1_foundations of nursing tics

Good Morning!!!

April14, 20117:30 a.m. – 10:30 a.m.

NURSING INFORMATICS

Clinical Instructor

Joahne P. Tipay R.N.

1.Uniform

2.Attendance

Absent

Late

3.Grading System

Class Standing

•Quizzes 60%

•Recitations 40%

Reference:

ESSENTIALS OF NURSING INFORMATICS

By:

Virginia K. Saba

Kathleen A. McCormick

COURSE DESCRIPTION:

• This course deals with the use of information technology system and data standards based on nursing informatics principles/theories. It further deals with the utilization of clinical information systems in the management and decision-making of patient care.

COURSE OBJECTIVES:• At the end of the course and given

relevant actual or simulated situations/conditions, the student will be able to:

1. apply concept, theories and principles of informatics in nursing and health care.

2. discuss issues and trends in informatics relevant to nursing and health.

The Course Outline

COURSE CONTENT:

I. Foundations of Nursing Informatics Computers and Nursing

a. Historical perspectives of nursing and the computer.

b. Theories, models and frameworks

c. Advanced terminology systems

COURSE CONTENT:II. Fundamentals of Information and

Communication Technologies

a. Computer hardware

b. Computer software and systems

c. Data processing

d. The Internet: a nursing resource

e. PDA and wireless devices.

COURSE CONTENT:III. Free and Open Source Software (FOSS)

a. Open source and free software IV. Nursing System Development Life Cycle

a. Implementing and upgrading clinical information systems

COURSE CONTENT:V. Technology Enhanced Nursing Care

Delivery I: Educational Applicationsa. Nursing Informatics and health care

policyb. The role of technology in medication-

use processc. Health care data standardsd. EHR form: A historical perspectivee. Electronic Health Record Systemf. Dependable systems for quality careg. Nursing minimum data set systems

COURSE CONTENT:

VI. Technology Enhanced Nursing Care Delivery I: Clinical Applications

a. Practice application

b. Critical care application

c. Community health application

d. Ambulatory care systems

Name

Age

Address

Contact Number

Code Name

Index Card

Next meeting, please bring one 1x1 picture for your sitting arrangement

What is this?

And this?

• Who among you owns a computer?• What type/brand?• What Operating System are you

using?

NURSING INFORMATICS“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.” (ANA Scope and Standards of Nursing Informatics Practice, 2001, pg vii)

Computers and Nursing

MANUAL HEALTH CARE SYSTEM

ADVANTAGES• Easy to implement• Low cost• No extra training required• Requires minimum effort• Quick processing• Can be stored anywhere• Cannot be easily corrupted (with proper

data storage)


ADVANTAGES• Easy to prepare• Data profiling can be processed easily• Readiness of data


DISADVANTAGES• Problem with maintenance• Volume of data becomes a problem

(storage problem)• Needs lots of paper• Problem with interpretation/transcription• Data is not converted easily to information


DISADVANTAGES• Readiness of the information (not data)• Accessibility to any health care personnel

and accessibility to any health care • Once the data is burned, it cannot be

reproduced easily• Coordination of data and information is a

problem


DISADVANTAGES• Integration with the other system such as

laboratory, accounting, etc is a problem• Data handling is a problem

COMPUTER INFORMATION SYSTEM

ADVANTAGES• Data maintenance• Low maintenance cost• Volume of data is not an issue• No paper is required• No problem with interpretation/ transcription• Data can be easily converted to information


ADVANTAGES• Readiness of the information and data• Accessibility to any health care personnel

and accessibility to any health care institution


ADVANTAGES• Data cannot be corrupted easily (with proper

back-up)• Can be integrated with the other system

such as laboratory, accounting, management, etc

• Data handling is easy• Data integrity is preserved


ADVANTAGES• Data communication is possible• Statistical information system can be

provided• Migration to other system is easy• Can be expanded• Easy data profiling


DISADVANTAGES• Implementation requires severe justification• High starting cost• Requires training for nurses and health care

giver• Requires additional effort to implement• Additional manpower is necessary


DISADVANTAGES• Special storage is necessary• Data communication system will have an

additional cost• Data can be easily corrupted (if no back-up

is provided)


DISADVANTAGES• Readiness of data and information is

possible when software is provided in the health information system

• Requires extensive planning, designing and commercial implementation

• Information management is essential

APPLICATION OF COMPUTER TO HEALTH PROFESSIONS

• Automatic searching of parallel records for medically ill person and critical medical information.

