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NCM 110 NURSING INFORMATICS
INTRODUCTION TO NURSING INFORMATICS
NURSING INFORMATICS
Informatics is the science and art of turning data into
information (Bemmel and Musen, 1997)
INFORMATICS
Healthcare Information and Management Systems
Society (HIMMS),2019)
Study of the structure, behavior, and interactions of
natural and engineered computational systems.
Studies the representation, processing, and
communication of information in natural and
engineered systems.
Has computational, cognitive, and social aspects.
HEALTH INFORMATICS
US National Library of Medicine, 2014
Interdisciplinary study of the design, development,
adoption, and application of IT-based innovations in
health care services delivery, management, and
planning
NURSING INFORMATICS (American Nurses Association,
2001)
American Nurses Association, 2001
A specialty that integrates nursing science, computer
science, and information science, to manage and
communicate data, information, and knowledge in
nursing practice.
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 using
information structures, information processes, and
information technology.
Computer science, information science, and nursing
science combined 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 (Canadian Nurses Association,
2018)
Canadian Nurses Association, 2018
Practice and science of integrating nursing
information and knowledge with technology to
manage and integrate health information.
Goal: improve health of people and communities
while reducing costs.
NURSING INFORMATICS (ANA 2019 ; HIMSS, 2019)
“Specialty that integrates nursing science with
multiple information and analytical sciences to
identify, define, manage and communicate data,
information, knowledge and wisdom in nursing
practice.”
HISTORICAL PERSPECTIVES IN NURSING
INFORMATICS
Nursing informatics emerged as a response to the
innovations and development in technologies in the
health care industry and in nursing practice.
SIX (6) IMPORTANT TIME PERIODS IN THE HISTORY OF
NURSING INFORMATICS
1. Before the 1960s
2. The 1960s
3. The 1970s
4. The 1980s
5. The 1990s
6. After 2000s
BEFORE THE 1960S
Computers were initially used in the health care
facilities for basic business office functions.
Early computers used punch cards to store data and
card readers to read computer programs, sort and
prepare data for processing.
Computers used around the 50s to 60s
THE 1960S
Studies were conducted to determine the effective
utilization of the computer technology in health care
industry and to identify the areas of nursing that needs
to be automated.
Hospital Information Systems (HIS) were developed
primarily to process financial transactions and serve as
billing and accounting systems.
THE 1970S
Nurses recognized the computer’s potential for
improving documentation of nursing practice, the
quality of patient care and the repetitive aspects of
managing patient care.
Nurses assisted in designing several mainframes for
the Health Information Systems (HIS)
Computers used in financial and management functions
were perceived as cost-saving technologies.
Many of the early Health Information Systems (HIS)
were developed and funded by contractors and grants
from federal agencies in the United States.
THE 1980S
Nursing informatics became an accepted specialty and
many nursing experts entered the field.
Discharge planning systems were developed and used
as referrals to community health care facilities in the
continuum of care.
Microcomputers/PCs emerged in this period.
THE 1990S
In 1992, Nursing Informatics was approved by the
American Nurses Association (ANA) as a new nursing
specialty. (McCormick, et al., 1994)
This was the period that brought laptops and notebooks
to the bedside and all the point-of-care settings.
Local Area Networks (LANs) were developed for
hospital nursing units. Wide Area Networks (WANs)
were developed for linking care across health care
facilities. Internet was also started to be used.
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NCM 110 – NURSING INFORMATICS

