Leadership Module 1- Ch. 7, 23, 24
Hints for conducting a literature search
1. Do some narrowing before you go to online databases. Think about some key terms or alternative terms for your problem. Be prepared to narrow or expand your search, depending on what you find. 2. Plan to spend time conducting your literature search, but do not waste valuable time. Query the online database "help" menu to assist you with getting started. 3. Begin by identifying the major professional nursing journals that publish nursing research. Determine if those journals are available in the database, and start your literature review with those. If your problem is in a specialty area, review specialty journals. 4. If you find an article related to your problem, look at that author's reference list for other current articles and journals. 5. Read the abstract of the article first; this will give you a quick overview of the article to determine if it is relevant to your topic under study. 6. Know the limitations of the databases where you do your search. 7. Carefully appraise information obtained from the Internet that is not part of an established online database, such as Journals@Ovid; EBSCOhost; ProQuest; Thomson Gale PowerSearch.
Analyzing a research article for potential use of findings in nursing practic
1a. The Purpose of the study is: 1b. The importance of this study to nursing practice is: 2. The Research Question/Hypothesis is: (If the question/hypothesis is not stated, it could be): 3a. The Independent Variable(s) is/are: 3b. The Dependent Variable(s) is/are: (If there are no independent and dependent variables, the Research Variable[s] is/are): 3c. Definition(s) of the variable(s) of interest to me is/are: 4. The Conceptual Model/Theoretical Framework linked with this study is: 5a. The content areas in the Review of Related Literature are: 5b. The review does/does not evaluate both supporting and nonsupporting studies: 6a. The Research Design used for the study is: 6b. The design is/is not appropriate for the research question: 6c. The control(s) used in this study is/are: 6d. The Study Setting is: 7a. The Target Population is: 7b. The Sampling Method is: 7c. The Sampling Method is/is not appropriate for the design: 7d. The criteria for participants are: 7e. The sample included ________ participants. 7f. The sample is/is not representative of the population: 8a. The Study Instrument(s) is/are: 8b. Instrument validity and reliability information is presented and is of adequate levels for confidence in using the results: 9a. The Data Collection Method(s) is/are: 9b. The Data Collection Method(s) is/are (is not/are not) appropriate for this study: 10. Steps were taken to protect the Rights of Human Subjects: 11a. The Data Analysis Procedure(s) is/are: 11b. The Data Analysis Procedure(s) is/are appropriate for the level of data collected and the research question/hypothesis: 11c. The Research Question/Hypothesis is/is not supported: 12. The author(s) major Conclusions and/or Implications for Nursing Practice are:
What Is the Educational Preparation of the Diploma Graduate?
2-3 yrs close relationship between nursing school and hospital easier roll transition for graduates to function in the institution they received training in while in nursing school
What Is the Educational Preparation of the Baccalaureate Graduate?
4 to 5 years in length 120-140 credits student must first meet all of the college's or the university's entrance requirements
Defining your practice context
A practice context entails a blending of all those factors and systems that contribute to the delivery of nursing care. This blend includes the health, social, and cultural characteristics of the patient population served: the type of practice setting, the economic resources of the setting, the type of health care delivery system, the existing policies and procedures, the staffing pattern, and the administrative structure
Patient Digital Assistant (PDA)
Allows bedside data collection and charting Conserves time and reduces steps to and from nurses' station Offers easier information transmission between workers Portability and information at your fingertips Can use to monitor: Blood glucose levels Blood pressure Diet Activity Calculate dosages Analyze lab results Access reference materials Check for drug interactions Schedule procedures Order prescriptions "Beam" assignments
Relevant websites and online Resources
American Nurses Association Research toolkit. https://www.nursingworld.org/practice-policy/innovation-evidence/improving-your-practice/research-toolkit/ American Speech-Language Hearing Association Evidence-based practice tutorials and resources. http://www.asha.org/Research/EBP/Evidence-Based-Practice-Tutorials-and-Resources/ California State University, Chico What is a scholarly article? https://www.csuchico.edu/lins/handouts/scholarly.pdf Duke University Medical Center Library & Archives Resources for EBP. http://guides.mclibrary.duke.edu/nursing/ebp Indiana Center for Evidence-Based Nursing Practice http://ebnp.org National Institute of Nursing Research Building the scientific foundation for clinical practice. https://www.ninr.nih.gov/ North Carolina State University Anatomy of a scholarly article. http://www.lib.ncsu.edu/tutorials/scholarly-articles/ Peer review in five minutes. http://www.lib.ncsu.edu/tutorials/pr/ Scholarly vs. popular materials guide. http://www.lib.ncsu.edu/guides/spmaterials/ The Academy of Medical-Surgical Nurses Evidence-based practice. https://www.amsn.org/practice-resources/evidence-based-practice University of North Carolina Evidence-based nursing introduction. http://guides.lib.unc.edu/c.php?g=8362&p=43029
Step 1: Define the Problem
As nursing professionals who will be responsible for implementing an EBP protocol with the goal of improving patient outcomes, we must first recognize and fully define the problem.
The agency for healthcare research and quality What Is Its Function?
As part of the Omnibus Budget Reconciliation Act of 1989, the Agency for Health Care Policy and Research (later renamed the Agency for Healthcare Research and Quality [AHRQ]) was established to enhance the quality and effectiveness of health care services. The AHRQ conducts and supports general health services research, develops clinical practice guidelines, and disseminates research findings and guidelines to health care providers, policy makers, and the public.
What Are the Health Care Delivery Characteristics of Your Setting?
As you continue to define your practice context, specify the type of practice setting, the economic constraints of the setting, the type of health care delivery system, the existing policies and procedures, the staffing patterns, and the administrative structures.
What are the other available educational options?
BSN completion programs career ladder or bridge programs external degree programs accelerated programs online university programs
Few doctors currently communicate with their patients through e-mail Could help to avoid "phone tag" with clients and improve efficiency Drug-refill requests and educational information could be accessed
what does finded research include?
Funded research includes health promotion and disease prevention, quality-of-life issues, health disparities, end-of-life and palliative care, symptom management research, data science, global health, and genomic science.
NI education
INs who want to hold leadership roles in NI will need graduate-level preparation. A student who held a leadership role in NI and was enrolled in a NI master's program once said that she thought she knew all about NI, but she learned that she only knew about it at her own organizational level. Her graduate-school education had broadened her perspectives and introduced her to new concepts and ways of thinking (C. Parker, 2011, personal communication).
What Are the Motivators and Barriers for Incorporating Nursing Research into Your Practice?
