Nursing Informatics and End-of-Life Care

Medication Safety and Nursing Informatics

• Medication Scanning:
  • Scan medication and patient bracelet to prevent errors.
• Nursing Informatics Defined:
  • Integration of technology and physical devices with nursing knowledge and clinical decision-making.
  • Addresses concerns about robots replacing nurses; emphasizes that nurses will always be needed because robots and AI are not replacements for human assessment.
  • Example of "smart scheduling" not working effectively, requiring human intervention.
• Nursing Informatics as a Specialty:
  • The American Nurses Association designated nursing informatics as a nursing specialty in 1992.
• Barcode Scanning:
  • Improves client safety and accurate EHR documentation.
• Health Literacy:
  • Healthy People 2020 identifies health literacy as a social determinant of health.
  • Low health literacy can lead to patient non-compliance and difficulty understanding their conditions.
• Simulation Labs:
  • Used for practice (e.g., Foley catheter insertion) but are not equivalent to real-life experience.
  • Highlights variability in real patients.

Preventing Medication Errors

• Informatics aims to mitigate medication errors using EMRs.
• Bypasses exist, so errors can still occur.

Evidence-Based Practice (EBP)

• Definition:
  • Practices based on studies and known effectiveness.
• Examples:
  • High protein diet (if not renal patient), turning, repositioning, hygiene care, and vitamin C for wound healing.
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• Diabetes and Wound Healing:
  • Controlling blood sugars is crucial for wound healing in diabetic patients.
• Teaching Patients:
  • Educate patients about high protein intake, turning, repositioning, and vitamin C.
• Cranberry Juice for UTIs:
  • Pure cranberry juice or tablets can help prevent UTIs.
• Role of Nurses as Educators:
  • Nurses educate patients and families to promote self-care.
• Benefits of EBP:
  • Improves client outcomes and nurses' experience
  • Increases professional satisfaction and lowers healthcare costs (cost-effectiveness).
  • Provides a framework for clinical judgment based on research and quality improvements.
• Hospital Projects for Certification (e.g., Magnet Status):
  • Units undertake projects on topics like pain or fall prevention to improve care.
• Addressing High Hospitalization Rate:
  • Data collection is used to pinpoint issues and patterns related to readmissions.
• Spirit of Inquiry:
  • Desire to clarify complex issues through research to influence client outcomes.
  • Aims to improve client outcomes by keeping individuals safe and healthy at home.
  • Supports awareness of practice environment and inspires exploration of problem-solving.

Scientific Literature

• Peer-Reviewed Articles:
  • Use peer-reviewed, published scientific research articles (e.g., ANA, NLM).
  • Avoid using blogs or social media as sole sources.
• Considering the Source:
  • Nurses must consider the source of their evidence.
• Scientific Method:
  • A systematic research process applies knowledge to nursing practice and re-evaluates outcomes.
• Empirical Data:
  • Collected through observation, assessment, and measurements.
  • Minimizes bias and informs research.

Vaccine Development

• Testing Process:
  • Medications are tested on animals before human use.
• COVID-19 Vaccine:
  • Developed and released quickly without the usual extensive FDA process.
  • Led to long COVID and side effects due to the rapid rollout.
  • Contrasts with the years of research and testing before influenza vaccines.

Nursing Process and Clinical Guidelines

• Nursing Process:
  • Assessment, analysis, planning, implementation, and evaluation.
• Clinical Guidelines:
  • Methodical statements focusing on specific care plans stored in the National Guideline Clearinghouse.
  • Optimize client outcomes and improve cost-effectiveness.
• Cost Savings Through Research:
  • Research-driven projects can identify inefficiencies and improve client outcomes, ultimately reducing costs.

End of Life

• Hospice Care:
  • Provides medical care to support clients with terminal illnesses.
  • Focuses on controlling the illness, not curing the patient.
• Palliative Care vs. Hospice:
  • Palliative care focuses on pain management while continuing curative treatments.
  • Hospice is for end-of-life care when curative treatments are no longer pursued.
• Acceptable Treatments in Hospice:
  • Antibiotics for UTIs and URIs. IV fluids and oxygen for comfort.
  • Pain medication for patient comfort
• End-of-Life Facilities:
  • Some family members choose facilities instead of home care.
• Conditions for Hospice Care:
  • Huntington’s, MS, and end-stage renal disease patients who choose to stop dialysis are candidates.
• Interprofessional Care:
  • Treats the whole person, including caregivers and family members.
  • Includes spiritual support.

Emotional Stages and Acceptance

• Family Dynamics
  • Families may experience denial, anger, or bargaining. Some may accept the patient's impending death more readily than others.
• **Hospice Admission **
  • Limited to patients with a life expectancy of less than six months.
  • Can last for three years, or patients can alternate between hospice and home care.
• Medication and End-of-Life Care:
  • Morphine eases pain, and helps patients relax.
    *Individual experiences vary; hospice provides support and educates family members to administer medication with support from hospice nurses.

Palliative Care

• Improves quality of life for both patient and family caregivers.
• Concentrates on lessening suffering by managing the symptoms of their disease
• Provided while the client is still engaging in curative treatments.
• ALS, MS, and Huntington's disease are diseases that are treated with palliative care.

Hospice vs. Palliative Care

• Hospice Care:
  • Focuses on symptom management.
  • May use medications to dry out secretions and ensures overall comfort.
• Family Support:
  • Hospice involves supporting and caring for the family, not just the patient.
• Dealing with Death and Grief:
  • First experiences of cleaning patients and postmortem care are crucial.
  • Nurses learn to cope to continue providing adequate care.

Physiological Changes

• End-of-life patterns
  • Grayish skin tone and changes in breathing patterns and fluid retention characterize the terminal phase.
• Breathing and Respirations:
  • Shortness of breath and the "death rattle."
  • Cheyne-Stokes respirations: irregular rates with quick breaths and periods of apnea
• Pain Management:
  • 60% of hospice patients experience it.
• Regulation of Body Temperature
  • Diminishes, causing fluctuations in temperature
• Mottling:
  • Occurs hours or days before death.
  • The upper and lower extremities feel cool with bluish discoloration.
  • Caused by ineffective pumping of blood, which leads to decreased perfusion.
• Lines of Lividity:
  • Pooling of blood after death.
• Vision and Hearing:
  • Hallucinations and reports of seeing deceased individuals.
    Patient starts reaching for these people as if they are there.

Maintaining Dignity

• Considered an everyday priority
• Health assistance and family members are responsible for giving and administering a good passing
• Ask family's for cultural and relgious beliefs to honor their death wishes.
• Provide closure at the end of life - clergy member available
• Patient's are still able to communicate while dying, healthcare assistance must stay in character and speak to them calmly

Physiological Changes (Continued)

• Dignity in Care:
  • Providing privacy and respect, even nearing death.
  • Refer to patients by name.

Postmortem Care

• Postmortem Events:
  • Patients may sit up or have bodily fluids.
• Precautions:
  • Cover yourself
• Steps:
  • Two people present."
  • Tag patient’s toe with MR number, birth date, and name.
    Ensure patient has passed.