DNP 805 Topic 1 DQ 2 Select one informatics theory from the areas of Communication Theories, Change Theories, or Human Factors

DNP 805 Topic 1 DQ 2 Select one informatics theory from the areas of Communication Theories, Change Theories, or Human Factors

DNP 805 Topic 1 DQ 2 Select one informatics theory from the areas of Communication Theories, Change Theories, or Human Factors

Topic 1 DQ 2

Apr 14-18, 2022

Select one informatics theory from the areas of Communication Theories, Change Theories, or Human Factors. Discuss how the application of the theory you select can guide the use of technology in advanced practice. What strengths does the theory possess that would make it useful to the DNP-prepared nurse? What weaknesses does the theory present that might prevent its use?  Keep in mind the Christian worldview when preparing your submission.

REPLY TO DISCUSSION

The study of human factor theory focuses on human interaction with equipment within an organization with the goal of increasing safety and satisfaction. Example: Theories on accident causation demonstrate that accidents can be caused by chains of human errors. Factors that can lead to human errors include lack of experience on how to do the job (Chung  & Williamson, 2018).

Reference

Chung, A. Z. Q., Williamson, A. (2018). Theory versus practice in the human factors and ergonomics discipline: Trends in journal publications from 1960 to 2010 Academic Journal In Applied Ergonomics. 66:41-51. DOI: 10.1016/j.apergo.2017.07.003,

REPLY

Unfreezing, moving or transitioning, and refreezing are the three processes in Kurt Lewin’s Theory of Planned Change. The first stage, unfreezing, involves acknowledging that change is required and that the equilibrium will be disrupted (Chen, 2021). The initial stage is the most difficult and time-consuming because restraining factors might prevent the change from progressing (Chen, 2021). A great example would be introducing the electronic health record. During the first stage, the old ways such as paper charge would be let go. Unfreezing the necessity for the change to be discussed in dialogues and through educational sessions. The second phase is moving or transitioning. This phase necessitates a clear action plan and may create anxiety and worry (Chen, 2021). During this phase, it would be critical to work with the stakeholders (Daly, 2017). For instance, if a facility were to transition to electronic health records versus paper charting, this step is crucial as it enables the analysis of the present situation, new structures, and other processes that are put into place to attain the desired outcome (Daly, 2017). The last stage is refreezing, during which it is critical to reinforce and incorporate the change while also conducting an efficacy audit (Daly, 2017). The change is stabilized at this point, and a new equilibrium is established (Chen, 2021). In other words, the changes made are frozen in place and become part of the normal workflow. One of the strengths of Lewin’s change model is that it is simple for others to understand. Unfreezing, transition and refreezing are easy steps to follow when implementing a change within an organization (Daly, 2017). Although its simplicity is its strength, it can also be a downfall. Some changes need a more detailed process other than just unfreezing, transitioning, and refreezing (Chen, 2021).

DNP 805 Topic 1 DQ 2 Select one informatics theory from the areas of Communication Theories, Change Theories, or Human Factors

References:

Chen, P. (2021). A new horizon: Transitioning from an experienced to novice nurse. Journal of Radiology Nursing, 40(4), 368–369. https://doi-org.lopes.idm.oclc.org/10.1016/j.jradnu.2021.08.007

Daly, S. (2017). Development and implementation of person-centered nursing documentation. International Journal of Integrated Care (IJIC), 17, 1–3.

REPLY

Thank you for your interesting post. Healthcare system is constantly changing and evolving. Changes can be challenging because they

contradict humans’ basic need for a stable environment and sometimes when you’re used to it already you don’t want to start a new one. The advent of New Public Management (NPM) has challenged the traditional professional dominance, introducing a logic of managerialism into health care, i.e. work should be organized and controlled by managers to achieve organizational goals of a cost-effective and efficient health care. Clinicians are expected to document their work accurately and participate in any advancement given by the management team.

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Reference:

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Rafferty AE, Jimmieson NL. Subjective perceptions of organizational change and employee resistance to change: direct and mediated relationships with employee well-being. Br J Manage. 2017;28:248–264. doi: 10.1111/1467-8551.12200. [CrossRef] [Google Scholar]

REPLY

Very well done. I like the way you break down and apply Lewin’s Theory. Acknowledgment that changes need to happen, transitioning to the new technology, and stabilization of new technology. This theory is good and works to explain the change. In comparison to the Human Factor theory, the main thing to consider when implementing healthcare technology is to remember the people who actually use the programs/system. (Matthews & Proctor, 2021). In my experience as a nurse clinical and nonclinical, programs that have stakeholder support at the onset of change are most successful. Another factor when in the various stages is to ensure that staff that will be working with the change are instrumental from the beginning.

Matthews, S. D., & Proctor, M. D. (2021). Public Health Informatics, Human Factors and the End-Users. Health Services Research and Managerial Epidemiology. https://doi.org/10.1177/23333928211012226

REPLY

Hello,

I completely agree with you that the first step is unfreezing is the most difficult stage, but I would also add that it is arguably the most important step. This step is vital in setting the foundation for a successful change. This step is really about breaking the status quo (el-shafy et al., 2020). This starts the momentum for the change. While it is challenging as you mentioned, it is worth the effort that it takes.

