INTEGRATIVE REVIEW ARTICLE DECISION-MAKING SYSTEM FOR NU

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1 INTEGRATIVE REVIEW ARTICLE DECISION-MAKING SYSTEM FOR NURSING: INTEGRATIVE REVIEW SISTEMA DE TOMADA DE DECISÃO PARA ENFERMAGEM: REVISÃO INTEGRATIVA SISTEMA DE TOMA DE DECISIÓN PARA ENFERMERÍA: REVISIÓN INTEGRATIVA Lays Nogueira Miranda 1, Isadora Pereira Farias 2, Thayse Gomes Almeida 3, Ruth França Cizino da Trindade 4, Daniel Antunes Freitas 5, Eveline Lucena Vasconcelos 6 ABSTRACT Objective: to analyze specifications of similar systems in order to find out what requirements must contain software for Nursing care. Method: integrative review, through search of articles in full, in databases MEDLINE, LILACS, Science Direct and SCIELO virtual library. The research was conducted in September / 2016, with a temporal cut from January / 2005 to August / 2016, using controlled descriptors contemplated in DeCS. Results: Brazil is country that most published on subject. Conclusion: integrative review is efficient in searching for specifications for a clinical decision support system. Descriptors: Decision Support Systems, Management; Nursing; Criticalcare; Review. RESUMO Objetivo: analisar as especificações de sistemas similares no intuito de descobrir que requisitos deve conter um software para a assistência de Enfermagem. Método: revisão integrativa, por meio de busca de artigos na íntegra, nas bases de dados MEDLINE, LILACS, Science Direct e biblioteca virtual SCIELO. A pesquisa foi realizada em setembro/2016, com recorte temporal de janeiro/2005 a agosto/2016, utilizando descritores controlados contemplados no DeCS. Resultados: o Brasil é o país que mais publicou sobre o tema. Conclusão: a revisão integrativa é eficiente na busca de especificações para um sistema de apoio a decisões clínicas. Descritores: Sistemas de Apoio a Decisões Administrativas; Enfermagem; Cuidados Críticos; Revisão. RESUMEN Objetivo: analizar las especificaciones de sistemas similares con el fin de descubrir que requisitos deben contener un software para la asistencia de Enfermería. Método: revisión integrativa, por medio de búsqueda de artículos en su totalidad, en las bases de datos MEDLINE, LILACS, Science Direct y biblioteca virtual SCIELO. La encuesta fue realizada en septiembre / 2016, con recorte temporal de enero / 2005 a agosto / 2016, utilizando descriptores controlados contemplados en el DeCS. Resultados: Brasil es el país que más publicó sobre el tema. Conclusión: la revisión integrativa es eficiente en la búsqueda de especificaciones para uno sistema de apoyo a decisiones clínicas. Descriptores: Sistemas de Apoyo a Decisiones Administrativas; Enfermería; Cuidados Críticos; Revisión. 1 Nurse, Master, Federal University of Alagoas / UFAL. Maceió (AL), Brazil. laysnm@hotmail.com; 2 Nurse, Master's student, Post- Graduate Program in Nursing, Federal University of Alagoas / UFAL. Maceió (AL), Brazil. isadorapfarias@gmail.com; 3 Nurse, Master, Federal University of Alagoas / UFAL. Maceió (AL), Brazil. thaysegalmeida@gmail.com; 4,6 Nurse, PhD, Professor, Federal University of Alagoas / UFAL. Maceió (AL), Brazil. ruth.trindade@esenfar.ufal.br; evelinelucena@gmail.com; 5 Odontologist, PhD, Professor, University of Montes Claros / UNIMONTES. Montes Claros (MG), Brazil. danielmestradounicor@yahoo.com.br J Nurs UFPE on line., Recife, 11(Suppl. 10): , Oct.,

2 INTRODUCTION The information volume and increasing complexity of health treatment protocols is detected, so that manual records become insufficient to cover all aspects of care. Clinical Decision Support Systems (CDSS) appear in this scenario as a promoter to improve quality of care provided, since y have great potential to help nurses deal with volume of information related to clinical practice. 1-2 Studies indicate that, despite benefits described in use of CDSS, re is still an underutilization of se by users, usually, due to failures in software design stage. 3- In a study carried out in United States, it was identified that main flaws in design of software were due to lack of involvement of users (13%), incomplete requirements (12%), requirements change (11%), unrealistic expectations (6%) and unclear objectives (5%). 