INTRODUCTION TO NURSING INFORMATICS

NURSING INFORMATICS

  • Informatics is the science and art of turning data into information (Bemmel and Musen, 1997) INFORMATICS
  • Healthcare Information and Management Systems Society (HIMMS),2019)
  • Study of the structure, behavior, and interactions of natural and engineered computational systems.
  • Studies the representation, processing, and communication of information in natural and engineered systems.
  • Has computational, cognitive, and social aspects. HEALTH INFORMATICS
  • US National Library of Medicine, 2014
  • Interdisciplinary study of the design, development, adoption, and application of IT-based innovations in health care services delivery, management, and planning NURSING INFORMATICS (American Nurses Association, 2001)
  • American Nurses Association, 2001
  • A specialty that integrates nursing science, computer science, and information science, to manage and communicate data, information, and knowledge in nursing practice.
  • 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 using information structures, information processes, and information technology.
  • Computer science, information science, and nursing science combined 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 (Canadian Nurses Association, 2018)
  • Canadian Nurses Association, 2018
  • Practice and science of integrating nursing information and knowledge with technology to manage and integrate health information.
  • Goal: improve health of people and communities while reducing costs. NURSING INFORMATICS (ANA 2019 ; HIMSS, 2019)
  • “Specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage and communicate data, information, knowledge and wisdom in nursing practice.” HISTORICAL PERSPECTIVES IN NURSING INFORMATICS
  • Nursing informatics emerged as a response to the innovations and development in technologies in the health care industry and in nursing practice. SIX (6) IMPORTANT TIME PERIODS IN THE HISTORY OF NURSING INFORMATICS
  1. Before the 1960s
  2. The 1960s
  3. The 1970s
  4. The 1980s
  5. The 1990s
  6. After 2000s BEFORE THE 1960S
  • Computers were initially used in the health care facilities for basic business office functions.
  • Early computers used punch cards to store data and card readers to read computer programs, sort and prepare data for processing. Computers used around the 50s to 60s THE 1960S
  • Studies were conducted to determine the effective utilization of the computer technology in health care industry and to identify the areas of nursing that needs to be automated.
  • Hospital Information Systems (HIS) were developed primarily to process financial transactions and serve as billing and accounting systems. THE 1970S
  • Nurses recognized the computer’s potential for improving documentation of nursing practice, the quality of patient care and the repetitive aspects of managing patient care.
  • Nurses assisted in designing several mainframes for the Health Information Systems (HIS)
  • Computers used in financial and management functions were perceived as cost-saving technologies.
  • Many of the early Health Information Systems (HIS) were developed and funded by contractors and grants from federal agencies in the United States. THE 1980S
  • Nursing informatics became an accepted specialty and many nursing experts entered the field.
  • Discharge planning systems were developed and used as referrals to community health care facilities in the continuum of care.
  • Microcomputers/PCs emerged in this period. THE 1990S
  • In 1992, Nursing Informatics was approved by the American Nurses Association (ANA) as a new nursing specialty. (McCormick, et al., 1994)
  • This was the period that brought laptops and notebooks to the bedside and all the point-of-care settings.
  • Local Area Networks (LANs) were developed for hospital nursing units. Wide Area Networks (WANs) were developed for linking care across health care facilities. Internet was also started to be used.

AFTER THE 2000S

  • Clinical Information Systems became individualized in the electronic patient record (EPR) or also known as electronic health record.
  • The internet has also provided a means for development of clinical applications.
  • Home health care has also increasingly partnered information technology for the provision of patient care.
  • Telenursing is increasing in popularity and providing patient care in an efficient. NI PHILIPPINE EVOLUTION
  • Pe Benito, n.d.
  • 1999: Development of Standards for health Information in the Philippines (SHIP)
  • 2005: Formation of Master of Science in Health Informatics
  • 2009: CMO No. 14. Policies and Standards for BSN – Informatics (2/1) is offered as part of the Math, Nat Sci & IT
  • 2010: Formation of the Philippine Nursing Informatics > Sub-specialty organization of PNA for nursing Informatics
  • 2017: CMO 15 – CHED Policy, Standards f and Guidelines for BSN Program WHY THE TREND TOWARDS INFORMATICS (HIMSS, 2 018)
  • Increasingly present in our profession due to changing and advancing technology.
  • Health care systems are integrating technology daily practice at very fast pace.
  • Security and patient privacy must be upheld while achieving the goal of transforming data into useful knowledge. ADVANTAGES OF NI ü Shared data ü Centralized control ü Disadvantages of redundancy in control ü Improved data integrity ü Improved data security & database systems ü Flexible conceptual design ROLE OF INFORMATICS IN NURSING? (HIMSS, 2014)
  • Help identify potential problems earlier
  • Identifying changes in patient status can occur quickly
  • Information is readily available
  • Data are interpreted, systematized, and arranged
  • Formalize an appropriate plan of action
  • Aligns nursing best practice with clinical workflows & care
  • Improves clinical policies, protocols, processes & procedures
  • Strengthen nurses ’clinical decision-making skills
  • Enhance nursing practice
  • Quicker access to patient information
  • Improve overall efficiency
  • Reduction in potential errors
  • Has potentia l to change nursing practice for the better – patient care delivery META STRUCTURES OF NURSING INFORMATICS
  • Data
  • Information
  • Knowledge
  • Wisdom DATA
  • Raw, uninterrupted fact, without meaning
  • Building blocks to create information INFORMATION
  • Group of data elements that have been organized and processed so that one can interpret the significance of the data elements.
  • Data and Information are both building blocks in producing knowledge. KNOWLEDGE
  • Built on a formalization of the relationships and interrelationships between data and information.
  • This is the part where you understand the information. WISDOM
  • Knowledge used to make appropriate decisions and acting on those decisions.
  • It is the appropriate use of data, information, and knowledge in making decisions and implementing nursing actions. NURSING INFORMATICS AS A SPECIALTY ROLES
  • Theory development
  • Analysis of information needs
  • Selection of computer systems
  • Design of computer systems and customizations
  • Testing of computer systems
  • Training users of computer systems
  • Education of users on information policies
  • Evaluation of the effectiveness of computer systems
  • On-going maintenance and enhancements
  • Identification of computer technologies that can benefit nursing
  • Compliance with regulatory requirements for information handling
  • Project management
  • Research NURSING INFORMATICS
  • Is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge 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 OPERATIONAL HEALTH SYSTEMS Nurses and Midwives have the best knowledge about the workings of the health systems in terms of:
  • Information and communication flows
  • Patient journeys through each episode of care

