Table of Contents
While the use of electronic gadgets in nursing was meant to improve the workability of nurses, the situation did not improve. For every record that needed to be put into the electronic system, much work was involved as the machines needed a second inputting, which is redundancy (Cater, 2005). The machines did not have a system that could remind nurses of a given task that would be expected to be done at a given time; yet the nurses anticipated that computerization would come with some automated reminding systems, such as a detailed alarm.
The power outages made the process of electronic recording complicated as the data could not always be fed into computer to in time (Arunachalam, 1999). Later, feeding of this data often led to a late information recording and probably a time inconvenience on the side of nurses. The main hindrance was the lack of a bridge between the system administrators who were supposed to be in charge of IT gadgets and the clinicians who were using the system. The miscommunication between these two parties led to frustration and dilemmas, especially on the side of nurses.
While the era of change for the better seems to have started, there is not much that can be done to stop the dynamism, so the nurses have no choice but to embrace the changes and find ways to adapt to the new technology (Collen & Walker, 2015). In spite of the complications that nurses go through as they encounter the computerized records system, the development is meant to bring quality, safety, satisfaction and efficiency in records keeping. However, in order to attain this, there has to be a more interactive IT section that both understands the nursing operations and is equally equipped with IT systems. The IT-nurses bridging group will ensure proper communication between nurses and the general swift flow of nurses’ digitalized services.
Current Electronic System Used in Nursing
Currently, the revolutionized medical care that uses technology seems rather advantageous to the most complicated surgeries possible (Detmer & Steen, 1996). Such operations provide increased safety, as well as minimize tearing of body tissues. The use of computers has been a stimulating factor for the young nurses. Operating the machines has been fun to learn, and everyone seems happy with the new knowledge at hand. The main issue appears when documenting using the devices since the process of feeding data is not easy, particularly when details are needed.
Records keeping information sheets is the main limitation of this new technology. The matter is complicated by the limited funds that have been invested in this section. Therefore, upgrading the systems to more recent ones has been a problem. The nurses, therefore, continue to use the old and complicated software that is hard to use. The process of making most nurses computer literate is still slow. Few nurses are literate, and therefore using the system where only a few of the practitioners are conversant with the machines will only make the situation worse. There is only a hope that future versions will be easy to use so that even less computer literate nurses can still work with the systems with not much trouble.
The current systems have not been designed in a nurse-friendly way (Ammenwerth, Haux, Pohl, & Ziegler, 2001). There are too many options for a nurse to determine which one is correct for their day’s operation. The software used has been designed in a way that makes one go through numerous procedures before getting an access to the wanted field to record. What is needed is the system designed in such a way that one can just log in and search their particular area (for instance, a given patient search by name) and start recording immediately.
Updating the data in the machines, especially the software and surgeon records for each case, demands much work. The process can only be done by nurses who are team leaders. Having five nurses in the leadership to monitor the data in the preference cards is a big problem, especially since the cards are almost two thousand. Updating these cards has become nearly impossible and often the data is inaccurate as it is outdated.
The hardware used is another concern since the desk areas where the desktops are placed makes typing an issue. One gets tired too quickly even before one is close to finishing entering the day’s records. Using a mouse and the keyboard for a given machine and at the same time being able to sit is strenuous. If one could be provided with a computer with an onscreen keyboard, it would be much easier, and one could even document the recorded observations right next to the patient and avoid the redundancy of having to record the information on a paper and then sitting at the desktop and recording again.
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Suggestions for a Future System
The first thing that should be done is provision of a system that is integrated, and therefore, accessible from all computers. This will ensure that an update from a given terminal will reflect all the available terminals.
Entering information into computers should be simplified by a touch screen to minimize the recording time. The recording software should be enabled to remember defaults and current entries and therefore automatically prompt them to save time.
Some calculations should be done by the machines, such as the hospital charges, which is a matter of taking values and multiplying them by preset multiplicands. This will also save time for the billing department.
The systems should have shortcuts key options for experienced users while the inexperienced users need the quick help tools that can aid them in working with the software. The report run options should be user-friendly so as to ensure that the data is accurate.
The Nurses Really Need to Improve Their Work
Among the professions that need one to be highly alert is nursing. One has to be as quick as possible to respond to an emergency since patients have their lives entrusted to them. The chance of any incident happening is also very high, especially because the health of the patients is unstable, and it needs quick access to the information about patient’s health in order to determine how severe the case is. Therefore, there is an acute need to boost the nurses’ efficiency. If a nurse could attend to as many patients as possible and, at the same time, be able to respond to any emergency, it would be a success in the nursing profession (Moody, Slocumb, Berg, & Jackson, 2004). There are some important factors that nurses want to be considered to simplify their work.
The main thing that nurses really need is a record keeping and accessing electronic gadget that is easy to use. This will ensure that they are aware of the progress of patients and can obtain critical information about any patient without necessarily visiting the patients’ room or the computer room where the information was recorded. This elasticity will promote efficiency as nurses can respond to emergencies appropriately as they become aware of the patients’ conditions right from their mobile electronic database. The information retrieved from the databases is meant to furnish the nurse with the basic information about the patient, and therefore, a nurse can determine the cause of the sudden instability of the sick by judging from an information obtained.
Using electronic systems will allow nurses to communicate with the doctors easily and quickly if the electronic computer system is Internet enabled. A confusing situation can be referred to a physician who may easily respond via a simple email or any other communication platform. It will not be critical to have the physician at the spot since a nurse can be advised by a physician on what to do remotely. This will save time and workload as one doctor can communicate with a few nurses at a time. The nurses can also execute their duties with more accuracy and confidence since when they doubt, a physician can aid in clarification.
