Original Article Evidence in the Palm of Your Hand: Development of an Outcomes-Focused Knowledge Translation Intervention Diane M. Doran, RN, PhD, FCAHS, John Mylopoulos, PhD, Andre�� Kushniruk, PhD, Lynn Nagle, RN, PhD, Brenda Laurie-Shaw, RN, MN, Souraya Sidani, PhD, Ann E. Tourangeau, RN, PhD, Nancy Lefebre, RN, MScN, Cheryl Reid-Haughian, RN, MHScN, Jennifer R. Carryer, RN, MN, Lisa A. Cranley, RN, MN, Greg McArthur, MSc ABSTRACT Aim: The aim of the project was to develop an electronic information gathering and dissemination system to support both nursing-sensitive outcomes data collection and evidence-based decision-making at the point-of-patient care. Background: With the current explosion of health-related knowledge, it is a challenge for nurses to regularly access information that is most current. The Internet provides timely access to health information, however, nurses do not readily use the Internet to access practice information because of being task-driven and coping with heavy workloads. Mobile computing technology addresses this reality by providing the opportunity for nurses to access relevant information at the time of nurse���patient contact. Method: A cross-sectional, mixed-method design was used to describe nurses��� requirements for point- of-care information collection and utilization. The sample consisted of 51 nurses from hospital and home care settings. Data collection involved work sampling and focus group interviews. Findings: In the hospital sector, 40% of written information was recorded onto ���personal papers��� at point-of-care and later transcribed into the clinical record. Nurses often sought information away from the point-of-care for example, centrally located health records, or policy and procedure manuals. In home care, documentation took place in clients��� homes. The most frequent source of information was ���nurse colleagues.��� Nurses��� top priorities for information were vital signs data, information on intravenous (IV) drug compatibility, drug references, and manuals of policies and procedures. Diane M. Doran, Professor, Associate Dean of Research, Lawrence Bloomberg Faculty of Nursing, University of Toronto John Mylopoulos, Department of Computer Science, University of Toronto Andre�� Kushniruk, Associate Professor, School of Health Information Science University of Victoria Lynn Nagle, Associate Professor (status only), Lawrence Bloomberg Faculty of Nursing, University of Toronto Brenda Laurie-Shaw, Director, Nursing Informatics, University Health Network Souraya Sidani, Professor, Faculty of Nursing, University of Toronto Ann E. Tourangeau, Assistant Professor and Career Scientist, Lawrence Bloomberg Faculty of Nursing, University of Toronto Nancy Lefebre, Senior VP Knowledge and Practice, Saint Elizabeth Health Care, Markham, ON Cheryl Reid-Haughian, Director, Professional Practice, ParaMed Home Health Care, Ottawa, ON Lisa A. Cranley, PhD Candidate, Lawrence Bloomberg Faculty of Nursing, University of Toronto Jennifer R. Carryer, Research Officer, Lawrence Bloomberg Faculty of Nursing, University of Toronto Greg McArthur, Research Associate, Department of Computer Science, University of Toronto, Toronto, Canada. The authors gratefully acknowledge the Ontario Ministry of Health and Long-Term Care, Ontario Centres of Excellence (OCE), Nortel, and Canadian Institutes of Health Research/Canadian Health Services Research Foundation, for their funding of this research. The opinions, results, and conclusions are those of the authors. No endorsement by the funding agencies or partners is intended or should be inferred. We especially acknowledge the significant contribution of Bruce Wallace, Lead Architect, Enterprise Solutions at Nortel for his contributions to both the technical aspects and policy implications of this research. We also gratefully acknowledge the significant contribution of Mariana Zerega for her contribution to the development of the software, and the in-kind support provided by the hospitals and home-care organizations that participated in this research. Address correspondence to Dr. Diane M. Doran, Faculty of Nursing, University of Toronto, #130 ��� 155 College Street, Toronto, Ontario, Canada, M5T 1P8 di- ane.doran@utoronto.ca Accepted 16 October 2006 Copyright ��2007 Sigma Theta Tau International 1545-102X1/07 Worldviews on Evidence-Based Nursing Second Quarter 2007 69

