Nursing Informatics: A Guide to the Future of Nursing Practice

“A specialty that integrates nursing science, computer
science and information science to manage and
communicate data, information, and knowledge in
nursing practice … to support patients, nurses, and
other providers in their decision-making in all roles
and settings.”
- American Nurses Association, 2008

Why do we need to study Nursing Informatics ?
• Information is doubling every 5 years , if not
tripling in quality and quantity
• INFORMATION is POWER
• Technology facilitates the creative process in
nurses, affording amazing vehicles for,
PATIENT EDUCATION, TEACHING and
LEARNING
•Provides health promotion and prevention in a
Global Scene.

Nursing Practice will be
revolutionized and we will truly be a
profession of nurses with our own
classification systems, bibliographic
systems, and payment systems.

What is Informatics ?
• Combination of the terms information and
automatic/ automation which means automatic
information processing.
•A science that combines the domain science,
computer science, information science and
cognitive science.

1977 – the first Nursing Information System Conference was
held in the United States
Here nurses adapts computer processes to enhance client care,
education, administration and management, and nursing
research
October 1995 – the first ANA certification examination in
Nursing Informatics was given.
This creates the Nurse Informaticists
They are responsible for interfacing between the client care
and information technology departments and assisting with the
development, implementation and evaluation of initiatives in
clinical information system.

1999 – a study was form to identify International
Standards for health information and their
adaptability in the Philippines referred to as
“Standards of Health Information in the Philippines
, 1999 ver. (SHIP99).
2003 - Master of Science in Health Informatics was
proposed to be offered by UP-Manila College of
Medicine (major in medical informatics) and the
College of Arts and Science (major in bioinformatics)
and was later approved to be offered starting
academic year 2005-2006.

2006 – creation of TIGER (Technology
Informatics Guiding Educational
Reform )
- Created to identify knowledge/information
management best practices and effective technology
capabilities of nurses.

2008 – Nursing Informatics course in the
undergraduate curriculum was defined by the
Commission on Higher Education (CHED)
Memorandum Order 5 Series of 2008, later revised
and included as Health Informatics course in CHED
Memorandum Order 14 Series of 2009,
and first implemented in the summer of 2010.

2009 - Mr. Kristian R. Sumabat and Ms. Mia
Alcantara-Santiago, both nurses and graduate
students of Master of Science in Health Informatics
at the University of the Philippines, Manila began
drafting plans to create a nursing informatics
organization
2010 - they began recruiting other nursing
informatics specialists and practitioners to organize
a group which later became as the Philippine
Nursing Informatics ,a sub-specialty
organization of PNA for nursing informatics.

Framework of Nursing Informatics
Data – discrete entities that are described
objectively without interpretation
Information – as data, however is
interpreted, organized or structured
Knowledge – as information that has been
synthesized so that interrelationships are
identified and formalized
… this results to DECISIONS that guides
practice…

Framework of Nursing Informatics

Computer System
A network of computers, users,
programs and procedures in an
organization – assists the health care
team with decision making and
communication.
Two (2) most common types of Computer System :
(1)Management Information System
(2)Hospital Information System

Management
Information System
(MIS)
Designed to facilitate the structure
and application of data used to
manage an organization or
department.
- Provides analyses used for strategic
planning, decision making and evaluation of
management activities.

Hospital Information
System (HIS)
An MIS that focus on the types of
data needed to manage client care
activities and health care
organization.
- Provides people with the data they need
to determine appropriate actions and
control them.

Scope of Nursing Informatics
P Practice
E Education
R Research
A Administration

Nursing Informatics & Practice
Nurses are expected to have knowledge about the
benefits and limitations of technology for communication
and decision making, and attitudes needed to value
technology and use informatics to both support and
protect clients. (Cronenwett et al. 2007)

DOCUMENTATION AND MEDICAL RECORD
KEEPING
Bedside Data Entry
These allows recording of client assessments, medication
administration, progress notes, care plan updating, client acuity,
and accrued charges.

KEEPING
Bedside Data Entry
The terminals can be fixed or handheld, and hardwired to the
central system or wireless with the ability to transmit the data to
distant sites.
POINT-OF-CARE / POINT-OF-SERVICE COMPUTER
-terminal is near, but not necessarily at, the client.

KEEPING
Computer-Based Client Records
Electronic Medical Records (EMR) / Computer
Based Patient Records (CPRs)
- permits electronic client data entry and retrieval by caregivers,
administrators, accreditors, and other persons who require the
data.

KEEPING
Electronic Medical Records (EMR) / Computer Based Patient
Records (CPRs)’s way of improving healthcare:
(1) Constant availability of client health information across the
lifespan
(2) Ability to monitor quality
(3) Access to stored data
(4) Ability of the clients to share in knowledge and activities
influencing their own health

Nurse Informaticist
- an expert who combines computer, information, and
nursing sciences
- Serves as a developer of policies and procedures that
promote effective and secure use of computerized records
by nurses and other health care professionals

KEEPING
Personal Health Record (PHR)
- an electronic document that contains the client’s medical,
personal, and health information but is controlled by the client,
rather than the health care provider.

KEEPING
Personal Health Record (PHR)
- an electronic record of health-related information on an
individual that conforms to nationally recognized interoperability
standards and that can be drawn from multiple sources while
being managed , shared , and controlled by the individual.

KEEPING
Clinical Decision Support System
- are electronic forms of charts, templates, algorithms , and the
likes, which incorporate evidence from the literature into a
particular client in order to guide care planning .
- some are simple alarms that appear when medical orders conflict
with another aspect of client’s situation ( allergies,
contraindications)

KEEPING
Tracking Client Status
- this is when the nurse can retrieve an d display a client’s
physiological parameters across time. Furthermore , Standardized
Nursing care plans, care maps, critical pathways can be stored in
the computer via EMR.

