Archive for January, 2010

Health care Informatics: data, information, knowledge, and wisdom

January 29, 2010

Health care informatics, as defined by Englebardt and Nelson, 2002, is the study of how health care data, information, knowledge, and wisdom are collected, stored, processed, communicated, and used to support the process of health care delivery to clients, providers, administrators, and organizations involved in health care delivery. There are many variations of this definition, all with ultimately the same meaning. The statement that effectively explains the importance of this field is by Hannah, Ball, and Edwards, 1999, that stated, health care informatics, is truly interdisciplinary. In its truest form it focuses on the care of the patient, not a specific discipline. Therefore, even though there are specific bodies of knowledge for each health care profession, they all interface at the patient. The increasing awareness health care organizations are developing towards the informatics discipline is proving its value. I realize it is an evolving discipline and will continue to progress and grow in correlation with technology and the electronic medical record. Information systems, information technology, information literacy, information management-information is all around us every day. Understanding how to evaluate the information available is critical to deciphering the true unbiased detail of the data. Although there is no control of the validity of data available on the Internet and the fact that there is an abundance of information, doesn’t necessarily mean the information on the subject is valid. Following criteria designed to evaluate information, will help an individual find and use quality information. Some criteria to use: is the source or authority reliable; is the data current; is it organized logically and easy to navigate; is it objective and free of bias; and is the data accurate and error-free. Developing a checklist and a form to assist with data collecting and decision making will serve as tools to enhance the evaluation of on-line material. In this age, information is plentiful. Understanding how to collect and process information is vitally important. One simply must be information literate.

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Information Technology: A Mandatory Part of Nursing Curriculum

January 29, 2010

I feel that most nursing programs do focus on the bedside care of the patients. As a clinical nursing instructor teaching disease process, nursing assessment, medications, clinical skills and patient education are a priority in our program. Our program has integrated technology however. The students that we have are very techno savvy. They have the ability to text page, while taking notes during lecture and respond to IM. These students will have no problem with the new computer charting that many of us “mature” nurses have. Our program gives the students PDA’s with dictionaries, drug books, and lab manuals loaded on them to use as references. Lectures are placed on Blackboard for students to download and study from. We have the ability to interact with our students online for preclinical assignments. This allows the students and instructors to be at home with family and friends rather than back out in the classroom. Nursing schools don’t necessarily have to teach computer skills as part of the curriculum, but can have the students take a class as a prerequisite. Each hospital has their own system and the types of equipment changes as newer and better one arrive. The new nurses will get the training on the equipment and system that is used by that hospital as part of the orientation process. I believe that we are doing a good job of using some of this technology in my program to help better prepare our students.

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Information Literacy and Information Systems

January 29, 2010

Information Literacy There is a phenomenal amount of information available to us every day, which is generally not difficult to acquire: although time-consuming in some instances. We now live in an era where information is all around us, available in various forms and from various sources and relatively inexpensive, and, often at no cost. When an issue requires researching one can gain the knowledge from resources such as: text books, journals, local and national newspapers, television, radio, and the never-ending World Wide Web. To be most effective in utilizing these areas of information gathering, it is important to know how to locate, search, obtain, access, and evaluate the information. This allows for an efficient use of resources. I am pleased to learn of the Information Literacy Competency Standards for Higher Education, which provides a framework for assessing the information by a literate individual. Developing information literacy within an individual is critical to their journey throughout their life. I find it extremely beneficial these standards extend the opportunity to articulate its information literacy competencies within K-12 grades, in order for a continuum of expectations to develop for students at all levels. How fabulous it is to see that information literacy is becoming more of a requirement than a nice-to-know subject in many areas. Additionally, I applaud the regulatory agencies for identifying the need for information literacy to be part of their criteria, this proves how valuable information literacy truly is in the world we live in today. Information Systems is yet another fascinating topic to understand the depths of its function. Basically, this is the “heart beat” of many organizations today. Information systems provide information to the users, which will facilitate the work of the organization. Many times it seems as though Information Systems departments drive an organization and until they say “yes,” to a particular project affecting the company’s infrastructure, it doesn’t happen. This tends to be frustrating for most individuals within an organization. However, understanding the needs, analysis, infrastructure, and resources involved is a critical factor in determining the necessity of implementation of a project request. Unfortunately, moving an organization to another level of automation can be very time-consuming and expensive; however, many times the outcomes can improve workflow processes, increase productivity, and improve data integrity. As I learned, the basic information system consists of 4 elements: people, procedures, communication, and data. As I reflected on these elements, I realized it is an awesome way to identify any “information system” whether manual or automated. For an organization to be successful each element plays a vital role in handling information.

