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To Prepare:

Reflect on the concepts of informatics and knowledge work as presented in the Resources.
Consider a hypothetical scenario based on your own healthcare practice or organization that would require or benefit from the access/collection and application of data. Your scenario may involve a patient, staff, or management problem or gap.


Post a description of the focus of your scenario. Describe the data that could be used and how the data might be collected and accessed. What knowledge might be derived from that data? NURS-6051N Module 1: Week 1: Discussion THE APPLICATION OF DATA TO PROBLEM-SOLVING How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?

In looking at the importance of access to data for nursing decision-making, and considering an issue at my place of employment where I do not always get access to important data, one common scenario instantly comes to mind.
I will actually be leaving my present company and starting a new job next Monday. But in discussing the company I work for now, while there is usually pretty good team communication, there are often times when I have not gotten the data I could use to serve my clients better.
McGonigle and Mastrian (2022) discuss how in healthcare, people operating in their own “silos” can disrupt necessary communication between departments and units. And they discuss how the use of information systems and IT can increase that communication. While these authors discuss things happening in different silos, as more of a thing of the past, this definitely occurs in my agency due to the way our leadership is structured NURS-6051N Module 1: Week 1: Discussion THE APPLICATION OF DATA TO PROBLEM-SOLVING.
My agency does in-home addiction treatment, and the basic team is two Recovery Advisers ( who are like peer support workers) with a team leader of a Care Coordinator (a Nurse or an LCSW).
We are a team, serving an individual client. However, there is also the effect of different silos because the recovery advisors have their own manager and their own processes. Another barrier to communication and access to data is that we also work from home and serve people in their own homes. So, while we may communicate by phone and zoom meetings about individual patients, there is not the same type of situational awareness of patient conditions that a nurse may have while being on the same unit with the patients. So, communication via our technology is key, however, it does not always happen when it should.
One important area where communication could be enhanced through the use of technology is when a client has a recurrence of use (our language for a relapse). When a client of ours has a recurrence of use it is not always instantly communicated to all team members. For example, if a client has a recurrence on a Saturday night, the Care Coordinator may not be instantly notified. By Monday that recurrence should be documented in both a note and a “relapse screening” in the EHR. However, unless the Care Coordinator takes the time to read through every new note on Monday morning (a good idea, but not always possible if an emergent situation pops up first thing Monday) the recurrence may be missed. Any relapse/recurrence is important data for the Care Coordinator to know, especially because there may be serious medical implications. And yet that data is not always transmitted to the Care Coordinator in any sort of timely fashion.
So, the problem is the lack of communication in a timely manner. Nagle et al,. (2017) discuss how Information systems can be used to transmit data to team members and keep communication between teams open, and expedient.  And Sweeney (2017) also discusses the importance of utilizing Healthcare Information Systems to better communicate.
The hypothetical improvement or benefit I am suggesting would be to use technology to more instantly inform the care coordinator about a recurrence so they could decide on appropriate action, rather than hearing about it a few days after the fact as often happens.  One way this could happen is for the EHR to automatically send out notifications to the rest of the team when a relapse screening is completed. Luxton et al (2011) discuss the use of smartphones and the many benefits as far as self-assessment, and educational opportunities these devices have. And obviously, the most glaring benefit of having a smartphone is communication NURS-6051N Module 1: Week 1: Discussion THE APPLICATION OF DATA TO PROBLEM-SOLVING. My suggestion would be to have an alert to the Care Coordinator’s phone automatically generated and sent as soon as the relapse screening is completed.
Due to the nature of working from home, while also serving people in their homes,  the central location of data about the patient is the EHR. This is really true with any agency/facility, but with our agency, it is very important to consider as the team often communicates by updating the patient chart. Realistically people can not just keep reading through charts to keep up to date. So, an alert that is generated by the EHR to give important data to the nurse would really be a good way to use technology to deliver important data to where it is needed.
