Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
Miranda LN, Farias IP, Almeida TG et al. Sistema de tomada de decisão para enfermagem...
English/Portuguese
J Nurs UFPE on line., Recife, 11(Suppl. 10):4263-72, Oct., 2017 4263
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.10712-95194-3-SM.1110sup201732
DECISION-MAKING SYSTEM FOR NURSING: INTEGRATIVE REVIEW SISTEMA DE TOMADA DE DECISÃO PARA ENFERMAGEM: REVISÃO INTEGRATIVA
SISTEMA DE TOMA DE DECISIÓN PARA ENFERMERÍA: REVISIÓN INTEGRATIVA Lays Nogueira Miranda1, Isadora Pereira Farias2, Thayse Gomes Almeida3, Ruth França Cizino da Trindade4,
Daniel Antunes Freitas5, Eveline Lucena Vasconcelos6
ABSTRACT
Objective: to analyze specifications of similar systems in order to find out what requirements must contain software for Nursing care. Method: integrative review, through search of articles in full, in the databases MEDLINE, LILACS, Science Direct and SCIELO virtual library. The research was conducted in September / 2016, with a temporal cut from January / 2005 to August / 2016, using controlled descriptors contemplated in DeCS. Results: Brazil is the country that most published on the subject. Conclusion: integrative review is efficient in searching for specifications for a clinical decision support system. Descriptors: Decision Support Systems, Management; Nursing; Criticalcare; Review.
RESUMO
Objetivo: analisar as especificações de sistemas similares no intuito de descobrir que requisitos deve conter um software para a assistência de Enfermagem. Método: revisão integrativa, por meio de busca de artigos na íntegra, nas bases de dados MEDLINE, LILACS, Science Direct e biblioteca virtual SCIELO. A pesquisa foi realizada em setembro/2016, com recorte temporal de janeiro/2005 a agosto/2016, utilizando descritores controlados contemplados no DeCS. Resultados: o Brasil é o país que mais publicou sobre o tema. Conclusão: a revisão integrativa é eficiente na busca de especificações para um sistema de apoio a decisões clínicas. Descritores: Sistemas de Apoio a Decisões Administrativas; Enfermagem; Cuidados Críticos; Revisão.
RESUMEN
Objetivo: analizar las especificaciones de sistemas similares con el fin de descubrir que requisitos deben contener un software para la asistencia de Enfermería. Método: revisión integrativa, por medio de búsqueda de artículos en su totalidad, en las bases de datos MEDLINE, LILACS, Science Direct y biblioteca virtual SCIELO. La encuesta fue realizada en septiembre / 2016, con recorte temporal de enero / 2005 a agosto / 2016, utilizando descriptores controlados contemplados en el DeCS. Resultados: Brasil es el país que más publicó sobre el tema. Conclusión: la revisión integrativa es eficiente en la búsqueda de especificaciones para uno sistema de apoyo a decisiones clínicas. Descriptores: Sistemas de Apoyo a Decisiones Administrativas; Enfermería; Cuidados Críticos; Revisión. 1Nurse, Master, Federal University of Alagoas / UFAL. Maceió (AL), Brazil. E-mail: [email protected]; 2Nurse, Master's student, Post-Graduate Program in Nursing, Federal University of Alagoas / UFAL. Maceió (AL), Brazil. E-mail: [email protected]; 3Nurse, Master, Federal University of Alagoas / UFAL. Maceió (AL), Brazil. E-mail: [email protected]; 4,6Nurse, PhD, Professor, Federal University of Alagoas / UFAL. Maceió (AL), Brazil. E-mail: [email protected]; [email protected]; 5Odontologist, PhD, Professor, University of Montes Claros / UNIMONTES. Montes Claros (MG), Brazil. E-mail: [email protected]
INTEGRATIVE REVIEW ARTICLE
Miranda LN, Farias IP, Almeida TG et al. Sistema de tomada de decisão para enfermagem...
