Nursing informatics: a personal review of the past, the present and the future

There is evidence that nurses have been involved in, or have been affected by health- related computer projects since the mid-1960's. Since those early years nurses have made many significant contributions to the wider bio-health informatics agenda. This article reflects on the evolution of Nursing Informatics, from attempts to define the discipline, through the development of support systems, to the current state-of-the-science for one particular and important field of study, namely clinical terminologies. The article concludes with a call for increased professionalisation of Nursing Informatics

The use of computerised clinical decision support systems in emergency care : a substantive review of the literature

Objectives: This paper provides a substantive review of international literature evaluating the impact of computerised clinical decision support systems (CCDSS) on the care of emergency department (ED) patients. Material and Methods: A literature search was conducted using Medline, CINAHL, EMBASE electronic resources and grey literature. Studies were selected if they compared the use of a CCDSS with usual care in a face-to-face clinical interaction in an ED. Results: Of the 23 studies included approximately half demonstrated a statistically significant positive impact on aspects of clinical care with the use of CCDSSs. The remaining studies showed small improvements, mainly around documentation. However, the methodological quality of the studies was poor with few or no controls to mitigate against confounding variables. The risk of bias was high in all but six studies. Discussion: The ED environment is complex and does not lend itself to robust quantitative designs such as Randomised Controlled Trials. The quality of the research in approximately 75% of the studies was poor and therefore conclusions cannot be drawn from these results. However the studies with a more robust design show evidence of the positive impact of CCDSSs on ED patient care. Conclusion This is the first review to consider the role of CCDSSs in emergency care and expose the research in this area. The role of CCDSSs in Emergency Care may provide some solutions to the current challenges in EDs but further high quality research is needed to better understand what technological solutions can offer clinicians and patients. OBJECTIVES This paper provides a description of a substantive review of published international literature evaluating the impact of computerised clinical decision support systems (CCDSS) on the care of emergency department (ED) patients. The principal aims of this review are: to identify the body of CCDSS research undertaken in EDs, the research methods used, their quality and the impact of CCDSSs on clinical care in EDs. The discussion synthesises what is known and not known about the effectiveness of CCDSSs in Emergency Care and the quality of the current evidence base

Designing health IT to support falls prevention in hospitals: Findings from a realist review.

Inpatient falls are an international patient safety concern, accounting for 30-40% of reported safety incidents in acute hospitals. They can cause both physical (e.g. hip fractures) and non-physical harm (e.g. reduced confidence) to patients. We used an approach known as a realist review to identify theories about what interventions might work for whom in what contexts, focusing on what supports and constrains effective use of multifactorial falls risk assessment and falls prevention interventions. One of these theories suggested that staff will integrate recommended practices into their work routines if falls risk assessment tools, including health IT, are quick and easy to use and facilitate existing work routines. Synthesis of empirical studies undertaken in the process of testing and refining this theory has implications for the design of health IT, suggesting that while health IT can support falls prevention through automation, such tools should also allow for incorporation of clinical judgement

Practices of falls risk assessment and prevention in acute hospital settings: a realist investigation

