support@bestonlineessays.com

THE INCLUSION OF NURSES IN THE SYSTEMS DEVELOPMENT LIFE CYCLE

THE INCLUSION OF NURSES IN THE SYSTEMS DEVELOPMENT LIFE CYCLE

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.

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.

  • McGonigle and Mastrian, (2022) discuss the Systems Development life cycle or SDLC. They cite various approaches to the SDLC, including The waterfall model, where the output from one stage flows into the next, RAD or rapid application development that uses a quickly developed prototype that can be tested by users, Object Oriented Systems Development or OOSD, which assigns commodities that exist in reality to objects within computer software. Per Gogou et al, (2002), the benefit of this is that the system can focus on the relationship of these objects to each other rather than be designed from a procedural standpoint. There is also DSDM or the Dynamic System Development Model, which per McGonigle and Mastrian, (2022) is useful when a new system must be developed quickly and may have to be adjusted to meet unforeseen needs as it is developed. There is also a method discussed called Agile, which emphasizes the way the work (that the system will be supporting) is done and the way the people doing the work perform together.

    These different approaches have different names for their phases. However, per Dr. Kevin Johnson in Walden (2018) the four general phases of SDLC are Planning, Design, Implementation, and Evaluation/ Maintenance. This video also stresses the importance of nurse involvement in each phase for the success of the new system.

    Planning

    In the planning stage, Dr. Johnson (Walden, 2018) describes two critical steps. First, he states that the individuals involved in systems development must remember that the whole thing is a cycle, and steps may need to be revisited. Second, he states that we must define what we need the system to do. It is essential that there is nurse representation, especially in this stage, because nurses will be the ones using the system, and they need to have input on how the system should operate. McGonigle and Mastrian, (2022) discuss for example, working with stakeholders (in this case, the nurses) to ask what a system “should have, must have, could have and would have,” identifying the “must have” facets of a system as the ones necessary for its success.

    BUY A PLAGIARISM-FREE PAPER HERE

    Design

    Per McGonigle and Mastrian, (2022) use of healthcare technology can save lives, but when it is implemented without regard to actual workflow, it can create more danger than safety. This is why a nurse needs to be involved in the design stage of the systems development life cycle. These writers state that workflow analysis is a key part of the design (or re-design) process and that workflow analysis is a key skill that a nurse informaticist should possess to be part of the team that looks at workflow during the design stage of the SDLC. . I can think of a time in my last agency when the project team spent months “redesigning” the system with little or no influence from the direct care staff, and the result was basically to move all our widgets around and give the calendar a new look. There were no processes added that could have enhanced our workflow, such as the ability to create a working client list for each nurse or to do batch processes like adding vitals for all clients on a list. If the nurse staff had any input into this planning stage, it could have given the project management team better direction and resulted in changes that were more meaningful to patient care. The new design, without input from staff, actually got in the way of care by offering no meaningful changes to actually help the workflow. It also required a few days of learning where the design team relocated the same old tools to just affect a different “look”.

     

    Implementation

    In Walden University (2018) Kevin Johnson speaks about the most significant challenge to implementation being acceptance of change among the end users of the system. To ensure buy-in, he speaks about the necessity of collecting input from staff, with the recognition that not all views on what is the best direction can be satisfied. So during implementation, there needs to be the recognition that not all system users will be happy with the new system (because even if they had input, their input might not have been utilized). Cho et al, (2021) discuss resistance to change during implementation and state that resistance may not be apparent because nurses may understand the implications to their career by overtly resisting the change. But there may be hidden resistance, which can be even more damaging to the process. These writers state that an important nurse role in the implementation change is to have nurses that are super users (that they refer to as “nurse champions”) who are well trained in the use of the EHR, and can demonstrate and also promote from within the benefit of the EHR to other staff. McGonigle and Mastrian, (2022) also discuss training as an important step of implementation. In this area, nurses need to participate to be trained. But another critical role for the nurse and nurse informaticist is to be able to train their cohorts. And in the case of a major change like the adoption of a new system, it is not just about educating people on use but leading them to embrace change. Tyler (2019) describes an important role of a nurse informaticist as being able to lead their cohorts through change. The nurse informaticist needs to be involved to get people to “unfreeze” and accept change, move through the process of change, and then embrace the new way of working. I was not here for the new implementation of EPIC at my present place of employment. However, the physician I work under told me of several Physicians, who were at the end of their careers, and quit due to the complexities of the new system. These were providers who may have delayed their retirement by a few years but got so frustrated learning to use EPIC that they left early. It is clearly important that there are cohorts who can help new users learn the system , not just for the success of the system, but also for employee engagement.

     

    Maintenance/Evaluation

    In the Maintenance and evaluation stage of the SDLC the new system needs to be evaluated to see if it is working and have the necessary changes applied (This goes back to Dr. Kevin Johnson’s statement in Walden (2018) that the process is cyclic and constantly needs to be revisited and evaluated to ensure it is meeting the needs of the healthcare facility and its patients. Untalan et al, (2022), besides recommending the use of super users for direct staff training as part of implementation also support the importance of evaluation and maintenance of the system through some sort of metric like lean sigma six to see if the system is meeting its goals. In their case, they created an audit tool. They combined it with nursing huddles to discuss barriers and pathways to meet specified nursing issues until their system had 100% resolution of identified issues. This demonstrates the importance of nursing involvement in this phase. If the nurses are not able to meet their care goals with the use of the system, and if the system cannot be modified to let nurses meet their patient care goals then it is not going to be much help to the facility’s nurses or patients. In my old agency, we were at least asked for feedback after the changes. I did not see any immediate changes to the system after feedback was collected. But there was at least an avenue for quality improvement that was staff experience related.

     

    Along the SDLC the involvement of nurses (the people who will be mostly utilizing the system for patient care ) will always be of the strongest importance. Input into what a system will be used for, how it can be designed to do the job, whether it is accepted, embraced, and learnable, and how it works for its users revolves around the nursing staff. It is especially up to the nurse informaticist to bridge the gap between the nursing staff and the IT professionals who will be coding and building the system.

     

    References

    Cho, Y., Kim, M., & Choi, M. (2021). Factors associated with nurses’ user resistance to

    change of electronic health record systems. BMC Medical Informatics & Decision

         Making, 21(1), 1–12. https://doi.org/10.1186/s12911-021-01581-zLinks to an external site.

     

    Gogou, G., Mavromatis, A., Maglaveras, N., Engelbrecht, R., & Pappas, C. (2002).

    DIABCARD CCMIS—A Portable and Scalable CPR for Diabetes Care. IEEE

         Transactions on Biomedical Engineering, 49(12), 1412.

    https://doi.org/10.1109/TBME.2002.805460Links to an external site.

     

     

    McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of

          knowledge (5th ed.). Jones & Bartlett Learning.

     

    Tyler, D. D. (2019). A Day in the Life of a Nurse Informaticist: Super Users. Journal of

          Informatics Nursing, 4(1), 18–20.

     

    Untalan, E., Cardenas, P., & Jenkins, Z. (2022). From Old to New: Process of

    Integrating PACU Phase 1 Documentation and Workflow from Old Electronic Health

    Record (EHR) System to New Electronic Health Record (EHR) System. Journal of

         PeriAnesthesia Nursing, 37(4), e9. https://doi.org/10.1016/j.jopan.2022.05.024Links to an external site.

     

    Walden University, LLC. (Producer). (2018). Managing Health Information

         Technology [Video file]. Baltimore, MD: Author.

     

    Walden University, LLC. (Producer). (2018). Systems Implementation [Video file

    Baltimore, MD: Author.

     Reply to Comment

    • Collapse SubdiscussionDeanna Linn Howe

      Hi Matthew and all,

      I appreciate your comments here. The process of updating or adding new technology can be very complicated especially if the organization is large and/or there are outdated technology resources in the setting. Those involved in this process of deciding which health information technology system would be implemented would include management and staff, concerns and ideas should be considered and evaluated. It would be important to include a sample of nurses into this process to ensure that the system obtained meets all needs and expectations. If few recommendations proposed by nursing were ever implemented this could be very frustrating for staff and bad for morale.  What has been your experience with sharing input regarding technology updates? Do you have a manager who will advocate for your ideas? If not, how can you better advocate for the nurse voice to be heard? Thanks, Dr. Howe

       Reply to Comment

      • Collapse SubdiscussionMatthew Baron

        Hi Dr. Howe,

        My experience is recently split between two facilities, as I took on a new role with a new agency just last December.

        In my previous company, I would say there was little input from nurses doing direct care for patients when new updates were made to the EHR. This WAS frustrating. Farina (2018) discusses the importance of getting stakeholder buy-in and creating excitement for the change right from the beginning. In this case, there was a concerted effort to create excitement for the changes by making announcements about when the rollout would happen, but there was no effort to create buy-in from the people who would be using the system.

        I can definitely say it was a safe environment to voice concerns, and I know my manager advocated for us based on our suggestions, but not a lot manifested from those suggestions.

        In my new role and facility, we utilize EPIC, a pretty complex EHR. I was not an employee when it was rolled out, so I am unsure how much input nurses had. However, the informatics team where I now work is very responsive to requests for help. For instance, my role as a Recovery RN is new to an outpatient substance use program. I am in the process of discovering my workflow. When I asked my manager about concerns for the EHR guiding, rather than supporting my patient care, he set me up with an informatics trainer who helped me navigate and customize my EPIC to my workflow.

        So, I felt heard and supported. My Epic trainers were also both very knowledgeable and enthusiastic. Their enthusiasm and ability to explain in depth the use of the EHR helped me to get on board and be happy with the product. This is supported by Yuan et al, (2015), who state that those super users who are positive, proactive, and able to explain in depth can have a greater impact on EHR acceptance.

         

        Farina, L. (2018). Tips and lessons learned for a successful clinical EHR

        implementation. Health Management Technology, 39(4), 20–21.

         

        Yuan, C. T., Bradley, E. H., & Nembhard, I. M. (2015). A mixed methods study of how

        clinician “super users” influence others during the implementation of electronic

        health records. BMC Medical Informatics & Decision Making, 15(1), 1–10.

        https://doi.org/10.1186/s12911-015-0154-6

         Reply to Comment

    • Collapse SubdiscussionJames Mangrum

      Matthew,

      I enjoyed the experiences you applied to this discussion. I was a little off, when I saw the request to apply our experiences to this post, because I don’t have any experience with SDLC in nursing. I think I was actually a little short sited though because I guess I could have of course used other systems integration changes in other fields. I have been in the Army Reserves for 19 years and have most definitely seen a ridiculous amount of changes over the years. I have also watched a long list of people struggle and resist those changes. Your talk about the physicians that retired rather than use a new system strikes true there. Ifenthaler et al., talks about how departments with limited experience with new technology can cause a resistance to change across an entire organization (2021). Resistance can be compounded in the undercurrent of organization.

      In another connection to the military, I noticed how the SDLC as with many processes is very similar to the Army’s troop leading procedures (TLP). The final step in the process is Supervise, and in that step is reevaluation of the outcome of current plans and adjusting as necessary. The importance or value of quality supervision is often understated in many processes. Better supervisory relationships in general have decreased burnout and improved performance across organizations (Hiebler-Ragger et al., 2021).

       

       

      References:

      Ifenthaler, D., Hofhues, S., Egloffstein, M., Helbig, C. (2021). Digital Transformation of Learning Organizations. Springer Open. https://doi.org/10.1007/978-3-030-55878-9

      Hiebler-Ragger, M., Nausner, L., Blaha, A., Grimmer, K., Korlath, S., Mernyi, M., & Unterrainer, H. F. (2021). The supervisory relationship from an attachment perspective: Connections to burnout and sense of coherence in health professionals. Clinical psychology & psychotherapy, 28(1), 124–136. https://doi.org/10.1002/cpp.2494

       Reply to Comment

      • Collapse SubdiscussionMatthew Baron

         

        Hi James,

        I definitely agree that the experience you had with systems change in the military is transferable to discussing system change and development in healthcare. Wong et al (2022) discuss the importance of stakeholder input at multiple phases of developing a new software system (not necessarily healthcare related). Ono and Tangteerasunun (2022) elaborate on this by supporting a process called stakeholder mapping. Stakeholder mapping is where each stakeholder, and their relationships with each other, need to be identified and have their needs and concerns met throughout the development process. It is obvious that nurses are serious stakeholders in any change of process in a healthcare setting whether it is a new electronic system or a policy change.

        The methods for SDLC we learned about in McGonigle and Mastrian (2022) such as Agile or the Waterfall method, are project management methods that work across all industries, not just healthcare. And so, experience of projects and system changes within the military is relevant. Seeing firsthand how resistance from team members that did not experience buy-in for a change, and how that affects acceptance and success of the change is transferable to why nurses as primary stakeholders in a new system development need to be involved at all phases of the SDLC.

         

        McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of

              knowledge (5th ed.). Jones & Bartlett Learning.

         

        Ono, K., & Tangteerasunun, P. (2022). Design Thinking Framework for Values Capturing and

        Technical Features Validation for Digital Healthcare Platform. 2022 IEEE Technology &

             Engineering Management Conference – Asia Pacific (TEMSCON-ASPAC),2022 IEEE, 075–

        1. https://doi.org/10.1109/TEMSCON-ASPAC52831.2022.9916553

         

        Wong, W. Y., Hai Sam, T., Too, C. W., & Fong Pok, W. (2022). Software Quality Assurance

        Plan: Setting Quality Assurance Checkpoints within the Project Life Cycle and System

        Development Life Cycle. 2022 IEEE 18th International Colloquium on Signal Processing &

                 Applications (CSPA), Signal Processing & Applications (CSPA), 2022 IEEE 18th

                 International Colloquium On, 214–219. https://doi.org/10.1109/CSPA55076.2022.9782044

         Reply to Comment

        • Collapse SubdiscussionJames Mangrum

          Matthew,

          I definately agree that systems experience across professions can be relatable. I also agree about how nurses as primary stakeholders need to be held accountable for maintaining the SDLC process effectively. How do you feel about SDLC stagnation? Like in the maintenance step, if we hold certain information technology at the status quo for longer than effective. I’m thinking of dinosaur systems that corporations hold on too due to cost. Outdated systems can actually increase the incidence of errors (Bowman, 2013). Have you ever used Meditech? I really wish there was a deep dive into the functionality and incidence of errors in that system. Also I wonder if there is any issues with the fact that Meditech, Cerner, and Epic control 75% of the market in EHR software (Landi, 2020).

           

          References:

          Bowman S. (2013). Impact of electronic health record systems on information integrity: quality and safety implications. Perspectives in health information management10(Fall), 1c.

          Landi, H. (May 1, 2020). Epic, Meditech gain U.S. hospital market share as other EHR vendors lose ground. Fierce Healthcare. Retrieved on January 26, 2023 from https://www.fiercehealthcare.com/tech/epic-meditech-gain-u-s-hospital-market-share-as-other-ehr-vendors-lose-ground

           Reply to Comment

    • Collapse SubdiscussionBlessing Okafor

      Hi Matthew,

      I enjoy reading your post, nurses have a unique understanding of the workflow of a healthcare system, and they can identify the challenges that a system may face in the different stages of development. This knowledge is invaluable in the planning stage, as nurses are the ones who will be using the system, and they must have input on how the system should operate. In the SDLC design stage, nurses should be involved in the workflow analysis process to ensure that the system is designed best to meet the needs of the nurses and patients (Risling & Risling, 2020). During the implementation stage, nurses can help to promote the new system and train other staff in its use. Finally, during the evaluation and maintenance stage, nurses should gather user feedback to ensure that the system meets its goals.

      Nurses play an important role in the SDLC as they are the ones who will be using the system and can provide valuable insight into how the system should be designed and used. Nurses must be included in each stage of the SDLC, as their knowledge and expertise can help to ensure that the system is designed and implemented in the best way possible (Risling & Risling, 2020 ). With nurse input, a system could be developed that is suitable for the healthcare environment or one that is not accepted by the staff. Therefore, nurses must be involved in the SDLC to ensure that the system meets the healthcare facility’s and its patients’ needs.

      The role of the nurse informaticist is key in bridging the gap between the nursing staff and the IT professionals who will be coding and building the system (Wang et al., 2019). The nurse informaticist can help ensure that the system meets the needs of the nurses and their patients. They can provide insight into the workflow analysis and identify areas where the system requires improvement.

       

                                                                                                                  References

      Risling, T. L., & Risling, D. E. (2020). Advancing nursing participation in user-centred design. Journal of Research in Nursing, 25(3), 226-238. https://doi.org/10.1177/1744987120913590

      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.2

       Reply to Comment

    • Collapse SubdiscussionFlavin Akande

      Dear Mathew,

      Usually, nurses are the end-users of information technology systems in the healthcare industry. Therefore, it is important to involve them in the System Development Life Cycle (SDLC). Besides, they have first hand experience with the existing systems and will therefore be resourceful in giving insights into gaps and areas that need to be improved in the new systems (Sharma & Singh, 2015). Moreover, they are usually at the bedside and the fact that they spend more time with patients, they understand their needs better and what should be done to increase the quality of care and promote patient satisfaction. Nurses should actively participate in all the stages of SDLC, from planning, analysis, designing, implementation, and testing (Jain & Suman, 2015). Failure to include nurses might lead to resistance, non-adherence, and failure of the project to meet its objectives.

      References

      Jain, R., & Suman, U. (2015). A systematic literature review on global software development life cycle. ACM SIGSOFT Software Engineering Notes40(2), 1-14. https://doi.org/10.1145/2735399.2735408Links to an external site.

      Sharma, P., & Singh, D. (2015). Comparative study of various SDLC models on different parameters. International Journal of Engineering Research4(4), 188-191. https://doi.org/10.17950/ijer/v4s4/405Links to an external site.

       

       Reply to Comment

      • Collapse SubdiscussionSopheap Ly

        System development life cycles is important to have the involvement of nurses because they are the ones who experience patient interaction and become resourceful when it involves to the protocol that is developed in regards to patient care.  “A way to deliver efficient and effective information systems (ISs) that fit with the strategic business plan, which stems from the mission, of the organization” (McGonigle, 2022).  Assuring that we having the necessary resources and staff to educate other healthcare professionals is important because healthcare is continuously evolving

         

        McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning

         Reply to Comment

  • Collapse SubdiscussionFatmata Sharpless

           As defined by McGonigle (2022), Systems development life cycle or SDLC is a “way to deliver efficient and effective information systems (ISs) that fit with the strategic business plan, which stems from the mission, of the organization”. In layman’s term, this is a plan implemented to improve an organization’s way of patient care based on their mission and purpose. This plan is also put into place to pin point any needs of the organization and present interventions that can help meets those needs or develop alternate solutions. The SDLC was created with steps that must be initiated one after the other in order to be deemed effective and profitable. Before moving on the next phase, the previous phase must be done, completed and initiated. Nurses play a major role when it comes to SDLC. As noted in the case scenario (pg.191), SDLC has many similarities to the nursing process of our patients in “assessing, diagnosing, planning implementing and evaluating” plan of cares. This is looked at the same way. When a diagnosis is presented in a plan of care, in order to proceed to the evaluation, all of the previous steps must be completed to make sure it can actually work. If not, we must go back to square one to reevaluate the plan for the patient. This works the same way when new systems are being presented for use with our patients.

    Steps

    Feasibility

    During this step a project/situation is presented and brought to the table. Ideas are presented on how it could be initiated and supported. During this phase a cost-benefit analysis is also done to determine pros and cons of the plan and if it is worth moving forward with. Although this is about healthcare it is also still a business and people want to make sure money will be spent accordingly. Nurses are needed in this step to bring forth ideas and changes they may want and need while working on their units and departments.

    Analysis/Design

    In my opinion these two stages go hand in hand. This is where ideas are put down and steps on how to go about initiating the new plan are created. In the design phase, to me I would consider it the blueprint stage. The nurse’s role within these two stages is to be the eyes and help setup different designs and template that would be beneficial for nurses to use and make sense in relation to patient care.

    Implement

    This is where the trial program or template is executed to see how it can work. Including nurses during this phase a very important. Without the support of the nurses during this step, this can become very hard and some nurses may become resistant in trying something new.

    Test

    Nurses are very instrumental during this stage to where they are able to truly assess whether or not the design, template and software actually work in relation to documenting patient care. They would be able to determine if any challenges present themselves as well as the benefits (Verma, 2017).

    Maintain

    Once testing is completed, during this last stage the main focus is to become more efficient when using the new technology presented and help to maintain the support amongst its users.

     

    At my current healthcare facility, I had no “true” input when new systems where being rolled out. They did come around and ask for our opinions and what could be different and what we would like to see more of. It was then I did give my opinion but I have yet to really be apart of an official roll out of a new system to be implemented.

    Nurses should always be included when healthcare facilities want to incorporate new systems that deal with patient care. We are the ones who are primarily on the front lines and can give you the honest truth about what works, what doesn’t work and what can work effectively. This can also work from a multidisciplinary standpoint as well where we are able to give proper evidence-based knowledge to support it. If healthcare leadership neglects to include nurses in any of the phases of SDLC method of introducing new technology to facilities in general, this could really present more issues rather than fixing old ones and preventing new ones from occurring (Cleveland, 2019).

     

     

    References

    McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning

    Medha Piplani Verma, Sandhya Gupta. Software Development for Nursing: Role of Nursing Informatics. Int. J. Nur. Edu. and Research. 2017; 5(2): 203-207. doi: 10.5958/2454-2660.2017.00044.8

    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=printLinks to an external site.

     Reply to Comment

    • Collapse SubdiscussionDeanna Linn Howe

      Hello Fatmata and all,

      I appreciate your comments here. You have plenty of time be a part of a testing or implementation team in your (hopefully) long career. Technology and research are always changing and continue to advance.  The use of SDLC models and the implementation of it reflects the knowledge and skills of the team.  Applying the SLDC model and the prediction of success depends on the quality of the organization and its decision-making process throughout the course of the project. Looking forward to the inevitable changes that will likely occur with technology how can you advocate to be a part of the change process? How will you advocate for yourself and colleagues in future opportunities related to system changes? Thanks, Dr. Howe

       Reply to Comment

    • Collapse SubdiscussionMarie Lo

      Hi Fatmata,

      It is critical for nurses to understand new technology, just as it is critical for technology engineers to understand how the equipment and software will need to interact with the facility’s existing system (Weckman & Janzen, 2009). Nurses are subject matter experts who understand the dynamic flow of patient care and the frequent interactions required between multiple healthcare providers while providing nursing care (Weckman & Janzen, 2009). Nurses must be involved at all stages of the SDLC for any project to succeed. Involving them early in the software development process would result in a more unique and clinically relevant product (Verma & Gupta, 2017).

      Most healthcare organizations do not include nursing staff when it comes to implementing new technologies. Because of this, success can be difficult to achieve specially when nurses are not part of the planning, design, and implementation of a new project. Quality healthcare cannot be achieved unless nurses take the lead. It is past time for healthcare leaders to recognize and delegate nurses to ‘prepare for future e-healthcare,’ as intelligent use of information technology has the potential to revolutionize quality management (Verma & Gupta, 2017).

      Verma, M. P., & Gupta, S. (2017). Software development for nursing: Role of Nursing Informatics. International Journal of Nursing Education and Research5(2), 203. https://doi.org/10.5958/2454-2660.2017.00044.8

      Weckman, H., & Janzen, S. (2009). The critical nature of early nursing involvement for introducing new technologies. OJIN: The Online Journal of Issues in Nursing14(2). https://doi.org/10.3912/ojin.vol14no02man02

       

       

       Reply to Comment

    • Collapse SubdiscussionOyindamola Mubarakat Gbadamosi

      Hi Fatmata,

      I enjoyed reading your discussion post, it is detailed and provides support for the need to involve nurses when implementing a new healthcare information system and you clearly identified the role of nurses throughout the SDLC stages. As you stated, nurses will find the SDLC process less challenging if they address it the same way as the nursing process. Although healthcare organizations are in the business of care delivery, one way to ensure the organization’s plans are met is to get nurses on board early. As stated by McGonigle and Mastrian (2018), “the plan must identify the needs of the organization as a whole and propose solutions to meet those needs or a way to address the issues” (p. 476). Involving nurses in this process from the early onset will ensure nurses provide outstanding patient care with the resources they are given. As you mentioned, nurses are the primary front-line workers and provide direct care to the patients, therefore, they are in the best position to help analyze, design, implement, and test a new healthcare information system. “Clinical nurses are the best judge to assess the positive aspects and to identify the challenges that may hinder the functioning of software created for patient care” (Verma & Gupta, 2017, p. 205).

      References

      McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Jones & Bartlett Learning.

      Verma, M. P., & Gupta, S. (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

       Reply to Comment

    • Collapse SubdiscussionGina Phillips

      Great discussion Fatmata

      Love the fact that you broke down the steps, The use of SDLC which is a systems development life cycle that is used to deliver efficient and effective information system.  The system is used to develop an organize way to develop a system that understands problems and knows the business needs. ( McGonicle & Mastrian, 2022).

      Organizations need to know that it is important to get their nurses involved in changes that they have in the facility, it is good to hear that your institution took the time to actually asked for pointers since most don’t.  I remember coming in some days and just seeing changes to the EPIC systems that we had no clue took place, but as nurses we adjust and learn quickly in order to made the workflow work for us.  As mentioned the Test phase of SDLC is the most important since in this phase according to McGonicle and Mastrian is where the system is evaluated and tested by the team, really to determine if it actually will help with performing their jobs.

      As new technology advances SDLC models are being develop but it is important to note that these projects only become successful when the team is involved with the planning and implementation, making the project interoperable will definetly define the longevity of the project.

      Reference

      Health Information and Management Systems Society (HIMSS). (n.d). Interoperability in healthcare. https://www.himss.org/resources/interoperability-healthcareLinks to an external site. Isaias.P.,& Issa, T (2015). High level models and methodologies for information systems. Springer.

      McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

       

       

       Reply to Comment

    • Collapse SubdiscussionRowan Wicks

      Fatmata,

      You have done a great job explaining the steps of SDLC and the purpose of using the layout in order to improve new systems. Like McGonigle & Mastrian (2022) mentioned, SDLC is used to deliver efficient and effective systems that fit with the business plan. Which stems from the organization’s mission. Overall, the steps you have laid out are correct and additionally you have done a great job explaining why nurses are integral to the development of a new system every step of the way. For nurses to not be involved in a new system while being implemented is asking for failure. This is like a facility that has a high turnover rate not to do exit interviews. It does not address the issue head on but rather avoids it. So, it becomes essential that facilities involve their staff while making any drastic changes. Verma & Gupta (2017) stated that, “Nurses need to participate in initial stages to identify improvement areas for quality patient care, where IT can contribute” (p. 204). Like Verma and Gupta stated, it is important to involve the nursing staff in all steps including the early stages. That way the staff can identify areas that need improvement which can result in better patient outcomes.

      References

      McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

      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

       Reply to Comment

    • Collapse SubdiscussionMegan Nicole Starnes

      Hello Fatmata,

      I enjoyed reading your discussion. I concur that nurses should be involved at the first stage of the SDLC to discuss their views and the needs of their clinic. It is crucial that nurses recognize the fact that nursing informatics is nursing and that each nurse has a responsibility to play in the development of the field of digital health (Risling & Risling, 2020). Even though they lack professional expertise in information technology-related issues, most nursing leaders actively participate in projects to acquire and upgrade electronic healthcare information systems alongside their IT and health informatics counterparts. (McLean et al., n.d.). The input of nurses at any stage of the SDLC leads to the improvement of the health care system and ultimately better patient care.  The effectiveness of an information system’s implementation depends on nurses being involved in the system’s evaluation and selection (McLean et al., n.d.). Recently, my current employer introduced a new electronic health record, however, only 25% of its capabilities have been programmed and most of the features are non-functional. Lastly, I feel it should be required for at least nursing leaders to be a part of every step of the SDLC.

      McLean, Frisch, & Roudsari. (n.d.). Nursing’s Voice in Healthcare IT Acquisition Decisions | Canadian Journal of Nursing Informatics. Nursing’s Voice in Healthcare IT Acquisition Decisions | Canadian Journal of Nursing Informatics. Retrieved January 27, 2023, from https://cjni.net/journal/?p=4248

      Risling, T. L., & Risling, D. E. (2020). Advancing nursing participation in user-centered design. Journal of research in nursing: JRN25(3), 226–238. https://doi.org/10.1177/1744987120913590Links to an external site.

       Reply to Comment

    • Collapse SubdiscussionFlavin Akande

      Hello Fatmata,

      It is a good thing that you were involved in the systems development, especially in the most critical steps, selection and planning.  Nurses have first hand experience with healthcare systems and patient needs since they spend more time with them compared to other healthcare professionals. Hence, it is important to include nurses in all the stages of System Development Life Cycle (SDLC). Besides, engaging them saves time and cost of training, which would otherwise have been lengthy and costly. The planning stage involves idea development and identifying opportunities, resources, cost, and challenges while the analysis state involves brainstorming the project idea. (Ergasheva & Kruglov, 2020) The project is actualized in the design stage, where the system developers assemble the architecture of the project (Feldman et al., 2018). When the program is ready for use, it must be tested and regularly maintenance should be done.

      References

      Ergasheva, S., & Kruglov, A. (2020). Software development life cycle early phases and quality metrics: A systematic literature review. Journal of Physics: Conference Series1694, 012007. https://doi.org/10.1088/1742-6596/1694/1/012007Links to an external site.

      Feldman, S. S., Buchalter, S., & Hayes, L. W. (2018). Health information technology in healthcare quality and patient safety: Literature review. JMIR Medical Informatics6(2), e10264. https://doi.org/10.2196/10264Links to an external site.

       

       

       Reply to Comment

    • Collapse SubdiscussionSopheap Ly

      Hi Fatmata, great post! According to Zhang, “The system life cycle processes standard is proposed to solve the problem of full life cycle management of complex systems, especially to provide a reference framework and important processes for enterprise and organizations that need to build complex systems.” The use of technology allows patient care to be readily accessible for all. Determining the pros and cons of the ideas that are being presented allows the healthcare staff to evaluate the circumstance and develop a plan that would be appropriate, beneficial, and productive for all including the patient.  Nurses should be the ones to analyze and implement the ideas because nurses provide hands on care to patients and can determine what works best for both the patient and the staff member.  Addressing any problems that may arise in the early stages of implementing the plan is important.  “The asset performance monitoring should be done to find out and review the reported data whether it has been in line with the reality or not. It is important to identify the occurring problems to be immediately handled. The information system development aimed to build the existing system. Thus, it will be more effective and efficient to produce information,” (Muhamad, 2021).

       

       

       

      Zhang, Y., Liu, Z., Han, Q., & Zhang, W. (2021). Development of System Life Cycle Processes Standardization and Future Evolution Analysis†. 2021 8th International Conference on Dependable Systems and Their Applications (DSA), Dependable Systems and Their Applications (DSA), 2021 8th International Conference on, DSA, 240–246. https://doi.org/10.1109/DSA52907.2021.00036

       

      Muhamad Agung Santoso, Rina Fiati, & Ratih Nindyasari. (2021). The system development life cycle model implementation on information system of performance reporting IT asset case study: PT Kereta Api Indonesia (Persero). Matrix: Jurnal Manajemen Teknologi Dan Informatika11(2), 95–106. https://doi.org/10.31940/matrix.v11i2.2274

       

       Reply to Comment

    • Collapse SubdiscussionChike Emejuaiwe

      Hi Fatmata,

      Your post highlights the overaching methods to SDLC. In our assignment and research it is clear that the stages of system development overlay one another. The scope of activities associated with a system, encompassing the system’s initiation, development and acquisition, implementation, operation and maintenance, and ultimately its disposal(Crsc.gov, n.d.).

      During the feasibility phase, the problem is identified and the beginning phases of a solution utilizing HIT is established. It is during this that stakeholders are identified. The Feasibility Phase is the initial investigation, or brief study of the problem to determine whether the systems project should be pursued. A feasibility study established the context through which the project addresses the requirements expressed in Business Case and investigates the practicality of a proposed solution(Mtu.edu, n.d.).

      The analysis phase is taken into effect with the feasibility phase in mind. This phase formally defines the detailed functional user requirements using high-level requirements identified in the Initiation and Feasibility Phases. The requirements are defined in this phase to a  level of detail sufficient for systems design to proceed. They need to be measurable, testable(Mtu.edu, n.d.).

      Without nursing involved user centric and patient centric features are omitted creating a redundant system.Nursing involvement in equipment design makes the equipment simpler and safer for nurses to use. Greater nurse understanding and involvement in the design process may have prevented some of the early equipment problems we experienced when we tried to implement the BCMA system in a patient care environment. (Weckman & Janzen, 2009).

      Within the testing phase, Nursing involvement becomes crucially apparent. As Frontline workers nurses approach to care management is systematic in nature and utilizing a system that flows in such a manner is crucial to efficient and improved health outcomes. Translation of knowledge into rational care is as essential and pressing as the development of new diagnostic or therapeutic devices, and is arguably even more important and without nursing such  knowledge and its translation will not exist.

      As you mentioned in your conclusion,  maintaining being the final phase, remain ongoing as new requirements are initiated, Older parameters adjusted to meet changing needs and updates made to facilitate organizational improvements to care and its delivery. All processes will result in system degradation, inefficiencies and redundancies without nursing involvement.

      References

      Computer security resource center. (n.d.). System Development Life Cycle (SDLC). CSRC. Retrieved January 30, 2023, from https://csrc.nist.gov/Glossary/?term=2684&page=73Links to an external site.

      Michigan Tech. (n.d.). Security and compliance: Michigan Tech Information Technology. Michigan Technological University. Retrieved January 30, 2023, from http://mtu.edu/it/securityLinks to an external site.

      Weckman, H. N., & Janzen, S. K. (2009, May 31). The Critical Nature of Early Nursing Involvement for Introducing New Technologies. Retrieved January 30, 2023, from http://ojin.nursingworld.org/

       

       

       Reply to Comment

  • Collapse SubdiscussionRaymond Mwanje

    MAIN POST

    The Inclusion of Nurses In The Systems Development Life Cycle

    The SDLC is recognized as a structured process that fosters or enables the production of a high quality, low cost and meets the organization and customer expectations (Agency for Healthcare Research and Quality, n.d). Ch The cycle entails five stages, enabling the healthcare sector stakeholders to adopt and assimilate changes easily, and involving nurses in each SDLC stage when adopting and implementing new technology or program is an important aspect of an organization’s success. Consequently, failure to involve nurses can result in unwanted consequences on the change process for the organization, the customer, or the patients (McGonigle & Mastrian, 2022).

    First lack of involving nurses in the SDLC process reduces stakeholders’ participation in the implementation process. This is whereby nurses feel like strangers in the process, avoiding the change process, and overall unsuccessful adoption. In the first stage of the SDLC process (planning and requirements definition), lack of nurse participation reduces the ability to identify the impact and required resources for the incoming technology (Yen et al., 2017). Failure to include the nurse in the first stage results in an aimless inability to identify the end product or specific needs of the incoming change or program. Secondly, there is the analysis stage which entails designing a workflow. The inability to include nurses in the stage results in the development of a system full of challenges and flaws in processes and workflows.

    Thirdly, there is the design stage in SDLC in which the omission of nurses’ input increases the risk of unsuccessful adoption of an ineffective design of the proposed program. Nurses’ exclusion in this stage results in overlooking key data, which ultimately reduces the system’s efficiency (McGonigle & Mastrian, 2022). The implementation stage is the fourth level in the SDLC cycle and entails applying for the designed program in care delivery practices. Failure to include nurses in the implementation stage can result in unfunctional systems that do not align with organizational and clinical care. More so, the lack of nurses’ participation excludes important participation from indispensable stakeholders (Yen et al., 2017). Finally, there is the last SDLC stage post-implementation, and a lack of nurses’ inclusion can result in the adoption and implementation, which will be ineffective in not delivering clinical care. More so, a lack of nurses’ participation will result in ineffective programs or systems with no feedback on their performance hence ineffective in delivering care as required.

    Regarding my organization, the SDLC entails the participation of diverse stakeholders, including nurses. The leadership ensured effective briefing to all players, which incorporated all nurses into the process. The collaboration and inclusion of nurses proved to be a critical aspect as it defined the success of the process (Wei et al., 2019). Nurses provided input and feedback on diverse approaches to improve the system. In summary, it can be argued that nurses’ role in SDLC proves indispensable and arguably could not be ignored in the process.

     

     

    References

    Agency for Healthcare Research and Quality. (n.d). Health IT evaluation toolkit and evaluation measures quick reference guide Links to an external site.. Retrieved January 26, 2022, from https://digital.ahrq.gov/health-it-evaluation-toolkitLinks to an external site.

    McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

    Wei, H., Roberts, P., Strickler, J., & Corbett, R. W. (2019). Nurse leaders’ strategies to foster nurse resilience. Journal of nursing management27(4), 681-687.

    Yen, P. Y., Phillips, A., Kennedy, M. K., & Collins, S. (2017). Nursing informatics competency assessment for the nurse leader: instrument refinement, validation, and psychometric analysis. JONA: The Journal of Nursing Administration47(5), 271-277. https://doi.org/10.1097/NNA.0000000000000478Links to an external site.

     Reply to Comment

    • Collapse SubdiscussionMatthew Baron

      Hi Raymond,

      I appreciate your stating the importance of involving nurses, especially in the initial or planning stage, by stating that not doing so can affect stakeholder participation. Our text  (McGonigle and Mastrian, 2022) describes several systems development methods, such as the Agile process, Dynamic system development method, and Rapid Application development. In all of these, our text discusses staff involvement early in the initial stage. The Rapid Application Development process begins with a focus group to identify needs. Kane et al. (2006) describe the agile process as relying heavily on input from the system users. And in DSDM or Dynamic System Development Method, our text (McGonigle and Mastrian, 2022) states that the first step is to create buy-in (which can only be achieved through the involvement of the nursing staff that will be using the system). And Wilkinson et al. (2020) describe an EHRIF or best practice EHR implementation framework, in which the planning stage consists of getting buy-in from all consumers/stakeholders, including nursing. So even though there are different iterations of the SDLC, each one promotes the initial involvement of nurses as users and stakeholders.

      It is clear that nurses must be involved at all stages in the SDLC, and this includes from the beginning.

       

       

      Kane, D. W., Hohman, M. M., Cerami, E. G., McCormick, M. W., Kuhlmman, K. F., &

      Byrd, J. A. (2006). Agile methods in biomedical software development: a multi-site

      experience report. BMC Bioinformatics, 7, 273–12. https://doi.org/10.1186/1471-Links to an external site.

      2105-7-273

       

      McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of

            knowledge (5th ed.). Jones & Bartlett Learning.

       

      Wilkinson, S., Borycki, E., & Kushniruk, A. (2020). Best practices for EHR

      implementation: A BC First Nations community’s experience. Healthcare

            Management Forum, 33(1), 39–46. https://doi.org/10.1177/0840470419860863

       Reply to Comment

    • Collapse SubdiscussionImelda Briones Balili

      Hi Raymond,

       

      I am impressed with your realistic views about the need for nurses’ involvement in implementing health information technology systems in their workplace. Acquiring knowledge about the Software Development Life Cycle Model (SDLC) framework opens our minds to its significance to our practice in today’s advancement of technology in the healthcare industry and in our best effort to be effective in providing a quality standard of care to our patients. However, our success relies on an organization’s willingness to introduce its staff to SDLC’s functionality in providing their workers with quality training to obtain the organization’s purpose of improved clinical skills for their nurses. Nowadays, nurses are expected to be knowledgeable about the new methodological approaches and digital insights in response to evolving technology solutions. Advancing one’s skills and readiness to adopt digital technologies requires an integrated approach involving management abilities, technical ideas, and communication skills. Proper training helps boost the adoption of new technology skills, enabling healthcare professionals to effectively execute their daily tasks using digital tools. Healthcare has been in a profound transformation, moving toward the decentralization of services, which undeniably produced a significant impact on the efficiency of clinical management and its organizational assets (Isidori et al., 2022).  According to technology specialists, nurses understand the dynamic flow of patient care and effectively collaborate with other healthcare providers. Experts suggested that nurses should be on top of new technology processes in their workplace and the need for technical engineers to understand how equipment software will need to interface with the healthcare facility’s existing systems. Involving nurses in introducing new technology facilitates a smooth transition in their digital applications, increasing nurses’ buy-in of the system. Nurses’ input into the planning and implementation process in different trials of various types of digital equipment in different clinical settings impacts the company’s success when purchasing a new health information technology system. Without the user’s involvement, the chance of failure is expected. In the application of software development practice, the integration of disciplinary expertise in user-centered digital design was made possible through an analytic framework as part of an interdisciplinary research process. An analytical framework allows nurses to analyze collected data into a robust set of functional requirements for software developers while still engaging in a fulsome interpretative analysis. Therefore, one should consider more roles in advancing technology innovation in their workplace. Familiarity with design thinking and associated practical experience promotes nursing voices in this area. Introducing healthcare software technology tools and their processes by an organization enhances an existing nursing methodology that helps develop disciplinary design capacity that leads to a positive patient care outcome (Risling, 2020).

       

       

                                                                                      References:

      Isidori, V., Diamanti, F., Gios, L., Malfatti, G., Perini, F., Nicolini, A., Longhini, J., Forti, S., Fraschini, Bizaarri, G., Brancorsini, S., Gaudino, A. (2022). Digital Technologies and the Role of Healthcare Professionals: Scoping Review Exploring Nurses’ Skills in the Digital Era and in the Light of the COVID-19 Pandemic.

      https://pubmed.ncbi.nlm.nih.gov/36194466/Links to an external site.

      Risling, T. (2020). Advancing Nursing Participation in User-Centered Design.

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932478/Links to an external site.

       

       

       Reply to Comment

    • Collapse SubdiscussionTulany Mupandasekwa

      Hi Raymond

      Nurses who are actively using innovative technologies and who have received enough training in their use can show other staff members how they work and advocate for them internally. Resistance will inevitably arise without engagement. Organizational life inevitably involves some level of resistance, and there is a wealth of research on this topic from several academic fields. Research has historically viewed resistance as a constraining force that prevents employees from embracing changes suggested by managers and has mostly been viewed as an endeavor to maintain the status quo (Nilsen et al.,2016). 

      The adoption of modern nursing information systems is significantly hampered by nurse resistance. The largest obstacle to adopting large-scale systems has proven to be user resistance to information systems. Adequate tools, such as modern workstations, and suitable network bandwidth and training for nurses should be provided as organizational support for nurses to boost perceived ease of use. A bigger workforce may also be needed during the transition period leading up to the deployment of a new Electronic Health Record (EHR) system as nurses get accustomed to it. These circumstances might simplify the transition for nurses and boost their perception of the new system’s usability, which would lessen their resistance to it. The ease of use of new EHR systems may be perceived by nurses as having strong self-efficacy, which will lessen their reluctance to change. Higher self-efficacy nurses could be used by hospitals as advocates to influence their coworkers’ perceptions of them positively. Increases in nurses’ self-efficacy necessitate both formal nursing informatics education and system training, yet notable nursing schools are still obliged to include more nursing informatics instruction in their curricula. To decrease user resistance behavior and ensure effective user training when implemented in a hospital, it is advised that nursing schools increase their nursing informatics curriculum (Cho et al.,2021). 

      References 

      Cho, Y., Kim, M., & Choi, M. (2021). Factors associated with nurses’ user resistance to change of electronic health record systems. BMC Medical Informatics and Decision Making21(1). https://doi.org/10.1186/s12911-021-01581-zLinks to an external site. 

      Nilsen, E. R., Dugstad, J., Eide, H., Gullslett, M. K., & Eide, T. (2016). Exploring resistance to implementation of welfare technology in municipal healthcare services – a longitudinal case study. BMC Health Services Research16(1). https://doi.org/10.1186/s12913-016-1913-5Links to an external site. 

       Reply to Comment

    • Collapse SubdiscussionDeanna Linn Howe

      Hi Raymond and all,

      I appreciate your insight. Great progress has been made over the years in developing new systems in order to improve patient care. Nurse’s involvement throughout all phases of the SDLC process, including the planning, design, implementation, and evaluation phase is an important key to success in using all new system implemented within an organization.   McGonigle and Mastrian (2018), note that it is not the type of systems adopted that is important, but rather the method in which they are put into practice. Administrators must be aware of how a lack of collaboration will affect both the healthcare organization and the healthcare delivery system as a whole. Have you seen any impact when administrators exclude nurses in the initial planning phase? Has this led to dissatisfaction amongst nurses? Thanks, Dr. Howe

       Reply to Comment

    • Collapse SubdiscussionGina Phillips

      Great discussion Raymond:

       

      Agree that organizations should involved all stakeholders when it comes to been involved in the implementation of the SDLC planning.  Involvement helps nursing and other users achieve ultimate workflow, in order to create a safe work environment, according to McGonicle and Mastrian a critical part of informatics is workflow. Nursing informatics has the task of engaging every stakeholder in the analysis and redesign of the processes of new technology.

      Workflow also provides the healthcare professional with data to make the best decision for their patients, nurses should be involved in ” meaningful data collections and reporting”, hence the reason why SDLC planning should involved, not only does it affect their workflow but it affects how they  take care of their patients.

      Reference

      McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

      Agency for Healthcare Research and Quality. (n.d.a). Health IT evaluation toolkit and evaluation measures quick reference guide Links to an external site.Links to an external site.. Retrieved January 25, 2023, from https://digital.ahrq.gov/health-it-evaluation-toolkitLinks to an external site.

       

       

       Reply to Comment

    • Collapse SubdiscussionKenechukwu Ezeanya

      Raymond Mwanje

      Including caregivers in a new system’s design through a participatory design approach can significantly affect the adoption and implementation process. The healthcare system is constantly working to improve patient care. The new system serves as the framework for a comfortable, effective, and secure environment for patient care (Wei et al., 2019). Nurses assume a significant part in patient treatment since they are the patient’s primary contact and know what is crucial. Sitters play various roles during the development of a new system. She explained the nurse’s duties clearly, which included figuring out whether the new approach was effective. Early involvement of caregivers in all system development stages can aid in anticipating the benefits and drawbacks of a new system and avert potential issues (McGonigle & Mastrian, 2022). The nursing staff will guide you on the conditions that apply to different procedures. Your report on the role of nurses early in the cost-effectiveness analysis process, for instance, shows the importance of including nurses in system development.

      References

      McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

      Wei, H., Roberts, P., Strickler, J., & Corbett, R. W. (2019). Nurse leaders’ strategies to foster nurse resilience. Journal of nursing management27(4), 681-687.

       Reply to Comment

    • Collapse SubdiscussionOyindamola Mubarakat Gbadamosi

      Hello Raymond,

      Your post clearly reflects the benefits and challenges that are associated with involving nurses in the SDLC process. I truly believe the primary stakeholders in the development and implementation of a new healthcare information system are nurses and any healthcare organization stands to benefit more from adopting nurses early in the process. The benefits of including nurses in the SDLC process will facilitate a smooth transition into the new system and valuable feedback on the system’s usability, accuracy, and effectiveness are assessed before implementation. Clinical nurses are likely the most knowledgeable and experienced of all healthcare providers about the needs of patients, since they are in attendance and provide care for patients 24/7 (Stichler, 2015), for this reason alone, nursing input is of the uttermost value and should not be disregarded.

      On the contrary, as you mentioned, a lack of nursing input will lead to the overall unsuccessful adoption of the new system. Not involving nurses in this process can be detrimental to patient care and organizational goals, which can lead to frustration and dissatisfaction among nurses with the new system. It can also lead to an increased nurse turnover rate and constant interruption in workflow. In addition, I believe the lack of nursing enthusiasm to get involved in the technical/IT process can be a setback for nursing. If only nurses can engage the SDLC process the same way as the nursing process, I believe we will make strides on both ends. A lack of familiarity with design thinking and associated practical experience impedes nursing voices in this area (Risling & Risling, 2020).

      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/10.1177/1744987120913590

      Stichler, J. (2015). Clinical Nurse Involvement in Healthcare Design. HERD: Health Environments Research & Design Journal, 9(1), 6-9. https://doi.org/10.1177/1937586715596997

       

       Reply to Comment

  • Collapse SubdiscussionAlicia Brooke Richardson

    Systems Development Life Cycle (SDLC) is a standardized framework to develop and implement information technology projects (McGonigle & Mastrian, 2022). It is a developmental cycle that guides the process of planning, designing, implementing, maintaining, and evaluating high-quality software systems that meet the organization’s needs. Dr. Kevin Johnson (Laureate Education, 2018) mentioned in the video file that it is essential to recognize that SDLC is a cycle and will always be ongoing. With the implementation of a new EHR, it is crucial to include the major stakeholders as well as the end-users for the success of the project. Not involving nurses in each stage of the system development will pose negative outcomes for both the end-users and patients’ care. In our organization, the nursing leaders together with nurse informaticists and staff nurses were involved in every step of the SDLC. Planning involves knowing the problem, magnitude of the project, anticipated outcome, and financial needs (McBride & Tietze, 2019). In this stage, nurses’ input on the need for a standardized EHR for the whole hospital system is chosen by the stakeholders giving importance to cost-effectiveness and usability. When our hospital announced the implementation of EPIC to replace our paper charts, the younger nurses welcomed the idea more than the more senior ones. I believe that it has something to do with implementing change to an already established routine workflow and therefore needing to learn a new system. Our nursing leader with the nurse informaticist at that time evaluated our workflow, how we charted assessments, how we take orders from physicians and our level of competency with the use of computers. The nurse’s inputs were mainly on what we chart and how we document for each patient. The selection process and design stage (configuration of the software based on our workflow) for a new software system for our organization was easier than we thought since EPIC is a user-friendly system that was easy to navigate and learn. The flowsheets were customized based on our workflow of documentation and the order of our charting. Our nursing leaders also had to plan for staffing issues that will greatly impact the unit during training and implementation of the new system. Patient privacy measures or actions were also included during the planning and design to ensure compliance with HIPAA. Our nurse informaticist worked closely with the staff nurses to bridge the technical aspects of EPIC to our clinical expertise. If the nurses were not informed and had no input on computer use and workflow, productivity goals won’t be met, and patient outcomes will be affected due to more time being spent on charting on the computer than taking care of patients. Before the implementation of EPIC, the nurses were given three days to learn the system. EPIC Super Users who were handpicked nurses were also trained as our “go-to” experts when we face issues with charting. Sandbox in EPIC was used as a practice environment. During this phase, we gave our concerns about the usability and some additions to the flowsheets that we needed to document on before the final product goes live. If the quirks of the software were not addressed during the testing phase, I would imagine that during the Go Live, the nurses and other physicians will feel lost and frustrated. During the implementation stage or the Go Live, we had the EPIC support team present as well as the Super Users. They helped with issues not previously addressed and with evaluating the staff on readiness and the need for further training. I remembered that after the training, even the more senior nurses had little issues with navigating the software and documenting. The physicians were mostly the ones affected due to the ordering process and recording their H&P’s. Having nurses as superusers at that time helped because they know how our workflow goes and are very open to helping. Maintenance and evaluation stages remain in the cycle. Upgrades were rolled out by our IS department, and the nursing informaticist continually evaluates nursing evidence-based practices that can be implemented in our workflow to improve patient care outcomes further. When systems had to be upgraded, we use downtime machines where we can still access the patient’s charts but cannot make any changes. This helps to look up the history and medication schedules. Our IS department also sent out emails to notify us ahead of time of any changes in the system. The education department with the help of our nurse informaticist created online learning modules that nurses can learn from for any updated workflow or systemwide changes in our EPIC EHR. Every six months during our IS council meetings, we also make suggestions on how we can further improve EPIC and if future upgrades were necessary. In conclusion, nurses’ input, and feedback during the SDLC process for EHR conversion is very important in the success of its implementation because we are the major workforce or end-users and are at the frontlines of patient care (Weckman & Janzen, 2009).

     

     

    References

    Laureate Education (Producer). (2018). Managing Health Information Technology [Video file].

    Baltimore, MD: Author.