NCM 110 – NURSING INFORMATICS

DISCIPLINES WITH INFLUENCE ON NURSING INFORMATICS

THE NURSING INFORMATICS MODEL

INFORMATION SCIENCE

  • Include information technology which involves the process of sending and receiving information and understanding how the organizational environments are structured and how information flows in that environment
  • Enables the processing of information. This processing links people and technology
  • Impacts information interfaces, influencing how people interact with information and subsequently develop and use knowledge INFORMATION SCIENCE
  • Deals with the interchange (or flow) and scaffolding (or structure) of information and involves the application of information tools for solutions to patient care and business problems in health care
  • To use and synthesize information effectively, one must be able to: o Obtain o Perceive o Process o Synthesize o Comprehend o Convey o Manage the information COMPUTER SCIENCE
  • Development, configuration, architecture of computer hardware and software
  • Everything that occurs in informatics derives from insights and changes in computer technology, which is the core of both teaching and understanding informatics NURSES AND COMPUTER TECHNOLOGY Computer systems assists nurses to provide quality care:
  • Computer enable nurses to quickly access important information about the patient’s health or illness and treatment plan from the electronic health record which helps them monitor recovery process over time.
  • Enables nurses to access information such as laboratory tests and x-ray results and health reports from other health-care team members to formulate the optimal plan of care
  • Enable nurses to record health information, treatment, medications, and progress for ready access and use by other health team members
  • Enables nurses to use the computer to search drug databases, libraries, and best practice resources to obtain important related to the patient’s diagnosis and care of find health education information for the patient. COMPUTER SCIENCE
  • Deals with understanding the development, design, structure, and relationship of computer hardware and software
  • Offers valuable tools that can facilitate the acquisition and manipulation of data and information by nurses
  • How? – by synthesizing the resources into ever- evolving knowledge and wisdom base
  • The development of knowledge tools like: o Automation of decision making o Strides in artificial intelligence
  • The ability to structure knowledge electronically facilitates the ability to share knowledge structures and enhance collective knowledge. CONCEPTS AND TOOLS FROM INFORMATION SCIENCE AND COMPUTER SCIENCE
  • Information management – an elemental process by which one files, stores, manipulates, and reports data for various uses
  • Information communication – enables systems to send data and to present information in formats that improve understand
  • Information structures – organize data, information, and knowledge for processing by computers
  • Information technology – includes computer hardware, software, communication, and network technologies, derived primarily from computer science. Its use distinguishes informatics from more traditional methods of information management COGNITIVE SCIENCE
  • Is an interdisciplinary field that results from the convergence of psychology, linguistics, computer science, philosophy, and neuroscience
  • The focus of cognitive science is understanding of the mind and the phenomena the mind addresses
  • From perception to thinking, understanding, and remembering
  • The traditional and widely accepted definition of NI advanced by Graces and Corcoran (1989) is that Ni is a combination of nursing science used to describe the processes nurses use to manage data, information, and knowledge in nursing practice
  • Turley (1996) proposed the addition of cognitive science to this mix, as nurse scientists are seen to strive to capture and explain the influence of the human brain on data, information, and knowledge processing and to elucidate how these factors in turn affect nursing decision making
  • Connectionism is a component of cognitive science that uses computer modeling through artificial neural networks to explain human intellectual abilities
  • Deals with how human mind functions
  • Encompasses how people think, understand, remember, synthesize and access stored information and knowledge
  • The nature of knowledge, including how was it developed, used, modified, and shared provides the basis for continued learning and intellectual growth.

