Nursing Informatics in South America

South America Overview

South America, a subcontinent, includes 13 countries and 3 territories.
It covers 12% of Earth's surface with an area of 17,819,100 km^2, and 6% of the world’s population.
Brazil has the largest population at 201,033,000, followed by Colombia (47,130,000) and Argentina (41,350,000).
Spanish is the official language for most countries, while Portuguese is spoken in Brazil.
In 1991, Argentina, Brazil, Paraguay, and Uruguay formed MERCOSUR via the Treaty of Asunción.
- The primary goal was the integration of these states through:
  - Free movement of goods, services, and productive factors.
  - Establishment of a Common External Tariff (TEC).
  - Adoption of a common commercial policy.
  - Coordination of macroeconomic policies.
  - Harmonization of relevant legislation.
Venezuela joined MERCOSUR in 2012.
The Fund for Structural Convergence of MERCOSUR (FOCEM), created in 2004, supports programs for:
- Promoting structural convergence.
- Developing competitiveness.
- Promoting social cohesion, particularly in smaller economies and regions with lagging development.
- Supporting the institutional structure and strengthening integration.
Brazil contributes 70% of FOCEM resources, while Argentina provides 27%.

Health Systems

Health systems vary across South American countries.
Six countries, including Brazil, consider health a universal right in their constitutions.
Others mention it in general terms related to social determinants or access to services.
Universal social protection in health is not uniformly completed like in European countries.
Formal coverage may reach the entire population, but systems are generally fragmented and segmented.

Nursing Education and Informatics

Nursing education primarily occurs in public or private universities.
Most countries have graduate programs focusing on local needs like Women's Health, Prenatal Care, and Intensive Care.
Nursing Informatics development relies more on individual activities rather than government or national policies.
Technological resource deployment varies, but technology has significantly evolved health and nursing education, practice, research, and administration.
South America has consistently shown the highest growth in information technology over the past 25 years.
Factors impacting broad adoption of health IT include infrastructure and human resources.

ICT in Healthcare

Information and communication technology (ICT) is used to improve quality of life, health conditions, and professional performance.
Nurses have progressively incorporated information systems and educational resources into their practice.
ICT resource use reflects the region's technological evolution.
Developed regions have better access and ability to implement health IT in nursing care and education.
Governmental bodies and stakeholders recognize the need for additional investments to optimize resources in underdeveloped regions.
Computers and ICT are recognized as important tools for supporting nurses, but adoption varies.
Internet and wireless communication are definitive trends, with universities and educational institutes using them for distance learning.
Hospitals are exploring new resources to facilitate patient care and promote quality and safety.

Chapter Objective

The chapter aims to provide an overview of nursing informatics development in South America.
It includes examples of using information technology and communication in clinical practice and education.
It also describes educational and distance learning efforts, primarily focusing on some South American countries and Cuba.
Nurses must ensure the inclusion of nursing elements in patient records by collaborating with programmers, vendors, and developers.
Nursing education programs are essential for preparing new professionals.
Congresses, conferences, workshops, and training programs are organized to share experiences in nursing informatics and find solutions to enhance patient care.

Background

Nursing has been identified as an emerging profession for over 100 years.
The 100th anniversary of Florence Nightingale's death was celebrated in 2010.
Nurses are primary technology users in healthcare and are accustomed to adapting new tools and creating new models for enhanced patient care.
Technology offers opportunities for innovation and redesigning care methods.
Traditional methods of teaching, managing, and practicing healthcare no longer meet modern requirements.
Continuous and diverse education is crucial, and information is key for decision-making.
Technology facilitates access to information that must be easily available for clinical decisions.
Health systems worldwide seek improvements in overall health, operative capacity, mortality and morbidity rates, and quality of life through informatics-based systems.
Countries are becoming aware of IT's potential to enhance care quality, despite the delay caused by a lack of national policies.
There is a growing trend toward computerization of health records and increased Internet access.
The Pan American Health Organization (PAHO) has published guidelines for deploying ICT in Latin America and the Caribbean.
The South American region ranks third in information technology expenditure.
The Information Society Index measures the use of information, computers, and social infrastructure.
In April 2013, the Economic Commission for Latin America and the Caribbean (ECLAC) endorsed ICT in the region to improve health services access and quality.
The eHealth Strategy and Plan of Action (2012–17) aims for sustainable development, digital literacy, access to information, and ongoing training.
Indicators for facilitating this process include the number of hospitals and primary care centers with Internet access and the level of computer and Internet use for managing patient information.