Electronic Access to Client Data
Client Monitoring and Computerized Diagnostics
- these devices, with their minute but powerful computer chips,
makes it possible to extend the nurses’ observations and provide
valid and reliable data

Electronic Access to Client Data
Telemedicine / Telehealth
- uses technology to transmit electronic data about clients to
persons at distant locations.

Practice Management
- Terminals used to order supplies, tests, meals and
services from other departments.
- Computers used extensively for scheduling (client
appointment and staff scheduling requests)
- For Insurance keeping so that billing can be
accurate.

Community and Home Health
-A computer placed in a high-risk client’s or family’s
home allows them to access information on a
variety of topics, search Internet, or e-mail a health
care provider with questions and concern.
-Home alert systems that allow the client to signal
the base station in an emergency situation.
-CHN uses notebook computer to transmit data to
the main office.

Case Management
-Tracking of a group of clients – the caseload.
- keeps abreast of the latest regulations affecting
eligibility for health care benefits, the reporting
requirements of the payer’s agencies, the detailed
facts about the variety of service providers that the
client needs to access.

Teaching and Learning
Computer enhances both students and
faculties in 4 ways:
(1)Literature
(2)Computer assisted instruction
(3)Classroom technologies
(4)Distance learning strategies

Literature Access and Retrieval
-Continuous updated cumulative indexes
of related materials can be searched
electronically in a fraction of the time.
- Once a list of search matches is
displayed on the computer screen, users
can select all of certain citations and
etheir print them or store.

Computer assisted instruction
(CAI)
- Software programs that cover topics
from drug dosage calculations to ethical
decision making are classified according
to the format: tutorial, drill and practice,
simulation , or testing.

(CAI)
- Diagrams, graphics, animations, video,
and audio via CD-ROMs or via the
internet.

(CAI)
- Allow almost instant access to any
section of the program and can be
designed to branch to different sections
depending on user’s responses.

Classroom Technology
- Electrical outlets for students to plug in
laptops and wirings (Wi Fi) for network
and internet access.

- “smart classrooms” with projectors
that display the content of computer
screens and document cameras that
display objects and print materials for
the entire classroom.

- “clickers” use of audience response
systems and class-capture systems that
record and post lectures and visuals to
the Internet.

-Tools ranging from systems that use
computers and small devices to provide
skills practice (task trainers)
-High fidelity Human Patient Simulators
with the ability to breathe , speak, and
display digital readouts that reflect the
impact of nursing interventions.

Distance Learning
-Educational opportunities delivered
under situations in which the teacher
and the learner are not physically in the
same place at the same time.
- asynchronous – when the persons
involved are not interacting at the same
time.
-Synchronous – when teachers and
students are communicating
simultaneously

Distance Learning
-Faculty can post syllabi, handouts,
assignments, and examination in
individual course shells, and students can
submit papers and hold discussion online

Distance Learning
-Faculty and students can create avatars
– virtual self to navigate through
simulated worlds and communicate
using audio-visual lectures, discussion
and posters.

Testing
- Computers are ideal for conducting
types of learning evaluation
-Large banks of potential items can be
written and the computer generates
different exams for each student
depending on the selection criteria
designated by the faculty

Testing
- the computer determines if the
applicant passed the examination by
using a scoring algorithm that ensures
all required competencies have been
evaluated fairly

Student and Course Record
Management
- Computers are useful for maintaining
results of students’ grade or attendance
using spreadsheets.
-Programs can calculate percentages ,
sort student scores in order, and print
results for the students and the faculty.

Student and Course Record
Management
- data warehousing – the accumulation
of large amounts of data that are stored
over time and can be examined for
output in different types of reports
(charts & tables)

PROBLEM IDENTIFICATION
Locating current literature
about the problem and related
concept, as unknown to the
researcher, a solution to the
problem has already been
found and reported.

Literature Review
-Utilization of online search and CD-ROM
Bibliographic data base.
-Software programs that facilitate
searches contain thesaurus thus,
appropriate terms can be searched.
-Closely related topic can be searched
-The increase in availability of full text
journal articles online has made the
electronic literature search process even
more productive.

Research Design
-Searching of literature for the
instruments that have already been
established or to design and instruments
that need to be developed for the
particular study.

Data Collection and Analysis
-Variables should be recognized and
manipulate (coding the data) by the
computer for analysis. e.g. NVivo and
Ethnograph
-Variables if coded, can be calculate
descriptive and analytic statistics. e.g.
SPSS(Statistical Package for Social
Sciences), SAS (Statistical Analysis
System), -- this will perform analysis and
present it in tables, chart or lists.

Research Dissemination
-Computers speed completion of the
research project and the availability of
the findings to the public.

Human Resources
-Maintains database: Demographic data, Salary, and
Performance Appraisals
-Database can be use to communicate with the employee,
examine staffing patterns, and create budget projections.

Medical Records Management
-It is expensive to keep records, but it is more expensive
not to be able to access what is in them.
-Allows client records to be searched for trends

Facilities Management
-A/Cs , Ventilations and Alarm systems
-Scanners (ID), Bar codes,
-Inventories

Budget and Finance
-Computerized billing vs Handwritten
-Nurses can directly bill

Quality Assurance and Utilization Review
- Facilitates the accumulation and analysis of data for
individual groups or client, when standards, pathway and
key indicators, and other vital data have been identified
and described.
- Utilization review consists of examining trends and
proposing advantageous disposition of resources.

Accreditation
-To monitor quality indicators, so as to reduce the
difficulty of time involved in the accreditation proces

Nursing Informatics: A Guide to the Future of Nursing Practice

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