Understanding the Role of Clinical Decision Support Systems Among Hospital Nurses Using the FITT (Fit Between...

Area of Science:

• Nursing Informatics
• Health Informatics
• Human-Computer Interaction

Background:

• Clinical Decision Support Systems (CDSSs) are increasingly vital in healthcare for decision-making and patient outcomes.
• Nurses utilize CDSSs for patient monitoring, care planning, and early detection of clinical deterioration.
• Limited research exists on nursing-specific facilitators and barriers to CDSS adoption, unlike physician-focused studies.

Purpose of the Study:

• To explore facilitators and barriers influencing the adoption and use of CDSSs by hospital nurses.
• To apply an extended Fit Between Individuals, Tasks, and Technology (FITT) framework to understand CDSS integration in nursing.

Main Methods:

• A qualitative study involving semistructured interviews with 22 nurses across three hospital types in the Netherlands.
• Thematic analysis of interview transcripts, using inductive coding followed by deductive categorization within the extended FITT framework.
• Rigorous analysis involving dual coding by two researchers and expert panel review.

Main Results:

• Twenty-six distinct factors influencing CDSS adoption were identified across FITT dimensions.
• Factors included facilitators (cognition, clarification), barriers (alarm fatigue, poor design), and context-dependent elements (acceptance, training).
• Key value tensions emerged, balancing standardization with autonomy and decision support with administrative burden.

Conclusions:

• CDSS adoption in nursing is complex, influenced by interactions across FITT dimensions.
• Recommendations include participatory design, targeted training, improved alert management, and organizational support.
• Addressing value tensions and aligning CDSS with workflows can enhance adoption and patient outcomes.