Data Use in Clinical and Administrative Decision-Making in Nursing Health Care - Literature review Example

? DATA USE IN CLINICAL AND ADMINISTRATIVE DECISION MAKING IN NURSING HEALTH CARE By Presented to in partial fulfillment of the requirements for the degree of [degree name] [university name] [university location] [date] ABSTRACT The application of IT technology in nursing sector still holds many challenges. However there is much hope that these challenges will be overcome. Nurses remain the pioneers in integrating IT technology in health care sector, but it also presents them with some of the most challenging problems that can take place with the use of this technology. For now, the people can benefit from health through the clinical services of the nurses and byte technologies of computer. DATA USE IN CLINICAL AND ADMINISTRATIVE DECISION MAKING IN NURSING HEALTH CARE An interesting fact about nursing care is that as opposed to the popular concept, nurses do not devote more time to patient care (Westra et al, 2010, pp 336 and Ball, 2005, pp 1). In fact, nurses have been documented to spend as less as 15% of their total time taking care of the patients, and the remaining time in organizing and documenting the data that they receive (Ball, 2005, pp 1). This creates a concern for health care professionals and even nurses, since more documentation means that there is less clinical experience gained through direct contact with the patients (Ball, 2005, pp 1). The challenge does not end here. Nurses are now providing more services to the patients and the health care industry than that in the past (Ball, 2005, pp 2). They are taking on more active roles in providing care for their patietns, instead of taking a backseat to doctors and other senior health care administrators. This means that the responsibilities and challenges have also increased substantially. Patients are now benefitting from innovative nursing services such as information prescriptions (Ball, 2005, pp 2). However with newer responsibilities come newer challenges and needs and increased pressure on the nursing staff to provide the excellent levels of care. Based on this information, it is easily understandable why nursing is among the first of the few medical professions to take up and accept the concept of IT in health care (Ball, 2005, pp 1). Computerized methods have made it increasingly easier to document at a faster pace, which means that nurses are able to work more in less time and provide the highest levels of quality care to the patients (Ball, 2005, pp 1, Weber, 2010, np). It reduces the time and effort involved in communication between different personnel by providing the information within easy access, and through a proper set of guidelines and protocols (Ball, 2005, pp 1). Nurses are better able to coordinate the different activities that need to take place during a patient’s care, and create analogies and associations within it, so as to reach better decisions regarding care of the patient. This increases their efficiency in clinical areas too (Ball, 2005, pp 1). The use of technological tools in the nursing field is not a new concept. However, due to lack of skills in the area, nurses were unable to apply this system. Alongside, lack of motivation may also be one of the reasons why IT did not become an integral part of nursing till now. The applications of such IT systems however, have increased so much in the nursing sector that now it is even able to take up clinical decision challenges. In this regard, the literature review aims to highlight the contribution of IT sector in the various management activities of the nursing professionals. It aims to highlight how nurses can benefit through these technologies to improve their performances and clinical decisions. By understanding the advantages, the challenges as well as future applications of this technology, new researches can be carried out to improve the quality of care in nursing profession. There are many reasons why an age old process such as clinical decision making remains one of the most challenging areas in nursing practice. Many barriers exist which prevent nurses from reaching the right decisions in caring for their patients (O’Reilly, nd, np). For example, the most common factor is the lack of experience and knowledge among nursing staff about taking a clinical decision. Experience in medical industry is one of the most valued assets for any health professional (O’Reilly, nd, np). It helps one particular professional stand out from the next. It is the a skills mark for the professional and shows his or her ability to assimilate knowledge, gather assessments and reach a final decision on the treatment plan (O’Reilly, nd, np, Weber, 2010, np). While this quality is desirable, it does have a very serious implications and consequences should error take place. Therefore, nurses, as with other health care professionals, may be daunted by such a big responsibility (O’Reilly, nd, np). Another key challenge lies in lack of creating thinking among the health care professionals. Sadly, it is one of the main problems that occur due to the heavy textbook and symptomology related thought and cognitive processes that are developed in the health care students (O’Reilly, nd, np). This leads to lack of original thinking