The Evolution of Nursing Informatics

Nurses have been delivering compassionate care using technology since the time of
Florence Nightingale. Technology, coined from the Greek language tekhnolohiga
meaning systematic treatment (1), is defined as a scientific method of achieving a
practical purpose (2). As healthcare evolves to meet the needs of mankind, nurses are
faced with greater challenges on how to apply technology in practice, education, and
research. Now more than ever, the term technology exponentially covers a greater
meaning in healthcare to include informatics.

Coined from the French word informatique, Gorn

(1983) first defined informatics as computer science plus information science ( 3). As it
relates to nursing, it has been labeled as Nursing Informatics. American Nurses
Association Scope and Standards (2001) defines Nursing Informatics as a specialty that
integrates 1) nursing science, 2) computer science, and 3) information science to
manage and communicate data information and knowledge in nursing information

The Lead Informatics Nurse began her presentation by introducing the

rest of the team present, explaining that they were a reflection of the
fact that informatics, safety, quality, process change, education and
research were all pulled together into one nursing department. This
was probably my strongest take home message for the trip if you
separate the use of technology from the normal clinical practice of
nursing teams, and make it something on top of their normal
workload, youre doomed to fail.The team felt that their role had a
significant leadership role to drive forward process change across
clinical settings.
The presentation provided lots of useful info about how to ensure
nursing order sets (suggested guidance for the care pathway of a
child) are correct involve clinical nursing teams all the way along the
process, use the evidence base and dont be afraid to change it if its
not working. There was also discussion on how the informatics teams
worked with pharmacy and medical colleagues to ensure medical
order sets were useful too. This was great to hear, as it reflected the
good work we do in my own hospital to ensure we work together
collaboratively in this way. Lurie Hospital is further down their
eMedicines journey than we are, so it was useful to see that they have
seen the benefits of working in this way.

We were then told about the development program for registered

nurses at the hospital. Every registered nurse was encouraged to get
involved with one of the practice councils of nursing; quality,
informatics or education. I asked the question of how easy each of the
groups was to recruit to, and was told that each has similar numbers of
applications. I think this is a reflection of the skills of the nursing
informatics team, who show such a positive impression of the use of
information and technology towards achieving quality and positive
patient experience.
The end of the presentation was a great reminder that you cant do
everything all at once, and that managing peoples expectations is key.
Our host explained to us that they continued to highlight
developments they wanted to make to their existing systems, and the
exciting developments in healthcare technology that they were
planning to consider in future. It seems implementing technology is a
never ending journey who knew?!
The technology we saw was certainly 21 century; a full electronic
medical record with well-developed nursing documentation; nurses
carrying smart phones so they could be contacted wherever they were;
RFID technology on all the equipment (and soon to be on
st

the nurses too); single unit dose dispensing

units in every treatment room for all medicines and all supplies; and

patient portals used to deliver individually targeted health information

for children and their parents/families.
The technology throughout the building was matched with an
environment which had clearly been designed and built with the
interests of children in mind. Our hosts told us that children and their
families had been involved right throughout the process and this was
evident from what we saw throughout the building. There was a huge
well equipped school in the building and we were told there were
special spaces where the siblings of children being treated could go
they really had thought of everyone.
The hospital had also asked local community groups including
theaters and art groups to get involved, each taking a floor of the
building to work creatively on. The whole ethos of this place was
inclusive of patients, technology, their families and the local
community.

Nursing Informatics 101 Workshop

1. June Kaminski October 2 nd , 2008 08:30 12:00 Nursing Informatics

101 Atlantic Nursing Informatics Conference Pre-Conference Workshop
2. Workshop Overview
o Nursing Informatics An Evolving Science
o The Art of Nursing Informatics
o A Wide Lens Perspective of Nursing Informatics

o Professional Development in Nursing Informatics

3. Workshop Objectives
o Explore the development and principles of the science and
art of nursing informatics.
o Recognize the evolving scope and arenas within the field of
nursing informatics, including systems use within practice,
e-health, tele-nursing, client education, social and
professional networking, research and education, and
professional development
o Explore how nurses can/do uniquely contribute to the
emerging fields of telehealth, e-health, electronic health
records, hospital and community health systems,
educational and networking initiatives
o Examine technological, utility, and leadership competencies
in nursing informatics
o Explore user, modifier, and innovator levels of competencies
within nursing informatics
o Engage in personal professional development activity
planning
4.
5. Nursing Informatics an Evolving Science
o Nursing, Information and Computer Science
o Data Information Knowledge Paradigm
o Privacy, Security, Confidentiality
o Ergonomics and Asepsis
SECTION ONE
6. Nursing informatics is.
o 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 (Staggers & Bagley-Thompson,
2002, p. 262).
7. The goal of nursing informatics.
o is to improve the health of populations, communities,
families, and individuals by optimizing information

