Ruth Wetherald has over 30 years of experience as a registered nurse working in various areas including neurology, postpartum, labor and delivery. She recently earned a second bachelor's degree in healthcare information technology and is now pursuing a Master of Science in Nursing with a specialization in nursing informatics. Her goals are to obtain her master's degree and informatics certifications to qualify for a position in a non-profit organization working to improve healthcare technology and workflow.

1. - 1 -
Walden University – School of Nursing
Final Portfolio
NURS 6600 -01 Capstone Synthesis Practicum – Nursing Informatics and Leadership &
Management
Aug 10, 2016
Ruth Wetherald
315 N 200 W
Blackfoot, ID 83221
208-785-5825
ruthirenew@msn.com
Women’s Services RN
Portnuef Medical center
Pocatello, ID

2. - 2 -
Table of Contents
Program of Study.............................................................................................................................3
Professional Development Plan (PDP) ……………………………………………………..…….4
CV or Résumé ………………………………………………………………………………..….. 9
Portfolio Assignments from each of the following courses
NURS 6050: …………………………………………………………………………………..…12
NURS 6051: ……………………………………………………………………………………..20
NURS 6052: ……………………………………………………………………………………..27
NURS 6053: ……………………………………………………………………………………..34
NURS 6401:...................................................................................................................................40
NURS 6411:...................................................................................................................................46
Access database icon: ………………………………………………………………………….. 50
NURS 6421 ...................................................................................................................................53
Workflow charts icon……………………………..…………………………………………….. 70
PowerPoint icon ...…………………………………………………………….…………………70
NURS 6441: ……………………………………………………………………………………..71
Project charter icon………………………………………………………………………………78
Project WBS icon………………………………………………………………………………..78
NURS 6431: …………………………………………………………………………………….79
PowerPoint icon ……………………………………………………………………………….. 97
NURS 6600: .…………………………………………………………………………..…….... 98
Continuing Education (CE)…………………………………………………………………….. 99
End of Program Outcomes Evidence Chart ………………………………………………….. 100
Final Reflection………………………………………………………………………………. 103

3. - 3 -
Program of Study Form
Master of Science in Nursing, BSN Track
Based on the information that you provided, the following credits may be transferred into your program at Walden University.
This information is unofficial until all official transcript(s), international evaluation, and course description or syllabus is received.
Academic changes in the program you are considering may also influence the final review. For the most updated information
once you start your program, please refer to your degree audit located on your student portal.
Name: Ruth Wetherald Student ID Number: A00449436 Enrollment Date: March, 2014
Program: Master of Science in Nursing Specialization: Nursing Informatics
TransferofCreditMaximum: 25QuarterCredits
Course
Number
Course Title Credi
t
Hour
s
Transfer Course
CoreCourses
(21credits)
Core Courses: (All core courses must be completed before starting
the specialization courses.)
NURS 6001 Foundations of Graduate Study 1 Spring 2014
NURS 6050 Policy and Advocacy for Improving Population Health 5 Spring 2014
NURS 6051 Transforming Nursing and Healthcare Through Technology 5 Summer 2014
NURS 6052 Essentials of Evidence-Based Practice 5 Fall 2014
NURS 6053 Interprofessional Organizational and Systems Leadership 5 Winter 2014
Specialization
Courses
(30credits)
NURS 6401 Informatics in Nursing and Healthcare 5 Spring 2015
NURS 6411 Information and Knowledge Management 5 Summer 2015
NURS 6421 Supporting Workflow in Healthcare Systems 5 Fall 2015
NURS 6431 System Design, Planning and Evaluation 5 Winter 2015
NURS 6441 Project Management: Healthcare Information Technology 5 Spring 2016
NURS 6600C Capstone Synthesis Practicum 5 Summer 2016
Tentative focus for practicum experience: Joseph Higgins
Total Credits: 51
Transfer Courses
Course
Number Course Title Institution Grade Credits
Official transcripts are required to award Transfer of Credit. We are in receipt of your official transcripts.
Admissions Specialist Signature: Gabe Valdovinos Date: 07/08/2013

4. - 4 -
Professional Development Plan
Ruth Wetherald
Walden University
NURS 6001, Section 13, Foundations of Graduate Study
April 13, 2014

5. - 5 -
Professional Development Plan
The purpose of this assignment is to reflect on my experience and my goals as I start a
new program of study. Developing a program of study and aligning my professional
development plan with my program of study will aid me in accomplishing my objectives.
Education and Professional Background
My name is Ruth Wetherald. I now live in Idaho. I am not married and have no children.
I come from a large family. My parents also came from large families. My mother, one brother
and one sister and their families live within driving distance. I am very involved in their lives and
my nieces and nephews lives. I have many animals and foster for the humane society.
I started my education after high school by taking a year of classes at a Bible school. I
then went on to pre- nursing school classes at a local community college before transferring to
the University of Portland. I graduated with a B.S. in nursing in 1980. School was a very
challenging time in my life since some of the credits I took at community college (term classes)
did not transfer to the university (semester classes). I ended up taking 20 credit hours a semester
for two semesters. Sixteen to eighteen hours of each semester were in various science classes.
This heavily weighted science curriculum brought my GPA down. Needless to say, when I
graduated I was burned out with school.
I started my career working on a neurology floor at a hospital in Portland, Oregon. I was
there for 10 years. One of my interests in nursing school was the OB department. I took a job on
Postpartum at a hospital in Seattle, Washington where I stayed for 8 years. I then progressed to
working in Labor and Delivery at a hospital in Denver, Colorado where I stayed for about two
years. I now work Postpartum at a hospital in Idaho. In all these areas (except for L&D) I have
been in a Charge nurse role. I now charge night shift, do the schedule for night shift staff, and
support CPOE/EHR by being a super user for both nursing and physicians.

6. - 6 -
Nursing has been enjoyable but not a passion. I have other interests outside of work that I
keep me busy. I do enjoy working with new mothers. I enjoy teaching both patients and co-
workers. I have had no desire to go into management. With the passing of the years, I have seen
many changes in nursing. Some were good, some not so good. With the advent of information
technology, I have found another area to interest me that will allow me to continue to teach and
be a part of helping my profession with implementing technology in a way that is useful. This
education may actually lead to a management position in order to fulfill the goal of improving
usability of workflow and technology interface.
To get increased knowledge of this topic, I decided to return to school. I received my
second B.S. in healthcare information technology, graduating with a 4.0 GPA. I found out after I
applied for graduation that I was only two classes away from getting an informatics security
certification. Since this is a topic dear to my heart because it pertains to keeping patient
information safe I may elect to take those classes.
I feel ready to take on this master’s degree. I need to continue to work on my APA style.
I must keep my attention on the goal. Keeping my eyes on the goal without distraction will be
hard since I work full time and have upkeep on a 5 acre property. I usually have spring fever and
want to be outside when to weather is good. I also have a good many family functions and crafts
that I like to do.

7. - 7 -
Professional Goals
My personal goal is to work hard to achieve a 4.0 GPA and gain the information I need to
be an asset to any future employers. My professional goal is to obtain my Masters in nursing
informatics. The second goal is to get certificates pertaining to this profession. Finally, I need to
find a position in a government or non-profit organization. I prefer to work with non-profit
organizations as I have found them to have philosophies and visions for caring and bettering the
human condition, both individually and globally, which are similar to my own.
Since I am single and work full time I will be doing one course at a time. This will allow
me to keep up with schoolwork and still have some semblance of a life. This decision will extend
out my graduation date. I may try to do two classes once I get to the informatics specialization
classes since I have already taken them once. I have a friend that is also doing a master degree at
Walden. She is taking more than one course at a time and frequently has 3-4 discussion questions
a week and frequently has more than one paper due at the same time. Her experience and my
previous experience with my first nursing degree is enough to convince me that 10 hours a
quarter would be too much for me to do while working full time,
Course Outcomes
I have had a good review of APA requirements. I do still struggle with this area of
writing. Grammarly should help with this if I can get my papers done early enough to submit
them and make changes. Taking two classes and going on a trip to Tennessee for my graduation
ceremony fine-tuned my ability to manage my time. Since I just got done with an online degree I
am familiar with most of the ideas presented in this class. This course re-enforced my awareness
of the need for personal time apart from school and work to avoid burnout.

8. - 8 -
Practicum
My plan for the practicum is to do this with the CIO of the organization I am working for
now. He is a graduate of Walden Nursing informatics and has already stated that he is willing to
do this. Since I am looking for a position in informatics at this time I may not be in a position to
work with him when this course is taken. I may have to reassess my plan and find another
mentor. Since I do not know what projects will be available to work on, or where I will be, the
project will depend on circumstances before the course starts.
I did have to reassess my plan for the practicum. I did the practicum at a Community
healthcare center with the CIO of that organization since the CIO of the organization I work for
has to do too much traveling at this point in time to be a mentor.
Summary
Going through a second informatics degree, this time with a nursing viewpoint, will help
me with my goal of gaining an informatics job in the healthcare field. Taking only one class at a
time will extend out my graduation date but will be worthwhile in the long run.

9. 9
Curriculum Vitae/Résumé
Ruth Wetherald
315 N 200 W  Blackfoot, ID 83221
208-785-5825 (home)  208-604-2130 (cell)
ruthirenew@msn.com
Objective
To obtain a nursing informatics position that will utilize my many years of nursing experience
and variety of skills.
Qualifications
 Able to collaborate with others
 Able to be self-directed
 Able to teach in small or medium group settings
 Able to multitask
 Able to delegate tasks based on team member abilities and strengths
 Able to focus on and prioritize project tasks on an ongoing basis
 Able to identify problems and find solutions
 Data abstraction and analysis
Education
Masters in Nursing Informatics
Walden University,
Minneapolis, MN
Expected graduation date: 08/2016
Summa Cum Laude
Bachelor of Science in Healthcare Information Technology
Capella University,
Minneapolis, MN
Graduation date: 2013
Summa Cum Laude
Bachelor of Science in Nursing
University of Portland,
Portland, OR
Graduation date: 1980

10. 10
Employment History
Portnuef Medical Center, Pocatello, ID 2003- Currently
Postpartum, nursery, Gyn
Charge nurse nights
Bingham Memorial Hospital birthing center 2006-2007
LDRP
Per Diem
Mountain View medical center Idaho Falls ID 2003
LDRP
Readylink Travel Nursing 2002-2003
LDRP
Bannock Regional Medical Center, Pocatello ID. 2000-2002
Labor and Delivery
Medical Center of Aurora, Aurora Co 2000
Labor and Delivery
Exempla St Joseph’s Hospital, Denver Co. 1998-2000
Labor and Delivery
Providence Hospital, Seattle W.A., 1990-1998
Childbirth Center, Postpartum, Gyn surgical area
Relief charge, nights
Four years transition/level two nursery relief
Good Samaritan Hospital, Portland OR. 1978-1990
Neurological Unit
Neurological Acute Care Unit
Epilepsy Telemetry Unit
Relief charge evenings and nights
Good Samaritan Hospital, Portland OR. 1990-1995
PerDiem house float, occasional weekends

11. 11
Licenses and Certificates
RN License: Oregon
ID #080045975RN
Date: 2007-2017
RN License: Idaho
ID # N-29961
Date : 2001-2017
 BLS
 NRP
 Basic Fetal Monitoring
 Advanced Fetal Monitoring
 S,T.A.B.L.E. -needs renewal
Other responsibilities
Night shift scheduling
Super user for CPOE/EHR
References Available Upon Request

12. 12
Developing a Health Advocacy Campaign
Ruth Wetherald
Walden University
NURS 6050, Section 18, Policy & Advocacy for Improving Population Health
May 11, 2014

13. 13
Population Health Issue
The population health issue that will be discussed in this paper concerns the increase in
childhood obesity partially brought on by decreased physical activity. The decrease of physical
activity from various lifestyle and technology changes, namely decrease activity during school
hours and the increased use of video, computer, and smart phone games, during non-school
hours at home, have contributed to an increase in weight gain in school age children. The most
logical place for increased physical activity and health education would be a public school
system. The majority of children spend time regularly in school which would make it the best
place to focus any policy or program efforts (Davidson, 2007).
Recess is necessary for developing social skills. Physical activity increases appetite,
increases attention span and learning, and may result in increased activity after school. Student
inattention in class, lack of ability to focus on tasks, and decreased social skills are all results of
lack of recess breaks during the school day (Jarrett, & Waite-Stupiansky, 2009).
There is more pressure on public schools to focus on academic learning. This has been
increased with the passing of the “No Child Left Behind.” Because of limited time and financial
resources many schools have elected to decrease or eliminate recess. This is more prevalent in
school districts in low income areas. Minorities were more likely to not receive recess (39%
African American vs 16% White). Low income children were more likely to be deprived of
recess (44% vs 17%). Test scores were higher in children that had recess (Jarrett, & Waite-
Stupiansky, 2009).

