Research and data collection are an important part of identifying problems and solutions to improve practice. Nursing research specifically has a huge impact on future practice and policy as the research is often focused on promoting optimal nursing care (Tingen et. al., 2009). The scenario that I chose which would benefit from data collection is the process of obtaining blood cultures, as it relates to preventing and identifying contamination. I believe that conducting a study where data collection would occur by comparing baseline contamination numbers as the control, with a group using sterile technique to obtain cultures as the experimental group would be beneficial to guiding future practice within my healthcare organization. Bram et. al. (2021) concluded in their study that sterile blood culture technique is an effective method of preventing contamination. The other issue which would need to be studied with this method is the possible increased cost which could occur when using more supplies to obtain blood cultures with sterility, which could outweigh the positive effects. This study would need to be a two-part study or have multiple groups so that there could be a control group and an experimental group. Information would be collected on how many contaminated blood cultures occur with each method, and then compare the findings. Cost would also need to be calculated with both scenarios. The technique which had the lower number of contamination, and/or the lower cost could then guide future practice. The nurse leader would use the knowledge acquired and generated from this study to determine the validity of the research by analyzing the research design and methods, and the applicability of the findings to the given population (McGonigle & Mastrian, 2022, p.579). The nurse would then disseminate the information to other colleagues for help processing, to find the best way to integrate this information into future practice.
Informatics and Knowledge Work
Description of scenario
Informatics is a field involving the collection, analysis, and application of data to solve issues in nursing practice or facilitate more effective delivery of healthcare. Preventing adverse drug-to-drug interactions is one scenario where data can be applied with great effect. I have noted that patients admitted to our facility receive numerous medications. On an individual basis, each of the medications is intended to facilitate treatment as an antibiotic, anti-inflammatory, steroid, or for pain management. Sometimes, patients receive medications they are unknowingly allergic to, or the medications themselves interact to yield poor health outcomes. Drug-drug interactions (DDIs) occur after medication administration and can manifest through diminished effectiveness, withdrawal symptoms, poor drug tolerance in patients, drug-seeking tendencies, seizures, gangrene, delirium, arrhythmia, or even death. It is inarguable that drug-drug interactions compromise patient safety and lead to increased length of hospital stay and medical costs (Zheng et al, 2018). As such, this discussion looks into the application of data for DDI prevention.
Data collection assessment and use
Even though nurse practitioners have a fair understanding of pharmacology, DDIs remain prevalent for several reasons. Some prescribers lack sufficient information and underestimate the risks of drug-drug interactions. Also, DDIs are difficult to recognize when they are intermittent or seem to be symptoms of an illness (Matters, 2015). Prescribers may lack awareness of all medications a patient is currently on. Medication safety is a concern that technology companies recognize and have invested in to create electronic prescription assistance programs. Notably, computerized information systems can access vast databases of information and are faster than a human being at making matches between drugs and adverse events. These systems, however, have limited usability, and inconsistent performance, and produce alerts of uncertain clinical relevance (Matters, 2015). In addition, the systems often fail to correlate the multiple drug types that patients often receive at the hospital. Consequently, serious DDIs still occur.
One of the areas where informatics can be helpful is in the collection and cataloging of drug-drug interactions based on a patient’s history, co-morbidities, and medications used. Understandably, pharmaceutical companies research DDIs and avail this information to prescribers and developers of medication administration systems (Grissinger, 2016). However, the data supplied comes from laboratory testing and lacks the depth that is derived from use in diverse settings and populations such as those we work with at the hospital. I would recommend the use of the case for the extension of data collection, classification, and utilization of drug-drug interaction.
Data and Knowledge Work
The data collected in my scenario is data on medication types, usage rates, patient biometrics, co-morbidities, and observed drug-drug interactions of any kind. This particular use of informatics in the clinical setting is informed by the understanding that given a large enough population of patients, disease types, treatments, and patient traits can be organized in sets from which nurse practitioners can garner insight into the likelihood of this. The data collected would be richer and more informative than the alerts thrown up by current electronic systems. The nurse leader would use the knowledge gained and generated from this study to assess the research’s validity by looking at its design, methodologies, and application to the target population. (McGonigle & Mastrian, 2022). This understanding would inform practitioners’ clinical judgment and reasoning on which medications to use and which to avoid depending on patient traits, co-morbidities, and drugs already in use (Matters, 2015). In such a scenario, informatics would truly effectively serve the function of supporting clinical decision-making and not simply as an alert mechanism.
Nursing information (NI) incorporates computer science and information science to communicate data in nursing practice. (McGonigle, D., & Mastrian, K. G. (2022), not only in nursing but Medicine in general constantly evolves with new technologies. (Walden University, LLC. (Producer). (2018).
Paper charting to EMR, such as Epic allows you to filter the information you need to see within seconds of clicks. EMR system has allowed providers to offer knowledge management systems (KMSs) to our patients, which entails knowledge, including assessments, diagnoses, and interventions to form clinical decision-making for each patient. (McGonigle, D., & Mastrian, K. G. (2022). For instance, the program has allowed healthcare professionals to communicate better, such as preventing us from a redundant workload and creating an efficient filing system. For example, a nurse taking care of a cardiology patient with baseline chronic problems of endocrinology issues can filter different specialties’ notes and procedures to keep a better general picture of a patient for quality nursing care. Such advancement has allowed healthcare professionals to deliver safe care to our patients. For example, in the Epic, the avatar icon allows nurses and doctors to mark things like drains and wounds, enabling better communication within the system. When dressing changes need to be done by a nurse, a nurse can easily access pt avatar and see the general picture of the patient before going into a room instead of scrolling on the flowsheet to find which areas need to be dressed. Having a patient-representative avatar helps us have a better overall picture of our patients. Another excellent informatics event I have witnessed within Epic is the secure-chat option. The secure-chat option allows healthcare professionals to communicate better regarding patient care instead of the classic paging system. It is incredible to see how informatics has shaped our healthcare system positively. With the advancement of informatics technologies, patient access and communication are within the tips of our fingers. Advancing nursing informatics is crucial in providing the best practice to our patients, and nurses are the core group in any healthcare facility. Nurses influence the policies and management infrastructure and support within a healthcare system. It’s hard to imagine the advance in informatics without the help and contributions of nurses. (Nagle, L., Sermeus, W., & Junger, A. (2017).
I have spent a lot of my career working in surgical services, specifically PACU. If you have ever had surgery, you might remember being told not to rub your eyes over and over again as you wake up. But despite the PACU staff reminding patients of this, they still may develop a corneal abrasion. While these injuries typically heal overnight and don’t have long term complications, they are still an injury that resulted from surgery. Collecting data on this and trending potential causes I feel could help minimize the incidence. In fact, others felt the same way because corneal abrasions account for 3%-8% of anesthesia related malpractice claims (Moos & Lind, 2006). In the study conducted they were only able to determine the exact cause in only 10% of the cases (Moos & Lind, 2006). As a nurse leader in surgical services, I would want to collect this data to see what additional interventions could be utilized to protect the patients. To collect the data most hospitals, require an incident report be filed on every corneal abrasion. I would gather all the cases that had an abrasion then would look for the following information; type of surgery, type of anesthesia, positioning of the patient, any comorbidities or known eye issues, what phase of surgical care the abrasion was noted, surgical team members. By doing this I would be able to notice the trends of when they are occurring. If majority of injuries happen during a trauma, or if the patient is in a prone position, or if a specific staff member shows up. After getting a better feel for common themes I could then further implement changes or change practices. For instance, if a CRNA shows up often it could be as simple as seeing how they manage the patient in the OR, for example are they taping eyes shut or using eye lubricant or not. For specific positioning maybe different equipment or headgear could be used to better protect. Maybe starting eye drops in the pre-operative area would decrease risk of an abrasion by ensuring hydrated eyes prior to surgery. I think a lot of prevention in surgical complications should start before a patient ever comes into a hospital, through education and interventions prior to surgery. Much like they started implementing patients drinking protein like drinks leading up to surgery to promote healing, maybe prophylactic pre-operative eye treatment should be considered also. Data collect and evaluation on this topic could lead to great insight on preventative measures for nurse leadership.
