CHAPTER 1: OVERVIEW OF NURSING INFORMATICS
Lesson 1: Nursing Informatics
Overview
Nurses are directly engaged with information systems and technologies because
they are the foundation for:
1. Evidence-based practice
2. Clinical-decision support tools
3. The electronic health record (EHR)
4. Not all nurses are fully prepared to use these tools to support patient care.
5. Nursing Informatics, has emerged over the past 20 years
Nursing informatics supports the collection, storage, analysis, retrieval, communication, and
use of information to help nurses to:
A. CARE for patients to the highest quality
B. SHARE data, information, and knowledge
C. COMPARE theory and practice to advance nursing knowledge and practice.
Components of ANA Definition of Nursing
1. Technical Skills:
- to manage equipment and perform procedures
2. Interpersonal skills:
- to interact appropriately with people
3. Cognitive skills:
- To observe, recognize and collect data, analyze and interpret data and reach a
reasonable conclusion that forms the basis of a decision
4. Information Intensive Skills:
- Nursing is an information-intensive profession
TERMINOLOGIES RELATED:
NURSING SCIENCE
The ethical application of knowledge acquired through education research and practice
to provide services and interventions to patients in order to maintain enhance or restore
their health
NURSING THEORY
Concepts propositions and definitions that represent a methodical viewpoint and
provide a framework for organizing and standardizing nursing actions
NURSES’ DECISION MAKING
Is described as a collection of decisions that include specific behaviors, and cognitive
processes surrounding a group of issues
CRITICAL THINKING
Is the intellectual process of actively and skillfully using knowledge
NURSING INFORMATICS
HEALTH + INFORMATION (before, health informatics) and covering these five other
concepts
COMPUTER SCIENCE
It is the study of the theoretical foundations of information and computation and of
practical techniques for their implementation and application in computer systems. The
theoretical foundations of information and computation together with their
implementation and application in computer systems. (science behind computers/
computer hardware)
INFORMATION SCIENCE
It is an interdisciplinary science primarily concerned with the analysis, collection,
classification, manipulation, storage, retrieval and dissemination of information. The
interaction between people, organizations and information systems (computer software)
HEALTH INFORMATICS
The intersection of information science, computer science and health care It deals with
the resources, devices, and methods required to optimize the acquisition, storage,
retrieval and use of information in health and biomedicine (research supporting nursing
practice)
COGNITIVE SCIENCE
It is the process of human thinking, understanding and remembering (nurses’
intelligence or intellect)
WISDOM
ethics, goodness and badness of actions
MEDICAL INFORMATICS
It refers to the application of informatics to all of health care disciplines as well as to
the practice of medicine.
NURSING INFORMATICS
Evolved from the German word “informatik” or French word “informatique”
“automatic/automated information”
Is a specialty that integrates nursing science computer science cognitive science and
information science to manage and communicate data, information, knowledge, and
wisdom, in nursing practice
It facilitates the integration of data, information, and knowledge to support patients,
nurses, and other providers in their decision-making in all roles and settings.
This support is accomplished through the use of information structures, information
processes, and information technology;
Synthesis of nursing science, information science, computer science and cognitive
science to facilitate the management of healthcare data for the improvement of patient
care and advancement of the nursing profession.
ROLES OF NURSES
Collect data when assessing and monitoring the health of patients and record their
observations in the patient’s chart
Exchange service requests to, and receive results from, other departments
Receive and review admission data and discharge summaries
Review information on the results of clinical research and clinical trials
Communicate patients’ information between service providers
Summarize, calculate, and interpret workload indices for their nursing units for
monitoring and management purposes
Consult evidence-based clinical guidelines and protocols to guide their practice
Use concepts such as these to influence decision making
*Nurse Informaticist
a. Informatics Nurse Specialist (INS):
- An RN with formal, graduate education in the field of informatics or a related field
and is considered a specialist in the field of nursing informatics.
b. Informatics Nurse (IN):
- An RN with an interest or experience working in an informatics field.
