Saturday, February 21, 2015

New Technologies to Help the Workflow in Nursing

We all know that there is a shortage of nurses and this shortage is only going to increase over the next several years.  There are increasing numbers of elderly that need to be taken care of and the nurses work load is increasing.  Invasive procedures take time.  Increased nursing workload and lack of nurses can equal decreased patient safety and poor patient outcomes.  What can healthcare do to fix this problem?  There are new emerging technologies that will soon impact the way nursing care is provided and improve the workflow in nursing. 

One such emerging technology is the use of less invasive and more accurate tools for diagnostics and treatment in healthcare.  Non-invasive and minimally invasive tools for diagnostics and treatment generally result in lower patient risk and cost (Huston, 2013).

 
In the future heart disease is likely to be diagnosed by a new blood test that eliminates the need for risky diagnostic angiograms. There is a new 23-gene blood test that checks for certain blood proteins linked to heart disease and in a recent trial, the blood test was 85% accurate in detecting potentially harmful blockages among patients (Huston, 2013). 
 
Blood Glucose Tattoos have also  been developed that can monitor blood glucose without a finger prick.   The miniature tattoo, which is only a few millimeters in size, is made up of nanosensors that contain a yellow-orange dye. The dye lights up when glucose levels are high and becomes darker when the levels drop. The tattoos are applied once a week and completely non-invasive (Huston, 2013). 
 
 
 
 
So how will this new technology improve nursing workflow and increased patient safety for better patient outcomes?  New technology can improve safety in several ways.  One, it can facilitate a more rapid response after an adverse event has occurred (Bates & Gawande, 2003).  For example, by wearing the blood glucose tattoo, an intervention to a high or low blood glucose level can occur quicker.  Through technology information can also be tracked and information about adverse events can be obtained quicker  (Bates & Gawande, 2003).  Technology tools can improve communication, make knowledge more accessible, assist with calculations, perform checks in real time, assist with monitoring, and provide decision making support (Bates & Gawande, 2003). 
 
In 2002 the American Academy of Nursing started an investigation to identify nursing practice environment and workflow practices that could result in nursing workflow inefficiencies, nursing dissatisfaction and nursing turnover which could affect the nurse's ability to meet the demand for safe, quality patient care.(Bolten, Gassert, & Cipriano, 2006).  Nurses identified 327 workflow issues that were part of he nurse's care delivery. The eight major workflow categories of concern were admission, discharge, care coordination, care delivery, communication, documentation, medication administration, patient movement, and supplies/equipment (Bolten Gassert, & Cipirano, 2006).  It was determined that each workflow category could be improved with the use of technology.  Further comparison between nursing care and patient outcomes through technology can be found here.
 
 
References
 
Bates, D., & Gawanda, A. (2003).  Improving safety wit information technology.  The New England Journal of Medicine, 348, 2526-2534.
 
Bolton, L., Gassert, C., & Cipriano, P. (2008).   Smart technology, enduring solutions.  Journal of Health Information Management, 28(4), 24-30.
 
Huston, C.  (2013) "The impact of emerging technology on nursing care: Warp speed ahead.  The Online Journal of Issues in Nursing Vol. 18, No. 2, Manuscript 1.
 


 


Monday, February 16, 2015

Nursing Leadership Incorporating Technology into Administrative and Clinical Settings


 
It is becoming increasingly important for nurses to have the ability to use technology in order to improve population health outcomes, health care quality, and to achieve health equity   Nurses can no longer be the keepers of knowledge, but rather they need to collect and share their knowledge with others.  Nurse leaders must obtain technology knowledge so that they can maintain human caring with technology, and provide technology education to the emerging nursing workforce in both the clinical and administrative settings (Huston, 2013). 

 
Technology is becoming the greatest tool available in the  the delivery of nursing care.  This is why it is imperative that nurse leaders are familiar with technology have the ability to teach it to their staff.  In 2004 the TIGER Initiative (Technology Informatics Guiding Education Reform) was formed.  This initiative was formed to bring nursing stakeholders together to develop a shared vision, strategies, and specific actions for improving nursing practice, education, and the delivery of patient care through the use of health information technology. The premise behind this initiative was to ensure that nursing leaders were held accountable to ensure nursing care that is delivered is patient centered, safe and high quality through the help of technology (Technology Informatics Guiding Education Reform, 2004).  The American Nurses Association also instituted Health IT initiatives that support the strongest of beliefs in nursing--education of the patient and family (American Nurses Association, 2014).  This video shows how leaders in healthcare have implemented a tracking system for families while loved ones are in surgery.  This use of technology has improved patient and family satisfaction through the implementation of technology by leaders in healthcare.

 
  
References
 
American Nurses Association.  (n.d.).  Information retrieved February 10, 2015 from, http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Health-IT
 
Huston, C. (2013).  The impact of emerging technology on nursing care: Warp speed ahead.  The Online Journal of Issues in Nursing Vol. 18, No. 2, Manuscript 1.
 
Technology Informatics Guiding Education Reform.  (2004).  Information retrieved February 12, 2015 from, www.thetigerinitiative.org.


Saturday, February 7, 2015

Human-Technology Interface

 
Patient Sensors Improving Patient Outcomes



            Passive Sensor Technology is being used by clinicians to monitor activity levels of the elderly.  The elderly have special needs that need addressing and the use of sensor technology can assist in these matters (Alexander, Wakefiedl, Rantz, Skubic, Aud, Erdelez, & Ghenaimi, 2011).  For example in independent living centers, sensors can detect when reduced activity has occurred, and early intervention can take place.  Robert Jennings, 86 has a system in his home which monitors a host of things, from motion in particular rooms to whether he has taken his medicine.   This information is collected about his daily habits and condition, and then relay that in real-time to doctors or family members (Sutter, 2010).  This technology enables early intervention when for example an elderly person has fallen and can't get up or reach a telephone to call for help.  Decrease movement by an elderly person can alert family members that something may be wrong. 