Luxton, D. D., McCann, R. A., Bush, N. E., Mishkind, M. C., & Reger, G. M. (2011). mHealth for
Mental Health: Integrating Smartphone Technology in Behavioral Healthcare. Professional
     Psychology: Research and Practice, 42(6), 505–512. https://doi.org/10.1037/a0024485Links to an external site.
McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of 
     knowledge (5th ed.). Jones & Bartlett Learning.
Nagle, L., Sermeus, W., & Junger, A. (2017).  Evolving Role of the Nursing Informatics
Specialist. In J. Murphy, W. Goosen, &  P. Weber  (Eds.), Forecasting Competencies for
     Nurses in the Future of Connected Health (212-221). Clifton, VA: IMIA and IOS Press.
Retrieved from https://serval.unil.ch/resource/serval:BIB_4A0FEA56B8CB.P001/REFLinks to an external site.
Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1) NURS-6051N Module 1: Week 1: Discussion THE APPLICATION OF DATA TO PROBLEM-SOLVING.


Respond to at least two of your colleagues* on two different days, asking questions to help clarify the scenario and application of data, or offering additional/alternative ideas for the application of nursing informatics principles.
Thank you for your detailed and informative post.  As I read your post, I instantly could visualize the concerns present both with your community-based agency and the one in which we work.  Our electronic health record system is user-friendly but needs to be more intuitive.  The agency would benefit from an intuitive approach of “if this, then that.”  I can also see where, within the noting system, the team members could either check a specific box or apply some flag that could immediately alert any tied team members to the case.  I have often thought something like this would also be helpful for our team.  McGonigle and Mastrian’s representation of silos is a thing of the past.  They have not found themselves engaged in the difficult work of community-based mental health and substance abuse services (2022).  Coordinating care is often just as difficult now as years prior.  They usually require a different action for each communication that needs to be made instead of direct alerts or push notifications.  As such, I would agree with your suggestions for improved communication through intelligent technology.
Communication is key to safe and effective patient care and the continued teamwork of the interdisciplinary team (Zajac et al., 2021).  In your scenario, it’s clear that you present a multidisciplinary team with a similar end goal but different frameworks of practice to get there.  Quick, clear, and consistent communication is instrumental to the team’s success.  Informatics should be able to provide the framework by which this process can occur.  As you present in Nagle et al., information systems can and should be used to keep communication between teams open and practical (2017).
Thank you for your discussion post.  It is a pleasure to be in a course with such talented nurses, and I look forward to the opportunity to continue to learn together NURS-6051N Module 1: Week 1: Discussion THE APPLICATION OF DATA TO PROBLEM-SOLVING.
Nagle, L., Sermeus, W., & Junger, A. (2017).  Evolving Role of the Nursing Informatics Specialist.  In J. Murphy, W. Goosen, & P. Weber (Eds.), Forecasting Competencies for Nurses in the Future of Connected Health (212-221).  Clifton, VA: IMIA and IOS Press.  Retrieved November 30, 2022, from https://serval.unil.ch/resource/serval:BIB_4A0FEA56B8CB.P001/REFLinks to an external site.
McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.).  Jones & Bartlett Learning NURS-6051N Module 1: Week 1: Discussion THE APPLICATION OF DATA TO PROBLEM-SOLVING.
Zajac, S., Woods, A., Tannenbaum, S., Salas, E., & Holladay, C. L. (2021). Overcoming challenges to teamwork in Healthcare: A Team Effectiveness Framework and evidence-based guidance.  Frontiers in Communication, 6.  Retrieved November 30, 2022, from  https://doi.org/10.3389/fcomm.2021.606445Links to an external site.  NURS-6051N Module 1: Week 1: Discussion THE APPLICATION OF DATA TO PROBLEM-SOLVING

Module 1 Main Discussion Post
The Application of Data to Problem Solving
Information science enables the processing of information, which links people and technology and can be of great benefit when driving change and promotion of improved patient outcomes (McGonigle & Mastrian, 2022).  Healthcare continues to change and evolve by utilizing electronic devices to provide data and information to enhance and improve patient care.  Data, according to McGonigle and Mastrian, are raw facts and information is data that has meaning (2018). It is vital to review meaningful data in order to drive positive change.
