Evidence-based nursing
Harnessing technology to promote patient-centered care By Cheryl A. Fisher, EdD, RN-BC, and Kathryn Feigenbaum, MSN, CGRN, CDE
N
ursing leaders are charged with keeping their staff knowledgeable and engaged in evidence-based practice (EBP) in tandem with the rapid rate of medical technology advances. Additionally, increased workloads, patient complexity, and fiscal considerations are competing for attention and adding to daily challenges. Striving to provide safe, quality, data-driven care to patients is a strategic goal of all healthcare organizations. In order to attain this goal, it’s important to provide the clinician with easily accessible, usable, evidence-based data at the point of care. This article will discuss some of the many technical options, skills, and solutions that nurses must utilize to achieve the best outcomes through delivery of the best possible care. Specifically, digital systems that support EBP processes, competencies to enhance practice, and personalized decision support at the point of care. At the National Institutes of Health (NIH) Clinical Center, nurse managers play a critical role in supporting clinical research nurses in EBP and are strong advocates for the use of technology to support patient care. Informatics and competencies As the field of informatics science advances, so do the opportunities to bring technology to the clinician to support evidence-based care decisions. Five building blocks of an informatics infrastructure for EBP have been described: (1) standardized terminologies and structures, (2) digital sources of evidence, (3) standards that facilitate healthcare data exchange among heterogeneous systems, (4) informatics processes that support the acquisition and application of evidence to a specific clinical situation, and (5) informatics competencies.1 The
14 January 2015 • Nursing Management
application of nursing informatics knowledge is empowering for all healthcare practitioners in achieving patient-centered care. In 2009, the Technology Informatics Guiding Educational Reform, or TIGER, Initiative developed a set of nursing informatics competencies to prepare the clinical workforce for using technology to improve healthcare delivery.2 These competencies are grouped into three subsets, including information literacy, clinical information management, and basic computer skills.3 With basic knowledge and skills in these areas, nurses are better equipped to provide clinical care and can more easily access, utilize, implement, and communicate care requirements based on evidence. Technical infrastructure to support EBP In addition to competencies, new mobile devices have launched us into exciting times with a plethora of choices for accessing data and the need to maximize their use. Nurse managers have the prime opportunity to ensure that staff members are aware of and have access to these technologies that support their efforts to practice evidence-based care. For example, mobile computers at the bedside in the form of workstations on wheels have become commonplace, along with smartphones and tablets that are now equally as essential as the stethoscope. These technologies allow nurses quick access to real-time data that can impact and influence patient care decisions. The nurse manager’s advocacy becomes critical for the hospital to budget for these technologies and demonstrate the value that these devices bring to the clinical setting. Nurse leaders must stay informed about the changing landscape of information technology and advocate for the most up-to-date infrastructure for their staff. Nurses must have access to scholarly evidence and the means to analyze and critique publications. Databases should be available at the nurse’s fingertips for every nurse to use at any time. Accessing the literature is a critical first step in EBP after the PICO question or idea is formulated. Webinars, www.nursingmanagement.com
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Evidence-based nursing online tutorials, and a library resource or informationist can help refine searches and keywords. Subscriptions for journals need to be available so that full-text articles can be obtained and referenced at the point of care. Often, nurses cite lack of time as a barrier to using evidence when formulating a care plan for individual patients. However, with easy access at the point of care, this barrier can be overcome. The many systems of support After the literature has been retrieved, nurses need to have the knowledge, skills, and appropriate tools to organize and analyze the information. Most literature on EBP emphasizes the use of formally published technical and scientific findings, such as research evidence or peer-reviewed primary literature. However, evidence-based decisions may also include other sources of information, such as retrieval from the electronic health record (EHR) or queries from a databased system. Computer software can provide tools to develop evidence tables and help systematically organize findings. Software is also available to provide ways to network among staff members who are working on the same project or connect to experts in the field. These networking capabilities provide staff with the ability to share desktops and video and/or voice chat without having to be in the same place at the same time. Social networking sites provide another venue for staff to dialog with professionals who may have the same issue or concern. Coming down the virtual pike Virtual community software is another option, providing educational, resource, and networking capability at the local or national level. This concept was embraced www.nursingmanagement.com
