Nursing Informatics and Evidence-based Practice

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Nursing Informatics andEvidence-based Practice

• Chapter 13

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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

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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

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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

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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

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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

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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

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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.

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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.

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Using Information Technology Within the Care
Setting

• Employers expectations
• Understanding IT systems
• Security systems
• Billing systems
• Patient information retrieval

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

• Order entry
• Nursing data entry
• Computerized medication administration systems
• Other computer resources

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Accessing Information Resources

• Texts and reference books
• Libraries
• Policies and standards

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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

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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

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Healthcare Indexes for Finding Information
Resources (cont'd)

• Psych Index
• Social Sciences Index
• Many journals publish their own annual index

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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

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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

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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.

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Evidenced-based Practice

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

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Evidenced-based Practice (cont'd)

• Infection control data
• Pathophysiology
• Cost-effectiveness analysis
• Patient preferences

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The Research Process

• Statement of problem/question
• Review of literature
• Theoretical framework
• Refining the plan
• Implementing the study

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The Research Process (cont'd)

• Analyzing the data
• Presenting and interpreting findings
• Limitations
• Disseminating research results

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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.

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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.

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Reading Research

• Types of research
• Quantitative
• Qualitative
• Combined
• Meta-analysis

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Reading Research (cont'd)

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

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Reading Research (cont'd)

• Variable
• Validity and reliability
• Probability and statistical tests
• Clinical significance

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Legal and Ethical Considerations in Research

• Institutional approval
• Institutional review board
• Educational institution review board
• Funding agencies

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Legal and Ethical Considerations in Research
(cont'd)

• Consent for research
• Informed consent
• Formal consent form
• Describes the researchers credentials
• How the participant was chosen
• Purposes of the research
• Procedures that will be followed

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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

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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.

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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
  riskbenefit ratio of the research.

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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

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Systematic Analysis of Information and Evidence

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

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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

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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