One nursing theory will be presented as a framework to resolve a problem occurring within one of the professional areas of leadership, education, informatics, healthcare policy or advance clinical practice. The same nursing theory selected in Assignment
Running Head: ADAPTATION OF ELECTRONIC MEDICAL RECORDS
Adaptation of Electronic Medical Records
The development of nursing theory, and evidenced based research are essential to the advancement of nursing practice and the profession. Chinn and Kramer (1995) defines theory as: "A creative and rigorous structuring of ideas that project a tentative, purposeful, and systematic view of phenomenon" (p.72). Nursing theories are considered holistic when they conceptualize nursing to include the four concepts of the person, environment, health and the nurse who provides the care. Nursing theory development is directly influenced by a distinct focus on the discipline of nursing, otherwise known as nursing's unique perspective. Theories such as grand, middle-range and borrowed theories can be applied to nursing practice to resolve issues relevant to any specialty within the nursing profession.
Nursing theory is often utilized by nursing professionals to describe, explain, predict or prescribe a particular situation of interest; used in turn as a guide to solve issues relevant to nursing practice (Kenney, 2013). Nursing theory identifies and utilizes concepts of care and helping, define relationships, structure ideas, facilitate disciplined inquiry, communicate, and also predict outcomes of practice to guide the discipline of nursing. The application of nursing theory in combination with knowledge and clinical experience facilitates critical thinking that allows the nurse to formulate appropriate interventions and make informed moral and ethical decisions based on proven concepts.
Nursing theory, research and practice are essential to the growth of the nursing profession and are applicable in solving issues within the healthcare system. The choice of grand, middle-range or borrowed theories are dependent on the issue that needs to be resolved. Nursing theories aim to improve nursing practice and the health of the population in general.
Roy Adaptation Model is a logical theory with a strong focus on observing how individuals, families, groups and organizations interact with their changing environment. Roy's theory embraces four modes of adaptation, which include: physiologic needs, self- concept, role function and inter-dependence. The model confirms that the process of adaptation is successful when individuals show positive response to changes in the environment, through conscious awareness, self-reflection and individual choice to integrate the human with the environment (Phillips & Harris, 2010).
Roy's Adaptation model will be used as a framework in solving issues related to the use of, electronic medical record systems by healthcare professionals in nursing practice. The model will be conceptualized to formulate clear objectives and interventions to solve the issue. This will conclude with a summary of applicable new knowledge of nursing theory to practice.
Issue
The evolution of advanced computerized technology has brought about a worldwide change, converting paper-recording systems to electronic records. The fast constant explosion of technology has challenged organizations and individuals to change their old ways of paper charting/recording and adapt to an environment that brings promise to improved health-care systems and organizations. Electronic medical records are records of a patient in digital form containing all pertinent information regarding a patient's medical history, status, labs, diagnostic tests, diagnoses and treatment plan. Electronic medical records have several advantages over paper recording systems. Medical records in electronic form, increase office space as it lessen the requirement of paper charts, improve efficiency as it decreases time spent locating paper charts, provide health maintenance reminders and significantly minimize errors. Paper recording systems are at a disadvantage as they are subject to a larger number of errors due to misspelling, illegibility and different terminologies, requires a lot of storage space, can be untidy, misplaced or lost, is often time consuming (Benefits of EMRs, 2014). Despite the many advantages of electronic medical records, change from paper recording systems and adaptation to that change has faced an enormous amount of resistance within the medical field.
Resistance to the adaptation of new technology within an organization is often linked to the organizations culture rather than the computer system itself. Organizational cultures that promote resistance to change, foster environments that resent adaptation and refer to the way things were done prior to any change. Healthcare professions within these organizations, often relate the issue of change and adaptation to be that of the system being introduced rather than themselves. Kumar, Bhati, and Chiang (2013) acknowledged that nurses and other health care providers are known for resisting change, therefore appropriate communication and careful change management plans must be instituted in favor of the adaptation process. (p. 472).
Adaptation may be significantly impacted by negative perceptions to change, for example, healthcare professionals may find it difficult to make the transition from paper documentation to electronic medical records because they perceive that the process would be time consuming, or that the nurse-patient relationship and patient-physician relationships would be affected. Risk and benefits to the patient is also an important aspect considered and hinders adaptation. Such risk may involve, transfer of incorrect data, which can be fatal for future treatments provided to patients. More experienced healthcare professionals view themselves as competent and proficient with the use of paper recording systems. They share the belief that the notion of adapting to an unfamiliar system, such as, electronic medical records may somehow impact their level of competence. Some healthcare professionals such as nurses attribute their resistance to change and adaptation to their moral and ethical obligations to patients. That is, the needs of the patient takes priority, therefore the idea of placing machines before patient care is dehumanizing and not concurrent with the goals of nursing practice.