    McBride, S., & Tietze, Mari. (2019). Nursing informatics for the advanced practice nurse:

    patient safety, quality, outcomes, and interprofessional. New York, NY: Springer Publishing Company

    McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge

    (5th ed.). Burlington, MA: Jones & Bartlett Learning

    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.

    Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?

    direct=true&db=rzh&AN=105264473&site=eds-live&scope=site

     Reply to Comment

    • Collapse SubdiscussionMatthew Baron

      Hi Alicia,

      Our facility also uses EPIC and so far it has been a good experience. I appreciate that you mention that younger nurses took to adopting the new system more so than senior nurses. I have seen this in my experience, which is also supported by Ngusie et al, (2022) who state age and level of computer literacy as factors in readiness for EHR adoption. This is an important idea to me personally because I am in my late 50s. I also happen to be comfortable with and love technology.  I know a lot of other nurses close to my age are not as comfortable with digital technology but can usually become comfortable with the right approach to training.

      Tissera et al. (2021), go further with this and states that EHR adoption without the right support for older nurses could lead to those nurses taking early retirement and bringing their skills and years of experience with them. They state that older nurses if they are included early on in the process of new EHR implementation and have the right amount of post-implementation training, will actually be more likely to embrace the technology and be comfortable with its use. This seems to echo your experience with the older nurses in your facility responding to Epic’s support personnel being there with the super users.

      I agree that nursing input is necessary at all stages of the SDLC and also appreciate that you discussed the specific issue of older nurses and new technology adoption. It would probably help to have representatives from more senior nurses included in the process as well to identify concerns and potential training opportunities.

      References

       

      Ngusie, H. S., Kassie, S. Y., Chereka, A. A., & Enyew, E. B. (2022). Healthcare

      providers’ readiness for electronic health record adoption: a cross-sectional study

      during the pre-implementation phase. BMC Health Services Research, 22(1), 1–12.

      https://doi.org/10.1186/s12913-022-07688-xLinks to an external site.

       

      Tissera, S., Jedwab, R., Calvo, R., Dobroff, N., Glozier, N., Hutchinson, A., Leiter, M.,

      Manias, E., Nankervis, K., Rawson, H., & Redley, B. (2021). Older Nurses’

      Perceptions of an Electronic Medical Record Implementation. Studies in Health

            Technology and Informatics, 284, 516–521. https://doi.org/10.3233/SHTI210786

       Reply to Comment

    • Collapse SubdiscussionImelda Briones Balili

      Hi Alicia,

       

      Thank you for your informative ideas in this week’s discussion post. I can relate to your sentiment regarding nurses’ vital role in the System Development Life Cycle (SDLC) in line with the application of electronic health records. The Eisenhower Health Operating room department has used EPIC healthcare software for several years. The adoption of EPIC software in our unit had an easy transition. Considering its efficiency in locating and processing patients’ information, its capacity to streamline administrative tasks, including integrated scheduling systems and automated coding, helps an organization improve its medical practice management. That is why EPIC is considered one of the user-friendly software systems. However, we should consider nurses’ contribution to EPIC’s software development, the value of collaboration amongst healthcare providers, and patient feedback that helps improve its functionality in time. Transparency in patient information exchange ensures comprehensive health information that enables patients to make sound decisions in their treatment. Healthcare Information Exchange (HIE) incorporates EHRs in laboratory results, monitoring clinical data, and processing clinical care summaries, an electronic document that contains pertinent patient information related to their treatment, such as medical history, diagnosis, immunization, and demographics. Its objective is to provide patients with quality nursing care on an ongoing basis. Although, the HIE’s success depends on the nurse’s involvement. The organization’s ability to enhance its collaboration with its employees, stakeholders, vendors, and patients is vital in coming up with a potential solution to every challenge and issue concerning a specific software’s functionality. Healthcare leaders should make informed decisions to address the factors that halt the progress of HIE initiatives in the modern setting by enhancing the cross-platform cooperation of service providers. Therefore, it is suggested to have comprehensive research to focus on technical and leadership challenges in the healthcare industry at large (Ashfaque, 2020).

       

      Concerning the effects of digital technology on the healthcare workflow, a study found interruptions that contribute to risk factors and outcomes in nursing. Maniya, (2018) discussed workflow interruptions caused by the fast transition from one system software to another, which increases the stress and workload of the nurse. Such changes often need to be clarified, resulting in ineffective care practices in the early stage of software implementation. For example, when a senior nurse learns a new electronic system, she might find it challenging to determine where to chart necessary information as many confusing tabs are presented. Unfortunately, this real issue places an additional task on overloaded nurses. An encounter with a poorly designed computer system results in a delay in patient care, thus affecting the quality of care nurses provide. For instance, medication orders often are delayed due to the implementation of a new software system, which significantly affects a patient’s treatment progress. I highly agree when you said that younger nurses welcomed these changes more than senior ones, and this is because more experienced nurses have a defined workflow pattern, and typically, those who less willingly accept significant changes. Younger nurses are more familiar with contemporary digital technology, which is easier for this population to adjust to the system.

       

       

       

                                                                                      References:

      Ashfaque, M. (2020). Adoption of the Health Information Exchange (HIE) System and the Role of the Healthcare Leadership.

      https://digitalcommons.pepperdine.edu/cgi/viewcontent.cgi?article=2148&context=etdLinks to an external site.

      Maniya, C. (2018). Workflow Interruptions: Risk Factors and Outcomes in Nursing.

      https://huskiecommons.lib.niu.edu/cgi/viewcontent.cgi?article=2400&context=studentengagement-honorscapstonesLinks to an external site.

       

       

       Reply to Comment

    • Collapse SubdiscussionRaymond Mwanje

      RESPONSE 1:

      Great post Alicia. Your post highlights the importance of involving major stakeholders, including nurses, in the development and implementation of a new EHR system. In agreement with the views you have mentioned, it is true that failure to not include nurses in each stage of the system development has the potential to lead to negative outcomes for both end-users and patient care. It is essential to have the input and feedback from nurses to ensure that the new system is user-friendly and meets the needs of the clinical staff, and in turn, the patients they care for (Cleveland, Motter & Smith, 2019). Involving nurses in the development of the EHR system increases the chances of successful adoption and implementation. On the planning stage of the SDLC, you have placed emphasis on the importance of stakeholder involvement and in particular nurses (Shafiq et al., 2021). You wrote that there is great importance in involving nurses in the planning stage of the EHR implementation and highlights that their input is valued by the stakeholders. Adding my opinion on this, I believe that the nurses’ input on the need for a standardized EHR across the whole hospital system should be regarded with a focus on cost-effectiveness and usability. This approach would help ensure that the new system meets the needs of the clinical staff and is efficient in terms of cost and usability, which can improve the overall healthcare delivery for the patients.

      Elaborating a little further on your views and having written a post on the same, I could add that the involvement of nurses in the Systems Development Life Cycle (SDLC) process leads to several long-term benefits. One of these is improved usability and user satisfaction (Tyler, 2019). Nurses are the primary users of healthcare systems, and their input and feedback ensures that the systems are designed to meet their needs and are easy to use. There is also increased efficiency and productivity. Nurses are familiar with the workflow and processes in a healthcare setting, and their involvement in the SDLC leads to the development of systems that streamline these processes and improve efficiency.

      References

      Tyler, D. D. (2019). A Day in the Life of a Nurse Informaticist: Super Users. Journal of Informatics Nursing, 4(1), 18–20.

      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.

      Shafiq, S., Mashkoor, A., Mayr-Dorn, C., & Egyed, A. (2021). A Literature Review of Machine Learning and Software Development Life Cycle Stages. IEEE Access.

       Reply to Comment

    • Collapse SubdiscussionBlessing Okafor

      Hello Alicia,

      I enjoy reading your post, nurses involvement in the Systems Development Life Cycle (SDLC) process is very crucial  for the successful implementation of an Electronic Health Record (EHR). Involving these professionals in each step of the SDLC gives them the opportunity to provide valuable input on how the system should work, how it should be used, and what needs to be included to ensure that it meets the needs of the organization and its patients. Nursing leaders, nurse informaticists, and staff nurses are essential stakeholders in the SDLC process and should be included in the planning, design, implementation, maintenance, and evaluation stages.

      During the planning stage, nurses can provide input on the need for a standardized EHR for the whole hospital system including cost-effectiveness, usability, and practicality. It is also essential to consider the different levels of competency with computers and the potential resistance to change in the organization. Nursing leaders must evaluate the workflow, charting processes, and how orders are taken from physicians.

      In the selection and design stage, nurses can provide valuable information on the flowsheets and customization of the software based on the current workflow. They can also provide insight on patient privacy measures and HIPAA compliance. During the implementation stage, nurses can assist with training and implementation of the new system. Super users (nurses who have been trained in the EHR system) can serve as “go-to” experts when issues arise. In the maintenance and evaluation stages, nurses can provide input on upgrades, evidence-based practices that can be implemented, and online learning modules that can be used for systemwide changes. During the six-month IS council meetings, nurses can provide suggestions for how to improve the EHR system and if any future upgrades are necessary.

      In conclusion, nurses’ input is essential throughout the SDLC process, as they are the ones in direct contact with patients and have a better understanding of the needs and workflow of the organization. Involving nurses in each stage of the SDLC will ensure that the EHR system meets the needs of the organization and its patients, and that the transition is smooth and successful. 

       

                                                                                                                  References

      Jason C. (2020, August 3). Ochsner Health System Boosts Interoperability with Epic Systems EHR. EHR INTELLIGENCE. https://ehrintelligence.com/news/ochsner-health-system-boosts-interoperability-with-epic-systems-ehrLinks to an external site.

      Ochsner Health System. (2022, August 9). AI technology to save lives in real time | Ochsner health. https://blog.ochsner.org/articles/ai-technology-to-save-lives-in-real-timeLinks to an external site.

       

       Reply to Comment

  • Collapse SubdiscussionDamacrine Morangi Anyuga

    Main Post

    The Inclusion of nurses in the Systems Development Life Cycle (SDLC)

    A software Development Life Cycle (SDLC) is a process of developing systems used by organizations to develop systems from the origin to the end of the life cycle in a manner that suits the organization’s needs (Mohino et al., 2019). This is best achieved using a hybrid approach which utilizes two or more models for a more vigorous development process (McGonigle & Mastrian, 2022). Several steps are involved in the SDLC process, including analysis and planning, design, testing, implementation, and maintenance. The successful implementation of this system depends on the level of involvement of critical stakeholders such as nurses, who are one of the primary end users of these systems. Failure to involve the nurses in each stage of the SDLC process could lead to the following.

    Analysis and Planning– In this stage, the available technology is evaluated to establish any gaps or challenges. This will be used as a base for more improved technology to be implemented. The stakeholders establish and define the functional scope of the system as per the problem it is intended to solve (Arrey, 2019). The nurses are the primary caregivers, have more understanding of clinical workflow and patient care needs, and are more likely to identify any challenges in storing, retrieving, and utilizing patient information. Not involving the nurses at this stage will mean that such issues are not promptly addressed. This may lead to frustration and decrease the adoption of the new technology.

    Design- This is the stage where software, hardware, and database configuration are defined (McGonigle & Mastrian, 2022). The team critically thinks and verifies essential data. Nurses have a deeper understanding of patient care processes and how technology can support them. Nurses should be involved in identifying databases and software that will be more useful in the delivery of better care. Without their input, the system may not be user-friendly or efficient, leading to decreased productivity and increased errors.

    Testing stage- During this phase, the new system is put into action to ensure it does what it is intended to do. Nurses can provide valuable input on the testing process, including identifying potential issues with the system and providing feedback on usability. Without their involvement, problems may go unidentified once the system is implemented, resulting in costly delays.

    Implementation– This is the phase where the designed Information Technology is brought into activation through programming code (McGonigle & Mastrian, 2022).IT experts and nurses must work together to ensure the system is used as intended. Nurses are critical to implementing the program as they can train other nurses and assist with the transition to the new system. Without their involvement, the adoption of the new technology may be slowed, and the organization may not realize the full benefits of the new technology.

    Maintenance and support– After the systems have been successfully implemented, software adherence activities are put in place to meet any new or changed operations due to user defects or other factors related to software aging (Shafiq et al., 2021). Nurses work closely with the IT specialists to identify any problems in the functionality and report them to the IT specialist for correction. If nurses are not involved in this stage, the new system may not be sustained in the organization.

               The current organization where I work had nurses involved when planning on rolling in the new system and doing away with paper charting. However, the involvement did not include deciding which kind of electronic records system they preferred. Nurses were asked to give their input on whether they would prefer the new system, and they voted for it. The organization has also kept the nurses involved in the maintenance of the system as they have nurses informaticists who work hand in hand with the nurses on the ground and IT personnel to handle any issues that arise with the use of the new systems. This allows the identification of any areas that need to be addressed and working on them for a better system.

    References

    Arrey, D. A. (2019). Exploring the integration of security into software development life cycle (SDLC) methodology (Doctoral dissertation, Colorado Technical University).

    McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

    Mohino, J. D. V., Higuera, J. B., Higuera, J. R. B., & Montalvo, J. A. S. (2019). The Application of a New Secure Software Development Life Cycle (S-SDLC) with Agile Methodologies. Electronics (Web)8(11), 1218.

    Shafiq, S., Mashkoor, A., Mayr-Dorn, C., & Egyed, A. (2021). A Literature Review of Machine Learning and Software Development Life Cycle Stages. IEEE Access.

     

     

     

     

     

     Reply to Comment

    • Collapse SubdiscussionKara Meghan Knodel

      Response #1

      Hi Damacrine,

      With the implementation of a new system that will be used on the front line by nurses, one would suggest that having input from nursing staff would be valuable to the configuration of the system. Unfortunately, that is not always the case. I have seen processes differ from this in other facilities I have worked as well. They implement a new system and then teach the nurses how to utilize it for patient charting. Subsequently, many nursing staff have questions as to why they are having to chart in a certain fashion that delays patient care, for example. This particular organization I am referring to quickly implemented new structures to enhance the program to provide more user-friendly options. With that, they also assembled a nursing informatics team that had equal input in workflow and design. The outcome was much more preferred by users, me included. AHRQ (n.d.) state that research assessing health IT implementations demonstrates that delays in patient care, billing, and communication are likely to occur if workflow is not taken into account. This is generally due to the fact that clinical and practice management requirements are overlooked or oversimplified.

      The American Nurses Association has identified nursing informatics as a specialty, and it plays an important role in healthcare as technology surrounds us daily. Daly (2015) states the roles of the clinical nurse, informatics nurse, and informatics nurse specialist are complementary. This is supported by ANA’s position, which states that clinical nurses must be involved in the selection, design, development, implementation, evaluation, and improvement of EHRs and electronic patient-care devices used in patient-care settings. Clinical nurses have many opportunities to get involved during the EHR selection and implementation process (p. 25).

      References

      AHRQ. (n.d.). What is workflow? What is workflow? | Digital Healthcare Research. Retrieved January 24, 2023, from https://digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/workflow

      Daly, P. (2015). Clinical nurses lead the charge with Ehr. Nursing45(10), 25–26. https://doi.org/10.1097/01.nurse.0000471426.47075.d2

       Reply to Comment

    • Collapse SubdiscussionDeanna Linn Howe

      Hi Damacrine and all,

      I appreciate your comments here.  Nurses need to be involved in the development phase of healthcare technology.  Collaboration with stakeholders and system administrators are necessary during the decision process. Collaboration ensures that the right system is being initiated that has the most value to the nurse.  Nurses can exchange and share their personal knowledge of what is necessary from a variety of departments. Knowledge exchange results when there is the clear understanding of the process that promotes learning and contributes to the future success of a project (McGonigle & Mastrian, 2018). Partnering with other disciplines contributes to knowledge sharing.  Would you want to be a part of a team for new technology? What aspects do you think would be most enjoyable? Worrisome? Thanks, Dr. Howe

      McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning

       Reply to Comment

      • Collapse SubdiscussionDamacrine Morangi Anyuga

        Hi  Dr.Howe ,

        Thank you for your comment professor. Nurses create the largest group of healthcare professionals who use these systems the most and in my opinion that alone should give them an upper hand when it comes to involvement on choosing the systems to be implemented. I, for sure would like to be part of the new technology team as I believe that I will be more placed to represent what most nurses would want to be implemented/what works most for the nurses. The only worry would be lack of support from the leadership or the organization, and opposition from other departments who might want things done differently without taking to consideration the other users.

         Reply to Comment

    • Collapse SubdiscussionGeorgette Ross

      Response:

       

      Hi Damacrine,

       

      A systems development life cycle (SDLC) according to McGonigle and Mastrian (2022) is a process used to upgrade, replace, or establish an information system. The SDLC method can be used in the healthcare organization to improve the quality of patient care. You provided great examples in the waterfall model of how nurses’ inclusion can lead to success of the system. Involving nurses in all phases of introducing a new technology facilitates a smooth transition (Weckman & Janzen, 2009). I am glad that your facility saw the importance of involving nurses as you transitioned away from paper charting. This allowed nurses to voice their opinions about why it may or may not work for them. Thank you for sharing.

       

      References

       

      McGonigle, D., Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning

       

      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), 1C-13C. https://www.proquest.com/scholarly-journals/critical-nature-early-nursing-involvement/docview/229512181/se-2

       

       Reply to Comment

    • Collapse SubdiscussionKenechukwu Ezeanya

      Damacrine Morangi Anyuga

      You clearly explain how nurses can advance medical technology in her overview of the health sector. I concur that the health industry is expanding quickly. I am glad your business is adopting this trend to guarantee the quality of the healthcare services you offer. Researchers assert that improvements in medical technology are crucial for enhancing patient safety by lowering medication errors and adverse effects (McGonigle & Mastrian, 2022). I agree that applying the SDLC methodology must create a successful and effective health information system. Your analysis of the SDLC system includes the five stages of planning, analyzing, designing, implementing, and maintaining the newly created system. On the other hand, the SDLC technique entails the following steps: gathering and analyzing requirements, framework advancement, framework execution and coding, testing, execution, framework activity, and support (Arrey, 2019). Are the SDLC process post-implementation testing and deployment phases crucial?

      References

      Arrey, D. A. (2019). Exploring the integration of security into software development life cycle (SDLC) methodology (Doctoral dissertation, Colorado Technical University).

      McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

       

       Reply to Comment

    • Collapse SubdiscussionCassandra Lynn Johnson

      Damacrine,

      Thank you for your detailed discussion post detailing the system development life cycle, SDLC.  Reviewing your post, I find it challenging to address any element of the SDLC that you still need to include within the post.  Using the staged approach of the SDLC ensures the effective and efficient delivery of a system that meets the end user’s needs (McGonigle & Mastrian, 2022).  With that said, I concur with you and our classmates regarding the benefits of nursing involvement throughout the SDLC. Health information technologies are becoming increasingly sophisticated and designed to support end users meaningfully (Strudwick et al., 2019). Nurses and nurse leaders are essential in acquiring and implementing health information systems (Strudwick et al., 2019).

      As it relates to involvement in planning and rolling out a new electronic health record system, it is interesting that in your present organization, they allowed the staff to vote on a new system.  I am interested in how that process played out and how those who may have voted for a different approach were re-engaged with the majority selected EHR. As noted in this discussion, end users needed input in selecting our current system.  It is clear that when end users are involved in the process from beginning to end, there is better buy-in and increased functionality in the system.  Thanks for your discussion.

       

      References

      McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

      Strudwick, G., Nagle, L. M., Morgan, A., Kennedy, M. A., Currie, L. M., Lo, B., White, P. (2019, September).  Adapting and validating informatics competencies for senior nurse leaders in the Canadian context: Results of a Delphi study. International Journal of Medical Informatics.  Retrieved January 27, 2023, from https://www.sciencedirect.com/science/article/abs/pii/S1386505619303211Links to an external site..

       Reply to Comment

    • Collapse SubdiscussionShannon Marlar

      Damacrine,

      I enjoyed your post! Until I began my role as ADON at a skilled nursing facility, I had no experience with SDLC. Our administrative nursing staff is involved with updates and new system additions. Online education and IT specialists are available for use upon introduction of a new system. My fall prevention program is going through several different hoops so to speak before it is introduced into the facility. The IT specialists answer any questions we may have about the new system.

      Nursing’s integral contribution to the process of selecting and implementing a hospital information system is essential to the success of the system. This process, defined as the systems life cycle, comprises four phases: analysis, design, development and implementation. Defining the role of nursing in each of these phases clearly indicates the significance of input from the hospital’s largest user group. Explored here are the contributions nurses can provide in each phase of the systems life cycle in order to promote optimal success of a hospital information system (Glancey, et al., 1990).

      Before an addition of a new system is done, we have a meeting to discuss and vote on updates and system additions. The planning process begins in the main office and we are a part of the process through virtual means in every stage of development. After introduction, another meeting is performed to gain knowledge from staff on how the new system is working for the employees and patients.

      Nurse leaders need to be involved in the planning and implementation of new healthcare technology to ensure it is appropriate and practical for frontline workers (Hamer & Ciprian0, 2017). Throughout history, nurses have been accepting of change and adapted to new ways of working. Despite this, nursing has a reputation of being obstructive to change, particularly around technology. Healthcare leaders of today are from a generation where technology was unheard of, so in my past experience, I noted it was more difficult to integrate new technology to the older generation because of their lack of knowledge in technology altogether. Healthcare technology implementation is not always successful and we argue that this is because nurses and other frontline workers are not involved enough in the change process. Nurse leaders need to be actively involved in the debate over appropriate technology and resources.

      References

      Glancey, T. S., Brooks, G. M., & Vaughan, V. S. (1990). Hospital information systems. Nursing’s integral role. Computers in nursing, 8(2), 55–59.

      Hamer S. & Cipriano P. (2013) Involving nurses in developing new technology. Nursing Times; 109: 47, 18-19.

       Reply to Comment

  • Collapse SubdiscussionDawn Cahill

    The system’s development life cycle (SDLC) is a process of implementing a new health information technology system within an organization. SDLC is divided into four stages: planning, design, implementation, and maintenance/evaluation (Walden University, 2018). Consequences to the healthcare organization for not including nurses during the planning stage may mean more work and updates later in the process. Nurses participate in the planning stage to help identify quality improvement areas for patients (Verma and Gupta, 2017). The design stage nurses work closely with IT staff in the development of clinical workflows and standardizing nursing language such as the bar-coding medication system (Verma and Gupta, 2017). If nurses are not included during the design phase, I believe this is what gives way to medication errors. Nurses begin to use workarounds, which is a process used to override an issue within the system, and this can increase errors because the computerized system is used as another step to reduce medication errors (McGonigle and Mastrian, 2022). Implementation phase can hinder the efforts to change if nurses are not involved. Nurses can help identify challenges within the software and assist with identifying changes that should occur before the “go-live” (Verma and Gupta, 2017). Then the maintenance/evaluation phase is after the “go-live” which typically has many “kinks” to work out. Updating clinical workflows may not occur without the involvement of a nurse. Nurses can help guide nurse informaticists with identifying issues in workflow and can help identify areas for improvement after the computerized system is established.

    Involving a nurse is an important step to avoid during the SDLC process because nurses are on the front lines, utilizing technology and assisting with patient care. Nurses can provide input as they understand the patient care process and the clinical workflow. This alone can place a nurse in a good position to help evaluate the software during development to the maintenance phase to identify whether it will be beneficial to healthcare providers and patient care or will be a burden (Verma and Gupta, 2017).

    Personally, I have not been included in the selection or planning for new health information technology. I was working during the “go-live” transition, switching from Meditech to EPIC. We had a 24-hour IT help line option and EPIC staff members in all departments within the hospital to assist with issues. The staff stayed on sight for three days, in my opinion not a long enough time. To me it seemed more like a learn as you go situation because it was not 1:1 EPIC staff to in house staff.

    I have been a part of the maintenance phase. When I transitioned to the behavioral health clinic, I identified workflows that are either missing completely or could save nursing staff time as well as providers time searching for the information and to assist staff with meeting Joint Commission Standards. The way we (floor nurses) are involved at my organization is to place a “ticket” which is outlined like an SBAR, then it goes through different committees and eventually to the IT team. I have been contacted mostly through email for further information on the design of the workflow, and clarification on different aspects and I think there were two zoom meetings for presentation of SBAR. Being a part of an IT EPIC enhancement has been a positive experience for me.

    References:

    McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

    Verma, M., & Gupta, S., (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

    Walden University, LLC. (2018). Interoperability, Standards, and Security [Video file]. Baltimore, MD: Author.

     Reply to Comment

    • Collapse SubdiscussionAlicia Brooke Richardson

      I appreciate your post about how nurses must be involved in every step of the SDLC as well as the consequences of not consulting with them in the processes. We, nurses, are the “clinical sight,” and our clinical knowledge and experiences with the practice will significantly benefit the whole planning and development of the SDLC. Having the largest workforce of the organization during the four stages of SDLC will promote the optimal success of a project when distinct roles are provided (Glancey et al., 1990). These roles of giving our input for the need for a program that is well-suited to our workflow, customizable and user-friendly, and easy to maintain and upgrade in the future. A prospective study done in China for a tertiary hospital by Yingjuan Cao and Marion Ball (2018) emphasized the use of the nursing leadership, nursing staff, safety committees, and hospital quality subcommittees to come up with their hospital adverse events reporting systems. Utilizing the nursing aspect of the workflow during their SDLC proved to have positive outcomes with patient safety and workflow productivity. With your experience with eloping patients, the wander guard device is the best for detecting them without causing too much anxiety about wearing one. Your involvement in the committee just proved that nurses are not only workers but also innovators in our way to always improve patient safety.

      References

      Glancey TS, Brooks GM, & Vaughan VS. (1990). Hospital information systems: nursing’s integral role. Computers in Nursing, 8(2), 55-59. Retrieved fromhttps://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=rzh&AN=107519115&site=eds-live&scope=site.

