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Practicum Report on the Current Practices and Educational Needs on the Use of Computerized Provider Order Entry (CPOE)
This practicum focused on analysing the current practice of a nursing home care setting by analyzing the current practice and educational needs of nurses at the initial use of the Computerized Provider Order Entry (CPOE), in addition to developing, implementing and evaluating evidence-based practice for staff development. The main participants in the program were nurses with BSN who were using the technology for the first time. The core principle used during the six months training program was the change theory formulated by Kurtz Lewin.
The main activities during the program constituted evaluation of the knowledge level of the nurses with regards to health informatics, their capacity to use the technology in a home setting and the education need in enhancing their capacity for handling the CPOE capabilities. In accordance with the Lewin's Model of Change, the trainees were first taken through the unfreezing phase which focused on enabling the nurses understand the changes in the medical field with respects to informatics and thus preparing them for the change (Miner, 2005). This was followed by the transition and freezing phases which focused on taking the trainees through the change process and stabilizing their ability in the use of informatics respectively. From the model, the acceptance of change hast to embrace preparation for each one to accept it. Through this familiarity of what is to occur will develop making each person understand why the transition has to occur.
The Practicum project
The training took place within our medical facility which is also furnished with lecture rooms for providing tuition to interns within the hospital. Visits to community members where practical training were conducted in homes and community centres also provided an adequate environment for the training. During the six months period, the health informatics department within our facility set on a mission to improve the quality of operations within our health care centre in a bid to enhance service provision to the visiting patients and other stakeholders. This objective was to be fulfilled both at the health care centres and at the home levels. This made training in both the medical facility and the communities a necessity.
With respect to the communities and their inhabitants, the goal of the facility was to improve the quality of life of the members of the society and more so with respect to those who needed specialized care at home. Sensitizing the community on the importance and the effectiveness of informatics was also an objective for the facilities. As such most churches and academic institutions acted as the main locations for which the team conducted practical. Volunteers were also used from the communities to aid in facilitating the outcome of the program.
The main objective entailed
To perform in the role of a nurse informatics staff development administrator in a nursing home care setting by analyzing the current practice and educational needs of nurses at initial use of the Computerized Provider Order Entry (CPOE), and by developing, implementing, and evaluating an evidence-based practice staff development program based on Lewins change theory for nurses using CPOE for the first time.
Overall, the objectives of the program constituted;
Advancing the capacities of the nursing graduates in dealing with health care needs in the contemporary world of technology and Informatics
Enhancing change among t he medical practitioners and the communities with regards to their perception on modern medical technologies.
Sensitizing the public on the availability of advanced technological capabilities in medicine and the benefits which they can draw from such capacities
Reinforcing the nurses' capabilities in using the CPOE features in providing home-based care.
Identifying the gaps in knowledge when it comes to the uses of Health Informatics Features and providing educative programs for instilling the appropriate knowledge.
Encouraging the use of the automated health care systems among nurses and other medical practitioners.
During the project it was discovered that most of the nurses were well versed with basic aspects of computing like retrieval of information although their knowledge on doing the same with medical records was minimal. Their abilities of handling and managing medical records using t he automated system was also limited and thus needed some considerable reinforcement. Considering that all of them were to use the CPOE system for the first time, their knowledge was close to nil and tutoring them on the application of the system was to begin from scratch. Although most of them were familiar with taking care of patients in the medical facilities, only few had been in a position of providing home-based care. Those familiar with home-based care were however not familiar with the use of Health Informatics capabilities in the home environments.
The widespread use of manual systems in training facilities and in health care centres was evident in this situation. Currently, some medical facilities have most of their records in manual systems, the shift from manual to automated system has also not been as speedy as it should be owing to fear of change and the need for start up expenses required to facilitate the installation of automated systems, among other reasons. Trainees and workers who work within the institutions are forced to work with the systems and this explains the oblivion that exists among a number of medical practitioners with respect to the existence of automated systems such as CPOE
This information provided a pathway for the project where the nurses were trained fully in the areas where they had minimal knowledge while reinforced in areas where they had some familiarity. Activities included training on the use of the CPOE system where the students, while in the medical facilities, were provided with overall knowledge on how to work with and handle the systems. Practical and theoretical training on how to enter records into the systems and how to access and retrieve the information were availed. Features of enhancing security of records, deleting unwanted records, creating backups and dealing with various problems within records were addressed in the programme.
In enhancing change within the trainees and the community, practical training on the benefits of using the system and the problems it was bound to solve were availed. In the process of reinforcing their capabilities of using the system., the trainees were informed of the advantages of using CPOE which included the fact that; it enhances security of the documents, saves on space, saves time, say on retrieval of information and saves costs of information management. Subsequently, the communities were also made aware of these benefits in an effort to help them accept and indulge in the use of such features (Kawamoto, et al., 2005). The graduate nurses were also allowed to practically experience using the systems in nursing home-based care settings.
By the end of the project, the capacity of the nurses under training in using the Computerized Provider Order Entry was close to the requirements needed for a standard graduate nurse. They were able to properly use the system and solve problems whenever they cropped up in the system. The nurses were also aware of the advantages of using the systems and the benefits that the feature would bring not only to them but to all stakeholders within the medical field. They had a completely positive attitude on the use of the system and stated their priority on using the system over the manual types. The gaps that were experienced during the practicum entailed fear of adapting to the new changes. The community was also pleased with the effectiveness of the system, accepting it for use within nursing home settings and within other medical facilities. They also mentioned their preferences of the automated system. The nurses also voiced their acceptance of the use of other automated medical systems…[continue]
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