Technology in healthcare is forever changing and becoming advanced about patient care efficiency, improved safety, the development of medical equipment, and new software for data systems. According to McGonigle, & Mastrian (2017), nursing informatics is a specialty in nursing that integrates into nursing science, computer science, and science to help communicate and manage data and increase nursing knowledge into practice. These days, most healthcare information is the use of electronic database systems that include all the patient's health information. Forman, Armor, & Miller, (2020). All nurses are responsible for learning the database system in which their facility uses to achieve better communication and improve patient care efficiency.
The scenario I choose for this discussion is an 86-year-old female I admitted to the med surg unit with a stroke-related diagnosis to right side weakness, blurred vision, and slurred speech. The patient is connected to a heart monitor that shows a heartrate of 175 and a blood pressure of 189/110; the patient is alert and oriented and rates her pain 0/10. Moreover, this patient has three admissions to our floor in the past year; she has a past medical history of hypertension, diabetes type 1, high cholesterol, and a previous stroke in 2017 with no deficits from it. The patient has received a CAT scan and MRI to rule out hemorrhage or ischemic stroke.
The CAT scan results show a negative hemorrhage stroke but positive for an ischemic stroke in the left hemisphere. Since the patient waited a day to come to the Emergency Room, she is not a TPA; she will stay admitted on the med surg unit for a few days to receive numerous tests. On the other hand, a 12 lead EKG is performed that shows normal sinus rhythm; the carotid echo is done, which shows a 75% blockage without normal blood flow. Also, a doppler was performed, and results show a DVT in the patient's left leg; orders are given to start the patient on a heparin drip.
On day two, our female patient is vomiting and complains of a migraine, all vitals are within normal limits, but the doctor ordered a repeat CAT scan. The scan showed cranial bleeding, and the doctor was notified and ordered the heparin drip to be discontinued immediately. The patients were transferred to the Intensive Care Unit. The doctors and nurses can look up the patient's medical record; in this case, using the database helped the staff look up the patient's information and treat them accordingly. According to Naik, Voong, Bamford, Smith, Joyce, & Grinspun (2020), Using this information, we as healthcare professionals can enhance patient care delivery and safety and provide positive outcomes for our patients.
Forman, T. M., Armor, D. A., & Miller, A. S. (2020). A Review of Clinical Informatics Competencies in Nursing to Inform Best Practices in Education and Nurse Faculty Development. Nursing Education Perspectives, 41(1), E3–E7. https://doi-org.ezp.waldenulibrary.org/10.1097/01.NEP.0000000000000588
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
Naik, S., Voong, S., Bamford, M., Smith, K., Joyce, A., & Grinspun, D. (2020). Assessment of the Nursing Quality Indicators for Reporting and Evaluation (NQuIRE) database using a data quality index. Journal of the American Medical Informatics Association, 27(5), 776–782. https://doi-org.ezp.waldenulibrary.org/10.1093/jamia/ocaa031
Response
Wow, what a scenario! I read a post by Joy, and she mentioned that human error, machine error, transmission errors, and malware are four key threats to data integrity and must be taken into account when applying to healthcare practices (Mcgonigle & Mastrian, 2017), and I think that because we have access to the internet does not mean that it is right all the time, sadly. But, having a database that contains a lot of the information we need is so important. I also think that our number one priority as healthcare workers is to ensure that our patients are healthy and safe, just like you mentioned in the last sentence.
As for the idea that all nurses are responsible for learning the database, I completely agree! I think that we must be reliable for our own actions. Hughes (2008) says that as the largest health care workforce, nurses apply their knowledge, skills, and experience to care for the various and changing needs of patients. A large part of the demands of patient care is centered on the work of nurses. When care falls short of standards, whether because of resource allocation (e.g., workforce shortages and lack of needed medical equipment) or lack of appropriate policies and standards, nurses shoulder much of the responsibility.
Reference:
Hughes RG. Nurses at the “Sharp End” of Patient Care. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 2.
Mcgonigle, D., & Mastrian, K. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Jones & Bartlett Learning. https://doi.org/bookshelf.vitalsource.com/#/books/97812
Discussion: The Application of Data to Problem-Solving
In the modern era, there are few professions that do not to some extent rely on data. Stockbrokers rely on market data to advise clients on financial matters. Meteorologists rely on weather data to forecast weather conditions, while realtors rely on data to advise on the purchase and sale of property. In these and other cases, data not only helps solve problems, but adds to the practitioner’s and the discipline’s body of knowledge.
Of course, the nursing profession also relies heavily on data. The field of nursing informatics aims to make sure nurses have access to the appropriate date to solve healthcare problems, make decisions in the interest of patients, and add to knowledge.
In this Discussion, you will consider a scenario that would benefit from access to data and how such access could facilitate both problem-solving and knowledge formation.
To Prepare:
- Reflect on the concepts of informatics and knowledge work as presented in the Resources.
- Consider a hypothetical scenario based on your own healthcare practice or organization that would require or benefit from the access/collection and application of data. Your scenario may involve a patient, staff, or management problem or gap.