by the National Nursing Practice Network, which provides webinars on a monthly basis to discuss research articles or an evidence base for particular clinical topics, podcasts on EBP topics, guides for critique of research, and the latest on practice recommendations.4 A similar concept is in development at the NIH Clinical Center, with plans to establish an online environment for clinical nurses to access online education, participate in journal clubs, access resources, and collaborate with each other and hospital experts on various topics and areas of interest. This online capability will support EBP through increased access to resources, education, and support in an asynchronous manner that won’t pull nurses away from the unit. The EBP Infobot can extract EHR information to support patientspecific personalization of care plans.5 The EBP Infobot uses specific patient information (such as diagnosis, age, medications, and gender) to customize the search for relevant information from databases and other resources necessary to develop an individualized care plan. All of this information can be accessed via the computer and provides valuable and useful information for a personalized care plan and patient education. Another technology that can be of assistance with EBP at the point of care is a clinical dashboard to query multiple databases and provide a visual representation of key performance indicators in a single report. The dashboard provides a concise overview of a large volume of data and, when combined with EHRs, can provide near real-time surveillance to improve patient outcomes.6 Other ways to track outcomes and comparison groups are national databases such as the National Database of Nursing Quality Indicators,®
which can track metrics on catheterassociated infections, pressure ulcers, and many other clinical indexes of quality care. These data can then be used to guide the focus of evidencebased interventions or evaluate progress. Turning evidence into practice Nurse leaders must support their staff in the pursuit of EBP and safe, quality care. Technology and the skills to use it at the point of care can minimize time barriers and promote evidence utilization for patient-centered care. As technology rapidly advances, nurse leaders have the opportunity to fully engage with the many technical options available to provide new and exciting ways of integrating evidence into practice. NM
REFERENCES 1. Bakken S. An informatics infrastructure is essential for evidence-based practice. J Am Med Inform Assoc. 2001;8(3):199-201. 2. Hebda TL, Calderone TL. Informatics competencies for healthcare professionals: the Technology Informatics Guiding Education Reform (TIGER) Initiative model. Drug Metabol Drug Interact. 2012;27(3):145-149. 3. Hunter KM, Dee M, Hebda T. Operationalizing TIGER NI competencies for online assessment of perceived competency. Nurs Inform. 2012;2012:181. 4. Titler MG. Overview of evidence-based practice and translation science. Nurs Clin North Am. 2014;49(3):269-274. 5. Demner-Fushman D, Seckman C, Fisher C, Thoma GR. Continual development of a personalized decision support system. Stud Health Technol Inform. 2013;192: 175-179. 6. Wilbanks BA, Langford PA. A review of dashboards for data analytics in nursing. Comput Inform Nurs. 2014;32(11):545-549. At the National Institutes of Health Clinical Center in Bethesda, Md., Cheryl A. Fisher is a senior nurse consultant, Office of the Chief Nurse, and Kathryn Feigenbaum is a clinical nurse specialist, Medical-Surgical Specialties. The authors have disclosed that they have no financial relationships related to this article. DOI-10.1097/01.NUMA.0000459044.24554.af
Nursing Management • January 2015 15
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Harnessing technology to promote patient-centered care By Cheryl A. Fisher, EdD, RN-BC, and Kathryn Feigenbaum, MSN, CGRN, CDE
N
ursing leaders are charged with keeping their staff knowledgeable and engaged in evidence-based practice (EBP) in tandem with the rapid rate of medical technology advances. Additionally, increased workloads, patient complexity, and fiscal considerations are competing for attention and adding to daily challenges. Striving to provide safe, quality, data-driven care to patients is a strategic goal of all healthcare organizations. In order to attain this goal, it’s important to provide the clinician with easily accessible, usable, evidence-based data at the point of care. This article will discuss some of the many technical options, skills, and solutions that nurses must utilize to achieve the best outcomes through delivery of the best possible care. Specifically, digital systems that support EBP processes, competencies to enhance practice, and personalized decision support at the point of care. At the National Institutes of Health (NIH) Clinical Center, nurse managers play a critical role in supporting clinical research nurses in EBP and are strong advocates for the use of technology to support patient care. Informatics and competencies As the field of informatics science advances, so do the opportunities to bring technology to the clinician to support evidence-based care decisions. Five building blocks of an informatics infrastructure for EBP have been described: (1) standardized terminologies and structures, (2) digital sources of evidence, (3) standards that facilitate healthcare data exchange among heterogeneous systems, (4) informatics processes that support the acquisition and application of evidence to a specific clinical situation, and (5) informatics competencies.1 The
14 January 2015 • Nursing Management
application of nursing informatics knowledge is empowering for all healthcare practitioners in achieving patient-centered care. In 2009, the Technology Informatics Guiding Educational Reform, or TIGER, Initiative developed a set of nursing informatics competencies to prepare the clinical workforce for using technology to improve healthcare delivery.2 These competencies are grouped into three subsets, including information literacy, clinical information management, and basic computer skills.3 With basic knowledge and skills in these areas, nurses are better equipped to provide clinical care and can more easily access, utilize, implement, and communicate care requirements based on evidence. Technical infrastructure to support EBP In addition to competencies, new mobile devices have launched us into exciting times with a plethora of choices for accessing data and the need to maximize their use. Nurse managers have the prime opportunity to ensure that staff members are aware of and have access to these technologies that support their efforts to practice evidence-based care. For example, mobile computers at the bedside in the form of workstations on wheels have become commonplace, along with smartphones and tablets that are now equally as essential as the stethoscope. These technologies allow nurses quick access to real-time data that can impact and influence patient care decisions. The nurse manager’s advocacy becomes critical for the hospital to budget for these technologies and demonstrate the value that these devices bring to the clinical setting. Nurse leaders must stay informed about the changing landscape of information technology and advocate for the most up-to-date infrastructure for their staff. Nurses must have access to scholarly evidence and the means to analyze and critique publications. Databases should be available at the nurse’s fingertips for every nurse to use at any time. Accessing the literature is a critical first step in EBP after the PICO question or idea is formulated. Webinars, www.nursingmanagement.com
