Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
J Am Med Inform Assoc. 2021 Oct 12;28(11):2502-2513. doi: 10.1093/jamia/ocab123.
The study sought to summarize research literature on nursing decision support systems (DSSs ); understand which steps of the nursing care process (NCP) are supported by DSSs, and analyze effects of automated information processing on decision making, care delivery, and patient outcomes.
We conducted a systematic review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed, CINAHL, Cochrane, Embase, Scopus, and Web of Science were searched from January 2014 to April 2020 for studies focusing on DSSs used exclusively by nurses and their effects. Information about the stages of automation (information acquisition, information analysis, decision and action selection, and action implementation), NCP, and effects was assessed.
Of 1019 articles retrieved, 28 met the inclusion criteria, each studying a unique DSS. Most DSSs were concerned with two NCP steps: assessment (82%) and intervention (86%). In terms of automation, all included DSSs automated information analysis and decision selection. Five DSSs automated information acquisition and only one automated action implementation. Effects on decision making, care delivery, and patient outcome were mixed. DSSs improved compliance with recommendations and reduced decision time, but impacts were not always sustainable. There were improvements in evidence-based practice, but impact on patient outcomes was mixed.
Current nursing DSSs do not adequately support the NCP and have limited automation. There remain many opportunities to enhance automation, especially at the stage of information acquisition. Further research is needed to understand how automation within the NCP can improve nurses' decision making, care delivery, and patient outcomes.
本研究旨在总结护理决策支持系统（DSS）的研究文献；了解 DSS 支持护理照护过程（NCP）的哪些步骤，并分析自动化信息处理对决策制定、护理提供和患者结局的影响。
我们根据 PRISMA（系统评价和荟萃分析的首选报告项目）声明进行了系统评价。从 2014 年 1 月至 2020 年 4 月，我们在 PubMed、CINAHL、Cochrane、Embase、Scopus 和 Web of Science 上搜索了专门供护士使用及其影响的 DSS 研究。评估了自动化的各个阶段（信息获取、信息分析、决策和行动选择以及行动实施）、NCP 和影响的信息。
在检索到的 1019 篇文章中，有 28 篇符合纳入标准，每篇文章都研究了一个独特的 DSS。大多数 DSS 都涉及 NCP 的两个步骤：评估（82%）和干预（86%）。就自动化而言，所有纳入的 DSS 都实现了信息分析和决策选择的自动化。有 5 个 DSS 实现了信息获取的自动化，只有 1 个实现了行动实施的自动化。对决策制定、护理提供和患者结局的影响是混合的。DSS 提高了对建议的遵守度并缩短了决策时间，但影响并不总是可持续的。证据实践得到了改善，但对患者结局的影响是混合的。
当前的护理 DSS 不能充分支持 NCP，并且自动化程度有限。在提高自动化程度方面仍有许多机会，特别是在信息获取阶段。需要进一步研究以了解 NCP 中的自动化如何改善护士的决策制定、护理提供和患者结局。
