Its Primary purpose is to ensure quality patient care and managing the cost of that care. Its secondary purpose as defined by the Institute of Medicine (IOM) deals with individual users for education, regulations, policies and public health from data entered, verified, corrected or analyzed directly or indirectly. Homeland Security has recently been added to the list of users, including patient care providers, managers and staff, coders and patients themselves. Patients can make changes as necessary. Other users might include lawyers, employers, law enforcement and researchers.
For these reasons there’s the need for Clinical decision support system (CDSS) to support the physicians in making right clinical decisions. Defining Clinical decision support system (CDSS) Clinical decision support system (CDSS) provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care. [1] CDSS encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools include computerized alerts and reminders to care providers and patients; clinical guidelines; condition-specific order sets; focused patient data reports and summaries; documentation templates; diagnostic support, and contextually relevant reference information, among other tools. This paper will discuss the need for CDSS in the health sector particularly on clinical tasks.
Nursing diagnosis is a way to express care needs that identify those who receive care, enabling application of possible nursing interventions. Such diagnoses also lead to possible standardized language among nurses and contribute to the development of nursing knowledge. The NANDA International classification(20) brings together a set of nursing diagnoses. Therefore, the language used in NANDA-I helps professionals to communicate their experiences with patients. It also contributes to patient care by classifying nursing phenomena and standardizing language among nurses.
Factors such as age, gender, race, and educational background can affect the way one must communicate with another. The words used, the nonverbal gestures, such as eye contact or touch, and even one’s tone of voice can affect how a patient perceives the information that the nurse is providing. According to Williams, “Healthcare communication involves an effective line of communication between medical professionals, clients and the patient. An essential component of patient healthcare providers’ communication is the ability to provide information that can improve patient understanding. Effective communication between patients and healthcare providers is a critical element to quality healthcare” (Healthcare Communication).
Personal and Professional Healthcare Communication Pape/350 HEALTH CARE COMMUNICATION12/13/2011Randall WebbHealthcare Communication Health care communication can be defined in different ways. Health care communication is between health care providers or between providers and patients or communities. It is the process of communicating heath information for the use of patient care or for individuals to obtain, process, and understand the health information needed to make appropriate health decisions. Many times it occurs either verbally or non-verbally and is a process that enhances the sharing of ideas and knowledge. The relevancy of effective personal healthcare communication with other healthcare professionals, clients, patients It is very important for the health care team to communicate with all team members regarding assessment, intervention, outcomes, and client status.
Not only is it important for healthcare providers to construct and implement a treatment plans, but also to involve patients in medical decision making about their treatment. To determine effectiveness, healthcare providers must assess how treatment of the illness effects the patient in addition to their own evaluation of treatment. The dictionary definitions of effective are (a) adequate to accomplish a purpose, producing the intended or expected result; (b) in operation or in force, functioning; (c) producing a deep or vivid impression; (d) prepared and available for service; and (e) a member of the armed forces fit for duty or active service (“Effective”, n.d. a). According to Stedman’s Medical Dictionary (2006), the medical definitions of effective are (a) the extent to which a treatment achieves its intended purpose; (b) A measure of the accuracy or success of a diagnostic or therapeutic technique when carried out in an average clinical environment. According to Wikipedia (n.d. b), the usage of effective includes (a) mathematics, can be used as a synonym of
These are all potential sources of the problem. Given the chance to help the hospital become proficient and improve the data entry. There are a few things that I would want to analyze. First, review the various reports from the different hospitals in attempts to identify the commonalities throughout the hospitals in their data entry. A comparison of these reports to the archived reports would
Nursing uses theories, research based models and scientific systems to collaborate care provided within the health care systems. Nursing utilizes multiple sciences and knowledge development models to create a diverse education base. The nursing knowledge disciplines use empiric knowledge, esthetics, personal knowledge, and ethics. Nursing science encompasses the relationship between health and illness while addressing biologic, social, and behaviors to seek truth to provide better patient outcomes and enhance better living for all humans. Nursing knowledge expands to create a meaningful, holistic approach to providing health care needs and meeting the challenges of the social aspects of patient care.
Uses of Statistical Information Statistics are used in many ways in the health care profession. Statistics improve patient care and patient outcomes. Hospitals collect data that relates to the type of patients they serve, the number of patients they serve, and the areas in which they serve them. Data related to the patients’ perceived care is also collected. This data is processed and statistically analyzed to determine ways in which the hospital can improve patient care and patient outcomes.
INTRODUCTION On admission to a healthcare facility, a health assessment is a mandatory tool in assessing the patient’s health status. In general an assessment is broken down into two types of reviews, by conducting a health history which includes the collection of subjective data (information elicited by the patient or patients’ family members) and a physical examination of the patient which includes the gathering of evidence based data (Wilson & Giddens, 2009). Collecting and documenting accurate information is imperative in providing the allied health team this information to facilitate an efficient and well-formed care plan in addition to establishing a baseline for subsequent assessments (Springhouse, 2004; Wilson & Giddens, 2009). PATIENT INTERVIEW A health assessment should consist of establishing a patient profile and incorporate a full medical history (Harvey, 2004). The traditional approach includes collecting subject matter on “biographical data, present health concerns (or present illness) and the chief complaint, past history, family history, review of system and patient data” (Farrell & Dempsey, 2010, p. 74).