Patient care decisions should be supported by timely clinical information, reflecting the best evidence possible (Institute of Medicine 2013). Present and future professional nurses must be able to use informatics and technology to facilitate critical decision-making for optimal patient outcomes (Massachusetts Department of Higher Education Nursing Initiative 2016). Nursing clinical informatics competencies involve the collection and use of patient data for analysis and dissemination. Nursing informatics with computer science was established to create innovative ways to provide quality care to our patients. Evidence based practice is a cornerstone to making NI better for the future. Without EBP there would be no such thing. 

What I see for the future is that technology would be expanding at a faster rate. There would be less hands on and more robotics. What I mean by this is that robots would be administering meds at the bedside, documenting task, and even doing patient consults. I believe that this would be in the near future to come because it would cut the need for nursing staff in half and it would be cost effective for the company. The only thing that would be the downfall to this is that robots do not pose interpersonal skills so patient questions would go unanswered and in would block the communication to building a rapport. We have already advanced to telemedicine which in some cases can be beneficial to the patient being seen by the physician. 

Another thing that would probably be good for the up and coming future would be if we could use the pyxis like we use Alexa and Siri. If we could give them voice commands where it could dispense patient medications that are due just by giving the first and last name of the patient would cut down on the time spent pulling meds. Instead of your taking 30mins to 1 hour pulling meds could just take about 15 to 20 mins. Modern technology is advancing so much that some of us cannot not keep up with the new demands of the workplace. In nursing we are always learning new things and we must continue to learn as we advance in our careers in order to be successful. New media offer new possibilities in teaching and learning. However, the appropriation of new knowledge and skills in dealing with technology, especially for older adults, is a critical challenge. This needs to be considered against the background of the digital divide. Which describes, among other things, the lack of information on the ability of older adults to use technology among those who have access to ICTs and new media in healthcare. In conclusion informatics will be changing for the better.

Reference 

Institute of Medicine. (2013). Core measurement needs for better care, better health, and lower costs: Counting what counts, workshop summary. Washington, DC: National Academies Press. doi:10.17226/18333 

Massachusetts Department of Higher Education Nursing Initiative. (2016). Massachusetts nursing of the future nursing core competencies. Retrieved from https://www.mass.edu/nahi/documents/NOFRNCompetencies_updated_March2016.pdf (Links to an external site.) 

Reply 2

The origin of health informatics began in the 1950s when computers were introduced into healthcare. Computers allowed new technology to expand the fields of medicine and nursing education (Nelson, 2014, p. 596). Today, health informatics takes the information technology that exists and applies it to systems in place already, creating a more innovative vision for healthcare. This can be accomplished by reviewing the current trends, as well as offering tools for predicting the future. Health professionals and informatics specialists can then prepare their leadership roles in planning effective future healthcare information systems (Nelson, 2014, p. 612).  

Our textbook further explains these changes by dividing the scope of change into three levels. The first level of change makes the process in use more efficient without changing the process or goal. An example of this would be for health care to completely move from paper documentation to an electronic way of inputting patient information. As I have discussed in other posts, this can be achieved by providing organizations that rely on pen and ink with the resources they need to provide all their cases electronic devices for accessing the plan of care for patients and medication administration records. Having patients check in to doctor’s offices with an iPad versus a clipboard and paper is another way the first level of change can occur. Second level changes involve changing how a specific outcome is achieved (Nelson, 2014, p. 614). An example of this today is the rise of telehealth medicine. Allowing patients more access to therapies and physicians through the phone offers more accessibility to those quarantining or social-distancing due to COVID-19. Telehealth medicine allows clinics the opportunity to limit the number of clients that are in a room to minimize risks for other patients and healthcare workers. Another example would be the initiation of apps for accessing health information and scheduling appointments. Phone applications can be downloaded and used at the discretion of patients 24/7 rather than patients calling the doctor for test results, medication refills, appointment scheduling, and taking printouts of visit summaries. The third level of change alters the process and refocuses the goal at the societal and institutional level (Nelson, 2014, p. 614). Phones have had the ability to track location since cell towers were installed. This past summer, location tracking has taken on a new role in the life of coronavirus. Digital contact tracing has become popular with governments of various countries to identify infected individuals and tracing people they have been in contact with. The process uses Bluetooth technology that logs when devices are near another device associated with an infected user for a prolonged period (Frith & Saker, 2020). Changing how phone tracking is used to benefit the community and allowing health agencies to monitor those who should be social-distancing due to a positive COVID-19 virus. The use of technology in this way  shows how a third level change can reflect the changes happening in our society. However, some oppose digital contact tracing because of HIPAA and surveillance concerns. My hope for the future of informatics is to successfully find the balance between technology and patient-centered care. Taking into consideration what nurses need to do their jobs most efficiently, improving patient care to be most accessible, and seamlessly integrate technology into the community to improve health in our neighborhoods is my vision of the future of health informatics.  

