NR 393 Discussion Impact in the 21st Century 

NR 393 Discussion Impact in the 21st Century 

NR 393 Discussion Impact in the 21st Century 

Technology is an event of the 21st century that has made a huge impact on evidence in professional nursing practice.  The patient’s electronic health record puts a plethora of information at the nurse’s fingertips, with nurse charting, doctor and nurse notes, test results, orders, medications, and treatments, to name some of the valuable communication available.  “RNs utilize Internet resources . . .”, (Judd & Sitzman, 2014), also for patient care.  Not to mention, that all this information is quick to look up and record data, thus leaving more time to enhance the patient’s quality of care.  With information so readily available, and with computer charting saving time, evidence has shown that nurses have more time for “value-adding” activities, such as talking with patient’s families, increased time with the patient, communication with other team members, and personal satisfaction in their job performance (with less burnout).  (Moore et al, 2020). 

Health information technology also plays a part this century with patient safety, by using a barcode to scan a patient’s medication and the patient, and with information being in a typed form vs. handwritten (such as in doctor’s orders), to name a couple.  According to an article from NCBI, “The impact of health information technology on patient safety”, it states, “In 1999 the Institute of Medicine’s report “To err is human” called for developing and testing new technologies to reduce medical error. . .  This article is intended to review the current available scientific evidence on the impact of different health information technologies on improving patient safety outcomes.  We conclude that health information technology improves patient safety by reducing medication errors, reducing adverse drug reactions, and improving compliance to practice guidelines” (Alotaibi & Federico, 2017). 

Technology is ever changing and there is no getting away from it.  Technology is created to improve care and provide faster care.  Sometimes technology is good and sometimes not.  Transitioning from paper charting to computer charting was a plus.  Nurses do not have to keep track of papers during their work shift.  Thanks to the role of the nurse informaticist, the flow of nurse charting on the computer has been arranged for easier charting.  The computer also has all the patient information right there for you, if you need to look something up, rather than rifling through papers.  Patient safety with using technology has improved by no longer having to read a doctor’s handwriting for orders, and with medication errors.  The barcode scan is a safety measure for medications that works effectively, to stop from giving a patient a wrong medication or dose.  Of course, technology cannot always be relied upon.  Equipment does fail at times or can give a wrong result.  I have had the electronic Dynamaps read a blood pressure that did not seem correct, and in checking the blood pressure manually, there was quite a difference.  Even with technology, nurses must still check the patient, as machinery cannot replace eyes, caring, and the nurse’s knowledge.  Patients still need the human touch. 

References

Alotaibi, Y. K., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi medical journal38(12), 1173–1180. https://doi.org/10.15537/smj.2017.12.20631

Judd, D., & Sitzman, K.  (2014).  A history of American nursing:  Trends and eras.  (2nd ed.).  Jones & Bartlett.

Moore, E. C., Tolley, C. L., Bates, D. W., & Slight, S. P. (2020). A systematic review of the impact of health information technology on nurses’ time. Journal of the American Medical Informatics Association : JAMIA27(5), 798–807. https://doi.org/10.1093/jamia/ocz231Links to an external site.

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I can see why technology are so important in nursing. While most nurses do think about technology equaling EMR, nurses use so much more technology than we realize. On our newest unit in the hospital we have beds that speak to the patient and tell them to not get out of bed and to call the nurse. Rather than just a loud alarm going off, the alarm only sounds on the nurses vocera and at the nurses station. The mirrors also tell the patient good morning. We have voceras that ring a patient’s call light to the nurse in case we are not at the desk and to decrease alarm fatigue.  We utilize programable IV pumps, for heparin drips, you program the patient’s weight the desired mg/kg/hr, then the pump will set the ml/hr based off the same and once the nurse programs the desired ML to infuse the pump will determine the length of infusion. The nurse just has to make sure that the ml/hr is not over the max infusion rate. In nursing school we learn how to calculate drip rates, how to calculate infusion rates, while a lot of the time the IV pumps are now doing it for you. Nurses most know how to do these things on their own to make sure that the pump is correct. 