English/Portuguese
J Nurs UFPE on line., Recife, 11(Suppl. 10):4263-72, Oct., 2017 4264
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.10712-95194-3-SM.1110sup201732
The information volume and increasing
complexity of the health treatment protocols
is detected, so that the manual records
become insufficient to cover all aspects of
care. Clinical Decision Support Systems (CDSS)
appear in this scenario as a promoter to
improve the quality of care provided, since
they have great potential to help nurses deal
with the volume of information related to
clinical practice.1 -2
Studies indicate that, despite the benefits
described in the use of CDSS, there is still an
underutilization of these by users, usually,
due to failures in the software design stage.3-
In a study carried out in the United States, it
was identified that the main flaws in the
design of the software were due to the lack of
involvement of the users (13%), incomplete
requirements (12%), requirements change
(11%), unrealistic expectations (6%) and
unclear objectives (5%).4
In the area of Nursing, the underutilization
of CDSS has been related to the fact that
these systems are based on data from the
medical practice.4 This finding affirms the
importance of involving nurses in the process
of defining the requirements of specific
systems for their professional practice, that
knowledge in the field of Nursing care, in its
genesis, is available to these professionals
through the use of CDSS.
The requirements of a system are the
descriptions of what the system should do, the
services it offers and the restrictions on its
operation. These reflect the needs of users for
a system that serves a particular purpose. The
process of discovering, analyzing,
documenting, and verifying these services and
constraints is called requirements
engineering.5
In spite of the existence of methodologies
to support the software design stage, such as
the Requirements Engineering Process
proposed by Sommerville, 5 it is observed in
the literature, that the systems developed, to
support nurses in the development of Nursing
care, are often, elaborated empirically and do
not follow a methodology for the software
design process.6-10 It should be emphasized
that this may result in ineffective software,
which does not satisfy the needs of its users.11
According to the literature5, Requirements
Engineering encompasses four high level
activities: 1. Feasibility Study (which has the
purpose of identifying the problem and
assessing the usefulness of the system for the
market); 2. Elicitation and Analysis of
Requirements (survey of the services that the
system must offer); 3. Specification (process
of writing user and system requirements in a
requirements document); 4. Validation
(examination of the specification to ensure
that all software requirements have been
unambiguously stated; inconsistencies,
omissions, and errors have been detected and
corrected).
In this sense, the researchers started with
the following guiding question to carry out
this review: What requirements must be
contained in Nursing care software, with
direct and active involvement of nurses, based
on a methodology that bases the design
process on the same one as a Decision Support
System Clinics in Cardiology Intensive Care
Unit (CICU)?
● To analyze the specifications of similar
systems in order to discover the requirements
that Nursing software should contain.
For the development of this review, the six
stages were covered12: 1) Establishment of a
hypothesis or question of research; 2)
Sampling or search in the literature; 3)
Categorization of studies; 4) Evaluation of
studies included in the review; 5)
Interpretation of results; 6) Synthesis of
knowledge or presentation of the review.
The search for productions was carried out
in the Latin American and Caribbean
Literature in Health Sciences (LILACS), Medcal
Literatury Analisys and Retrieval System
Online (MEDLINE), Science Direct and the
Scientific Electronic Library Online virtual
library (Scielo ), from search strategies
composed of the descriptors, included in the
Descriptors in Health Sciences -DeCs,
controlled: Nursing Informatics,
NursingProcess, Nursing, Decision Support
Systems, Clinical and Software.
Included, in this search, were articles
describing Nursing care support software,
available electronically in full, and published
from January 2005 to August 2016. Among the
exclusion criteria are articles describing
software used in teaching and research in
Nursing.
The search, was conducted, in September
2016, for online access to the databases,
following the pre-established inclusion and
exclusion criteria and generating a final
sample of 23 articles. To analyze the data, a
synoptic table containing the following
variables was constructed in the Microsoft
Office Excel 2010 for Windows program:
METHOD
OBJECTIVE
INTRODUCTION
Miranda LN, Farias IP, Almeida TG et al. Sistema de tomada de decisão para enfermagem...
English/Portuguese
J Nurs UFPE on line., Recife, 11(Suppl. 10):4263-72, Oct., 2017 4265
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.10712-95194-3-SM.1110sup201732
article title, authors, year of publication,
scope and software functionalities.
The flowcharts of the article selection
process were constructed (Figure 1), starting
with the search strategies used, the databases
consulted, the total number of articles
resulting from the search strategy, and the
number of articles selected, after the
application of the inclusion and exclusion
criteria.
Figure 1.-Selection of articles by search strategy in databases. Maceió (AL), Brazil, 2017.
