Category: Health & Medicine 13691

Hand hygiene is a critical process in ensuring patient safety and quality treatment outcomes in health care facilities. As such, it is necessary for health care facilities to initiate and implement hand hygiene proposals to help in the reduction of infections acquired at the hospital like Catheter-Associated Urinary Tract Infection (CAUTI). While the process of change implementation may offer various challenges, health care workers should stay determined to ensure effective hand hygiene practices. Nonetheless, hand hygiene is a process that applies to both health care professionals and patients. This paper outlines two possible barriers to effective handwashing techniques in preventing CAUTI and gives recommendations to overcome them.

One of the most highlighted barriers to effective hand hygiene is the lack of knowledge and training for hand hygiene measures among health care providers and patients. Studies have also found that lack of efforts has led to disregarding 80% of hand hygiene guidelines provided by the World Health Organization (WHO) (Mearkle, Houghton, Bwonya, & Lindfield, 2016). The second barrier to effective hand hygiene practice is infrastructural deficit, such as insufficient water supply and poor quality of antiseptic soap (Ataiyero, Dyson, & Graham, 2019). Subsequently, the successful implementation of an effective handwashing technique to reduce the rate of CAUTI requires certain recommendations to be considered.

Consequently, to overcome the barriers that have been mentioned, the hospitals management should hire public health professionals to provide handwashing education to patients and clinicians in the inpatient wards and outpatient. The public health officials will train patients and clinical professionals to wash their hands using soap and running water thoroughly. Additionally, the hospital will also have to ensure the procurement of high-quality antiseptic soaps and increase sanitizers to address the problem of insufficient water supply and poor quality of antiseptic soap. Thus, by adhering to the recommendations, the hospital will be able to implement the change proposal effectively and reduce the rate of CAUTI.

Overall, hand washing is an essential step towards the reduction of hospital-acquired infections like CAUTI. Therefore, health care facilities should ensure the implementation of effective hand hygiene practices. This can be done by addressing barriers such as lack of knowledge and training as well as an infrastructural deficit. Accordingly, the provision of handwashing education and procurement of alternative hand washing detergents, such as sanitizers are recommended to ensure effective implementation of the change proposal.

References

Ataiyero, Y., Dyson, J., & Graham, M. (2019). Barriers to hand hygiene practices among health care workers in sub-Saharan African countries: A narrative review. American Journal of Infection control, 47(5), 565-573. Web.

Mearkle, R., Houghton, R., Bwonya, D., & Lindfield, R. (2016). Barriers to hand hygiene in ophthalmic outpatients in Uganda: A mixed-methods approach. Journal of Ophthalmic Inflammation and Infection, 6(1), 1-6. Web.

Introduction

Nurses are among the important players in health care provision around the world. Their positive contribution to the medical industry cannot be emphasized enough. Zerwekh and Claborn (2006) affirm that nurses are an essential part of the health-delivery systems adopted all over the world. Despite their overall importance in the health care industry, nurses are faced with numerous personal and professional challenges as they conduct their duties.

This paper shall set out to provide a thematic analysis on the various experiences nurses have as they pursue their profession. The data analysis shall be based on a transcribed interview conducted by the researcher. The observable themes shall be identified, and an explanation of each theme provided in a bid to understand why the selected nurse chose this profession. In addition, the inherent benefits and challenges faced in the profession and the participants personal view on nursing shall also be highlighted.

Identification of Themes

After going through the transcribed interview, there were major themes that were identified. Noted Themes:

• Professional identity
• Professional socialization

However, further analysis revealed other themes which were subcategorized as shown in the table below:

Table showing the themes and their subcategories

The main objective of this research was to explore various aspects that influence an individuals decision of becoming a professional nurse. To this end, an unstructured interview was used as the primary tool for data collection. The interview focused on the background of the participant, experiences during the profession, and the participants evaluation of nursing. An analysis of the data collected during the interview enabled the researcher to come up with the aforementioned themes.

Thematic Analysis of Identified Themes

Professional Identity

The identity of nursing and the people who practice it has met various challenges over the past decades. Thupayagale and Dithole (2005) stated:

Nursing has, for many years, struggled with an inner hunger, a deep need for professional congruency and effectiveness. The perception by many people, except those aligned to nursing, see nursing as an inferior and inadequate undertaking to be regarded as a profession. (p. 152)

This statement shows that nursing lacks recognition and tolerates being oppressed. Evidence of this during the interview emerged as the interviewee shared her childhood stories. For example, she stated that her grandmother had little regard to nursing and stated that it had a bad reputation. In addition, the interviewees grandmother referred to nurses as whorish individuals. Such perceptions go to show how nursing and nurses are viewed by some members of society. In addition, it shows that regardless of its importance in the health care industry, nursing is not fully appreciated and recognized as a profession. Data from the interview (in addition to that collected from nursing literature) showed that nursing professional identity had been eroded. This would explain why nurses (including the interviewee) have to work hard to prove that what they do is equally as important as any other profession.

Parental Approval/Acceptance

From the interview, it was clear that the interviewees parents played a significant role in her choice of career. She descriptively narrates how her mothers dampened desire to become a nurse inspired her to become a nurse. In addition, as early as age fourteen, her father provided the resources (books and money) needed to pursue this career path. As a result, she dedicated her efforts towards becoming a nurse despite the fact that she hated reading. As such, her determination to succeed in this regard can be viewed as an attempt to guarantee parental approval/acceptance.

The interviewee further stated that she took good care of her fathers friends when she treated them. In return, they told her father how good she was at her job. This also shows that she wished to maintain her fathers pride in relation to what she did. It is also evident that she ensured her success in order to prove to herself and those that had a negative attitude towards nursing that nursing is as good a profession as any other since it offered the practitioners a chance to help others and positively impact their society. The struggles discussed under this theme relate to the theme of professional identity in the sense that the interviewee tried to uplift the professional identity of nursing and nurses through her actions and efforts.

Essence of time and care

This theme was deduced from the stories the interviewee narrated in regard to how nursing has lost the essence of quality care over the decades. As an example, she stated that there is no time to take care of patient due to documentation constraints, just time to do the basics. Hospitalization time has decreased substantially. She explained that nurses no longer have adequate time to properly cater for their patients needs. She attributed this to working conditions, which saw nurses working long shifts as a result of a large influx of sick people.

CTs comment regarding the working conditions of nurses is supported by Zerwekh and Claborn (2006), who agree to the fact that there seems to be a general shortage of nurses in most parts of the world. The authors further assert that this shortage has resulted in a situation where the few nurses available are overworked and stressed. Consequently, more mistakes are being made by nurses and lesser time allocated to patients as nurses try to attend to the large number of patients flowing into healthcare facilities. The interviewees desire to work in the 70s clearly supports the fact that there has been substantial erosion in the professional identity of nursing and nurses over the decades.

Stechmiller (2002) also states that job strain and emotional exhaustion are among the key challenges faced by nurses. The author further states that the high mortality rates experienced in ICUs, numerous human errors and ethical dilemmas faced by nurses, lack of mentoring experience and poor interdisciplinary coordination are as a result of high stress levels exhibited by nurses. The author also reveals that nurses inability to provide routine care is as a result of time and procedural constraints that characterize todays healthcare systems.