- A generalist in the field of informatics in nursing
Lesson 2: Computers and Health Information Technology
Computers
- First introduced into healthcare facilities in the 1960s
- For the processing of basic administrative tasks
- The computer is an essential tool in Healthcare Information Technology (HIT)
systems
Health Information Technology (HIT)
a. Captures health information
b. Processes health information
c. Generates health information
Computerization affects all aspects of healthcare delivery including:
a. Provision and documentation of patient care
b. Education of healthcare providers
c. Scientific research for advancing healthcare delivery
d. Administration of healthcare delivery services
e. Reimbursement for patient care
f. Legal and ethical implications
g. Safety and quality issues
A shift is gearing towards:
a. Integrating multiple technologies and telecommunication devices
b. Invisible storage devices such as cloud storage
c. User-friendly, menu-driven, touchscreen manipulation methods
Computers in nursing are used for:
a. Managing patient care information
b. Monitoring quality
c. Evaluating outcomes
d. Communicating data and messages via the Internet
e. Accessing resources
f. Interacting with patients on the Web
g. Documenting and processing real-time plans of care
h. Supporting nursing research
i. Testing new systems
j. Designing new knowledge databases
k. Developing data warehouses
l. Advancing the role of nursing in the healthcare industry and nursing science
Lesson 3: Major Historical Perspectives of Nursing and
Computers
SEVEN TIME PERIODS
1. PRIOR TO THE 1960s
a. Developed in the late 1930s and early 1940s
b. Use in healthcare did not begin until the 1950s and 1960s
c. A few experts formed a cadre to adapt computers to healthcare and nursing
d. Computers in healthcare were used for administrative and accounting functions
e. Punch cards
Healthcare began to use computers in the 1950s:
- Computers, in this era, were typically used in the business office
- Computers were initially used in health care facilities for basic business functions.
- Period for rapid growth in nursing and increase in health care facilities
2. The 1960s
a. Use of computer technology began to be explored
b. Studies were conducted to determine how computer technology could be utilized
c. The nurses’ station was viewed as the most appropriate center for the development of
computer applications
d. The mid-1960s presented nurses with new opportunities for computer use
e. Increased time devoted to the documentation and a rise in medication errors prompted
the investigation of emerging computer-based information systems
Hospital Information Systems (HIS) was developed primarily to process financial
3. The 1970s
a. During the late 1960s through the 1970s, hospitals began developing computer-
based information systems which initially focused on (1) Physician order entry (2)
Results reporting (3) Pharmacy (4) Laboratory (5) Radiology reports (6) Information
for financial and managerial purposes (7) Physiologic monitoring systems in the
intensive care unitsA few systems started to include (1) Care planning (2) Decision
support (3) Interdisciplinary problem lists
b. A few systems started to include (1) Care planning (2) Decision support (3)
Interdisciplinary problem lists
c. Nurses were often involved in implementing systems
d. Interest in computers and nursing began to emerge in public and home health and
education.
e. In the 1970s, conferences helped public and home health nurses (1) Understand
the importance of nursing data and their relationship to new Medicare and Medicaid
legislation (2) Provide information on the usefulness of computers for capturing and
aggregating home health and public health information
f. Hospitals and public health agencies embarked on investigating computers and
nursing
g. The opportunity to improve education using computer technology also began
h. Early nursing networks helped to expand nursing awareness of computers and the
impact HIT could have on practice
i. The Clinical Center at the National Institutes of Health implemented the Technicon
Medical Information System (TDS) computer system
j. TDS is one of the earliest clinical information systems (called Eclipsys & Allscripts)
k. TDS was the first system to include nursing practice protocols
In the 1970’s, nursing began to realize the importance of computers to the nursing profession
and became involved in the design, purchase, and implementation of information systems.
- Steps were taken to merge computers with nursing
- Nurses assisted in the design and development of nursing applications for the HIS
and other environments where the nurses function.
- Management Information (MIS) was developed
4. The 1980s
a. The field of nursing informatics exploded and became visible in the healthcare and
nursing
b. The nursing profession needed to update its practice standards and determine its data
standards, vocabularies, and classification schemes that could be used for the
computer-based patient record systems
c. Many mainframe healthcare information systems (HISs) emerged with nursing
subsystems
d. These systems documented several aspects of the patient record
e. The microcomputer or personal computer (PC) emerged during this period
f. The first Nursing Special Interest Group on Computers met for the first time during
SCAMC (Symposium on Computer Applications in Medical Care) in 1981
g. In 1985, the ANA approved the formation of the Council on Computer Applications in
Nursing (CCAN)
h. CCAN became a very powerful force in integrating computer applications into the
nursing profession
i. The first edition of this book was published in 1986
- In the 1980s, medical and nursing informatics specialties emerged.
