Posted: May 25th, 2022
As technology becomes more sophisticated the effects of new technologies affect all aspects of our lives. Technological advances affect many different occupations as well, especially the field of health care. As a result the advancements in technology have impacted the field of nursing as well. For instance, advances in technology affecting the nursing affects almost every aspect of the field including daily routine tasks such as charting. The use of electronic charting has resulted in an increase in the safety of patients and a subsequent decrease in the time nurses utilize for documentation. For many nurses advances in technology have made their jobs easier, for the most part. However, as with any advancement there is a trade-off in efficiency with other areas. In is impossible to list all the effects of technology of nursing within the confines of this paper. Therefore the primary discussion for this paper will be limited to the effects of computerized reporting systems and their effects on nursing.
There can be little doubt that advancements in computerized technology have lead to more efficient patient care. For instance, before the implementation of IV pump infusions and electronic IV monitors a patient who needed an IV of any type had it administered under the care and attentive eye of their nurse as the old manual IVs were prone to stopping or flowing too quickly. Thus, a nurse often was needed to remain near the patient’s side when they were in need of an IV. Given how often patients need IVs this new innovation has made a nurse’s job much easier and allowed them time to attend to other duties while patients have IVs (Kaplan & Harris-Salamone, 2009). The nursing specialty that investigates the involvement of computers and how it affects the practice of nursing is called Nursing Informatics (Hardwick, Pulido and Adelson, 2007). Nursing Informatics can be defined as the interaction of nursing and information management with information processing and communication technology to support the health of patients. Thus, Nursing Informatics makes clinical documentation readily available for evaluation by making information technology available at the patient’s bedside (Hardwick, Pulido and Adelson, 2007).
Computerized documentation has been viewed as a major innovation in healthcare and has assisted nurses with organization of information, saved time, and led to an overall improved workflow (Lee, 2007). However, technology changes and when there is an implementation of a new computerized documentation system this can lead to a disruption in the established routine. At first it is typically very time consuming to learn and chart in a new system. The stress of learning a new format, sometimes needing to acquire new typing skills, the unavoidable mistakes and other issues can result in job dissatisfaction, lapses in patient care, stress-related issues for everyone. Therefore it is very help to involve the nurses in the early stages when implementing a new system so they can be involved in the process of providing input regarding the design and potential snags to a smooth transition (Lee, 2007). Courtney, Demiris and Alexander (2005) advise that new information technology (IT) innovations should be flexible as to allow a type of dual change. In other words, new technologies should lead to changes in nursing practices; however, nursing practices should also result in shaping IT changes and innovations. The changes implemented by new IT should therefore be bi-directional. These computerized systems have other potentials in addition to assisting the nurse with documentation. For example, computerized prompts or computerized reminders for patient care interventions can be quite beneficial. Moreover, the use of computer guided interventions can be linked to the diagnosis entered by the nurse into the system to make them readily available to nurses and physicians on the spot (Lee, 2007).
As stated above the use of computers has resulted in improved speed and more efficient documentation by nurses. The use of portable handheld devices is also often incorporated into the electronic medical record system (EMR). Potable handheld devices or wireless computerized systems allow the nurse to enter the patient’s vital signs and other documentation while at the bedside. Moreover, these devices allow the nurse to read a patient’s laboratory values, any new orders from physicians, and view other important information without ever leaving the patient while at bedside (Hardwick, Pulido, & Adelson, 2007). These portable IT devices have been truly amazing. There has also been empirical evidence that such real time documentation results in a potential minimization of omission errors and communication errors (Strople & Ottani, 2006). One study found that utilizing an EMR and potable documentation devices such as handheld devices or a wireless computer system reduced vital sign documentation errors by more than 50% when compared to the use of traditional pen and paper charting methods (Gearing et al., 2006).
Even when not used in integration with an EMR, the new handheld devices can be helpful for patient documentation by taking the place of the traditional clipboard. The use of a handheld device in place of a clipboard can allow a nurse to enter information directly and efficiently at the patient’s bedside and later either transpose the information to a paper chart or upload it into a computer (Hardwick, Pulido, & Adelson, 2007). Strople and Ottani (2006) found that the use of personal digital assistants (PDAs) use decreased the time nurses spend documenting their activities by nearly two hours, led to greatly improved efficiency in overall patient care, and have a positive impact on patient safety and overall patient outcomes.
The use of electronic handheld devices offers other resources for nurses. For example, many of the portable devices have access to reference materials. This allows a nurse to look up information such as drug lists, drug interactions or side effects, and other important clinical references without ever having to return to their office or go to the nursing station. Many of the new handheld devices, such as PDA’s, offer other tools that can be of assistance. Many also include applications such as clocks, timers, calendars, schedules, etc. that can be used as medication or treatment reminders. Hardwick, Pulido, and Adelson (2007) point out several different ways that such tools and applications can be helpful not only in the hospital but also in the home healthcare setting.
In 2006 The Joint Commission on Accreditation of Health Care Organizations (JCAHO) identified communication failures as the leading cause of sentinel events in healthcare settings and found that a major contributing factor to these failures was the shift report (Strople & Ottani, 2006). The standard practice for these reports is the use of memory and the chart when giving report. This can lead to the omission of important information as memory is unreliable (Hardwick, Pulido, & Adelson, 2007; Strople & Ottani, 2006). The use of paper worksheets could be replaced by a PDA device. This way the information would be permanently documented and readily available making it much less likely that important information would be missed. Moreover as discussed earlier using these handheld devices or another type of electronic reporting would increase the amount of time of direct patient care which has been demonstrated to reduce issues such as the rate of UTI, medication errors (Bradley, Stelenkamp, & Hite, 2006), and pulmonary compromise (Strople & Ottani, 2006). EMR use can increase the quality, effectiveness, and efficiency of a patient-centered shift report.