In regard to quality of care, the interviewee noted that the quality of nursing today has deteriorated significantly as compared to the situation in the 70s. She insinuated that nurses today are making more mistakes and have shallow understanding on various ethical and moral issues that are pertinent to nursing. For example, she stated that nurses today place more emphasis on the financial gains attributed to the profession, rather than the quality of care they offer their patients. Johnstone (2008) states that nurses are expected to promote and protect the interests and wellbeing of their patients in accordance to the nursing ethical code of conduct. As such, nurses are expected to refrain from offering services that lack in quality, or behave in a manner that risks the lives of their patients.

Professional Socialization

According to Mooney (2007), professional socialization refers to the process through which practitioners learn various aspects of the profession from other practitioners in order to become professionals. This theme was deduced from the fact that the interviewee placed great emphasis on the importance of being a team player and working as a team in the nursing profession. Professional socialization is important to individuals since it gives them an opportunity to learn from the best and belong (associate and identify themselves with their colleagues).

Teamwork/Closeness of Staff

This theme focused on the interactive/socialization ability of nurses. The interviewee supported Reeves et al (2011), who states that teamwork is a very important factor when it comes to execution of duties. To support this statement, the interviewee gave an example of an incident where the nurses worked together to help a deteriorating patient. However, she claims that teamwork is threatened by the fact that todays healthcare practitioners are more concerned with lawsuits rather than the delivery of quality care. The fear of being sued has been documented as a major reason as to why medical practitioners prefer working alone (Nemie, 2009). In a team setting, all members are responsible for the mistakes made by one member. This may have serious legal, ethical and professional consequences. As such, most people like taking care of patients on their own to avoid such incidences.

Societal/Peer Influence on Education

According to Lesser and Pope (2010), society plays a pivotal role in determining who we are or who we become. This statement is supported by Eriksons developmental theory, which asserts that human behavior is as a result of social and environmental interactions (Lesser & Pope, 2010). From the onset, the interviewee clearly indicated that her society (particularly her family) valued education. Her mother wanted to be a nurse and her father tried his level best to get her the resources needed to further her education. Such instances show that the interviewees childhood society influenced her ability to learn and succeed in that endeavor. Similarly, the interviewees ambition to become a teacher shows that she believed that education would influence the upcoming practitioners attitude towards their professions and help them become more enlightened and professional in their practices.

CTs decision to go back to school because her peers were doing the same was a clear indication of peer influence. This was further supported by the fact that she wanted to be the best at what she does. The desire to excel in this case is a clear indication of competitiveness and need for self efficacy that is mostly inspired by peer influence (desire to be better than ones peers).

From the interview, it was clear that the participants educational professional and educational achievements were greatly determined by her surroundings. According to Chapman and Hopwood (2007, p.120), Vrooms expectancy theory suggests that people choose actions, effort levels and occupation that maximize their expected pleasure and minimize their expected pain, consistent with hedonism. Therefore, the participants motivation to excel stemmed from her expected gains, which included peer, parental and societal approval, as well as self gratification.

Conclusion

This paper set out to provide a thematic analysis of data collected during an interview. The major themes were identified and an explanation as to why they were chosen. From the interview critique presented herein, it is evident that professional identity and professional socialization are among the core issues that affect nursing and nurses around the world. Therefore, it would be a worthwhile endeavor to delve deeper into such issues to come up with possible and applicable solutions for the same.

References

Chapman, S., & Hopwood, G. (2007). Handbook of management accounting research. New York: Elsevier.

Johnstone, M. (2008). Questioning nursing ethics (ethics & legal). Australian Nursing Journal, 15(1), 19.

Lesser, J., & Pope, D. (2010). Human Behavior and the Social Environment: Theory and Practice. New York: Prentice Hall PTR.

Mooney, M. (2007). Professional socialization: The key to survival as a newly qualified nurse. International Journal of Nursing Practice, 13(2), 75  80.

Nemie, J. K. (2009). Challenges for the Nursing Profession in Malaysia: Evolving Legal and Ethical Standards. Journal of Nursing Law, 13(2), 54  63.

Reeves et al. (2011). Interprofessional Teamwork for Health and Social Care. Boston: John Wiley and Sons.

Stechmiller, J. K. (2002). The Nursing Shortage in Acute and Critical Care Settings. AACN Clinical Issues, 13(4), 577  584.

Zerwekh, G., & Claborn, C. (2006). Nursing today: transition and trends. New York: Elsevier Health Sciences.

Introduction

Patients today are not only more informed than ever before, but they seek to be proactive participants in their health care by seeking greater control over their healing process (Shipman, 2010). This view is reinforced by The Joint Commission, who has rolled out the Speak Up program with the aim to support patients and their advocates become more informed and involved in the health care process (The Joint Commission, n.d.). It is the aim of this paper to review and critique an undated brochure by The Joint Commission titled Help Prevent Errors in your Care. The information contained in this brochure will go a long way to assist adult patients to take steps towards ensuring that they become active participants in the care process.

Summary of the Brochure

Available literature demonstrates that process errors, such as diagnostic errors made by physicians, pose the most common threat to patient safety (Sammer et al, 2010). Towards ameliorating this deficit, the reviewed brochure comes up with advice on how patients can become active participants in the decisions made concerning their health. In particular, the brochure encourages patients to: speak up when faced with questions or concerns; pay attention to the care provided by ensuring they get the right treatments; educate themselves about their illnesses, the medical tests they get, and the treatment plan; engage the services of a close family member/friend to act as an advocate or advisor in the care process; have prior knowledge of the medicine they take and the reason behind taking them to avoid medical errors; use accredited health institutions to ensure quality standards, and; participate in all decisions made regarding their treatment (The Joint Commission, n.d.).

Evaluation of the Brochure

The Joint Commission has been effective in presenting the information in a succinct and easily understandable manner, implying that this information can be readily digested by a wide allay of patients. In the presentation, the Commission has also scored highly in underlining the critical importance of patient participation in the care process. However, some points should have been presented together to avoid repetition and achieve ease of flow considering the fact that most patients may not have the time or energy to go through the whole brochure.

Availing information on what patients should do to increase their safety in the health care process is important not only because it enhances the recovery process, but it increases the quality of life of these patients and reduces medical errors (Sammer et al, 2010). This observation informed the choice of topic.

The information contained in the brochure is beneficial and should be incorporated in patient education because most patients lack the right information to facilitate their participation in the health care process (Sammer et al, 2010). This brochure will therefore serve as an eye opener to such patients, not mentioning that it intrinsically educates them on the critical points to engage in the care process.

The information contained in the brochure has been presented clearly and succinctly, implying that the intended audience will be able to synthesize the information contained in the brochure and put it into practice. Here it is imperative to note that this brochure is intended for adult patients who are in constant need of health care services.

It is indeed clear that the information will go a long way to increase patient safety. Due to inadequate knowledge and ineffective communication channels, most patients continue to carry the perception that medical personnel should not be subjected to any form of questioning as they always know what they are doing (Shipman, 2010). This brochure proves this assertion wrong, and goes ahead to encourage patients to question the rationale of various medical processes used on them and the efficacy of the medicines given. Such a proactive disposition on the part of patients reduces medical errors, and hence increases patient safety (Sammer et al, 2010).

