Nursing Staffing Essay – The Application of Data to Problem-Solving Discussion

By Day 3 of Week 1
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? How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?

I work in a nursing home part-time. There is a nursing shortage currently possibly due to Covid 19, as some nurses I know are laid off and abusing the unemployment extra money. It could also be the facility that constantly had problems stemming from management. There is an average of 75 residents in the facility at any given time. The nursing home utilized trained medical assistants (TMA) on a medication cart during some shifts and two licensed nurses in the building at night, LPNs and 2-3 CNAs. There is an abundance of office people that only work from 9-5 and have all weekends off. When nurses in hospitals complain of nursing to staff ratio, they have nothing in nursing homes. I feel that after you have lived your entire life working, raising a family, and contributing to society—you deserve better than going to a nursing home. The residents may or may not get bathed regularly, the food is horrible and not nutritional, and many things fall through the cracks. One thing that would be beneficial is if management used the Management Information System outlined in the text to develop routine reports for decision making (McGonigle & Garver Mastrian, 2018). A periodic report used by management could schedule CNAs and nursing staff according to resident needs.

My other job is comprehensive home care. We are in the dark ages as we still use paper charting. I have tried to suggest using an electronic system so I would be able to bring a laptop to my client’s homes when assessing them. Sweeney reiterates, “Providers who do not typically use an EHR are now finding themselves in a learning curve while still maintaining their patient caseload and providing comprehensive care (para 4).” Our home care agency just changed the entire paperwork trail for the third time in three years, and electronic records would save time and money in the long run. The home care agency did incorporate electronic training in the field staff as home care is a rural entity. Some of my clients are veterans. The Veteran Administration uses telehealth and other components to keep their patients in communication with the providers, such as electronic scales and blood pressure monitors that send data directly to their provider. A few clients also have IPads to communicate face to face. In The Future of Home Health Care: Workshop Summary (Demiris, Kaushal, & Nilsen, 2015),

Nilsen noted that the workshop started from the assumption that technology could enhance health outside of hospitals and nursing homes by improving and sustaining health and increasing the quality of life; by allowing people to live at home longer; by reducing health care costs, especially the cost of unnecessary hospitalizations and rehospitalizations; and by reducing the strain on the health care workforce and family caregivers. Further, the participants looked for ways to use technology’s strengths to facilitate communication and data collection.

Since working home care after starting in a nursing home and assisted living, I strive to keep my clients healthier in their home, hoping they can enjoy living out their lives in the place they have worked hard to achieve.

References

Demiris, G., Kaushal, R., & Nilsen, W. J. (2015, August 4). The Future of Home Health Care: Workshop Summary. (N. A. Press, Producer) Retrieved 2021, from NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.: https://www.ncbi.nlm.nih.gov/books/NBK315926/?report=printable

McGonigle, D., & Garver Mastrian, K. (2018). Nursing Informatics and the Foundation of Knowledge (Fourth ed.). (J. &. Learning, Ed.) Retrieved 2021

Sweeney, J. (2017, Winter). Healthcare Informatics. Online Journal of Nursing Informatics, 21(1).

By Day 6 of Week 1
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.

response

Your post concerning the staffing issues and nursing homes hit home with me. As a teenager, I volunteered once a week on the weekends at a local nursing home. I would spend time with the residents, and they would typically want to sit and talk, or occasionally they would ask me to read to them. You could tell, though, that they just wanted to spend time with someone. It was heartbreaking to hear their life stories, to know that they have gone through and then see that no one visits them. Your statement that the residents deserve better than a life in a nursing home is true in many cases.

Nevertheless, the disappointing truth is that people need skilled facilities and nursing homes in many cases as they age. Data from the Nursing Home Abuse Center (2019) states that 1.4 million people live in nursing homes in the United States. According to the National Institute of Aging (2021), skilled living facilities are needed for services that include nursing care, 24-hour supervision, three meals a day, and assistance with everyday activities. Rehabilitation services, such as physical, occupational, and speech therapy, are also available.

Since data shows there is a significant need for skilled facilities to provide various services to the elderly, the least we can do is provide proper care. Proper care will not happen without adequate staffing. The evidence that proper staffing is crucial in health care is staggering. Data and research repeatedly demonstrate that staffing ratios affect every aspect of patient care, including length of stay and mortality rate. Even though I already responded to our classmate Joseph with this information, I will include the information for you again for reference. Halm et al. (2005) indicates a direct correlation between staffing ratios and patient mortality rates. Griffiths et al. (2018) directly correlate staffing ratios and patients’ length of stay.

For supervisors still not convinced that staffing at nursing homes is crucial, they should refer to the guidelines set forth by Medicare and Medicaid. The Reform of Requirements for Long-Term Care Facilities Act, which went into effect as of November 28, 2016, has precise wording for nursing home staff ratios (Centers for Medicare and Medicaid Services, 2021). This Act states that a nursing home “must have sufficient nursing staff with the appropriate competencies and skill sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable level of physical, mental, and psychosocial well-being of each resident, as determined by resident assessment and individual plans of care in considering the number, acuity, and diagnoses of the facility’s resident population in accordance with the facility assessment required at Section 483.70(e)” (Cornell Law, 2021).

Hopefully, one day we will see a time when nursing homes have the staff they need, and the patients obtain the care they deserve.

