Nursing informatics

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Nursing informatics is a sub-specialty of health informatics that integrates computer science and information science to manage 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.” [1]. As cited in the TIGER Report, Nursing Informatics is defined by the American Nurses Association (ANA), Nursing Informatics Practice Scope and Standards of Practice of 2008 as “the integration of nursing science, computer information science, and cognitive science to manage communication and expand the data, information, knowledge and wisdom of nursing practice” [2] p. 3. Nurse Informaticians analyze, design and implement information systems in a variety of settings, translate between health care providers, patients and technical staff, and ensure high quality data are captured and translated into knowledge that can be used to improve health outcomes [3].

History

A 2009 HIMSS survey on the impact of informatics nurses shows that nursing informatics is involved in a variety of roles related to information technology. This includes workflow analysis, education, HIT implementation and support. On a 1-7 point scale, with 7 being the highest, survey respondents rated the value of nursing informatics an average 6.29 This value is seen in patient safety, workflow, facilitating user acceptance and change management. (2)

In the last few years, hospitals have been shifting their focus from operations to outcomes. This shift translates into reimbursement. Leveraging information technology (IT) will facilitate this process. IT can be used in the collection of data to determine which quality outcomes an organization should emphasize. Nursing informaticists play a role in the collection and interpretation of this data. (3)

With the focus of the American Recovery and Reinvestment Act on electronic health records and financial incentive, the role of nursing informatics is becoming more important. Meaningful use criteria must be met by 2015 in order to receive full reimbursement. Nursing informaticists can help organizations achieve this goal. Their knowledge on the integration of evidence-based knowledge and information systems that promote patient safety and quality outcomes is essential to meet meaningful use. (4)

With the advent of the full implementation of the Affordable Care Act in 2014, an estimated 30 million new patients will be insured and demand care. The 3 million nurses currently practicing in the U.S. are expected to provide better quality, safer care to a larger number of people in a health care environment that is rapidly changing. The proficient use of technology is thought to facilitate the fulfillment of this enormous challenge.

Alliance for Nursing Informatics

The Alliance for Nursing Informatics (ANI) is a group of organizations that represent more than 5000 nursing informaticists. In a statement to the Robert Wood Johnson Foundation Initiative on the Future of Nursing, the ANI states that nurses are in a position to positively affect quality in healthcare. Nursing informatics brings skills in information technology, change management and quality improvement. With technology so integrated into nursing care, the ANI proposes that funding be dedicated to the partnership of nursing and nursing informatics in shaping the future of nursing. (5)

TIGER Group

The Technology Informatics Guiding Education Reform (TIGER) Initiative was formed in 2004 to bring together experts and develop a vision, a strategy and specific actions to improve nursing education and practice. In 2006 a TIGER summit was called and collaborative teams of experts constructed recommendations to create a nursing workforce capable of using IT to improve the delivery of care [4].


Nursing Informatics Education

Although the nursing informatics specialty has several complex competency requirements, in order to function in the increasingly complex healthcare environments, all nurses are expected to: have basic computer competencies, be information literate, and have information management skills [5]. Basic computer competency includes the understanding of basic information and computer technology and vocabulary (e.g. PDAs, CPU, memory, software, etc.), the proficiency in using computers, managing files, and common software programs, and the ability to produce presentations and browse the web. Information literacy on the other hand, refers to the ability to determine the nature and the extent of the information needed, to be able to access and use the information proficiently, and to evaluate it critically. Finally, information management refers to the data-information-knowledge continuum. It is the ability to collect data, process them, and transform them into knowledge that can be used to improve clinical outcomes.

Nursing Informatics Education: Past

The first curriculum in health care informatics appeared in 1977 at State University of New York at Buffalo, after that other universities joined and today there are several graduate certificate and master’s programs across the country and a few Nursing Informatics doctoral programs. [1]

Nursing Informatics Education: Present

In 2008 the National League of Nursing (NLN) published the results of a survey of deans and faculty across the nation. It found informatics content to be lacking and to be seriously misunderstood. Computer literacy and information literacy were usually equated to informatics training [6]. Among the respondents who claimed to teach informatics, the most commonly cite examples of how it was implemented in the curriculum was via assignments that require computer competency and taught information literacy. Online teaching was thought to be synonymous with informatics education. Nevertheless, informatics content related to privacy, security and confidentiality was frequently offered, and the use of handheld computers and software was increasingly being used in clinical teaching. According to the NLN survey, only 30% of schools have a terminal program objective that addresses informatics and that same proportion offer specific content in informatics. Fewer offer specific courses in the subject. The most commonly cited reasons for not including informatics content was that there was no room in the curriculum, that faculty lacked preparation, and that informatics was viewed as a low priority.