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The use of alarms needs to be discarded as it is an old and inefficient emergency alert method. Often, they are not audible, especially when the nurse is far from the alarm, for example, when she is in another ward or attends another patient in the bathroom. Besides, the signals do not indicate the kind of problems that the patient who gave the alarm is experiencing. It would be more appropriate for the signal to be a verbal message sent to the nurse. This way the message would provide details about the sick patient, such as the ward and bed number, as well as other emergency details.
Another efficiency measure that can be implemented is reducing paperwork and increasing bedside time (Poissant, Pereira, Tamblyn, & Kawasumi, 2005). The paperwork done when receiving a patient for admission takes much time, especially given the fact that information on some of the patients is already recorded during previous treatments. This leads to redundancy, which can be avoided with the help of system integration. It could be effective since a recovery of past medical details is easy. Besides, a single login to all the nursing sections would be more effective than different logins to the various sections. This is a matter of system integration. The time used to shift from a system’s physical access point to another could be used to attend to patients. The services that could be used include assessment of patients’ progress and determining whether there is a need for intervention.
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The Ugandan Case Study
Given the fact that Uganda is a developing economy, it has a struggling health status. Life expectancy is still very low; on average, it is 50 years. More than 72% of the country’s population lives below the economic standards (Nabirye & Moss, 2008). The medical record practice in Uganda takes place when a patient visits the hospital. Such basic details as name, age, and place of residence are put down in a registration book. Another sheet is then taken to record the patient’s diagnose. This document is known as the medical form 5 (MF5). The files in this paper include the diagnosis, the investigations ordered and the drugs prescribed. It is the obligation of the patient to keep this document as it gives an overall medical record of the patient in the various health centers a patient has visited. Should the form be filled, a new form is attached to this form, and the record continues.
The patient is also expected to take care of other documents that are used in their medication. Among these forms are the prescription forms or the medical drugs dosage. When a hospital does not have the prescribed medicine, the patient is usually expected to buy them at a pharmacy. In case the patient lacks money to purchase the drugs, there is no adequate follow-up to ensure that the patient gets the supposed medicine (Kintu, 2005). When a patient is admitted to a hospital, a new set of record is taken with a new serial number. All these files are filled without regard to the ones filled when the patient was previously diagnosed. This means that the outpatient record is made again in a different book, while this happens in the same hospital. While in the ward, a new file is set aside for this particular patient and all the medical history of the patient is recorded. The added material includes the physician's notes and the observations of progress made by the patient. Upon discharge, an exercise book (which is usually the MF5) is again filled with a brief history of the patient (Thede, 2008). Losing this form would mean a lifetime mistake since all the health records are lost. The loss of records that could provide evidence of a patients’ progress makes a patient repeat the course of treatment again. Retrieving all the recorded information is too much work for nurses in hospitals. The difficulty of retrieving this missing information leads to fatal mistakes, such as intoxication or wrong prescription. More cost is incurred as the patients have to re-take tests that had been recorded in the lost book.
The primary difficulty faced by the Ugandan medical practitioners in the recording practice is the use of paper records. The paper records have proven to be insecure as they can easily be lost and are inaccessible to others since only the person with the recorded paper can access the information. The other major issue associated with paper recording is a redundancy of information as there is always a need to rewrite the already existing information by duplicating the recorded documents. The time taken to rewrite data is absolutely wasted since this can be avoided.
The use of electronic health records (EHRs) can help in avoiding all these complications, risks and waste of time. However, implementation of this method has proved hard in the developing countries as they lack the infrastructure, funds, education and adequate policies that can incorporate this technology. These factors have led to computerization of the Health Management Information System (HMIS), which is a slow process. Nevertheless, some countries, such as Kenya, have still managed to develop (Hannan, Odero, Esamai, & Einterz, 2000). At the same time, as the demand for these technologies rises, it is expected that the country’s health system will also upgrade to convenient health recording methods.
The increased efforts of the Ugandan government to encourage and enhance education among the people is a positive factor that is likely to see more literate people, and thus, will help to incorporate technology (Nabirye & Moss, 2008). There is the transition of primary education to the universal standards, while the secondary school has also been upgraded. The change in education policies aimed at putting more emphasis on sciences will be a starting point for the country to develop in the technological sphere.
The government has made an effort to employ the HMIS in the public hospitals that will merge all the health record from more than 2000 hospitals so that a single database is created. This integration is done by individual IT experts working at the involved hospitals. This means the government provides IT experts for every hospital. They will be very resourceful in setting the integrated electronic data keeping system.
The government is working together with many medical research organizations so that more trained health experts, especially in the information technology, are available and ready to work for the country. This way, the IT health recording software development and maintenance have been possible. Other research areas have been made possible through collaboration with the country’s Makerere University and the research centers in North America, such as John Hopkins University (Gladwin, Dixon & Wilson, 2003).
However hard it is to implement the development of EHRs in developing countries, it has to be done. It has been noted that the Ugandan government is making an effort to ensure that the whole country, particularly the hospitals, is provided with electricity. These efforts together with the additional effort to reduce illiteracy will allow employing an electronic recording system in hospitals. The collaboration of the country with the research centers from the developed world will see the country provide adequate training for its workers who will be then able to impact the country’s health system revolution. The development of health systems is among the major goals for any developing country that is aimed at advancement.
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