru-21753DiVA, id: diva2:504979
Note

Mariann Fossum is also affiliated to Centre for Caring Research – Southern Norway, Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway

Available from: 2012-02-22 Created: 2012-02-22 Last updated: 2020-01-28Bibliographically approved
In thesis
1. Computerized decision support system in nursing homes
Open this publication in new window or tab >>Computerized decision support system in nursing homes
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to study the thinking strategies and clinical reasoning processes of registered nurses (RNs) and to implement and test a computerized decision support system (CDSS) integrated into the electronic health care record (EHR) to improve patient outcomes, i.e. to prevent pressure ulcers (PUs) and malnutrition among residents in nursing homes. 

A think-aloud (TA) study with a purposeful sample of RNs (n=30) was conducted to explore their thinking strategies and clinical reasoning (Paper I). A quasi-experimental study with a convenience sample of residents (at baseline, n=491 and at follow-up, n=480) from nursing homes (n=15) allocated into two intervention groups and one control group was carried out in 2007 and 2009 (Paper II). In Paper III residents’ records were reviewed with three instruments. Nursing personnel (n=25) from four nursing homes that had used the CDSS for eight months were interviewed and the CDSS was tested by nursing personnel (n=5) in two usability evaluations (Paper IV).

The results showed that the RNs used a variety of thinking strategies and a lack of systematic risk assessment was identified (Paper I). The proportion of malnourished residents decreased significantly in one of the intervention groups after implementing the CDSS, however there were no differences between the groups (Paper II). The CDSS resulted in more complete and comprehensive documentation of PUs and malnutrition (Paper III). The nursing personnel considered ease of use, usefulness and a supportive work environment as the main facilitators of CDSS use in nursing homes. Barriers were lack of training, resistance to using computers and limited integration of the CDSS within the EHR system (Paper IV). In conclusion, the findings support integrating CDSSs into the EHR in nursing homes to support the nursing personnel.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 95
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 36
Keywords
Computerized decision support, intervention study, malnutrition, nursing documentation, pressure ulcer, qualitative content analysis, think-aloud interviews, usability evaluation
National Category
Medical and Health Sciences Nursing Information Systems
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-21673 (URN)978-91-7668-857-1 (ISBN)
Public defence
2012-04-20, Hörsal P2, Prismahuset, Örebro universitet, Fakultetsgatan 1, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2012-02-16 Created: 2012-02-16 Last updated: 2018-01-12Bibliographically approved

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Fossum, MariannEhnfors, MargaretaEhrenberg, Anna

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