Module 1: Nursing Informatics

DEFINITIONS OF NURSING INFORMATICS

• GRAVES & COCORAN (1989) 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.

• TURLEY (1996) added another discipline, cognitive science, to the base for nursing
informatics. Cognitive science emphasizes the human factor in informatics. Its focus is the
nature of knowledge, its components, development, and use.

• ANA (2001) This specialty combines nursing, information, and computer sciences for the
purpose of managing and communicating data, information, and knowledge to support
nurses and healthcare providers in decision making.

• ANA (2008) NI is a specialty that integrates nursing science, computer science, and
information science to manage and communicate data, information, knowledge, and
wisdom in nursing practice.

• ANA (2015) NI supports consumers, patients, the interprofessional healthcare team, and
other stakeholders in their decision making in all roles, and settings to achieve desired
outcomes. This support is accomplished using information structures, information
processes, and information technology.

ANA states that the goal of NI is to optimize information management and communication
to improve the health of individual, families, population, and communities.

One of the main objectives of NI in the clinical area: To integrate data from all areas
pertinent to nursing care and present it in a manner that enables the clinical nurse to provide
quality care.

Overall goal of NI: To optimize information management and communication to improve

individual healthcare and the health of populations (ANA, 2015).

JUSTIFICATIONS WHY NI IS IN THE BSN CURRICULUM

• Mandated by CHED CMO 15 series of 2017– BSN Curriculum (Since CMO5, series of 2008)

• One of the 6 competencies according to Quality and Safety Education for Nurses (QSEN)

• One of the five core competencies healthcare provider should possess according to the
Institute of Medicine (IOM, 2003)

• The Technology Informatics Guiding Education Reform (TIGER) Initiative is designed to

address a set of skills that is needed by all nurses who will practice in the profession in the
21st century. The skill set includes informatics competencies that range from basic
computer skills to advanced-level information technology and literacy competencies
and expertise.
NURSING INFORMATICS EVOLUTION
The use of computers in healthcare started in the 1960s, mostly in financial areas, but with
the advance in computing power and the demand for clinical data, as nurses we are
using computers more and more in clinical areas. With this growth has come a change in
focus for information systems from providing solutions for just one process to an enterprise-
wide patient-centered system that focuses on data. This new focus provides the
functionality that allows the use of one piece of data in multiple ways. To understand and
work with clinical systems, as well as to fulfill other professional responsibilities, nurses need
to be computer fluent, information literate, and informatics knowledgeable.

How automated information system grew in the Philippines (Dicioco, 2010)

• early 1970s – first personal and network-ready computer systems started to appear in the
healthcare community exclusively used in business and accounting (automation of billing).

• mid 1970s – hospital networks expanded to include the information processed in the
admission, discharge, and transfer (ADT).

• late 1970s – networks further expanded to include pharmacy section. An integrated system
was formed connecting the three big departments (accounting, ADT, and pharmacy).

• early 1980s – the laboratory and imaging departments, with their special computers,
attempted to connect to the main integrated system but to no avail due to compatibility
reasons (remained to be stand-alone systems).

• mid 1980s – the integrated system expanded to clinical area. It is believed that NI started
during this period. Nursing clinical information systems were implemented and automated
the process of order entry.
- Nurses entered orders on medication and lab exams that are promptly transmitted to the
pharmacy and lab departments, respectively.
- They also entered request for linens and supplies that are immediately transmitted to the
central supply room.

• mid-late 1990s – hospitals bought conversion software and hardware from same vendor
who delivered the laboratory and imaging machines to link their stand-alone systems to
the main system creating interfaced systems.

• mid-2000s – laboratory information system (LIS) and radiology information system (RIS)
started to encroach into the main hospital information system (HIS) that are developed
with more flexible programing languages.

• late 2000s – the Philippine Heart Center (PHC) implemented the internet-based hospital
information system (HIS). This allows their healthcare team to access automated HIS
everywhere anytime through internet.

• Other hospitals in greater manila area followed: St. Luke’s Medical Center, Chinese
General Hospital (2008); National Kidney Institute, University of Santo Tomas Hospital, The
Medical City, Philippine General Hospital, Asian Hospital, Makati Medical Center, Lung
Center of the Philippines, Dela Salle University Medical Center (2009)

• Locally, the Baguio General Hospital and Medical Center, and Saint Louis Hospital of the
Sacred Heart have been using EMR as early as 2018.
THEORIES IN NURSING INFORMATICS

Nursing informatics Theory is concerned with the representation of nursing data, information,
and knowledge to facilitate the management and communication of nursing information
within the healthcare milieu.
Graves and Cocoran (1989), devised an information model for NI based on Bloom’s
taxonomy. This model identified data, information, and knowledge as the key components
of NI. Nelson & Joos (1992), Wisdom was added to this structure by shortly thereafter, but it
was ANA (2008) that officially incorporated wisdom into the nursing informatics model.

Data: are discrete, objective facts that have not been interpreted (Clark, 2010), or
are out of context; they are at the atomic level. Data are described objectively
without interpretation. They are the building blocks of meaning but lack context
and hence meaningless. Example: 80, 90, 110, 140

Information: is data that have some type

of interpretation or structure; that is, it
has a context. It is derived from
combining pieces of data (Clark, 2010).
A set of data, such as vital signs. When
interpreted over a period is information.
Example: Patient’s blood sugar taken at
several time interval

Knowledge: is a synthesis of information

with relationships identified and
formalized. It changes something or
somebody by creating the setting for
formulating possible effective actions,
evaluating their effects, and deciding
on the required action (Clark, 2010).
Example: Patient’s blood sugar level is
increasing beyond the normal range

Wisdom: is achieved through evaluating knowledge with reflection. It involves

seeing patterns and metapatterns and using them in different ways and knowing
when and how to apply knowledge to situations (ANA, 2015). Example: Refer to
physician; administer insulin as ordered.

Change theories

1. Rogers diffusion of innovation theory – this theory examines the pattern of acceptance
that innovations follow as they spread across the population and the process of
decision making that occurs in individuals when deciding whether to adopt an
innovation.
Societal changes: Rogers classifies people into 5 categories to view how innovations
are accepted by the general population (Individual change will not be discussed)
a. Innovators – readily adopt the innovation (2.5% of the population)
b. Early adopters – they are respectable opinion leaders who functions as promoters
of an innovation (13.5%)
c. Early majority – averse to risk but will make safe investments (34%)
d. Late majority – need to be sure that the innovation is beneficial. They may adopt
the innovation not because they see a use for it, but because of peer pressure (34%)
e. Laggards – they are suspicious of innovations and change and are quite resistant
(16%)
2. Lewin’s field theory – provide a guide to helping individuals achieve a positive decision
in relation to an innovation. Lewin divides changes into 3 stages of force fields:
a. Unfreezing – is based on the idea that a balance of driving and restraining forces
that creates equilibrium supports human behavior. To unfreeze, one must identify
and change the balance so that the driving forces are stronger than the
restraining forces. Driving forces can be involvement in the process, respect of
one’s opinion, and continuous communication during the process. Ultimately,
restraining forces are harder to identify and treat because they are often personal
psychological defenses or group norms embedded in the organizational or
community culture.

b. Moving – in this stage, the planned change is implemented. This is not a

comfortable period, and movement can occur in the wrong direction. Thus, it is
important to have the support of the administration in the planning process,
involve users so that the system serves them instead of creating more work,
thoroughly test the system before implementation for both bugs and usability,
provide adequate training, and deal with any implementational problems
immediately.

c. Refreezing – in this stage, equilibrium returns as the planned change become the
norm and it is surrounded by the usual driving and restraining forces. For this state
to occur, individuals need to feel confident with the change and feel in control
of the procedures involved in the new methods.

ROLE OF NURSE INFORMATICIST

Roles Responsibilities

Plans, coordinates, and facilitates education for all computer applications and
Systems
computer software for all user groups; develops and trains all user groups on
educators
clinical computer applications and online documentation processes

Information
Assesses the needs and opportunities for nurses with technology. Looks at both
Technology
the functional and operational needs of clinical users when using the system
Nursing
and translate these needs into information technology specific solutions
Advocate

Supports the system in each unit. Assist users with functionality, procedural
Superuser issues, and basic trouble shooting, often holds a clinical position in the assigned
unit

May work ay many different levels from the unit to the full agency. Acts as a
System
link between nursing and information services and is both a nursing resource
Specialist
and a representative

Clinical Systems Responsible for coordinating aspects of planning, design, development,

Coordinator implementation, maintenance, and evaluation of the clinical information
/analyst system. Troubleshoots issues with systems. Supports a clinical system

ROLE OF INFORMATICS NURSE SPECIALIST (w/ graduate degree in IN)

Roles Responsibilities

Plans and implements an informatics project. Must be able to

communicate effectively with all levels of management, users, and system
Project
developers. Must also be cognizant of all factors involved in the project
manager
including, but not limited to, managing change, assessing the need for the
new project, and planning for its implementation
 Provides expert advice, opinions, and recommendations from consultant’s
area of expertise. Must be able to analyze what the client wants, as well
Consultant
as what is needed, and integrate these to create what is possible,
technologically, and politically.

Facilitates the development, implementation, and integration for an

Director of
agency information system. Assist in developing the strategic and tactical
clinical
plans of the system. Develops plan for implementation and gaining
informatics
acceptance of systems

Uses informatics to create new knowledge. Encompasses research in any

area of nursing informatics. May be involve in basic research on the
symbolic representation of nursing phenomena, clinical decision-making,
Researcher
or applied research of information systems. Could be involved in
developing decision support tools for nursing or models of representation
for nursing phenomena

Participates in the development of new information system including

Product
designing, developing, and marketing of informatics solutions for nursing
developer
problems. Must understand the needs of both business and nursing

Contributes to health policy development by identifying nursing data, its

Policy availability, structure, and content, which are used to determine health
developer policy. These policies encompass not only information management but
also health infrastructure development and economics

Analyzes nursing information needs in clinical areas, education,

Entrepreneur
administration, and research; develops and markets solutions

Four levels of informatics competencies for practicing nurses (Stagger et al, 20021, 2002):
Skills needed by all nurses: Computer fluency and information literacy.

1. The beginning nurse should possess basic information management and computer
technology skills. Accomplishments should include the ability to access data, use a
computer for communication, use basic desktop software, and use decision
support systems.

2. Experienced nurses should be highly skilled in using information management and

computer technology to support their major area of practice. Additional skills for the
experienced nurse include being able to make judgements on the basis of trends
and patterns within data elements and to collaborate with informatics nurse
specialists to suggest improvements in nursing systems.

3. The informatics nurse specialist should be able to meet the information needs of
practicing nurses by integrating and applying information, computer, and nursing
sciences.

4. The informatics nurse innovator will conduct informatics research and generate
informatics theory.