Nursing Informatics: A Detailed Review - Term Paper Example

NURSING INFORMATICS – A DETAILED REVIEW Institutional affiliation Abstract The potential impact of informatics within the field of nursing has been recognised. At the core of the nursing informatics curriculum is the design, development, implementation, and evaluation of clinical applications.  Although implementation of a computerized patient record is proceeding slowly, 11% of healthcare facilities have complete systems and 32% have components of systems. These systems can play a crucial role in patient safety and error prevention, and nursing informatics is well positioned to influence their development and deployment. Thus, nursing informatics include, but not to be limited to, the use of artificial intelligence or decision-making systems to support the use of the nursing process; the use of a computer-based scheduling package to allocate staff in a hospital or health care organization; the use of computers for patient education; the use of computer-assisted learning in nursing education; nursing use of a hospital information system; or research related to information nurses use in making patient care decisions and how those decisions are made. It is an upcoming field with lot of career opportunities for healthcare professionals. Lot of research is being undertaken to streamline and adopt a common system for data documentation, retrieval, sharing in varied hospital settings. Introduction Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses practice in a wide range of settings, from hospitals to visiting people in their homes and caring for them, as researchers in laboratories, universities, and research institutions. They work in a large variety of specialties either independently or as part of a team. Nursing process is the core of patient care delivery. In the nursing process, nurses are constantly faced with data and information. Information science influenced nursing as far back as the 19th Century. Florence Nightingale is credited with being the founder of modern nursing and poten-tially the first nursing informatician. Nightingale, also a statistician, is well known for collecting, analysing, organising and reporting information about the health of the British population in order to improve it (Betts & Wright, 2003). A need was felt and therefore efforts were made to include technology while delivering compassionate care. Technology, coined from the Greek language “tekhnolohiga” meaning systematic treatment, is defined as a scientific method of achieving a practical purpose. 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, the term technology exponentially covers a greater meaning in healthcare to include informatics. Coined from the French word “informatique”, informatics was first defined as computer science plus information science. (Graves, Corcoran 1988). As it relates to nursing, it has been labeled as Nursing Informatics. The role of the informatics nurse is distinguished from other informatics roles by its association with patient care. It is a field within the field of health informatics, where people who have a nursing degree are involved in the implementation of a computer application in a hospital, nursing home, doctor’s office, public health clinics, or other healthcare setting. It refers to electronic information combined with nursing and any aspect of clinical practice, administration, research, or education (Guenther, 2006). The nursing informatics model below depicts at a glance the above definition very well. Figure 1. (Turley 1996) In 1994, the definition was modified by ANA in an effort to legitimize the specialty and guide efforts to create a certification examination. Thus, ANA defines Nursing informatics as the specialty that integrates nursing science, computer science, and information science in identifying, collecting, processing, and managing data and information to support nursing practice, administration, education, research, and expansion of nursing knowledge. It supports the practice of all nursing specialties, in all sites and settings, whether at the basic or advanced level. The practice includes the development of applications, tools, processes, and structures that assist nurses with the management of data in taking care of patients or in supporting their practice of nursing (ANA 2001). Summary of previous work done on Nursing Informatics As the impact of ICTs (Intensive care treatment) in health care grew, the Canadian Nurses Association initiated formal projects, policy statements and plans to guide the development of nursing informatics. Since the early 1990s, the Canadian Nursing Association has spearheaded several initiatives to prepare nurses to become active and knowledgeable participants in these developments.  One such initiative, begun in 1998, was the National Nursing Informatics Project, created to begin to develop a national consensus on definition, competencies, and educational strategies and priorities in nursing informatics development. "In 1998 a national steering committee was formed to address Nursing Informatics issues and develop strategies to ensure that Registered Nurses have the competencies required to successfully carry out the responsibilities of their practice - whether that be clinical, administrative, educational or research. In 2001, a discussion paper was published in the September Nursing Now Bulletin, entitled: What is Nursing Informatics and why is it so important? This publication was a critical overview of the essential characteristics of the emerging field of nursing informatics (Marion 2005). Theoretical Framework Because nursing informatics is a young specialty, perhaps it is not surprising that much of the research done to date has been problem driven, as opposed to model-driven. Continuing to struggle with definitions, nursing informatics lacks a theoretical base on which to build its science. When models or theories have been used to guide research, they typically have been applied to a single, or to very few, studies. Various models have been proposed to describe different aspects of the discipline. Schwirian was the first to propose a model to guide nursing informatics research. Her model included interacting components (information, user context, and technology) and a goal. This model was modified by Gassert by adding a fifth element – information processing. However, this model was not considered complete as patient was nowhere included. Graves and Corcoran in 1989 developed a model that depicts nurses as “knowledge workers” who convert raw data, first into information, and then into knowledge. It provides a useful foundation for an overarching model for nursing informatics in general. Goosen’s extension of Graves and Corcoran’s framework (Figure below) includes the processes