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The Impact of On-line Education in The Rural Setting

January 6, 2010

Education of nursing staff in the rural setting has long been a challenge. The cost of bringing educators out into the rural environment to present to a small handful of staff severely limit’s the amount of actual classes a facility can offer. This, coupled with the current economic times, has practically stopped on site education for the rural hospitals. The advent of easy to access and cost effective on line education has been a life saver to the educational component of nursing. It is now possible for the nurses to keep current on trends and standards of practice without having to travel long distances to do so. The hospital doesn’t have to spend as great a portion of it’s to few resources on the education needed by the staff. Those few dollars can now be used for the certifications that need to be done on site, such as trauma nursing core courses. The other benefit to on line courses is that nurses can take these classes while at work, during the times that the unit is patient free. This happens more often than we would like to see, but at least now the staff can use that time for something constructive.

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Internet Access: Changing Rural Nursing

January 5, 2010

Working in a small rural hospital you get used to doing without and making do with what you have. Money is always an issue, and the nursing staff longingly looks at more modern equipment, better forms, and electronic medical records.

While we may be small, we are still held to the same standards of nursing that any nurse is held to. We still need to do patient assessments, carry out doctors orders, and give good, solid patient care. The area that becomes problematic is in the education and discharge instructions that must be given to patients. Without the money to buy programs it has long been a struggle to develop adequate information that can be disseminated to the patient. It is now possible to go on line and take advantage of many free programs that offer patient education materials and discharge instructions.

Our hospital has been able to pick a site that the nurses and providers felt met our needs, and we can go online and print off any education and discharge instructions that will meet each patients needs. We are now able to give disease specific, up to date, instructions. Our patients are now very informed on their disease process, and we passed our Critical Access Hospital survey tag dealing with education and discharge planning.

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Changes in Cardiac Care

January 4, 2010

It used to be that if your heart was “acting funny” you were put in the hospital on a monitor and stuck in one unit in the hospital. Different drugs were tried on you, and you had to stay directly on that unit while someone sat at a desk and tried to capture that “funny” activity on a strip of paper.

We now have technology that allows much more freedom, both for the patient while the heart trouble is being diagnosed, and in the treatments that are available.

Patients are no longer stuck on one unit in a hospital while staff try to catch and document the funny electrical activity. A patient wears a holter monitor that is recording the hearts activity for 24 hours or longer while they continue on with their normal activities of daily living.

If the electrical activity turns out to be a conduction problem, the patient can undergo ablation therapy. This involves putting wires into the heart and stimulating the different pathways of the heart until the one that is causing the interruption is identified. At that point the pathway is ablated, cutting off the pathway. This is all done using computers to analyze the data from the heart.

If the patient does end up in the hospital, the nurse is no longer tied to the desk if they want to watch the patient’s cardiac activity. A patient’s telemetry unit now can be transmitted to small computers that the nurse carries with her as she goes about doing her usual duties. At any time the nurse can check the patient’s status. The small computer will also notify the nurse if it identifies a rhythm that is unusual.

These advances not only help with patient management, but also increase the safety of patient care.

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Charting in the Era of EMR

January 4, 2010

I am still of the era of nurses that entered a patients room with my rounds sheet tucked into my uniform pocket.  The secret was to not let the patient see this sheet, and be able to remember their name, main diagnosis, and what you needed to check in them.  You would go through your complete assessment including vital signs, and when you left the room you would pull out your little sheet of paper and write down all of the information you just collected.  This procedure was repeated for all eight of your patients.  When you were done, you then sat at the nurses’ station and pulled the individual charts so you could transfer the information onto the required forms. 

It is not hard to see how the electronic medical record has benefited the role of nursing.  The first improvement is in time management.  You can actually take the information and enter it once.  This is the only time you write the information.  The second advantage is in correct data entry.  You can enter the data as you gather it.  There is less chance of forgetting the information before you write it in the patient record.   The third benefit is in gathering the correct information on each patient.  Electronic medical records prompt you to gather the required information.

I speak purely from a hypothetical standpoint because I personally have not had the chance to utilize an electronic medical records system.  Our hospital is still struggling to come up with the money required to purchase and implement a system.  I can, however, dream about how easy it will make my life once we get one!!!

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