- Microcomputer or Personal Computer (PC) was developed and made accessible to
nurses
5. The 1990s
a. Advances in relational databases, client-server architectures, and new programming
methods
b. Better application development at lower costs
c. Legislative activity in the mid-1990s paved the way for electronic health records through
the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (public-law 104-
19)
d. The complexity of technology, workflow analysis, and regulations shaped new roles in
nursing
e. In 1992, the ANA recognized nursing informatics as a new nursing specialty separate
Scope of Nursing Informatics Practice Standards, and also established a specific
credentialing examination for it
f. The demand for nursing informatics (NI) expertise increased
g. The ANA developed the Nursing Information and Data Set Evaluation Standards
(NIDSEC) to evaluate and recognize nursing technology rapidly changed in the 1990s
h. The purpose of Information systems was to guide the development and selection of
nursing systems that included standardized nursing terminologies integrated throughout
the system
- Policies and legislations were adopted promoting computer technology in healthcare
including nursing.
- American Nurses Association (ANA) approved NI as a nursing specialty in 1992
- Laptops and netbooks were developed.
- Wireless technologies made it simpler for nursing and other healthcare professionals
to access applications at the point of care where the patient was (Saba & Erdiey,
2010).
- Internet became a tool for web-based clinical applications, communication, and
access to evidence-based resources. It moved to a social milieu in 1995 with e-mail
and WWW protocols which enhanced usability and user-friendliness.
6. The 2000s
a. More healthcare information became digitalized and newer technologies emerged
b. In 2004 an Executive Order 13335 (1) Established the Office of the National Coordinator
(ONC) for Healthcare Information Technology (HIT) (2) Issued a recommendation
calling for all healthcare providers to adopt interoperable electronic health records
(EHRs) by 2014/2015
c. Wireless, point of care, regional database projects, and increased IT solutions
proliferated
d. The use of barcoding and radio-frequency identification (RFID) emerged as a useful
technology
e. Smaller mobile devices with wireless or Internet access increased access to information
for nurses within hospitals and in the community
f. The development and refinement of Voice Over Internet Protocol (VoIP) provided voice
cost-effective communication
g. The Internet provided a means for the development of clinical applications
h. The nursing informatics research agenda promoted the integration of nursing care data
in HIT systems that would also generate data for analysis, reuse, and aggregation
- The post-2000 era saw an unprecedented explosion in the number and sophistication
of both computer hardware and software.
- Telemedicine became possible and was recognized as a specialty in the late 1990’s.
- NI has experienced rapid growth in the last 40 years which does not appear to be
slowing.
7. The 2010s
a. The impact of the Nursing Minimum Data Set (NMDS) demonstrated that continued
consensus and effort was needed to bring to fruition the vision and implementation of
minimum nursing data into clinical practice
b. A new nursing informatics research agenda for 2008–2018 emerged as critical for this
specialty
c. The new agenda is built on one originally developed and published by the National
Institute for Nursing Research (NINR) in 1993
d. In 2010, the ONC convened two national committees: (1) National Committee on Health
Policy (2) National Committee on Health Standards which outlined and designed the
focus for the “Meaningful Use” (MU) legislation
e. Meaningful Use was designed to be implemented in at least three stages
f. Consists of the regulations which built onto each other with the ultimate goal of
implementing a complete interoperable EHR and/or HIT system in all US hospitals
g. In 2011/2012 MU Stage 1 was initiated focusing primarily on the Computerized
Physician Order Entry (CPOE) initiative for physicians
g. In 2012/2013 MU Stage 2 was introduced focusing primarily on the implementation of
Quality Indicators
h. The Quality Indicators are used to guiding hospitals in patient safety and if not
implemented used as indicators subject to financial penalties
i. It is anticipated that MU Stage 3 will be implemented in 2014/2015
j. The Center for Medicare and Medicaid Services (CMS) plans to increase reimbursement
for the implementation of “MU” regulations in their HIT and/or EHR systems through
2015
k. CMS may even penalize eligible providers and facilities who do not meet the proposed
MU criteria
l. As the MU requirements increase, they will impact the role of the NI experts in hospitals
m. MU requirements ultimately on the roles of all nurses in the inpatient facilities, making
