Nursing informatics: Equity vs. Equality and Information Distribution

Social justice is defined as the fair distribution of laws that all people no matter their ethnic origin, gender, possessions, race, or religion are to be treated equally (Business Dictionary, n.d.). According to Braveman and Gruskin (2003) equity can be defined as social justice or fairness, based on the principles of fairly distributing resources in society. There is a difference between equity and equality. The image that is attached at the beginning on the blog can explain the difference between equity and equality. Equality is giving every body the exact same things no matter their social status, state of health, or resources. Equity is giving people what they need to have the same outcome as others. Not all shoe sizes fit all; equality is giving everybody the same shoe and shoe size, equity is giving everybody a good shoe that fits.

The current distribution of resources is unfair and consequently leads to inequality in the health among individuals. Everyone should have access to the ‘highest attainable standard of health”(Bravement & Gruskin, 2003), however, currently it only pertains to the wealthy. This is a social justice issue, the inequitable distribution of resources allow for a greater health in people with higher social status and income.

There is also inequity in the access and usability of information from technology. Britz (2004) describes the term ‘information poverty’ as a situation in which individuals and communities do not have the skills, abilities, or materials to have access to information, understand it and use it effectively. Technology has grown and has caused a change in the knowledge of certain populations; however, it has intensified the gap between the rich and the poor. Human decision making and problem solving is supported by reliable information. The ability to use information and apply it is determined by the level of skills, experience and education (Britz, 2004).

Individuals from a higher social status are more likely to attend prestigious schools and attain a better education than those with a lower social status (Doob, 2013) Therefore, people with higher education are at a greater advantage to access and interpret health information they are exposed to online. The distribution of resources is creating a greater advantage for people in the higher social classes.

Consequently, the inequity of distribution of resources puts lower class populations who are already at a disadvantage at an even further disadvantage, as they might not be able to access, interpret, or apply the health information.If there was health equity it would mean that there is no difference in the health of people of different social classes, race, gender, background as everyone would receive the resources they need to attain the highest standard of health possible (Bravement & Gruskin, 2003). Our society has to work towards equity in health information distribution from technology among all the social classes, and make sure that it is applicable and effective.

References

Doob, C. S. (2013). Understanding stratification, inequality, and social class in the u.s. Retrieved from https://www.boundless.com/sociology/understanding-stratification-inequality-and-social-class-in-the-u-s/

Britz, J. J. (2004). To know or not to know: A moral reflection on information poverty. Journal of Information Science, 30(3), 192-204. doi: 10.1177/0165551504044666

Braveman, P., & Gruskin, S. (2003). Defining equity in health. Journal of Epidemiology and Community Health, 57(4), 254–258. doi: 10.1136/jech.57.4.254

Queer, O. (Photographer). (2013, November 12). Equality vs Equity [Print Photo]. Retrieved from https://twitter.com/queerontario/status/403507508578226176/photo/1

Nursing Informatics: Patient Generated Data and Policy issues

image: miscommunication/shutterstock

New health care technologies are changing the roles of nurses in the health care field (tiffin, 2012). Brooks (1989) defines public policy as a broad framework of ideas and values in which decisions and action is taken by governments to solve a problem. Since there are changing roles of nurses and clinicians because of technology, governments need to address policy issues that are created because of these changes.

According to Brennan (2013), patient engagement is describes as the patient participating in his or her own health and health care. Engagement of the patient is assisted by a rapid increase in health information technology, especially through mobile devices and applications. Mobile applications that are targeted towards self-monitoring and can lead to more self-awareness in patients and also offer the health care provider a view into the patients everyday live. In the United States, Robert Wood Johnson Foundation funded the Project HealthDesign to develop and implement mobile applications to enable people to self-monitor their health and also share information with the health care provider. This application was created to assist patients in tracking important signs and symptoms. Additionally, the patient can include their observations of daily living (ODL), which are sensations, thoughts, attitudes, and behaviors, exposures that give patients cues to their own health but also become reasons for actions (Brennan, 2013). Furthermore, Brennan states that to fully achieve patient center care, patient generated data, such as this interactive application, must include ODL.

