The impression I received by reading the materials is that nursing has a very long way to go in order to come up with a comprehensive mechanism/tool for decision support. Data quality has so many components to it, and the complexity of defining nursing activities, decisions, and how these interact or compete is quite complicated. Looking at how nurses define things compared to others in the medical profession is very problematic. I have always felt that we complicate things for some fundamentally political reasons. Nursing diagnosis is just one such area that confounds the problem. Sometimes I wanted to scream when I would write out... "alteration in cardiac output related to ...blah, blah, blah....ITS A MYOCARDIAL INFARCTION !, the docs know it, the lab knows it, and the EKG tech knows it...but we can't call it that. If we keep trying to separate ourselves this way- it will only make the utility of anything we come up with too esoteric for anyone else to use. (gee, I hope the love of nursing diagnoses isn't one of the professors doctoral dissertations....I guess I should have googled more on our teachers). Defining exactly what we do and how it relates to patient outcomes is going to be difficult. Some areas are more obvious than others. The quality and types of data we use in our DSS really has to have some other purposes despite the obvious (or legal) ones we are already used to.
I was dissappointed to see that nurses really don't access data to support their decisions proactively, rather they tend to "look things up" later- after the consequences are likely beyond repair. Because of this fact, and the realities of (bedside) nursing- we need good DSS now more than ever. We need more studies of nursing outcomes to evaluate the impact of what we do so we can tailor tools to be sure we do the things that create the best scenario for our patients. Athough the readings brought up most of these concerns, I left with the feeling that it will be a long time before we have all the pieces put together. It also made me feel bad for informaticists in nursing- uphill battle ahead!
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2 comments:
I too have a hard time with nursing diagnosis. I propose a support system that links the medical diagnosis with nursing tasks and skills. Hence you would be connected to evidence-based practice with nursing reminders, tasks, and real-time patient needs. Great write up you made me smile.
Judi
Lynn,
Your blog entry is pretty funny - I needed to laugh tonight!! When I worked as a nurse manager I thought one of the most useless things I had to do was harass the nurses into writing care plans! I agree that it is disappointing that nursing has been so slow to accept EBP. We are not necessarily unique in this lag, however. I have seen my physician colleagues facing some of the same battles. I have found that I am cautious when MDs begin lecturing on "the evidence". If the information is critical to know I usually look it up myself. In many ways "evidence" has become a buzzword that is used pretty lightly.
Marilyn
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