REFERENCES

Centers for Medicare and Medicaid Services. (2021, April 9). Nursing Homes | CMS. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Nursing-Homes

Cho, E., Park, J., Choi, M., Lee, H. S., & Kim, E. Y. (2017). Associations of Nurse Staffing and Education With the Length of Stay of Surgical Patients. Journal of Nursing Scholarship, 50(2), 210–218. https://doi.org/10.1111/jnu.12366

Cornell Law. (2021). 42 CFR § 483.35 – Nursing services. LII / Legal Information Institute. https://www.law.cornell.edu/cfr/text/42/483.35#:%7E:text=%C2%A7%20483.35%20Nursing%20services.,-The%20facility%20must&text=(3)%20The%20facility%20must%20ensure,in%20the%20plan%20of%20care.

Griffiths, P., Ball, J., Bloor, K., Böhning, D., Briggs, J., Dall’Ora, C., Iongh, A. D., Jones, J., Kovacs, C., Maruotti, A., Meredith, P., Prytherch, D., Saucedo, A. R., Redfern, O., Schmidt, P., Sinden, N., & Smith, G. (2018). Nurse staffing levels, missed vital signs and mortality in hospitals: retrospective longitudinal observational study. Health Services and Delivery Research, 6(38), 1–120. https://doi.org/10.3310/hsdr06380

Halm, M., Peterson, M., Kandels, M., Sabo, J., Blalock, M., Braden, R., Gryczman, A., Krisko-hagel, K., Larson, D., Lemay, D., Sisler, B., Strom, L., & Topham, D. (2005). Hospital Nurse Staffing and Patient Mortality, Emotional Exhaustion, and Job Dissatisfaction. Clinical Nurse Specialist, 19(5), 241–251. https://doi.org/10.1097/00002800-200509000-00007

National Institute of Aging. (2021). Residential Facilities, Assisted Living, and Nursing Homes. https://www.nia.nih.gov/health/residential-facilities-assisted-living-and-nursing-homes

Nursing Home Abuse Center. (2019, October 18). Facts and Statistics about U.S. Nursing Homes. https://www.nursinghomeabusecenter.org/informative/facts-statistics-nursing-homes/#:%7E:text=Across%20the%20U.S.%2C%20there%20are,are%2085%2D94%20years%20old.

The Application of Data to Problem-Solving
Nursing informatics combines nursing, computer, information, and cognitive sciences to identify and fill gaps in the healthcare system to provide a better patient experience (Sweeney, 2017).

I currently work as a utilization review nurse for a company that administers self-insured health plans. My position requires uninterrupted focus as I review inpatient hospital stays for medical necessity based on national standards and evidence-based practice and compare the criteria against the specific health plan to ensure coverage. The health plans I work with require facilities to use up-to-date practice applications to ensure the best patient outcomes. I come across practices that are not up to par with the latest evidence-based practice in which I cannot approve; it has been estimated that evidence-based findings take an average of 17 years to reach clinical practice (Nagel et al, 2017). Our team is made up of both clinical and non-clinical members, and workflows are in place to ensure patient-facing nurses are not interrupted unnecessarily. Clinical leaders are available to take on non-clinical team members’ questions. However, I have been receiving an abundance of internal calls that are not UR-related, in which the customer service representative acknowledges that I am not the appropriate person to outreach. However, no one else would answer their phone, so they tried me as a last resort. Unfortunately, when this happens, the customer service representative wastes their time and mine because I cannot answer their questions that are not UR specific. I have to recover my train of thought and figure out where I was in my review, which also be time-consuming. While I am happy to help in any way I can, the increased frequency at which this is occurring has become frustrating because I cannot help in this situation. Our Healthcare Informatics textbook explains the importance of establishing policies and coordinating communication is for effective patient care (Sweeney, 2017). This information further supports the importance of reviewing and establishing effective policies and processes for efficient communication and workflow.

Data to be used

Number of calls I receive in a day not meant for me, number of missed calls the appropriate staff member misses leading to call coming to me.

How data is collected and accessed

Data will be collected by monitoring the inbound calls I receive in a day and the clinical leader’s calls in a day through our phone system. The data will then be compared to assess for trends. Knowledge derived from the data: The knowledge derived from the data will allow the nurse to gain an understanding of the amount of unnecessary interruptions and time wasted per day and can be used to determine a course of action to resolve this issue as explained by McGonigle and Mastrian (McGonigle & Mastrian, 2018).

Use of Information

The nurse leader can use this information to use clinical reasoning and judgment in the formation of knowledge to determine what events prohibit the appropriate staff member from being available to take these calls. The knowledge gained will also provide insight as to what takes place that encourages the customer service representative to outreach me as the UR nurse for non-UR questions. Once this knowledge is gained, management can determine what education needs to be provided and to whom, at what level to ensure the appropriate process is being followed.

References

McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundation of knowledge. 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/REF

Sweeney, J. (2017). Healthcare Informatics. Online Journal of Nursing Informatics, 21(1), 4–1.

Discussion: The Application of Data to Problem-Solving
In the modern era, there are few professions that do not to some extent rely on data. Stockbrokers rely on market data to advise clients on financial matters. Meteorologists rely on weather data to forecast weather conditions, while realtors rely on data to advise on the purchase and sale of property. In these and other cases, data not only helps solve problems, but adds to the practitioner’s and the discipline’s body of knowledge.

Of course, the nursing profession also relies heavily on data. The field of nursing informatics aims to make sure nurses have access to the appropriate date to solve healthcare problems, make decisions in the interest of patients, and add to knowledge.

In this Discussion, you will consider a scenario that would benefit from access to data and how such access could facilitate both problem-solving and knowledge formation.

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.
By Day 3 of Week 1
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? How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?

