New technology—and the application of existing technology—only appears in healthcare settings after careful and significant research. The stakes are high, and new clinical systems need to offer evidence of positive impact on outcomes or efficiencies.

Nurse informaticists and healthcare leaders formulate clinical system strategies. As these strategies are often based on technology trends, informaticists and others have then benefited from consulting existing research to inform their thinking.

In this Assignment, you will review existing research focused on the application of clinical systems. After reviewing, you will summarize your findings.

To Prepare:

• Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the context of nursing practice and healthcare delivery.
• Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.”
• Identify and select 5 peer-reviewed articles from your research.

The Assignment: (4-5 pages)

In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Be sure to address the following:

• Identify the 5 peer-reviewed articles you reviewed, citing each in APA format.
• Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.

Rubric

In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Be sure to address the following:
·   Properly identify 5 peer-reviewed articles selected.
·   Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.–

Excellent 77 (77%) – 85 (85%)The responses accurately and clearly identify 5 peer-reviewed research articles for the Assignment.

The responses accurately and thoroughly summarize in detail each study reviewed, explaining in detail the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described.

Specific, accurate, and detailed examples are provided which fully support the responses.Good 68 (68%) – 76 (76%)The responses identify 5 peer-reviewed research articles for the Assignment.

The responses summarize each study reviewed, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described.

Accurate examples are provided which support the responses provided.Fair 60 (60%) – 67 (67%)The responses vaguely or inaccurately identify 5 or less peer-reviewed articles for the Assignment.

The responses summarize each study reviewed, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described that is vague or inaccurate.

Examples provided to support the responses are vague or inaccurate.Poor 0 (0%) – 59 (59%)The responses vaguely and inaccurately identify less than 5 peer-reviewed articles for the Assignment, or are missing.

The responses vaguely and inaccurately summarize each study reviewed, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described, or are missing.

Examples provided to support the responses are vague and inaccurate, or are missing.

Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.–

Excellent 5 (5%) – 5 (5%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity.Good 4 (4%) – 4 (4%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.Fair 3.5 (3.5%) – 3.5 (3.5%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%- 79% of the time.Poor 0 (0%) – 3 (3%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation–

Excellent 5 (5%) – 5 (5%)Uses correct grammar, spelling, and punctuation with no errors.Good 4 (4%) – 4 (4%)Contains a few (1-2) grammar, spelling, and punctuation errors.Fair 3.5 (3.5%) – 3.5 (3.5%)Contains several (3-4) grammar, spelling, and punctuation errors.Poor 0 (0%) – 3 (3%)Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.–

Excellent 5 (5%) – 5 (5%)Uses correct APA format with no errors.Good 4 (4%) – 4 (4%)Contains a few (1-2) APA format errors.Fair 3.5 (3.5%) – 3.5 (3.5%)Contains several (3-4) APA format errors.Poor 0 (0%) – 3 (3%)Contains many (≥ 5) APA format errors.Total Points: 100 

5

The Application of Clinical Systems to the Study of Traumatic Brain Injury

G.G.

Walden University

NURS 6051, Section 49, Transforming Nursing and Healthcare

April 25, 2019

The Application of Clinical Systems to the Study of Traumatic Brain Injury

An area of research that has always sparked a keen interest in me revolves around rehabilitation medicine. I used to volunteer at TIRR Memorial Hermann, a nationally known rehab facility that deals with patients in recovery from significant injuries. Their patient population includes persons recovering from a stroke, spinal cord injury, traumatic brain injury, and a multitude of other less common illnesses. Because of that passion, I am interested in how nursing technology has evolved to help patients recovering from traumatic brain injuries (TBI). This paper will summarize a brief literature search of five articles that apply clinical systems to TBI recovery.

Informatics Database

Caban and associates (2016) studied whether building a large-scale informatics database would facilitate collection of standardized clinical data and obtain trends of the longitudinal outcomes of service members diagnosed with mild TBI. The article written as a result of this study mentioned how the detailed clinical guidelines for treating mild TBI rely too heavily on behavior observations and subjective recollections (Caban et. al., 2016). Knowing there was a need for an informatics database, these researchers created one using a combination of several other electronic health records systems. This database will improve outcomes in TBI because it will provide immediate concrete information that is objective and can be used to determine treatment paths for new TBI patients.

Prognosis Calculator

In the article “The Aggressiveness of Neurotrauma Practitioners and the Influence of the IMPACT Prognostic Calculator,” researchers investigated how effective a prognosis calculator is improving outcomes for TBI patients. 154 medical professionals responded to a survey that specifically questioned them regarding the usefulness and effectiveness of the IMPACT prognosis calculator. The prognosis calculator is a clinical system that was created to assist with care planning for TBI patients. The calculator is supposed to provide an accurate estimate of the future prognosis of the patient so that doctors can know whether to use aggressive treatment strategies or not. Survey responses were collected using a research electronic data capture system and the responses were statistically analyzed using SPSS software (Letsinger, Rommel, Hirschi, Nirula, & Hawryluk, 2017). Although the IMPACT system is the most significant technological advances in modern TBI care, the results of this article reveal that physicians are not properly aware of the capabilities of this software (Lestinger et. al., 2017). Unfortunately, more medical professionals use it as a communication tool more than anything else.

