Review the media Patient-Centered Technologies, and reflect upon Dr. Simpson’s statements about the ownership of patient data.

Discussion: Integrating PHRs Into EHR Platforms

When electronic health records (EHRs) first entered the market, their primary focus was to collect and analyze patient information within health care settings. As technological capabilities grew, so did the interest in making these records available to patients. In addition, many health care professionals saw benefits in allowing the patient to enter his or her own health data into EHR platforms. Though many patients are already utilizing personal health records (PHRs) to manage and track their own health, some believe that an integrated system would provide a better, more comprehensive picture of a patient’s health history.

As a result, many EHR platforms are now equipped with a PHR tool. This PHR tool allows patients to enter health information as they would in a stand-alone PHR system. In addition, web-based portals within the EHR allow patients to access information entered by their physicians and health care providers.

Like many emerging trends and technologies, there is much discussion about the potential benefits and challenges of this type of integrated system. While many health care professionals are excited about the empowerment provided to patients, others express significant concerns about access, security, ethics, and other implications.

In this Discussion, you explore how integrating PHRs into EHR platforms could impact you and your patients.

To prepare:

  • Review the media Patient-Centered Technologies, and reflect upon Dr. Simpson’s statements about the ownership of patient data.
  • Review the article, “Dreams and Nightmares: Practice and Ethical Issues for Patients and Physicians Using Personal Health Records” found in this week’s Learning Resources. Consider how PHR capabilities can be integrated into EHR platforms.
  • Examine the “dreams” and the “nightmares” the authors associate with this type of integrated health record. Select one benefit or one challenge of integrating PHRs into EHR platforms. Then, consider its potential impact on health care providers and patients. Why is this considered to be a benefit or challenge for health care professionals and patients?

By Day 3

Post a brief description of your selected benefit (I choose Promoting data use or Promoting responsibility) or challenge and support your selection. Explain the potential impact on health care professionals and patients.

APA Style, 600 characters minimum (not including the reference on this 600 words count)

 

As I write above, I choose Promoting data use or Promoting responsibility one of those. 

Required Readings

Saba, V. K., & McCormick, K. A. (2015). Essentials of nursing informatics (6th ed.). New York, NY: McGraw-Hill.
Review Chapter 1, “Historical Perspectives of Nursing Informatics”
In this chapter, the authors explain the transition from paper-based records to electronic records. The chapter provides an overview of the historical events that contributed to the rise of electronic health records.

Chapter 25, “Care Delivery Across the Care Continuum: Hospital-Community-Home”
Chapter 25 analyzes the impact of home health on the health care system. The chapter explains the current level of home health technology and how the Patient Protection and Affordable Care Act (PPACA) changes this aspect of health care.

Chapter 44, “Initiation and Management of Accessible, Effective Online Learning”
This chapter explores the past and present perspectives of distance education, important teractive electronic tools and essential strategies for the online learner.

Chapter 45, “Social Media in the Connected Age: Impact on Healthcare Education and Practice”
The focus of this chapter is on the evolution of the Internet, mobile tools and the use of social media in healthcare education.

Chapter 35, “Consumer/Patient Engagement and eHealth Resources”
As access to health care information increases, patients are becoming more informed about and engaged in their health. This chapter discusses current trends in health care, including patient empowerment, consumerism, and widespread use of computers and technologies for health.

Crilly, J. F., Keefe, R. H., & Volpe, F. (2011). Use of electronic technologies to promote community and personal health for individuals unconnected to health care systems. American Journal of Public Health101(7), 1163–1167.
Retrieved from the Walden Library databases.

The authors of this article describe technologies that have been used to increase access to health care for underserved populations. The authors present strategies, benefits, and challenges of addressing this issue, and they provide examples of successful programs.

Walker, J., Leveille, S. G., Ngo, L., Vodicka, E., Darer, J. D, Dhanireddy, S., … Delbanco, T. (2011). Inviting patients to read their doctors’ notes: Patients and doctors look ahead: Patient and physician surveys. Annals of Internal Medicine155(12), 811–819.
Retrieved from the Walden Library databases.

In this article, the authors discuss the results of their study on the outcomes of allowing patients to read their doctors’ notes. The study highlights the benefits of sharing notes with patients and how doing so can promote better outcomes.

