Saturday, May 17, 2014

Nursing Informatics 1


  • Nursing Informatics 
  • is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge and wisdom in nursing practice. 
  • NI supports consumers, patients, nurses, and other providers in their decision-making in all roles and settings. 
  • to improve the health of populations, communities, families, and individuals by optimizing information management and communication. 

Introduction to NI 

  • NI is one example of a discipline-specific informatics practice within the broader category of health informatics. 
  • NI has become well established within nursing since its recognition as a specialty for registered nurses by the American Nurses Association (ANA) in 1992. 


  • Metastructures are overarching concepts used in theory and science. 
  • Data, which are processed to information and then knowledge, may be obtained from individuals, families, communities, and populations. 
  • Data, information, and knowledge are of concern to nurses in all areas of practice 
  • Knowledge focuses on what is known; wisdom focuses on the appropriate application of that knowledge. 
  • If the study of NI was limited to what the computer can process, the study of informatics could not fully appreciate the interrelationships that exist between nursing science/practice and information science/technology. 
  • The appropriate use of knowledge involves the integration of empirical, ethical, personal and aesthetic knowledge in the process of implementing actions. 
  • An example of applied wisdom demonstrating this integration in NI is the appropriate use of information management and technological tools to support effective nursing practice. 
  • NI is now concerned with the use of information technology to improve the access and quality of health care that is delivered to individuals, families and communities. 

Nursing Informatics Framework 
  • In the times leading up to the development of standards of practice and the ANA involvement in the discipline of nursing informatics, several practitioners posed concepts, frameworks and theory of nursing informatics. 

Schwirian (1986) 
  • was the first and she proposed a model for nursing informatics where information, goal, user context and computer all lead to nursing informatics activity. 

Transformation of Data to Knowledge
  • a key concept of the nursing informatics role and has the potential to significantly impact nursing practice. 
Three components:
1. Data are discrete entities that are described objectively without interpretation
2. Information is data that are interpreted, organized, or structured
3. Knowledge is information that is synthesized so that relationships are identified and formalized.

Sciences Underpinning Nursing Informatics 
  • NI is a combination of nursing science, information science, and computer science to manage and process nursing data, information, and knowledge to facilitate the delivery of health care. 
  • The combination of sciences creates a unique blend that is greater than the sum of its parts, a unique combination that creates the definitive specialty of NI. 
  • Computer and information science applied in isolation will have less impact than when they are applied within a disciplinary framework. 
Structured Language as a Tool for Nursing Informatics 
  • Nursing knowledge is gained by the ability to extract data that specifically defines nursing phenomena. 
  • Many different languages and ways of organizing data, information and knowledge exist based on different concepts. 
  • The ANA has formalized the recognition of these languages/vocabularies through a review process of the Committee on Nursing Practice Information Infrastructure (CNPII). 
  • At a higher level of structure, several resources have developed to facilitate interoperability between different types of systems of concepts and nomenclature. 
  • The importance of languages and vocabularies cannot be understated. 
  • The INS must attempt to envision the differing functions that may be used with the data, information and knowledge that have been created. 

Concepts and Tools from Information Science and Computer Science 
  • Informatics tools and methods from computer and information sciences are considered fundamental elements of NI. 
  • Information technology includes computer hardware, software, communication, and network technologies, derived primarily from computer science. 
  • Information structures organize data, information, and knowledge for processing by computers. 
  • Information management is an elemental process within informatics in which one is able to file, store, and manipulate data for various uses. 
  • The use of information technology distinguishes informatics from more traditional methods of information management. 

Phenomena of Nursing 
  • The metaparadigm of nursing comprises four key concepts: nurse, person, health, and environment. 
  • Nursing actions are based upon the inter-relationships between the concepts and are related to the values nurses hold relative to them. 
  • The decisions that nurses make can be characterized by both the quality of decisions and the impact of the actions resulting from those decisions. 
  • The process of decision-making in nursing is guided by the concept of critical thinking. 
  • Critical thinking is the intellectually disciplined process of actively and skillfully using knowledge. 
  • Wisdom in informatics is the ability of the NIS to evaluate the documentation drawn from a Health Information System (HIS) and the ability to adapt or change the system settings or parameters to improve the workflow of the clinical nurse. 
  • Nurses’ decision-making is described as an array of decisions that include specific behaviors, as well as cognitive processes surrounding a cluster of issues. 
  • Nurses make decisions about potential problems presented by an individual and about appropriate recommendations for addressing those problems. 
  • Decisions also may occur within specific environments such as executive offices, classrooms, and research laboratories. 
  • Decision support systems are typically rule-based, using a specified knowledge base and a set of rules to analyze data and information and provide recommendations. 
  • An expert system is a type of decision support system that implements the knowledge of one or more human experts. 
  • The future of Nursing Informatics promises increased saturation of informatics concepts and solutions into mainstream nursing and health care practices. 
  • As informatics solutions become as common a tool as the stethoscope, each nurse may be considered, in part, an informatics nurse. 
  • New materials and concepts will evolve in the future. 

Beyond Nursing Practice 
  • Nurse researchers must acquire and process new knowledge as they design and conduct their research studies. 
  • The future of nursing science and nursing informatics is intimately associated with the nursing education and nursing research arenas. 
  • Informatics and the use of technology in the practice of nursing are equally important in the nursing research arena 
Nursing in the Future 
  • Participants in the development of The National Nursing Research Agenda (NNRA) identified these two technology related priorities (among other research priorities) for nursing research: 
–Nursing Informatics: Enhancing Patient Care 
–Technology Dependency across the Life-span 
  • Goosen (2002) believes that the focus on nursing informatics research should be on the structuring and processing of patient information and how these inform nursing decision making in clinical practice. 
  • It is clear that the increasing use of technology to enhance nursing practice, nursing education, and nursing research will open new avenues for acquiring, processing, generating, and disseminating knowledge. 

