Evidence-Based Nursing Practice & Care Plans

Evidence-Based Practice

• Evidence-based practice (EBP) entails gathering, analyzing, and using research findings to enhance clinical practice, work settings, and patient results.
• The goal of EBP is to swiftly integrate the most current research along with clinical experience and patient preferences to make well-informed patient care decisions.
• EBP applies or translates research findings into daily patient care and decision-making, integrating evidence, knowledge, and patient preferences.
• Evidence-based nursing aims to provide top-quality, cost-effective care.

Nursing Care Plan

• A Nursing Care Plan offers direction and standardization for the nursing care a patient requires to enable evidence-based holistic care.

Computerized Nursing Care Plan

• A computerized nursing care plan digitally records care plans.
• This manages large volumes of data in modern healthcare.
• Nurses use computers to store client databases, update information, create/revise care plans, and track patient progress.
• Assessment involves using computer terminals to record admission information and entering further data as prompted by the software.
• Implementation is the use of computers to record interventions and management performed, saving time and improving documentation accuracy.
• Evaluation is the the use of computers to record observations, patient responses to interventions, and evaluation statements.

Advantages of the Computerized Nursing Care Plans

• Eliminates Manual Documentation
• Can execute computerized prescriptions based on nursing diagnosis.
• Can import patient data as part of a nursing assessment.
• Maintains uniformity of nursing diagnoses across healthcare facilities.
• Provides a selection of nursing interventions based on diagnoses.
• Improves patient reception for individualized care, reduced time for diagnostic elaboration

Disadvantages of the Computerized Nursing Care Plans

• Potential limitations if the nursing diagnosis is limited to an outdated healthcare system
• May be difficult for less tech-savvy nurses to use
• Risk of total data loss if the system were to crash

Critical Pathway

• Also known as care map, is a key tool for healthcare quality management through standardization of care processes.
• First introduced in 1990 in the US and UK.
• It is a management tool that helps medical care providers coordinate patient care for specific cases; a guide to usual treatment patterns, giving the "big picture"
• The Clinical Pathway usually recommends total regimens formulated through multidisciplinary collaboration.

Critical Pathways Aims and Outcomes

• Aims to promote organized, efficient, evidence-based patient care to optimize acute and home care outcomes.
• Proper development and implementation can lead to desirable patient outcomes and improved operational effectiveness for the healthcare facility.

Clinical pathway components

• Timeline: Clearly defines the coverage and time elements for each step.
• Categories of care: Groups care sets into categories, including assessment, diagnosis, diet therapy, nursing care, and medical regimen.
• Intermediate/long-term outcome criteria: Pathways provide clear health outcomes to healthcare providers to evaluate care and patient response with outcome criteria as signposts.
• Variance record: Documentation of variance, which is a quality that is divergent or inconsistent with the expected outcome

Benefits of Pathways

• Evidence-based, improves communication/teamwork/care planning, well-defined standards, improved clinical outcomes, optimum care, and continuous quality improvement.
• Maximizes resources and can be integrated into most EHR systems.

Clinical Guidelines

• Clinical Protocols, Clinical Practice Guidelines (CPGs), and Medical Guidelines
• Developed by governing bodies in specific fields or with deputized authority
• The AHA works for cardiac conditions, RITM deals with communicable diseases, and WHO is the global health authority.

Defined As

• Systematically developed statements to assist practitioner decisions about appropriate health care for specific clinical circumstances to reduce inappropriate variations in practice and to promote the delivery of quality, evidence-based healthcare.

Clinical Practice Guideline

• It is a developed statement designed to help healthcare professionals make decisions about care for specific clinical circumstances.
• Aims to ensure consistent, evidence-based care for critical patients using current knowledge.
• Guideline development is a 4-stage process, starting with a detailed literature search for studies on the appropriateness/effectiveness of different clinical strategies, using the research to build guidelines with a small group representing interested parties.
• The guideline is tested by professionals not involved in development for clarity/consistency/acceptability.
• Guideline is tested in settings to see whether it is feasible for use in routine practice.
• Guideline should be reviewed after a specified time period and modified to take into account new knowledge.

Principles

• Clarity: Terms defined and no gray areas
• Compatibility: All components accepted by disciplines
• Clear rationales: Rationales for every recommendation and must be evidence based
• Sensitivity to practical issues: Should take cultural, economic and other related logistics into consideration

Critical Guidelines Benefits and Limitations

• Benefits: Improves health outcomes, reduces mortality/morbidity, improves procedure frequency, promotes standardization.
• Can help reduce healthcare costs.
• Limitations: General patient approach, requires understanding/interpretation of scientific evidence, may not prioritize needs correctly

E-Journals

• An electronic journal are electronic published in electronic format
• They provide a forum for clinicians to share learning and experiences.
• Provides a mechanism to keep readers up to date with current research.

Examples of electronic journals

• American Journal in Critical Care, American Journal of Nursing, International Journal of Nursing Practice and Care, Journal of Clinical Nursing, Nursing Research, Philippine Journal of Nursing.

