COLLAPSE

The systems development life cycle (SDLC) concept applies to a range of hardware and software
configurations, as a system can be composed of hardware only, software only, or a combination
of both. There are usually six stages in this cycle: requirement analysis, design, development and
testing, implementation, documentation, and evaluation (McGonigle & Mastrian, 2018). Nurses
who are providing the direct care to patients and supportive documentation of the care that has
been provided, should be involved in the final decisions when organizations are choosing or
updating their EMR software. There are many factors that need to be considered. Time of
charting tasks and user friendliness. No nurses want to provide patient care and then have a
complex, tedious computer system that is going to complicate their shift.
One example of nurses not participating in the planning of support for further or newly updated
health information systems, is the factor of time or lack of support for trouble shooting. One
example to promote further staff support for change is availability for support staff or super
users that are readily available to assist within every shift. Super users can help in the training
process to assist those with less technical experience and understanding. The training process
should simulate actual use, and the team should not assume that users can learn on their own
without assistance. Deployment support is essential in this phase. This phase ends with a “go-
live” decision and should include contingency plans to address challenges as the system is
implemented. (Singletary, 2019). It is important for the system to be maintained and in working
order. This phase includes user support through software changes that may happen over time
(McGonigle & Mastrian, 2015). The overall goal for enhancing organizational informatics is to

improve the quality of care and business performance. Nurses readily embrace technology that
helps save lives, reduces the risk of error, eliminates redundancy, and minimizes mundane tasks.
When technology enables effective and efficient workflows, it’s more likely to be adopted
quickly. Integrated and labor-saving technologies have greater value. As technologies improve
work environments for nurses, nurse satisfaction increases, which can translate to greater patient
satisfaction (Virginia Nurse Today, 2010). If nurses are involved during this phase there will be a
few nurses who knows what is going on and can teach the other nurses. It will also create less
chaos as we all know nurses do not like change. I can honestly say that in my history of a
practicing nurse, I have not been involved, as well as other staff as implementation or selection
of input on new computerized health charting. The time I had worked during the transition of
system update or migration, it was a complete ineffective, difficult and an overall challenge. The
organization had chosen a computerized system for charting that benefited them for financial
gain. All employees were thrown into this scenario. During the time period of three weeks the
corporation would send out personal resources for both day and night shifts to watch and provide
time to answers to questions. It was a nightmare. It was very difficult to provide patient care
with corporate advocates to review your personal knowledge to the new computer systems. This
was not a good decision that the leadership of the organization had mandated for all. All the
staff was completely overwhelmed with this learning. This is an example of why it is imperative
to be proactive in new technologies to be integrated within personal practice.
References
McGonigle, D., & Mastrian, K. (2018). Nursing informatics and the foundation of
knowledge (4th ed.).

Nurse leaders discuss the nurse’s role in driving technology decisions. (2010). Virginia Nurses
Today, 18(1), 8-9. Retrieved from http://web.b.ebscohost.com.ezp.waldenulibrary.org
Singletary, V. J. (2019). Building informatics-savvy health departments: The systems
development life cycle. Journal of Public Health Management & Practice, 25, 610-11.
https://doi.org/10.1097/PHH.0000000000001086

Reply

Hey Brinegar,
Thank you for the good work. As you have correctly explained, the benefits
of nurses embracing technology in their work are numerous. However, the
benefits can only be realized if the technology systems used to aid nurses work
effectively and efficiently. Without involvement of nurses in selection and
implementation of healthcare technology systems, the systems are unlikely to be
effective (McGonigle & Mastrian, 2017). More importantly, as you have explained
well, the system is unlikely to be embraced by nurses is they are not involved in
its design and implementation. Nurse participation in selection, design,
implementation, and evaluation of a healthcare technology is key for both buy-in
from other nurses and smooth implementation (McBride & Tietze, 2018). Nurses
who would have participated in the entire design and implementation process will
teach their colleagues about their new systems thus enabling quick embrace of
the new system.

