MacKington

Training, New Information System, & Evaluation

The healthcare organization provides information systems to each level of management in the right form, at the right time, and in the rights place. This provision ensures that decisions are made efficiently and effectively. The health information system plays a pivotal role in initiating, planning, organizing, and controlling hospital operations, thus facilitating synergistic organization. Given the benefits of health information systems, training is required to achieve the best patient care, including improved quality, reducing cost, and facilitating efficient delivery of services. Training should include critical factors vital for the successful implementation of information systems and offer specific formulas and guidelines (Sligo et al., 2017). Also, training should include the socio-technological approach, which is vital in providing specific formulas. Examples of specific formulas provided during the training include the attempt to place the health systems with a predictable and standardized context of information technology systems.

The critical factors during the training focus on delivering concepts such as usability, organizational structure, leadership, and technical support. Consequently, the socio-technical approach provides specific factors for success and uniquely examines each situation to create an environment for enhanced change, thus promoting successful implementation. Additionally, training should pay more attention to the usability of the information system. Time and monetary investment are vital for the staff to adequately learn how to use the information systems (Sligo et al., 2017). Sufficient time on information system usability enables healthcare personnel to integrate it into their unique setting.

Furthermore, there is a need for on-site support and follow-up training to ensure that users that have a different level of computer users are comfortable with the software. Additionally, it is important to include internal sources for technical assistance for those who have a better and quicker understanding of the new information system. Similarly, this understanding of specific members of staff will ensure continuous training is available for staff with a slower level of understanding.

Training should also focus on user satisfaction. Notably, end-user satisfaction is vital for the successful implementation of information systems. Individual differences must be addressed since it is believed that the information system’s failure is chiefly due to organizational and psychological issues rather than technological issues. Furthermore, during the training, it is important to examine user satisfaction. This involves examining aspects such as interface satisfaction, content satisfaction, organization satisfaction, and personal aspect such as likes and dislikes of the system (Sligo et al., 2017). Also, regular training with updated knowledge can help in promoting satisfaction and improving job performance.

Since nurses form the highest population among healthcare personnel, they have a role in evaluating the information systems on a regular basis. In addition to evaluation, the nurse can provide necessary information to promote knowledge, promote better health information systems in the future, and guarantee a more efficient information system. One aspect nurses should evaluate is the technology factor (Lee, 2016). Technological aspects include structural qualities of the software (usability), hardware (system availability), and system functionality.

Another component is the social factor, where nurses should evaluate how the information affects the interaction with other healthcare providers and also the patient. For instance, while a nurse may use online documentation, physicians may resist applying the system in front of the patient due to poor familiarity with the system (Lee, 2016). Finally, timing is an important aspect during evaluation since it enables nurses to determine the amount of time the system has been used and whether the system needs to be improved due to current technology.

Lany

In the company I work for we are currently in the transition phase into electronic medical records (EMR). We are presently working on paper charting and documentation. During this transition process there has been intermittent training on the already developed part of the EMR. There are current training modules on our company education and training website. This where employees can access any course related to the upcoming roll out of our EMR system. Because this is a new process for us, and we are not currently using electronic medical records the company has put an entire program surrounding the implementation of the program. They have already involved nursing into the development process and currently have nursing involved in finalizing different systems and processes. They have organized a group of individuals in every facility called superusers of two to three people who will be able to assist other staff in the use of the system during roll out season this coming August 2021. So much thought and energy has been put into this system and because of the specialty of our work with the large number of clients we serve this will impact the way we do our work now.

Outside of our upcoming amazing EMR system we do have electronic reporting system that we do use in correlation with our documentation called OBIS. It is like the old das systems and it is difficult or should I say impossible to hack. We work with high profile individuals and having a system that is fail safe and phishing proof is vital to our operations. We work closely with other entities that use this system as well which is very important to put vital information in without violating HIPPA regulation (Nelson & Staggers, 2014). The information entered in this system follows the patient all over the state of Florida, but it does not cross over to any other state. This recording system helps keep track of the patients’ appointments and the appointments the patient already had.

// A young woman with Depression

Case #2 A young woman with Depression

 

SUBJECTIVE

Stefanie is a 32-year-old female from Puerto Rico who presents to your office today with complaints of difficulty sleeping. You learn that Stefanie can go for a few days with minimal sleep (about 3 hours/night), but does not seem to be fatigued the next day. Stefanie explains that after 3 days with minimal sleep, she “crashes” and has a good night’s sleep. She states that sleep will be “alright” for a few days, even a few weeks, and then she will have a similar issue with sleep.

