Advanced Technology and Information Systems
Chapter 7
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Technological Advancements in Acute Care Clinical Practice
Information Technology (the use of computers to gather, organize, process and communicate information) is one of the highest priorities in health care today.
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Technological Advancements in Acute Care Clinical Practice
Computers will be involved in almost every area of direct client care, making it possible to accomplish work more effectively and efficiently.
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Technological Advancements in Acute Care Clinical Practice
The acute care setting (hospital) uses advanced technology and computerized equipment that is up-to-date and ever-changing.
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Hospital
IV and gastric infusion pumps Patient-controlled analgesia (PCA) Vital signs, oxygen blood saturation
levels Computer-assisted ventilators Pulmonary function, blood gas, cardiac
and intracranial pressure monitoring
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Technological Advancements in Acute Care Clinical Practice
Computers at the bedside facilitate more efficient recording of assessments and actions.
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Hospital
Wireless Communication• Paging systems allow nurses to be
contacted regardless of their location.• Electronic phone devices (cell phones) allow
two-way communication among nurses.
Handheld wireless computer devices or personal digital assistants (PDAs)
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Hospital
Electronic Health Record (EHR)• All information related to the client is
recorded electronically.• Information is recorded legibly and more
completely than in handwritten form.• Provides accessibility to all members of
health care team from any point of service.• Orders are conveyed to appropriate
departments from a computer terminal.
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Hospital
Electronic Health Record • Laboratory results are posted directly into
client’s record.• Appointments are scheduled.• Printed discharge summaries, referral
orders, teaching guides can be customized.• Home care nurses have access to the
hospital information system.
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Hospital
Decision-Making Support Systems (Expert Systems)• Alert the nurse to abnormal diagnostic
findings.• Warn the nurse regarding factors related to
medication administration.• Support use of the nursing process.• Additional programs provide procedural
guidelines.
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Legal and Ethical Issues: Privacy and Confidentiality
Methods to limit access to client information via computerized systems:• A firewall, passwords, codes provide limited
access.• Backup files should be stored separately.• Computers are placed in a secure area.• Closed-circuit television surveillance.• Automatic recording of any activity.
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Legal and Ethical Issues: Privacy and Confidentiality
When documenting with computers, the nurse must still remember the principles for legal documentation.• Identify the right client and the right record.• Record date and time of each entry.• Sign the entry with correct professional
credentials.
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Technological Advancements in Ambulatory Care Services
Ambulatory care services are client care services that are delivered within 24 hours.
Ambulatory care centers are usually satellites within a hospital network.
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Advanced Technology and Ambulatory Care
Provide many short-term services that require advanced technology:• Endoscopic Examinations• Elective Surgeries• Dialysis• Radiation• Chemotherapy
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Advanced Technology and Ambulatory Care
Free-standing birthing centers Day care Rehabilitation centers Community-based, nurse-managed
centers
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Advanced Technology and Ambulatory Care
This child is having an audiology test performed in a community-based, nurse-managed center.
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Advanced Technology and Ambulatory Care
Mammogram technology has become a common method for wellness promotion for women over the age of 40.
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Advanced Technology and Ambulatory Care
This bone density scan equipment is very expensive and requires adequate resource allocation for smaller health care agencies to afford its purchase.
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Technological Advancements in Ambulatory Care Services
Care Map• A plan of care based on standards that
reflect optimal timing of sequential steps in managing health problems.
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Technological Advancements in Ambulatory Care Services
Advanced Technology and Documentation • Provide access to a client’s hospital/clinic
records.• Used to order prescriptions, schedule tests
and future appointments.• Used to record information related to the
visit.