By Day 3 of Week 1
Post a description of the focus of your scenario. Describe the data that could be used and how the data might be collected and accessed. What knowledge might be derived from that data? How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?
By Day 6 of Week 1
Respond to at least two of your colleagues* on two different days, asking questions to help clarify the scenario and application of data, or offering additional/alternative ideas for the application of nursing informatics principles.
Informatics is blending technology and information to create a useful tool to deliver high-quality patient care (Laurette Education, 2018). Nurses can use informatics to identify trends, monitor errors, and implement a new patient care system. In my current workplace, one of my job duties is to transfer patients out of the emergency room to another facility that can treat the patient accordingly.
It has been a struggle to have specialized providers offer on-call services to the emergency room, resulting in many patients being transferred out of the area. One of the concerns for transferring patients out of the area is the patient's cost and the loss of reimbursement from the patients' health insurance policy.
My department would conduct quarterly meetings with the Medical Director for the emergency room, where we analyze all transfers. During these meetings, transfers are analyzed to determine the need for the transfer and can the hospital make changes. By analyzing the data and showing supportive evidence to identify the need for specialized providers, this will decrease the number of emergency room transfers and help increase hospital revenue.
The next step is looking at the hospital budget to see how much the hospital can afford to offer on-call specialized providers. We currently are dealing with urology providers who do not want to do their on-call schedule due to the high number of COVID-19 patients in the hospital. This is resulting in an overwhelming number of urology transfers. The Medical Director any my department is trying to resolve this issue. One option my department wants to discuss at the next meeting is using another urology group, but we are not involved with the hospital budget to see if this is something the hospital can financially afford. The hospital is currently transferring at least one urology case every day, and the hospital is not providing the public with the resources they need.
Nursing informatics was first established in 1988 (Cummins et al., 2016). Nursing informatics is becoming a common practice in healthcare. Nursing informatics has grown interested and has been recognized at the local jurisdictions, and also on the national and international level; nursing informatics is in every part of the clinical nursing setting (Nagle et al., 2017). Nursing informatics has evolved into part of the daily duties of a nurse.
References
Cummins, M. R., Gundlapalli, A. V., Murray, P., Park, H. A., & Lehmann, C. U. (2016). Nursing Informatics Certification Worldwide: History, Pathway, Roles, and Motivation. Yearbook of medical informatics, (1), 264–271. https://doi.org/10.15265/IY-2016-039
Laurette Education (Producer). (2018). What is Informatics? [Video file]. Baltimore, MD: Author
Nagle, L., Sermeus, W., & Junger, A. (2017). Evolving Role of Nursing Informatics Specialist. In J. Murphy, W. Goosen, & P.Weber (Eds.), Forecasting Competencies for Nurses in the Future of Connected Health (212-221). Clifton, VA: IMIA and IOS Press. Retrieved from https://serval.unil.ch/resource/serval:BIB_4A0FEA56B8CB.P001/REF
sample 3
A hypothetical scenario, based on my own healthcare practice, that would benefit from the collection and application of data would be at a Military Psychiatric Hospital. According to the U.S. Government Accountability Office, 2.1 million veterans received mental health treatment from the U.S. Department of Veterans Affairs in the five year period from 2006 through 2010 (National Veterans Foundation, 2018). The 34 year old male, brought into patient access (triage), has been in the Air Force for 10 years. He was brought in on a voluntary basis by his Commander. The active military patient has a diagnosis of Major Depressive Disorder, and had a recent suicide attempt by overdosing on Wellbutrin. Wellbutrin is used to treat Depression, as well as certain other mental disorders.
Upon assessment, data was collected, which included the patient’s vital signs and medical history. The vital signs which were taken was entered and updated in the medical records. This important data was used to compare the patient’s baseline for normal versus abnormal. Labs were obtained, which were also compared with the patient’s prior hospital admission. All of the vital information obtained were aimed at providing clarification of the patient’s current health status upon admission.
A Nurse leader can utilize clinical reasoning and judgement in the formation of knowledge from this experience by 1st anticipating the patient’s needs and prioritizing them of the most critical. A Nurse Leader needs to preform an ongoing assessment of the patient during his stay. Clinical reasoning can be utilized to check, recheck, and check again in regards to the patient to ensure safety. We must remember that the purpose of reasoning and decision making is to make decisions based on objective evidence and intuition about actions to be taken to be treated as immediately as possible or actual physiological deterioration in patients and to collaborate with medicine to manage such deterioration (Douglas, 2018).
National Veterans Foundation. (2018, July 26). Veteran Mental Health - Facts and Stats that need to be Addressed. Retrieved September 02, 2020, from https://nvf.org/veteran-mental-health-facts-statistics/
PTSD Screening. (n.d.). Retrieved September 02, 2020, from https://www.myhealth.va.gov/mhv-portal-web/ptsd-screening
Douglas, L. (2018). Clinical Reasoning and Decision-making. Retrieved September 02, 2020, from https://www.carefulnursing.ie/go/overview/professional_practice_model/practice_competence_excellence/clinical_reasoning_decision_making