4.17.2010

Informatics of Nursing Education

Instead of raising your hand to ask a lecturer a question, why not press a button?

Why not put a screen on that button so it tells you how many people pressed their buttons first? Say you had only four people sharing one of these buttons. Two people might press the button one after another, then two numbers would be displayed. Add a second button to cancel the most recent button-press. Put microphones in all the buttons so everyone can be heard.

That would have been a nice lecture to have.


The anachronism that is Paper Charting continues to gnaw at me. The more I understand what's going on around me in a paper charting environment, the clearer it is to me that huge swaths of our time is being wasted in fools' errands. The worst part about it, to me, is that the charting isn't even fulfilling it's purpose. Conveying information. The charting of most healthcare institutions I've seen is more concerned with how to get reimbursements than conveying information in a useful and meaningful way.

I daydream, sometimes, about what an electronic charting tool for CNAs, LPNs and RNs in a skilled nursing facility might look like on a spiffy linux based tablet like the german-engineered wepad.

Nurses seem to be a pretty technophobic bunch, but many of them deftly use facebook, for example.

User Interface Design seems like a wholly foreign concept to the developers of most of the information technology I've seen in educational and healthcare institutions. Menus made up of laundry lists of nonsense and irrational depth, unintuitive layouts, it's like they aren't trying. Your fancy multi-million dollar computerized charting system is worthless if it's unintuitive and frustrating. More frustrating than, say, a piece of paper and a pen.

I struggle on with paper charting, since I'm not too optimistic that whatever electronic charting tool I'm handed will fail to infuriate me.

We have a computer at our desk, that's the thing that kills me the most. A computer none of us use. It's not that great, but even a low-end computer from a few years ago is light-years beyond what the old room-sized punch-card computers could do.

I'm not trying to crack the atom here, this is really simple.

For each person:
-What went into them?
-What came out of them?
-How are they feeling?
-What can they do?
-What did you do for them?

The CNA interface could just be icons. Tasks can be organized and presented for quick reference, signed by the person that completed them. Punch in that 120ml glass of water on the spot, no need to remember or "guestimate" what percentage of their meal so-and-so ate. Just tap it in while you're there. Signing off on when different types of care are performed also provides valuable information to anyone interested in bowl-and-bladder issues, sleep&rest, etc.

The floor nurse's view contains all the CNA info along with med-administration and treatment info. Instead of a huge 3-ring binder of flip-cards to initial, why not just a list of what needs to be done, and when it needs to be done by? Add to it a feed of the CNA's activities and the floor nurse knows right away if someone's been using the bathroom more often than usual or is suddenly incontinent when they weren't before. While they're at it, they can add the 120ml of water THEY gave the resident along with their meds. Info goes to the same place. Most importantly, maybe, current orders regarding activity and precaution are presented uniformly, universally, and changes are instantaneous. Better still, recent labs, consult reports and therapy progress notes could be referred to at any time. Medication orders would update automatically, without errors in transcription or comprehension.

The nursing supervisor would have all of the same info as the first two views, but with expanded options for managing workflow and staff scheduling, as well as a running list of all issues everyone in the unit is currently having, and what kind of help people need. Let's say someone gets tied up in an emergency, and hasn't gotten around to getting someone's blood-sugar or giving them their IV antibiotic. If there's already crap going on, who has time to run around looking for help?

There's an easier way, and we could probably put it together from scrap parts cheaper than our pulse oximeter.

This issue may be central to the future of the nursing profession. If we can't organize ourselves well enough to train new nurses quickly enough, more and more of the functions of the nursing profession will be ceded to unlicensed technicians with specialized functions.

I say specialization is for insects!

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