The Inclusion of Nurses in the Systems Development Life Cycle

Nurses need to be part of every step when a healthcare organization wants to get and put in place a new health information technology system. Because nurses will use it the most, it’s important they help plan it to make sure it works well with their work. But sometimes, organizations don’t ask nurses for their thoughts. This can lead to nurses having more work, doing things less efficiently, spending less time with patients, and patients not having good experiences. The Systems Development Life Cycle (SDLC) is a way to make sure new tech systems are made well and fit the organization’s plans. It’s become a common way to do things in public health agencies. By following this approach, agencies can avoid problems with their systems. The SDLC can use different methods like the waterfall, rapid prototyping, or dynamic system development. The waterfall method has six stages: checking if the project should start, looking at what’s needed, planning how it will work, putting it in place, testing it, and keeping it working.

First, a hospital might decide to start a project if they have a lot of urinary tract infections caused by catheters. Nurses can give ideas on what should be in the project to stop these infections. Then, the organization needs to figure out why these infections happen so much. Working with a specialist who knows about nursing and informatics can help. They can look at the data in the electronic health record system and talk to nurses about what works and what doesn’t. They can help plan how to prevent these infections. For example, they can make sure everything related to catheter insertion is recorded, like when it’s done, the catheter size, any issues after insertion, and the patient’s symptoms. They can also remind staff to remove the catheter after a certain time. When the system is put in place, nurses can try it out to see if it helps prevent infections and makes their work easier. The system goes through tests to make sure it works right. Nurses can help with these tests to make sure it does what it’s supposed to do. After testing, nurses can keep using the system and give feedback on how well it works. This helps improve the system.

In my nursing job, I haven’t been part of choosing new tech systems. But at the healthcare organization where I worked, they made sure everyone knew how to use the new system when it started. They also had experts to help in each area, so everyone felt comfortable with it. Being involved in the decisions didn’t cause any problems. They made sure everyone’s thoughts were considered to pick the best option.

References: 

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning. 

Singletary, V., & Baker, E. L. (2019). Building Informatics-Savvy Health Departments: The Systems Development Life Cycle. Journal of Public Health Management and Practice, 25(6), 610– 611. https://doi.org/10.1097/PHH.0000000000001086Links to an external site. 

Why Involve Nurses in Healthcare IT Development? (2019, April 1). TeleTracking. https://www.teletracking.com/resources/why-involve-nurses-in-healthcare-it-developmentLinks to an external site. 

Inclusion of Nurses in the System Development Life Cycle (SDLC)

Initial post

Inclusion of Nurses in the SDLC

Introduction

An ongoing cycle of procedures is involved in creating new systems to guarantee effective execution. Delivering efficient and productive information systems (ISs) that mesh with an institution’s strategic plan for operation requires following the systems development life cycle (SDLC). The process of implementing a new clinical system should involve nurses to ensure that functions are adequately integrated into evidence-based healthcare delivery. Nurses also provide valuable input for vendors in the development of user-friendly interfaces. In addition, nurses can help ensure that the software meets safety and quality standards and is compliant with applicable laws and regulations. Further, nurses can train other healthcare professionals on the use of the software system, helping to ensure its successful implementation.

Consequences of a Healthcare Organization Not Involving Nurses

A healthcare organization’s decision to purchase and install a new health information technology (HIT) system is likely to have adverse effects if nurses are not included in every stage of the software development life cycle (SDLC) (Mustaquim & Nyström, 2015). The HIT system might not be able to accommodate the needs of the nursing staff. Another effect is the HIT system’s potentially poor integration with the rest of the healthcare institution’s systems and procedures.

Nurses play an important role in the Software Development Life Cycle (SDLC). By understanding the needs of the patient and their care, nurses can provide valuable insights into the design of software systems. In addition, nurses can give feedback on the usability of the software and the impact of the technology on patient care. This feedback is important for designers to ensure the software meets the user’s needs.

Issues at Each Stage of the SDLC

When building a new health information technology (HIT) system, several potential challenges could arise at each stage of the software development life cycle (SDLC), and the involvement of nurses can assist in solving these concerns.

Planning

The healthcare organization might need a more precise grasp of the demands and requirements of the nursing staff, which could be a problem during the planning stage. This could result in the creation of a framework that is not user-friendly and does not cater to the demands of the nurses. However, the healthcare organization can get insight into the unique requirements and preferences of the nursing staff and create a system suited to those needs by incorporating nurses in the planning process.

Analysis

The healthcare organization needs to fully comprehend the current workflow and procedures of the nursing staff, which may result in the creation of a system that interferes with existing processes and workflows, lowering productivity (Qin et al., 2017). The healthcare organization may better understand the present workflow and ensure that the new platform is integrated into these procedures by including nurses in the analysis process. Nurses should be included in any project relating to their line of work’s analytical phase. This helps ensure that the nursing staff will accept the new system or solution and that it will integrate easily into their current workflow and operations. In addition, the healthcare organization can better understand the nursing staff’s difficulties and needs by including them in the analytic process. This helps inform the design of the new system or solution. Involving nurses in the analysis phase can also foster the project’s buy-in and support from the nursing team, which can be essential to its success.

Design

The system may not be simple or intuitive for nursing staff to operate. This may result in a drop in system acceptance and utilization, leading to inefficiencies and mistakes (McGonigle & Mastrian, 2021). On the other hand, the healthcare organization may ensure that the system is simple to use and intuitive for the nursing staff, which will increase acceptance and usage of the system.

Implementation

The new HIT system might need to be adequately integrated with the other systems and procedures used by the healthcare organization (Qin et al., 2017). The healthcare organization may make sure that the new system integrates seamlessly into the current environment and that the nursing staff is adequately trained to utilize the system by including nurses in the implementation process. Another potential issue is user adoption. If the nursing staff feels uncomfortable with the new system or does not find it easy to use, they may not use it properly. This can lead to data errors, incorrect documentation, and other problems. To mitigate this, healthcare organizations should involve nurses in the design process to tailor the system to their needs, provide ongoing training and support, and offer incentives to use the system correctly.

Maintenance

During the maintenance phase, it is possible that the system will not be updated or maintained regularly, which could result in decreased performance and potential faults (Weckman & Jansen, 2009). However, the healthcare organization may guarantee that the system is routinely updated and maintained to ensure maximum performance and dependability by incorporating nurses in the maintenance process.

My Input in the Selection and Planning of New Health Information Technology Systems

In my nursing practice and healthcare organization, I have had a say in the decision-making and planning process for new health information technology systems. In particular, I was a team member that assessed, contrasted, and made recommendations for our company’s new electronic health record (EHR) system. In addition, I offered feedback on how the plans would impact patient care, nurse workflow, and staff morale as we looked at several vendors and their products. We also discussed how the system should be altered to suit our requirements. The consequences could have been severe if I had not been involved in the decision-making process. For instance, the system might not have been designed with our needs in mind, and the changes to the workflow created commotion and confusion. In addition, the system may not have had the features and capabilities required to enable our patient care.