You learn throughout the assessment process that Stefanie has had this problem for years. She noticed that it began in college and thought it was just because of the workload and academic demands. However, she found that it persisted after college. She also notices that she has periods where she will engage in increased amounts of goal-directed activity, states that things will just “pile up” at work and she gets this burst of energy to “make everything right.” She states that these bursts will last most of the day and states that these periods show up probably every 2 to 3 weeks.

Stefanie also confesses to problems with being “down in the dumps.” She states that when she has her episodes in which she endeavors to “make everything right,” she feels fantastic and on top of the world. However, when these periods of energy end, she reports that she feels “depressed”—but then states: “well, maybe not depressed, but I definitely feel sad and empty.” She also endorses feelings of fatigue and a decreased ability to concentrate when she is feeling sad. She finally tells you: “I have lived with this for so long, I have to admit that it is finally a relief to tell someone how I feel!”

Psychopharmacologic Approaches To Treatment Of Psychopathology

OBJECTIVE

Stefanie is dressed appropriately to the weather. She has no gait abnormalities. Physical assessment is unremarkable. Gross neurological assessment is within normal limits.

MENTAL STATUS EXAM

Stefanie is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. Self-reported mood is “sad.” Affect does appear consistent with dysphoria. Eye contact is normal. Speech is clear, coherent, and goal directed. She denies visual or auditory hallucinations. No overt evidence of paranoid or delusional thought processes noted. She denies suicidal or homicidal ideation and is future oriented.

At this point, please discuss any additional diagnostic tests you would perform on Stefanie.

Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO STEFANIE?

In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

 Bipolar I, current phase, depressed  Bipolar II, current phase, hypomanic  Cyclothymic disorder

Academic Clinical History & Physical Notes for Cerebral Ischemia

I am presenting the academic clinical history and physical notes for the patient of ischemic stroke. Ischemic stroke or cerebral ischemia occurs when one of the cerebral arteries is blocked by the clot leading to diminished blood supply and oxygen to brain cells resulting in damage or death of brain cells (Celik et al., 2020)

History and Physical Note

1. Chief complaint/reason for admission/visit/consult.

A 52 years old male patient came to the acute care hospital with the chief complaint of sudden severe headache, dizziness, and slurred speech.

HPI for the H&P or consult notes.

The patient felt a severe burning and shooting pain in the frontal region of the head while he was reading the newspaper in the morning, said that he developed blurred vision during readin, felt numbness when the pain started (Harriot et al., 2020) and said that the pain was not subsiding with the time as it persisted since its onset. The pain scale was nine by 10, started in the frontal region, and radiated towards the temporal region.

The associated symptoms with pain are nausea, vomiting, aphasia, dysarthria, apraxia, and vertigo (De Cock, et al., 2020). The symptoms become aggravate in a standing position and become alleviating when he lay down on the bed with 3 pillows. The patient felt a significant change in body posture. He is positive for facial drooping while negative for fever and chills. He finds difficulty in sitting and maintaining coordination. The patient stated that he had a medical history of neck trauma in a road accident. He was hospitalized for 3 weeks after neck surgery.

Academic Clinical History & Physical Notes for Cerebral Ischemia

2. Medical, surgical, family, social, and allergy history.

Medical history

The patient has hypertension and hypercholesterolemia (Haegens, et al., 2018).

Surgical history

The patient underwent neck surgery after neck trauma at the age of 42.

Family history

The patient’s mother is alive and diabetic. The father of the patient died due to a cardiac stroke. His sister is normal. One of the two brothers has hypertension, and the other is normal. Currently, the patient is living with his normal wife.

Social history

The patient has a long history of smoking and boozing, coupled with a sedentary lifestyle.

Allergy history

· Raw fruits and vegetables, Shellfish, Soy.

· Amoxicillin and aspirin.

3. Home medications, including dosages, route, frequency, and current medications, if a consultation note.

Antihypertensive drugs Edarbi & Hygroton.

40 mg oral Edarbi once a day, as the patient is on diuretics, Hygroton. Oral 50 mg Hygroton once in the morning.

Hypercholesterolemic drugs Lipitor

Oral tablet 40 mg once a day. He takes this tablet at night.

