Nursing and Technology

The rapid increase growth in technological advancement has made some changes to our nursing practice. I believe that the increasing trend in the use of technology is going to have a radical impact on health care delivery and the education of nurses. Through the use of the internet patients and families are increasingly equipped with knowledge that at one point only health professionals knew. These days, nurses have taken a variety of roles and are also involved in activities that range from design and implementation of clinical information systems to research and the use of technology to improve client outcomes (Kelly & Crawford, 2008).

In this essay I am going to discuss the increase trend of technology in the healthcare system and the impact to nursing practice and delivery of care. Kelly & Crawford (2008) write, “The explosion in information – some estimate that all information is replaced every 9-12 months – requires nurses to be on the cutting edge of knowledge to practice ethically and safely.” (pg 82) The authors also mention that nursing information helps “promote the generation, management and processing of relevant data in order to use information and develop knowledge that supports nursing in all practice domains.”

The National Nursing Informatics defines nursing informatics as “the application of computer science and information science to nursing”. I think in this age of technology not every nurse will need to be an informative specialist but every nurse must be computer literate and be able to navigate their way around different trained programs. Already, distance learning has facilitated students and instructors from different locations to communicate in the name of enhancing and continuing professional learning.

A variety of factors have been noted in the explosion of information technology, these include advances in processing capacity and speed, the development of interactive user interfaces, developments in image storage and transfer technology (Kelly & Crawford, 2008). The authors write, “The ongoing development of computer technology – smaller, faster machines with extensive storage capabilities…is making the goal of an integrated electronic system a realistic option…”(pg 81). Changes in telecommunication technology and the ever increased affordability of computer gadgets have also made this explosion possible. Berner, Detner and Simburg (2005) write, “an influence of forces including improved technology, government support and physician and patient receptivity to the benefits of information…lead to increased use of health information technology.”

In the 1960’s, the first computers were placed in hospitals, mostly for financially based reasons to capture orders, charges and patient billing. This rapidly changed and expanded to being used in nursing units. Nursing informatics (2011) write, “By late 1980 most hospitals had at least a rudimentary information system that required nurses to enter common data such as admission profiles…” Today, technology in nursing has evolved to be an integral part of our day to day health care delivery practice. I believe technologies emerging in the areas of telecommunications; video and digital imaging and micro processing are changing and shaping the future of nursing practice.

Nurses need to be able to embrace these changes; they should be aware and also have a desire to be literate to the computer world. I think all nursing curriculums should include an informatics course as a base of understanding to the uses of computers in the practice. Carty & Rosenfeld (1998) indicated that “IT topics and skills training need to be included into the current nursing education curriculum.”

The training is also needed to be available for the nurses already in the field. Nurses already in the work force have to be encouraged to adapt and embrace technology changes. McIntyre and McDonald (2010) agree with this notion, they highlight,” Similarly, nurses currently working within the healthcare system in Canada will require adequate supports and education” (p.241). Alpay & Russell (2002) acknowledge that the use of information technology by nurses was a function of a unit or a department culture. The authors also indicated that the use of information technology was highly dependent on coworkers’ attitudes and understanding. I believe this is why it is important to include knowledge of information technology in nursing courses to ready graduates of the need and importance for nurses to be able to integrate nursing informatics competencies into their practices.

Nursing informatics can be applied in different areas of practice that include: Education, Research Administration and Clinical Practices (Kelly & Crawford, 2008). The integrations of new technologies will affect nursing practice and processes of patient care. Since the time of Florence Nightingale nurses have provided bedside, direct care to patients. The interpersonal; contact between nurses and patients, with the new implementation of technology might be something of the past.

Advances in information technology have accelerated efforts to implement informatics deliveries such as the telehealth. Moore (2000) writes, “Telehealth is recognized as the delivery of clinical services, healthcare and/or health education at a distance using telecommunications or information technologies.” She also goes on to mention that the use and purpose of the telehealth is to increase access to health services to healthcare providers and patients as well as provide clinical and educational support.

She indicated the use of telehealth also provided a cost saving practice and removed the distance barriers for patients in remote areas.

