| Title |
Advancing beyond the system: telemedicine nurses’ clinical reasoning using a computerised decision support system for patients with COPD – an ethnographic study
|
|---|---|
| Published in |
BMC Medical Informatics and Decision Making, December 2017
|
| DOI | 10.1186/s12911-017-0573-7 |
| Pubmed ID | |
| Authors |
Tina Lien Barken, Elin Thygesen, Ulrika Söderhamn |
| Abstract |
Telemedicine is changing traditional nursing care, and entails nurses performing advanced and complex care within a new clinical environment, and monitoring patients at a distance. Telemedicine practice requires complex disease management, advocating that the nurses' reasoning and decision-making processes are supported. Computerised decision support systems are being used increasingly to assist reasoning and decision-making in different situations. However, little research has focused on the clinical reasoning of nurses using a computerised decision support system in a telemedicine setting. Therefore, the objective of the study is to explore the process of telemedicine nurses' clinical reasoning when using a computerised decision support system for the management of patients with chronic obstructive pulmonary disease. The factors influencing the reasoning and decision-making processes were investigated. In this ethnographic study, a combination of data collection methods, including participatory observations, the think-aloud technique, and a focus group interview was employed. Collected data were analysed using qualitative content analysis. When telemedicine nurses used a computerised decision support system for the management of patients with complex, unstable chronic obstructive pulmonary disease, two categories emerged: "the process of telemedicine nurses' reasoning to assess health change" and "the influence of the telemedicine setting on nurses' reasoning and decision-making processes". An overall theme, termed "advancing beyond the system", represented the connection between the reasoning processes and the telemedicine work and setting, where being familiar with the patient functioned as a foundation for the nurses' clinical reasoning process. In the telemedicine setting, when supported by a computerised decision support system, nurses' reasoning was enabled by the continuous flow of digital clinical data, regular video-mediated contact and shared decision-making with the patient. These factors fostered an in-depth knowledge of the patients and acted as a foundation for the nurses' reasoning process. Nurses' reasoning frequently advanced beyond the computerised decision support system recommendations. Future studies are warranted to develop more accurate algorithms, increase system maturity, and improve the integration of the digital clinical information with clinical experiences, to support telemedicine nurses' reasoning process. |
X Demographics
The data shown below were collected from the profiles of 6 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Spain | 3 | 50% |
| France | 1 | 17% |
| United States | 1 | 17% |
| Unknown | 1 | 17% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 6 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 146 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 146 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Ph. D. Student | 27 | 18% |
| Student > Master | 15 | 10% |
| Student > Bachelor | 14 | 10% |
| Researcher | 13 | 9% |
| Student > Doctoral Student | 10 | 7% |
| Other | 17 | 12% |
| Unknown | 50 | 34% |
| Readers by discipline | Count | As % |
|---|---|---|
| Nursing and Health Professions | 32 | 22% |
| Medicine and Dentistry | 18 | 12% |
| Business, Management and Accounting | 10 | 7% |
| Social Sciences | 10 | 7% |
| Engineering | 4 | 3% |
| Other | 15 | 10% |
| Unknown | 57 | 39% |
Attention Score in Context
This research output has an Altmetric Attention Score of 3. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 02 September 2018.
All research outputs
#12,866,331
of 23,015,156 outputs
Outputs from BMC Medical Informatics and Decision Making
#863
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Outputs of similar age
#201,494
of 441,975 outputs
Outputs of similar age from BMC Medical Informatics and Decision Making
#17
of 29 outputs
Altmetric has tracked 23,015,156 research outputs across all sources so far. This one is in the 43rd percentile – i.e., 43% of other outputs scored the same or lower than it.
So far Altmetric has tracked 2,008 research outputs from this source. They receive a mean Attention Score of 4.9. This one has gotten more attention than average, scoring higher than 56% of its peers.
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We're also able to compare this research output to 29 others from the same source and published within six weeks on either side of this one. This one is in the 41st percentile – i.e., 41% of its contemporaries scored the same or lower than it.