Healthcare Occurs Everywhere: Patients self-diagnosing on the Internet

This week I will analyze the pros/cons of patients being able to access health care information on the internet. There is potential risk of credibility and reliability of health care information found on the internet and there is a concern with self-diagnosis among patients (Weber, Derrico, Yoon, & Sherwill-Navarro, 2010). 58% of internet users seek health care information on the internet (Underhill & McKeown, 2008) and 86% of patients use the internet to search  for their health concerns (Chew & Eysenbach, 2010). With this high prevalence of health related internet use is this safe for our patients? How can we as healthcare providers protect our patients from misinformation found on the internet.

PRO OUTLOOK

  • Improves patient-physician relationship (Tan & Goonawardene, 2017)
  • Social media can quickly spread health information to the public from credible resources (Chew & Eysenbach, 2010).
  • Healthcare providers can provide health teaching on credible resources on the internet (Weber et al., 2010).
  • Increase communication among patient – physician conversation (Weber et al., 2010).
  • Health information seeking can provide warning signs and symptoms of potential health concerns for patients (Weber et al., 2010).

CON OUtlook

  • Accuracy and reliability of health related information is questioned (Underhill & McKeown, 2008).
  • Social media can amplify or intensify pandemics (Chew & Eysenbach, 2010).
  • There is a lack of validity from internet users reading health information (Weber et al., 2010).
  • Patients may resort to web-based information instead of talking the their physicians (Weber et al., 2010).
  • Sites like Wiki can add, remove, or change content by any internet user affecting credibility (Weber et al., 2010).
  • Self-diagnosis can lead to inappropriate diagnosis, herbal or drug use, and ineffective self-treatment (Weber et al., 2010).
  • Patient may not be able to comprehend scientific articles found on the internet (Weber et al., 2010).
  • Websites containing healthcare information may be trying to sell products to the consumer which can mislead the reader to false tendencies (Weber et al., 2010).

As healthcare providers we should be open about the information found on the internet. According to Tan & Goonawardene (2017), patient internet use increases conversation and improves patient-physician relationship when concerns of internet findings are discussed. The internet can be a good source of information for patients if the patient is taught how to browse the internet and how to access and understand credible resources. According to Weber et al., (2010), the health care provider can teach the patients the following acronym GATOR when interpreting internet resources:

G- Genuine

A – Accurate

T- Trustworthy

O- Origin

R- Readability

Check out this video regarding patient self-diagnosing on the internet:

References

Chew, C., & Eysenbach, G. (2010). Pandemics in the age of Twitter: content analysis of Tweets during the 2009 H1N1 outbreak. PloS One5(11), e14118. doi:10.1371/journal.pone.0014118

Tan, S. S., & Goonawardene, N. (2017). Internet Health Information Seeking and the Patient-Physician Relationship: A Systematic Review. Journal of medical Internet research19(1), e9. doi:10.2196/jmir.5729

Underhill, C. & McKeown, L. (2008). Getting a second opinion: Health information
and the Internet Statistics Canada, Health Reports, 19(1).  Retrieved from http://www.statcan.gc.ca/pub/82-003-x/82-003-x2008001-eng.pdf

Weber, B. A., Derrico, D. J., Yoon, S. L., & Sherwill-Navarro, P. (2010). Educating patients to evaluate web-based health care information: The GATOR approach to healthy surfing. Journal of Clinical Nursing, 19(9-10), 1371-1377. doi:10.1111/j.1365-2702.2008.02762.x

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Utilization of Tanner’s (2006), Clinical Judgement Model

SCENARIO

A 68 y/o patient is admitted to the medical unit with a diabetic ulcer on his right toe and is ordered wet to dry dressings with half strength betadine. Dressing changes are scheduled TID 10:00, 14:00, and 20:00. You come onto the unit and accept care to the patient. Using Tanner’s (2006), Clinical judgement model the nurse will care for this patient.

NOTICING: CLINICAL JUDGEMENT MODEL

As a nurse on the medical-surgical unit you have expert experience with patients who have diabetic foot ulcers. The noticing component of Tanner’s, (2006), model is not just assessment but particularly focuses on nurse’s expectations and initial grasps. As a nurse on the medical/surgical unit who has many patients with diabetic foot ulcers will recognize the pain level that the patient is in and administer PRN pain medications prior to changing the dressing for effective pain control. The nurse will be able to assess when the dressing should be changed PRN and make appropriate assessments on the diabetic foot ulcer when changing the dressing. When changing the dressing the nurse notices that there is unusual redness and heat coming from the wound – an experienced nurse can notice the signs of infection and take a sample for bacteria growth while reporting the abnormal findings to the physician. With a change in the clinical situation the nurse was able to react in a way that will provide effective patient care to avoid further complications.

