Nursing Informatics and Evidence-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

Strategic HIT Planning for the Decade 2004-2014 (cont'd) 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) Established four goals 1) Inform clinical practice 2) Interconnect clinicians 3) Personalize care for clients 4) Enhance public health

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

Nursing Informatics (cont'd) 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

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.

Answer False. 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

Using Information Technology Within the Care Setting (cont'd) Order entry Nursing data entry Computerized medication administration systems Other computer resources

Accessing Information Resources Texts and reference books Libraries Policies and standards

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

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

Healthcare Indexes for Finding Information Resources (cont'd) Psych Index Social Sciences Index Many journals publish their own annual index

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

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 Development Types of evidence used Research studies Patient care data International, national, and local standards

Evidenced-based Practice (cont'd) Infection control data Pathophysiology Cost-effectiveness analysis Patient preferences

The Research Process Statement of problem/question Review of literature Theoretical framework Refining the plan Implementing the study

The Research Process (cont'd) Analyzing the data Presenting and interpreting findings Limitations Disseminating research results

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.

Answer C. 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

Reading Research (cont'd) Understanding research terminology Abstract Research question and purpose Hypothesis Population vs. sample Groups

Reading Research (cont'd) Variable Validity and reliability Probability and statistical tests Clinical significance

Legal and Ethical Considerations in Research Institutional approval Institutional review board Educational institution review board Funding agencies

Legal and Ethical Considerations in Research (cont'd) Consent for research Informed consent Formal consent form Describes the researcher’s credentials How the participant was chosen Purposes of the research Procedures that will be followed

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

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.

Answer True. 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

Implementing New Practices Based on Evidence (cont'd) 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