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Evidence-based nursing online tutorials, and a library resource or informationist can help refine searches and keywords. Subscriptions for journals need to be available so that full-text articles can be obtained and referenced at the point of care. Often, nurses cite lack of time as a barrier to using evidence when formulating a care plan for individual patients. However, with easy access at the point of care, this barrier can be overcome. The many systems of support After the literature has been retrieved, nurses need to have the knowledge, skills, and appropriate tools to organize and analyze the information. Most literature on EBP emphasizes the use of formally published technical and scientific findings, such as research evidence or peer-reviewed primary literature. However, evidence-based decisions may also include other sources of information, such as retrieval from the electronic health record (EHR) or queries from a databased system. Computer software can provide tools to develop evidence tables and help systematically organize findings. Software is also available to provide ways to network among staff members who are working on the same project or connect to experts in the field. These networking capabilities provide staff with the ability to share desktops and video and/or voice chat without having to be in the same place at the same time. Social networking sites provide another venue for staff to dialog with professionals who may have the same issue or concern. Coming down the virtual pike Virtual community software is another option, providing educational, resource, and networking capability at the local or national level. This concept was embraced www.nursingmanagement.com
by the National Nursing Practice Network, which provides webinars on a monthly basis to discuss research articles or an evidence base for particular clinical topics, podcasts on EBP topics, guides for critique of research, and the latest on practice recommendations.4 A similar concept is in development at the NIH Clinical Center, with plans to establish an online environment for clinical nurses to access online education, participate in journal clubs, access resources, and collaborate with each other and hospital experts on various topics and areas of interest. This online capability will support EBP through increased access to resources, education, and support in an asynchronous manner that won’t pull nurses away from the unit. The EBP Infobot can extract EHR information to support patientspecific personalization of care plans.5 The EBP Infobot uses specific patient information (such as diagnosis, age, medications, and gender) to customize the search for relevant information from databases and other resources necessary to develop an individualized care plan. All of this information can be accessed via the computer and provides valuable and useful information for a personalized care plan and patient education. Another technology that can be of assistance with EBP at the point of care is a clinical dashboard to query multiple databases and provide a visual representation of key performance indicators in a single report. The dashboard provides a concise overview of a large volume of data and, when combined with EHRs, can provide near real-time surveillance to improve patient outcomes.6 Other ways to track outcomes and comparison groups are national databases such as the National Database of Nursing Quality Indicators,®
which can track metrics on catheterassociated infections, pressure ulcers, and many other clinical indexes of quality care. These data can then be used to guide the focus of evidencebased interventions or evaluate progress. Turning evidence into practice Nurse leaders must support their staff in the pursuit of EBP and safe, quality care. Technology and the skills to use it at the point of care can minimize time barriers and promote evidence utilization for patient-centered care. As technology rapidly advances, nurse leaders have the opportunity to fully engage with the many technical options available to provide new and exciting ways of integrating evidence into practice. NM
REFERENCES 1. Bakken S. An informatics infrastructure is essential for evidence-based practice. J Am Med Inform Assoc. 2001;8(3):199-201. 2. Hebda TL, Calderone TL. Informatics competencies for healthcare professionals: the Technology Informatics Guiding Education Reform (TIGER) Initiative model. Drug Metabol Drug Interact. 2012;27(3):145-149. 3. Hunter KM, Dee M, Hebda T. Operationalizing TIGER NI competencies for online assessment of perceived competency. Nurs Inform. 2012;2012:181. 4. Titler MG. Overview of evidence-based practice and translation science. Nurs Clin North Am. 2014;49(3):269-274. 5. Demner-Fushman D, Seckman C, Fisher C, Thoma GR. Continual development of a personalized decision support system. Stud Health Technol Inform. 2013;192: 175-179. 6. Wilbanks BA, Langford PA. A review of dashboards for data analytics in nursing. Comput Inform Nurs. 2014;32(11):545-549. At the National Institutes of Health Clinical Center in Bethesda, Md., Cheryl A. Fisher is a senior nurse consultant, Office of the Chief Nurse, and Kathryn Feigenbaum is a clinical nurse specialist, Medical-Surgical Specialties. The authors have disclosed that they have no financial relationships related to this article. DOI-10.1097/01.NUMA.0000459044.24554.af
Nursing Management • January 2015 15
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