14. 14
Advocacy Programs
Healthy Schools Campaign had a program started by a school nurse. This program
entailed giving a token each month to children participating in a program called Trailblazers. For
every five miles walked on a path constructed on the school grounds the child received a token
that was based on some thyme for the month. The children can walk during recess or other free
time. Teachers also encourage the activity by taking their classes on walks before tests. This
seems to help concentration during the test period. Food rewards for achievement is not an
option since healthy eating is also part of the Healthy Schools Campaign (Buseman, 2011).
The second intervention was a study of the effect of having a recess enhancement plan.
This consisted of having a playground coach to help encourage and organize playground games.
Results showed that those playgrounds that had received coaching had higher levels of
playground physical activity even on days that the coach was not present than those playgrounds
that did not have a coach (Chin, & Ludwig, 2013).
Campaign Plan
The health issue to be addressed is childhood obesity. The policy needed to combat this
issue is to retain recess as part of the school day and to increase physical activity during school
recess. The policy objectives will be:
 Retain recess in the school day
 Adult supervision to manage recess time effectively and monitor behavior: Give adult
staff training to manage playground activities and monitor behavior.
 Encourage physical activity through the use of a playground coach or similar role
 Do not use denial of recess for punishment, find other forms of discipline.

15. 15
The campaign will focus on the local school district and PTA. Meetings with the school
principle, PTA board members and others that may be required to support the policy such as
school nurses, local pediatricians should be planned. Information and supporting facts will be
obtained from the Peaceful Playgrounds Right to Recess Campaign at
http://www.peacefulplaygrounds.com/right-to-recess-campaign/ .
This organization has an advocacy tool kit that provides information for those that want to
educate policy makers or educate the stakeholders that can affect policy makers. This tool kit
includes research and other data to support the policy implementation.
Key speaking points obtained from Peaceful Playgrounds PPT (2014) will be:
 Only 50% of children get recess
o Due to pressure to focus on academics
o Fear of litigation for playground injury (?) (no supporting data; just theory)
o Lack of playground supervision
 Positive effects of recess
o More attentive
o Increased memory retention
o Developing social skills
o Increased fitness = better academic test scores
o Recess in the AM produced increased appetite at lunch
 Actions you can take to ensure your child’s school has recess
o Call or write your legislator
o Talk to your school board members and principal
o Talk to friends and neighbors

16. 16
The trailblazer program documented by Buseman (2011) is a cost effective way to
encourage physical activity in children that might not be willing to participate in group games. It
also offers a way for teachers to decrease stress and increase student concentration before a test.
The study by Chin and Ludwig (2013) shows the benefit of having playground
supervision and support to encourage physical activity. Having adequate supervision will also
encourage appropriate student socialization and conflict resolution. This program was financed
by a grant. There are sources for financial help to educate and pay for adult supervision on the
playground or for training of volunteers to monitor the playground.
Legal Concerns
For the state of Idaho there are no requirements for school recess at any level. No school
board policies were found. No legislation at the state level was found. From looking at the Boise
substitute teachers manual the Boise school system has planned times for recess at all grade
levels. The Idaho state school system is under pressure to increase academic results as are all
public schools. This could make it difficult to get legislation through at the state level. There are
many who may see recess and Physical Education (PE) as time away from legitimate academic
study.
States that have legislation about PE and/ or recess are more likely to keep it than schools
with-in states with no legislation. States that mandate PE or recess, but not both, are more likely
to have the physical activity required by law but cut back on the one not required (Slater,
Nicholson, Chriqui, Turner, & Chaloupka 2012). This research finding makes it necessary to
lobby for legislation for recess at the state level.
The leg of lobbying that would be most effective in this situation would be grassroots
lobbying. This could be accomplished by starting at the local school level by gaining support of

17. 17
PTA members, school principals and teachers. With the PTA members talking to other parents
and neighbors support for the policy or legislation will grow. Involving district school nurses as
advocates for recess and PE will be the most effective way to get the lobbying started state wide
at the local level. As interest and support grow it can then be taken to the district school boards
and up to the state school board. The main area of objection and resistance will be the cost of
staff and equipment for the playground to encourage active play. This can be mitigated by using
grants from government or other institutions outside the public school system to pay for needed
items or education.
While this is being done supporters should be encouraged to write to their legislative
representative and the governor. It may take a few years to get to this point. There should be
some form of recess activity programs going in a few districts so that evaluation of effectiveness
can be obtained to use in the campaign. Getting endorsements and statements of support from the
state medical and nursing associations can add weight to the discussions. These organizations
also have professional lobbyist that may help get the legislation through.
Ethical concerns
As professional nurses and as adults we have a responsibility to encourage the next
generation to live a healthy lifestyle. Education and the instillation of healthy life choices is an
ethical obligation. Supporting the use of recess as a tool to increase activity is a way to prevent
health issues such as obesity which can have long term effects on student’s future health.
An active recess strategy not only help increase activity during recess, but also decreases
poor socialization behavior, such as bullying and increases behaviors such as cooperation and
negotiation (Leff, 2009). Bullying behavior can have adverse effects on the victims throughout
their life. Trained adult supervision on the playground is necessary to encourage appropriate

18. 18
behavior and discourage unacceptable behavior. Teaching respectful behavior to others should be
considered an ethical obligation of teachers and other adults in the school system.
Taking away a recess period as punishment is not acceptable or ethical considering the
many benefits of recess to academic learning and socialization behaviors. Other forms of
discipline should be employed by the teachers.

19. 19
References
Buseman, L., (2011). School nurse creates trailblazer’s project to get all students moving.
Retrieved from http://healthyschoolscampaign.typepad.com/healthy-schols-
campaign/2011/03/lily-lake-
Chin, J. J., PhD., & Ludwig, D., M.U.P. (2013). Increasing children's physical activity during
school recess periods. American Journal of Public Health, 103(7), 1229-1234. Retrieved
from http://search.proquest.com/docview/1399924095?accountid=14872
Davidson, F. (2007). Childhood obesity prevention and physical activity in schools. Health
Education, 107(4), 377-395. doi:http://dx.doi.org/10.1108/09654280710759287
Jarrett, & Waite-Stupiansky, (2009). Recess- It’s indispensable. Retrieved from
http://www.naeyc.org/columns
Leff, S., (2009). Bully-proofing playgrounds during school recess. Retrieved from
http://www.education.com/reference/article/promoting-social-skills-prevent-bullying/
Peaceful Playgrounds (2014). Right to recess campaign. Retrieved from
http://www.peacefulplaygrounds.com/right-to-recess-campaign/ .
Slater SJ, Nicholson L, Chriqui J, Turner L, & Chaloupka F. (2012). The Impact of State Laws
and District Policies on Physical Education and Recess Practices in a Nationally
Representative Sample of US Public Elementary Schools. Arch Pediatr Adolesc Med.
2012;166(4):311-316. doi:10.1001/archpediatrics.2011.1133.

20. 20
Creating a Flowchart
Ruth Wetherald
Walden University
NURS 6051 -2, Transforming Nursing and Healthcare through Technology
July 27, 2014

21. 21
Creating a Flowchart
Introduction
Flowcharts are used for many reasons. Two reasons that are important to this review are;
troubleshooting and regulatory/quality management (Hebb, 2014). The activity selected for this
workflow review is the administration of immunizations before patient discharge. Workflow
studies are used to find ways to streamline processes by understanding how the process is done at
the present time (Washington, 2008). Increasing the administration and documentation of
vaccines is a necessary part of the American Reinvestment and Recovery Act (ARRA). An
incentive program was developed by CMS to encourage EHR use by using funds provided by
ARRA. Stage 2 requires reporting agents or facilities to submit immunizations to the appropriate
government agencies electronically (CDC 2012). The first flowchart documents how the system
works now. The second flowchart shows an improved system.
The metrics used for quality assurance and to measure process improvement are the
number of patients who have immunizations documented on admission and the number of
immunizations offered/given to patients that need them upon discharge. These metrics are
sufficient to determine quality assurance and process improvement.

22. 22
Patient record
evaluated for
needed vaccines
when admitted to
unit
Vaccination order
sent to pharmacy
Vaccination order
placed on e-MAR
Discharge teaching
information placed
under discharge tab
in chart
discharge teaching
information
removed from chart
and given to patient
when discharged
Vaccine not given.
e-MAR was not
checked for
vaccination due at
discharge
Nurse checks
e_MAR and obtains
consent, fact sheet,
and immunization
for administration of
vaccine

23. 23
The RN evaluates the patient history on the EHR or obtains vaccination history from the
patient while doing an admission assessment. The vaccination history is placed on the patient
profile or marked as current if a patient profile is already in place on the EHR. The patient
admission is to be done by an RN within 24 hours per facility policy.
The vaccines needed are relayed to the pharmacy per M.D.s standing orders. If the
vaccine is identified as being needed it is to be administered to the patient by the discharge
RN/LPN before discharge after obtaining the patients informed consent.
The pharmacist places the required vaccination on the e-MAR. The RN reconciles the
medication on the e-MAR with the physician order.
The nurse discharging the patient then looks at the e-MAR when getting paperwork ready
for discharge teaching. This requires the nurse to take the time to look up medications on the e-
MAR before they discharge the patient. Many times this step is not done and the patient does not
get the required vaccination at discharge.
To remind nurses to give the vaccine at discharge the consent sheet and the immunization
information sheet are placed with the other paperwork to be given to the patient at discharge.
Finding these papers with the discharge teaching papers will remind the nurse to obtain
permission for the vaccine and to give the vaccine when the consent is signed before discharge.

24. 24
Vaccination consent
and fact sheet
placed in discharge
tab of patient chart
along with other
teaching material
Vaccination given at
discharge and
recorded on e-MAR
and patient profile
Vaccination order
sent to pharmacy
Vaccination order
placed on e-MAR
discharge teaching
information
removed from chart
and given to patient
when discharged
Patient record
evaluated for
needed vaccines
when admitted to
unit
Vaccination
retrieved from
medication room

25. 25
Summary
It is important to know at how an activity is accomplished by looking at the steps
involved and who is responsible for each step. The objective of Healthcare IT is to provide the
right information at the right time, providing a streamlined workflow. Matching workflow with
the abilities of the EHR being considered for purchase will increase chances of user acceptance.
Studying workflow allows for the discovery of problems both in real time before EHR is
implemented and potential problems when the EHR is implemented. These problems can be such
things as bottlenecks, increased errors, or quality issues (Washington, 2008).

