Title: Harnessing technology to benefit nursing: as technology and health informatics become an increasingly significant part of nursing practice, it is vital nurses are able to articulate their technological and professional needs for the benefit of patients

Author(s): Robyn Carr , Michelle Honey , Denise Irvine and Lucy Westbrooke

Source: Kai Tiaki: Nursing New Zealand. 16.10 (Nov. 2010): p24.

Document Type: Article

Full Text: 

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Technology is now an inseparable part of good nursing practice and nurses themselves have become leaders in the development of health informatics in New Zealand. Yet the term "nursing informatics" is comparatively new, having first being used here in the early 1990s.

Initially the use of computer technology in health care was limited. However, today all nurses would be familiar with a range of digital data collection devices--from electronic blood pressure machines, tympanic thermometers and blood sugar level equipment--and information technology (IT), eg electronic laboratory results, patient records and email communication, in both their personal and professional lives.

The increase in the use of information and computer technology in health care has led to health professionals, the government, through the Ministry of Health and New Zealand technology companies, to work together to consider how best to harness the opportunities technology-supported health care can provide. The umbrella group uniting those interested in this area is Health Informatics New Zealand (HINZ). Nurses are an active group within this organisation.

All of us are aware of the increasing place of technology in our lives, including our personal lives--such as audiovisual appliances and home computers. The common experiences of using automatic teller machines, internet banking and household devices such as video and microwave ovens are further examples.

Technology is also part of our professional lives, whether we work in clinical, management, administration, education or research. Nursing practice is seen as information-intensive, with one study estimating nurses spend nearly half their time documenting patient information. (1) Therefore, technology that reduces the time and effort in routine aspects of care delivery and documentation could lead to more quality time caring for our patients.

Technology can provide further gains beyond computerised documentation, including co-ordination of care, communication and medication management. There are many advantages for the profession of increasing the use of technology because of the storage, processing, retrieval, display, processing, analysis and communication capabilities of the computer. (2) For nursing to take advantage of the potential benefits of technology, it is essential nurses articulate what the profession needs and how technology can support nursing practice.

What is nursing informatics?

The International Medical Informatics Association special interest group in nursing informatics' (IMIA-NI) definition of nursing informatics was ratified by the 2009 general assembly as: "Nursing informatics, science and practice integrate nursing, its information and knowledge and their management with information and communication technologies to promote the health of people, families and communities world wide." (3)

A history of nursing informatics in New Zealand states: "Nursing and the use of information to improve patient care have gone hand-in-hand since at least the time of Florence Nightingale." (4) In fact, Florence Nightingale is often attributed as being the first nurse informatician, as she used data she collected during the Crimean War to change the way she cared for her patients. (5) The challenge for nurses is to consider how we can also use data to inform and improve our nursing care.

In the early 1990s, computers were becoming more common, though how the technology could be used in health care, and more specifically to support nursing practice, was less understood. In 1991, following a conference entitled Nursing informatics in New Zealand: An impetus for learning, organising committee chair Jan Hausman sought a mandate to form a group to continue sharing knowledge and ideas engendered by the conference.

The first meeting to set up a national nursing informatics group was held six weeks later. The objective for the fledgling group was: "to foster throughout New Zealand the development of knowledge and utilisation of information systems within all areas of nursing practice", and the name Nursing Informatics New Zealand (NINZ) was adopted. (4) The new millennium saw NINZ merge with the New Zealand Health Informatics Foundation (NZHIF) to form a new incorporated society, Health Informatics New Zealand (HINZ).

Role of HINZ

HINZ is a national, not-for-profit organisation. Its focus is to facilitate improvements in business processes and patient care in the health sector through the application of appropriate information technologies. (6) HINZ helps improve the effectiveness of health informatics business and acts as a single portal for the collection and dissemination of information about the health informatics industry. Membership is open to anyone with an interest in health and informatics who wants to be part of an organisation that can provide relevant, up-to-date information about health informatics, through information sharing, seminars and annual conferences.

HINZ has established working groups to mirror some of those within the IMIA-NI. The HINZ nursing informatics working group is the most active of HINZ groups.