Observations and Possible Futures
The use of an EMR has made it easier for nurses on the units I have been involved with to go about their routines. However, at first changes or the implementation of an EMR is very awkward and takes some time to get used to. Once the adjustments are made and the transition complete it is very effective. The implementation of an EMR system has the potential to increase patient safety in other areas besides the ones covered in the research. Using computerized physician orders can really lead to a decrease in transcription errors we commonly see when someone takes the order over the phone. A dual phone and computerized physician order system could lead to the provision of additional information that would reduce ordering errors related misreporting, a lack of drug knowledge, redundant medication orders, a lack of patient information, or rules violations. Most of the medication errors that occur are often due to an inability to correctly read written orders, medications being written for the wrong patient, or redundant orders. For instance Bradley, Stelenkamp, and Hite, (2006) have stated as a result of their review that the majority of medication errors are actually preventable. In studies following the implementing of a computerized ordering system the identification of medication errors increased and the level of patient harm fell dramatically. Even so there were still errors noted in computer entry like orders being placed for the wrong patient, but these mistakes were recognized more quickly. It appears that the use of a computerized order entry system leads to an increase in the recognition of errors and a subsequent decrease in patient risk. Moreover, by recognizing reporting errors the nurse can develop a strategy to prevent future errors. One immediate error that should be reduced is the problem of issues with illegible orders. Also when an electronic system is put into effect this should reduce overall transcription errors made by nurses as well. Any pharmacy transcription errors that occur should be identified by nurses pretty quickly as well with and electronic system. Thus, I think that all orders should be handled by an electronic system and any concerns can be addressed to the physician.
However, the use of EMR systems has not resulted in the entire world of nursing being turned into a paradise. First, these systems crash from time to time. When they do this is a major source of stress for nurses. There should be some type of backup system in place for these systems like people have on their PCs in order to keep things running smoothly.
Second, security concerns are a big issue when dealing with confidential patient information on a computer system. This is even a bigger issue compared to the traditional paper documentation. Traditionally the patient’s chart was in a secure location (well not always secure, but it was supposed to be at the nursing station when not in use). However, computerized information can be accessed on any computer hooked up to the system. The issue is that while a nurse is entering information in the computer anyone in eyesight of the nurse can see what is being entered. It is not uncommon to see a nurse entering patient information into a computer while someone else, either a patient’s relative (perhaps not even a relative of the patient on the computer screen), coworker, or anyone, stands over the nurse and engages in a conversation with them. EMR systems have made sensitive information much more accessible in a number of ways. Moreover, nurses sometimes do not log off and leave the computer up for anyone to access.
There are security features available for computers and handheld devices. All patient information must be password protected on electronic devices. Passwords are required for PDA’s in an EMR. It is crucial when handheld devices are used to have security settings in place. However, passwords and security settings are not infallible. When uploading patient information onto another computer or if one is sending patient information by means of email there should be some form of encryption developed to prevent unauthorized access to such information. The Health Insurance Portability and Accountability Act (HIPAA) has led to the creation of HIPAA compliant security settings that are available on PDA devices, but are not always used. These should be mandatory and other safeguards such as lockout programs should be developed for devices that have not been in use for a period or when unauthorized attempts to gain access to information are encountered.
Finally, there has been a loss of the personal touch when all this technology is used. For example, many computerized documentations are formatted. There is little room for personal reflections. I notice many nurses and aides just getting the required data from patients and not spending time talking to the patient. Once data is collected they are off to the nursing station or doing something else. It is important to make sure that in our quest to be more efficient we do not become less human.
Technology has benefited the nursing field. The improvements in technology for patient documentation have been demonstrated to improve nurse efficiency, patient outcomes, and safety. This technology can save time on documentation but should allow for more time to be spent with the patients; however, this is not always the case. While the risk of error and harm is decreased the risk of treating patients as data ports is increased. We must remember that patients are people and require subjective care.
Bradley, V.S., Steltenkamp, C.L., Hite, K.B. (2006). Evaluation of reported medication errors before and after implementation of computerized practitioner order entry. Journal of Healthcare Information Management, 20, 46-53.
Courtney, K.D., Demiris, G., & Alexandre, G.L. (2005). Information technology: Changing
nursing processes at the point-of-care. Nursing Administration Quarterly, 29 (4), 315-
Gearing, P., Olney, C., Davis, K., Lozano, D., Smith, L.B., & Friedman, B. (2006). Enhancing patient safety through electronic medical record documentation of vital signs. Journal of Healthcare Information Management, 20 (4), 40-45.
Hardwick, M.E., Pudilo, P.A., & Adelson, W.S. (2007). The use of handheld technology in nursing research and practice. Orthopaedic Nursing, 26(4), 251-255.
Kaplan, B. & Harris-Salamone, K.D. (2009). Health IT success and failure: Recommendations
literature and an AMIA workshop. Journal of the American Medical Informatics
Association, 163, 291 — 299.
Lee, T.T. (2007). Nurses’ experiences using a nursing information system: Early Stage of technology implementation . CIN: Computers, Informatics, Nursing, 25 (5), 294 -300.
Strople, B. & Ottani, P. (2006). Can technology improve intershift report? What the research reveals. Journal of Professional Nursing 22 (3), 197-204.
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