Assignment: Application:
Design Considerations and Workarounds

When nurse informaticists are tasked with identifying the most appropriate technology to meet a specific need within a health care setting, there are many questions that must be asked.

Consider the following scenario:

Riverdale Hospital has come under recent scrutiny for their medication procedures. Many times, paper medication records are not up to date or have been misplaced. As a result, patients have increasingly received their medications at the wrong times. Though each nurse is performing to the best of his or her ability, the fast pace of the hospital has caused some to ineffectively manage patient records. 

The lead nurse informaticist, Nancy, has decided that a bar code scanner could help streamline the documentation process while also improving patient quality and safety. Nancy knows that when selecting a bar coding system she must not only examine the hardware and software of the system but also consider the various human factors that can positively and/or negatively affect the outcomes of the system implementation. As such, Nancy asked three of the most reputable bar code vendors to bring sample systems to Riverdale Hospital. 

In evaluating each system, Nancy role plays the process of scanning a patient’s bar code. She rolls the coding cart into the room to begin her mock demonstration. First, Nancy scans her identification card to gain access to the medication screen. To scan the patient’s bar code identifier, Nancy then pulls the medication cart to the patient so that the attached scanner reaches the bar code on the patient’s wristband. When the scan is complete, the computer displays a screen that houses the patient’s personal information. By navigating the screens, Nancy finds that she can use the computer to track medication administration. In addition, Nancy is able to view applicable vitals and medication history. As Nancy continues to examine this system, she reflects on the other hardware and software facets she should be sure to consider. She also thinks about how human factors will affect this and other vendor systems.

In this Assignment, you consider how hardware, software, and human factors can impact the implementation of an informatics system.

To prepare:

· Review Chapter 30, “The Role of Technology in the Medication-Use Process,” in the course text, Essentials of Nursing Informatics. When examining computerized prescriber order entry (CPOE) systems and bar code-enabled technologies, what hardware, software, and human factors did the authors identify?

· Consider how each of these factors can negatively impact patient safety and quality of care.

· How might these factors translate to the usability, implementation, and outcomes of other informatics technologies?

· Review the media presentation Selecting New Technologies in this week’s Learning Resources. How did presenter Dr. Patricia Button take the above factors into consideration when selecting an informatics technology for her health care setting?

· When planning and selecting a new informatics system, what steps should informaticists take to ensure the system will address the needs of their health care setting? In addition, how can informatics leaders encourage all nurses to commit to using a new technology?

To complete:

Submit a 4- to 5-page paper that addresses each part of this Assignment:

· Part 1: Design Considerations

 Identify two (2) major design considerations associated with each of the following: hardware, software, human factors. (6 considerations in total).

 Describe why informaticists should play close attention to each of these 6 considerations when evaluating an informatics technology. In your description, include the potential dangers each of these pose to patient safety and quality of care.

· Part 2: Employee Workarounds

Even with a carefully thought out design and implementation, nurses and other health care employees may adopt workarounds. With this reality in mind:

What benefits and/or consequences do you associate with workarounds?

When selecting an informatics technology, would you opt to purchase a system that mitigates the opportunity for workarounds; or do you believe that workarounds are sometimes necessary? Justify your response.

Note: Your responses should focus on informatics technologies in general, not just bar code scanners as portrayed in the scenario. You may, however, use specific examples such as bar code scanners and other informatics technologies to justify your responses.

Case Assignment

Part I (approximately 1–1½ pages, total):

Copy and paste the following examples (1-6 below), then respond by classifying each of the following variables as either: nominal, ordinal, interval, or ratio. Provide a brief explanation where indicated.

