This course provides the foundational basis for the Leadership and Management specialized track. Students focus on theoretical and practical aspects of leadership and managerial functions in healthcare administration, and they explore standards of practice for nurse administration. They address a number of issues, including roles and duties, quality improvements, strategic planning and management, regulations, accreditation, and information systems. Through this course, students study the goals of the nurse leader, including techniques to enable efficient, quality healthcare delivery to achieve excellence in patient care and services. NURS 6201 - Leadership in Nursing and Healthcare Essay Assignments and Exams .

Sample Week 1  NURS 6051 Discussion 

Discussion: Standardized Coding Systems

As a result of the fragmented nature of the health care system, experts in various specialist areas of medicine have evolved their own distinct sets of vocabulary to communicate within that speciality. In the past, less emphasis has been made to codifying techniques in order for them to be understood and exploited across disciplines or across multiple information technology platforms. The introduction of a federally mandated electronic medical records system, therefore, provides a challenge to nursing professionals and others who must be prepared to utilize standardized codes for the new system. Why are coding standards crucial for delivering consistent, high-quality care?

According to Rutherford (2008, para. 15), “Improved communication with other nurses, health care providers, and administrators of the institution in which nurses work is a fundamental benefit of utilizing a standardized nursing language.” In this Discussion you analyze the logic behind and the value of standardized codification.

To prepare

Review the content in Nursing Informatics: Scope and Standards of Practice. Determine which set of terminologies are acceptable for your speciality or area of expertise.

Reflect on the necessity of continuity in terminology and coding systems.

In the essay, “Standardized Nursing Language: What Does It Mean for Nursing Practice?” the author recalls a visit to a local hospital to see the application of a new coding system. One of the nurses observed to her, “We document our treatment using standardized nursing terminology but we don’t completely understand why we do” (Rutherford, 2008, para. 1). (Rutherford, 2008, para. 1). Consider how you would inform this nurse (and others like her) of the necessity of standardized nursing terms.

Reflect on the significance of using a standard language in nursing practice. Consider if standardization may be limited to a particular area or if one standard language is needed across all nursing practice. Then, discover examples of standardization in your own specialization or area of knowledge. Conduct additional research using the Walden Library that supports your opinions on standardization of nursing terminology.

By Day 3

Post an explanation of why nurses need to document care using standardized nursing languages and whether this standardization can be limited to speciality areas or if it should be across all nursing practice. Support your response using specific examples from your own speciality or area of expertise and using at least one more resource from the Walden Library.

American Nurses Association. (2015). (2015). Nursing informatics: Scope & standards of practice (2nd ed.). Silver Springs, MD: Author.

“Metastructures, Concepts, and Tools of Nursing Informatics”

This chapter addresses the links between data, information, knowledge, and wisdom and how they operate together in nursing informatics. It also includes the influence that thoughts and tools have on the discipline of nursing.

McGonigle, D., & Mastrian, K. G. (2015). (2015). Nursing informatics and the foundation of knowledge (3rd ed). (3rd ed.). Burlington, MA: Jones and Bartlett Learning.

Chapter 6, “Overview of Nursing Informatics”

 This chapter defines the fundamentals of nursing informatics (NI) (NI). The authors specify the disciplines that are merged to generate nursing informatics, along with major NI principles.

Brokel, J. (2010). (2010). Moving forward with NANDA-I nursing diagnoses with Health Information Technology for Economic and Clinical Health (HITECH) Act Legislation: News updates. International Journal of Nursing Terminologies & Classifications, 21(4), 182–185.

Retrieved from the Walden Library databases.

 In this news brief, the author explains the steps that NANDA-I will implement to remain abreast of the HITECH legislation of 2009. The author explains two ideas for the federal government’s role in regulating vocabularies, value sets, and code sets throughout the health care system.

Matney, S., Brewster, P. J., Sward, K. A., Cloyes, K. G., & Staggers, N. (2011). (2011). Philosophical approaches to the nursing informatics data-information-knowledge-wisdom paradigm. Advances in Nursing Science, 34(1), 6–18.

