Patient Care and Health

Clinical Experience

The American Nurses Association (2008) define nursing informatics as the mixture of computer and information science and nursing towards improving healthcare delivery and patient outcomes. Nursing informatics is a career that has developed from the evolution of health informatics, which involves the use of knowledge to examine and translate health data into useful information that can be utilized in enhancing patient outcomes through improved processes. As the healthcare field continues to adopt technology rapidly, nursing informatics is one of the educational programs that has emerged to prepare the workforce towards effective use of health information technology to enhance patient care delivery (Dalrymple, 2011). Nursing informatics education include formal graduate programs that provide both theoretical and practical training (which includes working with an already practicing preceptor). The ANA Scope and Standards of Nursing Informatics Practice requires students in this profession to complete a formal practicum as part of practical training. This report will discuss my practicum experience at Northwell health informatics department. The discussion will include a comprehensive assessment and evaluation of my field experience, whether I met my objectives, and issues encountered during the course of the experience.

My Objectives

For this practicum, I had four major objectives/goals that I intended to achieve when conducting my various roles at Northwell health informatics department. The first goal or objective of this practicum was to examine and understand the role of a nurse informatics/CIS within a healthcare facility or organization. Secondly, the experience was geared towards understanding how the role of a nurse informaticians differs from the role of a non-clinical informatics team member. This was carried out through examining the organization's job descriptions or responsibilities and guidance obtained from the preceptor regarding role responsibility. The third objective entailed identifying measures for integrating project management skills and research into the role of an informatics nurse specialist based on feedback from the preceptor. The final objective of this practicum was to familiarize myself and become acquainted with the latest technological advances in electronic medical records.

My role at Northwell health informatics department provided me with an opportunity to engage in different tasks that revolved around these four objectives. Through my experience, I met each of these objectives or goals while working at the facility. These objectives were met in different ways including participating in meetings with nurse informatics clinical specialists and non-clinical informatics team members. According to the American Nurses Association (2008), nurse informatics clinical specialists provide necessary support to other members of the interdisciplinary healthcare team. In this regard, nurse informaticians work with physicians, nurses, patients, and consumers in decision-making processes relating to the use of information processes, structures, and technologies in healthcare delivery processes. My role at Northwell health informatics department involved working with different members of the interdisciplinary healthcare team such as registered nurses, staffs at the emergency department, and members of the health IT team. Working with these different team members enabled me to explore and understand the differences between nurse informatics clinical specialist and non-clinical informatics team members. According to McLane & Turley (2011), nurse informatics specialists act as supporting staffs to interdisciplinary healthcare teams by promoting the effective use of technology in workflow processes towards enhanced patient care delivery.

Secondly, I participated in different go-live sessions where the department transitioned from paper or other electronic systems to Sunrise. Through engaging in these sessions, I was able to understand the role of a nurse informatics specialists and became acquainted with the latest technological advances in electronic health records. The transition to Sunrise was primarily because its one of the latest technological developments in electronic medical records. I explored how this latest technological advancement in EHRs helped in improving patient care delivery processes in the organization. Additionally, participation in the go-live session helped me understand the role of nurse informatics clinical specialists in the implementation of health IT systems. This understanding was shaped by my involvement in gap analysis meetings where gaps in workflow processes were identified with regards to the use of health IT systems. Through gap analysis, I understood the role of a nurse informatics clinical specialists within the organization, especially when handling the implementation of a computer system for managing health data/information. The go-live sessions were crucial in this practicum

Practicum Experience

My practicum experience was carried out at Northwell health informatics department and lasted for a combined total of 100 hours. The computer system utilized in this department is Sunrise, which help in management of electronic health data or information in this healthcare facility. During my time at the hospital, I was present at different go-lives at Syosset and Huntington Hospital. My activities or assignments during the go-live session at Huntington Hospital included participating in innovation meetings and learning about innovative apps that could be used by the facility to enhance the management of electronic health data. Additionally, I was involved in providing assistance to staff at the facility with regards to system use, engaged in ongoing evaluation and documentation of workflow gaps from McKesson to Sunrise, and reviewing informatics schedule. My experience also involved conducting rounding on units with informatics specialists, participating in informatics teams at the Command Center.

At Staten Island go-live session, I evaluated the review of workflow, particularly during the transition from McKesson to Sunrise. This experience helped me to identify and understand gaps in workflow processes during the transition process. I also observed and reviewed workflow processes and activities at Syosset with regards to the effectiveness of the systems in promoting enhanced workflow. The observations at Syosset was carried out in the emergency department, which relied on paper documentation before Sunrise computer system was adopted. Therefore, the review process focused on determining how the system improved operations and patient care delivery at the emergency department.