management and communication. This includes the use of

information and technology in the direct provision of care, in
establishing effective administrative systems, in managing
and delivering educational experiences, in supporting
lifelong learning, and in supporting nursing research (CNIA,
2003, p. 1).
8. NURSING INFORMATICS TRIAD NURSING SCIENCE INFORMATION
SCIENCE COMPUTER SCIENCE
9. Nursing Informatics is critical to Health Care
o Nurses comprise the largest group of health providers
o Nurses spend the most time in direct care of clients = a
critical position to influence Health Informatics
10. DATA INFORMATION - KNOWLEDGE
o Health and nursing information science is the study of how
health care data is acquired, communicated, stored, and
managed, and how it is processed into information and
knowledge.
WISDOM DATA KNOWLEDGE INFORMATION
11. Information systems.
o .used in health care include the people, structures,
processes, and manual as well as automated tools that
collect, store, interpret, transform, and report practice and
management information.
12. Nursing knowledge.
o .is derived from the practice of nursing science. It
represents the rules, relationships, and experiences by
which data becomes information. Using their knowledge,
nurses synthesize information so that the patterns,
relationships, and themes are identified,
13. Nursing wisdom.
o .is knowing when and how to use knowledge. It develops
through praxis, and requires knowledge, values, and nursing
experience coupled with reflection on ones own practice.
14. Privacy, Security, Confidentiality
o Protected by Policies & Procedures
o Security refers to technological, organizational, or
administrative processes designed to protect data systems
from unwarranted access, disclosures, modification, or
destruction.

 15. Ergonomics.
o comes from the Latin ergos (to work) and nomos
(knowledge).
o the science of using knowledge of work activities and the
human bodys limitations to structuring work environments,
or "fitting the work to the worker".
16. Complete the Ergonomic Assessment
o Is your computer workstation safe and ergonomically
situated?
o If not, what do you need to change to work in an
ergonomically supported environment?
o What about using PDAs?
o Or Laptops?
o Or Cell Phones?
17. ASEPSIS AND COMPUTERS EXERCISE
o Research studies suggest that computers in the hospital
workplace can be prime habitats for various fungi, bacteria,
and other microorganisms including superbugs like MSRA.
o a. What activities do you think are the biggest culprits for
promoting the growth of these harmful micro-organisms?
o b. What can nurses do to protect their clients from
computer-transmitted infections?
o c. Who is responsible for cleaning computer and mobile
equipment in your employing agency or workplace?
18. The Art of Nursing Informatics
o Caring and Use of Technology
o Holistic assessment and planning
o Aesthetics and a Phenomenological Approach
SECTION TWO
19. CARING AND USE OF TECHNOLOGY
o The relationship between computer literacy, technological
competence and a nurse's ability to care is congruent for
quality nursing practice.
o Computer literacy represents a proactive response to
technology which enhances caring in nursing
20. Holistic assessment and planning
o The world of the screen is fast becoming a constant reality
within health care how do nurses counteract the potential
distancing and rupturing of relations with clients that can
occur?

