Posts Tagged ‘Online Instructor-Led Healthcare Informatics Courses’

Is it Necessary to Document Your Efforts in Providing Culturally Competent Care?

January 5, 2012

Cultural competence has been a responsibility addressed in nursing programs since before I became a student and I have noticed a steadily increasing amount of focus placed on the topic throughout the years. As with all aspects of nursing, there will always be room for improvement in how we conduct our profession in a culturally sensitive manner. It seems to be a basic understanding that any nurse be acutely aware of his or her own cultural beliefs, practices and biases. I also notice universal agreement that health care professionals need to attempt to learn about all clients’ cultural attitudes towards healthcare and allow for specific integration of these attitudes when at all possible. As this is a responsibility of the health care professional, is documentation of the practice necessary as well? Cultural competence can be applied in all aspects of nursing care; so documenting the practice is very complicated. Much discussion will be needed to determine how it can be applied to daily documentation without taking excessive time from other nursing responsibilities. A basic need of clients is to have their healthcare options given to them in their first language to maximize the potential for full understanding. Hospitals have addressed this need in a variety of ways including written translation of informed consent and having native speaking interpreters present during any medical explanation before “informed consent” is given. The practice of providing culturally sensitive care is then “documented” by the presence of the signed translated copy of the consent or the presence of the interpreter’s signature on the English version of the consent. The cost to health care providers in both the areas of finance and time is great to accommodate these needs. Therefore, the value of our current practice should be continuously evaluated in order to assure we meet the needs of the client without excessive cost. Value is the key word in this sentence. In the case of the written translated consent form, I have seen consents get signed without being read and this has forced me to think about the various reasons this might occur. Could the client read the consent? Although the consent was in the language self-identified by the client, was the terminology not familiar to the client? Were the opinion and “desires” of the healthcare professional deemed sufficient and therefore explanation not required? The signed consent, however, is placed in the client’s chart and acts as documentation that the client was explained the procedure in a manner facilitating understanding. Healthcare facilities are also managing costs by trying to minimize the amount of paper used in documenting. I have seen consents presented to clients in the form of laptop computers with electronic writing devices. Does this technology intimidate the patient and further compromise their comfort during their healthcare experience? I am sure the answers to the questions posed above are as varied as are the cultures and people of those cultures seeking healthcare in this country. Is it really of value, then, to “document” all of our efforts in providing culturally competent care? Or rather, should we seek to create an environment in healthcare settings where continued education and discussion enhances the healthcare professional’s awareness of the need for culturally competent care? This in turn might increase our accountability to this responsibility without further straining the healthcare system with the financial and emotional stress of balancing the application of good care with the documentation of the process.

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Standardized Language in Healthcare

November 18, 2011

As the electronic health record (EHR) becomes increasingly utilized across the nation, a standardized language will need to be implemented and followed. This will improve more accurate billing, informed patient management, increased precision of documentation, and improve knowledge. Functioning without standards would be chaotic, out of control, and confusing to all individuals. Standardization proves to enhance any process. With the strategic organizational initiatives of many physician offices, clinics, medical centers, and hospitals to implement an automated electronic environment for documenting a patient’s health history, which then automate other processes, the need increases for the uniformity of a language. The downside of the uncontrolled terminology of medicine has been accentuated by the computer age, because without standard vocabulary the ability to acquire knowledge about healing professions through information technology is limited. Many clinical applications available today have restricted utility because they cannot understand each other. It seems with the urgency of healthcare facilities implementing EMRs, the development of a standard language is critical and needs to be on a fast track to develop solutions. Healthcare information system developers are not waiting for the standards bodies, in existence today, to make these determinations. These developers know that precise medical words are needed to analyze the information from automated medical records, which will improve quality and service in healthcare. Rather than use any existing clinical vocabulary standard, they are creating their own dictionaries or vocabulary sets. Although this represents a slight improvement over un-encoded or free text documentation, each vendor working in isolation, are creating a terminology which cannot be read or understood by other systems. This makes the potential of data exchange and comparing impossible. It is imperative that healthcare organizations, vendors, and government agencies work collaboratively to implement measures to effectively localize, update, and disseminate healthcare terminologies, mappings, and other terminology-related content currently issued by national and international standards bodies. A standardized language in healthcare is something of a monumental task, but one that needs dedicated professionals in establishing these standards. Although some standard languages exist, developed by various standards organizations, the need is paramount of unifying a standardized language. Controlled medical terminology is essential to maximize the true benefits of implementing a fully operational EMR. Additionally, if all physicians, nurses, patients, hospitals, clinics, payers, and government agencies would commit to the same healthcare language, the one who unquestionably benefits from this is the patient who can be any one of us.