INTERPRETING AND RESPONDING: CLINICAL JUDGEMENT MODEL

In this situation, the nurse grasped an intuitive that the diabetic foot ulcer could be infected. The analytic component of Tanner’s, (2006), model would be the collection of a CBC and wound culture to determine whether or not the patient has a true infection. The tests that were collected will confirm the nurse’s hypothesis to reach an interpretation that supports an infection. Interventions will be applied and antibiotics will be discussed with the MD. These analytic and intuitive components that the nurse has shown represent clinical reasoning and responding (Tanner, 2006).

REFLECTING: CLINICAL JUDGEMENT MODEL

There are two components to reflection according to Tanner’s model: Reflection-in-action and Reflection-on-action (Tanner, 2006). Reflection-in-action is when the nurse is able to evaluate the patients response to the interventions applied (Tanner, 2006). The patient was given antibiotics for their infection that they have developed from their diabetic foot ulcer. In the meantime the nurse will be assessing the patients response to the antibiotic, fever will be monitored, and pain level is continually assessed. The nurse will document and assess the wound at each dressing change noting any positive or negative changes found at the wound site. Reflection-on-action is when the nurse can gain knowledge from the experience (Tanner, 2006). The nurse will reflect on how to properly change diabetic foot ulcers without breaking the sterile field to avoid future infections whether or not this was the cause. The nurse will be able to recognize wound infections quickly and efficiently and apply appropriate interventions in the future. As a result of nursing actions the patient has recovered from his diabetic foot ulcer infection and avoided life threatening complications such as sepsis or even septic shock leading to mortality.

How does this clinical judgement model reflect on e-health or informatics?

According to the Registered Nurses Association of Ontario [RNAO] ,(2012), Tanner (2006) stated:

“As we increasingly move toward an environment of instant and infinite information, it becomes less important for students to know, memorize, or recall information, and more important for them to be able to find, sort, analyze, share, discuss, critique, and create information. They need to move from being simply knowledgeable to being knowledge-able” (p.76).

Informatics can be used by nurse’s in the following ways:

  • Compare previous documented assessments
  • Evaluate patient response
  • Review MD and nursing notes
  • Review laboratory findings

(RNAO, 2012)

E-health resources can be used to reflect on up to date information in regards to dressing changes to promote wound healing. Continuing education can be applied by Best Practice Guidelines for use of appropriate tools for reference (RNAO, 2012). Evidence informed practice is used by nurses for accurate decisions and judgments on decision making (RNAO, 2012). Knowing how to find these resources through internet research is the key to finding and using these evidence based literature. (RNAO, 2012)

Reference

Registered Nurses Association of Ontario. (2012). Best practice guideline: Nurse educator ehealth resource. Retrieved from https://rnao.ca/sites/rnao-ca/files/Nurse_Educator_eHealth_Resource_-_2012_2.pdf

Tanner, C. (2006). Thinking like a nurse: a research-based model of clinical judgment in nursing. The Journal of Nursing Education45(6), 204-11. 
Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16780008

Article review of Darbyshire (2004), Computerized Patient Information System Charting

There are two key features that nurses voiced which was problematic with Computerized Patient Information System (CPIS) charting. The first disappointment was that clinicians were unable to capture the holistic nursing care perspective when documenting in the CPIS system (Darbyshire, 2004). After reviewing the article from Darbyshire (2004), There are two questions to consider:

  1. How do you make a CPIS system target toward nursing holistic care?
  2. How can we train system users to gather information efficiently when needed?

Nurses stated that what was important in nursing and the real stuff of nursing was unable to be properly documented in these computer systems (Darbyshire, 2004). It is important for these computer documentation systems to include all aspects of nursing care and not just a tick box method that they are experiencing (Darbyshire, 2004). Documentation needs a concise, accurate, comprehensive approach to provide proper nursing care documentation (Stewart et al., 2017). Nursing documentation is more than the management of physical symptoms and the documentation system used needs to reflect every aspect of nursing care (Stewart et al., 2017). Advances in this type of documentation practices and organizational support are needed to improve effective nursing documentation practices in the future (Stewart et al., 2017).