For the critical evaluation of the studies,
the selected articles were read in full and
then the data collection instrument was
completed. Data were exported and analyzed
in the Statistical Package for Social Science
(SPSS) program. The results of the selected
studies were synthesized and, after analysis,
listed in the form of requirements for the
development of new software.
Next, UML language use case diagrams
were developed with the help of Argo UML,
Miranda LN, Farias IP, Almeida TG et al. Sistema de tomada de decisão para enfermagem...
English/Portuguese
J Nurs UFPE on line., Recife, 11(Suppl. 10):4263-72, Oct., 2017 4266
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.10712-95194-3-SM.1110sup201732
0.30 software, in order to support the
elicitation of the requirements. The use case
may be taken as "a simple scenario describing
what a user expects from a system."5
Were evaluated 23 scientific articles, all
with level I of evidence, scientists that met
the inclusion and exclusion criteria, previously
established. The data in Figure 2 show the
synthesis of the characteristics of the included
studies and their respective software.
Title Authors Year Software scopre
Software functions
Computerized Nursing process: methodology for the association of clinical evaluation, diagnoses, interventions and results.
Sasso GTMD, Barra DCC, Paese F, Almeida SRW, Rios GC, Marinho MM, Debétio MG.
2013 Supporting the development of the Nursing process.
1) Cadastro de avaliação clínica; 2) Seleção de Diagnósticos; 3) Seleção de Intervenções; 4) Seleção de Resultados.
Informatics in Nursing: development of free software with assistance and management application.
Santos SB. 2010 Supporting the development of the Nursing process.
1) Cadastro de Histórico; 2) Cadastro de Exame Clínico; 3) Elaboração de Plano de Cuidados; 4) Cálculo de censo estatístico; 5) Acompanhamento de indicadores hospitalares; 6) Classificação de pacientes; 7) Dimensionamento de pessoal; 8) Controle de frequência; 9) Elaboração de escala de serviço.
Integrate information systems for elective chemotherapy medication administration.
Levy MA, Giuse DA, Eck C, Holder G, Lippard G, Cartwright J, Rudge NK.
2011 Enable the safe administration of medicines.
1) Controle de administração de medicamentos; 2) Emissão de alerta (paciente errado, droga errada, dose errada, via errada e/ou horário errado).
Nursing process decision support system for urology ward.
Hao ATH, Wu LP, Kumar A, Jian WS, Huang LF, Kao CC, Hsu CY.
2013 Supporting the development of the Nursing process.
1) Cadastro de avaliação; 2) cadastro de diagnósticos de enfermagem; 3) Elaboração de planejamento da assistência; 4) Cadastro de dados de execução.
Development and validation of computerized assessment from Nursing support diagnosis.
Zega M, D’Agostino F, Bowles KH, Marinis MGD, Rocco G, Vellone E, Alvaro R.
2014 Supporting the development of the Nursing process.
1) Cadastro de Avaliação; 2) Cadastro de exame físico; 3) Seleção de diagnósticos.
Nursing care planning - proposed software-prototype.
Sperandio DJ, Évora YDM.
2005 Supporting the development of the Nursing process.
1) Cadastro de paciente; 2) Cadastro de entrevista; 3) Cadastro de coleta de dados; 4) definição de problemas; 5) Cadastro de prescrição de enfermagem; 6) Cadastro de sinais vitais; 7) Cadastro de balanço hídrico.
Development of Electronic System of Nursing Clinical Documentation structured in diagnoses, results and interventions.
Peres HHC, Cruz DALM, Lima AFC, Gaidzinski RR, Ortiz DCF, Trindade MM,Tsukamoto R, Conceição NB.
2009 Supporting the development of the Nursing process.
1) Cadastrar avaliação; 2) Selecionar diagnósticos; 3) Selecionar resultados; 4) Selecionar intervenções; 5) Geração de resumo das avaliações; 6) Geração de relatórios.
Specialist system to support the decision in topical therapy of venous ulcers.
Sellmer D, Carvalho CMG, Carvalho DR, Malucelli A.
2013 Supporting nurses' decision-making in topical wound
1) Registration of anamnesis; 2) Evaluation and registry of venous ulcers 3) Indication of treatment; 4) Report generation.
