Use Of Pda In Nurses Nursing Essay

2.2 Nursing problems and their solutions

2.2.1 Nurse shortage

According to research study conducted by Aiken (2001). The current nursing shortage, high hospital nurse job dissatisfaction, and reports of uneven quality of hospital care are not uniquely American Phenomena. A paper presents reports from 43,000 nurses from more than 700 hospitals in the US, Canada, England, Scotland, and Germany in 1998-1999. Nurses in countries with distinctly different health care systems report similar shortcomings in their work environments and the quality of hospital care. While the competence of and relation between nurses and physicians appear satisfactory, core problems in work design and workforce management threaten the provision of care. Resolving these issues, which are amenable to managerial intervention, is essential to preserving patient safety and care of consistently high quality.

This research also found that errors on the part of the nursing staff increased dramatically when they worked shifts greater than 12 hours, worked significant overtime and when they consistently worked more than 40 hours per week on a regular basis. This finding is particularly disturbing for such important care units as ICU (critical care nurse), critical care and acute care where nurses are frequently fatigued as a result of working too many hours and thus this can have dire patient consequences. While it is understood that the shortage in nurses has resulted in the use of bank and temporary staffing to fill in the shortages, it would seem that administrative policy would concentrate on providing for more permanent staffing to units such as ICU, critical care and acute care as a result of the more important and potential dangerous onset of complications, thereby directing shortage fill in measures for other areas. (1)

In addition to that According to RCN 2005 Staffing Snapshot Survey the majority of nurses believed there were still not enough registered nurses on the wards to provide good standard of care. Nurses still report they work beyond their contracted hours, and it has remained relatively stable over the last 10 years with around 60% of nurses who work full time reporting they work additional 6 hours unpaid overtime per week. The RCN considers this to be the evidence of remaining underlying shortage of nursing staff. As you can see overloading existing personal in order to cover existing nurse shortage can bring to fatal consequences. However there is a possible solution, which is to increase work efficiency of nursing staff by eliminating or optimizing redundant and time consuming procedures like filling and updating paper documents that is an integral part of nurses’ daily work. (3)

2.2.1 Medical errors

Another major problem is the number of medical errors that occur when patients are handled by nursing staff. If we carefully analyze nurses’ work you will be surprised how they manage to memorize incredibly huge amount of information that is required to correctly perform their daily duties. For instance, some nurses need to have deep knowledge in medication, drug therapy, various treatment procedures etc. Of course all we are human and human factor takes place in nurses work as well. The Institute of Medicine report estimates that 44,000 to 94,000 deaths are caused annually from medical errors [2]. Studies estimate that 3–17% of inpatients experience adverse events significant enough to prolong hospitalization, cause significant morbidity, or lead to death [2-10]. Errors can be caused by a number of factors including lack of information about the patient or lack of knowledge about a therapy. In a study of errors in medication prescribing, 30% were related to knowledge in drug therapy and 29% were due to a lack of patient information[11]. Mostly it happens just because nurses and doctors can forget something, this is permissible for ordinary people but not for nurses and doctors. The cost of such mistake can be a human life. However nowadays modern information technologies can help us to improve this situation. Nursing staff needs to be supplied with mobile nurse assistant which supposed to provide to provide nurses with the most essential medical data.

2.2.3 Possible solutions

The authorities of health care systems around the world are actively searching for universal solution for the problems discussed above and we can say that they achieved some sort of success in this area. While searching the internet I found lots of software solutions created to help nurses and other medical staff on their duty. Some of them are broadly used, some of them not and limited to certain private hospitals. However we need to note that since nineties medical information systems grow in number, evolve in quality and spread geographically.

In general, it has been seen in several studies that the use of electronic recording systems of patient data was contributively lead to accurate and complete documentation that improve the quality of patient records , and eradicate the redundant paperwork that influence nurse’s time and contentment (Stengel et al., 2004). The majority (75%) of nurses in one study believed that computerizing patient record could improve the quality of documentation, safety and patient care (Moody et al., 2004).

