Paper topic: technology in nursing
This paper is from our first class in the RN to BSN program, the integration into professional nursing. You may use this paper on technology in nursing as a reference to obtain ideas for your own nursing essay.
5th edition APA and others are based on the 6th edition. Due to
instructor variations you will notice variety in writing style
especially from this paper until the final papers. All papers and
drafts have been submitted to turnitin. These papers are for reference
only and are not to be copied or submitted as your own work.
Advancements in technology
are everywhere and new technology is being presented every day. New
technology affects many areas, including the field of health care.
Technology’s advancements have therefore affected the field of nursing
as well. The use of technology in nursing includes many things, among
them is electronic charting. The use of computers in charting has lead
to an increase in patient safety and a decrease in the time needed for
nursing documentation. If we ask the question regarding technology in
nursing: Is it a friend or foe? The answer would be that overall
technology in the field of nursing has come to be considered a friend.
Technology is such a broad subject and cannot be covered completely in
this paper. The focus of this paper will be on the use of computers and
handheld electronic devices in nursing practice. The use of technology
and computers has lead to process improvements, which allow for less
time documenting, more time with patients and therefore an increase in
quality of patient care and safety. The use of electronic charting by
computers and other electronic devices has been shown to improve patient
outcomes and patient safety.
Nurses and Computers
Computerized documentation has been used “to help nurses organize information, and to improve workflow.” (Lee, 2007) Upon implementation of a new computerized documentation system, nurses generally have concerns regarding a change in workflow. Initially it may be more time consuming to chart in a new system. Nurses must learn a new format, and may need to learn typing skills; these issues can lead to stress and dissatisfaction. Involving nurses in the early stages of implementing a new system is very beneficial as they can offer input regarding design to assist with workflow. (Lee, 2007) “IT [Information Technology] has the capability to change work processes, communications, and the point-of-care for nurses.” (Courtney, Demiris & Alexander, 2005) “In addition to technology changing nursing practices, nursing practices should also shape IT development.” (Courtney et al., 2005) In addition to assisting with documentation, computerized systems also offer other assistance. Computerized reminders for patient care interventions are very beneficial, as well as computer guided interventions linked to the diagnosis entered. (Lee, 2007) Nursing Informatics is a nursing specialty that looks at the involvement of computers in the practice of nursing. Hardwick, Pulido and Adelson (2007) use the definition of nursing informatics as noted by the International Medical Informatics Association. “Nursing informatics is “the integration of nursing, its information, and information management with information processing and communication technology, to support the health of people world wide.” Hardwick (2007) goes on to say that “Nursing Informatics is committed to making clinical documentation available for evaluation and is resolved to making technology available at the bedside.”
Technology for Nursing Documentation
The use of computers and handheld devices by nurses can improve speed and efficiency of nursing documentation. The use of portable devices is often incorporated into an electronic medical record (EMR) system which allows nurses to quickly and efficiently enter vital signs and nursing documentation while at the bedside. It also allows the nurse to look at patient labs, new orders, and other information without leaving the patient’s bedside. (Hardwick, Pulido, & Adelson, 2007) Strople & Ottani (2006) state that real-time documentation “has the benefit of minimizing communication errors and omissions.” A study performed at University Community Hospital shows that “use of an EMR can reduce vital sign documentation errors by more than half, compared to traditional paper charts.” (Gearing, Olney, Davis, Lozano, Smith & Friedman, 2006) Even without integration into an EMR, a handheld device can be a useful tool for documentation, easily taking the place of a clipboard. (Hardwick et al., 2007) Using the device in place of a clipboard would allow the nurse to enter information directly at the bedside and either transpose it later into paper charting or, if the system is compatible upload it into the EMR. Strople & Ottani (2006) report that PDA use “has been found to decrease nursing time spent in documentation activities by almost 2 hours, to improve efficiency in patient care, and to positively impact patient outcomes and safety.”
Handheld Devices as a Tool
Electronic handheld devices also have the capability to be used as a resource tool for nurses. Many portable devices offer extensive reference materials. This allows for the nurse to look up information such as drug lists and clinical references without having to return to the nursing station. (Hardwick et al., 2007) Many handheld devices, such as PDA’s offer resource tools that can be helpful to nurses. Applications such as clocks and timers can assist with medication and treatment reminders, as well as any other activities that the nurse chooses to set. (Hardwick et al, 2007) Hardwick (2007) also points out how these tools are useful not only in bedside nursing but also in a home health setting.
