BY DAY 3 OF WEEK 9
Post a description of what you believe to be the consequences of a healthcare organization not involving nurses in each stage of the SDLC when purchasing and implementing a new health information technology system. Provide specific examples of potential issues at each stage of the SDLC and explain how the inclusion of nurses may help address these issues. Then, explain whether you had any input in the selection and planning of new health information technology systems in your nursing practice or healthcare organization and explain potential impacts of being included or not in the decision-making process. Be specific and provide examples.
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BY DAY 6 OF WEEK 9
Respond to at least two of your colleagues* on two different days, by offering additional thoughts regarding the examples shared, SDLC-related issues, and ideas on how the inclusion of nurses might have impacted the example described by your colleagues.
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The Inclusion of Nurses in the Systems Development Life Cycle
When a healthcare organization decides to acquire and implement a new health information technology system, it’s crucial to include nurses in every step of the process. Nurses are the ones who will use the system the most, so their insights are invaluable. Unfortunately, some organizations make these decisions without consulting nurses, leading to negative consequences such as increased workload, decreased efficiency, less time with patients, and poorer patient outcomes (Why Involve Nurses in Healthcare IT Development?).
The Importance of Involving Nurses in Health Information Technology
According to McGonigle & Mastrian (2017), the Systems Development Life Cycle (SDLC) is a method used to create effective information systems aligned with an organization’s goals. Many public health agencies across the country consider the SDLC a best practice for developing information systems central to their operations. This approach has helped prevent costly information system failures that disrupt operations.
The SDLC can involve various approaches, including the waterfall method, rapid prototyping, rapid application development, and dynamic system development. The waterfall method consists of six stages: feasibility, analysis, design, implementation, testing, and maintenance (McGonigle & Mastrian, 2017).
In the feasibility stage, organizations decide if a project is worth pursuing. For example, a hospital dealing with a high rate of catheter-acquired urinary tract infections (CAUTIs) might want to build a bundle into their electronic health record system (EHR) to prevent them. Nurses can provide feedback on what should be included in the bundle to ensure all relevant aspects are covered.
The analysis stage involves understanding why CAUTIs are prevalent. Working with a nurse informaticist specialist (NIS), organizations can evaluate the EHR data and gather input from nursing staff. The NIS can discuss effective CAUTI prevention measures with the nursing team, which will inform the design phase.
During the design phase, detailed information is recorded in the EHR, including insertion details, catheter size, post-insertion findings, and patient symptoms. Nurses stress the importance of timely catheter removal unless there’s a medical reason not to. The system is assembled, and nurses can test it to ensure it reduces CAUTIs and improves workflow.
Testing the system involves five layers to ensure it functions correctly. Nurses can assist in the final beta testing phase to confirm the system’s performance. After successful testing, the system is ready for use.
To ensure continuous improvement, nurse leadership can require staff to complete surveys during the initial months of system implementation.
In my nursing practice, I haven’t been involved in selecting and planning new health information technology systems. However, in the healthcare organization I worked for, they prioritized thorough training and included experts on every unit when they implemented the EPIC system. This inclusive approach ensured that the best decisions were made, benefiting both staff and patients.
References:
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
Singletary, V., & Baker, E. L. (2019). Building Informatics-Savvy Health Departments: The Systems Development Life Cycle. Journal of Public Health Management and Practice, 25(6), 610– 611. https://doi.org/10.1097/PHH.0000000000001086Links to an external site.
Why Involve Nurses in Healthcare IT Development? (2019, April 1). TeleTracking. https://www.teletracking.com/resources/why-involve-nurses-in-healthcare-it-developmentLinks to an external site.
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Collapse SubdiscussionMenard Tchatchou-Tchoubia The Inclusion of Nurses in the Systems Development Life Cycle
Response Post # 1
The Importance of Involving Nurses in Health Information Technology
Why It’s Crucial to Include Nurses in Health Information Technology
When it comes to introducing new technology in healthcare, nurses have a pivotal role to play, and their involvement should not be underestimated. Having nurses participate in the planning and implementation of health information technology (IT) systems is vital for several compelling reasons.
1. Making Technology User-Friendly:
Nurses are the ones who provide direct patient care. They use health IT systems daily for tasks like recording patient information, giving treatments, and monitoring vital signs. Including nurses in the development and design of these systems ensures they are easy to use, efficient, and meet the needs of healthcare providers.
2. Smoothing Workflow:
Nurses are well-versed in how healthcare processes work. By involving them in the planning and roll-out of health IT systems, it becomes easier to make processes more efficient and minimize any hiccups. Nurses can provide valuable input on how technology can be seamlessly integrated into their daily routines without disrupting patient care.
3. Ensuring Patient Safety:
Keeping patients safe is a top priority in healthcare. Nurses are responsible for administering medications, keeping an eye on patients, and providing care. Health IT systems can improve patient safety by providing accurate and up-to-date information. Having nurses help in system development ensures that these technologies support safe patient care.
4. Elevating Care Quality:
Nurses are in a unique position to evaluate how health IT impacts the quality of care. Their insights can reveal areas where technology can enhance care delivery, reduce mistakes, and elevate the overall quality of healthcare services.
5. Encouraging Acceptance:
The success of health IT systems hinges on user acceptance. When nurses are actively involved in planning and design, they are more likely to embrace the technology. Their participation fosters a sense of ownership and a commitment to making the system work effectively.
6. Problem-Solving Skills:
Nurses are natural problem solvers. In healthcare, challenges and unexpected situations crop up regularly. Engaging nurses in health IT development allows them to foresee and tackle potential issues, making the system robust and adaptable.
7. Continuous Improvement:
Healthcare is always evolving. Involving nurses in health IT planning provides an ongoing source of feedback and ideas for system enhancements. They can identify areas needing improvement and suggest updates to keep the technology current.
In summary, nurses are indispensable in the successful adoption and implementation of health information technology. Their expertise, experience, and dedication to patient care make them key players in developing IT systems that benefit both healthcare providers and patients. It’s crucial to acknowledge and value their contributions in the ever-advancing world of healthcare technology.
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References
Cao, Y., & Ball, M. (2017). A hospital nursing adverse events reporting system project: an approach based on the systems development life cycle. In MEDINFO 2017: Precision Healthcare through Informatics (pp. 1351–1351). IOS Press.
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
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Collapse SubdiscussionOluyemi Adeagbo Hi Raminder,
Your train of thought concerning nurse involvement in the Systems Development Life Cycle (SDLC) encompasses some informative insights. Including nurses in SDLC creates a solid foundation that takes into consideration elements such as efficiency, workflow, feedback, experiences, and patient outcomes (Risling & Risling, 2020). Failing to include nurses could bring deficiencies such as low nurse output or miscommunications that are costly particularly in the nursing field. Additionally, nurses provide front-line information that helps prevent adverse situations brought about by wrong medication, or missing data. Your Electronic Health Record (EHR) and Catheter-Acquired Urinary Tract Infections (CAUTIs) example, demonstrate the rationale behind nurse involvement. Organizations which integrate nurses in SDLC stages get more positive results during implementation (Wang et al., 2019). Consequently, institutions that negate the above statement, experience repercussions that ultimately impact patients. Finally, I urge all institutions to not only involve nurses in the SDLC process, but also offer adequate training on the same technologies.
References
Risling, T. L., & Risling, D. E. (2020). Advancing nursing participation in user-centred design. Journal of Research in Nursing, 25(3), 226–238.
Wang, J., Gephart, S. M., Mallow, J., & Bakken, S. (2019). Models of Collaboration and Dissemination for Nursing Informatics Innovations in the 21st Century. HHS Author Manuscripts, 67(4), 419-432. https://doi.org/10.1016/j.outlook.2019.02.003Links to an external site.
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Collapse SubdiscussionMaxine A Lewis Kaur, that was a very insightful response! You stated that nurses should be included in SDLC as they “use the health information technology system the most… and can provide feedback on the effectiveness” of the design to which I totally agree, We are problem solvers and innovators as a result of the way we apply the nursing process in our clinical practice. I remember greater than 25 years ago a few of us nurse started using the red trash bags to transfer our patients over from beds to stretchers, Years later who would have thought, someone would have changed the color to orange, inscribed “this side” then patent it for patient transfer device. From then on it as evolved to other transfer devices (see https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.simplymedical.com%2Fz-slider-transfer-sheet%2F663441pa&psig=AOvVaw3QqtxQyhwE1wYq2SDOhXyu&ust=1674875397250000&source=images&cd=vfe&ved=0CAsQjRxqFwoTCOjLkJrj5vwCFQAAAAAdAAAAABAELinks to an external site.).
According to Johnson and Johnsons, nurses are uniquely positioned to create innovative solution as they are the backbone of our healthcare system and has the ability to adapt to challenges as well as naturally identify opportunities to improve patient care, nurses bring resourcefulness and extensive patient experience to their roles (5 Nurses Making Waves in Healthcare Innovation, 2019). Nursing must play a greater role in advancing technological innovations in healthcare: Regrettably, nursing voices in this area are hampered by a lack of familiarity with design-thinking and associated practical experience (Risling and Risling, 2020).Nurses are often thought to be resistant to change but Hamer and Cipriano stated that the perceived resistance is the result of nurses … are not initially involved in the change or developmental process. Furthermore cites the authors, Nurse leaders must be actively involved in debates over appropriate technology and resources (Hamer and Cipriano, 2013).
References
Hamer S, Cipriano P. Involving nurses in developing new technology. Nurs Times. 2013 Nov 27- Dec 5;109(47):18-9. PMID: 24380174. https://pubmed.ncbi.nlm.nih.gov/24380174/
Johnson &Johnsons.2019, 5 Nurses Making Waves in Healthcare Innovation.
Risling, T. L., & Risling, D. E. (2020). Advancing nursing participation in user-centred design. Journal of research in nursing : JRN, 25(3), 226–238. https://doi.org/10.1177/1744987120913590
Edited by Maxine A Lewis on Jan 26 at 10:19pm -
Collapse SubdiscussionBarkisu Fortenberry Hello Raminder,
This is a great post. Nurses significantly impact overall healthcare; they must be included in every system development life cycle step. The primary aim of implementing SDLC is to promote healthcare services’ effectiveness, efficiency, and safety (McGonigle & Mastrian, 2017). One of the people who understand the pinches of a healthcare system is nurses. This gives them an upper hand in being among the top committee members that design and implement the SDLC so that every system component is looked at from the end user perspective. Nurses also interact with patients and their relatives the most. This means they get the patients’ feedback on how the system could serve them better. These feedbacks are crucial in the improvement of the system and could be essential during the development and implementation of the system (Why Involve Nurses in Healthcare IT Development, 2019). Excluding means the end users’ opinions are neglected. This does not mean that other healthcare professionals are lesser impactful or do not interact with patients. However, their level of interactions and hours are lesser than nurses, which means there is little yet important information about the system that they may be unaware of and could be ignored if nurses are not included in the system development life cycle (Singletary & Baker, 2019).
While we are advocating for nurses’ inclusion in SDLC, it is also essential for nurses to stand up for themselves and show how impactful they are. I am happy that this discussion has been brought here to spur us to stand up for ourselves because if we do not, no one will. We need to show that we can make essential decisions and impact the healthcare system more positively. We will not have to convince anyone to include us in the development process or agenda. They will be looking for us for the idea. We need to create value in ourselves and show that we have potential (Echo, n.d). I hope everyone will go out there and show this.
References
Echo, O. O. N. S. Tag Archives: Mohs Surgery. https://onenationsecho.com/tag/mohs-surgery/
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
Singletary, V., & Baker, E. L. (2019). Building Informatics-Savvy Health Departments: The Systems Development Life Cycle. Journal of Public Health Management and Practice, 25(6), 610– 611. https://doi.org/10.1097/PHH.0000000000001086 Links to an external site. Links to an external site.Links to an external site.
Why Involve Nurses in Healthcare IT Development? (2019, April 1). TeleTracking. https://www.teletracking.com/resources/why-involve-nurses-in-healthcare-it-developmentLinks to an external site.
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Collapse SubdiscussionOdion Iseki Hello Raminda,
You did a good job putting this write-up together; determining feasibility begins with whether to undertake a project. A hospital with high catheter-acquired urinary tract infections (CAUTIs). They may add a package to their EHR to prevent CAUTIs (EHR). To cover all bases, nurses may suggest current topics for the bundle before the process begins. The organization will analyze why CAUTIs are so common next. McGonigle & Mastrian (2017) recommend working with a nurse informaticist specialist (NIS) to examine EHR data and get nursing staff feedback. The NIS could discuss CAUTI prevention with nursing personnel. The NIS and nursing leadership might construct a CAUTI prevention plan (McGonigle & Mastrian, 2017). For instance, note the EHR’s date and time of the insertion, the catheter’s size, any findings following the insertion, and the patient’s symptoms before the insertion, such as burning or itchy. The nurse might also emphasize the need to remind staff to remove the catheter after a certain number of days unless there is a contraindication.
References:
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
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Collapse SubdiscussionBertina Boma Soh Hey, Raminder, whenever a healthcare institution is looking to acquire and implement a new health information technology system, I agree that nurses should be included at all points in the Systems Development Life Cycle (SDLC). Different system development models, tools, and applications were created before computers were used to process information. There is an increase in demand for software that is less expensive, has more features, can be delivered more quickly, and is of higher quality than what was available before computers were used (Olorunshola & Ogwueleka., 2022).
Like you, I have yet to have any say in what new health IT systems are implemented in my nursing practice or the healthcare organization I work for. Due to incompatibility, patient care suffers, and resources are well-spent. As a result, there is a pressing need to establish data sharing and exchange methods amongst the various health information systems (Torab-Miandoab et al., 2023).References
Olorunshola, O. E., & Ogwueleka, F. N. (2022). Review of system development life cycle (SDLC) models for effective application delivery. In Information and Communication Technology for Competitive Strategies (ICTCS 2020) ICT: Applications and Social Interfaces (pp. 281-289). Springer Singapore.
Torab-Miandoab, A., Samad-Soltani, T., Jodati, A., & Rezaei-Hachesu, P. (2023). Interoperability of heterogeneous health information systems: a systematic literature review. BMC Medical Informatics and Decision Making, 23(1), 1-13.
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Collapse SubdiscussionRemi Oluremi Ojo Hi Raminder.
Thank you for the informative post on Catheter-associated urinary tract infection (CAUTI). CAUTI is one of the most common healthcare-associated infection and source of secondary bloodstream infections. Regardless of many progress in diagnosis, prevention and treatment, CAUTI remains a serious healthcare burden, and resistance to antibiotic are at a alarmingly high rate (Werneburg, 2022). It is important to introduce preventative measures such as observation of the appropriate use of indwelling Foley catheters and timely removal when patients at high risk for catheter-associated urinary tract infection are identified. In a study by Hur et al., (2019), the Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection was programed using a risk-scoring algorithm that was based on a logistic regression model and integrated into the electronic health records. They included the following eight risk factors for urinary tract infection in the logistic regression model: highest neutrophil level (%), indwelling urinary catheter application period (days), length of stay, lowest blood urea nitrogen level of greater than 20 mg/dL, dependent physical activity, blood albumin level of less than 3.5 g/dL, lowest blood sodium level of less than 136 mEq/L, admission to the Intensive Care Unit. The risk groups were identified and classified by the Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection and displayed on the patient summary screen of the electronic health record. The study showed that Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection was effective in identifying patients that were high risk for CAUTI. It is beneficial and possible to assign nurses to monitor the use, removal, and management of indwelling Foley catheters and training and education by using the Automated Risk Assessment System for Catheter-Associated Urinary Tract Infection in clinical settings.
References
Hur, E. Y., Jin, Y., Jin, T., & Lee, S. M. (2019). Development and evaluation of the automated risk assessment system for catheter-associated urinary tract infection. Computers, informatics, nursing : CIN, 37(9), 463–472. https://doi.org/10.1097/CIN.0000000000000506Links to an external site.Links to an external site.Werneburg G. T. (2022). Catheter-associated urinary tract infections: Current challenges and future Prospects. Research and reports in urology, 14, 109–133. https://doi.org/10.2147/RRU.S273663
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Collapse SubdiscussionMenard Tchatchou-Tchoubia Inclusion of Nurses in the System Development Life Cycle (SDLC)
Initial post
Menard Tchatchou
Inclusion of Nurses in the SDLC
Introduction
An ongoing cycle of procedures is involved in creating new systems to guarantee effective execution. Delivering efficient and productive information systems (ISs) that mesh with an institution’s strategic plan for operation requires following the systems development life cycle (SDLC). The process of implementing a new clinical system should involve nurses to ensure that functions are adequately integrated into evidence-based healthcare delivery. Nurses also provide valuable input for vendors in the development of user-friendly interfaces. In addition, nurses can help ensure that the software meets safety and quality standards and is compliant with applicable laws and regulations. Further, nurses can train other healthcare professionals on the use of the software system, helping to ensure its successful implementation.
Consequences of a Healthcare Organization Not Involving Nurses
A healthcare organization’s decision to purchase and install a new health information technology (HIT) system is likely to have adverse effects if nurses are not included in every stage of the software development life cycle (SDLC) (Mustaquim & Nyström, 2015). The HIT system might not be able to accommodate the needs of the nursing staff. Another effect is the HIT system’s potentially poor integration with the rest of the healthcare institution’s systems and procedures.
Nurses play an important role in the Software Development Life Cycle (SDLC). By understanding the needs of the patient and their care, nurses can provide valuable insights into the design of software systems. In addition, nurses can give feedback on the usability of the software and the impact of the technology on patient care. This feedback is important for designers to ensure the software meets the user’s needs.
Issues at Each Stage of the SDLC
When building a new health information technology (HIT) system, several potential challenges could arise at each stage of the software development life cycle (SDLC), and the involvement of nurses can assist in solving these concerns.
Planning
The healthcare organization might need a more precise grasp of the demands and requirements of the nursing staff, which could be a problem during the planning stage. This could result in the creation of a framework that is not user-friendly and does not cater to the demands of the nurses. However, the healthcare organization can get insight into the unique requirements and preferences of the nursing staff and create a system suited to those needs by incorporating nurses in the planning process.
Analysis
The healthcare organization needs to fully comprehend the current workflow and procedures of the nursing staff, which may result in the creation of a system that interferes with existing processes and workflows, lowering productivity (Qin et al., 2017). The healthcare organization may better understand the present workflow and ensure that the new platform is integrated into these procedures by including nurses in the analysis process. Nurses should be included in any project relating to their line of work’s analytical phase. This helps ensure that the nursing staff will accept the new system or solution and that it will integrate easily into their current workflow and operations. In addition, the healthcare organization can better understand the nursing staff’s difficulties and needs by including them in the analytic process. This helps inform the design of the new system or solution. Involving nurses in the analysis phase can also foster the project’s buy-in and support from the nursing team, which can be essential to its success.
Design
The system may not be simple or intuitive for nursing staff to operate. This may result in a drop in system acceptance and utilization, leading to inefficiencies and mistakes (McGonigle & Mastrian, 2021). On the other hand, the healthcare organization may ensure that the system is simple to use and intuitive for the nursing staff, which will increase acceptance and usage of the system.
Implementation
The new HIT system might need to be adequately integrated with the other systems and procedures used by the healthcare organization (Qin et al., 2017). The healthcare organization may make sure that the new system integrates seamlessly into the current environment and that the nursing staff is adequately trained to utilize the system by including nurses in the implementation process. Another potential issue is user adoption. If the nursing staff feels uncomfortable with the new system or does not find it easy to use, they may not use it properly. This can lead to data errors, incorrect documentation, and other problems. To mitigate this, healthcare organizations should involve nurses in the design process to tailor the system to their needs, provide ongoing training and support, and offer incentives to use the system correctly.
