Computerized Decision Support System in Nursing Homes
av
Mariann Fossum
Akademisk avhandling
Avhandling för medicine doktorsexamen i medicinsk vetenskap med inriktning mot hälso-och vårdvetenskap,
som enligt beslut av rektor kommer att försvaras offentligt fredag den 20 april 2012 kl. 13.00,
Prismahuset Hörsal P2, Örebro universitet Opponent: Professor Anna Forsberg
Avdelningen för omvårdnad, Medicinska fakulteten, Lunds universitet
Örebro universitet
Institutionen för hälsovetenskap och medicin
Abstract
Fossum, M. (2012). Computerized Decision Support System in Nursing Homes. Örebro Studies in Care Sciences 36, 2012, 95 pp.
The overall aim of this thesis was to study the thinking strategies and clinical reasoning processes of registered nurses (RNs) and to imple-ment and test a computerized decision support system (CDSS) inte-grated into the electronic health care record (EHR) for preventing 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 reason-ing (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 resi-dents’ records were reviewed with three instruments. Nursing person-nel (n=25) from four nursing homes that had used the CDSS for eight months were interviewed and the CDSS was tested by nursing person-nel (n=5) in two usability evaluations (Paper IV).
The results showed that the RNs used a variety of thinking strate-gies 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 facili-tators 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 nurs-ing personnel.
Keywords: computerized decision support, intervention study,
malnutri-tion, nursing documentamalnutri-tion, pressure ulcer, qualitative content analysis, think-aloud interviews, usability evaluation.
Mariann Fossum, School of Health and Medical Sciences,
