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Introduction

If not all, most people usually carry a notebook or a notepad to take notes either at school, at work, in meetings or while undertaking personal projects. The Microsoft office OneNote unlike a notebook or notepad is a program which can allow different people to view and share notes at the same time electronically irregardless of their geographical location. The OneNote is the only method  capturing and gathering information that enables you to capture information and ideas electronically. It also allows to insert files from the web and saves data entered in a form that is easily retrievable with the right file name. 

The Microsoft office OneNote is mostly used with the Personal Digital Assistant(PDA).  The PDA is a hand held computer which can synchronize data with the larger computers. The OneNote is used with the PDA because of their portability nature. OneNote's are affordable components that if well used can have immense benefits to the nurses. Implementation of a more customized OneNote in nursing will offer solutions to most challenges that are facing the health care sector as well as the health care administrators. 

Abstract 

The following paper defines and explains the use of the Microsoft One-Note® in a Cloud Computing Environment as a Problem Solving tool in the nursing sector. It explains how the OneNote can be used to maximize production easeing operation, minimize deployment costs and to make the tasks of nursing care generally easier (Kimura et al, 2003). It also analyzes how the Microsoft  One-Note® is used in collaboration with the PDA to make the nursing career more exciting than a task. The paper also outlines the problem statement, hypothesis and the expected outcomes of the study.  In conclusion, the paper expounds the benefits and the implications of the study leaving room for further research. 

Literature review 

The functionality health care workers is one of the most threatened sector of economic development in the United States. The nursing sector is a working environment just like any other and is bound to experience organizational and working setbacks. The shortage of IT knowledge in health care in this clouded computing era is a major problem facing the nursing sector. Knowledge of IT is very essential in the collecting, analysis and presentation of data in this time we are living. Lack of this knowledge has contributed to human resource related challenges such as burnout amongst health care administrators and prolonged problem solving processes in the whole health care system. Technological challenges are a very significant issue in health care. 

Computer technology provides a solution to, if not all the most crucial challenges in the health care system. Information technology has the ability to offer relevant up to date information needed to support clinical decisions. The potential for computers to improve the work-flow in health care organizations is enormous as they provide a way for linking up to date research findings with clinical care (Kuziemsky, Laul and Leung, 2005,  pp335-342). 

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Problem statement

In establishing quality improvement, people intensive processes, time management and cost are among the difficult and thorny realities. Needs assessment will be a necessary systematic process so as to identify the learning needs of nurses in using the Microsoft One-Note® . The nursing process has a model for steps that can be followed in planning a budget, this include first, assessing the needs to be covered in the budget (Marquis and Houston, 2008).

The learning needs will be assessed here. The needs should be considered in terms of labor, operating expenses and equipment. In identifying the learning needs, the nurses performance analysis will be the method of choice. It will be based on the assumption that there is already a system which identifies problems in the organization by investigating multiple causes for poor performance. Staff competencies will be a component of the performance analysis. 

Hypothesis/ questions

The method of determining nursing learning needs will be based on McGregor’s framework of developing staff competencies which starts with developing a list of standards and skills (Russell, Swansburg and Swansburg, 1995). The learning needs will then be ascertained through interviews, verbal feedback, observations and unit quality assurance findings (Russell, Swansburg and Swansburg, 1995). Once learning needs have been identified the educational programs will be set up with skills achievement and knowledge tests being conducted to assess the achievement of the standards by the nurses. 

The learning outcomes will be measured using pre-tests and post-tests and spot checks for skills. For those nurses who may not meet the mastery level (mastery level for skills is put at 100% and for knowledge at 80%) remedial studying will be done which will be followed by retesting. 

The unit is a 28 bed step-down cardiac unit, where all aspects of preoperative and post-operative care are performed for patients.

The patients are received in the unit to recover post cardiac catheterization, post coronary artery bypass grafting and after angioplasty stent placement. The patients generally require acute care. The nurses work extensively with the patients and families while maintaining a fruitful nurse-client relationship. The nurses also have a role of working with physicians and other disciplines to ensure high quality care is provided to all the patients. The staff population is 25 RNS, 20LPNs and 25 UAPs. In every shift there are 4RNs, 2LPNs and 4UAPs. All the staff work 12 hour shifts. 

The numbers of the staff above are all considerations in making plans for their learning needs. The method of addressing their learning needs may be expensive hence certain cost containment measures will be considered. These include using readings and video taped material for the remedial topics as well as using data from quality management audits to provide insight on learning needs. The problem- centered approach has been used in identifying learning needs because it serves as a motivator to the adult learner who will want to see a real-world answer to problems they may have (Russell, Swansburg and Swansburg, 1995).

