Partnering to provide simulated learning to address Interprofessional Education Collaborative core competencies.

Learning to effectively communicate and work with other professionals requires skill, yet interprofessional education is often not included in the undergraduate healthcare provider curriculum. Simulation is an effective pedagogy to bring students from multiple professions together for learning. This article describes a pilot study where nursing and social work students learned together in a simulated learning activity, which was evaluated to by the Readiness for Interprofessional Learning Scale (RIPLS). The RIPLS was used before and after the simulated activity to determine if this form of education impacted students' perceptions of readiness to learn together. Students from both professions improved in their RIPLS scores. Students were also asked to identify their interprofessional strengths and challenges before and after the simulation. Changes were identified in qualitative data where reports of strengths and challenges indicated learning and growth had occurred. In conclusion, this pilot study suggests that interprofessional simulation can be an effective method to integrate Interprofessional Education Collaborative core competencies into the curriculum.

Defining documentation burden (DocBurden) and excess DocBurden for all health professionals: A scoping review.

OBJECTIVE: Efforts to reduce documentation burden (DocBurden) for all health professionals (HP) are aligned with national initiatives to improve clinician wellness and patient safety. Yet DocBurden has not been precisely defined, limiting national conversations and rigorous, reproducible, and meaningful measures. Increasing attention to DocBurden motivated this work to establish a standard definition of DocBurden, with the emergence of excessive DocBurden as a term. METHODS: We conducted a scoping review of DocBurden definitions and descriptions, searching six databases for scholarly, peer-reviewed, and gray literature sources, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extensions for Scoping Review (PRISMA-ScR) guidance. For the concept clarification phase of work, we used the American Nursing Informatics Association (ANIA)'s 6-Domains of Burden Framework. RESULTS: A total of 153 articles were included based on a priori criteria. Most articles described a focus on DocBurden, but only 18% (n=28) provided a definition. We define excessive DocBurden as the stress and unnecessarily heavy work a HP or healthcare team experiences when usability of documentation systems and documentation activities (i.e., generation, review, analysis and synthesis of patient data) are not aligned in support of care delivery. A negative connotation was attached to burden without a neutral state in included sources, which does not align with dictionary definitions of burden. CONCLUSIONS: Existing literature does not distinguish between a baseline or required task load to conduct patient care resulting from usability issues(DocBurden), and the unnecessarily heavy tasks and requirements that contribute to excessive DocBurden. Our definition of excessive DocBurden explicitly acknowledges this distinction, to support development of meaningful measures for understanding and intervening on excessive DocBurden locally, nationally and internationally.

An Overview of the National Quality Strategy: Where Do Nurses Fit?

The definition of quality healthcare, its accurate measurement, and its effective management is nebulous and constantly evolving. Even the most respected and knowledgeable experts cannot come to consensus on exactly what quality means. Levels of measurement, as well as questions of whom, how, and when to measure are topics of continual deliberation. These discussions occur at multiple levels through councils, committees, workgroups, task forces, and expert panels. Many policy-related decisions these groups make affect nurses and nursing care. All of them affect how patients receive or engage in healthcare. This article discusses the National Quality Strategy by offering a description and history of the quality conversation, including federal advisory committees and quality measurement data standards. There are several gaps in the quality conversation to which nurses could contribute valuable insights. The authors describe ways that nurses can engage in the national quality agenda. The article concludes with a call to action to encourage nurses to take a larger role in driving the National Quality Strategy.

25 × 5 Symposium to Reduce Documentation Burden: Report-out and Call for Action.

BACKGROUND: The widespread adoption of electronic health records and a simultaneous increase in regulatory demands have led to an acceleration of documentation requirements among clinicians. The corresponding burden from documentation requirements is a central contributor to clinician burnout and can lead to an increased risk of suboptimal patient care. OBJECTIVE: To address the problem of documentation burden, the 25 by 5: Symposium to Reduce Documentation Burden on United States Clinicians by 75% by 2025 (Symposium) was organized to provide a forum for experts to discuss the current state of documentation burden and to identify specific actions aimed at dramatically reducing documentation burden for clinicians. METHODS: The Symposium consisted of six weekly sessions with 33 presentations. The first four sessions included panel presentations discussing the challenges related to documentation burden. The final two sessions consisted of breakout groups aimed at engaging attendees in establishing interventions for reducing clinical documentation burden. Steering Committee members analyzed notes from each breakout group to develop a list of action items. RESULTS: The Steering Committee synthesized and prioritized 82 action items into Calls to Action among three stakeholder groups: Providers and Health Systems, Vendors, and Policy and Advocacy Groups. Action items were then categorized into as short-, medium-, or long-term goals. Themes that emerged from the breakout groups' notes include the following: accountability, evidence is critical, education and training, innovation of technology, and other miscellaneous goals (e.g., vendors will improve shared knowledge databases). CONCLUSION: The Symposium successfully generated a list of interventions for short-, medium-, and long-term timeframes as a launching point to address documentation burden in explicit action-oriented ways. Addressing interventions to reduce undue documentation burden placed on clinicians will necessitate collaboration among all stakeholders.

