Teaching Nursing Informatics –

I - Nursing Informatics Fundamentals – Maria Dolores B. Mangubat, Ed.D,

ACNS-BC, CCRN
1-31-2020
 Contents
Nursing Informatics A. Data, Electronic Health
Fundamentals Records and Ethics

C. Telenursing, eHealth and

B. Information
Community Health
Systems in Nursing
Informatics

Tools for Assessing Learning

Teaching Strategies for Outcomes in Nursing
Nursing Informatics Informatics
I - Nursing Informatics
Fundamentals –
I - Nursing Informatics Fundamentals –

A- Information
Systems in Nursing
History and Evolution of Nursing Informatics
• OBJECTIVES
• 1. Trace the evolution of nursing informatics from concept to specialty practice.
• 2. Relate nursing informatics metastructures, concepts, and tools to the
knowledge work of nursing.
• 3. Explore the quest for consistent terminology in nursing and describe
terminology approaches that accurately capture and codify the contributions of
nursing to healthcare.
• 4. Explore the concept of nurses as knowledge workers.
• 5. Explore how nurses can create and derive clinical knowledge from
information systems.
What Is Nursing Informatics?

• A specialty that integrates nursing science

with multiple information and analytical
sciences to identify, define, manage, and
communicate data, information, knowledge,
and wisdom in nursing practice
DIKW Paradigm
DIKW Paradigm
•DIKW stands for data, information,
knowledge, and wisdom.
•Nursing informatics centers on these
concepts.
Metastructures of Nursing Informatics
• 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: Application of knowledge to the
management and solution of human problems
An Example of DIKW
• Data: A patient’s vital signs
• Information: A serial set of vital signs, placed into a
context and used for longitudinal comparisons
• Knowledge: Recognition of a pattern and
identification of interventions
• Wisdom: Accuracy of the synthesis of information and
appropriate selection of interventions
Data vs. Information
• Data – Raw facts
• Information - Processed data that have meaning.
• For information to be valuable or meaningful, it
must be accessible, accurate, timely, complete, cost
effective, flexible, reliable, relevant, simple,
verifiable, and secure.
From Knowledge to Wisdom
• Knowledge focuses on what is known.
• Wisdom focuses on the appropriate application of
that knowledge.
• 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.
Use of Knowledge
• All nurses have the opportunity to be involved
in the formal dissemination of knowledge via
their participation in professional conferences,
as either presenters or attendees.
• All nurses, regardless of the practice arena,
must use informatics and technology to inform
and support that practice.
Knowledge Viability
• Refers to technology-based applications that offer
easily accessible, accurate, and timely information
obtained from a variety of resources and methods and
presented in a manner as to provide us with the
necessary elements to generate new knowledge
Wisdom in Informatics
• The ability of the system to evaluate the
documentation drawn from a health information
system, and to adapt or change the system 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.
• Can any aspect of nursing wisdom be automated?
Use of Wisdom
• Wisdom is the application of knowledge to an
appropriate situation.
• In the practice of nursing science, we expect
action and or actions directed by wisdom.
• Wisdom is developed through knowledge,
experience, insight, and reflection.
Nursing Science and the Foundation of
Knowledge Model  
 Nursing Science and the Foundation of
Knowledge
• Objectives
• Define nursing science and its relationship to various nursing
roles and nursing informatics.
• Introduce the Foundation of Knowledge model as the
organizing conceptual framework for the text.
• Explain the relationship among knowledge acquisition,
knowledge processing, knowledge generation, knowledge
dissemination, and wisdom
Building Blocks of Informatics

