NURS 3110 – Information Management and Patient Care Technology Essay

Patient safety is such an important part of our health care system and it helps define quality health care. Keeping our patients safe is a challenging issue because errors and mistakes can and do happen. Error occurs “when a planned sequence of mental and physical activities fail to achieve the intended outcome and when this failure cannot be attributed to some chance intervention or occurrence” (Ballard, 2003). According to the Institute of Medicine, medical error resulted in as many as 98,000 preventable deaths per year; twice the rate of traffic fatalities and the estimated cost in the US could be almost 29 billion dollars (Wells, 2001). Someone has to ensure operational systems and methods are taken to help reduce the likelihood that errors occur, but who is responsible for taking these proper measurers? Is it society, patients themselves, physicians, nurses, nursing professors, administrators, researchers, physicians, or professional associations? In the long run, all of these entities are responsible for making sure the patient has the safest possible outcome. This is a nationwide and worldwide issue that will never be completely resolved because error is always prone to happen. As nurses we need to make sure we are taking all appropriate actions to limit the amount of mistakes that will put our patients at risk. NURS 3110 – Information Management and Patient Care Technology Essay

Nursing definitely plays a huge part in patient safety. Nurses are directly in the core of patient care and can be caught in the middle of either witnessing medical error or being liable for a situation. Harming individuals who seek care and compassion is the last thing nurses intend to happen. The nursing shortage can take some responsibility for endangering the quality of care. When nurses are spread too thin, patients do not receive the adequate care they need and dangers are more likely to arise. In most health care settings, nursing care is more utilized than medical care is. NURS 3110 – Information Management and Patient Care Technology Essay

The goal of this literature review is to increase our knowledge about technology use in practice and to identify where there is need for improvement. Information technology seems to be a widely discussed topic these days and most nurses have no clear idea how it can transform the way we do things on an every day basis. We will also look at the impact technology has on nursing, patients, and colleagues. We will then focus on a specific nursing setting, in this case the emergency room. This literature review is organized to grow on each independent section so that you, the reader, can form your own opinion, but take with you the universal understanding of how information technology will lead us down a new and exciting career path
The areas at this time that are targeted for growth are: patient specific information at point of care, interactive point of care technology, medication dispensing systems, practice models available across the care setting, and efficient inpatient environments that respond to trust, responsibility, and accountability. NURS 3110 – Information Management and Patient Care Technology Essay
A nursing technology revolution is around the corner. In recent years several advances have been made towards the implementation of various programs that help hospitals move more efficiently from ordering tests to admitting the patient into the hospitals proprietary system. In larger hospitals computers have been installed at nursing workstation so that nurses can chart information, view trending, and print lab reports. This is a long way from where nursing was 15 years ago. NURS 3110 – Information Management and Patient Care Technology Essay

Nursing of the future builds on old technology and new innovations to continue to grow towards a common goal. Nurses are just starting to see some of the changes happening in their workplace. Laptop computers on wheels aka (Cows) have been implemented to make the recording of patient data happen at the bedside. Larry Flynn and Dave Barista (2005) reported that “Wireless networks allow nurses to continue the care to the patient and not the chart

According to Neil (92) technology has resulted into a complete revolution in the works of the nurses and doctors. He points out that all these care givers have utilized the advanced medical technology to increase their supply of information, which has in turn enabled them to address the looming disease outbreaks. He observes, because of the development of medical technology, certain medical controlling mechanisms have had to be faced out especially those, which are not compatible with the current technologies. On the other hand, medical technology has promoted the innovation of those medical control mechanisms that are compatible with the emerging technological information. NURS 3110 – Information Management and Patient Care Technology Essay

Even though technology has widely been used by doctors and nurses, it has not come without its challenges. Neil (92) notes that several doctors and nurses have found it difficult in coping with the emerging new information. According to him, this has gone a long way to especially affect these doctors’ social responsibilities towards patients. This has necessitated the employment of more nurses to assist the doctors in addressing various issues that arises from advancement of medical technologies. Both the nurses and doctors have had to deal with several issues emerging at their work places as a result of the emerging technologies. NURS 3110 – Information Management and Patient Care Technology Essay