Identify your bridges (motivators) and roadblocks (barriers) in the practice setting
Registration and Licensure
Licensure affords protection for the public by requiring an individual to demonstrate minimum competency by examination before practicing certain trades. By 1923, 48 states (Alaska and Hawaii did not become states until much later) had some form of nursing licensure in place. Nursing licensure is a process by which a governmental agency grants "legal" permission to an individual to practice nursing. This accountability is maintained through state boards of nursing, which are responsible for the licensing and registration process. Boards of nursing vary in structure and are based on the design of the nurse practice act within each state
Ch. 24 Conclusion
Nursing has a growing body of evidence on which we can support our practice. Moreover, research utilization is a key component of effectively implementing EBP protocols aimed at improving patient outcomes. Whether you are a new graduate or an experienced nurse, there are ample opportunities for you to apply research in your area of clinical practice. When areas of practice need to be changed, it is important to have valid information and data to support the need for change. Check out your hospital resources, establish networking and colleague support, and participate in EBP in your workplace setting.
What Is the Relationship Between Nursing Theory and Research Utilization?
Nursing theory used as the theoretic framework of a research study is essential for the continued development of nursing theories; new research findings will support theory or will suggest the modification of theory. In contrast, when a specific nursing theory is used as the framework for nursing practice, the focus is on the intervention. The intervention that is designed in the planning phase of research utilization must be consistent with the theory
PICOT
Patient population of interest Intervention of interest Comparison of interest Outcome Time
Research Utilization: What Is It Not?
Research utilization does not entail simply taking the findings of a single research study and using those findings in nursing practice Research utilization should not be confused with a review of nursing practice.
Steps for Conducting Research
Step 1: Identify the Problem Step 2: Establish What Is Already Known About the Problem Step 3: Establish a Plan for Conducting the Research Step 4: Implement the Research Study Step 5: Examine the Data Step 6: Utilize the Findings
Step 5: Evaluating
Step 5 involves the evaluation of the implementation (Step 4) to determine whether the new approach improved practice outcomes. Whether or not you will continue using the new approach in the practice setting may also be determined based on new technology, economic considerations, or changes in staffing. If there is no change in outcomes, you may want to return to the previous practice, or the evaluation phase may lead to another research utilization project. For example, if the practice problem is significant and the practice outcomes were not improved, another new approach may be tried.
Accrediting Organizations
The ACEN, the CCNE, and the NLN CNEA are accrediting organizations that accredit nursing programs nationwide. Specifically, the ACEN accredits clinical doctorate/DNP specialist certificate, master's/post-master's certificate, baccalaureate, associate, diploma, and practical nursing programs (ACEN, 2018). The NLN CNEA accredits licensed practical nurse/licensed vocational nurse (LPN/LVN), diploma, associate, bachelor, master's, and clinical doctorate degree nursing programs (NLN CNEA, 2018), and the CCNE accredits baccalaureate and graduate programs, postgraduate APRN certificates, and nurse residency programs (CCNE, 2018).
Nursing Journals and Literature Available
The American Journal of Nursing Nursing Year RN
The national institute of nursing research What Is Its Function?
The National Institute of Nursing Research (NINR) is a branch of the National Institutes of Health (NIH), which is under the jurisdiction of the U.S. Department of Health and Human Services. Each institute within the NIH focuses on a specific area of health care research; the NINR is a major source of federal funding for nursing research. The NINR also supports education in research methods, research career development, and excellence in nursing science. Other functions of the NINR are to establish a National Nursing Research Agenda.
How does the concurrent or dual pathway program begin?
The concurrent or dual pathway program will often begin with the student taking a university course the semester before beginning the community college nursing program. This is generally an introductory course that reviews nursing theory, the history of nursing, or an introduction to professional nursing practice. Following the initial course, the student will enter the nursing program at the community college, and the RN to BSN courses, which are most often offered online or in a hybrid format, will either be layered with the associate degree courses during traditional semesters or spaced during breaks, summers, and/or intercessions
Step 3: Planning
The first phase involves determining the new approach, or innovation, that will be used on the basis of the findings from the review of the literature Phase two of planning is the establishment of a systematic method for implementing the new approach. The third phase of planning involves establishing a method for evaluating the practice outcomes or effects of the new approach.
What About a Doctoral Path to Becoming a RN?
The last and least-common path leading to the RN licensure examination is the doctoral degree in nursing, where the graduate has a non-nursing baccalaureate degree. A doctoral nursing program provides basic nursing courses, along with advanced nursing courses. Upon completion, the graduate is eligible to take the NCLEX-RN examination. Currently, the University of Colorado and Case Western University are the only universities to offer a doctoral nursing program as an entry-level degree or prelicensure option
Step 2: Assessing
The second step in research utilization is the identification and critical evaluation of published research that is related to the practice problem you have identified. Your task will be to analyze and critically evaluate the research reports to determine which findings are adaptable to your practice problem and context. it is essential that the research reports you are reviewing are peer-reviewed to ensure credibility
Step 4: Implementing
This step involves the implementation or application of the new approach, along with the collection of the evaluation data. By following the specific plan that you established in Step 3, the new approach will be introduced into practice. It is important that you begin collecting your evaluation data at the same time so that you can clearly determine the effect of the new approach.
Patient Engagement
To be engaged, patients must use the resources available to maximize their health. When we add health information technology to the concept of patient engagement, we get the definition from the Office of the National Coordinator for Health Information Technology, "The ability of individuals to easily and securely access and use their health information electronically serves as one of the cornerstones of nationwide efforts to increase patient and family engagement and advance person-centered health" (HealthIt.gov, 2018b).
What Are the Health, Social, and Cultural Characteristics of the Patient Population Being Served?
To begin defining your practice context, you will need to identify any characteristics that are specific to the group of people who will be receiving nursing care. Is there some particular health characteristic that should be considered?
Doctoral Degree
Until recently, there were two basic models of doctoral education in nursing: the academic degree, or doctor of philosophy (PhD); and the professional degree, or doctor of nursing science (DNS, DSN, or DNSc). For either of these degrees, you must first have a master's in nursing. Nurses have other doctoral degree options available to them, such as the doctor of education (EdD), the doctor of public health (DrPH), the PhD in a discipline other than nursing, the nontraditional external degree doctorate, and the practice-focused nurse doctorate (ND), which was initiated as an entry-level degree.
How to read a nursing research article A research article should answer the following:
What?Read the problem statement, purpose, research question, and results/findings.Is the content of the article related to my question?Why?Read the problem statement or the review of literature.Why was the research done?When?Do more recent findings provide a better answer?When was the study done? Is it classic, current, or outdated?Read the date of publication.How?Read the method and design sections.What research method was used? Is it a quantitative, qualitative, or mixed-methods approach?Who?Read the method section.Who were the subjects? What was the sample?Where?Read the method section.In what setting was the research done?So What?Read the findings and discussion.Are the findings helpful to my problem and me?Do Not:Do not automatically accept what you read; critically evaluate the content. You can only evaluate what is written and reported; do not assume anything about what is not written.
The need for nursing practice based on research
increase in health care costs scrutiny of how health care dollars spent payments based on favorable client outcomes Today's need to base practice on nursing care documented to benefit patients
The Utilization of research
involves the systematic process of integrating the findings of completed nursing research studies into clinical nursing practice.