Healthcare professionals may view electronic medical recording systems as a threat, with the notion that it impedes critical-thinking and hands on approach to patient care. It may be viewed as non-user friendly because it dictates how to document and perform patient care.
Environmental or situational changes within an organization often ignite resistance to adaptation. In an effort to facilitate adaptation as it relates to the use of electronic medical records, identified concepts of Roy’s adaptation theory can be utilized. Roy theorizes that adaptation takes place when individuals are able to positively integrate changes within themselves and the environment (Phillips & Harris, 2010). Organizations must employ strategies that will encourage healthcare professionals to become involved in the process of technological advancement and adapt to new situations.
Strategy
Many organizations within the healthcare industry have recognized the benefits of converting from paper records to electronic medical records, which are more accurate, reliable and efficient. However as, organizations continue to introduce and implement the use of electronic medical records, they must address the embedded challenges within the organization culture that foster resistance to change and hinder adaptation. One such challenge is the lack of understanding on part of the employees to use the system, which may lead to uncertainty and errors.
According to Roy's Adaptation Model individuals are viewed, as a bio-psycho-social being that is always interacting with environmental changes, and for adaptation to take place, the individual must be able to positively respond to such changes (Phillips & Harris, 2010). Therefore in order to promote adaptation and facilitate a smooth transition from paper documentation to electronic medical records, organizations must provide adequate training and resources to employees.
To facilitate change and support the adaptation theory, the mentioned eight models of change management proposed by John P. Kotter can be implemented. 1) managers can create a sense of readiness and urgency in regard to change, 2) effectively communicate and promote the change process through team building, 3) Present a clear vision for the change and how it will occur, 4) involve healthcare professionals in the planning phase, 5) empower action by encouraging feedback and rewards, 6) establish short term goals to address the change process one step at a time, 7) train and coach participants, 8) prevent resistance to change by incorporating the needs of the healthcare professional (Parker, 2014).
Healthcare professionals and administrators are essential to the successful implementation of electronic medical records. The steps outlined by Kotter in conjunction with Roy’s adaptation model can promote adaptation of electronic medical record in the health care field. Adequate information regarding the process of change prior to initiation and throughout the process should be effectively communicated. Healthcare professionals should be actively involved in the change process with valued input on how the implementation of electronic medical records will affect the day-to-day activities of patient care and their moral and ethical obligations.
One legitimate concern of healthcare professionals is the capability of electronic medical records to safeguard patient privacy and confidentiality, to prevent Health Insurance Portability and Accountability Act (HIPPA) violations (Privacy & Security, 2013). Healthcare facilitators of change should effectively communicate strategies to eliminate the possible breach of patient privacy to help ensure the security of the patient's information. It is imperative that leaders within the healthcare system effectively communicate and acknowledge the physical and psychological needs of individuals prior to initiating the change process, to reduce resistance and promote seamless adaptation.
Conclusion
It is paramount that healthcare leaders set objectives to facilitate the change process and promote adaptation. The successful implementation and adaptation of electronic medical records rely heavily on the principles of Roy’s adaptation theory. Effective communication, training and education will reduce resistance, and foster an inviting environment that will streamline the adaptation of electronic medical recording systems for healthcare professionals.
The token value learnt from this paper is that the challenge to adapt to change does not reside with the system to be implemented, but with the users of that system to adapt to change. Communication is essential to effect change while, incorporating the physiological and psychological needs of the users to preserve their confidence, reduce resistance and allow for a smooth adaptation process. Healthcare professionals are at the forefront of patient care, therefore their involvement and valued input within the change process will promote adaptation and allow for continued competent care and improved outcomes.
References
Benefits of EHRs. (2014). What Is an Electronic Medical Record (EMR). Retrieved from www.healthit.gov/providers-professionals/electronic-medical-records-emr
Kenney, J. W. (2013). Theory-based advanced nursing practice. In W. K Cody (Ed.), Philosophical and theoretical perspectives for advanced nursing practice (5th ed; pp. 333–35). Sudbury, MA: Jones & Bartlett.
Kumar, A; Bhati, S; & Chiang, J. (2013). Deployment of an in-house designed training process in a quaternary care hospital. Technol Health Care, 21(5), 469-478. doi: 10.3233/THC-130750.
Nursing Theories. (n.d.). (2009). Mosby's Medical Dictionary, 8 ed. Retrieved from http://medical-dictionary.thefreedictionary.com/Nursing+Theories. April 2017.
Parker, B. (2014). Kotter's Eight Step Model. Retrieved from https://tipqc.org/qi/jit/leaders-guide/kotters-eight-step-change-model/
Phillips, K. D., & Harris, R. (2010). Roy’s adaptation model in nursing practice. Nursing Theory, 263.
Privacy & Security. (2013). Integrating Privacy & Security into your Practice. Retrieved from http://www.healthit.gov/providers-professionals/ehr-privacy-security/practice-integration