This article presents a philosophical framework for nursing informatics in which data, information, and knowledge can be synthesized by computer systems to enhance wisdom development. The authors describe how wisdom can contribute value to nursing informatics and to the nursing profession as a whole.

Rutherford, M. A. (2008). (2008). Standardized nursing language: What does it signify for nursing practice? OJIN: The Online Journal of Issues in Nursing, 13(1). (1). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/vol132008/No1Jan08/ArticlePreviousTopic/StandardizedNursingLanguage.html

The author of this essay presents rationale for the usage of a standardized nursing language, which will be important for introducing electronic documentation into the health care industry. The author defines standardized language in nursing, shows how such a language might be implemented in a practice setting, and highlights the benefits of employing a standardized language.

Westra, B. L., Subramanian, A., Hart, C. M., Matney, S. A., Wilson, P. S., Huff, S. M., … Delaney, C. W. (2010). (2010). Achieving “meaningful use” of electronic health records through the integration of the Nursing Management Minimum Data Set. The Journal of Nursing Administration, 40(7–8), 336–343.

This article covers the nursing management minimum data set (NMMDS), which is a research-based minimal collection of standard data for nursing management and administration. The article shows how the NMMDS can be utilized to minimize the load on health care administrators and maximize the value of electronic health records within the health care system.

Required Media

Laureate Education (Producer). (2012a) (2012a). Data, information, knowledge, and wisdom continuum. Baltimore, MD: Author.

McGonigle, D., & Mastrian, K. G. (2012). (2012). Nursing informatics and the foundation of knowledge (2nd ed). (2nd ed.). Burlington, MA: Jones & Bartlett Learning. (p. 98, Chapter 6, Figure 6) (p. 98, Chapter 6, Figure 6)

 The continuum of data, information, knowledge, and wisdom is used in the health care profession to define various levels of understanding connected to patient care and decision making. This movie provides an overview of the continuum from data to wisdom.

 Structure: Truran, D., Saad, P., Zhang, M., & Innes, K. (2010). (2010). SNOMED CT and its significance in health information management practice. Health Information Management Journal, 39(2), 37–39.

Brown, B. (2011). (2011). ICD-10-CM: What is it, and why are we switching? Journal of Health Care Compliance, 13(3), 51–79.

Retrieved from the Walden Library databases.

 Importent Note: What words do you use to describe pain? What words do your colleagues use to describe pain? Does every patient use the same adjectives when characterizing his or her level of pain? Consider the challenges these discrepancies can generate when attempting to assess a patient’s health concerns.

Health information technology has greatly increased the opportunity for the exchange of meaningful data and information across health care systems; however, in order for that to successfully occur, care must be taken to ensure that patient data is entered in a manner that allows for that information to retain its meaning across different systems. To be able to use health information technology to its maximum advantage, nurses need to develop an awareness of how data and information may be standardized and organized.

This week, you analyze the purpose of standardized terminology in informatics. In addition, you are introduced to the continuum of data, information, knowledge, and wisdom, and you consider the key features of each level.

Learning Objectives

Students will:

• Assess the importance of standardized terminologies used to document patient care
• Apply the data, information, knowledge, and wisdom continuum

Required sources:

• American Nurses Association. (2015). Nursing informatics: Scope & standards of practice (2nd ed.). Silver Springs, MD: Author.“Metastructures, Concepts, and Tools of Nursing Informatics”  This chapter explores the connections between data, information, knowledge, and wisdom and how they work together in nursing informatics. It also covers the influence that concepts and tools have on the field of nursing.
• McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
• Chapter 6, “Overview of Nursing Informatics” This chapter defines the foundations of nursing informatics (NI). The authors specify the disciplines that are integrated to form nursing informatics, along with major NI concepts.
• Brokel, J. (2010). Moving forward with NANDA-I nursing diagnoses with Health Information Technology for Economic and Clinical Health (HITECH) Act Legislation: News updates. International Journal of Nursing Terminologies & Classifications, 21(4), 182–185. In this news brief, the author describes the initiatives that NANDA-I will implement to remain abreast of the HITECH legislation of 2009. The author explains two recommendations for the federal government’s role in managing vocabularies, value sets, and code sets throughout the health care system.
• Matney, S., Brewster, P. J., Sward, K. A., Cloyes, K. G., & Staggers, N. (2011). Philosophical approaches to the nursing informatics data-information-knowledge-wisdom framework. Advances in Nursing Science, 34(1), 6–18. Retrieved from the Walden Library databases.
•  This article proposes a philosophical foundation for nursing informatics in which data, information, and knowledge can be synthesized by computer systems to support wisdom development. The authors describe how wisdom can add value to nursing informatics and to the nursing profession as a whole.
• Rutherford, M. A. (2008). Standardized nursing language: What does it mean for nursing practice? OJIN: The Online Journal of Issues in Nursing, 13(1). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/vol132008/No1Jan08/ArticlePreviousTopic/StandardizedNursingLanguage.html. The author of this article provides justification for the use of a standardized nursing language, which will be necessary for incorporating electronic documentation into the health care field. The author defines standardized language in nursing, describes how such a language can be applied in a practice setting, and discusses the benefits of using a standardized language.
• Westra, B. L., Subramanian, A., Hart, C. M., Matney, S. A., Wilson, P. S., Huff, S. M., … Delaney, C. W. (2010). Achieving “meaningful use” of electronic health records through the integration of the Nursing Management Minimum Data Set. The Journal of Nursing Administration, 40(7–8), 336–343.
• Retrieved from the Walden Library databases. This article explains the nursing management minimum data set (NMMDS), which is a research-based minimum set of standard data for nursing management and administration. The article describes how the NMMDS can be used to minimize the burden on health care administrators and increase the value of electronic health records within the health care system.
• Laureate Education (Producer). (2012a). Data, information, knowledge, and wisdom continuum. Baltimore, MD: Author.
• McGonigle, D., & Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge (2nd ed.). Burlington, MA: Jones & Bartlett Learning. (p. 98, Chapter 6, Figure 6)

Read Sample  NURS  6051 Here

Project Proposal: The implementation of the EHR System to Improve Patient Safety (Both Diagnostic and Medication safety) and to Better the Efficacy of Patient Care

Describe the Project You Propose

HIT (healthcare information technology) is currently changing how the healthcare sector functions. A primary HIT component is the EHR (Electronic Health Record) system. EHR, according to Aguirre, Suarez, Fuentes, and Sanchez (2019), refers to the digital forms/configurations of patient records that include patient data, e.g., Patients’ treatment plans, test results, allergies, medical history, and contact information. The EHR, like any other medical technology, is designed to improve/optimize the quality and efficiency of healthcare delivery, and ultimately improve patient outcomes. The EHR system will be integrated with various healthcare-related applications to enhance efficacy and improve patient safety. Some of the benefits of EHR systems, according to Aguirre et al. (2019), are increasing positive patient outcomes, improving efficiency, and bettering population health. 

Jette and Kwon (2019) also underscore the importance of EHR systems in improving the surveillance of infectious disorders, identifying populaces with significantly high-risk factors for chronic diseases, and in bettering the management of patients diagnosed with chronic illnesses. The implementation of the EHR system has also been associated with the improved provision of patient-centred and more coordinated care. Wolfe, Chisolm, and Bohsali (2018) further highlight the importance of implementing EHR systems in intensive care units, arguing that the aforementioned technology plays a crucial role in reducing the central line-associated bloodstream infections and surgical ICU mortality rates. EHRs offer secure access to patient data resulting in positive outcomes with regards to care quality and productivity. Furthermore, these systems have been utilized in the management of chronic disorders, e.g., diabetes and according to Wolfe, Chsolm, and Bohsali (2018), the regular utilization of EHR can minimize fragmentation of data and increase care continuity between providers in instances were providers take part in health data exchanges. When implemented in the ED (emergency department), EHRs can aid in improving medical decision making using a decision tree; it increases patients’ life quality and is cost-effective.

Stakeholders Impacted by this Project

The stakeholders impacted by this project include

Clinicians, e.g., allied health staff, nurses, and physicians: It is crucial to obtain clinicians’ input during the selection and planning procedure; this is mainly due to their frontline position during the provision of clinical services. They typically provide input into the design, live support, and workflow sign-off procedure (Aguirre et al., 2019).