4 In area of Nursing, underutilization of CDSS has been related to fact that se systems are based on data from medical practice.4 This finding affirms importance of involving nurses in process of defining requirements of specific systems for ir professional practice, that knowledge in field of Nursing care, in its genesis, is available to se professionals through use of CDSS. The requirements of a system are descriptions of what system should do, services it offers and restrictions on its operation. These reflect needs of users for a system that serves a particular purpose. The process of discovering, analyzing, documenting, and verifying se services and constraints is called requirements engineering. 5 In spite of existence of methodologies to support software design stage, such as Requirements Engineering Process proposed by Sommerville, 5 it is observed in literature, that systems developed, to support nurses in Nursing care, are often, elaborated empirically and do not follow a methodology for software design 6-10 It should be emphasized that this may result in ineffective software, which does not satisfy needs of its users. 11 According to literature5, Requirements Engineering encompasses four high level activities: 1. Feasibility Study (which has purpose of identifying problem and assessing usefulness of system for market); 2. Elicitation and Analysis of Requirements (survey of services that system must offer); 3. Specification (process of writing user and system requirements in a requirements document); 4. Validation (examination of specification to ensure that all software requirements have been unambiguously stated; inconsistencies, omissions, and errors have been detected and corrected). In this sense, researchers started with following guiding question to carry out this review: What requirements must be contained in Nursing care software, with direct and active involvement of nurses, based on a methodology that bases design process on same one as a Decision Support System Clinics in Cardiology Intensive Care Unit (CICU)? OBJECTIVE To analyze specifications of similar systems in order to discover requirements that Nursing software should contain. METHOD For this review, six stages were covered12: 1) Establishment of a hyposis or question of research; 2) Sampling or search in literature; 3) Categorization of studies; 4) Evaluation of studies included in review; 5) Interpretation of results; 6) Synsis of knowledge or presentation of review. The search for productions was carried out in Latin American and Caribbean Literature in Health Sciences (LILACS), Medcal Literatury Analisys and Retrieval System Online (MEDLINE), Science Direct and Scientific Electronic Library Online virtual library (Scielo ), from search strategies composed of descriptors, included in Descriptors in Health Sciences -DeCs, controlled: Nursing Informatics, NursingProcess, Nursing, Decision Support Systems, Clinical and Software. Included, in this search, were articles describing Nursing care support software, available electronically in full, and published from January 2005 to August Among exclusion criteria are articles describing software used in teaching and research in Nursing. The search, was conducted, in September 2016, for online access to databases, following pre-established inclusion and exclusion criteria and generating a final sample of 23 articles. To analyze data, a synoptic table containing following variables was constructed in Microsoft Office Excel 2010 for Windows program: J Nurs UFPE on line., Recife, 11(Suppl. 10): , Oct.,

3 article title, authors, year of publication, scope and software functionalities. The flowcharts of article selection process were constructed (Figure 1), starting with search strategies used, databases consulted, total number of articles resulting from search strategy, and number of articles selected, after application of inclusion and exclusion criteria. Figure 1.-Selection of articles by search strategy in databases. Maceió (AL), Brazil, For critical evaluation of studies, selected articles were read in full and n data collection instrument was completed. Data were exported and analyzed in Statistical Package for Social Science (SPSS) program. The results of selected studies were synsized and, after analysis, listed in form of requirements for new software. Next, UML language use case diagrams were developed with help of Argo UML, J Nurs UFPE on line., Recife, 11(Suppl. 10): , Oct.,

