Preferences, Challenges, and Areas for Development
How quantitative and qualitative research projects can be applied to evidence-based nursing practice.
Grove, Burns, and Gray (2013) defines evidence-based practice as a “conscientious integration of best research evidence with the clinical expertise and patient values and needs in the delivery of quality, cost-effective health care”. There are several methods of research that of which include quantitative, qualitative and mixed method with quantitative randomized control trials (RCT) serving as the strongest evidence for practice guidelines (Grove, Burns & Gray, 2013). More so, describing quantitative research as “a formal, objective, systematic process implemented to obtain numerical data for the understanding of aspects of the world” (Grove, Burns & Gray, 2013). Whereas, qualitative research is a viewed as a systemic, interactive, subjective, holistic approach used to describe experiences of life and provide meaning (Grove, Burns & Gray, 2013).
What characteristics of quantitative or qualitative research make it the most appropriate for addressing evidence-based practice problems?
I have chosen to read two articles, one of which was a quantitative and one qualitative to help aide with adequately answering this question. The first article was a qualitative analysis of Veterans health administration personnel experiences with a clinical informatics system by Bonner, Simons, Parker, Yano and Kirchner (2010). This qualitative study further explored nursing interactions and evaluations in the setting of implementing an electronic health record (Bonner & et al., 2010).
The study described perceptions of positive and negative effects in regard to introducing an electronic health record; especially considering the cost of using technology and the risk of technology facilitation potentially distracting interpersonal interactions (Bonner & et al., 2010). Concluding concerns for interferences in aspects of health care communication between patients and colleagues (Bonner & et al., 2010). The study would have held more validity had it been a mixed review study with quantitative results integrated to depict the statistics on time taken away from interpersonal communications before and after the implementation of an electronic health record; as well as evaluating overall patient satisfaction pre- and post- implementation.
The second article was a quantitative study on retaining nurses and other hospital workers: an intergenerational perspective of the work climate written by Lavoie-Tremblay, Paquet, Duchesne, Santo, Gavrancic, Courcy, and Gagnon (2010). This article “described and compared work climate perceptions and intentions to quite among three generations of hospital workers and nurses” (Lavoie-Tremblay and et al., 2010). It further dissected the different generations within the workforce, further evaluating retention.
Furthermore, comparing generation X to generation Y, on their different perspectives and influences on retaining staff in the workforce environment (Lavoie-Tremblay and et al., 2010). They utilized a psychological climate questionnaire to measure work climate and questions individual’s intentions to stay employed within the company; thus, gathering statistics to support findings. The drawback of this study was its small sample size. Essentially had the study been reproduced with a larger sample size; it would have held a stronger influence on supporting evidence-based research findings.
Bonner, L.M., Simons, C.E., Parker, L.E., Yano, E.M., & Kirchner, J.E. (2010). “To take care of
the patients”: Qualitative analysis of Veterans Health Administration personnel
experiences with a clinical informatics system. Implementation Science, 563-570
Grove, S.K., Burns, N., & Gray, J.R. (2013). The practice of nursing research: Appraisal,
synthesis, and generation of evidence (7th ed.). St. Louis, MO: Saunders Elsevier
Lavoie-Tremblay, M., Paquet, M., Duchesne, M., Santo, A., Gavrancic, A., Courcy, F., &
Gagnon, S. (2010). Retaining nurses and other hospital workers: An intergenerational
perspective of the work climate. Journal of Nursing Scholarship, 42(4), 414-422
Briefly share your nursing background and professional interests.
My nursing career began after working as a home health aid and later a first aid technician. My desire to help and care for the sick fueled my passion for becoming a nurse. Upon completing my undergraduate nursing program, the desire to care for others grew even greater. So, I became a geriatric nurse practitioner. I have experience working in correctional medicine, ICUs, outpatient clinics, long-term care, acute care, internal medicine, and home care. After years of nursing practice, my desire still burns to help future nurses, advance the nursing profession, and influence policies.
Summarize how informatics has impacted or changed nursing practice. Provide an example from your professional experience.
Informatics has changed the culture of nursing practice. Embracing technology is vital to health care reform. The American Recovery and Reinvestment Act of 2009 allocated $19 billion to invest in health information technology (HIT) (Ball et al., 2011). The Business Roundtable Report indicates favorable outcomes from investing in HIT that includes: more efficient medical transcription, reduction in redundant labs and imaging testing, decreased hospital stays, improved communication of patient’s medical history, reduction of medical errors and adverse events, decreased administration cost with electronic claims adjudication, more robust quality of reporting with electronic medical records, remote decision making through electronic transmission, portable personal health records, and increased security and privacy protocols (Ball et al., 2011).
I’ve worked with handwritten clinical notes and prescriptions at the beginning of my career in my professional experience. Often, I’d personally need to contact the medical provider if the notes or prescriptions were illegible. If the provider was unavailable, treatment was delayed. Health information technology improved the collaboration between providers and nurses.
Evaluate how established informatics competencies influence quality of care, safety improvements, and excellence in nursing practice.
Health information technology and informatics are crucial for increasing patient safety. A survey of registered nurses cited information technology had improved medication safety in their hospitals (Ball et al., 2011). Researchers found nurses with a high nurse-to-patient ratio result in increased patient mortality, poor health outcomes, poor quality of care, nurse burnout, decreased job satisfaction (Ball et al., 2011). The use of health information technology has made a significant difference in addressing ways to improve health care (Ball et al., 2011).
