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Nursing Informatics & Technology: A Blog for All Levels of Users

Social Media & Nursing Informatics - Part I - So Many Questions
September 29, 2014 1:17 PM by Angela Lewis

What are the first thoughts that come to mind when you read the term: "social media"? Do you think about your tween's Myspace page or your own LinkedIn account? Maybe when you hear the term, visions of unending kitten videos posted to Facebook come to mind? Perhaps you drew a blank when you read the term because you still refuse to even own a cell phone and associate "tweeting" with something birds do. For some, the term may conjure up everything from the Internet, to Google's search engine, to recipes for zucchini bread "pinned" on Pinterest boards.

Is it possible to utilize social media as a clinical practice tool? Perhaps social media is just a fad or only something for those of Generation X, Y or Z? Is it a way to communicate, socialize or just a marketing strategy for organizations? 

Regina Wysocki, BSN, RN, school nurse, wrote that social media "is a way for nurses who work in the informatics field as well as nurses who might be interested in informatics to network with one another." Svea Welch, M.A., LPC - MHSP, clinical therapist believes: "Social media is a great networking tool ... utilized by most people in and out of the [healthcare] field. It becomes dangerous when the incorrect information or too much information is shared." Is social media HIPAA compliant, a safe or appropriate venue for clinician-patient interactions?

Were you aware that blogs (like this one) are considered a form of social media? What's the connection between social media and healthcare? How are patient care, nursing informatics and social media related? Recently the American Nursing Informatics Association (ANIA) formed a work group to examine the organization's "social media presence."

Although a great deal has been written about social media outside of healthcare, in this and my next several blog posts I'd like to explore the above questions, discuss what social media is, what it isn't, what its implications are for patient care, clinical practice and nursing/healthcare informatics and, most importantly, I'd like to hear input from this community on the topic. To prime the pump here are a few more questions.

1.            What are the FIRST thoughts that come to mind when you hear/read the term social media?

2.            How would you define social media?

3.            How have you seen social media utilized in clinical practice and or clinical informatics?

4.            Does your organization have an official social media Policy & Procedure? If so why/what was the rational for implementing same?

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Facebook

Network with your colleagues on Facebook.

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Big Data Translates Into Big Change for Nurse Education and Training
September 22, 2014 1:55 PM by Susan Sportsman

Big data promises to have a big impact on nurse education and training, including the performance and success rates of nurse learners, whether they happen to be young Millennials or retirees who've just re-entered the workforce.  

But it will take time before big data and analytics transform the experiences of learners, educators and trainers and reshape how learners develop skills, knowledge and competencies. Nursing has just started to notice how nurse learners generate digital footprints, opening the door for nursing to collect and leverage data and information about educators and learners. Once nurse educators and trainers discover how to analyze data and control the way data works to fulfill a purpose, they'll see the impact of big data on nursing practice.     

Until recently, big data and data analytics would surface in functions like application processing and course management. Much of the data was "siloed" and limited to specific functions. Now, however, educators and trainers are zeroing in on individual learner data in the quest to improve learner service and support. Big data offers nurse educators and trainers the opportunity to ask more and better questions - not only about specific learners, but also about small and large groups of learners overtime and within diverse locations.

Understanding nurse learners demands that nursing identifies preferences, perceptions, attitudes, beliefs, values, strengths, weaknesses, goals and/or desires - facts that educators and trainers can integrate like never before  with big data. While some nurse educators and trainers will collect data directly from nurse learners, others will observe nurse learner behavior or document and review learner choices. 

No matter what strategy educators and trainers use, they'll be able to tap big data analytics to create enhanced learning experiences for individual learners. As they collect and analyze big data across cohorts and organizations, they can apply what they've learned to nurse education and training available via colleges and universities, online courses and provider organizations.

The more data educators and trainers collect about more learners, the more they can enhance the experience of nurse learners. In other words, they can offer more customized, personalized experiences and choices to help learners meet their learning, education and training goals and objectives.

The promised outcome of big data analytics thrills the nursing profession. Educators and trainers will be able to predict learner success, improve graduate and course completion rates and track learner behavior, including learners' level of engagement. They'll also receive alerts if nurse learners become bored, distracted or frustrated.

Organization and profession-level transformation will also occur. Organizations will see the results in highly personalized learning experiences, more satisfied and successful learners and less administrative work. Nurse educators and trainers will get the input they need to revamp content and measure learner performance beyond simple test scores.

Colleges, universities and provider organizations already realize that nurse learner and educator data is stored, manipulated and shared electronically. In the quest to ensure data integrity and privacy, some organizations may need to hire a professional - or even a team of professionals - to secure and protect learner and educator data.

Big data involves big change, but it also suggests big challenge. Organizations must find ways to contain personally identifiable data and forge a culture of transparency regarding data capture, storage, use and sharing. Also important is informing educators, trainers and learners about the power, function, scope and risks of big data. Among the frequently asked questions the merit answers are the following:    

  • Data type: What kind of learner data do you plan to collect?
  • Data purpose: What do you plan to do with the learner data? Why?
  • Data value: What is the value or benefit of learner data collection and analysis? How will the learner, educators, trainers, organization and nursing profession use this data?
  • Data risk: What could possibly go wrong as you collect, analyze and store this data? How do you plan to handle a crisis?

Nurse educators and trainers must enlist the support of nurse managers, executives and other members of the C-Suite to support big data literacy. Nurse learners must know how to use devices -f rom laptops, tablets and Google Glass, to smartphones, smart watches and desktop units. But they also need to develop digital literacy - the ability to access, analyze and use data and information available via data analytics systems, the Web and even social media.

Only by understanding the capabilities, uses, benefits and liabilities of big data and big data analytics can nursing fully integrate it into nurse education, training and clinical practice. Nurses owe it to themselves and the profession to become part of the big data conversation.    

Resources

Empowering Nurses with Data

Unlocking Big Data to Improve Care

Nursing Knowledge:  Big Data Research for Transforming Healthcare

Mother Lodes and Mining Tools:  Big Data for Nursing Science

Nursing Informatics:  A Specialty on the Rise

Big Data and Disruptive Innovation in Wound Care

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Nursing Informatics vs. Health Informatics

Renowned team of nursing informatics researchers creates definitions, boundaries, and priorities.

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The Documentation Paradox in Med-Surg
September 17, 2014 9:00 AM by Susan Niemeier, RN, BSN, MHA
The med/surg unit is an operationally intense care environment with typically two out of three hospitalized patients residing in this area. The acuity of patients in this setting is escalating, along with rising co-morbidities and patient age. In parallel, the hospital's patient population is shifting more toward outpatient care, increasing the number of short-stay patients. Short-stay patients are those who stay in the hospital for approximately 23 hours or less and are then discharged to go home. Often, these patients are placed in med-surg units and require a heightened level of observation to assess for subtle changes in their condition. As acuity increases, so do the number of devices at the bedside, along with the requirements for entering data into a patient's record.

Despite these conditions the nurse-to-patient ratio in med-surg units has not changed. This results in more work and immeasurable stress. Add to that the regulatory, legal and hospital compliance efforts for higher degrees of documentation, as well as pressure to discharge patients as soon as possible, and you can see that there is a "perfect storm" of increased workflow requirements that could lead to errors putting patients at risk.  

