A qualitative analysis of how advanced practice nurses use clinical decision support systems
A qualitative analysis of how advanced practice nurses use clinical decision support systemsScott Weber, EdD, PhD(c), MSN, APRN (Assistant Professor, and Health and Community Systems Coordinator) Nursing Education Graduate Program, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
Main Question: ‘‘How do APNs describe and characterize their experiences of using a clinical decision system in their critical care practices?’’
Purpose: The purpose of this study was to generate a grounded theory that will reflect the experiences of advanced practice nurses (APNs) working as critical care nurse practitioners (NPs) and clinical nurse specialists (CNS) with computer-based decision-making systems.
Data sources: Twenty-three APNs (13CNSand 10 NPs) were recruited from 16 critical care units located in six large urban medical centers in the U.S. Midwest. Single-structured in-depth interviews with open-ended audio-taped questions were conducted with each APN.
• Data were collected through audio-taped interviews, lasting approximately 1 h each, were used to gather data.
• The interview guide was used during each interview to assist the interviewer in asking relevant questions and ensure that all pertinent topics were fully explored with each participant
• Audio-taped content was summarized and imported into the NUD*IST 5 software package for qualitative data analysis.
- The unique contribution of system technology to clinical decision making was its ability to accurately predict or forecast patient clinical outcomes prior to actual human decision making.
- Participants who described themselves as being more knowledgeable about clinical decision technology used the system more often in patient care decision making.
- Understanding of technology helps in deciding whether to use the system in patient care decision making or not.
- Creating inferences directly affected participants’ level of system use. Positive inferences led to more advanced system use (comparing, applying, and forecasting with system data). Negative inferences led to less system use (no use or data entry use only).
- Participants’ decisions to use system technology to forecast decision outcomes were largely based on the results of their comparison of system data to clinical judgment and to actual observed patient outcomes.
- Similar results from the comparing activities guided participants to trust system-derived data and use the clinical decision system.
- Factors influencing clinical decision system satisfaction:
(a) extent of system knowledge (b) number of experiences when participants’ professional judgment was confirmed by the System (c) patients’ acuity level.
- Inhibiting factors relating to satisfaction included
(a) technical barriers, (b) system knowledge barriers (c) Participants’ concern for loss of patient individuality.
The findings of this study suggest that the main reason critical care APNs choose to integrate clinical decision systems into their practices is to provide an objective, scientifically derived, technology-based backup for human forecasting of the outcomes of patient care decisions prior to their actual decision making.
Comments: • This study gives us a lot of answers that may come to one’s mind about APNs’ experiences of using a clinical decision system in their critical care practice. • This study is good on the theoretical basis but is less effective on the practical side so we need more studies to show the interaction between the APN’s and the system in the real life.
Reviewed by Yomna Hafiz