NURS 6051: Transforming Nursing and Healthcare through Technology – Module 4 Assignment: Patient Safety & Health IT Case Study

Assessment Overview

Course: NURS 6051 – Transforming Nursing and Healthcare through Technology (Walden University / Advanced Practice Nursing Core)

Assessment Type: Case Study Analysis / Written Essay

Weighting: 20% of Final Grade

Length: a 1,050–1,400-word essay

Submission Format: Microsoft Word (.docx) via SafeAssign

Due Date: Day 7 of Week 8

Context

Health Information Technology (HIT) is designed to enhance patient safety, yet the implementation of electronic health records (EHRs) and clinical decision support systems (CDSS) often introduces “e-iatrogenesis”—patient harm caused by the technology itself. As an advanced practice nurse, you must lead the integration of these systems while remaining vigilant about potential errors like alert fatigue, incorrect data entry, and system downtime. This assessment challenges you to analyze a real or hypothetical clinical error involving technology and propose a sociotechnical solution that prioritizes patient safety.

Task Description

For this assignment, you will evaluate the intersection of nursing informatics and patient safety. Your analysis must cover the following specific domains:

1. Incident Analysis

Describe a clinical scenario where a health technology system contributed to a near-miss or an adverse patient event. You may use a case from your own practice or one found in peer-reviewed literature. Clearly identify the specific technology involved (e.g., CPOE, BCMA, or Smart Pumps).

2. Factors of Failure

Apply a recognized framework, such as the Deeplee’s Sociotechnical Model or Reason’s Swiss Cheese Model, to explain the breakdown. Distinguish between technical failures (software bugs) and human-factor failures (workarounds or cognitive overload).

3. Informatics Solutions

Propose a multi-level strategy to prevent recurrence. This must include a technical modification (e.g., refining CDSS logic) and a process modification (e.g., staff retraining or workflow redesign). Explain how these changes align with the Quality and Safety Education for Nurses (QSEN) informatics competencies.

4. Ethical and Legal Considerations

Briefly discuss the ethical implications regarding data integrity and the nurse’s professional responsibility when a system provides conflicting or incorrect information.

Requirements & Formatting

• Word Count: Your paper must be between 1,050 and 1,400 words (excluding title page and references).
• Evidence: Support your analysis with a minimum of three peer-reviewed scholarly sources in addition to course materials.
• APA Style: Use strict APA 7th edition formatting, including a professional title page, running head, and hanging indents for references.

Grading Rubric / Marking Criteria

The introduction of Barcode Medication Administration (BCMA) was intended to eliminate wrong-patient errors, yet recent data suggests that nursing workarounds often bypass these critical safety checks. When nurses encounter unreadable wristbands or malfunctioning scanners, they may resort to manual overrides that negate the system’s primary defensive function. Analyzing these failures through a sociotechnical lens reveals that the hardware limitations directly influence the clinician’s cognitive load and subsequent decision-making processes. Effective mitigation requires more than just updated software; it demands a cultural shift toward “Just Culture” where staff feel safe reporting system glitches without fear of retribution. Implementing a closed-loop communication protocol alongside periodic informatics audits can significantly reduce the incidence of medication errors (McGonigle & Mastrian, 2024). Furthermore, refining clinical decision support alerts to be more patient-specific helps prevent the pervasive issue of alert fatigue. Prioritizing user-centered design ensures that the technology serves the workflow rather than complicating it. Ultimately, the goal is to create a resilient system where technology acts as a redundant safety net for the human provider.

Reference: McGonigle, D., & Mastrian, K. (2024). Nursing informatics and the foundation of knowledge (6th ed.). Jones & Bartlett Learning. https://www.jblearning.com/catalog/productdetails/9781284220469

References

• McGonigle, D. and Mastrian, K.G. (2024) Nursing Informatics and the Foundation of Knowledge. 6th edn. Burlington, MA: Jones & Bartlett Learning. Available at: https://www.jblearning.com/catalog/productdetails/9781284220469
• Nelson, R. and Staggers, N. (2020) Health Informatics: An Interprofessional Approach. 2nd edn. St. Louis, MO: Elsevier. Available at: https://evolve.elsevier.com/cs/product/9780323402316
• Sittig, D.F. and Singh, H. (2023) ‘The sociotechnical components of safe and effective electronic health record use’, Health Informatics Journal, 29(1). doi: 10.1177/14604582231156342
• Waterson, P. et al. (2020) ‘The sociotechnical components of healthcare: A review and framework for analysis’, Applied Ergonomics, 89, 103215. doi: 10.1016/j.apergo.2020.103215