When looking at this weeks discussion board the first scenario or issue that came to mind was the COVID crisis we all encountered. I know in my own personal practice every ounce of knowledge I thought I had was thrown upside down. How we were used to treating respiratory illness simply did not seem to work when it came to the Pandemic. During COVID the EHR was essential in tracking cases and helping support providers during the crisis. The EHR helped to come up with standard of practice and care for these patients (Reeves,Hollandsworth, Torriani, Taplitz, Abeles, Seale, Millen,Clay, & Longhurtst, 2020) Along with the EHR the health organizations across the world were collaborating and coming together to formulate the best plan of care with the information that they had available to them at the time. The push in informatics to make EHR a possibility has lead to increased collaboration in both the public and private sectors. McGonigle, Mastrian, 2017)This pandemic required providers to be flexible and fluid because especially in the beginning there was no much that was unknown. There was a need for a centralized and trusted group to provide this evolving data. (Atique, Bautista, Block, Lee, Lozada-Perezmitre, Nibber, O’Conner,Peltoned,Ronquillo, Tayaben,& Thilo, 2020) This also means that hospitals need to keep track of important health care equipment such as Ventilators, Bi paps and Hi Flow also towards the end the need to track the oxygen patients were requiring on a daily basis was being tracked to monitor O2 tanks supplies. The same was being done in areas in NYC that had limited supplies available. Informatics was used to predict the availability of the equipment(Atique, Bautista, et al , 2020)

References:

Atique, S., Bautista, J. R., Block, L. J., Lee, J. J., Lozada-Perezmitre, E., Nibber, R., … & Topaz, M. ( 2020). A nursing informatics response to COVID-19: perspectives from five regions of the world.

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Reeves, J. J., Hollandsworth, H. M., Torrianti, F.J., Taplitz, R., Abeles, S., Tai- Seale, M., … & Longhurst, C. A. (2020) Rapid response to Covid-19; health informatics support for outbreak management in an academic health system. Journals of the American Medical Informatics Association, 27(6), 853-859

By Day 6 of Week 1
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.

*Note: Throughout this program, your fellow students are referred to as colleagues.

Thanks for the great post xx

      If there was an upside to COVID it was the collective collaboration between health care systems to share information for the advancement of best practices, treatments, and care for their communities. One of the main drivers for this sharing comes from a universal or unified electronic health record (EHR).  One such health system in New York had just completed this process in 11 plus hospitals and outpatient facilities which in total serve 1.1 million residents in NY.  The system was able to triage emergency patients with low acuity out quicker, order sets were designed for symptomatic presenting patients, and they integrated video capabilities for quarantined patients to talk with family members(Salway et al., 2020).  This integrated multi-system EHR system was able to utilize the full scope of the health care engine to its advantage.  The downside is that most health care systems aren’t fully integrated with one EHR system and in fact have multiple EHRs which don’t communicate at all. “The average health system, in fact, has 18 different EMR vendors when looking all the way across affiliated providers(Sullivan, 2018, p. 1).”  In my current practice which operates out of 4 different states and 5 different health care systems, I have had to become fluent with, EPIC, Cerner, Meditech, Wound Docs, and ECW to just name a few.  I think we have a long way to go to have organizations have the ability to share information but it is on its way.  The state health information exchange program is a major initiative of the  U.S. Department of Health and Human Services (HHS).  “The ONC-funded State Health Information Exchange (HIE) Cooperative Agreement Program promotes innovative approaches to the secure exchange of health information within and across states and ensures that health care providers and hospitals meet national standards and meaningful use requirements(The Office of the National Coordinator for Health Information Technology (ONC), 2019, p. 1).”   Hopefully, each organization can come together and put aside their objections for sharing this information and we can have a streamlined health care EHR system.

                                                                                                                                                                           References

Salway, R., Silvestri, D., Wei, E. K., & Bouton, M. (2020). Using information technology to improve covid-19 care at new york city health + hospitals. Health Affairs, 39(9), 1601–1604. https://doi.org/10.1377/hlthaff.2020.00930

Sullivan, T. (2018, May 16). Why EHR data interoperability is such a mess in 3 charts. HealthcareITNews. https://www.healthcareitnews.com/news/why-ehr-data-interoperability-such-mess-3-charts

The Office of the National Coordinator for Health Information Technology (ONC). (2019). State Health Information Exchange Cooperative Agreement Program. https://www.healthit.gov/sites/default/files/get-the-facts-about-state-hie-program-2.pdf

sample response 2

I agree with your post, EHR played helped assist with standard care of practice for patients and commuted date for equipment and supplies. Electronic Health Record as a tool played a critical role in tracking Coronavirus cases and assisting healthcare providers during the crisis. Allowing access and sharing of data across the public health system, facilitating reporting of both the confirmed and suspected cases, and better monitoring of Coronavirus cases. This tool so permitted a faster understanding of the pandemic behavior (Reeves et al., 2020). Typically, responding to a serious health issue such as the present Coronavirus epidemic required access to large and timely data or information with the goals of providing appropriate and timely information to health providers and policymakers, to keep the people safe and make essential resources readily available where it is required and carry research in order to advance collective knowledge that can be used in the future (Madhavan et al., 2021). The push to make EHR a possibility led to increased collaboration in healthcare settings and both private and public sectors. This was evident during the pandemic, healthcare organizations across the globe came together and collaborated in formulating suitable plans for care with the information available to them. Most healthcare organizations depended on one another in terms of resources and information about the treatment of the coronavirus.

References

Madhavan, S., Bastarache, L., Brown, J. S., Butte, A. J., Dorr, D. A., Embi, P. J., … & Ohno-Machado, L. (2021). Use of electronic health records to support a public health response to the COVID-19 pandemic in the United States: a perspective from 15 academic medical centers. Journal of the American Medical Informatics Association, 28(2), 393-401.