The environment wherein med-surg nurses work has become incredibly complex and demanding. The result is that they must provide increased effort, energy, and attention just to perform their normal, daily activities. Many are close to the breaking point; they simply cannot take on any more work or responsibility without significantly impacting patient care.

One responsibility that steals substantial time from patient care is documentation. The increasing complexity of patients seen in the med-surg unit means that nurses are constantly moving (between one and five miles during a typical 10-hour shift), making decisions on the fly, and multitasking, all of which takes a high toll on performance and work processes.1 Given all this, nurses view documentation as a lower priority item on their list, choosing to document in batch mode when they have a few minutes rather than in the real time.

In fact, studies find that it takes between two to twelve hours after collecting data from patients' monitors before nurses enter it into medical record. The manual entry of data leads to error rates as high as 17%.2 Yet documentation is taking up an increasing amount of nursing time, with studies finding that 35% of a nurse's time is spent on documentation (147 minutes in a 10-hour shift), while less than 20% is spent on patient care and education, and just 7% on assessment and surveillance.3

The focus on quality in today's healthcare environment means the EMR must be fully integrated into clinical care and decision making. Among the benefits when used properly, for instance, are better decisions and better coordinated care. With physician order entry, physicians need an ‘information rich' record with real-time data. Ancillary departments such as respiratory, physical, occupational and speech therapy also require access to an up-to-date medical record so they may immediately know a patient's state. Such information is equally important for pharmacy, infection control and discharge planning.

However, while EMRs can bring numerous benefits to the hospital environment and improve patient care, they are impractical and even dangerous if the data is not accurate, timely, and complete. So, therein lies the paradox: much of the data entered into an EMR is on the shoulders of med-surg nurses. Yet med-surg nurses are forced to place this task towards the bottom of their list because of their patient care priorities.

The current system relies on the nurse to function as a "human bridge" between medical devices and the EMR. The med-surg unit is no exception. Med-surg nurses capture patient data throughout the day from a number of devices, manually writing the data on a clipboard, sticky pads, paper towels or even alcohol wipes. At a later time during the shift, they key the data into each of their patients' electronic record. The danger of this approach is the increased likelihood of errors and potential for omissions. Moreover, valuable time slips by - time during which critical decisions are made based on data that could be hours old. Just as important, all of this activity of capturing data from various bedside devices and manually keying it into a record takes the clinicians away from direct patient care and surveillance, which can affect outcomes. Very simply, under the current system, clinicians doing both clinical documentation and patient assessment simultaneously is ... well ... incompatible, to put it lightly.  

There are solutions to this "human bridge" problem that can remove the nurse as the "middleman". There is increased focus on the automation of clinical documentation, that is:  the electronic transfer of data from a medical device to the EMR, and other clinical systems. The integration of data in med-surg is even more critical as the patient acuity rises along with the number of number of bedside devices to assist in monitoring. Due to the fundamental nature of vital signs, devices that take these measurements are typically among the first to be targeted for automation. Integration, however, is not limited to devices measuring vital signs. Other types of devices that can be integrated in med-surg include (but not limited to) scales, smart beds, infusion pumps, etc. By not having to record and transcribe information into the EMR, a considerable amount of time can be saved. And, automating the collection of data ensures that all desired information is accurately collected. This eliminates the possibility of accidentally omitting essential data during documentation. Recording patient data at a higher frequency allows for catching subtle changes in a patient status much sooner. 

In an environment where information is recorded automatically into the patient's record, there is no need for a physician and the interdisciplinary team to wait on the med-surg nurse to complete rounds and transcribe the data.

In the end, bringing a flexible, documentation automation system into med-surg can help reinvest nursing time to direct patient-care activities, improve nursing productivity and satisfaction, enhance the completeness of the medical record, and ultimately, improve the delivery of safe, high quality care.

My question to you is, why do hospitals choose not to automate device documentation in med-surg when the evidence is clear?

References

1. Potter P, Boxerman S, Wolf L, et al. Mapping the nursing process. J Nurs Adm. 2004; 34(2):101-109

2. Wager KA, et al. Comparison of the Quality and Timeliness of Vital Signs Data During a Multi-Phase EHR Implementation Computers in Nursing. CIN: Computers, Informatics, Nursing. 2010; 38(4):205-212

3. Hendrich A, Chow M, Skierczynski B, Zhenqiang L. A 36 hospital time and motion study: How do medical-surgical nurses spend their time? The Permanente Journal. 2008;12(3):25-34

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Gamification in Healthcare
September 11, 2014 10:33 AM by Nicole Mohiuddin

Video games aren't just for kids anymore. The earliest gaming consoles kept players stationary and sedentary, and became an object of concern in a world of rising obesity rates, diabetes and other health scares. But then came games that required players to move - to participate with their physical bodies. That opened up a whole new world of gaming that is quickly morphing into something more. It's been called the "gamification" of healthcare, and it is showing up everywhere - on computers, on smartphones and in the doctor's office.

Gamification makes a lot of sense on all ends of the healthcare spectrum. Games are fun, and that means instead of being "boring," healthcare can become more engaging and enjoyable. Games are also immediate, as they can be accessed on smartphones and other mobile devices. Value-based care focuses on prevention, and prevention often happens through changing behaviors, is something that games can help players do. The Millennial generation has grown up with gaming, making it much more likely that the use of healthcare games will increase as that generation ages and needs more medical care.

As with any new venture, the market is already brimming with hopeful startups. Games, invented by health insurers and a host of technology startups, are marketed directly to consumers, who use them to track their progress and record key health metrics such as blood sugar and pounds shed. Players of these games can win rewards, perhaps even cash, if they hit their health goals. Using motivational techniques from games is a big part, as is creating engaging experiences for people. These days, anyone with a smartphone can download a variety of games designed to make them healthier, whether that means helping them stick to an exercise routine, lose weight or manage a chronic illness.

In healthcare, however, gamification presents a distinctive set of challenges. Healthcare providers that want to offer games to their customers must do so without violating federal patient privacy regulations - a requirement that can make it difficult to target games to the patients who will benefit most from them. Even companies that are not subject to those regulations are finding themselves under pressure to protect players' most personal data. Insurers, hospitals and other health providers are bound by the Health Insurance Portability and Accountability Act (HIPAA), which requires them to conceal personal health information related to all patients in their care.

Then, there is the problem of the games themselves: How can companies make them engaging enough to keep customers interested? It can sometimes be challenging to build a game that's sufficiently serious and on topic, but also fun. But it all depends on the game, and how it's put to use. As Gartner put it in a 2012 report on the phenomenon - which predicted that, by this year, as many as 80 percent of gamified apps would be doomed by poor design - "gamification is currently being driven by novelty and hype." The verdict is still out on gamification, however as our demand for more mobile and smartphone apps increase, they are likely to continue to be utilized by healthcare consumers.

