Week 6- Chapter 13- Caring and Communicating

Question 1

A nurse manager was orienting new staff members with regard to computerized charting. To understand computerized charting, staff members must understand informatics. Which of the following are the core concepts in informatics?
a. Hardware, software, competency, and printers.
b. Data, information, knowledge, and wisdom.
c. Decision making, data gathering, data analysis, and reporting.
d. Wireless technology, voice recognition, and handheld devices.

Answer 1

ANS: B
Informatics is the application of technology to all fields of nursing to facilitate and extend nurses’ decision-making abilities and to support nurses in the use, storage, and linkage of clinical information in providing effective and efficient patient care. Nursing informatics, like all nursing communication, is founded on the concepts of data, information, knowledge, and, more recently acknowledged, wisdom.

Question 1

The nursing manager of a surgical unit has been asked by administration to evaluate patient outcomes after cardiac catheterization. Using data about patient outcomes after cardiac catheterization for the past 6 months so as to modify practice is an example of:
a. Gathering information
b. Cost-effective care.
c. Meeting standards.
d. Evidence-informed practice.

Answer 1

ANS: D
Evidence-informed practice is a systematic approach to clinical decision-making; to provide the most consistent and best possible care to patients in this scenario, evidence is being used to optimize care for patients after cardiac catheterization.

Question 2

The clinic nurse has just accessed a patient’s chart on the computer. The resident comes over and asks her to stay logged on because he needs to add a note to that patient’s chart. What should she say?
a. “No problem. Just log me off when you’re done.”
b. “I’ll put the note in for you. What do you want to say?”
c. “Just make sure that you sign your note because it’s under my password.”
d. “I’m sorry, but you will have to enter the information using your own password.”

Answer 2

D

Question 3

A home health nurse has been assigned to cover a 500-km2 area of remote Alberta. Mrs. Banister has just been discharged home and will need daily contacts for the next week. Because it is not possible to visit Mrs. Banister in person every day and see all the other patients, the nurse gives her a laptop computer with Internet meeting software installed. Each morning, both dial in at an agreed-upon time and discuss her progress. The home health nurse assesses whether the patient needs to be seen that day. This type of technology is called:
a. Distance learning.
b. Knowledge software.
c. Telecommunications.
d. Biomedical technology.

Answer 3

ANS: C
Telecommunications facilitate clinical oversight and provision of health care at a distance via telephone, remote monitoring, and the Internet.

Question 4

Nurses need to know how to operate a computer, compare data across time, and look for patterns in patient responses to treatment. These are examples of which of the following?
a. Canadian Nursing Informatics Association standards.
b. Information systems.
c. Informatics competencies.
d. Requirements for nursing licensure.

Answer 4

ANS: C
Nurses must utilize hospital database management, decision support, and expert system programs to access information and analyze data from disparate sources for use in planning for patient care processes and systems.

Question 5

The chief nursing officer understands that to be able to compare data across patient populations and sites, it is important that nurses use:
a. Similar settings.
b. Information systems.
c. Knowledge systems.
d. Consistent nursing languages.

Answer 5

D

Question 6

Leaders in nursing must advocate for information and knowledge systems that support nursing practice. How is this best accomplished?
a. Participating in organizational information technology committees.
b. Submitting written requests for needed information systems.
c. Requesting budgetary funds needed for systems.
d. Sending staff nurses to conferences that discuss cutting-edge technologies.

Answer 6

ANS: A
The nurse manager must recognize the utility of nursing involvement in the planning, design, choice, and implementation of information systems in the practice environment.

Question 7

You are in the process of designing a patient education program that will provide education and monitoring for patients with hypertension. To support your planning, you obtain and present patient data from which of the following?
a. A clinical database.
b. Biomedical technologies.
c. Email
d. Internet sources.

Answer 7

A

Question 8

As the head nurse involved in determining which patient surveillance systems to acquire for your unit, one of your aims is to avoid adverse events through the implementation of appropriate technology. What does this particular aim recognize?
a. Human error is significant in contributing to adverse events.
b. Documentation of patient data is often illegible and therefore misinterpreted.
c. Data systems provide backup documentation with adverse events that staff cannot
provide.
d. Physiologic monitoring systems enable detection of early changes before an
adverse event occurs.

Answer 8

D
Data about adverse events suggests that a majority of physiologic abnormalities are not detected early enough and may be present hours before an adverse event actually occurs. Physiologic monitoring aids in early detection of such changes.

Question 9

As a nurse manager in a multisite facility, you are comparing the effectiveness of prompted voiding training programs for staff by examining the effect of prompted voiding on the frequency of incontinence in patients. To do this, you access an NMDS, which allows you to:
a. Retrieve standardized information regarding patient care and trends.
b. Access medical diagnoses and pharmacologic interventions.
c. Learn sociodemographic and population-based trends.
d. Find information on public funding and private health insurance revenues.