2.2.4 Electronic health records

(5)The electronic health record (EHR) is a widely used medical data handling concept that helps medical officers to fight the problems outlined above. According to scientific research the concept of EHR comprised a wide range of information systems, from files compiled in single departments to longitudinal collections of patient data. Only very few papers offered descriptions of the structure of EHRs or the terminologies used. EHRs were used in primary, secondary and tertiary care. Data were recorded in EHRs by different groups of health care professionals. Secretarial staff also recorded data from dictation or nurses' or physicians' manual notes. Some information was also recorded by patients themselves; this information is validated by physicians. It is important that the needs and requirements of different users are taken into account in the future development of information systems. Several data components were documented in EHRs: daily charting, medication administration, physical assessment, admission nursing note, nursing care plan, referral, present complaint (e.g. symptoms), past medical history, life style, physical examination, diagnoses, tests, procedures, treatment, medication, discharge, history, diaries, problems, findings and immunization. In the future it will be necessary to incorporate different kinds of standardized instruments, electronic interviews and nursing documentation systems in EHR systems. In general it makes the clinical data available all the time, which facilitate timely decision making process (Wang et al., 2003). It can reduce the redundant unessential testing, improving the utilization of radiology examinations, accurate capturing of patients payments and reducing the errors in bills, which reduce the costs and improve incomes (Wang et al., 2003).

Handheld computers may improve quality of care by saving clinicians time in the accessing, retrieving and recording of data, allowing clinicians to focus more on patient care [13-15]. They can also provide clinical decision support at the point-of-care such as during electronic prescribing[16]. Improving access to knowledge databases at the point-of-care may also improve translation of knowledge into practice[17]. As well, many groups feel that mobile access to electronic medical records is the only way forward for certain complex care areas such as the emergency department[18,19]. (2)

2.2.4 Use of PDA in nurses’ daily work

A personal digital assistant (PDA) is a handheld device designed to help people organize their lives while on the move. While the original PDAs were somewhat limited to storing addresses, phone numbers, calendar appointments, and task lists, modern PDAs often work as a cell phone and fax, provide Internet connectivity, and much more. There are many different types, but almost all models can connect to a computer to sync information and access other optional features. (6)

The results from the Canadian Medical Association Physician Resource Questionnaire (Martin, 2003) indicated that a third of Canadian physicians were using some type of hand held device in their practice. A 2004 Forrester’s Technology Survey (as cited in Stolworthy, 2004) indicated that 47% of U. S. physicians used PDAs in their practice. Physicians who use handheld devices indicate that the devices boost efficiency by helping to track patient data and capture reimbursement information (Miller, 2003). They also report using them for prescribing medications and reviewing dosaging. (Rothschild, J.M., Lee, T.H., Bae, T., & Bates, D.W., 2002). The variety of point-of-care uses is vast and growing daily. They included the patient tracking information mentioned above as well as applications for data collection and measurement (Ault, 1998). The applications are also not confined to any particular clinical specialty with examples of utilization from the Geriatrics to Pediatrics.

The Forrester’s Technology Survey (as cited in Stolworthy, 2004) also indicated that 18% of nurses use PDAs. Nursing use, though lagging behind physician use, is increasing. As PDAs have been reported to improve physician practice, nursing practice is equally enhanced by PDA use. Nurses report time savings in the reduction of paperwork, increased point of care use of references from PDAs and patient tracking utilization (Hunt, 2002) to name a few. With an estimate that every half hour of patient care is accompanied by an hour of documentation, (Womack, Newbold, Staugaitis, & Cunningham, 2004) significant cost savings and manpower hours could result from technologies that expedite the documentation process.

In conclusion here are the Nursing Information System Benefits

1. More time spent with patient and less time at nurse station

2. Reduce paperwork/paper loss

3. Automated tools of nursing documentation

4. Uniform standards of nursing care are programmed (nursing process)

5. Cost reduction (Fewer loss of charges)

6. Quality can be measured