Maintenance
During the maintenance phase, it is possible that the system will not be updated or maintained regularly, which could result in decreased performance and potential faults (Weckman & Jansen, 2009). However, the healthcare organization may guarantee that the system is routinely updated and maintained to ensure maximum performance and dependability by incorporating nurses in the maintenance process.
My Input in the Selection and Planning of New Health Information Technology Systems
In my nursing practice and healthcare organization, I have had a say in the decision-making and planning process for new health information technology systems. In particular, I was a team member that assessed, contrasted, and made recommendations for our company’s new electronic health record (EHR) system. In addition, I offered feedback on how the plans would impact patient care, nurse workflow, and staff morale as we looked at several vendors and their products. We also discussed how the system should be altered to suit our requirements. The consequences could have been severe if I had not been involved in the decision-making process. For instance, the system might not have been designed with our needs in mind, and the changes to the workflow created commotion and confusion. In addition, the system may not have had the features and capabilities required to enable our patient care.
Conclusion
To ensure that the system satisfies the organization and its workforce’s requirements, nursing staff must be involved in the decision-making process surrounding health information technology systems. Furthermore, it raises the likelihood of successful implementation by fostering a sense of engagement and trust among the personnel. The nursing staff should be involved in all stages of the process, from the initial assessment of the organization’s needs to the implementation and training of the team. Involvement in the decision-making process should include providing input on the features and capabilities of the system, such as the design of the user interface, the ease of data entry and retrieval, and the security features. Additionally, nursing staff should be involved in the evaluation and testing of the system before and after it is implemented.
References
McGonigle, D., & Mastrian, K. (2021). Nursing informatics and the foundation of knowledge. Jones & Bartlett Publishers.
Mustaquim, M. M., & Nyström, T. (2015, June). A system development life cycle for persuasive design for sustainability. In International Conference on Persuasive Technology (pp. 217-228). Springer, Cham.
Qin, Y., Zhou, R., Wu, Q., Huang, X., Chen, X., Wang, W., & Yu, P. (2017). The effect of nursing participation in the design of a critical care information system: a case study in a Chinese hospital. BMC medical informatics and decision making, 17(1), 1-12.
Weckman, H., & Janzen, S. (2009). The critical nature of early nursing involvement for introducing new technologies. OJIN: The Online Journal of Issues in Nursing, 14(2).
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Collapse SubdiscussionOluyemi Adeagbo Hi Menard,
Effective incorporation of the Systems Development Life Cycle (SDLC) in healthcare institutions promotes quality and safety standards (Spanò & Ferri, 2020). Your post has echoed the above views. In SDLC implementation, nurses should get involved since they provide deep insight into healthcare delivery, patient complaints, patient needs, and opinions on the friendliness of user interfaces. I concur with you that failure to involve nurses births poor system integration because lacking user contribution will create a system that does not meet the actual needs. In such a situation. SDLC should get predicated upon step-by-step nurse involvement to ensure nursing requirements get captured as a strategy to boost nurses’ output (Dykes & Chu, 2020). However, a balance must exist between nursing staff requirements, usability, and Evidence-Based Practice (EBP) recommendations. I applaud the elaborate manner you have expounded on each SDLC phase as the explanations flow in thought.
References
Dykes, S., & Chu, C. H. (2020). Now more than ever, nurses need to be involved in technology design: lessons from the COVID-19 pandemic. The Internatinal Voice of Nursing Research, Theory and Practice, 30(7), e25-e28. https://doi.org/10.1111/jocn.15581Links to an external site.
Spanò, R., & Ferri, L. (2020). Information systems in healthcare: Current issues and future trends. Cambridge Scholars Publishing.
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Collapse SubdiscussionAndrea M Allen Hi Menard,
Great read. I am hoping by now, the importance of nurses involvement in the SDLC is evident in design and sustainability by developers. The hospital I work for is currently going through its second company for our EMAR. The primary focus is cost which has hindered the hospital’s progress. The first mistake was using a company that designed its software for a nursing home and not specific to a Hospital for Mental Health. As a result of that, there were numerous adjustments made until administration decided to abandon the program. The second program has a lot more features but also requires continuous adjustments. Recommendations for the more popular and efficient software programs were dismissed due to again, cost. Until nurses involvement are regarded as critical and necessary, we might have to sample other software programs before reality kicks in. As our knowledge expands, we will be able to enlighten the perspective of our employers as to why nurses opinion matters in each stage of the SDLC.
Best,
McGonigle, D., & Mastrian, K. (2021). Nursing informatics and the foundation of knowledge. Jones & Bartlett Publishers.
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Collapse SubdiscussionGuoming Feng Response #1
Hi Menard,
According to McKay & Vanaskie (2018), most of times, a new healthcare technological system ends up with failure is directly linked to exclusion or only partial inclusion of healthcare professionals in the system’s development. Nurses as backbone of healthcare should be included in all steps of the SDLC. You point out that nurse inclusion would “ensure that functions are adequately integrated into evidence-based healthcare delivery”. What a great viewpoint! Nurses provide direct patient care, they have valuable experiences to share and benefit the new healthcare technology system by helping in the steps of planning and design, ensuring the functions of the new systems would be evidence-based. I also totally agree with you that nurse involvement to the new system’s SDCL would benefit the new system to be more user-friendly. According to Risling (2020), nurses as the users of healthcare technological systems, their experiences of using the systems would determine whether or not the new systems are user-friendly or not. That is why it will be essential to include the users-the nurse in the new systems’ develop, especially in the testing steps.
McKay, C. and Vanaskie, K., 2018. Partnering for Success: The Role of the Nurse Leader in Health Information Technology Implementation for Coordination of Care. Nurse Leader, 16(6), pp.385-388.
Risling, T. L., & Risling, D. E. (2020). Advancing nursing participation in user-centred design. Journal of research in nursing: JRN, 25(3), 226–238. https://doi.org/10.1177/1744987120913590
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Collapse SubdiscussionMleh Porter Great post, Menard. I agree with you that involving nurses in each stage of the systems life development cycle (SDLC) when implementing a new health information technology system is important for the healthcare organization’s success and overall nursing performance. The failure to include nurses in this process leads to systems that are not user-friendly. Nurses can add valuable inputs in developing and introducing digital solutions into healthcare systems because of the unique interactions that nurses have with patients and other healthcare team members. To improve health information technology and make it more nurse-friendly, nurses need to occupy a more significant role in the advancement of technology innovation in healthcare (Risling & Risling, 2020). In one study, nurses were part of the design and implementation of an intensive care information system (ICIS), along with the hospital information team and the software engineers, which led to the implementation of a very useful ICIS (Qin et al., 2017). The ICIS implemented through the collaboratory effort led to a significant improvement and the efficiency of documentation for nurses, medication order transcription, and administration. The efficiency of the charting system allowed nurses to spend more time with patient care leading to improved patient care and nursing performance (Qin et al., 2017).
References
Risling, T. L., & Risling, D. E. (2020). Advancing nursing participation in user-centered design. Journal of Research in Nursing: JRN, 25(3), 226– 238. https://doi.org/10.1177/1744987120913590Links to an external site.
Qin, Y., Zhou, R., Wu, Q., Huang, X., Chen, X., Wang, W., Wang, X., Xu, H., Zheng, J., Qian, S., Bai, C., & Yu, P. (2017). The effect of nursing participation in the design of a critical care information system: A case study in a chinese hospital. BMC Medical Informatics and Decision Making, 17(1). https://doi.org/10.1186/s12911-017-0569-3
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Collapse SubdiscussionBertina Boma Soh Hello Manard; you performed an incredible job. Your highly detailed work taught me many essential things about the systems development life cycle, the ramifications of excluding the nurses, and the challenges at each SDLC level. Thank you for all of your help!
Your observation that “the healthcare organization might need a more exact knowledge of the expectations and requirements of the nursing staff, which could be a problem during the planning stage” is a highly fair point. You made this observation in the context of planning. This is so true, as it could lead to the development of a framework that is not user-friendly and does not respond to the requirements that are set forth by the nurses. It has been pointed out that the healthcare organization needs to have a comprehensive understanding of the current workflow and procedures of the nursing staff. Failing to do so may result in developing a system that disrupts the already-established workflows and processes, thereby reducing overall productivity. To put it simply, I couldn’t agree with you more.
There are many different motivations for carrying out risk assessments. The implementation of risk assessment procedures helps to mitigate the dangers that are associated with using software-based systems. In many companies, integrating security into each and every stage of the software development life cycle (SDLC) is a strenuous effort (Jimoh et al., 2022).
One potential problem could be user adoption. If the nursing staff is uneasy with the new system or needs help finding it straightforward to use, there is a possibility that they will not use it effectively. Because of this, inaccuracies in data, erroneous documentation, and other complications may arise. Because of the high quality of nursing data that is collected in clinical practice, it is uncommon for nursing data to be found in data repositories at the present time. The American Nurses Association advocates using the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) for classifying nursing problems, interventions, and observations in electronic health records to improve the overall quality of nursing data (Kim et al., 2020).
References
Jimoh, R. G., Olusanya, O. O., Awotunde, J. B., Imoize, A. L., & Lee, C. C. (2022). Identification of Risk Factors Using ANFIS-Based Security Risk Assessment Model for SDLC Phases. Future Internet, 14(11), 305.
Kim, J., Macieira, T. G., Meyer, S. L., Ansell, M., Bjarnadottir, R. I., Smith, M. B., … & Keenan, G. M. (2020). Towards implementing SNOMED CT in nursing practice: a scoping review. International journal of medical informatics, 134, 104035.
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Collapse SubdiscussionBarkisu Fortenberry Hello Menard,
The primary basis for the systems development life cycle is to improve the quality and safety of care being provided to patients. This necessitates understanding the factors that hinder achieving quality and safe care, and one of the most influential people in healthcare that can give that information are the nurses (Spanò & Ferri, 2020). Your post about why nurses should be included in the system development life cycle highlights the importance of nurses’ involvement in system development and improvement. You posted nurses understand healthcare delivery more than anyone. After all, they stay the longest with the beneficiaries of the hospital systems. The longer stay with patients means that nurses get immediate feedback from them and also see how the system impact delivery of patient care (McGonigle & Mastrian, 2021). Hence, they can advise the system development life cycle team on how to align the system development to meet patients’ needs. Failure to involve nurses in the system development life cycle will likely lead to developing and implementing a system that does not address the primary patient and system needs in institutions.
Still, while we are advocating for the inclusion of nurses in the system development life cycle, we need to show our value as nurses. It is the time that every nurse should stand up, be proud and confident of what they can do, and not let anyone kill our flames. The more we show the healthcare fraternity that we can, the more we will not need to validate our importance to anyone. Instead, our input will automatically be needed (Spanò & Ferri, 2020). I know nurses have been trying, and opportunities such as these are great to help nurses learn their importance in system development and involvement in improving the care delivery in our healthcare institutions.
References
Dykes, S., & Chu, C. H. (2021). Now more than ever, nurses need to be involved in technology design: Lessons from the COVID‐19 pandemic. Journal of Clinical Nursing, 30(7-8), e25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753642/Links to an external site.
McGonigle, D., & Mastrian, K. (2021). Nursing informatics and the foundation of knowledge. Jones & Bartlett Learning. https://books.google.com/books?hl=en&lr=&id=d94XEAAAQBAJ&oi=fnd&pg=PP1&dq=McGonigle,+D.,+%26+Mastrian,+K.+(2021).+Nursing+informatics+and+the+foundation+of+knowledge.+Jones+%26+Bartlett+Publishers.&ots=NjFSsCGAoV&sig=k7N7KvAA2GNQ813dkMPEH05IzOI#v=onepage&q=McGonigle%2C%20D.%2C%20%26%20Mastrian%2C%20K.%20(2021).%20Nursing%20informatics%20and%20the%20foundation%20of%20knowledge.%20Jones%20%26%20Bartlett%20Publishers.&f=falseLinks to an external site.
Spanò, R., & Ferri, L. (2020). Information systems in healthcare: Current issues and future trends. Cambridge Scholars Publishing. https://books.google.com/books?hl=en&lr=&id=uLXkDwAAQBAJ&oi=fnd&pg=PP6&dq=Information+systems+in+healthcare:+Current+issues+and+future+trends.+&ots=U1WNSNNvbq&sig=pgX6S4Zqs0lN7qhFq8x5GZAlTe4#v=onepage&q=Information%20systems%20in%20healthcare%3A%20Current%20issues%20and%20future%20trends.&f=false
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Collapse SubdiscussionColleen Lewis Response 1
Hi Menard,
Thank you for your thoughts on this topic. Nurses clearly possess insight that needs to be included in the SDLC. More nurses are now expected to have certain competencies related to use of health information systems (HIS). The inclusion of a nurse leader on the team for a new HIS project would be ideal. Nurse leaders in particular should have skills in budgeting and planning in a team for design and implementation of new HIS, along with other competencies related to tracking data and reporting (Collins et. al, 2017). A nurse leader can also provide support to fellow nurses and create a culture of positivity that helps with successful adoption of the new system.
Nurse leaders, as members of the healthcare team that not only typically possess the analytical skills and clinical knowledge of a bedside nurse, also have leadership skills that prime them to represent the needs of nurses and their workflow in team meetings for HIS updates and new projects. Communication between different members of the team is often one of the biggest issues faced when attempting to implement a new system (McGonigle & Mastrian, 2022). Nurses, who possess excellent communication skills and work regularly as a team in patient care are prime candidates to act as a leader to ensure effective communication is maintained from beginning to end in the SDLC, and that the interests of ALL stakeholders, including nurses, are accounted for.
References
Collins, S., Yen, P.-Y., Phillips, A., & Kennedy, M. K. (2017). Nursing informatics competency assessment for the nurse leader. JONA: The Journal of Nursing Administration, 47(4), 212–218. https://doi.org/10.1097/nna.0000000000000467
McGonigle, D., & Mastrian, K. G. (2022). Nursing Informatics and the foundation of knowledge. Jones & Bartlett Learning.
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Collapse SubdiscussionErica Schulte Erica Schulte – Response #1
Hello Menard, thank you for your post and it is great to hear a successful story of nurse involvement in systems development. Based on your response it seems that you were heavily involved in all stages of the systems development life cycle. As discussed in (McGonigle & Mastrian, 2022), the multiple stages of the development life cycle require end user involvement in order to achieve the greatest outcome for the newly established system. In the journal readings (Weckman & Janzen, 2009), there is a heavy level of support for nursing involvement through this development as well. There are common trends when the new systems are developed with success and nursing involvement is one of those.
References
McGonigle, D., & Mastrian, K. G. (2022). Chapter 9. In Nursing Informatics and the foundation of knowledge (pp. 194–194). essay, Jones & Bartlett Learning.
Weckman, H., & Janzen, S. (2009). The critical nature of early nursing involvement for introducing new technologies. OJIN: The Online Journal of Issues in Nursing, 14(2). https://doi.org/10.3912/ojin.vol14no02man02
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Collapse SubdiscussionOluyemi Adeagbo The Inclusion of Nurses in the Systems Development Life Cycle
The System Development Life Cycle (SDLC) is comprised of 7 stages. The stages of SLDC include planning, analysis, design, development, testing, implementation, and maintenance (Cloud Defense, n.d.). The planning stage is where the developers will create a plan to tackle the upcoming project. The analysis phase of SDLC involves determining which software/hardware or other supplies will be needed for the project. In the design phase, developers begin to design the software before it is developed. In the development stage, the program is built. In the testing phase, the program is tested for bugs and other kinks. In the implementation stage, the project is executed and tested by the users. Lastly, the maintenance stage is vital to continue to ensure that there are no kinks or bugs and if they arise, they can be quickly taken care of.
I believe that nurses should be part of each stage of the SDLC. When nurses are not integrated into the design process, there could be missed opportunities. As in, there could be functions and features that should be implemented but are not because there was no input from the nursing staff that would be using the program. Verma and Gupta (2017) provide examples of the consequences that stem from not including nurses in the SDLC. When nurses are not included in the planning phase, it is difficult to find a problem or project to address. If nurses are not involved in the analysis, design, and development of the system, the verbiage could be misconstrued or used incorrectly. For example, if the system is designed solely by techno wizards, they may not have the full understanding of medical terms and phrases and therefore may not use them appropriately or integrate them in the most effective ways. When nurses are not included in the testing and implementation phase of the system, it is difficult to gauge how well the system works since it is not being tested by the actual potential users.
The inclusion of nurses in each phase of the SDLC is crucial to having a system that works to the best possible extent. Allowing the end user to participate in the design and implementation process can eliminate kinks in the system and allow it to function better in the beginning rather than through trial and error. Bresnick (2018) states that allowing nurses to be part of the system process creates an avenue for the organization to “strengthen HER optimization” (p.1).
I personally have never been involved in the design or implementation process of a new system. However, when my previous company went live with Cerner, we were all testing the system and allowed to make suggestions for future changes so that the program would run more efficiently. I think that not having nurse input during the design phase created more complaints and left room for improvement with the system that could have otherwise been mitigated prior to launch had there been nursing input.
References:
Bresnick, J. (2018, May 23).Nurses play a critical role in EHR optimization and data governance. Health IT Analytics. https://healthitanalytics.com/news/nurses-play-a-critical-role-in-ehr-optimization-data-governanceLinks to an external site.
Cloud Defense. (n.d.).7 phases of the system development life cycle guide. Retrieved January 22, 2023, from https://www.clouddefense.ai/blog/system-development-life-cycleLinks to an external site.
Verma, M. P., & Gupta, S. (2017). Software development for nursing: Role of nursing informatics. International Journal of Nursing Education and Research,5(2), 203-207.https://doi.org/10.5958/2454-2660.2017.00044.8
Edited by Oluyemi Adeagbo on Jan 23 at 10:35am-
Collapse SubdiscussionRaminder Kaur Hello Oluyemi, Thanks for your post.
The opportunity for nurses to step into design-space processes is time-limited, and inaction will likely have detrimental consequences for nursing and patients. If healthcare administrations fail to include nurses during the SDLC process of purchasing and implementing new information technology systems, the effects could be the failure to identify pertinent issues (Cleveland et al., 2019). The perspective of nurses in technology development has traditionally been absent for several reasons: the prioritization of cost over functionality, an ill-conceived understanding that nurses are resistant to change, and a lack of encouragement from organizational leaders (Hamer & Cipriano, 2013). This has led to downstream effects, such as significant interruptions in provider workflow and the subsequent necessity for workarounds (Brown et al., 2020). A relevant example of the impact of poor technological design on patient care is barcode medication administration (BCMA), which purports to reduce medication errors and improve patient safety. By scanning the barcode on a patient’s armband followed by scanning the barcode on the prescribed medication, the technology enables clinical nurses to confirm the patient is receiving the right drug, at the correct dose, at the right time and through the proper route (Koppel et al., 2008). However, a nurse who administers medications throughout their shift may frequently encounter unreadable barcodes or malfunctioning scanners and, as a result, may implement workarounds to ensure timely patient care and meet the unit’s demands.
References:
Brown, J., Pope, N., Bosco, A. M., Mason, J., & Morgan, A. (2020). Issues affecting nurses’ capability to use digital technology at work: an integrative review. Journal of Clinical Nursing, pp. 29, 2801– 2819. https://doi.org/10.1111/jocn.15321
Cleveland, K. A., Motter, T., & Smith, Y. (2019, May 31). Affordable care: harnessing the power of nurses. OJIN: The Online Journal of Issues in Nursing. https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-24-2019/No2-May-2019/Affordable-Care.html?css=print
Hamer, S., & Cipriano, P. (2013). Involving nurses in developing new technology. Nursing times, 109 (47), 18–19.