RESULTS
Miranda LN, Farias IP, Almeida TG et al. Sistema de tomada de decisão para enfermagem...
English/Portuguese
J Nurs UFPE on line., Recife, 11(Suppl. 10):4263-72, Oct., 2017 4267
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.10712-95194-3-SM.1110sup201732
therapy. Prototype of documentation system in Nursing in the puerperium.
Veríssimo RCSS, Marin HF.
2013 Supporting the development of the Nursing process.
1) Register bed; 2) Search bed; 3) Register user; 4) look for user; 5) Register Patient; 6) Search for Patient; 7) View patient data; 8) Register hospitalization; 9) Finish hospitalization; 10) Register anamnesis; 11) Register physical examination; 12) Register Evolution; 13) Register diagnoses and interventions; 14) View Nursing processes; 15) Print evolution.
Essential arithmetic data archetypes for the care of endometriosis patients.
Spigolon DN, Moro CMC.
2012 Supporting the development of the Nursing process.
1) Register Nursing history; 2) Register Nursing diagnoses; 3) Register Nursing interventions; 4) Register Nursing prescription; 5) Register results and evaluations.
Mobile technology at the bedside - computerized Nursing process in intensive care from CIPE 1.0.
Barra DCC, Sasso GTMD.
2010 Supporting the development of the Nursing process.
Not reported.
Conception, development and application of the "Prince" clinical Nursing records system.
Pinto N. 2011 Supporting the development of the Nursing process.
1) Registration of Nursing consultation; 2) General data file; 3) Evolution register; 4) Register of vital signs; 5) Register of Nursing diagnoses; 6) Register of Nursing interventions; 7) Medical appointment scheduling; 8) Generation of statistical reports.
System of assistance to Nursing diagnoses for victims of trauma in advanced prehospital care using the NANDA and NIC taxonomies.
Caritá CEC, Nini RA, Melo AS.
2010 Supporting the development of the Nursing process.
1) Register of diagnoses; 2) Registration of interventions.
Computerized application with the NursingActivities Score: instrument for the management of Nursing care in the ICU.
Castro MCN, Dell’Acqua MCQ, Corrente JE, Zornoff DCM, Arantes LF.
2009 Evaluate the daily workload of the Nursing. team
1) Patient Registration; 2) Data Collection; 3) Issuance of reports.
NAS System -NursingActivities Score in mobile technology.
Catalan VM, Silveira DT, Neutzling AL, Martinato LHM, Borges GCM.
2011 Evaluate the daily workload of the Nursing team.
1) Patient Registration; 2) Data Collection; 3) Issuance of reports.
Evaluation of the functional performance and technical quality of an electronic documentation system of the Nursing process.
Oliveira NB, Peres HHC.
2015 Supporting the development of the Nursing process.
1) Register evaluation; 2) Select diagnostics; 3) Select results; 4) Select interventions; 5) Generation of summary of evaluations; 6) Generating reports.
Software for mapping the risks of pressure ulcer, fall and phlebitis.
Assis MG, Assis MA, Amate FC.
2012 Map and Classify patients regarding care risks.
1) Register Patient; 2) Revalidate Risks; 3) Patient output; 4) Filter risk factors; 5) Generate risk map.
Construction of a software prototype to support the Systematization of
Oliveira CG, Barros KAAL, Oliveira AG.
2010 Supporting the development of the Nursing process.
1) Patient Registration; 2) History record; 3) Register of Physical Examination; 4) Diagnostic registry; 5)
Miranda LN, Farias IP, Almeida TG et al. Sistema de tomada de decisão para enfermagem...
English/Portuguese
J Nurs UFPE on line., Recife, 11(Suppl. 10):4263-72, Oct., 2017 4268
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.10712-95194-3-SM.1110sup201732
Nursing Assistance, using software engineering and usability.
Prescription record; 6) Evolution register; 7) Result register; 8) User Registration; 9) Generation of statistics.
Alert systems in a computerized Nursing process for ICUs.
Barra DCC, Sasso GTMD, Baccin CRA.
2014 Supporting the development of the Nursing process.
1) History Record; 2. Diagnostic Registry; 3) Registration of Interventions; 4) Results Register; 5) Issuance of alerts related to indicators of quality of care.
Ultrasonography-based model for clinical decision support of ulcer wound management.
Kin HY, Park HA.