26. 26
References
CDC (2012) Meaningful use and immunization information systems. Retrieved from
http://www.cdc.gov/vaccines/programs/iis/meaningful-use/index.html
Hebb, N., (2014) The top 5 reasons to use flowcharts Retrieved from
http://www.breezetree.com/articles/top-reasons-to-flowchart.htm
Meaningful use HL7 version 2 (2011) retrieved from
http://www.hl7.org/documentcenter/public_temp_CC52B5D7-1C23-BA17-
0C6DB5D2E1122DE4/calendarofevents/himss/2011/Version%202%20and%20Immuniz
ation%20Registries.pdf
Washington, Lydia. (2008) "Analyzing Workflow for a Health IT Implementation." Journal of
AHIMA 79, no.1 (January 2008): 64-65. Retrieved from
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_036563.hcsp?dDoc
Name=bok1_036563

27. 27
PICOT Research for EBP
Ruth Wetherald
Walden University
NURS 6052 -36, Evidence Based Nursing
Oct 09, 2014

28. 28
Introduction
The use of alternative therapy/medicine is increasing across the globe. In the United
States the increased use of complementary and alternative medicine (CAM) has also increased.
Nurse Midwifes seem to be more open and willing to use these therapies and recommend these
therapies to their patients. Nurses at the facility where I work are uncomfortable working with
the Midwifes in part because of the alternative therapies being used. Giving care to women in
labor could be enhanced if the labor nurses were more knowledgeable and comfortable working
with CAM therapies.
Possible Research Questions
Developing a research question is an art form. Going through the process of articulating a
researchable question takes practice. According to Davies (2011) “One of the most challenging
aspects of EBP is to actually identify the answerable question”.
The Questions I developed are:
1. Does CAM therapy provide the benefits they claim to those that use them?
2. Are providers offering/supporting CAM because they believe it works or because patients
demand it?
3. How safe are the CAM therapies used by women in pregnancy?
4. Does patient labor experience improve with knowledgeable support of the nursing staff?
5. Does education on CAM improve/increase the use of CAM in nursing practice?
All the questions have the three elements of a qualitative research question. The elements
are; population of interest, the potential element of harm, and the possible outcomes expected
(Polit, & Beck, 2012). Question 1 is very general and looks at all therapies which is very broad
and could result in more information than could be gone through for this class. Question 2 is too

29. 29
specific and may not get enough data for this class. Question 3 may not get enough information
or get too much as it is a very broad question and again CAM covers a multitude of therapies. It
should be narrowed down for the purpose of this paper. Question 4 looks at the relationship
between nurse and patient and how increased knowledge can improve it. Question 5 also has the
three elements, but it is phrased in more general terms looking at all uses of CAM in nursing
practice. The Question chosen for the PICOT question is number 4.
PICOT question
The Question chosen for this research project will be “Does patient labor experience
improve with knowledgeable support of the nursing staff?”
Population: women giving birth vaginally.
Intervention: education of nurses about CAM therapies used in Labor.
Comparison: nursing care without nursing education about CAM therapies used in Labor.
Outcome: Increased comfort and satisfaction of both staff and patients.
Search Terms Selected
The terms selected for the search are; childbirth, vaginal delivery, labor, “practitioner
training”, CAM, “alternative medicine”, “prevalence of CAM use”, “causes”, and safety. The
first three terms relate to the population being targeted. The second three focus on the area of
research. The last two focus on cause and safety.

30. 30
Synthesis of studies
CAM use has increased globally over that last decade (Warriner, 2007). According to
Muñoz-Sellés, Vallès-Segalés, and Goberna-Tricas (2013) the use of CAM varies by country
from 18% up to 80%. Mitchell (2013) also found a large percentage of CAM use among
pregnant or laboring women. Women are attracted to these treatment modalities because they are
viewed as natural and safe as compared to western medicine (Dhany, Mitchell, & Foy, (2012),
Kalder, Knoblauch, Hrgovic, & Münstedt, (2011), Warriner, (2007) ).
There are theories about why there has been an increase of CAM use. Most theories state
that it is related to reduction of fear or an attempted to control fear by feeling in control through
making decisions about their healthcare choices (Kalder, Knoblauch, Hrgovic, & Münstedt,
(2011), Mitchell, (2013) ).
Kalder et. al. (2011) found that women feel that CAM was helpful in their delivery
experience. Nurses trained in CAM were more comfortable using it and felt that their care was
better and more well-rounded (Downey, (2007),
There has not been any formal training in CAM offered at traditional Medical and
Nursing learning. Professionals that want more education about the use of CAM usually acquire
the education on their own ( Muñoz-Sellés, Vallès-Segalés, and Goberna-Tricas 2013). With the
increase in demand by the public to use CAM in pregnancy and labor and delivery there is a
global push by many nursing and medical organizations to offer formal education on CAM
therapies (Downey, (2007), Kalder, Knoblauch, Hrgovic, & Münstedt, (2011), Muñoz-Sellés,
Vallès-Segalés, and Goberna-Tricas (2013) ). Warriner (2007) points out those in a medical
profession have a duty to provide safe care. Knowledge of CAM (and how to use it safely) is a
moral and ethical obligation.

31. 31
Critic of the articles located
The article by Muñoz-Sellés et.al. (2013) was a large study with good response to the survey
questions. This seems to be an adequate study.
The Mitchell (2013) was very small in the participant area. This study would need to be
repeated with a larger group or more studies of this type would be needed for adequate use in
EBP.
The Kalder, et. al. (2011) study was large enough to confirm that more formal education on
CAM methods and use were needed.
The Dhany et. al. (2012) study was a large study with good planning and validity.
The Downey (2007) study was a good sample but could be repeated with a larger sample. It
could also be done at other institutions providing CAM education.
EBP Practice
“Does patient labor experience improve with knowledgeable support of the nursing staff?”
The research found that there is an increase of the use of CAM among pregnant women.
There are not standards of practice for this area of medical knowledge. There is no formal
training required for this area of practice. Patients feel that CAM is helpful when used in
pregnancy and delivery. Nurses are more likely to use CAM when they are familiar with specific
types of CAM and have the appropriate equipment to implement it (Muñoz-Sellés, et. al. pg 6
(2013). Kalder et. al. (2011) recommends education about CAM (pg 481). Education the nursing
staff of labor and delivery will allow nurses to be more comfortable with using CAM and
contribute to both patient and nursing satisfaction.

32. 32
Nurses and nurse midwifes that are not educated about the safe use of different CAM
methods are less likely to use it or recommend it. If they use it when they do not have the
knowledge to use it safely it could put the patient and fetus in danger.
The first step would be to encourage the nurses to obtain further training in CAM
methods used by the nurse midwifes on their own. The second step would be to present the
information to the nursing and hospital administration to convince them to provide CAM training
to the staff or pay for training off site. For both groups emphasis should be on the patient( and
fetus) satisfaction and safety.
Summary
There has been an increase of the use of CAM throughout the globe in all areas of
medicine. It is especially increased in pregnant and delivering women. There has not been much
research on the effects or safety of some modalities being used. More research is needed. Some
modalities are consistently used by midwifes. Education of medical personnel during their
formal education has been recommended by many medical organizations throughout the globe.
While formal education on the use of CAM is beginning to be implemented, as an organization
and as personal goal CAM education should be obtained to ensure safe use of CAM. This will
result in better, safer patient care and higher patient satisfaction scores
Conclusion
The use of CAM has increased though out the world to the point that there is concern about
the safety of such modalities. There should also be more education of nurses, midwifes, and
doctors about the use and practice of these alternative measures.

33. 33
References
Dhany, A., Mitchell, T., & Foy, C. (2012). Aromatherapy and Massage Intrapartum Service
Impact on Use of Analgesia and Anesthesia in Women in Labor: A Retrospective Case
Note Analysis. Journal Of Alternative & Complementary Medicine, 18(10), 932-938.
doi:10.1089/acm.2011.0254
Davies, K. S. (2011). Formulating the evidence based practice question: A review of the
frameworks. Evidence Based Library and Information Practice, 6(2), 75–80. Retrieved
from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144
Downey, M. (2007). Effects of holistic nursing course: A
paradigm shift for holistic health practices. Journal of
Holistic Nursing, 25, 119-126.
Kalder, M., Knoblauch, K., Hrgovic, I., & Münstedt, K. (2011). Use of complementary and
alternative medicine during pregnancy and delivery. Archives Of Gynecology And
Obstetrics, 283(3), 475-482. doi:10.1007/s00404-010-1388-2
Mitchell, M. (2013). Women's use of complementary and alternative medicine in pregnancy: A
journey to normal birth. British Journal Of Midwifery, 21(2), 100-106.
Muñoz-Sellés, E., Vallès-Segalés, A., & Goberna-Tricas, J. (2013). Use of alternative and
complementary therapies in labor and delivery care: a cross-sectional study of midwives'
training in Catalan hospitals accredited as centers for normal birth. BMC Complementary
And Alternative Medicine, 13318. doi:10.1186/1472-6882-13-318
Warriner, S. (2007). Over-the-counter culture: complementary therapy for pregnancy. British
Journal Of Midwifery, 15(12), 770-772.

34. 34
Planned Change in a Department or Unit
Ruth Wetherald
Walden University
Nurs 6053

35. 35
Introduction
The facility has changed from traditional shift change report to bedside report. The
change has resulted in longer reports increasing overtime. The report is longer because the nurses
on our unit want an overview of all the patients on the floor before getting individual report. This
is especially important to the charge nurse who makes patient assignments.
Change proposal
The change that would be appropriate would be to have the charge nurse shift start early
by 15 minutes to obtain the overview of patient status and allow the early assignment for staff.
When staff arrives for duty they can get their assignment and receive report from the appropriate
staff at the bedside. This will save time and money for the facility.
The change in timing of charge nurse report and assignment given will decrease the
overtime generated by the unit. The change in practice could be construed to match the hospital
value of “We recognize that carelessness, avoidance, and judgment if others are enemies of
quality care.” This change is less carless of the department‘s resources.
Allowing the charge nurse to get information on all the patients increases patient safety
by allowing the charge nurse to make appropriate staff assignments and organize the floor
activities to best utilize the unit resources. This will match with the value of “We work together
to create memorable experiences for our patients”.
The change in practice will decrease staff frustration with overtime due to bedside report
while continuing best practice of bedside report as recommended by the Institute of Patient and
Family centered care (IPFCC) and the Joint Commission (goal thirteen of the national patient

36. 36
safety goals). Bedside report is meant to increase patient satisfaction and encourage patient and
family participation in their own health care.
Change model
The model to be chosen is Lippitts theory of change. There are four main stages for this
theory. (7 steps) some of which I have combined for the purpose of this paper. Assess the
situation, plan the intervention, implement the intervention, and evaluate the intervention. This
relates well to the nursing process and is iterative (Mitchell, 2013).
Plan for change
Assessment:
The first step is diagnosing a problem that demands a change.in this case prolonged
report times resulting in overtime and staff dis-satisfaction.
The second step of the assessment is evaluation of the resistance to change. The hold
back for this change is the day shift nurses not wanting the charge task pre assigned. The second
hold back is that the day shift barely makes it on time for shift report and this would require the
designated charge to come in even earlier.
The third step is to look at the resources and motivation for change. The motivation is
decrease in overtime and less staff frustration about the length of time report is taking. The
resources are the manager’s authority to demand a change in reporting process. This is not a new
idea. This process is already being done on other units in this facility.
Planning:
The fourth step is to state the final change objective. The objective is decrease report time
while maintaining patient safety and staff satisfaction.

37. 37
The fifth step is to decide the change agent. The change agent in this case will be the
upper unit management.
Implementation:
The sixth stage is maintaining the change. This will require observation and perhaps
physical presence of managers at shift change until the change is well established.
Evaluation:
The seventh and final stage is the evaluation. Evaluation of the success of this
intervention will be the decrease in overtime related to shift change and improved staff
satisfaction with the length of time needed for shift report.
Leader characteristics
Managers will need to initiate this change due to the resistance of the day shift nurses.
The night shift nurses have already approached the day shift about doing this change and were
met with rejection. According to Mitchell (2013) there are three management styles. These are
autocratic, democratic and laissez-faire. Autocratic is mostly seen in large organizations. This is
true for our top organization that controls many facilities. This is also the management style of
the unit mangers with charge nurses coming in early for report. Democratic is the process of
choice for change but is not always effective. Laissez-faire is nonfunctional leadership and rarely
gives direction. The staff nurses take control. This is the type of management style of the unit
managers of the unit requiring change.
Leaders need to be good communicators, give good support and feedback, role model,
offer good rewards or fair reprimands, have self-confidence (know their strengths and
weaknesses) and help their staff develop good self-images/self-confidence. The leader need to

38. 38
have the confidence and respect of their staff. According to Mitchel (2013) “shortcomings in
leader’s characteristics can lead to problems among followers”.
Summary
This change proposal will only work if the management is willing to change their style of
leadership. They need to assign charge duties and require the charge nurse to start their shift 15
minutes early to streamline the bedside reporting process. Attempts by other nurses to initiate
change (democratic or collaborative) have failed.