Online (Web-Based) Programs
it is possible to earn ADN, BSN, master's, and doctoral degrees in web-based or web-enhanced formats. At times, it can be confusing and overwhelming to find the right programs. Several sites are available to help users locate specific web-based or web-enhanced courses (and course descriptions). See the Internet resources listed on this book's Evolve website. When considering which program is the best fit for your career goals, it is important to consider the cost of an online program but also if the program is in an enhanced nurse licensure compact (eNLC) state.
A Shortage of Qualified Nursing Faculty
the "average ages of doctorally prepared faculty holding the ranks of professor, associate professor, and assistant professor were 62, 57, and 51 years, respectively" (AACN, 2017d, para 5). There are fewer nurses entering the profession who are choosing a teaching role. Because of decreased numbers of new teachers, along with the number of current faculty retiring, the number of qualified faculty will continue to decline. The ability to earn more in the clinical and private sector is also attracting potential nurse educators to leave academia. The American Association of Nurse Practitioners (AANP) gives the average salary of a nurse practitioner as $97,083 whereas the AACN reported that master's-prepared faculty had an annual income of $77,022.
two distinct roles in NI:
the IN and the informatics nurse specialist (INS) The IN has experience in NI but does not have an advanced degree in the specialty. The INS has graduate-level education in informatics or a related field
Qualitative Research
• Acquire understanding of phenomena by observing behaviors, reactions, statements of study participants • Inductive approach • Study typically focuses on central concept or aspect for further exploration • Open-ended questions • Questions ask, "How" or "Why"? • Broad questions that seek to explore perceptions, beliefs, attitudes of a particular phenomenon of interest • Data collected through observing, interviewing, audio/video recording • Small sample size • Study participants are typically selected by researcher • Researcher interprets data by developing themes based on participants' views and observations • Data analyzed is subjective in nature; may include words, artifacts, images, anecdotal statements
Quantitative Research
• Examination of a cause-and-effect relationship • Deductive approach • Study focuses on supporting or refuting the null hypothesis • The research variables are discussed and examined in detail to determine if a relationship or causality exists • Closed-ended questions • Questions ask, "What differences exist," "What is the effect," "What is the relationship ... ?" • Null hypothesis is either supported or refuted based on study findings • Follows specific sequence • Similar to scientific method; numeric data collected through questionnaires, surveys, established instruments • Large sample size • Statistical analysis; numeric data reported • Data analyzed is unbiased and objective
When the statistical procedures are beyond your level of understanding:
• Read the results section, being alert for specific phrases that will tell you the answer to the research question. For example, "the hypothesis was not supported." • Look at the tables; tables should be understandable without the narrative. • Assume that the appropriate statistical analysis was performed correctly and that the researcher has interpreted the results correctly. • Have someone who understands the statistics read the article and ask his or her opinion, or get a consultant.
CAFE internet research
▪ Challenge the information and demand accountability. ▪ Adapt and require more credibility and evidence for stronger claims—it is okay to be skeptical of the information. ▪ File new information in your mind rather than immediately believing or disbelieving it. ▪ Evaluate and reevaluate regularly. Recognize the dynamic, fluid nature of the information.
Although there are multiple theories that are applicable to NI practice, the three most common are as follows:
▪ General systems theory—This theory organizes interdependent parts working together to produce a product that none used alone could produce. Key elements are input, process, output, control, and feedback. ▪ Rogers' diffusion of innovation theory—A five-step process of an individual's decision to adopt an innovation, which includes knowledge, persuasion, decision, implementation, and confirmation (Rogers, 2003). ▪ Change theory—Kurt Lewin's change theory
Watson is being used in several areas of health care already, including the following:
▪ Managing care of complex patients ▪ Accelerating drug discovery by being able to manage the volume of drug research data far better than humans can ▪ Identifying appropriate cancer treatments in studies ▪ Matching patients with clinical trials (Speights, 2018)
WHO (2018b) goes on to define mHealth as
"a component of eHealth and involves the provision of health services and information via mobile technologies, such as mobile phones, tablet computers, and Personal Digital Assistants (PDAs)."
HealthIT.gov defines EMR as
"a digital version of the paper charts.... An EMR contains the medical and treatment history of the patients in that office, clinic, or hospital"
Personal Health Record
"is an electronic record of an individual's health information by which the individual controls access to the information and may have the ability to manage, track, and participate in his or her own health care"
Nurses in both IN and INS roles
"support nurses, consumers, patients, the interprofessional health care team, and other stakeholders in their decision-making in all roles and settings to achieve desired outcomes. This support is accomplished through the use of information structures, information processes, and information technology"
Cloud Computing
"the delivery of computing services—servers, storage, databases, networking, software, analytics, and intelligence and more—over the Internet ('the cloud') to offer faster innovation, flexible resources, and economies of scale" (Microsoft Azure, 2018).
The World Health Organization (WHO) provides the following definition for eHealth
"the use of information and communication technologies (ICT) for health"
Nursing Certification
"voluntary process by which a nongovernmental agency or association certifies that an individual licensed to practice a profession has certain predetermined standards specified by that profession for specialty practice" (ANA, 1979, p. 67). Certification is a different credential from licensure and has a variety of interpretations—both for the nursing profession and the public. The nursing license is recognized as indicating minimum competency, whereas the certification credential indicates preparation beyond the minimum level.
Certified nurse-midwife (CNM)
An average 1.5-2 years of specialized education beyond nursing school, either in an accredited certificate program or at the master's level. In 2017, there were an estimated 11,826 nurses prepared as CNMs in the United States (ACNM, 2018).CNMs are well known for delivering babies in hospitals and homes, and providing well-woman gynecological and low-risk obstetrical care, including prenatal, labor and delivery, and postpartum care. The CNM manages women's health care throughout the lifespan, including primary care, gynecological exams, and family planning. CNMs have prescriptive authority in all 50 states.
What Is a BSN/MSN Completion Program?
BSN program designed for those who have obtained a diploma or ADN and hold a current RN license to practice Nurse receives transfer credit in basic education courses taken at other institutions 2 yrs in length
Certified Nurse Educator (CNE)
CNEs are registered nurses (RNs) who hold a master's or doctoral degree in nursing with an emphasis in nursing education.The majority of CNEs are nurse educators who facilitate student learning by providing innovative teaching methods in a variety of academic and practice settings, which may include community colleges, universities, hospitals, and technical programs (NLN, 2018).
EBP and Research
EBP goes beyond nursing research in considering other sources of documentation that may improve nursing care. Research published by other disciplines is included (e.g., medical research and social research), as well as nonresearch data that may contribute to practice (e.g., financial data and clinical experts). This is prudent at a time when the complexity of health problems is increasing and the discovery of new data is more rapid than ever before
What Is Nursing Informatics?