Conclusion

To ensure that the system satisfies the organization and its workforce’s requirements, nursing staff must be involved in the decision-making process surrounding health information technology systems. Furthermore, it raises the likelihood of successful implementation by fostering a sense of engagement and trust among the personnel. The nursing staff should be involved in all stages of the process, from the initial assessment of the organization’s needs to the implementation and training of the team. Involvement in the decision-making process should include providing input on the features and capabilities of the system, such as the design of the user interface, the ease of data entry and retrieval, and the security features. Additionally, nursing staff should be involved in the evaluation and testing of the system before and after it is implemented.

References

McGonigle, D., & Mastrian, K. (2021). Nursing informatics and the foundation of knowledge. Jones & Bartlett Publishers.

Mustaquim, M. M., & Nyström, T. (2015, June). A system development life cycle for persuasive design for sustainability. In International Conference on Persuasive Technology (pp. 217-228). Springer, Cham.

Qin, Y., Zhou, R., Wu, Q., Huang, X., Chen, X., Wang, W., & Yu, P. (2017). The effect of nursing participation in the design of a critical care information system: a case study in a Chinese hospital. BMC medical informatics and decision making, 17(1), 1-12.

Weckman, H., & Janzen, S. (2009). The critical nature of early nursing involvement for introducing new technologies. OJIN: The Online Journal of Issues in Nursing, 14(2).

Main Post

Discussion: Nurse Inclusion in the Systems Development Life Cycle

To successfully implement a newly developed system into practice, the proposed system must advance through a cycle of development phases. McGonigle and Mastrian (2017) shared that the systems development life cycle (SDLC) is a way to deliver efficient and effective information systems (ISs) that fit with the strategic business plan of an organization. This development cycle incorporates a newly developed system’s planning, analysis, design, implementation, and maintenance phases. Laurette Education (2018) shared that nurses should be active participants throughout the introduction of a new clinical system. Their active involvement ensures that systems are appropriately incorporated into evidence-based healthcare.

SDLC Stages and Nursing Involvement

The development of a new health information system involves a flow through development plan phases in a cyclic manner. The story of a new system should include an analysis of the needs within the organization, and these should be mutually agreed upon. Understanding and addressing organizational needs will lead to the proposed technology system’s development, implementation, evaluation, and maintenance. The waterfall model is a commonly used method for implementing a new technology system into nursing practice. It is essential to incorporate nurses using this technology during each phase of this model to ensure that it will be successfully integrated.

Feasibility

The first phase includes the feasibility of the project being introduced. To determine if the project benefits will outweigh the costs, nurses should provide insight into the needs and areas where existing budget adjustments can be made. A budget must be addressed from the start of any project to avoid overspending and failure.

Analysis

The cycle analysis includes examining the business that will be utilizing the proposed new technology. Before implementation, nurses can share the current order of the company as it stands. Introducing a new system may sound promising, and nurses can provide insight into how the latest technology can enhance existing procedures. If the newly developed technology was an electronic health record, nurses could address how this would affect patient care during the transition. Nurses can foreshadow possible difficulties that would occur and make recommendations to avoid possible nurses can provide insight from a different scope. They can ensure that every aspect of the current system is analyzed and reviewed to ensure best practices are achieved and maintained.

Design

The design phase looks closely into how the project’s proposed data and programming techniques will actually function. With a new electronic medical record, this phase would look into the software needed to meet the facility’s requirements. Nurses would create and test initial versions of the system for active participation. They can then provide helpful insight into which parts of the system could be more user-friendly, and they could address concerns before the system is finalized for use. If nurses are included in his phase, it would be easier for developers to backtrack. Nurses would also be given time to learn about the new system before it is life.

Implementation & Testing

The implementation phase of the cycle would include the programming and introduction of the newly developed system. The Agency for Healthcare Research and Quality (n.d) shared that the key to successfully implementing health information technology (health IT) is recognizing its impact on clinical and administrative workflow. With an electronic record, programmers would activate the system with the necessary programming codes. Nurses should be provided thorough training on accessing the system appropriately and getting used to the program functions within the electronic network. Some systems provide users with access to certain portions of the system, so all nurses and additional care team members should know how to use the implemented technology properly. An electronic system is implemented to enhance the care that patients are being provided. If nurses do not learn how to use the system properly, this could potentially harm the patients being cared for. Proper testing of this electronic record would allow nurses the time to analyze the technology and provide feedback. Nurses can explain where they foresee problems occurring and make recommendations for improved use to ensure patient care is continuous and uninterrupted.

Maintain

Constant evaluation of a system is required to maintain an efficient practice. Once a system has been tested and modified for implementation, the review process does not end. Scheduled software is necessary at regular intervals, and staff should be informed when changes are made. Nurses are an essential part of every phase, and the maintenance of a system depends on its users. As time passes, nurses should continue making observations and recommendations about how this system is used in their practice. If nursing input is not valued during the maintenance phases of technology, systems can become obsolete in patient care practices, and evidence-based practice can be negatively affected.

Personal Experience with Health Information Technology Systems

The health information technology used in our adolescent behavioral health facility was preselected during our merger with the Lifespan Network two years ago. The technology was predetermined on a corporate level, and the nurses, clinicians, and milieu staff were not included during any phase of the implementation process. Due to our unique outpatient psychiatric setting, we have found that the preselected programs have only sometimes fit our needs. One specific nursing-related issue included the documentation of patient medications within the electronic health record. We are considered an Outside Provider location, so our facility is not authorized to use the electronic MAR (Medication Administration Record) in the electronic patient record. We are required to document all medications in the Home Medications section of the chart, but this only includes a list of currently provided medications that are confirmed during admission. We found that providers and nurses from varying locations were mis-documenting past and present taking medicines in this chart section. Providers did not use this list when prescribing, and some were making errors. Due to the level of potential harm that this entailed, I contacted our Residential Nursing Supervisor to address this situation and provide a possible solution. We now document medications in a newly provided medical record section and have been granted access to the Medication History section of the electronic record. Allowing proper input of previously taken drugs in addition to those currently being prescribed has allowed for successful continuity of patient care within our facility and during their transitions to the community. This change provided positive outcomes for our patients and a smoother coordination of care among our team. If the developers included nursing staff in the development and implementation process of this technology, we could have likely made this change before it was put into practice. I am thankful that they listened to my recommendations.

References

Agency for Healthcare Research and Quality. (n.d). Health IT evaluation toolkit and evaluation measures reference guide. Retrieved from https://healthit.ahrq.gov/health-it-tools-andresources/evaluation-resources/workflow-assessment-health-it-toolkitLinks to an external site.

Laureate Education (Producer). (2018). Systems Implementation [Video file]. Baltimore, MD: Author.

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Software Development Life Cycle is the steps used within the software business to design, develop and examine software’s quality (Tutorial Point, n.d.). The engagement of nurses within each stage of SDLC is proven beneficial when accruing and implementing new healthcare software. Health systems maintain and advance healthcare by enhancing quality and improving patient care. Nurses are vital team players in the medical profession and work firsthand with patients. According to (Risling, T.L. & Risling, D.E., 2020) there is a demand for nursing to dominate major roles in development of technology in healthcare. They are most experienced and educated on the patient’s needs and how to improve patient outcomes; hence, nurses must be involved in the systems development life cycle. Including nurses can only assist in ensuring systems are organized efficiently and will meet the needs of patients. The SDLC has several stages: Planning, Analysis, Design, Testing, Implementation, and Maintenance.

