WISECARE Project Networks European Nurses, Promotes Evidence-Based Care

SAN DIEGO, California—The Workflow Information Systems for European Nursing Care (WISECARE) program is using information technology to foster knowledge sharing and to promote evidence-based nursing care among 15 European cancer centers.

Speaking at the Oncology Nursing Society’s 26th Annual Congress, Nora Kearney, RGN, MSc, head of the Nursing and Midwifery School, University of Glasgow, Scotland, and Derek Hoy, RN, MSc, research fellow, Glasgow Caledonian University, Edinburgh, described the development and initial experiences with this ambitious project.

"In Europe, nursing costs account for 40% to 60% of total health care costs. So nursing care is a hugely significant resource," Ms. Kearney said.

But, she added, the relationship between nursing care and patient outcomes is largely unknown. "The information that nurses use in managing patient care is rarely collected to influence practice," she said. "We use the information on an individual-patient basis but rarely exchange that information with our colleagues across the country, much less across Europe. We wanted to change that."

The purpose of the WISECARE project was to evaluate the impact of nursing care on the total quality of patient care in Europe. The goal was to systematically use clinical nursing data stored in electronic patient records for clinical and resource management.

Program developers reasoned that this would encourage a shift in emphasis from individual knowledge to knowledge sharing, which ultimately would lead to improved patient care.

Moreover, they anticipated that the interactive sharing of experiences in the database with other institutions would lead to the development of a knowledge base of "best practices" in nursing care. This, in turn, would allow participants to compare and measure their performances against the "best practices" of other institutions.

Working with the European Oncology Nursing Society, WISECARE developers set out to design a workflow information model that would quantify patient diversity, variability of care, patient outcomes, and nursing resources in cancer care centers across Europe. The initial validation sites were in the United Kingdom, Belgium, the Netherlands, Finland, and Greece.

After examining clinical priorities in the oncology setting, the WISECARE team chose fatigue, pain, nausea and vomiting, and oral care as the focus of their validation project. These clinical outcomes were examined with validated and reliable assessment tools during the 10 days after chemotherapy or surgery.

In addition, to aid nurse managers in resource management, information on nursing staff intensity, number of hours worked, and the qualification level of the staff was collected on a random day each week.

WISECARE encompassed both informal and formal networking and information exchange. State-of-the-art technology, such as natural coding systems, advanced statistical data analysis, multimedia presentations, Lotus Notes networks, CD-ROMs, and World Wide Web servers, were used to collect and process data and provide feedback information.

"We saw the project from a technological view as being clinical networking in its widest sense," Mr. Hoy said. "It was about building relationships among people in different countries, from different cultures, and with different languages. The expectation was to bring these people together and establish a dialogue, with the end result hopefully being knowledge sharing."

Email, a website discussion board, and similar networking tools helped facilitate this informal interaction among nurses at distant sites. The more formal networking, however, required the development of a variety of new software programs. The functional requirements for this software were the ability to collect data, transfer that data in a secure and confidential way, and provide feedback to the users, Mr. Hoy said.

The final project tools included the following:

• WiseNet and WiseWeb (the communication tools including all links, protocols, and benchmarks).

• Wise2 (the "knowledge server" for nausea and vomiting, fatigue, pain, and oral care, which contains information on patient risk assessment, symptom profiles, measurement scales, and disease management).

• WiseCompass (the tool that analyzes the effect of implementing WISECARE technology).

• WiseLink (the import/export function that allows access to electronic patient records).

The WISECARE team also developed a WISECARE Simulation Game to be used as a demonstration package for explaining the capabilities and benefits of using WISECARE technology.  

Clinical results documented in the first phase of the project were a 53% decrease in nausea and vomiting from baseline; an 18% decrease in pain; a 25% decrease in fatigue; and an 18% decrease in oral problems. At one center, none of the nurses were managing fatigue before they became involved in WISECARE.

WISECARE encourages a focus on effectiveness and outcome by measuring and benchmarking, Ms. Kearney said, and it challenges nurses to work in a more structured way.

Nurses expressed improved job satisfaction from being part of a large European network, and from the increased interaction with nursing colleagues. Moreover, the program makes the process of nursing more visible and empowers nurses with tangible data on nursing care and patient outcome. These data also can be used as an educational tool.

Finally, WISECARE has been an important tool for nurse managers in dealing with nurse workload, staffing, and budget decision-making by quantifying nurses’ contributions to health care.

Future goals for the WISECARE project are to expand the network, develop more clinical indicators, and develop a WISE Knowledge Center with scales, guidelines, and benchmarks.

Ms. Kearney used the analogy of Columbus, who was not the first European explorer to come to North America, but he opened a pathway to a new land. WISECARE, she believes, is opening a new pathway to nursing care that is evidence-based, outcome-driven, interdisciplinary, networked, and benchmarked.