DISCUSSION- 1
The Effects of “To Err Is Human” in Nursing Practice
The 1999 landmark study titled “To Err Is Human: Building a Safer Health System” highlighted the unacceptably high incidence of U.S. medical errors and put forth recommendations to improve patient safety. Since its publication, the recommendations in “To Err Is Human’ have guided significant changes in nursing practice in the United States.
In this Discussion, you will review these recommendations and consider the role of health information technology in helping address concerns presented in the report.
To prepare:
Review the summary of “To Err Is Human” presented in the Plawecki and Amrhein article found in this week’s Learning Resources.
Consider the following statement:
“The most significant barrier to improving patient safety identified in “To Err Is Human” is a “lack of awareness of the extent to which errors occur daily in all health care settings and organizations (Wakefield, 2008).”
Review “The Quality Chasm Series: Implications for Nursing” focusing on Table 3: “Simple Rules for the 21st Century Health Care System.” Consider your current organization or one with which you are familiar. Reflect on one of the rules where the “current rule” is still in operation in the organization and consider another instance in which the organization has effectively transitioned to the new rule. The Effects of “To Err Is Human” in Nursing Practice
Please Provide References
Learning Resources
Required Readings
American Nurses Association. (2015). Nursing informatics: Scope & standards of practice (2nd ed.). Silver Springs, MD: Author.
“Introduction”
This portion of the text introduces nursing informatics and outlines the functions of the scope and standards.
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 1, “Nursing Science and the Foundation of Knowledge”
This chapter defines nursing science and details its relation to nursing roles and nursing informatics. The chapter also serves as an introduction to the foundation of knowledge model used throughout the text.
Chapter 2, “Introduction to Information, Information Science, and Information Systems”
In this chapter, the authors highlight the importance of information systems. The authors specify the qualities that enable information systems to meet the needs of the health care industry.
Wakefield, M. K. (2008). The Quality Chasm series: Implications for nursing. In R. G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses (Vol. 1, pp. 47–66). Rockville, MD: U. S. Department of Health and Human Services.
Pages 1–12
These 12 pages highlight the issues raised by the Quality Chasm Series and examine their long-term implications for nursing. The text reviews external drivers of safety and quality, design principles for safe systems, and guidelines for health care redesign.
Cipriano, P. F., & Murphy, J. (2011). Nursing informatics. The future of nursing and health IT: The quality elixir. Nursing Economic$, 29(5), 282, 286–289.
In this article, the authors focus on how nurses can use health information technology to help transform health care using the recommendations included in the 2010 Institute of Medicine report “The Future of Nursing, Leading Change, Advancing Health.” The author also discusses the 2011 National Strategy for Quality Improvement in Health Care.
Plawecki, L. H., & Amrhein, D. W. (2009). Clearing the err. Journal of Gerontological Nursing, 35(11), 26–29.
This article presents a summary of the Institute of Medicine report “To Err Is Human: Building a Safer Health System.” The authors provide an overview of what has been accomplished in the decade following the IOM report, focusing in particular on health information technology. The Effects of “To Err Is Human” in Nursing Practice
Required Media
Laureate Education (Producer). (2012e). Introduction to nursing informatics. Baltimore, MD: Author.
In this video, Doris Fischer, Richard Rodriguez, Carina Perez, and Carmen Ferrell introduce the concept of nursing informatics. These individuals provide insight into how informatics is transforming the health care system by improving efficiency and quality of care.
Optional Resources
Hilts, M. E. (2010). Up from the basement. Health Management Technology, 31(9), 14–15.
Retrieved from the Walden Library databases.
Institute of Medicine. (1999). To err is human: Building a safer health system. Retrieved from http://web.archive.org/web/20141016134546/http://www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf
Kohn, L. T., Corrigan, J. M., & Donaldson, M.S. (Eds.). (2000). To err is human: Building a safer health system. Washington, D. C.: Institute of Medicine. Retrieved from the National Academies Press website: https://download.nap.edu/catalog.php?record_id=9728
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DISCUSSION-2
Nursing Informatics Competencies The Effects of “To Err Is Human” in Nursing Practice
Today’s fast-paced health care environment demands nurses to be skilled not only in their clinical practice or specialty area but in the use of technology tools that improve practice and lead to better patient care. Basic and advanced technology competencies are required and expected as technology increasingly touches and changes the job of every nurse. Numerous organizations, including the American Nurses Association (ANA), the American Medical Informatics Association (AMIA), and Healthcare Information and Management Systems Society (HIMSS), have developed nurse-specific technology competencies. The challenge for nurses is to identify both needs and training opportunities.