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Using nursing informatics to assist patients recovering from heart surgery

November 2, 2011

I am using “Health Assessment for Nursing Practice by Wilson. After reading chapter 18 of the textbook, Heart and Peripheral Vascular System, I was thinking about the many different ways in which nursing informatics could have a positive impact and possible help improve patient outcomes. I searched the internet and found an interesting article published by the Journal of Advanced Nursing titled “HeartCare: an Internet-based information and support system for patient home recovery after coronary artery bypass graft (CABG) surgery.” Heart-Care is reportedly an Internet based program designed to assist and support patients who have undergone coronary artery bypass graft surgery in the recovery process at home. This type of program offers a good example of how nursing informatics may be used extensively in the future especially if programs like this one can provide positive patient outcomes.

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Reduce our national debt by reducing the federal electronic medical records mandate, comment

July 21, 2011

Your post Reduce our national debt by reducing the federal electronic medical records mandate is right on target. The federal government and President Obama should not be mandating electronic medical records in the way they propose. The medical/nursing community and hospitals know what is best for themselves and their budgets.

I will add that hospitals should pull the reigns on electronic medical records. What I see is fierce competition between hospitals to draw patients. This competition occurred with CAT scans, MRIs, helicopter ports, etc. Just because one hospital in town has the latest item, does not mean the other hospitals in town should follow suit. Sure, time and saving lives are critical things to consider. The money spent could be used in providing some basic and needed items for rural hospitals. This includes providing the personnel needed for some of the rural hospitals. Our rural hospitals have a greater need than our city hospitals.

Original Post
July 11, 2011

Reduce our national debt by reducing the federal electronic medical records mandate

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Reduce our national debt by reducing the federal electronic medical records mandate

July 11, 2011

I agree that electronic medical records (EMR) that help to save lives, reduce paperwork, reduce expenses, and secure healthcare information. Larger vehicles like SUVs can also save lives and secure passengers. But, this does not mean that every family or business needs to trade in their fuel efficient smaller cars for larger SUVs. This is more true when these families and businesses are struggling during this economic recession (or depression).

Our government can save money by not currently dealing with the EMR mandate, by not tying up our court system with this mandate and letting our hospitals spend this money within their communities (meaning the government does not have to put extra money into these communities).

President Obama, this is one way of reducing your stress, the legislators’ stress, the courts’ stress, and the stress of the American people. Relieve our nation of the current EMR mandate. Consider a revised and later mandate.

Thank you.

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Risk of Injury

July 7, 2011

One of the assessment questions I ask when interviewing one of our patients is “Have you fallen in the past 3 months”? It is a part of a standard assessment questionnaire. Our electronic medical record can be set so that it always has to be answered. To my surprise, often patients answer “yes”. The populations mostly saying yes are 65-75 year olds.

As we get older our vision starts to change. The ability to see in low light decreases and it makes walking in dim hallways or night driving a challenge. The light we see lessens due to the pupil shrinking. The lens of our eye thickens and can turn a yellow color. A patient described it to me as “having a dark pair of yellow sunglasses on all the time”.

Recommendations that I give my patients are to aide them in the fall prevention.  These include de-cluttering hallways in their homes and making sure all the small rugs in the house are removed. I have found that the use of a red light for a night light instead of a white light cuts down the glare and patients can then see better in the hallways. For outside, I also recommended the use glow strips on their stairs and entrances to their homes, garages and yards. If the patient is still driving, limiting nighttime driving would be a best choice for all involved. We discuss when they last had their eyes examined. One of my patients said “we do not think of those things all the time we just figure it is old age”.  Getting an exam is a good way to be proactive to prevent an eye complication. Once examined, the patient can be aided by a simple pair of glasses or a surgical procedure to improve one’s vision and prevent falls.  To expedite this process, I have the ability to do a direct transfer of the patient to the Eye Care Center at our clinic, so they can easily make their appointment.