• Automatic searching of nationwide databases holding registries of patients with critical problems.


• Automated review of similar patients to determine expected lengths of stay, costs, and rates of complications – allowing better financial forecasting for the hospital and better information for the patient and caregiver.


• System will allow the user to very easily pull information from vast numbers of patients (without names!) into spreadsheets, databases, graphing packages to create instant displays of outcome, treatment paths and options.

APPLICATION OF COMPUTER TO HEALTH PROFESSIONS• Improved communication between

multiple providers to reduce the “it slipped through the cracks” syndromes that plague the smooth running of operating rooms.

• Patient care and management – care providers are using data entry devices to document care given both at the bedside and at central terminals.

APPLICATION OF COMPUTER TO HEALTH PROFESSIONS• Patient records - compilation of patient

or test data, maintenance and retrieval of these records and use of these records for billing and usage and outcome analysis.

APPLICATION OF COMPUTER TO HEALTH PROFESSIONS• Patient monitoring - by recording patient

data on-line and from various tests.• Exchange of medical data - from the

compilation and maintenance of databases.

• Interactive medical education – from database and tutorial software.

• Physician decision making – from the use of patient records and other databases.

• NI represents the transition of data and data information and knowledge into action.

• NI represents the practice, administration, community health, nursing education, and nursing research applications.

• It also addresses other new applications such as international aspects or peripheral to the field such as legal, consumer issues, or theoretical issues.

AN OVERVIEW

• In the past 25 years, NI specialists emerged as a new specialty by the ANA.

• In 1981, there was approximately 15 nurses who identified this new specialty as their area of interest and expertise

• In 1990 this number increased by 500% to approximately 5,000 nurses

• Year 2000, it increased by approximately another 500%

• By year 2010, it is anticipated that majority of nurses entering the profession will be computer literate

• It is also anticipated that every healthcare setting – acute care hospital, academic school of nursing, large community health agency of health care where nurses function – will employ at least one NI specialist and will implement some type of CIS.

• Increased interest in NI occurred because of the concerted efforts of several groups that promoted nursing as an integral part of the EHR systems being implemented in health care.National and international professional nursing

organizations began to endorse and approve data standards as separate or as an integral components of the EHR systems.

Individual nurses began to demand CIS to document their care, regardless of where they work

Vendors of EHR systems began to include nursing care components in their systems

HISTORICAL PERSPECTIVES OF NURSING AND THE

COMPUTER• The computer is the most powerful

technological tool to transform the nursing profession.

• Computer has transformed nursing paper-based records to computer-based records

• Today and tomorrow, the computer and the internet are essential for all settings where nurses function


COMPUTER• “Computer” is an all encompassing term

referring to information technology (IT), computer systems, and when they are used in nursing, refer to nursing information systems (NISs), nursing application, and/or nursing informatics (NI)


COMPUTER

• NI has emerged as a new term encompassing these technologies enabling nurses to manage health care and patient care more efficiently and effectively.


COMPUTER

• Computers in nursing are used to manage information in patient care, monitor the quality of care, and evaluate the outcomes of care.


COMPUTER• Computers and networks are now used for

communicatingSending/receiving data and messages via the

internetAccessing resourcesInteracting with patients on the World Wide

Web (WWW)


COMPUTER• Nurses are increasingly involved with

systems used for planning, budgeting, and policy-making for patient care services as well as enhancing nursing education and distance learning with new media modalities.


