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NR 599 MIDTERM REVIEW
General principles of Nursing Informatics
- Verbalize the importance of health information systems with clinical practice. - Have knowledge of types and clinical and administrative uses of health information systems. - Ensure confidentiality of protected patient health information. - Assure access control in the use of health information systems. - Informatics: Science and art of turning data into info. - Nursing Informatics ANS: The specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice. o Nursing Informatics supports nurses, consumers, patients, the inter- professional healthcare team, and all other stakeholders in their decision making in all roles and settings to achieve desired outcomes. o 2 Levels NI practice: generalists and informatics-nurse specialists. Knowledge
- Awareness and understanding of a set of information and ways that information can be made useful to support specific task or arrive at a decision
- Information that’s synthesized so that relationships are identified and formalized.
- Processed information that helps to clarify or explain some portion in our environment or world that we can use a as basis for action or upon which we
can act.
- Often affected by assumptions and central theories of a scientific discipline and is derived by discovering patterns of relationships between different clusters of information.
- Answers questions of “why” and “how”
- Data – uninterpreted items, often referred to as data elements. An example might be a person’s weight. Without additional data elements such as height, age, overall well-being it would be impossible to interpret the significance of an individual number.
- Information – a group of data elements that have been organized and processed so that one can interpret the significance of the data elements. o For example, height, weight, age, and gender are data elements that can be used to calculate the BMI. The BMI can be used to determine if the individual is underweight, overweight, normal weight or obese.
- Ability to apply viable and valuable knowledge, experience, understanding, and insight while being prudent and sensible. - Appropriate use of knowledge to solve human problems. Scientific Underpinning - The scientific underpinnings of practice provide the basis of knowledge for advanced nursing practice. - These scientific underpinnings include sciences such as biology, physiology, psychology, ethics, and nursing. - The sciences underpinning nursing informatics: Nursing science, information science, and computer science
- The advent of nursing science, specifically middle-range nursing theories, expanded the discipline of nursing. Thorough understanding of nursing theory provides a solid foundation for advanced nursing practice.
- The importance of using science-based concepts to evaluate and enhance health care delivery and improve patient outcomes. The Foundation of Knowledge Model - Model that proposes that humans are organic information systems constantly acquiring, processing, and generating information or knowledge in both their professional and personal lives. - Involves integrating four main kinds of knowledge, which are: knowledge acquisition, knowledge dissemination, knowledge generation and knowledge processing. o Knowledge worker : working with info. And generating info and knowledge as a product. o Knowledge acquirer: Providing convenient and efficient means of capturing and storing knowledge. o Knowledge engineers: Designing developing, implementing, and maintaining knowledge. o Knowledge managers: Capturing and processing collective expertise and distributing it. o Knowledge developers and generators: Changing and evolving knowledge based on the tasks at hand and the information available. - With time, we begin to transform our experiences and applied knowledge into it highest form known as...wisdom. - Knowledge is a powerful tool and that nurses focus on information as a key building block of knowledge.
- Facilitates the acquisition and manipulation of data and information by nurses, who can then synthesize these into evolving knowledge and wisdom base. Cognitive science - Study of thought, learning, and mental organization, which draws on aspects of psychology, linguistics, philosophy, and computer modeling. - Interdisciplinary field that studies the mind, intelligence, and behavior from an information processing perspective. Information science - Deals with the retrieval and management of information as well as human- computer interactions. - Studies the application and usage of information and knowledge in organizations and the interface or interaction between people. - Concerned with the input, processing, output, and feedback of data and information through technology integration with a focus on comprehending the perspective of the stakeholders involved and then applying IT as needed. - An interdisciplinary, people-oriented field that explores and enhances the interchange of information to transform society, communication science, computer science, cognitive science, library science, and the social sciences. - Encompasses aspect of computer science, cognitive science, social science, communication science, and library science to deal with obtaining, gathering, organizing, manipulating, managing, storing, retrieving, recapturing, disposing of, distributing, and broadcasting information. - Studies everything that deals with information and can be defined as the study of ISs.
- Enables the processing of information. - Links people and technology - Impacts information interfaces, influencing how people interact with information and subsequently develop and use knowledge. Standard Terminology (Week 1)
- Standardized terminologies (STs) contribute to the development of knowledge because they ensure that all professionals share the same understanding or meaning of a given concept, to clarify communication, facilitate research, and provide structure for decision support tools and EHRs.