In 1994, the American Nurses Association (ANA) recognized the field of NI. In 2015, the ANA updated the definition of NI as "the specialty that integrates nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice" (ANA, 2015, p. 1).
The Certification Process
In 1994, the American Nursing Credentialing Center (ANCC) provided a method for nurses to become certified in this specialty. The baccalaureate degree is the minimum requirement needed to take the certification exam. Nurses can obtain RN-BC certification in informatics nursing through the ANCC.
Credentials in Nursing
In nursing, the educational credentials that an individual holds indicate not only academic achievement but also the attainment of a minimum level of competency in nursing skills. An ADN, a diploma in nursing, or a baccalaureate degree in nursing (BSN or BS) represents academic achievement. After academic preparation and successful completion of the NCLEX, you will have a legal credential—your nursing license—that permits you to practice as an RN. Additional nursing credentials may reflect practice in special areas, such as critical care registered nurse (CCRN) and certified addictions registered nurse (CARN).
What Is an External Degree Program?
In the early 1970s, the external degree program was a nontraditional program that allowed a student to gain credit, meet external degree requirements, and obtain a degree from a degree-granting institution without attending face-to-face classes. One of the earliest external degree (or distance education) programs was offered through the New York Board of Regents external degree programs (REX), which is now Excelsior College. External degree programs may offer an ADN, a BSN, and a master of science in nursing (MSN). These programs are designed to allow individuals to obtain degrees in nursing without leaving their jobs or their communities.
The following is an excerpt from the 2019 NCLEX-RN Test Plan regarding the content area of Information Technology on the NCLEX-RN exam:
Information Technology • Receive and transcribe health care provider ordersa • Apply knowledge of facility regulations when accessing client records • Access data for client through online databases and journals • Enter computer documentation accurately, completely and in a timely manner • Utilize resources to enhance client care (e.g., evidenced-based research, information technology, policies, and procedures)a Confidentiality/Information Security • Assess staff member and client understanding of confidentiality requirements • Maintain client confidentiality and privacya • Intervene appropriately when confidentiality has been breached by staff members
The 2 Types of Accreditation
Institutional or regional accreditation refers to an entire university or college being accredited, indicating that all components of the institution contribute toward the institution or college's objectives and mission, whereas program or specialized accreditation refers to a specific discipline, department, or individual program of study within the university or college that is accredited
Step 4: Implement the Change in Nursing Practice
Move the new plan into nursing practice on a defined schedule. Staff in-services may be required so that those involved can fully understand the change. Monitor and evaluate the implementation process. Moreover, as noted by Melnyk and Fineout-Overholt (2005), EBP must recognize the great experience that nurses bring to the practice setting and patient input and preferences if successful implementation is to be realized (Fig. 24.2).
Websites for Health Information
The US National Library of Medicine and National Institutes of Health provides an excellent website on Evaluating Health Information at http://www.nlm.nih.gov/medlineplus/evaluatinghealthinformation.html, including some resources in Spanish. As nurses, we need to have a better understanding of how consumers find health information on the Internet, how to evaluate the quality of this information, and how to help our patients critically evaluate and manage the information
Nursing Research Utilization
The ability to transfer research into clinical practice is essential for ensuring quality in nursing. The process of research utilization involves transferring research findings to clinical nursing practice. In the process of research utilization, the emphasis is on using existing data (findings or evidence) from previous nursing research studies to evaluate a current nursing practice. A major component of the process is reviewing completed nursing research studies that have been published in the literature. In contrast, conducting new research involves the collection of new data to answer a specific clinical practice question.
Certified academic clinical nurse educator (CNEcl)
The academic CNEcl is an RN who holds a BSN degree or higher and is employed by an educational institution to provide clinical instruction to nursing students (NLN, 2018).The academic CNEcl supports the learning of nursing students throughout their clinical experiences in nursing school by serving as a clinical instructor or preceptor during the student's clinical rotation (NLN, 2018).
What Are Regulatory and Accreditation Requirements?
the Health Insurance Portability and Accountability Act (HIPAA) and The Joint Commission (TJC) impact the daily work of every clinician and organization. The nurse must have a clear understanding of HIPAA regulations and of TJC requirements to be able to provide safe nursing care.
Proprietary Nursing Schools
A proprietary nursing school is a for-profit school with a nursing program. Many proprietary schools have nursing programs in more than one state. Because not all nursing boards have the same requirements for licensure, it is important to review the requirements in your state to make sure that you will be eligible for licensure once you complete the program. A prospective student should also make sure that the program is accredited and review the pass rates on the NCLEX examination for their graduates.
What is an accelerated program?
Accelerated programs are offered at both the baccalaureate and master's degree levels; they are designed to build on previous learning to help a person with an undergraduate degree in another discipline make the transition into nursing.
The Aging Population
According to the Administration for Community Living (HHS ACL, 2018, p. 2), by 2040 there will be about 82.3 million older persons, over twice their number in 2000. The population age 65 and older has increased from 37.2 million in 2006 to 49.2 million in 2016 (a 33% increase) in just 10 years and is projected to more than double to 98 million by 2060. The older adult population represented 15.2% of the US population in 2016, but are expected to grow to 21.7% of the US population by 2040. The population age 85 and older is projected to double from 6.4 million in 2016 to 14.6 million in 2040 (a 129% increase!). Nursing educators need to address the provision of health care to the older adult population and continue to ensure its inclusion in nursing curriculum.
A Shortage of Registered Nurses
According to the US Department of Health and Human Services, Health Resources and Services Administration (HRSA, 2017), there were approximately 2.8 million nurses employed in 2014, and it is projected that the number will increase to 3.9 million by 2030, which is a 39% increase nationally. Although these projections indicate that there will not be a nursing shortage nationwide, it is predicted that seven states will still be experiencing a nursing shortage.