Conclusion

From the review, it is clear that the brochure deals with ways through which patients could become more informed and involved in their health care. It has been revealed that such participation not only reduces medical errors by ensuring that patients get the right kind of treatment options, but it enhances their quality of life and enlighten them on what treatment strategies are best for them, and the health institutions to visit. Having the right kind of information is also critical to the patients recovery process.

Reference List

Sammer, C.E., Lykens, K., Singh, K.P., Mains, D.A., & Lackan, N.A. (2010). What is patient safety culture? A review of literature. Journal of Nursing Scholarship, 42(2), 156-165.

Shipman, B. (2010). The role of communication in the patient-physician relationship. Journal of Legal Medicine, 31(4), 433-442.

The Joint Commission. (n.d.). Help prevent errors in your care. The Speak UP Program.

Leukemia or, in other words, cancer of the blood and bone marrow is a disease connected to the abnormality of white blood cells. At the initial stage, it can be unnoticed by the patients since the condition implies the growing weakness of ones body, which can be ascribed to other health issues (Bernard et al., 2017). In the course of the diseases development, the immune systems deficiency stemming from the specified dysfunction leads to the emergence of such problems as the inability to fight infections (Bernard et al., 2017). This symptom is easier to reveal, and, therefore, it marks the beginning of the treatment.

This condition is accompanied by other disruptions in the patients body, which add to the diagnosis. Thus, since leukemia is a disease characterized by weakness, it correlates with anemia, which is recognized by the general feeling of illness and fatigue due to the low levels of red blood cells (Bernard et al., 2017). It is also connected to thrombocytopenia since this issue implies easy bruising or bleeding because of a shortage of blood platelets (Bernard et al., 2017). The link between leukemia and neutropenia is in the latters role in causing the disease as it means the inability of white blood cells to fight infection (Bernard et al., 2017). Therefore, the consideration of these symptoms allows diagnosing leukemia at initial stages, when there are no other signs of the disease.

A child with leukemia, when diagnosed in the hospital setting, can have either a high or low white blood cell count. These lab results indicate that, in the first case, the patient has many cells which do not protect from infection, whereas in the second situation, the problem is bleeding and bruising due to a shortage of blood platelets (Bernard et al., 2017). They allow specialists to choose the proper treatment depending on the type of leukemia.

Reference

Bernard, S. C., Abdelsamad, E. H., Johnson, P. A., Chapman, D. L., & Parvathaneni, M. (2017). Pediatric leukemia: Diagnosis to treatment  A Review. Journal of Cancer Clinical Trials, 2 (2), 1-3. Web.

Introduction

Though the title of the article is short, it comprehensively expresses the impact of the study. The introduction affirms that though information regarding pathophysiology, in addition to treatment of sepsis in individuals across the lifetime exists in health and nursing studies, the capability of nurses and other health professionals to properly and effectively identify sepsis, particularly in the course of early phases, remains fairly wavering. Present studies establish that clear and well-timed interventions in the treatment of patients with sepsis could considerably reduce the death rates of grown-ups and pediatric patients (Jeffery, Mutsch, & Knapp, 2014). Nevertheless, it should be recognized that treatment of sepsis can just start following suitable evaluation and diagnosis. The introduction draws the concentration of the reader as it thoroughly exemplifies the worth of the study in a highly sensitive topic.

Statement of Purpose

The authors included a clear statement of purpose in the article. The statement of purpose clearly ascertains the rationale behind the study to be the indirect measurement of the understanding of acute care pediatric nurses with respect to Systemic Inflammatory Response Syndrome (SIRS) diagnostic criterion, sepsis strategies, and the significance of SIRS identification. The authors employed an indirect assessment because of the intricacy of assessing nursing knowledge articulated as performance and since the practice greatly connects with knowledge (Jeffery et al., 2014).

Research Questions

The authors employed two research questions in the study, which are stated subsequent to the purpose of the study. The two questions are just based on the knowledge of nurses and none on the best method of addressing SIRS and sepsis, which carries a great weight of the research.

Literature Review

Regardless of the ample application of substantiation (referencing) with regard to the preparations for the study in the introduction section, the article failed to depend on pre-existing studies profoundly in the review of the literature. The literature review is weak and short thus inadequately covering the topic. Moreover, the literature review does not splendidly reveal the way the knowledge of nurses or successful methods have been applied in the management of SIRS and sepsis to enhance the quality of care. On this note, the literature review is incomprehensive.

Methodology

Out of 1,500 nurses that were qualified to take part in the study, 242 finished the survey (Jeffery et al., 2014). The sample size was large enough to carry out the quantitative study. The sample for the study is easily recognized from the article and is supported by the demographic variables, which encompassed years of experience, age, and gender to mention a few. However, the sample was biased in that females consisted of 95 percent of the entire participants thus resulting in poor representation of male nurses. In this regard, the sample failed to include an even representation with respect to gender and that could have affected the results of the study as the knowledge of male nurses was underrepresented. Moreover, the explanation regarding the selection of the sample lacks precision. The participants were selected from a large metropolitan pediatric hospital in a Midwestern country and others from organizations, and since it is not evidently mentioned, the reader is just left to assume that the participants represent a convenience sample.

Presentation and Analysis of Data

The application of both Likert and non-Likert questions led to a thorough presentation and analysis of data with every information discussed in detail. The non-Likert part was composed of fifty items with the first set asking participants to report on the recognition of sepsis, the second requiring selection of signs and symptoms of SIRS or sepsis in a patient, and the third asking for the choice of diagnostic tests involved in the early management of SIRS or sepsis. The answers on the Likert scales illustrated that augments in the years of experience as a nurse enhanced the possibility of selecting Agree or Strongly Agree on the scale (Jeffery et al., 2014).

Implications and Discussion

Within the implications part, the authors concentrated on the outcomes of their present study and the manner in which it could be employed to enhance future research with respect to reducing mortality through recognition of SIRS and sepsis prior to the development of advanced sepsis or septic shock. This acted as great worth of the article as it makes recommendations for guiding future studies. Before the discussion section, the authors pointed out limitations in the research such as small sample size as well as multidimensionality of study design, which raised the possibilities of inaccuracies (Jeffery et al., 2014).

Conclusion

The authors failed to include a conclusion section of their study, and one would assume that it is merged with the discussion. Nevertheless, the discussion part is too small thus inadequately discussing the study. The authors tackle a sensitive subject with the issues of SIRS and sepsis and the influence of caregivers in ensuring quality of care, which leads to a great necessity for an intervention. Regardless of a number of weaknesses, the authors inclusively handled the subject matter and recommended the best intervention to handle the predicament successfully.

Reference

Jeffery, A. D., Mutsch, K. S., & Knapp, L. (2014). Knowledge and recognition of SIRS and sepsis among pediatric nurses. Pediatric Nursing, 40(6), 271-278.

Comparing and contrasting the major roles of the innate immune system and the acquired immune system

Innate immune system prevents the entry of pathogenic microbes and toxins into the body. According to IQWiG (2012), this is achieved through surface barriers including the skin, mucosae and various secretions by the body such as saliva, sweat, and hydrochloric acid which is secreted in the stomach. The innate immune system also prevents entry of pathogens through internal mechanisms which include production of various cells and chemicals. The innate immune system offers instant protection against infections through production of chemical mediators known as cytokines. Innate IS boosts a system that recognizes bacteria, and arouse macrophages. It also aids the exclusion of dead cells/antibody complexes.