39. 39
References
Institute for Family-Centered Care. (2010). Updated January 14,
2010. Retrieved from http://www.familycenteredcare.org/
The Joint Commission on the Accreditation of Healthcare
Organizations. (2007). 2008 National Patient Safety Goals.
Joint Commission Perspectives, 27(7), 10Y22.
Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing
Management - UK, 20(1), 32-37.

40. 40
Application: Design Considerations and Workarounds
Ruth Wetherald
Walden University
Informatics in Nursing and Healthcare
NURS 6401-4
April 12, 2015

41. 41
Application: Design Considerations and Workarounds
Introduction
Information technology is generally believed to improve quality, efficiency and patient
safety when used in healthcare. These improvements depend on the implementation of a system
that works in the organizations environment. Carayon’s Systems Engineering Initiative for
Patient Safety is a human factors model that can be useful in evaluating systems for
implementation (Sittig,& Singh 2009).
This paper will address the three main areas of consideration when implementing a
healthcare Information system. Hardware, Software and Human Factors will be looked at. The
pros and cons of workarounds will also be discussed.
Design considerations
There are three main design considerations; hardware, software, and human factors.
These all are inter-related and depend on each other to create the safe, efficient workplace
environment necessary for quality and cost reducing patient care.
Hardware
Hardware must be capable of supporting all required software activities. The network
should be reliable, providing enough speed to work efficiently during heavy work flow. Factors
that disrupts or slows workflow could potentially affect patient safety (Sittig, & Singh.2009).
There should be enough access points that all staff can log on without waiting for a device to be
free (Oder, Nauseda, Carlson, Llewellyn, Brown, Catrambone,, ... & Garcia, 2010).
Choosing the type of devices for clinician use depends on many factors. The device
should have enough memory and processing power to operate the software. Battery power is a
consideration if the device is mobile. Clinical workflows should be considered when evaluating

42. 42
the devices usefulness. Devices that do not match or improve workflow may encourage
workarounds or delay the input of clinical information (Oder et. al. 2010).
Software
Software should comply with the national and international standards and be certified by
the appropriate designated agency appointed by the ONC. There should be a list of requirements
that the stake holders expect the software to be able to perform. This list of requirements will
make up a check list when looking at vendor software. When the list is narrowed to a few
vendors the stake holders should be invited to evaluate the systems using various use cases
(Gleason, & Farish-Hunt, 2014). Actual use of the system will allow for stake holders to evaluate
system usability and workflow match assuring better user acceptance of the change. Systems that
have a good match to work flow potentially can decrease workarounds.
Human factors
Human factors are those factors that make the use of tools in a person’s environment
appropriate for the tasks that are required. In the case of human-computer interaction the
computer (tool) should make the task (charting) more efficient and decrease errors (Saba, &
McCormick, 2011 pg. 120). Workflow should be considered before implementation occurs to
ensure that there are no gapes in process caused by the implementation (Gomez, 2010).
Usability is related to efficiency, safety, and user satisfaction or fatigue. Evaluating
usability is based on the amount of time required to complete a task, number of interactions or
key strokes to complete a task sequence, and number of screens used before a task is completed
(Force, H. E. U. T. 2009).

43. 43
Employee workarounds
Workarounds happen for many reasons. The main reasons are efficiency, no path for
workflow, design errors in the EMR software system and memory. Some work habits are
considered workarounds if they do not follow policy. Paper is used when there is no access to a
device at point of care. Paper is considered a memory notation. An inaccurate entry may be
forced on a clinician or nurse when the system does not allow for data input other than what is
presented as a choice (Zinger, 2013).
Benefits and Consequences
Paper is a useful tool when there is no point of care access to the EMR/EHR system. As a
memory device this workaround is useful. Problems include loss of paper before information is
input to the system, or not being input at all resulting in information not being communicated to
others on the healthcare team.
Inaccurate data because of interface configuration can be a safety issue and should be
addressed. Having inaccurate data can result in errors or poor decisions regarding patient care.
Mitigating workaround opportunities
Having access to the EMR at point of care will decrease the necessity for the use of a
memory device. Allowing some way to free text information into the electronic chart will
increase data accuracy. There should also be a way for staff to request changes to the interface to
allow a more accurate data selection.

44. 44
Conclusion
There are many factors to be considered when considering an EMR/EHR
implementation. Hardware, software and human factors all combine to make workflow efficient
and safe while preventing potentially harmful workarounds. Understanding clinical workflow
process makes the Nurse Informaticist a valuable asset when implementing clinical systems.

45. 45
Reference
Force, H. E. U. T. (2009). Defining and Testing EMR Usability.
Gleason, R. P., & Farish-Hunt, H. (2014). How to Choose or Change an Electronic Health
Record System. The Journal for Nurse Practitioners, 10(10), 835-839.
Gomez, R. (2010). EHR upgrade considerations. Nursing management, 41(12), 35-37.
Saba, V. K., & McCormick, K. A. (2011). Essentials of nursing informatics (5th ed.). New York,
NY: McGraw-Hill.
Oder, K., Susan Nauseda, B. S. N., Carlson, E., Llewellyn, J., Fred Brown, D. N. P.,
Catrambone, C., ... & Garcia, B. How to Select End User Clinical Data Entry Devices.
Sittig DF, Singh H.( 2009) Eight Rights of Safe Electronic Health Record Use. JAMA.
2009;302(10):1111-1113. doi:10.1001/jama.2009.1311.
Zinger, A., (2013). Physicians using paper, electronic workarounds to address EMR gaps.
Retrieved from http://www.hospitalemrandehr.com/2013/28/physiciands-using-paper-
electronic-workarounds

46. 46
Team A Project: Constructing a Database
Janie Emralino, Alex Folami, Michelle Millam, Tamara Parker, Ruth Wetherald
Walden University
NURS6411, Section 1, Information and Knowledge Management
August 9, 2015

47. 47
Team A Project: Constructing a Database
This semester, Team Superkey has been eagerly working towards tangible database
design. Through a series of steps and preparations, our team aimed to create a database that
measures the successfulness of patient pain assess and reassessments (Emralino, Folami, Millam,
Parker, and Wetherald, 2015). The purpose of this paper is to first, highlight the developmental
elements required to ensure useful and meaningful pain information, and second, evaluate the
build process, including the effectiveness of our group. This final implementation phase has not
only solidified our learning of database design but has also afforded us the opportunity to
understand further the dynamics of teamwork.
Desired Database Outputs
Database architecture needs to be developed in such a way that business targets are met
(Nolle 2013). Understanding the questions that are to be answered to improve quality and
patient needs is required to develop a database in such a manner that data integrity and input
ensures that the outputs are accurate.
Team Superkey’s clinical question, “Is the hospital’s current policy on pain
management; assessment and reassessment, useful in treating a patient’s pain?” requires certain
information to be gathered in order to assess how effective the hospital’s pain management
policy is in helping to control the pain of their patients. Team Superkey has decided that the
policy includes using a numeric pain scale of 0-10. The policy also includes pain reassessment
within 30 min of IV medication and 60 min of PO or IM administration. The decrease of the
pain scale number at reassessment will be used to determine if the pain medication was effective.
The outputs will be the pain scale assessment and reassessment numbers, time of
assessment/reassessment, and type (method) of medication used; IM, IV, or PO. A thorough
understanding of the purpose of data outputs is necessary to gather the most appropriate inputs.

48. 48
Required Database Inputs
The data inputs required for answering the clinical and other related questions are: pain
scale, time of assessment, time of reassessment, type of intervention, and time of intervention.
Assessment ID (PK) and episode number (FK) will also be a part of this table. Patient
information is also required to relate the pain intervention and assessment to individual patient
tracking. These will be the patient medical record number (PK), patient name (first and last),
date of birth, and sex. This table will be called Patient. The Admission table will include the
patient episode number (PK), patient MRN (FK), admission date, and discharge date. With these
data tables and data fields, the team will be able to answer questions regarding the pain control
issues using queries and forming reports. Additionally, these data should be audited more
frequently to maintain the integrity of the information entered.
Data and Data Input Integrity
Data integrity provides data that is accurate and verifiable. Data redundancy will
increase the chances of data inconsistency. Redundancy occurs when the same data resides in
more than one place and can be changed in more than one place (Coronel, & Morris 2015). One
way to ensure data integrity is to limit the information that can be input into a field. This can be
accomplished by having drop down windows or labels in forms with instructions if necessary
(SSA, 2013). The fields of Pain scale, intervention type, and assessment type will have drop
down menus to ensure that the information entered is consistent.
Furthermore, by enforcing data integrity, the quality of data within the database is
ensured. For example, if a patient were assigned a patient ID number 341, the database should
never allow a user to assign that same number to another patient. Also, if one has a patient pain-
rating column intended to have values ranging from 0 to 10, the database should never allow a

49. 49
user to enter any number below zero or above 10. Therefore, the database should only allow
valid values while disallowing non-existent, invalid values (Gresch, 2014).
The overview of Team Superkey’s database design, reviewed above, is the result of
weeks of learning, planning, and patience. Although our team feels very confident with the final
product, we would not have been successful without overcoming a number of obstacles.
Through a process of team reflection, we can acknowledge our team’s wins, challenges, and
hindsight evaluations.
Successes and failures of Database Creation—Tamara
While completing the project, there were many factors that contributed to helping and or
complicating the assignment’s progression. The first thing that posed some difficulty was
attempting to formulate a topic. Once the topic was established, creating tables, deciding on
field names, inputting data, identifying primary and foreign keys, and establishing relationships
amongst tables proved to be time-consuming. After several online group conversations,
determining appropriate information for the tables became a little easier. As the project
progressed, processes became more detailed and intricate. It was discovered that configuring
tables to deliver accurate data takes planning, which in the end will save time and frustration
during the building of the database.
It is imperative to design a database that allows users to input, update, replace, and
manipulate data without disrupting the validity or integrity of retrieved information (Coronel &
Morris, 2015). Obstacles may have arisen when attempting to create the forms, reports and
queries for the tables. Structuring the tables to perform commands without violations also
proved to be complicated at times. As a group, we conquered those hurdles by collaborating as a
team to identify team member’s strengths and weaknesses in building a database. As a team, it
was important to resolve any issues by communicating respectfully to any concerns that arose.

50. 50
Database Reflection: What would Team Superkey do differently?
Team Superkey had a uniform vision, goal, plan, and purpose when working together in
completing the project assigned. With any group project, it is expected that trials and challenges
will be experienced. The key to successfully completing this project was to establish a strong
foundation of teamwork.
Looking back, we are able to identify additional activities that would promote an efficient
operation. Each team member was not exposed to Microsoft Access prior to this course and it
would have been helpful to learn, in depth, the ins and outs of this program beforehand so that
the database would have been easier to create and complete. Also, setting specific timelines for
each member of the team to submit their portion of the paper or provide feedback would have
allowed for an ample amount of time to discuss further questions and issues. This would have
improved the group’s work process in completing the project while allowing the foreseeing of
any edits that need to be made within the database or written portion of the paper. By week nine,
Team Superkey should have completed the database and at least the draft portion of the paper.
During week ten, Team SuperKey could have been more organized to avoid working under
pressure with the edits that needed to be made, glitches in the database, and deadlines.
Throughout the duration of this team project, Team Superkey was able to adapt
successfully and overall work well together despite the different challenges we experienced as a
group. There are many things that may be garnered from working within this group that may
contribute to future, more efficient teamwork initiatives.

51. 51
Summary
In conclusion, a meaningful database was developed for hypothetical use. However, the
input and outputs created by Team Superkey could provide useful information for real facilities
questioning the effectiveness of their pain management assessment policies. In the event of
actual creation, the fields and entities of this database, as well as, data integrity would need to be
reviewed to ensure the most accurate of valuable outputs dependent on the individual facility.
Team Superkey found the necessary common ground needed to complete this project. We did
not allow our many obstacles to detour us from completing the build and its explanation. Our
team’s professionalism shown as we dedicated the necessary time and effort to build a database
that provided valid, tangible information dedicated to patient care.

