Assignment: Application of Technology

Assignment: Application of Technology
Assignment: Application of Technology
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C791 Advanced Information Management and the Application of Technology Competencies:
This course provides guidance to help you demonstrate the following :
Competency 744.3.1: Information Management
The graduate evaluates information management systems that support timely, high quality, patient-centered care.
Competency 744.3.2: Leadership in Nursing Informatics
The graduate integrates knowledge of nursing initiatives, professional organizations, and leadership into strategies for enhancing nursing informatics.
Competency 744.3.3: Health Information Systems
The graduates distinguishes between the critical and useful electronic data needed for effective decision support (clinical, financial and administrative outcomes) to provide high quality and efficient care.
Competency 744.3.4: Information Security
The graduate evaluates the privacy and security of data within healthcare organizations.
ensure quality patient outcomes.
Competency 744.3.5: Current and Future Technologies
The graduate evaluates the implications of current and emerging technologies for practice, research,education, and administration.
Preparing for Success
The information in this section is provided to detail the resources available for you to use as you complete this course.
Assignment: Application of Technology
Assignment: Application of Technology
Assignment: Application of Technology
Assignment: Application of Technology
Learning Resources
The learning resources listed in this section are required to complete the activities in this course. For many resources, WGU has provided automatic access through the course. However, you may need to manually enroll in or independently acquire other resources. Read the full instructions provided to ensure that you have access to all of your resources in a timely manner.
Automatically Enrolled Resources
You can access the learning resources listed in this section by clicking on the links provided throughout the course. You may be prompted to log in to the WGU student portal to access the resources.
Tan, J. and Payton, F.C. (2009) Adaptive Health Management Information System, 3d edition. ISBN 13978076375691-8
Mastrian, K. G., McGonigle, D. (2017). Burlington, MA: Jones & Bartlett Learning.ISBN-13 is: 9781284102635
Pacing Guide
The average student should be able to complete one Unit per week.
Topics and Pacing
Unit 1: Introduction and Getting Started
· Module 1:Introduction and Getting Started
Unit 2: Information Management
· Module 2:Information Management
Unit 3: Health Information Systems
· Module 3: Health Information Systems
Unit 4: Information Security
· Module 4: Information Security
Unit 5: Current and Future Technologies
· Module 5: Current and Future Technologies
Unit 6: Leadership in Nursing Informatics
· Module 6: Leadership in Nursing Informatics
Unit 7: Final Performance Assessments
Please continue to the next section to begin your course work.
Assignment: Application of Technology
Working in environments of increasingly complex clinical care and contending with the management of large volumes of information, nurses need to avail themselves of the technological tools that can support quality practice that is optimally safe, informed, and knowledge-based. Despite the availability of the latest hi-tech tools, unless the information gathered is analyzed and used appropriately, it is of little value; in fact it may have a negative impact on patient care. Equally important to the gathering of the data is an attention to the quality of that data.
The quality of the data itself is closely tied to quality indicators. The quality indicators themselves are not an adequate benchmark if the data or information used to make informed decisions is flawed. For example, if only half of the prescription errors occurring at a health organization are actually reported, then it could be inaccurately concluded that there is no problem.
What exactly is quality information? It is information that is accurate and correct. There are specific characteristics that can be used to evaluate the quality of a piece of information. These include:
Assignment: Application of Technology
Assignment: Application of Technology
Assignment: Application of Technology
Relevance
Quality information is relevant. This means that the information being used must apply directly to the reason that it is needed.
For instance, if information is needed about a patient’s health history, in order to better assess and diagnose the patient, it is relevant to collect information on the patient’s previous hospitalizations. It would not, however, be relevant to use public health data to analyze a patient’s health history.
Timely
Another characteristic of quality information is that it is timely. When there is a lag in information, it may no longer be of use or properly serve its purpose. Information must be efficient and must be provided in a timely manner so that nurses can utilize it in their practice.
