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    Brief History of Nursing Informatics in Canada

    "Registered nurses need to be able to demonstrate their unique contributionto the health of Canadians within Canada's rapidly evolving health care system.Basic, essential nursing information is required by nurses, employers, researchers,educators, policy makers, and clients so that informed decisions can be madeabout nursing's role in the changing health care system,"- Canadian Nurses' Association, 1993:Policy Statement on Health Information: Nursing Components, p. 1.

    TheCNA wrote this policy statement to highlight theimportance of developing the nursing data components thatwill be included in our emerging national health informationsystem. The CNA has also spearheaded an initiative, the

    National Nursing Informatics Project, to begin to develop a

    national consensus on definition, competencies, andeducational strategies and priorities.

    The use of technology in nursing is not new, in fact nurses have become proficient inutilizing and adapting complex technology into caring nursing practice for decades, at least

    since the time of Florence Nightingale in the United Kingdom and even earlier, when Jeanne

    Mance (1606-1673) founded the first hospital inMontreal,Canada in 1642. Various forms of machinery such asventilators and physiological monitors were first used in

    intensive and critical care settings, and are now currentlyused in adapted form in less acute areas, even in home care.Nursing has evolved significantly over the past few decades,

    with many of the changes being driven by advances in

    information and communication technology (ICT). ICT haspermeated all aspects of society, including health care andaffects all members of the interdisciplinary health team. Since

    nurses are the largest group of health care providers,

    discipline-specific competencies in the use of ICT and othertechnologies are imperative. This realization has catalyzed the

    steady development of nursing informatics. Nurses in Canada

    have made an enormous contribution to all aspects ofCanadian society. Their involvements have influenced thewider social, economic and political history of Canada, as well as the history and politics of

    health care. Nursing history provides the public with valuable perspectives on emerging

    technologies, health care reform and gender issues in Canadian history (Canadian NursesAssociation, 2004, p. 2).

    Nursing informatics began to evolve as nurses participated in the early initiatives inhospital information system adoption in various health agencies across the nation. As these

    systems improved, specialized nursing components and even free-standing nursing

    information systems began to sprout up. Early systems were primarily imported from othercountries, especially the USA. By the late 1980s, most hospitals had at least a rudimentary

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    information system that required nurses to enter common data such as admission profiles

    and basic care requirements like diet, medications, and treatments into a computer as partof their routine duties.

    The National Nursing Informatics Project

    In 1998, the Canadian Nurses Association spearheadedanother initiative, the National Nursing Informatics Project, tobegin to develop a national consensus on definition,

    competencies, and educational strategies and priorities innursing informatics development. "In 1998 a national steeringcommittee was formed to address Nursing Informatics issuesand develop strategies to ensure that Registered Nurses have

    the competencies required to successfully carry out theresponsibilities of their practice - whether that be clinical,

    administrative, educational or research. The committeemembership represented the Canadian Association of

    University Schools of Nursing, Canadian Nurses Association,Registered Nurses Association of British Columbia, Academy of Canadian Executive Nurses

    and the COACH Nursing Informatics Special Interest Group. Each participating organization

    appointed a nurse expert in Nursing Informatics to a five-member working group to developand initiate a plan to:

    develop consensus on a definition of Nursing Informatics for Canada; recommend Nursing Informatics competencies for entry level nurses and specialists,

    managers, educators, and researchers;

    identify curriculum implications and strategies for both basic and continuing nursingeducation; and

    determine priorities for implementing national nursing informatics educationstrategies.

    The first phase of the project was the development of a Discussion paper in 1999, and thecollection of feedback on key issues related to nursing informatics competenciesdevelopment from Canadian nurses.

    Nursing Minimum Data Set

    The Nursing Minimum Data Set was the first major CanadianNurses Association informatics initiative beginning in 1990.

    This was in response to the strong conviction that nursing

    data must be included in the centralized national health datasystem being planned by the Canadian Institute of Health

    Information (CIHI) described in Chapter 2.Registered nurses,

    as the single largest group providing health care services, playa major role in health care in Canada. Incredibly, thiscontribution is not abstracted from client records and saved in

    a permanent database of health information. Most health care

    data collected in Canada include medical diagnoses andinterventions but do not reflect the contribution of other

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    health care professionals. Decisions are made in the absence of data reflecting the value of

    nursing (Canadian Nurses Association, 2000, p. 5). .The Canadian Nurses Association

    considered it imperative that nursing data, that distinctly reflected nursing care became partof the permanent health record being designed for the nation. The impact of nursing shouldbe captured in national health care databases through the use of effective nursingclassification systems (Canadian Nurses Association, 2003, p. 1).