Reeves, J. J., Hollandsworth, H. M., Torriani, F. J., Taplitz, R., Abeles, S., Tai-Seale, M., … & Longhurst, C. A. (2020). Rapid response to COVID-19: health informatics support for outbreak management in an academic health system. Journal of the American Medical Informatics Association, 27(6), 853-859.

sample response 3

As you stated, The COVID-19 pandemic has changed what even experienced nurses knew about healthcare. McGonigle & Mastrian (2017) states that “the increased use of technology to enhance nursing practice, nursing education, and nursing research will open new avenues for acquiring, processing, generating, and disseminating knowledge”. Last summer the sudden rise of patients battling severe COVID-19 cases and the healthcare facilities running out of equipment such as ventilators, bipaps, ecmo machines, and personal protective equipment (PPE) showed us how important nursing informatics is in practice. In an article by Nahm et al. (2020), they discussed how health information exchange (HIE) services allows physicians as well as patients access to medical records from different facilities and companies. Having access to all of a patient’s medical history can help the providers create a more personalized plan of care for patients battling the virus.

References

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Nahm, E. , Schoenbaum, A. , Behm, C. & Rowen, L. (2020). Health Information Exchange. JONA: The Journal of Nursing Administration, 50 (11), 584-589. doi: 10.1097/NNA.0000000000000941.

NURS 6051 week 1 Discussion: The Application of Data to Problem-Solving
Scenario: The fall of 2020 saw the rise of corona throughout the globe, impacting regular lifestyle, millions of people where admitted to hospital for treatment. Many of these patient have pre-existing condition that need to be taken into account while treating them for the virus infection.

Resolution: Pertaining to this scenario data played a very important role in not only managing such vast population of patient, but also ensuring that all patient where formally addressed based on their pre-existing condition. The data acquisition process showcases detailed information being collected for patient earlier medical records from the data base of hospital using EHR – Electronic health record of the patient, for those who are regular in-house patient for the hospitals. In case outpatient admitted to the hospital details are collected using social security number of the patient logged with patient medical insurance, which provided detailed information about patient medical history allowing the right approach to be made for each patient while handling their COVID infection.

These information thus gathered about each patient allowed the nursing staff to recognize the previous history of the patient based on which treatment approaches are implemented by the doctors. This allowed the nursing staff to gain knowledge on treating COVID patient based on their pre-existing condition and how based on different pre-existing condition, different approaches has been put into place for treatment. Further these accesses to the information also brought in easier resolution process considering the knowledge gained on patient history from the data making the process of treatment easier.

References

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

response

It is certainly true that patients with pre-existing conditions were more affected by the covid virus. Heart disease, diabetes, and those that are immunocompromised were more at risk to develop complications from disease (ADPH, 2021). Using an EHR to track these populations and their risks, treatments, and long-term effects is crucial to understanding and treating future patients (Eddy, 2020). Additionally, clinics that cater to these populations can track numbers affected, fatalities, and long-term complications. In a hospital setting, an EHR can track lab values, daily trends, or even unit success/failures while still being HIPPA compliant.

ADPH. (2021). Frequently Asked Questions | Alabama Department of Public Health (ADPH). Alabamapublichealth.gov. Retrieved 2 June 2021, from https://www.alabamapublichealth.gov/covid19/faq.html.

Eddy, N. (2020). Using EHRs to track patients in real time. Healthcare IT News. Retrieved 2 June 2021, from https://www.healthcareitnews.com/news/using-ehrs-track-patients-real-time.

Discussion: The Application of Data to Problem-Solving
In the modern era, there are few professions that do not to some extent rely on data. Stockbrokers rely on market data to advise clients on financial matters. Meteorologists rely on weather data to forecast weather conditions, while realtors rely on data to advise on the purchase and sale of property. In these and other cases, data not only helps solve problems, but adds to the practitioner’s and the discipline’s body of knowledge.

Of course, the nursing profession also relies heavily on data. The field of nursing informatics aims to make sure nurses have access to the appropriate date to solve healthcare problems, make decisions in the interest of patients, and add to knowledge.

In this Discussion, you will consider a scenario that would benefit from access to data and how such access could facilitate both problem-solving and knowledge formation.

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.
By Day 3 of Week 1
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? How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?

By Day 6 of Week 1
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.

*Note: Throughout this program, your fellow students are referred to as colleagues.

Nursing Informatics is a developing science that merges nursing science and technology to allow data to be collected, analyzed, and interpreted in order to gain all the necessary knowledge to diagnose and treat patients promptly and efficiently (McGonigle & Mastrian, 2017). This collected data must be both accessible and accurate in order to be reliable. When used correctly nursing informatics can be used to help nurses track both acute issues and patient’s long-term health concerns. Some examples of informatics being integrated into healthcare currently are electronic health records, patient care portals, off-site dictation, data collection, and patient condition/medication surveillance.

    One way that informatics can be used to save lives is by assisting with patient monitoring and alerting to changes outside of a normal reference range or set of values (Quinn,2017 ). This allows nurses to stay engaged with patient care while still ensuring that acute patient conditions are noticed and treated in an appropriate manner. For a moment envision yourself as patient Anna Smith, a 45-year-old female, in the emergency room for abdominal pain. In this acute situation a nurse takes a temperature and then applies a pulse ox, EKG leads, and a blood pressure cuff. Vitals are monitored continuously and entered into the patient’s electronic health record at 15-minute intervals. An algorithm monitors this information along with lab values and medications administered. If appropriate, alerts are triggered to initiate additional nursing care acts. One of these alerts that are triggered by gathering, analyzing, and interpreting multiple data inputs is a sepsis alert. Once triggered, a nurse begins a sepsis protocol that includes additional interventions and order sets to help reduce the time until treatment once sepsis is identified (Westphal et al., 2018).

