SIMPRO Model For Effectivennes Nursing Model
SIMPRO Model For Effectivennes Nursing Model
SIMPRO Model For Effectivennes Nursing Model
Search terms: PURPOSE: The study aims to develop and test the effectiveness and efficiency of
Effectiveness and efficiency, the SIMPRO. SIMPRO was developed with NANDA-I, Nursing Intervention Classifi-
nursing care documentation, cation, and Nursing Outcome Classification nursing language.
nursing information system METHOD: The research was divided into two parts, in which we used two different
designs—incremental and quasi-experimental design. Two hundred fifty-five
samples of nursing documentations were randomly assessed with computer-
Author contact:
assisted clustering out of 1,040 nursing records of discharged patients. Data were
[email protected], [email protected], analyzed using Wilcoxon test to compare each elements of evaluation before and
with a copy to the Editor: after the implementation of the system.
[email protected] RESULT: SIMPRO improved the quality of documentation (p = .0001) and time
efficiency (p = .0001).
CONCLUSION: SIMPRO increased the quality and functions of the decision
support system in delivering nursing care as well as in nursing management.
TUJUAN: Penelitian ini bertujuan untuk mengembangkan dan menguji
keefektifan dan efisiensi SIMPRO. SIMPRO adalah sistem informasi manajemen
keperawatan yang dikembangkan dengan menggunakan NANDA-I, Nursing Inter-
vention Classification dan Nursing Outcome Classification.
METODE: Penelitian ini dibagi menjadi dua tahap yang menggunakan desain
incremental dan kuasi-eksperimental. 255 sampel dokumentasi keperawatan
diambil secara acak dengan menggunakan klustering yang dibantu dengan
komputer dari 1040 catatan keperawatan pasien yang sudah pulang. Data
dianalisis dengan Uji Wilcoxon untuk membandingkan masing-masing elemen
sebelum dan sesudah implementasi sistem.
HASIL: SIMPRO memperbaiki kualitas dokumentasi (p = .0001) dan efisiensi
(p = .0001).
KESIMPULAN: SIMPRO meningkatkan kualitas dan fungsi sistem dukungan
dalam memberikan asuhan keperawatan dan manajemen keperawatan.
Nursing documentation is an integral part of the nursing ity and accountability of nurses, and database for research
process. Documentation of the nursing care is important for purpose or evidence-based policy making.
continuity of care, communication between nurses and Nursing documentation requires completeness, rel-
other professionals, as well as the legal aspect of care evance, and accuracy of the data (Blair & Smith, 2012;
(Ammenwerth, Rauchegger, Ehlers, Hirsch, & Schaubmayr, Hariyati, 2004). A number of strategies are developed to
2011; Jefferies, Johnson, Nicholls, & Lad, 2012). Documen- assist nurses in documentation. Some of them are narrative
tation is important to provide quality and safe nursing care charting, problem-oriented approaches, clinical pathways,
to patients (Geurden, Wouters, Franck, Weyler, & Ysebaert, and focus notes. However, many factors still hinder nurses to
2014). Furthermore, nursing documentation also serves as maintain complete, accurate, and legally prudent documen-
the indicator of the service quality, evidence of responsibil- tation. Some of the issues are lack of time for nursing
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R. T. S. Hariyati et al. The Effectiveness and Efficiency of SIMPRO
control group before and after the implementation of mentation. For nursing implementation, NANDA-I was
SIMPRO. Ethical approval was obtained from the institu- linked with NIC and was also incorporated with daily nursing
tional review board prior to the commencement of the monitoring, such as vital signs, fluid balance, and medica-
study. tion. Moreover, we added the content of hospital-acquired
infection and patient safety monitoring in the system as it is
Results a crucial element of hospital management (Montalvo,
2007).