    Raising Canadian Nursing Awareness

    The Canadian Nurses Association released a number of othersupportive documents in 2001. A key one was published inthe September Nursing Now Bulletin, entitled: What is NursingInformatics and why is it so important? This publication was a

    critical overview of the essential characteristics of theemerging field of nursing informatics in Canada. It also

    introduced a definition of nursing informatics, formulated bythe National Nursing Informatics Project working group.

    Nursing Informatics (NI) is the application of computerscience and information science to nursing. NI promotes the

    generation, management and processing of relevant data in

    order to use information and develop knowledge that supportsnursing in all practice domains (Canadian Nurses Association,2001, p.1).

    Another influential group, theCanadian Institute for Health Information (CIHI) alsoplays a unique and crucial role in the development of this new Canadian health information

    system. CIHI has described its' role as:

    1. Setting National standards for financial, statistical, and clinical data

    2. Setting National standards for health information technology,3. Collecting, processing, and maintaining health related databases and registries

    The CIHI links federal, provincial, and territorial governments with non-government,health-related groups. Rhial LeBlanc, President and Chief Executive Officer of CIHI described

    the organization as having one main focus, "The work of health care facilities and

    professionals is what CIHI supports, and truly improving that service is our constantobjective," (1996, p.1). LeBlanc was clear that CIHI exists to "...serve all elements of

    Canada's health care system in an equal and responsive way." Even though CIHI wasinitially formed by federal, provincial, and territorial Ministers of Health, the Institute has

    been given latitude to grow and chart it's own course. CIHI members have chosen to keep

    at "arms-length" from the various levels of government and do not report directly togovernment officials. The Canadian Nurse's Association (CNA) and the provincial nursing

    associations (for example, the R.N.A.B.C.) plan to link more and more with CIHI in thefuture.

    The CIHI helped introduce the Strategic Plan for Health Information Management in BritishColumbia in 1996 that provides guidelines for holistic assessment and processing of

    information. The Plan is based on the four domains of people, environment, health system

    and processes. In 1995, the CIHI initiated a project to provide a cohesive set of guidelines

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    for Canadian health information privacy. In 1999, a second edition of these guidelines was

    produced, which incorporated issues related to the advancement of health information and

    techology. In 2002, an updated version Privacy and Confidentiality of Health Information atCIHI: Principles and policies for the protection of health information ,the 3rd edition isavailable in PDF (437 k) format

    In March 2000, the CIHI published an updated version oftheRoadmap Initiative, a national vision and four-year action

    plan to modernize Canada's health information system. Led by

    CIHI, this Initiative is a collaborative effort with StatisticsCanada, Health Canada and many other groups at thenational, regional and local levels.

    The CIHI also provide a comprehensiveGoodsourcingStatisticswebsite related to Canadian health and health care,society, the environment and National populations. Dozens of

    other reports are available on the CIHI website, related to

    population health, health indicators, health workforce, issuesin health and health care institutions.

    Another national organization, the Canadian Organizationfor the Advancement of Computers inHealth orCOACH, founded in 1975, has actively initiated

    professional protocols for using computer systems in Canadianhealth care. One important document, Guidelines to PromoteConfidentiality and Security of Automated Health-related

    Information (1979), has been incorporated into the national

    accreditation guidelines approved by the Canadian Council of

    Health Facilities Association in 1991. These guidelines werealso supported by theCNA in 1993.

    In 2001, COACH, as Canada's Health Informatics Association,launched the Patron Program. As an individual member basedorganization, COACH promotes understanding and effective

    utilization of information and information technologies withinthe Canadian Healthcare industry through education,

    information, networking and communication. With the

    development of the Patron program, members are hoping tobuild stronger links between COACH and private and publicenterprise in pursuit of this mission. It is an opportunity for

    corporations to join in partnership with COACH. COACH'svision is to be THE catalyst in advancing the practice of healthinformation management in Canada.

    Today, COACH is a leading organization with an evolvingmembership. It is in the forefront of the Canadian Healthcareinformation resource and technology field by workingcooperatively with health institutions, professions,

