Analysis of obstacles to the implementation of nursing clinical decision support system from the perspective of specialized nurses in neurology

XU Cailing; WANG Jianyu; GAO Rui; LIU Yin; QIU Minjie

doi:10.12102/j.issn.2095-8668.2025.23.016

Abstract：Objective: To explore the barriers to implementing a nursing clinical decision support system (CDSS) from the perspective of neurology specialty nurses, in order to provide references for improving the quality of clinical nursing decisions. Methods: A quantitative study was used to evaluate the effectiveness of CDSS implementation, comparing the incidence of adverse nursing events in the neurology department of a hospital before (July 2022 - July 2023) and after (August 2023 - August 2024) CDSS implementation. A qualitative study was used to assess the barriers to CDSS implementation. Based on the HOT-fit framework, an interview outline was developed, and 20 neurology specialty nurses from the hospital were interviewed one-on-one. The interview data were analyzed using thematic analysis. Results: The incidence of adverse nursing events in the neurology department was lower in the post-CDSS implementation group compared to the pre-implementation group (P < 0.05). The barriers to CDSS implementation were categorized into four levels: human, organizational, technical, and net benefit. At the human level, traditional nursing thinking and operational models hindered the application of CDSS, and nurses had low enthusiasm for using CDSS. At the organizational level, the effectiveness of CDSS training was unsatisfactory, and the lack of CDSS operation standards failed to meet the needs of nurses in using CDSS. At the technical level, the complicated interface design of CDSS and the inability to share and link patient information with electronic medical records affected the user experience of nurses. At the net benefit level, the increased workload of nurses and the perception that specialty nurses did not benefit from CDSS led to the incomplete role of CDSS implementation. Conclusion: CDSS has certain application effects on the nursing decision-making of neurology specialty nurses, but there are still various barriers after its introduction, mainly at the levels of human, organizational, technical, and net benefit. Improving and promoting CDSS requires the joint efforts of technicians, management, and clinical nurses.