1. NURS 736: Technology Solutions for Knowledge Generation in Healthcare
Module 1: Nursing Informatics (NI) Roles and Competencies
NURS 736: Technology Solutions for Knowledge Generation in Healthcare

2. Objectives Discuss the concept of nurses as knowledge workers.
Examine metastructures, concepts and tools in nursing informatics
Describe the evolving roles and competencies of nursing informatics practice.

3. Nurse as Knowledge Worker
Knowledge can be defined as “the distillation of information that has been collected, classified, organized, integrated, abstracted, and value added” (HIMSS, 2006, p. 49).
A worker is “one that works especially at manual or industrial labor or with a particular material” (Merriam-Webster, 2007).
The term knowledge worker was first coined by Peter Drucker in his 1959 book, Landmarks of Tomorrow (Drucker, 1994).
Knowledge work is defined as nonrepetitive, nonroutine work that entails a significant amount of cognitive activity (Sorrells-Jones & Weaver, 1999a).
Drucker (1994) describes a knowledge worker as one who has advanced formal education and is able to apply theoretical and analytical knowledge.
Nurses use data and information which is converted to knowledge. The nurse then acts upon this knowledge by initiating a plan of care, updating an existing one or maintaining status quo.
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Knowledge Needs
Nurses rely on an extensive amount of clinical information and specialized knowledge in order to evaluate the processes they have implemented and measure the corresponding outcomes (Snyder-Halpern, Corcoran-Perry, & Narayan, 2001).
Nurses rely on their own knowledge, but there are times when this is not adequate and they must access information in order to provide safe patient care.
A national survey was conducted and found that consulting a peer was the most frequent way that information was obtained.
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5. Nursing Informatics Competencies
One challenge that health care is currently facing is the vast differences in computer literacy and information management skills that healthcare workers possess (McNeil, Elfrink, Beyea, Pierce, & Bickford, 2006).
Staggers, Gassert, & Curran (2001) believe that nursing students and practicing nurses should be educated on core NI competencies (see next slide).
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6. Staggers, Gassert, & Curran (2001)
Beginning Nurses (Level 1) “Beginning nurses have fundamental information management and computer technology skills and use existing information systems and available information to manage their practice.”
Experienced Nurses (Level 2) “Experienced nurses have proficiency in their domain of interest (e.g., public health). These nurses are highly skilled in using information management and computer technology skills to support their major area of practice. They see relationships among data elements, and make judgments based on trends and patterns within these data. Experienced nurses use current information systems, but collaborate with the informatics nurse specialist to suggest system improvements.”
Staggers, Gassert, and Curran (2002) conducted a Delphi study of nurses’ informatics needs over several levels of skill, experience, and educational preparation. From this study, they made the following recommendations regarding minimal NI competencies for RN practice. These competencies were initially proposed to the ANA and published in the Scope and Standards of Nursing Informatics Practice (2001) and are included in Nursing Informatics, Scope and Standards of Practice (2008). These competencies do not consider the ages or previous levels of computer science experience or proficiency, but instead focus on the nursing skill level and education.

7. Staggers, Gassert, & Curran (2001)
Informatics Specialists (Level 3) “Informatics [nurse] specialists (INSs) are registered nurses prepared at least at the baccalaureate level who possess additional knowledge and skills specific to information management and computer technology. They focus on information needs for the practice of nursing, which includes education, administration, research, and clinical practice. INS’s practices are built on the integration and application of information science, computer science, and nursing science. In their practice, INS’s use…critical thinking, process skills, data management skills, systems development life cycle, and computer skills.”
Informatics innovators (Level 4) “Informatics innovators are educationally prepared to conduct informatics research and to generate informatics theory. These nurses lead the advancement of informatics practice and research… [They] function with an ongoing healthy skepticism of existing data management practices and are creative in developing solutions. Innovators possess a sophisticated level of understanding and skills… [and] understand the interdependence of systems, disciplines, and outcomes, and can finesse situations to maximize outcomes.”

8. What Is Nursing Informatics Specialty Practice?
NI is an established and ever-evolving profession that began when computers were introduced into health care.
Nursing Contributes to Healthcare Informatics
Scopes and Standards: NI is important to nursing and health care as it focuses on representing nursing data, information, and knowledge.
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9. NI Early Beginnings Florence Nightingale - First Informatician 1970’s
First Hospital Information System (HIS) in El Camino Hospital (Mt View, CA)
National Institutes of Health also has a Clinical System during this time
NCHSR (now AHRQ), VA, DOD developing systems
First journal dedicated to medical informatics (1976)
1980’s
First NI conference at St. Agnes, Baltimore (1982)
UMB started first NI program (1989)
1990’s
Nancy Staggers first PhD in NI (1991)
ANA Scope & Standards of NI Practice (1994)
NCHSR-National Center for Health Services Research