Generally, the practicum experience was humbling experience for me to enter a health informatics department as a novice nurse informatician. This was a crucial element in my academic journey since it provided me with field experience on the clinical responsibilities and duties of nurse informaticians. Generally, the transition from a health informatics student to a practicing one is a difficult one and requires time to develop practical experience. This practicum provided me with practical field experience that will help make my transition to a practitioner a relatively easy one. Based on the lessons I learnt from this process, nurse informaticians need to be competent both in the classroom and clinical setting in order to make meaningful contributions towards enhancing patient care delivery. With the guidance of my preceptor, Michele Burk, I was able to gain experience in the nurse informatics clinical setting.

This practicum provided me numerous opportunities to apply the knowledge I have obtained from the course and guidance from my preceptor. This experience enabled me to meet some of the standards by the American Nurses Association, which were practiced through the different learning opportunities. One of the ANA standards that was met during this clinical field experience is issue identification. The ANA Scope and Standards of Practice for Nursing Informatics provides guidelines on the assessment of data or processes in order to identify specific issues relating to the use of health IT systems in healthcare delivery processes. This clinical field experience provided me with an opportunity to practice this standard by working with an interdisciplinary healthcare team. During this process, observations were made relating to workflow processes and documentation of specific issues identified was carried out. This was specifically achieved during participation in gap analysis meetings where identified gaps in workflow processes were documented. In this case, I focused on identifying issues and the need for IT involvement in addressing the gaps in operations and patient care delivery processes.

The other standard prescribed by the ANA Scope and Standard for Nursing Informatics is outcomes identification, which involves determining the anticipated results for the plan of action (American Nurses Association, 2008). However, the ANA Scope and Standard for Nursing Informatics requires these outcomes to comply with clinical guidelines and be geared towards enhancing value addition to patient care processes and outcomes. The need to ensure that outcomes focus on adding value to patient care is attributable to the fact that nurse informatics practice involves integrating information and communication technologies to enhance the health and wellbeing of patients, families, and communities (Murphy, 2010). Actually, technology adoption in the healthcare sector is geared towards enhancing patient outcomes through improving the delivery of care. For this practicum, outcomes identification was met through the gap analysis meeting, which not only focused on identification of issues but was also centered on examining patient outcomes. Additionally, I examined workflow processes with regards to patient care processes and how it contributes to the desired patient outcomes. Working at the emergency departments to examine workflow processes vis-a-vis the utilization of health IT systems provided an opportunity to meet this standard.

Nursing Informatics Issues in this Practicum Experience

As previously mentioned, one of the standards in the American Nurse Association Scope and Standards of Practice is issue identification. This clinical field experience provided me an opportunity to identify several issues relating to the practice of nurse informatics and the adoption of health information and communication technologies in patient care delivery. These issues not only affect patient care delivery processes but also have significant impacts on patient outcomes. The major nursing informatics issues that were identified during the course of this clinical experience at Northwell health informatics department include . . .

Encrypted Testing

One of the major issues raised during this practicum experience is the need for encrypted testing by healthcare professionals. Encrypted testing is an important aspect of the use of electronic health records given that one of the major roles of healthcare professionals is to protect health data. The protection of health information is increasingly complex because of the constant changes in the healthcare environment. Actually, healthcare professionals are facing the need to ensure that electronic health information is effectively safeguarded because the modern health environment is characterized by the need for enhanced mobility support. Data protection helps in improving physician-patient communications and interactions, which are crucial towards enhancing patient care delivery processes and outcomes.

During this practicum experience, encrypted testing by healthcare professionals emerged as a major issue because of the increased adoption of electronic health information management systems, especially Sunrise computer system. For instance, during Syosset go-live session, the healthcare team shifted from paper documentation to Sunrise, which was utilized in inpatient areas. While Sunrise helped in improving screening processes, the integrity of this system was crucial because of its role in providing information relating to screening of patients. Data encryption is an important aspect in promoting the integrity and security of Sunrise computer system through safeguarding health information. Actually, data encryption is considered as one of the measures for enhancing the privacy and security of health data. Since Northwell adopted Sunrise for its operations in patient care delivery, encryption testing would help prevent unauthorized access to health information. The computer system needs to adopt processes and systems that ensure data encryption since the encryption process is not automatic but requires establishing suitable processes and tools.

Easier Documentation

The second issue that emerged during the course of this clinical experience is the need for easier documentation by nurses at the bedside. In the current framework, nurses experience excessive documentation since they document similar things in different places. For example, nurses document patients' mental status on the flow-sheet, then at the end of the shift on their outcome. In this case, the outcomes need to be short, precise, and focus on changes in order to enhance the effectiveness of this system in generating desired patient outcomes through enhancing patient care delivery processes. If the mental status did not change during the length of the stay the nurse should not write it in the outcome. Based on analysis of the current framework, nurses seemingly think that if something is not documented, it did not happen. Therefore, addressing this issue of excessive documentation would require changing the way nurses think about documentation.