Koppel, R., Wetterneck, T. J. L., & Karsh, B.-T. (2008). Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety Journal of the American Medical Informatics Association, 15(4), 408– 423. https://doi.org/10.1197/jamia.M2616-
Collapse SubdiscussionMansong Ntekim Hello Yemi,
Thanks for your informative discussion post. Good information on the seven stages of SDLC you wrote about. I wrote on the five stages of SDLC by Laureate Education (2019), which are planning, analysis, design, implementation, and maintenance.
Nurses are the largest section of healthcare workers and are the primary providers of patient care delivery in the nation’s hospitals and long-term care facilities. Nurses made up 30% of total hospital employment in May 2019 (U. S Bureau of Labor Statistic, 2020). Nurses comprising such a high number of the healthcare workers, it is vital for nurses to be involved in all aspects of care including the system development life cycle (SDLC). When nurses are involved, the rate of acceptability and utilization of the system is high (Castner, et al., 2016). Also, involving nurses in all stages of SDLC empowers nurses to direct their time and efforts on the successful implementation of the new system (Cherry & Jacob, 2016). And failing to involve them in the change process could result in apathy towards the change, loss of trust of the management. Failure to include nurses heightens the chances of missing vital input or output data which can limit the efficacy of the system, and nurses may be reluctant to give feedbacks that could help improve the efficiency of the system.
I worked at a facility that changed EHR system without any involvement from the nursing staff. The news of the impending change created anxiety among some nurse. Some nurses left the job for fear of the uncertainty created by lack of information about the impending change. It is, therefore, encouraging to inform nurses and include them in any system change.
References
Castner, J., Sullivan, S. S., Titus, A. H., & Klingman, K. J. (2016). Strengthening the role of nurses in medical device development. Journal of Professional Nursing, 32(4), 300-305.
Cherry, B. & Jacob, S. (2016). Contemporary nursing: issues, trends, & management. Amsterdam: Elsevier Health Sciences.
Laureate Education (Producer). (2018). Systems Implementation [Video file]. Baltimore, MD: Author.
U. S. Bureau of Labor Statistics (2020). Registered nurses made up 30 percent of hospital employment in May 2019. The Economics Daily. https://www.bls.gov/opub/ted/2020/registered-nurses-made-up-30-percent-of-hospital-employment-in-may-2019.htmLinks to an external site.
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Collapse SubdiscussionKatrina Brooks Hi Oluyemi,
I too have never had any involvement with implementation of a new system but was able to get a change made with CERNER at the facility I currently work at. I have only worked with EPIC therefore I wasn’t use to time flowing from right to left . The travelers I came with was having the same issue, I spoke with IT and asked for the option to switch the time to flow from left to right, after several complaints they made the change.
The use of technology in healthcare seems to have sky-rocketed since the pandemic. “The COVID‐19 pandemic highlights the urgent need for nurses to become involved in technology design, acquisition and implementation, and to provide considerations for the complexities of technology use within all levels—micro, meso and macro—of the healthcare system” (Dykes & Chu, 2022). Technology developers need to understand the importance of involving the end users in the development process. As end users, nurses input is essential in the success of healthcare technology systems.
Nurses should surely be involved in the testing phase of SDLC. “Testing software is described as validating a system through spotting a glitch, void or incomplete configuration” (Why testing is important in the software development life cycle, 2016). Nurses will be the ones to notice the glitch and advise of the necessary changes.
Referenes
Dykes, S., & Chu, D. (2020, December 16). Now more than ever, nurses need to be involved in technology design: lessons from the COVID-19 pandemic. Journal of clinical nursing. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753642/Links to an external site.Why testing is important in the software development life cycle. UTOR. (2021, March 16). https://u-tor.com/topic/omportance-of-testing-in-sdlcLinks to an external site. -
Collapse SubdiscussionMenard Tchatchou-Tchoubia The Inclusion of Nurses in the Systems Development Life Cycle
Response Post # 2
Menard Tchatchou
The Inclusion of Nurses in the Systems Development Life Cycle
Great post Oluyemi! I concur with the post that the involvement of nurses in every phase of the SDLC is essential for a successful project. The post has provided many excellent examples of the consequences that stem from not including nurses in the design process. For example, the use of medical terminology can be misinterpreted or used in inappropriate ways if nurses are not part of the development stage. Additionally, if nurses are not included in the testing and implementation phase, it is difficult to gauge how well the system works since it is not being tested by the actual potential users (Wei et al., 2019). I agree with the sentiment expressed in this post that nurses should be included in all stages of the SDLC, as their expertise is essential to ensuring that any system functions as intended. However, in addition to the examples provided in the post, I believe that nurses should not only be included in the planning, analysis, design, development, testing, implementation, and maintenance stages, but also in the evaluation and monitoring stages. This is important in order to ensure that the system is being used as intended and that any necessary changes are made (Wei et al., 2019). By including nurses in the evaluation and monitoring stages, it can help to identify potential areas of improvement and provide valuable insight into how the system is being used. Furthermore, nurses can provide invaluable feedback regarding user experience and usability, both of which are important factors when considering any system.
In terms of the example provided in the post about Cerner, it is clear that the lack of nurse input can cause problems, as mentioned. Without nurse input in the design phase, there were a number of complaints from the nursing staff regarding the functionality of the system (Foster et al., 2019). Had nurses been included in the design process, some of these issues could have been avoided, resulting in a smoother transition and adoption of the system. I believe that the lack of nurse input could have been even more detrimental. For example, if nurses are included in the planning stage, they could identify potential issues that may have been missed or overlooked by the techno wizards. Nurses could also help identify areas of improvement and suggest changes that could be made prior to launch.
In conclusion, the post is clear why nurses should play a key role in the System Development Life Cycle (SDLC). The inclusion of nurses in each phase of the SDLC ensures that the system is designed and implemented in the most effective way possible. Without the input from nurses, there is a risk that the system will not be used efficiently and effectively, leading to issues and complaints.
References
Wei, H., Roberts, P., Strickler, J., & Corbett, R. W. (2019). Nurse leaders’ strategies to foster nurse resilience. Journal of nursing management, 27(4), 681-687.
Foster, K., Roche, M., Delgado, C., Cuzzillo, C., Giandinoto, J. A., & Furness, T. (2019). Resilience and mental health nursing: An integrative review of international literature. International journal of mental health nursing, 28(1), 71-85.
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Collapse SubdiscussionSheila Ankrah Response
Hello Oluyemi,
Thumbs up for such an excellent post. Reading through your post, I can flashback to when I worked with an organization that had just settled on using the new system. It was a great challenge, given the changes and time frame allocated to adapt to the changes. The implementation stage is the most critical in the System Development Life Cycle (SDLC) stages. This requires keen attention and cooperation from all stakeholders.
In my opinion and observation, though COVID-19 was a terrible menace to us all, it propagated significant steps in the use of technology. The technology that came up and continues to emerge after the pandemic calls for the speedy involvement of nurses in technology design, testing, and implementation. Nurses’ participation at the design stage is critical, given their close conduct with most patients. Thus their contribution is problem-based and solution geared. Nurses, the end users of the various technologies, have an excellent standing in what they feel is best for the patients they assist. Nurses should indeed be involved in the testing phase of SDLC. “Testing software is described as validating a system through spotting a glitch, void or incomplete configuration” (Kale, Bandal & Chaudhari, 2019). Having first-hand information and the closest conduct with patients makes nurses the best fit to contribute to what they want to be done.
References
Kale, A. M., Bandal, V. V., & Chaudhari, K. (2019). A Review Paper on Software Testing. International Research Journal of Engineering and Technology, 5(2), 1268. https://www.academia.edu/download/58350813/IRJET-V6I1234.pdfLinks to an external site.
Mohan, V. (2022). System Development Life Cycle. In Clinical Informatics Study Guide: Text and Review (pp. 177-183). Cham: Springer International Publishing. https://link.springer.com/chapter/10.1007/978-3-030-93765-2_12Links to an external site.
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Collapse SubdiscussionJodian Walford Dear colleague
Great post: I share the same points that the inclusion of nurses in the system development cycle is only fitting to ensure it can meet the complete needs of its primary users. The Systems Development Cycle is a non-ending cycle aiming to provide an effective and beneficial system. Nurses must be included in the system development cycle as they are at the forefront of healthcare and spend the most time with the patients compared to all other healthcare professionals. They are knowledgeable and equipped to add invaluable expertise to the development of the system. Nurses can add significant value throughout the six stages of the systems development cycle. It is also beneficial as it enhances trust and knowledge. It can motivate nurses to have confidence and feel valued so that they will be better able to understand and use the systems to their fullest potential so that patient outcomes can be increased. Thomas, Seifert & Joyner (2016) highlight that when nurses are not engaged in the phases of the system development cycle, pertinent information is missed, which can create an ineffective or insufficient final product.
When the nurses are undermined and not included in the system development cycle, it can slow progression and lead to insufficient systems that may be complicated for the same people it was designed for. It will only meet some of their needs and requirements. On the flip side, when they are knowledgeable, they can enhance patient safety and assist other coworkers or professionals who may be having trouble. Nurses can utilize the system firsthand and able to deduce the effectiveness or efficiency (McGonigle & Mastrian, 2017).
References
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
W. Thomas, P. C. Seifert, and J. C. Joyner (2016). Registered nurses are driving forward-thinking initiatives—the Online Journal of Issues in Nursing (OJIN), 21 (3).
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Collapse SubdiscussionJodian Walford Dear Colleague,
Great post: I agree there could be missed opportunities when nurses are not included in the decision-making process. Nurses are at the forefront and can be labeled as the main backbone and strength within the healthcare industry. In the system development life cycle, it is only fair that nurses are included as they are the primary users of the clinical systems. McGonigle & Mastrian (2022) highlights that nurses and healthcare workers are the ones who utilize the program; hence, they need to have the ability to input their likes and dislikes of the functionality.
When nurses are left out of the decision-making, it can lead to several disadvantages and the contribution of valuable expertise is not gained. Nurses may lack confidence and be dissatisfied if they are not properly introduced to the system. From personal experience, when my institution introduced a new system that nurses were not privy to contribute to the decision-making, I found several documentation errors due to limited knowledge of a non-user-friendly system. It took a long time to get integrated. Risling (2020), explains that allowing nurses to integrate their disciplinary expertise in user-centered digital design is an excellent way to lessen errors.
References
McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.
Risling, T.L. and Risling, D.E. (2020) Advancing nursing participation in user-centred design, Journal of research in nursing: JRN. U.S. National Library of Medicine.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932478/
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Collapse SubdiscussionSheila Ankrah Main Post
Discussion: Nurse Inclusion in the Systems Development Life Cycle
To successfully implement a newly developed system into practice, the proposed system must advance through a cycle of development phases. McGonigle and Mastrian (2017) shared that the systems development life cycle (SDLC) is a way to deliver efficient and effective information systems (ISs) that fit with the strategic business plan of an organization. This development cycle incorporates a newly developed system’s planning, analysis, design, implementation, and maintenance phases. Laurette Education (2018) shared that nurses should be active participants throughout the introduction of a new clinical system. Their active involvement ensures that systems are appropriately incorporated into evidence-based healthcare.
SDLC Stages and Nursing Involvement
The development of a new health information system involves a flow through development plan phases in a cyclic manner. The story of a new system should include an analysis of the needs within the organization, and these should be mutually agreed upon. Understanding and addressing organizational needs will lead to the proposed technology system’s development, implementation, evaluation, and maintenance. The waterfall model is a commonly used method for implementing a new technology system into nursing practice. It is essential to incorporate nurses using this technology during each phase of this model to ensure that it will be successfully integrated.
Feasibility
The first phase includes the feasibility of the project being introduced. To determine if the project benefits will outweigh the costs, nurses should provide insight into the needs and areas where existing budget adjustments can be made. A budget must be addressed from the start of any project to avoid overspending and failure.
Analysis
The cycle analysis includes examining the business that will be utilizing the proposed new technology. Before implementation, nurses can share the current order of the company as it stands. Introducing a new system may sound promising, and nurses can provide insight into how the latest technology can enhance existing procedures. If the newly developed technology was an electronic health record, nurses could address how this would affect patient care during the transition. Nurses can foreshadow possible difficulties that would occur and make recommendations to avoid possible nurses can provide insight from a different scope. They can ensure that every aspect of the current system is analyzed and reviewed to ensure best practices are achieved and maintained.
Design
The design phase looks closely into how the project’s proposed data and programming techniques will actually function. With a new electronic medical record, this phase would look into the software needed to meet the facility’s requirements. Nurses would create and test initial versions of the system for active participation. They can then provide helpful insight into which parts of the system could be more user-friendly, and they could address concerns before the system is finalized for use. If nurses are included in his phase, it would be easier for developers to backtrack. Nurses would also be given time to learn about the new system before it is life.
Implementation & Testing
The implementation phase of the cycle would include the programming and introduction of the newly developed system. The Agency for Healthcare Research and Quality (n.d) shared that the key to successfully implementing health information technology (health IT) is recognizing its impact on clinical and administrative workflow. With an electronic record, programmers would activate the system with the necessary programming codes. Nurses should be provided thorough training on accessing the system appropriately and getting used to the program functions within the electronic network. Some systems provide users with access to certain portions of the system, so all nurses and additional care team members should know how to use the implemented technology properly. An electronic system is implemented to enhance the care that patients are being provided. If nurses do not learn how to use the system properly, this could potentially harm the patients being cared for. Proper testing of this electronic record would allow nurses the time to analyze the technology and provide feedback. Nurses can explain where they foresee problems occurring and make recommendations for improved use to ensure patient care is continuous and uninterrupted.
Maintain
Constant evaluation of a system is required to maintain an efficient practice. Once a system has been tested and modified for implementation, the review process does not end. Scheduled software is necessary at regular intervals, and staff should be informed when changes are made. Nurses are an essential part of every phase, and the maintenance of a system depends on its users. As time passes, nurses should continue making observations and recommendations about how this system is used in their practice. If nursing input is not valued during the maintenance phases of technology, systems can become obsolete in patient care practices, and evidence-based practice can be negatively affected.
Personal Experience with Health Information Technology Systems
The health information technology used in our adolescent behavioral health facility was preselected during our merger with the Lifespan Network two years ago. The technology was predetermined on a corporate level, and the nurses, clinicians, and milieu staff were not included during any phase of the implementation process. Due to our unique outpatient psychiatric setting, we have found that the preselected programs have only sometimes fit our needs. One specific nursing-related issue included the documentation of patient medications within the electronic health record. We are considered an Outside Provider location, so our facility is not authorized to use the electronic MAR (Medication Administration Record) in the electronic patient record. We are required to document all medications in the Home Medications section of the chart, but this only includes a list of currently provided medications that are confirmed during admission. We found that providers and nurses from varying locations were mis-documenting past and present taking medicines in this chart section. Providers did not use this list when prescribing, and some were making errors. Due to the level of potential harm that this entailed, I contacted our Residential Nursing Supervisor to address this situation and provide a possible solution. We now document medications in a newly provided medical record section and have been granted access to the Medication History section of the electronic record. Allowing proper input of previously taken drugs in addition to those currently being prescribed has allowed for successful continuity of patient care within our facility and during their transitions to the community. This change provided positive outcomes for our patients and a smoother coordination of care among our team. If the developers included nursing staff in the development and implementation process of this technology, we could have likely made this change before it was put into practice. I am thankful that they listened to my recommendations.
References
Agency for Healthcare Research and Quality. (n.d). Health IT evaluation toolkit and evaluation measures reference guide. Retrieved from https://healthit.ahrq.gov/health-it-tools-andresources/evaluation-resources/workflow-assessment-health-it-toolkitLinks to an external site.
Laureate Education (Producer). (2018). Systems Implementation [Video file]. Baltimore, MD: Author.
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
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Collapse SubdiscussionAdrienne Aasand Response #1
Sheila,
Thank you for your discussion post about the importance of the nurse’s contribution to developing new systems. Your experience at work with combining the medical records in order to gain access to the patients’ medication list is a great example of how nurses should be included when developing new systems. Not only does it make the intake process more efficient, but it keeps the patients safer by avoiding medication errors. According to McGonigle & Mastrian, “creating the right team to manage system development is key” (2022, p. 191). Specifically, your experience demonstrates that the design of a new system must consider the existence of the organization within the larger healthcare system (McGonigle & Mastrian, 2022). Only having a list of medications given on your behavioral health unit without considering medications coming from outside specialties can be very dangerous for the patients. I read one study that compared paper charting with electronic health records on a behavioral health unit. The study found that the units using the electronic health record that communicated with the entire healthcare organization provided more comprehensive information such as the reason for the medication administration, who initiated the administration and the effectiveness of the medication (Martin et al., 2018). This information is essential to provide good nursing care and is an additional reason that nurses should be contributing to developing new systems.
References
Martin, K., Ham, E., & Hilton, N. (2018). Documentation of psychotropic pro re nata medication administration: An evaluation of electronic health
records compared with paper charts and verbal orders. Journal of Clinical Nursing, 27(15-16), 3171-3178.
https://doi.org/10.1111/jocn.14511
McGonigle, D. & Mastrian, K. (2022). Nursing Informatics and the Foundation of Knowledge (5th ed.). Jones & Bartlett Learning.
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Collapse SubdiscussionChristiana Nuworsoo Sheila,
Nice post. I am in total agreement that involving nurses in the SDLC ensures systems are appropriately
incorporated into evidence-based healthcare, especially since, nurses tend to use the end products more. In
order to create an effective system that directly translates the health language into the software being used,
nurses must be included in the early stages of the SDLC process; it is necessary to identify champions or
problem solvers for the implementation and adoption of such systems (Verma & Gupta, 2017). Also, nurses
have a better understanding of clinical flow and patient care procedures, and including them will produce a
user-friendly system that is not intimidating to most.
Not including nurses in the SDLC process results in a system that is not beneficial but costly and leads to
incorrect documentation and errors, which you experience at your facility. Using an information system that
results in medication errors defeats the purpose of health IT. To Err Is Human by the Institute of Medicine
brought the issue of medical errors to light and emphasized why every US healthcare organization needs to
prioritize safety. One of the most frequent sources of injury, according to research, is medication errors. It has
been discovered that adverse drug events can be decreased by computerizing medicine ordering and
providing computerized clinical decision assistance to the ordering clinician (Bates & Singh, 2018). Therefore,
a system that still creates such errors, does not serve the intended purpose that it should. However, updates
can be made to create a better system, so it is great that you have a supervisor that listens and takes action
resulting in a system/product that works well for all.
References
Bates, D. W., & Singh, H. (2018). Two decades since to err is human: an assessment of progress and emerging
priorities in patient safety. Health Affairs, 37(11), 1736-1743.
Links to an external site.https://doi.org/10.1377/hlthaff.2018.0738Links to an external site.
Verma, M. P., & Gupta, S. (2017). Software Development for Nursing: Role of Nursing Informatics. International
Journal of Nursing Education and Research, 5(2), 203-207.
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Collapse SubdiscussionGuoming Feng Response Post #2
Hi Sheila,
Your post is very insightful about the importance of nurse involvement in each step of the SDLC for the informatic technology system implementation, I totally agree with them. What impressed me most is your personal experience on the healthcare information technology system. First, you played a great role of patient advocacy when you found the need for a new system to ensure the patients’ safety. You “contacted our Residential Nursing Supervisor to address this situation.” As Nsiah and Ninnoni (Nsiah & Ninnoni, 2019) point out that “emphasis on patient safety has increased the awareness of the critical role advocacy plays in promoting safe clinical practice.” This is how a nurse involved in the planning step of SDLC, because new system is initiated by finding a problem and planning to solve the problem. Then you involved in the design step by “provide a possible solution”. As the user of the new system, your opinion about the solution meant a lot to the system designing. Last, after the new system was implemented, you used it and evaluated the system “provided positive outcomes for our patients and a smoother coordination of care among our team.”