NI an integral component of all professional nursing services
Lesson 4: Nursing Standards Initiatives
1. Nursing practice standards have been developed and recommended by the ANA
2. Nursing Scope and Standards of Practice that focused
a. On the organizing principles of clinical nursing practice
b. The standards of professional performance
3. Nursing Informatics Scope and Standards of Practice builds on
a. Clinical practice standards
b. Outlines further the importance for implementing standardized content to support
nursing practice by specialists in nursing informatics
Nursing Education Standards
1. Since the NLN’s Nursing Forum on Computers in Healthcare and Nursing was formed in
1985, it has supported the integration of computer technology in the nursing curriculum
2. The American Association of Colleges of Nursing (AACN), revised The Essentials for
Doctoral Education for Advanced Nursing Practice and The Essentials of Baccalaureate
Education for Professional Nursing Practice to require the use of computers and
informatics for both baccalaureate and graduate education
Nursing Content Standards
1. The nursing process data elements in EHRs are essential for the exchange of nursing
information across information systems and settings
2. Standardization of healthcare data began in 1893 with the List of International Causes
of Death for the reporting of morbidity cases worldwide
3. The standardization of nursing began with Florence Nightingale’s six cannons in her
“Notes on Nursing”
4. In 1955, Virginia Henderson published her 14 Daily Patterns of Living as the list of
activities and conditions that became the beginning of nursing practice standards in the
United States
5. In 1970, the ANA accepted the Nursing Process as the professional standards for
nursing practice and which was followed by the standardization of nursing content-data
elements in 1973
6. Currently, the ANA has recognized 12 nursing terminologies
7. The ANA selected six of the ANA recognized nursing languages for inclusion in the
NLM’s Metathesaurus of the Unified Medical Language System (UMLS) and for inclusion
in the Systematized Nomenclature of Medicine—Clinical Terms (SNOMED-CT)
8. There are a large number of standards organizations that impact healthcare data
content as well as healthcare technology systems
Lesson 5: History of Nursing Informatics in the Philippines
Origins
- Since 1998, several faculty members of the University of the Philippines began formal
education and training. Dr. Herman Tolentino took a post-doctoral fellowship in medical
informatics at the University of Washington.
- Dr. Alvin Marcelo followed a year later for his training at the National Library of Medicine.
- Dr. Cito Maramba went to Coventry for his Masters in Information Sciences at the
University of Warwick.
- They were later followed by other physicians such as Dr. Micheal Muin and Dr. Ryan
Bañez.
- By the year 2003, a Master of Science in Health Informatics was proposed to be offered
by UP-Manila College of Medicine (major in medical informatics) and the College of Arts
and Science (major in bioinformatics) and was later approved to be offered starting
academic year 2005-2006.
- In 1999, a study group was formed headed by the National Institute of Health of the
University of the Philippines Manila. This group identified international standards for
health information and its adaptability in the Philippines. The document is referred to as
the "Standards of Health Information in the Philippines, 1999 version" or "SHIP99".
Representatives from various sectors collaborated on this project including the Philippine
Nurses Association (PNA) in the person of Ms. Evelyn Protacio.
CHED as a Catalyst
- The nursing community was still yet to follow its international counterparts in the
adoption of information, communication, and technology in nursing practice in the
Philippines.
- Despite the inclusion of Informatics course in the undergraduate curriculum which
focused on basic desktop applications, the need for genuine nursing informatics
course had not yet been realized
- In 2008, the Nursing Informatics course in the undergraduate curriculum was defined
by the Commission on Higher Education (CHED) Memorandum Order 5 Series of
2008. This was later revised and included as a Health Informatics course in CHED
Memorandum Order 14 Series of 2009. This was first implemented in the summer of
2010.
Organization
- Early in 2009, Mr. Kristian R. Sumabat and Ms. Mia Alcantara Santiago, both nurses
and graduate students of Master of Science in Health Informatics at the University of
the Philippines, Manila began drafting plans to create a nursing informatics
organization. In February 2010, they began recruiting other nursing informatics
specialists and practitioners to organize a group which later became as the Philippine
Nursing Informatics Association.
Issues and Challenges
- Like many other disciplines, nursing informatics face many challenges while in its
infancy stage.
