Bertocchi Luca, Dante Angelo, La Cerra Carmen, Masotta Vittorio, Marcotullio Alessia, Caponnetto Valeria, Ferraiuolo Fabio, Jones Dorothy, Lancia Loreto, Petrucci Cristina
Author Affiliations: Department of Life, Health & Environmental Sciences, University of L'Aquila, Italy (Drs Bertocchi and Ms Marcotullio; Messrs Masotta, Ferraiuolo, and Mr Lancia; and Mr Dante, Ms La Cerra, Dr Caponnetto, and Ms Petrucci); and The Marjory Gordon Program for Clinical Reasoning and Knowledge Development at Boston College, William F. Connell School of Nursing, MA (Dr Bertocchi and Ms Jones).
Comput Inform Nurs. 2024 Jan 1;42(1):44-52. doi: 10.1097/CIN.0000000000001066.
Computer-based technologies have been widely used in nursing education, although the best educational modality to improve documentation and nursing diagnostic accuracy using electronic health records is still under investigation. It is important to address this gap and seek an effective way to address increased accuracy around nursing diagnoses identification. Nursing diagnoses are judgments that represent a synthesis of data collected by the nurse and used to guide interventions and to achieve desirable patients' outcomes. This current investigation is aimed at comparing the nursing diagnostic accuracy, satisfaction, and usability of a computerized system versus a traditional paper-based approach. A total of 66 nursing students solved three validated clinical scenarios using the NANDA-International terminologies traditional paper-based approach and then the computer-based Clinical Decision Support System. Study findings indicated a significantly higher nursing diagnostic accuracy ( P < .001) in solving cancer and stroke clinical scenarios, whereas there was no significant difference in acute myocardial infarction scenario. The use of the electronic system increased the number of correct diagnostic indicators ( P < .05); however, the level of students' satisfaction was similar. The usability scores highlighted the need to make the electronic documentation systems more user-friendly.
基于计算机的技术已在护理教育中广泛应用,尽管使用电子健康记录提高记录和护理诊断准确性的最佳教育模式仍在研究中。弥补这一差距并寻求一种有效方法来提高护理诊断识别的准确性非常重要。护理诊断是一种判断,它代表护士收集的数据的综合,用于指导干预措施并实现理想的患者结局。本次调查旨在比较计算机化系统与传统纸质方法在护理诊断准确性、满意度和可用性方面的差异。共有66名护理专业学生使用国际护理诊断协会(NANDA)术语,先采用传统纸质方法,然后使用基于计算机的临床决策支持系统,解决了三个经过验证的临床案例。研究结果表明,在解决癌症和中风临床案例时,护理诊断准确性显著更高(P <.001),而在急性心肌梗死案例中没有显著差异。使用电子系统增加了正确诊断指标的数量(P <.05);然而,学生的满意度水平相似。可用性得分突出表明需要使电子记录系统更便于用户使用。