Relevant websites and online Resources
American Health Information Management Association (AHIMA) What Is a Personal Health Record (PHR)? http://www.myphr.com/StartaPHR/what_is_a_phr.aspx American Medical Informatics Association (AMIA) AMIA NI Working Group. http://www.amia.org/programs/working-groups/nursing-informatics American Nursing Informatics Association (ANIA) https://www.ania.org/ Centers for Medicare & Medicaid Services (CMS) Promoting Interoperability (PI). http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms/ HealthIT.gov Privacy, Security, and HIPAA. http://www.healthit.gov/providers-professionals/ehr-privacy-security HIMSS Impact of the Informatics Nurse Survey Final Report https://www.himss.org/library/2017-nursing-informatics-workforce-survey-full-results Nursing Informatics https://www.himss.org/library/nursing-informatics/%3FnavItemNumber%3D16520 Medicare.gov Manage Your Health. https://www.medicare.gov/manage-your-health/ Microsoft Microsoft Health Vault. https://www.healthvault.com/en-us/ U.S. Department of Health & Human Services (HHS) Health Information Privacy (2018). http://www.hhs.gov/ocr/privacy/ WebMD WebMD Personal Health Record. http://www.webmd.com/phr Your Mobile Device and Health Information Privacy and Security http://www.healthit.gov/providers-professionals/your-mobile-device-and-health-information-privacy-and-security
How to Evaluate Websites
Step 1: Authority Who is/are the author(s)? Describe each author's authority or expertise. Are professional qualifications listed? How can you contact the author(s)? Who is the site's sponsor? What does the URL tell you? What type of domain does it come from (.gov, .mil, .edu, .org)? Is the site copyright protected? If the website is offering medical information, is the website HONcode certified? To learn more about Health on the Net Foundation Code of Conduct (HONcode), visit: https://www.hon.ch/HONcode/Pro/. Step 2: Timeliness and Currency When were the site materials created? When did it become active on the Web? When was it last updated/revised? Are the links up-to-date? Are the links functional? When were data gathered? What version/edition is it? Step 3: Purpose Who is the targeted audience? What is the purpose of the website? Are the goals/aims/objectives clearly stated? Does the website present facts or opinions? Does the website offer an area for consumers and another one for health care professionals? Step 4: Content Accuracy and Objectivity Does the information provided meet the purpose? Who is accountable for accuracy? Are the cited sources verifiable and published within the last 5 years? What is the value of the content of this site related to your topical needs? How complete and accurate are the content information and links? Is the site biased? Does it agree with other expert sources? Does it contain advertisements? Step 5: Structure, Design, and Access What is the appearance of the site? Does the site load quickly? Do multimedia, graphics, and art used on the page serve a purpose, or are they just decorative or fun? Is there an element of creativity? Is there appropriate interactivity? Is the navigation intuitive? Are there icons? Is it a secured site? Is an index with links available?
the steps that will assist nurses to integrate EBP into their practice
Step 1: Define the Problem Step 2: Identify, Review, and Evaluate the Data Applicable to the Problem Step 3: Design a Practice Change Based on the Data While Incorporating the Clinical Expertise of the Nurse and Patient Preferences Step 4: Implement the Change in Nursing Practice
What Are the Steps for Nursing Research Utilization?
Step 1: Preutilization Step 2: Assessing Step 3: Planning Step 4: Implementing Step 5: Evaluating
The Joint Commission
TJC wrote the IM standards in the mid-1990s. These 10 standards outline the need for IM regulation. Since then, IM has been woven throughout various standards and the National Patient Safety Goals. An example of this is noted in Standard IM.02.01.03 of the revised requirements for the Laboratory Accreditation Program, where the lab must have a "written policy addressing the integrity of health information against loss, damage, unauthorized alteration, unintentional change, and accidental destruction" (TJC, 2014, p. 1).
Role of the Informatics Nurse/Informatics Nurse Specialist (IN/INS)
The IN/INS must have a basic knowledge of how computers and networks work as well as an understanding of system analysis, design principles, and information management (IM). It is important for the IN/INS to converse with both the clinical staff and the technology staff regarding hardware, software, communications, data representation, and security. An IN/INS will be comfortable with software and hardware implementation, training, testing, presenting, and facilitating knowledge Typical job responsibilities consist of (1) product evaluation; (2) system implementation, including preparing users, training, and providing support; (3) system development and quality initiatives, including system evaluations/problem solving and quality improvement/patient safety; and (4) other duties as assigned It is important to note that not all nurses in IN/INS roles work on implementation of the EMR/EHR. Some work for health care product vendors in both the hardware and software areas. They help inform the next generation of existing products, and they work with engineers/design teams to create new products, always bringing the patient care viewpoint and the needs of the end user to the design process. Others work for consulting firms and specialize in workflow improvement using technology, whereas others still work for government, third-party payers, and educational
The 10 E's in "E-Health"
1. Efficiency leading to decreasing costs by avoiding duplicate or unnecessary diagnostic or therapeutic interventions, through enhanced communication possibilities among health care establishments, and through patient involvement. 2. Enhancing quality of care by allowing comparisons among different providers, involving consumers as additional power for quality assurance, and directing patient streams to the best quality providers. 3. Evidence-based intervention effectiveness and efficiency should not be assumed but proven by rigorous scientific evaluation. 4. Empowerment of consumers and patients by making the knowledge bases of medicine and personal electronic records accessible to consumers over the Internet; e-health opens new avenues for patient-centered medicine and enables evidence-based patient choice. 5. Encouragement of a new relationship between the patient and health professional, toward a true partnership where decisions are made in a shared manner. 6. Education of physicians and health care providers through online sources (continuing education) and consumers (health education, tailored preventive information for consumers). 7. Enabling information exchange and communication in a standardized way among health care establishments. 8. Extending the scope of health care beyond its conventional boundaries. 9. Ethics e-health involves new forms of patient-physician interaction and poses new challenges and threats to ethical issues such as online professional practice, informed consent, privacy, and equity issues. 10. Equity to make health care more equitable is one of the promises of e-health, but at the same time there is a considerable threat that e-health may deepen the gap between the "haves" and "have nots," deepening the "digital divide."
Eight Core Functions of the Electronic Health Record
1. Health information and data 2. Result management 3. Order management 4. Decision support 5. Electronic communication and connectivity 6. Patient support 7. Administrative processes and reporting 8. Reporting and population health
The ANA recognized terminologies/data sets as listed in the 2018 revised position statement continue to include the following:
1. NANDA—Nursing Diagnoses, Definitions, and Classification 2. Nursing Interventions Classification System (NIC) 3. Nursing Outcomes Classification System (NOC) 4. Nursing Management Minimum Data Set (NMMDS) 5. Clinical Care Classification (CCC) (formerly Home Health Care Classification [HHCC]) 6. Omaha System 7. Perioperative Nursing Dataset (PNDS) 8. SNOMED CT 9. Nursing Minimum Data Set (NMDS) 10. International Classification of Nursing Practice (ICNP) 11. ABC Codes for billing 12. LOINC
Health care experts picked the top 12 ways AI will revolutionize the delivery and science of health care (Bresnick, 2018):
1. Unifying mind and machine through brain-computer interfaces 2. Developing the next generation of radiology tools—without the need for biopsies 3. Expanding access to care in underserved or developing regions 4. Reducing the burdens of electronic health record use 5. Containing the risks of antibiotic resistance 6. Creating more precise analytics for pathology images 7. Bringing intelligence to medical devices and machines 8. Advancing the use of immunotherapy for cancer treatment 9. Turning the electronic health record into a reliable risk predictor 10. Monitoring health through wearables and personal devices 11. Making smartphone selfies into powerful diagnostic tools 12. Revolutionizing clinical decision-making with AI at the bedside
What Is the Educational Preparation of the Associate Degree Graduate?
18 to 21 school calendar months at community college earning 60-72 semester credits attracts more of a diverse population conducive for those who prefer to attend school on a part time basis
What is credentialing?