The Future of Nursing Informatics Education

Given the overwhelming evidence that nurses require informatics training and the paucity of this content in curricula, the American Association of Colleges of Nursing (AACN) and the NLN incorporated the new competencies suggested by the 2003 IOM Report. These nursing schools accrediting bodies made modification to their requirements in 2008 to reflect the value and urgency of this change. The AACN Essentials of Baccalaureate Education [7] element IV is titled Information Management and Application, and recognizes that “knowledge and skills in information management and patient care technology are critical in the delivery of quality patient care” (p. 3), and therefore must be incorporated in nursing baccalaureate curricula.

The NLN position statement declared that “it is imperative that graduates of today’s nursing programs know how to interact with these important [informatics] tools to ensure safe and quality care” [8]. The NLN set goals for itself and made recommendations for nursing program administrators and for nursing faculty. It pledged to continue to develop the nursing informatics competencies, to disseminate them with exemplars, and to seek funding for nursing faculty education. Deans of nursing programs were encouraged to create opportunities for faculty to develop the skills and knowledge necessary to teach nursing informatics, to provide the planning and the resources to create the infrastructure necessary for such curricula to blossom. Faculty were asked to acquire informatics training, to take leadership at the local level and champion curricular changed that incorporate informatics, to integrate nursing language and terminology in the curricula, and to collaborate with clinical agencies to create opportunities for students to use informatics tools.

Meanwhile, the TIGER Initiative organized collaborate teams of experts and created several reports that provide an action plan based on best practices in nine areas. Three areas were related to the development of the workforce [9]. They focused on the informatics competencies nurses should have to practice effectively, the education and training faculty should have to teach informatics effectively, and the skills the leadership should have to transform the nursing education curriculum. The competencies suggested were discussed earlier in this manuscript and they include: basic computer competency, information literacy, and information management. Faculty were encouraged to offer informatics theory, research and practice throughout the curriculum. However, due to lack of faculty training in informatics, the TIGER Initiative encourages organizational leaders to create trainings and offer resources for nursing faculty to be able to teach informatics and create nursing informatics programs, develop a local task force to examine and integrate informatics content in the curriculum, encourage federal financial support and collaborations with industry and service organizations. In addition to a relevant curriculum and well-trained faculty, the TIGER reports suggest that nursing informatics curriculum or programs also need effective and knowledgeable leadership. Although chief nurse executives and deans were found to be proficient in most areas, they should also continue to have opportunities to evaluate the interaction between nursing practices, workflow, policies and procedures, and system implementation.


References

  1. American Nurses Association. (2001, October). Scope and Standards of Nursing Informatics Practice (Education Standards). Washington, D.C.: American Nurses Publishing.
  2. Healthcare Informatics and Management Systems Society. (2009, April 2). HIMSS 2009iInformatics nurse impact survey (Executive Summary). Retrieved from HIMSS website: http://www.himss.org/content/files/HIMSS2009InformaticsNurseImpactSurvey.pdf
  3. Murphy, J. (2010, August). The journey to meaningful use of electronic health records. Nursing Economics, 28, 283-286.
  4. Sensmeier, J. (2009, September). The latest? A shift from operations to outcomes. Nursing Management, 2-9.
  5. Sensmeier, J. (2010, January/February). Alliance for nursing informatics statement to the Robert Wood Johnson foundation initiative on the future of nursing: Acute care, focusing on the areas of technology, October 19, 2009. CIN: Computers, Informatics, Nursing, 63-67.
  6. Englebardt, S. P., & Nelson, R. (2002). Health care informatics: An interdisciplinary approach. St. Louis: Mosby.

Submitted by: Kathy Gaines and Michelle Tellez
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