UNIT 5 : PRACTICE APPLICATION I.

NURSING PROCESS NURSING PROCESS is a patient-centered and goal oriented processes by which nurses deliver effective care to patients which involve assessment, nursing diagnosis, planning, implementation and evaluation. It is a cyclical, repetitive and ongoing process of nursing care and healthcare delivery. It is not only focused on ways to improve the patients physical needs, but also on social and emotional needs as well.

Effective communication between nurses and patient encourage consistency of healthcare delivery for the patient and provide a comfort level for the nurse as well.

1. ASSESSMENT Nursing assessment involves collecting vital data and fundamental information necessary for the next process. These data are gathered by the nurse through physical assessment, interviewing, and observing, and involve the use of basic senses. Other relevant data such as drug orders, laboratory and x-ray examination results, and information from other caregivers can also ne integrated in the system. Computer-enhanced automated nursing assessment can mitigate recording error and gathering erroneous data by integrating it to the statistical information system. Vital data can be coupled to the basic data and derived the necessary additional information.

2. DIAGNOSIS

Nursing diagnosis involves proper comprehension of the patients condition and response. Diagnostic process is complex and utilizes aspect of intelligence, critical thinking, and deeper thoughts of understanding.

It involves the interpretation of human behavior related to health. It provides the basis of selection of nursing intervention to achieve outcomes for which the nurse is accountable.

It can be best executed when there is a strong evidence of such results; evidence-based diagnosis can be enhanced through

computer based methods. Integration of all health information system offers sharing of techniques, strategies, success processes medication performance, good tactics and simple medication approach.

The automated system can provide predictive values which can facilitates diagnosis and decision process. 3. PLANNING Setting priorities, predicting expected outcome and establishing time tables are the main ingredients and components of nursing care planning. It sets a stage for writing nursing actions by establishing nursing pathways to streamline the activity, response and directions. Nursing care planning can be further enhanced through computer simulation; the computer program can predict results and test if the expected results match with the available data. Computer program can also prepare time table and optimal schedule and efficient strategies that is streamline in the nursing care process.

4. IMPLEMENTATION Nursing implementation is the action phase of the nursing process. It will detail the specific actions and activities the nurse needs to execute based on the plans. a. Independent nursing actions are those actions that needs own discretion and self judgment that does not require written guidelines and validation activities. Dependent nursing action or Collaborative actions involves actions that requires mutual decision making. (eg. MDs order and referral to other specialist) Nursing documentation should capture these very important actions executed and should be even more definite than what is generally found in the physician orders.

b.

Computer simulations can further enhance the decision making process of a nurse. The nurse can verify the next action involve and can also predict the possible solution to the situations

involved. The nurse can also search for other possible options and solutions that is readily fit to the condition. 5. EVALUATION Evaluation of the processes using computers with large amounts of patient data, help identify outcomes patients are likely to achieve based on individual problems and needs, and estimate the time frame for reaching outcome goals. During nursing evaluation, use the computer to record and store observations, patients responses to nursing interventions, and your own evaluation statements. You may also use information from the shared information of the strategies and future actions relevant to the service.

NURSING DOCUMENTATION It focuses mainly on health assessments, clients care plans, medications, administration records, nursing notes and discharge plans. All of these processes can be automated and enhanced with the use of computer system. The computer can store standard nursing care plans in a format determined by the hospitals and clinics, to be used by nurses as the basis for developing individualized clients care plan. It can also perform drug dosage calculation faster and more accurately. Nurses notes can be entered quickly by choosing statements, appropriate for a particular client from multiple preprogrammed choices.

BENEFITS OF NURSING INFORMATICS TO PRACTICE APPLICATION Nursing Informatics or Nursing Information System (NIS) are computer systems that manage clinical data a variety of healthcare environments, and made available in a timely and orderly fashion to aid nurses in improving patient care.

Some of the Key Features of Nursing information System

PATIENT CHARTING: Nursing assessments, care plan and nursing notes can be entered into the automated system with the graphical user interface. The data

are stored in the central repository system such as data warehouse for enhanced retrieval and accessibility of data when needed. These data are then translated into information via statistical information system that are embedded in the system. CLINICAL DATA INTEGRATION: Data and information can be shared to other department. With proper authority, these data and information can also be access by other entity and can be retrieved, viewed and analyzed by nursing stuff and then integrated into the clients care plan. DECISION SUPPORT: Decision support module can be added to nursing informatics system, and they provide prompts and reminders, along with guides to disease linkages between signs/symptoms, online access to medical resources can also be available. OPTIMAL OPERATION OF HOSPITAL AND CLINICS: Better drug administration, nursing staff scheduling, wards and rooms monitoring, patient profiling and patient mapping, and billing details.

