Chapter 11: Caring, Communicating, and Managing with Technology


Chapter 11: Caring, Communicating, and Managing with Technology
Yoder-Wise: Leading and Managing in Nursing, 6th Edition


1. A nurse manager was orienting new staff members to computerized charting. To understand computerized charting, staff members must understand informatics. The three core concepts in informatics are:
a. Hardware, software, and printers.
b. Data, information, and knowledge.
c. Decision making, data gathering, and reporting.
d. Wireless technology, voice recognition, and handheld devices.
Informatics is the application of technology to all fields of nursing to facilitate and extend nurses’ decision-making abilities and to support nurses in the use, storage, and linkage of clinical information to provide effective and efficient patient care.

REF: Page 187 TOP: AONE competency: Business Skills

2. The nursing manager of a surgical unit has been asked by administration to evaluate client outcomes post cardiac catheterization. Using data about client outcomes post cardiac catheterization for the past 6 months so as to modify practice is an example of:
a. Information.
b. Cost-effective care.
c. Meeting standards.
d. Evidence-based practice.
Technology enables evidence-based practice by collecting good clinical knowledge, translating nursing knowledge into reference materials that can be accessed at the point-of-care, and, potentially, assisting nurses to take action based on best evidence for practice (Lang, 2008; Lang et al., 2006; Staggers & Brennan, 2007).

REF: Page 205 TOP: AONE competency: Knowledge of the Health Care Environment

3. Mr. Cruiser has been surfing the Web. He is looking for healthcare information on low back pain. He shows the clinic nurse a Webpage he thinks is great and tells her that he has been following the exercises recommended by the author. He wants to know what she thinks about the site. When the clinic nurse evaluates this site, she discovers that its author is a personal trainer. No credentials are listed. In several testimonials on the page, people (their pictures are included) say how wonderful they feel after having done these exercises. The exercises all have animated demos when you click on the pertinent highlighted text or icon. They seem easy to follow. The site was posted five years earlier and was last updated three years before. The clinic nurse advises Mr. Cruiser to:
a. Avoid this site.
b. Check with his primary healthcare provider.
c. Continue with the exercises.
d. Contact the author for additional exercise and feedback.
Patients need coaching as to how to use and decipher information that is available through the Internet. In this situation, the provider on the site lacks credibility because no credentials are listed, and the information is not current.

REF: Page 206 TOP: AONE competency: Business Skills

4. A primary care clinic in a small urban center sees a high volume of cardiology patients. Patients who attend the clinic have smart cards that they use at hospitals, clinics, and emergency departments within that region of the state. A primary benefit of the smart card for these patients would be:
a. Rapid and accurate treatment in emergency situations.
b. Reduced wait times to see specialists.
c. E-mail notification of test results.
d. Readily available information regarding medications.
Credit card–like devices called smart cards store a limited number of pages of data on a computer chip and serve as a bridge between the clinician terminal and the central repository of the electronic health record (EHR), making patient information available to the caregiver quickly and cheaply at the point-of-service. Smart cards provide information to healthcare providers regarding the patient’s demographic and contact information, allergies, immunizations, lab results, and past patient care encounters and are presented at the point-of-service.

REF: Page 198 TOP: AONE competency: Business Skills

5. The clinic nurse has just accessed a client’s chart on the computer. The resident comes over and asks her to stay logged on because he needs to add a note to that client’s chart. She should say:
a. “No problem. Just log me off when you’re done.”
b. “I’ll put the note in for you. What do you want to say?”
c. “Just make sure that you sign your note because it’s under my password.”
d. “I’m sorry, but you will have to enter the information using your own password.”
System users must never share the passwords that allow them access to information in computerized clinical information systems. Each password uniquely identifies a user to the system by name and title, gives approval to carry out certain functions, and provides access to data appropriate to the user. All users must be aware of their responsibilities for the confidentiality and security of the data they gather and for the security of their passwords.

