Problem and purpose: Liver cancer patients are a complex patient population, and the treatment of choice is radioembolization with Yttrium-90 treatment, when surgery is not suitable. It was identified that the current workflow flow process to coordinate a treatment was inefficient and fragmented due to the use of a paper-based approach. This process caused omissions that resulted in delays of treatment and delays in surveillance imaging in post-radioembolization treatments. The purpose of this project is to implement an electronic checklist to improve patient safety and timeliness of obtaining surveillance imaging in liver cancer patients who have undergone a radioembolization treatment.
Evidence/background: The literature reveals that it is critical to have close follow-up and timely surveillance in post-radioembolization treatments. Surveillance imaging is used to determine tumor response and detect new lesions. A radioembolization treatment can lead to progression free survival and result in successful downstaging of tumor. It can also prepare a patient for liver transplant candidacy.
Methods: An electronic checklist was developed within the existing electronic health record for patients undergoing a radioembolization treatment in the interventional radiology department. Patients diagnosed with liver cancer and candidates for a radioembolization treatment were reviewed for six months to determine the number of patients who did not have any omissions in the pre-radioembolization evaluation and number of patients that obtained a timely surveillance imaging post-radioembolization. The plan-do-study-act cycle was performed to monitor the progress of the electronic checklist.
Results: The use of the electronic checklist resulted in three omissions in the pre-radioembolization treatment phase. Out of the 24 patients who were referred for a radioembolization consultation, six patients underwent a radioembolization within the 6-month time frame. The data revealed that 66% obtained timely surveillance imaging studies post-radioembolization treatment.
Conclusion: The implementation of the electronic checklist showed overall improvement in patient safety and streamlining the workflow process. Continued success of this quality improvement project will warrant an agreed upon policy by the interventional radiologists and medical oncologists with specific surveillance imaging guidelines.
Considering the vast amount of unstructured data in nursing documentation from the electronic health record systems, natural language processing (NLP) was used to find an association with any antecedent factors and any contiguous sequences of two and three words/events related to aggressive behaviors for predicting restraint/seclusion in an adolescent psychiatric inpatient unit.
The purposes of this study were 1) to apply an NLP method to develop a model for predicting the need for the use of restraint/seclusion based on analysis of EHR free text psychiatric nursing notes and 2) to understand predictors of aggressive behavior within a context, by identifying any contiguous sequences of two and three words/events related to aggressive behaviors that might be potential antecedent factors, using NLP. An explorative and predictive quantitative design using data mining of secondary was conducted using patients' electronic health records collected between January 2017 and August 2017. The data (455 adolescent psychiatric inpatients, 80,000 clinical notes) was retrieved from the records of the Bradley hospital. Additionally, all paper-based data was entered manually for data analysis. All the data were analyzed using two software R 3.4.2. (R Core Team, 2013) for data mining, and Python 3.6.3. (Python, 2017) for NLP, following Fayyard’s KDD process (Fayyad, 1995). NLP was used to extract unstructured data, using Python 3.4.2 (with Python natural language toolkit, ver. NLTK 3.) in order work with human language data. Specifically, we used powerful word embedding approach word2vec (Mikolov et al. 2013) to convert words into a sparse vector space where objects with similar semantics where locate closely. All identified patients’ risk factors from NLP were analyzed by three different algorithms: two shallow models, including logistic regression and decision tree, and one deep model including recurrent neural networks (RNN) with long short-term memory (LSTM). The NLP-based algorithm identified all potential antecedent factors and contiguous sequences of two and three words/events in the free text. From this study, we can better understand the sequential patterns of aggressive behavior within the psychiatric inpatient units, using NLP from unstructured nursing data. NLP could extract meaningful data from narrative unstructured nursing text to predict/identify the need for the use of restraint/seclusion in psychiatric adolescent inpatient units. Multiple factors potentially could be used to provide early intervention for reducing the use of restraint/seclusion. In addition, we could better understand the aggressive behavior as a highly dynamic contextual problem.
