Question:
Discuss about the Use Of The Nursing Informatics.
Patient centered care is an important aspect of nursing and high quality care. The use of the nursing informatics and the online social media helps to facilitate the person centered care. The key features of the both the systems are discussed in the essay. Further, the quality of both the systems in nursing practice to deliver the person centered care is evaluated. The evaluation is based on elements of dissemination of information, efficiency, ethical issues, potential related to the management of patients, confidentiality and privacy. The opportunities of these system in promoting innovation in nursing or establishing the therapeutic relationship with patients is discussed. The analysis also includes the relevant policies at the regulatory level and the service level.
Patients should get right care at right time. This is possible if they receive the right information, by right providers. Information technology is useful to give right information to the patients and it is the heart of the patient centred care. Person centered care is the type of care given to the patients that adds value and meaning. Person centered care is the nursing principle of treating each patient equally, individually, by establishing therapeutic relationship with them. Therapeutic relationship between the caregiver and the user is based on mutual trust and understanding (Entwistle & Watt 2013, p. 30).
Respecting the client’s cultural values, needs, and preferences is the first principle of the patient centered care. It helps in decision-making as the client feels that his/her dignity, autonomy and respect are maintained. The second principle of the person-centered care is the care coordination and integration. The feelings of vulnerability and powerlessness can be eliminated by coordination of clinical care, frontline patient care, and the ancillary support. The third principle is the promotion of health by providing the right information and education to the patients. The fourth principle is the provision of emotional support and enhancing the physical comfort to decrease anxiety and fear in patients. The fifth principle is family involvement for shared decision-making and the last principle is to help the patient’s self-caring capability after discharge. It also includes supporting the patients to have continuous, social, financial, physical, and clinical support (Eaton Roberts & Turner 2015).
Health care information, with the use of technology can be acquired and stored. It is called informatics. Nurses use informatics to provide information to the clinicians. The clinicians can use this data and integrate the information to deliver patient centered care (Snyder et al. 2011).
Nurses use electrical health record system or EHR to manage complicated health data of the patient. ePAS which stands for “electronic Patient Administration System” is the foundational module of the EHR and it provides free and open source software. Informatics allows to have the participatory care record that improves the patient centred care (Snyder et al. 2011). In this paper the main focus will be on EPAS
In South Australia, the EPAS patient record system is widely used. It is the new electronic health record system that allows to have all the patients health record in one place. The health care providers use the patient’s data recorded electronically. It is no more exist in hard copy format. This electronic record comprises of both clinical details (diagnosis, treatment plan, list of medications, scans and others) and the administrative details (name, address, date of birth, appointment lists etc). With this system, the clinical staff will have all the information at fingertips. They can review these records anytime and decide about the required tests and medications electronically at the bedside of the patient. It indicates the effective care, with more face-to-face time with the patient (Sahealth.sa.gov.au 2017). The various advantages of EPAS is discussed in the subsequent sections.
The advantage of EPAS is the sharing of the clinical information to the multiple providers. It assists the nurses to collaborate with the multidisciplinary team members at a time as more than one member can access the information in a given time. This process aids in quick decision-making, as there is no delay in the data retrieval and transfer between patient and the health providers. Thus, this tool acts as a bridge between the patients and the nurses and eliminates the communication gap. However, without the use of appropriate technologies, it is difficult to make use of the potential of EPAS (Hanna 2017, p. 495). This novel approach provides dynamic display system. It prevents the hassle related to patient’s information being buried in hundreds of pages. Instead, at the point of care, it meticulously displays the vast history of the patient, along with the patterns of responses, and other essential aspects of their lives. The medical records in the static history are lost and moving these records from here allows to personalise the care. It is also advantageous to use when the patient’s speech is impaired (Sewell & Thede 2013).
Several researchers studied the effectiveness of delivering the person centered care in the nursing by the use of informatics. As per the assessment report by McGonigle, the patient safety is increasing and improving by the use of nursing informatics, particularly the EHR and EPAS system. Nursing informatics helps in collecting evidence related to patient’s health issue and design appropriate intervention. Patient can complain on allergies due to medication or any complication in EPAS system. Thus, it is leading to evidence based practice. It can be concluded that the nursing informatics is significantly influencing the clinical practice. It is advantageous as it decreases the time invested by the nurses in the indirect care. These reports showed an improvement in the nursing diagnosis and the identification of the treatment symptoms. Further, an overall improvement was noticed in treating the psychosocial problems using EPAS. It pertains to quick data capture and its integration in the point of care. EPAS also improved the person-centered care in oncology nursing care (McGonigle 2014, p. 324).
