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Student Response 2

It is essential for healthcare organizations to involve nurses in every stage of the System Development Life Cycle (SDLC) of a new health information technology system. There are unfortunate and costly consequences when nurses are not involved in the entire SDLC process. Consequences of not including nurses include delays in achieving milestones, poor usability, waste of time and resources, system inefficiencies, decreased success rate, lack of buy-in, heightened frustrations, and increased costs due to time and resources spent modifying the system. Nurses are the primary end-user, understand workflow, can provide insight into whether a system is useful and facilitates patient care, ensure proper allocation of healthcare resources, and address problems (Verma & Gupta, 2017). If nurses are involved in all stages, the likelihood of implementing a system that is acceptable for nurses is improved, promoting buy-in and success. Leadership must acknowledge the value of a partnership with nurses because they may be the most affected by a project that involves a new health information technology system. The most successful SDLC governance structure consists of some level of user participation (Walden University, LLC, 2018). Nurses’ primary concerns involve providing efficient and quality care to the patient; therefore, their input is essential during the SDLC of a new health information technology system.

The planning stage involves understanding the need for a system. If nurses are not included in the planning stage, executives may determine a system satisfies a need when the system may not promote efficient workflow. Most end-users in healthcare are nurses; therefore, they must be included in the understanding of the need for a system (Verma & Gupta, 2017). The involvement of nurses in the planning phase ensures a relevant system (Verma & Gupta, 2017). It is crucial to align and collaborate with stakeholders early in the SDLC because their feedback is essential throughout the SDLC (McGonigle & Mastrian, 2022). 

The system’s requirements are identified during the analysis phase by examining workflows and business practices (McGonigle & Mastrian, 2018). Nurses are the experts in identifying typical workflow and can advocate for plans that promote the typical nursing workflow, encouraging buy-in and decreasing frustrations. If nurses are included, they can suggest alterations during the planning phase to facilitate the project’s success and diminish hours spent on modifications to the system. Nurses are the best judge of positive aspects and challenges that may hinder functionality (Verma & Gupta 2017). The design phase involves identifying needed programs, how they will interact, and how they will work (McGonigle & Mastrian, 2022). If nurses are not involved in the design phase, they may miss opportunities to define what data and programs are required and essential. Prototypes of screenshots, reports, and processes help the team clarify requirements and align ideas, limiting costly glitches (McGonigle & Mastrian, 2022). Nurses can help with this customization.

Many issues arise in the implementation phase if nurses are omitted. Hardware and software may not be installed in needed areas. Policies and procedures may be instituted that do not support the day-to-day efficiencies of nursing. One of the most significant challenges to implementation in the SDLC is stakeholder resistance to change (Walden University, LLC, 2018). Issues in the implementation phase can be avoided or diminished by developing a partnership with nursing (Walden University, LLC, 2018). Nurses are typically the end-user that can identify if the system is running well and provide education amongst peers. Additionally, nurse champions can help with education, support, and system evaluation. Nurses play a crucial role in providing direction during the SDLC and informing leadership of what is and is not working. Successful implementation requires significant resources to effectively alleviate challenges and train stakeholders (Walden University, LLC, 2018).

Maintenance involves user support throughout changes (McGonigle & Mastrian, 2022). If nurses are not involved, they cannot report concerns and possible solutions. Nurses can identify when systems are not meeting the needs of patients and issues are present (McGonigle & Mastrian, 2022). Nurses can look to peers to see what strategies they have implemented, informing the decision process (Walden University, LLC, 2018). It is also essential to implement skilled project management to keep the project on track, manage relationships, hold others accountable, and provide routine updates (Walden University, LLC, 2018). There is an adjustment phase after project implementation, and it is essential to be patient; however, when issues arise, it is critical to make rapid changes (Walden University, LLC, 2018). Nurse champions can assist with identifying problems and supporting rapid changes. 

I have not specifically had any input in the selection and planning of new health information systems within the hospital; however, an entire nursing informatics team was involved from the beginning of the SDLC of the Epic system. The nursing informatics team collaborated with Epic and created a group of nurse champions who assisted with planning the SDLC process. This led to a smooth transition from paper charting and a hybrid electronic health record approach to the Epic system. I appreciated receiving education about the system from my peers and felt comfortable going to them with issues or concerns. The implementation team always understood frustrations, as they have been in similar situations and understand the nursing workflow. Working closely with the nursing informatics team throughout my career led to the mutual respect that assisted with buy-in, education, and understanding of nursing workflow. 

References

McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

Verma, M. P., & Gupta, S. (2017). Software Development for Nursing: Role of Nursing Informatics. International Journal of Nursing Education and Research, 5(2), 203–207. https://doi.org/10.5958/2454-2660.2017.00044.8 

Walden University, LLC. (Producer). (2018). Managing Health Information Technology [Video file]. Baltimore, MD: Author.

