Nursing Informatics

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 nursing practice, education, research,
and administration (Graves & Corcoran, 1989)
Tuesday, May 15, 2012
Theories in Nursing Informatics
A. Change Theories
Computerization of information system involves change, moving from paperbased environment to a completely paperless environment. It can be minor or major
change depending on the maturity of the previous system, most importantly the
users of the information system.

1. Roger's Diffusion of Innovation

Theory (unplanned change) - examines
the pattern of acceptance that
innovations follow as they spread
across population of people who adopt
it.

2. Lewin's Change Theory (planned

change) - describes the processes that
occur in a planned change into 3 stages.
B. Information Theories

1. Blum's Theory - Blum stated in 1986 that computer functions can be categorized
into 3 groups:

*data is processed
*information is processed
*knowledge is processed

2. Data-Information-Knowledge-Wisdom Continuum

C. Cognitive Theory -Cognitive science includes mental models, skills acquisition,

perception and problem solving that adds an understanding of how the brain
perceives and interprets a computer screen.

WHAT IS HEALTH INFORMATICS

22. HEALTH INFORMATICSIntegration of healthcare sciences, computer science,
information science, and cognitive science to assist in the management of
healthcare information.A subdiscipline of informatics
Present an illustration using the description delineating Health Informatics and its
sub disciplines.Health informatics have subdomains such as medical informatics,
dental informatics, pharmacy informatics, nursing informatics, etc.Each of these
subdomains have integrated content and which are collaboratively working with
each other.
Limit your illustration using only circles, squares and arrows and texts.Use any
application (paint, Msword, Ppt) in making your diagram.Finally present the
illustration using powerpoint.Further explain your diagram.

ADMINISTRATIVE APPLICATION OF INFORMATION TECHNOLOGY FOR

NURSING MANAGERS
NURSING MANAGEMENT TODAY:
Ironically, the constituencies shaping healthcare global leaders, healthcare CIO and
CEOs, vendors and patients are accidental jurists in the court of healthcare IT
futures.
Nursing, which has traditionally steered clear of the process, must now trade in its
IT blinders for binoculars, taking control of its own future by grappling with present
informational challenges.
Three major issues:
The Nursing Shortage
Increased Demand for Patient Safety
The Need for Visibility

1.The nursing shortageWithin 10 years, 40% of the working registered nurses (RNs) will be 50yrs or older.
As those RNs retire the supply of working RNs will be 20% below requirements by
the year 2020 (Buerhaus, Straigers, and Auerbach, 2000).
Three primary factors contributing current shortage:
Steep population growth and an aging population, which are increasing the need for
healthcare service.A diminishing pipeline of the new students innursing.An aging
nursing workplace.
Unfortunately, there is no simple solution to the nursing shortage. Nursing must
approach the problem from all angles from finding ways to stem the ride of nurses
leaving the profession, to attracting a new generation to itall while not losing sight
of patients care, safety, and satisfaction.
Increased demand for patient safety:
Patient safety is an international issue. In 2001, in Britain there more than 10,000
recorded medicine errors resulting in 1,100 deaths. The United States recorded
750,000 medical errors with deaths rate of between 44,000 and 90,000.According
to international statistics, one in every 300 errors will result in a serious, and
possibly fatal effect.
Healthcare Organization (JCAHO), and business coalitions like the Leapfrog Group
increasingly require organization to demonstrate their effectiveness and quality of
patients care services. The pressure is not just external outcomes measurement is
a critical part of internal business requirements for both continuous quality and
process improvement
activities.
Part of the challenge of measuring outcomes rests in defining exactly what an
outcome rests in defining exactly what an outcomes is.
Indeed outcomes measurements in following area:
1.Organization Performance
2.Clinical Effectiveness
3.Patient Satisfaction
4.Service Quality
5.Appropriate of Care
6.Patient Responses to Treatment