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Role and Goal of NI
NI supports consumers, patients, nurses, and other providers in their decision-making in all roles and settings.
The goal of NI is to improve the health of populations, communities, families, and individuals by optimizing information management and communication.
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Focus of NI
NI provides representation of nursing data, information, knowledge and wisdom*
* Note the term “wisdom” is now added to the Graves & Corcoran model
NI assists in the management and communication of nursing information within the broader context of health informatics.
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Metastructures of NI
Data - discrete entities that are described objectively without interpretation
Information - data that are interpreted, organized, or structured
Knowledge - information that is synthesized to identify and formalize relationships
Wisdom - the appropriate application of knowledge to the management and solution of human problem
Here they are again!!! This must be important….
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13. From Knowledge to Wisdom
Knowledge focuses on what is known
Wisdom focuses on the appropriate application of that knowledge
For example, a knowledge base may include several options for managing an anxious family, while wisdom would guide the decisions about which of these options are most appropriate with a specific family.
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Wisdom in Informatics
Wisdom in informatics is the ability of the NIS to evaluate the documentation drawn from a Health Information System (HIS) and the ability to adapt or change the system settings or parameters to improve the workflow of the clinical nurse.
Nurses’ decision-making is described as an array of decisions that include specific behaviors, as well as cognitive processes surrounding a cluster of issues.
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Examples of DIKW
Data - vital signs for an individual’s heart rate, respiration, temperature, and blood pressure
Information - serial set of vital signs taken over time, placed into a context, and used for longitudinal comparisons
Knowledge – recognition of a pattern and identification of interventions reflects information synthesis (knowledge) based on nursing knowledge and experience.
Wisdom – accuracy of the synthesis of information and appropriate selection of interventions
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16. Concepts and Tools from Information Science and Computer Science
Informatics tools and methods from computer and information sciences are considered fundamental elements of NI.
Information technology includes computer hardware, software, communication, and network technologies, derived primarily from computer science.

17. Concepts and Tools from Information Science and Computer Science
Information structures organize data, information, and knowledge for processing by computers.
Information management is an elemental process within informatics in which one is able to file, store, and manipulate data for various uses.
The use of information technology distinguishes informatics from more traditional methods of information management.
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18. Structured Language as a Tool for Nursing Informatics
Nursing knowledge is gained by the ability to extract data that specifically defines nursing phenomena.
Many different languages and ways of organizing data, information and knowledge create difficulties in mapping nursing phenomena.
The importance of developing universal languages and vocabularies cannot be understated.
The Informatics Nurse Specialist (INS) must attempt to envision the differing functions that may be used with the data, information and knowledge that have been created.
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19. Specialty Education and Certification
Nurses who specialize in nursing informatics have two certifications available to them.
The American Nurses Credentialing Center (ANCC) exam specific for the informatics nurse. Requires:
Licensed registered nurse (RN) with at least 2 years of recent experience
Baccalaureate degree in nursing (BS/BSN)
Completed 30 contact hours of continuing education in informatics
Certification exam sponsored by HIMSS. Candidates who successfully pass this exam will carry the designation of certified professional in healthcare information and management systems (CPHIMS).

20. Nursing Informatics Roles
Project Manager – manages the implementation of technologies that support nursing practice and patient care delivery
Consultant – uses various skills to support technology assessment, selection, implementation, and maintenance for clients at all levels
Educator – uses NI knowledge and skills to assess training needs, develop curricula, teach, and evaluate effectiveness of education to improve healthcare practice and instructional techniques using or involving technology
Researcher – conducts research underlying the assessment, design, development, implementation, and evaluation of technology

21. Nursing Informatics Roles
Product Developer/System Analyst – participates in design, development, and marketing of NI solutions
Decision Support/Outcomes Manager – uses system tools to manage data integrity, facilitate data gathering and analysis, identify outcomes, and develop accurate measures of performance
Advocate/Policy Developer – with a focus on the information and technology needs of nurses and other healthcare practitioners, these INSs propose, analyze, and evaluate public and institutional policy
Chief Information Officer (CIO)/VP – this role is not beyond the reach of informatics nurse specialists to provide strategic and visionary leadership within healthcare organizations related to information technology and informatics

22. Pioneers in Nursing Informatics
Carol Gassart
Nancy Staggers
Marion Ball
Roy SImpson
Carol Romano
Judy Ozbolt
Susan Grobe
Judy Murphy
James Turley
Patty Abbott
Virginia Saba
Susan Bakken
Nancy Staggers- Human Factor Research (Staggers and Parks Human-Computer Interaction Model). Currently is a professor at UMB SON!
Judy Ozbolt - She initiated the Nursing Terminology Summit Conferences, invitational working meetings that have contributed substantially to standards for nursing data in ISO, LOINC, and SNOMED.
Marion Ball – Wrote and coauthored over 14 books on informatics,
Carol Romano – Involved in the initial implementation of the EMR at the National Institutes of Health in the 1970’s. Served as the Assistant Surgeon General and Chief of Staff to the Surgeon General of the U.S. She was a Rear Admiral in the Navy and currently is an Associate Dean at Uniformed Services University.
Carol Gassart - early writing on informatics; professor at University of Utah
Roy Simpson - vice president, nursing informatics, at Cerner Corporation. Widely published/speaker
James Turley - During , Dr. Turley was project director for the development of the Community nursing Minimum Data-Set Australia. He is a founding faculty member of the School of Health Information Sciences. Recent research interests include healthcare knowledge modeling, and the impact of data display on decision making of clinicians and layperson
Virginia Saba -over 35 years pioneered the integration of technology in nursing. She spearheaded the nursing informatics movement, initiated academic technology programs, and supported the development of healthcare information technology (HIT) systems including the Clinical Care Classification (CCC) System.
Judy Murphy - She is currently Vice President, Information Services at Aurora Health Care in Milwaukee, Wisconsin,
Susan Bakken - emphasis on terminology and standardized outcome measures at Columbia University
Susan Grobe – extensive research on nurses and computer use
Dr. Abbott is best known for her early work in helping to establish the Nursing Informatics Specialty. She was a member of the Author team for the original Scope and Standards of NI Practice with the ANA, and then her work..
These are only a few of the many talented nurses who contributed to the early beginnings of NI. If you are interested, you can hear what the pioneers have to say about their role in informatics at this link:

23. Future of Nursing Informatics
The future of Nursing Informatics promises increased saturation of informatics concepts and solutions into mainstream nursing and health care practices.
Currently, NI specialists are in great demand in hospitals, doctors offices, academia, and with healthcare software vendors.
Research in informatics is exploding and this is a great time to be part of this profession.