NURS 6051 Discussion: The Inclusion of Nurses in the Systems Development Life Cycle

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RE: Discussion – Week 9

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Colleagues:

According to McGonigle and Mastrian, SDLC is a series of actions used to develop an IS. The SDLC is like the nursing process, in which the nurse must assess, diagnose, plan, implement, evaluate, and revise. The plan is developed in this way to meet the patients’ needs or if a new problem arises, the nurse either revises and updates the plan or starts anew.

In the planning process, Burns, (2012) states, big data is set to change the way care is delivered, but for analytics to improve quality, organizations need to be sure the data they have available is accurate and relevant. This is where nurses come in. Because nurses are responsible for a large amount of record-taking, they must be sure to use IT tools to collect the most accurate data possible.

In the implementation process, Wickman and Janzen (2009) state, involving nurses who work at the point of care in all phases of introducing a modern technology facilitates a smooth transition to using the modern technology and increases nurses’ buy-in to the system. The Standish Group (1995) has noted that without user involvement the chance of failure increases dramatically. Kramer and Schmalenberg (2008) have observed that nurses will and do adopt modern technologies if they have had the opportunity to provide input into the planning and implementation processes by conducting trials of several types of equipment in different clinical settings, and the evaluation process by which they can confirm whether changes designed to improve the work environment have been effective.

References:

Burns, Ed, (October 17, 2012) Nurses have an important role to play during technology implementation Retrieved on 01/27/2022 from https://searchhealthit. Techtarget.com

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Weckman, H., Janzen, S., (May 31, 2009) “The Critical Nature of Early Nursing Involvement for Introducing New Technologies” OJIN: The Online Journal of Issues in Nursing, Vol. 14, No. 2, Manuscript 2.

DOI: 10.3912/OJIN.Vol14No02Man02

NURS 6051 Discussion: The Inclusion of Nurses in the Systems Development Life Cycle

 

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NURS 6051 Discussion: The Inclusion of Nurses in the Systems Development Life Cycle

By Day 3 of Week 9

Post a description of what you believe to be the consequences of a healthcare organization not involving nurses in each stage of the SDLC when purchasing and implementing a new health information technology system. Provide specific examples of potential issues at each stage of the SDLC and explain how the inclusion of nurses may help address these issues. Then, explain whether you had any input in the selection and planning of new health information technology systems in your nursing practice or healthcare organization and explain potential impacts of being included or not in the decision-making process. Be specific and provide examples.

The nurse leader and the System Development Life Cycle (SDLC) (weeks 9-10).

“What would be the consequences of a healthcare organization not including the nurse in each stage of the SDLC when purchasing and implementing a new health information technology system”.

IT Software generally is not tailored to unit specifics or patient trends in specific healthcare goals. According to McGonigle and Mastrian (2022) The first step in developing a system is to understand the problem or business needs. The nurse is vital in this role of assisting with the information technology developers in the specifics of patient care. Patient specific issues addressed and documented accurately, “must have, should have could have and would have” (McGonigle & Mastrian,2022). Avoiding Potential safety issues with falls, medical errors risk, tied to the unit teaching education of the illness focused. “The Clinical Information Systems and the patient care support systems “are designed to collect patient data in real time and enhance care by putting data at the clinicians finger tips and enabling decision making where it needs to occur which is at bedside”(McGonigle and Mastrian,2022).Extracting branded information for unit measurements data and extracting component documents compilation. “The team members work strategically to align their goals with the goals of the organization where the system is to be used. The focus for these groups is on planning, resources management, transitioning and ongoing support of the system” (McGonigle & Mastrian,2022).

Organization of company specific information utilized for billing patients, doctor charges, supply usage company figures extracted and formation of patient success stories for the organization benefit. “The SDLC is a way to deliver efficient and effective information systems that fit with strategic business plans, which stems from the mission of the organization” (McGonigle & Mastrian,2022).Ultimately, this helps in securing all patient prescriptions, lab work, documents, nutritional needs, allergies, mental capacity and all sensor information in one place for constant access anytime, any location, always filed and stored.