1. A researcher studying lifespan categorizes individuals into single, married, divorced, or widowed. What type of variable measurement is this?
2. A cognitive scientist places her subjects into categories based on how anxious they tell her that they are feeling: “not anxious,” “mildly anxious,” “moderately anxious,” and “severely anxious,” and she uses the numbers 0, 1, 2 and 3 to label categories where lower numbers indicate less anxiety. What type of variable measurement is this? Are the categories mutually exclusive?
3. A Physician diagnoses the presence or absence of disease (i.e., yes or no). What type of variable measurement is this?
4. A person weighing 200 lbs. is considered to be twice as heavy as a person weighing 100 lbs. In this case, what type of measurement is body weight?
5. A nurse takes measurements of body temperature on patients and reports them in units of degrees Farenheit as part of a study. What type of variable measurement is this?
6. Patients rate their experience in the emergency room on a five point scale from poor to excellent (1 = very poor, 2 = not very good, 3 = neither good nor bad, 4 = quite good, and 5 = excellent). What type of variable measurement is this? Is the difference between a 1 and a 2 necessarily the same as the difference between a 3 and a 4? Explain briefly.

Part II: Statistics (1/2 page)

Given what you’ve learned in this module about the meaning of “statistics,” choose one of the examples from Part I (1-6), and raise a relevant question of your own that could be answered by a statistician. Then without answering your own question, explain how a pattern could be studied or a useful prediction made based on data that are to be collected.

Part III: Quantitative vs. Qualitative Data (approximately 1–1½ pages)

A health scientist wishes to measure how well participants diagnosed with Post Traumatic Stress Disorder are coping. Explain how a variable such as coping could be measured quantitatively or qualitatively.

Assignment Expectations

Assessment and Grading: Your paper will be assessed based on the performance assessment rubric that is linked within the course. Review it before you begin working on the assignment.

The following guidance appears only in Module 1, but it applies to the assignments throughout the course:

File format: Your work should be prepared using Microsoft Word, PowerPoint, or Excel depending upon the assignment instructions. For assignments requiring video or voice recordings, use media formats that are supported by MyTLC Courses as noted in our Trident Support page.

In-text citations and references: Be sure that all information and ideas in your papers are supported by in-text citations and corresponding references at the end of the paper.

Scholarly sources: Online sources must be limited to credible professional and scholarly publications such as peer-reviewed journal articles, e-books, or specific webpages on websites from a university, government, or nonprofit organization (these have extensions .edu, .gov, or .org). Presenting consumer sources such as e-magazines, newspapers, Wikipedia, WebMD, or other commercial websites (these have extensions .com) as references is not appropriate.

Scholarly writing: Use an academic paper format, not an essay based on your opinions or experience. Avoid using the first person in writing. Synthesize what you learned from the sources you read; write papers in your own words; and cite sources within the text, as well as include a properly formatted reference list.

Use of direct quotes: Use of direct quotes should be avoided. Only use direct quotes when preserving the exact words of an author is necessary. In the rare instance that directly quoted material is used, it must be properly cited (with quotation marks and page numbers in the in-text citation); quotes should not exceed 5-10% of the total paper content.

Question 1 An older patient recalls family members using garlic for medicine. What purpose does garlic serve as a health care practice?

Select all that apply.

1. Forces other people to stay away
2. Belief that garlic keeps the evil spirits away
3. Cures a sore throat
4. Helps indigestion

Question 2 A group of nurses is talking about different ethnocultural practices regarding health that are followed within each of the nurses’ families. What purpose will this discussion serve?

Select all that apply.

1. Reawaken the types of HEALTH practices within each nurse’s family
2. Make known the similarities and differences across ethnic and religious groups
3. Help to realize that all people practice a certain amount of traditional medicine
4. Understand that nurses often delay in seeking professional healthcare

Question 3 A patient of the Austrian-American Jewish tradition tells the nurse how to treat boils. What will this patient most likely explain to the nurse?

1. Apply a fried chopped onion compress to the area.

2. Press cold tea bags to the area.

3. Apply a flaxseed poultice to the area.

4. Place hot Epsom salts on the area.

Question 4 Which dietary practice is followed by individuals of Swedish-American Protestant heritage to treat feeling run-down and tired?

eating a whole head of lettuce

Question 5 A patient recalls being told about various childhood illnesses by his mother. Why is heritage exploration often done through women?

