Nursing Theories and Informatics

Introduction

Nursing informatics involves the use of relevant information tools and technology to improve the profession of a nurse. An example is the use of computers. The nursing practice posseses standards of practice to ensure its accountability. Therefore, integrating tools and technology into nursing practice is a great challenge. Knowledge development is significant in the scientific nursing discipline, as well as in the development of the nursing theory. Theories developed in the 1980s have been recosnidered to initiate the development of middle-level theories. These theories are used by nurses and students to conduct thir research. These theories should be evaluated properly to determine the suitable theory for a given research problem.

Myra Levine developed a concept that consisted in the fact that energy conservation is equal to health. It is distinct as it is based on conservation principles as a nurses’ action guideline. The theory also encourages the conservation of the environment and the endangered species. Environmental conservation is important due to the instability of the universe systems. The adaptation to these changes includes mutation of genes for individual species to fit into the internal and external surroundings. Redundancy is one of the adaptive responses to environmental changes. The theory describes ways to deliver nursing care, goals for nursing actions, and the reasons for the nursing actions through patient resource conservation and change of the patient environment to fit the resources (Greenberg, Kramer, Welch, O’Sullivan & Hall 2006).

Case study: A 48 year old woman rushed to the emergency room following severe chest pain on the left arm, shortness of breath, nausea, and vomiting. She showed several symptoms including t- 37.0, Cr-110, bpm-30rmp, bp-140/90mmgh. She was administered with the 2-4 l pm, 4mg of morphine, and 1 metaclopramid. She had diabetes mellitus type II, administered capillary blood glucose, and Humulin r 10 units. The key concepts for management for this case study are based on several aspects:

  • Energy conservation: The energy output and input balance to avoid fatigue through adequate rest, exercise, and balanced nutrition.
  • Structural energy conservation: Preservation of anatomical structures to promote healing and avoid body breakdown through exercise and personal hygiene.
  • Personal integrity: Individuals need respect, self awareness, self determination and strive for respect to protect patients’ needs.
  • Social integrity conservation: Recognition of human interaction within a community, tribe, political system, and a nation for one’s support system (Greenberg, Kramer, Welch, O’Sullivan & Hall 2006).

Descriptive strategic solutions

The computer based order system has been the topic of debate in the past two decades due to the barriers on changes needed in patterns of practice, roles of the care system team, teaching and institutional requirements. The rationale behind the system is to enhance process improvement, cost effectiveness, time management, and clinical decision making support. For successful implementation, the system should be fast and efficient. There should be a joint effort from the teaching and policy making institutions and the clinicians. Relevant stakeholders should commit to regular meetings to ensure that the right procedure is followed in the implementation process.

The center of national health services research in 1971 chose El Camino hospital in California to research on how a technician data system impact the nursing care. The system was in use for five years by the admission department and physicians. It was used to order and report results, and this confirmed the previous results from a research conducted in a medical center within the New York City. It was observed that the system was competent and accurate as it indicated a drop in error omission. Today, public hospitals serve a large number of patients daily. These are regular and walk-in patients. Hospitals that are well-equipped have moved from paper work records to computer data storage. This is meant to enhance time management and easy retrieval of data to maintain records of these patients effectively. This has resulted into a positive outcome. A help clinical information system was developed in an LDS hospital, Salt Lake City to facilitate the ordering of blood products. The system was introduced in compliance with the joint commission of accreditation of healthcare organization guidelines. The results indicated that the computer-based system was effective in cost and time management compared to manual searching and paper-based laboratory results. In 1986, investigators developed a Regenstrief medical record system for a patient medical reminder. This system produces automatic results with the associated treatments (Greenberg, Kramer, Welch, O’Sullivan & Hall 2006).

Ontario Cancer care

In 1996, the Ontario government began developing a computer based order system. This was designed to be used by the nurses, pharmacists, and physicians. This system has been adopted by other institutions to provide chemotherapy care; it serves 50% of the patients in the province. Around 500 physicians are employed yearly, and more than half a million medication orders are made. Apart from the provision of care, the institution enhances clinical knowledge transfer. The management of cancer is complicated, making it the typical source of solution to the computerized system.

Sociological Barriers

The health care system faces the challenges in the implementation of a computer based order system. This is due to the perception that the system shifts the clerical work of physician to reduce costs. The system should enhance integration of decision making in support of timely order generation and support of efficient communication for better care services. There is fear that the system minimizes the time spent on routine protocol, thus de-intellectualizing. There is a lack of buffer between the practitioner and regulations with the computer order based system for prevention of mistakes. Therefore, the paperwork clerks modify the order if a problem with the order is detected, or when the order does not comply with the hospital regulations. Thus, the system developers should invest more energy and skills into the design to ensure that no human buffer is needed. The shift in roles within the care team is a challenge. The computer order system reduces verbal order though the regulations should be flexible towards accepting the use of some important orders. For instance, a physician can call to make necessary instructions for patients. Therefore, members of the care team should make some considerations (Nightingale, Skretkowicz & Nightingale, 2010).