In the everyday clinical practice, nurses work hand in hand with patients and families to co-ordinate multiple services that impact the patient care. The explosion of nursing informatics has assisted the movement of evidence-based practices. McIntyre and McDonald (2010) write,” At the point of patient care, nurses can use technology to improve the quality of patient and client care and generate data about nursing outcomes” (p.240). The need of nurses and the health professionals to have the required information for decision making at the point of care has increased. DeCenso & Callum (1998) indicated that “evidence-based clinical practice involves integrating the best available evidence with clinical judgement, client values and consideration of available resources.”

A well-designed clinical application can serve as the integrator that supports and facilitates clinical judgement with proven outcomes and up to date evidence-based practice. Kelly & Crawford (2008) also highlighted the importance of having current information at all times, they write, “Nurses are knowledgeable workers who require accurate and up-to-date information for their professional work.” When evidence-based practice is used appropriately, it will allow computerized nursing documentation to nurses so that they can track client care and focusing on improving outcomes. This in the long run only will result in improved patient safety and improved measurable outcome from evidence-based care.

Nurses should be at the fore-front of shaping the technology and applications they use on a day by day basis. Nurses have information and work process needs that are different from those of other health care providers because of their unique role.

As the largest group of healthcare providers, I believe the field of nurses specialized in informatics are important and should be encouraged to all nurses. Having more nurses specialized in informatics will ensure that nursing is represented in decisions that impact clinical system and different practice settings. McIntyre and McDonald (2010) write, “To date, nurses have rarely been at the table in regard to developing much of the biomedical technology that affects their practice” (p.241)

Technology is changing the way health care is delivered, whether in clinics, hospitals or the patient’s home. With the increased use of clinical information systems (CIS), nurses are able to deliver client centered care, and organizations are moving toward the use of Electronic Health Records. “Electronic health record systems can improve communication and co-ordination of clinical care, resulting in better care outcomes” (Madison & Staggers, 2011). I believe the goal of nursing is to have these technologies improve and maintain nursing care for patients and families. Madison & Staggers (2011) noted that the ultimate goal of EHR was to be able to communicate through a national health information network.

Having such a system better serves patients, as the system can record and keep health data across a person’s lifetime that could be accessed across the nation. This will improve quality, safety and efficiency and also reduce health disparities (Madison & Staggers, 2011).

EHR have the potential to enhance nurse’s decision-making regarding the delivery of care by having an up to scale access of the patient records. I think emphasis is needed for all nurses and health professionals to be more aware and knowledgeable about the technology that is designed to manage an information process. Regarding nursing education programs, McIntyre and McDonald indicate that, “have yet to conquer the larger issues surrounding the necessary knowledge, skills, and practice competencies required for nurses to function in the future.”

As the use of technology in health increases there are some issues that will tend to rise. Issues of privacy, confidentiality, security, misuse of the applications and ethical and legal will also be on the rise. The use of computers was made easy for a wide range and an impressive amount of health information to be organized and managed. An important requirement system is the protection and security of data. Kelly & Crawford (2008) write, “Security systems must ensure that access to data is provided to those who are authorized and have a legitimate purpose…”

Because information can be accessed and connected nation-wide or even world-wide, they become vulnerable to hackers. Desktops and laptops can be stolen, placing personal information at risk for identity theft. I think nurses must be well informed about protection of information and be taught about positive methods that ensure protection in data. Kelly & Crawford (2008) suggest that the designs of security functions be compliant with legislation regulations and standards.

Three important concepts concerning information security in health care environment include privacy, confidentiality and consent (Kelly & Crawford, 2008). Privacy refers to “the rights of individuals to keep information about themselves from being disclosed to anyone” (Kelly & Crawford, pg 80). To ensure privacy, access to servers should require that users provide their name, email address and registration number.

Confidentiality is the secure status and degree of privacy agreed between the individual and the organization receiving it (Kelly & McKenzie, 2002). To also ensure protection of confidentiality, nurses must also be cautious about data access. Security arrangements for data storage and transmission of personal information should be established with passwords. Nurses should not be allowed to access information from their homes or even take work laptops home. Nurses should consider it an essential duty to take appropriate precautions to secure information collected on patients.

