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Nursing Informatics - Week 1 and 2
Terms in this set (55)
Evidence Based Practice (EBP)
the integration of best research evidence with clinical expertise and patient values
6 dalhousie website criteria
Evidence based practice is NOT
- a formula for approaching all situation and all individuals
- a replacement for nursing ax of a situation or individual
Video: crowd source your health
Video: the future of medical technology
what is nursing informatics
- ANA considers it the wisdom to use knowledge and make clinical judgements consistent with entry-level nursing education --> wisdom is derived from experience and evidence
Health care before EBP
- prior to movement toward EBP clinical practice was guided by expert opinion, experience, trial and error, etc.
- ex. Bloodletting, babies don't experience pain
The need for EBP
- the need has never been greater
- new interventions, meds, tx
- focus on pt safety and quality care
- increased quantity of research
Today's nurses must
- caring for increasingly sick individuals with an increasing variety of interventions
- partnering with pt care assitants, RPNs and need to delegate w/in the team
- have to keep up to day on evidence r/t their work
- learning how to effectively access information is critical*
Sources of evidence
- Research articles
- Medical databases (e.g. CINAHL)
- Internet search engines (e.g. Google)
- Clinical practice guidelines/best practice guidelines
- Nursing and health organizations
- Electronic health records and other point-of-care systems
- Hospital health information systems
- Pre-printed orders, clinical pathways
- Hospital charts
When reading research articles consider:
1. Is the study potentially helpful to your situation?
2. Would applying the results be consistent with your agency's policies and standards?
3. Is it reasonable to implement the study findings?
4. What are the benefits and barriers?
5. How strong is the research design?
Searching the internet for evidence (2 ways)
1. ID credible websites and search those websites for evidence related to your topic OR
2. use a search engine (ex. google) to search you topic (ex. smoking cessation) and then filter through the results for credible sources
both methods of searching require you to be able to assess the quality of the source
Using websides to find information - pros and cons
Pros: quick, access to a large quantity of information
Cons: potential lack of quality in evidence, large quantity of sources to sort through
Reviewing websites for quality
- Organization and purpose
- Author credentials and bias
- Accurate and verified content
- Website and content maintained and current
- Clear references
- Valid recommendations
Examples of credible websites
- Public Health Agency of Canada
- RNAO BPG
Clinical or Best Practice Guidelines
- conducting a database or internet search for all clinical issues is generally not feasible
- practice guidelines allow for quick retrieval of research info that has already been evaluated for quality and translated into clinical practice
- many guidelines are available online and free of charge, ex. RNAO
Patient education - Health and the internet
- with widespread access, many individuals search the internet for health info and tools
- ex. google search of "sore throat" retrieves over 18,000,000 results
- the common use of smart phones allows individuals to access the internet in a variety of settings
Nursing plays a key role in developing health literacy skills in pts by
- helping them assess the quality of info and tools
- increasing awareness of accurate source of information and tools
- online quality ax tools
- Canadian public health association "evaluating health information online"
- reputable organization's website, ex. Health Canada
- avoid .com sites (use credible sources, then type in disease of interest - watch for advertised sites)
Individual Characteristics to consider - 4 complications of ehealth
Accessing info online may not be appropriate for all individuals and may be complicated by
- health literacy
- language barriers
- physical barriers (ex. visual impairment)
- cognitive barriers (ex. dementia)
How can you tell if a website is credible?
the HON code on the website
(week 2 start) Florence nightingale and information seeking
"In attempting to arrive at the truth, I have applied everywhere for information, but in scarcely an instance have I been able to obtain hospital records fit for any purpose of comparison..."
eHealth and public + pts
- laboratory, pharmacy, imaging
- acute care, primary care, public health, community care
Concept of nursing informatics- origin and 3 components
Can be traced back to the russian term "informatika" which was used in the context of computers in the 1960's
1) Data- discrete, objective entities with not interpretation
2) Information - as data that are interpreted, organized or structure
3) Knowledge - as information that is synthesized with the ID and formalization of relationships
The relationship of data, information, knowledge and wisdom
As our interactions and inter-relationships increase and the complexity increases, there sequence of
1. Data (naming, collection, organizing)
2. Information (organizing and interpreting)
3. Knowledge (interpreting, integrating, understanding)
4. Wisdom (understanding, applying, applying with compassion)
Myth: I won't understand my lab results if I access them online because they are too complicated.
Fact: In a study, 76% of patients who first saw their lab results online were confident they understood the results
Myth: The introduction of virtual visits means I won't see my doctor anymore.
Fact: Face-to-face visits will remain a cornerstone of primary care, but sometimes an in-person visit isn't required.
Myth: The quality of care offered in a virtual visit is not as good as the care in a face-to-face visit.
Fact: While in-person visits are essential in some cases, there are many scenarios in which virtual visits can provide the same standard of care.
Myth: Digital health will marginalize populations who may not have online access.
Fact: Many Canadians face barriers to access to care and virtual care helps reduce those barriers.
