• Nursing
  • Nurses need an eHealth communication platform too

    As eHealth expands its healthcare role and impact, a significant emphasis’s on nurses’ needs for better information and communication’s essential. They comprise healthcare’s biggest professional cadre. A white paper from Spok, a global healthcare communication company, sets out a way to do it.

    CONNECT THE DOTS: NURSING 3 Ways to Enhance Workflows for Nurses With an Enterprise Healthcare Communications Platform says 54% of nurses are dissatisfied with their current communication methods outside EHRs. It can inhibit nursing evolution such as:

    Changing healthcareTaking on more responsibilities and dutiesExpanding regulationsCost pressuresIncreasing collaborationAdopting new technologiesIncreasing complexities of their roles.

    About 54% of nurses are dissatisfied with their current communication services outside EHRs, so initiatives are needed to support them. These must be structured, with practical strategies for:

    Care team communicationPatient Care co-ordinationWorkflow efficiency.

    Spok’s solution includes eHealth that supports automated communication such as:

    Messaging and location trackingWorkload assignment and managementCapturing patient data on mobiles and transmitting urgent requests to other nurses and healthcare professionals and their servicesFind and link with appropriate clinicians promptlyEfficient patient discharge and transfer processes.

    With eHealth’s allure of better clinical standards within finite budgets, not everything can be achieved simultaneously. eHealth for better communication between healthcare professionals offers valuable healthcare quality too, so Africa’s eHealth strategies and programmes should find a place for this. It can build from its existing mHealth priorities and investment.

  • Five guidelines help nursing and social care

    Increasing demand for healthcare has seen an expansion in the potential for community care to make a bigger contribution. Community care isn’t a new idea. It’s been part of many health systems for decades. Two of its features have been its underdeveloped role, so impact, and effective integration of community health services and social services. 

    A European Union (EU) project’s been seeking ways to improve this. Starting in December 2013 and ending in November 2015, ENS4Care presented its solutions at the EU’s 7th Innovation Summit. An overarching goal for ENS4Care is sharing good practices in nursing and social care. 

    ENS4Care’s five guidelines are for eHealth services for prevention, clinical practice for Chronic Obstructive Pulmonary Disease (COPD), integrated care, continuity of care and nurse ePrescribing and the design of advanced roles. Each of these is seen in a context of a vibrant, motivated and highly qualified health and social care workforce. eHealth’s role is clarified too.

    The guidelines are being deployed in Romania, Bulgaria and Poland. This is in parallel to additional effort with the European Nursing Research Foundation, known as HOTUS, to apply evidence-based policy-making in European health and social care policy. 

    ESN4Care’s guidelines offer Africa’s health systems an excellent step up in developing their community services as part of responses to severe health worker shortages. They also show numerous opportunities for eHealth’s contribution. A short summary of each guideline’s:

    Prevention

    Nurses and social workers with the right knowledge and skills will add considerable value to, and form an important link between, technological innovation, health promotion and disease prevention eHealth tools and technologies should be user friendly for patients, carers, the public, professionals and everyone else involved Choices of eHealth tools and technologies should be based on sound scientific principles eHealth interventions should be assessed for cost effectiveness Nurses and social workers should assess the health literacy levels of patients, carers, families and communities to ensure they’re enabled to harness and gain maximum benefit from changing eHealth technologies Nurses and social workers should have the knowledge, skills, opportunities and capacity to use the tools and technologies effectively eHealth tools and approaches must comply with local and national policies and structures for data protection, patient confidentiality and privacy and legal and governance requirements

    Clinical practice for COPD 

    All eHealth services must be supported by robust governance arrangements Planning for all eHealth services must include statements on how ICT components will benefit practices and citizens During eHealth implementation, consideration needs to be given to the disruption that it may cause to staff In a citizen self-monitored service, citizens should maintain their own records, such as data about symptom scores and vital measurements, and assume responsibility for sending the data to hospitals, GPs, primary care centres or call centres Biometric measuring devices, such as equipment that monitors heart rate, blood pressure, blood glucose levels, oxygen saturation, and weight should be considered for remote monitoring and management of citizens with acute and chronic illnesses in patients’ homes Secure transfer, access and storage of health and social care data’s essential Ethical principles and standards should guide the governance and risk management structures of services A strong leadership presence is essential through implementation of all eHealth services Consideration needs to be given to developing clear and accessible staff documentation such as instruction manuals, guidelines and protocols eHealth education and training should involve citizens, carers, health professionals and social workers Evaluation processes should identify changes in key indicators that reveal areas where the eHealth service has positive or negative impact Maintaining citizen privacy and safety are crucial to the long-term success of any eHealth service that hosts citizen and provider data eHealth should be user friendly eHealth should be well integrated with existing ICT systems so they can be easily accepted and used by health workers.

