coursework-banner

Discussion: The Inclusion of Nurses in the Systems Development Life Cycle

NURS 6051 Discussion: The Inclusion of Nurses in the Systems Development Life Cycle

Discussion: The Inclusion of Nurses in the Systems Development Life Cycle

According to McGonigle & Mastrian (2018), a systems development life cycle (SDLC) is a process of developing systems to deliver information systems in an efficient and effective way.  The many approaches to SDLC can be applied to individual businesses needs to determine which approach would be the most beneficial to implement depending on the need of the business.  As an example the waterfall method of systems development life cycle has multiple steps including feasibility, analysis, design, implement, test and maintain.  Throughout each step it would be important to involve nursing staff because often these systems that are implemented affect our workflow and the direct clinical care we are able to deliver (Agency for Healthcare Research and Quality, n.d.).

Cognizant of  the role that training plays when it comes to improving a nurse’s competencies in EBP and thus empowering them to contribute to the development of EBP, here are certain strategies that can be undertaken from both an organizational level, to the larger professional level. At the organizational level, the organization can organize for opportunities where their nurses can get trained on evidence based practice. On the greater professional levels, professional bodies such as the ANA and the ANCC have developed certification program for nurses. By including components of evidence based practice  in the certification exams, this ensures that nurses will prepare and apprise themselves on EBP and thus, in order to earn the certification, they will have to be competent in EBP. Alternatively, the institutions can include a whole different certification for EBP, where nurses will specifically be trained on EBP, tested on the same and thus, their competency will be proven by their certification. This will ultimately improve their ability to participate in the development and implementation of EBP.

Discussion: The Inclusion of Nurses in the Systems Development Life CycleIn the feasibility stage of the waterfall method the business addresses whether the project should be initiated and is often when the budget for the project is proposed.  As an example my hospital implemented a new labeling system hospital wide, roughly a 1,000-bed facility, due to the amount of specimen labeling errors.  By involving nurses in this stage of the systems development life cycle staff would be privy to the data behind the amount of specimen labeling errors made and be able to make it apparent why it is important to improve the labeling system. BY not including nurses in this part of the decision making process you fail to include them in the reason for the change.  The next stage, analysis, helps determine current business practices and details about the needs are assessed.  Involving nurses in the analysis stage allows administrative staff the opportunity to understand how the technology is being utilized on a day-to-day basis so that educated decisions can be made on the proceedings of the issue.  In the design phase, probably the most important phase due to the impact on nursing workflow, nurses should be involved when it comes to choosing between the different systems (in this case choosing labeling programs and printers) and sampling the new workflow prior to a permanent decision being made.  Not considering those who use the technology in day to day patient care can often be more dangerous than not having any technology available at all (McGonigle & Mastrian, 2018).  If a new technology creates a more difficult workflow for nurses there are potential for further mistakes to be made and the delivery of patient care could suffer.

In the implementation phase the vision of this new technology is brought to life through the programming.  While some nurses may not have the technological savvy to understand the operating systems required for these programs to run it is important for them to test their functionality in simulated and real-life situations and they also do this during the test phase.  During the test phase the program may be implemented in stages, like with new label making the program itself and new printers were rolled out to outpatient

Discussion The Inclusion of Nurses in the Systems Development Life Cycle
Discussion The Inclusion of Nurses in the Systems Development Life Cycle

care areas prior to inpatient areas to determine if the system preformed appropriately and were achieving the goals of the business (McGonigle & Mastrian, 2018).  Nurses are key to the testing phase in this case because these are the individuals who are going to be going through that workflow each and every shift they work.  Finally in the maintain phase after the testing has concluded that the program implementation is worth continuing it is important to involve nurses by training them as super users to train and assist other nurses during technology transitions and by having technology support available for any questions or concerns during the transitions from an old to a new program.  During this systems development life cycle floor nurses were not involved in the initial process from the feasibility to the design stage but our opinions, questions and concerns were heard and addressed from the implementation phase on.  This I feel can create a problem in not only nursing workflow but also in the communication between administrative, IT and nursing staff due to the implementation without the consideration of actual practicing bedside nurses.  It is also important when implementing new technology systems to determine whether these systems communicate with each other appropriately, otherwise known as interoperability, such as the ability of the electronic health record to communicate with the labeling system to correctly transmit patient information (Laureate Education, 2018).

References

Agency for Healthcare Research and Quality. (n.d.). Workflow assessment for health it toolkit. Workflow Assessment for Health IT Toolkit | AHRQ Digital Healthcare Research: Informing Improvement in Care Quality, Safety, and Efficiency. https://digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit.