52. 52
References
Coronel, C. & Morris, S. (2015). Database systems: Design, implementation, and management
(11th ed.). Stamford, CT: Cengage Learning. ISBN: 978-1-285-19614-5
Emralino, J., Folami, A., Millam, M., Parker, T., & Wetherald, R. (2015). Team A Project:
Database Plan, Walden University.
Gresch, A. (2014). Data Integrity: The Cornerstone Of Any Quality HTM Program. Biomedical
Instrumentation & Technology, 48(4), 285-287. doi:10.2345/0899-8205-48.4.285
Nolle, T., (2013). Architecture plan and design best practices: Outputs, interfaces, and
scheduling. Retrieved from http://searchsoa.techtarget.com/tip/Architecture-plan-and-
design-best-practices-Outputs-interfaces-and-scheduling
SSA accessibility resource center (2013). Input controls. Retrieved from
http://www.ssa.gov/accessibility/bpl/bps/forms/input_controls/default.htm
Access database

53. 53
Gap Analysis Plan
Ruth Wetherald
Walden University
Informatics in Nursing and Healthcare
NURS 6421-1 Supporting Workflow
Oct 04, 2015

54. Running head: CURRENT STATE WORKFLOW 54
Gap Analysis Plan
Introduction
A gap analysis is the process of comparing the desired workflow with the actual
workflow and then identifying areas that can be improved on. There are methods that can assist
in gathering information. Direct observation, surveys, interviews, and data gathering can be used
to find problems or issues (Laureate Education, Inc. (Executive Producer). 2012).
Technology is being promoted as a way to improve productivity, safety, and
communication. Workflow is a consideration when implementing any technology. One view of
technology use is that the technology should match the existing work flow. This can be useful to
decrease change resistance when implementing a new system. Another view is that the existing
work flow should change to match the system. Change in the work flow can increase resistance
to the new technology. A change in technology or a workflow can have a negative effect on
communication, patient safety, or productivity (McGonigle, & Mastrian, (Eds.). 2012).
Workflow issue
The work flow issue that is of concern at my organization is the flow of order entry for
Women’s services. I will be focusing mainly on how the pharmacy orders are processed. At this
point my understanding is that the MD orders the L&D orders including drugs through using
order sets. The anesthesiologist also uses order sets in the CPOE. The CPOE is found on the
general hospital EMR which is a different charting system from the Labor and delivery system.
When patients go from a critical care area to a more general care area the previous orders
are discontinued. Examples would be transfer from operating room/PACU to the surgical unit,
transfer from ICU to med surg, or transfer from L&D to PP. This is accepted as standard practice
in every hospital I have ever worked in.

55. 55
The doctors order the L&D orders and the postpartum orders at the same time instead of
ordering the PP orders after delivery. Even when the pp orders are ordered after delivery the
patient is on L&D for a few hours before transfer. When the orders are placed the pharmacy
automatically get their portion of the order set to process. Since pharmacy does not know where
the patient is in the labor-recovery process they order all the drugs. All drug orders are activated
on the medication Pyxis cabinets. The L&D nurses have access to every drug on the Pyxis as an
override.
Because L&D nurses are on a different charting system they do not always process the
order sets on the CPOE system. If the nurses process the order sets they process them all, even
the PP orders. When the patient is transferred to PP the nurses have to call Pharmacy and tell
them to discontinue the L&D orders, or the surgical/PACU orders. Because the pharmacy does
not get the drug orders by order sets they do not always know what needs to be discontinued. If
this step is not taken the PP nurses may give drugs that were ordered for PACU or L&D since
they are still available on the Pyxis and on the e-MAR.
OB can be a complicated area in which to write or follow orders. There are multiple types
of providers such as OB?GYN, Anesthesia, and Nurse Midwifes. Patients can go from
observation, Labor, Surgery, Recovery or combinations of these types of care. Before the advent
of CPOE the nurses and providers ordered paper order sets as patients moved from one
status/unit to another. The pharmacy received orders after the patients were placed in each area.
The medication flow was easy to follow. Discontinue previous orders were on the paper order
sets. If order sets were not used the pharmacy and nurses clearly understood that hospital policy
required previous orders to be discontinued and it was automatically done. With the advent of
computer use orders can be placed before the patient has moved to the appropriate area of care.

56. 56
This can be confusing and frustrating when trying to determine when orders should be processed
and activated (Campbell, Guappone, Sittig, Dykstra, and Ash, 2009).
Meaningful Use Issues
The meaningful use issues are communication and safety. Maintain active medication
list, and perform medication reconciliation at transition of care and at appropriate encounters
(Brown, 2010). Communication is important for patient safety, electronic communication is not
always as clear as one would hope. Both the sender and receiver of the communication needs to
be clear about what is communicated and the order of the communications if there are more than
one. Meaningful use does not require that the system demonstrate three important items;
verification that the message was received, that the communication was understood by the
receiver, and that such communication is effective in increasing patient safety (Effken, &
Carrington, 2011).
Goals for Gap analysis
The information goals to be discovered are:
1. Perception of work flow duties for each team member by the team members.
2. Workarounds that may be used by each area team members.
3. Areas that could be changed to improve workflow, staff efficiency, and
patient safety.
Data Collection Methods
The gap analysis will start by interviewing a pharmacist, a labor nurse, and an OB
physician. Since this is a teaching hospital a resident should also be interviewed. Interviewing
the clinical analyst may shed light on how the IT department envisions the flow of information
and communication between departments. Surveys for each practice discipline might also be

57. 57
used to determine workflow perceptions and workarounds. . Continuous observation of a work
shift for each area is not necessary at this time. Documenting how many times pharmacy is
called to discontinue L&D orders and how many times PP orders are processed by L&D nurses
(or not), may give useful metrics.
These information collection methods will help to define how orders are processed, what
work arounds may be in place and how work flow could be better organized. Possible solutions
may include adding a “discontinue previous orders” as a note to pharmacy when step down unit
orders are processed/sent to pharmacy. Sending orders to pharmacy by order set names may also
help clarify communication.
Conclusion
Workflow defines who does what at what when. Workflow looks at people and processes
to create business value. To improve the process the current state needs to be compared to the
desired state. Performing a gap analysis can identify areas to improve communication, patient
safety or productivity (Davis, & Miller, 2009).

58. 58
Reference
Brown, B. (2010). 25 steps to meaningful use. Journal of Health Care Compliance, 12(3), 33–
34, 68–69.
Campbell, E. M, Guappone, K. P., Sittig, D. F., Dykstra, R. H., & Ash, J. S. (2009).
Computerized provider order entry adoption: Implications for clinical workflow. Journal
of General Internal Medicine, 24(1), 21–26.
Davis, K., & Miller, J., (2009). Fundamentals of workflow analysis: Implementing new systems.
AHIMA Webinar, March 17, 2009
Effken, J. A., & Carrington, J. (2011). Communication and the electronic health record:
Challenges to achieving the meaningful use standard. Online Journal of Nursing
Informatics, 15(2).
Laureate Education, Inc. (Executive Producer). (2012) 6421-1 week 3 project introduction
McGonigle, D., & Mastrian, K. (Eds.). (2012). Nursing informatics and the foundation of
knowledge (Laureate Education, Inc., custom ed.). Burlington, MA: Jones and Bartlett.

59. 59
Current State Workflow
Ruth Wetherald
Walden University
Informatics in Nursing and Healthcare
Nurs 6421-1 Supporting Workflow
October 18, 2015

60. Running head: WORKFLOW REDESIGN 60
Current State Workflow
The Women’s Services Department of the organization being discussed has an inefficient
and unsafe medication workflow process for the delivering women. This involves different
departments and roles such as MD, Nursing and Pharmacy. A gap analysis of the workflow issue
was conducted by interviewing members of each discipline. The process of gap analysis
compares the current state with what the ideal state would be and then looks for ways to get
closer to the ideal state (BusinessDictionary.com 2015).
Gap Analysis Results
The doctor is responsible to discontinue previous orders when writing transfer orders for
patients moving from L&D to Post-Partum (PP). This is not happening, since as one MD stated
“You can order by order sets but you have to discontinue every order individually which takes a
lot of time”. When asked if they would prefer to be able to discontinue by order set or just have
an order on the PP order set that said “discontinue previous orders” all doctors interviews stated
they would prefer to have the order on the order set as it would save them several steps in the
process. Some doctors were not aware that they had to discontinue orders when a patient was
transferred.
The Pharmacy is responsible to activate medications as they are received through CPOE.
They do not receive medications by order set name even if the medications are ordered by order
set by the MD. Without a “discontinue previous medications” order or having the MD
discontinue orders manually there are duplicate medications on the e-MAR. Medications that are
ordered for L&D but not for PP are still available after transfer. Pharmacists interviewed would
like the medications that are ordered in an order set to come to them by order set name. Having
orders by order set name would make it easier to identify transfer orders so that the pharmacist

61. 61
can discontinue previous medications per hospital policy (even if the MD has not ordered it).
They also would like a “Discontinue previous orders” on the transfer order sets so that they have
an MD order.
L&D nurses use a CERNER EHR for charting in L&D. They use the Paragon CPOE
system that the rest of the hospital is on, but that is the only system in Paragon that they use. The
nurses interviewed were not aware that there are recovery orders on the L&D order set. They
thought they needed to activate the PP recovery orders while the patient was still in L&D. The
newly hired RNs activate all orders in CPOE. The nurses that have been around for a while do
not activate any CPOE orders and prefer to ignore the system, resulting in missed orders
occasionally. L&D nurses need to be educated on which order sets they are to acknowledge and
use.
PP nurses reconcile the PP recovery orders on the order set with the medications on the e-
MAR. If there are still L&D orders active the nurse stops the reconciliation and then calls the
pharmacy to discontinue the L&D medications. After the L&D meds are discontinued she then
reconciles the medication list. If there are no orders flagged when the patient is transferred the
nurse has to look at the list of acknowledged orders to see if the PP order set was activated. Since
orders are processed as individual orders and not as named as an order set in the active orders list
the nurse needs to know what is on the PP order set to be able to recognize of the orders were
processed or it there were none ordered. Some PP nurses do not reconcile the medication lists
and just use whatever is activated.

62. 62
Goal 1) perception of workflow duties:
a. Doctors may not be aware they need to discontinue orders.
b. Doctors that are aware do not discontinue orders because of perceived/actual
extra time issues.
c. Pharmacy knows to discontinue orders but do not receive the information they
need to manage active medications appropriately.
d. L&D nurses need more education about CPOE use.
e. New PP nurses need education on what is in the order sets to be able to
identify if the PP orders have been acknowledged by L&D or if they were not
ordered.
f. PP nurses need education about medication reconciliation requirement.
Goals 2) identify work arounds:
a. MD ignorant of / or ignores need to discontinue orders.
b. Pharmacy waits to be notified of transfer and need to discontinue previous
orders
c. L&D acknowledges all CPOE orders or ignores all CPOE orders.
d. PP reconciles active medication lists or uses all medications on the active list
without doing reconciliation.
Goal 3) areas for improvement:
a. Medications ordered by order set are sent to pharmacy by order set name.
b. Orders ordered by order set are acknowledged by order set name in active
order list.
c. Orders may be discontinued by order set.

63. 63
d. Education of L&D staff re: CPOE order set use.
e. Education of PP staff re: content of order sets.
f. Education of PP staff re: Medication reconciliation requirement.
EHR and Meaningful Use Issues
The meaningful use issue is maintaining an accurate active medication list.
Medication reconciliation is necessary with transition in care and at other appropriate times.
(Brown, 2010). Communication of role duties is vital to increase patient safety. The flow of
information needs to be clear to all disciplines in the patient’s chain of care. (Effken, &
Carrington, 2011).
Verbal Explanation of the Visio Model
MD swimlane: The flow of information as the workflow now operates starts with the
MD/Provider ordering the PP order set. All the orders are flagged for acknowledgment by the
RN. The medications ordered are also set to the Pharmacy.
.RN swimlane: The PP nurse acknowledges all the orders or checks the orders in the
order list if the orders have been acknowledged by L&D. Medication reconciliation is then done.
If the L&D medications are still active on the e-MAR then the reconciliation is stopped and
Pharmacy is notified that L&D medications are to be discontinued. PP nurse then verifies the
active medication list against the ordered medications. Accurate e-MAR achieved. The
medications are now active and ready to give to the patient.
Pharmacy swimlane: Pharmacy receives new medication orders without a discontinue
order for previous medications. Pharmacist that is familiar with PP order set will discontinue
previous orders. Pharmacists who are new just add new orders to existing orders. Pharmacy
discontinues previous medication when notified by RN to do so. Accurate e-MAR achieved.

