A randomized evaluation of a computer-based nursing documentation system. Evaluation of a home based health record booklet. Development and testing of a pediatric pain management sheet. Written and computerized care plans. Organizational processes and effect on patient outcomes. The Newbury Maternity Care Study: a randomized controlled trial to assess a policy of women holding their own obstetric records. Intensive care information system reduces documentation time of the nurses after cardiothoracic surgery.
A two-month randomized, controlled trial based on 60 patients has been performed on a ward of the Department of Psychiatry at Heidelberg University Medical Center, Germany, to investigate the influence of computer-based nursing documentation on time investment for documentation, quality of documentation and user acceptance. Time measurements, questionnaires, documentation analysis and interviews were used to compare patients documented with the computer-based system (PIK group) with the control group (patients documented with the paper-based system). The results showed the advantages and disadvantages of computer-based nursing documentation. Time needed for nursing care planning was lower in the PIK group. Some formal aspects of quality were considerably better in the PIK group. On the other hand, time required for documentation of tasks and for report writing was greater in the PIK group. User acceptance increased significantly during the study. The interviews indicated a positive influence of PIK on the cooperation between nurses and physicians. Despite the widespread use of home based child health records of varying complexity in England, there is a notable absence of their evaluation. Such a record booklet developed in the West Lambeth Health Authority has been used by parents, doctors, and community nurses to build up an independent chronological record of a child's birth statistics, health, growth, immunisation, development checks, and contacts with health services. A randomised controlled evaluation of the record, analyses of entries in it, and a survey of the views of mothers and health professionals using the record have been carried out. The need for such a record was confirmed by those questioned and analyses of entries in the booklet helped to modify and improve it. The evaluation was unable to show, however, any effect of the record on immunisation and developmental assessment service uptake. Its value in improving communication between the numerous health and other care agencies was dependent on its proper use. A pediatric pain flow sheet was developed to provide health professionals with a simple means of documenting the child's pain experience. This instrument was pretested and used in a research study to ascertain whether its use would make any difference to the child's postoperative pain intensity and management. Results indicated that nurses who implemented the flow sheet had patients who were in less pain, were assessed more frequently and received more narcotic analgesics. The purpose of this study was to determine how use of a standardized nomenclature for nursing diagnosis and intervention statements on the computerized nursing care plan in a long-term care (LTC) facility would affect patient outcomes, as well as organizational processes and outcomes. An experimental design was used to compare the effects of two methods of documentation: Computer care plan and paper care plan. Twenty participants (10 in each group) were randomly assigned to either group. No statistically significant differences were found by group for demographic data. Repeated measures ANOVA was computed for each of the study variables with type of care plan, written or computerized, as the independent variable. There were no statistically significant differences between participants, group (care plan), within subjects (across time), or interaction (group and time) effects for the dependent variables: Level of care, activities of daily living, perception of pain, cognitive abilities, number of medications, number of bowel medications, number of constipation episodes, weight, percent of meals eaten, and incidence of alteration in skin integrity. There were significantly more nursing interventions and activities on the computerized care plan, although this care plan took longer to develop at each of the three time periods. Results from this study suggest that use of a computerized plan of care increases the number of documented nursing activities and interventions, but further research is warranted to determine if this potential advantage can be translated into improved patient and organizational outcomes in the long-term care setting. To assess a policy of women holding and thus having constant access to their own obstetric records, 290 women attending a peripheral consultant clinic in Newbury, West Berkshire, were randomly allocated to hold either their full case notes, or the more usual co-operation card. Women holding their full records were significantly more likely to feel in control of their antenatal care (rate ratio 1.45; 95% confidence interval 1.08-1.95) and to feel it was easier to talk to doctors and midwives (rate ratio 1.73; 95% confidence interval 1.16-2.59). No other beneficial effects were detected. Asked about their preferences for any subsequent pregnancies, women holding their own records in the index pregnancy were more likely to say they would prefer to hold the same kind of record again in a subsequent pregnancy than were women holding a co-operation card (rate ratio 1.56; 95% confidence interval 1.34-1.81). There was no evidence of negative effects. In particular, women holding their case notes did not feel more anxious than co-operation card holders. The policy of women holding their notes resulted in savings in clerical time, without evidence of an increase in the rate of lost notes. Nowadays, registration of patient data on paper is gradually being replaced by registration using an intensive care information system (ICIS). The aim of this study was to evaluate the effect of the use of an ICIS on nursing activity.
                Randomized controlled trial with a crossover design.
                An 18-bed medical-surgical ICU in a teaching hospital. PATIENTS, NURSES AND INTERVENTIONS: During a 6week period 145 consecutive adult patients admitted to the ICU after uncomplicated cardiothoracic surgery were randomized into two groups: for one group the documentation was carried out using a paper-based registration (Paper), in the second group an ICIS was used for documentation.
                The nursing activities for these patients were studied during two separate periods: the admission period and the registration phase (the period directly following the admission procedure). The duration of the admission procedure was measured by time-motion analysis and the nursing activities in the registration phase were studied by work sampling methodology. All nursing activities during the registration phase were grouped in four main categories: patient care, documentation, unit-related and personal time. The duration of the admission procedure was longer in the ICIS group (18.1+/-4.1 versus 16.8+/-3.1 min, p<0.05). In the registration phase, a 30% reduction in documentation time (Paper 20.5% of total nursing time versus ICIS 14.4%, p<0.001), corresponding to 29 min (per 8h nursing shift) was achieved. This time was completely re-allocated to patient care.
                The use of the present ICIS in patients after cardiothoracic surgery alters nursing activity; it reduces the time for documentation and increases the time devoted to patient care. Electronic supplementary material: is available if you access this article at http://dx.org/10.1007/s00134-002-1542-9. On that page (frame on the left side), a link takes you directly to the supplementary material.
We found some limited evidence of effects on practice attributable to changes in record systems. It is clear from the literature that it is possible to set up the randomised trials or other quasi-experimental designs needed to produce evidence for practice. Qualitative nursing research to explore the relationship between practice and information use could be used as a precursor to the design and testing of nursing information systems.