References

McBride, S., & Tietze, M. (2018). Nursing informatics for the advanced practice
nurse: patient safety, quality, outcomes, and interprofessionalism. Springer
Publishing Company.
McGonigleMcGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the
foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Marina DeLuca
RE: Discussion – Week 9

COLLAPSE

The systems development life cycle (SDLC) is an application development strategy that enables
users to transform a newly-developed project into operational use. There are four stages of the
life cycle. The stages include planning, design, implementation, and maintenance/evaluation
stage (Laureate Education, 2018). If done correctly, the outcome can produce numerous positive
outcomes for users and organizations. This is especially true when it comes to procedures that
involve the nursing process as nurses spend the majority of their time in direct patient care (Kent
et al., 2016).
If nurses are not part of all the stages of the process, adverse outcomes could be the
consequences. Some of these consequences involve products that are not easily used by nurses
disrupting workflow, and leading to inadequate documentation, or processes that are less than

effective (Kent et al., 2016). I have recently experienced this at the psychiatric facility in which I
work. I am in the admissions department, and recently the initial assessment paperwork has been
changed. The changes are terrible. It is not easy to follow; important information has been taken
out and replaced by more detailed questions regarding issues that are not as relevant or do not
require as much detail.
Further, repeat questions are causing us to do duplicate documentation. Also, I have taken part
in the precertification process with insurance companies using our assessment to prove the
patient clinically requires admission. The new assessment tool makes precertification difficult
because of the missing information. Therefore, nurses who have never done the
precertification’s are unaware of the information the insurance companies need to support a paid
admission. I find I need to write a longer, more detailed assessment note to cover the information
that should be included in the questionnaire. However, nurses who are unaware of the need for
such detailed information do not document it because they are not prompted to. Hence, several
admissions have been denied due to a lack of evidence to support admission need. This was only
happening rarely before the change and since the change is happening more frquently.
Therefore, it is also hurting the organization financially. I questioned the director about who
implemented the new admissions assessment. He indicated that it was sent from the main
headquarters and he is unsure of who was involved in the process.
It is clear to me that there was not a nurse who was involved in the admissions process, involved
in the design development. It is critical when system processes are changed that all stakeholders
are involved from the beginning to the end of the process. Nurses are an iatrical part of the team.
They should be included during the need’s assessment and throughout the entire process
(McGonigle & Mastrian, 2017). I was not even aware that management had identified areas that

needed improvement. In talking with the other nurse’s I work with, they also denied a lack of
knowledge regarding our previous documentation as being inadequate. Laureate Education
(2018), discusses a need for a steering committee to suide clinical information and an
implementation team. Both of these committees would require nurses that are directly affected
by the changes. I do not believe the SDLC process was used in this case and we are now dealing
with the negative consequence of the change.

References

Kent, B., Redley, B., Wickramasinghe, N., Nguyen, L., Taylor, N. J., Moghimi, H., & Botti, M.
(2015). Exploring nurses ‘reactions to a novel technology to support acute health care delivery.
Journal of Clinical Nursing, 24(15), 2340-2351. doi: https://doi-
org.ezp.waldenulibrary.org/10.1111/jocn.12881
Laureate Education (Producer). (2018). Managing Health Information Technology [Video
file]. Baltimore, MDL Author.
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of
knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Reply

Hey DeLuca,

You have done a good job explaining the negative effects of not involving nurses in
implementation of healthcare technology systems. Sengstack (2016) argues that IT and
nurse leaders need to collaborate with each other when making decisions that affect, among
other things, timeliness of care, patient experience, and clinical workflow. When there is no
proper collaboration between nurse leaders and IT personnel, there is risk of installing
systems that are ineffective and which create confusion in communication, add extra
workload to nurses, and detract nurses from their core work of providing care to patients
(McBride & Tietze, 2018). Indeed, the example you have provided proves this. Had there
been collaboration between IT personnel and nurses, the system set up would not have
created such a mess in documentation.
All the best
Student

References

McBride, S., & Tietze, M. (2018). Nursing informatics for the advanced practice
nurse: patient safety, quality, outcomes, and interprofessionalism. Springer
Publishing Company
Sengstack, P. P. (2016). Information System Lifecycles in Health Care. In Clinical
Informatics Study Guide (pp. 255-286). Springer, Cham.