Assistive Technology for Cognition

A common clinical system is the use of assistive technology to aid in TBI recovery. Wang and associates (2016) created a survey to investigate user experiences with a portable assistive technology for cognition (ATC). Researchers wanted to improve the timing and effectiveness of activities of daily living in veterans diagnosed with a TBI by teaching them how to use a portable ATC. A smartphone and other similar technologies qualify as being labeled an ATC. The three most challenging areas of activities of daily living were remembering names and faces, staying focused on a task, and locating items (Wang, Ding, Teodorski, Mahajan, & Cooper, 2016). The results of this study showed how the TBI participants were pleased with the functionality of the portable ATC, even though they may have faced some initial difficulty with learning how to work it. The most significant part of the findings in this article was the fact that TBI patients are able to improve their daily functioning with the use of a portable ATC as it helps them to overcome their cognitive limitations.

EEG

I would not be able to research clinical systems useful in improving TBI outcomes without making mention of the electroencephalogram. Most people are aware that an EEG is used to measure electrical activity in the brain and to find any potential issues. EEGs are especially significant in treating TBI patients because the exaggerated neurological trauma creates a perfect recipe for many complications. Disorganized electrical activity can result in seizures which can further complicate recovery. In the article “Is Routine Continuous EEG for Traumatic Brain Injury Beneficial,” researchers wanted to determine whether using a continuous EEG would improve outcomes in TBI patient. With the use of continuous EEG, the TBI patient remains connected to the machine for a specific time period following their injury (Aquino et. al., 2017). The time period is generally based on how critical the patient remains. Unfortunately, researchers found less than a 5 percent incidence of catching seizures after continuous EEG use. As a result of such low incidences and the significant cost of a continuous EEG, this clinical application was not recommended.

Chronic Phase MRI

The last article I found involved the use of magnetic resonance imaging to predict outcomes in TBI patients. Ledig and associates (2017) analyzed MRI images in TBI patients and used segmentation to estimate brain measurements from both acute and chronic patients. This article was very interesting to read because the researchers used simple measurements to predict the sizes of neurological structures. These measurements then allowed them to determine whether a TBI patient would have a favorable outcome. As previously mentioned, predictions are significant in treating TBI patients because medical professionals need to get an accurate account of how aggressively they need to treat the injury. Being able to know the appropriate size estimates of neurological organs, such as the amygdala and hippocampus, will help physicians determine just how swollen a patients’ brain is following their TBI. The more swelling they are suffering from, the more aggressive the treatment options should be.

Conclusion

Although this was a brief literature review, the usefulness of clinical applications to improved treatment outcomes is a popular area of research. A TBI is a life-changing injury with a prognosis that gets poorer as the level of injury increases. More aggressive initial treatments have been shown to improve outcomes and create a better prognosis. Because of that, clinical systems are needed to aid in this process. Nursing informatics is all about making the best use of available technology, and systems that target TBI recovery do just that.

References

Aquino, L., B.A., Kang, C. Y., M.D., Harada, M. Y., B.A., Ko, Ara,M.D., M.P.H., Do-Nguyen,

A., Ley, E. J., M.D., . . . Alban, R. F., M.D. (2017). Is routine continuous EEG for traumatic brain injury beneficial? The American Surgeon, 83(12), 1433-1437. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search-proquest-com.ezp.waldenulibrary.org/docview/1991564748?accountid=14872

Caban, J. J., PhD., Bonnema, A.,U.S.A.F.M.C., Bueno, E. R., M.B.A., DeGraba, T., M.D.,

Grammer, G.,M.C.U.S.A., Greenhalgh, W.,M.C.U.S.N., & Kass, S.,M.C.U.S.N. (2016). A large-scale informatics database to advance research and discovery of the effects of mild traumatic brain injury. Military Medicine, 181(5), 11-22. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.7205/MILMED-D-15-00138

Ledig, C., Kamnitsas, K., Koikkalainen, J., Posti, J. P., Takala, R. S. K., Katila, A., . . . Rueckert,

D. (2017). Regional brain morphometry in patients with traumatic brain injury based on acute- and chronic-phase magnetic resonance imaging.PLoS One, 12(11) doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1371/journal.pone.0188152

Letsinger, J., Rommel, C., Hirschi, R., Nirula, R., & Hawryluk, G. W. (2017). The

aggressiveness of neurotrauma practitioners and the influence of the IMPACT prognostic calculator. PloS one, 12(8), e0183552.

Wang, J., M.S., Ding, D., Teodorski, E. E., M.S., Mahajan, H. P., PhD., & Cooper, R. A., PhD.

(2016). Use of assistive technology for cognition among people with traumatic brain injury: A survey study. Military Medicine, 181(6), 560-566. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.7205/MILMED-D-14-00704