Nursing Information Systems Survey

Nursing Information Systems Survey Study of Nursing Information Systems (NIS) in teaching hospital of Zahedan University of Medical Sciences Leila Erfannial Msc1,Yousef Mehdipour PhD 1,Afsaneh Karimi Msc 1,Ayeshe Zarei Bs 1,Nahid Mehrabi Msc 2 ABSTRACT Purpose: Nurses are one of the biggest providers in health industry that effect directly on health service quality and outcomes. Nurses need correct information in correct time to have an effective service for patient and other member of health society. Nursing information system (NIS) is subsystem of hospital information system that can help nurse to have better performances. The main goal of this study is evaluation of nursing information system in teaching hospital of Zahedan according standard criteria. Materials and Methods: This research is based on a descriptive – cross sectional study that has done on 2013.Nursing information system of 4 teaching hospital in Zahedan were evaluated. For data gathering, we use a checklist that its reliability and validity was verified. Results: According our result, NIS of our study has met 42.19% of priority in general scopes, 72.33% for nursing data set, none of them had classification system standards. They had 45% of nursing data register priorities and 61.12% of report requirement was met. Conclusion: According our system weakness in general aspects, data register and data classification, we propose educational package such as workshops, classes and bulletin for nurses in hospitals toward optimal using of NIS. In other hand , provide nurses with enough hardware requirements , management supervision on using system , provide NIS systems by nursing classification standards and contribution of nurses in selection and implementation of this system is suggested. Keywords: nursing information system; hospital information system; nurse INTRODUCTION There is an increasing growth in information production in different sciences and theqnics, so the management of these volumes of information is very difficult. Information technology is a useful tool for management and useful application of this information. Health industry has faced with increasing rate of information generation that are multiple and complicated in nature1. So health information technology can help this high-demanded industry to manage information. Health information systems are some kinds of tools that integrate and communicate patient data and information and also can process the data and make some new information2. Nurses are one of the biggest providers in health industry that effect directly on health service quality and outcomes. Nurses need correct information in correct time to have an effective service for patient and other member of health society3. Nursing information system (NIS) are subsystem of hospital information system that can help nurse to have better performances, more nursing knowledge and make available data and information for nurses to have a role in health policy making and also decision making around health society and patients4. Furthermore, NIS can participate in hospital information process so lead to a better communication between health care team in hospital 5 . Margaretconclude that using NIS in hospital has a positive effect on information quality that provide by nurses6 .Ammenwerth state that NIS lead to better and more complete documentation of patient information and also better quality of information process5 .Toolabi in her study conclude that optimization of hospital information system would lead to a significant progress in nursing care average and better communication between nurses , patient and health care team and consequently patient more truth to health system ,health services and nurses, more patient family satisfaction and at the end , decrease patient claims7. Zahedan, the capital city of a province in southeast of Iran uses hospital information system in teaching hospital. Nursing information system is one this system module that use in these hospitals. So the basic objective of this study is to evaluate Nursing information system according standard indexes in four sections: general specification of systems, nursing data set , nursing nomenclature and classification specification , documentation registration and reporting specification of systems. MATERIALS AND METHODS This research is based on a descriptive – cross sectional study that has done on 2013.nursing information system of 4 teaching hospital in Zahedan were evaluated. For data gathering, we use a checklist that its reliability and validity was verified. Checklist has 5 section at whole: section 1 has some questions about the system, vendor and some general information about NIS module, section 2 was about general specification of nursing information system. The questions has two answers yes or no.this section involve 23 question about patient care process,11 about ward management process, 10 about communication process and 1 question research and education process.in section 3 , we have some questions about nursing data set that involve 5 question about nursing care data specification, 15 about patient data specification and 14 about service providing data specifications. Section 4 has some question about nursing nomenclature and classification data specification with 25 questions and in section 5 nursing data, registration and reporting requirements were evaluated by 6 questions about personnelreport, 14 questions about clinical report and 3 about financial report. The researchers attended in hospitals and by deep interviewing and also direct observation of systems, gather information and register in checklists. Supervisor of hospital, health information technologist and some professional nurse who uses NIS and familiar with the potential of system was interviewed; furthermore, during interview the researchers can observe the NIS and its functions. After gathering information, we use descriptive statistics to analysis our data by using Excel 2010 tables. RESULTS According our study, general specification of our NIS was evaluated in 5 aspects and 4 hospitals.