Usability evaluation: results from "Evaluation of mobile information technology to improve nurses' access to and use of research evidence".

Usability evaluations are necessary to determine the feasibility of nurses' interactions with computerized clinical decision-support systems. Limitations and challenges of operations that inhibit or facilitate utilization in clinical practice can be identified. This study provided nurses with mobile information terminals, PDAs and tablet PCs, to improve point-of-care access to information. The purpose of this study was to determine usability issues associated with point-of-care technology. Eleven nurses were self-selected. Nurses were videotaped and audiotaped completing four tasks, including setting up the device and three resource search exercises. A research team member completed a usability checklist. Completion times for each task, success rate, and challenges experienced were documented. Four participants completed all tasks, with an average time of 3 minutes 22 seconds. Three participants were unable to complete any of the three tasks. Navigating within resources caused the greatest occurrence of deviations with 39 issues among all participants. Results of the usability evaluation suggest that nurses require a device that (1) is manageable to navigate and (2) utilizes a user-friendly interface, such as a one-time log-in system. Usability testing can be helpful to organizations as they document issues to be cognizant of during the implementation process, increasing the potential for successful implementation and sustained usability.

Supportive decision making at the point of care: refinement of a case-based reasoning application for use in nursing practice.

Variations in nursing care have been observed, affecting patient outcomes and quality of care. Case-based reasoners that benchmark for patient indicators can reduce variation through decision support. This study evaluated and validated a case-based reasoning application to establish benchmarks for nursing-sensitive patient outcomes of pain, fatigue, and toilet use, using patient characteristic variables for generating similar cases. Three graduate nursing students participated. Each ranked 25 patient cases using demographics of age, sex, diagnosis, and comorbidities against 10 patients from a database. Participant judgments of case similarity were compared with the case-based reasoning system. Feature weights for each indicator were adjusted to make the case-based reasoning system's similarity ranking correspond more closely to participant judgment. Small differences were noted between initial weights and weights generated from participants. For example, initial weight for comorbidities was 0.35, whereas weights generated by participants for pain, fatigue, and toilet use were 0.49, 0.42, and 0.48, respectively. For the same outcomes, the initial weight for sex was 0.15, but weights generated by the participants were 0.025, 0.002, and 0.000, respectively. Refinement of the case-based reasoning tool established valid benchmarks for patient outcomes in relation to participants and assisted in point-of-care decision making.

Supporting evidence-based practice for nurses through information technologies.

PURPOSE: To evaluate the usability of mobile information terminals, such as personal digital assistants (PDAs) or Tablet personal computers, to improve access to information resources for nurses and to explore the relationship between PDA or Tablet-supported information resources and outcomes. BACKGROUND: The authors evaluated an initiative of the Nursing Secretariat, Ontario Ministry of Health and Long-Term Care, which provided nurses with PDAs and Tablet PCs, to enable Internet access to information resources. Nurses had access to drug and medical reference information, best practice guidelines (BPGs), and to abstracts of recent research studies. METHOD: The authors took place over a 12-month period. Diffusion of Innovation theory and the Promoting Action on Research Implementation in Health Services (PARIHS) model guided the selection of variables for study. A longitudinal design involving questionnaires was used to evaluate the impact of the mobile technologies on barriers to research utilization, perceived quality of care, and on nurses' job satisfaction. The setting was 29 acute care, long-term care, home care, and correctional organizations in Ontario, Canada. The sample consisted of 488 frontline-nurses. RESULTS: Nurses most frequently consulted drug and medical reference information, Google, and Nursing PLUS. Overall, nurses were most satisfied with the Registered Nurses Association of Ontario (RNAO) BPGs and rated the RNAO BPGs as the easiest resource to use. Among the PDA and Tablet users, there was a significant improvement in research awareness/values, and in communication of research. There was also, for the PDA users only, a significant improvement over time in perceived quality of care and job satisfaction, but primarily in long-term care settings. IMPLICATIONS: It is feasible to provide nurses with access to evidence-based practice resources via mobile information technologies to reduce the barriers to research utilization.

What nurses want: diffusion of an innovation.

We investigated the usability of personal digital assistants (PDAs) to improve research utilization and timely access to electronic practice information to assist in clinical decisions. Nurses used a decision support tool on a PDA to collect point-of-care outcomes data. Follow-up interviews documented usability. Nurses liked the portability and size of the PDA, as well as ease of use of the PDA software. Electronic decision support tools at point of care have the potential to improve nurses' research utilization and quality of care.