NCM 110 – NURSING INFORMATICS

INTRODUCTION TO NURSING INFORMATICS

NURSING INFORMATICS 6. After 2000s
– Informatics is the science and art of turning data into
information (Bemmel and Musen, 1997) BEFORE THE 1960S
• Computers were initially used in the health care
INFORMATICS facilities for basic business office functions.
– Healthcare Information and Management Systems • Early computers used punch cards to store data and
Society (HIMMS),2019) card readers to read computer programs, sort and
– Study of the structure, behavior, and interactions of prepare data for processing.
natural and engineered computational systems.
– Studies the representation, processing, and Computers used around the 50s to 60s
communication of information in natural and
engineered systems.
– Has computational, cognitive, and social aspects.

HEALTH INFORMATICS
– US National Library of Medicine, 2014
– Interdisciplinary study of the design, development,
adoption, and application of IT-based innovations in
health care services delivery, management, and
planning

NURSING INFORMATICS (American Nurses Association,

2001) THE 1960S
– American Nurses Association, 2001 • Studies were conducted to determine the effective
– A specialty that integrates nursing science, computer utilization of the computer technology in health care
science, and information science, to manage and industry and to identify the areas of nursing that needs
communicate data, information, and knowledge in to be automated.
nursing practice. • Hospital Information Systems (HIS) were developed
– Facilitates the integration of data, information, and primarily to process financial transactions and serve as
knowledge to support patients, nurses, and other billing and accounting systems.
providers in their decision-making in all roles and
settings. This support is accomplished using THE 1970S
information structures, information processes, and
• Nurses recognized the computer’s potential for
information technology. improving documentation of nursing practice, the
– Computer science, information science, and nursing quality of patient care and the repetitive aspects of
science combined to assist in the management and managing patient care.
processing of nursing data, information, and
• Nurses assisted in designing several mainframes for
knowledge to support the practice of nursing and the
the Health Information Systems (HIS)
delivery of nursing care.
• Computers used in financial and management functions
were perceived as cost-saving technologies.
NURSING INFORMATICS (Canadian Nurses Association,
2018) • Many of the early Health Information Systems (HIS)
were developed and funded by contractors and grants
– Canadian Nurses Association, 2018
from federal agencies in the United States.
– Practice and science of integrating nursing
information and knowledge with technology to
manage and integrate health information. THE 1980S
– Goal: improve health of people and communities • Nursing informatics became an accepted specialty and
while reducing costs. many nursing experts entered the field.
• Discharge planning systems were developed and used
NURSING INFORMATICS (ANA 2019 ; HIMSS, 2019) as referrals to community health care facilities in the
– “Specialty that integrates nursing science with continuum of care.
multiple information and analytical sciences to • Microcomputers/PCs emerged in this period.
identify, define, manage and communicate data,
information, knowledge and wisdom in nursing THE 1990S
practice.” • In 1992, Nursing Informatics was approved by the
American Nurses Association (ANA) as a new nursing
HISTORICAL PERSPECTIVES IN NURSING specialty. (McCormick, et al., 1994)
INFORMATICS • This was the period that brought laptops and notebooks
– Nursing informatics emerged as a response to the to the bedside and all the point-of-care settings.
innovations and development in technologies in the • Local Area Networks (LANs) were developed for
health care industry and in nursing practice. hospital nursing units. Wide Area Networks (WANs)
were developed for linking care across health care
SIX (6) IMPORTANT TIME PERIODS IN THE HISTORY OF facilities. Internet was also started to be used.
NURSING INFORMATICS
1. Before the 1960s
2. The 1960s
3. The 1970s
4. The 1980s
5. The 1990s
AFTER THE 2000S – Building blocks to create information
• Clinical Information Systems became individualized in
the electronic patient record (EPR) or also known as INFORMATION
electronic health record. – Group of data elements that have been organized and
• The internet has also provided a means for processed so that one can interpret the significance of
development of clinical applications. the data elements.
• Home health care has also increasingly partnered – Data and Information are both building blocks in
information technology for the provision of patient care. producing knowledge.
• Telenursing is increasing in popularity and providing
patient care in an efficient. KNOWLEDGE
– Built on a formalization of the relationships and
NI PHILIPPINE EVOLUTION interrelationships between data and information.
• Pe Benito, n.d. – This is the part where you understand the information.
• 1999: Development of Standards for health Information
in the Philippines (SHIP) WISDOM
• 2005: Formation of Master of Science in Health – Knowledge used to make appropriate decisions and
Informatics acting on those decisions.
• 2009: CMO No. 14. Policies and Standards for BSN – – It is the appropriate use of data, information, and
Informatics (2/1) is offered as part of the Math, Nat Sci knowledge in making decisions and implementing
& IT nursing actions.
• 2010: Formation of the Philippine Nursing Informatics >
Sub-specialty organization of PNA for nursing
Informatics
• 2017: CMO 15 – CHED Policy, Standards f and
Guidelines for BSN Program

