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Revista Uruguaya de Enfermería (En línea)

Print version ISSN 2301-0371On-line version ISSN 2301-0371

Abstract

HERNANDEZ, Uber Zalmen Amador. Design of Electronic Record Model for the Development of the Nursing Discharge Plan. Revista urug. enferm. (En línea) [online]. 2023, vol.18, n.2, e203.  Epub Dec 01, 2023. ISSN 2301-0371.  https://doi.org/10.33517/rue2023v18n2a5.

The current scenario of transition towards digital registration in Uruguay is an opportunity to design interoperable standards that facilitate and optimize registration time, to propose them in the Electronic Medical Record, thus contributing to the development and visibility of the discipline and the strengthening of state policies.

Objective:

was to design an electronic record model of Professional Nursing Care Management at discharge.

Material and methods:

a quantitative study was carried out, for the consensus and validation of contents by experts applying the Delphi technique. The experts who participated were professionals linked to the electronic registry, National and International, residing in Latin America and the Caribbean. Through an online questionnaire, the information from the experts was collected, obtaining consensus in the second round of responses, this process covered the first and second semester of 2019.

Results:

variables were proposed for the process and its form of registration electronic, the first round was carried out with 61 % approval of the proposed variables (X= 1 - 1.16/ Dst=0.00 - 0.04), 11 % were excluded (X= 1.4/ Dst=0, 63) and 28 % required reformulation (X=1.2/ Dst=0.49).

Conclusion:

A Nursing discharge plan model was built containing 25 variables and its electronic record form.

Keywords : Medical Records; Patient Discharge; Electronic Health Records.

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