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NR 599 Midterm Study
Guide
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 is the 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. 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. 2 Levels NI practice generalists and informatics-nurse specialists. Knowledge 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. 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. Knowledge - is built on a formalization of the relationships and interrelationships between data and information. A knowledge base makes it possible to understand that an individual may have a calculated BMI that is over 30 and not be obese. At this time, several automated decision support systems included a knowledge base and a set of rules for applying the knowledge base in a specific situation. For example, the knowledge base may include the following information. A fever or elevated temperature often begins with a chill. At the beginning of the chill the patient’s temperature may be normal or even sub-normal but in 30 minutes it is likely the patient will have spiked a temp. A rule might read: if a patient complains of chills, then take the patient’s temperature and repeat in 30 minutes. Wisdom Wisdom may be defined as the appropriate use of data, information, and knowledge in making decisions and implementing nursing actions. It includes the ability to integrate data, information, and knowledge
with professional values when managing specific 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 Foundation of Knowledge Model The "Foundation of Knowledge model is a model that proposes that humans are organic information systems constantly acquiring, processing, and generating information or knowledge in both their professional and personal lives" (Mastrain & McGonigle, 2009, p.453). This theory involves integrating four main kinds of knowledge, which are: knowledge acquisition, knowledge dissemination, knowledge generation and knowledge processing. With time, we begin to transform our experiences and applied knowledge into it highest form known as...wisdom. Computer science Studies the theory underpinning information and computation and their implementation in computer systems. Looks at how the human mind works from an information processing perspective. Cognitive science the study of thought, learning, and mental organization, which draws on aspects of psychology, linguistics, philosophy, and computer modeling. Information science Deals with the retrieval and management of information as well as human-computer interactions Standard Terminology 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. As you look at the Foundation of Knowledge model, STs support knowledge acquisition, dissemination, generation, and processing: Nomenclature refers to a system of rules and procedures for adding names used in an art or science, such as nursing.
Meaningful Use was defined by the use of certified EHR technology in a meaningful manner (for example electronic prescribing); ensuring that the certified EHR technology connects in a manner that provides for the electronic exchange of health information to improve the quality of care. Developed as an incentive program to assure that EHRs are used according to standards that achieve quality, safety, and efficiency measures 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. Clinical Decision Support Systems Clinical decision support (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. 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. 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 Electronic Medical Records An Electronic Health Record (EHR) is an electronic version of a patients 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 Improves patient care by:
- Reducing^ the incidence of medical error by improving the accuracy and clarity of medical records.
- Making^ the health information available, reducing duplication of tests, reducing delays in treatment, and patients well informed to take better decisions. - Reducing^ medical error by improving the accuracy and clarity of medical records
Human-Technology Interface Human-Technology Interface (HTI) is the interaction between human and technology. With the evolution of technology and computer science, healthcare has been through many developments in respond to tech- world. Human-Technology Interface in nursing defined as the application of computer technology to all fields of nursing. It is hardware and software through which the user interacts with any technology (e.g., computers, patient monitors, and digital screens). Indeed, the use and the development of technology in the clinical areas has become a necessity. Such technology has been already practiced in many nursing departments. For example, the cardiac monitoring systems, defibrillators, electronic thermometers, intravenous pumps, Patient-controlled analgesia (PCA) pumps and many others hardware. Health Information Technology HIT has been promoted as a key strategy to achieve better care, affordable care, and healthy populations and communities. HIT is 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.Health information technology (health IT) 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 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 a person born or brought up during the age of digital technology and therefore familiar with computers and the Internet from an early age.
and/or practitioners 6. Determines whether the initial query should be revised. 7. Evaluates the procured information and the entire process.
- Standard Four The information literate nurse, individually or as a member of a group, uses information effectively to accomplish a specific purpose. 1. Applies new and prior information to the planning and creation of a particular product. 2. Revises the development process for the product.