COMPUTER• Computers are also used to support

nursing research, test new systems, design new knowledge databases and advance the role of nursing in the health care industry

• Computer technology emerged in nursing in response to the changing and developing technologies in the health care industry and in nursing practice.

MAJOR HISTORICAL PERSPECTIVES OF NURSING

AND THE COMPUTER

• It is analyzed according to1. Six time periods

2. Four major nursing areas

3. Standards initiatives

4. Significant landmark events

5. Major landmark milestone chart


AND THE COMPUTER

1. Six time periods– Prior to the 1960s, 1960s, 1970s, 1980s, 1990s

and post 2000

2. Four major nursing areas– Nursing practice, administration, education,

and research


AND THE COMPUTER

Nursing Informatics can be applied to all areas of nursing practice, which include; clinical practice, administration, education, and research.

Below are some examples of how nursing informatics, information technology and computers, are used to support various areas of nursing practice.

APPLICATION OF NURSING INFORMATICS

Nursing Clinical Practice (Point-of-Care Systems and Clinical Information Systems)– Work lists to remind staff of planned nursing

interventions– Computer generated client documentation– Electronic Medical Record (EMR) and Computer-Based

Patient Record (CPR)– Monitoring devices that record vital signs and other

measurements directly into the client record (electronic medical record)


Nursing Clinical Practice (Point-of-Care Systems and Clinical Information Systems)– Computer - generated nursing care plans and critical

pathways– Automatic billing for supplies or procedures with nursing

documentation– Reminders and prompts that appear during

documentation to ensure comprehensive charting


Nursing Administration (Health Care Information Systems)– Automated staff scheduling– E-mail for improved communication– Cost analysis and finding trends for budget purposes– Quality assurance and outcomes analysis


Nursing Education– Computerized record-keeping– Computerized-assisted instruction– Interactive video technology– Distance Learning-Web based courses and degree

programs– Internet resources-CEU's and formal nursing courses

and degree programs– Presentation software for preparing slides and

handouts-PowerPoint and MS Word


Nursing Research– Computerized literature searching-CINAHL, Medline

and Web sources– The adoption of standardized language related to

nursing terms-NANDA, etc.– The ability to find trends in aggregate data, that is data

derived from large population groups-Statistical Software, SPSS


3. Standards initiatives– Nursing practice, nursing data, and health care

standards

4. Significant landmark events

5. Major landmark milestone chart


AND THE COMPUTER

THEORIES, MODELS AND FRAMEWORKS

INFORMATION SYSTEM IN HEALTHCARE INDUSTRY

• Informatics (informatics comes from the French word informatique which means computer science). Informatics is defined as computer science + information science.

• Used in conjunction with the name of a discipline, it denotes an application of computer science and information science to the management and processing of data, information, and knowledge in the named discipline.

• Thus we have, medical informatics, nursing informatics, pharmacy informatics and so on.


• Hebda (1998 p. 3), defines nursing informatics as "the use of computers technology to support nursing, including clinical practice, administration, education, and research."

• American Nurses Association (ANA) (1994) has defined nursing informatics as "the development and evaluation of applications, tools, processes, and structures which assist nurses with the management of data in taking care of patients or supporting the practice of nursing.”


• Graves, J. R., & Corcoran, S. (1989). The Study of Nursing Informatics. Image: Journal of Nursing Scholarship, 27, 227-231. define nursing informatics as "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."


Informatics– Is the science of information, the practice of

information processing, and the engineering of information system.

– Studies the structure, algorithms, behavior and interactions of natural and artificial systems that store, process, access, and communicate information.


Informatics– Develops its own conceptual and

theoretical foundations and utilizes foundations developed in other fields


Information System– Is a collective term referring to a system

of data records and activities that processes and translate the data to information in an automated process

– The processing of data involves the use of computer systems and specialized software that manipulates the information-processing activities of an organization


Information System– Computer-based information

systems are in the field of information technology.

