A nursing career in informatics Nurses at every level now work with informatics through patient records and other technology. It doesnât replace nurses. To do this, a clinical case study will be presented, along with discussion of nurse experiences using the EHRs in a recent study (McBride, Tietze, Hanley, & Thomas, 2015). It is not accurate and orders tend to disappear. Documentation that fails to meet these principles can result in undesirable outcomes for the nurse, patients and families, or for the healthcare organization (ANA, 2015). Burlington, MA: Jones & Bartlett Learning. These same formulaic alerts can present challenges to clinical decision making for clinical teams working with an actual patient, raising practical and ethical considerations. Nursing administration: Scope and standards of practice (3rd ed.). Clinical ethics residency for nurses: An education model to decrease moral distress and strengthen nurse retention in acute care. Kim, D. Y. Documentation must be clear and accurate to provide a basis for the contribution of nurses to patient outcomes and the viability of healthcare organizations (ANA, 2015). As the use of technology explodes into the health care industry, its effects have the potential to become destructive elements to the nursing profession. The purpose of this article is to identify and address ethical issues raised by nurses in use of electronic health records. Research suggests that it can become a “third party “in the process, potentially reshaping the interaction, changing the patient narrative, and diverting nurse attention away from the patient (Rathert et al., 2016). The ED physician follows the CDS sepsis alerts that call for fluid resuscitation. The patient is likely unaware of the false entry, but subsequently applies for health or life insurance. How do you see that use changing in the future? Retrieved from doi:10.1016/j.jcjq.2017.04.007, Hawkins, S. F., & Morse, J. (2016). Commentary: Lost in translation? Technology enables care and enhances safety by au - tomating functions both simple and complex. As nurses, we face ever changing and challenging practice situations; competency in nursing informatics promises to strengthen our clinical decision-making skills. Health Informatics â Oregon Institute Of TechnologyOregon Institute of Technology Bachelor of Science degree in Health Informatics Program is the choice for students who are looking ⦠Nurse ethical awareness: Understanding the nature of everyday practice.Nursing Ethics, 24(5), 517-524. doi:10.1177/0969733015615172, Office of National Coordinator for Health Information Technology. A nursing informatics specialist combines technology with the care and communicative aspects of nursing to customize software and hardware for care solutions. In 2009, President Barack Obama further advanced the use of EHRs through Medicare and Medicaid incentive programs that reward hospitals and providers who demonstrate meaningful use of EHRs. Ahn, M., Choi, M., & Kim, Y. Dr. McBride was the Principal Investigator for a Texas Statewide Study of Nurses Satisfaction with their electronic health records. At the end of 2013, 80% of hospitals and 50% of healthcare providers implemented EHRs.1 But, the ⦠WEEK 7 pplication of Nursing Theory to Practice (graded) We believe the ethical issues, in particular, warrant further exploration and require models of decision making to support clinical interprofessional teams in appropriate decision-making and subsequent action. Ethical Decision Making: A Process Influenced by Moral Intensity, Global health ethics: an introduction to prominent theories and relevant topics, Research across the disciplines: a road map for quality criteria in empirical ethics research, Ethical Principles of Psychologists and Code of Conduct, By clicking accept or continuing to use the site, you agree to the terms outlined in our. Nursing informatics is a growing field. Goodman, K. W. (2015). We are unable to see any notes/assessments that we did not personally input. doi:10.1542/peds.2010-2184, Sulmasy, L., López, A., & Horwitch, C. (2017). Trappings of technology: Casting palliative care nursing as legal relations. System was not designed by the people who would use it. Nursing Inquiry, 19(4), 334-344. doi:10.1111/j.1440-1800.2011.00568.x, Lown, B. It takes several hours to get thru discharges due to links that do not work. (2012). Worldwide, 3.4 billion people own a smartphone, and half will be using mobile health apps. Retrieved from https://www.americannursetoday.com/doing-the-right-thing-pathways-to-moral-courage/, Larsen, A. answer