    It is important to remember that even though data is collected and analyzed with the help of technology, nurses must still ensure that data is accurate and relevant (McGonigle & Mastrian, 2017). For example, nurses should make sure that the blood pressure cuff being used is the appropriate size and that lab specimens are not contaminated in order to ensure data is accurate and relevant.

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Westphal, G. A., Pereira, A. B., Fachin, S. M., Sperotto, G., Gonçalves, M., Albino, L., Bittencourt, R., Franzini, V. R., & Koenig, Á. (2018). An electronic warning system helps reduce the time to diagnosis of sepsis. Um sistema eletrônico de alerta ajuda a reduzir o tempo para diagnóstico de sepse. Revista Brasileira de terapia intensiva, 30(4), 414–422. https://doi.org/10.5935/0103-507X.20180059

Quinn, J. (2017). Five Ways Healthcare Informatics Help Nurses: Health-Notes. Retrieved May 31, 2021, from https://www.ebsco.com/blogs/health-notes/five-ways-healthcare-informatics

The Application of Data to Problem-Solving Discussion
I am going to choose a topic for this discussion that hits home for me. I currently work on an inpatient psychiatric ward in a hospital. Our unit can fit 30 patients. As per our nursing union contract, we are to have 4 Registered Nurses (RN) per shift. Very rarely does our census fall below 25, therefore there is no reason to justify having less nurses. We are currently having a staffing crisis on my unit for night shifts. We never have 4 RNs. We consistently have 3 RN, which puts the ration to 10 patients to 1 RN, which is a dangerous ratio. Most recently, we have experienced unacceptable staffing. Three times this month we were left with 2 RNs due to sick calls. Day shift nurses did not offer to stay and help out. On these nights are ratio was 15 patients to 1 RN. This is unacceptable and dangerous for staff and for the patients themselves. According to the Journal of Nursing Management, the number of nurses has been shown to have a significant effect on patient‐safety outcomes, but the structure of the nursing staff has received little attention. There are safeguards in place to help protect us nurses. Our union has a form that allows us to fill out if our staffing is not sufficient, which is called a Protest of Assignment. According to Sullivan, in the state of California, the RN is not responsible for something if the ratios are too high.

So the data that can be used by management is how patient outcomes are affected by poor staffing ratios. Also the higher risk of mistakes made by RN’s when their workload is too heavy. If management were to do this research, maybe they would have a better understanding of how important better ratios are. In another study it is actually shown that RN staffing ratios have a relationship to patient mortality (Sasichay-Akkadechanunt, Scalzi & Jawad, 2003). It is clear that nursing management should use this data to ensure their units are sufficiently staffed.

Sasichay-Akkadechanunt T, Scalzi CC, & Jawad AF. (2003). The relationship between nurse staffing and patient outcomes. JONA: The Journal of Nursing Administration, 33(9), 478–485. https://doi-org.ezp.waldenulibrary.org/10.1097/00005110-200309000-00008

Sullivan GH. (2004). Advice of counsel. When staffing ratios aren’t met, is the nurse responsible? RN, 67(11), 64–51.

Wang, L., Lu, H., Dong, X., Huang, X., Li, B., Wan, Q., & Shang, S. (2020). The effect of nurse staffing on patient‐safety outcomes: A cross‐sectional survey. Journal of Nursing Management (John Wiley & Sons, Inc.), 28(7), 1758–1766. https://doi-org.ezp.waldenulibrary.org/10.1111/jonm.13138

response

The topic of staffing and the lack thereof has hit home to me, and I feel very passionate about how unsafe it is for patients and nurses when working in unsafe patient-to-nurse ratios. Currently, there is a campaign through the National Nurses United for safe RN-to-patient staffing ratios. Currently, some of those proposed staffing ratios are ICU 1:2, PACU 1:2. L&D 1:2, pediatrics 1:3, ER 1:3, telemetry 1:3, med/surg 1:4, and psychiatric 1:4 (National Nurses United, n.d.) These ratios seem fair, reasonable, and safe, yet, I have not seen them in my current hospital. Our ICU is currently 1:2-3 patients, ER anywhere from 4-10 (ranging from inpatient holds, ICU, and ER patients), and most recently from this weekend; our tele floor was 1:7. It has been studied and proven through multiple research the dangers of unsafe patient-to-nurse ratios. There are several consequences to unsafe workloads: adverse patient safety, high nursing turnover, and nursing shortage, and nursing is expected to do nonprofessional tasks such as delivering meal trays, housekeeping, transporting, and coordinating ancillary cares (Hughes et al., 2008).

At what point will administrations look at this like the national crisis it is and start staffing hospitals adequately? How many patients have to be harmed or, worse, die before action is taken? And why must it come to that? Nurses risk their license to take care of an unmanageable number of patients for administration to receive yearly bonuses and no risk to any license they may hold. Healthcare has turned into a business and has strayed away from patient-centered care. I hope in my healthcare time, I see a shift in direction, and we go back to the model of true patient-centered care.

National Campaign for Safe RN-to-Patient Staffing Ratios. National Nurses United. (n.d.). https://www.nationalnursesunited.org/ratios.

Hughes, R., Gurses, & Pascale, C. (2008). In Patient Safety and Quality: An Evidence-Based Handbook for Nurses. essay, Agency for Healthcare Research and Quality. Chapter 30. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK2657/

sample response 2

Staffing is essentially a concern in all health care facilities worldwide. When legislatures determine the patient-to-nurse ratio, they do not consider the acuity of the patients. The hospital where I work has telemetry and med surg combined. Being able to monitor the tele units while taking care of the other 6 or 7 patients is unsafe. ICU is also responsible for overlooking the tele units, however often times the alarms are ignored because “that person is probably getting up to the BR again” or “I am tired of listening to room 112’s alarm”.