•Nursing science
•Information science
•Computer science
•Cognitive science
Nursing Science and Informatics
• What is nursing informatics?
• One widely accepted is that it is a combination of nursing
science, information science, and computer science (and we
add cognitive science).
• Nursing science as a building block of nursing informatics
• One of the most frequently quoted and widely accepted
definitions of nursing informatics is that it is a
combination of nursing science, information science, and
computer science.
Use of Knowledge
• Individuals have an amazing ability to manage
knowledge. This ability is learned and honed
from birth.
• We experience our environment and learn by
acquiring, processing, generating, and
disseminating knowledge
Nursing and Knowledge (1 of 2)
• Nurses are:
• Knowledge workers
• Working with information and generating information and
knowledge as a product
• Knowledge acquirers
• Providing convenient and efficient means of capturing and
storing knowledge
• Knowledge users
• Benefiting from valuable, viable knowledge
Nursing and Knowledge (2 of 2)
• Nurses are (cont’d):
• Knowledge engineers
• Designing, developing, implementing, and maintaining knowledge
• Knowledge managers
• Capturing and processing collective expertise and distributing it
where it can create the largest benefit
• Knowledge developers or generators
• Changing and evolving knowledge based on the tasks at hand and
information available
 Information Science
• The science of information
• Study of the application and use of information
and knowledge in organizations and the
interfacings or interaction between people,
organizations, and information systems
• Information science enables the processing of
information
 Information Processing
•Information science and computational
tools are extremely important in
enabling the processing of data,
information, and knowledge in health
care
Information System
• Combinations of hardware, software, and telecommunications
networks that people build and use to collect, create, and distribute
useful data, typically in organizational settings
• Acquires data or inputs
• Processes data that consist of the retrieval, analysis, and/or synthesis of
data
• Disseminates or outputs in the form of reports, documents, summaries,
alerts, prompts, and/or outcomes
• Can disseminate, provide feedback, and adjust the data and
information based on these dynamic processes
Computer Science
• Learning Objectives:
• 1. Describe the essential components of computer systems including
hardware and software.
• 2. Appreciate the rapid evolution of computer systems and the benefit of
keeping up to date with current trends and developments.
• 3. Analyze how computer systems function as tools for managing
information and generating knowledge.
• 4. Define the concept of human–technology interfaces.
• 5. Assess how computers can support collaboration and information
exchange.
Introduction to Cognitive Science
• Learning Objectives:
• 1. Describe cognitive science.
• 2. Assess how our minds process and generate information
and knowledge.
• 3. Explore cognitive informatics.
• 4. Examine artificial intelligence (AI) and its relationship to
cognitive science and computer science.
Cognitive Science
• Interdisciplinary field that studies the mind,
intelligence, and behavior from an information
processing perspective
• Provides the scaffolding for the analysis and modeling
of complicated, multifaceted human performance
• Has tremendous effect on issues impacting informatics
• End user is the focus; in nursing, the end user could be
clinician providing patient care.
Cognitive Informatics (CI)
• According to Wang (2003), CI is an emerging
transdisciplinary field that attempts to bridge the gap of
understanding how information is processed in the
mind and in the computer.
• Computing and informatics theories can be applied to
help understand the information processing of the brain
• Cognitive and neurologic sciences can be applied to
build more efficient computer processing systems.
Artificial Intelligence (AI)
• AI deals with the conception, development, and
implementation of informatics tools based on
intelligent technologies.
• It attempts to capture the complex processes of
human thought and intelligence.
Summary
• Nurses must use their wisdom and make informed,
judicious, prudent, and intelligent decisions while
enacting care.
• Cognitive science, cognitive informatics, and artificial
intelligence will continue to evolve to help us build
knowledge and wisdom.
Nursing Informatics as a Specialty
• Learning Objectives:
• Describe the nursing informatics specialty.
• Explore the scope and standards of nursing informatics practice.
• Assess the evolving roles and competencies of nursing informatics
practice.
• Appreciate the future of nursing informatics in our rich, technology
laden healthcare environments.
 Legislative Aspects of Nursing Informatics:
HITECH AND HIPAA
• Learning Objectives:
• Explore HIPAA legislation.
• Describe the purposes of the Health Information Technology for
Economic and Clinical Health (HITECH) Act of 2009.
• Explore how the HITECH Act is enhancing the security and privacy
protections of the Health Insurance Portability and Accountability
Act (HIPAA) of 1996.
Optional: Precare and Care Support
• Systems Development Life Cycle: Nursing Informatics and Organizational
Decision Making
• Learning Objectives:
• Describe the system development life cycle (SDLC).
• Explore select approaches to SDLC.
• Assess interoperability and its importance in addressing and meeting the
challenges of implementing the HITECH Act in health care.
• Reflect on the past to move forward into the future to determine how
new systems will be developed, integrated and interoperable in health
care.
Administrative Information Systems
• Learning Objectives:
• 1. Explore agency-based health information systems.
• 2. Evaluate how administrators use core business systems in their
practice.
• 3. Assess the function and clinical information output from selected
information systems used in healthcare organizations.
Information systems commonly used in
healthcare facilities:
• Clinical Information System (CIS)
• Financial Information System (FIS)
• Laboratory Information System (LIS)
• Nursing Information Systems (NIS)
• Pharmacy Information System (PIS)
• Picture Archiving Communication System (PACS)
• Radiology Information System (RIS)

