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Unit 5 Nursing Issues Computer in health care delivery and nursing Computer science in nursing practice The informatics nurse combines nursing science with information management science and computer science to manage information nurses need and to make that information accessible. This field encompasses the full range of activities that focus on information management in and assists nurses to carry out the work of nursing efficiently and effectively. Benefits of clinical information systems include improved patient safety, reduction in variability of care, improved communication, improved clinical decision making, and increased efficiency of staff. IT refers to a variety of computer-based applications used to communicate, store, manage, retrieve, and process information. Nurses assumed much of the responsibility for data entry and retrieval with the development of this technology. Computers are common on nursing units and at the bedside, and most hospitals have at least some degree of computerization of the medical records. One goal in health care reform includes going “paperless,” that is, that all medical orders, patient records, and other documents will be digitally stored and available for convenient transmittal across various record systems and health care facilities. Any other care provider can access data at any time, as opposed to the single hard copy chart that only one person can view or use at a time. In some health care organizations, nursing information systems are handheld, allowing nurses to enter and access data about the patient directly from the patient’s side, whether in an inpatient, outpatient, or home setting. This type of technology allows for more timely documentation of care, and because documentation is done at the time of care, the information is likely to be more accurate. This convenience can come at the expense of patient privacy, and the privacy and confidentiality of patient information is both an ethical and a legal issue Knowledge technology is described as “technology of the mind.” It involves the use of computer systems to transform information into knowledge and to generate new knowledge. Through the creation of “expert systems,” this form of technology assists nurses with clinical judgments about patient management problems. An example of knowledge technology includes medication administration carts that prompt the nurse for data needed before giving a particular medication. Nurse clinicians and nurse leaders should play a role in developing these mechanisms to maximize their effectiveness in improving nursing care and patient outcomes. In addition, high-fidelity human simulation mannequins are gaining popularity in schools of nursing They make it possible to simulate a clinical event such as a cardiac arrest, pneumothorax, or even childbirth, allowing the student to practice clinical assessment and intervention skills. One of the benefits of computerized expert systems is that they can provide practice in decision making for novice nurses and nurses who may be working outside their area of expertise without increased risk to a patient. Technologic advances now allow nurses to monitor their patients’ conditions on computer screens at remote sites. Without even seeing the patient, nurses can gather large amounts of information and make nursing decisions based on that information. As nurses rely more on technology, they may actually spend less time with the patient, creating dissatisfaction on the part of patients and families. The use of technology must be applied carefully and never take the place of human-to-human contact and interaction. Successfully combining technology and caring requires sensitivity to patients’ physical, emotional, and spiritual needs. This has always been a part of nursing’s skill set. Applications in use by nurses : Clinical Systems Nurses use a variety of clinical systems, including the EHR, as they care for their patients. The most commonly used today are as follows: ? Computerized Provider Order Entry (CPOE) allows the direct entry of orders by prescribing clinicians, including verbal orders entered by nurses. The typical orders entered address medications, laboratory, radiology, nursing, and dietary needs, as well as orders for various consults. Nurses may receive work lists generated from these orders that are ultimately interventions based on patient condition. For example, an order set may generate a nursing order of “Assess for Falls Risk” or “Monitor for Falls Risk.” Nurses must decide exactly what interventions this order entails. ? Nursing Documentation allows the entry of nursing assessments, diagnoses, and interventions (which may originate from the CPOE). Documentation systems should permit the capture of the outcomes obtained by nursing actions when nurses reassess patients. ? Electronic Medication Administration Records (eMAR) are generally a by-product of the medication ordering function of CPOE. The eMAR should allow for the online documentation of medications administered along with any required parameters such as blood pressure, heart rate, pain level, or psychological state. Administrative Systems At present, nurses commonly use several administrative systems. Why are these of significance? With the need to be able to correlate nurse staffing ratios, nursing educational backgrounds, licensure types, and certifications with patient outcomes from within a hospital or unit, it is imperative that nurse managers and nurse researchers have the ability to compile data not only from clinical systems but also administrative systems. Here are but a few with which nurses may currently interact. ? Staff Scheduling Systems: allow nurses to enter their preferred days and times to work within allowable defined parameters. Scheduling systems permit managers to determine staffing levels and skill mix necessary to care for the patient population at hand in near real time. ? Human Resource Systems: maintain demographic data, but they also may contain data on education level, licensure types, and certifications earned. This data along with patient discharge diagnoses and length-of-stay data may be used to look at the impact of various nurse staffing patterns with patient outcomes. ? Modular Online Educational Software : is often used to conduct annual competency training. Online education also can be use to provide staff with various learning opportunities, including information technology and informatics competencies. Online education is a convenient way for nurses to update skills. Advantages and Disadvantages of the Paper Record Advantages • People know how to use it. • It is fast for current practice. • It is portable. • It is unbreakable. • It accepts multiple data types, such as graphs, photographs, drawings, and text. • Legal issues and costs are understood. Disadvantages • It can be lost. • It is often illegible and incomplete. • It has no remote access. • It can be accessed by only one person at a time. • It is often disorganized. • Information is duplicated. • It is hard to store. • It is difficult to research, and continuous quality improvement is laborious. • Same client has separate records at each facility (physician’s office, hospital, home care). • Records are shared only through hard copy.