ANA Definition of Nursing (2003)
“Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.”
  • The focus of nursing is on the human responses to actual or potential health problems, and advocacy for various clients. 
  • Nurses must possess the technical skills to manage equipment and perform procedures, interpersonal skills to interact appropriately with people, and cognitive skills to observe, recognize and collect data, analyze and interpret data and reach a reasonable conclusion that forms the basis of a decision. 
  • Nursing is an information intensive profession. 
  • The steps of utilizing information, applying knowledge to a problem, and acting with wisdom form the basis of nursing practice science. 
  • We acquire data and information in bits and pieces and then transform the information into knowledge. 

Nursing and Knowledge 
  • Nurses are knowledge workers, working with information and generating information and knowledge as a product. 
  • Nurses are knowledge acquirers, providing convenient and efficient means of capturing and storing knowledge. 
  • Nurses are knowledge users, individuals or groups who benefit from valuable, viable knowledge. 
  • Nurses are knowledge engineers, designing, developing, implementing and maintaining knowledge. 
  • Nurses are knowledge managers, capturing and processing collective expertise and distributing it where it can create the largest benefit. 
  • Nurses are knowledge developers or generators, changing and evolving knowledge based on the tasks at hand and information available. 
  • Information is processed data that has meaning:
Types of data: 
1. alpha 
2. numeric 
3. audio 
4.image data

  • Alphanumeric data that we are concerned with is in the form of our patient’s name, ID or medical record numbers. 
  • Image data would include graphics and pictures such as graphic monitor displays or recorded Electrocardiograms, X-rays, MRIs and CT scans 
  • Video data refers to animations, moving pictures or moving graphics. 
  • Data integrity can be compromised through : 
    • human error 
    • viruses 
    • worms, or other bugs 
    • hardware failures or crashes 
    • transmission errors 
    • hackers entering the system 
  • Information technologies can help to decrease these errors by putting safeguards in place such as backing up files on a routine basis, error detection for transmissions and developing user interfaces that help people enter the data correctly. 
  • It is imperative that we have clean data if we want quality information. 
Characteristics :
  1. transparency 
  2. reproducible 
  3. secure 
  4. accurate 
  5. complete 
  6. has utility 
  7. verifiable 
  8. accessibility 
  9. timely 
  10. relevant 
  11. flexible 
  12. reliable 
  13. objective 

Two ways in acquiring information 
  1. actively looking for it 
  2. having it conveyed to us by our environment. 
  • Currently, we receive information from : 
  1. computers (output) 
  2. through our vision, hearing or touch (input) 
  3. we respond (output) 
  4. to the computer (input) 
this is how we interface with technology. 
Information Science
  • Information science can be thought of as the science of information, studying the application and usage of information and knowledge in organizations and the interfacings or interaction between people,organizations and information systems. 
  • Information science is primarily concerned with the input, processing, output, and feedback of data and information through technology integration with a focus on comprehending the perspective of the stakeholders involved and then applying information technology as needed
Information Processing
•Information science enables the processing of information. 
•Humans are organic information systems constantly acquiring, processing and generating information or knowledge both in our professional and personal lives. 
•Information is data that is processed using knowledge. 
•In order for information to be valuable, it must be accessible, accurate, timely, complete, cost-effective, flexible, reliable, relevant, simple, verifiable and secure. 

Information Science and The Foundation of Knowledge
  • Information science is a multidisciplinary science that involves aspects from computer science, cognitive science, social science, communication science and library science to deal with obtaining, gathering, organizing, manipulating, managing, storing, retrieving, recapturing, disposing of, distributing or broadcasting information. 
  • Information science studies everything that deals with information and can be defined as the study of information systems.
  • This science originated as a sub-discipline of computer science, in an attempt to understand and rationalize the management of technology within organizations.
  • Information science impacts information interfacing, influencing how we interact with information, and subsequently develop and use knowledge.
  • Healthcare organizations have been profoundly affected by the evolution of and rely on information science to enhance the recording and processing of routine and intimate information while facilitating human-to-human and human-to-systems communications, delivery of healthcare products, dissemination of information and enhancing the organization’s business transactions.
  • Information science has had a tremendous impact on society and will expand its sphere of influence as it continues to evolve and innovate human activities at all levels, especially the nature of our work.
  • Information and information technology have become major resources for organizations and healthcare is no exception. 
  • Information technologies help to shape the healthcare organization, in conjunction with the personnel or people, money, materials and equipment.
Introduction to Information Systems 
  • In healthcare, information systems must be able to handle the volume of data and information necessary to generate the needed information and knowledge for best practices, the basis of our actions, since our goal is to provide the highest quality of patient care.
Information System ( IS’s ) 
  • Information systems can be manually-based but for the purposes of this text, we are referring to computer-based information systems. 
  • IS’s are designed for specific purposes within organizations. 
  • The IS’s capability to disseminate, provide feedback and adjust the data and information based on these dynamic processes are what sets them apart from other computer systems. 
  • Processing, the retrieval, analysis and/or synthesis of data, refers to the alteration and transformation of the data into helpful or useful information and outputs. 
  • The processing of data can range from storing it for future use to comparing the data, making calculations or applying formulas, to taking selective actions. 
  • Outcomes are the expected results of input and processing. 
  • Output devices are combinations of hardware, software and telecommunications and include sound and speech synthesis outputs, printers and monitors. 
  • The IS must also be able to generate payment either electronically or by generating a bill, and storing the transactional record for future use.
  • Feedback or responses are reactions to the inputting, processing and outputs. 
  • In ISs, feedback refers to information from the system that is used to make modifications in the input, processing actions or outputs.

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