4. Review of systems with all body systems for H&P or consult notes. Review of systems is what the patient or family/friends tell you (by body system).

General appearance

The patient shows facial weakness, numbness, confusion, sweating, and dizziness. Facial drooping present.

By Paul J. Hoehner

Throughout the land, arising from the throngs of converts to bioethics awareness, there can be heard a mantra, “…beneficence…autonomy…justice…” It is this ritual incantation in the face of biomedical dilemmas that beckons our inquiry (Clouser & Gert, 1990, p. 219).

Ethics as a theological discipline is the auxiliary science in which an answer is sought in the Word of God to the questions of the goodness of human conduct. As a special elucidation of the doctrine of sanctification it is reflection on how far the Word of God proclaimed and accepted in Christian preaching effects a definite claiming of man. (Barth, 1981, p. 3)

Essential Questions

· What are the four elements of a Christian worldview and how do they influence a Christian approach to medicine, healing, and medical ethics?

· What are the four principles of medical ethics and how are they defined? How can a Christian appropriately use these four principles?

· What is meant by specifying, balancing, and weighing the principles? How does a Christian worldview influence how one defines and uses each of these four principles?

· What is the four-boxes approach to organizing an ethical case study? What is the difference and the relationship between the four-boxes approach, and the four principles of medical ethics?

· What are the four ethical topics that compose the four-boxes approach and what questions does each topic entail? How does the four-boxes approach help solve ethical dilemmas in a case study?

Introduction

Biomedical ethics, or bioethics, is a subfield of ethics concerned with the ethics of medicine and the ethical issues involving the life sciences, particularly those raised by modern technologies, such as stem cell research and cloning. The term medical ethics is closely related to biomedical ethics but is primarily focused on ethical issues raised in the practice of medicine and medical research, such as abortion, euthanasia, and medical treatment decisions (World Medical Association, 2015).

Because the terms biomedical ethics and medical ethics are closely related and involve a great deal of overlapping subject area, they will be used interchangeably to avoid confusion. The study of biomedical ethics and medical ethics presents some of the most complex and controversial challenges in applied ethics. The complexities of dealing with individual patients and the intricacies of modern health care, coupled with the rapid advances being made in medical science, present formidable challenges. For many health care workers, clinical ethical dilemmas will often challenge their own settled positions, especially if they have not taken the opportunity to reflect critically on their own moral presuppositions and how their own intuitive ethical positions may be justified.

When one encounters the many ways the world and even portions of the Christian church respond to ethical issues, it is easy to be tempted to think there are no right or wrong answers. The complexity of these issues and the myriad of answers and justifications given by so many “experts” can drive many students toward some form of ethical relativism.

There are certainly many complexities in health care ethics: competing ethical ideologies, beliefs or virtues, different interpretations of the facts surrounding an issue, and differing approaches on how to address these issues; however, one should not confuse complexity with ethical relativism. These are two very different things. Relativism is the belief that “what is right and wrong, good and bad, true and false varies from time to time, place to place, and person to person. There are no absolute standards of truth or morality” (Cook, 1995, p. 726).

Coupled with the complexity of biomedical ethics is the loss of moral consensus in the medical profession and society as a whole, whereby moral positions once taken for granted cannot be taken for granted any longer. There are plenty of examples in the medical field: abortion, contraception, euthanasia, suicide, and anything that has to do with sexual morality. This lack of moral consensus is primarily a result of the cultural plurality that exists in many Western nations. Cultural plurality is a term that simply refers to the sheer diversity of race, value systems, heritage, language, culture, and religion. It is the simple observation that many cultures contain people with different worldviews, ideologies, and moral frameworks.

One of the consequences of many pluralistic societies is an increased tendency toward secularization. Secularized societies tend to relegate religious perspectives, and moral frameworks based on those perspectives, to the periphery of public discussion or limit them to the private spheres of life. According to most secularist thinkers, religious, spiritual, or faith-based perspectives may play an important role in one’s personal life, but they have no place in the public square of politics, public education, law, or medicine, particularly medical ethics. As Guinness (1983) notes, this results in a faith that is “privately engaging, but socially irrelevant” (p. 79). Limiting one’s faith, spirituality, or religion to merely private matters does not do justice to the role that religious or spiritual worldviews play in deciding how to live and interact within the world and society. Biblical Christianity stresses the role of the Christian in the world in matters of justice as well as civil engagement.