    Integrated care

    eHealth solutions should be considered for any health issue that requires an element of collaboration between primary and secondary healthcare and social workers All countries should have a common database-based network solution that can help with the coordination and communication between primary and secondary care providers, including nurses and social workers Integrated eHealth care needs equal involvement from primary and secondary care partners Outcome data and indicators of success that includes satisfaction with care, readmission rates and average length of hospital stays should be collected throughout the process Documentation should use the international standards of reference terminology model recommended by WHO Consideration should be given to establishing a single point of contact for staff support with a super-user who can respond to issues, troubleshoot and offer advice

    Nurse ePrescribing 

    Jurisdictional factors, including legislation and prescriptive authorities should be considered in the initial stages of planning for nurse ePrescribing Informatics infrastructure and platform should be considered in the initial stages of planning for nurse ePrescribing Competency in clinical decision-making should be considered in the initial stages of planning for nurse ePrescribing

    Advanced roles

    eHealth should not be seen as a substitute for face to face contact with health and social care professionals that citizens need at times of crisis and during acute phases of their illness Nurses and social workers should offer social prescriptions when it’s appropriate to offer citizens options of assistance to change their lifestyles as an alternative to medications or other clinical interventions Nurses and social workers should employ telehealth solutions to empower people living at home to assess their own state of health and enable health and social care professionals to remotely monitor their physiological data for diagnosis or disease management Nurses and social workers should employ telecare that uses a combination of sensors and other equipment, usually in the home environment, to help vulnerable and physically less able citizens to keep themselves safe and alert a control centre if help is required Nurses and social workers should empower service users to participate in implementing and monitoring their own service and treatment measures of care and the related decision-making processes.

    For each of these guidelines, the reports contain considerable detail about their deployment, use and benefits. They’re paths that Africa’s health systems can follow.

  • Nurses aren't convinced about EHRs either

    Not only doctors are unconvinced of EHR’s value, as posted earlier on eHNA. A Black Book report now shows that nurses have similar views. The team surveyed 13,650 US nurses to gauge their satisfaction with their hospitals’ EHR system. Full results are promised later this month and they charge for the full report. iHealthBeat has a short summary on the results.

    The report’s findings are full of lessons for African countries considering the costs and benefits of implementing EHRs. Thought to be a tool for improving information sharing and quality of care, the results are staggering. They include that:

    92% of nurses reported being dissatisfied with their organization’s inpatient EHR system 94% of respondents said they do not believe that communication between the nurse and the rest of the care team has improved 90% said their EHR system has adversely affected communication between nurses and patients 85% said they struggle daily with flawed EHR systems Only 26% agreed with the statement: “As a nurse, I believe the current EHR at my organization improves the quality of patient information”

    African countries face tough human resource challenges, with EHR vendors frequent claiming to help deal with these. It’s noteworthy that the report describes 79% of job-seeking nurses said the reputation of a hospital’s EHR system is a “top three” consideration for employment. Getting it right is important.

    On the cyber-security front 67% of nurses reported being taught workarounds in flawed EHRs to enable other providers to view appropriate patient information; and only 30% of nurses said their IT departments respond quickly to fix potential vulnerabilities in documentation.

    A particular warning for those procuring systems in Africa is that 88% of nurses blamed their hospitals’ financial administrators and CIOs for choosing low-performing systems based on price, rather than quality of care delivery. It’s a cogent reminder of the Ruskin quote, from Tom Jones’ August 2014 eHNA post on affordability “It’s unwise to pay too much, but it’s worse to pay too little.”

  • eHealth engagement means nurses too

    Nurses comprise the largest group of health workers. It is obvious that eHealth engagement strategies and arrangements must include them. In an interview for HIT Consultant, Elizabeth T. Jordan, Associate Professor University of South Florida College of Nursing, sets out why this is essential, but is not in place.

    She sees a generational divide in the way nurses use technology. Older nurses take longer than younger ones to adopt healthcare technology. This sounds familiar for all walks of life. Her main premise is that “Healthcare space is getting bigger, and nurses working on those units really rely on technology to be able to communicate.” The implications for the biggest workforce segment justify her proposition that she would like as part of the development and deployment stages of new technology.

    For African countries to maximise the use and benefits of their eHealth initiative, it is worth reviewing their engagement models.

  • Translating USA nursing benefits for Africa

    Patients’ demand for nurses exceeds their capacity. This is conventional wisdom. Liberating some of their time to be able to meet more demands is a constant goal. Having achieved some of this, the use of their redeployed time is not a generic set of steps. The difference is stark when comparing the USA to Africa, not a surprising fact. It is just as stark comparing Australia, Canada and Germany, which have broadly similar rates to the USA. The UK is out in front with more than 12 nurses per 1,000.

    In the USA, a redeployment goal is to spend more time with patients and their families. The SmartRoom initiative has helped to realize this. SmartRoom is a company that provides health IT solutions to improve clinical workflow and provide information for clinicians at the bedside. IBM and the University of Pittsburgh Medical Center (UPMC), USA are its financial backers. It has recently published a case study of its nursing information initiative. It is part of its Smarter Planet Leadership Series.

    Redeploying saved nurses’ time to spend more time with patients and families, needs reworking to fit healthcare systems in Africa. It could translate to being able to see more patients: an essential goal for most African health and healthcare strategies.

    The USA has about nine nurses per 1,000. Sub-Saharan Africa has an average of about 1.2, with a standard deviation of about 1.5, dropping to about one per 1,000 leaving out the Seychelles. Seychelles has the most nurses at about 7.9, similar to Spain and Japan. It is a distant outlier in an African list, but still more than 10% fewer than the USA. The lowest African rate is about 0.2 nurses per 1,000.

    The nursing shortage is well known, and matched by shortages in other healthcare professions. eHealth solutions on their own cannot close the gap, but they can help nurses to reduce time they spend on administrative and chasing tasks that they can redeploy to direct patient care. Investing in eHealth with this purpose is probably more valuable to African countries than to the USA. Dealing with more patients where unmet demand is massive could be higher value than the USA goal of nurses spending more time with patients and families. This difference is a direct result of their vastly different healthcare systems and resources.