Personally, I have not had the opportunity to be included in the development or purchasing of healthcare systems. However, it is more than vital to incorporate the nurse for function patient information and safety.

References

McGonigle,D. & Mastrian, K.A. (2022). Nursing Informatics and the foundation of knowledge; The fifth edition. Chapter 9 p.191-204.

McGonigle,D. & Mastrian, K.A. (2022). Nursing Informatics and the foundation of knowledge; The fifth edition. Chapter 12 p. 251-265.

McGonigle,D. & Mastrian, K.A. (2022). Nursing Informatics and the foundation of knowledge; The fifth edition. Chapter 13 p. 269-286.

By Day 6 of Week 9

Respond to at least two of your colleagues* on two different days, by offering additional thoughts regarding the examples shared, SDLC-related issues, and ideas on how the inclusion of nurses might have impacted the example described by your colleagues.

*Note: Throughout this program, your fellow students are referred to as colleagues.

Hello Kelly,

Thank you for sharing your weekly discussion post with us this week, I really enjoyed reading it. Please allow me to add also one of the methods to improve the use of technology in healthcare is to employ the SDLC process. Planning, developing, implementing, and providing post-implementation assistance are the five processes involved. Nurses will be involved in each step of the process to improve the system’s functionality. They are to assist in the identification of goals, feasibility evaluations, and evaluation of the system’s compatibility with the hospital environment, for example, during the planning phase. The function of the nurse in the analysis phase is to define the end users’ needs as well as the cognitive evaluation components. The nurse should be included in the design phase as well, dealing with things like cognitive support and safety concerns. Finally, because of the need to dispel the complexity associated with care environments by providing best practices to improve care while reviewing operations for any safety threats, the nurse is critical during the implementation phase.

References

Daly, P. (2015). Clinical nurses lead the charge with EHR. Nursing, 45(10), pp.25-26.

Rizvi, R. F., Marquard, J. L., Hultman, G. M., Adam, T. J., Harder, K. A., & Melton, G. B. (2017). Usability Evaluation of Electronic Health Record System around Clinical Notes Usage-An Ethnographic Study. Applied clinical informatics, 8(4), 1095–1105. doi:10.4338/ACI-2017-04-RA-0067

Kelly,

Great post.  I, too, feel nurses are instrumental in all stages of the SDLC.  However, nurses are not always involved until the implementation and evaluation phases. This is a disservice to any IT team as nurses are end-users of system products, and for any information system to work for potential end-users, they need to be a part of the processes from the planning stages (Walden University, 2018). The involvement of nurses in the beginning stages of HIT can help alleviate common problems that occur due to ill-designed software while ensuring better allocation of healthcare resources and the development of a system that is clinically relevant (Verma & Gupta, 2017).  Before a healthcare product is ever developed, the developers need to understand the needs of the ones who will be using it, the healthcare professionals (Verma & Gupta, 2017).  Nurses are in an excellent place to voice these needs to the developers as they understand clinical workflows and patient care processes and act as liaisons, actively communicating patient needs to other members of the healthcare team (Verma & Gupta, 2017). I feel that is one failure of my organization with the implementation of our EHR.  Nurses did not feel they were involved or valued in the planning stages.  Attitudes toward the product could have been improved by allowing nurse involvement.  What stage of the SDLC do you feel is most important for nurses to be involved in and why?

References

Verma, M.T., & Gupta, S. (2017). Software Development for Nursing: Role of Nursing Informatics. Retrieved from http://ijneronline.com/HTMLPaper.aspx?Journal=International+Journal+of+Nursing+Educ ation+and+Research%3bPID%3d2017-5-2-19

Walden University, LLC. (Producer). (2018). Systems Implementation [Video file]. Baltimore, MD: Author.

Submission and Grading Information

Systems Development Life Cycle

Nurses are specialists in the nursing field, but their involvement is vital every time a new system is being introduced in a patient care environment. Failure to involve nurses in the Systems Development Life Cycle impacts their effectiveness in the use of new technology and the overall ability of nurses to achieve their professional goals and objectives (Agency for Healthcare Research and Quality, 2018). Even though the implementation of systems development in a health care setting may require substantial information technology knowledge, it is essential to discuss the consequences of not involving nurses in the SDLC.