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Technological Advancements in the Home and the Community
Use of mechanical ventilators, infusion pumps modified for home use
Computer access to client records and diagnostic information
Communication with others on health care team
Electronic mail to transmit progress reports
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Technological Advancements in the Home and the Community
Home Care Monitoring Devices• Identify changes in a client’s condition.• Assist client and non-professional care
provider to follow prescribed plan of care.- Maintaining medication routines- Monitoring blood sugar levels- Recording vital signs
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Home Care Monitoring Devices
Cardiovascular Monitoring Devices• Holter cardiac monitor and diagnostic tool• Cardiac pacemaker monitoring and
regulating
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Home Care Monitoring Devices
Home Monitoring of High Risk Pregnancy • Evaluation of uterine activity and fetal heart
rate via television and telephone hookup
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Home Care Monitoring Devices
Automated Telephone Monitoring System “Home Talk”• Clients with chronic health problems• Menu of “problem specific” questions • Scores tallied and rated according to a
predetermined standard• Phone contact made for any negative
changes or client’s failure to answer a call
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Emergency Response Monitoring Systems
Particularly helpful to elderly persons living at home in the event of a:• Fall, heart attack, stroke
Linked directly to a monitoring agency.
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Telehealth, Telemedicine, and Telenursing
Home-based technology providing telecommunication services in health care delivery.
These services are conducted through video, audio, and computer systems.
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Telehealth, Telemedicine, and Telenursing
Allows “virtual office visits” via audio-video monitors.
Clients test their blood pressure, oxygen levels, and blood sugar levels.
Health care providers respond with instructions.
Access to on-line courses for clients. Additional communication by e-mail.
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Telehealth, Telemedicine, and Telenursing
The Government’s Role• Support for emergency care for combat
casualties, diagnostic studies, computerized client records, and links for aeromedical evacuation
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Telehealth, Telemedicine, and Telenursing
Telehealth Distribution• Worldwide connections between health
professionals and clients• Transmission of client information from
inside ambulances during transport
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Telehealth, Telemedicine, and Telenursing
Finances and Telehealth Issues• High costs of equipment and installation too
costly for many agencies.• Reluctance of some physicians, other health
care providers, and clients.• Reimbursement and interstate licensure
restrictions have limited widespread acceptance.
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Advances in Biotechnology
Magnetic Resonance Imaging (MRI) Computed Tomography (CT) Electromyography Fiber Optics Computerized Microscope Digital Cameras
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Cost of Biotechnology
Research and development costs overshadow need for funds for illness/disease prevention and health promotion measures.
Cost control strategy:• Managed care is major reimbursement
system at present.
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Nursing Roles and the Use of Advanced Technology
Nurse Administrators/Managers • Some nurses become certified in Nursing
Informatics.
Nurse Educators
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Advanced Technology Use by Nurse Administrators/Managers
Computer Information Systems• Community Health Information Networks
(CHINs)• Smart Card (computer disk for carrying
information)
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Advanced Technology Use by Nurse Educators
Computer-Assisted Instructional (CAI) Programs
Audio-Visual Presentations Distance Learning “Virtual Learning Labs”
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Nursing Research and Advanced Technology
National and international computer databases enhance literature searches.
Theses and dissertations to be submitted electronically to their universities and made available through digital libraries.
The Washington, DC Area Nursing Research Resources (WANRR) website.
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Classification Systems for Nursing Language
Computers have contributed greatly to the development of a standardized language for documenting nurse-sensitive outcomes and client outcomes.
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Classification Systems for Nursing Language
The Unified Nursing Language System (UNLS)• Developed by the American Nurses
Association (ANA) in 1991.• Encompasses common nursing terms from a
variety of vocabularies that can be used interchangeably.
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Classification Systems for Nursing Language
Advanced technology has allowed for an easier use of four classifications systems recognized by the ANA:• The North American Nursing Diagnosis
Association (NANDA)• The Omaha Classification System (OCS)• The Home Healthcare Classification (HHC)• The Nursing Interventions Classification
(NIC)
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High-Tech, High-Touch Nursing
It is imperative that the nurse balance “high-tech” (advanced technology) care with the caring aspect of nursing.
Personal contact is still a very important part of nursing that technology cannot replace.
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