Student Response 2

Patient Preferences and Decision-Making

Patient-centered care is one of the most recent developments in nursing and clinical practice. Incorporating clients into clinical decision-making has been shown to improve recovery plans, cost-effective interventions, and the selection of the best therapeutic modalities. In the long run, all of these have enhanced patient care and results. Patients and their families may decide on preferred treatment approaches for nurse practitioners to follow to make them feel more comfortable, or because the patient or family has researched high success rates. In home-based care, where the client’s family plays an important part in treatment and rehabilitation, patient preferences are critical. However, it is important to highlight that collaborative decision-making has limitations. As a result, by reviewing a specific clinical practice experience where patient preferences and inclusive decision-making impacted the progression of the situation and the treatment plan, this discussion will explore the specifics of how patient preferences influence the outcomes of care from a nurse’s perspective. The discussion also includes an explanation of how the chosen patient choice can benefit and aid future nursing professional practice.

Several therapeutic interventions in healthcare have attempted to incorporate patient preferences and collaborative decision-making to improve patients’ quality of life while undergoing treatments (Gärtner et al., 2019). This has been the case for patients in Palliative Care setting receiving therapy and care. Patient preferences for cancer therapy and treatment alternatives, when to commence specific treatment protocols, whether to go for screening tests, and the sort of therapies to choose based on the patient’s values, among other things, have all been accommodated.

Prior to working at my current position, I had worked with a 48-year-old mother with two daughters ages 15 and 13 years old respectively, who had survived breast cancer for ten years. Her breast cancer had relapsed and impacted her lumbar spine, thus she had chronic back discomfort. Her oncologist recommended treatment with anticancer hormone drugs in combination with radiation therapy. When it became evident that her disease would not be treatable in the long run, she was recommended for palliative treatment, which would help her manage her symptoms. She was subjected to several cancer therapies over three years, all of which proved futile in the end. The patient was compelled to choose between continuing her cancer treatments, undergoing further life-prolonging treatments such as cardiopulmonary resuscitation, and being admitted to the intensive care unit, among other options. I had the opportunity to use patient decision aids as one of her caregivers. Some of the decisions to be taken were micro-decisions which are sometimes fraught with difficulties due to communication gaps (Karlsen, 2020). The patient had to choose between staying in the hospital and being treated in the privacy of her own home. When shared decision-making is not launched effectively, significant complications can occur, and patient care must be patient-centered (Kon et al. 2016). It was necessary to consider the patient’s values. Thus, her caregivers, including me, unanimously supported her desire to receive home-based care so that she could spend quality time with her two girls. She needed palliative care in the comfort of her own home so that when it was time for her to die, she could die peacefully while surrounded by her loved ones.

The preferred aid I selected was intended to help the patient in part by focusing on her daughters. It entailed determining the breast cancer risks for her two kids, as requested by the patient. I suggested that they do a BRCA Gene Test to assess their hereditary propensity to breast cancer as well as other risk factors so that screening and treatment could begin sooner. The patient felt relieved and accepted her terminal situation after learning that her girls would be fine, and she didn’t have any regrets about opting for home-based care. 

Overall, patient preferences and participation in decision-making about their personalized care are crucial in achieving better results. When patients’ wishes are in accordance with the treatment and care interventions they get, they respond well to treatment. Decision aids improve decision-making by demonstrating the advantages and disadvantages of each option and highlighting some inherent possibilities.

References

Gärtner, F. R., Portielje, J. E., Langendam, M., Hairwassers, D., Agoritsas, T., Gijsen, B., . . . Stiggelbout, A. M. (2019).

               Role of patient preferences in clinical practice guidelines: a multiple methods study using guidelines from oncology as a case.

               BMJ Open, 1-11.            

               https://bmjopen-bmj-com.ezp.waldenulibrary.org/content/bmjopen/9/12/e032483.full.pdf

Karlsen, M. M., Happ, M. B., Finset, A., Heggdal, K., & Heyna, L. G. (2020). Patient involvement in micro-decisions in intensive care. Patient                      Education and Counseling, 1-8.

 https://wwwsciencedirectcom.ezp.waldenulibrary.org/science/article/pii/S073839912030207X?via%3Dihub.

Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared Decision Making in Intensive Care Units: Executive                           Summary of the American College of Critical Care Medicine and American Thoracic Society Policy Statement. American Journal of                         Respiratory and Critical Care Medicine, 193(12), 1334-1336. https://search- proquestcom.ezp.waldenulibrary.org/docview/1797885427?