NURSING INFOMATICS BEST PRACTICE

OVERVIEW
• Write 3–5 pages in which you describe a nursing informatics best practices policy for effective and safe data use in a nursing practice setting or organization.
Today’s health care professionals need to be accountable for the use of information systems that are repositories for copious amounts of protected health information (PHI).
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
o Competency 2: Identify strategies and best practices for using informatics in nursing and health care.
 Describe the best practices needed to promote and support data security.
 Describe the ethical standards needed to promote patient confidentiality.
 Describe regulatory requirements that promote and support positive patient outcomes related to a specific population.
 Describe the types of behaviors and skills nurse leaders need to guide the use of information technology and research for improved patient-care outcomes.
o Competency 4: Communicate in a manner that is consistent with expectations of a nursing professional.
 Write coherently to support a central idea in appropriate format with correct grammar, usage, and mechanics.
QUESTIONS TO CONSIDER
• To deepen your understanding, you are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of the business community.
o How do nurses develop best practice?
o How does research support best practice?
o What are best practices in your organization that you think are exemplars for improving patient care?
o What nursing roles should be in place to support the use of evidenced-based practice?
o How would you describe the concept of meaningful use and technology adoption stages: electronic health records (EHR) incentive programs, and how does this fit within the context of best practice?
o What are the main points to consider as you review The Health Insurance Portability and Accountability Act (HIPAA), and why is this best practice?
o How does the Patient Safety and Quality Improvement Act (PSQIA) support patient safety and improved patient outcomes?
ASSESSMENT INSTRUCTIONS
• Imagine an organization asks you to contribute to the development of an information system best-practices policy to help maintain patient safety and patient confidentiality in their practice setting. The organization wants you to create a document to help the group better understand why an informatics policy is needed and the practices that should be included in the policy.
A nursing informatics best-practices document can serve multiple purposes, such as a handout for new-hire orientation or as a background report given to a committee tasked with creating or updating a nursing informatics best-practices policy.
Preparation
To expand your understanding of nursing informatics best practices within the industry, research the most current information about the topics of nursing best-practices documents and nursing informatics best practices.
Using the Capella library, the suggested resources, and other methods (Web search, for example), locate 4–6 scholarly articles related to best practices designed to support positive patient outcomes related to the following areas:
o The meaning of secure data practices.
o Ethical standards needed to promote and support data security.
o Patient confidentiality.
o Regulatory requirements.
o Behaviors and skills nurse leaders need to guide the use of information technology and research for improved patient-care outcomes.
Directions
Create a description of a nursing informatics best-practices policy document designed to define and encourage effective and safe data use in a practice setting or organization.
o Purpose Statement: Statement of why an organization would create the policy. Include any reasons and intent that supports the creation of an informatics best-practices policy.
o Best Practices Definitions and Descriptions:
 Definitions of secure practices, data security, and patient confidentiality.
 Ethical standards.
 Regulatory requirements.
o Implementation:
 Behaviors – describe the behaviors nurse leaders will need to demonstrate that will guide implementation of the policy.
 Skills required – describe the skills needed to ensure policy adherence.
Format your document using the professional format and style (corporate identity) used in your organization or practice setting. Note: If you are not currently working in an organizational setting, follow the formatting instructions below.
Additional Requirements
o Written communication: Ensure written communication is free of errors that detract from the overall message.
o APA formatting: Format resources and citations according to current APA style and formatting guidelines.
o Number of resources: Cite a minimum of four peer-reviewed resources.
o Length: Submit 3–5 typed, double-spaced pages.
o Font and font size: Use Times New Roman, 12 point.
SUGGESTED RESOURCES
The following optional resources are provided to support you in completing the assessment or to provide a helpful context. For additional resources, refer to the Research Resources and Supplemental Resources in the left navigation menu of your courseroom.
Capella Resources
o APA Paper Template.
o APA Paper Tutorial.
Capella Resources
Ethics and Evidence-Based Practice.