Technology in Reporting
Strople & Ottani (2006) report that “The Joint Commission on Accreditation of Health Care Organizations (JCAHO) has identified communication failures as the leading cause of sentinel events in the United States and lists shift report as a contributing factor.” Strople & Ottani (2006) further discuss how nurses often use the chart and their memory when giving report which can lead to omission of important information. The worksheets the nurse uses and adds to throughout the shift could be replaced by use of a PDA device where the information would be permanently documented and therefore it would be less likely that information would be missed. As well as ensuring pertinent information is reported, the use of handheld devices or other means of electronic reporting “has the potential to increase the amount of time that nurses spend on direct patient care.” More time being spent with patients has been shown to decrease some patient problems such as UTI and pulmonary compromise. (Strople & Ottani, 2006) By exploring the full potential of an electronic reporting system, along with some changes in report processes holds promise “in increasing the quality, effectiveness, and efficiency of a patient-centered shift report, thereby improving patient safety and patient outcomes.” (Strople & Ottani, 2006)
Use of an EMR system can assist with patient safety issues in other areas as well. The use of computerized physician orders is “intended to primarily decrease ordering and transcription error” and “provides additional information to prevent ordering errors related to lack of drug knowledge, rules violations, lack of standardization, lack of patient information, and inadequate monitoring.” (Bradley, Steltenkamp & Hite, 2006) According to Bradley (2006), “Numerous studies conclude that many medication errors are preventable.” Bradley (2006) discusses a study from the University of Kentucky where after implementing a computerized ordering system medication error reporting increased and the level of patient harm decreased. There were errors noted in computer entry, such as orders being placed on the incorrect patient. Transcription errors were encountered by pharmacy entering the order incorrectly. Nursing errors were noted in transcribing orders onto a paper medication administration report (MAR) incorrectly, in those cases where an electronic MAR was not used. Overall upon implementation of a computerized order entry system reported errors did increase, but with the increase in reporting comes a decrease in risks. By using the reporting of errors or “near misses” a strategy to prevent errors can be developed. (Bradley et al., 2006) From a nursing standpoint, although transcription errors were found in this study, the use of computerized order entry should eliminate issues with illegible orders. With the use of an electronic MAR the nurses transcription error should decrease as well. Pharmacy transcription errors were reported as well, which should be caught by nursing prior to administration, but with a completely electronic system hopefully that will decrease as well.
Security concerns exist in relation to confidential patient information with computers just as they do in paper documentation. Security features are available with computers and handheld devices. All patient information should be password protected on electronic devices and computers. With the use of PDA’s in an EMR passwords are required, when being used as a resource for documentation it is also important to have security settings in place. In reference to uploading the information onto another computer or sending information via email, encryption is required to prevent unauthorized access to confidential information. To protect patients confidential health information, the Health Insurance Portability and Accountability Act (HIPAA) was created and HIPAA compliant security settings are available on PDA devices. (Hardwick et al., 2007)
Technology in the field of nursing can offer many benefits. This report only touches on the technology that is available to nursing. The use of technology for patient documentation is proven to be a link with patient outcomes and patient safety. By using technology in their everyday nursing practice, nurses can save time on documentation, allowing more time to be spent with the patients. To assist nurses in providing quality care to their patients, electronic reference tools are available for use at the bedside. When computerized physician order entry is in place, the risk of medication errors due to illegible hand writing can be decreased. Overall, the use of computers and handheld devices in nursing practice can lead to an increase the efficiency and quality of nursing care, and ultimately in an increase in patient safety.
Bradley, V. S., Steltenkamp, C.L., Hite, K.B. (2006). Patient Safety - Evaluation of Reported Medication Errors Before and After Implementation of Computerized Practitioner Order Entry [Electronic version]. Journal of Healthcare Information Management , 46-53.
Courtney, K. D., Demiris, G., & Alexandre, G.L. (2005). Information Technology: Changing Nursing Processes at the Point-of-Care [Electronic verion]. Nursing Administration Quarterly , 315-322.
Gearing, P., Olney, C., Davis, K., Lozano, D., Smith, L.B., & Friedman, B. (2006). Patient Safety -Enhancing Patient Safety through Electronic Medical Record Documentation of Vital Signs [Electronic version]. Journal of Healthcare Information Management , 40-45.Hardwick, M. E., Pudilo, P.A., & Adelson, W.S. (2007). The Use of Handheld Technology in Nursing Research and Practice [Electronic version]. Orthopaedic Nursing , 251-255.
Lee, T. (2007). Nurses’ Experiences Using a
Nursing Information System: Early Stage og Technology Implementation
[Electronic version]. CIN: Computers, Informatics, Nursing ,
294-300.Strople, B. & Ottani, P. (2006). Can Technology Improve
Intershift Report? What the Research Reveals [Electronic version].
Journal of Professional Nursing , 197-204.
Technology in nursing today is common place. It seems so unbelievable to us as a "seasoned nurse" who did not own a computer in nursing school never mind a cell phone. To the newer nurses or nursing students it may be unbelievable to think about a nursing career without technology. Technology in nursing including charting in electronic medical records that feeds your assessment everywhere it needs to go, drug guides and references available on line right at your fingertips, awesome apps to make life easier. We are still blown away but it is almost hard to remember our nursing career with paper and books only. Many nursing textbooks are available as ebooks for kindle or through the kindle app that makes ebooks available on your computer or another device. Although we have to admit we still like paper textbooks over ebooks. We do use our kindle and the kindle app on our ipad and when they are synced up we can switch between whatever device we happen to be using... showing our age here but we love this now that we figured it out.