each questions and make references to where u got ur ans fromâ¦.aka APA style and also use the links below 1. Statewide study assessing the experience of nurses with their electronic health records. Sometimes called ethical paradoxes in moral philosophy, ethical dilemmas may be invoked to refute an ethical system or moral code, or to improve it so as to resolve the paradox. The American Health Information Management Association (AHIMA, 2011) Code of Ethics has 11 principles with interpretive statements, referred to as guidelines, that seem to underscore the importance of practices that stand in stark contrast to the experiences of nurse participants in the Texas nursing research (McBride et al., 2015). Some features of the site may not work correctly. We provide a case scenario with application of the Four Component Model and describe a study of nurse experiences with the EHR. A statewide study was initiated to evaluate nurse perceptions about clinical information systems such as EHRs. Susan McBride, PhD, RN-C, CPHIMS, FAAN They have tremendous potential to improve efficiency of healthcare delivery and improvement of quality patient care. (2013). These rights of privacy and confidentiality pertain to all information in any manner that is communicated or transmitted” (ANA, 2015, p. 10). The human connection is the art of nursing and nurses need to be actively involved in determining how best to use technology to supplement, not eliminate, human resources. Randall Owen, PA-C. Technology has completely transformed how we work, shop, travel and communicate. The Code of Ethics states, “Patients’ rights are the primary factor in any decisions regarding personal information, whether from or about the patient. ... healthcare providers have experienced notable challenges to balance necessary time for patient care with computer entry. I know first-hand of 2 sentinel events caused by the systems (X and Y). Email: susan.mcbride@ttuhsc.edu. She subsequently reports the request by the physician to drip slowly in a verbal handoff to the ICU nurse who receives the patient. However, ethical issues surrounding dominance of institutional priorities over autonomous patient-centered practice and care driven by application of decision-support, templates, and/or clinical practice guidelines (CPGs) have been documented (Lown & Rodriguez, 2012; McBride, Tietze, Hanley, & Thomas, 2015; Sulmasy, López, & Horwitch, 2017). A., & Rodriguez, D. (2012). Not all issues will require an in-depth consideration of all elements in a specific model, and the goal is to reach a prudent choice, not certainty. Canadian Medical Protective Association, 2015(May), 1-3. Studies have indicated that, in many respects, care has improved with use of technologies and, when meaningful use of EHRs is fully achieved and experienced by nurses, they are much more likely to be satisfied with the EHR (McBride, Tietze, Hanley, & Thomas, 2017). The growing role of informatics in nursing has also created a number of new job titles for those with clinical experience and an interest in working with data. Ethical decision making. However, analysis of text comments found patterns and trends that reflected distress related to moral issues and ethical dilemmas (please note that we are using the terms "moral" and "ethical" interchangeably in accordance with the current literature). A conceptual model that reflects the overall common concepts detected in the thematic analysis was developed by the research group and is also noted in Figure 1. For example, the following was one of 352 statements by nurses about EHR experiences: Yes, the documentation of "quality standards" has greatly improved, but patient care and patient safety has not. She is currently an American Academy of Nursing Jonas Health Policy Scholar. Concerns that patients and their families have not been fully informed about their treatments or clinical prognosis is a common ethical concern of nurses, Ulrich reported. Although new technology may be a challenge for some, informatics will enhance nursing practice. The third component in the FCM, ethical motivation is the bridge between decision-making and action (Robichaux, 2017). Nurses must be prepared to face these challenges and recognize the requirements of state and federal law, workplace policies, and obligations of the profession. She worked for several years as a critical care nurse and later received her law degree. Online Journal of Issues in Nursing, 15(3), Manuscript 3. doi:10.3912/OJIN.Vol15No03Man03, Lachman, V. D. (2007). One change