– The discipline of nursing informatics is related to the processing of data of patients records into information which are supported by information system


Information System– There are various types of information

system in the healthcare industry such as:– Decision support system for patient care– Patient data profiling– Knowledge discovery and management– Transaction records processing system– Hospital information system– Pharmacy health system


Information System– There are various types of information

system in the healthcare industry such as:– Clinical information system– Electronic health records– Critical care system– Patient care management– Hospital facility management– Nursing information system


Information System– The starting point of the introduction of the

health care information system, most especially in the Philippines, is the proper education and appropriate teaching.

– Teaching nursing informatics today is very timely since the availability of the information technology is very widespread.

PRESERVATION OF HEALTHCARE QUALITY THROUGH NURSING

INFORMATICS– In the Philippines, many organizations such

as the DOH, are trying to educate and inform the public about healthcare quality.

– Regulatory reforms are already conceptualized when the fourteenth congress of the Republic of the Philippines, on its second session, introduces the implementation of Health Information Technology (HIT), through the effort of the senate.


INFORMATICS

Article 8 Section 11 of the 1987 Constitution

“ the State shall adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health and other social services available to all people”


INFORMATICS

– NI will help make patients aware of what they are really getting and enables them to make decisions that reflect their requirements and their ideals.

MODELS FOR NURSING INFORMATICS

– Models are representations of some aspect of the real world

– Models show particular perspectives of a selected aspect and may illustrate relationships.

– Models evolve as knowledge about the selected aspect changes and are dependent on the “world view” of those developing the model.

MODELS FOR NURSING INFORMATICS

– Different models reflect different viewpoints and are not necessarily competitive; there is no one “right” model.

– Different scholars in nursing informatics have proposed different models

NURSING INFORMATICS MODELS

General Models• Graves and Corcoran’s model• Schwirian’s model• Turley’s model• Data Information Knowledge (D-I-K) model • Benner’s Novice to Expert model

GRAVES AND CORCORAN’S MODEL (1989)

Nursing informatics as the linear progression - from data into information and knowledge

• Management processing is integrated within each elements, depicting nursing informatics as the proper management of knowledge – from data as it is converted into information and knowledge


The framework for nursing informatics relies on the central concepts of data, information and knowledge:

• data is defined as discrete entities that are described objectively without interpretation

• information as data that is interpreted, organized or structured

• knowledge as information that has been synthesized so that interrelationships are identified and formalized.


Resulting in decisions that guide practice

The management and processing components may be considered the functional components of informatics.

MANAGEMENT

DATA INFORMATION KNOWLEDGE



Data: 140 systolicInformation: 50 year-old male, day 3 of Hospitalization, BP 140/70Knowledge: Pt. demographics, record of BP readings, circulation system: anatomy & physiology, pharmacokinetics of ordered medicationDecisions: That guide practice

SCHWIRIAN’S MODEL (1986)

Nursing informatics involves identification of information needs, resolution of the needs, and attainment of nursing goals/objectives

Patricia Schwirian – proposed a model intended to stimulate and guide systematic research in nursing informatics

Model/framework that enables identification of significant information needs, that can foster research (somewhat similar to Maslow’s hierarchy of needs)

GOAL

USERS

TECHNOLOGY

RAW MATERIALS(Nursing-related information)

TURLEY’S MODEL (1996)

• Nursing informatics is the intersection between the discipline-specific science (nursing) and the area of informatics

• Core components of informatics:– Cognitive science– Information science– Computer science

COMPUTER SCIENCE

INFORMATIONSCIENCE

COGNITIVE SCIENCE

NURSING

DATA-INFORMATION-KNOWLEDGE MODEL

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

Nursing informatics is an evolving, dynamic process involving the conversion of data into information, and subsequently knowledge

Important Note: Processing of information does not always result in the development of knowledge.

