Posted: January 16th, 2023

Inclusion of Nurses in the Systems Development Life Cycle

Inclusion of Nurses in the Systems Development Life Cycle

NURS 6051 Discussion: The Inclusion of Nurses in the Systems Development Life Cycle

Often times we find that the systems that we work with as nurses are antiquated and must be updated to support the newest technology and evolving trends in nursing. How many times do we find ourselves on the phone with IT due to technical issues regarding the system that we are utilizing to document assessment findings on our patients or may be attempting to send information to another provider? These are issues that must be addressed to properly care for and document patient findings Inclusion of Nurses in the Systems Development Life Cycle.

When implementing a new system, much thought, planning, prioritizing and implementation must take place. Nothing is more frustrating than having someone sit in an office and make decisions for floor staff not knowing what is necessary to adequately perform their job. Nurses must be involved from the beginning, whether a committee is formed or a select few are delegated to make the decisions, nurses must be included. From the planning to the implementation, nurses need to pilot the system. By including the nursing staff “ this experience can serve as an invaluable example of the relationship between information management, patient management, cost management, and quality enhancement in the hospital setting” (Denger & Walker, 1988). Maintenance is necessary to maintain the system and can be completed by the IT department, but nurses need to be involved in the planning, analysis, design, and implementation so that they fully understand and are able to navigate the system.

I was a nurse educator at a LTC facility and was responsible for the implementation and training of a new system. I however was not part of the planning, analysis, and design. There were many faults to the system that was being piloted in the facility. Many of the tabs were not pertinent to the patients in LTC. It caused confusion and additional time wasted during times of documentation. If I would have had the opportunity to assist in the planning and design, the additional tabs would not have been placed on the KIOSK. The staff becomes very frustrated and new staff struggle to look over the information that is not necessary. Eliminating unnecessary information/tabs is the best approach when implementing a new system. I found it to be beneficial to gain knowledge by accessing the system prior to the initiation of it, but persuading the staff was difficult because change is a huge obstacle especially with the older generation Inclusion of Nurses in the Systems Development Life Cycle.

Nursing staff must be included in the planning, analysis, and design to ensure the proper inclusion of necessary information. Nurses are responsible for documentation on their shift including vital signs, telemetry readings, change in condition, meal consumption, ADL’s, ambulation, and signs and symptoms related to their diagnosis. Having the proper tabs to make it more efficient would save time in documentation as well as provide the clinicians with the pertinent information needed. For example, if a patient is admitted with CHF, it would be beneficial to be able to click on new symptoms so that the cardiologist can quickly identify whether the patient is improving or not.  Example: Check the necessary box(s)

• Shortness of breath
• Fatigue
• Weakness
• Swelling of the legs, ankles, feet
• Rapid/irregular heartbeat
• Cough/wheezing
• Increased urination at night

If nurses are not included in the planning, analysis, design, and implementation a lot of time is wasted in the training process of the staff as well as the hospital administration. There is a risk that vital information would not be included for documentation purposes and money will be lost in the addition of information that is needed to properly document patient findings. By not involving the nursing staff, you may lose interest, trust, and cooperation. Nurses are more engaged if they are included. It is easier to sell (implement) something if you have been part of the planning and design.

I know I am not alone when I say that it is no surprise to hear “if they would get out of their office and come out on the floor and help, they would know what is going on”.  With nurses making up the largest population in the healthcare facility, they should be incorporated into the equation of improving the documentation process (Glancey & Vaughan, 1990) Inclusion of Nurses in the Systems Development Life Cycle.

References

Denger, S., Cole, D., & Walker, H. (1988). Implementing an integrated clinical information system. The Journal of nursing administration, 18(12), 28–34.

Glancey, T. S., Brooks, G. M., & Vaughan, V. S. (1990). Hospital information systems. Nursing’s integral role. Computers in nursing, 8(2), 55–59.

Laureate Education (Producer). (2018). Interoperability, Standards, and Security [Video file]. Baltimore, MD: Author.

Laureate Education (Producer). (2018). Systems Implementation [Video file]. Baltimore, MD: Author.

Louis, I. (2011, August 17). Systems development life cycle (SDLC) [Video file]. Retrieved from https://www.youtube.com/watch?v=xtpyjPrpyX8

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Understanding and implementing hospital information systems. (1995). Health devices, 24(2), 71–83 Inclusion of Nurses in the Systems Development Life Cycle.

Discussion: The Inclusion of Nurses in the Systems Development Life Cycle

In the media introduction to this module, it was suggested that you as a nurse have an important role in the Systems Development Life Cycle (SDLC). With a focus on patient care and outcomes, nurses may not always see themselves as contributors to the development of new systems. However, as you may have observed in your own experience, exclusion of nurse contributions when implementing systems can have dire consequences.

By Day 3 of Week 9

By Day 6 of Week 9

I agree with you that it is frustrating when one or few people make decisions that affect the entire healthcare system without consulting them. Therefore, I back up your claim that nurses should be included in all the stages of implementing a new technological system from planning and design. You have also shared your experience that highlights the challenges of not including nurses in designing and planning a new system. This is common in many health institutions that ignore nurses’ voices in decision-making processes (Mclean et al., 2015). Nurses are the primary users of technological systems, and it is reasonable to include them in all decision-making processes (Denis, 2020). Additionally, nurses directly connect with patients more than other health providers and better understand what suits patients’ needs. You also pointed out that maintaining a system relies on nurses’ understanding of it, and failure to include them in planning and design may fail Inclusion of Nurses in the Systems Development Life Cycle.

References

Denis, I. (2020). Consequences of a healthcare organization not involving nurses » nursing experts. Nursing Experts. https://nursingexperts.org/consequences-of-a-healthcare-organization-not-involving-nurses/

McLean, A., Frisch, N., & Roudsari, A. (2015). Nursing’s voice in healthcare IT acquisition decisions. Canadian Journal of Nursing Informatics. https://cjni.net/journal/?p=4248

response 2

You are exactly right when it comes to nurses and knowing IT information systems and navigating it to be able to do your job. I have been in many situations where I have had to call IT because something is not working right or there is a glitch in the system. It amazes me how much a nurse is expected to know or be able to figure out on her own. The IT guy literally will walk you through so many ways to fix the problem and ask you everything you have done before he will take the time to come look at it himself. Nursing informatics has an expectation for nurses to study computer skills, informatics knowledge and informatics skills. Including nurses in an organizations health care information technology system is crucial for success, but the expectation level from a nurse is too high at the same time (2014, Darvish et al).

That sounds like an awesome tool to use for CHF documentation. One thing I can say about the health care information system that is currently being used at my place of employment is that there are too many places to document. It is crazy to me that the physician cannot see the nurse’s assessment! If the nurse decides she wants to put in a note on the patient, the physician can read it. Although there are many benefits to an updated electronic health care technology system, nurses’ assessments should be able to be visible to the physician to improve the nursing process with assessing, planning, implementing, and evaluating the patient (2019, RCH) Inclusion of Nurses in the Systems Development Life Cycle.

References

Darvish, A., Bahramnezhad, F., Kayhanian, S., Navidhamidi, M. (2014, June 24). The Role of

Nursing Informatics on Promoting Quality of Health Care and the Need for Appropriate

Education. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4825491/

The Royal Children’s Hospital. (2019, March). Nursing Documentation Principles. https://www.

rch.org.au/rchpg/hospital_clinical_guideline_index/nursing-documentation-principles/ Inclusion of Nurses in the Systems Development Life Cycle