A credential can be as simple as a written document showing an individual's qualifications. A high school diploma is a credential that indicates a certain level of education has been attained. A credential can also signify a person's performance. The attainment of a title—such as Fellow of the American Academy of Nursing (FAAN)—signifies excellence in performance; a postgraduate degree from an institution of higher learning (PhD or EdD) indicates success in terms of academic achievement and advanced nursing knowledge.
Educational Mobility
A growing number of individuals in health care are seeking more education. The issue is not one of entry into practice but rather of how to best facilitate the return of these individuals to nursing school for educational advancement that fits their professional and personal needs. The growth of dual-enrollment nursing programs and web-based (online) courses may facilitate educational mobility.
Clinical nurse specialist (CNS)
CNSs are RNs with advanced nursing degrees—master's or doctoral—who are experts in a specialized area of clinical practice such as psychiatric/mental health, adult/gerontology, pediatric, women's health, and neonatal health. The majority of CNSs specialize in adult health or gerontology (NACNS, 2016).Most CNSs work in the hospital setting, full time, and have responsibility for more than one department. CNSs can also work in clinics, nursing homes, their own offices, and other community-based settings, such as industry, home care, and HMOs. They conduct health assessments, make diagnoses, deliver treatment, lead evidence-based practice projects, and develop quality-control methods. In addition to delivering direct patient care, CNSs work in consultation, research, education, and administration. Some work independently or in private practice and receive reimbursement. Based on state laws where the CNS practices, CNSs are authorized to prescribe medications (NACNS, 2016).
Computerized Provider Order Entry
CPOE is a technology-enabled process that allows providers such as physicians, nurse practitioners, and pharmacists to enter patient care orders directly into a computer system that transmits these orders directly to the receiving department (pharmacy, radiology, dietary, etc.) without intervening steps such as RN review for clarity and completeness. The true benefits of CPOE come with implementing clinical decision support systems (CDSSs) at the same time
Certified registered nurse anesthetist (CRNA)
CRNAs are RNs who complete a graduate program and meet national certification and recertification requirements. There are an estimated 42,260 CRNAs in the United States (Bureau of Labor Statistics, 2017).In this oldest of the advanced nursing specialties, CRNAs safely administer approximately 43 million anesthetics to patients each year in the United States. In some states, CRNAs are the sole anesthesia providers in rural hospitals (AANA, 2016). This enables health care facilities to provide obstetrical, surgical, and trauma stabilization services. CRNAs provide anesthetics to patients in collaboration with surgeons, anesthesiologists, dentists, podiatrists, and other qualified health care professionals.
Clinical decision support (CDS)
Clinical decision support (CDS) is a type of health information technology that provides health care providers, nurses, patients, and other individuals with relevant person-specific information that is presented at the right time for the health care provider to make a clinical decision about the patient's plan of care. Computerized alerts, reminders, diagnostic support, potential drug interactions, and clinical guidelines are a few CDS tools that assist health care providers and nurses with clinical decision-making and improving workflow
Benefits of a concurrent or dual pathway program
Concurrent enrollment programs are a win/win for all. The student saves time and money, earning a nursing degree often preferred by employers. The community college and the university have engaged, motivated students and the ability to share resources to provide an affordable career ladder, placing competent, practice-ready graduates in the workplace who may then return to school for graduate degrees. The community benefits by having a highly skilled nursing workforce ready to meet the ever-expanding health care needs of a diverse population (Schultz, 2016, p. 1).
What Is a Concurrent Enrollment BSN Completion Program?
Concurrent or dual-enrollment programs layer nursing coursework, blending both the associate and RN to BSN curricula. Students meet all criteria for the community college associate program and then have the opportunity, based on a number of factors, to explore and select a university partner school. The student will complete all prerequisites for both the community college and the university and will make application to both colleges.
Privacy and Confidentiality
Confidentiality agreements should be reviewed and signed when starting employment and yearly thereafter. Breaches of security, confidentiality, or privacy should be addressed and resolved quickly, and the offender should be charged accordingly. Every lapse should be treated openly and used as an example for others to take note of. The IN may be involved in the investigation process and the writing of the policies and procedures.
Electronic Health Records
EHRs are essential for health care to leverage state-of-the-art technology to deliver the highest-quality, lowest-cost patient care. Two other terms coming into vogue are the comprehensive health record and the connected health record. These terms describe two different visions of the next generation of the EHR. These visions include social determinants of health and more into nontraditional sources of data, including families/caregivers, school clinics, senior centers, and community health facilities. Other experts see the next step in EHR development to include shared care planning, genomics and personalized medicine, population health and public health, and remote monitoring and sensors
What is evidence based practice?
Evidence-based practice (EBP) "is a problem solving approach to clinical practice that integrates a systematic search for and critical appraisal of the most relevant evidence to answer a burning clinical question, one's own clinical expertise, and patient preferences and values" (Melnyk & Fineout-Overholt, 2005, p. 6). Historically health care—and more specifically, nursing care—was based on tradition. In other words, we simply replicated what had been previously done in nursing, without question to the support of evidence for what we were doing or the impact on patient outcomes. As nursing has evolved and the expectation for continually improving patient outcomes has come to the forefront, a greater emphasis has been placed on implementing nursing care that is supported through the use of the best research available. EBP incorporates many additional sources of data that may contribute to improved nursing care.
What is a career ladder program?
Focuses on articulation without loss of credit RN to BSN to MSN or doctoral programs
Foreign Nurse Licensure
Foreign nurse graduates who want to practice nursing in the United States must contact the board of nursing in the state in which they want to practice to obtain licensure, because each state controls its own requirements for licensure. The state's board of nursing will review the candidate's nursing education and determine the requirements needed to obtain a license in that state. Most states require that foreign nurses take the Commission on Graduates of Foreign Nursing Schools (CGFNS) examination before the NCLEX-RN® examination. This examination determines proficiency in nursing and the English language, thus assisting in the prediction of success on the NCLEX-RN® examination. All foreign nurse graduates, regardless of licensure in their home countries, must successfully complete the NCLEX-RN® examination.
Robotics in Patient Care
From robots who greet and respond to verbal responses, to direct care robots, which can lift patients or lead patients in exercise activities to therapeutic robots—robotics are becoming part of the health care environment. Therapeutic robots built to look like cute animals such as a dog or baby harp seal deliver emotional responses based on sensors and produce the benefits of animal therapy without the problems live animals bring
Further description of EHRs
Further description of EHRs focuses on the total health of the patient—going beyond standard clinical data collected in a single event such as a provider's visit or hospitalization. They provide a broader view on a patient's care. EHRs are designed to reach out beyond the health organization that originally collects and compiles the information. They are built to share information with other health care providers so they contain information from all the clinicians involved in the patient's care
What about graduate school?
Graduate education programs are available on a part-time or a full-time basis. Graduate programs require a good grade point average (GPA) at the undergraduate level. Prerequisites for most graduate programs are satisfactory scores on the Graduate Record Examination (GRE) or the Miller Analogies Test (MAT). Although an increasing number of graduate programs are waiving the entrance examination requirements, it is strongly recommended that all students, whether they plan to pursue graduate studies or not, take the GRE after completing their undergraduate studies.