The systematic steps on the system development of This system also covers management functions and
SIMPRO are described in the following paragraphs. roles, which is planning, organizing, actuating, staffing, and
controlling (POSAC). The system is integrated with POSAC
System Development because the role and function of management cannot be
separated in the implementation of nursing information
The prototype model was developed based on the evalu- systems. The nursing manager has a major contribution in
ation of NMIS that we created on the previous study the successful implementation of the nursing information
(Hariyati et al., 2011). The old version of the NMIS database system. Therefore, the system needs to be equipped with a
consisted of the nursing assessment, nursing diagnosis, monitoring and directing system, as well as quality control
intervention, implementation, and evaluation. However, the related to patient safety and other quality indicators, such
limitation of the previous system we made was the lack of as monitoring of hospital-acquired infection, urinary tract
linkage between the elements of nursing process. Thus, in infections, and bronchopneumonia. The structure of the
this research, we emphasized the linkage of NANDA-I, NIC, nursing information management system, on which nursing
and NOC (Hariyati et al., 2011). The use of a standardized care and nursing management function are embedded, is
terminology, such as NANDA-I, facilitates the recording of depicted in Figure 2.
data, which plays an essential role in patient care and in Figure 2 depicts the decomposition diagram of SIMPRO.
communication among nurses and between nurses and This diagram shows the data file and components of the
other providers, improves the quality of care, and enhances system to design the data flow of SIMPRO. Two subdata,
patient safety (Albuquerque, Lira, & Lopes, 2010; Ferreira, namely the nursing care data and nursing management
Echer, & Lucena, 2014). data, were two major decomposition contents. The nursing
Figure 1 shows the SIMPRO model developed in this care database included the assessment, diagnosis,
research. The SIMPRO model can be described as follows. outcome, and intervention using NANDA-I, NIC, and NOC.
We used a head-to-toe approach for documenting a com- On the other hand, intervention covered up the vital sign
prehensive assessment, which covered bio-psycho-social- observation, discharge planning, fluid monitoring, and NIC
spiritual-cultural aspects. A head-to-toe approach was implementation. Collaborative interventions, such as medi-
selected as it is a systematic and effective way for docu- cation, were also listed. Subdata service consisted of
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The Effectiveness and Efficiency of SIMPRO R. T. S. Hariyati et al.
planning, organizing, directing, and evaluation functions. Meanwhile, the efficiency of SIMPRO was measured on
This database may play a role in evidence-based decision its time efficiency. Time efficiency was obtained from the
making in nursing management. differences of the time required to do nursing documenta-
tion before and after implementation of SIMPRO. Moreover,
The Effectiveness and Efficiency of the NMIS it also measured the efficiency in comparison with the full-
time equivalent (FTE).
The effectiveness of the system was measured on the Table 2 showed the average time spent in completing the
aspects of quality, completeness, relevance, and decision nursing documentation in the NMIS. The average total time
support system function of the documentation. The evalu- needed was 117 min before using SIMPRO and was lowered
ation of the effectiveness of the system is summarized in to 24.62 min after using SIMPRO. The time needed for com-
Table 1. The table shows that all the evaluation aspects pleting nursing documentation fell to 92.38 min after using
increased after the implementation of SIMPRO. SIMPRO SIMPRO. It took 27.86% of the total FTE for system docu-
could improve quality of documentation, completeness, rel- mentation before implementing SIMPRO. However,
evance, and decision support function (p < .05). it decreased to 3.86% of total FTE after SIMPRO
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R. T. S. Hariyati et al. The Effectiveness and Efficiency of SIMPRO
Variable Mean ± SD Neg (−) rank Pos (+) rank Ties MRank p
Quality
Pre 80.33 ± 12.39 69a 154b 2c 109.62 .0001*
Post 94 ± 20.5 117.32
Completeness
Pre 62.99 ± 9.58 75d 143e 7f 102.43 .004*
Post 67.51 ± 14.55 122.98
Relevance
Pre 19.22 ± 3.44 40g 173h 12i 101.20 .0001*
Post 22.85 ± 5.53 132.10
DSS
Pre 12.59 ± 2.39 51j 152k 22l 99.21 .0001*
Post 14,35 ± 3.37 110.30
Table 2. Time Needed for Nursing Documentation Figure 3. Scatter Time Needed Before and After
Before and After SIMPRO Implementation SIMPRO Implementation
Discussion
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The Effectiveness and Efficiency of SIMPRO R. T. S. Hariyati et al.