REF: Page 206 TOP: AONE competency: Business Skills

6. A home health nurse has been assigned to cover a 300-square-mile area of remote Montana. Mrs. Baker has just been discharged home following bowel surgery and has a new colostomy. She will need daily contacts for at least two weeks and then regular weekly contact following that week. Because it is not possible to visit Mrs. Baker in person every day and see all of the other clients, the nurse gives her a laptop computer with net meeting software installed. Each morning, both dial in at an agreed-upon time and discuss her progress. The home health nurse assesses whether or not the client needs to be seen that day and is able to view the colostomy site. This type of technology is called:
a. Distance learning.
b. Knowledge software.
c. Telecommunications.
d. Biomedical technology.
Telecommunications and systems technology facilitate clinical oversight of health care via telephone or cable lines, remote monitoring, information links, and the Internet. Patients sitting in front of the teleconferencing camera can be diagnosed, treated, monitored, and educated by nurses and physicians. EKGs and radiographs can be viewed and transmitted.

REF: Page 204 TOP: AONE competency: Business Skills

7. At a newly built outpatient surgical center, an integrated information system has been purchased. The chief nursing officer creates a series of staff development classes to orient the staff to this new system. One of the advantages of an integrated information system is that client-care data from all sites can be stored in and retrieved from a:
a. Nursing information system.
b. Central data repository.
c. Nurse expert system.
d. Handheld device.
Computer information systems manage large volumes of data, examine data patterns and trends, solve problems, and answer questions. In other words, computers can help translate data into information from both within and among organizations. Data from all patient encounters with the healthcare system are stored in a central data repository, where they are accessible to authorized users. Patient information in a centralized database is organized, legible, and easily retrievable from a variety of sources and reflects a variety of data.

REF: Page 193 TOP: AONE competency: Business Skills

8. Nurses need to know how to operate a computer, compare data across time, and look for patterns in client responses to treatments. These are examples of:
a. JCAHO standards.
b. Information systems.
c. Informatics competencies.
d. Requirements for nursing licensure.
The Quality and Safety Education for Nurses (QSEN) project identified informatics competency as a necessary component of the knowledge, skills, and attitudes for quality patient care. Nurses are anticipated to be able to use information and technology to communicate, manage knowledge, mitigate error, and support decision making. Nurses must utilize hospital database management, decision support, and expert system programs to access information and analyze data from disparate sources for use in planning for patient care processes and systems.

REF: Page 187 TOP: AONE competency: Business Skills

9. The chief nursing officer understands that to be able to compare data across client populations and sites, it is important that nurses use:
a. Similar settings.
b. Information systems.
c. Knowledge systems.
d. Structured nursing languages.
Data are standardized and use structured terminology, which enables cross-site comparisons.

REF: Page 205 TOP: AONE competency: Business Skills

10. Leaders in nursing must advocate for information and knowledge systems that support nursing practice. This is best accomplished by:
a. Participating in organizational information technology committees.
b. Submitting written requests for needed information systems.
c. Requesting budgetary funds needed for systems.
d. Sending staff nurses to conferences that discuss cutting-edge technologies.
Nurse leaders and direct care nurses must be members of the selection team, participate actively, and have a voice in the selection decision. The information system must make sense to the people who use it and fit effectively with the processes for providing patient care.

REF: Page 205 | Page 206 TOP: AONE competency: Business Skills

11. You are in the process of designing a patient education program that will provide education and monitoring for patients with hypertension. To support your planning, you draw out and present patient data from:
a. A clinical database.
b. Biomedical technologies.
c. E-mail.
d. Internet sources.
Clinical databases are collections of elements organized and structured for the processing, organization, and presentation of data for interpretation as information, which, in this particular instance, includes outpatient data.

REF: Page 191 TOP: AONE competency: Business Skills

12. You document your patient’s vital signs into a bedside documentation device and are able to compare your patient’s vital signs with patients who have similar diagnoses and similar medications, and who are of a similar age. You are accessing:
a. E-mail.
b. Telecommunications.
c. A database.
d. Technology.
A database is a collection of data elements stored and organized together for the purposes of interpreting information such as vital signs.

REF: Page 203 | Page 204 TOP: AONE competency: Business Skills

13. In an ICU, you order new devices to measure heart rhythm and rate, respiratory rate, oxygen levels, and intracranial pressure. These devices involve:
a. Biomedical technology.
b. Telecommunications.
c. Retrieval of patient history information.
d. Internet.
Physiologic monitoring devices and patient surveillance systems involve biomedical technology.