Contrastingly, the acquired immune system offers secondary protection against infection by attacking pathogens which evade or overpower the innate immune system. It is also specific in targeting pathogens (IQWiG, 2012). In regard to functions, the major difference is that innate immune system takes a short time to be activated. Nonetheless, it does not provide the host with a prolonged protective immunity. The acquired immune system takes long to be activated although it offers prolonged protective immunity. Normally, older people, infants and people with acquired immune systems are highly protected from some contagious diseases. This is a critical provision in the context of immunity and the protection of the human life. Basically, innate immune systems are in-built and are structured to fight all sorts of infections by providing natural resistance to infectious agents. Acquired immune system induces the execution of a meticulous action. It also enhances performance of antibodies and other bodys defense cells. As the levels of the acquired immunity systems increases, further performance and protection begin to endure. Acquired immune system operates with the memory of antigens causing diseases. Normally, there are specific antibodies produced to capture specific disease causing antigens. Such immunities increase focus and exclusivity of protection and therefore invigorate good health.

How the innate immune system and the acquired immune system work together to fight infectious agents

The innate immune system plays an important role in triggering the acquired immune system into action against pathogens present in the body. This is accomplished through making changes on the phagocyte surface which help in initiating the acquired immune system. After the phagocytes in the innate immune system have engulfed the invading infectious agents, they display antigens specific to these agents on their surface. These antigens are identified by the specialized antigen receptors on the surface of T-cells. This enables the T-cells produced by the acquired immune system to identify the infected cells. T-cells have the ability to generate immunological memory which makes it possible for the immune system to respond more quickly and strongly against future exposure to these infectious agents. The innate immune system also produces chemokines and cytokines which help in guiding various cells produced by the acquired immune system to sites within the body where the infectious agents have been identified (Jefferys, 2002). Additionally, innate immune system arousal hinders infection by localizing and normalizing immunity ranges. Headaches, hypertension, and immune disorders can result from compromised innate immunity thus compromising life quality. Capability, independence, relatedness, considerate, attention, potency, and conviction are just a few examples enhanced by optimized innate immunity. These needs are instinctive and widespread, and ought to be fulfilled for normal operation of the body.

References

IQWiG (Institute for Quality and Efficiency in Health Care). (2012). How do the innate and adaptive immune systems work together? Web.

Jefferys, R. (2002). The Immune System: Behind the Scenes. Web.

Risk refers to the probability that an event will occur within a certain timeframe. In dental epidemiology, risk refers to the probability that an individual will contract an oral complication or disease at a certain age or age span due to exposure to certain conditions or factors. Characteristics of risk include exposure and risk ratio. Risk factors refer to aspects of behavior, heredity, or environment that alter the probability of the occurrence of a disease (Burt, 2005). Examples of risk in dental epidemiology include tobacco use, harmful use of alcohol, unhealthy diet, and poor oral hygiene. These factors increase the probability that an individual will contract an oral disease if he/she is exposed to them. Risk ratio refers to the comparison of the probability of a disease occurring between two groups. The ratio is computed by dividing the risk encountered by people in group A with the risk encountered by people in group B (Timmreck, 2002). Factors used to divide people into groups when calculating risk ratio include sex and exposure to a certain risk factor.

Association refers to the statistical relationship between two events, variables, outcomes, or characteristics such as a risk factor and the prevalence of a disease (Wakeford & McElvenny, 2007). Types of the association include spurious association, indirect association, and direct association. Examples of measures of the association include risk ratio, rates ratio, odds ratio, and proportionate mortality ratio. Rate ratio is a comparison of incidence, person-time, and mortality rates of individuals in two groups that are separated by demographic characteristics such as sex and age (Timmreck, 2002). Characteristics of the association include dose-response relationship, consistency, time sequence, biological plausibility, and specificity (Burt, 2005). Specificity aims to establish whether exposure to a certain risk factor causes disease and whether the exposure occurs before the disease or not (Wakeford & McElvenny, 2007). The findings of such a study must be validated by other studies conducted in different populations in order to determine its consistency. Intense or more exposure of an individual to a risk factor should be associated with higher rates of the disease. Finally, the association must have biological credibility (Timmreck, 2002). In that regard, a plausible mechanism of how exposure causes the disease should be supplied. An example of an association in dental epidemiology is the relationship between long-duration breastfeeding (24 months or beyond) and dental carry.

Causation is an epidemiological concept that explains the occurrence of an event or outcome (Scheutz & Poulsen, 1999). For instance, if agent A leads to the development of a disease, then agent A is the cause of the disease. The main characteristics of a cause include positivity or negativity, existence as a host or environmental factor, and existence before the effect (Wakeford & McElvenny, 2007). A cause must precede the effect in order to be described as biologically plausible (Scheutz & Poulsen, 1999). In addition, it should exist as either a host or environmental factor. Examples of environmental factors include events, social or economic phenomena, lifestyle habits, and conditions. Finally, the cause can either be defined by the presence of a causative exposure or the absence of a preventive exposure (Timmreck, 2002). The criteria used to determine causation are based on factors that include the strength of the association between cause and outcome, consistency, specificity, temporality, experiment, coherence, and analogy (Timmreck, 2002). An example of causation in dental epidemiology is the relationship between tooth decay and the consumption of sugary foods coupled with poor oral hygiene.

References

Burt, B. A. (2005). Concepts of Risk in Dental Public Health. Community Dentistry and Oral Epidemiology 33(4), 240-247.

Scheutz, F., & Poulsen, S. (1999). Determining Causation in Epidemiology. Community Dentistry and Oral Epidemiology 27(3), 161-170.

Timmreck, T. C. (2002). Introduction to Epidemiology. New York, NY: Jones & Bartlett Learning.

Wakeford, R., & McElvenny, D. (2007). From Epidemiological Association to Causation. Occupational Medicine 5(7), 464-465.

Introduction

The paper is well written, and the topic is adequately addressed. The introduction of the paper gives the reader a grasp of what is being investigated in the study and what to expect. However, the main weakness is that it fails to give a cohesive thesis as a guide to the reader of the paper. Although the conclusion of the paper is well written and articulated, it fails to go in coherence with the thesis in the introduction part of the paper. The conclusion, however, does provide a very clear explanation of the findings and shows the reader the significance of the findings of the study.

Strengths and weaknesses of the paper

The main strength of the paper is that it used a quantitative approach in collecting data. The qualitative data provided is a strong point for the paper, because it does allow the reader to see the significance of the data, unlike in cases where the paper is based on qualitative data. The paper also uses semi-longitudinal data, which provides a way to observe the research subjects for some time, long enough to see the effects of the material being tested. The main weakness of the paper is that it lacks a smooth flow from the introduction to the method, findings and the conclusion of the paper. As a result, the reader is likely to lose focus as he or she reads the paper because somewhere in the paper, it is no longer clear what the paper is discussing. In the discussion section, the paper fails to focus on the fact that it is dealing with the effect of dual-focus soft contact lens wear on axial myopia progression in children, and looks at the broader issue of myopia.