is the use of the electronic health record (EHR). Kuhn, T., Basch, P., Barr, M., & Yackel, T. (2015). (2016) described the moral distress of ED nurses who are unable to meet their role obligations to provide safe and effective patient care in such environments. Very frustrating because we constantly have to do double work. Data breaches can occur if information is not secured, or if it is misused. CIN: Computers, Informatics, Nursing, 35(1), 18-28. doi:10.1097/CIN.0000000000000290, McBride, S., Zolnierek, C., Tietze, M. F., Hanley, M. A., Thomas, L., & Song, H. (2015). The centrality of the patient-nurse relationship to the nursing discipline is reflected in the interpretive statement, “The nurse’s primary commitment is to the recipients of nursing and health care services” (ANA, 2015, p. 5). Copy and paste functionalities can result in unintentional reliance on outdated or inaccurate clinically relevant information, such as treatment plan; distracted notes; diagnostic biases; incorrect information for a specific patient visit; and expired patient symptoms and assessments (Scruth, 2014; Weis & Levy, 2014). Retrieved from http://bok.ahima.org/doc?oid=105098#.WmtkOmQ-doE, American Nurses Association. The CDS fires alerts that prompt the ordering physician to fluid resuscitate the patient according to the Center for Disease Control guidelines for suspected sepsis. Because most of the notes are copy and pasted, there are many discrepancies (on one line, the patient is intubated; on the next line of the same patient, the patient is on nasal cannula). Lack of supervisory support, fear of reprisal, and hierarchal decision-making may silence nurses’ moral voices (Pavlish, Hellyer, Brown-Saltzman, Miers, & Squire, 2013). She serves on the American Nurses Association Center for Ethics and Human Rights Advisory Board and the University of Minnesota Medical Center (Fairview) ethics committee. Our computers at times freeze inside the room. Information technology and statistical analyses have the potential to both further complicate and to contribute to the resolution of chang⦠Nurses experience moral distress, a concept first highlighted by Andrew Jameton in 1984, when they "know the right thing to do while being in a situation in which it is nearly impossible to do it." Dr. Robichaux is an Adjunct Assistant Professor at University of Texas Health; San Antonio, Texas and The University of Mary in Bismarck, North Dakota. We provide a case scenario with application of the Four Component Model (FCM) (Rest, 1986). (2011). Overall, informatics has brought numerous benefits to the field of nursing and nursing education, yet more should be done to resolve ethical dilemmas. Perhaps the most troubling ethical issue noted is the potential erosion of the patient-nurse relationship (de Ruiter, Liaschenko, & Angus, 2016; Rathert, Mittler, Banerjee, & McDaniel, 2016). Changing nursing practice safely Education ⦠Continued What ethical issues have arisen or might arise from use of technology and informatics in professional nursing.How do you use informatics and technology in your nursing practice? Research focus is telehealth with a telemedicine, remote management and mobile health component. Nurses must have a seamless mechanism for reporting EHR challenges... Nurses face time constraints, overstaffing, and unfamiliarity with EHR systems on a daily basis. This case scenario can be examined in terms of the overall context of ethical implications in use of the EHR. Moral development: Advances in research and theory. When moral courage and ethical action are thwarted by constraints outside the nurse's control, moral distress can result. Retrieved from https://c.ymcdn.com/sites/www.texasnurses.org/resource/resmgr/HIT_Files/HIT_Survey_Report-Final.pdf, McBride, S., Tietze, M., Hanley, M. A., & Thomas, L. (2017). Developing moral courage may assist in overcoming personal and institutional barriers to further nurse advocacy. She feels very distressed but hopes for the best outcome for this patient. Nursing code of ethics issues surrounding EHRs Although the advent of electronic health records (EHRs) has provided many benefits, experts have found some ethical dilemmas surrounding their use â particularly when it comes to patient safety, according to a January 2018 study published in the Online Journal of Issues in Nursing. Defining Nursing Informatics (2012). Ethics, medicine, and information technology: Intelligent machines and the transformation of health care (2nd ed.). Comments by Nurses about their EHR Experience. Journal of Nursing Scholarship, 