Nursing Informatics Initiatives

Initial motivation for developing computer systems was driven by financial and administrative concerns.
Clinical information systems have been implemented in hospitals or health institutes in countries like Brazil, Argentina, Colombia, Chile, and Paraguay.
Few hospitals have developed applications for nursing documentation where nursing data can be processed.
Patient data used for nursing administration is either integrated or collected and analyzed separately.
Hospitals design their own systems, but national and international software industries are becoming more represented.
In Brazil, the economy opening has allowed international industries to commercialize products for local needs.
Private hospitals are adopting and customizing applications according to national rules and legislation.
Computers as an instrument to support nurses' activities still need considerable investment.
Clinical systems based on the nursing process are requested but not common.

Computer Systems

Most implemented systems control administrative data, nursing orders, and some unstructured nursing notes.
Free-text documentation makes it difficult to analyze and evaluate nursing care, resulting in a large amount of data but not necessarily useful information.
Nurses are increasingly involved with the design, implementation, and evaluation of clinical information systems.
International developers are investing in South America, recognizing it as a promising technology market.

Argentina

Health computer systems are acquired from the health software industry or locally developed.
Few applications include resources for nursing activities.
Argentina was one of the first South American countries to introduce health informatics in physician education.
The formal organization of nursing informatics began in 1991 and has since grown.
The II Argentine Symposium of Nursing Informatics was held in 2008 with over 100 participants.
The Nursing Informatics Group is affiliated with the Argentina Association of Medical Informatics (AAIM) and IMIA.
Project FAENET, a virtual network of nursing in Argentina, connects nurses and provides information management tools.
Argentinian nurses are deeply involved with the Working Group of Nursing informatics at IMIA-LAC.

Brazil

Nursing Informatics in Brazil initiated around 1985, focusing on education and practice.
Several nursing schools include nursing informatics content in the curriculum.
Technology can transform nursing practice, training, and educational models.
Nurses became primary users of computers and had to become computer-literate.
Nursing schools and hospitals initiated programs to prepare nurses in computer use.
Computer applications in nursing education shift the teaching model to an active learning process.
A grant from the Fogarty International Center of the National Institutes of Health (U.S.) established a bilateral consortium of health informatics faculty.
A training program enhanced teaching resources, reaching different regions of Brazil.
By 2003, 1724 professionals were involved with the program, which continued to stimulate conference participation.
The grant was renewed to support a distance education-based certificate program involving Maputo University (Mozambique, Africa).
In 2008, the Ministry of Education and Universidade Aberta do Brasil created a distance learning program provided by UNIFESP for 500 professionals.
Computer technology offers opportunities for students in distant regions to improve their knowledge.
In 2013, the program included 806 students supported by the Secretary of Health.
The RUTE network, deployed in 2006, integrates teaching hospitals and basic healthcare networks.
By 2013, it integrated approximately 131 healthcare institutions and hundreds of basic healthcare units, covering all Brazilian states.
RUTE improves access to healthcare and information for remote populations and supports research studies.
Currently, 64 Special Interest Groups (SIG) promote discussion and conferences, involving over 300 healthcare institutes.
Nurses use RUTE to promote meetings and scientific discussions and to support patient care activities.
Distance learning can train large numbers of nurses, and nurses should have computer-based education in their curriculum.
In February 2009, the first online social network for nursing informatics and telenursing was created.
Since 2010, several courses were organized focusing on various aspects of nursing care and informatics.
TIGER Brazil promotes harmonization of nursing curriculum content and defines competencies for nursing informatics.
The TIGER Initiative aims to improve nursing practice, education, and patient care through health information technology.
In 2013, a group initiated the development of a strategy and action plan for Tiger Brazil.
Research activities continue to be incremented, with 608 research groups included in the National Research Council for Science and Technology (CNPq).
There are 21 research groups in nursing informatics, including the Nursing Informatics Research Group at the Federal University of São Paulo (NIEn-UNIFESP).
Efforts have been made in Nursing Terminology, and the International Classification of Nursing Practice (ICNP) dissemination started around 1996.
The ICNP Beta 2 became available in a Brazilian Portuguese version, and Version 1 was published in Brazil in 2007, followed by Version 2 in 2011.
Other terminologies, such as the Home Health Care Classification (HHCC) System and the Clinical Care Classification (CCC) System, are also used.
No clinical vocabulary has been elected as the ultimate solution for clinical documentation.
Several obstacles exist before nursing communities embrace a standardized vocabulary.
ISO 18104—Health Informatics: Categorical structures for representation for nursing diagnoses and nursing actions in terminological systems was developed to cover terminologies of nursing documentation.
The aim was to establish a reference terminology model for nursing aligned with other health-specific models.
A study verified the model's adequacy with nursing documentation, showing that all records for nursing diagnoses had focus, judgment, or clinical finding.