4 0.30 software, in order to support elicitation of requirements. The use case may be taken as "a simple scenario describing what a user expects from a system." 5 Title Authors Year Software scopre Sasso GTMD, 2013 Supporting Barra DCC, Paese F, Almeida SRW, of Rios GC, Marinho MM, Debétio MG. Computerized Nursing process: methodology for association of clinical evaluation, diagnoses, interventions and results. Informatics in Nursing: free software with assistance and management application. Integrate information systems for elective chemorapy medication administration. Nursing process decision support system for urology ward. Development and validation of computerized assessment from Nursing support diagnosis. Nursing care planning - proposed softwareprototype. Development of Electronic System of Nursing Clinical Documentation structured in diagnoses, results and interventions. Specialist system to support decision in topical rapy of venous ulcers. Santos SB Supporting of Levy MA, Giuse DA, Eck C, Holder G, Lippard G, Cartwright J, Rudge NK. Hao ATH, Wu LP, Kumar A, Jian WS, Huang LF, Kao CC, Hsu CY. Zega M, D Agostino F, Bowles KH, Marinis MGD, Rocco G, Vellone E, Alvaro R. Sperandio DJ, Évora YDM. Peres HHC, Cruz DALM, Lima AFC, Gaidzinski RR, Ortiz DCF, Trindade MM,Tsukamoto R, Conceição NB. Sellmer D, Carvalho CMG, Carvalho DR, Malucelli A. RESULTS Were evaluated 23 scientific articles, all with level I of evidence, scientists that met inclusion and exclusion criteria, previously established. The data in Figure 2 show synsis of characteristics of included studies and ir respective software Enable safe administratio n of medicines Supporting of 2014 Supporting of 2005 Supporting of 2009 Supporting of 2013 Supporting nurses' decisionmaking in topical wound Software functions 1) Cadastro de avaliação clínica; 2) Seleção de Diagnósticos; 3) Seleção de Intervenções; 4) Seleção de Resultados. 1) Cadastro de Histórico; 2) Cadastro de Exame Clínico; 3) Elaboração de Plano de Cuidados; 4) Cálculo de censo estatístico; 5) Acompanhamento de indicadores hospitalares; 6) Classificação de pacientes; 7) Dimensionamento de pessoal; 8) Controle de frequência; 9) Elaboração de escala de serviço. 1) Controle de administração de medicamentos; 2) Emissão de alerta (paciente errado, droga errada, dose errada, via errada e/ou horário errado). 1) Cadastro de avaliação; 2) cadastro de diagnósticos de enfermagem; 3) Elaboração de planejamento da assistência; 4) Cadastro de dados de execução. 1) Cadastro de Avaliação; 2) Cadastro de exame físico; 3) Seleção de diagnósticos. 1) Cadastro de paciente; 2) Cadastro de entrevista; 3) Cadastro de coleta de dados; 4) definição de problemas; 5) Cadastro de prescrição de enfermagem; 6) Cadastro de sinais vitais; 7) Cadastro de balanço hídrico. 1) Cadastrar avaliação; 2) Selecionar diagnósticos; 3) Selecionar resultados; 4) Selecionar intervenções; 5) Geração de resumo das avaliações; 6) Geração de relatórios. 1) Registration of anamnesis; 2) Evaluation and registry of venous ulcers 3) Indication of treatment; 4) Report generation. J Nurs UFPE on line., Recife, 11(Suppl. 10): , Oct.,

5 Prototype of documentation system in Nursing in puerperium. Essential arithmetic data archetypes for care of endometriosis patients. Mobile technology at bedside - computerized Nursing process in intensive care from CIPE 1.0. Conception, and application of "Prince" clinical Nursing records system. System of assistance to Nursing diagnoses for victims of trauma in advanced prehospital care using NANDA and NIC taxonomies. Computerized application with NursingActivities Score: instrument for management of Nursing care in ICU. NAS System - NursingActivities Score in mobile technology. Evaluation of functional performance and technical quality of an electronic documentation system of