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Can Technology and Nursing Co-Exist?
August 13, 2014 8:56 AM by Nicole Mohiuddin
The topic of meshing the art and science of nursing with healthcare technology has come to the forefront recently. A video by National Nurses United features a patient whose care becomes compromised under the watch of "algorithms" dictated by a computer. Throughout most of the encounter, the patient is not seen by a nurse, because care by computer was deemed more cost efficient by administrators and bureaucrats, who are more interested in the patient's wallet than his well-being. Only in the last-minute, perhaps even unauthorized, intervention of a nurse saves the patient from certain doom.

The strong message is that healthcare technology takes clinicians out of the picture and force-fits patients into standardized, low-cost treatment plans without considering their individual situation. The video references a study  that suggests technology is harming rather than helping the patient. Overall, the series sounds an alarm that both nurses and patients are threatened by "the rise of the machines."

Such sensationalism fails to highlight either the benefits of EMRs or the role that nursing informaticians have played in the development, training and implementation of EMRs. Nursing informatics was developed to empower nurses to combine the best of technology and nursing, while safely and effectively providing patient care. Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge and wisdom in nursing practice (Nursing Informatics: Scope and Standards of Practice, ANA 2008).

Properly designed and utilized healthcare technology can indeed benefit patients. A study in the Journal of General Internal Medicine and another conducted by the Robert Wood Johnson Foundation, show EHRs to be associated with improved care. A recent literature review reported in Annuals of Internal Medicine found that clinical decision support systems were associated with quality improvements in 85 studies reviewed.

Healthcare technology is here to stay, but tools are only useful in the hands of those who know how and when to apply them. Nurses are best positioned to shape, to incorporate and to utilize technology to maximize the efficiency and the outcomes of frontline, hands-on patient care. Nursing and technology must work and grow together to address the needs and to fulfill the promises of healthcare.

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Nurses Will Reap the Benefits of Wearable Tech
August 5, 2014 8:06 PM by Susan Sportsman
Wearable technology is all the rage - not only among consumers, but also among professionals in healthcare and medicine. "Wearables" demonstrated at the 2014 Consumer Electronics Show (CES) ranged from smart watches from Pebble Steel and Razor Nabu, to fitness and sports tracker watches like Sapphire Wellness WatchSalutron LifeTrakHot WatchZTE BlueWatch and Casio STB-1000 Sports Gear. Also making a mark was eyewear like Google Glass and Oculus Rift and heart rate monitors positioned in bands, watches and earphones.

Wearable technology is an emerging market, according to ABI Research, which projects that wearable wireless medical device sales will reach more than 100 million devices annually by 2016. The market for wearable sports and fitness-related monitoring devices is also on the upswing, soaring to 80 million device sales by 2016.

Wearable tech will one day dominate nurse education and training, although educators and trainers have only begun to tap its power. Still, experts see the potential of clothing, jewelry and accessories that alert nurse students and practitioners of dangerous conditions or patient deterioration. Nurses might also come to rely on wearable cameras to capture a patient's progress, caregiver activity or conditions within a patient's home.

Wearable tech will allow nursing students and practitioners to rely on voice commands and gestures to send information, updates and alerts via text and e-mail. As a result, students and practicing nurses will find it easier and faster to communicate with each other and with faculty members and trainers.

Google Glass has already demonstrated its ability to reveal relevant information as users go about their daily routines. Nurses will one day do the same, accessing the Internet through gestures and voice commands and receiving alerts as new information develops.

In fact, some experts have outlined how Google Glass could transform education: Growing numbers of nursing students, practitioners and instructors will share videos and photos through Google+, Twitter, Facebook and Tumblr, send voice to text instant messages and receive phone calls.

As nursing students, educators and practitioners move forward with wearable tech, they will evaluate how they can use a wearable like Google Glass for education and patient care. Following are some ideas:

  • Teach and share procedure-based skills, much like surgeons have used Google Glass to guide surgeries, nurse faculty and trainers will record procedures and conduct training sessions with real-time data, reference resources and input from other nurses. In 2013, a surgeon from the Ohio State University Wexner Medical Center became the first physician in the U.S. to consult with a colleague using live operating room video transmitted via Google Glass.
  • Invigorate the learning environment. With Google Glass, instructors and trainers can project information without turning their backs on nurse audiences. They can also "livestream" lectures and demonstrations for remote access or augment presentations with the latest scientific evidence and developments.
  • Create mini documentaries and video essays. Instructors and trainers will encourage nurses to document a disease or condition, population group, or patient care environment. Or nursing students and practitioners will record and teach tasks ranging from deep wound packing and indwelling catheter removal, to application of an ace wrap and making an occupied bed.
  • Engage with patients. As more consumers acquire technologies like Google Glass, nurses will offer patients and colleagues guidance on how to use the technology to display real-time exercise statistics or present health-related food information when shopping or cooking.

MIT Media Lab is already demonstrating the potential of Google Glass by turning any surface into an interface. SixthSense, which embeds a camera, mirror and pocket projector into a pendant, projects information on any surface.

While Google Glass is already in the hands of professionals and consumers, other wearable technologies are bound to influence nursing practice. Among the most exciting: Self-adapting cameras.

  • Brain sensors: A highlight of the 2014 CES, MUSE will help nurses and patients manage stress, reduce anxiety and increase concentration. Billed as "the brain-sensing headband," MUSE uses sensors to detect and measure brain activity, which it transforms into data and displays on a tablet or smartphone. As MUSE technology grows in sophistication, nurses and other healthcare professionals may one day control electronic devices with their thoughts.
  • Magic gloves: Offering "freedom in the palm of your hand," Keyglove is a "wearable, wireless,open-source, glove-like input device" that nurses and patients-particularly disabled patients-could use to enter data, play interactive learning games or manipulate objects generated by 3-D printers.
  • Recorder: Billed as "the world's first wearable camera," Autographer is equipped with sensors that respond to changes in temperature, color, direction, speed and movement, triggering the camera to take thousands of pictures in a day. The technology could turn nurses and their patients into publishers and producers of healthcare content.
  • I, Robot: If nurses tire of cellphone charging shirts, they might experiment with robotic suits. Wearable robotics known as exoskeletons are already helping people to walk, according to the New York Times. Other robotic suits may help nurses lift and move heavy objectives or support disabled patients in their daily routine.

The future is bright. Wearable tech will provide nurses with virtual personal assistants that remind them of appointments and meetings, log professional conversations, maintain notes and serve up data and information in a matter of seconds. If nurses need to perform a procedure, wearable computers will remind them of specific steps and risks via links to videos or instant messages shared by nursing colleagues. Although wearable tech comes with limitations related to power, privacy, interface and connectivity, nurses will benefit from this game-changing innovation.

Implementing wearable technologies will require ongoing research on the impact of wearable devices on nurse education and training. Nurse education and training programs in colleges and universities and provider organizations must integrate wearable devices into existing learning initiatives as they explore how to best use wearables to improve patient care outcomes. Educators and trainers at all levels must address wearable technologies from the perspective of rationale, role, function, scope, risks, rewards, results, success factors and implementation strategies.

Especially important is the potential threat of wearable technologies to the security and privacy of patient and provider data and information. In a worst case scenario, students, healthcare professionals and patients could become the latest victims of hackers, opening the door to discrimination, identity theft and annoying ads. But organizations can't afford to back down. Instead, they must implement privacy and security policies that protect the data within wearable devices and invest in security technologies that safeguard data files.