Holistic approach to be included in documentation practices

The second area of concern based on Darbyshire (2004), article is most nurses found the CPIS difficult to use and time-consuming. Nurses believed that the retrieval of information was difficult to find and that data entry is lost after submitting in the system (Darbyshire, 2004). The nurses called this a black hole phenomenon which created frustration and time-consuming effort which was void upon retrieval of information (Darbyshire, 2004). The nurse must understand the benefits of computerized charting and that once the nurse is user friendly of the computer system is will save time and provide more bedside nursing available than the pen and paper method of charting. The nurse will receive appropriate training on the computerized system and can access additional assistance if needed (Harrison, 2003). My current place of employment has a clinical nurse that is always available during the week to walk through concepts of computerized charting that we may not completely understand. Practice, proper training, and efficiency of computerized charting I believe will void the negative complaints from nurses from computerized charting (Harrison, 2003).

References

Darbyshire, P. (2004). “Rage against the machine?”: nurses’ and midwives’ experiences of using Computerized Patient Information Systems for clinical information. Journal of Clinical Nursing13(1), 17-25.Retrieved from https://journals-scholarsportal-info.roxy.nipissingu.ca/pdf/09621067/v13i0001/17_atmnampisfci.xml

Harrison, B. (2003). Becoming familiar with computerized charting. Healthcare Traveler, 11(2), 70. Retrieved from http://moxy.eclibrary.ca/login?url=https://search-proquest-com.roxy.nipissingu.ca/docview/216631094?accountid=12792

Stewart, K., Doody, O., Bailey, M., & Moran, S. (2017). Improving the quality of nursing documentation in a palliative care setting: a quality improvement initiative. International Journal of Palliative Nursing23(12), 577–585. https://doi-org.roxy.nipissingu.ca/10.12968/ijpn.2017.23.12.577

Confidentiality and the use of Technology

“With the increased use of computerized electronic medical records there is a direct correlation to a rise in a breach of confidentiality among healthcare professionals”.


Mackenzie’s Thesis Statement

The purpose of this nursing informatics paper is to explore technologies used in nursing practice. I have chosen to explore the increased use of electronic charting in relation to breaches in confidentiality among healthcare workers. With the direct access to all patient files with just a username and password log in pertains to issues with privacy of patient health records. I will be exploring why people breach and what motivates somebody to look into a patient’s health record considering all the legal implications enforced for breaching of confidentiality. I will also be investigating cyber-attacks that can happen and create a network wide concern for privacy and confidentiality for our patients.

For more information read the news article by CTV news involving the cyber-attack of 24 Hospitals in Northern Ontario:

https://northernontario.ctvnews.ca/hsn-s-computer-virus-affecting-24-hospitals-in-north-east-1.4256232

Please watch this video for a clear understanding of the six types of breaches and the process used for reporting.

Reference

CTV News. (2019). HSN’s computer virus affecting 24 hospitals in the north east. Retrieved from https://northernontario.ctvnews.ca/hsn-s-computer-virus-affecting-24-hospitals-in-north-east-1.4256232

What is Nursing Informatics?

My name is Mackenzie Maillet and I am a Registered Practical Nurse in a small rural community in Northern Ontario. The importance of nursing informatics is understood as using technology to better the care that we give as nurses to our patients. Technology is used every day by nurses and all health care professionals to guide us in our care and communicate with each other to deliver quality medical care. According to Staggers & Thompson, (2002), their definition of informatics includes:


“A combination of computer science, information science, and nursing science designed to assist in the management and processing of nursing data, information, and knowledge to support the practice of nursing and the delivery of nursing care”(para. 23).

There are many ways in which nurses use technology to deliver efficient care to the patients that they are caring for. In my rural town hospital we use a system called Meditech which is a computer system that is connected to all domains of Northern Ontario Hospitals. We use this system to assess and input data on patients that can be viewed by and added by anyone within the circle of care. Being located in a rural community often creates a location determinant on access to specialists or physicians that should be included in the patients care. In our hospital we use information technology by Telehealth which allows the physician to have a face-face conversation with the patient and health care team saving the patient from the stress of travelling to see these health professionals. Technology has advanced and will continue to evolve and nurses will continue to benefit from the daily use of technology to provide standardized care for every patient. Within this blog I will be posting my learning journey through informatics and the importance of this information technology within nursing care.

Reference

Staggers, N., & Bagley Thompson, C. (2002). The Evolution of Definitions for Nursing Informatics: Journal of the American Medical Informatics Association9(3), 255-261. Retrieved from https://academic-oup-com.roxy.nipissingu.ca/jamia/article/9/3/255/748498