INFORMATICS APPLICATION IN EVIDENCE-BASED NURSING PRACTICE

4.1 Foundation of Nursing Care plan

4.2 Critical Pathways

4.3 Clinical Guidelines

4.4 E-journals

INTRO:

Informatics is becoming increasingly present in our profession due to rapidly changing

technologic advances. Healthcare systems are assimilating technology into daily practice at a
quick pace. Security and patient privacy must be upheld while achieving the goal of transforming
data into useful knowledge. Integrating informatics with evidence-based practice (EBP) can only
help improve the care we provide to our patients.

Applying technology to knowledge may help identify potential problems earlier. For example,
with the use of electronic documentation, identifying changes in patient status can occur quickly
because the information is readily available. Trending of patient vital signs is always accessible
and the data are interpreted, systematized, and arranged. The nurse is able to use this knowledge
to formalize an appropriate plan of action.

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 you prompted b the computers software program. Enter data about the patient’s
health status, history, chief complaint, and other assessments.
 Some software programs prompt you to asks 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.

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

IMPLEMENTATION

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

EVALUATION

 You can use computers to compare large amounts of patient data, help identify outcomes
patients are likes to achieve based on individual’s problems and needs, and estimate the time
frame for reaching outcome goals.
 During evaluation, use the computer to record and store observations, patient’s responses to
nursing interventions, and you 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 critical Pathway (CP) is a clinical management tool that helps medical
care providers coordinate the delivery of patient care for a particular case type or
condition. As a guide to usual treatment patterns, a CP gives a view of the "big picture." The
CP usually recommends a total treatment regimen.

Roark MK. Critical pathways. J Healthc Resour Manag. 1997 Jan-Feb;15(1):12-5. PMID: 10164677.

 CLINICAL PATHWAYS differs from clinical guidelines and protocols as they are 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 promotes continuous improvement and reliable care. In addition, clinical
pathways helps in pursuing the goals and improving patient care quality, maximizing the
efficient use of resources and supporting clinical effectiveness of health-care staff.
 Instead of the isolated and error-prone paper based pathways, the computerized 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 PRACTIVE GUIDELINES are recommendations on how to diagnose and treat a

medica condition. They are mainly written for doctors, but also for nurses and other health
care professionals.
 CLINICAL PRACTICE are systematically developed statements to assist practitioner decisions
about appropriate health care for specific clinical circumstances. “Guidelines can be used to
reduce inappropriate variation 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 FOUR (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 constructions takes place, usually through some
form of small group work, with representation from as many interested parties as possible.

THEN, the guidelines is tested by asking professionals not involved in the guideline
development to review it for clarity, internal consistency and acceptability. The guideline can be
then tested in selected healthcare settings to see whether it id feasible for use in routine
practice.

FINALLY, the guideline should be reviewed after a specified period and modified to take into
account new knowledge.

Following 11 Characteristics;

1. Validity
 2. Cost-effectiveness
3. Reproducibility
4. Reliability
5. Representative development
6. Clinical applicability
7. Clinical flexibility
8. Clarity
9. Meticulous documentation
10. Scheduled review
11. Unscheduled review

E-JOURNALS

 An ELECTRONIC JOURNALS 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 or 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 possess the
journals.

WHAT IS EVIDENCE BASED PRACTICE IN NURSING JOURNAL?

 Nursing students require education that integrated 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 be nursing practice.