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The Impact of Nursing Informatics on Patient Outcomes and Patient Care

The health care sector has significantly embraced technology in various ways and for different purposes. Underpinning the wide use of technology in health care is the incorporation of nursing informatics into patient care practice. Often, nursing informatics refers to the application of technology in health care (Forman, Armor & Miller, 2020). It comprises subjects like human computer-interaction, decision support system, information science, electronic health records, telemedicine and mobile health applications (Forman et al., 2020).

The significance of nursing informatics has been recognized in patient outcomes and care goals. As described by Forman et al. (2020), the appropriate use of nursing informatics has resulted in better patient outcomes and care goals. Therefore, a nurse informaticist has a role to play collaboratively with other health care providers to ensure the achievement of pertinent care goals. The purpose of this paper is to write a proposal of a nursing informatics project to a healthcare organization, which improves patient outcomes. The project entails the stakeholders impacted, patient outcomes to be improved, technologies used, and the project management team involved.

Description of the Project

The fervor to create the project comes from an identified gap on management of patients with chronic comorbidities such as heart failure and chronic obstructive pulmonary disease. Multiple research studies have noted an increasing readmission rates and prolonged hospital stay of such patient despite the extensive use standard care. Therefore, an alternative nursing intervention to mitigate the readmission rates alongside other problems encountered with chronic illnesses is required. However, it is difficult to design and implement a better alternative in contemporary care practice without incorporation of nursing informatics. My health care facility has rolled out a nursing informatics contrivance to improve the outcomes of the patients outside the hospital.

The project proposed includes the use of a remote patient monitoring (RPM) tool. The RPM is used to collect medical data from patients in one location and transmit the data electronically to health care providers in another locale. The Tele-monitoring equipment is based at the patient’s home. It is proposed to have a Bluetooth device with a wireless transmission pod, and devices that measure blood pressure, heart rate, weight and serum glucose levels. Since the patients suffer chronic conditions, their management in unbaiting.

Therefore, the RPM enables care provider to continually monitor the patients outside the facility, and to provide continuous care and health education. In a previous research done by Rojahn et al. (2016), incorporation of RPM into chronic diseases management improves patients’ quality of life, independence and prevents complications. The RPM suggested takes patients’ health data such as vital signs, blood pressure, weight, heart rate, blood glucose levels and cardiac electrical activity and transmits the collected data to the health care organization electronically.

The project is part of a benevolence act from my health care organization to patients from an identified neighboring low-socioeconomic community. An eligibility criterion for the patients included an age of 50 years and above, receiving active treatment on heart failure, diabetes and COPDs, and who are to be discharged to their homes. Even though the implementation is to consume inordinate expenditure, various financiers have volunteered. Further, the duration of the project implementation is estimated to be a period of 1-year.

Stakeholders

Various individuals are impacted by the project either directly or indirectly. First, patients with chronic conditions are greatly impacted as they are the primary beneficiaries. The eligibility criteria cover patients with heart failure, diabetes and COPDs. Further, the eligibility criteria required is the selection of patients from a low-socioeconomic community. The patients benefit directly from the RPM services such as weight, blood pressure and serum glucose monitoring. The second group of stakeholders involves the health care providers.

The group includes nurses as the majority, clinicians, physicians and the health records department. During the current COVID-19 pandemic, the significance of RPM is widely evident. The RPM enhances safety by ensuring the providers and the patients keep social distance hence reducing risk of transmission of infections (Forman et al., 2020). Secondly, health care providers are able to monitor many patients at the same time hence time-saving. Further, care providers can easily access patients’ data and deliver the best quality care without experiencing burn out.

The families of the patients also benefit from the project. Due to decreased travels to hospital facilities, there is a significant reduction in the cost of care, which translates to less expenditure by the families on patient management. Finally, the government is also a stakeholder despite being impacted indirectly. Due to reduced readmission rates and reduced cost of care, annual government’s expenditure on management of chronic illnesses will reduce once the project is enrolled on a nationwide scale. The government therefore can channel the funds to other equally significant areas.

Patient Outcomes

RPM is undoubtedly essential in the improvement of patient outcomes. First, it significantly lowers the readmission rates among patients with chronic conditions. The decreased readmission rates are attributed to various factors, among them, close patient monitoring, increased adherence to treatment, etc. First, the close monitoring enables the nurse-patient relationship to thrive (Ong et al., 2016). Therefore, nurses provide the best care and education to the individuals. The education to heart failure patients, for instance, addresses areas such as blood pressure monitoring, weight monitoring, physical activity, nutrition and drug adherence.

The education enables patients to acquire self-management skills which ultimately lead to reduced readmission rates. In a research conducted by Ong et al. (2016) on the effectiveness of RPM on discharged patients with heart failure, the findings revealed a subtle difference in readmission rates among the patients who used RPM and the control group (did not use RPM). The results indicated a 49% readmission rates among participants who used RPM and 51% readmission rates among those who received usual care. Even though the difference is not significant, there is a slight reduction in readmission rates among RPM clients as compared to those who just received standard care.

RPM also has significant effects on the quality of life of the patients. The improvement will occur through intensive patient monitoring and education. The RPM improves patient self-management skills, adherence behaviors, and physical activities which are associated with improved outcomes of health. Further, the daily patient-nurse interaction will result in improved patients’ satisfaction (Ong et al., 2016), an important aspect of patient care management and recovery process.

