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Nursing Informatics andEvidence-based Practice
Chapter 13
Strategic HIT Planning for the Decade 2004-2014
The Decade of Information Technology (Thompson, & DHHS, 2004)
Information Technology (IT)
Critical needs of the health care system
– Avoid medical errors
– Improve use of resources
– Accelerate diffusion of knowledge
Reduce variability in access to care
Advance consumer role
Strengthen privacy and data protection
Promote public health and preparedness
Strategic HIT Planning for the Decade 2004-2014 (cont'd)
Strategic HIT Planning for the Decade 2004-2014 (cont'd)
Established four goals– 1) Inform clinical practice
– 2) Interconnect clinicians
– 3) Personalize care for clients
– 4) Enhance public health
Strategic HIT Planning for the Decade 2004-2014 (cont'd)
Strategic HIT Planning for the Decade 2004-2014 (cont'd)
Nursing InformaticsEmerging fieldInformatics refers to:
– Broader field of understanding the information needs
– How information can or should be stored and retrieved
– How to use information technology
Part of the larger field of health care and medical informatics
Mechanism to collect and analyze data from nursing care
Establish and maintain computerized documentation systems
Nursing Informatics (cont'd)Nursing Informatics (cont'd)
Strategic Directions for Nursing Informatics
Include informatics in nursing education
Prepare nurses with specialized informatics skills
Enhance nursing practice and education through informatics projects
Increase nursing faculty preparation in informatics
Encourage collaboration
Question Is the following statement true or false?
The specialist in nursing informatics helps to build a systematic nursing language, making data more secure from hackers and enhancing the ability to use the data to build aggregated information upon which insurance decisions can be based.
AnswerFalse.
Rationale: with an interdisciplinary focus, the specialist in nursing informatics helps to systematize the nursing language, making data more retrievable and enhancing the ability to use the data to build aggregated information upon which practice decisions can be based. One aspect of this work is to make electronic health care information safe, but has nothing to do with insurance decision making.
Using Information Technology Within the Care Setting
Employers expectations
Understanding IT systems
– Security systems
– Billing systems
– Patient information retrieval
Order entry
Nursing data entry
Computerized medication administration systems
Other computer resources
Using Information Technology Within the Care Setting (cont'd)Using Information Technology Within the Care Setting (cont'd)
Accessing Information Resources
Texts and reference books
Libraries
Policies and standards
The Internet– E-mail
– Online group discussions
– World Wide Web
– Search engines
– Health-related Web sites
– Blogs
Bookmarking Web sites
Accessing Information Resources (cont'd)
Accessing Information Resources (cont'd)
Healthcare Indexes for Finding Information Resources
Indexes available– MEDLINE, produced by the National Library of
Medicine (NLM)
– CINAHL (Cumulative Index for Nursing and Allied Health Literature), produced by the CINAHL corporation
– International Nursing Index
– RNdex
– Hospital Literature Index
Psych Index
Social Sciences Index
Many journals publish their own annual index
Healthcare Indexes for Finding Information Resources (cont'd)Healthcare Indexes for Finding Information Resources (cont'd)
Techniques for effective searching
– Subject
– Author
– Thesaurus for the index
– Understanding the ways in which publications are indexed
– Key words
Healthcare Indexes for Finding Information Resources (cont'd)Healthcare Indexes for Finding Information Resources (cont'd)
Question
Jeff Scott, RN, is a graduate nurse just starting his practice in a transplant step-down unit that deals mostly with heart and lung transplants. He finds that there are many ethical issues in his practice that he was not expecting.
Jeff chooses to deal with these issues by starting a blog on the Internet. What is a blog?
A. Online group discussion
B. Online journal
C. E-mail server site
D. Ethical discussion board
Answer
B. Online journal
Rationale: a blog (short for web-log) is a web site on which an individual (the blogger) publishes a journal providing information and opinion usually in relationship to a particular area of subject matter.
Evidenced-based Practice
DevelopmentTypes of evidence used
– Research studies– Patient care data– International, national, and local
standards
Infection control data
Pathophysiology
Cost-effectiveness analysis
Patient preferences
Evidenced-based Practice (cont'd)Evidenced-based Practice (cont'd)
The Research Process
Statement of problem/question
Review of literature
Theoretical framework
Refining the plan
Implementing the study
Analyzing the data
Presenting and interpreting findings
Limitations
Disseminating research results
The Research Process (cont'd)The Research Process (cont'd)
Question
In some nursing studies it falls to the staff nurses to collect the data for the study. When this happens, it is important that:A. Everyone learns the collection process from each other.B. The researcher picks out only the data that interests them.C. The researcher teaches everyone to collect the data in a specific way.D. Everyone learns the collection process from the charge nurse on their shift.
AnswerC. The researcher teaches everyone to collect
the data in a specific way.
Rationale: if multiple people are collecting data, it will be important to ensure that all are carrying out the study tasks in the same way. If different data collectors function differently, the results of the study may not be accurate.
Reading Research
Types of research– Quantitative– Qualitative– Combined– Meta-
analysis
Understanding research terminology– Abstract– Research question and purpose– Hypothesis– Population vs. sample– Groups
Reading Research (cont'd)Reading Research (cont'd)
Variable
Validity and reliability
Probability and statistical tests
Clinical significance
Reading Research (cont'd)Reading Research (cont'd)
Legal and Ethical Considerations in Research
Institutional approval
– Institutional review board
– Educational institution review board
– Funding agencies
Consent for research
– Informed consent
– Formal consent form
o Describes the researcher’s credentials
o How the participant was chosen
o Purposes of the research
o Procedures that will be followed
Legal and Ethical Considerations in Research (cont'd)
Legal and Ethical Considerations in Research (cont'd)
• Risks
• Discomforts
• Benefits expected
• Guaranteed anonymity or at least confidentiality
• If alternative treatments are available, they must also be described
• Participation is voluntary and can be terminated at any time
Legal and Ethical Considerations in Research (cont'd)
Legal and Ethical Considerations in Research (cont'd)
Question
Is the following statement true or false?
The beginning of a code of conduct pertaining to research was the Nuremberg Code. This document has been updated and modified several times, the last time being in 1983. Throughout these revisions a single theme has been: first, do no harm.
AnswerTrue.
Rationale: the most recent revision of this code was in 1983 (Code for Federal Regulations, 1983). Three principles guide these regulations. First, the research should do no harm. Second, the participants should be free from exploitation. Third, there should be careful attention to the risk:benefit ratio of the research.
Personal Involvement in Research
Identifying problems– Excellent observers
– Responsible for putting the whole complex of patient care together
Assisting with ongoing research– Your patients
– Follow procedures and protocols exactly
– Frontline safeguards
Systematic Analysis of Information and Evidence
Reliability of the source Bias of the source Timeliness Purpose Comparing settings or
situations
Implementing New Practices Based on Evidence
Institutional development of EBP– Iowa Model of Evidence-based Practice – ACE Star Model of EBP for Knowledge
Transformation– Focus on continuous improvement – Barriers to utilizing research in practice
Staff nurse role in EBP– Identify sources of evidence that can be helpful in
an individual nursing environment
– Evaluate that evidence in relationship to your setting
– Work collaboratively to introduce changes based on the evidence
– Evaluate the effectiveness of the changes
Implementing New Practices Based on Evidence (cont'd)
Implementing New Practices Based on Evidence (cont'd)