Wynia, M., & Dunn, K. (2010). Dreams and nightmares: Practical and ethical issues for patients and physicians using personal health records. Journal of Law, Medicine & Ethics, 38(1), 64–73.
Retrieved from the Walden Library databases.

The authors of this article highlight the primary uses and benefits of personal health records (PHRs) as an electronic health record (EHR) tool. In addition, the article presents an overview of practical and ethical issues that may emerge from integrating PHR components into EHR systems.

Reflect on the differences between certifying bodies that offer credentialing exams for registered nurses.

Discussion: Understanding Scope of Practice in relation to Certification and Licensure

The National Council of State Boards of Nursing (NCSBN) is a non-profit organization comprised of members from each state board of nursing in the U.S., the District of Columbia, and the four U.S. territories. Their role is to provide a platform for all state boards of nursing to convene, discuss, and ensure all state boards work together to provide the appropriate regulation to ensure that public health, safety, and welfare is the primary focus. A key element of NP licensure is understanding the components of Scope of Practice and subsequent practice within the parameters of the educational program completed and appropriate national certification.

To prepare:
  • Consider whether primary care NP graduates are qualified to seek employment in acute care settings such as ER, OR, or hospitalist/intensivist
  • Review and select one of the following case studies to research in depth:
    • Case Study One: Selecting the Certification Exam for your specialty.
      Mary is in the last two months of her program of study. She is trying to decide whether to take the American Association of Nurse Practitioner Credentialing Exam or the American Nurses Credentialing Exam.
    • Case Study Two: Obtaining initial licensure post matriculation.
      Amy, FNP-BC has recently graduated from an accredited Family Nurse Practitioner Program. She decides to relocate from her home state of Tennessee to Missouri and practice in a rural area. She is very excited about her new role and new position.
By Day 3

Post an explanation of the professional and/or clinical practice issues the new Nurse Practitioner will need to consider and address with the certification, licensure, credentialing, or relocation process. Compare Scope of Practice between the Acute Care, Family Practice, and Adult Gerontology Primary Care Nurse Practitioner and how practice may differ from state to state. Then, identify and explain at least two types of settings that are appropriate for FNP and AGPCNP graduates to practice.

Read a selection of your colleagues’ responses.

By Day 7

Respond to at least two of your colleagues on three different days in one or more of the ways listed below. Respond to colleagues who selected a different Case Study than you did.

  • Reflect on the differences between certifying bodies that offer credentialing exams for registered nurses.
  • Provide key components a Nurse Practitioner should consider when relocating from one state to another.

Identify the pathophysiology of the alteration that you associated with the cough.

Respiratory Alterations

Scenario

Kevin is a 6-year-old boy who is brought in for evaluation by his parents. The parents are concerned that he has a really deep cough that he just can’t seem to get over. The history reveals that he was in his usual state of good health until approximately 1 week ago when he developed a profound cough. His parents say that it is deep and sounds like he is barking. He coughs so hard that sometimes he actually vomits. The cough is productive for mucus, but there is no blood in it. Kevin has had a low-grade temperature but nothing really high. His parents do not have a thermometer and don’t know for sure how high it got. His past medical history is negative. He has never had childhood asthma or RSV. His mother says that they moved around a lot in his first 2 years and she is not sure that his immunizations are up to date. She does not have a current vaccination record.

To Prepare

– Review Chapter 27 and Chapter 28 in the Huether and McCance text.

– Identify the pathophysiology of the alteration that you associated with the cough.

– Reflect on how genetics and age factors might impact the disorder.

Post a description of the disorder and underlying respiratory alteration (Croup known as Laryngotracheobronchitis) associated with the type of cough in your selected scenario. Then, explain the pathophysiology of the respiratory alteration. Finally, explain how age and genetics factors might impact the disorder.

**This paper should have Introduction (with a purpose statement) and Conclusion

LEARNING RESOURCES

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

  • Chapter 26, “Structure and           Function of the Pulmonary System”

This chapter provides information relating to the structure and function of the pulmonary system to illustrate normal pulmonary function. It focuses on gas transport to build the foundation for examining alterations of pulmonary function.

  • Chapter 27, “Alterations of           Pulmonary Function”

This chapter examines clinical manifestations of pulmonary alterations and disorders of the chest wall and pleura. It covers the pathophysiology, clinical manifestations, evaluation, and treatment of obstructive lung diseases such as asthma, chronic obstructive pulmonary disease (COPD), chronic bronchitis, and emphysema.