2012 Supporting nurses' decision-making in topical wound therapy.
1) Registration of anamnesis; 2) Evaluation and registration of pressure ulcers; 3) Issuance of recommendations.
Detection and prevention of medication errors using real-time bedside nurse charting.
Nelson NC, Evans S, Samore MH, Gardner RM.
2005 Provide safe administration of medicines.
1) Control of medication administration; 2) Alert issue (wrong patient, wrong drug, wrong dose, wrong route and / or wrong time).
Evolutionary study on a computer tool for nurse management in the period 2005-2010.
Valverde MJ, Borrego AR, Alcaraz OL, Barbero JT, Perea JP, Molina PM.
2012 Supporting the development of the Nursing process.
Not reported.
On designing a usable interactive system to support transplant Nursing.
Narasimhadevara A, Radhakrishnan T, Leung B, Jayakumar R.
2008 Supporting the development of the Nursing process.
Not reported.
Figure 2. Synthesis of the studies and their respective software. Maceió, AL, Brazil, 2017.
The integrative review allowed the
identification of 23 articles, which presented
the description of software to support Nursing
care. The study countries, which composed
the sample (n = 23), were: Brazil, 15 (66%);
United States, two (9%); China, Italy,
Portugal, South Korea, Spain and Canada, with
one (4%) study each.
The characterization of the sample,
according to the year of publication of the
studies, is presented in Table 1.
Table 1. Demonstration of descriptive data with frequency and percentage values referring to the year of publication of the article (n = 23). Maceió, AL, Brazil, 2017.
Year of publication n %
2005 2 9 2008 1 4 2009 2 9 2010 4 17 2011 3 13 2012 5 22 2013 3 13 2014 2 9 2015 1 4 2016 X X
As to the design of the studies, the
majority (65%), n = 15, was characterized as a
methodological study of technological
production, while 26% (n = 6) were descriptive
studies, 4% (n = 1), and 4% (n = 1), almost
experimental studies of the before and after
type.
Twelve scientific journals were identified,
in which the studies are published, divided
equally between national and international
journals. The journals were, respectively:
Journal of the American Medical Informatics
Association and Latin American Journal of
Nursing, comQualis A1; Acta Paulista Nursing,
International Journal of Medical Informatics,
International Journal of Nursing knowledge,
Journal of Biomedical Informatics, Journal of
Nursing School, of USP and, Text and Context
Nursing, with Qualis A2; Gaúcha Nursing
Journal with Qualis B1; Clinical Nursing and
Miranda LN, Farias IP, Almeida TG et al. Sistema de tomada de decisão para enfermagem...
English/Portuguese
J Nurs UFPE on line., Recife, 11(Suppl. 10):4263-72, Oct., 2017 4269
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.10712-95194-3-SM.1110sup201732
Journal of Health Informatics, with Qualis B3;
and Journal of Oncology Practice does not
present Qualis. It is added that if the journal
presents Qualis distinct by areas, will be
presented the highest Qualis attributed to it.
As for the sites for which the technologies
were developed, the General Hospital Units
were the most prevalent (26%), n = 6,
followed by Intensive Care Units (n = 5), 22%,
and Ambulatory Units (n = 3), 13%. The other
39% (n = 9) consisted of Pre-Hospital
Emergency Care, Transplant Center, Oncology
and Urology Centers, Surgical and Medical
Clinics, Day-Hospital and Maternity.
The software was developed, mainly, in
order to support the development of the
Nursing process, (n = 16), 70%. Among the
other purposes of the softwares found in the
literature, there are: support nurses' decision
making in wound therapy, (n = 2), 9%;
evaluate the daily workload of the Nursing
team, two (9%); provide greater safety in drug
administration, (n = 2), 9%, and to map and
classify patients regarding care risks, (n = 1),
4%.
As to software (n = 16), developed to
support the increment of the Nursing process,
81% (n = 13) had their functionalities
described in the studies and, from these, it
was possible to identify which stages of the
process were supported by the use of the
software described. From this, it was
identified that no software supported all
stages of the Nursing process and that only
one software (7.7%) supported four of the five
stages of the process: data collection, Nursing
diagnosis, Nursing and evaluation.
