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NR 512 Week 1: Integration of Nursing Informatics Skills and Competencies

NR 512 Week 1: Integration of Nursing Informatics Skills and Competencies

Informatics is used in my personal practice through several ways. The first, is obviously through a computer. I work in the operating room, and our charting must be thorough and in-depth so that we are able to describe every event that happened during the patient’s surgery. The charting in the operating room is different than any other charting I have done. We do not do a full head to toe assessment, in fact we do not usually have time! We must be able to realize what happened in that surgery through our charting if it were too appear in court one day.

In the cognitive aspect of informatics, it is a little different in the operating room for nurses. I only get a few minutes to allow my patient to trust me with their care. They are asleep during their entire surgery and I am their advocate. I must use my cognitive intuition to call the shots regarding what this patient may or may not want. I must use my cognitive informatics to collect enough data or information about this patient to learn their needs and wants. Usually I only have about 3-5 minutes to do this. This then puts into effect my work that I do as a nurse and my decision-making skills. I believe that the primary area I use informatics would be my initial interview with my patient.

Before the patient comes to the operating room, I am to interview them, check their health record, check their history, make sure both an anesthesiologist and the surgeon have seen the patient, and find out as much information as I can to learn everything about this patient. In the interview, I ask them questions that pertain to them, what I have learned about them through their record, and any questions I may have, or they may have regarding their surgery.

I believe that both the computer side to informatics and the cognitive side to informatics allow us to ensure patient safety. By viewing my patient’s electronic health record, I am ensuring that everything matches what the patient says. Yes, they had hip surgery back in 2004 and need extra padding, or no they did not have hip surgery back in 2004 and can go in stirrups. As a nurse, I am using informatics to ensure that all benefits to the patient are realized (Strudwick et al., 2016).

Reference:

Strudwick, G., Booth, R., & Mistry, K. (2016). Can Social Cognitive Theories Help Us Understand Nurses’ Use of Electronic Health Records?CIN: Computers, Informatics, Nursing,34(4), 169-174. doi:10.1097/cin.0000000000000226

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I enjoyed reading your post about how informatics allows and ensures for patient safety and I could not agree more. My top three during admission database is going over the patients medication list, if the patient has fallen within the past six months, and if the patient has been readmitted within the past thirty days or ninety days. It is extremely important to ask patients what medications they are currently taken, what medications have been discontinued, and what medications are new. I make sure that their medication list is updated so that physicians are able to see what medications patients are currently taking, what may need to be re-ordered, or if any medications or dosages may need to be readjusted while they are in the hospital. My second question is about falls because too many times I have patients whom are extremely independent and stubborn (my cute elderly patients in the 80s and 90s) about getting up alone and may think that they do not need any help. It is our duty to ask when the last time patients have fallen and even if patients have never fallen, we still have to use our best judgments to consider if they are high risk for falls. If patients are considered to be high risk for falls, they get a high risk falls band, bed alarm on, and a sign outside their room letting everyone know.

Sometimes older patients may be forgetful and confused when they wake up and I like to be safe and prevent a fall when possible. In every room, when patients are lying flat in their beds, there is a huge sign attached to the ceiling that says “CALL, DON’T FALL.” We take falls very serious on our unit and charting and collecting these data is very useful. Asking patients if they have been readmitted within the past 30 days or 90 days is also very important. Informatics help in this department seeing that we are able to look back at the chart to see if it’s the same diagnosis, what kind of treatments were done, and when patients were discharged. This type of informatics also prevents any kind of treatments that may be needed to be repeated and it prevents errors as well. To prevent errors from occurring, there is a need for a set of performance indicators and metrics related to patient safety for classifying and measuring mistakes (Karami and Hafizi, 2017).

Reference:

Karami, M., & Hafizi, N. (2017). Enhancing Patient Safety Using Medical Imaging Informatics. Radiology Management, 39(2), 27-35.

Nursing informatics and critical thinking is an important component in the delivery of safe patient care and must be used simultaneously to ensure patient outcomes are positive. Nursing informatics is important to all nursing specialty areas; therefore, it is important for nurses to understand the relevance of incorporating nursing and informatics to the clinical practice, patient tracking, data trending, assessing workload, & appropriate and timely documentation (McGonigle, Hunter, Sipes, and Hebda, 2014). Nursing informatics is such an important concept to safe patient delivery that in 2004, an execute order from President Bush outlined a plan focused to ensuring that every American would have an electronic health record (EHR) by 2014; this executive order brought together a national conference in July 2004, called the Cornerstones for Electronic Health Record that included leaders across healthcare to discuss the technological infrastructure of technology into the healthcare arena (Shaw, Sensmeier, and Anderson, 2017). The Tiger initiative was established because of this conference in 2006, to engage and prepare nurses for the proper use and development of informatics in nursing practice. Therefore, the need for nurses and nurse leaders to understand the significant of informatics in nursing is very important to practice that lead to positive patient outcomes when documentation is detailed, timely, accurate, and within the unit and facility guidelines.