      Yingjuan Cao, & Marion Ball. (2018). A Hospital Nursing Adverse Events Reporting System  Project: An Approach Based on the Systems Development Life Cycle…16 World Congress of Medical and Health Informatics: Precision Healthcare Through Informatics(MedInfo2017), Hangzhou, China, 2017. Studies in Health Technology & Informatics,245, 1351. https://doi-org.ezp.waldenulibrary.org/10.3233/978-1-61499-830-3-1351

       Reply to Comment

    • Collapse SubdiscussionYetunde Adeola Adewoyin

      Response #1

      Hello Dawn, thank you for your informative post. I will agree with you that nurses should be involved in every step of developing a new health information technology in an organization. Nurses input at each stage of System Development Life Cycle (SDLC) will bring about effective result and prevent errors. Like you mentioned, the Bar Code Medication Administration (BCMA) system is a great example of how implementation phase of SDLC could be affected by not involving nurses in the process. Nurses are the main user of BCMA, so their involvement in the planning and designing the BCMA will determine effectiveness and outcomes (Weckman & Janzen, 2009).

      Implementing the SDLC when developing a new health information technology should fit the needs of the primary user of the system (Laureate Education, 2018). Nurses’ integral contribution to the process of selecting and implementing a new health information technology system is essential to the success of the system (Glancey et al., 2013).

      References

      Glancey, T.S., Brooks, G.M., & Vanghan, V.S. (2013). Hospital Information Systems. Nursing’s Integral Role. Comput Nurs. 8(2): 55-9. PMD: 2180537

      Laureate Education (Producer). (2018). Managing Health Information Technology. Baltimore, MD: Author

      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://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct-time&db=rz0h&AN=10524473&site=eds-live&scope=siteLinks to an external site.

       Reply to Comment

    • Collapse SubdiscussionCassandra Lynn Johnson

      Dawn,

      I truly appreciate the candor with which you provide your self-report of the EPIC rollout in your organization. This prompt offers an opportunity for review, reflection, and discussion regarding our various organizations and the software products they collectively decide to use. From what you have shared, your organization did not invest as much time, energy, or money in the system development life cycle as others using the same product. Using the system development life cycle framework ensures that the end users are involved in all aspects of the adoption process (Mohan, 2022). The framework additionally ensures that as the application is being developed and implemented, the organization will have the necessary supports to meet the needs of the end user and the organization as a whole (McGonigle & Mastrian, 2022).

      Similar to your organization, the one in which I am employed did not include anyone in the decision-making process. The system is designed with a “help desk” and the need to enter “tickets” as errors occur and an essential plan to “figure it out as you go” mentality. I am interested to know if you feel the organization followed the SDLC or if things would have been better if they had included nurses as their largest workforce in the decision-making process regarding the system rollout.

      References

      McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

      Verma, M., & Gupta, S. (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

       Reply to Comment

      • Collapse SubdiscussionDawn Cahill

        Cassandra,

        I really do not know whether my organization included nurses in parts of the SDLC, but after learning that the SDLC with nurse input can improve functionality of programs, I am led to believe maybe they did not include bedside nurses during the process. Because we made the transition during the COVID-19 pandemic this obviously limited most in-person meetings and trainings. There were “super-users” within each department during the implementation/evaluation phase. Staff can reach out to them and if they do not have an answer, we also have a phone number to reach out to the EPIC utilization team. This EPIC utilization team just started doing their quarterly rounding again, where they spend a day within each clinic or hospital unit and assist employees with questions or concerns.

        Thanks

         Reply to Comment

  • Collapse SubdiscussionImelda Briones Balili

             The software development life cycle (SDLC) involves planning, modifying, and writing software. The SDLC technical approach is significant to digital inventors in their software design and writing of modern software for developing technology devices such as computers, cloud deployment, mobile phones, and more. A deeper understanding of software development life cycle (SDLC) implementation in the healthcare system allows its staff to measure one’s technical work progress related to the company’s goals and ensure that everything is on track. Implementing critical planning steps to deliver solutions in every SDLC’s stages helps manage maintenance protocols and functional specifications (Coursera, 2022). The application of the nursing literature that contains an analysis of digital technologies helps advance its profession in its involvement with the hospital information systems that produce potential benefits to its practice and significance to patient care outcomes. These technology advancements are widely applied in the healthcare industry, positively contributing to nursing skills and education. However, challenges in adopting the rapid transformation of the healthcare practice into a digitally enabled profession brought complexities and challenges to healthcare systems and society. Equal access to resources enhances technological infrastructure expertise and health information transparency. Booth et al. (2021) reiterated the slow progress of nurses’ involvement in modern technological advancement in the healthcare environment due to a lack of leadership and investment that supports them to be knowledgeable about digital health initiatives.

     

    The primary purpose of the system design is to support nurses in executing challenging tasks, given the digital complexity of today’s healthcare. Nurses are vital informants in identifying weaknesses in the workflow process of a newly introduced health information technology system. Nurses’ involvement is crucial in understanding a software’s functionality and subsequent evaluation of each critical phase of SDLC. The adaption of the Software Development Life Cycle Model (SDLC) drives us through an iterative development process intersected by its stages of the formative evaluation of ecological validity. The adaptation of the Software model benefits the end-users; it is advantageous in the skills required by the health institutions they work in, based on nurses’ contribution to its software input deployment and decision-making process. Healthcare’s adaption of the software’s specifications and functionalities of the EHR’s design is in response to the nursing workflow for clinical documentation, nursing handoffs, and bedside tasks. Clinical teams and system developers keep communication open for any improvements necessary in the software application. An example of this is the facilitated interaction required for any technical issues concerning the use of the Electronic Health Record System. End users’ frustrations result in reporting technical problems that greatly benefit both parties. Ensuring the participation of healthcare workers in the early stage of the SDLC stage of evaluation helps maximize acceptance and the software’s usefulness (Ehrler et al, 2019).

     

    Four major SDLC phases are planning and analysis, designing and building, implementation and testing, monitoring, supporting, and evaluating. Multiple disciplines must produce regulatory-compliant, user-friendly software clinical tools such as the Electronic Health Record system to deliver safe and efficient patient care. The components of the EHR-integrated data are designed in a coordinated fashion to provide an organization’s administration, clinicians’ demographic, and financial information, which the SDLC framework helps attain a successful implementation. Foreseeable consequence brought by arbitrary and poor execution of an information system project contributes to the risk of potential costs of a system. A high level of risk mitigation and cost containment prevents significant financial losses. Nurses’ skills involve coordinating and managing multiple diverse situations with robust capabilities to manage complex projects in various work plans assigned to them. Without proper software education and training intended for nurses, it could significantly impact the organization’s workflow and effectiveness in providing a safe standard of care in all aspects of clinical tasks. Enable to meet regulatory and professional standards; service providers should continuously update healthcare information technology tools in response to the maintenance phase of the SDLC. In implementing a new health information technology system, observing proper checklist steps of SDLC’s stages should not be overlooked. Nurses’ daily use of the nursing process that requires problem-solving methodology underlies their successful performance in clinical informatics. Countless iterations of the problem-solving method are applied during the implementation and upgrading of software. The assimilation of software changes to team members by an organization into staff daily practice and software familiarization determines the project’s success. Attempting to execute a system without reviewing each SDLC’s checklist results in failure to gain end-user acceptance, expenditures exceeding budget, and anticipated benefits being unrealized, which results in an unmet project goal (Newbold, 2021).

     

    Five years ago, the Eisenhower Health Operating room department was planning to avail a new health technology system called mobile heartbeat. A mobile software device that updates medical charts by supporting the nurses’ work plan process. This EHR-connected software application provides the necessary intervention list and real-time documentation. That is also used as a communication medium to all hospital departments, including physicians, pharmacy, laboratory, and radiology departments. Before it was decided to be purchased by our department, staffing was involved in the decision-making process, and our nurse informaticist considered inputs regarding the mobile device’s functionality and features. The System Design Life Cycle planning stage is vital for project recommendations, where the project team conducts brain-storming session that brings advantages to the planned software proposal. One of the ideas accepted was my idea of incorporating a unique personal code for healthcare providers; its primary purpose is to protect patient confidentiality. We called it the “break the glass” code to give a designated person with direct patient care access to their patient’s records. During the SDLC analysis period, the collaboration of the project team members made a positive contribution to the IT implementation project proposal. The development of the mobile heartbeat fact-finding level; tackles gap analysis, technical requirements for hardware, networks, and its functional design document, in line with the clinical information system. A focused plan is implemented in developing technical specifications considering the institution’s policies and procedures in the design SDLC phase. Attaining all the SDLC’s framework and vital stages, a formative evaluation phase is imperative in the iterative development cycles. Possible software issues considered after its usability test in a realistic environment. The usability test helped the department detect design problems that could be a credible source of errors. Finally, an evaluation phase of the SDLC cycle provides essential information to help an organization deploy the software application at a larger scale (Ehrler, 2019).

     

     

                                                                                              References:

    Booth, R., Strudwick, G., McBride, S., O’Connor, S., Lopez, A. (2021). How the Nursing Profession should Adapt to Digital Future.

    https://www.bmj.com/content/373/bmj.n1190Links to an external site.

    Coursera. (2022). What is the Software Development Life Cycle? SDLC Explained.

    https://www.coursera.org/articles/software-development-life-cycleLinks to an external site.

    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.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482397/Links to an external site.

    Newbold, S. (2019). System Design Life Cycle: A Framework.

    https://nursekey.com/system-design-life-cycle-a-framework/Links to an external site.

     

     

     

     

     

     Reply to Comment

    • Collapse SubdiscussionDamacrine Morangi Anyuga

      Response #1

      Hi Imelda,

      There is a need for nurses to play a significant role in development of technology and other innovations in the healthcare sector as they are a crucial component of the interdisciplinary with expertise advice on development of user-friendly systems to enhance quality of care (Risling & Risling, 2020). The use of SDLC which is an ongoing development cycle allow nurses to be involved at all the stages to deliver effective systems to fit the needs of the organization (McGonigle & Mastrian, 2022). It is therefore crucial that the nurses are involved at all the stages of the SDLC cycle failure to which there could be delays in care and poor patient outcomes. I could also end up being costly to the organization if systems are implemented with low usability, forcing them to reevaluate and use more resources to make changes which should have been avoided in the first place.

      References

      McGonigle, D., & Mastrian, K. G. (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-centered design. Journal of research in nursing25(3), 226-238.

       

       Reply to Comment

    • Collapse SubdiscussionRaymond Mwanje

      RESPONSE 2:

       

      Kind hello,

      In support of your views, the nurse’s input is crucial in the SDLC as it makes sure that the system and software are developed with the patient’s safety and care in mind. The nurses, who work closely with patients and have hands-on experience in the healthcare environment, provide valuable insights into how healthcare technology should be designed and developed to meet the needs of patients (Verma & Gupta, 2017). The nurse’s input is vital in identifying potential risks to the patient and providing feedback on how the software should be designed to minimize those risks. For example, nurses provide suggestions on how to design the software or system to be user-friendly for healthcare professionals and how to make it more efficient and reliable. As well, they provide valuable input on how the software can be designed to improve patient outcomes and enhance the overall quality of care. I could also comment that by incorporating the nurse’s input into the SDLC helps ensures that the software is designed to meet the needs of the patient and healthcare professionals, while also providing a secure, reliable, and efficient platform for healthcare professionals. Ultimately, this leads to improved patient outcomes and enhances the overall quality of care.

      It was important for the nurse informaticist to get involved in the decision-making process for purchasing the mobile heartbeat technology system that you have discussed about your current organization. The justification for this is that informaticists have a unique understanding of the healthcare environment and the specific needs of nurses in the operating room. McGonigle and Mastrian (2022) noted that nurse informaticist have an experience with electronic health records (EHR) and other healthcare technology, and understand how these systems can be used to support the work of nurses and improve patient outcomes. The nurse informaticist added value to the decision-making process by providing input on the mobile device’s functionality and features (Mohino et al., 2019). They likely had specific suggestions for how the system could be designed to meet the needs of nurses in the operating room, such as ensuring that it is user-friendly and efficient, and that it includes the necessary intervention list and real-time documentation capabilities.

      References

      McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

      Mohino, J. D. V., Higuera, J. B., Higuera, J. R. B., & Montalvo, J. A. S. (2019). The Application of a New Secure Software Development Life Cycle (S-SDLC) with Agile Methodologies. Electronics (Web)8(11), 1218.

      Verma, M., & Gupta, S., (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

       

       

       

       Reply to Comment

  • Collapse SubdiscussionKenechukwu Ezeanya

    The Inclusion of Nurses in The Systems Development Life Cycle

    The System Development Life Cycle has seven stages (SDLC). The SLDC steps include to plan, analyze, design, develop, test, deploy, and maintenance (Mohan, 2022). The project developer decides the course of action during the planning stage. Find out what hardware, software, or other materials will be needed for the project during the SDLC analysis phase. The design phase is where the developers begin before creating the program. The development phase results in the creation of software. During testing, the software is examined for bugs and other issues. During the implementation phase, users implement and test projects. The maintenance phase, which comes in last but not least, is crucial to maintaining system stability and ensuring that any bugs or kinks can be fixed immediately.

    Nurses should be involved in the SDLC at every stage. Opportunities may be lost if caregivers are not included in the design process. For instance, some features and functions that should have been included were not included because the medical staff who would use the application needed to provide more information. The effects of removing nurses from SDLC are demonstrated (McGonigle & Mastrian, 2022). Developing a topic or issue can be challenging when the nursing staff isn’t involved in the planning stage.

    Language may be abused or misused if caregivers are not involved in the system’s analysis, design, and development. For instance, if most of the system’s developers are technologists, they don’t fully comprehend medical terminology or how to use or integrate it into the system in the most efficient way. It is challenging to predict how well the system will function once the sitter is no longer involved in the testing and implementation phase because the system needs to be evaluated by its intended users.

     

    For a system to operate as efficiently as possible, caregivers must be involved at every stage of the SDLC. Instead of learning through trial and error, mistakes can be fixed, and systems can start operating more efficiently immediately by involving end users in the design and implementation phases. Research claims that including nurses in the systems development process gives organizations a chance to enhance EHR optimization (Ehrler et al., 2019).

    I’ve never taken part in planning or implementing a new system. However, when my old employer switched to Cerner, we were all invited to test it out and offer suggestions for upcoming changes to make the system function more effectively. The lack of nurse input during the design phase resulted in more complaints and system changes that could have been avoided if the nurse had been more actively involved earlier.

    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 uHealth7(4), e12551. DOI: 10.2196/12551

    McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

    Mohan, V. (2022). System Development Life Cycle. In Clinical Informatics Study Guide (pp. 177-183). Springer, Cham.

     Reply to Comment

    • Collapse SubdiscussionFatmata Sharpless

      Kenechukwu

      This post literally got straight to the point! When nurses aren’t included in the different phases of SDLC and just in general, it can really create issues in healthcare as well as presents some challenges in providing patient care. Nurse Informaticists are the connectors in this realm; they have both the technological experience and the medical background to help provide sound evidence-based knowledge to situations such as this. Although we tend to focus on the nurses and their heavy involvement, installation of new programs and systems should be also thought about from a multidisciplinary lens.

      In an article by Khan (2019), he noted that for the documentation system that the nurse informaticists can assists the developers in recognizing the need of the end-user (Verma&Gupta,2017) and in this case, the end-user would be considered the Nurse practitioners, who are also heavily involved with patient care. He noted the example of being able to detect areas for correction or improvement such as “standard operating procedures, such as medication error avoidance and evidence-based practice.

      At the end of the day involvement from the nurses in general, can help provided success studies such as the one described in the article by Qin et.al, (2017), which involved an ICU department and the overall turnaround within their department after digitizing their nursing documentation making them much better in the quality, efficiency and overall direct care they were able to provide for their patients.

      References:

      Khan, Y. (2022, September 25). The role of the Nurse Informaticist in Systems Development and Implementation. GRIN. Retrieved January 24, 2023, from https://www.grin.com/document/1282298#:~:text=They%20contribute%20on%20each%20stage,practitioners%20and%20the%20software%20developers.

      Medha Piplani Verma, Sandhya Gupta. Software Development for Nursing: Role of Nursing Informatics. Int. J. Nur. Edu. and Research. 2017; 5(2): 203-207. doi: 10.5958/2454-2660.2017.00044.8

      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, December 6). 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. BioMed Central. Retrieved January 24, 2023, from https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-017-0569-3#citeas

       Reply to Comment

    • Collapse SubdiscussionDawn Cahill

      Response 1

      Kenechukwu

      I agree with Fatmata, you were getting right to the point with your discussion. Excellent job. Your post makes me wonder how many of the companies that we work for do involve nurses who have experience related to different specialties. Risling (2020) explains the need for more nurses to be involved in technology innovation because nurses provide in-depth knowledge, ethical expertise, and creative problem solving (Risling, 2020). We know the first step is the planning phase and during this phase healthcare organizations must determine what it is they need for their whole system (Walden University, 2018). The organization must look at various factors and understand the business needs as a whole (McGonigle & Mastrian, 2022). This is where all of those different specialties, physicians, and other professionals and offices would be needed to conduct a thorough needs assessment. According to Ehrler et al. (2019) the different specialties all have different workflows, specifications, documentation, tasks, and functionalities in which their input should be taken advantage of.

       

      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 uHealth7(4), e12551. DOI: 10.2196/12551

      McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

      Risling, T., & Risling D. (2020). Advancing Nursing Participation in User-Centred Design. Journal of Research in Nursing. 25 (3) 226-238. DOI: 10.1177/1744987120913590

      Walden University, LLC. (2018). Interoperability, Standards, and Security [Video file]. Baltimore, MD: Author.

       Reply to Comment

    • Collapse SubdiscussionTulany Mupandasekwa

      Hi Kenechukwu

      Nurses have improved in terms of their level of preparedness, competence, and independence thanks to higher education curricula and sophisticated educational training. Even while this development has directly improved clinical practice quality and helped individuals and the community, much more must be done due to the extensive digital health revolution we have been witnessing over the past few years. As services become more decentralized and outpatient activities are encouraged, the health care industry is currently undergoing significant changes. The management of healthcare and organizational assets are being affected to an ever-greater extent by the provision of medical treatments with the aid of modern technology. With the advent of the digital health revolution, novel issues and contexts are continually and fast developing, which underscores the need for highly skilled nursing staff who can adapt. The use and administration of modern technologies, as well as the capacity to support the use of technological tools for patients and caregivers, must be included in the training of nursing skills and competencies in this fast-changing environment. This includes identifying people who are qualified candidates for services made possible by digital technologies. Since nurses are responsible for educating patients about the technology, their involvement is necessary from the beginning for this to be successful (Isidori et al.,2022). 

      Digital health necessitates substantial collaborations not just across all prospective user groups of a proposed product or solution but also within many academic fields, medical organizations, and business. Nursing has recognized the importance of patients and professionals in the development of technological health solutions for more than ten years. The change to a digital health era has brought about a substantial paradigm shift in the way that healthcare is delivered, in part because of the complexity and expenses that are rising with healthcare provision globally. This progression, which goes well beyond conventional health systems, includes the development of consumer-driven health and related technologies like mobile health applications and individualized wearable technology (Risling & Risling,2020). Being fully involved would make it easier for nurses to disseminate knowledge about innovative technology because they play such a significant role in collaboration with other professionals. 

      References 

      Isidori, V., Diamanti, F., Gios, L., Malfatti, G., Perini, F., Nicolini, A., Longhini, J., Forti, S., Fraschini, F., Bizzarri, G., Brancorsini, S., & Gaudino, A. (2022). Digital Technologies and the Role of Health Care Professionals: Scoping Review Exploring Nurses’ Skills in the Digital Era and in the Light of the COVID-19 Pandemic. JMIR nursing5(1), e37631. https://doi.org/10.2196/37631Links to an external site. 

      Risling, T. L., & Risling, D. E. (2020). Advancing nursing participation in user-centred design. Journal of research in nursing : JRN25(3), 226–238. https://doi.org/10.1177/1744987120913590Links to an external site. 

       Reply to Comment

  • Collapse SubdiscussionFlavin Akande

    The Inclusion of Nurses in the Systems Development Life Cycle

    Healthcare facilities receive many patients every day and hence, they are involved in the collection, processing, storing, and managing of large and numerous patient files. In the past, patient records were documented and stored in manual files, but with the advancement and incorporation of information technology in healthcare, patient information is collected and stored in computer systems. Manual records were associated with loss of patient information, difficult accessing information, and errors (Feldman,2018). Therefore, information technology has not only made management of patient records easier, but also improved the quality of care. Healthcare systems are developed and managed by various systems such as the Systems Development Life Cycle (SDLC), which is a model used by software developers to develop and implement systems that meet patient needs (Jain & Suman, 2015). Nurses play important roles in system development and this paper will explore their contributions in the SDLC.

    Nurse Inclusion in SDLC Stages

    Requirements of the end use are one of the important factors considered in system development and in healthcare, nurses are the end users since they use the systems to collect and store patient information. Therefore, they are integral components in all SDLC stages.

    Planning

    Planning has a significant impact on the outcomes of a project and hence, proper planning translates to success. At this stage, stakeholders propose an idea, identify opportunities and shortcomings, and other requirements such as tools and resources required to develop and implement the system (Ergative & Kruglov, 2020). Nurses; role at the planning stage include provision of relevant information about the strengths and shortcomings of existing systems, and propose expectations of the new system; this is because they have first hand information about the systems they use.

    Analysis

    The expected outcome of the project is viewed at this stage; it creates a picture of how the system will turn out. Stakeholders assess the achievability of the project and the anticipated outcomes (Sharma & Singh, 2015); this enables them to devise effective interventions to address the problems. Just like in the planning phase, nurses are knowledgeable about challenges associated with the existing systems and are therefore resourceful in developing interventions.

    Design

    This phase involves designing the actual project by putting the ideas into a physical or visual presentation such as images, pictures, or videos. Software developers put together the architecture of the project (Ergative & Kruglov, 2020).  Nurses are important in designing since they understand patient needs and the gaps in the existing system, especially of the project involves modification of an existing system.

    Implementation and Post-implementation Support

    All systems are tested before they are actually implemented and unleashed for use. At this stage, the system is put into actual use to determine whether it meets the end-user needs (Kaur & Kaur, 2015). Usually, the software developers use codes to programme the systems and therefore, nurses should be involved to learn and confirm the new codes. This stage is very critical because if errors are made, for example, incorrect coding, the systems may not function as expected and this might also require additional costs; this causes unnecessary maintenance cost. Post-implementation involves training the end users on how to use the system and maintenance for effective running.

    Conclusion

    System development involves planning, analysis, design, implementation, and post-implementation support. Nurses play critical roles in all the stages since they are usually the end users of healthcare systems. The success of the project depends on adequate implementation of all the stages.

     

    References

    Ergasheva, S., & Kruglov, A. (2020). Software development life cycle early phases and quality metrics: A systematic literature review. Journal of Physics: Conference Series1694, 012007. https://doi.org/10.1088/1742-6596/1694/1/012007Links to an external site.

    Feldman, S. S., Buchalter, S., & Hayes, L. W. (2018). Health information technology in healthcare quality and patient safety: Literature review. JMIR Medical Informatics6(2), e10264. https://doi.org/10.2196/10264Links to an external site.

    Jain, R., & Suman, U. (2015). A systematic literature review on global software development life cycle. ACM SIGSOFT Software Engineering Notes40(2), 1-14. https://doi.org/10.1145/2735399.2735408Links to an external site.

    Kaur, A., & Kaur, K. (2015). Suitability of existing software development life cycle (SDLC) in context of mobile application development life cycle (MADLC). International Journal of Computer Applications116(19), 1-6. https://doi.org/10.5120/20441-2785Links to an external site.

    Sharma, P., & Singh, D. (2015). Comparative study of various SDLC models on different parameters. International Journal of Engineering Research4(4), 188-191. https://doi.org/10.17950/ijer/v4s4/405Links to an external site.

     

     Reply to Comment

    • Collapse SubdiscussionDamacrine Morangi Anyuga

      Response #2

      Hi Flavin,

      Great post with clear explanation on each phase of the SDLC. It’s true that the use of electronic systems in healthcare has been a very beneficial venture as important patient information can be stored and retrieved easily both by healthcare providers and patients and allow medical data sharing as needed to improve decisions- making (Shi et al., 2020). Nurses have a major role in the implementation of this systems and that’s why they should be involved at all phases of the SDLC, this is because they are more involved in patient care than any other healthcare professionals. Therefore, as nurse leaders we are in a better position to advocate for better our fellow nurses by communicating with them and establishing what works more efficiently. The SDLC process aims to optimize Electronic Health Records to increase interoperability of information systems for the healthcare professionals and the patients (McBride, 2022).

      References

      Shi, S., He, D., Li, L., Kumar, N., Khan, M. K., & Choo, K. K. R. (2020). Applications of blockchain in ensuring the security and privacy of electronic health record systems: A survey. Computers & security97, 101966.

      MCBRIDE, S., NEWBOLD, S. K., & FULTON, D. (2022). Systems Development Life Cycle and Project Management to Optimize Technology. Nursing Informatics for the Advanced Practice Nurse: Patient Safety, Quality, Outcomes, and Interprofessionalism, 175.

       Reply to Comment

  • Collapse SubdiscussionOyindamola Mubarakat Gbadamosi

    Involving Nurses Early in Systems Development Life Cycle

    As a nurse, it is crucial to understand the importance of utilizing technology and systems to improve patient care and outcomes, and involving nurses from the onset of a new health information technology system is in everyone’s best interest. According to Weckman and Janzen (2009) “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” (para. 2). However, I also recognize the potential negative consequences that can occur if nurses are not actively involved in the systems development life cycle process. When purchasing and implementing a new health information technology system, nurses’ input is essential every step of the way.

    The “systems development life cycle (SDLC) is an iterative process—a conceptual model that is used in project management describing the phases involved in building or developing an information system (IS)” (McGonigle & Mastrian, 2018, p. 480). SDLC comprises different stages that are essential to bringing a project from the initial idea or conception all the way to deployment and later maintenance. Preston (2021) identified the seven stages involved in SDLC as planning, analysis, design, development, testing, implementation, and maintenance.

    Planning- The consequence of nurses not being active participants in systems planning can be dire. If nurses are not included in the planning process, the system may not align with the needs of patients or the requirements of clinical practice. This can lead to frustration among healthcare providers and negatively impact the delivery of care.