In this Discussion, you identify the role informatics plays in your professional responsibilities. You pinpoint personal gaps in skills and knowledge and then develop a plan for self-improvement.
To prepare:
Review Nursing Informatics: Scope and Standards of Practice in this week’s Learning Resources, focusing on the different functional areas it describes. Consider which areas relate to your current nursing responsibilities or to a position you held in the past. For this Discussion, identify one or two of the most relevant functional areas.
Review the list of competencies recommended by the TIGER Initiative. Identify at least one skill in each of the main areas (basic computer competencies, information literacy competencies, and information management competencies) that is pertinent to your functional area(s) and in which you need to strengthen your abilities. Consider how you could improve your skills in these areas and the resources within your organization that might provide training and support.
Please Provide References
Learning Resources
Required Readings
American Nurses Association. (2015). Nursing informatics: Scope & standards of practice (2nd ed.). Silver Springs, MD: Author.
“Functional Areas for Nursing Informatics”
This chapter describes the key functional areas of nursing informatics. It also clarifies the roles of informatics nurse specialists and informatics nurses.
“Informatics Competencies: Spanning Careers and Roles”
This chapter details an informatics competencies matrix that has been developed by reviewing research. It outlines best practices for successful use of health information technology.
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 7, “Informatics Roles and the Knowledge Work of Nursing”
This chapter details the roles, competencies, and skills that ensure effective nursing informatics practice. The text also details the future of nursing informatics.
Chapter 8, “Information and Knowledge Needs of Nurses in the 21st Century”
In this chapter, the author emphasizes the need for embedding the core concepts and competencies of informatics into the practice of nurses. The chapter describes how this integration of concepts and competencies is necessitated by the integration of clinical information technologies into nursing practice.
Wakefield, M. K. (2008). The Quality Chasm series: Implications for nursing. In R. G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses (Vol. 1, pp. 47–66). Rockville, MD: U. S. Department of Health and Human Services. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2677/
Pages 12–19
This chapter discusses four of the Institute of Medicine’s reports on the quality and safety of health care. Specifically, the chapter focuses on the issues, concepts, findings, and recommendations of To Err Is Human, Crossing the Quality Chasm, Health Professions Education: A Bridge to Quality, and Quality Through Collaboration: The Future of Rural Health Care.
Cheeseman, S. E. (2011). Are you prepared for the digital era? Neonatal Network, 30(4), 263–266.
This article explores the application of health information technology (HIT) in neonatal intensive care units. In addition, the article highlights national initiatives advocating for the implementation of HIT throughout the health care delivery system.
AMIA. (2012). AMIA. Retrieved from http://www.amia.org/
This homepage of AMIA (formerly known as the American Medical Informatics Association) details the activities of the AMIA, including its publications, programs, events, and policies.
Healthcare Information and Management Systems Society. (2012a). Healthcare Information and Management Systems Society. Retrieved from http://www.himss.org/
This homepage of the Healthcare Information and Management Systems Society displays research conducted by HIMSS and introduces various tools, events, and resources for professional development.
Healthcare Information and Management Systems Society.(2012b). Resources/reports. Retrieved from https://web.archive.org/web/20151108084347/http://www.thetigerinitiative.org/resources.aspx
This page of the TIGER website contains a list of resources and reports related to the development and implementation of technology informatics.
Healthcare Information and Management Systems Society.(2012c). The TIGER initiative. Retrieved from http://www.thetigerinitiative.org/
This site includes information on the phases of the TIGER Initiative and includes related resources and reports, opportunities for strategic partnerships, and general information about TIGER.
Technology Informatics Guiding Educational Reform. (2009). TIGER informatics competencies collaborative final report. Retrieved from http://tigercompetencies.pbworks.com/f/TICC_Final.pdf
This text details foundational informatics competencies that nurses should possess in order to meet standards of providing safe, quality, and competent care. In particular, this article specifies requirements for nurses in the areas of basic computer competencies, information literacy, and information management. The Effects of “To Err Is Human” in Nursing Practice
The TIGER Initiative. (2009). Informatics competencies for every practicing nurse: Recommendations from the TIGER collaborative. Retrieved from https://web.archive.org/web/20150323183938/http://thetigerinitiative.org/docs/TigerReport_InformaticsCompetencies_001.pdf
This report supplies the findings and recommendations of the Informatics Competencies Collaborative Team. The text describes the background, methodology, findings, and recommendations for future work as stated by the team.