Kenneth James, Jacqueline Gouldbourne, Chloe Morris, and Denise Eldemire-Shearer wrote an very good paper on “Falls and Fall Prevention in the Elderly: Insights from Jamaica.” They were effective in writing about the use of electronic data bases and electronic health records in the research of their paper. These same healthcare informatics resources can be used to identify and address falls in the seniors that may occur in almost any given community.

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Healthcare Informatics Employment, comment

May 30, 2011

To the nurse writing about Acuity levels, I feel your frustration. This is a big reason I left clinical nursing to obtain a career in Healthcare Informatics. I do not worry about our nurse to patient ratio, acuity levels, or about working extra and not getting paid. In Healthcare Informatics, I handle policies, statistics, computer programs, and machines. I miss the clinical nursing. However with clinical nursing I was missing time with my family, with my health, and with my sanity. Now I feel better about myself and the work I am doing to help patients in a different way.

Original Post
March 23, 2011
Acuity levels
Using higher acuity as a talking point for our need for lower nurse:patient ratios has had no effect. I am totally frustrated, as are the nurses on my unit, on how to get the point across to administration. We are unable to provide the total amount of care our patients need.

We use HPPD, hours per patient day, to set up our allocation tables. And even though my Telemetry unit is at 8.35 HPPD and another unit may be at 7.5; we all end up with a 1:5 nurse patient ratio.

Looking for a way to assign acuity levels to the patients doesn’t seem to hold much impact. As I researched this, I found articles that found inconsistent results with changing ratios to acuity, with inconsistent results in outcomes.

So where do I go from here? Patients are barely getting the attention they need……..the patients are sicker, older, heavier, more are diabetic…..nurses can only find time to complete the tasks and not much more…nurses are so frustrated, they are looking for jobs elsewhere?

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The Elderly and the Internet, comment

November 29, 2010

My mother lives with me and it is amazing how much time she spends on the internet. She shops and emails friends and family. She also has projects she researches online such as her family tree and growing roses for different companies. She loves the interaction and I feel it keeps her young!

Original Post
September 7, 2009
Title: The Elderly and the Internet, comment
Having my grandmother who lives in another state send all of us daily emails has had a positive effect on not only us, but also my grandmother. She is sick and unable to travel, she finds comfort in sending out emails and jokes to her family. She has even recently joined Facebook! Which was shocking to me at first. But the more the elderly do stay in touch with friends and family the better! I have read many articles in the past regarding the importance of keeping your mind stimulated as you age and never stop learning. So for the elderly to branch out and learn new technology, can only bring them a wealth of information, and keep there minds stimulated!

Original Post:
August 26, 2009
The Elderly and The Internet, comment
While I agree that the Internet has enabled the elderly as well as many others an opportunity to research health information. The elderly must be aware that all sites do not contain quality accurate medical information and that the researchers should use caution. Information should be taken from sites with long established history for providing credible and reliable medical information. Now, from a purely mental health prospective, the Internet provides an opportunity for the elderly to connect with family, senior citizen groups, and other outside activities that they would otherwise not have any access. In this day of modern technology, not many family members are reachable by home phones; therefore cell phones, email, and text messages are the norms for communication. In fact, if one wants to keep in touch with family and especially the teenaged family members, email and text messages are their best chance for communication. In addition, with the limited amount of patience and attention teenagers’ exhibit, a brief and not so personal interaction with elderly relatives is about all they can stand. So if text messaging is the chosen method of communication, one must become well informed about the text language. In addition, for many elderly people having the ability to stay in regular contact with family members does as much or more for their psyche than anything else does.