- The inclusion of informatics as an integral part of the undergraduate curriculum has
been one of the most influential factors for the increased awareness and interest in
this field of nursing.
- However, the contents of the curriculum were adapted from international materials
which do not match the local needs.
- A community-centered approach to the use of information, communication, and
technology in nursing practice must be adapted to ensure the impact of the program
in the local healthcare system.
- Lack of certification and credentialing programs in post-graduate levels are also absent
with the scarcity of local nursing informatics experts.
- This new field has yet to gain acceptance and recognition in the nursing community as
a sub-specialty
Future Direction
- Development of training, certification, and credentialing programs are in the pipeline for
the Philippine Nursing Informatics Association.
- Future partnerships with local and international nursing and health informatics
organizations have started as well.
- Other programs are expected to be slowly delivered with PNIA's CORE X strategic
platform which stands for Competency, Organization, Recognition, Experience, and
Expertise.
- It is also a major thrust to support the use of health information standards in the
Philippines and to have nursing informatics specialists in every hospital in the country
-
CHAPTER 2: RELATED CONCEPTS TO NURSING INFORMATICS
Lesson 1: Theories, Models and Frameworks supporting Nursing Informatics
1. HUMAN-COMPUTER INTERACTION
- It is concerned with interactions between people and computers, is an area of study
concentrated on by human factors experts (Staggers, 2002).
- HCI is defined as the study of how people design, implement, and evaluate interactive
computer systems in the context of users’ tasks and work (Nelson & Staggers, 2014).
- HCI emerged in the 1980s as an interdisciplinary field incorporating ideals of computer
science, cognitive science, and human factors engineering professionals, but since has
grown into a science incorporating concepts and approaches from many other
disciplines.
- Human factor is important.
Human factors
- Is a discipline that optimizes relationships between technology and humans (Kantowitz
& Sorkin, 1983; McCormick & Sanders, 1982).
- In healthcare, human factors experts attempt to understand relationships between
humans, tools they use (i.e., computers), living and work environments, and tasks they
perform (Staggers, 1991; Staggers, 2003; Weinger, Pantiskas, Wiklund, & Carstensen,
1998)
THEORIES SUPPORTING NURSING INFORMATICS
- Nursing theories are about nursing practice — a nurse’s interactions or relationships
with individuals, groups, or communities (also known as patients or clients) focused on
applying the nursing process.
- Novice to Expert. Patricia Benner and other nurse educators adapted this model to
explain how nursing students and professional nurses acquired nursing skills.
- Computer science is the study of algorithms for solving computation problems.
- Information science focuses on the gathering, manipulation, classification, storage, and
retrieval of recorded knowledge.
- Communication theory uses these core concepts and additional principles developed
since then to analyze information transfer and the effectiveness and efficiency of
communications.
- Cognitive Science is the study of the mind—of how we think and it looks at our mental
activities and processes.
- Systems theory relates to the properties of systems as a whole, focuses on the
organization and interdependence of relationships within a system.
2. Novice to Expert by Patricia Benner
- Started with Hubert and Stuart Dreyfus (1980) as the Dreyfus Model of Skill Acquisition
- Within the field of nursing informatics, this theory can be applied to:
the development of nursing informatics skills, competencies, knowledge and
expertise in nursing informatics specialists;
the development of technological system competencies in practicing nurses working
in an institution;
the education of nursing students, from first year to graduation and;
the transition from graduate nurse to expert nurse.
- Communication theory uses these core concepts and additional principles developed
since then to analyze information transfer and the effectiveness and efficiency of
communications.
- Cognitive Science is the study of the mind—of how we think and it looks at our mental
activities and processes.
- Systems theory relates to the properties of systems as a whole, focuses on the
organization and interdependence of relationships within a system.
Stage 1: Novice
- Does not know anything of the subject; memorize its context-free features.
- Given rules for determining an action on the basis of these features.
- To improve: needs monitoring, either by self-observation or instructional feedback.
A novice does not know anything of the subject he/she is approaching and has to
memorize its context-free features.
The novice is then given rules for determining an action on the basis of these
features.
To improve, the novice needs monitoring, either by self-observation or instructional
feedback.
For example, a nurse learning to use a new hospital information system needs
explicit instruction and ‘rules’ to learn to use the computer interface and manipulate
the software
Stage 2: Advance Beginner
- Still dependent on rules, but as (s)he gains more experience with real life situations,
(s)he begins to notice additional aspects that can be applied to related conditions.