The presence of interactive mobile applications in health care can be very beneficial as they can reduce hospital visits, create empowerment among the patient, and reduces time and money for health care. The interactive mobile applications have patient generated data that can be shared with the health care provider without physical interaction. However, as this innovation can create benefits for the patient and health care provider, policy issues may arise.

A YouTube blog posted on May 24, 2013 by Patti Brennan states three policy issues that need to be addressed when implementing this program. One policy issue that Brennan stated which is important is implementing practice permissive policies.

These permissive practice policies should identify that clinicians not only act on the information given during physical interaction with the patient but also when information that the patient provides is in other formats (Brennan, 2013).

This policy is regarding the sharing of ODLs through the use of the application or other formats to connect with the health care provider. This information that the health care provider receives needs to be taken into account by the clinician so that holistic care of the patient is achieved. However, for effective care plans to take happen the interpretation of the information by the nurse must be in correspondence with the patients. In an article by Wayne Turmel (2011) titled ‘ You can Prevent Texting and Email miscommunication’ from http://www.CBSnews.com, states that most complaints about technological commination fall under two categories: lack of clarity or problems with tone. The image that is attached at the beginning of this Blog shows how miscommunication can lead to ineffective actions. The person in the image wanted a kitchen Island, however the word ‘island’ was clearly misinterpreted—perhaps through text— and an actual island was the result. This example is far-fetched; nevertheless it displays how misinterpretation can occur through technology if information is not further explored. Through the article by Turmel (2011) and the image attached it is understood that communication through technology can be misinterpreted. Therefore, thorough discussion about the information provided by the patient through technology should take place.

As a result of the constant interaction and sharing of information, changes in the care process might occur and clinicians should be able to act on this data, without a physical interaction with the patient (Brennan, 2013). As stated by Brennan 2013 YouTube blog the input of practice permissive policies that allow the clinician to act on data provided by the patient.

Through the use of Brennan’s Blog I was able to understand the importance of policies in the use of technology in health care. It is important for policies to be in place so that problems are minimal and the technology can be used to its full potential. A study done by Consumer Health Information Corporation (CHIC) 2010, stated that 58 percent of participants want to use a mobile application to mange disease or medications. Additionally, 80% of participants said they would be more likely to use interactive applications that can analyze logged information and provide feedback. Therefore, through the use of policies health information technology can be effective because consumers want interactive mobile applications to manage their health. Health care professionals and policy makers can work together in Canada to create interactive applications and effective policies to help in the care of patients.

References

Koliner, S., & Flatley Brennan, P. (2013). Advancing healthcare information technology    through policy. CIN: Computers, Informatics, Nursing, 31(5), 205–207. Doi  10.1097/NXN.0b013e318299dc34

Video Blog Project HealthDesign –P. Flatley Brennan policy considerations.http://www.youtube.com/watch?v=eeP06WIhIlk#at=13

Lewis, N. (2011, 05 4). Mobile health app users want intelligent, interactive features. Information Week Connecting the Business Technology Community,     Retrieved from http://www.informationweek.com/mobile/mobile-health-app          users-want-intelligent-interactive-features-/d/d-id/1097543?

Brooks, Stephen, Public Policy in Canada: An Introduction, McClelland and Stewart Inc., Toronto, Ontario, 1989.