In regards to having all of the patients information easily accessible, there might be need to start to develop guidelines for the use of the information. How much of the patients information can nurses and health professionals can be allowed to review? I think patients should have some control on the information available that can be easily accessed. Uckert and Prokosch (2002), suggested that patients could grant one-time-read –only access, emergency only access, access of certain portions of the record for specific providers.

Concerns about the information explosion in regards to medical information have been acknowledged for some time. As more and more medical information can be accessed online, nurses should be aware of what is readable and what is not.

Although there are some materials that are excellent and health related, they vary in terms of accuracy, content and being up to date. Kelly & Crawford write, “The wide open nature of the internet means that just anyone with a computer and online access can create a home page and post it for the world to see.” I think nurses should critically analyze and evaluate some of the information they obtain on the internet if they are going to use it in practice.

Another aspect I believe of great concern in nursing informatics are clinical decision support systems (CDSS). CDSS’s are “active knowledge systems which use two or more items of patient data to generate case-specific advice” (Clinical Decision, 2011). They have been shown to improve patient safety and reduce the cost of care (Garg, Adhikari et al, 2005). Clinical decision support systems help and assist nurses and other health professionals by providing them with patient-specific assessments to and in decision making. These systems have the potential to improve healthcare quality; however, concerns have been raised about being improperly used. Hsieh, Kuperman, Jaggi et al noted that drug alerts were frequently being over-ridden and were set at a very high threshold so that nurses were only alerted to the most dangerous interactions.

In a journal by Berner, Maisiak, Heudebert & Young (2003) described that clinicians did not always follow clinical decision support systems correct advice, because of overconfidence and because some clinicians found it difficult to distinguish correct and incorrect advice. They write, “Clinical decision support systems (CDSS) can impact both diagnostic and therapeutic decision making, but physicians sometimes fail to heed the appropriate CDSS advice…” I believe that by doing this it means that the full benefits of the systems are not realized.

The authors also noted that, “…clinicians may fail to alter their original wrong decisions, or worse, may change correct decisions to incorrect ones after using CDSS.”

Schiffman, Brandt et al (1999), suggested that users tend to understand and accept guideline recommendations if rational are provided. Combining rational and explanations to the evidence-based suggestions could increase confidence in users. I believe that if CDSS are used appropriately according to the manufacturer’s guidelines without people choosing what they want to use, there would be further improvement in diagnostic decision making and decrease in medication errors.

As the trend of information technology continues to grow in the health care industry, it is important that nurses become more knowledgeable about the technology around them. Information technology will continue to evolve and advance as time goes by. Courses and classes of information technology should be established whilst students are still in colleges and universities. It is inevitable that the technology trend is moving fast, and as healthcare professionals, we have to be in a position to embrace changes and adopt. As a nurse, I believe we should take advantage of these technological changes to enhance patient outcomes. McIntyre and McDonald (2010) write, “Technology has the potential to improve the availability of basic and continuing nursing education for those for whom geography or other barriers have prevented access…..”(p.253).

However, as informatics systems increase, so does the potential for information security. Nurses play an integral role as first-time defenders of data security. So it is important that all precautions are taken to protect patient’s private information.

McIntyre and McDonald (2010) notes, “Applied informatics will require nurses to adhere to standards of practice, codes of ethics, provincial legislation, and competencies established by regulatory bodies”. The authors go on to mention that to ensure privacy and confidentiality are met developments in establishing protocols are needed.

In conclusion, the essay highlights the significant impact of technological advancements on nursing practice and healthcare delivery. The evolution of information technology, particularly in nursing informatics, has transformed various aspects of the profession, from education to patient care. Embracing technology is crucial for both current and future nurses, requiring a shift in education curricula and ongoing training. The integration of electronic health records, telehealth, and clinical decision support systems has the potential to enhance patient outcomes, improve communication, and streamline healthcare processes. However, it is essential to address challenges such as information security, privacy, and ethical considerations associated with technology use in healthcare. Overall, nurses play a vital role in shaping and adapting to the changing landscape of healthcare technology, ultimately contributing to improved quality, safety, and efficiency in patient care.

References

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