Correcting these mistakes

One way to avoid this mistake is by making sure that the thesis of the paper is written, and that throughout the paper, the discussion is done in line and within the boundaries of the thesis. The thesis should be in line with the topic of study, to make sure that the paper is focused in the right direction and does not lose focus.

What the paper added to my knowledge

The main thing that I learned from the paper is that soft contact lenses can be used to correct myopia in children, without affecting the way their eyes develop (Anstice & Phillips, 2011). This is very important because, with children, it is good to know that their organs are still growing, and using focus lenses can affect the way their eyes will grow, which may make the eyes develop in a way that would badly affect the young children using the lenses. The revelation of the fact that using soft contact lenses does not affect the way their eyes develop was not only new information but also very useful because it can be used for future studies (Anstice & Phillips, 2011).

Overall opinion and evaluation

The paper is addressing a very important issue, and although the paper has some weaknesses, it does give the reader a better chance of understanding the issue. The paper is well articulated in that it is written in a manner that even a layperson on the subject can understand the issue being discussed in the paper.

Reference

Anstice, N.S., & Phillips, J. R. (2011). Effect of dual-focus soft contact lens wear on axial myopia progression in children. Ophthalmology, 118 (6), 1152-1161.

The article presents an empirical evaluation of the action and effect of the venous thromboembolism (VTE). This is a vital to health and lives of hospitalized individuals and generally remains preventable. As noted in the article, it is critical to note that there is considerably limited research on the action of this drug particularly in the management of those suffering from deep vein thrombosis (DVT) (Khouli & Grosu, 2011).

Reviewing clinical trials concerning the efficiency of thromboprophylaxis within the Medical Intensive Care Unit (MICU) patients is outlined as the basic objective of the empirical research. Additionally, as outlined in the article, the experiment aims to draw critical conclusions and of summary of the basic recommendations. The main methodology that was applied in this study involved the use of systemic review. The literatures reviewed were majorly from the internet search from different acknowledged sites. Some of these included the PubMed, Medline and Cochrane Library (Khouli & Grosu, 2011). Additionally, the Google Scholar, as well as other chosen investigations were used as vital sources for review.

The article stresses on the potential lethality of venous thromboembolism (VTE) among the hospitalized clients. It also highlights that the drug remains considerably avoidable and is more likely to cause mortality as well as morbidity amongst these populations. The inadequacy of scientific examinations or investigations on the potential effects of this drug on patients suffering from deep vein thrombosis (DVT) is also indicated.

There is also a general observation in the article that the control of VTE depends on the risk factors identification as well as suitable prophylaxis. These aspects, as indicated within the article, have been adequately established within surgical as well as general medical patients. The article postulates that even though the critically sick patients may depict numerous key risk factors for the VTE before the ICU admission, there are critical care conditions as well as interventions that may also potentiate vital risks (Khouli & Grosu, 2011). Such factors may include mechanical ventilation as well as vein catheterization.

It still remains unclear to note or approximate the extent of such interventions in increasing the severity of risk factors or worsening the patients already vulnerable health condition. The article reiterates that even though general guidelines for the prevention of VTE within severely ill medical patients are published by numerous critical care groups, there recommendations stream from scant literature (Khouli & Grosu, 2011).

Such literatures, as indicated in the article, usually entail mixed medical as well as surgical severely sick patients. Additionally, there has always been an extrapolation from the investigations of less severely sick patients suffering from acute medical complications. There is also an argument that the actual recommendations published within the general guidelines are usually not distinct or particular with regard to dosing as well as the period of thromboprophylaxis as well as consumption of the combined VTE prophylaxis modalities. From these observations, it can be noted that the article tends to reveal the existent gap between the focus of the empirical presentation and those of the past times.

The article tends to systematically review the existent medical literature linked to the VTE prophylaxis within critically sick medical patients. In achieving this objective, the article presents a study that particularly analyzes the prevalence as well as the incidence originate from DVT within the medical intensive care unit (MICU) (Khouli & Grosu, 2011). In addition, it reviews the efficiency of thromboprophylaxis within MICU adult patients. It is, thus, from this particular review that there is a consequential or final provision of critical recommendations meant for the DVT prophylaxis within the MICU patients.

Literature reviews are presented to be the main data sources for the investigation. English language data sources with period of January 1980 to September 2101 have been used in the investigation presented in this article. The article also outlines the study selection methodology applied in the investigation. Randomized controlled clinical trials, (RCCT) or cohort examination for the DVT prophylaxis was applied.

The patient population involved in the study included adult patients within the MICU. In addition, the screening methodologies involved the utilization of objective approaches to screen for the DVT complication (Khouli & Grosu, 2011). As outlined in the article, the examination used applied exclusion criteria by avoiding the investigations which enrolled distinctly neurosurgical, surgical, as well as trauma severely compromised patients. Additionally, the study also left out the investigations that had inadequate reporting the DVT rates.

The findings and recommendations within the article present very critical insights into the field of clinical practice. It is important for clinicians to note that the literature reveals vital inadequacies in the capacity to prepare evidence-based recommendations for the DVT. As presented in the study, the clinicians should note the noted restrictions for patient selection as well as the DVT risk factors, alternatives and durations of the screening tests applied in the detection of DVT (Khouli & Grosu, 2011).

Additionally, the clinicians should also note the options as well as dosages of pharmacologic or mechanical thromboprophylaxis applied. The article also presents critical insights for the varied VTE prophylaxis product endpoints. However, the clinicians should also note that apart from the obvious demerits associated with the drug, there are also evident advantages that accrue from this drug.

It is observed that minus the prophylaxis, there is a generally observed elevated DVT incidence within the MICU patients. From the demonstrations in the article, it is evident that pharmacological prophylaxis minimizes the hazard of DVT by approximately 50% (Khouli & Grosu, 2011). The article presents an important solution for assisting the DVT patients. For instance, the article proposes that pharmacological prophylaxis to MICU patients.

This, as it is indicated, should be in form of UFH or LMWH whenever there are no bleeding threats. Clinicians also learn a vital lesson that attaining the merit of thromboprophylaxis in minimizing the occurrence of controllable DVT as well as mortality bases on appropriate risk factor assessment (Welch & Bonner, 2010). Additionally, the clinicians ought to ensure the accomplishment of the prophylaxis. The application of computerized technology in clinical practice for necessary assessments and diagnosis in the process of treating DVT is vital if efficiency is to be enhanced in a proper manner.

The processes described herein to be conducted in the ICU during the therapeutic management of DVT remain critical. This is because they indicate the best practices that clinical interventions should follow when conducting such undertakings. Particularly the importance of real-time patient monitoring and documentation of notable conditions is critical as it is demonstrated in the articles process descriptions.

There are also precautionary measures to be taken in consideration during clinical practice (Barnett, 2007). These measures drawn from the article includes the prohibition of regular MICU patients screening to detect the asymptomatic DVT during particular instances. Generally, there is an overwhelming indication from the article that DVT prophylaxis amongst the MIU is advisable though additional randomized blinded investigations are necessary.

References

Barnett, G. (2007). High-grade gliomas: Diagnosis and treatment. New Jersey, NJ: Humana Press.