It is extremely difficult to staff facilities with the nursing shortage, but changes need to be made. Nurse-to-patient ratios have become one of the most controversial topics in health care (Tung, L., 2019) and understandably so. Patients are not receiving quality care which affects satisfaction surveys and results in poor publicity and a decrease in reimbursement from insurance companies due to rehospitalizations.

“Studies show that when RNs are forced to care for too many patients at one time, patients are at higher risk of preventable medical errors, avoidable complications, falls and injuries, pressure sores, increased length of stay, and readmissions.1 In addition, RNs experience higher burnout rates, and job dissatisfaction”(Aiken, L., et al.).

Relying heavily on informatics with evidence-based staffing, patients would receive high-quality care efficiently and safely while minimizing negative incidences and mortality within the healthcare system (Hyun, S., et al., 2008). Many studies are provided that the outcomes are much improved with a higher level of RN staffing.

Resources

Aiken, L., et al. “Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction.” Journal of the American Medical Association. 2002; 288(16): 1987-93, 1990. (43 percent of RNs surveyed had high burnout scores, and a similar proportion were dissatisfied with their current job. Both burnout and job dissatisfaction are indicators of turnover.)

Hyun, S., Bakken, S., Douglas, K., & Stone, P. W. (2008). Evidence-based staffing: potential roles for informatics. Nursing economic$. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440797/.

Submitted by ADonahue on May 10. (2021, May 12). National Campaign for Safe RN-to-Patient Staffing Ratios. National Nurses United. https://www.nationalnursesunited.org/ratios.

Tung, L. (2019, November 29). Why mandated nurse-to-patient ratios have become one of the most controversial ideas in health care. WITF. https://www.witf.org/2019/11/29/why-mandated-nurse-to-patient-ratios-have-become-one-of-the-most-controversial-ideas-in-health-care/.

Discussion: The Application of Data to Problem-Solving
In the modern era, there are few professions that do not to some extent rely on data. Stockbrokers rely on market data to advise clients on financial matters. Meteorologists rely on weather data to forecast weather conditions, while realtors rely on data to advise on the purchase and sale of property. In these and other cases, data not only helps solve problems, but adds to the practitioner’s and the discipline’s body of knowledge.

Of course, the nursing profession also relies heavily on data. The field of nursing informatics aims to make sure nurses have access to the appropriate date to solve healthcare problems, make decisions in the interest of patients, and add to knowledge.

In this Discussion, you will consider a scenario that would benefit from access to data and how such access could facilitate both problem-solving and knowledge formation.

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.
By Day 3 of Week 1
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? How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?

By Day 6 of Week 1
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.

*Note: Throughout this program, your fellow students are referred to as colleagues.

When preparing to begin a new class of student nurses, the process is always one of much preparation and collaboration. Processing the application, scheduling the entrance exam, and reviewing all necessary data. The only thing missing is the standards by which students should be admitted. Although criteria are suggested by the exam developer, the same criteria are not considered when choosing the next class. What would the retention and board pass rate look like if there was data to show statistics of the entrance exam scores, test scores and student pass/fail ratio? Would board pass rates improve if students were accepted based on the recommended criteria of the exam developer? Would students be successful and able to complete their education if the entrance process were followed correctly and based on entrance exam scores? Could disappointments of failure be eliminated by not accepting students that are not prepared for the demanding requirements of the nursing profession?

These are all questions that could be answered by utilizing data from previous classes enrolled at the nursing education facility where I work. Considering the initial application, essay, healthcare experience, and entrance exam prior to admission would assist with poor retention and failed board rates. If students are not prepared, dedicated, and compassionate about the journey of nursing, maybe another career choice would benefit them. Critical thinking and communication are both important aspects of nursing, potential students will be tested on this criterion as well as comprehension and some core subjects related to healthcare (Nursing entrance exam). It is imperative that you excel in more than one subject matter to score well on the exam. If unable to reach the recommended score, entrance should not occur and remediation on the given material should be a requirement before reapplication to the program. Reading, writing, math, science, and critical thinking are basic testing subjects and should be reviewed prior to the exam. This shows dedication and initiative and will assist with a successful score. Collecting data on those students that have prepared for the entrance exam would be an asset as well to the program and future students.

Nursing informatics would benefit the nursing education program by providing information on the success of potential students to the success of graduating nurses. This information would carry through the potential employers with information of progression and excelling in their education. The decision support system (DSS) and/or the executive support system could be implemented to input admission criteria while the informatic system would analyze the information and provide staff with the best candidate for admission (McGonigle & Mastrian, 2017).

By utilizing the data that is collected through the admission process, the program would be able to mitigate the stress of selecting future students and improve the student body as well as the education facility. The process would be more effective, accurate and improve the admission process (Laureate Education, 2018). The admission process would be strictly based on testing scores and unbiased.

Resources

Laureate Education (Producer). (2018). What is Informatics? [Video file]. Baltimore, MD: Author.