The major challenges with EPAS involve compromising the security of the patient’s health information. As per the evaluation of the nursing informatics particularly the EPAS system by Demiris & Kneale (2015, p. 15), there are several drawbacks to the system. Patients are worried to lose their privacy and confidentiality of information. Breach of privacy may involve several ethico-legal consequences. Other factors that are undermining the potential of the nursing informatics are lack of feasibility, social inequality and health literacy of patients. Nurses are also facing challenges due to vast array of information from which they have to find the high quality information for application at point of care. In some cases, the nurses were found to fail to integrate the clinical data of the patients. It was due to the lack of computer skills and sufficient knowledge on the information technology. Further, in EPAS system there is lack of appropriate list of drugs used in South Australia, as it is American based software. It prevented them to promote or access health websites. The nurses failed to consider the integrity of the patient’s data, accessibility and accountability for errors. On the other hand, the use of technology has also improved the nursing productivity as it created, positive attitude and reduced medication errors (Snyder et al. 2011, p. 211).
It is recommended by the AMIA to initiate the training and education programs for nurses on use of informatics (AMIA 2013). The nurses should learn to use innovative and analytic techniques for scientific inquiry and the way to interpret the information flow. Nurses should comply with the “National informatics standards for nurses and midwives”. The Australian Nursing and Midwifery Federation” (ANMF) developed these standards. These standards emphasise on the information literacy, management and computer skills for all nurses and midwifes (Eaton et al. 2015).
Social media adds new dimensions to nursing practices by acting as a tool for networked care. This online social media comes in various forms say websites, Facebook, Twitter, online blogs. With the advent of smartphones, it is easy to connect with people from distant places just in one click. This platform helps the nurses to give update to the clinicians, physicians, medical students and other nurses about the patient’s health status. In this system, both the patients and the providers use the digital social networks (Hao & Gao 2017, p. 2). The advantage of this online social media platform in nursing practice is to reach out to the patients living in remote areas. Writing the health promotional blogs can better help the patients to engage in health behaviours. It is useful to motivate the patients through blogs to undertake the behavioural change. Websites like WebMed and Mayoclinic discuss the pathophysiology of disease in a lucid language avoiding too many jargons. Similarly, Twitter is other tool for nurses and is the easiest way to connect with people during crisis, health safety alert or drug recall information (Bornkessel, Furberg & Lefebvre, 2014, p. 504).
In this section, the focus will be on the use of the Facebook pages, by nurses to promote patient centered health.
Facebook pages such “HER 2 positive Breast cancer patient/family survivors group”, “I have Cancer leukemia”, helps patients to share their health status and access relevant treatment or care support. These groups on specific illness create awareness (Hao & Gao 2017).
The use of Facebook pages such as “I have Cancer leukemia” have several advantages. Nurses can directly connect with patients to access their medical information and communicate with the family members as well. This tool not only aids in socialising for the nurses but also personalise the care (Moorhead et al. 2013). This Facebook page helps the nurses to have a debate on particular health issues to gain broad perspective with engagement of large number of people at a time. It is useful to promote the primary health care and exchange ideas on treatment options for people from diverse communities keeping in mind their health perspectives. It is useful to create alert on specific diet plan for particular cancer or inform about precautions to be taken or alert on disease outbreak. Nurse can answer emergency questions of patients. The delivery of the health care is enhanced by use of Facebook. As everyone, these days use Smartphone and Facebook awareness can be created rapidly (Shepherd et al. 2015, p. 29).
The ability of the Facebook pages and the other social media platforms to deliver the person centered care was assessed. Grajales (2014, p. 20) received feedback from patients who shared their health information over the Facebook. The data collected from the unstructured interview showed that Facebook pages on cancer awareness pages improved the health outcomes of the patients. It facilitated the active involvement of the patients due to facility to upload videos, post images, leave private or public messages. Social network improves two-way communication between nurses and the patients. Thus, nurses can better empathise with patients. It has proved to be advantageous for the cardiac patients. Cashin (2014, p. 550) argued that there is lack of strong supporting evidence that there are no ethical issues involved in use of social media by nurses. The challenges related to privacy and confidentiality of information remains. The ability of Facebook users to create fictitious profile can lead to skewing of data. Third party applications is the other drawback as they interfere with the other facebook users, having high chance to leak essential medical information (Casella, Mills & Usher, 2014, pp. 122).
Further, the nurses fail to understand the synergy between the evidence based practice and social media. There are incidents of self-aggregated negative-behaviour promoted by online social media (Cashin 2014, p. 550). For example, the cancer patients group in Facebook fail to serve as a model for patient-to-patient support. Sometimes the only purpose is to raise funds and create awareness. There is also a high risk for the nurse professionals to cross the professionals boundaries. This may include engagement with the client in intimate relationships or for monetary benefits and others include business transactions. Such private conversations cannot be evaluated, unless the patients expose the content. The “Nursing and Midwifery Board of Australia” (NMBA) has formulated the social media policy to which the nurses must adhere strictly (Nursing & Federation 2015).
