Trends in Nursing Informatics Introduction
The information revolution has changed the health care system to an unbelievable extent. Integration of informatics in nursing is going beyond data processing functions such as payroll, to an important role in patient care by: interpreting ECG, entering orders, reporting reporting results, and preventing drug interactions (by cross referencing drug compatibilities and warning the appropriate staff). Nurses are using information systems in clinical practice, administration, research and education. History of health Informatics •
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Initially, the term medical informatics was used to describe” those collected informational technologies which concern themselves with the patient care, medical, decision making process” (Greenburg 1975). Greenes and Shortliffe (1990) redefined medical informatics as “the field that concerns itself with the cognitive, information processing and communication tasks of medical practice, education and research, including the information science and the technology to support these tasks, an intrinsically interdisciplinary field with an applied focus addressing a number of fundamental research problems as well as planning and policy issues" Reston 1984, gave a parallel definition of medical informatics. Since nurses are health care practitioners who are involved in patient care decision- making process that uses information technologies, there clearly was a place for nursing in medical informatics. Mandil (1991), coined the phrase “health informatics” which he defined as the use of information technology( including both hardware and software) with information management concepts and methods to support the delivery of health care. Health informatics encompasses medical, nursing, dental, and pharmacy informatics. Health informatics focuses attention on the recipient of care rather than on the discipline of the care giver.
Definition •
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Nursing informatics, as originally defined, refers to the use of information technologies in relation those functions within the purview of nursing, and that are carried out by nurses when performing their duties. Nursing informatics is “a combination of computer science, information science, and nursing science 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. ( Graves and Corcoran, 1989).
Current trends and issues •
As nurses have been practicing in the automation of healthcare data and the integration of nursing data within information systems, a realization of the need for
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agreed-on definitions of the appropriate elements describing clients and their care came to light. (Grier, 1984; Mortiz, 1990). Werely and Lang 1998, have identified and described the need for a standardized data set in nursing, the Nursing Minimum Data Set in Nursing, the Nursing Minimum Data Set( NMDS). Adoption of the NMDS would allow for an ongoing collection of data that can be compared across setting and client populations for clinical and administrative decision making. According to the study groups on Nursing Information Systems (1983), computerizing the data facilitates the management and use of the information by standardization, organization and automation to produce timely and comprehensive information. The NMDS provides structure for electronic storage of nursing data, and the unified nursing language provides the substantive data definition to be stored in that structure (Hannah& Shaniman, 1992).
General purposes
Nursing’s data needs fall into four domains:Nurse need data about client care, provider staffing, administration of care and the organization, and knowledge based research. The first three are distinct areas, whereas research interacts with all of the other three. The four areas and the source for the data are: •
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Client: client care/ clinical care and its evaluation, clinical data, and client outcomes. Source: the client record. Provider: professional data, caregiver outcomes, and decision maker variables. Source: personnel records, national data banks, and links to client records. Administrative: management and resource oversight, administrative data, system outcomes, and contextual variables. Source: executive/ managerial data and fiscal and regulatory data. Research: knowledge base development. Source: existing and newly gathered data and relational data bases.
Eg: outcome and variables in three domains of nursing data needs. Domains client
Outcomes Client satisfaction
Provider
Administrative
Job enrichment
Costs
Job/work Achieved care satisfaction outcomes Physician Costs satisfaction Access to health care
Job stress Intent to leave
Productivity Turn over Income
Variables Attitudes/ beliefs
Attitudes, beliefs Agency philosophy Education Diagnosis, Priorities gender, age Years of experience Organizational Marital status structure Age Support Climate systems Work excitement Policy and Satisfaction procedures Level of dependency
Conflict
Severity of illness Intensity of nursing care Conclusion •
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As almost all care settings are moving towards the use of computers for all health care information, nurses are challenged to explore new ways of working and documenting their practice. Computer is making it possible to audit records on an ongoing basis and provide feedback to care providers on the completeness of their documentation. Information retrieval may become easier and individual segments of data may be pooled to enable statistical analysis of the effectiveness of various practices in achieving desired patient outcomes. As nurses participate in these changes, it is imperative that there may be thoughtful evaluation of how computer systems can contribute to quality of care rather than the computer system being the controlling force for practice.
Journal references 1. Exploring the impact of health information technology on communication and collaboration in acute care nursing
A focus group using nursing informatics experts as informants was conducted to guide development of a survey to explore the impact of health information technology on the role of nurses and interdisciplinary communication in acute care settings. Through analysis of focus group transcripts, five key themes emerged: information, communication, care coordination, interdisciplinary relationships, workflow, and practice effectiveness and efficiency. This served as the basis for development of a survey that will investigate perceptions of acute care providers across the United States regarding the impact of health
information technology on the role of nurses and interdisciplinary communication in acute care settings. The purpose of this paper is to describe the process of survey development including analysis of transcripts, emergence of key themes, and the processes by which the themes will be employed to inform survey development. 2. Nurses' experiences using a nursing information system: early stage of technology implementation
The purpose of this study was to explore nurses' experiences in the early stage of implementing a nursing information system. Focus groups were used to collect data at a medical centre in Taiwan. The results showed that nurses had problems with the system's content design, had insufficient training, were concerned about data security, were stressed by added work, and experienced poor interdisciplinary cooperation. To smooth this beginning stage, the author recommends involving nurses early in the system design, providing sufficient training in keyboard entry skills, redesigning workflow, and improving interdisciplinary communication. 3. The perfect role for nursing informatics: Nursing staff development
This is an opinion paper on the role of the hospital-l based nurse educator and the relevance of Informatics training for that position. The term "Nurse Educator" (NE) is used here describing a non-faculty position in a hospital or facility that deals with staff development of nurses. The standard roles for Informatics Nurses tend to be in the Information Technology (IT) department where exposure to practicing nurses is limited and decisions can be made without nursing practice input. The standard roles for the nurse staff educators tend to be involved with nursing decisions and nursing practice on various levels. This paper will discuss how having nurse educators prepared in informatics can strengthen nursing and patient care. References
1. Huber D. Leadership and nursing care management. ( 1 st edn). Philadelphia: W.B Saunders company; 1996. 2. Ellis R E, Hartely C L. Managing and coordinating nursing care.( 3 rd edn). Philadelphia: Lippincott; 1995. 3. Hannah K J, Ball M J& Edwards. Introduction to nursing informatics. Newyork: Springer- Verlag, 1994. 4. Cashen M S, Bradley V, Farrel A, Murphy J, Schleyer R, Sensmeir J, Dykes PC. Exploring the impact of health information technology on communication and collaboration in acute care nursing. Stud Health Technol Inform. 2006; 122:575-9. 5. Lee TT.Nurses' experiences using a nursing information system: early stage of technology implementation. Comput Inform Nurs. 2007 Sep-Oct; 25(5):294-300 6. Van de Castle B.The perfect role for nursing informatics: Nursing staff development. Stud Health Technol Inform. 2006;122:241-3