Myth: Digital health is only for the young and tech savvy.
Fact: Canadians are very connected, including seniors. 88.5% of Canadian households have Internet access.
Myth: If patients are able to view lab test results online before talking to their doctors, they will be overly anxious.
Fact: Patients who view their results online are no more anxious than those who wait to learn about them in person
Myth: Doctors will be flooded with calls if patients have access to their lab results online.
Fact: Patients who have access to their lab results online are less likely to call their physicians while waiting for results and they're less likely to have an in-person visit related to their results.
Myth: Patients don't want to see their health information and won't find the information useful. - %
Fact: 69% of Canadians who don't currently have online access to their medical records would like access.
Myth: Virtual visits are only for patients living in remote communities.
Fact: Canada is a world leader in the use of telehealth, which has revolutionized access to care in remote communities.
Myth: Patient-doctor relationships suffer when there is a computer screen in the exam room.
Fact: Technology does not impact the quality of the interaction
Myth: Digital health is just for health care providers.
Fact: 69% of Canadians who don't currently have online access to their medical records would like access.
Myth: My doctor receives all the information needed to provide my care.
Fact: There is still work to be done to connect points of information
Myth: There has been little to no progress in digital health in Canada.
Fact: The key components of Canadians' health records are now 93.8% digitized and available electronically
Myth: Allowing patients to book appointments online (e-booking) means clinicians will lose control over their schedule and won't be able to see urgent cases.
Fact: e-Booking can allow physicians to customize their schedules so they can block time for urgent cases in a way that suits their needs and practice model.
Myth: The government and insurance companies will be able to see my digital health records.
Fact: All provinces and territories in Canada have laws that protect the confidentiality of your personal health information.
Myth: Canada has spent billions of dollars on digital health with nothing to show for it.
Fact: Substantial progress has been made in Canada, with the key components of Canadians' health records now 93.8% digitized and available electronically.
Myth: I don't have a right to access my health record.
Fact: Your health care provider is the custodian (trustee) of your health record, responsible for proper use and management of the record. However, the information in the record is yours and you have a right to access it.
Canada Health Infoway
- not for profit organization founded in 2001
- used to promote transformation of HC through health information technology by dev't of blueprint for eHeath REcords, fostering the adoptions of eRecords for all Canadians, creating standards for tech and communication and promoting clinician facility with health info tech
Romanow, 2002 quote
"Electronic health records are one of the keys to modernizing Canada's health system and improving access and outcomes for Canadians."
Standardized nursing data offers many opportunities to:
- advance nursing practice
- increase visibility of nursing contribution in pt care
- support dev't of nsg practice guidelines = improve pt outcomes
- easier to ID trends in pt data
- provide info to decision-makers
Standardized clinical terminologies
- common languages that describe health conditions, tx plans and ix
- needed for interoperable eHealth records
- 2 examples in Canadian nursing
2. SNOMED CT
Standardized clinical terminologies - INCP
International Council of Nurses Practice (ICNP)
- try to standardize nsg language
- includes: nursing ix, dx, outcomes
Standardized clinical terminologies - SNOMED CT
Systematized Nomenclature Of MEDicine Clinical Terms (SNOMED CT)
- allows clinical info to be communicated between health professionals and settings
- facilitates inter-professional teamwork
- collects international data for analysis
which is nursing specific: SNOMED CT or ICNP
SNOMED CT will be used in Pan-Canadian eHealth Records
ICNP is nursing specific, but can be integrated into inter-disciplanry systems like SNOMED CT
Ran from 2007-2010 and included partnership between CNA and Canada Health Infoway
1. Standardize Can nsg terminology with the ICNP
2. systematically capture nurse-sensitive clinical outcomes (Ex. pain intensity, falls, pressure injury)
3. store the data for use in EHRS and databases
Nurses at sites particpating in C-Hobic collected routine info duirng: admission ax, discharge ax, regular basis for long-term
Subsequent C-Hobic projects
- mapping and publishing of nursing outcome categories to the ICNP
- outcome categories: functional status, therapeutic self-care, symptom mx, pt safety, pt satisfaction with nsg care
- developing of synoptic reports
- eCharting with built-in cues of what document and where to document it
C-hobic data and 3 care outcomes
1. prevent re-admission
2. improved transitions (ex. acute care to long-term care facility)
3. nursing interventions and patient outcomes
Use of C-hobic data
- generating nsg practice guidelines based on the evidence for nursing interventions collected in the project
- care planning based on the nursing resources (ex. time) required to perform these interventions
- designing EHRS with standardized clinical terms to describe nsg ix
how nursing informatics is being used in Ontario
- RNAO - nursing order sets
- clear intervention statemetns based on the ICNP and SNOMED CT in BPGs
How long does it take evidence to reach nursing practice?
THIS SET IS OFTEN IN FOLDERS WITH...
Nursing Informatics - Glossary Terms
Week 3 Nsg Informatics - Health Literacy
eHealth RNAO nsg informatics
Electronic documentation - May 29 Nsg Informatics
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