BETTER CARE PLANNING: Time spent on care planning is reduced, while the
quality of while the quality of what is recorded is improved. This makes for more complete care plans and more complete assessments and evaluations.

II. CRITICAL CARE APPLICATION CRITICAL CARE NURSING is an area of expertise within nursing that focus specifically with human responses to life-threatening problems. A critical care nurse is responsible to ensure that critically ill clients and seriously conditioned individuals, in addition, critical care nurse or staff should ensure that families of the medically ill clients should receive optimum care. Intensive Care Units (ICU) Pediatric Intensive Care Units (PICU) Neonatal Intensive Care Units (NICU) Cardiac Care Units (CCU) Cardiac Catheter Laboratory And other special areas

CRITICAL CARE APPLICATIONS are areas where patients require complex assessment, high-intensity medication, continuous therapy and interventions, and unrelenting nursing attention and continuous watchfulness.

CRITICAL CARE NURSES work in a wide variety of applications, filling many responsibilities and work around. Examples are bedside clinicians, educators, guidance, researchers, report managers, advocate, specialists and practitioners. They need to keep pace with the latest information and develop skills to manage new treatment methods and technologies.

CRITICAL CARE INFORMATION SYSTEM will provide real-time resource utilization data and management of information and access critical care areas through the integration of the medical facilities in the critical care or intensive care unit to an intelligent computer system which is capable of processing all of these data. It also enables the electronic collection of hospital and patient-specific critical care data of the entire patient in the critical care areas which can be processed to create a patient profile which generate real-time and historical reports on indicators including bed occupancy, delayed discharges, readmission rates and outcomes.

The Medical Information Bus (MIB) provides a generalized method

of attaching patient monitoring devices to a common interface. It also has the ability to filter, store and select information sent for inclusion into the clinical medical record on the clinical computer system Bed side monitoring system such as heart rate from the ECG, parameters from arterial and pulmonary arterial invasive blood pressures, temperatures, arterial saturation and heart rate from pulse oximetry, infusion pumps, ventilators and other equipments are now transmitting clinical information for use in clinical data reporting and decision making. The manual and automatics information collected is used for complete computerized charting and for computerized decision making.

ADVANTAGES OF CRITICAL CARE INFORMATION SYSTEM Intelligently integrates and process physiologic and diagnostic information and store it to secure clinical repository Creates trends analysis with graphical representation of results Offline simulation can be performed to test the condition of the patient Provide clinical decision support system Provide access to vital patient information Provide feedback and quick evaluation of the patient condition and provides alert

III. AMBULATORY CARE APPLICATION AMBULATORY CARE covers a wide range of health care services that provided for clients who are not admitted overnight to a hospital. These services are performed at outpatient clinics, ER, primary care centers and others.

AMBULATORY CARE INFORMATION SYSTEM provides automated processing of data and information such as allergies and medical alerts, client accounting system, registration management for booking of appointments, client registration, emergency management and many more. With this system, the client waiting time is optimized through effective queue management.

ADVANTAGES OF AMBULATORY CARE INFORMATION SYSTEM Real-time and easy access to clients medical records by healthcare providers Improved workflow, which allows more time for comprehensive patient counseling and review

Reduced errors with the availability of various automation engines drug interaction engine; medical alert engine; etc

Automated and integrated back-end processes such as

pharmacy, billing, etc Improved clinical outcome analysis enhanced research productivity through data mining and facilitate institutional handling of managed care challenges in a timely manner Improvement in hospital inventory management Better monitoring & management of costs prescription, consumables, doctors fee, etc

IV. COMMUNITY HEALTH APPLICATION COMMUNITY HEALTH INFORMATION SYSTEM is a collective term for the methodical application of information sciences and technology to community and public health process.

Environmental factors are among the common concern of the community health information system. It also emphasizes on the prevention of diseases, medical intervention and public awareness.

One of the key goals of community health informatics is the effective and timely assessment involves monitoring and tracking the health status of the population which includes identifying and controlling disease outbreaks and epidemics. By relating health status to a variety of demographic, geographic, environmental, and other risk factors, it is possible to develop a correlation and identify risk factors that contribute to health problems.

Policy development in community health is based on science, but it is also derived from values, beliefs, and opinions of the society it serves.

Hospital Information System, Clinical Information System, HER focused more on individual and single resource contrary to community health information system which focused on information about majority of populations.