Nurse involvement in the SDLC planning stage should be a must to ensure the software is appropriate and meets the expected needs of patient care in a practical manner. According to Brown et al. (2020). Excluding nurses at this stage means the technology’s overall objective may fail to account for the critical aspects of patient care and experience. The project is evaluated in the analysis stage, weighing the pros and cons and who is better to be an evaluator than the main stakeholders. The design and testing stage is where the project data techniques are formulated. Nurses would assist in making and assessing the different software within the system, providing insight on ways to make the system more adaptive and friendly to users before the official version’s publication. Excluding nurses at this stage means the overall technology may fail. Nurses can ensure the system is tailored to ensure patients receive safe and optimal care. The installation stage is where the system is placed into action, integrated into the institution, and sets standards for the level of training required for the users. The maintenance stage is where the system is reviewed at intervals to ensure it is kept upgraded and current and continues to meet the expected needs of its users. Utilizing nurses within this phase gives an understanding of what upgrades will be required and how patient needs have improved or decreased.

Within my institution, paper charting was used pre-covid. However, they promptly switched to Electronic Health recording during the pandemic; unfortunately, nurses were not allowed to partake in this project’s SDLC stages. Due to same, the transition was slower and led to more errors in documentation as nurses needed to find many areas to be user-friendly, and the level of training received required much more. Many nurses questioned themselves and lost confidence in their capabilities to perform. If time allowed and nurses had been integrated from the initial phases, it would have created a smoother transition. Being one of the most significant users with firsthand knowledge that advocates patient care and safety, it would have been designed better to meet patients’ needs.

References

Brown, J., Pope, N., Bosco, A. M., Mason, J., & Morgan, A. (2020). Issues affecting nurses’ capability to use digital technology at work: An integrative review. Journal of clinical nursing, 29(15-16), 2801-2819.

Tutorial Point (n.d.) SDLC – Overview, Tutorials Point. Available at:

https://www.tutorialspoint.com/sdlc/sdlc_overview.htm

Risling, T.L. and Risling, D.E. (2020) “Advancing nursing participation in user-centered design,” Journal of Research in Nursing, 25(3), pp. 226–238.

https://doi.org/10.1177/1744987120913590.

The healthcare sector is changing rapidly, and institutions must change to be relevant. Every healthcare organization must improve the safety and quality of care they provide (Echo n.d). At the same time, healthcare organizations must ensure that their interventions are effective and relevant to patients’ needs and current changes. As a result, healthcare institutions must ensure constant system development of their life cycle to improve their effectiveness and efficiency while ensuring optimal patient safety. System development usually begins with understanding the problem or business needs. It is followed by developing strategies to meet those identified needs, then implementing them and later evaluating them (Singletary & Baker, 2019). Finally, if they are effective, the healthcare institution must find ways to maintain those strategies.

The system development life cycle is a crucial component of the innovation that makes a difference in our healthcare organization’s operations and meeting its patients’ needs. Since nurses are the only healthcare professionals who stay with patients the longest time and understand them and how the system affects their care and recovery, the system development life cycle is likely to suffer the hugest brunt if nurses are not included in its initial stages of planning and implementation (Why Involve Nurses in Healthcare IT Development, 2019). Some consequences include developing and implementing systems that do not adequately align with patients’ or system needs. For instance, some hospitals may need better systems because of a lack of end-user input. As a result, the project becomes obsolete quickly because it needs to align with the nurse’s and patient’s needs regarding effectiveness and efficiency in ensuring patient safety and quality care.

Including nurses as end users in the innovation will help increase the perspective on which the idea and objectives of the innovation are viewed. This, in turn, ensures that the system is better designed with the end user’s needs in mind, leading to mutual and optimal benefit to patients, healthcare professionals, and institutions. For example, I worked in an institution implementing the automated Alaris infusion pump. The pump would synchronize information from all the electronic healthcare records systems within the hospital and the medication pyxis. Unfortunately, nurses were not included in the system development and implementation. As a result, it was later noted that some medications were incompatible with the pump interface and did not accept the manual entry, which would constitute missed medication on the system. These consequences delayed care and wasted time nurses, and other healthcare professionals would have used for other tasks. In addition, the electronic health record platform network was slow, and healthcare professionals needed more than two days of orientation to understand how to operate it. Overall, the system turned chaotic and stressful, and many hours were lost as the team tried to figure out where the problem was.

References

Singletary, V., & Baker, E. L. (2019). Building Informatics-Savvy Health Departments: The Systems Development Life Cycle. Journal of Public Health Management and Practice, 25(6), 610– 611. https://doi.org/10.1097/PHH.0000000000001086 Links to an external site.Links to an external site.

Echo, O. O. N. S. Tag Archives: Mohs Surgery. https://onenationsecho.com/tag/mohs-surgery/

Why Involve Nurses in Healthcare IT Development? (2019, April 1). TeleTracking. https://www.teletracking.com/resources/why-involve-nurses-in-healthcare-it-developmentLinks to an external site.

The Inclusion of Nurses in the Systems Development Life Cycle

             The system’s development life cycle (SDLC) are steps used to create an effective, interactive, and efficient information system or technology tailored to a business or organization’s goal or vision (McGonigle and Mastrian, 2022). Now more than ever nurses are spending more time using technologies to increase efficiency in delivering patient care. Therefore, it is essential to include nurses in the SDLC process to develop a system with high usability which will increase the chance of successful implementation and adherence as well as decrease unnecessary economic loss to facilities. On the other hand, the failure of a healthcare organization to involve nurses at each stage of the system development life cycle results in failure in the initiation of a technological system: resistance, increased issues with patient confidentiality or safety, and induction of technologies that are too complicated and incompatible with nurses’ skill set and practice.  

              Failure to involve nurses in the feasibility stage of buying or developing a product will result in a product that is inefficient and redundant. For example, the introduction of handheld multifunctional devices for patient care of which one function is medication administration within my work facility. There are clear indicators that nurses’ Input was not encouraged in this device secondary to redundancy (1 of many issues). For instance, logging on is a chore (especially if a med is needed emergently), next in administering the required medication the patient is scanned, then the medication then the patient has rescanned after which the medication is rescanned once more. Now the next stage is another set of issues issue if it is an intravenous medication the site of the iv must be entered and cannot be bypassed despite filling in this area on prior administration in the same shift. Recently I found out that most of us in our unit decided it was a better pill crusher than its intended use. Fortunately for us, we also have some workstations on wheels (WOWS) available which are preferred because they are more efficient and Userfriendly. The manufacturing of WOWs was a result of designers evaluating the ineffectiveness of computers on wheels (COWS) for bedside charting etc. and nurses’ complaints. The IT (Information Technologist) designers then enlisted the nurses’ input in all stages of SDLC which are feasibility, analysis, design, implementation, test, and maintenance which resulted in WOWS (HMT MAG, 2008). Not including nurses in the stages of SDLC also increases economic loss to facilities as the product will be short-lived as seen in the multipurpose handheld devices being used for pill crushers. 