Informatics and Knowledge Work
Nurses have the opportunity to address the needs of the ever-changing healthcare systems. Nursing informatics defined by The American Nurses Association (ANA) is combining the nursing science with technology and patient care (Backonja et al., 2021). A nurse could use their nursing skills with data to ultimately improve patient care. In the past the information in healthcare has doubled every hundred years up until 1900’s, then started doubling every 18 months and now the information is even faster. For nurse’s this means by the time you finish school the information you learned could be out of date (Murphy et al., 2017).
I am currently a nurse navigator for a gynecology/oncology department. I was able to develop a distress screening tool that was uploaded into our electronic charting system to evaluate the level of distress a patient is experiencing on a new patient start. I was then able to educate and train the medical assistants to input the data into our electronic charting system. The criteria for the screening if scored above a level 7 then triggers a referral to the nurse navigator. The nurse navigator then evaluates the need for appropriate referrals for the patient depending on what is causing the distress, behavior health, nutrition, financial, etc.
Given the higher chances of oncology patients having psychosocial and psychiatric concerns during their oncology experience it has become mandatory to screen for them. The screening process is useful to perform at the beginning of their cancer care (Donovan et al., 2020). The data that the healthcare system can collect, track and manage will assist in the proper referrals for the cancer patient at the beginning or throughout their care (Donovan et al., 2020). As nurses become more knowledgeable at utilizing data, they have the ability to advocate for their patients and improve their outcome (McGonigle & Mastrian, 2022).
Concepts of Informatics and Knowledge Work
I can reflect on a scenario such as more efficient and effective access for teaching education by the nurse to the patient. This would also benefit access to data while facilitating problem-solving and knowledge formation. A patient hospitalized becomes interested in their health condition, which is newly diagnosed, and requests information regarding the health condition and how to manage it outside at home. The nurse becomes frustrated because the health information appropriate for the patient is difficult to find in the hospital computer system. Many different searches must be done to find individual patient education for each disease and illness. One way educational data could be accessed is through a healthcare application on an I pad or smartphone, which can be used for each patient and includes videos along with reading material for each diagnosed patient’s health condition. With one touch on the correct patient condition, all educational information and videos would be available for viewing, listening, or reading. The I pad or smartphone could be brought to the patient’s room for easy access to nurse-to-patient teaching regarding conditions such as heart disease. A touch screen with a fast and efficient data application for both nurse and patient would benefit from knowledge derived from the data. Digital health, such as smartphones, has been used in healthcare to provide quick communication, and a healthcare application can provide answers to questions about disease or illness and home care advice (Grys, 2022).
Efficient access to patient education will increase the knowledge of the patient and create a better understanding of what they may need to do at home to prevent unsafe situations. The data on the I pad or smartphone for patient education may prevent medication errors and dangerous drug interactions at home. This empowers the patient to understand and gain better knowledge of how to provide safe self-care at home. Nagle et el. (2017) noted that “Information and continuity consist on the one hand in the exchange and transfer of information among health care providers and to patients and on the other hand how the knowledge of the patient is accumulated” (para. 3.3). The right knowledge through education of proper patient care provides evidence-based practice for the nurse from a reliable source to empower the patient with self-care.
A nurse leader can use clinical reasoning and judgment to form knowledge from this experience of using rapid and easily accessible education and data on a mobile device. Clinical reasoning can help the nurse to understand and critically think through the patient illness to implement safe interventions leading to safe outcomes for the patient, all the while teaching patient education utilizing the health application. Computer science and technology utilized in nursing practice can create strong knowledge and skill and can be applied in ways that help nurses gain the power of the data and information collected (McGonigle & Mastrian, 2022). Gaining power and knowledge through digital health applications can also contribute to effective judgment in patient care because it can improve the health of the population with easy access and visualization, which can engage patients in accountability with care at home.
Benefits of Data in Clinical Practice
Mrs. Jones, a patient in a nursing home, has a history of diabetes, kidney disease, chronic pain, and dementia. Her nurse noted Mrs. Jones to be clutching her abdominal area. Due to her advanced dementia, Mrs. Jones cannot adequately verbalize her pain or discomfort. As the day progressed, Mrs. Jones became more lethargic and increased her physical indications of distress. She was noted to have bloating in her stomach. She was sent to the Emergency Room, where she was reported to have a significant bowel obstruction resulting in surgery and hospitalization. The nursing home staff could not note the resident’s last bowel movement.
Data of Benefit
In this situation, they know it would have been beneficial when Mrs. Jones had her last bowel movement. Most electronic health record (EHR) systems in long-term care can record each resident’s daily elimination patterns. The certified nursing assistant (CNA) records the data within the EHR when the resident has a bowel movement. Within each system, alerts can then be set to notify the nurse if a bowel movement has not occurred within a designated period (Cavalier et al., 2022). This information would then allow the nurse to use her knowledge of the digestive system to implement the physician’s order for a PRN laxative to prevent complications from lack of a bowel movement (McGonigle & Mastrian, 2022).
Failure to prevent large bowel obstructions in older adults in nursing homes can prove fatal. Many residents face high-risk factors for bowel obstruction, including reduced liquid intake related to diminished thirst, chronic consumption of pain medication, and inability to verbalize discomfort in the early stages of the crisis. Surgical interventions can correct obstructions, but many residents are not candidates for surgical interventions due to other comorbidities (Perrone et al., 2018). Therefore, we must utilize our providers’ resources to prevent such catastrophes.
As a floor nurse in an urgent care center, I retrieve prescription medications from an on-site pharmacy that are then dispensed to patients by a provider. With over 100 prescription drugs available, more than half are antibiotics in various forms and dosages for adults and children. Since the center has laboratory and x-ray services, patients commonly seek treatment for suspected urinary, respiratory, skin, and ear infections. Often expressing their desire to be given an antibiotic even before undergoing tests to detect bacteria in blood, urine, or lungs. Even after the lab and radiology results return normal or negative for bacteria, patients continue to insist, and providers eventually oblige. Patient pressure, patient satisfaction, and time constraints were identified as some factors influencing antibiotic prescribing practices in a brief by the PEW Charitable Trusts (2017).