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning

Nursing Entrance Exams–Which One is Right for You. All Nursing Schools. (2021, March 22). https://www.allnursingschools.com/how-to-get-into-nursing-school/entrance-exams/.

response

I thought your topic that you chose was very unique. I presume that you work as a nurse educator or on the staff in a nursing school? I live in the tri-state area (New Jersey, New York, Pennsylvania) and I can tell you that it is extremely competitive here to get into a nursing program. I had to wait 2 years to get into mine. Some schools are extremely selective and some have really long waitlists. My friend is trying very hard to get into a nursing program, has mostly all A’s in the prerequisites, but got one C, and was not accepted into the nursing program because of that one grade. It is discouraging to many students. I agree with you that data can definitely help the decision makers when it comes to admission, but I believe that there should be more that is taken into consideration when deciding a students fate. Previous studies suggest that Grade Point Average (GPA) from previous academic studies (in schools or at tertiary level) provides a good predictive power for achievements in undergraduate health profession programs (Shulruf, Wang, Zhao & Baker, 2011). I believe that total GPA is a great indicator for future outcomes, although it should not be only factor. A nursing school in Indiana made a revision to their admission process to add more factors to their decision making process, like an interview, a writing sample and a service requirement (McNeilis, Wellman, Hrisomalos, McElveen & South, 2010). I believe that adding more criteria will only help students’ chances to gain admission to nursing programs and help bridge the gap in the nursing shortage we are experiencing in the United States.

References

McNelis AM, Wellman DS, Krothe JS, Hrisomalos DD, McElveen JL, & South RJ. (2010). Revision and evaluation of the Indiana University School of Nursing baccalaureate admission process. Journal of Professional Nursing, 26(3), 188–195. https://doi-org.ezp.waldenulibrary.org/10.1016/j.profnurs.2010.01.003

Shulruf, B., Wang, Y. G., Zhao, Y. J., & Baker, H. (2011). Rethinking the admission criteria to nursing school. Nurse Education Today, 31(8), 727–732. https://doi-org.ezp.waldenulibrary.org/10.1016/j.nedt.2010.11.024

Discussion: The Application of Data to Problem-Solving
In the modern era, there are few professions that do not to some extent rely on data. Stockbrokers rely on market data to advise clients on financial matters. Meteorologists rely on weather data to forecast weather conditions, while realtors rely on data to advise on the purchase and sale of property. In these and other cases, data not only helps solve problems, but adds to the practitioner’s and the discipline’s body of knowledge.

Of course, the nursing profession also relies heavily on data. The field of nursing informatics aims to make sure nurses have access to the appropriate date to solve healthcare problems, make decisions in the interest of patients, and add to knowledge.

In this Discussion, you will consider a scenario that would benefit from access to data and how such access could facilitate both problem-solving and knowledge formation.

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.
By Day 3 of Week 1
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? How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?

I agree that healthcare is another field that relies on data and statistical analysis in treatment, management, and preventative care. Currently I work in a Rehabilitation and Long Term Care Facility, we are currency performing COVID testing on all of our staff and employees based on the state average of positive COVID 19 cases. Currently in Arizona we are at 2.9% positivity rate based on the past 7 days (Ritchie et al., 2020). Whenever we reach above 5% we must test our staff weekly, and below 5% we must test monthly.

This method of testing concurrently uses the data to appropriately test whilst adding to the ongoing data collection and continuing the overall accuracy of this disease and disease process. This is important to see when and where the spikes occur in positivity, and mitigate for the staffing shortages that may occur in this instance.

Another term that people may be well accustomed to now is “contact tracing”.Contact tracing works to help slow the spread of diseases, for example COVID- 19. Contact tracing usually takes place in the community, like clinics, labs, schools and hospitals. Contact tracing works by sending the names and demographics of people diagnosed with COVID- 19 to the local health department. The health department then further explores who the infected person has been in contact with and anonymously notifies those individuals to seek testing and begin quarantine (Marshall, 2021).

A clinical leader would use contact tracing as a method of understanding the characteristics of the disease (Keeling, 2020). For example the demographics, geographical location, socioeconomic status, employment status and time of year in which those are contracting the illness. With this information you can plan to order more PPE, sticiter isolation and quarantine protocols, limit visitation time(s) within a facility and many more methods to mitigate the risks of infecting more people.

Hannah Ritchie, Esteban Ortiz-Ospina, Diana Beltekian, Edouard Mathieu, Joe Hasell, Bobbie Macdonald, Charlie Giattino, Cameron Appel, Lucas Rodés-Guirao and Max Roser (2020) – “Coronavirus Pandemic (COVID-19)”. Published online at OurWorldInData.org. Retrieved from: ‘https://ourworldindata.org/coronavirus’ [Online Resource]

Keeling, M. J., Hollingsworth, T. D., & Read, J. M. (2020). Efficacy of contact tracing for the containment of the 2019 novel coronavirus (COVID-19). Journal of Epidemiology and Community Health. https://doi.org/10.1136/jech-2020-214051

Marshall , W. F. (2021, May 18). Can contact tracing stop coronavirus? Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/covid-19-contact-tracing/faq-20488330.

By Day 6 of Week 1
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.

Response 1

Thank you for the informative post. I agree, Informatics is essential in healthcare, from electronic medical records (EMRs) and key performance indicators (KPIs) to big data. Informatics can improve outcomes for patients and assist healthcare professionals with continuity of care. In the past, the United States’ healthcare data has been utilized primarily for billing, internal organizational management, and regulatory reporting, and public health officials have primarily focused on data of communicable diseases and reportable events (Gamache Kharrazi, and Weiner, 2018). There are currently multiple attempts to integrate these data sources to improve outcomes for patients and communities. Most health organizations and facilities do government reporting on KPIs through the National Healthcare Safety Network (NHSN) that is managed by the Centers for Disease Control and Prevention Division of Healthcare Quality Promotion (ODPHP, n.d). NHSN is the nation’s most widely used healthcare-associated infection (HAI) tracking system that provides the country with data needed to identify problem areas and measures prevention efforts to eliminate HAIs (ODPHP, n.d) eventually. Over the next decade, the healthcare data will more than double. In 2015 an international survey was conducted and identified education, research, practice, visibility, and collaboration as the five key areas where healthcare informatics need to improve (Mordi, Guignard-Duff, Hall, New, and Lang, 2020). As patient data grows at an ever-increasing rate, we must remain mindful of potential liabilities related to HIPAA and the risk of a potential data breach (Sweeney, 2017). Healthcare informatics combined with the patient data received will help guide future treatment options and innovation.  