Nurses and Technology

Just like the doctors, technology has impacted differently on the nurses operations. Runny (1) also admits that even though nurses are normally reluctant to venture into the new technologies, there access and familiarization of such technologies have revolutionized their healthcare service delivery. He points out that technology has increased the supply of information that has affected the nurses’ health care delivery in terms of its speed and capacity. This has been made possible by the invention of advanced technologies such as electronic IV monitors, which has greatly improved the medical healthcare among the patients. NURS 3110 – Information Management and Patient Care Technology Essay

According to Bonnel and Smith (5), technology has improved how nurses manage their patient’s records. They point out that, nurses under their healthcare services are required to maintain and provide accurate health records of their respective patients to avoid miss diagnosis cases and missing of records. Neil (99) agrees with the two scholars noting that nurses have made use of the computerization programs that are available in various health centers to help them maintain accurate patients’ records in their database programs. This has improved the patients’ health care service delivery as their daily health progress records are made available for perusal in seconds. NURS 3110 – Information Management and Patient Care Technology Essay

Bonnel and Smith (1) argue that even though it has been widely reported that technology has reduced the physical interaction between the nurses and their corresponding patients, nurses have remain to be more close to patients as compared to doctors. They note that the invention of various technologies have made it easier for nurses to access and even personalize patients health records. This has enabled the nurses to closely monitor the health progress of their patients. Bonnel and Smith (1) further note that the technology has enabled the nurses to share the records of their patients between different departments within the health facilities. NURS 3110 – Information Management and Patient Care Technology Essay

Even with the many advantages that have been seen in the delivery of healthcare services as a result of the improvement in technology, a number of negative effects have been identified. Bonnel and Smith (1), for example, have noted that the patients have also not been left out by the negative impacts of technology. They observe that in most cases, patients feel unease with their nurses based on the environment that might have been created by sharing of their health status among the nurses. This has resulted into complains among the patients that computerization of their records violates their privacy. Such complains have, in some cases, generated conflicts between the nurses and the patients thereby negatively affecting the delivery of health services by the nurses. NURS 3110 – Information Management and Patient Care Technology Essay

Runny (1) also agrees that technology has also impacted negatively on patient’s health care. She points out that unlike the previous years where nurses could administer drugs and stay in put by the patient’s sides, the evolution of technology has enabled nurses to limit the time they take with their patients. This has negatively affected the relationship between the patients and nurses resulting in a number of negative impact on the health care services. Today many nurses are unable to fully address the patients’ issues, because they rarely get to know them better. NURS 3110 – Information Management and Patient Care Technology Essay

According to Runny (1), the evolution of medical technology has also necessitated the employment of more nurses, who have advance ideas on such technologies. This has raised the cost of treatment because the technological knowledgeable nurses have always demanded for higher compensation compared to other nurses. This means that the advanced technology has also impacted negatively on nurses who have little technological knowhow, thereby, causing divisions among the nurses. According to Bonnel and Smith (1), the increased cost of treatment has also resulted from the computerization of most of the operations in the healthcares. They argue that this has made it difficult for the low-income patients to get full medical services. For instance, they note that patients from poor families, who are to be hospitalized are unable to exploit the hospital nursing services due to their financial constraints. NURS 3110 – Information Management and Patient Care Technology Essay

Bonnel and Smith (1) point out that, just like in the case of doctors, technology can impact negatively on the nurses’ performance. They note that technology not only reduces the physical interaction of nurses and patience, but it also does the same between hospital departments. This reduces the performance of nurses as they are unable to physically interact during their professionalism. Separating the nurses limits the frequency with which they can share their views on various healthcare service deliveries. Bonnel and Smith (1) note that it is always advisable for nurses to physically interact with their colleagues as this enables them to develop more skills and approaches on how to handle various patients. NURS 3110 – Information Management and Patient Care Technology Essay

Bonnel and Smith (2) also argue that technology has affected the social ethical standards of most of the nurses. They note that just like doctors, nurses have continuously used the social internet sites in engaging in social relationships. Bonnel and Smith argue that unlike the doctors, who at many times develop internet blogs to reach to their patients, nurses normally concentrate on the social perspective due to their lower medical level. They observe that in the processes of sharing their views in the social sites, some nurses have at times speculated on an issue that portrays them negatively. In such cases, nurses usually experience working opposition from either their colleagues or their respective patients that adversely affect their healthcare service delivery. NURS 3110 – Information Management and Patient Care Technology Essay

