An understanding of client need assists you in creating an individualized treatment plan. A treatment plan is designed to reduce symptomology while restoring mental health and promoting wellness. To support client success, a mental health plan provides opportunities for the client to change and grow. The ability to identify need and individualize a treatment plan will assist in career development and increase client success.

Assignment Directions

For this assignment, you will select one of the Suggested Case Studies and create two separate treatment plans from different perspectives (e.g., corrections, policing, courts). You will compare and contrast these two subspecialties in forensic psychology, noting areas of need for the identified client.

Include the following in your discussion and support your responses with relevant details, explanations, references to the case, and/or research-based evidence:

• Identify the forensic psychology subspecialty selected for each treatment plan.
• Create a forensic treatment plan for each subspecialty (1–2 pages each) based on at least two or three needs/issues of the client in the selected case.
  • Be sure to evaluate each need from a correctional, policing, and/or courts perspective.
  • Identify treatment goals and activities for each.
• In 2–3 paragraphs, compare and contrast the different subspecialties used to create the treatment plans.

Assignment Guidelines

Your assignment should be 3–5 pages, not including the title and reference pages, and should include the following elements:

• Title page: Provide your name, title of assignment, course and section number, and date.
• Body: Answer all the questions in complete sentences and paragraphs.
  • Be sure to include an introductory paragraph, thesis sentence, and summary paragraph.
  • Your responses should reflect professional writing standards, using proper tone and language. The writing and writing style should be correct, accurate, and reflect knowledge of the principles of forensic psychology.
• Reference page: Sources listed in APA format.
  • Include a minimum of two scholarly or academic sources, such as empirical research and peer-reviewed journal articles that were published within the last 5 years to support your responses and conclusions.
  • Be sure to carefully select sources after reviewing the literature and evaluating the credibility, relevance, quality, and research merit of each source.
• Use Arial or Times New Roman 12-point font, double-spaced and left aligned.
• Use standard 1″ margins on all sides.
• Use current APA formatting and citation style.
  • If you need assistance with APA style, please visit Academic Writer.

This assignment assesses the following Course Outcome:

PS550-4: Create a treatment plan to assess client needs from the perspective of two forensic psychology subspecialties.

Reply 1 with 2 References

Hillary St James

Module 3: Discussion

Initial Post

Personal Experience: Nursing Informaticists interacting with staff nurses

While working on an inpatient child and adolescent behavioral health unit I spent a large part of my time ensuring I had my documentation done. Charting in the electronic medical record is vital to meeting quality assurance measures, covering yourself and your hospital for liability issues and making sure patient health needs are identified and addressed (Griffith, 2004; Upadhyay & Hu, 2022). Information from the EMR can also be used to promote evidence-based decision making, improve patient outcomes, contribute to research, enhance patient safety, and reduce costs to the healthcare system (Upadhyay & Hu, 2022). During my last year on the unit, I switched from a daytime schedule 7am to 7pm to a nighttime schedule 7pm to 7am. As a night shift nurse, I continued to provide patient care, document in the electronic medical record, administer medications and address behavioral and health issues, with additional nighttime duties. One of my main nighttime duties was chart auditing. I followed an audit check list and audited every chart every day. As a dayshift nurse I had heard my coworkers complain about the night shifts audits and them being ‘picky’ or ‘sticklers.’ We did not have specialized nurse informaticist on our unit or to my knowledge in the hospital, so I believe the work of the night nurses’ audits qualifies them as nurse informaticist interacting with coworkers.

Chart auditing is supposed to be a way to ensure care providers are accurately and completely documenting patient data required by the facility, insurers and JACHO. Reviewing the EMR is a way to increase accountability and improve quality (Hut-Mossel et al., 2021). However, it is often seen as annoying, unnecessary, and bureaucratic (Wolfe et al., 2018; Hut-Mossel et al., 2021). On my unit the dayshift nurses were frequently complaining about corrections or suggestions made by the auditing nurses. The electronic medical record is an amazing tool that has so many benefits and applications to improving care, health costs and patient satisfaction (Kreidler, 2021; Hut-Mossel et al., 2021). Unfortunately the use of electronic medical records has also led to nurses and other providers creating and using workarounds such as, using paper as a cognitive tool, scanning patient identifiers that aren’t connected to the patient, entering free text documentation instead of in structured fields, producing batched documentation, giving medications or treatments before orders are in or conversely documenting treatment before actually providing it, bypassing safety measures, scanning medications for multiple patients at once and more (Fraczkowski et al., 2020; Stevenson et al., 2018). These workarounds can be dangerous and are often the result of a few key factors: Nurses not wanting to inconvenience the patient, environmental constraints (like space), organizational issues where policy doesn’t match up with procedure, task issues (emergencies, insufficient time, previous tasks not documented), Technology and usability (functional issues and understanding issues) (Fraczkowski et al., 2020). Identifying and pointing out workarounds can cause tension between staff nurses and nurse informaticists. 