References 

Frith, J., & Saker, M. (2020). It Is All About Location: Smartphones and Tracking the Spread of COVID-19. Sage Journals. https://doi.org/10.1177/2056305120948257 (Links to an external site.) 

Nelson, R., & Staggers, N. (2014). Health Informatics: An Interprofessional Approach (2nd ed.). Mosby. 

Edited by Wood, Carmen on Oct 7 at 12:46pm

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Exercise Content

1. State Strategies (20% of grade) The purpose of this assignment is to familiarize students with health reform strategies adopted by states. Students will select a state health policy reform innovation and describe the rationale, how it was adopted (e.g., federal waivers, passage by state legislature), the funding structure, and (to the extent statistical data are available) its impact. Students should summarize their findings in a 1-2 page, single-spaced memo. Sample memo attached. A memo is required, see attached sample. A few examples of state innovations include Vermont’s single payer system, Massachusetts’ health reforms and Kentucky’s Medicaid healthcare program (none of these can be used). Please see attached rubric.. 

im from Miami Florida.  please turniting report

Respond  to  your  colleagues by recommending at least one additional way you  would treat a  child or adolescent client differently than you would an  adult and at  least one additional way you would address the legal and  ethical issues  involved.  

(NOTE: Positive Comment)

                                                        Main Discussion

Psychiatric  emergencies are severe behavioral changes that may  result from  worsening mental illness. Psychiatric emergency is any  disturbance in  thoughts, feelings, or actions that require immediate  therapeutic  intervention (Stahl, S. M., 2014). The providers approach,  attitudes and  work environment may escalate the situation and interfere  with the  quality of care. Certain therapeutic measures can reduce the  intensity  of the situation and provide a more dignified way for  patients to  recover from the crisis. It is thus important that the  PMHNP understand  how to assess patient’s emergency status and address  their unique needs  while maintaining safety.

  Case selected.

Patient  is a 25-year-old AA male who presents to the emergency  department with  psychotic behavior in believing he should kill his  mother which led to  his attempt to stab his mother. Patient is admitted  for inpatient  psychiatric stabilization. Patient has a history of  schizoaffective  disorder and major depression that was managed with use  of clozapine  150mg twice a day and Zoloft 100mg daily. Family reported  that patient  has a history of medication non-compliant and had been on  different  psychiatric medications in the past but were not working for  him.  Additional reports by his parents shows that patient had missed  several  doses of his medication, decompensated and they had notices  some changes   recently including increase agitation, delusional  believes that he is  the savior in the family and God had directed him  to cast the demon in  his mother. Reports also that he had drawn a  picture of himself with  knives cutting a woman he portrayed as a demon  with blood flowing with a  man standing to the side, laughing. Patient  currently stated that he  participates in a meeting with angels from  which he gets directives on  how to attack his mother which led to his  attempt to stab his mother.  Because of this, patient was considered  dangerous to his mother per  admitting physician. Patients symptoms  include psychosis, extreme  agitation, paranoia, verbal outburst,  combative and very difficult to  redirect. Patient has no known drug  allergies per parents.  Verbal  restraint was used including letting  patient know what will happen if  he does not comply, respecting his  autonomy, empathetic listening,  decrease environmental stimulation,  reassure patient that they will be  safe, and maintain a safe  environment. The patient was given emergency  medications including  haloperidol lactate 5mg, lorazepam 2mg, and  diphenhydramine 50mg all IM  for severe agitation and danger to others.  To prevent  re-hospitalization within 12-24 hours of discharge, the  physician  ordered outpatient therapy and continued use of clozapine and  Zoloft  along with necessary lab work.