Logistical Challenges Involved in strategy Implementation

There are various logistical challenges the computer based data order are facing. They include implementation of terminal location and number, as well as training and time required to enter orders. Some of the implementation challenges include taking care of patients when they are transferred from a computer based system to the paperwork unit. Another challenge is in converting the information from one unit source to another development order to match every departmental need. A high powered station is important to support every care unit. The terminal inter-distance should be minimized to avoid time wasted from one station to another by physicians. Handheld equipment should be developed to enhance order relay in the future. The use of computerized system can only be efficient with enough trained staff. Training is important for any institution that uses technological equipment to improve on efficiency. Training should be done concurrently to reduce the cost (Nightingale, Skretkowicz & Nightingale, 2010).

Future implementation

The computerized system should be fast and considerably easy to use. In this case, in case of a technological support needed, it can be done in less than twenty four hours. The institutional leaders should be committed to the efficiency of the system and remain on the implementation path to solve any emerging problem or challenge. The group representative and every department should meet regularly to enhance the decision making process, and draw conclusions necessary for problem solving before the following meeting. The order entry is common in hospitals all over the world, and has compelling benefits. In the past, the industry relied on the paperwork system, and some hospitals in the developing countries still lag behind. The learning institutions should incorporate these changes in the educational system (Nightingale, Skretkowicz & Nightingale, 2010).

Theoretical concept application

If a nurse that receives a trauma patient at the emergency room, he or she can use the Myra Levine’s concepts and principles of conservation to promote the patients’ health through adaptation. The patient needs a 24 hour bed rest as directed by the physician following the assessment of his or her condition irrespective of the patient’s severity condition. This is in line with the conservation of energy principle of Myra’s theory. Bone breakage and skin damage are common in trauma patients. In case of bone fracture, the bed rest would protect the patient from further structural deterioration. If the condition is serious, the doctor would refer the patient to surgery. The wounds are dressed using aseptic for protection against infection, and change of position for patients in bed rest protects the skin. This is an application for structural conservation principle. The application of a patients integrity involves handling the patient while maintaining privacy. The patient is involved in the care plan to show respect and restore self worth. The hospitals allow family members to visit to enable the patient understand that he/she is part of the family despite his/her situation (Peterson & Bredow, 2009).

The application of the Myra’s concepts involves the introduction of technology. Information technology tools play an integral role in nursing practice more than most professions. In the past, nurses were not involved in the clinical decision making resulting into the poor care provision. An America’s leading theorist, Omer Warner noted that tools should be used to innovate for the solution of the present and the future problems. There are several stages of integration that include substitution, innovation, and transformation. Replacement of a manual fashion of working is necessary to increase speed, efficiency, and effectiveness. The introduction of computers in health care provision enables relay of information between the admission room and other relevant terminals. The Myra’s concept of energy conservation should be replaced by applying for orders for energy supplement drugs and nutritious diets from the computer based order system. These drugs usually act faster than the provision of bed rest to patients. The hospital data can generate appropriate antibiotics to maintain the patient’s hygiene and protection from infection. The physician using their knowledge can advise the patient on how to protect one’s space needs. Innovation involves the introduction of technology to do things that were previously done manually. Computers are available in a health care system. Therefore, information for patients with several clinical problems are accessible from any room making work easier. Transformation is the reinvention of how things work or how they can be done. Radiology is one system of transformation that provided computed tomography scan. Nursing is not just an evolving activity, but also a transforming professional. In the treatment of the patient, radiology can be used to scan the left arm, and confirm the anatomical status for bone breakage and ligament tear detection. The theory is surrounded by many assumptions that cannot be supported. That is the reason why the use of technology is necessary for speedy and efficient services. Applying these theoretical concepts requires accurate interpretation of the each empirical knowledge into the clinical practice (Nightingale, Skretkowicz & Nightingale, 2010).

Conclusion

The human body has different redundancy aspects that enable the body to function despite the failure in some elements. There is no optimum health. The body systems are problematic in most cases, thus, is important to understand how the body elements relate to each other. The application of nursing theory to informatics is a critical aspect of health care. The nursing profession has integrated the use of information technology in health care delivery. Nursing informatics has been met with resistance from some quarters in the health care industry. However, there is no doubt that nursing informatics have enhanced efficiency in health care delivery.

References

Greenberg, A., Kramer, S., Welch, V., O’Sullivan, E. & Hall, S. (2006). Cancer Care Ontario’s Computerized Physician Order Entry System: A Province-wide Patient Safety Innovation. Web.

Nightingale, F., Skretkowicz, V., & Nightingale, F. (2010). Florence Nightingale’s Notes on nursing: What it is and what it is not & Notes on nursing for the laboring classes: commemorative edition with commentary. New York: Springer.

Peterson, S.J., & Bredow, T.S. (2009). Middle range theories: Application to nursing research. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.