NURSING INFORMATICS

CHAPTER 1
1

OVERVIEW OF NURSING
INFORMATICS
 CHAPTER OBJECTIVES
2

1. Define nursing informatics (NI) and key

terminology.
2. Explore NI Metastructures, concepts and tools
3. Reflect on the sciences underpinning NI
4. Describe phenomena of nursing
 CHAPTER INTRODUCTION
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— Nurses are expected to provide safe, competent,

and compassionate care in an increasingly
technical and digital environment
— A major theme in this new healthcare environment
is the use of information systems and technologies
to improve the quality and safety of patient care
— Nurses are directly engaged with information
systems and technologies because they are the
foundation for:
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1. Evidence-based practice
2. Clinical-decision support tools
3. The electronic health record (EHR)
4. Unfortunately, not all nurses are fully prepared to
use these tools to support patient care.
5. A new specialty, called Nursing Informatics, has
emerged over the past 20 years to help nurses
fully use information technology to improve the
delivery of care.
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— Nursing informatics supports the collection, storage,

analysis, retrieval, communication and use of
information to help nurses to:
A. CARE for patients to the highest quality
B. SHARE data, information and knowledge
C. COMPARE theory and practice to advance nursing
knowledge and practice.
 WHAT IS NURSING
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The American Nurses’ Association (ANA, 2003)

Definition of Nursing:

Nursing is the protection, promotion, and

optimization of health and abilities;
prevention of illness and injury; alleviation of
suffering through the diagnosis and treatment
of human response; and advocacy in the care
of individuals families communities and
populations
 Components of ANA Definition of Nursing
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— The focus of nursing is on the human responses to

actual or potential health problems, and advocacy
for various clients
— Nurses must possess the following skills:
1. Technical Skills: to manage equipment and
perform procedures
2. Interpersonal skills: to interact appropriately
with people
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3. Cognitive skills: to observe, recognize and

collect data, analyze and interpret data and reach
a reasonable conclusion that forms the basis of a
decision
4. Information Intensive Skills: Nursing is an
information intensive profession
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Nursing Science:
The ethical application of knowledge acquired
through education research and practice to provide
services and interventions to patients in order to
maintain enhance or restore their health; to
advocate for health and to acquire process
generate and disseminate nursing knowledge to
advance the nursing profession
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Nursing Theory:
Concepts propositions and definitions that
represent a methodical viewpoint and provide a
framework for organizing and standardizing
nursing actions
 PHENOMENA OF NURSING
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— The metaparadigm of nursing comprises four key

concepts:
1. The Nurse
2. The Person
3. The Health
4. The Environment.
— Nursing actions are based upon the inter-
relationships between these concepts and are
related to the values nurses gives to them
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— The characteristic of the nursing decision has two

sides:
a. The quality of the decision
b. The impact of the actions resulting from those
decisions on individuals and communities
— The process of decision-making in nursing is
guided by the concept of critical thinking.
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Nurses’ decision making:

Is described as a collection of decisions that
include specific behaviors, and cognitive
processes surrounding a group of issues

Critical thinking:
Is the intellectual process of actively and skillfully
using knowledge
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Wisdom:
Is the ability to apply valuable and practical
knowledge, experience, understanding and insight
while being careful and sensible. It is focused on
our own minds and the synthesis of our
experience, insight, understanding and knowledge.
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Wisdom in informatics:
Is the ability of the Nurse Informatics to evaluate
the documentation drawn from a Health
Information System (HIS) and the ability to adapt
or change the system settings or parameters to
improve practice and decision making of the nurse
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— Nurses make decisions about potential problems

presented by an individual and about appropriate
recommendations for addressing those problems.
— Computer applications designed to facilitate
human decision making processes.
— In Nursing Informatics nurses use Decision
Support Systems (DSS)
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Decision support system (DSS):

Usually DSS are rule-based, using a specified
knowledge base and a set of rules to analyze data
and information and provide recommendations
typically through the use of a knowledge base and
rules to make recommendations to users
 INTRODUCTION TO NI
18
— Nursing Informatics supports consumers, patients,
nurses, and other providers in their decision-
making in all roles and settings.
— The goal of NI is to improve the health of
populations, communities, families, and individuals
by optimizing information management and
communication.
— NI has become well established within nursing
since its recognition as a specialty for registered
nurses by the American Nurses Association (ANA)
in 1992.
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Nursing Informatics:
Is a specialty that integrates nursing science
computer science cognitive science and
information science to manage and communicate
data, information, knowledge, and wisdom, 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.
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— This support is accomplished through the use of

information structures, information processes, and
information technology; synthesis of nursing
science, information science, computer science
and cognitive science to facilitate the management
of healthcare data for the improvement of patient
care and advancement of the nursing profession.
— Because information and knowledge are essential
for nurses when interpreting data and making
decisions, it is important to know the difference
between these important concepts
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— Nurses collect data when assessing and

monitoring the health of patients and record their
observations in the patient’s chart
— Nurses exchange service requests to, and receive
results from, the clinical laboratory, radiology and
other departments
— Nurses receive and review admission data and
discharge summaries
— Nurses review information on the results of clinical
research and clinical trials
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— Nurses communicate patients’ information

between service providers
— Nurses summarize, calculate, and interpret
workload indices for their nursing units for
monitoring and management purposes
— Nurse consult evidence-based clinical guidelines
and protocols to guide their practice
— As knowledge workers, nurses use concepts such
as these to influence decision making
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— Nursing Informatics (NI) centers on the concepts

of:
1. DATA
2. INFORMATION
3. KNOWLEDGE
4. WISDOM
— These concepts are known as Metastructures in
Nursing Informatics
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— Data: Raw facts which lacks meaning and