64. 64
Changes to Visio Draft
The only change made to the flowchart was to change the “no” arrow from the decision
diamond in the nurse swimlane to the decision diamond in the pharmacy swimlane. Previously it
went from the nurse swimlane decision diamond to the first process block in the pharmacy lane.
After feedback it seemed the flow would be clearer if it went from decision to decision. There
were no issues discovered from the gap analysis that would change the diagram that this author
could discern.
Conclusion
Clear communication is necessary and important to patient safety. The implementation of
technology can help or hinder communication depending on how it is configured. Everyone
involved in the process no matter what discipline needs to know what is expected of their role
and have the information necessary to perform their duties in a timely and safe manner (Effken,
& Carrington, 2011).

65. 65
Reference:
Brown, B. (2010). 25 steps to meaningful use. Journal of Health Care Compliance, 12(3), 33–
34, 68–69.
Effken, J. A., & Carrington, J. (2011). Communication and the electronic health record:
Challenges to achieving the meaningful use standard. Online Journal of Nursing
Informatics, 15(2).
Gap analysis. BusinessDictionary.com. Retrieved October 18, 2015, from
BusinessDictionary.com website: http://www.businessdictionary.com/definition/gap-
analysis.html

66. 66
Workflow Redesign
Ruth Wetherald
Walden University
Informatics in Nursing and Healthcare
NURS 6421-1
November 1, 2015

67. Running head: EVALUATION PLAN 67
Workflow Redesign
Proposed solution
The workflow targeted by the Gap Analysis is the inefficient medication order flow when
transferring patients from one area to another. The solution identified is adding a “discontinue
previous orders” line to the Postpartum (PP) order sets. This order will also be sent to the
pharmacy along with the medication orders. Along with this IT solution education of staff about
the change and what order sets each role needs to acknowledge will also be implemented.
These solutions will allow the facility to meet the meaningful use objective of maintaining an
active medication lists (Brown, 2010).
Use case scenario
Use case name Medication orders-administration process
Use case actors Providers
Pharmacists
Nurses
Use case
description:
The provider will order transfer medication and discontinue previous orders.
The orders will go to pharmacy. The pharmacist will activate new orders
and discontinue previous orders. The nurse will do medication
reconciliation and activate the medications orders. The medications will be
ready to administer to patients.
Main success
scenario
1. The provider will place new orders and discontinue old orders.
2. The pharmacy will activate new orders and discontinue old orders.
3. The nurse will reconcile medication orders with pharmacy
medication lists.
4. The nurse will acknowledge/activate the new medications.
5. The nurse will administer active medications as needed.

68. 68
Major steps and changes
There should be minimal changes within the organization. Adding the “discontinue
previous order” to the order sets will make the process of order discontinuation simpler for the
providers. The added order will also make the process of medication reconciliation easier for the
pharmacist and nurses in order to provide an accurate active medication lists.
Education of all actors as to their duties and responsibilities regarding use of order sets
will be provided by the facility. Education can be accomplished through e-mail, staff meetings,
and/or committee meetings in the case of the providers. Education should be done by multiple
modalities, the more education the better (Fickenscher, & Bakerman, 2011).
Implementation strategy
The conversion strategy will be a direct implementation since adding one order line to the
order sets will not require a large amount of time on the part of the IT department. Since this
order will be limited to the PP order sets it will be implemented in one area of the organization
(Dennis, Wixom, & Roth, 2015).
Education will be accomplished before the conversion will be done. Communication will
accomplish two things. The first is giving the actors a reason for the change, the second is to
decrease fear of the unknown and increase the confidence of the actors (Fickenscher, &
Bakerman, 2011)

69. 69
Conclusion
Adding an additional order to the provider order set is the simplest way to improve the
workflow. There are other areas of improvement identified in the gap analysis that should be
considered as a possible future project. Education of all the actors should be done. Follow up to
ensure compliance should be the responsibility of the managers

70. 70
Reference:
Brown, B. (2010). 25 steps to meaningful use. Journal of Health Care Compliance, 12(3), 33–
34, 68–69. Retrieved from the Walden Library databases.
Dennis, A., Wixom, B. H., & Roth, R. M. (2015). Systems analysis and design (6th ed.).
Hoboken, NJ: Wiley.
Fickenscher, K., & Bakerman, M. (2011). Change management in health care IT. Physician
Executive, 37(2), 64–67. Retrieved from the Walden Library databases.
Workflow charts
Nurs 6421 wk7
swimflow chart.jpg
Nurs 6421 wk9
Proj-Wetherald-R swimflow chart.jpg
PowerPoint
Nurs 6421
WK11Proj-WetheraldR.pptx

71. 71
Team Project Portfolio: Team Project Closeout
February 12, 2016
NURS 6441-1 Project Management: Healthcare Information Technology
Alex Folami
Danielle Vindigni
Jonetta Meis
Ruth Wetherald

72. 72
Team Kudos and Contributions: Alex Folami
By far this is one of the best teams of group members I’ve had the honor to work with.
Ruth was a God sent. She made herself available for questions and concerns throughout the
project, and took lead on all assignment tasking. Danielle, what would will I have done without
your editing expertise? Thank you so much for bringing this valuable skill to the table. Jonetta,
without your super-user skill with google docs, Team 5 would have struggled and sent too many
versions of the assignment – so thank you for bring this skill to assist the team. Thank you so
much all for everything you brought to make this team rock.
Team Kudos and Contributions: Danielle Vindigni
Working as part of Team 5 for the group project within this course was a very helpful
experience for me. There was great communication and feedback, as well as helpful support
from each student at all times. Our achievements in this course could not be possible without
Ruth taking the leadership role. As a group we greatly benefitted from Ruth taking charge and
organizing different aspects of the assignment. Along with a great deal of project management
insight, Jonetta provided us with a great technical resource, by uploading documents to the
GoogleDocs website. This allowed us all to work and edit from one paper, which made things
much easier throughout the course. Alex brought great knowledge, input and feedback to the
team that helped bring the tasks together. Working with Team 5, we made sure to meet all of the
deadlines that were set and we were able to complete the project as a successful group of project
managers.

73. 73
Team Kudos and Contributions: Jonetta Meis
Our team worked well to complete the project. We all met the deadlines set and
communicated with the group if we were unable to do so. This ensured that our assignment
deadlines were always met. In the first phase of the project, Ruth took the leadership role without
being assigned as the “leader”. She did an exceptional job as our group leader, and kept us all on
track with open communication.
Team Kudos and Contributions: Ruth Wetherald
The team worked well bringing all parts of the group project together. Danielle
volunteered to edit our group submission and did a great job in creating a cohesive paper.
Jonetta uploaded the paper to Google docs; it was her idea to place them there. The idea was
very beneficial as it allowed all of us to work on the paper, and made less work for Danielle as
the editor. Jonetta also attempted to place the WBS into google, but that did not work out so
well; the group members still appreciated her effort.
We all contributed to each paper and the WBS. The two areas that Dr. Gracie
commented on from the project charter were the sections that Alex was assigned. Way to go
Alex!
Lessons learned: Alex Folami
Providing support and conducting evaluations are key roles in many organizations and
with its stakeholders share. Effective evaluation is an ongoing process and not an event that
occurs only at the end of a project. This is one aspect team five took very seriously, and the
same concept applied to team debriefing. Debriefings are a form of feedback many
organizations employ to assess their project team’s performances. Following an action period,

74. 74
team debriefing is facilitated amongst team members in a form of a dialogue to review and
reflect on the team’s performance. Team members utilize this process to reflect, as well as
discuss their perception of what they can do to improve and become more successful during the
project implementation process.
Any project involving multiple people or stakeholders can face many challenges.
Depending on the location of all of the key players, the project can either suffer – failing,
missing deadlines or succeed without delays. However, through team debriefing via email and
telephone dialogue, Team 5 was able to get every team member on board to produce successfully
completed work. Nevertheless, to experience delays while putting a project plan together is not
an easy task. Yet, investing time to discuss and finalize a project scope is one way to ensure that
all team members produce a solid project charter that does not require changes or modifications
in the future. During Team 5’s assignment, to put together a project plan for Casino Medical
Center, I learned a few things and they are as follows: no one single person can conclude a
project without having a complete buy-in from all group members and stakeholders alike. Every
team member comes with valuable experiences and these experiences cannot be overlooked. I
was privileged with the opportunity to learn the project management process, as well as what it
takes to complete a project on time.
Lessons Learned: Danielle Vindigni
During the Project Management in Healthcare course, I learned a great deal about
communicating effectively and working together as a team, in the role of the project manager.
This position was very new to me at the start of the course. My classmates and I worked
together, to assist one another, and we quickly learned the job duties and responsibilities of those

75. 75
in the project management career setting. Each of us brought different strengths and skill sets to
the table, and were able to come together and successfully work as Team 5.
Using our individual knowledge and backgrounds, we were able to relate our own
experiences to the project scenario that we were provided. With implementing Casino Medical
Center’s Medication Administration System (MAS), our team constructed and organized all of
the stages of the planning process, and held discussions to be able to collectively make
adjustments and modifications when necessary. We successfully divided tasks and assignments
amongst one another, with a great deal of overall support available from each student throughout
the project’s timeline.
Once a project is complete, it is extremely important to take the time to evaluate how it
functioned in its entirety. When I reflect on our achievements within our project management
assignment, I believe that working together allowed each of us to learn to appreciate the benefits
of good communication, meaningful discussions, and constructive critiques. I am confident that
the experience we gained from this course has allowed us to grow, and prepared us to aid in the
real-world success of project management.
Lessons Learned: Jonetta Meis
Throughout the team project I have become educated on the project management process.
The things that I have learned include a project must be well organized and follow a strategic
process, the team is a necessity to complete the project, and to be flexible with the project scope
when it is appropriate.
Organization within a project allows for timelines to be obtained and can ensure that
work is not being duplicated. When a scope is defined the team needs to make sure that all team
members know what assignments they are to complete, and the deadline for each task. Project

76. 76
management task deadlines should be defined to ensure that each aspect is completed in the
correct order. If a task is completed prior to another task, and it is a prerequisite for the first task,
it can throw the whole project off and can inadvertently cause the team to miss a deadline.
Teamwork is a necessity to complete a project. The team must ensure proper
communication with one another and be supportive of the other team members. The project
manager also needs to have the support of the team to ensure that each team member is doing
their part. If a team member is not participating the project manager needs to address it in a
professional manner to keep the team on task. I have learned with Team 5 how well a project
can flow when teamwork is a priority, we have worked well as a team and I appreciate that.
The project should always allow for flexibility within the project scope. Stakeholders can
always add to the project and the team should allow a flexibility in time, staff and to have some
cushion in the budget in case changes are made to the original project. If the project has tasks to
be added to it, it needs to be implemented without going outside the scope project.
Lessons learned: Ruth Wetherald
The end of a project is a good time to reflect on what was learned as an individual and as
a group. The reflection provides a way to grow and evolve as a person and as a professional.
Projects are complicated, the larger they are the more complicated they can be. Projects
take a team effort to plan and complete. There are several steps to go through and many
agreements and contracts to complete before the project can begin. There are a variety of areas
to keep track of while the project progresses. Project closeout must take into account finalizing
the financial costs, requirements, and training in preparation of product go live. Deliverables
must be accepted by the project sponsors, and the process reflected on by the team, in order to
develop lessons learned for future reference.