NCM 110 – NURSING INFORMATICS

RELEVANT THEORIES AND CONCEPTS IN NURSING

INFORMATICS

GENERAL SYSTEMS THEORY

  • One of the oldest theories
  • Explains that systems are complex and intricate yet held commonalities
  • Emphasizes the interactions of the various parts of systems, instead of individual parts
  • Can be physical structures (education, financing, etc.), manual (patient’s hygiene, baking a cake etc) or those that are electronic or computerized (electronic medical record, automatic medication dispensing, etc)
  • It’s premise – the whole is greater than the sum of its parts
  • There are three main components – input, throughput, and output o Input – where raw data enters the system o Throughput – involves the processes used in managing information o Output – resulting end-product of the processed information
  • Example: Hospital System
  • The admission and registration process and how they relate to wait time, patient satisfaction and the quality of care
  • The interrelationships are more relevant than each of the processes as separate
  • Each part is relevant but only to the extent that it influences the efficient and effective flow of patients into the system Other assumptions in the general systems theory that need mentioning:
  • There is a purpose for the system that needs to be achieved
  • There are structures, functions, and tasks within the system that are meant to be carried out efficiently and effectively in order to achieve the purpose of the system
  • The structure also follows the function, with specifications and attributes designed to meet the expectations
  • There is dynamic homeostasis or the capability to maintain stability or equilibrium
  • There is entropy or the tendency to break into its smallest parts
  • There is also negentropy or the likelihood to grow big and complex
  • The system has the capacity for specialization or the ability to be unique and differentiate from the whole
  • There is also reverberation which makes changes cut across the entire system
  • There is equifinality or the ability to reach the same end despite varying beginning points COMMUNICATIONS THEORY SHANNON AND WEAVER’S INFORMATION- COMMUNICATION MODEL (1949)
  • As we communicate, there are various channels that our information goes through. The model as overly simplistic (Al-Fedaghi, 2012)
  • It provides an easy conceptual and visual model that is easily understood in order to demonstrate its relationship to nursing informatics and the work of nurses
  • Nurses spend 90% of their work schedule communication – verbally, written or through behavioral cues
  • Manual or electronic, the model remains a good framework use in explaining how things can go well or wrong CHANGE THEORIES LEWIN’S THEORY OF PLANNED CHANGE
  • For planned change
  • Has three distinct steps: unfreezing, moving, and refreezing o Unfreezing
  • is creating an imbalance or some form of distraction to shake up the status quo between the driving forces (motivators for change) versus the restraining forces (factors that resist change)
  • the unfreezing stage is such a crucial step in the change process because it creates some form of conflict that makes the scenario conducive to questioning the status quo
  • Once the imbalanced is created, it is somewhat easier to influence change or to encourage resistors to consider and embrace the change. Once this is achieved, the second step sets in – moving, or altering forces o Moving – is when the actual change occurs, if prior to moving the restraining forces are stronger, at this stage, they have now become susceptible to change
  • Change is then adopted and the driving forces become more dominant. However, for change to stick, the third step has to set in – o Refreezing , or assuring that change has indeed occurred and has been adopted ROGER’S DIFFUSION OF INNOVATION THEORY
  • For unplanned change
  • When planned accordingly and done correctly, Lewin’s model works best in effectuating change. When introducing computer applications to healthcare staff and professionals, this is often helpful since it is a long process and there is more time to pump up the driving forces and weaken the restraining forces by holding many meetings, open town hall discussions of the pros and cons of the change. There is more opportunity to hear both sides and weigh the advantages and disadvantages Five (5) groups of Individuals that an individual need to work with: Each group has its own characteristics, and the strategies to influence the adoption of change naturally differ from group to group
  1. Innovators – 25%; hear what the change is and its benefits – no need to convince them, quick to embrace change
  2. Early adopters – 13.5% - ask some questions but generally adopts change
  3. Early majority – 34% require a bit more convincing – have some questions
  4. Late majority – 34 % - they dilly-dally – have a lot more questions, refuse to comprehend the need for change
  5. Laggards – 16% - hard core resistors, avoid accepting change