Thank you for your great post!
Nsiah, C., Siakwa, M., & Ninnoni, J. P. K. (2019). Registered Nurses’ description of patient advocacy in the clinical setting. Nursing open, 6(3), 1124–1132. https://doi.org/10.1002/nop2.307
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Collapse SubdiscussionColleen Lewis Response 2
Hi Sheila,
I appreciate your post and agree with the points you raise. One of the problems that I think realistically keeps many systems from having more success is the lack of attention to nurse workflow when analyzing and designing. Nurses are often primary end-users of many of the new systems implemented, and typically we just have to adapt our workflow to the new system we’re using. Very rarely have I encountered a system that seems to be designed with the nursing process in mind. One of the problems that is faced then, is successful adoption of the new system, since there may be resistance from end users, such as nurses, who find the new system to be inconvenient rather than create an improvement. One of the concerns many nurses have is that a new system will add to their already heavy workload (Williams et al 2021). One of the ways this potential issue can be avoided is by having a nurse leader offer insight to the workflow of nurses and their needs in a new system. The nurse leader can then help to support positive perceptions of the new technology or system and assist in training (McKay & Vanaskie 2018). In this way, nurses can provide support and advocate for their needs both during the initial stages of the SDLC, and in the implementation phase.
McKay, C., & Vanaskie, K. (2018). Partnering for success: The role of the nurse leader in Health Information Technology implementation for coordination of care. Nurse Leader, 16(6), 385–388. https://doi.org/10.1016/j.mnl.2018.07.012
Williams, M. D., Coppin, J. D., Martel, J. A., Stibich, M., Simmons, S., Passey, D. G., Chatterjee, P., Choi, H., Ramirez, H., Crowley, P., & Jinadatha, C. (2021). Frontline nurse feedback during the development of a system to track cleaning of Portable Medical Equipment. CIN: Computers, Informatics, Nursing, 39(12), 1035–1040. https://doi.org/10.1097/cin.0000000000000754
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Collapse SubdiscussionJodian Walford Software Development Life Cycle is the steps used within the software business to design, develop and examine software’s quality (Tutorial Point, n.d.). The engagement of nurses within each stage of SDLC is proven beneficial when accruing and implementing new healthcare software. Health systems maintain and advance healthcare by enhancing quality and improving patient care. Nurses are vital team players in the medical profession and work firsthand with patients. According to (Risling, T.L. & Risling, D.E., 2020) there is a demand for nursing to dominate major roles in development of technology in healthcare. They are most experienced and educated on the patient’s needs and how to improve patient outcomes; hence, nurses must be involved in the systems development life cycle. Including nurses can only assist in ensuring systems are organized efficiently and will meet the needs of patients. The SDLC has several stages: Planning, Analysis, Design, Testing, Implementation, and Maintenance.
Nurse involvement in the SDLC planning stage should be a must to ensure the software is appropriate and meets the expected needs of patient care in a practical manner. According to Brown et al. (2020). Excluding nurses at this stage means the technology’s overall objective may fail to account for the critical aspects of patient care and experience. The project is evaluated in the analysis stage, weighing the pros and cons and who is better to be an evaluator than the main stakeholders. The design and testing stage is where the project data techniques are formulated. Nurses would assist in making and assessing the different software within the system, providing insight on ways to make the system more adaptive and friendly to users before the official version’s publication. Excluding nurses at this stage means the overall technology may fail. Nurses can ensure the system is tailored to ensure patients receive safe and optimal care. The installation stage is where the system is placed into action, integrated into the institution, and sets standards for the level of training required for the users. The maintenance stage is where the system is reviewed at intervals to ensure it is kept upgraded and current and continues to meet the expected needs of its users. Utilizing nurses within this phase gives an understanding of what upgrades will be required and how patient needs have improved or decreased.
Within my institution, paper charting was used pre-covid. However, they promptly switched to Electronic Health recording during the pandemic; unfortunately, nurses were not allowed to partake in this project’s SDLC stages. Due to same, the transition was slower and led to more errors in documentation as nurses needed to find many areas to be user-friendly, and the level of training received required much more. Many nurses questioned themselves and lost confidence in their capabilities to perform. If time allowed and nurses had been integrated from the initial phases, it would have created a smoother transition. Being one of the most significant users with firsthand knowledge that advocates patient care and safety, it would have been designed better to meet patients’ needs.
References
Brown, J., Pope, N., Bosco, A. M., Mason, J., & Morgan, A. (2020). Issues affecting nurses’ capability to use digital technology at work: An integrative review. Journal of clinical nursing, 29(15-16), 2801-2819.
Tutorial Point (n.d.) SDLC – Overview, Tutorials Point. Available at:
https://www.tutorialspoint.com/sdlc/sdlc_overview.htm
Risling, T.L. and Risling, D.E. (2020) “Advancing nursing participation in user-centered design,” Journal of Research in Nursing, 25(3), pp. 226–238.
https://doi.org/10.1177/1744987120913590.
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Collapse SubdiscussionRaminder Kaur Hi Jodian,
Nurses should be at the forefront of planning and involved before implementing new system technology so their input and knowledge facilitate the new system’s efficiency. The use of technology is known to provide a means to improve patient care and outcomes (McGonigle & Mastrian, 2018). Nurses play an integral role in determining and defining the range of issues to be addressed, enlisting, and discussing potential solutions, resource collection, confining the timeline of the project, and identifying the necessities to formulate outputs that the SDLC developers will use to build codes (Thomas, Seifert & Joyner, (2016). Therefore, it is essential to incorporate nurses’ input in each stage of the SDLC since they have the proper clinical understanding of an organization’s operations and workflow. Furthermore, including nurses in implementing new systems technology is critical for the effectiveness of the desired change. As you indicated, failure to include nurses will result in the development of a system that does not address specific patient care needs.
As nurses are one of the immediate groups that use newly developed health information technology, it is essential and productive to integrate the input from these professional groups. This inclusion will allow for the development of a plan and assess the needs of an organization, with expert knowledge of nurses through their analysis of current procedures and recommendations for improvements. A development plan needs assessment should include outreach connections, partnerships, and integrated or shared functions and including all vital members during each phase is crucial for successful completion. (McGonigle and Mastrian 2017).
References
McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning
Thomas, T. W., Seifert, P. C., & Joyner, J. C. (2016). Registered nurses are leading innovative changes. OJIN: The Online Journal of Issues in Nursing, 21(3). DOI: 10.3912/OJIN
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Collapse SubdiscussionMaxine A Lewis Jodian, not only does excluding nurses in the SDLC process result in a design not relevant to the patients’ needs but also it will also result in difficulties or even failure to launch a new design.
Involving nurses who work at the point of care in all phases of introducing a new technology facilitates a smooth transition to using the new technology and increases nurses acceptance of the design (Weckman and Janzen, 2009)). The Standish Group cites that without user involvement the chance of failure increases dramatically. Software development is increasingly becoming a team effort, rather than a piece-by-piece affair as in the old concept of “developing” software. Shorter time frames result in an iterative process of design, prototype, develop, test, and deploy small elements – this is known as “growing software”. Growing the software the practice of involving the user earlier in the process, each component has an owner or a small group of owners, and expectations are realistically set (Standish Group, 1995). Involving nurses initially in the SDLC process as well as “listening carefully to the comments and feedback from nurses is essential, because it is the nurses who are in the best position to identify the clues needed to resolve underlying systemic issues and offer ideas for possible resolution” (Weckman and Janzen, 2009).
References
The Standish Group. (1995). The Standish group report. Retrieved October 28, 2008, from: www.cs.nmt.edu/~cs328/reading/Standish.pdf.
Weckman, H. N., & Janzen, S. K. (2009). The critical nature of early nursing involvement for introducing new technologies. Online Journal of Issues in Nursing, 14(2), 1–11. https://doi.org/10.3912/ojin.vol14no02man02
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Collapse SubdiscussionMleh Porter Hello Jodian,
Thank you for your post. It was informative. Nurses occupy a unique position in delivering care as the primary providers of patient care in the acute care setting, making them critical users of health information technology. They need to be familiar with emerging technologies in other to be able to use them for excellent patient care and outcome (Verma & Gupta, 2017). When new healthcare technologies are being implemented, it is essential to include nurses in all stages of introducing new health information technologies to allow for a smooth transition to the current technology. This will allow nurses time to add their input at all process stages. The systems development life cycle (SDLC) provides reliable and productive information. Frequently, nurses are involved when systems are tested and when health information technology is being implemented in the organization. However, nurses must be involved in the early stages of health technology system development to have an efficient system that effectively translates the language of health into the software being used (Verma & Gupta, 2017).
You provide excellent examples of the consequences of failure to include nurses at the beginning of the SLDC. The Inclusion of Nurses in the SDLC will result in a system that works effectively for the end users, such as nurses, healthcare professionals, and even patients. Failure to include nurses in the process often results in complicated systems that create more workload rather than improve patient care and safety (Lopez et al., 2021).
References
Dunn Lopez, K., Chin, C. L., Leitão Azevedo, R. F., Kaushik, V., Roy, B., Schuh, W., Banks, K., Sousa, V., & Morrow, D. (2021). Electronic health record usability and workload changes over time for providers and nursing staff following transition to new EHR. Applied Ergonomics, 93, 103359. https://doi.org/10.1016/j.apergo.2021.103359
Verma, M. P., & Gupta, S. (2017). Software development for nursing: Role of nursing informatics. International Journal of Nursing Education and Research, 5(2), 203. https://doi.org/10.5958/2454-2660.2017.00044.8
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Collapse SubdiscussionBenedicta Kwevie Response 2
Hi Jodian
I agree with you on your point about excluding nurses. In addition, incorporating nurses in the planning stage can help facilities and workplaces transform and move from one place to another in terms of updates to systems (Weckman & Janzen, 2009). Nurses make up a large portion of care providers in the medical field, and including them in the decision-making process can help them gain a better idea and understanding of skills needed in software development (Nursing’s Voice in Healthcare IT Acquisition Decisions | Canadian Journal of Nursing Informatics, n.d.). Your experience with nurses being excluded in SDLC stages and transitioning is a prime example of what happens when nurses are pushed away from helping and coordinating with others; things start to become slowed down and back up from lack of experience, expertise, or knowledge of things being newly integrated into systems.
References
Nursing’s Voice in Healthcare IT Acquisition Decisions | Canadian Journal of Nursing Informatics. (n.d.).
https://cjni.net/journal/?p=4248Links to an external site.
Weckman, H., & Janzen, S. (2009, May 31). The Critical Nature of Early Nursing Involvement for
Introducing New Technologies. Ojin.nursingworld.org.
leofContents/Vol142009/No2May09/Nursing-Involvement-and-Technology.htmlLinks to an external site.
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Collapse SubdiscussionBarkisu Fortenberry The healthcare sector is changing rapidly, and institutions must change to be relevant. Every healthcare organization must improve the safety and quality of care they provide (Echo n.d). At the same time, healthcare organizations must ensure that their interventions are effective and relevant to patients’ needs and current changes. As a result, healthcare institutions must ensure constant system development of their life cycle to improve their effectiveness and efficiency while ensuring optimal patient safety. System development usually begins with understanding the problem or business needs. It is followed by developing strategies to meet those identified needs, then implementing them and later evaluating them (Singletary & Baker, 2019). Finally, if they are effective, the healthcare institution must find ways to maintain those strategies.
The system development life cycle is a crucial component of the innovation that makes a difference in our healthcare organization’s operations and meeting its patients’ needs. Since nurses are the only healthcare professionals who stay with patients the longest time and understand them and how the system affects their care and recovery, the system development life cycle is likely to suffer the hugest brunt if nurses are not included in its initial stages of planning and implementation (Why Involve Nurses in Healthcare IT Development, 2019). Some consequences include developing and implementing systems that do not adequately align with patients’ or system needs. For instance, some hospitals may need better systems because of a lack of end-user input. As a result, the project becomes obsolete quickly because it needs to align with the nurse’s and patient’s needs regarding effectiveness and efficiency in ensuring patient safety and quality care.
Including nurses as end users in the innovation will help increase the perspective on which the idea and objectives of the innovation are viewed. This, in turn, ensures that the system is better designed with the end user’s needs in mind, leading to mutual and optimal benefit to patients, healthcare professionals, and institutions. For example, I worked in an institution implementing the automated Alaris infusion pump. The pump would synchronize information from all the electronic healthcare records systems within the hospital and the medication pyxis. Unfortunately, nurses were not included in the system development and implementation. As a result, it was later noted that some medications were incompatible with the pump interface and did not accept the manual entry, which would constitute missed medication on the system. These consequences delayed care and wasted time nurses, and other healthcare professionals would have used for other tasks. In addition, the electronic health record platform network was slow, and healthcare professionals needed more than two days of orientation to understand how to operate it. Overall, the system turned chaotic and stressful, and many hours were lost as the team tried to figure out where the problem was.
References
Singletary, V., & Baker, E. L. (2019). Building Informatics-Savvy Health Departments: The Systems Development Life Cycle. Journal of Public Health Management and Practice, 25(6), 610– 611. https://doi.org/10.1097/PHH.0000000000001086 Links to an external site.Links to an external site.
Echo, O. O. N. S. Tag Archives: Mohs Surgery. https://onenationsecho.com/tag/mohs-surgery/
Why Involve Nurses in Healthcare IT Development? (2019, April 1). TeleTracking. https://www.teletracking.com/resources/why-involve-nurses-in-healthcare-it-developmentLinks to an external site.
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Collapse SubdiscussionAndrea M Allen Hi Barkisu,
Thanks for the read. As you stated that healthcare sector is changing rapidly…It is. According to (Wang, 2019), Nursing informatics innovations are constantly adapting to a rapidly changing healthcare environment. Nurses are more educated and aggressive in taking a stand in areas that was once occupied by other professionals and should be an integral part of the SDLC. Whether its EHR, Patient Portals, Telemedicine software, E-prescribing software, Medical Image Analysis, Medical Diagnosis software, Remote Patient Monitoring, Hospital management to name a few, nurses remain the driving force from planning to post implementation. The framework allows nurses to parse collected data into functional requirements as well as non functional software (Risling, 2020). It makes sense that if a software for instance is being built for nurses to use, who would better know what tools are needed but the user? which is the nurse in this case. To exclude nurses is a grave mistake and until society understands the connection, nurses will continue to be overlook and under appreciated. The pandemic did a great job on shedding light on healthcare but quickly people forget. Nurses have to take control and demand a seat at the table in order for that stake in society to remain fixed.
Wang, J., Gephart, S., […[ and Bakken, S. ( 2019). Models of Collaboration and Dissemination for Nurses Informatics Innovations in the 21st Century. Nurs. Outlook. 67(4): 419-432. doi: 10.1016/j.outlook.2019.02.003
Risling, T.L. and Risling, D.E. (2020) “Advancing nursing participation in user-centered design,” Journal of Research in Nursing, 25(3), pp. 226–238. https://doi.org/10.1177/1744987120913590.
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Collapse SubdiscussionMaxine A Lewis The Inclusion of Nurses in the Systems Development Life Cycle
The system’s development life cycle (SDLC) are steps used to create an effective, interactive, and efficient information system or technology tailored to a business or organization’s goal or vision (McGonigle and Mastrian, 2022). Now more than ever nurses are spending more time using technologies to increase efficiency in delivering patient care. Therefore, it is essential to include nurses in the SDLC process to develop a system with high usability which will increase the chance of successful implementation and adherence as well as decrease unnecessary economic loss to facilities. On the other hand, the failure of a healthcare organization to involve nurses at each stage of the system development life cycle results in failure in the initiation of a technological system: resistance, increased issues with patient confidentiality or safety, and induction of technologies that are too complicated and incompatible with nurses’ skill set and practice.
Failure to involve nurses in the feasibility stage of buying or developing a product will result in a product that is inefficient and redundant. For example, the introduction of handheld multifunctional devices for patient care of which one function is medication administration within my work facility. There are clear indicators that nurses’ Input was not encouraged in this device secondary to redundancy (1 of many issues). For instance, logging on is a chore (especially if a med is needed emergently), next in administering the required medication the patient is scanned, then the medication then the patient has rescanned after which the medication is rescanned once more. Now the next stage is another set of issues issue if it is an intravenous medication the site of the iv must be entered and cannot be bypassed despite filling in this area on prior administration in the same shift. Recently I found out that most of us in our unit decided it was a better pill crusher than its intended use. Fortunately for us, we also have some workstations on wheels (WOWS) available which are preferred because they are more efficient and Userfriendly. The manufacturing of WOWs was a result of designers evaluating the ineffectiveness of computers on wheels (COWS) for bedside charting etc. and nurses’ complaints. The IT (Information Technologist) designers then enlisted the nurses’ input in all stages of SDLC which are feasibility, analysis, design, implementation, test, and maintenance which resulted in WOWS (HMT MAG, 2008). Not including nurses in the stages of SDLC also increases economic loss to facilities as the product will be short-lived as seen in the multipurpose handheld devices being used for pill crushers.
Another issue with the handheld device is the multi ridiculous steps needed to access the language line (interpretation purpose). I recently had a patient who was visiting from Panama and spoke Spanish. I remembered a few words from college, so I was able to gesture and use the few words I knew plus her daughter also was present the first night and able to translate. The next night, my patient woke suddenly yelling my name. I rushed in as she pointed to her chest; “hurt” she said, then “back lungs” so naturally now I needed the language line as I fumbled through the unfriendly screens, 4-5 screens while assessing for any cardiac signs (diaphoresis, etc.). I thought what if my patient passes out before I get an interpreter online? I finally got an interpreter online to interpret as I assess my patient for possible cardiac symptoms. While assessing and interpreting the line malfunctioned, we had to restart the complete process. I found myself wishing for the old language phone (with the 2 receivers) that was one simple step I.e., pickup up the phone which automatically dials and hello! An interpreter on the line!
This multipurpose handheld device is a clear indicator that nurses were not involved in the feasibility, analysis, design, or purchase of this product, hence resulting in a delay of treatment and not practical to our area of practice (critical care). Honestly, as a critical care nurse, I felt so helpless navigating through the unnecessary screens and feeling like I was wasting precious time accessing the unfriendly device. My patient’s blood pressure climbed from 140 systolic to 200/100, her sat 98% (her dx was bilateral pulmonary embolus) and she is looking at me all wide-eyed and scared I wished at that moment we had a device like earbuds when place in both our ears we would automatically begin to understand each other. Now that would be an effective, user-friendly, and invaluable device! The lack of proper usability makes it difficult for nurses, doctors, or other users to access specific information and makes searching for information provided by the system inefficient (Khajouei and Jaspers, 2008) as well as jeopardizes patient safety.
Another design is our new electronic transport system of course we were not consulted on the design or purchase: just do the mandatory online course which was a waste of time. The usability of the prior system was 6/10 but this present transport system is more complicated and involves approximately 6 screens before we can request transport. So, we night shift nurses resolve to be our own transport instead of trying to manipulate the system. Of course, this system has contributed to added workload for the night shift nurses as there are unit secretaries during the day to aid in the transport requests. In conclusion in the ideal world of research and textbooks, it is wonderful to ask for the nurses’ opinions initially in buying or designing patient care products but in the “real world” it seldom occurs resulting in expensive devices becoming door holders, hammers, pill crushers or retired/buried in the equipment room graveyard.