  • Chapter 28, “Alterations of           Pulmonary Function in Children”

This chapter focuses on alterations of pulmonary function that affect children. These alterations include disorders of the upper and lower airways.

Hammer, G. G., & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine. (7th ed.) New York, NY: McGraw-Hill Education.

  • Chapter 9, “Pulmonary           Disease”

This chapter begins with an overview of normal structure and function of the lungs to provide a foundation for examining various lung diseases such as asthma and chronic obstructive pulmonary disease (COPD).

** American Lung Association. (2012). Retrieved from http://www.lung.org/ 

** Asthma and Allergy Foundation of America. (2012). Retrieved from http://www.aafa.org 

** Cystic Fibrosis Foundation. (2012). Retrieved from http://www.cff.org/ 

Instructor Requirements

As advanced practice nurses, we are scholars, nurse researchers and scientists. As such, please use Peer-Reviewed scholarly articles and websites designed for health professionals (not designed for patients) for your references. Students should be using the original citation in up to Date and go to that literature as a reference. The following are examples (not all inclusive) of resources/websites deemed inadmissible for scholarly reference:

1. Up to Date (must use original articles from Up to Date as a resource)

2. Wikipedia

3. Cdc.gov- nonhealthcare professionals section

4. Webmd.com

5. Mayoclinic.com

– This work should have Introduction and Conclusion

– It should have at least 3 current references (2013 and up)

– APA format

Describe      the pathophysiological mechanisms of chronic asthma and acute asthma      exacerbation. Be sure to explain the changes in the arterial blood gas      patterns during an exacerbation.

Asthma

Complications of asthma can be sudden. Consider the case of Bradley Wilson, a young boy who had several medical conditions. He appeared in good health when he went to school, returned home, and ate dinner. However, when he later went outside to play, he came back inside wheezing. An ambulance took him to the hospital where he was pronounced dead (Briscoe, 2012). In another case, 10-year-old Dynasty Reese, who had mild asthma, woke up in the middle of the night and ran to her grandfather’s bedroom to tell him she couldn’t breathe. By the time paramedics arrived, she had passed out and was pronounced dead at the hospital (Glissman, 2012). These situations continue to outline the importance of recognizing symptoms of asthma and providing immediate treatment, as well as distinguishing minor symptoms from serious, life-threatening symptoms. Since these symptoms and attacks are often induced by a trigger, as an advanced practice nurse, you must be able to help patients identify their triggers and recommend appropriate treatment options. For this reason, you need to understand the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation.

To Prepare

  • Review      “Asthma” in Chapter 27 of the Huether and McCance text. Identify the      pathophysiological mechanisms of chronic asthma and acute asthma      exacerbation. Consider how these disorders are similar and different.
  • Select      one of the following factor: gender, ethnicity, or behavior. Think about      how the factor you selected might impact the pathophysiology of both disorders.      Reflect on how you would diagnose and prescribe treatment of these      disorders for a patient based on the factor you selected.
  • Construct      two mind maps—one for chronic asthma and one for acute asthma      exacerbation. Consider the epidemiology and clinical presentation of both      chronic asthma and acute asthma exacerbation.

To Complete

Write a 2 pages paper that addresses the following:

  • Describe      the pathophysiological mechanisms of chronic asthma and acute asthma      exacerbation. Be sure to explain the changes in the arterial blood gas      patterns during an exacerbation.
  • Explain      how the factor you selected might impact the pathophysiology of both      disorders. Describe how you would diagnose and prescribe treatment for a      patient based on the factor you selected.
  • Construct      two mind maps—one for chronic asthma and one for acute asthma exacerbation.      Include the epidemiology, pathophysiology, and clinical presentation, as      well as the diagnosis and treatment you explained in your paper.

**This paper should have Introduction (with a purpose statement) and Conclusion

LEARNING RESOURCES

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

  • Chapter 26, “Structure and           Function of the Pulmonary System”

This chapter provides information relating to the structure and function of the pulmonary system to illustrate normal pulmonary function. It focuses on gas transport to build the foundation for examining alterations of pulmonary function.