    Analysis- One way in which nurses can contribute to systems development is by participating in workflow analysis that can be used to analyze current workflow processes to identify areas for improvement. Nurses can provide valuable insight into how a new system or technology will impact their daily workflow and the workflow of other nurses and healthcare providers by assisting with gathering all the specific details required to build the new system.

    Design- During the design phase a nurse can contribute to systems development by providing input on the design and functionality of the system. Nurses firsthand understand the challenges faced by healthcare providers in the clinical setting and can provide valuable insights into the needs of the patients and the requirements of clinical practice. This input can help ensure that the system is user-friendly and efficient, and supports the delivery of safe and effective care.

    Development- If nurses are not actively involved in systems development, it can lead to systems that are not user-friendly and do not improve patient care and outcomes. It can also lead to frustration and dissatisfaction among nurses and other healthcare providers, resulting in decreased adoption and implementation of new systems.

    Testing- Nurses can also contribute to the evaluation of new systems and technologies through testing before the system is implemented. Which can be used to measure the effectiveness and impact of new systems on patient care and outcomes. Testing provides valuable feedback on the system’s usability, accuracy, and effectiveness. This feedback can help identify any issues that need to be addressed before the system is implemented, ensuring that the system will be effective in the clinical setting. Nurses can provide valuable feedback on how a new system is impacting their ability to provide care and the care provided to patients.

    Implementation- nursing inclusion in the implementation phase lays a critical foundation in the Systems Development Life cycle (SDLC) by providing valuable input and feedback on the patient care and outcomes that new systems may impact. By being an active participant in the systems development life cycle process, I can ensure that the systems being implemented align with the needs and goals of the patients and the nursing staff.

    Maintenance- Involving nurses in the maintenance phase helps identify potential errors early that can impede the smooth flow of the new health information system. Participating in workflow maintenance and evaluations ensures that nurses can provide valuable insight and feedback that can lead to more effective and efficient systems.

    In conclusion, it is crucial that nurses actively participate in the systems development process to ensure that new systems and technologies are user-friendly and improve patient care and outcomes. I have not had the privilege of participating in the selection and planning of any new health information technology systems in my healthcare organization, however, I believe if nurses are not involved in the SDLC process, issues may not be identified until after the system is implemented, leading to costly and time-consuming fixes. In addition, I believe it is essential that nurses are included in the new system development process to ensure that the system aligns with the needs of patients and the requirements of clinical practice, and to identify any issues before the system is implemented. Stichler (2015) emphasized the importance of involving clinical nurses, nurse leaders, and the chief nursing officer as interprofessional partners with designers in creating innovative design solutions that improve workflow processes, efficiency, and effectiveness of clinical practice (para. 10).

    References

    McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Jones & Bartlett Learning.

    Preston, M. (2021). System Development Life Cycle Guide. CloudDefense AI, https://www.clouddefense.ai/blog/system-development-life-cycle#:~:text=What%20Are%20the%207%20Phases,testing%2C%20implementation%2C%20and%20maintenanceLinks to an external site..

    Stichler, J. (2015). Clinical Nurse Involvement in Healthcare Design. HERD: Health Environments Research & Design Journal, 9(1), 6-9. https://doi.org/10.1177/1937586715596997Links to an external site.

    Weckman, H., & Janzen, S. (2009). The Critical Nature of Early Nursing Involvement for Introducing New Technologies. OJIN: The Online Journal of Issues in Nursing, Vol. 14(2), https://doi.org/10.3912/OJIN.Vol14No02Man02Links to an external site.

     Reply to Comment

    • Collapse SubdiscussionFatmata Sharpless

      Oyindamola  

             Great post! Although we are focused on the involvement of nurses in the planning and designing stages when trying to implement new systems in healthcare, it really can affect other health professionals as well involved in a patients care. In an article by Dykes and Chu (2020), it notes that nurses are the best people to include in the planning and designing phase due to being able to “identify potential solutions to workflow and usability issues”. In one of the articles, you used in your post it also defends the argument about how nurses play an important role by being the “most familiar with the patient’s needs and the implications in the design of patient care units and the patient care room on patient outcomes” (Stichler ,2015). This is big deal in the realm of nursing but in order to get to this point, support from the nursing leaders is also needed in order to advocate for the inclusion of clinical nurses. This inclusion will help nurses to continue to bridge many gaps in healthcare which can meet the needs of both the clinician and the patient (Dykes & Chu ,2020). 

       

      Reference 

      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 nursing30(7-8), e25–e28. https://doi.org/10.1111/jocn.15581 

      Stichler, J. (2015). Clinical nurse involvement in healthcare design. HERD: Health Environments Research & Design Journal9(1), 6–9. https://doi.org/10.1177/1937586715596997Links to an external site. 

       

       

       Reply to Comment

  • Collapse SubdiscussionChike Emejuaiwe

       Nurses are at the forefront to change the face of healthcare as they take a step forward in the successful implementation of Health IT (Verma & Gupta, 2017). Though health information technology remains in its infancy stage with newer and more efficient systems being developed daily, its significance in improving healthcare efficiencies and outcomes is evident. A patient can now access an application to look for disease-related information, seek opinions from any specialist globally, manage appointments, and access electronic health records for previous disease history (Verma & Gupta, 2017). Given the unrelenting pace of technological advancement, however, it is imperative nurses reconcile that nursing informatics is nursing and that every nurse has a role to play in our collective digital health future (Risling & Risling, 2020).

    The first step in developing a system is to understand the problems or business needs. This step is followed by understanding the solution, or how to address those needs; developing a plan; implementing the plan; evaluating the implementation; and, finally, performing plan maintenance, plan review, and system destruction (McGonigle & Mastrian, 2022). Like the approach of nursing care involving the assessment phase, diagnosis, planning, implementation, and evaluation, the stages of the SDLC follow a unique and sometimes varied pattern but a sequence, however. For a health information system to be efficient, it must be user-friendly in that it comprises components such as Easy to understand, Requires minimal effort at the user end, is clinically relevant, and Provides easily retrievable information. Nurses working in clinical settings are in a better position to judge whether the software is useful and facilitates patient care, or just adds to the burden of formality for the healthcare professionals. The involvement of nurses could also address common problems that may arise due to ill-designed software, as well as ensure better allocation of healthcare resources. The need for nurses to be a part of the software development process has long been recognized. It is important that nurses be involved in the selection, development, and implementation of any system (Verma & Gupta, 2017).

    System development life cycle is a term used to define the various phases in the development of software. Following are the phases of software development (Verma & Gupta, 2017).

    Understanding the Problem: Prior to software creation, developers are tasked with providing a “user-friendly” product and nurses being at the forefront of healthcare delivery play a very significant role in this stage. Clinical nurse leaders and managers can contribute significantly in explaining and putting the requirement in a coherent manner so that the product that comes out is not redundant (Verma & Gupta, 2017). Also in this stage, the lack of nursing involvement will lead to product irrelevance clinically as products are developed that do not affect nursing care provision. Developers singularly are unable to identify areas of improvement within systems development as healthcare information systems are tailored specifically to nursing duties and roles such as the development of standard operating procedures to prevent medication errors, antibiotic resistance, etc. engagement of nurses here, will be helpful in tracking such important areas (Verma & Gupta, 2017).

    Coding Planned Solution/Technology solution hypothesis research question: This is the second stage of the development lifecycle and it involves coding solutions to established problems in a usable language. Software developers require nurses to guide medical terminology and patient care data relevant to acuity systems without which can create a false clinical picture (Verma & Gupta, 2017). Without nursing involvement, systems will become inefficient and non-functional, and inadequate in patient-centered care. Care provision becomes inept, and outcomes are detrimental and inefficient as overall nursing language is omitted from the functionality of the system.

    Data collection and analysis/Testing actual program: As has been noted, this work must also fulfill the needs of software development requirements gathering, including prompts that will reveal both functional and non-functional requirements of the proposed solution(Risling & Risling, 2020). Without nurse crucial input, gathering patient-centered data and analysis of this data will affect methodologies such as end-user prompts to highlight issues like hypertension, cerebrovascular accidents, or increased intracranial pressure. Clinical nurses are the best judge to assess the positive aspects and identify the challenges that may hinder the functioning of software created for patient care. It is important for the decision-makers to involve nurses before a system or software is adopted as nurses remain an important link to many clinical processes in healthcare(Verma & Gupta, 2017). Without nursing, system operability cannot be determined nor adjusted leading to redundancy and a lack of beta testing.

    Deployment and Maintenance of Product/Testing the effectiveness of the intervention: Users/nurses must continue to be consulted in this phase to monitor for unintended consequences or complications that can often occur in new technologies(Risling & Risling, 2020). The guidance at this point cannot be ignored in order to smart track data using checklists, nursing alerts, and clinical guidelines that promote evidence-based practices. Data can be structured systematically to check performance through dashboards and compliance records(Verma & Gupta, 2017). The system can track the progress of individual users and identify problems faced by them in using the system. For example, the software is developed with the intent to save nursing time, but the data indicates otherwise as the nurses are not comfortable using the system and find it difficult to access. Such problems can be identified when the software is put into action in the clinical setting. Nurses can not only identify such issues but would be in a better position to suggest an alternative that is more practical and clinically relevant. Nurses can work as solution architects to guide the team in the development of software as per the client’s requirement and improvise it with time (Verma & Gupta, 2017). Without nursing input systems development will lack interoperability and not be user-friendly which in turn will affect productivity and quality of care. This will create a lap or gap in care delivery and hinder patient health outcomes.

    It is clear that as end users nursing involvement in SDLC is critical in systems operability and interoperability. The lack of which impacts end-user friendliness and ability to utilize the software which in essence will impact care delivery and patient outcomes. The growth of health IT is crucial to healthcare and its growth. Nurses make up a significant number of the work force and tend to members of our societal employment sector hence ensuring that nurses and involved in SDLC is clinically relevant and required for efficient and intended healthcare outcomes.

     

    References

    McGonigle, D., & Mastrian, K. G. (2022). 9/Systems Development Life Cycle: Nursing Informatics and Organizational Decision-Making. In Nursing Informatics and the foundation of knowledge (pp. 191–204). essay, Jones & Bartlett Learning.

    Risling, T. L., & Risling, D. E. (2020, May 3). Advancing nursing participation in user-centred design. Retrieved January 24, 2023, from https://journals.sagepub.com/doi/full/10.1177/1744987120913590Links to an external site.

    Verma, M. P., & Gupta, S. (2017). International Journal of Nursing Education and research. Software Development for Nursing: Role of Nursing Informatics. Retrieved January 24, 2023, from https://ijneronline.com/AbstractView.aspx?PID=2017-5-2-19

     Reply to Comment

  • Collapse SubdiscussionKyle Hickman

    Main Post

    When changing to a new health information system, it is imperative to include nurses. First and foremost, nurses will actually be the ones using the programs rather than those who decide which program to buy. Having a system that nurses can provide feedback for gives nurses the ability to have a voice rather than having resentment to management for buying a system that is not compatible with the work being done. Nurses need to feel involved in the process to better help with implementation and have the end result of improved patient care (McMurtrey, 2013). Even if the program does not appeal to all nurses, having that voice in the decision gives the sense of responsibility and can help nurses take pride in what they implement, causing for a smoother transition and less push back from other staff. Another reason why nurses need to be involved is because the documentation process can be so involved that it needs an expert in the process to create a smooth process. This efficiency ultimately allows nurses to spend more time with the patient, improving quality of care (Qin et al, 2017).

    The Systems Development Life Cycle includes first, understand the problem, second, understand the solution, and third, planning maintenance (McGonigle & Mastrian, 2022). There are various issues that will be faced during each of these processes that can be addressed and nullified with proper input from staff. During the first stage of understanding the problem, if nurses are involved, they can bring the specific problem to the discussion and their perspective of it. Management has a different view and focus and therefore do not think the way nursing staff does. With the two different perspectives, they can cover more aspects of the specific problem. During the second stage, a potential problem could be having difficulty in the implementation and receiving pushback from staff. When the nurses are involved in this process, they are able to ease the tension of learning something new and help to teach staff how to use the system. Finally, a problem during the last stage of SDLC could be needing feedback to fine tune the new system. Nurses are able to give the feedback for a new system and assist in creating a good workflow, allowing more time for patients.

    Recently my facility went through the process of changing the EHR and multiple times asked for input from nurses and which system they had used in the past. Management asked for input from as many nurses as possible because they knew this new system would be used for the next decade and was a huge investment. If they did not ask for input from nurses, they would not know which system worked the best for the type of work that was being done in our facility. Each EHR is similar but has a different workflow and since it would impact everyone, many different views were needed to choose the best choice for our facility.

    References

    McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

    McMurtrey, M. (2013). A Case Study of the Application of the Systems Development Life Cycle (SDLC) in 21st Century Health Care: Something Old, Something New?. Journal of the Southern Association for Information Systems. 1(1). http://dx.doi.org/10.3998/jsais.11880084.0001.103

    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 (165). https://doi.org/10.1186/s12911-017-0569-3

     Reply to Comment

    • Collapse SubdiscussionDawn Cahill

      Response 2

      Kyle

      I completely agree with your comments in regard to nurses’ need to feel involved and including them in decision making processes including something that they will ultimately be working with on a daily basis. I remember in another class of mine talking about the different styles of nursing leadership and how to be most effective with employees. Participative and transformational leaders both inspire and invite change. These leaders want to be a part of the solution and listen to their employees and involve them in decision-making processes (Leadership, 2022). For instance, when I brought my issue on improving a certain workflow, initially my boss was for this idea. But when I started questioning staff members on their process and their thoughts for change and improvement, there was backlash and some did not want to change. At this point my supervisor was no longer supporting my efforts to implement this change. Even though I had the research and responses back from The Joint Commission Standards Interpretation Group to show this EPIC enhancement is needed to meet criteria. For a moment, I wanted to just stop then, if she did not want me to improve our practice then I had that thought, of why should I? One reason according to AHRQ (2020) is that nursing involvement in workflows and assessing health IT can impact patient care and my own practice. Also, I am an advocate for change, and for suicide prevention, and I knew we had to make this change for our patients. So, I went above my supervisor, directly to the Suicide Prevention Committee, the Quality Improvement Director, and nursing informatics, who as I mentioned previously will take EPIC changes to multiple boards and stakeholders before approving. I think I submitted all of my research, SBAR, and EPIC enhancement in October and it is just now getting to the nursing informatics team who will be building this workflow.

      References:

      Agency for Healthcare Research and Quality. (n.d.b). Workflow assessment for health IT toolkit Links to an external site.Links to an external site.. Retrieved January 28, 2022, from https://digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkitLinks to an external site.

      Leadership (2022). The Five Most Common Leadership Styles and How to Find Yours. Retrieved January 28, 2022, from https://www.imd.org/reflections/leadership-styles/

       Reply to Comment

  • Collapse SubdiscussionGeorgette Ross

    Main Question Post:

     

    Systems Development Life Cycle

     

    The systems development life cycle (SDLC) is a model used in project management that describes the phases involved when developing an information system (IS). The SDLC must identify the needs of the organization and propose solutions to meet those needs. When developing a system, a waterfall approach can be used to show sequential development of the process. Steps of the waterfall method include feasibility, analysis, design, implementation, testing, and maintain. (McGonigle & Mastrian, 2022).

     

    Nurses’ inclusion in the SDLC

     

    When a healthcare organization decides to implement a new system, I think nurses should be included in the process. Nurses’ involvement is crucial since systems are operated by nurses on a daily basis to maintain patient care. The feasibility phase determines whether a project should be initiated. It is especially important for nurses to be involved in this phase because this is technically the “beginning”. This is where nurses could discuss whether the project would be beneficial. During the analysis phase the system requirements are examined. System requirements can be broken down to the functions of the systems workflow. Agency for Healthcare Research and Quality (n.d.) describe workflow as physical and mental tasks performed by various people within work environments. An example is the workflow of ordering a medication. This includes communication with the provider, the patient, should it be a written prescription or an electronic prescription. Nurses should be involved in this phase to ensure that the workflow method is understood. During data design the team assesses which data are essential. Nurses input during this phase could help catch possible glitches in the system and allow nurses to see how the system will look before it launches. The testing phase is when the systems performance is tested by the users. Nurses would be able to use the system and discuss what may or may not work well. Lastly, is the maintain phase, which is when the system is finalized. To maintain a system users must be supportive of software updates and its use. I think that if nurses were involved in the SDLC approach from start to finish, then the last phase to maintain would be easier to manage since you would already know the “in’s and out’s” of the system.

     

    Current Healthcare Organization

     

    I currently work in an Endoscopy unit. Whenever a system is developed or changed, we are alerted by email. The email will usually describe changes to a current system, or a new system being implemented. My job uses an electronic health record (EHR) system to store patient data. An EHR is a digital version of a patient’s paper chart (HealthIT, 2018c). When the system is updated for any reason an email notifies us of the change. It can be challenging to understand how to document or where to find a particular place to document (if it has been moved elsewhere in the EHR). Therefore, if nurses were involved in the process it could decrease confusion and troubleshooting issues among users.

     

     

    References

     

    Agency for Healthcare Research and Quality (n.d.) What is workflow? Department of Health & Human Services. https://digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/workflowLinks to an external site.

     

    HealthIT.gov. (2018c). What is an electronic health record (EHR). Retrieved from https://www.healthit.gov/faq/what-electronic-health-record-ehrLinks to an external site.

     

    McGonigle, D., Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning

     Reply to Comment

    • Collapse SubdiscussionDeanna Linn Howe

      Hi Georgette and all,

      I appreciate your comments here. The feasibility and test phase are the most critical phases in the implementation of HIT.  Nurses need to be involved from step one to the very last phase where the system has been tested, approved and now maintenance throughout its lifetime is required.  The project team is important because they need to express the value of the electronic system to the providers and end-users that it will be affecting in order to win them over and decrease the chance of resistance (Hunt et al., 2013).  The input, support, and patience of both providers and the public are essential to the success of the HITECH Act and the implementation of the EHR’s in order to increase the quality of care and make practices safer. Do you think the HITECH Act has improved healthcare delivery through technology use? Thanks, Dr. Howe

      Hunt, E. C., Sproat, S. B., & Kitzmiller, R. R. (2013). The nursing informatics implementation guide. (1-18). Springer Science & Business Media.

       

       Reply to Comment

    • Collapse SubdiscussionMarie Lo

      Hi Georgette,

      Nurses provide direct patient care, but must deal with the consequences of an EHR that does not meet their needs or structure a proper workflow to provide patient care in a timely manner if they are not given a voice early in the process (Hoover, 2017). Because of this, much thought, planning, prioritization, and implementation must go into the implementation of a new HER system. Nothing is more aggravating than having people make decisions for nursing staff who do not understand what is required of them. Nurses must be involved from the start, whether a committee is formed or a select few are delegated to make the decisions. Involving nurses in decision-making encourages an active discussion of current performance outcomes and identifies the weakest areas that the SDLC can address. Ignoring the role of nursing staff, on the other hand, increases the likelihood of inappropriate optimization solutions that are irrelevant to specific settings (Risling & Risling, 2020).

      Hoover, R. (2017). Benefits of using an electronic health record. Nursing Critical Care12(1), 9–10. https://doi.org/10.1097/01.ccn.0000508631.93151.8dLinks to an external site.

      Risling, T. L., & Risling, D. E. (2020, May). Advancing nursing participation in user-centred design. Journal of research in nursing : JRN. Retrieved January 27, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932478/

       

       

       

       Reply to Comment

    • Collapse SubdiscussionCourtney Britten

      Response #2

       

      Georgette,

      The hospital I work at also sends us an email notification when EPIC is planned to be down or when it crashes. Staff can even sign up for text message alerts. We also get a notification from the computer network and a written message on EPIC informing us of any planned downtime/updates. Notifications like this are an example of a downtime procedure. Downtime procedures should be implemented ahead of time to ensure that workflow is minimally affected, to ensure that medical errors are not increased, and that charting and medical data are accurately documented, all to ensure that the patient outcomes are not ultimately affected by the downtime (Fahrenholz et al., 2009). The Systems Development Life Cycle (SDLC) is a project management model that organizes the process of project development into four stages which are planning, design, implementation, and maintenance/evaluation (Walden University, 2018). Downtime procedures are included in the maintenance/evaluation stage of the SDLC cycle.

       

      References

      Fahrenholz, C., Smith, L., Tucker, K., & Warner, D. (2009). Plan B: A Practical Approach to Downtime Planning in Medical Practices. Journal of American Health Information Association, 80(11), 34-38. Retrieved from https://library.ahima.org/doc?oid=95715#.Y9c51uzMLMILinks to an external site.

      Walden University, LLC. (Producer). (2018). Managing Health Information Technology [Video]. Baltimore, MD: Author.

       Reply to Comment

  • Collapse SubdiscussionTulany Mupandasekwa

    A software development life cycle (SDLC) is a framework that describes the procedure organizations use to build an application from its inception to the end of its life cycle. The SDLC consists of several processes, including analysis and planning, design, testing, implementation, and maintenance(Mohino et al.,2019). The stage of planning is when the project’s developers come up with a strategy on how to approach the forthcoming task. Identifying the software, hardware, and other supplies required for the project is done during the analysis phase of the SDLC. Before development, developers start designing the program during the design phase. The program is built during the development stage. During the testing phase, the program is examined for flaws and problems. The project is carried out and tested by the users during the implementation phase. The maintenance phase, which comes last, is crucial to maintaining the system’s stability and ensuring that any flaws or kinks can be quickly fixed if they do appear. Every phase of the SDLC should include nurses for it to be effective. 

    There may be missed opportunities if nurses are not included in the design process. Because the nursing staff utilizing the application did not provide input, several features and functionalities that should have been included would not have been. There are repercussions from leaving nurses out of the SDLC, and finding a project or problem is challenging when nurses are not involved in the planning stage. The language may be misused or misused if nurses are not involved in the system’s analysis, design, and development. For instance, if technologists primarily created the system, it’s possible that they needed to fully comprehend medical terminology and know how to use or incorporate it into the system in the most efficient ways ( Bresnick,2018). 

    It is challenging to evaluate how well the system functions when nurses are excluded from the testing and deployment phases since actual potential users need to be used in the testing. To have a system that works to its fullest potential, nurses must be included in each stage of the SDLC. By including the end user in the design and implementation phases, flaws may be ironed out. The system can operate more effectively immediately rather than learning via trial and error. The organization may boost EHR optimization by including nurses in system operations. When Cerner was introduced at my place of employment, everyone had the opportunity to test it out and offer suggestions for future improvements to make the program function more effectively. Since our patient’s needs were distinct, we made numerous adjustments. We are still making modifications today. For instance, when we transitioned to Cerner, we kept utilizing the Morse Fall Risk scale we used to assess falls on paper charting. However, while we were becoming used to the system, we found that the Wilson Sims Fall Risk Assessment tool was more applicable to our geriatric psychiatric patients because we were involved in the planning phase. Excluding the nurse’s involvement during the design process results in more grievances and leaves gaps in the system that, with nursing input, could have been filled before implementation. 

    References 

    Bresnick, J. (2018). Nurses play a critical role in EHR optimization, data governance. Health IT Analytics. Health IT Analyticshttps://healthitanalytics.com/news/nurses-play-a-critical-role-in-ehr-optimization-data-governanceLinks to an external site. 

    Mohino, J. D. V., Higuera, J. B., Higuera, J. R. B., & Montalvo, J. A. S. (2019). The Application of a New Secure Software Development Life Cycle (S-SDLC) with Agile Methodologies. Electronics (Web)8(11), 1218. https://doi.org/10.3390/electronics8111218Links to an external site. 

    Verma, M. P., & Gupta, S. (2017). Software development for nursing: Role of nursing informatics. International Journal of Nursing Education and Research5(2), 203. https://doi.org/10.5958/2454-2660.2017.00044.8Links to an external site. 

     

     Reply to Comment

  • Collapse SubdiscussionSopheap Ly

    A systems development cycle (SDLC) “is a specific plan that guides the team members as they come up with the idea for the system, review it, design it, build it, and put it into use,” (Ungvarsky, 2022).  The first stage is the planning stage which is when a company investigates the system and develop a possible solution to address the issue.  “The projects team will identify the problem to be solved, look at potential alternatives, and determine whether going forward with the system design is the best course of action,” (Ungvarsky, 2022).  After the planning phase is the analysis which is when the information is analyzed by overviewing what needs to be analyzed followed by the designing of the plan with a blueprint of what is to be completed.  the development phase is the phase that focuses on the building of the system. “Sufficient technical accumulation can lay a solid foundation for subsequent development, and modeling concepts can help people establish a clearer and more efficient research and development path,” (Zhang, 2021). It is important to have the nurses included in the systems development cycle when it involves the policies and procedures of the hospitals because they are the ones who experience it all firsthand.  They are the ones who learn how to deal with situations head on allowing them to develop a plan on how to approach and consult the situation.  Knowing what resources are available for the situation is an important one because knowledge is power.  “While effective management of processes is imperative, it is an onerous task as knowledge is tacit and implicit. Although best practice to ensure the quality of such processes has been documented in the International Standard ISO/IEC/IEEE 15288, it is limited to human-readable descriptions and not a computer interpretable knowledge representation,” (Yang, 2017).  The policies that have been implemented at the hospital I work at has many protocols that was developed by someone who was not a floor nurse.  This can be seen on the approach to the situation.  When there is a policy that is nurse developed, there are much evidence to support the protocol and is based and developed due to the success rate of the experiments that were done on the experiment prior to the implementation of the procedure.  “In other words, the input, output, control, or enabler can be regarded as special roles of a SLCO plays in a system life cycle process (SLCP),” (Yang, 2017).  Impacts that develop with nurses’ inclusion in the process has been shown to make a big difference in the outcomes.

     

    Ungvarsky, J. (2022). Systems development life cycle (SDLC). Salem Press Encyclopedia of Science.