Software for mapping risks of pressure ulcer, fall and phlebitis. Construction of a software prototype to support Systematization of Veríssimo RCSS, Marin HF. Spigolon DN, Moro CMC. Barra DCC, Sasso GTMD. rapy Supporting 2012 Supporting 2010 Supporting Pinto N Supporting Caritá CEC, Nini RA, Melo AS. Castro MCN, Dell Acqua MCQ, Corrente JE, Zornoff DCM, Arantes LF. Catalan VM, Silveira DT, Neutzling AL, Martinato LHM, Borges GCM. Oliveira NB, Peres HHC. Assis MG, Assis MA, Amate FC. Oliveira CG, Barros KAAL, Oliveira AG Supporting 2009 Evaluate daily workload of. team 2011 Evaluate daily workload of team Supporting 2012 Map and Classify patients regarding care risks Supporting 1) Register bed; 2) Search bed; 3) Register user; 4) look for user; 5) Register Patient; 6) Search for Patient; 7) View patient data; 8) Register hospitalization; 9) Finish hospitalization; 10) Register anamnesis; 11) Register physical examination; 12) Register Evolution; 13) Register diagnoses and interventions; 14) View Nursing processes; 15) Print evolution. 1) Register Nursing history; 2) Register Nursing diagnoses; 3) Register Nursing interventions; 4) Register Nursing prescription; 5) Register results and evaluations. Not reported. 1) Registration of Nursing consultation; 2) General data file; 3) Evolution register; 4) Register of vital signs; 5) Register of Nursing diagnoses; 6) Register of Nursing interventions; 7) Medical appointment scheduling; 8) Generation of statistical reports. 1) Register of diagnoses; 2) Registration of interventions. 1) Patient Registration; 2) Data Collection; 3) Issuance of reports. 1) Patient Registration; 2) Data Collection; 3) Issuance of reports. 1) Register evaluation; 2) Select diagnostics; 3) Select results; 4) Select interventions; 5) Generation of summary of evaluations; 6) Generating reports. 1) Register Patient; 2) Revalidate Risks; 3) Patient output; 4) Filter risk factors; 5) Generate risk map. 1) Patient Registration; 2) History record; 3) Register of Physical Examination; 4) Diagnostic registry; 5) J Nurs UFPE on line., Recife, 11(Suppl. 10): , Oct.,

6 Nursing Assistance, using software engineering and usability. Alert systems in a computerized Nursing process for ICUs. Ultrasonography-based model for clinical decision support of ulcer wound management. Detection and prevention of medication errors using real-time bedside nurse charting. Evolutionary study on a computer tool for nurse management in period On designing a usable interactive system to support transplant Nursing. Barra DCC, Sasso GTMD, Baccin CRA. Kin HY, Park HA. Nelson NC, Evans S, Samore MH, Gardner RM. Valverde MJ, Borrego AR, Alcaraz OL, Barbero JT, Perea JP, Molina PM. Narasimhadevara A, Radhakrishnan T, Leung B, Jayakumar R Supporting 2012 Supporting nurses' decisionmaking in topical wound rapy Provide safe administration of medicines Supporting 2008 Supporting Prescription record; 6) Evolution register; 7) Result register; 8) User Registration; 9) Generation of statistics. 1) History Record; 2. Diagnostic Registry; 3) Registration of Interventions; 4) Results Register; 5) Issuance of alerts related to indicators of quality of care. 1) Registration of anamnesis; 2) Evaluation and registration of pressure ulcers; 3) Issuance of recommendations. 1) Control of medication administration; 2) Alert issue (wrong patient, wrong drug, wrong dose, wrong route and / or wrong time). Not reported. Not reported. Figure 2. Synsis of studies and ir respective software. Maceió, AL, Brazil, The integrative review allowed identification of 23 articles, which presented description of software to support Nursing care. The study countries, which composed sample (n = 23), were: Brazil, 15 (66%); United States, two (9%); China, Italy, Portugal, South Korea, Spain and Canada, with one (4%) study each. The characterization of sample, according to year of publication of studies, is presented in Table 1. Table 1. Demonstration of descriptive data with frequency and percentage values referring to year of publication of article (n = 23). Maceió, AL, Brazil, Year of publication n % X X As to design of studies, majority (65%), n = 15, was characterized