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Respond by offering additional thoughts regarding the examples shared, Systems Development Life Cycle SDLC-related issues, and ideas on how the inclusion of nurses might have impacted the example described by your colleagues.
Systems Development Life Cycle
The systems development life cycle (SDLC) is a process whereby a company or entity determines the need for the implementation of new technology. SDLC provides information systems that are effective at incorporating the company’s business plan (McGonigle & Garver Mastrian, 2018). It is essential that a working knowledge of the problems or issues are understood. In the case of healthcare organizations, this means establishing an assessment that discovers the needs of each department (McGonigle & Garver Mastrian, 2018). Most of the time when analyzing these needs an outside company is brought in to assess, interview, and determine the type of system that would benefit the company.
Consequences of Lack of Inclusion of Nurses
In the application of any new technology or policy, it is essential to trial it with the individuals that will be using it. When considering an update or new system in the healthcare setting, it is beneficial to involve nurses in the decision-making process. The Agency for Healthcare and Research (n.d.a) report that it is important to consult with nurses in the preliminary period of development. By incorporating nurses into the initial design, the researchers learn nursing processes, possible new tasks, effect the technology will have on patient care, staffing needs, and usability of the design. This analysis of workflow is used to determine the best use of technology (McGonigle & Garver Mastrian, 2018). Including nurses in this process opens routes for discussion and collaboration that will benefit the designers and users.
Failure to include nurses in the planning stages of technology design is detrimental to the intended use of the new system. A researcher or computer designer could miss critical elements of the nursing process due to their lack of knowledge regarding nursing procedures. McGonigle & Mastrian (2018) state, “nursing informatics professionals should always be included in these activities to represent the needs of clinicians and to serve as a liaison for technological solutions to process problems” (p. 250). The role of the informatics nurse and a nurse, in general, can play in designing technology is critical. Their contribution to the analysis of workflow and clinical implications is invaluable information needed for the formation of a system that will be used to its potential.
An Example of Collaboration
A study was done in Canada to determine the impact of the initiation of computerized order entries for medications on nursing workflow and reduction of medication errors. Registered nurses participated in a study where interviews and observations were used to study the effects of digital technology on the nursing process (Vito, Borycki, Kushniruk, & Schneider, 2017). The researchers spent considerable time observing and recording how the technology affected nurses and the influence it made on time spent with patients. This study is one example of the impact that nurses can have on the design and implementation of technology in the healthcare setting.
Current Healthcare Facility
When our facility transitioned to electronic health records (EHR) as an ER nurse, I was not involved in the planning. The nurse informaticist I assume worked with the company to create templates that are in use today. Within the ER portion of the EHR, there have been changes made because of nursing input. As a unit, we have asked for an ED narrator to be developed with our order sets, documentation narrators, and medication administration policies. Recently we asked for changes to our trauma narrator to include additional documentation options for different trauma levels. As a group we have also discussed missing pieces of data that is beneficial for everyday use and discussed this with our leaders. The leaders take this information to the information technology (IT) individuals that work directly with the EHR company and changes are then made. There are times when the nurse’s input is not embraced due to financial constraints or leadership ability to see the need. The size of the healthcare organization plays a significant role in the inclusion of nurses in decision-making practices. Many variables exist to modification of technology in healthcare. In an ideal setting, it would be ideal to include nurses throughout the design process.
Agency for Healthcare Research and Quality (n.d.a). Health IT evaluation toolkit and evaluation measures quick reference guide. Retrieved April 17, 2019, from https://healthit.ahrq.gov/sites/default/files/docs/page/impact-of-hit-on-nurses-quick-reference-guide.pdf
McGonigle, D., & Garver Mastrian, K. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning, LLC.
Vito, R., Borycki, E., Kushniruk, A., & Schneider, T. (2017). The impact of computerized provider order entries on nursing practice. Studies in Health Technology and Informatics, 234, 364-369. doi:/10.3233/978-1-61499-742-9-364
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