title: Challenges and facilitators to nurse use of a guideline-based nursing information system: recommendations for nurse executives.
abstract: OBJECTIVE
  The aims of this study were to develop empirical data on how nurses used an evidenced-based nursing information system (NIS) and to identify challenges and facilitators to NIS adoption for nurse leaders.
  
  
  BACKGROUND
  The NIS was part of the electronic health record with 200 evidence-based, interdisciplinary clinical practice guidelines from which clinicians selected to guide the patient's care.
  
  
  METHODS
  A purposeful sample of 12 randomly selected nurses in three units across two hospitals participated in scenario-testing. Sessions were audio-recorded, transcribed, content analyzed, and coded for themes.
  
  
  RESULTS
  Major themes emerged: computer placement in patient rooms; difficulty using NIS; documentation completeness; efficiency; time spent at the bedside; team communication; training; unintended consequences of workflow changes; perceived NIS value as challenge to adoption.
  
  
  CONCLUSIONS
  Nurse executives' opportunities to improve adoption include enhancing communication to/from front-line clinicians about the hospitals' goals, perceived NIS value at the bedside, and constructive feedback especially for patient care/safety and software functionality.
authors.affiliation: Drexel University College of Nursing and Health Professions, 245N 15th St, Philadelphia, PA, USA. Electronic address: pss44@drexel.edu.
authors.forename: Paulina S
authors.initials: PS
authors.lastname: Sockolow
authors.affiliation: Drexel University College of Information Science and Technology, Philadelphia, PA, USA. Electronic address: mlr92@drexel.edu.
authors.forename: Michelle
authors.initials: M
authors.lastname: Rogers
authors.affiliation: University of Pennsylvania School of Nursing, Room 340 Fagin Hall 418 Curie Blvd. Philadelphia, PA, USA. Electronic address: bowles@nursing.upenn.edu.
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Bowles
authors.affiliation: University of Pennsylvania School of Nursing, Philadelphia, PA, USA. Electronic address: heigoldk@nursing.upenn.edu.
authors.forename: Kristin E
authors.initials: KE
authors.lastname: Hand
authors.affiliation: University of Pennsylvania Health System, Philadelphia, PA, USA. Electronic address: Jessie.george@uphs.upenn.edu.
authors.forename: Jessie
authors.initials: J
authors.lastname: George
mesh_terms: D057286:Electronic Health Records; D007256:Information Systems; D009718:Nurse Administrators; D048108:Nursing Informatics; D017410:Practice Guidelines as Topic
keywords: Clinical information systems; Evaluation studies; Evidence-based nursing; Nursing informatics