 How I would treat the client differently if he or she were a child or adolescent

Children and adolescent are usually brought for treatment when  their  behavior or thoughts come to the attention of parents, teachers,   social workers, or school.  For pediatric patients in a mental health   crisis, the typical chaotic nature of the situation may easily further   exacerbate an already traumatized state of the patient. Just like in   adults, as a PMHNP I would perform an evaluation to determine the type   of emergency and contributing factors in child and adolescent emergency   by assessing not just the child but also the entire family.   Additionally, safety and protection are essential mandate in  psychiatric  emergency evaluation especially when the patient pose  imminent threat  to self or others. What I will do different when  interviewing children  especially younger children is to assess the  underlying cause of the  violent behavior and delusional symptoms within  a developmental context. Specifically,  I would clarify that “bizarre  thinking ” or accounts of seeing or  hearing things that others do not  see or hear are different from  developmentally appropriate fantasy or  difficulty while distinguishing  inner voices from distressing  hallucinations. On like in adults where  they can provide information  during the interview, when it comes to  younger children, I would need  to obtain information from parents or  guardian. For adolescents,  I  would obtain information from the patient first then talk to their   parent or guardian if the adolescent is able to tell most of their own   story. This may also help to give a sense of autonomy and control to  the  adolescent which promote cooperation with the interview process.    However, information from family is very crucial particularly for a   child who is psychotic, frightened, unable, or unwilling to corporate   with the provider to help understand how the situation occurred and the   severity of the behavior. 

Same  interviewing strategies used in adult may be used including  speaking in  a soft voice respecting patients’ autonomy, assuring  safety, validating  feelings, offering distractions (like video games)  especially with very  young children, and clear limit-setting can be  helpful. However,  children should be evaluated in a carefully planned  setting with doors  closed for limiting access, and be sure appropriate  backup is available  (Margret, C. P., & Hilt, R., 2018).  

In  violent situations children may require a different approach in   deescalating the situation than adults. Safety is the essential mandate   in an aggression evaluation, with the interviewer specifically looking   for imminent threats, plans, targeted people, and access to means of   harm (Margret, C. P., & Hilt, R., 2018). Because adults are much   stronger, they may require physical restrain specially to administer   medication to calm the patient. Verbal restrain such as providing  verbal  directions in a nonthreatening manner, setting limits, and  assuring the  child that treatment may help them calm may be used for  children first.  However, if the child is dangerously out of control and  aggressive,  they may need medication to keep them calm and safe.

Legal or ethical issues I would consider when working with a child or adolescent emergency case

The  ethical issue I will consider when working with children and  adolescent  is respect for their autonomy, privacy, and confidentiality.  For very  young children parents must consent to treatment and the  health care  provider treating the child should make every reasonable  effort to  obtain and document informed consent. (American Academy of  Pediatrics,  2015). Just like adults, maintaining a patient’s  confidentiality is an  important ethical consideration when providing  care to children and  adolescents. However, when  a PMHNP is concerned  that the patient may be at imminent risk for harm  to self or others,  confidentiality requirements no longer apply (Chun,  T. H., Katz, E. R.,  & Duffy, S. J., 2013). This means that the PMHNP  in this situation  may disclose information collected  from patient to  caregivers or  others as needed and may obtain information from others  such as  friends, family members, school personnel, employers and other  without  obtaining consent from the patient or guardians (Chun, T. H.,  Katz, E.  R., & Duffy, S. J., 2013. Patient  autonomy is a major principle in  making decisions about an individual’s  health, and as a PMHNP we are  obligated to respect this right and allow  patients to practice their  autonomy in the course of their treatment  (Parsapoor, A., Parsapoor, M.  B., Rezaei, N., & Asghari, F., 2014).  However, a psychiatric  emergency and age may limit a child’s ability to  make such decisions.  Regardless, it is always important to involve the  child in informed  decision making even if the consent is signed by the  parents or  guardian.

References

Chun, T. H., Katz, E. R., & Duffy, S. J. (2013). Pediatric mental health emergencies and special 

health care needs. Pediatric clinics of North America, 60(5), 1185–1201. Retrieved from,

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3792398/

Da Silva, A. G., Baldaçara, L., Cavalcante, D. A., Fasanella, N. A., & Palha, A. P. (2020). The 

Impact of Mental Illness Stigma on Psychiatric Emergencies. Frontiers in psychiatry, 11, 

573. https://doi.org/10.3389/fpsyt.2020.00573

Margret, C. P., & Hilt, R. (2018). Evaluation and Management of Psychiatric Emergencies in 

Children. Pediatric Annals, 47(8), e328–e333. https://doi-

org.ezp.waldenulibrary.org/10.3928/19382359-20180709-01

Parsapoor, A., Parsapoor, M. B., Rezaei, N., & Asghari, F. (2014). Autonomy of children and 

adolescents in consent to treatment: ethical, jurisprudential and legal considerations. 

Iranian journal of pediatrics, 24(3), 241–248. Retrieved from, 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4276576/

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New 

York, NY: Cambridge University Press.

 This week you watched a video on how to input data and practiced with a spreadsheet. 

List five things you learned to do this week in excel?

Is this your first experience with this program? (If not share the experience)

If you were afraid of this program are you less fearful now? explain

This post needs to be 100-150 words in length using the APA-6th-Edition-Template-without-Abstract.dot

100pts