  • Chapter 27, “Alterations of           Pulmonary Function”

This chapter examines clinical manifestations of pulmonary alterations and disorders of the chest wall and pleura. It covers the pathophysiology, clinical manifestations, evaluation, and treatment of obstructive lung diseases such as asthma, chronic obstructive pulmonary disease (COPD), chronic bronchitis, and emphysema.

  • Chapter 28, “Alterations of           Pulmonary Function in Children”

This chapter focuses on alterations of pulmonary function that affect children. These alterations include disorders of the upper and lower airways.

Hammer, G. G., & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine. (7th ed.) New York, NY: McGraw-Hill Education.

  • Chapter 9, “Pulmonary           Disease”

This chapter begins with an overview of normal structure and function of the lungs to provide a foundation for examining various lung diseases such as asthma and chronic obstructive pulmonary disease (COPD).

** American Lung Association. (2012). Retrieved from http://www.lung.org/ 

** Asthma and Allergy Foundation of America. (2012). Retrieved from http://www.aafa.org 

** Cystic Fibrosis Foundation. (2012). Retrieved from http://www.cff.org/ 

Instructor Requirements

As advanced practice nurses, we are scholars, nurse researchers and scientists. As such, please use Peer-Reviewed scholarly articles and websites designed for health professionals (not designed for patients) for your references. Students should be using the original citation in up to Date and go to that literature as a reference. The following are examples (not all inclusive) of resources/websites deemed inadmissible for scholarly reference:

1. Up to Date (must use original articles from Up to Date as a resource)

2. Wikipedia

3. Cdc.gov- nonhealthcare professionals section

4. Webmd.com

5. Mayoclinic.com

– This work should have Introduction and Conclusion

– It should have at least 4 to 6 current references (at least 2 from the above class learning resources).

– APA format

How might you, as a nurse manager, use performance appraisals and other performance management strategies, such as positive discipline, in your leadership approach?

Discussion: Performance Standards and Appraisals  Performance appraisals should be timely, thoughtful, consistent, thorough, and free from bias. How can performance appraisal systems be structured to facilitate this type of environment? Effective performance standards and appraisals can promote an open and continuous relationship among the nurse manager, HR professionals, and employees. How might you, as a nurse manager, use performance appraisals and other performance management strategies, such as positive discipline, in your leadership approach?  In this Discussion, you reflect on questions that commonly arise when assessing performance appraisal processes. •Performance Standards: •Who creates performance standards, and how are they communicated to employees? •Are performance standards consistent with quality standards commonly used in the nursing profession? •Do performance standards align with legal and ethical nursing practice?  •Performance Appraisals: •How is employee performance (i.e., behaviors, attitudes, abilities, and skills) documented? •What measures, if any, protect employees from subjectivity? •Are employees asked to engage in any form of self-evaluation?  •Do colleagues participate in peer evaluations such as 360-degree appraisals? •Does the performance appraisal process encourage employee development? •Aside from the written performance measures, what aspects contribute to success or failure in achieving performance improvement?   To prepare •Review this week’s media, “Performance Management,” and consider the best practices highlighted by this week’s presenters. •Reflect on the performance standards and appraisal systems used in your current organization or one with which you are familiar. With the above questions in mind, identify this organization’s strengths and areas for improvement. •Drawing from ideas presented in this week’s Learning Resources, think of specific ways you might improve your organization’s use of performance standards and/or the performance appraisal process.  •Review the article, “Positive Discipline Reaps Retention.” As a nurse manager, how might you incorporate positive discipline into your performance management approach? What effect–good, bad, or indifferent–do you think it would have on your nursing staff?  By Day 3  Post a description of the performance appraisal system used in your workplace, including how performance standards are created and communicated to employees. Describe the effectiveness of the performance appraisal system by sharing at least two strengths and two areas for improvement. Conclude your posting by explaining how you might incorporate positive discipline into your performance management approach and what impact you think it will have.

