Can Decision Support Improve Nurses'Use of Knowledge?

Nursing, University of Alberta, Edmonton, Canada. Kimberly D. Fraser, MA, RN, Doctoral Student at the Faculty of Nursing, University of Alberta, Edmonton, Canada. Her work is supported by the Centre for Knowledge Transfer, University of Alberta, Edmonton, Canada. Lena Gunningberg, PhD, RN, Assistant Professor, Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, and Leader of Nursing Research & Development, Surgical Centre, University Hospital, Uppsala, Sweden. Corresponding author: Anna Ehrenberg, PhD, RN, Faculty of Nursing, Clinical Sciences Building, University of Alberta, Edmonton, Alberta T6G 2G3, Canada (e-mail: anna.ehrenberg @ualberta.ca). There continues to be a gap between what we know and what we do, despite the development of advanced technology for diagnosis and treatment and increasingly well-educated professionals. Studies in North America and Europe suggest that 30%-40% of patients do not receive care according to current scientific research. One example of this gap is the treatment of pressure ulcers, which continues to present a major problem in nursing care, causing avoidable patient suffering, extended hospitalizations, and unnecessary healthcare expenditures. Currently, 26% of inpatients in Alberta, Canada, are reported to have pressure ulcers. Research in this area suggests that a 50% reduction in pressure ulcers is possible with adequate assessment and preventive measures. The purpose of this fourth paper in the series on knowledge utilization is to discuss the usefulness of decision support in nursing care as an additional way of facilitating knowledge use. Previous articles have discussed the role of context and intermediaries in enhancing nurses’ use of research in their clinical practice. Clinical decisions are characterized by significant uncertainty in today’s complex healthcare environments. Appropriate supports for clinician judgment and decision making are not yet well developed. Compared to other services in modern societies, for example, aviation, this is a striking deficiency. Scientific knowledge is growing exponentially, and the knowledge base, even in a specialized nursing field, is already too vast for a single nurse to manage. Clinical practice guidelines aid decision making as they provide condensed and structured information that can assist clinicians in using evidence-based knowledge to improve care. Guidelines integrated with decision-support systems are even more effective. We no longer believe that lack of adherence to current knowledge and errors in healthcare result from individual recklessness. Rather, we believe the cause is primarily faulty systems, processes, and conditions, resulting in the implementation of outdated routines. This contributes to mistakes, especially in judgments about diagnostic procedures and treatment decisions. Clinical decision making in today’s high-velocity healthcare environment is complex and demanding. An observational study in acute care reported that a given staff nurse faces 1 decision task every 10 minutes during a 3-hour period. The computerized patient record (CPR) opens new possibilities for integrating knowledge and decision support so that they are readily available to clinicians when needed.We have the potential to facilitate communication and improve the accessibility of data with emerging new technologies and increasing demand for evidence-based care decision support tools, such as the CPR. The CPR has the potential for improved accuracy of personal health information that would further lead to system efficiencies and the provision of aggregate data that can be used in health research and health surveillance. These aggregated data are often used in the construction of decision support tools and in the calculation of probabilities that are useful in specific clinical decision-making episodes between a patient and his or her clinician. SPOTLIGHT ON RESEARCH