- It improves communication, supports data reuse, contributes to the further development of nursing knowledge and provides a framework for EHRs. Informatics Competencies (Week 2)
- Information Literacy: Refers to the use of digital technology to locate, navigate, manage, integrate, evaluate, create, and effectively communicate in a rapidly changing healthcare environment. The most important aspects of information literacy reflect information discovery, retrieval, and delivery as well as the ability to acquire, process, generate, and disseminate knowledge in ways that help those managing the knowledge reevaluate and rethink what an individual understands.
o Ability to identify when information is needed as well as the skills to find, evaluate, and effectively use the same o Evaluation of online resources for quality o Able to search literature databases effectively
- Computer Literacy o Basic familiarity with computer uses and common applications o Ability to navigate hyperlinks o Able to set up and use a database to collect and retrieve information
- Clinical Information Management o Uses clinical decision making (CDS) and system safeguards to protect patients and protected health information (PHI) o Able to request and evaluate reports for the purpose of informed decision making o Participate in the selection, design, and evaluation of clinical information systems and patient-care technologies o Uses available technologies to appropriately and effectively communicate Health literacy (Week 2) - Degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. - Is dependent on individual and systemic factors: Communication skills of lay persons and professionals. - Is a major goal of Healthy People 2010 Meaningful Use (Week 3) - The American Recovery and Reinvestment Act of 2009 specifies 3 main
o Stage 1: baseline for electronic data capture and info sharing o Stage 2 & 3 continues to expand on this baseline and be developed through future rule making. Patient-centered Information Systems
- EMRs, aggregate information systems, patient unique identifiers. - Aggregated data are used for the generation of routine reports and indicators, and for strategic planning and guidance within the health system. - Focused on collecting data and disseminating info related to direct care. - Most commonly types found in healthcare organizations: o Clinical documentation systems o Pharmacy info systems o Laboratory info systems o Radiology info systems. Clinical Decision Support Systems (CDS) - Provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care. - CDS encompasses a variety of tools to enhance decision-making in the clinical workflow. o These tools include computerized alerts and reminders to care providers and patients; clinical guidelines; condition-specific order sets; focused patient data reports and summaries; documentation templates; diagnostic support, and contextually relevant reference information, among other tools. - Provides HIT functionality that builds upon the foundation of an EHR to provide
persons involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care
- Promotes accurate medical diagnoses and suggest appropriate medical and nursing interventions based on patient data. Electronic Medical Records - Electronic version of a patient’s medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology report
become a necessity. Such technology has been already practiced in many nursing departments. o For example, the cardiac monitoring systems, defibrillators, electronic thermometers, intravenous pumps, Patient-controlled analgesia (PCA) pumps and many others hardware.
- May present information using text, numbers, images, icons or sound. o Auditory, visual, or even tactile alarms may alert users to important information.
- Problems may include: o Nurses devise workarounds, such as removing armband from the patient o Major cause of as many as 87% of all patient monitoring incidents Health Information Technology - HIT has been promoted as a key strategy to achieve better care, affordable care, and healthy populations and communities.
- Comprised of “hardware, software, integrated technologies or related licenses, intellectual property, upgrade, or packaged solutions sold as services that are designed for or support the use by healthcare entities or patients for the electronic creation, maintenance, access or exchange of health information. - Involves the exchange of health information in an electronic environment. Widespread use of health IT within the health care industry will improve the quality of health care, prevent medical errors, reduce health care costs, increase administrative efficiencies, decrease paperwork, and expand access to affordable health care. - It is imperative that the privacy and security of electronic health information be ensured as this information is maintained and transmitted electronically. Alarm fatigue (Week 2) - Multiple false alarms by smart technology that cause workers to ignore or respond slowly to them. - the desensitization of a clinician to an alarm stimulus that results from sensory overload causing the response of an alarm to be delayed or missed According to The Joint Commission (TJC) between 2009 and 2012, there were reports of 98 alarm-related sentinel events, in which 80 resulted in death, 13 in permanent loss of function, and five in unexpected prolonged care conditions Digital natives - Person born or brought up during the age of digital technology and therefore familiar with computers and the Internet from an early age.
o provide administration and curriculum committees a shared understanding of student competencies and need; and o provide a framework for continuing education in the area of information literacy for the field of nursing practice and research
- (^) Standard One: The information literate nurse determines the nature and extent of the information needed. o Defines and articulates the need for information. o Identifies a variety of types and formats of potential^ sources^ for information. o Has working knowledge of the literature in nursing-related fields and how it is^ produced. o Considers the costs and benefits of acquiring the needed information. o Re-evaluates the nature and extent of the^ information^ need.
- (^) Standard Two: The information literate nurse accesses needed information effectively and efficiently. o Selects the most appropriate investigative methods or information retrieval systems for accessing the needed information. o Constructs and implements efficient and effectively designed search strategies. o (^) Retrieves information online or in person using a variety of methods. o Refines the search strategy, if necessary o Extracts, records, and manages the in-formation and its sources.
- Standard Three: The information literate nurse critically evaluates the procured information and its sources, and, as a result, decides whether or not to modify the initial query and/or seek additional sources and whether to develop a new research process.
o Summarizes the main ideas to be extracted from the information gathered. o Selects information by articulating and applying criteria for evaluating both the in-formation and its sources. o Synthesizes main ideas to construct new^ concepts. o Compares new knowledge with prior knowledge to determine the value added, contradictions,^ or^ other unique characteristics of the information. o Validates understanding and interpretation of the information through discourse with other individuals, subject-area experts, and/or practitioners o Determines whether the initial query should be revised. o Evaluates the procured information and the entire process.