Turmel, W. (2011, 04 27). You can prevent texting and email miscommunication. CBS News. Retrieved from http://www.cbsnews.com/news/you-can-prevent-texting  and-email-miscommunication/

Tiffin, C. S. (2012, 03 28). Beyond the bedside: The changing role of toda’ys nurses. Huff Post Good News. Retrieved from http://www.huffingtonpost.com/charles-tiffin phd/nursing-school_b_1384285.html

Godin, S. A. (Designer). (2013, 05 12). “There was some misunderstanding about the term Island” [Web Drawing]. Retrieved from            http://image.shutterstock.com/display_pic_with_logo/807910/126869348/stock photo–there-was-some-misunderstanding-about-the-term-island-126869348.jpg

Difference and Benefits of Personal and Electronic Health Records

http://globalnews.ca/news/988042/pilot-programtests-the-waters-of-online-health-records/

The personal health record is a record that the patient controls independently. Personal health records are records that the patient accesses and maintains, it can contain anything the patient wishes to input about their health such as : record of appointments, information about medicine, their progress etc. (EHO, 2013). An example that reminds of a personal health record is the Lawson SMART record. This is a phone application and it is is similar to a personal health record because it allows the patients dealing with mental health to: collect, manage and share information with their case manager to track their health (MHEN, 2012). The application is suppose to help the patient manage their symptoms and reduce hospital visits (MHEN, 2012). Lawson SMART record is similar to the personal health record and has similar benefits. A pilot for a personal health record program is currently underway in Nova Scotia and it has shown to have positive feedback. The drawbacks that were stated were that patients need to have consistent and reliable email access and for the program to be effective (Wong, 2013). It was also stated that the general public will not have a say in the decision of fully implementing this program, at this point I think it is up to the health care professional in this area to rally for this. What could this mean for nursing is that if the patient shared their personal health record, they will have detailed information of the patients health. This could save time and also benefit the patient in getting faster more efficient care (EHO, 2013)

The electronic health record is a health record that is in an organization, for example a hospital that has all of the health information attained from a patient from one or multiple visits. The benefits of implementing an electronic health record that are identified are: reducing medical errors, improving quality of care, save time, sharing patient information with medical team, and efficiency at work (David & Thakkar, 2006). It enables the organization to have the information of the patient right away, this can improve the quality of care. These health records are beneficial to health care as they help deliver fast and efficient care. However, part of the nursing process is to interact and interview the patient and to record their health history. Perhaps the lack of this interacting might hinder the nurse-patient relationships. Although this could happen in some cases, it is evident that the electronic and personal health records are beneficial and nurses should work to effectively implement them in their practice. Nurses should also work so that implementing this electronic health record will not allow them to lose focus on the patient.

eHealth Ontario. (2008-2013). Electronic health records ehrs explained. Retrieved from http://www.ehealthontario.on.ca/en/ehrs

Wong, J. (2013, November 25). Pilot program tests the waters of online health records. Globalnews.ca. Retrieved from http://globalnews.ca/news/988042/pilot-programtests-the-waters-of-online-health-records/

Davis, D. C., & Thakkar, M. (2006). Risks, barriers, and benefits of ehr systems: A comparative study based on size of hospital. Perspectives in Health information Management, 3(5),

Health Care Reform

Amber Case studies the symbiotic relationships between humans and machines, in the Ted Talk video that I have embedded “Amber Case: We are all cyborgs now”, she says technology is a form of self because it is created by humans and it helps us to do things that we want to do. Physical tools are an extension of our physical self because they help us to perform physical tasks examples are: hammers, bikes, cars, space rockets. Therefore, technology is an extension of the mental self and it helps us perform tasks faster and communicate around the world. Humans and technology are correlated—technology grows because of humans and humans grow because of technology. However, she also states that in order for us to grow and develop personally we need time to self reflect upon our lives. This video correlates with the implementation of technology in the health care system because technology created by health care professionals can grow and be amazing. In turn, this technology can help health care professionals to learn, grown and develop new goals. This video has helped in my understanding of the use of technology in the workplace. Technology is important and it is part of our daily lives. The new technological health care system should be implemented with ideas from health care professionals; it should be an extension of the health care team, a part of them that enables them to achieve more.