- An advanced beginner is still dependent on rules, but as (s)he gains more experience
with real life situations, (s)he begins to notice additional aspects that can be applied to
related conditions.
Stage 3: Competent
- Grasps all the relevant rules and facts of the field and is, for the first time, able to bring
his/her own judgment to each case.
- Stage of learning that is often characterized by the term “problem solving.”
Stage 4: Proficient
- Fluency and step-by-step analysis and solving of the situation to the holistic perception
of the entirety of the situation.
- Know how to interpret data from all departmental information and provide guidance to
other disciplinary members as needed.
Stage 5: Expert
- Experienced situations is so vast that normally each specific situation immediately
dictates an intuitively appropriate action.
- Discovers that without his consciously using any rules, situations simply elicit from him
or her appropriate responses.
- Sees what needs to be done, and decides how to do it. The expert not only knows what
needs to be achieved, s/he knows how to achieve his or her goal.
3. Grave’s and Concoran’s Model
- Proponent: Graves and Corcoran (1989)
- Their model placed data, information, and knowledge in sequential boxes with one-way
arrows pointing from data to information to knowledge.
- The model is a direct depiction of their definition of nursing informatics.
- A combination of computer science, information science, and nursing science is
designed to assist in the management and processing of nursing data, information, and
knowledge to support the practice of nursing and the delivery of nursing care.
- Nursing informatics as the linear Ø progression - from data into information and
knowledge
- Management processing is integrated within each element, depicting nursing
informatics as the proper management of knowledge – from data as it is converted into
information and knowledge
4. Schwirian’s Model
Proponent: Patricia Schwirian (1986)
A model of nursing informatics intended to stimulate and guide systematic research in
this discipline.
Proposed a model intended to stimulate and guide systematic research in nursing
informatics in 1986
•Model/framework that enables identification of significant information needs, that can
foster research (somewhat similar to Maslow’s hierarchy of needs)
Four elements are: (1) Raw material (nursing-related information) (2) Technology (a
computing system comprised of hardware and software) (3) Users surrounded by
context (nurses, students) (4) Goal (or objective) toward which the preceding elements
are directed
Provides a framework for identifying significant information needed, which in turn can
foster research.
▪ FOCUS: Sparse volume of research.
5. Turley’s Model
Proponent: James P. Turley (1996)
- In which the core components of informatics (cognitive science, information science,
and computer science) are depicted as intersecting circles.
- Nursing science is a larger circle that completely encompasses the intersecting circles.
- Nursing informatics is the intersection between the discipline-specific science (nursing)
and the area of informatics.
Core components of informatics are:
a. Cognitive Science
b. Information Science
c. Computer Science
Nursing Informatics is an intersection between the discipline-specific Science (Nursing) and the
area of informatics.
6. Mcgonigle and Mastrian’s Foundation of Knowledge Model
Proponent: Dee McGonigle and Kathleen Mastrian
- The base of this model shows data and information distributed randomly.
- From this base, transparent cones grow upward and intersect.
- The upward cones represent the acquisition, generation, and dissemination of
knowledge.
- Knowledge processing is represented by the intersections of these three cones.
- Circling and connecting all of the cones is feedback.
7. Technological Competency as Caring in Nursing: A Model for Practice
Proponent: Rozzano C. Locsin, PhD, RN, FAAN
1. A conceptual model that presents the link between technology and caring in nursing as
coexisting harmoniously. (Locsin, 1995)
Grounded in the harmonious coexistence between technology and caring in nursing.
- nurses value technological competence as an expression of caring
2. Dimension of Technological Value in the theory
a. Technology as completing human beings – re-formulate the ideal human body -
replacement of parts: mechanical (prostheses,) or organic (transplant)
b. Technology as machine technologies – computers and gadgets
c. Technologies that mimic human beings and human activities – to meet the demands
of nursing care: cyborgs or robots
3. Technological Competency as caring in nursing
a. Coexistence of nursing and technology
b. Harmonozation between 2 concepts can exist
c. When technology is used to know persons continuously in the moment, nursing
is lived
Technology makes work more efficient. Does not remove human or nursing interaction. Be
competent in technology to be more caring
8. DIKW Model
- Data - Discrete entities that are described objectively without interpretation
- Information - Data that is interpreted organized or structured
- Knowledge - Information that has been synthesized so that interrelationships are
identified and formalized
- Wisdom - Knowledge applied in a practical way or translated into actions.
