CHAPTER 15:
Chapter 15: Nursing Informatics Study Guide
This study guide provides a comprehensive overview of nursing informatics, focusing on the integration of nursing science, computer science, and information science. It emphasizes the role of technology in enhancing patient safety, improving clinical outcomes, and supporting evidence-based practice.
Module 1: Introduction and Foundations of Nursing Informatics
Informatics is a broad academic field that encompasses artificial intelligence, cognitive science, computer science, information science, and social science. Within the health care sector, two distinct specialties exist:
• Medical Informatics: Refers to informatics related to health care as a specialty in the discipline of medicine. it focuses on the resources, devices, and methods required to acquire, store, retrieve, and use information in health and biomedicine.
• Nursing Informatics: A specialty area that addresses the use of health information systems to support nursing practice. According to the American Nurses Association (ANA), it integrates nursing, computer, and information science to manage and communicate data, information, knowledge, and wisdom.
The DIKW Framework
The foundation of nursing informatics is based on the progression from raw data to clinical wisdom.
Level
Definition
Application in Nursing
Data
Facts, observations, and measurements used for reasoning or calculation. Raw data are meaningless until organized.
A patient’s blood pressure reading or pulse rate.
Information
Organized and processed data that is meaningful and useful to the recipient.
A series of blood pressure readings over time showing a trend.
Knowledge
Organized and processed information applied to problem-solving and decision-making.
Recognizing that a trend of rising blood pressure constitutes hypertension.
Wisdom
The appropriate application of knowledge and experience to manage and solve problems.
Using critical thinking to interpret nursing knowledge and evaluate patient care.
Module 2: Health Care Technologies and Point-of-Care Systems
The advancement of Information Technology (IT) has introduced various tools into the clinical environment to improve communication, reference, and documentation.
Point-of-Care Technology
Nurses use technology at the bedside to ensure real-time charting and access to information. Examples include:
• Bedside Computers and Tablets: Used for immediate documentation and data retrieval.
• Workstations on Wheels (WOWs): Mobile computer stations that can be moved to the patient's bedside.
• Handheld Devices: Smartphones and pocket devices used for accessing medical references and drug information.
Connected Health and Telehealth
• Connected Health: Uses mobile apps and wearable technology to monitor patients remotely and promote wellness.
• Telehealth/Telemedicine: Uses the Internet to link medical experts with clinicians or patients for remote consultations via high-fidelity video links.
• Telenursing: The transmission of electronic data, images, or audio by a nurse from a patient's bedside or home to other providers to improve outcomes.
Robotics and Advanced Tech
• Operating Room Robotics: Facilitates less invasive surgical procedures.
• Pharmacy Robotics: Supports safer medication selection.
• Digital Imaging: X-rays are now stored in digital form for immediate access.
Module 3: EHRs, Decision Support Systems, and Patient Safety
Information technology is a primary tool for mitigating errors and ensuring the "right data on the right patient at the right time."
EHR vs. EMR
• Electronic Medical Record (EMR): The documentation of a single episode of care (e.g., one inpatient stay or one outpatient visit).
• Electronic Health Record (EHR): A longitudinal, long-term record of a patient’s health care encounters across various settings.
Medication Safety: BCMA
Bar-Code Medication Administration (BCMA) significantly reduces errors. The process involves:
1 Nurse signs in or scans their ID badge.
2 The nurse scans the patient's ID band.
3 The nurse scans the medication bar code.
4 The system checks the 6 Rights of Medication Administration: Right Patient, Right Medication, Right Dose, Right Time, Right Route, and Right Documentation.
5 The nurse performs 3 Checks: Patient allergies, the order, and drug expiration.
Provider Orders and Decision Support
• Computerized Provider Order Entry (CPOE): Allows providers to enter orders directly into the system, communicating them to the pharmacy, lab, or dietary department. This eliminates transcription errors and ambiguity from handwriting.
• Clinical Decision Support Systems (CDSS): Paired with CPOE to suggest dosages, cross-check for allergies or drug-drug interactions, and provide "safe practice alerts."
◦ Alert Fatigue: A risk where users receive too many warnings and begin to ignore them, potentially compromising safety.
Workflow Management
EHRs generate work lists that organize nursing measures by time or task type, ensuring that care and medications are delivered appropriately.