Educators and trainers must realize that wearable technology is a journey, not a destination. New devices will continue to emerge, as evidenced in Information Week's "Wearable Tech: 5 healthcare Wins," as well as companies just accepted into the New York Digital Health Accelerator. Embrace the wearable technology revolution, making sure that new and emerging devices enhance care quality, safety, efficiency and outcomes.

 

Resources

Wearable Technology at CES2014

http://www.cbsnews.com/pictures/wearable-technology-ces-2014/

 

Can Wearable Technology Boost Productivity?

http://edition.cnn.com/2013/10/21/business/can-wearable-technoloy-boost-productivity/

 

Wearable Technology and the Future of Healthcare

http://www.hitconsultant.net/2014/01/24/wearable-technology-and-the-future-of-healthcare-infographic/

 

Will Wearable Technology Bring Humanity a Sixth Sense?

http://www.livescience.com/42490-wearable-biosensor-technology.html
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The Right Technology at the Right Time
July 25, 2014 1:12 PM by Susan Niemeier, RN, BSN, MHA
I find myself spending large amounts of time in airports, arriving early to get through strict security, or passing time in terminals due to weather or mechanical delays. During those periods, I seek refuge at a quiet boarding gate that has a high concentration of power outlets or Internet access. Finding these spots is often a challenge, as I peer under seats, circle support columns and poke around vending machines. Occasionally, if I'm lucky, I run across a re-charging station to at least take care of my power needs.

These recharging stations are becoming more and more popular as business travelers flock to them to charge a plethora of devices. There you can find the latest "must have" or "cool" device / gadget on the market. But as I glance at the array of devices, I wonder, "Is cool always smart?" As a nurse, what really matters to me is the impact a device has on workflow or how I do my job, not necessarily its "coolness."

By many estimates, the typical nurse spends approximately 2 hours a shift simply keeping numbers current in patient medical records. By the time the doctors and multidisciplinary care team actually receive the information, it's often already outdated. To me, "smart" gadgets should help me decrease the time I spend inputting data and increase the time I spend directly caring for my patients.

Mobile devices, such as tablets and smart phones, may be the latest technology, and what many hospitals are considering incorporating into every part of nursing workflow. But I'm not so sure these devices will help a nurse achieve what he/she intends. In my experience, adding to nurses' tool belts (which can include as many as 15 other devices) can sometimes weigh us down rather than increase the time directly interacting with patients. We should be "hands on" with our patients, not with another device.

As nurses, our focus should always be on delivering safe, competent, and compassionate care. We should take caution with becoming the first to use an innovative new technology. So, before moving ahead with the introduction of the latest and greatest mobile technologies, perhaps a hospital should consider the following items:

  • Is it easy to use? Has it been thoroughly tested in the care environment?
  • How many steps must the nurse complete in order to get data to its end location? Is it intuitive? Simple? Fast?
  • Does it need to be put down for best data input? Where do we put the device if the patient needs our immediate attention? Then what about the transmission of infectious properties as we go from room to room?

As with any technology purchase, good research and asking the right questions are musts to help assure the tools acquired are more than "cool," but actually useful. When it comes to nursing and patient care, that usefulness equates to quality care, so we must be aware of the shiny new gadget and be confident that we are implementing the right technology, for the right people, at the right point in time.

2 comments »     
Creating a Culture of Learning for RNs
June 12, 2014 10:53 AM by Susan Sportsman
"Learning cultures" within hospitals, health systems, and other healthcare organizations across the care continuum are rooted in the practices and policies of schools, colleges and universities. This blog explores how nurse educators can use supportive learning environments created within schools and colleges as a foundation for creating positive learning environments in healthcare organizations (HCOs).

Nurse educators can build a learning culture where students, faculty and administrators develop lifelong, positive learning attitudes, beliefs, values and behaviors by taking these steps:

  • Sharing: Create opportunities where students, faculty and administrators can pose questions and share information and insights. Encourage everyone to capture and tell stories about how individuals and teams have transformed patient care and the profession of nursing.
  • Reflection: Offer everyone-students, faculty and administrators--the chance to reflect on lessons learned, predict consequences and explore underlying assumptions, values, beliefs, attitudes and expectations. Equally important, develop programs and activities that promote the value of sustained experimentation and innovation by RNs.
  • Talent: HCOs should hire, retain and promote faculty and administrators based on their ability to learn and adapt to new processes, systems and situations, and nurse educators can help identify and foster these staff members. Anchor performance reviews in positive learning behaviors and demonstrated innovations-not just technical nursing expertise.
  • Feedback: Solicit student, faculty and nursing community input on learning programs, processes and outcomes. Then incorporate the feedback into plans, programs and projects.

Engineering a positive learning culture within nurse education is the first step toward building pro-learning cultures within HCOs, including hospitals, health systems, and medical groups. Nurse executives and managers can maintain learning cultures through these actions:

  • Set learning goals and objectives: Encourage the C-suite to turn the concept of a pro-learning culture into an organization-wide commitment and goal. In a second step, link learning culture to the organization's clinical, financial and operational objectives.
  • Promote Individual/group accountability: Invite RNs to identify personal learning needs via analyses of performance appraisals and competency based assessments. Teamwork is just as important, so encourage RNs to join teams or networks to share information and knowledge throughout the learning process. Finally, use special events and awards to celebrate the power of individuals and teams to achieve desired learning outcomes.
  • Create a low-barrier learning environment: Nurse executives can support RN learning if they design and implement learner-centric environments and remove typical obstacles to learning. Such barriers often include adequate time for learning, ongoing funding, access to learning content, tools and technologies, and integration with learning programs with nursing unit and organizational goals.
  • Promote the significance of learning: Nurses executives and managers must help RNs understand why they must engage in lifelong learning, including how they will likely contribute to the development of learning cultures. One strategy is to appoint learning coaches and mentors-experienced nurses who can help RNs tweak learning plans, make program choices and solicit feedback on learning program quality, accessibility and effectiveness. This model is similar to what the Nurse Faculty Leadership Academy of Sigma Theta Tau Intl. tries to do. The NFLA is supported by a grant from The Elsevier Foundation.
  • Encourage experimentation and innovation: Nurse executives can support RNs in their quest to investigate fresh ideas for nursing practice and assume calculated risks. For example, nurse executives might encourage RNs to explore the healthcare and nursing implications of innovations like 3-D printing, augmented reality, wearables and mobility. Or they might challenge RNs to analyze the evolution and impact of healthcare trends like accountable care, continuum of care, population health, care collaboration and primary care shortages on professional nursing practice.

Building positive learning environments within nursing education and HCOs means offering RNs the opportunity to simultaneously function as learners, teachers and trainers. When the C-suite commits to building a training- and learning-focused culture, it can create nurse leaders and champions at all levels of the organization. It can also attract "the best and the brightest" nurses, boost RN productivity and facilitate nurse succession planning and promotions based on results.

RNs can create pro-learning environments if they secure the commitment of top management, align the pro-learning environment with business and clinical goals and personalize and individualize learning opportunities. As RNs eliminate or minimize common learning barriers, they will create environments that support rather than constrain learning, experimentation and innovation.

