JONA Highlights: Digital strategies to support nursing workflow

The Use of Technology

“Now more than ever, health systems must protect nurses from spending time on work that falls outside of core nursing responsibilities.9 Technology can make life easier for medical professionals and patients alike. It can help relieve the burden on the clinical nurse by enabling some responsibilities to be automated and more expedient, freeing time for nurses to prioritize more critical patient needs. There are numerous innovative technologies leaders should consider integrating into nurse workflow so care teams can think and work in new ways. Examples include the following:

  • Technology-driven pumps and monitors that automate the collection of information needed for care
  • Smart devices, including automated beds and vital sign monitoring
  • Wearables that provide clinical data to the provider
  • Virtual rounding technology that prompts patients and family members with questions via text to scale rounding efforts and prioritize needs
  • Electronic white boards integrated with the electronic health record to keep patients and families up to date
  • Centralized data command centers that integrate multiple systems into a single monitoring center, including coordination of care, requests for services, and discharge tracking
  • Robotics to save nursing and ancillary care time 10
  • Artificial intelligence to assist with wound assessment and sepsis capture for nurses that results in quality outcomes at lower cost 11
  • Tele-technology that enables virtual inpatient care models, including virtual sitter and virtual expert RN models 12
  • Mobile apps that enable bidirectional communication between patients and clinicians across all levels of care. These can improve nurses’ access to patient information, streamline communication and patient education, and provide patients themselves more control over their health. When digital health apps have the look and feel of other mobile apps such as Doordash or Netflix, which are already familiar to consumers, they will require minimal or no instruction.”
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Nurse education satisfaction scales

“Engagement with a course may improve academic performance, however, appropriate instruments are needed to measure engagement. Using an exploratory factor analysis approach, the 23-item Student Course Engagement Questionnaire (SCEQ) was used to quantify undergraduate nursing (n = 102), mid-wifery (n = 64), and paramedicine (n = 40) student engagement.” (Brown, et al)

(Brown, et al)

Brown, S., Bowmar, A., White, S., & Power, N. (2017). Evaluation of an instrument to measure undergraduate nursing student engagement in an introductory Human anatomy and physiology course. Collegian, 24(5), 491-497.
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Innovative orientation models in the critical care setting

“Nursing leaders responsible for orientation are challenged by the plethora of nursing knowledge and clinical skills required by nurses to provide safe care to critically ill patients. The goal is for new and experienced nurses to master the complexities of care and advanced technology and support the well-being of all. One way to achieve this goal is to actively engage new-to-practice nurses and experienced nurses in orientation programs designed to
transfer knowledge and skills needed to provide bedside care”.(Monforto)

Monforto, K., et al (2020801). Outcome-Focused Critical Care Orientation Program: From Unit Based to Centralized. Critical Care Nurse., 40(4), 54-64. Full Text for Emory Users

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What factors lead to resilient healthcare teams?

Psychological resilience, “the human ability to adapt in the face of tragedy, trauma, adversity, hardship, and ongoing significant life stressors,”[1] is thought to be a state of internal balance where “we are at our best, able to learn, solve problems, and work effectively with others”, resulting in better patient outcomes, and less employee burnout and turnover.[2]

Leadership techniques for team resilience training have been researched. One study found that managers addressed difficult situations by “facilitating teamwork through goalsetting, problem-solving and circumventing the technical systems’ limitations”, noting that increased team collaboration is supported by “team members’ abilities to predict the behavior of each other.”[3] Other strategies include “those that: a) foster connections within the team; b) provide education and training to develop behaviors that assist in controlling or limiting the intensity of stress, or aiding recovery; and c) assist in processing emotion and learning from experiences.”[4]

Additionally, in workshops, medical residents found greater personal strength from the group experience when they reflected on difficult cases and discussed them as a group, along with reviewing the “4 S’s” of resilience (Supports, Strategies, Sagacity [what wisdom did they gain], and Solutions to the problem).[5]

Resiliency is a factor for team success outside of healthcare as well. A Harvard Business Review survey[6] of 2,000 National Collegiate Athletic Association (NCAA) basketball coaches found that,

The “characteristics of a resilient team are:

  • They believe they can effectively complete tasks together.
  • They share a common mental model of teamwork.
  • They are able to improvise.
  • They trust one another and feel safe.”
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Executive Leadership During COVID-19

Members of the Advisory Board of the Washington, DC-based Nursing Executive Center offer “5 Executive Actions to Engage Staff Amid COVID-19:

  • Ensure that staff are safe and feel safe when working.
  • Reinvigorate your staff input channels and act on what you can.
  • Do not sugarcoat the challenge ahead.
  • Plan for your worst-case scenarios so you do not go back on even one commitment.
  • Transition your leaders from sprint mode to marathon mode.”

Berkow S, Virkstis K, Herleth A, Whitemarsh K, Rewers L. An Executive Strategy to Support Long-Term Clinician Engagement Amid the COVID-19 Pandemic. J Nurs Adm. 2020 Dec;50(12):616-617. doi: 10.1097/NNA.0000000000000946. PMID: 33181597.
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