It was also identified that 53.8% (n = 7) of
the Nursing process support software, with
features described in the articles (n = 13),
supported the development of three stages of
the Nursing process: data collection, Nursing
diagnosis and Nursing planning; 23.1% (n = 3)
supported the data collection stage and
Nursing diagnoses completely, while the
planning stage was incompletely supported
because it did not allow the establishment of
Nursing results. And the remaining 15.4% (n =
2) supported the development of two steps in
the Nursing process. Of the latter, one
supported the steps of data collection and
Nursing diagnoses, while the other supported
the steps of Nursing diagnoses and planning.
Tables 2 and 3 present, respectively, the
Nursing terminologies and the theoretical
foundations used for the development of
software to support the Nursing process.
Table 2. Demonstration of the descriptive data with frequency and percentage values referring to the Nursing terminologies used in the software to support the Nursing process (n = 16). Maceió, AL, Brazil, 2017.
Nursing terminolgy n %
CIPE 5 31 NANDA 7 44
NANDA and CIPE 1 6 Not reported 3 19
It should be noted that 69.2% (n = 9) of the
software to support the Nursing process with
described functionalities presented
managerial functionalities, in addition to
those directly related to the Nursing process
steps. Examples of these functionalities are:
calculation of the occupational census of the
unit; follow-up of care indicators (incidence of
patient fall, incidence of unplanned
extubation of the endotracheal cannula,
incidence of pressure ulcer and others);
Nursing team dimensioning; frequency
control; reporting on the incidence of Nursing
diagnoses, among others.7-9, 13
Regarding the software developed to
support nurses' decision making in wound
therapy, it was identified that they issued
treatment indications from the information
record about wound characteristics such as
extent, depth, presence and characteristics of
the wound. exudate, type of tissue present in
the wound bed and others.14
The software that evaluated the daily
workload of the Nursing team did it through
Table 3. Demonstration of descriptive data with frequency and percentage values referring to the theoretical foundations used in software to support the Nursing process (n = 16). Maceió, AL, Brazil, 2017.
Theoretical foundation n %
Not Reported 13 81 Basic Human Needs of Wanda Horta 2 12 Marjorie Gordon's Functional Health Standards 1 6
Miranda LN, Farias IP, Almeida TG et al. Sistema de tomada de decisão para enfermagem...
English/Portuguese
J Nurs UFPE on line., Recife, 11(Suppl. 10):4263-72, Oct., 2017 4270
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.10712-95194-3-SM.1110sup201732
the computerized application of the Nursing
Activities Score (NAS). While those with a
view to making drug administration more
secure were made possible through the
control of medication administration in the
dispensation, preparation and administration
stages and the issuing of warnings such as,
wrong patient, wrong drug, wrong dose,
wrong route, and / or wrong time.15-6
The software developed with the purpose
of mapping and classifying the patients
regarding the care risks carried out the risk
classification of pressure ulcer, fall and
phlebitis, by completing a computerized form
containing the factors associated with such
risks.14
After analyzing the Nursing assistance
software described in the literature, it was
identified that the software to be used in the
UTIC must support all stages of the Nursing
process, possessing, in addition to the
functionalities related to the stages of the
Nursing process, general functionalities which
will support the team in the development of
their assistance to inpatient clients.
In discussing this study, it is possible to
point out, the relevance of this study in
presenting innovative facts that will enable
the definition of the scope of the Nursing
assistance software and its initial
functionalities, focused on the development
of the Nursing Process (NP).
From this literature review, it was
identified the importance of developing a
decision support system for Nursing care, with
the objective of supporting the development
of the NP, to be used by the Nursing team
working in CICU.
Based on this literature review, it was
verified that there is a gap related to the
creation of support systems for the decision-
making in CICU, with the objective of
supporting the development of the entire NP,
to be used by the team working in that unit .
In this sense, it was possible to identify
that no job, among the ones found in the
search, contained software that supported
decision making in all stages of the NP. Thus,
emerging the need to create softwares that
help Nursing to make quick decisions and ideal
for each type of treatment performed in CICU,
because this is a unit in which the speed and
precision of the actions taken can be decisive
when saving a life.
It was verified that the year 2012 was the
year that more articles were published (five)
that presented software to support decision-
making for Nursing. Thus, it is well known that
there is still much to be studied and
disseminated so that Nursing can be a
recognized science for using technology when
making decisions that qualify caring.
