1. Presentation By: Leaniza F. Igot-Scheir, RN Clinical Nursing Information System First Sem. 2013- 2014 Chapter 20: Practice Applications Chapter 20 by Joyce E. Johnson & Molly Billingsley

2. Historical Perspective  1850- Florence Nightingale emphasized the critical importance of using nursing informatics.  Late 1950-1960’s- hospitals began using …….computerized information systems  1965-American Hospital Association endorses NI  1970s-development of the silicon chip  1980s-Usage of computer for diverse hospital functions  1990s-Expanded use of computers to improve patient ………care and conduct research  2001-Point and click system of health care utilized

3. Nursing Informatics: An Evolving Definition Evolving definition by the American Nursing Association changing focuses: 1980 – (1) technological & (2) the role of nurses 1989- (1) integration of nursing science, (2) information science, and (3) computer science 1992- expanding role of the informatics nurse specialist 2001- “the phenomena of nursing” the interrelation of (1)nurse, (2) patient, (3) health, and (4) the environment.

4. Essential elements of nursing informatics: Patient Health Environment Scientific Foundations Nursing, Computer and Information Science Tools from information science and computer science Information technology, structures management and communication American Nurses Association (2001) Scopes and Standards of Practice for Nursing Informatics Nurse Essential elements of nursing informatics: Dynamic interactions Metastructures Data, Information and Knowledge

5. Standards for Practice  ANA standards repeatedly emphasize the central role that plays in the practice of nursing and its importance for all nurses  Guidelines clarify the different perspectives of nurses who are and who are not nursing informatics specialist

6. Standards for Practice The foci of nursing vs. nursing informatics- metastructures, concepts and tools Nursing Nursing informatics Nurses, patients, health, environment Nursing data, information and knowledge Content of information Design, structure and presentation of information for nurses’ decision making Using information applications and technology Optimizing information structures, applications and technology for use in managing and communicating data, information and knowledge American Nurses Association (2001) Scopes and Standards of Practice for Nursing Informatics

7. Informatics Competencies: Beginning to Experienced Three Major Domains of Computer Literacy 1. Computer Literacy Skills -able to use basic computer skills 2. Information Literacy Skills –able to recognize the need for information 3. General Informatics Competencies – able to apply informatics as integral part of NP, “experienced nurses”

8. Problem Solving as an Organizing Framework  A problem-solving framework which support all aspect of nursing informatics standards of practice which include six major areas that mirror traditional nursing process: Assessment, Diagnosis, Identification of outcomes, Planning, Implementation and Evaluation  ANA includes guidelines for work performance of nurses who specialize informatics 1)Assessment 2) Diagnosis 3) Identification of outcomes 4) Planning 5) Implementation 6) Evaluation American Nurses Association (2001.Nursing informatics standards of practice: The problem –solving framework)

9. IT and Actual Work of Nurses  Underutilization in the 20 th Century due to: -lack of computer availability, -lack of awareness of computer benefits, -Lack of computer literacy among nurses, -Lack of computer training specifically for nurses, -emphasis of computer use by office staff, not nurses.

10. Nursing Documentation  Computer-based patient record  Patient record became more complex with the application of NI.  Recognition of 13 standardized languages that support nursing practice  In 1993, ANA House of Delegates passed a resolution to develop nursing classifications specifically aimed at diagnosis, interventions and nursing sensitive patient outcomes, and support activities directed toward the inclusion of nursing data elements in healthcare bases. (McCormick et al, 1994: cited in Saba & McCormick, 2006 )

11. Care Planning automation of the NCP  Computer-based patient record facilitates the automation of nursing care plan.  “The ability to electronically record, integrate and analyze data and information enable nurses to quickly move to the synthesis of nursing knowledge and the development of nursing wisdom,” (Meadows, 2002).  Enable managers to view and query clinical records with questions about how care was given and the results.

12. Decision-Making with Administrative Data Cost control and decision making are dependant on: 1. Patient flow info 2. Patient acuity 3. Resource use 4. Staffing levels 5. Costs 6. Budget balance A decision support system for effective nursing resource management Improve cost containment Ease of use, perceived usefulness and user satisfaction Improve nurse managers’ financial management Provide essential information and decision support for effective financial management, resource allocation, activity planning and staffing Developing a decision support to meet nurse mangers’ information need for effective resource management. ( Ruland, 2001)

13. Discharge Planning  Discharge care planning systems provides continuity of care from home to hospital and back to the community.  Ideal software and hardware infrastructure like PDA allows communication among health care providers which can result to up-to-date discharge plans.  Computer discharge care plans also have potential benefit aside from direct patient care such as QA, auditing, research and coding at discharge for payment.

14. Summary/ Conclusion  This topic describes the use of computers in the work of nurses within the 21 st century.  Simply maintaining the status quo with NI is not a realistic option in the 21 st century when the global nursing shortage is of such concern, more is needed.  As technology advances certain concerns arise within the profession: pattern of underutilization, and problems with standardization of computer languages.  “If technology is a tool of commonality, then nurses must use this tool to its fullest to advance patient care and nursing practice,” (Miller and Carlton).