N1140 Final

Nursing Practice: Digital Health Environment

• Nurses should conduct initial and ongoing assessments of patients and families to determine their accessibility, motivation, knowledge, and preferences, as well as the suitability of Digital Health Technologies (DHTs)
• Nurses should educate individuals and families about DHT use
• Nurses should be involved in the procurement, adaptation, adoption, and implementation of DHTs
• The ICN (2023) supports the ethical, safe, and inclusive use of digital health in nursing
  • It advocates for nurse involvement in tech design and leadership, promoting digital competency development
  • It aims to close the digital divide while ensuring privacy, safety, and environmental protection
• The CNA, in conjunction with CNIA (2024), urges nurses to take the lead in shaping digital healthcare
  • This involves promoting digital literacy, incorporating ethical technology use and AI, and delivering patient-centered care
  • Emphasis is placed on nurse education, policy involvement, as well as leadership in digital innovation, equity, and environmental responsibility

Health Information Technology (HIT) and Nursing Informatics

• Health informatics integrates healthcare, nursing, and information/digital technology
• It promotes health and wellness worldwide, enhancing nursing roles across the board
• The fundamental theorem posits that technology and practice together create the best healthcare outcomes
• Digital health technology refers to the use of technologies for health-related activities and behaviors
• It supports health outcomes, promotion, disease prevention, and surveillance

Assessment and Implementation of DHT

• Assessment considerations include preferences, goals, capability, motivation, digital, health and reading literacy, willingness, fit, technology availability and cost, and the family or client's needs
• Implementation considerations for DHT involve physical space and facility access, provision and receiving care, interaction with providers, receiving and assessing health information, healthcare assessments, and nursing care

Implications of Nursing Practice

• Nursing informatics requires specific knowledge, skills, abilities, and competencies
• Factors such as the social determinants of health, digital literacy, and ecosystem play a vital role
• Adherence to standards, competencies, policies, regulations, social justice, and health equity is essential
• Patient safety, evidence, and ethically informed practices are key
• Technology applications and emerging technologies must be considered alongside benefits, opportunities, and challenges
• Interprofessional and intersectoral collaboration, decision-making, advocacy, leadership, and professional development are essential

Digital Health in the Workplace and Social Media Use

• Newly qualified Canadian nurses face challenges due to limited digital health exposure during education
• This leads to issues such as inconsistent training, varying support levels, and technology infrastructure gaps
• There is a need for improved digital health education
• Nursing students engage in both formal and informal learning through social media, using it for community building
• However, professionalism is a concern

Competencies

• Competency is a complex combination of knowledge, skills, attitude, internal and external resources to apply appropriately to specific situations
• Facebook is the most used social media platform, followed by YouTube, then Instagram

Formal and Informal Uses of Social Media

• Formal social media uses include course assignments, clarifying content, sharing course-related material, studying for exams, and patient education
• Informal social media uses comprise connecting with peers, seeing what is happening "behind the scenes", reviewing clinical skills, exploring areas of interest, and scaffolding knowledge

Professional Expectations (Six P's)

• Professional behavior
• Positive attitude
• Maintaining a patient/person-free approach
• Protecting oneself
• Ensuring privacy
• Pausing before posting online

Social Media and Professionalism

• Social media use involves benefits and risks and impact professional image
• Confidentiality, privacy, and boundaries are crucial
• Expectations, integrity, employer policies, and accountability must be observed

Regulatory Policies and Conduct

• College of Nurses requires you to demonstrate professionalism, respect for colleagues, maintain public confidence and be accountable for decisions and actions
• Standards of practice that discourage disgraceful, dishonourable, and unprofessional conduct
• National Council of State Boards of Nursing provides guidelines for social media use
• The INRC promotes professional integrity on social media, using proper channels for conflict, and respecting colleagues/clients online
• You have to be mindful of credibility, relevance, accuracy, legitimacy, potential distraction, professionalism, and accessibility before posting

Digital Health Equity

• Digital health technologies should be designed with equity in mind, involving diverse stakeholders, human-centered design, and benefiting underserved populations
• Policies should outline expectations, values, and serve as a basis for consistent decision-making and resource allocation
• Health policies should encompass decisions, plans, and actions to achieve specific healthcare goals
• The Canada Health Act of 1984 seeks to protect the well-being of Canadians and ensure healthcare access without financial barriers
• The People’s Health Care Act of 2019 is committed to a sustainable, digitally enabled, publicly funded care system
• The Personal Health Information Protection Act of 2004 governs healthcare information policy in Ontario, granting clients control over their personal health information
• Sharing of health care information within health care teams is permitted, provided it is secure and confidential

Personal Health Information and Determinants of Health

• Personal Health Information is any identifying data about clients
• This includes verbal, written, or electronic information, such as physical or mental health details, family health history, and health card number
• Clients maintain the right to refuse or withdraw consent regarding the collection, use, and disclosure of their health information
• Social determinants of health include social and economic factors such as income, employment, education, childhood experiences, physical environment, social supports, healthy behaviors, access to health services, biology, genetics, culture, gender, and race
• Digital determinants of health are factors rooted in the digital world that influence health, like internet access, device availability, digital literacy, AI, and digital divides