This will be valuable in motivating the nurses and will also sever the purpose of improving the quality of care. When quality of care has improved it often results in reduced costs as less is spent on managing hospital acquired infections, managing patients who may have fallen or may have developed pressure sores or other hospital associated problems that may result from poor quality care. 

Purpose of the study and expected outcomes.

The study was carried to determine the use of the Microsoft OneNote in nursing and the entire health care. After thorough analysis, the following were expected to be the best possible outcomes of the above study:

  1. The use of the  Microsoft OneNote in nursing will aid in the gathering, storing and managing of information and notes in an efficient manner. This information includes pictures , texts, both video/ audio records and digital capturing in one location. This will help in making more organized and informed decisions.
  2. It will help in providing back up information. Information stored in the computer is considered more safer than information saved as hard copy. 
  3. Enable easy retrieval of information. Using the  Microsoft OneNote makes access of information very easy as long as you have the right file name.
  4. Fosters team work. The sharing of information in groups makes people feeling appreciated hence promotes group works in organizations. It also allows groups at different geographical locations to look, share and even make changes on information at the same time. 
  5. Makes information hard to duplicate. The Office OneNote 2007 helps you to keep on track of information to avoid duplicating ideas in meetings and briefings. 
  6. Helps in organizing information just the way you want it be. Helps in choosing your own way. It also provides room to add hyper links. 
  7. Also helps in choosing the priorities from the less priorities. You can customize the note tags as per your needs to enable easy access of information and data.
  8. Will help in increasing productivity in meetings. It offers the nurses with the advantage of accessing all the information released in the meetings making them to become more productive. It ensures that all members have the same understanding of information in meetings since all members are on the same page. 
  9. Will help increase speed of performance and prevent time wastage. 
  10. Will help in the improvement of the production level in and away from the office. Synchronizing the windows in your computer with your mobile phone will guarantee access of information in the PC anytime anywhere.

Significance of Microsoft office OneNote's in nursing

If well implemented in the nursing care, the Microsoft office OneNote will help reduce the time nurses spend on paperwork significantly. This leaves the nurses with more time to give nursing care to a patient which translates to better patient outcomes. The OneNote is aimed at giving the nurse access to schedules, medical references, patients’ charts and to fill and submit nursing forms any time any place. 

The OneNote also has the benefit of being a ready reference for any doubts that may arise while delivering patient care as well as the capability to decrease prescription errors (Pochciol and Warren, 2009). The nurses are also more likely to practice evidence based care due to access to a computer (Pochciol and Warren, 2009). This is because the information needed for practice is easily accessible on the OneNote. 

The OneNote if used with a PDA synchronizes data with larger computers for import and export of data. It has the option of accessibility in terms of storage of information in password protected databases which is important to ensure the security of patient information. The ability to recognize one’s handwriting is a unique safety precaution as it means that it is not possible for someone to steal the nurse’s identity and gain access to confidential information in the system. The password allows one to store information in an encrypted style making it even more secure. Through integration with other systems such as drug management, ordering, blood transfusion management it is possible to confirm that the drug and patient match thus preventing administration of the wrong drug. This contributes to patient safety in a significant way. 

With respect to safety, research has also shown that OneNote technology is effective in the enhancement of critical thinking and it also reinforces the necessary core knowledge for practice (Kupier, 2008). Kupier (2008) also points out that dependence on memory is unreliable and unsafe; hence by providing the nurse with a store of information, the nurse’s practice will be safer due to the ability to counter check when in doubt. 

Use of the OneNote has the potential to increase patient outcome as it means nurses have a greater access to information. With a OneNote the nurse is able to find information more quickly and thus clear any doubts that may arise during patient care. This means that the potential for errors in giving treatment is reduced. This also adds to the nurse’s confidence in giving nursing care. The overall effect will be better patient outcomes in the unit. 

In addition to reducing errors, the OneNote also gives the nurse more time to interact directly with the patient especially by reducing the time spent on documentation and searching for copies of documents. The OneNote is also able to offer a comprehensive report on crucial information about patient contraindications, interactions, compatibility with other drugs and prescribing indications. The nurse is thus able to provide more holistic care to the patient which again improves patient outcomes. The portability of the OneNote makes it appropriate for use at the patient’s bedside and can even provide a means for which health education to the patient can be done. 