Patient Portals
HealthIT.gov (2017) defines a patient portal as a secure online website that gives patients convenient, 24-hour access to personal health information from anywhere with an Internet connection. Using a secure username and password, patients can view health information such as the following: ▪ Recent doctor visits ▪ Discharge summaries ▪ Medications ▪ Immunizations ▪ Allergies ▪ Lab results Some patient portals also allow you to: ▪ Securely message your doctor ▪ Request prescription refills ▪ Schedule non-urgent appointments ▪ Check benefits and coverage ▪ Update contact information ▪ Make payments ▪ Download and complete forms ▪ View educational materials
The Changing Student Profile
It has previously been stated that there is a growing population of nontraditional students—individuals who are making midlife career changes in part because of job displacement or job dissatisfaction. Minority individuals, foreign-educated students, and disadvantaged students are looking toward nursing education for career opportunities. These changes mean that nurse educators will have to go further in addressing the needs of the adult learner. More programs will be needed that permit part-time study and allow students to work while attending school. One option may be for more night or weekend course and clinical offerings. There will continue to be a need for emphasis on remedial education such as developmental courses in math, English, and English as a second language. The diversity in the student population means increased diversity in the nursing workforce, which will contribute to quality health care for the nation's diverse population
What About a Master's Degree as a Path to Becoming a RN?
MSN programs are particularly attractive to the growing number of college graduates who decide to enter nursing later in life. Generally, the program is 24 to 36 months long. Upon graduation, these students are expected to demonstrate the same entry-level competencies in nursing as baccalaureate graduates. MSN graduates from these programs are then eligible to take the NCLEX-RN examination. Currently, there are 69 entry-level master's programs in the United States (AACN, 2017a).
Nurse Practitioner (NP)
Most of the approximately 330 NP education programs in the United States today confer a master's degree. The majority of states require NPs to be nationally certified by ANCC, AANP, or a specialty nursing organization. In 2018, more than 248,000 advanced practice nurses were NPs (AANP, 2018).Working in clinics, nursing homes, hospitals, health maintenance organizations (HMOs), private industry or their own offices, NPs are qualified to handle a wide range of basic health problems. Most have a specialty—for example, an adult, family, or pediatric health care degree. At minimum, NPs conduct physical examinations, take medical histories, diagnose and treat common acute minor illnesses or injuries, order and interpret laboratory tests and radiographs, and counsel and educate patients. In all states they may prescribe medication according to state law. Some work as independent practitioners and can be reimbursed by Medicare or Medicaid for services rendered.
NI Conclusion
Nursing informatics is a specialty grounded in the present while planning for the future. Nursing informatics nurses face many challenges in their daily activities, because they are in a position to wear many hats and bear many responsibilities. The next challenge after EHR implementation will be using the data in a meaningful way to improve patient care and lower costs. Computing devices and applications will continue to evolve and improve point-of-care access. Touch screens and voice input are already beginning to have an impact. Change is the only constant. At the end of this chapter are relevant websites and online resources on the concepts that have been presented. The challenge will be for informatic nurses and informatics nurse specialists to assume leadership roles in informatics, while the nurse educator, manager, and practicing nurse prepare to embrace the generalized applications of working within a computerized environment. No longer will it be sufficient to turn on a computer and complete a simple task. A nurse will need to be able to use technology in all the forms found in health care organizations, access information, as well as access and use data and evaluate the content of the information provided to the patient population. Wishing will not make technology go away, so savvy nurses will focus on the benefits that technology brings to patient care, learn the skills they need, and embrace the future with all the changes it will bring.
Online Nursing Programs (External) Accreditation
Online nursing programs are accredited by the ACEN (formerly the National League for Nursing Accrediting Commission [NLNAC]), the NLN CNEA, or the CCNE, which is an autonomous accrediting agency associated with the AACN. In undergraduate nursing programs, all students are required to pass specific college-level tests and performance examinations in two components: general education and nursing. On completion of the undergraduate external degree programs, students are eligible in most states to take the RN licensure exam.
Why would I want a Master's Degree?
Policy statements from the nursing profession reflect the need for more education in preparation for the changing role of nursing, a result of health care reform. As care delivery moves increasingly from the acute care center to the community setting, there will be an increased need for advanced clinical practice nurses. Nursing programs are already responding to this changing need.
Step 3: Design a Practice Change Based on the Data While Incorporating the Clinical Expertise of the Nurse and Patient Preferences
Prepare a written plan for the new nursing practice. The plan needs to be consistent with your practice context to be effective. For maximum benefit, the plan will also require the consensus of those who will implement it.
"sweeping change" to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules
The changes in the final rulemaking provide the public with increased protection and control of personal health information. The HIPAA Privacy and Security Rules have focused on health care providers, health plans and other entities that process health insurance claims. The changes announced today expand many of the requirements to business associates of these entities that receive protected health information, such as contractors and subcontractors. Some of the largest breaches reported to HHS have involved business associates. Penalties are increased for noncompliance based on the level of negligence, with a maximum penalty of $1.5 million per violation. The changes also strengthen the Health Information Technology for Economic and Clinical Health (HITECH) Breach Notification requirements by clarifying when breaches of unsecured health information must be reported to HHS. Individual rights are expanded in important ways. Patients can ask for a copy of their electronic medical record in an electronic form. When individuals pay by cash they can instruct their provider not to share information about their treatment with their health plan. The final omnibus rule sets new limits on how information is used and disclosed for marketing and fundraising purposes and prohibits the sale of an individual's health information without their permission.
Step 1: Preutilization
The first step in the application of nursing research to nursing practice is the recognition that some aspect of nursing practice could be done in a safer, more efficient, more beneficial, or simply a different way. This begins an exploratory phase in which nursing colleagues in the practice setting are consulted regarding their opinions about the need to find a new approach for some aspects of nursing practice A second phase of Step 1 is consensus building, which is used to identify the specific practice to be changed. The third and final phase of Step 1 delineates the aspect of nursing practice that will be changed into a concise statement of the practice problem.
Health Insurance Portability and Accountability Act of 1996
The major impact from this regulatory legislation is in these areas are as follows: ▪ Health information privacy law ▪ Data security standards ▪ Electronic transaction standards
Types of Master's Programs
The master of science (MS) and the MSN are the most common degrees. The usual requirements for admission include a baccalaureate degree from a program that is accredited in nursing by the ACEN, CCNE, or CNEA (the accrediting body of the NLN since 2013), licensure as an RN, completion of the GRE or MAT, and a minimum undergraduate GPA of 3.0. The majority of programs are at least 18 to 24 months of full-time study. Unlike undergraduate students, master's students usually choose an area of role preparation, such as education or administration, and an area of clinical specialization, such as pediatrics or adult health. Some of the more common areas of role preparation include education, administration, case management, health policy/health care systems, informatics, and the increasingly popular advanced clinical practice roles.