as a methodological study of technological production, while 26% (n = 6) were descriptive studies, 4% (n = 1), and 4% (n = 1), almost experimental studies of before and after type. Twelve scientific journals were identified, in which studies are published, divided equally between national and international journals. The journals were, respectively: Journal of American Medical Informatics Association and Latin American Journal of Nursing, comqualis A1; Acta Paulista Nursing, International Journal of Medical Informatics, International Journal of Nursing knowledge, Journal of Biomedical Informatics, Journal of Nursing School, of USP and, Text and Context Nursing, with Qualis A2; Gaúcha Nursing Journal with Qualis B1; Clinical Nursing and J Nurs UFPE on line., Recife, 11(Suppl. 10): , Oct.,

7 Journal of Health Informatics, with Qualis B3; and Journal of Oncology Practice does not present Qualis. It is added that if journal presents Qualis distinct by areas, will be presented highest Qualis attributed to it. As for sites for which technologies were developed, General Hospital Units were most prevalent (26%), n = 6, followed by Intensive Care Units (n = 5), 22%, and Ambulatory Units (n = 3), 13%. The or 39% (n = 9) consisted of Pre-Hospital Emergency Care, Transplant Center, Oncology and Urology Centers, Surgical and Medical Clinics, Day-Hospital and Maternity. The software was developed, mainly, in order to support Nursing process, (n = 16), 70%. Among or purposes of softwares found in literature, re are: support nurses' decision making in wound rapy, (n = 2), 9%; evaluate daily workload of team, two (9%); provide greater safety in drug administration, (n = 2), 9%, and to map and classify patients regarding care risks, (n = 1), 4%. As to software (n = 16), developed to support increment of process, 81% (n = 13) had ir functionalities described in studies and, from se, it was possible to identify which stages of process were supported by use of software described. From this, it was identified that no software supported all stages of process and that only one software (7.7%) supported four of five stages of process: data collection, Nursing diagnosis, Nursing and evaluation. It was also identified that 53.8% (n = 7) of process support software, with features described in articles (n = 13), supported three stages of process: data collection, Nursing diagnosis and Nursing planning; 23.1% (n = 3) supported data collection stage and Nursing diagnoses completely, while planning stage was incompletely supported because it did not allow establishment of Nursing results. And remaining 15.4% (n = 2) supported two steps in Of latter, one supported steps of data collection and Nursing diagnoses, while or supported steps of Nursing diagnoses and planning. Tables 2 and 3 present, respectively, Nursing terminologies and oretical foundations used for software to support Table 2. Demonstration of descriptive data with frequency and percentage values referring to terminologies used in software to support process (n = 16). Maceió, AL, Brazil, Nursing terminolgy n % CIPE 5 31 NANDA 7 44 NANDA and CIPE 1 6 Not reported 3 19 Table 3. Demonstration of descriptive data with frequency and percentage values referring to oretical foundations used in software to support process (n = 16). Maceió, AL, Brazil, Theoretical foundation n % Not Reported Basic Human Needs of Wanda Horta 2 12 Marjorie Gordon's Functional Health Standards 1 6 It should be noted that 69.2% (n = 9) of software to support process with described functionalities presented managerial functionalities, in addition to those directly related to process steps. Examples of se functionalities are: calculation of occupational census of unit; follow-up of care indicators (incidence of patient fall, incidence of unplanned extubation of endotracheal cannula, incidence of pressure ulcer and ors); Nursing team dimensioning; frequency control; reporting on incidence of Nursing 7-9, 13 diagnoses, among ors. Regarding software developed to support nurses' decision making in wound rapy, it was identified that y issued treatment indications from information record about wound characteristics such as extent, depth, presence and characteristics of wound. exudate, type of tissue present in wound bed and ors. 14 The software that evaluated daily workload of team did it through J Nurs UFPE on line., Recife, 11(Suppl. 10): , Oct.,