implemented nursing care, and to record medical history factors that hindered nurses in doing proper nursing docu-
for future care (Hariyati, 2004). Moreover, real-time data mentation. Meanwhile, support from the user, information,
management in the nursing information system should technology, and organization might also affect the effec-
avoid delays in decision making and action to respond to tiveness of a system implementation (Alter, 2002). The
actual patient conditions (Hariyati et al., 2011). On the other current study was found to be consistent with those previ-
hand, information technology system also allows nurses to ous findings.
create an innovative discharge planning as part of nursing SIMPRO was found to be efficient in terms of the time
care (Hariyati, Afifah, & Handiyani, 2010). requirement for completing nursing documentation and the
Prior studies tested the nursing information technology productivity of the system. The total time spent to fill the
system using the NANDA-I, NIC, and NOC on its implications nursing documentation in the system was statistically sig-
toward nursing practice (Lundberg et al., 2008; Scherb, nificantly lower after using SIMPRO. Prior study supported
2003). Darmer et al. (2006) also concluded that an NMIS this finding and stated that the NMIS helped nurses save
that uses NANDA-I, NIC, and NOC terminology improved the time for doing paperwork on documentation and instead
quality, completeness, and relevance of the documentation, have more time with the patients. At the beginning of the
as well as the accuracy of nursing diagnosis, outcomes, and SIMPRO implementation, the nurses took time to adapt to
interventions. Meanwhile, Bjorvell, Ekstrand, Wredlin, and the computer-based data charting. However, after 6
Ekstrand (2003) implied that the nursing documentation months, the nurses got accustomed to SIMPRO, thus low-
system could improve patient safety. A qualitative evalua- ering the time required for data charting. According to
tion of the NMIS by Yu (2006) also indicated that it helped Lafond and Field (2003), a new system would need some
nurses implement nursing care plans and deliver more process to be well accepted in an organization. Therefore,
quality nursing interventions. In line with those previous the theory of change must be the basis to develop the NMIS.
research results, the present study found that SIMPRO Eventually, the NMIS may decrease workload and lead to
improved the quality of nursing documentation. SIMPRO improved patient care (Moody et al., 2004).
addressed the barriers of nursing documentation, such as
tedious, inefficient forms, as well as the lack of time for
Conclusions
doing nursing documentation.
SIMPRO in this study, on the other hand, was also created
to assist nurse managers in doing their role and functions of It could be concluded that SIMPRO is an effective and
POSAC. A previous study supported the managerial efficient way to improve nursing documentation in this
decision-making support functions of the information study. It increased the quality, completeness, relevance and
system (Rainio & Ohinmaa, 2005). A computerized informa- sustainability, and functions of the decision support system
tion system could also be used as a communication tool in delivering nursing care as well as in nursing management.
between healthcare teams in care delivery, education, and SIMPRO showed many benefits on nursing documentation.
research (Hellese & Ruland, 2008; Layman, 2009; Pereira, It might assist nurses in having thorough, complete, and
2005). better quality nursing documentation. Thus, it might con-
The effectiveness, time efficiency, and cost are some of tribute to better and continuous nursing care, as well as
the performance indicators of an information system. The improved patient safety. SIMPRO might also help commu-
effectiveness of an information system is measured on the nication within nurses and between other healthcare
system’s usability and performance, while efficiency is professionals.
assessed on its economic value and efficiency of time
needed to complete a certain task. In the current study, the
effectiveness was examined from the quality, complete- References
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