References
McGonigle, D., & Mastrian, K. (2022). Nursing Informatics and the Foundation of Knowledge (5th ed.). Jones & Bartlett Learning.
Khajouei, R., & Jaspers, M. W. M. (2008). CPOE system design aspects and their qualitative effect on usability. Studies in Health Technology and Informatics, 136, 309–314.
COWs and WOWs, Oh My! HMT MAG< 2008, Healthcare Innovations,
https://www.hcinnovationgroup.com/home/article/13000590/cows-and-wows-oh-my
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Collapse SubdiscussionChristiana Nuworsoo Maxine,
Reading your post brought so many undesired memories because most of the things you described, I
have experienced and still do one in particular. I totally agree with you that nurses need to be involved in the
SDLC processes to come up with a product or system that is user-friendly so as to increase the likelihood of
successful implementation and adherence, which prevents financial loss to the organization. Nurse
involvement could improve healthcare resource allocation and alleviate typical issues that may develop as a
result of poorly designed software. The analysis, development, and implementation of any system should
incorporate nurses (Verma & Gupta, 2017).
Software developers must comprehend user needs before creating a product for healthcare clinicians.
Since nurses coordinate and carry out many tasks connected to patient care, they make up the bulk of the
users in healthcare. Nurse participation in the early stages of software development would guarantee a
superior end product that is unique and more therapeutically applicable (Verma & Gupta, 2017). In order to
discover areas for improvement in patient care that IT can help with, nurses must get involved early. In the
case of the language line, I cannot say for sure that nurses were not involved but I can definitely without a
doubt admit that I do prefer the phone process to the handheld or in my case an IPad on wheels that requires
several steps as opposed to the two-step process. This is one device that I do not think is beneficial in any
way, because in emergency situations, it has failed me every time. Therefore, it’s crucial to involve nurses in
the decision-making process when choosing a health IT system in order to increase adoption and foster a
sense of ownership. Usability tests offer a practical way to involve users in the selection process while also
gathering their input (Agency for Healthcare Research and Quality, n.d.).
References
Agency for Healthcare Research and Quality. (n.d.a). Health IT Evaluation Toolkit and Evaluation Measures Quick
Reference Guides. Retrieved January 29, 2023, from https://digital.ahrq.gov/health-it-evaluation-toolkitLinks to an external site.
Verma, M. P., & Gupta, S. (2017). Software Development for Nursing: Role of Nursing Informatics. International
Journal of Nursing Education and Research, 5(2), 203-207.
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Collapse SubdiscussionAdrienne Aasand Steps of Systems Development Life Cycle (SDLC)
The first steps of the Systems Development Life Cycle (SDLC) are to understand the problems or business needs, understand how to address the needs, and to develop a plan. It is important to “identify the needs of the organization as a whole and propose solutions to meet those needs or a way to address the issues” (McGonigle & Mastrian, 2022, P. 192). Depending on the system, the development of the system, or implementation of the plan can be done within the organization or can be outsourced. Once the new system has been implemented, the system needs to be evaluated. Finally, maintenance, review and destruction of the system must be planned (McGonigle & Mastrian, 2022).
Development of an ePRO System
This discussion will review how nurses could contribute to the development of a new electronic patient reported outcome (ePRO) system for the organization I work for. The purpose of an ePRO system is to allow patients to report disease symptoms or treatment side effects from the comfort of their home on their smart phone or device, without needing to call into the clinic and potentially wait on hold or wait for a return phone call from a nurse. This collection of ePROs will help patients recognize problematic symptoms and will encourage self-management. In addition, reporting of symptoms may trigger clinical interventions that will improve symptom management outside of regular clinic visits (Hassett et al., 2022).
Nurse contribution
It is important for the nurse to contribute to each stage of SDLC when planning for a new ePRO System. “The SDLC is similar to the nursing process in which the nurse must assess, diagnose, plan, implement, evaluate, and revise” (McGonigle & Mastrian), 2022, p. 193). Often, without nurses feedback, upper management might not know there is a problem that needs a solution. Creating a new system starts with a problem that is often only seen by the staff who work directly with patients every day. And once the solution is implemented, again it is up the nursing staff to use this new system in their daily care of patients and determine if it is beneficial to the organization. With the daily use, it is also the nurses who might offer changes or additions to the system to make it fit into the workflow better.
Consequences
If a healthcare organization does not involve nurses in each stage of the SDLC there will be negative consequences for the users and patients. One study examined the impact of implementing a new ePRO system on workflow and workload for nurse navigators in a cancer clinic. The result of the study showed that the introduction of the ePRO to the clinic did not increase the nurses’ workload, but did require a restructured workflow for the nursing and administrative staff (Riis et al., 2021).
For example, the introduction of the new system would require reorganization in workflow to provide sufficient appointments that are required as a result of the additional communication. In addition, nurses now needed more time in their day to read and respond to messages from patients, meaning less time face to face with patients in clinic. In some clinics, additional nursing staff was needed to be primarily responsible for the ePRO system, while the other nursing staff focused on patients in the clinic (Riis et al., 2021).
In this case, if the nurse navigators were not interviewed about their opinions of the ePRO, it would not have been known that workflow required restructuring. Without restructuring the workflow, the ePRO could not be a successful new system. With some minor modifications to how the nurses do their jobs the ePRO could be very beneficial to the nursing staff, providers and the patients.
Potential issues
The inclusion of nurses can help to address potential issues at each stage of the SDLC.
- Problem: Patients need to communicate their symptoms to their providers. Calling the clinic results in long hold times. Nurses are the first to hear from patients that communication via phones is a problem. A solution is needed to correct this issue.
- Solution: Nurses and nurse managers propose ePRO as a solution to this problem. If other solutions are proposed, nurses are responsible for giving feedback on the most practical solution based on their experience.
- Plan: This step includes a feasibility study to determine if ePRO should be implemented. The budget should be evaluated, technological issues should be addressed, a cost-benefit analysis should be done. These steps are typically done by upper management. Nurses should be involved in addressing issues related to operational feasibility of the new system (McGonigle & Mastrian, 2022). Will the ePRO system address the communication problem between patients and providers? Is it feasible for the nurses to collect ePRO messages from patients, does this fit into the workflow? Will patients be able to easily learn to use this system?
- Design / Implementation: In the design phase, nurses address issues related to how the ePRO system will actually work. Nurses should critically think about and verify which data are required or essential (McGonigle & Mastrian, 2022). Nurses should consider how the new system will impact their daily work and how it will impact patient outcomes. For example, when designing an ePRO system, the nurses should consider details such as “How can we design this system to make it easy to use for our patients?” and “How can we design this system to make patient responses easily viewed by nurses so nothing is missed?” or “How can we design the system so that urgent or emergency responses are triaged to the top?”. The answers to each of these questions should influence the design of the system.
- Evaluation: Nurses play an important role in evaluating a new system as they are the main users of a system such as ePRO. When evaluating a new system, leaders first need to ask What do we want to learn?, How do we plan to collect the data?, and How will we analyze the data?. To gather this information, team leaders should create focus groups of nurses and ask what has worked, what has not worked, and what are some unintended consequences of the new system? In addition, real-time observations are helpful (Agency for Healthcare Research and Quality, n.d.a). In the focus groups and real-time observations,
My input in the planning of new systems
The ePRO system is not yet implemented at Minnesota Oncology, but in the past for the implementation of new systems (such as our updated EHR) the nurse managers combined with IT have lead the process. The nurse managers create focus groups consisting of clinic and infusion nurses to gather information and evaluate needs in the clinic setting. I have been part of these focus groups. The nurse managers create a list of questions related to implementing the new system into the clinic setting and the nurses are responsible for giving feedback based on how they see this new system working in the clinic. Often, these discussions bring up issues that had not been considered at a higher level and lead to revisions in the system. For example, when implementing our new EHR, the nurses in our focus group brought up the importance of linking the patient portal to the EHR rather than having two separate systems. This feedback was reviewed by the team and implemented.
References
Agency for Healthcare Research and Quality (n.d.a). Health IT evaluation toolkit and evaluation measures quick reference guide. Retrieved January 22, 2023,
from https://digital.ahrq.gov/health-it-evaluation-toolkitLinks to an external site.
Hassett, M., Wong, S., Osarogiagbon, R., Bian, J., Dizon, D., Jenkins, H., Uno, H., Cronin, C. & Schrag, D. (2022). Implementation of patient-reported
outcomes for symptom management in oncology practice through the SIMPRO research consortium: A protocol for a pragmatic type II hybrid
effectiveness-implementation multi-center cluster-randomized stepped wedge trial. Trials, 23(1), 1-15. doi.org/10.1186/s13063-022-06435-1
McGonigle, D. & Mastrian, K. (2022). Nursing Informatics and the Foundation of Knowledge (5th ed.). Jones & Bartlett Learning.
Riis, C., Stie, M., Bechmann, T., Jensen, P., Coulter, A., Moller, S., & Steffensen, K. (2021). ePRO-based individual follow-up care for women treated for
early breast cancer: Impact on service use and workflows. Journal of Cancer Survivorship: Research and Practice, 15(4), 485-496.
https://doi.org/10/1007/s11764-020-00942-3
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Collapse SubdiscussionKatrina Brooks The systems development life cycle (SDLC) is a process used for developing software. “The SDLC is a way to deliver efficient and effective information systems (ISs) that fit with the strategic business plan, which stems from the missions of the organization” (McGonigle & Mastrian, 2022). The phases of SDLC include: planning, analyzing, designing, implementation, testing and maintenance. “These phases are handled in a continuous loop, meaning at any stage in the cycle, it is possible to go back and forward again which helps the development team to produce high-quality software” (Clarusway, 2022).
Nurses being frontline workers and the ones who spend the most time with patients makes them capable of providing their input in new health information technology systems implemented to improve quality of care. The purpose of including nurses is to ensure that both organization and patient care needs are met. According to Weckman and Janzen involving nurses who work at the point of care in all phases of introducing a new technology facilitates a smooth transition to using the new technology and increases nurses’ buy-in of the system, without user involvement the chance of failure increases dramatically” (n.d.).
There are consequences associated with not involving nurses in the stages of SDLC when implementing a new system. The consequences include having a system that is not user-friendly, developing a system that is ineffective and doesn’t meet the needs of the organization, creating non-realistic healthcare goals, etc.
The planning phase is used to determine the objective for the new system, define the problem of any existing system, set the project schedule and secure funding and resources. Not allocating enough funding or misplacement of funding can be an issue in this phase. Nurses have the knowledge to shift funding to certain areas based on the needs of the patients.
The analysis phase includes gathering specific details required for the system; the stakeholders analyze the data and look for ways to implement them. Nurses can avoid stakeholders and other members of the team from providing requirements that are impossible to implement and do not fit the needs of the organization or will not work on units in the facility.
In the design process system and software design documents are prepared. Prototypes are often made to show the look and feel of the software. Nurses can provide input on changes that need to be made before the official design as they are the ones who will be utilizing the system.
In the implementation and testing phase the overall design for the software will come to life. Coding is done and the software is developed and ready to be tested. The system is then tested to determine whether it performs appropriately. Nurses have firsthand experience with using other systems therefore they can determine whether this system meet the needs for both staff and patients and whether it supersedes the previous system.
I personally have not had experience with providing input in the selection and planning of new health information technology systems. I have however interacted with IT in my current facility to create the option to change the chronological time in CERNER. For those who are used to EPIC, the time flows forward from right to left, but in CERNER it goes from left to right. Lots of travelers, including myself who had no previous experience with CERNER made several mistakes when documenting. In the end IT was able to add the option and documentation errors were reduced.
References
Clarusway. (2022, December 20). What Is SDLC (Software Development Life Cycle) – Clarusway. Online IT Bootcamp; Learn Coding, Data Science, AWS, DevOps, Cyber Security & Salesforce https://clarusway.com/what-is-software-development-life-cycle/Links to an external site.
McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.
Weckman, H., & Janzen, S. (n.d.). OJIN Homepage. https://ojin.nursingworld.org/table-of-contents/volume-14-2009/number-2-may-2009/nursing-involvement-and-technology/Links to an external site.
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Collapse SubdiscussionIrvin Michael Jones Hi Katrina,
Nurses certainly are one of the primary frontline workers that spend the most time with the patients which makes including them in the SDLC process incredibly beneficial. Alfuqaha et al. (2022) states nurses are more receptive to new health information technology implementations when included in the process. When nurses are not included in this process it may feel that leadership is simply putting something into the workplace without considering how it affects the workflow of the nursing staff members. As you mentioned, including nurses in the process will ensure that they are able to provide input to make sure the technology implemented is beneficial. According to Alhendawi (2022) health information technology integration is important for improving patient care outcomes and reducing costs which is where nurse input is needed. If nurses are not included in the process it could lead to technology that is implemented that may not be used very much and may not impact patient outcomes successfully.
References
Alfuqaha, O., Rabay’ah, M., Al. khashashneh, O., & Alsalaht, M. (2022). Technology acceptance model among nurses and other healthcare
providers during the 2019 Coronavirus pandemic: a comparative cross-sectional study. Central European Journal of Nursing &
Midwifery, 13(4), 775–782. https://doi.org/10.15452/CEJNM.2022.13.0023
Alhendawi, K. M. (2022). Task-technology fit model: Modelling and assessing the nurses’ satisfaction with health information system
using AI prediction models. International Journal of Healthcare Management, 1–13.
https://doi.org/10.1080/20479700.2022.2136881
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Collapse SubdiscussionAndrea M Allen The Inclusion of Nurses in the Systems development Life Cycle
Software Development Life Cycle (SDLC) Provides a standard project management framework to improve the quality of information systems that is required for healthcare as example. Nurses can collect data into vigorous set of functional use in software that is required by software developers. Nursing is critical in occupying a significant role in every stage of the SDLC Planning to Post Implementation and can familiarize themselves with design-thinking and practical expression capacity to work hand -in-hand with system developers.
As a result of not involving nurses in each stage of the SDLC when purchasing and implementing a new health information technology system, the system will not be efficient. There will be loss of early engagement by nurses due to their attention not being captured as well as lack of faith in the change process by both the implementers as well as nurses. Competing priorities will lower the nurses interest resulting in dissatisfaction and fatigue and loss of personal connection to the new system due to nurses’ core views and individual aspirations that may differ from those of the organization.
At the planning stage, the nurse will not be able to engage in the system implementation strategy where there is budgeting, creation of project leadership and team structure. Therefore, nurses will not be able to voice concerns and give feedback.
At the Analysis stage, the graduate nurse would not be able to engage in the evaluation of the aspects of the documentation system such as quality and functionality, Enabling possible inefficiencies of the documentation system and lack of vital information such as proper skin assessment with MORSE Scale.
At the Design stage, the nurse should gauge the system’s functionality such as the hardware, interface format, software, intelligence of the system, and the cognitive compatibility of the documentation system to that of the nurse practitioners (Curry (2007). Without a nurse’s input, there will be documentation challenges, communication and security issues and lack of ability to verify system in place before initiation.
Engaging nurse leaders in the implementation process relieves the complexity of the process since having a better understanding of the documentation system allows the nurse leader to easily explain to the other nursing staff (Curry, 2007). Not being able to recognize the implementation of errors, mistakes, and missing details of the develop systems will bring chaos and increase cost to rewrite the system.
At the post implementation phase, the evaluation will no doubt spawn a new cycle of analysis, design, project planning, design, coding and implementation, testing, and development maintenance which could possibly hinder the organization from advancing into the 21st century.
It is very important to follow the SDLC steps for effective development of healthcare technology system and the engagement of stakeholders are important expert opinions to ensure success of a its health information technology.
At the institution where I work, Implementation of the EHR is a slow process. We started with EMAR and are still ironing out some issues to try and perfect the system and meanwhile have incorporated an electronic laboratory software system. Again, we are currently undergoing changes. Lab Orders are placed on the computer after which specimens are drawn by a phlebotomist from an outside Laboratory. However, as a mental health facility, some labs that are drawn such as Clozaril levels or other specialized test ordered by specialists are not compatible with the new system. As a result, the lab had to install a new code and a comment section when I realized that the orders were not visible on the requisition form. This was clearly a gap in the system that would prevent proper monitoring of our chronic or new Clozaril users.
Being part of this experience is rewarding in that it makes what we do as nurses feels more valuable, our concerns were validated because we had an input. We were also motivated to finding more errors or glitches to enhance the software system and was further motivated to encourage full implementation of EHR to advance the institution. If a Mental Health nurse was involved at the pre planning stage, some of the blind spots we discovered could have been prevented. In fact, some of the tests required for our patients are sent out by our current lab because they are not able to accommodate the test. The hospital has a Nurse Informaticists in training who is also bombarded with calls. It will take some time to sort out the glitches but at least it’s a start. We are mostly onboard to learning the process and finds the challenge exciting as well as keeping up with current trends.
References
Curry, J., McGregor, C., & Tracy, S. (2007). A Systems Development Life Cycle Approach to Patient Journey Modeling Projects. PubMed. DOI: 10.3233/978-1-58603-774-1-905
Mohd, Ehmer, Khan, S., Shadab, M. & Khan, F. (2020). Empirical Study of software Development Life Cycle and its various Models. International Journal of Software Engineering Vol. 8 (2). https://www.cscjournals.orgLinks to an external site.
Ergasheva, S & Kruglov, A. (2020). Software Development Life Cycle early phases and quality metrics: A Systematic Literature Review. Journal of physics. Conf. Ser.1694 012007 doi:10.1088/1742-6596/1694/1101207
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Collapse SubdiscussionIrvin Michael Jones Hi Andrea,
I also found that if nurses were excluded in every stage of the SDLC process that the end result may not meet the initial intentions of the initial technology purchase. Competing priorities could certainly lower the nurses’ interest in the project and lead to dissatisfaction with the project from all staff involved in its use. According to Bagot et al. (2020) health information technology implementations such as telehealth require a level of buy-in from nurses to achieve positive patient outcomes. Including nurses in the process of purchasing and implementing new technology allows leadership to get a sense of the technology’s usefulness to the nursing staff. Al Alamin and Uddin (2021) state the SDLC functions as a proven method to decrease challenges and provide quality assurance to any organization. Within the healthcare setting, nurses are critical in implementing new technology, and if they are not utilized effectively in the SDLC process then quality assurance may not occur. Nurses should be included from the planning stage all the way to the implementation phase and beyond to avoid any unnecessary challenges.
References
Al Alamin, M. A., & Uddin, G. (2021). Quality assurance challenges for machine learning software
applications during software development life cycle phases. In 2021 IEEE International
Conference on Autonomous Systems (ICAS) (pp. 1-5). IEEE.
Bagot, K., Moloczij, N., Arthurson, L., Hair, C., Hancock, S., Bladin, C. F., & Cadilhac, D. A. (2020).
Nurses’ role in implementing and sustaining acute telemedicine: a mixed‐methods, pre‐
post design using an extended technology acceptance model. Journal of Nursing
Scholarship, 52(1), 34-46.
