Professional Standards – Informatics

This week I will recreate College of Nurses of Ontario [CNO] specific to informatics in nursing. These professional standards contains content from the modules in the course Informatics in Nursing.

Accountability

(Volkov, 2015).
  • Sharing nursing informatics knowledge and expertise with clients
  • Seeking assistance appropriately with nursing informatics technology
  • “Ensuring practice is consistent with CNO’s standards of practice and guidelines as well as legislation” (CNO, 2018, p. 4).
  • Taking responsibility for errors related to nursing e-health
  • Reporting unsafe use of informatic techonology
  • The nurse uses apomediation to clients giving relevant and trustworthy information to clients

Continuing Competence

(The Law Society, 2017).
  • Assuming responsibility for informatic technology development and sharing this knowledge with others
  • investing time and knowledge to improve e-health awareness and gain knowledge, skill, and judgment within informatic technology
  • Advocate for technology advancements in the workplace
  • Work together to create a setting that provides continuing competence in regards to informatics technology
  • The nurse should become aware of health promotion opportunities online and organizations to gain accessibility of healthcare resources
  • The nurse will gain knowledge on health enabling methods such as mobile apps and virtual communities

ethics

(Glean Info, 2017)
  • The nurse identifies ethical issues related to informatics and communicating them within the health care team
  • “Identifying options to resolve ethical issues” (CNO, 2018, p. 6)
  • The nurse will obtain privacy and confidentiality within electronic medical records

knowledge

(Business Marketing Engine, 2019).
  • Being informed of the role nursing informatics has on healthcare
  • Being informed of the nurses role in relation to e-health usage
  • Understanding how to use informatics technology in the workplace
  • Knowing how to access resources when unsure of technology use.
  • Being aware how an e-health environment can affect professional practice
  • Understanding the benefits and disadvantages of informatics in nursing
  • The nurse must not become technology dependant within data information
  • The nurse appreciates how health information is socially generated and mediated using more dynamic features on the internet

knowledge application

(Salas, 2016)
  • The nurse is able to apply knowledge using informatics in their nursing practice
  • The nurse is able to interpret explicit data and use nursing knowledge to apply a meaning to data retrieved
  • The nurse can critically analyze client data to address client’s needs.
  • The nurse is aware of the Best practice guideline Registered Nurses Association E-health Toolkit (RNAO, 2019)
  • The nurse identifies and addresses informatic related issues
  • The nurse is able to collect, aggregate, and manage info in a faster fashion
  • The nurse is able to convert basic data and info into more complex knowledge and understanding
  • The nurse is able to assess and critique health information on websites using honeycomb and CRAAP models.

leadership

(The New Times, 2019).
  • Providing direction and guidance with e-health technology to novices, students, and unregulated care providers.
  • The nurse acts as a role model and a mentor within the context of nursing informatics
  • Provides leadership with nursing informatics technology when there are questions or teaching opportunities
  • Resolves conflict within nursing informatics
  • The nurse will communicate via technology effectively and efficiently through the interprofessional team

relationships

(RCNi, 2017)
  • The nurse provides boundaries between professional therapeutic relationship and social media personal relationships
  • Demonstrate respect and empathy when using technology devices during client interactions
  • Maintain boundaries between professional and cyber-life
  • The nurse will be aware of cyber-bullying and their detrimental effects on mental health

References

Business Marketing Engine. (2019). How
growing your knowledge can grow your business.
[Photograph]. Retrieved from https://businessmarketingengine.com/how-growing-your-knowledge-can-grow-your-business/

College of Nurses of Ontario. (2018). Professional standards:
Revised 2002. Retrieved from 
https://www.cno.org/globalassets/docs/prac/41006_profstds.pdf

Glean Info. (2017). The role in
communications pros in improving corporate ethical behaviour.
[Photograph].
Retrieved from https://glean.info/role-communications-pros-improving-corporate-ethical-behavior/

RCNi. (2017). Therapeutic
relationships
. [Photograph]. Retrieved from https://rcni.com/keywords/therapeutic-relationships

Registered Nursing Association. (2019). E-health. Retrieved from http://ehealthtoolkit.rnao.ca/

Salas, A. (2016). KCA: A simplified
training strategy for learning and development.
[Photograph]. Retrieved
from https://elearningindustry.com/kca-simplified-training-strategy-learning-development

The Law Society. (2017). Continuing competence: Meeting requirements is
easier than you think. [Photograph]. Retrieved from https://www.lawsociety.org.uk/news/blog/continuing-competence-meeting-requirements-is-easier-than-you-think/

The New Times. (2019). Leadership (Part
Eight).
[Photograph]. Retrieved from https://www.newtimes.co.rw/business/leadership-part-eight

Volkov, M. (2015). Compliance program
effectiveness requires accountability
. [Photograph]. Retrieved from https://blog.volkovlaw.com/2015/03/compliance-program-effectiveness-requires-accountability/

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Case of Doyle Byrnes

This week in my blog I will be talking about professionalism in nursing which surrounds the aspects of social media. There was a case scenario in 2010 when a nursing student named Doyle Byrnes was removed from her nursing program due to uploading a picture of herself and a human placenta on Facebook. Doyle Byrnes uploaded this picture because she wanted to show her friends and family the experiences she was having while in her nursing program. Before uploading the photo she was given permission from her clinical instructor to upload to social media with the exception that no identifiers of the patient would be included. Shortly after posting the picture she was asked to remove the picture and ultimately was expelled from the program. Doyle Byrnes took the case to court and won her case as no confidentiality measures were broken and was granted permission to continue the program.

Questions to consider

  • Should Doyle Byrnes question her professionalism before uploading this picture to Facebook?
  • Did Doyle Byrnes or the clinical instructor break any of the CNO professional standards?
  • Even though Doyle Byrnes was granted back into the program; How will this affect her credibility for future job prospects? Should Doyle Byrnes question her professionalism before uploading this picture to Facebook?

Thompson et al., (2008), defines professionalism “as a core competency, outlining diverse domains such as compassion, responsiveness to patient needs that supersedes self-interest, respect for patient privacy, and sensitivity to diverse patient populations” (para. 1). I believe that posting the placenta broke the respect for patient privacy and sensitivity. Doyle Byrnes broke the CNO (2018), professional standard accountability. By posting this picture on social media Doyle represented disrespect to the profession and had a negative effect on patient sensitivity. Also, the clinical instructor broke the leadership component of the CNO (2018), professional standards. According to CNO (2018), leadership is demonstrated by the nurse educator by “providing professional and educational advice to committees and teams” (p. 10). The clinical instructor failed by granting permission to upload the picture on Facebook.

This incident will effect Doyle Byrnes representation online for future employees. Even though she won her case in court this incident follows her online for the rest of her life. Thompson et al., (2008), identified that “medical educators, colleagues, future employers, and even patients may have access to their content online” (para. 2). Upon my current google search of Doyle Byrnes this is what I found:

References

College of Nurse of Ontario. (2018). Professional Standards, Revised. Retrieved from http://www.cno.org/globalassets/docs/prac/41006_profstds.pdf

Thompson, L. A., Dawson, K., Ferdig, R., Black, E. W., Boyer, J., Coutts, J., & Black, N. P. (2008). The intersection of online social networking with medical professionalism. Journal of general internal medicine23(7), 954–957. doi:10.1007/s11606-008-0538-8

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

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