This review found five softwares that
included the CIPE language. The literature
indicates that the development of software to
support the Nursing process, using the CIPE as
reference, terminology contributes to the
organization and development of the nurses'
clinical reasoning in the care process, through
the establishment of a concrete association
between clinical evaluations , the diagnoses,
the results and the Nursing interventions.
Likewise, it is affirmed that there is
improvement in communication among health
professionals, enabling a safer and more
efficient care to the client and reducing the
associated errors.17-9
It should be emphasized that the data
suggested by the system must be evaluated by
the nurses in the sector that are using the
software to accept or refuse them. This,
combined with the functionality of
constructing the diagnoses, results and
interventions, based on the seven axes of the
CIPE, guarantees the clinical reasoning and
judgment process of the professional; so that
the software will be an aid to the professional
and not a replacement of it.
Among the magazines that published on the
use of software and Nursing care, it was
verified that most have Qualis ranging from A1
to B3 and only one did not have it. However,
it is evident that even the articles, most of
them, having been published in journals
classified as A, these manuscripts did not
treat the Nursing EP in its entirety.
It is evidenced that most of the softwares
proposed in the literature are not supported
by any theoretical basis of the care proces.
So, it is believed that they do not function as
an instrument to support safe decision making
for nurses.
The analysis of the scientific production on
the identification of the specifications of
similar systems, in order to discover the
requirements that must contain a software for
Nursing care, object of this study, evidenced
the importance of the creation of clinical
decision support systems for the assistance of
Nursing, which contemplates all the stages of
the Nursing process and also, that are
supported by some theoretical foundation of
the care process.
CONCLUSION
DISCUSSION
Miranda LN, Farias IP, Almeida TG et al. Sistema de tomada de decisão para enfermagem...
English/Portuguese
J Nurs UFPE on line., Recife, 11(Suppl. 10):4263-72, Oct., 2017 4271
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.10712-95194-3-SM.1110sup201732
The integrative review has proved to be an
indispensable tool in the search for the
requirements that will be the basis for the
creation of software with the characteristics
necessary to provide an individualized and
quality assistance without giving up the work
of the nurse.
1. Oliveira CG, Barros KAAL, Oliveira AG.
Development of a software prototype to
support the systematization of nursing care. J
Health Inform [Internet]. 2010 Jan/Mar [cited
03 Jan 2016];2(1):1-6. Available from:
http://www.jhi-sbis.saude.ws/ojs-
jhi/index.php/jhi-sbis/article/view/83/49
2. Sousa PAF, Sasso GTMD, Barra DCC.
Contributions of the electronic health recods
to the safety of intensive care unit patient: an
integrative review. Texto contexto-enferm.
2012 Oct/Dec; 21(4): 971-9. Doi:
http://dx.doi.org/10.1590/S0104-
07072012000400030
3. Teixeira L, Ferreira C, Santos BS. User-
centered requirements engineering in health
information systems: a study in the
hemophilia field. Comput Methods Programs
Biomed. 2012 June; 106(3):160-74. Doi:
10.1016/j.cmpb.2010.10.007
4. Vries AE, Van der Wal MH, Nieuwenhuis
MM, Jong RM, Van Dijk RB, Jaarsma T, et al.
Perceived barriers of heart failure nurses and
cardiologists in using clinical decision support
systems in the treatment of heart failure
patients. BMC Med Inform Decis Making. 2013;
13(54):1-8. Doi: 10.1186/1472-6947-13-54
5. Sommerville I. Engenharia de software.
9th ed. São Paulo: Pearson Prentice Hall;
2011.
6. Zega M, D’Agostino F, Bowles KH, Marinis
MG, Rocco G, Vellone E, et al. Development
and Validation of a Computerized Assessment
Form to Support Nursing Diagnosis. Int J Nurs
Knowl. 2014 Feb; 25(1):22-9. Doi:
10.1111/2047-3095.12008
7. Pinto N. Design, development and impact
of the clinical nursing records system
“PRINCE”. J Health Inform [Internet]. 2011
Oct/Dec [cited 03 Jan 2016]; 3(4):146-52.
Available from: http://www.jhi-
sbis.saude.ws/ojs-jhi/index.php/jhi-
sbis/article/view/158/101
8. Peres HHC, Cruz DALM, Lima AFC,
Gaidzinski RR, Ortiz DCF, Trindade MM, et al.