When I first started auditing, I thought it was somewhat unnecessary and busy work, however that perception quickly changed when I saw how much was missing or inappropriately documented in patient’s charts. After reviewing documentation for a few weeks, I noticed my own charting improved due to familiarity with what was needed. I was able to identify and notify my colleagues about charting they incorrectly entered, and they were sometimes able to resolve the issue. Also, I found evidence of batch charting and addressed that with the staff to improve quality of charting. I found that on my unit the biggest issues were, time, understanding of the system or actual procedure for documentation, and perception of necessity.

Improvement strategy

To improve the quality of nursing documentation as well as the relationship between staff nurses and nurse informaticists, I have two suggestions. The first is that all nurses should be trained to audit their peers’ charts. In many hospitals nurses volunteer or are assigned to an audit committee to get ready for JACHO visits, but I suggest this be an ongoing rotating task. This is because a familiarity with the system and the requirements comes from spending time with them. Increasing experience with an electric medical record system increases satisfaction with using the system (Wolfe et al., 2018). Additionally, most staff learn to use the EMR primarily on the job, three days of training doesn’t cut it, so most staff pick up tips and tricks from senior staff who may or may not have ever learned how to correctly use the systems in the first place, this is how EMR workarounds are passed around (Fraczkowski et al., 2020). The main complaints about using EMRs are technical difficulties and the increase in workload related to clinical documentation (Fraczkowski, 2020; De Groot et al., 2022). While the former is sometimes a systems problem, they can both be improved by increasing the understanding of the system and protocols (Wolfe et al., 2018; De Groot et al., 2022). I believe this strategy would foster collective responsibility for documentation quality (ending the us vs them mentality by giving all nurses a little more of a nurse informaticist role) and promote peer learning. 

If having nurses increase their workload by auditing seems too burdensome of a solution my second suggestion would see the employment of a nurse informatics specialist for on the unit training and trouble shooting. This solution uses the guiding principles described in Mosier et al.’s systems level method for nursing informatics solutions development, but in a slightly different way in a day-to-day clinical setting instead of specific solution development (2019). Firstly, it would provide clear lines of responsibility by creating a dedicated position (Mosier et al., 2019). The utilization of a nurse informaticist to literally follow people around and assist them in learning and understanding the best way to use the system and what they actual need to be doing would also work would lean into the on the job learning pattern of most nurses. Having this type of collaboration between a specialized nurse informaticist and the unit nurses would decrease barriers and make the nurse informaticist more personable as well as giving a known and comfortable resource for trouble shooting. Providing a dedicated staff member who knows the burdens of nurses and the system and policies necessary for proper documentation would allow the staff to feel more comfortable and supported while allowing for respect for different types of expertise removing tensions (Mosier et al. 2019). Having them available during work hours instead of just reporting issues in documentation would allow for learning instead of frustration at being critiqued. I hypothesis that this would increase the likelihood of unit nurses asking for help, taking an interest in better understanding the systems and self-monitoring for workarounds. Working as a unit towards the goal of better documentation, increased work satisfaction and increased patient outcomes by removing some of the burden on staff nurses and providing support through a IT nurse specialist speaks to the guiding principle of Commitment to the vision (Mosier et al., 2019) In addition, having a specialist nurse informaticist on the units could help identify and address changes to the EMR systems to better meet the needs of nurse workflow which has been cited as an issue with using the EMR (Moy et al., 2023; Fraczkowski et al., 2020)

Impact of nursing informatics evolution

With the evolution of nursing informatics, we have a unique opportunity to create a connection between the IT world and the in-person nursing world. Nursing informatics, like nursing itself, has many far-reaching branches and opportunities. For this discussion I want to explore the in-person role of a specialized nurse informaticist to foster a sense of connectedness and collaboration on individual units. The world of IT has been far removed and elusive for many over the years. On many nursing units if you had an IT problem you would need to make a call or send an email request for tech assistance which would be answered by some unidentifiable ‘IT guy.’ As a result, you would only call these IT workers for something functional that you could not figure out, not for improved understanding of the system. Recognition is an important tool to promote engagement (George & Massey, 2020). Leaders use recognition to increase organizational excellence through improved staff engagement and a perceived supportive culture (George & Massey, 2020). Visibility and accessibility have been shown to increase utilization of resources in many fields from electronic resources to healthcare for vulnerable populations (Bhatt & Bathija, 2018; Zuniga, 2022). I hypothesis this principle can be adapted to positive nursing engagement with informatics such as the EMR on the unit to increase quality and promote adherence to organization protocols and best practices. Having visible, available, and relatable IT nurses on units to train staff and trouble shoot system problems would be a functional and beneficial evolution of nursing informatics.