Result in decisions that guide practice.
- Y axis – complexity
- X axis – human intellect
Application:
Data – 250 BSN2 students LMS users
Information – 95 users visit NI page, 150 users visit MCN page, 5 students just logs-in ; Out of
250 users – 70% is age bracket of 20-24 years old, 20% is 25-29 years old; 80% of the
students access the LMS from 9am to 11pm (Whi, what, when, where)
Knowledge – collection of information that can be made useful – see the usefulness; they do
something to retain in memory – like when you memorize a concept
How question
“How do they use their LMS?”
Wisdom – last step; considers the output from all levels and sets them to other human
concepts and principles like morals and ethics
Why question
right and wrong, good or bad, improvement in the decisions
NURSING AND KNOWLEDGE
Nurses are:
1. Knowledge workers: working with information and generating information and
knowledge as a product
2. Knowledge acquirers: providing convenient and efficient means of capturing and storing
knowledge
3. Knowledge users: individuals or groups who benefit from valuable, viable knowledge.
4. Knowledge engineers: designing, developing, implementing and maintaining knowledge.
5. Knowledge managers: capturing and processing collective expertise and distributing it
where it can create the largest benefit.
6. Knowledge developers or generators: changing and evolving knowledge based on the
tasks at hand and information available.
9. Framework: Informatics Research Organizing Model, A. Judith A. Effken, PhD
(2003)
The organizing model is composed of 2 component models.
The first is the systems development life cycle (SDLC), a process model which is represented
by the center ring as 5 distinct phases. Evaluation, sometimes considered the sixth phase, is
represented as occurring throughout.
The second, shown by the outer ring, represents the 4 constructs of the original systems
research organizing (SRO) model.
In the IRO model, the client construct is composed of the data and information collected from
clients, as well as client behaviors and characteristics.
Context is defined as the cultural, economic, and social environment in which the intervention
occurs.
Outcomes correspond to the information, knowledge, decisions, and actions that emerge from
the data to improve cost, quality, safety, and satisfaction outcomes.
Nursing informatics intervention corresponds to nursing (in the nursing metaparadigm) and
describes the nursing informatics solution in terms of the content, structure, and flow of the
information, as well as the technology used. These two circles in the dynamic model (the
conceptual model and the process model) are distinct, but each presents an incomplete picture
without the other.
At any stage in the SDLC, for example, design, analysis, or implementation, the SRO model
concepts are considered. Although at first, it may seem counterintuitive, the arrow between
clients and outcomes also goes in both directions. Outcomes here act as a feedback loop. The
SRO concepts are connected by 3 different sets of arrows to represent the different levels of
analysis at which the model may operate (eg, individual client data to information; or
aggregated group information to knowledge). The corresponding multiple lines connecting the
client to outcome and context to intervention have been omitted here to simplify the design.
10. Framework: Nurse—Patient Trajectory Framework, Gregory L. Alexander
(2007)
The aim of this study was to examine to what extent residents, family members, and clinicians
find a sensor data interface used to monitor elder activity levels usable and useful in an
independent living setting.
The Nurse-Patient Trajectory Framework can be used to predict which information structures,
processes, and technologies can be used to achieve desired outcomes for patients and
providers (Bakken, Stone, & Larson, 2008).
Research using this framework was designed to focus specifically on how nurses and patients
interact with information systems and how those interactions influence decision making and
outcomes. However, it is also important to consider other people who interact with nurses and
patients as they make decisions and arrive at outcomes along their trajectories.
Lesson 2: Benefits of Nursing Informatics in Health Care
The goal of NI is to improve the health of populations, communities, families, and individuals
by optimizing information management and communication. NI has become well established
within nursing since its recognition as a specialty for registered nurses by the American Nurses
Association (ANA) in 1992.
Benefit #1: Nursing Informatics informs and influences IT systems
- help move healthcare away from paper forms into electronic documentation.
- EHR systems, workflows and decisions are more informed and efficient.
Nursing informatics specialists are trilingual.
1. They understand the clinical language of efficient patient care
2. They translate knowledge and clinician feedback into the technical language of
business analysts and programmers.