Quality and Safety Education for Nurses. (2012). Quality and Safety Education for Nurses. Retrieved from http://www.qsen.org/
This homepage supplies information on quality and safety competencies, teaching strategies, faculty resources, pilot schools, and QSEN Consultants.
Required Media
Laureate Education (Producer). (2012d). Health information technology competencies. Baltimore, MD: Author.
Optional Resources
Schleyer, R. H., Burch, C. K., & Schoessler, M. T. (2011). Defining and integrating informatics competencies into a hospital nursing department. CIN: Computers, Informatics, Nursing, 29(3), 167–173.
DISCUSSION-3
Standardized Coding Systems
As a result of the fragmented nature of the health care system, professionals in various specialty areas of medicine have developed their own unique sets of terminology to communicate within that specialty. In the past, limited attention has been given to codifying practices in order for them to be understood and utilized across disciplines or through different information technology systems. The implementation of a federally mandated electronic medical records system, therefore, poses a challenge to nursing professionals and others who must be prepared to utilize standardized codes for the new system. Why are coding standards important for promoting consistent, high-quality care?
According to Rutherford (2008, para. 15), “Improved communication with other nurses, health care professionals, and administrators of the institution in which nurses work is a key benefit of using a standardized nursing language.” In this Discussion you consider the reasoning behind and the value of standardized codification.
To prepare
Review the information in Nursing Informatics: Scope and Standards of Practice. Determine which set of terminologies are appropriate for your specialty or area of expertise.
Reflect on the importance of continuity in terminology and coding systems.
In the article, “Standardized Nursing Language: What Does It Mean for Nursing Practice?” the author recounts a visit to a local hospital to view its implementation of a new coding system. One of the nurses commented to her, “We document our care using standardized nursing languages but we don’t fully understand why we do” (Rutherford, 2008, para. 1). Consider how you would inform this nurse (and others like her) of the importance of standardized nursing terminologies.
Reflect on the value of using a standard language in nursing practice. Consider if standardization can be limited to a specialty area or if one standard language is needed across all nursing practice. Then, identify examples of standardization in your own specialty or area of expertise. Conduct additional research using the Walden Library that supports your thoughts on standardization of nursing terminology.
Please Provide References
Learning Resources
Required Readings
American Nurses Association. (2015). Nursing informatics: Scope & standards of practice (2nd ed.). Silver Springs, MD: Author.
“Metastructures, Concepts, and Tools of Nursing Informatics”
This chapter explores the connections between data, information, knowledge, and wisdom and how they work together in nursing informatics. It also covers the influence that concepts and tools have on the field of nursing.
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 6, “Overview of Nursing Informatics”
This chapter defines the foundations of nursing informatics (NI). The authors specify the disciplines that are integrated to form nursing informatics, along with major NI concepts.
Brokel, J. (2010). Moving forward with NANDA-I nursing diagnoses with Health Information Technology for Economic and Clinical Health (HITECH) Act Legislation: News updates. International Journal of Nursing Terminologies & Classifications, 21(4), 182–185.
In this news brief, the author describes the initiatives that NANDA-I will implement to remain abreast of the HITECH legislation of 2009. The author explains two recommendations for the federal government’s role in managing vocabularies, value sets, and code sets throughout the health care system.
Matney, S., Brewster, P. J., Sward, K. A., Cloyes, K. G., & Staggers, N. (2011). Philosophical approaches to the nursing informatics data-information-knowledge-wisdom framework. Advances in Nursing Science, 34(1), 6–18.
This article proposes a philosophical foundation for nursing informatics in which data, information, and knowledge can be synthesized by computer systems to support wisdom development. The authors describe how wisdom can add value to nursing informatics and to the nursing profession as a whole.
Rutherford, M. A. (2008). Standardized nursing language: What does it mean for nursing practice? OJIN: The Online Journal of Issues in Nursing, 13(1). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/vol132008/No1Jan08/ArticlePreviousTopic/StandardizedNursingLanguage.html
The author of this article provides justification for the use of a standardized nursing language, which will be necessary for incorporating electronic documentation into the health care field. The author defines standardized language in nursing, describes how such a language can be applied in a practice setting, and discusses the benefits of using a standardized language.
Westra, B. L., Subramanian, A., Hart, C. M., Matney, S. A., Wilson, P. S., Huff, S. M., … Delaney, C. W. (2010). Achieving “meaningful use” of electronic health records through the integration of the Nursing Management Minimum Data Set. The Journal of Nursing Administration, 40(7–8), 336–343.