Impact of new technologies

New technologies can also help bridge the gap between staff nurses and nursing informatics. Many staff nurses resent the burden of increased clinical documentation in the EMRs, partly due to insufficient understanding of the systems and protocols (Fraczkowski et al., 2020; De Groot et al., 2022). New AI technologies could provide support, guidance, and other assistance to nurses in the near future. AI-based education and training modules could provide similar assistance as an on-staff IT nurse, minus relatability. Leveraging AI algorithms to analysis and address individual gaps in knowledge or practice could enhance engagement and comprehension of nurses with the EMR software. The most common type of EMR workaround identified is the use of paper as a cognitive tool; to remember vitals to put into the system later, to organize tasks, track medication and plan patient care (Fraczkowski et al., 2020). To address this issue the use of AI virtual assistant technologies could provide real time feedback and assist in organizing data via voice commands or chat interfaces. AI virtual assistants could also offer clarification on protocols, tech trouble shooting and documentation requirements. 

Conclusion

 The interaction between Nursing staff and nurse informatics specialists can be distant and might contain tension, as in the case between the staff nurses on my unit and those providing auditing. The role of nursing informatics is pivotal to addressing challenges within the healthcare world, in particular in relation to electronic medical record documentation. Strategies such as peer chart auditing and the integration of on unit specialized nurse informaticists could be a positive evolution of the nurse informaticist/staff nurse collaborative relationship. The continued evolution of nursing informatics coupled with the emergence of new technology, like AI, offers promising avenues to bridge the gaps between staff nurses and informatics nurses, ultimately leading to improved patient outcomes.

References

Bhatt, J., & Bathija, P. (2018). Ensuring access to quality health care in vulnerable communities. Academic medicine: Journal of the Association of American Medical Colleges, 93(9), 1271–1275. https://doi.org/10.1097/ACM.0000000000002254 

De Groot, K., De Veer, A. J. E., Munster, A. M., Francke, A. L., & Paans, W. (2022). Nursing documentation and its relationship with perceived nursing workload: A mixed-methods study among community nurses. BMC nursing, 21(1), 34. https://doi.org/10.1186/s12912-022-00811-7

Fraczkowski, D., Matson, J., & Lopez, K. D. (2020). Nurse workarounds in the electronic health record: An integrative review. Journal of the American Medical Informatics Association: JAMIA, 27(7), 1149–1165. https://doi.org/10.1093/jamia/ocaa050Links to an external site.

George, V., & Massey, L. (2020). Proactive strategy to improve staff engagement. Nurse leader, 18(6), 532–535. https://doi.org/10.1016/j.mnl.2020.08.008Links to an external site.

Griffith R. (2004). Putting the record straight: the importance of documentation. British Journal of Community Nursing, 9(3), 122–125. https://doi.org/10.12968/bjcn.2004.9.3.12436

Hut-Mossel, L., Ahaus, K., Welker, G., & Gans, R. (2021). Understanding how and why audits work in improving the quality of hospital care: A systematic realist review. PloS one, 16(3), e0248677. https://doi.org/10.1371/journal.pone.0248677Links to an external site.

Kreidler, M. L. (2021). Quality improvement in health care. Salem Press Encyclopedia. Quality Improvement in Health Care: @ Walden University Library (ebscohost.com)Links to an external site.

Mosier, S., Roberts, W. D., & Englebright, J. (2019). A systems-level method for developing nursing informatics solutions: The role of executive leadership. JONA: The Journal of Nursing Administration, 49(11), 543-548. A Systems-Level Method for Developing Nursing Informatics Solutions: The Role of Executive Leadership (ovid.com)Links to an external site.

Moy, A. J., Hobensack, M., Marshall, K., Vawdrey, D. K., Kim, E. Y., Cato, K. D., & Rossetti, S. C. (2023). Understanding the perceived role of electronic health records and workflow fragmentation on clinician documentation burden in emergency departments. Journal of the American Medical Informatics Association, 30(5), 797–808. https://doi.org/10.1093/jamia/ocad038Links to an external site.

