INFORMATICS APPLICATION IN EVIDENCE-BASED NURSING PRACTICE

COMPUTER GENERATED IN NURSING CARE PLANS

A COMPUTER INFORMATION system can either stand alone or be part of a larger system the
whole facility uses. A nursing information system (NIS) can increase efficiency and accuracy in
all phases of the nursing process—assessment, nursing diagnosis, planning, implementing, and
evaluating. It can help you meet standards of nursing practice and documentation. In addition, an
NIS can help you spend more time meeting patients' needs. Consider the following uses of
computers in the nursing process.
Assessment
Use the computer terminal to record admission information. As you collect data, enter further
information as prompted by the computer's software program. Enter data about the patient's
health status, history, chief complaint, and other assessments.

Some software programs prompt you to ask specific questions, then offer pathways to gather
further information. In some systems, if you enter a value that's outside the usual acceptable
range, the computer will flag the entry so you can fix it.

Nursing diagnosis
Most current programs list standard diagnoses with associated signs and symptoms as references.
After you use your clinical judgment to determine a nursing diagnosis for each patient, you can
rapidly get information related to that diagnosis.

For example, the computer can generate a list of possible diagnoses for a patient with certain
signs and symptoms or it may enable you to retrieve and review a patient's records according to
the nursing diagnosis.

Planning
To help you begin writing a plan of care, newer computer programs display recommended
interventions for the selected diagnoses and expected outcomes. Computers also can track
outcomes for large patient populations.

Implementing
Use the computer to record interventions and patient information, such as transfer and discharge
instructions, and to communicate this information to other departments. Computer-generated
progress notes automatically sort and print out patient data—such as medication administration,
treatments, and vital signs—making documentation more efficient and accurate.

Evaluating
You can use computers to compare large amounts of patient data, help identify outcomes patients
are likely to achieve based on individual problems and needs, and estimate the time frame for
reaching outcome goals.

During evaluation, use the computer to record and store observations, patients' responses to
nursing interventions, and your own evaluation statements. You also may use information from
other health care team members to determine future actions and discharge planning. If a desired
patient outcome hasn't been achieved, record new interventions taken to ensure desired
outcomes. Then reevaluate them.

CLINICAL PATHWAYS
A clinical pathway, also known as care pathway, integrated care pathway, critical pathway, or
care map, is one of the main tools used to manage the quality in healthcare concerning the
standardisation of care processes. It has been shown that their implementation reduces the
variability in clinical practice and improves outcomes. Clinical pathways aim to promote
organised and efficient patient care based on evidence-based medicine and aim to optimise
outcomes in settings such as acute care and home care.
Clinical pathways differ from clinical guidelines and protocols as they are a set of practical
treatment processes detailing how to implement clinical guidelines, including both clinical
guidelines and non-clinical activities.
• Physicians use clinical pathways to give appropriate instructions on a daily basis. The nurses
review the orders and confirm their accomplishment. Other care team members such as the
therapist, nutritionist, interns and clerks carry out all the orders in the pathway pertaining to
them.
• Patients’ progress in the pathway will be reviewed and the variances will be recorded by nurses
and physicians
• Pathways thus promote continuous improvement and reliable care. In addition, clinical
pathways help in pursuing the goals of improving patient care quality, maximising the efficient
use of resources and supporting clinical effectiveness of health-care staff.
• Instead of the isolated and error-prone paper-based pathways, the computerised and shared
pathway throughout the treatment process will help in achieving a patient-centric process,
improving care coordination and efficiency, as well as reducing medical errors.

CLINICAL GUIDELINES
 Clinical practice guidelines (or simply “clinical guidelines”) are recommendations on
how to diagnose and treat a medical condition. They are mainly written for doctors, but
also for nurses and other health care professionals.
  “systematically developed statements to assist practitioner decisions about appropriate
health care for specific clinical circumstances.” Guidelines can be used to reduce
inappropriate variations in practice and to promote the delivery of high quality, evidence-
based health care.
 The purpose of guidelines is to improve the quality of care for patients and improve
clinical effectiveness by implementation of evidence-based care in daily practice.
 Clinical guidelines can be developed either locally (internal guidelines) or regionally or
nationally (external guidelines). Although internal guidelines may need fewer resources
and may be more likely to be adopted into clinical practice because of local ownership,
local groups may not have the skills required for guideline development.An alternative is
the development of guidelines at regional or national levels and subsequent modification
to suit local circumstances.
Guideline development has 4 stages.
 Firstly, it is essential that guidelines are based on the best available research evidence,
and therefore a detailed literature search is done to identify evidence from research
studies about the appropriateness and effectiveness of different clinical strategies.
 Next, using the research evidence, guideline construction takes place, usually through
some form of small group work, with representation from as many interested parties as
possible.
 Then, the guideline is tested by asking professionals not involved in the guideline
development to review it for clarity, internal consistency, and acceptability. The guideline
can then be tested in selected healthcare settings to see whether it is feasible for use in
routine practice.
 Finally, the guideline should be reviewed after a specified time period and modified to
take into account new knowledge.
following 11 characteristics:
 validity,
 cost effectiveness,
 reproducibility,
 reliability,
 representative development,
 clinical applicability,
 clinical flexibility,
 clarity,
  meticulous documentation,
 scheduled review, and
 unscheduled review.

E-JOURNALS
 An electronic journal is a periodical publication which is published
in electronic format, usually on the Internet. 
 Electronic journals have several advantages over traditional printed journals: You can
search the contents pages and/or the full text of journals to find articles on a certain
subject.
Advantages of E-Journals: 
 E-journals are becoming increasingly in demand both as a means of rapid desktop access
to current research materials and as a way to view past volumes.
 The main disadvantage of electronic journal is that libraries cannot physically posses
the journals.
What is evidence based practice in nursing journal?
 Nursing students require education that integrates evidence-based practice (EBP)
knowledge across classroom and clinical settings. This study was conducted to identify
and examine the literature related to nursing students' use of evidence in clinical
education and to identify associated research gaps.
 Evidence-Based Nursing searches a wide range of medical journals applying strict
criteria for the validity of research and relevance to best nursing practice.