The role of the OneNote in nursing education is valuable especially with the potential it has for continuing nurse education. The OneNote has been used in undergraduate nursing courses both in the classroom and for practical experience. Students have reported major improvements in their understanding of core material as well as a feeling of being better prepared in the practical area as it is easier to interact with their clinical instructors via the OneNotes. The OneNote can be used in the same way for the already qualified nurse for continued medical education through its ability to access the Internet and also its capacity to store information from various journal articles.

OneNote incorporation into the nursing unit: questions for consideration

Before making the decision to incorporate OneNotes in the nursing unit some of the things to be considered include the desirable capabilities of the OneNote. Several characteristics are key in this consideration; these include the type of operating system (Pocket PC versus Palm OS), cost, memory, size, and battery life. The Palm OS is less expensive, lighter and smaller. 

Both devises have software programs available for them but the Palm OS has a wider range of software (George and Davidson, 2005). The Palm OS has also released a OneNote that has the capability to save programs even when the battery drains completely. The Pocket PCs have more memory (RAM of about 64-128 MB) than the Palm OS. They however require more RAM to operate similar programs. Their screens are larger and they generally have more peripheral features (video players, voice recording, MP3 players). 

The cost of the program ranges from $20 to $200 depending on the features present on the OneNote. The OneNotes will mainly be used to access information about patients and as a reference tool for nurses, thus features such as a telephone, MP3 player will not be necessary. However a long battery life, wireless capability may be desirable to assist in meeting the needs of the nurses. Size is another important consideration for ease of use. The nurses will be using the OneNotes at the patient’s bedside thus an easily portable device will be more appropriate for the nursing unit as opposed to a larger device. 

The size will be moderate however to ensure that the screen is clear enough for use by the nurses. Most OneNotes now come with a memory card that can be used as extra memory. This may be the more cost-effective option, in place of buying Pocket PC which is more expensive yet requires more memory to run the same programs as the Palm OS (George and Davidson, 2005). Battery life is very important to the nurses because if the battery runs short, the usefulness of the OneNote is reduced. Palm OS devices generally have a longer battery life than Pocket PC devises. 

With all the considerations mentioned, the Palm OS device seems the better choice for the nursing unit as it more cost-effective and is more likely to meet the needs of the nurses in the unit. Software programs for the OneNote that will support evidence-based nursing care will be the programs of choice. These include clinical reference software, calculation programs, patient tracking and management and nursing procedure programs among others. This will however be the main ones in the OneNote's. 

To integrate the OneNote technology into the nursing unit, the team leaders of the nurses will have some experience with the OneNote's prior to introduction to the rest of the nurses. They will then teach the other nurses how to use them. Support for nursing staff will include training and frequent brown bag sessions. For newly employed nursing staff intense training will also be necessary. 

Managing the limitations of the OneNote

One of the major barriers to integration of OneNote;s into nursing practice is the short technological life and cost of these programs. Consideration of the benefits of the OneNote however makes these barriers manageable. In addition technology is constantly progressing such that the OneNote's currently being manufactured have longer life cycles and are generally reducing in cost.

The fact that information may be lost if the OneNote is not upgraded frequently is a limitation to use of the OneNote but this is hardly sufficient to completely reject the OneNote for use in improving patient care. The OneNote is generally easy to use and has a user friendly interface thus most of the nurses are likely to adapt well to its use in the unit. It is however expected that there may be some trepidation especially due to a lack of technology preparedness. 

Conclusion

To facilitate the adoption of OneNote's in the unit, financial support will be necessary as well as changes in the organizational set up and social acceptance of the OneNote. Cost effectiveness will be achieved by settling on a products with the features that meet the units objectives. To reduce on cost, high end specifications will not be necessary. Since the use of the OneNote is not entirely new to health care, these changes are not very radical and it should be easy for the nurses and other health care professionals to adapt to. In areas where the use of OneNote's has been implemented nurses have been noted to have a good understanding of the OneNote technology thus social acceptance should be an issue easy to manage. 

The rationale for use of OneNote's in the nursing unit is based on the very real possibility that the OneNote will add value to the nursing care given to the patient. The use of OneNote's will have substantial effect on efficiency, data accessibility and clinical education in the unit and is also likely to manage some of the challenges that come with shortage of nursing staff.  The main goal of health care is to have a positive patient outcome as far as is possible; the use of the OneNote in the nursing unit will go a long way in achieving this.

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