Required Readings  Lussier, R. N., & Hendon, J. R. (2016). Human resource management: Functions, applications, & skill development (2nd ed.). Thousand Oaks, CA: Sage Publications.     •Chapter 8, “Performance Management and Appraisal” (pp. 274–314) This chapter introduces the performance appraisal process. The authors explain how to effectively carry out performance appraisals, the methods of assessment one can use, and who should be responsible for assessing employees.      •Chapter 9, “Rights and Employee Development&rdquo (pp. 316–355) Chapter 9 provides an overview of employee rights and privileges. It also explains the processes of developing or terminating an employee, providing counseling for problem employees, and effectively using discipline and termination.    Dupee, J. M., Ernst, N. P., & Caslin, K. E. (2011). Does multisource feedback influence performance appraisal satisfaction? Nursing Management, 42(3), 12–16.  Retrieved from the Walden Library databases.     The article focuses on the effects of multisource feedback (MSF) in a nursing environment.   Murray, B. (2003). Positive discipline reaps retention. Nursing Management, 34(6), 19–22.  Retrieved from the Walden Library databases.      Positive discipline can transform communication and relationships between nurse managers and nursing staff. This article examines how nurse managers at a medical center in Boise, Idaho shifted their feedback process to an Alternative Correction Action model based on positive discipline philosophies.

How might these factors translate to the usability, implementation, and outcomes of other informatics technologies?

Assignment: Application:
Design Considerations and Workarounds

When nurse informaticists are tasked with identifying the most appropriate technology to meet a specific need within a health care setting, there are many questions that must be asked.

Consider the following scenario:

Riverdale Hospital has come under recent scrutiny for their medication procedures. Many times, paper medication records are not up to date or have been misplaced. As a result, patients have increasingly received their medications at the wrong times. Though each nurse is performing to the best of his or her ability, the fast pace of the hospital has caused some to ineffectively manage patient records.

The lead nurse informaticist, Nancy, has decided that a bar code scanner could help streamline the documentation process while also improving patient quality and safety. Nancy knows that when selecting a bar coding system she must not only examine the hardware and software of the system but also consider the various human factors that can positively and/or negatively affect the outcomes of the system implementation. As such, Nancy asked three of the most reputable bar code vendors to bring sample systems to Riverdale Hospital.

In evaluating each system, Nancy role plays the process of scanning a patient’s bar code. She rolls the coding cart into the room to begin her mock demonstration. First, Nancy scans her identification card to gain access to the medication screen. To scan the patient’s bar code identifier, Nancy then pulls the medication cart to the patient so that the attached scanner reaches the bar code on the patient’s wristband. When the scan is complete, the computer displays a screen that houses the patient’s personal information. By navigating the screens, Nancy finds that she can use the computer to track medication administration. In addition, Nancy is able to view applicable vitals and medication history. As Nancy continues to examine this system, she reflects on the other hardware and software facets she should be sure to consider. She also thinks about how human factors will affect this and other vendor systems.

In this Assignment, you consider how hardware, software, and human factors can impact the implementation of an informatics system.

To prepare:

· Review Chapter 30, “The Role of Technology in the Medication-Use Process,” in the course text, Essentials of Nursing Informatics. When examining computerized prescriber order entry (CPOE) systems and bar code-enabled technologies, what hardware, software, and human factors did the authors identify?

· Consider how each of these factors can negatively impact patient safety and quality of care.

· How might these factors translate to the usability, implementation, and outcomes of other informatics technologies?

· Review the media presentation Selecting New Technologies in this week’s Learning Resources. How did presenter Dr. Patricia Button take the above factors into consideration when selecting an informatics technology for her health care setting?

· When planning and selecting a new informatics system, what steps should informaticists take to ensure the system will address the needs of their health care setting? In addition, how can informatics leaders encourage all nurses to commit to using a new technology?

To complete:

Submit a 4- to 5-page paper that addresses each part of this Assignment:

· Part 1: Design Considerations

Identify two (2) major design considerations associated with each of the following: hardware, software, human factors. (6 considerations in total).

Describe why informaticists should play close attention to each of these 6 considerations when evaluating an informatics technology. In your description, include the potential dangers each of these pose to patient safety and quality of care.

· Part 2: Employee Workarounds

Even with a carefully thought out design and implementation, nurses and other health care employees may adopt workarounds. With this reality in mind:

What benefits and/or consequences do you associate with workarounds?

When selecting an informatics technology, would you opt to purchase a system that mitigates the opportunity for workarounds; or do you believe that workarounds are sometimes necessary? Justify your response.

Note: Your responses should focus on informatics technologies in general, not just bar code scanners as portrayed in the scenario. You may, however, use specific examples such as bar code scanners and other informatics technologies to justify your responses.