| Course | NURS 6451 Evaluation Methods for Health Information Technology |
|---|---|
| Week | Week 9 |
| Paper type | Discussion post with two peer replies |
| Length | About 510 words, 3 pages |
| Format | Discussion post, APA 7 citations |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | September 2026 |
Free sample paper for NURS 6451 Week 9
Week 9 Discussion: Initial Post
The Pharmacist Saw It First: Why Evaluations Should Ask the People Downstream of the User
Three weeks after the messaging app went live on our second unit, a pharmacist stopped me in the hallway. She said she was now sending prescribers two or three clarification messages a shift because orders no longer matched what had been agreed in message threads. Nobody on the evaluation team had heard this, because none of our measures asked a pharmacist anything.
The roles that detect an unintended consequence earliest are often downstream of the person using the system, and they are rarely sampled by the instruments an evaluation already has. Our measures watch nurses who send messages and prescribers who receive them. The pharmacist never opens the app, yet she absorbs the cost when a dose agreed in a thread is entered differently or late. Ash and colleagues separated errors made while entering and retrieving information from errors in how clinicians communicate and coordinate (Ash et al., 2004), and those are exactly the consequences that surface in someone else's work. Research on order entry systems likewise found new work for clinicians and changes in communication patterns among the most frequent unintended consequences (Campbell et al., 2006).
The fix is a detection channel built into the evaluation: a short standing prompt, sent every two weeks to pharmacists, unit clerks, night-shift coverage and the rapid response nurse, asking one question, what has the messaging app changed for you, good or bad, since the last time we asked? Responses are read by the evaluation team within a week and any pattern is followed up with observation. The prompt costs each person about two minutes, and it reaches the people our current instruments never touch. It also tells them the evaluation wants to hear from them.
This matters because the other instruments are built around the question we chose at the start. A well-defined primary measure is necessary, but it narrows vision. The downstream prompt is how an evaluation notices what its design did not anticipate.
Reply to Hannah
Hannah, you pointed out that not every unintended consequence is harmful, and you gave the example of unit clerks on your unit who, freed from paging, now spend more time helping families at the desk. I agree, and it is a good reason to word the prompt as good or bad. Wu and colleagues, observing wards at five teaching hospitals, described effects on senders, receivers and collaboration between professions, and not all of them were negative (Wu et al., 2013). Did anyone plan for your clerks' new work, or did it just happen?
Reply to Rafael
Rafael, you suggested relying on incident reports instead of a new prompt. I would keep incident reports but not rely on them for this. Incident systems capture events someone judges reportable, usually harm or a near miss. A pharmacist's extra clarification messages, or a decision that lives only in a thread, rarely meets that bar, so it would never be reported. The prompt catches the changes that are too ordinary to report and too important to miss.
References
Ash, J. S., Berg, M., & Coiera, E. (2004). Some unintended consequences of information technology in health care: The nature of patient care information system-related errors. Journal of the American Medical Informatics Association, 11(2), 104-112. https://doi.org/10.1197/jamia.M1471
Campbell, E. M., Sittig, D. F., Ash, J. S., Guappone, K. P., & Dykstra, R. H. (2006). Types of unintended consequences related to computerized provider order entry. Journal of the American Medical Informatics Association, 13(5), 547-556. https://doi.org/10.1197/jamia.M2042
Wu, R. C., Lo, V., Morra, D., Wong, B. M., Sargeant, R., Locke, K., Cavalcanti, R., Quan, S. D., Rossos, P., Tran, K., & Cheung, M. (2013). The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: A prospective observational case study of five teaching hospitals. Journal of the American Medical Informatics Association, 20(4), 766-777. https://doi.org/10.1136/amiajnl-2012-001160
Reading the NURS 6451 Week 9 instructions
This late thread usually asks you to consider unintended consequences of health IT and how an evaluation can detect them, drawing on research about side effects of clinical systems. Sections generally want a clear claim, at least one scholarly source and replies that engage classmates' examples. By this point, graders expect you to connect the discussion to your own evaluation design. Choose one consequence that your current measures would miss, explain why and propose a practical way to detect it. Keep examples composite, and consider positive as well as negative consequences. A proposal that costs little time is more likely to be adopted.
Inside the NURS 6451 Week 9 example
The post opens with the pharmacist's observation in three sentences. The second paragraph states the highlighted claim about downstream roles, explains why the pharmacist absorbs the cost without using the app and cites research separating entry errors from communication and coordination errors, and order entry research on new work. The third proposes the detection channel, a one-question prompt every two weeks, and explains its cost and reach. The fourth argues that a well-defined primary measure narrows vision. One reply accepts that consequences can be positive and cites a five-hospital study. The other explains why incident reports would not capture these changes. The fourth paragraph explains why a narrow primary measure needs a wider net beside it.
NURS 6451 Week 9 rubric: what earns full marks
Late-term discussion rubrics usually reward a supported, specific claim, application to the student's own evaluation, accurate use of research and replies that add something. Specificity earns credit when the post names a consequence, a role and a mechanism. Application rewards a proposal that could be added to the evaluation plan. Evidence should address unintended consequences of health IT specifically. Replies score well when they accept a classmate's point and extend it, or explain why a proposed alternative would miss the problem. Writing marks cover clarity and APA citations. Some sections also credit a reply that offers a fresh case, for instance clerks with time for other work. Tone toward classmates is also noticed.
NURS 6451 Week 9 help: mistakes that cost marks
Weak posts tend to list generic unintended consequences from the literature with no connection to the student's system. Another is treating all unintended consequences as harms. Some posts suggest adding more surveys of existing users, which misses downstream roles. Replies that restate the post add little. Start from one observed or plausible consequence, name who notices it first and why your measures would not, propose a simple way to hear from those people and use replies to test whether other channels, such as incident reports, would work instead. Also word any detection prompt so it invites good as well as bad news. Keep it to one question. Cite research on unintended consequences.
Get a NURS 6451 Week 9 example written to your instructions
For Week 9, send the thread prompt, the rubric and any classmates' posts you must answer, and the consequences post is written around the system you have been evaluating all term. A first sample is free, back within 24-48h, with replies that answer the arguments actually made in your thread.
More NURS 6451 papers and MSN samples
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- NURS 6451 Week 2: Evaluation question memo
- NURS 6451 Week 3: Literature matrix
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- NURS 6451 Week 5: Measurement plan
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NURS 6451 Week 9 questions, answered
How is this thread different from the Week 1 post?
Week 1 separates evaluation from adoption reporting using the vendor's dashboard. This thread assumes an evaluation exists and asks what it would miss, specifically the side effects that appear among people who never use the app directly. The two share a hospital and a system, and the sample keeps their arguments apart so neither post repeats the other.
Are unintended consequences always harmful?
No, and one of the sample's replies says so. Some are neutral shifts in who does what, and a few help someone the designers never considered, such as a clerk freed for other work. The prompt usually asks for consequences in general, and posts that count only harms tend to miss the workflow changes graders expect an evaluator to notice.
Why not rely on incident reports?
Incident systems are built to capture events someone judges reportable, usually harm or near-harm. A shift in who answers pharmacy questions, or a decision that never reaches the chart, rarely meets that bar and goes unreported. The post argues for a separate channel inside the evaluation, and one reply makes the same case to a classmate who disagreed.
Where can I find a free NURS 6451 Week 9 sample paper?
The full Week 9 thread, including both replies and references, is free on this page. If your section asks about a different system, a matching post can be drafted on request.
Are unintended consequences always harmful in NURS 6451?
No. Some are neutral shifts in who does what, and some help people the designers never considered, such as clerks freed for other work. An evaluation should look for both.