            A study was performed to determine the perception of elderly individuals and the idea of using sensors.  The study found that any system or technology that could prolong an elderly persons independence was well received (Steele, Lo, Secombe, & Wong, 2009). 
Elderly individuals felt they could remain independent, yet know that their healthcare providers are there if they are needed.  A nurturing and caring relationship can be maintained with healthcare providers and family because the elderly individuals remains independent, yet they know if something happens their family and healthcare providers will be alerted.   A trusting and caring relationship can  form between nurse and patient if the nurse relates to the patient in the here and now and interacts with technology after the patient assessment is completed.  Patients need a caring, and unquestioning relationship with the nurse that allows for optimal health and wellness. Maintaining focus on the actual patient while integrating technology as a tool to provide safe and competent care is vital in meeting the needs of the patient (Hill, 2013).  Through the use of a sensor for elderly patients, this relationship can be maintained.
 

 
References 
Alexander, G., Wakefield, B. Rantz, M., Skubic, M., Aud, M., Erdelez, S., & Ghenaimi, S. (2011).     Passive sensor technology interface to assess elder activity in independent living.  Nursing Research, 60(5), 311-325.
 
Hill, T. (2013). Invited Editorial: Caring and Technology. Online Journal of Nursing Informatics, 17 (3). Available at  http://ojni.org/issues/?p=2856.

Sutter, D. (2010).  Sensors monitor older people at home.  Information obtained February 4, 2015 from, http://www.cnn.com/2010/TECH/innovation/11/19/sensors.aging/. 
 
Steele, R., Lo, A., Secombe, C., Wong, Y. (2009).  Elderly persons' perception and acceptance of using wireless sensor networks to assist healthcare.  International Journal of Medical Informatics, 78, 788-801.



Sunday, February 1, 2015

Nursing Intervention Classification (NIC)/Nursing Outcomes Classification (NOC)


OVERVIEW OF NIC
 
The Nursing Interventions Classification (NIC) is a comprehensive, research-based, standardized classification of interventions that nurses perform. It is useful for clinical documentation, communication of care across settings, integration of data across systems and settings, effectiveness research, productivity measurement, competency evaluation, reimbursement, and curricular design (University of Iowa, 2010). 

NIC interventions are grouped hierarchically into 30 classes within seven domains. The seven domains are:
  • Behavioral
  • Community
  • Family
  • Health System
  • Physiological: Basic
  • Physiological: Complex
  • Safety
(Bulechek, G.,  Butcher, H., Dochterman, J., & Wagner, C., 2013).

PURPOSE

NIC provides a standardized classification system for treatments performed by nurses (University of Iowa, 2010). 

IMPORTANCE TO NURSING

The NIC  is important to nurses because it systematically classifies nursing care in clinical settings.  The importance of having a standardized classification of interventions is important because it provides better communication among nurses and other health care providers, increases the visibility of nursing interventions, improves patient care, enhances data collection to evaluate nursing care outcomes, and provides greater adherence to standards of care (Rutherford, 2008). 
 
For an example of a nursing intervention click HERE.





OVERVIEW OF NOC

The Nursing Outcomes Classification (NOC) is a comprehensive, standardized classification of patient/client outcomes developed to evaluate the effects of interventions provided by nurses or other health care professionals. Standardized outcomes are essential for documentation in electronic records, for use in clinical information systems, for the development of nursing knowledge and the education of professional nurses (University of Iowa, 2010). 

 NOC consists of three levels: domains, classes, and outcomes. The outcomes are organized into 31 classes and 7 domains.  Each outcome consists of a definition, a 5-point measurement
scale or combination of scales, a list of associated indicators for the outcome concept (Lundberg, et al., 2008).  These outcomes are coded for use in the electronic health record.

PURPOSE

The NOC is a system to evaluate the effects of nursing interventions used in nursing care (University of Iowa, 2010). 

IMPORTANCE TO NURSING

The use of NOC allows nurses to determine the outcomes of the care (or interventions) provided to individual patients (Lundberg, et al., 2008).

The use of NOC for use in electronic health records provides an opportunity to conduct effective  outcome data that can be measured at different intervals. For nurses, this effectiveness can identify linkages among the diagnoses; interventions and outcomes for specific patient populations (Lundberg, et al., 2008). 
 


For an example of nursing outcomes click HERE.



References

Bulechek, G.,  Butcher, H., Dochterman, J., & Wagner, C. (Eds.). (2013). Nursing interventions    classification (NIC) (6th ed.). St. Louis, MO: Elsevier.

Lundberg, C., Warren, J., Brokel, J., Bulecheck, G., Butcher, H., McCloskey-Dochterman, J.,...& Giarrizzo-Wilson, S. (2008).  Selecting a Standardized Terminology for the Electronic Health Record that Reveals the Impact of Nursing on Patient Care.  Online Journal of Nursing Informatics, 12,2. 

Rutherford, M., (Jan. 31, 2008)  "Standardized Nursing Language: What Does It Mean for Nursing Practice? "OJIN: The Online Journal of Issues in Nursing. Vol. 13 No. 1.

University of Iowa.  (2010).  Information retrieved January 29, 2015 from, http://www.nursing.uiowa.edu/center-for-nursing-classification-and-clinical-effectiveness.