of collecting, aggregating, representing, and using information for decision making and the actions taken based on those decisions. Figure 2. (Goosen 2000) Evaluation includes both patient outcomes and evaluation of the care provided. Two-way arrows indicate the nonlinearity of the model. This model thus on a whole includes role of nursing, patient care, health (as outcome) in concept of evaluation and context in transition of data to information and is the closest resemblance as per definition of nursing informatics. However, Goosen’s depiction of categories of information (data, knowledge, information) and categories of control (decision, action, evaluation), as if they were a sequential process, is somewhat problematic because these two categories have a reciprocal relationship much like two sides of a coin (eg, information leads to some action, which changes the information, leading to a different action, etc) (Judith 2003). A process model used widely in informatics is the systems development life cycle (SDLC) was modified by Thompson, Snyder-Halpern, and Staggers to define more clearly the role of nurse informaticist. But this model does not explicitly include descriptions of nurse, patient, or health. Likewise, a number of models have been proposed for various aspects of nursing informatics. The most recent model proposed for Nursing Informatics is an Organizing Model. As per Judith A. Effken an organizing model is needed that could serve as a frame work for development of Nursing informatics as a Science. This model combines informatics research organizing (IRO) model and SDLC model. The strength of this model is its broad applicability to guide research in any kind of computer application and any kind of outcome in any setting . The limitation of the model is that it is too general to be of use as an organizing framework and further research is required through its application by many nursing informatics researchers in many setting will establish the model’s utility (Judith 2003). Factors Influencing Nursing Informatics Nursing Informatics makes it easier for nurses to chart and spend more time at the bedside. But there are factors that greatly influence Nursing informatics today. Ethics and patient confidentiality are big factors that need to be considered in the great world of Nursing Informatics. When paper records were used health providers sealed them away in file cabinets and prohibited others from seeing them. State laws which governed the use and disclosure of this information left many gaps which became very evident when computers arrived. As a result of this patient information has sometimes been shared inappropiately. According to Thede in Informatics and Nursing the protection of patient data has three parts. They are privacy, confidentiality and security (Thede 2008). Privacy allows the patient to choose who they will share their private information with. They will select which information shared with their health provider will become known to others. Confidentiality refers to the people who have access to the patients health information and how they protect it. Finally security deals with protecting data from errors such as input or system errors. Protecting a patients privacy is every healthcare workers professional responsibility. It is important that the information patients share is safeguarded. When a patient is interviewed the environment should ensure that the interview is not overheard by anyone. In the next step, care should be taken when charting this imformation in the computer. The computer screen should not be visible to anyone except the person doing the charting. Confidentiality according to Thede, is a constant balancing act. Computer records have brought the issue of confidentiality to the forefront. It is easier for health professionals to access health information in the system and view more than one record at a time which wasnt easy with paper records. Not all health professionals are given authority to gain access to stored data. The most secure method of authentication is biometrics. This is the use of physiological characteristics such as fingerprints, retinal or iris scans, or even a voice print that is presumably unique to a specific person. The second most secure system is the card or key entry system accompanied by a password. The least secure system is the user ID and password. Most systems force the user to change their password every certain amount of time and dont allow the use of the same password to make it more secure. Data security has three aspects. The first deals with the accuracy of the data, the second deals with protection of the data from unathorized eyes inside or outside the agency, and the third with internal or external damage to the data. Accuracy of the original data is the responsibility of the user. The user should make sure that they dont change the information. Data should also be protected from getting lost. Backup of data must be routinely created and stored off site in a secure place. A disaster recovery plan should be devised and tested (Thede 2008). Responsibilities of Nursing Informaticist In 2007, the Healthcare Information and Management Systems Society Nursing Informatics Awareness Task Force estimated that 50 percent of a nurses time is spent on documentation. Because of explosive strides in information technology and the huge body of medical knowledge amassed, controlling medical errors and health care costs are paramount in the health care professions, including nursing. According to RN Journal, handwriting on a piece of paper has been largely replaced by reports from medical devices at the point of care, and nurses have to master electronic documentation. Nursing informatics was recognized as a specialty in 1992 and a scope of practice was developed through the American Nurses’ Association in 1994. The first American Nurses Credentialing Center nursing informatics exam was available in November 1995. The course involves training of nurses in:- 1. System Analysis and Design 2. System Implementation and Support 3. System Testing and Evaluation In 2007, 0.80% of all 22,159 certifying nurses were nursing informaticists. These specialized nurses add value to an organization by: increasing the accuracy and completeness of nursing documentation improving the nurse’s workflow eliminating redundant documentation automating the collection and reuse of nursing data facilitating the analysis of clinical data A Nursing informacist can be a Project Manager, Researcher, Educator, Consultant, Policy Developer, Product Developer, Decision support/ Outcomes Manager (Graves 1995). Future of Nursing Informaticist There are many emerging roles for nursing informaticist – CIO, entrepreneurs, product developers, web design, independent consultants. As per the Nursing