               Another issue with the handheld device is the multi ridiculous steps needed to access the language line (interpretation purpose). I recently had a patient who was visiting from Panama and spoke Spanish. I remembered a few words from college, so I was able to gesture and use the few words I knew plus her daughter also was present the first night and able to translate. The next night, my patient woke suddenly yelling my name. I rushed in as she pointed to her chest; “hurt” she said, then “back lungs” so naturally now I needed the language line as I fumbled through the unfriendly screens, 4-5 screens while assessing for any cardiac signs (diaphoresis, etc.). I thought what if my patient passes out before I get an interpreter online? I finally got an interpreter online to interpret as I assess my patient for possible cardiac symptoms. While assessing and interpreting the line malfunctioned, we had to restart the complete process. I found myself wishing for the old language phone (with the 2 receivers) that was one simple step I.e., pickup up the phone which automatically dials and hello! An interpreter on the line!  

             This multipurpose handheld device is a clear indicator that nurses were not involved in the feasibility, analysis, design, or purchase of this product, hence resulting in a delay of treatment and not practical to our area of practice (critical care). Honestly, as a critical care nurse, I felt so helpless navigating through the unnecessary screens and feeling like I was wasting precious time accessing the unfriendly device. My patient’s blood pressure climbed from 140 systolic to 200/100, her sat 98% (her dx was bilateral pulmonary embolus) and she is looking at me all wide-eyed and scared I wished at that moment we had a device like earbuds when place in both our ears we would automatically begin to understand each other. Now that would be an effective, user-friendly, and invaluable device! The lack of proper usability makes it difficult for nurses, doctors, or other users to access specific information and makes searching for information provided by the system inefficient (Khajouei and Jaspers, 2008) as well as jeopardizes patient safety. 

            Another design is our new electronic transport system of course we were not consulted on the design or purchase: just do the mandatory online course which was a waste of time. The usability of the prior system was 6/10 but this present transport system is more complicated and involves approximately 6 screens before we can request transport. So, we night shift nurses resolve to be our own transport instead of trying to manipulate the system. Of course, this system has contributed to added workload for the night shift nurses as there are unit secretaries during the day to aid in the transport requests. In conclusion in the ideal world of research and textbooks, it is wonderful to ask for the nurses’ opinions initially in buying or designing patient care products but in the “real world” it seldom occurs resulting in expensive devices becoming door holders, hammers, pill crushers or retired/buried in the equipment room graveyard. 

References

McGonigle, D., & Mastrian, K. (2022). Nursing Informatics and the Foundation of Knowledge (5th ed.). Jones & Bartlett                     Learning.  

Khajouei, R., & Jaspers, M. W. M. (2008). CPOE system design aspects and their qualitative effect on usability. Studies in Health Technology and Informatics, 136, 309–314. 

COWs and WOWs, Oh My! HMT MAG< 2008, Healthcare Innovations, https://www.hcinnovationgroup.com/home/article/13000590/cows-and-wows-oh-my 

The systems development life cycle (SDLC) is a process used for developing software. “The SDLC is a way to deliver efficient and effective information systems (ISs) that fit with the strategic business plan, which stems from the missions of the organization” (McGonigle & Mastrian, 2022). The phases of SDLC include: planning, analyzing, designing, implementation, testing and maintenance. “These phases are handled in a continuous loop, meaning at any stage in the cycle, it is possible to go back and forward again which helps the development team to produce high-quality software” (Clarusway, 2022).

Nurses being frontline workers and the ones who spend the most time with patients makes them capable of providing their input in new health information technology systems implemented to improve quality of care. The purpose of including nurses is to ensure that both organization and patient care needs are met. According to Weckman and Janzen involving nurses who work at the point of care in all phases of introducing a new technology facilitates a smooth transition to using the new technology and increases nurses’ buy-in of the system, without user involvement the chance of failure increases dramatically” (n.d.).

There are consequences associated with not involving nurses in the stages of SDLC when implementing a new system. The consequences include having a system that is not user-friendly, developing a system that is ineffective and doesn’t meet the needs of the organization, creating non-realistic healthcare goals, etc.

The planning phase is used to determine the objective for the new system, define the problem of any existing system, set the project schedule and secure funding and resources. Not allocating enough funding or misplacement of funding can be an issue in this phase. Nurses have the knowledge to shift funding to certain areas based on the needs of the patients.

The analysis phase includes gathering specific details required for the system; the stakeholders analyze the data and look for ways to implement them. Nurses can avoid stakeholders and other members of the team from providing requirements that are impossible to implement and do not fit the needs of the organization or will not work on units in the facility.

In the design process system and software design documents are prepared. Prototypes are often made to show the look and feel of the software. Nurses can provide input on changes that need to be made before the official design as they are the ones who will be utilizing the system.

In the implementation and testing phase the overall design for the software will come to life. Coding is done and the software is developed and ready to be tested. The system is then tested to determine whether it performs appropriately. Nurses have firsthand experience with using other systems therefore they can determine whether this system meet the needs for both staff and patients and whether it supersedes the previous system.

I personally have not had experience with providing input in the selection and planning of new health information technology systems. I have however interacted with IT in my current facility to create the option to change the chronological time in CERNER. For those who are used to EPIC, the time flows forward from right to left, but in CERNER it goes from left to right. Lots of travelers, including myself who had no previous experience with CERNER made several mistakes when documenting. In the end IT was able to add the option and documentation errors were reduced.

References

 Clarusway. (2022, December 20). What Is SDLC (Software Development Life Cycle) – Clarusway. Online IT Bootcamp; Learn Coding, Data Science, AWS, DevOps, Cyber Security & Salesforce https://clarusway.com/what-is-software-development-life-cycle/Links to an external site.

McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

Weckman, H., & Janzen, S. (n.d.). OJIN Homepage. https://ojin.nursingworld.org/table-of-contents/volume-14-2009/number-2-may-2009/nursing-involvement-and-technology/Links to an external site.

The Inclusion of Nurses in the Systems development Life Cycle

Software Development Life Cycle (SDLC) Provides a standard project management framework to improve the quality of information systems that is required for healthcare as example.  Nurses can collect data into vigorous set of functional use in software that is required by software developers.  Nursing is critical in occupying a significant role in every stage of the SDLC Planning to Post Implementation and can familiarize themselves with design-thinking and practical expression capacity to work hand -in-hand with system developers.

As a result of not involving nurses in each stage of the SDLC when purchasing and implementing a new health information technology system, the system will not be efficient.  There will be loss of early engagement by nurses due to their attention not being captured as well as lack of faith in the change process by both the implementers as well as nurses.   Competing priorities will lower the nurses interest resulting in dissatisfaction and fatigue and loss of personal connection to the new system due to nurses’ core views and individual aspirations that may differ from those of the organization.

At the planning stage, the nurse will not be able to engage in the system implementation strategy where there is budgeting, creation of project leadership and team structure.  Therefore, nurses will not be able to voice concerns and give feedback.

At the Analysis stage, the graduate nurse would not be able to engage in the evaluation of the aspects of the documentation system such as quality and functionality, Enabling possible inefficiencies of the documentation system and lack of vital information such as proper skin assessment with MORSE Scale.

At the Design stage, the nurse should gauge the system’s functionality such as the hardware, interface format, software, intelligence of the system, and the cognitive compatibility of the documentation system to that of the nurse practitioners (Curry (2007).  Without a nurse’s input, there will be documentation challenges, communication and security issues and lack of ability to verify system in place before initiation.

