Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland.
Faculty of Medicine, University of Geneva, Geneva, Switzerland.
JMIR Mhealth Uhealth. 2019 Apr 11;7(4):e12551. doi: 10.2196/12551.
Nurses are increasingly spending time on computers, and providing them with a tailored tool to access clinical information and perform documentation at the bedside could help to improve their efficiency. Designing an app to support nurses' work at the bedside is a challenging task, given the complexity of the care process.
This study aimed to present the design, development, and testing of a smartphone app for nurses guided by an adapted software development life cycle model that takes into consideration the complexity and constraints of a health care setting.
The model drives us through an iterative development process intersected by 3 stages of formative evaluation of growing ecological validity.
The initial requirements identification stage included 11 participants who helped us select the most important functionalities to integrate into the tool. Starting with a usability evaluation allowed for the identification of design issues that could have caused misuse. Then, making on-site evaluations under the supervision of an investigator helped to understand the adequacy of the tool with limited risks. Finally, the on-site evaluation allowed us to validate the acceptance of the app by caregivers.
The interpretation of the collected evaluation confirms the necessary involvement of end users early in the process to help address the heterogeneity of the nursing workflow processes in the different wards. We also highlight the delicate balance between high-security measures to protect access to patient data and maintaining ease of access for efficiency and usability. Although a close collaboration with clinicians throughout the entire project facilitated the development of a tailored solution, it was also important to involve all stakeholders, in particular, the information technology (IT) security officers.
护士越来越多地在计算机上花费时间，为他们提供一个定制的工具来访问临床信息并在床边执行文档记录，这有助于提高他们的工作效率。考虑到护理过程的复杂性，设计一个支持护士在床边工作的应用程序是一项具有挑战性的任务。
本研究旨在展示一款智能手机应用程序的设计、开发和测试，该应用程序是根据一个经过修改的软件开发生命周期模型设计的，该模型考虑了医疗保健环境的复杂性和限制。
该模型通过 3 个阶段的形成性评估（不断提高生态有效性）的迭代开发过程指导我们。
初始需求识别阶段包括 11 名参与者，他们帮助我们选择了最重要的功能集成到工具中。从可用性评估开始，可以确定可能导致误用的设计问题。然后，在调查员的监督下进行现场评估有助于了解工具的充分性，同时降低风险。最后，现场评估使我们能够验证护理人员对应用程序的接受程度。
对收集到的评估结果的解释证实，在整个过程中尽早让最终用户参与进来是必要的，这有助于解决不同病房护理工作流程的异质性问题。我们还强调了在保护患者数据访问的高安全性措施和提高效率和可用性的便捷性之间保持微妙平衡的重要性。虽然在整个项目中与临床医生密切合作有助于开发定制解决方案，但让所有利益相关者参与进来也很重要，特别是信息技术（IT）安全人员。