- Communicates the product effectively to others. - (^) Standard Five The information literate nurse understands many of the economic, legal, and social issues surrounding the use of information and accesses and uses information ethically and legally. 1. Understands many of the ethical, legal, and socio-economic issues surrounding information and information technology. 2. Follows laws, regulations, institutional policies, and etiquette related to the access and use of information resources. 3. Acknowledges the use of information sources in communicating the product or performance. HITECH Act The HITECH Act was created to motivate the implementation of electronic health records (EHR) and supporting technology in the United States. President Obama signed HITECH into law on February 17, 2009 as part of the American Recovery and Reinvestment Act of 2009 (ARRA), an economic stimulus bill.Health Information Technology for Economic and Clinical Health Act. Creates incentives related to health care information technology, including incentives for the use of electronic health record (EHR) systems among providers. HITECH strengthened HIPPA security. Providers that comply with meaningful use requirement (EHRs) qualify for additional reimbursement over a period of several years. Penalties will be imposed for providers that do not use approved technology to comply with meaningful use. TIGER-based Nursing Informatics Competencies Model Technology Informatics Guiding Education Reform A) Basic computer competencies. B) Information Literacy. C) Information management. Goal: To make healthcare safer, more effective, efficient, patient- centered, timely and equitable by interweaving evidence and technology seamlessly into practice, education, and research fostering learning healthcare system and is a useful resource. Review Questions found online: The nurse understands that nursing informatics is recognized as a specialty area of practice by which statement?
- Research priorities for nursing informatics include the development of a standard nursing language and the development of databases for clinical information.
Which statement by the nurse verifies that the nurse is "information literate"?
- "I understand how to search for a website and evaluate its usefulness for health care needs." What is information? data that can be interpreted. Example: patient’s temperature. Grouping of data process into meaningful structured form.
- The nurse gathers much data when caring for clients. Which is an example of the higher- level "information" useful in caring for clients? After receiving Rocephin (ceftriaxone sodium) 1.0 gram IV yesterday, the client reported feeling better today. Which statement best distinguishes the difference between information literacy and computer literacy?
- Information literacy forms the basis for ongoing learning whereas computer literacy refers to a familiarity with the use of personal computers Which statement indicates the appropriate level of informatics competencies to the correct nurse?
- A nurse informatics specialist extrapolates data to develop best practice model for indwelling catheter care. What is Quality Information?
- Information that is timeliness, precision, accuracy, numerically quantifiable, easily available, unbiased, clear and reliable What is data?
- collection of numbers, characters, or facts that are gathered for a need EX: patients vital signs. Raw unprocessed numbers, symbols or words that have no meaning by themselves.Without context data is meaningless What is data integrity?
- ability to collect, store, and retrieve correct, complete, and current data so data is available to authorized users What is necessary to determine if a website has quality information?
- Credited seal, good contact info, not selling things, creditable author, unbiased (things discussed in class) has URAC or HON CODE, updated Offline: thumb drive, CD, something stored on a medium, not used as much Online: Safe through network, backs it up, easy access, used more frequently, Computer literate: use of computers, know how to work it, basic computer skills EX: word processing, spreadsheet, email Information literate: helps ethical issues, can recognize relevance, and know how to apply it Ex: reliable sources Heal literate: ability to understand, obtain, and process basic health information in order to make informed health decisions Ex: definition of medical terms
Define Purpose: Why are you doing the search? Why do you need this information? Define Focus: Basic information for you, lay oriented for your patients, professionally orientated for you colleagues Define Approach: Broad and general with information that can be quickly accessed Edu: education org: nonprofit organization com: commercial enterprise net: internet provider gov: governmental body mil: military A disadvantage to the utilization of the electronic medical record (EMR) includes which of the following?
- The intensive training in the beginning needed to prepare staff members to use the EMR Which action indicates the nurse is functioning as a knowledge worker?
- The nurse auscultates diminished breath sounds in a postoperative client the morning after abdominal surgery and encourages the client to turn, cough, and deep breathe every hour instead of every two hours. A nurse manager wishes to hire a new nurse who has just graduated from nursing school. At the beginning level of informatics competencies, the nurse should be able to do which of the following?
- Input vital signs and intake and output data in the electronic medical record. In which way does medical informatics overlap with nursing informatics?
- Medical and nursing informatics focus on the areas of information retrieval. Health care consumers have all the information and tools to make health care choices because they can easily compare quality and cost of care. Which of the following is correct?.
- The statement is false because the tool has not been developed. The role of the informatics nurse does not include assessing the usability of devices for health care consumers. This statement is false because of which of the following reasons?
- The development of policy regarding usability is an important part of the informatics nurse's role. Over the next few years, nursing informatics and other health informatics disciplines will crisscross, resulting in more interdisciplinary projects. This statement is true because of which of the following reasons?
- Nurse informatics specialists will work collaboratively with other disciplines to develop user- friendly systems.
The best estimate of the number of informatics nurses needed over the next few years is which of the following?
