ABSTRACT
The nurse in clinical practice must demonstrate a scientific base for practice grounded in research findings. The purpose of this study was to explore the nurse's perception of the barriers and facilitators to using research findings in nursing practice. A survey methodology was used, and a sample of 356 practicing registered nurses responded. Data were collected using a scale that rated the barriers and facilitators to research utilization. The greatest barriers were insufficient time on the job to implement new ideas, lack of knowledge of nursing research findings, and inaccessibility of relevant literature. The advanced practice nurse is in a pivotal position to decrease the barriers to research utilization.
Subject(s)
Clinical Nursing Research , Diffusion of Innovation , Adult , Clinical Nursing Research/methods , Female , Humans , Male , Middle Aged , Nurse Clinicians , Sampling Studies , Time FactorsABSTRACT
A decision support system for prevention and management of pressure ulcers was developed based on AHCPR guidelines and other sources. The system was implemented for 21 weeks on a 20-bed clinical care unit. Fifteen nurses on that unit volunteered as subjects of the intervention to see whether use of the system would have a positive effect on their knowledge about pressure ulcers and on their decision-making skills related to this topic. A similar care unit was used as a control. In addition, the system was evaluated by experts for its instructional adequacy, and by end users for their satisfaction with the system. Preliminary results show no effect on knowledge about pressure ulcers and no effect on clinical decision making skills. The system was rated positively for instructional adequacy, and positively for user satisfaction. User interviews related to satisfaction supplemented the quantitative findings. A discussion of the issues of conducting experiments like this in today's clinical environment is included.
Subject(s)
Decision Support Systems, Clinical , Pressure Ulcer/therapy , Therapy, Computer-Assisted , Computer Simulation , Consumer Behavior , Evaluation Studies as Topic , Health Knowledge, Attitudes, Practice , Humans , Nursing Staff, Hospital , Pressure Ulcer/prevention & controlABSTRACT
As part of a research project intended to provide problem-based knowledge to clinicians at the point of care, we have developed a system that supports the nurse's development of patient-specific, guideline-based treatment plans for patients who have pressure ulcers or are at risk for developing them. The system captures coded data about assessment, diagnosis and interventions using a point-and-click interface. Knowledge is accessible to the user via: 1) hypertext links from the data entry screens; 2) explicit entry into an indexed version of the guideline; 3) imbedded knowledge-based rules that critique the diagnosis and offer guidance for treatment; and 4) explicit entry into interactive algorithms. The system has been implemented experimentally on one care unit at our hospital, where its impact will be assessed in comparison with a control unit. Data on 113 patients were entered during the 21-week experimental period. The system is being evaluated for its instructional adequacy, its impact on clinicians' decision-making and knowledge, and on processes of care. Users' perceptions of the system are also being evaluated. Dissemination issues in the context of today's health care environment are addressed.
Subject(s)
Decision Making, Computer-Assisted , Expert Systems , Patient Care Planning , Pressure Ulcer/nursing , Boston , Humans , Pressure Ulcer/prevention & control , Program Evaluation , User-Computer InterfaceABSTRACT
We have developed a Pressure Ulcer Prevention and Management System to assist clinicians with patient-specific decision making. The system captures coded data about assessment, diagnosis and interventions using a point-and-click interface. Guideline-based knowledge is imbedded into the system, and is accessible in several ways: 1) via hypertext links from the data entry screens; 2) via explicit entry into an indexed version of the guideline; 3) via imbedded knowledge-based rules that critique the diagnosis and offer guidance for treatment; and 4) via explicit entry into interactive algorithms. The system has been implemented experimentally on one care unit at our hospital, where its impact will be assessed in comparison with a control unit. Preliminary usage data are provided. Issues with rendering guideline material useful for patient-specific decision support are discussed. In our setting, these issues had to do with a) incongruity with local standards; b) insufficient specificity; and 3) insufficient comprehensiveness. Issues of use and dissemination in the context of today's health care environment are also addressed.
Subject(s)
Practice Guidelines as Topic , Pressure Ulcer/therapy , Therapy, Computer-Assisted , Aged , Aged, 80 and over , Algorithms , Evaluation Studies as Topic , Humans , Hypermedia , Pressure Ulcer/prevention & control , United States , United States Agency for Healthcare Research and QualityABSTRACT
A microcomputer-based system designed to provide nurses and physicians access to expert synthesized knowledge in the area of pulmonary arterial waveform troubleshooting has been developed and implemented. Evaluation using triangulation methods show that there was a substantive increase in knowledge in both nurses and physicians.¿.
Subject(s)
Decision Making, Computer-Assisted , Expert Systems , Hospital Information Systems , Attitude of Health Personnel , Catheterization, Peripheral/adverse effects , Catheters, Indwelling/adverse effects , Clinical Competence , Computer Systems , Evaluation Studies as Topic , Humans , Microcomputers , Monitoring, Physiologic , Nurses , Physicians , Pulmonary Artery/physiology , Surveys and Questionnaires , User-Computer InterfaceABSTRACT
This paper reports on a user satisfaction survey of a system for consultation and education in troubleshooting pulmonary artery catheter waveforms. The twelve-item End-User Computing Satisfaction Questionnaire was used to assess users' ratings in four areas. On a scale of 1-5 (with 1 the lowest), the ratings were: Content, 3.5; Accuracy, 4.5; Format, 4.2; Ease of Use, 4.4, and Timeliness, 4.1. Comparison with ratings in a survey that included a variety of applications and settings is provided.
Subject(s)
Consumer Behavior , Expert Systems , Pulmonary Artery/physiology , Attitude to Computers , Blood Flow Velocity , Catheterization , Data Collection , Humans , Pulmonary Artery/diagnostic imaging , UltrasonographyABSTRACT
A collaborative educational program for Japanese nurses was developed, which merged the resources of the practice and education settings at the Massachusetts General Hospital (MGH) and the MGH Institute of Health Professions. Two concurrent programs were developed--Adult Health and Maternal-Child Health. These concurrent programs focused on content reflecting key areas in the realm of nursing practice and education in both Japan and the United States. Complementary clinical tours were an integral part of the program. This dyad of lecture and clinical experiences provided a forum to focus on issues relevant to nursing worldwide.
Subject(s)
International Educational Exchange , Maternal-Child Nursing/education , Oncology Nursing/education , Perioperative Nursing/education , Humans , Japan , MassachusettsABSTRACT
This paper describes a microcomputer system for providing computer-based access to expert knowledge in the area of troubleshooting pulmonary artery (PA) catheter waveforms. The system is used by both nurses and physicians in an 18-bed medical intensive care unit. Its dominant features are 1) problem-focused access to knowledge, and 2) heavy use of graphics and images to explicate knowledge. The system is used by both nurses and physicians in an 18-bed medical intensive care unit. An evaluation protocol is in place to examine the impact of the system on clinicians' knowledge, their decision-making skills, their satisfaction with the system, and costs of orientation related to PA waveform troubleshooting.