Engaging nurse leaders in the implementation process relieves the complexity of the process since having a better understanding of the documentation system allows the nurse leader to easily explain to the other nursing staff (Curry, 2007).  Not being able to recognize the implementation of errors, mistakes, and missing details of the develop systems will bring chaos and increase cost to rewrite the system.

At the post implementation phase, the evaluation will no doubt spawn a new cycle of analysis, design, project planning, design, coding and implementation, testing, and development maintenance which could possibly hinder the organization from advancing into the 21^st century.

It is very important to follow the SDLC steps for effective development of healthcare technology system and the engagement of stakeholders are important expert opinions to ensure success of a its health information technology.

At the institution where I work, Implementation of the EHR is a slow process.  We started with EMAR and are still ironing out some issues to try and perfect the system and meanwhile have incorporated an electronic laboratory software system.  Again, we are currently undergoing changes.  Lab Orders are placed on the computer after which specimens are drawn by a phlebotomist from an outside Laboratory.  However, as a mental health facility, some labs that are drawn such as Clozaril levels or other specialized test ordered by specialists are not compatible with the new system.  As a result, the lab had to install a new code and a comment section when I realized that the orders were not visible on the requisition form.  This was clearly a gap in the system that would prevent proper monitoring of our chronic or new Clozaril users.

Being part of this experience is rewarding in that it makes what we do as nurses feels more valuable, our concerns were validated because we had an input.  We were also motivated to finding more errors or glitches to enhance the software system and was further motivated to encourage full implementation of EHR to advance the institution.  If a Mental Health nurse was involved at the pre planning stage, some of the blind spots we discovered could have been prevented.  In fact, some of the tests required for our patients are sent out by our current lab because they are not able to accommodate the test.  The hospital has a Nurse Informaticists in training who is also bombarded with calls.  It will take some time to sort out the glitches but at least it’s a start.  We are mostly onboard to learning the process and finds the challenge exciting as well as keeping up with current trends.

References

Curry, J., McGregor, C., & Tracy, S. (2007). A Systems Development Life Cycle Approach to Patient Journey Modeling Projects. PubMed. DOI: 10.3233/978-1-58603-774-1-905

Mohd, Ehmer, Khan, S., Shadab, M. & Khan, F. (2020). Empirical Study of software Development Life Cycle and its various Models. International Journal of Software Engineering Vol. 8 (2). https://www.cscjournals.orgLinks to an external site.

Ergasheva, S & Kruglov, A. (2020). Software Development Life Cycle early phases and quality metrics: A Systematic Literature Review. Journal of physics. Conf. Ser.1694 012007 doi:10.1088/1742-6596/1694/1101207

Main Post

When a health organization is to develop and implement a new health information technology system, they usually follow the way called Systems Development Life Cycle (SDLC). The SDLC model contains seven steps: planning, analysis, design, development, testing, implementation, and maintenance (McGonigle & Mastrian, 2017). Nurses, as backbone of the healthcare system, should be very necessary included in each stage of the SDLC. Lack of listening to nurses and lack of receiving feedback from nurses can have a negative impact on any program implementation (Risling, 2020). If nurses are not included in each stage of the SDLC, the health information technology system implementation would not be successful.

Plan, analysis, and design

In the initial planning phase, the organization realize that they have a problem or business need, which is followed by coming up with a solution to addressing it, but without the involvement of the nurses and their sharing opinion about the project goal, the potential healthcare information technology system would lack of goal-oriented characteristics. For example, to decrease the HAI c-diff infection rate, a healthcare organization decided to develop an information technology system to monitor and track infection precaution interventions to every patient admitted to the inpatient units. In the plan and analysis stages, the nurse should be included to share how they think the realistic project goals could be reachable; the nurse also should be included to reflect the current procedure of HAI c-diff infection prevention, so that to analysis the potential effective infection prevention strategies in the new program.  In the analysis step, nurses should be included to develop a successful model. Nurses will be the users of the health information technology system, communication regarding end-user requests facilitates success (Zadvinskis et al., 2018).

Develop and testing steps

Prior to the implementation of the new systems, nurses including in important. If the nurses are not included in the develop and testing steps, they will not have an opportunity to familiarize themselves with the new system, and once when the new system is implemented, some of the nurses may need extra time and training on how to use the new system, which will badly slowing the workflow. For example, if the nurses are not included in the develop and test steps of a healthcare information system to monitor and tracking the HAI C-diff infection, the nurses do know any detail about this system, and they may need longer time for training on how to use this system, which will put additional workload on them and slow their workflows.

Implementation and maintenance

Implementation of a new system is working culture and working flow change, and the new system must be accepted by the people who are ready to implement it. As the users of the new system, nurses apply the new system for their daily direct patient care. It is essential for the implementation of the new system with the nurses’ thoughts and feedback. For example, even if the new system to monitor HAI C-diff infection is developed, without the nurse’ implementation, the new system will not do any good to improve patient outcome. Only with the users-the nurses’ consistently implementation and maintenance, the new system is possible successful.

I personally don’t have experience of input in the selection and planning of any new health information technology systems in my nursing practice or healthcare organization, but for many times, before the informatics and IT team was trying to put some new functions to the exist EHR (CPRS), they came to our nurses and asked our opinions about the relationship of new function of charting and patient care.

References

Farokhzadian, J., Khajouei, R., Hasman, A. et al. Nurses’ experiences and viewpoints about the benefits of adopting information technology in health care: a qualitative study in Iran. BMC Med Inform Decis Mak 20, 240 (2020). https://doi.org/10.1186/s12911-020-01260-5

Risling, T. L., & Risling, D. E. (2020). Advancing nursing participation in user-centered design. Journal of research in nursing: JRN, 25(3), 226–238. https://doi.org/10.1177/1744987120913590Links to an external site.

Zadvinskis, I. M., Garvey Smith, J., & Yen, P. Y. (2018). Nurses’ Experience With Health Information Technology: Longitudinal Qualitative Study. JMIR medical informatics, 6(2), e38. https://doi.org/10.2196/medinform.8734

The Inclusion of Nurses in the Systems Development Life Cycle (SDLC)

The SDLC is a framework that directs the stages of innovation in nursing informatics (Wang et al., 2019). Initially, there were five stages of SDLC: Planning, Design, Development, Testing, and Implementation. As time went on, Analysis and Maintenance were added to make up the seven stages of the SDLC (Preston, 2023).

Involving nurses in each stage of the SDLC when purchasing and implementing new Health Information Technology (HIT) is crucial because nurses are the primary end-users and, hence, are in the best position to pinpoint what is/will be effective in achieving targeted nursing outputs (McGonigle & Mastrian, 2022). We can take a look at potential issues and how nurses may help address them as follows:

Planning stage: Those planning may not know what problems nurses need to address. For instance, a system is acquired that records patients’ vital signs but gives out only numerical read-outs, meaning that the nurses still have to check that the read-outs are within normal range, cutting down on the time that could have been spent performing other nursing tasks. A nurse involved in the planning stage would be able to point out that a better option is to get a system that processes the patients’ vitals received and puts it out in chart form so that nurses can tell, at a glance, what is going on with the patient and then have time to perform other tasks.

