2 references per response
Post #1
As a psychiatric nurse in an inpatient mental health unit, I am responsible for assessing the safety of my patients with various mental health conditions such as suicidal, self-harming, homicidal, experiencing auditory, visual, tactile hallucinations. During my shift, I conduct a head-to-toe assessment, interview the patient, and perform a chart review. In addition to the information derived from above, I complete the Columbia Suicide Severity Rating Scale (C-SSRS) for all patients. This scale predicts future suicidal behavior based on the patient’s past actions and current presentation. This tool provides the treatment team with more robust, direct information into the suicidal thoughts of the patient and their present risk for self-harm (National Suicide Prevention Lifeline, 2009).
Currently, this scale is completed in paper form at my hospital. The scoring is done by the nurse who conducts the interview. Although most charting is electronic, this daily assessment tool remains in the paper chart format. As a result, a daily risk of providers (psychiatrists, nurses, nurse practitioners) not receiving this information promptly. Sometimes the paper scoring is not filed on time in the paper chart. This can result in the omission of critical information during the review of patient acuity and risk factors by other providers. The missing data can result in inaccurate treatment plans, interventions, and possible sentinel events. Including the C-SSRS in the electronic health record (EHR) will improve information accessibility and the timely availability of this data by nurses to convert the information into knowledge and timely interventions (McGonigle & Mastrian, 2022, p. 15).
Using clinical reasoning and judgment, the nurse leader will mitigate this limitation by working with the IT department to integrate the Columbia Suicide Severity Rating Scale into the HER system. The system will provide automatic scoring of the scale and each patients’ daily comparison of the score from the previous day. According to Sweeney (2017), healthcare and nursing informatics help improve patient outcomes.
Post #2
Nursing informatics plays a vital role in the continuity of patient care. Nursing informatics is defined as using technology to collect and analyze data to improve patient care and outcomes (RegisteredNursing.org Staff Writers, 2021). My scenario is there is a patient in fluid resuscitation. In our burn center, we have a protocol that if the urine output is greater than 50 ml an hour, we decrease the fluid intake by 1/3 and if the urine output is less than 30 ml an hour, we increase the fluid intake by 1/3. We must figure out a starting point for fluid intake. To do so we use the parkland formula, although there are many other factors we must consider. The patient I will be using has a single good kidney due to a past medical history of renal cancer.
Describe the data that could be used and how the data might be collected and accessed.
The urine output and fluid input will be the main numbers used in the decision-making process of fluid resuscitation. During this process we also draw labs every 12 hours to keep an eye on the patient’s kidney function. To keep an accuratecount of input and output the patient is on continuous intravenous fluids, in our burn center we use lactated ringers and Albumin. The patient is put on an Accuryn urine monitor that keeps an hourly count of his urine output through an indwelling urine foley catheter. Since the late 1980’s informatics in nursing have been increasingly helpful with continuity of care. Nursing informatics is a field that is becoming increasingly important with healthcare. The use of this data through the growth of technology is improving patient outcomes (Gaudet, 2021).
What knowledge might be derived from that data?
The data given is hourly urine output versus the intravenous fluids going in. This data lets us know just how well the patient’s kidneys are functioning with the fluid shifting that happens with burn patients.
How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?
A nurse leader could take this patient’s case and follow trends in his urine output versus what the fluid intake is. This could help improve our fluid resuscitation protocol which could result in better patient outcomes and potentially result in a decline of patients needing dialysis. Nursing informatics is used to help find areas of improvement and help them grow using the most recent data (OJIN,2021).
