Article type
Year
Abstract
Introduction: The local healthcare organisation was in the process of reviewing the introduction of computer based nursing records and care plans but was unsure of their value. The Cochrane Collaboration was undertaking a systematic review of the relationship between record keeping, care planning and patient outcomes but was not expected to report in time for the strategic decision to be made by the hospital authorities. The Research and Development Department was asked to undertake a systematic review which focused only manual records and care plans and patient outcomes which could inform healthcare policy locally.
Methods: The review covered literature in English, published between 1987 (the introduction of the nursing process in the UK) and 1997 (the end date for the review). A comprehensive search strategy using MeSH terms and specific inclusion/exclusion criteria was used. A total of 340 titles and/or abstracts were discovered, 43 full abstracts retrieved, and 13 full texts retrieved. Using a data extraction sheet, the material was critically appraised by the research team and a systematic review reading group. The hypothesis tested was that 'there is no measurable difference in patient outcomes when nursing record keeping and care planning using manual records was in place'.
Discussion: There were no findings from published material which met the criteria for inclusion and for meta-analysis and the hypothesis was neither rejected nor accepted. This is a somewhat disturbing finding, given the importance of records and care planning to patient care and the plethora of studies which have looked at it in practice. No study was methodologically robust and very few related record keeping and care planning to patient outcomes. In the absence of firm evidence, the hospital authorities have recommended further rigorous multi-centre research before financial investment is made in nursing record keeping and care planning, whether manual or computer based. This leaves healthcare practitioners and policy makers in a state of limbo. The remainder of this paper looks at the lessons to be learned from 'failed' systematic reviews for the design of future robust research to inform practice and policy.
Methods: The review covered literature in English, published between 1987 (the introduction of the nursing process in the UK) and 1997 (the end date for the review). A comprehensive search strategy using MeSH terms and specific inclusion/exclusion criteria was used. A total of 340 titles and/or abstracts were discovered, 43 full abstracts retrieved, and 13 full texts retrieved. Using a data extraction sheet, the material was critically appraised by the research team and a systematic review reading group. The hypothesis tested was that 'there is no measurable difference in patient outcomes when nursing record keeping and care planning using manual records was in place'.
Discussion: There were no findings from published material which met the criteria for inclusion and for meta-analysis and the hypothesis was neither rejected nor accepted. This is a somewhat disturbing finding, given the importance of records and care planning to patient care and the plethora of studies which have looked at it in practice. No study was methodologically robust and very few related record keeping and care planning to patient outcomes. In the absence of firm evidence, the hospital authorities have recommended further rigorous multi-centre research before financial investment is made in nursing record keeping and care planning, whether manual or computer based. This leaves healthcare practitioners and policy makers in a state of limbo. The remainder of this paper looks at the lessons to be learned from 'failed' systematic reviews for the design of future robust research to inform practice and policy.