Download - Chapter 13 Nursing in Format i Csf 09
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Nursing Informatics andEvidence-based Practice
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Strategic HIT Planning for the Decade
2004-2014
The Decade of Information Technology(Thompson, & DHHS, 2004)
Information Technology (IT)
Critical needs of the health care system
Avoid medical errors Improve use of resources
Accelerate diffusion of knowledge
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Strategic HIT Planning for the
Decade 2004-2014 (cont'd)
Reduce variability in access to care
Advance consumer role
Strengthen privacy and dataprotection
Promote public health andpreparedness
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Strategic HIT Planning for theDecade 2004-2014 (cont'd)
Established four goals
1) Inform clinical practice 2) Interconnect clinicians
3) Personalize care for
clients 4) Enhance public health
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Nursing Informatics
Emerging field
Informatics refers to: Broader field of understanding the
information needs
How information can or should be stored and
retrieved How to use information technology
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Nursing Informatics (cont'd) Part of the larger field of health care and
medical informatics
Mechanism to collect and analyze datafrom nursing care
Establish and maintain computerizeddocumentation systems
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Strategic Directions for Nursing
Informatics
Include informatics in nursing education
Prepare nurses with specialized informaticsskills
Enhance nursing practice and educationthrough informatics projects
Increase nursing faculty preparation in
informatics
Encourage collaboration
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Question Is the following statement true or false?
The specialist in nursing informatics helpsto build a systematic nursing language,making data more secure from hackers andenhancing the ability to use the data to
build aggregated information upon whichinsurance decisions can be based.
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AnswerFalse.Rationale: with an interdisciplinary focus, thespecialist in nursing informatics helps tosystematize the nursing language, making
data more retrievable and enhancing theability to use the data to build aggregatedinformation upon which practice decisionscan be based.
One aspect of this work is to make electronichealth care information safe, but has nothingto do with insurance decision making.
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Using Information Technology
Within the Care Setting
Employers expectations
Understanding IT systems
Security systems
Billing systems
Patient information retrieval
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Using Information TechnologyWithin the Care Setting (cont'd)
Order entry
Nursing data entry
Computerized medication
administration systems
Other computer resources
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Accessing Information Resources
Texts and reference
books
Libraries
Policies and standards
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Accessing Information Resources
(cont'd) The Internet
E-mail
Online group discussions
World Wide Web
Search engines
Health-related Web sites
Blogs
Bookmarking Web sites
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Healthcare Indexes for FindingInformation Resources
Indexes available
MEDLINE, produced by the National Library ofMedicine (NLM)
CINAHL (Cumulative Index for Nursing and AlliedHealth Literature), produced by the CINAHL
corporation International Nursing Index
RNdex
Hospital Literature Index
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Healthcare Indexes for FindingInformation Resources (cont'd)
Psych Index
Social Sciences Index
Many journals publish their own annual
index
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Healthcare Indexes for FindingInformation Resources (cont'd)
Techniques for effective searching
Subject
Author
Thesaurus for the index
Understanding the ways in which publications areindexed
Key words
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Question
Jeff Scott, RN, is a graduate nurse just startinghis practice in a transplant step-down unit thatdeals mostly with heart and lung transplants.He finds that there are many ethical issues in
his practice that he was not expecting.Jeff chooses to deal with these issues bystarting a blog on the Internet. What is a blog?
A. Online group discussionB. Online journal
C. E-mail server site
D. Ethical discussion board
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Answer
B. Online journal
Rationale: a blog (short for web-log) is aweb site on which an individual (theblogger) publishes a journal providing
information and opinion usually inrelationship to a particular area of subjectmatter.
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Evidenced-based Practice
Development
Types of evidence used
Research studies
Patient care data
International, national, and local standards
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Evidenced-based Practice (cont'd) Infection control data
Pathophysiology
Cost-effectivenessanalysis
Patient preferences
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The Research Process
Statement ofproblem/question
Review of literature
Theoretical framework
Refining the plan
Implementing the study
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The Research Process (cont'd) Analyzing the data
Presenting and interpretingfindings
Limitations
Disseminating research results
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Question
In some nursing studies it falls to the staff nursto collect the data for the study. When thishappens, it is important that:
A. Everyone learns the collection process fromeach other.
B. The researcher picks out only the data thatinterests them.
C. The researcher teaches everyone to collect thdata in a specific way.
D. Everyone learns the collection process fromthe charge nurse on their shift.
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Answer
C. The researcher teaches everyone to collect thedata in a specific way.
Rationale: if multiple people are collectingdata, it will be important to ensure that all are
carrying out the study tasks in the same way.If different data collectors functiondifferently, the results of the study may not beaccurate.
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Reading Research
Types ofresearch
Quantitative
Qualitative
Combined
Meta-analysis
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Reading Research (cont'd)
Understanding research terminology
Abstract
Research question and purpose
Hypothesis
Population vs. sample
Groups
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Reading Research (cont'd) Variable
Validity and reliability
Probability and statisticaltests
Clinical significance
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Legal and Ethical Considerations in
Research
Institutional approval
Institutional review board
Educational institution review board
Funding agencies
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Legal and Ethical Considerations inResearch (cont'd)
Consent for research
Informed consent
Formal consent form
o Describes the researchers credentials
o How the participant was chosen
o Purposes of the research
o Procedures that will be followed
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Legal and Ethical Considerations inResearch (cont'd)
Risks
Discomforts Benefits expected
Guaranteed anonymity or at least confidentiality
If alternative treatments are available, they must alsobe described
Participation is voluntary and can be terminated atany time
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Question
Is the following statement true or false?
The beginning of a code of conductpertaining to research was the
Nuremberg Code. This document hasbeen updated and modified severaltimes, the last time being in 1983.
Throughout these revisions a singletheme has been: first, do no harm.
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AnswerTrue.
Rationale: the most recent revision of this codewas in 1983 (Code for Federal Regulations,1983). Three principles guide these regulations.First, the research should do no harm. Second,the participants should be free from
exploitation. Third, there should be carefulattention to the risk:benefit ratio of theresearch.
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Personal Involvement in Research
Identifying problems
Excellent observers
Responsible for putting the whole complex ofpatient care together
Assisting with ongoing research
Your patients Follow procedures and protocols exactly
Frontline safeguards
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Systematic Analysis of Information
and Evidence
Reliability of the source
Bias of the source
Timeliness
Purpose
Comparing settings or
situations
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Implementing New Practices
Based on Evidence
Institutional development of EBP
Iowa Model of Evidence-based Practice ACE Star Model of EBP for Knowledge
Transformation
Focus on continuous improvement
Barriers to utilizing research in practice
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Implementing New PracticesBased on Evidence (cont'd)
Staff nurse role in EBP
Identify sources of evidence that can be helpful inan individual nursing environment
Evaluate that evidence in relationship to yoursetting
Work collaboratively to introduce changes basedon the evidence
Evaluate the effectiveness of the changes