The article  “Four Rules for the Reinvention of Health Care” stated that the design of new systems of care need to come from the people who are working in a health care field and not just people who create the technological program. The new health care system cannot be organizational and technological dependent from each other, they need to work together in order to be effective (2004). The people who are utilizing the health care system are the ones who need to provide the input to reinvent it because they know what works and what does not. It is evident that technology enhances our daily lives and it connects us with others, it provides us with multiple sources of information, it saves us time. Technological advances in health care are inevitable and it is up to the health care professionals to get involved in the design of this system (Coiera, 2004). The health care professionals need to accept the evolution of technology in their practice. As Darwin (1968) stated when studying populations of animals, adaptation is a process by where a population develops and more fit for the existence in its current environment. However, if adaptation is not possible or does not happen the animals becomes extinct. If health care professionals are reluctant to technologic change their existence may be at risk. Watching the video “We are all Cyborgs now” helped me understand how technology is a part of human beings, our society, and it is here to stay. Referring to Charles Darwin theory of evolution helped me explain that the evolution of technology in health care is crucial to the survival of health care and of effective client care because of our changing society.

Darwin, C. (1968). On the origin of species by means of natural selection. 1859. See also: http://www.literature. org/authors/darwin-charles/the-origin-ofspecies.

Coiera, E. (2004). Four rules for the reinvention of health care. BMJ, 328(7449), 1197–9. doi:10.1136/bmj.328.7449.1197

Case, A. (2010, January 11). Amber Case: We are all cyborgs now  [Video file].     Retrieved from http://www.ted.com/talks/amber_case_we_are_all_cyborgs_now.html

Accessing Credible Health Information Online

Accessing credible health information online can be difficult for some people. Finding unreliable information online is inevitable since there are so many consumer websites and blogs from people without medical credentials. Furthermore, this information is available to everyone with internet and not everyone with internet access has the right health literacy to depict right from wrong. Some people may not have the time to go to the hospital or clinic so that they can get an informed explanation on their symptoms and instead use the internet as their health resource. I have started out with googling my symptoms, for example, and a cough has lead me to websites where I read about potentially having lung cancer or bronchitis. My personal experiences and current education have taught me how to look for reliable sources and understand health information that I read online. However, the Canadian Public Health Association (2008) states that “more than half of working age adults in Canada (55% or 11.7 million) are estimated to have less than adequate health literacy skills”(p.3). Health literacy is important when conducting research regarding your medical health so that you can understand what you are reading. When people do not understand what they are reading or are reading unrealiable information it can lead to confusion and psychological stress. In my case, for example, if i did not have the education the internet could have lead me to believe that I had bronchitis. Considering that almost 55% of working age adults in Canada have less than adequate health literacy (2008,p.3) it is important for the health care team to redirect patients to the right resources and present them with reliable information about their health. According to the College of Nurses of Ontario Ethic practice standards (2009), supporting a clients well-being means to further their health, and avoid or remove harm. Therefore, when nurses educate patients about health information online and where to find it, they are avoiding the psychological harm it can cause the patient and they are following the nursing standards.

College of Nurses of Ontario. (2009, June). Practice Standard:  Ethics. Retrieved from http://www.cno.org/Global/docs/prac/41034_Ethics.pdf

Gordon-El-Bihbety, D., & Rootman, I. E. Canadian Public Health Association, (2008). A vision for a health literate canada: Report of the expert panel on health literacy.. Retrieved from website: http://www.cpha.ca/uploads/portals/h-l/report_e.pdf

Someecards. (Producer). (2013, 09 23). Here’s to all the ER nurses   who convinced me I’m not dying after medical Web sites  convinced me I was. [Web Graphic]. Retrieved from http://www.someecards.com/usercards/viewcard/MjAxMy0wMTM3YzJlODU2M2RiMmJk