SDLC and Nurses’ Involvement

SDLC is a model used in project management that defines the procedures involved in bringing a project from its start to completion (McGonigle & Mastrian, 2018). It is always vital that representatives in the health care system are involved in the process more so the end-users of the systems or employees, such as nurses, who adjust to the changes (Agency for Healthcare Research and Quality). As health care informatics become more widespread throughout the health care system, there is a dire need for information technology and health care professionals to integrate knowledge so that it is possible for nurses to achieve their objectives.

One of the impacts of not involving nurses in the Systems Development Life Cycle is the lack of safe and efficient care to patients (McGonigle & Mastrian, 2018). It would be unfortunate that a system is installed in a nursing care system by the nurses cannot use it effectively. The lack of safe and efficient patient care results from nurses’ inability to use the systems efficiently to provide adequate data collection, shared information and analytic capabilities.

Experience

When I was working for a local health center as a nursing intern, the administration realized the need for having the Electronic Health Record. The use of a manual health record had errors and made our nursing practice ineffective. The organization hired a group of IT practitioners to develop software that would help to enhance appointment booking for palliative care patients. The involvement of nurses in the steps of System Development life cycle is vital. The reason is that it ensures that what is being designed meets the needs of the nurses and will improve their performance. Failure to involve the nurses may lead to the development of systems that are irrelevant or difficult to use and may affect patient care.

References

Agency for Healthcare Research and Quality. (n.d.a). Health IT evaluation toolkit and evaluation measures quick reference guide . Retrieved September 27, 2018, from https://healthit.ahrq.gov/health-it-tools-and-resources/evaluation-resources/health-it-evaluation-toolkit-and-evaluation-measures-quick-reference

Agency for Healthcare Research and Quality. (n.d.b). Workflow assessment for health IT toolkit . Retrieved September 27, 2018, from https://healthit.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit

Louis, I. (2011, August 17). Systems development life cycle (SDLC) [Video file]. Retrieved from https://www.youtube.com/watch?v=xtpyjPrpyX8

McGonigle, D., & Mastrian, K. G. (Eds.). (2015). Nursing informatics and the foundation of knowledge. Jones & Bartlett Publishers.

RE: Discussion – Week 9

When implementing a new health information technology system, there are many steps involved.  Nurses are an essential piece when in the systems development life cycle (SDLC) when implementing a new program.  It is imperative to have nurses share their input as well during all phases of the SDLC.  The required media in this course (Laureate, 2018), stated the four stages of SDLC are planning, design, implementation, and maintenance/evaluation.  The planning stage is the most important.  This is where the functional and technical requirements are planned out, collaborate with colleagues such as nurses on their expertise in a particular area, document and define expectations, outcomes/results are discussed, as well as the financial benefit of the stakeholders and patient safety.  This is where nurses play an essential role in implementing a new system—their expertise on how this can affect their patient care.

The design phase is when the team establishes which programs are needed and how they will interact (McGonigle & Mastrain, 2018).  Creating how one patient chart which flows into the next database visit.  An example, such as a patient who is in a car accident, is treated in the ER, then later requires surgery from that accident.  Connecting each visit into the EHR is essential to create a timeline and necessary information.  The look and feel of the new system will be decided in this phase as well.  This phase is also crucial to getting stakeholders such as physicians and nurses on the same page and eliminating glitches that could result in costly software revisions in the future (McGonigle & Mastrain, 2018, p. 179).

Implementation is the next phase.  This is where meaningful use state is implemented, installation of the hardware, networks are established and works appropriately, user training, policies are placed, and develop the plan for evaluation (Laureate, 2018b).  Having nurses on a steering committee to assist and provide direction during this phase is critical.  Showing some sort of governance structure will help users participate more easily.  Having nurses also use the product in a clinical setting will also assist users to participate.  Nurses that work in IT or informaticists can also help with function disruptions and concerns regarding the implementation of a new program.