WHY THE TREND TOWARDS INFORMATICS (HIMSS,

2018)
– Increasingly present in our profession due to
changing and advancing technology.
– Health care systems are integrating technology daily
practice at very fast pace.
– Security and patient privacy must be upheld while
achieving the goal of transforming data into useful
knowledge.
NURSING INFORMATICS AS A SPECIALTY
ADVANTAGES OF NI
ü Shared data ROLES
ü Centralized control • Theory development
ü Disadvantages of redundancy in control • Analysis of information needs
ü Improved data integrity • Selection of computer systems
ü Improved data security & database systems • Design of computer systems and customizations
ü Flexible conceptual design • Testing of computer systems
• Training users of computer systems
ROLE OF INFORMATICS IN NURSING? (HIMSS, 2014) • Education of users on information policies
• Help identify potential problems earlier • Evaluation of the effectiveness of computer systems
• Identifying changes in patient status can occur • On-going maintenance and enhancements
quickly • Identification of computer technologies that can benefit
• Information is readily available nursing
• Data are interpreted, systematized, and arranged • Compliance with regulatory requirements for
• Formalize an appropriate plan of action information handling
• Aligns nursing best practice with clinical workflows & • Project management
care • Research
• Improves clinical policies, protocols, processes &
procedures NURSING INFORMATICS
• Strengthen nurses ’clinical decision-making skills – Is a specialty that integrates nursing science, computer
• Enhance nursing practice science, and information science to manage and
• Quicker access to patient information communicate data, information, and knowledge in
• Improve overall efficiency nursing practice
• Reduction in potential errors – It facilitates the integration of data, information, and
• Has potential to change nursing practice for the knowledge to support patients, nurses, and other
better – patient care delivery providers in their decision making in all roles and
settings
META STRUCTURES OF NURSING INFORMATICS – This support is accomplished through the use of
• Data information structures, information processes, and
information technology
• Information
• Knowledge
OPERATIONAL HEALTH SYSTEMS
• Wisdom
Nurses and Midwives have the best knowledge about the
workings of the health systems in terms of:
DATA
• Information and communication flows
– Raw, uninterrupted fact, without meaning • Patient journeys through each episode of care
MEDICAL INFORMATICS
– It is used as an overarching term both to describe any
informatics efforts related to health care and also to
describe a distinct specialty in the discipline of medicine

HISTORICAL DEFINITIONS OF NURSING INFORMATICS

GRAVES AND CORCORAN’S MODEL (1989)

• 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 nursing care
o It highlights the multidisciplinary nature of
nursing informatics and clearly indicates that the
goal of nursing informatics is the delivery of
nursing care
• They’ve identified the conceptual model that’s pivotal to
nursing informatics known as data, information,
knowledge, wisdom (DIKW) framework
• This framework has subsequently been used to define
how nursing informatics impacts nursing practice and
care delivery.

BRUCE BLUM (1986)

• Graves and Corcoran’s Models was built on Bruce
Blum’s concept
• Defined the concepts of data, information, and
knowledge in discussing the discipling of medical
informatics
• Goal: to explain that discipline could not be defined by
information technology that is used in the practice on
medical informatics, but rather the discipline of
informatics is defined by how the provider uses REVISED NELSON DATA TO WISDOM CONTINUUM
technology to meet human needs

Three Objects that can be process by IT:

1. Data
– Uninterpreted items, often referred to as data
elements
– Example: Person’s weight

2. Information
– a group of data elements that have been
organized and processed so that one can
interpret the significance of data elements
– Example: Height, weight, age, and gender

3. Knowledge
– built on a formalization of the relationships and
interrelationships between data and information
– Knowledge base in order to understand the
systems • The Nelson DIKW continuum should first be
conceptualized as an open living system with all the
NELSON AND JOOS (1989) characteristics of an open living system
• With such a system, time, the fourth dimension, is also
• Added the concept of wisdom to the triad of DIK
part of the picture.
• Wisdom
o appropriate use of data, information, and A. Information System (IS) – processes data to produce
knowledge in making decisions and implements information
nursing actions B. Decision Support System (DSS) – automated system
o It includes the ability to integrate data, that can support a decision maker in the process of
information, and knowledge with professional decision making by providing data and information
values when managing specific human problems C. Expert System (ES) – actually uses data and
information to make a decision
RELATIONSHIP OD DATA, INFORMATION,
KNOWLEDGE, AND WISDOM AND AUTOMATED Hermeneutic Circle – back and forth interplay that makes
SYSTEMS: VERSION 2 us aware of the “preunderstanding” that are essential to our
understanding of the world
 NCM 110 – NURSING INFORMATICS
DISCIPLINES WITH INFLUENCE ON NURSING INFORMATICS
THE NURSING INFORMATICS MODEL care of find health education information for the
patient.

