Transforming Nursing and Healthcare through Technology (NURS – 6051N – 37)

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.

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.

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

DISCUSSION-2

Nursing Informatics Competencies

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 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.

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?

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.

Literature Review -Masters nursing class

Literature Review

PICOT question

            In the ischemic stroke patient what are the obstacles to dispensing thrombolytic therapy within the time frame of three hours of arrival to the emergency department ?

To prepare:

locate 5 or more full-text research articles that are relevant to your PICOT question. Include at least 1 systematic review and 1 integrative review if possible.

Read through the articles carefully. Eliminate studies that are not appropriate and add others to your list as needed

Complete a literature review summary table using the Literature Review Summary Table Template

To complete:

Write a 4- to 5-page literature review that includes the following:

• A synthesis of what the studies reveal about the current state of knowledge on the question that you developed
  • Point out inconsistencies and contradictions in the literature and offer possible explanations for inconsistencies.
• Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry
• Your literature review summary table with all references formatted in correct APA style

USE THE ATTACHED TEMPLATED AND PAY CLOSE ATTENTION TO PAGE 5

Critical Thinking in Nursing practice

Review the article Critical thinking at the bedside: Providing safe passage to patients (Robert & Petersen, 2013).

Scenario:

Adam is a 10-year-old scheduled for discharge from the Emergency Department after a bicycle incident resulted in a fractured right ulna and radius. His arm has been casted, is immobilized and in a sling. Adam states, “My arm feels better now, and I am sleepy. The pain medicine makes me feel like I will vomit.” The RN is reviewing medications with Adam and his mother when the mother states, “We have a two (2) hour drive home from this emergency room. Can you give Adam something for nausea so he does not throw up in the car?” The RN has already completed the discharge paperwork, and the orthopedic physician who casted the arm has left the Emergency Department. The RN states, “No orders are available for Adam to have nausea medicine. I can give him another dose of pain medicine if you think that will help him sleep on the way home. Then he might not vomit.”

Initial Discussion Post:

• Identify two (2) cognitive skills used in critical thinking the RN should have applied in this scenario
• Provide an alternative nursing intervention to ensure safe patient care in this scenario.

Base your initial post on your readings and research of this topic. Your initial post must contain a minimum of 250 words. References, citations, and repeating the question do not count towards the 250 word minimum.

Nursing-Contemporary issue position essay

Choose a case from the AMA Journal of Ethics Case Index and take a position. Identify the potential legal arguments (consider current federal guidelines), indicate any potential professional code conflicts you foresee, and support your position with an explanation of your own ethical/moral foundation.

In your 2 page paper:

• Identify the issue and state your ethical position.
• How might this scenario play out or impact you in your role as a nurse practitioner? 
• Defend your position with legal, ethical, and professional evidence.
• As part of your position, propose strategies and solutions for addressing the issues.
• What other ethical issues does this case bring to light, if any?

Support your position with at least one scholarly source (it may be your text).  Be sure to cite the article you choose, use APA format, and include a title page and reference page.

Article:Is parental smoking neglect of an asthmatic child?

Position: Parental smoking is neglect of an asmatic child

link to article: http://journalofethics.ama-assn.org/2014/04/ecas3-1404.html

The article:

Is Parental Smoking Neglect of an Asthmatic Child?

Commentary by Bahareh Keith, DO, and Kimberly B. Handley, MSW, LCSW

A mother carrying a coughing child walks into the emergency room. She hysterically flags down a triage nurse and tells her that her daughter, Rose, is having trouble breathing. The nurse directs mother and child to a bed in the emergency room cordoned off by a light blue curtain. Less than five minutes later, Tricia, a third-year medical student on her pediatrics rotation, shows up to do a thorough history and physical of the patient. The first thing Tricia notices is that both mother and daughter are saturated in the scent of cigarettes. Upon questioning, the mother admits to smoking two packs a day in the house.

“Have you tried quitting?” Tricia asks.