Antibiotic resistance occurs when previously successful antibiotics become ineffective in killing bacteria. The incidence is not known until after a patient has been treated with an antibiotic and the symptoms worsen, likely resulting in hospitalization (Cleveland Clinic, 2021). Implementing stewardship interventions, such as delayed prescriptions, technology prompts, and education and training, are necessary to curtail inappropriate antibiotic prescribing practices and use (PEW, 2017). In conjunction with these methods, if a point-of-service laboratory test were available to detect antibiotic resistance in a patient, identifying which antibiotics will be ineffective in the patient, this would improve patient safety by minimizing hospital admissions due to infections and also reduce inappropriate prescribing practices. No matter the treating facility or provider, patients would know their antibiotic resistance status and inform any future prescriber in the same way drug allergies and current medications are disclosed. Through nursing intervention, regardless of practice location or specialty, patients would understand the significance of antibiotic resistance as a medical condition and how critical it is to maintain a healthy lifestyle to reduce the likelihood of an infection. In a questionnaire study by Seipel et al. (2021), education levels correlated with a patient’s understanding of appropriate antibiotic versus over-the-counter medication use, especially in treating respiratory infections caused by viruses. Knowing a patient’s antibiotic resistance status allows nurses to reduce the pressure on prescribers to inappropriately order antibiotics without clinical evidence.
Informatics nurses play a crucial role in guiding the effective use of technology and incorporating content for nurses and other clinicians across various settings and areas of technology innovation. The scenario I want to discuss is vascular access infection in patients on hemodialysis, particularly patients with perm catheters. Sepsis is a significant health problem leading to increased hospitalizations, morbidity, mortality, and a financial burden to the healthcare system. According to the National Kidney Foundation 2006; Pisoni, 2005, the incidence of morbidity and mortality related to dialysis access is higher in the catheter group compared to patients with graft and arteriovenous fistula.
The Guidelines for preventing Intravascular Catheter-Related Infections have been developed for practitioners who insert catheters and persons responsible for surveillance and controlling infections in hospitals, outpatients, and home healthcare. Once it is documented in our unit, the hemodialysis patient shows signs and symptoms of infection like chills, with or without fever, noted with pus, or discharged in the catheter site. The nurse should draw the blood culture per our unit protocol and report to the doctor; some doctors order IV antibiotics immediately as initial prophylaxis, and some doctors will wait for the blood culture result. Technology and multimedia integrated into the nursing curriculum promote informatics tools as an integral practice component and increase patient safety (Norton et al., 2006Links to an external site.). Through the advent of technology, the nurse can easily browse the patient history, the problem that occurred, and the management that has been done. Look for the ordered medication and finally follow up on blood culture results without going to the lab room and seeing the critical value. Immediately phone the ordering clinician as soon as possible without delay; thus, it improves the nursing management outcome.
The Nurse leader can use clinical reasoning through evidence-based guidelines; catheter-related infections are life-threatening but can be prevented. Therefore, it is of great significance to take effective nursing measures to reduce the incidence of vascular access infection in hemodialysis patients, promote their rehabilitation, and improve their prognosis. I think that collaboration with other health team members should be coordinated and communicated to maintain continuity of care. Well-organized programs that enable healthcare providers to provide, monitor, and evaluate care and become educated are critical to the success of this effort.
Clostridioides difficile infection is the primary cause of antibiotic-associated diarrhea and one of the most frequent healthcare-associated diseases in the US. CDC’s Emerging Infections Program (EIP) Healthcare-Associated Infections Community Interface conducts a population- and laboratory-based Clostridioides difficile infection surveillance program (HAIC). The EIP CDI program measures population burden, characterizes disease-associated C. difficile strains and tracks disease trends. The CDI surveillance program supports public health research, including investigations on C. difficile disease risk factors, vaccine priority populations, and preventative strategy success. (“Clostridioides Difficile Infection (CDI) Tracking | HAIC Activities | HAI | CDC”)
My hospital uses defining critical data gathering measures to ensure they don’t lose millions of dollars in reimbursement with the Center for Medicare and Medicaid Service’s (CMS) hospital-onset Clostridium difficile infections (HO-CDI) performance measures.
McGonigle and Mastrian (2022) reiterate the importance of organizations acknowledging their knowledge, represented by their personnel, experience, competency, or know-how, as well as inventive or novel ways. All of these assets rely on a robust information network that incorporates the information technology infrastructure, which is why my hospitals’ nurse-driven protocols prevent C Diff thrive to date.
The hospital staff collects data, but the epidemiologists ratify and evaluate the data collected on all the independent risk variables and then use it to ascertain the need for a C. difficile toxin assay. The data collected for independent risk variables for C. diff infection include: types of antibiotic use, advanced age, extended hospital stays, severe underlying conditions, gastric acid suppression, enteral feeding use, and number of days on mechanical ventilation (Riddle and Dubberke, 2009)
Eventually, the data collected is used to quantify the prevalence of CDI in the population, describe the types of C. diff strains linked to the disease, and track the progression of the disease over time. The CDI surveillance program also serves as a foundation for other types of public health research, such as studies designed to pinpoint causes of C. diff-related illness, target groups for vaccine development, and track the efficacy of preventative measures.
Nursing informatics is a specialization that combines nursing science with a variety of information and analytical sciences to identify, describe, manage, and transmit data, information, knowledge, and wisdom in nursing practice. Nursing informatics specialists are one-of-a-kind, hybrid healthcare heroes. Their work as champions for transformative innovation ensures that patients are safe and at the forefront. Workflows for healthcare professionals are improved due to their contributions and guidance, and best practices in the effective administration of information structures, processes, and technology are followed (HIMSS, 2021). Daily, a nurse informaticist monitors programs, systems, and patient care efforts using data and technology. Employs data analysis to determine what is and is not working to drive programs, make improvements, and bring about change.
Nurse informatics is essential in the creation and maintenance of technological solutions which nurses depend on to give the best possible patient care. Nurses require consistent and rapid access to information like as lab results, past medical history, medication lists, doctor notes, and more to provide safe patient care. A nursing informatics expert is in charge of supervising the data systems that store this information. A nursing informatics expert uses data analytics to increase efficiency and lower the costs of an organization’s nursing operations and utilize information to enhance patient outcomes.
For several years that I have worked in the health care system, I have come to appreciate and acknowledge the importance of Nurse informatics in different departments. The information they give out is essential for management during their planning, organization controlling, and coordinating all activities in the healthcare system. The data given by the nurse informaticists are also vital to the administration staff, nurses, and doctors as they treat, diagnose, and provide medication to the patients. Healthcare organizations use data to make critical decisions about patient care and operational and financial choices. Nursing informatics is a discipline that ensures that this crucial data is acquired, arranged, evaluated, and applied in the best possible manner. As a result, it has the potential to enhance many nursing procedures inside a healthcare institution.
Clinical and IT personnel can communicate more efficiently, thanks to nurse informaticists. They work closely with the other clinical and operational executives to build approaches for health IT procurement, execution, maintenance, and optimization. They are fluent in both technology and health care. They aid in examining patient data and spot patterns and connections that facilitate clinical judgment. Patient safety is valued by nurse informaticists, who also work to improve care and assist clinical nurses. They are dedicated problem-solvers who want to ensure that healthcare practitioners know about the available resources. (ONS Voice,2021).
Leadership in the healthcare facility can play an essential role in helping improve interactions between nurse informatics and other professionals within the healthcare organization. Considering their extensive knowledge of and control over healthcare, leaders or managers are ideally positioned to have an impact on different processes that are implemented in a healthcare organization (Mosier et al., 2019), for example, coming up with rules and regulations and policies that favor interactions between the different departments of healthcare and informatics. Short courses related to informatics can be implemented, and members can be trained to help build strong relationships and help all healthcare providers make good use of the data or information given to them to help improve patient care.