References:

McGonigle, D., Hunter, K., Sipes, C., & Hebda, T. (2014). Why Nurses Need to Understand Nursing Informatics. AORN Journal, 100(3), 324.

Shaw, T., Sensmeier, J., and Anderson, C. (2017). The Evolution of the TIGER Initiative. Computers, Informatics, Nursing, 35(6), 278-280.

As you stated nursing informatics is an important aspect in patient care delivery that provides a range of safety measures for improving patient care and improving the accuracy of shared information amongst healthcare providers.  Informatics in nursing allow data to promote accountability and shared knowledge to bridge the gaps in treatment and the direction of the patient’s plan of care. With accurate and real time information members of the patient’s healthcare team can make appropriate decisions to facilitate the best course of action for the patient that will lead to positive patient outcomes. For example, when a patient enters a health care facility a proper assessment and timely documentation can save a life of a patient displaying signs and symptoms of an acute ischemic infarct. In the case of an acute ischemic stroke, the use of intravenous tissue plasminogen activator (IV-tPA), if given within three hours of symptoms onset, has been proven to reduce the incidence of death or disability after a stroke (Sadeghi-Hokmadadi etc., 2016).

The American Heart Association/American Stroke Association guidelines emphasizes that suspected acute stroke patients should be triaged as a priority, regardless of the severity of neurological deficits, and door to CT scan time should be less than 25 minutes and door to needle (DTN) time should be less than 60 minutes (Sadeghi-Hokmadadi etc., 2016). For each 15-minute reduction in delay, there are an estimated 4% improvement in clinical outcomes and 5% lower odds in mortality (Sadeghi-Hokmadadi etc., 2016). The CDC estimates that that in the US every 40 seconds someone has a stroke, and every 4 minutes someone dies from a stroke (CDC, 2018); with the use of informatics, quick and accurate nursing assessment, and proper implementations of stroke interventions stroke morality and morbidity rates can be reduced. Informatics provides shared information that can be viewed by the healthcare team remotely to save a life and improve outcomes.

Reference:

https://www.cdc.gov/stroke/facts.htmLinks to an external site.

Sadeghi-Hokmadadi, E., Taheraghdam, A., Hashemilar, M., Rikhtegar, R., Mehrvar, K., & … Hasaneh Tamar, S. (2016). Simple In-Hospital Interventions to Reduce Door-to- CT time in Acute Stroke. International Journal of Vascular Medicine, 20161656212.

There are many different types of technology and equipment that facilitates care for my cardiac unit. The first technology that I would like to mention is the telemetry box that all our patients are required to wear until they have been cleared of cardiac. The telemetry box is extremely important as well as fascinating. In the sense of importance, it shows nurses their patients’ heart rate in all the rooms and heart rates and heart rhythms outside near the nurses’ station. The telemetry box is so crucial to have when patients are on cardiac drips to see if rhythms have been converted back to normal sinus or to see if rhythms are continuously dangerous. The only thing really challenging is when patients move and the leads are misplaced, it can show a wrong rhythm.

Another equipment that I would like to share is something brand new to our unit. This new and useful technology is an external female catheter called a purewick. Although my unit is more chest pain observation, we often take in patients whom are Congestive Heart Failure as well. Many times our CHF patients may be overweight, bedbound, high risk for falls, weak, and incontinence, and using a foley has caused patients to acquire an infection or patients whom are wearing diapers; it may be too difficult to measure accurate urine output. The neat thing about the purewick is that it is shaped like a banana and is made out of a sponge like material. For this purewick to work correctly, it must be placed in the proper place. There is suction at the top of the purewick that will be connected to the wall and as soon as the patient releases any urine, the sponge will suction it up into the wall and through a urine collecting container. When the purewick is in place and works properly, it is like magic. The challenging about this purewick is that improper placement of the external catheter can lead to urethral injury and soiled absorbent material can contaminate the urine specimen and alter urinary results (Karakashian, 2018).

Reference:

Karakashian, A. B. (2018). External Female Catheters: Applying. CINAHL Nursing Guide