• Ethical Standards Guiding Research
• The profession of nursing is uniquely positioned to ensure the ethical planning, design, and implementation of research conducted in all settings. The current approach to ethics in nursing research is based on the history of ethical and moral principles. In order for research to be ethical, it must have scientific merit. In other words, the research must be designed according to the scientific method to inform and enhance thinking about a research topic.
• In addition to the requirement for scientific merit, the research must also be viewed from the perspective of protecting those who agree to participate in the research so that risk is minimized and benefit is maximized. Nursing research has some commonalities with other professions in that research often focuses on practical issues with feasible solutions and, unlike some endeavors in the pure sciences, may be of a purely theoretical nature.
• Ethical codes and regulations provide a framework for scientists. The Nuremberg Code and the Declaration of Helsinki, for example, were created after certain experimental projects were determined to be unethical. An outcome of these human rights documents was the creation of the Belmont Report, one of the most important documents speaking to ethics and health care research. The report focuses on the principles of beneficence, justice, and respect for all individuals. The Belmont Report’s chief aim is to protect subjects or participants in clinical trials and research studies.
• The U.S. Department of Health and Human Services (DHHS) and the Food and Drug Administration (FDA) passed several regulations that govern the ethical conduct of research including the requirements for informed consent and external oversight. An Institutional Review Board (IRB) provides this oversight and consists of a committee of individuals who provide peer review of the research, including review of the proposed research prior to initiation, in addition to potential risks to the participants. More recent legislation addressing protection of individuals and data associated with research includes the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.
• Examining Evidence-Based Practice
• Nursing has a strong history of using current science generated by research evidence to implement best-care practices in the planning and care of patients. An important emphasis for understanding evidence-based practice (EBP) is to consider the historical context of the guideline and provide care guided by current research findings, clinical expertise, and patient conditions.
• Technology has enabled archiving and access of research articles and research findings to practitioners and the public to an extent in current times, which is extraordinary and unprecedented in scope. Databases of research information exist and are organized in ways that promote sharing of information. These database archives also allow researchers and clinicians alike to build on current knowledge and to press for new research with new questions and issues.
• Multiple models of EBP are available for use in clinical settings. There are nursing models for evaluation and utilization of research, as well as more sophisticated models for the construction of evidence-based practice guidelines based on collections of research about various practices, interventions, and topics.
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Capella Multimedia
Click the links provided below to view the following multimedia pieces:
o Ethical Scenarios in Research | Transcript.
Ethical Scenarios in Research
Introduction
This simulation follows Ashley, a Capella graduate learner. Ashley has been working hard with her mentor to develop possible dissertation topics for research. Ashley has developed several possible research questions and has decided to examine each question more closely. Ashley’s mentor has recommended she examine the ethical constraints of each of her possible research questions in addition to further investigating the process and concept of informed consent.
In each step of the simulation you will gather information and make decisions, based on the information presented in Capella’s IRB, The Belmont Report, American Psychological Association ethical guidelines, and the CITI Course in the Protection of Human Research Subjects. Each step of the simulation corresponds with a single ethical scenario. Although you will be directed to the appropriate step for each ethical scenario you may also want to follow the simulation from beginning to end to see how each step builds upon the previous one.
Instructions
In this simulation, you will work through several scenarios. In each scenario, we present you with a problem, decisions to make regarding the problem, resources to consult to aid in your decision making process, and feedback on the decisions you made.
Each simulation begins with the scenario itself. The scenario presents the key issue you will address. You can consult the resources tab to help you better understand the situation before you move on to the next phase of the simulation. After reviewing each resource, you are ready to Make a Decision.
There are several options for you to select in the Make a Decision section when trying to determine how a particular character in a simulation should address his or her situation. You may either select yes or no for each choice. Each choice will reveal recommendations that align with Capella’s policies.
The summary section explains Capella policy and provides further clarification on the best course of action for the characters in the scenario. Once you have completed a scenario, click a new scenario tab to proceed.
Scenario 1: Children: Obtaining Parental Permission and Child Assent
Every summer Ashley works as a camp counselor at her local summer day camp program. Ashley has noticed that the start of every summer, there are children who are terminally shy and find it difficult to make friends in the camp. She has also noticed that when the camp comes to a close at the end of summer, those same children are significantly less shy and have developed many healthy friendships.
