Nursing Informatics andEvidence-based Practice

Chapter 13

Strategic HIT Planning for the Decade 2004-2014

The Decade of Information Technology (Thompson, & DHHS, 2004)

Information Technology (IT)

Critical needs of the health care system

– Avoid medical errors

– Improve use of resources

– Accelerate diffusion of knowledge

Reduce variability in access to care

Advance consumer role

Strengthen privacy and data protection

Promote public health and preparedness

Strategic HIT Planning for the Decade 2004-2014 (cont'd)

Strategic HIT Planning for the Decade 2004-2014 (cont'd)

Established four goals– 1) Inform clinical practice

– 2) Interconnect clinicians

– 3) Personalize care for clients

– 4) Enhance public health

Strategic HIT Planning for the Decade 2004-2014 (cont'd)

Strategic HIT Planning for the Decade 2004-2014 (cont'd)

Nursing InformaticsEmerging fieldInformatics refers to:

– Broader field of understanding the information needs

– How information can or should be stored and retrieved

– How to use information technology

Part of the larger field of health care and medical informatics

Mechanism to collect and analyze data from nursing care

Establish and maintain computerized documentation systems

Nursing Informatics (cont'd)Nursing Informatics (cont'd)

Strategic Directions for Nursing Informatics

Include informatics in nursing education

Prepare nurses with specialized informatics skills

Enhance nursing practice and education through informatics projects

Increase nursing faculty preparation in informatics

Encourage collaboration

Question Is the following statement true or false?

The specialist in nursing informatics helps to build a systematic nursing language, making data more secure from hackers and enhancing the ability to use the data to build aggregated information upon which insurance decisions can be based.

AnswerFalse.

Rationale: with an interdisciplinary focus, the specialist in nursing informatics helps to systematize the nursing language, making data more retrievable and enhancing the ability to use the data to build aggregated information upon which practice decisions can be based. One aspect of this work is to make electronic health care information safe, but has nothing to do with insurance decision making.

Using Information Technology Within the Care Setting

Employers expectations

Understanding IT systems

– Security systems

– Billing systems

– Patient information retrieval

Order entry

Nursing data entry

Computerized medication administration systems

Other computer resources

Using Information Technology Within the Care Setting (cont'd)Using Information Technology Within the Care Setting (cont'd)

Accessing Information Resources

Texts and reference books

Libraries

Policies and standards

The Internet– E-mail

– Online group discussions

– World Wide Web

– Search engines

– Health-related Web sites

– Blogs

Bookmarking Web sites

Accessing Information Resources (cont'd)

Accessing Information Resources (cont'd)

Healthcare Indexes for Finding Information Resources

Indexes available– MEDLINE, produced by the National Library of

Medicine (NLM)

– CINAHL (Cumulative Index for Nursing and Allied Health Literature), produced by the CINAHL corporation

– International Nursing Index

– RNdex

– Hospital Literature Index

Psych Index

Social Sciences Index

Many journals publish their own annual index

Healthcare Indexes for Finding Information Resources (cont'd)Healthcare Indexes for Finding Information Resources (cont'd)

Techniques for effective searching

– Subject

– Author

– Thesaurus for the index

– Understanding the ways in which publications are indexed

– Key words

Healthcare Indexes for Finding Information Resources (cont'd)Healthcare Indexes for Finding Information Resources (cont'd)

Question

Jeff Scott, RN, is a graduate nurse just starting his practice in a transplant step-down unit that deals mostly with heart and lung transplants. He finds that there are many ethical issues in his practice that he was not expecting.

Jeff chooses to deal with these issues by starting a blog on the Internet. What is a blog?

A. Online group discussion

B. Online journal

C. E-mail server site

D. Ethical discussion board

Answer

B. Online journal

Rationale: a blog (short for web-log) is a web site on which an individual (the blogger) publishes a journal providing information and opinion usually in relationship to a particular area of subject matter.

Evidenced-based Practice

DevelopmentTypes of evidence used

– Research studies– Patient care data– International, national, and local

standards

Infection control data

Pathophysiology

Cost-effectiveness analysis

Patient preferences

Evidenced-based Practice (cont'd)Evidenced-based Practice (cont'd)

The Research Process

Statement of problem/question

Review of literature

Theoretical framework

Refining the plan

Implementing the study

Analyzing the data

Presenting and interpreting findings

Limitations

Disseminating research results

The Research Process (cont'd)The Research Process (cont'd)

Question

In some nursing studies it falls to the staff nurses to collect the data for the study. When this happens, it is important that:A. Everyone learns the collection process from each other.B. The researcher picks out only the data that interests them.C. The researcher teaches everyone to collect the data in a specific way.D. Everyone learns the collection process from the charge nurse on their shift.

AnswerC. The researcher teaches everyone to collect

the data in a specific way.

Rationale: if multiple people are collecting data, it will be important to ensure that all are carrying out the study tasks in the same way. If different data collectors function differently, the results of the study may not be accurate.

Reading Research

Types of research– Quantitative– Qualitative– Combined– Meta-

analysis

Understanding research terminology– Abstract– Research question and purpose– Hypothesis– Population vs. sample– Groups

Reading Research (cont'd)Reading Research (cont'd)

Variable

Validity and reliability

Probability and statistical tests

Clinical significance

Reading Research (cont'd)Reading Research (cont'd)

Legal and Ethical Considerations in Research

Institutional approval

– Institutional review board

– Educational institution review board

– Funding agencies

Consent for research

– Informed consent

– Formal consent form

o Describes the researcher’s credentials

o How the participant was chosen

o Purposes of the research

o Procedures that will be followed

Legal and Ethical Considerations in Research (cont'd)

Legal and Ethical Considerations in Research (cont'd)

• Risks

• Discomforts

• Benefits expected

• Guaranteed anonymity or at least confidentiality

• If alternative treatments are available, they must also be described

• Participation is voluntary and can be terminated at any time

Legal and Ethical Considerations in Research (cont'd)

Legal and Ethical Considerations in Research (cont'd)

Question

Is the following statement true or false?

The beginning of a code of conduct pertaining to research was the Nuremberg Code. This document has been updated and modified several times, the last time being in 1983. Throughout these revisions a single theme has been: first, do no harm.

AnswerTrue.

Rationale: the most recent revision of this code was in 1983 (Code for Federal Regulations, 1983). Three principles guide these regulations. First, the research should do no harm. Second, the participants should be free from exploitation. Third, there should be careful attention to the risk:benefit ratio of the research.

Personal Involvement in Research

Identifying problems– Excellent observers

– Responsible for putting the whole complex of patient care together

Assisting with ongoing research– Your patients

– Follow procedures and protocols exactly

– Frontline safeguards

Systematic Analysis of Information and Evidence

Reliability of the source Bias of the source Timeliness Purpose Comparing settings or

situations

Implementing New Practices Based on Evidence

Institutional development of EBP– Iowa Model of Evidence-based Practice – ACE Star Model of EBP for Knowledge

Transformation– Focus on continuous improvement – Barriers to utilizing research in practice

Staff nurse role in EBP– Identify sources of evidence that can be helpful in

an individual nursing environment

– Evaluate that evidence in relationship to your setting

– Work collaboratively to introduce changes based on the evidence

– Evaluate the effectiveness of the changes

Implementing New Practices Based on Evidence (cont'd)

Implementing New Practices Based on Evidence (cont'd)