REF: Page 188 TOP: AONE competency: Knowledge of the Health Care Environment

14. As the head nurse involved in leading determination of which patient surveillance systems to acquire for your unit, one of your aims is to avoid adverse events through the implementation of appropriate technology. This particular aim recognizes that:
a. Human error is significant in contributing to adverse events.
b. Documentation of patient data is often illegible and therefore, misinterpreted.
c. Data systems provide backup documentation with adverse events that staff cannot provide.
d. Physiologic monitoring systems enable detection of early changes before an adverse event occurs.
Data about adverse events suggests that a majority of physiologic abnormalities are not detected early enough and may be present hours before the event actually occurs. Physiologic monitoring aids in early detection of changes.

REF: Page 188 TOP: AONE competency: Knowledge of the Health Care Environment

15. A 39-year-old patient awaits a kidney transplant. Because he must immediately arrange to get to the hospital when a donor kidney is available, it is important that he can be reached anywhere and at any time. To ensure that he receives the message, what type of technology is most effective?
a. Internet
b. Telecommunications
c. WL pager
d. CDS
Wireless (WL) communication is an extension of an existing wired network environment and uses radio-based systems to transmit data signals through the air without any physical connections. Patients awaiting organ transplants are provided with WL pagers so that they can be notified if a donor is found.

REF: Page 197 TOP: AONE competency: Business Skills

16. A recent nursing graduate in a busy emergency department triages a patient who has sustained a large, deep puncture wound in his foot while working at a construction site. He is bleeding and is in pain. The nurse enters the triage data that she has obtained from the patient into a computerized, standard emergency patient classification system. After she enters the assessment data, she notices an alert on the computer screen that prompts her to ask the patient about the status of his tetanus immunization. What system of technology is involved in generating the alert?
a. Clinical decision support
b. WL technology
c. Computerized provider order
d. Electronic health record
Clinical decision support (CDS) is a clinical computer system, computer application, or process that helps health professionals make clinical decisions to enhance patient care. The clinical knowledge embedded in computer applications or work processes can range from simple facts and relationships to best practices for managing patients with specific disease states, new medical knowledge from clinical research, and other types of information.

REF: Page 191 TOP: AONE competency: Business Skills

17. Despite the implementation of bar-code medication administration (BCMA) on your busy medical unit, you notice that the number of medication errors has not significantly decreased. Which of the following reasons might explain the lack of change in errors?
a. A number of new medications have been introduced into the hospital pharmacy that are not yet recognized in the CDS.
b. There have been an unusually high number of patients on the unit who have been unable to confirm their identity at the time of medication administration.
c. Lack of staff understanding and support for BCMA has led to overrides or failures to scan bar codes during busy times.
d. Clinical data that have been entered into the system to guide administration of the medications are outdated.
Most errors related to technology involve mislabeled bar codes on medications, mistakes at order entry because of confusing computer screens, or issues with management of information. Errors also are related to dispensing devices and human factors, such as failure to scan bar codes or overrides of bar-code warnings.

REF: Page 200 TOP: AONE competency: Business Skills

18. A rural-urban health consortium enables physicians in a rural remote setting to consult with specialists in care through electronic conferencing, which includes consultation using intranet radiology images. This system may be in which phase of electronic medical technology adoption, according to the Healthcare Information and Management Systems Society (HIMSS)?
a. 0
b. 1
c. 3
d. 6
According to the HIMSS, this healthcare organization may be in phase 6, which includes the capacity to transmit all radiology images through intranet or another secure source. Level 1 refers to the installation of major ancillary clinical systems (such as radiology) and level 3 to the retrieval of radiology images from picture archives and communication systems.

REF: Page 194 | Page 195 TOP: AONE competency: Business Skills

19. As a nurse manager representative on a clinical information system selection team, you would be particularly concerned if the favored system:
a. Involves screen displays that are best configured for non-clinical users.
b. Requires an upgrade to servers in the facility.
c. Requires staff orientation and training during implementation of the software.
d. Minimizes the amount of data entry necessary.
An ideal hospital information system should include as much instrumentation as possible to minimize data entry. As a clinical end user, you would expect orientation and training on how the screen display can be configured so as to suit the purposes and preferences of users in clinical areas.

REF: Page 196 | Page 197 TOP: AONE competency: Business Skills

20. When assessing the appropriateness of adopting WL PDAs for a nursing unit, you need to consider the advantages, which include:
a. Lower cost relative to PCs.
b. Small display screen.
c. Font size.
d. Speed of operation.
PDAs offer a lower-cost method of documentation and communication than PCs, as well as easy portability. Disadvantages of PDAs include small screen size, suboptimal readability, and slowness in situations when speed is most needed.

