tool. They can be used, for example, to simulate electrocardiograms and hemodynamic body functions. Full-body, computer-integrated, physiologically accurate simulators, originally created for anesthesia training, can be used for critical care nursing education, although they require additional expenditures, space, computer literacy, and technical support (Rauen, 2001).

Decision Support at the Point of Care Delivery

Nurses also need mechanisms to help identify new sources of knowledge and integrate them into their ongoing practice at the point of care delivery. At a June 2002 invitational conference on Using Innovative Technology to Enhance Patient Care Delivery, sponsored by the American Academy of Nursing, attendees representing national health care associations, health care provider organizations, clinicians, and health care technology vendors identified minimal decision support for nurses within HCOs as a deficiency in their work environments (Bolton, 2002).

Such supports can be both low-tech and high-tech. Health care literature on decision support has addressed primarily high-tech, computer-assisted support for physicians in making diagnostic and treatment decisions (Brailer et al., 1996). Deploying informatics to develop and maintain databases and providing health care practitioners with such information as clinical practice guidelines when they need it at the point of care are recommended ways of assisting practitioners in acquiring new knowledge (Eisenberg, 2000).

Crossing the Quality Chasm (IOM, 2001a) also highlights the importance of using information technology to improve access to information and support clinical decision making. It calls attention to software that integrates information on individual patients with a computerized knowledge base to generate patient-specific assessments or recommendations, thereby helping clinicians or patients make clinical decisions. Decision supports for nurses are described less frequently; publications most often address the use of clinical pathways and automated support for medication administration. Other low-tech decision supports include using memory/ cognition aids, such as protocols and checklists, and providing access to clinical information at the point of care delivery. The use of clinical pathways can also provide support to nurses in integrating evidence-based knowledge.

Clinical pathways Clinical pathways are disease- or procedure-specific blueprints for clinical care specifying actions that need to be performed by nurses and other members of a patient’s health care team, and in what sequence. They frequently map the expected course of an illness or proce-



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