7.Cost of Services
8.Efficiency of Service Delivered( Simpson,2003)
The Need for Visibility..:
In the world of prove it healthcare, if it is not documented, it was not done. If the
nursing cannot establish its contribution to patient outcomes, nursing becomes
invisible and in a fiscally tightened market, invisibility can mean expendability.
Nursing must have a way to substantiate its role in the healthcare process, and
vitality to outcomes.
Together, these three issues the nursing shortage, the increased demand for patient
safety, and need for visibilty have created a wealth of opportunity for nursing in
terms of IT.
Nursing managements administrative needs:
In 2002 the American Healthcare Association (AHA) commissioned
PricewaterCoppers (PwS) to survey some of the American Hospitals about their
patient care and paperwork experiences. The results were disturbing:
1.In the emergency department every hour of the patients care require 1 hour of
paperwork.
2.For surgery and the impatient acute care requires 36 min of paperwork.
3.For home healthcare every hour of patients care in 48min of paperwork.
Two levels of nursing administration:
Nurse Manager- nurses who hold an administrative position at the nurse manager
level are responsible for:Implementing the philosophy, goals, and
standards.Implementing clinical nursing services,Planning, organizing,
implementing and controlling care.
Nurses Executives- the nurse executive responsible for managing organized nursing
services and the environment in which clinical nursing is practiced.
Managing organized nursing services
Ensuring the standards of nursing practice
Evaluating care delivery models and services
Fostering a climate for practice.
The real cost of administrative system:

Cost of the hardware and software

Cost of Education
Intellectual Resources
COST OF THE HARDWARE AND SOFTWARE: While hardware and software are often
the only things considered when determining cost they are today perhaps the least
costly element given the constantly declining cost of technology.
COST OF EDUCATION: A system is only effective if nurse use it and nurses cannot
use a system unless they get the necessary training. Training costs can comprise
everything from instruction fees to travel expenses and cost for temporary staffing
during training.
INTELLECTUAL RESOURCES: Nursing management should serve as advisor, director
and influencers of the technology that nursing uses. In fact in the selection of the
patient care system, the JCAHO now mandates nursing involvement and for good
reason.
Healthcare organization create, move, store, and retrieve billions of the patient
records every year. Although managed healthcare has increased healthcare
information requirements.The needs for nursing data standards.
For some time, there have been standards motivating nursing to focus on effective
and efficient administration. Established by the American Nurses Association (ANA)
in 1988 these standards remain the prevailing measures by which professional
nurses evaluate practice.
In additional JCAHO indicatives that have shifted the orientation of healthcare
information systems from monitoring processes to measuring outcomes.
Specifically the JCAHOs indicatives have created an additional need standards to
(porter 1993)
1.Support access to external comparisons database
2.Ensures data security and confidentially
3.Promote the development of knowledge
4.Support continuous quality improvement
5.Ensure data integrity
6.Integrate with existing standards and procedures
7.Support needs assessment

How nursing benefits from information technology:

Nursing administrative system fall into three basic categories:
1.Strategic
2.Operational
3.Tactical
In general they help nursing:
1.Improve communication
2.Improve order entry
3.Guide critical thinking
4.Tap into expert resources
5.Evaluate care
Specific computer applications for nursing administrators and managers:
Nurses Data Managers Data Needs
In general, nursing managers use computer system to collect data needed for
planning, budgeting, and reporting which ensure quality care. Their needs and the
applications they use include:
1.Allocating available resources to provide efficient and effective nursing care and
implementing clinical nursing services.
Nursing Intensity:
Patient Classification System
Acuity System
Staffing and Scheduling System
2.Providing input into executive level decision and collaborating with the nurse
executive and the others in organizational programming and committee work.
Unit Activity reports
Utilization Review
Shift Summary Reports

3. Planning, organizing implementing and controlling the care of individuals and

aggregates across the spectrum of healthcare setting. This includes, but is not
limited to, aspects of quality outcomes, staff development, care management, and
research.
Computer- Based patient record (CPR)
Census
Poison Control
Allergy and Drug Reaction
Error report
Incident report
Nurse executive data needs:
1.Managing organized nursing services and the environment in which clinical
nursing is practiced. Collaborating with other healthcare organization executives to
make decisions about the healthcare and organizational priorities.
Forecasting and planning
Financial planning
Hospital expansion
Ensuring that standards of nursing practice are established and implemented, and
are consisted with standards of professional organizations and regulatory agencies.
Quality Assurance
Regulatory Reporting
Consumer Survey
Evidence-based Practice.
3. Evaluating care delivery models and of services provided to individuals and
aggregates.
Personal Profile
Risk Pooling
Costing Nursing Care
What Nursing Administrators Need to know about Selecting a System:

By putting the patient at the center of the cost equation managing care making the
caregiver a critical determining of success. But caregivers can only be successful
with the proper technological tools.
Increasingly, healthcare decision-makers understand this CEO view improved
decision support for the clinicians as one of the most pressing IT priorities, and
other pressing IT needs for the integration of the healthcare delivery system
include:
1.Networking information access
2.Networking master patient index
3.User friendly system interface
4.Interface engines for system communications
5.Data rectories to facilitate data sharing
6.Specialized managed care software
7.Standards
8.System for data comparison
9.Software for longitudinal patients record
10.Standardized on a limited number of application vendors.
ITS INFLUENCE:
New Breed Clinical Information System- managed cares need to monitor both the
appropriateness and cost of care has led to a wave of new clinical applications.
Open System-open architecture client/server systems are only answer for true
enterprise wide, integrated information transfer and access.
Patient Centered Care-in mid 1990s the advent of managed care, followed closely
by a drop in federal Medicaid reimbursement , set off an economic crisis that left
one of every four hospitals in the red.
Healthcares increased focus on better quality lower cost patient care means more
organizations are turning to IT and clinical systemand turning to nursing to help
select them.
TELEMEDICINE Definition It is the use of electronic information &
communication technologies to provide & support health care when distance
separates the participants -institute of medicine, 1996

67. NECESSITY OF TELEMEDICINE IN INDIA low penetration of health services 90% of

secondary & tertiary health care facilities in cities & towns away from
rural India where 68% of population lives Despite several initiatives by govt &
private sector the rural & remote areas continue to suffer from absence of
quality health care
68. Highly inadequate primary health care facilities in rural population Significant
protection of patients in remote locations could be successfully managed locally
with advice /guidance from specialists /super-specialists in cities without having to
travel to the specialists. Key driver of public-private partnership for health care
delivery to the people of India
69. CURRENT EFFORTS Many programs worldwide using variety of telemedicine
technologies In India telemedicine programs actively supported by -dept of
information technology -Indian space research organization
70. -NEC telemedicine program for north eastern states Apollo hospitals Asia heart
foundation State governments Telemedicine technology also supported by some
other private organizations
71. APPLICATION OF TELEMEDICINE
72. APPLICATION OF IT IN PHC IN INDIA UK based Loughborough university
engineers have entered upon a partnership with experts of India to develop a
unique mobile phone (mp) health monitoring system.
73. The system which was first unveiled in 2005 , they use the mobile phones for
transmit vital signs, ECG, oxygen saturation . The software components under
development are patient data base management , interaction between doctor
& patients capture of medical data acquisition such s ECG, images of heart
& lung , eye etc and scheduling management.
74. The project involves development of following , A web based information system
for management of primary health care. SMS message from the patient using (GSM)
with the information system. WAP gateway for web access GPRS/3G/4G mobile
doctor for nurses with the web server development of localization support to
national & other Indian language in mobile by providing interface for
translation
75. the mobile based primary health care management system will seek to
achieve -increased quality of PHC services -increased efficiency of service care with
an adequate referral & remote consultation system -improved epidemiological
surveillance & control -better pregnancy care registration & management
-reduction of maternal & perinatal morbidity & mortality
76. APPLICATION OF IT IN PHC IN TAMILNADU REALTIME BIO-SURVEILLANCE
PROGRAM (RTBP)-USING MOBILE PHONE FOR COLLECTION A pilot project health

related information gathered through mobile handheld devices will be

communicated through the wireless local loop (WLL) networks to a central database
(DB) for analytics & monitoring .
77. The ICT system will use general packet radio service (GPRS) , SMS as transport
technologies to enable access to application to communicate information on
surveillance & alerting It will be assessed by measuring the performance
during the course of the project
78. Telemedicine It is possible to provide & support healthcare delivery through
a medical device & software application developed by neurosynaptic
communications pvt . ltd (NCPL) known as ReMeDi (remote medical diagnostics) It is
a telemedicine providers device which connects the rural villages & remote
areas to the urban medicos.
79. ABSTRACT MEDICAL EFFECTS OF CONTINUOUS USE OF COMPUTERS &
REMEDIES Repeated & continuous use of computer or laptop may lead to
various stress injuries on the following parts of the body - hands - back - legs - eyes
80. REMEDIES
81. HANDS & WRISTS
82. there should be a adjustable chair for proper anatomical position there should
be a rest to the fingers & wrist joints after continues use of fingers
83. use cold packs to affected site give sufficient rest & relaxation use
crepebandages in affected site advice to use soft touch key boards to reduce stress
o fingers
84. BACK
85. the chair should have adjustable & comfortable use analgesic drugs
physiotherapy hot water application
86. LEGS
87. The height of the chair should be adjustable Do physical exercise like walking ,
hopping etc.,
88. EYES
89. The users are advised to use spectacles Shift the computer monitor at a
reasonable distance to avoid eye strain
90. OTHER EFFECTS OF MEDICAL IMPORTANCE Electric shock
91. Skin irritation due to heat generate from computer