1. Women are the guardians of the family’s health/HEALTH and nurturance.
2. Women live longer than men and can remember events better.
3. Women have a better recall of events within a family context.
4. Women are the authority figures within families.

Question 6 Which health restoration practice for a cold would the nurse assess in a patient of English Catholic heritage?

1. Rubbing the chest with Vicks

2. Drinking honey and vinegar

3. Gargling with water and vinegar

4. Drinking warm milk

Question 7 Which heritage group boils a beef bone, breaks up toast in the broth, and drinks as a HEALTH restoration practice for a headache?

1. German-Americans
2. Polish-Americans
3. Irish-Americans
4. Canadians

Question 8 Which actions are considered to be health restoration practices for individuals of Eastern European Jewish heritage?

Select all that apply.

1. Chicken soup

2. Glass of wine

3. Alcohol massage

4. All of the above

Question 9 Which action would a patient from Italian-American Catholic heritage perform to protect health?

1. Never washing hair before going outdoors
2. Keeping a kitchen warm
3. Drinking water with meals
4. Taking regular vitamin tonics

Question 10 Through a health history, the nurse learns that a patient’s parents were of Austrian Jewish heritage. Which health practices would the nurse most likely assess in this patient?

Select all that apply.

1. Baking bread
2. Eating homegrown fruits and vegetables
3. Wearing camphor around the neck
4. Gargling with salt water

“A long-standing debate has roiled over whether addicts have a choice over their behaviors. The disease creates distortions in thinking, feelings, and perceptions, which drive people to behave in ways that are not understandable to others around them. Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause.”

–Dr. Raju Hajela, former president of the Canadian Society of Addiction Medicine

A common misconception is that addiction is a choice, and addicts are often labeled as individuals who lack morals, willpower, or responsibility. However, addiction is a clinical disorder that must be treated with the support of a health care professional. Although many people who are exposed to potentially addictive substances and behaviors continue life unaltered by their experiences, some people are fueled by these experiences and spiral out of control. In your role as the psychiatric mental health nurse practitioner, you must be prepared to not only work with these individuals who struggle with addiction, but also help them and their families overcome the social stigmas associated with addictive behavior.

This week, as you explore psychotherapy for addiction, you assess clients presenting with addictive disorders. You also examine therapies for treating these clients and consider potential outcomes. Finally, you develop diagnoses for clients receiving psychotherapy and consider legal and ethical implications of counseling these clients.

Learning Objectives

Students will:

· Develop diagnoses for clients receiving psychotherapy*

· Evaluate the efficacy of motivational interviewing techniques for clients*

· Analyze legal and ethical implications of counseling clients with psychiatric 

  disorders*

   Select a client whom you observed or counseled this week. Then, address the  

   following in your Practicum Journal:

·  Describe the client (without violating HIPAA regulations) and identify any  

   pertinent history or medical information, including prescribed medications.

· Using the DSM-5, explain and justify your diagnosis for this client.

·  Explain whether motivational interviewing would be effective with this client.   

   Include expected outcomes based on this therapeutic approach. Support your  

   approach with evidence-based literature.

·  Explain any legal and/or ethical implications related to counseling this client.

·  Support your approach with evidence-based literature.

· NOTE: PLEASE SEE THE ATTACHED Practicum Journal Template AND JOURNAL SAMPLE (TIME LOG & JOURNAL ENTRIES) FOR WRITING THIS ASSIGNMENT…..ALSO FOR THE TIME LOG AND JOURNAL ENTRIES, JUST MAKE UP A REASONABLE INFORMATION AND CLIENT INFORMATION IN MENTAL HEALTH NURSING.

Required Readings

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

• Chapter 7, “Motivational Interviewing” (pp. 299–312)
• Chapter      16, “Psychotherapeutic Approaches for Addictions and Related Disorders”      (pp. 565–596)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.