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Collapse SubdiscussionRemi Oluremi Ojo Hi Andrea,
Thank you for your post. I agree with you that it is important to involve nurses in all stages of the system development life cycle. In most healthcare organizations, technology execution intends to achieve business goals, while nurses focus on practice improvement. This focus on business has resulted in the benefits of organizational gains, but not directly in patient quality care and outcomes. The technology that focuses on helping nurses to deliver care has been handled separately and considered as an additional cost rather than a process to enhance care. Health technology projects involve senior managers, and administrators who are often inexperienced with the care setting, to advise on and set up processes. The system development life cycle (SDLC) involves a step-by-step approach, and it is advisable to encourage healthcare organizations to use this step-by-step approach when introducing new technology into healthcare practice. Technologies created for and utilized by nurses at the point of care are not always simple to use. If technology is related to direct care, nurses are likely to see its advantage and embrace it. Frontline nurses and other multidisciplinary team members emphasized the importance of involving those giving direct care in the design, selection, and testing of the technology, this advice is usually not adhered to when new systems or devices are purchased (Lin, et al, 2022). The healthcare profession has made progress toward dismissing the belief that nurses are sluggish to accept new technologies. The process of introducing a new system to an organization is a big change process, to enable nurses to understand the new technology being introduced, nurses must be involved in all the stages of SDLC. The involvement of nurses and other healthcare providers will increase their adaptation to change and educate them on the new system and its relevance to increased quality care and patient safety (Dykes, & Chu, 2021).
References
Dykes, S., & Chu, C. H. (2021). Now more than ever, nurses need to be involved in technology design: lessons from the COVID-19 pandemic. Journal of clinical nursing, 30(7-8), e25–e28. https://doi.org/10.1111/jocn.15581Links to an external site.
Lin, M. C., Kim, T. H., Kim, W. S., Hakanson, I., Hussein, A., & Hung, L. (2022). Involvement of frontline clinicians in healthcare technology development: Lessons learned from a ventilator project. Health and technology, 12(2), 597–606. https://doi.org/10.1007/s12553-022-00655-w
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Collapse SubdiscussionOdion Iseki The Inclusion of Nurses in the Systems Development Life Cycle
A never-ending loop of work goes into creating a new system that will work. A systems development life cycle (SDLC) is a method to deliver efficient and effective information systems (ISs) that fit with the strategic business plan of an organization, as stated by McGonigle and Mastrian (2017). The phases of planning, analysis, design and implementation are typical in this process. A new clinical system should be introduced with nurses’ full participation, as stated by Laurette Education (2018). Their input guarantees that the systems that deliver care based on evidence function optimally.
NURSING INVOLVEMENT IN THE SDLC LIFE CYCLE
Organizational and technological requirements are analyzed in cycles as part of a new health information system development plan. This procedure aims to determine where the organization’s current systems could be improved and devise a plan to fill those gaps.
FEASIBILITY
A feasibility study is the first step in a project’s development, used to assess whether the proposed project is likely to succeed and deliver the expected benefits. After this is done, a review of the project’s finances should be conducted to ensure that it can be finished on time and under budget.
ANALYSIS
This procedure aims to ascertain whether the company plans to adopt cutting-edge technology within the next few years. Nurses can discuss their present policies and the potential benefits of the new system by analyzing the latter. They can provide feedback that can be used to enhance the system’s performance.
DESIGN
At this project stage, designers consider how each part will function and how the underlying technology will function. During this time, nurses will test the system’s core functionality to ensure it meets their needs. Nurses’ input into the system’s design is another critical factor that developers should consider.
BUILDING AND TESTING
Coding and launching the brand-new system would be part of the cycle’s implementation phase. As stated by the Agency for Healthcare Research and Quality (n.d.), one of the most critical aspects of health IT adoption is understanding how health IT would change clinical and administrative processes. Making this happen requires new system programming. The system would be activated by programmers entering the appropriate programming codes. The use of an electronic record is intended to improve the quality of care given to patients. Hence nurses must have access to thorough training and testing of this system.
MAINTAIN
To keep doing things effectively, you must regularly assess how things are going. The system is thoroughly checked yearly to verify that everything is running smoothly. Software updates should be a regular occurrence. For optimal effectiveness, the system’s upkeep should also involve the nurses. Systems can become outmoded in-patient care practices, and evidence-based practice can only improve if nurses’ participation is valued during the maintenance phases of technology.
WORKING KNOWLEDGE OF HEALTH IT SYSTEMS FROM FIRST-HAND EXPERIENCE
Our building’s tech comes pre-set up and ready to go at the enterprise level. I am still determining the clinic’s involvement in the structure of the clinic atmosphere. Some of the pre-selected programs only sometimes match our needs because of the unique nature of our facility. Therefore, we have discovered numerous methods and locations in the electronic record dedicated to patient documentation. We may never know if we are seeing the complete medical history or the most up-to-date information because everyone is documenting in the way they were instructed. This could have been prevented if the medical staff had been consulted during the design phase.
References
Agency for Healthcare Research and Quality. (n.d). Health IT evaluation toolkit and evaluation measures reference guide. Retrieved from https://healthit.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkitLinks to an external site.
Laureate Education (Producer). (2018). Systems Implementation [Video file]. Baltimore, MD: Author.
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
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Collapse SubdiscussionGuoming Feng Main Post
When a health organization is to develop and implement a new health information technology system, they usually follow the way called Systems Development Life Cycle (SDLC). The SDLC model contains seven steps: planning, analysis, design, development, testing, implementation, and maintenance (McGonigle & Mastrian, 2017). Nurses, as backbone of the healthcare system, should be very necessary included in each stage of the SDLC. Lack of listening to nurses and lack of receiving feedback from nurses can have a negative impact on any program implementation (Risling, 2020). If nurses are not included in each stage of the SDLC, the health information technology system implementation would not be successful.
Plan, analysis, and design
In the initial planning phase, the organization realize that they have a problem or business need, which is followed by coming up with a solution to addressing it, but without the involvement of the nurses and their sharing opinion about the project goal, the potential healthcare information technology system would lack of goal-oriented characteristics. For example, to decrease the HAI c-diff infection rate, a healthcare organization decided to develop an information technology system to monitor and track infection precaution interventions to every patient admitted to the inpatient units. In the plan and analysis stages, the nurse should be included to share how they think the realistic project goals could be reachable; the nurse also should be included to reflect the current procedure of HAI c-diff infection prevention, so that to analysis the potential effective infection prevention strategies in the new program. In the analysis step, nurses should be included to develop a successful model. Nurses will be the users of the health information technology system, communication regarding end-user requests facilitates success (Zadvinskis et al., 2018).
Develop and testing steps
Prior to the implementation of the new systems, nurses including in important. If the nurses are not included in the develop and testing steps, they will not have an opportunity to familiarize themselves with the new system, and once when the new system is implemented, some of the nurses may need extra time and training on how to use the new system, which will badly slowing the workflow. For example, if the nurses are not included in the develop and test steps of a healthcare information system to monitor and tracking the HAI C-diff infection, the nurses do know any detail about this system, and they may need longer time for training on how to use this system, which will put additional workload on them and slow their workflows.
Implementation and maintenance
Implementation of a new system is working culture and working flow change, and the new system must be accepted by the people who are ready to implement it. As the users of the new system, nurses apply the new system for their daily direct patient care. It is essential for the implementation of the new system with the nurses’ thoughts and feedback. For example, even if the new system to monitor HAI C-diff infection is developed, without the nurse’ implementation, the new system will not do any good to improve patient outcome. Only with the users-the nurses’ consistently implementation and maintenance, the new system is possible successful.
I personally don’t have experience of input in the selection and planning of any new health information technology systems in my nursing practice or healthcare organization, but for many times, before the informatics and IT team was trying to put some new functions to the exist EHR (CPRS), they came to our nurses and asked our opinions about the relationship of new function of charting and patient care.
References
Farokhzadian, J., Khajouei, R., Hasman, A. et al. Nurses’ experiences and viewpoints about the benefits of adopting information technology in health care: a qualitative study in Iran. BMC Med Inform Decis Mak 20, 240 (2020). https://doi.org/10.1186/s12911-020-01260-5
Risling, T. L., & Risling, D. E. (2020). Advancing nursing participation in user-centered design. Journal of research in nursing: JRN, 25(3), 226–238. https://doi.org/10.1177/1744987120913590Links to an external site.
Zadvinskis, I. M., Garvey Smith, J., & Yen, P. Y. (2018). Nurses’ Experience With Health Information Technology: Longitudinal Qualitative Study. JMIR medical informatics, 6(2), e38. https://doi.org/10.2196/medinform.8734
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Collapse SubdiscussionOdion Iseki Hello Guoming,
Great post, McGonigle and Mastrian outline a series of steps—feasibility, design, testing, implementation, and analysis—required to develop new healthcare IT systems (2022). The SDLC creates effective processes for achieving various goals within a healthcare organization. Nurses should be included in all phases of the SDLC to ensure the adoption of evidence-based systems through a process that identifies gaps and creates strategies to remedy them. That guarantees the workflow will go off without a hitch.
The first step in the software development life cycle (SDLC) is the feasibility study, which evaluates whether or not the proposed system would achieve the set goals (Agency for Healthcare Research and Quality, n.d.a). Registered nurses, for instance, will weigh in on whether or not they think this technology would make patient records safer. The nurses’ input is crucial since they have invaluable first-hand expertise from working with various patients. After consulting with the nurses, the system’s backers determine whether or not to put money into a particular venture.
References
Agency for Healthcare Research and Quality. (n.d.a). Health IT evaluation toolkit and evaluation measures quick reference guide. https://digital.ahrq.gov/health-it-evaluation-toolkit
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Collapse SubdiscussionSimranjeet Brar Nurses spend most of their time with patients as they spend most of the time caring for the patients and their role in developing new systems cannot be assumed. Nurses play a crucial part in the Systems Development Life Cycle (SDLC) since new health information technology systems are used in healthcare. Their inclusion in developing new information systems can enhance patient health outcomes in diverse ways. This discussion demonstrates how including nurses in the SDLC helps to address challenges at the proper phases through their invaluable advice.
New information systems in healthcare require steps, including feasibility, design, testing, implementation, and analysis, according to McGonigle and Mastrian (2022). The SDLC is used to create workable mechanisms that ensure the attainment of various goals inside the healthcare institution. To ensure that evidence-based systems are adopted through a process that identifies gaps and creates strategies to solve them, nurses should be included in all stages of the SDLC. That ensures that the workflow will be successful.
The feasibility studies are the first stage of the SDLC, which determines if the suggested system would produce the desired results (Agency for Healthcare Research and Quality, n.d.a). For example, nurses will offer their opinion on whether the technology may improve the security of the health records. This stage requires the nurses’ participation since they offer first-hand knowledge based on their experiences with a diverse range of clients. The system’s proponents decide carefully whether to invest in a certain project with the nurses’ advice.
The analysis stage of the SDLC is when the application of the new system is evaluated considering potential future technical advancements. The primary question is whether the technology will continue to be useful in the future. Information about the potential of the new system in comparison to the present system will be provided by the nurses’ feedback. Input from nurses will also reveal how long a certain information system will be helpful before it becomes outdated.
The design phase of the SDLC is the next stage and involves assessing the various parts of the new system and how they will support the performance of the healthcare organization. Nurses will weigh in on whether the new technology will improve workflow during this phase (Agency for Healthcare Research and Quality, n.d.b). For instance, they can include details about how user-friendly the new system is. The designers make sure the new system is clear in ensuring greater organizational performance through their input.
The new information system must be put into use and updated in the following two phases. During these stages, the new system is operationally assessed to see if it improves the process (Agency for Healthcare Research and Quality, n.d.b). The new system’s ability to improve administrative or clinical processes is tested. Consider the case when a new EHR is being adopted. If so, the nurses will offer input on whether it enhances information flow while guaranteeing top security and ultimately raises the standard of healthcare services. The nurses and other stakeholders will also give feedback on the training’s efficacy throughout testing and implementation. Ineffective training will make it impossible to operate the new technology correctly.
The system is assessed to make sure it is efficiently operating during the maintenance phase of the SDLC. Software upgrades and enhancements are evaluated, for example. The feedback from the nurses is crucial in determining if the new system is appropriate for the company and sector. For instance, nurses might offer feedback on the necessity of updating the program every two weeks to increase the speed at which the EHR can be retrieved.
Despite having nursing expertise, my present employer did not involve nursing staff in creating a new information system. Senior management was the sole group involved in developing the new EHR system. Since most nurses believed the new system was outdated and incompatible with current nursing practices, there have been several issues as a result. Complaints have been filed as a result, and the administration has resolved to involve nurses in the decision-making process when creating new systems moving forward.
References
Agency for Healthcare Research and Quality. (n.d.a). Health IT evaluation toolkit and evaluation measures quick reference guide. https://digital.ahrq.gov/health-it-evaluation-toolkit
Agency for Healthcare Research and Quality. (n.d.b). Workflow assessment for health IT toolkit Links to an external site. https://digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit
McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge. Jones & Bartlett Learning.
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Collapse SubdiscussionIrvin Michael Jones Lack of Nurse Involvement Consequences
When healthcare organizations decide to implement a process improvement that involves the use of new technology, there are many factors to consider. Some of these factors include cost, efficiency, and patient outcomes. In order for the adoption and implementation of new technology to be successful it is important for organizations to also include input from the nursing staff who are expected to utilize this new technology. If nurses are not included, then they may be less likely to buy-in to the new technology as well as incorrectly use it causing a lack of efficiency. De Leeuw et al. (2020) states that there are many potential barriers that can cause the adoption of new technology to fail including lack of interest and training of staff members. A major example would be the implementation of electronic health record systems without including the nurses in the process. This would lead to nurses having difficulty using the system or believing that it will be ineffective in the long run. Many organizations utilize the systems development life cycle (SDLC) to implement new health information technology and if nurses are not included in the process there may be issues at each stage.
Planning
The planning stage is one of the most important stages within the SDLC as it is the stage that sets the timeline for the entire project. The planning stage is also the stage that determines what the health information technology is that will be implemented. Nurses should be involved in this stage as they are the ones who work on the floor and are able to identify many gaps within their prospective units. If they are able to identify various gaps where improvement is needed, they can assist in determining what type of health information technology may be needed to improve patient outcomes. Including nurses can also help determine the best times to fully implement the project so that it does not hinder daily operations.
Analysis
During this stage, healthcare organizations begin to gather information about the technology that they plan to implement then analyze this data to best determine how to implement it. Wang et al. (2019) states analyzing and evaluating data can relieve many issues in the later stages if done correctly. If nurses are not involved in this stage it can lead to difficulty coordinating the project while nurses are expected to continue to provide care daily. The process should be seamless so that it does not affect the nurses’ daily operations.
Design
During the design process organizations can finetune the new technology and ensure that it will be successful in its implementation. Nurses should be included in the process as they will be the main ones to use the new technology. Nurses can provide valuable input as to which modalities need to be included in the software. They can also cut costs by determining which modalities do not need to be purchased.
Implementation
This is one of the most important stages to include nursing staff as it is the stage where the finalized technology will debut on the floor. Nurses are important to include in this stage as they require training sessions to utilize the new technology. If they are not included in this phase, there may not be staff properly prepared to utilize the new health information technology.
Maintenance
This stage is important in finding gaps in the newly implemented technology as well as finding ways to improve it early in the process. Nurses are essential in finding any issues with the technology as they will be the primary users. Zadyinskis et al. (2018) states nurses are the largest set of employees within healthcare that utilize health information technology on a daily basis. If nurses are not included in this stage, then proper feedback will not be provided to the team implementing the project leading to poor outcomes.
Personal Involvement with New Technology
In my previous experience working in a long-term care facility, I was involved in the implementation of a new electronic health record system. I was glad to be a part of this process as I was able to be the voice for all of the nursing staff. I was able to recommend specific parts of the electronic health record to the team to purchase. For example, I suggested the purchase of the wound care module in order to better keep track of patients with pressure ulcers. I also made suggestions as to which purchases would least likely be used by the nursing team. While I knew the leadership team intended to make the best decision for the facility, I feel that it was important to include nurses in the SDLC process to ensure effective implementation.
References
De Leeuw, J. A., Woltjer, H., & Kool, R. B. (2020). Identification of factors influencing the adoption of health information technology by nurses who are
digitally lagging: in-depth interview study. Journal of Medical Internet Research, 22(8), e15630.
Wang, J., Gephart, S. M., Mallow, J., & Bakken, S. (2019). Models of collaboration and dissemination for nursing informatics innovations in the 21st
century. Nursing outlook, 67(4), 419–432. https://doi.org/10.1016/j.outlook.2019.02.003
Zadvinskis, I. M., Smith, J. G., & Yen, P. Y. (2018). Nurses’ experience with health information technology: longitudinal qualitative study. JMIR medical
informatics, 6(2), e8734.
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Collapse SubdiscussionBenedicta Kwevie The Inclusion of Nurses in the Systems Development Life Cycle (SDLC)
The SDLC is a framework that directs the stages of innovation in nursing informatics (Wang et al., 2019). Initially, there were five stages of SDLC: Planning, Design, Development, Testing, and Implementation. As time went on, Analysis and Maintenance were added to make up the seven stages of the SDLC (Preston, 2023).
Involving nurses in each stage of the SDLC when purchasing and implementing new Health Information Technology (HIT) is crucial because nurses are the primary end-users and, hence, are in the best position to pinpoint what is/will be effective in achieving targeted nursing outputs (McGonigle & Mastrian, 2022). We can take a look at potential issues and how nurses may help address them as follows:
Planning stage: Those planning may not know what problems nurses need to address. For instance, a system is acquired that records patients’ vital signs but gives out only numerical read-outs, meaning that the nurses still have to check that the read-outs are within normal range, cutting down on the time that could have been spent performing other nursing tasks. A nurse involved in the planning stage would be able to point out that a better option is to get a system that processes the patients’ vitals received and puts it out in chart form so that nurses can tell, at a glance, what is going on with the patient and then have time to perform other tasks.
Analysis: The facility needs to know whether or not the system they intend to acquire will impact the time nurses spend on direct patient care and whether it is worth it. Involving nurses will quickly provide this information.
Design: During this stage, the user-friendliness of the potential system comes into play. If a system is acquired, that is cumbersome to use; it negatively impacts its acceptance. Including nurses in this stage means they can point out which parts of the design are likely to cause problems and eliminate the issue even before it is rolled out.
Development and testing: Having a small group of nurses involved in “beta-testing” the HIT system before it is rolled out will help identify any faults that may have been overlooked in the design stage.
Implementation: As with any new system, there are likely to be people who will be against it, preferring to stay with what they know and are comfortable with. Here, nurses – preferably those involved in the testing phase- can serve as an example for acceptance of the system by disseminating information on its benefits or serve as trainers-of-trainees to ensure that all nurses are conversant with the system.
Maintenance: After the system is rolled out, there may be bugs or glitches. With nurses being the primary users, they are more likely to catch on to these issues quicker and know potential fixes. It is, therefore, essential to involve nurses in this stage to ensure the smooth running of the system.
Personally, I have not had the opportunity to input into the selection and planning of new Health Information Technology (HIT) systems, as what is currently being used in my facility predates the start of my employment. However, there is a system where the facility nurses can make suggestions as to what improvements they would like to see. I believe that being included in the decision-making process promotes satisfaction among the nursing staff as they feel heard and know that whatever concerns they may have with the HIT systems are being worked on.
References:
McGonigle, D., & Mastrian, K. G. (2022). Nursing Informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.
Preston, M. (2023). System Development Life Cycle Guide. Retrieved from.
Wang, J., Gephart, S. M., Mallow, J., & Bakken, S. (2019). Models of Collaboration and Dissemination for Nursing Informatics Innovations in the 21st Century. Nursing Outlook, 67(4): 419-432
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Collapse SubdiscussionMansong Ntekim Hi Benedicta,
Thanks for your informative discussion post. It is a fact that nurses make up 30% of total hospital employment (U. S Bureau of Labor Statistic, 2020) which means that nurses are the major users of any health information technology system used in the primary delivery of patient care, we could assume that it is imperative that healthcare organizations include nurses in all stages of the systems delivery life cycle (SDLC). It is vital to involve nurses in the planning, analysis, design, development, and implementation stages of SDLC. Who can better give feedback on the system than the primary users of the system? All systems are improved or adjusted effectively to meet the needs it is designed for through ideas and feedback from the potential users and primary users, and that is where nurses come in.