Office staff/manager: Office staff are essential stakeholders because they are usually responsible for the input of demographic, contact, and billing data of all patients within the healthcare setting. It is crucial for these professionals to have a system that enhances the easy and complete input of the aforementioned data; this stakeholder grouping can also offer vital input about the opportunities and challenges (Aguirre et al., 2019).

Head of billing/Billing manager: The billing department will require a system that integrates well with the already existing billing system or offer a new billing system in which claims can be processed correctly and efficiently.

Administration/Board members: These stakeholders will assume a crucial role either acting as a barrier to its success/implementation or by furthering the EHR project.

Marketing team: These stakeholders add value to the selection of EHR because the medical practice comprises more than just patient care. The marketing team will aid in creating an in-depth analysis of the needs of the healthcare setting (Schopf, Nedrebo, Daphu, & Laerum (2019).

Patients: The EHR project will bring about changes that can impact patients directly or alter the relationship between patients and clinicians, and therefore, it is crucial to consider patients’ perspectives as stakeholders.

Explain the Patient Outcomes or Patient-Care Efficiencies this Project is aimed at Improving

The proposed project is aimed to improve the following processes:

· Patient documentation: The EHR will facilitate the swift and easy documentation of the complete face-to-face encounter between the physician/nurse practitioner and patient.

· Quality assurance: The EHR system will enable care providers and hospitals to track the data they require to be in compliance with federal regulations and insurance companies. The EHR will act as a central database where physician orders for the various tests are stored; this data may be tracked to determine if the nurse practitioner/physician is ordering appropriate tests for the patient’s conditions. The system will also allow care providers to report quality information to the federal government.

· Tracking of patient utilization and healthcare costs: The EHR system can play a crucial role in streamlining the process of monitoring patient utilization and healthcare costs and provide real-time and accurate data (Schopf et al., 2019). These utilization statistics/data, when coupled with financial data, can be utilized to track healthcare costs and better efficiencies.

· Health record portability: The EHR system will facilitate the secure sharing of data between care providers during the provision of care to patients.

· Billing and Coding: Accurate coding and billing are very crucial in healthcare today. The EHR system will help with proper documentation, and with the help of the “built-in” diagnosis databases, the billers and coders will be able to produce/generate accurate healthcare claims.

· Patient confidentiality: The HIPAA is a stringent regulation that requires healthcare professionals to protect the security and privacy of their patients’ medical records or risk facing stiff penalties. EHRs should have in-depth security systems to prevent unauthorized access to patients’ medical records (Schopf et al., 2019). The system uses passwords, network firewall security, and biometrics; this will aid in preventing unauthorized access to patients’ health data.

Explain How this Improvement will Take Place

The implementation of the improvement project will be in line with the following steps:

· Creating an implementation team: the team will consist of nurses, physicians, administrative staff, compliance office staff, medical assistants, receptionists. The three essential roles to consider when building a team are that of the lead physician, lead super user, and project manager.

· Configuring the software: This step will involve working with the health IT vendor to configure the EHR to meet the required security measures (it may also involve performing a HIPAA risk assessment), developing a listing of build elements external to the electronic health records, and the modification of the EHR software to create speciality or provider-specific templates used to support documentation.

· Identifying hardware needs: This will involve hiring an IT service company to assist them with their system hardware.

· Transferring data: This phase will incorporate activities such as determining the method for migrating information from the previous recordkeeping system to the new EHR, preparing a checklist of items to be fed into the EHR, and establishing the amount of time required to transfer data for the average patient.

· Considering room layout, e.g., the “triangle of trust.”

· Creating workflows.

· Developing procedures for when the EHR system is down.

· Initiating training: Creating a training plan will ensure that every individual has the essential skills and knowledge required to utilize the EHR during the period of launch.

· Deciding on the launch approach (big bang or incremental approach): this will be decided by the staff and care providers, e.g., physicians and nurses.

Identify the Technologies Required to Implement this Project. Explain why.