3. They communicate clinical and technical matters with administrative leadership
Benefit #2: Nursing Informatics leverages evidence-based clinical best practices
1. Researching clinical nursing practices outside of their own experiences.
2. Finding evidence to prove which clinical practices are best.
3. Influencing the design of clinical systems to support and promote the best evidence-
based practices and workflows
4. Training other nurses to use clinical TT systems
Benefit #3: Nursing Informatics generates stronger nurse training in clinical IT
systems
- nursing informatics specialists are well-suited to teach other nurses how to get the full
benefits of these systems. Nursing informatics specialists are well-suited to teach other nurses
how to get the full benefits of these systems.
Benefit #4: Nursing Informatics leverages IT investments
Nurse informaticists help get maximum value from these investments in at least three ways:
1. They ensure that systems are designed to support effective patient care workflows (see
Benefit #1).
2. They help train other nurses to use TT efficiently (see Benefit #3).
3. They apply advanced analytics strategies to develop predictive models
Benefit #5: Nursing informatics contributes unique wisdom to clinical care that is
acquired only through a deep understanding of both clinical practice and data
analysis
Informatics nurse specialists identity the key areas where studies identity where problems
arise: inadequate discharge education, a patient doesn't have support at home, poor hearing
or sight, or being on multiple medications . "Informatics nurse specialists work with leadership
regarding regulatory and quality initiatives and governance for technology implementation and
change”.
Benefit #6: Nursing Informatics enriches the evolving healthcare delivery system
Advances in healthcare technology launch new options for healthcare delivery
Benefit #7: Nursing Informatics Improves Patient Care, Patient Safety, and
Outcomes
- More efficient electronic health records
- Better IT systems
- Research and application of clinical best practices
- Training of other nurses
- Analytics-based predictive models
- New avenues for patient education
- Support for telehealth technology
Lesson 3: Ways Informatics is Transforming Health Care
1. Dramatic Savings
- Health care is expensive
- The expenses associated with more traditional methods of sharing information,
delays in care, errors in care or delivery
- Electronic and connected system in place, less expense can happen
2. Shared Knowledge
- Nursing informatics provides a way for knowledge about patients, diseases,
therapies, medicines, and the like to be more easily shared.
- The practice of medicine gets better.
3. Patient Participation
When patients have electronic access to their own health history and recommendations:
a. it empowers them to take their role in their own health care more seriously.
b. able to educate themselves
c. also able to interact with doctors and nurses more easily
4. The lmpersonalization of Care
- Care is becoming less and less personal
- The job of “knowing" is placed on data and algorithms.
- Having a valid and accurate record that the patient and his care providers can access
remains vital.
5. Increased Coordination
Health care is getting more and more specialized, which means most patients receive care
from as many as dozen different people in one hospital stay. This increase in specialists
requires an increase in coordination, and it is health informatics that provides the way forward.
6. Improved Outcomes
- The most important way in which informatics is changing health care
- Higher quality care and safer care
Lesson 5: Applications of Nursing Informatics
A. Nursing Practice
- Worklists to remind staff of planned nursing interventions
- Computer‐generated client documentation including discharge instructions and
medication information
- Monitoring devices that record vital signs and other measurements directly into the
client record
- Computer‐generated nursing care plans and critical pathways
- Automatic billing for supplies or procedures with nursing documentation
- Reminders and prompts that appear during documentation to ensure comprehensive
charting
- Quick access to computer‐archived patient data from previous encounters
- Online drug information
B. Nursing Administration
- Automated staff scheduling
- Online bidding for unfilled shifts
- Electronic mail for improved communication
- Cost analysis and finding trends for budget purposes
- Quality assurance and outcome analysis
- Patient tracking and placement for case management
C. Nursing Education
- Online course registration and scheduling
- Computerized student tracking, and grade management
- Computer‐assisted instruction
- Course delivery and support for Web‐based education
- Remote access to library and internet resources
- Teleconferencing
- Presentation software for preparing slides and handouts
- Online test administration
- Communication with students
D. Nursing Research
- Computerized literature searching
- The adoption of standardized language related to nursing terms
- The ability to find trends in aggregate data, which is data derived from large population
groups
- Use of the internet for obtaining data collection tolls and conducting research
- Collaborate with other nurse researchers
