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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.
- 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. o 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 - Appropriate use of data, information, and knowledge in making decisions and implementing nursing actions. - Guides the nurse in recognizing the situation at hand based on patients’ values, nurse’s experience, and healthcare knowledge. - Implies a form of ethics, or knowing why certain things or procedures should or should not be implemented in healthcare practice. - Includes the ability to integrate data, information, and knowledge with professional values when managing specific human problems. - The use of knowledge and experience to heighten common sense and insight so as to exercise sound judgment in practical matters. - Thought to be the highest form of common sense, resulting from accumulated knowledge. - 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
- 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.
- As you look at the Foundation of Knowledge model, STs support knowledge acquisition, dissemination, generation, and processing.
- Structured controlled languages developed to represent concepts in a given domain in a clear, unambiguous fashion that conveys the exact same meaning for data, information, and knowledge across settings.
- Guidelines addressed aspects that include content, concepts, and identification of concepts, hierarchy, relationships and formal definitions.
- Are based upon concepts rather than terms and allow for growth over time.
- Current Terminology: o Nomenclature refers to a system of rules and procedures for adding names used in an art or science, such as nursing. o Classification systems that capture categories, which are then used to determine costs or outcomes but are insufficient in detail for clinical documentation purposes. o Taxonomy which uses classification according to a predetermined system, with the resulting catalog used to provide a conceptual framework for discussion, analysis, or information retrieval. o Data set which refers to a named collection of data consisting of individual information organized in a prescribed fashion.
- International Statistical Classification of Diseases and Related Health Problems (ICD) and Current Procedural Terminology (CPT) provides a description and a classification of known diseases and injuries. o Collection of morbidity and mortality statistics o Automated clinical decision support o Assignment of codes to medical diagnoses and procedures assoc. with hospital utilization in the US.
- 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 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
- 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.
- The term digital native doesn't refer to a particular generation. Instead, it is a catch-all category for children who have grown up using technology like the Internet, computers and mobile devices. Information Literacy Competency Standards for Nursing
- The purpose of the Information Literacy Standards for Nursing is to: o provide a framework for faculty and students of nursing at the associate, baccalaureate, master’s, and doctoral levels in the development of information literacy skills for evidence-based nursing practice o encourage the use of a common language for nursing faculty and librarians to discuss student information-seeking skills; o guide librarians and nursing faculty in creating learning activities that will support the growth of information literacy skills over the course of a program of nursing education and for lifelong learning;
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.
o Education: Maximize the possibilities of technology toward knowledge development and dissemination. o Communication and Collaboration: standardized, person-centered, technology-enabled processes to facilitate teamwork across the continuum of care. o Informatics Design: Evidence-based, interoperable intelligence systems o Information Technology: smart people centered technology-enabled processes o Policy: consistent, incentives-based initiatives that support advocacy and coalition-building o Culture: A respectful, open system that leverages technology and informatics across multiple disciplines Review Questions found online:
- The nurse understands that nursing informatics is recognized as a specialty area of practice by which statement? o 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"? o "I understand how to search for a website and evaluate its usefulness for health care needs."
- What is information? o 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? o 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? o 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? o A nurse informatics specialist extrapolates data to develop best practice model for indwelling catheter care.
- What is Quality Information? o Information that is timeliness, precision, accuracy, numerically quantifiable, easily available, unbiased, clear and reliable
- What is data? o A 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? o 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? o Credited seal, good contact info, not selling things, creditable author, unbiased (things discussed in class) has URAC or HON CODE, updated o Offline: thumb drive, CD, something stored on a medium, not used as much o 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 o 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
- Nursing Informatics: Managing and processing information applying to nursing practice, education, and research. Established and growing area of specialization in nursing. Nurses employ information technologies in their practice
- Knowledge: Is formed when data is grouped creating meaningful information and relationships which are then added to other structured information.
- Why do we need to study nurse informatics? o Information is Power and technology facilitates a creative process in nurses, and improves patient education, teaching, and learning
- What is a common reality that occurs with nursing and technology? o Nurses will be comfortable working with computers and advanced technology while providing care for clients.
- Definition of Nursing Informatics by ANA: o Specialty that integrates nursing science, computer science to manage and communicate data , info and knowledge in nursing practice
- What are the functions of computers in Nursing Practice?
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? o Input vital signs and intake and output data in the electronic medical record.
- In which way does medical informatics overlap with nursing informatics? o 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? o 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? o 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? o 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? o 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? o 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? o 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? o Development of a standardized nursing language
o Informatics nurse specialists
- The Informatics Nurse Specialist is an integral member of the health care team with the expertise to: Create standardized nursing languages.
- Which of the following answers is the best definition of data? o Data are a collection of numbers, characters, or facts that are gathered according to some perceived need for analysis and possibly action at a later point in time.
- What is the key impediment of telehealth? o Licensure
- What are the benefits of nursing terminologies? o Increased visibility, better communication, involved patient care, enhanced data collection, adherence to standards
- What are NANDA, NIC, NOC, CCC, PNDS, NMDS? o Examples of nursing terminologies
- Research that generates knowledge for nursing practice is called? o Evidence based practice
- What are the three sciences that nursing informatics utilized in the definition? o Nursing science, computer science, and information science
- Nursing informatics focuses in what four concepts? o Data, information, knowledge, and wisdom
- What are raw facts that lack meaning? o Data
- What are the modules of CDSS? o 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? o Artificial intelligence
- What is the longitudinal electronic record of patient health information produced by encounters in one or more care settings? o EHR - electronic medical record
- What are at least two economic benefits of telehealth? o Decrease ER visits, decrease length of stay, decrease admission, decrease travel costs, increase in productivity of clinicians
- What is the definition of nursing terminologies?
o 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? o Patient safety
- What are the components of the metaparadigm of nursing? o Nurse, patient, health, environment
- Who are the consumers of telehealth technology? o Chronically ill, isolated, concerned families and assisted living patients
- A DSS or CDSS should support, not replace what of a clinician or manager? o Judgement and critical thinking
- What are 3 peripheral devices used in telehealth? o 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? o Clinical decision support system
- What module is used to enter meds and other orders into the computer? o Order entry management
- What allows the clinician to be in contact with a patient without a face to face encounter? o Telehealth
- People who share a specialized knowledge? o Profession
- What is the ability to apply appropriate use of knowledge to manage and solve human problems? o Wisdom
- What is a RN with an advanced education possess additional knowledge skills to computer and information technology? o Nurse informatics specialist
- What is the goal of nursing informatics? o Improve health of populations, communities, families and individuals by optimizing information management and communication
- Data that is interpreted, organized or structured? o Information
- Information that is synthesized so that relationships are identified and formalized?
