EHRs: Losing the Nuances of Nursing Care, and the Value

Image by mcmurryjulie from Pixabay

Our December issue is out, but before we move on from the November issue I want to highlight the Viewpoint, “Advocating for HIT That Captures Nursing Process.” It’s about something that greatly affects nurses’ work, seems to be the bane of all clinicians, and, I think, often prevents individualized patient-centered care.

I’m referring to the electronic health record (EHR), a system built to capture data important for billing and tracking aggregate patient outcomes—but arguably not designed for what clinicians deem as most important for understanding and documenting patient care.

Dylan Stein and colleagues Jasmine Travers and Jacqueline Merrill write what most nurses know about EHRs:

“The nuances of our care get lost in task-oriented, quantitative drop-down menus and checkboxes, while the qualitative value of our interventions and impressions are not encoded in a useful way.”

Nursing notes devalued.

In the old days BC (before computers), clinicians used some checklists for charting but also relied heavily on narrative notes to describe the patient’s individual story. While there are areas one can add notes in an EHR, nurses tell me that it’s not very easy to do so and that no one really reads them because […]

2019-12-05T12:03:16-05:00December 5th, 2019|digital health, Technology|2 Comments
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The ECRI Top 10 Patient Safety Concerns of 2019

A list grounded in data and expert opinion.

Atlantic Training/Wikimedia Commons

Each year, ECRI Institute creates a list of top 10 patient safety concerns in order “to support organizations in their efforts to proactively identify and respond to threats to patient safety.”

The list isn’t generated out of thin air. The ECRI Institute relies both on data regarding events and concerns and on expert judgment. Since 2009, ECRI and partner patient safety organizations “have received more than 2.8 million event reports.”

2019 Top 10 Patient Safety Concerns

  1. Diagnostic Stewardship and Test Result Management Using EHRs
  2. Antimicrobial Stewardship in Physician Practices and Aging Services
  3. Burnout and Its Impact on Patient Safety
  4. Patient Safety Concerns Involving Mobile Health
  5. Reducing Discomfort with Behavioral Health
  6. Detecting Changes in a Patient’s Condition
  7. Developing and Maintaining Skills
  8. Early Recognition of Sepsis across the Continuum
  9. Infections from Peripherally Inserted IV Lines
  10. Standardizing Safety Efforts across Large Health System

[…]

2019-04-15T08:16:15-04:00April 15th, 2019|digital health, Nursing, patient safety, Patients|0 Comments
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How to Identify and Avoid Predatory Journals

Photo by Alice Rosen, via Flickr.

I remember receiving my first “accept” letter for a novel I was working on many years ago. In my excitement, I didn’t stop to think that it was strange that, before the editor began working with me, I would have to pay a large sum of money to get the manuscript into shape. When my euphoria died down and my skepticism shot up, I decided to submit a fake query to the same publisher, highlighting a novel that could never possibly get published. Imagine my dismay when I received the exact same acceptance letter.

So in a way, predatory publishing is not an entirely new concept. And in fact, many more or less legitimate self-publishing options for books, fiction or otherwise, still exist. But with the increasing dominance of the Web and the rise of the open access movement—established to help spread publicly funded research—a more invidious and widely pervasive form of predatory publishing has taken hold in scholarly publishing. And the stakes are far higher. While my novel probably wasn’t going to affect anyone’s life, articles published by unscrupulous publishers—especially medical and nursing literature—have a lot more power to cause damage.

Flawed, unreliable content.

Since predatory journals often forego rigorous […]

2018-01-19T10:56:23-05:00January 19th, 2018|digital health, nursing research, writing|0 Comments
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Can Your Fitness Tracker Save Your Life?

Megen Duffy, RN, BSN, CEN, works in hospice case management. She occasionally writes on nursing and digital health topics for AJN.

Fitness trackers and ‘wearables’ are becoming ubiquitous.

Fitness tracker “wearables” have become mainstream, with sales projected to reach $19 billion by 2018. If you don’t have one, many of your patients probably do, particularly this time of year when fitness goals are at the forefront of many New Year’s resolution lists. Wearables can track a lot of things, and people are claiming that they save lives. Are they all that? First, here’s a brief overview of wearables types and their uses.

Popular wearable brands include Fitbit (with 79% of sales), Jawbone, Nike, Apple (Apple Watch is a smart watch that has fitness tracker functionality), Garmin, and Misfit. Prices run from about $50 to as much as you want to spend: an Apple Watch costs from $275 to more than $10,000, depending on the model.

Increased functions. Wearables have far surpassed their pedometer function. They do all count steps, but now they also track sleep and heart rate and have increasingly more bells and whistles. The newer Fitbits and the new watchOS operating system for the Apple Watch even have “breathe” functions, intended to remind the wearer to take a few minutes several times a day and breathe to promote relaxation.

Wearables (including smart watches) now have extra features such as replaceable […]

2017-06-26T20:34:15-04:00January 12th, 2017|digital health, personal health practices|1 Comment
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Electronic Health Records: Still-Evolving Tools to Help or Hinder Nurses

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

Photo by Marilynn K. Yee/New York Times/Redux Photo by Marilynn K. Yee/New York Times/Redux

One of my earliest memories of electronic health records (EHRs) is the day I had to review a chart at another hospital in the city. As I headed over to medical records, I expected at worst a “big” chart—one of those 15-inch stacks of multiple folders from a long hospitalization. I wasn’t allowed access to their system to view the chart online, so I was escorted into a separate room, in which the printed-out chart was waiting for me.

But their electronic chart wasn’t “printer-friendly,” and the hard copy version now consisted of thousands of pages of documentation spread out over a nine-foot long table. Many […]

2016-11-21T13:01:40-05:00December 14th, 2015|digital health, Nursing, nursing perspective|2 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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