Estudio situacional de los registros electrónicos en una unidad de medicina interna: barreras y oportunidades

The objective of this study was to identify the resources, workflows and perception of nurses of internal medicine unit, related to electronic records in order to determine if the implementation of tablets in hospital units could cover the nurses’ needs more satisfactorily. A descriptive, cross-sectional study with non-probability sampling was carried out during July and August of 2016. The study involved 31 observations of 18 nurses, with 392 patients admitted. The variables were: shift, working methodology, "round" time, time taken to write up data, total time, number of patients admitted and time spent per patient. Each nurse was asked how they worked and why. The average total time was 59,16 min (DT:16,6), and 12.65 (DT:1,11) patients admitted. Time spent per patient was 4,65 min (DT:1,15) and was lower during the afternoon shift [M:4,14; [DT: 0.84] than during the night shift [M: 5.47; DT: 1,12]. The night shift always used the same method of work, whereas different systems were used during the afternoon. The nurses expressed the need for a lightweight record system that would enable them to record information in real time near the patient without having to go elsewhere, and which would make it easy to consult and exchange information. The two working methods used in the observation unit do not satisfy the needs of nurses, are slow and cumbersome and make it difficult for nurses to access and record information. The adoption of tablets could reduce these problems and meet nurses’ expectations and thus opens a new line of research.El objetivo de este trabajo fue conocer los recursos, flujos de trabajo y percepción de las enfermeras de una unidad de medicina interna, relacionados con los registros electrónicos, con el fin de determinar si la implantación de tablets en las unidades de hospitalización, podrían responder a sus expectativas. Se llevó a cabo un estudio descriptivo, transversal, muestreo no probabilístico, consecutivo durante los meses de julio y agosto del 2016.  Se realizaron 31 observaciones, a 18 enfermeras,  392 pacientes ingresados. Las variables: turno, metodología de trabajo, tiempo “ronda”, tiempo transcripción de datos, tiempo total, número de pacientes ingresados y tiempo invertido por paciente. También se preguntó a cada enfermera sobre cómo trabajaban y el motivo.La media de tiempo total fue 59,16 min (DT:16,6), y 12,65 (DT:1,11) pacientes ingresados. Tiempo invertido por paciente 4,65 min (DT:1,15), inferior en el turno tarde [M:4,14; DT: 0,84] que el de noche [M: 5,47; DT: 1,12]. El turno noche siempre utilizaba el mismo método de trabajo y era el turno tarde que presentaba sistemáticas diferentes. Las enfermeras manifestaron la necesidad de un sistema de registro ligero, en tiempo real, a pie de cama del enfermo, evitando desplazamientos, de fácil acceso para la consulta e intercambio de información. Los dos métodos de trabajo de la unidad de observación no satisfacen las necesidades de las enfermeras, son lentos, pesados y dificultan el acceso a la información y el registro. La incorporación de tablets podría reducir estos problemas y cubrir sus expectativas, abriendo una nueva línea de investigación

Investigating the need for clinicians to use tablet computers with a newly envisioned electronic health record

Objective: The Veterans Health Administration (VHA) has deployed a large number of tablet computers in the last several years. However, little is known about how clinicians may use these devices with a newly planned Web-based electronic health record (EHR), as well as other clinical tools. The objective of this study was to understand the types of use that can be expected of tablet computers versus desktops. Methods: Semi-structured interviews were conducted with 24 clinicians at a Veterans Health Administration (VHA) Medical Center. Results: An inductive qualitative analysis resulted in findings organized around recurrent themes of: (1) Barriers, (2) Facilitators, (3) Current Use, (4) Anticipated Use, (5) Patient Interaction, and (6) Connection. Conclusions: Our study generated several recommendations for the use of tablet computers with new health information technology tools being developed. Continuous connectivity for the mobile device is essential to avoid interruptions and clinician frustration. Also, making a physical keyboard available as an option for the tablet was a clear desire from the clinicians. Larger tablets (e.g., regular size iPad as compared to an iPad mini) were preferred. Being able to use secure messaging tools with the tablet computer was another consistent finding. Finally, more simplicity is needed for accessing patient data on mobile devices, while balancing the important need for adequate security

A aplicação do processo de enfermagem informatizado: revisão integrativa

Objective: To identify in the literature evidences about the nursing process (NP) applied to softwares. Method: Integrative review, search performed in PubMed, LILACS and CINAHL databases and reverse search, from August 28 to September 9, 2016. The descriptors used were nursing, nursing process, hospital information systems, medical informatics, medical informatics application, public health informatics, and informatics in nursing. The sample consisted of 23 articles. Results: There was an increase in productions from 2000 onwards; most of the publications originated in Brazil and were characterized as descriptive studies. There were two categories of analysis: development and use of softwares. Most studies contemplated all stages of the NP, two cite the theoretical reference and three use the system for the assistance and management dimensions. The taxonomies used were the ICNP, NANDA, NIC, NOC. Conclusion: The use of softwares with NP strengthens evidence-based practice and consolidates nursing as a scienceObjetivo: Identificar en la literatura la evidencia del proceso de enfermería (PE) que se aplica al software.Metodología: Una revisión integradora, la búsqueda se realizó en las bases de datos PubMed, Lilacs y CINAHL y búsqueda inversa en el período de 28 de agosto al 09 de septiembre de 2016. Se utilizaron los descriptores enfermería, proceso de enfermería, sistemas de información en hospital, informática médica, aplicaciones de informática médica, informática en salud pública e informática aplicada a la enfermería. Muestra de 23 artículos. Resultados: Hubo un aumento en la producción a partir de 2000, la mayor parte se originó en Brasil, se caracterizaron por estudios descriptivos. Nos mostraron dos categorías de análisis: el desarrollo y uso del software. La mayoría de las publicaciones contemplan todas las etapas del PE, dos mencionan la teórica y tres utilizan el sistema para las dimensiones de atención y gestión. Las taxonomías utilizadas fueron CIPE, NANDA, NIC, NOC. Conclusión: El uso de software con el PE fortalece la práctica basada en la evidencia y consolida la enfermería como ciencia.Objetivo: Identificar na literatura evidências sobre o processo de enfermagem (PE) aplicado à softwares. Metodologia: Revisão integrativa, busca realizada nas bases de dados PubMed, LILACS e CINAHL e busca reversa, no período de 28 de agosto a 09 de setembro de 2016. Os descritores foram enfermagem, processo de enfermagem, sistemas de informação hospitalar, informática médica, aplicação de informática médica, informática em saúde pública, e informática em enfermagem. Amostra composta por 23 artigos. Resultados: Houve aumento nas produções a partir de 2000, a maioria das publicações originada do Brasil e caracterizados por estudos descritivos. Evidenciou-se duas categorias de análise: desenvolvimento e utilização de softwares. A maioria contemplava todas as etapas do PE, dois citam o referencial teórico e três utilizam o sistema para as dimensões assistencial e gerencial. As taxonomias utilizadas foram a CIPE, NANDA, NIC, NOC. Conclusão: o uso de softwares com o PE fortalece a prática baseada em evidência e consolida a enfermagem como ciência