REF: Page 197 TOP: AONE competency: Business Skills

21. A nurse manager is excited by the possible use of speech recognition (SR) systems for documentation of patient care, especially during crisis situations when staff members need to focus on performing rapid assessments and implementation of procedures. She learns, however, that SR systems would be impractical at this point. What would lead to this conclusion?
a. SR systems are not available outside pilot projects.
b. The type of speech required for voice recognition is unlikely to occur in a pressured situation.
c. The hands-free function has not been perfected in SR technology.
d. Wireless communications are prone to unreliability in transmission.
Speech recognition systems rely on staccato-like speech, pauses between words, and programming for each user, any and all of which would be unlikely in a pressured crisis situation. SR is being used primarily for therapeutic purposes and in situations where data entry is stable.

REF: Page 198 TOP: AONE competency: Business Skills

22. As a nurse manager, one challenge is to orient new staff to your agency’s policies and procedures, as well as to provide training across various shifts. A cost-effective and effective learning strategy would be:
a. Development of new learning modules and software to support document retrieval.
b. E-mail distribution to staff home e-mail addresses regarding important policies.
c. Preparation of DVDs that can be viewed on computers at the nursing station during “down times.”
d. Linking policies and procedures to the network for access when required at the point-of-care.
Knowledge technology consists of systems that generate or process knowledge and provide clinical decision support (CDS). The clinical knowledge embedded in computer applications can range from simple facts and relationships to best practices for managing patients with specific disease states, new medical knowledge from clinical research, and other types of information. The most accessible and cost-effective approach would be utilization of what is already available in the work environment, such as the systems that provide CDS.

REF: Page 191 TOP: AONE competency: Business Skills

23. A necessary, basic condition for successful integration of clinical information systems is:
a. Software.
b. Standard medical nomenclature.
c. Confirmatory evidence from nursing-led studies.
d. Strong interdisciplinary cultures.
An integrated clinical information system draws on specific knowledge from many involved disciplines that interface at the patient. Successful integration of clinical information systems requires that the various disciplines work together collaboratively to transform the data into meaningful knowledge.

REF: Page 199 | Page 200
TOP: AONE competency: Communication and Relationship-Building

24. To improve outcomes on the stroke recovery unit, the unit manager leads an evidence-based practice (EBP) project. The goal of this project is to:
a. Enable detection of variations in clinical outcomes from well-researched standards that are supported by confirmatory evidence.
b. Gain quick access to literature based on studies of patients and families who have experienced stroke.
c. Develop a list of articles that could be accessed to address clinical issues and problems with stroke patients.
d. Advance the development of staff who are able to conduct independent nursing research on stroke outcomes.
Several “intelligent” clinical information systems are in place that collect good data and then translate nursing knowledge, such as well-researched standards, into reference materials at the point-of-care. In addition, computer applications assist nurses to take action and provide patient care based on the best evidence for practice.

REF: Page 205 TOP: AONE competency: Business Skills

25. As part of an information technology implementation team, you are implementing a clinical decision support system. Particular considerations for successful implementation of this project include:
a. Ensuring that the system is reliable.
b. Ensuring that patient information is reliable.
c. Developing unique identifiers for individuals.
d. Developing rules that support inferences.
Clinical decision support systems provide support for novice nurses, in particular, as they enable entry of real-time data from patient situations and inferences that apply the logic that expert nurses would use. These inferences require rules to be developed for the system.

REF: Page 192 TOP: AONE competency: Knowledge of the Health Care Environment


1. As a nurse manager, you want to institute point-of-care devices on your unit. The rationale that you provide to support the point-of-care devices includes (select all that apply):
a. Reduction in incidents of medication error.
b. Immediate documentation of care.
c. Comparison of patient data with previous data.
d. Immediate access to staffing schedules.
ANS: A, B, C
Point-of-care devices that allow documentation of assessment, care, and teaching at the bedside reduce the gap in time between care and documentation, thereby reducing error, increasing accuracy, and improving communication of care. Medication devices and patient databases enable accurate clinical decision making.

REF: Page 187 | Page 189 | Page 194 TOP: AONE competency: Business Skills