For instance, when attending to a patient with a clinical emergency, data and information, such as drug allergies or special medical conditions, are needed urgently. The faster the information is provided, the more efficient and effective the clinical services will be for the patient. However, if the information arrives too slowly, the patient could already suffer consequences of the clinical emergency.
Thorough
Quality information is thorough, which means that the information must be complete. Information that is not thorough might contain errors or lapses of information.
Consider the example of a patient who is allergic to latex. The nurse who filed the admission paperwork neglects to include the allergy warning on the medical record. Therefore, the next nurse who works with the patient is unaware of the patient’s allergy to latex, and uses latex gloves to provide clinical care. This is an example of incomplete, or non-thorough information, because an important fact was left out, which negatively impacts quality and safety as well as steps in the nursing process.
Objective
Quality information is objective. This means that information must be as close to the facts as possible and not based on individual opinions. If information becomes subjective, or based only on personal opinions or feelings of the nurse, errors can occur.
An example of a subjective report is “Patient needs more pain medication because she looks awful.” This subjective statement does not provide any facts or details. Instead, an example of an objective report is “Patient is shivering and looks pale. She continues to rub her legs, but the swelling has not gone down yet. Recommend more pain medication.” This statement is objective because it provides facts and details without blurring them with personal interpretations and demonstrates how objective information is used in assessing, diagnosing, and determining a nursing care plan.
Transparent
Transparency is another characteristic of quality information. Transparency, in this context, means that information is accessible and available. Information must be transparent so that anyone can use and apply the information in practice. If information is not transparent, others are unable to access it or put it to use.
For instance, if doctors are the only healthcare providers who can access patient information, the nurses on the team would not know vital information about the patient, such as the medications that the patient is taking, or whether the patient has any pre-existing health conditions. Not having the necessary information inhibits providing quality care and each step in the nursing process.
Reproducible
Information must be reproducible in order for it to be considered quality information. Reproducible information can be created again and again, which ensures validity and accuracy.
For example, if a nurse generates a report on the hospital’s average length of stay, but another nurse does not believe the results of the report, the nurse can check the numbers again and, if the information is reproducible, will find that the report still reflects the same information.
Verifiable
Quality information is able to be verified so that nurses can see that the information is accurate and error-free. Verifiable means that information is able to be checked for facts.
An example of verifiable information is when a nurse manager shares with the nursing team new information about medication side effects that was just issued by the Centers for Disease Control and Prevention (CDC). To verify this information, the other nurses decide to check the claims themselves by looking on the CDC’s website. Sure enough, the facts are there, and the information is therefore verifiable. Consider how this applies, then, to the nursing process. Imagine you are treating a patient that presents with some of the newly discovered side effects. Verifiable information is critical as nurses diagnose and develop care plans for patients. If you had not been able to verify the information, you may incorrectly assess or misdiagnose the patient’s health problem.
It is the integrity and quality of data and information that make it useful. Data integrity can be compromised through human errors, viruses, hardware failures or crashes, transmission errors, or hackers entering the system. Information management systems help to decrease these errors by putting safeguards in place such as automatic file backups so data is not lost, error detection for transmissions, and data entry error alerts (i.e. a field such as patient name was not completed). Only when high quality data is processed into information can it create meaning to inform patient care, the nursing process, and facilitate timely, high quality, patient-centered care.
The National Database of Nursing Quality Indicators (NDNQI) examines nursing’s impact on patient outcomes, especially when looking at nursing staff ratios to patient outcomes.
Quality indicators use data that is readily available in healthcare organizations to determine systemic problems that could be improved. In addition, they provide a guideline by which an organization can not only measure, but compare itself to other healthcare organizations. This ability to measure performance allows healthcare organizations to improve the quality of care delivered, which then leads to better patient outcomes.