    http://secure.cihi.ca/cihiweb/en/downloads/privacy_policy_priv2002_e.pdfhttp://secure.cihi.ca/cihiweb/en/downloads/privacy_policy_priv2002_e.pdfhttp://secure.cihi.ca/cihiweb/en/downloads/privacy_policy_priv2002_e.pdfhttp://secure.cihi.ca/cihiweb/en/downloads/privacy_policy_priv2002_e.pdfhttp://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=profile_roadmap_ehttp://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=profile_roadmap_ehttp://www.gdsourcing.com/works/CIHI.htmhttp://www.gdsourcing.com/works/CIHI.htmhttp://www.gdsourcing.com/works/CIHI.htmhttp://www.coachorg.com/http://www.coachorg.com/http://www.coachorg.com/http://www.cna-nurses.ca/http://www.cna-nurses.ca/http://www.cna-nurses.ca/http://www.cna-nurses.ca/http://www.coachorg.com/http://www.gdsourcing.com/works/CIHI.htmhttp://www.gdsourcing.com/works/CIHI.htmhttp://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=profile_roadmap_ehttp://secure.cihi.ca/cihiweb/en/downloads/privacy_policy_priv2002_e.pdfhttp://secure.cihi.ca/cihiweb/en/downloads/privacy_policy_priv2002_e.pdf
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    associations, consultants, vendors of information technology and applications, governmentand regulatory organizations in the pursuit of its mandate.

    The backgrounds of COACH members range from health executives, physicians, nurses andallied health professionals, researchers and educators to information systems managers,

    technical experts, consultants, and information technology vendor representatives.Organizations represented include the broad range of healthcare institutions, communityand public health, private practice, government, consulting firms, commercial providers of

    information and telecommunications technologies, educational institutions and industry.

    In February 1999 the Canadian Federal government published the timelydocument,Strengthening Health Care for Canadians,outlining new initiatives and funding topromote health care technology and informatics initiatives.

    Various nursing programs are beginning to offer courses and content in NursingInformatics. Some programs integrate informatics into individual courses, which is the

    model we have adopted in the BSN Nursing Program at Kwantlen. Others offer individualstand alone courses which provide computer skills and some theory. A generous list ofeducational opportunities in informatics is available on theCNIA site

    Slowly but steadily, other colleges and universities are expanding their curricula to includeNursing Informatics at both the undergraduate and graduate levels. As more nurses become

    computer literate, and become aware of the potential of technology to support nursingdocumentation, decisions, and professionalism, Nursing Informatics can become a strong

    and integral part of Canadian nursing science. With this goal in mind, the The BSN NursingProgram has adopted Nursing Informatics as an integral component of the curriculum.

    The Canadian Nursing Informatics Association

    In 2001, a new group, theCanadian NursingInformatics Association(CNIA) received emerging

    group status from the CNA and affiliate status in 2003.

    The CNIA now has full associate status with the CNA.The CNIA has awebsite and the executive boardencourages new members, including student members.

    The mission of the CNIA is to be the voice for NursingInformatics in Canada. Recognizing the importance of

    the work the CNIA is undertaking, the Canadian Nurses Association has granted associategroup status to the CNIA. The CNIA is also affiliated with COACH, Canada's National HealthInformatics Association. Through this strategic alliance CNIA is the Canadian nursing

    nominee to the International Medical Informatics Association - Special Interest Group inNursing Informatics (IMIA-SIGNI).

    http://www.fin.gc.ca/budget99/pamph/healpae.htmlhttp://www.fin.gc.ca/budget99/pamph/healpae.htmlhttp://www.cnia.ca/education_links.htmhttp://www.cnia.ca/education_links.htmhttp://www.cnia.ca/education_links.htmhttp://www.cnia.ca/http://www.cnia.ca/http://www.cnia.ca/http://www.cnia.ca/http://www.cnia.ca/http://www.cnia.ca/http://www.cnia.ca/http://cnia.ca/http://www.cnia.ca/http://www.cnia.ca/http://www.cnia.ca/http://www.cnia.ca/education_links.htmhttp://www.fin.gc.ca/budget99/pamph/healpae.html
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    The CNIA conducted a study in 2002 - 2003 on the Informatics Educational Needs ofCanadian Nurses, funded by the Office of Health and the Information Highway, Health

    Canada or OHIH calledEducating Tomorrow's Nurses: Where's Nursing Informatics?

    The intent of the study was to describe the current state of:

    informatics education opportunities currently available to students of nursing acrossthe country,

    the level of preparedness of nursing faculty to deliver these offerings, information and communication technology infrastructure and support for faculty in

    delivering these offerings, and

    opportunities to enhance nursing curricula, faculty preparedness, and ICTinfrastructure and support in schools of nursing across Canada.

    The study was conducted across Canada and includeda representative sample of nursing schools from across

    the country. Thefinal report of this studycan beviewed on the CNIA site. A Kwantlen nursing faculty isa longtime member of the CNIA Executive Board. June

    Kaminski (Kwantlen Polytechnic University, author of

    this informatics curriculum) was Director ofCommunications (and designer of the CNIA website)and is now the the President of the Association. The

    Canadian Journal of Nursing Informatics was launchedby the CNIA in 2006, which invites papers, multimedia,and other electronic media focused on the diverse arena of nursing informatics.