77. 77
Throughout the process of running a project, personal relationships need to be initiated
and maintained. Communication, tact, and the role of mediator, at times are necessary for those
in a leadership role during the stress of the project lifecycle. The small project that our group
worked on provided insights into the many facets of being a project manager and team member.
The experience of working with the Team 5 members was a good one. We worked well together
and communicated with each other to complete our assignments in a timely manner.

78. 78
Team Sign off Date
Alex Folami __________________________________11 Feb 16______
Danielle Vindigni______________________________12 Feb 16_______
Jonetta Meis__________________________________11 Feb 16_______
Ruth Wetherald________________________________11 Feb 16______
Addendum # 1 Project Charter
Nurs 6441 WK5
Team5
Addendum # 2 MS Project Plan
Nurs 6441 WK9
Group 5 WBS -WetheraldR.mpp

79. 79
Evaluation Plan
Ruth Wetherald
Walden University
System design, planning & evaluation
Nurs 6431-1
Dr. Scott
May 7, 2016

80. Running head: EVALUATION PLAN 80
Evaluation Plan
Hypothetical Scenario Chosen
The scenario chosen for this paper is Scenario 2 because of the problems encountered
with the CPOE issues at the facility that I work for. The view point of the physicians will be the
view point of the evaluation. Usability will be the focus of the evaluation. Usability relates to
physician acceptance and use of the system. Usability can also affect patient safety. CPOE is a
part of meaningful use and its use is purported to increase patient safety by producing legible
medication orders. Linked with decision support systems it should also alert for dosage, allergies,
drug-drug interactions and other potential problems (Zhan, C., Hicks, R. W., Blanchette, C. M.,
Keyes, M. A., & Cousins, D. D. 2006).
Scenario 2:
As the lead nurse informaticist in your hospital, you have been given the task of planning
an evaluation for a soon-to-be launched computerized provider order entry (CPOE) system. The
CPOE system is designed to replace conventional methods of placing medication, laboratory,
admission, referral, and radiology orders. CPOE systems enable health care providers to
electronically specify orders, rather than rely on paper prescriptions, telephone calls, and faxes.
The intended goal of a CPOE system is to improve safety by ensuring that orders are easily
comprehensible through the use of evidence-based order sets. In addition, the CPOE system has
the potential for improving workflow by avoiding duplicate orders and reducing the steps
between those who place medical orders and their recipients.

81. 81
Summarize your research findings on similar HIT implementations.
Usability of the CPOE interface can be unsafe and lead to unintended consequences
(Horsky, J., Kuperman, G. J., & Patel, V. L. 2005), (Khajouei, R., & Jaspers, M. W. M. 2010).
Implementing Clinical informatics and CPOEchanges the way clinicians interact and collaborate
with other team members and how they arrange their work flow (Campbell, E. M., Guappone, K.
P., Sittig, D. F., Dykstra, R. H., & Ash, J. S. (2009). Work flow should be studied by using the
sociotechnical theory to compare the technology workflow to the human workflow. This should
ensure the best match of the technology to the human factors. The study by Chan, Shojania,
Easty, and Etchells, (2011) concluded that usability principles should be used in the interface
design to improve workflow, decrease ordering errors and increase user satisfaction and
acceptance of CPOEuse.
Evaluation goal and viewpoint
The view for the evaluation will be from the clinician viewpoint. The goal of the
evaluation is to ensure that the CPOE is as easy to use as possible to ensure decreased order
errors, more efficient workflow and increased clinician acceptance. Change most usually meets
resistance. Ensuring that the technology is user friendly will help decrease end user resistance
and ensure that the technology is used. The PICO question that will be looked at is “Are the
provider order sets in the CPOE system adequate to cover the provider’s usual orders without
looking for items outside the order set?”

82. 82
Significance of PICO question
This question is important because most hospitals have or had a printed order set for
routine or usual orders. Having the same type of system in place on the CPOE will mirror part of
the physicians normal workflow and decrease the amount of time spent looking for various
orders in multiple categories such as lab, radiology, nursing, respiratory therapy etc. Technology
can change how team members communicate and change the workflow of the team members.
Creating a similar work flow in the technology used will lead to better user satisfaction and
compliance (Peikari, H. R., Zakaria, M. S., Yasin, N. M., Shah, M. H., & Elhissi, A. (2013).
Literature Review
The PICO question that was developed to evaluate is: Are the provider order sets in the
CPOE system adequate to cover the provider’s usual orders without looking for items outside the
order set?
There are many studies that point out that CPOE implementation can have unintended
consequences (Bonnabry, P., Despont-Gros, C., Grauser, D., Casez, P., Despond, M., Pugin, D.,
… Lovis, C. 2008), (Chan, J., Shojania, K. G., Easty, A. C., & Etchells, E. E. 2011), (Jalloh O,
Waitman L. 2006), (Khajouei, R., de Jongh, D., & Jaspers, M. W. 2009), (Khajouei, R., Peek, N.,
Wierenga, P. C., Kersten, M. J., & Jaspers, M. W. 2010), (Peikari, H. R., Zakaria, M. S., Yasin,
N. M., Shah, M. H., & Elhissi, A. 2013). Usability issues with the CPOEinterface can lead to
failed implementation, errors in ordering, time inefficiency, communication issues and work
flow problems (Bonnabry, et.al. 2008), (Chan, et. al. 2011), (Jalloh, &Waitman 206), ( Khajouei
et.al. 2009), (Khajouei, et.al. 2010), and (Peikari, et. al. 2013). Physician order sets can help

83. 83
decrease errors and improve efficiency and workflow, and improve implementation success
(Bonnabry, et.al. 2008), (Chan, et. al. 2011), and ( Khajouei et.al. 2009).
Conclusions from the evidence
Khajouei, et. al. (2010) found that the use of order sets increased efficiency of ordering
but usability issues can affect efficiency and safety. The addition or reconfiguration of the
interface to increase usability not only increased efficiency but also safety when ordering drugs
as well (Chan, et. al. 2011). CPOE usability issues should be considered when vendors design
the interface and when organizations evaluate the CPOE for purchase (Chan, et. al. 2011),
(Peikari, et.al. 2013).
Evaluation tools
The evaluation methodology that will be used to evaluate the PICO question is a short
questionnaire the CPOE Questionnaire for Physicians obtained from the Agency for Healthcare
Research and Quality website. A question asking how many times the physicians have ordered
outside the order set can be added to the questionnaire. This tool has been used by other
organizations and has been evaluated for reliability and validity. A second evaluation tool that
can data mine for orders submitted outside the order sets over the last two months can be used
(will need to confirm this is possible with the IT department). This will give both qualitative and
quantitative information to compare and analyze.
Evaluation methodology
The information will be obtained from the physicians/providers who are using the CPOE
and from historical ordering data obtained from the data base going back for a time frame of two

84. 84
months. The survey will be available to physicians/providers by the organizational I-net. A link
to the survey will be available through internal e-mails sent to the physicians. A reminder E-mail
will be sent two weeks after the initial e-mail to those who have not participated. The reliability
and validity of the survey will depend on the number of responses obtained (Keough, V. A., &
Tanabe, P. 2011). The data mined from the database regarding order entry will be used also.
This data can validate physician/provider perception of the amount of orders required outside the
order sets. The information can also be used to change or add to the order sets and increase
efficiency of CPOE use (Jalloh O, Waitman L.2006). The time allotted for the survey and the
data collection will be three weeks.
Success criteria
The data gathered from the data base will be measured by % of orders processed outside
the order set when the order set is used. The data base information used to evaluate the CPOE
order sets will be considered successful if the outside order % is less than 30%. The survey
question will be answered in text so that the physicians/providers can state the number of orders
they think they are ordering outside the order set. The evaluation survey will be considered
successful if there is a 65-70 % response. Results of the survey and data mining along with a
plan to modify the order sets if necessary will be disseminated to the Administration and
Physician/provider stakeholders. A Power Point presentation will be used.
Ethical issues
No ethical issues could be determined.

85. 85
Identification of Opportunities and Limitations
The evaluation of CPOE in relation to usability of clinician order sets may have a few
limitations when looking at future use. There may not be adequate response from the survey to
make adequate assessments. Since this is a small study from one site it will not have a big
enough sample to generalize to other sites. I plan on adding one question to the tool I am using.
This may decrease the reliability of the tool.
The second source of information will come from data on ordering histories outside of
the order sets. This may be more reliable than the survey and will gather 100% of order input.
The sample size will still be too small for results to be generalized to the general population.
Describe future opportunities that could build upon your evaluation plan.
The results of the survey could lead to improvement in system usability. Information
obtained could also highlight orders that might need to be included in the order sets. If, for some
reason, the CPOE/EHR system needs to be replaced the information obtained from this study
could be helpful with future evaluation of systems to be purchased.
Strategies for avoiding unintended consequences
If adding orders to the order sets is determined to be helpful, consult with clinicians
before adding new orders to their order sets. Training for CPOEusers should be done if the
CPOE interface or workflow is changed to decrease possible adverse consequences.

86. 86
References
Agency for Healthcare Research and Quality. (n.d.). Health IT survey compendium. Retrieved
from
http://healthit.ahrq.gov/portal/server.pt/community/health_it_tools_and_resources/919/he
alth_it_survey_compendium/27874
Bonnabry, P., Despont-Gros, C., Grauser, D., Casez, P., Despond, M., Pugin, D., … Lovis, C.
(2008). A Risk Analysis Method to Evaluate the Impact of a Computerized Provider
Order Entry System on Patient Safety. Journal of the American Medical Informatics
Association : JAMIA, 15(4), 453–460. http://doi.org/10.1197/jamia.M2677
Campbell, E. M., Guappone, K. P., Sittig, D. F., Dykstra, R. H., & Ash, J. S. (2009).
Computerized provider order entry adoption: implications for clinical workflow. Journal
of general internal medicine, 24(1), 21-26.
Chan, J., Shojania, K. G., Easty, A. C., & Etchells, E. E. (2011). Does user-centred design affect
the efficiency, usability and safety of CPOE order sets?. Journal of the American Medical
Informatics Association, 18(3), 276-281.
Chan, J., Shojania, K. G., Easty, A. C., & Etchells, E. E. (2011). Usability evaluation of order
sets in a computerised provider order entry system. BMJ Quality & Safety, 20(11), 932.
doi:http://dx.doi.org/10.1136/bmjqs.2010.050021
Horsky, J., Kuperman, G. J., & Patel, V. L. (2005). Comprehensive analysis of a medication
dosing error related to CPOE. Journal of the American Medical Informatics Association,
12(4), 377-382.

87. 87
.Jalloh O, Waitman L. Improving Computerized Provider Order Entry (CPOE) usability by data
mining users' queries from access logs. AMIA ... Annual Symposium Proceedings / AMIA
Symposium. AMIA Symposium [serial online]. 2006;:379-383. Available from:
MEDLINE with Full Text, Ipswich, MA. Accessed April 24, 2016
Keough, V. A., & Tanabe, P. (2011). Survey research: An effective design for conducting
nursing research. Journal of Nursing Regulation, 1(4), 37–44.
Retrieved from the Walden Library databases.
Khajouei, R., de Jongh, D., & Jaspers, M. W. (2009). Usability evaluation of a computerized
physician order entry for medication ordering. In MIE (pp. 532-536).
Khajouei, R., & Jaspers, M. W. M. (2010). The impact of CPOE medication systems' design
aspects on usability, workflow and medication orders. Methods of information in
medicine, 49(1), 3.
Khajouei, R., Peek, N., Wierenga, P. C., Kersten, M. J., & Jaspers, M. W. (2010). Effect of
predefined order sets and usability problems on efficiency of computerized medication
ordering. International journal of medical informatics, 79(10), 690-698.
Niazkhani, Z., Pirnejad, H., van der Sijs, H., & Aarts, J. (2011). Evaluating the medication
process in the context of CPOE use: the significance of working around the system.
International journal of medical informatics, 80(7), 490-506.
Peikari, H. R., Zakaria, M. S., Yasin, N. M., Shah, M. H., & Elhissi, A. (2013). Role of
computerized physician order entry usability in the reduction of prescribing errors.
Healthcare informatics research, 19(2), 93-101.