Introduction
During rounds, Charles encounters a rare pulmonary condition he has never personally seen and only vaguely remembers hearing about in respiratory therapy school. He takes a few moments to prepare himself by searching the Internet. That evening, he does even more research so that he can assess and treat the patient safely. He searches clinical databases online and his own school textbooks. Most of the information seems consistent, yet some factors vary. Charles wants to provide the safest and highest quality of patient care. He wonders which resources are best, which are the most trusted, and which are the most accurate.
The suggests that the most important aspect of information discovery, retrieval, and delivery is the ability to acquire, process, generate, and disseminate knowledge in ways that help those managing the knowledge reevaluate and rethink the way they understand and use what they know and have learned. These goals closely reflect the Information Literacy Competency Standards for Higher Education, published by the (ALA) in 2003 in response to changing perceptions of how information is created, evaluated, and used.
According to the ALA (), an information-literate individual is able to do the following:
Determine the extent of information needed
Access the needed information effectively and efficiently
Evaluate information and its sources critically
Incorporate selected information into one’s knowledge base
Use information effectively to accomplish a specific purpose
Understand the economic, legal, and social issues surrounding the use of information and access and use information ethically and legally (para. 8)
In addition, new challenges arise for individuals seeking to understand and evaluate information because information is available through multiple media (graphical, aural, and textual). The sheer quantity of information does not by itself create a more informed citizenry without complementary abilities to use this information effectively. Most significantly, information literacy forms the basis for lifelong learning, serving as a commonality among all learning environments, disciplines, and levels of education ().
This chapter introduces the concepts of information literacy, fair use of information, translational research concepts, and their role in promoting evidence-based practice. Information management technologies are an integral part of evidence-based practice, and it is important for all health care disciplines to appreciate the contribution of this aspect of health informatics to patient care.
Information Literacy
is an intellectual framework for finding, understanding, evaluating, and using information. These activities are accomplished in part through fluency with information technology and sound investigative methods but most importantly through critical reasoning and discernment. The ACRL () has suggested that “information literacy initiates, sustains, and extends lifelong learning through abilities that may use technologies but are ultimately independent of them” (p. 5).
The ability to recognize the need for a specific kind of information and then locate, evaluate, and effectively use that information (ALA, 1989) within the health informatics paradigm will catapult some health care professionals ahead of other health care professionals in providing evidence-based care. Traditional approaches to care that adhere to the “we have always done it this way” adage are no longer good enough. Our patients deserve care that utilizes the best available research and practice evidence.
Acquiring Knowledge Through Internet and Library Holdings
In an environment characterized by rapid technological change, coupled with an overwhelming proliferation of information sources, health care professionals face an enormous number of options when choosing how and from where to acquire information for their academic studies, clinical situations, and research. Because information is available through so many venues—libraries, special interest organizations, media, community resources, and the Internet—in increasingly unfiltered formats, health care practitioners must inevitably question the authenticity, validity, and reliability of information ().
Often, the retrieval of reliable research and information may seem to be a daunting task in light of the seemingly ubiquitous amount of information found on the Web. Focusing on specific information venues not only aids this search but also assists in negotiating the endless maze of resources, allowing a professional to find the best and most accurate information efficiently.
Professional Online Databases
Professional databases represent a source of online information that is generally invisible to all Internet users except those with professional or academic affiliations, such as faculty, staff, and students. These databases, which range from specific to general, act as collection points by aggregating information, such as abstracts and articles from many different journals; two such databases include the (CINAHL) and . CINAHL, for example, specifically includes information from all aspects of allied health, nursing, alternative medicine, and community medicine. The MEDLINE database contains more than 10 million records and is maintained and produced by the National Library of Medicine. Other databases, such as PsycInfo from the American Psychological Association and the (ERIC) database, may also benefit health care professionals. Still others are more specific by discipline, such as OTseeker (specific to occupational therapy), PEDro (specific to physical therapy), and speechBITE (for speech therapists). Many databases also offer full-text capabilities, meaning that entire articles are available online. The articles and abstracts contained within these databases have already withstood the rigors of publication in professional journals and, therefore, are considered viable and authentic peer-reviewed sources.
