ABSTRACT
We analyzed a set of clinical encounters (n=4,160) in which nurses received a reminder to screen for depression. Patients who were African-American or Hispanic were less likely to be screened as were those with Medicaid or Medicare insurance.
Subject(s)
Depression/ethnology , Depression/nursing , Mass Screening/statistics & numerical data , Minority Groups/statistics & numerical data , Nursing Care/statistics & numerical data , Racial Groups/statistics & numerical data , Reminder Systems/statistics & numerical data , Bias , Depression/diagnosis , Humans , New York , Practice Patterns, Nurses'ABSTRACT
Depression is under recognized in a variety of pediatric settings. The purpose of this paper is to describe the development and initial evaluation of a personal digital assistant (PDA)-based decision support system (DSS) for pediatric depression screening in ages 8 to 18 years of age by pediatric advanced practice nurse (APN) students. Three aspects are described: selection of depression screening instrument; integration of the instrument into the PDA; and quantitative (usage) and qualitative (focus group) evaluation. Only one third of eligible patients were screened. Twenty percent of those screened were identified as at risk for mood disorder. The barriers to screening identified through focus groups included a lack of time, knowledge, intervention protocol, referral resources, PDA usability issues, preceptor motivation and comfort, as well as perceived or real cultural barriers. Suggestions for educational, research, and interventions to integrate clinical based PDA-based screening are discussed.
Subject(s)
Computers, Handheld , Depression/diagnosis , Diagnosis, Computer-Assisted , Adolescent , Algorithms , Attitude to Computers , Child , Decision Support Systems, Clinical , Depressive Disorder/diagnosis , Female , Focus Groups , Health Knowledge, Attitudes, Practice , Humans , Male , Mass Screening , Pediatrics , Students, NursingSubject(s)
Ethics, Nursing , Medically Uninsured , Nurse Practitioners/ethics , Beneficence , Child , Drug Prescriptions , Female , HumansABSTRACT
The number of health sciences educational programs that are integrating personal digital assistants (PDAs) into their curricula is on the rise. In this paper, we report an evaluation of the usefulness of a PDA-based advanced practice nursing (APN) student clinical log through faculty stakeholder exemplars in three areas: pediatric asthma care; procedures of Acute Care Nurse Practitioner (NP) students; and diagnostic and screening procedures of Women's Health NP students. We generated descriptive data through routine queries and through custom SQL queries at the request of a specific faculty member who wished to examine a particular aspect of an educational program. In addition, we discussed the potential implications of the data with the respective faculty members. The exemplars provide evidence that faculty stakeholders found the APN student clinical log to be useful for a variety of purposes including monitoring of student performance, benchmarking, and quality of care assessments.
Subject(s)
Computers, Handheld , Documentation , Education, Nursing , FacultyABSTRACT
The purposes of this study were to identify the functional requirements of and to build the data model for a PDA-DSS. Through Use Case Analysis and UML modeling, seven Use Cases were documented, and Use Case Diagrams, Activity Diagrams, and Sequence Diagrams related to the management of were developed.
Subject(s)
Computers, Handheld , Decision Support Systems, Clinical , Obesity/nursing , Guideline Adherence , Humans , Obesity/diagnosis , Practice Guidelines as Topic , User-Computer InterfaceABSTRACT
The Institute of Medicine (IOM) Committee on Quality of Health Care in America identified the critical role of information technology in designing safe and effective health care. In addition to technical aspects such as regional or national health information infrastructures, to achieve this goal, healthcare professionals must receive the requisite training during basic and advanced educational programs. In this article, we describe a two-pronged strategy to promote patient safety through an informatics-based approach to nursing education at the Columbia University School of Nursing: (1) use of a personal digital assistant (PDA) to document clinical encounters and to retrieve patient safety-related information at the point of care, and (2) enhancement of informatics competencies of students and faculty. These approaches may be useful to others wishing to promote patient safety through using informatics methods and technologies in healthcare curricula.