The Ministry of Health is interested in information collection and hosts 17 national collections and systems. New Zealand is fortunate to have a National Health Index (NHI) database where each person has a unique health care identifier which follows the individual through each health care event in his/her life, allowing easier tracking of information through health care episodes. All information collection, storage, access and retrieval is governed by the Privacy Act (1993) and the Health Information Code (1994) and subsequent amendments.

Health care is guided by a national health strategy. This acknowledges the importance of good information management for better health outcomes, to reach the goal of good health and well-being for all New Zealanders throughout their lives. (7) The overall vision for information management is set out in this strategy. (8) Subsequent to a Ministerial review in 2009, changes to the health sector have been instigated, with the overall objective of "better, sooner, more convenient health services'; A major change has been the establishment of the National Health Board (NHB) and the formation of a sub-committee, the Information Technology Health Board. A number of informatics-related recommendations have been made, including strengthening health IT and prioritising new technologies and medical devices. The IT Health Board is seen as a health sector leadership group to support the delivery of high quality health care by providing strategic leadership on health information investments and solutions across the health and disability sector, and ensuring health sector policy is supported by appropriate health information and IT solutions.

Health technology plan

In July this year, the IT Health Board published a national health information technology plan. This aims to "drive a culture of innovation, partnership and respect to support health sector leaders to make appropriate health information technology investments in the context of the whole sector" (9) and to work towards the eHealth Vision. This vision has a clear aim: "To achieve high quality health care and improve patient safety, by 2014 New Zealanders will have a core set of personal health information available electronically to them and their treatment providers, regardless of the setting as they access health services". (9)

Pressures ahead

New Zealand currently faces a number of pressures, including:

* health inequalities and the need to address Maori health disparities because of the over representation of Maori in morbidity and mortality data; (10,11,12,13)

* a growing older population, and more people with long-term and complex health conditions. (14)

* a more informed consumer. With our history of free health services, there is an expectation that health care will continue to be freely available and that evidence-based best practice will determine the treatments, with no regard to cost.

* workforce issues, including an ageing workforce. The nursing workforce is the single largest health professional group, and is recognised as having enormous potential to advance health and disability outcomes. (15)

These pressures can only be expected to intensify in the next decade. We need to target and prioritise where health IT investments are made. Judicious use of technology could be the key to the long-term sustainability of a free health care service.

Conclusion

Nurses deserve to have quality information at their fingertips, when and where required, to ensure they can deliver the best care possible to individuals, communities and populations. Nurses cannot expect to practise effectively without reliable information delivered at the right place, in a timely fashion. Work is underway to achieve this, with the plans focusing on information exchange to support the continuum of care. Nurses need to be actively involved in this, so the right information and knowledge required to support care is targeted. The infrastructure and communications and IT have now matured sufficiently, so high quality health care can be achieved, and patient safety and health outcomes improved.

HINZ held its annual conference in Wellington early this month. For further information about HINZ, see the website www.hinz.org.nz. To find out more or keep in contact with other nurses about nursing informatics, contact chair of the nursing informatics working group at HINZ, Michelle Honey. Phone 09 9237308 or email: m.honey@auckland.ac.nz.

References

(1) Bowies, K. H. (1997) The barriers and benefits of nursing information systems. Computers in Nursing; 15: 4, 191- 196.

(2) Thede, L. Q. (1999) Computers in nursing: Bridges to the future. Philadelphia: Lippincott.

(3) IMIA-NI. (2010) IMIA NI--The Nursing Informatics Special Interest Group. http://www.imiani.org/. Retrieved 25/10/10.

(4) Appleton, M., Carr, R. & Hausman, J. (2000) NINZ: the first 10 years. Auckland, New Zealand: Nursing Informatics New Zealand Inc.

(5) Kenney, J. A. & Androwich, I. (2009) Nursing informatics roles, competencies and skills. In D. McGonigle & K. Mastrian (Eds), Nursing informatics and the foundation of knowledge (pp107-131). Sudbury, MA: Jones and Bartlett Publishers.

(6) Health Informatics New Zealand. (2010) About Health Informatics New Zealand. http://www.hinz.org.nz/page/abouthinz/about-hinz. Retrieved 09/06/10.

(7) Ministry of Health. (2000) The New Zealand Health Strategy. Wellington, New Zealand: Ministry of Health.

