Box 8.
Nurses and the computerised decision support system
Chronic disease management
“What happens, the patient gets asthma, the GP diagnoses . . . and does hopefully a few peak flows, the patient's sent to the nurse in the asthma clinic who then follows BTS guidelines, managing the asthmatic when they run into a problem they—and they would then come to us and say, look, this is how it is with the patient, I think they now need beclomethasone or whatever” (General practitioner, interview study)
“We've got that [shows NR a data collection tool]. I mean, but it's not very extensive. And I think she's [nurse] probably the only one using it at the moment for asthma” (General practitioner, interview study)
Access to computers
“We have not been able to load [the system] to practice nurses despite the fact that they came to the teaching day” (General practitioner, trial practice, feedback)
“You see the GPs have PCs, we just have the dumb terminal . . . there's a few things there when you go in they show us on their computers. ‘Oh that looks brilliant’ but that's no good on mine because we can't do it [laughs]. I mean . . . if they were overdue a smear or tetanus they would have a due date diary that would . . . it would flash. Well on their screen, because it's in colour it actually flashes in red . . . so it's something that stands out straight away, whereas in ours you know it's all black so it doesn't look . . . you know it doesn't stand out [voice drops]. I say we need one of them. It hasn't worked. We keep hinting. Maybe one day. I want a bit of colour [laughs]” (Nurse, interview study)
The computerised decision support system
“The plan for us is to delegate most of like heart disease management to our nurses, it's already the case and you can see a very good role for something like [the system]” (General practitioner, interview study)
“Well, I think my own personal view is that nurses are very good at working to protocols and pathways of care and all the rest of it and they're comfortable with going from A to B, whereas . . . our skill is perhaps in kind of thinking in a round about way and jumping through a few of those pathways through whatever it is, experience or whatever, so you don't ask people the 10 or 15 questions to get from question 1 to question 14 you know, you go straight from one to 14 by intuition almost” (General practitioner, interview study)
“I think with nursing you're into a lot of guidelines anyway you know . . . well we look at the clinical governance that they're bringing in—a lot of it's what nurses have to do anyway and have done . . . I think . . . I think they realise we do need guidelines” (Nurse, interview study)