A Nursing vignette, presented as a part of National Nurses Week.
Troy M Seagondollar, MSN-I, RN-BC, Certified Informatics Nurse Specialist, Kaiser Permanente SCAL Regional PCS
When I was thirteen, my father opened a computer store (an odd thing for an architect but that’s a story for another day about the evolution of technology in a different industry). In those days of the mid-70’s, the Apple, Commodore, and IBM “PC’s” we’re just beginning to come on the market, I learned about computers and the utility of using them in performing routine tasks. Unbeknownst to me at the time, this was to set the foundation for the future of my Informatics Nursing focus in the future.
When I turned twenty-three, I entered the nursing program of my local community college. I quickly realized that many aspects of practice were repetitive. Developing care plans followed a distinct pattern whereby after interviewing and assessing the patient as well as reviewing the medical treatment plan, I needed to apply nursing diagnoses and associated interventions to achieve a prospective outcome. Initially, this process was exciting and new but eventually I discovered that many times over I was repeating the same process for different patients with similar medical diagnoses. In addition, as I became more astute at what nursing interventions worked best for different identified nursing diagnoses, I was spending a lot of time rewriting the same things that took away time that could otherwise be spent with the patient.
Revisiting the years of my youth, I used my knowledge of information systems to build a database of nursing diagnoses, interventions, and prospective outcomes. I also copied the care plan template that we were required to use by the college into the computer. It was arduous but incredibly fulfilling because I was able to take the diagnoses, interventions, and outcomes and copy them directly into the template, never having to pick up a pen or open a book. My care plans were clean, consistent, and concise.
Interestingly, some of my instructors were less then accepting of my innovative process. I was challenged that I was not personalizing my care plans based on patient needs; essentially, they felt that I was creating “canned” care plans. I rebutted that in actuality, my practice enabled me to personalize care plans much more efficiently and ultimately allowed me to provide consistent interventions to patients who had similar issues thus increasing my ability to apply the right care to the right person for the right reasons with less variation. I also argued that by simplifying the process of care plan development, I was able to spend more time with my patients rather then writing redundant statements over and over. After much deliberation and a conference with the dean, I was approved to continue using my electronic care plan development process.
Fast forward to today and witness the evolution of electronic health records where all documentation is entered and stored electronically; where information about the patient is immediately retrievable; where information is displayed and shared across disciplines so team members can work collaboratively and cohesively to attain the greatest level of positive outcomes for the patient.
Informatics is not computers and software. Informatics is the ebb and flow of information using tools to enhance the capturing, displaying, and sharing of that information with members of the team. In addition, this information is utilized in research to correlate actions to outcomes so that evidence based practice can be realized and enlisted to increase care processes.