Mind, Body, and Spirit

“Mind, body, spirit” is the phrase that is brought to my mind when I think about holistic health in nursing. Mind, body, and spirit are all parts of a living person that can be affected in any way negative or positive throughout the course of their life.  As stated by the World Health Organization (1948) “health is a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity”. This definition coexist with the phrase “mind, body and spirit” when thinking about health and a person’s well-being. A person’s “mind plays a key role in health and that any presumed separation of mind and body is false”(Jacobs, 2001). This states that the mind and the body are interconnected and shouldn’t be analyzed separately . The “consideration of spirituality is seen as necessary to appreciate a truly holistic perspective of the client or client system” (Neuman & Fawcett, 2002) . If spirituality is not address a holistic perspective is not taken; everything needs to be taken into account. In class we discuses evidence-based nursing practice vs. evidence informed nursing practice, and discussed which one would be benefit holistic care; in this case evidence informed practice is essential. Clinical expertise is essential for nursing , and it comes with practice in a clinical setting. Research evidence is also very important because it give nurses stable grounds to their clinical practice. However, to assess the patient holistically their resources are important. A patient’s resources may be essential to their recovery (e.g., money, housing, food, transportation) if the nurse does not take this into account she is not giving the patient holistic care and their specific treatment may not have a positive outcome. Patient preference is also part of evidence informed nursing practice because it gives the patient power over their own medical situation e.g., if their religion/beliefs don’t coincide with the advised medical treatment, they may choose an alternative. I have learned that it is important to create a balance when assessing patients because their physical, mental, spiritual, social, and financial states are all interconnected.

Jacobs, G. D. (2001). The physiology of mind–body interactions: The stress response and the relaxation response. THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE, 7(1), S-83–S-92. Retrieved from http://online.liebertpub.com/doi/pdf/10.1089/107555301753393841

Neuman, B., & Fawcett, J. (2002). The Neuman systems model (4th ed.). New Jersey: Prentice Hall.

Uston. , & Jakob, World Health Organization , (2005).Bulletin of the world health organization. Retrieved from website: http://www.who.int/bulletin/bulletin_board/83/ustun11051/en/

John Millar (Blogger). (02/15/13). Mind and Soul [Blog], October 14, 2013, from: URL (http://john-millar.blogspot.ca/2013/02/body-and-soul.html)

Understanding the use of social media as a nursing student

Understanding the use of social media as a nursing student. There are boundaries that nurses and patients have to maintain in the profession. However, with new technology those lines can be cross. An example of that can be found the article I read “Ethical considerations and social media: A case of suicidal postings on Facebook. Journal of Dual Diagnosis”(2012), where a medical professional had seen suicidal pictures of a patient on their Facebook.  In class discussion it brought up the ethical dilemma of searching clients up on Facebook to check their health status. There was a fine line between private and public content on Facebook, so it was difficult to pinpoint if this is acceptable or not. It was stated that if the client puts information on the internet it is no longer private.. In a assigned article reading, I learned about ethical dilemmas regarding Twitter and what is appropriate to tweet when being in a professional setting or in your personal time. After this class and even my first nursing informatics class i started to double think when using my twitter account. The RNAO has certain guidelines nurses should follow when it comes to appropriate online conduct.  According to Registered Nurses’ Association of Ontario (2013), one of the social media guidelines for nurses to follow regarding online postings is that when i doubt, don’t post things online.

The picture above is of an article from Nursestogether.com, which talks about how you should think twice before tweeting anything about your professional practice. It can have a impact on your professional and personal profile as it has occurred in the past where some nurses violate patient privacy on social media cites.

Coe, S. (28, 11 2012). Social networking for all nurses: Think twice about what you write – see more at. Retrieved from http://www.nursetogether.com/social-networking-for-all-nurses-think-twice-about-what-you-write

Lehavot, K., Ben-Zeev, D., & Neville, R. E. (2012). Ethical considerations and social media: A case of suicidal postings on Facebook. Journal of Dual Diagnosis, 84 (4), 341 – 346. doi: 10.1080/15504263.2012.718928

Registered Nurses’ Association of Ontario, (2013). Social media guidelines for nurses. Retrieved from website: http://rnao.ca/sites/rnao-ca/files/Social_media_guidelines_2013.pdf

Renzetti, E. (2013, 7 20). Firing people for offensive tweets is worse than offensive tweets. The Global and Mail. Retrieved from http://www.theglobeandmail.com/commentary/whats-more-offensive-the-tweeting-or-the-firing/article14450045/