Evidence Based Practice and Nursing Informatics

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nursing competencies, outline what they are, and how they will influence the trajectory of my nursing career path. The American Association of Colleges of Nursing and the Quality and Safety Education in Nursing have put together a joint document that outlines six different competencies associated with nursing (QSEN, 2012). These six competencies are quality improvement, safety, teamwork and collaboration, patient-centered care, evidence-based practice and informatics. Quality improvement is associated with using data "to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems" (QSEN, 2012).

Safety refers to minimizing the risk of harm to patients. Teamwork reflects the ability to "function effectively within nursing and interprofessional team, fostering open communication" (QSEN, 2012). Patient-centered care recognizes the patient as the source of control and full partner in care. Evidence-based practice integrates the best current evidence and informatics reflects the use of information and technology to "communicate, manage knowledge, mitigate error and support decision-making" (QSEN, 2012).

The two competencies selected for this analysis are evidence-based practice and informatics. Evidence-based practice refers specifically to the reliance on hard scientific evidence in making nursing decisions. This seems rather obvious, but it stands in contrast to traditional nursing approaches that are based on different grand, mid-range and practice level nursing theories. Evidence-based practice as an approach demands that health care professionals ensure that they maintain a high level of awareness about the evidence for each situation, and what the best nursing approaches are based on that evidence (McKibbon, 1998). Nurses therefore need to have a grounding in how to not only acquire evidence, but to learn how to apply that evidence to their daily practice (Wood & Haber, 2005).

The theoretical basis for evidence-based practice is that facts are better than guesswork and theories. Evidence is gathered through testing of hypotheses, and over time there is a significant body of evidence to support certain interventions, while the value of other interventions is disproven. The use of evidence -- i.e. doing what we can prove works -- is how pretty much every other business in the world works, so it sort of makes sense that nursing should work on the same principle.

Informatics is a means of gathering, storing, and recalling knowledge. Informatics ties in well with evidence-based practice where decision-making systems are used. But there are other aspects to informatics, such as the use of electronic health records to store and transfer information about the patient. Staggers and Thompson (2002) note that there have been different definitions of the term informatics over the years. Definitions have tended to emphasize the application of information technology to nursing, or the performance of nursing using information technology. Staggers and Thompson (2002) looked at the previous definitions and ended up re-writing the first one with more words and some redundant passages -- ultimately it is IT for nurses and anything beyond that is inefficient verbal filler.

Ever since HIPAA brought forth the idea of electronic medical records being standard practice in health care, informatics has become gradually more important. While every other industry has been revolutionized by information technology, health care has lagged far behind and is perhaps the only industry today where electronic record keeping is not universal. This tells us that electronic health records, and electronic decision-making systems, are coming to health care sooner or later, if they have not yet already. The ramifications of this are fairly simple -- informatics is not going to be a specialty in nursing anymore, but something every nurse and every other health care practitioner will need to utilize, every day. There are few competencies more important to the modern nurse than understanding informatics and implementing evidence-based practice. The theoretical basis, therefore, of informatics is that this is going to be a major part of health care going forward, and nurses should have a strong degree of competency in informatics in order to excel in the 21st century.

Factors Shaping Competencies

The nurse has to take responsibility for his/her achievement in both of these competencies. It starts with recognizing that these are two of the most important competencies in the profession for the 21st century. The current environment is quite ready for nurses to have and to promote these particular competencies, both the technological and the social environments. Informatics is now driven by the availability of mass data storage, retrieval and processing analytics systems. Nursing informatics ten years ago simply was not as powerful, and twenty years ago might have been worthless by today's standards.

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But knowing what we can do today, it is imperative that the profession pursues the full use of the power of information and modern-day information systems to improve nursing practice. Moreover, the social and political environments expect it. Electronic health records are to be implemented, by law, but patients also expect it. Many older patients do not, but when you deal with younger patients, they basically expect you to work with evidence from journals, and information systems -- if that is what the market demands then that is what the nursing profession will have to deliver going forward.

Other paradigms of nursing are still used, but the move towards evidence-based practice and informatics has been underway for some time now. In other fields, these are the main methods of learning, and of making decisions, and it is expected that this will be the case in health care as well going forward.

The nurse, therefore, has to take responsibility for developing his/her own competencies in both of these areas. Developing these competencies begins with education. As of ten years ago, only around half of U.S. nursing schools were providing adequate informatics education (McNeil et al., 2005) so it is important to ensure that this is part of nursing studies, or that there is supplemental education given to those who have not been exposed to informatics during their formal training. Many master's level nursing programs now have some informatics training, though for nurses who do not wish to be specialists in informatics, getting the basics as part of their studies is not always so straightforward.

This places emphasis on training with respect to informatics. In one sense, because there are many different software applications. Not only will they not all be relevant to one's place of work, but software also changes over time. Education can provide knowledge about the basic principles, but can become outdated. Training, either vocational through special courses, or on-the-job training, ends up being the way that most nurses learn about informatics. At that point, however, it is important to take the initiative to learn more than what is needed for the role, so that working knowledge of nursing informatics becomes a strength rather than just a competency.

Evidence-based practice is something that can be learned in school. EBP requires that nurses understand how to find out information, and how to keep their knowledge current. Some of this falls to nurse leaders, who outline the procedures that a nurse should use in specific situations, but any nurse can gain access to the right literature and incorporate it into practice. The practitioner absorbs evidence from the literature, from the administrative environment (nurse leaders in particular) but also from the media, and the education environment. This process of absorbing knowledge from different areas, and ensuring that the knowledge is rooted in sound science, seems time-consuming, so it is best to learn these fundamental skills during one's formal education (Kitson et al., 1998).

Evidence-based practice needs to be properly implemented by the nurse as well. Sometimes this means the use of informatics to gain access to key information. But it is also an essential element of quality improvement, which is another competency. Quality improvement requires undertaking interventions and then measuring the effectiveness of those interventions, adjusting where needed to improve effectiveness. This is evidence-based practice, making decision on the basis of proven outcomes (Buysse et al., 2012). It is important to also remember that the masters' level nurse has to play a leadership role in the acquisition and dissemination of this knowledge to the other nurses -- the masters' level nurse will be looked upon as a leader especially in terms of knowledge and being up-to-date on current nursing practice, so this is a key role in which to excel to fulfill those expectations.

Application

My masters' studies should allow me to study each of these things, and to become an expert at them. They are part of lifelong learning -- in undergrad you learn some things about nursing in a more basic way. Then you work for a while, but by the time one commits to pursuing a masters in nursing, it is clear that lifelong learning is a priority for that person, and the goal of the next phase of learning is to add to, and build upon, the knowledge that was acquired through undergrad and the early working life. If one lacks the spirit of inquiry, then the….....

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