COMPUTER SCIENCE
• Deals with understanding the development, design,
structure, and relationship of computer hardware and
software
• Offers valuable tools that can facilitate the acquisition
and manipulation of data and information by nurses
• How? – by synthesizing the resources into ever-
evolving knowledge and wisdom base
• The development of knowledge tools like:
o Automation of decision making
o Strides in artificial intelligence
• The ability to structure knowledge electronically
facilitates the ability to share knowledge structures
and enhance collective knowledge.

CONCEPTS AND TOOLS FROM INFORMATION SCIENCE

INFORMATION SCIENCE AND COMPUTER SCIENCE
– Include information technology which involves the • Information management – an elemental process by
process of sending and receiving information and which one files, stores, manipulates, and reports data
understanding how the organizational environments are for various uses
structured and how information flows in that • Information communication – enables systems to
environment send data and to present information in formats that
– Enables the processing of information. This processing improve understand
links people and technology • Information structures – organize data, information,
– Impacts information interfaces, influencing how people and knowledge for processing by computers
interact with information and subsequently develop and • Information technology – includes computer
use knowledge hardware, software, communication, and network
technologies, derived primarily from computer science.
INFORMATION SCIENCE Its use distinguishes informatics from more traditional
• Deals with the interchange (or flow) and scaffolding (or methods of information management
structure) of information and involves the application of
information tools for solutions to patient care and COGNITIVE SCIENCE
business problems in health care – Is an interdisciplinary field that results from the
• To use and synthesize information effectively, one must convergence of psychology, linguistics, computer
be able to: science, philosophy, and neuroscience
o Obtain – The focus of cognitive science is understanding of the
o Perceive mind and the phenomena the mind addresses
o Process – From perception to thinking, understanding, and
o Synthesize remembering
o Comprehend – The traditional and widely accepted definition of NI
o Convey advanced by Graces and Corcoran (1989) is that Ni is
o Manage the information a combination of nursing science used to describe the
processes nurses use to manage data, information,
COMPUTER SCIENCE and knowledge in nursing practice
– Development, configuration, architecture of computer – Turley (1996) proposed the addition of cognitive
hardware and software science to this mix, as nurse scientists are seen to
– Everything that occurs in informatics derives from strive to capture and explain the influence of the
insights and changes in computer technology, which is human brain on data, information, and knowledge
the core of both teaching and understanding informatics processing and to elucidate how these factors in turn
affect nursing decision making
NURSES AND COMPUTER TECHNOLOGY – Connectionism is a component of cognitive science
that uses computer modeling through artificial neural
Computer systems assists nurses to provide quality care: networks to explain human intellectual abilities
• Computer enable nurses to quickly access important – Deals with how human mind functions
information about the patient’s health or illness and – Encompasses how people think, understand,
treatment plan from the electronic health record which remember, synthesize and access stored information
helps them monitor recovery process over time. and knowledge
• Enables nurses to access information such as – The nature of knowledge, including how was it
laboratory tests and x-ray results and health reports developed, used, modified, and shared provides the
from other health-care team members to formulate basis for continued learning and intellectual growth.
the optimal plan of care
• Enable nurses to record health information, treatment,
medications, and progress for ready access and use
by other health team members
• Enables nurses to use the computer to search drug
databases, libraries, and best practice resources to
obtain important related to the patient’s diagnosis and
 NCM 110 – NURSING INFORMATICS
RELEVANT THEORIES AND CONCEPTS IN NURSING
INFORMATICS
GENERAL SYSTEMS THEORY • Nurses spend 90% of their work schedule
• One of the oldest theories communication – verbally, written or through behavioral
• Explains that systems are complex and intricate yet cues
held commonalities • Manual or electronic, the model remains a good
• Emphasizes the interactions of the various parts of framework use in explaining how things can go well or
systems, instead of individual parts wrong
• Can be physical structures (education, financing, etc.),
manual (patient’s hygiene, baking a cake etc) or those CHANGE THEORIES
that are electronic or computerized (electronic medical
record, automatic medication dispensing, etc) LEWIN’S THEORY OF PLANNED CHANGE
• It’s premise – the whole is greater than the sum of its • For planned change
parts • Has three distinct steps: unfreezing, moving, and
• There are three main components – input, throughput, refreezing
and output o Unfreezing
o Input – where raw data enters the system – is creating an imbalance or some form of
o Throughput – involves the processes used in distraction to shake up the status quo
managing information between the driving forces (motivators for
o Output – resulting end-product of the processed change) versus the restraining forces
information (factors that resist change)
• Example: Hospital System – the unfreezing stage is such a crucial step
• The admission and registration process and how they in the change process because it creates
relate to wait time, patient satisfaction and the quality of some form of conflict that makes the
care scenario conducive to questioning the
• The interrelationships are more relevant than each of status quo
the processes as separate • Once the imbalanced is created, it is somewhat easier
• Each part is relevant but only to the extent that it to influence change or to encourage resistors to
influences the efficient and effective flow of patients into consider and embrace the change. Once this is
the system achieved, the second step sets in – moving, or altering
forces
Other assumptions in the general systems theory that o Moving – is when the actual change occurs, if
need mentioning: prior to moving the restraining forces are
• There is a purpose for the system that needs to be stronger, at this stage, they have now become
achieved susceptible to change
• There are structures, functions, and tasks within the • Change is then adopted and the driving forces become
system that are meant to be carried out efficiently and more dominant. However, for change to stick, the third
effectively in order to achieve the purpose of the system step has to set in –
• The structure also follows the function, with o Refreezing, or assuring that change has indeed
specifications and attributes designed to meet the occurred and has been adopted
expectations
• There is dynamic homeostasis or the capability to ROGER’S DIFFUSION OF INNOVATION THEORY
maintain stability or equilibrium • For unplanned change
• There is entropy or the tendency to break into its • When planned accordingly and done correctly, Lewin’s
smallest parts model works best in effectuating change. When
• There is also negentropy or the likelihood to grow big introducing computer applications to healthcare staff
and complex and professionals, this is often helpful since it is a long
• The system has the capacity for specialization or the process and there is more time to pump up the driving
ability to be unique and differentiate from the whole forces and weaken the restraining forces by holding
• There is also reverberation which makes changes cut many meetings, open town hall discussions of the pros
across the entire system and cons of the change. There is more opportunity to
• There is equifinality or the ability to reach the same end hear both sides and weigh the advantages and
despite varying beginning points disadvantages