NR 393 Discussion Impact in the 21st Century 
NR 393 Discussion Impact in the 21st Century 

I have been at my current place of employment for 4 1/2 years.  When I started working there, I was surprised to learn of a device called a telesitter.  I had not heard of this before.  Telesitters watch patients from a remote area.  They watch patients for safety reasons such as confused, unsteady patients getting out of bed alone, pulling on lines such as IV lines, removing oxygen, or any other reasons that leaving the patient alone can be unsafe.  I remember being told for the first time to get a telesitter for a patient I had, and I had no idea what that was.  This is a piece of technology that can be helpful to patient safety, with a watchful eye on the patient, as the nurse cannot remain in just one patient’s room.  Besides watching the patient, the telesitter can talk to the patient.  The telesitter is a helpful device, however, if the person in the remote area is not paying attention to the patient, accidents can still happen.  Usually, when something is going on in the patient’s room that the nurse needs to address quickly, the telesitter will alarm, or the person watching the patient will call the nurse’s station.  There have been incidents where patients have fallen and no warning was given ahead of time.  Did the telesitter step away? Did the telesitter look away? Is one person watching too many patients? Was the patient too quick for a warning? But, patients have fallen and no after warning even occurred.  Telesitters are a good tool, as long as the patient is always being viewed.  I do not know if also having a picture of the patient at the nurse’s station is feasible or not, for more sets of eyes on the patient for safety.

Through the Institute of Medicine, a gathering of leadership in nursing, we seek to improve the nursing field and care of patients. Part of the research shown by IOM is that Bachelor prepared nurses yielded greater patient care (Glasglow, Dunphy, and Mainous, 2010). My employer will still begin nurses at an Associate degree level but require that within 5 years that nurses obtain a BSN.  Nursing continues in the 21st century to establish entry level education requirements as well as revising requirements for nursing educators and higher practice nurses (Glasglow, Dunphy, and Mainous, 2010).

Nursing as a discipline aims to better educate those who wish to become nurses as a second career in accelerated Bachelor’s programs and promotes the support of Master’s and Doctorate prepared nurse (Glasglor, Dunphy, and Mainous, 2010). Nursing really is our own discipline and we have to promote it, make ourselves known, and justify our field now and in the future.

Reference

Glasgow MES, Dunphy LM, Mainous RO. (2010). Innovative nursing educational curriculum for the 21st century. Nursing Education Perspectives31(6):355-7.

Professor and class, 

On my unit they introduced a new call bell system that will not only alarm but send an alert to the nurses station at which specific room it is coming from. With this new technology I have found that patients are getting annoyed because they are so sensitive and tend to wake them up during the night going off if they move in the slightest. Some patients even know how to turn the alarm off themselves because it is attached to the wall. If I were to suggest something I would say the system should not be visible to our patients and should be hidden so they are not able to click it off themselves. As for the sensitivity, I don’t know how that can be improved maybe it has something to do with the way the alarm is placed on the mattress. 

I completely agree that technology is a huge part of 21st century nursing because you are correct that it is almost all the information that we need to do our job. Your examples of things such as charting, notes, test results, medications, and so on are just some of the things that we use during our shift and that technology has allowed us to access so much quicker. I remember in nursing school there was a push for a centralized nursing database because when patients are transferred from different hospitals and health systems it can lead to a delay in patient care and treatment. There are many benefits of having electronic documentation but I think the biggest is just how convenient that it is. “The electronic medical record (EMR) is rapidly replacing paper documentation of health care activities in hospitals across the United States. The use of an EMR is generally considered to be superior to paper documentation by virtue of being more accessible, more legible, and automatically author, time, and date stamped” (Coffey et all, 2015). The article really made me think about all the things that electronic documentation can do but the big one was time stamping. I have found this useful when it comes to change in status for my patients because having a time stamp forces intervention. If it was just noted on paper it could be presented differently than if there is documented times and interventions. It also shows if things are back charted which is useful. There is so many advantages to electronic charting and I think the future only holds more advantages such as a centralized patient database. 