Plurality, the fact that different worldviews exist side-by-side in a culture, needs to be distinguished from pluralism, an instance of relativism. The distinction is important. Pluralism is a philosophical or ideological statement that maintains that no single ideological or religious claim is actually “right;” all truth claims have equal validity (Hoehner, 2006). The practical result of philosophical pluralism is to deny any objective truth claim or deny that any objective truth can ever be obtained. This leads many students to conclude that there can be no common approach to finding right amid the many perplexing and complicated moral issues of the day.

In this postmodern and relativistic world, divine or even natural, given norms of moral behavior are soon replaced by a form of morality based solely on one’s own personal subjective views, conforming the world to one’s own feelings and desires. Instead of orienting one’s behavior to an objective standard beyond oneself (e.g., divine and biblical revelation), many in today’s postmodern society seek to orient norms and standards of morality to their own self-referential existence (e.g., what one feels, intuits, or wills according to one’s own needs, wants, or desires). What is “right” and “true” has no reference outside of one’s own personal experience and feelings. What is right and true for one person may not be right and true for another. This can be profoundly challenging and perplexing for the Christian health care worker attempting to insert a Christian ethic into this social mix. Most people would never apply this way of thinking to empirical scientific matters. There is an inconsistency in much of modern culture that holds simultaneously to both relativism and scientism; however, this way of thinking is itself incoherent and is generally only applied to issues of morality and religion.

How does the boundary affect your practice or have the potential to affect your practice? Provide examples.

The identified social boundary I chose to discuss is the cultural barrier. As a nurse practitioner, I have had the experience of working with diverse cultures and ethnicities throughout my practice. Before working with active-duty military and veterans, I worked in a primary Columbian clinic. At this clinic, I faced culturally sensitive communication barriers when discussing healthcare information with patients. Soon after, we received certified blue interpreter phones.

This helped ensure information was appropriately translated to the patients to ensure they had a thorough understanding of healthcare information. Working with active-duty military can be challenging as well. I have experienced language and healthcare literacy barriers with spouses and active-duty military members from Africa, Asia, India, as well as from the Middle East. Being culturally competent helps when providing care and education to individuals of different cultures because this helps to have a clear understanding of their relationship with healthcare. (Brooks, 2019)

As a leader, how can you have an impact on overcoming that boundary? Provide examples.

As a leader, having annual training on becoming well-rounded and improving cultural competence will help familiarize employees with providing care for individuals. Encouraging employees to be open-minded, respectful, and utilize all available resources when communicating with individuals of different cultures ensures the best standard and ethical care is being practiced. This will also help to improve patient care by increasing the knowledge and understanding of different cultures to improve the safety, health, and welfare of patients and their families.

What interprofessional relationships can you foster that can contribute to overcoming the boundary? Be specific and provide rationale.

Interprofessional relationships in which individuals can overcome barriers include collaborating with social workers, interpreters, linguists, nurse educators, and case managers to ensure cultural competence goals are being met. Having resources and ensuring employees are adequately educated to provide holistic care will ensure that dignity and respect of others backgrounds, religion, beliefs, and values are being taken into consideration when providing care for patients. (Lekas, 2020)

How will you leverage resources to overcome the selected boundary?

To leverage resources to overcome cultural barriers, I will ensure employees receive cultural humility vs. cultural competence training. Cultural humility consists of a lifelong commitment of self-assessments to ensure cultural competence is met. Encouraging employees to learn the basic information of different cultural backgrounds and healthcare practices will increase cultural awareness. With these methods in place, cultural awareness should be increased. (Kaihlanen et al., 2019)

References

Brooks, L.A., Manias, E., & Bloomer, M.J. (2019). Culturally sensitive communication in healthcare: A concept analysis. Collegian, 26(3), 383-391. https://doi.org/10.1016/j.colegn.2018.09.007 (Links to an external site.)

Kaihlanen, A.M., Hietapakka, L., & Heponiemi, T. (2019). Increasing cultural awareness: Qualitative study of nurses’ perceptions about cultural competence training. BMC Nursing, 18(1), 1-9.

Lekas, H-M., Pahl, K., & Fuller Lewis, C. (2020). Rethinking cultural competence: Shifting to cultural humility. Health Services Insights, 1-4. https://doi.org/10.1177/117863292097080