With continued evolution in nursing informatics and the emergence of new technologies daily, global connections between healthcare professionals are being impacted by digital technologies more and more. The prevalence of artificial intelligence (AI) and robotic technology is increasing, as is society’s reliance on mobile devices, the internet, and social media, as well as the rise of telehealth and other virtual models of care (Booth et al., 2021). I also feel that digital technologies, if not well controlled, are an unwelcome distraction from the therapeutic ties and hands-on caregiving that nurses and other medical professionals have with patients and their families as it conflicts with conventional nursing beliefs, like compassionate treatment.
Healthcare practice and the entire healthcare industry thrives on accurate data collection, processing, and interpretation. Access to data in health facilities across different departments and offices is essential to facilitate a streamlined patient service process. In practice, healthcare data is important in both problem-solving as well as the passage of knowledge and information (McGonigle & Mastrian, 2022). My specific scenario of focus as regards healthcare data access, processing, and utilization revolves around medical imaging. Medical imaging is cited as an important component of competent healthcare service delivery. Specifically, radiologists play a vital role when it comes to facilitating patient treatment in healthcare. To ensure accuracy in the data collection, processing, and transmission of radiographic information, radiologists work in a coordinated fashion with other healthcare service providers to collect such information and channel it accordingly to other health service providers (Fatahi et al., 2020).
Among the crucial data involved in the process includes collecting information relating to specific radiology data and information that is needed to facilitate patient treatment. In actual practice, this involves radiologists taking multiple specific images of the body parts of interest. Depending on the condition being diagnosed, different parts, such as full body, bones, and whole-body scans may be focused on. The information collected using specific radiographic formats can then be printed out or stored in electronic formats before being channelled through the recommended methods to the specific healthcare facilities of interest for purposes of coordinating patient care and treatment (Parmar et al., 2018).
In terms of the specific knowledge that is derivable from such radiological data, both radiologists and medical experts who request radiological information and scan data are trained on how to interpret it accordingly. Specific information that can be derived from radiography data includes the extent of disease progression in a specific part of the body, such as the bone or body organs. Such information can be derived from interpreting different aspects of the radiography scans, including the size, shape, positioning, orientation, and color of cells, organs, bones, blood vessels, and body parts (Mabotuwana et al., 2018). The correct interpretation of the radiographic images may also help nurses and medical experts to understand different stages of conditions or diseases, such as cancer (Murphy et al., 2019). In addition, scans of specific organs, such as lungs, can help identify the level of disease progression regarding respiratory conditions, including tuberculosis. Clinical interpretation of the information and data should be based on both subjective and objective opinions consistent with the values of evidence-based practice.
Nursing informatics is defined as an integration of nursing science, computer science, and information science to manage and communicate data in nursing practice (McGonigle & Mastrian, 2022, p.7).
The patient is admitted to the hospital with new onset chest pain that has since resolved. The patient arrives at the cardiovascular unit where the admission process is completed in an electronic medical record (EMR) system. The information retrieved from the patient includes allergies, vaccinations, past medical history, family history, social history including the use of drugs and/or alcohol, current, and past medications, weight, and nutrition/diet/activity level. The patient vital signs are taken which are automatically imported into the EMR system. The patient is attached to a cardiac monitoring system with small electrodes and wires. This cardiac monitoring system allows nurses, physicians, and cardiac/telemonitoring techs to continuously monitor the patient heart rate and rhythm. Throughout the shift, the patient complains of chest pain. A secured chat message is sent to the on-call provider. The provider is able to submit orders into the EMR system without even coming to the unit. Orders to give nitro and perform a STAT ECG is submitted. The medication is taken out of the electronic medication dispensary system. The patient medical ID bracelet is scanned and the medication is scanned in order to prevent medical errors. The patient is given the medication. A 12-lead ECG is performed and submitted. Results from the ECG and imaging of the ECG are automatically saved in the patient’s EMR for the provider to review.
Benefits of data collection
The use of electronic medical/health records in hospitals and other medical facilities has been growing for many years. The use of EMR has made access to medical records more efficient for all providers and hospital staff and improved the quality and safety of care. The use of EMR has increased patient safety and reduced medication errors (Boone, 2010).
A secure chat system allows nurses and providers to communicate safely and efficiently. There is no wasted time or delay of care. The provider is able to receive messages instantly and respond in a quick and safe time frame.
Documented data in the EMR system is analyzed in order for nurse leaders and managers to review patient outcomes, quality outcomes of falls, pressure ulcers, and catheter-associated urinary tract infections. Being able to analyze this data and come up with strategies to make changes where needed allows for the improvement of healthcare and patient experience, and also helps to decrease the cost of healthcare (Linnen, 2016).
The advancement of electronic health records has improved nursing-based research and data collection for randomized and non-randomized clinical trials. Pertinent patient data is able to be analyzed and compared with social determinants and population to help researchers provide insight into strategies for improving the quality of healthcare (Mordi et al., 2020). Clinical trial data has also helped the Food and Drug Administration in their decision to implementation of medicine.
Informatics and Knowledge Work
Knowledge workers that specialize in nursing are dependent on having access to information. As the healthcare field continues to develop in an information market that is becoming increasingly competitive, professionals who are knowledge workers need to be ready to make substantial contributions by utilizing relevant and current information (McGonigle, D., & Mastrian, K. G. (2022). To provide better patient care, all nurses must understand how to use the collected data to generate information and knowledge, improve efficiency, and strengthen communication skills (Walden University, LLC. (Producer). (2018).
I specialize in mental health nursing, mostly home care nursing. There are ongoing challenges in communication with providers, especially with medication changes and updates. There needs to be better communication between psychiatrists, primary care doctors, and other specialists, and especially when the providers are not from the same hospital, there is a delay in timely communication, putting patients at risk. For example, when a psychiatrist changes a patient’s medications, it is essential to consider other medicines prescribed by a cardiologist due to adverse side effects. Therefore, having technologies like Epic is beneficial to taking care of inpatient hospitals, but home care nurses need instant communication on changes, requiring a phone call communication. Changing from paper documentation to electronic has benefited patients’ outcomes and avoided making medication errors. At my current work, using a system called Casamba, where nurses have access to medications as a live document while on the road using iPad and internet access, any changes made by the previous nurse reflect immediately. Another great informatics is Ping; there is communication when a home care patient checks in at the hospital for emergency care; there is instant communication on Ping; this is an excellent tool for communication because it avoids unnecessary wellness checks on patients at home while they are inpatient.
As a nurse leader, technology that helps improve the care of patients at home, where nurses can quickly communicate with providers and patients, will be of great help. Technology equips nurses with a fresh set of tools, which enables them to facilitate and improve the nurse-patient connection (Dewsbury, G. (2019).
Nursing informatics is a specialty that integrates nursing, computer science, and information science to manage and communicate data, information, and knowledge in the nursing practice, “according to the ANA (McGonigle & Mastrian, 2017). The technology significantly impacts health systems, education, and nursing practice. Studying the role of nurses and emphasizing the need for adequate information technology educational programs to integrate with the rapidly advancing state of technology, therefore, becomes vital.
