Respond to Antoinette Anidi and Marteka Chitty, asking questions to help clarify the scenario and application of data, or offering additional/alternative ideas for the application of nursing informatics principles.
Antoinette Anidi
In the healthcare setting, the integration of informatics and knowledge work can significantly enhance patient care and operational efficiency. “The American Nurses Association (ANA) identified nursing informatics as “a specialty that integrates nursing, science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice” (Sweeny, J. 2017).” I will use a scenario involving a nurse leader addressing medication adherence among patients with chronic conditions, such as diabetes.
The scenario focuses on improving medication adherence among diabetic patients, which is crucial for their health outcomes and overall management of the disease. Non-adherence can lead to complications, increased hospital visits, and even death plus higher healthcare costs. The data to be used involves patient demographics which include age, gender, socioeconomic status, health literacy levels, and medication records: this involves the types of medications prescribed, dosages, and refill history. There are also patient feedback/surveys: which involves information on barriers to adherence, such as side effects, cost, or understanding of the treatment, and clinical outcomes: blood glucose levels, HbA1c results, hospital readmission rates, and lastly behavioral data: using health apps, reminders, or family support systems. Data collection can be accessed from electronic health record systems where medication prescriptions and patient history are documented. Patient surveys can be done through online platforms or during routine visits to gather qualitative data on patient experiences and barriers. Wearable devices could also be utilized to track health metrics related to diabetes management and conduct focus groups with patients to gain deeper insights into adherence challenges.
By analyzing this data, the nurse leader could derive several insights identifying common factors contributing to non-adherence and understanding the correlation between medication adherence and clinical outcomes. The nurse will also gain insights into patient preferences for medication reminders and support systems and recognize patterns in adherence among different demographic groups.
A nurse leader would use clinical reasoning and judgment in several ways by assessing the data to identify trends or gaps in adherence rates and understanding the underlying causes. She will also develop targeted interventions based on the data, such as educational programs tailored to specific demographics or implementing reminder systems. The nurse will continuously monitor the effectiveness of implemented strategies through follow-up data collection, adjusting interventions as necessary, and engaging with multidisciplinary teams to ensure a holistic approach to patient care, considering both clinical and psychosocial factors.
Marteka Chitty:
Imagine this: you arrive at work, and during your hand-off report, you notice one of your patients is behaving abnormally. Your loud and rambunctious patient is lying in bed with chills and cannot stop shivering. Her heart rate is indicating that she is tachycardic. What could be causing these symptoms?
In skilled nursing facilities, sepsis is becoming a more common issue. Sepsis leads to longer lengths of stay and higher healthcare costs. Sepsis also leads to unnecessary peripherally inserted central catheters (PICCs) and antibiotics treatment that the patient might not have needed initially. Early detection of infection can be beneficial to prevent unnecessary procedures. How can the signs and symptoms be interpreted before the patient gets septic in a skilled nursing setting? One way to detect the signs of an infection is a sepsis questionnaire.
Some data used in a sepsis questionnaire include evaluating vital signs and monitoring for changes in neurological status, gastrointestinal system, cardiac function, genitourinary system, and a skin assessment. Abnormal vital signs are one of the first clues to an impending infection. Questions include: is there any new or worsening confusion, or is there slow mental status? Evaluate the neurological aspect as infection in older individuals causes neurological issues. Changes in the gastrointestinal system tend to show up as diarrhea, nausea, and vomiting. Abnormal pulses can indicate an infection as well. Changes to the genitourinary system would be assessed by asking questions like any pain upon urination or decreased or increased urination. Issues such as chills, excessive perspiration, redness, swelling, and soreness are skin changes that we look for to indicate infection.
Once the data is collected and analyzed if two abnormal vital signs are present or any changes in one of the systems, further labs, and testing should be completed. Knowledge derived from this data could indicate an impending infection and alert nurses to the signs and symptoms of declining patients. The sepsis questionnaire will allow nurses to see and become familiar with patient bodily changes in real-time.
With this experience, nurses learn about sepsis and how it manifests in different people. Nurses also learn when sepsis is severe enough to transport patients to the hospital versus treating the infections in the facility. The nurse knows how sepsis is treated and how to ensure that the patients are less likely to become septic by using proper protocol. The overall process of using data from sepsis questionnaires can benefit all.
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