     

    Zhang, Y., Liu, Z., Han, Q., & Zhang, W. (2021). Development of System Life Cycle Processes Standardization and Future Evolution Analysis†. 2021 8th International Conference on Dependable Systems and Their Applications (DSA), Dependable Systems and Their Applications (DSA), 2021 8th International Conference on, DSA, 240–246. https://doi.org/10.1109/DSA52907.2021.00036

     

    Yang, L., Cormican, K., & Yu, M. (2017). Towards a methodology for systems engineering ontology development — An ontology for system life cycle processes. 2017 IEEE International Systems Engineering Symposium (ISSE), Systems Engineering Symposium (ISSE), 2017 IEEE International, 1–7. https://doi.org/10.1109/SysEng.2017.8088299

     

     Reply to Comment

    • Collapse SubdiscussionGeorgette Ross

      Response:

       

      Hi Sopheap,

       

      The systems development life cycle is a way to deliver efficient and useful information systems that fit within an organization. The system will most times replace or integrate new ideas to an old system (McGonigle & Mastrian, 2022). One of the systems that my hospital updates often is the electronic health record (EHR). The EHR is a software that is used to store patient data digitally. When it comes to system updates it is important for nurses to be involved, since they are the primary providers of bedside care. Organizations should always include nurses in system updates so that nursing care is adequately reflected, and ease of use can be guaranteed (Cline, 2020). My coworkers and I are usually informed about an update through email. This is often frustrating since some updates move certain documentation around and you have to find them. It would be better if nurses were at least informed, so we could discuss whether it would be beneficial in how we document patient care. Thank you for sharing.

       

      References

       

      Cline, L. (2020). The electronic health record and patient-centered care. Nursing Management, 51(3), 6-8. doi: 10.1097/01.NUMA.0000654880.27546.6a

       

      McGonigle, D., Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning

       Reply to Comment

  • Collapse SubdiscussionMarie Lo

    Nurses are essential to healthcare organizations as they are hands-on with patients and oversee the overall care that they receive. Nurses act as patient advocates, being involved in all aspects of the patient’s care. They must be involved from the start of any change in a healthcare organization in order to achieve the desired clinical outcomes (McLean et al., 2015). Understanding the problems or business needs is the first step in developing a system. Understanding the solution or how to address those needs is followed by developing a plan, implementing the plan, evaluating the implementation, and finally maintenance (McGonigle, 2017).

     

    Involving nurses who work at the point of care in all phases of introducing a new technology helps to ensure a smooth transition and increases nurses’ buy-in to the system (Weckman & Janzen, 2009). Nurses’ participation in the SDLC process is essential because they are the ones who use the systems the most. Nurses’ involvement in all phases of the process, including design, planning, implementation, and evaluation, is critical to the success of these technologies (Weckman & Janzen, 2009). Throughout their shift, nurses are at the bedside, electronically documenting and viewing patient data. They understand the system’s components, what needs to be changed, and which changes will be most effective. Without their knowledge and feedback, the organization overlooks the most important aspect of patient care. Without the nurses’ input and expertise, healthcare administrations will miss the target, and the tool’s success rate will be reduced.

     

    My current healthcare facility recently upgraded its EHR system to Epic. To ensure success, they included the nursing staff from the planning phase. They have selected a team of nurses (super users) and nurse informaticists from their current healthcare team to design and adapt the Epic program to meet the needs of the institution. These nurse EPIC Super Users are well-versed in workflows and Epic applications. They are supportive, approachable, knowledgeable, and responsible team members who work with the rest of the team to ensure the new system’s successful implementation. It was critical to include nurses because they were familiar with their workflow and how changes would affect the unit positively or negatively (McLean et al., 2015).

    McLean, A., Frisch, N., & Roudsari, A. (2015, December 19). Nursing’s voice in healthcare IT acquisition decisions. Nursing’s Voice in Healthcare IT Acquisition Decisions | Canadian Journal of Nursing Informatics. Retrieved January 24, 2023, from https://tinyurl.com/y3ql3oj9

    McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learn

    Weckman, H., & Janzen, S. (2009). The critical nature of early nursing involvement for introducing new technologies. OJIN: The Online Journal of Issues in Nursing14(2). https://doi.org/10.3912/ojin.vol14no02man02

     

     Reply to Comment

    • Collapse SubdiscussionDeanna Linn Howe

      Hello Marie and all,

      I appreciate your response. Nurses are stakeholders and critical players when a health institution develops a new program or system. Because nurses are involved with systems implemented and patients, we see everything and can offer the best advice on strategies. Therefore, nurses should be given governance to make the best decisions, primarily when it directly affects our jobs. Almost always the governance structures that succeed give people who are as close to the system as possible some function to both report concerns and to report back solutions. Having users involved it is possible to manage expectations of the technology solution and design solutions that are better structured to meet their requirements. Is there a formalized process for nurses to provide feedback in your institution? Thanks, Dr. Howe

       Reply to Comment

  • Collapse SubdiscussionCassandra Lynn Johnson

    Selecting, adopting, developing, and implementing an electronic health record system is a significant undertaking for an organization. Using the system development life cycle (SDLC) provides a common framework for organizations introducing new technology into operations (Mohan, 2022). The System Development Life Cycle provides stages by which the implementation process should include planning, design, implementation, maintenance, and evaluation (Walden University, 2018). The staged methodical application of a new program is designed to ensure the effective, efficient delivery of a system that will ultimately meet the needs of the end user and the organization (McGonigle & Mastrian, 2022).

    Throughout the SDLC, the organization should ensure the involvement of a collaborative interdisciplinary team of professionals/end users. Including nurses in all aspects of the SDLC increases overall buy-in while maintaining certainty that the product will provide the end user with the expected ease of use. System developers are experts in the field of system development however need a basic understanding of the overall process flow of daily nursing operations. Nurses can look at the essential functions of the planned systems and quickly note if the system as built has glaring obstacles to the widespread use of the product. A simple example may be using a particular icon that may be unfamiliar to the staff, whereas using a more common symbol may improve ease of use—the inclusion of nurses as end users can assist with the elimination of these obstacles.

    In my current employment, I was not involved in the selection, design, adoption, etc., of the current electronic health record we use. There was no end-user involvement in its designation as it was a decision made by the agency’s owner, selected in part for its low cost and his then relationship with the owner/builder of the EHR. This out-of-the-box system limits customization, requires increased staff time to document and reduces overall productivity. As we work through this module, I am actively preparing the organization for the potential redirection regarding its current EHR model. A system must be able to provide its users with the framework necessary to complete required charting with a focus on decreasing staff time away from patients. The use of the SDLC framework and the inclusion of nurses as end-users is ultimately imperative to the success of system adoption and roll-out.

     

    References

    McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

    Mohan, V. (2022). System Development Life Cycle. In: Finnell, J.T., Dixon, B.E. (eds) Clinical Informatics Study Guide. Springer, Cham. Retrieved January 25, 2023, from https://doi.org/10.1007/978-3-030-93765-2_12Links to an external site..

    Walden University, LLC. (2018). Interoperability, Standards, and Security [Video file]. Baltimore, MD: Author.

     Reply to Comment

    • Collapse SubdiscussionLaura Mcbee

      Hi Cassandra,

      I enjoyed your post and absolutely agree with your statement that the adoption of such a big technological advancement such as an electronic medical record (EMR) requires a multi-disciplinary approach.  Without buy in from end users, the increased risk for errors and poor patient outcomes increases.  Though health information technology (HIT) has been perceived as a means to providing improved quality of care to patients and improved efficiency, without buy in from end users it can be quite the opposite.  In one study, nurses stated their workflow was drastically changed and even increased due to the neediness of the computer and felt that the priority of patient centered care was altered (Bergey et al. 2019).  The initial implementation of the EMR your organization chose due to being less expensive has probably added addition cost to your organization due to its difficult use and its incompatibility of use for the end users. Evaluation of health technologies is not straightforward and requires the examination of factors including engineering, strategic implementation, uptake and cost (Meinert et al. 2018).  Technology can truly aid in providing better quality care, but an organizations must include the end users to ensure that their workflows, processes, and patient care are taken into consideration.  Technology that is implemented and inhibits quality care while also adding additional work will only create burn out from nurses and work dissatisfaction.  Evidence has shown that the pressure of adding health information technology in health systems has provided in a rapidly increasing rate of HIT failures (Dendere et al. 2021).  In fact, a study identified 65% of failures being due to poor project management such as insufficient resources, lack of detailed project and strategic planning, inadequate managerial support and insufficient funds (Dendere et al. 2021).  You could be a huge asset to your organization with your knowledge and awareness of the importance of a multi-disciplinary approach to HIT implementation.

      References

      Bergey, M. R., Goldsack, J. C., & Robinson, E. J. (2019). Invisible work and changing roles: Health information technology implementation and reorganization of work practices for the inpatient nursing team. Social Science & Medicine (1982)235, 112387. https://doi.org/10.1016/j.socscimed.2019.112387Links to an external site.

      Dendere, R., Janda, M., & Sullivan, C. (2021). Are we doing it right? We need to evaluate the current approaches for implementation of digital health systems. Australian Health Review45(6), 778–781. https://doi.org/10.1071/AH20289Links to an external site.

      Meinert, E., Alturkistani, A., Brindley, D., Knight, P., Wells, G., & de Pennington, N. (2018). Weighing benefits and risks in aspects of security, privacy and adoption of technology in a value-based healthcare system. BMC Medical Informatics and Decision Making, 18(1), 100. https://doi.org/10.1186/s12911-018-0700-0Links to an external site.

       Reply to Comment

    • Collapse SubdiscussionPatrick R King

      Hi Cassandra,

      The process of system development life cycles (SDLC) and bringing on a new electronic health record (EHR) system truly is a huge undertaking in a variety of aspects. After reading your post, I was curious on just how much it costs to implement a new EHR into a clinic or facility. According to HealthIT.gov (2014), bringing in a new EHR in-office will cost an estimate of $33,000 upfront, $4,000 yearly, and an estimated $48,000 for total costs in five years. Some EHRs are internet based, known as Software as a Service, that offer a cheaper upfront cost of an estimated $26,000 but higher yearly and five-year total costs of $8,000 and $58,000. Not only is it a long, time-consuming process, but it can be a costly mistake when not implemented properly or designed in a way that hinders workflow instead of improving it like it is meant to.

      I appreciate your comment that utilizing nurses in the SDLC stages will increase buy-in and a higher probability of longevity. Hamer and Cipriano (2013) believe that healthcare technologies fail when nurses and other frontline workers are not involved. Just as you stated, system developers are the experts in making new systems, but nurses are the ones who know how the clinical process works and what it best for their practice. Great work, and thank you for your post.

      References:

      Hamer S, Cipriano P (2013) Involving nurses in developing new technology. Nursing Times; 109: 47, 18-19.

      How much is this going to cost me? HealthIT.gov. (2014). Retrieved from https://www.healthit.gov/faq/how-much-going-cost-me

       Reply to Comment

  • Collapse SubdiscussionBlessing Okafor

    The Systems Development Life Cycle and Nursing

    When acquiring and deploying a new health information technology system, a healthcare organization’s failure to include nurses at each level of the Systems Development Life Cycle can have serious implications. The SDLC has several stages: Planning, Development, Design Analysis, Testing, and Deployment (Ehrler et al., 2019). At each stage of the process, nurses can provide valuable insight into implementing a new system’s potential benefits or drawbacks.

    During the Planning phase, nurses can provide input on the cost-effectiveness of a system, its usability, and its potential impact on patient safety. With input from nurses, the organization may purchase a cost-effective system that is easier for nurses to use; this can lead to wasted resources and a decrease in the quality of care provided to patients (Ehrler et al., 2019). In the Analysis phase, nurses can provide input on the type of data that needs to be collected and stored, as well as the potential impact of the new system on nursing workflow. Without nurse involvement, the organization may acquire a technology that does not satisfy the nurses’ needs or does not enhance workflow.

    During the design phase, nurses can provide input on the user interface of the system and the potential impact on patient safety. With input from nurses, the organization may purchase a system with a well-designed user interface that can lead to errors and delays in care. And in the development phase, nurses can provide input on the system’s potential impact on the nurses’ ability to provide quality care (Risling & Risling, 2020). In the Testing phase, nurses can provide input on the usability of the system and the potential impact of the system on nursing workflow. Without input from nurses, the organization may purchase a system that is difficult to use or does not improve workflow (Olorunshola & Ogwueleka, 2022). Finally, during the deployment phase, nurses can provide input on the training needs of the system, as well as the potential impact on patient safety and nursing workflow (Olorunshola & Ogwueleka, 2022). Without input from nurses, the organization may purchase a system that lacks proper training and does not improve patient safety or nurse workflow.

    I have had the chance to contribute to selecting and designing new healthcare information systems in my nursing practice (Risling & Risling, 2020). My contribution has ensured that the system fits the organization’s requirements and is simple. Being a part of the decision-making process has given me the ability to guarantee that the system is cost-effective and serves the demands of the patients and employer

                                                                                                            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.

    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) (pp. 281-289). Springer, Singapore. https://doi.org/10.1007/978-981-16-0739-4_28Links to an external site.

    Risling, T. L., & Risling, D. E. (2020). Advancing nursing participation in user-centred design. Journal of Research in Nursing, 25(3), 226-238. https://doi.org/10.1177/1744987120913590Links to an external site.

     Reply to Comment

    • Collapse SubdiscussionMegan Nicole Starnes

      Hello Blessing, I enjoyed reading your discussion this week. One of your examples of how nurses can help during the planning phase is safety. Providing properly functioning information technology resources medical professionals can improve the standard of care and ensure patient safety (True North, 2021). However, malfunctioning EHR systems could compromise patient safety. My present employer has not yet updated the newly deployed EHR section on allergies. Right now, the new system always automatically displays “no known allergies.” The patient would then be in danger of an allergic reaction and a serious mistake. In your example of the testing phase, you listed with the nurses input, this could help improve workflow. Poor HIT usability is harmful to nurses and doctors, according to a study, as it decreases productivity, stresses users out further, jeopardizes patient safety, and increases overall healthcare errors (Golay et al., n.d.). Overall, I discovered from this assignment that it is obvious that nurses must be involved at every stage of the SDLC in order for an electronic health system to be successful.

      Golay, Cajander, Hussein, Azeez, & Bonacina. (n.d.). Communication Breakdowns between Nurses and IT Department: Why Hospitals Fail at Improving the Usability of Health Information Technologyhttp://uu.diva-portal.org/Links to an external site.

      True North. (2021, May 10). How Electronic Health Records (EHR) Improve Patient Safety – TrueNorth ITG. TrueNorth ITG. Retrieved January 28, 2023, from https://www.truenorthitg.com/ehr-and-patient-safety/Links to an external site.

       Reply to Comment

  • Collapse SubdiscussionJames Mangrum

    Undeniably nursing is the backbone of modern healthcare. Nurses are the largest cohort of healthcare professionals and provide most of the hands-on day-to-day care (Salmond & Macdonald, 2021). It stands to reason then that when implementing new healthcare systems nurses may be the primary users. Organizations often use a process called the systems development life cycle when planning, implementing and maintaining informatics systems. When organizations choose not to involve nurses in each step of this process, they increase the risk of failure in the system.

    The first step of the SDLC is the planning stage. In the planning stage, organizations decide if there is a need for a new system to achieve their goals. Nurse leaders are essential members of this team as they hold the experience of nursing staff and therefore understand where the values of its members lie. Engagement of nursing staff in the necessity of any system is important because users of a system are much more likely to participate effectively in its use if they share its goals. Nurse leadership must also establish the information and resources necessary to create any integration into the EHR (Major, 2019).

    After the resources and information necessary for the development process have been established, the team must analyze the quality and functionality of the system. Once again, as nurses are often the primary users of such systems their involvement in this step is invaluable. System analysis is required to identify any gaps in the existing products and to assign processes to address these gaps (Mcbride & Newhold, 2016). Much like the planning step, this is an early development stage that is important to establish a base of information and direction for the systems development project. The data obtained in these early stages build a foundation from which everything else will be built therefore it is extremely important to engage the end user such as the nurse to not find significant gaps in knowledge later on in the process.

    The third step in the SDLC is the design process. In this step, the team builds the informatics system using the data obtained from the planning and analysis steps. This is the software design process where IT developers may be the primary actors but it is the responsibility of the nurse informaticists involved in the project to maintain an active role to refine the end user interface to best engage nursing staff as well as maintain the end documentation goal as a priority. Nurse leaders must ensure that the system creates a solution rather than a barrier to documentation issues. When nurses are excluded from the design, the product may develop is cumbersome to use or information input is difficult to navigate (McGonigle & Mastrian, 2022). Furthermore, if a system is difficult to use, users are more likely to not use it or to develop workarounds negating any functionality of the system.

    Implementation is the fourth step in the SDLC, and also one where nurses have the most direct interaction. During this step, the system is put into place and nurses are given the keys to the program. Not only the nurse leader or informaticist must be engaged in this process but the bedside nurse as well. This stage is where the operators of the system will be instructed on its use and will have direct access to provide feedback and recommendations on its installation. Systems operators need to understand systems use and instruction is key as misuse and underuse will limit functionality.

    The final step in the SDLC process is maintenance. Maintaining a system isn’t only the nuts and bolts, however, it is an evaluative and evolving process. As processes change the systems must follow. Nurse informaticists and leaders need to evaluate the effectiveness of the systems as well as their functionality throughout their use. The Agency for Healthcare Research and Quality offers several templates for evaluation throughout the process. One such that I found valuable was the evaluation toolkit (n.d.a). This template sets a list of standards to evaluate any healthcare system against making the process more digestible.

    In conclusion, the involvement and active engagement of all levels of nursing staff in the development of a healthcare system are not only invaluable it is necessary. Nurses have the bedside knowledge to offer an experience that may be otherwise missing in the planning process as well as the awareness of areas in a new system that may bridge data gaps. Nurses are the primary users of many of these systems and therefore must be involved in their processes to increase active engagement, otherwise, there will be a utilization limit. Finally, nurses are required to continue the maintenance and quality control of these systems and are thus the biggest sources of information in their maintenance of them.

     

     

     

     

     

     

     

    References:

    Salmond S., & Macdonald, M. (2021). Invest in nursing: the backbone of healthcare systems. JBI Evidence Thesis. 19(4), 741-744. doi: 10.11124/JBIES-21-00089

     

    Major, D. (2019). Developing effective nurse leadership skills. Nursing Standard, 34(6), 61-66. https://doi.org/10.7748/ns.2019.e11247

     

    McBride, S., & Newhold, S. (2016). Systems development life cycle for achieving meaningful use. In S. McBride & M. Tietze (Eds.), Nursing informatics for the advanced practice nurse: Patient safety, quality, outcomes, and interprofessionalism. (pp. 191–223). Springer Publishing Company.

     

    McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning

     

    Agency for Healthcare Research and Quality. (n.d.a). Health IT evaluation toolkit and evaluation measures quick reference guide Links to an external site. Retrieved January 26, 2022, from https://digital.ahrq.gov/health-it-evaluation-toolkit.

     Reply to Comment

    • Collapse SubdiscussionKara Meghan Knodel

      Response # 2

      Hi James,

      Great post! Nurse’s input during the SDLC process is crucial, as you stated, and can prevent failure in the system. Risling and Risling (2020) state that the SDLC is used by software professionals to refer to the common, sequential phases involved in creating an application or component. While there is no single, definitive template for exactly how an SDLC should be structured, most SDLCs share a core conceptualization. New software development must include gathering requirements, analysis and design, implementation, testing and deployment, and maintenance (p. 230). Including nurses in the development phases of the system can assist in addressing the needs of the staff that will utilize the system for patient care. Nurses simply have a better understanding of what may be more effective as they have a better understanding of the workflow requirements of the frontline staff. Tyler (2016) states that when possible, the informatics nurse will use standardized clinical terminologies and taxonomies as well as decision support tools to support and develop their findings, and they will document their findings, including a well-defined, detailed plan. Ironically, this step can benefit from the use of technology, which the informatics nurse helps implement using visual triggers, automated reminders, and suggestions based on embedded evidence-based practice and best practices (p.29).

      References

      Risling, T. L., & Risling, D. E. (2020). Advancing nursing participation in user-centered design. Journal of Research in Nursing25(3), 226–238. https://doi.org/10.1177/1744987120913590

      Tyler, D. D. (2016). A Day in the Life of a Nurse Informaticist. Journal of Informatics Nursing, 1(2), 29-31. https://www.proquest.com/scholarly-journals/day-life-nurse-informaticist/docview/2303661637/se-2

       Reply to Comment

  • Collapse SubdiscussionLaura Mcbee

    MODULE 5 Main Discussion Post

     

    Consequences of exclusion of nurses in the SDLC

    Purchasing and implementing a new health information technology system can be a big job that requires input from many different disciplines.  An example of purchasing and implementing a new technology in my facility is virtual nursing.  Creating the right team to management system development is key and there are many different methodologies utilized to organize the process such as the waterfall method that includes six phases: feasibility, analysis, design, implementation, testing, and maintaining (McGonigle & Mastrian, 2022).  It is important for nurses to be a constant presence in the development because as end users they provide valuable information on workflows, processes, and needs that may affect each phase differently.   Consequences of leaving a nurse out of the systems development life cycle is a failed launch or sustainability of a project. Virtual nursing implementation will be utilized as the example in this discussion post to better understand how a nurse plays a role in the SDLC phase and provide examples of issues that could arise when the nurse is left out.

    SDLC Phase: Waterfall Method

    In the feasibility phase, how effective the implementation of the project will be at meeting the needs, expectations and goals of the organization will be determined and nurses should play a pivotal role (McGonigle & Mastrian, 2022).  A nurse can provide how their particular need and further explain the outcomes of those needs in patient care delivery because without their input expectations and goals can be left up to the interpretation and leave out vital processes and even identified barriers that need addressed before moving to the next phase.  An issue could be implementing the virtual nursing during the month of May, and without a nursing representative available, there would be little acknowledgement of that being the time where onboarding of new nurses is at its highest of the season making implementation difficult and could cause dis-engagement and an unsuccessful project launch.  The analysis phase is where workflows practices are examined and the design is based off what is analyzed as detailed requirements (McGonigle & Mastrian, 2022).  Leaving out nurses in the analysis phase creates a rippling effect of potential poor design because the product was not designed around key workflows of the nurse.  A challenge in advancing the discussion may be the complexity of the terminology, and the interchangeable use of terms that carry distinct meanings (Risling & Risling, 2020).  Nurses provide valuable information on their workflows but the challenge of articulating this information and having it understood and interpreted could be a problem and it would be beneficial to have an informaticist to collaborate with bedside nurses and bridge the gap from nursing and IT to better facilitate for successful design.  Analyzing the needs for the virtual nurse to have access to the EPIC electronic record would be vital for the IT team to know they will need to implement an application to allow connection between the two applications. The implementation is the phase where the design is brought to life and placed on the chosen application or platform (McGonigle & Mastrian, 20220.  Including a team of bedside nurses and a nurse informaticist will allow for assessment that key elements from the design phase have been implemented in a way that is congruent with needed workflow.   Nurses can provide feedback on whether interpretation of needs in the design phase were carried out accurately on the application.  The implementation phase in the virtual nursing example would be an opportunity for the nurses to assess that the needed applications were present so the virtual nurse and bedside nurse had the ability to access the same patient information.  The test phase follows and the nurse and nurse informaticist to really actively walk through the process.  At our organization a “play site” is activated through our IT to attempt to carry out a practice running of the live process.  As the phases continue, it is easier to understand the involvement of the nurse, especially in the test and maintain phase, but without the nurses input in the beginning, the phases would get halted and re-started due to the high possibility of finding workflow inadequacies and problems that could be avoided with the input of nursing and clinical members.  Maintaining the software and its functionality and success requires a team approach and support.  To maintain the project and yield successful outcomes, it is important to clearly identify and document success of the organization at baseline before implementation is vital to ensuring the growing and continued success of a project implementation (AMA, 2022).

    The Benefits of Including Nurses

                Inclusion of nurses in the decision making process for implementing new technology advancements is vital for not only the success of implementation but for the improvement of patient outcomes.  Technology is advancing rapidly and it is imperative nurses reconcile that nursing informatics is nursing and that every nurse has a role to play in the collective digital health future and the positive outcomes of patient health (Risling & Risling, 2020).

    Personal Inclusion and Impact on Decision Making

    The implementation of virtual nursing in our organization has posed to be a large undertaking and though nursing informaticists and nursing leadership has been involved heavily; I have found that the inclusion of some specialties such as infection prevention have been over looked.  Currently we are in the implementation phase and when discussed in the last quality meeting, executive leadership asked directly how virtual nursing can support infection prevention in healthcare associated infection efforts.  The workflow and key elements of my role was not assessed and now we have found that we are back tracking to ensure that I have the ability through our EMR to identify the virtual nurses from bedside nurses to better facilitate communication.

     

    References

    American Medical Association. (2022). Telehealth Implementation Playbookhttps://www.ama-assn.org/system/files/ama-telehealth-playbook.pdfLinks to an external site.

    McGonigle, D., & Mastrian, K. G. (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 Nursing25(3), 226–238. https://doi.org/10.1177/1744987120913590Links to an external site.

     Reply to Comment

  • Collapse SubdiscussionRowan Wicks

               The systems development life cycle (SDLC) is being used in healthcare to advance an idea or design to implementation. SDLC can be very beneficial is ensuring a smooth transition to a new system or an advanced system. When SDLC is done properly, costly mistakes can be avoided and the transition for all users is smoother. When healthcare organizations do not involve all parties of a system it can be detrimental to the growth and usability of the new system. When starting the initiation and concept phase, Singletary & Baker (2019), stated that “public health agency staff must stay involved to ensure that the system under development satisfies requirements and conforms to security needs” (p. 611). Without involving the proper staff, the likelihood that the ability of staff to use the technology successfully with be significantly lower.

    Once the planning phase has begun it becomes important that nurses remain involved so that input and feedback can be given. The involvement of staff at phase three, requirements definition, allows for the system to be properly developed into a program that meets the needs of the organization. Without the use of staff, the system can be developed poorly due to the lack of feedback. This leads to a system that does not provide all of the necessary foundations needed to properly use the system. This can be costly because at some point the organization will need to go back to step one and modify the system for what is needed. During the design and development is it critical that staff remain involved to ensure the system is capable of what is needed. Without the involvement of staff, it is expected that the program will be lacking necessary tools.

