Bail Kasia, Davey Rachel, Currie Marian, Gibson Jo, Merrick Eamon, Redley Bernice
Synergy Nursing and Midwifery Research Centre and Health Research Institute, University of Canberra, Bruce, ACT 2617, Australia. Email:
Centre for Research and Action in Public Health, Health Research Institute, University of Canberra, Bruce, ACT 2617, Australia. Email:
Aust Health Rev. 2020 Sep;44(5):672-676. doi: 10.1071/AH18231.
The aim of this study was to investigate the implementation of a novel electronic bedside nursing chart in an acute hospital setting. The case study used multiple data sources captured within a real-life clinical ward context. Quantitative findings included significant reductions in nurse-reported missed care (P<0.05) and increased mean time spent at the bedside (from 21 to 28min h-1; P<0.0001); reductions in patient-reported missed care and nurses' walking distances were not significant. Qualitative themes included: (1) inconsistent expectations (perceptions about potential vs actual functionality and benefits of the technology); (2) decisional conflict between managers and end-user nurses (discordance between governance decisions and clinical operations; 30% of beds were closed and six of the eight trained nurse 'super-users' were moved from the pilot ward); and (3) workflow effects (ergonomic set-up of the digital interface). This study highlights the complex challenges of implementing and examining the effects of technology to support nursing care. Shared understanding of the technology goals and project scope in relation to nursing care and flexible and adaptive project and contingency planning are fundamental considerations. Complexity, unpredictability and uncertainty of 'usual business' are common confounders in acute hospital settings.
本研究旨在调查一种新型电子床边护理图表在急症医院环境中的实施情况。该案例研究使用了在实际临床病房环境中收集的多个数据源。定量研究结果包括护士报告的漏护情况显著减少（P<0.05），以及平均床边护理时间增加（从21分钟/小时增加到28分钟/小时；P<0.0001）；患者报告的漏护情况和护士行走距离的减少不显著。定性主题包括：（1）期望不一致（对技术潜在功能与实际功能及益处的认知）；（2）管理人员与终端用户护士之间的决策冲突（管理决策与临床操作之间的不一致；30%的床位关闭，八名经过培训的护士“超级用户”中有六名从试点病房调走）；以及（3）工作流程影响（数字界面的人体工程学设置）。本研究凸显了实施和检验支持护理的技术效果所面临的复杂挑战。对与护理相关的技术目标和项目范围达成共同理解，以及灵活且适应性强的项目和应急计划是基本考量因素。急症医院环境中，“日常业务”的复杂性、不可预测性和不确定性是常见的混杂因素。