 

Resources

"The Path to Continuously Learning Healthcare"

http://issues.org/29-3/robert/

"Becoming a Learning Organization: The Role of Health IT"

http://issues.org/29-3/robert/

"Continuous Learning Drives Healthcare Improvement"

http://www.hospitalimpact.org/index.php/2013/02/20/continuous_learning_drives_healthcare_im

"How Kaiser Permanente Become a Continuous Learning Organization"

http://share.kaiserpermanente.org/article/how-kaiser-permanente-became-a-continuous-learning-organization/

Leadership for Learning Organizations

http://sdm.mit.edu/news/news_articles/webinar_022513/webinar-levy-leadership.html

 

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Family Practice Nurse Practitioners Make HIT a Learning Priority
May 12, 2014 5:05 PM by Susan Sportsman
Advanced practice nurses (APNs) are in demand.  From Q1 2012 to Q1 2013, job postings for nurse practitioners (NPs) rose 15 percent, while nurse management postings increased 8 percent.  Family medicine NPs topped the list for most nurse practitioner job postings in the first quarter of 2013, according to the HealtheCareers Network and the U.S. Bureau of Labor Statistics.

The increasing numbers of family practice (FP) NPs now rely on health information technology (HIT) to deliver safe, quality care.  Required HIT competencies outlined by the American Association of Colleges of Nursing (AACN) call for changes in both master's level programs and learning interventions offered through hospitals, health systems and medical groups.    

Chief information officers (CIOs), chief nursing officers (CNOs), chief nursing informatics officers (CNIOs) and other members of the C-suite must join forces to educate, train, coach and mentor FPNPs in how to integrate technologies to manage knowledge and improve healthcare.  HCOs should measure competency by asking these questions:   

  • Education/coaching: Are FPNPs able to translate technical and scientific health information to meet patients' information and learning needs? Can they assess patient and caregiver educational needs? Are they able to coach patients and caregivers in positive behavioral change?
  • Decision making: Can FPNPs demonstrate information literacy skills in situations that require complex decision making?
  • Systems design: To what extent are FPNPs able to contribute to the design of clinical information systems?
  • Evaluation: Are FPNPs able to use technology to evaluate the quality, safety and efficiency of nursing care?

By demonstrating these HIT competencies, FPNPs have already achieved impressive gains. The Office of the National Coordinator for Health Information Technology (ONC) labels NPs "crucial primary care providers on the path to meaningful use."  NPs that enrolled in Regional Extension Center (REC) programs, which now work with half of the NPS and PAs in the U.S., have made even more dramatic progress.  Four out of five NPs and PAs enrolled in a REC are now live with an electronic health record (EHR).  

As more HCOs go paperless, FPNPs will rely even more on HIT, according to a January 2014 survey from TCS Health.  Of the respondents to TCS' 2012 survey, 30 percent said their office had already moved to a paperless environment up from 17 percent in 2008 and 23 percent in 2010. That, in turn, will require intense, ongoing education and training.   

Reliance on HIT is especially strong among FP physicians who outpace other office-based physicians in EHR adoption, according to a 2013 study in the Annals of Family Practice. That trend will continue as physicians adopt technologies to ease the transition to medical home, value-based accountable care and population health management.

But HIT doesn't end with EHRs. FPNPs must learn how to deliver care via technologies like iPads, mobile health apps, applications, smartphones, cloud-based computing and remote monitoring devices.  Eighty percent of physicians now access online health and medical content via smartphones, according to a 2012 Physician Mobile Survey.  FPNPs will do the same.

Equally important, FPNPs must master how to provide patients and families with relevant health education and information via links to specific pages within high quality Web sites or peer-reviewed patient education and discharge instructions available in print or video formats or integrated within the EHR

FPNPs must also learn how to manage and monitor patients' use of personal health records (PHRs).  Already associated with improved medication adherence, PHRs are on the upswing.  More than four million people now manage their health via My Health Manager , a personal health record available through Kaiser Permanente.  This trend will continue as more patients request PHR access via portals or mobile devices.

Remote patient monitoring will emerge as an essential component of FPNP education and training. Showcased at the Consumer Electronics Show in January 2014, options range from real-time devices that allow patients to receive care in any care setting to wearable devices that allow tracking of vital signs and health-promoting behaviors. Equally important in fulfilling Intel's vision to "make everything smart" is the "smart home" and other aging-in-place solutions that allow people to monitor variables that influence health.

The potential for FP NPs to transform healthcare via HIT is evident in the Health Information Management Systems Society's decision to bestow its 2013 HIMSS Davies Award for Excellence to White River Family Practice (WRFP), White River Junction, Vermont.  With six family practice physicians, two NPs and a support staff of 14, WRFP relied on EHR technology to create a "collaborative environment" that improved care quality for patients with chronic conditions like asthma and diabetes while improving smoking and alcohol cessation.  As a result, the National Committee for Quality Assurance (NCQA) granted WRFP certification as a Level III Patient Centered Medical Practice.

FPNPs have a bright future-especially if they  continue to build on their EHR knowledge, skill and experience through planned learning interventions in areas like remote patient monitoring, mobile health and patient education and engagement.  Doing so will help FPNPs prepare for new and emerging roles as educational content brokers, health information coaches and mentors, and integrators of data from wearable devices and smart phones.     

 

 

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Bring Your Own Device: A Look at the Future (or Present) of Nursing Technology
May 7, 2014 8:47 AM by Nicole Mohiuddin
Recently I observed several staff nurses using smartphones during their shift. They used them to scan medications, communicate with other staff members, receive calls from providers/ancillary departments and even look up drug-dosing information. What I witnessed is an ever-growing trend across hospitals: nurses in large numbers are adopting the use of smartphones - often their own personal devices - at the point of care. And, this happens whether their employer supports it or not.

This finding was highlighted in a white paper from the Menlo Park, Calif.-based Spyglass Consulting Group. The report is what Spyglass Managing Director Gregg Malkary called an outgrowth of a similar study performed in 2009. Malkary said the results demonstrate a definite change in attitude among nurses in the past five years. In fact, Malkary said most hospitals have rejected a BYOD approach for staff nurses out of hand; one factor, he said, is the potential for administrators and nurses' unions to get tripped up over simple affordability of smartphones. But more than half the hospitals in the report responded that they plan to either evaluate or invest in enterprise-class smartphone solutions over the next 18 months.

In the meantime, though, it appears nurses, dissatisfied with landlines and overhead paging, will increasingly use their personal devices. The study found that 67% of hospitals reported their nurses used them and 91% of hospitals said they were aware of this usage but did not have the time, tools or resources to monitor such usage.

"I suspected nurses were using their devices," Malkary said. "I just didn't realize how widespread it was. And it's not just nurses, it's doctors as well. Nobody wants to use a secure text messaging app. They don't want to have to use two apps, they want one, and the prevailing attitude is that unsecured SMS is just fine. They know it's a violation, but it's more fluid, they know everyone else's smartphone number, and they can coordinate care. They're leveraging consumer grade tools to facilitate closed loop communication, and to support multidisciplinary care. Unfortunately, it's outside the firewall."