Advantages of Electronic Documents

• Documents are more useful in electronic form due to enhanced search ability
• It is more economic to have electronic documents instead of printing and storing physical copies due to cost increases

Limitations

• May not all be free to access
• Will require connectivity
• May lead to bulk downloading
• Limited local nursing journals

Guidelines and Laws in Nursing Informatics

• Laws are standards, principles, and procedures that must be followed in society.
• Guidelines offer recommendations for specific standards but are open to interpretation and change.

Policy

• Outlines a government’s goals, evolves needed principles, is a document, not a law, guides organizations, etc. Informal and complies with the law.

Laws in Nursing Informatics

• Diverse laws related to nursing informatics.
• Intellectual Property Code of the Philippines, Copyright Law, Data Privacy Act, Electronic Commerce Act, Anti-Wiretapping Law, An Act Defining Cybercrime

Intellectual Property Code of the Philippines

• (RA 8293) protects the rights of scientists, inventors, artists, and other gifted and is important for informatics, as it involves information distributed online
• Intellectual property: Anything created by someone
• Divided into five areas

The Intellectual Property Office

• A government agency collecting intellectual properties and resolves conflicts.

The Law on Patents

• Exclusive rights to a new and useful product or process (plus improvements), giving the owner enough time to gain returns
• New and useful machines, products, processes (not biological), drugs and vaccine; machine improvements

Law on Trademarks

• Pertains to symbols/goods (trademarks), enterprise names, and rendered services (service marks).
• Importance: differentiates services/goods, aids consumer identification, grants exclusive rights.

The Law on Copyright

• It is the protection given to the owner of an original work covering literary works, musical pieces, paintings, and computer programs.
• Unauthorized third parties are prohibited from selling or distributing the works without owner consent, especially for trade purposes.

Economic and Moral Rights

• Economic: Profit gains created through distributed works
• Moral: Requires authorship attribution/integrity

Privacy and Confidentiality

• Encompasses a patient’s right to keep health information private while protecting them from identity theft, injury or unwanted publicity

Data Privacy Act

• (2012) protects privacy/communication while ensuring information flow, establishes a National Privacy Commission, and protects personal data

Data Privacy and Lifecycle

• Encompasses the rights of individuals and obligations of organizations in collecting, storing, using, disclosing, retaining, and disposing of personal data across its lifecycle.

Two Main Provisions of RA 10173

• Confidentiality of client information
• Processing of Sensitive/Privileged Information

What does it Protect?

• Personal Information: Any recorded data showing identity.
• Sensitive Personal Information: About individual's origin, affiliations, health, or any proceeding,
• privileged information: Established an executive order or an act of congress and kept classified

National Privacy Commision (NPC)

• Mandated to Administer Data Privacy Act

Data Sharing Agrrement

• Collects personal data to show legitimate purpose, prior consent, informing data subjects about the extent/purpose of processing, automated processing for profiling, or direct marketing

Processing Personal Data

• Includes collection, recording, organization, use, consolidation, blocking, erasure or destruction of data, with the exception of: data subject's consent, law, protecting life, for health, protect lawful rights in court.

Personal Informatio Controller and Process

• The controller decides what to collect, and the processor uses data for the controller

Nurse Guidelines for data breach

• Never breach security by sharing information, seek guidance, and follow all patient restrictions

Data Privacy Act Scope

• Applies to the processing of all types of personal information to natural or juridical persons, subject to qualifications.

Data Principles

• Transparency, Legitimate Purpose, Proportionality

General Data Privacy and Privacy Notice

• Privacy Notice needs to demonstrate transparency and organization's commitment

Data sharing

• Disclosure or transfer to a third party of personal data by a controller

Data Sharing Agreements

• Contract contains terms and conditions for sharing data between parties

Types of Data Breach

• Availability Breach leads to loss or destruction of personal data
• Confidentiality Breach leads to unauthorized access or disclosure
• Integrity Breach leads to altered data
• Unlawful Processing/Violation of Privacy by unauthorized data usage

E-Commerce Law RA 8792

• Provides recognition of electronic transactions/documents and signed into law on June 14, 2000, and made the country a legitimate member of the global marketplace.

Anti-Wiretapping Law [1965] (RA 4200)

• Prohibits/penalizes wiretapping and violations of communication privacy with mobile technology

Wiretapping Penalizations Under sections 1 & 4

• Includes unauthorized tapping, possessing/replaying records, or communicating content without consent.

Cybercrime Prevention Act Of 2012 (RA 10175)

• It defines and aims to fight cybercrimes and specifically criminalizes computer crimes and issues involving the Internet.

Rules of Netiquette

• Network etiquette concerned with the proper way to communicate online

Rules

• Remembering the human, Adhere standards of behavior, Where you are in cyberspace, Respecting time & bandwidth, Looking good online, Sharing expert knowledge, Keeping flame wars under control, Respecting privacy, Not abusing power, Being forgiving

When communicating

• Practice the Golden Rule: "Do unto others as you would have others do unto you".
• Remember, your written words are read by real people, all deserving of respectful communication.
• Use the "send" or "submit," and ask yourself, "Would I be okay with this if someone else had written it?"