The mother scowls. “The smoking’s not a problem. I keep all the windows open.” At that moment, her daughter has a severe coughing fit. She scoops Rose into her arms, and rubs soothing circles on her back. “My daughter has asthma. That’s why we’re here,” she tells the student.

Tricia jots a note in the patient’s record and sees Rose has been admitted multiple times in the past for asthma. After flipping through these notes, Tricia sees that the mother has been counseled repeatedly about the need to stop smoking for the sake of Rose’s health. Tricia goes to find her attending and presents Rose’s case, highlighting signs of neglect. She then asks whether or not this would be grounds to notify child protective services.

Commentary

Neglect is failure to satisfy a child’s basic needs, not only those for food, clothing, and shelter but also those for appropriate and timely medical care and shielding from exposure to family violence and substance abuse in the home, among other things. Implicit in these is the classification of lack of parental supervision or failure to protect a child from harm as neglect. In considering whether Rose’s mother’s behavior is neglectful, we must ask whether Rose’s asthma exacerbations can be tied solely to the mother’s smoking or whether other factors that could contribute to the problem, such as allergens or other environmental triggers, are present.

Neglect can be categorized as mild, moderate, or severe depending on the degree of harm (or risk of harm) to the child and the frequency and length of time of the neglectful behavior. The Children and Families Safe Act of 2003 defines child maltreatment as “any recent act or failure to act on the part of a parent or caregiver which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm” [1]. So we must consider: what is the effect of Rose’s mother’s smoking on her health, safety, and well-being?

Studies are now demonstrating that secondhand smoke (SHS) can exacerbate or cause children to develop asthma. In a metaregression review, Vork et al. demonstrated that the duration of secondhand smoke exposure can incite asthma. After adjusting for confounding factors they found a 33 percent higher incidence of asthma among those exposed to secondhand smoke [2]. In a recent large meta-analysis Burke et al. found that there may be a 28-70 percent increased risk of incidence of wheezing due to SHS [3]. This is also supported by findings that anti-SHS legislation has resulted in an overall decrease in asthma-related visits to local emergency rooms [4].

The US Department of Health and Human Services includes asthmatic children exposed to secondhand smoke as an example of exposure to hazard, which can be categorized as inadequate supervision and neglect [5]. This means HHS considers secondhand smoke to belong to the same category as poisons, loaded guns, unsanitary living conditions, and lack of vehicle safety restraints. It also means that parents’ failure to follow a physician’s instructions can be defined as medical neglect according to some state laws [6]. Family courts, too, have been receptive to information about SHS exposure, particularly when a child suffers from a chronic respiratory illness such as asthma [7]. In Lizzio v. Lizzio [8], the Supreme Court of New York reversed a custody decision and assigned physical custody to one parent because the other parent refused to provide a smoke-free environment for him. Ultimately, then, the scenario of Rose and her mother is a recognized example of neglect.

Interventions

So what should we do? First and foremost, we must remember that we are in a partnership with the families that we care for. When the care of a child is suboptimal, we must first look at ourselves to ensure that we have done our best to provide families with the tools they need to keep their children healthy. We must summon the optimist in ourselves and assume that the parents are doing what they feel is best for their children. If what they are doing does not appear to be adequate care, then perhaps we have not done our best to educate them or give them the tools to be successful.

Next we must do our part in a noncritical and helpful manner and record what we have done so that the caregivers who follow us have an accurate record of the situation.

In this case, the mother clearly does not believe there is a connection between her child’s asthma and her smoking, a not-uncommon misperception. Fifty-eight percent of parents surveyed by Farber et al. who smoked and had asthmatic children reported that tobacco smoke exposure had little or no negative effect on their child’s asthma [9]. The medical student’s review of Rose’s record reveals that the mother has been told this before, but our duty is to be certain that she understands it. On the other hand, preaching at our patients and families is not always the most effective tactic. We must meet them where they are in terms of education level, with consideration of psychosocial factors and readiness to stop smoking.