COMMUNICATIONS THEORY Five (5) groups of Individuals that an individual need to

work with:
SHANNON AND WEAVER’S INFORMATION- Each group has its own characteristics, and the strategies to
COMMUNICATION MODEL (1949) influence the adoption of change naturally differ from group
• As we communicate, there are various channels that to group
our information goes through. The model as overly 1. Innovators – 25%; hear what the change is and its
simplistic (Al-Fedaghi, 2012) benefits – no need to convince them, quick to
• It provides an easy conceptual and visual model that embrace change
is easily understood in order to demonstrate its 2. Early adopters – 13.5% - ask some questions but
relationship to nursing informatics and the work of generally adopts change
nurses 3. Early majority – 34% require a bit more convincing –
have some questions
4. Late majority – 34% - they dilly-dally – have a lot
more questions, refuse to comprehend the need for
change
5. Laggards – 16% - hard core resistors, avoid
accepting change
 • Change is inevitable
• The nurse informaticist will be some of the major
movers of change
• These are tools when faced with challenging
innovative scenarios

NURSING INFORMATICS TERMS

COMPUTERIZATION
– The adaptation of a system, device, etc to be
operated by a computer

INFORMATIZATION
– The process aimed at improving information
systems, control systems and other systems
through the use of computer equipment

DIGITALIZATION
– It refers to the creation of a digital representation of
physical objects or attributes

DIGITALIZATION
– Refers to enabling or improving process by
leveraging digital technologies and digitized data

INFORMATION SYSTEM
– An integrated set of components for collecting
storing and processing data for providing
information, knowledge and digital products

INFORMATION MANAGEMENT
– The process of colleting, storing, managing, and
maintaining formation in all its forms

COMPUTER SYSTEM
– It refers to the basic, complete and functional
hardware and software set-up with everything
needed to implement a computing performance

MODULE
– It refers to the self-contained element that are
partitions of the stem design or codes.

OPERATING SYSTEMS
– It run a computer and manages the computer
memory and processes.

INTERFACE
– A description of all external visible operations and
what other modules need to know and do to make
use of them

INTERACTIVE
– It is something that allows direct communication
between a human and a machine

AUTOMATION
– Use of the electronics and computer-controlled
devices to assume control of process.

ALGORITHM
– It is a procedure used for solving a problem in
performing a computation diagram that depicts a
process or a system

FLOWCHART
– Diagram the depicts a process or a system

WORKFLOW
– Shows that activities, tools and process needed to
produce or modify work, products or services