Nursing Informatics Telehealth and Graves and Corcorans Data-Information-Knowledge - Term Paper Example

?Nursing Informatics Telehealth and Graves and Corcoran’s Data-Information-Knowledge This paper seeks to describe how the perspective of Graves and Corcoran on data information technology theory influenced the emergence and development of telemedicine or telehealth. Tone (2011) quoted Graves and Corcoran (1989) to have said that nursing informatics is “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 patient care.” In turn, nursing informatics is part of healthcare informatics that Guenther (2006, p. E-92) had reported to have been defined by Saba and McCormick (2001) as “the integration of health sciences, computer science, information science, and cognitive science to assist in the management of health care information.” The striking similarity of the definitions between nursing informatics and health informatics should not be a surprise. It is highly likely that Graves and Corcoran have influenced the entire field of healthcare informatics as health care informatics may have influenced Graves and Corcoran. However, Guenther (2006, p. E-92) reported that medical informatics is a term that have been in used since the mid-70s and had referred to “information technologies that concern patient care and the medical decision-making process.” Further, Guenther (2006, p. E-92) reported that the term nursing informatics “was not seen in the literature until 1984” even if Guenther reported that nurses have been working on nursing informatics for more than twenty-five years as of 2006. It is not clear from Guenther who started the term nursing informatics in 1984. A 1988 work of Graves and Corcoran did not use the term “informatics” although one of the references used in their material involves the term “medical informatics” with a publication date of 1985. Graves and Corcoran (1988) used the term “clinical nursing information system” instead and their work involved identifying the data element categories for clinical nursing information systems based on an analysis of nursing practice. However, it should be pointed out that based on the work Scholes and Barber (1980), nursing informatics has been in used even before 1980 and, thus, Guenther (2006) may be wrong on the view that nursing informatics “was not seen in the literature since 1984.” Further, according to Thede (2010) based on the work of Sackett and Erdley, the term “informatics” was coined in 1966 but Scholes and Barber (1980) was probably the first to use the term “nursing informatics”. The work of Staggers and Thomson (2002) and Guenther (2006) are highly informative on the literature of nursing informatics as well as on how our notion of nursing informatics has evolved over the years. Staggers and Thomson (2002) emphasized the need for a definition of nursing informatics even if by that time, the American Nursing Association has already adopted a definition of nursing informatics in 2001. At minimum, the Staggers and Thomson (2002) expression of a need for a definition of nursing informatics probably indicated a discontent for the prevailing notion of nursing informatics in 2002. As Staggers and Thomson (2002, p. 255) themselves pointed out, “a definition is a fundamental element for shaping a specialty.” Staggers and Thomson (2006, p. 255) continued that “a definition for nursing informatics guides role delineation for nurses interested in informatics and suggests directions for practice, education, training, and research.” Further, a definition of nursing informatics “may be useful to other disciplines as they define informatics practice within their own specialties” (Staggers and Thomson, 2002, p. 256). Staggers and Thomson also emphasized that “a definition for nursing informatics is needed to help others, within and outside nursing, understand the legitimacy of the practice and the general competencies of a nurse who specializes in informatics” (p. 256). Guenther (2006) reported that Hannah defined in Hannah et al. (1985) that nursing informatics is the use of information technologies within the purview of nursing. Guenther (2006, p. E-92) contrasted Hannah’s 1985 definition with a more comprehensive definition from Graves and Corcoran (1989) that defined 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 and delivery of nursing care.” The phrase quoted by Guenther from Graves and Corcoran is similar but not an exact duplicate of those quoted by Tone (2011) which this work pointed out earlier. Nevertheless, the Tone’s and Guenther’s quotations were taken from the same material of Graves and Corcoran (1989). It appears highly reasonable to argue that the take off point of Graves and Corcoran’s 1989 notion of nursing informatics is the one that is not only comprehensive but also the more useful for nursing informatics. In the Graves and Corcoran’s 1989 notion, nursing practice and patient care is the take off point for the practice of nursing informatics. In contrast, Hannah’s 1985 definition as described by Guenther was also useful but was less enlightening in providing the direction for the practice of nursing informatics from the late 1980s until the more modern era. The influence of Graves and Corcoran (1989) is clear in 1994 and 1995 American Nurses Association’s definition of nursing informatics. According to Guenther (2006, p. E-92), the 1994 pamphlet of the American Nursing Association defined 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 the expansion of nursing knowledge.” Based on the narration of Guenther (2006), the ANA or American Nurses Association definition adopted in a document in 1994 as well as in 1995 is more comprehensive than that of Graves and Corcoran (1989). However, the influence of the Graves and Corcoran’s 1989 definition of nursing informatics is clear in the 1994, 1995, and 2006 definitions of the ANA on nursing informatics: the definition