Literacy

• Digital literacy is the ability to understand, integrate, communicate, evaluate, and create information safely and appropriately through digital technology
• Digital health literacy is the ability to seek, find, understand, and apply electronic health information to solve health problems
• Health inequity refers to unfair and modifiable health inequalities, such as unequal access to healthy foods for Canadians in remote areas
• Digital health equality means equal opportunities for individuals to benefit from digital health technology advancements

Social Justice and Equity

• Digital health related to social justice includes providing equitable starting points, individualized experiences, addressing inequities, creatively solving problems, and including marginalized communities
• Health equity constitutes the absence of unfair systems and policies that cause health inequities

Evaluating Misinformation Online and Bots

• Online searches to fact-check false news can increase its perceived veracity
• Approximately 66% of bots were involved in COVID-19 conversations, spreading misinformation through conspiracies and amplified narratives
• It is difficult to identify bots due to their sophisticated mimicking of human behavior

Health Literacy and Online Behavior

• Health literate means one is capable to obtain, understand and act upon health information and services to make informed decisions
• 60% of Canadian adults and 88% of Canadian seniors are not health literate
• 37% of Canadians search for health information online, and 23% reported negative reactions due to online health advice
• 43% of Canadians are highly susceptible to believing misinformation that is spread through social media algorithms
• Misinformation consists of news that is verifiably false

Evaluating Information and Fact-Checking

• 59% of Canadians are concerned about misinformation online
• 43% find it increasingly difficult to distinguish fact from fiction
• Factors influencing this include age, gender, education, income, and fact-checking skills
• Fact-checking involves determining the credibility of online information
• Most Canadians do not know how to fact-check; those who identify challenges are more likely to verify the accuracy of news stories
• SOTEN is a tool for searching online to evaluate news
• The theory of data void refers to gaps in online information that can spread misinformation

Nursing and Evidence-Based Practice

• All members of the nursing profession are required to collaborate with stake holders to arrive practice evidence
• Sources of evidence should be critically appraised before being used in decision-making
• A quality of evidence framework ranges from systematic reviews to background information
• The clinical expertise framework includes clinical state, setting, circumstance, patient preferences, healthcare resources and research data

Electronic Medical Records (EMR) Workarounds

• Around 46-64% of nurses employ workflow workarounds to navigate EMR-related obstacles
• Such obstacle arise due to electronic documentation issues, difficulties in accessing EMRs, issues in medication administration, electronic communication problems, connection failures, or insufficient staff proficiency

Theory and Frameworks

• Theory constitutes of assertions, descriptions, or predictions of relationships that must be logical, coherent, clear, include concepts, themes, principles and constructs, and be based on empirical data
• Frameworks provide a scholarly foundation informed by pre-existing theories and are used interchangeably with the term "model"

Sociotechnical Model Dimensions

• Hardware and software: Includes hardware and software required to run applications
• Clinical content: Includes sources of information
• Human computer interphase: interactions between users and system
• People: All human participants involved
• Workflow and communication: Collaborative nature of healthcare
• Internal policies, procedures, and culture: Budget and responsibilities, IT polices
• External rules and regulation: Polices and laws

Implementing and Using EMR Systems

• System measurement & monitoring – availability, usage effectiveness
• Workarounds and are context-dependent and add to burden and burnout
• Safety , efficiency & effectiveness

Health IT and Clinical Workflow

• Avoidance of technology
• Stress and confusion
• Tensions
• Workarounds
• A workaround is a method to bypass a perceived limitation of workflow
• An EMR workaround can increase immediacy but it increases likelihood of negligence

Interoperability

• Interoperability allows the secure exchange of health information between systems
• Leads to collaboration
• Improves health systems and outcomes
• Improves patient access, reduces time, and better transitions and time saving
• Improves health system capacity, and marketing time

Interoperability Gaps

• Leads to a risk of care coordination
• Increases burnout
• Impacts patient access and safety
• Can lead to disconnections
• Compromises data integrity social justice

Interoperability Road Map

• Focus client focused care
• Use electronic data
• Use and upgrade infrastructure
• Includes healthcare providers

Digital Health and DHT

• Students face challenges in using DHT in education
• Documentation reflects the client's needs
• There is a need for improved interprofessional communication

EHR Documentation

• Clear concise legal ethical and accurate
• EHR must include electronic health record
• Computer entry patient portal

Key Points for Documentation

• Maintain privacy and security
• Document in a timely manner
• Maintain complete records

Improving Quality of Data

• Remove blockers and implement standards
• Standardized collection of information from patients
• Structured data should be used for multiple purposes
• Data that demonstrates clear communication amongst providers

AI in HealthCare

• C-HOBIC are data outcomes for better info
• SNOWMED is clinical data within an EHR
• AI is structured to imitate human process
• It must learn and problem solve
• EHR can enhance workflows by improving patient care and predicting who is at risk

Week 10 and beyond

• Al can improve nursing capabilites
• AI must focus on maintaining integrity. compassion, ethics
• AI can also be used to improve access by way of healthcare delivery
• All parties must have clear literacy and regulations