The "look the other way" approach does not have long to live, though, according to Malkary. The HIPAA Omnibus ruling of 2013, he said, provides a strong incentive, such as million-dollar-plus fines per incident, to get mobile governance policies in order sooner rather than later. The good news, he said, is that both hardware and application vendors are stepping up to provide durable devices - he mentioned the Motorola MC40 and Spectralink Pivot as examples - and secure software from vendors such as Voalte and Extension Healthcare.

There are many challenges to nurses "bringing their own device." Often, a hospital's IT department may ban such devices outright, since it can be difficult to monitor and distinguish reasonable personal usage from HIPAA violations, network security issues, and inappropriate usage. Furthermore, most smartphones now incorporate cameras, which if misused could be another HIPAA violation. 

However, in light of all the challenges and concerns, it is worth noting that most hospitals permit and support patients bringing and using personal wi-fi devices. Doctors would be outraged if they were told they couldn't employ the tools that they found most effective. Somehow, we in healthcare must devise the tools and policies that respect and support nurses while addressing the legitimate needs of security, privacy and efficiency.

More information about BYOD here:

http://www.fiercemobileit.com/story/security-and-legal-ramifications-byod/2014-04-13

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Gerontological NPs Need Tech Knowledge and Skill to Function as Chronic Disease Managers
April 10, 2014 6:57 AM by Susan Sportsman
Ten years ago seniors accounted for just 12% of the population, according to the U.S. Census Bureau. By 2050, that figure will grow to more than 20%. Americans are living longer lives, but not necessarily healthier lives. Old age continues to bring chronic disease.

So severe is the crisis that by 2030, 170 million Americans may have to cope with chronic disease, forecasts the CDC.  Addressing the needs of this population will call for new approaches to education, learning and training for both nurses and patients.    

Nurses can help fill gaps in chronic care management by preparing to become adult-geronotological nurse practitioners (GNPs)-professionals who work with older adults in multiple care settings, according to the Gerontological Advanced Practice Nurses Association.

GNPs are registered nurses with master's degrees from academic NP programs. They specialize in caring for older adults, including diagnosing and managing acute and chronic diseases and, in some states, prescribing medications, notes the American Association of Colleges of Nursing (AACN).  

To function as GNPs, nurses must build knowledge, skill and competence in nursing informatics. Only by learning how to design, implement and evaluate systems that allow for real-time information sharing among providers, government agencies and community groups can GNPs manage chronic disease and improve community based chronic care. Nurses must also master how to access real-time actionable information at the point of care to support the diagnosis and treatment of older patients, as well as patient education and health coaching.    

Nurses who pursue specialized education and build the required repository of knowledge and skill to emerge as chronic care managers face bright career futures.  Providers like Partners Healthcare have already initiated chronic care programs with technologies like telemonitoring and electronic health information exchange.  Meanwhile, vendors like Alere have developed services like toll-free lines with nurse coaches, care alerts, biometric devices and chronic care reporting.  GNPs and advanced practice nurses (APNs) could easily function in both not-for-profit and vendor environments.      

But chronic care management involves more than the implementation of specific technologies. Nurses -specifically GNPs-must also pursue education that allows them to work throughout the continuum of care. Among the required competencies:  

  • Care coordination: To coordinate care, GNPs must learn how to use on cloud-based platforms that allow every member of the care team-nurses, physicians, patients and family members-to share healthcare information. Technology enabled communication and information sharing will emerge as key competencies.
  • Care management: Caring for older adults demands that GNPs have the education and training to ensure the secure, immediate transmission of biometric and lab data. Doing so will free them to make timely, accurate, evidence-based decisions and then share these decisions with patients and families.
  • Education and health promotion: The growth of Web-based portals for consumers, patients and clinicians requires that every member of the care team, including GNPs, have the knowledge and skill to access and ground decisions in evidence-based resources. Also needed is the knowledge and skill to work collaboratively with patients to promote better adherence to care plans.

Such developments come at a time when growing numbers of older chronic care patients rely on the Internet for health and medical research. Patients and consumers also tend to discuss conditions on social media and use mobile health apps to monitor data related to blood pressure, sleep behavior or glucose levels.  

GNPs must engage in a lifelong learning process focused on older patients' use of the Internet, mobile devices and social media. Among the issues for GNPs: 

  • Internet: How do older patients use the Internet if they do? Where do they tend to get health information? Which sites should GNPs recommend to older and chronic disease patients and families? What's the GNP's role in training patients and family members on Internet use and Web site evaluation?
  • Social media: How do older adults tend to use social media? What are the advantages and drawbacks? Should GNPs discourage social media use or point older patients and family members to specific social media resources? Should GNPs learn how they can make professional contributions to social media channels?
  • Mobile devices: How do older adults use mobile devices? Which devices are specifically engineered to meet the needs of older adults? How can GNPs assist older patients and family members in mobile device selection and use? And what's the role of the GNP in providing coaching and advice to patients and family members?
  • In the years ahead, GNPs will need education and training to advise patients and family members on how to track indicators and use the information to make more intelligent lifestyle decisions.

Supporting the trend toward patient-initiated tracking are a growing number of devices that call for involvement from GNPs, who will need to learn how to advise patients of available technologies and offer coaching on their use.  For example, a wellness service from Alarm.com plants sensors throughout a senior resident's home, including living rooms and bathrooms. The service sounds an alarm if it detects that a senior is inactive for long periods of time or is away from the bed for an extended period at night.  

Meanwhile, Zensorium has created Tinke which allows chronic care patients to measure heart and respiratory rates and blood oxygen levels through simple fingerprint scans.  Independa's Angela Express creates an almost immediate connection between rehab residents with family members, opening up the world of video chat, photo sharing, Gmail Facebook and broadcast video.

Going forward, GNPs must pursue continuing education to monitor the impact of enhancements to electronic health records (EHRs), mobile devices and remote sensor technologies. GNPs will be in the vanguard technology enabled transformation, educating themselves, patients and family members on how to select, use and evaluate the best technologies available to improve care outcomes.

Resources

Conversations in Health Care: How Technology Is Advancing Senior Care  http://www.westhealth.org/news/conversations-healthcare-how-technology-advancing-senior-care

Caregiving Goes Digital-and Lets Boomers Age in Place http://www.usatoday.com/story/news/nation/2013/11/24/technology-healthcare-boomers/3661007/

As Boomers Become Seniors, Health Technology Demand Grows http://www.informationweek.com/healthcare/patient-tools/as-boomers-become-seniors-healthcare-technology-demand-grows/d/d-id/1112786

 

 

 

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Analytics Improves Nurses’ Learning Outcomes
March 11, 2014 4:00 PM by Susan Sportsman
Learning analytics is a powerful tool for nurse education and training. Students and practicing nurses can monitor their progress against other learners while monitoring timelines and benchmarks.

Learning analytics can also predict which learners need more support and attention from instructors and trainers, who increasingly rely on analytics technology to enhance or create courses and modules based on learner feedback.

Learning analytics varies from data mining, which uses data to perform assessments and personalize learning. However, both learning analytics and data mining are plagued by similar problems. Like other learners, nurses question the risks of sharing data with employers, colleagues and educators. Others wonder about overreliance on software rather than human judgment to make learning decisions. And still others question the merit of evaluations based exclusively on correct or incorrect answers and not the process of problem solving.