(8) Health Information Strategy Steering Committee. (2005) Health Information Strategy for New Zealand. Wellington: Ministry of Health.

(9) Ministry of Health. (2010) IT Health Board. http://www.ithealthboard.health.nz/. Retrieved 10/06/10.

(10) Cannolly, M., Boyd, M.-A., Kenealy, T., Moffitt, A., Sheridan, N. & Kolbe, 3. (2010) Alleviating the burden of chronic conditions in New Zealand: The ABCC NZ Study Workbook 2010. Auckland: The University of Auckland and Freemason's Unit of Geriatric Medicine. http://dhbrf.hrc.govt.nz/media/documents_abcc/ ABCC_Study_Workbook_Final.pdf. Retrieved 19/02/10.

(11) Ministry of Health. (2007) Diabetes surveillance. Wellington: Ministry of Health.

(12) Ministry of Health. (2008) The health and independence report 2008. Wellington: Ministry of Health.

(13) Davey, J. A., & Gee, S. (2002) life at 85 plus: A statistical review. Wellington: New Zealand Institute for Research on Ageing.

(14) Statistics New Zealand. (2010) QuickStats of 2006 census data. http://www.stats.govt.nz/Census/ 2006CensusHomePage/QuickStats.aspx. Retrieved 24/02/10.

(15) Nursing and Midwifery Workforce Strategy Group. (2006) Nursing workforce strategy, http://www.dhbnz.org.nz/ includes/downioad.aspx?ID=25740. Retrieved 16/06/08,

* For a report on the recent world congress on medical and health informatics, see p29.

Michelle Honey, RN, PhD, is a senior lecturer with the University of Auckland's school of nursing.

Robyn Cart, RN, specialised in cardio thoracic surgery before becoming customer services manager of Auckland District Health Board's (DHB) IT division. She was IMIA-NI world chair from 2006-2009.

Denise Irvine, RN, BSocSci, MBS, is director of e3Health consultancy. She is on the HINZ executive and is NZNO's representative on the International Council of Nurses' telenuring and nursing informatics network.

Lucy Westbrooke, RN, DipNg, PGDipBus (health informatics), works as an information management consultant for Auckland DHB's information and technology service.

Honey, Michelle^Carr, Robyn^Irvine, Denise^Westbrooke, Lucy

Source Citation

Carr, Robyn, et al. "Harnessing technology to benefit nursing: as technology and health informatics become an increasingly significant part of nursing practice, it is vital nurses are able to articulate their technological and professional needs for the benefit of patients." Kai Tiaki: Nursing New Zealand Nov. 2010: 24+. Academic OneFile. Web. 4 May 2012.

Document URL
http://go.galegroup.com/ps/i.do?id=GALE%7CA243451589&v=2.1&u=phspuqc&it=r&p=AONE&sw=w

Gale Document Number: GALE|A243451589

Insights:
  In this article, New Zealand is making a big leap in the utilization of technology in health care delivery, and it's a good thing that nursing informatics are well supported by organizations. And maybe they would be able to meet their evision on 2014. Additional to that, they have a National Health Index database which means that health care providers including the nurses, will have a fast way of tracking health records of the patients, resulting to better health management and monitoring. Today, no doubt that informatics play a big role in the nurses career and patient's health. Higher quality technology means higher quality of health informations at hand. 

Nebulization Therapy

Nebulization Therapy

Nebulization is the process of medication administration via inhalation. It utilizes a nebulizer which transports medications to the lungs by means of mist inhalation.

Indication
Nebulization therapy is used to deliver medications along the respiratory tract and is indicated to various respiratory problems and diseases such as:

• Bronchospasms
• Chest tightness
• Excessive and thick mucus secretions
• Respiratory congestions
• Pneumonia
• Atelectasis
• Asthma

Contraindications
In some cases, nebulization is restricted or avoided due to possible untoward results or rather decreased effectiveness such as:

• Patients with unstable and increased blood pressure
• Individuals with cardiac irritability (may result to dysrhythmias)
• Persons with increased pulses
• Unconscious patients (inhalation may be done via mask but the therapeutic effect may be significantly low)