I chose the mental health community as my topic. Working with the Department of Mental Health for many years allowed me to provide care to people from various walks of life and to see the gaps within the healthcare system. I currently work for the aging population, and many patients are not connected to Primary Care Providers. Approximately 40% of my patients believe their Psychiatric provides the same care as an Internist or Gerontologist. Therefore, many of my patients are not associated with a PCP. Informatics can integrate behavioral and physical healthcare needs in a community that lacks so much (Johnson & Mahan, 2019).
Integrating behavioral and physical health care informatics is vital (Snyder et al., 2011). Collecting the data on how many of those within the mental health care community is not linked to PCP would be the first data needed to be collected. This data would be managed by assessing each patient or caregiver being seen within the department instead of not they’re joined by a PCP. Upon collecting said data, the need for a linkage to a PCP for our patients should be defined, and thus, policy changes should be developed to ensure patients are linked to PCP upon admission into the program.
Nursing leaders can implement new policies considering the data requiring staff to assess incoming patients for their last PCP appointment and PCP information. Many of the patients I care for do not favor doctor visits. Therefore, patients may not be forthcoming with PCP information, requiring the initial screener to obtain the PCP contact information for verification. Overall, informatics provides critical information to providers, scientists, and the pharmaceutical industry, leading to cutting-edge advancements in delivering care within the health care system (Ranallo et al., 2016)
The potential for information and communication technology use is growing in the modern world to improve nursing outcomes. Nurses are the most frequent users of technology and those who communicate with patients the most. The use of technology ought to encourage a productive mindset in nurses. In order to transform the culture of healthcare and increase the quality of care, nurses must be involved in the system’s early design.
At my current facility of practice, Long Beach Veteran Affairs Hospital there was no Behavioral Emergency Response Team (BERT) which at other facilities is commonly known as a Code Green Team. In 2018, I was part of an attempt to start a BERT program which proved unsuccessful due to some problems within leadership and accountability of the team members from various areas. Additionally, data collection was during this attempt. Most facilities already have BERT teams and although I have plenty of experience leading teams and promoting positive patient outcomes during a response, I found that I did not have the tools or guidance needed to establish a new team. Earlier this year new mental health leadership entered the facility with experience on beginning new programs and teams. I am currently a lead on the new program with expert guidance from our new chief of mental health services.
We have adapted a STOP5 debriefing form to meet the needs of our facility. The new Code Green Monitor form is to be brought to each Code Green within the facility and to be completed and the information transferred in to an excel spreadsheet. This information includes who responded and when, why was the code called, what was done prior to the code being called to address the problem, what was done by the code team, were there any injuries, were restraints necessary and many other data points. This data can help determine response compliance which can assist with accountability, frequency of triggers for calls, training needs for responding members and members on units being responded to, and various other needs. For instance, it was found that detox protocols for alcohol and opiate withdrawals needed updating and training for team members as patients in withdrawals lead to a bulk of Code Green calls over a short period of time. Information is being gathered at rapid rates.
It is estimated that knowledge development in healthcare, which has doubled every century until 1900, is now estimated to double every 18 months. And the pace is getting faster. This means that when nurses finish their education, the knowledge they gained might be already outdated (Nagle, Seamus & Junger 2017).
Continuing to gather data is important as from one month to the next our understanding of best practices especially in specialties can change rapidly. Gathering data, interpreting, and implementing quickly can lead to positive patient outcomes.
Nurse leaders can gain knowledge in the formation of new programs and policies and adapt the strategies used to promote and advance the programs as needed to other policies and programs of interest. Healthcare and nursing informatics are both vastly growing fields within the medical field and are continuously incorporating new and evolving technology (Sweeney, 2017). Learning how to relate data and research to back the necessity of programs is important and helps promote compliance among team members. Always addressing safety concerns for both the staff and patients is important especially when it’s a program that has higher risk of physical injury. The data collected can help guide trainings to address where gaps occur and to find effective methods for managing patients experiencing various types of mental health crisis. Remembering that Nurses are knowledge workers, acquirers, users, engineers, managers, developers and generators (McGonigle & Mastrian, 2022) is important for nurse leaders to continue to grow and develop their practice as well as the nursing practice at each facility they work at. Individual nurses have different strengths and as Ben Carson has said, “I think one of the keys to leadership is recognizing that everybody has gifts and talents. A good leader will learn how to harness those gifts toward the same goal.” Nursing is a team and endeavor and everyone benefits when team members are brought in to the fold.
My healthcare institution has recently taken the required actions to implement several new safety measures to ensure the assurance and welfare of our patients. We switched to keeping electronic medical records (EMR) on mobile devices like tablets from using paper charts. In this example, I will discuss the variations in charting methods I’ve encountered at two hospitals. In contrast to one of the facilities, my workplace uses an electronic charting system. When applied to healthcare, informatics has made a significant difference and significantly improved patient outcomes over the previous decade, paving the way for even more cutting-edge medical technologies. “Healthcare Informatics is defined as “the integration of healthcare sciences, computer science, information science, and cognitive science to assist in the management of healthcare information” (Sweeney, 2021, para 1). Many hospitals and clinics have switched to using electronic health records to boost the standard of treatment they offer. However, this is not the case in more modest settings. Despite all the technological advancements, they still rely on paper charts. In the past, I’ve worked in a smaller group home setting. Astoundingly, I’ve seen that several establishments are still employing the archaic practice of using paper charts. Medication mistakes were more frequently reported, and it took more work to get patient records quickly compared to my other employment where electronic medical records are used. Electronic medical records (EMR) are preferable to paper-based health records, as stated by Lin et al. (2020). Its advantages include reduced instances of pharmaceutical errors, enhanced opportunities for clinical collaboration, a higher quality of care, and an enhanced patient experience overall. “A past study found that EMRs led to reduced mortality in patients with severe illnesses” (Lin, et al., 2020, para 24). When it comes down to it, saving lives is what healthcare is all about.
Professional nurses and managers can better assess the state of the practice environment and brainstorm solutions when they have access to a centralized information system (Laureate Education, 2018). Information learned by nursing students majoring in informatics may need to be updated by the time they graduate (Nagel, et al., 2017). Despite this, it is crucial to be aware of technological changes. The opportunity to contribute to this as a younger practitioner is exciting as I advance my career and help shape nursing’s future.
While working with the elderly population they are considered as fall risks patients. Especially if the patient is taking sedative or diuretic medications, it can create a higher risk for falls. That is why nurses and nurses’ assistance are required to watch and round on these types of residents to ensure patient safety. When a patient falls, nurses are required to complete an incident report. You can collect data from incident reports by identifying the main problem and looking at the occurring incidents. According to our textbook ‘Nursing Informatics and the Foundation of Knowledge’ data are considered as raw facts. Information is processed into data which helps create meaning from it. Healthcare professionals constantly process data and information to help provide the best care for its patients (McGonigle 2022). Incident reports keep tracks of the number of falls within the facility. By recording this data, it provides statics on incidents being occurred and allow for facilities to fix the problem. Research must be conducted on this problem to provide education to staff on how to fix the problem. The traditional ways of new knowledge generation is through research and the dissemination of findings in research journals (Nagle, 2017). After conducting research facilities can fix the problem by hosting seminars or training for staff to help educate them on how to prevent falls. By educating the staff members number will reduce within fall incidents. A nursing leader could use clinical reasoning and judgment in the formation of this knowledge by monitoring the fall incidents and seeing if the numbers are being reduced. If the numbers are being reduced that means the trainings are effective. A nursing leader could utilize informatics when it comes to analyzing this topic. The use of informatics is seen in many processes within the clinical setting. Whether it is electronic medical records or data collection informatics is useful in analyzing the data collection process (Sweeney, 2017).