(table 1) At whole, the frequency of patient care process data specification was 44/56%, ward management data specification was 31.81%, communication process data specification 47.5% and education and research data specification was 50% in our society research. Nursing data set was evaluated in 4 aspects in 4 hospitals: nursing care data set , patient data set, service data set (table 2) According our study , nursing care data set specification was 40% , patient data set specification was 71.66% and service data set specification was 84%. None of our NIS , has nursing classification standards specification data. Data registration and reporting specification data was evaluated in 4 aspects.(table 3) DISCUSSION Information technology making a great service for nurses to perform their tasks8. According our result, by using NIS in all hospital, nurses can receive patient demographic data from admission,discharge,and transmission (ADT) system of hospitals and also can register of different request such as laboratory tests, radiology and pharmacy services. And also they can observe laboratory and radiology results. But none of NIS support nursing evidence based and alert variances from normal patterns. According Ammenwerthstudy, after using information systems, nurses report more quickly patient data documentation, better information monitoring and progress in patient information legibility5. Kossman state that electronic health record implementation in hospital lead to decrease inter-department communication and promote critical thinking between nurses9. Making electronic communication between different parts of hospital is one of the most important capabilities of hospital information systems. According our study, by using nursing information system, in all hospital, nurses can schedule the admission of patients in their wards. Nurses in hospitals can access to information in every place of hospital. In hospital Cand D , nurses can transmit all information by NIS when changing their shifts. According Hinsonstudy , using NIS would lead to the time increasethat nurses spend on patient direct care (10.66%) ,verbal communication 19.33% decrease and mean time for reviewing data 8.9% increase10. Standard NIS needs nursing concepts standards and nursing data standards3. Without unified nursing language , internal data integration and external connection of information would disappear when information are shared and also there would be some problem for clinical decision support.in other hand , nursing information are unstructured generally , so if we don’t use a standard unified language , the retrieval of information would be difficult11. Result of our study show that, none of NIS in Zahedan hospital use standard nursing classification. This issue is very similar to Ahmadi research, they suggest standard nursing classification system for standardization of nursing data and concept to facilities retrieval of information that register in nursing information system12. All NIS in our study, register patient demographic data , nursing diagnostic data and data about service provided by nurses can record ECG data.in hospital C and D , patient vital signs and input-output liquid balance data , can enter to the terminal near patient bed. Anderson state that a standard nursing data set should involve nursing diagnostic data , nursing intervention , nursing outcome and intensity of nursing services and declare , by using such standard data set , management of nursing service cost , supporting of resources that allocated to the nurses , nursing knowledge developed and at the end nursing nursing profession would be promoted13. Making different reports is one of basic management capability of nursing information system that can provide valuable information about personnel productivity, budget management and nursing workload management in different shifts14. In hospital A,B and D , NIS making schedule for personnelshifts. All NIS , can make clinical reports such as laboratory and pathology report and reports about admitted or discharged patients. In Ahmadi study, reporting specification data was met 20.4%,63.5% and 85.2% in personnel , clinical and financial reports4. CONCLUSION Nurses have a great role in health care systems so documentation of their services would be very easy by using nursing information system.so if we want to implement an effective NIS , at first , we should implement a powerful HIS as an infrastructure for any hospital ward subsystem. Nurses are the biggest group of NIS users , so nurses computer literature promotion , has an important role in success and acceptance of NIS. So educational workshop and classes for nurses in hospital would be helpful to make better utilization of nursing information system also increasing inter-hospital communication between nurses and health information technologist would have a helpful tool for transmitting professional knowledge between these groups. Using nurse’s knowledge and skills in all phase electronic system development and implementation and courage electronic health systems developer to use this knowledge in their production is an essential item for successfulness of NIS and systems li ke that. Since we don’t have any national nursing standard classification and nomenclature , prepare , provide an standard unified system according national requirements is another important factor for implementation and usage of NIS and at whole , establishment some professional workshop that has different different profession such as nursing , health information technology , policy making and so on , to start and monitored special effort about nursing information system requirement , development and implementation is very important. ACKNOWLEDGEMENTS The authors are grateful to nurses and health information technologist of educational hospital affiliated to Zahedan University of medical sciences who kindly participated in this study. 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Table1.frequency percentage of NIS general data specification in different hospital D C B A 17/52% 95/86% 73/21% 39/17% Patient care process 63/63% 36/36% 09/9% 18/18% Ward management process 50% 90% 30% 20% Communication process 100% 100% 0 0 Education and research process Table2.frequency percentage of nursing data set in different hospital. D C B A 60% 100% 0 0 Nursing care data set 60% 33/93% 60% 33/73% Patient data set 85/92% 57/78% 57/78% 71/85% Provided services data set Table3.frequency percentage of reporting data specification in different hospital. D C B A 33/33% 0 100% 33/83% Personnel report 71/85% 28/64% 28/64% 71/35% Clinical report 0 100% 100% 0 Financial report