Week 10: Policy Issues and Health Informatics within Nursing

Course Content and Class Discussions

With the rise in use of health technologies among the workplace, it’s important to consider the implication of policy. Nurses have a role as advocates to address the needs of their clients (individual, community, etc.) with regards to health policy.        

 

Ajami & Arab-Chadegani (2013) define EHRs as digitally stored healthcare information throughout an individual’s lifetime with the purpose of supporting continuity of care, education, and research p213. And with this amount of sensitive and important information available, it is important to consider policy making in order to provide holistic care for your client.

Koliner, & Flately-Brennan (2013) believe, “This is a unique and historic time for nurses to help shape public policy”, p.205. As nurses and advocates, we have the power to bring the voices of our patients to health policies related to health and information technologies, (Koliner, & Flately-Brennan, 2013) as well as healthy public policy.  

Koliner & Flately-Brennan introduce and idea of Meaningful Use and its standards, which shape the use of EHRs by encouraging patient engagement (2013). Something that many believe is an important asset in the success of EHRs and other health technologies.

            See the video: Texting That Saves Lives, below to see an example of how Nancy Lublin identified a significant issue and made a change through her role as an advocate!

             

Videos/Learning Tools

How Clinicians Can Help Shape Health Policies

http://www.youtube.com/watch?v=y0jZqMw4Ho8

 

Policy Writing Template

TedTalks: Texting That Saves Lives:
http://www.youtube.com/watch?v=LiUClSItcy0

 

Nursing Implications

             As advocates, when building health and information technology policies, it’s important that we have the knowledge as nurses that we require in order to make the appropriate changes in the best interest of our clients. What types of things do we need to consider? As Pat Flately-Brennan discussed in her above video blog there are four important aspects when thinking of policy considerations:

1)      Recognition that EHR is just one aspect

2)      Sent in a trustable/secure way

3)      Must be practice permissive

4)      Have an expanded concept of confidentiality and privacy

If nurses are unaware of these policy considerations, or unaware in general of their roles as health policy advocates, then it is likely that they will not have the tools they require to act as proper advocates.

It’s also important that nurses take the time to work with their clients in order to identify what is important to them in accordance with a strengths-based approach. We as nurses cannot assume what is important to the client when building policy, just like we cannot assume what is important to them when it comes to their immediate health concerns.

Some literature states that nurses themselves are having a hard time adapting to the new EHR systems and often, many are reluctant to use it - this in itself poses as a huge implication! If the nurses aren’t ‘on board’ with the types of technologies that will one day be implemented fully, then how will they be able to communicate with the client his/her concerns for policy?

 

Readings and Additional References

Ajami, S., & Arab-Chadegani, R. (2013). Barriers to implement electronic health records (EHRs). Materia Socio Medica, 213-215

Bruhn, M., & Peterson, R. (2003). Policy development for improved security. Computer and Network Security in Higher Education.

Koliner, S., & Flatley Brennan, P. (2013). Advancing healthcare information technology through policy. Computers, Information, Nursing, 205-207.

Week 9: The eShift Model of Care

Course Content and Class Discussions

            The occupation of nursing is inherently filled with a variety of stressors, such as demanding patients, lack of time, and work overload, (Demerouti, Bakker, Nachreiner, & Schaufeli, 2000). These nurses are usually available to patients on a one-on-one basis within hospitals and long-term care settings. As a result, many nurses experience what is known as ‘burnout’, defined as a specific type of an occupational stress-reaction as a result of the high demand of the job, which makes them particularly susceptible, (Demerouti et al., 2000). With the number of nurses decreasing, the stress and emotional demands associated with their jobs are passed on to family members who are required to care for their own loved ones at home. This often results in what is known as caregiver burnout, (South West LHIN, 2011).  The result of caregiver burnout is often a decreased ability to care properly for their loved one as they are no longer ‘well’ themselves. Providing care to family members can be exhausting, (Ralph, 2012), and so the SouthWest CCAC and LHIN have started a revolution in the home health care field. A program directed at palliative clients, the eShift Model of Care, has been implemented to help reduce the caregiver burnout by supplying health care professionals to help in the homes overnight, so the caregivers can receive a proper night’s sleep and be able to care for their loved one during the day, (South West LHIN, 2011). The program allows for what is known as an ePSW – the ‘e’ standing for enhanced, (South West LHIN, 2011) to work with families in the home to provide overnight care as needed. Every ePSW (enhanced personal support worker) performs under the direction of a nurse through an application on a mobile device, (South West LHIN, 2011).

With regards to the nurses, instead of working one on one with clients, they are now able to manage care for up to four locations at a time, (South West LHIN, 2011). This allows for a broader range of care without the stress of job demand on nurses – a service delivery model.

Videos/Learning Tools

eShift Video:

http://www.youtube.com/watch?v=qZjvb0dJaLw

A World without Nurses:

http://www.youtube.com/watch?v=XsjNXWIW28w

The eShift Model of Care:

  

Nursing Implications

             The idea of the eShift model raised several questions in class – as people are curious what exactly this ‘stranger’ would be doing in their home when immediate care is not required? Some students also questioned the safety of the client’s information, while others considered what implications may be involved in the event that a mistake is made by the ePSW? The answer to the latter is that the nurses are not responsible for mistakes made by the PSW as nurses are not their governing body!

            The thing that I take away from this new program is that it allows for clients at their end of life to die peacefully within their own home. Often times, these clients are stable in terms of what care they can receive and can be cared for just as well at home. As I am someone who’s always pictured myself working in a hospital setting, having a program like this would help to significantly decrease that type of care within the hospital allowing for more patients with more immediate issues to be cared for. This would save resources both in the form of hospital expenses but also in the way of nurses whose population, as mentioned earlier, is steadily declining.

            When addressing the issues of the responsibilities of the PSWs it is reasonable to believe that during the times that the ePSW is not attending to the client, he/she may be providing other care within the home, such as cleaning, or laundry. This would help to relieve some of the daytime stress on the caregiver as well.

Readings and Additional References

Demerouti, E., Bakker, A., Nachreiner, F., & Schaufeli, W. (2000). A model of burnout and life satisfaction amongst nurses. Journal of Advanced Nursing, 454–464.

Issa, A. M. (2007). Personalized medicine and the practice of medicine in the 21^st century. McGill Journal of Medicine, 53-57. Retrieved from: http://www.med.mcgill.ca/mjm/

Lawson Health Research Institute. (2012). Announcing the mental health engagement networks (MHEN). Mental Health Engagement Network.  Retrieved from: http://www.lhsc.on.ca/About_Us/LHSC/Publications/Features/MHEN.htm

Ralph, A. (2012). Informal caregivers’ experience of caring for a palliative family member. Western University, 1-117.

South-West Local Health Integration Network. (2011). EShift Helps Patients and the SouthWest CCAC. Retrieved from: http://www.southwestlhin.on.ca/newsletter.aspx?id=60