of Graves and Corcoran (1989) of nursing informatics was expanded to cover “nursing practice, administration, education, research and expansion of nursing knowledge” not only “nursing practice” . Guenther (2006) reported further that 1994 and 1995 documents that contained a definition of nursing informatics were consolidated by the ANA into a single document in 2001 known as the Scope and Standards of Nursing Informatics. The 2001 document of the American Nurses Association simply defined nursing informatics as “a specialty that integrates nursing science, computer science and information science to manage and communicate data, knowledge, and nursing practice” (Gunther, 2006, p. E-93). The Staggers and Thomson (2006, p. 260) articulation of the 2001 definition of nursing informatics adopted by the American Nursing Association, however, is more complete: “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.” Later, however, the ANA 2001 definition was expanded into something that is more comprehensive. Based on Thede (2010, last paragraph), the latest definition of the American Nurses Association based on the 2008 document Nursing Informatics: Scope and Standards of Practice (p. 65) is that: “Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice. Nursing informatics facilitates the integration of data, information, knowledge, and wisdom 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.” The 2008 ANA definition of nursing informatics is an improvement of the 2001 definition by the addition of the word “wisdom” in two sentences of the 2001 definition. In the 2008 definition, the noun “wisdom” is added to the noun “knowledge” on the scope of information that must be covered by the databases of nursing informatics. As such, nursing informatics can cover databases on nursing and medical practices that may have no scientific explanations but are proven by folk and medical practices to be valid or have the appearance of validity. Of course, this is not to diminish the importance of scientific investigation. At minimum, the coverage of the term “wisdom” encourages nursing and medical researchers to investigate into the scientific bases of why certain nursing or medical practices appear to work or whether the nursing or medical practices work at all. In telemedicine, as early as more than ten years ago, Smith (2001) has noted significant advances in telemedicine. Even during that time, Smith (2001, p. 825) had already noted that it has been “possible for telemedicine to be used in multiple areas of medicines, including trauma care.” Smith (2001, p. 825) even noted that “teleradiology and teleconsultation are becoming standard operating procedure for many rural facilities.” Smith (2001, p. 825) correctly anticipated that telemedicine will acquire increasing importance in the future and “will alter patterns of referral, consultation, and treatment.” Needless to say, this implies that nursing informatics will have to march in step with the advances in telemedicine. Patient records have to be recorded online while maintaining the nursing informatician’s commitment to the confidentiality of patients’ records and accuracy of records. Further, nursing informatics must assist the doctor or the medical specialist in making consultations, recording consultations and diagnosis, recording if not even following up medical prescriptions, and in therapy or treatment programs. Nursing informatics must also assist the doctor/specialist in making decisions that benefit the patient. Smith (2001) correctly pointed out the importance of teleconferencing and teleconsultation in medical practice. The advances in telemedicine imply that nursing informatics must also march along the progress and advances of telemedicine. Smith (2001, p. 825) recorded that other than providing teleradiology services, emergency medicine practitioners are able to be “immediately available for consultation with physicians, nurse practitioners, and physician’s assistants at rural hospitals” through telemedicine. Even during that time or in 2001, “one third of rural hospitals in the United States have at least limited capability to link with at least one tertiary care facility.” More important, what is most remarkable in telemedicine is that as early as more than ten years ago, Smith (2001, p. 825) has reported that the telemedicine has “documented many areas of improved patient care, including early triage of seriously ill patients, a decreased rate of transfer of patients who did not require treatment at a tertiary care facility, and more effective utilization of ground and air ambulance services.” The experience with telemedicine has not been limited to the United States because similar experiences were also reported by “several rural treatment facilities in the United Kingdom” (Smith, 2001, p. 825). In Canada, Hannah (2005) reported that health informatics in the country has emphasized on the role of nurses in managing information in health service organizations and care facilities. Quoting the Canadian Nurses Association (CAN) Hannah (2005, p. 45) reported that that the view taken by the CAN is that “registered nurses and other stakeholders in health care delivery require information on nursing practice and its relationship to client outcomes.” This being the case, Hannah (2005, p. 45) stressed that “a coordinated system to collect, store, and retrieve nursing data in Canada is essential for health resource planning and to expand knowledge and research on determinants of quality of nursing care.” At the same time, according to Hannah (2005, p. 45), “the focus of nursing informatics in Canada is on the role of nursing within health care organizations.” Hannah (2005, p. 45) pointed out that “in most health care organizations, nurses manage both patient care and patient care units within the organization.” Elaborating on this, Hannah (2005, p. 45) pointed out that “usually nurse clinicians