Conclusion
In conclusion, the information is the basis of all the managerial activities in the industry of nursing care. The ultimate product of the nursing care is the patient satisfaction. There are multiple benefits of the use of nursing informatics and the online social media used for delivering high quality care. It gives opportunity to the nurses to better collect the evidence. Consequently, it promotes the person centered care. The major benefit of both the system altogether include quick access of patient’s records, delivery of care on time, smooth sharing of information to the stakeholders and fast decision-making. However, the disadvantages to the both system includes privacy and confidently issues related to low data security. Overall, both the system are effective in promoting the person centred care. In order to avoid challenges pertaining to informatics and social media, the ANMF and NMBA policies should be used by the nurse.
References
AMIA, 2013, ‘Patient-centered care, collaboration, communication and coordination’, Retrieved from: https://www.amia.org/sites/amia.org/files/2013-AMIA-Policy-Meeting-Briefing-Document.pdf.
Bornkessel, A, Furberg, R & Lefebvre, RC, 2014. ‘Social media: opportunities for quality improvement and lessons for providers—a networked model for patient-centered care through digital engagement’, Current cardiology reports, vol. 16, no. 7, pp.504.
Casella, E, Mills, J, & Usher, K, 2014, ‘Social media and nursing practice: changing the balance between the social and technical aspects of work’, Collegian, vol. 21, no. 2, pp.121-126.
Cashin, A, 2014, ‘Collaborative arrangements for Australian nurse practitioners: a policy analysis’. Journal of the American Association of Nurse Practitioners, vol. 26, no. 10, pp.550-554.
Demiris, G & Kneale, L, 2015, ‘Informatics systems and tools to facilitate patient-centered care coordination’, Yearbook of medical informatics, vol.10, no.1, pp. 15.
Eaton, S, Roberts, S & Turner, B, 2015, ‘Delivering person centred care in long term conditions’, Bmj, 350, p.h. 181.
Entwistle, VA & Watt, IS, 2013, ‘Treating patients as persons: a capabilities approach to support delivery of person-centered care’, The American Journal of Bioethics, vol. 13, no. 8, pp. 29-39.
Grajales III, FJ, Sheps, S, Ho, K, Novak-Lauscher, H & Eysenbach, G, 2014. ‘Social media: a review and tutorial of applications in medicine and health care’. Journal of medical Internet research, vol. 16, no. 2.
Hanna, MG, & Pantanowitz, L, 2017, ‘The role of informatics in patient?centered care and personalized medicine’. Cancer Cytopathology, vol. 125, no. 6, pp. 494-501.
Hao, J, & Gao, B, 2017, ‘Advantages and Disadvantages for Nurses of Using Social Media’, pp. 2.
Masters, K, 2015, ‘Role development in professional nursing practice’, Jones & Bartlett Publishers.
McGonigle, D, Hunter, K, Sipes, C, & Hebda, T, 2014, ‘Why nurses need to understand nursing informatics’, Association of Operating Room Nurses. AORN Journal, vol.100, no.3, pp. 324.
Moorhead, SA., Hazlett, DE, Harrison, L, Carroll, J.K., Irwin, A & Hoving, C, 2013, ‘A new dimension of health care: systematic review of the uses, benefits, and limitations of social media for health communication’ Journal of medical Internet research, vol.15, no. 4.
Nursing, A, & Federation, M, 2015, ‘National informatics standards for nurses and midwives’, Australian Nursing and Midwifery Federation, Federal Office.
Sahealth.sa.gov.au (2017). ‘SA Health’s electronic health record’ :: SA Health. [online] Sahealth.sa.gov.au. Available at: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+reform/ehealth/sa+healths+electronic+health+record [Accessed 13 Sep. 2017].
Sewell, JP, & Thede, LQ, 2013, ‘Informatics and nursing’, Wolters Kluwer Health/Lippincott Williams & Wilkins.
Shepherd, A, Sanders, C, Doyle, M. & Shaw, J, 2015, ‘Using social media for support and feedback by mental health service users: thematic analysis of a twitter conversation’, BMC psychiatry, vol. 15, no. 1, pp. 29.
Snyder, C.F, Wu, A.W, Miller, RS, Jensen, RE, Bantug, ET, & Wolff, AC, 2011, ‘The role of informatics in promoting patient-centered care’. Cancer journal (Sudbury, Mass.), vol. 17, no. 4, pp. 211.
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