Analysis: The facility needs to know whether or not the system they intend to acquire will impact the time nurses spend on direct patient care and whether it is worth it. Involving nurses will quickly provide this information.

Design: During this stage, the user-friendliness of the potential system comes into play. If a system is acquired, that is cumbersome to use; it negatively impacts its acceptance. Including nurses in this stage means they can point out which parts of the design are likely to cause problems and eliminate the issue even before it is rolled out.

Development and testing: Having a small group of nurses involved in “beta-testing” the HIT system before it is rolled out will help identify any faults that may have been overlooked in the design stage.

Implementation: As with any new system, there are likely to be people who will be against it, preferring to stay with what they know and are comfortable with. Here, nurses – preferably those involved in the testing phase- can serve as an example for acceptance of the system by disseminating information on its benefits or serve as trainers-of-trainees to ensure that all nurses are conversant with the system.

Maintenance: After the system is rolled out, there may be bugs or glitches. With nurses being the primary users, they are more likely to catch on to these issues quicker and know potential fixes. It is, therefore, essential to involve nurses in this stage to ensure the smooth running of the system.

Personally, I have not had the opportunity to input into the selection and planning of new Health Information Technology (HIT) systems, as what is currently being used in my facility predates the start of my employment. However, there is a system where the facility nurses can make suggestions as to what improvements they would like to see. I believe that being included in the decision-making process promotes satisfaction among the nursing staff as they feel heard and know that whatever concerns they may have with the HIT systems are being worked on.

References:

McGonigle, D., & Mastrian, K. G. (2022). Nursing Informatics and the foundation of knowledge (5^th ed.). Jones & Bartlett Learning.

Preston, M. (2023). System Development Life Cycle Guide. Retrieved from.

             https://www.clouddefense.ai/blog/system-development-life-cycle#:~:text=What%20Are%20the%207%20Phases,testing%2C%20implementation%2C%20and%20maintenanceLinks to an external site.

Wang, J., Gephart, S. M., Mallow, J., & Bakken, S. (2019). Models of Collaboration and Dissemination for Nursing Informatics Innovations in the 21st             Century. Nursing Outlook, 67(4): 419-432

Week 9 Discussion

Nurses are the largest section of healthcare workers and are the primary providers of patient care delivery in the nation’s hospitals and long-term care facilities. Nurses made up 30% of total hospital employment in May 2019 (U. S Bureau of Labor Statistic, 2020). With such a high representation in the primary delivery of patient care, we could assume that it is imperative that healthcare organizations include nurse in the systems delivery life cycle (SDLC). According to McGonigle and Mastrian (2018), nurses are involved by developers of SDLC in all stages of the system to ensure that all organizational and patients’ needs are met. It is vital to include nurses in the process and implementation of any new system because nurses make up a significant number of the system users and nursing documentation comprises the greater part of healthcare documentation.

According to Laureate Education (2019), the five steps in SDLC are planning, analysis, design, implementation, and maintenance. And all steps must be accomplished for the process to be a success, and that failure to involve nurses in the process can adversely affect the success of the program. Nurses are the primary users of users of the delivery systems, and not involving them in the five steps of SLDC could delay the identification of some usage problems (Cleveland, 2019).

In the planning stage, it important to involve nurses since they have the clinical expertise and are the primary users of the system, Nurses exclusion from the planning stages can result in the implementation of a system that fails to address specific patient needs.

Nurses are conversant with the workflow, roles, and duties of staff involved in patient care. In the analysis phase, nurses help identify and discuss tools that could make the system easy to use and effective in the care process. Excluding nurses in the analysis phase could result in flaws in system development,

In the designing stage, nurses can discern the needed input and output data, can review the flowcharts and work procedure to ensure that they are in line to produce the anticipated output (Zytkowsi et al., 2015). Failure to include nurses heightens the chances of missing vital input or output data which can limit the efficacy of the system.

In the implementation phase, nurses use the system, troubleshoot and give feedbacks on the efficiency of the system.  Nurses may assist in the partnership effort of gathering, obtaining feedback, recognizing implementation problems and facilitators and areas that could be modified (McGonigle & Mastrian, 2018). Excluding nurses in the implementation phase could result in having a system that does not adequately meet the goals of clinical expectations.

In the maintenance phase, nurses are involved in supporting learning, using the system, providing feedbacks, and adapting software updates. Excluding nurses from this phase can limit improving the system to meet the changing care needs.

My facility of practice transitioned from Centricity to EPIC in December 2021. The change came about because there was a change of management. The management changed the system to align with the system of the parent company. The nurses were not involved in phase of the SDLC. There was anxiety about the impending change that some nurses resigned for fear of uncertainty. There was a breakdown in trust between the management and the nurses. The process led to low productivity rate as nurses did lacked the enthusiasm to embrace the change.

References

Bureau of Labor Statistics (2020). Registered nurses made up 30 percent of hospital employment in May 2019. The Economics Daily. https://www.bls.gov/opub/ted/2020/registered-nurses-made-up-30-percent-of-hospital-employment-in-may-2019.htmLinks to an external site.

Cleveland, K. A., Motter, T., & Smith, Y. (2019, May 31). Affordable Care: Harnessing the Power of Nurses. The Online Journal of Issues in Nursing. https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-24-2019/No2-May-2019/Affordable-Care.html?css=printLinks to an external site.

Zytkowsi, M., Paschke, S., McGonigle, D., & Mastrian, K. (2015). Administrative information systems. In D. McGonigle & K. G. Mastrian (Eds.), Nursing informatics and the foundation of knowledge (3^rd ed., pp. 187-200). Burlington, MA: Jones & Bartlett Learning. Inclusion of Nurses in the Systems Development Life Cycle.

Laureate Education (Producer). (2018). Systems Implementation [Video file]. Baltimore, MD: Author.

McGonigle, D., & Mastrian, K. G. (2018). Nursing Informatics and the foundation of knowledge.

. (4^th ed). Burlington, MA: Jones and Bartlett Learning

Initial Post

An organization’s system development life cycle (SDLC) is a conceptual model used in project management to

outline the stages involved in creating an information system (IS). It progresses from determining feasibility to project

initiation, analysis, design, implementation, testing, and maintenance (McGonigle & Mastrian, 2022). It is comparable

to the nursing process, in which a nurse must assess, diagnose, plan, implement, re-assess, evaluate and update

where necessary.  If new issues arise or something does not work well, re-evaluate and update.  It is a never-ending

process that is constantly evolving.

Consequences of not including nurses in SDLC stages

Nurses are one of the major users of health information systems and it will be difficult for them to advocate for

something that they are not involved in.  Not including nurses in the SDLC stages could cause resentment toward the

new technology, and result in a loss of enthusiasm for learning about the new system.  Also, from experience, it can

result in nurses leaving the profession to pursue other jobs/careers.  Another point to consider, not including nurses

might affect the flow of work and delay patient care if what is implemented is not understood (Agency for Healthcare

Research and Quality, n.d.).  Including nurses ensures that their views are heard.  Nurses are experts with first-hand

knowledge of what is needed and understand what and how best it would work.