Ashley believes summer camp is beneficial to the development of a child’s social skills and is interested in researching this further. Ashley is contemplating having the children fill out a questionnaire measuring their social skills on the first day of camp, and then again on the last day of camp. Because the parents have already signed a camp release form, she does not see the need to inform the parents. When is it appropriate to receive parental permission and child assent to use children as research subjects?
Make a Decision
Consult the Resources tab above to assist in your decision.
When is it appropriate to obtain parental permission and child assent to use children as research subjects?
• The researcher is not necessarily required to obtain written parental permission and child assent when using children as research subjects.
Incorrect
Parental permission and child assent waivers may be issued if the four criteria of the Common Rule are adhered to.
The four criteria are:
1. The research involves only minimal risk to subjects.
2. The rights and welfare of subjects are not adversely affected by the waiver.
3. Research could not be achieved without the waiver.
4. Subjects are debriefed after the study, when appropriate.
Correct
If the four criteria of the Common Rule are strictly adhered to, parental permission and child assent can be waived.
The four criteria are:
5. The research involves only minimal risk to subjects.
6. The rights and welfare of subjects are not adversely affected by the waiver.
7. Research could not be achieved without the waiver.
8. Subjects are debriefed after the study, when appropriate.
• If a child is an emancipated minor, parental permission can be waived.
Incorrect
Depending on each state’s laws, an emancipated minor may have the right to enter into a research study without parental permission.
Correct
Depending on each state’s laws, an emancipated minor may have the right to enter into a research study without parental permission.
• When engaging in research with children, it is only necessary to obtain parental permission before the research process begins.
Incorrect
When engaging in research that may cause unforeseen distress or harm to a child during the research process, it is necessary to obtain additional parental permission to continue to use the child in the research study.
Correct
In a research study where a child is experiencing unforeseen distress or potential harm, additional parental permission must be obtained to continue.
• The absence of a child’s opposition to participate in a research study is enough to be considered assent to participate.
Incorrect
A child must actively agree to participate in a research study. Depending upon the age of the child, this can be achieved in the form of verbal assent or older children may sign an assent form.
Correct
A child must actively agree to participate in a research study. Depending upon the age of the child, this can be achieved in the form of verbal assent or older children may sign an assent form.
Scenario 1 Summary
When working with vulnerable populations such as children, parental permission must be obtained (unless the child is an emancipated minor). In addition to parental permission, a child must willingly assent to participate in the research process. If the conditions of the research process change, it is necessary to submit an addendum of new ethical considerations to both the parent and the child.
Scenario 2: Vulnerable Populations: Research within the Prison Population
Through Ashley’s academic courses and journal reviews she had developed a hypothesis that there may be a correlation between women who were serving time in prison and possible histories of domestic violence and/or childhood sexual abuse.
Ashley is considering visiting the local women’s prison to conduct her research study. She would like to use personal interviews and a self-report survey to conduct her research with her participants. To compensate her participants for their time, she would like to give each participant a gift basket that contains fragranced soaps and body lotions. What are some of the ethical constraints that Ashley may need to consider when working with this population?
Make a Decision
Consult the Resources tab above to assist in your decision.
What are some of the ethical constraints that Ashley may need to consider when working with a prison population?
• Using the prison population is a convenient and ethical way for researchers to conduct all types of research.
Incorrect
Prisoners are classified and protected under strict ethical guidelines as part of a vulnerable population. These ethical guidelines place strict limits on prisoners’ involvement as research participants. Prisoners cannot be used as a population of convenience; the only research that is ethically allowable to be conducted with prisoners is research that is material to the lives of prisoners.
Correct
The U.S. Department of Health and Human Services has strict regulations containing additional safeguards for prisoners as research subjects. Prisoners cannot be used as a population of convenience.
• Providing appropriate inducements to prisoners for their time is appreciated by both the prisoner and the federal institution they are being held within.
Incorrect
One of the most important rules that must be followed when conducting research with the prisoner population is the rule of no undue inducements for prisoners who participate. In a confined environment where rights have been removed, a simple item such as fragranced soap could carry great significance and prove to ultimately be an undue influence.