88. 88
Sittig, D. F., Ash, J. S., Zhang, J., Osheroff, J. A., & Shabot, M. M. (2006). Lessons from
“Unexpected increased mortality after implementation of a commercially sold
computerized physician order entry system”. Pediatrics, 118(2), 797-801.
Zhan, C., Hicks, R. W., Blanchette, C. M., Keyes, M. A., & Cousins, D. D. (2006). Potential
benefits and problems with computerized prescriber order entry: analysis of a voluntary
medication error-reporting database. American Journal of Health-System Pharmacy,
63(4).

89. 89
Addendum: Literature Review
Citation Type of Study
Design Type
Framework/Theory
Setting Key
Concepts/Variables
Findings Hierarchy
of Evidence
Level
Bonnabry, P.,
Despont-
Gros, C.,
Grauser, D.,
Casez, P.,
Despond, M.,
Pugin, D., …
Lovis, C.
(2008). A
Risk Analysis
Method to
Evaluate the
Impact of a
Computerized
Provider
Order Entry
System on
Patient Safety.
Journal of the
Type of Study:
Quantitative evaluation
Design Type:
Comparative risk
analysis.
Framework/Theory:
Failure models, Effects,
and Critical Analysis
(FMECA) model
Geneva
Universit
y
Hospital
Concepts:
Identification of
possible failures and
the effects of the
failures before and
after CPOE
implementation
Independent
Variable:
Possible failure of
process at each step
before and after
CPOE
implementation
Dependent Variable:
Effects/outcomes of
failure rated by
severity of outcome.
Controlled Variable:
Process steps
For 12 out of
27 failure
modes the risk
was reduced by
the
implementation
of the CPOE
Level 3

90. 90
American
Medical
Informatics
Association :
JAMIA, 15(4),
453–460.
http://doi.org/
10.1197/jamia
.M2677
Chan, J., Shojania, K.
G., Easty, A.
C., &
Etchells, E. E.
(2011). Does
user-centred
design affect
the efficiency,
usability and
safety of
CPOE order
sets?. Journal
Type of Study:
Quantitative Evaluation
Design Type:
Comparative/
randomized
Framework/Theory:
None reported
Sunnybro
ok
Health
science
center
Concepts:
Positive usability in
technology leads to
improved acceptance
and use of
technology
Independent
Variable:
Randomized
presentation of order
set formats
Dependent Variable:
Time to complete
order set
Controlled Variable:
Order set format
The user
centered
design format
CPOE was
more usable
and efficient
that the
commercial
CPOE. The
user centered
design was as
efficient and
usable as the
paper charting.
The user center
design would
increase the
chances of the
CPOE system
being
successful.
Level 1

91. 91
of the
American
Medical
Informatics
Association,
18(3), 276-
281.
Citation Study
Design Type
Framework/Theory
Setting Key
Concepts/Variables
Findings Hierarchy
of Evidence
Level
Chan, J., Shojania, K.
G., Easty, A.
C., &
Etchells, E. E.
(2011).
Usability
evaluation of
order sets in a
computerised
provider order
Type of Study:
Quantitative evaluation
Design Type:
Objective based
Framework/Theory:
None reported
Sunnybro
ok health
science
center
Concepts:
Usability heuristics
should be included at
every stage of the
development process
Independent
Variable:
10 usability heuristics
Dependent Variable:
CPOE interface
Controlled Variable:
Test order sets
Recommendati
on to do
usability
evaluation
before
purchase or
implementation
of a CPOE
sytem
Level 5

92. 92
entry system.
BMJ Quality
& Safety,
20(11), 932.
doi:http://dx.d
oi.org/10.113
6/bmjqs.2010.
050021
.Jalloh O, Waitman
L. Improving
Computerized
Provider
Order Entry
(CPOE)
usability by
data mining
users' queries
Type of Study:
.Quantitative research
Design Type:
Comparison based
Framework/Theory:
None reported
Vanderbil
t
university
medical
center
Concepts:
Having frequently
used orders at the
top of the order return
would decrease order
times in CPOE
Independent
Variable:
Order of items
returned with search
Dependent Variable:
Time it takes to
process orders
Controlled Variable:
Order list return when
search initiated
Robust
machine
learning will
generate
relevant orders,
order sets, and
data mining by
user
preference.
Level 2

93. 93
from access
logs. AMIA ...
Annual
Symposium
Proceedings /
AMIA
Symposium.
AMIA
Symposium
[serial online].
2006;:379-
383.
Available
from:
MEDLINE
with Full
Text, Ipswich,
MA.
Accessed
April 24,
2016

94. 94
Khajouei, R., de
Jongh, D., &
Jaspers, M.
W. (2009).
Usability
evaluation of
a
computerized
physician
order entry for
medication
ordering. In
MIE (pp. 532-
536).
Type of Study:
Qualitative study
Design Type:
Cognitive walk through
Framework/Theory:
None stated
Academi
c medical
center,
Netherla
nds
Concepts:
Poor CPOE usability
can cause errors
Independent
Variable:
Ordering task
Dependent Variable:
Issues found when
trying to go through
the order process
Controlled Variable:
CPOE interface
Using
recommended
international
standard
organization
system design
and usability
Would have
prevented the
usability issues.
Level 3
Citation Study Design Type
Framework/Theory
Setting Key
Concepts/Variables
Findings Hierarchy
of Evidence
Level

95. 95
Khajouei, R., Peek,
N., Wierenga,
P. C., Kersten,
M. J., &
Jaspers, M.
W. (2010).
Effect of
predefined
order sets and
usability
problems on
efficiency of
computerized
medication
ordering.
International
journal of
medical
informatics,
79(10), 690-
698.
Type of Study:
Quantitative
Design Type:
comparative
Framework/Theory:
None provided
Academi
c medical
center,
Netherla
nds
Concepts:
Order and workflow
efficiency may be
affected by how
orders are found and
processed through
CPOE
Independent
Variable:
Individual order vs
order sets
Dependent Variable:
Mouse clicks and
keystroke number
Controlled Variable:
CPOE interface
regardless of
usability
problems, the
use of order-
sets can
improve
efficiency and
safety of the
use of CPOE
Level 2

96. 96
Peikari, H. R.,
Zakaria, M.
S., Yasin, N.
M., Shah, M.
H., & Elhissi,
A. (2013).
Role of
computerized
physician
order entry
usability in
the reduction
of prescribing
errors.
Healthcare
informatics
research,
19(2), 93-101.
Type of Study:
Choose an item.
Design Type:
Choose an item.
Framework/Theory:
Concepts:
Independent
Variable:
Dependent Variable:
Controlled Variable:

97. 97
Power point presentation Nurs 6431
Nurs 6431 WK10
Assgn 1P2 -WetheraldR.pptx

98. 98
Nurs 6600 capstone project presentation
Benchmarking at a
Community healthcare Center.pptx

99. 99
Continuing Education (CE) – Optional
Course Name Number of Hours/Units Date of Completion
NRP online examination 9.0 1/24/2016
NRP learning event
Skin Basics: A&P, Skin assessment and
pressure ulcer scoring
4.0
1.10
1/28/2016
3/19/2016
Table 2
Other Non-Electronic Documents
List those documents for which you do not have electronic versions (meeting programs,
evaluation forms, certificates, etc.) below.
Document Description Date
BLS Basic life support certification 1/20/2016

100. Running head: EVALUATION PLAN 100
End of Program Outcomes Evidence Chart
MSN Graduate
Characteristics
Individual Student
Learning Outcomes
(ISLOs)
Course #;
Learner
Assessments
(Evidence
according to
alignment of
learner
outcomes
from Syllabus
chart)
Student
Outcome:
Service
(Community/
Professional)
Student
Outcome:
Scholar-
Practitioner
(Scholarship/
Practice)
Student
Outcome:
Social
Change
LEADERS/CHANG
E AGENTS
LO1—Synthesize
organizational/system
s leadership for cost-
effective specialist
nursing practice that
contributes to high-
quality healthcare
delivery, advancement
of the nursing
profession,and social
change.
NURS6600
Weekly
Learning
Objective:
10:2
Synthesize
Practicum
Project
elements
into graduate
level
presentations
WK 10
Learner
Assessment
Assignment
10:
Practicum
Project
Presentation
s
I was able to:
Apply
knowledge
and expertise
to analyze
data in a
healthcare
setting
I was able
to:
Evaluate my
options for
possible
disseminatio
n of
scholarly
material
Positive
social
change
through
analysis of a
problem.
Analyze an
actual
problem in a
healthcare
facility
SCHOLAR-
/EVIDENCE-BASED
PRACTITIONERS
LO2—Critique
evidence-based
literature drawing
from diverse
theoretical
perspectives and
pertinent research to
guide decision making
that demonstrates best
practices for specialist
nursing practice in a
global society.
NURS6431
VII
Construct an
evaluation
plan using
evidence
based
practices and
validated
reliable tools
I was able to:
Develop a
synthesis of
literature
I was able
to:
Synthesize
elements of
an
evaluation
plan
Positive
social
change
through
development
of evidence
based
evaluation
plan

101. 101
PROFESSIONALS/
COLLABORATORS
LO3—Integratively
assess,diagnose,plan,
implement, and
evaluate cost-effective
healthcare strategies
that reduce health
disparities by
patient/population
advocacy for access to
specialist nursing
care.
NURS6441
IV. create a
project
charter for
an HIT
project
4.1 Analyze
the impact of
“triple
constraint”
when
developing a
project
charter
4:
Discussion:
participated
in the
classroom
discussion on
project
charter
elements
Applied the
information
while
producing a
charter for a
HIT project
Positive
social
change
through the
process of
planning an
improvemen
t
EFFECTIVE
COMMUNICATORS
LO4—Demonstrate
the ability to
effectively
communicate using
audience-specific oral,
written, and
information
technology for
professional delivery
of specialist nursing
care.
NURS6421
VII:
Apply visual
diagrammin
g tools to the
process if
workflow
modeling
I was able to:
Create
finalized
current state
and future
state work
flow in Visio
I was able
to:
Develop a
presentation
for a
proposed
workflow
redesign
project
Positive
social
change
through
workflow
improvemen
t
EDUCATORS/
CONSULTANTS
LO5—Evaluate health
needs of diverse
populations for
necessary
teaching/coaching
functions based on
specialist nursing
knowledge to
restore/promote health
and prevent
illness/injury.
NURS6401
IV:
Analyze
nursing
competencie
s
I was able to:
Evaluate
design
consideration
that impact
the success
of
informatics
technologies
I was able
to: evaluate
the
implications
of work
arounds
when using
new
technology
Positive
social
change
through
evaluation of
EHR use.
LIFELONG
LEARNERS
LO6—Exhibit
ongoing commitment
to professional
development and
value of nursing
theories/ethical
principles (altruism,
autonomy, human
dignity, integrity,
social justice) in
accordance with
NURS6401
VI:
Analyze how
Patient
centered
technologies
transform
healthcare
practices
I was able to:
Evaluate how
patient
centered
technology
can influence
health
management
I was able
to:
Apply the
information
learned to
evaluation
of the
impact of
work a
rounds in a
Positive
social
change
through
evaluation of
EHR use.

102. 102
ethically responsible,
legally accountable
specialist nursing
practice.
healthcare
setting
HEALTHCARE
PROVIDERS
LO7—Implement
specialist nursing
roles to promote
quality improvement
of patient-centered
care in accordance
with professional
practice standards that
transform health
outcomes for diverse
populations.
NURS6421
VI: Analyze
how patient
centered
technologies
transform
current
health care
practices
I was able to:
Analyze
work flow in
a health care
setting
I was able
to:
Evaluate
how patient
centered
technology
can
influence
health
managemen
t
Positive
social
change by
Improving
work flow

103. 103
Final Reflection
Through the educational journey taken I have learned leadership skills, improved my
presentation and written communication skills, and made some friends along the way. I have
learned that learning and skill improvement are lifelong goals. I will always be trying to improve
myself to become a better person and better professional. Even though the formal education is
over, the learning will be an ongoing process.