described objectively without interpretation: such
as
§ Age 15, 19, 23, 60, 70, 190, 110
§ Number of patients in ward: 20, 40, 50
§ Blood pressure: 120/80, 190/110
§ Disease: DM, Hypertension
§ Weight: 50 KG, 80 KG
§ Height: 160 CM, 170 CM
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— Information: Data that are interpreted, organized,

or structured. Data that is processed using
knowledge. Data made functional through the
application of knowledge: such as
§ Prevalence of patients falls per nursing ward per
month – this year compared to last year
§ Prevalence of stage 3 Cancer patients per year
on an Oncology Unit
§ Percentage (%) of staff absenteeism on surgical
ward among staff nurses per month
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— Knowledge:
Processed information that helps to clarify or
explain some aspects of our environment or world
that we can use as a basis for action or upon
which we can act
— Nursing knowledge:
Is defined as information that has been
synthesized so that interrelationships are identified
and formalized resulting in decisions that guide
nursing practice such as:
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§ Effectiveness of Patient Monitoring Program in

the prevention of patients falls on surgical wards
§ Cancer treatment Protocols
§ Relationship between surgical wards nurse
absenteeism and work load and work stress
§ Care plans for specific health conditions
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Decisions: such as
§ A diagnosis of Hypertension or DM
§ Using stage 3 Cancer protocol to treat this patient
§ Refer to hospital management records to identify
staff working loads
 History of Nursing Informatics
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— Healthcare began to use computers in the 1950’s.

— Computers, in this era, were typically used in the
business office.
— In the 1970’s, nursing began to realize the
importance of computers to the nursing profession
and became involved in the design, purchase, and
implementation of information systems.
— In the 1980’s, medical and nursing informatics
specialties emerged.
— 1995 saw the first certification exam for NI.
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— The post-2000 era saw an unprecedented

explosion in the number and sophistication of both
computer hardware and software.
— Telemedicine became possible and was
recognized as a specialty in the late 1990’s.
— NI has experienced rapid growth in the last 40
years which does not appear to be slowing.
 Nursing and Knowledge
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Nurses are:
1. Knowledge workers: working with information
and generating information and knowledge as a
product
2. knowledge acquirers: providing convenient and
efficient means of capturing and storing
knowledge
3. knowledge users: individuals or groups who
benefit from valuable, viable knowledge.
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4. Knowledge engineers: designing, developing,

implementing and maintaining knowledge.
5. Knowledge managers: capturing and
processing collective expertise and distributing it
where it can create the largest benefit.
6. Knowledge developers or generators:
changing and evolving knowledge based on the
tasks at hand and information available.
 Important Points to Remember about
Metastructures
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— Data, which are processed into information and

then into knowledge, may be obtained from
individuals, families, communities, and
populations.
— Knowledge focuses on what is known but Wisdom
focuses on the appropriate application of that
knowledge.
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— If the study of NI was limited to what the computer

can process, then it could not fully appreciate the
interrelationships that exist between nursing
science, practice and information, science,
technology.
— The appropriate use of knowledge involves the
integration of empirical, ethical, personal and
philosophical knowledge in the process of
implementing actions.
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— NI is now concerned with the use of information

technology to improve the access and quality of
health care that is delivered to individuals, families
and communities.
 Sciences Underpinning NI
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— NI is a combination of nursing science,

information science, and computer science to
manage and process nursing data, information,
and knowledge to facilitate the delivery of health
care.
— The combination of sciences creates a unique
blend that is greater than the sum of its parts, a
unique combination that creates the definitive
specialty of NI.
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— Computer and information science applied in

isolation will have less impact than when they are
applied within a disciplinary framework.
 Structured Language as a Tool for NI
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— Many different languages and ways of organizing

data, information and knowledge exist based on
different concepts.
— Nursing knowledge is gained by the ability to
extract data that specifically defines nursing
phenomena
— The ANA has formalized the recognition of these
languages/vocabularies through a review process
of the Committee on Nursing Practice Information
Infrastructure (CNPII).
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— Examples of languages and vocabularies are:

1. Perioperative Nursing Data Set (PNDS)
2. Patient Care Data Set (PCDS)
3. North American Nursing Diagnostic Association
(NANDA)
4. Nursing Interventions Classification (NIC)
5. Nursing Outcome Classification (NOC)
6. Nursing Management Minimum Data Set
(NMMDS)
7. Systematized Nomenclature of Medicine
Concepts and Tools from Information Science
and Computer Science
40

— Informatics tools and methods from computer and

information sciences are considered fundamental
elements of NI.
— Information technology includes computer
hardware, software, communication, and
network technologies, derived primarily from
computer science.
— Information structures organize data, information,
and knowledge for processing by computers.
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— Information management is an elemental process

within informatics in which one is able to file,
store, and manipulate data for various uses.
— The use of information technology distinguishes
informatics from more traditional methods of
information management.
 Human-Computer Interaction
42

— Elements of this interaction are rooted in

psychology, social psychology and cognitive
science
— Usability issues address the efficiency and
effectiveness of an application.
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— Human Computer Interaction (HCI):

The processes, dialogues and actions that a user
employs to interact with a computer; also the study
of interaction between people (users) and
computers; deals with people, software
applications, computer technology and the ways
they influence each other.
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— Informatics Nurse Specialist (INS):

An RN with formal, graduate education in the field
of informatics or a related field and is considered a
specialist in the field of nursing informatics.

— Informatics Nurse (IN):

An RN with an interest or experience working in an
informatics field. A generalist in the field of
informatics in nursing.