8 computerized application of Activities Score (NAS). While those with a view to making drug administration more secure were made possible through control of medication administration in dispensation, preparation and administration stages and issuing of warnings such as, wrong patient, wrong drug, wrong dose, wrong route, and / or wrong time The software developed with purpose of mapping and classifying patients regarding care risks carried out risk classification of pressure ulcer, fall and phlebitis, by completing a computerized form containing factors associated with such risks. 14 After analyzing assistance software described in literature, it was identified that software to be used in UTIC must support all stages of process, possessing, in addition to functionalities related to stages of Nursing process, general functionalities which will support team in ir assistance to inpatient clients. DISCUSSION In discussing this study, it is possible to point out, relevance of this study in presenting innovative facts that will enable definition of scope of assistance software and its initial functionalities, focused on of Process (NP). From this literature review, it was identified importance of developing a decision support system for Nursing care, with objective of supporting of NP, to be used by team working in CICU. Based on this literature review, it was verified that re is a gap related to creation of support systems for decisionmaking in CICU, with objective of supporting entire NP, to be used by team working in that unit. In this sense, it was possible to identify that no job, among ones found in search, contained software that supported decision making in all stages of NP. Thus, emerging need to create softwares that help Nursing to make quick decisions and ideal for each type of treatment performed in CICU, because this is a unit in which speed and precision of actions taken can be decisive when saving a life. It was verified that year 2012 was year that more articles were published (five) that presented software to support decisionmaking for Nursing. Thus, it is well known that re is still much to be studied and disseminated so that Nursing can be a recognized science for using technology when making decisions that qualify caring. This review found five softwares that included CIPE language. The literature indicates that software to support process, using CIPE as reference, terminology contributes to organization and nurses' clinical reasoning in care process, through establishment of a concrete association between clinical evaluations, diagnoses, results and interventions. Likewise, it is affirmed that re is improvement in communication among health professionals, enabling a safer and more efficient care to client and reducing associated errors It should be emphasized that data suggested by system must be evaluated by nurses in sector that are using software to accept or refuse m. This, combined with functionality of constructing diagnoses, results and interventions, based on seven axes of CIPE, guarantees clinical reasoning and judgment process of professional; so that software will be an aid to professional and not a replacement of it. Among magazines that published on use of software and Nursing care, it was verified that most have Qualis ranging from A1 to B3 and only one did not have it. However, it is evident that even articles, most of m, having been published in journals classified as A, se manuscripts did not treat EP in its entirety. It is evidenced that most of softwares proposed in literature are not supported by any oretical basis of care proces. So, it is believed that y do not function as an instrument to support safe decision making for nurses. CONCLUSION The analysis of scientific production on identification of specifications of similar systems, in order to discover requirements that must contain a software for Nursing care, object of this study, evidenced importance of creation of clinical decision support systems for assistance of Nursing, which contemplates all stages of process and also, that are supported by some oretical foundation of care J Nurs UFPE on line., Recife, 11(Suppl. 10): , Oct.,

