Commentary on Darbyshire P (2004) 'rage against the machine?: nurses' and midwives' experiences of using computerized patient information systems for clinical information. Journal of Clinical Nursing 13, 17-25.

摘要

Computerized patient information systems (CPIS) applications propose improvements for a multitude of process challenges within healthcare systems such as charge capture, efficient procedure scheduling, staff scheduling, interdisciplinary communication and care planning, safe medication administration and measurement of clinical outcomes. Many of these processes depend upon system acceptance and use by the direct caregiver to function optimally.Despite initial, optimistic attitudes, many nurses become disenchanted by difficulties and inefficiencies with the informatics tools that are intended to be used in their daily work. Dissatisfaction with CPIS has been associated with underused, unintended use and even sabotage of CPIS projects (McManus 2000, Lising & Kennedy 2005, McLane 2005). The gap between the theory of endless possibilities of CPIS and the frustrations expressed by bedside clinicians illustrates the need for better understanding of the experiences of end users of CPIS.Darbyshire's study was to gain a deeper understanding of nurses' and midwives, experiences with using CPIS. This study explored nurses' and midwives, meanings, perceptions, and understandings concerning CPIS. It also investigated clinicians, perspectives of the impact of CPIS on patient care, clinical practice and outcomes (Darbyshire 2004). Two themes emerged from the focus groups', interviews involving 53 nurses and midwives from a wide variety of settings. The first is CPIS as beneficial and valuable. The second is CPIS as irrelevant, useless or sinister. This dichotomy of nurses' and midwives' perception might be attributable to the dichotomy of their CPIS environment. Darbyshire noted the participantsreporting positive experiences of CPIS tended to. work with fully integrated 'state of the art, systems, accessible and used by all staff in a paperless environment. The opposite end of the spectrum of CPIS environments is described by nurses working in wards with one computer for all staff. Disparities and frustrations abounded in hardware and software functionality and access in the study participants' CPIS. The significance of the disparities was not included in the discussion of the study. Frustrations regarding hardware functionality and access can be fundamental to dissatisfaction with CPIS projects. Software capabilities were another source of dissatisfaction likely to be very different between the participants perceiving the CPIS as 'beneficial and valuable' and the participants perceiving the CPIS as 'irrelevant, useless or sinister'. A CPIS incapable of capturing the full essence of nursing care, including emotional and psychosocial aspects of nursing versus one that does not incorporate the communication of these important aspects of nursing care will be perceived very differently.