Equipments

• Nebulizer and nebulizer connecting tubes
• Compressor oxygen tank
• Mouthpiece/mask
• Respiratory medication to be administered
• Normal saline solution

Procedure

1. Position the patient appropriately, allowing optimal ventilation.
2. Assess and record breath sounds, respiratory status, pulse rate and other significant respiratory functions.
3. Teach patient the proper way of inhalation:
• Slow inhalation through the mouth via the mouthpiece
• Short pause after the inspiration
• Slow and complete exhalation
• Some resting breaths before another deep inhalation
4. Prepare equipments at hand
5. Check doctor’s orders for the medication, prepare thereafter
6. Place the medication in the nebulizer while adding the amount of saline solution ordered.
7. Attach the nebulizer to the compressed gas source
8. Attach the connecting tubes and mouthpiece to the nebulizer
9. Turn the machine on (notice the mist produced by the nebulizer)
10. Offer the nebulizer to the patient, offer assistance until he is able to perform proper inhalation (if unable to hold the nebulizer [pediatric/geriatric/special cases], replace the mouthpiece with mask
11. Continue until medication is consumed
12. Reassess patient status from breath sounds, respiratory status, pulse rate and other significant respiratory functions needed. Compare and record significant changes and improvement. Refer if necessary
13. Attend to possible side effects and inhalation reactions

Complications
Possible effects and reactions after nebulisation therapy are as follows:

• Palpitations
• Tremors
• Tachycardia
• Headache
• Nausea
• Bronchospasms (too much ventilation may result or exacerbate bronchospasms)

Teachings
As nurses, it is important that we teach the patients the proper way of doing the therapy to facilitate effective results and prevent complications (demonstration is very useful). Emphasize compliance to therapy and to report untoward symptoms immediately for apposite intervention.

SUCTIONING NASOPHARYNGEAL AND OROPHARYNGEAL AREAS

1. Determine need for suctioning. Administer pain medication before suctioning to postoperative patient.
2. Explain procedure to patient.
3. Assemble equipment.
4. Perform hand hygiene.
5. Adjust bed to comfortable working position. Lower side rail closet to you. Place patient in a semi-Fowler’s position if he or she is conscious. An unconscious patient should be placed in the lateral position facing you.
6. Place towel or waterproof pad across patient’s chest.
7. Turn suction to appropriate pressure.

1. Wall unit

·        Adult: 100 to 120 cm Hg

·        Child: 95 to 110 cm Hg

·        Infant: 50 to 95 cm Hg

2. Portable unit

·        Adult: 10 to 15 cm Hg

·        Child: 5 to 10 cm Hg

·        Infant: 2 to 5 cm Hg

8. Open sterile suction package. Set up sterile container, touching only the outside surface, and pour sterile saline into it.
9. Don sterile gloves. The dominant hand that will handle catheter must remain sterile, whereas the nondominant hand is considered clean rather than sterile.
10. With sterile gloves. The dominant hand, pick up sterile catheter and connect to suction tubing held with unsterile hand.
11. Moisten catheter by dipping it into container of sterile saline. Occlude Y-tube to check suction.
12. Estimate the distance form earlobe to nostril and place thumb and forefinger of gloved hand at that point on catheter.
13. Using nondominant hand, has the patient take several slow deep breaths. if the patient's oxygen saturation is <94%, or if he is in any distress, administer supplemental oxygen before, during, and after suctioning.
14. Gently insert catheter with suction off by leaving the vent on the Y-connector open. Slip catheter gently along the floor of an unobstructed nostril toward trachea to suction the nasopharynx. Or insert catheter along side of mouth toward trachea to suction the oropharynx. Never apply suction as catheter is introduced.
15. Apply suction by according suctioning port with your thumb. Gently rotate catheter as it is being withdraw. Do not allow suctioning to continue for more than 10 to 15 seconds at a time.
16. Flush the catheter with saline and repeat suctioning as needed and according to patient’s toleration of the procedure.
17. Allow at least a 20- to 30-second interval if additional suctioning is needed. The nares should be alternated when repeated suctioning required. Do not force the catheter through the nares. Encourage patient to cough and breathe deeply between suctioning.
18. When suctioning is completed, remove gloves inside out and dispose of gloves, catheter, and container with solution in proper receptacle. Perform hand hygiene.
19. Use auscultation to listen to chest and breath sounds to assess effectiveness of suctioning.
20. Record time of suctioning and nature and amount of secretions. Also note the character of the patient’s respirations before and after suctioning.
21. Offer oral hygiene after suctioning.