Potential issues at each stage of SDLC and how nurses may help address these issues

As stated above, there are six stages to the SDLC; feasibility, analysis, design, implementation, testing, and

maintenance. The feasibility stage is where a decision to initiate the project is considered.  A potential issue at this

stage will be in regard to if the project will be able to meet the needs and expectations of the organization and

actually achieve the business goal. The analysis phase examines workflows and business practices. The design phase

is focused on creating a fundamental structural framework that identifies the key elements of the product and how

they communicate with one another.  An issue at this stage will be to design a product that is difficult to use.  Nurses

can be vital at this stage by helping to develop a program that gets the job done and is simple to understand and use

by all. The next stage is the implementation phase where the product development process is executed. Then it goes

through the testing phase to ensure the system is accurately built in the way that it should. After testing when the

system is up and running is maintenance to ensure the system continues to work the way it is designed to. Not

maintaining the system could lead to system breakdown.  Therefore users/nurses are extremely important at this

stage for providing feedback and reporting things that cause system sluggish or slowdowns. The maintenance phase

is ongoing until it is decided that the system is no longer needed and a new system is implemented, thus starting the

SDLC all over again.

At my current facility and previous ones, I was not involved in the planning and implementation of any new

systems.  However, although I wasn’t involved, there are nurse informatics and nurse leaders that are included in the

planning and development, who make sure that those at the bedside get the best training necessary to use the new

systems. I am yet to find myself struggling with the training obtained, so I will say they were effective in helping me

be confident.  I am also a super-user of a few of the systems.

References

Agency for Healthcare Research and Quality. (n.d.b). Workflow assessment for health IT toolkit. Retrieved January 25,

2023, from https://digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-Links to an external site.Links to an external site.

health-it-toolkit

McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett

Learning.

Lalband, N., & Kavitha, D. (2019). Software engineering for smart healthcare applications. International Journal of

Innovative Technology and Exploring Engineering, 8(6S4), 325-331.

      The failure of healthcare organizations to involve nurses in the Software Development Lifecycle (SDLC) stages when purchasing and implementing a new health information technology system may present significant consequences. Booth et al. (2021) note that with the insight of nurses, these organizations may accurately identify the needs of the user base and the necessary functional and technical requirements for the system. The outcome this has is a poorly designed system that does not cater to the user experience. Without nurses’ input on design, the system may be developed without scalability, efficiency, and cost in mind, leading to higher costs for the organization.

Examples of potential issues at each stage of the SDLC

1. Planning: Objectives, scope, and feasibility that need to be clarified. The inclusion of nurses helps address these issues by providing a clinical perspective on the users’ needs and ensuring that the system meets the needs of patients.
2. Analysis: Inadequate gathering and analysis of user needs (McGonigle & Mastrian, 2021). Nurses would provide input on the clinical use of the system and ensure that it meets the intended needs of patients and other professionals.
3. Design: Insufficient attention to usability and user-centered design. Nurses would offer guidance and suggestions on the system’s usability from a clinical perspective and ensure the system is user-friendly.
4. Implementation: Lack of testing and training for users. Having nurses around at this stage would offer them opportunities to offer their input and perception of the usability and user-friendliness of the system.
5. Testing: Insufficient testing. Nurses would help deal with this issue by offering a firsthand view of the system in its current state and suggesting changes that might be required to fit and address their needs and other users effectively.
6. Deployment: Poor installation and maintenance. Nurses would propose how the system could be installed and maintained, considering how their operations would be impacted.
7. Maintenance: Lack of ongoing support and maintenance. Nurses would offer vital input on the importance of reliable support from the vendor organization and alternatives that would be needed if the support is unavailable.

My Input

I have had some input in selecting and planning a new electronic health record system in my nursing practice. Doing this helped ensure that the system met the needs of clinicians and patients, was user-friendly, and was cost-effective (Perezmitre et al., 2022). My involvement enabled me to model a system that meets the needs of the nurses and other healthcare providers and is tailored to our specific workflow. The absence of nurses in the process may lead to installing a system that fails to meet the users’ needs, resulting in poor user experience, increased training requirements, poor user adoption, and higher costs.

References

Booth, R., Strudwick, G., McMurray, J., Chan, R., Cotton, K., & Cooke, S. (2021). The Future of Nursing Informatics in a digitally-enabled world.               Health Informatics, 395–417. https://doi.org/10.1007/978-3-030-58740-6_16

McGonigle, D., & Mastrian, K. (2021). Nursing informatics and the foundation of knowledge. (5th ed.). Jones & Bartlett Learning.

Perezmitre, E. L., Ali, S., & Peltonen, L. M. (2022). Nursing informatics competencies for the next decade. Nursing and Informatics for the 21st                     Century – Embracing a Digital World,  131–148. https://doi.org/10.4324/9781003281009-8

Inclusion of Nurses in SDLC – Erica Schulte – Initial Post

Consequences of not including nurses in Systems Development Life Cycle

When a healthcare organization determines to take the step into a implementing a new technology system, to be successful they will proceed through various stages of a Systems Development Life Cycle.  There are various stages of the SDLC and various deliveries.  One of the oldest and most common of these methods is called the ‘waterfall method’ (McGonigle & Mastrian, 2022).  One of the most crucial elements of establishing the proper implementation team is ensuring that the right team members are included.  One of the most important team members is the end user, who can provide valuable feedback on problems to be solved, usability, and various functions.  In a healthcare system the end user is the nursing team, and not having them included you would have the potential to lose this valuable feedback and miss opportunities in system design.

Stages of Systems Development Life Cycle and nursing involvement. 

As mentioned above, the waterfall method is a common and successful implementation method.  The first step is feasibility.  Feasibility has to be measured in multiple areas including economical, legal, and operational.  Part of the operational feasibility is trying to understand problems and functions that need to be fixed and the end user, or nursing team is the most in tune team member to some of these challenges.  Not having a nurse included during this step would result in missing some of this valuable information, and ultimately resulting in designing a new system that would not be properly designed.  In reading (Weckman & Janzen, 2009), the inclusion of a nurse is heavily supported in their own implementation of a Bar Code Medication Administration.

The next stage is the analysis stage.  During this stage operational processes are further evaluated to help determine current challenges, issues, as well as strengths, to help determine the best design for the new system.  A nurses feedback here is crucial to fully understand these processes and the feedback of an end user.

Stage three is the design phase which will apply all feasibility and analysis to determine the best processes to include in the design.  Nursing feedback will continue to be valuable here as the design is progressed to ensure that all aspects of a new process are applied.

After the system is designed, the next two steps are implementation and testing.  During the testing phase the new system will in fact go into effect and the end users will begin to test the function.  Implementation teams can fail here if the proper end user is not involved in this testing phase and feedback is not properly received.  Having the nursing team involved in the testing to allow for proper feedback and review at all aspects of the new process and system will be crucial.

The final phase after implementation and testing is maintenance.  Maintaining the system will include a proper understanding of how the system functions, and the user having the ability to efficiently provide solutions and feedback of issues on a regular basis.  This will ensure that any fixes or necessary modifications are applied through the maintenance stage.  The proper end user providing this feedback will allow for proper maintenance through the lifestyle of the system.