Abstract Background Falls are the most common safety incident reported by acute hospitals. The National Institute of Health and Care Excellence recommends multifactorial falls risk assessment and tailored interventions, but implementation is variable. Aim To determine how and in what contexts multifactorial falls risk assessment and tailored interventions are used in acute National Health Service hospitals in England. Design Realist review and multisite case study. (1) Systematic searches to identify stakeholders’ theories, tested using empirical data from primary studies. Review of falls prevention policies of acute Trusts. (2) Theory testing and refinement through observation, staff interviews (n = 50), patient and carer interviews (n = 31) and record review (n = 60). Setting Three Trusts, one orthopaedic and one older person ward in each. Results Seventy-eight studies were used for theory construction and 50 for theory testing. Four theories were explored. (1) Leadership: wards had falls link practitioners but authority to allocate resources for falls prevention resided with senior nurses. (2) Shared responsibility: a key falls prevention strategy was patient supervision. This fell to nursing staff, constraining the extent to which responsibility for falls prevention could be shared. (3) Facilitation: assessments were consistently documented but workload pressures could reduce this to a tick-box exercise. Assessment items varied. While individual patient risk factors were identified, patients were categorised as high or low risk to determine who should receive supervision. (4) Patient participation: nursing staff lacked time to explain to patients their falls risks or how to prevent themselves from falling, although other staff could do so. Sensitive communication could prevent patients taking actions that increase their risk of falling. Limitations Within the realist review, we completed synthesis for only two theories. We could not access patient records before observations, preventing assessment of whether care plans were enacted. Conclusions (1) Leadership: There should be a clear distinction between senior nurses’ roles and falls link practitioners in relation to falls prevention; (2) shared responsibility: Trusts should consider how processes and systems, including the electronic health record, can be revised to better support a multidisciplinary approach, and alternatives to patient supervision should be considered; (3) facilitation: Trusts should consider how to reduce documentation burden and avoid tick-box responses, and ensure items included in the falls risk assessment tools align with guidance. Falls risk assessment tools and falls care plans should be presented as tools to support practice, rather than something to be audited; (4) patient participation: Trusts should consider how they can ensure patients receive individualised information about risks and preventing falls and provide staff with guidance on brief but sensitive ways to talk with patients to reduce the likelihood of actions that increase their risk of falling. Future work (1) Development and evaluation of interventions to support multidisciplinary teams to undertake, and involve patients in, multifactorial falls risk assessment and selection and delivery of tailored interventions; (2) mixed method and economic evaluations of patient supervision; (3) evaluation of engagement support workers, volunteers and/or carers to support falls prevention. Research should include those with cognitive impairment and patients who do not speak English. Study registration This study is registered as PROSPERO CRD42020184458. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129488) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 5. See the NIHR Funding and Awards website for further award information

A community-based parent-support programme to prevent child maltreatment : Protocol for a randomised controlled trial

The prevention of child abuse and neglect is a global public health priority due to its serious, long-lasting effects on personal, social, and economic outcomes. The Children At Risk Model (ChARM) is a wraparound-inspired intervention that coordinates evidence-based parenting- and home-visiting programmes, along with community-based supports, in order to address the multiple and complex needs of families at risk of child abuse or neglect. This paper presents the protocol for a study that will be carried out to evaluate this new service model (i.e. no results available as yet). The study comprises a multi-centre, randomised controlled trial, with embedded economic and process evaluations. The study will be conducted in two child-welfare agencies within socially disadvantaged settings in Ireland. Families with children aged 3-11 years who are at risk of maltreatment (n = 50) will be randomised to either the 20-week ChARM programme (n = 25) or to standard care (n = 25) using a 1:1 allocation ratio. The primary outcomes are incidences of child maltreatment and child behaviour and wellbeing. Secondary outcomes include quality of parent-child relationships, parental stress, mental health, substance use, recorded incidences of substantiated abuse, and out-of-home placements. Assessments will take place at pre-intervention, and at 6- and 12-month follow-up periods. The study is the first evaluation of a wraparound-inspired intervention, incorporating evidence-based programmes, designed to prevent child abuse and neglect within high risk families where children are still living in the home. The findings will offer a unique contribution to the development, implementation and evaluation of effective interventions in the prevention of child abuse and neglect. The trial is registered with the International Standard Randomised Controlled Trial Number Registe

Uma visão da produção científica internacional sobre a classificação internacional para a prática de enfermagem

A Classificação Internacional para a Prática de Enfermagem (CIPE®) é um sistema classificatório que visa padronizaruma linguagem universal para Enfermagem. Este artigo propõe identificar os estudos desenvolvidos noâmbito mundial abordando a CIPE®, categorizando-os segundo suas finalidades. Trata-se de uma revisão de literatura,em base de dados da Biblioteca Virtual em Saúde, pelo o termo “ICNP”, com abrangência até 2009. Foramencontrados 124 artigos; 65 analisados, cujo conteúdo foi agrupado em nove categorias: abordagens gerais;aplicabilidade à prática; avaliação de classificações; experiências com recursos computacionais; desenvolvimento einclusão de termos; abordagem sobre sistemas classificatórios; uso para ancorar a construção de declarações deenfermagem; traduções; e outros. Verificou-se que poucos trabalhos apresentam projetos ou avaliam resultados deaplicações práticas da CIPE®; a maioria aborda aspectos conceituais ou realiza comparações com outras classificações.Diversos trabalhos concluem sobre a adequação e relevância da CIPE®, mas apontam a necessidade de aperfeiçoamento