Inadequate Handwashing Compliance Data
As an infection prevention coordinator, surveillance of hand hygiene compliance is an important activity that should provide important data and information on areas of improvement and real time education to staff on ways to improve hand hygiene efforts and inform staff of missed opportunities.  However, for the last four or five years, the utilization of the direct observation method for hand hygiene surveillance in my organization has continued to yield inadequate and unusable data due to human error, bias, and minimal data collection.  The International Society for Infectious Disease states that direct observations for hand hygiene compliance has been the gold standard for decades, but can, in fact, have several limitations such as being a time consuming process that yields a small proportion of hand hygiene opportunities, often excludes nighttime and weekends, and can be limited by visibility or patient privacy issues (ISID, 2018) NURS-6051N Module 1: Week 1: Discussion THE APPLICATION OF DATA TO PROBLEM-SOLVING.  The gold standard, in healthcare today, may in fact be the old standard.  In fact, nearly three years ago, an electronic hand hygiene representative reached out to me to provide a demo of a new product that would provide electronic monitoring and data collection of hand hygiene compliance. However, it was not well received and perceived as an unnecessary expense.  Hospital acquired infections began to steadily increase in my facility and I desperately wanted to have accurate data to help drive decisions and decrease the chances of hospital acquired infections in an already fragile healthcare system.  A valuable and key element to implementation of an electronic hand hygiene monitoring system is its ability to assist the staff with reminders by beeping and changing colors with required hand hygiene opportunities. The incorporation of an electronic hand hygiene compliance system also would provide the organization with real data that could potentially help assist in drilling down on gaps in hand hygiene, cross contamination occurrences, missed hand hygiene opportunities and provide feedback on personal performance of the healthcare worker, provide data to support leadership in holding individuals accountable and overall identify areas of needed improvement.    An important and ongoing process is the struggle to integrate new knowledge with old knowledge to enhance wisdom (McGonigle & Mastrian, 2022).
Nursing Leadership and the Formation of Knowledge
Nurses are constantly making decisions and often life altering.  An important component to the integration of nursing informatics is to help make better decisions and promote improved health outcomes.  In fact, in an article written by Nibbelink, C.W. et. al., poor decision making has been linked to 98,000 deaths in hospitals each year with research indicating that critical care nurses make approximately 238 decisions an hour (Nibbelink, C.W. et.al. 2018).  Nurses are often the leaders in care for their patients and assisting them by providing electronic reminders of important and critical hand hygiene opportunities should be a vital element of support.  Nursing leaders can utilize the data from an electronic hand hygiene system to support their nursing staff while also providing opportunities for growth and improvement.  Our organization has been trialing an electronic hand hygiene system and have found that the nursing informatics and data derived yields great opportunity for growth, improvement and enhancement in patient care NURS-6051N Module 1: Week 1: Discussion THE APPLICATION OF DATA TO PROBLEM-SOLVING.
International Society for Infectious Disease. (2018). Guide to Infection Control in the Healthcare Setting: Hand Hygiene Monitoring.  https://isid.org/guide/infectionprevention/hand-hygiene-monitoring/#:~:text=Direct%20Observation&text=This%20is%20considered%20the%20gold,identify%20other%20infection%20control%20opportunitiesLinks to an external site..
McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of 
     knowledge (5th ed.). Jones & Bartlett Learning.
Nibbelink, C. W., Young, J.R., Carrington, J.M., & Brewer, B.B. (2018). Informatics Solutions for Application of Decision-Making Skills. Critical care nursing clinics of North America, 30(2), 237-246. https://doi.org/10.1016/j.cnc.2018.02.006Links to an external site.