This article explains the nursing management minimum data set (NMMDS), which is a research-based minimum set of standard data for nursing management and administration. The article describes how the NMMDS can be used to minimize the burden on health care administrators and increase the value of electronic health records within the health care system.
Required Media
Laureate Education (Producer). (2012a). Data, information, knowledge, and wisdom continuum. Baltimore, MD: Author.
McGonigle, D., & Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge (2nd ed.). Burlington, MA: Jones & Bartlett Learning. (p. 98, Chapter 6, Figure 6)
The continuum of data, information, knowledge, and wisdom is used in the health care field to describe discrete levels of understanding related to patient care and decision making. This video provides an overview of the continuum from data to wisdom.
Optional Resources
Truran, D., Saad, P., Zhang, M., & Innes, K. (2010). SNOMED CT and its place in health information management practice. Health Information Management Journal, 39(2), 37–39.
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Brown, B. (2011). ICD-10-CM: What is it, and why are we switching? Journal of Health Care Compliance, 13(3), 51–79.
Discussion:-4
Current Information and Communication Technologies
With so much attention focused on health care reform, it is important that nurses be given the opportunity to use high-quality technology tools. These tools can increase access to vital medical information, promote effective communication among health care professionals, and improve the patient experience. By actively seeking out and adopting these tools, nurses can greatly enhance the quality and safety of care that they provide.
This Discussion focuses on identifying quality technology tools that increase the ability of nurses to provide safe, effective care.
To prepare:
Review the various technology tools described in this week’s Learning Resources.
Identify a recently adopted information, education, or communication technology tool in your specialty area. Reflect on how it is used and how its use impacts the quality of care.
Consider how your identified technology tool might impact nursing practice if it were more widely used. What are some barriers preventing increased usage? How could wider implementation be facilitated? The Effects of “To Err Is Human” in Nursing Practice
Please Provide References
Learning Objectives
Students will:
Evaluate the effectiveness of a technology tool in your specialty area
Appraise the barriers and facilitators of implementing an information technology tool in your specialty area
Learning Resources
Required Readings
American Nurses Association. (2015). Nursing informatics: Scope & standards of practice (2nd ed.). Silver Springs, MD: Author.
“The Future of Nursing Informatics”
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 12, “The Human-Technology Interface”
This chapter describes the human-technology interface and explores some of the problems that result from its usage. The author also reflects on methods for improving the interface.
Chapter 19, “Telenursing and Remote Access Telehealth”
This chapter explores the usage of telehealth in nursing practice. The authors examine the role of telehealth, along with potential issues that may arise in its usage.
Brewer, E. P. (2011). Successful techniques for using human patient simulation in nursing education. Journal of Nursing Scholarship, 43(3), 311–317.
This article identifies studies that have used human simulation as an effective instructional tool in nursing education. The article describes different strategies for incorporating human simulation into nursing education, and it also offers insight on improvements that could be made to current practices.
Guarascio-Howard, L. (2011). Examination of wireless technology to improve nurse communication, response time to bed alarms, and patient safety. Herd, 4(2), 109–120.
The author explains the results of a study on the outcomes of using wireless communication devices to improve patient safety by allowing nurses to communicate more quickly and easily with other nurses. The results indicate that this technology can increase the value of team nursing, improve response time, and increase patient safety, although there are some drawbacks and challenges associated with the devices.
Simpson, R. L. (2012). Technology enables value-based nursing care. Nursing Administration Quarterly, 36(1), 85–87.
This article describes how technology can be used to address problems in the U.S. health care system, such as lack of consistency and lack of effective treatment. The article explains the use of value-based care initiatives and outlines how nurses can use these initiatives to improve outcomes in treatment and research.
Vinson, M. H., McCallum, R., Thornlow, D. K., & Champagne, M. T. (2011). Design, implementation, and evaluation of population-specific telehealth nursing services. Nursing Economic$, 29(5), 265–272, 277.
Telehealth is defined as health services that integrate electronic information and telecommunications to improve health care access, outcomes, and costs. This article describes how a telehealth implementation project was designed, enacted, and evaluated, and it analyzes the results of that project.
Required Media
Laureate Education (Producer). (2012c). Health care technologies. Baltimore, MD: Author.
This video features Katie Skelton, Doris Fischer, Carina Perez, Shannon Mori, Carmen Ferrell, and Lynn Tamanaha as they discuss current technologies and innovations in health care. They also describe a specific bed management-system that has improved their hospitals’ efficiency. The Effects of “To Err Is Human” in Nursing Practice
