title: Integrative review of clinical decision support for registered nurses in acute care settings.
abstract: To report on the state of the science of clinical decision support (CDS) for hospital bedside nurses.
  
  
  
  We performed an integrative review of qualitative and quantitative peer-reviewed original research studies using a structured search of PubMed, Embase, Cumulative Index to Nursing and Applied Health Literature (CINAHL), Scopus, Web of Science, and IEEE Xplore (Institute of Electrical and Electronics Engineers Xplore Digital Library). We included articles that reported on CDS targeting bedside nurses and excluded in stages based on rules for titles, abstracts, and full articles. We extracted research design and methods, CDS purpose, electronic health record integration, usability, and process and patient outcomes.
  
  
  
  Our search yielded 3157 articles. After removing duplicates and applying exclusion rules, 28 articles met the inclusion criteria. The majority of studies were single-site, descriptive or qualitative (43%) or quasi-experimental (36%). There was only 1 randomized controlled trial. The purpose of most CDS was to support diagnostic decision-making (36%), guideline adherence (32%), medication management (29%), and situational awareness (25%). All the studies that included process outcomes (7) and usability outcomes (4) and also had analytic procedures to detect changes in outcomes demonstrated statistically significant improvements. Three of 4 studies that included patient outcomes and also had analytic procedures to detect change showed statistically significant improvements. No negative effects of CDS were found on process, usability, or patient outcomes.
  
  
  
  Clinical support systems targeting bedside nurses have positive effects on outcomes and hold promise for improving care quality; however, this research is lagging behind studies of CDS targeting medical decision-making in both volume and level of evidence.
authors.affiliation: Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, IL, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Dunn Lopez
authors.affiliation: Community and Systems Health Science, College of Nursing, University of Arizona, Tucson, USA.
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Gephart
authors.affiliation: Information Services, Library of Health Sciences, University of Illinois at Chicago, IL, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Raszewski
authors.affiliation: Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, IL, USA.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Sousa
authors.affiliation: Community and Systems Health Science, College of Nursing, University of Arizona, Tucson, USA.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Shehorn
authors.affiliation: Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, IL, USA.
authors.forename: Joanna
authors.initials: J
authors.lastname: Abraham
mesh_terms: D020000:Decision Support Systems, Clinical; D003936:Diagnosis, Computer-Assisted; D006761:Hospitals; D006801:Humans; D016247:Information Storage and Retrieval / Q000379:methods; D009726:Nurses; D048108:Nursing Informatics; D019095:Point-of-Care Systems
keywords: computerized clinical decision support; decision-making; nursing informatics; registered nurse; review