- 6000 to 12, There are no available nursing informatics programs including doctoral degrees; therefore, nurses prepare for advanced practice through medical informatics curriculum. This answer is false because of which of the following reasons?
- There are a number of accredited advanced nursing education programs in informatics in the United States. The American Nurses Credentialing Center (ANCC) incorporated the foundation provided by the American Nurses Association (ANA) in its definition of nursing informatics and scope and standards of practice. Applicants for the Informatics Nurse credentialing examination are required to meet which of the following minimum criteria?
- Equivalent of two years of full-time professional practice, Baccalaureate or higher degree in nursing (or relevant field baccalaureate), Current, active license as a professional nurse Nursing informatics employs information and computer technology to support all aspects of nursing practice, including research. Which is an example of supporting research?
- Development of a standardized nursing language Which role is only appropriate for the informatics nurse specialist (INS)?
- The design of nursing research protocols and databases Which of the following examples demonstrate how nursing informatics helps to support nursing practice? Standard Text: Select all that apply.
- Quick access to computer-archived patient data from previous encounters
- Computer-generated client documentation including discharge instructions
- Computer-generated nursing care plans and critical pathways
- Prompts that appear during documentation to ensure comprehensive charting Information is defined as which of the following?
- Interpreted data Nurses need to become skilled at using patient-centered IT tools to access information that can expand their knowledge in a just-in-time, evidence-based approach. Which one of these answers best indicates the nurse is functioning as a knowledge worker?
- The nurse shifts from primarily using critical thinking to also using critical synthesis. The TIGER initiative is an acronym for which of the following?
- Technology Informatics Guiding Education Reform
Nursing informatics focuses in what four concepts?
- Data, information, knowledge, and wisdom What are raw facts that lack meaning?
- Data What are the modules of CDSS?
- Reminders, alerts, drug/drug, drug/allergy checking, guidelines and protocols, image recognition, and interpretation What filed attempts to capture the complex process of the human thought and intelligence?
- Artificial intelligence What is the longitudinal electronic record of patient health information produced by encounters in one or more care settings?
- EHR - electronic medical record What are at least two economic benefits of telehealth?
- Decrease ER visits, decrease length of stay, decrease admission, decrease travel costs, increase in productivity of clinicians What is the definition of nursing terminologies?
- A systematic standardized way of describing nursing practice and includes data sets, taxonomies, nomenclatures and classification The number one focus of EHR as stated by the IOM?
- Patient safety What are the components of the metaparadigm of nursing?
- Nurse, patient, health, environment Who are the consumers of telehealth technology?
- Chronically ill, isolated, concerned families and assisted living patients A DSS or CDSS should support, not replace what of a clinician or manager?
- Judgement and critical thinking What are 3 peripheral devices used in telehealth?
- Scale, BP monitor, pulse oximeter, thermometer, glucometer, EKG or heart monitor, PTT/INR meter, camera What is a system designed to support health care providers in making decision about the delivery and management of patient care?
- Clinical decision support system What module is used to enter meds and other orders into the computer?
- Order entry management
What allows the clinician to be in contact with a patient without a face to face encounter?
- Telehealth People who share a specialized knowledge?
- Profession What is the ability to apply appropriate use of knowledge to manage and solve human problems?
- Wisdom What is a RN with an advanced education possess additional knowledge skills to computer and information technology?
- Nurse informatics specialist What is the goal of nursing informatics?
- Improve health of populations, communities, families and individuals by optimizing information management and communication Data that is interpreted, organized or structured?
- Information Information that is synthesized so that relationships are identified and formalized?
- Knowledge The appropriate use of knowledge to manage and solve human problems?
- Wisdom Process of actively and skillfully using knowledge to apply analyze, synthesize and/or evaluate data and information?
- Critical Thinking Informatics- The interdisciplinary study of the design, application, use, and impact of information technology. Nursing Informatics- A combination of computer, information, and nursing science designed to assist in the management and processing of nursing data, information, and knowledge. Healthcare Informatics- AKA Clinical Informatics Directed at the level of individuals An umbrella term including medical, dental, and nursing Benefits of Nursing Informatics: -Enhances practice and allows nursing science to develop -Improves documentation (saves time) -Uses data for quality control and research -Builds evidence-based nursing knowledge Informatics Pyramid (Bottom to Top): Data --> Information --> Knowledge --> Wisdom Structured Data: Follows standards; easily shared; less flexible, reliable reporting Unstructured Data: Easy to use; flexible; requires analytics; not as reliable; not as easily shared