Chile

The Ministry of Health established the Digital Agenda Initiative to promote healthcare development through technology.
In 2010, the Computer Health Center at the Faculty of Health Sciences in the University Central of Chile was created with nursing leadership.
The mission is to generate and disseminate scientific knowledge and develop networks.
The center provides education for healthcare professionals and engineers using distance education and conducts research.
Projects include digital literacy of students and the Project FONDEF, which develops a mobile solution of electronic clinical record for homecare.
The Red de Enfermería Informática de Chile (REICH) promotes cooperation between Chilean nurses for nursing informatics development.
The Faculty of Sciences of the University Central of Chile has nursing students who perform clinical practice in hospitals and family healthcare centers.
A Clinical Simulation Center supports the training of students and assures continuous education in safety and welfare of the patient.
It integrates concepts from basic sciences and promotes work in a multi-professional team.
Nursing informatics in Chile has had a vertiginous development in the past five years, emphasizing mobile-health projects.

Cuba

Nursing informatics in Cuba has been evolving since the 1970s.
The use of Computer-Assisted Instruction (CAI) applications has been commonplace.
Multimedia tools and the Cuban link to the Internet improved CAI and supported education.
Nursing Informatics courses are offered at a basic level, and there is a goal to offer NI degrees at various levels.
Existing HIT systems focus on clinical systems in hospitals and community health systems.
Emergency Units are equipped with automated systems for nursing assessment and intervention.
Intranets are frequently used to strengthen nursing management.
Cuba established the network of Nursing Informatics (REDENFI), a group for scientific cooperation and exchange of knowledge.
The group promotes Nursing Informatics and organizes conferences and workshops.

WGNI IMIA-LAC

The WGNI IMIA-LAC was established in 2008 during the IMIA LAC conference in Argentina.
It focuses on activities to organize a workforce and promote nursing informatics in the region.
The main goal is to integrate activities and avoid duplicated tasks.
The WGNI IMIA-LAC is also responsible for the coordination of the International Network of Nursing Informatics of PAHO (RIEI).
WGNI IMIA-LAC and RIEI work together to create resources for collaboration and share knowledge.
The coordinating group includes Patricia Abbott, Erika Caballero, Hugo Leonzio, Niurka Vialart, and Jose Angel Sanguino.
Participating countries include Argentina, Cuba, Brazil, Chile, Colombia, Cuba, United States, Mexico, El Salvador, Panama, Mexico, Peru, Venezuela, and Uruguay.

Summary

Nursing informatics follows the progress of health informatics.
Development of nursing informatics is conducted on a case-by-case basis, considering specific requirements.
It is dependent on national priorities, policies, human capabilities, and continuous research.
Healthcare reforms require nurses to be prepared for leading and managing in a global healthcare environment.
Technological advances give nurses the opportunity to drive their professional destinies.
Adapting resources helps nurses see emerging trends as challenges and opportunities.
Nurses must stand out in the use and selection of technology and have information available when needed.
Usability is critical, and technology is a means to promote and increase the quality of service.