Nurses' use of computerised clinical decision support systems: a case site analysis

Area of Science:

• Nursing Informatics
• Clinical Decision Support Systems
• Health Technology Adoption

Background:

• Limited evidence exists on the benefits of computerized clinical decision support systems (CDSS) in nursing.
• Existing research primarily focuses on CDSS for telephone triage, neglecting broader clinical applications.
• Factors such as nurse experience, system features, and organizational context are suggested to influence CDSS use.

Purpose of the Study:

• To investigate how nurses utilize computerized clinical decision support systems in their daily practice.
• To identify key factors influencing the adoption and utilization of these systems by nurses.

Main Methods:

• A multiple case site study design was employed.
• Data collection involved non-participant observation of 115 nurse-patient consultations and interviews with 55 nurses across four purposively selected sites.
• Thematic content analysis was used to analyze the collected data.

Main Results:

• Nurses used computerized decision support systems for various tasks, including data recording, patient monitoring, and decision confirmation.
• Nurses' experience with clinical decisions and technology, alongside their adaptability, significantly impacted system usage and the likelihood of overriding system recommendations.
• The study observed nurses adapting the technology to align with local clinical practices.

Conclusions:

• Nurses' use of computerized decision support is a dynamic interaction between their experience and their capacity to adapt the technology to fit clinical workflows.
• Unanticipated uses, such as routine overriding of recommendations, were identified, potentially increasing rather than decreasing clinical variation or errors.
• The findings highlight the need to consider user adaptation and context when implementing and evaluating computerized decision support systems in nursing.