Khouli, H. & Grosu, H. (2011). Efficacy of Deep Venous Thrombosis Prophylaxis in the Medical Intensive Care Unit: A Systemic Review. European Journal of Clinical & Medical Oncology, 3 (4), 91-97.

Welch, E., & Bonner, L. (2010). Venous thromboembolism: A nurses guide to prevention and management. London: Wiley-Blackwell.

Introduction

Medical records are a crucial tool for clinicians in the provision of health care to patients. For more than a century, these tools have been used to record observations, provide knowledge, justify the proposed medical intervention, and monitor the performance of a patient. Traditionally, doctors all over the world have utilized paper-based medical records (PMRs) in their practice. In spite of their long use, PMRs suffer from significant shortcomings including poor legibility, disorganization, and incompleteness. Using PMRs therefore has a negative impact on the efficiency of the doctor and this has led to the provision of lower quality care for the patient.

As the health care industry has grown over the decades, new technology has been utilized to increase efficiency. Medical records have evolved to exploit technological innovations and today many nations are starting to rely on Electronic Medical Records (EMRs) in place of PMRs. Lau et al. observes that increased investments are being made for electronic medical records by hospitals in developed nations (1). It is therefore worthwhile to investigate if EMRs are indeed the wave of the future. The paper will undertake an informative research into EMRs and their impact on physicians. It will conclude by noting that while electronic medical records are not yet matured, they are a great improvement to the paper based medical record system.

What are Electronic Medical Records?

By definition, an electronic medical record is a digital version of the paper based medical records and it fulfills the requirements of recording and communicating patient information. EMRs contain data on a patients medical history and the doctor is able to enter real time data on diagnosis and treatment of the patient (Rustagi and Singh 142). EMRs are supposed to replace paper based medical records (PMR) which have been used traditionally by clinicians. PMRs have been essential tools for documentation and communication in relation to patient care delivery. However, these traditional means have suffered from the major demerits of illegible handwritings, incomplete date, and date fragmentation leading to problems in the quality and continuity of care.

A basic EMR acts as a simple electronic storage system with all the information of a PMR system entered into the EMR database. More sophisticated EMR systems contain system-generated templates into which the doctor enters medical information (Terry et al. 509). A typical EMR system comprises of an initial history of the patient, fields for inputting clinical notes, an exhaustive list of medical conditions, and fields highlighting the tests carried out and the results obtained (Furukawa 297). EMRs help to deal with the inadequacies of PMRs and include more detailed information on the patients history. EMRs also provide computer-generated health care suggestions based on the problems recorded by the physicians and the test records. The doctor also gets automated reminders for patients who need to be attended. The EMRs documenting method has gained increasing popularity in the recent years with its supporters stating that it will be the documentation tool of the future.

Benefits of Electronic Medical Records

EMRs have significantly reduced the risk of medical errors. Doctors using EMR systems have a greater and easier access to medical reference information and they are therefore able to prescribe the relevant medication to the patient. Since the patients medical information is easily accessible, the doctor can check on detailed patient issues such as drug tolerance, allergy information, and drug interaction (Kahn and Ranade 188). Medical errors can therefore be avoided since the physician has all the relevant information. The switch to electronic medical records by most doctors and hospital in the US has already resulted in improved safety.

There is evidence that EMRs improve quality in guideline adherence by medical practitioners. Lau et al. state that use of EMRs results in increased consistency and accuracy of patient record content (1). Furukawa notes that EMRs encourage physicians to adhere to evidence-based guidelines leading to greater consistency in health care and better health outcomes for patients due to the use of best practices by doctors (298). Using EMRs ensures that the health care services provided by the doctor are consistent with current professional knowledge therefore increasing the positive health outcomes for the patient.

EMRs assist in the communication between doctors therefore improving the quality of health care provided to the patient. When paper based medical records are used, clinicians might put down inaccurate and incomplete information. By their very nature, EMRs force doctors to enter accurate information since inaccurate information will be deemed invalid by the system (Tang, LaRosa and Gorden 246). The information presented will also have to be complete since there are templates and the doctor has to fill in data in each field. If the doctor does not fill in each field, the system will flag this as an inconsistency. The transfer of patients across and within the health care settings can therefore occur in a seamless manner since the new doctor will be presented with a complete medical record of the patient enabling him/her to have a comprehensive and accurate medical history of the patient.

Doctors are able to make more informed decisions especially in the cause of returning patients with the help of EMRs. With the traditional record keeping system, the decision-making capability of physicians was hampered by lack of access to relevant patient information. Greiver et al. acknowledge that PMRs are easy to replace and even when they are found, they might lack compete patient information (2). Physicians using PMRs are therefore forced to delay their decision until they can retrieve the necessary information, or make decisions with incomplete information on the patient. EMRs provide the doctor with complete information and in a timely fashion making it possible for him/her to make competent decisions based on good information.

EMRs can help to promote preventative health care and therefore increase the health outcomes of patients while reducing the costs associated with health care. EMR systems have proved to be potent tools in the prevention of childhood obesity. This is an important contribution considering the fact the prevalence of childhood obesity has risen from 5% to 17% over the past 30 years and one-third of children today are overweight or obese. Childhood obesity has negative health outcomes and is estimated to cost the country an excess of three billion dollars each year. Bode and Roberts reveal that EMRs help improve in the documentation of preventable disease such as obesity (115). EMRs improve the quality of preventive care by having prompts that indicate when a patient has a higher BMI facilitating diet treatment and exercise in good time therefore reducing the risks of the disease. By observing the data on BMI percentiles and BMI growths through the EMR, a doctor can diagnose the risk of overweight and obesity during the early stages. Preventative care can then be recommended therefore addressing the imminent problem.

EMRs have the potential to reduce the overall health care costs. Health care in many developed nations continues to be excessively high making universal access to health care impossible in some cases. While EMR systems do not purport to cause major reductions in health care services, these systems can foster modest reductions in health care (Rustagi and Singh 143). By making patient medical records easily accessible across health care providers, EMRs will foster coordinated care and avoid duplicate tests that lead to higher costs of health care.

EMR systems make the sharing of patient clinical data between facilities easy which increases the efficiency of health care provision. Current EMR systems are built with interoperability in mind and systems in hospitals are supposed to easily read data inputted from systems in other hospitals. Carrying out of research is also aided by these systems since comparing electronic data across the health care sector is easier. As far back as 1873, the celebrated founder of modern nursing, Florence Nightingale pointed to the inadequacy of PMRs in helping clinicians to detect trends and compare notes across the health care system (Tang et al. 246). EMRs do not suffer from this setback making them potent tools for medical research. Studies on the effectiveness of medical treatments are easier to carry out using EMRs.

Disadvantages of Electronic Medical Records

EMR technology is expensive and doctors must make a substantial initial investment when moving to this system. In addition to the initial high cost of getting the system, there are other expenses that have to be incurred. The system needs regular maintenance, and this cost has to be provided for by the doctor or the hospital administration. In addition to this, technology is constantly changing and upgrades will have to be undertaken along the way. Maintaining an EMR system is therefore very expensive compared to the PMR system where all the doctor needed where paper files and cabinets to store the file. Gill contends that if a doctor is not able to fully utilize the EMR in his practice, there is great possibility of it becoming just an expensive system for storing patient charts (514).