I worked at a facility where the system was changed without any input from the nurses, it was a disaster. There was so much anxiety prior to the implementation phase. Some nurses left the job for fear of the uncertainty of change. Our first contact with the system was on implementation. There was a fall in the productivity rate as nurses were reluctant to adapt to the system. There was resentment of the management, just because of the lack of involvement in the change process, not because the complexity of the system.
Reference
Bureau of Labor Statistics (2020). Registered nurses made up 30 percent of hospital employment in May 2019. The Economics Daily. https://www.bls.gov/opub/ted/2020/registered-nurses-made-up-30-percent-of-hospital-employment-in-may-2019.htmLinks to an external site.
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Collapse SubdiscussionMansong Ntekim Week 9 Discussion
Nurses are the largest section of healthcare workers and are the primary providers of patient care delivery in the nation’s hospitals and long-term care facilities. Nurses made up 30% of total hospital employment in May 2019 (U. S Bureau of Labor Statistic, 2020). With such a high representation in the primary delivery of patient care, we could assume that it is imperative that healthcare organizations include nurse in the systems delivery life cycle (SDLC). According to McGonigle and Mastrian (2018), nurses are involved by developers of SDLC in all stages of the system to ensure that all organizational and patients’ needs are met. It is vital to include nurses in the process and implementation of any new system because nurses make up a significant number of the system users and nursing documentation comprises the greater part of healthcare documentation.
According to Laureate Education (2019), the five steps in SDLC are planning, analysis, design, implementation, and maintenance. And all steps must be accomplished for the process to be a success, and that failure to involve nurses in the process can adversely affect the success of the program. Nurses are the primary users of users of the delivery systems, and not involving them in the five steps of SLDC could delay the identification of some usage problems (Cleveland, 2019).
In the planning stage, it important to involve nurses since they have the clinical expertise and are the primary users of the system, Nurses exclusion from the planning stages can result in the implementation of a system that fails to address specific patient needs.
Nurses are conversant with the workflow, roles, and duties of staff involved in patient care. In the analysis phase, nurses help identify and discuss tools that could make the system easy to use and effective in the care process. Excluding nurses in the analysis phase could result in flaws in system development,
In the designing stage, nurses can discern the needed input and output data, can review the flowcharts and work procedure to ensure that they are in line to produce the anticipated output (Zytkowsi et al., 2015). Failure to include nurses heightens the chances of missing vital input or output data which can limit the efficacy of the system.
In the implementation phase, nurses use the system, troubleshoot and give feedbacks on the efficiency of the system. Nurses may assist in the partnership effort of gathering, obtaining feedback, recognizing implementation problems and facilitators and areas that could be modified (McGonigle & Mastrian, 2018). Excluding nurses in the implementation phase could result in having a system that does not adequately meet the goals of clinical expectations.
In the maintenance phase, nurses are involved in supporting learning, using the system, providing feedbacks, and adapting software updates. Excluding nurses from this phase can limit improving the system to meet the changing care needs.
My facility of practice transitioned from Centricity to EPIC in December 2021. The change came about because there was a change of management. The management changed the system to align with the system of the parent company. The nurses were not involved in phase of the SDLC. There was anxiety about the impending change that some nurses resigned for fear of uncertainty. There was a breakdown in trust between the management and the nurses. The process led to low productivity rate as nurses did lacked the enthusiasm to embrace the change.
References
Bureau of Labor Statistics (2020). Registered nurses made up 30 percent of hospital employment in May 2019. The Economics Daily. https://www.bls.gov/opub/ted/2020/registered-nurses-made-up-30-percent-of-hospital-employment-in-may-2019.htmLinks to an external site.
Cleveland, K. A., Motter, T., & Smith, Y. (2019, May 31). Affordable Care: Harnessing the Power of Nurses. The Online Journal of Issues in Nursing. https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-24-2019/No2-May-2019/Affordable-Care.html?css=printLinks to an external site.
Zytkowsi, M., Paschke, S., McGonigle, D., & Mastrian, K. (2015). Administrative information systems. In D. McGonigle & K. G. Mastrian (Eds.), Nursing informatics and the foundation of knowledge (3rd ed., pp. 187-200). Burlington, MA: Jones & Bartlett Learning. Inclusion of Nurses in the Systems Development Life Cycle.
Laureate Education (Producer). (2018). Systems Implementation [Video file]. Baltimore, MD: Author.
McGonigle, D., & Mastrian, K. G. (2018). Nursing Informatics and the foundation of knowledge.
. (4th ed). Burlington, MA: Jones and Bartlett Learning
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Collapse SubdiscussionSimranjeet Brar Mansong,
I enjoyed reading your post explaining stages of SDLC and the importance of nurses’ inclusion during implementation. As you’ve mentioned, the implementation of EPIC didn’t involve nurses causing low productivity. Even though EPIC is probably one of the best systems out there, no involving nurses caused the breakdown in trust between the staff and management. It points out the importance of staff buy-in during any change within organization. The success of the organization will be impacted to a greater and greater extent by nurses’ buy-in to development and change across the SDLC while purchasing and implementing a new health information technology framework. There are four consequences if nurses are excluded. Loss of commitment due to the nurses’ lack of consideration. Moreover, there is a loss of faith in the competence and expertise of the implementers as well as the change cycle. Thirdly, the new framework provides conflicting requirements that lessen the nurses’ advantage, making it difficult to adapt decisions, leading to dissatisfaction and burnout (Ratwani et al., 2019). Last but not least, the nurses may not share the organization’s ideas and personal goals, which results in a loss of distinctive engagement with the new framework. A percentage of the nurses won’t be able to participate in the most effective way to use the new framework’s training, which will hinder their capacity to do so and slow down the work process. It may cause mistakes to be made and erroneous orders to be entered into the framework. The result would be that the benefits of the framework would not be grasped and would be viewed as a letdown. Because the design and layout are handled without the end users’ participation, the project will be badly developed if nurses are not included in the intended development (Califf et al., 2020). Additionally, because the project did not address the nurses’ concerns about their expertise in patient attention and security considerations, it may become obsolete months after it was completed.
References
Califf, C. B., Sarker, S., & Sarker, S. (2020). The bright and dark sides of technostress: A mixed-methods study involving healthcare IT. Mis Quarterly, 44(2).
Ratwani, R. M., Reider, J., & Singh, H. (2019). A decade of health information technology usability challenges and the path forward. Jama, 321(8), 743-744.
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Collapse SubdiscussionRoberto Monroy Hello Mansong!
Thanks for the read; nurses make up the world’s most prominent healthcare workforce and account for the majority of end users of these healthcare systems. According to an article, nurses must participate in the initial development of health systems to identify improvement areas to improve patient care; nurses can take supervision roles to oversee the projects and guide developers to meet their needs (Verma and Gupta, 2017). Including nurses in all stages of development is crucial to the success of healthcare systems.
Both technology and the nursing profession continue to grow at an exponential rate. According to Pepito and Locsin “Combining advanced analytics of artificial intelligence with the experience, knowledge, and critical thinking skills of nurses would result in making better clinical reasoning and clinical decision-making which improves patient care at lower costs (Pepito and Locsin, 2018). Utilizing both the advancement of technology with nurses’ clinical expertise will yield better outcomes for all stakeholders in healthcare.
References
Pepito, J. A., & Locsin, R. (2018). Can nurses remain relevant in a technologically advanced
future?. International journal of nursing sciences, 6(1), 106–110.
https://doi.org/10.1016/j.ijnss.2018.09.013Links to an external site.Medha Piplani Verma, Sandhya Gupta. (2017). Software Development for Nursing: Role of
Nursing Informatics. Int. J. Nur. Edu. and Research, 5(2): 203-207. doi: 10.5958/2454-
2660.2017.00044.8
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Collapse SubdiscussionRemi Oluremi Ojo NURS 6051 Week 9 DiscussionThe Inclusion of Nurses in the Systems Development Life CycleThe Systems Development Life Cycle (SDLC) is vital to successfully implement any healthcare information and technology system (HIT). Software professionals refer to SDLC as general, successive stages involved in the design of an application or component. The key stages involved in the SDLC process are planning, analysis, design, implementation, testing, and maintenance to achieve a successful outcome. These steps may occur once, twice, or repeatedly depending on the SDLC model followed (Risling & Risling, 2020). Technology specialists are professionals in the technical field who understand the process of new technology. Likewise, nurses are professionals in the nursing field who understand the active flow of patient care and the regular interactions required between several healthcare providers while delivering nursing care. It is therefore expedient for nurses to understand new technology, and for technology engineers to understand how the software and equipment will need to collaborate with the facility’s current systems. It is important to involve nurses who work at the point of care in all stages of the new technology introduction. This will facilitate an efficient transition to using new technology and increase nurses’ acceptance of the system. The chance of failure increases greatly without the users’ involvement. Nurses will adopt new technology if allowed to provide input in the planning, and implementation processes and evaluate if the changes designed to improve the work have been effective.A great example of how implementation could be affected when a nurse is not involved in the process of the implementation of the barcode medication administration (BCMA) system. The BCMA system software is a point-of-care system for verifying that the right medication is about to be administered to the right patient appropriately. The licensed practical nurses (LPNs) and the registered nurses (RNs) primarily use this system.Nursing Involvement in planning stageDuring the planning of the BCMA system, the interdisciplinary team needs to work more closely with the nurses. The first version of the BCMA that was invented excluded the documentation of IV fluids, it just marks it as hanging or discontinued, the IV fluid had a readable bar code but there was no link between the drug file and the BCMA. There were no safety checks to confirm that the right fluid was hung making it impossible to differentiate between normal saline from normal saline with potassium. A second version of the BCMA software was created in partnership with nurses and pharmacists to include patient-specific IV medications with readable bar codes. (McBee, & Patterson, 2019). This made it possible for nurses to scan the IV and verify it against the patient’s order electronically in the electronic medical record (EMR).Nursing Involvement in the implementation phaseIn the implementation phase, nurses are great at providing important feedback when technology changes during trial periods and implementation of the new technology. During the trial period of implementation of the BCMA system, there were challenges with the white space between the printed information on the wristband and the bar code printed immediately next to it. Nurses examined the challenges concerning the white space and adjusted the wristband print program so there was a larger amount of white space on the wristbands, after then, the wristbands were scanned 100% of the time for the entire facility.Nursing Involvement in Evaluation StageNurses discovered that the original BCMA system did not support great infection control practices for patients in isolation. A bedside nurse discovered a safe infection control practice to work with patients in isolation. This practice involved using a plastic bag to cover the scanner or pocket personal computer during medication administration. This practice is now being used to prevent the spread of infection (Barakat, & Franklin, 2020).Improvement has been made in creating new technology to improve patient care. Nurses’ participation throughout all phases of the process, which includes the design, planning, implementation, and evaluation phases, is an essential key to success in using these technologies. Listening to the observations and responses from nurses is important because it is the nurses who are in the most excellent position to recognize the indications needed to resolve underlying systemic issues and offer ideas for a possible solution.ReferencesBarakat, S., & Franklin, B. D. (2020). An Evaluation of the Impact of Barcode Patient and Medication Scanning on Nursing Workflow at a UK Teaching Hospital. Pharmacy (Basel, Switzerland), 8(3), 148. https://doi.org/10.3390/pharmacy8030148Risling, T. L., & Risling, D. E. (2020). Advancing nursing participation in user-centered design. Journal of research in nursing: JRN, 25(3), 226–238. https://doi.org/10.1177/1744987120913590McBee, M. E., Kuhlmann, M., & Patterson, P. (2019). What You Need to Know about Bar-Code Medication Administration. Journal of Nursing & Interprofessional Leadership in Quality & Safety, 2 (2). Retrieved from https://digitalcommons.library.tmc.edu/uthoustonjqualsafe/vol2/iss2/2 -
Collapse SubdiscussionChristiana Nuworsoo Initial Post
An organization’s system development life cycle (SDLC) is a conceptual model used in project management to
outline the stages involved in creating an information system (IS). It progresses from determining feasibility to project
initiation, analysis, design, implementation, testing, and maintenance (McGonigle & Mastrian, 2022). It is comparable
to the nursing process, in which a nurse must assess, diagnose, plan, implement, re-assess, evaluate and update
where necessary. If new issues arise or something does not work well, re-evaluate and update. It is a never-ending
process that is constantly evolving.
Consequences of not including nurses in SDLC stages
Nurses are one of the major users of health information systems and it will be difficult for them to advocate for
something that they are not involved in. Not including nurses in the SDLC stages could cause resentment toward the
new technology, and result in a loss of enthusiasm for learning about the new system. Also, from experience, it can
result in nurses leaving the profession to pursue other jobs/careers. Another point to consider, not including nurses
might affect the flow of work and delay patient care if what is implemented is not understood (Agency for Healthcare
Research and Quality, n.d.). Including nurses ensures that their views are heard. Nurses are experts with first-hand
knowledge of what is needed and understand what and how best it would work.
Potential issues at each stage of SDLC and how nurses may help address these issues
As stated above, there are six stages to the SDLC; feasibility, analysis, design, implementation, testing, and
maintenance. The feasibility stage is where a decision to initiate the project is considered. A potential issue at this
stage will be in regard to if the project will be able to meet the needs and expectations of the organization and
actually achieve the business goal. The analysis phase examines workflows and business practices. The design phase
is focused on creating a fundamental structural framework that identifies the key elements of the product and how
they communicate with one another. An issue at this stage will be to design a product that is difficult to use. Nurses
can be vital at this stage by helping to develop a program that gets the job done and is simple to understand and use
by all. The next stage is the implementation phase where the product development process is executed. Then it goes
through the testing phase to ensure the system is accurately built in the way that it should. After testing when the
system is up and running is maintenance to ensure the system continues to work the way it is designed to. Not
maintaining the system could lead to system breakdown. Therefore users/nurses are extremely important at this
stage for providing feedback and reporting things that cause system sluggish or slowdowns. The maintenance phase
is ongoing until it is decided that the system is no longer needed and a new system is implemented, thus starting the
SDLC all over again.
At my current facility and previous ones, I was not involved in the planning and implementation of any new
systems. However, although I wasn’t involved, there are nurse informatics and nurse leaders that are included in the
planning and development, who make sure that those at the bedside get the best training necessary to use the new
systems. I am yet to find myself struggling with the training obtained, so I will say they were effective in helping me
be confident. I am also a super-user of a few of the systems.
References
Agency for Healthcare Research and Quality. (n.d.b). Workflow assessment for health IT toolkit. Retrieved January 25,
2023, from https://digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-Links to an external site.Links to an external site.
health-it-toolkit
McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett
Learning.
Lalband, N., & Kavitha, D. (2019). Software engineering for smart healthcare applications. International Journal of
Innovative Technology and Exploring Engineering, 8(6S4), 325-331.
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Collapse SubdiscussionSimranjeet Brar Christiana,
I appreciate the information in your post. I enjoyed reading the explanation of stages of SDLC and agree that the SDLC is a useful approach for improving the effective and efficient delivery of information systems that are in line with healthcare requirements and essential to achieving the intended results in terms of safety, quality, and efficiency in healthcare delivery. To successfully deploy a health information system, healthcare organizations and stakeholders should follow the SDLC guidelines. A project including the implementation of a new health information system can benefit from the nurses’ advanced knowledge and expertise in health technology (Garcia-Sierra et al., 2018).
Not involving nurses during a major change within an institution, such as implementing a new health information system, can cause a loss of trust because their individual goals and core beliefs may not align with the organizational goals. Since they feel undervalued and uninvolved in the healthcare system, it might cause nurses to become demotivated and lose their morale. By including nurses in the planning process, different ideas and viewpoints may be generated to help with decision-making and to determine the optimal strategy for project execution (Wan et al., 2018).
References
Garcia‐Sierra, R., & Fernandez‐Castro, J. (2018). Relationships between leadership, structural empowerment, and engagement in nurses. Journal of Advanced Nursing, 74(12), 2809-2819. https://doi.org/10.1111/jan.13805Links to an external site.Links to an external site.
Wan, Q., Zhou, W., Li, Z., Shang, S., & Yu, F. (2018). Work engagement and its predictors in registered nurses: A cross-sectional design. Nursing & Health Sciences, 20(4), 415-421. https://doi.org/10.1111/nhs.12424Links to an external site.
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Collapse SubdiscussionMleh Porter The failure of healthcare organizations to involve nurses in the Software Development Lifecycle (SDLC) stages when purchasing and implementing a new health information technology system may present significant consequences. Booth et al. (2021) note that with the insight of nurses, these organizations may accurately identify the needs of the user base and the necessary functional and technical requirements for the system. The outcome this has is a poorly designed system that does not cater to the user experience. Without nurses’ input on design, the system may be developed without scalability, efficiency, and cost in mind, leading to higher costs for the organization.
Examples of potential issues at each stage of the SDLC
- Planning: Objectives, scope, and feasibility that need to be clarified. The inclusion of nurses helps address these issues by providing a clinical perspective on the users’ needs and ensuring that the system meets the needs of patients.
- Analysis: Inadequate gathering and analysis of user needs (McGonigle & Mastrian, 2021). Nurses would provide input on the clinical use of the system and ensure that it meets the intended needs of patients and other professionals.
- Design: Insufficient attention to usability and user-centered design. Nurses would offer guidance and suggestions on the system’s usability from a clinical perspective and ensure the system is user-friendly.
- Implementation: Lack of testing and training for users. Having nurses around at this stage would offer them opportunities to offer their input and perception of the usability and user-friendliness of the system.
- Testing: Insufficient testing. Nurses would help deal with this issue by offering a firsthand view of the system in its current state and suggesting changes that might be required to fit and address their needs and other users effectively.
- Deployment: Poor installation and maintenance. Nurses would propose how the system could be installed and maintained, considering how their operations would be impacted.
- Maintenance: Lack of ongoing support and maintenance. Nurses would offer vital input on the importance of reliable support from the vendor organization and alternatives that would be needed if the support is unavailable.
My Input
I have had some input in selecting and planning a new electronic health record system in my nursing practice. Doing this helped ensure that the system met the needs of clinicians and patients, was user-friendly, and was cost-effective (Perezmitre et al., 2022). My involvement enabled me to model a system that meets the needs of the nurses and other healthcare providers and is tailored to our specific workflow. The absence of nurses in the process may lead to installing a system that fails to meet the users’ needs, resulting in poor user experience, increased training requirements, poor user adoption, and higher costs.
References
Booth, R., Strudwick, G., McMurray, J., Chan, R., Cotton, K., & Cooke, S. (2021). The Future of Nursing Informatics in a digitally-enabled world. Health Informatics, 395–417. https://doi.org/10.1007/978-3-030-58740-6_16
McGonigle, D., & Mastrian, K. (2021). Nursing informatics and the foundation of knowledge. (5th ed.). Jones & Bartlett Learning.
Perezmitre, E. L., Ali, S., & Peltonen, L. M. (2022). Nursing informatics competencies for the next decade. Nursing and Informatics for the 21st Century – Embracing a Digital World, 131–148. https://doi.org/10.4324/9781003281009-8
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Collapse SubdiscussionBenedicta Kwevie Response 1
Hi Mleh
I agree with you about the presentation of the consequences of not involving nurses. Including them can be one factor that ensures the system is a success (Ts et al., 1990). With their input, they can add things to systems around them to better working conditions for the other nurses and the workplace. I agree with your experience of being involved in things that help benefit things and systems in the workplace; getting involved and having leadership can help their caretaking of patients and system development (American Nurse: The Official Journal of the American Nurses Association) ANA), n.d.).