The nursing informatics workforce: who are they and what do they do?

Nursing informatics has evolved into an integral part of health care delivery and a differentiating factor in the selection, implementation, and evaluation of health IT that supports safe, high-quality, patient-centric care. New nursing informatics workforce data reveal changing dynamics in clinical experience, job responsibilities, applications, barriers to success, information, and compensation and benefits. In addition to the more traditional informatics nurse role, a new position has begun to emerge in the health care C-suite with the introduction of the chief nursing informatics officer (CNIO). The CNIO is the senior informatics nurse guiding the implementation and optimization of HIT systems for an organization. With their fused clinical and informatics background, informatics nurses and CNIOs are uniquely positioned to help with "meaningful use" initiatives which are so important to changing the face of health care in the United States.

Patient as center of the health care universe: a closer look at patient-centered care.

We need to consider how the health care system should revolve around the patient, rather than the patient rotating around the hospital. Considering a patient-centric point of view when implementing and optimizing the use of health information technology (HIT) provides new perspectives on the meaning of "integrated" health care. ot only do we need to give patients the opportunities to participate as true partners in their health care, we must convince them why this partnership makes sense. We should not be naive and believe all patients want this involvement in their care today and are ready to do all their health care transactions electronically. But considering and using these practices are important steps in the health care reform journey to improve quality and decrease cost. Many patients will benefit by our working with them to demystify the health care experience through patient-centric practices and the use of HIT.

Engaging patients and families in ehealth.

National Health IT Week, which ran from September 11-16, 2011, served as a time to highlight the importance of efficient information systems that protect the privacy and security of personal health information while improving the delivery of health care in the United States. During the week, the health IT community came together to raise national awareness regarding the consistent breakthroughs and hard work industry professionals, providers, and consumers have put forward to ensure they are moving toward the common goal of advancing the future of health care through private and secure health IT. Two events during the week (the Consumer Health IT Summit and the launch of the HealthlT.gov web site) brought home a theme increasingly seen as important to improving our health care system--patients participation in their care. Nurses will need to work with patients so they understand the importance of their participation as a partner in their care, instead of playing a passive role. One way we can do that is to encourage our patients to actively use technology to manage their own health care and to share information with their health care providers.

How to fast-track your meaningful use effort.

While there is no shortcut to meaningful use, getting the fundamentals right is essential to smoothing the way to qualifying for incentives.

AI in Healthcare.

The potential value of AI to healthcare, and nursing in particular, ranges from improving quality and efficiency of care to delivering on the promise of personalized and precision medicine. AI systems may become virtually indispensable as ever more data is amassed about every aspect of health. AI can help reduce variability in care, while improving precision, accelerating discovery and reducing disparities. AI can empower patients and potentially allow healthcare professionals to relate to their patients as healers supported by the combined wisdom of the best medical research and analytic technology. There are, however, many challenges to understanding the optimal uses of AI; addressing the technological, systemic, regulatory and attitudinal roadblocks to successful implementation; and integrating AI into the fabric of health care. This paper provides a grounding in the origins and fundamental building blocks of AI, applications in healthcare and for nursing, and the critical challenges facing implementation in healthcare.

Clinician and Health Care Leaders' Experiences with-and Perceptions of-COVID-19 Documentation Reduction Policies and Practices.

BACKGROUND: Substantial strategies to reduce clinical documentation were implemented by health care systems throughout the coronavirus disease-2019 (COVID-19) pandemic at national and local levels. This natural experiment provides an opportunity to study the impact of documentation reduction strategies on documentation burden among clinicians and other health professionals in the United States. OBJECTIVES: The aim of this study was to assess clinicians' and other health care leaders' experiences with and perceptions of COVID-19 documentation reduction strategies and identify which implemented strategies should be prioritized and remain permanent post-pandemic. METHODS: We conducted a national survey of clinicians and health care leaders to understand COVID-19 documentation reduction strategies implemented during the pandemic using snowball sampling through professional networks, listservs, and social media. We developed and validated a 19-item survey leveraging existing post-COVID-19 policy and practice recommendations proposed by Sinsky and Linzer. Participants rated reduction strategies for impact on documentation burden on a scale of 0 to 100. Free-text responses were thematically analyzed. RESULTS: Of the 351 surveys initiated, 193 (55%) were complete. Most participants were informaticians and/or clinicians and worked for a health system or in academia. A majority experienced telehealth expansion (81.9%) during the pandemic, which participants also rated as highly impactful (60.1-61.5) and preferred that it remain (90.5%). Implemented at lower proportions, documenting only pertinent positives to reduce note bloat (66.1 ± 28.3), changing compliance rules and performance metrics to eliminate those without evidence of net benefit (65.7 ± 26.3), and electronic health record (EHR) optimization sprints (64.3 ± 26.9) received the highest impact scores compared with other strategies presented; support for these strategies widely ranged (49.7-63.7%). CONCLUSION: The results of this survey suggest there are many perceived sources of and solutions for documentation burden. Within strategies, we found considerable support for telehealth, documenting pertinent positives, and changing compliance rules. We also found substantial variation in the experience of documentation burden among participants.