    Once testing is started, again it remains important to keep staff a part of the process. The users should be the ones testing the system to ensure any issues can be weeded out. If staff has been involved in the testing they can then become super users when it comes to training and implementation. This allows for an easier transition for all staff when there is someone who can show them the ropes of the new system. SoftwareSix (2018), reported that “To ensure long-term and operational success, company-wide communication and feedback must be recognized” (para 6). To not involve nurses in the implementation of a new system is to increase the risk of unexpected costs and patient care or medication errors. Additionally, it reduces safety as well as nursing engagement since there is no involvement. Qin et al. (2017), reported that “user participation, better tools for modelling the relevant healthcare processes and better management of the development project are recommended to reduce the risks for HIT failure” (p. 2).

    Currently at my healthcare facility there are no new health information technologies or any current ones in place. There is talk that within the next five years there will be electronic health records being implemented. If I am a part of this facility at this time, it will be my goal that I be an integral person in the design and implementation of the new service. Without the use of the nursing staff when enacting the new service would be detrimental because we are a small facility. Yet, there are those in administration who do not know the day-to-day work of our inpatient facility. Without the use of staff, the technology could either be too simple or advanced for our needs. Therefore, it becomes crucial that when the service does come to play, that nursing staff is being involved to ensure minimal issues.

    References

    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(165), 1-12. https://doi.org/10.1186/s12911-017-0569-3

    Singletary, V., & Baker, E. L. (2019). Building informatics-savvy health departments: The systems development life cycle. Journal of Public Health Management & Practice, 26(6), 610-611. https://doi.org/10.1097/PHH.0000000000001086Links to an external site.

    Softwaresix. (2018, May 7). The application of SDLC in the healthcare industry. https://www.softwaresix.com/blog/sdlc-healthcare-applications/

     Reply to Comment

    • Collapse SubdiscussionAlicia Brooke Richardson

      Rowan,

      I have the same issues you have. There are currently no new health information technologies or any current ones in place. At my part-time job, I get to experience the technologies, but I wish my full-time job would catch up and get the EHR at least.  The consequences you mentioned in each stage verify the importance of having the end-user’s input in every step of the implementation as evidenced by a study conducted by Bano & Zowghi (2015) where 87 studies resulted in the project success by involving the end-users all throughout the SDLC. With your current systems being slowed down by decision-making vision-making regarding the right hardware for implementation involves the interprofessional team and should include management, users, and systems analysts in the information technology (IT) sector (Mcbride & Tietze, 2019).  This shows that all nurses should have input into all new technologies put into place.

      References

      Bano, M., & Zowghi, D. (2015). A systematic review on the relationship between user involvement and system success. Information and Software Technology, 58, 148-169. https://doi.org/10.1016/j.infsof.2014.06.011

      McBride, S., & Tietze, Mari. (2019). Nursing informatics for the advanced practice nurse: patient safety, quality, outcomes, and interprofessional. New York, NY: Springer Publishing Company

       Reply to Comment

    • Collapse SubdiscussionLaura Mcbee

      Module 5 Discussion Response 1

      Hey Rowan,

      I certainly think you are a big asset to your facility if they do implement an electronic medical record or anything in the near future.  Your discussion identified key elements that are needed at each stage and how the systems future is largely in the balance of proper inclusion during the implementation of new technology.  A nurse is very patient driven when making decisions and organizations must understand a nurse’s value when implementing new healthcare technologies.  If technology is purchased by an organization because of its appeal from a healthcare technology perspective but requires the end user to perform numerous steps, the patient experience may be disrupted and patient care even delayed (Denham & Matthews, 2018).  Collaboration and communication is vital in the day to day operations and especially during the implementation of a new healthcare technology that touches so many disciplines.  A healthcare technology professional is an expert on how to integrate the technologies and optimize their use and the nurse may be an expert on the clinical environment that the medical device will be used which is why it is so important to close the loops of communication by collaborating with different disciplines that will be affected by the new technology (Denham & Matthews, 2018).  Because you are in a small facility, I am sure cost is a factor for implementing new technologies such as an EMR.  It would be important to research options for implementation and choose a company that is able to adapt to the needs of a small facility and provide support for implementation as well.  The decision of vendor in your case would provide its own challenges.  When organizations begin to research companies it would be beneficial to look for companies that provide clinical end-user training and a simple and less expensive options such as virtual simulation training that is interactive with the clinical team (Devers, 2018).  Nurses would certainly play a vital role in this and could be better tailored to clinical schedules and promote a more successful implementation.

      References

      Denham, N., & Matthews, B. (2018). Nursing Underscore Value of Collaboration when Implementing Health Technology. Biomedical Instrumentation & Technology, 52(1), 32-36. https://doi.org/10.2345/0899-8205-52.1.32Links to an external site.

      Devers, V. (2018). Use of Simulation-Based Training to Aid in Implementing Complex Health Technology. Biomedical Instrumentation & Technology, 52(1), 44-48. https://doi.org/10.2345/0899-8205-52.1.44Links to an external site.

       Reply to Comment

  • Collapse SubdiscussionShannon Marlar

    Week 9 Main Discussion

    The SDLC is widely used in the industry for information system design and implementation. The system development life cycle is a project management model that defines the stages involved in bringing a project from inception to completion (Singletary & Baker, 2019). The company I work for has an IT department that assists in all aspects of technology. When a new program is brought on board, there are virtual training sessions available for staff. Also, there are tutorials available for all those who have issues using new technology. The use of the standard SDLC has become a best practice in many public health agencies across the nation as they design and develop information systems central to agency operations. By adhering to this proven approach, public health agencies have avoided costly information system disasters with attendant disruption of operations. Furthermore, by adopting the SDLC approach, agency staff have gained the knowledge and know-how to be full partners with IT staff in the design and development of information systems, thereby ensuring that new systems better meet the needs of the agency (Singletary & Baker, 2019). Nurses are the backbone of healthcare and when they are not involved in the design and decision-making processes of the Systems Development Life Cycle the results can be catastrophic. According to the author (Weckman, 2009) nurses are the frontline and chief users of electronic health record (EHR) systems, it only makes sense they’d have a major say in EHR design and upgrades. Unfortunately, however, in many facilities, EHR design is left primarily to IT and only minor input is taken into consideration from the nursing staff. When subject matter experts, such as nurses, don’t have autonomy and responsibility within the design process, implementing and utilizing an EHR can take longer because providers are distanced from the outcomes (Stanley, 2017).

    When nurses are included in technology design, it enables and enhances safety (Curry & Tracy, 2007). A study was done in 2009 on early nursing involvement during the implementation of a Bar Code Medication Administration (BCMA) system (. The authors of this study describe how nurses participated in the early design, planning, implementation, and evaluation phases of the BCMA. The study found that the benefits of early nursing involvement in each phase of BCMA technology greatly outweigh the problems that can arise from early nursing involvement (Weckman, 2009). This study found that in order to find success when implementing new technologies, it is essential that nurses be involved throughout all phases of the process. Comments and feedback from nurses provide the necessary clues that are needed to resolve underlying systemic issues and can offer possible resolutions. Evaluations at my facility are completed by all new employees unanimously regarding training and orientation. Together, nurses can facilitate change in how we learn new technology.

    References

    Curry, J. M., McGregor, C., & Tracy, S. (2007). A systems development life cycle approach to patient journey modeling projects. Studies in health technology and informatics129(Pt 2), 905–909.

    Singletary, V., & Baker, E. L. (2019). Building Informatics-Savvy Health Departments: The Systems Development Life Cycle. Journal of public health management and practice : JPHMP25(6), 610–611. https://doi.org/10.1097/PHH.0000000000001086Links to an external site.

    Stanley, D. (2017). Clinical nursing and healthcare leadership: putting beliefs into action (2nd ed.). John Wiley & Sons, Ltd., Hoboken, NJ. Discussion: Nurses’ Inclusion in the System Development Life Cycle
    Consequences of a Healthcare Organization not Involving NursesLinks to an external site.

    Weckman, H., Janzen, S., (2009) “The Critical Nature of Early Nursing Involvement for Introducing New Technologies” OJIN: The Online Journal of Issues in Nursing, Vol. 14, No. 2, Manuscript 2. DOI: 10.3912/OJIN.Vol14No02Man02

    https://doi.org/10.3912/OJIN.Vol14No02Man02Links to an external site.

     Reply to Comment

    • Collapse SubdiscussionCourtney Britten

      Response #1: January 26th, 2023

      Shannon, 

      The Systems Development Life Cycle (SDLC) is a project management model that organizes the process of project development into four stages which are planning, design, implementation, and maintenance/evaluation (Walden University, 2018). Nurses should be involved in each phase of the cycle serving as advocates for patients and front-line staff, as well as, to ensure that workflow efficiency is maintained. Because the IT department are not front-line staff they could not possibly consider and understand all workflow processess. To determine how implementation would benefit from including nurses, a research team conducted a survey to determine the success rate of implementation with and without nurse involvement. The results indicated “an 83% higher success rate of EHR adoption” when nurses were involved (Continuum, n.d., para. 6). Some specific ways that nurses can be useful throughout the cycle includes serving as advocates for HIPPA, providing information on routine charting procedures and requirements, and by recommending the software be easy to access and use with included features that increase the efficiency of charting (Continuum, n.d.). Nurses can serve as “super users” who train and assist other staff, even doctors, on the new software and update the project team with issues that need to be addressed within the system.

      At the hospital I work at, I have experienced annoying organization issues within epic after updates. One recent update put the hourly rounding on the bottom of the flowsheets (it had previously been at the top), accidentally eliminated the charting for meal percentage, and eliminated the option to chart “ambulation” or “medication” under the VTE prevention flowsheet. Me and several others reported the issues to our education manager on the unit. She then updated those above us. The meal percentage charting was reinstated but the other issues unfortunately still remain.

       

      References 

      Continuum. (n.d.). What role should nurses play in EHR implementation? https://www.carecloud.com/continuum/what-role-should-nurses-play-in-ehr-implementation/Links to an external site.

      Walden University, LLC. (Producer). (2018). Managing Health Information Technology [Video]. Baltimore, MD: Author.

       Reply to Comment

    • Collapse SubdiscussionYetunde Adeola Adewoyin

      Response #2
      Hello Shannon,

      I appreciate your post. You did a great job sharing the importance of using Systems Development Life Cycle (SDLC) approach in developing a new system of Health Information Technology (HIT) in an organization. I agree with you that the use of SDLC approach, and the involvement of nurses in every stage of the new system have proven to prevent system disaster after implementation stage, which can be cost greatly to organizational operations.  The life cycle approach in software development provides a methodology for enhancing the quality of software applications in an organization. The benefits of SDLC in system development can be achieved if the developers, such as the Information Technology Specialist in an organization understand end user’s needs, and also follows the plans that has been set up to meet these needs.
      You also shared in your post the challenges that may arise from not including nurses’ voices in decision making process. Nurses should be included in all steps of SDLC and need to pilot the system from the planning to the implementation stage. Nurses are the primary users of HIT, and it is reasonable to include them in all decision-making processes (Dennis, 2020). The implementation of a newly developed healthcare information technology is not always successful because nurse and other users of HIT are not always involving in the change process, especially at the planning and designing phase of SDLC (Hammer & Cipriano, 2013). The inclusion of nurses in each step of SDLC will stimulate the commitments of nurses, and also help to improve the engagement of nurses in using the new system to help patients in their care. The use of SDLC approach will also help nurses to focus their time and energy on the successful implementation of the new system (Cherry & Jacob, 2016).

      References
      Cherry, B., & Jacob, S. (2016). Contemporary nursing: issues, trends, & management. Amsterdam: Elsevier Health Sciences.

      Dennis, I. (2020). Consequences of a healthcare organization not involving nurses. Nursing Experts. Retrieved from https://nusingexperts.org/consequencies-of-a-healthcare-organization-not-involving-nurses/.

      Hammer, S., Cipriano, P. (2013). Involving nurses in developing new technology. Nursing Times; 109: 47, 18-19. Retrieved from https://www.nursingtimes.net/clinical-archive/healthcre-it/involving-nurses-in-developing-new-technology-22-11-2013/.

       Reply to Comment

    • Collapse SubdiscussionConor Westerman

      Hi Shannon,

       

      Your post highlights how important it is to include nurses in each phase of the SDLC. The study by Curry enforced that nurses’ involvement in the cycle outweighs the potential complications. This highlights that organizations should be using nurses more when implementing their new technology. Many times Nurses’ input is not valued and this truly is a detriment in healthcare.

      Nurses should be involved directly with IT teams in the planning and management of healthcare software. The study from the Journal of public health management and practice demonstrated that nurses can work directly with IT teams in developing software (Curry & Tracy, 2007). Having nurses work closely like this would eliminate confusion and ensure that the system would be efficient for daily use. It is essential that nurses be involved in each step of the SDLC to help identify issues that would arise with the systems that you identified in your post.

       

      Thank you

       

       

       

      References

       

      Curry, J. M., McGregor, C., & Tracy, S. (2007). A systems development life cycle approach to patient journey modeling projects. Studies in health technology and informatics129(Pt 2), 905–909.

       

      Singletary, V., & Baker, E. L. (2019). Building Informatics-Savvy Health Departments: The Systems Development Life Cycle. Journal of public health management and practice : JPHMP25(6), 610–611. https://doi.org/10.1097/PHH.0000000000001086Links to an external site.

       

      (Singletary & Baker, 2019)

       Reply to Comment

  • Collapse SubdiscussionYetunde Adeola Adewoyin

    MAIN POST

    The Inclusion of Nurses in the System Development Life Cycle (SDLC)

              SDLC is a guiding framework that is primarily used for the development of information systems. SDLC involves five steps of Planning/Analyzing, Designing, Implementation, Evaluation, and Maintenance. Nurses are involved in direct patient care and responsible for most of the data collection related to patient care. Nurses should be encouraged to be actively involved in the change process regarding healthcare technology implementation and appropriate resources.

    Nurses’ integral role in the process of selecting and implementing a new hospital information technology is essential to the success of the system. The steps in System Development Life Cycle (SDLC) are essential in selecting information technology system that is suitable for the organization (McGonigle & Mastrian, 2017). Defining the role of nursing in each of these steps clearly indicates the significance of input from the hospital’s largest user group.

     Planning/Analysis

             Planning is a critical phase of defining the problems, providing the direction of the project, explore solutions, feasibility test, and project development. The role of nurses at this phase of developing a new healthcare technology is to provide information regarding their experience on the challenges and benefits of using the existing information system. Nurses are best placed in critical systems challenges in collecting, assessing, storing, retrieving and using the information within the existing information system. Analyzing the development of new healthcare information technology involves reviewing organizational policies, generating alternatives, and prioritizing requirements for healthcare technology system. This step is vital to ensure the new system meets the needs of the organization, and avoids errors, prevents delay, and break in communication (McGonigle & Mastrian, 2017).

    Design

               This stage identifies the most relevant user interface, databases, hardware, software, and how all aspects of the Health Information Technology (HIT) system can integrate into an effective and efficient whole. Designing is a critical stage at which the team members determine what data is essential and required for the organization. Nurses play a crucial role in proposing specific operational mechanism that should be incorporated into the new healthcare system to enhance performance. Nurses are involved in guiding the HIT specialist on the appropriate and vital data needed as they are knowledgeable as to what data is necessary relating to patient care.

     

    Implementation

    In this phase, the organization configures and enables system security features, tests the functionality of these features, installs, or implement the system, and obtains a formal authorization to operate the system. Nurses have an expertise and a perspective that can be helpful during the implementation phase of a new system. For instance, the Bar Code Medication Administration (BCMA) system is used mostly by nurses, therefore the input and expertise of nurses is important in every step of healthcare technology development. According to the study conducted by Weckman and Jazen (2009), lack of nurses involvement in system implementation could result in the development of flaws and resulting in high cost.

    Evaluation

    This step involves evaluating the functionality of the system. The real and perceived usefulness of technology influences its application (Yen & Bakken, 2012). At this phase, the system is tested and evaluated to ascertain the effectiveness of the new system. The role of nurses during this phase is to assess the new system by using it to perform daily duties of data collection and empty, and establish of the system is user friendly or not.

    Maintenance

    Maintenance of the new system involves the organization collaborating with the Health Information Technology Specialist and developer in identifying and fixing any problem that may arise from the new system. Nurses role is to report any problem that may arise from the use of the new system to the organization Information Technology Specialist, who will in turn initiate corrective and preventive measures. The system is also modified as needed in this phase to better serve the user.

    Conclusion

                A System Development Life Cycle (SDLC) provides a standard project management framework that can improve the quality of information systems. Nurses facilitates the end product of the SDLC process, so as to make the new system user friendly, and be easily embraced by all healthcare providers. Nurses are to be involved in each step of SDLC for improved functionality of the system. Nurses are experts and involving nurses in the development of new healthcare technology system provide the information technology specialist with the understanding of how effective the new technology will be (Weckman & Janzen, 2009). Successful implementation of Electronic Health Information Technology (EHIT) depends on the extent to which nurses, as majority end-users are engaged throughout the systems development life cycle (McLead et al., 2015).

     

    References

    McGonigle, D. & Mastrian, K.G. (2017). Nursing Informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett.

    McLead, A., Frisch, N., & Roudsari, A. (2015). Nursing’s voice in Healthcare IT Acquisition Decisions. Canadian Journal of Nursing Informatics, 10 (3), 1-24.

    Weckman, H.N., & Janzen, S.K. (2009). The critical nature of early nursing involvement for introducing new technology. Online Journal of Issues in Nursing, 14(2), 1-11. https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=time&db=rzh&AN=105264473$site=eds_live$scope=siteLinks to an external site.

    Yen, P. Y., & Bakken, S. (2012). Review of health information technology usability study methodologies. J. AM Med inform Assoc, 19 (3), 413-422

     

     Reply to Comment

  • Collapse SubdiscussionConor Westerman

               According to research, nurses can have unique input on making a healthcare system such as an EMR, more user-friendly (McGonigle & Mastrian 2022). I have experienced this recently as a lead trainer on my healthcare organization’s new EMR. I believe it has been extremely helpful to be involved in the implementation of our new EMR as I have been able to discover a few pieces that can be improved, and the IT team has gone back and fixed those issues. I also was able to use the system prior to launch to familiarize myself with it before employing it with my patients. A consequence of not involving Nurses in the SLDC is that the system may not satisfy the needs of the patient and can result in the loss of information or the need to implement paper systems to track patient information. Not involving Nurses could also alienate the healthcare team and make them feel unvalued in their current role.

            Software development and healthcare advancement are two subjects that are married together. As technology becomes more intelligent, more efficient, and more available, the healthcare system can decrease workload and improve patient outcomes. The system development life cycle (SDLC) should most definitely involve nurses as a resource in each stage as their experience on the frontlines and working knowledge of health information technology is a vital resource.

    References

    McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of

          knowledge (5th ed.). Jones & Bartlett Learning.

     

    Walden University, LLC. (Producer). (2018). Managing Health Information

         Technology [Video file]. Baltimore, MD: Author.

     

    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.2019.02.003Links to an external site.

     Reply to Comment

  • Collapse SubdiscussionGina Phillips

    Gina Philliips

    Initial post.

     

     

    The development of electronic records nationwide has really enhanced the way nurses practice and the way they improve the care for their patients.  It is also used greatly in research and the fact that it uses data to access and used best evidence-based practice in the clinical settings.  The use of SDLC which is a systems development life cycle that is used to deliver efficient and effective information system.  The system is used to develop an organize way to develop a system that understands problems and knows the business needs, the next step in the system is to understand a solution and how to evaluate and implement changes.

     

    To implement an SDLC implements an effective information systems (ISs), for example to develop this in the healthcare system for a hospital organization the first thing they look at is the mission of the hospital and the needs of the organization.  The best way to implement this will mean to get all stakeholders involved, meaning staff physicians, nurses and also assistive staff.  It is important for staff to be involved in this decision, because they will be the ones to work with the new implemented system, it is also important for nurses to know what changes will be implemented, since this will affect outputs for earlier phases of changes in the system.  For example, implementing a new system application and not consulting the nurses will mean dissatisfaction and not making the workflow user friendly, for instance in my institution IT sometimes changes the features in EPIC without even getting the staffs opinion on how this will work better for them or how it will affect the workflow.   I have never been asked for input in any of the SDLC in my institution.

     

    Organizations should consider the value of the staff’s opinion because according to McGonicle and Mastrian the success of a project is often directly related to how the organization makes their decision, meaning how well they plan is followed and documented, also the amount of creating involvement of integrating and interoperable system will define how healthcare does in the future.

     

    Reference:

    Agency for Healthcare Research and Quality. (n.d.a). Health IT evaluation toolkit and evaluation measures quick reference guide Links to an external site.Links to an external site.. Retrieved January 25, 2023, from https://digital.ahrq.gov/health-it-evaluation-toolkitLinks to an external site..

    Agency for Healthcare Research and Quality. (n.d.b). Workflow assessment for health IT toolkit Links to an external site.Links to an external site.. Retrieved January 25, 2023, from https://digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkitLinks to an external site..

    McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

     Reply to Comment

    • Collapse SubdiscussionKyle Hickman

      Gina,

      Thank you for your informative post. I can agree with you that the best method for implementation of any new system or policy is to have as many interested parties involved as possible. Braithwaite (2018) shares the viewpoint that healthcare changes frequently over time and ultimately cannot be understood knowing the specific individual pieces. Oftentimes, when something new is introduced in healthcare, there are multiple factors that lead to unintended consequences and cause issues with the change. Healthcare constantly requires changes and adjustments to better care for the population. Sittig et al. (2018) discusses how there is much that has been improved and is known about health informatics but there still is much to learn and much to do. Unfortunately, there is not a perfect solution for implementing changes and adjustments will always need to be made continuously to better assist in the care of patients.

      References

      Braithwaite, J. (2018). Changing how we think about healthcare improvement. BMJ 361. doi: https://doi.org/10.1136/bmj.k2014

      Sittig, D. F., Wright, A., Coiera, E., Magrabi, F., Ratwani, R., Bates, D. W., & Singh, H. (2020). Current challenges in health information technology-related patient safety. Health informatics journal26(1), 181–189. https://doi.org/10.1177/1460458218814893

       Reply to Comment

    • Collapse SubdiscussionRowan Wicks

      Gina,

      Thank you for your discussion response! I agree that healthcare organizations should always consider the value of their staff’s opinion. This is because without the staff being heard or valued, they can leave and then the organization will be left with no support. It is too bad to hear that you have never been asked for any additional input at your place of work. Where I work, we do not have any healthcare technology, but they do plan to implement a new system in the next couple years. I would expect that they would ask because as workers it is important that we be involved and are valued. Without consulting with staff, it makes them feel undervalued. In order to create a successful implementation of new technology it is important to recognize the value of all staff and their feedback (Agency for Healthcare, n.d.). Additionally, McGonigle & Mastrian (2022) reported that the success of a new task or project is usually correlated with how the organization makes their decisions. Therefore, if an organization bases their beliefs around including everyone, the likelihood of the success of the organization is much higher because everyone is working together as a team rather than against one another.

      References

      Agency for Healthcare Research and Quality. (n.d.). Workflow assessment for health IT toolkit. Retrieved January 28, 2023, from https://digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkitLinks to an external site.

      McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

       Reply to Comment

  • Collapse SubdiscussionKara Meghan Knodel

    Main Post 

    Systems Development Life Cycle (SDLC) Steps

    McGonigle and Mastrian (2022) state that the SDLC is a way to deliver efficient and effective information systems that fit with the strategic business plan, which stems from the organization’s mission. In the world of healthcare, the development of information systems includes a needs assessment of the entire organization, which should include outreach linkages and partnerships and merged or shared functions. The organization’s participating physicians and other ancillary professionals and their offices are included in a thorough needs assessment (p. 191-192).

     

    The Rapid Application Development model sparks particular interest. The significant advantage of this model is that it can be executed within three months. This model has milestones coinciding with one another, unlike the Waterfall model, where each phase is completed thoroughly prior to moving on to the next phase. Analysis and quick design is being built while testing and implementation are also active. Three phases, including the build, demonstrate, and refine phases, are constantly pushing content out. McGonigle and Mastrian (2022) state that one of the most significant disadvantages to this model is that once it is locked into a tight development schedule, the process may be too fast for adequate testing to be put in place and completed. The most dangerous lack of testing is in the realm of security (p. 197).

     

    Purchasing and Implementing a New Health Information Technology System

     

    The process of implementation has been observed to include mostly administration staff. Until recently, my organization did not have a nurse informaticist. Not having a nurse informaticist is a significant ramification in system development. This disadvantage made it challenging to execute the new programs. Without the input of a nurse informaticist, there was much missing content, and processes were not thought out at the nursing level. This delayed the launch and resulted in the administration frequently returning to the hypothetical drawing board to revamp the program to better suit the frontline staff’s needs.

     

    Cresswell et al. (2013) state that the hope is that the very substantial financial, human, and organizational investments being made in electronic health records, electronic prescribing, whole system telehealth care, and related technologies will streamline individual and organizational work processes and thereby improve the quality, safety, and efficiency of care. The reality is, however, that these technologies may prove frustrating for frontline clinicians and organizations as the systems may not fit their usual workflows, and the anticipated individual and organizational benefits take time to materialize (p.9). When implementing a new program, it is crucial to choose a system that meets the organization’s needs while ensuring that staff is trained appropriately and the system flows well.

     

    The Role of the RN in Implementation

     In the RAD (Rapid Application Development) model discussed above, the nurse informaticist would be beneficial during many stages. Throughout the stages of building, demonstrating, and refining the program, the nurse informaticist enables a seamless flow between the information systems and the healthcare personnel utilizing these systems. Lenz et al. (2022) state that clinical processes are characterized by a high degree of communication and cooperation among physicians, nurses, and other groups of personnel (p. 571).

     

    Analysis and Quick Design Phase

    The nurse’s role during this stage is relative to analyzing the workflow of the nursing department. The nurse provides input to the information systems members, allowing them to determine what the organization needs.

     

    Testing Phase

    The nurse’s role during this stage is to test the program in real-time with test patients and testing staff within the system. When a barrier is met, the nurse can stop the process at any stage, bring the concerns back to the team, and refine the errors. After the errors are addressed, the nurse informaticist would test the program once again until the glitches are cleared, and the workflow is appropriate.