Nursing informatics is a specialty that integrates science, information technology, and information management to enhance efficiency (Sweeney, 2017). Also, informatics is essential in various clinical settings, including inpatients, outpatients, electronic medical records, and data collection devices (Sweeney, 2017). Furthermore, implementing healthcare informatics enables clinicians to provide patients with comprehensive, efficient, safe, and affordable care.
According to Kuznetsky et al. (2021), informatics has played a significant role in providing digital care delivery for the global response. In the case of the Covid-19 pandemic, telehealth contributed to mitigating the spread of the virus despite its existence even prior to the outbreak.
The scenario I will discuss is my experience working in a nursing home. The facility still uses paper charts for charting. As a result of paper-based charting, admitting, and discharging patients was a complex process. With paper charting, admitting one patient would take approximately two hours. As noted by Akhu-Zaheya et al. (2017), paper-based documentation is time-consuming, making it challenging to meet the standard of high-quality documentation and hindering communication between healthcare providers.
Furthermore, it is challenging to locate the patient’s chart when another multidisciplinary team member takes it, causing delays in patient treatment. Some providers wrote in illegible handwriting, for example. Although the transition from paper-based to electronic health records initially appeared challenging, it has reduced the time spent by staff in admitting and discharging patients. A computerized charting system enhances patient safety, improves access to information, and improves communication among healthcare professionals. Electronic health records are more efficient than paper charts in healthcare delivery. In addition, it has made it easier to assess the effectiveness of the tools.
The nursing informatics department has worked tirelessly during the covid-19 pandemic to ensure that the electronic health record is aligned with public health recommendations such as order sets, infection control, clinical documentation, and nursing care plans (Garcia-Dia, 2021).
In healthcare, data is valuable because it guides clinical decisions, improving the quality of care for patients. Our facility, for instance, screened all patients for symptoms similar to Covid-19 during the Covid-19 pandemic. The patients who reported symptoms regardless of their negative covid test were quarantined for 14 days. Based on the collected data, the necessary interventions were determined.
Information technology (IT) is strongly associated with improved patient safety, care quality, availability, and efficiency. Nursing professionals must clearly demonstrate their proficiency with computers, information systems, and digital technology to use IT for practice, training, and research. The innovation that has been accessible to us for years of study and practice is intrinsically linked to the mental health care that is now available. Technical advancements such as smartphones, sensors, and informatics may accomplish more than merely enhancing current support systems. The facts on mental disorders may be further understood by us with the help of new technology, which may also force us to reevaluate our fundamental beliefs about the structure, boundaries, and forms of psychiatric therapy (Alenezi & Alghamdi, 2022).
The delivery of compassionate, person-centered care has historically been supported by the nursing profession’s use of cutting-edge technologies. The introduction and quick uptake of “intelligent” technologies that can function autonomously but are frequently embedded and “invisible” to consumers uses will have opportunities to change their position in the healthcare value chain as a result of the profession’s proactive rethinking of the nursing job in an era where technology is shifting from discrete transaction processing and monitoring applications to pervasive computing, are forcing the nursing profession to reevaluate its position in the future healthcare system ( Chen et al., 2021). Since data are frequently kept in medical records, they are frequently utilized as the foundation for additional analysis, computation, and/or discussion. Information is the knowledge of facts and concepts within a certain context.
Consider a scenario of a 30-year-old female with post-partum depression admitted to an inpatient psychiatric unit with a diagnosis of suicidal ideation and a plan to overdose on her medication. The patient was admitted to the Emergency department after going through medical clearance. She has a history of Depression, anxiety, panic attack, bipolar and borderline personality disorder. During the assessment, the patient was noted to be anxious, crying, paranoid and not forthcoming with information. Obtaining information from the patient was very difficult due to her state of paranoia. She also refuses to grant permission for nursing staff to contact her family. Unable to contact family members for information due to her refusal for staff to contact relatives and family members, who are not able to visit due to the covid-19 restriction. No visitation on the unit is permitted.
Digital phenotyping, a helpful data source created for the computer-assisted identification and course prediction of mood disorders, can be used in the case mentioned above. Torus created the idea of digital phenotyping. It refers to the identification of particular, quantitative, and objectifiable mental symptoms using biosensor-based technologies. The database may also be used to get other data on the patient, such as recently prescribed drugs, diagnostic tests, and recent lab work, including the universal drug test, urine test, and blood work. Access to this data will be important for ensuring continuity of care, increasing efficiency, improving communication, ensuring safe drug use, and enhancing patient care ( Chen et al., 2021).
Before beginning therapy, the nurse leader will use the Mini-Mental Status to determine the patient’s state of awareness. They will also look at the patient’s mood and affect. Finally, they will use the DSM-5 and her clinical judgment to gather crucial information about the patient’s condition. To get the optimum patient-desired outcome, data analysis and interpretation from both critical and rational viewpoints are employed. In order to accomplish the patients’ goal, the nurse leader uses her expertise and knowledge while taking into account many options (Bourla et al., 2020)
In conclusion, nurses have important roles in patient care, particularly in psychiatry where they have a well-defined job integrating a clinical and psychological component. (Bourla et al., 2020). It was discovered that more technical effort is required for innovative therapies for complicated mental diseases such as organic psychiatric disorders. It is crucial to evaluate nurses’ understanding of attitudes toward, and representations of this new technology in doing so will unavoidably change how they care for their patients.
In recent experience, the post-anesthesia care unit (PACU) at the facility I was on contract with was undergoing a change to its charting system to better suit the patient population served and improve nurse workflow. Nurse Informaticists (NI) utilized their base knowledge of the nursing requirements of this particular unit and combined it with their ability to generate a more effective charting system. Following the foundation of the knowledge model, their development was disseminated to the staff (McGonigle & Martian, 2022, p 10). As Sweeny states, the rollout of new initiatives can cause chaos but the benefits will allow safer, more comprehensive, evidence-based care to patients (2017). Nurses and other healthcare staff using the charting system then provided constant feedback to the NIs for analysis. The knowledge derived from this feedback would provide NIs with the awareness of what adjusted features slow down productivity, improve workflow, and any missing charting requirements to improve documentation accuracy and ultimately improve patient outcomes.
Data Nurse Informaticists would be assessed on how long a particular section of a patient’s chart took to document, what sections were consistently undocumented, how long after a patient was discharged pertinent information backlogged, and what sections were most concisely written. This data would be assessed by the date and timestamps associated with each piece of charted information. A nurse leader’s role in this formation of knowledge would be to stay up to date on changes made to the charting system provided by the NIs, assess the relevance of the charting system to the patient population and workload effectiveness, provide feedback for improvement, then act as a resource to the remaining staff. My contract concluded before the process was finalized, but I have a new appreciation for having witnessed it firsthand and for all the behind the scene effort by Nurse Informatics to improve the future of healthcare.
Nurses have the opportunity to make a difference in the patient’s well-being and outcomes. Nursing Informatics, nurses analyze various data, and collaborate with the providers for better patient outcomes. Technology can reduce the chance of medical errors in a healthcare organization. I work as a Correctional Nurse for The Department of Corrections. Women have higher rates of depression during incarceration compared to the males.