Libraries with subscriptions to databases often employ library professionals who are able to help patrons sift through the vast amounts of available electronic information; using the expert research capabilities of a health science librarian at one’s local university is the best way to learn how to conduct database searches that yield the most efficient and useful results. Also useful are websites that provide tutorials on best searching practices specifically for medically oriented databases, such as the tutorials provided by EBSCO support to search the CINAHL database ( and ).
Search Engines
Search engines allow users to surf the Web and find information on nearly anything, although many involved in conducting scholarly research steer clear of search engines because of the vast amounts of unsubstantiated information they are likely to uncover. Because no legitimacy needs to be provided for any information that appears on the Web, an author can make claims, substantiated or not, and still use the Web as a publishing venue. Despite the pitfalls associated with search engines in general, they can yield a bounty of useful information when used with discretion.
Different search engines will produce different results when used for the same research. For example, one popular search engine ranks its results by number of hits that a page or site has received. Whereas the most popular research results are likely to be relevant, the order in which results appear does not indicate quality or viability of the source.
Different Web address (domain) suffixes (.com, .edu, .org, .gov, and so forth) indicate who is responsible for creating the website. Although an .edu site is hosted by an educational institution and for that reason may seem legitimate, consider that it could also belong to a student stating personal opinion, gossip, or guesswork. In contrast, .gov sites are maintained by the government and nearly always have professional contact information. Web hosts develop new domain suffixes constantly, so although looking at the suffix can be useful, it should not be the sole deciding factor when choosing to trust information.
One should never blindly trust information found on a webpage. When possible, check the date of the most recent update (How old is the page?), contact information (Is a bibliography or list of sources provided?), links to external sources (Do they seem relevant?), and previous attained knowledge from other reputable sources (Is the information too unbelievable?).
Fees and information retrieval charges should be approached with skepticism. Private companies do offer information aggregation services for a fee. In these cases, users pay a flat monthly fee for access to collections of articles in a particular field. What users (especially those affiliated with an academic institution) may not realize is that they are likely to have free access to the same, if not more complete, information through their institution’s library system.
Some legitimate databases and traditional newspapers that maintain a Web presence do provide access for a small fee, but just as many others simply ask users to register to see articles for free. Many students and professionals affiliated with a university may find that their university library has already purchased access for those affiliated with the university—students, faculty, and staff.
Electronic Library Catalogs
Nearly all higher education institutions have placed their library catalogs online. Although this is an obvious convenience for many students, some health care professionals unaccustomed to working completely online may be intimidated by an e-catalog. Library professionals at the tiniest university and the busiest community college are available to demonstrate how to navigate a basic search of their library’s catalog. Asking for assistance in learning how to access the vast assortment of journals, books, databases, and other resources available at one’s college library is an excellent idea. Students in health care programs at larger universities will likely find free classes that specifically teach users how to navigate and use the online catalog. If smaller colleges and universities do not offer these services, one should take advantage of the library’s online tutorials, help pages, frequently-asked-questions pages, and online reference service (if available). Local public libraries often have subscriptions to popular databases and offer free classes on searching techniques to patrons, providing yet another free access point to the best information for one’s research needs. Making full use of available library resources serves to strengthen information literacy skills, enabling learners to master content and extend their investigations, become more self-directed, and assume greater control over their own learning ().
Information Sharing and Fair Use
laws in the world of technology are notoriously misunderstood. The same copyright laws that cover physical books, artwork, and other creative material apply in the digital world. Have you ever given a friend a CD that contains a computer game or some other type of software that you paid for and registered? Have you ever downloaded a song from the Internet without paying for it? Have you ever copied a section of online content from a reference site and used that content as if it were your own? Have you ever copied a picture from the Internet without asking permission from the photographer who took the picture? Have you ever copied and pasted information about a disease or drug from a website and then printed out the information to give to a patient or family member? These are all examples of the type of copyright infringements enabled by technology that occur almost without thought.