92. Battery packs contain toxic materials which may leak & cause injuries

Critical Care Applications

Areas where patients require complex assessment, high-intensity medication,
continuous therapy and interventions, and unrelenting nursing attention and
continuous watchfulness.
The Role of Nurse Using Information System in the Ambulatory Care System
The very basic objective of the automated ambulatory care information system is to
easily integrate the data to the other data and easily translate these data into
information.
The effective transformation of data can be integrated to the other processes to
transform it into knowledge.
The ambulatory care nurse and other health care provider should be capable
enough to implement the process effectively.

Community Health Application System

Encourages optimal application of computer system, computer programs and
communication system for the benefit of majority of individuals, families and
community.
Primary Focus of Community Health Information System
Preventing, identifying, investigating and eliminating communicable health
problems.
Accessibility of data and information, through communication
Educating and empowering individuals to adopt health life style
Facilitate the retrieval of data
Effective transformation of data into information
Effective integration of information to other disciplined to concretized
knowledge and creates better understanding.
Creation of computerized patient records, medical information system
Central repositions of all data such as data warehouse
Simple Graphical User Interface (GUI) for nurses and other healthcare
provider, patient ad consumer
Computer Based Survey System
Health Statistical Surveys
Are used to collect quantitative information about items in a population to
establish certain information from the obtained data.
Focused on opinions or factual information depending on its purpose and
many surveys involves administering questions to individuals.
Advantages of Integration of Community Health Systems
Consistent exchange of response

 Disease tracking
Data and information sharing
Building strategies
Early detection and monitoring of disease and sickness
Control of spread of disease
National alertness and preparedness
Building strong communication
Maintaining strong relation between nurses and other healthcare provider
Continuous coordination of the healthcare professionals
Synchronization of the decisions
Streamlining of the process
Effective management of data and information
Optimal operation of hospital and clinics

Nursing Education in the Information Age

The art and science of nursing has been around for centuries, and is recognized for it's
multi-faceted contributions to healthcare, research, and medicine. Not too long ago,
nursing was primarily a female dominated profession and viewed as a demeaning
profession until the days of Florence Nightengale.
Florence Nightengale recognized the importance of nursing and raised the standard of
the nurse as a professional with a respectable education and career which now attracts
men and woman of all backgrounds.
Imagine such pioneers as Florence Nightengale and the impact such leaders have on
society like Steve Jobs and John Chambers with the high-tech industry. Could you
image such a conversation if the aformentioned three leaders were to collaborate on
how to teach within a LVN program or LPN program? If we were to be so lucky as to
witness such a meeting, it would probably look something like the licensed vocational
nursing skills lab at Gurnick Academy of Medical Arts. A hybrid of nursing wisdom
blended with high-tech mannequins called simulators in incubation for a state of the
art simulation lab. The technology available today is not only advancing our social
and business lives, but also changing the way nurse educators teach.
Say good-bye to dusty chalk and screeching blackboards. You don't have to look at the
back of your nursing instructors head anymore and wonder if she wore her hair the
same as when she wore a nursing cap back when nurses wore white caps as she bores
you while writing on the old chalkbaord. Today, when nursing students sit in a
classroom, you will find that the information age has rooted itself deeply into the
education of our future nurses. Laptops and projectors are a basic staple of the

delivery of lectures. Now, not only are the instructors utilizing technology in the
theory, but also in the laboratory setting. Life like simulators breathing, possesing a
pulse, and capable of a collapsed lung are utilized for training. Computers capable of
the same functions found in high-end hospitals are at the nurse educators fingertips.
Rest assured that we are not to fear the future, but embrace it and benefit from the
high level of education growing in our licensed vocationalnursing schools. Healthcare
is definitely catching up with technology, and the two together may be the exact
formula or recipe which may generate cures for untreatable cancers and illnesses like
AIDS. LVNs and LPNs will be able to hold their heads high with the confidence that
the education they are receiving today combines both classic nursing theories,
humanitarian devotion, and the integration of the advancement of technology.