9 The integrative review has proved to be an indispensable tool in search for requirements that will be basis for creation of software with characteristics necessary to provide an individualized and quality assistance without giving up work of nurse. REFERENCES 1. Oliveira CG, Barros KAAL, Oliveira AG. Development of a software prototype to support systematization of nursing care. J Health Inform [Internet] Jan/Mar [cited 03 Jan 2016];2(1):1-6. Available from: 2. Sousa PAF, Sasso GTMD, Barra DCC. Contributions of electronic health recods to safety of intensive care unit patient: an integrative review. Texto contexto-enferm Oct/Dec; 21(4): Doi: 3. Teixeira L, Ferreira C, Santos BS. Usercentered requirements engineering in health information systems: a study in hemophilia field. Comput Methods Programs Biomed June; 106(3): Doi: /j.cmpb Vries AE, Van der Wal MH, Nieuwenhuis MM, Jong RM, Van Dijk RB, Jaarsma T, et al. Perceived barriers of heart failure nurses and cardiologists in using clinical decision support systems in treatment of heart failure patients. BMC Med Inform Decis Making. 2013; 13(54):1-8. Doi: / Sommerville I. Engenharia de software. 9th ed. São Paulo: Pearson Prentice Hall; Zega M, D Agostino F, Bowles KH, Marinis MG, Rocco G, Vellone E, et al. Development and Validation of a Computerized Assessment Form to Support Nursing Diagnosis. Int J Nurs Knowl Feb; 25(1):22-9. Doi: / Peres HHC, Cruz DALM, Lima AFC, Gaidzinski RR, Ortiz DCF, Trindade MM, et al. Development Eletronic Systems of Nursing Clinical Documentation structured by diagnosis, outcomes and interventions. Rev Esc Enferm USP Dec; 43(2): Doi: 7. Pinto N. Design, and impact of clinical nursing records system PRINCE. J Health Inform [Internet] Oct/Dec [cited 03 Jan 2016]; 3(4): Available from: Santos SR. Computers in nursing: free software application with care and management. Rev Esc Enferm USP June; 44(2): Available from: Hao AT, Wu LP, Kumar A, Jian WS, Huang LF, Kao CC, et al. Nursing process decision support system for urology ward. Int J Med Inform July; 82(7): Doi: /j.ijmedinf Pressman RS. Engenharia de Software: uma abordagem profissional. 7th ed. Porto Alegre: AMGH; Mendes KDS, Silveira RCCP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto contexto-enferm Oct/Dec; 17(4): Doi: Veríssimo RCSS, Marin HF. Prototype of system for nursing documentation in postpartum period. Acta Paul Enferm. 2013;26(2): Doi: Assis MG, Assis MA, Amste FC. Software para o mapeamento dos riscos de Úlcera por Pressão, queda e flebite. J Health Inform [Internet] Dec [cited 02 Jan 2016]; 4(Spe): Available from: Catalan VM, Silveira DT, Neutzling AL, Martinato LHM, Borges GCM. The NAS System: nursing activities Score in mobile technology. Rev Esc Enferm USP Dec;45(6): Doi: Castro MCN, Dell Acqua MCT, Corrente JE, Zornoff DCM, Arantes LF. Computer application with nursing activities score: an intensive care management instrument. Texto contexto-enferm July/Sept; 18(3): Doi: Barra DCC, Sasso GTMD. Mobile bedside technology: computerized nursing processes in intensive care unit from icnp 1.0. Texto contexto-enferm Mar;19(1): Doi: Moreira APA, Amim EF, Souza TM, Queluci GC, Brandão ES, Camacho ACF. The applied informatics in nursing: an integrative review. J Nurs UFPE on line., Recife, 11(Suppl. 10): , Oct.,

10 J Nurs UFPE online [Internet] Oct [cited 11 Jan 2016];7(10):62. Available from: m/index.php/revista/article/view/3064/pdf_ Sasso GTMD, Barra DCC, Paese F, Almeida SRW, Rios GC, Marinho MM, et al. Computerized nursing process: methodology to establish associations between clinical assessment, diagnosis, interventions, and outcomes. Rev Esc Enferm USP. 2013; 47(1): Doi: Submission: 2017/03/23 Accepted: 2017/09/22 Publishing: 2017/10/15 Corresponding Address Isadora Pereira Farias Rua Izenilda Félix de Oliveira, 22 Bairro Tabuleiro dos Martins CEP: Maceió (AL), Brazil J Nurs UFPE on line., Recife, 11(Suppl. 10): , Oct.,