The next and last phase is the maintenance/evaluation phase.  Having the patients know that the facility has an equipped and reliable system is essential.  This program needs to be as good as the facility’s mission statement (Laureate, 2018c).  Goals are accomplished in this phase.  Nurses are integral during this phase because they are the front line workers using this program.  To get to this phase, the previous stages must be concluded to reach the maintenance/evaluation phase (McGonigle & Mastrain, 2018, p. 180)

.  This is an everchanging phase.  Software updates will occur during this phase, and challenges will arise.  Every upgrade involves change, and users such as nurses need to educate staff about the program updates.

Absence of strong leadership in all phases of SDLC includes finances, start delays, waste of time and resources, poor decision making, delays with patient care, and communication.  Anytime a change is made, especially when implementing or updating IT, the workflow with clinical and practice management processes will change (Agency for Healthcare Quality and Research n.d.).

A couple years ago we upgraded our Meditech system.  Our supervisors met first, and then the Meditech committee test ran the program.  Once that part was complete, each nurse went into our supervisors’ office and practiced the program.  This is where I was involved and was allowed to see the use of the use and flow of the system.  It is important to have the staff or floor nurses be involved in the SDLC process because we may see or have advice on certain areas

References

Agency for Healthcare Research and Quality. (n.b.d.). Workflow assessment for health IT toolkit. Retrieved April 20, 2020, from https://healthit.ahrq.gov/health-it-tools-and-rescources/evaluation-rescources/workflow-assessment-health-it-toolkit

Laureate Education (Producer). (2018). Managing Health Information Technology [Video file]. Baltimore, MD: Author

McGonigle, D., & Mastrain, K. G. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning, LLC.

RE: Discussion – Week 9

                Nurses are highly involved with indirect patient care such as legislation process or technology design among other aspects of health care. In a situation where nurses are not involved in aspects of the System Development Life Cycle (SDLC) when purchasing and implementing new health information systems, I believe, there are potential negative consequences. This is made up of different stages which are planning, analysis, designing, implementation, and maintenance (Wang et. al., 2019). Lack of involvement of nurses could result in poor attitudes directed at their jobs, poor work morale, nonadherence to the use of the technology, frustration, poor satisfaction with their jobs, decreased patient satisfaction, and poor patient outcomes.

Adaptations to new technology by nurses are critical for the technology to be effective and useful (Zadvinskis et. al., 2018). For nurses to not be involved would be a great error. Nurses know their needs and the needs of their patients. Issues that could arise are interrupted workflow resulting in mistakes in patient care, patient dissatisfaction, and poorer outcomes. For example, if an electronic medical record does not give notifications for drug interactions or allergy warnings, this could be missed and create a safety issue for patients. These issues could arise at any point in the SDLC.

Including nurses would help to address some of these issues. Including nurses in this process would allow nurses to give their professional input and knowledge base to the design of the technology (Risling & Risling, 2020). This would create an efficient working system. When nurses are involved with the implementation, they can more easily educate other nurses on the use of that technology and provide a positive outlook on the system. Nurses must be involved in the process of design for technology to be able to reach its full potential usefulness (Sharpp et. al., 2019).

I have had the opportunity to be involved in the new health information technology systems at my place of employment. The hospital purchased the charting platform; however, I was able to give input on areas that should be in daily charting. The audit done on patients for alcohol screening was not appearing under the required documentation. I also had the opportunity to raise awareness of a glitch in the charting during the admission process, the advanced directives section was not properly working. Had these two issues been missed, there could have been negatives outcomes with patient care and satisfaction.

References

Risling, T. L., & Risling, D. E. (2020). Advancing nursing participation in user-centred design. Journal of    Research in Nursing25(3), 226-238.

Sharpp, T. J., Lovelace, K., Cowan, L. D., & Baker, D. (2019). Perspectives of nurse managers on            information communication technology and e‐Leadership. Journal of nursing management27(7),        1554-1562.

Wang, J., Gephart, S. M., Mallow, J., & Bakken, S. (2019). Models of collaboration and dissemination for nursing informatics innovations in the 21st century. Nursing outlook67(4), 419–432.           https://doi.org/10.1016/j.outlook.2019.02.003