The value of creative material—whether it is written content, a song, a painting, or some other type of creative work—lies not in the physical medium on which it is stored but rather in the intangibles of creativity, skills, and labor that went into creating that item. The person who created the material should be properly credited and possibly reimbursed for the use of the material. How would musicians be reimbursed for their music if everyone just downloaded their songs illegally from the Internet? Imagine that you created a game to teach patients with type 1 diabetes how to manage their diet and other dieticians copied and distributed that game without getting your permission to do so. How would you feel?
Almost all software, music CDs, and movie DVDs come with restrictions on how and why copies can be made. The license included with the software clarifies exactly which restrictions are applicable. The most common type of software license is a “shrink wrap” license, meaning that as soon as the user removes the shrink wrap from the CD or DVD case, he or she has agreed to the license restriction. Most computer software developers allow for a backup copy of the software to be made without restriction. If the hard drive fails on the user’s computer, the software can usually be reinstalled through this backup copy. Some software companies even allow the purchaser of a software package to transfer it to a new user. In this case, the software typically must be uninstalled from the original owner’s computer before the new owner is free to install the software on his or her computer. Most of these restrictions depend on the honesty of the user in reading and following the licensing agreement. As a result of widespread abuses, however, the music and film industries commonly include hardware security features in their products that block users from making a working copy of a music CD or movie DVD.
The bottom line: Copyright laws also apply to the digital world, and copyright violations can lead to prosecution. Advances in technology have made the sharing of information easy and extremely fast. A scanner can convert any document to digital form instantly, and that document can then be shared with people anywhere in the world. Nevertheless, the person who originally created that document has the right to approve of the sharing of their work. Carefully read the fine print of any software purchased and be sure to clarify any questions regarding how that software can be copied. Avoid downloading music illegally from the Internet, and do not use information from the Internet without permission to do so or without citing the reference appropriately. Health care organizations that allow access to the Internet from a network computer should ensure that users are well aware of and compliant with all copyright and principles.
Clarification of Research Terms
Evidence-based practice, translational research, and research utilization are all terms that have been used to describe the application of evidential knowledge to clinical practice. The following paragraphs explore the definitions of each term. Although these terms are related, they have slightly different meanings and applications.
(EBP), developed originally for its application to medicine, is defined by Sackett, Rosenberg, Gray, Haynes, and Richardson () as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients” (p. 71). The “best evidence” in this context refers to more than just research. Goode and Piedalue () state that EBP should be combined with other knowledge sources and “involves the synthesis of knowledge from research, retrospective or concurrent chart review, quality improvement and risk data, international, national, and local standards, infection control data, pathophysiology, cost effectiveness analysis, benchmarking data, patient preferences, and clinical expertise” (p. 15). EBP starts with a clinical question to resolve a clinical problem. For example, published research studies are used in health care quality initiatives as the evidence behind the development of practice algorithms designed to decrease practice variability, increase patient safety, improve patient outcomes, and eliminate unnecessary costs. Use of EBP promotes the use of clinical judgment and knowledge, with procedures and protocols being linked to scientific evidence rather than based on what is customary practice or opinion ().
is the use of findings from one or more research studies in a practical application unrelated to the original study (Polit & Beck, 2008, p. 29) resulting in the generation of new knowledge. Stetler () defines research utilization as the “process of transforming research knowledge into practice” (p. 274). Research utilization can be self-limiting if research is inconsistent or not enough research is available to develop a consensus regarding the answer to the clinical question ().