Module 4: Informatics Competencies, Skills, and Educational Initiatives
Nurses must possess specific competencies to integrate IT into practice effectively.
Literacy Definitions
• Computer Literacy: Knowledge of computers and the ability to use them efficiently.
• Information Literacy: The ability to recognize when information is needed and the ability to locate, evaluate, and use that information to create new knowledge.
Competency Categories
1 Technical: Proficiency in using computers, software, and hardware.
2 Utility: Applying critical thinking and evidence-based practice; knowing how to search and evaluate data.
3 Leadership: Addressing ethical and management issues related to IT.
National Initiatives
• QSEN (Quality and Safety Education for Nurses): Defines informatics as a core competency for students to communicate, manage knowledge, and mitigate error.
• TIGER (Technology Informatics Guiding Education Reform): Identifies skills for 21st-century nurses across five pillars: Management and Leadership, Education, Communication and Collaboration, Informatics Design, and IT Policy and Culture.
• Certifications: The American Nurses Credentialing Center (ANCC) and the Healthcare Information and Management Systems Society (HIMSS) offer nursing informatics certifications.
Module 5: Standardized Terminologies in Nursing
Standardized terminologies provide a common language, ensuring that documentation is understood consistently across different settings.
Terminology
Content and Purpose
NMDS (Nursing Minimum Data Set)
The first attempt to standardize core nursing data (diagnoses, care, outcomes, resources).
SNOMED CT
A multidisciplinary coding system and nomenclature for history, illnesses, and outcomes; now includes ICNP.
ICNP (International Classification for Nursing Practice)
Standardized dictionary for nursing diagnoses, outcomes, and interventions.
NANDA-I
Standardized nursing diagnoses.
NIC (Nursing Interventions Classification)
Standardized nursing interventions.
NOC (Nursing Outcomes Classification)
Measurable patient outcomes.
PNDS (Perioperative Nursing Data Set)
Standardized terminology for the perioperative setting.
NMMDS (Nursing Management Minimum Data Set)
Standardized data for nurse managers.
Module 6: Consumer Health Information, Education, and Health Literacy
Nurses act as advocates by helping patients navigate the vast amount of health information available online.
Health Literacy
The HRSA defines Health Literacy as the degree to which individuals can obtain, process, and understand basic health information to make appropriate health decisions.
Website Evaluation Criteria
Nurses should teach patients to evaluate websites using the following criteria:
• Authority: Who is the sponsor or publisher? What are the author's credentials?
• Purpose: Is the site intended to inform, sell, or disclose? Who is the audience?
• Coverage: Are citations correct? Is there a balance of text and images?
• Currency: When was the site created and updated?
• Objectivity: Is there evidence of bias?
• Accuracy: Are information sources footnoted or linked?
• Verification: Can the information be found in other reputable sources?
HONcode: An international initiative by the Health on the Net Foundation that promotes reliable online health information.
Module 7: Ethical, Legal, and Professional Practice Concerns
The use of IT introduces specific ethical and legal responsibilities for the nurse.
Privacy and Confidentiality
• HIPAA (1996): Sets the legal standards for security and confidentiality of health care information and defines penalties for breaches.
• System Security: User access codes and passwords must never be shared.
• Audit Trails: Electronic records leave a trail of all users who access a file, allowing for audits to ensure only staff caring for a patient are viewing their records.
Social Media Guidelines
The NCSBN provides guidelines to prevent unprofessional conduct:
• Never transmit patient images.
• Never post patient information or identifiers.
• Avoid disparaging comments about patients or co-workers.
• Do not contact patients outside the work setting.
• Breaching these guidelines can lead to the permanent loss of a nursing license.
Ten Commandments of Computer Ethics (Computer Ethics Institute)
1 Thou shalt not use a computer to harm other people.
2 Thou shalt not interfere with other people’s computer work.
3 Thou shalt not snoop around other people’s computer files.
4 Thou shalt not use a computer to steal.
5 Thou shalt not use a computer to bear false witness.
6 Thou shalt not copy or use proprietary software for which you have not paid.
7 Thou shalt not use other people’s computer resources without authorization.
8 Thou shalt not appropriate other people’s intellectual output.
9 Thou shalt think about the social consequences of the programs you write.
10 Thou shalt always use a computer in ways that ensure consideration and respect for others