Description, Background, and Stakeholders
The role of a nursing care provider encompasses many types of support for patients that ensure that not only the patient receives proper treatment, but also his or her health-related issues are fully addressed by health care providers (Husso et al., 2012). This support includes screening for abuse and ensuring that a patient or a victim of abuse has access to appropriate resources that can help him or her avoid violence and return to safety. However, nurses often found themselves deprived of opportunities to help their patients who are victims of violence because of policy restrictions.
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Domestic violence is officially known as intimate partner violence. The definition of an intimate partner is “a spouse, a former spouse, a person who shares a child in common with the victim, or a person who cohabits or has cohabited with the victim” (“Federal domestic violence laws,” 2015, para. 21). A major problem in the attempts to address the issue of domestic violence from the legal or social perspectives is that many cases of domestic violence remain unreported (Ross, 2014).
Even if victims confess to having been abused, they may opt for staying with the person who abuses them and avoiding reporting to the authorities. In this situation, nursing care providers are those people who can help by properly recording the fact of abuse and providing advice on who should be contacted for help, legal instructions, and support. However, these abilities of nurses are currently limited.
Many health care facilities today employ electronic health record (EHR) systems, and they are acknowledged to be capable of improving the efficiency of nurses’ work and the quality of care (Charles, Gabriel, & Furukawa, 2015).
However, a major disadvantage is that many such systems do not allow keepings track of patients’ narratives or creating a detailed body map of a victim so that the injuries are properly recorded. The indicated information can be put into the system only if a request is made to the designer of a particular system, and approval of the request needs to be obtained (Hewins, DiBella, & Mawla, 2013). This is a major barrier to providing necessary support to patients.
Lacking proper instruments to record the evidence of domestic violence, nurses may find it difficult to fully address the needs of their patients who are victims of intimate partner violence. In this situation, four categories of stakeholders are recognized: nurses, patients, facilities, and communities. If the electronic health record system policy is improved, nurses will be provided with an instrument to effectively protect their patients from the negative effects of domestic violence.
Also, the patients will receive additional support and access to social assistance and legal actions that will ensure that those patients are no longer exposed to domestic violence. Facilities in which nurses work will become more empowered, and a positive, constructive culture will be established; in this culture, facilities that provide medical care will be seen as not only places to go to receive treatment but also places in which substantial support can be provided to protect patients from violence to which they may be exposed.
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Finally, there are benefits for the community: feeling the support, more people will be willing to share their exposure to intimate partner violence, and the number of unreported cases, i.e. cases in which nurses cannot help patients due to unawareness of the problem, will decrease. However, there are also risks: the new policy can disrupt the work of EHR systems’ producers, and some of them may leave the market due to their inability to comply with the new requirements.
The issue recognized based on the background above is the lack of policy to require EHR systems’ developers to include options for recording patients’ narratives and creating body maps with the description of injuries. This is a scope-of-practice policy issue because it refers to the ability of nurses to perform certain actions in the workplace that are needed to ensure appropriate quality of care; currently, nurses are deprived of an opportunity to perform them.
Since requirements for an EHR system are something developed by facilities in collaboration with authorities, it is proposed to implement policy change by creating a policy that will require facilities to include the two options—patient narratives and body maps—in their criteria for assessing if an EHR system that a facility is planning to adopt is adequate; those systems that do not feature the two options will not be approved for adoption.
Nowadays, domestic violence is a major public health issue that affects numerous lives (Ross, 2014). Some of the negative outcomes of domestic violence include reduced quality of the lives of victims and witnesses (especially children), which can involve psychological and physical traumas and even deaths, and noticeable governmental expenses (Hewins et al., 2013). The latter outcome is partially connected to the healthcare efforts of combating the issue.
Some of the key healthcare activities that contribute to the resolution of the problem include preventative and educational measures, emergency and follow-up care, and various counseling services (Hewins et al., 2013; “Standards of care,” 2013). In general, healthcare is one of the major players in combating domestic violence, but it needs the support of the remaining ones, including the legislative and political systems (“Standards of care,” 2013).
The idea of policy-based interventions for the combating domestic violence is a relatively recent development; for example, the Violence Against Women Act was issued in 1994 (“Federal domestic violence laws,” 2015). As a result, it is not surprising that the mechanisms of supporting domestic violence interventions in the field of healthcare can be described as lacking (Husso et al., 2012).