Despite these barriers, learning analytics has made inroads in creating highly personalized education opportunities for nurses and other professionals. Platforms like no-cost Always Prepped aggregate and analyze the most important aspects of a learner's performance on a single dashboard. Instructors can send learners real -time report cards with a single click, while integrating accounts from other sites.

Kno turns textbooks into interactive learning experiences by adding links, multimedia, flashcards and quizzes. Equally important, the textbook advises learners on how much they understand content and compares their performance to others. Kno already offers multiple learning texts on nursing. Learners can purchase Nursing Now for about $32 or rent it for a year for $16. Within the book, learners can engage in advanced search engage in advanced search of chapters and notes, create journal entries, generate flashcards of terms and definitions, and access 3-D images, and track study habits, engagement and progress in the textbook.

Billed as "an engagement, assessment and classroom intelligence system," Learning Catalytics allows faculty members and trainers to assess learners in real time through open-ended or critical thinking questions, which learners can address with numerical, textual or graphical responses. Faculty members and trainers can pinpoint areas that need further explanation and group learners for follow-up discussion and problem solving. They can also author questions on their own or collaborate with faculty who share question ratings and comments.

Technologies like Knewton deliver a platform that personalizes learning content developed by others. Faculty and trainers get feedback on what learners know at a specific percentile of proficiency. They can also pinpoint the source of an incorrect answer, including lack of proficiency, forgetfulness, distraction or a misworded question. Equally important, the technology sorts through multiple education goals and offers faculty and trainers feedback on what content the learner should focus next. Finally, faculty and trainers can calculate the probability that a learner will pass an upcoming test or quiz, as well as what the learner can do to enhance that probability.

Learning analytics will continue to influence nurse education and training as nursing benefits from a growing number of personalized and adaptive learning solutions. More learning management systems and learning platforms will integrate learning analytics features, advising trainers and faculty members on how to monitor and evaluate learner behavior. Over time, learning analytics will tap big data to present even more refined insights into learning outcomes and organizational performance.

Resources

The Growth of Learning Analytics http://www.trainingmag.com/content/growth-learning-analytics

Enhancing Teaching and Learning through Educational Data Mining and Learning Analytics: An Issue Brief http://www.ed.gov/edblogs/technology/files/2012/03/edm-la-brief.pdf

Society for Learning Analytics Research http://www.solaresearch.org/resources/

 

 

 

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Consumer Digital Health Trends to Watch
February 18, 2014 8:10 AM by Nicole Mohiuddin
Digital health dominated the 2014 Consumer Electronics Show (CES) (http://www.cesweb.org/home). While curved TVs, 3-D television and Ultra HD were the talk of the show, the real happening at CES was the growth in the connected space and digital health. The Consumer Electronics Association (CEA), the organization behind CES, has reported a 40% growth in digital health exhibitors over past year with over 300 exhibitors in the medtech space. Now that health and wellness are becoming increasingly consumer-oriented, a younger more health-conscious population enters the market. In addition, the Baby Boomer generation looks for better ways of managing their health.

Where medical equipment manufacturers have traditionally thought of the healthcare provider as their consumer, a new, secondary business model is opening up, one that goes directly from the manufacturer to the patient. There is an overall trend toward digital technology across multiple industries. Perhaps, this can be linked to an overarching trend, which is that every business is a digital business and every consumer, or patient, is a digital consumer.

Here are three key trends that dominated the consumer digital health space at CES this year:

#1 - Self Tracking and Wearables

It should be no surprise to anyone that wearable devices and fitness trackers would have been a big presence at CES. According to the 2014 Accenture Digital Consumer Tech Survey, 52% of consumers are interested in buying wearable health trackers. A July 2013 survey done by CEA found that one-third of mobile smartphone or tablet users have tracked some aspect of their health in the past 12 months.

Wearables are gaining popularity, as they will be more discrete and will blend into people's daily lives by being embedded in clothes and everyday products. Wearables will provide a more user-friendly experience that offers more ease when it comes to analyzing data, sharing it across the Internet and social media, and data protection. New wearable products from major companies like Sony and LG have released the Sony Core and LG Lifeband Touch - both targeted at tackling the next-gen fitness tracking market.

#2 - Aging in Place Solutions

This year the first generation of Baby Boomers will be turning 68. Most people can tell you a funny story about trying to teach your parents or grandparents how to use the Internet. Yet AARP reports that eight in 10 of its members own a computer, tablet, or e-reader. And a 2012 AARP survey of seniors over the age of 50 found that 36% of those surveyed reported being "extremely or very comfortable" with technology.

 Seniors and retirees are looking for options to receive assisted care they need in a way that they don't have to overly sacrifice their independence or standard of living. And electronics companies are seeing the potential in capturing a market that is tech savvy, but also increasingly in need of healthcare solutions. CES 2014 marked the unveiling of healthcare products for supporting increased social engagement, injury prevention, even early detection and treatment of chronic diseases among seniors.

MobileHelp is introducing the Celluar DUO, a personal emergency response system targeted at seniors and is capable of automatic fall detection. The DUO operates on AT&T's cellular network, ensuring patient safety in the absence of a land line. It will also work in conjunction with MobileHelp's just-announced MobileHelp Connect online portal, which provides patients and their families and caregivers with the ability to virtually track patient activity levels, medication adherence, and trends over time. A&D Medical, a manufacturer of biometric monitoring solutions, has unveiled its Connected Wellness platform which connects A&D devices, including weight scales and blood pressure monitors, via Bluetooth Smart - enabling patients to monitor their health across multiple devices on an Android or iOS smartphone. Siemens Healthcare won an Innovations Design and Engineering Awards Honor at CES this year with its miniTek, a device that can remotely connect a patient's hearing aid to phones, TV, music players, and other audio devices via Bluetooth. An accompanying Android-based app allows users to control their hearing aid's volume

#3 - Real Time Remote Monitoring

According to a Brookings Institute analysis, remote monitoring technologies could save the U.S. healthcare system $197 billion between 2010 and 2035. Industry experts believe the combination of Internet, video, and wireless technology for inbound patients and those with chronic conditions will create an explosion of consumer products with evolving patient monitoring capabilities. They also believe we will see further evolution including implanted bioelectric sensors and options to detect a deeper range of physiological information along with sensors that can track nonlinear data like bathroom visits, coughs, and erratic behaviors. Packaged behind these more powerful sensors will be systems such as monitoring apps for smartphones and tablets, that provide two-way communication to remote healthcare consultants.

SMK Electronics demonstrated a video game for remote rehabilitation (telehabilitation). The company's platform, which was developed in coordination with the University of Manitoba, uses the Gyration Air Mouse - a motion-tracking computer mouse that can be used while held in the air - to rehab patients with arthritis and balance and gait disorders. 

Vancive Medical Technologies, a division of Avery Dennison, showcased its Metria Informed Health Technology Platform - a series of disposable, adhesive, sensor-based products for health monitoring and clinical applications. Vancive's first consumer level product, the Metria IH1, is intended for "lifestyle management applications" and measures activity, sleep, calories via a sensor that sticks directly onto the body - something that could be a welcome change for consumers whose wrists are already occupied with smartwatches and fitness bands.