• The need for interoperability and to explain how IS systems are

interoperable.
The Human-Technology Interface
• Learning Objectives
• 1. Describe human–technology interface.
• 2. Explore human–technology interface problems.
• 3. Reflect on the future of the human–technology interface.
 I - Nursing Informatics Fundamentals
B- Data, EHR and Ethics
• B1- Data
• Defining data and databases –
• Data states
• Three states
• Data at rest on a storage device
• Data in use being read or written
• Data in motion moving between applications or over
network
Databases

• Databases
• An organized collection of related data
• The possibility of finding data depends on four factors
• Indexing and organizational schemes
• Size and complexity of the database
• Type of data within the database
• Database search methodology
Database Management System (DBMS)

• A DBMS is a computer program that is

used to:
• Input
• Store
• Modify
• Process
• Access data in a database
Data Warehouses

• A large collection of data imported from several different

systems into one database
• Can be from external sources
• Smaller collections are data marts
• Functions of a data warehouse
• Be able to extract data from various computer systems
• Function as a database
• Support activities for end users of their data needs
Data Analysis and Presentation

• Analytics
• Process for making decisions using available
data
• One can use spreadsheets or tools designed for
large datasets
• Dashboards
• Process and present data in a visual layout
Data Quality

• The concept of data steward becomes

appropriate when thinking about who is
responsible for the quality of that data
• The data steward is the keeper of the data, not
the owner
The Development of Big Data
• 3-V’s describe Big Data: volume, velocity
and variety
• These data are more unstructured than one
usually finds in a database
Data/Information to Knowledge (KDD)
• Data Mining
• Traditional methods unable to handle sheer amount of data generated by
healthcare industry
• Purpose of data mining is to find previously unknown patterns for health care
• 7 step process:
• Task analysis
• Data selection
• Data cleaning
• Data transformation
• Data mining
• Pattern interpretation and evaluation
• Deployment
Data Mining as a Research Tool (Optional)
• Learning Objectives:
• 1. Describe big data.
• 2. Assess knowledge discovery in data.
• 3. Explore data mining.
• 4. Compare data mining models.
 B2- EHR - Electronic Health Records (Practice
Applications: Care Delivery (Clinical
Informatics )
• Learning Objectives:
• 1. Describe the common components of an electronic health
record (EHR).
• 2. Assess the benefits of implementing an EHR.
• 3. Explore the ownership of an EHR.
• 4. Evaluate the flexibility of the EHR in meeting the needs of
clinicians and patients.
EHR 8 Essential Components
• Health information and data
• Results management
• Order entry management
• Decision support
• Electronic communication and connectivity
• Patient support
• Administrative processes
• Reporting and population health management
Ownership of EHRs
• Adopting EHRs involves multiple steps and requires
integrating the EHR into both the organization’s day-to-day
operations and long-term vision, and the clinician’s day-to-
day practice.
• The first step of ownership is typically a vendor selection
process.
• EHR certification ensures that a quality product will be
selected.
System Selection
• Select a system based on the organization’s current
and predicted needs.
• The criteria should include both subjective and
objective items that cover topics such as common
clinical workflows, decision support, reporting,
usability, technical build, and maintenance of the
system.
Implementation
• Implementation planning occurs in the selection
process, during assessment of :
• Scope of the work
• Initial sequencing of the EHR components