Lack of resources or psychosocial burdens may contribute to this mother’s behavior [10]. Suppose, for example, that she is a single mother who lives in an apartment complex that does not allow smoking in public spaces and has a high crime rate. She may have decided that smoking inside with the window open is safer for her and her child than taking the risk of going across the street from her apartment to smoke.

A second place we may have failed this mother is by not giving her feasible options. Smoking is an addiction and, if she is unable to quit, merely counseling her to do so is not an effective way to reduce Rose’s secondhand smoke exposure. If a parent is not ready to quit, then other solutions should be offered. Hennessey et al. found that many families intend to ban smoking in their homes but encounter obstacles to doing so [11]. They concluded that it may be more effective to focus on considering alternative locations to smoke. Having the smoker take small steps—focusing on eliminating or reducing smoke exposure—could be more feasible and better received. For example, we may ask if it is possible for the mother to smoke outside. Other concrete practical instructions would include no smoking in the car, using a smoking jacket that is left outside, and washing hands after smoking.

It is also important to discern whether there are other neglectful actions—such as failure to fill the child’s prescriptions regularly or missed medical appointments—that could be contributing to Rose’s frequent exacerbations.

Once all this is done, if the child is still repeatedly harmed by the parent’s behavior then we must involve others to ensure that the child is safe. Reporting to child welfare authorities is mandatory if the effects on the child are severe. The state child welfare agency is more likely to provide services if the harm to the child is severe or if there is a pattern of neglect; e.g., the mother is not keeping doctor’s appointments or not filling the child’s medications. If there is uncertainty, then we must consider whether it would be beneficial to report. Reporting may cause a family to feel accused, become uncomfortable disclosing pertinent information accurately in the future for fear of repercussions, or even sever the therapeutic relationship. The essential and difficult question that physicians must ultimately answer is whether exposure to secondhand smoke is more harmful to Rose than being removed from her home would be.

Conclusion

Overall, employing supportive measures that augment parents’ natural tendency to protect their children may be the most effective approach to reducing secondhand smoke exposure in children. We must begin by providing parents with adequate, timely, and easily understandable education. Next we need to give them palatable options for decreasing their children’s smoke exposure. If we have helped the mother troubleshoot obstacles to reducing Rose’s smoke exposure and the child continues to be harmed by SHS, then we are ethically and legally bound to report that Rose is being neglected.

On a larger scale we can protect children by advocating for policy change; for example, a ban on smoking in cars and homes. Smoking in a vehicle in the presence of children is already banned in numerous areas of the world, including Australia, the United Arab Emirates, South Africa, and 5 American states [12]. Physicians could, for example, advocate for smoke-free laws governing all indoor spaces where children may be exposed.

Nursing Informatics and Patient Safety

In 2011, Mason General Hospital was named by Hospitals & Health Networks magazine as one of the “Most Wired” hospitals in the United States. What makes this particularly significant is that Mason General is a small, 25-bed, rural hospital in the state of Washington. It credits its success to nurse Eileen Branscome, director of clinical informatics. Under her leadership, the hospital adopted such innovations as visual smart boards where real-time patient information is always available. According to the magazine, those hospitals designated as “Most Wired” “show better outcomes in patient satisfaction, risk-adjusted mortality rates, and other key quality measures through the use of information technology (IT)” (Mason General Hospital and Family of Clinics, 2012).

Developments in information technology have enabled patients and health care providers to collaborate for quality improvement at an unprecedented level, and nurses have consistently been at the forefront of these efforts. This week you focus on the IOM report “To Err Is Human” and consider how health information technology has helped to address the issues of patient safety and quality health care.

Students will:

• Analyze the utilization of health information technology to address issues raised in the IOM report “To Err Is Human”
• Assess the role of informatics in improving health care safety.

Note: 1 or 1 1/2 pages discussion with 3 references, APA.