Capabilities of computerized decision support systems supporting the nursing process in hospital settings: a scoping...

The implementation of the Nursing process (NP) is a complex and cognitively demanding task that can be enhanced by using clinical decision support systems (CDSSs). While some CDSSs assist in the management of patients with specific patient conditions, nursing process clinical decision support systems (NP-CDSSs) are designed to support nursing decisions through all five sequential NP steps: assessment, nursing diagnosis (NDs), planning, intervention, and evaluation. Although an internationally agreed standard for NP-CDSS development (ICS4NP-CDSSs) was published in 2016, outlining recommended design and functional features for NP-CDSSs, current NP-CDSSs show limited compliance with these guidelines.

A PubMed search was conducted to identify NP-CDSSs used in hospital settings and published between January 2013 and February 2024. The objective was to assess how well these systems adhered to ICS4NP-CDSSs including coverage of all NP steps, use of standardized nursing languages (SNLs), and compliance with recommended technical features. The search also examined whether NP-CDSSs had been implemented and evaluated and whether any outcome related to system impact or any nurses' feedback on barriers and facilitators influencing NP-CDSS implementation was documented.

Of the 986 papers retrieved, 35 related to 21 systems met the eligibility criteria. Only seven systems addressed all NP steps, with the evaluation step remaining underdeveloped. Seventeen systems provided NDs based on entered characteristics or risk factors, 15 included automatic linkages between NDs and interventions, but only 10 included linkages to outcomes at the evaluation step. Most retrieved systems used NANDA-I/NANDA, NIC, NOC as SNL. Only four systems reached the post-implementation evaluation phase; none reported patient outcomes analysis, while four collected nursing outcomes. Barriers during implementation included a lack of trust and perceived usefulness to improve daily workflows, limited validation, and missing technical features.

NP-CDSS development is still in its infancy. This review identifies a gap between ICS4NP-CDSS best-practice recommendations and their implementation in current NP-CDSSs, which still lack features like full coverage of NP steps and necessary linkages between them. To enhance NP-CDSSs, strategies should focus on reducing documentation burden, providing comprehensive education and support for nurses, and demonstrating the impact of NP-CDSSs through outcome studies.