Laureate Education (Producer). (2018). Interoperability, standards, and Security [Video file]. Baltimore, MD: Author.

McGonigle, D., & Mastrian, K. G. (2018). In Nursing informatics and the foundation of knowledge (4th ed., pp. 175–261). essay, Jones & Bartlett Learning.

Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: Discussion: The Inclusion of Nurses in the Systems Development Life Cycle

To effectively apply any healthcare process and technology system, developers must follow the Systems Development Life Cycle (SDLC); planning, analysis, design, implementation, and maintenance (Laureate Education, 2019). To develop a new health information system focused on patient care and outcomes, it is crucial to involve nurses to provide substantial inputs (Weckman et al., 2009). Therefore, the lack of nurse contributions in the implementation phase can bring terrible consequences (Laureate Education, 2019). Six months ago, the administration team of my organization (Hospice) decided to switch our electronic documentation system from Citrix to WellSky without involving the field nurses in the SDLC process. Instead of selecting an outside Electronic Medical Record (EMR), if the administration had decided to work with the company team (IT, informatics nurses, and the field nurses) to design an EMR that will meet all the staff needs, they would have saved many complications.

As a result, the administration team had to make many changes to the new system due to staff resistance and negative feedback with the new system. This forced the administration to re-evaluate and gather input from nurses to adjust the new system. If the administration team had involved the nurses in the selection of the new EMR at the beginning, the company would have saved a lot of time and stress. To be successful, the administration should have approached the implementation of the system by working as a team and involving nurses at each stage of the SDLC, from planning to maintenance (feedback). For instance, if nurses are involved in the planning phase, they can share project goals and contributions for significant efficacy. In the analysis, involving nurses in the design phase would have allowed the nurse to develop or select a successful EMR that will fit the patient and healthcare staff’s needs when documenting the head-to-toe assessment and general notes. Nurses should not have been left in the implementation phase since nurses give direct patient care and are active members of the nursing process.

Implementation is the most crucial phase in involving nurse thoughts and feedback. Implementing healthcare systems is essential, but the most important segment involves all stakeholders for successful implementation (Agency for Healthcare Research and Quality [AHRQ], 2014). In the healthcare setting, nurses are fundamental stakeholders for system implementation, and for this reason, they need to be involved for successful system implementation. If nurses were initially involved in the scenario mentioned above, the company could have saved time and budget.

References

Agency for Healthcare Research and Quality. (2014). Designing and Implementing Medicaid Disease and Care Management Programs: Section 2: Engaging Stakeholders in a Care Management Program. https://www.ahrq.gov/patient-safety/settings/long-termcare/resource/hcbs/medicaidmgmt/mm2.html

Laureate Education (Producer). (2018). Systems Implementation [Video file]. Baltimore, MD: Author.

Burlington, MA: Jones & Bartlett Learning. Weekman, H., Janzen, S. (2009). The critical nature of early nurse involvement for Introducing new technologies. The Online Journal of Issues in Nursing, 14(2). doi: 10.3912/OJIN.Vol1402Man02.

RE: Discussion – Week 9

Systems Development Life Cycle (SDLC) is a multistep technique that is used in healthcare to be able to develop, plan, explore, excute, and assess the health information of technology (HIT) systems in the hospital (McGonigle & Mastrian, 2018). Nurses play a huge role in all aspect of care and this even includes being a part of SDLC implementations and participating in making changes with the technology advancements. In order for the changes to be working successfully it requires nurses to be involved in each phase of the developmental cycle and to complete all the way through. If nurses do not partake in each cycle it will lead to system failure and when it comes time to implementing the new system there will be errors in the system and this will cause a delay in care and will affect patient outcome as well. For example, one of the steps in the SDLC is implementation, if nurses do not offer suggestions and ideas during this time it can lead to poor ideas and will make it more challenging for users to operate the final system. Also, one great way to evaluate the efficiency of HIT systems would be using Health IT evaluation, this is a toolkit consist of three sections that can help healthcare teams evaluate their IT projects. (Agency for Healthcare Research and Quality., n.d). 