The employment of EHR, which is already a widely-implemented and helpful tool in healthcare (Charles et al., 2015; Nguyen, Bellucci, & Nguyen, 2014), to the benefit of healthcare interventions with respect to domestic violence is an attractive opportunity with some risks. In particular, there are privacy considerations that should be taken into account (Caine & Hanania, 2012), and the challenge of change might be viewed as problematic by the vendors. As a result, the proposed change will need a careful consideration of a variety of aspects, including the assessment of various options for addressing the problem.
Methods of Addressing the Issue
Currently, EHR systems are regulated by the Office of the National Coordination for Health Information Technology (ONC). The authority primarily focuses on encouraging eligible facilities to adopt these systems and explaining what benefits of the use of these systems exist (“How to attain meaningful use,” 2013). However, there is a lack of recognition that some electronic health record systems lack important functions, and there should be the requirement for facilities to avoid adopting those systems in which such functions are not enabled (Caine & Hanania, 2012).
The method of policy change is presenting to the facility’s decision makers arguments for adopting a new requirement for EHR systems; if the initiative is successful on this facility level, it will be taken further, and it will be proposed to amend the Health Information Technology for Economic and Clinical Health (HITECH) Act, the legislation that regulates the operation of the ONC.
Goals and Options for Changes
The goal is to have a positive impact on nursing care providers’ work by allowing them to address the needs of their patients who are victims of intimate partner violence effectively. Within electronic systems that nurses use in their work, it should be possible to record any violence-related narratives and injuries; otherwise, nurses will not be able to support their patients fully (“Standards of care,” 2013). The policy change can be implemented at the facility level; however, it is further planned to propose amendments to the relevant federal legislation.
Since the first step of implementation will be on the facility level, the primary measurement in evaluating the successfulness of the proposed policy change is feedback from the facility decision makers after they are presented the issue and the proposed change. If the initiative is approved, and the EHR system is modified, the next step of evaluation is receiving feedback from the facility’s nursing care providers.
The method will be surveying; nurses will be asked to evaluate how much they benefit from the new policy (Nguyen et al., 2014). If positive feedback is received, it will be used as evidence of the policy’s effectiveness in improving the quality of care, and it will be proposed to amend the current legislation based on this evidence.
Personal Perspective and Practice
As a nurse practitioner, I think that the absence of policy-mandated tools for domestic violence screening is a problem that should be rectified. I know that a change in policy would have a positive impact on my practice because it would be easier for me to detect the issue and provide advice on it, ensuring the safety of my patients. I also suppose that the mentioned change risks are minor: the introduction of new features into EHRs is more likely to be viewed by the vendors as an opportunity to develop and distinguish their product, and the privacy matters, while complex, will be managed in favor of patients. Thus, my personal opinion on the policy is that it will be exceptionally helpful for my practice if it is changed.
At the initial stage of implementation, it is recommended to collect stories from intimate partner violence victims and nurses. The stories should demonstrate that, while the victims were seeking support or were proposed support from nurses, nurses were unable to provide it appropriately because the existing EHR system did not allow nurses to document the evidence of violence properly so that it can help protect victims from further abuse. These stories will add to the evidence presented to the facility’s decision makers.
Caine, K., & Hanania, R. (2012). Patients want granular privacy control over health information in electronic medical records. Journal of the American Medical Informatics Association, 20(1), 7-15.
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Charles, D., Gabriel, M., & Furukawa, M. F. (2015). Adoption of electronic health record systems among US non-federal acute care hospitals: 2008-2014. Web.
Federal domestic violence laws. (2015). Web.
Hewins, E., DiBella, B. & Mawla, J. (2013). Domestic violence and the role of the healthcare provider: The importance of teaching assessment and intervention strategies. Web.
How to attain meaningful use. (2013). Web.
Husso, M., Virkki, T., Notko, M., Holma, J., Laitila, A., & Mäntysaari, M. (2012). Making sense of domestic violence intervention in professional health care. Health & Social Care in the Community, 20(4), 347-355.
Nguyen, L., Bellucci, E., & Nguyen, L. T. (2014). Electronic health records implementation: An evaluation of information system impact and contingency factors. International Journal of Medical Informatics, 83(11), 779-796.
Ross, L. E. (Ed.). (2014). Continuing the war against domestic violence (2nd ed.). Boca Raton, FL: CRC Press.
Standards of care: Ontario network of sexual assault & domestic violence treatment centres. (2013). Web.