PRIMARY FOCUS OF COMMUNITY HEALTH INFORMATION SYSTEM Preventing, identifying, investigating communicable health problems and eliminating

Accessibility of data and information, through communication Educating and empowering individuals to adopt healthy lifestyle Facilitate the retrieval of data Effective transformation of data into information Effective integration of information to other disciplined concretized knowledge and create better understanding to

Creation of computerized patient records, medical information system Central repositories of all data such as data warehouse

ADVANTAGES OF COMMUNITY HEALTH INFORMATION SYSTEM Consistent exchange of response Disease tracking Data and information sharing Building strategies Early detection and monitoring of disease and sickness Control of spread of disease National alertness and preparedness

Building strong communication Maintain strong relation between nurses and other healthcare providers Continuous coordination of the healthcare professionals Synchronization of the decisions Streamlining of the process Effective management of data and information Optimal operation of hospital and clinics

V. EMERGENCY PREPAREDNESS AND RESPONSE EMERGENCY AND RESPONSE PROCESS is to halt the spread of diseases, infection, widespread sickness, epidemics, etc. Dengue outbreaks, for example, immediately spread in many areas, because there is lack of preparation, emergency measures and proper response of the healthcare providers, government, and most specially the public.

Through the effective use of technology, the healthcare industry can have immediate and instantaneous processed information, and in this way nurses and other healthcare providers can have a proper preparation for emergency and execute correct and timely response to the prioritized individuals.

Through the effective use of National Health Information System (NHIS) it will link all hospitals, practices and health practitioners as well as students in the country through the used of computer-based communications channels. The HER, HIS, CIS, etc are integrated through a central database system that are controlled and protected by a government health institution such as the Department of Health. With this, it can IMPROVE HEALTHCARE SERVICES by providing healthcare professionals better data access, quicker data retrieval, readily translated data into information, more versatile data output and presentation, less mathematical skills, no need to memorized index, patient profile, tables for references and good visualization of the results.

Segregation of data should also be captured in the reporting system to eliminate redundancy of data and maintain integrity of results. Repetition of data inputs should be eliminated so that propetr response and effective preparedness should be manifested.

Data tracker should be incorporated in the hospital information system through public and community health systems.

To enhance the emergency preparedness and response system, a special system such as national electronic disease surveillance system can be coupled and integrated to national information system.

PATIENT AND CONSUMER HEALTH INFORMATICS The ultimate goal of the health informatics is to bridge the gap between the healthcare system, information system and technology, communication system and health science. Healthcare and nursing focused on patient and consumer service particularly on: Developing an effective way to communicate with the client and customer without sacrificing the ultimate responsibilities of the nurse Development of system for the improvement of existing information and communication system Participate in the implementation of the integration of nursing informatics in the Philippines Development information system to support of client care and effective healthcare delivery system Removal of redundant systems of entering and recording the same data Strengthen the decision process of the nurses and healthcare providers Eliminate transcription errors Manage patient waiting time to reduce delay To humbly serve clients

NURSING INFORMATICS in the Philippines id relatively very young and the scope is enormous. It finds application in the conceptualization of clinical decision support systems of nurses and healthcare providers, development of computer systems, networks, and communication systems and in the study of the very essence of medicine and nursing. It is evaluated based on the nursing output, such as treatment of clients, how to handle clients, delivery of service

and healthcare provided based on the available information and how effectively that information is communicated from nurses to clients. PATIENT AND CONSUMER HEALTH INFORMATICS provides support they need to better manage their health decisions using the effective facilities, nursing and healthcare provider skills and other tools. This system also provides opportunity to manage certain aspects healthcare without going to the hospital and clinics. Internet-Based Health Information System increases accessibility of information provided by the Internet, and especially the World Wide Web protocols. When a healthcare provider suggests a medication or treatment to illness, disorder and sickness, it can be done remotely via a communication protocol. e-Health is defined as the application of Internet and other related technologies in the healthcare industry to improve the access, efficiency, effectiveness and quality of clinical and business processes utilized by healthcare organizations, practitioners and clients in an effort to improve the health status of clients. The quality control of health information on the internet in dependent of its main components: Proper education to the client Encouraging the self regulation of providers of health information Proper evaluation of the information Correct implementation of enforcement and sanctions in cases of dissemination of fraudulent or harmful information SECURITY is achieved by addressing its components such as integrity, privacy, availability, confidentiality and accountability. The data and information should not be made available or disclosed to unauthorized persons. The data should not be altered or shattered in an unauthorized manner. However, availability of data and information should be granted only to authorize person. Accountability is the ability to audit the processes and raw data which interact with the information to determine its appropriateness. THREATS exist to computer system and information: 1. Wicked code such as viruses, Trojan horses and worms 2. Malicious code often takes benefit of vulnerabilities in operating system software *proper use of programs and software such as antivirus and other potential threat of virus *responsibility for protecting the security of computerized information assets *organizations must perform an information security risk assessment which serves as the foundation for an assurance plan