USING THE PEN-AND-PAD INFORMATION MODEL TO SUPPORT HOSPITAL-BASED CLINICAL CARE

The PEN&PAD model for clinical record systems has been successfully us ed for medical records in both General Practice and hospital-based car e. This paper describes experiences of using the model for developing computer-based nursing records. Results from this work show that there are some problems with directly applying the model to the nursing dom ain. Whilst the main purpose of the nursing record is to document and communicate a patient's care, it has several other, possibly incompati ble, roles. Furthermore, the structure and content of the information contained within the nursing record is heavily influenced by the need for the nursing profession to visibly demonstrate the philosophical fr ameworks underlying their work. By providing new insights into the pro fessional background of nursing records, this work has highlighted the need for nurses to clarify and make explicit, their uses of informati on, and also provided them with some tools to assist in this task.