and looking from a fresh perspective quality among the professionals, including nurses (O’Reilly, nd, np). Challenges to this form of thinking can help overcome this hiatus and can help nurses become proficient in decision making. Other most common causes that can affect the clinical decision making among nurses include stress, inadequate staffing and interpersonal conflict among a few (O’Reilly, nd, np). With quick and astute identification of IT as the next potential life saver for the nursing profession, nurses are now eagerly taking up learning related to nursing informatics and IT technological systems. The evidence of this trend can be easily seen with the variety of programs that are being offered by universities across the globe centered on Health Informatics (Ball, 2005, pp 3, Weber, 2010, np). Nowadays there are many clinical assessment tools available that are helping nurses achieve good clinical competency. Ireland for example has created a novel system known as the Nursing Minimum Data Set or NMDS which can be applied with equal ease in all types of health care setting. This set includes the most important information that is needed by the nurses to manage their different every day professional duties. The NMDS is directly in line with the current need to create a set of data that is able to encompass and utilize all areas of nursing care and demographics of a given region (The Irish NMDS, 2009, pp 1). It provides clinical and administrative guidelines in dealing with patients and their care takers, and how to address various care issues these patients and families come across with during the course of care provision (The Irish NMDS, 2009, pp 1). The gathering of such data and its proper compilation aims to provide clues to the new areas of research that are needed in nursing management, and to ensure provision of information and help in various clinical decision making processes (The Irish NMDS, 2009, pp 1). The process to create this data set of information is still in its early stages. Therefore, the current aims in nursing are all focused on understanding how nurses carry out their administrative and clinical responsibilities in different settings (The Irish NMDS, 2009, pp 1). They can then identify their areas of strengths and weakness; and after doing so they can create policies and method that can help them provide better health care to the patients (The Irish NMDS, 2009, pp 1). The initial sets of this kind can help create a framework for nurses to organize their working in a particular manner (The Irish NMDS, 2009, pp 2). This will allow the nurses to identify how the proposed system works, what is its applicability, how it can help in creating a better outcome for the nursing and patient population and what are the areas of concern and research to be investigated (The Irish NMDS, 2009, pp 2). Current nursing data management systems have come out of their shell to not only include various clinical care related documentations, but also areas associated with financial information systems, point of care technologies, computer aided visualization techniques, non invasive diagnostic methods, and different care processes in different clinical settings (Ball, 2005, pp 2). The same data can then be utilized for making decisions about quality improvement (Westra et al, 2010, pp 337). The data can be used to identify patterns, variations and anomalies in the nursing care system. The use of the new nursing data sets hold potential for overcoming some of the most prominent challenges in nursing clinical care (Westra et al, 2010, pp 337 and 338). The question arises as to how clinical decisions can be integrated in the new IT information sector and whether there is any benefit that can be derived from such a process. Weber’s research (2007) provides some clues as to how nurses can use this technology to achieve clinical results (Weber, 2007, pp 663). since there is lack of nursing practitioners with IT experience, the next best solution is to draw conclusions from the senior nursing staff, introduce them to the new concept of IT in nursing and benefit from them in finding the best method of utilization of this technology in the clinical decision making process. A total of 23 professionals were selected for this study, and information was collected on what themes and areas were the most important consideration in the provision of clinical care for nurses based on their experience (Weber, 2007, pp 663). Comparative analysis of the data revealed that the concept of ‘forecasting decision outcomes’ can help nurses flex their clinical decision skills (Weber, 2007, pp 663). Reasons why senior nurses may advocate the use of clinical decision making processes in their practices are to provide “an objective, scientifically derived, technology based backup for human forecasting of the outcomes of patient care decisions prior to their actual decision making (Weber, 2007, pp 664 and 665). Therefore, the current clinical decision making systems are providing information, guidance and decisions in four critical areas of patient care. The first of these are the administrative decisions, such as clinical coding, documentation, authorization of procedures and referrals. The second area of concern include management of complex issues pertaining to clinical