A study by Evangelista et al. (2015) investigated the effects of RPM on older patients with chronic heart failure and showed that participants in the RPM group recorded improvements in self-care, activation and quality of life compared to those in the control group. Examples of improved quality of life that will be attributed to the effects of RPM in our set up includes reduced symptoms of heart failure, decreased exacerbations of COPD, better weight management, increased efficiency in serum glucose and weight control and improved physical activity.

Technologies

There are diverse technological components for a successful implementation of RPM. The technologies used in this case include sensors, telecommunication devices, data storage devices and diagnostic application software. For example, in patients with heart failure, vitals such as blood pressure and oxygen saturation data will be collected by a sensor connected to a peripheral device. The peripheral devices include a blood pressure cuff and pulse oximeter. The data collected is therefore stored at the patients’ site by the local data storage.

Additionally, transmission of the data to the hospital or to the health care provider occurs via a telecommunication device. The healthcare providers therefore evaluate the data for any potential problem and design an immediate intervention plan. Alternatively, the diagnostic application software analyzes the health data and alerts the care giver in case of any problem. In patients with diabetes, the sensors are connected to blood pressure cuffs, glucometer and weight scales, and the data collected is relayed via telecommunication device.

Project Management Team

Successful implementation of a RPM requires a multidisciplinary approach. The project requires an inter-professional collaboration, drawing expertise from various disciplines. The project management team includes a project manager, nurses, physicians, Information Technology (IT) experts, strategic analysts, nurse informaticists and patient relatives. Nurses, being the majority of the healthcare workers, have a major role to play. First, they virtually interact with the patients, monitoring the equipment and checking the vital signs.

The information is then sent to the physicians to review. The order is based on the present community’s perception that nurses are the greatest accomplices of physicians. The project manager oversees the implementation process and provides solutions to problems identified, delegate duties and monitor the implementation progress. Further, the project manager is tasked with the communication role, informing different departments of the progress. IT experts undoubtedly, form part of the implementation process. The IT experts ensure a smooth process by checking the function of the devices. Further, strategic analysts determine the economic, legal, technical, operational and the scheduling feasibility of the project.

A nurse informaticist supports and trains the nursing staff on using the technologies. Nurse informaticists work as educators, implementation consultants, researchers and communication and information technology developers (Kassam, Nagle & Strudwick, 2017). In this project, a nursing informaticist ensures appropriate use of nursing informatics or technology in the implementation process. Being that technology is required throughout the process, a nurse informaticist must be omnipresent. Further, in reference to Kassam et al. (2017), they must be competent in research methodologies, information and communication technologies and evidence-based practice. Due to the continual advancements in technology in the health care sector, nurse informaticists ensure the new options are beneficial to the patients and the care providers.

Conclusion

Proposed in this project proposal is the use of RPM in the monitoring and collection of data about vital body processes among patients suffering from such chronic diseases as heart failure, COPD and diabetes. The project aims at leveraging telemonitoring in delivering enhanced post-discharge patient care and education to mitigate the instances of patient readmission and to eliminate unnecessary physical nurse-patient interaction during the COVID-19 pandemic period. For this project to be successful, an interdisciplinary and multi-stakeholder approach is necessary. Upon successful implementation, the project is expected to result in improved patient homecare outcomes and reduced patient rehospitalization.

References

• Evangelista, L. S., Lee, J., Moore, A. A., Motie, M., Ghasemzadeh, H., Sarrafzadeh, M., & Mangione, C. M. (2015). Examining the Effects of Remote Monitoring Systems on Activation, Self-care, and Quality of Life in Older Patients with Chronic Heart Failure. The Journal of Cardiovascular Nursing, 30(1), 51. https://dx.doi.org/10.1097%2FJCN.0000000000000110.
• Forman, T. M., Armor, D. A., & Miller, A. S. (2020). A Review of Clinical Informatics Competencies in Nursing to Inform Best Practices in Education and Nurses Faculty Development. The Research Journal of the National League for Nursing 41 (1), E3-E7 https://journals.lww.com/neponline/fulltext/2020/01000/a_review_of_clinical_informatics_competencies_in.27.aspx.
• Kassam, I., Nagle, L., & Strudwick, G. (2017). Informatics Competencies for Nurse Leaders: Protocol for a Scoping Review. BMJ Open, 7(12), e018855. https://dx.doi.org/10.1136%2Fbmjopen-2017-018855.
• Ong, M. K., Romano, P. S., Edgington, S., Aronow, H. U., Auerbach, A. D., Black, J. T., De Marco, T., Escarce, J. J., Evangelista, L. S., Hanna, B., Ganiats, T. G., Greenberg, B. H., Greenfield, S., Kaplan, S. H., Kimchi, A., Liu, H., Lombardo, D., Mangione, C. M., Sadeghi, B., Sarrafzadeh, M., Ting, K., Fonarow, G. C. (2016). Effectiveness of Remote Patient Monitoring After Discharge of Hospitalized Patients With Heart Failure: The Better Effectiveness After Transition-Heart Failure (BEAT-HF) Randomized Clinical Trial. JAMA Internal Medicine, 176 (3), 310-318. DOI: 10.1001/jamainternmed.2015.7712
• Rojahn, K., Laplante, S., Sloand, J., Main, C., Ibrahim, A., Wild, J., Sturt, N., Areteou, T., & Johnson, K I. (2016). Remote Monitoring of Chronic Diseases: A Landscape Assessment of Policies in Four European Countries. PloS One, 11(5), e0155738. https://dx.doi.org/10.1371%2Fjournal.pone.0155738