Personal Experience 

In my past life I was able to be included in a new system implementation process.  A hospital that I had worked in early in my career was implementing the new Epic system through our organization.  While I was unable to be included in the early stages of the development life cycle, I did have the opportunity to give feedback during the testing and maintenance stages.  Our leadership ensured that all of our nursing team was able to apply feedback during these stages to ensure that the early stages of the new system would be applied properly.  This allowed for proper fixes and adjustment as our organization adopted the new system.

References

Louis, I. (2011, August 17). .

.%20retrieved%20from%20https//www.youtube.com/watch?v=xtpyjPrpyX8%20%20Systems%20Development%20Life%20CycleLinks%20to%20an%20external%20site.%20%20Walden%20University,%20LLC.%20(Producer).%20(2018).%20Interoperability,%20Standards,%20and%20Security%20[Video%20file].%20Baltimore,%20MD:%20Author.%20%20Walden%20University,%20LLC.%20(Producer).%20(2018).%20Managing%20Health%20Information%20Technology%20[Video%20file].%20Baltimore,%20MD:%20Author.” target=”_blank” rel=”noopener”>Systems development life cycle Links to an external site.(SDLC) [Video file]. Retrieved from https://www.youtube.com/watch?v=xtpyjPrpyX8McGonigle, D., & Mastrian, K. G. (2022). Chapter 9. In Nursing Informatics and the foundation of knowledge (pp. 194–194). essay, Jones & Bartlett Learning.

Weckman, H., & Janzen, S. (2009). The critical nature of early nursing involvement for introducing new technologies. OJIN: The Online Journal of Issues in Nursing, 14(2). https://doi.org/10.3912/ojin.vol14no02man02

Inclusion of Nurses in Development and Design of Health Information Systems

Introduction

The SDLC is a process by which an information system (IS) is developed for an organization based on their business objectives and needs. The stages of needs assessment and system development should involve all stakeholders. First, the problems and needs of the organization must be understood to then develop a solution. A plan is developed for how to address the problems and needs identified, and then the plan is implemented based on the steps required to achieve the identified solution. Maintenance and review of the system follow, and if major changes need to be made for various reasons, the system is destroyed, and the cycle begins again (McGonigle & Mastrian 2022).

Consequences of not including nurses in purchase and implementation

Nurses are key stakeholders in the development and implementation of an IS. They have an important perspective of the needs and issues of the business or organization due to their involvement in the daily flow and first-hand knowledge of issues, as well as insight to solutions. Typically, nurses will be primary end-users of a new system in the clinical setting. As such, the IS should be designed in such a way that allows for ease of use and minimizes disruption to workflow. A consequence of an inefficient or overly complicated IS is low end-user compliance due to inconvenience and perceived ineffectiveness of the system.

Issues at each stage of the SDLC and how nurses can support improvement

Feasibility is the first stage in the SDLC. This refers to a determination of whether the project should be initiated and if it will be supported. Operational feasibility looks at how effective the system will be in addressing or solving the issue of concern. This is an area where developers may encounter an issue – the system may seem to address a certain issue in theory but at the clinical level it is ineffective. This is where the input of nursing staff would be extremely helpful to gauge the potential effect or impact of the system in question.

Analysis is the next stage, during which time the workflow and practices of the business are examined to determine what will be required of the system in order to be useful (McGonigle & Mastrian 2022). Because the workflow of a particular process or series of tasks often is different on paper when compared to the workflow as it manifests in clinical practice, development of a system based on the supposed workflow, as opposed to the actual workflow may result in a system not well suited to current clinical processes. There are always ways to improve workflow in healthcare, but a system with the aim of improving a certain problem can only be truly effective by accounting for the details of the actual daily practices. Nurses are key informants for the “why” of certain practices that can inform how to make improvements that will have likelihood of being adapted to current practice.

The design phase is extremely important, and developers must ensure the overall configuration, such as how the program(s) will look and work, is in line with what stakeholders agree will be most effective. At this stage, the nurses’ input is of high value, especially if they will be the primary end-users of the program or system. If it is not user-friendly or causes disruption in the clinical flow, there will be low compliance in its use. This issue is best avoided by consulting the nursing staff and gathering information from their clinical perspective.

Implementation is the stage when the design is brought to life (McGonigle & Mastrian 2022). Staff will be trained on its use. There may be issues with staff acceptance of the new system and sufficient training must be provided for users to increase likelihood of its adoption. By involving nurses early on in providing feedback regarding the functionality, a more user-friendly and effective system can be developed.

Testing is the phase when staff begin to utilize the program or system and determine if it performs in a way that is conducive to improvement of current issues. During this time, again, there may be an issue with user compliance. Nurses may request further training or may have input regarding certain details for improvement.

In the maintenance phase, the system may require updates or need slight changes to make it easier for users to implement. In this stage, it’s possible that the system doesn’t adequately address the need it was designed for. This issue can cause frustration for both end-users and program developers. As nurses are frequently a large percentage of the end-users, they will be able to provide feedback about where the system falls short or misses the mark in addressing needs. Nurses can provide suggestions for changes that would make the system work more effectively in the clinical setting.

Did I have input on selection of new technology systems?

I have never been consulted on the purchase of new systems, only instructed on how to use them. As the pediatric primary care office was a relatively new addition to the larger health care clinic, I was consulted on modifications made to the current IS to screen for delays in written and verbal language comprehension and expression. However, the system developer made the changes they felt were appropriate and never returned to ask if the changes made were adequate for our needs and patient needs in the pediatric office.

Impacts of not being included 

As a result of not being included, the system was inefficient – I had to write many extra notes during each patient visit if the child was experiencing delays in language comprehension or expression. Many of our patients were from households with low literacy where Spanish or a Mayan dialect is the primary language and English is the second or third language. The IS built for our office was ineffective for our needs as providers and for our patients’ needs as well. As a result, it was very difficult to track interventions and progress in our patient population.

Conclusion

Nurses are seldom involved directly in the planning and development of systems they will be expected to use. In a study by Martikainen et al (2020), a survey was used to obtain feedback from nurses and physicians regarding their experience with health information system (HIS) development and how they prefer to be engaged to participate in its design. In the youngest age group, (<35) 70.4% of nurses and physicians stated they had never participated in HIS development (Martikainen et al 2020). All age groups agreed that communicating with a person in charge of HIS development was the most popular option for providing feedback (Martikainen et al 2020). There are consequences to not involving nurses in the planning and development process, namely a lack of efficiency in addressing the issue and a disruption to workflow. Additionally, end-users may avoid using the system if it is complicated or time consuming to use. McBride and Tietze (2023) affirm the SDLC “should result in a high-quality system that meets or exceeds customer expectations, reaches completion within time and cost estimates, works effectively and efficiently in the current and planned information technology infrastructure, and is inexpensive to maintain and cost-effective to enhance” (p. 193). Nurses must be more actively involved in the planning and development of HIS in order to improve their effectiveness clinically.

References

Martikainen, S., Kaipio, J., & Lääveri, T. (2020). End-user participation in Health Information Systems (HIS) development: Physicians’ and nurses’ experiences. International Journal of Medical Informatics, 137, 104117. https://doi.org/10.1016/j.ijmedinf.2020.104117

McBride, S., & Tietze, M. (2023). Nursing Informatics for the advanced practice nurse: Patient safety, quality, outcomes, and interprofessionalism. Springer Publishing Company, LLC.

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