(science) describes the methods used in translating medical, biomedical, informatics, and health care research into clinical interventions. Woolf () describes translational research in two ways:
T1: the transfer of clinical research to its first testing on humans
T2: the transfer of clinical research to an everyday clinical practice setting
Difficulties in translating research to the T2 setting exist when research applications do not fit well within the clinical context or practical considerations within the organization constrain the application in a clinical setting. Translational research is complicated by the follow-up analysis, practice, and policy changes that occur when adopting research into practice; consequently, available evidence-based health care practices are often not fully incorporated into daily care (Titler, 2004, ). Organizational culture influences the changes made to a clinical application and establishes the groundwork and the support for change-making activities (Titler, 2004). The study of ways to promote the adoption of evidence in the health care context is called “translation science” (Titler, 2010).
History of EBP
Research results are crucial to furthering EBP. The concept of using randomized controlled trials (RCTs) and systematic reviews as the gold standard against which one should evaluate the validity and effectiveness of a clinical intervention was introduced in 1972 by Archie Cochrane (), a scientist and a physician. Cochrane’s experiences as a prisoner of war and medical officer while interning during World War II led to his belief that not all medical interventions were needed and that some caused more harm than good. Cochrane viewed the randomized clinical trial as a means of validating clinical interventions and limiting the interventions to those that were scientifically based, effective, and necessary (Dickersin & Manheimer, 1998).
Cochrane’s colleague, Iain Chalmers, began compiling a comprehensive clinical trials registry of 3,500 clinical trial results in the field of perinatal medicine. In 1988, after being published in print 3 years earlier, the registry became available electronically. Chalmers’s methods for compiling the trials databases became a model for future registry assembly. Eventually, the National Health Service in the United Kingdom, recognizing the value of and need for systemic reviews for all of health care, developed the Cochrane Center. The Cochrane Collaboration () was initiated in 1993 and expanded internationally to maintain systematic reviews in all areas of health care (Dickersin & Manheimer, 1998). Many universities subscribe to the Cochrane Collaboration database, making this information easily accessible to students, faculty, and health care professionals who work for university hospital systems.
Evidence
The RCT is considered the most reliable source of evidence. Yet RCTs are not always possible or available; consequently, health care professionals must use critical analysis to base their clinical decision making on the best available evidence (). The updated Stetler model of research utilization (Stetler, 2001) identifies internal and external forms of evidence. External evidence originates from research and national experts, whereas internal forms of evidence originate from nontraditional sources, such as clinical experience and quality improvement data.
includes standards of practice, codes of ethics, philosophies of practice, autobiographic stories, aesthetic criticism, works of art, qualitative studies, and patient and clinical knowledge (Melnyk, Fineout-Overholt, Stone, & Ackerman, 2000). French () summarizes evidence as “truth, knowledge (including tacit, expert opinion and experiential), primary research findings, meta-analyses and systematic reviews” (p. 254). Health care professionals may additionally draw on evidence from the , such as audit and performance data, the culture of the organization, social and professional networks, discussion with stakeholders, and local or national policy (, p. 86).
To use evidence in practice, the weight of the research, also called , must be determined. Evidence hierarchies have been defined to grade and assign value to the information source. For example, an evidential hierarchy developed by Stetler et al. () prioritizes evidence into six categories:
1. Meta-analysis
2. Individual experimental studies
3. Quasi-experimental studies
4. Nonexperimental studies
5. Program evaluations, such as quality improvement projects
6. Opinions of experts
The hierarchy identifies as the best-quality evidence because it uses multiple individual research studies to reach a consensus. It is interesting to note that opinions of experts are considered the least significant in this hierarchy, yet health care professionals most often seek the opinion of a more experienced colleague or peer when seeking information regarding patient care (Pravikoff, Tanner, & Pierce, 2005).
Qualitative research allows one to understand the way in which the intervention is experienced by the researcher and the participant and the value of the interventions to both parties (). Qualitative research is not always considered in EBP because methods for synthesizing the evidence do not currently exist. The Cochrane Qualitative Research Methods Group (CQRMG) is developing search, appraisal, and synthesis methodologies for qualitative research ().
Bridging the Gap Between Research and Practice
The time between research dissemination and clinical translation may be significant

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