This paper examines the implementation of informatics systems in nursing, covering the integration of nursing science, computer science, and information science to support clinical decision-making and patient care. It identifies key design considerations across three dimensions: hardware (upgradeability and maintenance), software (compatibility, tailor-ability, and ease of use), and human factors (technical competency and staff willingness to adopt new technology). The paper also addresses the role of employee workarounds in healthcare—evaluating both their benefits, such as unblocking workflow and compensating for system failures, and their risks, including procedural violations and reliance on individual judgment. The discussion concludes that workarounds remain a necessary cultural reality in nursing practice, particularly as a safeguard when informatics systems fail.
The nursing profession continues to evolve alongside advancing technology, ensuring that it maintains standards of quality in service. In the endeavor to facilitate quality healthcare, the profession has endorsed the use of medical informatics systems. Nursing informatics integrates three disciplines: nursing science, computer science, and information science. The practice employs these fields in managing and communicating data and information in the course of clinical duty. Informatics in nursing facilitates the integration of information and knowledge to support patients, nurses, and doctors in decision-making roles and the administration of care (McGonigle & Mastrian, 2012). Information technology is essentially the core aspect of informatics; thus, it is necessary for hospitals to carefully consider the quality of the technology they employ.
Medical informatics systems support a variety of activities in hospital and clinic settings. These systems concentrate largely in the areas of order entry and clinical decision-making, which are prominent areas for service improvement and error reduction (Australian National Health Informatics Conference, Maeder & Martin, 2012). In the hospital setting, as evidence from past occurrences reveals, serious medication errors and adverse drug events constitute many preventable deaths in hospitals across the country. These errors include actions such as overdosing a patient due to misunderstanding or misreading prescription notes, administering the wrong medication to the wrong patient, and failing to administer medication at the indicated time. Additionally, human errors in decision-making caused by poor analysis or evaluation of a patient's condition can result in adverse effects.
This reality necessitates the implementation of information systems to assist in providing quality and effective care to patients. Such technology includes tools that assist in managing patient information, maintaining medication schedules, monitoring individual patient progress, managing orders for hospital medication stock, and generating receipts and drug prescriptions for patients (Joan, 2007). Drug alert systems can assist in maintaining patient medication schedules and reducing the serious errors that arise from human error. Thus, in selecting an informatics system for nursing, it is necessary to ensure that the computers will fully meet user requirements. These requirements fall across hardware, software, and human factor considerations.
In selecting the appropriate technology, there are various design factors to consider. Hardware considerations include the ability to upgrade the system and the ease of its maintenance (Goveia, 2009). Software considerations include the compatibility and tailor-ability of the software, as well as its simplicity of use. Human factor considerations include the technical knowledge of the people who will use the technology and their willingness to adopt it. These considerations are crucial to the success of informatics systems in their field of application.
Regarding hardware, the first consideration is upgradeability. Technology has a remarkably dynamic nature and continues to evolve rapidly. Therefore, systems acquired for nursing informatics should have the capacity to be upgraded when new capabilities enter the market (Buerhaus, 2013). If systems cannot be upgraded, the costs of acquiring entirely new systems whenever technology improves become prohibitively high for hospitals. The second hardware consideration is maintenance. Information systems are subject to wear and tear, and hardware can develop defects; thus, it is essential to evaluate both the provider of maintenance services and the costs involved. Maintenance of the system is typically governed by the warranty terms and by the service provider the hospital selects.
The software considerations are equally significant when selecting the design of an informatics system for nurses. The factor of compatibility and tailor-ability becomes especially important during implementation. The software of the new system should accommodate the existing legacy system in order to ensure a smooth transition. The changeover phase largely determines the success of a new informatics system; if the new system is not compatible, the transition can be expensive, as a parallel changeover carries high costs, while a complete system cutover carries high risk. On the matter of tailor-ability, the system may require customization to accommodate functions not included in the initial design (Azad & King, 2008). The software must therefore be capable of being tailored to meet user needs.
The second software consideration is ease of use. Before purchasing software, it is essential to assess how user-friendly it is. The simplicity of application determines the success of informatics system implementation. A system with complicated operation may require extensive training, which is costly in both resources and time. Thus, the software must be straightforward for end users to apply.
The human factor considerations carry equal weight. Nurses and other clinical staff are the end users of the system, and their requirements are critical to its success. The first factor is technical competency — specifically, whether the nurses possess sufficient knowledge to use the system or whether additional training will be required. The second factor is the willingness of nurses to adopt the new technology (Ball & Hannah, 2011). In numerous system implementation processes, adoption has failed due to employee resistance. Concerns that the system will replace staff roles must be addressed directly; nurses need assurance that the system is intended to ease their workload and increase efficiency, not to compete with them. Securing nurse buy-in is therefore essential to the success of any informatics system adoption.
In the day-to-day running of a hospital, healthcare providers regularly face challenges from poorly performing work systems, broken equipment, failures in information communication, and depleted supplies. Despite these problems, hospitals continue to deliver quality care. Nurses navigate these challenges to provide care to patients, and as a result, workarounds have become part of the culture of healthcare facilities (Debono, Greenfield, Travaglia, Long, Black, Johnson & Braithwaite, 2013). Workarounds help professionals circumvent and resolve emerging problems before situations deteriorate. Specifically, they assist nurses in unblocking disrupted workflows, solving problems, sidestepping rules that impede service delivery, addressing deficiencies in workflow design and system function, backing up data, compensating for inadequate technology, patching software glitches, covering shortfalls in staffing and supplies, and saving time.
On the negative side, workarounds are by definition a non-standard and irregular method of performing duties. They carry the connotation of being a subset of errors. Workarounds are shortcuts and deviations that may violate procedural standards for quality patient care (Debono et al., 2013). Additionally, they are subject to misuse because they rely on the personal judgment of the individual implementing them. When weighing the positives against the negatives, it is important to recognize that healthcare is a high-hazard industry dealing directly with human lives, and that mistakes can lead to devastating outcomes, including patient deaths. The application of workarounds is shaped by organizational culture; in the hospital setting, there is realistically no way to eliminate workarounds entirely.
"Compatibility, ease of use, and staff adoption factors"
"Benefits and risks of nurse-initiated workarounds"
McGonigle, D., & Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge. Burlington, MA: Jones & Bartlett Learning.
You’re 72% through this paper. Sign up to read the remaining 2 sections.
Sign Up Now — Instant Access Already a member? Log inAlways verify citation format against your institution’s current style guide requirements.