     

    Implementation Phase

    All the team members are vital in this stage, but the nurse informaticist now presents the program to the end-users. Training begins with the superusers of the organization. This may include tech-savvy nurses or those in management positions that would utilize the program functions differently. End-user training would take place in the form of meetings and one-on-ones for less tech-savvy people. In the first two weeks after implementation, the superusers would sign up to be on-call to support staff working alternating shifts. The nurse informaticist would also ensure their availability during work hours and provide one-on-one training.

     

    References

    Cresswell, K. M., Bates, D. W., & Sheikh, A. (2013). Ten key considerations for the successful implementation and adoption of large-scale health information technology. Journal of the American Medical Informatics Association20(e1), 9–13. https://doi.org/10.1136/amiajnl-2013-001684

    Lenz, R., Elstner, T., Siegele, H., & Kuhn, K. A. (2002). A practical approach to process support in Health Information Systems. Journal of the American Medical Informatics Association9(6), 571–585. https://doi.org/10.1197/jamia.m1016

    McGonigle, D., & Mastrian, K. G. (2022). Nursing Informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

     Reply to Comment

    • Collapse SubdiscussionKyle Hickman

      Response #2

      Kara,

      Thank you for your informative post. It is unfortunate when management does not include the rest of the healthcare team when creating and implementing new systems. As you said, it delays the release and lowers quality as it benefits just a small part rather than the whole facility. Benedictis et al. (2020) researched the implementation of new electronic medical records and found that as management finds use for staff, such as implementing super users, they can better facilitate and motivate needed changes. Having managers who are able to facilitate change are necessary for organizations. Essentially, change is the only constant (Fusch et al., 2020) and managers who are able to adapt and use all the resources at their disposal can benefit their patients and staff at a much higher level. Easing transition towards new technologies can also help staff build trust in their management and trust that management has their best interest in mind.

      References

      Benedictis, A., Lettieri, E., Gastaldi, L., Masella, C., Urgu, A., Tartaglni, D. (2020). Electronic Medical Records implementation in hospital: An empirical investigation of individual and organizational determinants. https://doi.org/10.1371/journal.pone.0234108

      Fusch, G., Ness, L., Booker, J., Fusch, P. (2020). People and Process: Successful Change Management Initiatives. Journal of Social Change. 12 (1)166-184. Doi.org/10.5590/JOSC.2020.12.1.13

       Reply to Comment

    • Collapse SubdiscussionFlorah Deann Tackett

      Response #2

      Hello Kara,

      Your post was informative. My healthcare organization has a nurse informaticist that is involved when new technology is implemented. My organization also has super users on each inpatient floor that help train nurses and are there for any questions. Bringing on the right members when implementing systems is vital (McGonigle & Mastrian, 2022). Once you have the correct members in place, they will be able to recognize and organize the steps of the system development better (Agency for Healthcare Research and Quality, n.d.).

       

      References

      Agency for Healthcare Research and Quality. (n.d.). Workflow assessment for health IT toolkit. Retrieved January 26, 2022, from 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 (5th ed.). Jones & Bartlett Learning.

       Reply to Comment

  • Collapse SubdiscussionPatrick R King

    Initial Post

    The idea behind a Systems Development Life Cycle (SDLC) is “to deliver efficient and effective information systems” for healthcare systems (McGonigle & Mastrian, 2022). Nurses are the frontline workers within the healthcare industry and utilize electronic health records (EHR) and other systems, yet some organizations do not include nurses in the SDLC process. This comes with the consequence of creating systems that are not efficient as planned, not user friendly, and cause nurses to spend more time documenting within the system rather than focus on patient-care interactions. If a system is not designed and implemented properly, nurses will see an increase in time required for task documentation (Eichstädter et al.,2001). This is the opposite of the goal SDLC’s are supposed to address. This can be mitigated by involving nurses in every stage of the SDLC.

    The SDLC process consists of four stages: Planning, Design, Implementation, and Maintenance/Evaluation. According to Dr. Kevin Johnson, these four stages are part of a cycle, meaning there is constant revision and revisiting to these stages (Walden University, 2018). Each stage has potential issues that can be solved by having a nurse involved. The creators engaged in the Planning stage may create something that they believe will make the work more efficient, but it is not. With planning, a nurse can assist in addressing the biggest potentials in barriers of efficiency or what would be most beneficial for those utilizing a new system. The nurse will address the problem that needs attention or will provide input into important features they wish to be included if a new system is being developed. Designing a new system can prove challenging if the creators believe it is “perfect.” Nurses can assist in designing the new system to make it more user-friendly and to avoid potential problems in navigating the system. This will increase efficiency for nurses if it takes the click of a few buttons to find lab values as compared to diving into different aspects of the system to find these values. Then, nurses can help implement the system by encouraging and teaching other nurses and other employees how to best utilize the system. This will help the new system reach its full potential and used the way it was intended. Without the proper education and overall positive consensus, a new system can be implemented and neglected within a short timeframe. Lastly, nurses can assist in the evaluation stage by providing the feedback they have from interacting with the new system in a real-time. The developers are not the ones talking with patients and putting the information into the new system, so it is difficult for appropriate maintenance and evaluation to be performed by these individuals. Nurses can provide the most accurate and necessary feedback to help further evolve the system or scrap it completely. When healthcare technology implementation is not successful, it is most likely because of the omission of nurses and other frontline workers in the development process. Nurse leaders are a necessity in the “debate over appropriate technology and resources” (Hamer & Cipriano, 2013).

    Personally, I have not had any input or the opportunity to get involved in the selection of new health information technology systems. The system my organization uses has been used for many years and there are no plans to develop a new system. However, the closest example I can use, while not involving nursing practice or organizational processes, is a change to a work schedule application we use. This application started being used in late 2020 and was used for scheduling extra shifts or requesting days off. An employee’s paid time off was also visible and can be easily accessed for use. Within the last eight months, a new update rolled out that took away the ability to schedule extra shifts, request days off, or even view paid time off hours. Shift members could also be seen with one click, but now it takes three clicks to see who is working a shift. I sent a message to the developers stating essentially, they have made the application harder to use and less efficient for the needs of the employees. I suggested they should have used a focus group because I didn’t have a single peer who thought the update was an improvement. Naturally, I did not receive a reply, but if they had someone who was a nurse be involved, it would not be as bad as it is.

    References:

    Eichstädter, R., Haux, R., Pohl, U., Rebel, S., Ziegler, S., & Ammenwerth, E. (2001). A randomized evaluation of a computer-based Nursing Documentation System. Methods of Information in Medicine40(02), 61–68. https://doi.org/10.1055/s-0038-1634465

    Hamer S, Cipriano P (2013) Involving nurses in developing new technology. Nursing Times; 109: 47, 18-19.

    McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed., p 191). Jones & Bartlett Learning.

    Walden University, LLC. (Producer). (2018). Managing Health Information Technology [Video file]. Baltimore, MD: Author

     Reply to Comment

    • Collapse SubdiscussionDeanna Linn Howe

      Hi Patrick and all,

      I appreciate your comments to this week’s discussion post.  It appears that when there is no system development life cycle or plan in place, frustrations can certainly be felt by not only you but all staff.  If there are nursing work groups in place to provide input, will the end product be better received by nursing staff?  How can you and colleagues have your voice heard moving forward? How would you let administration know of the importance of inclusion of staff nurses? Thanks. Dr. Howe

       Reply to Comment

  • Collapse SubdiscussionFlorah Deann Tackett

    Main Post

    Systems Development Life Cycle and Involving Nurses

    The systems development life cycle (SDLC) is the process of delivering an information system that is well organized and effective that will align with the plan of the healthcare organization (McGonigle & Mastrian, 2022). There are different models of the SDLC, but the main concept stages are Planning, Design, Implementation, and Maintenance. (McGonigle & Mastrian, 2022). In the planning stage, there are changes to help the new system stay afloat. When the healthcare organization fails to involve nurses in all the stages of the SDLC when getting a new system, this can lead to several problems.

    Planning

                The planning stage also called the feasibility stage, is where the healthcare organization developers plan for the project. If nurses are not involved in this stage, it will lead to losing the interest and trust of the nurses. Healthcare organizations involving nurses in this stage would gain their interest and trust in the new system.

    Design

                The design stage is when the healthcare organization developers have all the required information for the new system. If nurses are not involved in the design stage, the developers will not be able to see if the new system information goes along with what healthcare professionals need. Involving nurses in this stage would do away with this problem. Nurses can also see if the new system is user-friendly.

    Implementation

    The implementation stage is the stage that occurs after the system has been accepted. If nurses are again not involved in this stage, it can lead to a slower workflow. Involving nurses will decrease this issue, and nurses will understand the new system better.

    Maintenance

                The new system will be monitored and updated in the maintenance stage. If nurses are not involved in this stage, they will not be aware of what to expect with upgrades and updates, which could slow the workflow. Nurses need to be involved with all the updates to the new system.

    Conclusion

    I have yet to have any input with selection and planning in my healthcare organization. However, I am new to the organization. My organization does get the opinions of the nurses. The healthcare organization will have better outcomes if nurses are included in the decision-

    making process Healthcare organizations would gain the nurses’ trust and be more accepting of the new system. Also, it would lead to increased workflow. If nurses are not involved, it might create mistrust or setbacks for the healthcare organization. Nurses are problem solvers in the healthcare field (Oncology Nursing Society, 2021). The key to having a new system successfully implemented is knowing what is affected on the administration and clinical sides (Agency for Healthcare Research and Quality, n.d.).

     

    References

    McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of   knowledge (5th ed.). Jones & Bartlett Learning.

     

    Oncology Nursing Society. (2021, August 3). Nursing informaticists are the backbone of

    technology-driven care. ONS Voice. Retrieved January 25, 2023, from

    https://voice.ons.org/news-and-views/nursing-informaticists-are-the-backbone-of-

    technology-driven-care

     

    Agency for Healthcare Research and Quality. (n.d.). Workflow assessment for health IT toolkit.Links to an external site.

    Retrieved January 25, 2023, from https://digital.ahrq.gov/health-it-tools-and-

    resources/evaluation-resources/workflow-assessment-health-it-toolkit

     

     Reply to Comment

    • Collapse SubdiscussionDeanna Linn Howe

      Hi Florah and all,

      I appreciate your comments here. Many nurses feel their opinion does not count towards big decisions. But as end-users of these programs, the nurse’s opinion is highly important. Nurses should be consulted on impactful decisions related to health technology. Page (2011) explains the importance of getting nurses involved early in the design and testing phases so that onboarding end -users is more tangible. Page (2011) goes on to explain during the implementation phase, nurses must be super-users of technology so they can help with physician and other disciplines in onboarding processes. Does your work area have super users? If so, in what capacity are they helpful? Would you want to be a super user? Thanks.  Dr. Howe

      Page, D. (2011). Turning nurses into health IT superusers. Hospitals & Health Networks, 85(4), 27–28. 
PMID: 21591563

       Reply to Comment

    • Collapse SubdiscussionConor Westerman

      Hello Florah,

      According to many researchers there has been a breakdown in nursing informatics and nursing as a whole. The idea of the research article went on to state that nursing informatics has been viewed as a specialty, rather than something all Nurses should be involved in at some level Risling, T & Risling, D, 2020). I agree with you that the main stages of the SDLC should involve Nurses for some of the specific reasons you pointed out. Firstly, if Nurses are involved in the initial phases of the project, they would be more apt to continue to be involved and have feedback. This is a great point and would add to the collaborative aspect of Nurses and the Informatics team.

      Nurses being involved in the planning phase would help bridge the gap that is mentioned above. The research that says Nurses are problem solvers is correct (Oncology Nursing Society, 2021). Nurses have a unique skill set and are specifically trained to use critical-thinking techniques that would be useful in all stages of the SLDC. It is unfortunate that your organization seemingly does not value the input of nurses when they are developing new technology that the Nurses will be utilizing. Failure to involve Nurses in the SDLC can result in more errors and cause further breakdown in the healthcare system (McGonigle, & Mastrian, 2022).

       

      References

      McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed., p 191). Jones & Bartlett Learning.

       

      Oncology Nursing Society. (2021, August 3). Nursing informaticists are the backbone of

      technology-driven care. ONS Voice. Retrieved January 25, 2023, from

      https://voice.ons.org/news-and-views/nursing-informaticists-are-the-backbone-of-

      technology-driven-care

       

       

      Risling, T. L., & Risling, D. E. (2020). Advancing nursing participation in user-centred design. Journal of research in nursing : JRN25(3), 226–238.

      https://doi.org/10.1177/1744987120913590

       Reply to Comment

    • Collapse SubdiscussionChike Emejuaiwe

      Hello Flora

      Your post was both informative and easy to read, Nurses play an integral part when it comes to SDLC. As you noted, trust and interest Ina new system is dependent on the nurses level of involvement from the beginning stages through evaluation and destruction. role of nurse has grown beyond helping the IT folks design electronic medical record (EMR) screens and choose equipment. It is now an integral part of the healthcare delivery and a differentiating factor in the selection, implementation, and evaluation of health IT in order to support safe, high quality, patient-centric care (Verma & Gupta, 2017).

      In the design phase, it is also important that the system function to accommodate and suite its end users. Nurses being in the forefront of patient care are Apt to leverage systems that are user friendly and efficient in completion of tasks. The pursuit of participatory stakeholder co-design holds additional value from a nursing perspective as the discipline continues to experience the delivery of technological innovation into practice settings without consultation or opportgunities for design collaboration(Risling & Risling, 2020).

      In the implementation phase user centered interest and adaptability is important as nurses are able to advice on usability and areas that need improvement or updates. Without nursing involvement, developers are unable to match functionality with predetermined objectives. Clinical nurses are the best judge to assess the positive aspects and to identify the challenges that may hinder the functioning of software created for patient care(Verma & Gupta, 2017).

      Healthcare being a very enigmatic specialty, changes abound. Nurses are involved with daily updates to treatment plans and modalities. Nurses makes changes and updates to care plans. A system must accommodate and facilitate such constant changes hence maintenance and updates are a nursing centered feature as SDLC tend to be user and patient centric.Users must continue to be consulted in this phase to monitor for unintended consequences or complications that can often occur in new technologies(Risling & Risling, 2020).

      References

      Risling, T. L., & Risling, D. E. (2020, May 3). Advancing nursing participation in user-centred design. Retrieved January 24, 2023, from https://journals.sagepub.com/doi/full/10.1177/1744987120913590Links to an external site.

      Verma, M. P., & Gupta, S. (2017). International Journal of Nursing Education and research. Software Development for Nursing: Role of Nursing Informatics. Retrieved January 24, 2023, from https://ijneronline.com/AbstractView.aspx?PID=2017-5-2-19Links to an external site.

      McBride, S., & Newbold, S. K. (2022, February 8). Systems development life cycle for achieving meaningful use. Springer Publishing. Retrieved January 28, 2023, from https://connect.springerpub.com/content/book/978-0-8261-4055-5/section/part02/chapter/ch08

       Reply to Comment

  • Collapse SubdiscussionMegan Nicole Starnes

             Health information technology is drastically changing healthcare. This move has been well received by nurses, who are currently helping to improve its success. The system development life cycle (SDLC), a project management model, describes the phases needed to take a project from conception to completion. Phases in the life cycle of a system development include planning, system analysis, system design, development, implementation, integration and testing, and operations and maintenance (Veracode, n.d.). This technology enables the creation of an electronic version of patient records that makes it possible to access vital information quickly and easily (Risling & Risling, 2020).

    Furthermore, these systems are primarily intended to contain patient-related data, access the tools for making successful decisions based on the evidence, and streamline the workflow of healthcare providers. Nurses must participate in the software development cycle to produce a system that successfully translates the language of health into the application being utilized. (Verma & Gupta, n.d.). Working with a lead nurse or nurse informaticist is crucial to ensuring that the software development cycle is efficient, and user-centered and that it translates the language of health into the application being used (Risling & Risling, 2020).

    Software developers must comprehend the needs of the user from the first planning stage of the SDLC before developing a product for healthcare professionals. Nurses make up most of those using healthcare technology since they organize and perform many tasks linked to patient care. The new system would only be effectively put together to address patient care objectives if a nurse leader and other clinical staff were included in the early stages of the SDLC design.

    System analysis is the next part of the SDLC. In this part, the software development team and the nurse discuss requirements. The software development team may need guidance regarding some of the medical terminology. A standardized nursing language must be defined in patient care systems for nurses and other healthcare professionals to effectively communicate patient care information (Walden University, 2018). To improve usability and simplicity for healthcare providers, nurses must also be involved in the design phase of the SDLC. A system’s design efficiency may ultimately suffer if nurses are not included since doing so raises the likelihood that vital input or output data may be forgotten.

    A small group of healthcare professionals should test the program’s usability and overall functionality as part of the SDLC implementation process before it is fully launched. A non-functional system that cannot support clinical care may be developed if nurses are not involved in the deployment process. A trial launch test will identify any faults and prevent staff displeasure. Once testing is finished, continuing system updates will be required, if problems develop as nurses and staff start entirely using the system during deployment. If nurses are not involved in this phase, a system may be created without support for other patient care roles or with significant clinical care delays.

    The company I am employed with implemented our new system one year ago. Nurses and staff were not part of any step throughout the system’s design, implementation, or deployment. The new system was launched with numerous burdening flaws. Additionally, most system functions to this day need to be fixed. I have discovered that several of the most fundamental features, including alerts and printing lab requisitions, need to be revised to improve our productivity.

    Furthermore, there is no warning to make sure an allergy is recorded in the allergy section of the design. The “no known allergy” message is also consistently listed, but it should only be displayed if entered in by staff because it can be confusing and result in a mistake. I could go on and on about this system’s enormous burdens, which lower productivity and make users more irritable. However, they have enabled a system in which we can submit a ticket for each concern. It takes a lot of time and effort to describe an issue via email to someone who isn’t in the healthcare industry.

    All in all, nurse and staff involvement in any system, to improve patient care processes and quality, as well as a source of convenience, is crucial. Nurses in the clinical field are more qualified to assess if a piece of software helps with patient care or just increases the administrative burden on healthcare providers. Nurse involvement could help allocate healthcare resources better and address typical issues that may develop due to poorly designed software. It has long been understood that nurses must participate in the software development process for it to be successful. Given that they have a superior understanding of clinical flow and patient care processes, nursing staff should be required to participate fully in the software development process.

    References

    Verma, M. P., & Gupta, S. (n.d.). Software Development for Nursing: Role of Nursing Informatics. International Journal of Nursing Education and Research5(2), 203. https://doi.org/10.5958/2454-2660.2017.00044.8Links to an external site.

    Pham, Desai-Naik, Hammond, & Abdeljabbar. (2020, October 19). 10.2: Systems Development Life Cycle (SDLC) Model. Retrieved January 24, 2023, from https://workforce.libretexts.org/Bookshelves/Information_Technology/Information_Systems/Information_Systems_for_Business/02%3A_Information_Systems_for_Strategic_Advantage/10%3A_Information_Systems_Development/10.02%3A_Systems_Development_Life_Cycle_(SDLC)_ModelLinks to an external site.

    Risling, T. L., & Risling, D. E. (2020). Advancing nursing participation in user-centred design. Journal of research in nursing: JRN25(3), 226–238. https://doi.org/10.1177/1744987120913590Links to an external site.

    Veracode. (n.d.). What is Systems Development Life Cycle | Veracode. Retrieved January 24, 2023, from https://www.veracode.com/security/what-systems-development-life-cycleLinks to an external site.

    Walden University. (2018, October 5). the-advantages-of-using-standardized-nursing-language. Walden University. Retrieved January 25, 2023, from https://www.waldenu.edu/online-masters-programs/master-of-science-in-nursing/resource/the-advantages-of-using-standardized-nursing-languageLinks to an external site.

     

     Reply to Comment

  • Collapse SubdiscussionCourtney Britten

    Wk9 Discussion Post: Initial Post 

    The Systems Development Life Cycle (SDLC) is a project management model that organizes the process of project development into four stages which are planning, design, implementation, and maintenance/evaluation (Walden University, 2018). When implementing a new health information technology system for example, the steps of the SDLC should be followed to ensure the intended outcomes are accomplished. Nurses, especially nurse informaticists, should be included throughout every step of the cycle, as they can provide valuable insight into how the technology may affect daily workflow, as well as, serve as an advocate for front-line staff which ultimately ensures that patient care outcomes and efficiency are improved by the new technology system.

    Planning 

    The first stage of the SDLC is planning. During this stage the intended outcomes of a new health information system are established (purpose), an actual system is chosen, the project outline is created, and a plan for establishing needed resources is discussed (McGonigle & Mastrian, 2022). During this stage front-line nurses and nurse managers can share their opinions on characteristics/features they would appreciate in a system, share their unique job experiences and thoughts on how the system could positively or negatively affect workflow. I feel that it is the most important to have nurses involved at this stage since it involves the core design for the entire project. Time and money could be wasted if concerns are found in the implementation stage that could have been addressed in the planning stage, had nurses been included.

    Design 

    Specific technical requirements, included features, and the layout of the system are chosen and organized in this stage (McGonigle & Mastrian, 2022). The overall implementation is also completed and fine tuned in this stage. Policies and procedures should be created within this stage as well so that they are available to staff during the implementation stage. Nurses can help customize policies to ensure they are as relevant as possible and share thoughts on specific features they would use or not use at this stage. If not included, small issues in the software design can arise. For example, nurses could stress the importance of having a system layout that is organized and easy to navigate. If the system is too complicated, nurses might miss or be unable to locate important patient health data like critical lab values.

    Implementation 

    This is the action stage of the cycle. The health information technology system is activated by IT and implemented into real practice. Training is also included in this stage. Nurse involvement plays a large role in this stage because the system is now a part of their workflow.  The negative effects of the failure to assess workflow include “delays in patient care, billing, and communication” (Agency for Healthcare Research and Quality, n.d.).

    Nurses should share their input on resource related concerns, such as staffing for training in this stage. As with the previous stage, but even more so in this stage, nurses can point out flaws and problems that need to be addressed immediately so that patient care is not negatively affected. For example, if the new system was glitchy and would freeze several times throughout the shift, nurses could report their frustration.

    Maintenance/Evaluation

    This part of the cycle is ongoing and doesn’t end. As with any technology system, software updates and maintenance are a key part of maintaining functionality and efficiency. IT should be readily available to help resolve issues. Nurses can continue to give feedback on potential issues that arise. For example, in a recent EPIC update at my organization, the hourly rounding that was previously at the top was moved to the bottom after the update. Because of this, it was harder to locate and less people were charting it.

     

    Input at my organization 

    It is possible that I had the opportunity to provide input at the hospital I work at in regards to new information technology systems. At Regions we frequently get emails requesting us to fill out surveys on our thoughts. I cannot recall if the emails mentioned any specific topic, rather just had a link. Honestly I have not done every survey since my unit is often very busy. I wish that we were given the opportunity to fill out those surveys at home, where we could spend more time doing so. I also wish they would have drawn more attention to the topic of the surveys. Not feeling heard by an organization can lead to feelings of frustration and disdain among employees.

    But, in terms of technology changes in general, I do remember when our hospital implemented new glucometers that we were offered the opportunity to fill out paper questionnaires with thoughts on the new technology after receiving our in person device training. The staff there also encouraged us to reach out to our unit nurse educators if we had any concerns or questions after using the glucometers in practice.

     

    References 

    Agency for Healthcare Research and Quality. (n.d.). What is Workflow? https://digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/workflowLinks to an external site.

    McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

    Walden University, LLC. (Producer). (2018). Managing Health Information Technology [Video]. Baltimore, MD: Author.

     Reply to Comment

    • Collapse SubdiscussionPatrick R King

      Hey Courtney,

      It amazes me how the risks of excluding nurses from assisting to develop new systems are consistently overlooked. As you have said, with nurses omitted from the planning stage, the whole process is a pit to throw away time and money. There are many different technologies that are introduced to the nursing field that ultimately die off. Hamer and Cipriano (2013) argue that the biggest reason why these technologies fail is because nurses are not included in the development stages.

      Implementing the new system is such a crucial step that desperately needs the inclusion of nurses. With the nurses being the most prominent individuals utilizing the system, it needs to function appropriately and efficiently if it is to achieve the goal of increasing productivity and workflow. When new software is released, sometimes it can make the work flow opposite of its intended goal. Documentation time will increase and there will be less patient-centered care and interactions if not designed and implemented appropriately (Eichstädter et al.,2001). Thank you for your post this week.

      References:

      Eichstädter, R., Haux, R., Pohl, U., Rebel, S., Ziegler, S., & Ammenwerth, E. (2001). A randomized evaluation of a computer-based Nursing Documentation System. Methods of Information in Medicine40(02), 61–68. https://doi.org/10.1055/s-0038-1634465

      Hamer S, Cipriano P (2013) Involving nurses in developing new technology. Nursing Times; 109: 47, 18-19.

       Reply to Comment

    • Collapse SubdiscussionFlorah Deann Tackett

      Response #1

      Hello Courtney,

      Your post was very informative. Having nurses fill out surveys is an excellent way to get their opinions on how the new technology is working. I have worked at very few healthcare organizations that give the nurses surveys or questionnaires to fill out to get input from nurses. When deciding which development method to use with new technology, it is essential to choose the correct development method for the new technology (Agency for Healthcare Research and Quality, n.d.). Nurses need to be more familiar with new technology development methods (Risling & Risling, 2020). Nurses being familiar with different development methods is one way to ensure nurses are involved in new technology development.

       

      References

      Agency for Healthcare Research and Quality. (n.d.). Appendix 2-A. Application and System Development requirements. Retrieved January 27, 2023, from https://www.ahrq.gov/research/publications/pubcomguide/pcguide2apa.html.

      Risling, T. L., & Risling, D. E. (2020). Advancing nursing participation in user-centred design. Journal of research in nursing : JRN25(3), 226–238. https://doi.org/10.1177/1744987120913590

+1 631 259 7728
WhatsApp chat +1 631 259 7728
https://bestonlineessays.com/
We will write your work from scratch and ensure it's plagiarism-free, you just submit the completed work.


WHATSAPP US, WE'LL RESPOND