Informatics work force survey, 48 percent work at a hospital and another 20 percent work at the corporate offices of a healthcare system. (www.himss.org) Clinical Background: Approximately half of the respondents indicated they had at least 16 years of clinical experience prior to beginning their informatics career. Duration of Informatics Career: Nurse informaticists in the 2011 survey have had longer careers than those who responded to the 2004 and 2007 survey as more than 39 percent of respondents report they have been a nurse informaticist for ten years or more. This suggests an increase in the length of career as the discipline continues to mature. Job Responsibilities: As in 2004 and 2007, the 2011 respondents identified systems implementation and systems development activities as their top two job responsibilities. Barriers to Success: Financial resources are no longer the most identified barrier to success as a nurse informaticist as mentioned in 2004 and 2007 surveys. In 2011, lack of integration/interoperability was mentioned most frequently as the top or secondary barrier. Financial resources were the second highest barrier mentioned in 2011. Information: Over the course of all three surveys, websites and the Internet are the resources most valuable for carrying out day-to-day job activities. While list servs were among the next highest mentions in 2004 and 2007, in 2011, networking became the second highest mentioned source for day-to-day job activities. As for continuing education credit sources, distance learning (e.g., audio conferences or webinars) were rated the highest, while national conferences are considered the top selection as the most valuable resource for continuing education. Compensation and Benefits: The average salaries reported in 2011 are almost 16 percent higher than in 2007 and 42 percent higher than in 2004. Implications Creating a safe patient environment is a very complex issue that will require the combined knowledge and skill of clinical informaticists, informatics faculty, researchers, and system designers. Further implications for nursing informatics education include: (1) the standardization and defining of terms and taxonomies that represent knowledge of the domain and can be linked to a “patient-centered” ontology that also supports other disciplines; (2) student projects that require informatics students and developers to work collaboratively to improve current systems, particularly clinical decision support systems to prevent and detect adverse errors; (3) project development content that prepares students to conduct rigorous usability testing, provide appropriate system training, and adopt quality improvement models to evaluate the effectiveness and accuracy of automated systems; and (4) emphasis on communication, information needs, and complex clinical environmental issues as they relate to systems engineering and implementation. Finally, informatics faculty should work together with system designers to expand the development of collaborative, safety-related student informatics projects in a “real-time” laboratory (Tubera 2010). Conclusion Because of explosive strides in information technology and the huge body of medical knowledge amassed, controlling medical errors and health care costs are paramount in the health care professions, including nursing (Efflen 2002). Nursing documentation is complex and situation-dependent. With different technology and medical charting methods in use, consistent education and training on documentation is difficult to achieve, especially electronically. There is no single device that generates a comprehensive patient record, stores it and makes it accessible to care providers in different locations. Therefore, duplication of information often occurs. Also, inability to access data in different locations makes decision making difficult. For example :- a modification in anesthesia procedure implemented in hospitals in a particular city requires results to be compiled from all the hospitals. Only then can a nursing informaticist take decision confidently whether the modification in the treatment can be put to practice on a routine basis or initiate the legal formalities so that the treatment is implemented across the hospitals. Bar codes on medicines, computerized physician order-entry, automated scheduling systems for nurse administrators, nursing student preparation for IT tools are just a few of the problems in nursing informatics. Another challenge faced in Nursing Informatics is unique distinctions between roles has not been defined. Nursing informatics is a vast field with multifaceted roles. As per the individual competencies, a system needs to be generated where responsibilities should be properly distributed among the informaticists. Systems have to be created where collected data is categorized and stored accordingly. Categorizing the data is of utmost importance. This will ease out data retrieval for future applications. Issues have been identified and lot of thought process already is being involved in informatics to address the above issues. New systems for data storage, data retrieval are being worked out. Again the challenge is to test utility of the new systems generated in healthcare environment and if found useful, implement it on a large scale (Guenther JT). Nurse practitioners are taking on increased responsibility, such as educating patients in disease management practices. More are providing primary care, since nurse-managed clinics are becoming a mechanism for delivering more affordable healthcare. Nursing staff able to use the outcomes information provided by disease surveillance and health reporting systems can improve care management. References 1. 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Retrieved March 19, 2011 from www.himss.org. 7. Judith A. E., (2003). An organizing framework for nursing informatics research. CIN: Computer, Informatics, Nursing. Vol 21 (6) : 316 – 323. Retrieved March 19, 2011 from at.phcc.edu. 8. Efflen JA. (2002). Different lenses, improved outcomes: a new approach to the analysis and design of healthcare information systems. (Electronic version). Int J Med Inf. 65: 59 – 74. 9. American Nurses. (2001). Scope and standards of nursing informatics practice. Washington, DC: American Nurses Association (ANA). Retrieved March 20, 2011 from Nursing Informatics Past Present Future (Compatibility Mode) – Microsoft Power Point Presentation. 10. Goosen W.T., (2000). Nursing informatics research. Nurse Res. Vol 8 (2) : 42-54. Retrieved March 18, 2011 from at.phcc.edu/NUR2820/PDFs/MOD2/Nursing-informatics.pdf. 11. Graves, J.R., Amos. L.K., Huether, S., Lange, L., and Thompson, C.B. (1995). Description of a graduate program in clinic nursing informatics. 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