SEMINAR ON ELECTRONIC NURSING

INTRODUCTION OF NURSING INFORMATICS

An international viewpoint was adopted at the 1998 meeting of the international medical informatics association workgroup on nursing informatics in Seoul, Korea; nursing informatics is the integration of nursing, its information and information management with information processing and communication technology, to support the health of people worldwide.(p-1)

DEFINITION OF NURSING INFORMATICS

Nursing informatics is a specialty of medical informatics (referred to in the broader sense as health informatics or health) and deals with the support of nursing by information systems in delivery, documentation, administration and evaluation of patient care and prevention of diseases. (.p-1)

NURSING INFORMATICS HISTORY

For three decades or more nurses have held informatics roles and been key state holders in developing, implementing, and evaluating informatics solutions. Although implementing informatics solutions continuous to be very important, more recently informatics nurse specialists have worked to develop and refine nursings language, implement telehealth systems, establish NI educational programs and expand the focus. (.p-2)

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How It All Began Late 1960s first computer systems were implemented in hospitals. Computer nurses began to appear in hospitals. 1. Excellent clinicians. 2. Technically curious and willing to try new things.

NEW DEFINITION OF NURSING INFORMATICS-ANA

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. Nursing informatics 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. (P-2).

FUTURE OF NURSING INFORMATICS AND GOAL OF NURSING INFORMATICS

Emerging roles CIO, entrepreneurs, product developers, web design, independent consultants. Challenges 1. Integration of data- duplication often. 2. Inability to access data for decision making. 3. Unique distinctions between roles have not been defined-competence.

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4. The goal of nursing informatics is to improve

the health of populations, communities, families, and individuals by optimizing information management and communication. This includes the use of technology in the direct provision of care, in establishing effective administrative systems, in managing and delivering education experiences, in supporting lifelong learning, and in supporting nursing research. (P-3).

BENEFITS OF NURSING INFORMATICS

More time spent with patient and less

time at nurse station. Reduce paperwork/paper loss. Automated tools of nursing documentation. Accurate logging of nurses activities. Uniform standards of nursing care are programmed (nursing process). Cost reduction (fewer losses). Decide if it is a local or a global system; may be used for benchmarking. (P-4).

INITIAL GOALS OF THE E-NURSING STRATEGY

Advocating for nurses access to ICT and the resources required to integrate ICT into nursing practice; Supporting the development and implementation of nursing informatics

competencies among the competencies required for entry-to-practice and continuing competence; Advocating for the involvement of nurses in decision- making about information technology and information systems. (Canadian nursing association, 2006, P-36).

PURPOSE OF THE E-NURSING STRATEGY

The purpose of the e-nursing strategy is to guide the

development of ICT initiatives in nursing to improve nursing practice and client outcomes (Canadian nurses association, 2006, P-7) Consider nurses in all domains of practice-clinical practice, education, research, administration and policy. Identify what nurses need, take advantage of existing quality products and programs, and reduce duplication of effort. Benefit individual nurses and their clients, employers, nursing professional and regulatory organizations and the nursing profession as a whole, nationally and around the world. (P-10).

E-NURING MANAGEMENT
E-nursing management suite is a fully fledged solution which automates the day-today processes in your nursing care facilities: from the patients application, admission process, tracking daily health status, all the way to the invoicing and payment transactions for month-end billing consolidation. You will be able to have a comprehensive solution that is a specifically designed to meet the needs of facilities that provide long-term care to patients.

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Patient application Capture patient bio data, medical condition and important contact information details. You will also be able to capture the latest MEANS testing and RAF information. With these, you will be able to ascertain the level of suitability of patient as well as the potential means of yours organization in caring for the patient.

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Patient administration and management

Administration work can be easily streamlined in Task hub. From admission preparation, bed assignment, norm charges details, patient care plan management and billing, all these functions can be easily accessed by your team. Real-time, anytime, anywhere. Staff Rostering Working on lean resources? Perform effective planning of staff roaster and functional duties scheduling so as to optimize your staff and at the same time, achieve optimal staff to resident ratio.

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Nurse schedule inquiry To lighten the already taxing demand of your healthcare specialists. Task hubs nursing management suite allows your nurses to perform real-time inquiries on tasks required for the shift, instead of having the need to remember what needs to be done. This will allow your staff greater control of their tasks for the day and what is the respective status for duties to be carried out.

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Daily nursing assessment

Critical patient details can be captured realtime and electronically. Designed to meet the common requirement of most inpatient care facilities, documentation of the patients input (e.g.; food, medication ) and output (e.g.; bowel movement, urine, vomit us ), vital signs like blood pressure, heart rate, etc, could be taken down in our system.

Cond Patient billing

With all information recorded in the system, billing could be performed easily, with human errors being reduced.

Global accounts payable management

This system allows user to review at the corporate headquarter level, the list of outstanding supplier invoices versus the fully paid invoices, across individual entities. Hence, this helps your finance department better manage the payables and cash flow matters within your organization. (P-3-4).

PRE-REQUISITES OF IMPLEMENTATION OF E-NURSING DOCUMENTATION (ACCORDING TO MOH)

A management committee would review the

collection of data. Each department clinical/ non clinical should decide type of data it requires. The committee review then advise the IT of hospitals overall requirement. The IT department will manage the software and hardware necessary to fulfill the requirements. Develop a strategic plan of the hospital to implement the system. Develop policies and procedures.(P-4).

IMPLEMENTATION OF E-NURSING DOCUMENTATION (ACCORDING TO MOH)

Organize education and training for users. Offers day to day assistance for hardware and

software troubleshooting. Grant right of access for staff to specific data bases. Use password system to safeguard confidentiality. Develop a maintenance system for equipment failure, contingency plans and back up of vital data. Regular software/ hardware audits should be conducted to develop corrective plan. (P-4-5).

ELECTRONIC NURSING DOCUMENTATION STANDARDS As technology continues to advance changes in the way nurses document the care they give has changed. Nurses are now required to electronically document all procedures, medications and services provided to every patient. (P-8). REASONS FOR ELECTRONIC DOCUMENTATION, NURSING DOCUMENTATION ROLE 1. According to a study conducted by the Maryland nursing workforce commission, there were a number of problems with traditional paper documentation all care given. It was found that documentation was often redundant, and time spent on documentation was taking away a nurses time for direct patient care. Additionally, nurses found themselves working overtime to complete documentation. As such, electronic documentation was found to be more effective.

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2. According to the college of registered nurses of

British Columbia, nurses need to document all data in a timely manner. Nursing documentation should include a nursing care plan, patient demographic data, assessment sheets, vitals, patient risk management, patient care flow sheets, pain management and a discharge plan. 3. By timely and correctly documentation electronic records, information is now readily available around the clock. The information is secure, timely and accurate. Doctors and nurses are able to see what care was given and continue on the correct path, guaranteeing a better patient outcome. Electronic documentation increases clinician workflow. (P-89).

EVALUATION OF ELECTRONIC NURSING RESOURCES

Electronic nursing resources can improve nursing performance and skills. Choosing electronic resources for use by the nursing staff is an important and expensive venture for any health care organization. Electronic resources must fit the needs of the nursing staff as they provide care to their patients. The program needs to support the nurses work. The resources must be flexible enough to grow and adapt as needed and produce meaningful reports. (P-5).

PROGRAMS OF ELECTRONIC NURSING DOCUMENTATION SYSTEM This application utilizes the Omaha system; a standardized classification system recognized by the American nurses association .the PHN program utilizes such information technology in order to link nursing practice, service data, health information and knowledge, pertinent to citizens current and emerging health needs. Program commitment to the utilization of information technology tools has supported standardized clinical documentation; improved clinical management; public health outcomes measurement; and preparation for program pursuit of CHAPS accreditation. (P-37).

E-NURSING STRATEGY ISSUES

The e-nursing strategy working group discussed the priority

issues facing nurses now and in the long term. Members identified seven key results expected when the strategy is implemented. The expected results are:
Nurses will integrate ICTs into their practice to achieve good

client outcomes.
Nurses will have the required information and knowledge to

support their practice.

Human resources planning will be facilitated.
New models of nursing practice and health services delivery will

be supported.
Nursing groups will be will connected. ICTs will improve the quality of nurses work environments. Canadian nurses will contribute to the global community of

nursing. (P-24).

PRE-CONDITION FOR A NURSING INFORMATICS PROJECT During the last decades nurses have gained political and social respect for the recognition of their work and have gained acceptance for the autonomy of their profession. (P40).

FACTORS INFLUENCING THE OBJECTIVES OF A NI PROJECT Legal factors: Due to the defined autonomy of the nursing profession nurses and nursing institutions have to face particular liability in documenting the nursing process.

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Nursing science factors: The influence of nursing science on a specific NI project basically depends on How deep nursing science theories are anchored in practice. How valued nursing sciences are within the specific in the context of client care, Which scientifically derived instruments are employed, Other methods considered suitable for practice, and The nursing model or framework employed in specific facility. (P-41).

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Monetary ( cost)factors:
From an administrative viewpoint, nursing homes are subject to strong cost management in order to be successful and transparent. Skill factors: Nurses develop a variety of abilities and knowledge in several subject areas during their education.

Motivational factors :
Motivational factors must be considered to be a complex field because on the one hand, positive commitments for the use of information technology were established in official nursing surveys yet, on the other hand, the analysis of the amount of IT innovations in Austrian nursing care institutions showed that the importance of ICT is widely communicated, yet hardly appreciated by nurses in practice.

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Organization and financial factors:
The implementation of information technology not only induces financial cost, but also demands important considerations in the field of organizational development. This can be difficult to incorporate into the everyday costs and functioning of institutions, even if the advantages of the change process are recognized. The organizational effort and change required as well as the necessary financial expense may prevent institutions form executing NI implementation projects. (P-41-47).

CONSULTING WITH THE NURSING COMMUNITY Feed back on the E-Nursing strategy
Respondents generally supported the expected result

of the strategy and emphasized the importance of nurses having timely, accessible, evidence-based information to improve client outcomes and patient safety. Many recognized that the successful incorporation of ICT into nursing will benefit not only the nursing profession, but the health-care system as a whole. Most recommendations for CAN regarding the integration of ICT into nursing in general were centered on:

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Advocating for nurses access to ICT and the

resources required to integrate ICT into nursing practice; Supporting the development and implementation of nursing informatics competence; among the competencies required for entry-to-practice and continuing competence. Advocating for the involvement of nurses in decision- making about information technology and information systems.

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Feedback On The E-learning strategy within the portal
Specific and generic education for particular practice setting is also needed as is education related to professional practice. The most frequently indentified education products, and tools that should be offered online were (in no order of importance); An up-to-date inventory of educational programs, educational institutions, workshops and conferences; Online database, journals, textbooks, CPS; Tutorials providing basic computer skills and search and appraisal training; Online course, including self-directed learning modules in specific areas of practice; Current information on timely topics, best practices, competencies; and A 24-hours helpline. (P-12-13).

THE EVOLUTION OF HEALTHCARE AND NURSING

Nursing has evolved dramatically in recent years. Many of the changes have been driven by advances in information and communications technology (ICT). The electronic tools now at nurses disposal are radically improving their ability to efficiently and accurately assess and treat their patients.ICT is no longer add-on traditional methods of health care, but rather an integrated , integral part of practice. As Canada seeks to maintain its leadership position in the health- care field, and to continuously improve the effectiveness of the health-care system, it will be important for nurses to improve their competencies and their use of ICT in their own practice. (P-16).

SMARTER DECISION MAKING ICT initiatives such as electronic health records, telehealth database, e-mail and internet resources enhance the decisionmaking process. They give nurses access to timely, evidence-based and expert information, enabling them to make swifter, better-information judgments on behalf of their patients. The result is safer patient care and better health outcomes. (P-16).

STRATEGIC DIRECTIONS OF E-NURSING

Following in depth analysis of the changing health-care environment and consultation with nurses across the country, the Canadian nurses association has defined three direction for an e-nursing strategy that will guide Canada forward and ensure positive change.

Access
Nurses can only reap the full benefits technology resources have to offer if they seek them out and incorporate them into their daily practice. As such access to ICT must be improved. Health care organizations must acknowledge this need and take the steps necessary to facilitate connectivity- by extending broadband infrastructure to ensure wider access to the internet, and by acquiring computers, personal digital assistants (PDAs) and other necessary hardware and software. (P-16).

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Competency
Development and ongoing use of ICT skills are key to improving nurses competencies. It is necessary that ICT competencies be embedded in undergraduate and graduate nursing curricula and in continuing education. (P-17).

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Participation
ICT has tremendous potential to improve the practice of nursing, if applied in appropriate, useful ways. Nurses insights into how this technology can enhance care are invaluable. As knowledge workers in this technological age, it is essential that nurses play an increased role in the development of ICT solution. By communicating changes and needs in their practice setting, they can ensure the right ICT tools are selected and implemented for maximum patient benefit. (P-17).

IMPORTANCE OF COLLABORATIOIN
Strategic partnerships
Collaboration among the following groups will be critical in advancing the e-nursing strategy.

Nurses in clinical practice

Participate in ICT initiatives, identify needs and evaluate possible solutions. Increase competence in use of ICT. Access multiple sources of information for evidencebased practice.

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Employers and administrators Recognize ICT as a tool of professional nursing practice. Support involvement of nurses in ICT initiatives. Encourage adoption of ICT that support nursing practice. Federal , provincial and territorial ministries Ensure participation of nurses in planning and decision-making related to ICT. Ensure broadband access is available to all Canadian nurses.

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Nursing organizations-professional associations, regulatory bodies and unions Provide leadership for nurses involvement in ICT Recognize ICT competencies as part of entry-level and continuing competence requirement. Educators and researchers Incorporate ICT competencies into curricula. Develop research programs to optimize nurses, use of ICT. (P-17-18).

THE CURRENT ELECTRONIC ENVIRONMENT There are many exciting developments in todays electronic world and nurses need to be part of them. Canada is viewed as a leader in both the development and application of ICTs and is committed to bringing the benefits of technology and an information society to people not only in Canada but around the world. (Government of Canada, 2003). Despite the incredible scope and success of ICTs accesses to information and knowledge has not been uniform across the world, creating what is referred to as the digital divide. (P-21-22).

Cond The goal of the government is to provide every community with broadband access so all Canadians can participate in activities such as telehealth, distance education and e-commerce. In May 2005, the government announced that broadband, or high-capacity internet, would be extended to several first nations, northern and rural communities.

SUMMERY AND CONCLUSION

THEORY APPLICATION

JOURNAL ABSTRACT
E-NURSING: ELECTRONIC NURSING RESOURCES ON YOUR DESTOP E-Nursing represents an innovative approach to nursing education that has the potential to support professional practice throughout the institution. This paper details the benefits, design and promotion of an electronic nursing resource collection. How to divide responsibility, cost and expertise in such a project is also discussed. Preliminary usage statistics validate E-Nursing as appoint-of-care education tool nurses at Mount Sinai hospital. A planned approach to implementation has been an effective means of introducing E-Nursing in an institution that previously relied on traditional hard-copy resources housed in hospitals library.

BIBLIOGRAPHY
NET REFERENCE; WWW.GOOGLE.COM

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