On the other hand, the evolution of technology has not fully addressed the healthcare service delivery of many nurses. Runny (1) notes that nurses still find it difficult to handle the older-age patients. This is because these patience’s’ healthcare demand for higher academic expertise of which is lacking among most nurses. She points out that these patients normally develop complexities because of their ages and therefore require delicate medical healthcare services from higher medical expertise. NURS 3110 – Information Management and Patient Care Technology Essay

Doctors and Technology

According to Neil (102), technology has changed the general objective and perception of the public on doctors. He notes that unlike the past, where doctors were seen as noble, caring and compassionate members in the society, today’s technology has changed such qualities with a great decrease in the general outstanding performance of doctors in the society. Lim (2) points out that even though advancement in technology has enabled doctors to specialize in their medical practices, they have in turn become bias towards offering their treatment services. He notes that many doctors have taken advantage of the expensive nature of the advanced technology to hike the cost of their treatment services. NURS 3110 – Information Management and Patient Care Technology Essay

As pointed out by Neil (92), doctors have actively used technology as an instrument that helps them in designing appropriate experiments for their medical research works. Lim (3) agrees with Neil noting that today’s advanced technology has enabled doctors to engage in sophisticated experiments that has resulted into more powerful drugs. However, Baynes (1) noting that the doctors have also not escaped the negative effects of technology, observes that a number of them have also been charged and jailed for poisoning their patients with powerful drugs. NURS 3110 – Information Management and Patient Care Technology Essay

According to Runny (1), technology has also negatively affected the relationship between doctors and patients as doctors are finding it difficult to maintain professional relationships with their patients. This is especially so in cases where patients have varying opinion towards doctors in regards to their personality as posted on the internet. Runny (1) notes that in certain cases, this has made it difficult for the doctor to offer nursing services to the patients as their services are questionable. NURS 3110 – Information Management and Patient Care Technology Essay

In, conclusion, it is, thus, clear that technology has impacted both negatively on the nurses, doctors, and even the patients. However, the contributions of technology in the field of nursing cannot be ignored. Technology has improved such areas like maintenance of clear patient databases and sharing information between the nurses and other medical practitioners. However, caution should be taken when using the technologies, especially in the social sites so that the medical practitioners are not affected negatively. Furthermore, for the medical practitioners to continue taking advantage of the ever-advancing technology there is need for them to be continuously trained on the same. NURS 3110 – Information Management and Patient Care Technology Essay

In both the United Stated and globally, patient safety and quality of care have been among the biggest concerns in healthcare. Several factors are associated with negative patient outcomes: heavy workloads and high job dissatisfaction. Unsatisfactory work environments result in nurse exhaustion and poor work quality, thus, putting patient care and safety at risk. To reduce these adverse effects on patient outcomes, reductions in nurse workload became obligatory in California when legislators approved Bill No. 394 (Tevington, 2011). The objective of this law is to increase nurse retention and reduce overworking by increasing nursing personnel. Unfortunately, this increase in nurse staffing will undoubtedly increase labor cost for hospitals and may in turn lead to a greater shortage of nurses due to a lack of resources. Research has yet to determine whether this type of regulation has any positive impact on patient safety and outcomes. NURS 3110 – Information Management and Patient Care Technology Essay

In an attempt to address patient safety and quality care, California passed a law regulating nurse to patient ratios but studies have yet to find evidence that the mandate improves patient safety and care. Studies did not find a significant positive relationship between lower nurse staffing levels and better patient outcomes, such as a lower Failure to Rescue (FTR) rate. In a study conducted by Cook, et al. (2012) patient care did not improve after implementation of the law. Studies analyzed nurse to patient ratios by comparing statistics before and after the implementation of the California law. Hospitals with reduced nurse to patient ratios as per the mandate did not exhibit any substantial change in patient outcomes. Likewise a study by Bolton et al, (2007) found an increase in direct patient care by RN, but no improvement in patient safety indicators such as fall rate, FTR, or reduced hospital acquired ulcers, was reported.