Correct
Undue inducements such as fragranced soap in an environment where rights have been reduced can carry great significance and prove ultimately be an undue influence.
• Asking prison participants to recall personal historical events that may have led them to their incarceration is deemed appropriate depending upon the researcher’s hypotheses.
Incorrect
Researchers must be very careful in the questions that they ask prison participants. Due to the limited support systems within a prison that an offender may utilize to work through stressful issues or feelings, the researcher must assess the level of harm that may occur when asking historical questions. Questions that may cause the participant high levels of distress, ultimately disrupting prison procedures, should be refrained from asking.
Correct
Researchers must be aware that there could be potential harm in asking historical research questions. Due to the limited support systems within a prison that an offender may utilize to work through stressful issues or feelings, the researcher must assess the level of harm that may occur when asking historical questions. Questions that may cause the participant high levels of distress, ultimately disrupting prison procedures should be refrained from asking.
• At least one member of the IRB must be a prisoner, or a prisoner representative with the experience to serve as such.
Incorrect
Although the majority of the IRB members should have no involvement with the prisoner population or the prison facility, there must be at least one member of the IRB, who is a prisoner or a prisoner representative. Persons holding the roles of former prisoner, prison chaplain, prison psychologist, prison social worker, or advocate for prisoners’ rights, are some of the qualified persons to represent the rights of prisoners as an IRB member.
Correct
There must be at least one member of the IRB who is a prisoner or a prisoner representative. The majority of the IRB members should have no involvement with the prisoners or the prison facility. Persons holding the roles of former prisoner, prison chaplain, prison psychologist, prison social worker, advocate for prisoners rights; are some of the qualified persons to represent the rights of prisoners as an IRB member.
Scenario 2: Summary
The prison population is classified as a vulnerable population. Vulnerable populations such as prisoners cannot be used as populations of convenience for research. The prison population is protected by stringent federal ethical guidelines, and these guidelines must be followed when conducting research with this population.
Scenario 3: Native Americans: Protecting Culturally Diverse Groups
Having lived in the Southwest all her life, Ashley has had the privilege of experiencing some Native American Indian culture. Through stories in the media, Ashley has become aware of the high unemployment rates within the Native American Indian reservation. She has also heard the negative stereotypes regarding the high rates of alcoholism within the Native American Indian culture.
With the onset of legal casino gaming on the Native American Indian reservation, Ashley is interested in researching the relationship of the effect of casinos on unemployment rates and rates of alcoholism within the Native American Indian community. What ethical guidelines must Ashley follow when working with this group?
Make a Decision
Consult the Resources tab above to assist in your decision.
What ethical guidelines must Ashley follow when working with Native Americans?
• Working with a culturally diverse group that does not belong to a federally protected group does not classify them as vulnerable populations and their ethical constraints are less strict.
Incorrect
When individuals are members of particular ethnic or racial groups, religious groups, occupational groups, or by physical condition, etc., they ma ybe classified as culturally or medically vulnerable groups. The harm does not fall upon the individual, but on the group as a whole.
Correct
When individuals are members of particular ethnic or racial groups, religious groups, occupational groups, or by physical condition, etc., they may be classified as culturally or medically vulnerable groups. The harm does not fall upon the individual, but on the group as a whole.
• Group vulnerability would include groups that have less access to education, health care, and social services.
Incorrect
These groups are deemed to be more vulnerable and subject to coercion, in order to take part in a research study. In addition, results of the study may harm the vulnerable group as a whole — even those individuals who did not wish to participate.
Correct
Groups that may be more vulnerable include groups with low socioeconomic status and groups who may be behaviorally or politically stigmatized. These groups would include drug users, legal and illegal prostitutes, and members of religious cults.
• Group harms may include group stigmatization, loss of status, genetic determinism, and possible violations of cultural or group norms and values.
Incorrect
Group harms may include some or all of the following: group stigmatization, loss of status, genetic determinism, and possible violations of cultural or group norms and values.
Correct
Group harms may include some or all of the following: group stigmatization, loss of status, genetic determinism, and possible violations of cultural or group norms and values.