 http://nursingcrib.com/demo-checklist/suctioning-nasopharyngeal-and-oropharyngeal-areas/

Nasogastric Tube Insertion

  Nasogastric Tube Insertion

 

Indications

By inserting a nasogastric tube, you are gaining access to the stomach and its contents. This enables you to drain gastric contents, decompress the stomach, obtain a specimen of the gastric contents, or introduce a passage into the GI tract. This will allow you to treat gastric immobility, and bowel obstruction. It will also allow for drainage and/or lavage in drug overdosage or poisoning. In trauma settings, NG tubes can be used to aid in the prevention of vomiting and aspiration, as well as for assessment of GI bleeding. NG tubes can also be used for enteral feeding initially.

Contraindications

Nasogastric tubes are contraindicated in the presence of severe facial trauma
(cribriform plate disruption), due to the possibility of inserting the tube intracranially. In this instance, an orogastric tube may be inserted.

Complications

The main complications of NG tube insertion include aspiration and tissue trauma. Placement of the catheter can induce gagging or vomiting, therefore suction should always be ready to use in the case of this happening.

Universal precautions:

The potential for contact with a patient's blood/body fluids while starting an NG is present and increases with the inexperience of the operator. Gloves must be worn while starting an NG; and if the risk of vomiting is high, the operator should consider face and eye protection as well as a gown. Trauma protocol calls for all team members to wear gloves, face and eye protection and gowns.

Equipment:

All necessary equipment should be prepared, assembled and available at the bedside prior to starting the NG tube. Basic equipment includes:

Personal protective equipment
NG/OG tube
Catheter tip irrigation 60ml syringe
Water-soluble lubricant, preferably 2% Xylocaine jelly
Adhesive tape
Low powered suction device OR Drainage bag
Stethoscope
Cup of water (if necessary)/ ice chips
Emesis basin
pH indicator strips

Procedures:

1. Gather equipment
   
   
2. Don non-sterile gloves
   
   
3. Explain the procedure to the patient and show equipment
   
   
4. If possible, sit patient upright for optimal neck/stomach alignment
   
   
5. Examine nostrils for deformity/obstructions to determine best side for insertion
   
   
6. Measure tubing from bridge of nose to earlobe, then to the point halfway between the end of the sternum and the navel
   
   
7. Mark measured length with a marker or note the distance
   
   
8. Lubricate 2-4 inches of tube with lubricant (preferably 2% Xylocaine). This procedure is very uncomfortable for many patients, so a squirt of Xylocaine jelly in the nostril, and a spray of Xylocaine to the back of the throat will help alleviate the discomfort.
   
   
9. Pass tube via either nare posteriorly, past the pharynx into the esophagus and
   then the stomach.
   
   Instruct the patient to swallow (you may offer ice chips/water) and advance the tube as the patient swallows. Swallowing of small sips of water may enhance passage of tube into esophagus.
   
   If resistance is met, rotate tube slowly with downward advancement toward closes ear. Do not force.
   
   
10. Withdraw tube immediately if changes occur in patient's respiratory status, if
    tube coils in mouth, if the patient begins to cough or turns pretty colours
    
    
11. Advance tube until mark is reached
    
    
12. Check for placement by attaching syringe to free end of the tube, aspirate sample of gastric contents. Do not inject an air bolus, as the best practice is to test the pH of the aspirated contents to ensure that the contents are acidic. The pH should be below 6. Obtain an x-ray to verify placement before instilling any feedings/medications or if you have concerns about the placement of the tube.
    
    
13. Secure tube with tape or commercially prepared tube holder
    
    
14. If for suction, remove syringe from free end of tube; connect to suction; set machine on type of suction and pressure as prescribed.
    
    
15. Document the reason for the tube insertion, type & size of tube, the nature and amount of aspirate, the type of suction and pressure setting if for suction, the nature and amount of drainage, and the effectiveness of the intervention.

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