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Flipped Classroom Blends E-Access to Content with Face-to-Face Problem-Solving
February 10, 2014 8:57 AM by Susan Sportsman
Growing numbers of nursing educators and trainers have come to rely on a learning model known as the "flipped classroom."  Simply stated, the flipped classroom restructures how nursing students and practitioners invest their time both within and outside the traditional classroom.  Even more important, the flipped classroom represents a shift in learning accountability from the nurse faculty member or trainer to the nursing student or practitioner.

Once nursing students and practitioners exit the formal classroom, they take on new responsibilities and tasks.  First, they must manage the content they decide to access and use.  They also must select a learning style, set a pace for learning, and identify strategies and tactics to demonstrate or verify learning. 

The shift in roles goes both ways.  The nurse faculty member or trainer takes on the role of learning navigator, guide or broker.  Rather than dispensing nursing content from a lectern or podium, the educator or trainer adapts varied learning approaches to the needs of students and practitioners and, as much as possible, brings learners along on a personalized learning journey.

Learners who once took copious notes within the confines of the classroom now rely on multiple technologies to master nursing competencies, knowledge, skills and procedures. They watch presentation videos, listen to podcasts, review enhanced e-book content and collaborate with faculty and fellow learners within online communities.  For example, a nursing student or practitioner might access nursing content through these channels:   

  • Participate in a webinar on implementing health assessments in primary care sponsored by the Agency for Healthcare Quality and Research;
  • Listen to a series of three podcast lectures on nursing ethics;
  • Consult chapters of e-books focused on evidence-based nursing care guidelines and pain management;
  • Attend virtual conferences sponsored by the National Hospice and Palliative Care Association and the Oncology Nursing Society.
  • Use adaptive learning systems to individually learn specific content and evaluate the ability to apply that knowledge

The flipped classroom remains a powerful learning channel.  However, instead of listening to lectures punctuated by questions, nursing students and practitioners use classroom time to engage in interactive, project-based learning.  For example, learners might solve real world problems related to the management of chronic disease like obesity, diabetes or congestive heart failure. 

Or they might devise real-world applications of findings from a 2014 AHRQ study that reported the most common diagnoses for hospitalization are live births, pneumonia, septicemia, congestive heart failure and osteoarthritis.  Or students and practitioners might identify emerging trends, implications and action steps related to research conclusions like these:

  • Post-menopausal women who followed the cancer-prevention guidelines developed by the American Cancer Society were 17 percent less likely to develop cancer and percent less likely to die from cancer. Question: How should nurses share cancer prevention strategies with patients?
  • The number of states with widespread flu activity increased from 25 to 35, according to the Centers for Disease Control and Prevention (CDC). Patients between the ages 18 and 64 have accounted for about 61 percent if flu-related hospitalizations nationwide. Question: How is the local community responding to the flu crisis? What's the appropriate role for hospitals, physician practices and nurses?
  • According to a 2014 study from researchers at Children's Hospital at Montefiore (CHAM), only 1 of 169 adults was able to demonstrate correct use of a metered-dose inhaler. Such inhalers are commonly used to treat asthma in children. Question: How can nurses provide parents with better guidance on the benefit and use of MDIs?

 

By shifting the focus from formal presentations to problem analysis and resolution, nursing students and practitioners can learn more by doing more. No longer tethered to the lectern, educators and trainers can lead learners through the processes of content interpretation, analysis, evaluation, and synthesis while devoting more time to interactions with individual learners. 

The flipped classroom doesn't stand alone.  Instead, it functions as one component of a cluster of solutions designed to making nurse education and training more active, fluid and engaging. Such concepts have won the approval of bodies as diverse at the President's Council of Advisors on Science and Technology, and the National Council of State Boards of Nursing.

In the years ahead, nursing educators and trainers will join forces with learners to aggregate lessons learned from a variety of models, including blended and inquiry based learning.  Meanwhile, nursing students and practitioners will gain access to an ever-growing array of online and offline learning resources, driving the inevitable transition to more self-directed, lifelong learning. 

As learners continue to access videos, podcasts, and online content at the time and place of their choosing, nurse educators and trainers will use classroom time for hands-on exercises in problem-solving, conflict resolution, decision making and collaboration.

Other educators and trainers will turn lectures into workshops where groups of nursing students or practitioners collaborate and compete to design care plans, deliver population-specific education and counseling, integrate patient information from a wide array of tools and devices and coordinate care with multiple healthcare professionals. Still others will experiment with one-on-one coaching and mentoring, independent learning projects and real world and virtual field trips. 

The future of nursing education and training is as broad as our imagination.  By partnering with educators learners, technology vendors, and government, we can extend the boundaries of learning with the nursing profession.      

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Interoperability of EMRs: A Nursing Challenge?
February 3, 2014 6:46 PM by Matthew Dambrosio

Despite the widespread adoption of electronic medical records (EMRs), nurses still spend a large part of their shift on patient charting. This time could be better spent delivering patient care and working toward outcome and quality goals. The first thought that comes to mind regarding the time spent working with the EMR is But I thought computers are supposed to save time.

Responding to that assertion, both to providers and healthcare consumers, is a tough task. Many people watch TV programs that showcase the marvels of science with regards to forensics, as it applies to criminal justice and medical issues. Most medical professionals know that existing tools actually pale in comparison to their fictional counterparts. The computer systems used in healthcare mimic this dichotomy between reality and television entertainment. The EMR provides a wonderful toolset for providers, particularly for nurses charged with patient documentation. However, EMR systems have not yet reached the perfect level of usability. And the main reason for this is a lack of interoperability standards.

So what does interoperability mean? The basic definition of interoperability is the ability of a system to interact with all its parts, thereby producing useful and meaningful results.

Nurses know that for quite awhile now blood laboratories have had the ability to share patient test results through an electronic system, speeding their delivery and helping to improve quality of care. Doctors and nurses can now view these test results in the central patient record nearly in real-time, as soon as the tests are completed. But the ability of the EMR to do more than simply display data is where the concept of interoperability comes into play.

For example, an interoperable EMR might integrate lab results with nursing workflows. Critical lab results, like a blood sugar value less than 60, would not only be highlighted in red, but would sound an audible alert and require nursing staff nurse to acknowledge the result and document the action that was taken. This can help ensure a fast, direct patient intervention – as well as provide an audit trail for accountability of care, since the intervention can be tracked electronically.

Even more advanced interoperability might take all of this information and send the data through the mobile phone system – securely encrypted, of course – so the physician on call is immediately alerted of the situation and the actions taken.

Nurses can play a role in attaining that level of interoperability. How? They can engage the EMR administrator and assist in integrating evidence-based practice into the overall system that’s used throughout the entire facility. This daunting task for nurses is one that could potentially lead to great rewards, including reducing the need for nurses to manually input data, which in turn could allow more time for bedside care – and thereby ensure a high level quality, safety, and transparency for the patient’s dynamic health condition. Only the diligence of nursing on the front lines and promoting the interoperability of systems can meet the needs of our patients in years to come.

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