What is accreditation?
The term accreditation is often confused with certification. Accreditation in higher education is a process by which a voluntary, nongovernmental agency or organization approves and grants status to institutions or programs (not individuals) that meet predetermined standards and criteria (US Department of Education, 2018). There are two types of accreditation in higher education and they are referred to as institutional or regional accreditation and programmatic or specialized accreditation.
Big Data
Think about all the data we collect on a single patient during a 4-day hospital stay. Now add all the data we collect on all the patients in that hospital during that same 4 days. Now add to that all the data we collect on all the patients in all the hospitals in the United States during those 4 days—that is a lot of data (i.e., Big Data!). All of this data is too much to do anything with using traditional data management. So people working in informatics have developed and continue to develop ways of using the massive amounts of data to look for patterns and trends that may help us identify early warning signs, predisposing factors, and other patterns to improve health and health care.
Telemedicine, Telehealth, and Health Monitoring
Today, the use of telecommunication technologies to provide health care is expanding at a phenomenal rate. Surprisingly, it's not just the under-30 population who is embracing this technology. Long labeled as technology-adverse, the senior population is proving just the opposite, especially since telemedicine visits via two-way video reduces the burden of travel to a provider's office.
What is the ultimate goal of healthcare organizations?
With the advent of both specialty and integrated clinical information systems (CIS), the longitudinal electronic health record (EHR) has become the goal of health care organizations and is now supported by federal mandate
Internet Resources
the US Surgeon General's Family History Initiative is a great place to start with promoting the importance of a well-documented family health history. In addition to the Office of the Surgeon General, other US Department of Health and Human Services (USDHHS) agencies involved in this project include the National Human Genome Research Institute (NHGRI), the Centers for Disease Control and Prevention (CDC), the Agency for Healthcare Research and Quality (AHRQ), and the Health Resources and Services Administration (HRSA). A downloadable free tool entitled "My Family Health Portrait" is available at http://www.genome.gov/27527640. This tool helps patients organize their family trees and identify common diseases that may run in their families. After completing the required information, the tool will create and print out a graphic representation of the patient's family generations and the health disorders that may have moved from one generation to the next. This is a powerful tool for predicting illnesses (USDHHS, 2016) and can be brought by the patient to a health care provider appointment.
4 Nurse Informaticist (NI)
the extensive clinical background of the IN/INS is invaluable to the success of the implementation of the hardware and software applications needed to transform health care. Nurses have a unique understanding of workflow, the hospital and clinical environment, and the specific procedures that are necessary for effective health care information infrastructure. Moreover, the IN/INS roles are critical members of the team when translating information into practical models that can be applied to improve the health care systems and patient outcomes.
Advantages of Electronic Health Records
• Simultaneous, remote access to patient from many locations • Legibility of record—no handwriting • Safer data—backup and disaster recovery system, so less prone to data loss • Patient data confidentiality—authorized use can be restricted and monitored automatically • Flexible data layout—can recall data in any order (chronologically or in reverse chronological order) • Integration with other information resources • Incorporation of electronic data—can automatically capture physiological data from bedside monitors, laboratory analyzers, and imaging devices • Continuous data processing—check and filter the data for errors, summarize and interpret data, and issue alerts and/or reminders • Assisted search—can search free-text or structured data to find a specific data value or to determine whether a particular item has been recorded previously • Greater range of data output modalities—data can be presented to users via computer-generated voice, two-way pagers, e-mail, and smartphones • Tailored paper output—data can be printed using a variety of fonts, colors, and sizes to help focus the clinician's attention on the most important data; images can be included to help see a more complete "picture" of the patient's condition • Always up-to-date
The following is a list of some simple precautions to take to help secure patient information that may be stored on a mobile device. These recommendations should be followed as standard practice:
▪ Keep careful physical control of the device at all times. ▪ Use a password or other user authentication and a time-out to reactivate the authentication. ▪ Install and enable encryption. ▪ Install and activate remote wiping and/or remote disabling. ▪ Disable and do not install or use file-sharing applications. ▪ Disable the infrared ports and Wi-Fi except when they are actually being used. ▪ Do not send infrared or Wi-Fi transmissions in public locations. ▪ Keep your security software up-to-date. ▪ Research mobile applications (apps) before downloading. ▪ Use adequate security to send or receive health information using public Wi-Fi networks. ▪ Delete all stored health information before discarding or reusing the mobile device.
There still remain major barriers to the complete integration of health information technology. These barriers include the following:
▪ Lack of standardization across care areas—the need for laboratory data and pharmacy systems to be integrated with the patient's EHR, and the ED systems need to share data with the inpatient systems. ▪ Siloed data—hospital data, provider practice data, and long-term care facility data may all be in separate systems with steep fees for building interfaces to allow for exchange of data. ▪ Cost and funding—information technology is costly, and often the major costs are borne by hospitals rather than shared by other providers, payers, and employers. ▪ Privacy and security concerns—a single set of privacy laws is needed to simplify the task of communicating across facilities, agencies, and local, state, and federal governments. ▪ Lack of a uniform approach (number) to match patients to their record—a single authentication number is needed to reduce safety risks and provide a uniform access to patient data
Cyberthreats include the following:
▪ Unpatched software—out-of-date software, which has not had updates and patches applied ▪ Ransomware—malware that prevents authorized users from accessing data until ransom is paid ▪ Phishing (pronounced "fishing")—using e-mail, telephone, or text message posing as a legitimate institution to lure individuals into providing sensitive and usable data ▪ Loss of data stored on mobile device ▪ Insider fraud and misuse of data
In 2018, the ANA updated its position statement on the inclusion of recognized terminologies to support nursing practice within health care information technology (HIT) systems to recommend the following:
▪ When exchanging data with another setting for problems and care plans, Systematized Nomenclature of Medicine—Clinical Terms (SNOMED CT) and Logical Observation Identifiers Names and Codes (LOINC) should be used for exchange. LOINC should be used for coding nursing assessments and outcomes and SNOMED CT for problems, interventions, and observation findings (ONC, 2018). ▪ Health information exchange between providers using the same terminology does not require conversion of the data to SNOMED CT or LOINC codes. ▪ Development of a clinical data repository that includes multiple recognized terminologies should be based on the national recognized terminologies of ICD-10, CPT, RxNorm, SNOMED CT, and LOINC (American Nurses Association, 2018).
The CARS Checklist
✓ Credibility—An authoritative source, which includes author's credentials and evidence of quality control such as peer review. ✓ Accuracy—A source that is correct today (not yesterday) and is comprehensive. ✓ Reasonableness—Look at the information for fairness, objectivity, moderateness, consistency, and worldview. ✓ Support—A source that provides convincing evidence for the claims made and which can be triangulated (find at least two other sources that support it).