This system can lead to negligence by the doctors due to the automation of some of the aspects of record keeping. This is especially evident when it comes to filling in test values. EMRs can lead to pitfalls as health care professionals rely more on templates, which can automatically fill in laboratory values (Gill 514). Instead of running laboratory tests to come up with the independent test values for the patient, doctors can make use of the values provided by the EMR with catastrophic results. Patients will suffer if the doctor relies on auto-generated data instead of running the tests by themselves.

EMRs can overwhelm physicians due to the availability of too much data. The ease with which data can be entered into EMR systems may lead to the input of excessive data. This will make it harder for the doctor to identify meaningful data as they have to shift through the vast amount of data recorded. Kahn and Ranade agree that EMRs can be a rich source of highly detailed clinical data but that this level of detail makes it harder for doctors to use the data in a clinically meaningful way (186). The efficiency of the doctor might therefore be reduced because of EMRs.

EMRs are more prone to tampering by a third party compared to PMRs. Gill observes that access to electronic records by unauthorized persons is easier than access to paper based records (514). Some EMRs make it possible for hospital data to be stored at a central location making it accessible to more people. Even with password restrictions, the data is more likely to be obtained by unauthorized personnel than if it was in paper files. This presents a privacy concern as well as the concern about tampering where the intruder might alter the medical records.

EMRs have contributed to the presence of incomplete information as health care providers make the move from PMRs. Physicians have not fully adopted EMRs and most continue to rely on PMRs in their practice. In health care settings where EMRs have been fully implemented, PMRs continue to play a role in medical data recording (Greiver et al. 1). A national survey of physicians in Canada revealed that most physicians continued to use paper and electronic medical records simultaneously. This leads to a scattering of data across the two different systems therefore increasing the amount of incomplete and duplicated data (Greiver et al. 6). Incomplete data leads to poor services being offered to the patients.

Implementation of Electronic Medical Records

Implementation is the most challenging part in the adoption of EMRs in health care settings. To begin with, it requires health care providers to invest in the necessary infrastructure. Doctors need to be provided with hand held devices for the real-time entry of medical data. Private practitioners have to buy these devices on their own making it significantly expensive to shift from paper based medical record keeping to EMRs. The move to EMRs necessitates the digitization of old patient files for storage in the EMR database (Fisher 1). Health care providers have therefore had to engage in the labor-intensive task of transcribing data from PMRs into EMRs. This task has made the implementation of EMRs more complicated due to the inherent financial and time requirements of the activity.

In recognition of the challenges inherent in switching to EMRs, the Federal government has provided financial incentives for hospitals and doctors to encourage them to adopt EMRs. Gill documents that in 2009, the government allocated $20 billion to help the health care industry adopt IT systems including electronic medical record systems (513). This financial incentive will help reduce the cost that health care providers will face as they move to the electronic system.

In addition to the financial incentives, the federal government has also set up regulations to catalyze the deployment of EMR systems on a national scale. The federal government will require all health care providers to adopt EMRs by the year 2015 (1). Deployment of these systems has proved to be a challenge since it requires computer literacy and additional training for the user. However, doctors have started to make the gradual change to EMRs and familiarize themselves with the system.

Impacts on Standard of Care

The move from paper-based records to EMRs has led to expectations that there will be significant improvements to the quality of care provided to patients. EMRs improve communication between health care professionals, therefore improving the quality of health care provided to the patient (Gill 513). Doctors are increasingly required to work in a collaborative fashion. The ease of access to medical records among collaborating doctors will ensure that the patient is offered the highest standard of care.

EMRs assist in the early identification of mistakes by health care professionals and corrective measures can be taken in good time. These systems have inbuilt alerts which are issued when inconsistencies are noticed or when the doctor commits an error. For example, EMRs will help in the identification of potential drug interactions and abnormal laboratory values therefore preventing negative outcomes for patients (Kahn and Ranade 188).

The move to EMRs will encourage quality assurance in the health care industry. There is increased focus on using performance data to measure quality and foster accountability among doctors. Technology can help to facilitate the attainment, monitoring, and implementation of quality-oriented services by doctors. EMRs enable health care providers to assess the quality of health services by making these services measurable. These systems make it possible to measure the quality of care that patients receive from health care providers. The ability to quantify services makes it possible to improve on the activities undertaken by the health care professionals. As a result, the quality, accuracy and completeness of information in medical records become integral to the provision of good care to patient and the improvement of quality (Greiver et al. 1).

Standards of care provided are raised as doctors have to be more attentive when they are using EMRs. When the old paper based medical recording system is used, doctors may lack motivation to be meticulous in their work. This is because in the event of significant error that causes great damage to the patient, the doctor can amend his records to protect himself medically and legally. EMRs offer a safeguard against such a lack of accountability by health care providers (Rustagi and Singh 143). Records inserted into the EMR system are time locked which means that the doctor cannot tamper with the records by amending them in case he/she made an error. The accountability of physicians has therefore been enhanced by EMRs since the clinicians know that their mistakes are easy to identify during an investigation. EMRs have therefore increased the level of services that patients receive from their caregivers.

Safety Concerns

Electronic systems are not flawless and they might contain bugs that will lead to errors. If the system is not monitored constantly, these errors might go undetected. The impact of system errors in EMR system is more damaging that errors made through the PMRs (Terry et al. 510). Concerns have been raised that small mistakes in the programming logic of EMRs could have negative impacts on many patients.

The requirement by EMRs for information to be provided in appropriate fields can lead to safety issues. Patient safety might be compromised if the clinician enters information in the wrong field (Tang et al. 246). A different doctor reviewing the patient file will not be able to get the information entered in the wrong place and this might lead to ignorance of important diagnosis leading to wrong medication.

EMRs might increase patient safety by reducing the number of corroborative tests that doctors undertake. Under the paper-based system, doctors could run tests to confirm the results of a diagnosis. EMRs encourage doctors to make use of historical information and avoid running duplicate tests. This might compromise patient safety since the proficiency of all doctors is not similar. Greiver et al. assert that the usefulness of the information provided through EMR is dependent on the quality of data entered into the EMR (6). This quality is dependent on the skills of the doctor and when unreliable information is inputted, the health of the patient will be affected.

There is a risk of error propagation through EMRs leading to safety issues. EMR systems are fitted with auto-fill and copy forwarding functions to enable physicians enter data faster (Furukawa 299). These functions are meant to reduce the amount of typing needed and therefore save on time and effort on the part of the physician. This presents a major risk since in most cases; doctors do not correct or update the new information being made. As such, any previous misinformation may be propagated.

The Effects on Doctors

EMRs have increased the level of effectiveness and efficiency by most physicians. Doctors feel that they are able to make better use of their time when they are using EMRs. By their very nature, PMRs are time consuming and doctors use up a significant amount of time retrieving, recording, storing, and updating patient records. A report by Tang et al. indicated that the tasks associated with paper based record keeping took up to 38% of the doctors time when dealing with returning patients (247). Considering how busy doctors are, any reduction in time spent record keeping would be desirable. EMRs assist physicians to realize this goal therefore increasing the level of satisfaction. The systems have also improved efficiency by assisting in the tracking of relevant information when doctors are working in collaboration. These record keeping systems have improved legibility and organization of data making it easy for a doctor who is familiar with the system to find information.