• Some groups have their own ethical review process for research that must be followed in order to conduct research within that group.
Incorrect
Groups such as Native American Indian tribes, retirement communities, and school districts may have their own ethical review process for research. In this case, researchers must work with the group’s review body before the process of research begins.
Correct
Groups such as Native American Indian tribes, retirement communities, and school districts may have their own ethical review process for research. In this case, researchers must work with the group’s review body before the process of research begins.
Scenario 3: Summary
When working with culturally diverse groups, researchers must follow rigid ethical guidelines to prevent harm from falling upon the cultural group as a whole. Culturally diverse groups who have less access to education, health care, and social services are deemed as vulnerable populations. Many culturally diverse groups have their own IRB processes that must be followed in addition to Capella University’s Institutional Review Board.
Scenario 4: Informed Consent: The Role of Informed Consent in Research
Ashley realizes regardless of the research topic she selects, if she decides to work with human subjects she will need to obtain informed consent. Each population she is interested in researching seems to have their own unique requirement of ethical guidelines. Ashley quickly comes to the conclusion that there may also be unique requirements for obtaining informed consent depending upon the characteristics of the population she will be researching. What are some of the more common and unique considerations Ashley may face when obtaining informed consent from her research population?
Make a Decision
Consult the Resources tab above to assist in your decision.
What are some of the more common and unique considerations Ashley may face when obtaining informed consent from her research population?
• Within requirements of informed consent, participants must be given an accurate description of the risks of a procedure, including information of previously reported adverse events.
Incorrect
Within the general requirement of any informed consent, participants must be told, with no uncertain terms, the risks and possible discomfort they may endure when participating in a research study, including previously reported adverse events.
Correct
Within the general requirement of any informed consent, participants must be told, with no uncertain terms, the risks and possible discomfort they may endure when participating in a research study, including previously reported adverse events.
• Informed consent is regulated by the Food and Drug Administration, the Office of Human Research Protections, and Capella University’s Institutional Review Board.
Incorrect
Compliance with informed consent regulations are regulated by the Food and Drug Administration, the Office of Human Research Protections, and the study institution’s Institutional Review Board.
Correct
Compliance with informed consent regulations are regulated by the Food and Drug Administration, the Office of Human Research Protections, and the study institution’s Institutional Review Board.
• As long as an informed consent is provided in the native language of the land where the research is occurring, translation to non-native speaking participants is not necessary.
Incorrect
All consent processes should be conducted in a language spoken by the participant. In addition, the consent form must be translated into the participant’s language. Participants who are not literate in their own language must have an interpreter to explain the study and translate the questions and answers between the experimenter and participant.
Correct
All consent processes should be conducted in a language spoken by the participant. In addition, the consent form must be translated into the participant’s language. Participants who are not literate in their own language must have an interpreter to explain the study and translate the questions and answers between the experimenter and participant.
• Cultural issues must be considered when obtaining informed consent. These cultural issues need to be fully understood by the researcher conducting the consent process.
Incorrect
There are many cultures where it is considered rude to ask questions of a person in authority and is perceived as ungrateful to decline a person asking of the favor. A participant in this situation may not feel they have the right to decline to participate in the research study. These are just some of the cultural issues that must be considered by the researcher when obtaining informed consent from their participants.
Correct
There are many cultures where it is considered rude to ask questions of a person in authority and is perceived as ungrateful to decline a person asking of the favor. A participant in this situation may not feel they have the right to decline to participate in the research study. These are just some of the cultural issues that must be considered by the researcher when obtaining informed consent from their participants.
Scenario 4: Summary
Informed consent regulations are regulated by the Food and Drug Administration, the Office of Human Research Protections, and Capella University’s Institutional Review Board. Informed consent requires the participants to be given an accurate description of the procedure of the study and takes into account specific cultural issues of its participants.
Resources
CITI
The CITI course site provides instruction in human subjects protection. Note that you can only access this page after you have taken the CITI course. https://www.citiprogram.org
APA
The American Psychological Association (APA) provides information on ethical principles and codes of conduct that guide psychologists.