Most of the time, many men and women have a history of substance abuse, psychosocial stressors, chronic medical challenges such as CAD, DMII, Hepatitis, HIV, and personality disorders. We are currently utilizing paper charting instead of the electronic medical records which would protect the privacy of the inmate information. The state has to provide treatment for Hepatitis and HIV patients. The medication for Hepatitis very expensive, one bottle of Epclusa of 18 pills cost $5,000 and if the state does not provide this medication, the inmate or the family can sue if the patient dies from Hepatitis. To keep the data readily available, we have a clinical coordinator that obtains and follows all individuals that has Hepatitis and seeking treatment.
Nursing Informatics is specialty that combines nursing and technology. The American Nurses Association (ANA) defines nursing informatics as the integration of “nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice.” The Department of Corrections should implement the electronic health record system for all individuals incarcerated so that the data is interchangeable between all institutions instead, when individuals are transferred, the medical charts are sent with the correctional officers, this could create a HIPPA violation if the charts are lost or misplaced. Overall, with the implementation of the EHR, all institutions would provide better documentation, time management because it takes time to locate the medical chart, document, place charts in the providers mailbox and the providers review and sign off when the return to the facility.
An advantage to having access to electronic health records, the information is attainable for all institutions because some of these individuals have medical charts that span over 50 years. The EHR, would reduce errors, and cost. The Electronic Health Record help providers to maintain and provide high quality care with favorable outcomes. The EHR automates and streamlines the clinician’s workflow (HIMSS).
Artificial intelligence is a vital asset to advancing education in healthcare. I believe it is necessary to study healthcare roles and draw attention to the demand for applicable information technology educational systems to fit in with the ever-growing stride of technology. Healthcare data is intricate and thrives from matters and topics such as ownership, access, disclosure, exchange, security, privacy, disposal, and dissemination. The extensive execution of electronic health records has supported partnerships among public and private sector shareholders on a wide-ranging collection of healthcare information explanations. At the end of the day, the integrity, veracity, and value of the data are what matters. The quality of the data should be accurate, complete, and consistent. As “knowledge workers,” we should understand that change is inevitable as we handle and process data daily (McGonigle et al., 2022). Analyzing critical and complex data can bring about difficulties & challenges. However, as healthcare professionals, we should band together to create strategies & solutions to combat & even prevent healthcare issues. All healthcare specialists should be trained and knowledgeable enough to provide patient-centered care as participants of an interdisciplinary team, highlighting evidence-based practice, quality development methods, and information science. We execute with communication technologies to support the health of families, individuals, and societies worldwide (Alliance for Nursing InformaticsLinks to an external site.).
At the healthcare facility where I work, we recently implemented a new method of scoring patients when they are admitted on whether they are at risk for skin breakdown. If scores are 14 and below, we apply Mepilexes to their heels, buttocks, and other areas to prevent pressure ulcers. Mepilex Border Sacrum and Heel dressings are self-adherent, multilayer foam dressings intended for use on the heel and sacrum, aiming to thwart pressure ulcers (Marshall et al., 2019). Originally if patients scored low, other interventions were already in place, such as turning the patient every 2 hours, floating heels off the bed, and frequent checks if patients are incontinent to make sure they are dry as possible to prevent skin breakdown. Mepilexes being automatically added without breakdown being present with a low score is what is new for us. We originally only applied them if they already had skin breakdown. But now it would be interesting to track the data to examine if applying the Mepilexes on admission in addition to other precautions, according to the low score, will, in fact, prevent breakdown. Of course, staff has to be compliant in applying the Mepilexes. Our Nursing Compliance Officer can view and track the skin assessment scores in our Electronic Medical Record by viewing the Braden score. She then makes rounds on patients with low scores to ensure that the nursing staff has these preventative measures in place. As the patient’s scores improve throughout the hospital stay, these preventative measures can be removed. Mepilexes are thought to be costly, so weighing cost efficiency and benefits is an area to examine as well for future research. Tracking these scores in our EMR system and assessing the data, as well as using these preventative measures, can be vital in helping prevent pressure ulcers that can lead to other health problems, such as pain and infection of the wound. Scoring the patients appropriately is also a factor. The nursing manager often reviews scores with staff and answers questions from those who have concerns about properly scoring a patient. Also, the nursing staff is required to complete online classes through our hospital’s intranet Advanced Learning Center, which reviews the prevention of skin breakdown.
Information systems and technology are very vital in healthcare delivery services, for data collection, storage, and accessibility which enhance the delivery of care and improve the quality of care. The information system has made life so easy, comfortable, and flexible for us, especially healthcare professionals. It has given us the opportunity to pursue a career while we are working. According to Hebda, T., & Czar, P. (2013 p. 3), If nurses understand the power of informatics, they can play an active role in evaluating and improving the quality of care, cost containment, and other consumer benefit. Data is a collection of information that helps us to identify a particular problem and find a solution. Information. Information has a huge impact on problem-solving. Without information, problems cannot be solved.
The scenario that I choose is how to identify a patient having or at risk of having a cardiovascular disease such as myocardial infarction and STEMI. This problem can be identified by carrying out tests like EKG, monitoring the heart rate, and collecting blood samples for Troponin levels. The collection of all this information and analyzing them will help to determine if a patient has MI or STEMI. According to Parikh, Selinger, & DeFilippo (2015). The standard biomarker and centerpiece for diagnosing acute myocardial infarction are cardiac Troponins. We learned that the best way to diagnose acute myocardial infarction is by checking the blood troponin level. Also, any patient with a cardiac symptom such as chest needs a regular checkup. I would like students who are preparing to be transformative leaders in the industry to understand those informatics is a set of tools, and that the important use of informatics has to do with how you use those tools strategically (Walden University, 2018).
All the data collected are huge information that will enable the nurse leader to form knowledge that will help in planning and finding a solution to identify the problem.
Central Line Associated Blood Stream Infections (CLABSI) remain one of the most common healthcare-acquired conditions resulting in increased length of stay, high morbidity, and increased healthcare costs averaging $ 50 000 per infection (Woods-Hill et al., 2021). Application of some steps in the Knowledge Management Lifecycle (KM Life Cycle), knowledge acquisition, knowledge sharing and dissemination, and outcomes evaluation, can be used as a very powerful tool for the elimination of CLABSI in patients (McGonigle & Mastrian, 2022).
CLABSI elimination has become the goal of many healthcare institutions and has led to the development of strategies such as the CLABSI bundle. The CLABSI bundle employs techniques such as handwashing, maximum sterile barriers at insertion, use of chlorhexidine gluconate, avoiding femoral central lines, evaluating daily needs, scrub hub and dressing changes with bio patch, and maximum protection dressings. In addition, some facilities are including an antimicrobial swab cap to the existing CLABSI bundles (Ferry et al., 2020). However, there remain the challenges of patient body habitus that ultimately result in the placement of femoral central lines and the complication of copious secretions that soak central line dressings in the subclavian or jugular areas, all of which pose a risk for CLABSI.