The TIGER-Based Assessment of Nursing Informatics Competencies (TANIC)© instrument represents an operationalized version of competencies first identified by the TIGER Initiative (Technology Informatics Guiding Education Reform, 2017) as knowledge and skills that every practicing nurse should possess to provide care in today's technology-rich healthcare environment. It is a self-assessment tool comprised of competencies grouped into the following categories: basic computer skills, information literacy, and clinical information management. The developers of the tool thought it would be useful to have students enrolled in graduate nursing informatics courses self-assess their knowledge and skills in these areas with the idea that it would help to make them aware of these competencies and that self-assessment would provide information useful to guide self-development as well as guide course development. Subsequent to development, the TANIC was piloted and has since been used in a number of academic and practice settings nationally and internationally. Until January 2019, it was only available as a paper-based self-assessment used by students, as well as a number of organizations who use the tool as a basis for job description requirements, limiting its use for course development and evaluation purposes. Students now have the ability to complete an electronic version of TANIC through a link provided in the course to Qualtrics, a survey development software that allows for statistical analysis. For the purpose of this comparison over time manual entry of data collected prior to January 2019 was entered into Qualtrics. Authors surmised that there might be an increase in informatics knowledge and skills with the passage of time. Insights and recommendations for future data collection will be presented in detail as well as implications for course changes and other uses. Initial instruments in the course did not collect demographic data.
This conversion of the TANIC to an electronic format follows recommendations from previous researchers and developers related to improving completion of the tool, as well as meeting the recommendations by ANA for standard 9 of the scope and standards: The informatics nurse systematically enhances the quality and effectiveness of nursing and nursing informatics process. The use of this tool will help further research endeavors, as well as implementation into practice to advance the NI profession.
Purpose: The purpose of this planned poster presentation will be to illustrate the use of innovative instructional design to incorporate the three main components of universal design for learning (UDL) to ensure accessibility for all students.
Background: According to the World Health Organization, 15% of the world’s population has a disability influencing their daily life (2014). The United States has legislation designed to help those with disabilities have the same access to places and services as everyone else. The Americans with Disabilities Act (ADA) was put into place in 1990 and it stipulates that regardless of the disability, public spaces and services must be accessible to all. Despite this legislation, more awareness about accessibility is needed. When UDL principles are used, the focus is on the creation of educational content to better engage all students, not just the imaginary “average” student.
Learning outcome: Instructional design strategies to be presented will include best use of multiple forms of media for instruction, ways to allow different methods of student expression, and opportunities for improved learner engagement.
Conclusion: “Universal design for learning (UDL) is a research-based set of principles to guide the design of learning environments that are accessible and effective for all” (CAST, Inc., 2019). The phrase, universal design for learning (UDL), originated from architectural design principles developed for ease of access to all buildings and structures at North Carolina State University (North Carolina State University, The Center for Universal Design, 1997). Over time, educational researchers have used these design principles to ensure access to learning, in all types of learning environments, for all students. The UDL framework is based upon education theory, developmental psychology, cognitive science, and cognitive neuroscience. There are three main components of UDL: 1) multiple representations of information, 2) alternative means of expression, and 3) varied options for engagement (Rogers-Shaw, C., Carr-Chellman, D. J., & Choi, J., 2018). When these guidelines are followed, information is presented to students in flexible ways, barriers to instruction are reduced, and all students have access to learning. The integration of UDL guidelines throughout nursing and other healthcare educational programs is necessary to adequately prepare tomorrow’s healthcare workers to provide patient care in the technology-laden healthcare environment.
References
1. CAST, Inc. (2019). About Universal Design for Learning. Retrieved from www.cast.org
2. North Carolina State University, The Center for Universal Design. (1997). The principles for universal design. Retrieved from https://projects.ncsu.edu/ncsu...
3. Rogers-Shaw, C., Carr-Chellman, D. J., & Choi, J. (2018). Universal Design for Learning: Guidelines for Accessible Online Instruction. Adult Learning, 29(1), 20–31. https://doi-org.ezhost.utrgv.e...
4. World Health Organization. (2014). Disability and Health (Fact Sheet No. 352). Retrieved from http://www.who.int/mediacentre...
A local chapter from a professional nursing organization hosted its first symposium. The chapter learned from this experience, and is seeking to disseminate this information to other chapter leaders and informatics professionals through a poster presentation. As chapter leaders, it is important to drive our mission and ensure that we are in alignment with the Nursing Informatics Scope and Standards of Practice, which identifies education as a standard of professional performance. Regional symposiums support knowledge sharing at a local level. By facilitating yearly symposiums, we support education accessible to those without the means to attend national conferences.