Reference: 

Coffey, C., Wurster, L., Groner, J., Hoffman, J., Hendren, V., Nuss, K., et al. (2015)  A Comparison of Paper Documentation to Electronic Documentation for Trauma Resuscitations at a Level I Pediatric Trauma Center: JEN. Journal of Emergency Nursing

I really enjoyed your post, thank you. You really made me think about the differences between electronic charting being time-saving for the nurse, and be able to spend more time with the patients, and their families. In personal experience, I’ve experienced the good and bad of electronic charting; I can’t say how many times I have been so caught up in all the charting that when I take time to talk to my patient or their family, I have to stay over in order to catch up on charting. Of course, every day is different, and there are times when we get the best of both worlds and have charting completely done and the utmost in communication to our patients can be handled. There are definitely pros and cons to paper and electronic charting, and I personally believe that we haven’t quite found that perfect balance of charting and being able to spend the most time possible, to give our patients the quality care that we can give! But, as you said, technology is only going to continue to increase its daily works in our lives, might as well embrace it fully and be sure to advocate when there may be a better, faster, or more conducive way to complete the task!

I also wanted to discuss an important advancement in health care for the 21st-century nurse and that is how the role of public health nurses has changed. Specifically, contract tracing and how this interfaces with technology to fight a novel virus. Contact tracing in Pennsylvania has become a position where nurses remotely trace positive cases, manage testing for positive patients, and notify individuals who may have come in contact with the infected individual. The technology that nurses use and also the changes that have come through public health will change nurses’ impact on public health as we are now able to assess and trace patients remotely through telehealth, communication apps, and mobile devices.  Because of COVID 19, the need for this type of nursing is increasing and will only continue in the future as we anticipate the possibility of an additional virus or other public health threat. I think that as nursing continues, this type of remote nursing will continue to provide more access to nursing services while keeping both patients and nurses safe. 

Thanks

References:

Chamberlain College of Nursing (2017): NR 390 Nursing History, Week 7 Lesson: 21st Century Nursing History.

Institute of Medicine (US) Committee of the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington (DC); National Academies Press (US); 2011.  Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK209880/doi:10.17226/12956Links to an external site.

https://www.health.pa.gov/topics/disease/coronavirus/Pages/Contact-Tracing.aspx

Covid-19 is an event that has occurred in 21st-century nursing and has had a great impact on the evidence in professional nursing practice. The pandemic has helped to improve the nurses’ use of aseptic procedures. The pandemic has hit the world so hard, and it has led to a lot of research being conducted on how to control the infections. The research has improved aseptic procedures. The nurses are now ensuring that they are using sterilized products and have increased the levels of hygiene both in the work station and in the patient wards. Hygiene has been proposed by research to be effective control of covid-19 infections, and therefore nurses are ensuring that high levels of cleanliness are implemented through ensuring taps with running waters and soaps are placed in patients’ wards and the hospital surroundings. 
Nurses have never been so serious about the use of PPEs, but now with the evidence based research proposing how effective use of PPEs helps prevent the spread of the virus, the nurses are more careful about how they use them. Evidence nursing research has helped build the capacity of nurses, and they now have improved nursing skills in handling critical care patients (Martland, 2020). Nurses have also improved their skills on how they handle the patients in the ICU, especially those using ventilators.
My choice of Covid-19 is due to the impact it has on health care. Many people have lost their lives, and it has led to a lot of research on the clinical and nursing field on how to improve the situation (Zhang, 2020). Prevention measures, as well as vaccines, have been developed and are still being developed through evidence research that is vital to healthcare.   

References

Martland, A. M., Huffines, M., & Kiersten Henry, D. N. P. (2020). Surge priority planning COVID-19: critical care staffing and nursing considerations. Chest.
Zhang, Y. (2020). Strengthening the Power of Nurses in Combating COVID‐19. Journal of nursing management.