Module 2: Informatics Applications in Evidence-Based Nursing Practice

Nursing Care Plan (NCP)

• It provides direction on the type of nursing care the individual/family/community may need.

• The main focus of a nursing care plan is to facilitate standardized, evidence-based and holistic care.

Computerized Nursing Care Plan

A digital way of writing the care plan, compared to handwritten

Computerized Nursing Care Plan

• have increased documentation of signs and symptoms, associated factors and nursing interventions.

• Using electronic devices when creating nursing care plans are a more accurate, accessible, easier completed and easier edited, in comparison with handwritten and pre-printed care plan.

• are an essential element of the nursing process.

Nursing Documentation

mainly focus on health assessments, clients’ care plans, medication, administration records, nursing notes and discharge plans.

Nursing Documentation

• The computer can be programmed to identify the data and time of all entries as well as the initials or name of the person making the entry.

• The computer can be programmed into sub-modules which process coordinates activities such as drug administration table.

• Nurse’s notes can be entered quickly by choosing statements, appropriate for a particular client from multiple pre-programmed choices

Critical Pathways

are also known as clinical pathways, multidisciplinary pathways, collaborative paths, or care maps to name a few

Critical Pathways

s a clinical management tool that helps medical care providers coordinate the delivery of patient care for a particular case type or condition.

total treatment regimen

The CP usually recommends a

protocols, algorithms, and clinical practice guidelines.

Components of CPs often include

Clinical Practice Guidelines

are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances

locally (internal guidelines) or regionally or nationally (external guidelines).

Clinical guidelines can be developed either…

Detailed Literature Search

Guideline Construction

Guideline Testing

Guideline Review

What are the four stages of Guideline Development?

Validity

o Means that if a guideline is followed it should lead to the health gains and costs predicted.

o This requires that the guideline be rigorously developed and

consistent with available scientific evidence.

Cost effectiveness

o Means that the improvements in health care should have acceptable costs.

o If guidelines ignore costs and concentrate only on benefits, practices might be recommended with major implications for resource use, which are not accompanied by correspondingly large improvements in patient outcomes.

Reproducibility

o Means that given the same evidence, another guideline development group would produce similar recommendations.

Reliability

o Means that given the same clinical circumstances, another health professional would apply the recommendations in a similar fashion; both are more likely to occur if the guideline is developed in a systematic and rigorous manner.

Representative Development

o Guideline development should be undertaken by a group with representation from all key disciplines and interests, including patients.

Clinical Applicability

o For a guideline to be clinically applicable, the target population should be defined in line with scientific evidence.

Clinical Flexibility

o Guidelines should also be flexible by identifying exceptions and how patient preferences are to be taken into account in the decision making process.

Clarity

o Guidelines should be clear, using precise definitions and user friendly formats.

Meticulous Documentation

o Guideline development process should include details of who took part, methods used, and assumptions made, and should link recommendations to the available evidence, which should be graded according to its method (e.g., from randomised controlled trials [grade I] to uncontrolled or consensus studies [grade III])

Scheduled Review & 11. Unscheduled Review

o Guidelines should also be reviewed periodically and modified to incorporate new knowledge.

dissemination and implementation

Once a clinical guideline is ready for use, 2 stages facilitate its introduction into practice:

Dissemination

o Refers to the method by which guidelines are made available to potential users.

o Dissemination strategies include publication in professional journals, sending guidelines to targeted individuals, as well as strategies involving an educational intervention.

Implementation

o Means ensuring that users subsequently act upon the recommendations.

o Implementation is a more active process, involving tailoring the message to the needs of the target audience, and actively working to overcome barriers to behaviour change.

Electronic journals

also known as ejournals, e-journals, and electronic serials, are scholarly journals or intellectual magazines that can be accessed via electronic transmission.

PDF and in HTML format

Often a journal article will be available for download in two formats -

Classic electronic journals

Some of the electronic journals are available through internet applications, which are also called classic e-journals. Originally they were distributed via email but now are available on the web and only alerts of new issues are distributed by email. Access to this category of e-journals is free of cost.

Parallel electronic journals or Electronic version of print

These are journals that are available both in print and electronically. Sometimes the electronic version may differ from the print journal e.g. article may appear electronically before they are printed or the electronic version may have supplementary material on it. The website offers previews and experts view of issues. The online version may include the full text of journal, only table of content, or selected articles from print versions.

Database model and software model

Under the database model articles reside in a centralized database maintained by the publisher and subscribers are given permission to access the database to locate and download articles. The software would have an expiration date that corresponds with the length of the subscription.

CD-ROM journals

Commercial publishers have also made journal titles available on CDROMs. The full text of journals has been made available on CD-ROMs. In many cases these titles duplicate print titles already held by libraries. Libraries have often subscribed to journals both in print and in CD-ROMs.

Full text

These are e-journals where complete articles are available rather than just summaries or abstracts. Usually the whole of the journals is available online.

Electronic only journals

These are journals that are only available electronically, no counterpart likes print or CD-ROM is available of these types of journals.