    The Canadian Nurses Portal Project, NurseONE, E-Nursing Strategy

    Over the last two decades Canadian leaders in nursinginformatics have discussed and conceptualized a nation

    wide nursing informatics strategy that would benefit allnurses and nursing students. In 2006, the CanadianNurses Association launched theCanadian Nurses

    Portal Project,shortened to NurseONE to address thisvision, in the form of a e-nursing strategy. Thepurpose of the e-nursing strategy is to guide the

    development of ICT initiatives in nursing to improve

    nursing practice and client outcomes (CanadianNurses Association, 2006, p. 7).

    Initial goals of this e-nursing strategy include:

    advocating for nurses' access to ICT and the resources required to integrate ICT intonursing practice;

    supporting the development and implementation of nursing informatics competenciesamong the competencies required for entry-to-practice and continuing competence;

    and

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    advocating for the involvement of nurses in decision-making about informationtechnology and information systems. (Canadian Nursing Association, 2006, p. 10).

    The e-nursing strategy will address these goals by adopting a three pronged approach:

    Access better connectivity in work environment, more access to a variety ofcomputer technologies, e.g. PDAs, hardware, software, station computers.

    Competency- ongoing ICT skill development, integration into nursing curriculum Participation -as knowledge workers in this technological age, it is essential that

    nurses play an increased role in the development of ICT solutions (Canadian NursingAssociation, 2006, p. 15).

    Nursing Informatics at Kwantlen Polytechnic University

    Kwantlen Polytechnic University offers The BSN Nursing Program which integrates boththeory and practice of Nursing Informatics across the program in BC, Canada. The faculty of

    the BSN Nursing Program fully support that Nursing Informatics is central to nursing in thevarious domains of practice. Since 1996, Kwantlen University College faculty haveintegrated Nursing Informatics into all eight semesters of the program.

    Learning activities which include:

    1. a Cognitive, ("to know" or epistemological),

    2. an Interactive, ("to do" or ontological) as well as3. a Reflective, ("to be" or phenomenological) component

    have been written to facilitate students' awareness and initiation into the science andpractice of Nursing Informatics.

    The assumption is that as students use computers tomanage information in their student role, they willmore readily use their critical thinking skills to learn

    related applications in their work as nurses.The BSN

    Nursing Program curriculum is designed to preparecaring nurses as "knowledge workers" for the changingeconomy of this new millennium.

    The faculty at Kwantlen are committed to thephilosophy that Nursing Informatics should beintegrated throughout the program. To meet this

    directive, learning activities related to NursingInformatics have been created by June Kaminski for

    every Nursing course in the program, except theConsolidated Practice Experiences. Faculty are dedicated to fostering computer literacy in all

    nursing students, and to help students realize the need to devise a long term personal planto keep abreast of the quickly developing field of Nursing Informatics.

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    Kwantlen Polytechnic University is working diligently to offer Internet access to everystudent, and on-campus access to a generous assortment of up-to-date computers and

    related technology. Computers are available for student use in a variety of computer labs

    and areas in Buildings "A", "D" and "G" and in the "Nursing Resource Center" on the Surreycampus, where the nursing program is offered.

    The Nursing Informatics learning activities in this program encourage you the student todevelop your literacy in a number of computer applications. Word processing, graphical

    design, using databases, desk-top publishing, spreadsheets, using the Internet, web pagedesign, multimedia design and the use of Nursing Information Systems (NIS) are someexamples.

    Concepts such as caring, empowerment, self-reflection and expression, computer literacy,confidentiality, bioethical decisions, networking, patient education, community developmentand cyberphobia represent some of the issues and actions explored.

    With the advent of this online version of the Kwantlen Polytechnic University BSNProgram's Nursing Informatics learning activities in 1999, new modes of interaction andcomputer use were made possible. As both faculty and students become more comfortable

    and adept in using computer applications, creative use of computers can become moreprevalent in the program. In time, interactive communication using computers will occur aseasily as in class communication.

    As well, more extensive web site design; use of virtual reality; establishing links with localhealth care agencies, and with schools in other national or global areas can eventually be

    incorporated. The possibilities are endless - only availability of funds, level of computerliteracy, commitment and access to knowledge about new developments in the field inhibitthe process.

    As Nursing Informatics develops in Canada as a recognized component of nursing,Kwantlen Polytechnic University Nursing faculty plan to offer related education in an

    increasingly sophisticated and creative way. Our goal is to assist nursing students to

    become aware of and comfortable using the diverse computer applications available in

    working with clients both in the community and in hospital settings. Faculty intend to

    acquaint nursing students with computers as "enabling tools" for nursing practice,

    education, administration, and research. We hope that our students find value in these

    learning activities and enjoy their initiation into the science and practice of Nursing

    5Informatics.