o How can nurses use technologies in ways that actually allow

more embodied time and presence with clients?
21. Aesthetics & a Phenomenological Approach
o What do we need to do differently when nurses must
transpose their presence, empathy and professionalism
through the circuitry and visual displays of a ICT machine?
o The nurse is still present and perceived as situated within
the health care interaction by the client, albeit through
electronic means.
22. How are Presence & Caring Conveyed?
23. A Wide Lens Perspective of Nursing Informatics
o Nursing Informatics in Clinical Practice
o Telehealth and Telenursing
o Nurse's Role in E-health
o Client Education
o Networking and ICTs
o Research and Education
SECTION THREE
24. Nursing Information Systems
o When time and energy are at a premium, using a Nursing
Information System (NIS) in acute care settings can assist in
applying nursing knowledge and wisdom to everyday care
o Documentation can be more timely, more complete, and
more accurate when captured at the point of origin,
usually the clients bedside in acute care settings.
25. Engaging with a Virtual client
o While engaging with the virtual representation of a client,
the nurse must strive to envision and experience the client's
three dimensional body and being in order to accurately
advise, assess, diagnose, and interact fully and dynamically.
o This perceiving must occur within a virtual network
environment, where both body-sense and body-awareness
are combined with digital information.
26. Electronic Health Record (EHR)
o a longitudinal electronic record of patient health information
generated by one or more encounters in any care delivery
setting. Included in this information are patient
demographics, progress notes, problems, medications, vital
signs, past medical history, immunizations, laboratory data
and radiology reports.

 27. EHRs.
o The EHR has the ability to generate a complete record of a
clinical patient encounter, as well as supporting other carerelated activities directly or indirectly via interface including evidence-based decision support, quality
management, and outcomes reporting.
28. STANDARDIZED NURSING LANGUAGE EXERCISE
o If you were on a planning committee to determine the
language to use to clearly articulate nursing data
(assessment, interventions, client perspectives &
experiences, outcomes, etc.) what important considerations
would you keep in mind?
o Would it be easy to reach consensus?
29. Telehealth and Telenursing Exercise
o Tele-health practices not only call for nurses to
reconceptualize presence, place, and bodies in nursing, but
also to explore how these practices threaten to displace
nursing. It is imperative for any nurse who engages in
telenursing to be aware of this, and to ensure that network
exchanges with their clients reflect dynamic, personable
caring and attentiveness, even when the interactions occur
via ICT mediums.
o WHAT CAN NURSES DO TO ENSURE THIS?
30. Nursing Roles in E-health
o E-health is a client-centered World Wide Web-based network
where clients and health care providers collaborate through
ICT mediums to research, seek, manage, deliver, refer,
arrange, and consult with others about health related
information and concerns
31. E-health Case Scenario
o Janet, a 43 year old mother and business owner was
diagnosed with rhematoid arthritis six months ago. She
sought medical treatment for her condition but has
experienced little relief with conventional treatment. She
begins to seek further information from other sources
beyond her family doctor, including internet resources.
Recently she decided to initiate an online support and
information group to explore treatments and experiences
with other people with arthritis.
32. Questions to Ask

o What roles could nurses adopt to support Janet in her

endeavor?
o What could nurses offer this new community of clients that
they could not organize themselves?
o What ethical considerations come to mind when reviewing
this scenario?
33. Nursing Roles in E-health
o health advisors
o Internet guides to help clients select reliable information
resources
o support group liaisons
o web information providers
o Nurses need to be involved in the design and
implementation of E-health portals and programs that
provide the best possible experience for health care clients.
34. Client Education Roles for Nurses
o Facilitative partnership with client
o Enablers, supporting self care and autonomy
o Coaching, informing and explaining
o Helping clients to generate alternatives
o Guiding clients to think issues through
o Validating the clients reality.
o Nursing Informatics can help to personalize and customize
client teaching
35. Networking and ICTs
o Client focused networks - telenursing, e-health, and client
support networks
o Work related networks - virtual work and virtual social
networks
o Learning and research networks - communities of practice
36. Networking Exercise
o Describe how networking with experts and other
professionals could help you to cultivate nursing informatics
competencies and knowledge, and how to apply these
within your area of practice.
37. Future of Networking
o Also, describe how you see the role of nurses evolving as
more and more client initiated networks, e-health initiatives,
and networking access become the norm.
38. Research and Education

o Planning informatics education content takes a substantial

amount of research, decision-making, and competencybased choices. This is true whether planning for one course
or an entire program.
39. Environmental Scans
o are tools that are often used when planning technological
initiatives.
o Environmental scanning is a kind of radar to scan the world
systematically and signal the new, the unexpected, the
major and the minor.
40. Environmental Scan Exercise
o Perform a brief and informal internal and external
environmental scan of your institution, program or course
environment.
o Focus on the factors and issues that relate to the
incorporation of nursing informatics into the existing
infrastructure.
41. Examine and Describe:
o Target environment
o Current Situation
o Projected Situation
o New & Emerging Technologies and Resources
o Key Information Sources
o Emerging Issues
42. Professional Development in Nursing Informatics
o Technological, Utility and Leadership Competencies
o User, Modifier and Innovator Competency Levels
o Personal Professional Development Planning
SECTION FOUR
43. Nursing Informatics Competencies
o Strategies: in-service training, intranet ready modules,
access to online resources, and opportunities for continuing
education.
o " Barriers to achieving NI competencies in the
workplace include restricted access to training and training
systems for nurses and nursing students, few leaders and
educators with NI skills, and limited empirical support for
the contributions ICT can or will realistically make to nursing
and patient outcomes" (p. 6).
44. Competency Levels