Evidence in the Palm of Your Hand Implications: A prototype software system was designed that enables nurses to use handheld computers to simultaneously document patients��� responses to treatment, obtain real-time feedback about patient outcomes, and access electronic resources to support clinical decision-making. Conclusion: The prototype software system has the potential to increase nurses��� access to patient outcomes information and evidence for point-of-care decision-making. Worldviews on Evidence-Based Nursing 2007 4(2):69���77. Copyright ��2007 Sigma Theta Tau International KEYWORDS nurses, cross-sectional, observation, focus groups, acute care, home care, knowledge translation, evidence-based practice, point-of-care, decision-making, hand-held computer INTRODUCTION Wtion ith the current explosion of accessible informa- and the continuing expansion of professional knowledge, for nurses to access information that is cur- rent and reliable is a challenge. The Internet now provides extensive and timely access to health information how- ever, a recent study by Estabrooks et al. (2003b) indicated that fewer nurses than physicians use the Internet to access practice-related information. The investigators suggest that Internet use by nurses could be increased if the information available on the Internet was more dynamic and contextu- ally relevant, and if computer access was more conveniently available to them. Another study showed that, for front- line staff nurses, being task-driven and coping with heavy workloads limits their attention to, and recognition of po- tential information needs and knowledge gaps (MacIntosh- Murray & Choo 2005). These findings show that, in such a demanding work culture, it is unlikely that nurses would search for practice-related information on the Internet even if computer terminals were readily available. A clinical de- cision support system that provides nurses with practice information automatically, in response to patient-specific assessment information, is proposed as a solution for in- creasing the utilization of research-based evidence in ev- eryday nursing practice. A systematic review of clinical decision support inter- ventions has shown that computerized information sys- tems were significantly more effective in improving clin- ical practice than were traditional manual systems 75% of interventions succeeded when clinical support was pro- vided automatically (Kawamoto et al. 2005). The authors concluded that clinical decision support systems that (1) provide decision support automatically as part of clinical workflow, (2) deliver decision support at the time and lo- cation of decision-making, (3) provide actionable recom- mendations, and (4) use a computer to generate the de- cision support are effective systems for improving clinical practice. In today���s technological context, mobile comput- ers, such as personal digital assistants (PDAs), can include these four features. PDAs in nurses��� hands could provide the opportunity to access current and relevant information right at the time and place of nurse���patient interaction (Lewis & Sommers 2003). BACKGROUND An increasing body of literature on research utilization and evidence-based nursing exists (Royle et al. 2000). In their review, Estabrooks et al. (2003a) identified six categories of determinants of research utilization: beliefs and atti- tudes, involvement in research activities, information seek- ing, professional characteristics, education, and socioeco- nomic factors. In another review, Royle et al. (1995) ex- plored the various resources that nurses utilize and the kinds of knowledge they require in their day-to-day work. They found that newly designed clinical information sys- tems must engage a full range of resources that will support all components of evidenced-based decision-making. A re- cent model showed the most useful resources as research evidence, clinical expertise, and patient preferences (Di- Censo et al. 1998). Another study by Royle et al. (2000) was focused specifically on the kind of information nurses identified as important in their practice. They found that, to access professional information, two thirds of the nurses consulted with their colleagues daily, most used reference sources and textbooks weekly, and two-thirds of them read journal articles monthly. Gosling et al. (2004) investigated nurses��� use of a new online resource (Clinical Information Access Program [CIAP]) in Australia. They found that 58% of the nurses sampled (n = 3,128) had heard of the CIAP, and of those, 70% had used the Web site���s resources. The authors concluded that the use of online evidence, partic- ularly among senior staff, was higher than was reported in previous studies (Gosling et al. 2004). Another group of authors investigated nurses��� use of the Internet in clin- ical ward settings (Morris-Docker et al. 2004). These au- thors found that 88 of the 97 nurses (91%) recruited into the study logged on and used the Internet. Nurses used the Internet for work and nonwork-related activities. This use occurred more often during quiet periods throughout the day and night. Many completed studies have indicated the use of hand- held computers in healthcare (Marasovic et al. 1997 Lal 70 Second Quarter 2007 Worldviews on Evidence-Based Nursing