Comments on: Give Some Love to Nurses Who Don’t Love Computers: Why Nerd-Designed Clinical Systems Are Underused

By: ITNurse

ITNurse — Tue, 22 Apr 2008 21:32:51 +0000

As a practicing RN, who stopped working on an MSN degree to complete a second major in computer science – I thouroughly enjoyed the original article and everyone’s responses. The computer science world includes analyzing, assessing, planning and implementation – just like nursing process. However I have learned that my mind does not behave like my development engineering colleagues – I have had to learn from them the skill of thinking in a more linear fashion – not an easy task. I have also, however ,waited over 25 years for IT to finally be addressing technology that supports care delivery and not registration and billing. Development and use of technology by nurses requires a fine line between pushing nurses to think in a different manner(needed as we are very good at normalizing workarounds!) while providing them tools that can dramatically impact the cost, quality and delivery of healthcare whilte preserving their desire to take care of the patient.

By: An Experience Designer

An Experience Designer — Tue, 15 Apr 2008 20:23:00 +0000

I am the Director of User Experience Design for a major HCIT vendor. This is a new role in a company who traditionally developed products as the author indicates: by engineers with clinician oversight. Today we bring Ethnographers, Interaction Designers and Industrial Designers to the table and put the end user at the very center of our process. As expected, our return on usability is in the hundreds of percent vs. the previous process, and clinicians love us for it.

Unfortunately it’s too easy for developers to “train and blame” clinicians. But designers look at the situation differently: the nurse is never wrong. We leverage “constraint-based design” to design-out error, eliminate the need for training, and reduce the gulf that exists between human behavior and system behavior. The proof is quantifiable both in the usability lab and in our bottom-line.

For those interested in learning more about this User-Centered approach, I highly recommend reading Alan Cooper’s excellent book “The Inmates are Running the Asylum.”

By: Too Much Junk

Too Much Junk — Fri, 11 Apr 2008 02:53:39 +0000

I don’t think IT is to blame for many of the troubles with nursing documentation. The regulated environment that we live in plays a large part. It’s hard to fit the hundreds of completely useless pieces of information that a nurse is required to document into a concise area. And how did they figure it out on paper? They didn’t, they wrote it wherever it fit. It may be easy to document, it’s impossible to read afterwards.

On a related note: unfortunately, one of the things I’ve found is that nurses are real good at documenting the things I as a patient don’t think are too valuable (ie I got a granola bar at 5 o’clock and Aunt Sally came to visit at 9) and real good at ignoring some of the safety measures a system brings. If there’s one thing I want my nurse doing, it’s not educating a person with emphysema about the dangers of smoking or educating an obese person about healthy diets, I want them being diligent about things like barcoding meds. It kills me everytime I see a nurse skip the barcoding or give a half glance at an insulin dual signoff. In an ideal world, nurses could skip documenting the junk and I’d promise not to sue them because they didn’t give me the Jell-O I asked for.

By: The Alchemist

The Alchemist — Thu, 10 Apr 2008 19:51:28 +0000

PTSD: You got me. I am a Hugo C Pribor follower since the 70’s. http://www.diagnosispro.com/authors/ We “Jesuit”" trained docs must stick together.

By: PTSD

PTSD — Thu, 10 Apr 2008 15:35:14 +0000

Kudos to Been There, Done Both. I have never heard of an IT person becoming a clinician. It is always formal healthcare training, clinical practice, and pick up IT along the way and/or go to school for IT. Churton hits it dead on. We need more clinicians to come to the IT side, and be mentored. Clinicians do have a hard time focusing on one line of thought because we are trying to do ten things at once. If you ask a nurse when she has an IV bag run dry, it is when she only has one patient with an IV. I dare say we need to have a barrage of information to function. That’s why we became nurses!

Alchemist, care delivery is an art. It should be a best practice driven, defined, and measured art, but it is an art. The variables you describe are discrete data forms. That is only the tip of what we do. Documentation needs to be done and preferably in a way that you can mine the data for information to make decisions, or at least spot and analyze trends. THAT is where today’s clinical systems fail. How does what we document impact what happens to the patient? Is it enough to document what we do (interventions) or is what happens as a result of what we do (outcomes) more important? If someone creates a clinical system that is relevant to the patient improving in every clinical area (even with hospice, there are measurables, just different goals or outcomes desired) then you would have complete clinician buy in… Wouldn’t you?