Abi Khalil Cynthia, Saab Antoine, Rahme Jihane, Bouaud Jacques, Seroussi Brigitte
Nursing Administration, Lebanese Hospital Geitaoui-UMC, Beirut, Lebanon.
Sorbonne Université, Université Sorbonne Paris Nord, INSERM, LIMICS, Paris, F-75006, France.
BMC Nurs. 2025 Jul 1;24(1):677. doi: 10.1186/s12912-025-03272-w.
The implementation of the Nursing process (NP) is a complex and cognitively demanding task that can be enhanced by using clinical decision support systems (CDSSs). While some CDSSs assist in the management of patients with specific patient conditions, nursing process clinical decision support systems (NP-CDSSs) are designed to support nursing decisions through all five sequential NP steps: assessment, nursing diagnosis (NDs), planning, intervention, and evaluation. Although an internationally agreed standard for NP-CDSS development (ICS4NP-CDSSs) was published in 2016, outlining recommended design and functional features for NP-CDSSs, current NP-CDSSs show limited compliance with these guidelines.
A PubMed search was conducted to identify NP-CDSSs used in hospital settings and published between January 2013 and February 2024. The objective was to assess how well these systems adhered to ICS4NP-CDSSs including coverage of all NP steps, use of standardized nursing languages (SNLs), and compliance with recommended technical features. The search also examined whether NP-CDSSs had been implemented and evaluated and whether any outcome related to system impact or any nurses' feedback on barriers and facilitators influencing NP-CDSS implementation was documented.
Of the 986 papers retrieved, 35 related to 21 systems met the eligibility criteria. Only seven systems addressed all NP steps, with the evaluation step remaining underdeveloped. Seventeen systems provided NDs based on entered characteristics or risk factors, 15 included automatic linkages between NDs and interventions, but only 10 included linkages to outcomes at the evaluation step. Most retrieved systems used NANDA-I/NANDA, NIC, NOC as SNL. Only four systems reached the post-implementation evaluation phase; none reported patient outcomes analysis, while four collected nursing outcomes. Barriers during implementation included a lack of trust and perceived usefulness to improve daily workflows, limited validation, and missing technical features.
NP-CDSS development is still in its infancy. This review identifies a gap between ICS4NP-CDSS best-practice recommendations and their implementation in current NP-CDSSs, which still lack features like full coverage of NP steps and necessary linkages between them. To enhance NP-CDSSs, strategies should focus on reducing documentation burden, providing comprehensive education and support for nurses, and demonstrating the impact of NP-CDSSs through outcome studies.
护理程序（NP）的实施是一项复杂且对认知要求较高的任务，使用临床决策支持系统（CDSS）可对其进行强化。虽然一些CDSS有助于管理患有特定病症的患者，但护理程序临床决策支持系统（NP - CDSS）旨在通过NP的所有五个连续步骤来支持护理决策：评估、护理诊断（NDs）、计划、干预和评价。尽管2016年发布了一项NP - CDSS开发的国际商定标准（ICS4NP - CDSSs），概述了NP - CDSS的推荐设计和功能特性，但目前的NP - CDSS对这些指南的遵循程度有限。
在PubMed上进行检索，以识别2013年1月至2024年2月期间在医院环境中使用并发表的NP - CDSS。目的是评估这些系统对ICS4NP - CDSSs的遵循程度，包括对所有NP步骤的覆盖、标准化护理语言（SNL）的使用以及对推荐技术特性的遵循情况。该检索还检查了NP - CDSS是否已实施和评估，以及是否记录了与系统影响相关的任何结果或护士对影响NP - CDSS实施的障碍和促进因素的任何反馈。
在检索到的986篇论文中，35篇与21个系统相关，符合纳入标准。只有7个系统涵盖了所有NP步骤，评价步骤仍未充分发展。17个系统根据输入的特征或风险因素提供护理诊断，15个系统包括护理诊断与干预之间的自动链接，但只有10个系统在评价步骤中包括与结果的链接。大多数检索到的系统使用NANDA - I/NANDA、NIC、NOC作为标准化护理语言。只有4个系统进入了实施后评价阶段；没有一个报告患者结果分析，而有4个收集了护理结果。实施过程中的障碍包括缺乏信任以及认为对改善日常工作流程无用性、验证有限和缺少技术特性。
NP - CDSS的开发仍处于起步阶段。本综述确定了ICS4NP - CDSS最佳实践建议与其在当前NP - CDSS中的实施之间的差距，当前NP - CDSS仍缺乏如NP步骤的全面覆盖以及它们之间必要链接等功能。为了改进NP - CDSS，策略应侧重于减轻文档负担、为护士提供全面的教育和支持，并通过结果研究证明NP - CDSS的影响。