CO

MP

LE

XIT

Y

HUMAN INTELLECT

KNOWLEDGE

INFORMATION

DATA

BENNER’S LEVEL OF EXPERTISE MODEL

• Every nurse must be able to continuously exhibit the capability to acquire skills (in this case, computer literacy skills parallel with nursing knowledge), and then demonstrate specific skills beginning with the very first student experience

LEVELS OF EXPERTISE (BENNER):

• Novice – individuals with no experience of situations and related content in those situations where they are expected to perform tasks

• Advanced Beginner – marginally demonstrate acceptable performance having built on lessons learned in their expanding experience base; needs supervision

• Competent – enhanced mastery and the ability to cope with and manage many contingencies

NOVICE

ADVANCED BEGINNER

COMPETENT

PROFICIENT

EXPERT

Proficient – evolution through continuous practice of skills, combined with professional experience and knowledge; individual who appreciates standards of practice as they apply in nursing informatics

Expert – individual with mastery of the concept and capacity to intuitively understand the situation and immediately target the problem with minimal effort or problem solving

LEVELS OF EXPERTISE (BENNER):

PHILIPPINE PERSPECTIVE

by: Kristian R. Sumabat, RNPresident, Philippine Nursing Informatics

Association• The Philippine nursing community have

long sought to keep up with increasing use of information and technology in the healthcare system.

• Nursing Informatics follows the footsteps of biomedical informatics which has gained relative popularity earlier than it's other allied medical counterparts.


Association• Despite being in it's early stages of

development the subspecialty of nursing informatics on the Philippines have more than a decade of history which led to future programs and activities.


Association• Some of the major milestones in nursing

informatics history in the Philippines which includes the participation of the Philippine Nurses Association (PNA) in the development of Standards for Health Information in the Philippines (SHIP) in 1999, the formation of the Master of Science in Health Informatics (MSHI) which began in 2005 and the formation of the Philippine Nursing Informatics Association (PNIA) in 2010 as a sub-specialty organization of PNA for nursing informatics.


Association• The words "nursing informatics" were unfamiliar

among the nursing community until the year 2008.

• There were only a handful of people with knowledge and experience in nursing informatics but the discipline have not yet found its recognition as a sub-specialty of nursing arts and science in the country.

• The origin of this budding discipline indirectly came from the pioneers of health informatics in the Philippines.


Association• Since 1998, several faculty members of the

University of the Philippines began formal education and training.

• Dr. Herman Tolentino• Dr. Alvin Marcelo• Dr. Micheal Muin • Dr. Ryan Bañez.


Association

• By the year 2003, a Master of Science in Health Informatics was proposed to be offered by UP-Manila College of Medicine (major in medical informatics) and the College of Arts and Science (major in bioinformatics) and was later approved to be offered starting academic year 2005-2006.

• In 1999, a study group was formed headed by the National Institute of Health of the University of the Philippines Manila.


Association

• This group identified international standards for health information and their adaptability in the Philippines.

• The document is referred to as the "Standards of Health Information in the Philippines, 1999 version" or "SHIP99".

• Representatives from various sectors collaborated on this project including the Philippine Nurses Association (PNA) in the person of Ms. Evelyn Protacio.


AssociationCHED as a Catalyst• The nursing community was still yet to follow its

international counterparts in the adoption of information, communication and technology in nursing practice in the Philippines.

• Despite the inclusion of Informatics course in the undergraduate curriculum which focused on basic desktop applications, the need for genuine nursing informatics course had not yet been realized.


AssociationCHED as a Catalyst• In 2008, Nursing Informatics course in the

undergraduate curriculum was defined by the Commission on Higher Education (CHED) Memorandum Order 5 Series of 2008.

• This was later revised and included as Health Informatics course in CHED Memorandum Order 14 Series of 2009.