In response to California law, Pennsylvania also tried to reduce nurse to patient ratios. A study by Aiken et al. (2002) identified a significant relationship between mortality, failure-to-rescue and nurse staffing. The increase of one extra patient per nurse assignment was linked to a 7% increase in mortality rates, and an increase in FTR. The increases of patients from 4 to 6 and 4 to 8 per nurse would increase mortality rates of 14% and 31%. A study by Weichenthal and Hendey (2011) found that the percentage of patients left without being seen by a provider improved 0.7% after nurse to patient ratios were reduced. However, others indicators such as medication errors and administering aspirin in acute MI patient remained unchanged. Data from a study by Duffield et al. (2011) also noted that a higher number of nurses are linked with lower patient adverse outcomes such as decreased rate of pressure ulcer, pneumonia, and sepsis. NURS 3110 – Information Management and Patient Care Technology Essay

In relation to nurse workload with patient outcomes, the studies conducted by Aiken et al. (2002), and Rafferty et al. (2007) found a strong relationship between decreasing nurse workload, balancing work environment and improvement in patient mortality rate. In a study of a Belgian acute care hospital by Myny et al. (2011) identified 26 factors that impact nurse workload. Among those factors work interruptions and high patient turnover rate were the highest factors associated with nurse workload. Another study designed to address the nurse workload and improve patient outcomes by Twigg et al. (2011) discovered patient outcomes improved after implementation of the NHPPD staffing method which served to reduce nurse workloads. In study overall, mortality rates decreased by 25—26% and post-surgical complications were reduced. A study by Cho and Yun (2009) concerning acute stroke patients admitted to ICUs throughout the Korean healthcare system found that the hospitals with high nurse to patient ratio had high mortality rate among stroke patients than units with better staffing. In unit with better staffing, nurses were able to provide basic care to their patient and did not use help from family member. On the other hand a study by Van den Heede et al. (2009) did not find any major correlation between the acuity-adjusted NHPPD, patient outcomes, and RNs with bachelor degrees. Although on patient adverse event the FTR was 6.16% the highest rate noted. Thus evidence of the effect of nurse staffing levels on patient outcomes are inconsistent. An article by Lyneham, Cloughessy, & Martin (2008) found the increased workload related to inadequate staffing in an emergency department of Australia impacted patient safety. NURS 3110 – Information Management and Patient Care Technology Essay

Overall, the literature indicated a strong relationship between nurses staffing levels patient sensitive outcomes. Most studies found high nurse workload impaired patient safety, and increased burnout, and decreased job performance. But whether or not a legal mandate can improve patient outcomes, improve staffing, reduce workload remains unknown. NURS 3110 – Information Management and Patient Care Technology Essay

Identification of Knowledge Gap
After reviewing studies conducted in the U.S. and internationally, it is clear that studies have not produced an answer to staffing problems, nor identified a strong direct relationship between reduced nurse-to-patient ratios and patient outcomes. “Not only do the data fail to conclude that minimum standards would be beneficial, they fail to conclude that such standards would not be detrimental.” (Spetz et al., 2000, p. 57). Still, there are 17 other states considering similar legislation, despite a lack of evidence of successful nurse-to-patient regulation (Tevington, 2011). Closing the gap between nursing shortages, rising costs, and improving quality care have yet to be addressed in context with nursing environments and time management skills. Thus, it is necessary to continue to investigate the effectiveness (or lack thereof) of California’s nurse-to-patient law before other states enact this type of policy. In conclusion, it is imperative that research based evidence be produced to see if mandated nurse staffing ratios do actually improve patient safety and whether or not money may actually be saved. NURS 3110 – Information Management and Patient Care Technology Essay

Proposed Solution
It is important to further investigate the mandated nurse to patient laws before being adopted by other states. These future studies should allow California and other states considering nurse-to-patient ratios to quantify the impact that mandated laws actually have on patient safety. All twelve articles investigate pros and cons of mandatory nurse-to-patient ratios and discussed several factors associated with patient outcomes. The California law was enacted on January 1, 2004, almost eight years ago. Since then, healthcare has experienced several changes such as like increased cost, increased nursing shortage, and increased labor cost. These adverse effects, combined with the California mandate may potentially cause hospital closures. Therefore a study of California should be conducted determine whether the mandate has had a positive or negative impact on healthcare within the last eight years. This information may be used by the State of California to determine if the current law should be sustained or divested. This would allow California and other states considering nurse patient ratio mandates to recognize the impact the ratio has on patient safety, hospital closures, and increased cost. It will also provide other states with the knowledge to make the most effective and beneficial decision regarding nurse-to-patient mandated laws. NURS 3110 – Information Management and Patient Care Technology Essay