Nurse leaders can employ reports from electronic health records to assess for CLABSI in the hospital, the duration of a central line, the last day a dressing was changed, the condition of central line dressings during an assessment, interventions to remedy inappropriate dressings, and the time from discovery to interventions (McGonigle & Mastrian, 2022). Such information can be used to identify causes other than insertion techniques and be used to develop continuing education to train nurses on CLABSI prevention. In addition, the information can also be used to evaluate the efficacy of nursing teaching on CLABSI prevention by evaluating outcomes such as no CLABSI in a unit.
Data is necessary to achieve high performance in all aspects of an organization. Healthcare is constantly evolving, presenting new operational challenges, and developing new innovative solutions. Using a data-driven approach in problem-solving is critical to producing better, more sustainable outcomes (Kroll, 2022).
My organization is continuously collecting, reviewing, and applying data for process improvement purposes and, ultimately, to ensure its ability to provide high-quality care. Data can be used to determine a given program’s impact and provide feedback on which strategies and interventions are most beneficial to clients. The ability to access large data sets helps to identify patterns, trends, and commonalities. The knowledge gained from data can then be used to inform practice, change behaviors, and improve outcomes.
To improve my organization’s in-home detox program, data is regularly collected from clients receiving these services, such as episodes of relapse following completion of in-home detox, disengagement, and use of medication-assisted treatments. This data collection provides the organization with objective evidence to show payors the value and success of the program.
There is a multitude of opportunities today that improves the way data is gathered and used. These new kinds of healthcare data include, but are not limited to, EHR data, big data, natural language processing, and machine learning. These data management and analysis opportunities increase the ability to measure and improve the quality of healthcare (Busch, 2021).
I currently work in labor and delivery and there has been one topic that has been on my mind lately and collecting data from this scenario would be beneficial to all involved. Throughout 2022, at the community hospital that I work at, we have seen a significant increase in the number of twin pregnancies we are delivering. I have not investigated the number of twin pregnancies and deliveries anywhere else, but I would be curious to see them. My thoughts behind this phenomenon have to do with the COVID-19 vaccine. Obviously, this is all speculation and I have no proof, but I do wonder if the COVID-19 vaccine has had the opposite effect on fertility that people originally feared and is increasing the number of fetuses in a pregnancy. I am going to start looking into this more at work because we do ask all our patients on admission if they have been partially or fully vaccinated against COVID-19 and I plan on collecting this data to see if there is any correlation and to satisfy my own curiosity. This data, regardless of what it shows, would have no impact on patient care, but since multiples are usually such a shock to families, if there was a correlation between the vaccine and a multiple pregnancy, the parents would have some idea that it is a possibility if the mother is COVID vaccinated. There are more common causes that we are all aware of for a multiple pregnancy, including IVF, the use of fertility drugs, and maternal age of greater than 35; but there is no research or data on the COVID-19 vaccine and the possibility of increased fertility. In this scenario, data about COVID-19 vaccine and side effects, including a multiple pregnancy, could help to prepare families for the possibility of a multiple pregnancy and help them in coping since it usually comes as quite a shock.
Informatics and Knowledge Work
Health Informatics is an important care coordination in Nursing. These days, healthcare system are assimilating technology into their daily practice to improve patient outcome. With the use of electronic documentation, identifying worsening condition or patients at risk for danger can be easily detected and preventive steps as soon as possible to reverse the condition.
The scenerio I am about to discuss is one of the ways informatics is being use in my work place to access critically ill patients before it gets off hand. Informatics is said to be problem- solving. I am discussing the effects of informatics in detecting and resuscitating ‘Sepsis Alert’. When the lab results and vital signs meet the criteria of dangerous patients condition in the electronic data system, The Automated alert system send notification of sepsis alert to the Charge nurse, Primary bedside nurse, Rapid Response Nurse and the primary medical team. This alert requires acknowledgement from the primary bedside nurse who immediately notifies the primary medical care team. In my facility, the primary bedside nurse has to acknowledge this alert, accesses patient and notifies Physician within 15minutes of the alert, and document in the electronic system with an hour. Sepsis is one of the major causes of morbidity and mortality rate in the hospitalized patients and rapid resuscitative measures are required to revert the danger. Informatics is said to be problem- solving as seen in these steps. The electronic alert and fast access to data prompted the rapid resuscitative interventions and this produces better patient outcome.
As a psychiatric nurse working in an inpatient facility without an electronic health record, I am frequently frustrated by the cumbersome process of accessing data in physical patient charts. To ease this burden, we often double or triple chart data so it can be found in multiple places. Data we frequently search for are trends within the organization’s utilization of seclusion and restraint. This data is sought for individual patients, and also by the population of each residential unit as a whole.
Data collection and access
Nagle et. al (2017) emphasizes that in addition to the data being collected, the collection process and how it impacts workflow within the organization. If our seclusion/restraint form were to be completed electronically, this data would be much easier to access and could have been completed in a more timely manner. This form has several portions that require input from multiple members of our interdisciplinary staff. As the form exists as a physical copy, it must be passed back and forth amongst the team to be completed. Ideally, this form could be initiated by the unit staff and collaboratively accessed and edited by each team member.
Knowledge, Clinical Reasoning, and Judgement
Most frequently, the nursing staff seeks to identify patterns in the time of day that seclusions and restraints are occurring, which staff are most frequently involved, and the utilization of pharmacological interventions. The goal of analyzing these data sets is to identify ways to reduce or prevent the usage of seclusion and restraint. According to the American Psychiatric Nurses Association, eliminating seclusion and restraint use is a goal that all organizations should be working towards (2018). This data is also provided to the physicians and may be considered when considering medication changes. Although this data is currently being documented and communicated, it is tedious to compile. If this data were easier to compile, interventions might be implemented more quickly. For example, if it becomes apparent that a patient frequently escalates daily around 1500, they may need changes to their medication schedule, or there may be a scheduled activity that is unknowingly triggering them. Nurses utilizing this trend data to inform care decisions is an example of nurses as information workers (McGonigle and Mastrian, 2022).
Accurate and applicable data collection is one of the key elements of fine-tuning the care that is delivered within the nursing profession and allowing theories to become accepted best practices. One of the areas in which I have seen profound evidence of the usefulness of data collection during my own practice is through the monitoring of hospital-acquired infections. The most commonly monitored hospital-acquired infections occur in the form of venous access central-line associated bloodstream infections, indwelling catheter-associated urinary tract infections, surgical site infections, hospital-acquired pneumonia, and hospital-acquired clostridium difficile infections (Monegro, Muppidi, & Regunath, 2022). By tracking the circumstances surrounding each case of these types of infections, facilities are able to identify trends and modify their policies and procedures to help reduce the prevalence of each.
By examining the data that surrounds these types of infections, many hospitals have put policies in place to take such steps as limiting the usage of antibiotics in order to reduce the likelihood of hospital-acquired C-Diff infections, reducing the amount of time that indwelling urinary catheters are left in place to reduce the risk of CAUTIs, and implementing a hygiene and dressing-change policy to reduce the risk of CLABSIs (Weise, 2022). It is important to ensure that even after changes have been put in place, that data continues to be collected because there are several dynamic factors within the healthcare environment that can affect the efficacy of these policy changes. This was especially evident in 2020, as many facilities saw a sharp increase in healthcare-associated infections as a result of the COVID pandemic. With the significantly increased strain on not only the capacity of healthcare facilities but also the resources and medications available due to supply chain issues, many facilities were forced to make adaptations to their previously implemented infection prevention policies (Dall, 2021).