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UBC Theses and Dissertations

Evaluation of an automated on-line bedside nurse documentation system Robinson, Carol J.


In recent years there has been an increased emphasis on source data capture, point-of-care systems or bedside computing in the health care industry. Many of those involved in health care have speculated that bedside computing could contribute to efficient, cost effective health care delivery. The purpose of this quasi-experimental study was to evaluate the effect of a bedside automated online nurse documentation system using a methodology designed to overcome some of the difficulties of previous studies. The first of four objectives was to determine the effect of the automated system on nurse productivity. The second objective was to determine the effect of the system on some nursing behaviours that have been predictors of quality of care. The third objective of the study was to evaluate nurse satisfaction with on-line bedside computing. Evaluation of the acceptance of the bedside computer by the patients and their satisfaction with their care was the final objective. The automated bedside-based nurse documentation system was implemented on a twenty-two bed Plastic Surgery unit in a quaternary care teaching hospital. The automated nurse documentation system was developed by the hospital over a three year period (1986-1989). Four bedside computers were placed in a four bed experimental room; a second four bed room was used as the control room. Two terminals with access to the bedside-based system were located at the nursing station. Sixteen full time registered nurses participated in the study. The nurses used the automated bedside system when documenting care for patients in the experimental room and the manual, nursing station based, paper system to document care for patients in the control room. Questionnaires and observations were used to collect data over the four months of the study (June through September, 1990). The results showed no increase in nurse productivity. The quality of care results showed more immediate documentation of the nurses' observations and interventions and more time spent viewing patient data in the experimental state. There was no significant difference between the control and experimental state in the nurses' reported ability to provide individualized care. The nurses expressed a general level of dissatisfaction with the on-line bedside-based system and a general dissatisfaction with documenting at the patient bedside. The nurses found the manual system to be significantly more convenient than the automated system. In addition, the nurses found the presentation of patient data to be significantly better in the manual system. There was no significant difference between the reported satisfaction of patients with their care and their feelings and attitudes about the use of computers by nurses and in health care in the control and experimental rooms. The results of the study lead the investigator to explore implications for implementation of bedside computing for nurses.

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