o Beginner, entry or user level

o Intermediate or modifier level
o Advanced or innovator level
45. All three levels demonstrate Competencies:
the use of information and communication technology
( technical competencies )
the use of automated information in a professional
context ( utility competencies )
decision-making with respect to planning for and using
both the technology and information ( leadership
competencies ).
46. User Level Competencies
"User" level of competency indicates
nurses who demonstrate core nursing informatics
competencies. This level includes practicing nurses,
nursing administration, nurse researchers and
educators. In most taxonomy, this is the basic level
that ALL nurses should minimally demonstrate, no
matter what area of practice he or she works in.
47. Modifier Level Competencies
A "Modifier" level of competency indicates
nurses who demonstrate intermediate nursing
informatics competencies. This level includes
practicing nurses, nursing administration, nurse
researchers and educators who have mastered basic
skills and use technology in inventive ways in their
practice.
48. Innovator Level of Competencies
An "Innovator" level of competency
indicates nurses who demonstrate advanced and
specialized nursing informatics competencies. This
level includes practicing nurses, nursing
administration, nurse researchers and educators who
have mastered expert skills and use technology in
design, plan and coordinate the use of technologies
and informatics theory in nursing.
49. Nursing Informatics Experts
o Some examples include: Nursing informatics Specialist,
Chief of Nursing informatics, Director of Nursing Informatics,

Clinical Information System Coordinator, Director of Clinical

Systems, CIO or Chief Information Officer, and so on.
50. NURSING INFORMATICS COMPETENCIES GOALS
o Write five goals for yourself, related to learning Nursing
Informatics theory and application. Try to make these fairly
short-term, i.e. within the next five years.

All nursing and medical assessments are entered electronically

and a closed loop medication system is in use which we were

advised has significantly improved patient safety and healthcare
staffs efficiency. It was very evident that the use of electronic
systems and processes are integral to the way they work.

The nursing informatics team work very closely with the clinical
teams and the IT department. They are not only responsible for the
development, implementation and support of new systems but are
instrumental in fostering a culture of enquiry amongst the

workforce. Front line staff want access to the data in order to make
improvements. There is clearly an appetite for investigating the
available data. Downtime is kept low and their performance for
unplanned downtime is zero.

There is a Shared Governance model at the hospital in which

clinical nurses have a voice in determining nursing practice,
standards and quality of care. It seems that this empowers nurses to
use their clinical knowledge and expertise to develop, direct and
sustain their professional practice.

There are a number of shared governance committees or councils

in place where all nurses including those in the informatics team
are able to contribute to and share responsibility and accountability
for decisions made about patient care delivery.

This model appears to be a common thread amongst Magnet

hospitals and links to the Magnet principle of Structural
Empowerment where influential leadership creates innovation and
strong professional practice flourishes.

Nursing Informatics and Nursing Process

The nursing process is the core of patient care delivery. In the nursing process
continuum, nurses are constantly faced with data and information. Data and
information are integrated in each step of the nursing process: 1) assessment, 2)
diagnosis, 3) planning, 4) implementation, and 5) evaluation.
Nursing documentation, which is often identified as the sixth step in the nursing
process, is vital in information management. Therefore, it is necessary for nurses to

document accurately and precisely to determine the desired outcome. Remember the
Rule Garbage InGarbage Out also applies to nursing documentation.

Nurses comprise the biggest workforce in healthcare. This being said, nurses are the largest
work-group of end-users of electronic medical record and clinical information systems;
therefore, it is imperative that nurses are well-represented in the selection, design,
implementation, and evaluation of clinical information systems. Evidence has shown that nurses
who were involved in the clinical information system cycle have more buy-in, user-acceptance,
and positive perception all are precursors to successful implementation.