I have participated in implementing new healthcare technology at my hospital; recently our hospital was bought by another facility and due to this new recent changes it requires us to change all of our systems and to learn how to document and chart properly with the new systems. One of those things that we had to chart at the beginning of every shift is the early sepsis screening, the screening needed to be charted at the beginning of every shift but the issue was that during shift change this is one of the most busiest time so it made it hard for nurses to document any septic changes. There was an incident happened and put patient safety at risk the patient had coded and had not made it. This issue came back up and all healthcare team members were involved; the issue that was brought up was the patient had come up positive for early sepsis but nobody has noticed this and one thing lead to another. I was able to state that sepsis screening during the beginning of shift can be challenging as there are a lot of things going on during this time like report, patient needs, phone calls, looking up patient documentations, labs are still being drawn, test are being done, etc. These tasks make it more challenging for nurses to be able to chart sepsis screening during shift change; I brought up the idea of changing the time for sepsis screening that correlates with the time that benefits the nurses more. Due to me voicing my opinion of this issue, the hospital has actually changed their documentations for sepsis detection and now there has not been any issues with sepsis detection and the nurses are able to detect early sepsis more efficiently. 

References

Agency for Healthcare Research and Quality. (n.d.a). Health IT evaluation toolkit and evaluation measures quick reference guide. Retrieved September 27, 2018, from

https://healthit.ahrq.gov/health-it-tools-and-resources/evaluation-resources/health-it-evaluation-toolkit-and-evaluation-measures-quick-reference

McGonigle, & Mastrian. (2022). Chapter 8, “Legislative Aspects of Nursing Informatics: HITECH and HIPAA.” In Nursing Informatics and the foundation of knowledge. essay, Jones et Bartlett Learning.

RE: Discussion – Week 9

The Inclusion of Nurses in The Systems Development Life Cycle

Nurses must be part of the Systems Development Life Cycle as they understand the clinical flow and patient care processes better. By including nurses at every stage, the nurses’ commitment to the new system will have an overall stimulation through engagement (Assal et al., 2018). When nurses do not have autonomy in the design process, the implementation and utilization of a new system may take longer because the providers are distanced from the outcomes of the process. In the analysis stage, there may be a lack of identification of the patients’ problems when there is no involvement of nurses in the process. Nurses know their patients well, and they play a major role in identifying the specific issues that patients have (Scott et al., 2018). In the design phase, there may be a lack of the necessary feedback from the system developers. The nurse’s involvement will ensure that there is the provision of feedback in the time since they have direct communication with patients (Palmer et al., 2018). A problem that may be encountered at the development phase is; budget constraints. The involvement of a nurse in the phase will ensure the provision of an adequate budget concerning the needs of the patients (Scott et al., 2018). In the implementation phase, a problem may arise with the lack of enough time allocated for the testing of the system. The nurse’s involvement will ensure that they provide an estimate of the time necessary since they understand the needs of the patients at a particular time.

My current healthcare facility is changing its EHR system. They have selected a specific team of nurses that are part of their healthcare team to design and adapt the new program that will meet the institution’s requirements. As a nurse, I’m excited to be part of the team to develop the new system. The involvement in the process ensured that we addressed the common problems encountered while developing the system. We also ensured that the system did not take up too much money, hence ensuring that there is a better utilization of resources for healthcare.

References

Assal, H., & Chiasson, S. (2018). Security in the software development lifecycle. In Fourteenth   Symposium on Usable Privacy and Security ({SOUPS} 2018) (pp. 281-296).

Palmer, K., Marengoni, A., Forjaz, M. J., Jureviciene, E., Laatikainen, T., Mammarella, F., … & Onder, G. (2018). Multimorbidity care model: Recommendations from the consensus meeting of the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS). Health Policy122(1), 4-11.

Scott, S. M., & Scott, P. A. (2021). Nursing, advocacy, and public policy. Nursing Ethics28(5),   723-733.

RE: Discussion – Week 9

I agree that inclusion of nurses in the systems development life cycle is fundamental to attain successful implementation. Nurses have experience, a better understanding of patients and care processes. Through their inclusion in the SDLC process at each stage, nurses enhance their commitment to the novel systems. The deployment and use of a new system may take longer if nurses do not participate and give their views during the design process. At the analysis stage, nurses can offer input about effective diagnosis of patients and patient problems. Nurses are patients’ advocates and understand them better (Scott & Scott, 2021). Through their involvement at the feedback stage, nurses can gather information and offer a better insight into the health problem under investigation. The involvement of nurses at the design stage ensures that nurses and leaders access sufficient resources to roll out effective interventions to address patient problems. Implementation stage requires more time and resources. Therefore, by involving nurses in the SDLC process, an organization reaps benefits associated with effective planning and management of resources and time (Laureate Education, 2018). Inclusion of nurses implies that nurses form part of the inter-professional team to provide better insight on the requirements as they interact more with patients than other healthcare providers in their facilities.