References 

Office of Disease Prevention and Health Promotion ODPHP. National Healthcare Safety Network (NHSN).https://health.gov/healthypeople/objectives-and-data/data-sources-and-methods/data-sources/national-healthcare-safety-network-nhsn

Gamache, R., Kharrazi, H., & Weiner, J. P. (2018). Public and Population Health Informatics: The Bridging of Big Data to Benefit Communities. Yearbook of medical informatics, 27(1), 199–206. https://doi.org/10.1055/s-0038-1667081 

Mordi, I. R., Guignard-Duff, M., Hall, C., New, B. J. M., & Lang, C. C. (2020). Use of Population-Based Health Informatics Research to Improve Care for Patients with

Cardiovascular Diseases. Diseases (Basel, Switzerland), 8(4). https://doi-org.ezp.waldenulibrary.org/10.3390/diseases8040047

Sweeney, J. (Feb, 2017). Healthcare Informatics. Online Journal of Nursing Informatics (OJNI), 21( 1), Available at http://www.himss.org/ojni 

response 2

I also work in the same type of setting and, at our facility in Minnesota, we are currently testing weekly based on cases in our county. Minnesota Department of Health is the guideline that nursing homes follow. As of April 30, 2021, fully vaccinated asymptomatic staff does not need testing as part of routine staff screening. However, MDH states that regardless of vaccination, employers have to test immediately. If the asymptomatic staff has high-risk exposure or symptomless resident has prolonged close contact with a positive person, testing occurs again on day 5-7 (COVID-19 Testing Recommendations for Long-term Care Facilities, 2021). Does your facility use information collected to benefit them in the future, or do they pass the data off to the state of Arizona? I do not think our facility utilizes statistical numbers for future reference, and I am unsure if they even share much with MDH.

I found a collaborative webinar series pdf with some great informatics resources searching for nursing informatics and the pandemic. Therefore, I am posting the link below for your review.

https://www.amia.org/sites/default/files/AMIA-COVID19-Webinar-Series-NIWG-ANI-Clinical-Informatics-3.pdf

Page 52 of this document has several more helpful links from the CDC and the WHO, such as where to report, clean and disinfect the virus, cope with stress, self-care, and more. Some of the links do not work, but most do.

The pandemic will change how people collect information and utilize it; moreover, the future of health may move in increased telehealth making health care more affordable and accessible. Telehealth could benefit the increasing elderly population as fewer nursing homes and assisted living facilities have long waiting lists. I would like to see increased income potential for personal care attendants (PCAs) and home health aides (HHA) so people could remain in their own homes. Informatics could assist in this direction as the internet has expanded to reach remote areas, more people know how to use computers, iPads, and cellphones. McGonigle & Garver Mastrian say the future of health care will be dependent on the use of clinical documentation systems and clinical decision support (p. 123, 2018).

I dream of a health care field that shares information of the patient, without jeopardizing HIPAA, in a faster and more thorough way so that collaboration and communication between multiple providers alleviate duplication of medicines and cohesiveness of customer care. Unfortunately, things get missed and fall through the cracks in health care due to lack of time, communication, follow-through, shift change, or multiple caregivers.

Best wishes for the rest of the semester,

Diane Ward

References

COVID-19 Testing Recommendations for Long-term Care Facilities. (2021, April 30). Retrieved 2021, from MINNESOTA DEPARTMENT OF HEALTH: https://www.health.state.mn.us/diseases/coronavirus/hcp/ltctestrec.pdf

McGonigle, D., & Garver Mastrian, K. (2018). Nursing Informatics and the Foundation of Knowledge (Fourth ed.). Burlington, Maine: Jones & Bartlett Learning. Retrieved 2021

Nursing Informatics in Times of COVID-19: Achievements, Challenges, and New Ideas. (2020, April 14). Retrieved 2021, from American Medical Informatics Association: https://www.amia.org/sites/default/files/AMIA-COVID19-Webinar-Series-NIWG-ANI-Clinical-Informatics-3.pdf

Place your order
(550 words)

Approximate price: $22

Calculate the price of your order

550 words
We'll send you the first draft for approval by September 11, 2018 at 10:52 AM
Total price:
$26
The price is based on these factors:
Academic level
Number of pages
Urgency
Basic features
  • Free title page and bibliography
  • Unlimited revisions
  • Plagiarism-free guarantee
  • Money-back guarantee
  • 24/7 support
On-demand options
  • Writer’s samples
  • Part-by-part delivery
  • Overnight delivery
  • Copies of used sources
  • Expert Proofreading
Paper format
  • 275 words per page
  • 12 pt Arial/Times New Roman
  • Double line spacing
  • Any citation style (APA, MLA, Chicago/Turabian, Harvard)

Our Guarantees

Money-back Guarantee

You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.

Read more

Zero-plagiarism Guarantee

Each paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.

Read more

Free-revision Policy

Thanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.

Read more

Privacy Policy

Your email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.

Read more

4-hour deadlines

Your urgent tasks will be completed within 4 hours. Your discussion responses and late orders will be will be handled fast and we still maintain our quality.

Read more
error: