Overview of Nursing Informatics (AACN Essential 5: 1, 2, 4, and 5)

Week 2: Lesson

Overview of Nursing Informatics (AACN Essential 5: 1, 2, 4, and 5)

Introduction

NI integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice (American Nurses Association, 2015). While only a few of you will choose NI as your specialty area of practice, all nurses need an appreciation for the focus and practice of NI as well as the resources and support that it can provide, and the NI skills that you require as nurse leaders. The rapid emergence of technology and informatics may lead to the identification of additional NI skills in the future. As a specialty, NI is fairly new. It was recognized in 1992, based upon evidence of the following criteria for designation of a nursing specialty:

• how the specialty is different from other nursing specialties and from general practice nursing;
• specific academic preparation for the specialty;
• defined research programs;
• organizational representation; and
• a credentialing program.

The American Nurses Association published the Scope of Practice for Nursing Informatics in 1994. The first credentialing exam was offered shortly afterwards. The American Nurses Credentialing Center provides the only certification available in nursing informatics, although certification is offered in other informatics areas by other organizations.

NI differs from other areas of nursing specialization because its phenomena of interest are the structures and processing of data, information, and knowledge used by practicing nurses rather than nursing’s phenomena of interest, namely person, health, environment, and nurse. In fact, the processing of data, information, and knowledge provides the foundation for the metastructures of NI.

Metastructures of NI

Metastructure is an overarching structure for theory and the conceptual framework for a discipline and is similar to a metaparadigm that you discussed in your NR501 Theoretical Basis for Advanced Nursing Practice class. The metastructures of NI are data, information, knowledge, and wisdom, although every nurse uses these concepts in daily practice to some degree. Other disciplines also use the concepts of data, information, knowledge, and wisdom.

Data is a discrete entity, which when viewed by itself, has no meaning. A single unit of data, otherwise referred to as datum, is a discrete entity. Data can be connected to a data element. A data element is the name of something that can have one or more values or facts, such as a weight, temperature, pulse, respiratory rate, or blood pressure. A weight of 132 doesn’t tell the nurse anything. It might be normal, it might represent a weight loss, or it might represent an obese child. Further judgment is not possible without a context.

CDC Growth Chart (Links to an external site.)Links to an external site.

Information occurs when data are viewed in a context, such as a series of readings that indicate a downward trend in weight, or perhaps plotting a weight of 132 pounds on a growth chart by age for a 10-year-old boy, which places him above the 95th percentile for weight by age.

CDC Growth Chart (Links to an external site.)Links to an external site.

Knowledge occurs with the synthesis of information from several sources, such as planned learning, experience, and research to produce a single concept or idea. In the instance of the child’s weight that falls above the 97th percentile for age, one might conclude that the child is overweight.

Wisdom is more difficult to define but occurs when knowledge is appropriately applied.

Current Status of NI

NI continues to grow and evolve as it works to create its own knowledge base. NI has its own research agenda that holds interest and benefits for all nurses because NI supports all areas of nursing practice. The National Institute for Nursing Research Strategic Plan addresses the use of informatics and informatics-based solutions to facilitate health, prevent disease, and engage patients in the management of their own care.

The American Nurses Association (ANA, 2015, p. 1) defines NI as

…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. This support is accomplished through the use of information structures, information processes, and information technology.

The Nursing Informatics Special Interest Group of the International Medical Informatics Association (IMIA-NI, 2009) adopted a similar definition that differs primarily in its emphasis upon promotion of global health.

The Nursing Informatics: Scope and Standards of Practice (American Nurses Association, 2015) addresses two levels of NI practice—generalists and informatics-nurse specialists (INSs). Generalists have experience in the field and may be very knowledgeable, but have not been educated at the graduate level. The INS has completed graduate-level education in informatics or a related field. Practice at the INS level reflects innovation and often research. There are many formal degree programs today that offer an informatics or nursing informatics focus. Another popular option may be seen with post-graduate certificate programs that can range from 9–30 credits in length. Both the informatics nurse and the INS can be invaluable resources for nurses in other areas of practice, but not every setting has either informatics nurses or INSs in place; although, every setting that employs nurses requires at least a basic level of nursing-informatics competencies.

NI Functional Areas

Informatics nurses and INSs wear many different hats and work under many different titles. The Nursing Informatics: Scope and Standards of Practice (American Nurses Association, 2015) identifies the following functional areas for INS practice:

• administration, leadership, and management;
• analysis;
• compliance and integrity management;
• consultation;
• coordination, facilitation, and integration;
• development;
• educational and professional development;
• research and evaluation;
• policy development and advocacy; and

Reflection

Not surprisingly, many of you incorporate at least some of these functional areas in what you currently do. Does that make you an INS?

Last week, we established the need for all nurses to have informatics skills. Moving forward, we look more closely at the specific competencies that all nurses need.

Nursing Informatics for All Nurses

Last week, we spoke of nursing as “knowledge work” and that nurses routinely collect data, turning it into information, knowledge, and ideally, wisdom. This process can be completed without information technology (IT), although IT can support the transformation. In either event, the transformation makes use of information-management principles.

Reflection

Is wisdom the same as critical thinking or clinical reasoning? How are they alike? How are they different

The following exercise asks you to recognize and categorize a partial list of competencies that all nurses should have. See how well you do! Match the competency to the appropriate description.

Transcript (Links to an external site.)Links to an external site.

Information Literacy

• Ability to identify when information is needed as well as the skills to find, evaluate, and effectively use the same
• Evaluation of online resources for quality
• Able to search literature databases effectively

Computer Literacy

• Basic familiarity with computer use and common applications
• Ability to navigate hyperlinks
• Able to set up and use a database to collect and retrieve information

Clinical Information Management

• Uses CDS and system safeguards to protect patients and PHI
• Able to request and evaluate reports for the purpose of informed decision making
• Participate in the selection, design, and evaluation of clinical information systems and patient-care technologies
• Uses available technologies to appropriately and effectively communicate

Reflection

Is wisdom the same as critical thinking or clinical reasoning? How are they alike? How are they different?

The Question

Consider which informatics competencies are required for the integration of evidence-based practice.

Your Answer

The Expert Says

• Recognize information that is needed
• Effectively use scholarly databases to conduct a search
• Identify scholarly sources
• Critique research findings

Information and Communication Technologies for Practice and Education

When one thinks about technology and communication, particularly within the workplace, one typically thinks about e-mail; however, there is a growing use of text-message notices and alerts on smartphones and VOIP phones, as well as messaging capability that is built into various clinical systems, such as the hospital information system or barcode medication administration system. There is also a growing use of social media to promote healthcare delivery-system services.

Reflection

Consider some ways that you use messaging capability within your present work setting—how might that capability be better used? Are there any related concerns with the way that your messaging capability is used now? Or might be used?

Reflection

What are some important points to keep in mind when using electronic communication for professional purposes?

Using Technology Well

It is not enough to just be able to muddle through using bedside patient-care technologies and information systems. It is conceivable that “muddling through” just to get past a screen in the clinical information system or a setting on bedside technologies may actually introduce harm, record incorrect information, or fail to capture information required for regulatory and reimbursement purposes. All nurses should be able to use various forms of patient-care technologies, information systems, and communications devices with skill and in a fashion that promotes patient benefits and safety and complies with organizational policy. Understanding its purpose and capabilities is important to foster appropriate, effective, and efficient use. Master’s- prepared nurses should analyze HIT for its support for safety, its effectiveness, and its efficiencies. As leaders, master’s-prepared nurses serve as resources, provide examples, and provide oversight.

The Question

Nurse Jo needs to register patients who come to the asthma clinic in the information system in order to enter orders, notes, and treatments, and to view old records. Nurse Jo does not like to register patients because she doesn’t feel comfortable with this part of the system. She picks the first Sally Smith that she sees in the system and quickly presses the “Enter” key to key through all of the registration screens without verifying information with the client. Does this behavior exhibit an appropriate level of informatics competencies? Why or why not? How would you address this behavior if Jo was your employee? Your orientee?

Your Answer

The Expert Says

Jo does not demonstrate an appropriate skill level. She does not demonstrate an appropriate knowledge level and fails to apply safeguards built into the system, starting with a failure to determine if she has picked the correct patient, which could pull up incorrect history and allergy information, jeopardizing patient safety, or merge information from two patients. At the very least, this behavior could also result in lost revenue to her organization because charges would be made to the wrong patient. This is unsafe and fails to adhere to principles of positive patient identification. It is not appropriate professional behavior. Clearly as Jo’s superior, staff development professional, or even colleague, you have an obligation to address this behavior and take corrective action. If Jo fails to use technology safely and in accordance with policy, then she needs to understand that such behavior can and ultimately will result in termination.

The Role of the Master’s-Prepared Nurse in Promoting and/or Using HIT and Informatics

The master’s-prepared nurse is expected to develop and display a more advanced understanding and mastery of informatics competencies that include the activities listed below.

• Critical review of HIT for benefits (safety, cost effectiveness, improved outcomes) as well as potential problems
• Input into the design, selection, and use of  HIT
• Support the integration of HIT and evidence-based practice
• Use data and information to drive decisions
• Role model appropriate/effective HIT use
• Serve as a resource on HIT matters
• Safeguard PHI
• Use electronic communication and systems to communicate effectively and appropriately
• Use HIT for quality improvement activities
• Provide oversight for optimal use of HIT by subordinates
• Use technology to support education

Reflection

Consider a specific example that would reflect one of the above areas. How might you do things differently to reflect your leadership role in adopting and using HIT?

Summary

NI is a fairly new nursing specialty, but one that has implications for all areas of nursing practice because its purpose is to support all areas of nursing practice as well as healthcare consumers and other healthcare professionals.

The phenomena of NI interest are the structures and processing of data, information, and knowledge. It is not enough to use technology it needs to be used well in order to avoid negative consequences.

The master’s-prepared nurse must be prepared to analyze HIT for its benefits as well as possible problems, provide input into HIT decisions, use data and information to drive decisions, role model a positive attitude and appropriate use of HIT, use technology effectively for education and communication, and provide oversight for optimal HIT use.

References

American Nurses Association. (2015). Nursing informatics: Scope and standards of practice. Silver Spring, MD: Nursebooks.org.

International Medical Informatics Association-Nursing Informatics Workgroup (IMIA-NI). (2009). Definition. Retrieved from http://imianews.wordpress.com/2009/08/24/imia-ni-definition-of-nursing-informatics-updated