Nursing Informatics 2

Lesson 2

Nursing Informatics Roles, Competencies and Skills 

Introduction 

• Nurses have historically gathered and interpreted data. 
• Nurses are able to access information quickly and easily. 
• Accessing the information via the internet or the electronic health record (EHR) allows the nurse to provide the best possible patient care.  
• Nursing recognized early on that computers would change healthcare and became actively involved in shaping how computers were used in healthcare. 
• The American Nurses Association (ANA) first recognized Nursing Informatics (NI) as a specialty in 1992 (Saba & McCormick, 2006; American Nurses Association [ANA], 2001). 

What is Nursing Informatics? 

• derived from the French term “ informatique,” which means to refer to the computer milieu (Saba, 2001). 
• The Health Information and Management Systems Society (HIMSS) defines informatics as “the discipline concerned with the study of information and manipulation of information via computer-based tools” (2006, p. 44).  
• Graves and Corcoran : 
• “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”
• The ANA points out that even though NI is based on science, it is an applied science and not a basic science. 
• Graves and Corcoran (1989) and the ANA (2001) both believe that data, information, and knowledge are key components of NI practice. 
• Data, information, knowledge, and the core sciences, when combined, represent the foundation of NI practice. 

History 

• Healthcare began to use computers in the 1950’s. 
• Computers, in this era, were typically used in the business office (Saba & McCormick, 2006).
• 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 (Saba & McCormick).
• In the 1980’s, medical and nursing informatics specialties emerged.
• 1995 saw the first certification exam for NI (Saba & McCormick).
• 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 (Saba & McCormick).
• NI has experienced rapid growth in the last 40 years which does not appear to be slowing.

The Nurse as a Knowledge Worker

• It has been established that nurses use data and information.
• This information is then converted to knowledge.
• The nurse then acts upon this knowledge by initiating a plan of care, updating an existing one or maintaining status quo.
• Knowledge can be defined as “the distillation of information that has been collected, classified, organized, integrated, abstracted, and value added” (HIMSS, 2006 )
• A worker is “one that works especially at manual or industrial labor or with a particular material” (Merriam-Webster, 2007).
• Drucker (1994) describes a knowledge worker as one who has advanced formal education and is able to apply theoretical and analytical knowledge.
• The knowledge worker must be a continuous learner and a specialist in a field.

Knowledge Workers and Healthcare

• Healthcare needs to begin making the transition from the Industrial Age to the Information Age.
• Healthcare can begin this transition by adopting a new philosophy that recognizes that employees are mature, self-reliant, independent-thinking adults who function as partners in carrying out the work of the organization.

Nurses as Knowledge Workers

• Nursing entails a significant amount of knowledge and non-knowledge work.
• Knowledge work would include such things as interpreting trends in labs and symptoms.
• Non-knowledge work would include such items as calling the lab to check on lab results or making beds.
• Nurses rely on their extensive clinical information and specialized knowledge in order to implement and evaluate the processes and outcomes related to patient care.
• Nurses are data gatherers by nature.
• Nurses collect and record objective clinical data on a daily basis (Snyder-Halpern, et al., 2001).
• Nurses will transition from knowledge users to knowledge builders when they examine clinical data and trends across groups of patients.
• The data gatherer requires a system that will capture and store data accurately and reliably and allow the data to be readily accessed.

Nursing Challenges

• In order for nurses to be treated as a knowledge workers, nurses must first be recognized as knowledge workers (Snyder-Halpern, et al., 2001).
• Nursing still has a long way to go before being accepted as an equal participant in the interdisciplinary knowledge team.

The Nurses Knowledge Needs

• Computers, technology, and the informatics fields are assisting healthcare workers in dealing with this information explosion.
• Nurses deal with a vast amount of information and knowledge every day which they use to care for their patients.
• Nurses rely on their own knowledge but there are times when this is not adequate and they must access information in order to provide safe patient care.
• Decision support systems (DSSs) may be incorporated into the EHR.
• One challenge, that healthcare is currently facing, is the vast differences in computer literacy and information management skills that healthcare workers possess (McNeil, Elfrink, Beyea, Pierce, & Bickford, 2006).

Nursing Informatics Specialty Practice

• NI is an established and ever evolving profession which began when computers were introduced into healthcare (Belanger, 2006).
• Nursing has been involved in the purchase, design, and implementation of Information Systems (IS) since the 1970’s (Saba & McCormick, 2006).
• Nursing is involved heavily in the design of educational materials for practicing nurses, student nurses, other healthcare workers, and patients.
• Computers have revolutionized the way patients access information as well as revolutionized the educational process (Saba).
• NI is important to nursing and healthcare as it focuses on representing nursing data, information, and knowledge.
• NI has become a viable and essential nursing specialty with the introduction of computers and the electronic health record (EHR) to healthcare.
• Nurses who enter this field may have done so by accident because they were comfortable working with computers and their co-workers used them as a resource for computer related questions.
• Assisting nurses to incorporate this new technology into their daily workflow is one of many challenges that the nurse informatics specialist (NIS) may tackle.
• One position that nurses do quite well in is the role of the project manager which is a result of their ability to manage multiple complex situations at one time (HIMSS Nursing Informatics Awareness Task Force).
• The first two graduate NI programs were introduced at the University of Maryland and the University of Utah in 1989.
• The first doctoral program was offered in 1991 at the University of Maryland (Duke University School of Nursing, 2007).
• Local colleges and universities should be researched to see which may have added informatics programs.
• NI is a nursing specialty that does not focus on direct patient care but instead focuses on how to improve patient care and safety as well as improving the workflow and work processes of nurses and other healthcare workers utilizing technology.
• Continuing education allows the NIS to improve a process or workflow within the hospital or to change the way a system upgrade is rolled out.

The Goal of Informatics

• Although already in use for a number of decades, the term “informatics” is typically viewed by the broader nursing community as the use of computers by nurses.

There are some nurse authors beginning to de-emphasize the notion of “nursing informatics” and discussing the role of nurses and their work processes in the context of “health informatics” (Hannah, 1995).

•  Health informatics has been described as “knowledge of health services delivery, technology, applications, information, methodologies, and data management processes” (Kathryn Hannah cited in Thede, 2006).
• The umbrella of “health” informatics suggests that the informatics work being done by nurses must fit within the context of the “whole system”.
• More timely access to data and information, clinical and financial, has been identified as a necessity in the climate of 21st century healthcare delivery (Hannah, 1995).
• Health service organizations, societies, and governments throughout the industrialized world are obsessed with assuring that healthcare delivery is:
• safer
• knowledge-based
• cost-effective
• seamless
• timely
• An additional challenge within the nursing profession is the pending human resource crisis and dire projections of imminent shortages.
• Nursing’s focus on IT has been elevated as a central means by which nurses can be sufficiently supported in their work environments.
• IT has the potential to reduce the waste of valuable nursing resources by reducing the time spent in the “care and feeding” of patient records. Having more time for direct client care that is supported by ready access to information and knowledge translates into the provision of safer, quality care.