Nursing informatics assimilates the subjects of nursing, information technology, and analytical sciences to enhance communication and understanding of concepts (Darvish et al, 2014). In nursing practice, the aim is to provide quality healthcare, and this is enhanced by availing the right information and improving the understanding of healthcare professionals. Some of the medical errors that occur in healthcare include wrongful or misdiagnosis, medication errors, and hospital-acquired infections. Most of these errors can be reduced through improved information flow, understanding, and access to relevant data that informs decision-making.
Medication errors mostly occur through under-dosing, overdosing, administration of the wrong medicine amongst others (Amy et al, 2019). Such errors could be costly to both the patients and the hospital. The patient could suffer adverse drug reactions, irreversible damages to major organs, or even death. The hospital, on the other hand, could be sued, the involved professionals could lose their licenses or suffer the associated consequences. Most of these medication errors can be prevented through access to the right information.
One way to reduce cases of medication errors such as over- or under-dosing and wrongful administration is through the use of computerized physician order entry (Srinivasamurthy et al, 2021) that also has a support system for decision making. The computerized order entry will provide critical information such as the dose, routes of administration, drug interaction, allergies, and contraindications amongst others. Such information will guide clinicians to make the right orders and this system allows easy documentation and retrieval of information.
Medication errors can be controlled by monitoring their occurrence and establishing measures to reduce them with regular monitors for success evaluations. To keep track of the medication errors, the hospital could establish an efficient reporting strategy (Schiff et al, 2015) that includes the stages at which the medication error occurred. These stages could be listed during prescription, transcription, administration, and or monitoring. The staging process could further be broken down to include the details such as wrongful administration, wrong dose, wrong route, and this could also include medication classes NURS-6051N Module 1: Week 1: Discussion THE APPLICATION OF DATA TO PROBLEM-SOLVING.
Technological equipment and machines that allow all the healthcare professionals who are treating the same patient to access the same information would benefit the process. Also, technological equipment could be used to improve the processes of monitoring to reduce errors that occur post-administration and during recovery (Alotaibi & Federico, 2017). Besides the technical and computerized systems, it is expected that nurses and caregivers in healthcare should realize that the social aspect of medicine contributes to better patient outcomes and put in the efforts towards providing the right support for their patients.
Amy Wu, Ambulatory Care Pharmacist, Permanente, K., & Virginia, S. (2019). Minimizing medication errors in pediatric patients. U.S. Pharmacist – The Leading Journal in Pharmacy. https://www.uspharmacist.com/article/minimizing-medication-errors-in-pediatric-patientsLinks to an external site.
Alotaibi, Y. K., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi medical journal, 38(12), 1173–1180. https://doi.org/10.15537/smj.2017.12.20631
Darvish, A., Bahramnezhad, F., Keyhanian, S., & Navidhamidi, M. (2014). The role of nursing informatics on promoting quality of health care and the need for appropriate education. Global journal of health science, 6(6), 11–18. https://doi.org/10.5539/gjhs.v6n6p11Links to an external site.
Schiff, G. D., Amato, M. G., Eguale, T., Boehne, J. J., Wright, A., Koppel, R., Rashidee, A. H., Elson, R. B., Whitney, D. L., Thach, T., Bates, D. W., & Seger, A. C. (2015). Computerised physician order entry-related medication errors: Analysis of reported errors and vulnerability testing of current systems. BMJ Quality & Safety, 24(4), 264-271. https://doi.org/10.1136/bmjqs-2014-003555Links to an external site.
Srinivasamurthy, S. K., Ashokkumar, R., Kodidela, S., Howard, S. C., Samer, C. F., & Chakradhara Rao, U. S. (2021). Impact of computerised physician order entry (CPOE) on the incidence of chemotherapy-related medication errors: A systematic review. European Journal of Clinical Pharmacology. https://doi.org/10.1007/s00228-021-03099-9Links to an external site. NURS-6051N Module 1: Week 1: Discussion THE APPLICATION OF DATA TO PROBLEM-SOLVING

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