Original Post
April 29, 2009
The Elderly and the Internet
The Internet has become not only a useful tool for the elderly by providing a lifeline to friends and family, but also offers a source of references for those seeking health information. Health Promotion (2006) notes: “because individuals will be increasingly responsible for their own health, they will need access to quality information that has not been readily available in the past.” They also go on to recommend “Net Wellness, an electronic consumer health information services that provides the best possible health information to the broadest possible populations.” This site not only provides consumers with information on health topics, they also assists in locating health centers and provides a reference library. In addition, the site will respond to health related questions, drawing upon a panel of almost 500 experts. It has become a one-stop shopping mall for the health information consumer. As long as the resources are available (computer and hook-up), the ease of using a computer is readily mastered for most, regardless of age. My mother has been proficient on her PC for many years, and in the Human Resource office of the organization where I work, Bob, a 94-year old volunteer, has assisted customers with filling out on-line applications for several years. I think he is always amazed by the number of younger people that are not comfortable on the computer and takes a sense of pride in his skill level. By using the computer to broaden one’s knowledge of health promotion, we all become wiser consumers, including those of all ages.

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Nurse charting in the hospital setting: Does electronic charting win? (comment)

November 29, 2010

We recently started electronic charting in the ED and it has been a challenge for all! One of the biggest pros in our ED are the decrease in patient complaints of never seeing a nurse or doctor. Our computers are stationary at each bedside so nurses are more visible and available for patients and families. It is so simple now to view patients charts without hunting down paper charts. Downtime is a problem but one that we are getting more accustom to.

Original Post
August 13, 2010
Title: Nurse charting in the hospital setting: Does electronic charting win?
Two years ago my hospital transitioned to electronic nurse charting. Adapting this new form of documentation caused a rumble amongst much of the staff. It seems there is always a natural fear that arises when something so new in form is implemented. At that time I had only been a nurse for a little over a year, so I was open to just about anything as I was not too set in my ways. I continue to hear the occasional comment reflecting back to the good ol’ days when charting involved nothing more than a pen and paper. Last week our computer system was out of service for three hours for upgrades and as I was charting, once again on paper, I began to contrast and compare the two different styles of documentation in my mind.

Electronic charting has many benefits. It’s legible, finite, organized, and consistent. For example, intake and output are entered and it automatically gives the nurses and doctors a net positive or negative daily fluid balance. With paper charting we had to painstakingly calculate intake and output hourly, which is basic math, but still remains time consuming. Patients’ lab values are automatically uploaded to their e-chart which also saves time. Vital signs automatically flow from the bedside monitor to the e-chart and simply need confirmation to be permanent. No longer are the days of placing triangles and dots for graphical depiction of vital signs.

There are some negatives to electronic charting. As stated above, down time for upgrades is always an annoyance. It causes inconsistencies in the patent record and is a hurdle for newer staff that never used our paper flowsheets. Some aspects are actually more time consuming than that of paper charting. Lags in servers and computer glitches often time cause sluggish operating systems. And of course there are always times when you have almost finished charting a long, detailed note, when the whole system crashes!

Grievances aside, I guess at the end of the day we all know that patient safety is the most important concern. With that said, I must admit that electronic charting is much safer than that of paper, therefore it wins my vote. As stated earlier, there is little room for misinterpretation. There is consistency among all staff, and patient records can be accessed by physicians anywhere in the hospital. Perhaps we are in the initial stages of developing a universal system that can be accessed by all institutions across the country. Wouldn’t that be nice!

Internet Education and a changing belief among traditional nurse educators, comment

November 29, 2010

I also have mixed feelings about online education. I feel it is beneficial for experienced nurses who are going back to college but not for nurses who are fairly new. Deciding experience and new is the difficult part. I know some experienced nurses who definitely need to sit in a class room and newer nurses who can grasp ideas without any problem. I think any nurse doing a online program should be actively working and should only be able to do an online program with the recommendation from there immediate supervisor.

Original Post
July 29, 2010
Title: Internet Education and a changing belief among traditional nurse educators, comment
I personally have mixed feelings about online education. I feel there are a variety of pros and cons dealing with this issue. The pros are that the student has high flexibility are far as the time constraints go and the student has the ability to take test and complete work according to their work schedule. The main negative is that the student has very limited amount of instructor interaction. Therefore if the student is having issues or a problem they can’t figure out they may become more anxious about completing assignments.


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