As a nurse, one always feels motivated when they participate in decision-making concerning the implementation of different health information technology systems. As you note, you were excited as part of the team to implement the new charting system in your facility. This implies that involvement in the process ensures that nurses in the practice can address common issues that may arise during the implementation or any other stage of the SDLC process.

References

Laureate Education (Producer). (2018). Systems implementation [Video file]. Baltimore, MD:

Author.

Scott, S. M., & Scott, P. A. (2021). Nursing, advocacy, and public policy. Nursing Ethics, 28(5),

723-733. doi: 10.1177/0969733020961823.

RE: Discussion – Week 9

Healthcare facilities receive many patients every day and hence, they are involved in the collection, processing, storing, and managing of large and numerous patient files. In the past, patient records were documented and stored in manual files, but with the advancement and incorporation of information technology in healthcare, patient information is collected and stored in computer systems. Manual records were associated with loss of patient information, difficult accessing information, and errors (Feldman,2018). Therefore, information technology has not only made management of patient records easier, but also improved the quality of care. Healthcare systems are developed and managed by various systems such as the Systems Development Life Cycle (SDLC), which is a model used by software developers to develop and implement systems that meet patient needs (Jain & Suman, 2015). Nurses play important roles in system development and this paper will explore their contributions in the SDLC.

Nurse Inclusion in SDLC Stages

Requirements of the end use are one of the important factors considered in system development and in healthcare, nurses are the end users since they use the systems to collect and store patient information. Therefore, they are integral components in all SDLC stages.

Planning

Planning has a significant impact on the outcomes of a project and hence, proper planning translates to success. At this stage, stakeholders propose an idea, identify opportunities and shortcomings, and other requirements such as tools and resources required to develop and implement the system (Ergative & Kruglov, 2020). Nurses; role at the planning stage include provision of relevant information about the strengths and shortcomings of existing systems, and propose expectations of the new system; this is because they have first hand information about the systems they use.

Analysis

The expected outcome of the project is viewed at this stage; it creates a picture of how the system will turn out. Stakeholders assess the achievability of the project and the anticipated outcomes (Sharma & Singh, 2015); this enables them to devise effective interventions to address the problems. Just like in the planning phase, nurses are knowledgeable about challenges associated with the existing systems and are therefore resourceful in developing interventions.

Design

This phase involves designing the actual project by putting the ideas into a physical or visual presentation such as images, pictures, or videos. Software developers put together the architecture of the project (Ergative & Kruglov, 2020).  Nurses are important in designing since they understand patient needs and the gaps in the existing system, especially of the project involves modification of an existing system.

Implementation and Post-implementation Support

All systems are tested before they are actually implemented and unleashed for use. At this stage, the system is put into actual use to determine whether it meets the end-user needs (Kaur & Kaur, 2015). Usually, the software developers use codes to programme the systems and therefore, nurses should be involved to learn and confirm the new codes. This stage is very critical because if errors are made, for example, incorrect coding, the systems may not function as expected and this might also require additional costs; this causes unnecessary maintenance cost. Post-implementation involves training the end users on how to use the system and maintenance for effective running.

Conclusion

System development involves planning, analysis, design, implementation, and post-implementation support. Nurses play critical roles in all the stages since they are usually the end users of healthcare systems. The success of the project depends on adequate implementation of all the stages.

References

Ergasheva, S., & Kruglov, A. (2020). Software development life cycle early phases and quality metrics: A systematic literature review. Journal of Physics: Conference Series1694, 012007. https://doi.org/10.1088/1742-6596/1694/1/012007

Feldman, S. S., Buchalter, S., & Hayes, L. W. (2018). Health information technology in healthcare quality and patient safety: Literature review. JMIR Medical Informatics6(2), e10264. https://doi.org/10.2196/10264

Jain, R., & Suman, U. (2015). A systematic literature review on global software development life cycle. ACM SIGSOFT Software Engineering Notes40(2), 1-14. https://doi.org/10.1145/2735399.2735408

Kaur, A., & Kaur, K. (2015). Suitability of existing software development life cycle (SDLC) in context of mobile application development life cycle (MADLC). International Journal of Computer Applications116(19), 1-6. https://doi.org/10.5120/20441-2785

Sharma, P., & Singh, D. (2015). Comparative study of various SDLC models on different parameters. International Journal of Engineering Research4(4), 188-191. https://doi.org/10.17950/ijer/v4s4/405

System Development Life Cycle (SDLC), according to McGonigle and Mastrian (2018), is a way to deliver an effective, efficient information system. That can fit an organization’s business plan. The cycle is a continuous revolving process that spans the software’s life. For example, planning software production to update, renew, or a new system is developed (McGonigle & Mastrian, 2019). The SDLC process has five stages, namely, Planning, Design, Implementation, Maintenance, and Evaluation (Laureate, 2018).