Reference

el-shafy, I. A., Zapke, J., Sargeant, D., Prince, J. M., & Christopherson, N. A. M. (2019). Decreased Pediatric Trauma Length of Stay and Improved Disposition With Implementation of Lewin’s Change Model. Journal of Trauma Nursing, 26(2), 84–88. https://doi-org.lopes.idm.oclc.org/10.1097/JTN.0000000000000426

REPLY

Kotter’s change theory goes thru a series of eight steps on how to effectively prepare the team for change and to be adaptable to the change (Carpenter et al., 2021). This theory can be instrumental in the success of using technology in advanced practice. Without setting the environment for change. One example is how the change theory was used to in a healthcare system wide practice of primary care to reduce the overall amount of opioid prescriptions among patients with chronic pain. It was vital in starting and sustaining a change long term (Carpenter et al., 2021).

This theory really provide a solid framework with eight steps to follow for a sustainable change. It guides step by step how to prepare for the change, get buy in, and the solidify the change. This is easily used an any change planning. It is apparent that this would be successful in change implementation. This theory is so important because without the foundation work then it will not likely result in a lasting transformational change. The step that I find the most important to not miss is the development of short term wins. It is sometimes overlooked and can lead to discouragement resulting in and reverting to old practices. There are not any identified weaknesses to this theory. It is an excellent foundation to be used when planning an implementation of change.

I love this theory. This gives me a different perspective on how I practice as a nurse and how I treat each other. It is easy to become judgmental when this goes wrong. However, I am reminded that it is usually a sequence of human events that create problems, accidents, and errors. Many errors are made in the health field from a series of events. Even our attitudes in how we treat each other on the job occur as a result of a series of events. It would be beneficial to be patient and kind when dealing with uncomfortable situations, bearing in mind that most occurrences are attributed to overload, incompatibility, or improper activities. I concur with you that overload has three different components: load, capacity, and state. The load could be the task, environment, internal states (like stress), or situational (such as level of danger). I agree that the state of mind, training, and level of fatigue are examples of capacity while motivational level contributes to the state. I am in favor of this belief, that incompatibility is due to stimulus-response, stimulus-stimulus, response-response or workstation, and improper activities related to worker knowledge and action. When these events line up, it leads to human error which contributes to accidents. This is a very true statement.

I appreciate you reviewing Ferrell’s human factory theory. I began reviewing this one as I completed the change theory review. A human factor error associated with technology is something I review when I receive event reports regarding medication errors. The context before the medication error assists in developing improvements for the future. There is one error in particular that comes to mind regarding a nurse who gave an intravenous antibiotic too early. The nurse reported the shift to be frantic and was assisting another nurse by administering the medication. The patient’s name and allergies were verified along with the correct order, drug name and dose. The nurse reported that the MAR showed the medication was due and therefore the nurse administered it. The concern was that the nurse did not look back to the previous administration time in order to ensure the medication was given at the correct time. Technoloy used the EHR assists with preventing errors if used correctly however human factors can continue to contribute to errors. Human factors associated with health technology remain problematic and further development is needed (Carayon & Hoonakker, 2019).

Carayon, P., & Hoonakker, P. (2019). Human factors and usability for Health Information Technology: Old and new challenges. Yearbook of Medical Informatics, 28(01), 071–077. https://doi.org/10.1055/s-0039-1677907

Nursing informatics has become a critical health care field as health care providers continue embracing technology and science in patient care. Through the use of information, technology, and related processes, nursing informatics supports decision-making for health care professionals and patients and makes processes more efficient and accurate. Informatics theories include concepts and relationships serving as the foundation of widely used frameworks. Such frameworks define nursing informatics and its underlying concepts.

Among many theories, Patricia Schwirian’s NI pyramid provides a theoretical framework for defining nursing informatics and its application in patient care. According to Schwirian, nursing informatics involves using information technology in any functions within the nurse’s scope of practice (Mankowitz, 2018). The pyramid contains four elements. They include raw materials such as patient observations, technology, users, and the objective (Mankowitz, 2018). The Schwirian model demonstrates that nursing informatics works best through relationships. Besides, nurses should apply information technologies to achieve a specific objective.

Regarding strengths, Schwirian emphasizes the value of information technology in improving patient care. Information technology can be used to facilitate communication between health care professionals, track patient care, and report outcomes (Griffin & Chung, 2020). Such benefits are instrumental in optimizing health outcomes since efficient communication is the foundation of interprofessional collaboration. Despite these strengths, the NI pyramid focuses on one dimension of informatics- information technology. According to Alexander et al. (2019), comprehensive informatics application encompasses information, computer, and nursing sciences. Secondly, the NI pyramid focuses primarily on the nurse’s role despite the health care profession being broader in scope.

Theories inform health care professionals in decision-making, communication, and care coordination, among other crucial aspects of care. They provide concepts that advanced practice nurses apply to solve dilemmas, implement an intervention, and improve relationships. Many theories define and explore the application of informatics. The NI pyramid by Patricia Schwirian demonstrates the relationships necessary in applying information technology to optimize patient care.

References

Alexander, S., Frith, K. H., & Hoy, H. (Eds.). (2019). Applied clinical informatics for nurses (2nd ed.). Jones & Bartlett Learning.

Griffin, A. C., & Chung, A. E. (2020). Health tracking and information sharing in the patient-centered era: A Health Information National Trends Survey (HINTS) Study. AMIA … Annual Symposium proceedings. AMIA Symposium, 2019, 1041–1050. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7153080/#

Mankowitz, S. (Ed.). (2018). Clinical informatics board review and self assessment. Springer.