Stevenson, J. E., Israelsson, J., Nilsson, G., Petersson, G., & Bath, P. A. (2018). Vital sign documentation in electronic records: The development of workarounds. Health Informatics Journal, 24(2), 206–215. https://doi.org/10.1177/1460458216663024Links to an external site.

Upadhyay, S., & Hu, H. F. (2022). A qualitative analysis of the impact of electronic health records (EHR) on healthcare quality and safety: Clinicians’ lived experiences. Health services insights, 15, 11786329211070722. https://doi.org/10.1177/11786329211070722

Wolfe, L., Chisolm, M. S., & Bohsali, F. (2018). Clinically excellent use of the electronic health record: Review. JMIR human factors, 5(4), e10426. https://doi.org/10.2196/10426Links to an external site.

Zuniga, H. (2022) Accessibility and e-resources: Why

REply 2 With 2 references

Amelia Proctor

Main post

Nurse Informaticists Collaboration

               Patient safety is the biggest concern in the nursing field. Nursing informatics has promoted different technological advancements in nursing to make patient care safe and much more innovative for nurses. “Although the new technologies, such as smart pumps, bar-code medication administration systems, electronic health records (EHRs), wearables, and smartphones, being introduced into our practice environments are designed to increase efficiency, promote safety, and streamline the work of nursing, we need to ask, to what extent do these technologies disrupt the nurse-patients caring encounter?” (McGonigle & Mastrian, 2022). The level of safety that technology has provided nurses is profound. Though we have technology, we nurse need to triple-check variables in the field for errors. In the mother-baby unit, the nurse informaticists come onto our unit to inform us of changes to our daily charting, and they often change it in ways that make it safer for patients and efficient for nurses. If there are any errors, the nurse informaticist makes the changes and does the research to update the issue and make it less likely for a mistake to occur. 

Strategy for Improvement

“Together, nurse executives and nurse informaticists are forging new solutions to improve nursing processes and patient care. The challenge is determining how best to coordinate the efforts of subject matter experts from nursing, informatics, and information technology to design, develop, and deploy solutions to complex problems. Nursing leadership is well poised to influence these processes by their broad understanding and oversight of nursing care. While not usually engaged in developing nursing informatics solutions, we propose that executive leadership is necessary to this process” (Mosier et al., 2019). Getting together and making a change is vital to ensure improvements are being made to the field. Nursing informatics must collaborate with nurses who perform daily activities in nursing. The reality for improvement is that the medical field has to work together to improve in the health field. Incorporating informatics into the nursing field is necessary for the new nurses to understand the need for the field. “The framework was based on 3 guiding principles: clear lines of responsibility and authority, respect for each type of expertise necessary to the project, and clear commitment to the aims of the project” (Mosier et al., 2019).

Evolution of Nursing Informatics

Technology has improved healthcare more than we can imagine. Imagine not being able to know what is happening internally when a patient is having internal bleeding or damage. How about a patient who has broken bones? What would we as healthcare providers do if we did not have access to all the current technology? Before the introduction of technology, many errors occurred in the health field. Many people died from one mistake. With the force stops and the flags for healthcare providers, there are ways to see if incompatibilities and medications are given too close together. Our safest method of medication administration is the MAR and the eight rights of medical administration. “The emergence of new technologies is accompanied by limitless possibilities and potential benefits in the delivery of high-quality and cost-effective patient care. The key to sustainability for mHealth technologies will be the use of an appropriate tool, at an appropriate time, for an appropriate patient. Collection of relevant data will also be needed to support use for patients and in clinical workflow. With their combination of clinical and technological expertise, nurse informaticists are poised to integrate mHealth applications in clinical practice and connect patients and HCPs in ways that are compatible with life, work, and the health of populations” (Ng et al., 2018).

References

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

Mosier, S., Roberts, D. Wm., & Englebright, J. (2019, November). A Systems-Level Method for Developing Nursing Informatics Solutions: The Role of Executive Leadership. OVID. https://oce.ovid.com/article/00005110-201911000-00008/HTML

Ng, Y. C., Alexander, S., & Frith, K. H. (2018). Integration of mobile health applications in Health Information Technology Initiatives. CIN: Computers, Informatics, Nursing, 36(5), 209–213. https://doi.org/10.1097/cin.0000000000000445

reply 3 with 2 references