Development Eletronic Systems of Nursing
Clinical Documentation structured by
diagnosis, outcomes and interventions. Rev
Esc Enferm USP. 2009 Dec; 43(2):1149-55. Doi:
http://dx.doi.org/10.1590/S0080-
62342009000600002
9. Santos SR. Computers in nursing:
development of free software application with
care and management. Rev Esc Enferm USP.
2010 June; 44(2):295-301. Available from:
http://dx.doi.org/10.1590/S0080-
62342010000200008
10. Hao AT, Wu LP, Kumar A, Jian WS, Huang
LF, Kao CC, et al. Nursing process decision
support system for urology ward. Int J Med
Inform. 2013 July; 82(7):604-12. Doi:
10.1016/j.ijmedinf.2013.02.006
11. Pressman RS. Engenharia de Software:
uma abordagem profissional. 7th ed. Porto
Alegre: AMGH; 2011.
12. Mendes KDS, Silveira RCCP, Galvão CM.
Revisão integrativa: método de pesquisa para
a incorporação de evidências na saúde e na
enfermagem. Texto contexto-enferm. 2008
Oct/Dec; 17(4):758-64. Doi:
http://dx.doi.org/10.1590/S0104-
07072008000400018
13. Veríssimo RCSS, Marin HF. Prototype of
system for nursing documentation in the
postpartum period. Acta Paul Enferm.
2013;26(2):108-15. Doi:
http://dx.doi.org/10.1590/S0103-
21002013000200002
14. Assis MG, Assis MA, Amste FC. Software
para o mapeamento dos riscos de Úlcera por
Pressão, queda e flebite. J Health Inform
[Internet]. 2012 Dec [cited 02 Jan 2016];
4(Spe):130-7. Available from: http://www.jhi-
sbis.saude.ws/ojs-jhi/index.php/jhi-
sbis/article/view/243
15. Catalan VM, Silveira DT, Neutzling AL,
Martinato LHM, Borges GCM. The NAS System:
nursing activities Score in mobile technology.
Rev Esc Enferm USP. 2011 Dec;45(6):1419-26.
Doi: http://dx.doi.org/10.1590/S0080-
62342011000600020
16. Castro MCN, Dell’Acqua MCT, Corrente JE,
Zornoff DCM, Arantes LF. Computer
application with the nursing activities score:
an intensive care management instrument.
Texto contexto-enferm. 2009 July/Sept;
18(3):577-85. Doi:
http://dx.doi.org/10.1590/S0104-
07072009000300022
17. Barra DCC, Sasso GTMD. Mobile bedside
technology: computerized nursing processes in
intensive care unit from icnp 1.0. Texto
contexto-enferm. 2010 Mar;19(1):54-63. Doi:
http://dx.doi.org/10.1590/S0104-
07072010000100006
18. Moreira APA, Amim EF, Souza TM, Queluci
GC, Brandão ES, Camacho ACF. The applied
informatics in nursing: an integrative review.
REFERENCES
Miranda LN, Farias IP, Almeida TG et al. Sistema de tomada de decisão para enfermagem...
English/Portuguese
J Nurs UFPE on line., Recife, 11(Suppl. 10):4263-72, Oct., 2017 4272
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.10712-95194-3-SM.1110sup201732
J Nurs UFPE online [Internet]. 2013 Oct [cited
11 Jan 2016];7(10):62. Available from:
http://www.revista.ufpe.br/revistaenfermage
m/index.php/revista/article/view/3064/pdf_
3797
19. Sasso GTMD, Barra DCC, Paese F, Almeida
SRW, Rios GC, Marinho MM, et al.
Computerized nursing process: methodology
to establish associations between clinical
assessment, diagnosis, interventions, and
outcomes. Rev Esc Enferm USP. 2013;
47(1):242-9. Doi:
http://dx.doi.org/10.1590/S0080-
62342013000100031
Submission: 2017/03/23 Accepted: 2017/09/22 Publishing: 2017/10/15
Corresponding Address
Isadora Pereira Farias Rua Izenilda Félix de Oliveira, 22 Bairro Tabuleiro dos Martins CEP: 57072-900 – Maceió (AL), Brazil