EMRs decrease the level of frustration that doctors feel in their work. The traditional record keeping systems are cumbersome and led to delayed decision-making due to incomplete or unavailable patient records. This increases the level of efficiency for clinicians causing them to be frustrated as their efforts to provide patient care are hampered. The dissatisfaction felt by physicians because of the limitations of traditional record keeping systems is highlighted by empirical studies which indicated that physicians regard PMRs as an inadequate tool to support their activities of patient care provision (Tang et al. 247).

The systems have led to increased attentiveness leading to improved quality of care to patients. Doctors perceive that EMRs enable them to provide improved care especially for outpatients through the reminders and tracking features of the systems. EMRs enable doctors to easily monitor and keep track of their patients. EMRs can be configured to provide automated reminders and prompts indicating that a test is due or follow up needs to be done on a certain patient (Rustagi and Singh 142). Doctors do not need to go through their records searching for patients who need follow-up or who require testing.

EMRs have eased the task of billing for doctors ensuring that they are adequately compensated for their services. While health care provision is the primary concern for health care practitioners, billing is an integral part of the health care system. Kahn and Ranade note that EMRs provide detailed level of data which makes it possible to accurately calculate medications charged and the tests undertaken (186). EMRs also help avoid fraud by incorporating the rules regarding billing and documentation.

In spite of the inherent advantage of EMRs, some doctors feel that they have to enter too much irrelevant information in the system. When a patient visits a doctor with specific symptoms, the EMR requires the doctor to obtain a significant amount of background information from the patient. Fisher confirms that EMRs require physicians to key in ever-increasing amounts of in information of no relevance to the patients presenting problem (2).

Transition to the system increased the efforts required by the doctors leading to resistance. On introduction, EMRs lead to a slowdown in productivity as doctors get to familiarize themselves with the new system and gain proficiency. Doctors also had to undergo training on how to use the new system A study by Terry et al. revealed that in most settings, EMRs received an initial negative reaction from doctors due to lack of familiarity with the system (512).

Patient Perspective

Patients perceive that EMRs have an adverse effect on the privacy of their medical records. They have therefore raised concerns about their privacy when these systems are utilized. Patient privacy is especially an issue of concern for individuals with psychiatric conditions or those being treated for substance abuse. This data is then stored in the hospital computer systems where it can be retrieved easily by the authorized personnel. A reality with electronic data is that copying and transmitting files saved in an electronic format is easier than doing the same for paper records. In the event of a health data security breach, this information which is regarded as personal by the patient, might be available to unauthorized persons (Rustagi and Singh 144). While an intruder can break into the physicians office and steal medical records, the likelihood of this happening are very low. Patients are therefore apprehensive that their private medical records will find their way into the public sphere if the hospitals computer system is compromised.

Patients perceive that EMRs will reduce their rights in the health care system. One of the purported advantages of EMRs is the ease of clinical data across health care providers. This advantage might come at the expense of patient rights as the data could be used without the informed of the patient (Fisher 1). Doctors using EMRs have to ask patients a lot of sensitive medical information and input the same to the system. This information might then be used to run medical research that will benefit the community. Without receiving consent from the patient, such activities will be a violation of patient rights.

Patients perceive an increase in efficiency when they visit their health care providers due to EMR systems. The time that a doctor takes to trace a patients record is greatly reduced when using EMRs (Furukawa 300). The patient therefore spends less time waiting for the doctor to retrieve his/her records and more time being served by the doctor. In addition to this, the ease of record retrieval has led to increased access to health information by the patient.

Discussion

Medical records are integral for many tasks including documenting complicated treatment protocols, assisting in decision making when ordering for tests, pharmacy intervention, supporting billing, and communicating information to patients and other doctors. Effective methods of keeping medical records are integral to improving the standards of health care provision. EMR systems have emerged as the means for ensuring efficiency and therefore promoting quality health care. The adoption of EMRs by physicians in the country is picking up pace and it can be expected that these systems will be the standard in the near future. In the US, billions of dollars worth of financial incentives has been provided to the health care industry to catalyze the deployment of EMR systems on a national scale. These systems are projected to be fully implemented in all health care facilities by the year 2015.

This paper has observed that EMRs have many advantages to the patient and the doctor. However, for the full benefits of the EMR to be realized, the doctor has to have an advanced knowledge on the use of EMRs. The implementation process has major barriers and the efficiency of doctors during the early stages will be reduced. The transition process is bound to be frustrating for some and it might lead to a slowdown in work and productivity by the doctors. However, as the doctors overcome their reluctance and learn how to work with the system, they are able to integrate it into their everyday practice and reap its benefits.

Conclusion

This paper set out to argue that EMRs are the wave of the future. It begun by defining what the EMRs are and proceeded to highlight their merits and demerits. From the discussions provided, it is clear that the advantages of the systems far outweigh the disadvantages. The overall impact of EMRs on the health care system is positive and as such, the system should be embraced universally. The paper has observed that while EMRs are prone to human errors just like PMRs, the level of errors in EMRs is markedly low and furthermore, there are continuous efforts in play to build safer systems. Although EMR systems have a number of significant challenges to overcome before they can be fully beneficial, these systems have already proved to be a great improvement to the paper based medical record keeping system.

Works Cited

Bode, David, and Roberts Timothy. Increased Adolescent Overweight and Obesity Documentation Through a Simple Electronic Medical Record Intervention. Military Medicine 178.1 (2013): 115-118. Web.

Fisher, Wes. Patient Safety and the Ethics of EMR Implementation. 2013. Web.

Furukawa, Michael. Electronic Medical Records and Efficiency and Productivity During Office Visits. The American Journal of Managed Care 17.4 (2011): 296-303. Print.

Gill, James. EMRs for Improving Quality of Care: Promise and Pitfalls. Family Medicine 41.7 (2009): 513-515. Print.

Greiver, Michelle, Barnsley Jan, Glazier Richard and Harvey Bart. Measuring data reliability for preventive services in electronic medical records. BMC Health Services Research 12.1 (2012): 1-9. Web.

Kahn, Michael and Ranade Daksha. The impact of electronic medical records data sources on an adverse drug event quality measure. J Am Med Inform Assoc 17.1 (2010): 185-191. Web.

Lau, Francis, Morgan Price, Boyd Jeanette, Partridge Colin, Bell Heidi, and Raworth Rebecca. Impact of electronic medical record on physician practice in office settings: a systematic review. Lau et al. BMC Medical Informatics and Decision Making 12.10 (2012): 1-10. Web.

Rustagi, Neeti and Singh Ritesh. Electronic medical record: Time to migrate?. Perspectives in Clinical Research 3.4 (2012): 142-145. Web.

Tang Paul, LaRosa Michael, Gorden Susan. Use of computer-based records, completeness of documentation, and appropriateness of documented clinical decisions. J Am Med Inform Assoc 6.3 (1999): 245251. Web.

Terry, Amanda, Giles Gavin, Belle Brown, Thind Amardeep and Moira Stewart. Adoption of Electronic Medical Records in Family Practice: The Providers Perspective. Family Medicine 41.7 (2009): 508-512. Web.