manage patient care and nurse managers administer the patient care units within the organization.” For some time, the nurse’s role in the management of information “has been considered to include both the information necessary to manage patient care using the nursing process and the information necessary for managing patient care units within the organization” (Hannah, 2005, p. 45). Thus, based on the foregoing, “with regard to the nursing management of health care, nursing practice is information intensive” in Canada (Hannah, 2005, p. 45). Nurses in Canada “usually handle enormous volumes of information of patient information.” In this area of responsibility of the nurse on information, nursing informatics provides a good approach for the nurse to be more competent in his or her work. Hannah (2005, p. 45) pointed out that similarly, nursing informatics is also important in the United States. For instance, Hannah (2005, p. 45) pointed out that in at least three New York hospitals, “registered nurses spend from 36 to 46% of their time on information handling.” In other words, what is suggested is that nurses today spend a great percentage of their nursing hours on handling information, depriving the nurse of occasions for more face-to-face and warm interactions with his or her patients and their significant others. With nursing informatics, more opportunities will be created for the nurse to interact with the patients and their relatives/friends on a face-to-face basis. Ainsley and Brown (2009) have stressed the importance of nursing informatics in the educational curricula for nursing because nursing informatics promotes evidence-based nursing, communication, and collaboration. Ainsley and Brown (2009, p. 231) also pointed out that nursing informatics promotes the “opportunity to interact and collaborate with and learn from a diverse group of faculty and peers via online educational settings and technology.” In turn, according to Ainsley and Brown (2009, p. 231), interaction and collaboration with their peers through nursing informatics “can promote growth and the nursing profession’s caring attitude.” The conclusion of the Ainsley and Brown (2006, p. 231) study is that “exposure to technology and informatics in nursing education can have the broad impact of improved health care.” According to Harris et al. (2006), the ANA has been consistently advocating nursing competencies on nursing informatics. They have also stressed that nursing informatics is an important area in which nursing administration graduates must be highly proficient. McCormick et al. (2007) articulated the perspective of the American Medical Information Association Nursing Informatics Working Group on what they believe to be four guideposts for stabilizing the future of nursing informatics. The four key guideposts are as follows. Firstly, nursing informatics must contribute to the development of informatics solutions. Secondly, nursing informatics education must prepare nursing professionals to be ready to work in a multidisciplinary environment as well as use advanced technologies. Thirdly, nursing informatics research must be strengthened. And, finally, or fourthly, collaboration opportunities in nursing informatics must be seized and exploited. In the area of contributing to the development of nursing informatics solutions, McCormick et al. (2007, p. 21) emphasized that “nurses must play key roles in developing information systems so that the systems improve the quality of care.” McCormick et al. (2007, p. 21) stressed however that nurses must remain patient focused even if personal health records of patients are important. McCormick et al. (2007) strongly emphasized that nursing informatics must remain involved in developing consumer-focused applications, including decision support tools. According to McCormick (2007), the last point also means that patients’ personal health records must serve as tools for capturing all the patient’s clinical encounters; promoting the implementation of health promotion activities, monitoring exercise, nutrition, and spiritual well-being; providing decision support and advise; serving as an important channel of health information and education; managing health-related benefits and financial resources for health; and monitoring exposure to environmental risks and community health information. Most importantly, in the area of guideposts for developing informatics solutions, “nursing informatics should encompass emergency preparedness, biodefense, and public health nursing” (McCormick et al., 2007, p. 21). Related to nursing informatics, Demerschalk (2011) underscored the importance of “seamless integrated telemedicine systems of care.” According to Demerschalk (2011, p. 1507, the “seamless integrated stroke telemedicine systems of care” is a “potential solution for acute stroke care delivery delays and inefficiency.” This being the case, it is also logical to argue that nursing informatics for stroke patients can be an important element or component in the “seamless integrated stroke medicine systems of care.” At the moment though, “there remains some work to be performed refining the operations of regional networks designed to maximize intravenous eligibility and administration for patients with acute ischemic stroke” (Demaerschalk, 2011, p. 1507). As the system of “seamless integrated telemedicine systems of care,” nursing informatics in support of stroke and potential stroke patients should be able to complement the advances made in the management of stroke via telemedicine. In developing countries, Wynchank and Fortuin (2009) reported that telemedicine may not be widely available but recent developments pertaining to improved means of communication and internet provide optimism for the eventual use of telemedicine in developing countries. This implies that nursing informatics will eventually become a standard not only in developed countries