References
American Nurse: The Official Journal of the American Nurses Association (ANA). (n.d.). American Nurse.
https://www.myamericannurse.com/nursings-role-in-healthcare-reform/#:~:text=As%20the%20healthcare%20professionals%20most%20actively%20engaged%20in
Glancey, T. S., Brooks, G. M., & Vaughan, V. S. (1990). Hospital information systems. Nursing’s integral
role. Computers in nursing, 8(2), 55–59
Edited by Benedicta Kwevie on Jan 27 at 11:11pm
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Collapse SubdiscussionRoberto Monroy The systems development life cycle is a process in which needs are identified, solutions are proposed, development and implementation occur, and results are evaluated and either changed, destroyed, or replaced (McGonigle and Mastrian, 2022). When it comes to healthcare, it is crucial to gain the expertise and insight of clinical professionals such as nurses for the best possible outcome when implementing a new technology system. Nurses make up the largest healthcare workforce in the world; they offer in-depth knowledge of healthcare as a profession and are more than capable of influencing digital health evolution (Risling, T. L. and Risling, D. E., 2020).
The first step of the SDLC is identifying a need or problem within the facility; arguably, nurses spend the most time on the floor than any other healthcare professional; they should be the number one resource when attempting to find solutions to an identified problem. Failing to do so can lead to clinical systems being incapable of meeting the facility’s needs. Nurses are equally important during the development and implementation phases as they can offer feedback on approaches and guide personnel in creating systems that are easy to use by clinical staff and incorporate pertinent information into the designs. Failure to maximize user efficiency and understanding of the system can lead to significant deficits in care; machine learning systems are only as good as the users, so ensuring they are utilized correctly is essential. Lastly, as primary users of such systems during the evaluation phase, we can help continue to build the system after first-hand use in the clinical setting and recommend removal or additional features.
In my psychiatric hospital facility, we are not regulated or required to have any technology systems; everything is manually completed via paper charting. There have been talks about implementing EMR and Pyxis systems; however, to no avail. If a new health system technology were to be implemented in any facility, It is still essential to include all stakeholders in the systems development life cycle to enable systems to meet the needs of their users and facilitate usability (Ehrler et al., 2019).References
Ehrler, F., Lovis, C., & Blondon, K. (2019). A Mobile Phone App for Bedside Nursing Care: Design and Development Using an Adapted
Software Development Life Cycle Model. JMIR mHealth and uHealth, 7(4), e12551. https://doi.org/10.2196/12551Links to an external site.McGonigle, D., & Mastrian, K. (2022). Nursing Informatics and the Foundation of Knowledge (5th ed.). Jones & Bartlett Learning.
Risling, T. L., & Risling, D. E. (2020). Advancing nursing participation in user-centred design. Journal of research in nursing : JRN, 25(3),
226–238. https://doi.org/10.1177/1744987120913590Edited by Roberto Monroy on Jan 25 at 10:53pm -
Collapse SubdiscussionErica Schulte Inclusion of Nurses in SDLC – Erica Schulte – Initial Post
Consequences of not including nurses in Systems Development Life Cycle
When a healthcare organization determines to take the step into a implementing a new technology system, to be successful they will proceed through various stages of a Systems Development Life Cycle. There are various stages of the SDLC and various deliveries. One of the oldest and most common of these methods is called the ‘waterfall method’ (McGonigle & Mastrian, 2022). One of the most crucial elements of establishing the proper implementation team is ensuring that the right team members are included. One of the most important team members is the end user, who can provide valuable feedback on problems to be solved, usability, and various functions. In a healthcare system the end user is the nursing team, and not having them included you would have the potential to lose this valuable feedback and miss opportunities in system design.
Stages of Systems Development Life Cycle and nursing involvement.
As mentioned above, the waterfall method is a common and successful implementation method. The first step is feasibility. Feasibility has to be measured in multiple areas including economical, legal, and operational. Part of the operational feasibility is trying to understand problems and functions that need to be fixed and the end user, or nursing team is the most in tune team member to some of these challenges. Not having a nurse included during this step would result in missing some of this valuable information, and ultimately resulting in designing a new system that would not be properly designed. In reading (Weckman & Janzen, 2009), the inclusion of a nurse is heavily supported in their own implementation of a Bar Code Medication Administration.
The next stage is the analysis stage. During this stage operational processes are further evaluated to help determine current challenges, issues, as well as strengths, to help determine the best design for the new system. A nurses feedback here is crucial to fully understand these processes and the feedback of an end user.
Stage three is the design phase which will apply all feasibility and analysis to determine the best processes to include in the design. Nursing feedback will continue to be valuable here as the design is progressed to ensure that all aspects of a new process are applied.
After the system is designed, the next two steps are implementation and testing. During the testing phase the new system will in fact go into effect and the end users will begin to test the function. Implementation teams can fail here if the proper end user is not involved in this testing phase and feedback is not properly received. Having the nursing team involved in the testing to allow for proper feedback and review at all aspects of the new process and system will be crucial.
The final phase after implementation and testing is maintenance. Maintaining the system will include a proper understanding of how the system functions, and the user having the ability to efficiently provide solutions and feedback of issues on a regular basis. This will ensure that any fixes or necessary modifications are applied through the maintenance stage. The proper end user providing this feedback will allow for proper maintenance through the lifestyle of the system.
Personal Experience
In my past life I was able to be included in a new system implementation process. A hospital that I had worked in early in my career was implementing the new Epic system through our organization. While I was unable to be included in the early stages of the development life cycle, I did have the opportunity to give feedback during the testing and maintenance stages. Our leadership ensured that all of our nursing team was able to apply feedback during these stages to ensure that the early stages of the new system would be applied properly. This allowed for proper fixes and adjustment as our organization adopted the new system.
References
Louis, I. (2011, August 17). .
.%20retrieved%20from%20https//www.youtube.com/watch?v=xtpyjPrpyX8%20%20Systems%20Development%20Life%20CycleLinks%20to%20an%20external%20site.%20%20Walden%20University,%20LLC.%20(Producer).%20(2018).%20Interoperability,%20Standards,%20and%20Security%20[Video%20file].%20Baltimore,%20MD:%20Author.%20%20Walden%20University,%20LLC.%20(Producer).%20(2018).%20Managing%20Health%20Information%20Technology%20[Video%20file].%20Baltimore,%20MD:%20Author.” target=”_blank” rel=”noopener”>Systems development life cycle Links to an external site.(SDLC) [Video file]. Retrieved from https://www.youtube.com/watch?v=xtpyjPrpyX8McGonigle, D., & Mastrian, K. G. (2022). Chapter 9. In Nursing Informatics and the foundation of knowledge (pp. 194–194). essay, Jones & Bartlett Learning.
Weckman, H., & Janzen, S. (2009). The critical nature of early nursing involvement for introducing new technologies. OJIN: The Online Journal of Issues in Nursing, 14(2). https://doi.org/10.3912/ojin.vol14no02man02
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Collapse SubdiscussionRoberto Monroy Hello Erica
That’s awesome to hear you were involved in implementing a new system in your facility. I have yet to be involved in one, but I hope my paper charting facility will soon move to a system like EPIC. EPIC simplifies tasks such as gathering a past health history, imaging and consultations notes can be viewed, and even allows instant messaging between clinicians (Virdee et al., 2022). Your contributions to implementing this system will significantly benefit you and your peers.
I also agree with your point about the importance of involving the appropriate team members in the implementation process. The nursing perspective can maximize the potential of healthcare technologies; through their guidance, they can facilitate the development of systems that meet their facility’s needs without sacrificing the efficiency of the nursing care process (Dykes and Chu, 2021). Involving nurses in this process is critical, as many nurses have the clinical expertise needed to implement such systems; they are a valuable resource that should not be underestimated.
References
Dykes, S., & Chu, C. H. (2021). Now more than ever, nurses need to be involved in
technology design: lessons from the COVID-19 pandemic. Journal of clinical
nursing, 30(7-8), e25–e28. https://doi.org/10.1111/jocn.15581Links to an external site.Virdee, J., Thakrar, I., Shah, R., & Koshal, S. (2022). Going electronic: an Epic
move. British dental journal, 233(1), 55–58. https://doi.org/10.1038/s41415-022-4404Edited by Roberto Monroy on Jan 28 at 12:07am -
Collapse SubdiscussionSheila Ankrah Response #2
Hi Erica,
Thank you for such a wonderful post. It is motivating to learn that you were once involved in implementing a new system at your workplace. Plans are continually being developed, and their implementation contributes largely to better service delivery. EPIC, for instance, has made it easy to gather information about health history and other consultation notes. Information is power, as said; thus, a system that makes it easy to share information contributes immensely to delivering it (Sergi, 2022). As you contribute to implementing this system, much is expected regarding benefits directed to you and those you are closely associated with.
Appropriate member/team involved in any system development and implementation is inevitable. The end users are vital in the development and implementation process. The potential of healthcare technologies can be maximized by implementing workable systems. Those designed, tested and implemented by qualified professionals (Krick et al., 2019). The clinical expertise of nurses must be addressed in the implementation process of any system.
References
Krick, T., Huter, K., Domhoff, D., Schmidt, A., Rothgang, H., & Wolf-Ostermann, K. (2019). Digital technology and nursing care: a scoping review on acceptance, effectiveness and efficiency studies of informal and formal care technologies. BMC health services research, 19, 1-15. https://www.emerald.com/insight/content/doi/10.1108/JKM-01-2020-0018/full/htmlLinks to an external site.
Sergi, C. M. (2022). Implementing epic beaker laboratory information system for diagnostics in anatomic pathology. Risk Management and Healthcare Policy, pp. 323-330. https://www.tandfonline.com/doi/abs/10.2147/RMHP.S332109Links to an external site.
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Collapse SubdiscussionBertina Boma Soh The Life Cycle of System Development (SDLC) consists of seven distinct phases. Planning, analysis, design, development, testing, implementation, and maintenance are the phases of SLDC (Cloud Defense, n.d.). The developers will build a strategy for the forthcoming project in the planning phase. In the analysis phase of the SDLC, the required software/hardware and other supplies for the project are determined. Before developing the program, developers begin designing it in the design phase. In the stage of development, the software is constructed. The program is examined for bugs and other flaws in the testing step. During the implementation phase, the users execute and test the project. Lastly, the maintenance phase is essential to ensure that there are no kinks or issues and that any that do develop can be rapidly resolved. Nurses should be involved at every level of the Systems Development Life Cycle (SDLC) when a healthcare institution attempts to acquire and install a new health information technology system. Because they will utilize the health information technology system the most, nurses must design a current strategy that allows them to provide feedback on the workflow’s effectiveness.
Consequences of Not Including Nurses in SDLC
The consequences of failing to incorporate nurses in each phase of the System Development Life Cycle (SDLC) are numerous. For instance, if nurses are not included in the first stage of the SDLC, the requirements and analysis stage, some of the present system’s shortcomings would go undetected. Therefore, the new (proposed) method will need specific needs or features required by users, in this case, the nurses. The new system will likely need more crucial security and communication features if nurses are included in the design process. The hardware and operating system may not be suited for specific nursing roles. Lastly, suppose nurses are not participating in the testing phase. In that case, it may be impossible to assess whether the system adequately fulfills its fundamental goal of improving patient service delivery. Failure to include nurses in the analysis, planning, designing, and testing phases increases the likelihood that the new system will not fulfill the demands of nurses and other users.
My Organization’s Participation in the Selection and Planning of a Health Information System
I participated in selecting and planning a new healthcare information system at my organization. This resulted in three significant advantages for the Information Technology (IT) team and the corporation. First, it was possible to identify the system’s strengths and limitations comprehensively from a nursing perspective. This served as the basis for determining the new system’s appearance and the solutions it would offer. Second, my participation in the SDLC ensured that the technology utilized the most suitable hardware and software, which were, among other things, user-friendly. By participating in the resting of the new healthcare information system before and during its installation, verifying that it satisfied all nurse requirements was possible.References
Cao, Y., & Ball, M. (2017). A hospital nursing adverse events reporting system project: an approach based on the systems development life cycle. In MEDINFO 2017: Precision Healthcare through Informatics (pp. 1351-1351). IOS Press.
McMurtrey, M. E. (2013). A case study of applying the systems development life cycle (SDLC) in 21st-century health care: Something old, something new? The Journal of the Southern Association for Information Systems, 1(1), 14-25.
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Collapse SubdiscussionColleen Lewis Inclusion of Nurses in Development and Design of Health Information Systems
Introduction
The SDLC is a process by which an information system (IS) is developed for an organization based on their business objectives and needs. The stages of needs assessment and system development should involve all stakeholders. First, the problems and needs of the organization must be understood to then develop a solution. A plan is developed for how to address the problems and needs identified, and then the plan is implemented based on the steps required to achieve the identified solution. Maintenance and review of the system follow, and if major changes need to be made for various reasons, the system is destroyed, and the cycle begins again (McGonigle & Mastrian 2022).
Consequences of not including nurses in purchase and implementation
Nurses are key stakeholders in the development and implementation of an IS. They have an important perspective of the needs and issues of the business or organization due to their involvement in the daily flow and first-hand knowledge of issues, as well as insight to solutions. Typically, nurses will be primary end-users of a new system in the clinical setting. As such, the IS should be designed in such a way that allows for ease of use and minimizes disruption to workflow. A consequence of an inefficient or overly complicated IS is low end-user compliance due to inconvenience and perceived ineffectiveness of the system.
Issues at each stage of the SDLC and how nurses can support improvement
Feasibility is the first stage in the SDLC. This refers to a determination of whether the project should be initiated and if it will be supported. Operational feasibility looks at how effective the system will be in addressing or solving the issue of concern. This is an area where developers may encounter an issue – the system may seem to address a certain issue in theory but at the clinical level it is ineffective. This is where the input of nursing staff would be extremely helpful to gauge the potential effect or impact of the system in question.
Analysis is the next stage, during which time the workflow and practices of the business are examined to determine what will be required of the system in order to be useful (McGonigle & Mastrian 2022). Because the workflow of a particular process or series of tasks often is different on paper when compared to the workflow as it manifests in clinical practice, development of a system based on the supposed workflow, as opposed to the actual workflow may result in a system not well suited to current clinical processes. There are always ways to improve workflow in healthcare, but a system with the aim of improving a certain problem can only be truly effective by accounting for the details of the actual daily practices. Nurses are key informants for the “why” of certain practices that can inform how to make improvements that will have likelihood of being adapted to current practice.
The design phase is extremely important, and developers must ensure the overall configuration, such as how the program(s) will look and work, is in line with what stakeholders agree will be most effective. At this stage, the nurses’ input is of high value, especially if they will be the primary end-users of the program or system. If it is not user-friendly or causes disruption in the clinical flow, there will be low compliance in its use. This issue is best avoided by consulting the nursing staff and gathering information from their clinical perspective.
Implementation is the stage when the design is brought to life (McGonigle & Mastrian 2022). Staff will be trained on its use. There may be issues with staff acceptance of the new system and sufficient training must be provided for users to increase likelihood of its adoption. By involving nurses early on in providing feedback regarding the functionality, a more user-friendly and effective system can be developed.
Testing is the phase when staff begin to utilize the program or system and determine if it performs in a way that is conducive to improvement of current issues. During this time, again, there may be an issue with user compliance. Nurses may request further training or may have input regarding certain details for improvement.
In the maintenance phase, the system may require updates or need slight changes to make it easier for users to implement. In this stage, it’s possible that the system doesn’t adequately address the need it was designed for. This issue can cause frustration for both end-users and program developers. As nurses are frequently a large percentage of the end-users, they will be able to provide feedback about where the system falls short or misses the mark in addressing needs. Nurses can provide suggestions for changes that would make the system work more effectively in the clinical setting.
Did I have input on selection of new technology systems?
I have never been consulted on the purchase of new systems, only instructed on how to use them. As the pediatric primary care office was a relatively new addition to the larger health care clinic, I was consulted on modifications made to the current IS to screen for delays in written and verbal language comprehension and expression. However, the system developer made the changes they felt were appropriate and never returned to ask if the changes made were adequate for our needs and patient needs in the pediatric office.
Impacts of not being included
As a result of not being included, the system was inefficient – I had to write many extra notes during each patient visit if the child was experiencing delays in language comprehension or expression. Many of our patients were from households with low literacy where Spanish or a Mayan dialect is the primary language and English is the second or third language. The IS built for our office was ineffective for our needs as providers and for our patients’ needs as well. As a result, it was very difficult to track interventions and progress in our patient population.
Conclusion
Nurses are seldom involved directly in the planning and development of systems they will be expected to use. In a study by Martikainen et al (2020), a survey was used to obtain feedback from nurses and physicians regarding their experience with health information system (HIS) development and how they prefer to be engaged to participate in its design. In the youngest age group, (<35) 70.4% of nurses and physicians stated they had never participated in HIS development (Martikainen et al 2020). All age groups agreed that communicating with a person in charge of HIS development was the most popular option for providing feedback (Martikainen et al 2020). There are consequences to not involving nurses in the planning and development process, namely a lack of efficiency in addressing the issue and a disruption to workflow. Additionally, end-users may avoid using the system if it is complicated or time consuming to use. McBride and Tietze (2023) affirm the SDLC “should result in a high-quality system that meets or exceeds customer expectations, reaches completion within time and cost estimates, works effectively and efficiently in the current and planned information technology infrastructure, and is inexpensive to maintain and cost-effective to enhance” (p. 193). Nurses must be more actively involved in the planning and development of HIS in order to improve their effectiveness clinically.
References
Martikainen, S., Kaipio, J., & Lääveri, T. (2020). End-user participation in Health Information Systems (HIS) development: Physicians’ and nurses’ experiences. International Journal of Medical Informatics, 137, 104117. https://doi.org/10.1016/j.ijmedinf.2020.104117
McBride, S., & Tietze, M. (2023). Nursing Informatics for the advanced practice nurse: Patient safety, quality, outcomes, and interprofessionalism. Springer Publishing Company, LLC.
McGonigle, D., & Mastrian, K. G. (2022). Nursing Informatics and the foundation of knowledge. Jones & Bartlett Learning.
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Collapse SubdiscussionAdrienne Aasand Response #2
Colleen,
Thank you for your discussion post. It was interesting to read about your experience with the system created to screen for delays in written and verbal language comprehension and expression. You point out that this system should have been modified to meet the needs of the patient population at your clinic. I believe when large systems are created for healthcare it is essential to evaluate the system by getting feedback from staff, and then make modifications based on specific clinic needs. This is the only way a system can be successful and improve patient outcomes. When planning to evaluate a new system, it is important to first look at the original project goals. Specifically, clinical outcomes, workflow impact, and provider adoption (Agency for Healthcare Research and Quality, n.d.a.). It seems that if the administrators of your new system had used this format for evaluation, changes could have been made to make the system more efficient and useful for your staff and patients. It would have benefited your clinic if the Systems Development Life Cycle (SDLC) model had been used because it includes continuous user input and involvement. This means the team, including nurses and clinic staff, will be continuously evaluating the new system, and in a short period of time the analysis, design, and development phases occur simultaneously (McGonigle & Mastrian, 2022). With this model the system in your clinic could have been revised to accommodate patients with low literacy or patients for whom English is a second or third language.
References
Agency for Healthcare Research and Quality (n.d.a). Health IT evaluation toolkit and evaluation measures quick reference guide. Retrieved January 28,
2023, from https://digital.ahrq.gov/health-it-evaluation-toolkitLinks to an external site.
McGonigle, D. & Mastrian, K. (2022). Nursing Informatics and the Foundation of Knowledge (5th ed.). Jones & Bartlett Learning.
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