An interprofessional service-learning course: uniting students across educational levels and promoting patient-centered care.

Recognizing the importance of interprofessional education, we developed a pilot interprofessional education course at our institution that included a total of 10 nursing, BS health psychology, premedical, and pharmacy students. Course goals were for students to: 1) learn about, practice, and enhance their skills as members of an interprofessional team, and 2) create and deliver a community-based service-learning program to help prevent or slow the progression of cardiovascular disease in older adults. Teaching methods included lecture, role-play, case studies, peer editing, oral and poster presentation, and discussion. Interprofessional student teams created and delivered two different health promotion programs at an older adult care facility. Despite barriers such as scheduling conflicts and various educational experiences, this course enabled students to gain greater respect for the contributions of other professions and made them more patient centered. In addition, inter-professional student teams positively influenced the health attitudes and behaviors of the older adults whom they encountered.

The journey to meaningful use of electronic health records.

The American Recovery and Reinvestment Act and its important Health Information Technology Act provision became law on February 17, 2009. Commonly referred to as "The Stimulus Bill" or "The Recovery Act," the landmark legislation allocated $787 billion to stimulate the economy, including $147 billion to rescue and reform the nation's seriously ailing health care industry. Of these funds, $19 billion in financial incentives were earmarked for the relatively short period of 5 years to drive reform through the use of advanced health information technology (HIT) and the adoption of electronic health records (EHRs). he incentives were intended to help health care providers purchase and implement HIT and EHR systems, and the HITECH Act also stipulated clear penalties would be imposed beyond 2015 for both hospitals and physician providers who failed to adopt use of EHRs in a meaningful way. Nurses will be integral to achieving a vision that will require a nationwide effort to adopt and implement EHR systems in a meaningful way.

Nursing and technology: a love/hate relationship.

The fundamental value of information technology in clinical settings is no longer in question, as clinicians enter and retrieve information in order to deliver care and the benefit of ubiquitous availability to clinical data using computers cannot be overplayed. The question now is how to increase adoption, improve productivity, and support transformational changes in health care delivery. It is important to get the interplay between people, process, and technology right for successful implementations which support care transformation. We must lead projects with the clinical practice changes being enabled by the technology, and then ensure the technology supports the practice change. Nurse leaders must consider letting the quality improvement process drive and define when and how technology is used, running our projects as practice changes and not IT implementations, with nursing sponsors owning the projects and leading the charge.

Nursing informatics: the intersection of nursing, computer, and information sciences.

Nursing informatics (NI) is a well-established specialty within nursing. Background on the birth and evolution of NI, and the NI scope of practice and certification are explored. NI has played a vital role in influencing health care information system features and functions. Today, nursing informatics has evolved to be an integral part of health care delivery and a differentiating factor in the selection, implementation, and evaluation of health IT that supports safe, high-quality, patient-centric care.

An IT innovation for individualizing care: success with clinicians leading the way.

In 2004, the Knowledge-based Nursing Initiative (KBNI) began as a partnership between a university-based college of nursing, an informatics vendor, and a large, integrated health care system. The goal was to develop a process for translating evidence into actionable recommendations, embedding the recommendations into the computerized decision support and documentation systems, and supporting nurses' use of the nursing process to individualize care. This paper will describe the essential administrative, information technology (IT), educational and clinical support activities that were used to deploy this innovation into the electronic health record (EHR) and workflow of nurses on two acute care medical pilot units in July of 2008. The project supported every nurse to document their evidenced-based practice with each patient contact and populate the EHR database with rich, nursing sensitive, retrievable data for quality improvement and research. The results included verifying data reliability and validity, evaluating go-live preparation, and summarizing the qualitative and quantitative findings. Two critical factors that made this implementation a success were that the project had a transformational vision and that it was led by the clinical team and strongly supported by the IT team. The lessons learned in the adoption phase will be diffused to the rest of the health care system and beyond.

Validation of the Impact of Health Information Technology (I-HIT) Scale: an international collaborative.

In 2005, the Healthcare Information Management Systems Society (HIMSS) Nursing Informatics Community developed a survey to measure the impact of health information technology (HIT), the I-HIT Scale, on the role of nurses and interdisciplinary communication in hospital settings. In 2007, nursing informatics colleagues from Australia, England, Finland, Ireland, New Zealand, Scotland and the United States formed a research collaborative to validate the I-HIT across countries. All teams have completed construct and face validation in their countries. Five out of six teams have initiated reliability testing by practicing nurses. This paper reports the international collaborative's validation of the I-HIT Scale completed to date.

Forecasting Informatics Competencies for Nurses in the Future of Connected Health.

This presentation will be in a workshop format with a panel of presenters representing four countries. All speakers are authors and will address various aspects from the content of the book published as a result of the NI 2016 Post Conference in Switzerland, Forecasting Informatics Competencies for Nurses in the Future of Connected Health [1], before inviting the audience to discuss and share their views. The discussion will be focused on defining the informatics competencies for nurses in practice and the requirements for informatics training in nursing programs around the world.