In 2017, we used Survey Monkey to gather information on who comprises the chapter and what days work best to host events. The data gathered from the survey drove our 2018 member meetings, where topics of interest were identified. With this knowledge in mind, we sought counsel from the regional director, who was able to connect us with another chapter that had hosted several symposiums. After speaking with the other chapter leaders, it became evident that we would need to seek out our members to form a task force. We created the symposium task force and recruited chapter member volunteers through email using the listserv. By including our members in the event planning, it brought in a wide range of experience and ideas, while at the same time increasing chapter member engagement. A monthly meeting date and time was chosen from volunteer input using a Doodle pool. Google Calendar was used to send out meeting invites. We used a conference call service for calls, and later used Zoom for screen sharing capability.
Early in the planning, we identified smaller task groups: facility, promotions, registration, and moderators. During monthly meetings, we were able to identify and assign tasks and had those groups work on action items between meetings. The facility team was comprised of chapter members that worked at the host site. They held multiple onsite meetings during planning. Registration was done using JotForm, a web-based application used to collect registration information and process payments. Promotions created marketing materials, agendas, and a photo frame. We utilized the chapter Google shared drive to store symposium planning documents. An excel spreadsheet of tasks, assignments, and due dates for tracking our planning was created. In addition, a vendor request letter was created, and two vendors were recruited to attend. We identified multiple team leads for the day of the symposium, such as vendor point of contact, food, registration, moderators, facility, and chapter sales. Having leads for each area was integral to a smooth coordination of the event.
The symposium was a success; 48 members attended from New York, Connecticut, and New Jersey. One of the members that attended the event has approached the chapter with interest to host next year’s symposium. A post-event survey was sent out using Survey Monkey to measure attendee satisfaction. Ninety percent of attendees would very likely recommend the event to a colleague.
Our organization spends considerable time and effort training and onboarding inpatient nurses for our electronic medical record (EMR). Nurses average approximately eight hours of EMR training for system functionality that covers fundamental workflows such as patient admission, shift duties, and patient discharge. Despite the efforts made for staff nurses, nurse leaders have not had their own training despite their unique needs. In fact, the evidence suggests that nurse managers lack initial and ongoing training needed to perform their job duties.1
Onboarding managers and charge nurses are not typically responsible for direct patient care, yet they should still know staff nurse workflows in the event they may need to cover. From a leadership perspective, having system knowledge to understand unit metrics, revenue, patient throughput, and making staff assignments is essential. The reporting features of the EMR can be used to ensure that nurses are meeting required documentation and compliance with orders as dictated by organizational policy and regulatory bodies, such as The Joint Commission. The ability to track nurse-sensitive quality indicators using reporting features of the EMR is helpful to see trends on the unit and subsequently intervene as appropriate.
In January 2020, we will be piloting an EMR training class specifically for nurse managers. The pilot will include approximately 15-20 nurses from select units. At the conclusion of training, a course evaluation will be provided to these nurses to determine course effectiveness and satisfaction. Using metrics provided from our EMR vendor, we will then be able to track nurse leaders with their adoption of reporting features and other tools that enhance efficiency.
Our hope is to be able to educate these leaders to be able to better manage staff and monitor their units for potential patient safety risks. We wish to present via poster the outcomes of our pilot and lessons learned along the way.
References
1. Soriano, R., Siegel, E., Kim, T., Catz, S. Nurse Managers’ Experiences with Electronic health Records in Quality Monitoring. 2019, Nursing Administration Quarterly, 43(3), 222-229.
Many authoritative and credible sources have called for nurses at all levels to demonstrate informatics competencies. However, gaps related to incorporating informatics into nursing curricula continue to exist. Knowledge pertaining to technology, informatics, and data management are essential for PhD level nurses, particularly as they engage in the process required to answer research questions using available data sources. Yet, there is little guidance related to how informatics competencies should be infused into a nursing PhD program. The informatics for healthcare teams and scholarly inquiry course was designed to enable nursing PhD students to develop informatics skills and competencies using a research-oriented approach.
Many graduate nursing programs offer didactic courses via e-learning, also referred to as online or distance accessible methods. The concerns about the quality and depth of an online research-based PhD course prompted faculty to explore potential pedagogical methods to enhance teaching nursing informatics content. The purpose of this presentation is to describe and present strategies used in teaching a nursing PhD informatics course online which was designed to equip students with knowledge about technology that supports and/or facilitates their research.
This presentation will highlight how an online informatics course has the potential to yield the best possible learning outcomes for nursing PhD students. Faculty will describe the process of selecting appropriate interactive teaching strategies and the use of a variety of technology tools to meet multiple pedagogical principles. Guidelines for strategies that have already been successful in facilitating learning of informatics-related concepts within an online format will also be shared. Anecdotal feedback and challenges encountered will be shared.