areas and details, such as keeping patients on research and chemotherapy protocols, tracking different orders, referrals and follow-ups, and preventive care provision. Third area of application is cost control, whereby decisions are made to provide the necessary medications and investigations but prevent reuse or unnecessary procedures. Finally, the clinical decision making systems are involved in the decision regarding the best suitable treatment plan, promotion of these practices, and creating and informing about the most up to date guidelines based on population statistics (Decision Support systems, nd, np). The emerging research and efforts therein is opening up the minds of the nursing professionals to the new ways information technology can be utilized in the provision of quality health care. Not the least of concerns among these is the ethical aspects of health care delivery (Wilson, 1998, pp 319). The current administrative and clinical decision making tasks are very strongly governed by the ethical aspects of care along with the already important clinical considerations (Wilson, 1998, pp 323). Information IT in this way can also help create data bases that discuss the ethical aspects of various cases. This information in the future can help nurses become more aware and informed about the ethical care perspectives, and will allow them to become more astute about their decision making processes (Wilson, 1998, pp 322 and 324). Many clinical decision models have been introduced so far, some of the most popular being Internist I (1974), MYCIN and its later prodigy EMYCIN, CASNET and PIP or the Present Illness Program respectively (Decision Support systems, nd, np). Nurses however, still do not accept the computer having a final word about the various clinical decision processes that may be directed towards it. This shows that issues and challenges remain in integrating IT in nursing care provision (Weber, 2010, np). Nurses still believe that while there may be a human factor involved in making critical health care decisions, the computers still cannot be used as the sole guide to provide decisions in this regard. Researches show extremely positive or negative responses of health care professionals to the efficacy of computers to replace human health related decision making power (Weber, 2010, np). Creating a middle ground must be carried out in order to prevent extreme reactions in a sensitive working environment (Weber, 2010, np). CONCLUSION Clinical decision making process is the interplay of many factors that integrate together to provide the final treatment plan. Nurses are placed in a challenging position when they have to take touch health care decisions in clinical practice (Banning, 2008, pp 190). Clinical decision making process comes through learning, observation, gathering information and through experience in clinical practice. With the selection of a particular field of specialization, nurses can gain proficiency in a certain type of clinical set of cases (Banning, 2008, pp 189 and 193). Alongside the use of research based evidence, clinical decision processes can be used together to make best decisions about patients (Weber, 2010, np). The application of IT technology in nursing sector therefore, still holds many challenges. However there is much hope that these challenges will be overcome. Nurses remain the pioneers in integrating IT technology in health care sector, but it also presents them with some of the most challenging problems that can take place with the use of this technology. For now, the people can benefit from health through the clinical services of the nurses and byte technologies of computer. REFERENCES Ball MJ, 2005. Nursing Informatics of Tomorrow. Health Informatics Online. The McGraw Hills Company. Banning M,2008. A Review of Clinical Decision Making: Models and Current Research. Journal of Clinical Nursing vol 17, Issue 2, pp 187-195. Decision Support Systems, nd. Site last accessed on March 20th, 2011 from http://www.openclinical.org/dss.html#functions The Irish Nursing Minimum Data Set, 2009. Measuring the Nursing and Midwifery Contribution Update 2. National Council for the Professional Development of Nursing and Midwifery, September 2009. O’Reilly P, np. Barriers to Effective Clinical Decision Making in Nursing. Site last accessed on March 20th, 2011 from http://www.ciap.health.nsw.gov.au/hospolic/stvincents/1993/a04.html Weber, S. (Fall, 2010). Impacts of Clinical Decision Support Technology on Nursing and Medical Practice in U.S. Critical Care.  CJNI: Canadian Journal of Nursing Informatics, 5 (4), Article Three. http://cjni.net/journal/?p=1094 Weber S, 2007. A Qualitative Analysis of How Advanced Practice Nurses Use Clinical Decision Support Systems. Journal of the American Academy of Nurse Practitioners Vol 19, Issue 12, pp 652-667. Westra BL, Subramanian A, Hart CM, Matney SA, Wilson PS, Huff SM, Huber DL, Delaney CW, 2010. Achieving “Meaningful Use” of Electronic Health Records Through the Integration of the Nursing Management Minimum Data Set. Journal of Nursing Administration vol 40, Issue 7/8, pp 336-343. Wilson DM, 1998. Administrative Decision Making in Response to Sudden Health Care Agency Funding Reductions: Is There a Role for Ethics? Nurs Ethics July 1998, vol 5, no 4, pp 319-329. Read More