Answer 9

ANS: A
Although there continues to be inconsistency in nursing language, the NMDS defines essential nursing data to be collected for all patients that enable comparison of patient data, description of patient care, determination of trends, stimulation of nursing research, and provision of nursing data to influence decision-making.

Question 10

As a nurse manager representative on a team to select a clinical information system, you would be particularly concerned if the system has which of the following characteristics?
a. It involves screen displays that are best configured for nonclinical users.
b. It requires an upgrade to servers in the facility.
c. It requires staff orientation and training during implementation of the software.
d. It minimizes the amount of data entry necessary.

Answer 10

ANS: A
An ideal hospital information system should include as much instrumentation as possible to minimize data entry. As a clinical end-user, you would expect orientation and training on how the screen display can be configured so as to suit the purposes and preferences of users in clinical areas.

Question 11

When assessing the appropriateness of adopting personal digital assistants (PDAs) for a nursing unit, you need to consider which of the following advantages?
a. Lower cost in relation to personal computers.
b. Small display screen.
c. Font size.
d. Speed of operation.

Answer 11

A

Question 11

A nurse manager is excited by the possible use of speech recognition (SR) systems for documentation of patient care, especially during crisis situations when staff members need to focus on performing rapid assessments and implementation of procedures. She learns, however, that SR systems would be impractical at this point for this. What characteristic would lead to this conclusion?
a. SR systems are not available outside pilot projects.
b. The type of speech required for voice recognition is unlikely in a pressured
situation.
c. The hands-free function has not been perfected in SR technology.
d. Wireless communications are prone to unreliability in transmission.

Answer 11

ANS: B
Speech recognition systems rely on staccato-like speech, pauses between words, and programming for each user, any and all of which would be rare in a pressured crisis situation. SR is being used primarily for therapeutic purposes and in situations in which data entry is stable.

Question 12

For a nurse manager, one challenge is to orient new staff to the agency’s policies and procedures, and also to provide training across various shifts. Which of the following would be a cost-effective and effective learning strategy?
a. Development of new learning modules and software to support document retrieval.
b. Email distribution to staff home email addresses regarding important policies.
c. Preparation of digital video disks (DVDs) that can be viewed on computers at the
nursing station during “down times.”
d. Linking policies and procedures to the network for access when required at the
point of care.

Answer 12

ANS: D
The most accessible and cost-effective approach would be use of what is already available in the work environment. Development of new software is often expensive; DVDs are visually appealing but less nimble in enabling staff to find answers quickly at the point of care.

Question 13

What is the most critical factor in ensuring nurses’ comfort and knowledge in the use of technology in health care regardless of age, education level, or area of practice?
a. Confidence in using technology.
b. Adequacy and substance of professional development.
c. Repeated training sessions. d. Peer and leader support.

Answer 13

ANS: B
Confidence in using technology was found to be the result of the adequacy of professional development in the (Wang, Nagle, Li, et al., 2004) study. Regardless of age, education level, and area of practice, peer and leader support appropriate professional development was critical to success

Question 14

Peggy, a nurse leader on a busy medical surgical unit, is concerned that the rapid expansion in use of EHRs and clinical decision support systems may lead to leaked patient information and breach of confidentiality. She decides to form a nurse led committee to address these concerns. Which of the following must be addressed to prevent breach of confidentiality? (Select all that apply.)
a. Assign a password that uniquely identifies a user to the system by name and title.
b. Ensure nurse confidentiality through ongoing discussion.
c. Ensure nurses understand privacy legislation that applies to them, and their work
setting.
d. Monitor individual nurses.

Answer 14

ANS: A, B, C
Password must have a uniqNue sRignIaturGe asBsi.gnCed tMo a nurse that is traceable to
USNT O
documentation and care the nurse provides. Having staff nurses involved in this process provides maximum input on the issue and keeps the information at the critical level to ensure confidentiality. Understanding privacy legislation and work policies provides a framework for ethical standards. Monitoring individual nurses is unlikely as the unique individual identifiers will highlight a problem if an anomaly is detected.

Question 15

Nurses rely on technology to lessen the number of adverse events that are well documented, yet are challenged in keeping the unique therapeutic relationship between nurse and patient with increasing use of technology. What approaches can be used to ensure the therapeutic relationship is preserved (Select all that apply.)
a. Involving patients in decisions about their own care.
b. Actively listening while conducting electronic charting.
c. Showing patients what is being documented.
d. Repeatedly monitoring equipment while documenting.

Answer 15

A, B, C

Question 16

As a nurse manager, you want to institute point-of-care devices on your unit. The rationale that you provide to support the point-of-care devices includes which of the following? (Select all that apply.)
a. Reduction in incidents of medication error.
b. Immediate documentation of care.
c. Improving discharge planning.
d. Increasing confusion with nursing workflow.

Answer 16

ANS: A, B, C
Point-of-care devices that allow documentation of assessment, care, and teaching at the patient’s bedside reduce the gap in time between care and documentation, thereby reducing error, increasing accuracy, and improving communication of care, discharge planning, and teaching, in addition to fitting better with nursing workflow.