Burns (2012) purports that nurses are not always included in decision-making as it relates to technology implementation. He continued, “if an organization considers what is best for the patient, they will see that nurse plays a decisive role in Information Technology (IT) system implementation, and should be involved at all stages in the process.

The planning stage incorporates the needs of a particular system and technical requirement and should answer the question” what is best for the patient (Laureate Education, 2018). Nurses represent the largest professional group, and they spend the most time interacting with patients through direct patient care. Thus, they would be the majority end users of information systems in an organization and would know what is best to meet the patients’ needs (McGonigle &Mastrian, 2018).

During analysis, the requirement for the system is identified from the organization’s data. The needs and current practices are examined to determine possible changes (McGonigle &Mastrian (2019). According to Burns (2012), organizations should ensure their data is correct, and this can be done by utilizing nurses. Because nurses are responsible for recording a large amount of data. Notably, Burns (2012) states, “nurses believe they need to play a more active role when their organization is implementing new technology.”

Analysis and design are essential in the cycle. The design focuses on what programs are needed and established how they are connected. It involves deciding on a specific function of the hardware, software, and networking possibilities. Analysis and design are crucial in the cycle; nurses can analyze the design to determine shortcomings, thus preventing costly revision dow the road (McGonigle & Mastrian, 2019).

Implementation/ Evaluation in the phase where to software is put to work, in other words, “Go Live.” Burns (2012) states implementation is an important stage where workflows occur. Nurse leaders, Nurse informaticists, and Chief Nursing Officers can ensure a smooth transition of the software for the end-users.

I was not a part of the planning of the IT systems in my organization; however, I believe I have an impact on decision-making. I have a role to play in learning about the system, and it helps me as an individual and impacts the decision made. It is my responsibility to learn the system. I would be able to identify the software’s strengths and weaknesses and seek to become involved in the evaluation process. According to Burns (2012), if more nurses are involved in technology implementation, that could help hospitals embrace new models of care.

In conclusion, nurses are essential to quality healthcare delivery and should be involved in the life of the cycle of System Development. Nurses touch every aspect of care. This means they need to manage change and lead, particularly when it comes to IT (Burns, 2012).

References

Burns, E., (2012). Nurses have an important role to play during technology implementation

https://searchhealthit.techtarget.com/news/2240166948/Nurses-have-an-important-role-to-play-during-technology-implementation

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of

knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Laureate Education (2018). Interoperability, Standards, and Security [Video file]. Retrieved

from. https://class.waldenu.edu/bbcswebdav/institution/USW1/202070_27/MS_NURS/NURS_5051_WC/USW1_NURS_5051_module05.html?course_uid=USW1.26538.202070&service_url=https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/wslinks&b2Uri=https%3A%2F%2Fclass.waldenu.edu%2Fwebapps%2Fbbgs-deep-links-BBLEARN

The Inclusion of Nurses in the Systems Development Life Cycle

In the media introduction to this module, it was suggested that you as a nurse have an important role in the Systems Development Life Cycle (SDLC). With a focus on patient care and outcomes, nurses may not always see themselves as contributors to the development of new systems. However, as you may have observed in your own experience, exclusion of nurse contributions when implementing systems can have dire consequences.

In this Discussion, you will consider the role you might play in systems development and the ramifications of not being an active participant in systems development.

Resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To Prepare:

  • Review the steps of the Systems Development Life Cycle (SDLC) as presented in the Resources.
  • Reflect on your own healthcare organization and consider any steps your healthcare organization goes through when purchasing and implementing a new health information technology system.
  • Consider what a nurse might contribute to decisions made at each stage of the SDLC when planning for new health information technology.

By Day 3 of Week 9

Post a description of what you believe to be the consequences of a healthcare organization not involving nurses in each stage of the SDLC when purchasing and implementing a new health information technology system. Provide specific examples of potential issues at each stage of the SDLC and explain how the inclusion of nurses may help address these issues. Then, explain whether you had any input in the selection and planning of new health information technology systems in your nursing practice or healthcare organization and explain potential impacts of being included or not in the decision-making process. Be specific and provide examples.

By Day 6 of Week 9

Respond to at least two of your colleagues* on two different days, by offering additional thoughts regarding the examples shared, SDLC-related issues, and ideas on how the inclusion of nurses might have impacted the example described by your colleagues.

*Note: Throughout this program, your fellow students are referred to as colleagues.