*IMPORTANT TERMINOLOGIES (DATA SETS):

• ABC codes• Perioperative Nursing Data Set (PNDS)• SNOMED CT• International Classification for Nursing

Practice (ICNP)• Patient Care Data Set (PCDS)• NANDA• LOINC

ABC CODES

• mechanism for coding integrative health interventions by clinician for administrative billing and insurance claims

• includes complementary and alternative medicine interventions and codes that map all NIC, CCC, and Omaha system interventions

PERIOPERATIVE NURSING DATA SET (PNDS)

• universal language for perioperative nursing practice and education; standardize documentation of perioperative data in all perioperative settings

• Diagnosis based on NANDA, interventions based on NIC, and outcomes based on NOC

SNOMED CT

• core clinical terminology containing over 357,000 healthcare concepts with unique meanings and formal logic-based definitions organized into multiple hierarchies

INTERNATIONAL CLASSIFICATION FOR NURSING PRACTICE (ICNP)

• integrated terminology for nursing practice developed under sponsorship of International Council of Nurses

ICNP elements:• Nursing phenomena (nursing

diagnosis)• Nursing actions (nursing interventions)• Nursing outcomes

PATIENT CARE DATA SET (PCDS)

• terms and codes for patient problems, therapeutic goals, and patient care orders

• developed by Dr. Judith Ozbolt

ORGANIZATIONS AS RESOURCES

• AMIA• NLN• HIMSS• SHS• ACM• ARMA• ASIS & T

AMERICAN MEDICAL INFORMATICS ASSOCIATION

(AMIA)• authoritative body in the field of medical

informatics and frequently represents the United States in the informational area of medical informatics in international forums

• dedicated to the development and application of medical informatics in the support of patient care, teaching, research, and healthcare administration

NATIONAL LEAGUE FOR NURSING (NLN)

Mission: To advance quality nursing education that prepares the nursing workforce to meet the needs of diverse populations in an ever-changing healthcare environment

Addresses faculty development and educational research

*Educational Technology and Information Management Advisory Council (ETIMAC) – promote effective use of technology in nursing education, as a teaching tool and outcome for student-faculty learning

HEALTHCARE INFORMATION AND MANAGEMENT

SYSTEMS SOCIETY (HIMSS)

• assumes leadership role in the health care information technology standards of nursing and advocacy of key innovations in health care delivery and administration

SOCIETY FOR HEALTH SYSTEMS (SHS)

Individual membership organization that exists to enhance the career development and continuing education of professionals who use industrial and management engineering expertise for productivity and quality improvement in the healthcare industry.

ASSOCIATION FOR COMPUTING MACINERY

(ACM) Founded in 1947 Major force in advancing skills of information

technology professionals and students worldwide

ARMA INTERNATIONAL

MISSION: provide education, research, and networking opportunities to information professionals, to enable them to use their skills and experience to leverage the value of records, information and knowledge as corporate assets and as contributors to international success.

Association of Records Managers & Administrators

AMERICAN SOCIETY FOR INFORMATION SCIENCE

AND TECHNOLOGY

The society for information professionals leading the search for new and better theories, techniques, and technologies to improve access to information

ASSIGNMENT1. Trace the history of computers. Give the

description of each class of computer. How are they different from one another in terms of:

a. Memory

b. Speed

c. Function

2. Give your idea about the different types of computer. Which type, in your opinion, is best for student use and why.

“digital nativesversus digital immigrants”

• A common assumption espoused by the popular media and educators is that young people have higher competency with ICT than their elders.

• According to Prensky (2001a), students born after roughly 1980 are “digital natives” because they have grown up with digital media and spend a great deal of time engaging with new digital devices and exploring online.

“digital nativesversus digital immigrants”

• Prensky (2001a) has described in detail the media consumption habits of these so-called digital natives:Today’s average college grads have spent less than 5,000 hours of their lives reading, but over

10,000 hours playing video games (not to mention 20,000 hours watching TV). Computer games, emails, the Internet, cell phones and

instant messaging are integral parts of their lives (p. 1).their elders

1_foundations of nursing tics

Documents

health care data standards

data accessibility

integration of data

data processing

coordination of data

nursing care delivery

information science

fundamentals of information