but also in developing countries as well. Wynchank and Fortuin (2009) affirmed that some of the possible applications of telemedicine are in radiology, neonatal echocardiology, and general pediatric echocardiology. Needless to say, the implication is that nursing informatics must be advanced alongside the development of all medical fields such as in pediatrics. In the guidepost for nursing informatics education, McCormick et al. (2007, p. 21) recommended that “new nursing information management system must be developed to help nurses evaluate workflow, assess risk, plan care strategies, and evaluate outcomes.” According to McCormick et al. (2007), an important element of the guidepost is the development of evidence-based nursing knowledge. In this area, as well as in all areas of nursing informatics, software vendors can fulfill an important role of providing the appropriate software (McCormick et al., 2007). McCormick et al. (2007) identified many specifics on how education curriculum for nursing informatics can be improved but they are no longer presented here for brevity. In the guideposts for nursing informatics research, McCormick et al. (2007) argued for a federal government funded research agenda that is highly relevant for current and anticipated health care priorities. The McCormick et al. (2007) recommended guidepost components in this area include areas that are potentially debatable: secondary use of clinical data which can intrude on the right of patients for consent, security, and use of biometrics. However, there are aspects that can probably earn popular support: promoting the use of standards, studies of population change as they relate to race and ethnicity, and using standardized vocabularies. In the guidepost for collaboration, McCormick et al. (2007, p. 23) emphasized that “nurses should also design, monitor, implement, and respond to standards proposed by the Consolidated Health Informatics (CHI) initiative, the Federal Health Architecture work, and security programs in the National Institute of Standards and Technology (NIST).” Some of the other concerns identified by McCormick et al. (2007, p. 23) that will also require collaboration includes “interoperability, e-prescribing, and Pay 4 performance.” The recommendations forwarded by Ainsley and Brown (2009) are also useful for supplementing the guideposts identified by McCormick et al. (2007). In particular, Ainsley and Brown (2007) suggested that nursing informatics should include web-based photo albums, audio and video files, and must facilitate the establishment of a collaborative and collegial environment among nurses and health professionals. Ainsley and Brown (2009, p. 232) also emphasized on the importance for instructors to “promote students’ caring attitude, desire to achieve, and future nursing practice” in the education for nursing informatics. In conclusion, we can say that nursing informatics has progressed far and beyond what has been anticipated by Graves and Corcoran’s perspective on the relationship among data, information, and knowledge. Nevertheless, nursing informatics has progressed along the lines of what has been correctly anticipated by Graves and Corcoran. It is also viable to point out that today’s nursing informatics tend to focus on the management of the patient’s health information data rather than other aspects of nursing informatics that directly support the practice of nursing care. However, as nursing informatics are able to absorb most of the chores of nursing pertaining to data management, nurses will have more time to focus on face-to-face interaction with their patients by way of cheering them up and as the nurses deliver health care to the patients. As nurses are assisted with nursing informatics in the management of data, patients will probably get better faster as they receive the warmth and care of the nurse who is deeply and genuinely concern for their health as well as highly competent in health service delivery. One of the more important insights of the study of Burtson and Stichler (2010) is that nurse caring can potentially result into long-term improvements among patients. Of course, this is not to say that nursing informatics is limited to data management. As pointed out by the 2008 ANA definition of nursing informatics, nursing informatics is also about knowledge and wisdom in health care as well as many other things on health care. Today’s perspective on nursing informatics has moved and progressed consistent with the track laid down by Graves and Corcoran. At the same time, nursing informatics has progressed and expanded way beyond what Graves and Corcoran had anticipated. Every nurse in the 21st century, especially in the modern world, has a specific role or set of tasks in nursing informatics. Simultaneously, nursing informatics is a specialty option in nursing since 1992 (Abrdo, 2008). Nursing informatics specialists perform a crucial role in health services delivery as well as in promoting a stronger patient or customer-focused health care by nurses as well as other health professionals as data, knowledge, and wisdom management are addressed by a specific sector of health professional and face-to-face health service delivery is addressed by another set of nurses and other health professionals. On these, nursing informatics owe a lot to Graves and Corcoran. References Abdrbo, A. (2008). Significance of nursing informatics research studies. Canadian Journal of Nursing Informatics, 3 (3), 14-19. Available in http://cnia.ca/journal/Abdrbo_2008.pdf (Accessed 19 September 2011). Ainsley, B. and Brown, A. (2009). The impact of informatics on nursing education: A review of the literature. The Journal of Continuing Education in Nursing, 40 (5), 228-232. Burtson, P. and Stichler, J. (2010). Nursing work environment and nurse caring: relationship among motivational factors. 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