• Resources required
• The implementation plan should also account for the
long-term optimization of the EHR.
Informatics Tools to Promote Patient Safety
and Clinical Outcomes
• Learning Objectives:
• 1. Explore the characteristics of a safety culture
• 2. Examine strategies for developing a safety culture
• 3. Recognize how human factors contribute to errors
• 4. Appreciate the impact of informatics technology on patient
safety
•   “Failure Modes and Effects Analysis (FMEA)
• Just Culture
• Human errors
• Computerized Physician Order Entry (CPOE) Benefits
• Apps
• Bar-code medication labeling or RFID technology
• Automated dispensing machines
• Smart Pump Technology
• Clinical Decision Support (CDS)
• Technologies for Home Medication
• Smart Room Technology
• Patient Monitoring Technologies
• Robotics, chips
Electronic Security
• Learning Objectives:
• 1. Assess processes for securing electronic
information in a computer network.
• 2. Identify various methods of user authentication and
relate authentication to security of a network.
• 3. Explain methods to anticipate and prevent typical
threats to network security.
Workflow and Beyond Meaningful Use
• Learning Objectives:
• Provide an overview of the purpose of conducting workflow analysis
and design.
• Deliver specific instructions on workflow analysis and redesign
techniques.
• Cite measures of efficiency and effectiveness that can be applied to
redesign efforts.
• Explore meaningful use and beyond with MACRA
 B3- Ethics
Ethical Applications of Informatics
• Learning Objectives:
• 1. Recognize ethical dilemmas in nursing informatics.
• 2. Examine ethical implications of nursing informatics.
• 3. Evaluate professional responsibilities for the ethical use of
healthcare informatics technology.
• 4. Explore the ethical model for ethical decision making.
• 5. Analyze practical ways of applying the ethical model for ethical
decision making to manage ethical dilemmas in nursing informatics.
ETHICAL Model for Decision Making
• Examine the ethical dilemma
• Thoroughly comprehend the possible alternatives
• Hypothesize ethical arguments
• Investigate, compare, and evaluate the arguments for each alternative
• Choose the alternative you would recommend
• Act on your chosen alternative
• Look at the ethical dilemma and examine the
• outcomes while reflecting on the ethical decision
Nursing Code of Ethics
• The International Council of Nurses code of ethics
states that “The nurse holds in confidence personal
information and uses judgment in sharing this
information.”
• Identify moral dilemmas in healthcare informatics that
would best be approached with the use of an ethical
decision-making framework.
• Discuss the evolving healthcare ethics traditions within
their social and historical contexts.
 C- Telenursing, eHealth and Community
Health Informatics
• I-C-1-Telenursing
• Telenursing and Remote Access Telehealth
• Learning Objectives:
• Explore the use of telehealth technology in nursing practice.
• Identify the socioeconomic factors likely to increase the use of telehealth
interventions.
• Apply the Foundation of Knowledge Model to home telehealth.
• Describe clinical and nonclinical uses of telehealth.
• Specify and describe the most common telehealth tools used in nursing practice.
• Explore telehealth pathways and protocols.
• Identify legal, ethical, and regulatory issues of home telehealth practice.
• Describe the role of the telenurse.
 I-C-2-eHealth
eHealth – Patient Engagement and Connected Health

• Learning Objectives:
• 1. Define health literacy and e-health.
• 2. Explore various technology-based approaches to consumer health
education.
• 3. Identify barriers to use of technology and issues associated with
health-related consumer information.
• 4. Imagine future approaches to technology supported consumer
health information