46(4), 263-270. doi:10.1111/jnu.12077, Healthy Aging Team. The physician agrees with the nurse but states, "just drip it in slow, otherwise if we don’t follow protocol we may fall out of the sepsis quality metric for the hospital. âNursing informatics specialists are the translators that have evolved into health tech innovators who establish businesses, manage medical economics, create technology and amplify the voice of end-user clinicians,â said Danielle Siarri, MSN, RN, a HIMSS member and social media ambassador, global nursing expert and the lead publisher at InnoNurse. (2012). In the case scenario, Nancy recognized that adhering to the EHR-triggered CDS guideline might result in a poor outcome. Moral courage can also be “learned, practiced, and mentored” (Hawkins & Morse, 2014, p. 268). Improving outcomes with CDS: An implementer’s guide (2nd ed.). By using powerful analytics engines, medical informatics delves deeper into healthcare data than ever before, revealing trends and correlations that otherwise might go undetected to improve patient outcomes as well as organizational efficiency. Most importantly, the EHR must not substitute for a current and accurate clinical assessment, and appropriate intervention (Campbell & Rankin, 2017; Lown & Rodriguez, 2012; Sulmasy et al., 2017). Nurse managers and executives have a particular obligation to ensure that direct care nurses are empowered to identify and engage in ethical situations associated with EHRs. An ethical dilemma or ethical paradox is a decision-making problem between two possible moral imperatives, neither of which is unambiguously acceptable or preferable. Legal concerns over notification of federally regulated drug interactions, through pop-ups or alerts, can be overwhelming or desensitizing to the nurse (Sittig & Singh, 2011). Quality nursing documentation in the medical record. Although privacy, security, and confidentiality have been identified as three main areas of concern when using EHRs, little attention has focused on false entries, work-arounds, or system bypasses (Ayatollahi, Mirani, & Haghani, 2014; CMPA, 2015). ...formulaic alerts can present challenges to clinical decision making... One strength associated with certified EHRs under the HITECH Act of 2009 for supporting patient safety and quality is that evidenced-based protocols can be reinforced by using clinical decision support (CDS). She suspects that the afebrile patient does not have sepsis, but instead has an exacerbation of HF with possible pulmonary edema because the patient also exhibits 2+ pitting edema and crackles in both lung bases. Does Ethics Education Influence the Moral Action of Practicing Nurses and Social Workers? Nurse ethical sensitivity: An integrative review. Most importantly, the EHR must not substitute for a current and accurate clinical assessment, and appropriate intervention. [Nancy] feels very distressed but hopes for the best outcome for this patient. Barriers to innovation: Nursesʼ risk appraisal in using a new ethics screening and early intervention tool. The text narrative responses were then reorganized according to concepts and summarized into categorical statements. Although the case study and the Texas nurses’ comments reflected ethical issues raised by nurses, there are significant implications for the entire care team given the EHR is the primary means of interprofessional communication. Since 2010, she has been the co-chair of the Texas Nurses Association/Texas Organization of Nurse Executives Health Information Technology committee to represent nurses' experiences related to information technology use in their practice of patient care delivery. Jameton described three components that can apply to the pain expressed by the nurses that contributed to the Texas study: knowing what is right, being in a situation that constrains acting on that knowledge, and the psychological distress resulting from that inability to do the right thing (Jameton, 2017). The TNA-TONE HIT committee was charged with examining how Texas nurses were impacted by newly implemented EHRs across the state and to establish baseline measures of nurse satisfaction to inform evidence-based improvement strategies. You are currently offline. Nursing ethics and professional responsibility in advanced practice (2nd ed.). (2015). The AHIMA principles cite the primacy of accuracy, avoidance of conflicts of interest, and similar to the ANA code, “respect [for] the inherent dignity and worth of every person” (AHIMA, 2011, 11).
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