The technologies required to implement the project include

· Computerized Physician Order Entry: This is an application utilized by care providers, e.g., nurse practitioners and physicians to order radiology, pharmacy and laboratory services, as well as other physician orders. CPOE allows providers t order tests electronically; this, in turn, ensures the accuracy of orders and notifies the appropriate unit the patient will be reporting (Aguirre et al., 2018). CPOE functions are also listed among the federal provisions of meaningful use requirements.

· Laboratory information systems: Laboratory information systems need to be interfaced into the EHR system to enhance the exchange of testing results and patient data.

· Radiology information systems: These systems should also be interfaced with the HER to allow the viewing and sharing of digital radiology images within the EHR system. RIS typically contains patient data, radiology orders, test results, image tracking, and schedules (Aguirre et al., 2019).

· Pharmacy systems: Pharmacy systems should also be interfaced into the EHR because this is where drug allergies and drug interactions are tracked within the EHR system (Jette & Kwon, 2019). The organization's EHR pharmacy application will also facilitate e-prescribing.

· Clinical decision support system: This system plays a vital role in helping nurses and physicians to choose/select the accurate course of action on a specific patient, as per the patient's condition.

· Quality management systems: This system facilitates the tracking of patient outcomes, and provides healthcare providers with the tools required to report the information to government entities (Jette & Kwon, 2019).

Identify the project team by roles and explain how you would incorporate the nurse informaticist

· EHR team lead

· Project manager/EHR implementation manager: Who oversees the design and implementation phase of the EHR system. The project manager will work closely with all the staff in practice and vendors to keep stakeholders focused on their timelines, track the projects' progress, and manage day-to-day issues (HealthIT.gov, 2019).

· Application analyst: Responsible for data cleansing migration.

· Application developer: Responsible for system customization.

· QA test engineer: Responsible for system performance and testing (HealthIT.gov, 2019).

· Physician advocate/Lead physician: Tasked with the duty of representing physicians and providing advice on training, testing, and data. The lead physician will guide the organization all through the process of implementation, serving as the link between the administrative and technical staff and front-line users.

· Nurse advocate/staff lead: Tasked with the duty of representing nurses and providing advice on system testing, data, and training.

· Billing advocate/staff lead: Tasked with the role of representing the billing department and offering advice on testing, data, and training (HealthIT.gov, 2019).

· Medical assistant lead, scheduler Lead, registration staff lead, laboratory staff lead, and an information staff lead (HealthIT.gov, 2019).

· EHR builder and workflow redesign lead (HealthIT.gov, 2019)

· Meaningful Use manager: He/she would be needed if MU attestation is required.

· Lead super user: He/she will act as the in-house expert in the new project. The lead super user will configure the EHR software, create templates and order sets, and develop standard operating processes or revised workflows to address issues raised by front-line users.

The nurse informaticist will be involved in the selection, design, implementation, development, evaluation, improvement, and the ongoing maintenance and optimization of the EHRs in patient-care settings.

 

References

1. Aguirre R. R., Suarez O., Fuentes M., Sanchez-Gonzalez A. M., (2019). Electronic Health Record Implementation: A Review of Resources and Tools. Cureus,11(9), e5649. Doi:10.7759/cureus.5649.
2. HealthIT.gov (2019, May 19; 1a). Who are the key stakeholders during electronic health record (EHR) implementation? Retrieved from https://www.healthit.gov/faq/who-are-key-stakeholders-during-electronic-health-record-ehr-implementation.
3. Jetté N., and Kwon C., (2019). Electronic Health Records—A System Only as Beneficial as Its Data. JAMA Network Open, 2(9), e1911679. Doi:10.1001/jamanetworkopen.2019.11679
4. Schopf, R. T., Nedrebø, B., Hufthammer, O. K., Daphu, K. I., and Lærum, H., (2019). How well is the electronic health record supporting the clinical tasks of hospital physicians? A survey of physicians at three Norwegian hospitals. BMC Health Services Research, 19, 934. https://doi.org/10.1186/s12913-019-4763-0.
5. Wolfe L., Chisolm M. S., and Bohsali F., (2018). Clinically Excellent Use of the Electronic Health Record: Review. JMIR Human Factors, 5(4), e10426. Doi: 10.2196/10426.