Assess your informatics strengths and preferences, as well as potential challenges and areas for development. (Be sure to refer to specific TIGER and ANA competencies.)
The Technology Information Guiding Education Reform (TIGER) Initiative believes that all nurses should be proficient in a technology-driven health system. TIGER focuses on informatics tools, principles, theories, and practices to make health care safer, more efficient, patient-centered, timely, and equitable (American Nurses Association, 2015). The evolution of information technology and mandate for electronic health information has increased the demand for competence in all levels of the nursing profession (American Nurses Association, 2015). According to the American Association of Colleges of Nurses (AACN), information management and the application of technology in patient care are fundamental in nurses’ education in baccalaureate, master’s, and doctoral programs (American Nurses Association, 2015).
My strengths lie in basic computer knowledge and information management. In my nursing career, I experienced handwritten, voice dictation, and documenting via electronic health records. I prefer to document with electronic technology. I find this method efficient and needed to collaborate with others in health care safely and securely.
Describe one strategy for enhancing your informatics skills and competencies.
An area I’d to enhance my skills in is information literacy. Information literacy is vital in integrating evidence-based practice into nursing practice (TIGER, n.d.). It helps identify specific information, locate pertinent information, evaluate the information, and apply it correctly (TIGER, n.d.). A strategy that I can use to continue to improve my skills is to increase my participation in competency-based training programs offered by my health care organization.
American Nurses Association. (2015). Nursing informatics: Scope and standards of practice. Silver Spring, MD: Author.
Ball, M. J., Douglas, J. V., Hinton Walker, P., DuLong, D., Gugerty, B., Hannah, K. J., Kiel, J. M., Newbold, S. K.., Sensmeir, J., Skiba, D. J., Troseth, M. R. (Eds.) (2011). Nursing informatics: Where technology and caring meet (4th ed.). London, England: Springer-Verlag.
Technology Informatics Guiding Education Reform (TIGER). (n.d.). The TIGER Initiative: Informatics competencies for every practicing nurse: Recommendations from the TIGER collaborative. Retrieved from: http://www.mhsinformatics.org/CI-Fellowship/Workforce-Development/Competencies/Tiger.Report_Competencies_final.pdf.
Professional Background and Interests
I graduated from a School of Nursing in 1981 and would not hear of nursing informatics until 2004. In the early ’80s an electronic system was initiated which housed the hospital and surgical census. Patients were tracked in this fashion however, the rest of the medical staff continued to document on paper charts, with 12-hour blocks of time identified with black ink for 0700 to 1859 and red ink from 1900 to 0659. I attained my BSN in 2004 and was introduced to the idea of informatics. 2004, President George W. Bush signed an executive order to develop the office of the national Coordinator of Health Information Technology and thus began the quest for all Americans to have an electronic health record (Ozbolt & Saba, 2008). The American Recovery and Reinvestment Act of 2009 would provide the external incentive needed for organizations to build their electronic platforms (Ball et al., 2010). My organization recruited staff nurses to commit to a three-year timeframe away from the bedside and assist with the development of an electronic medical record system. Several staff members did and were able to step back into their staff nurse position although some remained as part of what is now the clinical informatics team. I returned for my MSN through Walden unsure of a specialty I selected Informatics graduating in 2016.
Informatics Impact and Changes in Nursing Practice
Bar Code Medication Administration (BCMA) is one of the meaningful use incentives put in place to provide an uninterrupted flow from provider to administration with the least amount of human interaction. Clinical Decision Support Systems create a safety net when programmed to create alerts indicating duplication, missed, or untoward events that may occur (Health Informatics | HIMSS, 2020). I work in the post-anesthesia care unit (PACU) an episodic and quick-paced environment. Tylenol has become an adjunct in pain management and may be given, pre, intra, or post-procedure. With the advent of the BCMA and best practice alerts (BPA), the nurse upon scanning the medication is notified that it may be too soon for this medication to be repeated. This safety check allows the nurse an additional layer for patient safety when administering medications. One function I have utilized with the BCMA scanner is opening the patient’s chart. When using the scanner on the patient’s wristband it opens the patient’s current chart. I have also been able to identify through this process when registration has incorrectly selected the wrong encounter as the alert will state “there is no patient for this encounter”.
Strengths, Preferences, Challenges, and Areas for Development
I assist in process improvement and providing evidence-based strategies in the surgical services department. I enjoy evaluating workflow and identifying process gaps and developing best practices. I would like to further develop my process improvement skills. In reflecting on these projects, I see areas for improvement are:
- Locating, identifying, and evaluating research studies. This includes navigating library systems and database systems such as Cochrane, Joanna Briggs Institute, CINHAHL and others. I have found the Walden Library to continue a plethora of information podcasts and webinars that I will begin to investigate and review along with my continued studies in doctoral courses.
- Team building: Building communication styles that entice collaboration and teamwork. Encouraging others to engage in projects and assisting nurses to be part of the solution and to have their voices heard as end-users.
Ball, M. J., Douglas, J. V., Walker, P. H., DuLong, D., Gugerty, B., Hannah, K. J., Kiel, J., Newbold, S. K., Sensmeier, J. E., Skiba, D. J., & Troseth, M.
R. (Eds.). (2010). Nursing Informatics: Where Technology and Caring Meet (4th ed. 2011 edition). Springer.
Health Informatics | HIMSS. (2020, September 9). https://www.himss.org/resources/health-informatics
Ozbolt, J. G., & Saba, V. K. (2008). A brief history of nursing informatics in the United States of America. Nursing Outlook, 56(5), 199-205.e2.